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