1. Wisconsin Department of Health Services January 2014 P-00522M Healthiest Wisconsin 2020 Baseline and Health Disparities Report Physical Activity

2. PHYSICAL ACTIVITY Background Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report Healthiest Wisconsin 2020 objectives and indicators Rationale Key points Data Weight and physical activity among youth Weight and physical activity among adults Environmental factors and resources References Links to additional reports and resources Contacts Chapter Outline 2 Chapter outline

3. PHYSICAL ACTIVITY Report Overview This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf 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: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf Report overview 3

4. PHYSICAL ACTIVITY Report Format 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 Sample annotated slide Report overview 4

5. PHYSICAL ACTIVITY 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 Report overview 5

6. PHYSICAL ACTIVITY 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 care Report overview 6

7. PHYSICAL ACTIVITY Report Outline: Detail Section 5: Data summaries by population  Racial/ethnic minority populations o American Indians o Asians o Blacks o Hispanics  People of lower socioeconomic status  People with disabilities  Lesbian, gay, bisexual, and transgender populations  Geography Report overview 7

8. PHYSICAL ACTIVITY Data notes Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf 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. Report overview 8

9. PHYSICAL ACTIVITY Factors that influence health Social determinants of health Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach Report overview 9

10. PHYSICAL ACTIVITY Healthiest Wisconsin 2020 objectives and indicators Objective 1 By 2020, increase physical activity for all through changes in facilities, community design, and policies. Objective 1 Indicators Proportion of high school students who meet federal physical activity guidelines for aerobic physical activity and muscle- strengthening. Proportion of adults who meet federal physical activity guidelines for aerobic physical activity and muscle- strengthening. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Physical Activity Focus Area Profile. 10 HW2020 objectives

11. PHYSICAL ACTIVITY Objective 2 By 2020, every Wisconsin community will provide safe, affordable and culturally appropriate environments to promote increased physical activity. Objective 2 Indicators Percent of children less than 18 years old living in a neighborhood with a nearby park or recreation center and sidewalks. Percent of Wisconsin communities with satisfactory scores as measured by the Wisconsin Assessment of the Social and Built Environment. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Physical Activity Focus Area Profile. 11 HW2020 objectives Healthiest Wisconsin 2020 objectives and indicators

12. PHYSICAL ACTIVITY Objective 3 By 2020, every Wisconsin community will provide safe, affordable and culturally appropriate environments to promote increased physical activity for individuals among populations of differing races, ethnicities, sexual identities and orientations, gender identities, and educational or economic status. Objective 3 Indicators Inventory of environments by community (including parks, facilities, workplace programs). Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Physical Activity Focus Area Profile. 12 HW2020 objectives Healthiest Wisconsin 2020 objectives and indicators

13. PHYSICAL ACTIVITY Rationale Physical activity means any bodily activity that enhances or maintains physical fitness and overall health. Regular physical activity can help to reduce the risk of certain chronic diseases, such as high blood pressure, stroke, coronary artery disease, type 2 diabetes, obesity, colon cancer, and osteoporosis. Physical activity recommendations include strategies to make physical activity an easy choice. This can be accomplished by creating opportunities for children, adults, and older adults to be active where they live, play, work and learn. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Physical Activity Focus Area Profile. 13 Rationale

14. PHYSICAL ACTIVITY Key points Youth During 2007-2011, approximately 10% of high school students in Wisconsin were obese and 14% were overweight. In 2010, 14% of children (ages 2-4 years) enrolled in WIC were obese. Significant disparities exist in the prevalence of physical activity and sedentary behavior among youth in Wisconsin by race/ethnicity and sexual minority status. For example, compared to White youth, Black, Hispanic, and Asian youth were significantly less likely to exercise throughout the week, and were more likely to watch three or more hours of television a day. A greater percentage of Black children lived in neighborhoods with multiple resources for physical activity, but Black parents were less likely than White parents to feel that their neighborhoods were safe for their children. 14 Key points

15. PHYSICAL ACTIVITY Key points Adults In 2009-2011, approximately two-thirds (65%) of Wisconsin adults were overweight or obese and 29% were obese. Significant disparities exist in the prevalence of adult obesity. For example: o Black and American Indian adults were significantly more likely to be obese compared to White adults. o Adults with the lowest household income were significantly more likely to be overweight or obese compared to middle- or high-income adults. o Among Wisconsin adults ages 18-64, those with a disability were more likely to be overweight or obese than those without a disability. 15 Key points

16. PHYSICAL ACTIVITY Key points Adults Physical inactivity is significantly more prevalent among: o Black, Hispanic, and American Indian adults, compared to White and Asian adults. o Adults with lower household incomes, compared to adults with higher incomes. o Adults living with a disability, compared to adults without a disability. 16 Key points

