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Healthiest Wisconsin 2020 Baseline and Health Disparities Report American Indian Population

Healthiest Wisconsin 2020 Baseline and Health Disparities Report American Indian Population. Chapter outline. Chapter Outline. Background Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report Key points Data quality Data Demographic characteristics Risk factors

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Healthiest Wisconsin 2020 Baseline and Health Disparities Report American Indian Population

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  1. Healthiest Wisconsin 2020 Baseline and Health Disparities ReportAmerican Indian Population

  2. Chapter outline Chapter Outline Background • Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report • Key points • Data quality Data • Demographic characteristics • Risk factors • Health outcomes • Protective factors • Youth outcomes • Mental health References Links to additional reports and resources Contacts

  3. Report overview Report Overview • This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf • The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included. • Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations. • Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

  4. Report overview Report Format Sample annotated slide Full Report • Format: PDF • Intended use: reference document Chapters • Format: Annotated PowerPoint slide set • Intended uses: presentations to • Decision-makers • Service providers • Community leaders • The public

  5. Report overview Report Outline Executive Summary Section 1: Introduction Section 2: Demographic overview Section 3: Health focus areas Section 4: Infrastructure focus areas Section 5: Data summaries by population Section 6: Technical notes

  6. Report overview Report Outline: Detail Section 3: Health focus areas Section 4: Infrastructure focus areas

  7. Report overview Report Outline: Detail Section 5: Data summaries by population

  8. Report overview Data notes • Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf • The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution. • Population estimates that are considered unreliable are excluded. • Misclassification of racial/ethnic groups may affect the accuracy of rates. • Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non-Hispanic. Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach

  9. Report overview Factors that influence health Social determinants of health Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach

  10. Report overview Historical trauma • Historical trauma is the cumulative exposure to traumatic events that not only affect the individual exposed, but continue to affect subsequent generations. • Descendants of those who experienced the traumatic stressor may still exhibit symptoms. • Populations affected by historical trauma include American Indians, African Americans/Blacks, Hispanics/Latinos, Asians, immigrants and refugees, war veterans, and families experiencing intergenerational poverty. • Current manifestations may include: • Mistrust of health care, legal, and educational systems; • Higher rates of risk behaviors such as alcohol and drug abuse, suicide, homicide, and domestic violence; and • Higher rates of chronic diseases. • Sources: SAMHSA, Fact Sheet: Historical Trauma http://gainscenter.samhsa.gov/cms-assets/documents/93078-842830.historical-trauma.pdf, Texas Department of Health Services, Trauma Informed Care Training, http://www.dfps.state.tx.us/Training/Trauma_Informed_Care/page35.asp

  11. Summary Key Points • American Indians in Wisconsin are younger than the general population and more likely to live in rural areas. • American Indians in Wisconsin are more likely to live in poverty, less likely to be in a married couple household, and less likely to have a college degree compared to Whites. • Key health issues for American Indian adults include: consequences from alcohol use, tobacco use and exposure, asthma, diabetes, intentional injury, premature death from coronary heart disease, and cancer.

  12. Summary Key Points • Key health issues for American Indian youth include: obesity, motor vehicle crashes, school violence, and teen pregnancy. • Better data on American Indians are needed due to small sample size, racial misclassification, and data access issues.

  13. Data issues Data quality issues: American Indian population Data on American Indians are limited due to five major issues: • Data access • Inconsistent measures used for race and ethnicity • Racial misclassification • Small population size • Other data quality considerations

  14. Demographic and socioeconomic data

  15. Demographics and socioeconomic data Demographic Characteristics Wisconsin’s American Indian population is younger than the White population, more rural than other racial/ethnic groups, and increasing in numbers. • Wisconsin's American Indian population, 2010: 48,511; 0.9%of state total • Change in the American Indian population, 2000 to 2010: 13%increase • Median age, 2010: American Indian, 30years (Whites, 41.5 years) The median age is the age at which half the population is older and half is younger. • American Indians living in non-metropolitan counties: 41% (Whites, 33%) Sources: http://www.dhs.wisconsin.gov/health/MinorityHealth/Report.htm and U.S. Census Bureau.

