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Behavioral Risk Factor Surveillance, 1991: Monitoring Progress Toward the Nation's Year 2000 Health Objectives


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General: Centers for Disease Control and Prevention. CDC Surveillance Summaries, August 27, 1993. MMWR 1993;42(No. SS-4). Specific: {Author(s).} {Title of particular article.} In: CDC Surveillance Summaries, August 27, 1993. MMWR 1993;42:(No. SS- 4):{inclusive page numbers}.

CIO Responsible for this publication:

Epidemiology Program Office

Abstract

Problem/Condition: Risk reduction is a major focus of the national health objectives for the year 2000. Progress toward several of these objectives can be evaluated by using data from the Behavioral Risk Factor Surveillance System (BRFSS). Year 2000 objective areas measurable by BRFSS data include those for overweight, lack of physical activity, smoking, safety belt use, and medical screening for breast and cervical cancer and elevated blood cholesterol. BRFSS data have been used to guide health promotion/disease prevention programs.

Reporting Period: 1991.

Description of System: BRFSS is a state-based random-digit-dialing telephone survey of noninstitutionalized adults ( greater than or equal to 18 years of age); 47 states and the District of Columbia participated in BRFSS in 1991.

Results: Some year 2000 objectives appear to be readily attainable for many states, whereas others do not. For example, among participating states, a median 57.8% (range = 45.6%-82.8%) of women ages greater than or equal to 50 years reported having had both a clinical breast examination and a mammogram in the previous 2 years (year 2000 objective: greater than or equal to 60%). In contrast, a median 37.3% (range = 22.1%-52.5%) of persons with annual family income less than $20,000 reported that they did not engage in leisure-time physical activity -- more than twice the year 2000 objective (greater than or equal to 17%).

Interpretation: BRFSS data demonstrate substantial state-to-state variation in progress toward year 2000 objectives and highlight areas (e.g., lack of leisure-time physical activity) in which substantial progress remains to be made in most states.

Action Taken: The BRFSS will continue to report data that relate to year 2000 health objectives. BRFSS data will enable states to monitor progress toward these objectives and develop health policies aimed at achieving them.

INTRODUCTION

Modifiable high-risk behaviors contribute heavily to morbidity and mortality from noninfectious disease. Similarly, preventive medical practices such as cholesterol screening and mammography can reduce the burden of disease. Reducing the prevalence of high-risk behaviors and increasing the appropriate use of medical screening tests are critical components of the year 2000 national health objectives (1).

In 1991, 47 states and the District of Columbia participated in the Behavioral Risk Factor Surveillance System (BRFSS). (For simplicity, the term "states" in this report includes the District of Columbia.) BRFSS provides state-specific estimates for the prevalence of several high-risk behaviors addressed in Healthy People 2000, including overweight, physical inactivity, smoking, and safety belt nonuse. The system also provides information on the use of selected medical screening tests, including mammography, clinical breast examination, Papanicolaou (Pap) smear, and blood cholesterol screening. These BRFSS data will help state health departments set priorities and monitor progress toward year 2000 health objectives.

One of the national goals stated in Healthy People 2000 is to "reduce health disparities among Americans." Particular emphasis is placed on special population subgroups for whom the average incidences of death, disease, and disability may be increased. Characteristics upon which these disparities are based include age, race/ethnicity, income, and educational attainment. BRFSS includes data on each of these characteristics, and, because the data are state specific, the system is also capable of describing geographic disparities. This report presents a comprehensive description of the BRFSS data that can be used to identify groups to target with prevention efforts and measure progress toward year 2000 health objectives.

METHODS

Sampling

Using random-digit-dialing telephone survey techniques, each state selects a probability sample of its noninstitutionalized adult population ( greater than or equal to 18 years of age) having telephones. In 1991, 38 states used a multistage cluster-sampling design based on the Waksberg method (2). To meet individual needs, other states have chosen to use different sampling methods, such as simple random or stratified sample designs.

Questionnaire

The interviewing instrument consists of three parts: a) a core series of questions asked by all states, b) standardized modules of questions on selected topics that are developed by CDC and added at the discretion of each state, and c) questions developed and administered by a particular state to meet its own needs. Whenever feasible, questions used in national surveys such as the National Health and Nutrition Examination Surveys (NHANES) and the National Health Interview Survey (NHIS) have been adopted.

Data Processing and Analysis

When the interviewing cycle is completed each month, the data are sent to CDC for editing. In 1991, 36 states used a computer-assisted telephone interviewing (CATI) system, which permits direct entry of data into a computer file. CATI facilitates interviewer monitoring, data coding and entry, and quality-control procedures.

For the current study, the edited data were weighted to the age-, race-, and sex- specific population counts from the 1990 census in each state, as well as for the respondent's probability of selection (3,4). These weights were used to estimate the prevalence of risk factors and the use of medical screening tests for each state. SESUDAAN, a procedure for analyzing complex sample-survey data, was used to calculate the standard errors for the prevalence estimates (5). State sample sizes ranged from 1,178 to 3,417. Sample sizes for demographic subgroups were smaller; therefore, confidence intervals for these estimates are greater. Prevalence estimates are shown only when the sample size was greater than or equal to 50. * Response rates for completed interviews, by state, ranged from 65.2% to 94.8%.

The design, characteristics, and use of the BRFSS have been described previously (3,7,8).

Definitions of Risk Factors and Medical Screening Practices

Overweight -- body mass index (BMI = weight {kg}/height {m2}) greater than or equal to 27.8 for men and greater than or equal to 27.3 for women). These values approximate the sex-specific 85th percentile of BMI, estimated from NHANES II, for 20- to 29-year-olds in the United States.

No leisure-time physical activity -- no exercise, recreation, or physical activities (other than regular job duties) during the previous month.

Smoking -- current regular use of cigarettes by someone who has ever smoked at least 100 cigarettes.

Safety belt nonuse -- not always using a safety belt when driving or riding in a car. (To remain consistent with the objectives as stated in Healthy People 2000, the data are presented in terms of safety belt use rather than nonuse.)

Cholesterol screening -- had blood cholesterol checked within the previous 5 years.

Breast cancer screening:

  1. ever had a mammogram and clinical breast examination

(women greater than or equal to 40 years of age).

b) had mammogram and clinical breast examination within the previous 2 years (women greater than or equal to 50 years of age). **

Pap smear (women greater than or equal to 18 years of age with intact uterine cervix):

  1. ever had a Pap smear.

  2. had a Pap smear within the previous 2 years.

Definitions were chosen that match as closely as possible those described in Healthy People 2000. In the following cases, however, BRFSS-derived definitions could not be made identical to Healthy People 2000 definitions: a) BRFSS contains only self-reported data for height, weight, and high blood pressure, whereas year 2000 objectives derived from NHANES II data are based on measured values. b) BRFSS responses did not include a category for having had most recent Pap smear 2-3 years previously; therefore, this document reports the percentage of women who had a Pap smear within the preceding 2 years rather than within the preceding 3 years, as specified in Healthy People 2000. c) BRFSS questions regarding smoking cessation differ from those used in some other surveys. d) Some year 2000 objectives refer to greater than or equal to 20 years of age as the population base; the current document includes the entire BRFSS data set (i.e., persons greater than or equal to 18 years of age).

In previous reports (7,9-12), safety belt nonuse was defined as "sometimes, seldom, or never" wearing a safety belt (as compared with "always" or "nearly always"). In this report, respondents who reported nearly always wearing safety belts are classified as nonusers. This definition produces estimates closer to those obtained from observational surveys (13,14).

In some cases, definitions for sociodemographic variables in Healthy People 2000 vary among objectives. For example, the year 2000 objectives define low income in some cases as less than $10,000 annual family income and in other cases as less than $20,000. Similarly, two different cut-offs are used for educational level: "less than high school education" in some objectives and "high school education or less" in others. The definitions used in this report conform to those used in Healthy People 2000.

RESULTS

Overweight

The proportion of adults greater than or equal to 18 years of age who were overweight ranged from 17.8% in Colorado to 28.7% in Michigan (median = 23.4%) (Table_1). When compared with the total population, the median prevalence of overweight was higher among low-income women (30.3%) and black women (39.0%). Although the median for Hispanic women was lower (24.4%), the sample size was sufficient for analysis in only 10 states. The percentage of adults with self-reported high blood pressure who were overweight was high (median = 40.5% for women and 42.5% for men).

No Leisure-Time Physical Activity

The percentage of adults who did not engage in leisure-time physical activity varied nearly threefold, from 16.6% in Montana to 42.6% in Mississippi (median = 28.0%) (Table_2). In general, prevalences were lower in western states (Colorado, 18.0%; Oregon, 19.6%; and Washington, 20.6%). The median percentage among both low-income persons (37.3%)and adults greater than or equal to 65 years of age (42.3%) was substantially higher than for the total adult population.

Smoking

The percentage of adults greater than or equal to 18 years of age who reported that they were cigarette smokers ranged from 14.3% in Utah to 30.2% in Kentucky (median = 23.0%) (Table_3). The median prevalence among adults who had a high school education or less was about five percentage points higher than the median among the total adult population. The percentage of current regular smokers who quit smoking at least 1 day in the past year ranged from 42.0% in Ohio to 60.9% in Michigan (median = 55.6%).

Only Utah reported a prevalence of smoking that met the year 2000 objective in the total adult population (Table_3). No state reported a prevalence below the smoking objective for adults with a high school education or less or for women of reproductive age.

Safety Belt Use

The percentage of adults greater than or equal to 18 years of age who reported that they always wore a safety belt while riding or driving in a car ranged from 22.8% in South Dakota to 87.8% in Hawaii (median = 58.2%) (Table_4).

Cholesterol Screening

The percentage of adults greater than or equal to 18 years of age who had had a blood cholesterol screening test within the previous 5 years ranged from 56.2% in New Mexico to 71.3% in Connecticut (median = 63.7%) (Table_5). Prevalences were highest in four northeastern states and Florida: New Jersey (71.2%), Florida (71.1%), New Hampshire (70.2%), Rhode Island (69.6%), and Massachusetts (68.0%). The median percentage of adults who had had a blood cholesterol screening test within the previous 5 years (63.7%) was about 10 percentage points below the year 2000 objective (greater than or equal to 75%). As of 1991, no state had reported a prevalence consistent with this objective.

Breast Cancer Screening

The percentage of women greater than or equal to 40 years of age who had ever had both a mammogram and a clinical breast examination ranged from 55.5% in Louisiana to 83.1% in the District of Columbia (median = 69.7%) (Table_6). However, the median prevalences were lower for each of the population subgroups specified in Healthy People 2000.

The percentage of women greater than or equal to 50 years of age who had had a mammogram and a clinical breast examination within the previous 2 years was highest in the District of Columbia (82.8%) and lowest in Louisiana (45.6%) (median = 57.8%) (Table_7). The prevalence of screening was lowest among low-income women greater than or equal to 50 years of age (median = 41.4%).

The median percentage of women greater than or equal to 40 years of age who had ever had both a clinical breast examination and a mammogram (69.7%) was about 10 percentage points below the year 2000 objective ( greater than or equal to 80%). The District of Columbia (83.1%) and Washington (81.4%) met that objective in 1991. Many states reported prevalences above the year 2000 target percentage ( greater than or equal to 60%) for women greater than or equal to 50 years of age who had had both examinations within the previous 2 years. Only the District of Columbia, however, reported prevalences higher than this objective for each population subgroup.

