arhi · mha, senior project manager ... appendix a5.1. physical exercise: ... management class...

December 2009, Prepared by the Voinovich School of Leadership and Public Affairs

AppAlAchiAn RuRAl heAlth instituteHealth Needs Assessment Survey III · Research Report

ARHI

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ARHI: Appalachian Rural Health Institute

Health Needs Assessment Survey III Research Report

Prepared by: The Voinovich School of Leadership and Public Affairs at Ohio University

Building 22, The Ridges Athens, OH 45701

(740) 593-4388

December 2009

APPALACHIANRURALHEALTHINSTITUTE(ARHI)HealthNeedsAssessmentSurveyIII∙ResearchReport

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APPALACHIANRURALHEALTHINSTITUTE(ARHI)HealthNeedsAssessmentSurveyIII∙ResearchReport

Acknowledgments

Manyindividualscontributedtothesuccessfulundertakingofthisreport,andweextendourgratitudetoallofthepeoplewhogavetheirtimeandassistance.

VoinovichSchoolofLeadershipandPublicAffairsatOhioUniversity

SaraLichtinBoyd,BSN,MHA,SeniorProjectManager

FigenKaradogan,MS,ResearchAssistant

HollyRaffle,PhD,CHES,AssistantProfessorofLeadershipandPublicAffairs

AnirudhV.S.Ruhil,PhD,AssociateProfessorofLeadershipandPublicAffairs

LezleeJ.Ware,PhD,ResearchAssociate

NicoleYandell,MA,ResearchAssociate

HollyCraycraft,ResearchAssistant

KateLeeman,Editor

VladPascal,CoverPhotography

LindseySiegrist,GraphicDesign

EliasBarberi,UndergraduateVoinovichScholarOhioUniversityScrippsSurveyResearchCenter

JerryL.Miller,PhD,AssociateProfessor,SchoolofCommunicationStudies

MaxLaird,GraduateResearchAssistantAppalachianRuralHealthInstitute

SharonDenham,DSN,RN,Director

JaneHamel‐Lambert,MBA,PhD,AssociateDirector

FrankSchwartz,MD,Director,ARHIDiabetesCenter,AssociateProfessorofEndocrinology

ThisprojectwasfundedbytheU.S.DepartmentofHealthandHumanServices,HealthResourcesandServicesAdministration,OfficeofRuralHealthPolicy.

APPALACHIAN RURAL HEALTH INSTITUTE (ARHI) Health Needs Assessment Survey III ∙ Research Report

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Table of Contents

I. EXECUTIVE SUMMARY ............................................................................................................................... 1

II. INTRODUCTION ......................................................................................................................................... 7

III. SURVEY METHOD ..................................................................................................................................... 9

SURVEY DESIGN ............................................................................................................................... 9

SURVEY PROCESS ............................................................................................................................. 9

POST‐SURVEY PROCEDURES ............................................................................................................ 9

COMPARING THE ARHI STUDY RESULTS TO PREVIOUS RESEARCH ............................................... 10

IV. SURVEY FINDINGS .................................................................................................................................. 13

INTRODUCTION .............................................................................................................................. 13

Distribution of the Survey Sample .................................................................................... 13

GENERAL HEALTH STATUS ............................................................................................................. 15

EXAMINED HEALTH CONDITIONS .................................................................................................. 17

Asthma Rates .................................................................................................................... 18

Arthritis Rates ................................................................................................................... 19

Diabetes Rates .................................................................................................................. 20

Heart Attack Rates ............................................................................................................ 21

Heart Disease Rates .......................................................................................................... 22

Stroke Rates ...................................................................................................................... 23

High Blood Pressure Rates ................................................................................................ 24

High Blood Pressure Medication Use .................................................................. 25

High Cholesterol Rates ...................................................................................................... 26

SPOTLIGHT ON DIABETES ............................................................................................................... 27

Comorbid Conditions ........................................................................................................ 27

Diabetes Diagnosis Before Age 40 .................................................................................... 28

Daily Blood‐Glucose Testing ............................................................................................. 29

Diabetes Pill Use ............................................................................................................... 30


Insulin Use ......................................................................................................................... 31

Diabetes Class Attendance ............................................................................................... 32

Annual Diabetes‐Related Doctor Visit .............................................................................. 33

Annual Dental Visit and Diabetes ..................................................................................... 34

Cost Restricting Diabetes Care .......................................................................................... 35

Cost Restricting Doctor Visits ............................................................................... 35

Cost Restricting Medication ................................................................................. 36

Cost Restricting Glucose Checks .......................................................................... 37

RISK FACTORS ................................................................................................................................. 39

Body Mass Index ............................................................................................................... 40

Rate of Healthy Weight ........................................................................................ 40

Rate of Obesity .................................................................................................... 41

Activity Level ..................................................................................................................... 42

Moderate Exercise ............................................................................................... 42

Vigorous Exercise ................................................................................................. 44

Smoking ............................................................................................................................. 46

Smoked 100 Cigarettes ........................................................................................ 46

Current Smokers .................................................................................................. 47

Self‐Reported Depressed Mood ....................................................................................... 48

HEALTH CARE ACCESS .................................................................................................................... 49

Single Primary Care Physician ........................................................................................... 49

Cost Prohibiting Necessary Care ....................................................................................... 50

Annual Dental Visit ........................................................................................................... 51

Insurance Coverage .......................................................................................................... 52

Insurance Demographics .................................................................................................. 53

Detailed Insurance Coverage ............................................................................................ 54

Prescription Coverage ....................................................................................................... 55


List of Figures and Tables

Figure 1. General Health Status ........................................................................................................... 15

Figure 2. Examined Health Conditions ................................................................................................ 17

Figure 3. Asthma Rates ........................................................................................................................ 18

Figure 4. Arthritis Rates ........................................................................................................................ 19

Figure 5. Diabetes Rates ....................................................................................................................... 20

Figure 6. Heart Attack Rates ................................................................................................................. 21

Figure 7. Heart Disease Rates ............................................................................................................... 22

Figure 8. Stroke Rates ........................................................................................................................... 23

Figure 9. High Blood Pressure Rates ..................................................................................................... 24

Figure 10. High Blood Pressure Medication Use .................................................................................. 25

Figure 11. High Cholesterol Rates ........................................................................................................ 26

Figure 12. Diabetes Diagnosis Before Age 40 ....................................................................................... 28

Figure 13. Daily Blood‐Glucose Testing ................................................................................................ 29

Figure 14. Regular Diabetes Pill Use ..................................................................................................... 30

Figure 15. Regular Insulin Use .............................................................................................................. 31

Figure 16. Diabetes Class Attendance .................................................................................................. 32

Figure 17. Annual Diabetes‐Related Doctor Visit ................................................................................. 33

Figure 18. Annual Dental Visit and Diabetes ........................................................................................ 34

Figure 19. Cost Restricting Doctor Visit ................................................................................................ 35

Figure 20. Cost Restricting Medication ................................................................................................ 36

Figure 21. Cost Restricting Glucose Checks .......................................................................................... 37

Figure 22. Rate of Healthy Weight ....................................................................................................... 40

Figure 23. Rate of Obesity .................................................................................................................... 41

Figure 24. 5 Days or More of Weekly Moderate Exercise .................................................................... 42


Figure25. 3 Days or More of Weekly Vigorous Exercise ....................................................................... 44

Figure 26. Smoked 100 Cigarettes ........................................................................................................ 46

Figure 27. Current Smokers .................................................................................................................. 47

Figure 28. Self‐Reported Depressed Mood .......................................................................................... 48

Figure 29. Single Primary Care Physician .............................................................................................. 49

Figure 30. Cost Prohibiting Necessary Care.......................................................................................... 50

Figure 31. Annual Dental Visit .............................................................................................................. 51

Figure 32. Insurance Coverage ............................................................................................................. 52

Figure 33. Detailed Insurance Coverage ............................................................................................... 54

Figure 34. Prescription Coverage ......................................................................................................... 55

Table 1. Employment and Insurance Coverage .................................................................................... 53

Table 2. Income and Insurance Coverage ............................................................................................ 53


Table of Appendices

Appendix A. Weighted ARHI III Data ........................................................................................................... 58

Appendix A1. General Health Status .............................................................................................. 58

Appendix A2. Examined Health Conditions ................................................................................... 61

Appendix A3. Diabetes ................................................................................................................... 66

Appendix A3.1. Diabetes: Belmont County ...................................................................... 67

Appendix A3.2. Diabetes: Columbiana County ................................................................. 68

Appendix A3.3. Diabetes: Gallia County ........................................................................... 69

Appendix A3.4. Diabetes: Harrison County ...................................................................... 70

Appendix A3.5. Diabetes: Jefferson County ..................................................................... 71

Appendix A3.6. Diabetes: Lawrence County ..................................................................... 72

Appendix A3.7. Diabetes: Monroe County ....................................................................... 73

Appendix A3.8. Diabetes: Muskingum County ................................................................. 74

Appendix A3.9. Diabetes: Noble County ........................................................................... 75

Appendix A4. Body Mass Index (BMI) Categories .......................................................................... 76

Appendix A5. Physical Exercise ...................................................................................................... 77

Appendix A5.1. Physical Exercise: Belmont County .......................................................... 78

Appendix A5.2. Physical Exercise: Columbiana County .................................................... 79

Appendix A5.3. Physical Exercise: Gallia County .............................................................. 80

Appendix A5.4. Physical Exercise: Harrison County .......................................................... 81

Appendix A5.5. Physical Exercise: Jefferson County ......................................................... 82

Appendix A5.6. Physical Exercise: Lawrence County ........................................................ 83

Appendix A5.7. Physical Exercise: Monroe County .......................................................... 84

Appendix A5.8. Physical Exercise: Muskingum County .................................................... 85

Appendix A5.9. Physical Exercise: Noble County .............................................................. 86


Appendix A6. Smoking ................................................................................................................... 87

Appendix A7. Self‐Reported Depressed Mood .............................................................................. 90

Appendix A8. Health Care Access .................................................................................................. 93

Appendix A9. Insurance Coverage ................................................................................................. 98

Appendix B. Weighted Demographics ...................................................................................................... 103

Appendix B1. Weighted Demographics: Belmont County ........................................................... 104

Appendix B2. Weighted Demographics: Columbiana County ..................................................... 105

Appendix B3. Weighted Demographics: Gallia County ................................................................ 106

Appendix B4. Weighted Demographics: Harrison County ........................................................... 107

Appendix B5. Weighted Demographics: Jefferson County .......................................................... 108

Appendix B6. Weighted Demographics: Lawrence County ......................................................... 109

Appendix B7. Weighted Demographics: Monroe County ............................................................ 110

Appendix B8. Weighted Demographics: Muskingum County ...................................................... 111

Appendix B9. Weighted Demographics: Noble County ............................................................... 112

Appendix C. Weighted and Unweighted Sample Demographics .............................................................. 113

Appendix D. Statistical Limitations: A Tutorial .......................................................................................... 114

Appendix D1. Cross‐Tabulated Variables at the County Level ..................................................... 114

Appendix D2. Standard Errors Reported as Zero ......................................................................... 116

Appendix E. Comprehensive Description of the Survey ........................................................................... 117

APPALACHIANRURALHEALTHINSTITUTE(ARHI)HealthNeedsAssessmentSurveyIII∙ResearchReport 1

AspartoftheAppalachianRuralHealthInstitute(ARHI)DiabetesResearchInitiative,residentsinBelmont,Columbiana,Gallia,Harrison,Jefferson,Lawrence,Monroe,Muskingum,andNoblecountiesparticipatedinahealthcareneedsassessmentsurvey.Thesurveycollectedprevalencedataonanumberofchronicdiseaseswithanemphasisondiabetes.Additionalinformationwascollectedonrelevantriskfactors,includingsmoking,physicalexercise,highcholesterol,andobesity.Thesurveywasintentionallymodeledafterthe2007BehavioralRiskFactorSurveillanceSystemsurvey(BRFSS),createdbytheCentersforDiseaseControlandPrevention(CDC)1,toallowforstateandnationalcomparisonsofthesurveyresults.Further,surveyresultswere,wheneverpossible,comparedtotheCDC’sHealthyPeople20102–anationalhealthpromotionandpreventionplanwithdefinedgoalsandbenchmarksintendedtoenhancethehealthstatusofAmericans.Thecurrentsurvey(ARHIIII)includesmanyofthequestionsfrompreviousARHIsurveysconductedin2006(Jackson,Meigs,Morgan,Perry,Ross,Scioto,andWashingtoncounties)and2003(Athens,Hocking,Pike,andVintoncounties).

Somecriticalpointstotakeawayfromthisneedsassessmentsurveyinclude:

1. Whencomparedtothe2007BRFSSratesforOhioandthenation,ARHIIIIrespondentsreportworseoverallhealthstatus.

• AsmallerproportionofARHIIIIresidentsreportedtheirhealthasexcellentorverygoodascomparedtothestateandnational2007BRFSSResults.

• AgreaterproportionofARHIIIIresidentsdescribedtheirhealthasfairorpoorascomparedtothestateandnational2007BRFSSresults.

• ARHIIIIresidentswhoseself‐reportedhealthstatuswasfairorpoorhadasignificantlygreater3likelihoodofhavingachronicdisease,demonstratingtherelationshipbetweenself‐reportedhealthstatusanddiseaseprevalence.

• BodyMassIndex(BMI)wasrelatedtohealthstatus,withobeseindividualssignificantlymorelikelytoreportthattheirhealthwasfairorpoor.

2. TheARHIIIIregionalprevalenceratesofallsevenchronicdiseasessurveyed(asthma,

arthritis,diabetes,heartattack,heartdisease,stroke,andhighbloodpressure)exceededthenational2007BRFSSratesand,inallbutoneinstance(arthritis),theOhio2007BRFSSrates.

1InformationontheBRFSScanbefoundathttp://www.cdc.gov/BRFSS2HealthyPeople2010informationcanberetrievedathttp://www.healthypeople.gov3Thewordsignificantlydenotesastatisticallymeaningfuldifference.Pleaseseepage13fordetails.

EXECUTIVE SUMMARY


• TherateofasthmaamongARHIIIIresidentsis14.1%,whichishigherthantheOhio(13.1%)andnational(12.9%)2007BRFSSrates.

• TherateofarthritisamongARHIIIIresidentswas32.2%,whichisthesameastheOhio(32.2%)andhigherthanthenational(26.9%)2007BRFSSrates.

• TherateofdiabetesamongARHIIIIresidentsis12.5%,whichishigherthantheOhio(9.5%)andnational(8.6%)2007BRFSSrates.

• TherateofheartattackamongARHIIIIresidentsis7.3%,whichishigherthantheOhio(5.4%)andnational(4.2%)2007BRFSSrates.

• TherateofheartdiseaseamongARHIIIIresidentsis6.7%,whichishigherthantheOhio(5.1%)andthenational(4.2%)2007BRFSSrates.

• TherateofstrokeamongARHIIIIresidentsis4.2%,whichishigherthantheOhiorate(3.1%)andthenational(2.7%)2007BRFSSrates.

• TherateofhighbloodpressureamongARHIIIIresidentsis32.2%,whichishigherthantheOhio(28.4%)andthenational(27.7%)2007BRFSSrates.

3. TherateofdiabetesamongARHIIIIresidents(12.5%)isapproximatelythreepercentage

pointshigherthantheOhio2007BFRSSrate(9.5%)andapproximatelyfourpercentagepointsabovethenational2007BRFSSrate(8.6%).

• AmongthoseARHIIIIresidentslivingwithdiabetes,49.2%werediagnosedwiththediseasebeforetheageof40,whichisamuchhigherproportionthanseenacrossthenation(19.0%).4

• TherateofARHIIIIresidentslivingwithdiabetesthatchecktheirblood‐glucoselevelatleastonceaday(71.9%)exceededtheHealthyPeople2010targetrateof60.0%.

• TherateofARHIIIIresidentslivingwithdiabetesthatregularlyusediabetespills(67.2%)fallsbelowthenational2007BRFSSrateof70.2%.

• TherateofARHIIIIresidentslivingwithdiabetesthatregularlyuseinsulinis28.4%whichisabovethenational2007BRFSSrateof(26.8%).

• TherateofARHIIIIresidentslivingwithdiabetesthathaveattendedadiabetes‐managementclass(46.4%)fallsbelowthenational2007BRFSSrate(55.1%)andbelowtheHealthyPeople2010targetrate(60.0%).

• TherateofARHIIIIresidentslivingwithdiabeteswhohaveanannualdiabetes‐relateddoctorvisitis95.0%,whichexceedsthenationalrateof85.2%.

4Thisnationalrateisfromthe2007NationalHealthInterviewSurvey(NHIS).Thisdatacanbereviewedathttp://www.cdc.gov/diabetes/statistics/age/fig1.htm


• TherateofARHIIIIresidentslivingwithdiabetesthatvisitadentistatleastonceannuallyis58.2%,whichfallsbelowtheHealthyPeople2010targetrateof75.0%.

• TherateofARHIIIIresidentslivingwithdiabeteswhocannotaffordtoseeadoctoris26.3%.

• TherateofARHIIIIresidentslivingwithdiabeteswhocannotafforddiabetes‐relatedmedicationis16.9%.

• TherateofARHIIIIresidentslivingwithdiabeteswhocannotaffordteststripstochecktheirblood‐glucoselevelsis23.6%.

4. BMI(BodyMassIndex)isanimportantriskfactorforthemajorityofhealthconditions

surveyed.• TheHealthyPeople2010targetistoreducethenumberofobeseindividualsto

15.0%andincreasethenumberofhealthyweightadultsto60.0%.• AcrosstheARHIIIIcounties,30.7%ofadultsareobeseandonly34.0%area

healthyweight.• ForeachincreaseinBMIcategory,thereisasignificantlyhigherlikelihoodof

reportingthefollowingconditions:diabetes,arthritis,highbloodpressure,andhighcholesterol.

• ARHIIIIresidentswhoareobeseoroverweightaresignificantlymorelikelytoreporthavingaheartattackthanhealthyweightindividuals.

• ARHIIIIresidentswhoareobeseoroverweightaresignificantlymorelikelytohaveheartdiseasethanhealthyweightindividuals.

5. TheHealthyPeople2010targetisfor30.0%ofAmericanstoengagein20minutesof

moderateexerciseatleast5daysaweek.• AcrosstheARHIIIIcounties,35.6%ofresidentsaremeetingthistarget.• ARHIIIIresidentswhoaremeetingtheHealthyPeople2010goalformoderate

exercisearesignificantlylesslikelytoreporthavingarthritis,diabetes,aheartattack,heartdisease,highbloodpressure,highcholesterol,andstroke.

