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  1. Behavioral Risk Factor Surveillance System 2017 Report Health Surveillance healthvermont.gov

  2. Table of Contents Page Page Introduction ……………………………………. 4 19 Disability ……………………………….………….. MethodologyChanges ……………………. Chronic Conditions …………………….. 4 21 Executive Summary ………………………… 5 Arthritis …………………………………………… 22 Demographics ………………………………… 7 Asthma …………………………………………...... 24 Sex …….……………………………………………………. 8 Cancer Diagnosis ……………………………….. 25 Age…….……………………………………………………. 8 Skin Cancer Diagnosis ……………………….. 26 Education Level ………………………………………. 8 Cardiovascular Disease ..……………………. 27 Chronic Obstructive Pulmonary Disease (COPD) …………………………………. Household Income Level ….…………………….. 8 28 Education Level …………………………………….... 8 Depressive Disorder ………………………….. 29 Race/Ethnicity ……………………………….………… 8 Pre-Diabetes ………….………………………….. 30 Sexual Orientation/Gender Identity .……….. 8 Diabetes …………….……………………………... 31 Employment Status ……………………………….... 9 33 High Cholesterol ……………………………….. Marital Status …………………………………………. 9 34 Hypertension ……………….……………………. County of Residence ……………………………….. 10 35 Kidney Disease ………………………………….. Veteran Status …………………………………………. 10 36 Obesity and Overweight ……………………. Risk Factor Indicators …………………. Pregnancy Status …………………………………….. 10 37 Children in Household …………………………….. 10 Alcohol Consumption ……………………….. 38 Homeowner Status …………………………………. 10 Community Safety for Walking ………….. 41 Health Status Indicators ..………………… 11 HIV Transmission Risk ..……………………... 44 General Health Status ……………………………… 12 Intimate Partner Violence .………………... 43 Medical Health Plan Coverage ………………… 13 Marijuana Use …………………………………... 46 15 No Leisure Time Physical Activity …….… 48 Medical Health Care Access ….………………… Prescription Drug Misuse ….…………………….. Quality of Life/Healthy Days ……………………. 17 49 2017 Behavioral Risk Factor Surveillance Survey Report 2

  3. Table of Contents Page Risk Behaviors (continued) .…………….. Seatbelt Use ..……………..…………………………… 50 Sugar Sweetened Beverages ..……….………… 51 Tobacco Use ……………………………………………. 52 Preventive Behaviors & Screenings ... 57 Immunizations ………………………………………… 58 Routine Doctor Visits ….…………………………… 61 Cholesterol Screening ……………………………… 62 Fruit and Vegetable Consumption …………… 63 Physical Activity Recommendations ………… 66 Strength Training Recommendations ..…….. 67 Lung Cancer Screening ………………………….... 68 HIV Testing ………………………………………………. 69 2017 Behavioral Risk Factor Surveillance Survey Report 3

  4. Introduction The Behavioral Risk Factor Surveillance System (BRFSS) is a telephone survey conducted annually among adults 18 and older. The Vermont BRFSS is completed by the Vermont Department of Health in collaboration with the Centers for Disease Control and Prevention (CDC). All U.S. states, Washington D.C., and most U.S. territories participate in the BRFSS. Additional information about the BRFSS can be found on the Department of Health and CDC websites: • http://healthvermont.gov/research/brfss/brfss.aspx • http://www.cdc.gov/brfss Methodology Changes In 2011, the CDC implemented changes to the BRFSS weighting methodology in order to more accurately represent the adult population. In 2011 and forward, weights are calculated using an iterative proportional fitting (or “raking”) methodology. This allows the weights to be calculated using a smaller sample size, adjusts for more demographic variables, and incorporates cell phone interview data into estimates. While these adjustments make the calculations more representative of the population, the changes in methodology also limit the ability to compare results from 2011 forward with those from previous years. The Vermont Department of Health recommends that comparisons between 2011 data and earlier years be made with caution. Statistical differences between data collected in 2011 or later and that from 2010 and earlier may be due to methodological changes, rather than changes in opinion or behavior. 2017 Behavioral Risk Factor Surveillance Survey Report 4

  5. Executive Summary Background The Behavioral Risk Factor Surveillance System (BRFSS) is a telephone survey conducted annually among adults 18 and older. The Vermont BRFSS is completed by the Vermont Department of Health in collaboration with the Centers for Disease Control and Prevention (CDC). All U.S. states, Washington D.C., and most U.S. territories participate in the BRFSS. In 2017, Vermont BRFSS surveys were completed among 6,516 adults from across the state. These results were then weighted to be representative of the entire adult population. Health Status Indicators Most Vermont adults report having access to health care. More than nine in ten (92%) adults 18-64 have a health plan, and 87% of all adults report having a personal health care provider. Relatively few, less than one in ten (9%) said they did not visit a doctor in the last year because of cost. Across each of these measures, Vermont reported significantly better access to health care than U.S. adults. The proportion of Vermont adults 18-64 with a health plan was statistically similar in 2016 and 2017 (94% vs. 92%), and has increased significantly since 2011 (from 89% to 92%). Chronic Condition Indicators Among Vermont adults the prevalence of chronic conditions included on the Vermont BRFSS has been stable since 2011. As compared with the U.S., prevalence of the following chronic conditions are all statistically lower among Vermont adults: obesity (28% vs. 31%), diabetes (8% vs. 11%), high cholesterol (28% vs. 32%), hypertension (26% vs. 30%), and chronic kidney disease (2% vs. 3%). Arthritis (28%) and depression (25%) are reported by about a quarter of Vermont adults, and at a significantly higher rate than among U.S. adults. Also experienced at a higher rate among Vermont adults than U.S. adults is asthma, which is reported by 12% of Vermont adults. Risk Behavior Indicators Fifteen percent of Vermont adults reported using marijuana in the last month. This continues the recent trend towards increasing use from 7% in 2013, to 11% in 2015, 12% in 2016, and 15% in 2017. While the increase from 2016 to 2017 is not statistically significant, the proportion of adults reporting using marijuana in the last 30 days in 2017 is statistically higher than that in 2011-2015. A new question on how adults use marijuana was added in 2017. More than eight in ten (82%) usually use marijuana by smoking it. Eight percent vape it, while six percent usually consume marijuana by eating it in a food or drink product and two percent dab it. Tobacco use, including cigarettes (17%), smokeless tobacco (3%), and e-cigarettes (18% ever, 3% current) was similar in 2017 and 2016. While cigarette use among Vermont adults is the same as the U.S., smokeless tobacco use, ever and current e-cigarette use are all statistically lower among Vermont adults. Alcohol use is higher among Vermont adults than the U.S. Nearly two-thirds (63%) of Vermont adults drank any alcohol during the previous month, compared with 54% of U.S. adults. Eight percent of Vermont adults heavily drank in the last month, while only six percent of U.S. adults said the same. Both of these differences are statistically significant. Binge drinking is the same for Vermont and U.S. adults (17%). Not participating in any leisure time physical activity is statistically lower among Vermont adults than US adults (21% vs. 27%). 2017 Behavioral Risk Factor Surveillance Survey Report 5

  6. Executive Summary Preventive Behaviors & Health Screenings Screening for lung cancer was a new topic on the 2017 Vermont BRFSS. Of eligible adults, 15% had been screened for lung cancer in the last year. Eligible adults include those ages 55-80 with a 30 pack-year smoking history that currently smoke or quit within the previous 15 years. Eight in ten (81%) Vermont adults 65 and older have gotten the pneumococcal vaccine and six in ten got a flu shot in the last year (60%). Pneumococcal vaccination has increased statistically since 2011, both among all adults and those 65 and older. Among all adults pneumococcal vaccination rates also increased statistically from 2016 to 2017 (39% to 45%). In contrast, flu vaccination rates have decreased significantly from 2011 to 2017 among adults 65 and older (65% vs. 60%). Shingles vaccination among adults 50 older has more than doubled since 2012, increasing from 17% in 2012 to 37% in 2017, a statistically significant change. This increase is likely due in part to increased availability of the vaccine at pharmacies and through programs such as the Vermont Department of Health’s Vaccines for Adults Program. Receipt of screening for high cholesterol during the previous five years is statistically lower among Vermont adults than U.S. adults (83% vs. 86%), as is HIV testing. Thirty-six percent of Vermont adults have ever been tested for HIV compared with 40% of U.S. adults. In the past year, eight percent of Vermont adults were tested while 12% of U.S. adults were. In 2017, fruit and vegetable consumption among Vermont adults was higher than the U.S. Four in ten Vermont adults eat fruits at least two times daily, 22% eat vegetables at least three times a day, and a quarter (26%) eat fruits and vegetables a combined five or more time per day. Among U.S. adults, the percentages are 33%, 16%, and 18%, respectively. 2017 Behavioral Risk Factor Surveillance Survey Report 6

