Contents:

• Tobacco Use
• Physical Activity
• Nutrition: Fruit and Vegetable Consumption
• Overweight and Obesity
• Alcohol Risk Behavior
• Adult Immunizations
• Other Risk Factors
• HIV/AIDS
• Diabetes Prevalence
• Asthma Prevalence
• Summary of Risk Behavior By County

Adult Health Risks in Delaware: 2003

Tobacco Use

Smoking prevalence decreased to 21.9% among Delaware adults in 2003. This is down from 24.6% in 2002. The decrease was largest among young adults, age 18-24. Prevalence among young adults dropped from 36% in 2002 to 26.7% in 2003. The decrease in smoking was almost entirely among women. For detailed smoking data, go to our fact sheet on adult smoking in Delaware.

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Physical Inactivity

26.5% of Delaware adults report getting no leisure time physical activity in the past month (other than activity on their jobs).

Risk from sedentary lifestyle increases steadily with age, from 21.3% of 18-24 year-olds reporting no leisure time activity to 40% among adults age 65 and older.

No leisure-time physical activity by race:

• White non-Hispanic = 24.2%
• Black/African American = 33.7%
• Hispanic = 40%*

Adults with less than a high school education are more likely to be sedentary (44.6%) than high school graduates (34%) or college graduates (14%).

30.3% of women report no leisure-time physical activity, compared to 22.4% of men.

More than half – 56.2% – of all adults get insufficient physical activity. That is, they do not meet minimum recommendations for even moderate physical activity, or they get no activity at all.

Only 43.8% of Delaware adults meet recommendations for regular, moderate or vigorous physical activity.

Only 24.2% of Delaware adults get regular, vigorous physical activity.

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Nutrition: Fruit and Vegetables

The Behavioral Risk Factor Survey measures fruit and vegetable intake as an indicator of a healthy diet. Dietary guidelines from the U.S. Department of Health and Human Services and from the National Academy of Sciences recommend between 5 and 10 servings of a variety of vegetables and fruits every day.

Only 22% of Delaware adults eat the recommended 5 or more servings of vegetables and fruits daily.

Percentage of adults 18 and older who eat 5 or more servings a day:

• Men = 18.4%
• Women = 25.3%
• White, non-Hispanic = 21.6%
• Black/African American = 20.8%
• Hispanic = 23.5% *

College graduates and older adults are slightly likely to eat 5 or more servings a day.

People with incomes higher than $75,000 a year are more likely to eat 5 serving a day (29.5%) than other income groups (mostly in the low 20% range).

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Overweight and Obesity

About 60% of all adult Delawareans are estimated as either "overweight“ or “obese.”

This is a conservative estimate, given that validity studies indicate a tendency by respondents to overestimate height and underestimate weight. The BRFS asks height and weight, and uses Body Mass Index (BMI) to calculate overweight (BMI >25 - <=30) and obesity (BMI > 30).

36.2% of adults are overweight, and another 24% are obese. Obesity levels have been increasing for the past 14 years.

Obesity by gender:

• Men = 24.6%
• Women = 23.4%

Obesity increases by age (the decline among older adults is likely attributable to death from obesity-related diseases including diabetes, heart disease and cancer):

• 18-24 = 10.4%
• 25-34 = 19.6%
• 35-44 = 26.8%
• 45-54 = 31.7%
• 55-64 = 28.9%
• 65+ = 23.6%

Obesity by racial/ethnic group:

• White, non-Hispanic = 22.4%
• Black/African American = 32.8%
• Hispanic = 28.1%*

College graduates are significantly less likely to be obese (18%) than high school graduates (25.7%) and adults with less than a high-school education (35%).

Direct medical expenditures in Delaware attributable to obesity are estimated at $207 million a year. [Finkelstein et al, “State-Level Estimates of Annual Medical Expenditures Attributable to Obesity,” Obesity Research, 12:1, Jan 2004.]

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Alcohol Risk Behavior

18.6% of Delaware adults report episodes of acute heavy drinking, usually called binge drinking, during the past month.

