Indicator Definitions and Data Sources
For the Key Health Indicators

1. Indicator Definitions and Data Sources
2. How Healthy Are We Overall?
3. How Safe and Supportive Are Our Surroundings?
4. How Safe and Supportive Are Our Communities?
5. How Supportive Is Our Health Care System?
6. How Safe and Supportive Are Our Families?
7. How Healthy Are Our Behaviors?
   
    

Indicator Definitions and Data Sources For the Key Health Indicators

These notes describe how the key health indicators presented in the Report Card on Health are defined and measured. Information is provided about each indicator in the order it appears in the Report Card. Grading criteria and technical notes related to the grading components are presented in “Report Card Grading Criteria.”

Data sources used for more than two indicators include the Behavioral Risk Factor Surveillance System, the Healthy Youth Survey and similar school-based surveys, and population counts needed to develop rates. Unless otherwise noted, all data were prepared by the Washington State Department of Health Non-Infectious Conditions Epidemiology (NICE) unit.

 

Behavioral Risk Factor Surveillance System (BRFSS)

In general, for indicators that use BRFSS questions that are used nationally, we obtained the datasets for 1995 – 2004 from the Centers for Disease Control and Prevention website, http://www.cdc.gov/brfss/technical_infodata/surveydata.htm . For these years, NICE developed prevalence rates for both Washington and the United States. There are no substantive differences between the Washington rates provided on the CDC website and those developed by NICE. For some indicators, the rates from the two sources for Washington differ by about 0.1% most likely due to rounding. Rates for the U.S. are not available at the website. We obtained prevalence rates for Washington for 1990 – 1994 directly from the CDC website. For BRFSS questions that are on the Washington survey, but not asked nationally, we obtained data from the Washington State Department of Health Center for Health Statistics.

Washington BRFSS began offering a Spanish language option in 2003. Because this change could affect annual trends and trends in disparities, we assessed these trends both including and not including Spanish language questionnaires. There were no substantive differences. For assessing current disparities, we combined 2003 and 2004 surveys, both of which had large sample sizes. BRFSS asks three questions about race and Hispanic ethnicity. The first question asks “Are you Hispanic or Latino?” The second question asks, “Which one or more of the following would you say is your race?” Respondents who indicate more than one race are asked their preferred race. To determine race and Hispanic ethnicity for assessing disparities, we classified anyone answering “yes” to the first question as Hispanic. Respondents answering “no” to the first question were classified as belonging to one of four non-Hispanic race groups based on their response to the second question or their preferred race if they indicated more than one race on the second question. More information on the BRFSS is available at http://www.doh.wa.gov/ehsphl/chs/chs-data/BRFSS/BRFSS_homepage.htm . The national BRFSS website is www.cdc.gov/brfss .

 

Healthy Youth Survey (HYS) and similar school-based surveys

For indicators relying on school-based surveys, we developed Washington State rates for 2002 and 2004 using HYS data. To assess disparities, we used data from 2002 and 2004 combined. The HYS asks one question on race and ethnicity: “How do you describe yourself? Select one or more responses.” Responses include Asian or Asian American, American Indian or Alaska Native, Black or African American, Hispanic or Latino/Latina, Native Hawaiian or other Pacific Islander, White or Caucasian, and Other. Respondents who reported they were Hispanic, with or without reporting a race, are counted as Hispanic. Non-Hispanic respondents who indicated more than one race are omitted from the analyses because preferred race is not known. This method differs from that used in other reports of HYS data including the Department of Health’s interactive website. Unless otherwise noted, we obtained rates for 1990, 1992, 1995, 1998, and 2000 from technical reports of the Washington State Survey of Adolescent Health Behaviors and rates for 1999 from the technical report of the 1999 Washington Youth Risk Behavior Survey (YRBS). National comparison data are from the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report Surveillance Summaries from May 21, 2004: 53(SS-2), June 28, 2002:51(SS-4) and June 9, 2000:49(SS-5). These summaries provide data from the national YRBS that is administered in the spring of odd numbered years. Information on the HYS is available at http://www3.doh.wa.gov/HYS .

