University of Mississippi Medical Center

Transcription

1 University of Mississippi Medical Center Community Health Needs Assessment

2 I. Introduction 4 II. Locations 6 III. Definition of Community 10 a. Population growth b. Age c. Sex d. Race and ethnicity e. Socioeconomic profile IV. Community Health Needs Assessment 15 a. Overview b. Methodology i. Input from Community Representatives ii. Community Survey V. The Findings: Health Needs of Our Community 19 a. Qualitative analysis b. Survey findings i. Overview ii. Demographics of survey respondents iii. List of counties surveyed VI. Limitations 35 VII. Next Steps 36 VIII. References 37 IX. Appendices 38 Appendix A Additional Survey Findings Appendix B UMMC CHNA Survey Appendix C Mississippi Behavioral Risk Factor Surveillance Survey 2013 Appendix D 2015 County Health Rankings for Mississippi Appendix E America s Health Rankings 2014 Edition Mississippi 2

3 We wish to thank members of the community who participated in the focus groups, key informant interviews, completed surveys, and provided other valuable contributions to the Community Health Needs Assessment of the University of Mississippi Medical Center. Sincerely, 3

4 The University of Mississippi Medical Center (UMMC), located in Jackson, Mississippi is the state s only academic medical center. The mission of UMMC is to improve the health and wellbeing of patients and the community through excellent training for health-care professionals, engagement in innovative research, and the delivery of state-of-the-art health care. It is the vision of UMMC to be a premier academic health sciences system that is recognized nationally for high-quality clinical care, for innovative research, and for training committed to health-care professionals who work together to improve health outcomes and eliminate health disparities. UMMC s patient care programs includes University Physicians, the state s largest medical group comprised of approximately 500 providers representing more than 125 specialties. This medical group has a number of clinics throughout the Jackson metropolitan area and University Physicians providers see approximately 600,000 patients each year. The largest location, University Physicians Pavilion, features 16 clinics within one location and is equipped with a full-service laboratory and pharmacy. A variety of services are provided including: mammography, MRI, cardiology testing, including echocardiograms and cardiac stress testing, and physical therapy. Bone marrow aspirations, lumber punctures, endoscopy and minor surgical procedures are also performed in the Pavilion. UMMC is also Mississippi s only Level 1 trauma hospital, the only Level 4 neonatal intensive care nursery, and offers the only organ transplant programs in the state along with a number of referral services. The Jackson campus houses University Hospital along with three specialty hospitals, Batson Children s Hospital, Wiser Hospital for Women and Infants, and Conerly Critical Care Hospital, along with the University Hospital. The medical center has recently expanded to include two community hospitals, UMMC Holmes County and UMMC Grenada. UMMC is the largest diagnostic, treatment and referral care system in the state. The medical center has a total of 722 beds that accommodate approximately 27,000 hospital stays annually. The UMMC emergency department and clinics have more than 418,000 outpatient and emergency visits every year. 4

5 UMMC is a thriving health sciences campus with more than 3,000 students enrolled in 28 programs offered in six professional schools: Medicine, Nursing, Dentistry, Health Related Professions, Graduate studies, and Pharmacy. The medical center is the sole provider for baccalaureate and professional degrees in disciplines such as allopathic medicine, dental, physical therapy, occupational therapy and dental hygiene. Nearly 600 residents and fellows also receive graduate medical training at UMMC. Additional, the medical center provides continuing health professional education for practicing healthcare professionals in order to promote lifelong learning, expand knowledge and improve the skills necessary for the provision of quality health care in the state. UMMC has many notable research achievements since its inception in 1955 and continues to pursue scientific discoveries that can improve the health of Mississippians. The medical center has undergone a considerable expansion of research programs and physical facilities and is actively engaged in cutting-edge efforts to study health and disease. Research is a major tool that keeps our faculty and health-care providers at the cutting edges of their fields and prepared them to use biomedical discoveries to improve human health. 5

6 The University of Mississippi Medical Center provides services to patients throughout Mississippi in each of its 82 counties. UMMC is located in Jackson, Mississippi, which is in Hinds County. Several of the campus locations are indicated on the map shown on page 9. University Hospital University Hospital is the teaching hospitals for all University of Mississippi Medical Center education programs and a 722-bed diagnostic and treatment referral center for the entire state. Medical staffs are appointed from the Schools of Medicine and Dentistry. Batson Children's Hospital A special hospital for children, Batson Children's Hospital is staffed by pediatric specialists - physicians who have completed a residency in general pediatrics and then have specialized further by learning about one particular body system in children. It is the only hospital of its kind in the state. Conerly Critical Care Hospital An intensive care hospital links the adult hospital, the emergency department and the operating and surgical suites. It includes Coronary Intensive Care, Neuro Intensive Care, Medical Intensive Care, Surgical Intensive Care and Bone Marrow Transplant Unit for children and adults. 6

7 UMMC Holmes County UMMC Holmes County offers inpatient and outpatient services for area residents, including Lexington, Durant, Tchula, Pickens, Goodman, Cruger, Sallis, and West. Conveniently located in Lexington, its goal is to provide affordable and innovative healthcare services for the region. Wiser Hospital for Women and Infants The comprehensive hospital for women and infants is a six-story contemporary structure with 160 beds. The hospital offers tertiary health services for women throughout their life cycle and for newborns in the first few months of life. UP Pavilion The University Physicians Pavilion is a free-standing clinic arranged in a mall design to provide delivery of outpatient health care. All basic services are under one roof. Jackson Medical Mall Most of UMMC's medical specialties are represented with clinics at the mall. Services include radiology, a cardiopulmonary rehab center, diabetes education center, dialysis unit and ACT tobacco cessation program as well as the Cancer Institute. 7

8 UMMC Grenada UMMC Grenada gives residents of Grenada County and surrounding areas high-quality care close to home. This 156-bed hospital and outpatient clinics provide a broad range of health services to adults and children, including specialty care available through the state s only academic medical center. 8

9 Children s of Mississippi Tupelo UMMC Grenada UMMC Holmes County University Physicians Face & Skin Center University of MS Medical Center (Main campus) University Physicians Women s Specialty Care University Physicians Flowood Family Medicine Center 9

10 Population Growth Mississippi had an estimated population of 2,991,207 in 2013 and 2,994,079 in 2014, which is a 0.9 percent increase since the 2010 U.S. Census. 1 The population growth rate is much lower than the national average rate of 9.71%. Jackson, is the state capital and the Mississippi s largest city with approximately 173,514 residents. According to the U.S. Census Bureau s 2013 American Community Survey, Mississippi has 1,294,738 housing units. 1 The Mississippi population density is 63.5 people per square mile, which is lower than the national average of 89.5 people per square mile. 3,050,000 Figure 1. Mississippi Population from 2000 to ,000,000 2,967,297 2,978,464 2,986,137 2,992,206 2,994,079 2,950,000 2,900,000 2,850,000 2,844,658 2,800,000 2,750,000 Yr 2000 Yr 2010 Yr 2011 Yr 2012 Yr 2013 Yr 2014 SOURCE: MS Demographics Starter Report; American Community Survey

11 Age According to the U.S. Census Bureau s 2013 American Community Survey, the Mississippi population is equally distributed across age groups stratified by decade. Twenty eight percent (28%) of Mississippi s population is younger than 19 years of age and one out of every three Mississippi residents (33%) are older than 50 years of age. 1 Figure 2. Age Profile for Mississippi Adults 450, , % 14.30% 13.50% 12.50% 12.90% 13.40% 350, , % 9.10% 250, , , , , , , , , , , ,000 50, SOURCE: MS Demographics Starter Report; American Community Survey

12 Sex In 2013, women made up 51.5 percent of the Mississippi s population, which is slightly higher than national estimates (50.8%) provided by the U. S. Census Bureau. 1 Figure 3. Sex Profile of Mississippi Adults 1,539,975 Female 51% 1,451,232 Male 49% SOURCE: MS Demographics Starter Report; American Community Survey

13 Race and Ethnicity According to the U.S. Census Bureau s 2013 American Community Survey 1, Whites make up the largest racial group at 57.4 percent and Blacks are the second largest racial group (37.6%). Asians (0.9%) and American Indians (0.4%) are other racial groups with a presence in the state. Hispanics are the state s largest ethnic group; however, this group represents a small percentage (2.7%) of Mississippi residents. 1 Table 1. Race and Ethnicity Profile of Mississippi Adults Race and Ethnicity N (percent) Non-Hispanic 2,910,752 (97.3) White 1,716,080 (57.4) Black 1,124,524 (37.6) American Indian 11,651 (0.4) Asian 27,784 (0.9) Islander 268 (0.0) Other 2,472 (0.1) Two or more 27,973 (0.9) Hispanic 80,455 (2.7) Total Population 2,991,207 Figure 4. Race Profile of Mississippi Adults Other 2% Black 39% White 59% SOURCE: MS Demographics Starter Report; American Community Survey

14 Socioeconomic profile According to the U.S. Census Bureau s 2014 American Community Survey, the Mississippi median household income in the past 12 months is $39,680 in 2014 inflation-adjusted dollars. 1 In 2013, the majority of the population 25 years and over (1,931,054) reported the highest level of education as either high school (30.6%) or some college (31.4%). Only 12.9% of the population 25 years and over had a graduate or professional degree. 1 Approximately, 8.6% of the population ages 16 and older are unemployed, but seeking work. 2 Figure 5. Education Profile of Mississippi Adults Graduate 7% No diploma 18% 144,918 Bachelor's degree 13% 248, , , ,240 Some college 31% High school 31% SOURCE: MS Demographics Starter Report; American Community Survey

15 The Patient Protection and Affordable Care Act (PPACA), enacted March 23, 2010, is a federal statute designed to drive better health outcomes, reduce the costs of healthcare, and improve practices among hospitals and primary physicians. The act includes the requirement that nonprofit hospitals conduct a community health needs assessment (CHNA) every three years. This requirement provides an opportunity for hospital organizations, numerous governmental public health agencies, and additional stakeholders to gather data that can be used to identify community needs and to inform strategies to address them. The purpose of this report is to present results associated with the CHNA for our community. The framework used to guide UMMC through the CHNA process was based on an adaptation of the Association for Community Health Improvement s Assessment Process Map below. 3 Consistent with the requirements of the ACA, qualitative and quantitative methods were utilized to collect primary data regarding perceive community health needs regarding adults in the catchment area served by UMMC, which includes all of Mississippi. Data for this report were drawn from a community health needs assessment conducted throughout Mississippi. Extant data were drawn from the Mississippi Behavioral Risk Factors Surveillance Survey 2013 Prevalence Report, 2015 County Health Rankings for Mississippi, and America s Health Rankings 2014 Edition for Mississippi. Qualitative Data Collection: Focus Groups & Structured Interviews Focus Groups A focus group is defined as a small-group discussion guided by a trained leader to obtain feedback on a designated topic. 4 Five focus groups were conducted with external stakeholders at various health care clinics and community-based organizations. Each focus group included 5-12 individuals, with a total of 45 participants. Participants were provided with background 15

16 information on the CHNA and asked to share their insights on factors that contribute to adult health issues, resources that are available to help community members to be healthy, and suggestions for addressing these issues in the future. Focus group participants were also asked to complete a brief survey containing questions asking them to provide basic background information (e.g., gender, age, race, marital status, employment status, and level of education). Focus Group Questions: 1. What do you think are the four leading health issues for people in Mississippi? 2. What can be done to prevent these health issues? 3. What resources are available to help people to be healthy? 4. What would a healthier version of your county [or Mississippi] look like? 5. What types of programs and initiatives could be implemented to improve community health? 6. How can the University of Mississippi Medical Center better partner with you or your organization to improve the health of the community? 7. [For health care providers] Do you see any barriers that prevent patients you serve from being healthier? Two UMMC staff members trained in qualitative data collection facilitated the focus group discussions. The focus group sessions were digitally recorded and transcribed. Two staff members read transcripts to code and catalogue key themes. The organizations represented at the focus group sessions included: Mississippi Healthy Linkages Initiative; Jackson Medical Mall Foundation; Mississippi Roadmap to Health Equity, Inc.; Mississippi Primary Health Care Association; and Jackson-Hinds Comprehensive Health Center (Dr. James Anderson Health Facility). Semi-structured Interviews Semi-structured interviews were conducted with external stakeholders at various health care clinics and community-based organizations, with a total of 45 participants. Interview questions followed the same format as the focus group questions. The interviews were digitally recorded 16

17 and transcribed. Two staff members read transcripts to code and catalogue key themes. Interview participants were also asked to complete a brief survey with questions asking them to provide basic background information (e.g., gender, age, race, marital status, employment status, and level of education). ORGANIZATIONS REPRESENTED AT INTERVIEW United Way of the Capital Area Stewpot Community Services Mississippi Health Advocacy Program Mississippi Center for Nonprofits Mission Mississippi Mississippi Action for Community Education, Inc. Delta Health Collaborative Mississippi State Department of Health American Heart Association (Metro Jackson) Mississippi Organ Association Mississippi Lung Association Women for Progress of Mississippi, Inc. Delta Health Alliance Catholic Charities, Inc. Steps Coalition Mississippi Center for Justice NOTE: Not all organizations are listed due to interviewee s request for this information to remain confidential. 17

