Contents:

• Tobacco Use
• Physical Activity
• Obesity and Overweight
• Diabetes Prevalence
• Alcohol Risk Behavior
• Adult Immunizations
• HIV/AIDS Testing
• Asthma Prevalence
• Cancer Screening Tests
• General Health and Health Care
• Selected Risk Behaviors By County

Tobacco Use

Source: DHSS, Division of Public Health, BRFSS, 1997-2007.

Smoking prevalence in Delaware reached an all-time low in Delaware in 2007.  Prevalence 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. Tobacco use remains the leading preventable cause of premature death and disability in Delaware and the nation.

Smoking prevalence decreased to 18.9% among Delaware adults in 2007, the lowest smoking prevalence in Delaware since the Behavioral Risk Factor Surveillance System began in 1982.

•  Current adult smokers:  18.9% (Confidence Interval = 17.1-20.7%)
•  Adult male smokers:  17.5% (CI = 15-20%)
•  Adult female smokers:  20.3% (CI = 17.9-22.7%)
•  Non-Hispanic white smokers:  19.4% (CI = 17.4-21.4%)
•  Non-Hispanic African American smokers:  14.6% (CI = 10.3-18.9%)
•  Smoke every day:  15.1% (CI = 13.5-16.7%)
•  Smoke some days:  3.8% (CI = 3-4.6%)
•  Former smokers:  26.1% (CI = 24.3-27.9%)
•  Never smoked:  54.9% (CI = 52.7-57.1%)

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Physical Inactivity

In 2007, 22.1% (CI = 20.3-23.9%) of adult Delawareans reported getting no leisure time physical activity in an average month.

A slight majority of Delaware adults are still sedentary , that is they either get no exercise or insufficient activity to meet Centers for Disease Control and Prevention (CDC) recommendations for moderate or vigorous physical activity.

•  11.2% (CI = 9.4-13%) report no physical activity.
•  40.9% (CI = 38.5-43.3%) get insufficient activity to meet either set of recommendations.
• Women are less likely to meet recommendations than men: 44.6% (CI = 41.7-47.5%) of women get insufficient activity, compared with 36.9% (CI = 33.4-40.4%) of men.
• There was no significant difference between non-Hispanic white and African American adults.

Active Adults—Meeting CDC Recommendations

The BRFS uses Centers for Disease Control and Prevention (CDC) recommendations for moderate and physical activity. The survey asks a set of questions about types, duration, and frequency of physical activity. A formula is then used to determine if respondents meet CDC recommendations for "moderate" or "vigorous" activity, or meet both sets of recommendations.

•  20.4% (CI = 18.6-22.2%) of Delaware adults get moderate physical activity 30 or more minutes a day, 5 or more days a week.
•  13.5% (CI = 11.7-15.3%) of Delaware adults get vigorous physical activity for 20 or more minutes a day, 3 more more days a week.
•  Another 14% (CI = 12.2-15.8%) of Delaware adults meet both recommendations for moderate and vigorous physical activity.
•  A total of 47.9% (CI = 45.5-50.3%) of Delaware adults are physically active at levels which will benefit their health.
•  52.2% (CI = 48.5-55.9%) of adult men meet one or both sets of recommendations for physical activity.
•  44.1% (CI = 41.2-47%) of adult women meet one or both sets of recommendations.
•  49.9% (CI = 47.4-52.4%) of non-Hispanic white adults meet one or both sets of recommendations.
•  38.2% (CI = 30.6-45.8%) of African American adults meet one or both sets of recommendations.

Since 2001, the prevalence of recommended physical activity has been slowly but consistently increasing among the state's adult population. The BRFS measures physical activity in odd-numbered years. The prevalence of recommended physical activity has increased from 41.5% in 2001 to 47.9% in 2007.

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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.

In 2007, a majority of Delaware adults—65%—were either overweight or obese.

Overweight:

• Adults who are overweight:  36.8% (CI=34.4-39.2%)
• Males who are overweight:  42.8% (CI=39.1-46.5%)
• Females who are overweight:  31.1% (CI=28.6-33.6%)
• Non-Hispanic whites overweight:  36.5% (CI=34.1-38.9%)
• Non-Hispanic African Americans overweight:  38.2% (CI= 29.4-47.0%)

Overweight increases with age, from a low of 27.4% among 18-24 year olds to a 40.7% among adults age 65 and older.