• ARHIIIIresidentswhoaremeetingtheHealthyPeople2010goalformoderateexercisearesignificantlylesslikelytobeobese.

6. TheHealthyPeople2010targetisfor30.0%ofAmericanstoengagein20minutesof

vigorousexerciseatleast3daysaweek.• AcrosstheARHIIIIcounties,27.0%ofresidentsaremeetingthistarget.


• ARHIIIIresidentswhoaremeetingtheHealthyPeople2010goalforvigorousexercisearesignificantlylesslikelytoreporthavingarthritis,diabetes,aheartattack,heartdisease,highbloodpressure,highcholesterol,andstroke.

• ARHIIIIresidentswhoaremeetingtheHealthyPeople2010goalforvigorousexercisearesignificantlylesslikelytobeoverweightorobese.

• Witheachincreaseinagecategoryaftertheageof44,thelikelihoodofmeetingtheHealthyPeople2010goalforvigorousexercisesignificantlydecreases.

• Males(33.4%)aresignificantlymorelikelytomeettheHealthyPeople2010goalforvigorousexercisecomparedtofemales(21.1%).

7. Onequarter(25.6%)ofARHIIIIresidentsreportedsmokingeverydayorsomedays;greatlyexceedingthenational2007BRFSSrateof19.3%andtheHealthyPeople2010targetof12.0%.

• Individualswhohavesmoked100ormorecigarettesintheirlifetimehaveasignificantlygreaterlikelihoodofhavingarthritis,diabetes,heartattack,andheartdisease.

8. TherateofARHIIIIresidentswhoreportedfeelingdepressedinthepreviousmonthwas

38.0%,whichwasbelowthenational2007BRFSSrate(41.9%).• Individualswithhouseholdincomesbelow$15,000weresignificantlymorelikely

toreportfeelingdepressedduringthepreviousmonththanindividualsinhigherincomebrackets.

• ObeseindividualsweresignificantlymorelikelytoreportfeelingdepressedwithinthepreviousmonthcomparedtootherBMIcategories.

• Ratesofdepressedfeelingsweresignificantlyhigheramongfemales(41.3%)thanmales(34.5%).

9. AccesstohealthcareacrossARHIIIIcountieswasroughlyequivalenttostateandnational2007BRFSSrates.

• Therateofindividualswhohaveasingle,primarycarephysicianacrosstheARHIIIIcounties(80.2%)isabovetheOhiorate(79.5%)andthenational(71.9%)2007BRFSSrates.However,itisstillbelowtheHealthyPeople2010targetof85.0%.

• AmongARHIIIIcounties,therateofresidentswhoareunabletoaffordadoctoris15.2%,whichisabovetheOhiorate(12.4%)andthenational(13.5%)2007BRFSSrates.

• AcrossARHIIIIcounties,69.5%ofresidentshavehadanannualdentalexam,whichishigherthantheHealthyPeople2010targetof56.0%.


• TherateofARHIIIIresidentswithinsurancecoveragewas85.9%,whichisbetweentheOhio(88.2%)andnational(84.4%)2007BRFSSrates.TheHealthyPeople2010targetisforeveryindividualtohaveinsurancecoverage.


TheAppalachianRuralHealthInstitute(ARHI)ResearchInitiativeisacomprehensiveprojectwiththegoalofimprovingthehealthstatusandrelatedqualityoflifeinunderservedandruralpopulations;particularlythoseinruralAppalachianOhio.Itisanumbrellaorganizationforinterdisciplinaryresearch,education,andservice.DiabetesisaspecialemphasisoftheARHIResearchInitiative.

ThisreportcontainsfindingsfromtheneedsassessmentsurveyconductedbetweenNovember2008andFebruary2009aspartofthiscomprehensiveinitiative.ThisisthethirdtimeARHIandtheVoinovichSchoolofLeadershipandPublicAffairs(GVS)haveconductedsuchasurvey,thefirsttakingplaceinDecemberof2003andthesecondinJanuaryof2006.Asintheprevioustwostudies,theintentofthissurveyistoassessandimproveunderstandingofthehealthproblemsoftheresidentsofAppalachianOhio,withaspecialemphasisondiabetesandtheassociatedhealthproblems.Thistime,thesurveywasconductedinninecounties–Belmont,Columbiana,Gallia,Harrison,Jefferson,Lawrence,Monroe,Muskingum,andNoble–andisreferredtoastheARHIIII.Informationwasgatheredontheprevalenceratesforcertainchronichealthconditions,includingdiabetesandrelateddisorders,aswellasrelevantriskfactorsfortheseillnesses.Inadditiontotheseriesofquestionsaimedtowardsrespondentslivingwithdiabetes,thesurveyalsocollectedinformationongeneralhealthstatus,accesstohealthcare,activitylevel,bodymass,andsmoking.AprimarygoalofthesurveydesignwastoallowforcomparisonsbetweenthecurrentstatewidefindingsinOhioandnationalfindingsfromtheU.S.CentersforDiseaseControlandPrevention’s(CDC)2007BehavioralRiskFactorSurveillanceSurvey(BRFSS)5aswellastheCDC’sHealthyPeople2010standards.

AllninesurveyedcountiesareinAppalachianOhio.Eightoftheninearedesignated,inpartorinwhole,asMedicallyUnderservedAreas(MUA)bytheU.S.DepartmentofHealthandHumanServices,HealthResourcesandServicesAdministration(HRSA).6HRSAappliesthisdefinitiontogeographicareaswithhighpovertyandinfantmortalityrates,alowprimarycarephysiciantopopulationratio,andalargeelderlypopulation.

5CentersforDiseaseControlandPrevention(CDC).BehavioralRiskFactorSurveillanceSystemSurveyQuestionnaire.Atlanta,Georgia:U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention,[2007].6AllofColumbiana,Harrison,Lawrence,Monroe,andMuskingumcountiesaredesignatedasMUAswhilecertaintownshipsinBelmont,JeffersonandNoblecountieshavetheMUAdesignation.GalliaCountyistheonlyoneintheARHIIIIregionwithoutaMUAdesignation.Thesedatawereretrievedatthefollowingwebsite:http://muafind.hrsa.gov/

INTRODUCTION


Whatfollowsisabriefdescriptionoftheprocessbywhichthissurveywasdesigned,administered,andanalyzed.Foramorecompletedescriptionofthemethodology,includingthesurveydesign,datacollectionandsamplingplan,andweightingofthedata,pleaserefertoAppendixVofthisreport.

SurveyDesign

TheinstrumentutilizedforthistelephonesurveymostlyreplicatestheprevioustwoARHIneedsassessmentinstruments.7ThemajorsourceforbothphasesoftheARHIsurveywastheBehavioralRiskFactorSurveillanceSystemsurvey(BRFSS)fromtheCentersofDiseaseControlandPrevention(CDC).8Changesfromthe2006ARHIinstrumentincludetheadditionofseveraldiabetesquestionsmodeledafterthe2007BRFSSdiabetesmodule,moreactivitylevelinformation,andmorecomprehensivehealthaccessitems.Inanefforttokeepthesurveyasconciseaspossible,afewquestionsweredroppedthatdidnotprovidesufficientlyusefulinformationoranopportunityforcomparisonwithresultscollectedwithintheBRFSS.

SurveyProcess

Thetelephonesurveys9tookplacebetweenNovember2008andFebruary2009.Allpotentialparticipantswereadvisedthattheirinvolvementinthesurveywasvoluntaryandconfidential.Onegoaloftheresearchteamwastostratifytheresultsofthesurveybycountyinordertoaccuratelyrepresentthepresenceofvarioushealthconditionswithinthepopulationsoftheseninecounties.Thisnecessitatedthecollectionofarelativelylargesamplesize.Atotalof3,841surveyswerecollectedfromresidents18andolder.TheindividualARHIIIIcountysamplecountsareprovidedinAppendixC.Differencesamongthenumberofpeoplesurveyedineachcountygenerallyreflecttherelativedifferencesincountypopulations.

Post‐SurveyProcedures

Oncethesurveywasconducted,post‐stratificationweightswerecomputedinordertomakethesampleasrepresentativeoftheentireARHIIIIpopulationaspossible.Forthissurvey,theweightswereconstructedbystratifyingeachcounty’spopulationbythegenderandagecategoriesgiveninthe2000U.S.CensusofPopulationestimates.Post‐stratificationweights

7PreviousARHIreportsandinformationcanbefoundathttp://www.oucom.ohiou.edu/arhi/research.htm8ThefullBRFSSquestionnaireanddatacanbelocatedathttp://www.cdc.gov/BRFSS9Onlylandlinetelephonenumbersweretargetedandnopost‐samplingadjustmentsweremadetocorrectforwireless‐onlyhomes.

SURVEY METHOD


werethencomputedasusual(i.e.,theratioofthewithin‐stratumpopulationproportiontothewithin‐stratumsampleproportion).Theseweightswerethenappliedtothesurveydatapriortoinitiatingtheanalysesmotivatingthisreport.TheassignedweightsareprovidedinAppendixIII.

ComparingtheARHIStudyResultstoPreviousResearch

OneofthegoalsofthisprojectwastoallowforacomparisonoftheARHIIIIsurveyresultstotheOhioandnational2007BRFSSfindings.Tomakesuchcomparisons,theARHIIIIsurveywasdesignedtoincludeidenticallywordedquestionsandresponsesfromexistinghealthsurveysconductedbytheCDC.Specifically,andasemphasizedearlierinthisreport,theAHRIIIIsurveyincludesquestionsfromtheCDC’sBRFSS.TheBRFSSisatelephonesurveydesignedbytheCDCandadministeredbytheindividualstatesandUSterritories.Itincludescorequestionsaswellasmodules.Allgovernmententitiesaskthecorequestions,andcanelectwhichmodulestouse.Forinstrumentationpurposes,thesurveyquestionswerecarefullydrawnfromtheBRFSScoreandfromthediabetesmodule.BecausethestateofOhiodidnotadministerthediabetesmodulein2007,comparisonsforthosequestionscanonlybemadewithnationaldata.ComparisonsbetweentheARHIIIIandthestateandnational2007BRFSSdataarealwaysmadebetweenweighteddata,andallratecomparisonsareunadjusted.

SincetheARHIIIIsurveyalsocontainsquestionsnotfoundintheBRFSS,notalloftheARHIIIIresultscanbecomparedtostateandnationaldata.Furthercomparisonsaremade,whenpossible,totheHealthyPeople2010targetspublishedbytheCDC.HealthyPeople2010isanationwidehealthpromotionanddiseasepreventionplanwhichhasdevelopedtargetsandobjectivesfortheU.S.population.Wheneverpossible,thesurveyresultsforeachAHRIIIIcountyarecomparedtothesehealthbenchmarks.10

TheBRFSSdataaremadepubliclyavailable,makingitpossibletocomparetheresultsoftheARHIIIIsurveyagainstboththe2007BRFSSdataandtheHealthyPeople2010targets.Todoso,the2007BRFSSdatawereretrievedfromtheCDCwebsite,11andthe2007BRFSSmasterdatafile(N=430,912)wasretainedinitsoriginalformforsubsequentanalysisofthenationalsample.12Forderivingthestateestimatesdocumentedinthisreport,theprojectteamtrimmedthismasterdatafiletocreateaseconddatafilethatincludedonlyOhioans(NOhio=11,229).BoththemasterdatafileandtheOhiosubsamplefilewerethenweighted(accordingtoBRFSSprotocols)asfollows:

FINALWT=STRWT*(1/IMPNPH)*NUMADULT*POSTSTR

10HealthyPeople2010informationcanberetrievedathttp://www.healthypeople.gov.11http://www.cdc.gov/BRFSS12Notethatthenationalsampleincludesrespondentsinallfiftystates,DC,andallUSterritories.


whereSTRWTisstratumweight,IMPNPHisthenumberoftelephonenumbersperhousehold,NUMADULTSisthenumberofadultsinthehousehold,andPOSTSTRisthepost‐stratificationweightcomputedfromthe2000U.S.CensusofPopulationandHousingestimates.TheaccuracyofthereconstructedBRFSSweightswastestedbycomparingtheGVSweightedfrequencytabulationsforrandomlyselectedsurveyitemsagainstnationalandOhio2007BRFSStabulatedprevalencedatareportsretrievedfromtheBRFSSwebsite.


Introduction

Inthefollowinganalysisofthesurveyresults,findingsfromtheninecountiesthatmakeuptheARHIIIIsurveyareaaredisplayedingraphs,providingcomparisonsamongeachcounty,theOhioandnational2007BRFSSrates,andtheHealthyPeople2010targetbenchmarks,whenavailable.PrevalenceratesacrosstheARHIIIIareprovidedinthetext.AllratecomparisonsbetweenARHIIIIandthe2007BRFSSareunadjusted.

AcomprehensivereviewofthesurveyresultsisprovidedwithinAppendixA.AppendixAconsistsofaseriesoftablesreportingtheweightedresponsedatafortheARHIIIIregionandeachcounty,aswellasthestandarderror,andupperandlowerconfidenceintervallimits(allconfidenceintervalsareatthealpha.05levelindicatinga95%confidencethatthetruepopulationmeanfallswithinthatrange).AppendixBprovidestheweighteddemographicsfortheentireARHIIIIregionaswellaseachcounty.

Comparisonsbetweengroupswerealwaysmadeatanalphalevelof.05.Therefore,allstatementsindicatingasignificantdifferencebetweengroupsorcategorylevelsidentifyastatisticallymeaningfuldifferencethatisatorbelowaprobabilitylevelofp≤.05.Forexample,thestatement“menaresignificantlymorelikelytoengageinregularvigorousexercise,”denotesastatisticallymeaningfuldifferenceinvigorousexerciseengagementbetweenmenandwomen.

Furtherstatisticalbreakdownsbeyondwhatisprovidedinthisreport–specificallycountybreakdownsforcombinedvariables–arenotpossibleduetothincellvalueswhichmaketheresultsunreliable.AtutorialisprovidedinAppendixDtodemonstratethislimitation.

DistributionoftheSurveySample

Between100and816surveyswerecollectedfromeachoftheninecounties.Thisrangereflectsthegreatvariationincountypopulationsize.Forexample,themostpopulatedcounty,Columbiana,has112,075residentsovertheageof18whiletheleastpopulatedcounty,Noble,has14,058adultresidents.BoththeweightedandunweightedfrequenciesreflectthesepopulationdifferencesandcanbefoundinAppendixC.

SURVEY FINDINGS


Respondentsfirstansweredaquestionaboutgeneralhealthstatus.TheARHIIIIsurveyemployedthesamewordingandresponsecategoriesusedbytheBRFSS,allowingforthedirectcomparisonofweightedresponses.

Wouldyousaythatingeneralyourhealthisexcellent,verygood,good,fair,orpoor?

Figure1.GeneralHealthStatus

• AcrosstheARHIIIIcounties,fewerresidentsreportedtheirhealthasexcellent(16.7%)orverygood(32.9%)whencomparedtoratesfromtheOhio(18.6%and35.8%,respectively)orthenational2007BRFSS(20.3%and32.3%,respectively).

• Further,acrosstheARHIIIIcounties,moreresidentsreportthattheirhealthstatusisfair(14.9%)orpoor(5.4%)whencomparedtoratesfromtheOhio(11.8%and4.0%,respectively)orthenational2007BRFSS(12.2%and4.5%,respectively).

GENERAL HEALTH STATUS

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• AcrosstheARHIIIIcounties,individualsreportingtheirhealthasfairorpoorhadsignificantlyhigherratesofdisease(asthma,arthritis,diabetes,heartattack,heartdisease,highbloodpressure,andstroke)comparedtoindividualsreportingtheirhealthstatusasexcellentorverygood.13

• BodyMassIndex(BMI)14wasalsofoundtoberelatedtoself‐reportedhealthstatus,withobeseindividualssignificantlymorelikelytodescribetheirhealthasfairorpoorcomparedtohealthyweightindividuals.

13Thewordsignificantindicatedastatisticallymeaningfuldifferenceatanalphalevelof.05;pleaseseepage13forfurtherexplanation.14BMIwascalculatedusingtheguidelineslistedbytheCDC:[(weightinlbs)/(heightininches)2]*703.ThreeBMIcategorieswerecreated,combining“underweight”and“normal”BMIlevels,replicatingthethreecategoriesusedbytheBRFSS:healthyweight≤24.9,overweight25‐29.9,andobese≥30.Only1.79%ofrespondentsfellintothe“underweight”category,andthemajorityofthesewerewithin1pointofthe“normal”category.


InordertodeterminetheprevalenceofcertainchronicdiseasesintheARHIIIIcounties,respondentswereaskedifadoctor,nurse,orotherhealthcareprofessionalhadevertoldthemthattheyhaveagivenchroniccondition.Thewordingandresponsecategoriesfortheseitemsmatchthe2007BRFSS,allowingforprevalencecomparisonsbetweentheARHIIIIcounties,thestateofOhio,andthenation.HealthyPeople2010targets,whereapplicable,arealsousedascomparisonbenchmarks.

Figure2.ExaminedHealthConditions

• AcrosstheARHIIIIcounties,therearenoticeablyhigherprevalenceratesofallchronicconditionssurveyedincomparisontotheOhioandnational2007BRFSSfindings,withtheexceptionofarthritis.ArthritisratesfortheARHIIIIregionandtheOhioBRFSSarecomparable,andbothexceedthenationalBRFSSrate.

EXAMINED HEALTH CONDITIONS

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AsthmaRates

Hasadoctor,nurse,orotherhealthprofessionalevertoldyouthatyouhadasthma?

Figure3.AsthmaRates

• AcrosstheARHIIIIcounties,theasthmarateis14.1%,whichishigherthantheOhio(13.1%)andthenational(12.9%)2007BRFSSrates.

• AcrosstheARHIIIIcounties,theasthmaratesareaslowas11.5%(inbothHarrisonandJeffersoncounties)andashighas18.1%(GalliaCounty).

• WithintheARHIIIIcounties,individualswithasthmaaresignificantlylesslikelytoengageinregularvigorousexercise.

• Asthmarateswerefoundtobesignificantlyhigherinwomen(57.8%)thanmen(42.2%).

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ArthritisRates

Hasadoctor,nurse,orotherhealthprofessionalevertoldyouthatyouhadarthritis,rheumatoidarthritis,gout,lupusorfibromyalgia?