Pap Smear

The percentage of women greater than or equal to 18 years of age who had ever had a Pap smear was high in all states, ranging from 86.8% in New York to 95.3% in Colorado (median = 92.4%) (Table_8). The median prevalences for the special population subgroups were lower (range = 83.9%-85.8%). Washington and Oregon were the only states where at least 90% of all groups reported having had a Pap smear.

The median percentage of women greater than or equal to 18 years of age who had ever had a Pap smear was less than 3 percentage points below the year 2000 objective of 95%. Colorado, Maine, Oregon, and Washington reported prevalences at least as high as this objective. With regard to special population subgroups, Washington reported a prevalence at least as high as the year 2000 objective for low-income women, Idaho for women who had less than a high school education, and Colorado for Hispanic women.

The percentage of women greater than or equal to 18 years of age who had had a Pap smear within the past 2 years ranged from 73.7% in West Virginia to 87.5% in the District of Columbia (median = 79.7%) (Table_9). Median prevalences were lower for each of the special subgroups, particularly for women greater than or equal to 70 years of age (55.7%). Fewer than half of women greater than or equal to 70 years of age had had a Pap smear within the past 2 years in Georgia, Indiana, Kentucky, Louisiana, Massachusetts, New Hampshire, and Vermont.

The median percentage of women ages greater than or equal to 18 years who had a Pap smear within the previous 2 years (79.7%) was about 5 percentage points below the year 2000 objective of greater than or equal to 85%. The District of Columbia and Maryland reported prevalences at least as high as this objective. Only the District of Columbia reported a prevalence at least as high as the year 2000 objective for each special population subgroup.

DISCUSSION

The prevalence of targeted behaviors varied considerably by type of behavior and among states. Median prevalences of overweight were substantially higher than the year 2000 objectives for all groups except Hispanic women and women with elevated blood pressure (Table_1). Because overweight persons tend to underreport their weight (15), BRFSS data tend to underestimate the true population prevalence of overweight. Furthermore, overweight women tend to underreport their weight by a larger amount than do overweight men. This differential reporting by sex may explain in part why the BRFSS median for overweight among hypertensive men is higher than among hypertensive women. In contrast, the Healthy People 2000 baseline prevalences of overweight among hypertensive persons (obtained by direct measurement in NHANES II) were higher for women (50%) than for men (39%).

In 1991, the median prevalence of overweight was higher than in any of the 4 previous years (7), suggesting that the percentage of overweight persons may be increasing. Increased prevalence of overweight has been reported elsewhere for the United States (16,17) and for the upper Midwest (18).

Median percentages of adults who reported that they did not engage in any leisure-time physical activity were approximately twice the year 2000 objectives for all three demographic groups (Table_2). No state reported a prevalence that achieved these objectives. The 1991 median for all adults greater than or equal to 18 years of age (28.0%) was slightly lower than the median for 1990 (28.7%). For the years 1986-1989, the lowest median prevalence was 30.0% (2). These data suggest that the percentage of people who exercise may have begun to increase slightly.

BRFSS physical activity data are limited by the absence of information about work-related physical activity. The observed higher percentage of low-income persons who report that they do not engage in leisure-time physical activity might overstate the association between socioeconomic status and total physical activity if low-income persons tend to be more active during the work day. Data from one study indicate that including work and household activity may offset some of the disparities in socioeconomic status among men but not among women (19). The percentage of persons who reported to the NHIS in 1991 that they did not participate in leisure-time physical activity was lower than for BRFSS (all adults ages greater than or equal to 18 years, 24% vs. 28.0%; adults with annual family income less than $20,000, 32% vs. 37.3%; and adults greater than or equal to 65 years of age, 29% vs. 42.3%) (20). These differences may reflect the different survey modes (telephone vs. in-person), as well as the longer list of activities about which respondents to NHIS are queried.

The observed median smoking prevalence for women of reproductive age exceeded the year 2000 target prevalence by a larger amount than for any other demographic subgroup. These data reflect the low target prevalence set for this group in light of tobacco-related health risks unique to women of reproductive age. First, cigarette smoking during pregnancy increases the risk to the fetus for low birth weight and premature birth, miscarriage, stillbirth, sudden infant death syndrome, and infant mortality (21). Second, in addition to the general risks for chronic disease associated with cigarette smoking, women of reproductive age who both smoke cigarettes and use oral contraceptives are at higher risk for myocardial infarction because of the synergistic effects of smoking and oral contraceptives (22).

In 1991, the BRFSS median prevalence of smokers who reported that they had quit for 1 or more days during the previous year (55.6%) is higher than the target rate expressed in year 2000 objective #3.6 ( greater than or equal to 50%). Because the smoking-cessation questions in the 1991 BRFSS were changed, this difference should not be interpreted to mean that a majority of states have achieved this objective. The questionnaire changes may increase the 1-day quit rate estimate by approximately 18 percentage points. *

Hawaii was the only state with a self-reported safety belt use rate that exceeded the year 2000 objective. The five states with the highest safety belt use rates (Hawaii, Oregon, California, North Carolina, and New Mexico) have safety belt laws that allow for primary enforcement. With primary enforcement, a motor vehicle operator may be stopped by a law enforcement officer for an observed safety-belt-use law violation alone, rather than requiring that a vehicle first be stopped for some other violation (secondary enforcement). Primary enforcement laws are associated with greater and more rapid increases in safety belt use than are secondary enforcement laws (23).

The median percentages of women ages greater than or equal to 50 years who reported having had a clinical breast exam and a mammmogram within the previous 2 years and of women ages greater than or equal to 18 years with an intact uterine cervix who reported having had a Pap smear within the previous 2 years were both only a few percentage points below the year 2000 targets. However, when survey data are used to monitor progress toward year 2000 objectives for medical screening procedures, self-reported data may yield biased results with regard to the time frame in which survey participants actually received a screening test. For example, in one study in which survey results were validated by using records from medical institutions, about 27% of women who reported having had a mammogram within the previous year had actually had the test more than a year before (24).

Data from this report indicate that states vary in their degree of progress toward behavior-related year 2000 health objectives. BRFSS data can help state health officials monitor progress and target programs toward greatest local need. To better enable states to monitor their progress toward BRFSS-measurable year 2000 health objectives, this report includes a template table (see Appendix 1). This table includes year 2000 objective values as well as the low, median, and high BRFSS values for 1991. The column of blank spaces at the right can be filled in with the values for a particular state.

State-specific BRFSS data will be reported annually in CDC Surveillance Summaries and will periodically include year 2000 health objective updates.

Appendix 1. Table_A1

Appendix 2. Table_A2

References

  1. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report with commentary. Washington, DC: US Department of Health and Human Services, 1991; DHHS publication no. (PHS 91-50212).

  2. Waksberg JS. Sampling methods for random digit dialing. J Am Stat Assoc 1978;73:40-6.

  3. Frazier EL, Franks AL, Sanderson LM. Using behavioral risk factor surveillance data. In: Using chronic disease data: a handbook for public health practitioners. Atlanta: CDC, 1992.

  4. Gentry EM, Kalsbeek WD, Hogelin GC, et al. The behavioral risk factor surveys. Part II. Design, methods, and estimates from combined state data. Am J Prev Med 1985;1:9-14.

  5. Shah BU. SESUDAAN: Standard Errors Program for Computing Standardized Rates from Sample Survey Data. Research Triangle Park, North Carolina: Research Triangle Institute, 1981.

  6. Daniel WW. Biostatistics: a foundation for analysis in the health sciences. 5th ed. New York: John Wiley and Sons, 1991.

  7. Siegel PZ, Brackbill RM, Frazier EL, et al. Behavioral risk factor surveillance, 1986-1990. MMWR 1991;40(No. SS-4):1-23.

  8. Remington PL, Smith MY, Williamson DF, et al. Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981-1987. Public Health Rep 1988;103:366-75.

  9. CDC. Behavioral risk factor surveillance -- selected states, 1984. MMWR 1986;35:253-4.

  10. CDC. Behavioral risk factor surveillance in selected states -- 1985. MMWR 1986;35:441-4.

  11. CDC. Behavioral risk factor surveillance -- selected states, 1986. MMWR 1987;36:252-4.

  12. Anda RF, Waller MN, Wooten KG, et al. Behavioral risk factor surveillance, 1988. MMWR 1990;39(No. SS-2):1-21.

  13. CDC. Comparison of observed and self-reported seat belt use rates -- United States. MMWR 1988;37:549-51.

  14. Hunter WW, Stewart JR, Rodgman EA. Characteristics of seatbelt users and nonusers in a state with a mandatory belt use law. Health Educ Res 1990;5:161-73.

  15. Rowland ML. Reporting bias in height and weight data. Stat Bull 1989;(April-June):2-11.

  16. Rodale R, ed. The prevention index, 1992. Prevention magazine. Emmaus, Pennsylvania: Rodale Press, 1992.

  17. Flegal KM, Harlan WR, Landis JR. Secular trends in body mass index and skinfold thickness with socioeconomic factors in young adult women. Am J Clin Nutr 1988;48:535-43.

  18. Shah M, Hannan PJ, Jeffery RW. Secular trend in body mass index in the adult population of three communities from the upper mid-western part of the USA: the Minnesota Heart Health Program. Int J Obesity 1991;15:499-503.

  19. Ford ES, Merritt RK, Heath GW, Powell KE. Physical activity behaviors in lower and higher socioeconomic status populations. Am J Epidemiol 1991;133:1246-56.

  20. National Center for Health Statistics. Health, United States, 1992. Hyattsville, Maryland: US Department of Health and Human Services, PHS, CDC (in press).

  21. CDC. Reducing the health consequences of smoking: 25 years of progress -- a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC) 89-8411.

  22. Shapiro S, Slone D, Rosenberg L, et al. Oral contraceptive use in relation to myocardial infarction. Lancet 1979;1:743 -- 7.

  23. Escobedo LG, Chorba TL, Remington PL, et al. The influence of safety belt laws on self-reported safety belt use in the United States. Accid Anal Prev 1992;24:643-53.

  24. Degnan D, Harris R, Ranney J, et al. Measuring the use of mammography: two methods compared. Am J Public Health 1992;82:1386- 8.

* A minimum sample size of 30 has been recommended for simple random surveys (6). BRFSS uses a minimum sample size of 50 to allow for the variance that results from a multistage sample design. Additional information on the precision of population subgroup estimates derived from the BRFSS is available (3).

** Reported prevalences include women who may have had the tests because of a breast condition such as cancer or a breast lump. 

*** Baseline data for Healthy People 2000 objective #3.6 were obtained from the Adult Use of Tobacco Survey, which uses questions similar to those in the NHIS. Before 1991, BRFSS used smoking cessation questions similar to those in the NHIS; in 1990, 1-day quit rates obtained from NHIS and BRFSS were similar (about 38%). In 1991, BRFSS simplified its questions on smoking cessation.

