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State of Alaska

Complete Health Indicator Report of Physical Activity - Adults (18+) - Recommended Levels - 2008 Guidelines (HA2020 Leading Health Indicator: 6A)

Definition

Percentage of adults aged 18 years of age and older who report on the Behavioral Risk Factor Surveillance System (BRFSS) doing at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week.

Numerator

Weighted number of adults (18+) who report on the BRFSS engaging in 150 minutes or more total per week of moderate or vigorous exercise where each minute of vigorous exercise contributes two minutes to the total.

Denominator

Weighted number of adults (18+) responding to physical activity questions on the BRFSS, excluding those with missing, "Don't know/Not sure" or "Refused" responses.

Data Interpretation Issues

The Physical Activity Rotating Core (PARC) is part of the BRFSS core asked in odd-numbered yearto measure progress toward meeting 2008 Physical Activity Guidelines for Americans.^4^ The PARC consists of three components of (1) presence of leisure-time physical activity, (2) listing up to two aerobic activities along with their frequency and duration, and (3) the frequency of muscle-building activities.^5^ The first component of no leisure-time physical activity is measured by the question: "During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?" The second component of aerobic activity questions is only asked to respondents who said 'yes' to the no leisure-time physical activity question. It consists of two sets of three questions with the first set being: "What type of physical activity or exercise did you spend the most time doing during the past month?"; "How many times per week or per month did you take part in this activity?"; and "And when you took part in this activity, for how many minutes or hours did you usually keep at it?" The second set of questions is: "What other type of physical activity gave you the next most exercise during the past month?"; "How many times per week or per month did you take part in this activity?"; and "And when you took part in this activity, for how many minutes or hours did you usually keep at it?" The third component of muscle-strengthening activities is measured by the question: "During the past month, how many times per week or per month did you do physical activities or exercises to STRENGTHEN your muscles? Do NOT count aerobic activities like walking, running, or bicycling. Count activities using your own body weight like yoga, sit-ups or push-ups and those using weight machines, free weights, or elastic bands."

Why Is This Important?

Regular physical activity can improve the health and quality of life of Alaskans of all ages, regardless of the presence of a chronic disease or disability. Adults benefit from moderate physical activity, of at least 150 minutes each week. Physical activity is recognized as an independent protective factor against cardiovascular disease. Physical activity has been shown to reduce the risk of some cancers, type 2 diabetes, stroke, and heart disease; and improve general physical and mental health.^1^ Weight-bearing activity can improve bone density, reducing the risk of hip fractures in elderly persons. Regular activity helps to relieve pain from osteoarthritis.^2^ Regular physical activity is also known to improve affective disorders such as depression and anxiety, and increase quality of life and independent living among the elderly.^3^[[br]] [[br]] {{class .SmallerFont # Centers for Disease Control and Prevention. Physical activity and health: a report of the surgeon general. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Promotion; 1996. # Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346(6):393-403. # Kesaniemi, Y., et al. (1994). Dose-response issues concerning physical activity and health: an evidence-based symposium. Medicine and Science in Sports and Exercise, 33(6 suppl), S351-S358 }}

Healthy People Objective: Increase the proportion of adults who engage in aerobic physical activity of at least moderate intensity for at least 150 minutes/week, or 75 minutes/week of vigorous intensity, or an equivalent combination

U.S. Target: 47.9% as measured by the National Health Interview Survey (NHIS) for adults 18 years of age and older.

Other Objectives

Healthy Alaskans 2020 Indicator 6.a: Increase the percentage of adults (age 18 years and older) who meet the 2008 U.S. Dept. of Health and Human Services Physical Activity Guidelines (150 minutes or more total minutes per week of moderate or vigorous exercise) to 61% by 2020. Healthy People Objective PA-2.2: Increase the proportion of adults who engage in aerobic physical activity of at least moderate intensity for more than 300 minutes/week, or more than 150 minutes/week of vigorous intensity, or an equivalent combination. U.S. Target: 31.3% as measured by the National Health Interview Survey (NHIS) for adults 18 years of age and older. Healthy People Objective PA-2.3: Increase the proportion of adults who perform muscle-strengthening activities on 2 or more days of the week. U.S. Target: 24.1% as measured by the National Health Interview Survey (NHIS) for adults 18 years of age and older. Healthy People Objective PA-2.4: Increase the proportion of adults who meet the objectives for aerobic activity and muscle-strengthening activity. U.S. Target: 20.1% as measured by the National Health Interview Survey (NHIS) for adults 18 years of age and older. Healthy Alaskans 2020 Indicator 6.a: Increase the percentage of adults (age 18 years and older) who meet the 2008 U.S. Dept. of Health and Human Services Physical Activity Guidelines (150 minutes or more total minutes per week of moderate or vigorous exercise) to 61% by 2020.

How Are We Doing?

