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State of Alaska

Complete Health Indicator Report of Mental Health - Increased Confusion or Memory Loss - Adults (45+)

Definition

Percentage of adults 45 years of age and older who responded "Yes" on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the question: "During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?"

Numerator

Weighted number of adults (45+) who responded "Yes" on the BRFSS to the question: "During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?"

Denominator

Weighted number of adults (45+) with complete and valid responses on the BRFSS to the question on increased confusion or memory loss, excluding those with missing, "Don't know/Not sure", or "Refused" responses.

Data Interpretation Issues

Data on Increased Confusion or Memory Loss (ICML) was collected using the 2015 version of the BRFSS Cognitive Decline module.^1^ ICML has also been referred to as cognitive decline or subjective cognitive decline (SCD). Beginning in 2015 the ICML question module was only asked to respondents aged 45 and up. The findings in this report are subject to at least four limitations. First, data are self-reported, not validated by any clinical measurement, and might be subject to recall bias. Second, the survey design is cross-sectional, and causality of specific diseases or conditions cannot be inferred. Third, although questions underwent multiple rounds of cognitive testing to ensure that respondents understood the questions, given misperceptions surrounding dementia, respondents might provide the most "socially acceptable" answer, which could vary by race/ethnicity or geography. Furthermore, whether increased confusion or memory loss interferes with a respondent's ability to accurately describe functional difficulties is unknown. Fourth, these results might underestimate confusion or memory loss and functional difficulties because BRFSS does not include residents of nursing homes or other facilities where a high percentage of people with cognitive impairment reside, and results were limited to telephone survey responses.^2^[[br]] [[br]] ---- {{class .SmallerFont See "'Resources and References"' tab for references. }}

Why Is This Important?

Worsening or more frequent confusion or memory loss (often referred to as subjective cognitive decline) is one of the earliest warning signs of Alzheimer's disease and may be a way to identify people who are at high risk of developing mild cognitive impairment, Alzheimer's, and other dementias.^3,4^ Subjective cognitive decline does not refer to occasional problems with forgetting names or keys, but rather relates to more serious problems such as trouble recalling how to do familiar tasks or not remembering things usually known. Many people who experience subjective cognitive decline develop mild cognitive impairment or Alzheimer's disease and other dementias, but others do not.^5^ Memory loss or increased confusion can affect individuals' ability to manage their chronic conditions, care for themselves, and recover from illness or injury.^6,7^ Healthy People 2020 includes the objective to "increase the proportion of persons with diagnosed Alzheimer's disease and other dementias, or their caregiver, who are aware of the diagnosis."^8^ Discussions between older adults and health care providers about changes in cognition can support identification and treatment of reversible conditions that mimic cognitive impairment and dementia, such as depression or vitamin deficiency.^9^ Early detection of potential cognitive impairment also can help health care providers provide better care for comorbidities and help people with subjective cognitive decline to build a care team and make plans for future care and finances.^10^ Early diagnosis can help individuals and families connect with appropriate services early on, which often results in people being able to live safely in their own homes for a longer time, sometimes at a lower cost, and with improved quality of life. [[br]] [[br]] ---- {{class .SmallerFont See "'Resources and References"' tab for references. }}

Other Objectives

Healthy Alaskans 2020 Indicator 9: Reduce the mean number of days in the past 30 days that adults (age 18 and older) report being mentally unhealthy to 2.9 days by 2020.

How Are We Doing?

The percentage of Alaska adults reporting increased confusion or memory loss is highest among those who are 65 years of age and older at 14.4%. As an age-related impairment, lower rates were reported by those 45-55 years of age (7.8%) and the prevalence of increased confusion or memory loss was highest among those 75 years of age and older at 18.4%. Among those less than 45 years of age and older, respondents with less than a high school education or those unable to work were at the highest risk for increased confusion or memory loss for those aged, 26.6% and 34.8% respectively. For both groups, increased confusion or memory loss declined for the top 2 income brackets. Rates of increased confusion or memory loss from the BRFSS are initially presented for all Alaskans and Alaska Native people for 2016. Subsequent analyses were conducted for demographic subpopulations (i.e., sex, age, race/ethnicity, marital status, education, employment status, income, and poverty status). Crosstabulations were also conducted for body mass index, current smoking, sexual orientation, disability, adverse childhood experiences, and self-report general health. Higher levels of increased confusion or memory loss were associated with obesity, current smoking, being disabled, exposure to adverse childhood experiences, and self-report of fair or poor general health. Rates of increased confusion or memory loss by regions of Alaska are presented for all Alaskans and Alaska Native people for combined years 2013 and 2016: 1) 7 Alaska Public Health Regions, 2) 5 Metropolitan and Micropolitan Statistics Areas and rural remainder, and 3) 10 behavioral health assessment regions based upon aggregations of 20,000 population. There were insufficient responses to tabulate by the 29 boroughs and census areas or the 12 tribal health organization regions. Limitations attributable to increase confusion or memory loss are displayed by all Alaskans and Alaska Native people.

How Do We Compare With the U.S.?