  7. Demographics Demographics 2017 Behavioral Risk Factor Surveillance Survey Report 7

  8. Demographics Using BRFSS data, the next few pages describe the demographic make-up of adult (ages 18 and older) Vermont residents in 2017. Demographics Characteristics: Sex Percent Male 49% Half of adults are women (51% vs. 49%). Female 51% About one in every eight (13%) Vermont adults are 18-24 years of age. More than six in ten are ages 25-44 or 45-64 (63%), while nearly a quarter (23%) are 65 and older. Age 18-24 13% 25-44 28% A third (32%) of Vermont adults have a college or higher education. Nearly four in ten (38%) have a high school education or less and three in ten have some college education (29%). 45-64 35% 65+ 23% Education Level Half of Vermont adults live in a home making less than $50,000 per year. About two in ten (19%) makes $50,000 to less than $75,000 annually, while a third makes $75,000 or more. High School or Less 38% Some College 29% College or Higher 32% Ninety-four percent of Vermont adults are white, non-Hispanic. Six percent are a person of color. Household Income Level Ninety-three percent of Vermont adults identify as heterosexual or cisgender, while seven percent identify are Lesbian, Gay, Bisexual, or Transgender. Low (<$25K) 24% Middle ($25K-<$50K) 26% High ($50K-<$75K) 19% Highest (≥$75K) 32% Race/Ethnicity White, non-Hispanic 94% Person of Color 6% Sexual Orientation/Gender Identity Heterosexual/Cisgender 93% LGBT 7% 2017 Behavioral Risk Factor Surveillance Survey Report 8

  9. Demographics In 2017, six in ten Vermont adults were employed, which was defined as those responding ‘employed for wages’ or ‘self-employed’. Two in ten were retired. Seven percent or fewer adults reported their employment status as: currently unable to work, a student, unemployed, or as homemaker. About half of Vermont adults reported being married (51%) in 2017. Twenty-three percent had never been married, while 12% were divorced, six percent widowed, and five percent part of an unmarried couple. Few (2%) reported their marital status as separated. Employment Status Employed 60% Retired 20% Unable to Work 7% Student 6% Unemployed 4% Homemaker 4% Marital Status Married 51% Never Married 23% Divorced 12% Widowed 6% Unmarried Couple 5% Separated 2% 2017 Behavioral Risk Factor Surveillance Survey Report 9

  10. Demographics In 2017, a quarter (26%) of Vermont adults reported living in Chittenden county. County of Residence Ten percent lived in Rutland county and nine percent lived in Washington and Windsor counties. Between five and seven percent lived in: Franklin, Windham, Addison, Bennington, Caledonia, and Orange counties. Less than five percent lived in Orleans, Lamoille, Grand Isle, and Essex counties. Chittenden 26% Rutland 10% Washington 9% One in ten Vermont adults has ever been on active duty in the military. This includes National Guard or reservists who were activated to active duty. Windsor 9% Franklin 7% Seven in ten (71%) of Vermont adults have no children under the age of 18 in their home. An additional 13% have one child and 11% have two children in their home. Three percent have three children, while two percent counted four or more children in their home. • Four percent of women 18-44 were currently pregnant. Windham 7% Addison 6% Bennington 6% Caledonia 5% Eighty-six percent of Vermont adults reported using the internet at least once in the previous 30 days. Three-quarters (73%) of Vermont adults said they own their home. Two in ten rent, while six percent have some other arrangement. Orange 5% Orleans 4% Lamoille 4% Grand Isle 1% Essex 1% 2017 Behavioral Risk Factor Surveillance Survey Report 10

  11. Health Status Health Status Indicators Indicators 2017 Behavioral Risk Factor Surveillance Survey Report 11

  12. General Health Status General Health Fair or Poor Vermont Adults, 2017 In 2017, 14% of Vermont adults said their health is fair or poor, significantly lower than the 19% among U.S. adults. • A fifth of adults said their health was excellent, 36% said it was very good, and three in ten said good (29%). U.S. 19% 14% Vermont Male Female 14% 14% Vermont men and women report their health as fair or poor at the same rate (14%). Increasing age results in a higher proportion who report their health as fair or poor. • Adults 45 and older are significantly more likely than those 18-44 to have fair or poor health. 18-24 25-44 45-64 65+ 7% 10% 17% 19% Lower levels of education and household income yield larger proportions with fair or poor health. • All differences by education and annual household income level are statistically significant. High School or Less Some College 23% 11% 6% College+ There are no statistical differences in reported fair or poor health by race and ethnicity or sexual orientation and gender identity. Low (<$25K) 31% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) 16% 8% 4% Overall, the proportion of Vermont adults with fair or poor health has not changed statistically in the in the past 10 years. WNH POC 14% 14% Non-LGBT LGBT 14% 11% General Health Fair or Poor Vermont Adults, 2008-2017 14% 13% 13% 13% 12% 12% 12% 12% 11% 11% 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2017 Behavioral Risk Factor Surveillance Survey Report 12

  13. Medical Health Plan Coverage Have a Medical Health Plan Vermont Adults 18-64, 2017 More than nine in ten (92%) Vermont adults under the age of 65 said they have a health plan, in 2017. This is significantly higher than the 85% reported for the U.S. U.S. 85% 92% Vermont Women in Vermont are statistically more likely than men to report having a health plan. Male Female 90% 95% There are no differences by age in having a health plan. 18-24 25-44 45-64 65+ 91% 91% 94% Those with more education and income are more likely to have a health plan. • Adults with at least some college education are statistically more likely than those with less education to have a health plan. • Those in homes with incomes of at least $75,000 annually are significantly more likely to have a health plan, compared to those with less income. 0% High School or Less Some College 88% 95% 96% College+ There are no statistical differences in having a health plan by race and ethnicity or sexual orientation and gender identity. Low (<$25K) 90% 88% 92% 98% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) Health coverage rates among Vermont adults 18-64 were similar in 2016 and 2017, but has increased significantly since 2011 (89% to 92%). WNH POC 93% 87% Non-LGBT LGBT 93% 95% Have a Medical Health Plan Vermont Adults 18-64, 2008-2017 94% 93% 92% 92% 90% 89% 89% 88% 88% 87% 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2017 Behavioral Risk Factor Surveillance Survey Report 13

  14. Medical Health Plan Coverage Among adults with a health plan, regardless of age, more than four in ten (45%) have a plan purchased through their or someone else’s employer. An additional one in ten purchased their health plan themselves. A quarter of Vermont adults have Medicare, while 14% have Medicaid or some other state insurance program. Few, three percent have military or some other type of insurance. Compared with 2014, the proportion of Vermont adults with an employer purchased health plan has decreased statistically from 50% to 45%. The proportion with Medicare increased by a similar amount from one in five (21%) to more than a quarter (26%), also a statistically significant change. All other types of health plan were reported at similar rates in both years. As would be expected, when looking specifically at adults 18-64, a higher proportion, nearly six in ten have an employer purchased health plan compared with adults overall (57% vs. 45%). Fewer have Medicare (8% vs. 26%), while more report having Medicaid (18% vs. 14%). The proportion with self-purchased, military, or other health plans are similar regardless of age limitations. There are no statistical differences in the distribution of health insurance type among adults 18-64 in 2017 compared with 2014. Source of Health Plan Coverage, 2017: Vermont Adults with a Health Plan Vermont Adults 18-64 with a Health Plan 3% 3% 3% 3% Employer 9% 11% Medicare 45% Medicaid/Other State Program 14% 18% 57% Self-Purchased 8% Military or Other Government 26% Other Note: source of health plan coverage data exclude the few (<0.5%) of adults who have a health plan but do not have health insurance. 2017 Behavioral Risk Factor Surveillance Survey Report 14

