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State of Alaska

Complete Health Indicator Report of Adverse Childhood Experiences: Substance Abuse in Household

Definition

Percentage of adults 18 years of age and older who responded "Yes" on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to at least one of the following questions: "Did you live with anyone who was a problem drinker or alcoholic?" or "Did you live with anyone who used illegal street drugs or who abused prescription medications?"

Numerator

Weighted number of adults (18+) who responded "Yes" on the BRFSS to at least one of the following questions: "Did you live with anyone who was a problem drinker or alcoholic?" or "Did you live with anyone who used illegal street drugs or who abused prescription medications?"

Denominator

Weighted number of adults (18+) who responded to the household substance 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 responses.

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 substance abuse in the household 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?

Alaska has one of the highest per capita alcohol consumption rates in the nation, and the prevalence of alcohol dependence and alcohol abuse is twice the national average.^2^ Alaska adults and youth have higher rates of per capita substance abuse.^3^ A survey of Alaskans for the [http://hss.state.ak.us/ha2020/ Healthy Alaskans 2020] Initiative identified alcohol use and abuse and other substance abuse as two of the top ten health issues in Alaska.^4^ Household substance abuse and dependence have a negative impact on the physical and emotional well-being of children and can cause home environments to become chaotic and unpredictable, leading to child maltreatment. Household substance abuse disrupts childhood development, including a disruption of the bonding process, and contributes to emotional, academic, and developmental problems; lack of supervision; social stigma; and adolescent substance use and delinquency. Compared to children of parents who do not abuse alcohol or drugs, children of parents who do are more likely to experience physical, intellectual, social, and emotional problems.^5^ As a child experiences living with a household member with substance abuse, the impacts of overwhelming stress on the brain continue into adulthood and can have generational impacts. As Alaska children are exposed to household substance abuse, they may find negative ways to cope with their damaged stress responses. When as adults they start families of their own, these behaviors can become ACEs for another generation.^3^ In fact, alcoholism runs in families, and children of alcoholics are four times more likely than other children to become alcoholics.^2^ 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.^6^[[br]] [[br]] ---- {{class .SmallerFont See "References and Resources" section for references. }}

How Are We Doing?

In 2013-2015 combined, 29.7% of Alaska adults reported having experienced living with a household member who was a problem drinker, used illegal street drugs, and/or abused prescription medications. Alaska Native adults reported significantly higher prevalence at 41.1%. Females reported significantly higher prevalence exposure to substance abuse in the household at 32.8% compared to males at 27.0%. Those adults who were college graduates reported a significantly lower prevalence of exposure at 25.0% than those who had less than a high school education at 41.2%. Overall, there were few significant differences in rates among geographic public health regions in Alaska. Rates of exposure to substance 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 exposure to substance 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 (Arkansas, Louisiana, Tennessee, New Mexico, Washington) that used the BRFSS ACEs module. When compared to the five states, Alaska reported the highest rate of adults who had experienced living with someone with substance abuse.^7^ 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, Alaska had higher rates of adults reporting they had experienced living with a household member with substance abuse.^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. 7. 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?

Currently the Alaska Department of Health and Social Services, through the divisions of Behavioral Health, Juvenile Justice, and the Office of Children's Services, issue grants to a diverse array of community-based organizations with the goal of developing creative programs focused on prevention of youth substance abuse; strengthening individual, family, school, and community approaches to prevention; and increasing community readiness to decrease substance abuse among youth. State agencies work in partnership to fund communities in a collaborative manner so that services are implemented without duplication or competition.^2^ The two primary objectives chosen by the Alaska Strategic Prevention Framework State Incentive Grant (SPF SIG) Advisory Committee of the Alaska Department of Health and Social Services were to reduce youth alcohol use (e.g., lifetime, current, heavy, and binge drinking) and adult alcohol abuse (e.g., heavy and binge drinking). The SPF SIG used a five-step Strategic Prevention Framework developed by the [http://www.samhsa.gov/ Substance Abuse and Mental Health Services Administration (SAMHSA)] to identify and develop data-driven prevention strategies. They identified four key strategies: enhance the Alaska Prevention workforce; develop regional/community capacity to promote prevention principles and strategies; increase the understanding and use of community coalitions and environmental strategies to accomplish sustainable community change; and increase regional/community understanding and use of data to drive decision-making, implementation, evaluation, and continuous quality improvement of strategies and interventions.^8^ The [http://hss.state.ak.us/ha2020/ Healthy Alaskans 2020] initiative developed strategies by content experts to reduce youth and adult alcohol binge drinking and alcohol-induced deaths. Public health partners around the state are aligning work around these approaches adapted by Alaska's unique needs. Alaska strategies include: 1. Ensuring access to a seamless system of care throughout Alaska for assessment, treatment, and aftercare for people with both mental health and substance use disorders. 2. Promote environmental strategies that change community conditions to reduce alcohol consumption. 3. Provide electronic screening and brief intervention (SBIRT) in certain healthcare settings throughout Alaska. SBIRT is an approach to identify and intervene early for substance misuse. 4. Expand therapeutic courts that provide treatment programs in place of incarceration for certain alcohol-related offenses throughout Alaska. 5. Fund Strategic Prevention Framework Grants that address local needs and reduce substance abuse problems. 6. Provide the Prime for Life curriculum for alternative high school students, Job Corps participants, and youth caught with alcohol or any illegal substance. 7. Conduct a positive community media campaign to promote attitude and behavior change around alcohol use among youth. 8. Increase children's social and emotional learning through adopting formal standards and curricula for schools in Alaska.^4^ The Alaska Mental Health Board and Advisory Board on Alcoholism and Drug Abuse have coordinated the efforts of many organizations to gather Alaska-specific ACE data.^6^ The Boards have focused since 2008 on community wellness and personal resilience. The Division of Public Health partnered with the Alaska Native Tribal Health Consortium and the 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^[[br]] [[br]] ---- {{class SmallerFont See "References and Resources" section for references. }}