18 Quantitative Data Collection: Community Survey Community members completed a self-administered survey in-person or online. The community health needs assessment survey was designed to learn more about the health needs of communities throughout Mississippi. The survey consisted of items designed to measure selfreported behavioral, community, and sociocultural factors that can influence health. Demographic characteristics of survey participants were also collected and included: gender, age, race, marital status, level of education, annual household income, and employment status. Survey data were collected from 746 residents in Mississippi. Participants were eligible if they were 18 years of age or older and a resident of Mississippi. 18

19 Focus Group and Interview Responses A total of five focus groups were conducted with external stakeholders at various health care clinics and community-based organizations. Each focus group included 5-12 individuals, with a total of 45 participants. Semi-structured interviews were conducted with external stakeholders at various health care clinics and community-based organizations, with a total of 45 participants. Focus group and semi-structured interview participants identified the top four leading health issues in Mississippi for adults as: Obesity Hypertension Diabetes Cardiovascular disease What do you think are the four leading health issues for people in Mississippi? Key Themes: The majority of focus group and interview participants identified obesity, hypertension, diabetes, and cardiovascular disease as the primary health issues in Mississippi. There was considerable agreement about the primary diseases adversely impacting the lives of Mississippians. However, respondents also cited other factors contributing to compromised health. Health education was also cited as a factor impacting health as one participant noted, There is not enough education involved in people s health care. Other respondents shared similar sentiments and identified health literacy as an important factor having implications for health. Several participants asserted that a significant segment of Mississippi residents did not have a clear understanding of key principles associated with health and health care. It was There is not enough education involved in people s health care. thought that compromised health literacy was a function of the historical, cultural, and social environment in Mississippi. The following participant statement summarizes the line of thought: because of the history and culture of Mississippi, our problem is health literacy 19

20 Other noteworthy factors highlighted in the interviews and focus groups included health care affordability, health care access, and trust. It was stated on a number of occasions that citizens from underserved communities avoid seeking medical care because of concerns about the quality of care. Some people just don t trust the diagnoses of health care providers. Some hospitals and clinics just have bad histories. Fear and distrust can be powerful factors that encourage those with health problems to delay treatment until they become much worse. What can be done to help prevent these health issues? Key Themes: Most of the individuals participating in the focus groups agreed that the community could play an important role in the prevention of the primary causes of disease and death in Mississippi. Respondents did not spend a great deal of time defining community, however, they did note that it involved community members coming together and pooling their resources to address health issues. For example, one respondent stated, there s power in getting community members involved and in charge of their health. It should be noted that health advocacy for individuals and groups can be tempered by the realities of daily living. The statement, how can I be concerned with my health when I am concerned with my day-to-day living? underscored the challenges associated with health promotion or advocacy efforts. Troublesome matters and responsibilities that occur on a daily basis may cause one to disregard health maintenance. Participants also emphasized the importance of pediatric health care in disease prevention. One respondent stated, We need to work with the children. This is where the biggest impact can be made. In addition to pediatric health care, the presence of health care providers was also thought to be important for disease prevention. Several participants seemed to agree that many health care providers were leaving the state once they had obtained an education. A number of respondents demonstrated this line of thought by stating, people need more access to specialty care and others agreed with the statement, We need to encourage providers to stay in the state and take care of our people. There s power in getting community members involved and in charge of their health. 20

21 The answer is working together for a common cause. What resources are available to help people to be healthy? Key Themes: A number of focus group and interview participants identified churches as key community institutions that could be tapped to help keep people healthy. One respondent noted, Churches are the biggest community asset. They have so much power over controlling the health of community members. The answer is working together for a common cause. Respondents also cited the presence of other community-based programs or centers. Some participants indicated that these resources have not been fully leveraged because individuals in the community are largely unaware of their presence. One health professional from a community-based organization noted that, most people don t even know how many programs we offer. We are an untapped resource. What would a healthier version of your county [or Mississippi] look like? Key Themes: A number of focus group and interview participants indicated that a healthier Mississippi would be one where the prevalence of chronic disease and poverty rates were low and all citizens had access to healthy foods and primary care. Some respondents articulated that a healthier Mississippi was one with healthier children. Many participants indicated that they would like to see children being more active. For example, one respondent stated that they would like to see children playing outside, instead of playing on electronic devices. Public safety was also associated with a healthier Mississippi as several participants also indicated that Mississippi communities should have more safe places to engage in physical activities, including the inclusion of more sidewalks: Less food deserts, more sidewalks, and more access to safe gyms and playgrounds. Equity was also a component of a healthier Mississippi. One participant specified that it is necessary for Mississippi to have, access to primary care providers and adequate coverage for all Mississippians. I want instruction on how to eat better and how to purchase healthy foods at an affordable cost. 21

22 What types of programs and initiatives could be implemented to improve community health? Key Themes: Most participants agreed that Mississippi should have programs to increase healthy eating or access to healthy foods. Many acknowledged the importance of healthy eating; however, some expressed concerns about the knowledge and awareness of healthy meal preparation. One participant emphasized, I want instruction on how to eat better and how to purchase healthy foods at an affordable cost. Others agreed by stating, I would like to see more programs that address the challenge of healthy eating and access to healthy foods. Health education and awareness were common themes among participant responses. One interview participant suggested to better use the media in increasing awareness of health and community-based programs: We need more public service ads on TV. Exposing people to health concepts through marketing just may increase the health of our communities. This response further adds to the discussion that people are unaware of the resources already available in the community. Several participants also suggested that health screenings and prevention would have a great impact on community health: We need to have more attention on prevention and early intervention. We should focus on healthy people staying healthy. While most agreed with this statement, there were a number of respondents who suggested that, we need health care professionals and other community-based programs to work in holistic approaches. This sentiment conveys that there are many different determinants of health that should be addressed in order for Mississippians to be healthy. 22

23 How can UMMC better partner with you or your organization to improve the health of the community? Key Themes: A significant segment of individuals responding to this question indicated they were satisfied with their relationship with UMMC. Some participants thought that UMMC could improve their engagement efforts by providing more primary care and specialty physicians to work with community-based organizations. There was a particular interest in working with student trainees and one respondent summarized this idea with the statement, I would like to see more student healthcare providers helping in the community and as a part of our health fairs and programs. They could really help us to expand our reach and we can help introduce them to the population that needs their help the most. Respondents also suggested that UMMC should have more community-based partnerships that would lower the barriers to health care access. One participant stated, I would like to see UMMC work more with organizations that have direct contact with the community. UMMC has the means to make a big impact, but community navigators are needed to provide access. Some people just don t understand their coverage. [This] prevents them from getting the care they need. [For health care providers]: Do you see any barriers that prevent patients you serve from being healthier? Key Themes: The question was addressed by the only focus group consisting of health care providers. Members of this focus group highlighted several barriers including, poverty, health literacy, access to healthy foods, few available health screenings, lack of support, and environmental barriers. However, most agreed that factors associated with health care coverage were the primary barriers. One respondent noted that the lack of health care coverage compromises health. One of the biggest barriers is access to coverage. Either patients don t have the coverage or finances needed for specialty care. Another participant suggested that poor understanding of health care coverage could be associated with increased health risks. Some people just don t understand their coverage. [This] prevents them from getting the care they need. 23

24 Survey Findings The CHNA consisted of items designed to measure self-reported behavioral, community, and sociocultural factors that may influence health. Demographic characteristics of survey participants were also collected and included: gender, age, race, marital status, level of education, annual household income, and employment status. Survey data were collected from 746 residents in Mississippi. Participants were eligible if they were 18 years of age or older and a resident of Mississippi. Survey participants identified the four leading health issues in Mississippi for adults as: Overweight and inactivity Access to health care Drug and alcohol use Mental health HEALTH STATUS Survey respondents were asked to rate their health status and their response choices were: excellent, very good, good, fair, or poor. A substantial segment of respondents (43%) rated their health as very good or excellent. Twenty-two percent of respondents rate their health as fair or poor. Only 30 respondents (4.1%) reported that, in general, their health status is poor ; however, an overwhelming majority of respondents who rated their health as poor are women. These findings are consistent with statewide estimates as black females had the largest segment of individuals rating their health as poor. 5 Overall, Mississippi ranks as 50 th in health status. 6 Table 2. Self-Reported Health Status Health status Total Sample N (percent) Male N (percent) Female N (percent Excellent 109 (14.9) 40 (19.1) 69 (13.3) Very good 206 (28.1) 53 (25.2) 150 (28.9) Good 258 (35.2) 66 (31.4) 190 (36.6) Fair 131 (17.9) 46 (21.9) 85 (16.4) Poor 30 (4.1) 5 (2.4) 25 (4.8) 24

25 Survey respondents were asked how often they have problems with stress, anxiety, depression, anger, or any other emotional health problems. Only 15.9 percent (115) of the respondents reported that they experience stress or other emotional health problems most or all of the time; whereas 21.2 percent (153) of the respondents reported that they experience stress or other emotional health problems all of the time. More than half (61%) reported that they either experience stress or other emotional health problems some or a little of the time. Table 3. Amount of Stress or Emotional Health Problems Amount of Stress Total Sample N (percent) Male N (percent) Female N (percent) All of the time 52 (7.2) 11 (5.4) 41 (8.0) Most of the time 63 (8.7) 11 (5.4) 52 (10.1) Some of the time 182 (25.2) 49 (26.9) 133 (25.9) A little of the time 255 (35.3) 85 (41.5) 165 (32.2) None of the time 153 (21.2) 41 (20.0) 112 (21.8) Don t know/not sure 18 (2.5) 8 (3.9) 10 (2.0) Diabetes Survey respondents were asked if they have ever been told by a health professional that they have diabetes. Approximately 15 percent of respondents indicated that had been diagnosed with diabetes (see Table 3). Mississippi ranks 3 rd among U. S. states in diabetes prevalence as roughly 13 percent of its adult residents have diabetes. 5 In 2012, diabetes was the sixth leading cause of death in Mississippi with a death rate of 34.8 per 100,000 population. 5 According to the Mississippi BRFSS 2013, Mississippians most at risk for diabetes are those who carry excess weight and do not exercise regularly. Table 4. Diabetes Awareness Diabetes Total Sample N (percent) Male N (percent) Female N (percent) Yes 109 (14.9) 28 (13.4) 81 (15.6) No 621 (85.1) 181 (86.6) 437 (84.4) 25

26 High Blood Pressure and Cholesterol Survey respondents were also asked if they had ever been told by a health professional that they have high blood pressure or high blood cholesterol. Roughly half of the sample were diagnosed with hypertension and nearly 4 out of every 10 respondents had been told they had high cholesterol (see Tables 4 and 5). Mississippi ranks 3 rd among U. S. states in hypertension prevalence, as 40.2% of its adult residents have been diagnosed with hypertension. Hypertension represents a major health problem in Mississippi as untreated high blood pressure increases the risk of stroke, heart attack, and kidney failure. 5 Table 5. Hypertension Awareness High blood pressure Total Sample N (percent) Male N (percent) Female N (percent) Yes 359 (49.3) 87 (41.8) 270 (52.4) No 369 (50.7) 121 (58.2) 245 (47.6) Table 6. Cholesterol Awareness High blood cholesterol Total Sample N (percent) Male N (percent) Female N (percent) Yes 261 (35.9) 69 (33.3) 192 (37.1) No 467 (64.2) 138 (66.7) 326 (62.9) HEALTH BEHAVIORS Survey respondents were asked how many times a day they eat or drink fruits and/or vegetables. The vast majority of individuals completing surveys had fruit or vegetables at least once per day. Nearly 6 out of every 10 respondents report consuming fruit or vegetables 1 or 2 times per day. The daily recommended number of servings of fruit and vegetables for adults is five. 7 26

27 Table 7. Consumption of Fruits and Vegetables Consumption of Fruits/Vegetables Total Sample N (percent) Male N (percent) Female N (percent) None 37 (5.2) 22 (10.6) 15 (3.0) 1 to 2 times a day 427 (59.5) 110 (52.9) 315 (62.1) 3 to 4 times a day 169 (23.5) 52 (25.0) 116 (22.9) 5 to 6 times a day 43 (6.0) 10 (4.8) 33 (6.5) 7 or more times a day 22 (3.1) 3 (1.4) 19 (3.8) Don t know/not sure 20 (2.8) 11 (5.3) 9 (1.8) Survey respondents were also asked if they had participated in any physical activities or exercises in the past month other than their regular job such as running, calisthenics, gardening or walking. More than half (59%) of the respondents reported that that they had some physical activity during the past month (see Table 8). According to the Robert Wood Johnson Foundation s State of Obesity 2014 report, Mississippi had the highest level (38.1%) of inactivity among adults. 5 These results are confirmed by findings in the BRFSS 2013, where the authors found that 38.3 percent of the individuals surveyed reported that they did not participate in any physical activity outside of work over the past 30 days. 5 Table 8. Participation in Physical Activities and Exercise Participate in Physical Activities/Exercise Total Sample N (percent) Male N (percent) Female N (percent) Yes 426 (59.0) 135 (65.2) 288 (56.5) No 280 (38.8) 69 (33.3) 209 (41.0) Don t know/not sure 16 (2.2) 3 (1.5) 13 (2.6) Survey respondents were asked to select each healthy behavior (listed in Table 9) that applies to their lifestyle. The majority of survey respondents reported that they wear a seat belt (83.8%), visit with friends and family (75.2%), and get an annual checkup (65.8%). The results also showed that respondents were likely to engage is some unhealthy behaviors as a majority of survey respondents indicate that they do not wear protective equipment (87.7%), wear sunscreen (80.4%), or get an annual flu shot (60.9%). 27