The Cognitive Decline (CD) module was asked in 21 states in 2016.^11^ A national baseline for comparison has not been reported.[[br]][[br]] ---- {{class .SmallerFont 11. National Center for Chronic Disease Prevention and Health Promotion. 2016 Modules by State by Data Set & Weight. https://www.cdc.gov/brfss/questionnaires/modules/state2016.htm. Accessed September 22, 2017. }}

What Is Being Done?

Reducing poor mental health in adults was identified as one of 25 leading health indicators to be addressed by Healthy Alaskans 2020.^12^ The Alaska strategies being followed are: 1. Identify adults who rate their mental health as not good and connect them to screening, treatment, and social support services without delay. 2. Identify environmental and individual strengths of Alaskans who are mentally healthy to inform health promotion strategies. 3. Create supportive environments that promote resilient, healthy, and empowered individuals, families, schools, and communities.[[br]][[br]] ---- {{class .SmallerFont 12. Alaska Department of Health and Social Services and the Alaska Native Tribal Health Consortium. Healthy Alaskans 2020. [http://hss.state.ak.us/ha2020/]. Accessed May 5, 2016. }}

Evidence-based Practices

As part of the Healthy Alaskans 2020 health improvement process, groups of Alaska subject matter experts met over a period of months in a rigorous review process to identify and prioritize strategies to address the 25 health priorities. Below are the strategies identified for enhancing adult support systems. '''Strategy 1:''' [[br]]Identify adults who are experiencing or at-risk of experiencing mentally unhealthy days and connect them to screening, treatment, and social support services immediately (indicated prevention). '''Evidence Base:''' [[br]]Individuals who receive treatment and/or behavioral interventions earlier are less likely to develop serious mental health disorders. Screening for both depression and substance abuse is indicated, as the impact of misuse and dependence on alcohol and drugs in overall mental health is substantial. The U.S. Preventive Services Task Force recommends depression screening for adults at higher risk, including those experiencing substance misuse, chronic medical diseases, unemployment, and poverty. '''Sources:''' [[br]][http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2a.html Depression Guide to Clinical Preventive Services] [http://beta.samhsa.gov/sites/default/files/sbirtwhitepaper_0.pdf Screening, Brief Intervention and Referral to Treatment (SBIRT) in Behavioral Healthcare] '''Strategy 2:''' [[br]]Identify the environmental and individual strengths of Alaskans reporting 0-3 mentally unhealthy days per month to inform mental health improvement strategies. '''Evidence Base:''' [[br]]Individuals have both biological and psychological characteristics that affect their vulnerability and resiliency to potential behavioral health problems. Protective factors might include positive self-image, self-control, or social competence. Understanding the specific characteristics of mentally healthy Alaskans will inform prevention and health promotion activities tailored to improve mentally healthy days. '''Source:''' [[br]]Bonanno, GA. Loss, Trauma, and Human Resilience: Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events? American Psychologist 2004;59(1):20-8. '''Strategy 3:''' Create supportive environments that promote resilient, healthy, and empowered individuals, families, schools, and communities (universal prevention). '''Evidence Base:''' The World Health Organization holds that "a supportive environment is of paramount importance for health. The two are interdependent and inseparable" (Sundsvall Statement on Supportive Environments for Health, 1991). Supportive environments can help protect people from risk factors for poor health, encourage participation in health care and health promotion, expand individuals' health competencies and self-reliance, and support person-centered health care. Stigma and attitudes about help-seeking (specifically seeking treatment or services for mental health conditions) are key barriers to promoting mental and emotional health and preventing mental illness. Creating communities that de-stigmatize depression and mental illness and encourage people to seek mental health services when needed can increase the number of people accessing services. '''Sources:''' [[br]]Segal DL, Coolidge FL, Mincic MS, O'Riley A. Beliefs about mental illness and willingness to seek help: a cross-sectional study. Aging and Mental Health 2005;9(4):363-7. Reynders A, Kerkhof AJFM, Molenberghs G, Van Audenhove C. Attitudes and stigma in relation to help-seeking intentions for psychological problems in low and high suicide rate regions. Social Psychiatry and Psychiatric Epidemiology 2014;49(2):231-9. A listing of strategies, actions, and key partners on this measure can be found at: [http://hss.state.ak.us/ha2020/assets/Actions-Partners_9_MentalHealth_Adults.pdf].

