Health and Socioeconomic Status

www.healthypeoplehealthyplacesjeffco.com

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Ana MarinEpidemiologist

Jefferson County Public Health

Community Health Improvement plan Work Groups

October 22, 2013

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The objectives of this presentation are:• To give an overview of the

demographic trends in Jefferson County

• Present healthy eating, active living data and their relationship with obesity and chronic disease

• The data will be broken into three groups, adults, youth, and children

• Finally, discuss how the Social-Ecological Model can help address the increase in obesity by improving healthy food access and physical activity

Sociodemographic factors that influence health

Healthy eating, active living data

The Socio-Ecological Model

Children(2-14)

Youth(High

School)

Adult(over 18 years old)

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Overview:

Population

4thHighest county population

population: 534,543

45th fastest growth rate(out of 63 counties)

Sociodemographic FactorsPopulation

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Source: U.S. Census Bureau

Under 5 years

5 to 9 years

10 to 14 years

15 to 19 years

20 to 24 years

25 to 29 years

30 to 34 years

35 to 39 years

40 to 44 years

45 to 49 years

50 to 54 years

55 to 59 years

60 to 64 years

65 to 69 years

70 to 74 years

75 to 79 years

80 to 84 years

85 to 89 years

90 years & over

5 4 3 2 1 0 1 2 3 4 5

2000

Males Females

Percentage in age group from total population

Age

grou

p


2010


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These population pyramids show the changes in population over the ten year period in Jefferson County from 2000 to 2010 by age groups and gender

118, 754

Children under 18

68, 000Adults 65 and

older

Source: Colorado State Demography Office,2010


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Age is an important factor for health, therefore, it is important to consider age groups in Jefferson county when we think about how to increase healthy food access and physical activity in our community. Having a healthy population is important to the vitality and economic success of our county.

Source: U.S. Census Bureau 2000, 2010

2000 2010

84.9% 79.9%

10.0%14.3%

0.9% 0.9%2.3% 2.6%2.2% 2.3%

Population Distribution by Race and Ethnicity, Jefferson County, 2000 and 2010Non Hispanic White Hispanic or Latino Non Hispanic Black Non Hispanic Asian OtherPopulation Distribution by Race and Ethnicity, Jefferson County, 2000

and 2010

BlackAsianOther

BlackAsianOther

Sociodemographic FactorsPopulation by race/ethnicity

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These graphs show the race and ethnic distribution in Jefferson county comparing data from 2000 to 2010


2000 2010

84.9% 79.9%

10.0%14.3%

0.9% 0.9%2.3% 2.6%2.2% 2.3%

Population Distribution by Race and Ethnicity, Jefferson County, 2000 and 2010Non Hispanic White Hispanic or Latino Non Hispanic Black Non Hispanic Asian OtherPopulation Distribution by Race and Ethnicity, Jefferson County, 2000 and 2010

BlackAsianOther

BlackAsianOtherThe

Hispanic/Latino Population

grew

30% in 10 years

Sociodemographic FactorsPopulation by race/ethnicity

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Less than 9th grade; 2.0%

9th to 12th grade, no diploma; 4.7%

High school graduate (includes equivalency); 22.2%

Some college, no degree; 22.7%

Associate's degree, 7.50%

Bachelor's degree, 26.40%

Graduate or professional degree; 14.4%

*Adults 25 and older

48.3% of Jefferson County residents over 25 have completed an associate’s degree or higher education

6.7% of Jefferson County residents over 25 did not received a High School diploma, or equivalent


Sociodemographic FactorsEducational attainment

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Source: U.S. Census Bureau, 2010 American Community Survey

Sociodemographic FactorsEducation and Income

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The map on the left shows the areas of the county where a higher percent of the population did not graduate from high school, the darker the blue on the map the more people who live in those areas that did not graduate from high school.The map on the right shows family poverty level, the darker the blue, the more families living under poverty live in those areas of the county.These maps clearly show that educational attainment is directly related to income.