**** See Appendix 2 of the preceding report.


Table_1
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TABLE 1. Prevalence of overweight * among adults ages >=18 years in participating
states, by selected characteristics -- Behavioral Risk Factor Surveillance System, 1991
======================================================================================================================================
                                                                       Women
                       Total         ---------------------------------------------------------------------------
                    population        Low-income +            Black             Hispanic            w/HBP &            Men w/HBP &
                  ---------------    ---------------     ---------------     ---------------     ---------------     ---------------
State              %   (95% CI @)     %     (95% CI)       %    (95% CI)      %     (95% CI)      %     (95% CI)      %     (95% CI)
------------------------------------------------------------------------------------------------------------------------------------
Alabama           25.7  +/-(2.3)     35.1  +/-( 5.9)     36.0  +/-( 6.7)      --   +/-  --       41.2  +/-( 6.5)     47.7  +/-(10.6)
Alaska            24.6     (3.1)     25.8     (12.5)      --        --        --        --       30.6     (12.0)     43.1     (13.7)
Arizona           20.6     (2.3)     35.4     ( 9.1)      --        --       31.7     ( 8.0)     40.9     ( 8.3)     37.7     (11.1)
Arkansas          23.1     (2.5)     32.8     ( 8.3)     43.0     (12.2)      --        --       40.9     ( 9.1)     46.2     (11.6)
California        22.1     (1.7)     26.9     ( 5.8)     38.2     ( 9.6)     26.6     ( 5.5)     43.6     ( 7.2)     43.9     ( 8.0)

Colorado          17.8     (1.9)     23.3     ( 8.5)      --        --       18.5     ( 9.6)     31.0     ( 8.1)     36.7     (10.2)
Connecticut       20.6     (2.2)     25.5     ( 8.7)     41.9     (10.8)      --        --       42.5     ( 8.9)     30.4     ( 9.3)
Delaware          27.5     (2.7)     32.3     ( 9.4)     47.6     ( 9.5)      --        --       45.7     ( 9.0)     36.4     ( 9.7)
District of
  Columbia        26.8     (2.6)     42.1     ( 9.9)     37.6     ( 4.4)      --        --       54.6     ( 9.1)     46.3     (14.8)
Florida           21.7     (2.0)     32.2     ( 7.6)     39.0     ( 9.2)     25.6     ( 8.7)     37.6     ( 6.9)     39.3     (10.4)

Georgia           20.6     (2.1)     35.5     ( 7.7)     35.1     ( 6.8)      --        --       41.9     ( 7.7)     32.3     ( 9.0)
Hawaii            19.6     (2.0)     28.6     ( 9.6)     37.0     ( 9.9)     17.0     ( 8.1)     25.4     ( 7.8)     33.3     ( 9.2)
Idaho             22.5     (2.1)     25.5     ( 6.5)      --        --        --        --       39.9     ( 7.1)     38.6     ( 9.6)
Illinois          23.3     (2.0)     27.2     ( 6.6)     31.0     ( 7.8)      --        --       42.2     ( 7.4)     40.5     ( 8.9)
Indiana           26.9     (2.1)     28.3     ( 7.0)     39.4     ( 9.8)      --        --       45.4     ( 6.5)     44.8     ( 8.1)

Iowa              25.9     (2.4)     21.9     ( 8.0)      --        --        --        --       40.1     ( 7.8)     47.7     (10.5)
Kentucky          25.7     (2.3)     31.4     ( 5.7)     43.4     (13.8)      --        --       43.1     ( 7.0)     48.5     ( 9.8)
Louisiana         26.6     (2.5)     37.9     ( 6.5)     36.4     ( 6.9)      --        --       51.8     ( 8.4)     33.4     (10.0)
Maine             23.3     (2.7)     25.0     ( 8.1)      --        --        --        --       41.3     (11.6)     36.1     (12.3)
Maryland          20.6     (2.2)     32.0     (14.7)     35.0     ( 7.0)      --        --       30.8     ( 7.4)     45.0     (11.3)

Massachusetts     21.0     (2.3)     31.8     ( 9.6)      --        --        --        --       44.3     (10.1)     30.4     (11.1)
Michigan          28.7     (2.0)     36.9     ( 6.3)     44.7     ( 8.4)      --        --       48.6     ( 6.7)     44.9     ( 8.3)
Minnesota         23.4     (1.5)     28.6     ( 5.5)      --        --        --        --       36.8     ( 6.0)     42.3     ( 7.7)
Mississippi       27.8     (2.5)     40.1     ( 6.5)     46.3     ( 6.8)      --        --       44.7     ( 6.8)     38.4     (10.0)
Missouri          23.8     (2.4)     29.6     ( 8.1)     42.5     (12.6)      --        --       39.6     ( 8.2)     35.5     ( 9.6)

Montana           20.5     (2.4)     26.7     ( 9.0)      --        --        --        --       31.0     ( 8.3)     42.0     (13.8)
Nebraska          24.4     (2.5)     25.8     ( 8.0)      --        --        --        --       43.6     ( 8.5)     44.3     (10.8)
New Hampshire     20.9     (2.3)     28.7     ( 9.4)      --        --        --        --       36.3     ( 9.4)     35.3     (11.9)
New Jersey        20.4     (2.4)     30.4     (13.6)      --        --        --        --       38.9     ( 8.6)     48.4     (11.7)
New Mexico        18.9     (2.6)     27.0     ( 9.3)      --        --       18.9     ( 5.5)     24.0     (10.3)     32.4     (13.1)

New York          24.2     (2.2)     35.6     ( 8.2)     40.0     ( 8.6)     23.1     ( 8.3)     44.4     ( 7.8)     44.6     (10.3)
North Carolina    23.0     (2.1)     31.6     ( 6.9)     33.6     ( 7.7)      --        --       35.1     ( 7.4)     49.1     (10.5)
North Dakota      24.0     (2.1)     33.0     ( 7.5)      --        --        --        --       49.5     ( 8.6)     42.1     (10.3)
Ohio              24.3     (2.7)     40.4     ( 9.1)     25.0     (10.4)      --        --       46.1     (10.7)     43.4     (14.9)
Oklahoma          23.8     (2.4)     24.3     ( 7.3)     35.5     (13.2)      --        --       38.0     ( 7.5)     38.2     (10.2)

Oregon            22.1     (1.5)     26.8     ( 6.3)      --        --       29.0     (12.8)     37.2     ( 5.5)     41.7     ( 7.7)
Pennsylvania      27.1     (2.0)     34.4     ( 7.2)     40.7     (10.7)      --        --       48.2     ( 6.9)     52.3     ( 8.5)
Rhode Island      20.9     (2.2)     29.9     ( 8.1)      --        --        --        --       31.1     ( 7.7)     44.7     ( 9.5)
South Carolina    25.2     (2.2)     31.6     ( 6.9)     37.5     ( 6.1)      --        --       43.0     ( 6.7)     38.9     ( 9.0)
South Dakota      24.2     (2.2)     25.8     ( 6.7)      --        --        --        --       36.0     ( 8.2)     43.1     ( 9.8)

Tennessee         24.2     (1.9)     34.8     ( 5.6)     43.8     ( 7.1)      --        --       46.0     ( 6.1)     42.8     ( 8.2)
Texas             25.3     (2.6)     39.6     ( 8.8)     42.3     (11.3)     35.0     ( 8.4)     35.4     ( 8.3)     43.3     (11.8)
Utah              19.8     (2.0)     19.0     ( 8.6)      --        --       20.0     ( 7.0)     34.8     ( 7.8)     40.9     ( 9.8)
Vermont           22.6     (2.3)     32.1     (11.1)      --        --        --        --       34.8     ( 8.5)     44.4     ( 9.8)
Virginia          18.9     (2.1)     27.5     ( 9.2)     34.6     ( 8.7)      --        --       33.7     ( 9.9)     46.1     (13.1)

Washington        20.0     (1.9)     28.0     ( 9.3)      --        --        --        --       36.6     ( 7.7)     50.5     ( 9.4)
West Virginia     28.0     (2.1)     30.3     ( 4.9)     40.3     (13.2)      --        --       49.1     ( 5.8)     43.8     ( 7.9)
Wisconsin         25.7     (2.3)     35.1     ( 5.9)     36.0     ( 6.7)      --        --       41.2     ( 6.5)     47.7     (10.6)

Median            23.4               30.3                39.0                24.4                40.5                42.5
Low               17.8               19.0                25.0                17.0                24.0                30.4
High              28.7               42.3                47.6                35.0                54.6                52.3
HP 2000
  obj ** #2.3   <=20.0             <=25.0              <=30.0              <=25.0              <=41.0              <=35.0
------------------------------------------------------------------------------------------------------------------------------------
-- Fewer than 50 respondents.
 * Body mass index >=27.8 for males and >=27.3 for females.
 + Annual family income <$10,000.
 & Told on more than one occasion by a health professional that blood pressureis high (HBP).
 @ Confidence interval.
** Healthy People 2000 objective was written for adults ages >=20 years.
======================================================================================================================================


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Table_2
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TABLE 2. Prevalence of no leisure-time physical activity * among adults ages >=18 years
in participating states, by selected characteristics -- Behavioral Risk Factor
Surveillance System, 1991
===================================================================================================
                               Total population          Low income +              Age >=65 yrs
                               ----------------         ---------------          ----------------
State                           %    (95% CI &)          %     (95% CI)           %      (95% CI)
-------------------------------------------------------------------------------------------------
Alabama                        34.2   +/-(2.4)          43.2   +/-(4.2)          47.1   +/-( 5.6)
Alaska                         22.1      (3.2)          25.0      (6.9)          48.6      (13.2)
Arizona                        24.3      (2.4)          31.3      (4.4)          31.0      ( 5.8)
Arkansas                       36.0      (3.0)          41.9      (4.8)          48.7      ( 6.1)
California                     23.3      (1.7)          31.0      (3.4)          26.7      ( 4.4)

Colorado                       18.0      (1.9)          23.7      (3.9)          27.2      ( 5.6)
Connecticut                    25.8      (2.3)          37.2      (5.7)          42.8      ( 5.9)
Delaware                       31.4      (2.7)          44.5      (5.2)          47.9      ( 6.9)
District of Columbia           39.4      (3.1)          46.1      (5.5)          56.3      ( 6.7)
Florida                        28.4      (2.2)          37.7      (4.2)          30.8      ( 4.5)

Georgia                        39.9      (2.6)          50.1      (4.7)          53.9      ( 6.8)
Hawaii                         23.4      (2.2)          28.7      (4.8)          23.3      ( 5.3)
Idaho                          22.0      (2.2)          28.1      (3.9)          33.7      ( 4.9)
Illinois                       36.1      (2.4)          43.6      (4.0)          49.0      ( 5.6)
Indiana                        26.9      (2.1)          33.6      (3.9)          39.3      ( 5.0)

Iowa                           30.0      (2.5)          36.7      (4.5)          40.1      ( 5.5)
Kentucky                       42.0      (2.6)          52.5      (4.0)          56.0      ( 5.4)
Louisiana                      32.6      (2.6)          36.8      (3.8)          45.5      ( 6.6)
Maine                          34.9      (2.9)          39.4      (4.9)          42.8      ( 6.8)
Maryland                       27.8      (2.5)          38.1      (6.7)          42.3      ( 6.5)

Massachusetts                  25.1      (2.5)          36.1      (5.3)          39.9      ( 7.1)
Michigan                       28.6      (2.0)          37.4      (4.0)          39.7      ( 5.2)
Minnesota                      23.7      (1.6)          33.1      (3.4)          36.6      ( 4.1)
Mississippi                    42.6      (2.8)          46.9      (4.2)          55.3      ( 6.2)
Missouri                       36.3      (2.8)          42.9      (4.9)          47.8      ( 5.8)

