the big 4: obesity, tobacco use, physical inactivity, and ...galen conti, mph . overview ......

The Big 4: Obesity, Tobacco Use, Physical Inactivity, and Substance Abuse

Tennessee Behavioral Risk Factor Surveillance System 2011-2017

Division of Population Health Assessment Office of Population Health Surveillance

Galen Conti, MPH

Overview

• Section I – Introduction to BRFSS and the Big 4

• Section II – Tennessee Demographics

• Section III – Obesity

• Section IV – Smoking

• Section V – Physical Inactivity

• Section VI – Substance Abuse (Binge Drinking)

• Section VII – Data Request and Contact Information

2

Behavioral Risk Factor Surveillance System

BRFSS: The Behavioral Risk Factor Surveillance System

A Centers for Diseases Control and Prevention (CDC) supported surveillance system designed to assess behavioral risk factors and their association with chronic disease.

• Person:

Randomly sampled non-institutionalized adult individuals, aged 18+ years, residing in the state of Tennessee.

• Place:

Random-digit dialed phone numbers throughout the state of Tennessee.

• Time:

From 2011 to 2017 – a seven year time frame.

3

Section I: Introduction to BRFSS and the Big 4

Introduction to the Big 4

• The Tennessee Department of Health’s (TDH) mission is to “Protect, Promote, and Improve the health and prosperity of people in Tennessee”.

• Focus on the “Big 4”: obesity, tobacco use, physical inactivity, and substance abuse.

• These four risk factors are strongly associated with the leading causes of death in Tennessee and nationwide.

• The CDC includes obesity, tobacco use, and physical inactivity in their “Winnable Battles” list, which includes indicators whereby progress may be made in a short time frame.

4

Section I: Introduction to BRFSS and the Big 4

Introduction to the Big 4

• Obesity – Assessed using individual Body Mass Index (BMI) which was calculated using imputed BRFSS variables from self-reported height and weight. ‘Obese’ is a BMI of 30 or more .

• Smoking – Current smoker status is an imputed variable that includes respondents who answered that they have smoked at least 100 cigarettes in their lifetime and currently smoke some days or every day.

• Physical Inactivity - An imputed variable created from questions which ask the respondent if they have completed any physical activity or exercise within the past 30 days.

• Substance abuse (Binge Drinking) – An imputed variable that includes male respondents who answered that they have had five or more drinks on one occasion during the past month, and female respondents who answered that they have had four or more drinks on one occasion over the past month.

5

Section I: Introduction to BRFSS and the Big 4

Tennessee BRFSS Sample Sizes

6

Section I: Introduction to BRFSS and the Big 4

5914

7056

5815

5142

5979 6167

5843

0

1000

2000

3000

4000

5000

6000

7000

8000

2011 2012 2013 2014 2015 2016 2017

Number of Respondents:

TN BRFSS, 2011 to 2017

Education in Tennessee BRFSS

7

Section II: Tennessee Demographics

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Education: TN BRFSS, 2011 to 2017

Did not graduate Graduated High School

Attended college or technical school Graduated from college or technical school

Household Income in Tennessee BRFSS

8

Section II: Tennessee Demographics

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Income: TN BRFSS, 2011 to 2017

Less than $15,000 $15,000 to less than $25,000 $25,000 to less than $35,000

$35,000 to less than $50,000 $50,000 or more

Employment in Tennessee BRFSS

9

Section II: Tennessee Demographics

*Respondents who answered that they were a student, homemaker, out of work for under a year, or out of work for over a year were classified as “Not working.” “Employed” captured respondents who were employed for wages and self employed.

0%

20%

40%

60%

80%

100%

2011 2012 2013 2014 2015 2016 2017

Employment: TN BRFSS, 2011 to 2017

Employed Not working Retired Unable to Work

Health Status in Tennessee BRFSS

10

Section II: Tennessee Demographics

0%

25%

50%

75%

100%

2011 2012 2013 2014 2015 2016 2017

Reported Health Status:

TN BRFSS, 2011 to 2017

Good/Very good/Excellent Health Fair/Poor Health

Tennessee Demographics Summary

• About 3 out of 4 adult Tennesseans reporting being White, non-Hispanic.

• The highest proportion of Tennesseans reported having a high school diploma as their highest level of education.

• At least 1 out of 3 Tennessean households reported making $50,000/year or more.

• About half of Tennesseans reported being employed or self-employed.

• About 3 out of 4 Tennesseans reported having good, very good, or excellent health.

