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Prevalence of Selected Risk Behaviors and Chronic Diseases --- Behavioral Risk Factor Surveillance System (BRFSS), 39 Steps Communities, United States, 2005

Fred Ramsey, MS1
Ann Ussery-Hall, MPH2
Danyael Garcia, MPH3
Goldie McDonald, PhD1
Alyssa Easton, PhD1
Maisha Kambon, MPH3
Lina Balluz, ScD1
William Garvin 1
Justin Vigeant3
1Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion
2Ginn Group, Atlanta, Georgia
3Northrop Grumman, Atlanta, Georgia

Corresponding author: Ann Ussery-Hall, MPH, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, 4770 Buford Hwy, N.E., MS K-93, Atlanta, GA 3041-3717. Telephone: 770-488-8636; Fax: 770-488-8488; E-mail: aussery@cdc.gov.

Abstract

Problem: Behavioral risk factors (e.g., tobacco use, poor diet, and physical inactivity) can lead to chronic diseases. In 2005, of the 10 leading causes of death in the United States, seven (heart disease, cancer, stroke, chronic lower respiratory diseases, diabetes, Alzheimer's disease, and kidney disease) were attributable to chronic disease. Chronic diseases also adversely affect the quality of life of an estimated 90 million persons in the United States, resulting in illness, disability, extended pain and suffering, and major limitations in daily living.

Reporting Period Covered: 2005.

Description of the System: CDC's Steps Program funds 40 selected U.S. communities to address six leading causes of death and disability and rising health-care costs in the United States: obesity, diabetes, asthma, physical inactivity, poor nutrition, and tobacco use. In 2005, a total of 39 Steps communities conducted a survey to collect adult health outcome data. The survey instrument was a modified version of the Behavioral Risk Factor Surveillance System (BRFSS) survey, a community-based, random-digit--dialing telephone survey with a multistage cluster design. The survey instrument collected information on health risk behaviors and preventive health practices among noninstitutionalized adults aged >18 years.

Results: Prevalence estimates of risk behaviors and chronic conditions varied among the 39 Steps communities that reported data for 2005. The proportion of the population that achieved Healthy People 2010 (HP 2010) objectives also varied among the communities. The estimated prevalence of obesity (defined as having a body mass index [BMI] of >30.0 kg/m² as calculated from self-reported weight and height) ranged from 15.6% to 44.0%. No communities reached the HP2010 objective of reducing the proportion of adults who are obese to 15.0%.

The prevalence of diagnosed diabetes (excluding gestational diabetes) ranged from 4.3% to 16.6%. Eighteen communities achieved the HP2010 objective to increase the proportion of adults with diabetes who have at least an annual foot examination to 75.0%; five communities achieved the HP2010 objective to increase the proportion of adults with diabetes who have an annual dilated eye examination to 75.0%.

The prevalence of reported asthma ranged from 7.0% to 17.6%. Among those who reported having asthma, the prevalence of having no symptoms of asthma during the preceding 30 days ranged from 15.4% to 40.3% for 10 communities with sufficient data for estimates. The prevalence of respondents who engaged in moderate physical activity for >30 minutes at least five times a week or who reported vigorous physical activity for >20 minutes at least three times a week ranged from 42.0% to 62.2%. The prevalence of consumption of fruits and vegetables at least five times a day ranged from 15.6% to 30.3%.

The estimated prevalence among respondents aged >18 years who reported having smoked >100 cigarettes in their lifetime and who were current smokers on every day or some days at the time of the survey ranged from 11.0% to 39.7%. One community achieved the HP2010 objective to reduce the proportion of adults who smoke to 12.0%. Among smokers, the prevalence of having stopped smoking for >1 day as a result of trying to quit smoking during the previous 12 months ranged from 47.8% to 63.3% for 31 communities. No communities reached the HP2010 objective of increasing smoking cessation attempts by adult smokers to 75%.

Interpretation: The findings in this report indicate variations in health risk behaviors, chronic conditions, and use of preventive health screenings and health services. These findings underscore the continued need to evaluate intervention programs at the community level and to design and implement policies to reduce morbidity and mortality caused by chronic disease.

Public Health Action: Steps BRFSS data can be used to monitor the prevalence of specific health behaviors, diseases, conditions, and use of preventive health services. Steps Program staff at the national, state, local, and tribal levels can use BRFSS data to demonstrate accountability to stakeholders, monitor progress in meeting program objectives, focus programs on activities with the greatest promise of results, identify opportunities for strategic collaboration, and identify and disseminate successes and lessons learned.

Introduction

Behavioral risk factors (e.g., tobacco use, poor diet, and physical inactivity) can lead to chronic diseases (e.g., diabetes, asthma, and obesity) (1). In 2005, of the 10 leading causes of death in the United States, seven (heart disease, cancer, stroke, chronic lower respiratory diseases, diabetes, Alzheimer's disease, and kidney disease) were attributable to chronic diseases, and chronic diseases affect the quality of life of an estimated 90 million U.S. residents (2). The estimated direct and indirect annual costs of diabetes, asthma, and obesity are $132 billion for diabetes (2,3), $16.1 billion for asthma (4), and $118 billion for obesity (5). Diabetes, asthma, and obesity largely can be prevented and controlled through the modification of certain interrelated risk behaviors (e.g., exercising regularly, eating a healthy diet, and avoiding tobacco use and exposure). To respond to the chronic disease burden, CDC's Steps Program uses a population-based approach that addresses multiple determinants of health. Key elements of this approach include implementing evidence-based interventions, responding to community needs, reaching diverse population groups, working across multiple sectors (e.g., schools, work sites, health care, and the community), and creating nontraditional partnerships (e.g., with transportation and cooperative extension services). All of these elements serve to accelerate positive health changes in communities and reduce chronic disease.

CDC's Steps Program operates a cooperative agreement that provides funding to 40 communities nationwide to support evidence-based community interventions. Interventions focus on six priority areas, comprising three health conditions or diseases (obesity, diabetes, and asthma) and three related risk behaviors (physical inactivity, poor nutrition, and tobacco use). Communities were selected as part of a Request for Funding announcement (RFA) designed to ensure inclusion of populations disproportionately affected by chronic disease and associated risk factors; inclusion of geographic areas with high age-adjusted rates of chronic disease and associated risk factors; geographic distribution of Steps programs nationwide; and inclusion of communities of varying sizes, including rural, suburban, and urban communities. Steps sites include small cities and rural communities (with sites coordinated at the state level), large cities and urban communities, and tribal communities. As part of the RFA, grantees participate in the Steps Behavioral Risk Factor Surveillance System (BRFSS) to collect data on health conditions and diseases and on related risk factors at the community level and track Steps Program health outcomes and behaviors over time. This report provides baseline data for Steps communities; additional years of data will be used to make community to community, national, and HP2010 comparisons. Data are reported for 39 Steps communities* that reported data for 2005 on the six priority areas.

Methods

The Steps BRFSS survey instrument is a modified version of the 2005 BRFSS national survey and includes standardized questions related to the three Steps-specific disease outcomes (diabetes, asthma, and obesity) and the three related risk factors (physical inactivity, poor nutrition, and tobacco use). A multistage cluster design based on random-digit--dialing methods was used to select a representative sample of the civilian, noninstitutionalized population aged >18 years. To ensure coordinated efforts and efficient use of resources, 39 Steps communities used BRFSS infrastructure and capacity already in place at the national, state, and local levels to collect data. The survey instrument included standard 2005 BRFSS questions (available at http://www.cdc.gov/brfss) related to the six priority areas. Data collection procedures or processes varied by community because of each community's particular characteristics. For example, certain Steps communities conducted a stand-alone survey whereas others coordinated data collection with the state or local BRFSS. Several Steps communities adapted their data collection methods to respond to local cultural needs. For the majority of Steps communities, CDC provided technical assistance, data cleaning, weighting, and analysis of surveillance data.

Questionnaire

The 2005 Steps BRFSS questionnaire comprised three parts: 1) core questions, 2) optional supplemental modules containing sets of questions on specific topics (e.g., diabetes, health-related-quality of life, and arthritis management), and 3) state-added questions. The 2005 Steps BRFSS questionnaire asked core and optional questions related to risk factors associated with obesity, diabetes, and asthma and the accompanying underlying risk factors of physical inactivity, poor nutrition, and tobacco use. Questions from the following Core Sections of the 2005 BRFSS National Survey were used: Healthy Days, Health Care Access, Diabetes, Asthma, Tobacco Use, Demographics, Fruits, Vegetables, and Physical Activity. In addition, certain questions from the following Optional Modules were part of the survey: Diabetes Self-Management, Adult Asthma History, and Smoking Cessation. Additional information about the national BRFSS standard questions is available at http://www.cdc.gov/brfss/questionnaires.