  15. Medical Health Care Access Personal Health Care Provider Vermont Adults, 2017 Eighty-seven percent of Vermont adults reported having a personal health care provider in 2017, significantly higher than the 78% reported by U.S. adults. U.S. 78% Vermont 87% Women are statistically more likely than men to have a personal doctor. Male Female 83% Older adults are more likely to have a health care provider. • All differences by age are statistically significant except between those 18-24 and 25-44. 92% 18-24 25-44 45-64 65+ 80% 79% 92% 96% Vermont adults with more education and higher annual household incomes are more likely to have a personal doctor. • Adults with at least a college degree are statistically more likely than those with a high school degree or less to have a personal doctor. • Those in homes making at least $75,000 annually are statistically more likely than those with less income to have a doctor. High School or Less Some College 85% 88% 89% College+ Low (<$25K) 85% 84% 87% 92% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) Having a personal doctor does not vary statistically by race and ethnicity or sexual orientation and gender identity. WNH POC 88% 84% The proportion of adults with a personal health care provider is statistically similar since 2011. Non-LGBT LGBT 89% 81% Personal Health Care Provider Vermont Adults, 2008-2017 90% 89% 88% 88% 88% 88% 87% 87% 87% 87% 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2017 Behavioral Risk Factor Surveillance Survey Report 15

  16. Medical Health Care Access Did Not Visit Doctor Due to Cost Vermont Adults, 2017 About one in ten (9%) Vermont adults said there was a time in the last year they did not go to the doctor because of cost. This is significantly lower than the 13% among U.S. adults. U.S. 13% 9% Vermont Men and women report not seeing a doctor due to cost at similar rates. Male Female 9% 8% Cost as a barrier to care is lower among Vermonters 65 and older, when compared with those 25-64. Those with lower levels of education and annual household income are more likely to have forgone care due to cost, as compared with those with more education or higher income. • Differences by education level are not statistically significant. • Adults in homes making less than $25,000 annually are statistically more likely than those making at least $50,000 per year to delay care due to cost. • Additionally, those in homes making $25,000 to $74,999 annually are statistically more likely than those in homes with more income to not seek care due to cost. 18-24 25-44 45-64 65+ 9% 12% 9% 5% High School or Less Some College 11% 8% 8% College+ Low (<$25K) 14% 11% 9% 4% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) There are no statistical differences in delaying care due to cost by race and ethnicity or sexual orientation and gender identity. WNH POC 9% 9% The proportion of Vermont adults who delayed care in the last year due to cost in 2017 is statistically similar to that in 2016 and 2011. Non-LGBT LGBT 8% 13% Did Not Visit Doctor Due to Cost Vermont Adults, 2008-2017 11% 11% 10% 10% 9% 9% 9% 9% 8% 8% 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2017 Behavioral Risk Factor Surveillance Survey Report 16

  17. Quality of Life or Healthy Days Poor* Physical Health Vermont Adults, 2017 One in ten (11%) Vermont adults reported poor* physical health in 2017, similar to the 12% reported among U.S. adults. U.S. 12% 11% Vermont men and women report similar rates of poor physical health. Vermont Poor physical health increases as Vermonters age. • Adults 45 and older are statistically more likely to have poor physical health than younger adults, ages 1844. Male Female 11% 12% 18-24 25-44 45-64 65+ Suppressed** Those with less education and lower annual household income levels are more likely to report poor physical health. 9% 14% 14% • All differences by education level are statistically significant. • All differences by annual household income level are statistically significant except that between those in middle and high income homes. High School or Less Some College 16% 11% 7% College+ Low (<$25K) 24% There are no statistical differences in reported poor physical health by race and ethnicity or sexual orientation and gender identity. Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) 13% 9% 4% The proportion of Vermont adults with poor physical health is statistically unchanged since 2011. WNH POC 11% 10% Non-LGBT LGBT 11% 12% Poor* Physical Health Vermont Adults, 2008-2017 11% 11% 11% 11% 11% 10% 10% 10% 10% 9% 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 *Poor physical health defined as 14+ days in the last 30 where physical health self-reported as not good. **Value suppressed because sample size too small or relative standard error (RSE) is > 30. 2017 Behavioral Risk Factor Surveillance Survey Report 17

  18. Quality of Life or Healthy Days Poor* Mental Health Vermont Adults, 2017 In 2017, thirteen percent of Vermont adults reported poor* mental health, similar to that among U.S. adults (12%). U.S. 12% 13% Vermont women are more likely than men to report poor mental health, however the difference is not statistically significant. Vermont Male Female 11% 15% Reported poor mental health is highest among younger adults. • Adults 18-44 are statistically more likely than those 45 and older to report poor mental health. 18-24 25-44 45-64 65+ 23% 15% 13% 7% Adults with less education and lower annual household income levels more often report poor mental health. • Adults with a less than college degree are statistically more likely than those with more education to report poor mental health. • All differences by annual household income level are statistically significantly except that between those in homes with middle and high incomes. High School or Less Some College 17% 15% 7% College+ Low (<$25K) 25% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) 13% 11% 6% There are no statistical differences in reported poor mental health by race and ethnicity. WNH POC 13% 17% LGBT adults are statistically more likely than non- LGBT adults to report poor mental health. The proportion of Vermont adults with poor mental health is statistically unchanged since 2011. Non-LGBT LGBT 12% 31% Adults with any poor physical or mental health days in the last month said, on average, their poor health kept them from participating in their usual activities for 4.5 days in the last month. Poor* Mental Health Vermont Adults, 2008-2017 13% 12% 12% 11% 11% 10% 10% 10% 9% 9% 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 *Poor mental health defined as 14+ days in the last 30 where mental health self-reported as not good. 2017 Behavioral Risk Factor Surveillance Survey Report 18

  19. Disability Vermont Adults with a Disability, 2017 Disability includes anyone who reports serious difficulty seeing, hearing, walking or climbing stairs, dressing or bathing, concentrating or making decisions, or who, because of a physical, mental, or emotional condition has difficulty doing errands alone. U.S. 27% 25% Vermont Male Female 24% 26% In 2017, a quarter of Vermont adults reported that they are disabled, statistically similar to the 27% among U.S. adults overall. 18-24 25-44 45-64 65+ 21% 17% 25% Men and women in Vermont report disability at similar rates. Disability is higher among older adults. • Adults 65 and older are statistically more likely than younger adults to be disabled. • Likewise, adults 45-64 are more likely to be disabled than those 25-44. 38% High School or Less Some College 36% 23% 15% Adults with less education and lower annual household income levels are more likely to report disability than those with more education and higher incomes. • All differences by education and annual household income levels are statistically significant. College+ Low (<$25K) 48% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) 28% 17% 10% There are no statistical differences in the prevalence of disability by race and ethnicity or sexual orientation and gender identity. WNH POC 25% 26% The proportion of Vermont adults with a reported disability increased significantly from 2016 to 2017 (22% to 25%). Due to changes in the questions used to define disability in 2016, comparisons to prior years cannot be made. Non-LGBT LGBT 25% 28% Vermont Adults with a Disability, 2008-2017 26% 25% 24% 23% 23% 23% 22% 22% 21% 21% 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2017 Behavioral Risk Factor Surveillance Survey Report 19

  20. Disability In 2017, individual questions were asked about specific disabilities or challenges adults may face related to disability. Due to a physical, mental, or emotional conditions, one in eight (12%) Vermont adults have difficulty walking or climbing stairs. Slightly fewer, one in ten, have serious difficulty concentrating, remembering, or making decisions. Eight percent of Vermont adults have a hearing impairment, while six percent or fewer have serious difficulty doing errands alone (6%), seeing (4%), and dressing or bathing (3%). The proportion of Vermont adults with each type of disability has remained similar since 2015. Type of Disability 2015 2016 2017 12% 11% 11% 10% 9% 9% 8% 6% 6% 6% 6% 4% 3% 3% 3% 3% 3% N/A Walking or Climbing Stairs Concentrating/ Remembering/ Making Decisions Hearing Impairment Doing Errands Alone Blind Dressing or Bathing Note: Hearing impairment was not asked about on the 2016 BRFSS. 2017 Behavioral Risk Factor Surveillance Survey Report 20

