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State of Alaska

Complete Health Indicator Report of Adverse Childhood Experiences: Physical Neglect

Definition

Percentage of adults 18 years of age and older who responded "Once" or "More than once" on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the question: "How often did ANY of the following events apply to you: You didn't have enough to eat, you had to wear dirty clothes, or you had no one to protect you?"

Numerator

Weighted number of adults (18+) who responded "Once" or "More than once" on the BRFSS to the question: "How often did ANY of the following events apply to you: You didn't have enough to eat, you had to wear dirty clothes, or you had no one to protect you?"

Denominator

Weighted number of adults (18+) who responded to the physical neglect question on the BRFSS, excluding those with missing or "Refused" responses. Those who responded "Don't know/Not sure" are defined as a negative response for that ACE category.

Data Interpretation Issues

The preamble to each of the Adverse Childhood Experiences (ACEs) question was: "I'd like to ask you some questions about events that happened during your childhood. This information will allow us to better understand problems that may occur early in life, and may help others in the future. This is a sensitive topic and some people may feel uncomfortable with these questions. At the end of this section, I will give you a phone number for an organization that can provide information and referral for these issues. Please keep in mind that you can ask me to skip any question you do not want to answer. All questions refer to the time period before you were 18 years of age. Now, looking back before you were 18 years of age ---" While the individual adverse childhood experience (ACE) an Alaska adult may have experienced is important, the strength of the research lies in the often multiple ACEs an individual has during childhood: "The ACE score, a total sum of the different categories of ACEs reported by participants, is used to assess cumulative childhood stress. Study findings repeatedly reveal a graded dose-response relationship between ACEs and negative health and well-being outcomes across the life course...Dose response describes the changes in an outcome (e.g., alcoholism) associated with differing levels of exposure (or doses) to a stressor (e.g., ACEs). A graded dose-response means that as the dose of the stressor increases the intensity of the outcome also increases."^1^ The ACEs question on physical neglect was asked in 2014 and 2015.[[br]] [[br]] ---- {{class .SmallerFont 1. U.S. Centers for Disease Control and Prevention (CDC). Adverse Childhood Experiences (ACE) Study. [http://www.cdc.gov/violenceprevention/acestudy/index.html]. Updated April 1, 2016. Accessed April 26, 2016.}}

Why Is This Important?

Physical neglect is common but difficult to identify. Failure or refusal to provide physical necessities endangers the child's physical health, well-being, psychological growth, and development. Physical neglect can severely impact a child's development by causing failure to thrive; malnutrition; serious illness; physical harm in the form of cuts, bruises, burns, or other injuries due to the lack of supervision; and a lifetime of low self-esteem.^2^ The impacts of overwhelming stress on the brain continue into adulthood and can have generational impacts. As Alaska children exposed to physical neglect grow up, they may find negative ways to cope with their damaged stress responses. Adverse Childhood Experiences (ACEs) are potent risk factors for later involvement in domestic violence, alcohol dependence, and suicide attempts. When children exposed to physical neglect mature into adults and start families of their own, these behaviors can become ACEs for another generation.^3^ The Adverse Childhood Experiences (ACE) Study, a collaborative between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego, assessed associations between childhood maltreatment and later-life health and well-being.^1^ It is critical to understand how some of the worst health and social problems can arise as a consequence of adverse childhood experiences. Sixteen of the [http://hss.state.ak.us/ha2020/ Healthy Alaskans 2020] measures have been shown through peer-reviewed journal articles to be negatively impacted by adverse childhood experiences. Alaska takes on the burden of approximately $82 million in costs (e.g., health care costs, welfare costs, special education costs) each year due to nonfatal child maltreatment. Realizing these connections is likely to improve efforts towards prevention and recovery.^4^[[br]] [[br]] ---- {{class .SmallerFont 1. U.S. Centers for Disease Control and Prevention (CDC). Adverse Childhood Experiences (ACE) Study. [http://www.cdc.gov/violenceprevention/acestudy/index.html]. Updated April 1, 2016. Accessed April 26, 2016. 2. American Humane Society. Chronic child neglect - understanding the definition and impact of neglect. [http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/child-neglect.html]. Accessed April 26, 2016. 3. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Investing in prevention: working together in early childhood for healthy Alaskan children, families, and communities 2015. [http://dhss.alaska.gov/abada/aceak/Documents/State_Interagency_Prevention_2015.pdf]. Accessed April 26, 2016. 4. Sidmore P. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Economic costs of adverse childhood experiences in Alaska. [http://dhss.alaska.gov/abada/ace-ak/Documents/ACEsEconomicCosts-AK.pdf]. Accessed April 26, 2016. }}

How Are We Doing?

