Community Health Needs Assessment Milwaukee 2013

Transcription

1 Community Health Needs Assessment Milwaukee 2013

2 Contents Introduction...2 Acknowledgements...3 Methodology...3 Our community...4 Geography profile...5 Population profile...5 Demographics profile...5 The findings: health needs of our community...9 Highest health priorities...10 Priority #1: access to mental, oral and primary health care...11 Priority #2: obesity and weight management...12 Priority #3: infant mortality...13 Priority #4: sexual health...14 Priority #5: community and home safety...14 Community assets...15 Appendices Appendix A Public Health Contributors Appendix B Milwaukee Health Survey Appendix C Key Informant Interviews Report Appendix D Secondary Data Report List of figures Figure 1. Race and ethnicity profile...5 Figure 2. Age profile...6 Figure 3. Income profile...6 Figure 4. Poverty profile...7 Figure 5. Childhood poverty rates in Milwaukee...7 Figure 6. Insurance status profile...8 Figure 7. Homeowner status profile...8 Figure 8. Homeowner household size...9 Figure 9. Renter household size...9 Figure 10. Dental checkup rates...12 Figure 11. Youth obesity and overweight comparisons

3 Introduction A community health needs assessment is one tool for stakeholders to evaluate the health needs of our community and advocate for and create better health care delivery, coverage and outcomes for all members in our community. The community health needs assessment process includes significant input from community residents, health care providers, public health officials, public school officials and other stakeholders. This range of voices ensures that health in our community is viewed broadly and all encompassing. Beyond traditional health indicators, the assessment looks at a myriad of other issues that can affect health, such as transportation, poverty, education and the economy. To assess the health needs of our community, Children s Hospital of Wisconsin and four other Milwaukee-area hospitals that comprise the health care membership of the Milwaukee Health Care Partnership commissioned a comprehensive community health needs assessment in Milwaukee County. This process allowed Children s Hospital to: Provide baseline information about the health status of our community; Assess the health needs of our community; Identify areas for improvement that Children s could impact; and Prioritize community benefit programming at Children s Hospital. About Children s Hospital of Wisconsin Children s Hospital of Wisconsin is the region s only independent health care system dedicated solely to the health and well-being of children and is recognized as one of the leading pediatric health care systems in the United States. In addition to hospitals in Milwaukee and Neenah, Wis., Children s Hospital has community-based service locations throughout Wisconsin. Children s Hospital provides primary care, specialty care, urgent care, emergency care, community health services, injury prevention services, foster care and adoption services, child and family counseling, child advocacy services and family resource centers. Children s Hospital also engages in advocacy on behalf of children in areas such as dental care, environmental effects on asthma, health coverage and access, and sports injuries. In 2011, Children s Hospital invested more than $100 million in the community to improve the health status of children through medical care, advocacy, education and pediatric medical research. Children s Hospital achieves its mission in part through donations from individuals, corporations and foundations and is proud to be a Children s Miracle Network Hospital. Children s Vision The Children s Hospital vision is simple to have the healthiest kids in the country live in Wisconsin. As the map to the right shows, the foundation is internal integration building a culture without silos where resources are aligned to achieving the vision. The strategy includes external collaboration as a large part of the process, acknowledging that no organization can achieve such an enormous goal alone. Above all, this strategy map puts healthy kids at the center of every decision made at Children s Hospital. For more information about Children s Hospital, visit the website at chw.org. 2

4 Acknowledgements The following institutions were integral to the completion of the community health needs assessment: Aurora Health Care, Columbia St. Mary s Health System, Froedtert Health, Wheaton Franciscan Healthcare and public health officials in the City of Milwaukee and other Milwaukee County municipalities. Methodology In 2011, Children s Hospital initiated a community-based effort to improve child health that acknowledges the influence of social, cultural and environmental factors on health and recognizes that such influences may have particularly deleterious effects when they occur during critical periods over one s life. Children s Hospital has selected three Milwaukee neighborhoods for initial engagement efforts. These neighborhoods Metcalfe Park, Franklin Heights/Amani neighborhood, and Lindsay Heights were identified because 1) they had a high concentration of pediatric-age residents; 2) there were significant, but modifiable challenges to child health outcomes; and 3) they had an existing trusted community resource(s) that was willing to partner with Children s Hospital in engaging the community in new ways to improve child health outcomes. The initiative began with community cafés, which were listening sessions modeled after the World Café. At the community cafés, residents were asked open-ended questions and engaged in table conversations over dinner providing input on what concerns and what assets exist within each of the three neighborhoods. Residents identified themselves or their neighbors to serve on neighborhood advisory committees that they lead and invite partners to participate in discussions and action around priorities. These community cafés provided Children s Hospital with a good foundation to initiate a more detailed look at the health of the broader Milwaukee community. In 2013, Children s Hospital and four other health systems in Milwaukee commissioned a comprehensive community health needs assessment in collaboration with the Milwaukee Health Department and other municipal health departments. See Appendix A for a full list of contributing public health entities. This assessment consists of three narrower reports meant to provide a holistic picture of health in Milwaukee: Milwaukee County Community Health Survey. The purpose of the MCCHS is to assess the health status of residents. Primary objectives were to (a) gather specific data on behavioral and lifestyle habits of the adult population; (b) gather data on the prevalence of risk factors and disease conditions existing within the adult population; (c) compare, where appropriate, health data of residents to previous health studies; and (d) compare, where appropriate and available, health data of residents to state and national measurements. Approximately 1,200 Milwaukee County residents were sampled using random landline and cell phone-only samples. Combined, post-stratification was conducted by sex and age to reflect the 2010 census proportion of these characteristics in the area. See Appendix B for the full report. Key Informant Report. The Key Informant Report is a summary of findings from policymakers, health care providers, local experts and community members conducted as a part of the community health needs assessment. The survey asked respondents to rank up to five public health issues, based on the focus areas presented in Wisconsin s State Health Plan. See Appendix C for the full report. Secondary Data Report. The Secondary Data Report is a supplement to the primary data collection conducted in the Milwaukee County Community Health Survey and the Key Informant Report. The report summarizes the distribution of health indicators among socioeconomic groups within the City of Milwaukee and Milwaukee County. The report uses publicly available data sources from local, state and national levels. See Appendix D for the full report. 3

5 While these reports provide rich data and a holistic view of health in Milwaukee, the primary focus is the adult population. Given this limitation, the following data sources were used to supplement the findings of the Milwaukee Health Care Partnership s community health needs assessment to ensure Children s Hospital s highest priority children are well represented: KIDS Count! Data. Kids Count is a national and state-by-state effort to track well-being indicators for children in the United States. Funded by the Annie E. Casey Foundation, Kids Count offers high-quality data and trends analysis. Kaiser State Health Facts. Kaiser State Health Facts, funded by the Henry J. Kaiser Family Foundation, provides free data on more than 800 health indicators at the state, national and county level. Data, compiled from a variety of public, private and government sources, allows users to map, rank, trend or download information. United States Census Bureau. In addition to conducting a census decennially, the U.S. Census Bureau collects and disseminates data across a variety of topics. Sources for this information include the Population and Housing Census, National Health Interview Survey, Economic Census, The American Community Survey, Current Population Survey and other related surveys. Other Public and Government Sources. Additional public and government data sources include the Center for Disease Control, Wisconsin Institute on Poverty and University of Wisconsin Population Health Institute. Our community Children s Hospital s main campus is located in Milwaukee County, Wisconsin. Although Children s Hospital serves children and youth in communities across the entire state of Wisconsin and Midwest, we defined our community as the children and youth in southeastern Wisconsin, including Milwaukee, Waukesha, Racine, Kenosha, Ozaukee and Washington counties, for the purposes of the CHNA. The CHNA results showed that the highest levels of needs are in the city of Milwaukee 43 and, therefore, in alignment with our core values and 41 Lake Michigan mission, Children s Hospital has focused on and invested in significant resources to address health disparities in the city of Milwaukee s lowest income neighborhoods Children s Hospital of Wisconsin Milwaukee 94 4

6 Geography profile Milwaukee is situated on the western shore of Lake Michigan and is the largest city in the state of Wisconsin. Milwaukee covers a total area of square miles. i Large cities that are closest to Milwaukee are Madison, Wis., (79 miles west) and Chicago (92 miles south). Population profile Milwaukee is the most populous city in Wisconsin, with an estimated population of 598,916. Milwaukee represents about 10.5 percent of the state s total population. ii It is the 30th most populous city in the U.S. Demographics profile A review of secondary data shows that Milwaukee is markedly different in key areas from the rest of Wisconsin, including race and ethnicity composition of the population, household income and insurance coverage status. The following section provides more detail on the population in Milwaukee. Race and ethnicity Milwaukee has a diverse mix of races and ethnicities, and it serves as a diversity hub in Wisconsin. The figure below shows the distribution of race and ethnicity in Milwaukee compared to Wisconsin. Figure 1. Race and ethnicity profile iii Of Milwaukee residents, 40 percent identify themselves as black or African-American, 37 percent as white, 17 percent as Hispanic/Latino, 3.5 percent as Asian, 0.8 percent as American Indian and 3.4 percent as other/mixed race or ethnicity. 5

7 Age Milwaukee mirrors Wisconsin in terms of age distribution. The figure below shows the age distribution in Milwaukee compared to Wisconsin. Figure 2. Age profile iv In Milwaukee, less than one-tenth of the population is older than 65 (8.9 percent) and less than 3 in 10 residents are under the age of 18 (27.1 percent). Most residents are between the ages of 18 and 64 (64 percent). Income Milwaukee lags with regard to median household income. The figure below shows Milwaukee s median household income compared to Milwaukee County and Wisconsin. Figure 3. Income profile v The 2010 median household income in our community was $35,851, which is considerably lower than the Wisconsin median household income of $52,374. 6

8 Poverty Milwaukee has the highest rate of poverty of any city in Wisconsin and is one of most impoverished cities in the U.S. vi The figure below shows Milwaukee s overall poverty rate compared to Milwaukee County and Wisconsin. Figure 4. Poverty profile vii Childhood poverty rates in Wisconsin In 2011, Wisconsin had an overall rate of poverty of 10.7 percent. The poverty rate was 17.8 percent in Milwaukee County and 29.4 percent viii in Milwaukee. Moreover, the percentage of children in Milwaukee who live in families that earn below the federal poverty level has steadily increased over the last five years, as the following figure demonstrates: Figure 5. Childhood poverty rates in Milwaukee ix In 2011, nearly 43% of children under the age of 18 in Milwaukee were at or below the federal poverty line. x 7

9 Insurance status Milwaukee residents are more likely to be uninsured than their counterparts in Wisconsin across all demographics. The table below shows the percent of uninsured broken down by gender, race/ethnicity, income and age for Milwaukee as compared to Wisconsin. Percent uninsured (2011) Wisconsin Milwaukee TOTAL 9.0% 15.6% GENDER Male Female RACE/ETHNICITY White African-American American Indian Asian Hispanic EDUCATION High school or less College graduate AGE Under 18 years to 64 years years and older Figure 6. Insurance status profile xi Fortunately, people younger than 18 experience relatively low rates of uninsurance in Milwaukee (4.3 percent) and Wisconsin (4.4 percent). xii Homeowner status The figure below compares the homeowner status in Milwaukee compared to Wisconsin: Figure 7. Homeowner status profile xiii A majority of homes (57.2 percent) in Milwaukee are renter-occupied households. In Wisconsin, the opposite is true, where a majority of households are owner-occupied (67.9 percent). 8

10 Homeowner household size About 64 percent of homeowner-occupied households in Milwaukee have 2 or fewer people in the home, which is roughly the same in Wisconsin overall with 63 percent. Owner-occupied households with more than 4 people represent 20.2 percent of Milwaukee households and 22.3 percent of Wisconsin households. The following figure shows the household size composition for owner-occupied homes in Milwaukee compared to Wisconsin. Figure 8: Homeowner household size xiv Renter household size About 66 percent of renter households in Milwaukee have 2 or fewer people in the home, which is less than Wisconsin overall with 70 percent. Renter households with more than 4 people represent 18.3 percent of Milwaukee households and 15.6 percent of Wisconsin households. The following figure shows the household size composition for renters in Milwaukee compared to Wisconsin. Figure 9: Renter household size xv The findings: health needs of our community In 2013, Children s Hospital and the Milwaukee Health Care Partnership released an executive summary of findings from the collective community health needs assessment, which included findings from the Milwaukee County Community Health Survey, a Key Informant Report and Secondary Data Report. In this summary, several broad themes emerged: Health care access and coverage Health care access and health insurance coverage were identified as a concern, issue or need in every assessment conducted in connection with the Community Health Needs Assessment. This includes responses from community members, public health officials, staff members and clinical providers. 9

11 Behavioral health Community members who participated in the MCCHS identified alcohol and drug use as the top priority for the community, whereas mental health emerged as the top priority issue in the Key Informant Report. Obesity, nutrition and physical activity The combined reports suggest that consumption of fruits and vegetables is on the decline and access to fresh produce has not increased. The Key Informant Report identified obesity as a top concern. Chronic disease The MCCHS revealed increasing rates of high blood pressure, diabetes and asthma in the overall population. More concerning, rates for heart failure, diabetes and chronic obstructive pulmonary disease were significantly higher in the lowest income ZIP codes compared to the highest income ZIP codes in Milwaukee County. Infant mortality Infant mortality is a top issue for key informants and community residents alike. Low birth weight, prematurity and receiving late or no prenatal care are risk factors for infant mortality seen at high rates in Milwaukee s lowest income ZIP codes. Sexual health The Henry J. Kaiser Family Foundation estimates there are more than 200,000 new cases of sexually transmitted infections in Wisconsin each year. Rates for teenage pregnancy and sexually transmitted infection in Milwaukee continue to be some of the highest in the U.S. Teenage birth rates, chlamydia and HIV infection have high risk ratios in Milwaukee s lowest income ZIP codes compared to the highest income ZIP codes. Health literacy Stakeholders identified issues relating to how health information is disseminated, accessed and understood. Challenges to navigating complex health systems also were noted. Disparate impact: race, ethnicity, education and income The Community Health Needs Assessment confirmed the persistence of racial, ethnic and socioeconomic disparities and recognized these issues continue to impact the community s health. Highest health priorities Because Children s Hospital is a pediatric specialty hospital, it is important to focus our attention and resources on areas where we can make the biggest impact on the health of children. We convened several meetings of cross-sector staff members to prioritize the findings from the Milwaukee Health Care Partnership s Community Health Needs Assessment and to select the highest priorities to guide our work. Considerations for prioritization included clear alignment with Children s Hospital s mission and vision, the scope of the problem, the availability of the necessary resources and expertise to adequately address the issue and the projected capacity of Children s Hospital to create a positive impact on the issue. The following issues were identified as the highest health needs of the pediatric community and the highest priorities for Children s Hospital: Access to mental, oral and primary health care Obesity and weight management Infant mortality Sexual health Community and home safety 10

12 Priority #1: access to mental, oral and primary health care Access to primary care Having health insurance does not necessarily result in access to quality health care. High rates of insurance coverage do not always translate to better health outcomes. For instance, Wisconsin has fewer uninsured children than most states, ranking No. 44 out of 50 with an uninsured rate of 5 percent. xvi However, an ongoing shortage of pediatricians in Wisconsin means access to care is restricted. In 2011, the Wisconsin Hospital Association released a report that indicated 100 new primary care physicians would be needed each year to meet the projected demand for primary care services in Wisconsin. xvii Pediatricians are of particular concern, as retiring pediatricians are not being replaced with new pediatricians at the same rate. xviii Second, shortages of pediatricians accepting Medicaid patients create burdens on the limited networks available to patients, creating long waits for appointments. Third, the issue of churning, fluctuating off and on federal health insurance programs, continues to create administrative barriers to seeking and maintaining care. And finally, other barriers, such as lack of transportation, inflexible work hours and lack of daycare prevent timely access to health care services. Access to oral health services Oral health is essential to overall health. The relationship between oral health and other long-term health conditions has been well documented, including cardiovascular disease, diabetes and osteoporosis. xix Among children, tooth decay is one of the most preventable common chronic illnesses. xx The triennial Milwaukee County Community Health Survey asked adult respondents whether they had received a dental checkup within the past year and found that 51 percent of respondents in Milwaukee County had. These results represent a decrease in the overall percent of respondents who reported having a dental checkup in the past year. The following graph shows the downward trend for Milwaukee County residents: 11

13 Dental checkup rates The Milwaukee County Community Health Survey also shows significant disparities in dental checkups in key demographic areas. The following chart shows several of these findings: Dental checkup rates TOTAL 66% 58% 52% 51% GENDER Male Female RACE White African-American Other EDUCATION High school or less College graduate Figure 10. Dental checkup rates xxi Furthermore, 10 percent of respondents to the MCCHS reported there was a time in the last 12 months their child did not get the dental care needed. The American Academy of Pediatric Dentists recommends a dental checkup twice a year for most children, even if the child has never had a cavity or other dental issue. xxii Three percent of respondents reported their child did not receive needed medical care while 2 percent reported their child did not visit a specialist they needed to see. Respondents who reported about their daughter were more likely to report their child did not get the dental care needed (14 percent) compared to respondents who reported about their son (6 percent). The reasons most cited for their child s unmet care were: unable to find an office who accepts child s insurance, unable to get appointment, the lack of insurance or insurance not covering the procedure. Access to mental health services Mental health, like oral health, can have a serious impact on physical health and the progression of a child into adulthood. Mental health also is associated with the prevalence and progression of chronic diseases, including diabetes, heart disease and cancer. In Wisconsin, the percent of children (ages 2-17) with emotional, developmental or behavioral problems who received mental health care is about 65.4 percent and the national average is 61.0 percent. xxiii This indicates that there are significant unmet mental health needs for our children. Given the importance of a child s doctor in their healthy physical development, it is a natural fit for that doctor to address behavioral/mental health needs. Priority #2: obesity and weight management Obesity and being overweight can contribute to many short-term and long-term health problems in children and adults. Obese and overweight youth are more likely to have risk factors for cardiovascular disease and diabetes, such as high blood glucose levels, high cholesterol and high blood pressure. xxiv Furthermore, research has demonstrated a strong relationship between childhood obesity and adulthood obesity. Obese children are at a disadvantage and are more at risk for adult health problems such as heart disease, osteoarthritis, type 2 diabetes 12

14 and several types of cancer, including cancer of the breast, colon, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix and prostate. Childhood obesity also puts our youth at risk for psychological problems including depression, behavioral problems, distorted body image and low self-esteem. Children are considered obese when their body mass index is greater than or equal to 30.0 and are considered overweight when their BMI is greater than or equal to Youth obesity and overweight comparisons The following graph shows trends in the prevalence of obesity and overweight designations for adolescents in Milwaukee and Wisconsin in a six-year period, using data from the U.S. Centers for Disease Control and Prevention s Youth Risk Behavior Surveillance System. This graph shows that while rates for obesity and overweight designations have remained relatively consistent in Milwaukee and Wisconsin, adolescents in Milwaukee experience these conditions at rates higher than their counterparts in the rest of the state. Figure 11. Youth obesity and overweight comparisons xxv According to the Milwaukee Public School s Youth Risk Behavior Survey there are many factors leading to obesity in children throughout Milwaukee County. Specifically, the report shows: 18 percent of MPS high school students are overweight, while an additional 17 percent are obese. Overall, MPS high school students report inadequate levels of physical activity and consumption of fruits and fruit juices. 27 percent of MPS middle-school students ate junk food every day during the past week. Priority #3: infant mortality Infant mortality appeared on the top lists of every group that participated in the community health needs assessment. According to U.S. Centers for Disease Control and Prevention s National Center for Health Statistics data, analyzed by Kids Count, Wisconsin ranks 19th in the nation for number of child deaths per 1,000 live births, with 5.8 child deaths per 1,000 live births. xxvi This figure narrowly comes in under the national average of 6.1 child deaths per 1,000 live births. Milwaukee does not fare as well. The City of Milwaukee ranks 7th worst for infant mortality among the 53 largest cities in the United States. xxvii The Milwaukee Health Department states the overall city rate for infant mortality in 2008 was per 1,000 births. Moreover, infant mortality rates do not impact the population evenly in Milwaukee. The black-white infant mortality gap is one of the highest in the nation. For Milwaukee s non-hispanic 13

15 families, the white infant mortality rate in 2008 was 5.49 deaths. For the same year, the Hispanic rate was and the black rate was per 1,000 births. A study published in the Wisconsin Medical Journal reported that for Milwaukee infants, race matters. The study looked at the relationship between socioeconomic status (SES) and infant mortality rates. Generally speaking, there are higher rates of infant mortality in areas with lower SES. While this general pattern held true in Milwaukee, it also cut across racial lines. The researchers found that in Milwaukee, African American infants born in the upper SES groups fared the same or worse than white infants born in lower SES groups. xxviii Priority #4: sexual health In a report released by the Wisconsin Department of Health Services, students in Wisconsin report sexual risk behaviors that occur with about the same frequency as their U.S. peers. In 2009, 46 percent of U.S. students reported ever having had sexual intercourse compared to 41 percent of Wisconsin students and 61 percent of U.S. students reported using a condom the last time they had sexual intercourse compared to 63 percent of Wisconsin students. xxix However, students in Milwaukee report overall riskier sexual behaviors than their peers in the rest of Wisconsin and U.S. Approximately 63 percent of students in Milwaukee reported ever having had sexual intercourse. Additionally, 33 percent of male students in Milwaukee reported 4 or more lifetime partners compared to 11 percent in Wisconsin and 16 percent in the U.S. In 2006, Milwaukee had one of the highest rates of teenage pregnancy in the United States with a rate of 52 pregnancies per 1,000 girls. By 2012, this rate had declined significantly to 33.4 pregnancies per 1,000 girls. xxx Despite the decline in teenage pregnancies, community stakeholders are still actively addressing causes and creating solutions to bring this number down. Milwaukee has not only had problems with teenage pregnancy, but also sexually transmitted infections/ diseases. Milwaukee County accounts for 50 percent of all STDs in the state of Wisconsin and among 63 cities cited by the CDC, Milwaukee ranked 10th highest in STD case rates in the nation. Priority #5: community and home safety Child maltreatment Child maltreatment the abuse and neglect of children is a health problem. There are four types of child maltreatment: sexual abuse, physical abuse, emotional abuse and neglect. All forms of maltreatment carry long-term consequences. Research has demonstrated links between child maltreatment and a range of mental disorders, drug use and risky sexual behavior in adolescence. xxxi In 2011, county Child Protective Services agencies in Wisconsin and the Bureau of Milwaukee Child Welfare received a total of 64,132 referrals for alleged maltreatment of children. xxxii Of this number, there were 4,808 child victims of maltreatment in 2011, which represents 3.5 children per 1,000 children in Wisconsin. A child is a victim if he/she had at least one substantiated maltreatment finding at the conclusion of a CPS initial assessment. Females were more likely to be victims than males due to higher rates of sexual abuse. Bullying Bullying is defined as unwanted, aggressive behavior among school-age children that involves a real or perceived power imbalance. There is a demonstrated link between bullying, behavioral/mental health and physical health. Children who are bullied are more likely to experience physical symptoms of stomachaches, anxiety, headaches, depression and suicide attempts. The Wisconsin Department of Public Instruction offers the statewide Youth Risk Behavior Survey every other year and 2011 s results found 44.3 percent of students agree bullying by other students is a problem at their school. Moreover, 14

16 17 percent of respondents indicated they were cyber-bullied. The 2009 survey posed this question for the first time. Based on the report, approximately 36 percent of male students and 54 percent of female students believed bullying and harassment were a problem at their school. As a comparison, in the 2009 survey, 41.9 percent of all respondents reported perceiving bullying to be a problem in their school. Locally, the statistics are similar. In the 2011 MPS Youth Risk Behavior Survey, 42 percent of Milwaukee Public School high school students agreed or strongly agreed with the statement that harassment and bullying by other students is a problem at their school. This represents a significant increase from the 2009 survey, which reported at 33 percent. At the middle school level, more than one in three (36 percent) of MPS middle school students reported that they have been bullied on school property at least one time in their life and 16 percent have been electronically bullied, according to the same 2011 MPS Youth Risk Behavior Survey. Community assets Children s Hospital recognizes that it takes a village to address the health needs of our children. The following chart lists some existing resources in select priority areas in the community that can be complemented by Children s Hospital and leveraged to achieve goals. Priority Access to primary care Obesity and weight management Community Resources Marquette University School of Nursing Clinic for Women & Children Sixteenth Street Community Health Center Lisbon Avenue Health Clinic Isaac Coggs Heritage Health Center Hillside Family Health Center Columbia St. Mary s St. Ben s Clinic Aurora Walker s Point Community Clinic Angel of Hope Medical Clinic MLK Heritage Health Center Downtown Health Center Marquette University School of Dentistry Community Dental Clinic Milwaukee Health Services Columbia St. Mary s, St. Elizabeth Ann Seton Dental Clinic Milwaukee Childhood Obesity Prevention Project Members: Medical College of Wisconsin United Neighborhood Centers of Milwaukee Agape Community Center Children s Hospital of Wisconsin COA Youth and Family Centers Journey House Milwaukee Christian Center Neighborhood House of Milwaukee Next Door Foundation Northcott Neighborhood House Silver Spring Neighborhood Center Active Across America Badgerland Striders Boys and Girls Club of Greater Milwaukee Milwaukee Area Technical College Milwaukee County Parks City of Milwaukee Health Department Marquette University 15

17 Obesity and weight management Community and home safety Milwaukee Bicycle Works Milwaukee Public Schools Planning Council Playworks Milwaukee Sixteenth Street Community Health Center Wisconsin Milk Marketing Board Zilber Neighborhood Initiative Y-Eat Right Growing Power SET Ministries Mobile Market Hunger Task Force YMCA YWCA University of Wisconsin Extension; EFNEP and SNAP Wisconsin Department of Health and Family Services, Division of Public Health Women Infant and Children s Supplemental Food Programs (WIC) Xalaat African Drum and Dance For Life Milwaukee Area Health Education Center System Athletes for Autism Fondy Food Center s Youth Chef Academy Alice s Garden Milwaukee Health Department Around the Corner to Better Health Lindsay Heights Corner Store Initiative Lindsay Heights Neighborhood Health Alliance Healthy Choices Program at Sixteenth Street Community Health Center Walnut Way The Froedtert & the Medical College of Wisconsin Comprehensive Weight Loss Center Wisconsin Partnership for Activity and Nutrition (WI PAN) Center for Healthy Communities & Research, Department of Family and Community Medicine, Medical College of Wisconsin Feeding America, Eastern Wisconsin CHW Community Health Mission Health e-learning (K 8 th grades) Wisconsin Partnership for Activity and Nutrition (WI PAN) Center for Healthy Communities & Research, Department of Family and Community Medicine, Medical College of Wisconsin Feeding America, Eastern Wisconsin Safe Kids Southeast Wisconsin National Program for Playground Safety Big Brothers Big Sisters of Metro Milwaukee City of Milwaukee Police Department City of Milwaukee Fire Department City of Milwaukee Health Department Community Advocates St. Mary s Burn Center i U.S. Census Bureau. ii iii iv v ibid. U.S. Census Bureau American Community Survey 1-year Estimate. ibid. ibid. vi Glauber, B and Ben Poston Milwaukee s poverty rate stands at Milwaukee Journal Sentinel. Accessed on July 30, vii viii ibid. Wisconsin Institute on Poverty. Wisconsin Poverty Report: Is The Safety Net Still Protecting Families from Poverty in 2011? 16

18 irp.wisc.edu/research/wisconsinpoverty/pdfs/wi-povertyreport2013.pdf ix Annie E. Casey Foundation. Data Source(s): Population Reference Bureau, analysis of data from the U.S. Census Bureau, Census 2000 Supplementary Survey, 2001 Supplementary Survey, 2002 through 2011 American Community Survey. x xi xii xiii xiv xv xvi xvii xviii xix xx ibid. ibid (U.S. Census Bureau). ibid. ibid. ibid. ibid. The Kaiser Family Foundation State Health Facts. Data Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau s March 2011 and 2012 Current Population Survey (CPS: Annual Social and Economic Supplements). Wisconsin Hospital Association New Physicians a Year: An Imperative for Wisconsin. Moca, D Wisconsin Facing Pediatrician Shortage. CBS58 News. Accessed on Aug. 5, Mayo Clinic. Centers for Medicare & Medicaid Services (CMS), Center for Medicaid, CHIP and Survey & Certification (CMCS) MEDICAID/CHIP ORAL HEALTH SERVICES FACT SHEET OCTOBER xxi Wisconsin Department of Children and Families, Bureau of Milwaukee Child Welfare. Wisconsin Child Abuse and Neglect Report xxii xxiii xxiv Healthy People 2020 Plan. HealthyPeople.gov. The Kaiser Family Foundation State Health Facts. Data Source(s): Child and Adolescent Health Measurement Initiative National Survey of Children s Health, Data Resource Center for Child and Adolescent Health website. Retrieved June Center for Disease Control: Childhood Obesity Facts. xxv U.S. Centers for Disease Control and Prevention. Youth Risk Behavior Survey xxvi xxvii Annie E. Casey Foundation. Data Source(s): National KIDS Count. c=1&loct=2#ranking/2/any/true/133/any/ The Big Cities Health Inventory 2007: The Health of Urban USA. Available at xxviii Ward TC, et al Influence of Socioeconomic factors and race on birth outcomes in Urban Milwaukee. Wisconsin Medical Journal 109 (5): xxix xxx xxxi Wisconsin Department of Health Services and Wisconsin Department of Public Instruction. April Wisconsin Youth Sexual Behavior and Outcomes: Update. Marquette Tribune. Norman RE, Byambaa M, De R, Butchart A, Scott J, et al The Long-Term Health Consequences of Child Physical Abuse, Emotional Abuse, and Neglect: A Systematic Review and Meta-Analysis. PLoS Med 9(11): e doi: /journal.pmed xxxii Wisconsin Department of Children and Families, Bureau of Milwaukee Child Welfare. Wisconsin Child Abuse and Neglect Report

19 Appendix A Public Health Contributors

20

21 Appendix B Milwaukee Health Survey

22 Milwaukee County Community Health Survey A full report of a resident phone survey Sponsored by: Health System Members of the Milwaukee Health Care Partnership Aurora Health Care Children s Hospital of Wisconsin Columbia St. Mary s Health System Froedtert Health Wheaton Franciscan Healthcare In Collaboration with: City of Milwaukee and other Municipal Health Departments in Milwaukee County Prepared by: JKV Research, LLC

23 The Milwaukee Health Care Partnership is a public/private consortium dedicated to improving health care coverage, access and care coordination for underserved populations in Milwaukee County with the goals of improving health outcomes, eliminating disparities and reducing the total cost of care. Its members include the following partnering health systems and hospitals: Aurora Health Care Aurora Sinai Medical Center Aurora St. Luke s Medical Aurora St. Luke s South Shore Aurora West Allis Medical Center Aurora Psychiatric Hospital Children s Hospital and Health System Children s Hospital of Wisconsin Columbia St. Mary s Columbia St. Mary s Hospital Milwaukee Sacred Heart Rehabilitation Institute Froedtert Health Froedtert Hospital Wheaton Franciscan Healthcare Wheaton Franciscan Healthcare- St. Francis Wheaton Franciscan- St. Joseph Campus Wheaton Franciscan Healthcare- Franklin Wheaton Franciscan- Midwest Spine and Orthopedic Hospital and Wisconsin Heart Hospital This report was prepared by JKV Research, LLC.

24 Table of Contents Section Title Page Number Purpose... 1 Methodology... 1 Summary... 4 Key Findings Rating Their Own Health Health Care Coverage Health Care Needed Health Information and Services Routine Procedures Vaccinations Prevalence of Select Health Conditions Physical Well Being and Body Weight Nutrition Women s Health Men s Health Colorectal Cancer Screening Tobacco Use Exposure to Cigarette Smoke Alcohol Use Household Problems Mental Health Status Personal Safety Issues Children in Household Community Health Issues Appendix A: Questionnaire Frequencies Appendix B: Survey Methodology Table Title Page Number Table 1. Weighted Demographic Variables of Survey Respondents for Table 2. Fair or Poor Health by Demographic Variables for Each Survey Year Table 3. Personally No Health Care Coverage by Demographic Variables for Each Survey Year Table 4. Personally Not Covered by Health Insurance in Past 12 Months by Demographic Variables for Each Survey Year Table 5. Someone in Household Not Covered by Health Insurance in Past 12 Months by Demographic Variables for Each Survey Year Table 6. Prescription Medications Not Taken Due to Cost in Past 12 Months by Demographic Variables for Table 7. Unmet Health Care in Past 12 Months by Demographic Variables for Table 8. Health Information Source by Demographic Variables for Table 9. Doctor s or Nurse Practitioner s Office as Primary Health Care Service by Demographic Variables for Each Survey Year Table 10. Advance Care Plan by Demographic Variables for Each Survey Year Table 11. Routine Checkup Two Years Ago or Less by Demographic Variables for Each Survey Year Table 12. Cholesterol Test Four Years Ago or Less by Demographic Variables for Each Survey Year Table 13. Dental Checkup Less than One Year Ago by Demographic Variables for Each Survey Year Table 14. Eye Exam Less than One Year Ago by Demographic Variables for Each Survey Year Table 15. Flu Vaccination by Demographic Variables for Each Survey Year Table 16. Pneumonia Vaccination Ever (65 and Older) by Demographic Variables for Each Survey Year Milwaukee County Community Health Survey Report 2012

25 Table Title Page Number Table 17. High Blood Pressure in Past Three Years by Demographic Variables for Each Survey Year Table 18. High Blood Cholesterol in Past Three Years by Demographic Variables for Each Survey Year Table 19. Heart Disease/Condition in Past Three Years by Demographic Variables for Each Survey Year Table 20. Mental Health Condition in Past Three Years by Demographic Variables for Each Survey Year Table 21. Diabetes in Past Three Years by Demographic Variables for Each Survey Year Table 22. Current Asthma by Demographic Variables for Each Survey Year Table 23. Recommended Moderate Physical Activity by Demographic Variables for Each Survey Year Table 24. Recommended Vigorous Physical Activity by Demographic Variables for Each Survey Year Table 25. Recommended Moderate or Vigorous Physical Activity by Demographic Variables for Each Survey Year Table 26. Overweight by Demographic Variables for Each Survey Year Table 27. Two or More Servings of Fruit on Average Day by Demographic Variables for Each Survey Year Table 28. Three or More Servings of Vegetables on Average Day by Demographic Variables for Each Survey Year Table 29. Mammogram Within Past Two Years by Demographic Variables for Each Survey Year (Respondents 50 and Older) Table 30. Bone Density Scan by Demographic Variables for Each Survey Year (Respondents 65 and Older) Table 31. Pap Smear Within Past Three Years by Demographic Variables for Each Survey Year (Respondents 18 to 65 Years Old and With a Cervix) Table 32. Prostate Cancer Screening Within Past Two Years by Demographic Variables for Each Survey Year (Respondents 40 and Older) Table 33. Blood Stool Test Within Past Year by Demographic Variables for Each Survey Year (Respondents 50 and Older) Table 34. Sigmoidoscopy Within Past Five Years by Demographic Variables for Each Survey Year (Respondents 50 and Older) Table 35. Colonoscopy Within Past Ten Years by Demographic Variables for Each Survey Year (Respondents 50 and Older) Table 36. Colorectal Cancer Screening in Recommended Time Frame by Demographic Variables for Each Survey Year (Respondents 50 and Older) Table 37. Current Smokers by Demographic Variables for Each Survey Year Table 38. Other Tobacco Use in Past 30 Days by Demographic Variables for Table 39. Current Smokers Quit Smoking for One Day or Longer in Past Year by Demographic Variables for Each Survey Year Table 40. Doctor, Nurse or Other Health Professional Advised Respondent to Quit Smoking in Past Year by Demographic Variables for Each Survey Year Table 41. Smoking Not Allowed in Home by Demographic Variables for Each Survey Year Table 42. Nonsmokers Exposure to Second-Hand Smoke in the Past Seven Days by Demographic Variables for Each Survey Year Table 43. Binge Drinking in Past Month by Demographic Variables for Each Survey Year Table 44. Driver or Passenger in Vehicle When Driver Perhaps Had Too Much to Drink by Demographic Variables for Each Survey Year Table 45. Household Problem Associated with Alcohol in Past Year by Demographic Variables for Each Survey Year Table 46. Always/Nearly Always Felt Sad, Blue or Depressed in Past 30 Days by Demographic Variables for Each Survey Year Table 47. Considered Suicide in the Past Year by Demographic Variables for Each Survey Year Table 48. Seldom/Never Find Meaning and Purpose in Daily Life by Demographic Variables for Each Survey Year Table 49. Afraid for Personal Safety by Demographic Variables for Each Survey Year Table 50. Pushed, Kicked, Slapped or Hit by Demographic Variables for Each Survey Year Milwaukee County Community Health Survey Report 2012

26 Table Title Page Number Table 51. At Least One of the Personal Safety Issues by Demographic Variables for Each Survey Year Table 52. Did Not Receive Care Needed in Past 12 Months by Demographic Variables for 2012 (All Children) Table 53. Nutrition and Exercise by Demographic Variables for 2012 (Children 5 to 17 Years Old) Table 54. Current Asthma by Demographic Variables for 2012 (All Children) Table 55. Experienced Bullying in Past 12 Months by Demographic Variables for 2012 (Children 8 to 17 Years Old) Table 56. Community Health Issues by Demographic Variables for 2012 (Part 1) Table 56. Community Health Issues by Demographic Variables for 2012 (Part 2) Figure Title Page Number Figure 1. Rate Own Health for Figure 2. Fair or Poor Health Figure 3. Type of Health Care Coverage for Figure 4. Health Care Coverage Figure 5. Health Information and Services Figure 6. Routine Procedures Figure 7. Vaccinations Figure 8. Health Conditions in Past Three Years for Figure 9. Health Conditions in Past Three Years Figure 10. Physical Activity/Week for Figure 11. Physical Well Being and Body Weight Figure 12. Fruit and Vegetable Consumption on an Average Day Figure 13. Women's Health Tests Figure 14. Prostate Cancer Screening in Past Two Years (Male Respondents 40 and Older) Figure 15. Colorectal Cancer Screenings (Respondents 50 and Older) Figure 16. Tobacco Use (Past 30 Days) Figure 17. Smoking Cessation in Past 12 Months (Current Smokers) Figure 18. Smoking Policy Inside Home for Figure 19. Exposure to Cigarette Smoke Figure 20. Alcohol Use in Past Month Figure 21. Household Problems in Past Year Figure 22. Felt Sad, Blue or Depressed in Past 30 Days for Figure 23. Mental Health Status Figure 24. Personal Safety Issues in Past Year Figure 25. Community Health Issues for Milwaukee County Community Health Survey Report 2012

27 Purpose The purpose of this project is to provide Milwaukee County with information for an assessment of the health status of residents. Primary objectives are to: 1. Gather specific data on behavioral and lifestyle habits of the adult population. Select information will also be collected about the respondent s household. 2. Gather data on the prevalence of risk factors and disease conditions existing within the adult population. 3. Compare, where appropriate, health data of residents to previous health studies. 4. Compare, where appropriate and available, health data of residents to state and national measurements. Methodology This report was commissioned by Aurora Health Care, Children s Hospital of Wisconsin, Columbia St. Mary s Health System, Froedtert Health and Wheaton Franciscan Healthcare in partnership with the Center for Urban Population Health. The purpose of this effort was to gather information on the health practices and health-related behavioral risks of residents. Respondents were scientifically selected so that the survey would be representative of all adults 18 years old and older. The sampling strategy was two-fold. 1) A random-digit-dial landline sample of telephone numbers which included listed and unlisted numbers. The respondent within each household was randomly selected by computer based on the number of adults in the household (n=1,428). 2) A cell phone-only sample where the person answering the phone was selected as the respondent (n=542). At least 8 attempts were made to contact a respondent in both samples. Screener questions verifying location were included. Data collection was conducted by Management Decisions Incorporated. A total of 1,970 telephone interviews were completed between June 20 and November 7, With a sample size of 1,970, we can be 95% sure that the sample percentage reported would not vary by more than ±2 percent from what would have been obtained by interviewing all persons 18 years old and older who lived in Milwaukee County. The margin of error for smaller subgroups will be larger. For the landline sample, weighting was based on the number of adults in the household and the number of residential phone numbers, excluding fax and computer lines, to take into account the probability of selection. For the cell-phone only sample, it was assumed the respondent was the primary cell phone user. Combined, post-stratification was conducted by sex and age to reflect the 2010 census proportion of these characteristics in the area. Throughout the report, some totals may be more or less than 100% due to rounding and response category distribution. Percentages occasionally may differ by one or two percentage points from previous reports or the Appendix as a result of rounding, recoding variables or response category distribution. The survey was conducted by JKV Research, LLC. For technical information about survey methodology, contact Janet Kempf Vande Hey, M.S. at (920) or janet.vandehey@jkvresearch.com. For further information about the survey, contact Mark M. Huber, M.S., Chair, Milwaukee Health Care Partnership Community Health Assessment Task Force at (414) or mark.huber@aurora.org. Milwaukee County Community Health Survey Report

28 Demographic Profile of Milwaukee County Community Health Survey Table 1. Weighted Demographic Variables of Survey Respondents for 2012 Survey Results TOTAL 100% Gender Male 47% Female 53 Age 18 to 24 15% 25 to to to to and Older 15 Race 1 White 57% African American 32 Other 11 Hispanic Origin Hispanic 9% Non-Hispanic 91 Education High School Graduate or Less 38% Some Post High School 30 College Graduate 31 Household Income Bottom 40 Percent Bracket 48% Middle 20 Percent Bracket 13 Top 40 Percent Bracket 24 Not Sure/No Answer 16 Married 37% Percentages occasionally may differ by 1 or 2 percentage points from the Appendix as a result of rounding, recoding variables and response category distribution. 1 Other includes the following: Asian, American Indian, Alaska Native, Native Hawaiian or other Pacific Islander, another race or multiple races. What do the percentages mean? Results of the Milwaukee County Community Health Survey can be generalized to the adult population with telephones. In 2010, the Census Bureau tabulated 711,358 adult residents. When using percentages from this study, it is important to keep in mind what each percentage point, within the margin of error, actually represents in terms of the total adult population. One percentage point equals approximately 7,110 adults. So, when 20% of respondents reported their health was fair or poor, this roughly equals Milwaukee County Community Health Survey Report