Available Services

'''Aging and Disability Resource Centers''' Alaska's [http://dhss.alaska.gov/dsds/pages/adrc/default.aspx ADRCs] connect seniors, people with disabilities, and caregivers with long-term services and supports of their choice. The ADRC network serves Alaskans statewide, regardless of age or income level, through regional sites. Office locations: ANCHORAGE Agency: Municipality of Anchorage 825 L Street, Suite 203 Anchorage, Alaska 99501 Phone: 907-343-7778 | Fax: 907-343-6320 Website: [http://www.muni.org/Departments/health/PHIP/pages/ADRC.aspx] MAT-SU Agency: LINKS Mat-Su ADRC 3161 E. Palmer-Wasilla Hwy #2 Wasilla, AK 99654 Phone: 907-373-3632 | Fax: 907-373-3620 Email: [mailto:linksinfo@linksprc.org linksinfo@linksprc.org] Website: [http://www.linksprc.org] BRISTOL BAY Agency: Bristol Bay Native Association Box 310, Dillingham, AK 99576 Phone: 907-842-4139 | Toll free: 1-800-478-4139 Fax: 907-842-4106 Website [http://www.bbna.com/website/ElderlyServ.html] KENAI PENINSULA Agency: Independent Living Center, Inc. Website: [http://www.peninsulailc.org] Homer 3953 Bartlett P.O. Box 2474 Homer, AK 99603 Phone: 907-235-7911| Fax: 907-235-6236 Central Peninsula 47255 Princeton Ave. Suite 8 Soldotna, Alaska 99669 Phone: 907-262-6333 | Fax: 907-260-4495 Seward 201 Third Ave., Suite 102 P.O. Box 3523 Seward, AK 99664 907-224-8711 | Fax: 907-224-7793 SOUTHEAST Agency: Southeast Alaska Independent Living Center Website: [http://www.sailinc.org] Haines 24 Fort Seward Drive Haines, AK 99827 Mailing address: P.O. Box 183 Haines, AK 99827 Phone: 907-766-3297 | Fax: 907-766-2753 Email: [mailto:haines@sailinc.org haines@sailinc.org] Juneau 3225 Hospital Drive, Suite 300 Juneau, AK 99801 Toll free: 1-800-478- SAIL(7245) | Fax: 907-568-4980 | TTY: 907-523-5285 Afterhours/Weekend contact Interpreter requests: 907-321-4085 Ketchikan Independent Living Specialist 602 Dock Street, Suite 107 Ketchikan, AK 99901 Toll free: 1-888-452- SAIL(7245) | Local: 907-225-4735 | Fax: 907-247-4735 Sitka 514 Lake Street, Suite C Sitka, AK 99835 Toll free: 1-888-500-7245 | local: 907-747-6859 | Fax: 907-747-6783 Email: [mailto:sitka@sailinc.org sitka@sailinc.org] A [http://dhss.alaska.gov/dsds/Pages/adrc/map.aspx Map Link] is also available or call 1-877-6AK-ADRC (1-877-625-2372) toll-free.


Related Indicators

Related Relevant Population Characteristics Indicators:


Related Health Care System Factors Indicators:


Related Risk Factors Indicators:


Related Health Status Outcomes Indicators:




Graphical Data Views

Percentage of adults (45+, 65+) who reported increased confusion or memory loss, all Alaskans and Alaska Natives, 2016

::chart - missing::
data tableconfidence limits

Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 4
45+All Alaskans11.5%9.5%13.7%2241,845
45+Alaska Native people10.8%6.3%17.9%38307
65+All Alaskans14.4%11.1%18.5%109717
65+Alaska Native people13.1%6.6%24.1%16110

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by sex, all Alaskans, 2016

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data tableconfidence limits

Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 4
45+Males10.9%8.5%13.9%111852
45+Females12.1%9.3%15.6%113993
65+Males14.9%10.2%21.3%56342
65+Females13.9%9.7%19.5%53375

Data Notes

The sex of the respondent is only asked if necessary.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+) who reported increased confusion or memory loss, by age groups, all Alaskans, 2016

::chart - missing::
data tableconfidence limits

Respondents are asked, "What is your age?, which is coded in years. Responses of Refused are excluded.
Age GroupPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 4
under 557.8%5.1%11.8%41465
55-6412.5%9.2%16.8%74663
65-7413.1%9.5%17.8%71516
75+18.4%12.1%27.0%38201

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by race/ethnicity, 2016

::chart - missing::
data tableconfidence limits

** = Data statistically unreliable due to fewer than 50 respondents in the denominator.
Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 14
45+Alaska Native (any mention)10.8%6.3%17.9%38307
45+Asian (non-Hispanic)**24
45+Black (non-Hispanic)**25
45+Native Hawaiian/Other Pacific Islander (non-Hispanic)**2
45+White (non-Hispanic)12.7%10.4%15.3%1761,410
45+Multiracial/Other (non-Hisp.)**6
45+Hispanic (alone or multi)**31
65+Alaska Native (any mention)13.1%6.6%24.1%16110
65+Asian (non-Hispanic)**8
65+Black (non-Hispanic)**8
65+Native Hawaiian/Other Pacific Islander (non-Hispanic)**1
65+White (non-Hispanic)17.5%13.5%22.3%90565
65+Multiracial/Other (non-Hisp.)**2
65+Hispanic (alone or multi)**4

Data Notes

Race/ethnicity is determined by responses to three questions: [[br]] 1) "Are you Hispanic, Latino/a, or Spanish origin?" "If yes, are you...?" One or more categories may be selected from categories of (1) "Mexican, Mexican American, Chicano/a"; (2) "Puerto Rican"; (3) "Cuban"; (4) "Another Hispanic, Latino/a, or Spanish origin".[[br]] 2) "Which one or more of the following would you say is your race?" Response categories consist of "White", "Black or African American", "American Indian or Alaska Native", "Asian" (with subcategories of Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or Other Asian), "Pacific Islander" (with subcategories of Native Hawaiian, Guamanian or Chamorro, Samoan, or Other Pacific Islander), Other, or No additional choices. [[br]] 3) If more than one response to race, then "Which one of these groups would you say best represents your race?" with choices from the list enumerated above. Responses of Don't Know/Not Sure or Refused are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by marital status, all Alaskans, 2016