In 2014 and 2015 combined, 11.1% of Alaska adults reported having experienced childhood physical neglect. Those adults who were college graduates reported significantly lower prevalence of physical neglect at 8.4% than those who had less than a high school education at 15.4%. Employed adults had a prevalence of 10.2% having been physically neglected but those unable to work reported a significantly higher exposure at 28.8%. There was also a significant difference in exposure to physical neglect among adults with different incomes - those making less than $15,000 reported 19.2%, while those making more than $75,000 reported 9.7% experiencing physical neglect. Rates of physical neglect during childhood from the BRFSS are initially presented for all Alaskans and Alaska Native people for the combined 2-year period from 2014-2015. Subsequent analyses were conducted for demographic subpopulations (i.e., sex, age, race/ethnicity, ethnicity, marital status, education, employment status, income, and poverty status). Crosstabulations were also conducted for 2-year averages by body mass index, current smoking, sexual orientation, and disability. Significant differences were evident in current smoking, sexual orientation, and disability rates. Rates of physical neglect during childhood by regions of Alaska are presented for all Alaskans and Alaska Native people for the 2-year average of surveys conducted between 2014-2015: 1) 7 Alaska Public Health Regions, 2) 5 Metropolitan and Micropolitan Statistics Areas and rural remainder, 3) 10 behavioral health assessment regions based upon aggregations of 20,000 population, 4) 29 boroughs and census areas, and 5) 12 tribal health organization regions.

How Do We Compare With the U.S.?

There are no national statistics on physical neglect available.

What Is Being Done?

Poverty plays a substantial role in child physical neglect. [http://dhss.alaska.gov/dpa/Pages/atap/default.aspx Alaska Temporary Assistance Program (ATAP)] provides cash assistance and work services to low-income families with children to help them with basic needs while they work toward becoming self-sufficient.^5^ The [http://dhss.alaska.gov/dpa/Pages/nutri/wic/participants/wicprogramoverview.aspx Women, Infants, and Children program (WIC)] also provides checks that help pregnant women, new mothers, and young children eat well.^6^ The [http://hss.state.ak.us/ha2020/ Healthy Alaskans 2020] initiative developed strategies by content experts to reduce child maltreatment. Public health partners around the state are aligning work around these approaches adapted by Alaska's unique needs. Alaska strategies include: 1. Promote screening and monitoring for child abuse in primary care offices and public health clinics. 2. Use the [http://www.cssp.org/reform/strengtheningfamilies Strengthening Families Protective Factors] framework in family programs. 3. Expand home visiting programs. 4. Expand and strengthen quality early childhood programs. 5. Train providers on brain development, adverse childhood experiences (ACEs), and resiliency.^7^ Alaska has many groups working on preventing childhood trauma and easing the effects of damage already done. Here are a few examples (as of early 2015):^8^ Statewide, teachers and public health nurses provide teens with information on healthy relationships and life skills. They have partnered with the Alaska departments of Health and Social Services and Education and Early Development, the [http://www.dps.alaska.gov/cdvsa/ Council on Domestic Violence and Sexual Assault], and the [http://www.andvsa.org/ Alaska Network on Domestic Violence and Sexual Assault] on an evidenced-based curriculum for the 7th-9th grade called [https://education.alaska.gov/tls/schoolhealth/fourth.html "the Fourth R for Healthy Relationships."] The Division of Public Health partnered with the Alaska Native Tribal Health Consortium and the [http://dhss.alaska.gov/dph/chronic/pages/injuryprevention/akfvpp/default.aspx Alaska Family Violence Prevention Project] to develop a teen safety card, a gender-neutral resource developed for Alaska teens with guidance from Alaska teens. The card provides information about healthy and unhealthy relationship characteristics, what consent looks and sounds like, and where to get help, if needed. Another safety card was designed specifically for women.^9^ The Division of Behavioral Health has promoted trauma-informed care for several years. Efforts include development of "Trauma 101" and "Trauma 201" curriculum for behavioral health providers, used around the state. [http://tundrapeace.org/programs/taav/ Teens Acting Against Violence (TAAV)] is a violence-prevention and youth empowerment program at the [http://tundrapeace.org/ Tundra Women's Coalition] for teenagers living in Bethel. Participation is voluntary and open for any interested teens age 12-18.^10^[[br]] [[br]] ---- {{class .SmallerFont See "References and Resources" section for references. }}

