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State of Alaska

Complete Health Indicator Report of Mental Health - Past 30 Days - Adults (18+) (HA2020 Leading Health Indicator: 9)

Definition

Weighted mean number of days reported by adults 18 years of age and older on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the question: "Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?"

Numerator

Weighted number of days reported by adults (18+) on the BRFSS to the question: "Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?"

Denominator

Weighted number of adults (18+) with complete and valid responses to the BRFSS question on mentally unhealthy days, excluding those with missing, "Don't know/Not sure", or "Refused" responses.

Data Interpretation Issues

The Behavioral Risk Factor Surveillance System (BRFSS) is a source for estimating the mean number of mentally unhealthy days for Alaska. The median of states, District of Columbia, and territories provides a comparison for the United States (U.S.). The BRFSS is a telephone survey of adults 18 and over. Information on background and methodology of the BRFSS managed by the Centers for Disease Control and Prevention (CDC) can be found at: [http://www.cdc.gov/brfss/]. The website for the Alaska BRFSS is: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx]. Alaska data were obtained from the Standard AK BRFSS from 1993-2003, and from the Standard and Supplemental AK BRFSS surveys combined from 2004 onward. The Supplemental BRFSS survey is conducted using identical methodology as the Standard BRFSS and allows a doubling of the BRFSS sample size for those measures included in both surveys. The question of "Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?" has been asked since 1993. Post-stratification weights were used for Alaska prior to 2006; raking weights were used from 2007 onward. For more on this methodological change see: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/method.aspx].

Why Is This Important?

Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. Mental health is indispensable to personal well-being, family and interpersonal relationships, and contribution to community or society. Mental health was recognized in the U.S. Surgeon General's 1999 report as being fundamental to overall health.^1^ Poor mental health can occur across the lifespan, affecting persons of all racial and ethnic groups, both sexes, and all educational and socioeconomic groups. Evidence has shown that mental disorders are strongly related to the occurrence, treatment, and course of many chronic diseases including diabetes, cancer, cardiovascular disease, asthma, and obesity, as well as many risk behaviors for chronic disease, including physical inactivity, smoking, excessive drinking, and insufficient sleep.^2^ In teens, sadness or depression can lead to poor grades at school, alcohol or drug use, unsafe sex, and other problems.^3-4^ National studies have found that mental health issues have been the most commonly identified precipitating circumstance in suicide deaths.^5-7^[[br]] [[br]] ---- {{class .SmallerFont 1. U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. [http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBBHS]. Published 1999. Accessed September 15, 2016. 2. Chapman DP, Perry GS, Strine TW. The vital link between chronic disease and depressive disorders. [http://www.cdc.gov/pcd/issues/2005/jan/04_0066.htm]. Published 2005. Accessed September 15, 2016. 3. Frjd SA, Nissinen ES, Pelkonen MU, Marttunen MJ, Koivisto AM, Kaltiala-Heino R. Depression and School Performance in Middle Adolescent Boys and Girls. J Adolesc 200831(4):485-98. 4. Diego MA, Field TM, Sanders CE. Academic Performance, Popularity, and Depression Predict Adolescent Substance Use. Adolescence 2003;38(149):35-42. 5. Ortega LA, Karch D. Precipitating Circumstances of Suicide Among Women of Reproductive Age in 16 U.S. States, 2003-2007. Journal Women's Health 2010;19(1):5-7. 6. Karch DL, Logan J, McDaniel DD, Floyd CF, Vagi KJ. Precipitating Circumstances of Suicide Among Youth Aged 10-17 Years by Sex: Data from the National Violent Death Reporting System, 16 States, 2005-2008. J Adolesc Health 2013;53(1 Suppl):S51-3. 7. Trigylidas TE, Reynolds EM, Teshome G, Dykstra HK, Lichenstein R. Paediatric Suicide in the USA: Analysis of the National Child Death Case Reporting System. Inj Prev 2016;22:268-273. }}

