Peer Reviewed: Workers’ Health Risk Behaviors by State, Demographic Characteristics, and Health Insurance Status

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Abstract
Employers often lack data about their workers' health risk behaviors. We analyzed state-level prevalence data among workers for 4 common health risk behaviors: obesity, physical inactivity, smoking, and missed influenza vaccination (among workers older than 50 years). We analyzed 2007 and 2008 Behavioral Risk Factor Surveillance System data, restricting the sample to employed respondents aged 18 to 64 years. We stratified health risk behavior prevalence by annual household income, educational attainment, health insurance status, and race/ethnicity. For all 4 health risk behaviors, we found significant differences across states and significant disparities related to social determinants of health - income, education, and race/ethnicity. Among uninsured workers, prevalence of smoking was high and influenza vaccinations were lacking. In this national survey study, we found that workers' health risk behaviors vary substantially by state and by workers' socioeconomic status, insurance status, and race/ethnicity. Employers and workplace health promotion practitioners can use the prevalence tables presented in this article to inform their workplace health promotion programs.
VOLUME 8: NO. 1 JANUARY 2011
Workers’ Health Risk Behaviors by State,
Demographic Characteristics, and Health
Insurance Status
ORIGINAL RESEARCH
Suggested citation for this article: Huang Y, Hannon PA,
Williams B, Harris JR. Workershealth risk behaviors by
state, demographic characteristics, and health insurance
status. Prev Chronic Dis 2011;8(1). http://www.cdc.gov/
pcd/issues/2011/jan/10_0017.htm. Accessed [date].
PEER REVIEWED
Abstract
Introduction
Employers often lack data about their workers’ health
risk behaviors. We analyzed state-level prevalence data
among workers for 4 common health risk behaviors: obe-
sity, physical inactivity, smoking, and missed influenza
vaccination (among workers older than 50 years).
Methods
We analyzed 2007 and 2008 Behavioral Risk Factor
Surveillance System data, restricting the sample to
employed respondents aged 18 to 64 years. We strati-
fied health risk behavior prevalence by annual household
income, educational attainment, health insurance status,
and race/ethnicity.
Results
For all 4 health risk behaviors, we found significant dif-
ferences across states and significant disparities related
to social determinants of health income, education, and
race/ethnicity. Among uninsured workers, prevalence of
smoking was high and influenza vaccinations were lacking.
Conclusion
In this national survey study, we found that workers
health risk behaviors vary substantially by state and by
workers socioeconomic status, insurance status, and race/
ethnicity. Employers and workplace health promotion prac-
titioners can use the prevalence tables presented in this arti-
cle to inform their workplace health promotion programs.
Introduction
Health risk behaviors are common among workers, are
strongly related to chronic illness and death, increase
health care costs, and reduce productivity (1). One key to a
successful workplace health promotion program is to mea-
sure workers’ baseline health needs and use the data to
inform the program (2,3). However, most employers do not
have access to data about their workers’ health behaviors.
Many midsized and small employers lack the resources
to conduct health risk appraisals (HRAs). In addition,
employer-run HRAs often have low response rates and
overrepresent healthy workers (4).
Readily available data about risk behaviors could help
employers plan and evaluate their workplace health pro-
motion programs. Obesity, physical inactivity, and tobacco
use are 3 of the most common lifestyle health risk behav-
iors in the United States (5,6) and cause approximately
one-third of all deaths (7). Influenza vaccination is also
of interest to employers because influenza leads to lost
productivity and can trigger severe pulmonary and car-
diovascular diseases. Vaccination reduces the incidence of
influenza and can save employers money in a short time
frame (1 year or less) (8).
The objective of this study was to provide employers
and other workplace health promotion practitioners with
Yi Huang, MD; Peggy A. Hannon, PhD, MPH; Barbara Williams, PhD; Jeffrey R. Harris, MD, MPH, MBA
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health
and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
www.cdc.gov/pcd/issues/2011/jan/10_0017.htm • Centers for Disease Control and Prevention 1
VOLUME 8: NO. 1
JANUARY 2011
2 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2011/jan/10_0017.htm
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the
Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and
does not imply endorsement by any of the groups named above.
state-specific data for these 4 health risk behaviors (obesi-
ty, physical inactivity, smoking, and no influenza vaccina-
tion [among workers older than 50 years]) among workers.
We stratified the behaviors by insurance status and social
determinants of health: annual household income, educa-
tional attainment, and race/ethnicity. To meet this objec-
tive, we show the prevalence of each health risk behavior
by state and workers’ characteristics, using data from
the 2007 and 2008 Behavioral Risk Factor Surveillance
System (BRFSS), the most recent data available.
Methods
Design
We conducted a cross-sectional study by using BRFSS
data collected in 2007 and 2008. With assistance from the
Centers for Disease Control and Prevention (CDC), state
health departments conduct BRFSS surveys among US
resident civilian, noninstitutionalized adults aged 18 years
or older in all 50 states, the District of Columbia, and US
territories (9).
Using a multistage cluster design, BRFSS selects state-
specific probability samples of households to produce
a nationally representative sample (5). After calling a
selected home telephone number, the interviewer ran-
domly chooses 1 adult in that household to complete the
telephone interview. BRFSS data are weighted by race/
ethnicity, age, and sex distributions found in each state,
along with the respondent’s probability of selection.
Sample
The median cooperation rate, or the proportion of all
respondents interviewed from all eligible units in which a
respondent was selected and contacted, was 72.1% in 2007
and 75.0% in 2008 (10,11). Our study population included
employed adults aged 18 to 64 years in 50 states and
the District of Columbia. We considered adults employed
if they were employed for wages or self-employed. We
excluded adults older than 64 years because Medicare is
available for most of this group.
Measures
The BRFSS questionnaire has 3 parts: core questions,
optional modules, and state-added questions. All states
must ask core questions every year or every other year.
States may also choose optional modules or add their own
questions to meet their specific data needs. Both English-
and Spanish-language versions of the survey are provided
to each state.
In this article, all data are from the core questions
used in every state. The health risk behaviors are life-
style behaviors (obesity, physical inactivity, and smoking)
and no influenza vaccination in the past year. Obesity is
defined as having a body mass index of at least 30 kg/m
2
(12). Physical inactivity is defined as not meeting the
CDC physical activity guideline of at least 5 days per
week for 30 minutes per day of moderate-intensity activ-
ity or at least 3 days per week for 20 minutes a day of
vigorous-intensity activity (13,14). Tobacco use is defined
as ever having smoked at least 100 cigarettes and cur-
rently smoking every day or some days. Workers aged 50
to 64 years who reported no influenza vaccination in the
past 12 months (either by injection or nasal spray) were
defined as not vaccinated. We restricted the influenza
vaccination analysis to workers older than age 50 because
CDC’s Advisory Committee on Immunization Practices
recommends influenza vaccination for those adults (15).
We analyzed workerssocioeconomic status (SES), race/
ethnicity, health insurance status, and health risk behav-
iors. The SES measures are annual household income
and educational attainment as reported in the BRFSS
data. We used 2007 BRFSS data for the physical inactiv-
ity measure because these questions were not included
in the 2008 survey. We used 2008 data for the rest of the
measures.
Analysis
We calculated national and state rates for workers
stratified by 1) annual household income (<$35,000,
$35,000-$74,999, >$75,000), 2) educational attainment
(high school graduate or less, some college, college
graduate), 3) health insurance (any, none), and 4) race/
ethnicity (African American, American Indian/Alaska
Native, Asian/Hawaiian/Pacific Islander, Hispanic, and
white). We identified the national prevalence of each health
risk behavior among workers, the range across states, and
the range across states for characteristics associated with
the highest risk behavior prevalence nationally.