Evidence-based Practices

Recovering from trauma is a challenging process. Building resiliency and having a supportive adult in your life can help with recovery. Positive experiences - such as exposure to environments rich in a range of developmentally appropriate opportunities for social play and exploration - can compensate for and even reverse the negative consequences of stress Efforts during childhood are essential because over time, some stress-induced detriments are increasingly resistant to reversal. Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment approach shown to help children, adolescents, and their caregivers overcome trauma-related difficulties. It is designed to reduce negative emotional and behavioral responses following traumatic events. The treatment - based on learning and cognitive theories - addresses distorted beliefs and attributions related to the abuse and provides a supportive environment in which children are encouraged to talk about their traumatic experience. TF-CBT also helps parents who were not abusive to cope effectively with their own emotional distress and develop skills that support their children.^11^ ACEs are best addressed through a coordinated effort to implement prevention programs across multiple settings and populations. Research indicates the majority of health and social challenges are interconnected and often share the same root causes. The following steps need to be taken to address these root causes: 1. Support quality early childhood programs. 2. Ensure access to health care including behavioral health care. 3. Strengthen capacity for social emotional learning throughout Alaska's schools. 4. Maintain and expand prevention efforts that have proven to be effective.^3^ The [http://www.cssp.org/ Center for the Study of Social Policy] spent two years researching and identifying five protective factors that prevent child abuse and neglect. These are: parental resilience, social connections, concrete support in times of need, knowledge of parenting and child development, and social and emotional competence of children. Research studies support the common-sense notion that when these protective factors are well established in a family, the likelihood of child abuse and neglect diminishes. Research shows that these protective factors are also "promotive" factors that build family strengths and a family environment that promotes optimal child and youth development.^12^[[br]] [[br]] ---- {{class .SmallerFont 3. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Investing in prevention: working together in early childhood for healthy Alaskan children, families, and communities 2015. [http://dhss.alaska.gov/abada/ace-ak/Documents/State_Interagency_Prevention_2015.pdf]. Accessed April 26, 2016. 11. Child Welfare Information Gateway. Trauma-focused cognitive behavioral therapy for children affected by sexual abuse or trauma. [https://www.childwelfare.gov/pubPDFs/trauma.pdf]. Accessed April 26, 2016. 12. Alaska Department of Health and Social Services. Office of Children's Services. Strengthening families. [http://dhss.alaska.gov/ocs/Pages/families/default.aspx]. Accessed April 26, 2016. }}


Related Indicators

Related Relevant Population Characteristics Indicators:


Related Health Care System Factors Indicators:


Related Risk Factors Indicators:


Related Health Status Outcomes Indicators:




Graphical Data Views

Percentage of adults (18+) who experienced physical neglect, crude rate, by all Alaskans and Alaska Natives, 2014-2015 (2-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
All Alaskans11.1%10.0%12.3%7437,172
Alaska Native people13.9%11.4%16.9%1871,237

Data Source

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by sex, all Alaskans, 2014-2015 (2-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
Males10.1%8.7%11.8%2833,230
Females12.1%10.4%14.0%4603,942

Data Notes

The sex of the respondent is only asked if necessary.

