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State of Alaska

Complete Health Indicator Report of Adverse Childhood Experiences: Sexual Abuse

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 any of the following questions: "How often did anyone at least 5 years older than you or an adult ever touch you sexually?"; "How often did anyone at least 5 years older than you or an adult try to make you touch them sexually?"; or "How often did anyone at least 5 years older than you or an adult force you to have sex?"

Numerator

Weighted number of adults (18+) who responded "Once" or "More than once" on the BRFSS to any of the following questions: "How often did anyone at least 5 years older than you or an adult ever touch you sexually?"; "How often did anyone at least 5 years older than you or an adult try to make you touch them sexually?"; or "How often did anyone at least 5 years older than you or an adult force you to have sex?"

Denominator

Weighted number of adults (18+) who responded to the sexual abuse questions 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^ ACEs questions on sexual abuse were asked in 2013 through 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?

Childhood sexual abuse is a major public health concern. Alaska has the highest rate of forcible rape in the nation^2^ and a rate of reported rape that is three times the national average.^3^ More than 9% of Alaska high school students have experienced sexual violence.^4^ The impacts of overwhelming stress on the brain caused by sexual abuse continue into adulthood and can have generational impacts. As Alaskans exposed to child abuse grow up, they may find negative ways to cope with their damaged stress responses. Adverse Childhood Experiences (ACEs) are potent risk factors for involvement in domestic violence, alcohol dependence, and suicide attempts. When Alaskans exposed to child abuse grow up and start families of their own, these behaviors can become ACEs for another generation.^5^ In one study, 80% of 21-year-olds who reported childhood abuse met the criteria for at least one psychological disorder.^6^ 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. It is critical to understand how some of the worst health and social problems can arise as a consequence of adverse childhood experiences.^1^ 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.^7^ Realizing these connections is likely to improve efforts towards prevention and recovery.[[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. Alaska Department of Public Safety. Public safety frequently asked questions. [http://dps.alaska.gov/dpsfaq.aspx]. Accessed April 26, 2016. 3. Federal Bureau of Investigations . 2012 crime statistics. [http://www.fbi.gov/stats-services/crimestats]. Accessed April 26, 2016. 4. Alaska Department of Public Safety. Alaska Council on Domestic Violence and Sexual Assault. 2014 Alaska dashboard: key issues impacting domestic violence and sexual assault in Alaska. [http://dps.alaska.gov/Cdvsa/docs/DVSA_Dashboard_2014.pdf]. Published January 2014. Accessed April 26, 2016. 5. 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. 6. Silverman AB, Reinherz HZ, Giaconia RM. The long-term sequelae of child and adolescent abuse: a longitudinal community study. Child Abuse & Neglect 1996;20(8):709-23. 7. 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/aceak/ Documents/ACEsEconomicCosts-AK.pdf]. Accessed April 26, 2016. }}

How Are We Doing?

In 2013-2015 combined, 13.7% of Alaska adults reported having experienced some form of childhood sexual abuse. Alaska Native adults at 17.4% had statistically higher prevalence than all Alaska adults. The 10.6% of Alaska Native adults reporting having been made to have sex by an individual five years older or an adult before they were 18 years old is significantly higher than the 6.2% experienced by the general Alaska adult population. Females reported significantly higher prevalence with 20.1% having been sexually abused, while 7.7% of males reported having been sexually abused. Those adults who were divorced or separated reported significantly higher prevalence of sexual abuse while children at 20.8% than those who were married (13.0%) or never married (10.6%). Employment status was also associated with prevalence of childhood sexual abuse: 13.1% of employed adults but those unable to work reported significantly higher prevalence at 30.9%. Those adults earning $75,000 or more reported significantly lower prevalence of childhood sexual abuse than those earning less than $25,000. This pattern continues with those with middle/high incomes reporting significantly lower prevalence of sexual abuse than those who are poor or near poor. Rates of sexual abuse during childhood from the BRFSS are initially presented for all Alaskans and Alaska Native people for the combined 3-year period from 2013-2015. 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 3-year averages by body mass index, current smoking, sexual orientation, and disability. Significant differences were evident in all 4 contrasts. Rates of sexual abuse during childhood by regions of Alaska are presented for all Alaskans and Alaska Native people for the 3-year average of surveys conducted between 2013-2015: 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 ACEs available; however, in 2009 the CDC released a study comparing ACEs data from five states (i.e., Arkansas, Louisiana, Tennessee, New Mexico, Washington) that used the BRFSS ACEs module. When compared to the five states, Alaska reported the highest in rates of adults who had experienced childhood sexual abuse.^8^ Compared to data from adults from the 10 states (i.e., Hawaii, Maine, Nebraska, Nevada, Ohio, Pennsylvania, Utah, Vermont, Washington, and Wisconsin) that implemented the ACEs module in 2010, the rate of Alaska adults reporting experiencing childhood sexual abuse was lower.^1^[[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. 8. U.S. Centers for Disease Control and Prevention (CDC). Adverse childhood experiences reported by adults - five states, 2009. MMWR 2010;59(49):1609-13. [https://www.cdc.gov/mmwr/pdf/wk/mm5949.pdf] Accessed October 31, 2017. }}

What Is Being Done?