Data Collection and Processing

A total of 39 Steps communities* collected data in 2005 using trained interviewers to administer the survey via a computer-assisted telephone interviewing (CATI) system; 30 communities forwarded their data to CDC for data reliability checks and preparation for analyses, and nine communities conducted individual analyses and reported the results to CDC. Six of the nine communities that conducted their own analysis sent weighted data to CDC to produce estimates. For each community, data were collected either monthly or at a single point in time.

Data Weighting and Analysis

Upon completion of data collection, 30 communities submitted data to CDC, which edited and aggregated the data files to create a sample for each community. For this analysis, each sample was weighted to the respondent's probability of selection and to the age- and sex-specific population or to the age-, sex-, and race-specific population data, using current population estimates provided by the community or 2005 intercensal estimates provided by Claritas, Inc. (San Diego, California), a private data vendor that uses census projections as part of its process for developing yearly population estimates. These sampling weights then were used to calculate community-level prevalence estimates. Detailed weighting and analytic methodologies used for BRFSS have been documented previously (6).

Statistical Analyses

SAS® (release 9.1.3) and SUDAAN® were used in the analyses to account for the complex sampling design and to calculate prevalence estimates, standard errors, and 95% confidence intervals (CIs) (7,8). Statistics for selected communities were reported as "not available" if the unweighted sample size for the denominator was <50 or the CI half width was >10. Because those data are not included in this report, the number of communities represented for each indicator varies (range: 20--39).

Data Presented

The tables in this report contain the weighted percentage, sample size, standard error, and CIs. Data for three of the communities that conducted their own data analysis are reported without standard errors. Standard errors are reported for the six communities that conducted their own data analysis and sent their data to CDC to produce estimates from the weighted data set that they provided. When comparable, national BRFSS median prevalence estimates and Healthy People 2010 (HP2010) goals are presented (9,10). National prevalence estimates are not available for questions from BRFSS optional modules. For several questions, comparative HP2010 goals are not available because the results cannot be compared with the BRFSS indicators.

Results

Overweight and Obesity

Prevalence of Overweight and Obesity Among Adults Aged >18 Years

Self-reported weight and height were used to calculate body mass index (BMI) (weight [kg]/height [m2]). Being overweight or obese was defined as having a BMI of >25.0 kg/m2; obesity alone was classified as BMI of >30.0 kg/m2. The estimated prevalence of respondents aged >18 years being overweight or obese ranged from 35.4% (95% CI = 33.0--37.9) in Cleveland, Ohio, to 75.5% (95% CI = 64.7--83.9) in Colville Confederated Tribes, Washington (median: 60.8%) (Table 1). The 2005 nationwide BRFSS median was 61.3%; this median was exceeded by 19 Steps communities.

Prevalence of Obesity Among Adults Aged >18 Years

Overall, the estimated prevalence of obesity (BMI >30.0 kg/m2) among respondents aged >18 years ranged from 15.6% (95% CI = 13.5--17.6) in Teller County, Colorado, to 44.0% (95% CI = 36.3--51.6) in Inter-Tribal Council, Michigan (median: 24.6%) (Table 2). The HP2010 objective is to reduce the proportion of adults who are obese to 15.0%. The 2005 nationwide BRFSS median was 24.4%; this median was exceeded by 20 communities, and no communities achieved the HP2010 objective† (objective no. 19.2) to reduce the proportion of adults who are obese to 15.0%.

Diabetes

Overall Rate of Diabetes

Overall, the estimated prevalence of diabetes among respondents aged >18 years who reported ever having been told by a doctor that they have diabetes (other than during pregnancy) ranged from 4.3% (95% CI = 2.4--6.2) in St. Paul-Ramsey County, Minnesota, to 16.6% (95% CI = 10.1--23.1) in Inter-Tribal Council, Michigan (median: 8.1%) (Table 3). The nationwide 2005 BRFSS median was 7.3%; this median was exceeded by 25 Steps communities.

Foot Examination Among Adults Aged >18 Years with Diabetes

Among 25 Steps communities, the estimated prevalence among respondents aged >18 years who reported having ever been told by a doctor that they have diabetes (excluding women who were told only when pregnant) and who reported having a clinical foot examination during the preceding 12 months ranged from 60.4% (95% CI = 50.8--70.0) in Santa Clara County, California, to 93.6% (95% CI = 88.7--98.6) in Inter-Tribal Council, Michigan (median: 79.7%) (Table 4). The HP2010 objective (objective no. 5-14) is to increase the proportion of adults with diabetes who have at least an annual foot examination to 75.0%.

Dilated Eye Examination Among Adults Aged >18 Years with Diabetes

Among 21 Steps communities, the estimated prevalence among respondents aged >18 years who reported having ever been told by a doctor that they have diabetes (excluding women who were told only when pregnant) and who reported having received a dilated eye examination during the preceding 12 months ranged from 63.2% (95% CI = 53.5--72.9) in Cleveland, Ohio, to 81.9% (95% CI = 74.2--89.7) in Boston, Massachusetts (median: 72.0%) (Table 5). The HP2010 objective (objective no. 5.13) is to increase the proportion of adults with diabetes who have an annual dilated eye examination to 75.0%.

Glycosylated Hemoglobin Measurement at Least Twice a Year Among Adults Aged >18 Years with Diabetes

Among 22 Steps communities, the estimated prevalence among respondents aged >18 years who reported having ever been told by a doctor that they have diabetes (other than during pregnancy) and who reported having received a glycosylated hemoglobin measurement ("A1c") at least twice a year ranged from 54.8% (95% CI = 45.8--63.8) in Cleveland, Ohio, to 89.8% (95% CI = 83.5--96.0) in Inter-Tribal Council, Michigan (median: 69.8%) (Table 6).

Self--Blood Glucose Monitoring Among Adults Aged >18 Years with Diabetes

Among 22 Steps communities, the estimated prevalence among respondents aged >18 years who reported ever having been told by a doctor that they have diabetes (other than during pregnancy) and who reported self--blood glucose monitoring at least twice daily ranged from 28.2% (95% CI = 19.2--37.1) in Austin, Texas, to 46.8% (95% CI = 37.5--56.1) in Philadelphia, Pennsylvania (median: 40.2%) (Table 7).

Self--Foot Examination Among Adults Aged >18 Years with Diabetes

Among 20 Steps communities, the estimated prevalence among respondents aged >18 years who reported ever having been told by a doctor that they have diabetes (other than during pregnancy) who reported checking their feet at least once daily for any sores or irritations ranged from 61.7% (95% CI = 52.7--70.7) in Chautauqua County, New York, to 79.2% (95% CI = 72.5--85.9) in Southeast Alabama (median: 74.6%) (Table 8).

Asthma

Symptom-Free Days Among Adults Aged >18 Years with Asthma

Among 35 Steps communities, the prevalence of reported asthma ranged from 7.0% (95% CI = 4.3--9.7) in Santa Cruz County, Arizona, to 17.6% (95% CI = 15.2--20.0) in Philadelphia, Pennsylvania (Table 9). The Steps communities' median was 12.4%. The national BRFSS median was 12.6%; this median was exceeded by 18 Steps communities. Of persons with asthma who reported having had an episode of asthma or an asthma attack during the preceding 12 months, the prevalence of persons reporting having had no symptoms in the previous 30 days ranged from 15.4% (95% CI = 9.1--21.7) in Pueblo County, Colorado, to 40.3% (95% CI = 30.5--50) in St. Petersburg-Pinellas County, Florida. Among 10 communities, the median was 20.9% (Table 10).

Physical Activity Among Adults Aged >18 Years

Overall, the estimated prevalence among respondents aged >18 years who reported engaging in moderate physical activity for >30 minutes at least five times a week or who reported engaging in vigorous physical activity for >20 minutes at least three times a week ranged from 42.0% (95% CI = 38.7--45.3) in New Orleans, Louisiana, to 62.2% (95% CI = 59.0--65.3) in Jefferson County, New York (median: 51.1%) (Table 11). The nationwide 2005 BRFSS median was 49.1%; this median was exceeded by 22 Steps communities.

Fruit and Vegetable Consumption Among Adults Aged >18 Years

Overall, the percentage of respondents aged >18 years who reported eating fruits and vegetables at least five times a day ranged from 15.6% (95% CI = 13.7--17.5) in Cherokee Nation, Oklahoma, to 30.3% (95% CI = 27.6--33.0) in Salinas-Monterey County, California (median: 24.9%) (Table 12). The nationwide 2005 BRFSS median of 23.2% was exceeded by 27 Steps communities.