29 142,200 residents ±14,220 individuals. Therefore, from 127,980 to 156,420 residents may have fair or poor health. Because the margin of error is ±2%, events or health risks that are small will include zero. The 2010 Census found 393,782 occupied housing units in Milwaukee County. In certain questions of the Community Health Survey, respondents were asked to report information about their household. Using the household estimate, each percentage point for household-level data represents approximately 3,940 households. For example, 21% of survey respondents reported that someone in their household was not covered by health insurance at least some of the time in the past year. Thus, the estimated number of households with someone not covered by health insurance would be 82,740. Definitions Marital status: Married respondents were classified as those who reported married and those who reported a member of an unmarried couple. All others were classified as not married. Household income: It is difficult to compare household income data throughout the years as the real dollar value changes. Each year, the Census Bureau classifies household income into five equal brackets, rounded to the nearest dollar. It is not possible to exactly match the survey income categories to the Census Bureau brackets since the survey categories are in increments of $10,000 or more; however, it is the best way to track household income. This report looks at the Census Bureau s bottom 40%, middle 20% and top 40% household income brackets each survey year. In 2003, the bottom 40% income bracket included survey categories less than $30,001, the middle 20% income bracket was $30,001 to $50,000 and the top 40% income bracket was at least $50,001. In 2006, 2009 and 2012, the bottom 40% income bracket included survey categories less than $40,001, the middle 20% income bracket was $40,001 to $60,000 and the top 40% income bracket was at least $60,001. The recommended amount of physical activity by the Centers for Disease Control is moderate activity for at least 30 minutes on five or more days of the week or vigorous activity for at least 20 minutes on three or more days of the week. Moderate physical activity includes walking briskly, bicycling, vacuuming, gardening or anything else that causes small increases in breathing or heart rate. Vigorous physical activity includes running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate. Insufficient physical activity includes participation in either activity, but not for the duration or the frequency recommended. Inactive respondents reported no moderate or vigorous physical activity in a typical week. Overweight was calculated using the Centers for Disease Control s Body Mass Index (BMI). Body Mass Index is calculated by using kilograms/meter 2. A BMI of 25.0 to 29.9 is considered overweight and 30.0 or more is obese. Throughout the report, the category overweight includes both overweight and obese respondents. Current smoker is defined as someone who smoked at least some days in the past 30 days. The definition for binge drinking varies. Currently, the Centers for Disease Control (CDC) defines binge drinking as four or more drinks per occasion for females and five or more drinks per occasion for males to account for weight and metabolism differences. Previously, the CDC defined binge drinking as five or more drinks at one time, regardless of gender. In 2003 and 2012, the Milwaukee County Health Survey defined binge drinking as four or more drinks per occasion for females and five or more drinks per occasion for males to account for weight and metabolism differences. All other study years were five or more drinks, regardless of gender. Milwaukee County Community Health Survey Report

30 Summary This research provides valuable behavioral data, lifestyle habits, and the prevalence of risk factors and disease conditions of Milwaukee County residents. The following data are highlights of the comprehensive study. Overall Health Vaccinations (65 and Older) Milwaukee County Milwaukee County Excellent 19% 18% 18% 17% Flu Vaccination (past year) 77% 71% 69% 63% Very Good 35% 33% 33% 35% Pneumonia (ever) 58% 71% 72% 69% Fair or Poor 16% 18% 18% 20% Other Research: (2010) WI U.S. Other Research: (2010) WI U.S. Flu Vaccination (past year) 68% 68% Fair or Poor 14% 15% Pneumonia (ever) 73% 69% Health Care Coverage Health Conditions in Past 3 Years Milwaukee County Milwaukee County Not Covered High Blood Pressure 22% 27% 29% 30% Personally (currently) 8% 11% 12% 14% High Blood Cholesterol 18% 22% 22% 21% Personally (past 12 months) 21% 19% Mental Health Condition 13% 14% Household Member (past 12 months) 23% 26% 25% 21% Asthma (Current) 9% 10% 12% 12% Diabetes 7% 8% 9% 10% Other Research: (2010) WI U.S. Heart Disease/Condition 8% 8% 9% 8% Personally Not Covered (currently) 11% 15% Cancer 3% 4% Stroke 2% 2% 2% 2% Did Not Receive Care Needed (Past 12 Months) Condition Controlled Through Medication, Milwaukee County 2012 Exercise or Lifestyle Changes Prescript. Meds Not Taken Due to Cost (Household) 11% High Blood Pressure 96% Unmet Care High Blood Cholesterol 86% Dental Care 19% Mental Health Condition 81% Medical Care 11% Asthma (Current) 92% Mental Health Care 4% Diabetes 92% Heart Disease/Condition 91% Health Information and Services Milwaukee County Physical Health Health Information Source Milwaukee County Doctor 45% Physical Activity/Week Internet 28% Moderate Activity (5 times/30 min) 28% 33% 31% 35% Advance Care Plan 27% 32% 31% 29% Vigorous Activity (3 times/20 min) 22% 19% 24% Primary Source of Health Advice/Service Recommended Moderate or Vigorous 45% 41% 47% Doctor/nurse practitioner s office 77% 73% 70% Overweight 62% 63% 66% 66% Hospital emergency room 6% 7% 7% Fruit Intake (2+ servings/day) 66% 61% 58% 62% Urgent care center 3% 6% 7% Vegetable Intake (3+ servings/day) 30% 24% 21% 26% Public health clinic/community health center 5% 7% 6% Hospital outpatient 3% 2% 3% Other Research: WI U.S. No usual place 5% 4% 6% Overweight (2010) 64% 64% Recommended Mod. or Vig. Activity (2009) 53% 51% Routine Procedures Milwaukee County Women s Health Routine Checkup (2 yrs. ago or less) 87% 85% 85% 83% Milwaukee County Cholesterol Test (4 years ago or less) 74% 73% 75% 72% Mammogram (50+; within past 2 years) 84% 78% 78% 77% Dental Checkup (past year) 68% 63% 60% 56% Bone Density Scan (65 and older) 67% 73% 71% Eye Exam (past year) 51% 44% 42% 42% Pap Smear (18-65; within past 3 years) 91% 90% 89% 86% Other Research: WI U.S. Other Research: (2010) WI U.S. Routine Checkup ( 2 years; 2000) 79% 84% Mammogram (50+; within past 2 years) 80% 78% Cholesterol Test ( 5 years; 2010) 77% 77% Pap Smear (18+; within past 3 years) 85% 81% Dental Checkup (past year; 2010) 75% 70% Milwaukee County Community Health Survey Report

31 Men s Health (40 and Older) Alcohol Use in Past Month Milwaukee County Milwaukee County Prostate Cancer Screening Binge Drinker 17% 19% 20% 31% Within Past 2 Years 61% 64% 51% Driver/Passenger When Driver Perhaps Had Too Much to Drink 3% 3% 3% 2% Colorectal Cancer Screenings (50 and Older) Milwaukee County Other Research: (2010) WI U.S. Blood Stool Test (within past year) 36% 23% -- 14% Binge Drinker 22% 15% Sigmoidoscopy (within past 5 years) 10% 10% Colonoscopy (within past 10 years) 58% 61% Household Problems Associated With Screening in Recommended Time Frame 61% 67% Milwaukee County Alcohol 3% 3% 2% Cigarette Use Marijuana 2% Milwaukee County Gambling 1% Current Smokers (past 30 days) 26% 26% 25% 24% Misuse of Prescription or OTC Drugs <1% Other Tobacco Products (past 30 days) 6% Cocaine, Heroin or Other Street Drugs <1% Of Current Smokers Quit Smoking 1 Day or More in Past Children in Household Year Because Trying to Quit 51% 54% 53% 64% Milwaukee County 2012 Saw a Health Care Professional Past Year Personal Health Doctor/Nurse who And Advised to Quit Smoking 77% 72% 80% Knows Child Well and Familiar with History 89% Visited Personal Health Professional for Other Research: WI U.S. Preventive Care (past 12 months) 93% Current Smokers (2010) 19% 17% Did Not Receive Care Needed (past 12 months) Tried to Quit (2005) 49% 56% Dental Care 8% Medical Care 2% Exposure to Smoke Specialist 2% Milwaukee County Current Asthma 11% Smoking Policy at Home Safe in Community/Neighborhood (seldom/never) 4% Not allowed anywhere 64% 74% Children 5 to 17 Years Old Allowed in some places or at some times 14% 10% Fruit Intake (2+ servings/day) 78% Allowed anywhere 4% 4% Vegetable Intake (3+ servings/day) 26% No rules inside home 18% 12% Physical Activity (60 min/5 or more days) 66% Nonsmokers Second-Hand Smoke Children 8 to 17 Years Old Exposure in Past Seven Days 29% 23% Unhappy, Sad or Depressed Always/Nearly Always (past 6 months) 7% Other Research: (WI: 2003; US: ) WI U.S. Experienced Some Form of Bullying (past 12 months) 22% Smoking Prohibited at Home 75% 79% Verbally Bullied 18% Physically Bullied 10% Mental Health Status Cyber Bullied 2% Milwaukee County Felt Sad, Blue or Depressed Community Health Issues Always/Nearly Always (past 30 days) 7% 8% 8% 7% Milwaukee County 2012 Find Meaning and Purpose in Daily Life Alcohol or Drug Use 58% Seldom/Never 6% 5% 6% 7% Violence 55% Considered Suicide (past year) 3% 6% 5% 5% Chronic Diseases 52% Teen Pregnancy 35% Personal Safety in Past Year Infectious Diseases 26% Milwaukee County Mental Health or Depression 21% Afraid for Their Safety 6% 10% 9% 7% Infant Mortality 21% Pushed, Kicked, Slapped, or Hit 4% 5% 6% 4% Lead Poisoning 3% At Least One of the Safety Issues 9% 13% 12% 9% --Not asked in 2009 Milwaukee County Community Health Survey Report

32 Overall Health and Health Care Key Findings In 2012, 52% of respondents reported their health as excellent or very good; 20% reported fair or poor. Respondents who were female, 45 to 64 years old, African American, with a high school education or less, in the bottom 40 percent household income bracket, who were unmarried, overweight, inactive or smokers were more likely to report fair or poor conditions. From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported their health as fair or poor. In 2012, 14% of respondents reported they were not currently covered by health care insurance; respondents who were male, 18 to 24 years old, non-white, Hispanic, with a high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. Nineteen percent of respondents reported they personally did not have health care coverage at least part of the time in the past 12 months; respondents who were male, 18 to 24 years old, non-white, Hispanic, with a high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. Twenty-one percent of respondents reported someone in their household was not covered at least part of the time in the past 12 months; respondents who were in the bottom 40 percent household income bracket or unmarried were more likely to report this. From 2003 to 2012, the overall percent statistically increased for respondents 18 and older as well as for respondents 18 to 64 years old who reported no current personal health care insurance. From 2009 to 2012, the overall percent statistically decreased for respondents who reported no personal health care insurance at least part of the time in the past 12 months. From 2003 to 2012, the overall percent statistically remained the same for respondents who reported someone in the household was not covered at least part of the time in the past 12 months. In 2012, 11% of respondents reported that someone in their household had not taken their prescribed medication due to prescription costs in the past 12 months; respondents in the bottom 40 percent household income bracket were more likely to report this. Nineteen percent of respondents reported they did not get the dental care needed in the last 12 months; respondents who were 18 to 24 years old, African American, with some post high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. Eleven percent of respondents reported they did not get the medical care needed in the last 12 months; respondents who were 18 to 24 years old, 45 to 64 years old, African American, with a high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. Four percent of respondents reported they did not get the mental health care needed in the last 12 months; respondents who were 45 to 54 years old, non-white and non-african American, Hispanic, with some post high school education or in the bottom 40 percent household income bracket were more likely to report this. In 2012, 45% of respondents reported they receive most of their health information from a doctor while 28% reported the internet. Seventy percent of respondents reported their primary place for health services was from a doctor s or nurse practitioner s office; respondents who were female, 65 and older, white, non-hispanic, with a college education, in the top 40 percent household income bracket or married respondents were more likely to report this. Twenty-nine percent of respondents had an advance care plan; respondents who were 65 and older, white, non-hispanic, with a college education, in the top 40 percent household income bracket or married respondents were more likely to report an advance care plan. From 2006 to 2012, there was a statistical decrease in the overall percent of respondents reporting their primary place for health services was from a doctor s or nurse practitioner s office. From 2003 to 2012, there was no statistical change in the overall percent of respondents having an advance care plan. In 2012, 83% of respondents reported a routine medical checkup two years ago or less while 72% reported a cholesterol test four years ago or less. Fifty-six percent of respondents reported a visit to the dentist in the past year while 42% reported an eye exam in the past year. Respondents who were female, 65 and older, African American or non-hispanic were more likely to report a routine checkup two years ago or less. Respondents who were 65 and older, white, non-hispanic, with a college education, in the top 40 percent household income bracket or married respondents were more likely to report a cholesterol test four years ago or less. Respondents who were female, 45 to Milwaukee County Community Health Survey Report

33 54 years old, white, non-hispanic, with a college education, in the top 40 percent household income bracket or married respondents were more likely to report a dental checkup in the past year. Respondents who were 65 and older, non-hispanic, with at least some post high school education or married were more likely to report an eye exam in the past year. From 2003 to 2012, there was a statistical decrease in the overall percent of respondents reporting a routine checkup two years ago or less, a dental checkup in the past year or an eye exam in the past year. From 2003 to 2012, there was no statistical change in the overall percent of respondents reporting a cholesterol test four years ago or less. In 2012, 38% of respondents had a flu vaccination in the past year. Respondents who were female, 65 and older or married were more likely to report a flu vaccination. Sixty-nine percent of respondents 65 and older had a pneumonia vaccination in their lifetime. From 2003 to 2012, there was no statistical change in the overall percent of respondents 18 and older who reported a flu vaccination in the past 12 months. From 2003 to 2012, there was a statistical decrease in the overall percent of respondents 65 and older who reported a flu vaccination in the past 12 months. From 2003 to 2012, there was a statistical increase in the overall percent of respondents 65 and older who had a pneumonia vaccination. Health Risk Factors Key Findings In 2012, out of eight health conditions listed, the two most often mentioned in the past three years were high blood pressure or high blood cholesterol (30% and 21%, respectively). Respondents who were female, 65 and older, African American, non-hispanic, with a high school education or less, in the bottom 40 percent household income bracket, who were unmarried, overweight or inactive were more likely to report high blood pressure. Respondents who were 55 and older, white, non-hispanic, with a high school education or less, who were married, overweight or inactive were more likely to report high blood cholesterol. Respondents who were 65 and older, non-hispanic, with a high school education or less, in the bottom 40 percent household income bracket, who were overweight or inactive were more likely to report heart disease/condition. Respondents who were female, 45 to 54 years old, with some post high school education, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report a mental health condition. Respondents who were 65 and older, African American, with a high school education or less, in the bottom 40 percent household income bracket, who were overweight or inactive were more likely to report diabetes. Respondents who were female, 18 to 24 years old, 35 to 44 years old, nonwhite, Hispanic, with some post high school education, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report current asthma. From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported high blood pressure, high blood cholesterol, diabetes or current asthma. From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported heart disease/condition or stroke. From 2009 to 2012, there was no statistical change in the overall percent of respondents who reported a mental health condition. From 2009 to 2012, there was a statistical increase in the overall percent of respondents who reported cancer. In 2012, 7% of respondents reported they always or nearly always felt sad, blue or depressed in the past 30 days; respondents who were 45 to 54 years old, non-white and non-african American, Hispanic, with a high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. Five percent of respondents felt so overwhelmed they considered suicide in the past year; respondents who were 18 to 24 years old, non-white and non-african American, in the bottom 40 percent household income bracket or unmarried were more likely to report this. Seven percent of respondents reported they seldom or never find meaning and purpose in daily life; respondents who were male, with a high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported they always or nearly always felt sad, blue or depressed or they seldom/never find meaning and purpose in daily life. From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported they considered suicide. Milwaukee County Community Health Survey Report

34 Behavioral Risk Factors Key Findings In 2012, 35% of respondents did moderate physical activity five times a week for 30 minutes while 24% did vigorous activity three times a week for 20 minutes. Combined, 47% met the recommended amount of physical activity; respondents who were 18 to 34 years old, non-white and non-african American, Hispanic, with at least some post high school education or respondents who were not overweight were more likely to report this. Sixty-six percent of respondents were classified as overweight. Respondents who were 45 to 64 years old, non-white, Hispanic, with some post high school education or less or inactive respondents were more likely to be classified as overweight. From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported moderate physical activity five times a week for at least 30 minutes. From 2006 to 2012, there was a statistical increase in the overall percent of respondents who reported vigorous physical activity three times a week for at least 20 minutes. From 2006 to 2012, there was no statistical change in the overall percent of respondents who met the recommended amount of physical activity. From 2003 to 2012, there was a statistical increase in the overall percent of respondents being overweight. In 2012, 62% of respondents reported two or more servings of fruit while 26% reported three or more servings of vegetables on an average day. Respondents who were female, 25 to 34 years old, non-african American, with a college education, in the top 40 percent household income bracket, who were not overweight or who met the recommended amount of physical activity were more likely to report at least two servings of fruit. Respondents who were female, 35 to 44 years old, white, non-hispanic, with a college education, in the top 40 percent household income bracket, who were married or met the recommended amount of physical activity were more likely to report at least three servings of vegetables on an average day. From 2003 to 2012, there was a statistical decrease in the overall percent of respondents who reported at least two servings of fruit on an average day or at least three servings of vegetables on an average day. In 2012, 77% of female respondents 50 and older reported a mammogram within the past two years; respondents who were in the top 60 percent household income bracket or married were more likely to report this. Seventy-one percent of female respondents 65 and older had a bone density scan; respondents with at least some post high school education were more likely to report this. Eighty-six percent of female respondents 18 to 65 years old reported a pap smear within the past three years; respondents who were 35 to 44 years old, African American, non-hispanic, with a college education or married respondents were more likely to report this. From 2003 to 2012, there was a statistical decrease in the overall percent of respondents 50 and older who reported having a mammogram within the past two years. From 2006 to 2012, there was no statistical change in the overall percent of respondents 65 and older who reported a bone density scan. From 2003 to 2012, there was a statistical decrease in the overall percent of respondents 18 to 65 years old who reported having a pap smear within the past three years. In 2012, 51% of male respondents 40 and older had a prostate cancer screening within the past two years with either a digital rectal exam (DRE) or a prostate-specific antigen (PSA) test. Respondents 50 and older were more likely to report this. From 2006 to 2012, there was a statistical decrease in the overall percent of male respondents 40 and older who reported a prostate cancer screening within the past two years. In 2012, 14% of respondents 50 and older reported a blood stool test within the past year. Ten percent of respondents 50 and older reported a sigmoidoscopy within the past five years while 61% reported a colonoscopy within the past ten years. This results in 67% of respondents meeting current colorectal cancer screening recommendations. From 2003 to 2012, there was a statistical decrease in the overall percent of respondents who reported a blood stool test within the past year. From 2009 to 2012, there was no statistical change in the overall percent of respondents who reported a sigmoidoscopy within the past five years or a colonoscopy within the past ten years. From 2009 to 2012, there was a statistical increase in the overall percent of respondents who reported at least one of these tests in the recommended time frame. Milwaukee County Community Health Survey Report

35 In 2012, 24% of respondents were current smokers; respondents who were male, 25 to 34 years old, African American, with a high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to be a smoker. Six percent of respondents reported other tobacco use such as cigars, pipes, chewing tobacco or snuff in the past 30 days; respondents who were male or 25 to 34 years old were more likely to report this. In the past 12 months, 64% of current smokers quit smoking for one day or longer because they were trying to quit; respondents who were 18 to 24 years old or African American were more likely to report this. Eighty percent of current smokers who saw a health professional in the past year reported the professional advised them to quit smoking; respondents 35 to 54 years old were more likely to report this. From 2003 to 2012, there was no statistical change in the overall percent of respondents who were current smokers. From 2003 to 2012, there was a statistical increase in the overall percent of current smokers who reported they quit smoking for one day or longer in the past 12 months because they were trying to quit. From 2006 to 2012, there was no statistical change in the overall percent of current smokers who reported their health professional advised them to quit smoking. In 2012, 74% of respondents reported smoking is not allowed anywhere inside the home. Respondents who were in the top 40 percent household income bracket, married, nonsmokers or in households with children were more likely to report smoking is not allowed anywhere inside the home. Twenty-three percent of nonsmoking respondents reported they were exposed to second-hand smoke in the past seven days; respondents who were male, 18 to 24 years old, non-white, Hispanic, with some post high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. From 2009 to 2012, there was a statistical increase in the overall percent of respondents who reported smoking is not allowed anywhere inside the home. From 2009 to 2012, there was a statistical decrease in the overall percent of respondents who reported they were exposed to second-hand smoke in the past seven days. In 2012, 31% of respondents were binge drinkers in the past month. Respondents who were male, 25 to 34 years old or in the top 40 percent household income bracket were more likely to have binged at least once in the past month. Two percent reported they had been a driver or a passenger in the past month when the driver perhaps had too much to drink. From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported binge drinking in the past month. From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported in the past month they were a driver or passenger when the driver perhaps had too much to drink. In 2012, 2% of respondents reported someone in their household experienced a legal, social, personal or physical problem in the past year in connection with drinking. Two percent of respondents reported someone in their household experienced a problem in connection with marijuana use. One percent of respondents reported a household problem with gambling while less than one percent of respondents each reported a household problem with the misuse of prescription drugs/over-the-counter drugs or with cocaine/heroin/other street drugs. From 2006 to 2012, there was a statistical decrease in the overall percent of respondents reporting they, or someone in their household, experienced some kind of problem, such as legal, social, personal or physical, in connection with drinking in the past year. In 2012, 7% of respondents reported someone made them afraid for their personal safety in the past year; respondents with some post high school education were more likely to report this. Four percent of respondents reported they had been pushed, kicked, slapped or hit in the past year; respondents who were male, 18 to 24 years old or unmarried were more likely to report this. A total of 9% reported at least one of these two situations; respondents who were 18 to 24 years old, 55 to 64 years old, with some post high school education or unmarried respondents were more likely to report this. From 2003 to 2012, there was no statistical change in the overall percent of respondents reporting they were afraid for their personal safety or they were pushed, kicked, slapped or hit. From 2003 to 2012, there was no statistical change in the overall percent of respondents reporting at least one of the two personal safety issues. Milwaukee County Community Health Survey Report

36 Children in Household In 2012, a random child was selected for the respondent to talk about the child s health issues. Eighty-nine percent of respondents reported they have one or more persons they think of as their child s personal doctor or nurse, with 93% reporting their child visited their personal doctor or nurse for preventive care during the past 12 months. Eight percent of respondents reported there was a time in the last 12 months their child did not receive the dental care needed. Two percent of respondents each reported their child did not receive the medical care needed or their child did not visit a specialist they needed to see in the past 12 months. Seventy-eight percent of respondents reported their 5 to 17 year old child ate two or more servings of fruit on an average day while 26% reported three or more servings of vegetables. Sixty-six percent of respondents reported their 5 to 17 year old child was physically active five times a week for 60 minutes. Eleven percent of respondents reported their child currently had asthma, with 40% of them having had an asthma attack in the past year. Eight percent of respondents with a child two years old or younger reported as an infant, their child slept in a bed with them or with another person. Seven percent of respondents reported their 8 to 17 year old child always or nearly always felt unhappy, sad or depressed in the past six months. Four percent of respondents reported their child was seldom or never safe in their community or neighborhood. Twenty-two percent reported their 8 to 17 year old child experienced some form of bullying in the past 12 months. Eighteen percent reported verbal bullying, 10% reported physical bullying and 2% reported cyber bullying. Community Health Issues In 2012, respondents were asked to pick the top three health issues in the area out of eight listed. The most often cited were alcohol or drug use (58%), violence (55%) and chronic diseases (52%). Respondents who were non-white and non-african American or married were more likely to report alcohol or drug use as a top community health issue. Respondents in the middle 20 percent household income bracket were more likely to report violence. Respondents who were white, non-hispanic, with a college education or in the top 40 percent household income bracket were more likely to report chronic diseases. Respondents who were female, 18 to 24 years old, non-white and non-african American, Hispanic, with a high school education or less or unmarried respondents were more likely to report teen pregnancy. Respondents who were 18 to 24 years old, African American, with some post high school education, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report infectious diseases as a top community health issue. Respondents who were 35 to 44 years old, non-hispanic or with a college education were more likely to report mental health or depression. Respondents who were female, 25 to 34 years old, 45 to 54 years old, white, with a college education, in the middle 20 percent household income bracket or married respondents were more likely to report infant mortality. Respondents who were Hispanic or with a high school education or less were more likely to report lead poisoning as a top community health issue. Milwaukee County Community Health Survey Report

37 Key Findings Rating Their Own Health (Figures 1 & 2; Table 2) KEY FINDINGS: In 2012, 52% of respondents reported their health as excellent or very good; 20% reported fair or poor. Respondents who were female, 45 to 64 years old, African American, with a high school education or less, in the bottom 40 percent household income bracket, who were unmarried, overweight, inactive or smokers were more likely to report fair or poor conditions. From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported their health as fair or poor. In 2010, 57% of Wisconsin respondents reported their health as excellent or very good while 14% reported fair or poor. Fifty-five percent of U.S. respondents reported their health as excellent or very good while 15% reported fair or poor (2010 Behavioral Risk Factor Surveillance) Findings Fifty-two percent of respondents said their own health, generally speaking, was either excellent (17%) or very good (35%). A total of 20% reported their health was fair or poor. Figure 1. Rate Own Health for 2012 Good 28% Fair 15% Poor 5% Very Good 35% Not Sure <1% Excellent 17% Female respondents were more likely to report their health was fair or poor (22%) compared to male respondents (18%). Thirty-one percent of respondents 55 to 64 years old and 29% of those 45 to 54 years old reported their health was fair or poor compared to 11% of respondents 25 to 34 years old. Thirty percent of African American respondents reported their health was fair or poor compared to 24% of those who were non-white and non-african American or 14% of white respondents. Twenty-eight percent of respondents with a high school education or less reported their health was fair or poor compared to 21% of those with some post high school education or 10% of respondents with a college education. Milwaukee County Community Health Survey Report

38 Thirty-two percent of respondents in the bottom 40 percent household income bracket reported their health was fair or poor compared to 10% of those in the middle 20 percent income bracket or 4% of respondents in the top 40 percent household income bracket. Unmarried respondents were more likely to report their health was fair or poor compared to married respondents (24% and 12%, respectively). Overweight respondents were more likely to report their health was fair or poor (22%) compared to respondents who were not overweight (15%). Thirty-seven percent of inactive respondents reported their health was fair or poor compared to 23% of those who did an insufficient amount of physical activity or 13% of respondents who met the recommended amount of physical activity. Smokers were more likely to report their health was fair or poor (29%) compared to nonsmokers (17%). Year Comparisons From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported fair or poor health. In 2006 and 2012, female respondents were more likely to report fair or poor health. In all other study years, gender was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of female respondents reporting fair or poor health. In 2003, respondents who were 65 and older were more likely to report fair or poor health. In 2006, respondents 55 and older were more likely to report fair or poor health. In 2009, respondents 45 and older were more likely to report fair or poor health. In 2012, respondents 45 to 64 years old were more likely to report fair or poor health. From 2003 to 2012, there was a noted decrease in the percent of respondents 18 to 24 years old and a noted increase in the percent of respondents 35 to 64 years old reporting fair or poor health. In 2003, respondents who were non-white and non-african American were more likely to report fair or poor health. In 2006 and 2012, African American respondents were more likely to report fair or poor health. In 2009, respondents who were non-white were more likely to report fair or poor. From 2003 to 2012, there was a noted increase in the percent of African American respondents reporting fair or poor health. In 2003, Hispanic respondents were more likely to report fair or poor health. In all other study years, Hispanic origin was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of Hispanic respondents and a noted increase in the percent of non-hispanic respondents reporting fair or poor health. In all study years, respondents with a high school education or less were more likely to report fair or poor health, with a noted increase in From 2003 to 2012, there was a noted increase in the percent of respondents with a college education reporting fair or poor health. In all study years, respondents in the bottom 40 percent household income bracket were more likely to report fair or poor health, with a noted increase in From 2003 to 2012, there was a noted decrease in the percent of respondents in the top 40 percent household income bracket reporting fair or poor health. In all study years, unmarried respondents were more likely to report fair or poor health, with a noted increase in Milwaukee County Community Health Survey Report

39 In all study years, overweight respondents were more likely to report fair or poor health. From 2003 to 2012, there was a noted increase in the percent of respondents who were not overweight reporting fair or poor health. In 2006, 2009 and 2012, inactive respondents were more likely to report fair or poor health. From 2006 to 2012, there was a noted increase in the percent of respondents who did an insufficient amount of physical activity reporting fair or poor health. In 2006, 2009 and 2012, smokers were more likely to report fair or poor health. In 2003, smoking status was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of smokers reporting fair or poor health. Milwaukee County Community Health Survey Report

40 Table 2. Fair or Poor Health by Demographic Variables for Each Survey Year, TOTAL a 16% 18% 18% 20% Gender 2,4 Male Female a Age 1,2,3,4 18 to 24 a to to 44 a to 54 a to 64 a and Older Race 1,2,3,4 White African American a Other Hispanic Origin 1 Hispanic a Non-Hispanic a Education 1,2,3,4 High School or Less a Some Post High School College Graduate a Household Income 1,2,3,4 Bottom 40 Percent Bracket a Middle 20 Percent Bracket Top 40 Percent Bracket a Marital Status 1,2,3,4 Married Not Married a Overweight Status 1,2,3,4 Not Overweight a Overweight Physical Activity 2,3,4 Inactive Insufficient b Recommended Smoking Status 2,3,4 Nonsmoker Smoker a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Physical activity was defined differently in demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 b year difference at p 0.05 from 2006 to 2012 Milwaukee County Community Health Survey Report

41 From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported their health as fair or poor. 100% Figure 2. Fair or Poor Health 80% 60% 40% 20% 16% 18% 18% 20% 0% Health Care Coverage (Figures 3 & 4; Tables 3-5) KEY FINDINGS: In 2012, 14% of respondents reported they were not currently covered by health care insurance; respondents who were male, 18 to 24 years old, non-white, Hispanic, with a high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. Nineteen percent of respondents reported they personally did not have health care coverage at least part of the time in the past 12 months; respondents who were male, 18 to 24 years old, non-white, Hispanic, with a high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. Twenty-one percent of respondents reported someone in their household was not covered at least part of the time in the past 12 months; respondents who were in the bottom 40 percent household income bracket or unmarried were more likely to report this. From 2003 to 2012, the overall percent statistically increased for respondents 18 and older as well as for respondents 18 to 64 years old who reported no current personal health care insurance. From 2009 to 2012, the overall percent statistically decreased for respondents who reported no personal health care insurance at least part of the time in the past 12 months. From 2003 to 2012, the overall percent statistically remained the same for respondents who reported someone in the household was not covered at least part of the time in the past 12 months. Milwaukee County Community Health Survey Report

42 Personally Not Covered Currently The Healthy People 2020 goal for all persons having medical insurance is 100%. (Objective AHS-1.1) In 2010, 11% of Wisconsin respondents 18 and older reported they personally did not have health care coverage. Fifteen percent of U.S. respondents reported this. Thirteen percent of Wisconsin respondents 18 to 64 years old did not have health care coverage while 18% of U.S. respondents 18 to 64 years old reported this (2010 Behavioral Risk Factor Surveillance) Findings Fourteen percent of respondents reported they were not currently covered by any health care insurance. Fortyfour percent reported they were covered by an employer sponsored insurance plan. Six percent reported private insurance bought directly from an insurance agent/company. Seventeen percent reported Medicaid, including medical assistance, Title 19 or Badger Care, while 18% reported Medicare. Figure 3. Type of Health Care Coverage for 2012 Private Insurance 6% Employer Insurance Plan 44% Medicaid 17% Medicare 18% None 14% Something Else <1% Not Sure 2% Male respondents were more likely to report no current personal health insurance (18%) compared to female respondents (11%). Respondents 18 to 24 years old were more likely to report no personal health care insurance (30%) compared to those 35 to 44 years old (6%) or respondents 65 and older (less than one percent). Twenty percent of African American respondents and 18% of respondents who were non-white and non- African American reported no health insurance compared to 9% of white respondents. Hispanic respondents were more likely to report no health insurance compared to non-hispanic respondents (20% and 13%, respectively). Twenty-two percent of respondents with a high school education or less reported no health insurance compared to 13% of those with some post high school education or 5% of respondents with a college education. Twenty-one percent of respondents in the bottom 40 percent household income bracket reported no health insurance compared to 4% of those in the middle 20 percent income bracket or 3% of respondents in the top 40 percent household income bracket. Milwaukee County Community Health Survey Report

43 Unmarried respondents were more likely to report no health insurance compared to married respondents (18% and 7%, respectively). Year Comparisons From 2003 to 2012, the overall percent statistically increased for respondents 18 and older as well as for respondents 18 to 64 years old who reported no current personal health care insurance. In all study years, male respondents were more likely to report no health insurance. From 2003 to 2012, there was a noted increase in the percent of respondents across gender reporting no health insurance. In 2003, respondents 45 to 54 years old were more likely to report no health insurance. In 2006, 2009 and 2012, respondents 18 to 24 years old were more likely to report no health insurance. From 2003 to 2012, there was a noted increase in the percent of respondents 18 to 34 years old reporting no health insurance. In 2003, African American respondents were more likely to report no health insurance. In 2006 and 2009, respondents who were non-white and non-african American were more likely to report no health insurance. In 2012, non-white respondents were more likely to report no health insurance. From 2003 to 2012, there was a noted increase in the percent of respondents across race reporting no health insurance. In 2006, 2009 and 2012, Hispanic respondents were more likely to report no health insurance. In 2003, Hispanic origin was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents across Hispanic origin reporting no health insurance. In all study years, respondents with a high school education or less were more likely to report no health insurance. From 2003 to 2012, there was a noted increase in the percent of respondents with some post high school education or less reporting no health insurance. In all study years, respondents in the bottom 40 percent household income bracket were more likely to report no health insurance, with a noted increase in In all study years, unmarried respondents were more likely to report no health insurance. From 2003 to 2012, there was a noted increase in the percent of respondents across marital status reporting no health insurance. Milwaukee County Community Health Survey Report

44 Table 3. Personally No Health Care Coverage by Demographic Variables for Each Survey Year TOTAL All Respondents a 8% 11% 12% 14% Respondents 18 to 64 Years Old a Gender 1,2,3,4 Male a Female a Age 1,2,3,4 18 to 24 a to 34 a to to to and Older 2 <1 <1 <1 Race 1,2,3,4 White a African American a Other a Hispanic Origin 2,3,4 Hispanic a Non-Hispanic a Education 1,2,3,4 High School or Less a Some Post High School a College Graduate Household Income 1,2,3,4 Bottom 40 Percent Bracket a Middle 20 Percent Bracket Top 40 Percent Bracket Marital Status 1,2,3,4 Married a Not Married a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

45 Personally Not Covered in the Past 12 Months 2012 Findings Nineteen percent of respondents reported they were not covered by health insurance at least part of the time in the past 12 months. Male respondents were more likely to report they were not covered at least part of the year (22%) compared to female respondents (15%). Forty percent of respondents 18 to 24 years old reported they were not covered compared to 12% of those 35 to 44 years old or 2% of respondents 65 and older. Twenty-six percent of non-white respondents reported they were not covered compared to 13% of white respondents. Hispanic respondents were more likely to report they were not covered compared to non-hispanic respondents (32% and 17%, respectively). Twenty-eight percent of respondents with a high school education or less reported they were not covered at least part of the year compared to 19% of those with some post high school education or 8% of respondents with a college education. Twenty-seven percent of respondents in the bottom 40 percent household income bracket reported they were not covered compared to 10% of those in the middle 20 percent income bracket or 5% of respondents in the top 40 percent household income bracket. Unmarried respondents were more likely to report they were not covered compared to married respondents (23% and 12%, respectively). Year Comparisons From 2009 to 2012, the overall percent statistically decreased for respondents who reported no personal health care insurance at least part of the time in the past 12 months. In both study years, male respondents were more likely to report no coverage, with a noted decrease in In 2009, respondents 18 to 34 years old were more likely to report no coverage. In 2012, respondents 18 to 24 years old were more likely to report no coverage. From 2009 to 2012, there was a noted decrease in the percent of respondents 25 to 44 years old reporting no coverage. In 2009, respondents who were non-white and non-african American were more likely to report no coverage. In 2012, respondents who were non-white were more likely to report no coverage. From 2009 to 2012, there was a noted decrease in the percent of respondents who were non-white and non-african American reporting no coverage. In both study years, Hispanic respondents were more likely to report no coverage. From 2009 to 2012, there was a noted decrease in the percent of non-hispanic respondents reporting no coverage. Milwaukee County Community Health Survey Report

46 In both study years, respondents with a high school education or less were more likely to report no coverage. From 2009 to 2012, there was a noted decrease in the percent of respondents with a college education reporting no coverage. In both study years, respondents in the bottom 40 percent household income bracket were more likely to report no coverage. In both study years, unmarried respondents were more likely to report no coverage, with a noted decrease in Milwaukee County Community Health Survey Report

47 Table 4. Personally Not Covered by Health Insurance in Past 12 Months by Demographic Variables for Each Survey Year TOTAL a 21% 19% Gender 1,2 Male a Female Age 1,2 18 to to 34 a to 44 a to to and Older 3 2 Race 1,2 White African American Other a Hispanic Origin 1,2 Hispanic Non-Hispanic a Education 1,2 High School or Less Some Post High School College Graduate a 12 8 Household Income 1,2 Bottom 40 Percent Bracket Middle 20 Percent Bracket Top 40 Percent Bracket 5 5 Marital Status 1,2 Married Not Married a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2009 to 2012 Someone in Household Not Covered in the Past 12 Months 2012 Findings Twenty-one percent of all respondents indicated someone in their household was not covered by insurance at least part of the time in the past 12 months. Milwaukee County Community Health Survey Report

48 Thirty-one percent of respondents in the bottom 40 percent household income bracket reported someone in their household was not covered in the past 12 months compared to 13% of those in the middle 20 percent income bracket or 5% of respondents in the top 40 percent household income bracket. Unmarried respondents were more likely to report someone in their household was not covered in the past 12 months compared to married respondents (25% and 14%, respectively). Year Comparisons From 2003 to 2012, the overall percent statistically remained the same for respondents who reported someone in their household was not covered at least part of the time in the past 12 months. In all study years, respondents in the bottom 40 percent household income bracket were more likely to report someone in their household was not covered in the past 12 months. From 2003 to 2012, there was a noted decrease in the percent of respondents in the top 60 percent household income bracket reporting someone in their household was not covered in the past 12 months. In all study years, unmarried respondents were more likely to report someone in their household was not covered in the past 12 months, with a noted decrease in Table 5. Someone in Household Not Covered by Health Insurance in Past 12 Months by Demographic Variables for Each Survey Year TOTAL 23% 26% 25% 21% Household Income 1,2,3,4 Bottom 40 Percent Bracket Middle 20 Percent Bracket a Top 40 Percent Bracket a Marital Status 1,2,3,4 Married Not Married a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

49 Health Care Coverage Overall Year Comparisons From 2003 to 2012, the overall percent statistically increased for respondents 18 and older as well as for respondents 18 to 64 years old who reported no current personal health care insurance. From 2009 to 2012, the overall percent statistically decreased for respondents who reported no personal health care insurance at least part of the time in the past 12 months. From 2003 to 2012, the overall percent statistically remained the same for respondents who reported someone in the household was not covered at least part of the time in the past 12 months. 100% 80% 60% Figure 4. Health Care Coverage Someone in HH not covered in past 12 months Personally not currently covered (18 and older) 40% 26% 25% 23% 21% 20% 21% 13% 15% 19% 9% 16% 14% 11% 12% 8% 0% Personally not currently covered (18 to 64 years old) Personally not covered in past 12 months (18 and older) Milwaukee County Community Health Survey Report

50 Health Care Needed (Tables 6 & 7) KEY FINDINGS: In 2012, 11% of respondents reported that someone in their household had not taken their prescribed medication due to prescription costs in the past 12 months; respondents in the bottom 40 percent household income bracket were more likely to report this. Nineteen percent of respondents reported they did not get the dental care needed in the last 12 months; respondents who were 18 to 24 years old, African American, with some post high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. Eleven percent of respondents reported they did not get the medical care needed in the last 12 months; respondents who were 18 to 24 years old, 45 to 64 years old, African American, with a high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. Four percent of respondents reported they did not get the mental health care needed in the last 12 months; respondents who were 45 to 54 years old, non-white and non-african American, Hispanic, with some post high school education or in the bottom 40 percent household income bracket were more likely to report this. Prescription Medications Not Taken Due to Cost 2012 Findings Eleven percent of respondents reported that someone in their household had not taken their prescribed medication due to prescription costs in the past 12 months. Fifteen percent of respondents in the bottom 40 percent household income bracket reported someone not taking prescribed medication due to prescription costs compared to 12% of those in the middle 20 percent income bracket or 6% of respondents in the top 40 percent household income bracket. Table 6. Prescription Medications Not Taken Due to Cost in Past 12 Months by Demographic Variables for TOTAL 11% Household Income 1 Bottom 40 Percent Bracket 15 Middle 20 Percent Bracket 12 Top 40 Percent Bracket 6 Marital Status Married 10 Not Married 12 Children in Household Yes 12 No 11 Percentages occasionally may differ by 1 or 2 percentage points from the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2012 Milwaukee County Community Health Survey Report

