Contents:

• Tobacco Use
• Physical Inactivity
• Obesity and Overweight
• Heart Disease and Stroke
• Diabetes Prevalence
• Alcohol Risk Behavior
• Adult Immunizations
• HIV/AIDS Testing
• Asthma Prevalence
• Cancer Screening Tests
• Safety Belt Use
• Disabilities and Activity Limitations
• Mental Health
• General Health and Health Care
• Selected Risk Behaviors By County

Tobacco Use

Tobacco use remains the leading preventable cause of premature death and disability in Delaware and the nation.  Smoking prevalence in Delaware has been declining among both adults and youth since 1997, when a comprehensive Tobacco Prevention and Control program was initiated by the Division of Public Health and its partners in the Impact Delaware Tobacco Prevention Coalition.  Activities involve community and school-based educational programs, smoking cessation services, enforcement of laws regarding sales to minors, and environmental and policy changes such as the Clean Indoor Air Act and increased excise taxes on cigarettes.

Smoking prevalence decreased to 20.7% among Delaware adults in 2005, the lowest smoking prevalence in Delaware since the Behavioral Risk Factor Surveillance System began in 1982. Smoking prevalence in 2006 was 21.7%, not a statistically significant difference from the previous year. In a companion survey, the Delaware Adult Tobacco Survey (using the same questions and methodology), 2006 smoking prevalence was 19.8%. Both prevalence rates are within the confidence interval for the previous year. Preliminary data from the BRFSS for the first 8 months of 2007 indicate a prevalence under 20%.

• Current adult smokers:  21.7%  (Confidence Interval 19.7% - 23.7%)
• Adult male smokers:  23.3% (C.I. 20.2% - 26.4%)
• Adult female smokers: 20.3% (C.I. 17.8% - 22.8%)
• Non-Hispanic white smokers:  22.1% (C.I. 19.7% - 24.5%)
• Non-Hispanic African American smokers: 20% (C.I. 14.1% - 25.9%)
• Smoke every day:  16.7% (C.I. 14.7% -18.7%)
• Smoke some days:  5% (C.I. 4.1% - 6.1%)
• Former smokers:  27.3% (C.I. 25.3% - 29.3%)
• Never smoked:  50.9% (C.I. 48.5% - 53.3%)

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Physical Inactivity

In 2006, nearly 22% (C.I. 19.8% - 23.4%) of adult Delawareans reported getting no leisure-time physical activity in an average week [compared to 23.3% in 2005].

Physical activity and nutrition questions are asked in odd-numbered years in the BRFS.  For more information on physical activity, go to our 2005 BRFS summary page.

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Obesity and Overweight

Obesity combines with physical inactivity as the second-leading cause of premature death and disability in Delaware and the United States. The BRFS measures uses self-reported height and weight to calculate Body Mass Index (BMI). A BMI of 25 to 29.9 is considered "overweight," while a BMI of 30 or greater is considered "obese." Because people tend to slightly under-report weight and slightly overestimate height, these prevalence rates are conservative. Studies show that actual rates of obesity in the population may be as much as 3 to 5 percentage points higher than these self-reported estimates.

In 2006, a majority of Delaware adults—63.8%—are either overweight or obese.

Overweight:

• Adults who are overweight:  37.8% (C.I. 35.6% - 40%)
• Males who are overweight:  45.9% (C.I. 42.4% - 49.4%)
• Females who are overweight:  30.1% (C.I. 27.6% - 32.6%)
• Non-Hispanic whites overweight:  38.6% (C.I. 36.1% - 41.1%)
• Non-Hispanic African Americans overweight:  33.4% (C.I. 26.9% - 39.9%)

Overweight increases with age, from a low of 27.5% among 18-24 year olds to a 41.6% among adults age 55-64.

Obesity:

• Adults who are obese:  26% (C.I. 24% - 28%)
• Obese males:  27.2% (C.I. 24.1% - 30.3%)
• Obese females:  24.8% (C.I. 22.1% - 27.5%)
• Obese non-Hispanic whites:  23.6% (C.I. 21.4% - 25.8%)
• Obese non-Hispanic African Americans:  39.9% (C.I. 33% - 46.8%)

Obesity also increases with age, from a low of 20.1% among 18-24 year olds to a high of 32.9% among adults age 55-64. About 22% of adults 65 and older are obese. The lower prevalence of obesity in the over-65 group may be largely attributed to premature death from lifestyle-related chronic diseases such as heart disease, stroke, lung diseases, diabetes, and cancer.