Our analysis took into account the survey design and
VOLUME 8: NO. 1
JANUARY 2011
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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the
Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and
does not imply endorsement by any of the groups named above.
weighted sampling probabilities of the data source and
was performed by using Stata version 10.0 (StataCorp
LP, College Station, Texas). All the statistical tests were
2-sided and significance was set at P < .05. We calculated
95% confidence intervals (CIs) for all prevalence rates
(versions of the tables with CIs are available from the cor-
responding author on request). Because of the very small
numbers of respondents in some categories, we restricted
the prevalence estimates to the categories in which there
were 50 or more respondents.
Results
Final sample
There were 430,912 respondents in the 2007 BRFSS,
and 414,509 respondents in the 2008 BRFSS. When we
restricted our data sample to employed respondents aged
18 to 64 years, 48.3% of the 2007 sample (physical inactiv-
ity) and 47.5% of the 2008 sample (obesity, smoking, and
influenza vaccination) remained. For each of the analy-
ses described below, we excluded respondents who were
missing data for the health risk behavior under study;
therefore, the number of subjects varies slightly across
the analyses. We further excluded respondents who were
missing data for SES, insurance status, or race/ethnicity
from all analyses stratified by these characteristics (8.3%
in 2007 and 8.0% in 2008 were missing 1 or more of these
variables). Thus, of the respondents who met our employ-
ment and age criteria, we were able to include more than
85% in our analyses (range: 87.0% for physical activity to
91.8% for smoking).
Obesity
In 2008, 27.0% of employed adults in the United States
were obese (Table 1); obesity rates were lowest in Colorado
(19.5%) and were highest in West Virginia (34.6%).
Nationally, the highest obesity rates were reported by
those with annual household incomes less than $35,000
(30.2%), those who did not graduate from college (30.5%),
and African Americans (37.3%). Obesity rates among
workers with these characteristics varied significantly
across states, from 21.8% (95% CI, 18.3%-25.2%) in
Colorado to 39.2% (95% CI, 35.0%-43.4%) in Mississippi
for low-income workers; from 23.5% (95% CI, 21.0%-
26.1%) in Massachusetts to 39.1% (95% CI, 33.1%-45.1%)
in Tennessee among workers with a high school education
or less; and from 17.9% (95% CI, 6.5%-29.4%) in Nevada
to 49.9% (95% CI, 33.3%-66.4%) in Nebraska for African
American workers.
Physical inactivity
In 2007, 49.2% of employed adults did not meet physi-
cal activity recommendations (Table 2); physical inactiv-
ity rates were lowest in Alaska (37.2%) and highest in
Louisiana (58.4%). Nationally, the highest physical inactiv-
ity rates were reported by workers with household incomes
less than $35,000 (54.3%), high school education or less
(52.5%), and Asians/Hawaiians/Pacific Islanders (63.1%).
Physical inactivity rates for workers with these charac-
teristics varied significantly across states, from 42.5%
(95% CI, 37.8%-47.2%) in Montana to 68.7% (95% CI,
63.0%-74.3%) in Tennessee for low-income workers; from
36.1% (95% CI, 29.4%-42.8%) in Alaska to 61.0% (95% CI,
57.0%-65.1%) in Louisiana for workers with a high school
education or less; and from 40.1% (95% CI, 22.1%-58.1%) in
Pennsylvania to 70.2% (95% CI, 63.3%-77.1%) in California
for Asian/Hawaiian/Pacific Islander workers.
Smoking
In 2008, 19.2% of employed adults reported that they
currently smoke cigarettes (Table 3); smoking rates were
lowest in Utah (9.8%) and highest in Indiana (27.6%).
Nationally, the highest smoking rates were reported
by workers with household incomes less than $35,000
(28.9%), high school education or less (29.3%), no health
insurance (32.5%), and American Indians/Alaska Natives
(27.8%). Among workers with these characteristics, smok-
ing rates varied significantly across states, from 15.3%
(95% CI, 11.1%-19.5%) in Utah to 45.6% (95% CI, 38.4%-
52.8%) in Indiana for low-income workers; from 17.6%
(95% CI, 14.2%-21.0%) in Utah to 41.1% (95% CI, 35.7%-
46.5%) in Indiana for workers with high school education
or less; from 13.8% (95% CI, 9.1%-18.5%) in Utah to 54.9%
(95% CI, 45.9%-63.9%) in Indiana for uninsured workers;
and from 10.9% (95% CI, 2.3%-19.5%) in Arizona to 53.1%
(95% CI, 32.6%-73.5%) in North Dakota for American
Indian/Alaska Native workers.
No influenza vaccination
In 2008, 59.3% of workers aged 50 to 64 years reported
no influenza vaccination (Table 4); the lowest rate was
in South Dakota (47.1%) and the highest was in Nevada
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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the
Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and
does not imply endorsement by any of the groups named above.
(71.4%). Nationally, workers most likely to report no
influenza vaccination had household income less than
$35,000 (68.6%), high school education or less (66.3%),
no health insurance (77.1%), and were Hispanic (67.1%).
Among workers with these characteristics, rates of no
influenza vaccination varied significantly across states,
from 49.0% in Virginia (95% CI, 36.3%-61.7%) to 83.3%
(95% CI, 77.1%-89.4%) in Nevada for low-income work-
ers; from 51.6% (95% CI, 46.6%-56.6%) in South Dakota
to 82.0% (95% CI, 75.5%-88.5%) in Nevada for workers
with a high school education or less; from 59.5% (95% CI,
47.6%-71.4%) in Iowa to 90.2% (95% CI, 83.3%-97.1%) in
Indiana for uninsured workers; and from 50.9% (95% CI,
34.7%-67.0%) in Hawaii to 84.3% (95% CI, 75.0%-93.6%) in
Nevada for Hispanic workers.
Discussion
The most effective workplace health promotion efforts
are tailored to the risk behaviors and needs of the work-
ers (2,3). However, for many employers, data describing
their workers are unavailable or unrepresentative of their
workforce (4,16). To address this need, we used BRFSS
data, a very large, recent data set of employed adults in
the United States, and calculated prevalence for 4 common
health risk behaviors stratified by state and by the worker
characteristics that employers routinely collect to describe
their workforce.
In this national sample of employed adults aged 18 to 64
years, we found significant disparities related to SES and
race/ethnicity for all 4 health risk behaviors and significant
disparities by insurance status for smoking and influenza
vaccination. We also found significant variations in health
risk behaviors within and across states. Our findings both
replicate and extend our prior study of employed workers
health risk behaviors, which found significant disparities
by SES and race/ethnicity among insured workers (6).
The findings make state-level data for workers available
for the first time, include uninsured workers, and show
that disparities are worse for the uninsured for influenza
vaccination and tobacco use than for obesity and physical
inactivity.
Limitations
Our study and prevalence tables have several limita-
tions. First, BRFSS includes only people who have home
telephones and speak either English or Spanish. Second,
all of the health risk behaviors are self-reported. These 2
limitations suggest that our results may underreport the
prevalence of workers’ health risk behaviors. Third, in
many states, fewer than 50 members of some racial/ethnic
groups were included in the sample, and we were not able
to present health risk behavior rates in these cases. In
other states, we were able to present health risk behavior
rates for every racial/ethnic group, but some of the con-
fidence intervals are wide because of small numbers in
these groups. Fourth, our study was cross-sectional; our
findings show associations between characteristics and
health risk behaviors but not causation.