Population counts needed to develop rates

Unless otherwise noted, we obtained counts needed to develop rates for Washington from the Washington State Office of Financial Management (OFM) www.ofm.wa.gov/pop/stfc/stfc2004.pdf . The OFM estimates do not include counts by race and ethnic group. Thus, to develop rates for assessing health disparities, we used 1990-2003 Population Estimates: Washington State Department of Health, Vista Partnership, Krupski Consulting; Washington State Population Estimates for Public Health. October 2004

Rates , Confidence Intervals, and Tests of Statistical Significance

Our use of rates is described under “Definitions” in the Report Card Grading Criteria. We either obtained confidence intervals (CIs) directly from the data source or calculated them as follows.

• Survey data: We computed 95% CIs for BRFSS and HYS data by using SUDAAN Software for the Statistical Analysis of Correlated Data ( Research Triangle Park, New Jersey) to calculate standard errors, and then multiplying the standard errors by 1.96.
• Population data: We computed 95% CIs by calculating the standard errors based on a Poisson distribution (by dividing the square root of the number of cases by the population and multiplying as necessary to achieve the desired scale; e.g., multiplying by 100,000 for indicators reported “per 100,000”) and then multiplying the standard errors by 1.96.

For determining whether WA differed from the U.S. we used tests of statistical significance (chi-square) where we had raw data for both Washington and the U.S. For some indicators from non-survey data, we assumed that the U.S. rate did not vary and considered Washington to be statistically different from the U.S. if the Washington CI did not include the U.S. rate. Determinations of statistical significance for trends and disparities are described in “Report Card Grading Criteria.”

1. How Healthy Are We Overall?

How good is our general physical and mental health?

Expected years of healthy life at age 20

“Years of healthy life” is calculated by adjusting life expectancy derived from death certificate data (see injury indicators below) with health status measured by the BRFSS question, “Would you say your health in general is excellent, very good, good, fair, or poor?” The method used is described in U.S. Centers for Disease Control and Prevention, National Center for Health Statistics (CDC-NCHS) Statistical Notes, Number 21, August 2001. The method is slightly modified because the measure of health status is available only for people age 18 and older. Thus, we calculate years of expected healthy life (referred to as “healthy life expectancy” in the CDC-NCHS report) as the number of additional years a 20 year-old is expected to live in good, very good, or excellent health. For U.S. comparison data, we combined national BRFSS data with national life expectancy data available at http://www.cdc.gov/nchs/products/pubs/pubd/lftbls/life/1966.htm.

 

Percent of adults who report 14 or more days of poor mental health in the past month

Emotional well-being is measured by the percent of people answering 14 or more days in response to the BRFSS question, “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?” This measure has yielded similar results to longer measures of recent mental health (CDC. Self-Reported Frequent Mental Distress among Adults – United States, 1993-1996. MMWR 1998; 47:326-331).

Are we a healthy weight?

Percent of adults who are obese

Obesity in adults is defined as a body mass index (BMI) of 30 or more. Body mass index is based on an individual's height and weight and is calculated by dividing weight in kilograms by height in meters squared. Obesity in adults is measured by calculating the percent of adults who have a BMI of 30 or more based on their answers to the following BRFSS questions: "About how much do you weigh without shoes?" and "About how tall are you without shoes?"

 

Percent of 10th graders who are overweight

For youth, being overweight is defined as being above the 95th percentile for body mass index (BMI) based on reference data from age and gender specific growth charts developed by the Centers for Disease Control and Prevention. Body mass index is based on an individual's height and weight and is calculated by dividing weight in kilograms by height in meters squared. Overweight in youth is measured by calculating the percent of tenth graders who are in the 95th percentile for BMI according to the reference data, based on their answers: “How tall are you without your shoes on?” and “How much do you weigh without your shoes on?” These questions were asked on the Washington YRBS in 1999 and the HYS in 2002 and 2004. Information on the growth charts is available at http://www.cdc.gov/growthcharts/.

2. How Safe and Supportive Are Our Surroundings?

Do we have illnesses commonly associated with unsafe food, unsafe water, and poor hygiene?