Tobacco Use

Cigarette Smoking Among Adults Aged >18 Years

The estimated prevalence among respondents aged >18 years who reported having smoked at least 100 cigarettes in their lifetime and who were current smokers on every day or some days ranged from 11.0% (95% CI = 7.6--14.4) in Rochester-Olmstead County, Minnesota, to 39.7% (95% CI = 28.8--51.6) in Colville Confederated Tribes, Washington (median: 21.7%) (Table 13). The national 2005 BRFSS median was 20.6%; this median was exceeded by 24 Steps communities. The HP2010 objective (objective no. 27-1a) is to reduce the proportion of adults who smoke to 12.0%.

Tobacco Use Cessation Attempts by Smokers Aged >18 Years

Among 31 communities, the estimated prevalence among smokers aged >18 years who reported having stopped smoking for >1 day during the preceding 12 months because they were trying to quit smoking ranged from 47.8% (95% CI = 41.7--54.0) in Teller County, Colorado, to 63.3% (95% CI = 55.0--71.6) in DeKalb County, Georgia (median: 55.9%) (Table 14). The HP2010 objective (objective no. 27.5) is to increase smoking cessation attempts by adult smokers to 75.0%.

Discussion

The CDC Steps Program responds to community needs and works to affect change at the population level using a community-based approach. The program funds communities across the country to demonstrate how local initiatives across sectors (e.g., community, school, worksite, and health care) in collaboration with traditional and nontraditional partners (e.g., media outlets and departments of, transportation) can reduce the burden of chronic conditions such as obesity, chronic diseases such as diabetes and asthma, and the underlying risk factors of physical inactivity, poor nutrition, and tobacco use. The Steps Program's focus of joining the resources and perspectives of a wide range of sectors and entities dedicated to collaboration for health improvement draws on common interests and accelerates progress toward health promotion efforts. Such efforts create measurable improvements in community health through the selection, implementation, and evaluation of programmatic activities.

The findings in this report indicate variations in the estimated prevalence of chronic conditions and diseases, health-risk behaviors, and use of preventive screening practices across Steps communities. With respect to achieving HP2010 objectives, 18 communities achieved the HP2010 objective to increase the proportion of adults with diabetes who have at least an annual foot examination to 75.0%; five communities achieved the HP2010 objective to increase the proportion of adults with diabetes who have an annual dilated eye examination to 75.0%; one community achieved the HP2010 objective to reduce the proportion of adults who smoke to 12.0%. No communities achieved the HP2010 objective to reduce the proportion of adults who are obese to 15.0% or achieved the HP2010 objective to increase smoking cessation attempts by adult smokers to 75.0%.

Steps communities' use of BRFSS questions for community-specific surveys permits useful collection of data at the local level. The data presented in this report indicate that communities vary widely in prevalence rates of important chronic disease indicators. In part, this variability might reflect differences in state and local laws and policies, enforcement practices, availability of effective community interventions, prevailing behavioral and social norms, demographic and adult practices, characteristics of the population, and other social determinants of health.

Going forward, collection of Steps BRFSS data will provide trend estimates that will permit making community-to-community, national, and HP2010 comparisons. These data also will provide useful information for programmatic decision-making at the community, local, and state levels and guide local health officials and decision-makers in program planning and evaluation. Steps Program staff and other public health and education practitioners can use these data to assess changes in these behaviors over time and assist in evaluating the effectiveness of Steps community programs. An examination of the variations among communities can identify which communities would benefit from additional targeted technical assistance related to effective community interventions and policies. Differences between communities also can alert program managers to the opportunity to learn from each other by taking advantage of the national network they have established within the Steps Program. Communities can use these data to identify, prioritize, and develop community-specific activities to further reduce obesity, diabetes, and asthma by increasing physical activity, encouraging healthy eating, and reducing tobacco use.

Limitations

The findings in this report are subject to at least five limitations. First, the Steps BRFSS survey queries only persons with landline telephone access and excludes persons who reside in households that lack telephone access or persons who use only cellular telephones; therefore, the data might not reflect the characteristics of persons who reside in households without landline telephones. Second, prevalence estimates are self-reported and thus the reported estimates might be subject to recall bias. Third, each Steps community has the option to modify BRFSS data collection methodology, which might preclude standardization in some cases. Fourth, the number of interviews varied widely (range: 490--2,247). Therefore, estimates for some communities are based on smaller sample sizes and might yield unstable estimates for rare events. Finally, Steps BRFSS does not collect information from institutionalized persons, thereby excluding persons residing in nursing homes, long-term--care facilities, and correctional institutions.

Conclusion

Steps BRFSS data enable public health authorities to monitor health risk behaviors over time and support focused prevention and intervention programs. Steps Program staff at the national, state, local, and tribal levels will use these data for decision-making, program planning, and enhancing technical assistance. The Steps Program works to achieve HP2010 objectives by using BRFSS data to enhance existing program activities, focus existing programs on activities with the greatest promise of results, identify opportunities for strategic collaboration, and disseminate lessons learned.

References

  1. Mokdad A, Marks J, Stroup D, Gerberding J. Actual causes of death in the United States, 2000. JAMA 2004;291:1238--45.
  2. CDC. The burden of chronic diseases and their risk factors: national and state perspectives 2004. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2004. Available at: http://www.cdc.gov/nccdphp/burdenbook2004.
  3. Colditz GA. Economic costs of obesity and inactivity. Med Sci Sports Exerc 1999;31:S663--7.
  4. American Lung Association. Trends in asthma morbidity and mortality 2007. New York, NY: American Lung Association; 2007. Available at http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=33347.
  5. CDC. Beh Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005;293:1861--7.
  6. CDC. Behavioral Risk Factor Surveillance System operational and user's guide, version 3.0. Atlanta, GA: US Department of Health and Human Services, CDC; 2004.
  7. SAS Institute, Inc. SAS® version 8.02 [software and documentation]. Cary, NC: SAS Institute; 2001.
  8. Research Triangle Institute. SUDAAN®, version 9 [software and documentation]. Triangle Park, NC: Research Triangle Institute; 2004.
  9. US Department of Health and Human Services. Healthy people 2010: national health promotion and disease prevention objective---full report with commentary. Washington, DC: US Department of Health and Human Services, US Public Health Service; 2000. Available at http://www.cdc.gov/nchs/about/otheract/hpdata2010/abouthp.htm.
  10. CDC. Surveillance of certain health behaviors among states and selected local areas---United States, 2005. In: CDC Surveillance Summaries, May 11, 2007. MMWR 2007;56(No.SS-4).

* One Steps community, the Tohono O'odham Tribe, did not report data because BRFSS does not include persons residing in households without telephones, and this community's low telephone coverage precluded reaching the numbers required for standard sampling methodology.

† The HP2010 objective refers to adults aged >20 years whereas Steps data are collected for adults aged >18 years.


Table 1

TABLE 1. Estimated prevalence of respondents aged >18 years who have a body mass index (BMI) of >25.0 kg/m² calculated from self-reported weight and height, by community — United States, Behavioral Risk Factor Surveillance Steps Communities, 2005 Community Sample Size Weighted % SE* 95% CI† River Region, Alabama 1,197 64.4 1.9 60.7–68.0 Southeast Alabama, Alabama 1,295 71.3 1.7 68.0–74.7 Southeast Alaska Regional Health Consortium, Alaska 538 70.8 2.4 66.1–75.5 Cochise County, Arizona 459 58.1 3.0 52.3–63.9 Santa Cruz County, Arizona 479 67.5 2.5 62.7–72.3 Yuma County, Arizona 459 66.6 2.8 61.0–72.1 Salinas-Monterey County, California 1,556 69.5 1.4 66.7–72.2 Santa Clara County, California 1,557 61.5 1.6 58.5–64.6 Mesa County, Colorado 1,400 59.0 1.5 56.1–62.0 Pueblo County, Colorado 1,415 58.5 1.7 55.2–61.7 Teller County, Colorado 1,470 52.5 1.5 49.6–55.4 Weld County, Colorado 1,376 60.7 1.6 57.6–63.9 Hillsborough, Florida 1,521 61.5 1.6 58.4–64.5 St. Petersburg-Pinellas County, Florida 1,510 56.9 1.5 53.9–59.9 DeKalb County, Georgia 1,839 56.9 1.7 53.5–60.3 New Orleans, Louisiana 1,421 59.8 1.6 56.6–63.0 Boston, Massachusetts 1,533 55.1 § 51.7-58.6 Inter-Tribal Council, Michigan 581 73.3 3.7 66.0–80.5 St. Paul-Ramsey County, Minnesota 465 59.2 2.9 53.5–64.9 Minneapolis, Minnesota 514 55.4 2.8 49.8–60.9 Rochester-Olmstead County, Minnesota 459 59.0 2.8 53.5–64.4 Willmar, Minnesota 475 60.6 2.9 55.0–66.2 Broome County, New York 1,469 61.4 1.7 58.1–64.7 Chautauqua County, New York 1,407 60.7 1.8 57.2–64.2 Jefferson County, New York 1,453 63.4 1.7 60.1–66.7 Rockland County, New York 1,380 59.3 1.8 55.9–62.7 Cleveland, Ohio 1,056 35.4 § 33.0-37.9 Cherokee Nation, Oklahoma 2,138 65.5 1.3 62.9–68.1 Philadelphia, Pennsylvania 1,455 60.2 1.6 57.0–63.4 Fayette County, Pennsylvania 1,493 69.7 1.4 67.1–72.4 Luzerne County, Pennsylvania 1,445 63.2 1.4 60.4–66.0 Tioga County, Pennsylvania 1,478 66.6 1.4 63.9–69.2 Austin, Texas 1,418 59.8 2.0 55.8–63.7 San Antonio, Texas 486 66.0 2.8 60.6–71.4 Chelan-Douglas-Okanogan Counties, Washington 1,507 63.1 1.5 60.1–66.1 Clark County, Washington 1,503 62.0 1.5 59.0–64.9 Colville Confederated Tribes, Washington 150 75.5 § 64.7-83.9 Seattle-King, County, Washington 1,494 56.6 1.5 53.6–59.6 Thurston County, Washington 1,574 60.9 1.6 57.8–63.9 Range 35.4–75.5 Median 60.8 National range 18.2–31.8 National median 24.4% * Standard error. † Confidence interval. § Data analysis conducted by the community; SE not reported.
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Table 2

