Healthiest Wisconsin 2020 Baseline and Health Disparities Report Black Population This chapter summarizes demographic and socioeconomic data for Blacks/African.

Healthiest Wisconsin 2020 Baseline and Health Disparities Report Black Population
This chapter summarizes demographic and socioeconomic data for Blacks/African Americans in Wisconsin and highlights health risk factors and health outcomes where this population experiences disparities compared to other racial/ethnic groups. In the 2010 Census, “Black or African American” refers to a person having origins in any of the Black racial groups of Africa. The Black racial category includes people who marked the “Black, African Am., or Negro” checkbox. It also includes respondents who reported entries such as African American; Sub-Saharan African entries, such as Kenyan and Nigerian; and Afro-Caribbean entries, such as Haitian and Jamaican. Sub-Saharan African entries are classified as Black or African American with the exception of Sudanese and Cape Verdean because of their complex, historical heritage. North African entries were classified as White, because the federal Office of Management and Budget defines White as a person having origins in any of the original peoples of Europe, the Middle East, or North Africa. 1 In the data presented in this report, a person counted as Hispanic is not also counted by race. Therefore, data in this chapter refer to non-Hispanic Blacks. The text for many of the figures in this chapter compares rates for non-Hispanic Blacks to those of non-Hispanic Whites. This report uses the term “Black,” rather than “African American,” since it is more inclusive. Immigrants from the African diaspora may identify as Black but not African American. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Chapter Outline Chapter outline Background
Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report Key points Data Demographic and socioeconomic data Access to health care Overall health and mental health Risk behaviors Chronic disease outcomes Reproductive and sexual health 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 the progress on 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.2 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.3 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.4 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.5 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.6 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

Report overview Historical trauma Historical trauma is the cumulative exposure to traumatic events that not only affect the individual exposed, but continue to affect subsequent generations. Descendants of those who experienced the traumatic stressor may still exhibit symptoms. Populations affected by historical trauma include American Indians, African Americans/Blacks, Hispanics/Latinos, Asians, immigrants and refugees, war veterans, and families experiencing intergenerational poverty. Current manifestations may include: Mistrust of health care, legal, and educational systems; Higher rates of risk behaviors such as alcohol and drug abuse, suicide, homicide, and domestic violence; and Higher rates of chronic diseases. Sources: SAMHSA, Fact Sheet: Historical Trauma Texas Department of Health Services, Trauma Informed Care Training, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Key Points: Black population
Demographics: The Black population in Wisconsin is younger than the general population and is concentrated in the Southeastern part of the state. Socioeconomic status: Blacks in Wisconsin are more likely to live in poverty and less likely to have a college degree compared to Whites. Access to health care: Blacks have lower rates of health insurance and dental care coverage, similar rates of cancer screening, and higher rates of doctor visits compared to Whites. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Health risk behaviors and outcomes: Blacks face significant health disparities compared to Whites, and in some cases compared to other racial/ethnic groups. Worse overall health and mental health outcomes. Less of a sense of safety at school, neighborhood, and personal levels. Higher rates of risk behaviors that bear upon chronic disease, such as obesity, lack of exercise, and smoking, but lower rates of binge drinking. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Health risk behaviors and outcomes (continued): Worse chronic disease outcomes, including for stroke, diabetes, high cholesterol, and asthma. Higher rates of cancer incidence and mortality. Higher rates of reproductive and sexual risk behaviors and outcomes, including unintended pregnancies, sexually transmitted diseases, and HIV. Higher infant mortality rates, despite a significant decrease in recent years. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Demographic and socioeconomic data
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Demographic Characteristics
Demographics and socioeconomic data Demographic Characteristics Wisconsin's Black population, 2010: 336,056; 6.2% of state total Change in the Black population, 2000 to 2010: 20% increase Median age, 2010: Black, 27 years (White, 41.5 years) The median age is the age at which half the population is older and half is younger. Percent of Blacks who are living with a disability, 2010: 28% (White, 21%) Percent of Blacks who are foreign-born, 2010: 3% (Total population, 4%) Source: and U.S. Census Bureau. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Socioeconomic data Demographics and socioeconomic data
Wisconsin’s Black population has a higher poverty rate and less education compared to Whites. Median household income in Wisconsin, : Blacks, $27,400 (Whites, $53,000) Poverty rate, 2010: Blacks, 39% (Whites, 10%) The poverty rate is the percent living below the federal poverty level. Bachelor’s degree or more education (age 25 and older), : Blacks, 14% (Whites, 27%) Married couple households as a percent of family households, : Blacks: 33% (other racial/ethnic groups range from American Indians, 52% to Whites, 82%) Source: and U.S. Census Bureau, American Community Survey. Regarding family households, a family is a group of two people or more (one of whom is the householder) related by birth, marriage, or adoption and residing together; all such people (including related subfamily members) are considered as members of one family. A family household is a household maintained by a householder who is in a family, and includes any unrelated people who may be residing there ( The distribution of family households varied by race/ethnicity. In , more than half of Black family households in Wisconsin were female-headed, about one in ten was male-headed, and one-third were married-couple households. Whites and Asians had the highest percentage of married-couple households—about 80% of family households, followed by Hispanics (61%). Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Black population by county, Wisconsin, 2010
Demographics and socioeconomic data Black population by county, Wisconsin, 2010 Wisconsin’s Black population, 6.2% of the total statewide in 2010, was concentrated in southeastern and southern Wisconsin and Brown County. Blacks made up one-quarter of Milwaukee County residents. Source: U.S. Census, 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Demographics and socioeconomic data
Level of urbanization of Wisconsin residents, by race/ethnicity, Some data in the report are shown by level of urbanization. The 2006 National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme for Counties classifies all U.S. counties and county-equivalents into six levels—four for metropolitan counties and two for nonmetropolitan counties. For ease of interpretation in this report, these six classifications were consolidated into three categories: “large metropolitan, central,” “smaller metropolitan,” and “non-metropolitan.” In Wisconsin, Milwaukee County is the only county that is classified as “Large metropolitan, central” and therefore is labeled simply “Milwaukee County” in the figures. There were 24 smaller metropolitan counties, and 47 non-metropolitan counties. In , level of urbanization in Wisconsin varied by racial/ethnic group. Two-thirds of Blacks lived in Milwaukee County, and 28% lived in smaller metropolitan counties. Source: American Community Survey, . Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Access to health care Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Access to health care Lack of health insurance coverage and Medicaid enrollment among Wisconsin adults, by race/ethnicity, The Wisconsin Behavioral Risk Factor Survey (BRFS) is an annual telephone survey of state residents ages 18 and older carried out by the Wisconsin Department of Health Services in conjunction with the Centers for Disease Control and Prevention (CDC). Individuals who lack health insurance may have limited access to needed clinical care, including prevention services, and may not seek medical care because of financial concerns. Missing or delaying health care can lead to poorer health and potentially to greater long-term medical expenditures.7 Medicaid is a health and long-term care coverage program that is jointly financed by states and the federal government for eligible persons of all ages whose income and resources are insufficient to pay for health care. Medicaid beneficiaries often have difﬁculty obtaining a source of primary care. Research on the National Health Interview Survey demonstrated that Medicaid beneficiaries face greater barriers to accessing primary care than people on private insurance and that these barriers are associated with higher emergency department utilization.8 During , the percentage of Wisconsin adults without health insurance coverage varied considerably by race/ethnicity, as did the percentage receiving Medicaid or BadgerCare. Approximately one in five Blacks ages was without coverage. Nearly 40% of Black adults were enrolled in Medicaid or BadgerCare, compared to 12% of White adults. 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