28 Table 9. Healthy Behaviors as Reported by Survey Respondents Healthy behavior Checked N (percent) Unchecked N (percent) Wear sunscreen 146 (19.6) 600 (80.4) Get an annual checkup 491 (65.8) 255 (34.2) Wear a seat belt 625 (83.8) 121 (16.2) Wear protective equipment 92 (12.3) 654 (87.7) Volunteer to help others 350 (46.9) 396 (53.1) Participate in a faith/spiritual experience 393 (52.7) 353 (47.3) Sleep 7 to 8 hours per day 400 (53.6) 346 (46.4) Take vitamins 332 (44.5) 414 (55.5) Get an annual flu shot 292 (39.1) 454 (60.9) Visit with friends and family 561 (75.2) 185 (24.8) Participate in similar interest groups 337 (45.2) 409 (54.8) Survey respondents were asked how often they smoke cigarettes and drink at least one alcoholic beverage. The majority (84.9%) of this sample reported that they do not smoke cigarettes (see Table 10). Almost half (49.5%) of this sample reported that they do not drink alcoholic beverages (see Table 11). According to the BRFSS 2013, about one-fifth of the deaths in Mississippi each year are from tobacco-related causes. 5 Currently, 23% of Mississippi adults are smokers. 5 Tobacco use is the single leading preventable cause of death in Mississippi and the United States. 5 According to the Mississippi State Department of Health 5, only 8.7 percent of female respondents reported to having five or more drinks on one occasion during the last 30 days compared to 16.6 percent for males. Table 10. Tobacco Use Smokes cigarettes N (percent) Every day 45 (6.2) Some days 58 (8.0) Not at all 615 (84.9) Table 11. Alcohol Use Drinks alcoholic N (percent) beverages 0 days (none) 359 (49.5) 1-2 days per month 189 (26.1) 1-2 days per week 128 (17.7) 5 days per week 20 (2.8) Every day 16 (2.2) Don t know/not sure 13 (1.8) 28

29 HEALTH CARE Paying for health care can be a major expenditure for individuals and families, making health insurance a critical asset. The majority of respondents (74.6%) indicated that they have some type of health coverage, including health insurance, or prepaid plans such as HMOs, or government plans such as Medicare or Medicaid (see Table 12). These findings are consistent with results from BRFSS indicating that 76.8 percent of the Mississippi respondents had a health care plan. 5 Table 12. Health Care Coverage Health care coverage Total Sample N (percent) Male N (percent) Female N (percent) Yes 525 (74.6) 130 (66.7) 390 (77.4) No 179 (25.4) 65 (33.3) 114 (22.6) Survey respondents were asked if there was a time in the past 12 months when they needed to see a doctor, but did not or could not. A vast majority (75.3%) reported they could see a doctor when necessary (see Table 13). Survey respondents were also asked where they usually go for health care services. The majority of respondents (76.1%) indicated that they use a personal doctor as their primary health care provider; whereas, 147 (20.4%) reported that they either go to the emergency room or some alternative care (see Table 14). Table 13. Deferral of Care Did not see doctor when needed Total Sample N (percent) Male N (percent) Female N (percent) Yes 177 (24.7) 42 (20.3) 135 (26.8) No 523 (73.0) 158 (76.3) 360 (71.4) Don t know/not sure 16 (2.2) 7 (3.4) 9 (1.8) Table 14. Primary Health Care Provider Health care service N (percent) Personal doctor 548 (76.1) Emergency room 95 (13.2) Alternative care 52 (7.2) Don t know/not sure 25 (3.5) 29

30 Survey respondents were asked if, in the last 12 months, they or anyone in their household did not take prescribed medicine due to prescription costs. A compelling 17.9 percent of the respondents reported that they, in fact, did not take prescription medicine due to cost during this time (see Table 15). Table 15. Prescription Noncompliance Due to Cost Did not take N (percent) prescription due to cost Yes 128 (17.9) No 536 (75.0) Don t know/not sure 51 (7.1) BELIEFS, PERCEPTIONS, & ATTITUDES Survey respondents were asked to identify the most important health issue in the community. Among the health issues listed were mental health, access to health care, overweight and inactivity, affordable housing, drug and alcohol use, and tobacco use. The survey respondents identified overweight and inactivity (42.1%), access to health care (20.3%), drug and alcohol use (14%), and mental health (9.1%) among the top four important health issues. Table 16. Most Important Health Issues Most important health issue Total Sample N (percent) Male N (percent) Female N (percent) Overweight/inactivity 309 (42.1) 84 (40.0) 223 (43.0) Access to health care 149 (20.3) 40 (19.1) 109 (21.0) Drug/alcohol use 103 (14.0) 46 (21.9) 55 (10.6) Mental health 67 (9.1) 13 (6.2) 54 (10.4) Don t know/not sure 50 (6.8) 10 (4.8) 39 (7.5) Affordable housing 34 (4.6) 14 (6.7) 20 (3.9) Tobacco use 12 (1.6) 2 (1.0) 10 (1.9) Other 10 (1.4) 1 (0.5) 9 (1.7) 30

31 Survey respondents were asked the level of importance for promoting healthy behaviors, managing chronic diseases, and public health facilities and services. A small segment of respondents indicated that ( %) none of the categories were important (see Table 17). Table 17. Perception of Importance Promoting healthy behaviors Total Sample N (percent) Male N (percent) Female N (percent) Very Important 514 (74.9) 137 (71.4) 375 (76.7) Important 157 (22.9) 51 (26.6) 103 (21.1) Not Important 15 (2.2) 4 (2.1) 11 (2.3) Managing chronic diseases Very Important 564 (83.9) 151 (80.8) 412 (85.5) Important 91 (13.5) 34 (18.2) 55 (11.4) Not Important 17 (2.5) 2 (1.1) 15 (3.1) Public health facilities/services Very Important 478 (74.0) 129 (71.3) 346 (75.2) Important 156 (24.2) 51 (28.2) 103 (22.4) Not Important 12 (1.9) 1 (0.6) 11 (2.4) 31

32 Demographics of Survey Respondents The majority of the respondents were female (71.2%) and black (76.3%). More than half (56.6%) of the survey respondents had full-time jobs and completed some form of post-secondary education (53.6%). A more complete demographic profile of respondents is presented in Table 18. Table 18. Demographics from Survey Gender N (percent) Female 523 (71.2) Male 212 (28.8) Age (years) (15.2) (16.0) (13.6) (20.9) (19.4) (9.6) (4.8) >85 4 (0.5) Race or origin White 144 (19.3) Black/African American 569 (76.3) Asian 8 (1.1) Native Hawaiian or other 3 (0.4) Pacific Islander American Indian or 9 (1.2) Alaska Native Hispanic or Latino 2 (0.3) Middle Eastern or Arab 2 (0.3) Other 9 (1.2) Marital status Single, never married 274 (37.3) Married 278 (37.9) Separated/Divorced 143 (19.5) Widowed 39 (5.3) Employment status N (percent) Full-time (at least (56.6) hours/week) Part-time (at least (11.5) hours/week) Retired 92 (14.8) Unemployed 51 (8.2) Medical disability 20 (3.2) Student 35 (5.7) Education level (completed) Did not graduate high 47 (6.4) school High school graduate 123 (16.7) Attended college 171 (23.2) Technical school graduate 43 (5.8) 4 year college graduate 221 (30.0) Masters or doctorate 131 (17.8) degree Annual household income Less than $20, (29.7) $20,000-34, (18.4) $35,000-49,999 $50,000-74,999 $75,000 or more 151 (21.0) 110 (15.3) 112 (15.6) NOTE: Percentages may not add to 100 due to rounding. 32

33 UMMC List of Counties for Survey Participants The residence counties for the survey participants are listed in the table below. Residence counties were determined by the zip code provided by each survey participant. The number of survey participants for each zip code is indicated in parentheses. COUNTY Atala (1) Bolivar (9) / (1) ZIP CODES Copiah (15) / (8) / (5) DeSoto (19) / (13) Forrest Harrison (2) / (1) Hinds Holmes (15) Jackson (2) / (1) Jefferson (2) Jones (2) (9) / (6) / (7) / (1) / (1) (1) / (18) / (1) / (23) / (28) / (22) / (1) / (8) / (6) / (14) / (40) / (24) / (10) / (26) / (71) / (1) / (1) / (1) / (28) / (1) Lamar (13) / (2) / (2) / (1) Lawrence (3) Lee (2) / (1) / (1) Leflore (1) / (1) Lincoln (2) / (2) Lowndes (1) Madison (27) / (1) / (7) / (9) Marion (2) Pike (1) 33

34 UMMC List of Counties for Survey Participants (continued) COUNTY Rankin Sunflower (1) Walthall (17) Warren (2) Washington Winston (1) Yazoo (1) NOTE: 6 survey participants did not respond to question regarding zip code. ZIP CODES (7) / (6) / (1) / (3) / (13) / (16) / (2) (77) / (1) / (56) / (7) / (5) 34

35 This community needs assessment was conducted to identify important needs and concerns within the primary service area of UMMC. Data were drawn from over 800 individuals who live across the state and have experience with the services provided by UMMC. The results provide some insights into community health needs; however, there are some limitations worth noting. The results were compiled from a convenience sample of individuals, therefore the results are not generalizable to any particular racial, ethnic, gender, resident, or age group. It also should be noted that data were collected a one point in time, therefore, it not possible to discuss health trends or draw conclusions about the causes of important health issues. All of the usual limitations associated with self-report data apply. All results should be interpreted in conjunction with other Mississippi data. 35

36 Identification of priorities by community stakeholders was a critical component of the CHNA process. UMMC leaders will participate in developing work plans and establishing metrics to measure progress. The first step will be to provide a framework to organize the CHNA results into a logical set of health improvement investments based on the hospital s overall strategic plan. UMMC will then develop an implementation plan of strategic objectives to achieve improvement in the issues identified during the CHNA process. The next step will be to establish measurable outcomes for each strategic objective linked to each priority identified during the CHNA process. Furthermore, UMMC will build on existing community programs and partnerships to address the health needs identified through the 2015 Community Health Needs Assessment process. The University of Mississippi Medical Center Community Health Needs Assessment Report may be found on the UMMC public websites ( or and are downloadable. To obtain a copy, contact the UMMC Office of Population Health at

37 1. United States Census Bureau American Community Survey Accessed August 12, University of Wisconsin Population Health Institute. County Health Rankings. Madison, WI: University of Wisconsin Population Health Institute; Association for Community Health Improvement. Assessment Process Map. 2012; Accessed March, Kamberelis G, & Dimitriadis, G. Focus Group Research: Retrospect and Prospect. The Oxford Handbook of Qualitative Research. New York: Oxford University Press; 2014: Mississippi State Department of Health. Mississippi Behavioral Risk Factor Surveillance Survey. Jackson, MS: Mississippi State Department of Health; United Health Foundation. American's Health Rankings: Mississippi Profile. Minnetonka, MN: United Health Foundation; Moore LV, Thompson FE. Adults Meeting Fruit and Vegetable Intake Recommendations United States, Morbidity and Mortality Weekly Report. 2015;64(26):

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39 Health Status Respondent Felt Depressed Over Past 30 Days Felt sad, blue, or N (percent) depressed Never 158 (22.3) Seldom 217 (30.6) Sometimes 259 (36.5) Nearly always 43 (6.1) Always 17 (2.4) Don t know/not sure 16 (2.3) Health Behaviors Minutes Spent Exercising Minutes per week N (percent) 30 minutes or less per week 268 (39.3) More than 30 but less than (18.0) minutes per week At least 60 but less than (14.1) minutes per week At least 150 minutes or more 68 (10.0) per week Don t know/not sure 127 (18.6) Drank 4 or More Drinks on Occasion in Past 30 Days Drank 4 or more N (percent) drinks No 586 (81.1) Yes, on at least one 101 (14.0) occasion, I drank 4 drinks Yes, on at least one 29 (4.0) occasion, I drank 5 or more drinks Don t know/not sure 7 (1.0) 39

40 Health Care Deferral of Dental Care Did not see dentist when N (percent) needed Yes 198 (27.8) No 486 (68.2) Don t know/not sure 29 (4.1) Deferral of Mental Health Care Did not get mental N (percent) health care when needed Yes 62 (8.8) No 600 (85.4) Don t know/not sure 41 (5.8) Primary Source for Health Information Source N (percent) Doctor 470 (65.3) Internet 95 (13.2) Health newsletter 15 (2.1) All others 23 (3.2) Other health professional 22 (3.1) Myself/family member in 52 (7.2) health care field TV 9 (1.3) Work 3 (0.4) Family/friends 18 (2.5) Don t know/not sure 13 (1.8) Flu Shot/Vaccine Sprayed in Nose in Past 12 Months Flu shot/vaccine N (percent) sprayed in nose Yes 258 (36.6) No 442 (62.7) Don t know/not sure 5 (0.7) 40

