Healthiest Wisconsin 2020 Baseline and Health Disparities Report People with Disabilities This chapter highlights health risk factors and health outcomes.

Healthiest Wisconsin 2020 Baseline and Health Disparities Report People with Disabilities
This chapter highlights health risk factors and health outcomes for adults with a disability and children with special health care needs. Definitions are provided as each population is introduced. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Chapter Outline Chapter outline Background
Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report Context Key points Data Demographic and socioeconomic data Access to and use of health care services Risk behaviors and health outcomes References Links to additional reports and resources Contacts Healthiest Wisconsin 2020 Baseline and Health Disparities Report

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

Report Format Full Report Chapters Format: PDF
Report overview Report Format Sample annotated slide Full Report Format: PDF Intended use: reference document Chapters Format: Annotated PowerPoint slide set Intended uses: presentations to Decision-makers Service providers Community leaders The public The report is available in two formats. The first, intended to serve as a reference document, is a PDF of annotated slides, as shown in this slide. The second is a series of slide sets, each of which is a chapter in the report. The purpose for providing slide sets is to foster sharing of the data in presentations to decision-makers, service providers, community leaders, and the public. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Report Outline Executive Summary Section 1: Introduction
Report overview Report Outline Executive Summary Section 1: Introduction Section 2: Demographic overview Section 3: Health focus areas Section 4: Infrastructure focus areas Section 5: Data summaries by population Section 6: Technical notes Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Report Outline: Detail
Report overview Report Outline: Detail Section 3: Health focus areas Alcohol and other drug use Chronic disease prevention and management Communicable diseases Environmental and occupational health Healthy growth and development Injury and violence Mental health Nutrition and healthy foods Oral health Physical activity Reproductive and sexual health Tobacco use and exposure Section 4: Infrastructure focus areas Access to health services Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Report Outline: Detail
Report overview Report Outline: Detail Section 5: Data summaries by population Racial/ethnic minority populations American Indians Asians Blacks Hispanics People of lower socioeconomic status People with disabilities Lesbian, gay, bisexual, and transgender populations Geography Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Data notes Report overview
Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution. Population estimates that are considered unreliable are excluded. Misclassification of racial/ethnic groups may affect the accuracy of rates. Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non-Hispanic. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Factors that influence health
Report overview Factors that influence health Social determinants of health drive at least 50% of morbidity and mortality rates.1 Social determinants of health include socioeconomic status (SES), usually measured by income, employment, education, or housing. Groups with lower SES typically have significantly shorter life expectancy, higher rates of infant mortality, higher rates of chronic disease, and significantly lower self-rated health status.2 Health inequities are costly. The Joint Center for Political and Economic Studies estimates that the combined costs of health inequalities and premature death in the United States during were $1.24 trillion.3 Further, addressing social determinants of health is an essential component of several key principles of the Public Health Code of Ethics which frame the ethical practice of public health.4 Healthiest Wisconsin 2020, the State Health Plan, lists two crosscutting focus areas: 1) Health Disparities, and 2) Social, Economic and Educational Factors that Influence Health.5 These broad focus areas have the potential to affect both the health focus area and public health infrastructure components of the plan and help set priorities in order to achieve large, equitable changes in health outcomes while saving health care dollars in Wisconsin. Social determinants of health Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