TABLE 2. Estimated prevalence of respondents aged >18 years who have a body mass index (BMI) of >30.0 kg/m² calculated from self-reported weight and height, by community — United States, Behavioral Risk Factor Surveillance Steps Communities, 2005 Community Sample Size Weighted % SE* 95% CI† River Region, Alabama 1,197 28.7 1.7 25.4–32.1 Southeast Alabama, Alabama 1,295 33.5 1.7 30.2–36.8 Southeast Alaska Regional Health Consortium, Alaska 538 30.8 2.4 26.1–35.5 Cochise County, Arizona 459 27.6 2.7 22.4–32.8 Santa Cruz County, Arizona 479 23.2 2.3 18.7–27.7 Yuma County, Arizona 459 30.6 2.7 25.4–35.9 Salinas-Monterey County, California 1,556 28.5 1.4 25.7–31.2 Santa Clara County, California 1,557 20.6 1.3 18.0–23.1 Mesa County, Colorado 1,400 20.3 1.3 17.8–22.8 Pueblo County, Colorado 1,415 22.6 1.4 19.8–25.3 Teller County, Colorado 1,470 15.6 1.0 13.5–17.6 Weld County, Colorado 1,376 24.0 1.4 21.3–26.8 Hillsborough, Florida 1,521 27.0 1.5 24.0–29.9 St. Petersburg-Pinellas County, Florida 1,510 22.0 1.2 19.5–24.4 DeKalb County, Georgia 1,839 20.6 1.3 18.1–23.2 New Orleans, Louisiana 1,421 24.9 1.4 22.2–27.7 Boston, Massachusetts 1,533 21.4 § 18.7–24.1 Inter-Tribal Council, Michigan 581 44.0 3.9 36.3–51.6 St. Paul-Ramsey County, Minnesota 465 22.4 2.6 17.3–27.5 Minneapolis, Minnesota 514 20.8 2.3 16.4–25.2 Rochester-Olmstead County, Minnesota 459 20.8 2.3 16.3–25.2 Willmar, Minnesota 475 23.6 2.3 19.2–28.0 Broome County, New York 1,469 25.6 1.5 22.7–28.5 Chautauqua County, New York 1,407 23.7 1.5 20.9–26.6 Jefferson County, New York 1,453 24.2 1.5 21.3–27.0 Rockland County, New York 1,380 17.9 1.4 15.2–20.7 Cleveland, Ohio 1,056 33.1 § 30.7–35.5 Cherokee Nation, Oklahoma 2,138 27.8 1.2 25.5–30.1 Philadelphia, Pennsylvania 1,455 28.6 1.4 25.9–31.4 Fayette County, Pennsylvania 1,493 31.0 1.4 28.3–33.7 Luzerne County, Pennsylvania 1,445 25.6 1.3 23.0–28.1 Tioga County, Pennsylvania 1,478 28.1 1.3 25.5–30.6 Austin, Texas 1,418 24.1 1.7 20.7–27.4 San Antonio, Texas 486 31.0 2.5 26.1–35.9 Chelan-Douglas-Okanogan Counties, Washington 1,507 25.3 1.3 22.7–27.9 Clark County, Washington 1,503 25.4 1.3 22.8–28.0 Colville Confederated Tribes, Washington 150 33.3 § 23.1–45.4 Seattle-King, County, Washington 1,494 21.7 1.3 19.3–24.2 Thurston County, Washington 1,574 23.7 1.3 21.1–26.3 Range 15.6–44.0 Median 24.5 National range 18.2–31.8 National median 24.4% Healthy People 2010 (HP 2010) objectiveΆ 15.0 * Standard error. † Confidence interval. § Data analysis conducted by the community; SE not reported. Ά The HP2010 objective refers to adults aged >20 years whereas Steps data are collected for adults aged >18 years.
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Table 3

TABLE 3. Estimated prevalence of respondents aged >18 years who reported ever having been told by a doctor that they have diabetes (other than during pregnancy), by community — United States, Behavioral Risk Factor Surveillance System, 39 Steps Communities, 2005 Community Sample Size Weighted % SE* 95% CI† River Region, Alabama 1,249 10.3 1.0 8.3–12.3 Southeast Alabama, Alabama 1,351 11.4 1.0 9.4–13.3 Southeast Alaska Regional Health Consortium, Alaska 562 8.3 1.4 5.5–11.1 Cochise County, Arizona 490 12.8 1.9 9.2–16.5 Santa Cruz County, Arizona 513 10.8 1.6 7.8–13.8 Yuma County, Arizona 507 9.4 1.4 6.6–12.1 Salinas-Monterey County, California 1,696 8.3 0.7 6.9–9.7 Santa Clara County, California 1,701 8.2 0.8 6.6–9.7 Mesa County, Colorado 1,465 6.9 0.7 5.5–8.3 Pueblo County, Colorado 1,489 8.0 0.8 6.6–9.5 Teller County, Colorado 1,520 4.5 0.6 3.4–5.6 Weld County, Colorado 1,483 5.8 0.7 4.4–7.3 Hillsborough, Florida 1,568 9.2 0.9 7.5–10.9 St. Petersburg-Pinellas County, Florida 1,551 11.0 1.0 9.1–12.9 DeKalb County, Georgia 1,949 6.4 0.6 5.2–7.6 New Orleans, Louisiana 1,495 8.5 0.8 6.9–10.0 Boston, Massachusetts 1,616 7.6 § 6.2–9.0 Inter-Tribal Council, Michigan 610 16.6 3.3 10.1–23.1 St. Paul-Ramsey County, Minnesota 487 4.3 1.0 2.4–6.2 Minneapolis, Minnesota 536 5.2 1.1 3.1–7.3 Rochester-Olmstead County, Minnesota 477 5.8 1.0 3.8–7.8 Willmar, Minnesota 499 6.5 1.1 4.3–8.7 Broome County, New York 1,528 7.6 0.7 6.2–8.9 Chautauqua County, New York 1,486 6.9 0.6 5.7–8.1 Jefferson County, New York 1,524 7.5 0.7 6.2–8.8 Rockland County, New York 1,455 5.8 0.6 4.6–7.0 Cleveland, Ohio 1,107 11.1 § 9.8–12.5 Cherokee Nation, Oklahoma 2,243 9.6 0.7 8.2–10.9 Philadelphia, Pennsylvania 1,516 10.2 0.9 8.4–12.0 Fayette County, Pennsylvania 1,557 11.2 0.8 9.6–12.9 Luzerne County, Pennsylvania 1,516 8.9 0.8 7.3–10.4 Tioga County, Pennsylvania 1,552 11.0 0.9 9.3–12.8 Austin, Texas 1,588 6.8 0.8 5.3–8.3 San Antonio, Texas 527 12.3 1.5 9.4–15.3 Chelan-Douglas-Okanogan Counties, Washington 1,594 7.4 0.7 6.0–8.8 Clark County, Washington 1,594 5.5 0.6 4.4–6.5 Colville Confederated Tribes, Washington 153 10.4 § 5.7–18.5 Seattle-King, County, Washington 1,592 7.0 0.7 5.7–8.2 Thurston County, Washington 1,639 6.9 0.7 5.6–8.1 Range 4.3–16.6 Median 8.1 National range 4.4–12.5 National median 7.3 * Standard error. † Confidence interval. § Data analysis conducted by the community; SE not reported.
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Table 4

