Community Epidemiology &
Program Evaluation Group
Influential Factors in Healthy Living:
A survey study of selected health conditions and behaviors
among Colorado adults
December 2014
Prepared for the Cancer, Cardiovascular Disease and Pulmonary Disease Grants Program,
Colorado Department of Public Health and Environment
Community Epidemiology & Program Evaluation Group
cepeg‐ucdenver.org Faculty and staff Arnold H. Levinson, PhD MJ, Director Erin Martinez, MPH Michele Kimminau, General Manager Carol‐Ann Demaio Goheen, MSPH Hillary Anderson, MPH Katherine James, PhD MSPH MSCE (School of Medicine) Korrine J. Thomas, MPH Whitney Jones, PhD MSPA Alice Franco, MA Yaqiang Li, PhD MPH Kathleen Moreira Kim McFann, PhD Talia Brown, MS Sara L. Cooper, PhD MSPH Ali Billings Ming Ma, MD MPH Vicki Weister Patricia Alvarez Valverde, PhD MPH Erin McKay Kathleen Garrett, MA NCC MINT
Affiliates Ashley Brooks‐Russell, PHD MPH Adam Atherly, PhD Yvonne Kellar‐Guenther, PhD Eline Van Den Broek, PhD William Betts, PhD Mark Gritz, PhD Ernesto A. Moralez, MPH Tessa L. Crume, PhD MSPH Edie Bridge Kristin Kidd, MA The current report was prepared by Drs. James, Li, and Levinson, and Erin Martinez.
Prepared for the Cancer, Cardiovascular Disease and Pulmonary Disease Grants Program,
Colorado Department of Public Health and Environment
TABS-IFHL Results
Contents Background ................................................................................................................................................... 1 Methods ........................................................................................................................................................ 1 Access to healthy food .................................................................................................................................. 3 Provider contact ............................................................................................................................................ 7 Mental health engagement .......................................................................................................................... 9 Obesity ........................................................................................................................................................ 10 Diabetes ...................................................................................................................................................... 12 Hypertension ............................................................................................................................................... 15 Workplace Environment ............................................................................................................................. 18 Appendix A .................................................................................................................................................. 22 Results from TABS-IFHL
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Background This report presents information from Influential Factors in Healthy Living (IFHL), a study of selected health behaviors among Colorado adults. IFHL was conducted by the Community Epidemiology & Program Evaluation Group (CEPEG), University of Colorado Denver, in response to a request from the Cancer, Cardiovascular Disease and Pulmonary Disease Grants Program ("CCPD") of the Colorado Department of Public Health and Environment (CDPHE). The study domains include four chronic conditions – diabetes, high blood pressure (hypertension), high blood cholesterol (hyperlipidemia), and unhealthy weight. Marijuana‐related behaviors and attitudes were also asked, given recent legalization of "recreational" marijuana sales. Interview questions focused on attitudes, health‐risk behaviors, and both self‐management and interpersonal (health care, workplace) management of any of the four chronic conditions. Interviews were conducted during December 2013 through April 2014. Methods IFHL participants were a sample of respondents to The Attitudes and Behavior Survey (TABS) on Health, a population‐level survey among Colorado adults. In 2012, TABS on Health respondents were invited to be available for future studies; 58% agreed (n=8,693 of 14,998) and were enrolled in a survey research registry. Registry volunteers and decliners were similar in terms of sex, prevalence of self‐reported diabetes or high blood pressure, body mass index (BMI), and smoking status. Registry members were more likely than decliners to