People with disabilities: context
Summary People with disabilities: context Healthiest Wisconsin 2020 focuses on the elimination of health disparities. For the first time, people with disabilities are included in the plan as a population that experiences significant disparities in health and health care access. People with disabilities can be healthy and well; however, many face social, structural and environmental barriers that restrict participation in daily activities and/or access to care. Gaining a better understanding of these barriers can assist public health, health care providers, and the public in reducing health disparities for people with disabilities. Nationally, an estimated one in six adult Americans lives with a disability, defined as a limitation in function. Many are at higher risk for multiple chronic conditions, injuries, and increased vulnerability during disasters. Compared to people without disabilities, people with disabilities are four times more likely to report their health to be fair or poor and 2.5 times more likely to have unmet health care needs compared to people without disabilities. Public health can help change this by promoting wellness and preventing disease in people with disabilities. 6 Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Key Points: Adults with disabilities
One in six (16%) adults ages and 28% of adults ages 65 and older in Wisconsin are living with a disability. Compared to people without a disability, adults with a disability are more likely to: Be low-income. Have less access to health care. Report higher health risk factors such as tobacco use, secondhand smoke exposure, obesity, and obesity-related chronic conditions. The presence of a chronic condition, such as diabetes or asthma, may be the reason some people report having a disability. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Key Points: Children and youth with special health care needs (CYSHCN)
About 22% of Wisconsin children have a special health care need. Compared to children and youth without a special health care need, CYSHCN: Have more unmet medical/dental needs and more difficulty getting specialty care, despite being more likely to have a medical home and to receive preventive care. Have two or more adverse childhood experiences (ACEs). Have lower school attendance and engagement. Parents of CYSHCN are: More likely than other parents to be stressed and to have their work life affected by childcare issues. The National Survey of Children’s Health (NSCH) is a telephone survey conducted by the National Center for Health Statistics under the direction and sponsorship of the federal Maternal and Child Health Bureau. Randomly sampled telephone numbers are called to find households with children ages 0-17; one child is randomly selected to be the subject of the interview, and an adult who knows the most about the child’s health and health care is interviewed.7 Source: National Survey of Children’s Health, 2011/2012. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Adults living with a disability
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Demographic characteristics

Percent of adults with disabilities by age group, Wisconsin, 2009-2011
Demographic and socioeconomic data Percent of adults with disabilities by age group, Wisconsin, Definitions of disability, and therefore estimates of prevalence of disability in Wisconsin, differ somewhat between the American Community Survey (ACS) and the Behavioral Risk Factor Survey (BRFS). The ACS defines disability as deafness or serious difficulty hearing; blindness or serious difficulty seeing – even when wearing glasses; serious difficulty concentrating, remembering or making decisions; serious difficulty walking or climbing stairs; difficulty dressing or bathing; difficulty doing errands alone such as visiting a doctor’s office or shopping. The BRFS defined disability as being limited in any way in any activities because of physical, mental or emotional problems. The current American Community Survey definition will be used in the BRFS in future years. According to the ACS, 12% of all Wisconsin adults, 9% of those 18-64, and 32% of those 65 and older have a disability. BRFS estimates are also shown in the figure because the BRFS provides related estimates of health risk behaviors and outcomes that are not available from the ACS, so it is useful to understand that, according to the BRFS, 26% of adults have a disability. Sources: American Community Survey, ; Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-cellphone combined dataset. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Demographic and socioeconomic data
Percent of Wisconsin adults ages with disabilities, by race/ethnicity, In , Black adults in Wisconsin had a higher rate of disabilities compared to White and Hispanic adults. No estimate for Asians could be presented due to the small sample size. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Demographic and socioeconomic data
Percent of Wisconsin adults ages with disabilities, by income level, In this report, household income is divided into three levels: low income of less than $25,000 per year, middle income of between $25,000 and $74,999 per year, and high income of more than $75,000 per year. Adults with low household income were more than twice as likely to have a disability as were adults with middle household income, and more than three times as likely as were those with high household income. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Access to health care and health status

Access to health care Use of and barriers to health care among Wisconsin adults ages 18-64, by disability status, Compared to Wisconsin adults ages without a disability, those with a disability are less likely to go without a doctor visit in the past year, and less likely to be without a personal doctor. One in four (24%) people with a disability was unable to obtain medical care due to cost, compared to one in ten people without a disability. In , Wisconsin adults with and without a disability were equally likely to be uninsured (about 15% in each group - data not shown). Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); land-line only dataset. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Health status Rates of fair or poor health by disability status, Wisconsin adults ages 18-64, BRFS respondents were asked to describe their health as one of the following: excellent, very good, good, fair, or poor. According to BRFS estimates, Wisconsin adults ages with a disability are about six times as likely to report fair or poor health as those without a disability. Note: The BRFS does not collect information on the cause of disability, and the presence of a chronic disease may be the reason some individuals report themselves as having a disability. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); land-line only dataset Note: Health status questions only asked Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Health risk factors and outcomes