17. PHYSICAL ACTIVITY Weight and physical activity among youth 17

18. PHYSICAL ACTIVITY Overweight, obesity, and weight loss attempts among Wisconsin high school students, by race/ethnicity, 2007-2011 Weight and physical activity among youth 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. 18

19. PHYSICAL ACTIVITY Overweight, obesity, and weight loss attempts among Wisconsin high school students, by sexual minority status, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Weight and physical activity among youth 19

20. PHYSICAL ACTIVITY Physical activity and sedentary behaviors among Wisconsin high school students by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Weight and physical activity among youth 20

21. PHYSICAL ACTIVITY Physical activity and sedentary behaviors among Wisconsin high school students by sexual minority status, 2007-2011 Weight and physical activity among youth Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. 21

22. PHYSICAL ACTIVITY Rate of physical inactivity among Wisconsin adults, by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset. 22 Weight and physical activity among youth

23. PHYSICAL ACTIVITY Obesity among children ages 10-17, by disability status, Wisconsin, 2011-2012 Source: 2011-2012 National Survey of Children's Health Weight and physical activity among youth 23

24. PHYSICAL ACTIVITY Obesity among children (ages 2-4 years) enrolled in the Supplemental Nutrition Program for Women, Infants, and Children (WIC), by race/ethnicity, Wisconsin, 2001 and 2010 Source: Centers for Disease Control and Prevention (CDC) Pediatric Nutrition Surveillance Survey 2010. Note: Based on >= 95 th growth chart percentiles for Body Mass Index for age. WIC is the Supplemental Nutrition Program for Women, Infants, and Children. Weight and physical activity among youth 24

25. PHYSICAL ACTIVITY Weight and physical activity among adults 25

26. PHYSICAL ACTIVITY Overweight and obesity among Wisconsin adults, by sex, 2009-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 landline-cellphone combined dataset. Weight and physical activity among adults 26

27. PHYSICAL ACTIVITY Overweight and obesity among Wisconsin adults, by age, 2009-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 landline-cellphone combined dataset. Weight and physical activity among adults 27

28. PHYSICAL ACTIVITY Age-adjusted rates of overweight and obesity among Wisconsin adults by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 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. Weight and physical activity among adults 28

29. PHYSICAL ACTIVITY Age-adjusted rates of overweight and obesity among Wisconsin adults, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Weight and physical activity among adults 29

30. PHYSICAL ACTIVITY Age-adjusted rates of overweight and obesity among Wisconsin adults, by level of urbanization, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Weight and physical activity among adults 30

31. PHYSICAL ACTIVITY Overweight and obesity among Wisconsin adults ages 18-64, by disability status, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline only dataset Weight and physical activity among adults 31

32. PHYSICAL ACTIVITY Overweight and obesity among Wisconsin adults, by sexual orientation and sex, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Weight and physical activity among adults 32

33. PHYSICAL ACTIVITY Physical inactivity among Wisconsin adults, by sex, 2009-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 combined landline-cell dataset. Weight and physical activity among adults 33

34. PHYSICAL ACTIVITY Physical inactivity among Wisconsin adults, by age, 2009-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 combined landline-cell dataset. Weight and physical activity among adults 34

35. PHYSICAL ACTIVITY Age-adjusted rate of physical inactivity among Wisconsin adults, by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset Weight and physical activity among adults 35

36. PHYSICAL ACTIVITY Age-adjusted rate of physical inactivity among Wisconsin adults, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset Weight and physical activity among adults 36

37. PHYSICAL ACTIVITY Age-adjusted rate of physical inactivity among Wisconsin adults, by level of urbanization, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset Weight and physical activity among adults 37

38. PHYSICAL ACTIVITY Physical inactivity among Wisconsin adults ages 18-64, by disability status, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Weight and physical activity among adults 38

39. PHYSICAL ACTIVITY Physical inactivity among Wisconsin adults, by sexual orientation, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset Weight and physical activity among adults 39

40. PHYSICAL ACTIVITY Environmental factors and resources 40

41. PHYSICAL ACTIVITY Neighborhood environment of children less than 18 years of age, by race/ethnicity, Wisconsin, 2011-2012 Source: 2011-2012 National Survey of Children's Health. *Neighborhoods that include all four of these amenities. Data were not available for other races. Environmental factors and resources 41

42. PHYSICAL ACTIVITY Percentage of census blocks close to parks and fitness centers, Wisconsin and United States, 2007 Source: Centers for Disease Control and Prevention (CDC), State Indicator Report on Physical Activity, 2010. Environmental factors and resources 42