An important limitation of our study is that the preva-
lence tables are at the state rather than the local level. As
such, they cannot provide employers with as accurate a
view of their workers’ health risk behaviors as they could
achieve by surveying their workers. For many employers,
acquiring health behavior data from their own workers
is often not feasible. Finally, our findings do not address
the time and financial challenges employers face in imple-
menting workplace health promotion programs. However,
our findings can serve employers by 1) providing data on
the health risks of workers in their state with similar char-
acteristics to those of their own workforce (comparable to
the intent of county health-ranking systems that motivate
policy makers to take action to improve health risks in
their counties [17]) and 2) serving as a planning tool for an
individual employer’s health promotion efforts.
Conclusion
To our knowledge, this is the first time that state-level
BRFSS tables summarizing health risk behaviors of the
US employed population have been made available. We
found significant differences in workers’ health behav-
iors across states and within states, depending on their
SES, insurance status, and race/ethnicity. Employers,
workplace health promotion professionals, insurers, and
vendors can use these tables to inform workplace health
promotion planning when data for a given employer’s
workers are not available.
Acknowledgments
Research supporting the information in this article
was sponsored by the University of Washington Health
VOLUME 8: NO. 1
JANUARY 2011
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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the
Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and
does not imply endorsement by any of the groups named above.
Promotion Research Center, a CDC Prevention Research
Center (HPRC cooperative agreement no. U48/DP000050-
03). Additional funding support came from CDC and the
National Cancer Institute through the Cancer Prevention
and Control Research Network, a network within the
CDC Prevention Research Centers program (grant no.
1-U48-DP-000050), and the CDC Office of Public Health
Research through its Centers of Excellence in Health
Marketing and Health Communication program (grant no.
5-P01-CD000249-03).
Author Information
Corresponding Author: Peggy A. Hannon, PhD, MPH,
University of Washington, 1107 NE 45th St, Ste 200,
Seattle, WA 98105. Telephone: 206-616-7859. E-mail:
peggyh@uw.edu.
Author Affiliations: Yi Huang, Barbara Williams,
Jeffrey R. Harris, University of Washington, Seattle,
Washington.
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VOLUME 8: NO. 1
JANUARY 2011
6 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2011/jan/10_0017.htm
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the
Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and
does not imply endorsement by any of the groups named above.
Tables
Table 1. Prevalence of Obesity
a
by State Among Workers Aged 18 to 64 Years, 2008 Behavioral Risk Factor Surveillance System
(BRFSS)
State
No. of
Respon-
dents
c
Prevalence of Obesity
b
, %
Overall
Annual Household Income, $ Educational Attainment
Health Insurance
Status Race/Ethnicity
<35,000
35,000-
74,999 ≥75,000
High
School
Graduate
or Less
Some
College
College
Graduate Any None White
African
American
Asian/
Hawaiian/
Pacific
Islander
American
Indian/
Alaska
Native Hispanic
Alabama 2,561 32.3 37.2 36.4 26.7 35.0 35.9 26.7 32.9 29.4 30.3 39.1
Alaska 1,631 25.3 25.2 25.7 26.5 26.9 28.6 20.4 27.5 15.8 25.8 34.0 9.4
Arizona 2,214 25.7 26.2 32.1 23.2 29.6 24.8 23.1 25.3 27.5 22.7 49.5 31.5
Arkansas 2,369 30.8 34.1 33.9 25.9 33.7 31.0 27.3 31.1 30.1 30.4 37.0 30.8
California 5,258 24.5 27.5 26.5 21.3 28.9 27.0 18.5 24.1 26.5 23.2 33.3 7.5 29.3
Colorado 5,946 19.5 21.8 20.0 18.2 23.7 22.4 15.1 19.3 20.6 18.2 27.6 5.7 25.4
Connec-
ticut
2,884 20.6 24.3
22.2 19.6 24.7 22.8 17.5 20.6 19.4 19.8 30.2 9.7 28.9
Delaware 1,934 29.0 36.4 32.0 24.8 33.4 34.8 22.7 28.2 39.0 25.7 47.6 46.8
District of
Columbia
2,170 20.9 28.4 26.8 15.9 32.3 36.9 14.1 20.5 26.1 9.6 34.4 19.9
Florida 4,353 25.0 30.3 23.7 24.8 32.4 25.8 18.4 25.1 24.1 23.5 33.2 28.3
Georgia 2,650 27.6 32.3 28.6 24.8 32.0 34.7 20.6 27.4 29.1 24.2 39.1 27.5
Hawaii 3,466 23.2 25.0 23.9 21.6 27.4 25.2 18.6 23.4 20.2 19.0 17.4 29.2
Idaho 2,382 26.1 29.2 26.2 23.7 25.2 32.8 21.2 25.7 27.7 25.3 26.3
Illinois 2,494 27.9 33.3 29.8 24.4 31.4 32.9 22.2 26.5 36.0 25.6 38.9 15.8 33.8
Indiana 2,299 26.7 26.0 30.0 25.8 24.9 31.3 25.6 28.1 20.4 27.5 36.5 15.0
Iowa 3,069 27.2 35.1 28.4 23.2 29.9 30.4 21.8 27.1 28.5 26.9 34.6
Kansas 4,352 29.3 31.1 32.5 26.6 31.4 31.7 26.1 29.8 24.4 28.8 48.5 33.2
Kentucky 3,225 31.0 36.7 32.2 26.4 32.8 32.3 28.1 30.6 31.5 30.0 48.5
Louisiana 2,738 29.4 33.3 34.8 24.6 32.7 31.4 24.8 29.4 29.0 26.6 35.3 35.9
Maine 3,267 26.4 27.8 29.7 22.5 30.7 30.8 20.2 26.2 27.9 26.5
Maryland 4,787 26.3 29.6 27.8 25.3 29.7 31.8 22.1 26.3 26.4 23.4 35.2 18.8 22.9
Massachu-
setts
10,188 21.6 23.3 23.8 20.3 23.5 25.9 18.6 21.7 20.2 21.6 28.2 4.5 26.0
Michigan 3,918 28.9 31.9 31.9 25.6 30.2 33.9 24.0 28.8 29.4 28.3 43.6 19.8
Minnesota 2,299 25.2 29.0 25.9 24.1 27.1 27.9 22.4 26.0 16.2 25.6 23.3
Mississippi 3,181 34.5 39.2 35.6 28.6 36.3 36.1 30.9 34.2 35.2 31.3 41.4 42.0
Missouri 2,314 30.6 31.3 32.5 27.7 29.4 36.0 27.9 30.6 31.4 29.9 34.9
Montana 3,204 24.3 28.9 23.0 21.4 26.6 28.1 19.8 23.7 26.6 23.5 43.3 21.9
Nebraska 8,285 28.0 29.2 32.1 26.1 28.8 33.2 23.4 28.3 26.9 27.6 49.9 25.4
Nevada 2,244 26.5 30.3 27.2 23.5 30.5 25.3 22.6 26.3 28.0 23.9 17.9 22.4 33.5
New
Hampshire
3,460 24.5
27.2 26.7 22.6 27.2 29.3 20.7 24.6 24.8 24.6
New Jersey 5,706 23.4 25.8 27.2 21.4 28.8 26.5 18.4 23.5 22.8 23.3 34.1 8.4 24.3
a
Obesity is defined as having a body mass index ≥30 kg/m
2
.
b
We restricted the prevalence estimates to the categories in which there were 50 or more respondents; blank cells indicate fewer than 50 respondents in this
category. Confidence intervals are available from the authors on request.
c
The total number of employed respondents in the 2008 BRFSS data stratified by 50 states and Washington, DC (excluding respondents missing obesity
data).