51 Unmet Health Care 2012 Findings Nineteen percent of respondents reported there was a time in the last 12 months they did not receive the dental care needed while 11% did not get the medical care needed and 4% reported they did not receive the mental health care needed. Respondents 18 to 24 years old were more likely to report they did not receive the dental care needed while respondents who were 18 to 24 years old or 45 to 64 years old were more likely to report they did not receive the medical care needed. Respondents 45 to 54 years old were more likely to report they did not receive the mental health care needed compared to their counterparts. African American respondents were more likely to report they did not receive the dental care needed or medical care needed compared to their counterparts. Respondents who were non-white and non-african American were more likely to report they did not receive the mental health care needed. Hispanic respondents were more likely to report they did not receive the mental health care needed compared to non-hispanic respondents. Respondents with some post high school education or less were more likely to report they did not receive the dental care needed while respondents with a high school education or less were more likely to report they did not receive the medical care needed. Respondents with some post high school education were more likely to report they did not receive the mental health care needed in the past 12 months compared to their counterparts. Respondents in the bottom 40 percent household income bracket were more likely to report they did not receive the dental care, medical care or mental health care needed compared to their counterparts. Unmarried respondents were more likely to report they did not receive the dental care or medical care needed compared to married respondents. o Being uninsured, the inability to pay, poor care and insurance did not cover it were the most often mentioned reasons for unmet care. Milwaukee County Community Health Survey Report

52 Table 7. Unmet Health Care in Past 12 Months by Demographic Variables for 2012 Mental Dental Care Medical Care Health Care TOTAL 19% 11% 4% Gender Male Female Age 18 to 24 25* 16* 5* 25 to 34 21* 8* 4* 35 to 44 15* 9* 4* 45 to 54 17* 15* 8* 55 to 64 22* 14* 5* 65 and Older 12* 5* 1* Race White 14* 8* 3* African American 26* 16* 5* Other 20* 12* 8* Hispanic Origin Hispanic * Non-Hispanic * Education High School or Less 21* 14* 5* Some Post High School 21* 11* 6* College Graduate 12* 8* 3* Household Income Bottom 40 Percent Bracket 26* 17* 7* Middle 20 Percent Bracket 12* 7* <1* Top 40 Percent Bracket 8* 4* 2* Marital Status Married 14* 7* 3 Not Married 21* 13* 5 Percentages occasionally may differ by 1 or 2 percentage points from the Appendix as a result of rounding, recoding variables and response category distribution. *demographic difference at p 0.05 in 2012 Milwaukee County Community Health Survey Report

53 Health Information and Services (Figure 5; Tables 8-10) KEY FINDINGS: In 2012, 45% of respondents reported they receive most of their health information from a doctor while 28% reported the internet. Seventy percent of respondents reported their primary place for health services was from a doctor s or nurse practitioner s office; respondents who were female, 65 and older, white, non-hispanic, with a college education, in the top 40 percent household income bracket or married respondents were more likely to report this. Twenty-nine percent of respondents had an advance care plan; respondents who were 65 and older, white, non-hispanic, with a college education, in the top 40 percent household income bracket or married respondents were more likely to report an advance care plan. Health Information Source 2012 Findings From 2006 to 2012, there was a statistical decrease in the overall percent of respondents reporting their primary place for health services was from a doctor s or nurse practitioner s office. From 2003 to 2012, there was no statistical change in the overall percent of respondents having an advance care plan. Forty-five percent of respondents reported they receive most of their health information from a doctor while 28% reported the internet, 6% reported other health professional and 5% reported family/friends. Female respondents were more likely to report a doctor as their primary source compared to male respondents. Male respondents were more likely to be split between the doctor and the internet as their primary source of health information. Respondents 65 and older were more likely to report doctor as their primary source. Respondents 25 to 34 years old were more likely to report the internet compared to their counterparts. Respondents with a college education were more likely to be split between the doctor and the internet as their primary source of health information compared to respondents with some post high school education or less. Respondents in the top 60 percent household income bracket were more likely to be split between the doctor and the internet as their primary source of health information compared to respondents in the bottom 40 percent household income bracket. Milwaukee County Community Health Survey Report

54 Table 8. Health Information Source by Demographic Variables for 2012 Doctor Internet TOTAL 45% 28% Gender 1 Male Female Age 1 18 to to to to to and Older 59 9 Race White African American Other Hispanic Origin Hispanic Non-Hispanic Education 1 High School or Less Some Post High School College Graduate Household Income 1 Bottom 40 Percent Bracket Middle 20 Percent Bracket Top 40 Percent Bracket Marital Status Married Not Married Percentages occasionally may differ by 1 or 2 percentage points from the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2012 Milwaukee County Community Health Survey Report

55 Primary Health Care Services 2012 Findings Seventy percent of respondents reported they go to a doctor s or nurse practitioner s office when they are sick or need health advice. Seven percent of respondents each reported hospital emergency room or urgent care center while 6% reported public health clinic/community health center. Six percent reported no usual place. Female respondents were more likely to report a doctor s or nurse practitioner s office (75%) compared to male respondents (65%). Eighty-seven percent of respondents 65 and older reported a doctor s or nurse practitioner s office compared to 62% of those 25 to 34 years old or 49% of respondents 18 to 24 years old. White respondents were more likely to report a doctor s or nurse practitioner s office (79%) compared to African American respondents (60%) or respondents of another race (57%). Non-Hispanic respondents were more likely to report a doctor s or nurse practitioner s office compared to Hispanic respondents (72% and 57%, respectively). Seventy-nine percent of respondents with a college education reported a doctor s or nurse practitioner s office as their primary place for health services compared to 70% of those with some post high school education or 64% of respondents with a high school education or less. Eighty-three percent of respondents in the top 40 percent household income bracket reported a doctor s or nurse practitioner s office compared to 75% of those in the middle 20 percent income bracket or 62% of respondents in the bottom 40 percent household income bracket. Married respondents were more likely to report a doctor s or nurse practitioner s office compared to unmarried respondents (80% and 65%, respectively). Year Comparisons From 2006 to 2012, there was a statistical decrease in the overall percent of respondents reporting their primary place for health services was from a doctor s or nurse practitioner s office. In all study years, female respondents were more likely to report a doctor s or nurse practitioner s office. From 2006 to 2012, there was a noted decrease in the percent of respondents across gender reporting a doctor s or nurse practitioner s office as their primary place for health services. In all study years, respondents 65 and older were more likely to report a doctor s or nurse practitioner s office. From 2006 to 2012, there was a noted decrease in the percent of respondents who were 18 to 34 years old or 45 to 64 years old reporting a doctor s or nurse practitioner s office. In all study years, white respondents were more likely to report a doctor s or nurse practitioner s office, with a noted decrease in In all study years, non-hispanic respondents were more likely to report a doctor s or nurse practitioner s office. From 2006 to 2012, there was a noted decrease in the percent of respondents across Hispanic origin reporting a doctor s or nurse practitioner s office. Milwaukee County Community Health Survey Report

56 In all study years, respondents with a college education were more likely to report a doctor s or nurse practitioner s office. From 2006 to 2012, there was a noted decrease in the percent of respondents across education reporting a doctor s or nurse practitioner s office. In 2006, respondents in the top 60 percent household income bracket were more likely to report a doctor s or nurse practitioner s office. In 2009 and 2012, respondents in the top 40 percent household income bracket were more likely to report a doctor s or nurse practitioner s office. From 2006 to 2012, there was a noted decrease in the percent of respondents in the bottom 60 percent household income bracket reporting a doctor s or nurse practitioner s office. In all study years, married respondents were more likely to report a doctor s or nurse practitioner s office. From 2006 to 2012, there was a noted decrease in the percent of respondents across gender reporting a doctor s or nurse practitioner s office. Milwaukee County Community Health Survey Report

57 Table 9. Doctor s or Nurse Practitioner s Office as Primary Health Care Service by Demographic Variables for Each Survey Year TOTAL a 77% 73% 70% Gender 1,2,3 Male a Female a Age 1,2,3 18 to 24 a to 34 a to to 54 a to 64 a and Older Race 1,2,3 White a African American Other Hispanic Origin 1,2,3 Hispanic a Non-Hispanic a Education 1,2,3 High School or Less a Some Post High School a College Graduate a Household Income 1,2,3 Bottom 40 Percent Bracket a Middle 20 Percent Bracket a Top 40 Percent Bracket Marital Status 1,2,3 Married a Not Married a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2006; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2006 to 2012 Advance Care Plan 2012 Findings Twenty-nine percent of respondents reported they had an advance care plan, living will or health care power of attorney stating their end of life health care wishes. Milwaukee County Community Health Survey Report

58 Sixty-six percent of respondents 65 and older reported they had an advance care plan compared to 17% of those 25 to 34 years old or 7% of respondents 18 to 24 years old. White respondents were more likely to report they had an advance care plan (35%) compared to African American respondents (22%) or respondents of another race (17%). Non-Hispanic respondents were more likely to report they had an advance care plan compared to Hispanic respondents (31% and 12%, respectively). Thirty-five percent of respondents with a college education reported they had an advance care plan compared to 29% of those with some post high school education or 25% of respondents with a high school education or less. Thirty-seven percent of respondents in the top 40 percent household income bracket reported they had an advance care plan compared to 26% of those in the middle 20 percent income bracket or 24% of respondents in the bottom 40 percent household income bracket. Married respondents were more likely to report they had an advance care plan compared to unmarried respondents (35% and 26%, respectively). Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents having an advance care plan. In 2003, female respondents were more likely to report having an advance care plan. In all other study years, gender was not a significant variable. In all study years, respondents 65 and older were more likely to report having an advance care plan, with a noted increase in In all study years, white respondents were more likely to report having an advance care plan, with a noted increase in In all study years, non-hispanic respondents were more likely to report having an advance care plan, with a noted increase in In 2006, 2009 and 2012, respondents with a college education were more likely to report having an advance care plan. In 2003, education was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents with a college education reporting they had an advance care plan. In 2006 and 2009, respondents in the top 60 percent household income bracket were more likely to report having an advance care plan. In 2012, respondents in the top 40 percent household income bracket were more likely to report having an advance care plan, with a noted increase since In 2003, household income was not a significant variable. In 2006, 2009 and 2012, married respondents were more likely to report having an advance care plan. In 2003, marital status was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of married respondents reporting they had an advance care plan. Milwaukee County Community Health Survey Report

59 Table 10. Advance Care Plan by Demographic Variables for Each Survey Year, TOTAL 27% 32% 31% 29% Gender 1 Male Female Age 1,2,3,4 18 to to to to to and Older a Race 1,2,3,4 White a African American Other Hispanic Origin 1,2,3,4 Hispanic Non-Hispanic a Education 2,3,4 High School or Less Some Post High School College Graduate a Household Income 2,3,4 Bottom 40 Percent Bracket Middle 20 Percent Bracket Top 40 Percent Bracket a Marital Status 2,3,4 Married a Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. In 2006, living will or health care power of attorney was added. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

60 Health Information and Services Overall Year Comparisons From 2006 to 2012, there was a statistical decrease in the overall percent of respondents reporting their primary place for health services was from a doctor s or nurse practitioner s office. From 2003 to 2012, there was no statistical change in the overall percent of respondents having an advance care plan. 100% Figure 5. Health Information and Services 80% 60% 77% 73% 70% Doctor/Nurse Practioner Office as Primary Health Care Service Advance Care Plan* 40% 20% 27% 32% 31% 45% 29% 28% Doctor as Primary Source for Health Information Internet as Primary Source for Health Information 0% *In 2006, living will or health care power of attorney was added. Routine Procedures (Figure 6; Tables 11-14) KEY FINDINGS: In 2012, 83% of respondents reported a routine medical checkup two years ago or less while 72% reported a cholesterol test four years ago or less. Fifty-six percent of respondents reported a visit to the dentist in the past year while 42% reported an eye exam in the past year. Respondents who were female, 65 and older, African American or non-hispanic were more likely to report a routine checkup two years ago or less. Respondents who were 65 and older, white, non-hispanic, with a college education, in the top 40 percent household income bracket or married respondents were more likely to report a cholesterol test four years ago or less. Respondents who were female, 45 to 54 years old, white, non-hispanic, with a college education, in the top 40 percent household income bracket or married respondents were more likely to report a dental checkup in the past year. Respondents who were 65 and older, non- Hispanic, with at least some post high school education or married were more likely to report an eye exam in the past year. From 2003 to 2012, there was a statistical decrease in the overall percent of respondents reporting a routine checkup two years ago or less, a dental checkup in the past year or an eye exam in the past year. From 2003 to 2012, there was no statistical change in the overall percent of respondents reporting a cholesterol test four years ago or less. Milwaukee County Community Health Survey Report

61 Routine Checkup In 2000, 65% of Wisconsin respondents reported in the past year they had a routine checkup, 14% reported past two years, 9% past five years and 11% five or more years ago. Nationally, 72% reported past year, 12% past two years, 7% past five years and 8% five or more years ago (2000 Behavioral Risk Factor Surveillance) Findings Eighty-three percent of respondents reported they had a routine checkup in the past two years. Female respondents were more likely to report a routine checkup in the past two years (88%) compared to male respondents (78%). Ninety-two percent of respondents 65 and older reported a routine checkup in the past two years compared to 79% of those 18 to 24 years old or 76% of respondents 25 to 34 years old. African American respondents were more likely to report a routine checkup in the past two years (90%) compared to white respondents (81%) or respondents of another race (79%). Non-Hispanic respondents were more likely to report a routine checkup in the past two years compared to Hispanic respondents (84% and 78%, respectively). Year Comparisons From 2003 to 2012, there was a statistical decrease in the overall percent of respondents reporting a routine checkup two years ago or less. In all study years, female respondents were more likely to report a routine checkup two years ago or less. From 2003 to 2012, there was a noted decrease in the percent of respondents across gender reporting a routine checkup two years ago or less. In 2003, respondents who were 18 to 24 years old or 65 and older were more likely to report a routine checkup two years ago or less. In 2006, 2009 and 2012, respondents 65 and older were more likely to report a routine checkup two years ago or less. From 2003 to 2012, there was a noted decrease in the percent of respondents 18 to 34 years old reporting a routine checkup two years ago or less. In all study years, African American respondents were more likely to report a routine checkup two years ago or less. From 2003 to 2012, there was a noted decrease in the percent of white respondents reporting a routine checkup two years ago or less. In 2009 and 2012, non-hispanic respondents were more likely to report a routine checkup two years ago or less. In all other study years, Hispanic origin was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents across Hispanic origin reporting a routine checkup two years ago or less. Education was not a significant variable in any study year. From 2003 to 2012, there was a noted decrease in the percent of respondents with a high school education or less reporting a routine checkup two years ago or less. Household income was not a significant variable in any study year. From 2003 to 2012, there was a noted decrease in the percent of respondents in the bottom 40 percent household income bracket reporting a routine checkup two years ago or less. Milwaukee County Community Health Survey Report

62 Marital status was not a significant variable in any study year. From 2003 to 2012, there was a noted decrease in the percent of respondents across marital status reporting a routine checkup two years ago or less. Table 11. Routine Checkup Two Years Ago or Less by Demographic Variables for Each Survey Year TOTAL a 87% 85% 85% 83% Gender 1,2,3,4 Male a Female a Age 1,2,3,4 18 to 24 a to 34 a to to to and Older Race 1,2,3,4 White a African American Other Hispanic Origin 3,4 Hispanic a Non-Hispanic a Education High School or Less a Some Post High School College Graduate Household Income Bottom 40 Percent Bracket a Middle 20 Percent Bracket Top 40 Percent Bracket Marital Status Married a Not Married a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

63 Cholesterol Test The Healthy People 2020 goal for blood cholesterol screening within the preceding five years is 82%. (Objective HDS-6) In 2010, 77% of Wisconsin respondents and 77% of U.S. respondents reported they had their cholesterol checked within the past five years (2010 Behavioral Risk Factor Surveillance) Findings Seventy-two percent of respondents reported having their cholesterol tested four years ago or less. Four percent reported five or more years ago while 17% reported never having their cholesterol tested. Ninety percent of respondents 65 and older reported a cholesterol test four years ago or less compared to 60% of those 25 to 34 years old or 34% of respondents 18 to 24 years old. Seventy-eight percent of white respondents reported a cholesterol test four year ago or less compared to 70% of African American respondents or 52% of respondents of another race. Non-Hispanic respondents were more likely to report a cholesterol test four years ago or less compared to Hispanic respondents (74% and 55%, respectively). Eighty percent of respondents with a college education reported a cholesterol test four years ago or less compared to 72% of those with some post high school education or 67% of respondents with a high school education or less. Eighty-two percent of respondents in the top 40 percent household income bracket reported a cholesterol test four years ago or less compared to 79% of those in the middle 20 percent income bracket or 67% of respondents in the bottom 40 percent household income bracket. Married respondents were more likely to report a cholesterol test four years ago or less compared to unmarried respondents (81% and 68%, respectively). Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported a cholesterol test four years ago or less. In 2006 and 2009, female respondents were more likely to report a cholesterol test four years ago or less. In all other study years, gender was not a significant variable. In 2003, 2006 and 2009, respondents 55 and older were more likely to report a cholesterol test four years ago or less. In 2012, respondents 65 and older were more likely to report a cholesterol test four years ago or less. From 2003 to 2012, there was a noted decrease in the percent of respondents 18 to 24 years old reporting a cholesterol test four years ago or less. In all study years, white respondents were more likely to report a cholesterol test four years ago or less. In all study years, non-hispanic respondents were more likely to report a cholesterol test four years ago or less. Milwaukee County Community Health Survey Report

64 In all study years, respondents with a college education were more likely to report a cholesterol test four years ago or less. In 2003, 2009 and 2012, respondents in the top 40 percent household income bracket were more likely to report a cholesterol test four years ago or less. In 2006, respondents in the top 60 percent household income bracket were more likely to report a cholesterol test four years ago or less. In all study years, married respondents were more likely to report a cholesterol test four years ago or less. Table 12. Cholesterol Test Four Years Ago or Less by Demographic Variables for Each Survey Year TOTAL 74% 73% 75% 72% Gender 2,3 Male Female Age 1,2,3,4 18 to 24 a to to to to and Older Race 1,2,3,4 White African American Other Hispanic Origin 1,2,3,4 Hispanic Non-Hispanic Education 1,2,3,4 High School or Less Some Post High School College Graduate Household Income 1,2,3,4 Bottom 40 Percent Bracket Middle 20 Percent Bracket Top 40 Percent Bracket Marital Status 1,2,3,4 Married Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

65 Dental Checkup Counseling patients to visit a dental care provider on a regular basis as well as floss, use fluoride properly, et cetera is recommended. 1 The Healthy People 2020 goal for an oral health care system visit in the past 12 months is 49%. (Objective OH-7) In 2010, 75% of Wisconsin respondents and 70% of U.S. respondents reported they visited the dentist or dental clinic within the past year for any reason (2010 Behavioral Risk Factor Surveillance) Findings Fifty-six percent of respondents reported a dental visit in the past year. An additional 22% had a visit in the past one to two years. Female respondents were more likely to report a dental checkup in the past year (59%) compared to male respondents (53%). Sixty-six percent of respondents 45 to 54 years old reported a dental checkup in the past year compared to 46% of those 25 to 34 years old or 41% of respondents 18 to 24 years old. Sixty-two percent of white respondents reported a dental checkup in the past year compared to 51% of respondents who were non-white and non-african American or 46% of African American respondents. Non-Hispanic respondents were more likely to report a dental checkup in the past year compared to Hispanic respondents (57% and 48%, respectively). Seventy-one percent of respondents with a college education reported a dental checkup in the past year compared to 53% of those with some post high school education or 46% of respondents with a high school education or less. Seventy-eight percent of respondents in the top 40 percent household income bracket reported a dental checkup in the past year compared to 62% of those in the middle 20 percent income bracket or 44% of respondents in the bottom 40 percent household income bracket. Married respondents were more likely to report a dental checkup in the past year compared to unmarried respondents (67% and 50%, respectively). Year Comparisons From 2003 to 2012, there was a statistical decrease in the overall percent of respondents who reported having a dental checkup in the past year. In 2006, 2009 and 2012, female respondents were more likely to report a dental checkup. In 2003, gender was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents across gender reporting a dental checkup. 1 Chapter 61: Counseling to Prevent Dental and Periodontal Diseases. U.S. Preventive Services Task Force: Guide to Clinical Preventive Services. 2 nd ed. Baltimore: Williams & Wilkins, Page 711. Milwaukee County Community Health Survey Report

66 In 2003, respondents who were 18 to 24 years old or 35 to 44 years old were more likely to report a dental checkup. In 2006, respondents 35 to 64 years old were more likely to report a dental checkup. In 2009, respondents 35 to 54 years old were more likely to report a dental checkup. In 2012, respondents 45 to 54 years old were more likely to report a dental checkup. From 2003 to 2012, there was a noted decrease in the percent of respondents 18 to 44 years old reporting a dental checkup. In all study years, white respondents were more likely to report a dental checkup. From 2003 to 2012, there was a noted decrease in the percent of respondents across race reporting a dental checkup. In 2006, 2009 and 2012, non-hispanic respondents were more likely to report a dental checkup. In 2003, Hispanic origin was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents across Hispanic origin reporting a dental checkup. In all study years, respondents with a college education were more likely to report a dental checkup. From 2003 to 2012, there was a noted decrease in the percent of respondents across education reporting a dental checkup. In all study years, respondents in the top 40 percent household income bracket were more likely to report a dental checkup. From 2003 to 2012, there was a noted decrease in the percent of respondents in the bottom 60 percent household income bracket reporting a dental checkup. In all study years, married respondents were more likely to report a dental checkup. From 2003 to 2012, there was a noted decrease in the percent of respondents across marital status reporting a dental checkup. Milwaukee County Community Health Survey Report

67 Table 13. Dental Checkup Less than One Year Ago by Demographic Variables for Each Survey Year TOTAL a 68% 63% 60% 56% Gender 2,3,4 Male a Female a Age 1,2,3,4 18 to 24 a to 34 a to 44 a to to and Older Race 1,2,3,4 White a African American a Other a Hispanic Origin 2,3,4 Hispanic a Non-Hispanic a Education 1,2,3,4 High School or Less a Some Post High School a College Graduate a Household Income 1,2,3,4 Bottom 40 Percent Bracket a Middle 20 Percent Bracket a Top 40 Percent Bracket Marital Status 1,2,3,4 Married a Not Married a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

68 Eye Exam 2012 Findings Forty-two percent of respondents had an eye exam in the past year while 29% reported one to two years ago. Respondents 65 and older were more likely to report an eye exam in the past year (61%) compared to those 18 to 24 years old (34%) or respondents 25 to 34 years old (33%). Non-Hispanic respondents were more likely to report an eye exam in the past year compared to Hispanic respondents (43% and 35%, respectively). Forty-five percent of respondents with at least some post high school education reported an eye exam in the past year compared to 38% of respondents with a high school education or less. Married respondents were more likely to report an eye exam in the past year compared to unmarried respondents (46% and 40%, respectively). Year Comparisons From 2003 to 2012, there was a statistical decrease in the overall percent of respondents who reported an eye exam less than a year ago. In 2003, 2006 and 2009, female respondents were more likely to report an eye exam less than a year ago. In 2012, gender was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents across gender reporting an eye exam less than a year ago. In all study years, respondents 65 and older were more likely to report an eye exam less than a year ago, with a noted decrease in From 2003 to 2012, there was a noted decrease in the percent of respondents 25 to 54 years old reporting an eye exam less than a year ago. In 2009, white respondents were more likely to report an eye exam less than a year ago. In all other study years, race was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents who were white or African American reporting an eye exam less than a year ago. In 2003, 2009 and 2012, non-hispanic respondents were more likely to report an eye exam. In 2006, Hispanic origin was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of non- Hispanic respondents reporting an eye exam less than a year ago. In 2006, respondents with some post high school education were more likely to report an eye exam less than a year ago. In 2009, respondents with a college education were more likely to report an eye exam less than a year ago. In 2012, respondents with at least some post high school education were more likely to report an eye exam less than a year ago. In 2003, education was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents with a high school education or less or with a college education reporting an eye exam less than a year ago. In 2009, respondents in the top 40 percent household income bracket were more likely to report an eye exam less than a year ago. In all other study years, household income was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents in the bottom 60 percent household income bracket reporting an eye exam less than a year ago. Milwaukee County Community Health Survey Report

69 In 2012, married respondents were more likely report an eye exam less than a year ago. In all other study years, marital status was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents across marital status reporting an eye exam less than a year ago. Table 14. Eye Exam Less than One Year Ago by Demographic Variables for Each Survey Year TOTAL a 51% 44% 42% 42% Gender 1,2,3 Male a Female a Age 1,2,3,4 18 to to 34 a to 44 a to 54 a to and Older a Race 3 White a African American a Other Hispanic Origin 1,3,4 Hispanic Non-Hispanic a Education 2,3,4 High School or Less a Some Post High School College Graduate a Household Income 3 Bottom 40 Percent Bracket a Middle 20 Percent Bracket a Top 40 Percent Bracket Marital Status 4 Married a Not Married a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

70 Routine Procedures Overall Year Comparisons From 2003 to 2012, there was a statistical decrease in the overall percent of respondents reporting a routine checkup two years ago or less, a dental checkup in the past year or an eye exam in the past year. From 2003 to 2012, there was no statistical change in the overall percent of respondents reporting a cholesterol test four years ago or less. 100% 80% 60% 40% 20% Figure 6. Routine Procedures 87% 85% 85% 83% 74% 68% 73% 75% 72% 63% 60% 56% 51% 44% 42% 42% Routine checkup (2 yrs. ago or less) Cholesterol test (4 yrs. ago or less) Dental checkup (less than 1 yr. ago) Eye exam (less than 1 yr. ago) 0% Vaccinations (Figure 7; Table 15 & 16) KEY FINDINGS: In 2012, 38% of respondents had a flu vaccination in the past year. Respondents who were female, 65 and older or married were more likely to report a flu vaccination. Sixty-nine percent of respondents 65 and older had a pneumonia vaccination in their lifetime. Flu Vaccination From 2003 to 2012, there was no statistical change in the overall percent of respondents 18 and older who reported a flu vaccination in the past 12 months. From 2003 to 2012, there was a statistical decrease in the overall percent of respondents 65 and older who reported a flu vaccination in the past 12 months. From 2003 to 2012, there was a statistical increase in the overall percent of respondents 65 and older who had a pneumonia vaccination. The Healthy People 2020 goal for adults 18 to 64 years old having an annual influenza vaccination is 80% and for persons 65 and older is 90%. (Objectives IID-12.5 and 12.7) In 2010, 68% of Wisconsin respondents and 68% of U.S. respondents 65 and older reported a flu vaccination in the past 12 months (2010 Behavioral Risk Factor Surveillance). Milwaukee County Community Health Survey Report

71 2012 Findings Thirty-eight percent of respondents had a flu shot or flu vaccine that was sprayed in their nose in the past 12 months. Female respondents were more likely to report receiving a flu vaccination (40%) compared to male respondents (34%). Respondents 65 and older were more likely to report receiving a flu vaccination (63%) compared to those 18 to 24 years old (31%) or respondents 25 to 34 years old (29%). Married respondents were more likely to report receiving a flu vaccination compared to unmarried respondents (42% and 35%, respectively). Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents 18 and older who reported a flu vaccination in the past 12 months. From 2003 to 2012, there was a statistical decrease in the overall percent of respondents 65 and older who reported a flu vaccination in the past 12 months. In 2006, 2009 and 2012, female respondents were more likely to report a flu vaccination. In 2003, gender was not a significant variable. In all study years, respondents 65 and older were more likely to report a flu vaccination, with a noted decrease in From 2003 to 2012, there was a noted increase in the percent of respondents 25 to 44 years old reporting a flu vaccination. In 2006 and 2009, white respondents were more likely to report a flu vaccination. In all other study years, race was not a significant variable. Hispanic origin was not a significant variable in any study year. From 2003 to 2012, there was a noted increase in the percent of Hispanic respondents reporting a flu vaccination. In 2009, respondents with a college education were more likely to report a flu vaccination. In all other study years, education was not a significant variable. In 2003, respondents in the bottom 40 percent household income bracket were more likely to report a flu vaccination. In 2009, respondents in the top 40 percent household income bracket were more likely to report a flu vaccination. In all other study years, household income was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents in the bottom 40 percent household income bracket and a noted increase in the percent of respondents in the top 40 percent household income bracket reporting a flu vaccination. In 2012, married respondents were more likely to report a flu vaccination. In all other study years, marital status was not a significant variable. Milwaukee County Community Health Survey Report

72 Table 15. Flu Vaccination by Demographic Variables for Each Survey Year, TOTAL 37% 36% 40% 38% Gender 2,3,4 Male Female Age 1,2,3,4 18 to to 34 a to 44 a to to and Older a Race 2,3 White African American Other Hispanic Origin Hispanic a Non-Hispanic Education 3 High School or Less Some Post High School College Graduate Household Income 1,3 Bottom 40 Percent Bracket a Middle 20 Percent Bracket Top 40 Percent Bracket a Marital Status 4 Married Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. In 2006, nasal spray was added. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

73 Pneumonia Vaccination The Healthy People 2020 goal for persons 65 and older ever having a pneumococcal vaccine is 90%. (Objective IID-13.1) In 2010, 73% of Wisconsin respondents and 69% of U.S. respondents 65 and older reported they received a pneumonia shot (2010 Behavioral Risk Factor Surveillance) Findings Sixty-nine percent of respondents 65 and older reported they received a pneumonia vaccination in their lifetime. There were no statistically significant differences between demographic variables and responses of receiving a pneumonia vaccination in their lifetime. Year Comparisons From 2003 to 2012, there was a statistical increase in the overall percent of respondents who had a pneumonia vaccination in their lifetime. Gender was not a significant variable in any study year. From 2003 to 2012, there was a noted increase in the percent of female respondents reporting a pneumonia vaccination. In 2003, 2006 and 2009, white respondents were more likely to report a pneumonia vaccination. In 2012, race was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of African American respondents reporting a pneumonia vaccination. In 2009, respondents with at least some post high school education were more likely to report a pneumonia vaccination. In all other study years, education was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents with a high school education or less reporting a pneumonia vaccination. Marital status was not a significant variable in any study year. From 2003 to 2012, there was a noted increase in the percent of unmarried respondents reporting a pneumonia vaccination. Milwaukee County Community Health Survey Report

74 Table 16. Pneumonia Vaccination Ever (65 and Older) by Demographic Variables for Each Survey Year, TOTAL a 58% 71% 72% 69% Gender Male Female a Race 1,2,3 White African American a Education 3 High School or Less a Some Post High School or More Marital Status Married Not Married a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Other race, Hispanic origin and household income not included as a result of too few cases for statistical reliability. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Vaccinations Overall Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents 18 and older who reported a flu vaccination in the past 12 months. From 2003 to 2012, there was a statistical decrease in the overall percent of respondents 65 and older who reported a flu vaccination in the past 12 months. From 2003 to 2012, there was a statistical increase in the overall percent of respondents 65 and older who had a pneumonia vaccination. 100% Figure 7. Vaccinations 80% 60% 40% 20% 77% 58% 37% 71% 36% 72% 69% 40% 69% 63% 38% Pneumonia Vaccination (Ever, 65+) Flu Vaccination (Past Year, 18+)* Flu Vaccination (Past Year, 65+)* 0% *In 2006, nasal spray was added. Milwaukee County Community Health Survey Report

75 Prevalence of Select Health Conditions (Figures 8 & 9; Tables 17-22) Respondents were asked a series of questions regarding if they had certain health conditions in the past three years. Current diagnosis of asthma was asked. KEY FINDINGS: In 2012, out of eight health conditions listed, the two most often mentioned in the past three years were high blood pressure or high blood cholesterol (30% and 21%, respectively). Respondents who were female, 65 and older, African American, non-hispanic, with a high school education or less, in the bottom 40 percent household income bracket, who were unmarried, overweight or inactive were more likely to report high blood pressure. Respondents who were 55 and older, white, non-hispanic, with a high school education or less, who were married, overweight or inactive were more likely to report high blood cholesterol. Respondents who were 65 and older, non-hispanic, with a high school education or less, in the bottom 40 percent household income bracket, who were overweight or inactive were more likely to report heart disease/condition. Respondents who were female, 45 to 54 years old, with some post high school education, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report a mental health condition. Respondents who were 65 and older, African American, with a high school education or less, in the bottom 40 percent household income bracket, who were overweight or inactive were more likely to report diabetes. Respondents who were female, 18 to 24 years old, 35 to 44 years old, non-white, Hispanic, with some post high school education, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report current asthma Findings From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported high blood pressure, high blood cholesterol, diabetes or current asthma. From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported heart disease/condition or stroke. From 2009 to 2012, there was no statistical change in the overall percent of respondents who reported a mental health condition. From 2009 to 2012, there was a statistical increase in the overall percent of respondents who reported cancer. Respondents were more likely to report high blood pressure (30%) or high blood cholesterol (21%) in the past three years. Figure 8. Health Conditions in Past Three Years for 2012 High Blood Pressure 30% High Blood Cholesterol 21% Mental Health Condition Asthma (Current) Diabetes Heart Disease/Condition 14% 12% 10% 8% Cancer Stroke 2% 4% 0% 20% 40% 60% 80% 100% Milwaukee County Community Health Survey Report

76 High Blood Pressure 2012 Findings Thirty percent of respondents reported high blood pressure in the past three years. Female respondents were more likely to report high blood pressure (32%) compared to male respondents (27%). Respondents 65 and older were more likely to report high blood pressure in the past three years (62%) compared to those 25 to 34 years old (13%) or respondents 18 to 24 years old (8%). African American respondents were more likely to report high blood pressure (36%) compared to white respondents (29%) or respondents of another race (17%). Non-Hispanic respondents were more likely to report high blood pressure compared to Hispanic respondents (31% and 13%, respectively). Thirty-six percent of respondents with a high school education or less reported high blood pressure compared to 28% of those with some post high school education or 24% of respondents with a college education. Thirty-five percent of respondents in the bottom 40 percent household income bracket reported high blood pressure compared to 25% of those in the middle 20 percent income bracket or 19% of respondents in the top 40 percent household income bracket. Unmarried respondents were more likely to report high blood pressure compared to married respondents (31% and 27%, respectively). Thirty-six percent of overweight respondents reported high blood pressure compared to 16% of respondents who were not overweight. Inactive respondents were more likely to report high blood pressure (40%) compared to those who did an insufficient amount of physical activity (30%) or respondents who met the recommended amount of physical activity (26%). o Of the 583 respondents who reported high blood pressure, 96% had it under control through medication, exercise or lifestyle changes. Year Comparisons From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported high blood pressure. In 2006, 2009 and 2012, female respondents were more likely to report high blood pressure. In 2003, gender was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents across gender reporting high blood pressure. In all study years, respondents 65 and older were more likely to report high blood pressure. From 2003 to 2012, there was a noted increase in the percent of respondents who were 18 to 34 years old or 45 to 64 years old reporting high blood pressure. Milwaukee County Community Health Survey Report

77 In all study years, African American respondents were more likely to report high blood pressure, with a noted increase in From 2003 to 2012, there was a noted increase in the percent of white respondents reporting high blood pressure. In 2006 and 2012, non-hispanic respondents were more likely to report high blood pressure. In all other study years, Hispanic origin was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of non-hispanic respondents reporting high blood pressure. In all study years, respondents with a high school education or less were more likely to report high blood pressure. From 2003 to 2012, there was a noted increase in the percent of respondents across education reporting high blood pressure. In all study years, respondents in the bottom 40 percent household income bracket were more likely to report high blood pressure, with a noted increase in In 2012, unmarried respondents were more likely to report high blood pressure. In all other study years, marital status was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents across marital status reporting high blood pressure. In all study years, overweight respondents were more likely to report high blood pressure. From 2003 to 2012, there was a noted increase in the percent of respondents across overweight status reporting high blood pressure. In 2006, 2009 and 2012, inactive respondents were more likely to report high blood pressure. From 2006 to 2012, there was a noted increase in the percent of respondents who met the recommended amount of physical activity reporting high blood pressure. In 2003, 2006 and 2009, nonsmokers were more likely to report high blood pressure. In 2012, smoking status was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents across smoking status reporting high blood pressure. Milwaukee County Community Health Survey Report

78 Table 17. High Blood Pressure in Past Three Years by Demographic Variables for Each Survey Year, TOTAL a 22% 27% 29% 30% Gender 2,3,4 Male a Female a Age 1,2,3,4 18 to 24 a to 34 a to to 54 a to 64 a and Older Race 1,2,3,4 White a African American a Other Hispanic Origin 2,4 Hispanic Non-Hispanic a Education 1,2,3,4 High School or Less a Some Post High School a College Graduate a Household Income 1,2,3,4 Bottom 40 Percent Bracket a Middle 20 Percent Bracket Top 40 Percent Bracket Marital Status 4 Married a Not Married a Overweight Status 1,2,3,4 Not Overweight a Overweight a Physical Activity 2,3,4 Inactive Insufficient Recommended b Smoking Status 1,2,3 Nonsmoker a Smoker a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Physical activity was defined differently in demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 b year difference at p 0.05 from 2006 to 2012 Milwaukee County Community Health Survey Report

79 High Blood Cholesterol 2012 Findings Twenty-one percent of respondents reported high blood cholesterol in the past three years. Thirty-nine percent of respondents 65 and older and 37% of those 55 to 64 years old reported high blood cholesterol in the past three years compared to 1% of respondents 18 to 24 years old. White respondents were more likely to report high blood cholesterol (25%) compared to African American respondents (17%) or respondents of another race (16%). Non-Hispanic respondents were more likely to report high blood cholesterol compared to Hispanic respondents (22% and 15%, respectively). Twenty-five percent of respondents with a high school education or less reported high blood cholesterol in the past three years compared to 20% of those with a college education or 18% of respondents with some post high school education. Married respondents were more likely to report high blood cholesterol compared to unmarried respondents (24% and 20%, respectively). Overweight respondents were more likely to report high blood cholesterol (27%) compared to respondents who were not overweight (11%). Inactive respondents were more likely to report high blood cholesterol in the past three years (31%) compared to those who did an insufficient amount of physical activity (25%) or respondents who met the recommended amount of physical activity (16%). o Of the 423 respondents who reported high blood cholesterol, 86% had it under control through medication, exercise or lifestyle changes. Respondents 65 and older were more likely to report they had their high blood cholesterol under control through medication, exercise or lifestyle changes. Year Comparisons From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported high blood cholesterol. Gender was not a significant variable in any study year. From 2003 to 2012, there was a noted increase in the percent of male respondents reporting high blood cholesterol. In all study years, respondents 55 and older were more likely to report high blood cholesterol. From 2003 to 2012, there was a noted increase in the percent of respondents 35 to 54 years old reporting high blood cholesterol. In all study years, white respondents were more likely to report high blood cholesterol, with a noted increase in From 2003 to 2012, there was a noted increase in the percent of respondents who were non-white and non-african American reporting high blood cholesterol. Milwaukee County Community Health Survey Report

80 In 2003, 2006 and 2012, non-hispanic respondents were more likely to report high blood cholesterol. In 2009, Hispanic origin was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of non-hispanic respondents reporting high blood cholesterol. In 2006, respondents with some post high school education were more likely to report high blood cholesterol. In 2009 and 2012, respondents with a high school education or less were more likely to report high blood cholesterol. In 2003, education was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents with a high school education or less reporting high blood cholesterol. Household income was not a significant variable in any study year. From 2003 to 2012, there was a noted increase in the percent of respondents in the middle 20 percent household income bracket reporting high blood cholesterol. In 2003, 2006 and 2012, married respondents were more likely to report high blood cholesterol. In 2009, marital status was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of unmarried respondents reporting high blood cholesterol. In all study years, overweight respondents were more likely to report high blood cholesterol, with a noted increase in In 2006, 2009 and 2012, inactive respondents were more likely to report high blood cholesterol. From 2006 to 2012, there was a noted decrease in the percent of respondents who met the recommended amount of physical activity reporting high blood cholesterol. In 2003, nonsmokers were more likely to report high blood cholesterol. In all other study years, smoking status was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of smokers reporting high blood cholesterol. Milwaukee County Community Health Survey Report

81 Table 18. High Blood Cholesterol in Past Three Years by Demographic Variables for Each Survey Year, TOTAL a 18% 22% 22% 21% Gender Male a Female Age 1,2,3,4 18 to to to 44 a to 54 a to and Older Race 1,2,3,4 White a African American Other a Hispanic Origin 1,2,4 Hispanic Non-Hispanic a Education 2,3,4 High School or Less a Some Post High School College Graduate Household Income Bottom 40 Percent Bracket Middle 20 Percent Bracket a Top 40 Percent Bracket Marital Status 1,2,4 Married Not Married a Overweight Status 1,2,3,4 Not Overweight Overweight a Physical Activity 2,3,4 Inactive Insufficient Recommended b Smoking Status 1 Nonsmoker Smoker a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Physical activity was defined differently in demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 b year difference at p 0.05 from 2006 to 2012 Milwaukee County Community Health Survey Report