In 2013, the prevalence for getting the recommended equivalent amount of 150 minutes or more per week of moderate or vigorous physical activity was 55.0% for all Alaskan adults and 46.8% for Alaska Native adults, both below the Healthy Alaskans 2020 goal of 61.0%. There was a broad-based decline in the percentage meeting the recommended aerobic physical activity recommendation of 150 or more minutes per week in 2013 compared to the levels obtained by the groups in 2011. However, most groups still maintained a percentage higher than the Healthy People 2020 target of 47.9% for this measure. Alaskan adults in general were also doing better in 2013 than the national average and Healthy People 2020 targets for the 3 other physical activity measures. For the physical activity recommendation of engaging in 300 or more minutes of aerobic physical activity, Alaskan adults were 36.6%, higher than the Healthy People 2020 target of 31.3%. For the recommendation of engaging in muscle-strengthening activities at least 2 times per week, Alaskan adults had a rate of 33.5%, exceeding the Healthy People 2020 target of 24.1%. For the combined measure of meeting recommendations for aerobic physical activity (i.e., 150+ minutes per week) and at least twice weekly muscle-strengthening activities, Alaska adults were 25.0%, exceeding the Healthy People 2020 target of 20.1%. The rates for Alaska Native adults, although slightly lower than the mean for all Alaskan adults, still matched or exceeded the targets. The prevalence rates for the standard aerobic physical activity measure (i.e., 150+ minutes per week) 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. The aerobic physical activity measure of 300+ minutes per week for additional and more extensive health benefits is presented for all Alaskans and Alaska Native adults. Recommended levels of twice-weekly strength training and overall physical fitness (150+ minutes per week) in conjunction with the strength training are displayed for all Alaskans, Alaska Natives adults, and the national median. Subsequent analyses of the 150+ minutes per week of physical activity recommendation are presented by demographic subpopulations (i.e., sex, age, race/ethnicity, ethnicity, marital status, education, employment status, income, and poverty status). Regional displays of this aerobic physical activity recommendation are presented for the most recent time period allowing reporting for all Alaskans and Alaska Native people: 1) single-year for the 6 Alaska Public Health Regions, 2) two-year averages by the 7 Metropolitan and Micropolitan Statistics Areas and rural remainder, 3) single-year for the 10 behavioral health assessment regions based upon aggregations of 20,000 population, 4) two-year averages for 29 boroughs and census areas, and 5) two-year averages for the 12 tribal health organization regions.

How Do We Compare With the U.S.?

When compared to the national average of adults, Alaskan adults display higher rates of physical activity. In 2013, 55.0% of Alaskan adults met the recommended amount of 150+ minutes per week of aerobic physical activity compared to the national median value of 50.5%. For the measure of twice weekly muscle-strengthening activities, 33.5% of Alaskan adults met the recommendation compared to the national median of 29.8%. One-quarter (25.0%) of Alaskan adults met both the aerobic and muscle-strengthening recommendations compared to just one-fifth (20.1%) for the national median.

What Is Being Done?

The Play Every Day campaign delivers Alaska-specific messages focused on raising awareness about childhood obesity in Alaska and encouraging parents and families to prioritize daily physical activity and serving fewer sugary drinks to their families.^6^ Play Every Day uses community and school events, as well as media and other marketing resources, to create a sustained campaign aimed at increasing youth and family physical activity, promoting participation in the Healthy Futures Challenge and physical activity events, and reducing sugary drink consumption.[[br]] [[br]] {{class .SmallerFont 6. [http://www.dhss.alaska.gov/dph/PlayEveryDay/Pages/default.aspx\ Play Every Day]. Alaska Department of Health and Social Services, Division of Public Health. }}

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. Public health partners around the state are aligning work around these approaches adapted to Alaska's unique needs. '''Strategy 1:''' [[br]]Implement a comprehensive social marketing campaign promoting physical activity. Choose campaign topics strategically. '''Evidence Base:''' [[br]]Citing the Community Guide and other reviews, the CDC recommends community-wide campaigns as effective in increasing physical activity. '''Sources:''' [[br]]Centers for Disease Control and Prevention. Increasing physical activity: A report on recommendations of the Task Force on Community Preventive Services. MMWR. 2001; 50(RR-18): 1-16. The Community Guide: [http://www.thecommunityguide.org/pa/index/html] Kahn EB, Ramsey LT, Brownson RC, et al. The effectiveness of interventions to increase physical activity: a systematic review. Am J Prev Med. 2002; 22(4S): 73-107. '''Strategy 2:''' [[br]]Adopt and implement new school physical activity and Nutrition policies, also known as "wellness policies". '''Evidence Base:''' [[br]]Many of the evidence-based strategies to address childhood obesity (such as promoting quality PE and health education, and establishing a Safe Routes to School program) depend on the support of schools, communities, and parents to implement. Therefore a strategy recommended by the CDC, US DHHS and the IOM is to support the adoption and implementation of school physical activity and nutrition policies (also known as "wellness policies") by school districts. '''Sources:''' [[br]][http://www.cdc.gov/healthyyouth/npao/strategies.htm CDC School Health Guidelines]. Institute of Medicine. Progress in preventing childhood obesity: How do we measure up? Koplan JP, Liverman CT, Kraak VI, Wisham, SL editors. Washington: National Academies Press; 2007. US Department of Health and Human Services. The Surgeon General's Vision for a Healthy and Fit Nation. Rockville, MD: US Department of Health and Human Services, Office of the Surgeon General, January 2010. USDA [http://www.gpo.gov/fdsys/pkg/PLAW-111publ296/pdf/PLAW-111publ296.pdf Healthy, Hunger-Free Kids Act of 2010 SEC. 204 Local School Wellness Policy Implementation] A listing of strategies, actions, and key partners on this measure can be found at: [http://hss.state.ak.us/ha2020/assets/Actions-Partners_6_Physical_Activity.pdf].