(Continued on next page)
VOLUME 8: NO. 1
JANUARY 2011
www.cdc.gov/pcd/issues/2011/jan/10_0017.htm • Centers for Disease Control and Prevention 7
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the
Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and
does not imply endorsement by any of the groups named above.
State
No. of
Respon-
dents
c
Prevalence of Obesity
b
, %
Overall
Annual Household Income, $ Educational Attainment
Health Insurance
Status Race/Ethnicity
<35,000
35,000-
74,999 ≥75,000
High
School
Graduate
or Less
Some
College
College
Graduate Any None White
African
American
Asian/
Hawaiian/
Pacific
Islander
American
Indian/
Alaska
Native Hispanic
New Mexico 2,880 26.9 29.1 27.8 23.1 30.5 30.8 20.3 26.9 26.5 21.3 35.1 31.8
New York 3,634 25.3 26.8 29.6 22.8 28.6 30.3 20.6 25.2 26.8 24.1 34.2 7.4 30.2
North
Carolina
7,070 30.8 34.0 32.5 27.9 34.2 35.2 23.9 29.5 36.4 29.1 41.4 5.7 37.6 26.7
North
Dakota
2,643
28.8 30.6 30.6 26.7 32.3 28.9 25.8 28.9 25.8 28.6 47.6
Ohio 5,740 29.8 33.7 34.1 26.1 32.4 32.8 25.7 30.2 26.7 29.4 37.0 8.4 38.5
Oklahoma 3,317 32.3 32.2 34.8 30.8 31.6 35.7 30.5 33.1 29.0 31.2 41.0 39.3 33.0
Oregon 2,147 24.8 27.2 26.6 22.3 26.5 28.9 20.6 25.3 21.9 25.4 17.7
Pennsyl-
vania
5,658
29.9 36.0 30.6 25.8 34.4 33.4 23.2 29.3 34.9 29.1 42.1 9.6 32.0
Rhode
Island
2,237
22.9 29.5 23.5 21.4 27.3 24.2 19.4 22.8 23.8 21.6 30.3 27.8
South
Carolina
4,217 30.9 39.0 31.7 24.9 35.3 33.4 24.7
29.9 36.2 26.6 43.4 34.0
South
Dakota
3,491
29.1 34.4 30.3 24.4 32.6 30.7 24.7 28.9 30.8 28.5 41.1
Tennessee 1,896 32.3 33.9 34.5 25.6 39.1 33.3 23.4 32.5 31.4 29.9 38.4
Texas 4,525 29.1 30.1 33.1 27.2 30.0 35.1 24.4 29.8 27.3 28.2 37.7 3.7 31.7
Utah 2,838 24.0 28.2 24.6 23.3 25.9 23.1 23.0 24.0 24.4 24.4 20.8
Vermont 3,715 22.6 23.2 25.2 19.2 27.5 25.7 17.2 22.5 23.7 22.7
Virginia 2,389 26.1 24.3 26.8 25.4 30.4 27.9 23.0 26.9 18.5 27.3 33.7 17.7
Washington 10,222 26.1 26.6 28.4 24.7 29.7 30.2 20.8 26.4 23.8 26.5 28.3 15.0 36.8 25.5
West
Virginia
1,729 34.6 34.5 35.7 32.5 37.1 36.5 29.4 34.6 34.8 34.4
Wisconsin 3,700 27.2 32.6 28.2 21.7 29.3 30.4 22.8 26.7 31.0 26.1 42.0 43.1 29.0
Wyoming 4,159 26.3 26.6 27.7 26.3 27.7 28.5 22.6 27.3 21.7 25.9 43.1 25.9
United
States
189,055
27.0 30.2 29.3 24.1 30.5 30.5 21.9 26.9 27.6 26.1 37.3 9.1 32.5 29.3
a
Obesity is defined as having a body mass index ≥30 kg/m
2
.
b
We restricted the prevalence estimates to the categories in which there were 50 or more respondents; blank cells indicate fewer than 50 respondents in this
category. Confidence intervals are available from the authors on request.
c
The total number of employed respondents in the 2008 BRFSS data stratified by 50 states and Washington, DC (excluding respondents missing obesity
data).
Table 1. (continued) Prevalence of Obesity
a
by State Among Workers Aged 18 to 64 Years, 2008 Behavioral Risk Factor Surveillance
System (BRFSS)
VOLUME 8: NO. 1
JANUARY 2011
8 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2011/jan/10_0017.htm
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the
Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and
does not imply endorsement by any of the groups named above.
Table 2. Prevalence of Physical Inactivity
a
by State Among Workers Aged 18 to 64 Years, 2007 Behavioral Risk Factor Surveillance
System (BRFSS)
State
No. of
Respon-
dents
c
Prevalence of Physical Inactivity
b
, %
Overall
Annual Household Income, $ Educational Attainment
Health Insurance
Status Race/Ethnicity
<35,000
35,000-
74,999 ≥75,000
High
School
Graduate
or Less
Some
College
College
Graduate Any None White
African
American
Asian/
Hawaiian/
Pacific
Islander
American
Indian/
Alaska
Native Hispanic
Alabama 2,843 54.4 59.3 53.5 49.1 55.8 56.3 50.8 53.9 57.4 53.1 59.5
Alaska 1,475 37.2 43.1 38.1 31.6 36.1 38.7 37.0 36.2 43.2 36.4 47.3
Arizona 1,891 45.0 56.1 46.9 36.3 54.5 42.4 38.9 44.0 49.4 41.5 32.0 55.7
Arkansas 2,348 51.5 51.0 53.2 49.4 52.7 52.0 49.7 51.6 52.2 50.7 56.8 57.3
California 2,711 51.0 57.9 53.5 43.8 55.3 52.8 46.1 51.0 50.9 42.5 55.4 70.2 56.1
Colorado 6,245 43.8 51.5 45.4 37.0 50.2 45.6 38.5 42.4 50.6 41.4 52.8 40.4 52.4
Connecticut 3,537 45.9 55.4 43.8 44.6 47.2 46.0 45.2 45.6 48.7 43.9 55.6 68.9 53.7
Delaware 1,989 49.2 55.5 48.4 48.5 52.4 44.2 50.0 49.6 45.2 47.3 55.7 62.0
District of
Columbia
2,005 41.3 54.7 44.8 35.9 58.4 42.0 36.7 41.0 45.6 31.6 47.6 45.1
57.5
Florida 16,435 50.8 56.3 50.4 46.7 56.1 49.0 47.7 49.8 55.0 48.5 53.7 46.1 47.2 58.4
Georgia 3,394 49.6 49.9 49.7 50.9 50.6 48.6 49.8 50.1 46.6 48.7 55.1 37.1
Hawaii 3,681 48.7 57.6 48.5 45.1 51.5 51.0 44.5 48.9 46.0 39.9 58.0 51.9
Idaho 2,566 43.2 49.2 42.2 39.3 45.3 42.8 40.9 42.4 46.1 42.8 50.9
Illinois 2,586 49.2 54.4 52.4 43.0 53.4 49.3 46.6 48.7 52.9 45.8 52.9 62.2 58.2
Indiana 2,809 48.8 52.9 50.1 43.2 51.6 48.4 46.0 49.3 46.5 48.6 45.4 53.7
Iowa 2,822 49.5 49.6 51.6 44.8 50.1 48.2 50.0 50.6 42.2 49.2 60.6
Kansas 4,384 48.7 54.4 48.6 44.6 52.9 46.1 47.5 48.4 52.5 48.3 48.7 55.4
Kentucky 2,398 50.0 51.3 52.4 44.5 50.9 49.9 48.6 50.3 48.3 51.1 41.3
Louisiana 3,013 58.4 62.9 59.1 55.3 61.0 60.5 54.4 57.4 62.1 58.9 55.3 71.1
Maine 3,391 41.1 44.5 41.7 38.6 41.2 44.6 38.6 42.8 30.9 40.9
Maryland 4,315 50.3 59.7 51.8 46.8 53.6 54.0 46.9 50.0 52.3 46.6 55.7 55.0 62.9
Massachu-
setts
9,867 46.3 55.8 47.1 43.7 52.4 46.8 43.5 45.9 52.1 44.0 54.0 61.2
56.4
Michigan 3,290 47.5 48.2 49.9 45.0 46.9 49.2 46.7 48.3 41.8 46.8 53.4 28.1
Minnesota 2,615 49.1 54.9 49.0 45.9 55.9 49.6 44.7 48.4 55.9 48.4 55.1
Mississippi 3,296 57.3 57.6 58.7 52.8 57.3 60.1 54.8 56.4 60.9 55.5 61.3 51.5
Missouri 2,448 50.3 47.7 47.6 51.6 48.6 53.0 49.8 51.3 43.5 48.8 64.7
Montana 2,895 39.5 42.5 39.8 34.8 38.2 42.2 38.6 38.1 45.3 39.4 48.4 29.9
Nebraska 5,540 46.2 52.0 45.2 41.7 50.9 41.3 46.0 46.0 47.6 45.7 51.4
Nevada 2,040 47.6 51.1 48.0 44.2 51.2 45.4 45.6 47.2 49.2 46.3 52.8
New
Hampshire
2,982 45.1 47.4 48.8 41.7 49.3 43.6 43.2 45.5 41.9 44.8 44.7
New Jersey 3,153 49.8 58.7 50.6 46.2 53.9 51.5 46.7 48.0 61.8 45.0 54.8 69.9 57.3
New Mexico 3,093 44.4 50.3 39.4 40.5 51.5 41.3 39.4 42.7 49.9 40.6 44.2 47.7
New York 3,107 48.0 51.3 49.3 44.8 51.9 45.6 46.6 47.4 52.0 44.1 51.6 61.3 59.2
a
Physical inactivity is defined as not meeting the Centers for Disease Control and Prevention physical activity guideline of at least 5 days per week for 30 min-
utes a day of moderate-intensity activity or at least 3 days per week for 20 minutes a day of vigorous-intensity activity.