Montana                        16.6      (2.4)          22.1      (4.1)          32.1      ( 6.1)
Nebraska                       25.1      (2.5)          31.9      (4.3)          40.6      ( 5.7)
New Hampshire                  21.2      (2.2)          31.2      (5.4)          35.5      ( 6.9)
New Jersey                     31.4      (2.8)          48.3      (8.4)          45.6      ( 6.5)
New Mexico                     33.7      (2.9)          43.6      (5.3)          42.4      ( 8.8)

New York                       34.2      (2.4)          46.6      (4.9)          49.8      ( 6.0)
North Carolina                 33.4      (2.5)          41.3      (4.1)          47.4      ( 5.6)
North Dakota                   28.0      (2.3)          30.9      (3.6)          42.3      ( 5.2)
Ohio                           39.6      (3.1)          37.5      (5.4)          46.8      ( 6.6)
Oklahoma                       36.6      (2.8)          42.1      (4.5)          49.0      ( 6.6)

Oregon                         19.6      (1.5)          24.9      (2.8)          31.5      ( 3.8)
Pennsylvania                   26.4      (2.0)          33.9      (3.6)          42.7      ( 5.1)
Rhode Island                   27.9      (2.4)          37.2      (4.7)          39.3      ( 5.5)
South Carolina                 35.4      (2.5)          45.7      (4.2)          49.5      ( 5.4)
South Dakota                   27.1      (2.3)          30.5      (3.8)          37.0      ( 5.2)

Tennessee                      38.7      (2.0)          48.8      (3.6)          50.0      ( 4.7)
Texas                          27.0      (2.8)          39.0      (5.1)          39.6      ( 7.1)
Utah                           20.8      (2.1)          25.1      (3.8)          30.4      ( 5.8)
Vermont                        26.6      (2.5)          39.2      (5.0)          45.8      ( 6.3)
Virginia                       25.2      (2.4)          37.3      (6.0)          38.7      ( 7.0)

Washington                     20.6      (1.9)          24.5      (3.9)          24.3      ( 4.9)
West Virginia                  42.3      (2.3)          50.5      (3.3)          55.8      ( 4.6)
Wisconsin                      25.0      (2.6)          34.9      (5.0)          33.0      ( 6.3)

Median                         28.0                     37.3                     42.3
Low                            16.6                     22.1                     23.3
High                           42.6                     52.5                     56.3
HP 2000 obj @ #1.5           <=15.0 **                <=17.0 **                <=22.0 **
-------------------------------------------------------------------------------------------------
 * No exercise, recreation, or physical activities (other than regular job duties) during the
   previous month.
 + Annual family income <$20,000.
 & Confidence interval.
 @ Healthy People 2000 objective.
** Objective written for persons ages >=6 years.
===================================================================================================


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Table_3
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TABLE 3. Smoking * prevalence among adults ages >=18 years in participating states, by
selected characteristics -- Behavioral Risk Factor Surveillance System, 1991
======================================================================================================================================
                                        High school                                                                       Quit
                       Total           education or                                               Reproductive-      1+ days in past
                     population           less +              Blacks             Hispanics         aged women &           year
                  ----------------    ---------------     ---------------     ---------------     --------------     ---------------
State              %    (95% CI @)     %     (95% CI)      %     (95% CI)      %     (95% CI)      %    (95% CI)      %    (95% CI)
------------------------------------------------------------------------------------------------------------------------------------
Alabama           22.0  +/-( 2.0)     25.4  +/-( 2.7)     19.1  +/-( 4.1)      --   +/-  --       18.0  +/-(3.3)     59.6  +/-(4.5)
Alaska            25.9      (3.2)     33.0      (5.0)      --        --        --        --       24.9     (5.2)     57.4     (6.8)
Arizona           23.7      (2.4)     28.7      (3.7)     13.8     ( 8.7)     17.0     ( 5.1)     21.6     (4.2)     51.7     (5.6)
Arkansas          26.5      (2.6)     29.3      (3.5)     17.6     ( 7.4)      --        --       29.7     (5.1)     49.1     (5.4)
California        19.5      (1.6)     24.0      (2.6)     22.1     ( 6.5)     13.3     ( 3.0)     17.4     (2.6)     57.1     (4.2)

Colorado          23.5      (2.2)     33.4      (4.3)     22.8     (10.5)     24.9     ( 9.0)     24.6     (3.8)     59.2     (5.2)
Connecticut       22.4      (2.2)     28.3      (3.6)     19.8     ( 8.0)     25.1     (15.3)     26.1     (4.4)     58.5     (4.9)
Delaware          25.9      (2.4)     33.0      (3.6)     21.7     ( 6.2)      --        --       27.2     (4.3)     56.3     (5.1)
District of
  Columbia        21.5      (2.5)     26.8      (4.0)     26.2     ( 3.4)      --        --       20.2     (3.9)     57.6     (6.2)
Florida           24.6      (2.2)     28.8      (3.2)     19.3     ( 7.8)     15.0     ( 4.6)     22.0     (3.8)     55.1     (4.5)

Georgia           21.7      (2.2)     26.5      (3.3)     21.8     ( 4.7)      --        --       19.1     (3.5)     49.5     (5.4)
Hawaii            20.3      (2.0)     24.1      (3.4)     28.8     ( 7.3)     26.6     ( 8.3)     18.1     (3.5)     60.2     (4.7)
Idaho             21.1      (2.1)     26.7      (3.2)      --        --        --        --       21.1     (3.7)     55.6     (5.3)
Illinois          23.6      (2.0)     26.2      (3.2)     23.3     ( 5.8)     25.9     (11.4)     26.9     (4.0)     58.1     (4.9)
Indiana           24.4      (2.1)     29.5      (2.9)     35.8     ( 8.1)      --        --       27.0     (3.7)     52.1     (4.6)

Iowa              20.9      (2.2)     24.7      (3.4)      --        --        --        --       24.5     (4.4)     49.7     (5.5)
Kentucky          30.2      (2.3)     34.3      (3.0)     29.5     ( 9.9)      --        --       28.8     (4.0)     48.5     (4.5)
Louisiana         24.1      (2.3)     28.7      (3.3)     21.1     ( 4.4)     18.8     ( 9.6)     22.7     (3.7)     55.0     (5.4)
Maine             26.0      (2.7)     32.2      (3.7)      --        --        --        --       28.5     (4.8)     58.2     (5.6)
Maryland          21.7      (2.3)     27.5      (3.6)     20.7     ( 5.0)     12.7     ( 9.0)     21.2     (3.9)     54.5     (6.0)

Massachusetts     22.5      (2.4)     30.5      (4.0)     19.0     (11.4)      --        --       26.4     (4.3)     59.2     (5.5)
Michigan          27.5      (2.0)     33.6      (2.8)     33.1     ( 6.1)     32.9     (10.6)     30.4     (3.5)     60.9     (3.9)
Minnesota         23.3      (1.5)     28.2      (2.7)     42.3     (13.8)      --        --       25.9     (2.8)     55.4     (3.6)
Mississippi       24.1      (2.5)     27.2      (3.4)     20.1     ( 4.7)     39.3     (15.5)     25.4     (4.0)     57.7     (5.4)
Missouri          25.1      (2.4)     30.2      (3.4)     25.0     ( 8.3)      --        --       25.8     (4.6)     54.8     (5.4)

Montana           20.9      (2.6)     25.9      (4.2)      --        --        --        --       24.6     (5.1)     51.9     (6.7)
Nebraska          22.0      (2.5)     27.2      (3.8)      --        --        --        --       23.9     (4.8)     50.7     (6.1)
New
  Hampshire       23.8      (2.4)     30.2      (3.8)      --        --        --        --       23.8     (4.3)     58.5     (5.4)
New Jersey        22.4      (2.4)     27.1      (3.9)     30.7     (11.7)     17.2     (10.1)     24.5     (4.5)     56.1     (5.7)
New Mexico        16.4      (2.2)     21.4      (3.8)      --        --       14.0     ( 3.4)     17.8     (4.1)     55.5     (7.4)

New York          22.9      (2.1)     26.8      (3.2)     19.6     ( 4.8)     22.7     ( 6.6)     26.5     (4.0)     53.5     (4.5)
North Carolina    23.9      (2.2)     27.7      (3.0)     23.5     ( 5.3)      --        --       21.8     (4.0)     55.5     (4.8)
North Dakota      19.8      (2.1)     22.8      (3.1)      --        --        --        --       19.4     (3.6)     54.7     (5.6)
Ohio              22.9      (2.6)     28.1      (3.6)     21.5     ( 8.2)      --        --       25.9     (4.5)     42.0     (5.9)
Oklahoma          25.0      (2.4)     32.2      (3.7)     18.7     ( 8.9)      --        --       25.2     (4.3)     56.1     (5.2)

Oregon            20.6      (1.5)     27.0      (2.5)      --        --       20.9     ( 8.1)     20.8     (2.7)     55.1     (3.9)
Pennsylvania      25.3      (1.9)     28.7      (2.6)     22.9     ( 6.7)      --        --       29.6     (3.6)     54.8     (4.2)
Rhode Island      24.9      (2.2)     32.2      (3.4)      --        --        --        --       27.0     (4.1)     55.5     (4.6)
South Carolina    22.8      (2.2)     27.3      (3.1)     16.5     ( 3.9)      --        --       24.9     (4.1)     52.4     (5.1)
South Dakota      22.8      (2.0)     25.7      (3.0)      --        --        --        --       24.0     (3.9)     60.4     (4.8)

Tennessee         28.1      (1.9)     33.1      (2.6)     27.5     ( 5.0)      --        --       29.7     (3.4)     42.9     (4.0)
Texas             21.8      (2.3)     27.5      (3.6)     20.2     ( 7.2)     20.6     ( 5.4)     21.5     (3.8)     59.2     (5.6)
Utah              14.3      (1.8)     25.4      (3.6)      --        --       18.6     ( 5.2)     14.2     (3.1)     58.0     (6.2)
Vermont           21.5      (2.4)     27.4      (3.9)      --        --        --        --       19.5     (4.3)     59.1     (5.4)
Virginia          21.5      (2.2)     28.5      (4.0)     20.9     ( 6.3)     22.4     (13.0)     19.6     (3.7)     59.9     (5.2)

Washington        23.1      (2.0)     30.4      (3.4)      --        --       29.4     (12.5)     24.8     (3.6)     58.8     (4.5)
West Virginia     25.2      (1.9)     29.3      (2.4)     32.0     (10.7)      --        --       28.0     (3.6)     47.3     (4.3)
Wisconsin         26.4      (2.6)     32.0      (3.9)      --        --        --        --       25.0     (4.4)     56.3     (5.6)

Median            23.0                28.1                21.7                21.1                24.6               55.6
Low               14.3                21.4                13.8                12.7                14.2               42.0
High              30.2                34.3                42.3                39.3                30.4               60.9
HP 2000
  obj ** #3.4   <=15.0              <=20.0              <=18.0              <=18.0              <=12.0             >=50.0 +
------------------------------------------------------------------------------------------------------------------------------------
-- Fewer than 50 respondents.
 * Ever smoked 100 cigarettes and currently smoke regularly.
 + Objective #3.6.
 & Women ages 18-44 years.
 @ Confidence interval.
** Healthy People 2000 objective was written for adults ages >=20 years.
======================================================================================================================================