82 Heart Disease/Condition 2012 Findings Eight percent of respondents reported heart disease or condition in the past three years. Twenty-two percent of respondents 65 and older reported heart disease/condition compared to 2% of those 35 to 44 years old or 1% of respondents 18 to 24 years old. Non-Hispanic respondents were more likely to report heart disease/condition compared to Hispanic respondents (9% and 2%, respectively). Eleven percent of respondents with a high school education or less reported heart disease/condition compared to 9% of those with some post high school education or 5% of respondents with a college education. Eleven percent of respondents in the bottom 40 percent household income bracket reported heart disease/condition compared to 6% of those in the middle 20 percent income bracket or 2% of respondents in the top 40 percent household income bracket. Overweight respondents were more likely to report heart disease/condition (10%) compared to respondents who were not overweight (5%). Inactive respondents were more likely to report heart disease/condition (15%) compared to those who did an insufficient amount of physical activity (9%) or respondents who met the recommended amount of physical activity (5%). o Of the 162 respondents who reported heart disease/condition, 91% had it under control through medication, exercise or lifestyle changes. Respondents 55 and older were more likely to report they had their heart disease/condition under control through medication, exercise or lifestyle changes. Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported heart disease/condition. In all study years, respondents 65 and older were more likely to report heart disease/condition. From 2003 to 2012, there was a noted increase in the percent of respondents 45 to 54 years old reporting heart disease/condition. In 2003 and 2006, white respondents were more likely to report heart disease/condition. In all other study years, race was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of African American respondents reporting heart disease/condition. In 2006 and 2012, non-hispanic respondents were more likely to report heart disease/condition. In all other study years, Hispanic origin was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of Hispanic respondents reporting heart disease/condition. In 2003, 2006 and 2012, respondents with a high school education or less were more likely to report heart disease/condition. In 2009, respondents with some post high school education were more likely to report heart disease/condition. Milwaukee County Community Health Survey Report

83 In all study years, respondents in the bottom 40 percent household income bracket were more likely to report heart disease/condition. From 2003 to 2012, there was a noted decrease in the percent of respondents in the top 40 percent household income bracket reporting heart disease/condition. In 2009, unmarried respondents were more likely to report heart disease/condition. In all other study years, marital status was not a significant variable. In 2003, 2009 and 2012, overweight respondents were more likely to report heart disease/condition. In 2006, overweight status was not a significant variable. In 2006, 2009 and 2012, inactive respondents were more likely to report heart disease/condition. In 2003, nonsmokers were more likely to report heart disease/condition. In all other study years, smoking status was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of smokers reporting heart disease/condition. Milwaukee County Community Health Survey Report

84 Table 19. Heart Disease/Condition in Past Three Years by Demographic Variables for Each Survey Year, TOTAL 8% 8% 9% 8% Gender Male Female Age 1,2,3,4 18 to to to to 54 a to and Older Race 1,2 White African American a Other Hispanic Origin 2,4 Hispanic a Non-Hispanic Education 1,2,3,4 High School or Less Some Post High School College Graduate Household Income 1,2,3,4 Bottom 40 Percent Bracket Middle 20 Percent Bracket Top 40 Percent Bracket a Marital Status 3 Married Not Married Overweight Status 1,3,4 Not Overweight Overweight Physical Activity 2,3,4 Inactive Insufficient Recommended Smoking Status 1 Nonsmoker Smoker a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Physical activity was defined differently in demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 b year difference at p 0.05 from 2006 to 2012 Milwaukee County Community Health Survey Report

85 Mental Health Condition 2012 Findings Fourteen percent of respondents reported a mental health condition, such as an anxiety disorder, obsessivecompulsive disorder, panic disorder, post traumatic stress disorder or depression in the past three years. Female respondents were more likely to report a mental health condition in the past three years (17%) compared to male respondents (11%). Twenty-one percent of respondents 45 to 54 years old reported a mental health condition compared to 12% of those 25 to 34 years old or 9% of respondents 65 and older. Respondents with some post high school education were more likely to report a mental health condition (18%) compared to those with a high school education or less (15%) or respondents with a college education (9%). Twenty-one percent of respondents in the bottom 40 percent household income bracket reported a mental health condition compared to 8% of those in the top 40 percent income bracket or 7% of respondents in the middle 20 percent household income bracket. Unmarried respondents were more likely to report a mental health condition compared to married respondents (16% and 10%, respectively). o Of the 279 respondents who reported a mental health condition, 81% had it under control through medication, exercise or lifestyle changes. Year Comparisons From 2009 to 2012, there was no statistical change in the overall percent of respondents reporting a mental health condition. In both study years, female respondents were more likely to report a mental health condition. In 2009, respondents 55 to 64 years old were more likely to report a mental health condition. In 2012, respondents 45 to 54 years old were more likely to report a mental health condition. In 2009, Hispanic respondents were more likely to report a mental health condition. In 2012, Hispanic origin was not a significant variable. From 2009 to 2012, there was a noted decrease in the percent of Hispanic respondents reporting a mental health condition. In 2009, respondents with some post high school education or less were more likely to report a mental health condition. In 2012, respondents with some post high school education were more likely to report a mental health condition. In both study years, respondents in the bottom 40 percent household income bracket were more likely to report a mental health condition, with a noted increase in In both study years, unmarried respondents were more likely to report a mental health condition. Milwaukee County Community Health Survey Report

86 Table 20. Mental Health Condition in Past Three Years by Demographic Variables for Each Survey Year TOTAL 13% 14% Gender 1,2 Male Female Age 1,2 18 to to to to to and Older 9 9 Race White African American Other Hispanic Origin 1 Hispanic a Non-Hispanic Education 1,2 High School or Less Some Post High School College Graduate 10 9 Household Income 1,2 Bottom 40 Percent Bracket a Middle 20 Percent Bracket 10 7 Top 40 Percent Bracket 7 8 Marital Status 1,2 Married 9 10 Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2009 to 2012 Milwaukee County Community Health Survey Report

87 Diabetes 2012 Findings Ten percent of respondents reported diabetes in the past three years. Twenty-one percent of respondents 65 and older reported diabetes in the past three years compared to 2% of those 18 to 24 years old or 1% of respondents 25 to 34 years old. Fourteen percent of African American respondents reported diabetes compared to 9% of respondents who were white or of another race. Fourteen percent of respondents with a high school education or less reported diabetes compared to 9% of those with some post high school education or 6% of respondents with a college education. Thirteen percent of respondents in the bottom 40 percent household income bracket reported diabetes compared to 8% of those in the middle 20 percent income bracket or 5% of respondents in the top 40 percent household income bracket. Overweight respondents were more likely to report diabetes (14%) compared to respondents who were not overweight (4%). Sixteen percent of inactive respondents reported diabetes compared to 12% of those who did an insufficient amount of physical activity or 7% of respondents who met the recommended amount of physical activity. o Of the 201 respondents who reported diabetes, 92% had it under control through medication, exercise or lifestyle changes. Respondents who were male or with a high school education or less were more likely to report they had their diabetes under control through medication, exercise or lifestyle changes. Year Comparisons From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported diabetes. Gender was not a significant variable in any study year. From 2003 to 2012, there was a noted increase in the percent of respondents across gender reporting diabetes. In 2003, 2009 and 2012, respondents 65 and older were more likely to report diabetes. In 2006, respondents 55 and older were more likely to report diabetes. From 2003 to 2012, there was a noted increase in the percent of respondents who were 18 to 24 years old or 35 to 54 years old reporting diabetes. In 2003 and 2012, African American respondents were more likely to report diabetes. In all other study years, race was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of white respondents reporting diabetes. Hispanic origin was not a significant variable in any study year. From 2003 to 2012, there was a noted increase in the percent of respondents across Hispanic origin reporting diabetes. In 2009 and 2012, respondents with a high school education or less were more likely to report diabetes. In all other study years, education was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents with a high school education or less reporting diabetes. Milwaukee County Community Health Survey Report

88 In all study years, respondents in the bottom 40 percent household income bracket were more likely to report diabetes, with a noted increase in Marital status was not a significant variable in any study year. From 2003 to 2012, there was a noted increase in the percent of unmarried respondents reporting diabetes. In all study years, overweight respondents were more likely to report diabetes, with a noted increase in In 2006, 2009 and 2012, inactive respondents were more likely to report diabetes. From 2006 to 2012, there was a noted increase in the percent of respondents who met the recommended amount of physical activity reporting diabetes. In 2003 and 2009, nonsmokers were more likely to report diabetes. In all other study years, smoking status was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of smokers reporting diabetes. Milwaukee County Community Health Survey Report

89 Table 21. Diabetes in Past Three Years by Demographic Variables for Each Survey Year, TOTAL a 7% 8% 9% 10% Gender Male a Female a Age 1,2,3,4 18 to 24 a 0 <1 < to < to 44 a to 54 a to and Older Race 1,4 White a African American Other Hispanic Origin Hispanic a Non-Hispanic a Education 3,4 High School or Less a Some Post High School College Graduate Household Income 1,2,3,4 Bottom 40 Percent Bracket a Middle 20 Percent Bracket Top 40 Percent Bracket Marital Status Married Not Married a Overweight Status 1,2,3,4 Not Overweight Overweight a Physical Activity 2,3,4 Inactive Insufficient Recommended b Smoking Status 1,3 Nonsmoker Smoker a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Physical activity was defined differently in demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 b year difference at p 0.05 from 2006 to 2012 Milwaukee County Community Health Survey Report

90 Current Asthma In 2010, 8% of Wisconsin respondents and 9% of U.S. respondents reported they were told they currently have asthma (2010 Behavioral Risk Factor Surveillance) Findings Twelve percent of respondents reported they currently have asthma. Female respondents were more likely to report current asthma (16%) compared to male respondents (8%). Sixteen percent of respondents 18 to 24 years old and 15% of those 35 to 44 years old reported current asthma compared to 8% of respondents 25 to 34 years old or 65 and older. Eighteen percent of respondents who were non-white and non-african American and 16% of African American respondents reported current asthma compared to 9% of white respondents. Hispanic respondents were more likely to report current asthma compared to non-hispanic respondents (17% and 12%, respectively). Respondents with some post high school education were more likely to report current asthma (15%) compared to those with a high school education or less (13%) or respondents with a college education (8%). Seventeen percent of respondents in the bottom 40 percent household income bracket reported current asthma compared to 8% of those in the top 40 percent income bracket or 5% of respondents in the middle 20 percent household income bracket. Unmarried respondents were more likely to report current asthma compared to married respondents (14% and 8%, respectively). o Of the 238 respondents who reported current asthma, 92% had it under control through medication, exercise or lifestyle changes. Year Comparisons From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported current asthma. In all study years, female respondents were more likely to report current asthma, with a noted increase in In 2006, respondents who were 18 to 34 years old or 55 to 64 years old were more likely to report current asthma. In 2012, respondents who were 18 to 24 years old or 35 to 44 years old were more likely to report current asthma. In all other study years, age was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents who were 18 to 24 years old or 35 to 54 years old reporting current asthma. In 2003, respondents who were non-white and non-african American were more likely to report current asthma. In 2006 and 2012, respondents who were non-white were more likely to report current asthma. In 2009, African American respondents were more likely to report current asthma. From 2003 to 2012, there was a noted increase in the percent of African American respondents and a noted decrease in the percent of respondents who were non-white and non-african American reporting current asthma. Milwaukee County Community Health Survey Report

91 In 2003 and 2012, Hispanic respondents were more likely to report current asthma. In all other study years, Hispanic origin was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of non-hispanic respondents reporting current asthma. In 2003, 2006 and 2009, respondents with a high school education or less were more likely to report current asthma. In 2012, respondents with some post high school education were more likely to report current asthma, with a noted increase since In 2003, respondents in the bottom 60 percent household income bracket were more likely to report current asthma. In 2006, 2009 and 2012, respondents in the bottom 40 percent household income bracket were more likely to report current asthma. From 2003 to 2012, there was a noted increase in the percent of respondents in the bottom 40 percent household income bracket and a noted decrease in the percent of respondents in the middle 20 percent household income bracket reporting current asthma. In all study years, unmarried respondents were more likely to report current asthma, with a noted increase in Milwaukee County Community Health Survey Report

92 Table 22. Current Asthma by Demographic Variables for Each Survey Year TOTAL a 9% 10% 12% 12% Gender 1,2,3,4 Male Female a Age 2,4 18 to 24 a to to 44 a to 54 a to and Older Race 1,2,3,4 White African American a Other a Hispanic Origin 1,4 Hispanic Non-Hispanic a Education 1,2,3,4 High School or Less Some Post High School a College Graduate Household Income 1,2,3,4 Bottom 40 Percent Bracket a Middle 20 Percent Bracket a Top 40 Percent Bracket Marital Status 1,2,3,4 Married Not Married a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

93 Cancer 2012 Findings Four percent of respondents reported they had cancer in the past three years. o Breast cancer or melanoma/skin cancer was most often mentioned (19 responses each) followed by prostate cancer (10 responses). Year Comparisons From 2009 to 2012, there was a statistical increase in the overall percent of respondents who reported they had cancer in the past three years. Stroke 2012 Findings Two percent of respondents reported a stroke in the past three years. No demographic comparisons were conducted as a result of the low percent of respondents reporting a stroke in the past three years. o Of the 34 respondents who reported a stroke, 91% had it under control through medication, exercise or lifestyle changes. Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents reporting a stroke. No demographic comparisons were conducted between years as a result of the low percent of respondents reporting a stroke in all study years. Milwaukee County Community Health Survey Report

94 Health Conditions Overall Year Comparisons From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported high blood pressure, high blood cholesterol, diabetes or current asthma. From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported heart disease/condition or stroke. From 2009 to 2012, there was no statistical change in the overall percent of respondents who reported a mental health condition. From 2009 to 2012, there was a statistical increase in the overall percent of respondents who reported cancer. 40% Figure 9. Health Conditions in Past Three Years 27% 29% 30% High Blood Pressure High Blood Cholesterol 22% 22% 22% 21% 20% 18% 14% 13% 10% 12% 9% 12% 10% 8% 9% 8% 8% 7% 3% 4% 2% 2% 2% 2% 0% Heart Disease/Condition Mental Health Condition Diabetes Asthma (current) Cancer St roke Milwaukee County Community Health Survey Report

95 Physical Well Being and Body Weight (Figures 10 & 11; Tables 23-26) KEY FINDINGS: In 2012, 35% of respondents did moderate physical activity five times a week for 30 minutes while 24% did vigorous activity three times a week for 20 minutes. Combined, 47% met the recommended amount of physical activity; respondents who were 18 to 34 years old, non-white and non-african American, Hispanic, with at least some post high school education or respondents who were not overweight were more likely to report this. Sixty-six percent of respondents were classified as overweight. Respondents who were 45 to 64 years old, nonwhite, Hispanic, with some post high school education or less or inactive respondents were more likely to be classified as overweight. From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported moderate physical activity five times a week for at least 30 minutes. From 2006 to 2012, there was a statistical increase in the overall percent of respondents who reported vigorous physical activity three times a week for at least 20 minutes. From 2006 to 2012, there was no statistical change in the overall percent of respondents who met the recommended amount of physical activity. From 2003 to 2012, there was a statistical increase in the overall percent of respondents being overweight. Moderate Physical Activity in Usual Week Moderate physical activity includes walking briskly, vacuuming, gardening or anything else that causes small increases in breathing or heart rate. In 2005, 42% of Wisconsin respondents and 33% of U.S. respondents did moderate physical activity at least five times a week for 30 or more minutes (2005 Behavioral Risk Factor Surveillance) Findings Thirty-five percent of all respondents did moderate physical activity at least five times a week for 30 minutes or more. Forty-seven percent did some moderate activity, while 16% did not do any moderate physical activity. Forty-two percent of respondents 25 to 34 years old met the recommended amount of moderate physical activity compared to 33% of those 45 to 54 years old or 32% of respondents 55 and older. Respondents who were non-white and non-african American were more likely to meet the recommended amount of moderate physical activity (43%) compared to white respondents (38%) or African American respondents (29%). Thirty-eight percent of respondents with some post high school education and 37% of those with a college education met the recommended amount of moderate physical activity compared to 32% of respondents with a high school education or less. Respondents who were not overweight were more likely to meet the recommended amount of moderate physical activity (41%) compared to overweight respondents (33%). Year Comparisons From 2003 to 2012, there was a statistical increase in the overall percent of respondents who did the recommended amount of moderate physical activity in a week. Milwaukee County Community Health Survey Report

96 Gender was not a significant variable in any study year. From 2003 to 2012, there was a noted increase in the percent of respondents across gender meeting the recommended amount of moderate physical activity. In 2003 and 2012, respondents 25 to 34 years old were more likely to meet the recommended amount of moderate physical activity. In 2006, respondents 35 to 44 years old were more likely to meet the recommended amount of moderate physical activity. In 2009, age was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents who were 18 to 34 years old or 65 and older meeting the recommended amount of physical activity. In 2003 and 2012, respondents who were non-white and non-african American were more likely to meet the recommended amount of moderate physical activity. In all other study years, race was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of white respondents meeting the recommended amount of moderate physical activity. In 2003, Hispanic respondents were more likely to meet the recommended amount of moderate physical activity. In 2006, non-hispanic respondents were more likely to meet the recommended amount of moderate physical activity. In all other study years, Hispanic origin was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of non-hispanic respondents meeting the recommended amount of moderate physical activity. In 2003 and 2006, respondents with a college education were more likely to meet the recommended amount of moderate physical activity. In 2012, respondents with at least some post high school education were more likely to meet the recommended amount of moderate physical activity. In 2009, education was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents with some post high school education or less meeting the recommended amount of moderate physical activity. In 2006, respondents in the top 40 percent household income bracket were more likely to meet the recommended amount of moderate physical activity. In all other study years, household income was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents in the bottom 40 percent household income bracket or in the top 40 percent household income bracket meeting the recommended amount of moderate physical activity. In 2006, married respondents were more likely to meet the recommended amount of moderate physical activity. In all other study years, marital status was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents across marital status meeting the recommended amount of moderate physical activity. In all study years, respondents who were not overweight were more likely to meet the recommended amount of moderate physical activity. From 2003 to 2012, there was a noted increase in the percent of respondents across overweight status meeting the recommended amount of moderate physical activity. Milwaukee County Community Health Survey Report

97 Table 23. Recommended Moderate Physical Activity by Demographic Variables for Each Survey Year, TOTAL a 28% 33% 31% 35% Gender Male a Female a Age 1,2,4 18 to 24 a to 34 a to to to and Older a Race 1,4 White a African American Other Hispanic Origin 1,2 Hispanic Non-Hispanic a Education 1,2,4 High School or Less a Some Post High School a College Graduate Household Income 2 Bottom 40 Percent Bracket a Middle 20 Percent Bracket Top 40 Percent Bracket a Marital Status 2 Married a Not Married a Overweight Status 1,2,3,4 Not Overweight a Overweight a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Recommended moderate physical activity is 5 times/30+ minutes in a week. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

98 Vigorous Physical Activity in Usual Week Vigorous physical activity includes running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate. In 2009, 31% of Wisconsin respondents and 29% of U.S. respondents did vigorous physical activity at least three times a week for 20 or more minutes (2009 Behavioral Risk Factor Surveillance) Findings Twenty-four percent of respondents reported they did vigorous physical activity at least three times a week for 20 minutes or more. Twenty-one percent did some vigorous physical activity while 54% did not do any vigorous physical activity. Male respondents were more likely to report vigorous physical activity (28%) compared to female respondents (21%). Respondents 18 to 24 years old were more likely to report vigorous physical activity (39%) compared to those 55 to 64 years old (14%) or respondents 65 and older (9%). Respondents who were non-white and non-african American were more likely to report vigorous physical activity (32%) compared to white respondents (24%) or African American respondents (23%). Hispanic respondents were more likely to report vigorous physical activity compared to non-hispanic respondents (33% and 24%, respectively). Thirty-one percent of respondents with a college education reported vigorous physical activity compared to 26% of those with some post high school education or 17% of respondents with a high school education or less. Thirty-one percent of respondents in the top 40 percent household income bracket reported vigorous physical activity compared to 24% of those in the middle 20 percent income bracket or 22% of respondents in the bottom 40 percent household income bracket. Respondents who were not overweight were more likely to report vigorous physical activity (28%) compared to overweight respondents (23%). Year Comparisons From 2006 to 2012, there was a statistical increase in the overall percent of respondents who did the recommended amount of vigorous physical activity in a week. In all study years, male respondents were more likely to meet the recommended amount of vigorous physical activity. From 2006 to 2012, there was a noted increase in the percent of female respondents meeting the recommended amount of vigorous physical activity. In 2006 and 2012, respondents 18 to 24 years old were more likely to meet the recommended amount of vigorous physical activity. In 2009, respondents 25 to 34 years old were more likely to meet the recommended amount of vigorous physical activity. From 2006 to 2012, there was a noted increase in the percent of respondents 25 to 34 years old meeting the recommended amount of vigorous physical activity. Milwaukee County Community Health Survey Report

99 In 2006, respondents who were non-african American were more likely to meet the recommended amount of vigorous physical activity. In 2009 and 2012, respondents who were non-white and non-african American were more likely to meet the recommended amount of vigorous physical activity. From 2006 to 2012, there was a noted increase in the percent of respondents who were non-white meeting the recommended amount of vigorous physical activity. In 2012, Hispanic respondents were more likely to meet the recommended amount of vigorous physical activity, with a noted increase since In all other study years, Hispanic origin was not a significant variable. In all study years, respondents with a college education were more likely to meet the recommended amount of vigorous physical activity. In all study years, respondents in the top 40 percent household income bracket were more likely to meet the recommended amount of vigorous physical activity. From 2006 to 2012, there was a noted increase in the percent of respondents in the bottom 40 percent household income bracket meeting the recommended amount of vigorous physical activity. Marital status was not a significant variable in any study year. From 2006 to 2012, there was a noted increase in the percent of unmarried respondents meeting the recommended amount of vigorous physical activity. In all study years, respondents who were not overweight were more likely to meet the recommended amount of vigorous physical activity. From 2006 to 2012, there was a noted increase in the percent of overweight respondents meeting the recommended amount of vigorous physical activity. Milwaukee County Community Health Survey Report

100 Table 24. Recommended Vigorous Physical Activity by Demographic Variables for Each Survey Year, TOTAL a 22% 19% 24% Gender 1,2,3 Male Female a Age 1,2,3 18 to to 34 a to to to and Older Race 1,2,3 White African American a Other a Hispanic Origin 3 Hispanic a Non-Hispanic Education 1,2,3 High School or Less Some Post High School College Graduate Household Income 1,2,3 Bottom 40 Percent Bracket a Middle 20 Percent Bracket Top 40 Percent Bracket Marital Status Married Not Married a Overweight Status 1,2,3 Not Overweight Overweight a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Recommended vigorous physical activity is 3 times/20+ minutes in a week. 1 demographic difference at p 0.05 in 2006; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2012 a year difference at p 05 from 2006 to 2012 Milwaukee County Community Health Survey Report

101 Combined Recommended Amount of Physical Activity in Typical Week The recommended amount of physical activity by the Centers for Disease Control is moderate physical activity for at least 30 minutes on five or more days of the week or vigorous physical activity for at least 20 minutes on three or more days of the week. Moderate physical activity includes walking briskly, vacuuming, gardening or anything else that causes small increases in breathing or heart rate. Vigorous physical activity includes running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate. Insufficient physical activity includes participation in either activity, but not for the duration or the frequency recommended. Inactive respondents reported no moderate or vigorous physical activity in a typical week. In 2009, 53% of Wisconsin respondents and 51% of U.S. respondents met the recommended amount of physical activity (30+ minutes of moderate physical activity five days per week or 20+ minutes of vigorous physical activity three days per week) (2009 Behavioral Risk Factor Surveillance) Findings Forty-seven percent of respondents reported meeting the recommended amount of physical activity in a typical week (moderate activity 5 times/week for 30 minutes or vigorous activity 3 times/week for 20 minutes). Forty percent did an insufficient amount of physical activity while 13% did no physical activity in a typical week. Figure 10. Physical Activity/Week for 2012* Recommended 47% Insufficient 40% Inactive 13% *Recommended physical activity is moderate activity 5 times/30+ minutes in a week or vigorous activity 3 times/20+ minutes in a week. Fifty-eight percent of respondents 25 to 34 years and 57% of those 18 to 24 years old met the recommended amount of physical activity compared to 37% of respondents 65 and older. Respondents who were non-white and non-african American were more likely to meet the recommended amount of physical activity (54%) compared to white respondents (49%) or African American respondents (42%). Hispanic respondents were more likely to meet the recommended amount of physical activity compared to non- Hispanic respondents (56% and 46%, respectively). Fifty-two percent of respondents with a college education and 51% of those with some post high school education met the recommended amount of physical activity compared to 40% of respondents with a high school education or less. Milwaukee County Community Health Survey Report

102 Respondents who were not overweight were more likely to meet the recommended amount of physical activity (53%) compared to overweight respondents (44%). Year Comparisons From 2006 to 2012, there was no statistical change in the overall percent of respondents who met the recommended amount of physical activity in a week. In 2006 and 2009, male respondents were more likely to meet the recommended amount of physical activity. In 2012, gender was not a significant variable. In 2006, respondents who were 18 to 24 years old or 35 to 44 years old were more likely to meet the recommended amount of physical activity. In 2009 and 2012, respondents 18 to 34 years old were more likely to meet the recommended amount of physical activity. From 2006 to 2012, there was a noted increase in the percent of respondents 25 to 34 years old meeting the recommended amount of physical activity. In 2006, white respondents were more likely to meet the recommended amount of physical activity. In 2009 and 2012, respondents who were non-white and non-african American were more likely to meet the recommended amount of physical activity. From 2006 to 2012, there was a noted increase in the percent of respondents who were non-white and non-african American meeting the recommended amount of physical activity. In 2012, Hispanic respondents were more likely to meet the recommended amount of physical activity, with a noted increase since In all other study years, Hispanic origin was not a significant variable. In 2006 and 2009, respondents with a college education were more likely to meet the recommended amount of physical activity. In 2012, respondents with at least some post high school education were more likely to meet the recommended amount of physical activity. In 2006, respondents in the top 40 percent household income bracket were more likely to meet the recommended amount of physical activity. In 2009, respondents in the top 60 percent household income bracket were more likely to meet the recommended amount of physical activity. In 2012, household income was not a significant variable. From 2006 to 2012, there was a noted increase in the percent of respondents in the bottom 40 percent household income bracket and a noted decrease in the percent of respondents in the top 40 percent household income bracket meeting the recommended amount of physical activity. Marital status was not a significant variable in any study year. From 2006 to 2012, there was a noted increase in the percent of unmarried respondents meeting the recommended amount of physical activity. In all study years, respondents who were not overweight were more likely to meet the recommended amount of physical activity. Milwaukee County Community Health Survey Report

103 Table 25. Recommended Moderate or Vigorous Physical Activity by Demographic Variables for Each Survey Year, TOTAL 45% 41% 47% Gender 1,2 Male Female Age 1,2,3 18 to to 34 a to to to and Older Race 1,2,3 White African American Other a Hispanic Origin 3 Hispanic a Non-Hispanic Education 1,2,3 High School or Less Some Post High School College Graduate Household Income 1,2 Bottom 40 Percent Bracket a Middle 20 Percent Bracket Top 40 Percent Bracket a Marital Status Married Not Married a Overweight Status 1,2,3 Not Overweight Overweight Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Recommended moderate physical activity is 5 times/30+ minutes in a week and recommended vigorous activity is 3 times/20+ minutes in a week. 1 demographic difference at p 0.05 in 2006; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2012 a year difference at p 05 from 2006 to 2012 Milwaukee County Community Health Survey Report

104 Body Weight Being overweight contributes to many health problems. One nationally used definition of overweight status developed by the CDC is when a person s body mass index (BMI) is greater than or equal to A BMI of 30.0 or more is considered obese. Body Mass Index is calculated by using kilograms/meter 2. Throughout the report, the category overweight includes both overweight and obese respondents. The Healthy People 2020 goal for healthy weight is 34%. As a result, the unhealthy weight goal is 66%. (Objective NWS-8) The Healthy People 2020 goal for obesity is 31%. (Objective NWS-9) In 2010, 64% of Wisconsin respondents were classified as at least overweight (37% overweight, 27% obese). In the U.S., 64% were classified as at least overweight (36% overweight and 28% obese) (2010 Behavioral Risk Factor Surveillance) Findings According to the definition, 66% of respondents were overweight. Seventy-five percent of respondents 45 to 54 years old and 74% of those 55 to 64 years old were overweight compared to 47% of respondents 18 to 24 years old. Seventy-two percent of African American respondents and 70% of respondents who were non-white and non- African American were overweight compared to 61% of white respondents. Hispanic respondents were more likely to be overweight compared to non-hispanic respondents (73% and 65%, respectively). Sixty-eight percent of respondents with a high school education or less and 67% of those with some post high school education were overweight compared to 62% of respondents with a college education. Inactive respondents were more likely to be overweight (74%) compared to those who did an insufficient amount physical activity (68%) or respondents who met the recommended amount of physical activity (61%). Year Comparisons From 2003 to 2012, there was a statistical increase in the overall percent of respondents being overweight. In 2003, male respondents were more likely to be overweight. In all other study years, gender was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of female respondents being overweight. In 2003, respondents 45 and older were more likely to be overweight. In 2006, respondents 55 to 64 years old were more likely to be overweight. In 2009, respondents who were 35 to 44 years old or 55 to 64 years old were more likely to be overweight. In 2012, respondents 45 to 64 years old were more likely to be overweight. From 2003 to 2012, there was a noted increase in the percent of respondents 45 to 54 years old being overweight. In 2003 and 2009, African American respondents were more likely to be overweight. In 2006, respondents who were non-white and non-african American were more likely to be overweight. In 2012, respondents who were non-white were more likely to be overweight. Milwaukee County Community Health Survey Report

105 In 2003, 2006 and 2012, Hispanic respondents were more likely to be overweight. In 2009, Hispanic origin was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of non-hispanic respondents being overweight. In 2006, respondents with a high school education or less were more likely to be overweight. In 2012, respondents with some post high school education or less were more likely to be overweight. In all other study years, education was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents with some post high school education being overweight. In 2006, respondents in the bottom 60 percent household income bracket were more likely to be overweight. In all other study years, household income was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents in the top 40 percent household income bracket being overweight. In 2006, respondents who did not meet the recommended amount of physical activity were more likely to be overweight. In 2009 and 2012, inactive respondents were more likely to be overweight. Milwaukee County Community Health Survey Report

106 Table 26. Overweight by Demographic Variables for Each Survey Year, TOTAL a 62% 63% 66% 66% Gender 1 Male Female a Age 1,2,3,4 18 to to to to 54 a to and Older Race 1,2,3,4 White African American Other Hispanic Origin 1,2,4 Hispanic Non-Hispanic a Education 2,4 High School or Less Some Post High School a College Graduate Household Income 2 Bottom 40 Percent Bracket Middle 20 Percent Bracket Top 40 Percent Bracket a Marital Status Married Not Married Physical Activity 2,3,4 Inactive Insufficient Recommended Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Physical activity was defined differently in demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 b year difference at p 0.05 from 2006 to 2012 Milwaukee County Community Health Survey Report

107 Physical Well Being and Body Weight Overall Year Comparisons From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported moderate physical activity five times a week for at least 30 minutes. From 2006 to 2012, there was a statistical increase in the overall percent of respondents who reported vigorous physical activity three times a week for at least 20 minutes. From 2006 to 2012, there was no statistical change in the overall percent of respondents who met the recommended amount of physical activity. From 2003 to 2012, there was a statistical increase in the overall percent of respondents being overweight. Figure 11. Physical Well Being and Body Weight 100% Overweight 80% 60% 40% 20% 62% 28% 63% 45% 33% 22% 66% 41% 31% 19% 66% 47% 35% 24% Moderate Activity (5x/30+ min/week) Vigorous Activity (3x/20+ min/week) Recommended Physical Activity (Mod or Vig) 0% Nutrition (Figure 12; Tables 27 & 28) KEY FINDINGS: In 2012, 62% of respondents reported two or more servings of fruit while 26% reported three or more servings of vegetables on an average day. Respondents who were female, 25 to 34 years old, non-african American, with a college education, in the top 40 percent household income bracket, who were not overweight or who met the recommended amount of physical activity were more likely to report at least two servings of fruit. Respondents who were female, 35 to 44 years old, white, non-hispanic, with a college education, in the top 40 percent household income bracket, who were married or met the recommended amount of physical activity were more likely to report at least three servings of vegetables on an average day. From 2003 to 2012, there was a statistical decrease in the overall percent of respondents who reported at least two servings of fruit on an average day or at least three servings of vegetables on an average day. Milwaukee County Community Health Survey Report

108 Fruit Consumption Based on the USDA dietary guidelines, at a minimum, adults should have two servings of fruit each day. Age, gender and activity level may increase the recommended number of servings Findings Sixty-two percent of respondents reported at least two servings of fruit on an average day. Female respondents were more likely to report at least two servings of fruit a day (68%) compared to male respondents (55%). Sixty-five percent of respondents 25 to 34 years old reported at least two servings of fruit a day compared to 60% of those 55 to 64 years old or 57% of respondents 45 to 54 years old. Sixty-five percent of respondents who were non-african American reported at least two servings of fruit a day compared to 56% of African American respondents. Sixty-seven percent of respondents with a college education reported at least two servings of fruit a day compared to 64% of those with some post high school education or 57% of respondents with a high school education or less. Sixty-eight percent of respondents in the top 40 percent household income bracket reported at least two servings of fruit a day compared to 64% of those in the middle 20 percent income bracket or 59% of respondents in the bottom 40 percent household income bracket. Respondents who were not overweight were more likely to report at least two servings of fruit a day (66%) compared to overweight respondents (60%). Sixty-seven percent of respondents who met the recommended amount of physical activity reported at least two servings of fruit a day compared to 60% of those who did an insufficient amount of physical activity or 52% of inactive respondents. Year Comparisons From 2003 to 2012, there was a statistical decrease in the overall percent of respondents who reported two or more servings of fruit on an average day. In all study years, female respondents were more likely to report at least two servings of fruit per day. In 2003, 2009 and 2012, respondents 25 to 34 years old were more likely to report at least two servings of fruit per day. In 2006, respondents who were 18 to 24 years old were more likely to report at least two servings of fruit per day. From 2003 to 2012, there was a noted increase in the percent of respondents 18 to 24 years old and a noted decrease in the percent of respondents who were 25 to 34 years old or 55 and older reporting at least two or more servings of fruit. In 2003, white respondents were more likely to report at least two servings of fruit per day. In 2006 and 2012, respondents who were non-african American were more likely to report at least two servings of fruit per day. In 2009, respondents who were white or African American were more likely to report at least two servings of fruit per day. From 2003 to 2012, there was a noted increase in the percent of respondents who were non-white and non-african American reporting at least two or more servings of fruit. Milwaukee County Community Health Survey Report

109 In 2003, non-hispanic respondents were more likely to report at least two servings of fruit per day. In all other study years, Hispanic origin was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of non-hispanic respondents reporting at least two or more servings of fruit. In all study years, respondents with a college education were more likely to report two or more servings of fruit, with a noted decrease in In 2003, 2006 and 2012, respondents in the top 40 percent household income bracket were more likely to report at least two servings of fruit. In 2009, respondents in the top 60 percent household income bracket were more likely to report at least two servings of fruit. In 2003, 2006 and 2009, married respondents were more likely to report at least two servings of fruit. In 2012, marital status was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of married respondents reporting at least two or more servings of fruit. In 2006 and 2012, respondents who were not overweight were more likely to report at least two servings of fruit. In all other study years, overweight status was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of overweight respondents reporting at least two or more servings of fruit. In 2006, 2009 and 2012, respondents who met the recommended amount of physical activity were more likely to report at least two servings of fruit. Milwaukee County Community Health Survey Report

110 Table 27. Two or More Servings of Fruit on Average Day by Demographic Variables for Each Survey Year, TOTAL a 66% 61% 58% 62% Gender 1,2,3,4 Male Female Age 1,2,3 18 to 24 a to 34 a to to to 64 a and Older a Race 1,2,3,4 White African American Other a Hispanic Origin 1 Hispanic Non-Hispanic a Education 1,2,3,4 High School or Less Some Post High School College Graduate a Household Income 1,2,3,4 Bottom 40 Percent Bracket Middle 20 Percent Bracket Top 40 Percent Bracket Marital Status 1,2,3 Married a Not Married Overweight Status 2,4 Not Overweight Overweight a Physical Activity 2,3,4 Inactive Insufficient Recommended Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Physical activity was defined differently in demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 b year difference at p 0.05 from 2006 to 2012 Milwaukee County Community Health Survey Report

111 Vegetable Consumption Based on the USDA dietary guidelines, at a minimum, adults should have three servings of vegetables each day. Age, gender and activity level may increase the recommended number of servings Findings Twenty-six percent of respondents reported three or more servings of vegetables on an average day. Female respondents were more likely to report at least three servings of vegetables a day (30%) compared to male respondents (21%). Respondents 35 to 44 years old were more likely to report at least three servings of vegetables a day (36%) compared to those 65 and older (20%) or respondents 18 to 24 years old (17%). White respondents were more likely to report at least three servings of vegetables a day (28%) compared to African American respondents (23%) or respondents of another race (21%). Non-Hispanic respondents were more likely to report at least three servings of vegetables a day compared to Hispanic respondents (27% and 14%, respectively). Thirty-seven percent of college respondents reported at least three servings of vegetables a day compared to 27% of those with some post high school education or 16% of respondents with a high school education or less. Thirty-eight percent of respondents in the top 40 percent household income bracket reported at least three servings of vegetables a day compared to 23% of those in the middle 20 percent income bracket or 22% of respondents in the bottom 40 percent household income bracket. Married respondents were more likely to report at least three servings of vegetables a day compared to unmarried respondents (30% and 23%, respectively). Thirty percent of respondents who met the recommended amount of physical activity reported at least three servings of vegetables a day compared to 23% of respondents who did not meet the recommended amount of physical activity. Year Comparisons From 2003 to 2012, there was a statistical decrease in the overall percent of respondents who reported three or more servings of vegetables on an average day. In all study years, female respondents were more likely to report at least three vegetable servings per day. From 2003 to 2012, there was a noted decrease in the percent of respondents across gender reporting at least three vegetable servings per day. In 2003, respondents 25 to 34 years old were more likely to report at least three vegetable servings per day. In 2012, respondents 35 to 44 years old were more likely to report at least three servings of vegetables, with a noted increase since In all other study years, age was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents who were 25 to 34 years old or 55 and older reporting at least three vegetable servings per day. Milwaukee County Community Health Survey Report

112 In all study years, white respondents were more likely to report at least three servings of vegetables per day, with a noted decrease in In 2009 and 2012, non-hispanic respondents were more likely to report at least three servings of vegetables per day. In all other study years, Hispanic origin was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents across Hispanic origin reporting at least three vegetable servings per day. In all study years, respondents with a college education were more likely to report at least three servings of vegetables. From 2003 to 2012, there was a noted decrease in the percent of respondents with a high school education or less reporting at least three vegetable servings per day. In all study years, respondents in the top 40 percent household income bracket were more likely to report at least three servings of vegetables. From 2003 to 2012, there was a noted decrease in the percent of respondents in the middle 20 percent household income bracket reporting at least three vegetable servings per day. In all study years, married respondents were more likely to report at least three servings of vegetables, with a noted decrease in In 2009, respondents who were not overweight were more likely to report at least three servings of vegetables. In all other study years, overweight status was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents who were not overweight reporting at least three vegetable servings per day. In 2006, 2009 and 2012, respondents who met the recommended amount of physical activity were more likely to report at least three servings of vegetables. From 2006 to 2012, there was a noted increase in the percent of inactive respondents reporting at least three vegetable servings per day. Milwaukee County Community Health Survey Report

113 Table 28. Three or More Servings of Vegetables on Average Day by Demographic Variables for Each Survey Year, TOTAL a 30% 24% 21% 26% Gender 1,2,3,4 Male a Female a Age 1,4 18 to to 34 a to 44 a to to 64 a and Older a Race 1,2,3,4 White a African American Other Hispanic Origin 3,4 Hispanic a Non-Hispanic a Education 1,2,3,4 High School or Less a Some Post High School College Graduate Household Income 1,2,3,4 Bottom 40 Percent Bracket Middle 20 Percent Bracket a Top 40 Percent Bracket Marital Status 1,2,3,4 Married a Not Married Overweight Status 3 Not Overweight a Overweight Physical Activity 2,3,4 Inactive b Insufficient Recommended Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Physical activity was defined differently in demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 b year difference at p 0.05 from 2006 to 2012 Milwaukee County Community Health Survey Report

114 Nutrition Overall Year Comparisons From 2003 to 2012, there was a statistical decrease in the overall percent of respondents who reported at least two servings of fruit on an average day or at least three servings of vegetables on an average day. 100% Figure 12. Fruit and Vegetable Consumption on an Average Day 80% 60% 40% 20% 66% 30% 61% 24% 58% 21% 62% 26% Fruit (Two or more servings) Vegetable (Three or more servings) 0% Women s Health (Figure 13; Tables 29-31) KEY FINDINGS: In 2012, 77% of female respondents 50 and older reported a mammogram within the past two years; respondents who were in the top 60 percent household income bracket or married were more likely to report this. Seventy-one percent of female respondents 65 and older had a bone density scan; respondents with at least some post high school education were more likely to report this. Eighty-six percent of female respondents 18 to 65 years old reported a pap smear within the past three years; respondents who were 35 to 44 years old, African American, non- Hispanic, with a college education or married respondents were more likely to report this. From 2003 to 2012, there was a statistical decrease in the overall percent of respondents 50 and older who reported having a mammogram within the past two years. From 2006 to 2012, there was no statistical change in the overall percent of respondents 65 and older who reported a bone density scan. From 2003 to 2012, there was a statistical decrease in the overall percent of respondents 18 to 65 years old who reported having a pap smear within the past three years. Milwaukee County Community Health Survey Report