  21. Chronic Chronic Conditions Conditions 2017 Behavioral Risk Factor Surveillance Survey Report 21

  22. Arthritis Adults with Arthritis Vermont Adults, 2017 In 2017, nearly three in ten (28%) of Vermont adults said they have arthritis, statistically higher than the 25% reported for all U.S. adults. U.S. 25% 28% Vermont women report having arthritis at a statistically higher rate than men. Diagnosis of arthritis increases with increasing age. • All differences by age are statistically significant. Vermont Male Female 25% 31% Prevalence of arthritis decreases with increasing education level and annual household income level. • Adults with a high school degree or less are statistically more likely than those with at least a college degree to have arthritis. • Those in homes with the least income, less than $25,000 annually, are statistically more likely to have arthritis, compared with those with more household income. • Additionally, adults in homes with an income of $25,000 to less than $50,000 per year are statistically more likely than those in homes with incomes of at least $75,000 to have arthritis. 18-24 25-44 45-64 65+ Suppressed* 12% 35% 51% High School or Less Some College 32% 27% 24% College+ Low (<$25K) 39% 31% 25% 20% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) White, non-Hispanic adults report arthritis at a statistically higher rate than people of color. Non-LGBT adults are twice as likely as LGBT adults to have arthritis, a statistically significant difference. WNH POC 28% 21% The prevalence of arthritis has remained similar since 2011. Non-LGBT LGBT 30% 17% Adults with Arthritis Vermont Adults, 2009-2017 29% 28% 28% 28% 28% 27% 27% 27% 2009 2011 2012 2013 2014 2015 2016 2017 *Value suppressed because sample size too small or relative standard error (RSE) is > 30. 2017 Behavioral Risk Factor Surveillance Survey Report 22

  23. Arthritis Burden Arthritis can impact a person’s participation in social activities and limit both the amount and type of work they do. Half of Vermont adults with arthritis said they limited their usual activities due to arthritis or other joint symptoms. Four in ten (41%) adults with arthritis said their arthritis or joint symptoms limited their social activities at least a little bit. • Seventeen percent said their social activities were limited a lot, while a quarter said they were limited a little socially by their arthritis or joint pain. A third said their arthritis or joint symptoms affects whether they work, the type of work they do, and/or the amount of work they do. On average, Vermont adults with arthritis rated their joint pain in the last month as 4.2, on a scale of 1 to 10. Limitations Due to Joint Symptoms Vermont Adults with Arthritis, 2017 50% 41% 33% Usual Activities Limited* Social Activities Limited** Work Affected *Age adjusted to U.S. 2000 population. Also note, this measure is a Healthy Vermonters 2020 goal. **Limited social activities is defined as adults with arthritis who reported that their arthritis interfered with their normal social activities (e.g., going shopping or to the movies) a little or a lot. 2017 Behavioral Risk Factor Surveillance Survey Report 23

  24. Asthma Adults with Current Asthma Vermont Adults, 2017 In 2017, nearly one in five (18%) Vermont adults said they had ever been diagnosed with asthma, while 12% currently have asthma. Vermont adults have a statistically higher rate of current asthma than the U.S. overall (9%). U.S. 9% 12% Vermont Women are twice as likely to report having asthma, a statistically significant difference. Male Female 8% 15% There are no statistical differences in asthma prevalence by age. 18-24 25-44 45-64 65+ 15% 14% 11% 10% Those with less education and lower annual household income are more likely to have asthma. • Adults in homes with a high school degree or less are statistically more likely than those with at least a college degree to have asthma. • Those in homes with incomes of less than $25,000 annually are statistically more likely to have asthma than those with more income. High School or Less Some College 14% 12% 10% College+ Low (<$25K) 18% 11% 11% 10% There are no statistical differences in asthma prevalence by race and ethnicity or sexual orientation and gender identity. Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) The prevalence of asthma has remained similar since 2011. WNH POC 12% 14% Non-LGBT LGBT 12% 16% Adults with Asthma Vermont Adults, 2008-2017 12% 11% 11% 11% 11% 11% 11% 10% 10% 10% 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2017 Behavioral Risk Factor Surveillance Survey Report 24

  25. Non-Skin Cancer Diagnosis Adults Diagnosed with Cancer Vermont Adults, 2017 Eight percent of Vermont adults have ever been diagnosed with cancer, statistically similar to the 7% for the U.S. overall. This definition of cancer excludes skin cancer. U.S. 7% 8% Vermont Women are statistically more likely to have had cancer than men. Male Female 5% 10% As age increases, so does the proportion of Vermont adults ever diagnosed with cancer. • All differences by age are statistically significant. 18-24 25-44 45-64 65+ Suppressed* 4% 7% There are no differences in cancer prevalence by education level. 17% Adults in homes with incomes of less than $50,000 are statistically more likely to have had cancer than those with more income. High School or Less Some College 8% 6% 8% There are no statistical differences in the prevalence of cancer by race and ethnicity. A statistical comparison by sexual orientation and gender identity was not made due to suppression of some of data. College+ Low (<$25K) 10% 9% 5% 5% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) The prevalence of cancer has not changed significantly since 2011. WNH POC 8% 5% Non-LGBT LGBT 8% Suppressed* Adults Diagnosed with Cancer Vermont Adults, 2011-2017 8% 8% 7% 7% 7% 7% 6% 2011 2012 2013 2014 2015 2016 2017 *Value suppressed because sample size too small or relative standard error (RSE) is > 30.. 2017 Behavioral Risk Factor Surveillance Survey Report 25

  26. Skin Cancer Diagnosis Adults Diagnosed with Skin Cancer Vermont Adults, 2017 In 2017, seven percent of Vermont adults reported they had ever been diagnosed with skin cancer, statistically higher than the 6% among U.S. adults overall. U.S. 6% 7% Vermont Men and women report having skin cancer at the same rate. Male Female 7% 7% As age increases so does the proportion of Vermont adults ever diagnosed with skin cancer. • All differences by age are statistically significant. 18-24 25-44 45-64 65+ Suppressed* Suppressed* Skin cancer prevalence also increases with education level. • Adults with a college degree or higher are statistically more likely than those with a high school degree or less to have ever been diagnosed with skin cancer. 8% 18% High School or Less Some College 6% 7% 9% College+ Ever having skin cancer is statistically more likely among adults in homes making at least $75,000 annually, compared with those in homes making less than $25,000 per year. Low (<$25K) 5% 7% 7% 10% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) White, non-Hispanic adults are four times as likely as people of color to have ever been diagnosed with skin cancer, a statistically significant difference. WNH POC 8% 2% A statistical comparison by sexual orientation and gender identity was not made due to suppression of some data. Non-LGBT LGBT 8% The prevalence of skin cancer is statistically unchanged since 2011. Suppressed* Adults Diagnosed with Skin Cancer Vermont Adults, 2011-2017 7% 7% 7% 6% 6% 6% 6% 2011 2012 2013 2014 2015 2016 2017 *Value suppressed because sample size too small or relative standard error (RSE) is > 30. 2017 Behavioral Risk Factor Surveillance Survey Report 26

  27. Cardiovascular Disease Adults with Cardiovascular Disease Vermont Adults, 2017 Cardiovascular disease (CVD) is defined as ever having been diagnosed with coronary heart disease, a myocardial infarction (heart attack), or a stroke. U.S. 9% 8% In 2017, fewer than one in ten (8%) Vermont adults reported ever being diagnosed with CVD. • Five percent had a myocardial infarction, four percent had coronary heart disease, and three percent had a stroke. • This is statistically similar to the 9% among U.S. adults. Vermont Male Female 11% 6% 18-24 25-44 45-64 65+ Suppressed* 2% 8% Men are statistically more likely than women to have CVD. 21% CVD prevalence increases as Vermonters age. • All differences by age are statistically significant. High School or Less Some College 12% 7% 5% Adults with less education and lower annual household income levels are more likely to have CVD. • Adults with a high school degree or less are statistically more likely than those with more education to have CVD. • Adults in homes making less than $50,000 annually are statistically more likely than those in homes with more income to have CVD. There are no statistical differences in the prevalence of CVD by race and ethnicity or sexual orientation and gender identity. College+ Low (<$25K) 14% 10% 5% 3% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) WNH POC 8% 7% Non-LGBT LGBT 9% 5% The prevalence of CVD is unchanged since 2011. Adults with Cardiovascular Disease Vermont Adults, 2008-2017 8% 8% 8% 8% 8% 8% 8% 7% 7% 7% 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 *Value suppressed because sample size too small or relative standard error (RSE) is > 30. 2017 Behavioral Risk Factor Surveillance Survey Report 27