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Heart Disease and Stroke

The 2006 survey asked questions about the prevalence of cardiovascular disease and stroke:

• 4.6% (C.I. 3.8% - 5.4%) of Delaware adults (5.8% of men and 3.6% of women) have been told by a doctor that they had a heart attack or myocardial infarction. These are heart attack survivors. A comprehensive look at heart attacks in Delaware would also need to include fatal attacks.
• 4.1% (C.I. 3.5% - 4.7%) of Delaware adults (4.9% of men and 3.4% of women) have been told they have angina or coronary heart disease.
• 2.7% (C.I. 2.1% - 3.3%) of Delaware adults (2.2% of men and 3.2% of women) have been told they had a stroke.

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Diabetes Prevalence

About 8.1% (C.I. 7.1% - 9.1%) of Delaware adults say they have been told by a doctor that they have diabetes. Obesity is a major risk factor for diabetes, and the trends show both obesity and diabetes increasing in Delaware during the past decade. The prevalence of diabetes among adults in the state increased from 4.3% in 1995 to 8.1% in 2006.

Prevalence of diabetes is slightly higher among men than women, and slightly higher among African Americans than among whites:

• 9% (C.I. 7.2% - 10.8%) of adult men have been told they have diabetes.
• 7.2% (C.I. 6% - 8.4%) of adult women have been told they have diabetes.
• 8.2% (C.I. 7% - 9.4%) if non-Hispanic whites have been told they have diabetes.
• 10.1% (C.I. 6.8% - 13.4%) of non-Hispanic African Americans have been told they have diabetes.
• 4.2% (C.I. 1% - 7.3%) of Hispanics have been told they have diabetes.

The prevalence of diagnosed diabetes increases with age. Less than 1% of 18-24 year olds have been told they have diabetes, compared with 16% of 55-64 year olds and 18.7% of those 65 or older.

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Alcohol Risk Behavior

The majority of Delaware adults drink alcoholic beverages at least occasionally.  In 2006, 59.2% (C.I. 57% - 61.4%) of Delaware adults say they had at least one drink in the past month.  Men (68.2%) are more likely to be drinkers than women (50.9%).

19% (C.I. 17% - 21%) of Delaware adults report episodes of acute heavy drinking, usually called "binge drinking ," during the past month.  This is up from 15.6% in 2005.  Binge drinking is defined as males having 5 or more drinks on one occasion, or females having four or more drinks on one occasion.

Males, and especially young adult males, report the highest levels of binge drinking.

Binge drinking by gender and age:

• Male = 26.1%  (C.I. 22.8% - 29.4%)
• Female = 12.6%  (C.I. 10.6% - 14.6%)
• Young adults (age 18-24) = 30.8%  (C.I. 22.4% - 39.2%)
• Adults age 25-34 = 34.2%  (C.I. 28.1% - 40.3%)

"Binge drinking" by racial/ethnic group:

• White, non-Hispanic = 20.9%  (C.I. 18.7% - 23%)
• Black/African American = 12.6%  (C.I. 7.7% - 17.5% 

7.1% of adult Delawareans are at risk due to heavy drinking.  This is up from 5.4% in 2005.  Chronic heavy drinking is defined as adult men who average more than two drinks a day, or adult women who average more than one drink a day.  Breakdowns for heavy drinking:

• 7.9% (C.I. 5.7% - 10.1%) of adult males are heavy drinkers.
• 6.3% (C.I. 4.7% - 7.9%) of adult females are heavy drinkers.
• 16.5% (C.I. 9.4% - 23.6%)  of young adults, age 18-21, are heavy drinkers.
• 8% (C.I. 6.4% - 9.6%) of non-Hispanic whites are heavy drinkers.
• 2.1% (C.I. 0.1% - 4.1%) of non-Hispanic African Americans are heavy drinkers.
• 8%(C.I. 0% - 17%) of Hispanics are heavy drinkers.

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Adult Immunizations

About 35.3% (C.I. 33.1% - 37.5%) of Delaware adults said they had an influenza  ("flu") shot during the past year.  This is up from 28.2% in 2005.

Women are slightly more likely to have a flu shot than men, with 37.6% of women and 32.8% of men reporting the shot in the past 12 months.