Related Indicators

Relevant Population Characteristics

There are age, gender, and socio-economic related risk factors associated with physical inactivity.

Related Relevant Population Characteristics Indicators:


Health Care System Factors

Health care system factors relate primarily to access to care and a reported low rate of health care provider counseling for physical activity recommendations.

Related Health Care System Factors Indicators:


Risk Factors

The percentage of persons who reported no physical activity during leisure time was higher among women, older adults, people who were overweight or obese, and those with less formal education and less income.

Related Risk Factors Indicators:


Health Status Outcomes

Small changes in levels of physical activity such as walking or gardening can lead to big improvements in personal health. In fact, the greatest benefits occur among those who have never exercised regularly. Even moderate amounts of exercise can substantially reduce an individual's chance of dying from heart disease, cancer, or other causes.

Related Health Status Outcomes Indicators:




Graphical Data Views

Percentage of adults (18+) who reported getting the recommended amount of aerobic physical activity, all Alaskans, Alaska Natives, and U.S., 2011-2019

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confidence limits

Alaska ComparisonsYearPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 15
All Alaskans201157.5%55.0%59.8%1,8673,212
All Alaskans201355.0%52.7%57.4%2,3674,127
Alaska Natives201152.0%46.2%57.7%290560
Alaska Natives201346.8%40.6%53.1%353720
U.S.201151.6%
U.S.201350.5%
Healthy Alaskans Goal201361.0%
Healthy Alaskans Goal201561.0%
Healthy Alaskans Goal201761.0%
Healthy Alaskans Goal201961.0%
Healthy People Target201147.9%
Healthy People Target201347.9%
Healthy People Target201547.9%
Healthy People Target201747.9%
Healthy People Target201947.9%

Data Notes

U.S. values are based upon the median value of the states, District of Columbia, and territories. This measure is relevant for measuring progress to Healthy People 2020 Objective PA-2.1: Increase the proportion of adults who engage in aerobic physical activity of at least moderate intensity for at least 150 minutes/week, or 75 minutes/week of vigorous intensity, or an equivalent combination with a national target of 47.9%.

Data Sources

  • Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, 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)


Percentage of adults (18+) who reported getting the equivalent of at least 300 minutes of moderate aerobic physical activity per week, all Alaskans and Alaska Natives, 2011-2013

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confidence limits

Alaska ComparisonsYearPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 6
All Alaskans201137.1%34.8%39.5%1,2363,186
All Alaskans201336.6%34.4%38.9%1,5924,104
Alaska Natives201131.8%26.7%37.4%186553
Alaska Natives201330.7%25.2%36.7%236712
Healthy People Target201131.3%
Healthy People Target201331.3%

Data Notes

Definition: Percentage of adults aged 18 years of age and older who report on the Behavioral Risk Factor Surveillance System (BRFSS) doing at least 300 minutes (5 hours) a week of moderate-intensity, or 150 minutes (2 hours and 30 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week. Numerator: Weighted number of adults (18+) who report on the BRFSS engaging in 300 minutes or more total per week of moderate or vigorous exercise where each minute of vigorous exercise contributes two minutes to the total. Denominator: Weighted number of adults (18+) responding to physical activity questions on the BRFSS, excluding those with missing, "Don't know/Not sure" or "Refused" responses. This measure is relevant for measuring progress to Healthy People 2020 Objective PA-2.2: Increase the proportion of adults who engage in aerobic physical activity of at least moderate intensity for more than 300 minutes/week, or more than 150 minutes/week of vigorous intensity, or an equivalent combination with a national target of 31.3%.