report high cholesterol (33.3% vs. 29.1%) or a mental illness diagnosis (13.2% vs. 8.9%); to be white (82.4% vs. 75.7%), aged 45‐64 (43.3% vs. 35.2%), a college graduate (46.0% vs. 38.0%), or gay, lesbian or bisexual (3.0% vs. 2.1%), and to have income at or above 200 percent of the federal poverty level (63.1% vs. 42.7%). All registry members were eligible for the IFHL study, and interviews were attempted with 5,819 randomly selected members. The selection process oversampled small population groups in order to obtain more precise information about them non‐whites, young adults aged 18‐24, those who reported a diagnosis of diabetes or high blood pressure, those with low socioeconomic status). Participants were contacted through their preferred mode (email, postal mail, or telephone) and completed the questionnaire on paper, online, or by telephone interview. A total of 3,974 participants completed interviews (73.8% response rate).* Data were weighted for analysis, and results are approximately unbiased estimates for the Colorado adult population in 2013. The questionnaire investigated six domains: 





healthy food access; health care provider engagement; workplace health promotion environment; self‐management of chronic conditions (obesity, hypertension, diabetes); marijuana use; tobacco use. A positive status for diabetes or high blood pressure is based on respondent self‐report that a medical provider diagnosed the respective condition. Overweight and obesity are based on self‐reported height *
AAPOR response rate 4; the calculation takes into account sample members who are no longer eligible (e.g., moved away from Colorado) and the estimated proportion of non‐contacted sample members who are presumed eligible. See AAPOR. Response Rate – an Overview. Online at http://www.aapor.org/Response_Rates_An_Overview1.htm#.VGOdgq10ymw. Accessed 11/12/14. Results from TABS-IFHL
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and weight and determined using body mass index (BMI), where BMI < 25 is normal, 25 to < 30 is overweight, and BMI ≥ 30 is obese. Rates are reported as weighted estimates (with 95% confidence limits or "error margins") for the population as a whole and for the following sociodemographic groups: 









sex (male/female) age group (18‐24, 25‐34, 35‐44, 45‐54, 55‐64, 65+) ethnicity (Anglo, Hispanic/Latino, black/African American, American Indian/Alaska Native, Asian/Native Hawaiian, other) o For diabetes, due to small numbers, ethnicity is presented in four groups: Anglo, Hispanic/Latino, black/African American, other percent of the federal poverty level (<138%, 138% to 250%, >250%) health insurance status (private, Medicare, Medicaid, none) region (21 CDPHE‐defined health statistics areas) household income (<$15,000, $15,000‐24,999, $25,000‐34,999, $35,000‐49,999, $50,000‐
$74,999, ≥$75,000) education (no high school diploma, high school graduate/GED, some college, ≥college graduate) health insurance status (uninsured, insured) primary language among Hispanics/Latinos (Spanish, English, other) Abbreviations LCL: lower 95% confidence limit (margin of error) UCL: upper 95% confidence limit (margin of error) FPL: federal poverty level Results from TABS-IFHL
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Access to healthy food IFHL asked about grocery access, cost and quality. Key findings include these:  Roughly two‐thirds (64.2%; 61.7%, 66.7%) of Coloradans live within half a mile of a grocery store, and nine in ten live within 10 miles (table 1). But rural residents are less likely than others to live near a grocery outlet: o In Region 11,* 35.9% (18.8%, 53.0%) percent live within a half‐mile of a grocery outlet. o In Region 17:†  21.9% (7.7%, 36.2%) live within a half‐mile of a grocery outlet;  34.0% (15.0%, 53.0%) live within 10 miles of a grocery outlet. Table 1. Percent of Coloradans who live near grocery outlets within half a mile within ten miles type of outlet % (95% CI) % (95% CI) grocery store 64.2 (61.7, 66.7)
91.1 (89.2, 93.0) farmer’s market 23.8 (21.5, 26.2)
69.1 (66.5, 71.8) meat market 18.0 (15.9, 20.1)
56.4 (53.6, 59.3) warehouse 16.6 (14.6, 18.7)
64.8 (62.1, 67.4) fruit and vegetable stand 23.5 (21.2, 25.8)
58.8 (55.9, 61.7) corner store 73.8 (71.5, 76.0)
91.3 (89.1, 93.4) other 13.8 (11.9, 15.6)
17.1 (15.1, 19.1) 




Most Coloradans say it is easy to get to the supermarket or grocery store, but 6.2% say it's not easy (table 2). Nearly all grocery shoppers (95.8%; 94.8%, 97.0%) usually get to a grocery outlet by driving.
