1999 State of Hawaii Behavioral Risk Factor Surveillance System

Introduction

The surveillance of certain health behaviors, conditions, and preventive health care practices in a population is essential because of their important roles in many diseases and injuries, their relation to morbidity and mortality, and because many of them are potentially modifiable. The Behavioral Risk Factor Surveillance System (BRFSS) provides the only state-specific, population-based estimates for many health-related behaviors, conditions and preventive health care practices among adults 18 years old and over. The Hawaii State Department of Health (DOH) through cooperative agreement with the Center for Disease Control has been Collecting the Hawaii BRFSS data since 1984. These health behaviors, conditions and issues are health status, health care access, hypertension, blood cholesterol, diabetes, oral health, skin cancer awareness, cigarette smoking, alcohol consumption, women's health, immunization, colorectal cancer screening, injury control, physical activities, weight control, and HIV/AIDS. Along with these health data, the demographic characteristics are also collected.

Prevalence estimates are based on data collected from a modified random-digit-dial telephone survey of households within the islands of Oahu, Hawaii, Kauai, Maui, Molokai and Lanai throughout the year. Modified random-digit telephone number generation means the first five digits are already known to exist and only the last two digits of the seven digit number is randomly generated and joined with the first five known digits to form a seven digit phone number excluding the area code 808. One randomly selected adult was interviewed in each of these households. The data are weighted to represent estimates for the general adult population of Hawaii. Since the estimates are based on self-reported data, they may under estimate or over estimate the actual prevalence of a particular risk factor in the population. Despite these potential limitations, these data are useful and helpful for comparing prevalence estimates over time within Hawaii and in comparison with the prevalence estimates of other states. These data also can be used for targeting health education programs and risk reduction activities.

Should you decide to use any information in this report, the suggested citation is:

State of Hawaii 1999 BRFSS Report
Planning and Evaluation
Community Health Division
Department of Health

Description of Results Presentation

Almost all of the tables that are presented in this report will contain the same demographic variables as displayed in table Demographics. The variables included in demographics are age group, gender, self-reported ethnicity, marital status, education level, employment status, household income and county. These demographic variables mentioned are not strictly demographic but can also be called socio-economic variables such as education, household income and marital status. However, for simplicity in this report the term will be demographic variables or demographic characteristics or just demographics. The same categories or groups within demographics shown in table Demographics are reflected in most of the tables included in this report.

All percentages or prevalence rates presented in all the tables are weighted percentages, meaning that they are based on the estimated population after the sample has been weighted. Thus the weighted percentages are considered estimates for the general adult population of Hawaii. For each estimate, a 95 percent confidence interval is provided. For example, an estimate of 48.6 percent with 95% confidence interval between 45.8% and 51.4% means that there is a 95 percent probability that the unknown population value lies within this confidence interval (between 45.8% to 51.4%), or alternatively, that upon repeated sampling, 95 percent of all such intervals would include the unknown population value. The weighted estimate of the denominator sample size, meaning the estimated denominator population is not shown in the tables because there is no more room to fit it in a standard page. Instead, the denominator sample size, N, is shown in every table so that the reader may have an idea of the sample size in each of the demographic categories or cells. Those who are interested in the w eighted population estimates of the numerator or denominator can contact our office. For those who are visually oriented, most of the tables have corresponding graphs or figures of results that appear to be interesting. The questions associated with the tables and graphs can be found by clicking on the question symbol right after the section heading.

The sample size of the 1999 Hawaii BRFSS is 2,156. When weighted, this sample size represents 903,961 adults. The majority of the tables may fall short of the 2,156 samples. This happens because respondents who said 'don't know' or 'refused' the non-demographic questions or were not asked the question are excluded from the analysis. Fortunately, for most of the questions there are only very few don't knows and refusals.

The distribution of the sample size by county indicates that individual county analysis will encounter small numbers problem and thus unstable prevalence rate estimates. This is particularly true for the neighboring counties. For this reason, the county is included as part of the demographics and what is presented in this report is the overall county estimate. The respondents to the survey are more likely to be females than males and married than unmarried (46.1% vs. 53.9% and 52.9% vs. 46.9%). The unmarried here include the never married, divorced or separated or in living together arrangement [See table Demographics].