Rates per 100,000 population of

• Campylobacteriosis
• E. coli O157:H7 infection
• Giardiasis
• Listeriosis
• Salmonellosis
• Shigellosis
• Vibriosis (non-cholera)
• Yersiniosis

The Washington Administrative Code (WAC) 246-101 requires that health care providers, hospitals, and/or laboratories report diseases of public health importance to state or local public health officials. These reports are compiled at the state level and become part of the Infectious Disease Reporting System. Rates for the Report Card are based on the Office of Financial Management November 2004 population estimates, while rates in the Annual Communicable Disease Reports are based on population estimates available at the time of first publication. Thus, there are slight differences in some of the rates reported in these two documents. Additional information on the Infectious Disease Reporting System is available at http://www.doh.wa.gov/HWS/doc/AppendixB.doc . National comparison data are from The Morbidity and Mortality Weekly Report, Summary of Notifiable Diseases – United States, volume 52, number 54, April 22, 2005.For these indicators, we use 1990-2004 data to assess trends and 2002 – 2004 data as the most recent three-year period for assessing disparities.

Do we have clean drinking water?

Of the population whose homes receive water from group A public water systems, the percent on systems in compliance with:

• nitrate monitoring requirements;
• quality standards for nitrates;
• coliform monitoring requirements;
• quality standards for coliform bacteria.

To assure safe drinking water, public water systems must be tested and the water must be clean. Group A systems are public water supplies that have more than 14 connections or serve 25 or more people each day. Public water systems provide information on testing to the Washington State Department of Health Office of Drinking Water. The Department compiles this information into a data system called “sentry.” The residential population served is estimated by each public water system. For information on monitoring requirements and quality standards see http://www.doh.wa.gov/ehp/dw/Our_Main_Pages/regula.htm.

We are unable to locate comparable national data for the comparison to the U.S. The EPA website, www.epa.gov/safewater/data/pivottables.html , provides national data. However, the website lacks some of the detail needed for the comparison of Washington and the U.S., such as population served prior to 2004 and measures of variability. Additionally, the Washington data from this website are different from those used in this report (developed from sentry) indicating lack of comparability. We were unable to assess disparities because the water systems do not estimate population by race and ethnicity and the Office of Drinking Water has not yet completed a mapping project that would allow us to estimate race and ethnicity using census data.

An indicator for Group B systems is under development.

Do we have clean air to breathe?

Percent of population breathing air that is meeting the National Ambient Air Quality Standards

The National Ambient Air Quality Standards (NAAQS) include particulate matter (PM₁₀ and PM_2.5), carbon monoxide (CO), ground-level ozone (O₃), nitrogen dioxide, sulfur dioxide, and lead. The Washington State Department of Ecology and Local Clean Air Agencies currently monitor particulate matter (PM₁₀ and PM_2.5), CO and O₃. One monitoring site in Seattle also monitors nitrogen dioxide and sulfur dioxide. Monitoring for lead is not required in Washington because lead levels in air have not exceeded national standards for many years. This indicator provides the percent of people in Washington who live in areas that meet all of the NAAQS, excluding exceedances due to natural events.

The NAAQS for fine particulate matter may become more stringent and this change would be likely to have ramifications for the vast majority of Washingtonians who breathe air in compliance with the NAAQS. EPA staff has recognized that the current standards for particulate matter are insufficiently protective of life and health. Staff has proposed a number of options that make the standards more health-protective by lowering both the 24-hour and annual standards for particulate matter. In addition to the six pollutants regulated by the NAAQS, there are additional air pollutants that may be hazardous to health for which there are not standards or which are not tracked as consistently as the NAAQS, making it difficult to assess the potential impact of these air pollutants on health. The greatest (carcinogenic) risks from these toxic air pollutants are from exposure to fine particles from diesel exhaust and exposure to benzene.

In the Report Card, the percent of the population breathing air not in compliance with the NAAQS for 2001 was developed by downloading maps of areas not meeting the NAAQS (i.e. nonattainment areas) from the Department of Ecology's web site: http://aww.ecology.ecy.wa.gov/services/gis/gis.htm (accessed 11/04). Ecology's CO_naa and PM10_naa files were combined in ArcGIS9.0, producing a map of the combined nonattainment areas for CO and PM₁₀. Using the 2000 Census Block file, blocks with their center within a nonattainment area of the combined file were used to calculate the population within nonattainment areas. The percent of Washington's population breathing air that met the NAAQS was calculated by dividing the total state population within the nonattainment areas by the total population for all blocks in Washington and then subtracting this percent from 100. The U.S. value for the percent of population breathing air that is meeting the National Ambient Air Quality Standards is a 2001 value taken from the EPA's Draft Report on the Environment 2003, Technical Document, Chapter 1 - Cleaner Air. Available at: http://www.epa.gov/indicators/roe/pdf/tdAir1-1.pdf (accessed 11/04).