b
We restricted the prevalence estimates to the categories in which there were 50 or more respondents; blank cells indicate fewer than 50 respondents in this
category. Confidence intervals are available from the authors on request.
c
The total number of employed respondents in the 2007 BRFSS data stratified by 50 states and Washington, DC (excluding respondents missing physical
inactivity data).
(Continued on next page)
VOLUME 8: NO. 1
JANUARY 2011
www.cdc.gov/pcd/issues/2011/jan/10_0017.htm • Centers for Disease Control and Prevention 9
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the
Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and
does not imply endorsement by any of the groups named above.
State
No. of
Respon-
dents
c
Prevalence of Physical Inactivity
b
, %
Overall
Annual Household Income, $ Educational Attainment
Health Insurance
Status Race/Ethnicity
<35,000
35,000-
74,999 ≥75,000
High
School
Graduate
or Less
Some
College
College
Graduate Any None White
African
American
Asian/
Hawaiian/
Pacific
Islander
American
Indian/
Alaska
Native Hispanic
North
Carolina
6,560 53.5 58.2 53.8 47.9 59.7 52.2 48.4 53.0 56.2 50.7 58.1 54.2 50.4 70.3
North
Dakota
2,579 45.6 45.2 46.0 42.1 47.4 45.4 44.2 45.4 45.1 45.9
46.4
Ohio 5,013 48.1 51.3 48.0 45.7 48.3 49.8 46.7 48.2 46.5 47.5 52.4 69.0
Oklahoma 3,091 52.0 55.0 52.3 47.6 54.4 53.8 47.7 52.2 51.1 51.3 44.2 54.5 57.0
Oregon 2,237 43.0 47.1 44.4 38.0 47.8 43.7 39.0 42.4 45.5 42.3 52.0
Pennsyl-
vania
5,735 45.7 47.6 47.4 43.0 48.7 46.1 42.9 46.3 40.0 46.6 48.1 40.1
39.7
Rhode
Island
2,098 47.1 55.5 49.3 43.2 52.5 49.3 42.2 47.4 45.4 45.8 50.5 58.5
South
Carolina
4,586 51.0 55.6 49.5 48.6 53.0 51.2 48.7 50.3 54.3 49.7 56.8
41.2
South
Dakota
3,498 49.8 54.6 52.0 41.6 56.8 49.1 43.9 49.7 50.8 49.6
54.1
Tennessee 2,030 57.9 68.7 55.5 47.2 60.8 58.4 53.2 56.8 65.7 58.5 60.6
Texas 7,287 52.0 55.6 52.4 48.2 54.0 52.2 49.6 52.1 52.0 49.0 53.8 66.8 43.0 54.7
Utah 2,733 43.7 50.2 43.2 37.8 49.6 42.2 38.9 43.5 44.3 42.3 49.2
Vermont 3,724 40.3 45.3 40.4 37.9 46.9 42.9 34.1 41.3 33.9 40.0 55.7
Virginia 2,893 49.3 54.5 46.7 47.2 51.9 50.4 47.5 48.8 53.7 47.9 51.2 62.4 58.7
Washington 11,957 45.4 49.9 45.8 43.1 46.9 45.7 44.1 45.1 47.8 44.4 32.3 50.8 43.3 58.7
West
Virginia
1,888 50.4 49.3 51.6 49.7 48.8 50.3 53.2 52.1 42.1 50.7
Wisconsin 3,867 42.7 46.1 43.8 39.1 41.7 46.5 40.4 42.7 42.5 42.8 44.9 31.2
Wyoming 3,229 41.5 44.7 41.3 39.0 42.9 43.7 37.5 41.9 40.6 40.9 49.0
United
States
196,169 49.2 54.3 49.8 45.0 52.5 49.5 46.3 48.9 51.0 46.8 54.3 63.1 44.3 55.6
a
Physical inactivity is defined as not meeting the Centers for Disease Control and Prevention physical activity guideline of at least 5 days per week for 30 min-
utes a day of moderate-intensity activity or at least 3 days per week for 20 minutes a day of vigorous-intensity activity.
b
We restricted the prevalence estimates to the categories in which there were 50 or more respondents; blank cells indicate fewer than 50 respondents in this
category. Confidence intervals are available from the authors on request.
c
The total number of employed respondents in the 2007 BRFSS data stratified by 50 states and Washington, DC (excluding respondents missing physical
inactivity data).
Table 2. (continued) Prevalence of Physical Inactivity
a
by State Among Workers Aged 18 to 64 Years, 2007 Behavioral Risk Factor
Surveillance System (BRFSS)
VOLUME 8: NO. 1
JANUARY 2011
10 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2011/jan/10_0017.htm
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the
Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and
does not imply endorsement by any of the groups named above.