Hispanic (of any race) Non-Hispanic White0%

5%

10%

15%

20%

25%

Percent of the population living below 125% of poverty by race/ethnicity , Jefferson County,

2012

Sociodemographic FactorsEducation and Income

Source: U.S. Census Bureau, 2012 American Community Survey

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Source: United States Department of Agriculture, Accessed, October 2013

Food deserts low-income areas where a significant number of residents live “far” from a super market.

What is "far“? More than .5 mile for urban areas or 10 miles for rural areas from the nearest supermarket

Sociodemographic FactorsFood deserts

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Source: United States Department of Agriculture, Accessed, October 2013

DEN

VE

R

JEFFCO

Sociodemographic FactorsFood deserts

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The orange squares on the map represent food deserts by Census Tract.Keep in mind that some people and places, especially those with low-income, may face greater barriers in accessing healthy and affordable food retailers, which may negatively affect

diet and food security.

$63,826


Median household Income

Sociodemographic FactorsIncome

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Household income includes the income of the householder and all other individuals 15 years old and over in the household, whether they are related to the householder or not.

How much does it cost to live in Jeffco?

Family of 4:2 adults1 preschooler1 school-age child


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$62,952*

How much does it cost to live in Jeffco?

Source: *Colorado Center on Law and Policy, The Self-Sufficiency Standard for Colorado, 2011

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The $62,952 annual income is for a family of four with two adults, one preschooler, and one school-age child. This annual income was calculated using the Self-Sufficiency Standard which defines the income realistically needed to support a family, without public or private assistance.

Both parents working 40hrs/wk• No days off• No holidays

$7.78 Minimum Wage

How much does it cost to live in Jeffco?$62,952*



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Let’s think about a family in which both parents work full time, make minimum wage, and take no days off or holidays. What would be their combined annual gross income?


$32,365

$7.78 Minimum Wage




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Let’s think about a family in which both parents work full time, make minimum wage, and take no days off or holidays. What would be their combined annual gross income?The combined annual gross income would be about half of the Self Sufficiency Standard


This is roughly HALF of what is needed

$32,365

$7.78 Minimum Wage

$14.90 Self-sufficient Wage




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It was calculated that in Jefferson County for this family to meet the Self Sufficiency Standard, the minimum wage should be $14.90

Sociodemographic FactorsSocial determinants of health

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From the data on the previous slides we learned that the more education an individuals have, the higher the income they will make, and in turn the better their health

Sociodemographic FactorsIncome and health

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There is a strong relationship between income and health outcomes

<$25,000 $25,000-49,999 ≥$50,0000

5

10

15

20

25

30

35

27.0

19.1 18.6

32.3

24.7

20

Obesity Hypertension

Perc

en

t

Obesity and hypertension rates among adults by income, Jefferson County, 2009-2010

Source: Colorado Behavioral Risk Survey, 2009-2010

Sociodemographic FactorsIncome and health

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This graph shows the percent of obesity and hypertension by income. Notice that the lowest income bracket has the highest obesity rate and the largest percent of adults who have ever been told by a doctor, nurse, or other health professional that they have high blood pressure. In turn the highest income bracket has the lowest percent.

Overview:



Children(2-14)

Youth(High

School)


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Children (2-14)

85,339 children8.2% of population


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In 2010, in Jefferson County there were 85,339 children between the ages of 2-14 years old.