As an aid in evaluating progress towards the Healthy People (HP) 2000 objectives, the HP 2000 objectives are stated in the beginning of the relevant sections and the HP 2000 target prevalence rate is compared with the prevalence rate estimate derived from the 1999 Hawaii BRFSS.

Demographics

Table Demographics shows the number and percent distribution of the sample, the estimated population (weighted sample), and weighted percent distribution and its corresponding 95% confidence interval.

The weighted percent distribution indicated a sizable population age 65 years and over, 17.0%. In turn, the estimated percentage retirees/unable to work is 20.2%. The weighted proportion of males and females is fairly close to each other (50.5% vs. 49.5%). The estimated married adult is 58.5%. Only very few of the adults did not graduate from high school 7.0%. Interestingly enough, about the same proportion of adults, (7.4%) have household income under $15,000. The prevalence of unemployment is 4.3% with 95% confidence interval of 3.0% to 5.5%.

Section 1: Health Status _{(Click to see questionnaire)}

General Health

In 1999 about half of the adult population 18 years old and over in the state of Hawaii reported that their general health is very good or excellent (52.0%). However, approximately fourteen percent (14.3%) reported that their general health is fair or poor. Variation exists within demographic categories of age, ethnicity, marital status, education, employment status, household income and resident county [See table 1a, figure 1a and figure 1b]. The fair/poor general health perception:

• is significantly different by marital status (married vs. unmarried).
• declines with increasing education and increasing income.
• is lower among employed or student/homemaker than among the unemployed or retired/unable to work group.
• is highest among Hawaiians and lowest among Japanese.
• is highest among residents of Hawaii county.
• is significantly different by age 65 years and over versus age 18-44 years.
• is not significantly different by gender.

Health during the past 30 days

The responses to the two questions, namely, the number of days physical health was not good in the past 30 days and the number of days mental health was not good in the past 30 days were combined to estimate the number or prevalence of adults:

• not feeling good either physically or mentally in the past 30 days.
• with only physical health not good.
• with only mental health not good.
• with both physical and mental health not good.

In the past 30 days, about 42 % of the adults reported that their physical or mental health was not good. Contrary to the pattern described in the general health section,

• there is significant gender difference, female health not good 46.9% vs. male health not good 38.2%.
• the employed and students/homemakers had higher prevalence of not good health days versus the unemployed and retired/unable to work.

Consistent with the general health section findings, the prevalence of not good health days is significantly higher among unmarried adults than married ones [See table 1b, figure 1c].

Of the 42 percent of adults reporting during the past 30 days that their health was not good, approximately thirty-six percent had physical health not good, twenty-nine percent had mental health not good and thirty-five percent had both physical and mental health not good. By marital status, unmarried adults have significantly higher prevalence of both physical health and mental health not good versus the married ones (38.9% vs. 31.6%) [See table 1c].

Of the 42 percent of adults reporting during the past 30 days that their health was not good, the overall mean number of days that their health was not good is 9.2 [See table 1d, figure 1d]. However, when physical health only or mental health only is considered, the mean number of not good health days is 8.0 [See table 1d].

The mean number of days that either physical health, mental health or both was not good:

• increases with increasing age group.
• is significantly higher among retirees/unable to work versus the employed, student/homemaker.
• is longer for the females than the males.
• is longer for the unmarried than the married.
• decreases with increasing education level.
• is longest at the lowest income level.
• is longest for Hawaiians.

Limited usual activity due to not good health during the past 30 days

Approximately two out of every five adults who reported during the past 30 days that their health was not good were not able to do their usual activities (38.4%). This translates to 3.9% loss in productivity on the assumption that loss in productivity is measured by inability to carry out usual activity.

Of those who reported limitation of usual activity, the overall mean number of days their activity was limited is 7.3 days. As expected, the mean number of days with limited activity is longer when the health condition is both mental and physical (8.4), and shorter when the condition is physical only, (6.3) [See table 1e].

Females have longer days of limited activities than males, particularly when both physical and mental health conditions are present, 6.2 limitation days for males and 10.3 limitation days for females. The same general pattern exists by marital status with the unmarried having longer mean limited days than the married. [See table 1e].