Two‐fifths of Colorado adults (39.4%; 36.8%, 42.0%) report having a garden where someone in the household grows fruit or vegetables. Most adults eat a median of two (1.7, 2.3) fruits or vegetables a day; 4.7% report eating none. Overweight/obese adults eat fewer fruit/vegetable servings per day than other adults (median: 1.9 vs. 2.5; p<0.0001). The same is true for low SES vs. other SES adults (1.8 vs. 2.6; p< 0.0001), American Indians/Alaska Natives vs. Anglos (1.4 vs. 2.5; p<0.0001), and people with vs. without diabetes (1.7 vs. 2.0; p<0.0001). Table 2. Perceptions of availability, cost, and quality of fruits and vegetables agree perception % (95% CI) It is easy for me to get to a supermarket or grocery store 93.8 (92.6, 95.0) I wish a larger variety of fresh fruits and vegetables were available 72.5 (70.2, 74.8) I wish fruits and vegetables were more available in my neighborhood 71.7 (69.3, 74.0) I wish the fruits and vegetables available were better quality 66.6 (64.2, 69.1) I often buy fruits and vegetables outside of my neighborhood 51.6 (48.9, 54.3) The cost of fresh fruit and vegetables where I shop keeps me from buying 38.8 (36.2, 41.4) *
†
Jackson, Moffat, Rio Blanco, Routt counties. See Appendix A, map of Health Statistic Regions. Clear Creek, Gilpin, Park, Teller counties. Results from TABS-IFHL
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percent
Figure 2. How often someone in the household shops for fruit or vegetables (% of all households)
50
45
40
35
30
25
20
15
10
5
0
never
one time per 2‐3 times per one time per 2‐3 times per 4+ times per
month or less
month
week
week
week
Figure 3. Where household shoppers (%) bought fruits or vegetables at least once in past 12 months
100
90
80
percent
70
60
50
40
30
20
10
0
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Figure 4. Barriers to grocery store or food market access
80
70
percent
60
50
40
30
20
10
0
Among all adults, even if fruits and vegetables were sold at a corner/convenience store or gas station, 64.1% said they were unlikely to purchase from that location; 73.1% reported “never” buying fruits or vegetables from a convenience store (figure 5). Figure 5. How often selected types foods are bought at a corner/convenience store or gas station (% of households)
80
70
60
50
40
30
20
10
0
never
one time per 2‐3 times per
month or less
month
chips, candy, or other sweets
1 time per
week
sweetened drinks
2‐3 times per 4+ times per
week
week
fruits or vegetables
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Frequency of buying sweets or sweetened drinks was statistically different by weight, socioeconomic status (SES), and region (table 3). Table 3. Frequency (%) of purchasing sweets and sweetened drinks Weight SES Region Frequency normal overweight obese not low low rural urban Never 44.5
39.1 28.8
42.7
32.1 30.5
40.5
once/mo. 32.8
34.9 41.5
37.8
33.6 36.6
35.9
2‐3 times/mo. 10.9
15.0 17.8
11.4
17.5 15.8
13.7
Sweets once/wk. 7.5
4.6 7.1
5.4
8.0 8.5
5.9
2‐3 times/wk. 3.8
5.1 4.3
2.1
7.8 6.3
3.7
4+times/wk. 0.4
1.2 0.6
0.6
1.0 2.3
0.3
Never 50.7
45.8 37.0
51.2
37.6 36.9
48.0
once/mo. 24.4
25.4 29.0
27.5
23.9 23.8
26.2
Sweetened 2‐3 times/mo. 11.1
11.6 11.7
10.3
12.6 9.4
12.2
drinks once/wk. 5.5
6.8 12.0
4.7
12.1 11.0
6.8
2‐3 times/wk. 5.2
6.1 6.3
3.9
7.8 9.9
4.5
4+times/wk. 3.1
4.3 4.1
2.5
5.9 9.0
2.2