41 Beliefs, Perceptions, & Attitudes Worried About Events in Neighborhood Being mugged or robbed N (percent) Not worried 146 (22.1) Not very worried 179 (27.0) Fairly worried 150 (22.7) Very worried 187 (28.3) Car being stolen Not worried 156 (24.0) Not very worried 197 (30.4) Fairly worried 156 (24.0) Very worried 140 (21.6) Items stolen from car Not worried 157 (24.4) Not very worried 174 (27.1) Fairly worried 154 (24.0) Very worried 158 (24.6) 41

42 Demographics of Survey Respondents Gender N (percent) Female 523 (71.2) Male 212 (28.8) Age (years) (15.2) (16.0) (13.6) (20.9) (19.4) (9.6) (4.8) >85 4 (0.5) Race or origin White 144 (19.3) Black/African American 569 (76.3) Asian 8 (1.1) Native Hawaiian or other 3 (0.4) Pacific Islander American Indian or 9 (1.2) Alaska Native Hispanic or Latino 2 (0.3) Middle Eastern or Arab 2 (0.3) Other 9 (1.2) Marital status Single, never married 274 (37.3) Married 278 (37.9) Separated/Divorced 143 (19.5) Widowed 39 (5.3) Employment status N (percent) Full-time (at least (56.6) hours/week) Part-time (at least (11.5) hours/week) Retired 92 (14.8) Unemployed 51 (8.2) Medical disability 20 (3.2) Student 35 (5.7) Education level (completed) Did not graduate high 47 (6.4) school High school graduate 123 (16.7) Attended college 171 (23.2) Technical school graduate 43 (5.8) 4 year college graduate 221 (30.0) Masters or doctorate 131 (17.8) degree Annual household income Less than $20, (29.7) $20,000-34, (18.4) $35,000-49,999 $50,000-74,999 $75,000 or more 151 (21.0) 110 (15.3) 112 (15.6) NOTE: Percentages may not add to 100 due to rounding. 42

43 UMMC List of Counties for Survey Participants COUNTY ZIP CODES Atala (1) Bolivar (9) / (1) Copiah (15) / (8) / (5) DeSoto (19) / (13) Forrest Harrison (2) / (1) Hinds Holmes (15) Jackson (2) / (1) Jefferson (2) Jones (2) (9) / (6) / (7) / (1) / (1) (1) / (18) / (1) / (23) / (28) / (22) / (1) / (8) / (6) / (14) / (40) / (24) / (10) / (26) / (71) / (1) / (1) / (1) / (28) / (1) Lamar (13) / (2) / (2) / (1) Lawrence (3) Lee (2) / (1) / (1) Leflore (1) / (1) Lincoln (2) / (2) Lowndes (1) Madison (27) / (1) / (7) / (9) Marion (2) Pike (1) 43

44 UMMC List of Counties for Survey Participants (continued) COUNTY Rankin Sunflower (1) Walthall (17) Warren (2) Washington Winston (1) Yazoo (1) NOTE: 6 survey participants did not respond to question regarding zip code. ZIP CODES (7) / (6) / (1) / (3) / (13) / (16) / (2) (77) / (1) / (56) / (7) / (5) 44

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46 Community Health Needs Assessment For Office Use Only Participant ID: COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY University of Mississippi Medical Center Thank you for taking the time to complete this survey. This survey will assess information regarding the health needs in your community. Please respond to each item with an answer that best represents you. The answers that you provide will remain anonymous. Please complete all questions in this survey. Date: / / 20 (MM/DD/YYYY) 1. What is the ZIP Code where you live? 2. What is your gender? Male Female 3. How old are you? 18 to 24 years 55 to 64 years 25 to 34 years 65 to 74 years 35 to 44 years 75 to 84 years 45 to 54 years 85 years or older 4. What is your current marital status? Single, never married A member of an unmarried couple Married Separated Divorced Widowed Don t know / Not sure 5. What is the highest grade level of education you have completed? 8 th grade or less Some high school High school graduate or GED Some college Technical school graduate College graduate Advanced professional degree Don t know / Not sure 6. Would you say that in general your health is excellent, very good, good, fair, or poor? Excellent Fair Very good Poor Good 7. What do you think is the most important health issue in our community? (Mark one.) Mental health Access to health care Overweight and inactivity Affordable housing Drug and alcohol use Tobacco use Other Don t know / Not sure 8. In the past 30 days, how often did you have any problems with stress, anxiety, depression, anger, or any other emotional health problems? All of the time A little of the time Most of the time None of the time Some of the time Don t know / Not sure 9. What is your annual household income from all sources? Less than $20,000 $20,000 34,999 $35,000 49,999 $50,000 74,999 $75,000 or more 10. Have you EVER been told by a doctor, nurse, or other health professional that you have high blood pressure? No Yes Yes, but I was told during pregnancy I have only been told my blood pressure is borderline high or pre-hypertensive Don t know / Not sure University of Mississippi Medical Center 1

47 Community Health Needs Assessment 11. Have you EVER been told by a doctor, nurse, or other health professional that your blood cholesterol is high? Yes Don t know / Not sure No 12. Have you EVER been told by a doctor, nurse, or other health professional that you have diabetes? Yes Yes, but I was told during pregnancy No I have only been told I have pre-diabetes or borderline diabetes Don t know / Not sure 13. Do you smoke cigarettes every day, some days, or not at all? Every day Not at all Some days Don t know / Not sure 14. During the past 30 days, how many days per week or per month did you have at least one drink of any alcoholic beverage such as beer, wine, a malt beverage, or liquor? 0 days (none) 1 day per month 2 days per month 1 day per week 2 days per week 5 days per week Every day Don t know / Not sure 15. During the past 30 days, considering all types of alcoholic beverages, was there any time when you drank 4 or more drinks on an occasion? No Yes, on at least one occasion I drank 4 drinks Yes, on at least one occasion I drank 5 or more drinks Don t know / Not sure 16. Do you have any kind of health care coverage, including health insurance, or prepaid plans such as HMOs, or government plans such as Medicare or Medicaid? Yes Don t know / Not sure No For Office Use Only Participant ID: 17. Where do you usually go for health care services? My personal doctor or other health professional Urgent care center Pharmacy Emergency room Alternative care provider (e.g., herbalist, massage therapist, homeopath) Don t know / Not sure 18. Was there a time in the past 12 months when you needed to see a doctor, physician s assistant, or nurse, but did not or could not? Yes No (go to question #20) Don t know / Not sure (go to question #20) 19. Why weren t you able to see a doctor or other health care professional when you needed to? Cost Didn t want to go Didn t have time / too busy Could not get time off from work Could not get through on the telephone Could not get an appointment soon enough Could not find a doctor or health professional Clinic/doctor s office wasn t open when I went Didn t have transportation Didn t have childcare/respite care Other reason Don t know / Not sure 20. What is your race or origin? (Mark all that apply.) White Black or African American Asian Native Hawaiian or other Pacific Islander American Indian or Alaska Native Hispanic or Latino Middle Eastern or Arab Other Don t know / Not sure 21. About how much do you weigh without shoes? lbs. Don t know / Not sure 22. About how tall are you without shoes? feet in. Don t know / Not sure University of Mississippi Medical Center 2

48 Community Health Needs Assessment For Office Use Only Participant ID: 23. During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, gardening, or walking for exercise? Yes Don t know / Not sure No 24. How many minutes do you spend doing these types of physical activities or exercise? 30 minutes or less per week More than 30 but less than 60 minutes per week At least 60 but less than 150 minutes per week At least 150 minutes or more per week Don t know / Not sure 25. How many times a day do you eat or drink fruits and vegetables? This includes cooked, raw, fresh, frozen, or canned, and 100% fruit juices. None 1 to 2 times a day 3 to 4 times a day 5 to 6 times a day 7 or more times a day Don t know / Not sure 26. Do you? (Mark all that apply.) Wear sunscreen Get an annual health checkup Wear a seat belt Wear protective equipment (e.g., helmet, goggles, wrist guards) Volunteer or engage in an activity that helps others Participate in a faith or spiritual experience Sleep 7 to 8 hours per day Take vitamins Get an annual flu shot Visit with friends and family Participate in groups with interests similar to yours 28. Was there a time during the last 12 months that you felt you did not get the dental care you needed? Yes Don t know / Not sure No (go to question #30) 29. Why did you not receive the dental care you thought you needed? (Mark all that apply.) Uninsured Cannot afford to pay Insurance did not cover it Unable to find a dentist to take Medicaid or other insurance Unable to get appointment Co-payment is too high Poor dental care Don t know where to go Other 30. Was there a time in the last 12 months that you felt you did not get the mental health care you needed? Yes Don t know / Not sure No (go to question #32) 31. Why did you not receive the mental health care you thought you needed? (Mark all that apply.) Uninsured Cannot afford to pay Insurance did not cover it Unable to find a doctor to take Medicaid or other insurance Unable to get appointment Co-payment is too high Poor mental care Don t know where to go Other 32. From which source do you get most of your health information? Doctor TV Internet Work Health newsletter Family/friends 27. In the last 12 months, have you or anyone in your All others Not sure household not taken prescribed medication due to Other health professional prescription costs? Myself/family member in health care field Yes Don t know / Not sure No 33. During the past 12 months, have you had a flu shot or flu vaccine that was sprayed in your nose? Yes Don t know / Not sure No University of Mississippi Medical Center 3

49 Community Health Needs Assessment 34. During the past 30 days, about how often would you say you felt sad, blue, or depressed? Never Seldom Sometimes Nearly always Always Don t know / Not sure For Office Use Only Participant ID: 35. What is your present employment status? Full-time (at least 36.5 hours/week) Part-time (at least 20 hours/week) Retired Unemployed Medical disability Student The following questions are related to promoting healthy behaviors: 36. Please indicate the importance of promoting healthy behaviors to you and your constituent group. Very Important Important Not Important 37. When promoting healthy behaviors, which of the following services should be considered a priority? (Please check all that apply.) Alcohol Use/Abuse Immunizations/Vaccinations Physical Activity Dental Health Mental Health Pregnancy/Birth Drug Use/Abuse Nutrition Tobacco Health Physicals Obesity Other Health Screenings Sexually Transmitted Diseases If other, please specify: 38. Of the services you checked in the previous question (question #37), please list the two which you consider are the most important priorities for the community. Then check the column that best describes the availability of this service in your community. Service Available and meets existing needs Available but fails to meet needs Not Available The following questions assess the importance of treating chronic disease in the community: 39. Please indicate the importance of managing chronic diseases to you. (A chronic disease is a long-lasting condition that can be controlled, but not cured. Type 2 diabetes and hypertension are examples). Very Important Important Not Important 40. When managing chronic diseases, which of the following services should be considered a priority? (Please check all that apply.) Alzheimer s Diabetes Neurological Conditions Asthma Heart Disease Stroke Cancer Infant/Children s Health Suicide Kidney Disease Chronic Lower Respiratory Disease Other If other, please specify: University of Mississippi Medical Center 4

50 Community Health Needs Assessment For Office Use Only Participant ID: 41. Of the services you checked in the previous question (question #40), please list the two which you consider are the most important priorities for the community. Then check the column that best describes the availability of this service in your community. Service Available and meets existing needs Available but fails to meet needs Not Available The following questions assess the framework to support public health services and includes such concerns as access to health insurance, transportation, and workforce development: 42. Please indicate the importance of public health facilities/services & environmental hazards to you and your constituent group. Very Important Important Not Important 43. When considering public health infrastructure & environmental hazards, which of the following services should be considered a priority? (Please check all that apply.) Access to Medical Care Health Insurance Transportation Drinking Water Healthy Homes Workforce Development Food Safety Lead Poisoning Other Hazardous Materials/Waste If other, please specify: 44. Of the services you checked in the previous question (question #43), please list the two that you believe are the most important priorities for the community. Then check the column that best describes the availability of this service in your community. Service Available and meets existing needs Available but fails to meet needs Not Available 45. How worried are you about the following events occurring in your neighborhood? Event a. Being mugged or robbed b. Car being stolen c. Items stolen from your car Very worried (3) Fairly worried (2) Not very worried (1) Not worried (0) THANK YOU FOR COMPLETING THIS SURVEY! PLEASE RETURN THE SURVEY TO A STUDY STAFF MEMBER. University of Mississippi Medical Center 5

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52 2013 Behavioral Risk Factor Surveillance System Annual Prevalence Report Mississippi State Department of Health 570 East Woodrow Wilson Drive P. O. Box 1700 Jackson, MS

53 Mississippi Behavioral Risk Factor Surveillance Survey 2013 Prevalence Report December 18, 2014

54 Table of Contents Introduction... iv Methodology... v Definition of Terms and Risk Factors... viii Survey Results... 2 Health Status... 2 Health Care Coverage... 5 Healthy Days... 9 Tobacco Use Diabetes Hypertension Awareness Cholesterol Awareness Immunization Overweight and Obesity Asthma Exercise and Physical Activity Cancer Arthritis Cardiovascular Disease Disability Alcohol Consumption HIV/AIDS Seat Belt Usage Depression Chronic Obstructive Pulmonary Disease (COPD) Sleep Kidney Disease Mississippi Behavioral Risk Factor Surveillance Survey 2013 iii