Data Source

Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (18+) who reported getting the recommended amount of strength training, all Alaskans, Alaska Natives, and U.S., 2011-2013

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confidence limits

The percentage of adults whom strengthen muscles two-times per week is presented because the HHS 2008 Physical Activity Guidelines recommend muscle-strengthening activities that are of moderate to high intensity and involve all major muscle groups on 2 or more days a week.^4^[[br]] [[br]] 4. 2008 Physical Activity Guidelines for Americans. Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, U.S. Department of Health and Human Services. [http://health.gov/paguidelines/guidelines/]
Alaska ComparisonsYearPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 8
All Alaskans201133.3%31.0%35.6%1,0043,294
All Alaskans201333.5%33.3%37.8%1,3404,207
Alaska Natives201125.3%20.5%30.9%123586
Alaska Natives201328.7%23.2%34.8%187739
U.S.201129.6%
U.S.201329.8%
Healthy People Target201124.1%
Healthy People Target201324.1%

Data Notes

Definition: Respondent reports participation in muscle-strengthening activities at least 2 times per week. Numerator: Those responding to the question: "During the past month, how many times per week or per month did you do physical activities or exercises to STRENGTHEN your muscles? Do NOT count aerobic activities like walking, running, or bicycling. Count activities using your own body weight like yoga, sit-ups or push-ups and those using weight machines, free weights, or elastic bands." Denominator: Weighted number of adults aged 18 years and older responding to physical activity questions, excluding those with missing, "Don't know/Not sure" or "Refused" responses. U.S. values are based upon the median value of the states, District of Columbia, and territories. This measure is relevant for measuring progress to Healthy People 2020 Objective PA-2.3: Increase the proportion of adults who perform muscle-strengthening activities on 2 or more days of the week with a national target of 24.1%.

Data Sources

  • Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, 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)


Percentage of adults (18+) who reported getting the recommended amount of aerobic exercise and strength training, all Alaskans, Alaska Natives, and U.S., 2011-2013

::chart - missing::
confidence limits

Alaska ComparisonsYearPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 8
All Alaskans201124.7%22.6%27.0%7203,166
All Alaskans201325.0%22.9%27.1%9524,079
Alaska Natives201119.5%15.2%24.5%86543
Alaska Natives201319.8%15.0%25.8%121706
U.S.201120.9%
U.S.201320.4%
Healthy People Target201120.1%
Healthy People Target201320.1%

Data Notes

Definition: Respondent reports participation in muscle-strengthening activities at least 2 times per week AND at least 150 minutes per week of moderate-intensity activity, or at least 75 minutes per week of vigorous-intensity activity, or an equivalent combination of moderate-intensity and vigorous-intensity activity (multiplied by 2) totaling at least 150 minutes per week. Numerator: Weighted number of adults aged 18 years and older who report 150 minutes or more total per week of moderate or vigorous exercise where each minute of vigorous exercise contributes two minutes to the total and participates in muscle-strengthening activities at least 2 times per week. Denominator: Weighted number of adults aged 18 years and older responding to physical activity questions, excluding those with missing, "Don't know/Not sure" or "Refused" responses. This measure is relevant for measuring progress to Healthy People 2020 Objective PA-2.4: Increase the proportion of adults who meet the objectives for aerobic physical activity and for muscle-strengthening activity with a national target of 20.1%. U.S. values are based upon the median value of the states, District of Columbia, and territories.

Data Sources

  • Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, 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)


Percentage of adults (18+) who reported getting the recommended amount of aerobic physical activity, by sex, all Alaskans, 2011-2019

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confidence limits

HA: Males vs. FemalesYearPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 13
Males201158.2%54.7%61.6%8581,482
Males201354.3%51.0%57.6%1,0951,904
Females201156.7%53.3%60.0%1,0091,730
Females201355.8%52.5%59.1%1,2722,223
Healthy Alaskans Goal201361.0%
Healthy Alaskans Goal201561.0%
Healthy Alaskans Goal201761.0%
Healthy Alaskans Goal201961.0%
Healthy People Target201147.9%
Healthy People Target201347.9%
Healthy People Target201547.9%
Healthy People Target201747.9%
Healthy People Target201947.9%

Data Source

Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (18+) who reported getting the recommended amount of aerobic physical activity, by age group, all Alaskans, 2011-2019

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confidence limits

HA: Age Group: 18-24,25-34,35-44,45-64,65+YearPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 19
18-24201161.6%53.0%69.5%129203
18-24201359.7%51.9%67.1%192316
25-34201158.3%52.2%64.1%254448
25-34201362.1%56.5%67.5%365592
35-44201155.7%50.1%61.2%319543
35-44201346.6%41.0%52.2%362660
45-64201156.4%52.9%59.8%8411,446
45-64201354.5%51.0%57.9%1,0221,762
65+201158.5%52.9%64.0%324566
65+201351.8%46.5%57.1%426787
Healthy Alaskans Goal201361.0%
Healthy Alaskans Goal201561.0%
Healthy Alaskans Goal201761.0%
Healthy Alaskans Goal201961.0%
Healthy People Target201147.9%
Healthy People Target201347.9%
Healthy People Target201547.9%
Healthy People Target201747.9%
Healthy People Target201947.9%

Data Source

Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (18+) who reported getting the recommended amount of aerobic physical activity, by race/ethnicity, all Alaskans, 2011-2013 (2-year average)