Figure4.ArthritisRates

• AcrosstheARHIIIIcounties,thearthritisrate(32.2%)isthesameastheOhio2007BRFSSrate(32.2%),bothofwhichareabovethenationalBRFSSrate(26.9%).

• AmongtheARHIIIIcounties,thelowestarthritisratewasreportedinNobleCounty(22.9%)andthehighestratewasfoundinMonroeCounty(38.6%).

• Witheachincreaseinagecategory,thelikelihoodofhavingarthritissignificantlyincreases.

• WitheachincreaseinBMIcategory,thelikelihoodofhavingarthritissignificantlyincreases.

• Arthritisratesweresignificantlyhigheramongwomen(56.6%)thanmen(43.4%).

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DiabetesRates

Haveyoueverbeentoldbyadoctor,nurse,orotherhealthcareprofessionalthatyouhaveproblemswithhighbloodsugarorthatyouhavediabetesorsugar?

Figure5.DiabetesRates

• TheprimaryfocusoftheARHIIIIResearchInitiativeistheprevalenceandtreatmentofdiabetes.ThisreportincludesresultsfromtheBRFSSdiabetesmodule,locatedwithinSpotlightonDiabetes,whichbeginsonpage27.

• AcrosstheAHRIIIIcounties,thediabetesrateis12.5%,whichexceedstheOhio(9.5%)andthenational(8.6%)2007BRFSSrates.

• WithintheARHIIIIcounties,thediabetesrateswereaslowas8.8%inNobleCountyandashighas16.0%inMonroeCounty.

• WitheachincreaseinBMIcategory,thelikelihoodofhavingdiabetessignificantlyincreases.

• Diabetesratesweresignificantlyhigheramongresidentswithhouseholdincomesbelow$25,000(49.2%)comparedtoresidentswithhouseholdincomesabove$35,000(36.3%).

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HeartAttackRates

Hasadoctor,nurse,orotherhealthprofessionalevertoldyouthatyouhadaheartattackormyocardialinfarction?

Figure6.HeartAttackRates

• AcrosstheARHIIIIcounties,theheartattackrate(7.3%)ishigherthantheOhio(5.4%)andthenational(4.2%)2007BRFSSrates.

• AmongtheARHIIIIcounties,theheartattackratewasaslowas4.8%inNobleCountyandashighas13.5%inMonroeCounty.

• Regularlyengaginginanyamountofvigorousexercisesignificantlyreducesthelikelihoodofhavingaheartattack.

• Theheartattackrateforbothoverweight(36.9%)andobese(42.5%)individualsissignificantlyhigherthantherateforhealthyweightindividuals(20.6%).

• Heartattackratesweresignificantlyhigheramongmen(64.2%)thanwomen(35.8%).

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HeartDiseaseRates

Hasadoctor,nurse,orotherhealthprofessionalevertoldyouthatyouhadheartdisease,suchashardeningofthearteriesoranginaorcoronaryheartdisease?

Figure7.HeartDiseaseRates

• AcrossARHIIIIcounties,theheartdiseaserate(6.7%)isgreaterthanboththeOhio(5.1%)andnational(4.2%)2007BRFSSrates.

• AcrosstheARHIIIIcounties,heartdiseaserateswereaslowas4.0%inNobleCountyandashighas8.9%inLawrenceCounty.

• Regularlyengaginginanyamountofvigorousexercisesignificantlyreducesthelikelihoodofhavingheartdisease.

• Witheachincreaseinagecategoryaftertheageof54,thelikelihoodofhavingheartdiseasesignificantlyincreases.

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StrokeRates

Hasadoctor,nurse,orotherhealthprofessionalevertoldyouthatyouhadastroke?

Figure8.StrokeRates

• AcrosstheARHIIIIcounties,thestrokerate(4.2%)isabovetheOhio(3.1%)andthenational

(2.7%)BRFSSrates.

• AcrosstheARHIIIIcounties,thestrokeratesareaslowas2.3%inNobleCountyandashighas6.1%inMonroeCounty.

• WithintheARHIIIIregion,fivecounties(Columbiana,Jefferson,Lawrence,MonroeandMuskingum)haveastrokerateabove4.0%.

• Regularlyengaginginanyamountofvigorousexercisesignificantlyreducesthelikelihoodofhavingastroke.

• Individualsovertheageof54aresignificantlymorelikelytohaveastrokethanyoungerindividuals.

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HighBloodPressureRates

Hasadoctor,nurse,orotherhealthprofessionalevertoldyouthatyouhadhighbloodpressure,alsocalledhypertension?

Figure9.HighBloodPressureRates

• AcrosstheARHIIIIcounties,therateofhighbloodpressure(32.2%)isabovetheOhio(28.4%)andthenational(27.7%)2007BRFSSrates.

• TheHealthyPeople2010targetrateforhighbloodpressureis16.0%.NoneoftheARHIIIIcountiesaremeetingthisHealthyPeople2010target.

• AcrosstheARHIIIIcounties,thehighbloodpressureratesareaslowas21.1%inNobleCountyandashighas41.5%inMonroeCounty.

• WitheachincreaseinBMIcategory,thelikelihoodofhavinghighbloodpressuresignificantlyincreases.

• Witheachincreaseinagecategoryaftertheageof34,thelikelihoodofhavinghighbloodpressuresignificantlyincreases.

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HighBloodPressureMedicationUse

Ifyouhavebeentoldyouhavehighbloodpressure,areyounowtakingprescribedmedicationforyourhighbloodpressure?

Figure10.HighBloodPressureMedicationUse

• AcrosstheARHIIIIcounties,therateofmedicationuseforhighbloodpressure(71.1%)islowerthantheOhio(81.1%)andthenational(78.9%)2007BRFSSrates.

• WithintheARHIIIIcounties,therateofhighbloodpressuremedicationuseisaslowas56.5%inGalliaCountyandashighas89.2%inMonroeCounty.

• Highbloodpressuremedicationuseissignificantlyhigheramongwomen(77.3%)thanmen(65.0%).

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HighCholesterolRates15

Ifyouhaveeverhadyourcholesterolcheckedwithabloodtest,haveyoueverbeentoldbyadoctor,nurseorotherhealthprofessionalthatyourbloodcholesterollevelwashigh?

Figure11.HighCholesterolRates

• AcrosstheARHIIIIcounties,81.2%ofrespondentsreportedhavinghadatesttochecktheircholesterollevels.Amongtheseresidents,therateofhighcholesterolis38.4%.

• TheHealthyPeople2010targetrateforhighcholesterolis17.0%.AllARHIIIIcountiesfailedtomeetthetarget.

• AcrosstheARHIIIIcounties,theratesofhighcholesterolrangebetween33.9%inNobleCountyand43.3%inGalliaCounty.

15TheARHIIIIquestionlimitsrespondentstoindividualswhohavehadabloodtesttoconfirmtheircholesterollevels;theBRFSSquestionlimitsrespondentstoindividualswhohavehadabloodtestwithinthepreviousfiveyears.Therefore,itisnotappropriatetocomparetheBRFSSbenchmarkstotheARHIIIIdata.

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TheprimaryfocusoftheARHIIIIistheprevalenceandtreatmentofdiabetes.ThequestionsincludedaboutdiabetesmatchtheitemsinthediabetesmoduleoftheBRFSSwiththefollowingexception:inordertoaccommodatelocalvocabulary,theword“sugar”wasaddedtotheoriginalBRFSSquestions.SimilartotheBRFSSdiabetesmodule,femalerespondentsindicatingthattheyhavebeendiagnosedashavingdiabeteswerescreenedtodetermineiftheyhadonlybeendiagnosedashavingdiabetesduringpregnancy.Femaleswithonlygestationaldiabeteswerenotincludedinthediabetesratesandwerenotaskedfurtherdiabetes‐relatedquestions.Finally,becauseOhiodidnotconducttheBRFSSdiabetesmodulein2007,statewidecomparisonsareunavailable.

• AcrosstheARHIIIIcounties,thediabetesrate(12.5%)iswellabovetheOhiorate(9.5%)andthenationalrate(8.6%).

ComorbidConditions

Withintheproportionofpeoplewhohaveachronichealthcondition,thereisanincreasedlikelihoodofalsohavingdiabetes.

• Amongindividualswithasthma,thereisasignificantlyhigherlikelihoodofhavingdiabetes.

• Amongindividualswitharthritis,thereisasignificantlyhigherlikelihoodofhavingdiabetes.

• Amongindividualswhohavesufferedaheartattack,thereisasignificantlyhigherlikelihoodofhavingdiabetes.

• Amongindividualswithheartdisease,thereisasignificantlyhigherlikelihoodofhavingdiabetes.

• Amongindividualswithstroke,thereisasignificantlyhigherlikelihoodofhavingdiabetes.

• Amongindividualswithhighbloodpressure,thereisasignificantlyhigherlikelihoodofhavingdiabetes.

• Amongindividualswhohavehadabloodtestthatdiagnosedthemashavinghighcholesterol,thereisasignificantlyhigherlikelihoodofhavingdiabetes.

SPOTLIGHT ON DIABETES


DiabetesDiagnosisBeforeAge40

Howoldwereyouwhenyouweretoldthatyouhavediabetesorhighbloodsugar,orthatyouhavediabetesorsugar?

Figure12.DiabetesDiagnosisBeforeAge40

• AcrossARHIIIIcounties,therateofdiabetesdiagnosisbeforetheageof40is49.2%,whichgreatlyexceedsthenationalrateof19.0%.16

• AcrosstheARHIIIIcounties,therateofdiabetesdiagnosisbeforetheageof40wasaslowas27.4%inHarrisonCountyandwasashighas60.4%inNobleCounty.

16Thisnationalrateisfromthe2007NationalHealthInterviewSurvey(NHIS).Thisdatacanbereviewedathttp://www.cdc.gov/diabetes/statistics/age/fig1.htm

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DailyBlood‐GlucoseTesting

Abouthowoftendoyouusuallycheckyourbloodforglucoseorsugar?Includethetimeswhenitwascheckedbyafamilymemberorfriend,butdonotincludetimeswhenitwascheckedbyahealthcareprofessional.

Figure13.DailyBlood‐GlucoseTesting

• AmongtheARHIIIIcounties,71.9%ofresidentslivingwithdiabeteschecktheirblood‐glucoselevelsatleastonceaday,whichexceedsthenational2007BRFSSrateof61.4%.

• TheHealthyPeople2010targetratefordailyblood‐glucosetestingis60.0%.AllARHIIIIcountiesmetthisHealthyPeople2010target.

• AmongtheARHIIIIcounties,therangeofdaily‐glucosetestingisbetween65.3%inLawrenceCountyand84.1%inNobleCounty.

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DiabetesPillUse

Doyouregularlyusediabetespills?

Figure14.RegularDiabetesPillUse

• AmongARHIIIIcounties,therateofregulardiabetespilluseis67.2%,whichisbelowthenational2007BRFSSrateof70.2%.

• AcrosstheARHIIIIcounties,regulardiabetespillusevariedconsiderablywithratesaslowas50.5%(MuskingumCounty)andashighas94.9%(NobleCounty).

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InsulinUse

Doyoutakeinsulinshotsoruseaninsulinpump?

Figure15.RegularInsulinUse

• AmongARHIIIIcounties,therateofregularinsulinuseis28.4%,whichisslightlyabovethenational2007BRFSSrateof26.8%.

• WithintheARHIIIIcounties,therateofregularinsulinusewasaslowas17.3%inGalliaCountyandashighas47.2%inMonroeCounty.

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DiabetesClassAttendance

Haveyouevertakenacourseorclassonhowtomanageyourdiabetesyourself?

Figure16.DiabetesClassAttendance

• AmongtheARHIIIIcounties,therateofresidentslivingwithdiabeteswhohavetakenadiabetesmanagementclass,46.4%,isbelowthenationalrateof55.1%.

• TheHealthyPeople2010targetratefordiabetes‐managementcourseattendanceis60.0%.OnlytwoARHIIIIcounties(HarrisonandNoble)havemetthistarget.

• AmongtheARHIIIIcounties,therateofdiabetes‐managementcourseattendanceisaslowas34.3%inColumbianaCountyandashighas79.0%inNobleCounty.

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AnnualDiabetes‐RelatedDoctorVisit

Abouthowmanytimesinthepast12monthshaveyouseenadoctor,nurse,orotherhealthcareprofessionalforyourdiabetes,highbloodsugar,orsugar?

Figure17.AnnualDiabetes‐RelatedDoctorVisit

• AmongtheARHIIIIcounties,therateofannualdiabetes‐relateddoctorvisitsis95.0%,whichexceedsthenationalrateof85.2%.

• Therangeofannualdiabetes‐relateddoctorvisitsisbetween88.4%inMonroeCountyand100%inNobleCounty.

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AnnualDentalVisitandDiabetes

Figure18.AnnualDentalVisitandDiabetes

• AmongtheARHIIIIcounties,therateofARHIIIIresidentslivingwithdiabeteswhohaveseenadentistatleastonceinthelast12monthsis58.2%.

• TheHealthyPeople2010targetrateforannualdentalvisitsamongpeoplelivingwithdiabetesis75.0%.NoneoftheARHIIIIcountiesaremeetingtheHealthyPeopletargetrate.

• AcrosstheARHIIIIcounties,therateofannualdentalexamsamongpeoplelivingwithdiabetesisaslowas40.1%inNobleCountyandashighas62.5%inHarrisonCounty.

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CostRestrictingDiabetesCare

Doescosteverkeepyoufromseeingthedoctoronaregularbasisforyourdiabetes?

Figure19.CostRestrictingDoctorVisit

• AmongtheARHIIIIcounties,therateofpersonslivingwithdiabeteswhocouldnotaffordadiabetes‐relateddoctorvisitwas26.3%.

• TheHealthyPeople2010targetistoreducetherateofindividualsexperiencingdelaysordifficultiesobtaininghealthcareto7.0%.17AllARHIIIIcountiesfailedtomeetthistarget.

• WithintheARHIIIIcounties,therateofcostrestrictionsondiabetes‐relateddoctorvisitswasaslowas9.2%inNobleCountyandashighas52.8%inGalliaCounty.

17ThisHealthyPeople2010targetreferstoalltypesofhealthcareaccessandisusedasabenchmarkacrossindividualhealthcareaccessitemsinthisreport.

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Doescosteverkeepyoufromregularlytakingyourprescribeddiabetespillsorinsulin?

Figure20.CostRestrictingMedication

• AmongtheARHIIIIcounties,therateofresidentslivingwithdiabeteswhocannotafforddiabetesmedicationis16.9%.

• TheHealthyPeopletargetistoreducetherateofpersonshavingdifficultyordelaysingettinghealthcareto7.0%.NoneoftheAHRIIIIcountieshavemetthistarget.

• AmongtheARHIIIIcounties,therateofindividualsunabletoafforddiabetesmedicationisbetween8.1%inHarrisonCountyand35.1%inMonroeCounty.

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Doescosteverkeepyoufromregularlycheckingyourbloodsugarwithteststrips?

Figure21.CostRestrictingGlucoseChecks

• AmongARHIIIIcountyresidentslivingwithdiabetes,therateofindividualsunabletoaffordtheteststripsneededtocheckbloodglucoseis23.6%.

• TheHealthyPeople2010targetistoreducethenumberoffamiliesthatexperiencedelaysordifficultiesinobtaininghealthcareto7.0%.OnlyNobleCountyiscurrentlymeetingthistarget.

• WithinARHIIIIcounties,theratesofindividualsunabletoaffordteststripsareaslowas0%inNobleCountyandashighas39.6%inMonroeCounty.

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TheARHIIIISurveycontaineditemsrelatedtofourriskfactorsassociatedwithchronicdisease:bodymassindex,activitylevel,smoking,andself‐reporteddepressedmood.Eachfactorisdescribedinmoredetailbelow.

BodyMassIndex

Respondentswereaskedtheirweightandheightinordertocalculatetheirbodymassindex(BMI),ameasureofbodyfat.UsingtheCDCguidelinestocalculateBMI,threecategorieswerethencreatedinagreementwiththe2007BRFSS.IndividualswerecategorizedasobeseiftheirBMIwas30orabove;overweightifBMIlevelsfellbetween25and29.9.ThoughtheCDCcategorizesindividualswithaBMIunder18.5asunderweight,theBRFSScombinestheseindividualswiththoseinthenormalrange(18.6to24.9).Thus,thethirdcategory,referredtoashealthyweight,wasassignedtoindividualswithaBMIunder24.9.18

ActivityLevel

HealthyPeople2010hassetregular‐exercisebenchmarksforbothmoderateexerciseandvigorousexercise.Whetherornotrespondentsregularlyengagedineitherlevelofexercisewasfirstdeterminedbeforethefrequencyofengagementwasrecorded.

Smoking

Theuseoftobaccoproductsisarecognizedriskfactorforavarietyofillnessesincludingheartdisease,stroke,andhighbloodpressure.Onlysmokingbehavior,andnotsmokelesstobaccouse,wasinvestigatedintheARHIIIIand2007BRFSS.

Self‐ReportedDepressedMood

Depressedmoodwasusedasageneralmeasureofmentalwellbeing,whichhasbeenshowntobeimportantpartofphysicalhealth.

18Lessthan1.8%oftheentireARHIIIIsamplehadaBMIunder18.5,andthemajorityofthoseindividualswerewithin1pointofnormal.

RISK FACTORS


RateofHealthyWeight

Figure22.RateofHealthyWeight

• AcrossARHIIIIcounties,therateofhealthyweightindividualswas34.0%,whichisbelowtheOhio(36.5%)andthenational2007BRFSSrates(35.6%).

• TheHealthyPeople2010targetrateforhealthyweightadultsis60.0%.NoneoftheARHIIIIcountieshasmetthistarget.

• AmongtheARHIIIIcounties,therateofresidentsatahealthyweightwaslowestinMonroeCounty(20.8%)andhighestinHarrisonCounty(37.3%).

• Peopleatahealthyweight(i.e.,BMIbelow25)weresignificantlylesslikelytohavediabetes,arthritis,heartattack,heartdisease,highcholesterol,andhighbloodpressure.

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RateofObesity

Figure23.RateofObesity

• AmongtheARHIIIIcounties,therateofobesityis30.7%,whichisabovetheOhiorate(28.1%)andthenationalrate(25.1%).

• TheHealthyPeople2010targetrateforobesityis15.0%.NoneoftheARHIIIIcountiesaremeetingthistarget.

• AmongtheARHIIIIcounties,theobesityratesrangedbetween27.6%inNobleCountyand37.5%inMonroeCounty.

