Surveillance of Health Status in Minority Communities --- Racial and Ethnic Approaches to Community Health Across the U.S. (REACH U.S.) Risk Factor Survey, United States, 2009

Surveillance of Health Status in Minority Communities --- Racial and Ethnic Approaches to Community Health Across the U.S. (REACH U.S.) Risk Factor Survey, United States, 2009
Surveillance Summaries
May 20, 2011 / 60(SS06);1-41




Youlian Liao, MD

David Bang, PhD

Shannon Cosgrove, MHA

Rick Dulin, BS

Zachery Harris, BS

Alexandria Stewart, BS

April Taylor, MPH

Shannon White, MPH

Graydon Yatabe, MPH

Leandris Liburd, PhD

Wayne Giles, MD

Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion

Corresponding author: Youlian Liao, MD, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, MS K-30, 4770 Buford Hwy, N.E., Atlanta, GA 30341. Telephone: 770-488-5299; Fax: 770-488-5974; E-mail: ycl1@cdc.gov.



Abstract
Problem: Substantial racial/ethnic health disparities exist in the United States. Although the populations of racial and ethnic minorities are growing at a rapid pace, large-scale community-based surveys and surveillance systems designed to monitor the health status of minority populations are limited. CDC conducts the Racial and Ethnic Approaches to Community Health across the U.S. (REACH U.S.) Risk Factor Survey annually in minority communities. The survey focuses on black, Hispanic, Asian (including Native Hawaiian and Other Pacific Islander), and American Indian (AI) populations.

Reporting Period Covered: 2009.

Description of System: An address-based sampling design was used in the survey in 28 communities located in 17 states (Arizona, California, Georgia, Hawaii, Illinois, Massachusetts, Michigan, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Virginia, West Virginia, and Washington). Self-reported data were collected through telephone, questionnaire mailing, and in-person interviews from an average of 900 residents aged ≥ 18 years in each community. Data from the community were compared with data derived from the Behavioral Risk Factor Surveillance System (BRFSS) for the metropolitan and micropolitan statistical area (MMSA), county, or state in which the community was located and also compared with national estimates.

Results: Reported education level and household income were markedly lower in black, Hispanic, and AI communities than that among the general population living in the comparison MMSA, county, or state. More residents in these minority populations did not have health-care coverage and did not see a doctor because of the cost.

Substantial variations were identified in the prevalence of health-related risk factors among minority populations and among communities within the same racial/ethnic population. In 2009, the median prevalence of obesity among Asian/Pacific Islander (A/PI) men and women was 10.3% (range: 4.8%--45.3%) and 6.7% (range: 4.5%--38.2%), respectively, whereas it was 46.2% (range: 39.4%--53.6%) and 45.5% (range: 35.1%--55.1%), respectively, among AI men and women. The median percentage of cigarette smoking among black (28.0% in men and 19.9% in women) and AI communities (36.1% in men and 36.0% in women) was much higher than the national median (19.6% in men and 16.8% in women) among the 50 states and the District of Columbia (DC). Among the four minority communities, blacks had the highest median percentage of persons who reported engaging in no leisure-time physical activity (28.5% in men and 31.6% in women). A much lower percentage of black women met physical activity recommendations in almost all communities compared with that in the corresponding MMSA, county, or state.

Substantial variations were identified in self-perceived health status and prevalence of selected chronic conditions among minority populations and among communities within the same racial/ethnic population. In 2009, the median percentage of men who reported fair or poor health was 15.8% (range: 8.3%--29.3%) among A/PI communities and 26.3% (range: 22.3%--30.8%) among AI communities. The median percentage of women who reported fair or poor health was 20.1% (range: 13.3%--37.2%) among A/PI communities, whereas it was 31.3% (range: 19.4%--44.2%) among Hispanic communities. AI and black communities had a high prevalence of self-reported hypertension, cardiovascular disease, and diabetes. For most communities, prevalence was much higher than that in the corresponding MMSA, county, or state in which the community was located. The median percentages of persons who knew the signs and symptoms of a heart attack and stroke were consistently lower in all four minority communities than the national median.