43. PHYSICAL ACTIVITY References 1.University of Wisconsin Population Health Institute. County Health Rankings, 2013. http://www.countyhealthrankings.org/our-approach http://www.countyhealthrankings.org/our-approach 2.Center for Urban Population Health. Milwaukee Health Report, 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf 3.LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic% 20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic% 20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf 4.Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/ 5.Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf 6.Centers for Disease Control and Prevention (CDC). Adolescent and School Health: Childhood Obesity Facts. http://www.cdc.gov/healthyyouth/obesity/facts.htmhttp://www.cdc.gov/healthyyouth/obesity/facts.htm 7.CDC. Adolescent Health in the United States. http://www.cdc.gov/nchs/data/misc/adolescent2007.pdf http://www.cdc.gov/nchs/data/misc/adolescent2007.pdf 8.CDC. Adolescent and School Health: Physical Activity. http://www.cdc.gov/healthyyouth/physicalactivity/facts.htm http://www.cdc.gov/healthyyouth/physicalactivity/facts.htm 43 References

44. PHYSICAL ACTIVITY 9.CDC. Association Between Sedentary Behavior, Physical Activity, and Obesity: Inactivity Among Active Kids. http://www.cdc.gov/pcd/issues/2009/jan/07_0242.htmhttp://www.cdc.gov/pcd/issues/2009/jan/07_0242.htm 10.U.S. Department of Health and Human Services. Physical Activity Guidelines. Chapter 7: Additional Considerations for Some Adults. http://www.health.gov/paguidelines/guidelines/chapter7.aspx http://www.health.gov/paguidelines/guidelines/chapter7.aspx 11.U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Children with Special Health Care Needs in Context: A Portrait of States and the Nation, 2007. Rockville, MD: U.S. Department of Health and Human Services, 2011. http://www.mchb.hrsa.gov/nsch/07cshcn/ http://www.mchb.hrsa.gov/nsch/07cshcn/ 12.CDC. Obesity Prevalence Among Low-Income, Preschool-Aged Children - United States, 1998-2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a1.htm 13.CDC. About BMI for Adults. http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Definition http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Definition 14.Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Prevalence and Trends Data. http://apps.nccd.cdc.gov/brfss/http://apps.nccd.cdc.gov/brfss/ 15.CDC. Disability and Obesity. http://www.cdc.gov/ncbddd/disabilityandhealth/obesity.html http://www.cdc.gov/ncbddd/disabilityandhealth/obesity.html 16.Boehmer U, Bowen DJ, Bauer GR. Overweight and obesity in sexual minority women: evidence from population-based data. American Journal of Public Health. 2007; 97: 1134–1140. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1874217/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1874217/ 44 References

45. PHYSICAL ACTIVITY 17.National Eating Disorders Association. Eating Disorders in LGBT Populations. http://www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/LGBTQ. pdf http://www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/LGBTQ. pdf 18.CDC: Physical Activity. http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html 19.CDC: Physical Activity. Older adults. http://www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html http://www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html 20.CDC. State Indicator Report on Physical Activity, 2010. http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2010.pdf http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2010.pdf 21.Kahn EB, Ramsey LT, Brownson RC, et al. The effectiveness of interventions to increase physical activity: A systematic review. Am J Prev Med. 2002;22(4 suppl):73– 107. http://www.thecommunityguide.org/pa/pa-ajpm-evrev.pdfhttp://www.thecommunityguide.org/pa/pa-ajpm-evrev.pdf 45 References

46. PHYSICAL ACTIVITY Links to additional reports and resources The Epidemic of Chronic Disease in Wisconsin: Why it Matters to the Economy and What You Can Do to Help: http://www.dhs.wisconsin.gov/publications/P0/P00238.pdf http://www.dhs.wisconsin.gov/publications/P0/P00238.pdf Obesity, Nutrition, and Physical Activity in Wisconsin: http://www.dhs.wisconsin.gov/physical-activity/ http://www.dhs.wisconsin.gov/physical-activity/ State Indicator Report on Physical Activity, 2010: http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_ 2010.pdf http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_ 2010.pdf Wisconsin Nutrition, Physical Activity and Obesity Program: http://www.dhs.wisconsin.gov/physical-activity/ Centers for Disease Control and Prevention (CDC). Physical Activity: http://www.cdc.gov/physicalactivity/ 46 Links

47. PHYSICAL ACTIVITY Contact Jon Morgan, MS Physical Activity Coordinator Nutrition, Physical Activity and Obesity Program Bureau of Community Health Promotion Division of Public Health Wisconsin Department of Health Services Email: Jonathon.Morgan@dhs.wisconsin.govJonathon.Morgan@dhs.wisconsin.gov 47 Contacts