• Individualswhoareobese(i.e.,BMIatorabove30)weresignificantlymorelikelytohavediabetes,arthritis,heartattack,heartdisease,highcholesterol,andhighbloodpressurethanhealthyweightindividuals.

• Obeseindividuals(24.0%)weresignificantlylesslikelytobemeetingtheHealthyPeople2010goalforweeklymoderateexercisecomparedtooverweight(36.6%)andhealthyweightindividuals(39.5%).

• Obeseindividuals(21.4%)weresignificantlylesslikelytobemeetingtheHealthyPeople2010goalforweeklyvigorousexercisecomparedtooverweight(35.2%)andhealthyweightindividuals(43.3%).

• Obeseindividuals(42.9%)weresignificantlymorelikelytoreportfeelingdepressedwithinthelastmonththanindividualswhowereoverweight(35.1%)oratahealthyweight(37.0%).

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ModerateExercise

Pleasethinkaboutthemoderateactivitiesyoudowhenyouarenotworking.Inausualweekdoyoudomoderateactivitiessuchasbriskwalking,bicycling,vacuuming,gardening,oranythingelsethatcausessmallincreasesinbreathingorheartrateforatleast20minutesatatime?

Ifyes,howmanydaysperweekdoyoudomoderateactivitiesforatleast20minutesatatime?

Figure24.5DaysorMoreofWeeklyModerateExercise

• AmongtheARHIIIIcounties,therateofengaginginanyamountofmoderateexerciseduringaregularweekis77.0%.

• TheHealthyPeople2010targetistoincreasethepercentofindividualsperformingmoderateexercisefiveormoredaysaweekto30.0%.AmongallARHIIIIrespondents,35.6%reportperformingmoderateexercisefiveormoredaysaweek.

• AllARHIIIIcountiesaremeetingtheHealthyPeople2010target.• AmongtheARHIIIIcounties,theratesofmoderateexerciseperformedfiveormore

daysaweekwereaslowas32.4%inMuskingumCountyandashighas44.8%inHarrisonCounty.

• ARHIIIIresidentswhoaremeetingtheHealthyPeople2010goalformoderateexercisearesignificantlylesslikelytoreporthavingarthritis,diabetes,aheartattack,heartdisease,highbloodpressure,highcholesterol(asdeterminedbyabloodtest),andstroke.

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• ARHIIIIresidentswhoaremeetingtheHealthyPeople2010goalformoderateexercisearesignificantlylesslikelytobeobese.


VigorousExercise

Thinkaboutthevigorousactivitiesyoudowhenyouarenotworking.Inausualweekdoyoudovigorousactivitiessuchasrunning,aerobics,heavyyardwork,oranythingelsethatcauseslargeincreasesinbreathingorheartrateforatleast20minutesatatime?

Ifyes,howmanydaysperweekdoyoudovigorousactivityforatleast20minutesatatime?

Figure25.3DaysofMoreofWeeklyVigorousExercise

• AmongtheARHIIIIcounties,therateofengaginginanyamountofvigorousexerciseduringaregularweekis42.7%.

• TheHealthyPeople2010targetistoincreasethepercentofindividualsperformingvigorousexercisethreeormoredaysaweekto30.0%.AmongallARHIIIIrespondents,27.0%performvigorousexercisethreeormoredaysaweek.

• OnlytwoARHIIIIcounties(HarrisonandNoble)aremeetingtheHealthyPeople2010target.

• AmongtheARHIIIIcounties,theratesofengagementinvigorousexercisethreeormoredaysaweekwereaslowas24.6%inLawrenceCountyandashighas35.6%inNobleCounty.

• ARHIIIIresidentswhoaremeetingtheHealthyPeople2010goalforvigorousexercisearesignificantlylesslikelytoreporthavingarthritis,diabetes,aheartattack,heartdisease,highbloodpressure,highcholesterol(asdeterminedbyabloodtest),andstroke.

• ARHIIIIresidentswhoaremeetingtheHealthyPeople2010goalforvigorousexercisearesignificantlylesslikelytobeoverweightorobese.

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• Witheachincreaseinagecategoryaftertheageof44,thelikelihoodofmeetingtheHealthyPeople2010goalforvigorousexercisesignificantlydecreases.

• Males(33.4%)aresignificantlymorelikelytobemeetingtheHealthyPeople2010goalforvigorousexercisecomparedtofemales(21.1%).


Haveyousmoked100cigarettesinyourentirelife?

Figure26.Smoked100Cigarettes

• AmongARHIIIIcounties,therateofresidentssmoking100cigarettesormoreintheirlifetime(47.7%)isapproximatelythesameastheOhio(47.9%)andhigherthanthenational(43.4%)2007BRFSSrates.

• Havingsmokedatleast100cigarettessignificantlyincreasedthelikelihoodofhavingdiabetes,aheartattack,andheartdisease.

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Ifyouhavesmokedatleast100cigarettesinyourentirelife,doyounowsmokeeveryday,somedays,ornotatall?

Figure27.CurrentSmokers

• Currentsmokerswerecategorizedasindividualswhohavesmokedmorethan100cigarettesintheirlifetimeandcontinuetosmoke“everyday”or“somedays.”

• AmongtheAHRIIIIcounties,therateofcurrentsmokersis25.6%,whichgreatlyexceedsthenationalrateof19.3%.

• TheHealthyPeople2010targetistoreducethecurrentsmokingpopulationto12.0%.AllARHIIIIcountieshavefailedtomeetthistarget.

• AmongtheARHIIIIcounties,therateofcurrentsmokerswasaslowas23.3%(MuskingumCounty)andashighas29.1%(inbothGalliaandHarrisoncounties).

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Self‐ReportedDepressedMood

Duringthepast30days,abouthowoftendidyoufeelsodepressedthatnothingcouldcheeryouup?19

Figure28.Self‐ReportedDepressedMood

• AcrosstheARHIIIIcounties,therateoffeelingdepressedalittleofthetimetoallthetimeinthepast30dayswas38.0%,whichisbelowthenational2007BRFSSrate(41.9%).

• AmongtheARHIIIIcounties,theself‐reporteddepressionratewasaslowas31.7%(HarrisonCounty)andashighas39.6%(inbothGalliaandJeffersoncounties).

• ObeseindividualsweresignificantlymorelikelytoreportbeingdepressedwithinthelastmonthcomparedtootherBMIcategories.

• Individualsmakinglessthan$15,000weresignificantlymorelikelytoreportbeingdepressedthanindividualsinhigherincomebrackets.

• Ratesofdepressedfeelingsweresignificantlyhigheramongfemales(41.3%)thanmales(34.5%).

19ThecomparableBRFFSquestionreads:Duringthepast30days,forabouthowmanydayshaveyoufeltsad,blue,ordepressed?

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SinglePrimaryCarePhysician

Doyouhaveonepersonyouthinkofasyourpersonaldoctororhealthcareprovider?

Figure29.SinglePrimaryCarePhysician

• AmongtheARHIIIIcounties,therateofresidentsthathaveasingleprimaryphysicianis80.2%,whichisabovetheOhiorate(79.5%)andthenationalrate(71.9%).

• TheHealthyPeople2010targetrateforindividualsthathaveasingleprimarycarephysicianis85.0%.NoneoftheARHIIIIcountieshavemetthisHealthyPeople2010target.

• AmongtheARHIIIIcounties,therateofresidentsthathaveasingleprimaryphysicianrangesbetween73.9%inLawrenceCountyand83.9%inColumbianaCounty.

HEALTH CARE ACCESS

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CostProhibitingNecessaryCare

Wasthereatimeinthelast12monthswhenyouneededtoseeadoctorbutcouldnotbecauseofthecost?

Figure30.CostProhibitingNecessaryCare

• AmongARHIIIIcounties,therateofresidentsunabletoaffordtoseeadoctorwhenitwasnecessaryis15.2%,whichexceedstheOhiorate(12.4%)andthenationalrate(13.5%).

• TheHealthyPeople2010targetistoreducethenumberofindividualswhoexperiencedifficultiesordelaysinobtaininghealthcare,ordonotreceivenecessarytreatment,to7.0%.NoneoftheARHIIIIcountiesaremeetingthistarget.

• AmongtheARHIIIIcounties,therateofindividualsunabletoaffordanecessarydoctorvisitisaslowas12.3%inBelmontCountyandashighas19.6%inGalliaCounty.

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AnnualDentalVisit

Howlonghasitbeensinceyoulastvisitedadentistoradentalclinicforanyreason?

Figure31.AnnualDentalVisit

• AmongtheARHIIIIcounties,therateofannualdentalvisitsis69.5%.• TheHealthyPeople2010targetrateforannualdentalvisitsis56.0%.EveryARHIIII

countyhasmetthisHealthyPeople2010target.• AmongARHIIIIcounties,therateofannualdentalvisitsrangebetween59.1%inNoble

Countyand72.9%inBelmontCounty.

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InsuranceCoverage

Doyouhaveanykindofhealthcareinsuranceatthistime?

Figure32.InsuranceCoverage

• AmongARHIIIIcounties,therateofresidentswithinsurancecoverageis85.9%,whichisbetweentheOhiorate(88.2%)andthenationalrate(84.4%).

• TheHealthyPeople2010targetistohaveeveryindividualinsured.NoneoftheARHIIIIcountiesaremeetingthistarget.

• AmongtheARHIIIIcounties,therateofinsurancecoverageisaslowas83.9%inNobleCountyandashighas88.0%inBelmontCounty.

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InsuranceDemographics

Table1.EmploymentandInsuranceCoverage

• AmongtheARHIIIIcounties,thelowestrateofinsurancecoverage(62.5%)belongstounemployedresidents.

• AcrosstheARHIIIIcounties,studentsandemployedindividualsaccountfor27.0%ofthosewithouthealthinsurance;with13.5%ofstudentsand13.5%ofemployedindividualsbeinguninsured.

Table2.IncomeandInsuranceCoverage

• Individualswithannualhouseholdincomesbetween$15,000and$24,999havethelowestrateofinsurancecoverage(70.8%)comparedtootherincomebrackets.

Insured Not Insured

Employed 86.5% 13.5%

Unemployed 62.5% 37.5%

Homemaker 89.2% 10.8%

Student 86.5% 13.5%

Retired 95.3% 4.7%

Unable to Work 91.2% 8.8%

Insured Not Insured

Less than $15,000 76.4% 23.6%

$15,000 to $24,000 70.8% 29.2%

$25,000 to $34,999 83.8% 16.2%

$35,000 to $49,000 90.5% 9.5%

$50,000 to $74,000 92.8% 7.2%

$75,000 or more 95.2% 4.8%


DetailedInsuranceCoverage

Ifyoudohaveinsurance,whatkind?

Figure33.DetailedInsuranceCoverage

• AcrosstheARHIIIIcounties,therateofindividualswithoutinsurancecoverageis13.6%.• AmongARHIIIIcounties,themajority(56.0%)ofinsuredresidentsarecoveredby

privateorcommercialinsuranceonly.• AmongtheARHIIIIcounties,therateofresidentscoveredbyMedicaidis7.2%.20• AmongtheARHIIIIcounties,therateofresidentscoveredbyMedicareonlyis7.8%.• WithintheARHIIIIcounties,therateofresidentswhoarecoveredbyMedicareand

anotherpayeris8.6%.21• IntheARHIIIIcounties,therateofresidentscoveredbymilitaryinsurance(Veterans

AffairsorActiveMilitary)is2.0%.22

20ThecategoryMedicaidincludesindividualswhoareMedicaid/MedicareDualEligible,aswellasindividualswhohaveadditionalprivatecoverage.21ThecategoryMedicareandotherexcludesindividualswithMedicaidandMilitaryinsuranceasadditionalpayersource.22ThecategoryMilitaryincludesindividualswhohaveadditionalprivatecoverageorMedicare.

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PrescriptionCoverage

Doyouhaveinsurancethatpaysforatleastpartofyourprescriptioncost?

Figure34.PrescriptionCoverage

• AcrosstheARHIIIIcounties,approximately82.0%ofresidentshaveatleastpartialprescriptioncoverage.

• AmongtheARHIIIIcounties,therateofprescriptioncoverageisaslowas78.7%inHarrisonCountyandashighas86.0%inBelmontCounty.

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APPENDICES

Appendix A. Weighted ARHI III Data Appendix A1. General Health Status

General health status: Percent SE LCL

@ .95 UCL

@ .95 Entire 9 County Sample Excellent 16.74% 0.63% 15.50% 17.98%Very Good 32.88% 0.79% 31.34% 34.43%Good 30.13% 0.77% 28.62% 31.64%Fair 14.87% 0.55% 13.79% 15.96%Poor 5.37% 0.34% 4.70% 6.05%


@ .95 UCL

@ .95 Belmont County Excellent 17.75% 1.69% 14.45% 21.06%Very Good 32.77% 2.06% 28.72% 36.81%Good 32.42% 2.04% 28.42% 36.42%Fair 12.47% 1.27% 9.97% 14.96%Poor 4.59% 0.81% 3.01% 6.18%


@ .95 UCL

@ .95 Columbiana County Excellent 18.17% 1.39% 15.45% 20.90%Very Good 34.50% 1.71% 31.14% 37.86%Good 29.49% 1.63% 26.29% 32.69%Fair 13.18% 1.16% 10.91% 15.45%Poor 4.66% 0.71% 3.26% 6.05%


@ .95 UCL

@ .95 Gallia County Excellent 16.31% 2.30% 11.79% 20.82%Very Good 30.58% 2.79% 25.11% 36.05%Good 28.16% 2.79% 22.69% 33.64%Fair 20.14% 2.42% 15.38% 24.89%Poor 4.81% 1.15% 2.56% 7.07%

APPALACHIAN RURAL HEALTH INSTITUTE (ARHI) Health Needs Assessment Survey III ∙ Research Report 58



@ .95 UCL

@ .95 Harrison County Excellent 16.81% 3.29% 10.36% 23.26%Very Good 29.49% 3.48% 22.67% 36.31%Good 31.90% 4.11% 23.84% 39.96%Fair 13.63% 2.84% 8.06% 19.20%Poor 8.17% 2.28% 3.70% 12.65%


@ .95 UCL

@ .95 Jefferson County Excellent 16.52% 1.59% 13.41% 19.63%Very Good 32.41% 2.00% 28.50% 36.32%Good 28.76% 1.92% 24.99% 32.53%Fair 16.50% 1.47% 13.63% 19.38%Poor 5.80% 0.92% 4.01% 7.60%


@ .95 UCL

@ .95 Lawrence County Excellent 13.63% 1.49% 10.71% 16.54%Very Good 29.58% 1.93% 25.79% 33.36%Good 31.95% 1.98% 28.07% 35.83%Fair 17.77% 1.54% 14.76% 20.78%Poor 7.08% 1.05% 5.03% 9.13%


@ .95 UCL

@ .95 Monroe County Excellent 15.03% 3.13% 8.91% 21.16%Very Good 34.40% 4.37% 25.84% 42.97%Good 30.88% 4.25% 22.54% 39.21%Fair 15.09% 3.14% 8.93% 21.25%Poor 4.60% 1.76% 1.15% 8.05%





@ .95 UCL

@ .95 Muskingum County Excellent 17.55% 1.60% 14.40% 20.69%Very Good 33.62% 1.99% 29.72% 37.52%Good 28.42% 1.92% 24.67% 32.18%Fair 15.01% 1.36% 12.34% 17.68%Poor 5.40% 0.82% 3.78% 7.02%


@ .95 UCL

@ .95 Noble County Excellent 13.10% 3.97% 5.32% 20.88%Very Good 40.62% 5.37% 30.09% 51.14%Good 34.21% 4.78% 24.84% 43.58%Fair 8.08% 2.44% 3.28% 12.87%Poor 3.99% 1.61% 0.84% 7.14%

Appendix A. Weighted ARHI III Data Appendix A2. Examined Health Conditions

Examined health conditions: Percent SE LCL

@ .95 UCL

@ .95 Entire 9 County Sample Diabetes 12.49% 0.50% 11.51% 13.47%Asthma 14.06% 0.59% 12.90% 15.21%Arthritis 32.16% 0.68% 30.84% 33.49%Heart Attack 7.27% 0.38% 6.52% 8.02%Heart Disease 6.71% 0.37% 5.98% 7.43%Stroke 4.25% 0.31% 3.63% 4.86%Have you had a blood test to screen your cholesterol levels? Yes 81.18% 0.65% 79.91% 82.45%If Yes: Have you been told that you have high blood

cholesterol? Yes 38.41% 0.84% 36.75% 40.06%

High Blood Pressure 32.19% 0.69% 30.85% 33.54%

If Yes: Are you currently taking prescribed medication for high blood pressure?