Access to health care Public health insurance coverage and inadequacy of health insurance among children ages 6-17, by race/ethnicity, Wisconsin, The National Survey of Children's Health (NSCH) is a telephone survey conducted by the National Center for Health Statistics at the CDC, under the direction and sponsorship of the federal Maternal and Child Health Bureau. The survey addresses multiple intersecting aspects of children’s lives, including physical and mental health status, access to high-quality health care, and information on the child’s family and neighborhood. According to the Kaiser Survey of Children’s Health Coverage, many factors contribute to not having health insurance coverage for children, including a lack of access to employer-sponsored insurance (ESI) among low- and middle-income families, inability to afford ESI if it is available, and unawareness of and burdensome enrollment procedures for publicly funded insurance programs such as Medicaid and the State Children’s Health Insurance Program (SCHIP).9 Adequate insurance is defined by the following 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. If not all of these criteria are met, the insurance is considered inadequate. In , a significantly higher proportion of Black children ages 6-17 in Wisconsin had public insurance (71%) , compared to White children (27%). Approximately one out of four parents/guardians felt that their child’s health insurance coverage was inadequate, with no significant difference by race/ethnicity. Source: National Survey of Children's Health. Note: Wisconsin estimates were only available for White, Black, and Hispanic children. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Access to health care Lack of routine preventive medical and dental care among children, by race/ethnicity, Wisconsin, In , an estimated two out of five Black children did not receive routine preventive medical and dental care in the past 12 months. Differences by race/ethnicity were not significant. Source: National Survey of Children's Health. Note: Wisconsin estimates were only available for White, Black, and Hispanic children. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Access to health care Age-adjusted rates of use of and barriers to health care among Wisconsin adults, by race/ethnicity, Routine visits to the doctor can help prevent some health problems and detect others early when the chances for treatment and cure are better. Access to adequate and appropriate health services, screenings, and treatments improves the chances for living a longer, healthier life.10 Black adults were least likely to not have had a doctor’s visit in the past year (21%), compared to about one-third of White, Hispanic, and American Indian adults. The percentage of adults lacking a personal doctor did not differ significantly by race/ethnicity. Blacks were significantly more likely to be unable to obtain medical care due to cost compared to Whites. 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

Access to health care Emergency room utilization among Wisconsin residents, by race/ethnicity, The Family Health Survey asks respondents whether anyone in the household has been treated at a hospital emergency room in the past year. During , nearly one-quarter (23%) of Black residents in Wisconsin were treated in the emergency room in the past year. Asians had the lowest rate of emergency room utilization. Emergency room utilization is increasing throughout the country.11 In a 2011 study published by the CDC, 80% of adults who sought care in emergency rooms reported that it was due to a lack of access to other providers, a percentage significantly higher than the percentage who visited due to the seriousness of the medical problem (66%).8 Source: Wisconsin Department of Health Services, Family Health Survey, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Physical health and safety and mental health