By race:

• 38.3% (C.I. 35.9% - 40.7%) of white, non-Hispanic adults
• 25.7% (C.I. 20.4% - 31%) of non-Hispanic African American adults
• 17.3% (C.I. 8.3% - 26.3%) of Hispanic adults

Influenza shots are recommended for adults with chronic diseases and adults 50 and older (especially those 65 and older), as well as for young children. Appropriately, the prevalence of flu immunization is higher among older adults:

• 70.3% (C.I. 66.8% - 73.8%) of adults age 65 and older had a flu shot in the past year, up from 65.8% in 2005.

Health officials also recommend pneumonia vaccine for older adults and individuals of all ages with chronic diseases. Pneumonia vaccine does not need to given annually; you should check with your physician or health care provider to see if you need it.

• 23.4% (C.I. 21.6% - 25.2%) of all Delaware adults have had a pneumonia shot at some time.
• 65.6% (C.I. 61.9% - 69.3%) of adults age 65 and older have had the pneumonia shot.

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HIV / AIDS Testing

Among Delaware adults under 65 years of age, 43.3% (C.I. 40.6% - 46%) say they have been tested for the Human Immunodeficiency Virus (HIV) that causes AIDS.  This is a slight decrease from 2005, when 47.4% of adults said they had been tested at some time.

• 40.9% (C.I. 36.8% - 45%) of men have been tested at least once
• 45.6% (C.I. 42.3% - 48.9%) of women have been tested
• 38.5% (C.I. 35.6 - 41.4%) of non-Hispanic whites have been tested
• 60.7% (C.I. 53.4% - 68%) of non-Hispanic African Americans have been tested
• 63% (C.I. 56.9% - 69.1%) of the 25-34 age group have been tested — the highest rate of any age group
• 48.4% (C.I. 39 - 57.8%) of the 18-24 age group have been tested

Educational level does not seem to influence whether an individual has had an AIDS test. Low income, however, is related to HIV testing. About 61% (C.I. 51.7% - 70.5%) of adults with incomes under $15,000 a year said they had been tested at least once.

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Asthma Prevalence

The BRFS estimates that 9.6% (C.I. 8.2% - 11%) of Delaware adults—or about 62,400 adults—currently have asthma .

For more information on asthma in Delaware, see the Burden of Asthma in Delaware report, published in 2005.

Selected asthma breakdowns for 2006:

• Total current asthma = 9.6% (C.I. 8.2% - 11%)
• Male = 8.7% (C.I. 6.3% - 11.1%)
• Female = 10.4% (C.I. 8.8% - 12%)
• White, Non-Hispanic = 9.3% (C.I. 7.7% - 10.9%)
• Black/African American = 11% (C.I. 7.1% - 14.9%)
• Hispanic = 9.7% (C.I. 2.1% - 17.3%)

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Cancer Screening

The Behavioral Risk Factor Survey also asks questions about screening tests for several types of cancer:

• 68.4% (C.I. 65.7% - 71.1%) of Delaware adults age 50 or older have had a sigmoidoscopy or colonoscopy to check for colorectal cancer. There was no significant difference between males and females.
• 56.9% (C.I. 53% - 60.8%) of men age 40 and older had a Prostate Specific Antigen (PSA) test within the past two years to check for prostate cancer.
• 89% (C.I. 87% - 91%) of adult women reported having a Pap test for cervical cancer within the past three years.  There were no significant differences among racial or ethnic groups for Pap testing.
• 86.4% (C.I. 84% - 88.8%) of women age 50 and older had a mammogram in the past two years to check for breast cancer.  The prevalence of mammography testing among African American women was slightly higher (94%) than among non-Hispanic white women (85.5%).
• 83.7% (C.I. 81.5% - 85.9%) of women age 40 and older had a mammogram in the past two years.

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Safety Belt Use

Safety belt use prevalence was only 52% when the BRFS first measured it in 1991. After the state's first safety belt law was passed in that year, usage jumped to slightly more than 70% — where it stayed for most of the 1990s.  By 2002, 80.2% of Delaware adults said they always used their safety belts.  A 2003 law made non-use a primary offense; and in 2004, 82.3% of adults in the state reported always using safety belts.

In 2006, 85.5% (C.I. 83.7% - 87.3%) of Delaware adults said they "always" use their safety belts —the highest prevalence rate recorded by the BRFS.

When respondents who say they "almost always" use their safety belts are added the rate goes significantly higher: 93.6% (C.I. 92.2% - 95%) say they "always" or "nearly always" use their safety belts.