::chart - missing::
data tableconfidence limits

Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 10
45+Married9.6%7.6%12.2%1141,047
45+Widowed23.7%15.1%35.3%35216
45+Divorced/Separated12.0%7.6%18.5%47345
45+Never Married7.1%3.7%13.0%15180
45+Living with a Partner**47
65+Married12.4%8.9%16.9%48343
65+Widowed19.0%11.6%29.7%28166
65+Divorced/Separated17.1%9.1%29.8%25144
65+Never Married7.4%2.2%21.9%552
65+Living with a Partner**8

Data Notes

** = Data statistically unreliable Marital status is determined by the question, "Are you ...?" with responses of "Married", 'Divorced", "Widowed", "Separated", "Never married," or "A member of an unmarried couple". Responses of "Refused" are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by education, all Alaskans, 2016

::chart - missing::
data tableconfidence limits

Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 8
45+Less than High School26.6%16.5%39.9%2087
45+High School Graduate or GED7.3%5.0%10.6%49488
45+Some College or Tech. School14.1%10.6%18.7%84572
45+College Graduate8.8%6.2%12.5%70691
65+Less than High School**36
65+High School Graduate or GED9.7%5.6%16.3%22190
65+Some College or Tech. School18.5%12.5%26.5%45220
65+College Graduate12.8%7.8%20.4%38268

Data Notes

Education is based upon education completed by or after 25 years of age. Individuals less than 25 years of age are excluded. Education is assessed by responses to the question: "What is the highest grade or year of school you completed?" Responses are "Never attended school or only attended kindergarten", "Grades 1 through 8 (Elementary)", "Grades 9 through 11 (Some high school)", "Grade 12 (High School Graduate)", "College 1 year to 3 years (Some college or technical school)", "College 4 years or more (College graduate)", or "Refused". Refusals are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by employment, all Alaskans, 2016

::chart - missing::
data tableconfidence limits

Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 8
45+Employed6.9%5.0%9.4%71906
45+Unemployed10.5%5.0%20.7%1295
45+Not in Work Force14.0%10.9%17.9%103695
45+Unable to Work34.8%22.6%49.3%37129
65+Employed9.4%4.9%17.1%16154
65+Unemployed**22
65+Not in Work Force15.7%11.9%20.5%85503
65+Unable to Work**27

Data Notes

** = Data statistically unreliable due to fewer than 50 respondents in the denominator. Employment status is assessed by the question: "Are you currently ...?" with responses of "Employed for wages", "Self-employed", "Out of work for 1 year or more", "Out of work for less than 1 year", "A Homemaker", "A Student", "Retired", "Unable to work" or "Refused". Refusals are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by income, all Alaskans, 2016

::chart - missing::
data tableconfidence limits

Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 10
45+<$15,00023.0%12.6%38.4%24148
45+$15,000-$24,99918.8%11.8%28.6%39209
45+$25,000-$49,00013.3%9.0%19.2%50336
45+$50,000-$74,0007.6%4.8%11.9%28264
45+$75,000+7.7%5.4%10.8%58728
65+<$15,00031.1%12.6%58.4%952
65+$15,000-$24,99910.2%4.7%20.8%13104
65+$25,000-$49,00020.7%13.0%31.2%37177
65+$50,000-$74,00010.1%5.4%18.0%14104
65+$75,000+7.3%3.9%13.5%16184

Data Notes

Income is measure by the question: "Is your annual household income from all sources ---" with categories of "Less than $10,000", "Less than $15,000", "less than $20,000", "less than $25,000", "less than $35,000", "less than $50,000", "less than $75,000", "$75,000 or more", and "Don't know / Not sure" or "Refused". Responses of "Don't know / Not sure" or "Refused" are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by poverty threshold, all Alaskans, 2016

::chart - missing::
data tableconfidence limits

Poverty thresholds are intended for use as a statistical yardstick, not as a complete description of what people and families need to live. Poverty thresholds are the dollar amounts assigned by the U.S. Census Bureau to determine poverty status. Poverty thresholds are assigned based upon the size of the family and the ages of the members (i.e., adults versus children). The same thresholds are used throughout the United States. Poverty thresholds were originally derived in the 1963-1964 using U.S. Department of Agriculture food budgets designed for families under economic stress and data about what proportion of their income families spent on food. The thresholds are updated annually for inflation using the Consumer Price Index for All Urban Consumers (CPI-U). How the Census Bureau Measures Poverty - U.S. Census Bureau [https://www.census.gov/hhes/www/poverty/about/overview/measure.html]
Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 6
45+Poor20.5%10.0%37.3%1788
45+Near Poor17.6%10.1%28.8%20166
45+Middle/High11.7%9.2%14.8%111962
65+Poor**26
65+Near Poor20.6%9.6%38.6%1085
65+Middle/High14.0%10.3%18.6%55375