Physical health Age-adjusted indicators of poor health status among Wisconsin adults by race/ethnicity, BRFS respondents were asked to describe their health as one of the following: excellent, very good; good, fair, or poor. Nearly one-third (31%) of Black adults in Wisconsin described their health as fair or poor, compared to 12% of White adults. Half of Black adults said their physical health was not good on at least one day during the past month. Of these, two-thirds reported that their poor health limited their usual activities on at least one day in the previous month. 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

Environmental health Neighborhood environment of children less than 18 years of age, by race/ethnicity, Wisconsin, The location and environment in which people live affect their level of physical activity, especially as these elements relate to a person’s daily routine. Well-planned neighborhoods and workplaces can encourage people to engage in healthful physical activities. Youth with access to places for safe physical activity during non-school hours are more likely to be physically active.12 While differences in the percentage of children in living in neighborhoods with opportunities for physical activity were not statistically significant by race/ethnicity, Black parents were significantly less likely to feel that their neighborhood was safe. Source: National Survey of Children's Health. *Neighborhoods that include all four of these amenities. Data were not available for other racial/ethnic groups. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Injury and violence Perceptions of school safety among Wisconsin high school students, by race/ethnicity, The Youth Risk Behavior Survey (YRBS) is a biennial survey administered by the Wisconsin Department of Public Instruction in conjunction with the Centers for Disease Control and Prevention (CDC) as part of a national effort to monitor health risk and protective behaviors of high school students. All students have the right to learn in a safe and protective school environment. The YRBS asks several questions regarding students’ sense of school safety. Black students in Wisconsin reported feeling unsafe at school at significantly higher rates compared to White students. One in five Black students reported rarely feeling safe from physical harm while at school. Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined 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

Injury and violence Intentional injury deaths by race/ethnicity, age-adjusted rates per 100,000, Wisconsin, During , the Black population had the highest rate of age-adjusted deaths from intentional injury in Wisconsin (26 per 100,000), while Hispanics had the lowest (10 per 100,000) (data not shown). The suicide rate among Blacks was about half the rate among Whites. However, the death rate from homicide among Blacks was four times higher than among American Indians and almost 20 times higher than among Whites. Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Injury and violence Partner violence among Wisconsin high school students, by race/ethnicity, Partner or dating violence is defined as physical, sexual, or psychological/emotional violence within a dating relationship, as well as stalking. It can occur in person or electronically and between current or former dating partners. Teens are heavily influenced by their relationship experiences—healthy relationships can have a positive effect on a teen’s emotional development, while unhealthy, abusive, or violent relationships can result in negative short- and long-term consequences to the developing teen. Teen victims of dating violence are more likely to do poorly in school, engage in drug and alcohol use, have eating disorders, and think about or attempt suicide. Teens victims are at higher risk for victimization later in life.13 Black students were more likely than White and Asian students to report being hit by a boyfriend or girlfriend in the past 12 months. Approximately one out of ten Wisconsin high school students was forced into having sex at some point; differences by race/ethnicity were not significant. Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined 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

Mental health Age-adjusted rate of four or more Adverse Childhood Experiences (ACEs) among Wisconsin adults, by race/ethnicity, 2010 and 2011 Early childhood experiences may make lasting impacts on health and well-being. Negative experiences are major risk factors for the leading causes of illness and death as well as poor quality of life among adults.14 In 2010 and 2011, the Wisconsin BRFS asked adults whether they experienced one or more of 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. Adults in Wisconsin with four or more adverse childhood experiences were more likely to report being dissatisfied with their life, to be receiving Medicaid/Badger Care, to have ever been diagnosed with depression, and to be a current smoker.15 Nearly one in four (23%) Black adults had experienced four or more ACEs, a rate that was significantly higher than among White adults (15%). Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset Note: Question asked in 2010 and 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

Mental health Age-adjusted rate of frequent mental distress among Wisconsin adults, by race/ethnicity, Frequent mental distress is defined as 14 or more days of poor mental health in the past 30 days.16 Growing evidence indicates a strong association between poor mental health and premature death, chronic physical diseases, functional impairment, and overall quality of life. Black adults in Wisconsin were significantly more likely than White adults to experience frequent mental distress. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Question asked in 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

Mental health Depression among Wisconsin high school students by race/ethnicity, The YRBS asks students if they ever felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing usual activities. Compared to White students, Black students were significantly more likely to disengage in usual activities due to persistent sadness and hopelessness. According to the federal Office of Adolescent Health, approximately one out of five adolescents in the United States has a diagnosable mental health disorder, and one in four adolescents shows at least mild symptoms of depression. Mental health disorders can disrupt school performance, harm relationships, and lead to suicide.17 Additionally, depressed youth are at a higher risk for poor health outcomes as adults.18 Persistent sadness and hopelessness are symptoms of, and possible predictors of, clinical depression. Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS). Note: 95% confidence intervals are denoted by the error bars; larger confidence interval s may indicate less reliable estimates that should be interpreted with caution. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Mental health Suicide risk during past 12 months among Wisconsin high school students by race/ethnicity, Nationally, suicide is the third leading cause of death among adolescents after accidents (unintentional injury) and homicide.19 Suicidal behavior is not only associated with a range of mental health problems such as depression, anxiety, eating disorders, substance abuse, and behavior disorders, but may also be associated with physical health problems as well.20 While the suicide death rate in Blacks of all ages was roughly half that of Whites during (shown earlier), 12% of Black high school students had attempted suicide in the previous year compared to 5% of White students. Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS). Note: 95% confidence intervals are denoted by the error bars; larger confidence interval s may indicate less reliable estimates that should be interpreted with caution. 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