Yes 71.12% 1.31% 68.54% 73.70%


@ .95 UCL

@ .95 Belmont County Diabetes 11.97% 1.28% 9.46% 14.48%Asthma 12.98% 1.53% 9.98% 15.98%Arthritis 34.84% 1.79% 31.33% 38.34%Heart Attack 7.43% 1.07% 5.33% 9.54%Heart Disease 8.04% 1.11% 5.86% 10.21%Stroke 3.93% 0.87% 2.22% 5.64%Have you had a blood test to screen your cholesterol levels? Yes 83.96% 1.67% 80.69% 87.23%If Yes: Have you been told that you have high blood

cholesterol? Yes 40.67% 2.59% 35.58% 45.75%



Yes 75.51% 3.17% 69.28% 81.73%




@ .95 UCL

@ .95 Columbiana County Diabetes 10.40% 0.99% 8.46% 12.34%Asthma 13.36% 1.23% 10.95% 15.78%Arthritis 28.25% 1.42% 25.47% 31.02%Heart Attack 5.61% 0.73% 4.18% 7.04%Heart Disease 5.18% 0.71% 3.80% 6.57%Stroke 4.06% 0.67% 2.74% 5.38%Have you had a blood test to screen your cholesterol levels? Yes 79.76% 1.38% 77.06% 82.46%If Yes: Have you been told that you have high blood

cholesterol? Yes 37.10% 1.84% 33.49% 40.70%



Yes 64.10% 2.89% 58.43% 69.78%


@ .95 UCL

@ .95 Gallia County Diabetes 10.63% 1.75% 7.19% 14.06%Asthma 18.11% 2.32% 13.56% 22.66%Arthritis 34.16% 2.56% 29.14% 39.18%Heart Attack 7.29% 1.42% 4.50% 10.08%Heart Disease 6.54% 1.31% 3.96% 9.11%Stroke 3.79% 1.13% 1.58% 6.01%Have you had a blood test to screen your cholesterol levels? Yes 85.62% 2.18% 81.35% 89.89%If Yes: Have you been told that you have high blood

cholesterol? Yes 43.27% 2.80% 37.78% 48.76%



Yes 56.55% 3.45% 49.79% 63.31%




@ .95 UCL

@ .95 Harrison County Diabetes 13.70% 2.80% 8.22% 19.18%Asthma 11.49% 2.73% 6.14% 16.85%Arthritis 35.77% 3.93% 28.06% 43.49%Heart Attack 5.45% 1.83% 1.87% 9.04%Heart Disease 5.32% 1.87% 1.66% 8.98%Stroke 3.08% 1.45% 0.25% 5.92%Have you had a blood test to screen your cholesterol levels? Yes 77.32% 3.51% 70.44% 84.20%If Yes: Have you been told that you have high blood

cholesterol? Yes 37.49% 4.21% 29.23% 45.74%



Yes 69.66% 6.30% 57.31% 82.01%


@ .95 UCL

@ .95 Jefferson County Diabetes 14.11% 1.40% 11.37% 16.85%Asthma 11.51% 1.33% 8.90% 14.11%Arthritis 34.56% 1.76% 31.10% 38.02%Heart Attack 6.69% 0.93% 4.86% 8.52%Heart Disease 6.53% 0.90% 4.75% 8.30%Stroke 4.61% 0.80% 3.03% 6.18%Have you had a blood test to screen your cholesterol levels? Yes 82.50% 1.63% 79.32% 85.69%If Yes: Have you been told that you have high blood

cholesterol? Yes 38.73% 2.01% 34.78% 42.68%



Yes 75.20% 2.65% 69.99% 80.41%




@ .95 UCL

@ .95 Lawrence County Diabetes 15.26% 1.38% 12.56% 17.97%Asthma 15.20% 1.53% 12.20% 18.19%Arthritis 31.67% 1.80% 28.14% 35.20%Heart Attack 9.93% 1.16% 7.66% 12.21%Heart Disease 8.88% 1.13% 6.67% 11.09%Stroke 5.22% 0.87% 3.51% 6.94%Have you had a blood test to screen your cholesterol levels? Yes 84.35% 1.59% 81.23% 87.47%If Yes: Have you been told that you have high blood

cholesterol? Yes 39.55% 2.06% 35.52% 43.59%



Yes 78.43% 3.16% 72.23% 84.63%


@ .95 UCL

@ .95 Monroe County Diabetes 16.00% 3.03% 10.07% 21.94%Asthma 15.55% 3.02% 9.63% 21.47%Arthritis 38.59% 3.96% 30.82% 46.35%Heart Attack 13.50% 2.54% 8.53% 18.47%Heart Disease 6.92% 2.03% 2.94% 10.91%Stroke 6.07% 1.89% 2.36% 9.78%Have you had a blood test to screen your cholesterol levels? Yes 85.18% 2.31% 80.66% 89.71%If Yes: Have you been told that you have high blood

cholesterol? Yes 43.25% 3.82% 35.75% 50.75%



Yes 89.17% 2.20% 84.86% 93.48%





@ .95 UCL

@ .95 Muskingum County Diabetes 12.62% 1.20% 10.26% 14.98%Asthma 15.84% 1.60% 12.71% 18.97%Arthritis 32.24% 1.60% 29.10% 35.37%Heart Attack 7.53% 0.95% 5.67% 9.38%Heart Disease 6.90% 0.91% 5.11% 8.69%Stroke 4.10% 0.71% 2.69% 5.50%Have you had a blood test to screen your cholesterol levels? Yes 78.40% 1.75% 74.97% 81.82%If Yes: Have you been told that you have high blood

cholesterol? Yes 35.33% 1.96% 31.48% 39.17%



Yes 70.10% 4.27% 61.73% 78.47%


@ .95 UCL

@ .95 Noble County Diabetes 8.85% 2.60% 3.76% 13.94%Asthma 15.95% 3.94% 8.21% 23.68%Arthritis 22.92% 3.42% 16.21% 29.63%Heart Attack 4.81% 1.65% 1.58% 8.05%Heart Disease 4.00% 1.51% 1.04% 6.96%Stroke 2.33% 1.27% ‐0.17% 4.83%Have you had a blood test to screen your cholesterol levels? Yes 64.03% 4.80% 54.62% 73.43%If Yes: Have you been told that you have high blood

cholesterol? Yes 33.90% 5.25% 23.62% 44.19%



Yes 76.17% 2.28% 71.69% 80.64%

Appendix A. Weighted ARHI III Data Appendix A3. Diabetes

Respondents living with diabetes: Percent SE LCL @ .95 UCL @ .95 Entire 9 County Sample Age of diabetes diagnosis.

Under 18 years 10.05% 0.86% 8.36% 11.75%19 to 40 years 39.19% 1.59% 36.08% 42.30%41 to 49 years 16.38% 1.40% 13.64% 19.13%50 to 59 years 15.79% 1.19% 13.46% 18.13%Over 60 years 18.58% 0.90% 16.82% 20.35%

Diabetes related health care visits in the last 12 months.

None 4.98% 0.94% 3.14% 6.83%1 time 11.97% 1.19% 9.63% 14.32%2 or 3 times 34.83% 1.96% 30.99% 38.67%4-5 times 30.30% 1.69% 26.98% 33.61%6-10 times 10.32% 1.24% 7.88% 12.77%More than 10 times 7.59% 0.93% 5.77% 9.41%

Regular blood sugar checks. 3 or more times per day 17.58% 1.38% 14.86% 20.29%1 or 2 times per day 54.33% 2.15% 50.10% 58.55%

At least 1 time per week but less than daily 20.42% 1.75% 16.98% 23.86%Less than 1 time per week 7.68% 0.98% 5.76% 9.60%

Are insulin shots or pumps used regularly? Yes 28.41% 1.78% 24.91% 31.91%

Are diabetes pills used regularly? Yes 67.16% 1.83% 63.57% 70.75%

Have you taken a course/class on managing your diabetes?

Yes 46.37% 2.01% 42.43% 50.31%

Does cost keep you from seeing the doctor on a regular basis for your diabetes?

Yes 26.25% 1.84% 22.63% 29.87%

Does cost keep you from regularly taking your prescribed diabetes pills or insulin?

Yes 16.87% 1.48% 13.97% 19.77%

Does cost keep you from regularly checking your blood sugar with test strips?

Yes 23.64% 1.80% 20.10% 27.18%


Appendix A. Weighted ARHI III Data Appendix A3.1. Diabetes: Belmont County

Respondents living with diabetes: Percent SE LCL @ .95 UCL @ .95 Belmont County Age of diabetes diagnosis.

Under 18 years * * * *19 to 40 years 40.60% 3.87% 32.99% 48.20%41 to 49 years 16.44% 3.91% 8.76% 24.11%50 to 59 years 18.60% 3.97% 10.80% 26.41%Over 60 years 24.36% 2.61% 19.24% 29.49%


None 3.69% 1.82% 0.12% 7.26%1 time 6.67% 2.24% 2.27% 11.06%2 or 3 times 42.08% 5.65% 30.99% 53.17%4-5 times 38.52% 5.72% 27.29% 49.75%6-10 times 4.84% 2.07% 0.76% 8.92%

More than 10 times 4.20% 1.75% 0.76% 7.63%Regular blood sugar checks.

3 or more times per day 17.92% 4.19% 9.69% 26.15%

1 or 2 times per day 59.26% 5.89% 47.68% 70.84%

At least 1 time per week but less than daily 15.55% 5.26% 5.21% 25.88%

Less than 1 time per week 7.28% 2.53% 2.30% 12.26%




Yes 50.09% 7.28% 35.78% 64.39%


Yes 25.07% 5.26% 14.72% 35.41%


Yes 12.43% 1.98% 8.54% 16.31%


Yes 21.20% 5.06% 11.26% 31.14%*Denotes cells without observations.


Appendix A. Weighted ARHI III Data Appendix A3.2. Diabetes: Columbiana County

Respondents living with diabetes: Percent SE LCL @ .95 UCL @ .95 Columbiana County Age of diabetes diagnosis.

Under 18 years 4.91% 2.76% ‐0.52% 10.34%19 to 40 years 45.18% 4.69% 35.95% 54.40%41 to 49 years 17.84% 3.56% 10.85% 24.84%50 to 59 years 10.66% 2.88% 5.00% 16.32%Over 60 years 21.41% 2.30% 16.89% 25.92%


None 6.19% 2.86% 0.57% 11.80%1 time 6.32% 3.21% 0.02% 12.62%2 or 3 times 47.65% 5.72% 36.41% 58.89%4-5 times 22.82% 3.76% 15.43% 30.21%6-10 times 15.55% 4.36% 6.99% 24.12%More than 10 times 1.47% 0.84% ‐0.18% 3.13%



Are insulin shots or pumps used regularly? Yes 28.01% 5.34% 17.52% 38.50%Are diabetes pills used regularly? Yes 63.83% 4.48% 55.02% 72.64%Have you taken a course/class on managing your diabetes? Yes 34.33% 4.91% 24.67% 43.98%

Does cost keep you from seeing the doctor on a regular basis for your diabetes? Yes 25.60% 5.45% 14.89% 36.32%

Does cost keep you from regularly taking your prescribed diabetes pills or insulin? Yes 13.67% 4.19% 5.44% 21.90%

Does cost keep you from regularly checking your blood sugar with test strips? Yes 30.33% 4.95% 20.61% 40.06%


Appendix A. Weighted ARHI III Data Appendix A3.3. Diabetes: Gallia County

Respondents living with diabetes: Percent SE LCL @ .95 UCL @ .95 Gallia County

Age of diabetes diagnosis. 18.75% 0.00% 18.75% 18.75%Under 18 years 20.67% 1.67% 17.39% 23.95%19 to 40 years 16.45% 2.99% 10.58% 22.33%41 to 49 years 30.56% 3.90% 22.89% 38.22%50 to 59 years 13.57% 2.85% 7.97% 19.17%Over 60 years


3.30% 1.91% ‐0.45% 7.05%None 10.04% 3.52% 3.13% 16.95%1 time 23.70% 4.22% 15.41% 31.98%2 or 3 times 35.97% 5.59% 24.98% 46.96%4-5 times 23.82% 0.00% * *6-10 times 3.17% 2.08% ‐0.92% 7.26%More than 10 times

Regular blood sugar checks. 22.02% 4.68% 12.82% 31.22%3 or more times per day 43.40% 6.68% 30.28% 56.53%1 or 2 times per day

19.32% 4.44% 10.59% 28.05%At least 1 time per week but less than daily 15.26% 2.37% 10.60% 19.92%Less than 1 time per week

Are insulin shots or pumps used regularly? 17.28% 3.48% 10.46% 24.11%Yes

Are diabetes pills used regularly? 59.77% 4.75% 50.45% 69.09%Yes


36.56% 4.93% 26.88% 46.24%Yes


52.76% 3.30% 46.27% 59.26%Yes


24.88% 2.38% 20.20% 29.55%Yes


13.23% 2.62% 8.09% Yes 18.38%*Denotes cells without observations. When a standard error is a true zero, the confidence intervals are equal to the percentage. When a standard error rounds to zero, accurate confidence intervals cannot be calculated.


Appendix A. Weighted ARHI III Data Appendix A3.4. Diabetes: Harrison County

Respondents living with diabetes: Percent SE LCL @ .95 UCL @ .95 Harrison County

Age of diabetes diagnosis. * * * *Under 18 years

27.45% 0.00% * *19 to 40 years 18.81% 3.00% 12.92% 24.70%41 to 49 years 34.51% 6.82% 21.11% 47.90%50 to 59 years 19.24% 6.12% 7.21% 31.27%Over 60 years


8.09% 5.73% ‐3.16% 19.34%None 5.20% 4.50% ‐3.65% 14.04%1 time

14.08% 6.10% 2.09% 26.07%2 or 3 times 53.81% 8.17% 37.76% 69.85%4-5 times 18.83% 3.20% 12.55% 25.11%6-10 times

* * * *More than 10 times Regular blood sugar checks.

26.90% 6.46% 14.20% 39.60%3 or more times per day 45.34% 9.18% 27.30% 63.38%1 or 2 times per day

13.54% 6.93% ‐0.07% 27.16%At least 1 time per week but less than daily 14.21% 2.64% 9.02% 19.40%Less than 1 time per week




66.00% 5.41% 55.37% 76.63%Yes


16.57% 7.87% 1.12% 32.03%Yes


8.09% 5.73% ‐3.16% 19.34%Yes


13.99% 6.58% 1.07% Yes 26.91%*Denotes cells without observations. When a standard error rounds to zero, accurate confidence intervals cannot be calculated.


Appendix A. Weighted ARHI III Data Appendix A3.5. Diabetes: Jefferson County

Respondents living with diabetes: Percent SE LCL @ .95 UCL @ .95 Jefferson County

Age of diabetes diagnosis. 17.40% 2.52% 12.46% 22.35%Under 18 years 34.60% 3.80% 27.14% 42.06%19 to 40 years 16.99% 3.36% 10.39% 23.60%41 to 49 years 12.00% 2.79% 6.51% 17.49%50 to 59 years 19.00% 2.12% 14.83% 23.17%Over 60 years


2.25% 1.27% ‐0.25% 4.74%None 8.76% 3.31% 2.25% 15.28%1 time

37.76% 3.74% 30.41% 45.10%2 or 3 times 24.32% 3.79% 16.87% 31.77%4-5 times 8.85% 2.56% 3.82% 13.88%6-10 times

18.06% 3.57% 11.04% 25.08%More than 10 times Regular blood sugar checks.

26.08% 3.89% 18.43% 33.72%3 or more times per day 53.39% 4.35% 44.84% 61.94%1 or 2 times per day

7.28% 2.23% 2.90% 11.65%At least 1 time per week but less than daily 13.26% 3.25% 6.87% 19.65%Less than 1 time per week




52.72% 4.69% 43.51% 61.93%Yes


18.56% 3.80% 11.10% 26.02%Yes


12.10% 3.60% 5.02% 19.18%Yes


Yes 20.47% 4.16% 12.29% 28.65%


Appendix A. Weighted ARHI III Data Appendix A3.6. Diabetes: Lawrence County

Respondents living with diabetes: Percent SE LCL @ .95 UCL @ .95 Lawrence County Age of diabetes diagnosis.









Yes 37.62% 4.76% 28.27% 46.98%


Yes 22.48% 4.37% 13.90% 31.06%


Yes 12.98% 3.64% 5.82% 20.14%


21.98% 5.30% 11.58% 32.39%Yes When a standard error is a true zero, the confidence intervals are equal to the percentage.


Appendix A. Weighted ARHI III Data Appendix A3.7. Diabetes: Monroe County

Respondents living with diabetes: Percent SE LCL @ .95 UCL @ .95 Monroe County Age of diabetes diagnosis.

Under 18 years * * * *19 to 40 years 31.69% 4.54% 22.77% 40.61%41 to 49 years 11.63% 5.45% 0.92% 22.33%50 to 59 years 39.13% 3.01% 33.21% 45.05%Over 60 years 17.55% 3.01% 11.63% 23.47%


None 11.61% 5.83% 0.15% 23.07%1 time 15.17% 1.83% 11.57% 18.76%2 or 3 times 16.65% 6.81% 3.27% 30.03%4-5 times 34.29% 7.28% 19.98% 48.60%6-10 times 16.22% 3.83% 8.70% 23.74%More than 10 times 6.07% 3.83% ‐1.45% 13.59%

Regular blood sugar checks. 3 or more times per day * * * *1 or 2 times per day 66.05% 3.83% 58.53% 73.57%

At least 1 time per week but less than daily 32.00% 3.36% 25.39% 38.60%Less than 1 time per week 1.95% 1.83% ‐1.64% 5.55%




Yes 46.17% 8.55% 29.37% 62.97%


Yes 39.60% 3.83% 32.08% 47.12%


Yes 35.14% 6.14% 23.09% 47.20%


Yes 39.60% 3.83% 32.08% 47.12%*Denotes cells without observations.


Appendix A. Weighted ARHI III Data Appendix A3.8. Diabetes: Muskingum County

Respondents living with diabetes: Percent SE LCL @ .95 UCL @ .95 Muskingum County Age of diabetes diagnosis.





At least 1 time per week but less than daily 29.18% 4.23% 20.88% 37.48%Less than 1 time per week 1.88% 0.99% ‐0.08% 3.83%




Yes 56.68% 3.47% 49.86% 63.51%


Yes 30.31% 3.29% 23.84% 36.77%


Yes 27.86% 3.50% 20.98% 34.74%


Yes 25.93% 2.98% 20.07% 31.80%


Appendix A. Weighted ARHI III Data Appendix A3.9. Diabetes: Noble County

Respondents living with diabetes: Percent SE LCL @ .95 UCL @ .95 Noble County Age of diabetes diagnosis.

Under 18 years * * * *19 to 40 years 60.38% 7.72% 45.20% 75.55%41 to 49 years 6.73% 5.50% ‐4.08% 17.54%50 to 59 years 15.88% 8.50% ‐0.81% 32.58%Over 60 years 17.01% 6.92% 3.41% 30.61%


None * * * *1 time 10.28% 4.20% 2.03% 18.53%2 or 3 times * * * *4-5 times 45.71% 9.48% 27.09% 64.34%6-10 times 34.85% 5.50% 24.05% 45.66%More than 10 times 9.15% 6.48% ‐3.57% 21.88%

Regular blood sugar checks. 3 or more times per day 14.29% 7.72% ‐0.88% 29.47%1 or 2 times per day 69.82% 6.92% 56.22% 83.42%

At least 1 time per week but less than daily 15.88% 8.50% ‐0.82% 32.59%Less than 1 time per week * * * *




Yes 78.98% 9.48% 60.35% 97.60%


Yes 9.15% 6.48% ‐3.57% 21.88%


Yes 14.29% 7.72% ‐0.88% 29.47%


Yes * * * **Denotes cells without observations.