11

Tennessee BRFSS: Obesity

12

Section III: Obesity

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Obesity: TN BRFSS, 2011 to 2017

Tennessee BRFSS: Obesity

13

Section II: Obesity Section III: Obesity

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Obesity by Sex: TN BRFSS, 2011 to 2017

Male Female

Tennessee BRFSS: Obesity

14

0%

10%

20%

30%

40%

50%

2010 2011 2012 2013 2014 2015 2016 2017

Obesity by Race: TN BRFSS, 2011 to 2017

White, Non-Hispanic Black, Non-Hispanic Hispanic Multiracial Other

Section III: Obesity

Tennessee BRFSS: Obesity

15

Section III: Obesity

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Obesity by Age Group:

TN BRFSS, 2011 to 2017

Ages 18-24 Ages 25-34 Ages 35-44 Ages 45-54 Ages 55-64 Ages 65 and up

Tennessee BRFSS: Obesity

16

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Obesity by Reported Health Status:

TN BRFSS, 2011 to 2017

Good/Very good/Excellent Health Fair/Poor Health

Section III: Obesity

Tennessee BRFSS: Obesity

17

Section II: Obesity Section III: Obesity

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Obesity by Education:

TN BRFSS, 2011 to 2017

Did not graduate Graduated High School

Attended college or technical school Graduated from college or technical school

Tennessee BRFSS: Obesity

18

Section II: Obesity Section III: Obesity

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Obesity by Income:

TN BRFSS, 2011 to 2017

Less than $15,000 $15,000 to less than $25,000 $25,000 to less than $35,000

$35,000 to less than $50,000 $50,000 or more

Tennessee BRFSS: Obesity

19

Section II: Obesity Section III: Obesity

0%

25%

50%

75%

100%

2011 2012 2013 2014 2015 2016 2017

Obesity by Employment: TN BRFSS, 2011 to 2017

Employed Not working Retired Unable to Work

Tennessee BRFSS: Obesity

20

0%

10%

20%

30%

40%

50%

2016 2017

Obesity in Grand Divisions:

TN BRFSS, 2016 to 2017

West Middle East

Section III: Obesity

Tennessee BRFSS: Obesity Summary

• 1 out of 3 adult Tennesseans are obese.

• Middle aged adults (aged 35-64 years) had higher proportions of obesity.

• Respondents who reported having fair or poor health had much higher proportions of obesity than those with good health.

• Respondents with lower education generally had higher proportions of obesity.

• Respondents earning higher salaries had slightly lower proportions of obesity.

• Almost half of respondents who reported being unable to work were obese.

• Obesity was highest among Tennessee adults living in the West grand division, compared to Middle or East.

21

Section II: Obesity Section III: Obesity

Tennessee BRFSS: Smoking

22

Section IV: Smoking

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Smoking: TN BRFSS, 2011 to 2017

Tennessee BRFSS: Smoking

23

Section IV: Smoking

0%

25%

50%

75%

100%

2011 2012 2013 2014 2015 2016 2017

Smoking by Individuals who have tried to quit:

TN BRFSS, 2011 to 2017

Tried to quit Current Smoker

Tennessee BRFSS: Smoking

24

Section IV: Smoking

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Smoking by Sex: TN BRFSS, 2011 to 2017

Male Female

Tennessee BRFSS: Smoking

25

Section IV: Smoking

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Smoking by Race: TN BRFSS, 2011 to 2017

White, Non-Hispanic Black, Non-Hispanic Hispanic Multiracial Non-hispanic Other

Tennessee BRFSS: Smoking

26

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Smoking by Age Group:

TN BRFSS, 2011 to 2017

Ages 18-24 Ages 25-34 Ages 35-44 Ages 45-54 Ages 55-64 Ages 65 and up

Section IV: Smoking

Tennessee BRFSS: Smoking

27

Section IV: Smoking

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Smoking by Reported Health Status:

TN BRFSS, 2011 to 2017

Good/Excellent Health Status Fair/Poor Health Status

Tennessee BRFSS: Smoking

28

Section IV: Smoking

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Smoking by Education:

TN BRFSS, 2011 to 2017

Did not graduate Graduated High School

Attended college or technical school Graduated from college or technical school

Tennessee BRFSS: Smoking

29

Section IV: Smoking

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Smoking by Income:

TN BRFSS, 2011 to 2017

Less than $15,000 $15,000 to less than $25,000 $25,000 to less than $35,000

$35,000 to less than $50,000 $50,000 or more

Tennessee BRFSS: Smoking

30

Section IV: Smoking

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Smoking by Employment:

TN BRFSS, 2011 to 2017

Employed Not working Retired Unable to Work

Tennessee BRFSS: Smoking

31

Section IV: Smoking

0%

10%

20%

30%

40%

50%

2016 2017

Smoking in Grand Divisions:

TN BRFSS, 2016 to 2017

West Middle East

Tennessee BRFSS: Smoking Summary

• Almost 1 out of 4 adult Tennesseans reported being a current smoker.