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 mean number of mentally unhealthy days was 3.7 for all Alaskans and 4.7 for Alaska Native people in 2018. Females reported a significantly higher number of mentally unhealthy days (4.2) than males (3.2) in 2018. The 5.1 mentally unhealthy days reported by those with less than a high school education was significantly higher than the 2.6 days reported by those with a college education. Those unable to work had a significantly higher mean number of unhealthy days (9.4) compared to those who are employed (3.1) or not in the workforce (3.2). The mean number of mentally unhealthy days declined with increasing income. Mean number of mentally unhealthy days from the BRFSS are initially presented for all Alaskans, Alaska Native people, and the median from states, District of Columbia, and territories for all available years. Subsequent analyses by demographic subpopulations (i.e., sex, age, race/ethnicity, ethnicity, marital status, education, employment status, income, and Medicaid eligibility) are limited to 2010 and later to allow for ease of assessing recent trends. Crosstabulations were also conducted for three-year averages by body mass index, current smoking, sexual orientation, and number of Adverse Childhood Experiences. Significant differences occurred within each comparison. Mean number of mentally unhealthy days by regions of Alaska are presented for the most recent time period allowing reporting for all Alaskans and Alaska Native people: 1) single-year for the 7 Alaska Public Health Regions,2) single-year for the 11 behavioral health assessment regions based upon aggregations of 20,000 population, and 3) five-year averages for the 12 tribal health organization regions. These time intervals match those for the InstantAtlas health profiles for each of the geographic regionalizations of Alaska for those desiring longer time series.

How Do We Compare With the U.S.?

In Alaska, as in the US, there has been an increasing trend over time in the mean number of unhealthy days among adults. The median national value for the mean number of mentally unhealthy days in 2017 was the same as that for all Alaskans, 3.9.

What Is Being Done?

Reducing poor mental health in adults was identified as one of the 25 leading health indicators to be addressed by [http://hss.state.ak.us/ha2020/assets/Actions-Partners_9_MentalHealth_Adults.pdf Healthy Alaskans 2020]. 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.

Evidence-based Practices

As part of the Healthy Alaskans 2020 health improvement process, groups of Alaskan 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:''' 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:''' Individuals who receive treatment and/or behavioral interventions earlier are less likely to develop serious mental health disorders. Screening for both depression and substance misuse/abuse is indicated, as the impact of misuse/abuse 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/abuse, chronic medical diseases, unemployment, and poverty. '''Sources:''' Guide to Clinical Preventive Services. [http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2a.html#Depression] Screening, Brief Intervention and Referral to Treatment (SBIRT) in Behavioral Healthcare. [https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/SBIRT_Factsheet_ICN904084.pdf] '''Strategy 2:''' Identify the environmental and individual strengths of Alaskans reporting 0-3 mentally unhealthy days per month to inform mental health improvement strategies. '''Evidence Base:''' 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:''' Shrivastava A, Desousa A. Resilience: A psychobiological construct for psychiatric disorders. Indian J Psychiatry 2016;58:38-43. '''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:''' Kumar S, Preetha GS. Health Promotion: An Effective Tool for Global Health. Indian J Psychiatry 2012;37:5-12. 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):231-239. 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].


Related Indicators

Related Relevant Population Characteristics Indicators:


Health Care System Factors

Health insurance coverage for mental health problems is often inadequate for persons requiring long-term out-patient psychotherapy. Many psychotherapeutic medications (such as antidepressants and anti-anxiety drugs) are prescribed by primary care physicians. Primary care visits are an opportunity to identify and treat some mental health problems.

Related Health Care System Factors Indicators:


Related Risk Factors Indicators:


Health Status Outcomes

Persons who are depressed are at risk for suicide and substance abuse. Depression has also been linked to physical disease, such as heart disease. Persons with mental disorders are often less successful at negotiating the challenges of educational completion and career advancement. As a result, they are at risk for problems associated with poverty.

Related Health Status Outcomes Indicators:




Graphical Data Views

Mean number of days adults (18+) report being mentally unhealthy, all Alaskans, Alaska Natives, and U.S., 1993-2020