Obesity:

• Adults who are obese:  28.2% (CI=26.2-30.2%)
• Obese males:  30.7% (CI=27.6-33.8%)
• Obese females:  25.9% (CI=23.5-28.3%)
• Obese non-Hispanic whites:  27.7% (CI=25.5-29.9%)
• Obese non-Hispanic African Americans:  34.9% (CI=28.2-41.6%)
• Obese Hispanics:  16.8%  (CI= 7.6-26.0%)

Obesity also increases with age, from a low of 15.6% among 18-24 year olds to a high of 34.1% among adults age 55-64. About 25.1% of adults 65 and older are obese. The lower prevalence of obesity in the over-65 group may be largely attributable to premature death from lifestyle-related chronic diseases such as heart disease, stroke, lung diseases, diabetes, and cancer.

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Diabetes Prevalence

About 8.7% (CI=7.7-9.7%) of Delaware adults say they have been told by a doctor that they have diabetes. Obesity is a major risk factor for type 2 diabetes, and the trends show both obesity and diabetes increased in Delaware during the past decade. The prevalence of diabetes among adults in the state increased from 4.3% in 1995 to 8.7% in 2007.

There is no difference in prevalence by gender; but prevalence is slightly higher among African Americans than among whites:

• 8.6%  (CI=7.4-9.8%) of non-Hispanic whites have been told they have diabetes.
• 10.9%  (CI=7.6-14.2%) of non-Hispanic African Americans have been told they have diabetes.
• 2.8%  (CI=0.4-5.2%) 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 15.8% of 55-64 year olds and 19.7% of those 65 or older.

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Alcohol Risk Behavior

The majority of Delaware adults drink alcoholic beverages at least occasionally.  In 2007, 58.4% (CI=56.2-60.6%) of Delaware adults say they had at least one alcoholic drink in the past month.  Men (65.3%) are significantly more likely to be drinkers than women (52.1%).

18.4% (CI= 16.2-20.6%) of Delaware adults report episodes of acute heavy drinking, usually called "binge drinking ," during the past month.  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:  25.41%  (CI=21.7-29.1%)
• Female:  12.1%  (CI=10.1-14.1%)
• Young adults (age 18-24):  33.4%  (CI=25.0-41.8%)
• Adults age 25-34:  30.1%  (CI= 22.7-37.5%)

There was no statistically significant difference on "Binge drinking" by racial group:

• White, non-Hispanic = 18.9%  (CI=16.9-20.9%)
• Black/African American = 16.4%  (CI= 6.8-26.0%) 

7.1% (CI=5.5-8.7%) of adult Delawareans are at risk due to heavy drinking.   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:

Although males are slightly more likely to report heavy drinking than females, it is not a statistically significant difference. There were no differences on heavy drinking among racial or ethnic groups in 2007.

• 9% (CI=5.9-12.1%) of adult males are heavy drinkers.
• 5.3% (CI=4.1-6.5%) of adult females are heavy drinkers.
• 11.6% (CI=6.1-17.1%)  of young adults, age 18-21, are heavy drinkers.
• 7% (CI=5.6-8.4%) of non-Hispanic whites are heavy drinkers.
• 7.7% (CI=0-17.5%) of non-Hispanic African Americans are heavy drinkers.
• 6.5%(CI= 1.2-11.8%) of Hispanics are heavy drinkers.

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Adult Immunizations

About 41% (CI= 38.8-43.2%) of Delaware adults said they had an influenza ("flu") shot during the past year.  This is up from 28.2% in 2005 and 35.3% in 2006.

Women were slightly more likely to have a flu shot than men; with 43.2% of women and 38.7% of men reporting the shot in the past 12 months.

By race:

• 43.7% (CI=41.3-46.1%) of white, non-Hispanic adults
• 32.1% (CI= 25.6-38.6%) of non-Hispanic African American 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:

•  73.8% (CI=70.5-77.1%) of adults age 65 and older had a flu shot in the past year, up from 65.8% in 2005 and 70.3% in 2006.

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.