Children (2-14)Population characteristics

2006 2007 2008 2009 2010 20110

2

4

6

8

10

12

14

16

Percent of children under 18 living in families with in-come below poverty level, Jefferson County, 2006-2011

Perc

en

t

Data Source: U.S. Census Bureau, Small Area Income and Poverty Estimates (SAIPE)

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There has been a steady increase of poverty levels in Jefferson among families with children under 18

Overweight and obesity among children 2-14 by parent-reported race/ethnicity, Colorado, 2004-2008

Source: The Weight of the State: 2009 Report on Overweight and Obesity in Colorado

Children (2-14)Overweight and obesity by race/ethnicity

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The obesity rates for Black and Hispanic children is two times the rate of their White counterparts

Children (2-14)Fruit and vegetable, and fast food consumption


Fruit and vegetable and fast food consumption among children by age group, Colorado 2006-2008

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As children get older, their consumption of fruits and vegetables decreases meanwhile their consumption of fast food increases

In 2012, 34% of students in Jeffco qualified to receive free or reduced lunch (this is an average of all schools in the district). (Oct 2013)

Children (2-14)Free and reduced lunch (all grades)

Source: Jeffco Public Schools

of schools in Jeffco at least 3 out of 5 students qualify for free or reduced lunch. In other words, in 32 schools out of 145, more than 60% of students qualified for free or reduce lunch. (Oct 2013)

22%

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15,501

Children (2-14)Food insecurity

Open SNAP cases in Jeffco (September 2013)

26.1%Children in Jeffco received vouchers (2011)

Source: Hunger Free Colorado, 2013 Kids Count in Colorado Report

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Notice that this is the number of SNAP cases not the number of individuals.

Keep in mind that the WIC program is for children under the age of 5

of parents reported often or sometimes relied on low-cost food to feed their children because they were running out of money to buy food. (2012 data)

35.4%

Children (2-14)

Source: Colorado Child Health Survey, Colorado Department of Public Health and Environment

Children (2-14)Food insecurity

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Overview:



Children(2-14)

Youth(High

School)


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Youth (High School Students)

35,724ages 14-18


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In 2010, in Jefferson County there were 35,727 young adults between the ages of 14-18.Notice that the data presented for youth is collected in High School and may mean that those who participated might have been younger than 14 and/or older than 18 at the time of the health survey

Source: Colorado Department of Education

Youth (High School Students)High school graduation rates

District Non-Hispanic White Hispanic Black Asian American Indian or Alaska Native

0

10

20

30

40

50

60

70

80

90

100

79.183.1

64.8

73.1

89.0

61.8

High school graduation rates by race/ethnicity, Jef-ferson County, 2010-2011

Rate

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Although high school graduation rates in Jefferson County are high, the graduation rates vary depending on the race/ethnicity of the students. White students have the highest graduation rates while American Indian/Alaska Native students have the lowest. This is important to health because educational attainment is directly related to income and income is related to health.

Obese Overweight02468

1012141618

5%

8%

15%17%

Students in grades 9-12 who are overweight or obese by race/ethnicity, Colorado, 2011

Non-Hispanic White Hispanic

Perc

en

t

Source: Colorado Youth Risk Behavior Surveillance Survey, 2011

Youth (High School Students)Overweight and Obesity by race/ethnicity

Students in grades 9-12 who are overweight or obese by race/ethnicity, Colorado, 2011

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Hispanic/Latino high school students’ obesity rates are three times as high as those for White high school students

Youth (High School Students)Physical activity

of adolescents in high school met the recommendation of physical activity (2011)

Non-Hispanic White Hispanic

56.1%

44.9%

Percent of adolescents in high school who met the recommended physical ac-tivity by race/ethnicity, Colorado 2011

Source: Colorado Youth Risk Behavior Surveillance Survey, 2011

53.1%

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The recommendation for physical activity is at least 60 minutes per day on at least 5 of the past 7 days

Overview:



Children(2-14)

Youth(High

School)


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204, 88418 and older

Adults (18 and older)37

In 2010, in Jefferson County there were 204,884 adults 18 and older. The population of adults over 65 was 68,000.


Non-Hispanic White Hispanic Black$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

Median household income by race/ethnicity, Jef-ferson County, 2012

Perc

ent

Adults (18 and older)Income

Median $67,512

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Source: U.S. Census Bureau, 2012

Since income is directly linked to health, this graph shows income by race/ethnicity in Jefferson County. Notice that while Non-Hispanic Whites make more than the median, Hispanic and Blacks fall below the median income level.The median on this slide is different from the earlier slide where median income was presented because the data on this slide is from 2012 (the median household income in 2010 was $63,826).