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Provider contact An estimated 79.4% (77.1%, 81.8%) of Colorado adults visit a doctor, nurse, or other health care provider at least once a year, while 4.3% visit less often than every 5 years or never. Roughly two‐thirds (65.4%) saw a health care provider in the past year for a routine checkup or specific injury, and 67.1% saw a specialist (figure 6, table 4). Figure 6. Time since most recent medical provider routine visit or specialist visit for specific injury/illness
Medical Provider
Specialist
80
70
60
50
40
30
20
10
0
Within past 12
months
Within past 2 years
Within past 5 years
Never
5 or more years ago
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Table 4. Last reported doctor visit, by medical condition don't have
have condition last doctor visit condition condition within past 12 months
64.8
67.7 within past 2 years 17.9
15.3 within past 5 years 7.0
8.5 Obesity 5 or more years ago 8.1
7.2 never 1.8
1.0 don’t know 0.4
0.2 within past 12 months
60.9
81.9 within past 2 years 19.0
10.4 within past 5 years 8.7
3.6 Hypertension 5 or more years ago 9.4
2.3 never 1.6
1.6 don’t know 0.4
1.6 within past 12 months
63.8
85.4 within past 2 years 17.9
8.9 within past 5 years 8.0
2.2 Diabetes (type II) 5 or more years ago 8.3
2.0 never 1.7
1.5 don’t know 0.4
0.0 within past 12 months
68.3
64.9 within past 2 years 18.3
16.7 within past 5 years 7.1
7.8 Mental illness 5 or more years ago 3.8
8.8 never 2.0
1.6 don’t know 0.5
0.3 Results from TABS-IFHL
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Mental health engagement Roughly one‐third of Colorado adults were medically screened for depression in the past year, and roughly one‐fourth reported having a diagnosed depressive disorder (table 5). The average age of diagnosis with a depressive disorder is 31.4 years (28.3, 34.4). Women are more likely than men to be diagnosed with a depressive disorder (28.5% vs. 19.3%) and to have ever visited a mental health provider (41.3% vs. 32.5%). Low SES adults are more likely to be diagnosed with a depressive disorder (27.9% vs. 22.0% in non‐low SES). Mental health screening was much less prevalent among the uninsured (table 6). Table 5. Mental health screening and engagement by medical providers question yes 95% CI In the past 12 months has your medical provider asked if 33.5% (30.8%, 36.1%) you felt sad, blue, or depressed? (If yes) Were you asked at every medical visit? 46.7% (42.0%, 51.5%) Has any type of health care provider ever diagnosed you 23.9% (21.7%, 26.2%) with a depressive disorder, depression, or dysthymia? Has a health care provider ever prescribed you anti‐
26.5% (24.2%, 28.8%) depressant medication? (If yes) Are you currently taking anti‐depressants? 46.1% (41.1%, 51.1%) Have you ever had an appointment with a mental health 36.9% (34.3%, 39.4%) provider? Table 6. Mental health care engagement by insurance type private Medicare Medicaid In the past 12 months has your medical provider (who is 36.3% 38.8% 48.9% not a mental health provider) (32.9%, 39.8%) (33.2%, 44.5%) (38.0%, 59.9%) asked if you felt sad, blue, or depressed? Has any type of health care provider ever diagnosed you 30.1% 35.1% 54.9%* with a depressive disorder, (24.8%, 35.4%) (26.4%, 43.9%) (39.3%, 70.5%) depression, or dysthymia? Has a health care provider 25.7% 28.1% 42.5% ever prescribed you anti‐
(22.9%, 28%) (23.2%, 33.1%) (32.5%, 52.6%) depressant medication? Have you ever had an 36.8% 33.3% 57.2%* appointment with a mental (33.7%, 40.0%) (28.0%, 38.6%) (47.1%, 67.2%) health provider? * statistically different from other insurance categories. none 23.0%* (12.1%,34.0%) 19.3% (0.9%, 37.6%) 18.4%* (11.2%, 25.5%) 28.8% (19.9%, 37.6%) Results from TABS-IFHL