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 and the public on brain development, adverse childhood experiences (ACEs), and resiliency.^9^ 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): 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.[[br]] [[br]] ---- {{class .SmallerFont 9. Alaska Department of Health and Social Services. Healthy Alaskans 2020. [http://hss.state.ak.us/ha2020/]. Accessed April 26, 2016. 10. Alaska Native Tribal Health Consortium. Getting together - teen relationship safety card. [http://www.anthctoday.org/epicenter/healthyfamilies/teenCard_111014.pdf]. Accessed April 26, 2016. }}

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 been proven to be effective.^5^ 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 5. 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. 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 Risk Factors Indicators:


Related Health Status Outcomes Indicators:




Graphical Data Views

Percentage of adults (18+) who experienced sexual abuse, crude rate, by all Alaskans and Alaska Natives, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
All Alaskans13.7%12.8%14.6%1,91812,623
Alaska Native people17.4%15.2%19.9%4272,321

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 before age 18 were ever touched sexually by someone at least 5 years older, crude rate, by all Alaskans and Alaska Natives, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
All Alaskans13.6%12.6%14.6%1,65411,121
Alaska Native people18.0%15.6%20.8%3621,930

Data Notes

Based upon those who responded "Once" or "More than once" on the BRFSS to the following question: "How often did anyone at least 5 years older than you or an adult ever touch you sexually?"

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 before age 18 were ever tried to made touch sexually someone at least 5 years older, crude rate, by all Alaskans and Alaska Natives, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
All Alaskans10.0%9.2%10.8%1,18311,148
Alaska Native people13.3%11.1%15.8%2631,936

Data Notes

Based upon those who responded "Once" or "More than once" on the BRFSS to the following question: "How often did anyone at least 5 years older than you or an adult try to make you touch them sexually?"

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 before age 18 were forced to have sex with someone at least 5 years older, crude rate, by all Alaskans and Alaska Natives, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
All Alaskans6.2%5.6%7.0%71611,176
Alaska Native people10.6%8.6%13.0%2131,939

Data Notes

Based upon those who responded "Once" or "More than once" on the BRFSS to the following question: "How often did anyone at least 5 years older than you or an adult force you to have sex?"

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 sexual abuse, crude rate, by sex, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
Males7.7%6.7%8.8%4485,785
Females20.1%18.7%21.6%1,4706,838

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 sexual abuse, crude rate, by age groups, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 5
18-2410.0%7.5%13.1%78802
25-3410.7%8.9%12.9%1921,665
35-4415.3%12.9%18.1%2971,854
45-6417.1%15.7%18.6%9725,416
65+11.4%10.0%13.1%3702,745

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 sexual abuse, crude rate, by race/ethnicity, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 7
Alaska Native (any mention)17.4%15.2%19.9%4272,321
Asian (non-Hispanic)9.2%5.5%14.9%22243
Black (non-Hispanic)10.9%6.6%17.4%22177
Native Hawaiian/Other Pacific Islander (non-Hispanic)9.8%3.9%22.8%670
White (non-Hispanic)13.6%12.6%14.7%1,3559,165
Multiracial/Other (non-Hisp.)13.4%6.4%25.9%1885
Hispanic (alone or multi)12.8%8.3%19.3%43318

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 sexual abuse, crude rate, by ethnicity, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
Hispanic/Latino13.5%9.2%19.4%56372
Non-Hispanic/Latino13.7%12.8%14.7%1,84112,091

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 sexual abuse, crude rate, by marital status, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 5
Married13.0%11.9%14.2%9526,840
Widowed14.0%11.3%17.3%1481,012
Divorced/Separated20.8%18.2%23.6%4552,091
Never Married10.6%8.9%12.7%2642,045
Living with a Partner16.7%12.6%21.8%92518

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 sexual abuse, crude rate, by education, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 4
Less than High School14.3%10.9%18.5%101650
High School Graduate or GED13.8%12.0%15.8%4353,046
Some College or Tech. School15.8%14.1%17.5%6243,434
College Graduate12.8%11.5%14.2%6734,581