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Table_4
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TABLE 4. Prevalence of safety belt use * among adults ages >=18 years, in participating
states -- Behavioral Risk Factor Surveillance System, 1991
=========================================================================================
State                   %   (95 %CI +)          State                   %    (95% CI)
-------------------------------------------------------------------------------------
Alabama                49.2  +/-(2.6)           Missouri               58.2  +/-(2.8)
Alaska                 60.3     (3.5)           Montana                46.5     (3.1)
Arizona                71.2     (2.7)           Nebraska               28.7     (2.6)
Arkansas               49.5     (3.2)           New Hampshire          46.2     (2.8)
California             74.7     (1.8)           New Jersey             71.8     (2.7)
Colorado               63.7     (2.6)           New Mexico             72.7     (2.8)
Connecticut            62.9     (2.6)           New York               64.6     (2.5)
Delaware               53.0     (2.8)           North Carolina         73.7     (2.4)
District of Columbia   62.0     (2.9)           North Dakota           29.1     (2.5)
Florida                68.7     (2.4)           Ohio                   58.1     (3.1)
Georgia                58.7     (2.7)           Oklahoma               57.2     (2.9)
Hawaii                 87.8     (1.6)           Oregon                 74.9     (1.7)
Idaho                  48.2     (2.6)           Pennsylvania           52.9     (2.2)
Illinois               56.5     (2.5)           Rhode Island           39.0     (2.5)
Indiana                53.2     (2.4)           South Carolina         64.6     (2.6)
Iowa                   58.9     (2.7)           South Dakota           22.8     (2.1)
Kentucky               42.4     (2.6)           Tennessee              56.0     (2.1)
Louisiana              63.9     (2.7)           Texas                  70.8     (2.7)
Maine                  42.8     (3.0)           Utah                   46.4     (2.6)
Maryland               71.8     (2.6)           Vermont                50.7     (2.7)
Massachusetts          40.0     (2.8)           Virginia               72.5     (2.4)
Michigan               66.0     (2.1)           Washington             72.2     (2.1)
Minnesota              58.4     (1.9)           West Virginia          40.8     (2.1)
Mississippi            35.6     (2.6)           Wisconsin              52.2     (3.0)

Median                          58.2
Low                             22.8
High                            87.8
HP 2000 obj #9.12 &           >=85.0
-------------------------------------------------------------------------------------
* Persons who report always using a seat belt.
+ Confidence interval.
& Healthy People 2000 objective was written for adults ages >=20 years.
=========================================================================================


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Table_5
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TABLE 5. Percentage of respondents who had blood cholesterol checked within
previous 5 years among adults ages >=18 years, in participating states -- Behavioral
Risk Factor Factor Surveillance System, 1991
======================================================================================
State                   %   (95% CI *)         State                   %    (95% CI)
------------------------------------------------------------------------------------
Alabama                63.2  +/-(2.5)          Missouri               65.0  +/-(2.6)
Alaska                 57.1     (3.7)          Montana                58.6     (3.3)
Arizona                60.8     (3.0)          Nebraska               60.9     (3.0)
Arkansas               58.9     (2.9)          New Hampshire          70.2     (2.6)
California             63.3     (2.1)          New Jersey             71.2     (2.9)
Colorado               63.6     (2.7)          New Mexico             56.2     (3.1)
Connecticut            71.3     (2.5)          New York               66.4     (2.4)
Delaware               62.9     (2.9)          North Carolina         66.3     (2.6)
District of Columbia   66.2     (3.0)          North Dakota           63.1     (2.5)
Florida                71.1     (2.3)          Ohio                   63.2     (2.9)
Georgia                62.0     (2.6)          Oklahoma               65.0     (2.8)
Hawaii                 64.5     (2.5)          Oregon                 64.9     (1.8)
Idaho                  61.4     (2.5)          Pennsylvania           65.0     (2.1)
Illinois               61.4     (2.5)          Rhode Island           69.6     (2.5)
Indiana                60.3     (2.3)          South Carolina         63.7     (2.6)
Iowa                   66.2     (2.6)          South Dakota           63.0     (2.5)
Kentucky               57.9     (2.5)          Tennessee              63.4     (2.1)
Louisiana              60.8     (2.8)          Texas                  60.0     (2.9)
Maine                  65.0     (2.9)          Utah                   57.6     (2.6)
Maryland               65.8     (2.7)          Vermont                66.5     (2.6)
Massachusetts          68.0     (2.7)          Virginia               67.3     (2.6)
Michigan               66.8     (2.1)          Washington             67.0     (2.2)
Minnesota              67.5     (1.8)          West Virginia          62.8     (2.2)
Mississippi            56.9     (2.7)          Wisconsin              65.1     (2.9)

Median                          63.7
Low                             56.2
High                            71.3
HP 2000 obj + #15.14          >=75.0
------------------------------------------------------------------------------------
* Confidence interval.
+ Healthy People 2000 objective was written for adults ages >=20 years.
======================================================================================


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Table_6
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TABLE 6. Percentage of women ages >=40 years who had ever had a clinical breast
examination and a mammogram, in participating states, by selected characteristics --
Behavioral Risk Factor Surveillance System, 1991
=======================================================================================================================================
                                                          Less than high
                                                              school
                  Total population     Low income +         education         Age >=70 years          Blacks             Hispanics
                  ----------------    ---------------     ---------------     ---------------     ---------------     ---------------
State               %    (95% CI*)     %     (95% CI)      %     (95% CI)      %     (95% CI)      %     (95% CI)      %     (95% CI)
-------------------------------------------------------------------------------------------------------------------------------------
Alabama            66.6  +/-(3.7)     53.4  +/-( 7.7)     57.4  +/-( 6.6)     55.0  +/-( 7.9)     62.2  +/-( 8.9)      --   +/-  --
Alaska             72.5     (6.9)      --                 51.2     (16.1)      --        --        --        --        --
Arizona            67.1     (4.8)     55.0     (13.4)     55.3     (12.6)     69.6     ( 8.3)      --        --       60.9     (13.7)
Arkansas           55.9     (5.1)     36.0     ( 9.6)     40.5     ( 8.9)     46.9     ( 8.8)      --        --        --        --
California         77.5     (3.3)     69.7     ( 8.8)     61.4     (10.0)     72.2     ( 7.0)     76.3     (12.8)     67.8     (10.6)

Colorado           73.1     (4.0)     53.6     (12.4)     48.8     (13.9)     68.8     ( 9.1)      --        --        --        --
Connecticut        73.8     (4.1)     47.1     (12.7)     55.9     (11.6)     58.6     ( 9.5)      --        --        --        --
Delaware           72.5     (4.4)     59.8     (12.6)     62.4     ( 9.7)     64.6     ( 9.1)     63.7     (13.7)      --        --
District of
  Columbia         83.1     (4.0)     69.4     (13.4)     77.4     ( 9.9)     79.5     ( 8.0)     84.8     ( 4.7)      --        --
Florida            72.9     (3.5)     60.1     ( 8.8)     60.3     ( 8.4)     69.6     ( 6.8)     75.4     (10.7)     59.9     (12.1)

Georgia            71.1     (4.2)     54.2     ( 9.4)     60.0     ( 8.0)     59.3     ( 9.5)     57.5     ( 9.6)      --        --
Hawaii             70.1     (4.5)     60.6     (13.3)     62.7     (10.4)     66.2     (10.0)      --        --        --        --
Idaho              67.5     (4.0)     53.1     ( 9.1)     57.3     ( 8.4)     58.4     ( 7.4)      --        --        --        --
Illinois           67.0     (4.4)     50.3     ( 9.0)     63.7     ( 9.8)     58.0     ( 8.0)     67.4     (11.3)      --        --
Indiana            64.4     (3.8)     45.8     ( 9.8)     47.2     ( 8.0)     51.1     ( 7.7)     52.9     (14.1)      --        --

Iowa               62.6     (4.7)     48.0     (11.5)     57.5     (11.2)     53.3     ( 8.0)      --        --        --        --
Kentucky           61.3     (4.1)     46.4     ( 7.6)     47.8     ( 6.9)     48.3     ( 8.2)      --        --        --        --
Louisiana          55.5     (4.6)     46.8     ( 8.7)     41.3     ( 8.1)     47.3     ( 9.5)     49.2     (10.1)      --        --
Maine              76.3     (4.4)     62.0     (10.4)     63.0     ( 9.8)     68.0     ( 9.7)      --        --        --        --
Maryland           76.3     (3.9)      --        --       59.4     (10.5)     66.1     ( 9.6)     78.5     ( 7.5)      --        --

Massachusetts      75.8     (4.7)     61.6     (12.7)     61.7     (13.3)     67.2     ( 9.4)      --        --        --        --
Michigan           72.3     (3.5)     60.7     ( 8.2)     56.6     ( 7.9)     61.7     ( 7.1)     63.4     (12.0)      --        --
Minnesota          77.6     (2.8)     65.3     ( 7.4)     68.5     ( 7.6)     63.6     ( 6.0)      --        --        --        --
Mississippi        58.7     (4.2)     46.9     ( 8.4)     46.0     ( 7.5)     51.9     ( 8.4)     44.8     ( 9.1)      --        --
Missouri           66.4     (4.2)     58.6     ( 9.4)     58.3     ( 8.7)     61.7     ( 7.9)      --        --        --        --

Montana            69.6     (4.7)     42.7     (11.2)     46.8     (13.3)     55.1     ( 9.4)      --        --        --        --
Nebraska           59.6     (4.9)     47.5     (10.4)     49.8     (11.4)     49.1     ( 8.0)      --        --        --        --
New
  Hampshire        76.7     (4.2)     54.7     (12.2)     63.2     (12.8)     52.9     (11.0)      --        --        --        --
New Jersey         67.2     (4.4)      --        --       60.8     (12.7)     57.1     ( 8.9)      --        --        --        --
New Mexico         61.0     (6.1)     49.8     (16.6)     48.4     (14.9)     46.8     (14.7)      --        --       51.6     (10.8)

New York           68.0     (4.2)     62.6     (10.5)     55.0     ( 9.0)     63.5     ( 8.1)     72.0     (11.4)      --        --
North Carolina     66.8     (4.4)     59.8     ( 8.4)     51.8     ( 7.8)     61.3     ( 7.3)     61.8     (11.4)      --        --
North Dakota       72.1     (4.0)     62.9     ( 9.0)     59.0     ( 8.2)     64.5     ( 7.0)      --        --        --        --
Ohio               65.1     (5.2)     63.7     (12.0)     57.6     (11.1)     56.1     (10.8)      --        --        --        --
Oklahoma           63.8     (4.6)     44.6     ( 9.3)     52.8     ( 9.8)     56.4     ( 8.6)      --        --        --        --

Oregon             79.4     (2.5)     66.3     ( 7.7)     67.6     ( 8.6)     73.1     ( 5.3)      --        --        --        --
Pennsylvania       69.1     (3.6)     65.1     ( 8.1)     56.6     ( 8.2)     55.9     ( 7.6)     70.8     (13.0)      --        --
Rhode Island       76.0     (3.9)     70.8     ( 8.9)     74.7     ( 7.0)     67.0     ( 7.5)      --        --        --        --
South Carolina     67.5     (3.9)     50.1     ( 8.0)     54.2     ( 7.0)     56.5     ( 6.8)     57.6     ( 8.4)      --        --
South Dakota       67.4     (4.0)     52.1     ( 9.4)     59.5     ( 9.4)     58.7     ( 7.3)      --        --        --        --

