1. 2010 Saint - Paul, MN Metro Adult Health Survey for Ramsey County

2. I N THIS T ALK What is SHIP? What is MAHS? Results from the survey 1. General Health 2. Infrastructure & Environment 3. Health provider – patient interaction 4. Health behaviors Recommendations Next steps

3. W HAT IS THE S TATEWIDE H EALTH I MPROVEMENT P ROGRAM (SHIP)? Part of Minnesotas health care reform initiative that was signed into law in May 2008 In 2009, Saint Paul - Ramsey County Public Health received a two-year SHIP grant from the Minnesota Department of Health to create opportunities for healthier choices through policy, systems and environmental change to: Encourage healthy eating Encourage physical activity Reduce tobacco use & exposure

4. P URPOSE OF THE M ETRO A DULT H EALTH S URVEY (MAHS) 1. Identify opportunities for new and on-going initiatives to support health in Ramsey County. 2. Provide evidence to support policy recommendations and positive environmental and system changes to enable physical activity and healthy eating and to reduce tobacco use and exposure. 3. Increase public awareness of ways communities, organizations and employers can be involved in supporting healthy lifestyles of adults.

5. MAHS – D OMAINS AND T OPICS Six county* survey on : General health & chronic disease conditions Eating habits Physical activity Tobacco Use Neighborhood and Community perceptions Provider health behavior counseling *Ramsey, Dakota, Washington, Anoka, Carver, Scott

6. M ETHODOLOGY Use of addresses through random sample of households Response to survey either through mail or telephone Most recent birthday method used to select one adult respondent within each selected household 144 questions asked Total respondents: 3150 adult residents of six counties

7. S URVEY R ESPONDENTS Weighted % CategoriesRamsey CountyAll counties GenderMale47.148.6 Female52.951.4 Age categories18-2413.812.0 25-3420.418.7 35-4415.619.4 45-5418.321.5 55-6414.514.6 65-748.207.40 75+9.206.40 EducationHigh school graduate or less17.919.8 Some college 33.033.6 Bachelor's degree28.029.4 Graduate or professional degree21.217.3 Poverty status 200% below federal poverty line (FPL)30.023.2 Greater than 200% FPL70.076.8 Home locationAn urban area43.616.6 A suburb47.063.7 A town8.5012.2 A rural area0.907.40 TOTAL5383150

8. R ESULTS

9. R ESULTS DIVIDED IN TO 4 SECTIONS.. 1. Health Status 2. Infrastructure & Environment 3. Health provider - patient interaction 4. Health behaviors

10. R ESULTS DIVIDED IN TO 4 SECTIONS.. 1. Health Status 2. Infrastructure & Environment 3. Health provider - patient interaction 4. Health behaviors

11. H EALTH S TATUS – M ETRO A REA (6 C OUNTIES ) % self reported 9.5 %

12. P ERCENT REPORTING FAIR / POOR HEALTH BY COUNTY

13. P ERCENT REPORTING FAIR / POOR HEALTH BY GENDER AND AGE ( RAMSEY COUNTY ) GenderAge

14. P ERCENT REPORTING FAIR / POOR HEALTH BY EDUCATION AND HOUSEHOLD INCOME ( RAMSEY COUNTY ) aEducational attainmentPoverty status

15. C ALCULATED BMI ( OVERWEIGHT / OBESE ) BY COUNTY

16. P ERCEPTIONS OF W EIGHT FOR R AMSEY C OUNTY Average for all counties= 41.4% % self reported

17. P ERCEPTIONS OF W EIGHT FOR R AMSEY C OUNTY Average for all counties= 41.4% Ramsey county : 36% All counties: 39% % self reported

18. R ESULTS DIVIDED IN TO 4 SECTIONS.. 1. Health Status 2. Infrastructure & Environment 3. Health provider - patient interaction 4. Health behaviors

19. Infrastructure for Healthy Food choices Physical Activity Community Resources Reducing Tobacco use and exposure Smoke free air I NFRASTRUCTURE & E NVIRONMENT FOR..