• 82.2% (C.I. 79.5% - 84.9%) of men report always using safety belts
• 88.5% (C.I. 86% - 91%) of women always use safety belts
• 74% (C.I. 65% -83%) of 18-24 year old adults always use safety belts—the lowest prevalence of any age group
• 86.6% (C.I. 84.6% - 88.6%) of non-Hispanic whites always use safety belts
• 82.3% (C.I. 76.8% - 87.8%) of non-Hispanic African Americans always use safety belts

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Disabilities and Activity Limitations

20.9% (C.I. 19.1% - 22.7%) of Delaware adults reported some activity limitations as a result of physical, mental, or emotional disabilities.

• 19.6% (C.I. 16.9% - 22.3%) of men report some disability.
• 22.1% (C.I. 19.9% - 24.3%) of women report some disability.
• 23% (C.I. 21% - 25%) of non-Hispanic whites report some disability.
• 13.4% (C.I. 9.3% - 17.5%) of non-Hispanic African Americans report some disability.
• 8% (C.I. 2.9% - 13.1%) of Hispanic adults report some disability.
• Age is a major factor. Only 11.4% (C.I. 5.7% - 17.1%) of 18-24 year-old adults report a disability, compared to 29.7% (C.I. 26% - 33.4%) of those 65 or older.

To help distinguish the type of disability, the BRFS asks about use of special equipment, such as canes, wheelchairs, or special beds. Only 6% of Delaware adults (C.I. 5.2% - 6.8%) say they have to use special equipment as a result of their disability. About 5% (C.I. 3.7% - 6.8%) of men, and 7% (C.I. 5.8% - 8.2%) of women use special equipment. Age is again a major factor. Only 1.8% (C.I. 0.2% - 3.4%) of 18-24 year-old adults report a disability, compared to 14.9% (C.I. 12.2% - 17.6%) of those 65 or older.

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Mental Health

The Delaware BRFS included a module of questions about mental health for the first time in 2006. Specifically, the module asked respondents about depression and anxiety.

One of the questions asked, "Has a doctor or other health care provider ever told you that you had an anxiety disorder (including acute stress disorder, anxiety, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, phobia, post-traumatic stress disorder, or social anxiety disorder)?

• 12.1% (C.I. 10.3% - 13.9%) of Delaware adults answered "yes" to that question.
• 9.5% (C.I. 7.3% - 11.7%) of men
• 14.5% (C.I. 12.1% - 16.9%) of women
• 13.4% (C.I. 11.4% - 15.4%) of non-Hispanic whites
• 5.2% (C.I. 3% - 7.4%) of non-Hispanic African Americans
• 17.3% (C.I. 7.7% - 26.9%) of non-Hispanic mult-racial respondents
• 7.2% (C.I. 0% - 15.8%) of Hispanic respondents

Another question asked, "Has a doctor or other health care provider ever told you that you have a depressive disorder (including depression, major depression, dysthymia, or minor depression)?

• 17% (C.I. 15.2% - 18.8%) of Delaware adults answered "yes" to that question.
• 13.7% (C.I. 11.2%-16.2%) of men
• 20% (C.I. 17.5% - 22.5%) of women
• 18.7% (C.I. 16.5% - 20.9%) of non-Hispanic whites
• 10.1% (C.I. 6.2% - 14%) of non-Hispanic African Americans
• 24.7% (C.I. 15.1% - 34.3%) of non-Hispanic multi-racial respondents
• 6.6% (C.I. 0% - 14.4%) of Hispanic respondents

The set of mental health questions also included eight questions designed to determine prevalence of depression. Preliminary, unweighted analysis of those data suggest that about 5% of adults with depression have severe depression, and another 11% have moderately severe depression. The data are being analyzed by staff from the Division of Public Health and the Divison of Substance Abuse and Mental Health, and a separate report about depression will be issued early in 2008.

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General Health and Health Care

The BRFS asks about how respondents feel about their own health. Other studies have validated this is a good measure of quality of health in the population. Only 12.1% (C.I. 10.7% - 13.5%) say they are in "fair" or "poor" health. There are no statistically significant differences between men and women or among racial-ethnic populations.

About 5.8% (C.I. 4.8% - 7%) of Delaware adults say poor physical or mental health kept them from doing their usual activities in the past month.

81.6% (C.I. 79.6% - 83.6%) say they have a personal doctor or health care provider; and another 6.8% (C.I. 5.8% - 7.8%) say they have more than one personal doctor or health care provider.

In 2006, 9.6% (C.I. 8% - 11.2%) of Delaware adults did not have health insurance of any type.