For 2002, 2003 and 2004, information on areas with violations of the NAAQS were obtained from the Department of Ecology, personal communication, Doug Schneider, Ph.D., State Implementation Plan Planner, Air Quality Program, August 31, 2005. Not including violations due to natural events, for 2004, there were no violations of the NAAQS and for 2002 and 2003, the only exceedances were for the town of Colville. Based on the 2000 U.S. Census, about 0.1% of Washington’s population lives in Colville.

3. How Safe and Supportive Are Our Communities?

Do our incomes meet basic financial needs?

Percent of people living below the U.S. poverty level.

This indicator is measured by the percent of people in Washington State who live below the U.S. poverty threshold. For trends and comparison to the U.S., we use data from the Current Population Survey (CPS) conducted by the U.S. Bureau of Labor and Statistics and the U.S. Census Bureau. CPS defines poverty for individuals living in families with the poverty threshold depending on the number and ages of persons in the family. For example, in 2004, the federal poverty level for a family of two adults and two children was an annual income of $19,157; for a single person under age 65, the poverty level was $9,827. Poverty information from CPS is available at http://www.census.gov/hhes/poverty/prevdetailtabs.html .

The Washington State Office of Financial Management’s (OFM) State Population Survey (SPS) also collects information on persons living below the federal poverty level. SPS, however, defines individuals as living in households rather than families, resulting in small differences between the SPS and CPS estimates for persons living in poverty. Thus, the SPS data could not be used for comparison to the U.S. The SPS data were also not used for trends, because there were not sufficient years of data. The SPS data, compiled by OFM, were used to assess disparities. Information about the SPS is available at http://www.ofm.wa.gov/sps/index.htm.

Are we connected to our communities?

Percent of adults reporting that most people can be trusted

This indicator is measured as the percent who answer “most people can be trusted” to the question “Generally speaking, would you say that most people can be trusted or that you can’t be too careful in dealing with people?” This question has been used on large national surveys and has been associated with health status. It is also on the Social Capital Index developed by Robert Putnam (Bowling Alone, 2000). We included this question on the Washington State BRFSS in 2002 and 2004. National comparison data are from General Social Survey; this information was provided by gssdata@ropercenter.uconn.edu.

Percent of high school students dropping out of school

This is measured as the percent of students in grades 9-12 who are coded to “drop out” or “status unknown” in June of the academic year. The denominator for calculating this percent changed in 2000 from the number of students enrolled in October (based on P105 forms) to the total number of students served, minus transfers (based on P210 forms). These data are provided by the Office of Superintendent of Public Instruction. Information is available at http://www.k12.wa.us/dataadmin .

Rate of serious violent crime offenses per 100,000 population

This indicator reports the number of serious violent crime offenses per 100,000 population. When a citizen reports a crime or calls for law enforcement service, the crime is documented by the agency and counts as an offense. One person may be involved in multiple offenses. Serious violent crimes include murder, rape, robbery, and aggravated assault. Because not all serious violent crimes result in an arrest, offenses provide a more complete indicator of violence than do arrests. These data are from the Uniform Crime Reports that are reported from local jurisdictions to the state and national levels. Reporting is voluntary, but currently reports cover 99% of Washington’s population. (Homicides from non-reporting jurisdictions are included.) Rates are adjusted by either adjusting the population or the number of reports to reflect non-reporting. For comparison to the U.S., we obtained data from the Federal Bureau of Investigation Uniform Crime Reports, available at www.fbi.gov/ucr/ucr.htm . These data adjust for non-reporting by adjusting the number of reports. For trends and disparities, we used data from the Washington Association of Sheriffs and Police Chiefs, available at www.waspc.org. These reports have adjusted the populations to correct for non-reporting. Health disparities comparisons use arrests instead of offenses because unless there is an arrest, the offender may not be known.

Are we getting injured unnecessarily?