Data Notes

** = Data statistically unreliable due to fewer than 50 responses in the denominator. Poverty thresholds computed using the BRFSS assume that householders are less than 65 years of age as the ages of the household heads are not recorded. The maximum of the income range provided for the household is used to evaluate the proportion of the poverty threshold. This is a conservative approach as there are no errors of misclassification into the lowest poverty group. The category of Poor represents less than 100% of the poverty threshold. Near Poor is 100% through 199% of the poverty threshold. Middle/High income families are 200% or higher of the poverty threshold. How the Census Bureau Measures Poverty - U.S. Census Bureau [https://www.census.gov/hhes/www/poverty/about/overview/measure.html]

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by body mass index (BMI), all Alaskans, 2016

::chart - missing::
data tableconfidence limits

Age Groups: 45+, 65+Weight CategoryPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 6
45+Neither Overweight nor Obese13.2%9.5%18.0%72435
45+Overweight11.9%8.7%16.3%73600
45+Obese10.4%7.6%13.9%77523
65+Neither Overweight nor Obese15.7%10.2%23.4%37161
65+Overweight14.5%9.6%21.4%38226
65+Obese14.1%8.6%22.4%34197

Data Notes

Body Mass Index (BMI) is computed based upon responses to the questions, "About how much do you weight without shoes?" and "About how tall are you without shoes?" Responses of "Don't know / Not sure" or "Refused" to either questions are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by current smoking, all Alaskans, 2016

::chart - missing::
data tableconfidence limits

Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 4
45+Not current smoker11.3%9.2%13.8%1801,340
45+Current smoker12.4%8.2%18.3%40271
65+Not current smoker13.5%10.3%17.6%93547
65+Current smoker22.5%10.0%43.0%1353

Data Notes

Current smoking is assessed using two questions: "Have you smoked at least 100 cigarettes in your entire life?" and, if "Yes", "Do you now smoke cigarettes every day, some days, or not at all?" Current smokers are defined as those who have smoked at least 100 cigarettes and who now smoke every day or some days. Non-current smokers are those who have either never smoke 100 cigarettes or whom now smoke cigarettes not at all. Responses of "Don't know / Not sure" or "Refused" to either question are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by sexual orientation, all Alaskans, 2016

::chart - missing::
data tableconfidence limits

Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 4
45+Heterosexual11.4%9.4%13.7%2091,523
45+Gay, Lesbian, or Bisexual**27
65+Heterosexual14.7%11.3%19.1%102557
65+Gay, Lesbian, or Bisexual**12

Data Notes

** = Data statistically unreliable as it is based upon fewer than 50 respondents. Sexual orientation is assessed by the question: "Now I'm going to ask you a question about sexual orientation. Do you think of yourself as A. Gay or lesbian, B. Straight, that is, not lesbian or gay, C. Bisexual, or D. something else?" Responses of "Straight, that is not lesbian or gay" are contrasted with the combined responses to "Gay or lesbian" and "Bisexual". Responses of "Something else", "Don't Know / Not sure", or "Refused" are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by disability, all Alaskans, 2016

::chart - missing::
data tableconfidence limits

Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 4
45+Disability Present30.9%24.3%38.4%123294
45+Disability Absent6.1%4.6%7.9%951,300
65+Disability Present28.9%19.8%40.3%62146
65+Disability Absent7.7%5.4%10.9%43441

Data Notes

Disability is assessed using responses from 5 questions: 1) "Are you blind or do you have serious difficulty seeing, even when wearing glasses?"; 2) Because of physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?"; 3) "Do you have a serious difficulty walking or climbing stairs?"; 4) "Do you have difficulty dressing or bathing?"; and 5) "Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping?" A "Yes" response to one or more of the questions when all questions have valid answers is used to classify the respondent as having a disability. Responses of "No" to all 5 questions denotes the absence of a disability. Responses of "Don't know / Not sure" or "Refused" to one or more questions result in the survey being excluded from analysis on disability status.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (18+, 45+, 65+) who reported increased confusion or memory loss, by adverse childhood experiences (ACEs), all Alaskans, 2013

::chart - missing::
data tableconfidence limits

Age Groups: 18+, 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 12
18 and older04.1%3.0%5.5%801,369
18 and older16.4%4.5%9.1%56848
18 and older2-311.6%8.5%15.7%96936
18 and older4+15.4%11.8%19.7%119689
45 and older06.2%4.6%8.4%71932
45 and older110.7%7.6%14.9%48527
45 and older2-312.7%8.8%18.0%72575
45 and older4+19.5%14.7%25.4%79382
65 and older010.7%7.3%15.5%41345
65 and older115.2%9.4%23.5%26181
65 and older2-315.8%9.2%25.8%27159
65 and older4+20.3%10.8%35.0%1365