115 Mammogram Routine screening for breast cancer every one to two years with mammography is recommended for women 50 to 74 years old. 2 In 2010, 80% of Wisconsin women and 78% of U.S. women 50 and older reported a mammogram within the past two years (2010 Behavioral Risk Factor Surveillance) Findings Seventy-seven percent of female respondents 50 and older had a mammogram within the past two years. Three percent reported never. Eighty-five percent of respondents in the top 60 percent household income bracket reported a mammogram within the past two years compared to 73% of respondents in the bottom 40 percent household income bracket. Married respondents were more likely to report a mammogram within the past two years compared to unmarried respondents (83% and 74%, respectively). Year Comparisons From 2003 to 2012, there was a statistical decrease in the overall percent of respondents who reported having a mammogram within the past two years. Race was not a significant variable in any study year. From 2003 to 2012, there was a noted decrease in the percent of white respondents reporting a mammogram within the past two years. In 2009, respondents with at least some post high school education were more likely to report a mammogram within the past two years. In all other study years, education was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents with a high school education or less reporting a mammogram within the past two years. In 2006, 2009 and 2012, respondents in the top 60 percent household income bracket were more likely to report a mammogram within the past two years. In 2003, household income was not a significant variable. In 2006, 2009 and 2012, married respondents were more likely to report a mammogram within the past two years. In 2003, marital status was not a significant variable. 2 Screening for Breast Cancer. U.S. Preventive Services Task Force: The Guide to Clinical Preventive Services, Agency for Healthcare Research and Quality, Milwaukee County Community Health Survey Report

116 Table 29. Mammogram Within Past Two Years by Demographic Variables for Each Survey Year (Respondents 50 and Older), TOTAL a 84% 78% 78% 77% Race White a African American Education 3 High School or Less a Some Post High School or More Household Income 2,3,4 Bottom 40 Percent Bracket Top 60 Percent Bracket Marital Status 2,3,4 Married Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Other race and Hispanic origin not included as a result of too few cases for statistical reliability. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Bone Density Scan 2012 Findings Seventy-one percent of the 182 female respondents 65 and older had a bone density scan to determine if they are at risk for fractures or are in the early stages of osteoporosis. Seventy-nine percent of respondents with at least some post high school education reported having a bone density scan compared to 64% of respondents with a high school education or less. Year Comparisons From 2006 to 2012, there was no statistical change in the overall percent of respondents who reported having a bone density scan. In all study years, respondents with at least some post high school education were more likely to report having a bone density scan. In 2006, married respondents were more likely to report having a bone density scan. In all other study years, marital status was not a significant variable. Milwaukee County Community Health Survey Report

117 Table 30. Bone Density Scan by Demographic Variables for Each Survey Year (Respondents 65 and Older) TOTAL 67% 73% 71% Education 1,2,3 High School or Less Some Post High School or More Household Income Bottom 40 Percent Bracket Top 60 Percent Bracket Marital Status 1 Married Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2006; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2006 to 2012 Pap Smear Routine screening for cervical cancer with Papanicolaou (Pap) testing is recommended for all women who are or have been sexually active and who have a cervix. Pap smears should begin with the onset of sexual activity or at age 21 and should be repeated at least every three years. There is insufficient evidence to recommend for or against an upper age limit for Pap testing, but recommendations can be made on other grounds to discontinue regular testing after age 65 in women who have had regular previous screenings in which the smears have been consistently normal. 3 The Healthy People 2020 goal for women 21 to 65 years old having a pap test within the past three years is 93%. (Objective C-15) In 2010, 85% of Wisconsin women and 81% of U.S. women 18 and older reported a pap smear within the past three years (2010 Behavioral Risk Factor Surveillance) Findings A total of 86% of respondents 18 to 65 years old with a cervix reported they had a pap smear within the past three years. Respondents 35 to 44 years old were more likely to report a pap smear within the past three years (98%) compared to those 55 to 65 years old (79%) or respondents 18 to 24 years old (74%). African American respondents were more likely to report a pap smear within the past three years (92%) compared to white respondents (85%) or respondents of another race (72%). 3 Screening for Cervical Cancer. U.S. Preventive Services Task Force: The Guide to Clinical Preventive Services, Agency for Healthcare Research and Quality, Pages Milwaukee County Community Health Survey Report

118 Non-Hispanic respondents were more likely to report a pap smear within the past three years compared to Hispanic respondents (87% and 78%, respectively). Ninety-one percent of respondents with a college education reported a pap smear within the past three years compared to 86% of those with some post high school education or 81% of respondents with a high school education or less. Married respondents were more likely to report a pap smear within the past three years compared to unmarried respondents (89% and 84%, respectively). Year Comparisons From 2003 to 2012, there was a statistical decrease in the overall percent of respondents who reported a pap smear within the past three years. In 2003, 2006 and 2009, respondents 25 to 34 years old were more likely to report a pap smear within the past three years. In 2012, respondents 35 to 44 years old were more likely to report a pap smear within the past three years. From 2003 to 2012, there was a noted decrease in the percent of respondents 18 to 24 years old reporting a pap smear within the past three years. In 2003, 2009 and 2012, African American respondents were more likely to report a pap smear within the past three years. In 2006, race was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of white respondents reporting a pap smear within the past three years. In 2012, non-hispanic respondents were more likely to report a pap smear within the past three years, with a noted decrease since In all other study years, Hispanic origin was not a significant variable in any study year. In 2006 and 2012, respondents with a college education were more likely to report a pap smear within the past three years. In all other study years, education was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents with a high school education or less reporting a pap smear within the past three years. In 2003, respondents in the top 60 percent household income bracket were more likely to report a pap smear within the past three years. In 2006, respondents in the top 40 percent household income bracket were more likely to report a pap smear within the past three years. In all other study years, household income was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents in the middle 20 percent household income bracket reporting a pap smear within the past three years. In 2006, 2009 and 2012, married respondents were more likely to report a pap smear within the past three years. In 2003, marital status was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of unmarried respondents reporting a pap smear within the past three years. Milwaukee County Community Health Survey Report

119 Table 31. Pap Smear Within Past Three Years by Demographic Variables for Each Survey Year (Respondents 18 to 65 Years Old and With a Cervix) TOTAL a 91% 90% 89% 86% Age 1,2,3,4 18 to 24 a to to to to Race 1,3,4 White a African American Other Hispanic Origin 4 Hispanic Non-Hispanic a Education 2,4 High School or Less a Some Post High School College Graduate Household Income 1,2 Bottom 40 Percent Bracket Middle 20 Percent Bracket a Top 40 Percent Bracket Marital Status 2,3,4 Married Not Married a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

120 Women s Health Tests Overall Year Comparisons From 2003 to 2012, there was a statistical decrease in the overall percent of respondents 50 and older who reported having a mammogram within the past two years. From 2006 to 2012, there was no statistical change in the overall percent of respondents 65 and older who reported a bone density scan. From 2003 to 2012, there was a statistical decrease in the overall percent of respondents 18 to 65 years old who reported having a pap smear within the past three years. Figure 13. Women's Health Tests 100% 80% 60% 91% 84% 81% 90% 89% 86% 78% 78% 77% 75% 74% 73% 73% 71% 67% Pap Smear - within past 3 yrs. (18 to 65 yrs. old) 40% 20% Mammogram - within past 2 yrs. (50 and older) Mammogram - within past 2 yrs. (40 and older) Bone Density Scan (65 and older) 0% Men s Health (Figure 14; Table 32) KEY FINDINGS: In 2012, 51% of male respondents 40 and older had a prostate cancer screening within the past two years with either a digital rectal exam (DRE) or a prostate-specific antigen (PSA) test. Respondents 50 and older were more likely to report this. From 2006 to 2012, there was a statistical decrease in the overall percent of male respondents 40 and older who reported a prostate cancer screening within the past two years. Milwaukee County Community Health Survey Report

121 Prostate Cancer Screening The U.S. Preventive Services Task Force concludes there is insufficient evidence for or against routine screening for prostate cancer with a prostate-specific antigen (PSA) test or a digital rectal examination (DRE) Findings Fifty-one percent of male respondents 40 and older had a prostate cancer screening within the past two years. Twenty-six percent of male respondents never had a prostate cancer screening. Sixty-four percent of male respondents 50 and older reported a prostate cancer screen within the past two years compared to 26% of male respondents 40 to 49 years old. Year Comparisons In 2006 and 2009, men were asked separate questions about their most recent digital rectal exam and their most recent prostate-specific antigen test. In 2012, both tests were combined into one prostate cancer screening question. From 2006 to 2012, there was a statistical decrease in the overall percent of male respondents 40 and older who reported a prostate cancer screening within the past two years. In all study years, respondents 50 and older were more likely to report a prostate cancer screen in the past two years. From 2006 to 2012, there was a noted decrease in the percent of respondents across age reporting a screen within the past two years. Race was not a significant variable in any study year. From 2006 to 2012, there was a noted decrease in the percent of white respondents reporting a prostate screen in the past two years. Education was not a significant variable in any study year. From 2006 to 2012, there was a noted decrease in the percent of respondents with at least some post high school education reporting a prostate cancer screen within the past two years. Household income was not a significant variable in any study year. From 2006 to 2012, there was a noted decrease in the percent of respondents in the bottom 40 percent household income bracket reporting a prostate cancer screen within the past two years. In 2006 and 2009, married respondents were more likely to report a prostate cancer screen in the past two years. In 2012, marital status was not a significant variable. From 2006 to 2012, there was a noted decrease in the percent of married respondents reporting a prostate screen in the past two years. 4 Screening for Prostate Cancer. U.S. Preventive Services Task Force: The Guide to Clinical Preventive Services, Agency for Healthcare Research and Quality, Pages Milwaukee County Community Health Survey Report

122 Table 32. Prostate Cancer Screening Within Past Two Years by Demographic Variables for Each Survey Year (Respondents 40 and Older),, TOTAL a 61% 64% 51% Age 1,2,3 40 to 49 a and Older a Race White a African American Education High School or Less Some Post High School or More a Household Income Bottom 40 Percent Bracket a Top 60 Percent Bracket Marital Status 1,2 Married a Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. In 2006 and 2009, DRE and PSA tests were two separate questions. In 2012, they were combined into one prostate cancer screening question. Other race not included as a result of too few cases for statistical reliability. 1 demographic difference at p 0.05 in 2006; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2006 to 2012 Milwaukee County Community Health Survey Report

123 Men s Health Overall Year Comparisons From 2006 to 2012, there was a statistical decrease in the overall percent of male respondents 40 and older who reported a prostate cancer screening within the past two years. 100% Figure 14. Prostate Cancer Screening in Past Two Years (Male Respondents 40 and Older)* 80% 60% 61% 64% 51% 40% 20% 0% *In 2006 and 2009, DRE and PSA tests were two separate questions. In 2012, they were combined into one prostate cancer screening question. Colorectal Cancer Screening (Figure 15; Tables 33-36) KEY FINDINGS: In 2012, 14% of respondents 50 and older reported a blood stool test within the past year. Ten percent of respondents 50 and older reported a sigmoidoscopy within the past five years while 61% reported a colonoscopy within the past ten years. This results in 67% of respondents meeting current colorectal cancer screening recommendations. From 2003 to 2012, there was a statistical decrease in the overall percent of respondents who reported a blood stool test within the past year. From 2009 to 2012, there was no statistical change in the overall percent of respondents who reported a sigmoidoscopy within the past five years or a colonoscopy within the past ten years. From 2009 to 2012, there was a statistical increase in the overall percent of respondents who reported at least one of these tests in the recommended time frame. Milwaukee County Community Health Survey Report

124 Blood Stool Test 2012 Findings Fourteen percent of respondents 50 and older had a blood stool test within the past year. Fifty percent reported never. African American respondents were more likely to report a blood stool test within the past year (18%) compared to white respondents (12%). Year Comparisons From 2003 to 2012, there was a statistical decrease in the overall percent of respondents who reported a blood stool test within the past year. In 2003, male respondents were more likely to report a blood stool test within the past year. In all other study years, gender was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents across gender reporting a blood stool test within the past year. In 2006 and 2012, African American respondents were more likely to report a blood stool test within the past year. In 2003, race was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents across race reporting a blood stool test within the past year. Education was not a significant variable in any study year. From 2003 to 2012, there was a noted decrease in the percent of respondents across education reporting a blood stool test within the past year. In 2003, respondents in the top 60 percent household income bracket were more likely to report a blood stool test within the past year. In all other study years, household income was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents across household income reporting a blood stool test within the past year. Marital status was not a significant variable in any study year. From 2003 to 2012, there was a noted decrease in the percent of respondents across marital status reporting a blood stool test within the past year. Milwaukee County Community Health Survey Report

125 Table 33. Blood Stool Test Within Past Year by Demographic Variables for Each Survey Year (Respondents 50 and Older), TOTAL a 36% 23% 14% Gender 1 Male a Female a Race 2,3 White a African American a Education High School or Less a Some Post High School a College Graduate a Household Income 1 Bottom 40 Percent Bracket a Top 60 Percent Bracket a Marital Status Married a Not Married a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Other race and Hispanic origin not included as a result of too few cases. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Sigmoidoscopy A colonoscopy is recommended every 10 years for persons 50 and older while a flexible sigmoidoscopy is recommended more often Findings Ten percent of respondents 50 and older reported their last sigmoidoscopy was within the past five years. Seventy-four percent reported never. African American respondents were more likely to report a sigmoidoscopy within the past five years (15%) compared to white respondents (8%). 5 Screening for Colorectal Cancer. U.S. Preventive Services Task Force: The Guide to Clinical Preventive Services, Agency for Healthcare Research and Quality, Pages Milwaukee County Community Health Survey Report

126 Year Comparisons In 2003 and 2006, sigmoidoscopy and colonoscopy were combined as one question and cannot be compared to more recent data. From 2009 to 2012, there was no statistical change in the overall percent of respondents 50 and older who reported a sigmoidoscopy within the past five years. In 2009, male respondents were more likely to report a sigmoidoscopy within the past five years. In 2012, gender was not a significant variable. In 2012, African American respondents were more likely to report a sigmoidoscopy within the past five years. In 2009, race was not a significant variable. Table 34. Sigmoidoscopy Within Past Five Years by Demographic Variables for Each Survey Year (Respondents 50 and Older), TOTAL 10% 10% Gender 1 Male Female 8 9 Race 2 White 11 8 African American 9 15 Education High School or Less Some Post High School 9 10 College Graduate 11 9 Household Income Bottom 40 Percent Bracket Top 60 Percent Bracket 8 10 Marital Status Married 11 7 Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Other race and Hispanic origin not included as a result of too few cases. 1 demographic difference at p 0.05 in demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2009 to 2012 Milwaukee County Community Health Survey Report

127 Colonoscopy A colonoscopy is recommended every 10 years for persons 50 and older while a flexible sigmoidoscopy is recommended more often Findings Sixty-one percent of respondents 50 and older had a colonoscopy within the past ten years. Thirty-two percent reported never. Sixty-seven percent of respondents with a college education and 65% of those with some post high school education reported a colonoscopy within the past ten years compared to 55% of respondents with a high school education or less. Married respondents were more likely to report a colonoscopy within the past ten years compared to unmarried respondents (66% and 58%, respectively). Year Comparisons In 2003 and 2006, sigmoidoscopy and colonoscopy were combined as one question and cannot be compared to more recent data. From 2009 to 2012, there was no statistical change in the overall percent of respondents 50 and older who reported a colonoscopy within the past ten years. Race was not a significant variable in any study year. From 2009 to 2012, there was a noted increase in the percent of African American respondents reporting a colonoscopy within the past ten years. In 2012, respondents with at least some post high school education were more likely to report a colonoscopy within the past ten years. In 2009, education was not a significant variable. In 2009, respondents in the top 60 percent household income bracket were more likely to report a colonoscopy within the past ten years. In 2012, household income was not a significant variable. In both study years, married respondents were more likely to report a colonoscopy within the past ten years. 6 Screening for Colorectal Cancer. U.S. Preventive Services Task Force: The Guide to Clinical Preventive Services, Agency for Healthcare Research and Quality, Pages Milwaukee County Community Health Survey Report

128 Table 35. Colonoscopy Within Past Ten Years by Demographic Variables for Each Survey Year (Respondents 50 and Older), TOTAL 58% 61% Gender Male Female Race White African American a Education 2 High School or Less Some Post High School College Graduate Household Income 1 Bottom 40 Percent Bracket Top 60 Percent Bracket Marital Status 1,2 Married Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Other race and Hispanic origin not included as a result of too few cases. 1 demographic difference at p 0.05 in demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2009 to 2012 Colorectal Cancer Screening Recommendation Met The Healthy People 2020 goal for meeting the colorectal cancer screening recommendation is 71%. (Objective C-16) 2012 Findings Sixty-seven percent of respondents 50 and older had one of the three tests in the time frame recommended (blood stool test within the past year, sigmoidoscopy within the past five years, or colonoscopy within the past 10 years). There were no statistically significant differences between demographic variables and responses of reporting a colorectal cancer screen in the recommended time frame. Year Comparisons From 2009 to 2012, there was a statistical increase in the overall percent of respondents 50 and older who reported a colorectal cancer screen in the recommended time frame. Milwaukee County Community Health Survey Report

129 Gender was not a significant variable in any study year. From 2009 to 2012, there was a noted increase in the percent of female respondents reporting a colorectal cancer screen in the recommended time frame. Race was not a significant variable in any study year. From 2009 to 2012, there was a noted increase in the percent of African American respondents reporting a colorectal cancer screen in the recommended time frame. In 2009, respondents in the top 60 percent household income bracket were more likely to report a colorectal cancer screen in the recommended time frame. In 2012, household income was not a significant variable. From 2009 to 2012, there was a noted increase in the percent of respondents in the bottom 40 percent household income bracket reporting a colorectal cancer screen in the recommended time frame. In 2009, married respondents were more likely to report a colorectal cancer screen in the recommended time frame. In 2012, marital status was not a significant variable. Table 36. Colorectal Cancer Screening in Recommended Time Frame by Demographic Variables for Each Survey Year (Respondents 50 and Older),, TOTAL a 61% 67% Gender Male Female a Race White African American a Education High School or Less Some Post High School College Graduate Household Income 1 Bottom 40 Percent Bracket a Top 60 Percent Bracket Marital Status 1 Married Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. In 2009, blood stool test was not asked. Other race and Hispanic origin not included as a result of too few cases. 1 demographic difference at p 0.05 in demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2009 to 2012 Milwaukee County Community Health Survey Report

130 Colorectal Cancer Screenings Overall Year Comparisons From 2003 to 2012, there was a statistical decrease in the overall percent of respondents who reported a blood stool test within the past year. From 2009 to 2012, there was no statistical change in the overall percent of respondents who reported a sigmoidoscopy within the past five years or a colonoscopy within the past ten years. From 2009 to 2012, there was a statistical increase in the overall percent of respondents who reported at least one of these tests in the recommended time frame. 100% 80% 60% 40% 20% 36% Figure 15. Colorectal Cancer Screenings (Respondents 50 and Older) 23% 61% 58% 67% 61% 14% 0% 10% 10% At Least One Test within Recommended Time Frame Colonoscopy (within past 10 yrs.) Sigmoidoscopy (within past 5 yrs.) Blood Stool Test (past year)* *Not asked in Tobacco Use (Figures 16 & 17; Tables 37-40) KEY FINDINGS: In 2012, 24% of respondents were current smokers; respondents who were male, 25 to 34 years old, African American, with a high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to be a smoker. Six percent of respondents reported other tobacco use such as cigars, pipes, chewing tobacco or snuff in the past 30 days; respondents who were male or 25 to 34 years old were more likely to report this. In the past 12 months, 64% of current smokers quit smoking for one day or longer because they were trying to quit; respondents who were 18 to 24 years old or African American were more likely to report this. Eighty percent of current smokers who saw a health professional in the past year reported the professional advised them to quit smoking; respondents 35 to 54 years old were more likely to report this. From 2003 to 2012, there was no statistical change in the overall percent of respondents who were current smokers. From 2003 to 2012, there was a statistical increase in the overall percent of current smokers who reported they quit smoking for one day or longer in the past 12 months because they were trying to quit. From 2006 to 2012, there was no statistical change in the overall percent of current smokers who reported their health professional advised them to quit smoking. Milwaukee County Community Health Survey Report

131 Current Smokers The Healthy People 2020 goal for adult smoking is 12%. (Objective TU-1.1) In 2010, 19% of Wisconsin respondents were current smokers while 17% of U.S. respondents were current smokers (2010 Behavioral Risk Factor Surveillance) Findings Twenty-four percent of respondents were current smokers (17% every day and 7% some days). Male respondents were more likely to be current smokers (29%) compared to female respondents (21%). Thirty-two percent of respondents 25 to 34 years old were current smokers compared to 20% of those 18 to 24 years old or 11% of respondents 65 and older. African American respondents were more likely to be current smokers (31%) compared to white respondents (22%) or respondents of another race (18%). Thirty-three percent of respondents with a high school education or less were current smokers compared to 25% of those with some post high school education or 14% of respondents with a college education. Thirty-three percent of respondents in the bottom 40 percent household income bracket were current smokers compared to 20% of those in the middle 20 percent income bracket or 12% of respondents in the top 40 percent household income bracket. Unmarried respondents were more likely to be current smokers compared to married respondents (29% and 16%, respectively). Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents who were current smokers. In all study years, male respondents were more likely to report they were a current smoker. From 2003 to 2012, there was a noted decrease in the percent of female respondents who were current smokers. In 2003, respondents 18 to 44 years old were more likely to report they were a current smoker. In 2006, respondents 18 to 54 years old were more likely to report they were a current smoker. In 2009, respondents 35 to 44 years old were more likely to report they were a current smoker. In 2012, respondents 25 to 34 years old were more likely to report this. From 2003 to 2012, there was a noted decrease in the percent of respondents 18 to 24 years old who were current smokers. In 2003, 2006 and 2012, African American respondents were more likely to report they were a current smoker. In 2009, respondents who were non-white and non-african American were more likely to report they were a current smoker. From 2003 to 2012, there was a noted decrease in the percent of respondents who were nonwhite and non-african American who were current smokers. In 2009, Hispanic respondents were more likely to report they were a current smoker. In all other study years, Hispanic origin was not a significant variable. Milwaukee County Community Health Survey Report

132 In all study years, respondents with a high school education or less were more likely to be a current smoker. In all study years, respondents in the bottom 40 percent household income bracket were more likely to be a current smoker. From 2003 to 2012, there was a noted decrease in the percent of respondents in the top 40 percent household income bracket who were current smokers. In all study years, unmarried respondents were more likely to report they were a current smoker. From 2003 to 2012, there was a noted decrease in the percent of married respondents who were current smokers. Table 37. Current Smokers by Demographic Variables for Each Survey Year TOTAL 26% 26% 25% 24% Gender 1,2,3,4 Male Female a Age 1,2,3,4 18 to 24 a to to to to and Older Race 1,2,3,4 White African American Other a Hispanic Origin 3 Hispanic Non-Hispanic Education 1,2,3,4 High School or Less Some Post High School College Graduate Household Income 1,2,3,4 Bottom 40 Percent Bracket Middle 20 Percent Bracket Top 40 Percent Bracket a Marital Status 1,2,3,4 Married a Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

133 Other Tobacco Use in Past 30 Days 2012 Findings Six percent of respondents reported they used other tobacco products such as cigars, pipes, chewing tobacco or snuff in the past 30 days. Male respondents were more likely to report other tobacco use in the past month (11%) compared to female respondents (2%). Ten percent of respondents 25 to 34 years old reported other tobacco use in the past month compared to 5% of those 45 to 64 years old or 3% of respondents 65 and older. Milwaukee County Community Health Survey Report

134 Table 38. Other Tobacco Use in Past 30 Days by Demographic Variables for TOTAL 6% Gender 1 Male 11 Female 2 Age 1 18 to to to to to and Older 3 Race White 7 African American 5 Other 7 Hispanic Origin Hispanic 8 Non-Hispanic 6 Education High School or Less 5 Some Post High School 7 College Graduate 6 Household Income Bottom 40 Percent Bracket 6 Middle 20 Percent Bracket 8 Top 40 Percent Bracket 8 Marital Status Married 5 Not Married 6 Percentages occasionally may differ by 1 or 2 percentage points from the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2012 Milwaukee County Community Health Survey Report

135 Tobacco Use Overall Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents who were current smokers. 100% Figure 16. Tobacco Use (Past 30 Days) 80% 60% Current Smoker Other Tobacco Products 40% 20% 26% 26% 25% 24% 6% 0% Quit Smoking for at Least One Day in Past 12 Months as a Result of Trying to Quit The Healthy People 2020 goal for current smokers to have tried quitting for at least one day is 80%. (Objective TU- 4.1) In 2005, 49% of Wisconsin respondents reported they quit smoking for at least one day because they were trying to quit while 56% of U.S. respondents reported a cessation attempt for at least one day (2005 Behavioral Risk Factor Surveillance) Findings Of current smokers o o o Sixty-four percent of current smokers reported they quit smoking for one day or longer in the past year because they were trying to quit. Seventy-seven percent of respondents 18 to 24 years old reported they quit smoking for one day or longer in the past year because they were trying to quit compared to 59% of those 45 to 54 years old or 55% of respondents 55 and older. African American respondents were more likely to report they quit smoking for one day or longer in the past year (69%) compared to white respondents (58%). Year Comparisons o From 2003 to 2012, there was a statistical increase in the overall percent of current smokers who reported they quit smoking for one day or longer because they were trying to quit. Milwaukee County Community Health Survey Report

136 o o o o o o In 2006, male respondents were more likely to report they quit smoking for at least one day. In all other study years, gender was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents across gender reporting they quit smoking for at least one day. In 2003, 2006 and 2012, respondents 18 to 24 years old were more likely to report they quit smoking for at least one day. In 2009, age was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents 35 and older reporting they quit smoking for at least one day. In all study years, African American respondents were more likely to report they quit smoking for one day or longer because they were trying to quit. From 2003 to 2012, there was a noted increase in the percent of white respondents reporting they quit smoking for at least one day. Education was not a significant variable in any study year. From 2003 to 2012, there was a noted increase in the percent of respondents across education reporting they quit smoking for at least one day. In 2003, respondents in the bottom 40 percent household income bracket were more likely to report they quit smoking for at least one day. In all other study years, household income was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents in the top 60 percent household income bracket reporting they quit smoking for at least one day. Marital status was not a significant variable in any study year. From 2003 to 2012, there was a noted increase in the percent of respondents across marital status reporting they quit smoking for at least one day. Milwaukee County Community Health Survey Report

137 Table 39. Current Smokers Quit Smoking for One Day or Longer in Past Year by Demographic Variables for Each Survey Year, TOTAL a 51% 54% 53% 64% Gender 2 Male a Female a Age 1,2,4 18 to to to 44 a to 54 a and Older a Race 1,2,3,4 White a African American Education High School or Less a Some Post High School or More a Household Income 1 Bottom 40 Percent Bracket Top 60 Percent Bracket a Marital Status Married a Not Married a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Other race and Hispanic origin not included as a result of too few cases for statistical reliability. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Doctor, Nurse or Other Health Professional Advised Respondent to Quit 2012 Findings Of current smokers who have seen a health professional in the past 12 months o o Eighty percent of the 347 current smokers who have seen a health professional in the past 12 months reported their health professional advised them to quit smoking. Eighty-eight percent of respondents 35 to 44 years old and 86% of those 45 to 54 years old reported a health professional advised them to quit smoking in the past year compared to 70% of respondents 25 to 34 years old. Milwaukee County Community Health Survey Report

138 Year Comparisons o o From 2006 to 2012, there was no statistical change in the overall percent of respondents who reported their health professional advised them to quit smoking. In 2009, respondents 55 and older were more likely to report a health professional advised them to quit smoking in the past year. In 2012, respondents 35 to 54 years old were more likely to report a health professional advised them to quit smoking in the past year. In 2006, age was not a significant variable. Table 40. Doctor, Nurse or Other Health Professional Advised Respondent to Quit Smoking in Past Year by Demographic Variables for Each Survey Year, TOTAL 77% 72% 80% Gender Male Female Age 2,3 18 to to to to and Older Race White African American Education High School or Less Some Post High School or More Household Income Bottom 40 Percent Bracket Top 60 Percent Bracket Marital Status Married Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Other race and Hispanic origin not included as a result of too few cases for statistical reliability. 1 demographic difference at p 0.05 in 2006; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2006 to 2012 Milwaukee County Community Health Survey Report

139 Smoking Cessation Overall Year Comparisons From 2003 to 2012, there was a statistical increase in the overall percent of current smokers who reported they quit smoking for one day or longer in the past 12 months because they were trying to quit. From 2006 to 2012, there was no statistical change in the overall percent of current smokers who reported their health professional advised them to quit smoking. 100% Figure 17. Smoking Cessation in Past 12 Months (Current Smokers) 80% 77% 72% 80% 60% 40% 51% 54% 53% 64% Health Care Professional Advised Respondent to Q uit Quit Smoking for at Least 1 Day 20% 0% Exposure to Cigarette Smoke (Figures 18 & 19; Tables 41 & 42) KEY FINDINGS: In 2012, 74% of respondents reported smoking is not allowed anywhere inside the home. Respondents who were in the top 40 percent household income bracket, married, nonsmokers or in households with children were more likely to report smoking is not allowed anywhere inside the home. Twenty-three percent of nonsmoking respondents reported they were exposed to second-hand smoke in the past seven days; respondents who were male, 18 to 24 years old, non-white, Hispanic, with some post high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. Smoking Policy Inside Home From 2009 to 2012, there was a statistical increase in the overall percent of respondents who reported smoking is not allowed anywhere inside the home. From 2009 to 2012, there was a statistical decrease in the overall percent of respondents who reported they were exposed to second-hand smoke in the past seven days. In 2003, 75% of Wisconsin respondents reported smoking is prohibited in their home (2003 Tobacco Use Supplement to the Current Population Survey). In , 79% of U.S. respondents reported smoking is prohibited in their home ( Tobacco Use Supplement to the Current Population Survey). Milwaukee County Community Health Survey Report

140 2012 Findings Seventy-four percent of respondents reported smoking is not allowed anywhere inside the home while 10% reported smoking is allowed in some places or at some times. Four percent reported smoking is allowed anywhere inside the home. Twelve percent of respondents reported there are no rules about smoking inside the home. Figure 18. Smoking Policy Inside Home for 2012 Allowed Some Places/Some Times 10% Not Allowed Anywhere 74% Allowed Anywhere 4% Not Sure <1% No Rules About Smoking 12% Eighty-seven percent of respondents in the top 40 percent household income bracket reported smoking is not allowed in the home compared to 75% of those in the middle 20 percent income bracket or 66% of respondents in the bottom 40 percent household income bracket. Married respondents were more likely to report smoking is not allowed in the home compared to unmarried respondents (83% and 69%, respectively). Eighty-four percent of nonsmokers reported smoking is not allowed in the home compared to 42% of smokers. Respondents in households with children were more likely to report smoking is not allowed in the home (80%) compared to respondents in households without children (70%). Year Comparisons From 2009 to 2012, there was a statistical increase in the overall percent of respondents who reported smoking is not allowed anywhere inside the home. In both study years, respondents in the top 40 percent household income bracket were more likely to report smoking is not allowed in the home, with a noted increase in From 2009 to 2012, there was a noted increase in the percent of respondents in the bottom 40 percent household income bracket who reported smoking is not allowed in the home. In both study years, married respondents were more likely to report smoking is not allowed in the home. From 2009 to 2012, there was a noted increase in the percent of respondents across marital status who reported smoking is not allowed in the home. Milwaukee County Community Health Survey Report

141 In both study years, nonsmokers were more likely to report smoking is not allowed in the home. From 2009 to 2012, there was a noted increase in the percent of respondents across smoking status who reported smoking is not allowed in the home. In both study years, respondents in households with children were more likely to report smoking is not allowed in the home. From 2009 to 2012, there was a noted increase in the percent of respondents in households with children or in households without children who reported smoking is not allowed in the home. Table 41. Smoking Not Allowed in Home by Demographic Variables for Each Survey Year TOTAL a 64% 74% Household Income 1,2 Bottom 40 Percent Bracket a Middle 20 Percent Bracket Top 40 Percent Bracket a Marital Status 1,2 Married a Not Married a Smoking Status 1,2 Nonsmoker a Smoker a Children in Household 1,2 Yes a No a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2009 to 2012 Exposure to Second-Hand Smoke in Past Seven Days (Nonsmokers) The Healthy People 2020 goal for nonsmokers exposed to second-hand smoke is 34%. (Objective TU-11.3) 2012 Findings Twenty-three percent of nonsmoking respondents reported they were exposed to second-hand smoke on at least one day in the past seven days while they rode in a car or were in the same room with a person who was smoking. Male respondents were more likely to report exposure to second-hand smoke (27%) compared to female respondents (19%). Respondents 18 to 24 years old were more likely to report exposure to second-hand smoke (44%) compared to those 55 to 64 years old (16%) or respondents 65 and older (8%). Milwaukee County Community Health Survey Report

142 Thirty-one percent of respondents who were non-white and non-african American and 29% of respondents who were African American reported exposure to second-hand smoke compared to 18% of white respondents. Hispanic respondents were more likely to report exposure to second-hand smoke compared to non-hispanic respondents (35% and 21%, respectively). Twenty-seven percent of respondents with some post high school education or less reported exposure to second-hand smoke compared to 15% of respondents with a college education. Twenty-eight percent of respondents in the bottom 40 percent household income bracket reported exposure to second-hand smoke compared to 21% of those in the middle 20 percent income bracket or 19% of respondents in the top 40 percent household income bracket. Unmarried respondents were more likely to report exposure to second-hand smoke compared to married respondents (28% and 15%, respectively). Year Comparisons From 2009 to 2012, there was a statistical decrease in the overall percent of respondents who reported exposure to second-hand smoke in the past seven days. In 2012, male respondents were more likely to report second-hand smoke exposure. In 2009, gender was not a significant variable. From 2009 to 2012, there was a noted decrease in the percent of female respondents reporting second-hand smoke exposure. In both study years, respondents 18 to 24 years old were more likely to report second-hand smoke exposure. From 2009 to 2012, there was a noted decrease in the percent of respondents 25 to 44 years old reporting exposure. In 2009, respondents who were non-white and non-african American were more likely to report second-hand smoke exposure. In 2012, respondents who were non-white were more likely to report second-hand smoke exposure. From 2009 to 2012, there was a noted decrease in the percent of respondents who were white or African American reporting exposure. In 2012, Hispanic respondents were more likely to report second-hand smoke exposure. In 2009, Hispanic origin was not a significant variable. From 2009 to 2012, there was a noted decrease in the percent of non- Hispanic respondents reporting exposure. In both study years, respondents with some post high school education or less were more likely to report second-hand smoke exposure. From 2009 to 2012, there was a noted decrease in the percent of respondents with a college education reporting exposure. In both study years, respondents in the bottom 40 percent household income bracket were more likely to report second-hand smoke exposure. From 2009 to 2012, there was a noted decrease in the percent of respondents in the bottom 60 percent household income bracket reporting exposure. In both study years, unmarried respondents were more likely to report second-hand smoke exposure. From 2009 to 2012, there was a noted decrease in the percent of respondents across marital status reporting exposure. Milwaukee County Community Health Survey Report

143 Table 42. Nonsmokers Exposure to Second-Hand Smoke in the Past Seven Days by Demographic Variables for Each Survey Year TOTAL a 29% 23% Gender 2 Male Female a Age 1,2 18 to to 34 a to 44 a to to and Older 11 8 Race 1,2 White a African American a Other Hispanic Origin 2 Hispanic Non-Hispanic a Education 1,2 High School or Less Some Post High School College Graduate a Household Income 1,2 Bottom 40 Percent Bracket a Middle 20 Percent Bracket a Top 40 Percent Bracket Marital Status 1,2 Married a Not Married a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2009 to 2012 Milwaukee County Community Health Survey Report

144 Exposure to Cigarette Smoke Overall Year Comparisons From 2009 to 2012, there was a statistical increase in the overall percent of respondents who reported smoking is not allowed anywhere inside the home. From 2009 to 2012, there was a statistical decrease in the overall percent of respondents who reported they were exposed to second-hand smoke in the past seven days. 100% Figure 19. Exposure to Cigarette Smoke 80% 60% 64% 74% Smoking Not Allowed in Home 40% 20% 29% 23% Nonsmokers Exposed to Second-Hand Smoke (past 7 days) 0% Alcohol Use (Figure 20; Tables 43 & 44) KEY FINDINGS: In 2012, 31% of respondents were binge drinkers in the past month. Respondents who were male, 25 to 34 years old or in the top 40 percent household income bracket were more likely to have binged at least once in the past month. Two percent reported they had been a driver or a passenger in the past month when the driver perhaps had too much to drink. Binge Drinking in Past Month From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported binge drinking in the past month. From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported in the past month they were a driver or passenger when the driver perhaps had too much to drink. Binge drinking definitions vary. Currently, the Centers for Disease Control (CDC) defines binge drinking as four or more drinks per occasion for females and five or more drinks per occasion for males to account for weight and metabolism differences. Previously, the CDC defined binge drinking as five or more drinks at one time, regardless of gender. In 2012, Milwaukee County defined binge drinking as four or more drinks for females and five or more drinks for males. The Healthy People 2020 goal for adult binge drinking (5 or more drinks) is 24%. (Objective SA-14.3) Milwaukee County Community Health Survey Report

145 In 2010, 22% of Wisconsin respondents reported binge drinking in the past month (females having four or more drinks on one occasion, males having five or more drinks on one occasion). Fifteen percent of U.S. respondents reported binge drinking in the past month (2010 Behavioral Risk Factor Surveillance) Findings Thirty-one percent of all respondents binged in the past month (four or more drinks for females and five or more drinks for males). Male respondents were more likely to have binged in the past month (38%) compared to female respondents (25%). Respondents 25 to 34 years old were more likely to have binged in the past month (47%) compared to those 55 to 64 years old (22%) or respondents 65 and older (10%). Thirty-nine percent of respondents in the top 40 percent household income bracket binged in the past month compared to 34% of those in the middle 20 percent income bracket or 29% of respondents in the bottom 40 percent household income bracket. Year Comparisons In 2003 and 2012, the Milwaukee County Health Survey defined binge drinking as four or more drinks per occasion for females and five or more drinks per occasion for males. In all other study years the definition was five or more drinks, regardless of gender. From 2003 to 2012, there was a statistical increase in the overall percent of respondents who binged. In all study years, male respondents were more likely to have binged. From 2003 to 2012, there was a noted increase in the percent of respondents across gender reporting binge drinking. In 2003, respondents 18 to 24 years old were more likely to have binged. In 2006, 2009 and 2012, respondents 25 to 34 years old were more likely to have binged. From 2003 to 2012, there was a noted increase in the percent of respondents across age who reported binge drinking. In 2003 and 2009, white respondents were more likely to have binged. In 2006, respondents who were nonwhite and non-african American were more likely to have binged. In 2012, race was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents across race reporting binge drinking. In 2006 and 2009, Hispanic respondents were more likely to have binged. In all other study years, Hispanic origin was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents across Hispanic origin who reported binge drinking. In 2003 and 2006, respondents with some post high school education were more likely to have binged. In 2009, respondents with a college education were more likely to have binged. In 2012, education was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents across education reporting binge drinking. Milwaukee County Community Health Survey Report

146 In 2006 and 2012, respondents in the top 40 percent household income bracket were more likely to have binged. In 2009, respondents in the top 60 percent household income bracket were more likely to have binged. In 2003, household income was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents across household income who reported binge drinking. In 2003, unmarried respondents were more likely to have binged. In all other study years, marital status was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents across marital status reporting binge drinking. Milwaukee County Community Health Survey Report

147 Table 43. Binge Drinking in Past Month by Demographic Variables for Each Survey Year, TOTAL a 17% 19% 20% 31% Gender 1,2,3,4 Male a Female a Age 1,2,3,4 18 to 24 a to 34 a to 44 a to 54 a to 64 a and Older a Race 1,2,3 White a African American a Other a Hispanic Origin 2,3 Hispanic a Non-Hispanic a Education 1,2,3 High School or Less a Some Post High School a College Graduate a Household Income 2,3,4 Bottom 40 Percent Bracket a Middle 20 Percent Bracket a Top 40 Percent Bracket a Marital Status 1 Married a Not Married a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. In 2003 and 2012, 4 or more drinks on an occasion for females and 5 or more drinks on an occasion for males was used; in all other study years, 5 or more drinks on an occasion was used for both males and females. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

148 Driver or Passenger in Vehicle When Driver Perhaps Had Too Much to Drink in Past Month 2012 Findings Two percent of respondents reported in the past month they were a driver or passenger when the driver perhaps had too much alcohol to drink. No demographic comparisons were conducted as a result of the low percent of respondents who reported they were a driver or passenger when the driver perhaps had too much to drink. Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported they were a driver or passenger in the past month when the driver perhaps had too much to drink. In 2006 and 2009, male respondents were more likely to report they were a driver or passenger in a vehicle when the driver perhaps had too much alcohol to drink. In 2003, gender was not a significant variable. In 2003 and 2009, respondents 25 to 34 years old were more likely to report they were a driver or passenger in a vehicle when the driver perhaps had too much alcohol to drink. In 2006, respondents 18 to 24 years old were more likely to report they were a driver or passenger in a vehicle when the driver perhaps had too much alcohol to drink. In 2006, respondents who were non-white and non-african American were more likely to report they were a driver or passenger in a vehicle when the driver perhaps had too much alcohol to drink. In 2003 and 2009, race was not a significant variable. In 2009, Hispanic respondents were more likely to report they were a driver or passenger in a vehicle when the driver perhaps had too much alcohol to drink. In 2003 and 2006, Hispanic origin was not a significant variable. In 2003, respondents with some post high school education were more likely to report they were a driver or passenger in a vehicle when the driver perhaps had too much alcohol to drink. In 2006 and 2009, education was not a significant variable. In 2006 and 2009, unmarried respondents were more likely to report they were a driver or passenger in a vehicle when the driver perhaps had too much alcohol to drink. In 2003, marital status was not a significant variable. Milwaukee County Community Health Survey Report