• 25.9% (CI=23.9-27.9%) of all Delaware adults have had a pneumonia shot at some time.
• 72.2% (CI=68.7-75.7%) of adults age 65 and older have had the pneumonia shot.

Hepatitis B

In 2007, the BRFS also added questions about Hepatitis B vaccine.

• 40.5% (CI=38-43%) of Delaware adults said they had received the complete Hepatitis B vaccination. The vaccination is complete after the third shot is given.
• African Americans were significantly more likely to have received the vaccination. 53% (CI=44.8-61.2%) of African Americans reported receiving Hepatitis B vaccine, compared to 37% (CI=34.3-39.7%) of whites.
• 79.2% (CI=71.9-86.5%) of young adults age 18-24 had received the shots. The prevalence rate drops dramatically by each age group, with only 12% of respondents 65 and older reporting Hepatitis B vaccination.
• Responses to a question about risk factors for Hepatitis B indicated that about 9.6% (CI=7.6-11.6%) of the state's adult population is at risk for Hepatitis B.
• More African Americans reported risk behaviors for Hepatitis B than whites—15% (CI=5.6-24.4%) of African Americans compared to 8.1% (CI=6.3-9.9%) of whites.
• Young adults are also more likely to be at risk. 27.9% (CI=19.5-36.3%)of 18-24 year old adults reported risk factors, and 17.5% (CI= 9.7-25.3%) of 35-34 year olds.

Risk factors for Hepatitis B (similar to risk factors for HIV/AIDS) include: having hemophilia or receiving clotting factor concentrate, men having sex with men, taking street drugs with needles, trading sex for money, testing positive for HIV, sex with people who have these risk factors, or having sex with more than two partners in the past year.

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HIV / AIDS Testing

Among Delaware adults under 65 years of age, 47.2% (CI= 44.5-49.9%) say they have been tested at some time for the Human Immunodeficiency Virus (HIV) that causes AIDS.  This does not include tests done as part of a blood donation.

• 44.4% (CI=40.1-48.7%) of men have been tested at least once
• 49.8% (CI=46.5-53.1%) of women have been tested at least once
• 42.1% (CI=39.2-45.0%) of non-Hispanic whites have been tested at least once
• 68.8% (CI=61.2-76.4%) of non-Hispanic African Americans have been tested at least once
• 64% (CI=57.5-70.5%) of the 25-34 age group have been tested — the highest rate of any age group
• 43.8% (CI=35.0-52.68%) of the 18-24 age group have been tested at least once

Neither educational level nor income seems to influence whether an individual has had an AIDS test.

30.2% (CI=25.1-35.3%)of those who had been tested said their most recent test had been within the past year.

Another 42.9% (CI= 38.0-47.8%) said they had been test in the preceding five years (2002-2006).

The majority said they had been tested at a doctor's office or HMO (41%) or at a hospital or clinic (39%); and another 4.9% said they had been tested at a drug treatment facility.

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Asthma Prevalence

The BRFS estimates that 7.8% (CI= 6.6-9.0%) of Delaware adults—or about 51,647adults—currently have asthma .

Selected asthma breakdowns for 2007:

• Total current asthma = 7.8% (CI=6.6-9.0%)
• Male = 5.0% (CI=3.6-6.4%)
• Female = 10.4% (CI=8.6-12.2%)
• White, Non-Hispanic =   7.8 (CI=6.4-9.2%)
• Black/African American = 7.8% (CI=4.5-11.1%)
• Hispanic = 9.7% (CI= 1.9-17.5%)

Another 3.7% (CI=2.7-4.7%) of Delaware adults have been told that they have asthma but do not currently have symptoms.

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Cancer Screening

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

Source: DHSS, Division of Public Health, BRFSS, 1997-2007.