55 Introduction Among health care professionals there is a general consensus that certain health conditions and behavior patterns have a strong correlation with disease, injury and death. Some examples are cigarette smoking, physical inactivity, obesity, and alcohol consumption. The Behavioral Risk Factor Surveillance System (BRFSS) is a telephone surveillance system designed to estimate the prevalence of these along with other health risk factors in every state and some territories in the United States. The results provide a tool for evaluating health trends, assessing the risk of chronic disease, and measuring the effectiveness of policies, programs, intervention strategies and awareness campaigns. The BRFSS is a cooperative agreement between the Centers for Disease Control and Prevention (CDC) and the Mississippi State Department of Health (MSDH). The first survey was done in 1984 when the data was collected at one given point in time. The survey was repeated in 1988 using the same methodology. Beginning in 1990 there has been an annual survey with the data being collected monthly. The BRFSS survey contains a set of core questions provided by the CDC to gather comprehensive standard information nationwide. The questions are related to health status, access to health care, health awareness, lifestyles, and preventive health. Individual states may include questions addressing specific risk factors that are of particular concern to that state. Mississippi Behavioral Risk Factor Surveillance Survey 2013 iv

56 Methodology A. SAMPLING DESIGN The Mississippi BRFSS is a random sample telephone survey. Utilizing a disproportionate stratified sample (DSS) design with random digit dialing and the Computer Assisted Telephone Interviewing (CATI) system, the survey has the potential to represent all households in Mississippi that have telephones. A sample size of 7,453 interviews over a 12-month period was selected to obtain a 95 percent confidence interval of ±2.5% on risk factor prevalence estimates in the adult population. Prevalence estimates by individual demographic variables, comprising smaller sample sizes, do not achieve the same level of accuracy as the total sample. Until the 2013 survey, the BRFSS has relied exclusively on interviews of households with land line phones only. But the number of households with only cell phones increased by more than 700 percent between 2003 and Approximately three in ten American homes now have only cellular telephones; in Mississippi the rate is 35.1 percent. This trend has been especially strong among younger adults and those in social and ethnic minority groups. The 2013 Mississippi BRFSS has approximately 73 percent land line and 27 percent cell phone households in the survey. For land line surveys, interviewers, contracted by the MSDH, contact the residences during weekdays between 9:00 a.m. and 9:00 p.m. and Saturdays between 10:00 a.m. and 4:30 p.m. After a residence has been contacted, one adult (18 years of age or older) is randomly selected to be interviewed from all adults residing in the household. The majority of interviews are collected over a two-week period each month of the survey year. For cell phone surveys, the same protocol is followed except that the interviewer establishes that the person answering the phone is at least 18 years old, that it is safe for the respondent to be interviewed and that the person uses the cell phone for at least 90 percent of their telephone service. Also for cell phone surveys no random adult is selected. B. QUESTIONNAIRE The questionnaire, designed through cooperative agreements with the CDC, is divided into three sections. The first section contains questions on health conditions and behavior; the second section contains demographic information; and the third contains optional modules covering topics of interest to the state. Mississippi Behavioral Risk Factor Surveillance Survey 2013 v

57 C. DATA ANALYSIS Since 2011 the BRFSS has utilized a different weighting method called iterative proportional fitting, also known as raking. The procedure, while not new, has been made feasible through the development of ultra-fast computer processors. In addition to the standard age, gender, race and ethnicity variables, the use of raking allows for consideration of demographic variables such as education level, marital status, renter or owner status, and phone source. By including these additional variables into the weighting process the survey will more accurately reflect Mississippi s adult population. The data collected by the MSDH Office of Public Health Statistics was edited and weighted by the CDC. Weighted counts were based on the 2012 Mississippi population estimates to accurately reflect the population demographics. Therefore, the estimated prevalence of any risk factor from the survey represents the total population of Mississippi residents very well. The reader should be aware that the numbers presented in the tables of this report reflect the actual, non-weighted observations for each cell while the percentages in each cell represent the weighted prevalence. This report presents the weighted percentages of high-risk behaviors, conditions and certain chronic diseases by gender, age group, race, education level, annual household income, and employment status. Respondents who either refused to answer or did not know the answer to the questions on demographics were excluded from the tables. For this reason the total for each of the demographic sections may not be equal to the total for the entire table. D. LIMITATIONS OF THE DATA All data collection systems are subject to error, and records may be incomplete or contain inaccurate information. All information in this survey is self-reported; people may not remember essential information, a question may not mean the same thing to different respondents, and some individuals may not respond at all. It is not always possible to measure the magnitude of these errors or their impact on the data. The user must be the final arbiter in evaluating the accuracy of the data. E. SAMPLE SIZE In the 2013 BRFSS, 7,453 people were sampled: 5,465 landline surveys and 1,988 cell phone surveys. The reader should note that sample sizes by question and response category may vary because of non-response and skip patterns within the survey instrument. Overall estimates generally have relatively small sampling errors, but estimates for certain population subgroups may be based on small numbers and have relatively large sampling errors. Interpreting estimates that are based on small numbers can mislead the reader into believing that a given finding is more precise than it really is. When the number of events is small and the probability of such an event is small, considerable caution should be observed in interpreting the estimates or differences among groups. The BRFSS recommends not interpreting percentages where the Mississippi Behavioral Risk Factor Surveillance Survey 2013 vi

58 denominator is based upon fewer than 50 non-weighted respondents. In the tables of the report, such results are marked with an asterisk that indicates a sample size less than 50. Mississippi Behavioral Risk Factor Surveillance Survey 2013 vii

59 Definition of Terms and Risk Factors Alcohol Consumption Binge Drinking Risk Factor Respondents who report that they have had at least five drinks on one or more occasion during the past thirty days. Heavy Drinking Risk Factor Male respondents who report having more than two drinks per day and female respondents who report having more than one drink per day during the past thirty days. Arthritis Arthritis Awareness Respondents who have been told by a doctor or other health professional that they have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia. Limited Activity Respondents who report that their usual activities are limited because of joint pain caused by arthritis. Limited Work Respondents whose joint symptoms because of arthritis affect whether they can work or affects the amount and type of work they do. Asthma The reader should note that in 2003 the definition of arthritis was changed. Before 2003, it included respondents who not only had been diagnosed with arthritis but also those who reported pain or stiffness in the joints for at least thirty days during the previous year. Asthma Awareness Respondents who report being told they have asthma by a doctor, nurse or other health professional. Current Asthma - Respondents who report that being told they have asthma by a doctor, nurse or other health professional and who still suffer from the condition. Cancer Skin Cancer Awareness Respondents who report that they have been told by a doctor or other health professional that they had skin cancer. Other Cancer Awareness Respondents who report that they have been told by a doctor or other health professional that they had cancer other than skin cancer. Cardiovascular Disease Heart Attack Respondents who report that they have ever been diagnosed with a heart attack. Stroke Respondents who report that they have ever been diagnosed with a stroke. Mississippi Behavioral Risk Factor Surveillance Survey 2013 viii

60 Coronary Heart Disease Respondents who have ever been diagnosed with angina or coronary heart disease. Cholesterol Awareness Cholesterol Checked Respondents who report that they have ever had their blood cholesterol checked. Cholesterol Checked in Past Five Years Respondents who report having their blood cholesterol checked within the past five years. Cholesterol High Respondents who report their blood cholesterol checked and who have been told that their blood cholesterol is high by a doctor, nurse, or other health professional. COPD COPD Awareness Respondents who report that they have been diagnosed by a health professional with Chronic Obstructive Pulmonary Disease (COPD). Diabetes Diabetes Awareness Respondents who report they have ever been told by a doctor that they have diabetes. Female respondents diagnosed with diabetes only during pregnancy are not included. At Risk for Diabetes Respondents age 18 to 44 who are obese and report no exercise in the past 30 days, or respondents age 45 to 64 who are either obese or report no exercise in the past 30 days, or respondents age 65 and older who are obese. Disability Limited Activity Respondents who report that their activity is limited in any way because of physical, mental or emotional problems. Special Equipment Requirements Respondents who report having health problems that require the use of special equipment such as a cane, wheelchair, special bed or special telephone. Exercise Exercise in Last 30 Days Respondents who report that, excluding their regular job, in the past 30 days they participated in any physical activity or exercise such as running, walking, calisthenics, golf, or gardening. Health Insurance Health Care Coverage Respondents who report they have no health care coverage, including health insurance, Health Maintenance Organizations, or Medicare. Mississippi Behavioral Risk Factor Surveillance Survey 2013 ix

61 Unable to See a Doctor Respondents who report they needed to see a doctor within the past 12 months but were unable because of the cost. Health Status Self-Reported Health Status Respondents who report that their general health status is fair or poor. Healthy Days Physical Health Respondents who report more than seven days during the past month when their physical health was not good. Mental Health Respondents who report more than seven days during the past month when their mental health was not good. Activities Limited Respondents who report more than seven days during the past month when they could not perform their normal activities because of poor physical or mental health. HIV/AIDS Ever Tested for HIV Respondents age 18 to 64 who report that they have ever been tested for HIV, excluding tests done as part of a blood donation. High Risk Behavior Respondents age 18 to 64 who report that they have used intravenous drugs, have been treated for a sexually transmitted or venereal disease, have given or received drugs or money in exchange for sexual favors, or have had anal intercourse without a condom during the past year. Hypertension Hypertension Awareness Respondents who have ever been told they have high blood pressure by a doctor, nurse or other health professional. Taking Blood Pressure Medicine Respondents who have been told they have high blood pressure by a doctor, nurse or other health professional and who are taking medication to control it. Immunization Flu Shots Respondents who report receiving a flu shot or the flu spray vaccine within the last twelve months. Pneumonia Shots Respondents who report ever receiving a vaccination for pneumonia. Mississippi Behavioral Risk Factor Surveillance Survey 2013 x

62 Kidney Disease Kidney Disease Respondents who have been diagnosed by a healthcare professional with kidney disease. Mental Health Depression Awareness Respondents who report they have been diagnosed by a health professional with depression. Physical Activity Highly Active Respondents who report doing enough physical activity to meet the 300-minute per week (or vigorous equivalent) aerobic recommendation. Active Respondents who report doing minutes per week (or vigorous equivalent) of physical activity. Insufficiently Active Respondents who report doing insufficient physical activity ( minutes per week). Inactive Respondents who report doing no physical activity. Seat Belts Usage Sleep Respondents who report that they always or nearly alwayswear seat belts. Inadequate Sleep Respondents age who report less than eight hours of sleep per day and respondents age 22 and older who report less than seven hours per day. Tobacco Use Cigarette Smoker Respondents who have ever smoked 100 cigarettes in their lifetime and report currently smoking every day or some days. This relates to Healthy People 2020 Objective 27 Target 12%. Weight Based on Body Mass Index (BMI) Body Mass Index (BMI) Weight in kilograms divided by height in meters squared (kg/m 2 ). Healthy Weight Respondents whose BMI is 18.5 BMI This measures Healthy People 2020 Objective 19.1 Target 60%. Overweight Respondents whose BMI is 25.0 BMI Obese Respondents whose BMI is This measures Healthy People 2020 Objective 19.2 Target 15%.. Mississippi Behavioral Risk Factor Surveillance Survey 2013 xi

63 Survey Results Mississippi Behavioral Risk Factor Surveillance Survey

64 Percent Percent Health Status Survey Question: Would you say that in general your health is excellent, very good, good, fair, or poor? This part of the survey attempts to determine how people look at their personal health and how well they function physically, psychologically and socially while engaged in normal, daily activities. The questions are important because they may indicate dysfunction and disability not measured in standard morbidity and mortality data General Health Fair or Poor By Race and Sex Male Female Total White Black With respect to race and gender, black females Figure 1 reported the highest percentage of health that was fair or poor with a rate of 30.7 percent (Figure 1). Black respondents overall report their health as worse than whites. Black respondents reported fair or poor health at a rate of 28.3 percent compared to 22.5 percent for whites. 60 General Health Fair or Poor By Race and Age Group White Black Figure 2 Mississippi Behavioral Risk Factor Surveillance Survey

65 Not surprisingly, reported fair or poor health tended to increase with age. Persons in the 18 to 24 age group reported a rate of only 9.8 percent while those more than 65 years of age reported a rate of 38.3 percent (Figure 2 and Table 1). Mississippi Behavioral Risk Factor Surveillance Survey

66 Table 1: General Health Fair or Poor White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female , Age Group , Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work , Total 1, , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

67 Percent Percent Health Care Coverage Survey Question: Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare? The questions in this section are designed to estimate the number of people who cannot obtain the health care they need because they are not covered by a health care plan or other health insurance. People at risk are those without any coverage. In 2013, 23.2 percent of the respondents indicated they had no health care plan. According to the survey, black males have the highest rate of non-coverage at 33.4 percent; black females were next at 26.9 percent (Figure 3) No Health Insurance By Race and Sex Male Female Total White Black When viewed by age categories, Figure 3 blacks from the age of 25 to 34 reported the highest prevalence of no health care coverage at 41.8 percent (Figure 4). No Health Insurance By Race and Age Group White Black Figure 4 Mississippi Behavioral Risk Factor Surveillance Survey