Note that different estimates of average not good health days and limitation days are obtained when the median is used as a measure of average compared to the mean. The mean takes into account the whole range of responses from 1 to 30 days. The median applies only where half of the population is in the 1 to 30 days range. Using the median as a measure of average, the median number of days health is not good is 5.2, and the median number of days that the usual activities are limited is 3.9. These estimates are considerably shorter than the corresponding 9.2 and 7.3 mean days respectively.

Section 2: Health Care Access _{(Click to see questionnaire)}

HP 2000 Objective: To increase to at least 95% the proportion of people who have a specific source of ongoing primary care for coordination of their preventive and episodic health care and improve financing and delivery of clinical preventive services so that virtually no American has a financial barrier to receiving, at a minimum, the screening, counseling, and immunization services recommended by the U.S. Preventive Services Task Force.

Assuming that the presence of health insurance measures the above HP2000 target, the State of Hawaii adult population just about reached the target objective.

Health Insurance Coverage

The BRFSS 1999 results indicated about 95 of every 100 adults have some form of health insurance coverage ^[1]. The 5.1% of the adults who reported no health insurance coverage translate to approximately 46,000 uninsured adults in 1999.

The proportion of respondents with health insurance coverage increased consistently with increasing age. By age 65 years and older, the age at which almost everyone retires, almost all have health insurance coverage (99.7%). The same result is obtained by looking at the health insurance status of those who are retired/unable to work, 99.3% have health insurance coverage. The proportion of health insurance coverage also increases with increasing household income. The lowest health insurance coverage is among those with incomes under $15,000 and highest among those with incomes $50,000 and above. Looking at other demographic characteristics, the married adults are more likely to have health insurance than the unmarried, so are the employed than the unemployed, so are the non-Hawaiians than Hawaiians [See table 2a, figure2a].

Type of Health Insurance Coverage

Among respondents with health insurance coverage, the distribution of sources ^[2] of health insurance coverage was: 61.9% employment-related, 20.6% Medicare, 5.7% self-purchased, 3.9% Medicaid, 5.4% military services and 2.5% other sources. The elderly age 65 year and over and the retired are mainly covered by Medicare. Those who are at the prime working age 25 to 64 years old and those who are employed are mainly covered by their employer. The proportion of employer health insurance coverage increases with increasing education and increasing income. In contrast, the proportion of Medicare/Medicaid health insurance coverage increases with decreasing education and decreasing income [See table 2b, figure2b].

Cost

About 6.4% of all respondents reported that there was a time during the last 12 months when they needed to see a doctor but could not because of the cost. This represented about 57,835 of the general adult population. This cost barrier decreased with increasing age, education and increasing household income. This cost barrier was reported more often by females, unmarried and Hawaiians than males, married and other ethnic groups [See table 2c, figure2c].

Routine Checkup

Close to three out of every four adults (75.3%) had a routine checkup in the past year Females and those aged over 65 years and retirees were more likely to have routine checkups in the past year than were males, younger people and non-retirees, respectively [See table 2c, figure2d].

Section 3: Hypertension Awareness _{(Click to see questionnaire)}

HP 2000 Objective: To increase to at least 90% the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high.

More than 96 percent of the adult population had their blood pressure checked within the past two years exceeding the minimum HP2000 objective of 90%. In addition, close to 23 percent had been told by health professionals that their blood pressure was high, representing about 204,123 adults. Of those whose blood pressure was high, about three out of every four adults have been told that their blood pressure was high more than once [See table 3, figure3a]. From these last two statements, it is approximated that about 17 percent of the adult population have high blood pressure. This estimate is an indicator of the potential burden of hypertension in the adult population, although it does not measure the proportion of those diagnosed with hypertension.

Age was related to the presence of high blood pressure. The prevalence rate of ever being told blood pressure was high increases with increasing age. Looking at the ethnic background, the Japanese have the highest prevalence rate (30.8%) of ever being told of having high blood pressure than any other ethnic groups [See table 3].

The females are more likely to have had their blood pressure checked within the past two years than the males [See table 3].

Section 4: Cholesterol Awareness _{(Click to see questionnaire)}

HP 2000 Objective: To increase to at least 75% the proportion of adults who have had their blood cholesterol checked within the preceding 5 years.

