Minority Health Surveillance- REACH U.S. 2009
Substantial racial/ethnic health disparities exist in the United States. Although racial/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.
The Racial and Ethnic Approaches to Community Health across the U.S. (REACH U.S.) Risk Factor Survey is conducted annually in minority communities by CDC. The survey focuses on black, Hispanic, Asian (including Native Hawaiian and Other Pacific Islander), and American Indian (AI) populations.
An address-based sampling design was used in the 2009 survey in 28 communities located in 17 states. 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.
Obesity and Physical Activity
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.
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.
Tobacco UseThe 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).
Chronic Conditions and Clinical CareSubstantial 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, 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 men and women who knew the signs and symptoms of a heart attack were consistently lower in black (4.1%, 7.1%), Hispanic (3.2%, 4.7%), A/PI (5.8%, 4.9%), and AI (8.7%, 13.5%) communities than the national median (10.4%, 14.7%) respectively.
Similarly, the median percentage of persons who knew the signs and symptoms of stroke was consistently lower in all four minority communities compared to the national median percentage. 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 (HbA1C) test in the past year.
Screening and ImmunizationAmerican Indian women had the lowest mammography screening rate within 2 years among women aged ≥40 years (median: 72.7%; range: 69.4%–76.2%). Asian/Pacific Islander women 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%).
Using the Data to Make Community-Level ChangesData from the REACH U.S. Risk Factor Survey demonstrate that residents in most of the racial and ethnic minority communities continue to have 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.
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 tailored strategies that include system, environmental, and individual level changes can address the needs of these communities.