Unintentional motor vehicle deaths per 100,000 population

All deaths in Washington are reported to the Washington State Department of Health. The Department of Health compiles this information into the Death Certificate System. Comparable data are compiled in all states. States submit data to the Centers for Disease Control and Prevention (CDC) and CDC develops a national database based on the state submissions. Unlike the national database that is closed at a given date, Washington data are updated continuously. Over time an estimated 99% of all deaths are included in the dataset, and there are more deaths in the Washington dataset than in the Washington portion of the national dataset. For information on the Washington State Death Certificate System, see http://www.doh.wa.gov/HWS/doc/AppendixB.doc and http://www.doh.wa.gov/EHSPHL/CHS/CHS-Data/death/deatmain.htm .

Unintentional motor vehicle deaths have an underlying cause of death coded to E810-E825 using the International Classification of Diseases 9th Revision (ICD-9) or V02-V04, V09.0, V09.2, V12-V14, V19.0-V19.2, V19.4-V19.6, V20-V79, V80.3-V80.5, V81.0-V81.1, V82.0-V82.1, V83-V86, V87.0-V87.8, V88.0-V88.8, V89.0, and V89.2 using the 10th Revision (ICD-10).

To compare Washington and U.S. rates, we obtained rates for both Washington and the U.S. from the CDC Web-based Injury Statistics Query and Reporting System (WISQARS) at http://webappa.cdc.gov/sasweb/ncipc/mortrate10_fy.html . To assess trends and disparities, we used Washington State Annual Statistical File CD-ROM issued April 2005 by the Center for Health Statistics, Washington State Department of Health for the number of deaths, and population counts as described above.

Unintentional poisoning deaths per 100,000 population

All deaths in Washington are reported to the Washington State Department of Health. The Department of Health compiles this information into the Death Certificate System. Comparable data are compiled in all states. States submit data to the Centers for Disease Control and Prevention (CDC) and CDC develops a national database based on the state submissions. Unlike the national database that is closed at a given date, Washington data are updated continuously. Over time an estimated 99% of all deaths are included in the dataset, and there are more deaths in the Washington dataset than in the Washington portion of the national dataset. For information on the Washington State Death Certificate System, see http://www.doh.wa.gov/HWS/doc/AppendixB.doc and http://www.doh.wa.gov/EHSPHL/CHS/CHS-Data/death/deatmain.htm .

Unintentional poisoning deaths have an underlying cause of death coded to E850-E869 using ICD-9 codes and X40-X49 using ICD-10 coding.

To compare Washington and U.S. rates, we obtained rates for both Washington and the U.S. from the CDC Web-based Injury Statistics Query and Reporting System (WISQARS) at http://webappa.cdc.gov/sasweb/ncipc/mortrate10_fy.html . To assess trends and disparities, we used Washington State Annual Statistical File CD-ROM issued April 2005 by the Center for Health Statistics, Washington State Department of Health for the number of deaths, and population counts as described above.

Unintentional drowning deaths per 100,000 population

All deaths in Washington are reported to the Washington State Department of Health. The Department of Health compiles this information into the Death Certificate System. Comparable data are compiled in all states. States submit data to the Centers for Disease Control and Prevention (CDC) and CDC develops a national database based on the state submissions. Unlike the national database that is closed at a given date, Washington data are updated continuously. Over time an estimated 99% of all deaths are included in the dataset, and there are more deaths in the Washington dataset than in the Washington portion of the national dataset. For information on the Washington State Death Certificate System, see http://www.doh.wa.gov/HWS/doc/AppendixB.doc and http://www.doh.wa.gov/EHSPHL/CHS/CHS-Data/death/deatmain.htm .

Drowning deaths have an underlying cause of death coded to E830, E832 or E910 using ICD-9 codes and V90, V92, or W65-W74 using ICD-10 coding. We did not use WISQARS for drowning, because WISQARS codes for drowning do not include V90 and V92, drowning deaths related to boating.

To compare Washington and U.S. rates, we obtained rates for both Washington and the U.S. from the CDC WONDER available at http://wonder.cdc.gov/mortICD10J.html . To assess trends and disparities, we used Washington State Annual Statistical File CD-ROM issued April 2005 by the Center for Health Statistics, Washington State Department of Health for the number of deaths, and population counts as described above.