20. Smoke free air Physical Activity Community Resources Reducing Tobacco use and exposure Healthy Food choices I NFRASTRUCTURE & E NVIRONMENT FOR..

21. Cost Of those that indicated availability of fruits and vegetables one- half mile from home (55%), 92% High quality 88% Large selection was available 43% Too expensive Location 50%Fast food place within 1 mile of their home 36%Had a large supermarket within 1 mile from their home 22%Had a farmers market or place to pick up CSA that was less than 1 miles from their home 62%Get food from large supermarkets at least 1 time/week A CCESS & B ARRIERS TO H EALTHY F OOD CHOICES

22. P LACES FOR PURCHASE OF FOOD

23. P LACES FOR PURCHASE OF FOOD DURING THE GROWING SEASON

24. Infrastructure for Smoke free air Healthy Food choices Physical Activity Community Resources Reducing Tobacco use and exposure I NFRASTRUCTURE & E NVIRONMENT FOR..

25. A VAILABILITY & USE OF C OMMUNITY R ESOURCES FOR EXERCISE My community has this and I do not use it My community has this and I use it

26. A WARENESS OF C OMMUNITY R ESOURCES FOR EXERCISE I dont know if my community has this

27. Infrastructure for Smoke free air Healthy Food choices Physical Activity Community Resources Reducing Tobacco use and exposure I NFRASTRUCTURE & E NVIRONMENT FOR..

28. P ERCEPTIONS OF BARRIERS TO SMOKE FREE AIR Around 48% indicated that they had been near someone, in Minnesota, who was smoking in the past 7 days, not including home, workplace or car. o Sidewalks, building entrances, & restaurants/bars were the most common places that someone was seen smoking. Among renters(16%), more than half indicated that people in their building smoke in apartments, patios & balconies 16% have been in a vehicle with someone who was smoking in the past week; 26% of those have a college degree

29. R ESULTS DIVIDED IN TO 4 SECTIONS.. 1. Health Status 2. Infrastructure & Environment 3. Health provider - patient interaction 4. Health behaviors

30. S ELF REPORT VISIT 78.2% had seen a doctor, nurse or other health professional about their health during the past 12 months

31. H EALTH BEHAVIOR COUNSELING Among the 78% who visited a health professional, 56% were asked about their weight 56% were asked about their diet or nutrition 56% were asked about smoking or tobacco use 67 % were asked about their physical activity

32. R ESULTS DIVIDED IN TO 4 SECTIONS.. 1. Health Status 2. Infrastructure & Environment 3. Health provider - patient interaction 4. Health behaviors

33. 38% ate > 5 servings of fruits and vegetables on day prior to the survey 75% ate > 3 servings of fruits and vegetables on day prior to the survey 60% eat breakfast everyday in an average week 50% did not consume milk the day prior to the survey 75% did not consume pop/soda prior to the survey 50% ate a meal with their family for > 5 days in an average week 76% ate a home cooked meal > 5 times in an average week; while 11% ate at a fast food place at least 3 times per week F OOD CONSUMPTION

34. P HYSICAL ACTIVITY

35. 87 % reported participating in any form of physical activity or exercise in the past 30 days Usual place for exercise 70% - outdoors (parks, trails) 68% - at home 27% - at a health club 10% - public recreation facility or community center 47% have over 3 hours of TV and computer time per day (while not at work or school); 55 % of these are high school graduates or less 67 % reported having sedentary jobs P HYSICAL ACTIVITY

36. Cost of fitness programs, gym memberships or admission fees (24.2%) Lack of time (19.8%) Lack of self-discipline or willpower (17.0%) Long-term illness, injury or disability (10.3%) Dont like to exercise (9.1%) Lack of athletic ability (8.1%) Public facilities are not open or available at the times I want to use them (8.3%) T OPS ISSUES CONSIDERED BIG PROBLEMS IN PREVENTING PHYSICAL ACTIVITY