::chart - missing::
confidence limits

Alaska ComparisonsYearMean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 84
All Alaskans19932.72.33.11,502
All Alaskans19942.92.33.41,510
All Alaskans19952.92.43.51,506
All Alaskans19963.02.63.51,492
All Alaskans19973.22.73.71,506
All Alaskans19982.32.02.61,956
All Alaskans19993.22.83.72,010
All Alaskans20002.82.43.22,045
All Alaskans20013.22.93.62,826
All Alaskans20022.62.22.92,577
All Alaskans20032.82.53.22,623
All Alaskans20042.92.63.25,008
All Alaskans20053.12.93.45,655
All Alaskans20063.33.03.74,143
All Alaskans20073.63.23.94,949
All Alaskans20083.33.03.74,781
All Alaskans20092.82.53.14,627
All Alaskans20103.22.83.73,109
All Alaskans20113.22.83.55,932
All Alaskans20123.33.03.68,193
All Alaskans20133.12.83.39,029
All Alaskans20143.12.83.38,819
All Alaskans20153.63.33.98,054
All Alaskans20163.53.13.87,214
All Alaskans20173.93.54.26,860
All Alaskans20183.73.34.04,286
Alaska Native people19932.81.93.7311
Alaska Native people19942.81.83.8284
Alaska Native people19952.92.03.8303
Alaska Native people19962.72.03.5301
Alaska Native people19972.51.73.2306
Alaska Native people19982.41.53.3352
Alaska Native people19993.22.44.0403
Alaska Native people20003.72.55.0377
Alaska Native people20013.02.43.6604
Alaska Native people20022.92.03.8538
Alaska Native people20032.61.93.4561
Alaska Native people20043.02.43.61,060
Alaska Native people20053.32.73.91,168
Alaska Native people20064.53.25.8849
Alaska Native people20073.62.84.31,059
Alaska Native people20083.63.04.3987
Alaska Native people20093.12.53.7895
Alaska Native people20103.32.34.2567
Alaska Native people20114.03.15.01,124
Alaska Native people20124.53.65.41,744
Alaska Native people20133.53.04.11,534
Alaska Native people20143.02.53.51,386
Alaska Native people20154.03.24.71,491
Alaska Native people20164.23.45.01,276
Alaska Native people20174.33.45.01,190
Alaska Native people20184.73.95.6728
U.S.1993**
U.S.1994**
U.S.1995**
U.S.1996**
U.S.1997**
U.S.1998**
U.S.1999**
U.S.20003.2
U.S.20013.4
U.S.20023.0
U.S.20033.3
U.S.20043.4
U.S.20053.2
U.S.20063.2
U.S.20073.2
U.S.20083.3
U.S.20093.3
U.S.20103.4
U.S.20113.7
U.S.20123.8
U.S.20133.7
U.S.20143.6
U.S.20153.7
U.S.2016**
Healthy Alaskans Goal20132.9
Healthy Alaskans Goal20142.9
Healthy Alaskans Goal20152.9
Healthy Alaskans Goal20162.9
Healthy Alaskans Goal20172.9
Healthy Alaskans Goal20182.9
Healthy Alaskans Goal20192.9
Healthy Alaskans Goal20202.9

Data Notes

The 2002 U.S. data is for 23 states. U.S. values are based upon the median value of the states, District of Columbia, and territories. ** = Data not available

Data Sources

  • 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
  • U.S. Data: National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System (BRFSS)


Mean number of days adults (18+) report being mentally unhealthy, by sex, all Alaskans, 2010-2020

::chart - missing::
confidence limits

HA: Males vs. FemalesYearMean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 26
Males20102.72.13.41,401
Males20112.62.23.12,719
Males20122.52.12.83,797
Males20132.42.12.74,143
Males20142.62.33.04,021
Males20153.12.73.53,730
Males20162.92.43.33,304
Males20173.42.93.83,318
Males20183.22.73.62,084
Females20103.83.34.31,708
Females20113.73.34.23,213
Females20124.13.74.64,396
Females20133.93.54.34,886
Females20143.63.23.94,798
Females20154.23.74.64,324
Females20164.13.64.63,910
Females20174.43.85.03,542
Females20184.23.74.62,195
Healthy Alaskans Goal20132.9
Healthy Alaskans Goal20142.9
Healthy Alaskans Goal20152.9
Healthy Alaskans Goal20162.9
Healthy Alaskans Goal20172.9
Healthy Alaskans Goal20182.9
Healthy Alaskans Goal20192.9
Healthy Alaskans Goal20202.9

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


Mean number of days adults (18+) report being mentally unhealthy, by age group, all Alaskans, 2010-2020