Data Source

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by age, all Alaskans, 2014-2015 (2-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 5
18-2411.9%8.1%17.3%43392
25-3412.5%9.8%16.0%108869
35-4412.7%9.7%16.5%1181,005
45-6411.2%9.8%12.9%3453,154
65+6.5%5.1%8.1%1261,689

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by race/ethnicity, all Alaskans, 2014-2015 (2-year average)

::chart - missing::
confidence limits

** = Data not available due to few than 50 responses in the denominator.
Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 7
Alaska Native (any mention)13.9%11.4%16.9%1871,237
Asian (non-Hispanic)2.8%1.0%7.5%6128
Black (non-Hispanic)13.8%7.3%24.5%1390
Native Hawaiian/Other Pacific Islander (non-Hispanic)**32
White (non-Hispanic)10.6%9.3%11.9%4895,325
Multiracial/Other (non-Hisp.)**48
Hispanic (alone or multi)18.9%11.0%30.5%29176

Data Notes

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

Data Source

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by ethnicity, all Alaskans, 2014-2015 (2-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
Hispanic/Latino18.9%11.5%29.4%37207
Non-Hispanic/Latino10.6%9.5%11.8%6946,874

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by marital status, all Alaskans, 2014-2015 (2-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 5
Married9.7%8.3%11.3%3573,987
Widowed10.2%7.3%13.9%51587
Divorced/Separated16.1%13.2%19.4%1841,179
Never Married10.5%8.2%13.4%1101,084
Living with a Partner16.0%9.9%25.0%36282

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by education, all Alaskans, 2014-2015 (2-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 4
Less than High School15.4%10.5%22.0%50352
High School Graduate or GED11.0%8.8%13.6%1701,637
Some College or Tech. School11.9%10.0%14.1%2421,979
College Graduate8.4%7.1%9.9%2372,785

Data Notes

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

Data Source

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by employment status, all Alaskans, 2014-2015 (2-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 4
Employed10.2%8.9%11.7%4064,202
Unemployed14.8%11.0%19.7%72246
Not in Work Force9.2%7.1%11.9%1712,127
Unable to Work28.8%21.6%37.2%90353

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by income, all Alaskans, 2014-2015 (2-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 5
<$15,00019.2%14.4%25.1%96543
$15,000-$24,99916.7%12.8%21.6%112762
$25,000-$49,00011.1%8.7%14.0%1541,350
$50,000-$74,0009.1%6.8%12.1%921,082
$75,000+9.7%8.1%11.7%2502,771

Data Notes

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

Data Source

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by poverty threshold, all Alaskans, 2014-2015 (two-year average)

::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]
Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 3
Poor13.9%9.6%19.7%70470
Near Poor15.9%12.5%20.0%122772
Middle/High10.3%9.0%11.7%4124,378

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by body mass index, all Alaskans, 2014-2015 (two-year average)

::chart - missing::
confidence limits

Weight CategoryPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 3
Neither Overweight nor Obese10.5%8.6%12.8%2082,270
Overweight9.8%8.0%12.0%2372,497
Obese13.0%11.1%15.1%2662,095

Data Notes

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

Data Source

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by current smoking, all Alaskans, 2014-2015 (two-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
Not current smoker9.5%8.3%10.8%5315,886
Current smoker17.8%14.8%21.3%2071,246

Data Notes

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

Data Source

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by sexual orientation, all Alaskans, 2014-2015 (two-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
Heterosexual10.8%9.6%12.1%6866,722
Gay, Lesbian, or Bisexual24.1%16.4%34.0%34206

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.

Data Source

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by disability, all Alaskans, 2014-2015 (two-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
Disability Present20.3%17.2%23.8%2601,285
Disability Absent9.2%8.0%10.6%4695,803

Data Notes

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

Data Source

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by Alaska Public Health Regions, all Alaskans and Alaska Natives, 2014-2015 (two-year average)

::chart - missing::
confidence limits

Alaska ComparisonsPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 14
All AlaskansAnchorage10.8%8.7%13.4%1541,438
All AlaskansGulf Coast8.2%6.4%10.4%1011,068
All AlaskansInterior13.5%11.0%16.6%1571,507
All AlaskansMat-Su11.8%9.5%14.6%1211,087
All AlaskansNorthern12.7%8.6%18.5%44298
All AlaskansSoutheast10.4%8.2%13.1%1041,059
All AlaskansSouthwest9.8%5.6%16.6%62715
Alaska Native peopleAnchorage16.9%9.8%27.6%20129
Alaska Native peopleGulf Coast11.7%6.7%19.5%18103
Alaska Native peopleInterior14.5%9.3%21.8%33203
Alaska Native peopleMat-Su19.8%11.8%31.3%1897
Alaska Native peopleNorthern13.3%8.7%19.9%31165
Alaska Native peopleSoutheast18.5%11.8%27.9%28152
Alaska Native peopleSouthwest6.6%4.5%9.6%39388