Physical activity Rate of physical inactivity among Wisconsin adults, by disability status, Over one-third (36%) of all Wisconsin adults ages with a disability report that they have not participated in any physical activity in the past month other than at their job, compared to about one in five (19%) people without a disability. People with disabilities can find it more difficult to be physically active. This might be due to: • Physical limitations that can reduce a person’s ability to exercise. • Pain. • A lack of energy. • A lack of accessible environments (for example, sidewalks, parks, and exercise equipment) that can enable exercise. • A lack of resources (for example, money; transportation; and social support from family, friends, neighbors, and community members). Sufficient evidence now exists to recommend that adults with disabilities should get regular physical activity.8 Note: The BRFS does not collect information on the cause of disability, and the presence of a chronic disease may be the reason some individuals report themselves as having a disability. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); land-line only dataset. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Nutrition Rates of overweight and obesity by disability status, Wisconsin adults ages 18-64, Wisconsin adults ages 8-64 with a disability were significantly more likely to be overweight or obese than those without a disability (74% compared to 61%). People with disabilities can find it more difficult to always eat healthy, control their weight, and be physically active.9 This might be due to: • A lack of healthy food choices. • Difficulty with chewing or swallowing food, or with the taste or texture of foods. • Medications that can contribute to weight gain, weight loss, and changes in appetite. • Physical limitations that can reduce a person’s ability to exercise. • Pain. • A lack of energy. • A lack of accessible environments (for example, sidewalks, parks, and exercise equipment) that can enable exercise. • A lack of resources (for example, money; transportation; and social support from family, friends, neighbors, and community members). Note: The BRFS does not collect information on the cause of disability, and the presence of a chronic condition may be the reason some individuals report themselves as having a disability. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); land-line only dataset. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Chronic diseases Rates of diabetes by disability status, Wisconsin adults ages 18-64, Wisconsin adults ages with a disability are more likely to have both diabetes and prediabetes than are those without a disability. Note: The BRFS does not collect information on the cause of disability, and the presence of a chronic disease may be the reason some individuals report themselves as having a disability. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); land-line only dataset. Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes. Prediabetes question was only asked in years Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Chronic diseases Rates of high cholesterol and blood pressure by disability status, Wisconsin adults ages 18-64, 2009 and 2011 Nearly half of Wisconsin adults ages with a disability have ever been told they had high cholesterol compared to 29% of those without a disability. Adults with a disability are also about twice as likely to have been diagnosed with high blood pressure. Note: The BRFS does not collect information on the cause of disability, and the presence of a chronic disease may be the reason some individuals report themselves as having a disability. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); land-line only dataset. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Alcohol and other drug use
Rates of binge drinking and heavy drinking by disability status, Wisconsin adults ages 18-64, Binge drinking is defined as five or more drinks for men and four or more drinks for women on a single occasion, one or more times in the past 30 days. Heavy drinking is defined as more than two drinks per day for men and more than one drink per day for women. Among Wisconsin adults ages 18-64, those with a disability are less likely to engage in binge drinking than those without a disability. People with and without a disability are equally likely to engage in heavy drinking. Immediate consequences of excessive alcohol use can include unintentional injury, violence, risky sexual behavior, and alcohol poisoning.10 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); land-line only dataset. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Mental health Rate of Adverse Childhood Experiences (ACEs) by disability status, Wisconsin adults ages 18-64, The BRFS asked Wisconsin adults about the following adverse childhood experiences (ACEs): (1) Recurrent physical abuse; (2) emotional abuse; (3) sexual abuse; (4) an alcohol and/or drug abuser in the household; (5) an incarcerated household member; (6) a household member who was chronically depressed, mentally ill, institutionalized, or suicidal; (7) violence between adults in the home; (8) parental separation or divorce. Among Wisconsin adults ages 18-64, those with a disability were twice as likely to have experienced four or more adverse childhood experiences as were those without a disability. Early childhood experiences can affect long-term health and well-being. Negative childhood experiences are a major risk factor for the leading causes of illness and death as well as poor quality of life among adults.11 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); land-line only dataset. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Mental health Rates of insufficient sleep and emotional support by disability status, Wisconsin adults ages 18-64, Among Wisconsin adults ages 18-64, those with a disability were more likely have insufficient sleep than were people without disabilities. They were also twice as likely to receive insufficient emotional support. Both insufficient sleep and lack of emotional support play important roles in health and well-being. Insufficient sleep, defined as 14 or more days of poor sleep over the past 30 days, is associated with an increased risk of motor vehicle crashes, occupational injury, and chronic disease.12 Lack of emotional support can have health-, job-, family-, and economic-related consequences.13 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); land-line only dataset. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Oral health Rates of tooth removal and dental visits in the past year, by disability status, Wisconsin adults ages 18-64, The BRFS asks respondents whether they have visited a dentist, dental hygienist, or dental clinic in the past year, and how many permanent teeth have been removed due to tooth decay or gum disease. About half of Wisconsin adults ages with disabilities had had permanent teeth removed, compared to 29% of adults without a disability. Adults with disabilities were also more likely to not to have visited a dentist in the past year (35% compared to 26%). Routine dental visits are recommended at least once a year for preventive care. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Tooth removal question asked in 2008, 2010, and Dentist visit question asked in 2008 and 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Tobacco use and exposure