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Obesity An estimated 59.1% of Colorado adults in 2013 were overweight or obese (table 7). Table 7. Estimated prevalence of overweight/obesity,
Colorado adults 2013, by selected characteristics prevalence
95% CI
all 59.1%
(56.4%, 61.7%)
insurance status
insured 58.7%
(55.9%, 61.5%)
uninsured
62.4%
(53.0%, 71.7%)
socio‐economic status*
low SES 63.6%
(59.2%, 67.9%)
non‐low SES
57.1%
(53.6%, 60.6%)
age group 18‐24 44.8%
(35.7%, 53.8%)
25‐34 51.7%
(44.1%, 59.3%)
35‐44 63.4%
(56.7%, 70.2%)
45‐54 59.0%
(52.9%, 65.2%)
55‐64 66.5%
(61.6%, 71.3%)
65+ 64.7%
(60.5%, 68.9%)
ethnicity* Anglo 56.0%
(52.9%, 59.1%)
Hispanic/Latino
71.8%
(65.5%, 78.0%)
Black/AA
62.4%
(48.0%, 76.7%)
Asian 27.6%
(3.5%, 51.7%)
AIAN 75.1%
(56.0%, 94.3%)
other 56.8%
(39.3%, 74.3%)
sex* male 65.4%
(61.6%, 69.2%)
female 52.7%
(49.1%, 56.3%)
* Significantly different between categories, p< 0.05 Roughly two in five adults (39.7%) were advised by a health care provider about their weight, with nearly 90% advised to lose weight (table 8). Among overweight and obese adults who received advice to lose weight, more than half were advised how to go about it. Table 8. Health care engagement regarding weight management percent (95% CI)
In the past 12 months, did a health care provider advise you about your weight? Yes 39.7 (36.3, 43.1) no, and I did not want advice
39.2 (35.8, 42.6) no, and I would have liked some advice
13.0 (10.6, 15.4) I have not seen a health care provider in the past 12 months
7.2 (5.2, 9.1) Results from TABS-IFHL
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Table 8, cont. Health care engagement regarding weight management percent (95% CI) Which statement best describes your health care provider’s advice?
weight category
all
under,
normal,
over, BMI<18.5 18.5 to <25 25 to <30 to lose weight, and given advice 55.7 0.9
12.0
46.5 on how to do it (50.3, 61.1) (0.0, 2.7) (5.0, 18.9) (37.6, 55.4) to lose weight, not given advice 33.3
4.6
8.1
35.1 on how to do it (28.2, 38.3) (0.0, 13.7) (2.0, 14.3) (26.3, 44.0) 4.7 0 57.7
9.3 to stay the same weight (45.0, 70.4) (3.3, 15.4) (2.2, 7.2) 6.2 94.5
22.2
8.5 other (3.4, 8.9) (85.1, 100) (10.7, 33.6) (3.6, 13.4) obese,
≥30 60.8
(54.2, 67.3) 32.2
(26.0, 38.4) 2.1
(0.5, 3.8) 4.9
(1.6, 8.2) Nearly half (45.1%; 39.0%, 51.3%) of those receiving advice were advised to see a nutritionist, and among those so advised:  48.1% (38.7%, 57.5%) were referred to a specific nutritionist or weight loss program;  55.3% (43.2%, 67.4%) followed the recommendation. The most common reasons for not following the recommendation were "too busy" and "didn't want to" (figure 7). Figure 7. Reasons why respondents did not follow recommendation to see a nutritionist
70
60
percent
50
40
30
20
10
0
Cost too
much
Too busy
No
Didn't want Didn't need
family/friend
to
it
support
Other
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Diabetes An estimated 7.7% (6.5%, 9.0%) of Colorado adults in 2013 reported having diabetes, with no statistical difference by ethnicity, gender, and rural residence. Age of onset was significantly younger among Medicaid beneficiaries and the uninsured than among Medicare and privately insured adults (table 9). Table 9. Mean age (years) of diagnosis for diabetes by ethnicity and insurance status mean 95% CI ethnicity Anglo
53.1 (51.1, 55.1) 45.3 (42.0, 48.6) Black/African‐American
Hispanic/Latino
44.4 (36.8, 52.0) 51.6 (42.5, 60.7) other
insurance private
51.8 (49.7, 53.9) 53.6 (50.3, 57.0) Medicare
Medicaid
43.3 (38.0, 48.5) 43.9 (40.5, 47.2) uninsured