149 Table 44. Driver or Passenger in Vehicle When Driver Perhaps Had Too Much to Drink by Demographic Variables for Each Survey Year TOTAL 3% 3% 3% 2% Gender 2,3 Male Female Age 1,2,3 18 to to to to to < and Older <1 <1 <1 -- Race 2 White African American Other Hispanic Origin 3 Hispanic Non-Hispanic Education 1 High School or Less Some Post High School College Graduate Household Income Bottom 40 Percent Bracket Middle 20 Percent Bracket Top 40 Percent Bracket Marital Status 2,3 Married Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Data is not shown as a result of insufficient statistical reliability due to the low percentage reporting this. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

150 Alcohol Use Overall Year Comparisons From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported binge drinking in the past month. From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported in the past month they were a driver or passenger when the driver perhaps had too much to drink. 100% Figure 20. Alcohol Use in Past Month 80% Binge Drinking* 60% Driver/Passenger When Driver Perhaps Had Too Much to Drink 40% 31% 20% 17% 19% 20% 3% 3% 3% 2% 0% *In 2003 and 2012, 4 or more drinks on an occasion for females and 5 or more drinks on an occasion for males were used; in all other study years, 5 or more drinks on an occasion was used for both males and females. Household Problems (Figure 21; Table 45) KEY FINDINGS: In 2012, 2% of respondents reported someone in their household experienced a legal, social, personal or physical problem in the past year in connection with drinking. Two percent of respondents reported someone in their household experienced a problem in connection with marijuana use. One percent of respondents reported a household problem with gambling while less than one percent of respondents each reported a household problem with the misuse of prescription drugs/over-the-counter drugs or with cocaine/heroin/other street drugs. From 2006 to 2012, there was a statistical decrease in the overall percent of respondents reporting they, or someone in their household, experienced some kind of problem, such as legal, social, personal or physical, in connection with drinking in the past year. Household Problem Associated with Alcohol in Past Year 2012 Findings Two percent of respondents reported they, or someone in their household, experienced some kind of problem, such as legal, social, personal or physical, in connection with drinking in the past year. Milwaukee County Community Health Survey Report

151 No demographic comparisons were conducted as a result of too few respondents reporting a household problem in connection with drinking in the past year. Year Comparisons From 2006 to 2012, there was a statistical decrease in the overall percent of respondents reporting they, or someone in their household, experienced some kind of problem, such as legal, social, personal or physical, in connection with drinking in the past year. In 2009, respondents in the middle 20 percent household income bracket were more likely to report they, or someone in their household, experienced some kind of problem in connection with drinking. In 2006, household income was not a significant variable. Table 45. Household Problem Associated with Alcohol in Past Year by Demographic Variables for Each Survey Year TOTAL a 3% 3% 2% Household Income 2 Bottom 40 Percent Bracket Middle 20 Percent Bracket Top 40 Percent Bracket Marital Status Married Not Married Children in Household Yes No Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. Data is not shown as a result of insufficient statistical reliability due to the low percentage reporting this. 1 demographic difference at p 0.05 in 2006; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2006 to 2012 Other Household Problems in Past Year 2012 Findings Two percent of respondents reported someone in their household experienced some kind of problem, such as legal, social, personal or physical, in connection with marijuana use. One percent of respondents reported a household problem with gambling while less than one percent of respondents each reported a household problem with the misuse of prescription drugs/over-the-counter drugs or with cocaine/heroin/other street drugs. No demographic comparisons were conducted as a result of too few respondents reporting a household problem with any of the behaviors listed. Milwaukee County Community Health Survey Report

152 Household Problems Overall Year Comparisons From 2006 to 2012, there was a statistical decrease in the overall percent of respondents reporting they, or someone in their household, experienced some kind of problem, such as legal, social, personal or physical, in connection with drinking in the past year. Figure 21. Household Problems in Past Year 30% Drinking Alcohol Marijuana 20% 10% Gambling Misuse of Prescription Drugs or Over-the-Counter Drugs Cocaine, Heroin or Other Street Drugs 3% 3% 2% 1% 0% <1% Mental Health Status (Figures 22 & 23; Tables 46-48) KEY FINDINGS: In 2012, 7% of respondents reported they always or nearly always felt sad, blue or depressed in the past 30 days; respondents who were 45 to 54 years old, non-white and non-african American, Hispanic, with a high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. Five percent of respondents felt so overwhelmed they considered suicide in the past year; respondents who were 18 to 24 years old, non-white and non-african American, in the bottom 40 percent household income bracket or unmarried were more likely to report this. Seven percent of respondents reported they seldom or never find meaning and purpose in daily life; respondents who were male, with a high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported they always or nearly always felt sad, blue or depressed or they seldom/never find meaning and purpose in daily life. From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported they considered suicide. Milwaukee County Community Health Survey Report

153 Felt Sad, Blue or Depressed 2012 Findings Seven percent of respondents reported they always or nearly always felt sad, blue or depressed in the past 30 days. This represents up to 63,990 residents. Twenty-six percent reported sometimes and the remaining 66% reported seldom or never. Figure 22. Felt Sad, Blue or Depressed in Past 30 Days for 2012 Never 36% Seldom 30% Not Sure <1% Sometimes 26% Nearly Always 4% Always 3% Respondents 45 to 54 years old were more likely to report they always or nearly always felt sad, blue or depressed in the past 30 days (11%) compared to those 18 to 34 years old (7%) or respondents 65 and older (3%). Respondents who were non-white and non-african American were more likely to report they always or nearly always felt sad, blue or depressed in the past 30 days (12%) compared to African American respondents (10%) or white respondents (5%). Hispanic respondents were more likely to report they always or nearly always felt sad, blue or depressed in the past 30 days compared to non-hispanic respondents (14% and 7%, respectively). Thirteen percent of respondents with a high school education or less reported they always or nearly always felt sad, blue or depressed in the past 30 days compared to 6% of those with some post high school education or 2% of respondents with a college education. Respondents in the bottom 40 percent household income bracket were more likely to report they always or nearly always felt sad, blue or depressed (13%) compared to those in the top 40 percent income bracket (2%) or respondents in the middle 20 percent household income bracket (less than one percent). Unmarried respondents were more likely to report they always or nearly always felt sad, blue or depressed compared to married respondents (10% and 3%, respectively). Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported in the past 30 days they always or nearly always felt sad, blue or depressed. Milwaukee County Community Health Survey Report

154 In all study years, respondents 45 to 54 years old were more likely to report they always or nearly always felt sad, blue or depressed. In 2003 and 2006, African American respondents were more likely to report they always or nearly always felt sad, blue or depressed. In 2009 and 2012, respondents who were non-white and non-african American were more likely to report they always or nearly always felt sad, blue or depressed. In 2012, Hispanic respondents were more likely to report they always or nearly always felt sad, blue or depressed. In all other study years, Hispanic origin was not a significant variable. In all study years, respondents with a high school education or less were more likely to report they always or nearly always felt sad, blue or depressed in the past 30 days. In all study years, respondents in the bottom 40 percent household income bracket were more likely to report they always or nearly always felt sad, blue or depressed. From 2003 to 2012, there was a noted decrease in the percent of respondents in the middle 20 percent household income bracket reporting they always or nearly always felt sad, blue or depressed. In all study years, unmarried respondents were more likely to report they always or nearly always felt sad, blue or depressed. From 2003 to 2012, there was a noted decrease in the percent of married respondents reporting they always or nearly always felt sad, blue or depressed. Milwaukee County Community Health Survey Report

155 Table 46. Always/Nearly Always Felt Sad, Blue or Depressed in Past 30 Days by Demographic Variables for Each Survey Year TOTAL 7% 8% 8% 7% Gender Male Female Age 1,2,3,4 18 to to to to to and Older Race 1,2,3,4 White African American Other Hispanic Origin 4 Hispanic Non-Hispanic Education 1,2,3,4 High School or Less Some Post High School College Graduate Household Income 1,2,3,4 Bottom 40 Percent Bracket Middle 20 Percent Bracket a <1 Top 40 Percent Bracket 2 2 <1 2 Marital Status 1,2,3,4 Married a Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Considered Suicide All respondents were asked if they have felt so overwhelmed that they considered suicide in the past year. The survey did not ask how seriously, how often or how recent suicide was considered. Milwaukee County Community Health Survey Report

156 2012 Findings Five percent of respondents reported they felt so overwhelmed in the past year that they considered suicide. Although this is a small percent, it represents up to 49,770 residents who may have considered suicide in the past year. Respondents 18 to 24 years old were more likely to report they considered suicide in the past year (11%) compared to those 55 to 64 years old (3%) or respondents 65 and older (1%). Respondents who were non-white and non-african American were more likely to report they considered suicide in the past year (9%) compared to African American respondents (6%) or white respondents (3%). Respondents in the bottom 40 percent household income bracket were more likely to report they considered suicide in the past year (8%) compared to those in the top 40 percent income bracket (2%) or respondents in the middle 20 percent household income bracket (less than one percent). Unmarried respondents were more likely to report they considered suicide in the past year compared to married respondents (7% and 2%, respectively). Year Comparisons From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported they considered suicide in the past year. In 2003 and 2006, female respondents were more likely to report they considered suicide in the past year. In all other study years, gender was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of male respondents reporting they considered suicide in the past year. In 2006, respondents 18 to 54 years old were more likely to report they considered suicide in the past year. In 2009 and 2012, respondents 18 to 24 years old were more likely to report they considered suicide. In 2003, age was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents 18 to 24 years old reporting they considered suicide in the past year. In 2006 and 2009, African American respondents were more likely to report they considered suicide in the past year. In 2012, respondents who were non-white and non-african American were more likely to report they considered suicide in the past year. In 2003, race was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of African American respondents reporting they considered suicide in the past year. Hispanic origin was not a significant variable in any study year. From 2003 to 2012, there was a noted increase in the percent of non-hispanic respondents reporting they considered suicide in the past year. In 2003 and 2009, respondents with some post high school education or less were more likely to report they considered suicide in the past year. In 2006, respondents with a high school education or less were more likely to report they considered suicide in the past year. In 2012, education was not a significant variable. From 2003 to 2012, there was a noted increase in the percent of respondents with a college education reporting they considered suicide in the past year. In all study years, respondents in the bottom 40 percent household income bracket were more likely to report they considered suicide in the past year, with a noted increase since Milwaukee County Community Health Survey Report

157 In all study years, unmarried respondents were more likely to report they considered suicide in the past year, with a noted increase since Table 47. Considered Suicide in the Past Year by Demographic Variables for Each Survey Year TOTAL a 3% 6% 5% 5% Gender 1,2 Male a Female Age 2,3,4 18 to 24 a to to to to and Older Race 2,3,4 White African American a Other Hispanic Origin Hispanic Non-Hispanic a Education 1,2,3 High School or Less Some Post High School College Graduate a Household Income 1,2,3,4 Bottom 40 Percent Bracket a Middle 20 Percent Bracket <1 Top 40 Percent Bracket 2 3 <1 2 Marital Status 1,2,3,4 Married Not Married a Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

158 Find Meaning and Purpose in Daily Life 2012 Findings A total of 7% of respondents reported they seldom or never find meaning and purpose in daily life. Forty-nine percent of respondents reported they always find meaning and purpose while an additional 28% reported nearly always. Male respondents were more likely to report they seldom or never find meaning and purpose in daily life (8%) compared to female respondents (5%). Eleven percent of respondents with a high school education or less reported they seldom or never find meaning and purpose in daily life compared to 6% of those with some post high school education or 2% of respondents with a college education. Nine percent of respondents in the bottom 40 percent household income bracket reported they seldom or never find meaning and purpose in daily life compared to 4% of those in the middle 20 percent income bracket or 2% of respondents in the top 40 percent household income bracket. Unmarried respondents were more likely to report they seldom or never find meaning and purpose in daily life compared to married respondents (8% and 4%, respectively). Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported they seldom or never find meaning and purpose in daily life. In all study years, male respondents were more likely to report they seldom/never find meaning and purpose in daily life. In 2006 and 2009, respondents who were non-white and non-african American were more likely to report they seldom/never find meaning and purpose in daily life. In all other study years, race was not a significant variable. In 2006, Hispanic respondents were more likely to report they seldom/never find meaning and purpose in daily life. In all other study years, Hispanic origin was not a significant variable. In all study years, respondents with a high school education or less were more likely to report they seldom/never find meaning and purpose in daily life, with a noted increase in From 2003 to 2012, there was a noted decrease in the percent of respondents with a college education reporting they seldom/never find meaning and purpose in daily life. In all study years, respondents in the bottom 40 percent household income bracket were more likely to report they seldom/never find meaning and purpose in daily life. In 2006, 2009 and 2012, unmarried respondents were more likely to report they seldom/never find meaning and purpose in daily life. In 2003, marital status was not a significant variable. Milwaukee County Community Health Survey Report

159 Table 48. Seldom/Never Find Meaning and Purpose in Daily Life by Demographic Variables for Each Survey Year TOTAL 6% 5% 6% 7% Gender 1,2,3,4 Male Female Age 18 to to to to to and Older Race 2,3 White African American Other Hispanic Origin 2 Hispanic Non-Hispanic Education 1,2,3,4 High School or Less a Some Post High School College Graduate a Household Income 1,2,3,4 Bottom 40 Percent Bracket Middle 20 Percent Bracket Top 40 Percent Bracket Marital Status 2,3,4 Married Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

160 Mental Health Status Overall Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported they always or nearly always felt sad, blue or depressed or they seldom/never find meaning and purpose in daily life. From 2003 to 2012, there was a statistical increase in the overall percent of respondents who reported they considered suicide. Figure 23. Mental Health Status 40% 30% 20% Felt sad, blue, depressed always/nearly always (past 30 days) Find meaning & purpose in daily life seldom/never Considered suicide (past year) 10% 7% 8% 8% 7% 6% 6% 6% 5% 5% 5% 3% 0% Personal Safety Issues (Figure 24; Tables 49-51) KEY FINDINGS: In 2012, 7% of respondents reported someone made them afraid for their personal safety in the past year; respondents with some post high school education were more likely to report this. Four percent of respondents reported they had been pushed, kicked, slapped or hit in the past year; respondents who were male, 18 to 24 years old or unmarried were more likely to report this. A total of 9% reported at least one of these two situations; respondents who were 18 to 24 years old, 55 to 64 years old, with some post high school education or unmarried respondents were more likely to report this. Afraid for Personal Safety 2012 Findings From 2003 to 2012, there was no statistical change in the overall percent of respondents reporting they were afraid for their personal safety or they were pushed, kicked, slapped or hit. From 2003 to 2012, there was no statistical change in the overall percent of respondents reporting at least one of the two personal safety issues. Seven percent of respondents reported someone made them afraid for their personal safety in the past year. Milwaukee County Community Health Survey Report

161 Nine percent of respondents with some post high school education reported someone made them afraid for their personal safety in the past year compared to 7% of those with a college education or 5% of respondents with a high school education or less. o Fifty-seven percent of respondents who were afraid for their personal safety in the past year reported it was a stranger who made them afraid. Fifteen percent reported an acquaintance. Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported they were afraid for their personal safety. In 2003 and 2006, respondents 18 to 24 years old were more likely to report being afraid for their personal safety. In 2009, respondents 45 to 54 years old were more likely to report being afraid for their personal safety. In 2012, age was not a significant variable. In 2012, respondents with some post high school education were more likely to report being afraid for their personal safety. In all other study years, education was not a significant variable. In 2006, respondents in the bottom 40 percent household income bracket were more likely to report being afraid for their personal safety. In all other study years, household income was not a significant variable. In 2003, 2006 and 2009, unmarried respondents were more likely to report being afraid for their personal safety. In 2012, marital status was not a significant variable. Milwaukee County Community Health Survey Report

162 Table 49. Afraid for Personal Safety by Demographic Variables for Each Survey Year TOTAL 6% 10% 9% 7% Gender Male Female Age 1,2,3 18 to to to to to and Older Race White African American Other Hispanic Origin Hispanic Non-Hispanic Education 4 High School or Less Some Post High School College Graduate Household Income 2 Bottom 40 Percent Bracket Middle 20 Percent Bracket Top 40 Percent Bracket Marital Status 1,2,3 Married Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Pushed, Kicked, Slapped or Hit 2012 Findings Four percent of respondents reported they were pushed, kicked, slapped or hit in the past year. Milwaukee County Community Health Survey Report

163 Male respondents were more likely to report they were pushed, kicked, slapped or hit in the past year (6%) compared to female respondents (2%). Respondents 18 to 24 years old were more likely to report they were pushed, kicked, slapped or hit in the past year (7%) compared to those 45 to 54 years old (3%) or respondents 65 and older (less than one percent). Unmarried respondents were more likely to report they were pushed, kicked, slapped or hit in the past year compared to married respondents (5% and 2%, respectively). o Thirty-two percent of respondents who were pushed, kicked, slapped or hit in the past year reported it was a stranger who did it to them. Twenty percent reported it was a friend while 18% reported an acquaintance. Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported they were pushed, kicked, slapped or hit in the past year. In all study years, male respondents were more likely to report they were pushed, kicked, slapped or hit in the past year. In all study years, respondents 18 to 24 years old were more likely to report they were pushed, kicked, slapped or hit in the past year, with a noted decrease in From 2003 to 2012, there was a noted increase in the percent of respondents 55 to 64 years old reporting they were pushed, kicked, slapped or hit in the past year. In 2003, respondents who were non-white and non-african American were more likely to report they were pushed, kicked, slapped or hit in the past year. In 2006, respondents who were non-white were more likely to report they were pushed, kicked, slapped or hit in the past year. In all other study years, race was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents who were non-white and non-african American reporting they were pushed, kicked, slapped or hit in the past year. In 2006, Hispanic respondents were more likely to report they were pushed, kicked, slapped or hit in the past year. In all other study years, Hispanic origin was not a significant variable. In 2003, respondents with some post high school education were more likely to report they were pushed, kicked, slapped or hit in the past year. In 2006 and 2009, respondents with a high school education or less were more likely to report they were pushed, kicked, slapped or hit in the past year. In 2012, education was not a significant variable. From 2003 to 2012, there was a noted decrease in the percent of respondents with some post high school education reporting they were pushed, kicked, slapped or hit in the past year. In 2003 and 2006, respondents in the bottom 40 percent household income bracket were more likely to report they were pushed, kicked, slapped or hit in the past year. In all other study years, household income was not a significant variable. In all study years, unmarried respondents were more likely to report they were pushed, kicked, slapped or hit in the past year. Milwaukee County Community Health Survey Report

164 Table 50. Pushed, Kicked, Slapped or Hit by Demographic Variables for Each Survey Year TOTAL 4% 5% 6% 4% Gender 1,2,3,4 Male Female Age 1,2,3,4 18 to 24 a to to to to 64 a and Older <1 <1 <1 <1 Race 1,2 White African American Other a Hispanic Origin 2 Hispanic Non-Hispanic Education 1,2,3 High School or Less Some Post High School a College Graduate Household Income 1,2 Bottom 40 Percent Bracket Middle 20 Percent Bracket Top 40 Percent Bracket Marital Status 1,2,3,4 Married Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

165 Combined Personal Safety Issues 2012 Findings A total of 9% of all respondents reported at least one of the two issues. Eleven percent of respondents who were 18 to 24 years old or 55 to 64 years old reported at least one of the personal safety issues compared to 4% of respondents 65 and older. Twelve percent of respondents with some post high school education reported at least one of the personal safety issues compared to 8% of those with a college education or 7% of respondents with a high school education or less. Unmarried respondents were more likely to report at least one of the personal safety issues compared to married respondents (10% and 6%, respectively). Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents who reported at least one of the personal safety issues. In 2003, 2006 and 2009, male respondents were more likely to report at least one of the personal safety issues. In 2012, gender was not a significant variable. In 2003 and 2006, respondents 18 to 24 years old were more likely to report at least one of the personal safety issues. In 2009, respondents 18 to 64 years old were more likely to report at least one of the personal safety issues. In 2012, respondents who were 18 to 24 years old or 55 to 64 years old were more likely to report at least one of the personal safety issues. From 2003 to 2012, there was a noted decrease in the percent of respondents 18 to 24 years old reporting at least one of the personal safety issues. In 2006, non-white respondents were more likely to report at least one of the personal safety issues. In all other study years, race was not a significant variable. In 2003 and 2012, respondents with some post high school education were more likely to report at least one of the personal safety issues. In all other study years, education was not a significant variable. In 2006, respondents in the bottom 40 percent household income bracket were more likely to report at least one of the personal safety issues. In all other study years, household income was not a significant variable. In all study years, unmarried respondents were more likely to report at least one of the personal safety issues. Milwaukee County Community Health Survey Report

166 Table 51. At Least One of the Personal Safety Issues by Demographic Variables for Each Survey Year TOTAL 9% 13% 12% 9% Gender 1,2,3 Male Female Age 1,2,3,4 18 to 24 a to to to to and Older Race 2 White African American Other Hispanic Origin Hispanic Non-Hispanic Education 1,4 High School or Less Some Post High School College Graduate Household Income 2 Bottom 40 Percent Bracket Middle 20 Percent Bracket Top 40 Percent Bracket Marital Status 1,2,3,4 Married Not Married Percentages occasionally may differ by 1 or 2 percentage points from previous reports or the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2003; 2 demographic difference at p 0.05 in demographic difference at p 0.05 in 2009; 4 demographic difference at p 0.05 in 2012 a year difference at p 0.05 from 2003 to 2012 Milwaukee County Community Health Survey Report

167 Personal Safety Issues Overall Year Comparisons From 2003 to 2012, there was no statistical change in the overall percent of respondents reporting they were afraid for their personal safety or they were pushed, kicked, slapped or hit. From 2003 to 2012, there was no statistical change in the overall percent of respondents reporting at least one of the two personal safety issues. 40% Figure 24. Personal Safety Issues in Past Year 20% 13% 12% 9% 9% 10% 9% 7% 6% 5% 6% 4% 4% 0% Someone made you afraid for your personal safety Someone pushed, kicked, slapped or hit you At least 1 of the 2 issues Children in Household (Tables 52-55) KEY FINDINGS: In 2012, a random child was selected for the respondent to talk about the child s health issues. Eighty-nine percent of respondents reported they have one or more persons they think of as their child s personal doctor or nurse, with 93% reporting their child visited their personal doctor or nurse for preventive care during the past 12 months. Eight percent of respondents reported there was a time in the last 12 months their child did not receive the dental care needed. Two percent of respondents each reported their child did not receive the medical care needed or their child did not visit a specialist they needed to see in the past 12 months. Seventyeight percent of respondents reported their 5 to 17 year old child ate two or more servings of fruit on an average day while 26% reported three or more servings of vegetables. Sixty-six percent of respondents reported their 5 to 17 year old child was physically active five times a week for 60 minutes. Eleven percent of respondents reported their child currently had asthma, with 40% of them having had an asthma attack in the past year. Eight percent of respondents with a child two years old or younger reported as an infant, their child slept in a bed with them or with another person. Seven percent of respondents reported their 8 to 17 year old child always or nearly always felt unhappy, sad or depressed in the past six months. Four percent of respondents reported their child was seldom or never safe in their community or neighborhood. Twenty-two percent reported their 8 to 17 year old child experienced some form of bullying in the past 12 months. Eighteen percent reported verbal bullying, 10% reported physical bullying and 2% reported cyber bullying. Milwaukee County Community Health Survey Report

168 Children in Household 2012 Findings Thirty-eight percent of respondents reported they have a child under the age of 18 in their household. Seventysix percent of these respondents reported they make the health care decisions for their child(ren). For this section, a random child was selected to discuss that particular child s health issues. Seventy-four percent of the children selected were 12 or younger. Forty-eight percent were boys. Of these households, 65% were in the bottom 60 percent household income bracket and 55% were married. Child s Personal Doctor 2012 Findings Eighty-nine percent of respondents reported they have one or more persons they think of as their child s personal doctor or nurse who knows their child well and is familiar with their child s health history. Of these, 93% reported their child visited their personal doctor/nurse for preventive care during the past 12 months. Respondents who reported about their child who is 12 or younger were more likely to report their child has one or more persons they think of as their child s personal doctor or nurse (91%) compared to respondents who reported about their child who is 13 to 17 years old (85%). Ninety-five percent of respondents in the bottom 40 percent household income and 94% of those in the top 40 percent household income bracket reported their child visited their personal doctor/nurse for preventive care compared to 86% of respondents in the middle 20 percent household income bracket. Unmet Care 2012 Findings Eight percent of respondents reported there was a time in the last 12 months their child did not get the dental care needed. Two percent of respondents each reported their child did not receive the medical care needed or their child did not visit a specialist they needed to see. Respondents who reported about their daughter were more likely to report their child did not get the dental care needed (11%) compared to respondents who reported about their son (5%). Thirteen percent of respondents in the bottom 40 percent household income bracket reported their child did not get the dental care needed compared to 3% of respondents in the top 60 percent household income bracket. Unmarried respondents were more likely to report their child did not get the dental care needed compared to married respondents (12% and 5%, respectively). o Unable to find an office who accepts child s insurance, unable to get appointment, the lack of insurance or insurance not covering the procedure were the most often mentioned reasons for their child s unmet care. Milwaukee County Community Health Survey Report

169 Table 52. Did Not Receive Care Needed in Past 12 Months by Demographic Variables for 2012 (All Children) Dental Care Medical Care Specialist TOTAL 8% 2% 2% Gender Boy 5* Girl 11* Age 12 or Younger to 17 Years Old Household Income Bottom 40 Percent Bracket 13* Top 60 Percent Bracket 3* Marital Status Married 5* Not Married 12* Percentages occasionally may differ by 1 or 2 percentage points from the Appendix as a result of rounding, recoding variables and response category distribution. Data is not shown as a result of insufficient statistical reliability due to the low percentage reporting this. *demographic difference at p 0.05 in 2012 Nutrition and Exercise 2012 Findings Seventy-eight percent of respondents reported their 5 to 17 year old child ate two or more servings of fruit on an average day while 26% reported their child ate three or more servings of vegetables. Sixty-six percent of respondents reported their 5 to 17 year old child was physically active five times a week for at least 60 minutes each. Respondents who reported about their child who is 5 to 12 years old were more likely to report their child ate two or more servings of fruit on an average day or was physically active five times a week for at least 60 minutes compared to respondents who reported about their child who is 13 to 17 years old. Unmarried respondents were more likely to report their child was physically active five times a week for at least 60 minutes compared to married respondents. o Their child does not like to be physically active was listed by 30% of respondents with a child who was active on four or fewer days. Fourteen percent each reported likes to play video games/on computer or school/homework/other activities was the main reason their child was not physically active while 12% of respondents reported their child prefers to watch TV. Milwaukee County Community Health Survey Report

170 Table 53. Nutrition and Exercise by Demographic Variables for 2012 (Children 5 to 17 Years Old) Fruit (2 or More Servings) Vegetables (3 or More Servings) Physically Active (5x/Week/60 Min) TOTAL 78% 26% 66% Gender Boy Girl Age 5 to 12 Years Old 84* 28 75* 13 to 17 Years Old 67* 23 52* Household Income Bottom 40 Percent Bracket Top 60 Percent Bracket Marital Status Married * Not Married * Percentages occasionally may differ by 1 or 2 percentage points from the Appendix as a result of rounding, recoding variables and response category distribution. *demographic difference at p 0.05 in 2012 Current Asthma 2012 Findings Eleven percent of respondents reported their child currently had asthma. Seventeen percent of respondents in the bottom 40 percent household income bracket reported their child currently has asthma compared to 7% of those in the top 60 percent household income bracket. Unmarried respondents were more likely to report their child currently has asthma compared to married respondents (15% and 8%, respectively). o Forty percent of respondents reported in the past 12 months their child had an asthma attack that limited his or her activity more than usual or where they sought medical care. Milwaukee County Community Health Survey Report

171 Table 54. Current Asthma by Demographic Variables for 2012 (All Children) 2012 TOTAL 11% Gender Boy 12 Girl 10 Age 12 or Younger to 17 Years Old 14 Household Income 1 Bottom 40 Percent Bracket 17 Top 60 Percent Bracket 7 Marital Status 1 Married 8 Not Married 15 Percentages occasionally may differ by 1 or 2 percentage points from the Appendix as a result of rounding, recoding variables and response category distribution. 1 demographic difference at p 0.05 in 2012 Child s Sleeping Arrangement 2012 Findings Eight percent of respondents with a toddler (2 years old or younger) reported as an infant, their child slept with them or with another person. No demographic comparisons were conducted as a result of the low percent of respondents who were asked this question. Child s Emotional Well-Being 2012 Findings Seven percent of respondents reported their 8 to 17 year old child always or nearly always felt unhappy, sad or depressed in the past six months. No demographic comparisons were conducted as a result of the low percent of respondents who reported their child always or nearly always felt unhappy, sad or depressed in the past six months. Neighborhood Safety for Child 2012 Findings Four percent of respondents reported their child is seldom/never safe in their community or neighborhood. Milwaukee County Community Health Survey Report

172 No demographic comparisons were conducted as a result of the low percent of respondents who reported their child is seldom/never safe in their community or neighborhood. Child Experienced Bullying 2012 Findings Twenty-two percent of respondents reported their 8 to 17 year old child experienced some form of bullying. More specifically, 18% reported their child was verbally bullied, for example, mean rumors said or kept out of a group. Ten percent of respondents reported their child was physically bullied, for example, being hit or kicked. Two percent reported their child was cyber or electronically bullied, for example, teased, taunted, humiliated or threatened by , cell phone, Facebook postings, texts or other electronic methods. There were no statistically significant differences between demographic variables and responses of their 8 to 17 year old child experiencing some form of bullying. Table 55. Experienced Bullying in Past 12 Months by Demographic Variables for 2012 (Children 8 to 17 Years Old) Total Bullied Verbally Physically Cyber TOTAL 22% 18% 10% 2% Gender Boy Girl Age 8 to 12 Years Old to 17 Years Old Household Income Bottom 40 Percent Bracket Top 60 Percent Bracket Marital Status Married Not Married Percentages occasionally may differ by 1 or 2 percentage points from the Appendix as a result of rounding, recoding variables and response category distribution. Data is not shown as a result of insufficient statistical reliability due to the low percentage reporting this. *demographic difference at p 0.05 in 2012 Milwaukee County Community Health Survey Report

173 Community Health Issues (Figure 25; Table 56) KEY FINDINGS: In 2012, respondents were asked to pick the top three health issues in the area out of eight listed. The most often cited were alcohol or drug use (58%), violence (55%) and chronic diseases (52%). Respondents who were non-white and non-african American or married were more likely to report alcohol or drug use as a top community health issue. Respondents in the middle 20 percent household income bracket were more likely to report violence. Respondents who were white, non- Hispanic, with a college education or in the top 40 percent household income bracket were more likely to report chronic diseases. Respondents who were female, 18 to 24 years old, non-white and non-african American, Hispanic, with a high school education or less or unmarried respondents were more likely to report teen pregnancy. Respondents who were 18 to 24 years old, African American, with some post high school education, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report infectious diseases as a top community health issue. Respondents who were 35 to 44 years old, non-hispanic or with a college education were more likely to report mental health or depression. Respondents who were female, 25 to 34 years old, 45 to 54 years old, white, with a college education, in the middle 20 percent household income bracket or married respondents were more likely to report infant mortality. Respondents who were Hispanic or with a high school education or less were more likely to report lead poisoning as a top community health issue Findings Respondents were given a list of eight health issues that some communities face and were asked to select the three largest in their community. Respondents were more likely to select alcohol or drug use (58%), violence (55%) or chronic diseases like diabetes, cancer or obesity (52%). Figure 25. Community Health Issues for 2012 Alcohol or Drug Use Violence Chronic Diseases 52% 55% 58% Teen Pregnancy 35% Infectious Diseases Mental Health or Depression Infant Mortality 21% 21% 26% Lead Poisoning 3% 0% 20% 40% 60% 80% 100% Female respondents were more likely to report teen pregnancy or infant mortality as one of the three health issues compared to male respondents. Milwaukee County Community Health Survey Report

174 Respondents 18 to 24 years old were more likely to report teen pregnancy or infectious diseases as one of the three health issues. Respondents 35 to 44 years old were more likely to report mental health/depression compared to their counterparts. Respondents who were 25 to 34 years old or 45 to 54 years old were more likely to report infant mortality compared to their counterparts. Respondents who were non-white and non-african American were more likely to report alcohol/drug use or teen pregnancy while white respondents were more likely to report chronic disease or infant mortality as one of the three health issues. African American respondents were more likely to report infectious diseases compared to their counterparts. Non-Hispanic respondents were more likely to report chronic diseases or mental health/depression while Hispanic respondents were more likely to report teen pregnancy or lead poisoning as one the three health issues. Respondents with a college education were more likely to report chronic diseases, mental health/depression or infant mortality while respondents with a high school education or less were more likely to report teen pregnancy or lead poisoning as one of the three health issues. Respondents with some post high school education were more likely to report infectious diseases as one of the three health conditions. Respondents in the middle 20 percent household income bracket were more likely to report violence or infant mortality compared to their counterparts. Respondents in the top 40 percent household income bracket were more likely to report chronic diseases while respondents in the bottom 40 percent household income bracket were more likely to report infectious diseases as one of the three health conditions. Married respondents were more likely to report alcohol/drug use or infant mortality while unmarried respondents were more likely to report teen pregnancy or infectious diseases as one of the three health issues. Milwaukee County Community Health Survey Report

175 Table 56. Community Health Issues by Demographic Variables for 2012 (Part 1) Alcohol or Drug Use Violence Chronic Diseases Teen Pregnancy TOTAL 58% 55% 52% 35% Gender Male * Female * Age 18 to * 25 to * 35 to * 45 to * 55 to * 65 and Older * Race White 60* 56 55* 31* African American 53* 54 51* 39* Other 64* 57 43* 49* Hispanic Origin Hispanic * 50* Non-Hispanic * 34* Education High School or Less * 39* Some Post High School * 36* College Graduate * 31* Household Income Bottom 40 Percent Bracket 58 57* 51* 37 Middle 20 Percent Bracket 63 61* 45* 31 Top 40 Percent Bracket 62 52* 61* 33 Marital Status Married 63* * Not Married 56* * Percentages occasionally may differ by 1 or 2 percentage points from the Appendix as a result of rounding, recoding variables and response category distribution. *demographic difference at p 0.05 in 2012 Milwaukee County Community Health Survey Report

176 Table 56. Community Health Issues by Demographic Variables for (Part 2) Mental Infectious Diseases Health or Depression Infant Mortality Lead Poisoning TOTAL 26% 21% 21% 3% Gender Male * 2 Female * 3 Age 18 to 24 40* 16* 16* 2 25 to 34 29* 17* 25* 4 35 to 44 21* 30* 22* 2 45 to 54 28* 24* 24* 3 55 to 64 19* 24* 23* 3 65 and Older 18* 16* 18* 2 Race White 20* 20 26* 2 African American 39* 22 15* 3 Other 22* 23 18* 4 Hispanic Origin Hispanic 22 15* 27 7* Non-Hispanic 26 22* 21 2* Education High School or Less 25* 19* 14* 4* Some Post High School 30* 20* 23* 2* College Graduate 23* 25* 28* 2* Household Income Bottom 40 Percent Bracket 30* 21 18* 3 Middle 20 Percent Bracket 23* 22 31* 4 Top 40 Percent Bracket 20* 24 27* 1 Marital Status Married 21* 20 28* 2 Not Married 29* 22 18* 3 Percentages occasionally may differ by 1 or 2 percentage points from the Appendix as a result of rounding, recoding variables and response category distribution. *demographic difference at p 0.05 in 2012 Milwaukee County Community Health Survey Report

177 APPENDIX A: QUESTIONNAIRE FREQUENCIES Milwaukee County Community Health Survey Report

178 MILWAUKEE COUNTY COMMUNITY HEALTH SURVEY Conducted: June 20, 2012 through November 7, 2012 [Some totals may be more or less than 100% due to rounding and response category distribution. Percentages in the report and in the Appendix may differ by one or two percentage points as a result of combining several response categories for report analysis.] 1. Generally speaking, would you say that your own health is? Poor... 5% Fair Good Very good Excellent Not sure... <1 2. Currently, what is your primary type of health care coverage? No health care coverage... 14% An employer sponsored insurance plan Private insurance bought directly from an insurance agent or insurance company... 6 Medicaid including medical assistance, Title 19 or Badger Care Medicare Or something else... <1 Not sure Did you have health insurance during all, part or none of the past 12 months? All... 81% Part... 7 None Not sure... <1 4. Did everyone in your household have health insurance during all, part or none of the past 12 months? All... 77% Part... 7 None Not sure In the last 12 months, have you or anyone in your household not taken prescribed medication due to prescription costs? Yes... 11% No Not sure... <1 Milwaukee County Community Health Survey Report

179 6. Was there a time during the last 12 months that you felt you did not get the medical care you needed? Yes... 11% CONTINUE WITH Q7 No GO TO Q8 Not sure... <1 GO TO Q8 7. Why did you not receive the medical care you thought you needed? [221 Respondents; More than 1 response accepted] Uninsured... 38% Cannot afford to pay Poor medical care Co-payments too high Insurance did not cover it... 6 Unable to get appointment... 4 Not enough time... 4 Other (2% or less) Was there a time during the last 12 months that you felt you did not get the dental care you needed? Yes... 19% CONTINUE WITH Q9 No GO TO Q10 Not sure... <1 GO TO Q10 9. Why did you not receive the dental care you thought you needed? [364 Respondents; More than 1 response accepted] Uninsured... 45% Cannot afford to pay Insurance did not cover it Unable to find a dentist to take Medicaid or other insurance... 9 Unable to get appointment... 8 Co-payments too high... 4 Poor dental care... 3 Don t know where to go... 3 Other (2% or less) Was there a time during the last 12 months that you felt you did not get the mental health care you needed? Yes... 4% No Not sure... <1 CONTINUE WITH Q11 GO TO Q12 GO TO Q12 Milwaukee County Community Health Survey Report

180 11. Why did you not receive the mental health care you thought you needed? [83 Respondents; More than 1 response accepted] Uninsured... 48% Cannot afford to pay Insurance did not cover it Poor mental health care Not enough time... 3 Unable to get appointment... 3 Inconvenient hours... 3 Other (2% or less)... 5 Not sure From which source do you get most of your health information? Doctor... 45% Internet Other health professional... 6 Family/friends... 5 Myself/family member in health care field... 4 TV... 3 Work... 2 Health newsletter... 2 All others (1% or less)... 4 Not sure... <1 13. When you are sick or need advice about your health, to which one of the following places do you usually go? Doctor s or nurse practitioner s office... 70% Public health clinic or community health center... 6 Hospital outpatient department... 3 Hospital emergency room... 7 Urgent care center... 7 Some other kind of place... 1 No usual place... 6 Not sure... <1 14. Do you have an advance health care plan, living will or health care power of attorney stating your end of life health care wishes? Yes... 29% No Not sure... 1 Milwaukee County Community Health Survey Report

181 A routine check-up is a general physical exam, not an exam for a specific injury, illness or condition. About how long has it been since you last received a routine checkup? Less than a Year Ago 1 to 2 Years Ago 3 to 4 Years Ago 5 or More Years Ago Never Not Sure 15. A routine checkup... 62% 21% 7% 8% <1% <1% 16. Cholesterol testing Visit to a dentist or dental clinic <1 <1 18. Eye exam During the past 12 months, have you had a flu shot or a flu vaccine that was sprayed in your nose? Yes... 38% No Not sure... <1 20. Could you please tell me in what year you born? [CALCULATE AGE] 18 to 24 years old... 15% 25 to 34 years old to 44 years old to 54 years old to 64 years old and older A pneumonia shot or pneumococcal vaccine is usually given once or twice in a person s lifetime and is different from the flu shot. Have you ever had a pneumonia shot? [300 Respondents 65 and Older] Yes... 69% No Not sure... 6 In the past three years, have you been treated for or been told by a doctor, nurse or other health care provider that: Yes No Not Sure 22. You have high blood pressure?... 30% 70% <1% 23. (if yes) [583 Respondents]: Is it under control through medication, exercise or lifestyle changes? <1 24. Your blood cholesterol is high? (if yes) [423 Respondents]: Is it under control through medication, exercise or lifestyle changes? You had a stroke? <1 27. (if yes) [34 Respondents]: Is it under control through medication, exercise or lifestyle changes? You have heart disease or a heart condition? <1 29. (if yes) [162 Respondents]: Is it under control through medication, exercise or lifestyle changes? Milwaukee County Community Health Survey Report

182 Yes No Not Sure 30. You had a mental health condition, such as an anxiety disorder, obsessive-compulsive disorder, panic disorder, post traumatic stress disorder or depression?... 14% 86% <1% 31. (if yes) [279 Respondents]: Is it under control through medication, exercise or lifestyle changes? <1 32. You have cancer? <1 33. (if yes) [79 Respondents; Multiple responses accepted]: What type of cancer?... Breast respondents Melanoma/skin respondents Prostate respondents Cervical... 5 respondents Colon... 3 respondents Lymphoma... 3 respondents Kidney... 3 respondents Bladder... 3 respondents Brain... 3 respondents Uterine... 3 respondents All others (1 response each) respondents 34. You have diabetes (men) You have diabetes not associated with a pregnancy (women) <1 35. (if yes) [201 Respondents]: Is it under control through medication, exercise or lifestyle changes? Do you currently have asthma? (if yes) [238 Respondents]: Is it under control through medication, exercise or lifestyle changes? < On an average day, how many servings of fruit do you eat or drink? One serving is ½ cup of canned or cooked fruit, 1 medium piece of fruit or 6 ounces of juice. One or fewer servings... 38% Two servings Three or more servings Not sure On an average day, how many servings of vegetables do you eat? One serving is ½ cup of cooked or raw vegetable or 6 ounces of juice. One or fewer servings... 46% Two servings Three or more servings Not sure... 0 Milwaukee County Community Health Survey Report