Tennessee          66.1     (3.4)     52.0     ( 6.9)     52.3     ( 6.4)     58.3     ( 7.0)     64.5     (10.4)      --        --
Texas              70.6     (4.4)     52.4     (10.6)     50.9     (10.0)     60.8     (10.0)     55.2     (16.6)     55.7     (13.0)
Utah               69.8     (4.5)     60.6     (13.7)     66.4     (12.5)     67.9     ( 8.0)      --        --       68.8     (11.8)
Vermont            73.1     (4.0)     53.8     (11.9)     60.5     (11.3)     57.4     ( 9.6)      --        --        --        --
Virginia           70.6     (4.8)     51.6     (12.7)     61.5     (10.3)     65.5     (10.7)     60.7     (13.6)      --        --
Washington         81.4     (3.4)     66.1     (13.4)     63.9     (12.5)     78.3     ( 7.0)      --        --        --        --
West Virginia      61.2     (3.5)     46.9     ( 6.2)     48.6     ( 6.0)     58.2     ( 6.3)      --        --        --        --
Wisconsin          74.1     (4.8)     47.0     (12.6)     50.8     (12.7)     55.8     (10.3)      --        --        --        --

Median             69.7               53.8                57.4                59.0                62.8                60.4
Low                55.5               36.0                40.5                46.8                44.8                51.6
High               83.8               70.8                77.4                79.5                84.8                68.8
HP 2000
  obj & #16.11   >=80.0             >=80.0              >=80.0              >=80.0              >=80.0              >=80.0
-------------------------------------------------------------------------------------------------------------------------------------
-- Fewer than 50 respondents.
 * Confidence interval.
 + Annual family income <$10,000.
 & Healthy People 2000 objective.
=======================================================================================================================================


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Table_7
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TABLE 7. Percentage of women ages >=50 years who had a clinical breast examination and
a mammogram during the previous 2 years, in participating states, by selected
characteristics -- Behavioral Risk Factor Surveillance System, 1991
=======================================================================================================================================
                                                          Less than high
                                                              school
                 Total population      Low income +          education        Age >=70 years          Blacks             Hispanics
                 ----------------     ---------------     ---------------     ---------------     ---------------     ---------------
State              %   (95% CI *)      %     (95% CI)      %     (95% CI)      %     (95% Cl)      %     (95% CI)       %    (95% CI)
-------------------------------------------------------------------------------------------------------------------------------------
Alabama           53.2  +/-( 4.8)     38.3  +/-( 7.9)     46.6  +/-( 7.1)     47.1  +/-( 8.1)     45.8  +/-(11.0)      --   +/-  --
Alaska            61.4     (10.3)      --       --        34.4     (15.0)      --        --        --        --        --        --
Arizona           56.0     ( 5.9)     43.8     (14.7)     44.0     (14.1)     58.2     ( 8.8)      --        --        --        --
Arkansas          45.7     ( 6.0)     31.7     ( 9.8)     36.1     ( 9.5)     39.1     ( 8.4)      --        --        --        --
California        64.1     ( 4.5)     54.9     ( 9.8)     51.8     (11.2)     59.1     ( 7.6)      --        --       56.7     (15.2)

Colorado          59.9     ( 5.8)     39.6     (13.4)     30.3     (13.3)     56.3     (10.4)      --        --        --        --
Connecticut       60.7     ( 5.5)     41.6     (12.5)     44.0     (12.5)     49.9     ( 9.5)      --        --        --        --
Delaware          61.6     ( 5.6)     45.7     (13.2)     51.8     (10.7)     50.6     ( 9.6)      --        --        --        --
District of
  Columbia        82.8     ( 4.6)     76.2     (13.4)     80.7     ( 9.7)     76.9     ( 8.5)     86.9     ( 4.8)      --        --
Florida           62.3     ( 4.3)     47.3     ( 9.0)     52.0     ( 9.0)     59.3     ( 7.2)     60.4     (13.3)     55.5     (13.8)

Georgia           57.6     ( 5.9)     42.4     ( 9.9)     50.5     ( 8.7)     48.3     ( 9.5)     42.5     (12.0)      --        --
Hawaii            60.8     ( 5.7)     54.3     (15.0)     49.8     (11.4)     53.1     (10.8)      --        --        --        --
Idaho             52.7     ( 5.0)     34.7     ( 9.5)     37.8     ( 8.7)     43.4     ( 7.5)      --        --        --        --
Illinois          59.2     ( 5.4)     48.0     ( 9.4)     58.7     (10.2)     50.3     ( 8.1)     60.6     (15.4)      --        --
Indiana           49.7     ( 4.7)     37.0     ( 9.7)     41.2     ( 8.3)     37.9     ( 7.2)      --        --        --        --

Iowa              51.6     ( 5.5)     38.9     (11.6)     43.3     (11.0)     43.6     ( 7.8)      --        --        --        --
Kentucky          49.5     ( 5.1)     34.8     ( 8.1)     36.4     ( 7.3)     38.7     ( 8.0)      --        --        --        --
Louisiana         45.6     ( 5.5)     35.9     ( 9.1)     36.2     ( 8.8)     39.4     ( 9.6)     32.8     (11.3)      --        --
Maine             65.0     ( 5.8)     50.9     (11.1)     57.2     (10.6)     58.5     (10.8)      --        --        --        --
Maryland          69.3     ( 5.3)      --        --       53.7     (12.5)     55.0     (10.8)     75.0     (10.5)      --        --

Massachusetts     67.5     ( 6.1)     57.8     (13.2)     56.2     (14.1)     56.7     (10.2)      --        --        --        --
Michigan          61.0     ( 4.6)     45.6     ( 8.9)     44.9     ( 8.5)     48.3     ( 7.6)      --        --        --        --
Minnesota         65.0     ( 3.8)     50.9     ( 7.9)     54.5     ( 8.0)     50.8     ( 6.2)      --        --        --        --
Mississippi       45.7     ( 5.1)     35.0     ( 8.4)     34.3     ( 7.7)     34.4     ( 7.6)     34.8     (10.5)      --        --
Missouri          57.3     ( 5.2)     42.9     (10.4)     50.2     ( 9.0)     51.0     ( 8.2)      --        --        --        --

Montana           52.8     ( 6.3)     30.0     (11.1)     32.5     (13.1)     42.2     ( 9.9)      --        --        --        --
Nebraska          46.0     ( 5.5)     33.6     (10.2)     34.0     (10.9)     37.9     ( 7.9)      --        --        --        --
New Hampshire     63.8     ( 6.0)     45.6     (12.4)     58.0     (14.3)     45.8     (10.9)      --        --        --        --
New Jersey        55.9     ( 5.4)      --        --       51.1     (13.7)     44.8     ( 9.2)      --        --        --        --
New Mexico        52.6     ( 8.1)      --        --       42.0     (15.4)     32.6     (12.9)      --        --       41.6     (13.8)

New York          54.4     ( 5.4)     45.0     (11.7)     40.7     ( 9.8)     46.8     ( 8.8)      --        --        --        --
North Carolina    58.8     ( 5.0)     51.5     ( 9.0)     46.3     ( 8.0)     54.3     ( 7.6)     49.2     (13.7)      --        --
North Dakota      59.3     ( 4.9)     50.6     ( 9.2)     48.7     ( 8.6)     54.1     ( 7.4)      --        --        --        --
Ohio              51.3     ( 6.4)     50.2     (13.0)     47.3     (12.0)     46.0     (10.9)      --        --        --        --
Oklahoma          49.6     ( 5.5)     29.0     ( 9.0)     40.9     (10.2)     42.9     ( 8.4)      --        --        --        --

Oregon            64.2     ( 3.6)     40.3     ( 8.5)     51.3     ( 9.4)     53.7     ( 6.0)      --        --        --        --
Pennsylvania      58.1     ( 4.5)     56.2     ( 9.2)     46.0     ( 8.8)     48.5     ( 7.7)      --        --        --        --
Rhode Island      62.4     ( 5.2)     60.4     (10.1)     62.5     ( 8.6)     53.1     ( 8.3)      --        --        --        --
South Carolina    57.5     ( 4.6)     40.5     ( 8.4)     44.6     ( 7.4)     47.0     ( 6.8)     46.9     (10.1)      --        --
South Dakota      54.8     ( 5.0)     34.2     ( 9.2)     41.3     ( 9.0)     41.0     ( 7.4)      --        --        --        --

Tennessee         55.3     ( 4.4)     41.0     ( 7.3)     43.4     ( 6.7)     50.8     ( 7.2)     64.2     (12.1)      --        --
Texas             52.9     ( 6.0)     35.4     (11.7)     36.1     (10.1)     41.8     ( 9.7)      --        --        --        --
Utah              57.2     ( 5.4)     41.2     (14.9)     52.7     (14.3)     51.0     ( 8.7)      --        --        --        --
Vermont           61.0     ( 5.7)     27.3     (10.8)     36.4     (12.0)     42.3     (10.1)      --        --        --        --
Virginia          58.3     ( 6.6)     45.3     (13.7)     48.0     (12.1)     56.7     (11.1)     42.4     (16.3)      --        --

Washington        67.0     ( 4.9)     39.4     (14.5)     48.4     (13.5)     63.0     ( 8.2)      --        --        --        --
West Virginia     52.1     ( 4.0)     39.2     ( 6.4)     39.5     ( 6.3)     47.8     ( 6.3)      --        --        --        --
Wisconsin         58.9     ( 6.3)     37.3     (12.4)     42.3     (12.7)     41.3     (10.4)      --        --        --        --

Median            57.8                41.4                45.4                48.3                48.0                55.5
Low               45.6                27.3                30.3                32.6                15.6                41.6
High              82.8                76.2                80.7                76.9                86.9                56.7
HP 2000
  obj & #16.11  >=60.0              >=60.0              >=60.0              >=60.0              >=60.0              >=60.0
-------------------------------------------------------------------------------------------------------------------------------------
-- Fewer than 50 respondents.
 * Confidence interval.
 + Annual family income <$10,000.
 & Healthy People 2000 objective.
=======================================================================================================================================


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Table_8
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TABLE 8. Percentage of women ages >=18 years with an intact uterine cervix who had
ever had a Pap smear, in participating states, by selected characteristics -- Behavioral
Risk Factor Surveillance System, 1991
=====================================================================================================================
                                                          Less than high
                  Total population     Low income +       school education     Age >=70 years         Hispanics
                  ----------------    ---------------     ----------------     ---------------     ----------------
State               %   (95% CI *)     %     (95% CI)       %     (95% CI)      %     (95% CI)       %     (95% CI)
-------------------------------------------------------------------------------------------------------------------
Alabama            92.5  +/-(2.2)     84.8  +/-( 5.9)      87.2  +/-( 5.4)     78.0  +/-( 8.6)       --   +/-  --
Alaska             93.0     (3.6)     82.6     (13.6)      73.9     (18.5)     78.3     (20.6)       --        --
Arizona            91.0     (3.0)     87.8     ( 9.4)      91.2     ( 6.6)     93.8     ( 5.6)      84.1     ( 8.6)
Arkansas           91.5     (2.5)     75.3     ( 8.9)      83.6     ( 6.5)     79.5     ( 8.5)       --        --
California         90.1     (2.1)     83.5     ( 6.2)      73.7     ( 7.9)     89.5     ( 6.4)      80.8     ( 5.5)