Unintentional fall-related deaths among persons age 65 and older per 100,000 population

All deaths in Washington are reported to the Washington State Department of Health. The Department of Health compiles this information into the Death Certificate System. Comparable data are compiled in all states. States submit data to the Centers for Disease Control and Prevention (CDC) and CDC develops a national database based on the state submissions. Unlike the national database that is closed at a given date, Washington data are updated continuously. Over time an estimated 99% of all deaths are included in the dataset, and there are more deaths in the Washington dataset than in the Washington portion of the national dataset. For information on the Washington State Death Certificate System, see http://www.doh.wa.gov/HWS/doc/AppendixB.doc and http://www.doh.wa.gov/EHSPHL/CHS/CHS-Data/death/deatmain.htm .

Unintentional fall-related deaths have an underlying cause of death coded to E880-E886 or E888 using ICD-9 codes and W00-W19 using ICD-10 coding.

To compare Washington and U.S. rates, we obtained rates for both Washington and the U.S. from the CDC Web-based Injury Statistics Query and Reporting System (WISQARS) at http://webappa.cdc.gov/sasweb/ncipc/mortrate10_fy.html . To assess trends and disparities, we used Washington State Annual Statistical File CD-ROM issued April 2005 by the Center for Health Statistics, Washington State Department of Health for the number of deaths, and population counts as described above.

How Supportive Is Our Health Care System?

Are we able to get medical care when we need it?

Percent of households with people unable to obtain health care or experiencing a delay or difficulty in obtaining health care

This indicator is measured as the percent of households where a BRFSS respondent answers “yes” to any of the following questions:

• In the last 12 months, were you or any adult in your household unable to obtain any type of health care you or they thought was needed?
  
• In the last 12 months, did you or any adult in your household experience difficulty or delay in obtaining any type of health care you or they thought was needed?
  
• In the last 12 months, were any children living in your home unable to obtain any type of health care you thought they needed?
  
• In the last 12 months, did any children living in your home experience difficulty or delay in obtaining any type of health care you thought they needed?

These questions were included in the Washington BRFSS in 2001 and 2003. For this report, we developed Washington State data from the Center for Health Statistics BRFSS Data released November 2004. The questions are similar to those asked on the Medical Expenditure Panel Survey (MEPS). For this report, the Agency for Health Care Research and Quality compiled national comparison data for 2001 and 2003. More information about MEPS can be found at http://www.meps.ahrq.gov.

 

Do we have illnesses that could be prevented by immunization?

Rate per 100,000 population of

• Hepatitis A
• Hepatitis B
• Measles
• Mumps
• Pertussis
• Polio
• Rubella
• Tetanus

The Washington Administrative Code (WAC) 246-101 requires that health care providers, hospitals, and/or laboratories report diseases of public health importance to state or local public health officials. These reports are compiled at the state level and become part of the Infectious Disease Reporting System. Rates for the Report Card are based on the Office of Financial Management November 2004 population estimates, while rates in the Annual Communicable Disease Reports are based on population estimates available at the time of first publication. Thus, there are slight differences in some of the rates reported in these two documents. Additional information on the Infectious Disease Reporting System is available at http://www.doh.wa.gov/HWS/doc/AppendixB.doc . National comparison data are from The Morbidity and Mortality Weekly Report, Summary of Notifiable Diseases – United States, volume 52, number 54, April 22, 2005.For these indicators, we use 1990-2004 data to assess trends and 2002 – 2004 data as the most recent three-year period for assessing disparities.

 

How Safe and Supportive Are Our Families?

Are we planning for and spending time with our families?

Percent of pregnancies that are intended

This is measured as the percent of women with a recent pregnancy ending in a live birth who answered either “I wanted to be pregnant sooner” or “I wanted to be pregnant then” in response to the question “Thinking back to just before you got pregnant, how did you feel about becoming pregnant” on the Pregnancy Risk Assessment Monitoring Survey (PRAMS). Data were compiled by the Washington State Department of Health Maternal and Child Health Assessment Office. We did not Identify a suitable national comparison. More information about PRAMS is available at http://www.cdc.gov/reproductivehealth/srv_prams.htm.

Percent of families that regularly read to their young children

The importance of early childhood development for health has been well-documented. Over the past several years, policy makers in Washington have become interested in tracking early childhood development. The issue of "readiness to learn" is an important factor in child development but there are no statewide data to assess overall readiness to learn. This indicator was chosen because reading to young children has been shown to be associated with language development and, later on, reading comprehension and overall success in school. The indicator will be measured as the percent of adults with at least one child ages 2-5 who report that the child is either read to or told stories every day. This question has been added to the 2005 BRFSS.