TABLE 4. Estimated prevalence of respondents aged >18 years ever told by a doctor that they have diabetes (excluding women who were told only when pregnant) who reported having a clinical foot examination during the preceding 12 months, by community — United States, Behavioral Risk Surveillance System, 39 Steps Communities, 2005 Community Sample Size Weighted % SE* 95% CI† River Region, Alabama 146 81.0 3.7 73.8–88.2 Southeast Alabama, Alabama 175 79.3 3.3 72.8–85.7 Southeast Alaska Regional Health Consortium, Alaska 46 —§ — — Cochise County, Arizona 59 — — — Santa Cruz County, Arizona 59 — — — Yuma County, Arizona 52 — — — Salinas-Monterey County, California 164 65.2 4.2 56.9–73.5 Santa Clara County, California 152 60.4 4.9 50.8–70.0 Mesa County, Colorado 113 81.2 4.4 72.5–89.8 Pueblo County, Colorado 137 74.2 4.1 66.1–82.2 Teller County, Colorado 75 — — — Weld County, Colorado 86 — — — Hillsborough, Florida 154 73.1 4.4 64.5–81.6 St. Petersburg-Pinellas County, Florida 161 64.1 4.9 54.6–73.6 DeKalb County, Georgia 162 72.8 4.8 63.4–82.1 New Orleans, Louisiana 152 83.9 3.5 77.0–90.7 Boston, Massachusetts 145 76.3 Ά 64.9–87.6 Inter-Tribal Council, Michigan 93 93.6 2.5 88.7–98.6 St. Paul-Ramsey County, Minnesota 27 — — — Minneapolis, Minnesota 36 — — — Rochester-Olmstead County, Minnesota 38 — — — Willmar, Minnesota 39 — — — Broome County, New York 149 86.1 3.1 79.9–92.2 Chautauqua County, New York 132 80.2 3.7 72.9–87.6 Jefferson County, New York 147 80.1 3.4 73.4–86.8 Rockland County, New York 105 81.6 4.1 73.5–89.7 Cleveland, Ohio 154 79.7 Ά 68.9–90.5 Cherokee Nation, Oklahoma 0 — — — Philadelphia, Pennsylvania 171 84.0 3.3 77.5–90.5 Fayette County, Pennsylvania 191 75.8 3.3 69.4–82.2 Luzerne County, Pennsylvania 145 73.6 3.9 65.9–81.3 Tioga County, Pennsylvania 166 78.6 3.5 71.8–85.4 Austin, Texas 159 — — — San Antonio, Texas 82 — — — Chelan-Douglas-Okanogan Counties, Washington 131 82.2 3.7 75.0–89.5 Clark County, Washington 114 79.8 4.0 71.9–87.7 Colville Confederated Tribes, Washington — — Ά — Seattle-King, County, Washington 128 77.6 4.1 69.7–85.6 Thurston County, Washington 140 80.8 3.6 73.7–87.9 Range 60.4–93.6 Median 79.5 Healthy People 2010 objective 75.0 * Standard error. † Confidence interval. § Not available if the unweighted sample size for the denominator was <50 or if the CI half width is >10. Ά Data analysis conducted by the community; SE not reported.
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Table 5

TABLE 5. Estimated prevalence of respondents aged >18 years ever told by a doctor that they have diabetes (excluding women who were told only when pregnant) who reported having received a dilated eye examination during the preceding 12 months, by community — United States, Behavioral Risk Factor Surveillance System, 39 Steps Communities, 2005 Community Sample Size Weighted % SE* 95% CI† River Region, Alabama 146 73.6 4.5 64.8–82.4 Southeast Alabama, Alabama 184 73.6 3.8 66.2–81.0 Southeast Alaska Regional Health Consortium, Alaska 45 —§ — — Cochise County, Arizona 60 — — — Santa Cruz County, Arizona 59 — — — Yuma County, Arizona 52 — — — Salinas-Monterey County, California 163 68.9 4.1 60.8–77.0 Santa Clara County, California 152 69.3 4.6 60.4–78.3 Mesa County, Colorado 120 — — — Pueblo County, Colorado 142 75.8 4.0 68.0–83.6 Teller County, Colorado 74 — — — Weld County, Colorado 86 — — — Hillsborough, Florida 159 80.7 3.4 74.0–87.4 St. Petersburg-Pinellas County, Florida 171 72.8 3.9 65.2–80.4 DeKalb County, Georgia 162 — — — New Orleans, Louisiana 158 79.1 4.1 71.0–87.2 Boston, Massachusetts 153 81.9 Ά 74.2–89.7 Inter-Tribal Council, Michigan 93 — — — St. Paul-Ramsey County, Minnesota 27 — — — Minneapolis, Minnesota 36 — — — Rochester-Olmstead County, Minnesota 39 — — — Willmar, Minnesota 41 — — — Broome County, New York 153 72.8 4.1 64.8–80.8 Chautauqua County, New York 136 73.3 4.2 65.1–81.6 Jefferson County, New York 158 66.2 4.3 57.7–74.6 Rockland County, New York 107 81.8 4.2 73.6–90.0 Cleveland, Ohio 154 63.2 Ά 53.5–72.9 Cherokee Nation, Oklahoma 0 — — — Philadelphia, Pennsylvania 172 72.4 4.2 64.1–80.6 Fayette County, Pennsylvania 200 71.6 3.6 64.7–78.6 Luzerne County, Pennsylvania 148 65.9 4.8 56.4–75.3 Tioga County, Pennsylvania 167 63.4 4.4 54.8–71.9 Austin, Texas 167 — — — San Antonio, Texas 84 — — — Chelan-Douglas-Okanogan Counties, Washington 138 — — — Clark County, Washington 115 68.5 4.8 59.0–77.9 Colville Confederated Tribes, Washington — — Ά — Seattle-King, County, Washington 131 71.1 4.4 62.4–79.8 Thurston County, Washington 141 71.5 4.6 62.6–80.4 Range 63.2–81.9 Median 72.0 Healthy People 2010 objective 75.0 * Standard error. † Confidence interval. § Not available if the unweighted sample size for the denominator was <50 or if the CI half width is >10. Ά Data analysis conducted by the community; SE not reported.
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Table 6

TABLE 6. Estimated prevalence of respondents aged >18 years ever told by a doctor that they have diabetes (excluding women who were told only when pregnant) who reported having received a glycosylated hemoglobin measurement (“A1c”) at least twice a year, by community — United States, Behavioral Risk Factor Surveillance System, 39 Steps Communities, 2005 Community Sample Size Weighted % SE* 95% CI† River Region, Alabama 137 66.9 4.8 57.6–76.2 Southeast Alabama, Alabama 166 73.8 3.9 66.2–81.4 Southeast Alaska Regional Health Consortium, Alaska 40 —§ — — Cochise County, Arizona 56 — — — Santa Cruz County, Arizona 54 — — — Yuma County, Arizona 49 — — — Salinas-Monterey County, California 157 61.4 4.3 53.0–69.8 Santa Clara County, California 0 — — — Mesa County, Colorado 108 70.5 4.9 60.8–80.2 Pueblo County, Colorado 122 61.2 4.9 51.6–70.8 Teller County, Colorado 71 — — — Weld County, Colorado 83 — — — Hillsborough, Florida 137 64.7 5.0 54.8–4.5 St. Petersburg-Pinellas County, Florida 147 — — — DeKalb County, Georgia 154 66.6 5.0 56.9–76.4 New Orleans, Louisiana 145 — — — Boston, Massachusetts 122 73.3 Ά 63.7–82.9 Inter-Tribal Council, Michigan 90 89.8 3.2 83.5–96.0 St. Paul-Ramsey County, Minnesota 26 — — — Minneapolis, Minnesota 33 — — — Rochester-Olmstead County, Minnesota 37 — — — Willmar, Minnesota 39 — — — Broome County, New York 146 73.8 4.3 65.4–82.2 Chautauqua County, New York 128 77.2 4.1 69.2–85.2 Jefferson County, New York 143 66.0 4.7 56.8–75.2 Rockland County, New York 94 88.0 3.4 81.4–94.6 Cleveland, Ohio 154 54.8 Ά 45.8–63.8 Cherokee Nation, Oklahoma NA — — — Philadelphia, Pennsylvania 157 64.4 4.7 55.2–73.6 Fayette County, Pennsylvania 181 62.1 4.0 54.2–69.9 Luzerne County, Pennsylvania 135 64.4 4.8 55.0–73.7 Tioga County, Pennsylvania 161 75.2 3.7 68.0–82.5 Austin, Texas 145 — — — San Antonio, Texas 68 — — — Chelan-Douglas-Okanogan Counties, Washington 130 79.8 4.0 71.9–87.7 Clark County, Washington 107 77.9 4.2 69.7–86.2 Colville Confederated Tribes, Washington — — Ά — Seattle-King, County, Washington 125 69.8 4.7 60.7–78.9 Thurston County, Washington 134 76.1 4.4 67.4–84.8 Range 54.8–89.8 Median 69.8% * Standard error. † Confidence interval. § Not available if the unweighted sample size for the denominator was <50 or if the CI half width is >10. Ά Data analysis conducted by the community; SE not reported.
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Table 7