Variations were identified among racial/ethnic populations in the use of preventive services. Hispanics had the lowest percentages of persons who had their cholesterol checked, of those with high blood pressure who were taking antihypertensive medication, and of those with diabetes who had a glycosylated hemoglobin (HbAC) test in the past year. AIs had the lowest mammography screening rate within 2 years among women aged ≥40 years (median: 72.7%; range: 69.4%--76.2%). A/PIs had the lowest Pap smear screening rate within 3 years (median: 74.4%; range: 60.3%--80.8%). The median influenza vaccination rates in adults aged ≥65 years were much lower among black (57.3%) and Hispanic communities (63.3%) than the national median (70.1%) among the 50 states and DC. Pneumococcal vaccination rates also were lower in black (60.5%), Hispanic (58.5%), and A/PI (59.7%) communities than the national median (68.5%).

Interpretations: Data from the REACH U.S. Risk Factor Survey demonstrate that residents in most of the minority communities continue to have lower socioeconomic status, greater barriers to health-care access, and greater risks for and burden of disease compared with the general populations living in the same MMSA, county, or state. Substantial variations in prevalence of risk factors, chronic conditions, and use of preventive services among different minority populations and different communities within the same racial/ethnic population provide opportunities for public health intervention. These variations also indicate that different priorities are needed to eliminate health disparities for different communities.

Public Health Action: These community-level survey data are being used by CDC and community coalitions to implement, monitor, and evaluate intervention programs in each community. Continuous surveillance of health status in minority communities is necessary so that community-specific, culturally sensitive strategies that include system, environmental, and individual-level changes can be tailored to these communities.

Introduction

Substantial racial/ethnic health disparities have been identified in the United States (1). In 2006, one of every four U.S. residents identified themselves as being a racial or ethnic minority (2). The U.S. Census Bureau projects that by 2050, populations that have historically been called "minorities" will make up approximately 50% of the U.S. population (3). Achieving a healthy nation is impossible without healthy minority populations and without eliminating racial/ethnic health disparities. Eliminating health disparities was one of the goals of Healthy People 2010 (4). Individual health is closely linked to the health of the community* and environment in which persons live, work, and play (4). The health of a person is inseparable from the health of the larger community and the health of every community in every state/territory determines the overall health status of the nation. Healthy People 2010 called for community partnerships in building healthy communities (4).

CDC launched the Racial and Ethnic Approaches to Community Health (REACH) in 1999 (5). During 2000--2006, CDC funded the initial phase of the REACH project, REACH 2010, supporting 42 community coalitions in designing, implementing, and evaluating community-driven strategies to eliminate health disparities (5). The project supported the development and implementation of innovative approaches to working with racial and ethnic minority populations. REACH 2010 demonstrated that health disparities can be reduced and that the health status of populations traditionally most affected by health inequities can be improved (6). Building on the successes of the initial phase of the project, a new funding phase, REACH Across the U.S. (REACH U.S.), was launched in 2007. REACH U.S. endeavors to address the social determinants of health through policy, environmental, and system change and to disseminate effective strategies to more community partners (7). A total of 40 communities were selected competitively and funded by CDC on the basis of the cultural relevance of the proposed intervention, investigator expertise, community participatory strategies, and demonstrated success in prior training, translation, and dissemination activities. These 40 funded communities focused on one or more racial and ethnic population, including blacks, Hispanics, Asians (including Native Hawaiians and Other Pacific Islanders), and American Indians (AIs). The health focus areas include cardiovascular disease, diabetes mellitus, breast and cervical cancer, adult/older adult immunization, hepatitis B, asthma, and infant mortality.

In 2001, to monitor the health of racial/ethnic minority communities and as part of the REACH project evaluation, CDC began to conduct annual REACH 2010 Risk Factor Surveys. Baseline data for the REACH 2010 project have been published previously (8 ). This report presents data from the first survey year of the REACH U.S. project collected during May--November 2009.

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Surveillance of Health Status in Minority Communities --- Racial and Ethnic Approaches to Community Health Across the U.S. (REACH U.S.) Risk Factor Survey, United States, 2009