Risk behaviors for chronic disease

Physical activity Physical activity and sedentary behaviors among Wisconsin high school students by race/ethnicity, The CDC recommends that children and adolescents get at least 60 minutes of physical activity per day. Regular physical activity in childhood and adolescence improves strength and endurance, helps build healthy bones and muscles, helps control weight, reduces anxiety and stress, increases self-esteem, and may improve school performance, blood pressure, and cholesterol levels. Regular physical activity may result in a reduced risk of chronic disease.21 The benefits of physical activity may be moderated by sedentary behavior such as watching television or playing video or computer games. The American Academy of Pediatrics recommends no more than two hours of high-quality television and video viewing (e.g., educational television programs) per day for children two years and older.22 Compared to White students, Black students were significantly less likely to exercise at least one hour on five days of the week, and significantly more likely to watch three or more hours of television and play three or more hours of video games on an average school day. There were no significant differences in the percentages of students who attend physical education. Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Physical activity Age-adjusted rate of physical inactivity among Wisconsin adults, by race/ethnicity, Regular physical activity improves overall health and fitness, and reduces the risk for many chronic diseases. The CDC recommends that adults engage in two types of physical activity each week to improve health: aerobic and muscle-strengthening.23 The BRFS asks respondents whether they have participated in any physical activity other than at their jobs in the past month. Black adults in Wisconsin were significantly more likely to be physically inactive than were White adults. More than one-third of Black adults were physically inactive in the past month other than at their job. It is important to note that lower wage jobs are more likely than higher wage jobs to involve physical activity, and that racial/ethnic minorities are more likely than Whites to hold lower wage jobs. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Nutrition Age-adjusted rates of overweight and obesity among Wisconsin adults, by race/ethnicity, In , more than three-quarters of Black adults in Wisconsin were either overweight or obese. Black adults had the highest obesity rate of any racial/ethnic group—44%. 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

Tobacco use and exposure
Age-adjusted smoking rates among Wisconsin adults, by race/ethnicity, In , Blacks had a significantly higher rate of smoking compared to Whites. Of current or former smokers, the preference for menthol cigarettes was significantly greater among Blacks than among other populations: 84% of Black smokers smoked menthols compared to 40% of White smokers (data not shown). Menthol smoking is associated with lower rate of success in cessation, as well as earlier initiation.24 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

Tobacco use and exposure
Rates of secondhand smoke exposure among Wisconsin adults, by race/ethnicity, Secondhand smoke is a mixture of gases and fine particles that includes smoke from a burning cigarette, cigar, or pipe tip, and smoke that has been exhaled or breathed out by the person or people smoking. The mixture includes more than 7,000 chemicals, including hundreds that are toxic and about 70 that can cause cancer. Secondhand smoke exposure is associated with an increased risk of cardiovascular disease and lung cancer.25 In Wisconsin, blacks were significantly more likely to live in households that allow smoking and to be exposed to others’ smoke at home than were Whites. More than one in three American Indian adults worked in an environment where smoking was permitted, a rate significantly higher than among White adults. In Wisconsin, people in racial/ethnic minority groups had higher levels of secondhand smoke exposure and higher rates of tobacco use compared to Whites. “Bringing Everyone Along: A Strategic Plan to Eliminate Tobacco-Related Health Disparities in Wisconsin” provides more information on tobacco-related disparities by race/ethnicity.26 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: The smoking at work question was only asked in years 2009 and 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

Alcohol and other drug abuse
Rates of current drinking, binge drinking, and marijuana use among Wisconsin high school students, by race/ethnicity, Current drinking is defined as having consumed alcohol within the past 30 days, and binge drinking is defined as having had five or more alcoholic drinks in a row on at least one day during the past 30 days. Youth who drink alcohol are more likely to experience social and school-related problems, risky sexual behavior, violence, injuries from car crashes or other unintentional causes, poisoning, and mental health problems. Youth who binge drink are more likely to experience these problems than those who do not.27 Students who use marijuana are more likely to experience social and school-related problems, a decline in cognitive ability in adulthood, and physical and mental health problems.28 Black students were significantly less likely to report drinking any alcohol and binge drinking in the past 30 days compared to White students. The rate of marijuana use was considerably higher among Black students compared to White students. Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined 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

Alcohol and other drug abuse
Age-adjusted rates of binge drinking and heavy drinking among Wisconsin adults, by race/ethnicity, Rates of both binge drinking and heavy drinking were significantly lower among Black adults than among White adults. 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

Chronic disease outcomes

Environmental health Age-adjusted rates of asthma among Wisconsin adults, by race/ethnicity, Black adults had the highest percentages of lifetime and current asthma prevalence—significantly higher than in other racial/ethnic groups. Note: Due to changes in the weighting methodology implemented by the CDC in 2011, these estimates may vary from other estimates (e.g., by race/ethnicity) reported by the Wisconsin Asthma Program. 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