Among those with diabetes:  To help control their diabetes, 79% have been told by their health care provider to exercise more and 65.4% have been told by to change their eating habits (figure 8).  Two‐thirds have developed a self‐management plan with their provider (table 10), and half were fully following it when interviewed; most have had the plan for more than a year (table 11). Among those who were not adhering fully or not following the plan at all, nearly half said the reason is they "didn't want to" (45.8%; 31.8%, 59.8%. Figure 9).  82.9% (76.1%, 89.7%) are sure they can control their diabetes: o Confidence in diabetes control is lower among Medicaid vs. other insurance beneficiaries (50.5% vs. Medicare: 90.2%, or private: 88.9%), females vs. males (74.1% vs. 90.9%), 45‐54‐year‐olds vs. older adults (63.4% vs. 55‐64‐year‐olds: 86.8%, or 65+ year olds: 94.2%), and Latinos vs. Anglos (74.2% vs. 87.8%).  91.5% believe diabetes is likely to increase their risk for heart disease or stroke;  65.0% have participated in an education class related to diabetes. Of those that have not, 76.7% know classes are available to them. Reasons for not having attended a diabetes class are illustrated in Figure 9.  more than one‐third worry about the cost or health effects of diabetes medications (table 12); 8.8% reported having engaged with their pharmacist (median 2.2 times per year) to discuss medication dosage, changes to dosage, or the number of medications they are taking. Results from TABS-IFHL
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Figure 8. Types of advice from health care providers to help control diabetes or lower blood sugar
100
percent
80
60
40
20
0
change eating
habits
exercise more
lose weight
improve sleep enroll in weight take a diabetes
management management
plan
class
Table 10. Diabetic adults with a diabetes self‐management plan developed with health care provider self‐management plan percent 95% CI fully following plan at interview 52.3% (42.5%, 62.1%) following part of the plan 39.5% (30.0%, 49.1%) no plan 8.1% (2.9%, 13.4%) Table 11. Length of time on a diabetes management plan percent 95% CI < 1 year 22.9% (13.8%, 31.9%) 1‐5 years 31.2% (22.1%, 40.2%) 5‐10 years 17.4% (10.2%, 24.6%) > 10 years 28.6% (19.9%, 37.3%) Figure 9. Reasons why diabetic adults do not adhere
fully or at all to a self‐management plan
60
50
40
30
20
10
0
Cost too
much
No family
support
Didn't help Didn't need
Didn't
Didn't want
diabetes
to
understand
to
the plan
Other
Too busy
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Figure 10. Reasons for not attending a diabetes class
60
50
percent
40
30
20
10
0
too busy
cost too
much
no family
support
didn't think time/location didn't want
needed to
not
to
convenient
other
Table 12. Perceptions of medication use among Colorado adults reporting a diagnosis of diabetes percent 95% CI I understand my doctor’s/nurse’s instructions about the diabetes medicines I take.
I feel confident that each one of my diabetes medicines will help me.
I have someone in the health field whom I can call with questions about my diabetes medicines. I worry about how the diabetes medicines I am supposed to take will affect my health. Sometimes I worry about the cost of my diabetes medicines.
94.2% 91.1% 83.8% (88.9%, 99.5%)
(86.2%, 96.0%)
(76.2%, 91.5%)
40.9% (32.0%, 49.8%)
33.6% (25.4%, 41.8%)
Taking diabetes medicines more than once a day is inconvenient.
I just forget to take my diabetes medicines some of the time.
I have to take too many diabetes medicines a day.
I sometimes run out of my diabetes medicine because I don’t get refills on time.