Colorado           95.3     (1.8)     92.6     ( 5.0)      88.9     ( 9.5)     89.6     ( 7.3)     100.0     ( 0.0)
Connecticut        93.2     (2.1)     82.6     ( 8.9)      83.7     ( 9.3)     82.1     ( 9.0)       --        --
Delaware           93.4     (2.4)     84.2     (12.4)      87.5     ( 7.5)     78.8     ( 9.6)       --        --
District of
  Columbia         92.9     (2.3)     89.7     ( 6.4)      90.3     ( 6.6)     86.2     ( 8.9)       --        --
Florida            89.9     (2.6)     76.8     (10.1)      83.3     ( 7.0)     87.3     ( 6.3)      76.1     ( 8.7)

Georgia            94.1     (2.4)     88.3     ( 7.3)      84.4     ( 9.5)     81.7     (11.3)       --        --
Hawaii             89.3     (2.7)     84.1     (10.2)      82.1     ( 8.6)     86.8     ( 9.0)      91.4     (10.1)
Idaho              93.4     (2.2)     80.2     ( 9.5)      94.9     ( 4.1)     91.4     ( 5.2)       --        --
Illinois           87.1     (2.7)     72.9     ( 7.8)      79.6     ( 8.1)     74.8     ( 8.9)       --        --
Indiana            93.6     (1.8)     79.5     ( 8.0)      89.0     ( 5.1)     85.0     ( 6.1)       --        --

Iowa               93.2     (2.4)     81.0     ( 9.3)      88.4     ( 7.9)     79.6     ( 9.1)       --        --
Kentucky           91.7     (2.2)     89.3     ( 5.1)      85.5     ( 5.5)     76.5     (10.0)       --        --
Louisiana          92.5     (2.4)     84.7     ( 6.4)      82.2     ( 8.3)     82.5     ( 9.4)       --        --
Maine              95.1     (2.1)     86.9     ( 7.9)      84.7     ( 7.9)     85.3     (10.2)       --        --
Maryland           92.4     (2.3)      --        --        84.3     (11.3)     84.0     ( 9.6)       --        --

Massachusetts      92.0     (2.3)     87.3     ( 7.5)      73.6     (13.0)     80.2     ( 9.9)       --        --
Michigan           94.2     (1.6)     91.7     ( 4.2)      90.5     ( 4.4)     84.9     ( 6.8)       --        --
Minnesota          92.9     (1.6)     82.2     ( 6.2)      84.9     ( 6.4)     82.5     ( 6.1)       --        --
Mississippi        89.2     (2.9)     84.0     ( 6.2)      81.6     ( 7.9)     72.2     (10.0)       --        --
Missouri           92.6     (2.6)     81.2     (11.4)      92.7     ( 4.5)     84.2     ( 7.3)       --        --

Montana            93.1     (3.1)     87.8     ( 7.7)      80.9     (14.3)     81.6     ( 8.9)       --        --
Nebraska           93.5     (2.6)     92.3     ( 5.1)      84.4     ( 9.6)     85.0     ( 7.2)       --        --
New Hampshire      93.7     (2.3)     83.3     (10.2)      84.7     (10.8)     81.6     ( 9.6)       --        --
New Jersey         90.8     (2.4)      --        --        78.9     (11.4)     88.9     ( 6.0)       --        --
New Mexico         88.8     (3.5)     77.5     (10.9)      81.1     (11.8)      --        --        81.7     ( 7.0)

New York           86.8     (2.5)     82.9     ( 7.8)      72.9     ( 8.4)     76.3     ( 8.2)      84.8     ( 7.4)
North Carolina     92.4     (2.5)     88.0     ( 6.0)      80.7     ( 8.7)     86.6     ( 6.2)       --        --
North Dakota       91.2     (2.6)     85.2     ( 6.8)      76.2     (10.3)     84.5     ( 6.5)       --        --
Ohio               91.4     (2.8)     84.0     ( 9.2)      87.7     ( 8.1)     85.1     ( 9.5)       --        --
Oklahoma           93.1     (2.5)     86.1     ( 7.7)      93.2     ( 5.4)     86.0     ( 8.3)       --        --

Oregon             95.2     (1.5)     91.0     ( 6.4)      91.7     ( 6.5)     91.5     ( 5.0)      93.4     ( 7.5)
Pennsylvania       92.3     (1.8)     81.8     ( 7.3)      89.3     ( 5.3)     88.7     ( 5.1)       --        --
Rhode Island       91.8     (2.3)     85.7     ( 7.9)      87.2     ( 6.1)     81.3     ( 8.2)       --        --
South Carolina     94.1     (1.8)     83.8     ( 6.3)      89.9     ( 4.4)     84.3     ( 6.3)       --        --
South Dakota       93.8     (2.0)     86.6     ( 6.9)      83.2     ( 9.1)     88.8     ( 5.6)       --        --

Tennessee          91.5     (1.8)     86.7     ( 4.6)      88.6     ( 3.9)     76.5     ( 9.0)       --        --
Texas              91.4     (2.5)     83.6     ( 8.4)      78.4     ( 8.1)     82.6     ( 9.1)      86.7     ( 5.4)
Utah               90.9     (2.7)     79.9     (11.5)      84.1     (10.8)     93.5     ( 5.8)      87.4     ( 8.0)
Vermont            92.4     (2.5)     83.1     (10.4)      84.7     ( 8.5)     81.0     ( 9.2)       --        --
Virginia           91.7     (2.5)     79.1     (13.3)      84.8     ( 7.7)     85.6     ( 8.5)       --        --

Washington         94.9     (1.8)     95.3     ( 5.7)      89.9     ( 8.1)     93.6     ( 5.7)       --        --
West Virginia      91.2     (2.0)     84.6     ( 5.2)      88.6     ( 4.4)     79.7     ( 6.6)       --        --
Wisconsin          91.6     (2.8)     83.5     (10.3)      77.6     (12.3)     75.9     (12.4)       --        --

Median             92.4               83.9                 84.7                84.2                 85.8
Low                86.8               70.1                 72.9                72.2                 76.1
High               95.3               95.3                 94.9                93.8                100.0
HP 2000
  obj & #16.12   >=95.0             >=95.0               >=95.0              >=95.0               =>95.0
-------------------------------------------------------------------------------------------------------------------
-- Fewer than 50 respondents.
 * Confidence interval.
 + Annual family income <$10,000.
 & Healthy People 2000 objective.
=====================================================================================================================


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Table_9
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TABLE 9. Percentage of women ages >=18 years with an intact uterine cervix who had
had a Pap smear during the previous 2 years, * in participating states, by selected
characteristics -- Behavioral Risk Factor Surveillance System, 1991
===================================================================================================================
                                                             Less than
                        Total                               high school
                     population        Low income &          education        Age >=70 years         Hispanics
                   ---------------    ---------------     ---------------     ---------------     ---------------
State               %   (95% CI +)     %     (95% CI)      %     (95% CI)      %     (95% CI)      %     (95% CI)
-----------------------------------------------------------------------------------------------------------------
Alabama            82.4  +/-(2.9)     70.6  +/-( 7.2)     68.5  +/-( 7.5)     55.5  +/-(10.6)      --   +/-  --
Alaska             83.0     (4.5)     73.9     (14.9)     63.1     (18.3)      --        --        --        --
Arizona            78.9     (3.8)     72.6     (11.0)     73.2     (10.4)     65.5     (11.6)     71.8     ( 9.8)
Arkansas           74.7     (4.1)     55.2     (11.0)     53.5     ( 9.8)     55.7     (11.1)      --        --
California         80.4     (2.6)     73.5     ( 7.0)     62.8     ( 8.4)     72.7     ( 9.4)     74.8     ( 5.9)

Colorado           84.2     (2.9)     71.8     ( 9.4)     65.3     (12.8)     57.8     (13.2)     94.1     ( 5.6)
Connecticut        81.7     (3.0)     65.4     (11.9)     63.7     (12.0)     55.8     (11.4)      --        --
Delaware           82.4     (3.1)     61.7     (13.2)     68.2     ( 9.5)     57.4     (10.9)      --        --
District of
  Columbia         87.5     (3.0)     81.9     ( 9.3)     83.6     ( 8.7)     75.1     (11.1)      --        --
Florida            76.1     (3.3)     62.8     (10.5)     63.1     ( 9.4)     64.0     ( 9.0)     62.7     ( 9.5)

Georgia            82.7     (3.3)     64.9     ( 9.9)     59.2     (10.2)     47.4     (12.9)      --        --
Hawaii             79.3     (3.3)     71.5     (11.3)     71.9     ( 9.7)     63.1     (11.9)     83.3     (11.4)
Idaho              78.0     (3.4)     60.8     (10.2)     74.1     ( 8.0)     56.8     (10.9)      --        --
Illinois           79.1     (3.1)     63.8     ( 8.1)     69.8     ( 9.2)     52.4     (10.9)      --        --
Indiana            79.4     (2.8)     65.4     ( 9.3)     67.0     ( 8.7)     49.3     ( 9.5)      --        --

Iowa               80.8     (3.1)     67.9     (10.2)     66.5     (11.2)     60.0     (10.1)      --        --
Kentucky           77.2     (3.1)     63.1     ( 7.5)     60.9     ( 7.2)     43.8     (10.9)      --        --
Louisiana          82.4     (3.2)     73.3     ( 7.4)     62.2     ( 9.5)     49.2     (13.6)      --        --
Maine              83.3     (3.7)     74.0     ( 9.7)     68.7     (11.3)     69.6     (12.3)      --        --
Maryland           84.9     (2.8)      --        --       67.5     (12.4)     57.6     (14.3)      --        --

Massachusetts      77.4     (3.6)     69.4     (10.8)     53.1     (14.6)     49.0     (12.5)      --        --
Michigan           79.7     (2.7)     75.6     ( 6.5)     72.7     ( 6.9)     53.8     ( 9.7)      --        --
Minnesota          79.8     (2.2)     66.3     ( 6.8)     63.7     ( 8.4)     52.0     ( 7.4)      --        --
Mississippi        75.6     (3.5)     67.4     ( 7.3)     57.6     ( 9.0)     50.7     (10.3)      --        --
Missouri           83.7     (3.3)     71.1     (11.3)     77.1     ( 8.4)     66.0     ( 9.3)      --        --

Montana            78.8     (4.0)     74.4     ( 9.7)     59.8     (14.9)     57.1     (11.9)      --        --
Nebraska           78.5     (3.7)     76.3     ( 7.9)     58.3     (13.2)     55.6     (10.2)      --        --
New Hampshire      79.4     (3.4)     54.8     (12.1)     54.3     (13.0)     46.0     (13.1)      --        --
New Jersey         77.3     (3.3)      --        --       53.7     (13.3)     59.2     (10.8)      --        --
New Mexico         75.7     (4.7)     51.0     (13.4)     49.0     (14.0)      --        --       71.6     ( 7.7)