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confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 9
Alaska Native (any mention)49.5%45.2%53.7%6431,280
Asian (non-Hispanic)41.3%31.3%52.1%65133
Black (non-Hispanic)45.6%34.1%57.6%48104
Native Hawaiian/Other Pacific Islander (non-Hispanic)**45
White (non-Hispanic)59.6%57.7%61.4%3,2695,440
Multiracial/Other (non-Hispanic)66.0%49.0%79.6%3662
Hispanic (alone or multi)51.3%41.8%61.1%89171
Healthy Alaskans Goal61.0%
Healthy People Target47.9%

Data Notes

** = Data not available due to fewer than 50 respondents in the denominator.

Data Source

Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (18+) who reported getting the recommended amount of aerobic physical activity, by ethnicity, all Alaskans, 2011-2019

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confidence limits

HA: Ethnicity - Hispanic/LatinoYearPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 13
Hispanic/Latino201146.9%33.4%60.9%3070
Hispanic/Latino201356.6%44.5%68.0%72123
Not Hispanic/Latino201158.0%55.5%60.4%1,8293,130
Not Hispanic/Latino201354.9%52.5%57.3%2,2683,965
Healthy Alaskans Goal201361.0%
Healthy Alaskans Goal201561.0%
Healthy Alaskans Goal201761.0%
Healthy Alaskans Goal201961.0%
Healthy People Target201147.9%
Healthy People Target201347.9%
Healthy People Target201547.9%
Healthy People Target201747.9%
Healthy People Target201947.9%

Data Notes

Ethnicity is defined independent of race.

Data Source

Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (18+) who reported getting the recommended amount of aerobic physical activity, by marital status, all Alaskans, 2011-2019

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confidence limits

HA: Marital StatusYearPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 19
Married201157.3%54.2%60.6%1,0331,755
Married201357.4%54.5%60.3%1,3152,223
Widowed201151.6%40.9%62.1%115214
Widowed201347.0%37.8%56.3%163312
Divorced/Separated201153.1%47.3%58.8%316585
Divorced/Separated201344.1%38.3%50.0%347683
Never Married201157.6%51.4%63.7%296490
Never Married201358.3%52.5%63.9%415695
Living with a Partner201169.1%58.9%77.7%97149
Living with a Partner201349.8%39.7%59.9%116193
Healthy Alaskans Goal201361.0%
Healthy Alaskans Goal201561.0%
Healthy Alaskans Goal201761.0%
Healthy Alaskans Goal201961.0%
Healthy People Target201147.9%
Healthy People Target201347.9%
Healthy People Target201547.9%
Healthy People Target201747.9%
Healthy People Target201947.9%

Data Source

Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (25+) who reported getting the recommended amount of aerobic physical activity, by education, all Alaskans, 2011-2019

::chart - missing::
confidence limits

HA: Edu Level: < HS, HS, Some Coll, Coll GradYearPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 17
< HS201152.2%43.0%61.3%91195
< HS201339.5%29.4%50.6%87188
HS201147.5%42.9%52.1%417835
HS201349.8%45.2%54.3%4971,010
Some Coll201158.6%54.1%63.0%491855
Some Coll201351.8%47.7%55.9%5971,119
Coll Grad201165.8%61.8%69.6%3731,110
Coll Grad201367.0%63.5%70.3%9921,478
Healthy Alaskans Goal201361.0%
Healthy Alaskans Goal201561.0%
Healthy Alaskans Goal201761.0%
Healthy Alaskans Goal201961.0%
Healthy People Target201147.9%
Healthy People Target201347.9%
Healthy People Target201547.9%
Healthy People Target201747.9%
Healthy People Target201947.9%

Data Notes

Education is based upon education completed by or after 25 years of age. Individuals less than 25 years of age are excluded.

Data Source

Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (18+) who reported getting the recommended amount of aerobic physical activity, by employment status, all Alaskans, 2011-2019

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confidence limits

HA: EmploymentYearPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 17
Employed201158.0%54.9%61.0%1,1251,927
Employed201354.9%52.0%57.7%1,4572,522
Unemployed201155.9%47.5%63.9%144246
Unemployed201353.1%44.6%61.5%172300
Not In Work Force201160.3%55.2%65.1%522842
Not In Work Force201360.7%55.8%65.3%6561,074
Unable to Work201144.9%34.0%56.2%73184
Unable to Work201332.5%22.9%43.8%64195
Healthy Alaskans Goal201361.0%
Healthy Alaskans Goal201561.0%
Healthy Alaskans Goal201761.0%
Healthy Alaskans Goal201961.0%
Healthy People Target201147.9%
Healthy People Target201347.9%
Healthy People Target201547.9%
Healthy People Target201747.9%
Healthy People Target201947.9%

Data Source

Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (18+) who reported getting the recommended amount of aerobic physical activity, by income, all Alaskans, 2011-2019