The proportion of adults who have had their cholesterol checked in the last five years did not meet the goal of 75 percent set out in the HP 2000 objectives. Seven of every ten adults have ever had their cholesterol checked, and 67.3 percent have had their cholesterol checked within the past five years. Among those tested, 27.6 percent reported having ever been told by a health professional that their cholesterol was high.

Age was related to all three cholesterol indicators, with younger adults being less likely to have ever had their cholesterol checked and to have had it checked within five years, compared with older adults. Similarly, the proportion of adults who had ever been told by a health professional that their cholesterol was high increased with age.

Looking at gender differences, a slightly higher proportion of females than males reported having ever had their cholesterol level checked, and having had it checked within five years. However, a higher proportion of males than females were told that their cholesterol level was high.

The married are more likely than the unmarried to have ever had their cholesterol level checked, have it checked within five years and to be told that their cholesterol level was high.

Compared to any other ethnic group, the Japanese are more likely to have ever had their cholesterol level checked and have it checked within five years. In contrast, the Hawaiians are least likely to have ever had their cholesterol level checked and have it checked within five years.

Looking at education level, adults who graduated from College or have higher education are more likely to have ever had their cholesterol level checked, and have it checked within five years, but were less likely to have ever been told by a health professional that their cholesterol level was high, compared with non-College degree adults. It is not a surprise that the proportion of adults who reported having ever had their cholesterol level checked and have it checked within five years rose with increasing levels of annual household income, since education and income are positively correlated [See table 4, figure 4a, figure 4b for numerical details].

Section 5: Diabetes Awareness _{(Click to see questionnaire)}

HP 2000 Objective: To reduce diabetes to an incidence of no more than 2.5 per 1,000 people and a prevalence of no more than 25 per 1,000 people.

Excluding gestational diabetes, fifty-two out of every thousand adults have ever been told that they have diabetes. This diabetes prevalence rate is twice the prevalence rate objective of HP 2000. This 5.2% prevalence rate represents an estimated 46,900 adults.

Variation exists within demographic characteristics. The estimated prevalence of diabetes increases with increasing age. In contrast, the diabetes prevalence rate declines with increasing education. The males have higher prevalence rate than females. The married have a slightly higher prevalence rate than the unmarried. By ethnic group, the Japanese have the highest prevalence rate, followed by the Hawaiians. By geographic location, Kauai County has the lowest prevalence rate of diabetes (2.7%) [See table 5, figure 5].

Section 6: Oral Health _{(Click to see questionnaire)}

HP 2000 Objective: To increase to at least 70% the proportion of people aged 35 and older using oral health care system during each year.

The proportion of people aged 35 and older using the oral health care system within last year is 77.3 percent and the 95% confidence interval is between 74.2% and 79.9%.

Approximately three of every four adults 18 years old and over visited the dental office or facilities within the past year (74.7%). Similar proportions had their teeth clean within the past year (74.3%). These dental visit prevalence rates increase with increasing education attainment and household income. Among the ethnic groups, the Filipinos have the lowest dental visit rate for any reason or for the purpose of teeth cleaning. As would be expected, the unemployed have the lowest dental visit rates in comparison to other employment status groups. The unmarried adults dental visit rates are lower than the married adults and significantly different [See table 6a, figure 6a].

More than half of the adults have a complete set of permanent teeth ^[3](56.2%). In contrast, about 4% of adults have all of their permanent teeth removed, 30% of adults have 1 to 5 of their permanent teeth removed and another 10% have 6 or more of their permanent teeth removed. The rate of complete permanent teeth decreases with increasing age, from 85.7% at age 18-24 years down to 26.5% by age 65 years and over. In contrast, the rate increases with increasing household income and education. Only 46% of the adult Filipinos have complete permanent teeth, the lowest rate compared with other ethnic groups. The lowest rate of complete permanent teeth is in Hawaii County (48.3%) [See table 6b, figure 6b].