Environmental health Asthma hospitalizations by race/ethnicity, age-adjusted rate per 10,000, Wisconsin, 2010 In 2010, Blacks had an asthma hospitalization rate more than five times higher than the rate among Whites. Children in poor families are more likely to have been diagnosed with asthma. The risk for asthma among children is increased by multiple factors, an important one of which is exposure to secondhand tobacco smoke. Children living below or near the poverty level are more likely to have high blood levels of cotinine, a breakdown product of nicotine, than children living in higher income families.29 Source: Wisconsin Inpatient Hospitalization Discharge file, 2010. Note: Race groups include both Hispanic and non-Hispanic people; Hispanics may include people of various races. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Chronic diseases Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by race/ethnicity, In , approximately one in six Black adults (17%) had been diagnosed with diabetes, a significantly higher proportion than among Whites (7%). Rates of prediabetes were approximately the same among Whites and Blacks. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2. diabetes. 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

Chronic diseases Hospitalizations due to long-term complications from diabetes among Wisconsin adults, age-adjusted rate per 10,000, by race/ethnicity, 2010 Long-term complications of diabetes mellitus include renal (kidney), eye, neurological, and circulatory disorders.30 Diabetes is the leading cause of non-traumatic lower-limb amputations and new cases of blindness among adults in the United States. Management of blood sugars, diet, and physical activity may prevent or delay some of these adverse outcomes from occurring.31 In 2010, Black adults in Wisconsin had hospitalization rates for long-term diabetes complications and diabetes-related lower-extremity amputations that were four times higher than rates for White adults. Source: Wisconsin Inpatient Hospitalization Discharge file, 2010. Note: Hospitalization rates considered unreliable are excluded. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Chronic diseases Incidence of end-stage renal disease incidence among Wisconsin adults, age-adjusted rate per 100,000, by race/ethnicity, 2009 Diabetes is the leading cause of cause of kidney failure (end-stage renal disease).31 Kidney disease is a progressive disease that ultimately ends with end-stage renal disease (ESRD), requiring dialysis or transplantation. Early detection of kidney disease accompanied by proper medications can delay the onset of ESRD. While some cases of kidney failure due to diabetes cannot be avoided, other cases reflect inadequate control of blood sugar or delayed detection and treatment of early kidney disease due to diabetes.32 In 2009, the incidence rate for ESRD with diabetes as a primary diagnosis was more than five times higher for Blacks in Wisconsin than for Whites. Low socioeconomic status and less access to effective treatment are associated with high incidence of ESRD among people with diabetes.32 In 2009, the Wisconsin ESRD incidence rate among men with diabetes was disproportionality higher than among women (33.8 and 14.6 per 100,000, respectively; data not shown). Source: United States Renal Data System (USRDS), Renal Data Extraction and Referencing (RenDER) System. Note: Incidence rates considered unreliable are excluded. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Chronic diseases Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by race/ethnicity, 2009 and 2011 In 2009 and 2011, Black adults had the highest rate of high cholesterol (40%) compared to adults in other racial/ethnic groups. The rate of high blood pressure was also significantly higher among Black adults than among White adults. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Questions only asked in 2009 and 2011.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

Chronic diseases Age-adjusted rate of arthritis among adults, and percent of those with arthritis whose activity is limited due to joint pain, by race/ethnicity, During , arthritis was more prevalent among Blacks than among Whites. Of Black adults who had been diagnosed with arthritis, half experienced limited activity due to joint pain. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Arthritis question was asked in Question about limited activity due to joint pain question was asked in 2009 and 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

Chronic diseases Cancer incidence and mortality (all sites) age-adjusted rate per 100,000, by race/ethnicity, Wisconsin, 2010 In 2010, Blacks in Wisconsin had cancer incidence and mortality rates that were significantly higher than among Whites. While overall cancer incidence and mortality rates have declined over the past decade in Wisconsin, disparities have persisted. From 2000 to 2010, the disparity in cancer incidence increased between Whites and non-Whites. During this time, the cancer incidence rate declined among Whites, but increased among Blacks, Hispanics, Asians, and American Indians. The cancer mortality rate declined for both Whites and Blacks, but increased among Hispanics, Asians, and American Indians (data not shown). Differences in incidence may be influenced by socioeconomic, demographic, and behavioral factors; access to services; and rates of screening.33 Late detection and post-diagnosis factors, such as access to effective treatment and adherence to treatment, may contribute to the disparities in mortality The National Cancer Institute identifies low socioeconomic status and lack of health care coverage as the most important factors contributing to cancer disparities among racial and ethnic groups.36 Sources: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services; and National Center for Health Statistics, Wisconsin mortality file , Vital Statistics Cooperative Program, 2013. Note: Racial groups include both Hispanics and non-Hispanics; Hispanics include all races. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Chronic diseases Colorectal cancer mortality age-adjusted rate per 100,000, by race/ethnicity, Wisconsin and United States, Colorectal cancer is cancer that occurs in the colon or rectum, and is the third most common cancer among men and women in the United States. Colorectal cancer mortality is largely preventable through early detection and treatment. According to the Centers for Disease Control and Prevention (CDC), approximately 60% of deaths from colorectal cancer could be prevented if everybody aged 50 or older had regular screening tests.37 During , Blacks in Wisconsin had a significantly higher colorectal cancer mortality rate than Whites, Hispanics, or Asians. Colorectal cancer mortality rates among Blacks in Wisconsin and the United States were comparable, whereas rates for Whites and Asians were lower in Wisconsin than in the national as a whole. Factors that may contribute to these disparities include low socioeconomic status, lower rates of insurance coverage and/or access to preventive medical services, and the existence of comorbidities Risk factors that contribute to the incidence of colorectal cancer include obesity, diabetes, smoking, and binge drinking.38-40 Source: National Center for Health Statistics. Wisconsin mortality data file , Vital Statistics Cooperative Program, 2013. Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Chronic diseases Female breast cancer mortality age-adjusted rate per 100,000, by race/ethnicity, Wisconsin and United States, Breast cancer is the most common cancer and the second leading cause of cancer-related death among women in United States, following lung and bronchus cancer. 31,32 Although breast cancer can occur in both males and females, it is rare among males. During , Black women in Wisconsin and the U.S. were significantly more likely to die from breast cancer than White women, even though White women had the highest incidence rate (data not shown). Breast cancer care begins with regular screening, continuing with timely follow-up and appropriate treatment; disparities exist at each phase of this continuum of care.31,32 The National Cancer Institute identifies lack of health care coverage, barriers to detection and screening, and unequal access to improvements in cancer treatment as contributors to the differing trends in breast cancer incidence and mortality among women.36 Research also suggests that the more aggressive tumors associated with poorer survival are more common among younger Black and Hispanic women living in low-socioeconomic areas, contributing to the higher rates of mortality.31,32 Sources: Source: National Center for Health Statistics. Wisconsin mortality data file , Vital Statistics Cooperative Program, 2013. Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Sexual risk and reproductive behaviors and health outcomes