183 40. Now thinking about the moderate physical exercise you do when you are not working, in a usual week, do you do moderate activities for at least 10 minutes at a time, such as brisk walking, bicycling, vacuuming, gardening or anything else that causes small increases in breathing or heart rate? Yes... 84% No Not sure... <1 41. How many days per week do you do these moderate activities for at least 10 minutes at a time? 42. On the days you do these moderate activities for at least 10 minutes at a time, how much total time per day do you spend doing these activities? No moderate activity... 16% Less than 5 times/week for 30 minutes or less than 30 minutes each time times/week for 30 minutes or more Not sure Now thinking about the vigorous physical exercise you do when you are not working, in a usual week, do you do vigorous activities for at least 10 minutes at a time, such as running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate? Yes... 46% No Not sure... <1 44. How many days per week do you do these vigorous activities for at least 10 minutes at a time? 45. On the days you do these vigorous activities for at least 10 minutes at a time, how much total time per day do you spend doing these activities? No vigorous activity... 54% Less than 3 times/week for 20 minutes or less than 20 minutes each time times/week for 20 minutes or more Not sure... <1 Milwaukee County Community Health Survey Report

184 Q46 THROUGH Q48 FEMALES ONLY Now I have some questions about women s health. 46. A mammogram is an x-ray of each breast to look for breast cancer. How long has it been since you had your last mammogram? [413 Respondents 50 and Older] Within the past year (anytime less than 12 months ago)... 61% Within the past 2 years (1 year, but less than 2 years ago) Within the past 3 years (2 years, but less than 3 years ago)... 6 Within the past 5 years (3 years, but less than 5 years ago) or more years ago... 8 Never... 3 Not sure A bone density scan helps determine if you are at risk for fractures or are in the early stages of osteoporosis. Have you ever had a bone density scan? [182 Respondents 65 and Older] Yes... 71% No Not sure A pap smear is a test for cancer of the cervix. If you have not had a hysterectomy, how long has it been since you had your last pap smear? [814 Respondents 18 to 65 years old] Within the past year (anytime less than 12 months ago)... 61% Within the past 2 years (1 year, but less than 2 years ago) Within the past 3 years (2 years, but less than 3 years ago)... 6 Within the past 5 years (3 years, but less than 5 years ago) or more years ago... 5 Never... 6 Not sure... <1 Q49 MALES 40 AND OLDER ONLY 49. There are two prostate cancer screenings. One is a digital rectal exam where a doctor, nurse, or other health professional places a gloved finger into the rectum to feel the size, shape, and hardness of the prostate gland while the other is a Prostate-Specific Antigen test, also known as a PSA test, which is a blood test for prostate cancer. How long has it been since you had your last prostate cancer screening? [502 Respondents 40 and Older] Within the past year (anytime less than 12 months ago)... 38% Within the past 2 years (1 year, but less than 2 years ago) Within the past 3 years (2 years, but less than 3 years ago)... 5 Within the past 5 years (3 years, but less than 5 years ago) or more years ago Never Not sure... 2 Milwaukee County Community Health Survey Report

185 MALE & FEMALE RESPONDENTS 50 AND OLDER 50. A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood. How long has it been since you had a blood stool test? [746 Respondents 50 and Older] Within the past year (anytime less than 12 months ago)... 14% Within the past 2 years (1 year, but less than 2 years ago)... 7 Within the past 5 years (2 years, but less than 5 years ago) years ago or more Never Not sure A sigmoidoscopy is where a flexible tube is inserted into the rectum to view the bowel for signs of cancer or other health problems. How long has it been since you had your last sigmoidoscopy? [746 Respondents 50 and Older] Within the past year (anytime less than 12 months ago)... 3% Within the past 2 years (1 year, but less than 2 years ago)... 3 Within the past 5 years (2 years, but less than 5 years ago)... 4 Within the past 10 years (5 years but less than 10 years ago) years ago or more... 5 Never Not sure A colonoscopy is similar to a sigmoidoscopy, but uses a longer tube, and you are usually given medication through a needle in your arm to make you sleepy and told to have someone else drive you home after the test. How long has it been since you had your last colonoscopy? [747 Respondents 50 and Older] ALL RESPONDENTS Within the past year (anytime less than 12 months ago)... 12% Within the past 2 years (1 year, but less than 2 years ago) Within the past 5 years (2 years, but less than 5 years ago) Within the past 10 years (5 years but less than 10 years ago) years ago or more... 5 Never Not sure During the past 30 days, about how often would you say you felt sad, blue, or depressed? Never... 36% Seldom Sometimes Nearly always... 4 Always... 3 Not sure... <1 Milwaukee County Community Health Survey Report

186 54. How often would you say you find meaning and purpose in your daily life? Never... 3% Seldom... 4 Sometimes Nearly always Always Not sure... <1 55. In the past year have you ever felt so overwhelmed that you considered suicide? Yes... 5% No Not sure... <1 Now I d like to ask you about alcohol. An alcoholic drink is one can or bottle of beer, one glass of wine, one can or bottle of wine cooler, one cocktail or one shot of liquor. 56. Considering all types of alcoholic beverages, how many times during the past month did you have [five or more drinks (males); four or more drinks (females)] on an occasion? None... 68% One time Two or more times Not sure... <1 57. In the past 30 days, did you drive or ride when the driver had perhaps too much alcohol to drink? Yes... 2% No Not sure... <1 During the past year, has ANYONE IN YOUR HOUSEHOLD, INCLUDING YOURSELF, experienced any kind of problem such as legal, social, personal, physical or medical in connection with? Yes No Not Sure 58. Drinking alcohol... 3% 98% <1% 59. Marijuana <1 60. Cocaine, heroin or other street drugs... <1 99 <1 61. Misuse of prescription drugs or over-thecounter drugs... <1 99 <1 62. Gambling <1 Milwaukee County Community Health Survey Report

187 Now I d like to talk to you about cigarettes and tobacco. 63. Do you now smoke cigarettes every day, some days or not at all? Every day... 17% Some days... 7 Not at all Not sure... 0 GO TO Q67 GO TO Q During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit? [479 Current Smokers] Yes... 64% No Not sure... <1 65. In the past 12 months, have you seen a doctor, nurse or other health professional? [480 Current Smokers] Yes... 72% CONTINUE WITH Q66 No GO TO Q67 Not sure... <1 GO TO Q In the past 12 months, has a doctor, nurse or other health professional advised you to quit smoking? [347 Current Smokers] Yes... 80% No Not sure... <1 67. Which statement best describes the rules about smoking inside your home Smoking is not allowed anywhere inside your home.. 74% Smoking is allowed in some places or at some times.. 10 Smoking is allowed anywhere inside your home or... 4 There are no rules about smoking inside your home Not sure... <1 68. In the past seven days, how many days were you in the same room or did you ride in a car with someone who was smoking cigarettes? [1,487 Nonsmokers] 0 days... 77% 1 to 3 days to 6 days... 4 All 7 days... 4 Not sure... <1 69. In the past 30 days, did you use other tobacco products such as cigars, pipes, chewing tobacco or snuff? Yes... 6% No Not sure... <1 Milwaukee County Community Health Survey Report

188 Now, I have a few questions to ask about you and your household. 70. Gender [DERIVED, NOT ASKED] Male... 47% Female About how much do you weigh, without shoes? 72. About how tall are you, without shoes? [CALCULATE BODY MASS INDEX (BMI)] 73. Are you Hispanic or Latino? Not overweight... 34% Overweight Obese Yes... 9% No Not sure... <1 74. Which of the following would you say is your race? 75. What is your current marital status? White... 57% Black, African American Asian... 2 Native Hawaiian or other Pacific Islander... <1 American Indian or Alaska Native... <1 Another race... 5 Multiple race... 3 Not sure... <1 Single and never married... 44% A member of an unmarried couple... 3 Married Separated... 3 Divorced Widowed... 7 Not sure What is the highest grade level of education you have completed? 8th grade or less... 2% Some high school... 7 High school graduate or GED Some college Technical school graduate... 5 College graduate Advanced or professional degree Not sure... <1 Milwaukee County Community Health Survey Report

189 77. What county do you live in? [FILTER] Milwaukee % 78. What city, town or village do you legally reside in? [FILTER] Milwaukee city... 67% West Allis... 6 Greenfield... 4 Wauwatosa... 4 All others (3% or less) What is the zip code of your primary residence? % All others (3% or less) Q80 THROUGH Q82 LANDLINE SAMPLE ONLY [FOR SAMPLING PURPOSES] 80. Do you have more than one telephone number in your household? Do not include cell phones or numbers that are only used by a computer or fax machine. 81. How many of these telephone numbers are residential numbers? 82. Do you have a cell phone that you use mainly for personal use? Milwaukee County Community Health Survey Report

190 83. What is your annual household income before taxes? Less than $10, % $10,000 to $20, $20,001 to $30, $30,001 to $40, $40,001 to $50, $50,001 to $60, $60,001 to $75, $75,001 to $90, $90,001 to $105, $105,001 to $120, $120,001 to $135, Over $135, Not sure... 9 No answer How many children under the age of 18 are living in the household? None... 62% GO TO Q107 One Two or more Not sure... 0 GO TO Q107 For the next questions, we would like to talk about the [RANDOM SELECTED] child. 85. Do you make health care decisions for [HIM/HER]? [742 Respondents] Yes... 76% CONTINUE WITH Q86 No GO TO Q107 Not sure... <1 GO TO Q What is the age of the child? [564 Respondents] 12 or younger... 74% 13 to 17 years old Not sure Is the child a boy or girl? [565 Respondents] Boy... 48% Girl Not sure Was there a time during the last 12 months that you felt your child did not get the medical care [HE/SHE] needed? [565 Respondents] Yes... 2% CONTINUE WITH Q89 No GO TO Q90 Not sure... <1 GO TO Q90 Milwaukee County Community Health Survey Report

191 89. Why did your child not receive the medical care needed? [13 Respondents; More than 1 response accepted] Uninsured...4 respondents Insurance did not cover it...4 respondents Poor medical care...3 respondents Cannot afford to pay...2 respondents Co-payments too high... 1 respondent Unable to get appointment... 1 respondent Other... 1 respondent 90. A personal doctor or nurse is a health professional who knows your child well, and is familiar with your child s health history. This can be a general doctor, a pediatrician, a specialist, a nurse practitioner or a physician assistant. Do you have one or more persons you think of as your child s personal doctor or nurse? [565 Respondents] Yes... 89% CONTINUE WITH Q91 No GO TO Q92 Not sure... <1 GO TO Q Preventive care visits include things like a well-child check, a routine physical exam, immunizations, lead or other health screening tests. During the past 12 months, did [HE/SHE] visit their personal doctor or nurse for preventive care? [506 Respondents] Yes... 93% No... 6 Not sure... <1 92. Specialists are doctors like surgeons, heart doctors, allergists, psychiatrists, skin doctors and others who specialize in one area of health care. Was there a time during the past 12 months your child needed to see a specialist but did not? [565 Respondents] Yes... 2% No Not sure... 0 CONTINUE WITH Q93 GO TO Q94 GO TO Q Why did your child not see a specialist needed? [10 Respondents; More than 1 response accepted] Unable to get appointment...5 respondents Insurance did not cover it... 1 respondent Not enough time... 1 respondent Specialty physician not in area... 1 respondent Don t know where to go... 1 respondent 94. Was there a time during the last 12 months that you felt your child did not get the dental care [HE/SHE] needed? [566 Respondents] Yes... 8% No Not sure... <1 CONTINUE WITH Q95 GO TO Q96 GO TO Q96 Milwaukee County Community Health Survey Report

192 95. Why did your child not receive the dental care needed? [46 Respondents; More than 1 response accepted] Can t find dentist who accepts child s insurance...20 respondents Unable to get appointment...13 respondents No dental insurance...6 respondents Cannot afford to pay...4 respondents Don t know where to go...4 respondents Health plan problem/insurance did not cover it...3 respondents Not enough time... 1 respondent Dentist/specialist not in area... 1 respondent 96. Does your child have asthma? [565 Respondents] Yes... 11% CONTINUE WITH Q97 No GO TO Q98 Not sure... <1 GO TO Q Asthma attacks, sometimes called episodes, refer to periods of worsening asthma symptoms that make the child limit his or her activity more than usual, or make you seek medical care. During the past 12 months, has your child had an episode of asthma or an asthma attack? [62 Respondents] Yes... 40% No Not sure When your child was an infant of less than one year old, where did [HE/SHE] usually sleep? [124 Children 2 years old or younger] Crib or bassinette... 86% Swing... 0 Pack n Play... 4 Couch or chair... 0 Car... 0 Car seat... <1 Floor... 0 In bed with you or another person... 8 Not sure... <1 99. How often do you feel your child is safe in your community or neighborhood? [565 Respondents] Always... 55% Nearly always Sometimes Seldom... 1 Never... 3 Not sure... 0 Milwaukee County Community Health Survey Report

193 100. During the past 6 months, how often was your child unhappy, sad or depressed? [287 Children 8 to 17 years old] Always... 3% Nearly always... 4 Sometimes Seldom Never Not sure During the past 12 months, has your child experienced any bullying? [289 Children 8 to 17 years old] Yes... 22% No Not sure... < What type of bullying did your child experience? [289 Children 8 to 17 years old; More than One Response Accepted] Verbally abused for example, spreading mean rumors or kept out of a group... 18% Physically bullied for example, being hit or kicked Cyber or electronically bullied for example, teased, taunted, humiliated or threatened by , cell phone, Facebook postings, texts or other electronic methods On an average day, how many servings of fruit does your child eat or drink? One serving is ½ cup of canned or cooked fruit, 1 medium piece of fruit or 6 ounces of juice. [390 Children 5 to 17 years old] One or fewer servings... 21% Two servings Three or more servings Not sure On an average day, how many servings of vegetables does your child eat? One serving is ½ cup of cooked or raw vegetable or 6 ounces of juice. [392 Children 5 to 17 years old] One or fewer servings... 39% Two servings Three or more servings Not sure During the past seven days, on how many days was your child physically active for a total of at least 60 minutes that caused an increase in their heart rate and made them breathe hard some of the time [388 Children 5 to 17 years old] One or fewer days... 7% CONTINUE WITH Q106 2 through 4 days GO TO Q107 5 or more days GO TO Q107 Not sure... 5 GO TO Q107 Milwaukee County Community Health Survey Report

194 106. Why was your child not physically active for at least 60 minutes on more days? [113 Children 5 to 17 years old; More than 1 response accepted] Child does not like to be physically active... 30% Likes to play video games or on computer School/homework/other activities Prefers to watch TV Weather... 8 Lack of time... 7 Sick/ill... 6 Neighborhood is not safe to be outside... 3 Work... <1 Other The next series of questions deal with personal safety issues During the past year has anyone made you afraid for your personal safety? Yes... 7% No Not sure... 0 CONTINUE WITH Q108 GO TO Q109 GO TO Q What relationship is this person or people to you? For example, a spouse, spouse who is now separated, exspouse, boyfriend or girlfriend, parent, brother or sister, child, friend, acquaintance, a stranger, or someone else? Again, I want to assure you that all your responses are strictly confidential. [134 Respondents; More than 1 response accepted] Stranger... 57% Acquaintance Boyfriend or girlfriend... 9 Child... 5 Ex-spouse... 4 Friend... 3 Spouse... 2 Separated spouse... 2 Brother or sister... 2 Someone else... 3 Not sure During the past year has anyone pushed, kicked, slapped, hit or otherwise hurt you? Yes... 4% No Not sure... <1 CONTINUE WITH Q110 GO TO Q111 GO TO Q111 Milwaukee County Community Health Survey Report

195 110. What relationship is this person or people to you? For example, a spouse, spouse who is now separated, exspouse, boyfriend or girlfriend, parent, brother or sister, child, friend, acquaintance, a stranger, or someone else? [78 Respondents; More than 1 response accepted] Stranger... 32% Friend Acquaintance Boyfriend or girlfriend Child... 7 Parent... 4 Ex-spouse... 3 Brother or sister... 2 Spouse... 1 Someone else... 2 Not sure... < Finally, I will read you a list of health issues that some communities face. Please tell me the 3 largest health concerns in your community. Alcohol or drug use... 58% Violence Chronic diseases like diabetes, cancer or obesity Teen pregnancy Infectious diseases such as whooping cough, tuberculosis, or sexually transmitted diseases Mental health or depression Infant mortality Lead poisoning... 3 Milwaukee County Community Health Survey Report

196 APPENDIX B: SURVEY METHODOLOGY Milwaukee County Community Health Survey Report

197 SURVEY METHODOLOGY 2012 Community Health Survey The 2012 Milwaukee County Community Health Survey was conducted from June 20 through November 7, A total of 1,970 respondents were scientifically selected so that the survey would be representative of all adults 18 and older. The sampling strategy was two-fold. 1) A random-digit-dial landline sample of telephone numbers which included listed and unlisted numbers. The respondent within each household was randomly selected by computer based on the number of adults in the household (n=1,428). 2) A cell-phone only sample where the person answering the phone was selected as the respondent (n=542). For the landline sample, weighting was based on the number of adults in the household and the number of residential phone numbers, excluding fax and computer lines, to take into account the probability of selection. For the cell-phone only sample, it was assumed the respondent was the primary cell phone user. Combined, post-stratification was conducted by sex and age to reflect the 2010 census proportion of these characteristics in the area. With a sample size of 1,970, the margin of error is ±2%. The margin of error for smaller subgroups is larger Community Health Survey The 2009 Milwaukee County Community Health Survey was conducted from September 30, 2009 through January 28, One thousand nine hundred seventy-six respondents were scientifically selected so that the survey would be representative of all adults 18 and older. The sampling strategy was two-fold. 1) A random-digit-dial landline sample of telephone numbers which included both listed and unlisted numbers. The respondent within each household was randomly selected by computer based on the number of adults in the household (n=1,415). 2) A cellphone only sample where the person answering the phone was selected as the respondent (n=561). A reimbursement of $20 was offered to respondents to cover the cost of incoming minutes. For the landline sample, weighting was based on the number of adults in the household and the number of residential phone numbers, excluding fax and computer lines, to take into account the probability of selection. For the cell-phone only sample, it was assumed the respondent was the primary cell phone user. Combined, post-stratification was conducted by sex and age to reflect the 2000 census proportion of these characteristics in the area. With a sample size of 1,976, the margin of error is ±2%. The margin of error for smaller subgroups is larger Community Health Survey The 2006 Milwaukee County Community Health Survey was conducted from March 14 through August 11, A total of 3,271 random adults 18 and older within the community were interviewed by telephone. Due to the nature of the study, some areas were random digit dial which included unlisted and listed numbers while other areas were listed numbers only. Respondents within each household were randomly selected by computer based on the number of adults in the household. At least 8 attempts were made to contact a respondent. Survey respondents were weighted based on the number of adults in the household and the number of residential phone numbers, excluding fax and computer lines, to take into account the probability of selection. Post-stratification was also done by sex and age to reflect the 2000 census proportion of these characteristics in the area. With a sample size of 3,271, the margin of error is ±2%. The margin of error for smaller subgroups is larger Community Health Survey The 2003 Milwaukee County Community Health Survey was conducted from February 21 through June 10, A total of 1,951 random adults 18 and older within the community were interviewed by telephone. Due to the nature of the study, some areas were random digit dial which included unlisted and listed numbers while other areas were listed numbers only. At least 8 attempts were made to contact a respondent. Post-stratification was done by sex and age to reflect the 2000 census proportion of these characteristics in the area. With a sample size of 1,951, the margin of error is ±2%. The margin of error for smaller subgroups is larger. Milwaukee County Community Health Survey Report

198 Appendix C Key Informant Interviews Report

199 Key Informant Interview Report A summary of key informant interviews and focus groups in Milwaukee County Sponsored by: Health System Members of the Milwaukee Health Care Partnership Aurora Health Care Children s Hospital of Wisconsin Columbia St. Mary s Health System Froedtert Health Wheaton Franciscan Healthcare In Collaboration with: City of Milwaukee and other Municipal Health Departments in Milwaukee County Prepared by: Center for Urban Population Health

200 The Milwaukee Health Care Partnership is a public/private consortium dedicated to improving health care coverage, access and care coordination for underserved populations in Milwaukee County with the goals of improving health outcomes, eliminating disparities and reducing the total cost of care. Its members include the following partnering health systems and hospitals: Aurora Health Care Aurora Sinai Medical Center Aurora St. Luke s Medical Aurora St. Luke s South Shore Aurora West Allis Medical Center Aurora Psychiatric Hospital Children s Hospital and Health System Children s Hospital of Wisconsin Columbia St. Mary s Columbia St. Mary s Hospital Milwaukee Sacred Heart Rehabilitation Institute Froedtert Health Froedtert Hospital Wheaton Franciscan Healthcare Wheaton Franciscan Healthcare- St. Francis Wheaton Franciscan- St. Joseph Campus Wheaton Franciscan Healthcare- Franklin Wheaton Franciscan- Midwest Spine and Orthopedic Hospital and Wisconsin Heart Hospital This report was prepared by the Design, Analysis and Evaluation team at the Center for Urban Population Health. Courtenay Kessler, MS, Madeline Lamb, Carrie Stehman, MA, and David Frazer, MPH, prepared this report. If there are any questions, please feel free to contact them at

201 Table of Contents Introduction General Themes 4 5 Top Five Health Issues 6 Behavioral Health Mental Health and Alcohol and Drug 6 Access to Health Care Services 8 Physical Activity, Overweight and Obesity, and Nutrition 9 Health Insurance Coverage 10 Infant Mortality 11 Comparing City to County 11 Additional Health Issues 12 Asthma 13 Cancer Screening and Management 13 Cardiovascular Disease 13 Chronic Disease 13 Communicable Disease 14 Diabetes 14 Environmental and Occupational/Environmental Quality and Preparedness 15 Growth and Development 15 HIV Infection/AIDS 15 Immunization 16 Injury and Violence 16 Navigation of Health Care Services 16 Reproductive and Sexual Health/Responsible Sexual Behavior 17 Tobacco 17 Limitations 17 Appendix A. Interview Focus Group Participation for Milwaukee County 18

202 Milwaukee County Health Needs Assessment Introduction This report presents a summary of public health priorities for Milwaukee County, as identified in 2012 by providers, policy-makers, and other local experts and community members ( key informants ). These findings are a critical supplement City of Milwaukee Community Health Survey and the Secondary Data Analysis components of the overall community health needs assessment (CHNA) commissioned by the health system members of the Milwaukee Health Care Partnership in collaboration with local health departments. The CHNA incorporates input from persons representing the broad community served by the hospitals, focusing on a range of public health issues relevant to the community at large. Key informants in Milwaukee County were identified by the Milwaukee Health Care Partnership in collaboration with the City of Milwaukee Health Department. The interviews were conducted by Partnership members and graduate students supervised by the City of Milwaukee Health Department. The interviewers used a standard interview script ( schedule ) that included the following elements: Ranking of up to five public health issues, based on the focus areas presented in Wisconsin s State Health Plan, that are the most important issues for the County; and For those five public health issues: Existing strategies to address the issue Barriers/challenges to addressing the issue Additional strategies needed Key groups in the community that hospitals should partner with to improve community health All informants were made aware that participation was voluntary and that responses would be shared with the Center for Urban Population Health for analysis and reporting. The top issues were identified primarily through key informant rankings in combination with summaries of priority issues identified in the focus groups. Additionally, qualitative analysis of responses focused on relationships between issues, with emerging themes used to inform the final rankings. Lastly, representatives from each health system and the City of Milwaukee Health Department (all of whom had conducted interviews or supervised interviewers) participated in an analytic session to critique and validate findings. This report presents the results of this process, including cross-cutting themes, summaries of the top five health issues, and a comparison of results across jurisdictions (Milwaukee city v. other Milwaukee County municipalities). Additional summaries of each health issue are also reported. Forty-one individual key informant interviews were conducted in Milwaukee County. Of note, ten public health officers participated in the interviews as key informants. In addition, five group interviews were also conducted using the same interview schedule. 4

203 Milwaukee County Health Needs Assessment General Themes Poverty emerged as an important topic related to the health of Milwaukee County, often as a barrier to improved health. One key informant listed it as a top health issue in addition to the options provided in the interview schedule. Other related issues of socioeconomic status, joblessness, homelessness, and transiency were also mentioned. Housing (e.g., lead and other exposures), stress, and crime/incarceration were also noted as tied to both poor health and poverty. This overlaps with some key informants responses about disparities related to socioeconomic status being a concern for health in Milwaukee across topic areas. Race and Ethnicity emerged as important aspects influencing health in Milwaukee. First, respondents often identified culturally and/or neighborhood-specific prevention and treatment services and strategies to address health concerns. Organizations and initiatives on the South Side of Milwaukee (city) were identified as addressing health issues for the Latino residents living in that area, for example, and the Lifecourse Initiative for Health Families was offered as an example of a program to address the disparity in Black and White infant mortality. More broadly, race and ethnicity were mentioned in relation to concerns about health disparities. Respondents felt strategies addressing health issues in Milwaukee must be be inclusive and culturally competent. One respondent specifically mentioned racial segregation as a key barrier to better health. Chronic and communicable disease issues were important to the public. Broadly, these conditions were noted as having similar barriers and challenges. Suggested strategies generally focused on providing education to those in the community and increasing health literacy, and providing early detection methods and preventive services to the community. Social marketing emerged across the health topics. In some cases, marketing was named as a barrier or challenge, including topics like Chronic Disease (lack of marketing resources, competing messages), Tobacco (tobacco companies use marketing that targets children, minorities, low income areas), and Overweight/Obesity (marketing of fast food). Social media and marketing were also named as examples of strategies that could be used to address several issues. For example, social media and a public awareness campaign were suggested for Alcohol & Drug Use and a primary care campaign in media was suggested to address Access concerns. Schools, school districts, school programs, school-community partnerships, and parent-teacher organizations were named as leaders of existing strategies, potential strategies, and potential partnerships for many of the key focus area issues. Importantly, schools were noted as a point of contact for large portions of the population (both students and parents). A coalition led by the school district doing community outreach, school summer programs, and Franklin Area Parents and Students United are existing school-related strategies, for example, to address Alcohol and Drug use. Partnerships with schools around Asthma and early education efforts were common suggestions for needed strategies. Schools were listed as potential partners in addressing almost all of the key health issues presented. Health literacy was commonly noted by many respondents as a challenge to improving the community s health. This theme may tie into the related themes of enhanced social marketing strategies and education through schools and other community settings. In general, and across 5

204 Milwaukee County Health Needs Assessment issues and localities, respondents felt there was a need to increase the understanding of health issues and to work with community members and providers to make health information more comprehensible. Aside from general education, there were not many strategies offered as ways of addressing this barrier. Health Insurance Coverage, Access to Health Care Services, and Navigating Health Care Services emerged as key health concerns. These three issues were clearly intertwined for respondents. Each topic elicited similar challenges and each was mentioned as a barrier for the other. Considering these three topics, informants suggested common strategies to help Milwaukee County, focusing on the importance of creating and maintaining partnerships and expanding access by adding staff, reducing costs, and increasing availability of services. Respondents generally noted lack of awareness of how to enroll in insurance benefits, existing programs, and how insurance and health systems work as barriers to all three issues, providing examples of how the three issues can compound one another. Community health workers and navigators were named as a needed strategy to address all three issues. Additional work may be needed to disentangle these issues from one another and to pinpoint where the most pressing opportunities for change can be found. Top Five Health Issues The top five health issues that emerged as key priorities for Milwaukee County were: (1) Behavioral Health; (2) Access to Health Care Services; (3) Physical Activity/Overweight and Obesity/ Nutrition; (4) Health Insurance Coverage; and (5) Infant Mortality. Behavioral Health Key informants almost universally discussed mental health or alcohol and drug issues, with many discussing both. Mental health was more frequently discussed than alcohol and drug. Stigma and access to behavioral health services were noted as challenges to both areas. However, strategies to address the issue, both existing and needed, varied considerably. Because of these differences, as well as issue-specific challenges, we present the two issues separately under the larger umbrella of behavioral health. Mental Health: Mental health emerged as the most commonly discussed issue by Milwaukee County key informants. This area was noted as needing significant change and community investment, although several ongoing initiatives to make these changes were identified. Existing Strategies: The Milwaukee County Behavioral Health Redesign project was noted by many respondents as a critical strategy to address adult mental health issues, as was the related Nursing Voices project. Informants also identified a network of clinics, community programs and providers that address mental health for adults, children, families, and specific populations (Latinos). Many organizations have internal referral strategies or services, and there are also strategies to address the continuum of care across the community, like the community Warmline, Meta House, and the 6

205 Milwaukee County Health Needs Assessment Mobile Crisis Team. Outreach programs for patients and professionals, funding to provide mental health coverage (including the Affordable Care Act), and several child behavioral health programs (e.g., the Infant Mental Health Certificate Program through the UW Division of Continuing Studies) were noted. Barriers and Challenges: The key informants identified stigma and lack of general knowledge about mental health as barriers. Issues within the health care system (navigation, reimbursement, lack of providers, and lack of preventive services and screening as part of routine primary care), unemployment and poverty, lack of Spanish-speaking and Latino providers, cost of care, and transportation were barriers for patients attempting to find care. Informants also noted a lack of education and training for other public sector employees, a siloed system where each organization is on their own, and lack of funding for programs as challenges to the system. Although several strategies were noted that intend to address providing care across the community, several informants suggested the absence of a community system of care that went across or beyond the county s approach or individual health systems. Needed Strategies: The interviewees felt additional funds and providers, including physicians, will be needed to address mental health issues. Healthcare coverage, age- and culturally appropriate programs (especially for Latinos) to increase mental health awareness, screening, and education starting in schools and continuing through the lifecourse, the integration of mental health into primary care settings, and reimbursing supporting care agencies were also suggested as potential strategies to address this issue. Community education, for the general public and for professionals who encounter individuals with mental health concerns, could increase understanding of and compassion for individuals struggling with these issues. Additional strategies include improving care management and coordination, greater focus on holistic health, and addressing specific needs of the mentally ill (such as housing). Key Community Partners to Improve Health: Community nonprofits such as Meta House, National Alliance on Mental Illness (NAMI), Bread of Healing, Community Advocates, and AIDS Resource Center of Wisconsin (ARCW), pastors and churches, school districts, Warmline, County programs (such as the Behavioral Health Division and Mental Health Task Force), and police and emergency services are listed as key partners who will need to work with the community health systems to address mental health concerns in the community. The importance of health systems commitment to this issue was also noted. Alcohol and Drug / Substance Abuse: Many key informants ranked Alcohol and Drug as a top five health priority. Of note, this issue was considered separate from Tobacco, which was also commonly selected as a top health issue, with similar strategies and barriers. More information specific to Tobacco is presented separately. Existing Strategies: The Drink Less Campaign, Impact, Franklin Area Parents and Students United, Milwaukee County Mental Health System Redesign, and school summer programs were provided as examples of existing strategies. Several informants did not name any existing strategies. 7

206 Milwaukee County Health Needs Assessment Barriers and Challenges: The culture, state laws, lack of funding, lack of in-patient and out-patient resources, lack of clarity about how treatment will be financed under the Affordable Care Act, stigma, and lack of other social outlets were suggested as barriers and challenges to addressing alcohol and drug use. Needed Strategies: A community drop box for prescription drugs, education for providers and consumers, public policy changes, social media campaigns, peer mentors for teenagers, second chance strategies, and educational programming for children were named as examples of strategies needed to address these issues. Key Community Partners to Improve Health: Examples of key community groups that could be helpful in addressing these issues are schools, law enforcement, pharmacies, Medicaid, community agencies such as Meta House, Community Advocates, WCS, YMCA, and UCC, faithbased organizations, and the Department on Aging. Access to Health Care Services Access to Health Care Services was noted as a top concern for Milwaukee County. Respondents were concerned with the high cost of care, under-utilization of non-md practitioners, a lack of quality health care, and the disconnect between primary care and specialty services, specifically naming oral and mental health care services. In addition, access to other health-related services and goods was also noted both as a barrier to better health (lack of access to healthier food options) and as a reason for poor health (easy access to tobacco products). Access to services was routinely noted by key informants as barriers to addressing many health issues. Existing Strategies: Existing strategies listed by the interviewees included free clinics, the Dispensary of Hope, FQHC s, and the Milwaukee Health Care Partnership, and financial assessment education and enrollment efforts. Charity care, the health home model, and the Affordable Care Act were also noted. Barriers and Challenges: Lack of providers and low reimbursement rates, over reliance on physicians and underutilization of nurse practitioner and physician assistants, lack of focus on prevention, increased costs, language barriers, complex health systems, and lack of transportation were all named as barriers. Gaps in coverage for certain services (dental and mental health) and for in-betweeners not eligible for certain coverage types were also noted. Others noted mistrust of health professionals and fear of disclosing undocumented immigrant status as barriers. Needed Strategies: Informants suggested expanding capacity of free clinics, increasing efforts to improve health literacy, building trust with providers, employ more navigators, and raising awareness regarding primary care options. New partnerships that emphasis a holistic approach to mental health should be built and existing efforts like the Milwaukee Health Care Partnership should be sustained. Leaders and champions are needed in the community, including supporting community-based providers supported by public health programs, including efforts like the Promotoras model. Additionally, one respondent suggested the need to assess the impact of 8

207 Milwaukee County Health Needs Assessment access-related policies on the community and, more specifically, on minority populations. Key Community Partners to Improve Health: Nonprofit organization, corporate leaders, health departments, and funders were noted as key participants needed to address Access issues. Specifically, the Milwaukee Health Care Partnership, FQHCs, the Mayor, 211 Impact, United Way, Greater Milwaukee Foundation, Black Health Coalition, the United Neighborhood Centers of Milwaukee member organizations, Zilber School of Public Health, Health Watch, United Community Center and the Medical Society were all named as potential partners. Of note, Oral Health was consistently ranked as a health priority, with the vast majority of issues focused on access-related barriers: lack of insurance coverage and reimbursement, lack of providers who serve the underinsured and uninsured, shortage of bilingual services, and underutilization of dental hygienists and assistants. Respondents noted a number of ongoing community initiatives to address these challenges, including Marquette University Community Dental Clinics, St. Elizabeth Ann Seton Dental Clinic, and Sixteenth Street Community Health Center, and programs to train new dentists, work with retired dentists, and build new clinics. Several important community partners specific to oral health included the Dental Society, Milwaukee Public Schools sealant program, the Marquette School, Children s Health Alliance, and Progressive Community Health Clinic. Volunteers, including retirees, were suggested as one approach to improving oral health of the community. Additional leaders and champions are needed to bring this issue to the forefront of the health conversation. Physical Activity, Overweight and Obesity, and Nutrition Physical Activity, Overweight and Obesity, and Nutrition were high priorities for respondents, with suggested strategies, partners and challenges overlapping across these three topics. Respondents focused on children and encouraged the involvement of local school districts by improving school lunches and removing vending machines, increasing activity and physical education, and educating students about nutrition. The key informants also wanted the community to be involved in creating safer parks and community gardens, and expanding access to healthier fresh food. Existing Strategies: Existing strategies noted by the key informants included a variety of WIC Programs, grants, programs, utilization of Community Health Promoters, and community organizations that allow students and families to access healthy foods. Many community-based urban farming initiatives, gardens, health corner store initiatives, cooking class programs and health recipes, and workplace wellness discounts were identified. Formation of walking groups, the promotion of family activities, physical activity initiatives and education for youth (especially those that are family accessible, affordable, and culturally appropriate), and health programs to calculate BMI s and offer nutritional guidance were also noted. Barriers and Challenges: Keeping partners at the table, needing more community participation and involvement, poverty, and lack of resources (including funding, space, and programming) were noted as challenges. Barriers included the food environment and culture (promoting fast and 9

208 Milwaukee County Health Needs Assessment unhealthy food options), lack of information about preparing nutritious meals with limited resources ( how do you make balanced, nutritious meals with food stamps? ), lack of access to wholesome foods, and lack of education about healthy choices. In addition, some respondents felt the perception of these issues as personal health issues rather than as community or environmental concerns limited the menu of prevention efforts. Needed Strategies: Informants felt coordination between existing community efforts (support of urban agriculture and incentives for grocery stores to open up in urban areas), education for adults including more understandable nutrition fact labels, enhancing the school food environment (improve school lunch offerings and eliminate vending machines) and providing wellness screenings were promising strategies for Milwaukee. Federal, state, and local collaborations for consistent messaging, broader economic strategies, and coordination with nearby organizations were also suggested. Fun walks, runs, and play groups, lowering the cost of activities in the community, improving park safety, and starting a bike share program were also suggested. Key Community Partners to Improve Health: The strategies needed by Milwaukee require commitment of private partners, community organizations, social service agencies, women s organizations, employers, health departments, and policymakers. The YMCA, school districts, park systems, gardens and farmer market initiatives, the Sodexo Foundation, and local food establishments and retailers were key community partners listed by the informants. Health Insurance Coverage Although Coverage was closely linked to access, it emerged as a critical issue of its own. Existing Strategies: Education around care coordination and navigation, financial eligibility assessment, Medicaid expansion, and use of patient advocates and Promotoras were identified as existing strategies to increase coverage. Barriers and Challenges: Language barriers, limited health department staffing, lack of understanding about the Affordable Care Act or a coherent conversation around the issue, and providers screening out Medicaid and uninsured patients were provided as examples of barriers and challenges to addressing this issue. Financial resources and literacy issues, including an understanding of how health systems work, were noted as challenges for patients. Needed Strategies: Additional partnerships and HMO and community-based organization advocates were examples provided of strategies needed to address this issue. Most respondents felt the Affordable Care Act was on the right track and should be supported. Key Community Partners to Improve Health: FQHCs and free clinics, HMOs, Common Ground, AARP, charitable foundations, faith-based organizations, legislative advocacy groups, and refugee settlement agencies were examples of community groups that should partner with health systems to improve coverage. 10

209 Milwaukee County Health Needs Assessment Infant Mortality Existing Strategies: The Lifecourse Initiative for Healthy Families, United Way efforts, City of Milwaukee Health Department programming, Healthy Baby Zone, Parenting Network programming, and community awareness building were named as existing strategies to address infant mortality. Barriers and Challenges: Racism and health disparities, too much focus on co-sleeping /cultural biases about co-sleeping, lack of focus on support for new mothers and substance abuse and mental health, judgmental attitudes toward at-risk mothers, lack of education and awareness, young parents, missing fathers, poor nutrition, and poverty were all named as community challenges. Lack of cohesion between programs and community organizations was also named as a challenge. Needed Strategies: Our community does not lack for strategies. Social marketing campaigns, education about bed-sharing, breastfeeding support, faith community involvement, outreach work with community health workers and peer mentors, work within schools, and fatherhood support (specifically noted for African American fathers) including education and career training were named as additional strategies needed to address this issue. One respondent noted a plan has been laid out by the Milwaukee Lifecourse Initiative for Healthy Families: Community Action Plan. (It is important to note that plan focuses on the jarring disparity in infant mortality between black and white babies. Other informants suggested the importance of adopting different approaches for specific cultural groups including Latinos and Hmong families.) Key Community Partners to Improve Health: United Way, City of Milwaukee, the Lifecourse Initiative for Healthy Families, childcare providers, faith communities, W-2 agencies, health departments, schools, the Black Health Coalition, and the Milwaukee Health Care Partnership Access Initiative were named as key community groups needed as health system partners to improve community health around infant mortality. Comparing City to County A separate analysis focused on partners within the city of Milwaukee (rather than the larger Milwaukee County) was conducted to guide the work of the City of Milwaukee Health Department. CUPH compared the results from these interviews to the responses from representatives from other county municipalities to identify any differences in informant responses. Overall, top issues for the city were quite similar to those of the other county municipalities. Though key informants from the city and county chose many of the same health focus areas as priorities, there were some differences in their responses about existing strategies, barriers or challenges, strategies needed, and potential partners. In this section, a few key differences are highlighted. While it may be helpful to examine these differences, both the small number of respondents from each municipality and the differences municipalities likely influence the results. Generally, informants from Milwaukee city more often noted the need for more culturally competent providers and culturally appropriate education, services, and programs to address top health 11

210 Milwaukee County Health Needs Assessment concerns, particularly for Spanish speaking or bilingual Latino communities in Milwaukee. For example, more informants from the city of Milwaukee named specific programs and current or potential partners serving Milwaukee s South Side, such as the United Community Center, Sixteenth Street Community Health Centers, CORE/El Centro, and the Aurora Walker s Point Community Clinic. Discussion around the topic of Injury and Violence reflected some differences for city and county municipality informants. Responses from informants at the county level focused on injury prevention for children (e.g., crib, seatbelt, helmet, and bicycling safety, and drug abuse prevention education), whereas responses from Milwaukee city informants reflected additional concerns about gun violence, specifically the amount of guns and lack of effective gun control policy in Milwaukee. Also of note for city respondents were barriers and challenges related to racism, specifically the high incarceration rates of African American men and stereotypes of Black men as criminals, an issue not commonly addressed by respondents outside of Milwaukee city. Both county and city interviewees responses addressed concerns about intimate partner and domestic violence and both named law enforcement as an important collaborator for Injury and Violence prevention in general. Issues presented for Milwaukee city more often had nuances reflecting diversity as well as racism and racial and ethnic inequities or disparities in access to services. With few exceptions, the responses from other municipalities less often pointed explicitly to racial or ethnic diversity as a health-related issue. Responses that explicitly named racial disparities were common among city-based respondents. Racial disparities in birth outcomes, the need to address the concerns of Black fathers, potential immigrant mistrust of health care systems, racism in the criminal justice system, and the need for culturally appropriate mental health services for Latino and African American Milwaukeeans are some examples of issues identified by city-based respondents. As a point of comparison, poverty and socioeconomic disparities were commonly referenced as issues across jurisdictions. Alternatively, several specific issues were identified by County representatives from outside of Milwaukee City. These issues included: High prevalence of heroin use Prescription drug use Bullying, suicide, and hoarding as specific mental health issues Lastly, while informants from Milwaukee city and other municipalities alike discussed issues related to access to services and the impact of transportation, there were some slight variations in the nature of these barriers. One respondent from outside Milwaukee city noted large travel distances required of local residents accessing specific services that were only located in Milwaukee city, whereas city respondents focused on lack of public transportation. D. Additional Health Issues The remaining health issues and suggestions for addressing these concerns (all except for one identified as a top five health issue by at least one respondent) are described below in alphabetical order. 12