68 Percent Another factor that adversely affects the health status is access to medical care and in 2013, 21.8 percent of Mississippians said they were unable to see a doctor at some point in the prior twelve months because of cost. Blacks (29.0 percent) were more than one and one-half times as likely to have not seen a doctor due to cost as whites (16.8 percent). Also females of both races were much more likely to experience this phenomenon than males: 32.2 percent for black females to 25.1 percent males. The rate for white females was 21.1 percent; white males reported a rate of 12.2 percent. The survey revealed that one of the biggest barriers to access is income. Not surprisingly, those in the lower income ranges reported the greatest difficulty in gaining access to care (Figure 5). Unable to See Doctor Due to Cost By Race and Income Group White Black Figure 5 Mississippi Behavioral Risk Factor Surveillance Survey

69 Sex Table 2: Have No Kind of Health Insurance White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

70 Table 3: Unable to See Doctor in Past 12 Months at Some Point Due to Cost White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

71 Percent Healthy Days Survey Question: 1. Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good? 2. Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? In both public and private medicine, the concept of health-related quality of life refers to the physical and mental health perceived by a person or a group of persons. Health care professionals use health-related quality of life to measure the effects of chronic illness in patients and to better understand how an illness interferes with the day-to-day life activities of an individual. Similarly, health professionals use health-related quality of life to measure the effects of numerous disorders, short-term and long-term disabilities, and diseases in different populations. Tracking health-related quality of life in different populations can aid in identifying subgroups with poor physical or mental health and can help in developing policies or interventions to improve their health. Physical Health Not Good For More Than 7 Days in Past Month By Race and Age Group White Black Figure 6 In Mississippi, the 2013 BRFSS survey showed that days of poor physical health tends to increase with age while days of poor mental health were more evenly distributed among age groups. Figure 6 shows that people age reported the highest percentage (27.4) of more than seven days when their physical health was not good. Respondents age 65 and older Mississippi Behavioral Risk Factor Surveillance Survey

72 Percent reported a slightly lower rate of 24.3 percent. In the 55 to 64 group, white respondents had a rate of 24.7 percent compared to 31.2 percent for blacks. For those 65 and older, whites reported a rate of 23.8 percent compared to 26.1 percent for blacks. Those in the 35 to 44 year age group along with those 45 to 54 years old age had the highest percentage of seven or more days when their mental health was not good with a rate of 21.3 percent. Table 5 contains the details for both age groups. The group with the highest rate for days of poor mental health was people whose annual income is less than $15,000 per year with a rate of 30.2 percent: 33.8 percent for whites and 27.8 percent for blacks (Figure 7). The second highest category is the unemployed who report a rate of 31.3 percent. White respondents in this category had a rate of 36.4 percent; blacks a rate of 26.7 percent. 40 Mental Health Not Good For More Than 7 Days in Past Month By Race and Income Group White Black 0 Figure 7 Mississippi Behavioral Risk Factor Surveillance Survey

73 Table 4: Poor Physical Health for More Than 7 Days in Past Month White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female , Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work , Total , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

74 Table 5: Poor Mental Health for More Than 7 Days in Past Month White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

75 Table 6: Activity Limited for More Than 7 Days Due to Poor Physical or Mental Health White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

76 Percent Percent Tobacco Use Survey Question: Have you smoked at least 100 cigarettes in your entire life and do you now smoke cigarettes every day, some days, or not at all? Tobacco use is the single leading preventable cause of death in Mississippi and the United States. Each year, about one-fifth of the deaths in Mississippi are from tobacco-related causes. Health problems related to tobacco use include cancers, lung disease, and heart disease. Over the past decade the percentage of current adult smokers has not changed significantly. During the same period smokeless tobacco and cigar use among adults has increased. Mississippi was the Figure 8 Current Smokers By Race and Sex Male Female Total first state to reach a settlement with the tobacco industry. The Mississippi State Department of Health has drafted a state tobacco plan that includes strategies to prevent initiation of tobacco use White Black Current Smokers By Race and Income Levels White Black Figure 9 Mississippi Behavioral Risk Factor Surveillance Survey

77 among youth, promote cessation among youth and adults, and eliminate exposure to environmental tobacco smoke. According to the 2013 BRFSS report, the group with the highest percentage of current smokers is black males at 32.0 percent followed by white males at 26.1 percent and white females at 25.2 percent. The group with the lowest percentage of current smokers is black females at 17.1 percent (Figure 8). Overall, the rate of current smoking in Mississippi is 24.9 percent. The Healthy People 2020 objective is 12 percent. Mississippi Behavioral Risk Factor Surveillance Survey

78 Table 7: Current Smokers White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

79 Percent Percent Diabetes Survey Question: Have you ever been told by a doctor that you have diabetes? (Females diagnosed only while pregnant are excluded.) Diabetes was the sixth leading cause of death in Mississippi for the year 2012 with a death rate of 34.8 per 100,000 population. According to the 2013 BRFSS survey, 12.4 percent of all respondents reported being told by a doctor that they have diabetes Black females continue to comprise the largest group having a rate of 16.6 percent followed by white males with a rate of 12.6 percent. Black males and white females reported a rate of 11.6 percent. (Figure 10) Figure 10 Ever Diagnosed With Diabetes By Race and Sex Male Female Total White Black The rate of diabetes continues to show a pronounced difference by categories of education. 40 Ever Diagnosed With Diabetes By Race and Age Group White Black 0 Figure 11 Respondents who did not complete high school reported rates of 19.4 percent which is more than 27 percent higher than the next highest education category. Those with a high school Mississippi Behavioral Risk Factor Surveillance Survey

80 education reported a rate of 14.1 percent; those with some college work, a rate of 10.3 percent; and college graduates a rate of 8.1 percent (Table 8). There are also obvious differences seen by age of the respondent in the rate of diabetes. Only 0.7 percent of respondents under age 24 reported having diabetes while those age 65 and above reported a rate of 25.5percent: 22.9 percent for whites and 34.1 percent for blacks (Figure 11). Mississippi Behavioral Risk Factor Surveillance Survey

81 Table 8: Diagnosed With Diabetes White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

82 Percent Percent Hypertension Awareness Survey Question: Have you ever been told by a doctor, nurse or other health professional that you have high blood pressure? (Females reporting hypertension only during pregnancy are excluded.) Early detection of high blood pressure allows treatment that can prevent many complications of the disease. Untreated high blood pressure increases the risk of stroke, heart attack and kidney failure. High blood pressure can be controlled by losing weight, taking medication, exercising, not smoking, managing stress and lowering sodium and alcohol intake. Two indicators of hypertension in Mississippi are available in this report: a) Figure 12 respondents who have ever been told they have high blood pressure by a health care professional and b) respondents who are taking medication to control 90 Figure Figure Taking Medicine For Blood Pressure By Race and Sex Male Female Total 0 Ever Told Blood Pressure High By Race and Sex Male Female Total White Black high blood pressure. White Black The 2013 BRFSS survey indicates that approximately 40.3 percent of the people surveyed in Mississippi have been told they have high blood pressure by a health care professional. Blacks were slightly more likely to be hypertensive than whites. The overall rate of hypertension among blacks in Mississippi was 42.1 percent compared to 39.5 for whites. Black females in the survey Mississippi Behavioral Risk Factor Surveillance Survey

83 reported a rate of 46.1 percent rate for hypertension compared to 37.0 percent of the white females (Figure 12). White males, on the other hand, reported a rate of 42.1 percent compared to a rate of 37.5 percent for black males. Mississippi Behavioral Risk Factor Surveillance Survey

84 Table 9: Ever Told Blood Pressure High White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male , Female 1, , , Age Group , , , Education < High School Graduate High School Graduate or GED , Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed , Not Employed Student/Homemaker Retired/Unable to Work 1, , Total 2, , , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

85 Table 10: Taking Blood Pressure Medication 3 White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male , Female 1, , , Age Group * * * , , Education < High School Graduate High School Graduate or GED , Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work 1, , Total 2, , , Unweighted 2 Weighted * Sample Size<50 Mississippi Behavioral Risk Factor Surveillance Survey

86 Percent Percent Cholesterol Awareness Survey Question: Have you ever had your blood cholesterol checked? Persons having elevated blood cholesterol levels experience twice the risk of developing coronary heart disease. Studies reveal that small reductions in cholesterol levels are effective in reducing risks Cholesterol Ever Checked By Race and Sex White For those with high cholesterol readings, 10 changes in diet along with Male Female Total increasing physical activity will reduce the level approximately 75 percent of the time. The Figure 14 National Cholesterol Education Program recommends that healthy adults more than twenty years old have their blood cholesterol levels checked at least once every five years. Black Cholesterol Checked In Past Five Years By Race and Sex Male Female Total White Black The 2013 survey revealed that 77.9 percent of the respondents reported that they have had their blood cholesterol checked (Figure 14) and 74.3 percent reported that it had been checked in the past five years (Figure 15). White respondents were more likely to have had their cholesterol checked within five years reporting a rate of 76.7 percent than blacks who reported a rate of 70.8 percent (Table 12). Figure 15 Black male respondents reported the lowest rate for Mississippi Behavioral Risk Factor Surveillance Survey

87 examinations within the past five years with a rate of 64.9 percent. Of those who have ever had their cholesterol checked, 42.0 percent said they have been told their blood cholesterol is high but for the age group 65 and above, the rate was 58.9 percent. Mississippi Behavioral Risk Factor Surveillance Survey

88 Table 11: Ever Had Cholesterol Checked White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male 1, , Female 2, , , Age Group , , , , Education < High School Graduate High School Graduate or GED 1, , Some College or Technical School 1, , College Graduate 1, , Income < $15, , $15-$24, , $25-$34, $35-$49, $50-$74, $75, , Employment Status Employed 1, , Not Employed Student/Homemaker Retired/Unable to Work 2, , , Total 4, , , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

89 Table 12: Cholesterol Checked in Past 5 Years White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male 1, , Female 2, , , Age Group , , , Education < High School Graduate High School Graduate or GED 1, , Some College or Technical School 1, , College Graduate 1, , Income < $15, , $15-$24, , $25-$34, $35-$49, $50-$74, $75, Employment Status Employed 1, , Not Employed Student/Homemaker Retired/Unable to Work 1, , Total 3, , , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

90 Percent Immunization Survey Question: A flu shot is an influenza vaccine injected in your arm. During the past 12 months, have you had a flu shot or have you had a flu vaccine that was sprayed in your nose? Influenza and pneumonia was the tenth leading cause of death in Mississippi for 2012 producing a death rate of 18.7 per 100,000 in population. Flu Vaccination in Past 12 Months Age 65+ By Race and Sex The Healthy People goal for influenza vaccinations 60 is that 90 percent of the noninstitutionalized people age White Black and older have been 20 vaccinated in the preceding twelve months. The target for 0 those in the 18 to 64 age group who are not institutionalized is 80 percent. Influenza vaccine Male Female Total can prevent the disease and its complications. In the elderly, the Figure 16 vaccine is less effective in disease prevention, but reduces severity of disease and the incidence of complications and death. Vaccination is an important intervention to reduce hospitalizations due to complications of influenza. Influenza vaccine is recommended for all persons 65 years of age and older, and for those with chronic health problems which put them at risk for complications. In the 2013 BRFSS survey, 63.1 percent of the respondents age 65 and older reported they had received the influenza vaccine in the last 12 months. The proportion vaccinated in this age group reflected a marked difference according to race: 66.8 percent of whites reported having been vaccinated compared to only 52.8 percent for blacks (Figure 17). For the total population, females reported higher vaccination in the past twelve months with a rate of 39.8 percent compared to 34.6 percent for males (Figure 16). Only 30.1 percent of the respondents said that they had ever received a pneumonia vaccination. Respondents over the age of 65 reported a vaccination rate of 66.2 percent. As with influenza vaccinations rates on those 65 years of age and older, there was a marked difference with respect to race for pneumonia vaccinations: 71.9 percent for whites but only 48.7 percent for blacks (Table 15). Mississippi Behavioral Risk Factor Surveillance Survey

91 Percent Flu Vaccination in Past 12 Months By Race and Age Group White Black Figure 17 Mississippi Behavioral Risk Factor Surveillance Survey

92 Table 13: Flu Vaccination in Past 12 Months White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male , Female 1, , Age Group , , Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed , Not Employed Student/Homemaker Retired/Unable to Work 1, , Total 2, , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

93 Table 14: Flu Vaccination in Past 12 Months: Age 65+ White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female , Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, * $50-$74, * $75, * Employment Status Employed Not Employed * Student/Homemaker * Retired/Unable to Work 1, , Total 1, , Unw eighted 2 Weighted *Sample size <50 Mississippi Behavioral Risk Factor Surveillance Survey

94 Table 15: Ever Had Pneumonia Vaccination White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female 1, , Age Group , , Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work 1, , Total 1, , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

95 Table 16: Ever Had Pneumonia Vaccination: Age 65+ White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female , Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, * $35-$49, * $50-$74, * $75, * Employment Status Employed * Not Employed * Student/Homemaker * Retired/Unable to Work 1, , Total 1, , Unw eighted 2 Weighted *Sample size <50 Mississippi Behavioral Risk Factor Surveillance Survey