Data Notes

The presence of one or more Adverse Childhood Experiences (ACEs) is assessed using either the 10 domains that are grouped into: [[br]] '''Abuse:'''[[br]] 1) Verbal Abuse[[br]] 2) Physical Abuse[[br]] 3) Sexual Abuse][[br]] '''Dysfunctional Households:'''[[br]] 4) Substance Abuse[[br]] 5) Mental Illness[[br]] 6) Domestic Violence[[br]] 7) Separation/Divorce[[br]] 8) Incarceration among household members[[br]] '''Neglect:'''[[br]] 9) Emotional Neglect[[br]] 10) Physical Neglect[[br]] The presence of an Adverse Childhood Experience have grouped into scores of 0 (no exposure), 1 (single exposure to an ACE), 2-3 (exposure to 2 or 3 ACEs), and 4+ (exposure to 4 or more different ACEs) The questions associated with each type of ACEs is described in the [http://ibis.dhss.alaska.gov/indicator/index/Alphabetical.html respective reports]. A summary ACEs score is computed for those with valid responses to all domains. Respondents with refusals to one or more of the ACEs questions are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by self-reported general health, all Alaskans, 2016

::chart - missing::
data tableconfidence limits

Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 6
45+Excellent/Very Good6.0%4.3%8.3%57825
45+Good10.6%7.6%14.6%72503
45+Fair/Poor27.3%20.7%35.1%95286
65+Excellent/Very Good10.7%6.8%16.5%32303
65+Good12.4%8.0%18.7%37176
65+Fair/Poor26.2%16.9%38.2%40122

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by Alaska Public Health Regions, all Alaskans, 2013-2016 (2-year average)

::chart - missing::
data tableconfidence limits

Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 14
45+Anchorage10.8%8.4%13.8%94794
45+Gulf Coast11.1%8.5%14.4%81675
45+Interior12.1%9.6%15.0%104957
45+Mat-Su10.6%8.1%13.7%84678
45+Northern8.2%4.7%13.9%16186
45+Southeast12.9%10.0%16.6%93713
45+Southwest9.0%4.2%18.1%37418
65+Anchorage11.3%8.2%15.3%63470
65+Gulf Coast10.2%7.3%14.1%49385
65+Interior14.3%10.9%18.6%74600
65+Mat-Su11.4%8.2%15.6%56433
65+Northern5.0%2.2%11.1%7107
65+Southeast14.6%10.8%19.6%66432
65+Southwest11.4%4.4%26.5%23237

Data Notes

** = Data statistically unreliable due to fewer than 50 responses in the denominator. Geographic descriptions of the public health regions can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_phr.aspx].

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by Alaska Public Health Regions, Alaska Natives, 2013-2016 (2-year average)

::chart - missing::
data tableconfidence limits

Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 14
45+Anchorage21.1%10.7%37.3%1263
45+Gulf Coast11.5%4.6%25.8%964
45+Interior7.0%3.2%14.6%8110
45+Mat-Su**43
45+Northern4.4%1.8%10.2%6101
45+Southeast15.7%8.8%26.3%20100
45+Southwest15.9%6.1%35.6%21200
65+Anchorage**31
65+Gulf Coast**40
65+Interior7.5%3.2%17.0%673
65+Mat-Su**32
65+Northern3.6%1.0%11.7%354
65+Southeast20.5%10.3%36.6%1463
65+Southwest22.2%8.4%47.0%16115

Data Notes

** = Data statistically unreliable due to fewer than 50 responses in the denominator. Geographic descriptions of the public health regions can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_phr.aspx].

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by metropolitan/micropolitan statistical areas, all Alaskans, 2013-2016 (2-year average)

::chart - missing::
data tableconfidence limits

Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 10
45+Anchorage MSA10.8%8.8%13.1%1781,472
45+Fairbanks North Star MSA12.5%9.7%16.1%80692
45+Juneau MicroSA11.0%6.8%17.3%29290
45+Ketchikan Gateway MicroSA13.0%6.4%24.5%16134
45+Rural (non-Metro/MicroSA)11.0%9.2%13.2%2061,833
65+Anchorage MSA11.3%8.8%14.3%119903
65+Fairbanks North Star MSA14.8%10.9%19.7%58428
65+Juneau MicroSA13.8%7.7%23.6%20162
65+Ketchikan Gateway MicroSA12.0%5.4%24.4%1084
65+Rural (non-Metro/MicroSA)11.1%8.8%14.0%1311,087

Data Notes

** = Data statistically unreliable due to fewer than 50 responses in the denominator. Geographic descriptions of the metropolitan and micropolitan statistical areas can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_mmsa.aspx].

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by metropolitan/micropolitan statistical areas, Alaska Natives, 2013-2016 (2-year average)

::chart - missing::
data tableconfidence limits

Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 10
45+Anchorage MSA15.5%8.4%26.8%18106
45+Fairbanks North Star MSA**49
45+Juneau MicroSA**26
45+Ketchikan Gateway MicroSA**23
45+Rural (non-Metro/MicroSA)11.6%7.0%18.5%51477
65+Anchorage MSA7.9%3.5%16.9%963
65+Fairbanks North Star MSA**33
65+Juneau MicroSA**15
65+Ketchikan Gateway MicroSA**13
65+Rural (non-Metro/MicroSA)9.9%5.1%18.5%32284

Data Notes

** = Data statistically unreliable due to fewer than 50 responses in the denominator. Geographic descriptions of the metropolitan and micropolitan statistical areas can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_mmsa.aspx].