Smoking status among Wisconsin adults ages 18-64, by disability status, More than one in three (35%) Wisconsin adults ages with a disability is a current smoker, compared to one in five (21%) adults ages without a disability. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); land-line only dataset. Note: Menthol question was asked in 2009 and 2010; smokeless tobacco question was asked in Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Secondhand smoke exposure among Wisconsin adults ages 18-64, by disability status, Wisconsin adults with a disability are more likely to live in homes where smoking is allowed and more likely to report they are exposed to other’s secondhand smoke at home, compared to adults in this age group without a disability. People with disabilities report similar secondhand smoke exposure levels at work as those without disabilities. Secondhand smoke exposure is associated with an increased risk of cardiovascular disease and lung cancer.14 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); land-line only dataset. Note: Smoking at work question was only asked in 2009 and 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Reproductive and sexual health
HIV testing and risk behaviors among Wisconsin adults ages 18-64, by disability status, Among Wisconsin adults ages 18-64, those with a disability are significantly more likely to have been tested for HIV (42%) than are those without a disability (31%). Five percent of adults with disabilities have been in an HIV high-risk situation, compared to 3% of adults without a disability, a difference that is statistically significant. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); land-line only dataset. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Immunization among older adults
Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by disability status, Older adults with a disability are significantly more likely to have ever received pneumonia vaccination than are older adults without a disability. This may be an indication of greater use of health care services among people with a disability. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Children and Youth with Special Health Care Needs (CYSHCN)
The federal Maternal and Child Health Bureau defines children and youth with special health care needs (CYSHCN) as “those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.”15 The National Survey of Children’s Health (NSCH) is a telephone survey conducted by the National Center for Health Statistics under the direction and sponsorship of the federal Maternal and Child Health Bureau. Randomly sampled telephone numbers are called to find households with children ages 0-17; one child is randomly selected to be the subject of the interview, and the adult who knows the most about the child’s health and health care is interviewed.16 Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Demographics Percentage of children with special health care needs, Wisconsin and the United States, The National Survey of Children’s Health uses the CSHCN Screener©17 to identify children with special health care needs. The Screener is a five-item, parent-reported tool designed to reflect the federal Maternal and Child Health Bureau’s consequences-based definition of children with special health care needs. It identifies children across the range and diversity of childhood chronic conditions and special needs, allowing a more comprehensive and robust assessment of children's needs and health care system performance than is attainable by focusing on a single diagnosis or type of special need. This instrument has been used in several national surveys. The difference between the estimated percentage of children with special needs in Wisconsin (22%) and the United States (20%) is not significant. Source: National Survey of Children’s Health, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Demographics Percentage of children with special health care needs, by age, Wisconsin, The percentage of children with special health care needs increases dramatically when children reach school age. The higher prevalence among older children is likely attributable to conditions that are not diagnosed or that do not develop until later in childhood. As children begin school, emerging issues become more apparent as a child interacts with peers and begins formal education. In Wisconsin, 22% of children under age 18 have special health care needs, including 24% of boys and 19% of girls. Differences by racial/ethnic group and by household income are not significant (data not shown). Source: National Survey of Children’s Health, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Oral health Percentage of children with oral health needs, by disability status, Wisconsin, The NSCH defines oral health problems as having had a toothache, decayed teeth, or unfilled cavities in the past 12 months. Differences in the estimated percentages between children with and without special heath care needs in fair or poor teeth and one or more oral health problems are not significant. Source: National Survey of Children’s Health, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Nutrition Percentage of children ages 10-17, who are obese, by disability status, Wisconsin, Because children are growing, their weight constantly increases. As a result, overweight and obesity in children are defined relative to the population of children of the same age and sex, rather than against an absolute standard. “Children ages who are obese” is defined as being in the 95th weight percentile or above. More Wisconsin children with special health care needs are obese than are children without special health care needs, but the difference is not statistically significant. Obesity can be both a cause and a consequence of special health care needs. Overweight and obesity can lead to health problems, but functional limitations, diet changes, and medications related to health problems can also lead to overweight and obesity. Children with more complex service needs are the most likely to be overweight or obese.18 Source: National Survey of Children’s Health, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Missed school Percentage of children ages 6-17 who missed school because of illness or injury, by disability status, Wisconsin, School attendance and involvement in school activities are important predictors of long-term child and adolescent health outcomes. In , children with special health care needs were significantly more likely to miss 11 or more days of school in the past month due to injury or illness than were children without special health care needs. The National Survey of Children’s Health also asked parents two questions to assess their child’s engagement in school: whether the child cares about doing well in school and whether the child does all required homework. Only 37% of