211 Milwaukee County Health Needs Assessment Asthma Existing Strategies: The City s lead abatement efforts and the American Lung Association s programs were named as examples of strategies in place to address asthma in Milwaukee County. Barriers and Challenges: Lack of parent education about second hand smoke and environmental issues and lack of awareness of community clinics and hours were given as examples of barriers and challenges that need to be addressed. Needed Strategies: Informants felt parent education, school partnerships, and work with medical providers were needed to better address asthma in the community. Key Community Partners to Improve Health: The American Lung Association and organizations serving children (e.g., Next Door Foundation, Penfield Children s Center) were named as potential community partners for addressing this issue in Milwaukee County. Cancer Screening and Management Cancer Screening and Management was not ranked as one of the top health related priorities for the County. Neither strategies nor barriers were described. Cardiovascular Disease Existing Strategies: Programs in place through health systems, educational materials, and educational staff were listed as existing strategies to address cardiovascular disease. Barriers and Challenges: Lack of funding, lack of transportation, and few available resources to address the issue were named as current barriers or challenges. Needed Strategies: No additional strategies were identified to address this issue. Key Community Partners to Improve Health: The Lion s Club, faith-based communities, and Early Childhood Interagency Council were potential partners named to address cardiovascular disease. Chronic Disease Of note, the second survey broke this category into more specific disease groups, with most being ranked by at least one respondent as a top five health issue: Asthma; Diabetes; Cardiovascular Disease; HIV/AIDS; and Cancer. More information about each specific disease category is provided below under the Additional Health Issues section. Existing Strategies: The existing strategies that the key informants identified included care coordination and case management programs, promotion of the medical home model, screening and prevention strategies, the Well Women Program, and in-person and social media outreach. Barriers and Challenges: The interviewees listed barriers that included access issues, poverty, lack of marketing resources and uniform messaging, and individual resistance to lifestyle changes. 13

212 Milwaukee County Health Needs Assessment Informants also noted a lack of inter-agency collaboration and partnerships to address chronic disease issues in the community. Needed Strategies: Early detection and prevention programs, medical record exchange and health system collaboration, and expansion of services (including medical services as well as nontraditional prevention services like Fondy Foods) were noted as needed strategies. Partnerships to plan for the future, focusing on the Affordable Care Act and more generally, were recommended. Key Community Partners to Improve Health: Key partners included education partners (e.g., Milwaukee Public Schools (MPS), YMCA) that work with children, health departments, Federally Qualified Health Centers (FQHC) and other free clinics, and private sector partners. Several responses seemed to focus on engaging businesses, agencies, and organizations with a stake in nutrition and/or active living. Communicable Disease Existing Strategies: Strategies listed by the key informants are marketing campaigns to help share information with the community, early detection and preventive actions, TB treatment, and advance notice to professionals. Barriers and Challenges: Cuts to public health, misunderstanding and the use of the internet were listed as barriers by the key informants. Needed Strategies: Additional strategies that could help address this issue are improving health literacy and inter-agency collaboration and information sharing. Key Community Partners to Improve Health: In addition to the health systems, important partners listed by the key informants are public health, FQHCs, community organizations, and public schools. Diabetes Existing Strategies: Existing prevention strategies include wellness work done by CORE/El Centro, Walker s Point Community Clinic, the Sixteenth Street Community Health Center, and diabetes prevention programs. Barriers and Challenges: Poverty, prevention is a low priority, low educational attainment, low health literacy, lack of knowledge of risk factors, no medical home, and inadequate numbers of interpreters in health care settings were suggested as barriers. Needed Strategies: Health promoter programs to improve communication and access to information were suggested as an example of a strategy to address this issue. Focus on prevention and testing in children and at risk populations (Latinos). Key Community Partners to Improve Health: The Wisconsin Health Care Association, the Diabetes Association, United Community Center, employers and insurance companies, and Community Health Workers were named as key partners to improve community health around this issue. 14

213 Milwaukee County Health Needs Assessment Environmental and Occupational / Environmental Quality and Preparedness Existing Strategies: Radon screenings for homes, reverse 911 program, ordinance and statutes, Milwaukee County Crisis Team, and lead abatement are all existing strategies in Milwaukee County. Barriers and Challenges: Challenges listed by the key informants include lack of funding, lack of staff, no statutes for long term compliance, and general lack of knowledge and awareness. Needed Strategies: Public and neighbor awareness and education, increased number of staff, and reducing the use of everyday chemicals were mentioned as needed strategies. Key Community Partners to Improve Health: The Mental Health Complex and crisis team, partnerships with private companies and community departments, Milwaukee Riverkeeper- Senior Water Advocacy Network, Brico Fund, and the Urban Ecology Center were named as potential partners. Growth and Development Existing Strategies: The interviewees included the Lifecourse Initiative for Healthy Families, Birth to Three, Ages and Stages Questionnaire (ASQ) Screenings, Early Childhood Interagency Council, and reproductive health education as existing strategies. Barriers and Challenges: The challenges the key informants listed include lack of resources and information for the community, long wait for Children s Hospital of Wisconsin referrals, teen pregnancies, and lack of screenings. Needed Strategies: Nutrition and physical activity programs, health literacy programs, immunization programs, checklists for doctors and patients, advertising, increase the number services and providers, and pre-birth counseling were all included as additional needed strategies. Key Community Partners to Improve Health: School districts, midwives, and community based agencies and clinics were listed as key partnering groups for healthcare systems. HIV Infection/AIDS Existing Strategies: The Wisconsin AIDS Fund, the AIDS Resource Center of Wisconsin, and Diverse and Resilient were named as organizations currently addressing HIV/AIDS in Milwaukee. Barriers and Challenges: Homophobia, the perception of HIV/AIDS as only a gay problem, and denial in African American and Latino communities were named as barriers. Needed Strategies: Increased comprehensive sexual health education and testing are examples of further strategies needed to address this issue. Key Community Partners to Improve Health: Beyond the partners named above, the Black Health Coalition, the Sixteenth Street Community Health Center, and the Benedict Center were potential community partners named to address this issue in Milwaukee County. 15

214 Milwaukee County Health Needs Assessment Immunization Existing Strategies: School system, work place, and refugee immunization regulations and messaging and from health care providers were named as current strategies to address immunization. Barriers and Challenges: Policy changes, lack of records, language barriers, negative perceptions of vaccinations, and lack of funding were given as examples of challenges to addressing immunization. Needed Strategies: Parent education, health departments programs providing vaccination to the uninsured and underinsured, social marketing, and ongoing training and updates for staff were listed as needed strategies to address immunization challenges. Key Community Partners to Improve Health: Marketing agencies, schools, faith communities, and refugee resettlement groups were named as potential partners around this issue. Injury and Violence Existing Strategies: Existing strategies to address violence included anti-bullying campaigns, sexual assault/ domestic violence organizations (including Sojourner Family Peace Center) and police advocates. Focusing on injury prevention, informants listed seat belt, pedestrian and bicycle safety programs, safe sleep programs, and helmet distribution programs as current efforts. Reproductive planning and drug use prevention programs, and enforcement of city policies were also noted as impacting violence and injury. Barriers and Challenges: Lack of sidewalks, lack of resources, lack of candid discussion, the long amount of time it takes to break the cycle of violence, and lack of family support systems were named as examples of barriers and challenges to addressing the range of issues. Barriers to addressing gun violence are lack of enforcement and the increasing amount of guns present. Additional barriers included racial stereotyping and incarceration rates. Needed Strategies: Collaborative work and information sharing, infant safety and preventative education (youth education), extension of current services, access to counseling and awareness building in communities, and changing gun control policies are examples of strategies still needed to address these issues. Key Community Partners to Improve Health: School districts, Medical College of Wisconsin Violence Prevention Initiative, faith communities, police departments, day care centers, the Housing Authority, and women s groups are examples of key community groups who should be partnering to improve issues of Violence and Injury. Navigation of Health Care Services Existing Strategies: The Community Health Worker movement, City of Milwaukee Health Department, Lindsay Heights Health Care Commons, home visiting services, and enhanced personnel training (including LPNs) are examples of current strategies in use or development to address navigation issues. Barriers and Challenges: Waiting lists and project shutdowns, language barriers, health literacy, lack of confidence and trust, cost, and limited staffing were named as challenges. Needed Strategies: More staff (especially more cultural competent and better trained), new partnerships, medical homes that include mental health services, educate and empower patients, and transportation services were 16

215 Milwaukee County Health Needs Assessment named as strategies needed to address this issue. Key Community Partners to Improve Health: The Milwaukee Health Care Partnership, the Area Health Education Center, School of Public Health, United Way, the hotline, FQHCs, faith-based organizations, and interpreters were named as key potential community partners. Reproductive and Sexual Health / Responsible Sexual Behavior Existing Strategies: Milwaukee Public Schools health education in Human Growth and Development, programming through Planned Parenthood, the United Way Healthy Girls initiative, and the prevention network were listed as existing strategies to address these issues in Milwaukee County. Barriers and Challenges: Sex and sexuality as taboo topics and the moralization of these issues, a reduction in number of school nurses, and the health department no longer being able to take patients were listed as relevant barriers and challenges. Needed Strategies: Communication and community-level education are needed. Key Community Partners to Improve Health: No additional community groups were suggested as new partners, although it was noted that there are many partners already working to address these issues. Tobacco Existing Strategies: School events, D.A.R.E., and other tobacco use prevention programming in schools, taxes on tobacco products, public service announcements, and public health department efforts (cessation programs) were listed as strategies already in place to address this issue. Barriers and Challenges: Lack of funding and discussion (especially in transient communities) tobacco product marketing directed toward children, minorities, and in low-income areas, easy access to products, and lack of a strong lobby against tobacco were provided as examples of barriers and challenges to addressing this issue. Needed Strategies: Programming for younger children, social media campaigns against tobacco use, teen peer mentors, enforcing tobacco free zones around schools, compliance assessments, incentive programs to quit or not start, and programming that treats tobacco as an addictive drug were listed as additional strategies needed to address tobacco use in Milwaukee County. Key Community Partners to Improve Health: Schools, law enforcement, YMCA, parent-teacher organizations, the American Lung Association, the American Cancer Society, United Way, and SERVE marketing were suggested as potential partners. Limitations: The report relies on the opinions and experiences of a limited number of experts identified as having the community s pulse. However, it is possible that the results would have been different if a different set of informants had been interviewed. Moreover, several invited informants were not able to participate in the interviews. Results should be interpreted in conjunction with other Milwaukee County data (e.g., CHNA surveys and secondary data reports). The large number of interviewers could have resulted in some inconsistencies in data collection. Lastly, although CUPH used a consistent analysis process to review the interview data, it is possible that certain responses have been misinterpreted. 17

216 Milwaukee County Health Needs Assessment Appendix A. Interview and Focus Group Participants for Milwaukee County Key Informant Interview Participants Name Title Organization Nicole Angresano, MPH Vice President United Way of Greater Milwaukee Bevan Baker, FACHE, MHA Milwaukee Health City of Milwaukee Health Department Commissioner Jamie Berg, RS, MPH Health Officer North Shore Health Department Hector Colon, MS, OT Director Milwaukee County Department of Health & Human Services Matt Crespin, MPH, RDH Associate Director Children's Health Alliance of Wisconsin Kathleen Demien, RN Public Health Nurse North Shore Health Department Ricardo Diaz Executive Director United Community Center Scott Gelzer, MA Executive Director The Faye McBeath Foundation Michael Gifford, MBA President & CEO AIDS Resource Center of Wisconsin Veronica Gunn, MD, MPH, FAAP Vice President, Population Children s Hospital of Wisconsin Health Robert Harris Regional Director Wisconsin Department of Public Health Services Janel Hines, JD Director Greater Milwaukee Foundation Willie L. Hines, Jr. BA President Milwaukee Common Council Nancy Kreuser, RN, PhD Health Officer Wauwatosa Health Department Robin Mayrl, MSW Vice President Helen Bader Foundation Patricia McManus, PhD, MSN Executive Director & CEO Black Health Coalition of Wisconsin John Meurer, MD, MBA Director Medical College of Wisconsin Institute for Health and Society Michael Murphy, MPA Alderman, 10th District Milwaukee Common Council Sally Nusslock, RN, BSN Interim Health Officer West Allis & West Milwaukee Health Department Jacqueline Ove, RN Health Officer South Milwaukee Health Department Magda Peck, ScD Founding Dean, Professor UW-Milwaukee Joseph J. Zilber School of Public Health Paula Penebaker, BS President & CEO YWCA Milwaukee Debra Persak, RN Health Officer Hales Corners Health Department Larry Pheifer Executive Vice President Medical Society of Milwaukee County Kathy Platt, RN Public Health Nurse North Shore Health Department Judi Price, RN, BSN, MSHCA Health Officer Oak Creek Health Department Helen Ramon, MS Program Officer Helen Bader Foundation Darren J. Rausch, MS Health Officer Greenfield Health Department 18

217 Milwaukee County Health Needs Assessment Name Title Organization Kathy Scott, RN Public Health Officer Saint Francis Health Department Sue Shepeard, RN, MSN Health Officer Greendale Health Department Tony Shields, MSM Executive Director UNCOM (United Neighborhood Centers of Milwaukee) Ana-Paula Soares Lynch, MS, CPC Program Director/ Psychotherapist CORE/ El Centro Bill Solberg, MSW, LCSW Chair Director of Community Milwaukee Oral Health Task Force Columbia St. Mary's Services Joy Tapper, MPA Executive Director Milwaukee Health Care Partnership Jessie Tobin, MPH Program Manager Lindsay Heights Health Alliance Joe Volk CEO Community Advocates Kim Whitmore, MSN, RN, CPN Health Officer Cudahy Health Department William Wucherer, RN Health Officer Franklin Health Department Bob Yamachika President and CEO YMCA of Metro Milwaukee Mary Lou Young President and CEO United Way of Greater Milwaukee Virginia Zerpa-Uriona, MPH Interim Chair Latino Health Coalition Focus Groups: United Neighborhood Centers of Milwaukee (UNCOM) Executive Directors Boys and Girls Club of Greater Milwaukee Staff Housing Authority of the City of Milwaukee Residents from Parklawn (Family Housing) Housing Authority of the City of Milwaukee Residents from Highland Gardens (Senior and Disabled Housing) Medical Society of Milwaukee County 19

218 Appendix D Secondary Data Report

219 Secondary Data Report A summary of secondary data sources related to health in Milwaukee County Sponsored by: Health System Members of the Milwaukee Health Care Partnership Aurora Health Care Children s Hospital of Wisconsin Columbia St. Mary s Health System Froedtert Health Wheaton Franciscan Healthcare In Collaboration with: City of Milwaukee and other Municipal Health Departments in Milwaukee County Prepared by: Center for Urban Population Health

220 The Milwaukee Health Care Partnership is a public/private consortium dedicated to improving health care coverage, access and care coordination for underserved populations in Milwaukee County with the goals of improving health outcomes, eliminating disparities and reducing the total cost of care. Its members include the following partnering health systems and hospitals: Aurora Health Care Aurora Sinai Medical Center Aurora St. Luke s Medical Aurora St. Luke s South Shore Aurora West Allis Medical Center Aurora Psychiatric Hospital Children s Hospital and Health System Children s Hospital of Wisconsin Columbia St. Mary s Columbia St. Mary s Hospital Milwaukee Sacred Heart Rehabilitation Institute Froedtert Health Froedtert Hospital Wheaton Franciscan Healthcare Wheaton Franciscan Healthcare- St. Francis Wheaton Franciscan- St. Joseph Campus Wheaton Franciscan Healthcare- Franklin Wheaton Franciscan- Midwest Spine and Orthopedic Hospital and Wisconsin Heart Hospital This report was prepared by the Design, Analysis and Evaluation team at the Center for Urban Population Health. Courtenay Kessler, MS, Madeline Lamb, Carrie Stehman, MA, and David Frazer, MPH, prepared this report. If there are any questions, please feel free to contact them at

221 Notes: In the spring of 2012, the Center for Urban Population Health was enlisted to create reports detailing the health of various counties using secondary data. These health data reports are one component of a variety of data sources being used by six local health systems to describe their communities and the health priorities of their service areas. These reports were specifically developed to complement a telephone survey conducted in each county. Because of their complementary nature, these reports are not all-inclusive. Indicators for which primary data are being collected were excluded from this report. In addition, rather than repurposing data from the comprehensive County Health Rankings report created by the University of Wisconsin Population Health Institute (2012), the county level data from the rankings report are included in their entirety at the end of this report. All of the data used in this report come from publicly available data sources. Data for each indicator were presented by race and ethnicity and gender when the data were available. In some cases data were not presented by the data source due to internal confidentiality policies which specify that data will not be released when the number is less than five. In other cases, the data were available but the rates or percentages are not presented in this report. This is due to the indicator having small numbers in the numerator or denominator resulting in rates or percentages that were subject to large year to year fluctuations and, as such, would not have provided a meaningful representation of the data for the population subset. When applicable, Healthy People 2020 objectives are presented for each indicator. The objectives were not included unless the indicator directly matched with a Healthy People 2020 objective. University of Wisconsin Population Health Institute. County Health Rankings Accessible at

222 Table of Contents 2012 Milwaukee Health Report Summary and SES Zip Code Map 5 Milwaukee County High Hospital Utilization Corridor 5 Milwaukee Health Professional Shortage Area Maps 6 Total Population Demographics 7 7 Total Births 8 Percent Births Receiving First Trimester Care 8 Percent Late or No Prenatal Care 9 Tobacco Use During Pregnancy 9 Low Birth Weight 10 Infant Mortality 10 Premature Birth 11 Birth Rate Ages Birth Rate Ages Number of Deaths and Mortality Rate 12 Years of Potential Life Lost 13 Age-Adjusted Mortality Rate 14 Average Age at Death 14 Number and Rate of Injury Deaths 15 Number of Suicides 16 Rate of Suicides 17 Number and Rate of Injury Hospitalizations 18 Number and Cause of Emergency Room Visits for Injuries 19 Rate of Emergency Room Visits for Injuries 20 Sexually Transmitted Infections HIV Cancer Incidence 22 Health Behaviors from Behavioral Risk Factors Surveillance Survey Impact Statistical Call Summary 23 County Health Rankings 23

223 Milwaukee County Secondary Data Report 2012 Milwaukee Health Report Summary Center for Urban Population Health What is it? This report summarizes the current health of the city and distribution of key factors that may have implications for future health. The report provides information regarding health disparities among the socio-economic groups within the city of Milwaukee and offers comparisons of health outcomes and determinants between the City of Milwaukee, the State of Wisconsin and the United States. The report draws from national, state and local data sources. The report found that the lower SES zip code group continues to bear the burden of health disparities. This group experienced worse health compared to Wisconsin and the US across 24 measures, and worse health in even more areas compared to the Middle and Higher SES groups within Milwaukee. Of note, Obesity and Overweight status measures were the only measures to increase in all three SES groups. No Pap Smear and Children with Lead Poisoning increased in the lower and middle SES groups. The following table presents all measures where the lower SES zip code group had at least 2 times greater risk for an adverse health outcome in comparison to the higher SES zip code group. The greater the risk ratio, the greater the risk for the lower SES group. For example, teens in the lower SES zip codes have 7.5 times greater risk for pregnancy than teens in the higher SES zip codes. Measure Risk Ratio Teen birth rate 7.5 % of women reporting no pap smear in past 3 years 4.9 Chlamydia rate 4.88 % reporting childhood lead poisoning 3.9 % single parent households 3.6 HIV infection rate 3.4 No access to healthy food 2.5 % of adults who not receive needed health care in past year 2.5 % of adults reporting inadequate support 2.2 % adults without health insurance 2.1 Chen, H-Y., Baumgardner, D.J., Frazer, D.A., Kessler, C.L., Swain, G.R., & Cisler, R.A. (2012). Milwaukee Health Report 2012: Health Disparities in Milwaukee by Socioeconomic Status. Center for Urban Population Health: Milwaukee, WI. Milwaukee Health Report SES Zip Code Groups Center for Urban Population Health Map of the City of Milwaukee by ZIP Code and SES Group. Milwaukee County High Hospital Utilization Corridor Journal of Urban Health A recent study published in the Journal of Urban Health, looked at poverty, wealth, and health care utilization by geographic area in Milwaukee and Los Angeles. In Milwaukee, the study found that among working age adults, virtually all of the excess hospital utilization was attributable to very high utilization in Milwaukee s segregated poverty corridor. In comparing utilization among adults ages in the lowest vs. the highest income quartile zip codes in Milwaukee County, the study found that the number of hospital days per 1,000 residents of the lowest income zip codes was greater by 347% for heart failure 266% for diabetes 610% for chronic obstructive pulmonary disease (COPD) Cooper, R., Cooper, M., McGinley, E., Fan, X., Rosenthal, J.T., Poverty, Wealth, and Health Care Utilization: A Geographic Assessment. Journal of Urban Health: Bulletin of the New York Academy of Medicine, Vol. 89, No. 5. pgs:

224 Milwaukee County Secondary Data Report Milwaukee Health Professional Shortage Area Maps Wisconsin Primary Health Care Association 6

225 Milwaukee County Secondary Data Report Total Population State 2010 Total Population 947,735 5,686,986 Population Density Per Sq Mile 3, Total Population Non-Hispanic White 574, % 4,902,067 Non-Hispanic Black 253, % 359,148 Asian 32, % 129,234 American Indian and Alaska Native 6, % 1,827 Some Other Race 51, % 135,867 Hispanic or Latino 126, % 336,056 Total Population Male 457, % 2,822,400 Female 490, % 2,864,586 Total Population , % 1,102, , % 2,233, , % 1,573, , % 777,314 *US Census Bureau (2012). American Fact Finder. Retrieved November 14, 2012 from factfinder2.census.gov/faces/ tableservices/jsf/pages/ productview.xhtml? pid=dec_10_dp_dpdp1&prodt Demographics State 2010 Education level of adults 25 years or older Less than high school degree 15.0% 9.9% High school degree 30.4% 31.6% Some college/associates 27.8% 33.3% Bachelors degree or higher 26.8% 24.0% Percent of those ages 16 or older who are unemployed Unemployment rate 9.3% 8.90% Median HH Income (2010 dollars) Median Income $43,215 $49,001 Percent below poverty in last 12 months Percent below poverty 19.2% 15.3% Language spoken at home English 84.3% 91.7% Spanish or spanish creole 9.9% 4.4% Indo-European 3.1% 2.1% Asian and Pacific Island 2.1% 1.5% Other Languages 0.6% 0.3% *Data from American Community Survey 2010 estimates. Accessed at: americanfactfinder.com on November 14, 2012 Owner Occupied 53.4% 68.7% Renter Occupied 46.6% 31.3% 7

226 Milwaukee County Secondary Data Report Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, dhs.wisconsin.gov/wish/, Birth Counts Module, accessed 10/3/2012. Total Births Wisconsin 2010 Total Births 15,368 15,248 14,310 68,367 Total Births by Race/Ethnicity of Mother Non-Hispanic White 6,150 6,011 5,707 50,893 Non-Hispanic Black 5,471 5,484 5,053 6,845 Hispanic 2,818 2,761 2,631 6,560 American Indian ,129 Laotian/Hmong ,264 Other Race ,628 Total Births by Education of Mother Some High School or 3,669 3,484 3,050 8,921 High School Graduate 4,512 4,563 4,160 18,138 Some College 3,193 3,160 3,076 18,378 College Graduate 2,851 2,609 2,565 15,082 Post Graduate 1,049 1,277 1,230 7,325 Healthy People 2020 goal Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, dhs.wisconsin.gov/wish/, Prenatal Care Module, accessed 10/3/2012. Percent Births to Those Receiving First Trimester Care Wisconsin 2010 HP 2020 goal Total Births 15,368 15,248 14,310 68,367 Percent 1st trimester care 77.5% 80.5% 80.2% 84.2% 77.9% Percent Births to Those Receiving First Trimester Care by Race/Ethnicity of Mother Non-Hispanic White 86.6% 87.8% 88.3% 87.7% Non-Hispanic Black 70.5% 74.1% 74.5% 74.1% Hispanic 74.1% 79.1% 76.6% 74.5% American Indian 65.4% 76.0% 62.6% 72.3% Laotian/Hmong 60.9% 67.4% 64.1% 65.7% Other Race/Ethnicity 77.7% 82.6% 79.1% 73.8% 8

227 Milwaukee County Secondary Data Report Percent Late (started in third trimester) or No Prenatal Care Wisconsin Total Births 15,368 15,248 14,310 68,367 Percent late or no prenatal 4.6% 3.7% 4.2% 2.9% Percent Late or No Prenatal Care by Race/Ethnicity of Mother Non-Hispanic White 2.7% 1.7% 2.5% 2.2% Non-Hispanic Black 7.1% 6.3% 6.5% 6.4% Hispanic 3.5% 2.9% 3.3% 4.1% American Indian 5.9% 2.7% 12.3% 5.6% Laotian/Hmong 4.7% 2.9% 2.8% 2.3% Other Race 5.5% 4.1% 3.6% 3.2% Healthy People 2020 goal Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, dhs.wisconsin.gov/wish/, Prenatal Care Module, accessed 10/3/2012. Tobacco Use During Pregnancy Wisconsin 2010 Total Births 15,368 15,248 14,310 68,367 Percent of births where mother indicated smoking during pregnancy 10.9% 11.8% 10.9% 13.2% Percent of Mothers Who Smoked While Pregnant by Race/Ethnicity Non-Hispanic White 11.4% 11.4% 11.1% Non-Hispanic Black 13.9% 15.8% 14.2% Hispanic 5.5% 6.1% 5.9% American Indian 27.2% 29.0% 21.9% Laotian/Hmong 2.5% 5.4% 4.0% Other Race 1.2% 1.7% 1.4% Percent of Mothers Who Smoke by Education Some High School or High School Gradu- 3.9% 4.8% 4.4% Some College 2.2% 2.2% 2.3% College Graduate 0.3% 0.4% 0.3% Post Graduate 0.1% Healthy People 2020 goal No greater than 1.4% Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, dhs.wisconsin.gov/wish/, Birth Counts Module, accessed 10/3/

228 Milwaukee County Secondary Data Report Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, dhs.wisconsin.gov/wish/, Low Birth weight Module, accessed 11/12/2012. Percent of All Births That Are Low Birth Weight Wisconsin Total low birth weight births 1,375 1,463 1,332 4,813 Healthy People 2020 goal Percent low birth weight (<2, % 9.6% 9.3% 7.0% 7.8% Percent of All Births That Are Low Birth Weight by Race of Mother Non-Hispanic White 6.5% 6.6% 6.9% 6.2% Non-Hispanic Black 13.1% 14.6% 14.1% 13.8% American Indian 8.8% 8.2% 6.5% 7.5% Hispanic 6.7% 7.0% 6.0% 5.8% Laotian/Hmong 8.6% 8.6% 7.7% 7.4% Other Race/Ethnicity 6.0% 6.0% 8.6% 8.3% Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, dhs.wisconsin.gov/wish/, Infant Mortality Module, accessed 11/12/2012. Infant Mortality Wisconsin 2010 Total Births 15,368 15,248 14,310 68,367 Total number of Infant Deaths Healthy People 2020 goal Infant mortality rate (<365 days) per 1, Infant Mortality Rate per 1,000 Live Births by Race/Ethnicity of the Mother Non-Hispanic White Non-Hispanic Black American Indian Hispanic Laotian/Hmong Other Race/Ethnicity

229 Milwaukee County Secondary Data Report Premature Births (<37 weeks of gestation) Wisconsin Total number premature births 2,017 1,987 1,885 68,367 Healthy People 2020 goal Percent of all births that were premature 13.1% 13.0% 13.2% 10.8% 11.4% Percent Premature Birth by Race/Ethnicity of Mother Non-Hispanic White 10.2% 9.6% 10.2% 10.0% Non-Hispanic Black 17.0% 17.8% 18.0% 17.5% American Indian 8.1% 8.7% 14.2% 12.8% Hispanic 12.4% 11.9% 11.3% 10.8% Laotian/Hmong 13.6% 11.7% 11.4% 10.6% Other Race/Ethnicity 9.9% 10.6% 9.5% 9.2% Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, dhs.wisconsin.gov/ wish/, Low Birth weight Module, accessed 11/12/2012 Birth Rate for Teens Ages Wisconsin 2010 Total Births to Teens ,033 1,971 1,665 5,147 Birth rate per 1000 for Teens Ages Birth Rate for Teens Ages Wisconsin 2010 Total Births to Teens ,402 Birth rate per 1000 for Teens Ages Healthy People 2020 goal Healthy People 2020 goal Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, dhs.wisconsin.gov/ wish/, Teen Births - Teen Birth Rates Module, accessed 11/12/

230 Milwaukee County Secondary Data Report Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, dhs.wisconsin.gov/wish/, Mortality Module, accessed 11/12/2012. Number of Deaths Wisconsin 2010 Total Deaths 8,026 7,856 8,147 47,212 Number of Deaths by Race/Ethnicity Non-Hispanic 6,323 6,090 6,296 44,364 Non-Hispanic Black 1,583 1,653 1,725 2,226 American Indian Asian Hispanic Number of Deaths by Gender Male 3,841 3,861 3,906 23,198 Female 4,185 3,995 4,241 24,014 Mortality Rate (Per 100,000) Wisconsin 2010 Total Deaths 8,026 7,856 8,147 47,212 Mortality Rate Mortality Rate (Per 100,000) by Race/Ethnicity Non-Hispanic Non-Hispanic Black American Indian Asian Hispanic Mortality Rate (Per 100,000) by Gender Male Female Healthy People 2020 goal Healthy People 2020 goal 12

231 Milwaukee County Secondary Data Report Years of potential lost life per 100,000 population Wisconsin 2010 Total Deaths 8,026 7,856 8,147 47,212 Mortality Rate per 100, Years of potential life lost : rate per 100,000 70,743 71,729 70,784 6,023 Years Potential Life Lost by Race: rate per 100,000 population Non-Hispanic White 6,987 6,709 6,760 5,738 Non-Hispanic Black 11,408 12,338 11,168 10,046 Hispanic 5,468 5,075 3,884 3,266 American Indian 8,495 8,654 6,776 8,817 Asian 3,313 3,634 4,169 3,196 Years Potential Life Lost by Gender: rate per 100,000 population Male 9,936 10,362 9,905 7,466 Female 6,287 6,031 6,062 4,559 Healthy People 2020 goal Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, dhs.wisconsin.gov/wish/, Mortality Module, accessed 11/12/2012. * Years of Potential Life Lost (YPLL): An estimate of premature mortality, defined as the number of years of life lost among persons who die before age 75. YPLL is the sum of the differences between age 75 and the age at death for everyone who died before age

232 Milwaukee County Secondary Data Report Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, dhs.wisconsin.gov/wish/, Mortality Module, accessed 11/12/2012. Age Adjusted Mortality Rate (Per 100,000) Wisconsin 2010 Total Deaths 8,026 7,856 8,147 47,212 Age-adjusted Mortality Rate Age Adjusted Mortality Rate (Per 100,000) by Race/Ethnicity Non- Hispanic White Non- Hispanic Black 1, , , ,003.3 Hispanic American Indian ,005.0 Asian Age Adjusted Mortality Rate (Per 100,000) by Gender Male Female Healthy People 2020 goal Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, wish/, Mortality Module, accessed 11/12/2012. Average Age at Death Average Age at Average Age at Death by Race/Ethnicity Non-Hispanic Wisconsin Non-Hispanic Black Hispanic American Indian Asian Average Age at Death by Gender Male Female Healthy People 2020 goal 14

233 Milwaukee County Secondary Data Report Number Injury Related Deaths Wisconsin 2010 Total Deaths 8,026 7,856 8,147 47,212 Healthy People 2020 goal Number Injury Related ,528 Number Injury Related Death by Race/Ethnicity Non-Hispanic ,199 Non-Hispanic Black Hispanic Number Injury Related Death by Gender Male ,268 Female ,260 Injury Death Rate Per 100, Wisconsin 2010 Healthy People 2020 goal Injury Related Death Rate Injury Death Rate Per 100,000 by Race/Ethnicity Non-Hispanic White Non-Hispanic Black Hispanic American Indian Asian Injury Death Rate Per 100,000 by Gender Male Female Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, dhs.wisconsin.gov/ wish/, Injury Mortality Module, accessed 11/12/

234 Milwaukee County Secondary Data Report Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, dhs.wisconsin.gov/ wish/, Injury Mortality Module, accessed 11/12/2012, 3/4/2013. Number of Suicides Wisconsin 2010 Number of Suicides Number of Suicides by Race/Ethnicity Non-Hispanic White Non-Hispanic Black Hispanic 13 Other Race/Ethnicity 32 Number of Suicides by Gender Male Female Number of Suicides by Age Group Birth to to to to to to to and older 60 Healthy People 2020 goal 16

235 Milwaukee County Secondary Data Report Suicide Rate Per 100, Wisconsin 2010 Healthy People 2020 goal Suicide Rate Suicide Rate per 100,000 by Race/Ethnicity Non-Hispanic White Non-Hispanic Black Hispanic American Indian Asian Suicide Rate per 100,000 by Gender Male Female Suicide Rate per 100,000 by Age Group 5 to to to to to to to to to to to to to to to to to and older Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, dhs.wisconsin.gov/ wish/, Injury Mortality Module, accessed 11/12/2012, 3/4/

236 Milwaukee County Secondary Data Report Number Injury Hospitalizations Wisconsin 2010 Number of Injury Hospitalizations 10,740 9,669 9,820 53,560 Number Injury Hospitalizations by Race/Ethnicity Non-Hispanic White 7,199 6,517 6,530 45,618 Non-Hispanic Black 2,717 2,402 2,503 3,509 Hispanic ,429 American Indian Asian Other ,138 Number Injury Hospitalizations by Gender Male 5,220 4,637 4,704 24,883 Female 5,520 5,032 5,116 27,148 Healthy People 2020 goal Rate of Injury Hospitalizations Wisconsin 2010 Healthy People 2020 goal Total Injury Hospitalizations 10,740 9,669 9,820 53,560 Rate of Injury Hospitalizations 1, , , Average Patient Age Average Length of Hospital Stay Total Hospital Charges $341,852,781 $356,966,626 $367,666,365 $1,581,449,672 Average Hospital Charges $31, $36, $37, $30, Rate of Injury Hospitalizations by Race/Ethnicity (Per 100,000 population) Non-Hispanic White 1, , , Non-Hispanic Black 1, Hispanic American Indian Asian Rate of Injury Hospitalizations by Gender (Per 100,000 population) Male 1, , , Female 1, , , Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, Injury Hospitalization Module, accessed 11/12/2012 and 3/5/

237 Milwaukee County Secondary Data Report Number ER Visits for Injuries Wisconsin 2010 Total ER Visits for Injury 89,355 82,289 85, ,537 Average Age of ER Injury Patient Total Hospital Charges for All Injury Patients $109,168,532 $112,101,759 $119,837,305 $513,096,657 Average Hospital Charges Per Injury Patient $1, $1, $1, $1, Number ER Visits for Injuries by Gender Male 46,392 42,552 43, ,927 Female 42,963 39,737 41, ,815 Total ER Visits by Cause Motor vehicle crash- Occupant 8,861 7,836 8,038 28,977 Motor vehicle crash- Motorcyclist ,169 Motor vehicle crash- Pedal cyclist Motor vehicle crash- Pedestrian ,334 Motor vehicle crash- Other ,366 Motor vehicle- Self-inflicted/ Assault/ Undetermined Firearms Poisoning 1,805 1,714 1,525 8,179 Falls 25,823 23,810 23, ,309 Suffocation Drowning Fire, heat, chemical burns 1,244 1,153 1,213 6,516 Cutting or piercing objects 7,319 6,609 6,757 39,714 Healthy People 2020 goal Struck by or against object or person 14,359 13,594 13,419 67,233 Machinery ,785 Nontraffic pedal cyclist ,013 6,107 Nontraffic pedestrian Nontraffic transportation ,926 Natural or environmental factors 2,674 2,560 3,346 19,631 Overexertion 7,685 6,894 6,853 38,291 Other classifiable cause 4,746 4,083 4,341 24,371 Other unclassifiable cause 2,771 2,840 3,790 11,526 Unspecified cause 8,039 7,252 7,706 31,663 Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, Emergency Department Visits for Injury Module, accessed 11/12/2012 and 3/5/

238 Milwaukee County Secondary Data Report Rate of ER Visits for Injury Per 100,000 Pop. Healthy Wisconsin 2010 People 2020 goal Total ER Visits for Injury 89,355 82,289 85, ,537 Rate of ER Visits for Injury 9, , , , Rate of ER Visits for Injury per 100,000 Pop. by Gender Male 10, , , ,898.5 Female 8, , , ,870.6 Rate of ER Visits for Injuries by Cause, per 100,000 Pop. Motor vehicle crash- Occupant Motor vehicle crash- Motorcyclist Motor vehicle crash- Pedal cyclist Motor vehicle crash- Pedestrian Motor vehicle crash- Other Motor vehicle- Self-inflicted/ Assault/ Undetermined Firearms Poisoning Falls 2, , , ,238.6 Suffocation Drowning Fire, heat, chemical burns Cutting or piercing objects Struck by or against object or person 1, , , ,182.2 Machinery Nontraffic pedal cyclist Nontraffic pedestrian Nontraffic transportation Natural or environmental factors Overexertion Other classifiable cause Other unclassifiable cause Unspecified cause Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, Emergency Department Visits for Injury Module, accessed 11/12/2012 and 3/5/

239 Milwaukee County Secondary Data Report Sexually Transmitted Infections Incidence Rate per 100, Wisconsin 2010 STI Incidence Rate per 1,458 1,423 1, STI Incidence Rate per 100,000 by Race/Ethnicity Non- Hispanic Non- Hispanic 2,911 2,470 2,778 2,645 Hispanic American Asian/ Pacif Other Race/ NA NA NA NA STI Incidence Rate per 100,000 by Gender Male Female 1,982 1,909 1, Healthy People 2020 goal *Data accessed from /communicable/std/ Statistics_State.htm on October 3, HIV Incidence per 100,000 Milwaukee Milwaukee Wisconsin Incidence Rate HIV Incidence per 100,000 by Race/Ethnicity Non-Hispanic White Non-Hispanic Black Hispanic American Indian Asian/Pacific Islander Other Race/Ethnicity NA NA NA HIV Incidence per 100,000 by Gender Male Female Healthy People 2020 goal Data from aids-hiv/stats/index.htm accessed on October 3,

240 Milwaukee County Secondary Data Report Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, Cancer Module, accessed 10/3/2012. Cancer Incidence per 100,000 Milwaukee County Wisconsin Incidence Rate Cancer Incidence per 100,000 by Race/Ethnicity Non-Hispanic White Non-Hispanic Black Hispanic Other Race/Ethnicity NA Cancer Incidence per 100,000 by Gender Male Female Healthy People 2020 goal Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, BRFS Module, accessed 10/3/2012. Behavioral Health Risk Factors Survey Milwaukee County Wisconsin Percent of adults reporting they are heavy drinkers 7.9% 6.3% Percent of adults reporting they have ever been tested for HIV 43.3% 32.5% Healthy People 2020 goal 22

241 Milwaukee County Secondary Data Report IMPACT Statistical Call Report IMPACT What is it? This report provides an overview of the types and quantities of calls seeking resources and services related to health and health care. The report covers callers from 10 zip codes from January through December The 10 zip codes represent the lower SES group of neighborhoods within the City of Milwaukee as identified in the Milwaukee Health Report. The table is aggregated across each zip code and includes all service requests with 100 or more individual callers. The full report provides detail on each zip code as well as the full listing of 331 services and the quantity of their respective requests. Generally, these callers tend to be women and range from 18 years of age to 85, with most calls coming from year olds. Notice that many of the service request areas could be collapsed into broader areas. The most common requests are for community clinics and overall health care access, followed by oral health and mental health and substance use related needs. January - December 2012 Number of Service Calls Community Clinics 1,523 Aging and Disability Resource Centers 1,040 Emergency Dental Care 882 General Dentistry 542 General Assessment for Substance Abuse 318 Hospitals 282 Prescription Expense Assistance 281 Helplines/Warmlines 254 Inpatient Drug Detoxification 224 Domestic Violence Hotlines 151 General Crisis Intervention Hotlines 143 Central Intake/Assessment for Drug Abuse 127 Mental Health Hotlines 123 Psychiatric Disorder Counseling 114 Sexually Transmitted Disease Screening 102 County Health Rankings UW Population Health Institute Milwaukee County consistently ranks among the worst counties in the state of Wisconsin with regard to Health Outcomes and Health Factors. The 2012 County Health Rankings found Milwaukee County ranked 70th of 72 counties for Health Outcomes and 71st for Health Factors. To learn more about the methods and indicators, please visit or to view the Milwaukee specific page visit: wisconsin/2013/milwaukee/county/outcomes/overall/snapshot/byrank 23