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported increased confusion or memory loss, by behavioral health systems assessment areas, all Alaskans, 2013-2016 (2-year average)

::chart - missing::
data tableconfidence limits

Age Groups: 45+, 65+Lower LimitUpper LimitNumer- atorDenom- inator
Record Count: 22
45+Anchorage Muncipality10.8%8.4%13.8%94794
45+Fairbanks North Star Borough12.5%9.7%16.1%80692
45+City and Borough of Juneau11.0%6.8%17.3%29290
45+Kenai Peninsula Borough13.4%10.3%17.2%70497
45+Matanuska-Susitna Borough10.6%8.1%13.7%84678
45+Northwest Region8.2%4.7%13.9%16186
45+Other Interior Region9.4%6.1%14.3%31358
45+Other SE - Northern15.4%10.7%21.6%36223
45+Other SE - Southern13.3%8.0%21.4%28200
45+Y-K Delta Region12.8%3.6%36.6%13167
45+Southwest Region6.0%3.0%11.6%28336
65+Anchorage Muncipality11.3%8.2%15.3%63470
65+Fairbanks North Star Borough14.8%10.9%19.7%58428
65+City and Borough of Juneau13.8%7.7%23.6%20162
65+Kenai Peninsula Borough13.1%9.4%18.0%44292
65+Matanuska-Susitna Borough11.4%8.2%15.6%56433
65+Northwest Region5.0%2.2%11.1%7107
65+Other Interior Region11.5%6.6%19.4%20223
65+Other SE - Northern17.4%11.4%25.6%27141
65+Other SE - Southern13.0%7.4%21.8%19129
65+Y-K Delta Region22.0%5.2%59.0%983
65+Southwest Region4.0%2.0%8.0%15196

Data Notes

** = Data statistically unreliable

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported ICML-attributable limitations and consultations, all Alaskans, 2016

::chart - missing::
data tableconfidence limits

Restricted to initial respondents who answered "Yes" or "No" to the question, "During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?"
Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 8
45+HH Activities/Chores Restriction3.5%2.4%5.0%661,876
45+Social Activities Restriction4.2%3.0%5.9%701,879
45+Functional Difficulty4.9%3.6%6.7%881,787
45+Discussed ICML with HCP5.5%4.1%7.4%1001,879
65+HH Activities/Chores Restriction4.4%2.5%7.6%30714
65+Social Activities Restriction4.3%2.3%7.4%26716
65+Functional Difficulty5.5%3.4%8.7%39713
65+Discussed ICML with HCP6.8%4.4%10.2%48716

Data Notes

Household Activites/Chores Restriction - Respondents who answered "Always," "Usually," or "Sometimes" to the question, "During the past 12 months, as a result of confusion or memory loss, how often have you given up day-to-day household activities or chores you used to do, such as cooking, cleaning, taking medications, driving, or paying bills?" Social Activities Restriction - Respondents who answered "Always," "Usually," or "Sometimes" to the question, "During the past 12 months, how often has confusion or memory loss interfered with your ability to work, volunteer, or engage in social activities outside the home?" Respondents with household activities/chores restriction and/or social activities restriction were classified as having a functional difficulty. Discussed ICML with HCL - Respondents who answered "Yes" to the question, "Has anyone discussed with a health care professional, your confusion or memory loss?'

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (45+, 65+) who reported ICML-attributable limitations and consultations, Alaska Natives, 2016

::chart - missing::
data tableconfidence limits

Restricted to initial respondents who answered "Yes" to the question, "During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?"
Age Groups: 45+, 65+Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 8
45+HH Activities/Chores Restriction6.2%2.7%13.7%18312
45+Social Activities Restriction5.7%2.3%13.4%14312
45+Functional Difficulty7.3%3.5%14.6%22312
45+Discussed ICML with HCP3.6%1.8%6.9%17312
65+HH Activities/Chores Restriction6.9%2.8%16.0%9110
65+Social Activities Restriction0.9%0.2%4.4%2110
65+Functional Difficulty7.1%2.9%16.2%10110
65+Discussed ICML with HCP2.4%1.0%5.8%6110

Data Notes

Household Activites/Chores Restriction - Respondents who answered "Always," "Usually," or "Sometimes" to the question, "During the past 12 months, as a result of confusion or memory loss, how often have you given up day-to-day household activities or chores you used to do, such as cooking, cleaning, taking medications, driving, or paying bills?" Social Activities Restriction - Respondents who answered "Always," "Usually," or "Sometimes" to the question, "During the past 12 months, how often has confusion or memory loss interfered with your ability to work, volunteer, or engage in social activities outside the home?" Respondents with household activities/chores restriction and/or social activities restriction were classified as having a functional difficulty. Discussed ICML with HCL - Respondents who answered "Yes" to the question, "Has anyone discussed with a health care professional, your confusion or memory loss?'