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 sexual abuse, crude rate, by employment status, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 4
Employed13.1%12.0%14.3%1,0897,428
Unemployed14.0%11.4%17.2%142830
Not in Work Force11.8%10.3%13.4%4943,560
Unable to Work30.9%25.3%37.2%176631

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 sexual abuse, crude rate, by income, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 5
<$15,00022.1%18.5%26.2%2311,041
$15,000-$24,99917.6%14.6%21.0%2521,401
$25,000-$49,00014.1%12.2%16.3%3812,397
$50,000-$74,00013.1%11.0%15.4%2761,941
$75,000+12.4%11.1%14.0%6524,545

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 sexual abuse, crude rate, by poverty threshold, all Alaskans, 2013-2015 (3-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
Poor20.3%16.5%24.6%178873
Near Poor17.5%14.9%20.4%2971,540
Middle/High13.3%12.3%14.4%1,1517,672

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 sexual abuse, crude rate, by body mass index, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Weight CategoryPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 3
Neither Overweight nor Obese12.2%10.8%13.7%5493,966
Overweight12.9%11.4%14.5%6074,422
Obese16.6%15.0%18.5%6873,584

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 sexual abuse, crude rate, by current smoking, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
Not current smoker12.9%12.0%13.9%1,4589,942
Current smoker18.0%15.8%20.5%4492,311

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 sexual abuse, crude rate, by sexual orientation, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
Heterosexual15.0%14.0%16.0%1,77710,712
Gay, Lesbian, or Bisexual31.9%25.0%39.6%95315

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 sexual abuse, crude rate, by disability, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
Disability Present24.3%21.6%27.2%5592,198
Disability Absent11.7%10.8%12.7%1,3259,988

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 sexual abuse, crude rate, by Alaska Public Health Regions, all Alaskans and Alaska Natives, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Alaska ComparisonsPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 14
All AlaskansAnchorage12.6%11.0%14.5%3492,534
All AlaskansGulf Coast14.5%12.6%16.6%2951,892
All AlaskansInterior13.0%11.2%14.9%3542,615
All AlaskansMat-Su16.1%14.0%18.6%3151,828
All AlaskansNorthern13.6%10.0%18.3%95561
All AlaskansSoutheast15.2%13.3%17.3%3131,893
All AlaskansSouthwest12.9%10.4%15.8%1971,300
Alaska Native peopleAnchorage14.2%9.7%20.5%43263
Alaska Native peopleGulf Coast18.1%11.9%26.7%36192
Alaska Native peopleInterior18.8%14.0%24.8%71368
Alaska Native peopleMat-Su24.7%16.0%36.0%41155
Alaska Native peopleNorthern15.7%10.9%22.2%64338
Alaska Native peopleSoutheast19.5%14.4%25.9%59285
Alaska Native peopleSouthwest16.0%12.4%20.5%113720

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 sexual abuse, crude rate, by metropolitan/micropolitan statistical areas, all Alaskans and Alaska Natives, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Alaska ComparisonsPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 10
All AlaskansAnchorage MSA13.5%12.1%15.0%6644,362
All AlaskansFairbanks North Star MSA13.2%11.2%15.5%2591,905
All AlaskansJuneau MicroSA16.3%13.4%19.7%151815
All AlaskansKetchikan Gateway MicroSA14.3%10.4%19.4%56350
All AlaskansRural (non-Metro/MicroSA)13.7%12.5%15.0%7885,191
Alaska Native peopleAnchorage MSA17.4%13.1%22.8%84418
Alaska Native peopleFairbanks North Star MSA21.2%14.4%30.0%37172
Alaska Native peopleJuneau MicroSA29.2%19.0%42.0%2783
Alaska Native peopleKetchikan Gateway MicroSA19.8%9.2%37.6%957
Alaska Native peopleRural (non-Metro/MicroSA)15.8%13.4%18.6%2701,591