96 Percent Percent Overweight and Obesity Survey Question: There is no survey question that solicits the respondent to provide his body mass index (BMI) rather it is calculated from the selfreported height and weight. (See the Definitions section for the formula) The proportion of overweight persons has increased substantially during the past twenty years. Morbidity related to being overweight is the second leading cause of death in the United States and causes approximately 300,000 deaths each year. Overweight persons substantially increase their risk of illness from hypertension, high cholesterol, Type 2 diabetes, heart disease and stroke, gall bladder disease, cancer of the endometrium, breast, prostate and colon as well Figure 18 People Who Are Obese By Race and Sex Overweight or Obese By Race and Gender Male Female Total White Black as arthritis. Overweight people may also suffer from social stigmatization, discrimination and low self-esteem Figure 19 Male Female Total White Black Weight may be controlled by dietary changes such as decreasing caloric intake and by increasing physical activity. According to the 2013 BRFSS study 69.2 percent of those surveyed reported themselves as being either overweight ( BMI 25) or obese (BMI 30). The rate for whites was 66.4 percent compared to 74.2 percent for blacks (Table 17). The total obesity rate for 2013 was 35.2 percent: 31.1 for Mississippi Behavioral Risk Factor Surveillance Survey

97 whites and 42.4 for blacks (Table 18). Black females reported the highest rate of obesity at 48.4 percent and black males reported the second highest rate at 35.8 percent. Black respondents in the 45 to 54 age group have the highest rate of obesity at 58.7 percent compared to a rate of 40.0 for whites in the same age category. Mississippi Behavioral Risk Factor Surveillance Survey

98 Table 17: People Who Are Overweight or Obese White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male 1, , Female 1, , , Age Group , , , Education < High School Graduate High School Graduate or GED , Some College or Technical School , College Graduate , Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed 1, , Not Employed Student/Homemaker Retired/Unable to Work 1, , Total 2, , , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

99 Table 18: People Who Are Obese White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female , Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed , Not Employed Student/Homemaker Retired/Unable to Work , Total 1, , , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

100 Percent Asthma Survey Question: Have you ever been told by a doctor, nurse, or other health professional that you had asthma? If yes: Do you still have asthma? According to the U. S. Department of Health and Human Services, Healthy People 2020 publication, asthma is a serious and growing health problem. Asthma is a chronic inflammatory disorder of the airways characterized by episodes of reversible breathing problems due to airway narrowing and obstruction. These episodes can range in severity from mild to life threatening. Symptoms of asthma include wheezing, coughing, chest tightness, and shortness of breath. In some cases, the breathing may be so labored that an asthma attack becomes life-threatening. Most of the problems caused by asthma could be averted if persons with asthma Figure 20 and their health care providers managed the disease according to established guidelines. Effective management of asthma comprises four major components: controlling exposure to factors that trigger asthma episodes, adequately managing asthma with medicine, monitoring the disease by using objective measures of lung function and educating asthma patients to become partners in their own care. Such prevention efforts are essential to interrupt the progression from disease to functional limitation and disability and to improve the quality of life for persons with asthma. In Mississippi, the 2013 BRFSS survey revealed that 12.5 percent of the respondents said that they had ever had asthma. As has been true in recent years, blacks reported a higher rate of asthma, 13.8 percent, than whites who had a rate of 11.8 percent. Women reported a higher rate (15.0 percent) than men (9.9 percent). Table 19 contains the figures related to the various rates Ever Diagnosed With Asthma By Race and Sex Male Female Total White Black Mississippi Behavioral Risk Factor Surveillance Survey

101 Percent Ever Diagnosed With Asthma By Race and Age Group White Black 0 Figure 21 Mississippi Behavioral Risk Factor Surveillance Survey

102 Table 19: Ever Diagnosed With Asthma White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

103 Table 20: Presently Have Asthma White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

104 Percent Exercise and Physical Activity Survey Question: During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise? On average, physically active people outlive those who are inactive. Regular physical activity helps to maintain the functional independence of older adults and enhances the quality of life for people of all ages. The role of physical activity in preventing coronary heart disease (CHD) is of particular importance, given that CHD is the leading cause of death and disability in the United States and in Mississippi. Physically inactive people are almost twice as likely to develop CHD as persons who engage in regular physical activity. The risk posed by physical No Exercise in Past 30 Days By Race And Education Level White Black Figure 22 inactivity is almost as high as several well-known CHD risk factors such as cigarette smoking, high blood pressure and high blood cholesterol. Physical inactivity is more prevalent than any of these other risk factors. Regular physical activity is important for people who have joint or bone problems. It has been shown to improve muscle function, cardiovascular function, and physical performance. People with osteoporosis may respond positively to regular physical activity, particularly weightbearing activities such as walking and especially when combined with appropriate drug therapy and calcium intake. In Mississippi, 38.2 percent of the population is reported as not participating in any physical activity outside of work in the past 30 days. People with less education (Figure 22) and in lower income levels (Table 21) reported the highest percentage of physical inactivity. Mississippi Behavioral Risk Factor Surveillance Survey

105 Percent 80 Do Not Not Meet Physical Activity Recommendations By Race and Age Group White Black 0 Figure 23 Mississippi Behavioral Risk Factor Surveillance Survey

106 Table 21: No Leisure Time Physical Activity in Past 30 Days White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female 1, , Age Group , Education < High School Graduate High School Graduate or GED , Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work , Total 1, , , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

107 Table 22: Do Not Meet Physical Activity Recommendations White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male , Female 1, , , Age Group , , , Education < High School Graduate High School Graduate or GED , Some College or Technical School , College Graduate , Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed 1, , Not Employed Student/Homemaker Retired/Unable to Work 1, , Total 2, , , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

108 Percent Cancer Survey Question: Has a doctor, nurse, or other health professional ever told you that you had skin cancer? Has a doctor, nurse, or other health professional EVER told you that you had any other types of cancer? According to the Centers for Disease Control and Prevention (CDC), skin cancer is the most common form of cancer in the United States. The two most common types of skin cancer are basal cell and squamous cell carcinomas both of which are highly curable. However, melanoma, the third most common skin cancer, is more dangerous. About 65 to 90 percent of all melanomas are caused by exposure to ultraviolet light Ever Diagnosed With Skin Cancer By Race and Sex Male Female Total White Black Most skin cancers form in Figure 24 older people on parts of the body exposed to the sun or in people who have weakened immune systems. The American Cancer Society estimates that in 2014 there will be 81,220 new cases of skin cancer in the United States. The 2013 Mississippi BRFSS revealed that 5.9 percent of the population had been diagnosed with some form of skin cancer. There was a conspicuous difference between the rates based on race. Whites reported a rate of 9.3 percent compared to only 0.4 percent for blacks. Whites age 65 and older had a rate of 24.9 percent compared to 1.8 percent for blacks (Table 23). The second BRFSS question concerning cancer was whether the respondent had ever been diagnosed with any other type of cancer. Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells. If the spread is not controlled, it most likely results in death. Cancer is caused by both external and internal factors. These factors may act together or in sequence to initiate or promote carcinogenesis. Ten or more years often pass between exposure to external factors and detectable cancer. Mississippi Behavioral Risk Factor Surveillance Survey

109 Percent Ever Diagnosed With Other Cancer By Race and Sex White Black The 2013 BRFSS survey revealed that 6.7 percent of the people in Mississippi have been diagnosed with some form of cancer other than skin cancer which translates into more than 150,000 persons. The rate for white respondents was 8.2 percent while the rate for blacks was 4.2 percent (Figure 25). 0 Male Female Total Figure 25 Mississippi Behavioral Risk Factor Surveillance Survey

110 Table 23: Ever Diagnosed With Skin Cancer White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

111 Table 24: Ever Diagnosed With Other Cancer White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

112 Percent Arthritis Survey Question: Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia? According to the Healthy People 2020 publication, arthritis affects one in five adults in the United States and continues to be the most common cause of disability and generates more than $128 billion per year to the cost of health care. All of the human and economic costs are projected to increase over time as the population ages. There are more than 100 types of arthritis which commonly occurs with other chronic conditions, such as diabetes, heart disease, and obesity. Interventions to treat the pain and reduce the functional limitations from arthritis are important, and may also enable people with these other chronic conditions to be more physically active. Ever Diagnosed With Arthritis By Race and Age Group White Black Figure 26 The significant public health impact of arthritis is reflected in a variety of measures. First, arthritis is the leading cause of disability. Arthritis limits major activities such as regular work, housekeeping and school for nearly three percent of the U. S. population and almost twenty percent of those who are afflicted with the condition. Arthritis trails only heart disease as a cause of work disability. As a consequence, arthritis limits the independence of affected persons and disrupts the lives of family members and other care givers. Mississippi Behavioral Risk Factor Surveillance Survey

113 Health-related quality of life measures are consistently worse for persons with arthritis, whether the measure is healthy days in the past 30 days, days without severe pain, ability days (that is, days without activity limitations), or difficulty in performing personal care activities. For Mississippi, the 2013 BRFSS survey showed that 30.1 percent of the population had been diagnosed with arthritis by a health care professional. As noted in the Definitions of Terms and Risk Factors, the question in the current report has been amended so that only those who have actually been diagnosed with arthritis by a health care professional are being reported. Until 2003, the report included those who had reported pain or stiffness in the joints for at least 30 days during the previous year. As seen in Figure 26, the proportion increases with age. Respondents over the age of 65 reported being diagnosed with arthritis at a rate of 57.3 percent. The rate for blacks within this age group was than 13 percent higher than whites. Blacks reported a rate of 63.7 percent while whites were only 55.5 percent. Only 4.8 percent of those years old reported this condition. Of the people who were diagnosed with arthritis, 56.4 percent said that their usual, normal activities were limited by joint pain. Blacks reported a rate of 57.7 while white respondents had a rate of 55.9 percent (Table 26). A little more than 44 percent of diagnosed arthritics reported that the amount of work, the type of work or even if they are able to work at all is affected by their joint symptoms. Blacks at 51.6 percent had a much higher rate than whites with 40.2 percent. Little difference was noted between genders: males had a rate of 44.4 percent compared to 43.9 percent for females (Table 27). Mississippi Behavioral Risk Factor Surveillance Survey

114 Table 25: Ever Diagnosed With Arthritis White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female 1, , Age Group , , Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work 1, , Total 1, , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

115 Table 26: Activity Limited by Arthritis Symptoms White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female , Age Group * * * * Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, * $35-$49, * $50-$74, * $75, * Employment Status Employed Not Employed Student/Homemaker * Retired/Unable to Work , Total 1, , Unw eighted 2 Weighted 3 Denominator is those diagnosed w ith arthritis *Sample size <50 Mississippi Behavioral Risk Factor Surveillance Survey

116 Table 27: Do Arthritis Symptoms Affect Work 3 White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group * * * * * Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, * $50-$74, * $75, * Employment Status Employed Not Employed Student/Homemaker * Retired/Unable to Work Total , Unw eighted 2 Weighted 3 Denominator is those diagnosed w ith arthritis *Sample size <50 Mississippi Behavioral Risk Factor Surveillance Survey

117 Percent Percent Cardiovascular Disease Survey Question: Has a doctor, nurse, or other health professional ever told you that you had any of the following: A heart attack, also called a myocardial infarction? Angina or coronary heart disease? A stroke? Cardiovascular disease (CVD) includes coronary heart disease, stroke, complications of hypertension, and diseases of the arterial blood vessels. In addition to causing almost half of all deaths in Mississippi, CVD is the major cause of premature, permanent disability among working adults.. In the 2013 BRFSS survey over ten percent of Mississippi adults (more than 235,000 people) report having some kind of CVD, such as coronary heart disease, angina, previous heart attack, or stroke Diagnosed With Heart Attack By Race and Sex Male Female Total White Black In 2012 Mississippi reported Figure 27 7,248 deaths from heart disease and 1,509 from cerebrovascular disease (stroke). The two combined accounted for a nearly thirty percent of all the deaths Diagnosed With Stroke By Race and Sex Male Female Total White Black reported that year and more than forty percent of the total from the ten leading causes of death. Figure 28 Mississippi Behavioral Risk Factor Surveillance Survey

118 Percent The 2013 BRFSS survey revealed that 14.0 percent of the population 65 years of age or older reported that they have been diagnosed as having had a heart attack: 15.1 for white respondents and 11.3 for blacks. The second highest age group that reported being diagnosed with a heart attack was the 55 to 64 category. Whites reported a rate of 7.8 percent while blacks reported a rate of 6.4 for a total rate of 7.4 percent (Table 28) Diagnosed With Heart Disease By Race and Sex Male Female Total White Black Table 29 shows the rate Figure 29 for those age 65 and greater who had been diagnosed with a stroke was 9.5 for whites compared to a rate of 16.5 for blacks. In the 55 to 64 group the rates were 6.5 and 8.4 for whites and blacks respectively. Those in the older age groups also reported a higher rate of coronary heart disease. Those in the age group 65 and older reported a rate of 12.3 percent with white respondents having a rate of 13.3 percent compared to 9.3 for blacks. The 55 to 64 age category had an overall rate of 9.0 percent: 8.8 for whites and 9.0 for blacks (Table 30). Mississippi Behavioral Risk Factor Surveillance Survey