• 74.6% (C.I. 72.5% - 76.7%) of Delaware adults age 50 or older have had a sigmoidoscopy or colonoscopy to check for colorectal cancer. As the graph above shows, Delaware's screening prevalence is significantly higher than the national rate. In fact, in 2007, Delaware ranked third highest in the country in the percentage of adults 50 or older who have ever had a colonoscopy. 89.4% of those who said they had the test reported having been tested within the past 5 years.
• 54% of adults 50 and older said their doctors had talked to them about the importance of colorectal cancer screening in the past year.
• The overwhelming majority of 50-and-older adults said they either wanted a colonoscopy (20%) or they will have one if their doctor says its needed (65.8%)
• 95.1% (C.I. 93.3% - 96.9%) of adult women reported having a Pap test for cervical cancer within the past three years. There were no statistically significant differences among racial or ethnic groups for Pap testing. About 88% of the women who were tested had their Pap test within the past 3 years.
• 68.8% (C.I. 65.9% - 71.7%) of adult women "have ever had" a mammogram to check for breast cancer. The prevalence is significantly higher among older women. 92.6% of women 45-54 have had a mammogram, and 97% of women over 55.
• 85.1% of women who have had a mammogram, had one in the past two years.

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General Health and Health Care

The BRFS asks about how respondents feel about their own health. Other studies have validated that this is a good measure of quality of health in the population. Only 13% (C.I. 11.6% - 14.4%) say they are in "fair or poor" health. There are no statistically significant differences between men and women or among racial-ethnic populations.

About 6.5% (C.I. 5.1% - 7.9%) of Delaware adults said poor physical or mental health kept them from doing their usual activities during all or most of the past month.

In 2007, 9.1% (C.I. 7.5% - 10.7%) of Delaware adults did not have health insurance of any type.

• More men reported being uninsured than women. 10.6% (C.I. 8.1% - 13.1%) of adult men reported no health insurance, compared to 7.6% (C.I. 5.6% - 9.6%) of women.
• Young adults are far more likely to be without health insurance. 17.7% (C.I. 11% - 24.4% of adults age 18-24 had no health insurance.

Some adults may have health insurance, but still be unable to pay for needed health care. About 10.6% (C.I. 9% - 12.2%) reported that, at some time in the past year, they needed to see a doctor but couldn't because of cost.

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Selected Data Items by County

Risk Factors	New Castle	Kent	Sussex
Sedentary Lifestyle – No Leisure Time Exercise	21% (18.3-23.7)	24.7% (21.8-27.6)	23.2% (20.3-26.1)
Get Recommended Moderate or Vigorous Physical Activity	47.5% (44-51)	48.5% (45-52)	49% (45.3-52.7)
Adult Obesity (BMI 30 or higher)	25.8% (22.9-28.7)	32.7% (29.6-35.8)	32% (28.5-35.5)
Overweight (BMI 25-29.9)	37.1% (33.6-40.6)	35.5% (32.4-38.6)	37.2% (33.9-40.5)
"Fair or Poor" Health	11.5% (9.5-13.5)	13.7% (11.7-15.7)	16.6% (14.2-19.0)
Adults With Diabetes	7.5% (6.1-8.9)	9.4% (7.6-11.2)	11.4% (9.4-13.4)
Currently Have Asthma	7.2% (5.4-9.0)	8.4% (6.6-10.2)	9.2% (7.2-11.2)
Currently Smoke Cigarettes	17.2% (14.7-19.7)	24.2% (21.1-27.3)	19.8% (16.9-22.7)
Chronic Heavy Drinkers	8% (5.5-10.5)	5.9% (4.1-7.7)	5.5% (3.7-7.3)
Binge Drinkers	19.9% (16.8-23)	17.1% (14-20.2)	16.2% (13.1-19.3)
No Health Insurance	6.2% (4.4-8)	12.1% (9.4-14.8)	8.3% (6.3-10.3)
Had Flu Shot Past Year (age 65 and older only)	70.8% (65.3-76.3)	77.9% (72.8-83)	76.6%(72.1-81.1)
Ate 5 or More Fruits-Veggies A Day	22.3% (19.2-25.4)	18.9% (16.4-21.4)	20.4%(17.7-23.1)
Limited Activity Due To Physical or Mental Problem	20.4% (17.3-23.5)	18.7% (16.3-21.1)	23%(20.1-25.9)
Limited Activity: Need Special Equipment	7.3% (4.9-9.7)	6.9% (5.3-8.5)	8.3% (6.7-9.8)

Source: Delaware Health and Social Services, Division of Public Health, Behavioral Risk Factor Surveillance System (BRFSS), 2007.

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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 Delaware's Hispanic population, the confidence interval is larger. Estimates are not presented when the unweighted sample size for the denominator is less than 50, or when the confidence interval half-width is greater than 10. 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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