::chart - missing::
confidence limits

HA: Income: <$15k, $15k-$25k, $25k-$50k, $50-$75k, $75k+YearPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 19
<$15,000201154.0%44.5%63.1%130245
<$15,000201345.3%35.9%55.1%160331
$15,000 - $24,999201152.2%44.6%59.6%181358
$15,000 - $24,999201350.3%42.8%57.8%253476
$25,000 - $49,999201155.7%50.1%61.2%337601
$25,000 - $49,999201354.2%48.9%59.4%461810
$50,000 - $74,999201159.3%53.5%54.9%310
$50,000 - $74,999201353.8%48.3%59.2%399
$75,000+201162.7%58.7%66.5%6901,077
$75,000+201359.8%56.1%63.4%9271,487
Healthy Alaskans Goal201361.0%
Healthy Alaskans Goal201561.0%
Healthy Alaskans Goal201761.0%
Healthy Alaskans Goal201961.0%
Healthy People Target201147.9%
Healthy People Target201347.9%
Healthy People Target201547.9%
Healthy People Target201747.9%
Healthy People Target201947.9%

Data Source

Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (18+) who reported getting the recommended amount of aerobic physical activity, by poverty threshold, all Alaskans, 2011-2019

::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]
HA: Poverty ThresholdYearPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 15
Poor201158.4%47.9%68.3%110204
Poor201344.5%34.8%54.5%146297
Near Poor201145.9%38.8%53.2%178371
Near Poor201350.4%44.1%56.6%308606
Middle/High201159.8%56.7%62.7%1,2041,973
Middle/High201357.7%55.0%60.3%1,7462,902
Healthy Alaskans Goal201361.0%
Healthy Alaskans Goal201561.0%
Healthy Alaskans Goal201761.0%
Healthy Alaskans Goal201961.0%
Healthy People Target201147.9%
Healthy People Target201347.9%
Healthy People Target201547.9%
Healthy People Target201747.9%
Healthy People Target201947.9%

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.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (18+) who reported getting the recommended amount of aerobic physical activity, by Alaska Economic Regions, all Alaskans and Alaska Natives, 2013

::chart - missing::
confidence limits

Alaska ComparisonsAlaska Public Health RegionsPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 14
All AlaskansAnchorage - Mat-Su54.5%50.7%58.2%7831,377
All AlaskansGulf Coast52.5%47.7%57.3%367654
All AlaskansInterior55.1%50.5%59.5%510872
All AlaskansNorthern49.9%39.4%60.5%79181
All AlaskansSoutheast62.5%57.8%67.1%416646
All AlaskansSouthwest53.4%44.3%62.3%212397
Alaska NativesAnchorage - Mat-Su40.9%30.7%52.0%58137
Alaska NativesGulf Coast51.4%36.7%66.0%3769
Alaska NativesInterior54.0%41.1%66.5%55107
Alaska NativesNorthern46.3%34.0%59.2%47106
Alaska NativesSoutheast59.7%47.0%71.2%5291
Alaska NativesSouthwest50.3%39.8%60.7%104210
Healthy Alaskans GoalHealthy Alaskans Goal61.0%
Healthy People TargetHealthy People Target47.9%

Data Source

Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (18+) who reported getting the recommended amount of aerobic physical activity, by metropolitan/micropolitan statistical areas, all Alaskans and Alaska Natives, 2011-2013 (2-year average)

::chart - missing::
confidence limits

Alaska ComparisonsPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 16
All AlaskansAnchorage55.8%52.5%58.9%8351,452
All AlaskansFairbanks North Star MSA54.5%50.8%58.2%6701,169
All AlaskansJuneau MicroSA64.3%58.6%69.7%329489
All AlaskansKetchikan Gateway MicroSA57.4%48.3%66.0%130215
All AlaskansKodiak Island MicroSA58.7%49.3%67.4%123187
All AlaskansMatanuska-Susitna Borough55.7%51.3%60.1%5921,051
All AlaskansRural (non-Metro/MicroSA)56.5%54.0%59.1%1,5552,776
Alaska NativesAnchorage45.0%35.7%54.7%66155
Alaska NativesFairbanks North Star MSA51.3%38.3%64.1%4489
Alaska NativesJuneau MicroSA65.6%48.6%79.4%3151
Alaska NativesKetchikan Gateway MicroSA**34
Alaska NativesKodiak Island MicroSA**30
Alaska NativesMatanuska-Susitna Borough43.1%28.7%58.8%3980
Alaska NativesRural (non-Metro/MicroSA)51.8%47.2%56.4%423841
Healthy Alaskans GoalHealthy Alaskans Goal61.0%
Healthy People TargetHealthy People Target47.9%

Data Notes

** Data not available due to fewer than 50 respondents in the denominator.

Data Source

Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (18+) who reported getting the recommended amount of aerobic physical activity, by behavioral health systems assessment areas, all Alaskans and Alaska Natives, 2013