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

References and Community Resources

'''References:''' 1. U.S. Centers for Disease Control and Prevention (CDC). Behavioral risk factor surveillance system (BRFSS) cognitive decline module. [http://www.cdc.gov/aging/healthybrain/brfss-faq-cognitive.htm]. Updated July 1, 2015. Accessed September 20, 2017. 2. U.S. Centers for Disease Control and Prevention (CDC). Self-reported increased confusion or memory loss and associated functional difficulties among adults aged >=60 years -- 21 states, 2011. Morbidity and Mortality Weekly Report (MMWR) 2013;62(18):345-50. 3. Reisberg B, Gauthier S. Current evidence for subjective cognitive impairment (SCI) as the pre-mild cognitive impairment (MCI) stage of subsequently manifest Alzheimer's disease. Int Psychogeriatr 2008;20(1):1-16. 4. Jessen F, Wiese B, Bachmann C, Eifflaender-Gorfer S, et al. Prediction of dementia by subjective memory impairment: effects of severity and temporal association with cognitive impairment. Arch Gen Psychiatry 2010;67(4):414-22. 5. Reisberg B, Shulman MB, Torossian C, Leng L, et al. Outcome over seven years of healthy adults with and without subjective cognitive impairment. Alzheimers Dement 2010;6(1):11-24. 6. Wagster MV, King JW, Resnick SM, Rapp PR. The 87%. J Gerontol A Biol Sci Med 2012;67:739-740. 7. Hendrie HC, Albert MS, Butters MA, Gao S, et al. The NIH cognitive and emotional health project: report of the critical evaluation study committee. Alzheimers Dement 2006;2(1):12-32. 8. U.S. Department of Health and Human Services. Dementias, including Alzheimer's disease. [https://www.healthypeople.gov/2020/topics-objectives/topic/dementias-including-Alzheimer's-disease/objectives]. Accessed May 5, 2016. 9. Alzheimer's Association. 2015 Alzheimer's disease facts and figures. [https://www.alz.org/facts/downloads/facts_figures_2015.pdf]. Published 2015. Accessed May 5, 2016. 10. The Gerontological Society of America. Cognitive impairment detection and earlier diagnosis. [https://www.geron.org/programs-services/alliances-and-multi-stakeholder-collaborations/cognitive-impairment-detection-and-earlier-diagnosis]. Accessed May 5, 2016. 11. National Center for Chronic Disease Prevention and Health Promotion. 2016 Modules by State by Data Set & Weight. https://www.cdc.gov/brfss/questionnaires/modules/state2016.htm. Accessed September 22, 2017. 12. Alaska Department of Health and Social Services and the Alaska Native Tribal Health Consortium. Healthy Alaskans 2020. [http://hss.state.ak.us/ha2020/]. Accessed May 5, 2016. '''Resources:''' Alaska Commission on Aging [http://dhss.alaska.gov/acoa/Pages/default.aspx] Alaska Department of Health and Social Services, Senior and Disability Services. [http://dhss.alaska.gov/dsds/Pages/default.aspx] Alaska State Plan for Senior Services FY16-19. [http://dhss.alaska.gov/acoa/Documents/ACoA_StatePlan_FY16-FY19.pdf] Alzheimer's Resource of Alaska. [http://www.alzalaska.org/] National Institute of Mental Health: [http://www.nimh.nih.gov/] U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA): [http://www.samhsa.gov/] SAMHSA's National Mental Health Information Center: [http://www.mentalhealth.samhsa.gov/] "Mental Health: A Report of the Surgeon General": [http://www.surgeongeneral.gov/library/mentalhealth/home.html] More information on the Behavioral Risk Factor Surveillance System may be found on the website of the Centers for Disease Control and Prevention - [http://www.cdc.gov/brfss/]

More Resources and Links

Alaska and national goals may be found at the following sites:

Alaska health promotion resources may be found at the following site:

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Maps of health indicators for various subdivisions of Alaska may be found at the following site:

Additional indicator data by state and county may be found on these Websites:

Medical literature can be queried at the PubMed website.

For an on-line medical dictionary, click on this Dictionary link.

AK-IBIS Web Citation

Use and reproduction of the information published on this website are encouraged and may be done without permission. The following citation should accompany information from this website whenever it is used, reproduced, or published:

AK-IBIS Indicator Citation:
"[Indicator name]. Retrieved on [insert date] from Alaska Department of Health and Social Services, Indicator-Based Information System for Public Health (AK-IBIS) website: http://ibis.dhss.alaska.gov/.

Example:
Diabetes Prevalence. Retrieved on March 25, 2016, from Alaska Department of Health and Social Services, Indicator-Based Information System for Public Health (AK-IBIS) website: http://ibis.dhss.alaska.gov/.

Page Content Updated On 09/28/2017, Published on 09/28/2017
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health (Ak-IBIS) web site (http://ibis.dhss.alaska.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Mon, 24 June 2019 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health web site: http://ibis.dhss.alaska.gov ".

Content updated: Thu, 28 Sep 2017 11:27:35 AKDT
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Mon, 24 June 2019 20:30:13 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Indicator-Based Information System for Public Health Web site: http://ibis.dhss.alaska.gov/ ".

Content updated: Thu, 28 Sep 2017 11:27:35 AKDT