  16. Wisconsin’s American Indian population has higher poverty rates and less education compared to Whites. Median household income in Wisconsin, 2008-2010: American Indians, $35,000 (Whites, $53,000) Poverty rate, 2010: American Indian, 29% (Whites, 10%) The poverty rate is the percent living below the federal poverty level. Bachelor’s degree or more education (age 25 and older), 2007-2010: American Indian, 11% (Whites, 27%) Married-couple households as a percent of family households, 2008-2010: American Indian, 52% (other racial/ethnic groups range from Blacks, 33% to Whites, 82%) Source: http://www.dhs.wisconsin.gov/health/MinorityHealth/Report.htm and U.S. Census Bureau. Demographics and socioeconomic data Socioeconomic data

  17. Demographics and socioeconomic data American Indian population by county, Wisconsin, 2010 Source: U.S. Census, 2010.

  18. Demographics and socioeconomic data American Indian Tribes in Wisconsin Source: Great Lakes Inter-Tribal Council, Inc.

  19. Demographics and socioeconomic data Poverty rate by race/ethnicity, Wisconsin, 2010 Total, 13% Source: American Community Survey, 2010.

  20. Risk Factors in Youth and Adults

  21. Physical health Age-adjusted indicators of poor health status among Wisconsin adults by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

  22. Nutrition Obesity among children (ages 2-4 years) enrolled in WIC, by race/ethnicity, Wisconsin, 2001 and 2010 Source: Centers for Disease Control and Prevention (CDC) Pediatric Nutrition Surveillance Survey 2010. Note: Based on >= 95th growth chart percentiles for Body Mass Index for age. WIC is the Supplemental Nutrition Program for Women, Infants, and Children.

  23. Nutrition Age-adjusted rates of overweight and obesity among Wisconsin adults by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

  24. Alcoholand other drugs Rates of early initiation of alcohol and marijuana use among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.

  25. Alcohol and other drugs Age-adjusted rates of binge drinking and heavy drinking among Wisconsin adults, by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

  26. Injury and violence Motor vehicle risk behaviors among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.

  27. Injury and violence Exposure to school violence among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

  28. Reproductive and sexual health Estimated prevalence of sexual risk behaviors among Wisconsin high school students by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

  29. Mental Health

  30. Mental health Protective factors among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS).

  31. Mental health Depression among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS).

  32. Mental health Suicide risk during past 12 months among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS). Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

  33. Mental health Suicide deaths, age-adjusted rate per 100,000, by race/ethnicity, Wisconsin, 2008-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates..

  34. Health Outcomes

  35. Chronic diseases Percentage of coronary heart disease deaths under the age of 75, by race/ethnicity and sex, Wisconsin, 2006-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.

  36. Chronic diseases Percentage of stroke deaths under the age of 75, by race/ethnicity and sex, Wisconsin, 2006-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.

  37. Chronic diseases Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by race/ethnicity, 2009 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions only asked in 2009 and 2011.Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

  38. Chronic diseases Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

  39. Chronic diseases Cancer incidence and mortality (all sites) by race/ethnicity, age-adjusted rate per 100,000, Wisconsin, 2010 Sources: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services; and National Center for Health Statistics, Wisconsin mortality file 1995-2102, Vital Statistics Cooperative Program, 2013. Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.

  40. Chronic diseases Lung and bronchus cancer mortality by race/ethnicity, age-adjusted rate per 100,000, Wisconsin and United States, 2006-2010 Sources: Source: National Center for Health Statistics. Wisconsin mortality data file 1995-2010, Vital Statistics Cooperative Program, 2013. Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.

  41. Chronic diseases Female breast cancer mortality by race/ethnicity, age-adjusted rate per 100,000, Wisconsin and United States, 2006-2010 Sources: Source: National Center for Health Statistics. Wisconsin mortality data file 1995-2010, Vital Statistics Cooperative Program, 2013. Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.

  42. Chronic diseases Cervical cancer incidence by race/ethnicity, age-adjusted rate per 100,000, Wisconsin, 2006-2010 Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Wisconsin Department of Health Services. Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.

  43. Chronic diseases Prostate cancer mortality by race/ethnicity, age-adjusted rate per 100,000, Wisconsin and United States, 2006-2010 Source: National Center for Health Statistics, Wisconsin mortality file 1995-2102, Vital Statistics Cooperative Program, 2013. Note: Rate not displayed when based on fewer than 10 cases. In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.