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by metro/micropolitan statistical areas, all Alaskans and Alaska Natives, 2014-2015 (two-year average)

::chart - missing::
confidence limits

Alaska ComparisonsPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 10
All AlaskansAnchorage MSA11.1%9.4%13.1%2752,525
All AlaskansFairbanks North Star MSA13.9%10.9%17.4%1121,092
All AlaskansJuneau MicroSA10.8%7.5%15.3%46458
All AlaskansKetchikan Gateway MicroSA13.7%8.7%21.0%26194
All AlaskansRural (non-Metro/MicroSA)9.5%8.0%11.2%2842,903
Alaska Native peopleAnchorage MSA17.6%11.5%25.9%38226
Alaska Native peopleFairbanks North Star MSA14.8%7.9%26.1%16100
Alaska Native peopleJuneau MicroSA10.3%4.3%22.7%749
Alaska Native peopleKetchikan Gateway MicroSA26.2%9.6%54.4%524
Alaska Native peopleRural (non-Metro/MicroSA)11.7%9.3%14.6%121838

Data Notes

** = Data not available due to fewer than 50 respondents in the denominator. Geographic descriptions of the metropolitan and micropolitan statistical areas can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_mmsa.aspx].

Data Source

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by behavioral health areas, all Alaskans and Alaska Natives, 2014-2015 (two-year average)

::chart - missing::
confidence limits

Alaska ComparisonsPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 20
All AlaskansAnchorage Muncipality10.8%8.7%13.4%1541,438
All AlaskansFairbanks North Star Borough14.0%11.0%17.5%1131,096
All AlaskansCity and Borough of Juneau10.8%7.5%15.3%46458
All AlaskansKenai Peninsula Borough8.9%6.8%11.5%81753
All AlaskansMatanuska-Susitna Borough11.8%9.5%14.6%1211,087
All AlaskansNorthwest Region12.7%8.6%18.5%44298
All AlaskansOther Interior Region10.2%7.3%14.1%55572
All AlaskansOther Southeast Region10.1%7.3%13.6%58601
All AlaskansY-K Delta Region6.8%4.4%10.3%34322
All AlaskansSouthwest Region9.3%4.8%17.2%37547
Alaska Native peopleAnchorage Muncipality16.9%9.8%27.6%20129
Alaska Native peopleFairbanks North Star Borough14.6%7.8%25.8%16101
Alaska Native peopleCity and Borough of Juneau**49
Alaska Native peopleKenai Peninsula Borough16.8%9.2%28.6%1461
Alaska Native peopleMatanuska-Susitna Borough19.8%11.8%31.3%1897
Alaska Native peopleNorthwest Region13.3%8.7%19.9%31165
Alaska Native peopleOther Interior Region13.7%7.8%23.0%19120
Alaska Native peopleOther Southeast Region22.9%13.7%35.7%21103
Alaska Native peopleY-K Delta Region6.4%3.9%10.4%23203
Alaska Native peopleSouthwest Region5.9%3.4%10.3%18209

Data Notes

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by boroughs and census areas, all Alaskans and Alaska Natives, 2014-2015 (two-year average)