Percent of 10th graders who report most of the time or always eating dinner with their families

This is measured as the percent of 10th grade Healthy Youth Survey respondents who answer "most of the time” or “always” to the question: "How often do you eat dinner with your family?"

Are our families safe?

Number of offenses involving domestic violence per 1,000 population

Data on offenses involving domestic violence are reported from local jurisdictions to the Washington Association of Sheriffs and Police Chiefs. When a citizen reports a crime or calls for law enforcement service, the crime is documented by the agency and counts as an offense. Offenses include felonies, gross and simple misdemeanors, and violations of protection and no contact orders. An offense does not necessarily involve an arrest. Reporting is voluntary, but current reporting covers 99% of Washington’s population. Rates are adjusted by adjusting the population to correct for non-reporting. Comparable data are not reported nationally and so there are no U.S. comparison data. Data used to assess trends are available at www.waspc.org.

The first full year of these data is 1997. Race of the offender is not available.

Number of children reported as abused or neglected per 1,000 children

Child abuse and neglect is measured as the unduplicated number of children in Washington younger than 18 years old in referrals accepted for investigation by Washington State Child Protective Services per 1,000 children. About half of referrals to Child Protective Services are accepted, meaning that they passed an initial screening to determine whether investigation was required. Reports that do not provide enough information, that have no legal basis for complaint, or where the child cannot be located are not accepted for investigation. Also, if the suspected perpetrator is not a caretaker, the case might not be accepted by Child Protective Services but might instead be referred to law enforcement authorities for investigation. But Child Protective Services can become involved if the perpetrator is a licensed caretaker or if the child’s parent or guardian refuses to remove the child from a situation that places the child at risk of abuse. These data do not include findings of the subsequent investigation. “Unduplicated” means that each child is counted only once even if he or she is reported several times during a year. Race is coded as white, African American, API, AIAN, multiracial, and Hispanic; children with unknown or “other” race (11% of the total) are not included in the analyses of racial/ethnic disparities and so the rates by race/ethnicity are relatively lower than the overall rate including all children. Information on the number of children involved in accepted referrals is provided by the Washington State Department of Social and Health Services, Child Protective Services.

How Healthy Are Our Behaviors?

Do we smoke cigarettes?

Percent of adults reporting current cigarette smoking

This indicator is measured as the percent of BRFSS respondents who answer “yes” to “Have you smoked at least 100 cigarettes in your entire life?” AND “Some days or every day” to “Do you now smoke cigarettes every day, some days, or not at all?” While other forms of tobacco use and exposure to second hand tobacco smoke also have detrimental effects on health, cigarette smoking is the most common type of tobacco use. The questions on cigarette smoking have been asked annually since 1987.

Percent of 10th graders who report smoking cigarettes in the past 30 days

This indicator measures the percent of 10th graders who give any answer other than “0 days” in response to the question “During the past 30 days, on how many days did you smoke cigarettes?” on the HYS or similar surveys. This question was asked on the 2002 and 2004 HYS, the 1990, 1992, 1995, 1998 and 2000 Washington State Survey of Adolescent Health Behaviors and the 1999 Washington YRBS.

Percent of women who reported smoking during the last three months of pregnancy

Smoking during pregnancy is measured by the Pregnancy Risk Assessment Monitoring Survey (PRAMS). It is the percent of women with a recent pregnancy ending in a live birth who report any cigarette smoking in response to the question “In the last 3 months of your pregnancy, how many cigarettes or packs of cigarettes did you smoke on an average day?”

The Maternal and Child Health Assessment Office prepared Washington State data. We did not identify a suitable national comparison. More information about PRAMS is available at http://www.cdc.gov/reproductivehealth/srv_prams.htm.

 

Are we physically active?