New York           78.3     (3.0)     73.6     ( 8.8)     60.0     ( 9.1)     56.1     (10.4)     76.3     ( 9.4)
North Carolina     83.5     (3.1)     78.4     ( 7.0)     67.3     ( 9.1)     66.2     ( 9.0)      --        --
North Dakota       76.0     (3.3)     65.7     ( 8.7)     48.6     (10.3)     50.5     ( 8.8)      --        --
Ohio               80.2     (3.9)     68.5     (10.8)     60.9     (12.6)     59.0     (14.1)      --        --
Oklahoma           79.3     (3.6)     69.7     ( 9.8)     73.5     ( 9.7)     54.5     (12.3)      --        --

Oregon             83.4     (2.2)     77.6     ( 7.5)     68.9     ( 9.1)     63.4     ( 8.3)     81.5     (13.0)
Pennsylvania       76.5     (2.8)     63.8     ( 8.5)     62.4     ( 8.5)     53.5     ( 9.4)      --        --
Rhode Island       77.0     (3.5)     71.3     ( 9.6)     62.1     ( 9.4)     54.5     (10.6)      --        --
South Carolina     86.2     (2.4)     69.4     ( 7.7)     80.6     ( 5.8)     61.5     ( 8.4)      --        --
South Dakota       81.4     (2.8)     72.3     ( 8.1)     60.7     (10.4)     57.2     ( 9.0)      --        --

Tennessee          81.0     (2.6)     70.2     ( 6.2)     71.0     ( 6.1)     54.7     (10.0)      --        --
Texas              78.6     (3.5)     59.2     (10.5)     62.3     ( 9.3)     58.6     (13.3)     74.5     ( 7.8)
Utah               77.3     (3.5)     68.1     (11.9)     68.5     (13.3)     66.2     (10.3)     68.0     ( 9.8)
Vermont            80.1     (3.2)     61.1     (11.5)     66.2     (10.8)     48.3     (12.0)      --        --
Virginia           86.3     (2.9)     74.5     (13.5)     77.7     ( 9.3)     66.8     (12.8)      --        --

Washington         85.4     (2.5)     75.8    (10.6)      82.2     ( 9.6)     72.6     ( 9.8)      --        --
West Virginia      73.7     (2.8)     66.2    ( 6.1)      60.5     ( 6.5)     52.0     ( 7.8)      --        --
Wisconsin          80.6     (3.7)     67.1    (12.5)      68.2     (13.4)     50.6     (13.5)      --        --

Median             79.7               69.4                64.5                55.9                73.6
Low                73.7               51.0                48.6                43.8                62.7
High               87.5               81.9                83.6                75.1                94.1
HP 2000
  obj @ #16.12   >=85.0             >=80.0              >=75.0              >=70.0              >=80.0
-----------------------------------------------------------------------------------------------------------------
-- Fewer than 50 respondents.
 * Healthy People 2000 objective specifies within the previous 3 years, rather than 2 years.
 + Confidence interval.
 & Annual family income <$10,000.
 @ Healthy People 2000 objective.
===================================================================================================================


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Table_A1
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APPENDIX 1. Year 2000 health objectives for the nation: state summary of BRFSS *
data for 1991
==================================================================================================
                                              State:____________________________________________

                                                       BRFSS, 1991
                                       Year 2000     low-median-high @
Healthy People 2000 + objective &        target           (%)                   State, 1991
------------------------------------------------------------------------------------------------
Overweight (objective/#2.3)

  Ages >=18                              <=20%        17.8-23.4- 28.7       ____________________

  Low-income (annual family
    income $<10,000) women ages
    >=18 years                           <=25%        19.0-30.3- 42.3       ____________________

  Black women ages >=18 years            <=30%        25.0-39.0- 47.6       ____________________

  Hispanic women ages >=18 years         <=25%        17.0-24.4- 35.0       ____________________

  Women with high blood pressure         <=41%        24.0-40.5- 54.6       ____________________

  Men with high blood pressure           <=35%        30.4-42.5- 52.3       ____________________

No leisure-time physical activity
  (objective #1.5)

  Ages >=18 years                        <=15%        16.6-28.0- 42.6       ____________________

  Low income (annual family
    income <$20,000) ages >=18
    years                                <=17%        22.1-37.3- 52.5       ____________________

  Ages >=65 years                        <=22%        23.3-42.3- 56.3       ____________________

Cigarette smoking (objective #3.4)

  Ages >=18 years                        <=15%        14.3-23.0- 30.2       ____________________

  <= High school education
    ages >=18 years                      <=20%        21.4-28.1- 34.3       ____________________

  Blacks ages >=18 years                 <=18%        13.8-21.7- 42.3       ____________________

  Hispanics ages >=18 years              <=18%        12.7-21.1- 39.3       ____________________

  Reproductive-aged (18-44 years)
    women                                <=12%        14.2-24.6- 30.4       ____________________

Quit 1+ days in previous year
  (objective #3.6)

  Ages >=18 years                        >=50%        42.0-55.6- 60.9       ____________________

Safety belt use (objective #9.12)

  Ages >=18 years                        >=85%        22.8-58.2- 87.8       ____________________

Cholesterol screening within
  preceding 5 years
  (objective #15.14)

  Ages >=18 years                        >=75%        56.2-63.7- 71.3       ____________________

Clinical breast examination and
  mammogram (ever had)
  (objective #16.11)

  Women ages >=40 years                  >=80%        55.5-69.7- 83.1       ____________________

  Low income (annual family
    income <$10,000) women
    ages >=40 years                      >=80%        36.0-53.8- 70.8       ____________________

  Less than high school education
    women ages >=40 years                >=80%        40.5-57.4- 77.4       ____________________

  Women ages >=70 years                  >=80%        46.8-59.0- 79.5       ____________________

  Black women ages >=40 years            >=80%        44.8-62.8- 84.8       ____________________

  Hispanic women ages >=40 years         >=80%        51.6-60.4- 68.8       ____________________

Clinical breast examination and
  mammogram (had within 2 years)
  (objective #16.11)

  Women ages >=50 years                  >=60%        45.6-57.8- 82.8       ____________________

  Low income (annual family
    income <$10,000) women
    ages >=50 years                      >=60%        27.3-41.4- 76.2       ____________________

  Less than high school education
    women ages >=50 years                >=60%        30.3-45.4- 80.7       ____________________

  Women ages >=70 years                  >=60%        32.6-48.3- 76.9       ____________________

  Black women ages >=50 years            >=60%        32.8-48.0- 86.9       ____________________

  Hispanic women ages >=50 years         >=60%        41.6-55.5- 56.7       ____________________

Pap smear (ever had), women with
  intact uterine cervix
  (objective #16.12)

  Ages >=18 years                        >=95%        86.8-92.4- 95.3       ____________________

  Low income (annual family
    income <$10,000) ages >=18
    years                                >=95%        70.1-83.9- 95.3       ____________________

  Less than high school education
    ages >=18 years                      >=95%        72.9-84.7- 94.9       ____________________

  Ages >=70 years                        >=95%        72.2-84.7- 93.8       ____________________

  Hispanics ages >=18 years              >=95%        76.1-85.8-100.0       ____________________

Pap smear (had within preceding
  2 years), women with intact
  uterine cervix (objective #16.12)

  Ages >=18 years                        >=85%        73.7-79.7- 87.5       ____________________

  Low income (annual family
    income <$10,000) ages >=18
    years                                >=80%        51.0-69.4- 81.9       ____________________

  Less than high school education
    ages >=18 years                      >=75%        48.6-64.5- 83.6       ____________________

  Ages >=70 years                        >=70%        43.8-55.9- 75.1       ____________________

  Hispanics ages >=18 years              >=80%        62.7-73.6- 94.1       ____________________
------------------------------------------------------------------------------------------------
* Behavioral Risk Factor Surveillance System.
+ Public Health Service. Healthy people 2000: national health promotion and disease prevention
  objectives -- full report with commentary. Washington, DC: U.S. Department of Health and
  Human Services, 1991.
& In some cases, BRFSS definitions of objectives differ slightly from those in Healthy People
  2000. See definitions in Methods Section for further explanation.
@ Among participating states.
==================================================================================================


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Table_A2
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                                         APPENDIX 2.
Behavioral Risk Factor Surveillance System state coordinators, 1993
==================================================================================
State                       Coordinator                             Telephone
--------------------------------------------------------------------------------
Alabama                     Laurie E. Eldridge, MPH                 205-242-2848
Alaska                      Patricia G. Owen                        907-465-3140
Arizona                     John R. Contreras, MPA                  602-230-5945
Arkansas                    John W. Senner, PhD                     501-661-2497
California                  Laura E. Lund, MA                       916-327-7767

Colorado                    Marilyn G. Leff, MSW, MSPH              303-692-2168
Connecticut                 Mary L. Adams, MS, MPH                  203-566-7867
Delaware                    Fred N. Breukelman, CHES                302-739-4787
District of Columbia        Cynthia Y. Mitchell                     202-727-4921
Florida                     Doris McTague                           904-488-2901

Georgia                     Christopher W. Sellers, MD, MPH         404-894-4283
Hawaii                      Valerie F. Ah Cook, MPH                 808-832-5951
Idaho                       Joanne E. Mitten, MHE                   208-334-5933
Illinois                    Bruce F. Steiner, MS                    217-782-3702
Indiana                     Raymond J. Guest, MPH                   317-633-0268

Iowa                        Susan K. Schoon                         515-281-3763
Kentucky                    Karen Bramblett                         502-564-7112
Louisiana                   Shirley C. Kirkconnell, MSW, MPH        504-568-7210
Maine                       Randy H. Schwartz, MSPH                 207-289-5180
Maryland                    Alyse R. Weinstein, MPH                 410-225-6807

Massachusetts               Ruth I. Lederman, MPH                   617-727-2735
Michigan                    Harry McGee                             517-335-9081
Minnesota                   Nagi Salem                              612-623-5502
Mississippi                 Ellen C. Jones, MS, CHES                601-960-7499
Missouri                    Jeannette Jackson-Thompson, MSPH, PhD   314-876-3248

Montana                     Patrick Smith                           406-444-2555
Nebraska                    Susan M. Huffman                        402-471-3488
New Hampshire               Kathleen L. Zaso, RN, MPA               603-271-4549
New Jersey                  Georgette K. Boeselager, MS             609-984-6138
New Mexico                  Lydia Pendley, MHS                      505-827-2380

New York                    Colleen Baker                           518-473-0622
North Carolina              Chanetta R. Washington, MPH             919-733-7081
North Dakota                Marge Maetzold, LN                      701-224-2367
Ohio                        Ellen M. Capwell, PhD, CHES             614-466-2144
Oklahoma                    Neil E. Hann,MPH, CHES                  405-271-5601

Oregon                      Joyce A. Grant-Worley, MS               503-731-4028
Pennsylvania                Catherine J. Becker, MPH                717-787-5900
Rhode Island                Jay S. Buechner, PhD                    401-277-2550
South Carolina              Marcia J. Lane, MPH                     803-737-4120
South Dakota                Barbara L. Miller                       605-773-3361

Tennessee                   David L. Ridings                        615-741-5246
Texas                       Roger Diamond, MPH                      512-458-7405
Utah                        Rebecca P. Giles                        801-538-6120
Vermont                     Margaret M. Brozicevic                  802-863-7298
Virginia                    Ramona D. Schaeffer, MsEd               804-786-4065

Washington                  Teresa J. Jennings, MPA                 206-586-8729
West Virginia               Paul F. King                            304-558-9100
Wisconsin                   Eleanor Cautley, NMS                    608-267-9545
--------------------------------------------------------------------------------
==================================================================================

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