::chart - missing::
confidence limits

Alaska ComparisonsPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 58
All AlaskansAleutians East Borough3.5%1.3%8.9%562
All AlaskansAleutians West CA16.3%6.2%36.7%985
All AlaskansAnchorage Municipality10.8%8.7%13.4%1541,438
All AlaskansBethel CA8.0%5.0%12.8%28244
All AlaskansBristol Bay Borough2.3%0.5%10.4%259
All AlaskansDenali Borough0.5%0.1%3.7%170
All AlaskansDillingham CA6.5%2.7%15.0%8122
All AlaskansFairbanks North Star Borough14.0%11.0%17.5%1131,096
All AlaskansHaines Borough9.5%2.6%29.4%459
All AlaskansHoonah-Angoon CA**40
All AlaskansJuneau City and Borough10.8%7.5%15.3%46458
All AlaskansKenai Peninsula Borough8.9%6.8%11.5%81753
All AlaskansKetchikan Gateway Borough13.7%8.7%21.0%26194
All AlaskansKodiak Island Borough5.2%2.2%11.8%9154
All AlaskansKusilvak CA4.4%1.7%10.6%678
All AlaskansLake and Peninsula Borough36.1%8.1%78.4%465
All AlaskansMatanuska-Susitna Borough11.8%9.5%14.6%1211,087
All AlaskansNome CA13.8%7.6%23.7%18127
All AlaskansNorth Slope Borough9.8%3.4%25.2%878
All AlaskansNorthwest Arctic Borough14.4%8.2%24.0%1893
All AlaskansPetersburg Borough3.3%0.7%13.7%259
All AlaskansPrince of Wales-Hyder CA10.8%4.3%24.8%873
All AlaskansSitka City and Borough6.4%2.6%14.8%9121
All AlaskansSkagway Municipality**12
All AlaskansSoutheast Fairbanks CA10.3%6.2%16.9%19191
All AlaskansValdez-Cordova CA8.4%4.0%16.7%11161
All AlaskansWrangell City and Borough**30
All AlaskansYakutat City and Borough**13
All AlaskansYukon-Koyukuk CA17.1%10.4%27.0%24150
Alaska Native peopleAleutians East Borough**34
Alaska Native peopleAleutians West CA**26
Alaska Native peopleAnchorage Municipality16.9%9.8%27.6%20129
Alaska Native peopleBethel CA7.7%4.4%13.4%18135
Alaska Native peopleBristol Bay Borough**28
Alaska Native peopleDenali Borough**3
Alaska Native peopleDillingham CA8.4%3.2%20.4%662
Alaska Native peopleFairbanks North Star Borough14.6%7.8%25.8%16101
Alaska Native peopleHaines Borough**8
Alaska Native peopleHoonah-Angoon CA**12
Alaska Native peopleJuneau City and Borough**49
Alaska Native peopleKenai Peninsula Borough16.8%9.2%28.6%1461
Alaska Native peopleKetchikan Gateway Borough**24
Alaska Native peopleKodiak Island Borough**24
Alaska Native peopleKusilvak CA4.3%1.5%11.2%568
Alaska Native peopleLake and Peninsula Borough**35
Alaska Native peopleMatanuska-Susitna Borough19.8%11.8%31.3%1897
Alaska Native peopleNome CA18.5%9.8%32.3%1665
Alaska Native peopleNorth Slope Borough**37
Alaska Native peopleNorthwest Arctic Borough14.4%7.6%25.5%1263
Alaska Native peoplePetersburg Borough**6
Alaska Native peoplePrince of Wales-Hyder CA**21
Alaska Native peopleSitka City and Borough**19
Alaska Native peopleSkagway Municipality0.0%0
Alaska Native peopleSoutheast Fairbanks CA**21
Alaska Native peopleValdez-Cordova CA**18
Alaska Native peopleWrangell City and Borough**8
Alaska Native peopleYakutat City and Borough**5
Alaska Native peopleYukon-Koyukuk CA16.2%8.3%29.2%1478

Data Notes

** = Data not available due to fewer than 50 respondents in the denominator. Geographic descriptions of boroughs and census areas can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_bca.aspx].

Data Source

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


Percentage of adults (18+) who experienced physical neglect, crude rate, by tribal health regions, all Alaskans and Alaska Natives, 2014-2015 (two-year average)