children with special health care needs were “usually or always” engaged in school, compared to 51% of children with no special health care needs; this difference is statistically significant (data not shown). Source: National Survey of Children’s Health, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Mental health Percentage of children with parents who report usually or always feeling stressed from parenting and parents who have had to cut back hours or quit a job because of child care issues Based on the National Survey of Children’s Health results for , parents of children with special health care needs are four times more likely to report being usually or always stressed from parenting than are parents of children with no special health care needs. Children are counted in the “parents stressed group” if their parents responded "Usually" or "Always" to one or more of three questions about how they felt during the past 30 days: child was much harder to care for than other children; often bothered a lot by their child's behavior; and/or angry with child. Parents of children with special health care needs are more than three times more likely to report having to quit a job or reduce their work hours because of child care issues than are parents of children with no special health care needs. Source: National Survey of Children’s Health, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Access to health care Percentage of children ages 6-17 covered by public health insurance and whose health insurance (public and/or private) was inadequate, by disability status, Wisconsin, Wisconsin children with special health care needs are more likely to be covered by public insurance (an estimated 43% vs. 32%). The presence of certain special health care needs automatically make a child eligible for public insurance, which may explain the higher percentage. More than half (56%) of children with special health care needs are covered through private insurance. Nearly one-third of parents/guardians of children with special health care needs felt that their child’s insurance was inadequate. The difference between children with and without special needs was not significant. Adequate insurance is defined by these criteria: child currently has health insurance coverage AND benefits usually or always meet child's needs AND usually or always allow child to see needed providers AND either no out-of-pocket expenses or out-of-pocket expenses are usually or always reasonable. All of these criteria must be met in order for the insurance to be considered adequate. Source: National Survey of Children’s Health, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Access to health care Percentage of children who saw health care providers for preventive medical and dental care during the past 12 months, Wisconsin, Children with special health care needs are more likely to have had preventive medical and dental care in the past year than are children with no special health care needs. However, children with special health care needs are significantly more likely to have unmet needs for medical, dental, vision, mental health, or other care (14% for CSHCN versus 4% for children without SHCN, data not shown). Source: National Survey of Children’s Health, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Access to health care Percentage of children who have a medical home and percentage of children who have problems getting specialist care, by disability status, Wisconsin, The American Academy of Pediatrics specifies seven qualities essential to care in a “medical home”: accessible, family-centered, continuous, comprehensive, coordinated, compassionate and culturally effective. Ideally, medical home care is delivered within the context of a trusting and collaborative relationship between the child’s family and a competent health professional who is familiar with the child and family and the child’s health history. For the NSCH, presence of a medical home is measured by a composite based on five variables: personal doctor or nurse, usual source for sick and well care, family-centered care, problems getting needed referrals, effective care coordination when needed. To be counted as having a medical home, children must meet the criteria for adequate care on the first three components: personal doctor or nurse, usual source for care, and family-centered care. Any children who needed referrals or care coordination must also meet criteria for those components in order to be counted as having a medical home. Further information about the medical home concept and its measurement is available on the Data Resource Center Medical Home portal: And the National Center for Medical Home Implementation: Differences in the percentage of children with and without special health care needs who have a medical home are not significant. Children with special health care needs are more likely to have problems getting specialist care. Source: National Survey of Children’s Health, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Percentage of children who live with someone who uses tobacco and are exposed to secondhand smoke at home, by disability status, Wisconsin, An estimated one in four children with special health care needs in Wisconsin lives with someone who uses tobacco, a percentage that is not significantly higher than the percentage for children without special health care needs. Exposure to environmental smoke – from cigarettes, cigars or pipes – can be a serious health hazard for children. According to the Centers for Disease Control and Prevention, exposure to secondhand smoke is associated with higher rates of sudden infant death syndrome (SIDS), more frequent and severe asthma, and acute respiratory infections in young children. Environmental tobacco smoke exposure may be a particular risk for children with special health care needs given their chronic health conditions.18 Source: National Survey of Children’s Health, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Mental health Percentage of children who had two or more adverse childhood experiences (ACEs), by disability status, Wisconsin, In the NSCH, parents were asked about their child’s adverse experiences. The original Adverse Childhood Experiences (ACE) Study found significant associations between childhood abuse, neglect and exposure to violence with adult health problems.19 A modified version of the list of nine adverse childhood experiences was developed for this survey, which found that children with special health care needs are significantly more likely to experience two or more ACEs compared to children with no special health care needs. For each ACE, based on parent report: CSHCN Non-CSHCN Socioeconomic hardship 33% 23% Divorce/separation of parent 30% 17% Death of parent 4% 2% Parent served time in jail 12% 5% Witness to domestic violence 10% 6% Victim of neighborhood violence 13% 6% Lived with someone who was mentally ill or suicidal 18% 7% Lived with someone with alcohol/drug problem 16% 9% Treated or judged unfairly due to race/ethnicity 4% 2% Source: National Survey of Children’s Health, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