Section 7: Skin Cancer Awareness(Sunburn) _{(Click to see questionnaire)}

One of every three adults had sunburn in the past twelve months (33.5%). The sunburn prevalence rate is significantly higher among males than females (38.8% vs. 28.3%). The unmarried are more likely to have had sunburn than the married. The employed and student or homemaker have also higher sunburn rate than the unemployed and retirees or unable to work [See table 7a, figure 7a].

The sunburn prevalence rate declines with increasing age. There is a significant difference in rates at age 55 years and over versus those under age 55 years. This can be expected since the younger adults are more prone to outdoor activities than the older adults. It is interesting to note that those who have higher education and higher income tend to have higher sunburn rate. The Whites have the highest rate among all ethnic groups and the Filipinos have the lowest rate [See table 7a].

Among those who ever had sunburned last year, 26.8% had sunburn, 22.5% had two sunburns, 14% had three sunburns, and 36.6% had four or more sunburns [See table 7b, figure 7b].

Section 8: Smoking _{(Click to see questionnaire)}

HP 2000 Objective: To reduce cigarette smoking to a prevalence of no more than 15 percent among people aged 20 and older. A cigarette smoker is a person who has smoked at least 100 cigarettes and currently smokes cigarettes.

The State is still almost 4 percentage points short from reaching the HP 2000 objective of no more than 15% smoking prevalence. The proportion of those 20 years old and older currently smoking is 18.8 percent.

Current Smoker

The overall prevalence of cigarette smoking in 1999 was 18.5 percent, representing about 166,621 adults. The prevalence rate of current smoking is highest at age group 18-24 years (27.4%), among the Hawaiians (26.5%), among the males (20.1%), among the unemployed (39.4%), among those who live in Hawaii county (22%) and among adults with household income under $15,000 (30.1%). The proportion of respondents who reported being current smokers decreased as income increased. The current smoking rate of the married is significantly lower than the unmarried (14.5% 24.2%) [See table 8a, figure 8a and figure 8b].

Among current (everyday and some days) smokers, approximately one in ten smoke more than one pack of cigarettes per day (9.7%) and about five in ten (54%) smoke half to one pack a day [See table 8b]. More than half of the current smoker (50.7%) reported that they had tried to quit smoking for at least one day sometime during the past twelve months [See table 8c, figure 8c].

Former Smoker and Never Smoker

The good news is there are adults who quit smoking. In this report those who quit smoking are called former smokers. More than one in five adults are former smokers (22.9%). The former smokers prevalence rate increases with increasing age. At age 18-24 years, the former smoker rate is 4.6% and rises to 34.1% at age 65 years and over. The former smoker rate is significantly higher among males than among females (26.5 vs. 19.3) and also higher among married than among unmarried (24.9% vs. 20.0%). More than a third of smokers (37.0%) said that it had been 15 or more years since they had last smoked cigarettes regularly. About 1 in 5 former smokers (18.3%) quit less than a year ago [See table 8d, figure 8d].

The very good news is more than half of the adults never smoked (58.6%). Never smokers are more likely to be females than males, married than unmarried. Of all the employment status groups, income categories and education groups, the never smokers rate is highest among students/homemakers, among those with household annual income of $50,000 or more and among those who are at least College graduates [See table 8a, figure8a].

Section 9: Alcohol Consumption _{(Click to see questionnaire)}

HP 2000 Objective: To reduce the proportion who used alcohol in the past month for people aged 18-20 years to 29%.

Chronic drinking or heavy drinking was defined as consuming 60 or more alcoholic beverages on average in the past month. Binge drinking was defined as having consumed five or more drinks on a single occasion at least once in the past month, and drinking and driving was defined as one or more occasions of driving a vehicle after having had "perhaps too much drink".

The State failed to meet the HP2000 objective stated above. Of the adults aged 18-20 years, 46.8% drank alcohol in the past month, 16.6% percent are binge drinkers, 4.6 percent drink and drive and 1.6% are chronic drinkers.

About half of the adults (48.6%) had alcoholic beverage at least once during the past month. Those who did not drink alcohol in the past month tended to be older respondents, females and married [See table 9a, figure9a].

Self-reported drinking in the past month showed that 14 percent of adults were estimated to binge drink, 5.2 percent were estimated to be chronic drinkers and 2.3 percent reported they had driven a car after having too much to drink. Those who are at risk most for these potentially harmful drinking behaviors tended to be young. The drinking rates for males are significantly higher than females [See table 9a, figure 9b, 9c, and 9d].