TABLE 7. Estimated prevalence of respondents aged >18 years ever told by a doctor that they have diabetes (excluding women who were told only when pregnant) who reported self–blood glucose monitoring at least two times daily, by community — United States Behavioral Risk Factor Surveillance System, 39 Steps Communities, 2005 Community Sample Size Weighted % SE* 95% CI† River Region, Alabama 146 36.1 5.1 26.2–46.1 Southeast Alabama, Alabama 184 45.0 4.7 35.9–54.1 Southeast Alaska Regional Health Consortium, Alaska 43 —§ — — Cochise County, Arizona 60 — — — Santa Cruz County, Arizona 58 — — — Yuma County, Arizona 51 — — — Salinas-Monterey County, California 164 40.2 4.3 31.7–48.6 Santa Clara County, California 150 33.8 4.9 24.3–43.3 Mesa County, Colorado 117 NA NA NA Pueblo County, Colorado 141 44.4 4.8 35.0–53.8 Teller County, Colorado 76 — — — Weld County, Colorado 89 — — — Hillsborough, Florida 159 43.9 4.9 34.3–53.6 St. Petersburg-Pinellas County, Florida 169 38.5 4.8 29.1–47.8 DeKalb County, Georgia 166 40.2 5.0 30.5–49.9 New Orleans, Louisiana 159 42.8 4.8 33.3–52.2 Boston, Massachusetts 148 38.5 Ά 28.7–48.4 Inter-Tribal Council, Michigan 94 — — — St. Paul-Ramsey County, Minnesota 27 — — — Minneapolis, Minnesota 36 — — — Rochester-Olmstead County, Minnesota 38 — — — Willmar, Minnesota 41 — — — Broome County, New York 155 40.2 4.7 30.9-49.4 Chautauqua County, New York 139 44.1 4.6 35.1–53.2 Jefferson County, New York 157 39.2 4.6 30.2–48.1 Rockland County, New York 107 — — — Cleveland, Ohio 154 42.8 Ά 34.8–50.8 Cherokee Nation, Oklahoma 0 — — — Philadelphia, Pennsylvania 173 46.8 4.7 37.5–56.1 Fayette County, Pennsylvania 202 45.4 3.8 38.0–52.9 Luzerne County, Pennsylvania 150 45.5 4.8 36.0–54.9 Tioga County, Pennsylvania 171 40.0 4.2 31.6–48.3 Austin, Texas 165 28.2 4.6 19.2–37.1 San Antonio, Texas 84 — — — Chelan-Douglas-Okanogan Counties, Washington 136 39.0 4.8 29.7–48.4 Clark County, Washington 112 — — — Colville Confederated Tribes, Washington 0 — Ά — Seattle-King, County, Washington 132 43.0 4.8 33.5–52.4 Thurston County, Washington 139 42.9 5.1 33.0–52.8 Range 28.2–46.8 Median 40.2 * Standard error. † Confidence interval. § Not available if the unweighted sample size for the denominator was <50 or if the CI half width is >10. Ά Data analysis conducted by the community; SE not reported.
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Table 8

TABLE 8. Estimated prevalence of respondents aged >18 years ever told by a doctor that they have diabetes (excluding women who were told only when pregnant, refusals, and unknowns) who reported checking their feet at least one time daily for any sores or irritations, by community — United States, Behavioral Risk Surveillance System, 39 Steps Communities, 2005 Community Sample Size Weighted % SE* 95% CI† River Region, Alabama 147 74.6 4.3 66.1–83.1 Southeast Alabama, Alabama 178 79.2 3.4 72.5–85.9 Southeast Alaska Regional Health Consortium, Alaska 44 —§ — — Cochise County, Arizona 60 — — — Santa Cruz County, Arizona 59 — — — Yuma County, Arizona 51 — — — Salinas-Monterey County, California 163 67.3 4.3 58.9–75.8 Santa Clara County, California 0 — — — Mesa County, Colorado 115 — — — Pueblo County, Colorado 138 77.6 3.9 70.0–85.2 Teller County, Colorado 74 — — — Weld County, Colorado 88 — — — Hillsborough, Florida 158 74.6 4.6 65.6–83.6 St. Petersburg-Pinellas County, Florida 163 65.1 5.0 55.4–74.8 DeKalb County, Georgia 157 NA NA NA New Orleans, Louisiana 157 78.2 4.3 69.8–86.6 Boston, Massachusetts 150 65.3 Ά 54.4–76.3 Inter-Tribal Council, Michigan 91 — — — St. Paul-Ramsey County, Minnesota 27 — — — Minneapolis, Minnesota 35 — — — Rochester-Olmstead County, Minnesota 36 — — — Willmar, Minnesota 38 — — — Broome County, New York 152 64.5 4.4 56.0–73.1 Chautauqua County, New York 136 61.7 4.6 52.7–70.7 Jefferson County, New York 149 78.1 3.5 71.2–85.0 Rockland County, New York 105 74.2 4.5 65.5–83.0 Cleveland, Ohio 154 74.9 Ά 64.4–85.4 Cherokee Nation, Oklahoma 0 — — — Philadelphia, Pennsylvania 169 75.7 4.1 67.8–83.6 Fayette County, Pennsylvania 195 74.8 3.4 68.2–81.3 Luzerne County, Pennsylvania 147 74.7 4.5 65.9–83.4 Tioga County, Pennsylvania 167 69.4 4.0 61.6–77.1 Austin, Texas 162 — — — San Antonio, Texas 83 — — — Chelan-Douglas-Okanogan Counties, Washington 134 65.1 4.7 55.9–74.3 Clark County, Washington 114 — — — Colville Confederated Tribes, Washington 0 — Ά — Seattle-King, County, Washington 131 65.7 4.7 56.5–75.0 Thurston County, Washington 137 75.2 4.1 67.2–83.2 Median 74.6 * Standard error. † Confidence interval. § Not available if the unweighted sample size for the denominator was <50 or if the CI half width is >10. Ά Data analysis conducted by the community; SE not reported.
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Table 9

TABLE 9. Estimated prevalence of respondents aged >18 years who reported being told by health professional that they had asthma, by community — United States, Behavioral Risk Surveillance System, 39 Steps Communities, 2005 Community Sample Size Weighted % SE* 95% CI† River Region, Alabama 1,245 10.4 1.1 8.3–12.4 Southeast Alabama, Alabama 1351 14.2 1.4 11.6–16.8 Southeast Alaska Regional Health Consortium, Alaska 561 10.2 1.4 7.4–13.0 Cochise County, Arizona 490 14.5 2.1 10.4–18.6 Santa Cruz County, Arizona 513 7.0 1.4 4.3–9.7 Yuma County, Arizona 507 14.7 2.0 10.8–18.7 Salinas-Monterey County, California 1,695 9.7 0.9 8.0–11.4 Santa Clara County, California 1701 11.9 1.0 10.0-13.8 Mesa County, Colorado 1,465 12.2 1.0 10.3–14.2 Pueblo County, Colorado 1,485 14.2 1.1 12.0–16.4 Teller County, Colorado 1,521 14.1 1.0 12.1–16.1 Weld County, Colorado 1,480 12.3 1.1 10.2–14.4 Hillsborough, Florida 1,562 11.3 1.0 9.4–13.2 St. Petersburg-Pinellas County, Florida 1,547 13.1 1.0 11.1–15.0 DeKalb County, Georgia 1,946 12.4 1.1 10.3–14.5 New Orleans, Louisiana 1,497 10.2 1.0 8.3–12.2 Boston, Massachusetts § § § § Inter-Tribal Council, Michigan 613 17.6 2.2 13.4–21.9 St. Paul-Ramsey County, Minnesota 486 13.1 2.2 8.7–17.4 Minneapolis, Minnesota 532 15.6 2.0 11.6–19.6 Rochester-Olmstead County, Minnesota 475 9.4 1.6 6.4–12.4 Willmar, Minnesota 499 9.9 1.6 6.7–13.1 Broome County, New York 1,527 13.4 1.2 11.1–15.8 Chautauqua County, New York 1,484 13.5 1.2 11.2–15.8 Jefferson County, New York 1,521 12.7 1.2 10.4–15.1 Rockland County, New York 1,454 11.8 1.3 9.2–14.4 Cleveland, Ohio § § § § Cherokee Nation, Oklahoma 2,239 16.7 1.0 14.6–18.7 Philadelphia, Pennsylvania 1,516 17.6 1.2 15.2–20.0 Fayette County, Pennsylvania 1,553 10.8 0.9 9.1–12.6 Luzerne County, Pennsylvania 1,514 10.0 0.9 8.3–11.7 Tioga County, Pennsylvania 1,553 12.0 0.9 10.2–13.8 Austin, Texas 1,587 10.9 1.2 8.7–13.1 San Antonio, Texas 528 11.7 1.8 8.2–15.2 Chelan-Douglas-Okanogan Counties, Washington 1,589 14.5 1.1 12.3–16.7 Clark County, Washington 1,590 16.2 1.1 14.0–18.5 Colville Confederated Tribes, Washington § § § § Seattle-King, County, Washington 1,591 13.2 1.0 11.2–15.1 Thurston County, Washington 1,632 16.6 1.3 14.2–19.1 Range 7.0–17.6 Median 12.4 National range 8.9–19.3 National median 12.6 * Standard error. † Confidence interval. § Data not provided.
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Table 10