::chart - missing::
confidence limits

HA: Age Group: 18-24,25-34,35-44,45-64,65+YearMean number of unhealhty daysLower LimitUpper LimitDenom- inator
Record Count: 53
18-2420103.21.94.5133
18-2420112.81.83.7348
18-2420122.72.94.4565
18-2420133.62.94.3643
18-2420143.93.14.7487
18-2420154.53.65.5450
18-2420164.23.15.2389
18-2420175.44.16.8428
18-2420185.13.86.4263
25-3420103.62.54.8411
25-3420113.62.64.5783
25-3420123.32.74.01,288
25-3420133.22.63.71,243
25-3420143.52.94.11,041
25-3420154.23.45.0920
25-3420163.83.04.7744
25-3420174.53.55.5782
25-3420183.82.94.7453
35-4420102.61.93.3540
35-4420113.22.53.81,027
35-4420123.62.74.41,297
35-4420133.52.74.21,393
35-4420142.82.33.31,309
35-4420153.62.94.31,070
35-4420163.92.94.8903
35-4420174.13.35.0893
35-4420182.92.23.7550
45-6420103.42.74.21,462
45-6420113.42.93.82,645
45-6420123.22.73.63,458
45-6420133.02.63.43,896
45-6420143.12.83.53,854
45-6420153.32.93.73,484
45-6420163.32.83.83,074
45-6420173.63.14.12,774
45-6420184.23.64.71,560
65+20102.61.63.5525
65+20111.91.32.51,053
65+20122.61.73.61,488
65+20132.21.72.61,763
65+20142.01.62.41,992
65+20152.51.93.11,997
65+20162.41.73.01,956
65+20172.21.82.71,846
65+20182.82.13.61,369
Healthy Alaskans Goal20132.9
Healthy Alaskans Goal20142.9
Healthy Alaskans Goal20152.9
Healthy Alaskans Goal20162.9
Healthy Alaskans Goal20172.9
Healthy Alaskans Goal20182.9
Healthy Alaskans Goal20192.9
Healthy Alaskans Goal20202.9

Data Notes

Respondents are asked, "What is your age?", which is coded in years. 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


Mean number of days adults (18+) report being mentally unhealthy, by race/ethnicity, all Alaskans, 2016-2018 (3-year average)

::chart - missing::
confidence limits

Mean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 8
Alaska Native (any mention)4.43.94.93,193
Asian (non-Hispanic)2.21.23.2333
Black (non-Hispanic)4.93.26.6257
Native Hawaiian/Other Pacific Islander (non-Hispanic)3.82.55.189
White (non-Hispanic)3.43.23.613,366
Multiracial/Other (non-Hisp.)6.03.58.4185
Hispanic (alone or multi)4.43.15.8521
Healthy Alaskans Goal2.9

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


Mean number of days adults (18+) report being mentally unhealthy, by ethnicity, all Alaskans, 2010-2020

::chart - missing::
confidence limits

HA: Ethnicity - Hispanic/LatinoYearMean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 26
Hispanic/Latino20103.91.56.373
Hispanic/Latino20113.81.95.7163
Hispanic/Latino20123.32.14.5247
Hispanic/Latino20134.02.75.3263
Hispanic/Latino20144.22.75.7248
Hispanic/Latino20153.72.15.2222
Hispanic/Latino20164.72.56.9222
Hispanic/Latino20175.93.48.4217
Hispanic/Latino20182.61.43.7153
Not Hispanic/Latino20103.22.83.63,005
Not Hispanic/Latino20113.12.83.55,721
Not Hispanic/Latino20123.33.03.67,891
Not Hispanic/Latino20133.02.83.38,653
Not Hispanic/Latino20143.02.83.38,435
Not Hispanic/Latino20153.63.33.97,711
Not Hispanic/Latino20163.43.03.76,877
Not Hispanic/Latino20173.73.44.16,549
Not Hispanic/Latino20183.73.44.04,089
Healthy Alaskans Goal20132.9
Healthy Alaskans Goal20142.9
Healthy Alaskans Goal20152.9
Healthy Alaskans Goal20162.9
Healthy Alaskans Goal20172.9
Healthy Alaskans Goal20182.9
Healthy Alaskans Goal20192.9
Healthy Alaskans Goal20202.9

Data Notes

Ethnicity is defined independent of race. It is based upon responses to the question, "Are you Hispanic, Latino/a, or Spanish origin?" 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


Mean number of days adults (18+) report being mentally unhealthy, by marital status, all Alaskans, 2010-2020