  44. Chronic diseases Alcoholic liver disease deaths by race/ethnicity, age-adjusted rate per 100,000, Wisconsin, 2008-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Note: WISH suppresses small numbers (when cell size is less than 5) to comply with Wisconsin vital records data privacy guidelines; this means a rate may not be presented for every population group.

  45. Injury and violence Unintentional injury deaths (leading causes) by race/ethnicity, age-adjusted rates per 100,000, Wisconsin, 2008-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Note: WISH suppresses small numbers (when cell size is less than 5) to comply with Wisconsin vital records data privacy guidelines.

  46. Reproductive and sexual health Births to teens ages 15-19 as a percent of all births, by race/ethnicity, Wisconsin, 2000-2010 Percent of all births Source:  Wisconsin Department of Health Services, Division of Public Health, Office of Health Informatics: Births to Teens in Wisconsin, 2010.  January 2012.

  47. Communicable diseases Confirmed cases of invasive Streptocococcuspneumoniae and group B streptococcal (GBS) disease, rate per 100,000, by race/ethnicity, Wisconsin, 2007-2011 Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System. Note: Data were not available for Hispanics.

  48. References References • 2010 Census Briefs: The American Indian and Alaska Native Population: http://www.census.gov/prod/cen2010/briefs/c2010br-10.pdf • University of Wisconsin Population Health Institute. County Health Rankings, 2013. http://www.countyhealthrankings.org/our-approach • Center for Urban Population Health. Milwaukee Health Report, 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf • LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf • Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/ • Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf • Great Lakes Inter-Tribal Epidemiology Center, Data Challenges and Strategies, 2012, unpublished. • U.S. Department of Health and Human Services, Gaps and Strategies for Improving AI/AN/NA Data, 2007. http://aspe.hhs.gov/hsp/07/AI-AN-NA-data-gaps/index.htm

  49. References • American Community Survey. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=table • American Community Survey Glossary. http://factfinder2.census.gov/help/en/american_factfinder_help.htm#glossary/glossary.htm • Centers for Disease Control and Prevention (CDC). Obesity Prevalence Among Low-Income, Preschool-Aged Children - United States, 1998-2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a1.htm • CDC. Fact sheets - Underage drinking. http://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm • National Institute on Drug Abuse. Drug Facts: Marijuana. http://www.drugabuse.gov/publications/drugfacts/marijuana • CDC. Teen Drivers: Fact Sheet. http://www.cdc.gov/motorvehiclesafety/teen_drivers/teendrivers_factsheet.html • CDC. Understanding School Violence. http://www.cdc.gov/violenceprevention/pdf/schoolviolence_factsheet-a.pdf • CDC. About School Violence. http://www.cdc.gov/VIOLENCEPREVENTION/youthviolence/schoolviolence/index.html • CDC. Sexual Risk Behavior: HIV, STD and Teen Pregnancy Prevention. http://www.cdc.gov/HealthyYouth/sexualbehaviors/

  50. References • CDC. School Connectedness: Strategies for Increasing Protective Factors Among Youth. http://www.cdc.gov/healthyyouth/adolescenthealth/pdf/connectedness.pdf • CDC. Youth Risk Behavior Surveillance System. http://apps.nccd.cdc.gov/youthonline/App/Default.aspx • Office of Adolescent Health. Mental Health. http://www.hhs.gov/ash/oah/adolescent-health-topics/mental-health/home.html • Keenan-Miller D, Hammen CL, Brennan PA. Health outcomes related to early adolescent depression. Journal of Adolescent Health. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2034364/ • CDC. Mortality Among Teenagers Aged 12-19 Years: United States, 1999-2006. http://www.cdc.gov/nchs/data/databriefs/db37.htm • National Institute of Mental Health. Many Teens Considering Suicide Do Not Receive Specialized Mental Health Care. 2012. http://www.nimh.nih.gov/news/science-news/2012/many-teens-considering-suicide-do-not-receive-specialized-mental-health-care.shtml • CDC. Health Inequalities Report, 2011. http://www.cdc.gov/mmwr/pdf/other/su6001.pdf • CDC. Disparities in Premature Mortality Between High- and Low-Income U.S. Counties. http://www.cdc.gov/pcd/issues/2012/11_0120.htm • CDC. Racial/Ethnic and Socioeconomic Disparities in Multiple Risk Factors for Heart Disease and Stroke --- United States, 2003. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5405a1.htm

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