Table 3. Prevalence of Smoking
a
by State Among Workers Aged 18 to 64 Years, 2008 Behavioral Risk Factor Surveillance System
(BRFSS)
State
No. of
Respon-
dents
c
Prevalence of Smoking
b
, %
Overall
Annual Household Income, $ Educational Attainment
Health Insurance
Status Race/Ethnicity
<35,000
35,000-
74,999 ≥75,000
High
School
Graduate
or Less
Some
College
College
Graduate Any None White
African
American
Asian/
Hawaiian/
Pacific
Islander
American
Indian/
Alaska
Native Hispanic
Alabama 2,659 22.9 29.7 22.3 13.5 32.9 20.1 13.6 20.1 38.7 23.3 22.6
Alaska 1,658 20.1 32.8 17.2 14.4 33.8 16.9 7.9 17.8 30.5 16.7 35.1 15.0
Arizona 2,330 17.4 25.8 20.4 9.7 28.1 18.8 6.4 14.8 29.6 17.8 10.9 18.0
Arkansas 2,474 23.0 36.9 21.6 11.4 34.0 24.3 8.7 19.4 38.9 22.0 26.1 29.5
California 5,391 14.9 20.6 15.9 9.7 19.3 20.5 6.9 13.4 21.2 15.3 22.4 6.9 14.9
Colorado 6,157 17.9 28.3 21.8 10.2 29.6 21.6 7.6 15.7 29.5 16.5 21.4 12.9 21.7
Connecticut 3,006 17.5 29.3 22.0 12.2 28.8 23.3 9.6 16.2 31.1 17.4 16.5 12.0 20.0
Delaware 2,015 19.4 35.6 23.3 11.9 35.0 19.5 9.4 18.4 32.0 19.9 17.3 17.9
District of
Columbia
2,241 14.6 24.5
19.7 8.5 27.5 22.2 9.0 13.3 28.6 10.3 20.7 11.7
Florida 4,515 19.3 29.2 18.3 11.7 25.5 23.6 11.1 16.3 32.9 22.2 9.8 17.1
Georgia 2,719 19.4 27.3 21.1 15.0 31.3 20.3 10.5 16.9 34.1 20.5 15.4 16.1
Hawaii 3,506 17.1 28.2 19.2 11.8 27.1 16.5 9.9 16.2 29.9 15.4 13.5 16.4
Idaho 2,513 18.1 28.5 16.7 8.8 30.3 16.1 6.9 14.7 32.2 18.0 17.8
Illinois 2,581 21.4 33.0 22.6 15.4 34.8 23.7 10.3 19.3 34.0 21.2 22.5 11.9 24.2
Indiana 2,380 27.6 45.6 26.6 17.4 41.1 30.1 10.7 22.7 54.9 25.5 32.5 52.7
Iowa 3,244 20.9 37.9 20.4 11.5 35.2 20.3 7.4 18.2 47.6 20.4 24.4
Kansas 4,499 19.1 31.5 19.5 10.8 32.6 20.9 8.2 16.6 37.8 18.4 22.3 22.0
Kentucky 3,325 24.7 41.5 24.8 14.5 37.3 28.3 9.5 21.0 48.2 24.7 28.9
Louisiana 2,889 20.2 26.4 23.0 14.7 26.3 25.3 11.1 16.7 35.5 22.2 16.8 23.9
Maine 3,367 18.7 33.4 18.2 9.8 29.0 22.0 8.5 17.1 29.8 18.6
Maryland 4,941 14.9 23.9 19.5 10.0 25.2 19.6 7.3 13.3 27.0 16.4 15.1 4.3 8.9
Massachu-
setts
10,643 15.7 24.7
17.9 11.8 27.7 20.1 7.6 15.1 29.0 16.3 17.4 6.2 11.0
Michigan 4,091 20.1 32.8 20.1 13.0 33.6 20.1 10.2 18.1 37.2 19.4 18.5 33.2
Minnesota 2,355 18.1 31.8 20.4 9.2 30.2 21.5 9.6 16.2 39.9 17.5 21.5
Mississippi 3,259 22.0 28.0 21.9 13.4 29.6 23.1 11.8 18.9 35.4 23.6 19.1 24.1
Missouri 2,382 25.5 42.9 24.6 15.3 38.6 24.4 12.9 21.9 47.0 25.8 18.9
Montana 3,308 19.5 34.2 16.2 9.4 31.1 21.8 8.2 15.4 36.6 18.4 37.3 23.6
Nebraska 8,558 20.1 32.7 21.5 10.6 33.3 20.6 9.7 17.2 39.5 20.2 19.6 21.2
Nevada 2,339 22.1 32.7 22.6 16.8 26.5 26.5 12.5 20.4 29.4 21.7 16.4 21.2 22.6
New
Hampshire
3,610 18.3 32.0 23.2
11.1 31.8 22.8 8.7 15.7 41.1 18.4 1.5
New Jersey 6,002 16.1 21.2 20.9 11.4 25.1 20.1 8.5 15.3 21.6 17.4 17.7 9.8 12.7
New Mexico 2,987 20.5 29.5 17.6 14.2 28.6 22.8 10.4 17.5 32.3 21.0 11.7 21.9
New York 3,796 17.7 24.5 22.7 10.5 28.5 21.3 8.8 15.9 30.8 18.7 20.1 14.1 14.1
a
Tobacco use is defined as ever having smoked at least 100 cigarettes and currently smoking every day or some days.
b
We restricted the prevalence estimates to the categories in which there were 50 or more respondents; blank cells indicate fewer than 50 respondents in this
category. Confidence intervals are available from the authors on request.
c
The total number of employed respondents in the 2008 BRFSS data stratified by 50 states and Washington, DC (excluding respondents missing smoking
data).
(Continued on next page)
VOLUME 8: NO. 1
JANUARY 2011
www.cdc.gov/pcd/issues/2011/jan/10_0017.htm • Centers for Disease Control and Prevention 11
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the
Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and
does not imply endorsement by any of the groups named above.
State
No. of
Respon-
dents
c
Prevalence of Smoking
b
, %
Overall
Annual Household Income, $ Educational Attainment
Health Insurance
Status Race/Ethnicity
<35,000
35,000-
74,999 ≥75,000
High
School
Graduate
or Less
Some
College
College
Graduate Any None White
African
American
Asian/
Hawaiian/
Pacific
Islander
American
Indian/
Alaska
Native Hispanic
North
Carolina
7,331
22.0 32.4 21.2 13.8 33.5 21.3 10.1 19.5 33.9 22.8 21.0 22.0 40.3 16.3
North
Dakota
2,765 20.4 31.5
19.8 14.3 29.0 25.0 8.8 17.9 39.7 19.2 53.1
Ohio 5,991 20.9 38.1 22.0 9.9 35.7 22.3 7.0 17.7 45.3 20.0 22.7 8.9 41.0
Oklahoma 3,398 25.0 37.3 25.1 12.8 34.5 28.2 10.8 21.9 38.0 23.7 28.1 31.2 24.4
Oregon 2,218 16.3 23.4 17.1 9.3 29.0 16.3 6.0 13.6 30.6 16.1 11.6
Pennsyl-
vania
5,892
22.8 37.9 24.9 13.6 32.8 25.3 10.9 21.3 34.0 22.4 22.6 22.5 24.5
Rhode
Island
2,317
18.0 25.5 24.3 11.4 28.7 23.8 8.1 16.2 31.2 18.6 19.7 11.3
South
Carolina
4,388
19.9 28.7 19.8 14.7 29.9 19.6 10.7 16.7 36.2 21.5 15.9 16.6
South
Dakota
3,627
18.7 28.2 17.1 13.6 27.8 20.0 9.9 16.7 33.7 18.0 37.0
Tennessee 1,990 20.7 34.1 17.3 11.8 31.6 18.5 9.9 18.1 35.6 22.8 17.3
Texas 4,767 20.1 26.1 21.4 12.6 28.9 21.3 10.6 16.7 30.5 20.4 19.4 11.9 20.6
Utah 2,912 9.8 15.3 13.1 4.4 17.6 8.1 3.4 9.0 13.8 9.5 14.6
Vermont 3,829 16.8 32.7 15.4 7.7 29.2 16.1 8.1 14.6 32.6 16.6
Virginia 2,484 16.2 31.9 18.7 9.8 26.0 20.7 8.6 13.6 39.7 16.6 18.1 10.0 15.3
Washington 10,576 15.7 26.1 18.7 8.8 28.3 17.4 6.2 13.6 29.9 15.6 20.8 7.1 31.7 16.1
West
Virginia
1,794 26.7 40.1 25.4 14.1 37.9 24.2 13.0 22.4 47.6 26.3
Wisconsin 3,843 21.5 31.0 20.4 16.8 32.1 22.6 10.9 19.1 43.5 20.7 28.7 38.1 37.5
Wyoming 4,295 21.6 39.3 22.4 12.4 33.1 23.9 7.0 17.9 38.9 20.6 35.7 29.5
United
States
196,157
19.2 28.9 20.6 11.9 29.3 21.6 9.2 16.8 32.5 19.7 18.7 10.8 27.8 17.9
a
Tobacco use is defined as ever having smoked at least 100 cigarettes and currently smoking every day or some days.