::chart - missing::
confidence limits

HA: Marital StatusYearMean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 53
Married20102.62.13.01,802
Married20112.62.33.03,291
Married20122.32.02.64,415
Married20132.32.02.54,905
Married20142.21.92.54,953
Married20152.62.42.94,452
Married20162.42.02.74,051
Married20172.82.43.23,739
Married20182.72.33.12,275
Widowed20103.62.34.9227
Widowed20113.11.74.5408
Widowed20125.23.56.9607
Widowed20134.12.55.8662
Widowed20143.32.44.2673
Widowed20153.12.84.0659
Widowed20163.11.84.4615
Widowed20173.22.24.1582
Widowed20183.21.74.6386
Divorced/Separated20105.33.76.9493
Divorced/Separated20114.73.95.51,043
Divorced/Separated20125.24.16.31,357
Divorced/Separated20134.33.55.01,507
Divorced/Separated20145.04.25.71,434
Divorced/Separated20155.34.36.41,246
Divorced/Separated20164.93.86.01,100
Divorced/Separated20175.34.36.31,062
Divorced/Separated20185.03.96.2691
Never Married20103.82.64.9449
Never Married20113.42.64.3885
Never Married20123.93.34.61,406
Never Married20133.93.24.61,492
Never Married20143.83.24.41,326
Never Married20154.74.05.41,263
Never Married20164.83.95.71,099
Never Married20175.64.66.51,103
Never Married20185.14.26.0722
Living with a Partner20103.11.94.3114
Living with a Partner20114.42.56.2251
Living with a Partner20124.62.96.2347
Living with a Partner20134.12.85.4400
Living with a Partner20143.62.64.7344
Living with a Partner20154.63.55.8334
Living with a Partner20164.32.75.8262
Living with a Partner20172.82.13.6319
Living with a Partner20183.52.24.8176
Healthy Alaskans Goal20132.9
Healthy Alaskans Goal20142.9
Healthy Alaskans Goal20152.9
Healthy Alaskans Goal20162.9
Healthy Alaskans Goal20172.9
Healthy Alaskans Goal20182.9
Healthy Alaskans Goal20192.9
Healthy Alaskans Goal20202.9

Data Notes

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


Mean number of days adults (25+) report being mentally unhealthy, by education, all Alaskans, 2010-2020

::chart - missing::
confidence limits

HA: Edu Level: LT High School, High School, Some College, College GradYearMean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 44
LT High School20106.13.58.8185
LT High School20115.13.46.9358
LT High School20126.14.37.9508
LT High School20136.04.57.5444
LT High School20144.73.46.1427
LT High School20155.63.97.3379
LT High School20165.13.27.0299
LT High School20174.93.46.4325
LT High School20185.13.46.8218
High School20103.02.33.8805
High School20112.92.43.51,534
High School20122.92.43.42,008
High School20133.32.73.82,123
High School20142.82.43.31,963
High School20153.63.04.31,881
High School20163.62.84.41,711
High School20174.94.05.81,576
High School20184.13.24.91,038
Some College20103.22.43.9882
Some College20113.52.94.11,562
Some College20123.42.84.02,250
Some College20132.92.53.32,491
Some College20143.12.73.62,355
Some College20153.53.04.02,266
Some College20163.63.04.12,005
Some College20173.63.04.21,876
Some College20183.83.24.51,183
College Graduate20102.62.03.11,062
College Graduate20112.41.92.92,040
College Graduate20122.42.02.82,750
College Graduate20132.01.72.23,212
College Graduate20142.52.12.83,409
College Graduate20152.62.23.02,985
College Graduate20162.42.02.82,719
College Graduate20172.31.92.72,590
College Graduate20182.62.23.11,534
Healthy Alaskans Goal20132.9
Healthy Alaskans Goal20142.9
Healthy Alaskans Goal20152.9
Healthy Alaskans Goal20162.9
Healthy Alaskans Goal20172.9
Healthy Alaskans Goal20182.9
Healthy Alaskans Goal20192.9
Healthy Alaskans Goal20202.9

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


Mean number of days adults (18+) report being mentally unhealthy, by employment status, all Alaskans, 2010-2020