119 Table 28: Ever Diagnosed With Heart Attack White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

120 Table 29: Ever Diagnosed With Coronary Heart Disease White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

121 Table 30: Ever Diagnosed With a Stroke White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

122 Percent Disability Survey Question: Are you limited in any way in any activities because of physical, mental, or emotional problems? Traditionally, the health status of persons with disabilities has been associated with medical care, rehabilitation services and long-term care financing according to Healthy People A number of health care professionals believe that these are misconceptions resulting in a lack of emphasis on health promotion that target people with disabilities and have led to an increase in secondary conditions such as social, emotional, family and community problems. Activities Limited Due to Health Problems By Race and Age Group White Black 0 Figure 30 According to the Centers for Disease control and Prevention (CDC), people who have activity limitations report having had more days of pain, depression, anxiety, and sleeplessness and fewer days of vitality during the previous month than people not reporting activity limitations. In view of the increased rates of disability, it is important to target activities and services that address all aspects of health and well-being, as well as providing access to medical care. For an older person with a disability, it is important to target conditions that may threaten their well-being. There are few data systems that identify those with disabilities as a sub-population. Despite the paucity of data, some disparities between people with and without disabilities have been noted. These disparities include excess weight, reduced physical activity, increased stress, and less frequent mammograms for women over age 55 years with disabilities. Mississippi Behavioral Risk Factor Surveillance Survey

123 Percent In the 2013 BRFSS survey, 24.9 percent of Mississippians reported that their activities were limited because of health. White respondents reported a rate of 25.9 percent while blacks reported a rate of 23.5 percent. Figure 30 reflects the fact that these limitations increase with age for both races. People over the age of 65 report a rate of 34.9 percent (35.7 for whites and 33.0 for blacks) but the age group had a rate of only 8.6 percent (11.3 for whites and 6.3 for blacks). Health Problems Requiring Special Equipment By Race and Income Level White Black Figure 31 Only 10.4 percent of the population has health problems that require special equipment such as a wheelchair, special bed, cane or special telephone. Figure 31 shows that those with lower incomes tend to require special equipment for health problems. Mississippi Behavioral Risk Factor Surveillance Survey

124 Table 31: Activities Limited Due to Health Problems White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female , Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work , Total 1, , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

125 Table32: Health Problems Requiring Special Equipment White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

126 Percent Alcohol Consumption Survey Question: Considering all types of alcoholic beverages, how many times during the past 30 days did you have 5 or more drinks on an occasion? Excessive drinking has consequences for virtually every part of the human body. The wide range of alcohol-induced disorders is due, among other factors, to differences in the amount, duration, and patterns of alcohol consumption, as well as differences in genetic vulnerability to particular alcohol-related consequences. Binge Drinking By Race and Age Group White Black Figure 32 Alcohol use has been linked with a substantial proportion of injuries and deaths from motor vehicle crashes, falls, fires and drowning. It also is a factor in homicide, suicide, marital violence and child abuse and has been associated with high risk sexual behavior. Persons who drink even relatively small amounts of alcoholic beverages may contribute to alcohol-related death and injury in occupational incidents especially if they drink before operating a vehicle. In 2011 alcohol use was associated 25.9 percent of all motor vehicle crash fatalities, according to the Mississippi Office of Highway Safety. Although, historically the BRFSS survey has shown that the group with the highest rate of binge drinking has been white males in the age category 18-24, in 2013 the highest reported age group was white males in the 25 to 34 group who had a binge drinking rate of 23.2 percent. This rate exceeded that of white males in the 18 to 24 group who reported a rate of 20.3 percent (Table 33). Mississippi Behavioral Risk Factor Surveillance Survey

127 Males were almost twice as likely to indulge in binge drinking as females. Only 8.7 percent of female respondents said they had five or more drinks on one occasion during the last thirty days compared to 16.6 percent for males. Mississippi Behavioral Risk Factor Surveillance Survey

128 Table 33: At Risk From Binge Drinking White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

129 Table 34: At Risk From Chronic Drinking White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

130 Percent HIV/AIDS Survey Question: Have you ever been tested for HIV? CDC estimates that nearly 1.15 million people in the United States are living with HIV infection. One in five of those people are unaware of their infection. Despite increases in the total number of people in the U.S. living with HIV infection in recent years (due to better testing and treatment options), the annual number of new HIV infections has remained relatively stable. However, new infections continue at far too high of a level, with approximately 50,000 Americans becoming infected with HIV each year. In 2011, an estimated 49,273 people were diagnosed with HIV infection in the United States. In that same year, an estimated 32,052 people throughout the U.S. were diagnosed with AIDS. An estimated 15,529 people with AIDS died in 2010, and nearly 636,100 people with AIDS in the U.S. have died since the epidemic began Ever Tested for AIDS (Age 18-64) By Race and Sex Male Female Total White In 2013, Mississippi reported 370 new cases of HIV Disease and 177 new cases of Figure 33 AIDS. As of December 31, 2013 there 5,330 people in Mississippians living with the HIV infection and 5,146 living with AIDS for a total of total 10,473 with HIV, Questions about HIV and AIDS were only asked of persons between the ages of 18 and 64. One of the questions was whether the respondent had ever been tested for the AIDS virus. In 2013, 41.4 percent of the respondents reported that they had ever been tested. Black respondents were more likely to have ever been tested than whites: 55.8 percent to 33.1 percent. The rate for white respondents who have ever been tested was 35.0 percent for males and 31.3 percent for females. For blacks, the rates were 53.5 percent for males and 57.6 for females. (Figure 33 and Table 35). Black Mississippi Behavioral Risk Factor Surveillance Survey

131 Table 35: Ever Tested for AIDS: Age White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female , Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed , Not Employed Student/Homemaker Retired/Unable to Work Total 1, , , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

132 Percent Seat Belt Usage Survey Question: How often do you use seat belts when you drive or ride in a car? Would you say always, nearly always, sometimes, seldom or never? The Centers for Disease Control and Prevention reports that motor vehicle-related injuries cause more fatalities among children and young adults than any other single cause in the United States. According to the National Highway Traffic Safety Administration (NHTSA) in the United States during 2012, safety belts saved the lives of an estimated 12,174 people over five years of age. If all passenger vehicle occupants over age 4 had worn seat belts, an additional 3,031 lives could have been saved. The NHTSA further reports that seat belts reduce the risk of fatal injury to frontseat passenger car occupants by 45 percent and the risk of moderate-to-critical injury by 50 percent. For light-truck occupants, seat belts reduce the risk of fatal injury by 60 percent and moderate-tocritical injury by 65 percent. Ejection from the vehicle is one of the most injurious events that can happen to a person in a crash. In fatal crashes in 2012, 79 percent of passenger vehicle occupants who were totally ejected from the vehicle were killed. Seat belts Figure 34 Always or Almost Always Wear Seat Belts By Race and Sex Male Female Total are effective in preventing total ejections: only one percent of the occupants reported to have been using restraints were totally ejected, compared with 30 percent of the unrestrained occupants. White Black Among children under age five, an estimated 284 lives were saved in 2012 by child restraint use. Of these, 284 were associated with the use of child safety seats and 18 with the use of adult seat belts. Had child safety seats been used for all children under age five, an estimated 59 more lives could have been saved. Mississippi Behavioral Risk Factor Surveillance Survey

133 Percent The Agency also reports that 21,667 occupants of passenger cars and light trucks died in motor vehicle crashes during Among these victims were 900 children age 15 years and under plus 2,586 people ages 16 to 20 years. Approximately 55 percent of the people killed in motor vehicle crashes in 2012 were not wearing safety belts. NHTSA reports that child safety seats reduce the risk of death in passenger cars by 71 percent for infants and by 54 percent for toddlers ages one to four in passenger cars. For infants and toddlers in light trucks, the corresponding reductions are 58 percent and 59 percent, respectively. Always or Nearly Always Wear Seat Belts By Race and Age Group White Black Figure 35 During 2011 there were 6,670 serious traffic injuries in Mississippi and 22 percent of these, were not using safety belts. Fatalities among passengers ages 16 to 20 were unbelted at an astounding rate of 77 percent. There were 442 drivers who sustained life-threatening injuries. Also, there were 4,064 drivers with moderate injuries and almost 20 percent of those were unbelted. Moreover, 13,562 drivers sustained minor injuries; 94 percent of those were belted. The Mississippi Department of Highway Safety concludes that seat belts save lives and reduce injury. The 2013 BRFSS survey in Mississippi revealed that 92.0 of the respondents say that they always or nearly always wear a seat belt when they either drive of ride in a car. Females report that they use seat belts more often than men. Women had a usage rate of 94.9 percent compared to 88.8 percent for men (Figure 34). Younger respondents reported a higher rate of non-usage than older respondents. In the 18 to 24 age group, 84.0 percent said that they always or nearly always use seat belts while those age 65 and older reported a rate of 96.0 percent (Figure 35). Mississippi Behavioral Risk Factor Surveillance Survey

134 Table 36: Always or Nearly Always Wear Seat Belts White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male 1, , Female 2, , , Age Group , , , , Education < High School Graduate , High School Graduate or GED 1, , Some College or Technical School 1, , College Graduate 1, , Income < $15, , $15-$24, , $25-$34, $35-$49, $50-$74, $75, , Employment Status Employed 1, , Not Employed Student/Homemaker Retired/Unable to Work 1, , Total 4, , , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

135 Percent Depression Survey Question: Has a doctor, nurse, or other health professional ever told you that you a depressive disorder? The CDC states that depression is characterized by depressed or sad mood, diminished interest in activities which used to be pleasurable, weight gain or loss, psychomotor agitation or retardation, fatigue, inappropriate guilt, difficulties concentrating, as well as recurrent thoughts of death. Diagnostic criteria established by the American Psychiatric Association dictate that five or more of the above symptoms must be present for a continuous period of at least two weeks. As an illness, depression falls within the spectrum of affective disorders Figure 36 Ever Diagnosed With Depression By Race and Sex Male Female Total White Black Depression poses a substantial burden globally and also to the individual suffering from the disorder. Research has found that interpersonal relationships are particularly likely to suffer when someone is depressed, and data suggest that few families or networks of friends are likely to remain unaffected by depression. The urgency of the rate of depression to public health is likely compounded by the recognition that, if not effectively treated, depression is likely to lapse into a chronic disease. Experiencing just one episode of depression places the individual at a 50 percent risk for experiencing another, with subsequent episodes raising the likelihood of experiencing more episodes in the future. Major depression frequently goes unrecognized and untreated and may foster tragic consequences, such as suicide and impaired interpersonal relationships at work and at home. The use of medications and/or specific psychotherapeutic techniques has proven very effective in the treatment of major depression, but the condition is still misconstrued as a sign of weakness, rather than recognized as an illness. With respect to depressive disorders, 19.3 percent of those surveyed said they had been diagnosed with this condition. Women reported a much higher rate than men. Females reported a rate of 24.5 percent compared to only 13.3 percent for males (Figure 36). Similarly, the Mississippi Behavioral Risk Factor Surveillance Survey

136 Percent respondents in lower income categories reported higher rates of diagnosed depression than those in the upper income groups. The group with the highest rate of depression was white respondents whose income was less than $15 thousand annually with a rate of 41.4 percent (Figure 37 and Table 37). Ever Diagnosed With Depression By Race and Education Level White Black Figure 37 Mississippi Behavioral Risk Factor Surveillance Survey

137 Table 37: Ever Dianosed With Depression White Black Total Groups Number 1 Percent 2 Number 1 Percent 2 Number 1 Percent 2 Sex Male Female , Age Group Education < High School Graduate High School Graduate or GED Some College or Technical School College Graduate Income < $15, $15-$24, $25-$34, $35-$49, $50-$74, $75, Employment Status Employed Not Employed Student/Homemaker Retired/Unable to Work Total , Unw eighted 2 Weighted Mississippi Behavioral Risk Factor Surveillance Survey

138 Percent Chronic Obstructive Pulmonary Disease (COPD) Survey Question: Has a doctor, nurse, or other health professional ever told you that you had COPD, emphysema or chronic bronchitis? Chronic Obstructive Pulmonary Disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema, chronic bronchitis, and in some cases asthma Ever Diagnosed With COPD By Race and Sex White COPD is the fourth leading 6.0 Black cause of death in the United 4.0 States. The disease kills more than 120,000 Americans each 2.0 year, which is one death every 0.0 four minutes, and causes Male Female Total serious, long-term disability. The number of people with COPD is increasing. The CDC Figure 38 reports that more than 12 million people are diagnosed with COPD and that an additional 12 million are affected without knowing it. In the 2013 BRFSS survey, Mississippians reported a rate of diagnosed COPD at 8.7 percent which translates into almost 196,000 Mississippians with the disease. For whites the rate was 10.1 percent while blacks reported a rate of 6.4 percent. By gender category, white females reported the highest rate of COPD with a rate of 12.0 percent; next were white males with a rate of 8.1 percent followed by black females at 7.3 percent. Black males were the lowest with a rate of 5.3 percent (Figure 38). The survey revealed that the rate of COPD increased as annual income levels decreased. The category reporting the highest rate of COPD was white respondents who have less than $15,000 in annual income with a rate 25.8 percent followed by whites who earn between $15,000 and $25,000 annually with a rate of 16.9 percent. Additional details can be found in Table 38 and Figure 39. Mississippi Behavioral Risk Factor Surveillance Survey