37. S MOKING S TATUS 16% are current smokers 16.3% - Minnesota, BRFSS 2009

38. T OBACCO USE 27% of those below 200% FPL are current smokers 24% of18-34 yr olds are current smokers Among current smokers, half smoke a half pack or more per day

39. R ESOURCES TO QUIT SMOKING

40. 14% report having used another tobacco product (such as cigars, pipes, snuff, chewing tobacco, bidis) 31.7% of 18-24 yr olds 20.2% of males vs. 8% of females 88% indicated that smoking is NOT ALLOWED anywhere inside the house 76% indicated that smoking is NEVER allowed any vehicle O THER T OBACCO ISSUES

41. S UMMARY OF R ESULTS FOR RAMSEY COUNTY

42. Good health is not shared equally across populations in Ramsey county. Disparities in health status exist across gender, different educational attainment, income levels and age groups.

43. H EALTH B EHAVIORS About 30% have been told that they have high blood cholesterol or high blood pressure 61% are considered overweight or obese according to BMI 36% of those who considered themselves as about the right weight are obese or overweight by BMI 75% ate > 3 servings of fruits or vegetables on the day prior to the survey 74% met CDC physical activity recommendations of 150 minutes or more of mod or vigorous activity per week 16% are current smokers

44. E NVIRONMENT & SYSTEMS (F OOD CHOICES ) 43% indicated that although fresh fruits and vegetables were available in their neighborhood, they were too expensive Only 22% had a farmers market or place to pick up CSA that was less than 1 miles from their home 96% never purchased food / purchased food less than 1 time per month from a food shelf or pantry Food grown at home/community garden was the most common place for purchase of fresh fruits and vegetables in the growing season

45. More than 50% reported using walking trails or parks as places for exercising Only 27% indicated using health clubs even though they were available in the community Less than 30 % used public recreation centers, swimming pools or schools and colleges for physical activity. 25% did not know if there existed school or colleges for exercising in the neighborhood, followed by public recreation centers (15%) E NVIRONMENT & SYSTEMS ( PHYSICAL ACTIVITY )

46. Around 48% indicated that they had been near someone, in Minnesota, who was smoking in the past 7 days, not including home, workplace or car. o Sidewalks, building entrances, & restaurants/bars were the most common places that someone was seen smoking. More than half of those that rented apartments in multi-unit housing buildings indicated that people in their building smoke in apartments Around 67% indicated that they did not seek help from professional sources to help them quit smoking The most common treatment modality among those that sought help was nicotine replacement and prescription medication E NVIRONMENT & SYSTEMS ( TOBACCO USE )

47. 44% indicated that their providers did not ask about their weight, diet or nutrition smoking or tobacco use 33 % indicated that their provider asked them about their physical activity level E NVIRONMENT & SYSTEMS ( HEALTH SYSTEM )

48. R ECOMMENDATIONS (H EALTHY FOOD CHOICES ) Build infrastructure to facilitate easy access to fresh fruits and vegetables for: Farmers markets Local food production Build infrastructure to facilitate access to health food choices in small grocery stores Make fresh fruits & vegetables more available & affordable Future opportunities o Utilize the findings of the present study as a benchmark to measure progress

49. Create information hub of community resources to increase awareness of places for physical activity Provide affordable places for exercise Collaborate with health professionals, communities and organizations to encourage physical activity R ECOMMENDATIONS (P HYSICAL A CTIVITY )

50. Reduce tobacco use and exposure Implement smoke free Multi-unit housing policies Reinforce laws that provide Provide education and implement policies that reduce tobacco use across all age groups and socio-economic groups. Patient – provider counseling Implement clinical guidelines for weight management diet or nutrition counseling tobacco use R ECOMMENDATIONS ( CONTD.)

51. N EXT STEPS ? 1.Suggestions on recommendations 2.What is it that we want people to know? Fact sheet Leadership team Brief online report

52. T HANK YOU !