TABLE 10. Estimated prevalence of respondents aged >18 years with asthma who reported having no symptoms of asthma during the preceding 30 days, by community — United States, Behavioral Risk Surveillance System, 39 Steps Communities, 2005 Community Sample Size Weighted % SE* 95% CI† River Region, Alabama 89 —§ — — Southeast Alabama, Alabama 101 — — — Southeast Alaska Regional Health Consortium, Alaska 0 — — — Cochise County, Arizona 51 — — — Santa Cruz County, Arizona 18 — — — Yuma County, Arizona 46 — — — Salinas-Monterey County, California 116 — — — Santa Clara County, California 118 — — — Mesa County, Colorado 121 22.8 4.3 14.4–31.1 Pueblo County, Colorado 143 15.4 3.2 9.1–21.7 Teller County, Colorado 119 24.8 4.6 15.7–33.8 Weld County, Colorado 103 — — — Hillsborough, Florida 105 — — — St. Petersburg-Pinellas County, Florida 138 40.3 5.0 30.5–50.1 DeKalb County, Georgia 0 — — — New Orleans, Louisiana 88 — — — Boston, Massachusetts 0 — Ά — Inter-Tribal Council, Michigan 70 16.0 5.0 6.2–5.8 St. Paul-Ramsey County, Minnesota 0 — — — Minneapolis, Minnesota 0 — — — Rochester-Olmstead County, Minnesota 0 — — — Willmar, Minnesota 0 — — — Broome County, New York 0 — — — Chautauqua County, New York 0 — — — Jefferson County, New York 0 — — — Rockland County, New York 0 — — — Cleveland, Ohio 75 — — 10.3–22.3 Cherokee Nation, Oklahoma 0 — — — Philadelphia, Pennsylvania 172 26.7 4.1 18.6–34.8 Fayette County, Pennsylvania 123 19.8 4.2 11.6–27.9 Luzerne County, Pennsylvania 110 20.9 4.6 11.8–29.9 Tioga County, Pennsylvania 118 21.6 4.0 13.7–29.5 Austin, Texas 123 17.8 4.7 8.5–27.0 San Antonio, Texas 38 — — — Chelan-Douglas-Okanogan Counties, Washington 0 — — — Clark County, Washington 0 — — — Colville Confederated Tribes, Washington — — — — Seattle-King, County, Washington 0 — — — Thurston County, Washington 0 — — — Range 15.4–40.3 Median 20.9 * Standard error. † Confidence interval. § Not available if the unweighted sample size for the denominator was <50 or if the CI half width is >10.
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Table 11

TABLE 11. Estimated prevalence of number of adults aged >18 years who reported moderate physical activity for >30 minutes at least five times a week or who reported vigorous physical activity for >20 minutes at least three times a week, by community — United States, Behavioral Risk Surveillance System, 39 Steps Communities, 2005 Community Sample Size Weighted % SE* 95% CI† River Region, Alabama 1,188 43.5 1.9 39.8–47.2 Southeast Alabama, Alabama 1,263 44.7 1.9 41.0–48.4 Southeast Alaska Regional Health Consortium, Alaska 529 59.9 2.6 54.8–64.9 Cochise County, Arizona 458 54.0 2.9 48.2–59.7 Santa Cruz County, Arizona 476 48.2 2.8 42.8–53.6 Yuma County, Arizona 478 48.0 2.9 42.4–53.6 Salinas-Monterey County, California 1,562 51.7 1.6 48.6–54.8 Santa Clara County, California 1,594 44.9 1.6 41.8–48.0 Mesa County, Colorado 1,358 54.7 1.6 51.7–57.8 Pueblo County, Colorado 1,377 53.6 1.7 50.3–56.9 Teller County, Colorado 1,409 57.6 1.5 54.7–60.5 Weld County, Colorado 1,388 52.0 1.6 48.8–55.2 Hillsborough, Florida 1,469 46.6 1.6 43.4–49.7 St. Petersburg-Pinellas County, Florida 1,454 44.1 1.5 41.1–47.1 DeKalb County, Georgia 1,818 44.6 1.7 41.2–48.0 New Orleans, Louisiana 1,385 42.0 1.7 38.7–45.3 Boston, Massachusetts 1,522 51.1 § 47.7–54.5 Inter-Tribal Council, Michigan 417 52.7 3.2 46.4–59.0 St. Paul-Ramsey County, Minnesota 467 55.2 3.0 49.4–61.0 Minneapolis, Minnesota 496 56.6 2.9 50.9–62.3 Rochester-Olmstead County, Minnesota 445 52.5 2.9 46.8–58.2 Willmar, Minnesota 458 46.5 2.9 40.8–52.2 Broome County, New York 1436 51.3 1.7 47.9–54.6 Chautauqua County, New York 1359 51.8 1.8 48.3–55.3 Jefferson County, New York 1423 62.2 1.6 59.0–65.3 Rockland County, New York 1377 47.0 1.8 43.4–50.5 Cleveland, Ohio 1,020 44.4 § 41.6–47.2 Cherokee Nation, Oklahoma 2,086 43.7 1.4 41.0–46.4 Philadelphia, Pennsylvania 1,373 47.6 1.7 44.3–50.9 Fayette County, Pennsylvania 1,418 47.8 1.5 44.8–50.8 Luzerne County, Pennsylvania 1,384 51.1 1.5 48.1–54.1 Tioga County, Pennsylvania 1,395 52.0 1.5 49.1–54.9 Austin, Texas 1,501 50.6 2.0 46.7–54.4 San Antonio, Texas 482 42.8 2.8 37.3–48.4 Chelan-Douglas-Okanogan Counties, Washington 1,494 55.4 1.5 52.3–58.4 Clark County, Washington 1,520 54.7 1.5 51.6–57.7 Colville Confederated Tribes, Washington 145 48.8 § 37.3–60.4 Seattle-King, County, Washington 1,505 51.1 1.6 48.1–54.2 Thurston County, Washington 1,546 58.9 1.6 55.8–61.9 Range 42.0–62.2 Median 51.1 National range 35.7–59.2 National median 49.1 * Standard error. † Confidence interval. § Data analysis conducted by the community; SE not reported.
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Table 12