b
We restricted the prevalence estimates to the categories in which there were 50 or more respondents; blank cells indicate fewer than 50 respondents in this
category. Confidence intervals are available from the authors on request.
c
The total number of employed respondents in the 2008 BRFSS data stratified by 50 states and Washington, DC (excluding respondents missing smoking
data).
Table 3. (continued) Prevalence of Smoking
a
by State Among Workers Aged 18 to 64 Years, 2008 Behavioral Risk Factor
Surveillance System (BRFSS)
VOLUME 8: NO. 1
JANUARY 2011
12 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2011/jan/10_0017.htm
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the
Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and
does not imply endorsement by any of the groups named above.
Table 4. Prevalence of No Influenza Vaccination by State Among Workers Aged 50 to 64 Years, 2008 Behavioral Risk Factor
Surveillance System (BRFSS)
State
No. of
Respon-
dents
b
Prevalence of No Influenza Vaccination
a
, %
Overall
Annual Household Income, $ Educational Attainment
Health Insurance
Status Race/Ethnicity
<35,000
35,000-
74,999 ≥75,000
High
School
Graduate
or Less
Some
College
College
Graduate Any None White
African
American
Asian/
Hawaiian/
Pacific
Islander
American
Indian/
Alaska
Native Hispanic
Alabama 1,047 59.9 74.5 57.1 50.6 67.6 62.2 49.7 58.5 73.3 56.3 71.2
Alaska 614 58.2 64.6 61.3 51.2 64.8 58.5 53.2 55.7 73.6 59.6 46.4
Arizona 991 65.0 59.5 66.0 64.5 64.3 69.3 62.2 65.2 63.5 65.4 74.3
Arkansas 1,052 56.2 57.2 56.6 53.5 61.2 54.3 51.8 53.9 72.6 55.6 67.9
California 2,056 63.4 73.9 65.7 57.7 71.6 63.5 58.4 60.3 87.7 58.5 70.2 68.3 70.6
Colorado 2,474 53.3 64.6 54.6 49.8 61.1 55.9 48.2 50.9 75.9 52.5 57.4
Connecticut 1,254 54.1 63.6 54.1 51.5 56.3 56.0 52.4 52.9 75.7 52.5 61.9 70.0
Delaware 769 53.2 66.0 50.2 49.9 67.0 49.6 47.4 52.2 78.4 52.0 59.2
District of
Columbia
866 55.5 63.7 58.8 50.6 58.7 61.4 53.0 54.5 68.4 44.7 65.0
Florida 1,911 70.2 77.7 71.1 64.0 78.6 74.4 62.3 67.9 86.2 66.2 74.4 83.9
Georgia 1,045 62.2 66.5 64.1 58.4 64.5 65.5 58.3 60.7 73.0 60.0 66.4
Hawaii 1,480 53.9 58.4 53.8 52.0 59.2 56.8 49.9 52.6 87.5 58.6 45.9 50.9
Idaho 1,022 63.8 72.3 68.4 52.8 75.8 63.5 53.9 60.3 86.7 63.5
Illinois 1,000 63.7 78.8 65.1 57.8 69.4 64.9 59.1 63.0 73.3 62.8 69.5
Indiana 986 62.6 75.3 61.3 57.6 66.5 61.2 60.0 60.5 90.2 61.7 65.2
Iowa 1,315 52.3 64.2 51.3 47.6 59.0 51.4 44.9 51.7 59.5 52.0
Kansas 1,984 57.0 64.7 57.6 53.0 65.9 59.4 50.1 55.3 81.8 56.6 50.5 62.3
Kentucky 1,362 56.4 69.4 57.5 49.0 66.4 57.6 46.0 54.1 78.1 56.6
Louisiana 1,099 56.4 65.5 53.2 52.5 57.7 61.4 52.1 53.7 72.5 55.4 62.3
Maine 1,535 55.2 64.7 57.4 49.3 61.7 52.0 53.1 52.8 76.3 55.2
Maryland 1,991 54.6 61.7 59.3 51.6 67.7 53.4 49.1 53.7 68.2 51.3 61.9
Massachu-
setts
4,210 55.4 66.5 57.2 51.5 60.8 60.5 50.9 55.0 66.3 55.1 65.9
51.5
Michigan 1,735 60.9 72.1 61.5 56.1 68.9 64.1 53.6 59.6 75.5 59.5 69.8
Minnesota 995 50.4 64.5 51.3 44.4 57.6 51.7 45.4 48.4 88.0 50.0
Mississippi 1,360 63.2 71.6 63.1 55.8 68.5 62.0 58.1 60.2 80.5 59.4 70.6
Missouri 1,012 55.8 67.0 56.6 50.7 67.0 56.0 46.4 53.9 76.9 54.2 73.6
Montana 1,550 61.5 71.0 62.3 52.0 71.9 60.2 55.3 58.4 78.6 61.3 60.7
Nebraska 3,794 49.7 59.3 52.5 43.3 57.7 50.4 42.4 47.9 69.0 50.0 58.5
Nevada 922 71.4 83.3 74.7 65.7 82.0 70.7 64.2 69.3 87.8 67.4 84.3
New
Hampshire
1,571 52.8 57.8 56.4 50.4 62.9 55.3 47.0 51.2
72.0 52.6
New Jersey 2,396 60.7 66.8 66.0 56.7 67.1 61.7 56.3 59.4 74.2 60.2 64.7 62.3
New Mexico 1,265 62.0 68.5 60.4 57.9 70.2 59.5 58.4 59.4 77.4 60.6 49.8 65.9
New York 1,614 58.1 69.1 59.5 54.2 65.9 61.1 51.7 55.5 83.3 56.4 70.9 59.9
a
We restricted the prevalence estimates to the categories in which there were 50 or more respondents; blank cells indicate fewer than 50 respondents in this
category. Confidence intervals are available from the authors on request.
b
The total number of employed respondents in the 2008 BRFSS data stratified by 50 states and Washington, DC (excluding respondents missing influenza
vaccination data).
(Continued on next page)
VOLUME 8: NO. 1
JANUARY 2011
www.cdc.gov/pcd/issues/2011/jan/10_0017.htm • Centers for Disease Control and Prevention 13
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the
Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and
does not imply endorsement by any of the groups named above.