27.6% 26.2% 22.6% 12.4% (19.7%, 35.6%)
(17.8%, 34.5%)
(15.1%, 30.0%)
(6.1%, 18.6%)
Results from TABS-IFHL
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Hypertension Nearly one‐fourth (22.2%; 20.2%, 24.2%) of Colorado adults reported having high blood pressure, which was significantly more prevalent among obese respondents (34.9%) and those with disabilities (41.5%). Most IFHL respondents (83.6%) reported having their blood pressure measured at a doctor’s office over the past 12 months (figure 10). Figure 11. Where all IFHL respondents had their blood pressure measured over the past 12 months
90
80
70
60
50
40
30
20
10
0
Doctor's
office
Dentist's Community Pharmacy Health fair Nurse who
office
health
came to
center
house
Family
member
Other
Among those with high blood pressure:  63.1% have been told by their health care provider to increase exercise and 41% have been told by to eat healthy (figure 11).  of those with a self‐management plan for high blood pressure, 60% were fully following the plan when interviewed (table 12); most have had a plan for more than a year (table 13). Among those who were not adhering fully or not following the plan at all, more than a third said the reason is "didn't want to" (figure 12).  87.8% (83.8%, 91.7%) reported that they felt very or somewhat sure they were able to control their high blood pressure; low SES hypertensive adults were significantly less likely to report feeling confident (81.9% vs. 91.8% in non‐low SES).  95.6% of respondents feel confident that each one of their blood pressure medicines will help them, yet about one‐third worry about how the blood pressure medicines they are supposed to take will affect their health (table 14).  65.7% own a blood pressure monitor for personal use. Of those with a monitor, in the past 12 months, on average they monitored their blood pressure 1.2 times per week; however, the majority never sent the readings to their doctors (79.3%; 74.8%, 83.7%). o When asked about monitoring blood pressure at home, 84.5% agreed that it was convenient to monitor at home, while 60% said their blood pressure was under control and did not need to be monitored (table 15).  93.1% feel that high blood pressure increases their risk for stroke or heart disease. Results from TABS-IFHL
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Figure 11. Advice medical providers gave respondents with high blood pressure
70
60
percent
50
40
30
20
10
0
eat healthy
increase
exercise
reduce sodium reduce alcohol lose weight
reduce
smoking
Table 13. Hypertensive adults with self‐management plan developed with health care provider self‐management plan? percent
95% CI Fully following plan at interview 60.0% (52.1%, 67.9%) Following part of the plan 30.5% (23.0%, 38.1%) No plan 9.5% (4.7%, 14.3%) Table 14. Length of time on the hypertension management plan Length of time on the self‐management plan percent 95%CI < 1 year 17.5% (11.4%, 23.5%) 1‐5 years 35.5% (27.6%, 43.4%) 5‐10 years 14.4% (9.0%, 19.8%) > 10 years 32.6% (25.3%, 39.9%) Results from TABS-IFHL
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percent
Figure 12. Reasons why respondents with hypertension did not adhere fully or at all to the self‐management plan
40
35
30
25
20
15
10
5
0
Table 15. Reported perceptions of medication use among IFHL respondents with hypertension medication use perception percent 95% CI I understand my doctor’s/nurse’s instructions about the blood pressure
97.5% (95.5%, 99.5%) medicines I take I feel confident that each one of my blood pressure medicines will help 95.6% (93.0%, 98.1%) me I have someone in the health field whom I can call with questions 87.5% (83.3%, 91.8%) about my blood pressure medicines I have to take too many blood pressure medicines a day
15.0% (10.5%, 19.5%) I worry about how the blood pressure medicines I am supposed to take 32.5% (27.0%, 38.1%) will affect my health I just forget to take my blood pressure medicines some of the time
20.2% (15.3%, 25.0%) I sometimes run out of my blood pressure medicine because I don’t get 15.0% (10.5%, 19.6%) refills on time. Taking blood pressure medicines more than once a day is inconvenient
Sometimes I worry about the cost of my blood pressure medicines