Reproductive and sexual health
Estimated prevalence of sexual risk behaviors among Wisconsin high school students by race/ethnicity, Many adolescents engage in sexual risk behaviors that can result in unintended health outcomes, such as pregnancy and sexually transmitted diseases.41 Important disparities exist in sexual behavior by race/ethnicity. Rates of four measures of sexual behavior were higher among Blacks than Whites for all four indicators. Seventy percent of Black high school students reported having had sexual intercourse; 18% had intercourse before the age of 13, and 28% had four or more lifetime partners. Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined 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

Births to teens ages as a percent of all births, by race/ethnicity, Wisconsin, Percent of all births According to the Centers for Disease Control and Prevention (CDC), childbearing by teenagers is a matter of public concern because of the elevated health risks for teen mothers and their infants, as well as significant public costs.42 In Wisconsin, the percentage of births to teens declined in all racial/ethnic groups from 2000 to Births to teens continue to make up a considerable proportion of births in some groups. In 2010, 20% of births to Black women were to teen mothers ages In 2009, Milwaukee’s percentage of births to teens (16%) was the sixth highest of the nation’s 49 largest metropolitan areas.43 The teen birth rate is the rate of births to teens ages per 1,000 females in this age group. From 2000 to 2010, there was a significant decline in the teen birth rate in Wisconsin for each racial and ethnic group except American Indians (data not shown). The overall rate of decline was 26%, from 35 per 1,000 in 2000 to 26 per 1,000 in The greatest decline occurred among Asians (50%), followed by Hispanics (40%), Blacks (36%), and Whites (20%). The teen birth rate fluctuated among American Indians. In 2010, American Indians and Blacks had the highest teen birth rates, with no significant difference between the two populations (78 and 72 per 1,000, respectively). Both rates were more than four times higher than the White teen birth rate (17 per 1,000). The Hispanic (58 per 1,000) and Asian (31 per 1,000) teen birth rates were also significantly higher than the rate for Whites (17 per 1,000) (data not shown). Source: Wisconsin Department of Health Services, Division of Public Health, Office of Health Informatics: Births to Teens in Wisconsin, 2010. January 2012. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Healthy growth and development
Unintended pregnancy as a percent of births, by race/ethnicity, Wisconsin, The Pregnancy Risk Assessment Monitoring System (PRAMS) is a surveillance project of the CDC and state health departments. Wisconsin PRAMS collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy. The survey collects information from a sample of women who recently gave birth. The health of a woman before pregnancy has a great impact on birth outcomes, and birth outcomes affect health in childhood and adulthood. According to the CDC, unintended pregnancy is associated with an increased risk of problems for both mother and baby. If a pregnancy is not planned, a woman may not have achieved optimal health before conception.44 During , approximately 37% of all Wisconsin live births were the result of an unintended pregnancy (data not shown). An estimated two out of three births to Black women in Wisconsin were the result of an unintended pregnancy, twice the percentage among births to White women. Source: Wisconsin Department of Health Services, Division of Public Health, PRAMS, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Percentage of births to mothers who received prenatal care during the first trimester, by race/ethnicity, Wisconsin, 2010 The American College of Obstetricians and Gynecologists (ACOG) established guidelines that recommend early entry into prenatal care, with at least 13 visits during a full-term pregnancy. Women who begin prenatal care after the first trimester are at higher risk for poor pregnancy outcomes, such as low birthweight births, premature births, and infant and maternal mortality. The benefits of prenatal care are greatest among women who are most socially disadvantaged.45 In 2010, 84% of women who gave birth in Wisconsin received prenatal care during the first trimester (data not shown). Black and other racial/ethnic minority women were significantly less likely to receive prenatal care during the first trimester than were White women. Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident birth certificates. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Percentage of low birthweight (<5.5 pounds) births, by maternal race/ethnicity, Wisconsin, Low birthweight (less than 5.5 pounds) is the most important factor affecting neonatal mortality (deaths within 28 days of birth) and a significant determinant of postneonatal mortality (deaths between 28 days to 364 days after birth). Most low birthweight infants survive and are healthy. Nevertheless, low birthweight infants who survive are at increased risk for health problems ranging from neurodevelopmental disabilities to respiratory disorders.46 During , the percentage of low birthweight births among Black women (13.7%) was significantly higher than for any other population in Wisconsin. Over the past 10 years, Black women consistently had the highest percentage of low birthweight births, roughly double the rates in other racial and ethnic groups. Smoking during pregnancy is the most preventable cause of illness and death among mothers and infants. Smoking is associated with an increased risk for low birthweight delivery, spontaneous abortion, and sudden infant death syndrome, as well as long-term negative effects on infant growth and development, behavior and cognition.47 During , an estimated 13% of new mothers in Wisconsin smoked during the last three months of pregnancy. More than one in six Black women smoked during the last trimester of pregnancy (data not shown). Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident birth certificates. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Infant mortality by race/ethnicity, rate per 1,000 births, Wisconsin, Improvements in maternal and infant health beginning in 1900 have been among the greatest achievements in public health, both in Wisconsin and across the United States; however, considerable disparities exist among racial and ethnic groups. The infant mortality rate, the rate at which babies die before their first birthday, is considered to be a good indicator of the overall health of a population.48 In Wisconsin, the total infant mortality rate declined from 6.6 per 1,000 births in 2000 to 5.7 in 2010 (data not shown). From 2000 to 2010, Blacks had the highest rate of infant mortality. During this time, the infant mortality rate among Blacks peaked in 2004 (19.2 per 1,000) and declined 28% by In 2010, the infant mortality rate was significantly higher for Blacks (13.9 per 1,000)—nearly three times higher than the rate for Whites (4.9 per 1,000) and more than double the Laotian/Hmong infant mortality rate (6.3 per 1,000). Compared to national data, Wisconsin’s 2010 infant mortality rate for Whites was slightly lower (U.S. rate: 5.2 per 1,000); however, it was higher for Blacks (U.S. rate: 11.6 per 1,000).48 The U.S. Department of Health and Human Services attributes the decrease in infant mortality rates to the decline in maternal risk behaviors during pregnancy, such as smoking and alcohol and other drug abuse, in addition to programs that promote maternal health, such as affordable access to prenatal care and education campaigns.49 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Reported cases of selected sexually transmitted diseases, rate per 100,000, by race/ethnicity, Wisconsin, 2010 White Black Hispanic Asian American Indian In 2010, Blacks had the highest rates of chlamydia, gonorrhea, and syphilis infection in Wisconsin, while Whites had the lowest rates. For these three diseases, the difference in rates between Blacks and Whites ranged from 13 to 40 times. Source: Wisconsin Department of Health Services, Sexually Transmitted Diseases Program. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Rates of HIV testing and age-adjusted risk behaviors among Wisconsin adults, by race/ethnicity, In , two-thirds of Black adults had been tested for HIV, a proportion that was significantly higher than for any other race/ethnicity. Blacks were significantly more likely than Whites to report having been in a high-risk situation for HIV. Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Testing rates are not age-adjusted; rates of exposure to high-risk situations are age-adjusted. 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

Estimated HIV prevalence within
Reproductive and sexual health Estimated prevalence of HIV in selected demographic groups, ages 15-59, by race/ethnicity, Wisconsin, as of December 31, 2012 Estimated HIV prevalence within demographic group Less than 1.5% Disparities in HIV prevalence (persons living with HIV infection) occur both between men who have sex with men (MSM) and other demographic groups (non-MSM and females), and by race/ethnicity within each demographic group. In 2012, more than one in four (27%) Black MSM in Wisconsin was estimated to be HIV positive, compared to 7% of Hispanic MSM, and 3% of White MSM. Among non-MSM males and females, Blacks also had the highest rates of HIV, followed by Hispanics. Fewer than one in 1,000 females and non-MSM males in Wisconsin is HIV positive. Within these groups, the percentages are highest among Blacks (1.2% of Black non-MSM males and 0.7% of Black females). These percentages are based on published estimates of the percent of Wisconsin adolescent and adult males that are MSM (Black, 4.3%, Hispanic, 5.3%, and White, 5.6%)50, and CDC’s estimate that 18% of people living with HIV are unaware of their infection.51 Demographic Group Source: Wisconsin Department of Health Services, Wisconsin HIV Surveillance System. Note: MSM = Men who have sex with men. The estimated prevalence is adjusted to account for the CDC’s estimate that 18% of HIV-infected persons are unaware of their infection and therefore not reported. The MSM population for each racial/ethnic group uses the CDC’s estimate that 4% of adult males are MSM Healthiest Wisconsin 2020 Baseline and Health Disparities Report