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

Binge drinking by gender and age:

• Male = 29.5%
• Female = 8.8%
• Young adults (age 18-24) = 40%
• Adults age 25-34 = 26.5%
• Young adult males (age 18-24) = 56.2%
• Young adult females = 23.4%

Binge drinking by racial/ethnic group:

• White, non-Hispanic = 19.5%
• Black/African American =14.5%
• Hispanic = 28%* (*small sample size, larger confidence interval)

60.7% of adult Delawareans say they have consumed alcoholic beverages in the past month.

7.8% of adult Delawareans are at risk due to heavy drinking. Breakdowns for heavy drinking:

• 9.4% of adult males are heavy drinkers.
• 6.3% of adult females are heavy drinkers.
• 16% of young adults, age 18-21, are heavy drinkers.

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Adult Immunizations

About 35% of Delaware adults said they had an influenza, or "flu," shot during the past year.

Women are slightly more likely to have a flu shot than men, with 36.1% of women and 33.7% of men reporting the shot in the past 12 months.

By race or ethnic group:

• 37.3% of white, non-Hispanic adults
• 27.2% of black or African American adults
• 20.6% if 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% of adults age 65 and older had a flu shot in the past year.
• 73% of white, non-Hispanic adults age 65+
• Only 37% of black or African Americans age 65+. African American women are more likely than men to have a flu shot.
• Only 55.4% of 65+ adults with less than a high school education
• Only 59.4% of 65+ adults with incomes of $15,000 - $25,000 (compared with 80% of high-income older adults)
• However, among older adults with incomes of less than $15,000, about 70% had a flu shot in the past year.

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.

• 22.3% of all Delaware adults have had a pneumonia shot at some time.
• 67.4% of Delaware adults age 65 and older have had the shot (65.5% of men and 68.7% of women).
• 69% of non-Hispanic white older adults have had a pneumonia shot, compared to 51% of African Americans.

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Other Risk Factors

The Behavioral Risk Factor Survey also asks questions about other risk factors and conditions:

• 27.7 % of Delaware adults are aware that they have high blood pressure, also called hypertension. There is no statistically significant difference among racial or ethnic groups, but African Americans have a slightly higher prevalence (30.7%). Prevalence increases with age, from 4.2% of young adults to 57.8% of adults age 65 and older.
• About 78% of Delaware adults have had their blood cholesterol level checked within the past five years.
• 35.6% of Delaware adults had their cholesterol checked in the past 5 years and were told that it was high.
• 28% of Delaware adults report being told by a doctor or health professional that they have some form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia.
• Colorectal cancer screening is recommended for adults over 50. 43% of adults in this age group say they have used a home "blood stool" test.
• 62% of Delaware adults age 50 or older have had a sigmoidoscopy or colonoscopy to check for signs of colorectal cancer.
• Sun exposure is a risk factor for skin cancer. Slightly more than one-fourth (26.6%) of Delaware adults report having at least one sunburn in the past year. 29% of men have been sunburned in the past year, compared to 24.5% of women.
• Among adults age 46 and older, 10.4% report have had a fall in the past 3 months. Of those who fell, almost half (47.8%) were injured to the extent they had to see a doctor or their activities were limited for at least a day.
• 17.5% of Delaware adults report a disability, which is defined as "being limited in activities because of a physical, mental or emotional problem."
• About 6% of Delaware adults report a disability that requires them to use special equipment – such as a cane, a wheelchair, a special bed, or a special telephone.

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HIV / AIDS

Among Delaware adults under 65 years of age, 48.8% say they have been tested for the Human Immunodeficiency Virus (HIV) that causes AIDS. 47.6% of men and 50% of women say they have been tested at least once.

71% of adults in the 25-34 year age group say they have been tested at some time for AIDS, but only 45.5% of younger adults in the 18-24 age group have ever had an AIDS test. This includes testing required by an employer or the Blood Bank, as well as individuals who seek tests specifically to determine if they are infected with HIV. Of those who have ever been tested, 32% say it was required; and another 33% say it was "part of a check-up." Less than one-fourth (22.5%) of those who have ever been tested say they chose to be tested.