Among those who drank in the past month, about 56% drink once a week. About 11% or 46,700 adults drank daily in the past month. Close to 25% of these daily drinkers consumed one drink, 38% consumed two drinks, 28% consumed three to four drinks and 8% consumed five or more drinks, i.e., are binge drinkers. [See table 9b, figure 9e].

Section 11: Women's Health _{(Click to see questionnaire)}

HP2000 Objective: To increase to at least 80% the proportion of women aged 40 and older who have ever received a clinical breast examination and a mammogram, and to increase to at least 95% the proportion of women aged 18 and older with uterine cervix who have ever received a Pap Smear test, and at least 85% those who ever received a Pap Smear test within the preceding 1 to 3 years.

The proportion of women aged 40 and older who have received both clinical breast exam and mammogram is 81.2% with 95% confidence interval of 77.5% to 84.9%, passing the Healthy People 2000 target of at least 80%. The proportion of females 18 years old and over with a uterine cervix who had received a Pap Smear test is 93.5%, at the margin of approaching HP 2000 target of at least 95%. The proportion of women who had the test done within the preceding 1 to 3 years is 91.3% with 95% confidence interval of 88.9% to 93.7%, exceeding the HP2000 target of at least 85%.

Clinical Breast Exam

Looking at the breast exam measure, 86.6% of females had a clinical breast exam, and among those, 76.2% had the exam within the past year. The prevalence rate tends to increase with increasing age. The age of women who have had this exam peaked for women aged 55-64, but was lower for younger and older women [See table 11a, figure 11a and 11b].

The proportion of women having a breast exam increased with increasing household income levels. Married women and women with at least high school degree tend to have higher rate than those who were unmarried and with lower than high school education. The non-Honolulu counties have lower proportions of women who have had breast exams, the lowest being the Kauai County [See table 11a].

Among women who have had breast exams, 93.2 % reported that the breast exam was part of a routine checkup, 4.9 percent said it was done due to a breast problem, and 1.9 percent said that it was done due to previous breast cancer [See table 11b, figure 11c].

Mammogram Screening

Approximately 3 out of every 10 females (61.9%) had a mammogram screening, and 64% of those who have had the mammogram had the screening test within the past year. The rate consistently increases with increasing age. Women 60 years and older have the highest rate among all other age groups. Mammogram rates increase with increasing household income. The mammogram rate is highest among the Japanese females than any other ethnic group. The mammogram prevalence rate is significantly higher among married women than unmarried women (66.7% vs. 54.2%) [See table 11c, figure 11d and 11e].

Nine out of every ten women who had received a mammogram reported that their last exam was done as part of a routine checkup. 8.3% said it was done due to breast problems, and 1.6% said that was done due to previous breast cancer. About one in four women aged 18-39 year had mammograms because of breast problems (23.1%). In contrast, a majority of women aged 40 and over had mammogram as part of routine examination [See table 11d].

Pap Smear Screening

It is currently recommended that women receive a Pap screening test every one to three years. Among female respondents 18 and older, 93.5 percent reported that they had a Pap screening test. Among those who had Pap test, 72.4% had the test within the past year. The prevalence rate consistently increases with increasing age, increasing education and household income. Again, married women are more likely to have the test than those unmarried. The student/homemaker group has a lower Pap screening rate than the employed or the retirees/unable to work group [See table 11e, figure 11f and 11g].

Among women who had a Pap test, the majority (96.2%) had it as part of a routine checkup. [See table 11f].

Hysterectomy

There are 16 percent of women who have had hysterectomies. The prevalence rate of hysterectomy increases with increasing age and declines with increasing education level. Among ethnic groups, the Filipinos have the lowest hysterectomy prevalence rate. The retirees/unable to work, who are most likely elderly, also have the highest rate compared to non-retirees. The unmarried have higher hysterectomy rates than the unmarried. Hawaii County has the highest prevalence rate compared to the other three counties [See table 11g].