Data Notes

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 sexual abuse, crude rate, by behavioral health assessment regions, all Alaskans and Alaska Natives, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Alaska ComparisonsPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 20
All AlaskansAnchorage Muncipality12.6%11.0%14.5%3492,534
All AlaskansFairbanks North Star Borough13.2%11.2%15.5%2591,916
All AlaskansCity and Borough of Juneau16.3%13.4%19.7%151815
All AlaskansKenai Peninsula Borough14.5%12.3%16.9%2141,341
All AlaskansMatanuska-Susitna Borough16.1%14.0%18.6%3151,828
All AlaskansNorthwest Region13.6%10.0%18.3%95561
All AlaskansOther Interior Region14.6%11.7%18.2%141971
All AlaskansY-K Delta Region14.4%10.6%19.1%89590
All AlaskansSouthwest Region11.0%8.5%14.0%143989
All AlaskansOther Southeast Region14.2%11.9%16.9%1621,078
Alaska Native peopleAnchorage Muncipality14.2%9.7%20.5%43263
Alaska Native peopleFairbanks North Star Borough21.0%14.3%29.8%37173
Alaska Native peopleCity and Borough of Juneau29.2%19.0%42.0%2783
Alaska Native peopleKenai Peninsula Borough17.6%11.4%26.1%24117
Alaska Native peopleMatanuska-Susitna Borough24.7%16.0%36.0%41155
Alaska Native peopleNorthwest Region15.7%10.9%22.2%64338
Alaska Native peopleOther Interior Region14.2%9.3%21.0%37229
Alaska Native peopleY-K Delta Region16.4%11.8%22.5%62395
Alaska Native peopleSouthwest Region17.9%12.1%25.6%60366
Alaska Native peopleOther Southeast Region15.3%10.0%22.7%32202

Data Notes

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

Data Source

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


Percentage of adults (18+) who experienced sexual abuse, crude rate, by boroughs and census areas, all Alaskans and Alaska Natives, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Alaska ComparisonsPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 58
All AlaskansAleutians East Borough8.7%4.0%17.8%12110
All AlaskansAleutians West CA8.2%4.3%14.9%26177
All AlaskansAnchorage Municipality12.6%11.0%14.5%3492,534
All AlaskansBethel CA15.7%11.3%21.4%73427
All AlaskansBristol Bay Borough11.2%6.0%20.1%1598
All AlaskansDenali Borough9.1%4.5%17.7%12104
All AlaskansDillingham CA19.6%12.7%29.1%41218
All AlaskansFairbanks North Star Borough13.2%11.2%15.5%2591,916
All AlaskansHaines Borough17.3%9.8%28.8%1899
All AlaskansHoonah-Angoon CA20.8%11.1%35.6%1261
All AlaskansJuneau City and Borough16.3%13.4%19.7%151815
All AlaskansKenai Peninsula Borough14.5%12.3%16.9%2141,341
All AlaskansKetchikan Gateway Borough14.3%10.4%19.4%56350
All AlaskansKodiak Island Borough10.3%6.6%15.8%35279
All AlaskansKusilvak CA11.6%5.9%21.5%16163
All AlaskansLake and Peninsula Borough6.9%3.3%13.8%14107
All AlaskansMatanuska-Susitna Borough16.1%14.0%18.6%3151,828
All AlaskansNome CA15.3%9.5%23.7%41256
All AlaskansNorth Slope Borough10.7%5.4%20.0%23139
All AlaskansNorthwest Arctic Borough14.2%8.5%22.9%31166
All AlaskansPetersburg Borough7.9%3.8%15.7%899
All AlaskansPrince of Wales-Hyder CA14.7%9.0%23.0%23143
All AlaskansSitka City and Borough13.7%9.0%20.2%32223
All AlaskansSkagway Municipality**22
All AlaskansSoutheast Fairbanks CA12.0%7.9%17.9%42323
All AlaskansValdez-Cordova CA19.3%13.4%27.1%46272
All AlaskansWrangell City and Borough10.6%4.2%24.1%555
All AlaskansYakutat City and Borough**26
All AlaskansYukon-Koyukuk CA13.4%8.9%19.6%41272
Alaska Native peopleAleutians East Borough10.5%3.9%25.1%657
Alaska Native peopleAleutians West CA6.9%2.7%16.8%853
Alaska Native peopleAnchorage Municipality14.2%9.7%20.5%43263
Alaska Native peopleBethel CA20.0%13.8%27.9%51253
Alaska Native peopleBristol Bay Borough7.9%2.8%20.4%539
Alaska Native peopleDenali Borough**4
Alaska Native peopleDillingham CA25.5%15.2%39.5%26115
Alaska Native peopleFairbanks North Star Borough21.0%14.3%29.8%37173
Alaska Native peopleHaines Borough**13
Alaska Native peopleHoonah-Angoon CA**17
Alaska Native peopleJuneau City and Borough29.2%19.0%42.0%2783
Alaska Native peopleKenai Peninsula Borough17.6%11.4%26.1%24117
Alaska Native peopleKetchikan Gateway Borough19.8%9.2%37.6%957
Alaska Native peopleKodiak Island Borough**41
Alaska Native peopleKusilvak CA10.8%5.0%21.8%11142
Alaska Native peopleLake and Peninsula Borough7.7%3.2%17.5%661
Alaska Native peopleMatanuska-Susitna Borough24.7%16.0%36.0%41155
Alaska Native peopleNome CA21.1%12.6%33.3%33151
Alaska Native peopleNorth Slope Borough8.2%4.0%16.1%1273
Alaska Native peopleNorthwest Arctic Borough14.1%7.4%25.1%19114
Alaska Native peoplePetersburg Borough**10
Alaska Native peoplePrince of Wales-Hyder CA8.7%3.3%21.2%550
Alaska Native peopleSitka City and Borough**31
Alaska Native peopleSkagway Municipality**1
Alaska Native peopleSoutheast Fairbanks CA**40
Alaska Native peopleValdez-Cordova CA**34
Alaska Native peopleWrangell City and Borough**12
Alaska Native peopleYakutat City and Borough**11
Alaska Native peopleYukon-Koyukuk CA13.6%8.2%21.5%26151