::chart - missing::
confidence limits

Alaska ComparisonsBehavioral Health System Assessment RegionsPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 22
All AlaskansAnchorage Muncipality54.2%49.8%58.6%465821
All AlaskansFairbanks North Star Borough53.8%48.9%58.7%377655
All AlaskansCity and Borough of Juneau66.7%59.3%73.3%187273
All AlaskansKenai Peninsula Borough53.4%47.9%58.7%251467
All AlaskansMatanuska-Susitna Borough55.6%48.7%62.4%318556
All AlaskansNorthwest Region49.9%39.4%60.5%79181
All AlaskansOther Interior Region55.2%46.4%63.7%186309
All AlaskansOther Southeast Region59.6%53.3%65.6%229373
All AlaskansY-K Delta Region47.5%34.9%60.4%91179
All AlaskansSouthwest Region57.1%48.0%65.8%184313
Alaska NativesAnchorage Muncipality42.6%30.8%55.3%3895
Alaska NativesFairbanks North Star Borough**48
Alaska NativesCity and Borough of Juneau**23
Alaska NativesKenai Peninsula Borough**42
Alaska NativesMatanuska-Susitna Borough**42
Alaska NativesNorthwest Region46.3%34.0%59.2%47106
Alaska NativesOther Interior Region56.3%40.8%70.7%3870
Alaska NativesOther Southeast Region60.6%45.8%73.8%3968
Alaska NativesY-K Delta Region43.9%31.7%57.0%59121
Alaska NativesSouthwest Region54.1%37.2%70.1%54105
Healthy Alaskans GoalHealthy Alaskans Goal61.0%
Healthy People TargetHealthy People Target47.9%

Data Notes

** = Data not available due to fewer than 50 respondents in the denominator.

Data Source

Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (18+) who reported getting the recommended amount of aerobic physical activity, boroughs and census areas, all Alaskans and Alaska Natives, 2011-2013 (2-year average)

::chart - missing::
confidence limits

Alaska ComparisonsBoroughs/Census AreasPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 60
All AlaskansAleutians East Borough**47
All AlaskansAleutians West Borough58.2%38.7%57.5%4482
All AlaskansAnchorage Municipality55.8%52.5%58.9%8351,452
All AlaskansBethel Census Area50.6%40.5%60.5%109221
All AlaskansBristol Bay Borough**42
All AlaskansDenali Borough58.7%36.0%78.3%3250
All AlaskansDillingham Census Area61.0%46.0%74.1%60104
All AlaskansFairbanks North Star Borough54.5%50.8%58.2%6701,169
All AlaskansHaines Borough71.2%55.2%83.2%4058
All AlaskansHoonah-Angoon Census Area**28
All AlaskansJuneau City and Borough64.3%58.6%69.7%329489
All AlaskansKenai Peninsula Borough57.0%52.8%61.1%464837
All AlaskansKetchikan Gateway Borough57.4%48.3%66.0%130215
All AlaskansKodiak Island Borough58.7%49.3%67.4%123187
All AlaskansKusilvak Census Area52.4%34.4%69.8%4081
All AlaskansLake and Peninsula Borough**47
All AlaskansMatanuska-Susitna Borough55.7%51.3%60.1%5921,051
All AlaskansNome Census Area49.6%38.1%61.2%69140
All AlaskansNorth Slope Borough63.5%49.7%75.3%4488
All AlaskansNorthwest Arctic Borough48.1%35.5%61.0%4489
All AlaskansPetersburg Borough54.3%40.1%67.8%4369
All AlaskansPrince of Wales-Hyder Census Area43.4%31.9%55.6%4497
All AlaskansSitka City and Borough69.4%59.9%77.4%103151
All AlaskansSkagway Municipality**17
All AlaskansSoutheast Fairbanks Census Area62.6%51.1%72.9%86142
All AlaskansValdez-Cordova Census Area48.1%38.1%58.2%94169
All AlaskansWrangell City and Borough**41
All AlaskansYakutat City and Borough**17
All AlaskansYukon-Koyukuk Census Area55.0%45.1%64.6%93159
Alaska NativesAleutians East Borough**20
Alaska NativesAleutians West Borough**27
Alaska NativesAnchorage Municipality45.0%35.7%54.7%66155
Alaska NativesBethel Census Area48.9%36.7%61.3%67136
Alaska NativesBristol Bay Borough**13
Alaska NativesDenali Borough**1
Alaska NativesDillingham Census Area66.3%45.1%82.5%2854
Alaska NativesFairbanks North Star Borough51.3%38.3%64.1%4489
Alaska NativesHaines Borough**7
Alaska NativesHoonah-Angoon Census Area**6
Alaska NativesJuneau City and Borough65.6%48.6%79.4%3151
Alaska NativesKenai Peninsula Borough56.3%42.9%68.8%4378
Alaska NativesKetchikan Gateway Borough**34
Alaska NativesKodiak Island Borough**30
Alaska NativesKusilvak Census Area57.7%41.1%72.4%3573
Alaska NativesLake and Peninsula Borough**23
Alaska NativesMatanuska-Susitna Borough43.1%28.7%58.8%3980
Alaska NativesNome Census Area48.4%34.3%62.8%4185
Alaska NativesNorth Slope Borough**45
Alaska NativesNorthwest Arctic Borough50.9%35.7%65.9%3058
Alaska NativesPetersburg Borough**7
Alaska NativesPrince of Wales-Hyder Census Area**33
Alaska NativesSitka City and Borough**19
Alaska NativesSkagway Municipality**1
Alaska NativesSoutheast Fairbanks Census Area**26
Alaska NativesValdez-Cordova Census Area**30
Alaska NativesWrangell City and Borough**5
Alaska NativesYakutat City and Borough**10
Alaska NativesYukon-Koyukuk Census Area56.3%42.2%69.5%4884
Healthy Alaskans GoalHealthy Alaskans Goal61.0%
Healthy People TargetHealthy People Target47.9%