Section 12: Immunization _{(Click to see questionnaire)}

One out of every three adults had flu shot (influenza vaccination) in the past year (33.2%) and three out of every twenty adults had a pneumonia vaccination (15.2%). For both of these vaccinations, the Japanese respondents were more likely to report having had these vaccinations compared with other ethnic groups.

Older people tend to have higher prevalence rates of both vaccinations than younger people probably because flu and pneumonia vaccinations are recommended for all persons aged 65 and older unless contraindicated. Among adults aged 65 and older, 74.1 percent had a flu shot in the past year and 55.8% had a pneumonia vaccination [See table 12a, figure 12a and 12c].

Approximately three out of five adults (6.10%) who have had flu shots had them at the doctor's office. The rest of the adults had the flu shot either at the workplace, health department or hospital emergency room [See table 12b, figure 12b].

Section 13: Colorectal Cancer Screening _{(Click to see questionnaire)}

HP 2000 Objective: To increase to at least 50% the proportion of people aged 50 and older who have received fecal occult blood testing within the preceding 1 to 2 years, and to at least 40 % those who have ever received sigmoidoscopy or Colonoscopy.

Results indicated that the State of Hawaii has reached the above objectives. The proportion of people aged 50 and older who have received fecal occult blood testing within the preceding 2 years is 70.8% with a 95% confidence interval between 64.4% and 77.1%. The proportion of people aged 50 and older who have ever received sigmoidoscopy is 44.2% with a 95% confidence interval between 39.7% and 48.7%.

About the same percentage of adults 40 years old and older had a blood stool self-test and sigmoidoscopy/proctoscopy (31.8% and 32.0% respectively). Among those who had a blood stool self-test, 45.2% had the test within the past year. Among those who had a sigmoidoscopy/proctoscopy test, 79.1% had it with the past 5 years. The prevalence rate of these screening tests increase with increasing age but seem to decline with increasing education level.

The females were more likely than the males to have taken the blood stool test. In contrast, the males were more likely than the females to have taken the sigmoidoscopy/proctoscopy test.

The Japanese have the highest prevalence rate of taking the blood stool self-test and the sigmoidoscopy/proctoscopy test compared to any other ethnic group. The Kauai County has the highest prevalence rate for both tests compare to the other three counties [See table 13, figure 13a, 13b, and 13c].

Section 14: Injury Prevention _{(Click to see questionnaire)}

HP 2000 Objective: To increase use of helmets to at least 80% of motorcyclists and to at least 50% of bicyclists. Increase the presence of functional smoke detectors to at least one on each habitable floor of all inhabited residential dwellings.

The questions regarding unintentional injury were included in the 1999 Hawaii BRFSS. One was regarding the use of bicycle helmets by children, and the other one was regarding the existence of smoke detectors in the home.

More than half of the adults who had children in their households (56.4%) reported that their oldest child aged 5 to 15 years did not always wear a helmet when riding a bicycle [See table 14a and 14b, figure 14a and 14b]. The Filipinos, the low-income households, the lower educated and the unmarried reported a higher percentage of children not always using helmets when riding bicycles than other groups. The Hawaii County has the highest percentage of children not always using helmets when riding bicycle (75.9%) compare to the three other counties [See table 14a].

Thirteen percent of the adults reported that they did not have a smoke detector in their home. The proportion of those who did not have a smoke detector at home tend to be higher among those older people, people with less education, less income and the unemployed. The Hawaii County has the highest percentage of no smoke detectors at home (20.6%) compare to the three other counties [See table 14a, figure 14c].

Section 15: HIV/AIDS _{(Click to see questionnaire)}

Only respondents aged 18 to 64 years were asked questions about HIV/AIDS. Several questions were posed regarding the attitudes toward HIV/AIDS education and the use of condoms in prevention of HIV infection.

Adults opinion on HIV education and condom use for children

Adults were asked at what grade children should begin receiving education in school about HIV infection and AIDS. The mean grade at which they thought children should begin receiving this information was 4.9 [See table 15a].

An overwhelming majority of the adults (90.3%) reported that if they had a teenager they would encourage their sexually active teenager to use a condom. The proportion encouraging condom use declines with increasing age and education but tend to increase with income. The males and the unmarried were more likely to encourage condom use compared to the females and the married [See table 15b].