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 sexual abuse, crude rate, by tribal health organization regions, all Alaskans and Alaska Natives, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Alaska ComparisonsPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 24
All AlaskansAleutians and Pribilofs8.4%5.1%13.4%38287
All AlaskansAnchorage/Mat-Su13.5%12.1%15.0%6644,362
All AlaskansArctic Slope11.1%5.5%21.0%22125
All AlaskansBristol Bay14.1%9.9%19.8%70429
All AlaskansCopper R/Prince William Snd.18.9%13.1%26.5%47283
All AlaskansInterior13.0%11.3%15.0%3532,596
All AlaskansKenai Peninsula14.5%12.3%16.9%2141,341
All AlaskansKodiak Area10.3%6.6%15.8%35279
All AlaskansNorthwest Arctic13.8%8.3%22.1%32177
All AlaskansNorton Sound15.3%9.5%23.7%41256
All AlaskansSoutheast15.2%13.3%17.3%3131,893
All AlaskansYukon-Kuskokwim14.3%10.6%19.0%89595
Alaska Native peopleAleutians and Pribilofs8.8%4.3%17.0%14110
Alaska Native peopleAnchorage/Mat-Su17.4%13.1%22.8%84418
Alaska Native peopleArctic Slope8.6%4.0%17.3%1162
Alaska Native peopleBristol Bay18.6%11.8%28.1%37219
Alaska Native peopleCopper R/Prince William Snd.**36
Alaska Native peopleInterior19.2%14.3%25.2%71359
Alaska Native peopleKenai Peninsula17.6%11.4%26.1%24117
Alaska Native peopleKodiak Area**41
Alaska Native peopleNorthwest Arctic13.7%7.3%24.2%20123
Alaska Native peopleNorton Sound21.1%12.6%33.3%33151
Alaska Native peopleSoutheast19.5%14.4%25.9%59285
Alaska Native peopleYukon-Kuskokwim16.2%11.6%22.2%62400

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. Alaska Department of Public Safety. Public safety frequently asked questions. [http://dps.alaska.gov/dpsfaq.aspx]. Accessed April 26, 2016. 3. Federal Bureau of Investigations . 2012 crime statistics. [http://www.fbi.gov/stats-services/crimestats]. Accessed April 26, 2016. 4. Alaska Department of Public Safety. Alaska Council on Domestic Violence and Sexual Assault. 2014 Alaska dashboard: key issues impacting domestic violence and sexual assault in Alaska. [http://dps.alaska.gov/Cdvsa/docs/DVSA_Dashboard_2014.pdf]. Published January 2014. Accessed April 26, 2016. 5. 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. 6. Silverman AB, Reinherz HZ, Giaconia RM. The long-term sequelae of child and adolescent abuse: a longitudinal community study. Child Abuse & Neglect 1996;20(8):709-23. 7. 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/aceak/ Documents/ACEsEconomicCosts-AK.pdf]. Accessed April 26, 2016. 8. U.S. Centers for Disease Control and Prevention (CDC). Adverse childhood experiences reported by adults - five states, 2009. MMWR 2010;59(49):1609-13. [https://www.cdc.gov/mmwr/pdf/wk/mm5949.pdf] Accessed October 31, 2017. 9. Alaska Department of Health and Social Services. Healthy Alaskans 2020. [http://hss.state.ak.us/ha2020/]. Accessed April 26, 2016. 10. Alaska Native Tribal Health Consortium. Getting together - teen relationship safety card. [http://www.anthctoday.org/epicenter/healthyfamilies/teenCard_111014.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.

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 10/31/2017, Published on 10/31/2017
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 Sat, 23 February 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, 31 Oct 2017 10:24:37 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 Sat, 23 February 2019 3:30:14 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, 31 Oct 2017 10:24:37 AKDT