Data Notes

** = Data not available due to fewer than 50 respondents in the denominator.

Data Source

Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion


Percentage of adults (18+) who reported getting the recommended amount of aerobic physical activity, tribal health organization regions, all Alaskans and Alaska Natives, 2011-2013 (2-year average)

::chart - missing::
confidence limits

Alaska ComparisonsPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 26
All AlaskansAleutians and Pribilofs50.8%36.0%65.5%61129
All AlaskansAnchorage/Mat-Su55.8%53.1%58.4%1,4272,503
All AlaskansArctic Slope63.5%49.1%75.9%4079
All AlaskansBristol Bay65.9%55.6%74.8%123198
All AlaskansCopper River/Prince William Sound49.0%39.1%59.1%98173
All AlaskansInterior55.3%52.0%58.6%8711,505
All AlaskansKenai Peninsula57.0%52.8%61.1%464837
All AlaskansKodiak Area58.7%49.3%67.4%123187
All AlaskansNorthwest Arctic48.6%36.3%61.1%4696
All AlaskansNorton Sound49.6%38.1%61.2%69140
All AlaskansSoutheast61.6%58.0%65.2%7591,182
All AlaskansYukon-Kuskokwim50.2%41.6%58.8%153310
Alaska NativesAleutians and Pribilofs**47
Alaska NativesAnchorage/Mat-Su44.4%36.4%52.7%105235
Alaska NativesArctic Slope**38
Alaska NativesBristol Bay64.9%49.0%78.0%5293
Alaska NativesCopper River/Prince William Sound**30
Alaska NativesInterior54.7%45.1%64.0%103190
Alaska NativesKenai Peninsula56.3%42.9%68.8%4378
Alaska NativesKodiak Area**30
Alaska NativesNorthwest Arctic49.7%35.1%64.4%3163
Alaska NativesNorton Sound48.4%34.3%62.8%4185
Alaska NativesSoutheast56.9%47.5%65.3%97173
Alaska NativesYukon-Kuskokwim51.4%41.7%60.9%107218
Healthy Alaskans GoalHealthy Alaskans Goal61.0%
Healthy People TargetHealthy People Target47.9%

Data Notes

** = Data not available due to fewer than 50 respondents in the denominator.

Data Source

Alaska Data: http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspxBehavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion

References and Community Resources

'''References:''' 1. Centers for Disease Control and Prevention. Physical activity and health: a report of the surgeon general. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Promotion; 1996. 2. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346(6):393-403. 3. Kesaniemi, Y., et al. (1994). Dose-response issues concerning physical activity and health: an evidence-based symposium. Medicine and Science in Sports and Exercise, 33(6 suppl), S351-S358 4. [http://health.gov/paguidelines/guidelines/ 2008 Physical Activity Guidelines for Americans]. Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, U.S. Department of Health and Human Services. 5. Centers for Disease Control and Prevention. A Data Users Guide to the BRFSS Physical Activity Questions. [http://www.cdc.gov/brfss/pdf/PA%20RotatingCore_BRFSSGuide_508Comp_07252013FINAL.pdf How to Assess the 2008 Physical Activity Guidelines for Americans]. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Promotion; 2011. 6. [http://www.dhss.alaska.gov/dph/PlayEveryDay/Pages/default.aspx Play Every Day]. Alaska Department of Health and Social Services, Division of Public Health. '''Resources:''' [http://www.cdc.gov/nccdphp/dnpa CDC's Division of Nutrition and Physical Activity] [http://healthyfuturesak.org/ Healthy Futures]. The [http://www.nhlbi.nih.gov National Heart, Lung, and Blood Institute] has extensive resources on physical activity for patients, health care providers, and general consumers. The University of South Carolina's [http://prevention.sph.sc.edu/index.htm Prevention Research Centers] provide resources and information about physical activity to researchers, public health practitioners, and others who are interested in promoting physical activity in their communities. More information on the [http://www.cdc.gov/brfss/ Behavioral Risk Factor Surveillance System] may be found on the website of the Centers for Disease Control and Prevention.

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 03/04/2016, Published on 03/04/2016
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 Fri, 30 September 2016 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: Fri, 4 Mar 2016 11:20:05 AKST
The information provided above is from the Department of Health's Center for Health Data IBIS-PH web site (http://ibis.health.state.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Fri, 30 September 2016 7:06:29 from Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.gov ".

Content updated: Fri, 4 Mar 2016 11:20:05 AKST