  28. Chronic Obstructive Pulmonary Disease Adults with COPD Vermont Adults, 2017 About one in twenty (6%) Vermont adults had ever been told they have chronic obstructive pulmonary disease, or COPD, in 2017. This is similar to the U.S. rate (7%). U.S. 7% 6% Vermont Men and women report having COPD at a similar rate. Male Female 6% 7% The prevalence of COPD increases as Vermonters age. • Adults 45 and older are statistically more likely than younger adults to have COPD. 18-24 25-44 45-64 65+ Suppressed* 2% Adults with less education and lower annual household incomes are more likely to have COPD. • All differences by education level are statistically significant. • All differences by annual household income level, except that between adults in homes making $50,000 to $74,999 and $75,000 or more per year. 9% 12% High School or Less Some College 11% 5% 3% College+ There are no statistical differences in the prevalence of COPD by race and ethnicity or sexual orientation and gender identity. Low (<$25K) 15% 7% 3% 2% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) The prevalence of COPD is statistically higher in 2017 than 2011 (6% vs. 5%). WNH POC 6% 7% Non-LGBT LGBT 7% 6% Adults with COPD Vermont Adults, 2008-2017 6% 6% 6% 6% 6% 6% 5% 3% 2008 2011 2012 2013 2014 2015 2016 2017 *Value suppressed because sample size too small or relative standard error (RSE) is > 30. 2017 Behavioral Risk Factor Surveillance Survey Report 28

  29. Depressive Disorder Adults with a Depressive Disorder Vermont Adults, 2017 A quarter of Vermont adults reported ever being told they have a depressive disorder, significantly higher than the 19% among U.S. adults. • Depressive disorders were defined as depression, major depression, dysthymia, or minor depression. U.S. 19% 25% Vermont Male Female 20% Women are statistically more likely than men to report having a depressive disorder. 31% Adults 65 and older are statistically less likely than younger adults to report ever being diagnosed with a depressive disorder. 18-24 25-44 45-64 65+ 30% 29% 26% 18% Adults with less education and lower annual household incomes report higher rates of depressive disorders. • Those with some college education or less are statistically more likely to have a depressive disorder than those with a college degree or higher. • Adults in homes with less than $25,000 annual income are statistically more likely than those with more income to have a depressive disorder. High School or Less Some College 28% 28% College+ 19% Low (<$25K) 39% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) 24% 22% 20% There is no statistical difference in the prevalence of depressive disorders by race and ethnicity. WNH POC 26% 24% LGBT adults are nearly twice as likely as non-LGBT adults to have ever been diagnosed with a depressive disorder, a statistically significant difference. Non-LGBT LGBT 25% 46% Vermont adults have reported similar rates of depressive disorders since 2011. Adults with a Depressive Disorder Vermont Adults, 2008-2017 25% 23% 23% 23% 22% 22% 22% 21% 21% 2008 2010 2011 2012 2013 2014 2015 2016 2017 2017 Behavioral Risk Factor Surveillance Survey Report 29

  30. Pre-Diabetes Adults with Pre-Diabetes Vermont Adults, 2017 In 2017, seven percent of Vermont adults had been told they have borderline or pre-diabetes. Men and women report having pre-diabetes at statistically similar rates. N/A U.S. Vermont 7% As age increases, so does the rate of pre-diabetes. • All differences by age are statistically significant. Male Female 6% 8% Adults with less education and lower annual household incomes are more likely to have diabetes. • Adults with a high school degree or less are statistically more likely than those with a college degree to have pre-diabetes. • Adults in homes making less than $25,000 annually are statistically more likely than those with incomes of at least $75,000 to have pre-diabetes. 18-24 25-44 45-64 65+ Suppressed* 3% 8% 13% High School or Less Some College 9% 7% 5% College+ There are no statistical differences in the prevalence of pre-diabetes by race and ethnicity. A statistical comparison by sexual orientation and gender identity was not made due to data suppression. Low (<$25K) 11% 7% 7% 5% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) The prevalence of pre- diabetes is unchanged since 2011. WNH POC 7% 4% Pre-diabetes is likely under-reported due to a relatively low rate of testing. In 2017, 53% of Vermont adults said they had been tested for diabetes or high blood sugar in the preceding three years. • Fifteen percent of adults with pre-diabetes have ever participated in a lifestyle change program to improve their health or prevent diabetes. Non-LGBT LGBT 7% Suppressed* Adults with Pre-Diabetes Vermont Adults, 2008-2017 7% 6% 6% 5% 5% 4% 4% 2008 2009 2010 2012 2013 2014 2017 *Value suppressed because sample size too small or relative standard error (RSE) is > 30. 2017 Behavioral Risk Factor Surveillance Survey Report 30

  31. Diabetes Adults with Diabetes Vermont Adults, 2017 Less than one in ten (8%) of Vermont adults have been told they have diabetes, significantly lower than the 11% among U.S. adults. U.S. 11% 8% Men are statistically more likely than women to report having diabetes. Vermont Diabetes prevalence increases with age. • All differences by age are statistically significant. Male Female 10% 7% Adults with less education and lower annual household incomes are more likely to have diabetes. • Adults with a high school degree or less are statistically more likely than those with more education to have been diagnosed with diabetes. • Adults in homes making less than $50,000 annually are statistically more likely than those with more income to have been diagnosed with diabetes. 18-24 25-44 45-64 65+ Suppressed* 2% 10% 18% High School or Less Some College 11% 7% 6% College+ Low (<$25K) 14% 10% 5% 5% There is no statistical difference in the prevalence of diabetes by race and ethnicity. Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) Non-LGBT adults are statistically more likely to have diabetes than LGBT adults. The prevalence of diabetes is unchanged since 2011. WNH POC 8% 12% Non-LGBT LGBT 9% 4% Adults with Diabetes Vermont Adults, 2008-2017 8% 8% 8% 8% 8% 8% 7% 7% 6% 6% 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 *Value suppressed because sample size too small or relative standard error (RSE) is > 30. 2017 Behavioral Risk Factor Surveillance Survey Report 31

  32. Diabetes Care Receive Appropriate Care Vermont Adults with Diabetes, 2017 Adults with diabetes should receive specialized care from their physicians. In 2017, those with diabetes reported the following: • Nine in ten (89%) saw their doctor for their diabetes at least once in the past year. • Eight in ten (82%) said that a health professional checked their feet for sores or irritations in the last year. • Three-quarters (76%) received a test for their “A1C” at least twice in the last year. • “A1C” measures blood sugar levels over the past three months. • Two-thirds had an annual eye exam, where their eyes were dilated, in the last year. • Seven percent of adults with diabetes have been told by a doctor that their diabetes has affected their eyes or that they have retinopathy. • Sixty-one percent test their blood sugar at least once per day. • Less than half (45%) have taken a course or class on managing their diabetes. • About a third (35%) reported that they currently take insulin. Annual Doctor Visit 89% Annual Doctor Feet Check 82% A1C Test 2x/Year 76% Annual Eye Exam* 66% Daily Glucose Test 61% Diabetes Education* 45% *Age adjusted to U.S. 2000 population. [Note: Annual eye exams and diabetes education are Healthy Vermonters 2020 measures]. 2017 Behavioral Risk Factor Surveillance Survey Report 32

  33. High Cholesterol Adults Told Have High Cholesterol Vermont Adults, 2017 Nearly three in ten (28%) Vermont adults report they have been told they have high cholesterol. This is significantly lower than the 32% among all U.S. adults. • This is likely an underestimate as only 83% of adults have had their cholesterol checked in the last five years. • Six in ten adults with high cholesterol are taking medication to reduce it. U.S. 32% 28% Vermont Male Female 31% 25% Men are significantly more likely than women to report having high cholesterol. Suppressed* 18-24 25-44 45-64 65+ 13% All differences by age are statistically significant. 33% Rates of high cholesterol are highest among those with the lower education and annual household income levels. • Adults with a high school degree or less are statistically more likely to have high cholesterol than those with a college degree or higher. • Those in homes making less than $50,000 per year are statistically more likely than those in homes making $75,000 or more to have high cholesterol. 48% High School or Less Some College 31% 28% 26% College+ Low (<$25K) 32% 32% 28% 25% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) White, non-Hispanic adults are statistically more likely than people of color to have high cholesterol. WNH POC 29% Non-LGBT adults are statistically more likely than LGBT adults to have high cholesterol. 18% The proportion of Vermont adults with high cholesterol decreased from 2015 to 2017, however, changes in the question used to measure cholesterol screening make it difficult to know whether the change is a true decrease. Non-LGBT LGBT 31% 16% Told Have High Cholesterol Vermont Adults, 2003-2017 36% 36% 35% 35% 34% 34% 31% 28% 2003 2005 2007 2009 2011 2013 2015 2017 *Value suppressed because sample size too small or relative standard error (RSE) is > 30. 2017 Behavioral Risk Factor Surveillance Survey Report 33