::chart - missing::
confidence limits

HA: EmploymentYearMean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 43
Employed20102.72.23.22,002
Employed20112.52.22.83,646
Employed20122.72.43.05,009
Employed20132.52.22.75,415
Employed20142.52.32.85,248
Employed20153.02.73.44,679
Employed20163.02.53.44,038
Employed20173.43.03.83,944
Employed20183.12.73.52,287
Unemployed20105.63.37.9204
Unemployed20114.42.95.9447
Unemployed20125.13.66.7588
Unemployed20134.83.66.0612
Unemployed20145.24.06.5464
Unemployed20156.04.67.3476
Unemployed20166.95.28.7413
Unemployed20176.54.78.3374
Unemployed20185.74.07.3232
Not In Work Force20102.92.23.6749
Not In Work Force20112.62.13.21,523
Not In Work Force20122.82.33.32,146
Not In Work Force20132.92.43.32,494
Not In Work Force20142.72.33.22,597
Not In Work Force20153.22.63.72,365
Not In Work Force20162.72.23.22,280
Not In Work Force20173.22.43.92,062
Not In Work Force20183.22.63.81,481
Unable to Work201010.17.612.7140
Unable to Work201111.99.414.4291
Unable to Work201211.19.013.2414
Unable to Work20139.57.511.5430
Unable to Work20149.47.811.0413
Unable to Work20159.97.911.8380
Unable to Work20168.96.910.8350
Unable to Work20179.07.011.0352
Unable to Work20189.47.311.4247
Healthy Alaskans Goal20132.9
Healthy Alaskans Goal20142.9
Healthy Alaskans Goal20152.9
Healthy Alaskans Goal20162.9
Healthy Alaskans Goal20172.9
Healthy Alaskans Goal20182.9
Healthy Alaskans Goal20192.9

Data Notes

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


Mean number of days adults (18+) report being mentally unhealthy, by income, all Alaskans, 2010-2020

::chart - missing::
confidence limits

HA: Income: LT $15k, $15k-$25k, $25k-$50k, $50-$75k, $75k+YearMean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 53
<$15,00020105.63.97.4199
<$15,00020116.64.88.4425
<$15,00020126.85.48.2649
<$15,00020136.85.28.3691
<$15,00020145.64.66.7599
<$15,00020157.15.68.5540
<$15,00020167.15.48.9473
<$15,00020178.06.39.6499
<$15,00020189.17.211.0264
$15,000 - $24,99920105.63.97.4291
$15,000 - $24,99920114.33.15.4636
$15,000 - $24,99920125.13.96.3961
$15,000 - $24,99920134.93.95.91,008
$15,000 - $24,99920144.33.55.2924
$15,000 - $24,99920155.74.56.8874
$15,000 - $24,99920165.84.47.2722
$15,000 - $24,99920175.44.16.7770
$15,000 - $24,99920185.64.37.0467
$25,000 - $49,99920104.02.85.1600
$25,000 - $49,99920113.83.04.71,125
$25,000 - $49,99920123.72.94.51,595
$25,000 - $49,99920133.83.24.31,724
$25,000 - $49,99920144.13.44.71,626
$25,000 - $49,99920153.62.94.31,420
$25,000 - $49,99920163.82.94.71,307
$25,000 - $49,99920174.03.14.91,219
$25,000 - $49,99920183.42.64.3756
$50,000 - $74,99920102.41.33.5532
$50,000 - $74,99920112.31.82.9962
$50,000 - $74,99920122.62.03.11,299
$50,000 - $74,99920132.01.62.41,501
$50,000 - $74,99920142.41.92.91,373
$50,000 - $74,99920153.93.04.71,228
$50,000 - $74,99920162.92.33.61,099
$50,000 - $74,99920172.92.23.61,027
$50,000 - $74,99920183.12.23.9588
$75,000+20102.21.72.81,075
$75,000+20112.01.62.32,008
$75,000+20122.01.62.32,615
$75,000+20131.91.62.23,257
$75,000+20142.01.72.33,376
$75,000+20152.42.12.73,067
$75,000+20162.11.72.52,820
$75,000+20172.72.23.22,644
$75,000+20182.21.82.61,489
Healthy Alaskans Goal20132.9
Healthy Alaskans Goal20142.9
Healthy Alaskans Goal20152.9
Healthy Alaskans Goal20162.9
Healthy Alaskans Goal20172.9
Healthy Alaskans Goal20182.9
Healthy Alaskans Goal20192.9
Healthy Alaskans Goal20202.9

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


Mean number of days adults (18+) report being mentally unhealthy, by medicaid eligibility, all Alaskans, 2010-2020