• Men tend to have higher proportions of smokers than women.

• Tennesseans aged 65 years and older had the lowest proportions of smokers.

• Tennesseans who reported having fair or poor health had higher proportions of smokers than those with good health.

• Tennesseans with higher income and more education had lower proportions of smokers.

• Tennesseans unable to work had higher proportions of smokers than those who are employed or unemployed.

• Smoking was highest among Tennessee adults living in the East grand division, compared to Middle or West.

32

Section IV: Smoking

Tennessee BRFSS: Physical Inactivity

33

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Physical Inactivity:

TN BRFSS, 2011 to 2017

Section V: Physical Inactivity

Tennessee BRFSS: Physical Inactivity

34

Section V: Physical Inactivity

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Physical Inactivity by Sex:

TN BRFSS, 2011 to 2017

Male Female

Tennessee BRFSS: Physical Inactivity

35

Section V: Physical Inactivity

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Physical Inactivity by Race:

TN BRFSS, 2011 to 2017

White, Non-Hispanic Black, Non-Hispanic Hispanic Multiracial Other

Tennessee BRFSS: Physical Inactivity

36

Section V: Physical Inactivity

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Physical Inactivity by Age Group:

TN BRFSS, 2011 to 2017

Ages 18-24 Ages 25-34 Ages 35-44 Ages 45-54 Ages 55-64 Ages 65 and up

Tennessee BRFSS: Physical Inactivity

37

Section V: Physical Inactivity

0%

25%

50%

75%

100%

2011 2012 2013 2014 2015 2016 2017

Physical Inactivity by Reported Health Status:

TN BRFSS, 2011 to 2017

Good/Very good/Excellent Health Fair/Poor Health

Tennessee BRFSS: Physical Inactivity

38

Section V: Physical Inactivity

0%

25%

50%

75%

100%

2011 2012 2013 2014 2015 2016 2017

Physical Inactivity by Education:

TN BRFSS, 2011 to 2017

Did not graduate Graduated High School

Attended college or technical school Graduated from college or technical school

Tennessee BRFSS: Physical Inactivity

39

Section V: Physical Inactivity

0%

25%

50%

75%

100%

2011 2012 2013 2014 2015 2016 2017

Physical Inactivity by Income:

TN BRFSS, 2011 to 2017

Less than $15,000 $15,000 to less than $25,000 $25,000 to less than $35,000

$35,000 to less than $50,000 $50,000 or more

Tennessee BRFSS: Physical Inactivity

40

Section V: Physical Inactivity

0%

25%

50%

75%

100%

2011 2012 2013 2014 2015 2016 2017

Physical Inactivity by Employment:

TN BRFSS, 2011 to 2017

Employed Not working Retired Unable to Work

Tennessee BRFSS: Physical Inactivity

41

Section V: Physical Inactivity

0%

10%

20%

30%

40%

50%

2016 2017

Physical Inactivity in Grand Divisions:

TN BRFSS, 2016 to 2017

West Middle East

Tennessee BRFSS: Physical Inactivity Summary

• Around1 in 3 adult Tennesseans reported not participating in physical activity.

• A higher proportion of women reported physical inactivity than men.

• Physical inactivity was more prevalent in older populations than younger populations.

• Tennesseans with fair or poor health had higher proportions of reported physical inactivity than those with good health.

• Tennesseans with higher income and more education had lower proportions of reported physical inactivity.

• Tennesseans unable to work had higher proportions of reported physical inactivity than those who are employed or unemployed.

• Physical inactivity was highest among adult Tennesseans living in the West grand division, compared to Middle or East.