  34. Hypertension Adults with Hypertension* Vermont Adults, 2017 A quarter (26%) of Vermont adults report having been told they have hypertension, also known as high blood pressure. This is significantly less than the 30% among U.S. adults overall. • Three quarters (74%) of adults with diagnosed hypertension are currently taking medication to treat it. U.S. 30% 26% Vermont Male Female 29% 23% Men are statistically more likely than females to have been diagnosed with high blood pressure. Hypertension diagnosis increases as Vermont adults age. • All differences by age are statistically significant. 18-24 25-44 45-64 65+ 8% 14% 35% 56% Adults with lower education and annual household income levels are more likely to report having high blood pressure. • Adults with a high school degree or less are statistically more likely than those with more education to have hypertension. • Those in homes with incomes of less than $25,000 per year are statistically more likely than those with more income to have been diagnosed with hypertension. • Likewise, hypertension diagnosis is more likely among those in homes making $25,000-$49,999 vs. $75,000 or more. High School or Less Some College 31% 25% 21% College+ Low (<$25K) 37% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) 27% 26% 21% WNH POC 26% 26% There are no statistical differences in the prevalence of hypertension by race and ethnicity or sexual orientation and gender identity. Non-LGBT LGBT 26% 28% The prevalence of hypertension in 2017 (26%) is similar to 2015 (25%) and lower than in 2011 (27%), however the difference between 2017 and 2011 is not statistically significant. Adults with Hypertension* Vermont Adults, 2003-2017 27% 27% 26% 25% 25% 23% 22% 22% 2003 2005 2007 2009 2011 2013 2015 2017 *All data on this page are age-adjusted to U.S. 2000 population, except that by age and that for use of medications. [Note: This measure is a Healthy Vermonters 2020 goal]. 2017 Behavioral Risk Factor Surveillance Survey Report 34

  35. Kidney Disease Adults with Chronic Kidney Disease Vermont Adults, 2017 Two percent of Vermont adults reported having kidney disease in 2017, statistically lower than the 3% among U.S. adults. • Excluded from the kidney disease definition are the occurrence of kidney stones, bladder infections, and incontinence. U.S. 3% 2% Vermont Male Female 2% 3% Men and women report having kidney disease at a similar rate. 18-24 25-44 45-64 65+ Suppressed* Suppressed* Diagnosis with kidney disease increases with age. • All differences by age are statistically significant. 2% 5% There are no differences in the prevalence of kidney disease by education level. High School or Less Some College 3% 2% 2% Adults in homes making less than $25,000 per year are statistically more likely than those making at least $75,000 annually to report kidney disease. College+ Statistical comparisons were not made for the prevalence of kidney disease by race and ethnicity and sexual orientation and gender identity due to suppression of data. Low (<$25K) 4% 3% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) 1% The prevalence of kidney disease is statistically unchanged since 2011. WNH POC 2% Suppressed* Kidney disease is a concern for those with diabetes. In 2017, 11% of Vermont adults diagnosed with diabetes had kidney disease compared with two percent among those without diabetes, a statistically significant difference. Non-LGBT LGBT 3% Suppressed* Adults with Chronic Kidney Disease Vermont Adults, 2008-2017 3% 3% 3% 2% 2% 2% 2% 2011 2012 2013 2014 2015 2016 2017 *Value suppressed because sample size too small or relative standard error (RSE) is > 30. 2017 Behavioral Risk Factor Surveillance Survey Report 35

  36. Obesity and Overweight Obese* Adults In 2017, more than a quarter (28%) of Vermont adults (20 and older) reported being obese, while an additional 35% were overweight. The rate of obesity in Vermont is significantly lower than in the U.S. overall (31%), while the rate of overweight is the same (35%). Vermont Adults 20 and Older, 2017 U.S. 31% 28% Vermont Male Female 28% 28% Men and women report obesity at similar rates. Rates of obesity are lowest among those 18-24. • Adults 25 and older are statistically more likely than younger adults to be obese. 20-24 25-44 45-64 65+ 15% 29% 32% 27% Adults with less education and lower annual household income levels are more likely to be obese. • All differences by education level are statistically significant. • Adults in homes making less than $75,000 annually are statistically more likely than those with more income to be obese. High School or Less Some College 37% 29% 18% College+ There are no statistical differences in the prevalence of obesity by race and ethnicity or sexual orientation and gender identity. Low (<$25K) 37% 33% 29% 21% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) Among adults 20 and older in Vermont, the rate of obesity was unchanged from 2016 to 2017, and the increase from 2011 to 2017 is not statistically significant. The rate of overweight also remains statistically unchanged since 2011. WNH POC 28% 29% Non-LGBT LGBT 29% 30% Overweight and Obese* Adults Vermont Adults 20 and Older, 2008-2017 Overweight Obese 37% 37% 36% 36% 35% 35% 35% 35% 34% 34% 28% 2016 28% 2017 26% 2011 25% 2010 25% 2013 25% 2014 25% 2015 24% 2008 24% 2009 23% 2012 *All data on this page are age-adjusted to U.S. 2000 population, except that by age. [Note: This measure is a Healthy Vermonters 2020 goal]. 2017 Behavioral Risk Factor Surveillance Survey Report 36

  37. Risk Risk Behaviors Behaviors 2017 Behavioral Risk Factor Surveillance Survey Report 37

  38. Alcohol Consumption – Any in Last Month Any Alcohol Consumption Vermont Adults, 2017 More than six in ten (63%) of Vermont adults said they drank alcohol during the last 30 days, in 2017. Past 30 day alcohol use is significantly higher in Vermont compared to the U.S. (63% vs. 54%). U.S. 54% Vermont 63% Men report drinking alcohol significantly more than women. Male Female 68% Alcohol consumption is highest among those 25-44 and lowest among those 65 and older. • Rates are statistically higher among those 25-64 than those 65 and older. 58% 18-24 25-44 45-64 65+ 63% 68% 64% 54% Adults with more education and higher annual household income levels are more likely to report drinking alcohol than those with less income and lower income. • All differences by education level are statistically significant. • All differences by annual household income level are statistically significant except that between those in homes making $25,000-$49,999 and $50,000- $74,999. High School or Less Some College 48% 67% College+ 76% Low (<$25K) 45% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) 60% 68% There are no statistical differences in the consumption of alcohol by race and ethnicity or sexual orientation and gender identity. 78% WNH POC 63% The prevalence of any alcohol consumption is statistically similar to that in 2011 (65%) and 2016 (64%). 53% Non-LGBT LGBT 63% 62% Adults with Any Alcohol Consumption Vermont Adults, 2008-2017 65% 65% 65% 65% 64% 64% 64% 63% 63% 61% 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2017 Behavioral Risk Factor Surveillance Survey Report 38

  39. Alcohol Consumption – Binge Drinking Binge Drinking Vermont Adults, 2017 An episode of binge drinking is defined as five or more drinks on one occasion for men and four or more women. U.S. 17% 17% In 2017, seventeen percent of Vermont adults said they binge drank in the last month, the same as among U.S. adults. Vermont Male Female 22% Vermont men are nearly twice as likely as women to report binge drinking, a statistically significant difference. 13% 18-24 25-44 45-64 65+ 30% 27% Binge drinking decreases as Vermonters get older. • All differences by age are statistically significant, except that between adults 18- 24 and 25-44. 14% 5% Adults with some college education are statistically more likely than those with less education to binge drink. High School or Less Some College 15% 21% 17% College+ There are no statistical differences in binge drinking by annual household income level, race and ethnicity, or sexual orientation and gender identity. Low (<$25K) 15% 17% 18% 21% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) Binge drinking rates among Vermont adults are statistically unchanged since 2011. WNH POC 17% 20% Non-LGBT LGBT 17% 16% Adults who Reported Binge Drinking Vermont Adults, 2008-2017 19% 18% 18% 18% 17% 17% 17% 17% 17% 17% 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2017 Behavioral Risk Factor Surveillance Survey Report 39