::chart - missing::
confidence 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]
Medicaid Eligibility StatusYearMean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 18
Medicaid Eligible20105.13.96.4587
Medicaid Eligible20115.44.36.51,112
Medicaid Eligible20125.54.66.31,806
Medicaid Eligible20135.64.86.41,823
Medicaid Eligible20145.04.35.71,654
Medicaid Eligible20155.74.96.51,497
Medicaid Eligible20165.74.76.61,241
Medicaid Eligible20175.74.76.71,279
Medicaid Eligible20185.94.87.1656
Medicaid Ineligible20102.72.23.12,110
Medicaid Ineligible20112.62.32.94,044
Medicaid Ineligible20122.52.22.85,313
Medicaid Ineligible20132.32.12.56,358
Medicaid Ineligible20142.52.22.76,243
Medicaid Ineligible20153.02.73.35,631
Medicaid Ineligible20162.82.53.25,180
Medicaid Ineligible20173.22.83.64,880
Medicaid Ineligible20183.02.63.42,899

Data Notes

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


Mean number of days adults (18+) report being mentally unhealthy, by body mass index, all Alaskans, 2016-2018 (3-year average)

::chart - missing::
confidence limits

Weight CategoryMean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 4
Neither Overweight nor Obese3.73.34.05,400
Overweight3.22.93.56,243
Obese4.43.94.85,455
Healthy Alaskans Goal2.9

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.


Mean number of days adults (18+) report being mentally unhealthy, by current smoking, all Alaskans, 2016-2018 (3-year average)

::chart - missing::
confidence limits

Mean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 3
Not current smoker3.12.93.315,078
Current smoker6.25.66.83,000
Healthy Alaskans Goal2.9

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.


Mean number of days adults (18+) report being mentally unhealthy, by sexual orientation, all Alaskans, 2016-2018 (3-year average)

::chart - missing::
confidence limits

Mean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 3
Heterosexual3.53.33.716,192
Gay, Lesbian, or Bisexual7.46.08.8593
Healthy Alaskans Goal2.9

Data Notes

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.


Mean number of days adults (18+) report being mentally unhealthy, by ACEs score, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Mean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 5
01.51.31.73,904
12.42.12.82,339
2-33.63.24.12,562
4+5.65.06.21,859
Healthy Alaskans Goal2.9

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.


Mean number of days adults (18+) report being mentally unhealthy, by Alaska Public Health Regions, all Alaskans and Alaska Natives, 2018

::chart - missing::
confidence limits

Alaska ComparisonsMean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 15
All AlaskansAnchorage3.32.74.0865
All AlaskansGulf Coast4.13.24.9760
All AlaskansInterior3.93.14.81,015
All AlaskansMat-Su3.93.14.7496
All AlaskansNorthern2.71.73.8164
All AlaskansSoutheast3.73.14.3751
All AlaskansSouthwest3.52.04.9227
Alaska Native peopleAnchorage4.01.96.192
Alaska Native peopleGulf Coast5.43.17.897
Alaska Native peopleInterior5.83.58.0162
Alaska Native peopleMat-Su**42
Alaska Native peopleNorthern3.31.94.7105
Alaska Native peopleSoutheast5.93.28.5115
Alaska Native peopleSouthwest2.80.55.1114
Healthy Alaskans GoalHealthy Alaskans Goal2.9

Data Notes

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


Mean number of days adults (18+) report being mentally unhealthy, by behavioral health system assessment areas, all Alaskans and Alaska Natives, 2018

::chart - missing::
confidence limits

Alaska ComparisonsMean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 23
All AlaskansAnchorage Muncipality3.32.74.0865
All AlaskansFairbanks North Star Borough4.33.25.3714
All AlaskansCity and Borough of Juneau4.53.35.7282
All AlaskansKenai Peninsula Borough5.03.86.2362
All AlaskansMatanuska-Susitna Borough3.93.14.7496
All AlaskansNorthwest Region2.71.73.8164
All AlaskansOther Interior Region2.92.13.8511
All AlaskansOther SE - Northern2.72.03.3252
All AlaskansOther SE - Southern3.11.64.7217
All AlaskansY-K Delta Region2.11.03.388
All AlaskansSouthwest Region2.81.64.0327
Alaska Native peopleAnchorage Muncipality4.01.96.192
Alaska Native peopleFairbanks North Star Borough8.23.912.559
Alaska Native peopleCity and Borough of Juneau**30
Alaska Native peopleKenai Peninsula Borough**30
Alaska Native peopleMatanuska-Susitna Borough**42
Alaska Native peopleNorthwest Region3.31.94.7105
Alaska Native peopleOther Interior Region3.92.45.4133
Alaska Native peopleOther SE - Northern**44
Alaska Native peopleOther SE - Southern**41
Alaska Native peopleY-K Delta Region1.20.51.859
Alaska Native peopleSouthwest Region4.71.38.092
Healthy Alaskans GoalHealthy Alaskans Goal2.9