References References
University of Wisconsin Population Health Institute. County Health Rankings, Center for Urban Population Health. Milwaukee Health Report, LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057– Wisconsin Department of Health Services (DHS). Healthiest Wisconsin Where in health is disability? Public health practices to include people with disabilities, 2012: National Survey of Children’s Health, Sampling and Survey Administration, Child and Adolescent Health Measurement Initiative (2012): Healthiest Wisconsin 2020 Baseline and Health Disparities Report

References U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans Midcourse Report: Strategies to Increase Physical Activity Among Youth: CDC. Overweight and obesity among people with disabilities. CDC. Alcohol Use and Health. CDC. Adverse Childhood Experience Study. CDC. Insufficient sleep is a public health epidemic. CDC. Health-related quality of life: Well-being concepts. CDC. Smoking and Tobacco Use: Secondhand Smoke Facts. Health Resources and Services Administration (HRSA). 2009/10 NS-CSHCN: Health Conditions and Functional Difficulties. Data Resource Center: HRSA. Fast Facts: 2011/12 National Survey of Children’s Health. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

References Child and Adolescent Health Measurement Initiative (2002). Approaches to Identifying Children and Adults with Special Health Care Needs. HRSA. Children with Special Health Care Needs in Context: A Portrait of States and the Nation Felitti, et al., (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine - May 1998 (Vol. 14, Issue 4, Pages ). Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Links to additional reports and resources
References Links to additional reports and resources Wisconsin Department of Health Services (DHS): Disabilities and Impairments, Children and Youth with Special Health Care Needs Program, Centers for Disease Control and Prevention (CDC) Disability and Health Data System, National Survey of Children with Special Health Care Needs, Families with Special Needs, University of Wisconsin-Madison, Waisman Center Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Contacts Contacts Bureau of Community Health Promotion Division of Public Health Department of Health Services Sharon Fleischfresser, MD, MPH Medical Director Children and Youth with Special Health Care Needs Program Elizabeth Oftedahl, MPH CYSHCN Epidemiologist Maternal and Child Health Program Family Health Section Jessica Seay, MPH State Systems Development Initiative Coordinator Healthiest Wisconsin 2020 Baseline and Health Disparities Report

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Healthiest Wisconsin 2020 Baseline and Health Disparities Report People with Disabilities This chapter highlights health risk factors and health outcomes.

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