References References
2010 Census Briefs: Blacks/African Americans. 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 Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf 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 CDC. Health Care: See Why Being Insured Matters. Gindi RM, Cohen RA, Kirzinger WK. Emergency room use among adults aged 18–64: Early release of estimates from the National Health Interview Survey, January–June National Center for Health Statistics. May Available from: Healthiest Wisconsin 2020 Baseline and Health Disparities Report

References Kaiser Commission on Medicaid and the Uninsured. Next Steps in Covering Uninsured Children. Findings from the Kaiser Survey of Children’s Health Coverage. CDC. Regular Check-Ups Are Important. RAND Corporation. The Evolving Role of Emergency Departments in the United States. RR280.pdf CDC. State Indicator Report on Physical Activity, CDC. Understanding Teen Dating Violence. CDC. Adverse Childhood Experiences Study. O’Connor C, Finkbiner C, & Watson L. (2012). Adverse Childhood Experiences in Wisconsin: Findings from the 2010 Behavioral Risk Factor Survey. Madison, Wisconsin: Wisconsin Children’s Trust Fund and Child Abuse Prevention Fund of Children’s Hospital & Health System. Centers for Disease Control and Prevention (CDC). Self-Reported Frequent Mental Distress Among Adults --- United States, 1993— Healthiest Wisconsin 2020 Baseline and Health Disparities Report

References Office of Adolescent Health. Mental Health. health-topics/mental-health/home.html Keenan-Miller D, Hammen CL, Brennan PA. Health outcomes related to early adolescent depression. Journal of Adolescent Health. CDC. Mortality Among Teenagers Aged Years: United States, National Institute of Mental Health. Many Teens Considering Suicide Do Not Receive Specialized Mental Health Care news/2012/many-teens-considering-suicide-do-not-receive-specialized-mental- health-care.shtml CDC. Adolescent and School Health: Physical Activity. CDC. Association Between Sedentary Behavior, Physical Activity, and Obesity: Inactivity Among Active Kids. CDC: Physical Activity. National Cancer Institute: Menthol and Tobacco. CDC. Smoking and Tobacco Use: Secondhand Smoke Facts. acts/index.htm Healthiest Wisconsin 2020 Baseline and Health Disparities Report

References DHS. Bringing Everyone Along: A Strategic Plan to Eliminate Tobacco-Related Disparities in Wisconsin CDC. Underage Drinking. drinking.htm National Institute on Drug Abuse. Drug Facts: Marijuana. DHS. Burden of Asthma in Wisconsin, Agency for Healthcare Research and Quality (AHRQ). Diabetes mellitus: hospital admission rate for long-term complications. National Institute of Diabetes and Digestive and Kidney Disease. National Diabetes Statistics, Ward MM, et al. Access to care and the incidence of end-stage renal disease due to diabetes. Siegel R, et al. Cancer Statistics, A Cancer Journal for Clinicians. CDC. Vital Signs: Racial Disparities in Breast Cancer Severity — United States, 2005– Healthiest Wisconsin 2020 Baseline and Health Disparities Report

References Journal of the National Cancer Institute. Racial and Ethnic Disparities in the Receipt of Cancer Treatment. National Cancer Institute. Fact Sheet: Cancer Health Disparities. CDC. Basic Information about Colorectal Cancer. White A, et al. Racial Disparities in Colorectal Cancer Survival: To What Extent Are Racial Disparities Explained by Differences in Treatment, Tumor or Hospital Characteristics? Loconte NK, et al. Increasing disparity in colorectal cancer incidence and mortality among African Americans and Whites: A state's experience. Perdue DG, et al. Regional differences in colorectal cancer incidence, stage, and subsite among American Indians and Alaska Natives, CDC. Sexual and Reproductive Health of Persons Aged 10–24 Years. CDC. Birth Rates for the United States: Teenagers Reach Historic Lows for All Age and Ethnic Groups. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

References National Center for Health Statistics. Child Trends analysis of Natality microdata files from Centers for Disease Control and Prevention. =d&ind=4&dtm=252&tf=38 CDC. Unintended Pregnancies. CDC. During Pregnancy. CDC. Is low birthweight a health problem? htm CDC. PNSS Health Indicators. Indicators National Center for Health Statistics. National Vital Statistics Reports. Deaths: Preliminary Data for U.S. Department of Health and Human Services. Infant Mortality Fact Sheet. Lieb S, et al. Statewide estimation of populations of MSM in the United States. Public Health Reports 2011;126(1):60–72. CDC. HIV in the United States: At A Glance, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Links to additional reports and resources
Centers for Disease Control and Prevention, Minority Health, Black or African American Populations: U.S. Department of Health and Human Services, Office of Minority Health, African Americans: Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Contacts Contacts Evelyn Cruz, Minority Health Officer Wisconsin Division of Public Health, Office of Policy and Practice Alignment Karl Pearson, Demographer Wisconsin Division of Public Health, Office of Health Informatics Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Healthiest Wisconsin 2020 Baseline and Health Disparities Report Black Population This chapter summarizes demographic and socioeconomic data for Blacks/African.

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Healthiest Wisconsin 2020 Baseline and Health Disparities Report Black Population This chapter summarizes demographic and socioeconomic data for Blacks/African.

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Presentation on theme: "Healthiest Wisconsin 2020 Baseline and Health Disparities Report Black Population This chapter summarizes demographic and socioeconomic data for Blacks/African."— Presentation transcript:

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