  40. Alcohol Consumption – Heavy Drinking Heavy Drinking Vermont Adults, 2017 In 2017, eight percent of Vermont adults reported drinking heavily in the last month, significantly higher than the 6% among U.S. adults overall. • Heavy drinking is defined as more than two drinks per day for men and more than one drink for women. U.S. 6% 8% Vermont Male Female 8% 8% Among men and women in Vermont, heavy drinking rates are the same. Heavy drinking rates are highest among adults 18- 44, and decreases in older age groups. • Adults 25-44 are statistically more likely than those 65 and older to report heavy drinking. 18-24 25-44 45-64 65+ 9% 9% 8% 6% There are no differences in heavy drinking by education level or household income level. High School or Less Some College 7% 9% 8% Likewise, heavy drinking does not differ statistically by race and ethnicity. College+ Non-LGBT adults are three times as likely as LGBT adults to report heavy drinking, a statistically significant difference. Low (<$25K) 7% 7% 9% 10% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) Heavy drinking remains similar among Vermont adults since 2011. WNH POC 8% 8% Non-LGBT LGBT 9% 3% Adults who Reported Heavy Drinking Vermont Adults, 2008-2017 9% 9% 8% 8% 8% 8% 7% 7% 7% 7% 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2017 Behavioral Risk Factor Surveillance Survey Report 40

  41. Community Safety for Walking Adults Whose Community is Not* Safe for Walking Vermont Adults, 2017 One in ten (9%) of Vermont adults said their community is either only slightly safe (7%) or not at all safe (2%) for walking. • More than half (54%) said their community is extremely safe and 37% said it is quite safe for walking. U.S. N/A Vermont 9% Men and women report their community as not safe for walking at similar rates. Male Female 8% 10% There are no differences by age in reporting that their community is not safe for walking. 18-24 25-44 45-64 65+ 12% 8% 9% 9% Vermont adults with less education levels and lower annual household income levels are more likely to say that their community is not safe for walking. • All differences by education level are statistically significant. • Adults in homes making less than $25,000 per year are statistically more likely than those with more income to say their community is not safe for walking. • Those in homes making $25,000-$49,999 are statistically more likely than those in homes making at least $75,000 annually to feel their community is not safe for walking. High School or Less Some College 13% 8% 4% College+ Low (<$25K) 17% 10% 7% 4% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) There are no statistical differences community safety for walking by race and ethnicity or sexual orientation and gender identity. WNH POC 9% 14% Non-LGBT LGBT 9% 12% Community Safety for Walking Vermont Adults, 2011 & 2017 2011 2017 54% 48% 43% 37% 7% 7% 2% 2% Extremely Safe Quite Safe Slightly Safe Not at All Safe *Not safe for walking defined as those responding “not at all safe” or “slightly safe” to question: Overall, how would you rate your community as a safe place to walk? 2017 Behavioral Risk Factor Surveillance Survey Report 41

  42. HIV Transmission Risk HIV Transmission Risk Behaviors Vermont Adults, 2017 In 2017, respondents were asked about their participation in four high-risk behaviors for HIV transmission. • These included any of the following behaviors, during the last year: intravenous drug use, treatment for a sexually transmitted or venereal disease, gave or received sex or drugs for money, and anal sex without a condom. • Respondents were not asked to identify which of the behaviors they participated in, only whether they did any of them in the last year. U.S. 6% 7% Vermont Male Female 8% 5% 18-24 25-44 45-64 65+ 19% 11% 3% Seven percent of Vermont adults said they participated in a high-risk behavior during the last year, similar to the 6% among U.S. adults overall. High School or Less Some College 7% 8% 5% Men are statistically more likely than women to take part in high-risk HIV transmission behaviors. College+ Adults 18-24 are nine times more likely than those 45-64 to participate in high-risk behaviors related to HIV transmission, a statistically significant difference. Low (<$25K) 8% 7% 7% 6% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) There are no statistical differences by education level and annual household income levels. Statistical comparison by race and ethnicity was not made due to suppression of data. WNH POC 6% Suppressed* LGBT adults are more than four times as likely as non-LGBT adults to report participating in high-risk HIV transmission behaviors, a statistically significant difference. Non-LGBT LGBT 5% 23% The proportion of adults participating in high-risk HIV transmission behaviors in 2017, is statistically higher than 2011 (3%), but unchanged from 2016 (7%). Adults with High Risk HIV Transmission Behaviors Vermont Adults, 2008-2012, 2016-2017 7% 7% 4% 3% 3% 3% 3% 2008 2009 2010 2011 2012 2016 2017 *Value suppressed because sample size too small or relative standard error (RSE) is > 30. 2017 Behavioral Risk Factor Surveillance Survey Report 42

  43. Intimate Partner Violence - Physical Ever Physically Hurt by Intimate Partner Vermont Adults, 2017 Fifteen percent of Vermont adults said that a partner had ever physically hurt them. • One percent said they had been physically hurt in the last year. • Physically hurt is defined as being hit, slapped, pushed, kicked or hurt in any way. U.S. N/A Vermont 15% Male Female 9% Women are twice as likely as men (20% vs. 9%) to report ever being physically hurt by a partner, a statistically significant difference. 20% 18-24 25-44 45-64 65+ 17% 17% 15% 11% Adults 18-44 are most likely to report being physically hurt by a partner. • Adults 25-64 are statistically more likely than older adults to have ever experienced physical harm via a partner. High School or Less Some College Adults with some college education are statistically more likely than those with more education to have experience physical harm by a partner. 15% 18% 11% College+ Adults in homes with lower annual household incomes are more likely to have been physically hurt by a partner. • Those in homes making less than $25,000 annually are statistically more likely than those with more income to have been physically harmed by a partner. Low (<$25K) 23% 15% 14% 11% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) WNH POC 14% 16% There is no statistical difference by race and ethnicity in experiences with being physically hurt by a partner. Non-LGBT LGBT 14% LGBT adults are statistically more likely than non- LGBT adults to have experienced physical harm by a partner. 24% Reported physical harm by a partner is statistically similar in 2017 and 2014 (13%), the most recent year the topic was included on the survey. 2017 Behavioral Risk Factor Surveillance Survey Report 43

  44. Intimate Partner Violence - Threaten Ever Threatened by Intimate Partner Vermont Adults, 2017 In 2017, 14% of Vermont adults reported that an intimate partner had ever threatened them or made them feel unsafe. • Two percent said this had happened in the last year. U.S. N/A Vermont 14% Women are more than three times as likely as men (22% vs. 6%) to report every being threatened by a partner, a statistically significant difference. Male Female 6% 22% Ever experiencing threatening behavior or being made to feel unsafe by a partner decreases with age. • Adults 18-64 are statistically more likely than those 65 and older to have every been threatened or made to feel unsafe by a partner. 18-24 25-44 45-64 65+ 20% 17% 14% 8% High School or Less Some College Adults with some college education are statistically more likely to have been threatened by a partner than those with a college degree or higher. 14% 17% 12% College+ Likewise, those in homes with annual incomes of less than $25,000 annually are statistically more likely than those with more income to have been threatened by a partner. Low (<$25K) 22% 15% 13% 11% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) There are no statistical differences in having a partner ever threaten or made to feel unsafe by race and ethnicity. WNH POC 14% 21% LGBT adults are more than twice as likely as non- LGBT to report a partner having ever threatened them or made them feel unsafe (29% vs. 13%), a statistically significant difference. Non-LGBT LGBT 13% 29% Reported threatening behavior by a partner is statistically higher in 2017 than 2014 (14% vs. 12%), the most recent year the topic was included on the survey. 2017 Behavioral Risk Factor Surveillance Survey Report 44

  45. Intimate Partner Violence - Control Intimate Partner Ever Tried to Control Activities Vermont Adults, 2017 Fourteen percent of adults report that an intimate partner had ever tried to control their daily activities. • Two percent said this had happened in the last year. U.S. N/A Vermont 14% Women are statistically more likely than men to report a partner ever tried to control their behavior. Male Female 9% 18% Reported controlling behavior by a partner decreases with age. • All differences by age are statistically significant except that between adults 18- 24 and 25-44. 18-24 25-44 45-64 65+ 20% 18% 12% 8% Adults with some college education are statistically more likely than those with more education to have had a partner try to control their activities. High School or Less Some College 14% 17% 11% Those in homes with annual incomes of less than $25,000 per year are statistically more likely than those with more income to have had a partner control their daily activities. College+ Low (<$25K) 23% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) 14% 11% 10% There is no statistical differences by race and ethnicity in the experience of controlling behavior by a partner. LGBT adults are statistically more likely than non- LGBT adults to have had a partner try and control their activities. WNH POC 13% 19% Reported controlling behavior by a partner is statistically similar in 2017 and 2014 (13%), the most recent year the topic was included on the survey. Non-LGBT LGBT 13% 24% 2017 Behavioral Risk Factor Surveillance Survey Report 45