• More men were uninsured than women. 13.9% (C.I. 11% - 16.8%) of adult men reported no health insurance, compared to 5.7% (C.I. 4.5% - 6.9%) of women.
• There is also a racial disparity, with 8.5% (C.I. 6.9% - 10.1%) of non-Hispanic whites reporting no health insurance, and 13% (C.I. 8.5% - 17.5%) of African Americans.
• Young adults are far more likely to be without health insurance. 21.3% (C.I. 13.9% - 28.7% of adults age 18-24, and 13.1% (C.I. 12% - 20.2%) of adults in the 25-35 age group have no health insurance.  As a result of Medicare, only 1.6% (C.I. 0.8% - 2.4%) of the 65 and older population report no health insurance.

Some adults may have health insurance, but still be unable to pay for needed health care.  About 8% (C.I. 6.8% - 9.2%) report that, at some time in the past year, they needed to see a doctor but couldn't because of cost.

• 6.7% (C.I. 5.5% - 7.9%) of whites said they were unable to see a doctor because of cost in the past year.
• 14.9% (C.I. 9.6% - 20.1%) of African Americans were unable to see a doctor because of cost in the past year.
• 8.1% (C.I. 2% - 14.2%) of Hispanics were unable to see a doctor because of cost in the past year.

75.5% (C.I. 73.5% - 77.5%) of Delaware adults visited a dentist in the past year. Slightly more, 76.4% (C.I. 74.4% - 78.4%) said they had their teeth cleaned in the past year by a dentist or a dental hygienist.

57.8% (C.I. 55.4% - 60.2%) of Delaware adults report taking vitamin supplements. Using vitamin supplements is more common among women (61%) than men (54.2%), and more common among whites (61.2%) than blacks (44.8%).

The U.S. Centers for Disease Control and Prevention (CDC) recommends that women of childbearing age should take folic acid supplements to prevent birth defects. About 34% of Delaware women said they know about this recommendation. About 86% of women who take vitamin supplements said their supplement includes folic acid.

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Selected Data Items by County

Risk Factors	New Castle	Kent	Sussex
Sedentary Lifestyle - No Leisure Time Exercise	19.5% (16.9-21.9)	25.3% (22.4-28.1)	24% (21.3-26.7)
Adult Obesity (BMI 30 or higher)	24.4% (21.4-27.4)	29% (25.9-32.1)	28.6% (25.7-31.6)
Overweight (BMI 25-29.9)	38.4% (35.1-41.7)	34.5% (31.3-37.7)	38.4% (35-41.8)
"Fair or Poor" Health	10.7% (8.9-12.6)	12.7% (10.5-14.9)	14.8% (12.7-17)
Adults With Diabetes	7.2% (5.8-8.7)	9.7% (8-11.4)	9.3% (7.6-11.1)
Currently Have Asthma	9.6% (7.5-11.7)	10.3% (8.1-12.5)	9.1% (7.3-11)
Currently Smoke Cigarettes	20.1% (17.1-23.1)	24% (20.9-27.1)	24.9% (21.7-28.1)
Chronic Heavy Drinkers	7.1% (5.3-8.9)	4.9% (3.3-6.4)	8.7% (6.2-11.2)
No Health Insurance	8.7% (6.4-11)	9.2% (6.9-11.5)	12.4% (9.8-15)
Had Flu Shot Past Year (age 65 and older only)	72.6% (67.1-78.1)	68.2% (62.6-73.9)	65.9%(61-70.9)
Mammogram Past 2 Years (women 40 and older only)	84.3% (81-87.7)	81.8% (78.5-85.1)	84.5%(81.3-87.7)
Had Sigmoidoscopy/Colonoscopy (age 50 and older only)	67.6% (63.5-71.8)	68.2% (64.3-72.2)	70.7%(67.2-74.2)
Pap Test in Past 3 Years (women only)	89.3% (86.6-92.1)	89.5% (86.7-92.4)	88.6% (85.7-91.6)

Source: Delaware Health and Social Services, Division of Public Health, Behavioral Risk Factor Surveillance System (BRFSS), 2006.

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Notes:  Sample = 4,000 Delaware adults age 18 and older. Confidence interval (C.I.) is the range within which the true prevalence will occur with 95% confidence.  When the sample size is small, for example for the Delaware Hispanic population, the confidence interval is larger.  Cells with less than 100 respondents are suppressed.  The Behavioral Risk Factor Survey is a random sample telephone interview survey, conducted continuously throughout the year. Additional information is available on this website or the BRFSS website of the Centers for Disease Control and Prevention.

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