Adult self-perceived chance of getting HIV and Adult HIV testing

Less than ten percent of the adults thought that their chances of getting HIV infection were medium or high (8.8%). The proportion that perceived a medium to high risk for HIV was highest at age 18-24 years old compared to other age groups. Interestingly enough, the adults with some College education have the highest proportion of perceived medium to high risk for HIV. The proportion that perceived a medium to high risk for HIV declines with increasing income. The males have a higher perceived risk for HIV than the females. The unmarried prevalence rate of perceived medium to high risk for HIV is significantly higher from the married. There was a noticeable difference in the proportion of perceived high risk for HIV among ethnic groups. The highest rate is the Filipinos (13.5%) and the lowest rate is the Japanese (13.5% vs. 5.5%) [See table 15b, figure 15a].

More than 1 in every three adults reported having been tested for HIV (36.5%). The proportion estimated to have ever been tested for HIV tended to be higher among younger adults and highest at age group 25-34 years old. The females are more likely to report being tested than the males and so are the married than the unmarried. The reported prevalence rate of being tested for HIV increases with increasing level of education. A significantly high proportion of Whites reported having been tested for HIV (46.7%) compared to any other ethnic groups [See table 15b].

Section 16: Physical Activity Indicators _{(Click to see questionnaire)}

HP 2000 Objective: To increase to at least 20 % the proportion of people aged 18 and older who engage in vigorous physical activity that promotes the development and maintenance of cardio respiratory fitness 3 or more days per week for 20 or more minutes per occasion.

Diet and inactivity, which rank second to smoking as preventable causes of death, are important determinants of overweight and important risk factors for many chronic diseases. Approximately one in four adults 18 years old and over does not do any physical activity or is physically inactive (25.5%). In contrast, only 18.7% of the adults do regular and vigorous physical activity falling short of the HP 2000 target of at least 20%.

There are some adults who indulge in physical activity but not on a regular basis and for less than twenty minutes. The prevalence rate of this irregular physical activity is 22.6%. The prevalence rate of physically inactive and irregular physical activity when added together is called the sedentary lifestyle prevalence rate. Thus, the sedentary lifestyle prevalence rate is 48.1%. Overall, at least, about half of the adults have regular physical activity [See table 16a, figure 16a].

The adults at most risk of physical inactivity and or sedentary lifestyle are the females, those belonging to age group 45 year and over, those with lower education and those with lower household income. By ethnic group, the Hawaiians and the Filipino have about the same prevalence rate of physically inactive (31.2% and 31.7% respectively) and higher than any other ethnic groups [See table 16a, figure 16b].

The physically active adults are most likely to be engaged in walking. Approximately two in every five adults are walking (41.2%), and one in every five is doing aerobics (19.5%). About the same percentage of physically active adults is engaged in either ball sport activities or Jogging/running (11.4% and 11.8% respectively). Surprisingly, in spite of the fact that the State of Hawaii is surrounded by bodies of water, only 6% of the physically active adults are engaged in water activities [See table 16b, figure 16c].

Section 17: Weight Status Indicators _{(Click to see questionnaire)}

HP 2000 Objective: To reduce overweight to a prevalence of no more than 20 percent among people aged 20 and older. For people aged 20 and older, overweight is defined as body mass index (BMI) equal to or greater than 27.8 for men and 27.3 for women.

There are two different measures of overweight, namely weight equal to or greater than 120% of ideal weight, BMI equal to or greater than 27.8 for men and 27.3 for women. The body mass index (BMI) is estimated from the self-reported weight and height measurements. It is calculated by weight (in kilograms) divided by the square of height (in meters) or alternatively, weight (in pounds) is divided by the square of height (in inches) and the quotient is multiplied by 704.5.

The HP 2000 objective uses the definition of overweight based on the BMI. The estimated prevalence of people aged 20 and older who are overweight based on BMI equal to or greater than 27.8 for men and 27.3 for women, is 28.3% with a 95% confidence interval between 26.2% and 31.6%, failing to meet the HP2000 target of 20 percent or less.

The two different measures of overweight give different prevalence rates as shown in the table below. Regardless of the measures used, similar patterns of overweight prevalence across demographic characteristics emerge [See table 17a and 17b, figure 17a and 17b].