Women in the 25-34 age group (79.7%) are more likely to have had an AIDS test than men (62%).

Adults under 65 who have ever had an AIDS test, by race and ethnic group:

• White, non-Hispanic adults = 44.4%
• Black or African American = 67.3%
• Hispanic = 52% *

Education and income level do not seem to influence whether an individual has had an AIDS test.

To encourage honest responses and anonymity, the BRFS asks a general question about the major risk behaviors related to HIV transmission. The question is: "I'm going to read a list. When I'm done, please tell me if any of the situations apply to you. You don't need to tell me which one. You have used intravenous drugs in the past year. You have been treated for a sexually transmitted or venereal disease in the past year. You have given or received money or drugs in exchange for sex in the past year. You had anal sex without a condom in the past year."

Risky behavior by age group:

• 18-24 = 11.9%
• 25-34 = 6.3%
• 35-44 = 3.8%
• 45-54 = 1.5%
• 55-65 = 1.3%

Risky behavior by gender:

• Male = 6%
• Female = 3.4%

Risky behavior by race and ethnic group:

• White, non-Hispanic = 3.3%
• Black or African American = 11.3%
• Hispanic 7.3% *

Delaware adults with a high school education or less, and low-income adults – especially those with incomes under $15,000 a year – are more likely to engage in risky sexual and drug-related behaviors.

Only 43% of young adults, age 18-24, say they have been counseled by a doctor or health professional on prevention of sexually transmitted diseases through condom use. That drops to 12.8% among 25-34 year olds.

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Diabetes Prevalence

About 7.6% of Delaware adults say they have been told by a doctor that they have diabetes.

By gender:

• Male = 8.5%
• Female = 7%

By racial/ethnic group:

• White, non-Hispanic = 7%
• Black/African American = 10.7%
• Hispanic = 10.3%

Diabetes prevalence increases dramatically with age. Less than 1% of young adults report having diabetes, compared with 15.2% of adults 55-64, and 16.2% of adults over 65.

Diabetes prevalence is also higher among low-income adults and adults with less than a high school education – groups which also have a high prevalence of obesity.

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Asthma Prevalence

The % of adults with current asthma, and the projected number of Delaware adults with asthma for the past four years is:

• 2000 – 7.1% (40,536)
• 2001 – 7.5% (45,025)
• 2002 – 7.4% (44,744)
• 2003 – 7.5% (46,096)

"Have you ever been told by a doctor, nurse or other health professional that you had asthma?" There is no statistically significant difference between any of the years.

• 2000 – 10.4%
• 2001 – 12.0%
• 2002 – 11.8%
• 2003 – 11.7%

The racial/ethnic breakdowns for 2003:

• total current asthma - 7.5%
• white, non-Hispanic - 7.7% (CI = 6.53 - 8.93)
• black, non-Hispanic - 6.6% (CI = 4.16 - 9.02)
• Hispanic 5.7%* (*cell size under 100, confidence interval 0-11.8)

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County Data

Summary of 2003 Data by County

County Summary	New Castle	Kent	Sussex
Adults With No Physical Activity	25.6%	25.8%	29.3%
Adult Obesity	21.5%	27.4%	23%
Overweight OR Obese	54.5%	62.1%	60.7%
Eat 5 Fruits/Veggies a Day	23.1%	20%	20.6%
Adults With Diabetes	7%	8.1%	9.1%
Currently Have Asthma	7.6%	6.7%	7.6%
Currently Smoke Cigarettes	20.9%	25.1%	22.4%
Binge Drinkers	19.7%	16%	17.2%
Chronic Heavy Drinkers	8.2%	6.6%	7.1%

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Source: Delaware Health and Social Services, Division of Public Health, Behavioral Risk Factor Surveillance System (BRFSS), 2003.

Sample = 4,037 Delaware adults age 18 and older. Confidence interval on questions involving total sample is approximately ± 2% at a 95% confidence level. The Behavioral Risk Factor Survey is a random sample telephone interview survey, conducted continuously throughout the year. Additional information is available on the Division of Public Health website at www.deph.org or the BRFSS website at www.cdc.gov/brfss/.