Appendix A. Weighted ARHI III Data Appendix A4. Body Mass Index (BMI) Categories

Body Mass Index (BMI) categories: Percent SE LCL @

.95 UCL @

.95 Entire 9 County Sample Neither overweight nor obese 34.00% 0.78% 32.47% 35.53%Overweight 35.32% 0.79% 33.77% 36.86%Obese 30.69% 0.77% 29.18% 32.20%Belmont County Neither overweight nor obese 35.75% 2.08% 31.66% 39.84%Overweight 36.02% 2.09% 31.93% 40.12%Obese 28.23% 1.98% 24.35% 32.10%Columbiana County Neither overweight nor obese 34.19% 1.63% 31.00% 37.38%Overweight 36.71% 1.71% 33.35% 40.07%Obese 29.10% 1.61% 25.95% 32.25%Gallia County Neither overweight nor obese 34.23% 2.97% 28.41% 40.05%Overweight 37.83% 2.95% 32.05% 43.61%Obese 27.94% 2.82% 22.42% 33.46%Harrison County Neither overweight nor obese 37.26% 4.00% 29.42% 45.09%Overweight 30.14% 3.70% 22.89% 37.40%Obese 32.60% 3.95% 24.86% 40.34%Jefferson County Neither overweight nor obese 35.41% 2.02% 31.45% 39.38%Overweight 32.92% 1.96% 29.07% 36.77%Obese 31.66% 1.98% 27.77% 35.55%Lawrence County Neither overweight nor obese 31.54% 1.98% 27.66% 35.42%Overweight 36.44% 2.05% 32.41% 40.46%Obese 32.03% 2.02% 28.07% 35.98%Monroe County Neither overweight nor obese 20.82% 3.13% 14.69% 26.95%Overweight 41.71% 4.45% 32.98% 50.44%Obese 37.47% 4.49% 28.67% 46.26%Muskingum County Neither overweight nor obese 34.62% 1.99% 30.72% 38.52%Overweight 32.36% 1.90% 28.64% 36.09%Obese 33.02% 1.97% 29.15% 36.88%Noble County Neither overweight nor obese 33.03% 4.83% 23.55% 42.51%Overweight 39.39% 5.13% 29.32% 49.45%Obese 27.59% 4.20% 19.34% 35.83%


Appendix A. Weighted ARHI III Data Appendix A5. Physical Exercise

Physical exercise: Percent SE LCL

@ .95 UCL

@ .95 Entire 9 County Sample In a usual week, do you engage in moderate exercise? Yes 77.01% 0.69% 75.66% 78.37%

How many times per week do you do moderate activities for at least 20 minutes at a time?

1 3.75% 0.36% 3.05% 4.45%

2 10.46% 0.58% 9.32% 11.60%

3 24.29% 0.81% 22.70% 25.89%

4 15.21% 0.70% 13.85% 16.58%

5 14.40% 0.65% 13.12% 15.68%

6 4.82% 0.42% 3.99% 5.65%

7 27.05% 0.85% 25.38% 28.72%In a usual week, do you engage in vigorous exercise? Yes 42.68% 0.79% 41.14% 44.22%

How many times per week do you do vigorous activities for at least 20 minutes at a time?

1 18.97% 1.02% 16.96% 20.98%

2 19.16% 1.02% 17.16% 21.16%

3 26.10% 1.15% 23.84% 28.36%

4 10.97% 0.81% 9.39% 12.56%

5 10.98% 0.84% 9.34% 12.62%

6 3.16% 0.46% 2.25% 4.07%7 10.66% 0.83% 9.02% 12.29%


Appendix A. Weighted ARHI III Data Appendix A5.1. Physical Exercise: Belmont County

Percent SE LCL

@ .95 UCL

@ .95 Physical exercise: Belmont County

In a usual week, do you engage in moderate exercise? Yes 75.26% 1.85% 71.63% 78.90%


4.66% 0.98% 2.74% 6.58%1 10.16% 1.54% 7.14% 13.17%2 24.96% 2.22% 20.61% 29.32%3 16.15% 1.85% 12.52% 19.78%4 12.54% 1.53% 9.54% 15.53%5 2.33% 0.73% 0.89% 3.77%6

29.20% 2.34% 24.61% 33.79%7 In a usual week, do you engage in vigorous exercise? Yes 40.82% 1.98% 36.94% 44.70%


17.58% 2.76% 12.16% 23.00%1 16.40% 2.59% 11.32% 21.47%2 24.71% 3.08% 18.66% 30.75%3 9.92% 2.02% 5.95% 13.90%4

14.55% 2.53% 9.60% 19.51%5 4.25% 1.21% 1.88% 6.63%6

7 12.58% 2.47% 7.73% 17.44%


Appendix A. Weighted ARHI III Data Appendix A5.2. Physical Exercise: Columbiana County


@ .95 UCL

@ .95 Columbiana County In a usual week, do you engage in moderate exercise? Yes 79.12% 1.47% 76.25% 81.99%


1 3.76% 0.84% 2.11% 5.41%

2 10.15% 1.20% 7.79% 12.51%

3 24.97% 1.70% 21.63% 28.31%

4 16.43% 1.53% 13.44% 19.42%

5 14.68% 1.47% 11.80% 17.57%

6 5.31% 0.98% 3.38% 7.23%



1 21.30% 2.31% 16.77% 25.82%

2 19.70% 2.15% 15.48% 23.92%

3 25.37% 2.34% 20.79% 29.95%

4 13.71% 1.95% 9.88% 17.54%

5 9.28% 1.56% 6.21% 12.35%

6 2.39% 0.90% 0.63% 4.14%

7 8.26% 1.61% 5.10% 11.43%


Appendix A. Weighted ARHI III Data Appendix A5.3. Physical Exercise: Gallia County


@ .95 UCL

@ .95 Gallia County In a usual week, do you engage in moderate exercise? Yes 81.52% 2.36% 76.89% 86.16%


1 5.49% 1.60% 2.34% 8.63%

2 3.91% 1.18% 1.59% 6.23%

3 22.76% 2.78% 17.31% 28.20%

4 13.81% 2.41% 9.08% 18.53%

5 15.69% 2.47% 10.84% 20.54%

6 4.26% 1.33% 1.65% 6.88%



1 21.89% 3.86% 14.31% 29.47%

2 18.85% 3.76% 11.48% 26.22%

3 20.89% 3.62% 13.79% 27.99%

4 11.40% 2.69% 6.11% 16.68%

5 8.57% 2.34% 3.98% 13.16%

6 2.05% 1.39% ‐0.67% 4.77%

7 16.35% 3.48% 9.52% 23.18%


Appendix A. Weighted ARHI III Data Appendix A5.4. Physical Exercise: Harrison County

LCL @ .95 Physical exercise: Percent SE

UCL @ .95

Harrison County In a usual week, do you engage in moderate exercise? Yes 76.22% 3.40% 69.55% 82.88%


1 2.38% 2.06% ‐1.66% 6.43%

2 5.60% 2.14% 1.40% 9.81%

3 19.73% 4.25% 11.39% 28.06%

4 13.96% 3.41% 7.28% 20.64%

5 14.19% 3.18% 7.95% 20.43%

6 5.89% 2.29% 1.41% 10.37%



1 8.42% 3.21% 2.12% 14.72%

2 29.79% 5.68% 18.66% 40.93%

3 27.50% 5.29% 17.12% 37.87%

4 13.04% 4.13% 4.93% 21.14%

5 3.52% 1.84% ‐0.09% 7.12%

6 3.03% 1.94% ‐0.78% 6.83%

7 14.72% 5.17% 4.58% 24.86%


Appendix A. Weighted ARHI III Data Appendix A5.5. Physical Exercise: Jefferson County


@ .95 UCL

@ .95 Jefferson County In a usual week, do you engage in moderate exercise? Yes 75.06% 1.77% 71.58% 78.53%


1 3.30% 0.82% 1.70% 4.90%

2 11.16% 1.55% 8.12% 14.21%

3 22.95% 2.03% 18.97% 26.92%

4 14.27% 1.78% 10.77% 17.76%

5 15.96% 1.74% 12.54% 19.38%

6 6.77% 1.37% 4.09% 9.46%



1 11.73% 2.16% 7.50% 15.96%

2 21.38% 2.92% 15.65% 27.11%

3 26.47% 3.16% 20.26% 32.67%

4 8.16% 1.89% 4.45% 11.87%

5 16.18% 2.84% 10.61% 21.76%

6 5.02% 1.74% 1.60% 8.45%

7 11.06% 2.24% 6.66% 15.46%


Appendix A. Weighted ARHI III Data Appendix A5.6. Physical Exercise: Lawrence County


@ .95 UCL

@ .95 Lawrence County In a usual week, do you engage in moderate exercise? Yes 78.09% 1.74% 74.68% 81.49%


1 3.29% 0.82% 1.69% 4.90%

2 10.80% 1.53% 7.81% 13.80%

3 25.44% 2.03% 21.47% 29.41%

4 14.20% 1.68% 10.91% 17.49%

5 14.68% 1.70% 11.34% 18.02%

6 6.15% 1.15% 3.90% 8.41%



1 21.49% 2.85% 15.91% 27.08%

2 24.19% 2.87% 18.56% 29.82%

3 23.55% 2.84% 17.98% 29.12%

4 9.36% 1.96% 5.52% 13.19%

5 9.10% 1.90% 5.38% 12.83%

6 2.53% 1.01% 0.55% 4.51%

7 9.78% 2.01% 5.84% 13.72%


Appendix A. Weighted ARHI III Data Appendix A5.7. Physical Exercise: Monroe County

Percent SE LCL

@ .95 UCL

@ .95 Physical exercise: Monroe County

In a usual week, do you engage in moderate exercise? Yes 80.50% 3.46% 73.72% 87.29%


7.68% 2.52% 2.74% 12.62%1 8.82% 2.87% 3.19% 14.46%2

24.36% 4.16% 16.20% 32.52%3 12.48% 3.34% 5.92% 19.03%4 17.38% 3.83% 9.88% 24.88%5 1.96% 1.31% ‐0.62% 4.53%6

27.32% 4.75% 18.00% 36.64%7 In a usual week, do you engage in vigorous exercise? Yes 39.45% 4.37% 30.88% 48.02%


19.67% 4.13% 11.57% 27.76%1 10.55% 4.05% 2.61% 18.50%2 33.76% 6.78% 20.45% 47.07%3 8.13% 3.52% 1.23% 15.03%4

13.14% 3.98% 5.33% 20.94%5 2.44% 2.11% ‐1.70% 6.58%6

7 12.31% 5.30% 1.91% 22.72%


Appendix A. Weighted ARHI III Data Appendix A5.8. Physical Exercise: Muskingum County


@ .95 UCL

@ .95 Muskingum County In a usual week, do you engage in moderate exercise? Yes 75.34% 1.70% 72.00% 78.68%


1 2.61% 0.67% 1.29% 3.93%

2 14.50% 1.67% 11.22% 17.78%

3 23.84% 2.07% 19.78% 27.90%

4 15.88% 1.75% 12.45% 19.31%

5 14.26% 1.60% 11.12% 17.40%

6 2.88% 0.75% 1.41% 4.35%



1 24.01% 2.82% 18.47% 29.55%

2 14.78% 2.28% 10.30% 19.26%

3 29.48% 3.01% 23.58% 35.38%

4 11.32% 2.02% 7.37% 15.28%

5 10.34% 2.00% 6.41% 14.27%

6 2.19% 0.87% 0.48% 3.91%

7 7.87% 1.80% 4.34% 11.40%


Appendix A. Weighted ARHI III Data Appendix A5.9. Physical Exercise: Noble County


@ .95 UCL

@ .95 Noble County In a usual week, do you engage in moderate exercise? Yes 72.39% 4.88% 62.81% 81.96%


1 3.64% 2.51% ‐1.29% 8.57%

2 7.24% 2.55% 2.24% 12.25%

3 28.84% 5.73% 17.61% 40.07%

4 13.89% 4.20% 5.66% 22.13%

5 7.29% 2.51% 2.36% 12.22%

6 11.80% 4.07% 3.83% 19.78%



1 11.34% 4.14% 3.22% 19.46%

2 18.35% 5.29% 7.99% 28.72%

3 29.91% 6.67% 16.83% 42.99%

4 14.78% 4.86% 5.25% 24.30%

5 1.39% 1.14% ‐0.84% 3.63%

6 5.44% 2.72% 0.10% 10.77%

7 18.78% 4.43% 10.10% 27.46%


Appendix A. Weighted ARHI III Data Appendix A6. Smoking

LCL @ .95 Have you smoked at least 100 cigarettes in your entire life? Percent SE

UCL @ .95

Entire 9 County Sample Yes 47.65% 0.81% 46.06% 49.25%If yes: Do you smoke every day, some days, or not at all?

Every day 43.50% 1.14% 41.27% 45.73%

Some days 11.59% 0.78% 10.06% 13.12%

Not at all/I quit 44.91% 1.07% 42.81% 47.02%

Have you smoked at least 100 cigarettes in your entire life? Percent SE LCL

@ .95 UCL

@ .95 Belmont County Yes 47.69% 2.13% 43.51% 51.86%If yes: Do you smoke every day, some days, or not at all?

Every day 38.13% 3.18% 31.89% 44.37%

Some days 13.70% 2.13% 9.52% 17.87%

Not at all/I quit 48.17% 2.96% 42.37% 53.98%


@ .95 UCL

@ .95 Columbiana County Yes 46.24% 1.74% 42.84% 49.64%If yes: Do you smoke every day, some days, or not at all?

Every day 41.61% 2.27% 37.15% 46.07%

Some days 11.34% 1.59% 8.23% 14.44%

Not at all/I quit 47.05% 2.29% 42.56% 51.55%


@ .95 UCL

@ .95 Gallia County Yes 52.22% 2.99% 46.35% 58.09%If yes: Do you smoke every day, some days, or not at all?

Every day 44.26% 4.13% 36.17% 52.35%

Some days 10.63% 2.38% 5.96% 15.30%

Not at all/I quit 45.11% 4.02% 37.23% 52.99%



LCL @ .95 Have you smoked at least 100 cigarettes in your entire life? Percent SE

UCL @ .95

Harrison County Yes 48.04% 3.95% 40.30% 55.79%If yes: Do you smoke every day, some days, or not at all?

Every day 44.02% 5.95% 32.36% 55.68%

Some days 19.27% 4.94% 9.59% 28.95%

Not at all/I quit 36.71% 5.14% 26.63% 46.79%


@ .95 UCL

@ .95 Jefferson County Yes 50.36% 2.07% 46.30% 54.43%If yes: Do you smoke every day, some days, or not at all?

Every day 45.80% 2.74% 40.42% 51.18%

Some days 9.56% 1.86% 5.90% 13.21%

Not at all/I quit 44.65% 2.41% 39.91% 49.38%


@ .95 UCL

@ .95 Lawrence County Yes 49.37% 2.08% 45.30% 53.44%If yes: Do you smoke every day, some days, or not at all?

Every day 53.33% 2.99% 47.46% 59.20%

Some days 4.87% 1.32% 2.28% 7.45%

Not at all/I quit 41.80% 2.91% 36.09% 47.52%


@ .95 UCL

@ .95 Monroe County Yes 50.17% 4.31% 41.72% 58.61%If yes: Do you smoke every day, some days, or not at all?

Every day 42.42% 6.47% 29.72% 55.11%

Some days 10.41% 3.95% 2.66% 18.15%

Not at all/I quit 47.18% 6.16% 35.09% 59.26%





@ .95 UCL

@ .95 Muskingum County Yes 44.96% 2.06% 40.92% 49.00%If yes: Do you smoke every day, some days, or not at all?

Every day 37.38% 2.93% 31.63% 43.13%

Some days 15.28% 2.35% 10.67% 19.89%

Not at all/I quit 47.35% 2.80% 41.85% 52.84%


@ .95 UCL

@ .95 Noble County Yes 39.26% 4.61% 30.21% 48.31%If yes: Do you smoke every day, some days, or not at all?

Every day 64.67% 6.97% 51.01% 78.34%

Some days 16.74% 5.72% 5.51% 27.96%

Not at all/I quit 18.59% 4.61% 9.55% 27.63%

Appendix A. Weighted ARHI III Data Appendix A7. Self‐Reported Depressed Mood

During the past 30 days, about how often did you feel so depressed that nothing could cheer you up? Percent SE

LCL @ .95

UCL @ .95

Entire 9 County Sample All the time 2.26% 0.25% 1.77% 2.74%Most of the time 3.79% 0.31% 3.17% 4.40%Some of the time 11.96% 0.54% 10.89% 13.02%A little of the time 20.01% 0.66% 18.71% 21.31%None 61.99% 0.80% 60.41% 63.56%


LCL @ .95

UCL @ .95

Belmont County All the time 2.53% 0.75% 1.07% 4.00%Most of the time 3.37% 0.75% 1.90% 4.85%Some of the time 10.90% 1.36% 8.23% 13.57%A little of the time 20.54% 1.77% 17.07% 24.01%None 62.65% 2.09% 58.54% 66.75%


LCL @ .95

UCL @ .95

Columbiana County All the time 1.96% 0.51% 0.96% 2.96%Most of the time 3.63% 0.69% 2.27% 4.99%Some of the time 11.51% 1.16% 9.25% 13.78%A little of the time 21.52% 1.49% 18.60% 24.44%None 61.37% 1.75% 57.93% 64.81%


LCL @ .95

UCL @ .95

Gallia County All the time 2.28% 0.95% 0.42% 4.13%Most of the time 7.38% 1.61% 4.23% 10.52%Some of the time 11.89% 1.96% 8.06% 15.73%A little of the time 18.05% 2.30% 13.54% 22.56%None 60.41% 2.97% 54.58% 66.24%




LCL @ .95

UCL @ .95

Harrison County All the time 1.65% 1.11% ‐0.52% 9.70%Most of the time 5.41% 2.19% 1.13% 9.70%Some of the time 11.61% 2.74% 6.24% 16.97%A little of the time 13.05% 2.80% 7.56% 18.55%None 68.28% 4.16% 60.12% 76.44%


LCL @ .95

UCL @ .95

Jefferson County All the time 3.09% 0.70% 1.73% 4.46%Most of the time 3.79% 0.79% 2.24% 5.34%Some of the time 12.13% 1.34% 9.49% 14.76%A little of the time 20.62% 1.72% 17.26% 23.99%None 60.36% 2.02% 56.40% 64.32%


LCL @ .95

UCL @ .95

Lawrence County All the time 2.48% 0.65% 1.21% 3.76%Most of the time 4.35% 0.88% 2.62% 6.09%Some of the time 11.42% 1.35% 8.78% 14.07%A little of the time 20.05% 1.71% 16.70% 23.41%None 61.68% 2.07% 57.64% 65.73%