State
No. of
Respon-
dents
b
Prevalence of No Influenza Vaccination
a
, %
Overall
Annual Household Income, $ Educational Attainment
Health Insurance
Status Race/Ethnicity
<35,000
35,000-
74,999 ≥75,000
High
School
Graduate
or Less
Some
College
College
Graduate Any None White
African
American
Asian/
Hawaiian/
Pacific
Islander
American
Indian/
Alaska
Native Hispanic
North
Carolina
2,906 55.0 65.3 55.7 48.6 60.5 55.0 49.6 52.6 74.5 52.9 61.0
69.9 60.4
North
Dakota
1,202 56.0 55.7 58.0 54.8 62.2 55.5 51.3 54.7 69.2 55.7
Ohio 2,749 58.8 61.7 59.9 55.6 64.6 64.2 50.4 57.1 78.4 58.2 61.9
Oklahoma 1,361 49.9 63.6 46.3 43.7 58.6 48.9 41.8 46.5 70.5 50.5 49.4 42.7
Oregon 1,031 57.9 65.7 62.3 49.9 63.8 59.0 53.3 56.1 75.6 57.3
Pennsyl-
vania
2,462 59.2 69.6 57.4 58.0 65.1 60.5 52.3 57.8 77.3 59.1 50.5
Rhode
Island
1,008 50.4 54.8 50.5 49.7 55.7 55.1 45.5 49.3 65.7 49.8
South
Carolina
1,845 59.5 68.8 62.4 51.5 70.5 63.0 47.9 57.5 75.9 58.0 63.7
South
Dakota
1,636 47.1 54.0 46.1 43.9 51.6 48.9 41.5 44.6 74.6 47.0
46.6
Tennessee 851 60.7 66.2 59.9 52.5 68.2 60.0 51.9 59.1 71.9 57.6 69.3
Texas 1,883 58.6 66.5 61.8 51.5 67.8 59.9 50.3 56.5 67.8 54.7 71.6 64.5
Utah 1,004 51.2 67.2 53.0 45.5 58.5 56.1 43.1 49.1 79.4 50.9
Vermont 1,759 56.2 62.4 57.3 53.0 63.6 56.3 51.9 54.3 77.8 55.7
Virginia 1,043 54.5 49.0 54.7 53.6 59.7 52.4 52.5 53.4 68.7 54.9 67.2
Washington 4,829 56.8 66.8 60.2 51.6 67.2 58.5 51.0 55.0 80.1 57.0 43.2 55.3 55.9
West
Virginia
754 54.3 68.1 52.5 50.1 64.8 48.6 45.6 52.0 73.2 53.4
Wisconsin 1,575 57.2 62.8 59.3 51.9 63.7 58.8 49.9 55.4 76.2 56.7
Wyoming 1,896 56.9 64.3 59.1 52.7 63.5 59.0 49.3 54.5 75.7 56.8 54.0
United
States
82,071 59.3 68.6 60.5 54.4 66.3 61.0 53.3 57.4 77.1 57.4 66.8 60.3 56.3 67.1
a
We restricted the prevalence estimates to the categories in which there were 50 or more respondents; blank cells indicate fewer than 50 respondents in this
category. Confidence intervals are available from the authors on request.
b
The total number of employed respondents in the 2008 BRFSS data stratified by 50 states and Washington, DC (excluding respondents missing influenza
vaccination data).
Table 4. (continued) Prevalence of No Influenza Vaccination by State Among Workers Aged 50 to 64 Years, 2008 Behavioral Risk
Factor Surveillance System (BRFSS)
    • "Through Healthy People 2010, the CDC recommended that at least 75% of workplaces should offer a comprehensive workplace health promotion program [58]. In this sense, there is evidence supporting the fact that the integration of programs promoting lifestyle modifications in the workplace enhances the effectiveness of these programs [59], with these effects going beyond the work place and exerting a positive influence on family environment [60], [61]. Furthermore, several studies have tested the efficiency of different interventions in the workplace in workers with MetS, showing, among other results, improvements in insulin resistance metabolic-related parameters [62] and adoption of healthier lifestyles [63]. "
    [Show abstract] [Hide abstract] ABSTRACT: Metabolic Syndrome (MetS) is a complex disorder defined as a cluster of interconnected risk factors such as hypertension, dyslipidemia, obesity and high blood glucose levels. Premorbid metabolic syndrome (PMetS) is defined by excluding patients with previously diagnosed cardiovascular disease or diabetes mellitus from those suffering MetS. We aimed to determine the prevalence of PMetS in a working population, and to analyse the relationship between the diagnostic criteria of the International Diabetes Federation (IDF) and of the National Cholesterol Education Program Adult Treatment Panel III (ATPIII). The relationship between the presence of PMetS and cardiovascular risk factors was also analysed. A cross-sectional study was conducted in 24,529 male and 18,736 female Spanish (white western European) adult workers (20-65 years) randomly selected during their work health periodic examinations. Anthropometrics, blood pressure and serum parameters were measured. The presence of MetS and PMetS was ascertained using ATPIII and IDF criteria. Cardiovascular risk was determined using the Framingham-REGICOR equation. The results showed MetS had an adjusted global prevalence of 12.39% using ATPIII criteria and 16.46% using IDF criteria. The prevalence of PMetS was slightly lower (11.21% using ATPIII criteria and 14.72% using IDF criteria). Prevalence in males was always higher than in females. Participants with PMetS displayed higher values of BMI, waist circumference, blood pressure, glucose and triglycerides, and lower HDL-cholesterol levels. Logistic regression models reported lower PMetS risk for females, non-obese subjects, non-smokers and younger participants. Cardiovascular risk determined with Framingham-REGICOR was higher in participants with PMetS. PMetS could be a reliable tool for the early identification of apparently healthy individuals who have a significant risk for developing cardiovascular events and type 2 diabetes.
    Full-text · Article · Feb 2014
    • "Other studies have tried to identify determinants of seasonal influenza vaccination [13], but few have focused on identifying social determinants within a framework of health equity [14] or their focus has been in other age groups [15]. Social determinants of health (SDH) play a critical role in disease occurrence, distribution, and consequences. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Vaccination against influenza is considered the most important public health intervention to prevent unnecessary hospitalizations and premature deaths related to influenza in the elderly, though there are significant inequities among global influenza vaccine resources, capacities, and policies. The objective of this study was to assess the social determinants of health preventing adults ≥65 years old from accessing and accepting seasonal influenza vaccination. Methods A systematic search was performed in January 2011 using MEDLINE, ISI – Web of Science, PsycINFO, and CINAHL (1980–2011). Reference lists of articles were also examined. Selection criteria included qualitative and quantitative studies written in English that examined social determinants of and barriers against seasonal influenza vaccination among adults≥65 years. Two authors performed the quality assessment and data extraction. Thematic analysis was the main approach for joint synthesis, using identification and juxtaposition of themes associated with vaccination. Results Overall, 58 studies were analyzed. Structural social determinants such as age, gender, marital status, education, ethnicity, socio-economic status, social and cultural values, as well as intermediary determinants including housing-place of residence, behavioral beliefs, social influences, previous vaccine experiences, perceived susceptibility, sources of information, and perceived health status influenced seasonal influenza vaccination. Healthcare system related factors including accessibility, affordability, knowledge and attitudes about vaccination, and physicians’ advice were also important determinants of vaccination. Conclusions Our results demonstrate that the ability of adults ≥65 years to receive seasonal influenza vaccine is influenced by structural, intermediate, and healthcare-related social determinants which have an impact at the health system, provider, and individual levels.
    Full-text · Article · Apr 2013
  • [Show abstract] [Hide abstract] ABSTRACT: To the Editor: Adult vaccination rates are low (1), and workplaces are a useful location for increasing vaccination (2). In 2008, only 41% of US workers 50-64 years of age reported vaccination against influenza virus (3). Workplace vaccination is common and increases with employer size (4). Among adults, the workplace is the most common site for influenza vaccination for persons 18-49 years of age and second most common for persons 50-64 years (2). Offering vaccination in the workplace increases vaccination coverage (5).
    Article · Jun 2011
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