28.1% 29.1% (22.7%, 33.5%) (23.5%, 34.7%) Table 16. Respondents who agree with the following statements about monitoring blood pressure at home statement percent I can afford to buy a blood pressure monitor 80.2% My insurance covers buying blood pressure monitor 22.9% I know how to check my blood pressure at home 82.7% I know what I would do with blood pressure monitor information 89.1% It is convenient to monitor my blood pressure at home 84.5% My blood pressure is under control and does not need to be monitored 58.8% 95%CI (75.9%, 84.6%) (17.4%, 28.4%) (78.5%, 86.9%) (85.7%, 92.5%) (80.7%, 88.3%) (53.9%, 63.8%) Results from TABS-IFHL
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Workplace Environment Adults who reported being employed for wages were asked about their workplace environment and access to healthy food and programs. Majorities reported various health‐supporting workplace attributes: 79.2% report that their employer allows walking or exercise breaks, and 88.9% report they have safe places to walk (table 17). Nearly half (46.2%) report that organized health activities take place at their workplace. Table 17. Respondents reporting “strongly or somewhat agree” with the following workplace attributes statement percent 95% CI I have easy access to free drinking water 94.4 % (92.6%, 96.2%) My employer allows me to take breaks for walking or other exercise 79.2% (76.0%, 82.4%) I have access to safe places to walk at my workplace 88.9% (86.5%, 91.3%) People at my workplace organize health activities 46.2% (42.2%, 0.2%) I would like to participate in these activities 64.4% (60.6%, 68.2%) Employed adults spend a median of 3.9 hours a day sitting at work, with low SES employees spending much fewer hours sitting than non‐low SES employees (1.3 hours vs. 4.8 hours). Obese employees spend more time sitting at work than non‐obese respondents (4.7 hours vs. 3.7 hours). About half of employees (52.0%) reported having a vending machine at their work place, although most with vending machine access do not use it (figure 13). About one‐third (34.9%) reported having a cafeteria at their workplace.  About one fourth (22.2%) buy sweets, chips or candy from workplace vending machines once a month.  Asked hypothetically, 55% say they are “very likely” or “somewhat likely” to purchase 100% juice from a workplace vending machine, while a similar proportion (57.9%) say they are "very unlikely" to buy skim milk or low‐fat milk (Figure 13). Figure 13. Vending machine use among employed adults who have vending machines at their workplace
100
percent
80
60
40
20
0
never
1 time per
month
Sweets, chips, candy
2‐3 times per
month
1 time per
week
Sweetened Drinks
Fruits and Vegetables
2‐3 times per 4+ times per
week
week
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Figure 14. How likely employees are to purchase selected healthy foods from a workplace vending machine
100% Fruit Juice
Unsweetened Tea
Skim or Lowfat Milk
70
60
percent
50
40
30
20
10
0
very likely
somewhat likely
somewhat unlikely
very unlikely
Results from TABS-IFHL
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Marijuana use About half of Colorado adults (48.5%) have ever smoked marijuana, and 21.2% have used it in the past 30 days (table 18). Among past‐30‐day users, 17.9% drove a car more than 5 times while using marijuana, and 6.6% drove a car everyday while using marijuana; 72% did not drive a car while using marijuana in the past 30 days. Asked about whether they have changed their marijuana use since recreational marijuana was legalized on Jan 1, 2014, 93.6% reported no change, and only 2.7% reported increasing their use. Table 18. Marijuana use among IFHL respondents question 95% CI Ever smoked marijuana 48.5% (45.8%, 51.2%) median age (years) at first use 16.7 (16.3, 17.0) used more than 12 months ago 67.3% (63.5%, 71.2%) used >30 days to <12 months ago 10.6% (8.1%, 13.1%) used in past 30 days 21.2% (17.8%, 24.6%) smoked 95.8% (92.4%, 99.3%) consumed 45.9% (35.6%, 56.2%) Ever used synthetic marijuana 1.8% (1.0%, 2.6%) Have a medical marijuana license 3.6% (2.5%, 4.7%) Ever‐use was most common among GLB adults (72%), and more common among college graduates vs. those with less education and Anglos vs. blacks/African Americans (figure 16). Almost 60% of adults perceive that using marijuana presents a moderate or great risk of (figure 17) Figure 16. IFHL respondents having ever used marijuana, by demographic group
80%
70%
60%
50%
40%
30%
20%
10%
0%
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Figure 17. Perceived risk of using marijuana
35
30
percent
25
20
15
10
5
0
no risk
slight risk
moderate risk
great risk
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Appendix A