  46. Marijuana Use Current Marijuana Use Vermont Adults, 2017 More than one in seven (15%) Vermont adults said they currently use marijuana. Current use is defined as use in the last 30 days. • More than eight in ten (83%) of marijuana users said they usually smoke it. Eight percent usually vape marijuana, while six percent usually eat it in food or drink, and two percent dab it. U.S. N/A Vermont 15% Male Female 18% 11% Men are statistically more likely than women to currently use marijuana. 18-24 25-44 45-64 65+ 28% 25% Current use of marijuana is highest among younger age groups. • All differences by age are statistically significant except that between adults 18- 24 and 25-44. 11% 3% High School or Less Some College 16% 15% 12% Current use of marijuana decreases with increasing education level and annual household income level. • There are no statistical differences in current marijuana prevalence by education level. • Adults in homes making less than $25,000 annually are statistically more likely to use marijuana than those in homes with incomes of at least $75,000 per year. College+ Low (<$25K) 19% 17% 17% 11% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) Adults of color are statistically more likely than white, non-Hispanic adults to currently use marijuana. WNH POC 14% 24% LGBT adults are statistically more likely than non- LGBT adults to report use of marijuana. Non-LGBT LGBT 14% 27% Marijuana prevalence in Vermont has increased in each year since use was decriminalized (July 2013). In 2017, use is statistically similar to that in 2016, but statistically higher than that in every other year since 2011. Adults who Reported Current Marijuana Use Vermont Adults, 2007-2013, 2015-2017 15% 12% 11% 10% 8% 8% 8% 8% 7% 7% 2007 2008 2009 2010 2011 2012 2013 2015 2016 2017 2017 Behavioral Risk Factor Surveillance Survey Report 46

  47. Marijuana Use Driving After Marijuana Use Vermont Adults Who Currently Use Marijuana, 2017 In 2017, a quarter of marijuana users drove within three hours of using the drug, at least once in the last month. Men are about twice as likely as women to report driving after using marijuana, a statistically significant difference (31% vs. 17%). U.S. N/A Vermont 26% There are no other statistically significant differences in the use of marijuana before driving by demographic variables. Male Female 31% 17% 18-24 25-44 45-64 65+ 21% Statistical comparisons by race and ethnicity and sexual orientation and gender identity were not made due to suppression of data. 32% 20% Suppressed* Use of marijuana before driving decreased from 31% in 2016 to 26% in 2017, however the change is not statistically significant. The driving after marijuana use question changed in 2016, making it difficult to make direct comparisons with data collected before that time. High School or Less Some College 25% 25% 27% College+ Low (<$25K) 22% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) 32% 24% 25% WNH POC 27% Suppressed* Non-LGBT LGBT 27% Suppressed* *Value suppressed because sample size too small or relative standard error (RSE) is > 30. 2017 Behavioral Risk Factor Surveillance Survey Report 47

  48. No Leisure Time Physical Activity* No Leisure Time Physical Activity* Vermont Adults, 2017 One in five (21%) Vermont adults said they did not participate in any leisure time physical activity during the previous month, significantly lower than the 27% among U.S. adults overall. U.S. 27% 21% Vermont Men and women report not participating in leisure time physical activity at the same rate. Male Female 21% 21% As Vermonters age, the proportion with no participation in leisure time physical activity increases. • Adults 65 and older are statistically more likely than younger adults to have no leisure time physical activity. 18-24 25-44 45-64 65+ 18% 19% 21% 28% Adults with less education and lower annual household income levels are more likely to not participate in leisure time physical activity. • All differences by education level are statistically significant. • Adults in homes making less than $75,000 per year are statistically more likely than those in homes with more income to have no leisure time physical activity. • Those making less than $25,000 annually are also statistically more likely than those in homes making $25,000-$49,999 to have no leisure time physical activity. High School or Less Some College 30% 23% College+ 9% Low (<$25K) 31% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) 22% 23% 11% WNH POC 21% 24% There are no statistical differences in leisure time physical activity participation by race and ethnicity or sexual orientation and gender identity. Non-LGBT LGBT 21% 21% The proportion of adults with no leisure time physical activity increased from 2016 to 2017 (18% vs. 21%), however the change is not statistically significant. Likewise, the proportion in 2017 is also similar to 2011 (21%). No Leisure Time Physical Activity* Vermont Adults, 2008-2017 21% 21% 21% 20% 20% 19% 18% 18% 17% 16% 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 *All data on this page are age-adjusted to U.S. 2000 population, except that by age. [Note: This measure is a Healthy Vermonters 2020 goal]. 2017 Behavioral Risk Factor Surveillance Survey Report 48

  49. Prescription Drug Misuse Ever Used Prescription Drug Without Prescription Vermont Adults, 2017 In 2017, less than one in ten (8%) Vermont adults said they had ever taken a prescription drug without a prescription. • One percent said they did so in the last 30 days. U.S. N/A Vermont 8% Men are statistically more likely than women to report ever misusing prescription drugs. Male Female 10% 6% Younger adults are more likely to use prescription drugs without a prescription, compared with older adults. • Adults 18-64 are statistically more likely to misuse prescription drugs than those 65 and older. • Similarly, adults 25-44 are statistically more likely than those 45-64 to take prescription drugs without a prescription. 18-24 25-44 45-64 65+ 10% 16% 6% 3% High School or Less Some College 9% 9% 7% There are no statistical differences in ever misusing prescription drugs by education level. Reported misuse of prescription drugs decreases with increasing annual household income level. • Adults in homes making less than $25,000 per year are statistically more likely than those in homes making at least $75,000 annually. College+ Low (<$25K) 11% 10% 10% 6% Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) There are no statistical differences in reported misuse of prescription drugs by race and ethnicity. WNH POC 8% 8% LGBT adults are twice as likely as non-LGBT adults to have ever taken a prescription drug without a prescription, a statistically significant difference. Non-LGBT LGBT 8% 17% The rate of ever misusing prescription drugs remains statistically similar since 2011. Misuse of prescription drugs in the last 30 days is unchanged at one percent in each year since 2011. Ever Used Prescription Drug Without Prescription Vermont Adults, 2007-2013, 2015, 2017 10% 9% 9% 8% 8% 8% 7% 7% 6% 2007 2008 2009 2010 2011 2012 2013 2015 2017 *All data on this page are age-adjusted to U.S. 2000 population, except that by age. [Note: This measure is a Healthy Vermonters 2020 goal]. 2017 Behavioral Risk Factor Surveillance Survey Report 49

  50. Seatbelt Use Seldom/Never Wear Seatbelt Vermont Adults, 2017 Three percent of adults in Vermont said they seldom or never wear their seatbelt when driving or riding in a car. This is the same as among U.S. adults. U.S. 3% 3% Vermont Men are statistically more likely than women to seldom or never use a seatbelt. Male Female 5% 2% There are no differences in the use of seatbelts by age. Reported non-use of seatbelts is higher among those with lower education and annual household income levels. • Adults with a high school or less education are statistically more likely than those with more education to seldom or never wear a seatbelt. • Adults in homes making less than $25,000 per year are statistically more likely than those in homes making $25,000-$49,999 per year. Suppressed* 18-24 25-44 45-64 65+ 4% 3% 3% High School or Less Some College 6% 2% 1% College+ Low (<$25K) 8% 3% 4% Statistical comparisons by race and ethnicity and sexual orientation and gender identity were not made due to suppression of data. Middle ($25K-<$50K) High ($50K-<$75K) Highest ($75K) Suppressed* Non-use of seatbelts among Vermont adults remains similar since 2011. WNH POC 3% Suppressed* Non-LGBT LGBT 3% Suppressed* Seldom/Never Wear Seatbelt Vermont Adults, 2007-2008, 2010-2017 5% 5% 4% 4% 4% 4% 4% 4% 3% 3% 2007 2008 2010 2011 2012 2013 2014 2015 2016 2017 *Value suppressed because sample size too small or relative standard error (RSE) is > 30. 2017 Behavioral Risk Factor Surveillance Survey Report 50