42

Section V: Physical Inactivity

Tennessee BRFSS: Binge Drinking

43

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Binge Drinking: TN BRFSS, 2011 to 2017

Section VI: Substance Abuse (Binge Drinking)

Tennessee BRFSS: Binge Drinking

44

Section VI: Substance Abuse (Binge Drinking)

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Binge Drinking by Sex:

TN BRFSS, 2011 to 2017

Male Female

Tennessee BRFSS: Binge Drinking

45

Section VI: Substance Abuse (Binge Drinking)

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Binge Drinking by Race:

TN BRFSS, 2011 to 2017

White, Non-Hispanic Black, Non-Hispanic Hispanic Multiracial Other

Tennessee BRFSS: Binge Drinking

46

Section VI: Substance Abuse (Binge Drinking)

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Binge Drinking by Age Group:

TN BRFSS, 2011 to 2017

Ages 18-24 Ages 25-34 Ages 35-44 Ages 45-54 Ages 55-64 Ages 65 and up

Tennessee BRFSS: Binge Drinking

47

Section VI: Substance Abuse (Binge Drinking)

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Binge Drinking by Reported Health Status: TN BRFSS,

2011 to 2017

Good/Very good/Excellent Health Fair/Poor Health

Tennessee BRFSS: Binge Drinking

48

Section VI: Substance Abuse (Binge Drinking)

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Binge Drinking by Education:

TN BRFSS, 2011 to 2017

Did not graduate Graduated High School

Attended college or technical school Graduated from college or technical school

Tennessee BRFSS: Binge Drinking

49

Section VI: Substance Abuse (Binge Drinking)

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Binge Drinking by Income:

TN BRFSS, 2011 to 2017

Less than $15,000 $15,000 to less than $25,000 $25,000 to less than $35,000

$35,000 to less than $50,000 $50,000 or more

Tennessee BRFSS: Binge Drinking

50

Section VI: Substance Abuse (Binge Drinking)

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015 2016 2017

Binge Drinking by Employment:

TN BRFSS, 2011 to 2017

Employed Not working Retired Unable to Work

Tennessee BRFSS: Binge Drinking

51

Section VI: Substance Abuse (Binge Drinking)

0%

10%

20%

30%

40%

50%

2016 2017

Binge Drinking in Grand Divisions:

TN BRFSS, 2016 to 2017

West Middle East

Tennessee BRFSS: Binge Drinking Summary

• About 1 out of 10 adult Tennesseans reported binge drinking.

• About twice as many men as women reported binge drinking.

• Older Tennesseans were much less likely to report binge drinking.

• Tennesseans with good, very good, or excellent health were more likely to report binge drinking than those with fair or poor health.

• Tennesseans with more education and higher incomes had slightly higher proportions of reported binge drinking.

• Tennesseans who were employed had the highest proportion of binge drinking.

• Binge drinking was highest among adult Tennesseans living in the Middle grand division, compared to West or East.

• Binge drinking associations were very different than the other 3 health behaviors because it is a very different behavior.

52

Section VI: Substance Abuse (Binge Drinking)

Tennessee BRFSS

53

0

2

4

6

8

10

12

2011 2012 2013 2014 2015 2016 2017

Average days not feeling well per month:

TN BRFSS, 2011 to 2017

Obese Smoke Physically Inactive Binge Drink Overall

Tennessee BRFSS

54

*Chronic Diseases includes Arthritis, Asthma, Myocardial Infarction, Stroke, Diabetes, Angina, Coronary Obstructive Pulmonary Disease

0%

25%

50%

75%

100%

2011 2012 2013 2014 2015 2016 2017

Reporting at least one Chronic Disease:

TN BRFSS, 2011-2017

Among Obese Among Smokers Among Physically Inactive

Among Binge Drinkers Overall

Data Requests

You may request raw data or an analysis of prevalence estimates from the Tennessee Department of Health via the Health Statistic’s website’s portal:

https://www.surveygizmo.com/s3/1879037/DATA-REQUEST-FORM

55

Section VII: Data Request and Contact Info.

Acknowledgments

• Tennessee BRFSS project staff would like to express their gratitude to all of

the respondents who took time to participate in the survey. Their information

will provide public health professionals and researchers a better

understanding of the health and prosperity of adult Tennesseans.

• Project staff would like to acknowledge the BRFSS data users across the

state, our project partners, as well as our contractor for phone operations.

Special thanks to all members of the Office of Population Health Surveillance

for their contribution to this report.

• This publication was made possible by grant number 6 NU58DP006049-02-

01 from the Centers for Disease Control and Prevention. The contents are

solely the responsibility of the authors and do not necessarily represent the

official views of the Centers for Disease Control and Prevention.

56

Contact

Galen Conti, MPH | Epidemiologist and BRFSS Coordinator

Office of Population Health Surveillance

Division of Population Health Assessment

Andrew Johnson Tower, 2nd Floor

710 James Robertson Parkway, Nashville, TN 37243

p. 615-532-7890

tnbrfss.health@tn.gov

57