TABLE 12. Estimated prevalence of respondents aged >18 years who reported eating at least five fruits and vegetables per day, by community —United States, Behavioral Risk Surveillance System, 39 Steps Communities, 2005 Community Sample Size Weighted % SE* 95% CI† River Region, Alabama 1,228 23.3 1.6 20.1–26.5 Southeast Alabama, Alabama 1,325 22.6 1.5 19.7–25.5 Southeast Alaska Regional Health Consortium, Alaska 563 20.8 2.1 16.7–24.9 Cochise County, Arizona 484 26.8 2.4 22.0–31.6 Santa Cruz County, Arizona 499 28.4 2.4 23.7–33.1 Yuma County, Arizona 493 21.3 2.2 17.0–25.6 Salinas-Monterey County, California 1,697 30.3 1.4 27.6–33.0 Santa Clara County, California 1,649 28.0 1.4 25.3–30.8 Mesa County, Colorado 1,440 23.6 1.2 21.2–26.0 Pueblo County, Colorado 1,464 18.9 1.2 16.5–21.3 Teller County, Colorado 1,485 22.7 1.2 20.4–25.0 Weld County, Colorado 1,456 20.1 1.3 17.7–22.6 Hillsborough, Florida 1,537 27.7 1.4 24.9–30.5 St. Petersburg-Pinellas County, Florida 1,524 25.9 1.3 23.4–28.4 DeKalb County, Georgia 1,911 28.2 1.5 25.2–31.1 New Orleans, Louisiana 1,482 24.0 1.4 21.3–26.6 Boston, Massachusetts 1,601 24.8 § 21.9–27.6 Inter-Tribal Council, Michigan 613 21.6 3.5 14.8–28.4 St. Paul-Ramsey County, Minnesota 482 24.6 2.5 19.8–29.4 Minneapolis, Minnesota 532 25.4 2.3 20.8–29.9 Rochester-Olmstead County, Minnesota 473 22.5 2.2 18.3–26.8 Willmar, Minnesota 487 20.7 2.3 16.3–25.1 Broome County, New York 1,528 25.5 1.4 22.8–28.3 Chautauqua County, New York 1,87 26.2 1.5 23.3–29.1 Jefferson County, New York 1,526 26.4 1.5 23.5–29.4 Rockland County, New York 1,454 28.3 1.7 24.9–31.6 Cleveland, Ohio 1,031 29.2 § 27.9–31.5 Cherokee Nation, Oklahoma 2,225 15.6 1.0 13.7–17.5 Philadelphia, Pennsylvania 1,459 26.2 1.4 23.4–29.0 Fayette County, Pennsylvania 1,517 20.1 1.2 17.8–22.4 Luzerne County, Pennsylvania 1,481 23.8 1.2 21.4–26.2 Tioga County, Pennsylvania 1,533 26.0 1.2 23.6–28.5 Austin, Texas 1,586 25.3 1.6 22.1–28.4 San Antonio, Texas 511 18.8 2.1 14.7–23.0 Chelan-Douglas-Okanogan Counties, Washington 1,572 24.9 1.4 22.3–27.6 Clark County, Washington 1,584 25.0 1.3 22.5–27.4 Colville Confederated Tribes, Washington 153 24.8 § 16.2–36.0 Seattle-King, County, Washington 1,583 26.7 1.3 24.1–29.2 Thurston County, Washington 1,627 26.2 1.3 23.6–28.8 Range 15.6–30.3 Median 24.9 National range 14.3–32.3 National median 23.2 * Standard error. † Confidence interval. § Data analysis conducted by the community; SE not reported.
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Table 13

TABLE 13. Estimated prevalence of respondents aged >18 years who reported having smoked >100 cigarettes in their lifetime and who are current smokers on every day or some days, by community — United States, Behavioral Risk Surveillance System, 39 Steps Communities, 2005 Community Sample Size Weighted % SE* 95% CI† River Region, Alabama 1,246 21.7 1.6 18.6–24.8 Southeast Alabama, Alabama 1,349 22.4 1.6 19.3–25.5 Southeast Alaska Regional Health Consortium, Alaska 557 34.7 2.5 29.8–39.6 Cochise County, Arizona 487 20.8 2.4 16.2–25.5 Santa Cruz County, Arizona 512 21.3 2.3 16.8–25.7 Yuma County, Arizona 504 13.1 2.0 9.2–17.0 Salinas-Monterey County, California 1,697 14.8 1.1 12.6–17.0 Santa Clara County, California 1,698 14.9 1.1 12.8–17.1 Mesa County, Colorado 1,462 22.6 1.4 19.9–25.2 Pueblo County, Colorado 1,485 24.9 1.5 22.1–27.8 Teller County, Colorado 1,513 22.2 1.2 19.8–24.6 Weld County, Colorado 1,478 21.4 1.3 18.9–24.0 Hillsborough, Florida 1,558 24.8 1.5 21.9–27.8 St. Petersburg-Pinellas County, Florida 1,544 28.9 1.4 26.2–31.7 DeKalb County, Georgia 1,943 14.1 1.2 11.8–16.4 New Orleans, Louisiana 1,491 18.8 1.3 16.3–21.3 Boston, Massachusetts 1,612 17.1 § 14.7–19.5 Inter-Tribal Council, Michigan 612 33.6 2.5 28.8–38.5 St. Paul-Ramsey County, Minnesota 486 18.7 2.6 13.7–23.7 Minneapolis, Minnesota 532 22.0 2.3 17.4–26.6 Rochester-Olmstead County, Minnesota 476 11.0 1.7 7.6–14.4 Willmar, Minnesota 497 20.6 2.5 15.6–25.5 Broome County, New York 1,525 24.3 1.6 21.2–27.3 Chautauqua County, New York 1,484 23.6 1.5 20.7–26.6 Jefferson County, New York 1,519 22.4 1.4 19.6–25.2 Rockland County, New York 1,450 14.1 1.3 11.6–16.5 Cleveland, Ohio 1,103 31.6 § 29.3–33.9 Cherokee Nation, Oklahoma 2,238 28.5 1.2 26.0–30.9 Philadelphia, Pennsylvania 1,509 25.5 1.4 22.7–28.3 Fayette County, Pennsylvania 1,555 25.9 1.3 23.4–28.4 Luzerne County, Pennsylvania 1,510 27.7 1.3 25.1–30.3 Tioga County, Pennsylvania 1,547 23.4 1.2 21.1–25.7 Austin, Texas 1,584 20.2 1.6 17.0–23.4 San Antonio, Texas 528 19.8 2.2 15.4–24.1 Chelan-Douglas-Okanogan Counties, Washington 1,587 21.0 1.3 18.4–23.5 Clark County, Washington 1,587 19.5 1.2 17.1–21.9 Colville Confederated Tribes, Washington 151 39.7 § 28.8–51.6 Seattle-King, County, Washington 1,587 18.6 1.2 16.3–21.0 Thurston County, Washington 1,632 19.1 1.3 16.6–21.6 Range 11.0–39.7 Median 21.6 National range 8.1–28.7 National median 20.6 Healthy People 2010 objective 12.0 * Standard error. † Confidence interval. § Data analysis conducted by the community; SE not reported.
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Table 14

TABLE 14. Estimated prevalence of respondents aged >18 years who reported having stopped smoking for >1 day because they were trying to quit smoking during the preceding 12 months, by community — United States, Behavioral Risk Surveillance System, 39 Steps Communities, 2005 Community Sample Size Weighted % SE* 95% CI† River Region, Alabama 245 48.0 4.2 39.6–56.3 Southeast Alabama, Alabama 273 55.7 4.0 47.9–63.4 Southeast Alaska Regional Health Consortium, Alaska 174 48.3 4.6 39.3–57.3 Cochise County, Arizona 94 —§ — — Santa Cruz County, Arizona 98 — — — Yuma County, Arizona 59 — — — Salinas-Monterey County, California 225 57.9 4.1 49.8–65.9 Santa Clara County, California 235 54.7 4.0 47.0–62.5 Mesa County, Colorado 298 52.3 3.5 45.6–59.1 Pueblo County, Colorado 320 57.5 3.5 50.8–64.3 Teller County, Colorado 329 47.8 3.1 41.7–54.0 Weld County, Colorado 300 59.5 3.4 52.9–66.1 Hillsborough, Florida 362 58.9 3.6 51.8–66.0 St. Petersburg-Pinellas County, Florida 413 53.3 3.0 47.4–59.0 DeKalb County, Georgia 260 63.3 4.3 55.0–71.6 New Orleans, Louisiana 270 62.1 3.7 54.9–69.4 Boston, Massachusetts 215 58.0 4.6 48.9–67.0 Inter-Tribal Council, Michigan 300 59.9 Ά 52.6–67.1 St. Paul-Ramsey County, Minnesota 85 — — — Minneapolis, Minnesota 120 — — — Rochester-Olmstead County, Minnesota 57 — — — Willmar, Minnesota 89 — — — Broome County, New York 320 50.8 3.8 43.3–58.2 Chautauqua County, New York 312 52.3 3.7 45.1–59.6 Jefferson County, New York 313 55.0 3.6 48.0–62.0 Rockland County, New York 192 51.8 5.0 42.1–61.5 Cleveland, Ohio 319 61.1 Ά 55.5–66.7 Cherokee Nation, Oklahoma 608 53.2 2.6 48.0–58.4 Philadelphia, Pennsylvania 364 63.2 3.1 57.0–69.3 Fayette County, Pennsylvania 381 52.2 3.0 46.4–58.1 Luzerne County, Pennsylvania 394 56.0 2.9 50.4–61.5 Tioga County, Pennsylvania 346 53.2 3.0 47.3–59.0 Austin, Texas 303 59.9 4.3 51.5–68.2 San Antonio, Texas 95 — — — Chelan-Douglas-Okanogan Counties, Washington 314 61.6 3.3 55.1–68.0 Clark County, Washington 287 56.6 3.6 49.6–63.5 Colville Confederated Tribes, Washington 51 56.6 Ά 36.9–74.5 Seattle-King, County, Washington 288 51.2 3.6 44.1–58.2 Thurston County, Washington 275 58.0 3.6 50.9–65.2 Range 47.8–63.3 Median 55.9 Healthy People 2010 objective 75.0 * Standard error. † Confidence interval. § Not available if the unweighted sample size for the denominator was <50 or if the CI half width is >10. Ά Data analysis conducted by the community; SE not reported.
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