::chart - missing::
confidence limits

Alaska ComparisonsPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 24
All AlaskansAleutians and Pribilofs11.4%4.8%24.8%14147
All AlaskansAnchorage/Mat-Su11.1%9.4%13.1%2752,525
All AlaskansArctic Slope9.5%3.1%26.0%772
All AlaskansBristol Bay14.1%4.0%39.3%14247
All AlaskansCopper R/Prince William Snd.8.1%3.9%16.2%11168
All AlaskansInterior13.6%11.0%16.6%1571,497
All AlaskansKenai Peninsula8.9%6.8%11.5%81753
All AlaskansKodiak Area5.2%2.2%11.8%9154
All AlaskansNorthwest Arctic14.5%8.4%23.8%1998
All AlaskansNorton Sound13.8%7.6%23.7%18127
All AlaskansSoutheast10.4%8.2%13.1%1041,059
All AlaskansYukon-Kuskokwim6.8%4.4%10.2%34325
Alaska Native peopleAleutians and Pribilofs8.1%3.4%18.0%860
Alaska Native peopleAnchorage/Mat-Su17.6%11.5%25.9%38226
Alaska Native peopleArctic Slope**34
Alaska Native peopleBristol Bay6.3%2.8%13.7%8126
Alaska Native peopleCopper R/Prince William Snd.**20
Alaska Native peopleInterior14.9%9.6%22.3%33198
Alaska Native peopleKenai Peninsula16.8%9.2%28.6%1461
Alaska Native peopleKodiak Area**24
Alaska Native peopleNorthwest Arctic13.9%7.4%24.7%1266
Alaska Native peopleNorton Sound18.5%9.8%32.3%1665
Alaska Native peopleSoutheast18.5%11.8%27.9%28152
Alaska Native peopleYukon-Kuskokwim6.3%3.9%10.3%23205

Data Notes

** = Data not available due to fewer than 50 respondents in the denominator. 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. Centers for Disease Control and Prevention (CDC). Adverse Childhood Experiences (ACE) Study. [http://www.cdc.gov/violenceprevention/acestudy/index.html]. Updated April 1, 2016. Accessed April 26, 2016. 2. American Humane Society. Chronic child neglect - understanding the definition and impact of neglect. [http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/child-neglect.html]. Accessed April 26, 2016. 3. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Investing in prevention: working together in early childhood for healthy Alaskan children, families, and communities 2015. [http://dhss.alaska.gov/abada/aceak/Documents/State_Interagency_Prevention_2015.pdf]. Accessed April 26, 2016. 4. Sidmore P. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Economic costs of adverse childhood experiences in Alaska. [http://dhss.alaska.gov/abada/ace-ak/Documents/ACEsEconomicCosts-AK.pdf]. Accessed April 26, 2016. 5. Alaska Department of Health and Social Services. Division of Public Assistance. Alaska Temporary Assistance. [http://dhss.alaska.gov/dpa/Pages/atap/default.aspx]. Accessed April 26, 2016. 6. Alaska Department of Health and Social Services. Division of Public Assistance. Women, Infants & Children Program. [http://dhss.alaska.gov/dpa/Pages/nutri/wic/default.aspx]. Accessed April 26, 2016. 7. Alaska Department of Health and Social Services. Healthy Alaskans 2020. [http://hss.state.ak.us/ha2020/]. Accessed April 26, 2016. 8. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Adverse childhood experiences - overcoming ACEs in Alaska. [http://dhss.alaska.gov/abada/aceak/ Documents/ACEsReportAlaska.pdf]. Published January 2015. Accessed April 26, 2016. 9. Alaska Native Tribal Health Consortium. Getting together - teen relationship safety card. [http://www.anthctoday.org/epicenter/healthyfamilies/teenCard_111014.pdf]. Accessed April 26, 2016. 10. Teens Acting Against Violence. Tundra Women's Coalition - Crisis Line - 1-800-478-7799 or 907-543-3456 website. [http://tundrapeace.org/programs/taav/]. Accessed April 26, 2016. 11. Child Welfare Information Gateway. Trauma-focused cognitive behavioral therapy for children affected by sexual abuse or trauma. [https://www.childwelfare.gov/pubPDFs/trauma.pdf]. Accessed April 26, 2016. 12. Alaska Department of Health and Social Services. Office of Children's Services. Strengthening families. [http://dhss.alaska.gov/ocs/Pages/families/default.aspx]. Accessed April 26, 2016.

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 12/14/2016, Published on 05/30/2017
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health (Ak-IBIS) web site (http://ibis.dhss.alaska.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Mon, 23 September 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: Tue, 30 May 2017 14:13:15 AKDT
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Mon, 23 September 2019 2:57:33 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: Tue, 30 May 2017 14:13:15 AKDT