Less than high school diploma

High school diploma or equivalent or

higher

Bachelor's degree or higher

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Educational attainment among adults 25 and older by ethnicity, Jefferson County,

2010

White, Non-Hispanic or Latino Hispanic or Latino

Adults (18 and older)Educational attainment

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Thinking about the income and education relationship and the previous slide where we learned that income was highest for Non-Hispanic Whites, it make sense that non-Hispanic Whites have the highest educational attainment when compared to Hispanics. The low educational attainment among Hispanics may help explain their lower median incomes. From this data, we might suspect that health disparities exists among these two groups

2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

10

20

30

40

50

60

40.135.1 37.6 38.1 35.3 35.3 35.3 36.2 38.0

34.4

12.9

14.6 12.014.9

14.818.9 17.7 17.7

18.620.4

Percent of adults (18+) who are overweight or obese (BMI ≥ 25), Jefferson County, 2001-2010

Obese Overweight

Year

Perc

ent

Source: Colorado Behavioral Risk Factor Surveillance System, Colorado Department of Public Health and Environment

Percent of adults (18+) who are overweight or obese (BMI ≥ 25), Jefferson County, 2001-2010

Adults (18 and older)Overweight and Obesity

2016 Target

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Non-Hispanic White

Hispanic Black0

5

10

15

20

25

30

35

40

Percent of adults (18+) who are obese by race/ethnicity, Colorado, 2011-2012

Perc

en

t

Adults (18 and older)Obesity


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We can see in this graph that the income an education data are good predictors of obesity rates among Non-Hispanic Whites, Hispanics, and Blacks. There is strong correlation between income, education, and health outcomes. Non-Hispanic Whites have the highest educational attainment and the highest incomes, in turn they have the best health outcome (lowest obesity rates). The opposite is true for Hispanics and Blacks

Non-Hispanic White

Hispanic Black0

5

10

15

20

25

30

Percent of adults reporting not engaging in any leisure time physical activity during the past 30

days, Colorado, 2011-2012

Adults (18 and older)Physical activity


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Similar to obesity rates graph on the previous slide, this graph shows that income an education data are good predictors of health outcomes.

Percent of adults engaging in no physical activity (2008) by annual household income, Colorado.


Adults (18 and older)Not physically active by income

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The graph on the left shows that as income decreases, the percent of adults engaging in physical activity increases. Clearly showing that there is a strong relationship between income and health outcomes.



The Social-Ecological Model

Children(2-14)

Youth(High

School)


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Overview:

Effective prevention initiatives to improve access to healthy foods and physical activity to reduce obesity, should address multiple levels of the environment and engage multiple sectors of society in order to affect social change and achieve health impact.

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Source: CDC, http://www.cdc.gov/obesity/downloads/CDC_Healthy_Communities.pdf

The Social -Ecological Model stresses that society is composed of interconnected elements that invariably affect one another. The model is based on the premise that changes in individual behavior will come about through a combination of societal, community, organizational, interpersonal, and individual efforts

Social-Ecological Model

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Each individual may have different degrees of access to education, income and these factors may in turn affect the individual’s believes and behaviors toward eating healthier foods and being physically active.

Public Policies like the construction of parks and bike lanes support physical activity and active lifestyles

Activities at the community level help facilitate individual behavior change, for example, media and advocacy groups can help promote healthy eating, active living in the community

Organizational changes like having worksite wellness programs or providing healthy school lunches support individuals to live healthier lives

Relationships with our friends, family, and health care providers represent sources of interpersonal messages and can help support to healthy eating and an active lifestyle

COMMUNITY

ORGANIZATIONAL

RELATIONSHIPS

Social-Ecological Model

Technology

Health and Socioeconomic Status