Percent of adults meeting recommendations for moderate or vigorous physical activity through work or leisure

This indicator is measured as the percent of BRFSS respondents who report

• “mostly walking” or “mostly heavy labor or physically demanding work” in response to the question, “When you are at work, which of the following best describes what you do?” OR
  
• moderate physical activity for at least 30 minutes a day on five or more days a week in response to the questions, “In a usual week, do you do moderate activities for at least 10 minutes at a time, such as brisk walking, bicycling, vacuuming, gardening, or anything else that causes small increases in breathing or heart rate?” If yes, “How many days per week do you do these moderate activities for at least 10 minutes at a time?” and “On days when you do moderate activities for at least 10 minutes at a time, how much total time per day do you spend doing these activities?” OR
  
• vigorous physical activity for at least 20 minutes a day on three or more days a week in response to the questions, “In a usual week, do you do vigorous activities for at least 10 minutes at a time, such as running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate?” If yes, “How many days per week do you do these vigorous activities for at least 10 minutes at a time?” and “On days when you do vigorous activities for at least 10 minutes at a time, how much total time per day do you spend doing these activities?”

The questions on moderate and vigorous physical activity include an introductory sentence that tells people not to consider activity at work. These questions were asked on the 2001 and 2003 BRFSS.

Percent of 10th graders who report meeting recommendations for vigorous physical activity

This indicator is measured as the percent of 10th graders who report vigorous physical activity on three or more days in the past week in response to the question “On how many of the past 7 days did you exercise or participate in physical activity for at least 20 minutes that made you sweat and breathe hard, such as basketball, soccer, running, swimming laps, fast bicycling, fast dancing, or similar aerobic activities?” This question was on the 2002 and 2004 HYS and the 1999 Washington YRBS. For this indicator, we were unable to obtain the data directly from the 1999 technical report and so we calculated percentages using the YRBS 1999 dataset.

 

Are we eating right?

A healthy diet includes numerous factors, such as maintaining a balance among protein, carbohydrates, and fats; eating the number of calories needed to maintain a healthy weight; eating at least five servings of fruits and vegetables each day; and providing breast milk for children for at least six months.

Percent of adults who report eating fruits and vegetables five or more times daily

This indicator is a composite of six BRFSS questions that ask how many times the respondent drinks fruit juice and eats fruit, potatoes, carrots, green salad, and other vegetables. The respondent can answer as the number of times each day, week, month or year. The BRFSS measures times per day, not servings. A special survey conducted by DOH in 1998 indicated that the percent of people consuming at least five servings each day is about double the percent who consume fruits and vegetables at least five times each day.

Percent of 10th graders who report eating fruits and vegetables five or more times daily in the past week

This indicator is a composite of six HYS questions that ask how many times in the past week the respondent drank fruit juice and ate fruit, potatoes, carrots, green salad, and other vegetables. These questions were on the 2002 and 2004 HYS and the 1999 Washington YRBS. For this indicator, we were unable to obtain the data directly from the 1999 technical report and so we calculated percentages using the YRBS 1999 dataset.

Percent of 10th graders who report drinking two or more non-diet sodas yesterday

This is measured as the percent of 10th grade HYS respondents who answer “two”, “three”, or “four or more” in response to “How many sodas or pops did you drink yesterday? (Do not count diet soda.).” National comparison data are not available.

 

Do we abuse alcohol?

Percent of adults who report having five or more alcoholic drinks on one occasion during the past 30 days

This indicator is the percent of BRFSS respondents who answer “one or more times” to the question, “Considering all types of alcoholic beverages, how many times during the past 30 days did you have five or more drinks on an occasion?”

Percent of adults reporting chronic heavy drinking in the past 30 days: women who report more than one drink per day and men who report more than two drinks per day.

This indicator is the percent of female BRFSS respondents who report drinking one or more alcoholic beverages per day and male BRFSS respondents who report drinking two or more drinks per day. Average number of drinks daily is calculated from responses to the questions, “During the past 30 days, how many days per week or per month did you have at least one drink of any alcoholic beverage?” and “On the days when you drank, about how many drinks did you drink on the average?”

Percent of 10th graders who report drinking any alcohol in the past 30 days

This indicator is measured as the percent of 10th graders answering any number of days other than “none” in response to the question “During the past 30 days, on how many days did you drink a glass, can or bottle of alcohol (beer, wine, wine coolers, hard liquor)?” This question was included on the 2002 and 2004 HYS and the 2000 Washington State Survey of Adolescent Health Behaviors; the wording of the question was substantially different prior to 2000.