Data Notes

Geographic descriptions of the behavioral health systems assessment reporting regions can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_bhs.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


Mean number of days adults (18+) report being mentally unhealthy, by tribal health organization regions, all Alaskans and Alaska Natives, 2014-2018 (5-year average)

::chart - missing::
confidence limits

Alaska ComparisonsMean number of unhealthy daysLower LimitUpper LimitDenom- inator
Record Count: 25
All AlaskansAleutians and Pribilofs2.91.84.0645
All AlaskansAnchorage/Mat-Su3.73.54.012,097
All AlaskansArctic Slope2.92.33.6334
All AlaskansBristol Bay3.62.84.51,047
All AlaskansCopper R/Prince William Snd.2.82.23.4882
All AlaskansInterior3.53.13.87,663
All AlaskansKenai Peninsula3.83.44.23,688
All AlaskansKodiak Area1.91.42.4817
All AlaskansNorthwest Arctic2.41.63.3424
All AlaskansNorton Sound2.51.93.0651
All AlaskansSoutheast3.53.33.85,445
All AlaskansYukon-Kuskokwim2.42.02.81,304
Alaska Native peopleAleutians and Pribilofs3.91.56.2244
Alaska Native peopleAnchorage/Mat-Su5.14.35.91,112
Alaska Native peopleArctic Slope3.32.44.2178
Alaska Native peopleBristol Bay3.42.64.2522
Alaska Native peopleCopper R/Prince William Snd.3.92.65.2114
Alaska Native peopleInterior4.03.24.81,120
Alaska Native peopleKenai Peninsula4.73.06.4305
Alaska Native peopleKodiak Area2.10.73.5142
Alaska Native peopleNorthwest Arctic2.51.43.6275
Alaska Native peopleNorton Sound2.72.03.5380
Alaska Native peopleSoutheast4.53.75.3786
Alaska Native peopleYukon-Kuskokwim2.42.02.8853
Healthy Alaskans GoalHealthy Alaskans Goal2.9

Data Notes

Geographic descriptions of the tribal health organization regions can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_thr.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

References and Community Resources

'''References:''' 1. U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. [http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBBHS]. Published 1999. Accessed September 15, 2016. 2. Chapman DP, Perry GS, Strine TW. The vital link between chronic disease and depressive disorders. [http://www.cdc.gov/pcd/issues/2005/jan/04_0066.htm]. Published 2005. Accessed September 15, 2016. 3. Frjd SA, Nissinen ES, Pelkonen MU, Marttunen MJ, Koivisto AM, Kaltiala-Heino R. Depression and School Performance in Middle Adolescent Boys and Girls. J Adolesc 200831(4):485-98. 4. Diego MA, Field TM, Sanders CE. Academic Performance, Popularity, and Depression Predict Adolescent Substance Use. Adolescence 2003;38(149):35-42. 5. Ortega LA, Karch D. Precipitating Circumstances of Suicide Among Women of Reproductive Age in 16 U.S. States, 2003-2007. Journal Women's Health 2010;19(1):5-7. 6. Karch DL, Logan J, McDaniel DD, Floyd CF, Vagi KJ. Precipitating Circumstances of Suicide Among Youth Aged 10-17 Years by Sex: Data from the National Violent Death Reporting System, 16 States, 2005-2008. J Adolesc Health 2013;53(1 Suppl):S51-3. 7. Trigylidas TE, Reynolds EM, Teshome G, Dykstra HK, Lichenstein R. Paediatric Suicide in the USA: Analysis of the National Child Death Case Reporting System. Inj Prev 2016;22:268-273. '''Resources:''' U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA): [https://www.samhsa.gov/]. National Institute of Mental Health: [http://www.nimh.nih.gov/]. 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 09/26/2019, Published on 09/26/2019
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 Wed, 16 October 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: Mon, 30 Sep 2019 08:35:36 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 Wed, 16 October 2019 21:15:27 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: Mon, 30 Sep 2019 08:35:36 AKDT