LCL @ .95

UCL @ .95

Monroe County All the time 3.51% 1.95% ‐0.31% 7.33%Most of the time 2.30% 1.25% ‐0.16% 4.76%Some of the time 10.68% 2.65% 5.48% 15.88%A little of the time 21.90% 3.61% 14.81% 28.98%None 61.61% 4.52% 52.76% 70.47%





LCL @ .95

UCL @ .95

Muskingum County All the time 1.60% 0.48% 0.66% 2.54%Most of the time 2.63% 0.60% 1.45% 3.80%Some of the time 14.11% 1.46% 11.26% 16.97%A little of the time 18.45% 1.49% 15.52% 21.38%None 63.21% 1.93% 59.42% 67.00%


LCL @ .95

UCL @ .95

Noble County All the time 0.79% 0.75% ‐0.69% 2.26%Most of the time 3.41% 2.00% ‐0.52% 7.33%Some of the time 11.65% 3.70% 4.41% 18.90%A little of the time 21.03% 4.12% 12.96% 29.10%None 63.12% 5.14% 53.03% 73.20%

Appendix A. Weighted ARHI III Data Appendix A8. Health Care Access

Access to health care: Percent SE LCL

@ .95 UCL

@ .95 Entire 9 County Sample Do you have a doctor or health care provider? Yes, only one 80.18% 0.67% 78.86% 81.49%Yes, more than one 6.43% 0.40% 5.65% 7.21%No 13.40% 0.58% 12.25% 14.54%

In the past 12 months, was there a time you needed to see a doctor but could not afford to? Yes 15.18% 0.61% 13.99% 16.37%Time of last dentist visit. within the past year 69.49% 0.76% 67.99% 70.98%within past 2 years 9.88% 0.50% 8.90% 10.85%within past 5 years 6.91% 0.43% 6.07% 7.76%5 or more years ago 13.39% 0.55% 12.32% 14.47%never 0.33% 0.10% 0.14% 0.53%


@ .95 UCL

@ .95 Belmont County Do you have a doctor or health care provider? Yes, only one 81.35% 1.75% 77.92% 84.78%Yes, more than one 7.61% 1.08% 5.49% 9.73%No 11.04% 1.46% 8.18% 13.91%

In the past 12 months, was there a time you needed to see a doctor but could not afford to? Yes 12.27% 1.49% 9.35% 15.20%Time of last dentist visit. within the past year 72.89% 1.86% 69.24% 76.53%within past 2 years 7.46% 1.14% 5.23% 9.69%within past 5 years 5.71% 0.99% 3.77% 7.65%5 or more years ago 13.81% 1.38% 11.09% 16.52%never 0.14% 0.14% ‐0.13% 0.41%




@ .95 UCL

@ .95 Columbiana County Do you have a doctor or health care provider? Yes, only one 83.95% 1.35% 81.29% 86.60%Yes, more than one 3.92% 0.72% 2.50% 5.34%No 12.13% 1.21% 9.75% 14.51%

In the past 12 months, was there a time you needed to see a doctor but could not afford to? Yes 13.91% 1.27% 11.42% 16.41%Time of last dentist visit. within the past year 68.38% 1.69% 65.06% 71.69%within past 2 years 10.93% 1.14% 8.69% 13.17%within past 5 years 6.93% 0.95% 5.07% 8.79%5 or more years ago 13.16% 1.18% 10.85% 15.47%never 0.61% 0.31% 0.00% 1.21%


@ .95 UCL

@ .95 Gallia County Do you have a doctor or health care provider? Yes, only one 76.90% 2.62% 71.78% 82.03%Yes, more than one 3.30% 1.12% 1.12% 5.49%No 19.80% 2.48% 14.94% 24.65%





@ .95 UCL

@ .95 Harrison County Do you have a doctor or health care provider? Yes, only one 77.94% 3.18% 71.71% 84.17%Yes, more than one 9.37% 2.36% 4.73% 14.00%No 12.69% 2.29% 8.20% 17.19%

In the past 12 months, was there a time you needed to see a doctor but could not afford to? Yes 18.50% 2.90% 12.82% 24.18%Time of last dentist visit. within the past year 66.49% 4.22% 58.22% 74.76%within past 2 years 9.89% 2.75% 4.49% 15.29%within past 5 years 10.82% 2.52% 5.89% 15.76%5 or more years ago 12.80% 2.73% 7.45% 18.15%never * * * *

*Denotes cells without observations.


@ .95 UCL

@ .95 Jefferson County Do you have a doctor or health care provider? Yes, only one 81.20% 1.68% 77.92% 84.49%Yes, more than one 8.81% 1.15% 6.56% 11.06%No 9.99% 1.34% 7.37% 12.61%





@ .95 UCL

@ .95 Lawrence County Do you have a doctor or health care provider? Yes, only one 73.93% 1.84% 70.33% 77.53%Yes, more than one 5.85% 0.95% 3.99% 7.72%No 20.22% 1.64% 17.00% 23.44%



@ .95 UCL

@ .95 Monroe County Do you have a doctor or health care provider? Yes, only one 80.34% 3.52% 73.45% 87.23%Yes, more than one 10.29% 2.59% 5.20% 15.38%No 9.37% 2.55% 4.36% 14.38%







@ .95 UCL

@ .95 Muskingum County Do you have a doctor or health care provider? Yes, only one 79.07% 1.75% 75.63% 82.50%Yes, more than one 6.91% 1.04% 4.86% 8.95%No 14.03% 1.56% 10.97% 17.08%



@ .95 UCL

@ .95 Noble County Do you have a doctor or health care provider? Yes, only one 82.15% 4.21% 73.89% 90.41%Yes, more than one 6.29% 2.29% 1.80% 10.77%No 11.56% 3.80% 4.11% 19.02%



Appendix A. Weighted ARHI III Data Appendix A9. Insurance Coverage

Percent SE LCL

@ .95 UCL

@ .95 Health insurance coverage: Entire 9 County Sample 13.56% 0.60% 12.38% 14.73%

No insurance 7.78% 0.39% 7.01% 8.54%

Medicare only 8.65% 0.35% 7.95% 9.34%

Medicare and other 7.22% 0.45% 6.35% 8.10%

Medicaid 56.05% 0.78% 54.51% 57.58%

Private/commercial 1.97%

Military 0.24% 1.50% 2.43%

Other 4.78% 0.35% 4.09% 5.47%

Do you have insurance that pays for at least a part of your prescription costs? Yes 82.04% 0.66% 80.75% 83.33%

Percent SE LCL

@ .95 UCL

@ .95 Health insurance coverage: Belmont County 12.63% 1.54% 9.61% 15.64%

No insurance 12.54% 1.68% 9.25% 15.83%

Medicare only 20.28% 1.57% 17.19% 23.36%


Medicaid 15.16% 0.51% 14.16% 16.16%

Private/commercial 20.27% 5.28%

Military 9.92% 30.61%

Other 15.58% 2.71% 10.27% 20.89%




Percent SE LCL

@ .95 UCL

@ .95 Health insurance coverage: Columbiana County 24.67% 1.94% 20.87% 28.46%

No insurance 23.03% 2.18% 18.77% 27.30%

Medicare only 17.72% 1.69% 14.42% 21.03%


Medicaid 23.42% 0.62% 22.21% 24.63%


Military 5.90% 23.27% 46.41%

Other 24.23% 3.25% 17.65% 30.40%


Percent SE LCL

@ .95 UCL

@ .95 Health insurance coverage: Gallia County 6.83% 1.02% 4.84% 8.82%

No insurance 6.69% 1.11% 4.52% 8.87%

Medicare only 4.51% 0.81% 2.91% 6.10%


Medicaid 6.11% 0.32% 5.48% 6.74%

Private/commercial 5.61% 2.43% 0.85%

Military 10.37%

Other 5.62% 1.65% 2.39% 8.85%




Percent SE LCL

@ .95 UCL

@ .95 Health insurance coverage: Harrison County 3.39% 0.76% 1.90% 4.89%

No insurance 4.34% 1.05% 2.28% 6.41%

Medicare only 3.84% 0.82% 2.23% 5.46%


Medicaid 3.20% 0.24% 2.73% 3.66%

Private/commercial 2.59% 1.73% ‐0.79%

Military 5.98%

Other 3.79% 1.33% 1.18% 6.41%


Percent SE LCL

@ .95 UCL

@ .95 Health insurance coverage: Jefferson County 14.30% 1.57% 11.22% 17.38%

No insurance 18.92% 2.05% 14.90% 22.95%

Medicare only 20.55% 1.66% 17.29% 23.81%


Medicaid 15.67% 0.51% 14.67% 16.67%


Military 3.58% 5.13% 19.16%

Other 12.37% 2.55% 7.39% 17.37%




Percent SE LCL

@ .95 UCL

@ .95 Health insurance coverage: Lawrence County 12.42% 1.35% 9.76% 15.07%

No insurance 14.36% 1.63% 11.17% 17.55%

Medicare only 10.76% 1.19% 8.43% 13.09%


Medicaid 13.29% 0.43% 12.44% 14.14%


Military 3.76% 7.10% 21.85%

Other 9.93% 2.02% 5.96% 13.90%


Percent SE LCL

@ .95 UCL

@ .95 Health insurance coverage: Monroe County 3.01% 0.72% 1.59% 4.43%

No insurance 3.13% 0.85% 1.47% 4.80%

Medicare only 3.33% 0.71% 1.94% 4.72%


Medicaid 3.24% 0.22% 2.81% 3.68%

Private/commercial * * *

Military *

Other 4.36% 1.42% 1.56% 7.14%


*Denotes cells without observations




Health insurance coverage: Percent SE LCL

@ .95 UCL

@ .95 Muskingum County

No insurance 19.40% 1.75% 15.97% 22.82%

Medicare only 15.13% 1.80% 11.60% 18.66%


Medicaid 19.96% 2.59% 14.88% 25.04%

Private/commercial 16.47% 0.53% 15.43% 17.52%

Military 10.08% 3.34% 3.53% 16.63%

Other 22.15% 3.00% 16.27% 28.03%


Health insurance coverage: Percent SE LCL

@ .95 UCL

@ .95 Noble County

No insurance 3.37% 0.86% 1.68% 5.06%

Medicare only 1.84% 0.63% 0.61% 3.07%


Medicaid 1.48% 0.56% 0.37% 2.58%

Private/commercial 3.44% 0.22% 3.00% 3.87%

Military * * * *

Other 2.18% 1.02% 0.18% 4.17%


*Denotes cells without observations

Appendix B. Weighted Demographics


Demographics: Percent SE LCL

@ .95 UCL @

.95 Entire 9 County Sample Age 18 to 24 11.12% 0.00% 11.12% 11.12%25 to 34 16.04% 0.00% 16.04% 16.04%35 to 44 20.15% 0.00% 20.15% 20.15%45 to 54 18.75% 0.00% 18.75% 18.75%55 to 64 13.22% 0.00% 13.22% 13.22%65 and over 20.72% 0.00% 20.72% 20.72%

Income Less than $15,000 17.49% 0.79% 15.94% 19.04%$15,000 to $24,999 15.79% 0.75% 14.32% 17.26%$25,000 to $34,999 13.65% 0.66% 12.35% 14.95%$35,000 to $49,999 14.25% 0.66% 12.96% 15.55%$50,000 to $74,999 20.08% 0.75% 18.61% 21.55%$75,000 or more 18.74% 0.71% 17.36% 20.13%

Gender Male 48.09% 0.00% 48.09% 48.09%Female 51.91% 0.00% 51.91% 51.91%

Employment Employed 54.21% 0.74% 52.77% 55.66%Unemployed 11.35% 0.54% 10.30% 12.41%A homemaker 5.80% 0.36% 5.09% 6.50%A student 3.68% 0.36% 2.98% 4.38%Retired 20.60% 0.39% 19.84% 21.36%Unable to work 4.35% 0.33% 3.71% 4.99%

Education Never attended school 0.05% 0.03% ‐0.02% 0.11%Grade 1‐8 1.56% 0.20% 1.18% 1.95%Grades 9‐11 (some high school) 6.91% 0.44% 6.05% 7.77%Grade 12 or GED (high school graduate) 43.00% 0.82% 41.38% 44.61%College 1‐3 years (some college) 27.09% 0.74% 25.64% 28.53%College 4 or more (college graduate) 21.39% 0.66% 20.09% 22.69%

Ethnicity White 96.19% 0.35% 95.50% 96.88%Black or African American 1.80% 0.25% 1.31% 2.28%Asian 0.11% 0.05% 0.01% 0.21%Native Hawaiian or Pacific Islander 0.03% 0.02% ‐0.02% 0.07%American Indian or Alaskan Native 0.74% 0.14% 0.47% 1.02%Other 1.13% 0.21% 0.72% 1.54%

When a standard error is a true zero, the confidence intervals are equal to the percentage.

Appendix B. Weighted Demographics Appendix B1. Weighted Demographics: Belmont County


@ .95 UCL

@ .95 Belmont County Age 18 to 24 9.86% 0.00% 9.86% 9.86%25 to 34 15.26% 0.00% 15.26% 15.26%35 to 44 19.82% 0.00% 19.82% 19.82%45 to 54 19.16% 0.00% 19.16% 19.16%55 to 64 12.68% 0.00% 12.68% 12.68%65 and over 23.22% 0.00% 23.22% 23.22%




Education Never attended school * * * *Grade 1‐8 1.58% 0.49% 0.61% 2.54%Grades 9‐11 (some high school) 7.27% 1.19% 4.94% 9.60%Grade 12 or GED (high school graduate) 41.79% 2.13% 37.62% 45.97%College 1‐3 years (some college) 30.65% 2.02% 26.69% 34.62%College 4 or more (college graduate) 18.70% 1.67% 15.42% 21.98%

Ethnicity White 95.79% 1.00% 93.83% 97.74%Black or African American 2.17% 0.83% 0.55% 3.80%Asian 0.31% 0.22% ‐0.11% 0.73%Native Hawaiian or Pacific Islander * * * *American Indian or Alaskan Native 0.32% 0.22% ‐0.12% 0.76%Other 1.41% 0.46% 0.50% 2.32%

*Denotes cells without observations. When a standard error is a true zero, the confidence intervals are equal to the percentage.


Appendix B. Weighted Demographics Appendix B2. Weighted Demographics: Columbiana County


@ .95 UCL

@ .95 Columbiana County Age 18 to 24 10.37% 0.00% 10.37% 10.37%25 to 34 16.72% 0.00% 16.72% 16.72%35 to 44 21.07% 0.00% 21.07% 21.07%45 to 54 19.17% 0.00% 19.17% 19.17%55 to 64 12.80% 0.00% 12.80% 12.80%65 and over 19.86% 0.00% 19.86% 19.86%





Ethnicity White 96.19% 0.78% 94.66% 97.72%Black or African American 2.03% 0.59% 0.87% 3.20%Asian * * * *Native Hawaiian or Pacific Islander * * * *American Indian or Alaskan Native 0.54% 0.27% 0.01% 1.06%Other 1.24% 0.47% 0.33% 2.16%



Appendix B. Weighted Demographics Appendix B3. Weighted Demographics: Gallia County


@ .95 UCL @

.95 Gallia County Age 18 to 24 12.98% 0.00% 12.98% 12.98%25 to 34 15.69% 0.00% 15.69% 15.69%35 to 44 20.99% 0.00% 20.99% 20.99%45 to 54 18.24% 0.00% 18.24% 18.24%55 to 64 14.02% 0.00% 14.02% 14.02%65 and over 18.07% 0.00% 18.07% 18.07%





Ethnicity White 96.39% 1.13% 94.18% 98.60%Black or African American 0.35% 0.35% ‐0.33% 1.04%Asian * * * *Native Hawaiian or Pacific Islander * * * *American Indian or Alaskan Native 2.65% 0.99% 0.71% 4.60%Other 0.60% 0.43% ‐0.24% 1.45%



Appendix B. Weighted Demographics Appendix B4. Weighted Demographics: Harrison County


@ .95 UCL

@ .95 Harrison County Age 18 to 24 8.92% 0.00% * *25 to 34 14.41% 0.00% * *35 to 44 20.17% 0.00% * *45 to 54 19.39% 0.00% * *55 to 64 14.15% 0.00% * *65 and over 22.97% 0.00% * *


Gender Male 47.33% 0.00% * *Female 52.67% 0.00% * *

Employment Employed 57.10% 4.06% 49.14% 65.05%Unemployed 5.52% 1.92% 1.76% 9.28%A homemaker 8.70% 2.63% 3.53% 13.86%A student 0.75% 0.72% ‐0.66% 2.16%Retired 23.43% 2.76% 18.02% 28.84%Unable to work 4.51% 1.71% 1.15% 7.87%

Education Never attended school * * * *Grade 1‐8 2.21% 1.19% ‐0.13% 4.56%Grades 9‐11 (some high school) 8.59% 2.29% 4.11% 13.08%Grade 12 or GED (high school graduate) 51.16% 4.34% 42.66% 59.67%College 1‐3 years (some college) 21.85% 3.70% 14.60% 29.09%College 4 or more (college graduate) 16.19% 2.95% 10.41% 21.97%

Ethnicity White 98.34% 1.12% 96.15% 100.53%Black or African American 0.75% 0.72% ‐0.67% 2.17%Asian * * * *Native Hawaiian or Pacific Islander * * * *American Indian or Alaskan Native * * * *Other 0.91% 0.85% ‐0.76% 2.58%

*Denotes cells without observations. When a standard error rounds to zero, accurate confidence intervals cannot be calculated.


Appendix B. Weighted Demographics Appendix B5. Weighted Demographics: Jefferson County


@ .95 UCL

@ .95 Jefferson County Age 18 to 24 10.80% 0.00% 10.80% 10.80%25 to 34 13.93% 0.00% 13.93% 13.93%35 to 44 18.61% 0.00% 18.61% 18.61%45 to 54 19.31% 0.00% 19.31% 19.31%55 to 64 13.67% 0.00% 13.67% 13.67%65 and over 23.68% 0.00% 23.68% 23.68%





Ethnicity White 95.46% 0.85% 93.80% 97.13%Black or African American 2.82% 0.69% 1.47% 4.17%Asian * * * *Native Hawaiian or Pacific Islander 0.16% 0.16% ‐0.15% 0.46%American Indian or Alaskan Native 0.65% 0.32% 0.02% 1.27%Other 0.91% 0.37% 0.19% 1.63%



Appendix B. Weighted Demographics Appendix B6. Weighted Demographics: Lawrence County


@ .95 UCL

@ .95 Lawrence County Age 18 to 24 11.38% 0.00% 11.38% 11.38%25 to 34 17.39% 0.00% 17.39% 17.39%35 to 44 19.68% 0.00% 19.68% 19.68%45 to 54 18.39% 0.00% 18.39% 18.39%55 to 64 14.10% 0.00% 14.10% 14.10%65 and over 19.06% 0.00% 19.06% 19.06%





Ethnicity White 96.22% 0.81% 94.64% 97.79%Black or African American 1.53% 0.49% 0.56% 2.49%Asian 0.30% 0.22% ‐0.13% 0.73%Native Hawaiian or Pacific Islander * * * *American Indian or Alaskan Native 1.30% 0.48% 0.35% 2.24%Other 0.66% 0.38% ‐0.09% 1.41%



Appendix B. Weighted Demographics Appendix B7. Weighted Demographics: Monroe County


@ .95 UCL @

.95 Monroe County Age 18 to 24 9.25% 0.00% * *25 to 34 14.73% 0.00% * *35 to 44 19.22% 0.00% * *45 to 54 19.79% 0.00% * *55 to 64 15.74% 0.00% * *65 and over 21.27% 0.00% * *



Employment Employed 53.85% 4.20% 45.61% 62.09%Unemployed 12.71% 3.30% 6.24% 19.17%A homemaker 8.88% 2.42% 4.13% 13.63%A student 3.01% 1.34% 0.38% 5.63%Retired 19.24% 2.32% 14.69% 23.79%Unable to work 2.32% 1.28% ‐0.19% 4.84%


Ethnicity White 98.16% 1.25% 95.72% 100.60%Black or African American * * * *Asian * * * *Native Hawaiian or Pacific Islander * * * *American Indian or Alaskan Native 1.84% 1.25% ‐0.60% 4.28%Other * * * *



Appendix B. Weighted Demographics Appendix B8. Weighted Demographics: Muskingum County


@ .95 UCL

@ .95 Muskingum County Age 18 to 24 12.74% 0.00% 12.74% 12.74%25 to 34 16.85% 0.00% 16.85% 16.85%35 to 44 20.55% 0.00% 20.55% 20.55%45 to 54 17.97% 0.00% 17.97% 17.97%55 to 64 12.59% 0.00% 12.59% 12.59%65 and over 19.30% 0.00% 19.30% 19.30%





Ethnicity White 96.27% 0.97% 94.36% 98.18%Black or African American 1.64% 0.53% 0.60% 2.67%Asian 0.15% 0.15% ‐0.14% 0.44%Native Hawaiian or Pacific Islander * * * *American Indian or Alaskan Native 0.14% 0.14% ‐0.14% 0.43%Other 1.80% 0.80% 0.24% 3.36%

* Denotes cells without observations. When a standard error is a true zero, the confidence intervals are equal to the percentage.


Appendix B. Weighted Demographics Appendix B9. Weighted Demographics: Noble County


@ .95 UCL

@ .95 Noble County Age 18 to 24 15.06% 0.00% * *25 to 34 19.31% 0.00% * *35 to 44 21.84% 0.00% * *45 to 54 15.81% 0.00% * *55 to 64 11.10% 0.00% * *65 and over 16.88% 0.00% * *



Employment Employed 63.50% 3.81% 56.03% 70.96%Unemployed 4.85% 1.85% 1.22% 8.49%A homemaker 10.12% 2.10% 5.99% 14.24%A student 7.13% 2.93% 1.37% 12.88%Retired 11.97% 1.86% 8.32% 15.62%Unable to work 2.44% 1.31% ‐0.13% 5.00%


Ethnicity White 96.72% 1.90% 93.00% 100.44%Black or African American 0.80% 0.76% ‐0.70% 2.29%Asian * * * *Native Hawaiian or Pacific Islander * * * *American Indian or Alaskan Native 1.67% 1.56% ‐1.39% 4.72%Other 0.81% 0.77% ‐0.69% 2.31%



Appendix C. Weighted and Unweighted Sample Demographics


Demographics: Weighted Unweighted Percent N Percent N

County Belmont 15.03% 54,942 15.13% 581 Columbiana 23.20% 84,807 21.24% 816 Gallia 6.37% 23,298 7.39% 284 Harrison 3.34% 12,209 3.18% 122 Jefferson 15.89% 58,073 15.49% 595 Lawrence 12.87% 47,049 15.05% 578 Monroe 3.17% 11,599 2.97% 114 Muskingum 17.14% 62,655 16.95% 651 Noble 2.98% 10,878 2.60% 100

Gender Male 48.09% 175,792 43.24% 1,661 Female 51.91% 189,718 56.76% 2,180

Ethnicity White 96.19% 351,596 96.56% 3,676 Black or African American 1.80% 6,563 1.60% 61 Asian 0.11% 405 0.13% 5 Native Hawaiian or Pacific Islander 0.03% 91 0.03% 1 American Indian or Alaskan Native 0.74% 2,718 0.74% 28 Other 1.13% 4,136 0.95% 36

Age 18 to 24 11.12% 40,649 5.81% 223 25 to 34 16.04% 58,612 14.14% 543 35 to 44 20.15% 73,661 19.50% 749 45 to 54 18.75% 68,546 20.98% 806 55 to 64 13.22% 48,313 15.70% 603 65 and over 20.72% 75,729 23.87% 917

Education Never attended school 0.05% 171 0.05% 2 Grade 1‐8 1.56% 5,719 1.62% 62 Grades 9‐11 (some high school) 6.91% 25,257 6.61% 253 Grade 12 or GED (high school graduate) 43.00% 157,157 42.92% 1,644 College 1‐3 years (some college) 27.09% 99,014 27.21% 1,042 College 4 or more (college graduate) 21.39% 78,192 21.59% 827

Household income Less than $15,000 17.49% 63,926 16.07% 471 $15,000 to $24,999 15.79% 57,717 15.05% 441 $25,000 to $34,999 13.65% 49,895 13.72% 402 $35,000 to $49,999 14.25% 52,093 14.67% 430 $50,000 to $74,999 20.08% 73,377 20.74% 608 $75,000 or more 18.74% 68,502 19.75% 579

Employment Employed 54.21% 198,160 52.63% 2,009 Unemployed 11.35% 41,502 10.56% 403 A homemaker 5.80% 21,194 6.24% 238 A student 3.68% 13,458 2.31% 88 Retired 20.60% 75,292 23.68% 904 Unable to work 4.35% 15,903 4.58% 175

Appendix D. Statistical Limitations: A Tutorial Appendix D1. Cross‐Tabulated Variables at the County Level

The examples below provide a step‐by‐step explanation of why cross‐tabulated variables cannot be analyzed at the county level. Below are the simple, unweighted, frequencies for each variable:

Diabetes Status Frequency Percent

Yes 529 13.78 No 3,310 86.22 Total 3,839 100.00

Vigorous Exercise Frequency Percent

Less than 3 Days/Week 572 38.31 3 or More Days/Week 921 61.69

Total 1,493 100.00 Once the two variables are cross‐tabulated, the frequencies in some of the cells become quite small in comparison to the other cells.

Diabetes Status by Vigorous Exercise Yes No Total

Less than 3 Days/Week 44 527 571 3 or More Days/Week 56 864 920

Total 100 1,391 1,491 Examining the cross‐tabulated variables at the county‐level creates further statistical problems because the low frequencies of some cells can lead to very wide confidence intervals, which have limited usefulness. Further, confidence intervals extending beyond plausible values (0 and 100%) are not interpretable. The estimates for Monroe County (below) illustrate such problems.

Diabetes Status by Vigorous Exercise by County Percent SE

LCL @ .95

UCL @ .95

Monroe (N = 114) Diabetes Status= Yes Less than 3 Days of Vigorous Exercise ‐5.03% 7.76% 6.52% 20.44%

3 or More Days of Vigorous Exercise 14.89% 7.14% 0.89% 28.89%

Diabetes Status = No Less than 3 Days of Vigorous Exercise 92.24% 6.52% 79.45% 105.03%

3 or More Days of Vigorous Exercise 85.11% 7.14% 71.11% 99.11%


Appendix D. Statistical Limitations: A Tutorial Appendix D1. Cross‐Tabulated Variables at the County Level


Examining cross‐tabulated variables at the county level can also lead to empty cells, meaning that no frequencies exist and so results cannot be given. For example, in Noble County (below), there were no respondents who have been diagnosed with diabetes and who regularly perform vigorous exercise for 3 or more days a week.

Diabetes Status by Vigorous Exercise by County Percent SE

LCL @ .95

UCL @ .95

Noble (N = 100) Diabetes Status = Yes Less than 3 Days of Vigorous Exercise 12.31% 7.97% ‐3.33% 27.94%

3 or More Days of Vigorous Exercise * * * *

Diabetes Status = No Less than 3 Days of Vigorous Exercise 87.69% 7.97% 72.06% 103.33%

3 or More Days of Vigorous Exercise 100% 0.00% * * Due to small cell values, conclusions drawn from these types of analyses often fail to accurately reflect the true population within each county. Therefore, analyzing cross‐tabulated variables at the county level is often inappropriate.

Appendix D. Statistical Limitations: A Tutorial Appendix D2. Standard Errors Reported as Zero

The example below explains why standard errors with a value of 0.00% can provide different confidence interval values.

The first confidence interval calculated with a standard error of 0.00% has the same upper and lower limits as the relevant percentage. This is because the standard error is a true zero and so the confidence interval is capturing that percentage exactly.

Respondents living with diabetes: Percent SE LCL @ .95 UCL @ .95 Gallia County Age of diabetes diagnosis.



None 3.30% 1.91% ‐0.45% 7.05%1 time 10.04% 3.52% 3.13% 16.95%

23.70% 4.22% 15.41% 31.98%2 or 3 times 35.97% 5.59% 24.98% 46.96%4-5 times 23.82% 0.00% * *6-10 times 3.17% 2.08% ‐0.92% 7.26%More than 10 times

For the second confidence interval calculated with a standard error of 0.00%, no interval estimates are provided. This is because this standard error is not a true zero, but is actually very small. When using conventional rounding rules, the standard error will round to zero; therefore, it is reported as zero. For such a small standard error, confidence interval values cannot be properly calculated.


Appendix E. Comprehensive Description of the Survey


Survey Design

As there was no single existing national health survey adequate in its assessment of the areas under consideration in this project, the research team determined that it would be optimal to develop a new survey. A telephone survey was chosen over other methodological approaches because it allows for the collection of data from a larger percentage of the population of interest at a faction of the cost of mail surveys or personal interviews. Additionally, mail surveys are notorious for having poor response rates, while personal interviews are time‐consuming and do not provide the level of statistical confidence that can be achieved with a telephone survey.

The telephone survey used in 2003 for the first ARHI Needs Assessment survey was developed by GVS in collaboration with Frank Schwartz, M.D., Director of the ARHI Diabetes Center and with ARHI Co‐Directors Christopher Simpson, D.O. and Brooke Hallowell, Ph.D. Revisions were made to this instrument by the GVS in collaboration with the remainder of the survey project team for the second ARHI. This second survey incorporated questions from the 2004 BRFSS and the 2004 National Health Information Survey for comparability with state and national data. When an equivalent question was unable to be located, all members of the research team provided input on the development of the question. The current ARHI survey (ARHI III) was altered to include all the questions in the diabetes module of the 2007 BRFSS, and to expand the number of questions related to exercise and health access. Finally, to keep the survey brief, questions related to emphysema, cancer, and age of smoking onset were omitted.

In an attempt to encourage participation and prevent respondents from discontinuing midway through the interview, the survey was developed to last no more than eight minutes, taking into consideration all possible skip patterns. Additionally, the survey was ordered such that all health‐related questions were posed at the beginning of the interview to ensure that the most important data would be acquired even in cases of discontinuation.

Data Collection and Sampling Plan

A telephone survey was conducted to maximize generalizability, increase response rates, and restrict possible errors in the data.1 Sample size was determined based on the population of each individual county, proportional to gender and age group. Random digit, as well as age and gender‐targeted, samples of household phone numbers were purchased from ASDE Survey Sampler Inc. for each of the nine counties. Post survey stratification was planned to address gaps in meeting the sampling plan.

The complete survey was administered by Ohio University’s Scripps Survey Research Center using a Computer‐Assisted Telephone Interviewing (CATI) software program. Telephone calls were placed by trained students at the center across 34 days, Monday through Thursday between the hours

1 Only households with landlines were included in this survey, and no adjustments were made post‐sampling to correct for respondents in wireless‐only homes.



of 5:00 and 9:00 p.m. and Sundays between 1:00 and 9:00 p.m., during November 2008 through the beginning of February 2009.

At the time of the placed call, respondents were asked to participate in a survey that ARHI was conducting to assess the presence of health‐related problems in the area. Individuals were told that all of the information that they provided would be confidential, and that the survey would only take about eight minutes to complete. Participants were also informed that they needed to be 18 years or older to take part in the survey. If there was no answer at the time of a call, numbers were re‐dialed up to six times in order to increase the likelihood of reaching every available participant.

Prior to the start of the survey, it was decided that the youngest person over the age of 18 would be asked to respond to the survey. This “youngest eligible person” approach was used as opposed to the “first birthday” approach sometimes implemented in survey research because lower response rates were anticipated within the younger age brackets. The “first birthday” method requires the person with the most recent birthday, over the age of 18, to respond to the survey. Historically, it has been argued that applying this latter method will help reduce sampling biases. However, the need to include younger respondents necessitated the “youngest eligible person” method.

Post‐Sampling Procedures

Weighting the Data

Survey sampling attempts to draw respondents from every social stratum so that, within the sample, all existing respondent profiles are represented. Achieving this goal is difficult in practice; even the best survey samples end up either oversampling or undersampling (by accident or by design) some respondent profiles. Non‐response may also generate a discrepancy between population proportions for certain types of respondents and the proportions actually sampled. Potential disparities between what is sampled and what exists in the population are a direct reflection of four underlying factors associated with telephone‐interview surveys.

The first factor relates to household non‐response, which includes households that could not be contacted – due to the answering machine picking up, no answer, or a busy signal – and those that opted not to participate. Although non‐response is a typical problem associated with all telephone surveys, it can potentially lead to a misrepresentation of the population. For instance, research has indicated that younger adults and those who work evening shifts or hold multiple jobs are less likely to be sampled due to the time of day that the calls were made. Overall, within this study, there was a 10% response rate,2 a 20% cooperation rate, and a 37% refusal rate.3

2 The use of stratified sampling methods suppressed response rates by limiting the number of eligible survey participants. 3 Cooperation and refusal rates were calculated using the methods outlined by AAPOR. The American Association for Public Opinion Research. 2008. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. 5th edition. Lenexa, Kansas: AAPOR.



A second factor that can influence the representativeness of the sample is the selection probability of individuals within a household. Aspects that can affect selection probability include a participant’s gender, age, and size of the household. Women are more likely to answer the phone, assuming that both a man and woman are home to take the call. Age also has an effect – younger adults tend to have busier schedules and are, therefore, less likely to answer the phone. Finally, the relative number of eligible respondents within a household can impact selection probability. For example, individuals who live alone have a higher likelihood of being sampled than those that live with multiple people over the age of 18.

The final two factors capable of influencing the accuracy of a sample relate to the presence or absence of a landline telephone in the home. The first factor is the inability to contact households without landline telephones. The number of wireless telephones has been rapidly expanding, and with this expansion comes a decrease in landline telephones within the home.4 As of 2008, 1 out of every 6 American homes had only wireless telephones, making these households ineligible to participate in a landline telephone survey. Further influencing the representativeness of telephone surveys is the geographic and ethnic differences in homes with landline telephones. Finally, the number of landlines in a home influences the likelihood of a home being sampled; homes with multiple landlines have a higher probability of being sampled in comparison with homes that have a single landline.

In sum, various uncontrollable factors invariably force survey analysts to adjust the weights as needed to deliver sample respondent profiles that mimic those known to exist in the true population. For the ARHI III, post‐stratified weights were computed on the basis of the within‐stratum population counts drawn from the 2000 U.S. Census of Population and Housing. Post‐stratification weighting is commonly used with telephone survey data to bring the sampled data in agreement with population figures. For the ARHI III survey, this adjustment was specifically useful because health conditions vary as a function of demographic characteristics such as age and gender.

When reviewing findings contained in this report, it is critical to note that despite over‐sampling in each of the nine counties, there were still relatively large standard errors for some items. In particular, this occurred with questions that were asked of a subset of the entire survey sample, such as persons who have diabetes. In these cases, the percentages may not accurately capture the population overall, especially when only considering data for a given county.

Computing the Weights

A stratified sample was attempted. This sampling methodology requires that the population of interest first be divided into meaningful categories (e.g., county, gender and age) from which a random sample is obtained. The number of respondents needed from each category is a percentage of the whole sample (the target ARHI III sample was 4,000) that reflects the proportion that same category makes up out of the true population. If, for example, 10% of the true population in a county is

4 http://www.cdc.gov/nchs/data/nhsr/nhsr014.pdf



comprised of females between 25 and 34 years of age, then 10% of the county level sample should match these characteristics.

However, target quotas from certain categories were not obtained; therefore, the current ARHI data were post‐stratified to more accurately reflect the population of interest. Post‐stratification compares the number of respondents obtained from each category to the population demographic breakdown, obtained from the U.S. Census in this instance, to ascertain how accurately the sample reflects the true population. Thus, if a given subgroup of the population is underrepresented within the sample (i.e., males between 18 and 24), then a greater weight is given to those responses. Whereas, if a subgroup is well represented in the survey data, such as Caucasians over 65, a lower weight is applied to these responses.

The computed weights were based on aggregated composites of gender and age, as reported for each of the nine counties (Belmont, Columbiana, Gallia, Harrison, Jefferson, Lawrence, Monroe, Muskingum, and Noble) in the 2000 U.S. Census. Ethnicity was not included as a category given that the ARHI III counties are predominantly Caucasian (over 95%). For the purposes of weighting, age was broken down into the six categories used in the BRFSS (18‐24, 25‐34, 35‐44, 45‐54, 55‐64, and 65+) to increase the likelihood that each subgroup would be adequately represented within the sample. In total, weights were computed for 12 subgroups for each of the nine ARHI III counties. Weights were calculated for each demographic group by dividing the U.S. Census 2000 population for each group by the number of actual respondents in that category that were surveyed. A comparison of the weighted versus unweighted demographic data from the survey is provided in Appendix C.

arhi · mha, senior project manager ... appendix a5.1. physical exercise: ... management class...

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