Evidence-based Practices

The Healthy Alaskans 2020 initiative developed strategies by content experts to reduce youth and adult alcohol binge drinking and alcohol-induced deaths in Alaska. Their strategies were based on evidence based practices including: 1. Substance Abuse and Mental Health Services Administration (SAMHSA) recommends a modern addictions and mental health service system that includes prevention, treatment and recovery supports. This continuum of care comprises nine domains: Health Homes, Prevention and Wellness Services, Engagement Services, Outpatient and Medication Assisted Treatment, Community Supports and Recovery Services, Intensive Support Services, Other Living Supports, Out of Home Residential Services, and Acute Intensive Services. 2. There is substantial evidence that environmental strategies are effective in preventing and reducing substance abuse. Increasing fines for underage drinking, not selling cold, single-serving containers of beer in convenience stores, and increasing access to treatment services by providing counselors who speak the local language are all examples of environmental strategies. 3. SBIRT is a model listed in the SAMHSA'S National Registry of Evidence-based Programs and Practices that focuses on delivering early intervention and treatment services for people with substance use disorders, or those at-risk for developing substance use disorders. 4. SAMHSA's has a five-step planning process to guide the work of states and communities in their prevention activities. The framework allows communities to identify and select evidence-based interventions that address local needs to reduce substance abuse problems. The framework is to be used in a comprehensive strategic plan. 5. The Prime for Life curriculum was developed by the Prevention Research Institute and has been widely tested throughout the US and in Sweden. Providing practical and useful information, this research-based program leads the student through a process of self-evaluation and reflection upon his or her own personal decisions around alcohol and other drug use.^4^ 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.^10^ 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 Alaskas schools. 4. Maintain and expand prevention efforts that have proven to be effective.^5^[[br]] [[br]] ---- {{class .SmallerFont See "References and Resources" section for references. }}


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 a household member with substance 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 Alaskans29.7%28.5%31.0%3,72012,623
Alaska Native people41.1%38.0%44.2%9192,321

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 experienced a household member with alcohol abuse, crude rate, by all Alaskans and Alaska Natives, 2013-2015 (3-year average)

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confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
All Alaskans29.4%28.1%30.7%3,30611,260
Alaska Native people43.8%40.4%47.2%8531,956

Data Notes

Based upon responses to the question: "Did you live with anyone who was a problem drinker or alcoholic?"

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 a household member who used illegal street drugs or abused prescription medications, 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 Alaskans15.0%13.9%16.1%1,32711,276
Alaska Native people18.7%16.2%21.5%3091,965

Data Notes

Based upon responses to the question: "Did you live with anyone who used illegal street drugs or who abused prescription medications?"

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 a household member with substance 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
Males27.0%25.3%28.7%1,5375,785
Females32.8%30.9%34.6%2,1836,838

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 a household member with substance abuse, crude rate, by age, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 5
18-2430.5%26.2%35.1%232802
25-3431.4%28.3%34.7%5221,665
35-4429.8%26.7%33.1%5841,854
45-6431.7%29.9%33.6%1,7205,416
65+22.7%20.6%24.9%6432,745

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 a household member with substance 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)41.1%38.0%44.2%9192,321
Asian (non-Hispanic)11.6%7.0%18.7%25243
Black (non-Hispanic)20.5%13.7%29.6%35177
Native Hawaiian/Other Pacific Islander (non-Hispanic)16.3%8.6%28.9%1270
White (non-Hispanic)29.4%28.0%30.9%2,5569,165
Multiracial/Other (non-Hisp.)30.4%18.1%46.2%2385
Hispanic (alone or multi)33.7%26.5%41.8%99318

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 a household member with substance 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/Latino35.5%28.7%42.9%124372
Non-Hispanic/Latino29.6%28.3%30.8%3,56012,091

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 a household member with substance 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
Married27.4%25.9%29.0%1,9066,840
Widowed23.5%20.0%27.4%2561,012
Divorced/Separated33.1%29.9%36.4%7112,091
Never Married31.3%28.2%34.5%6132,045
Living with a Partner42.4%36.2%48.9%212518

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 a household member with substance 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 School41.2%35.4%47.3%236650
High School Graduate or GED31.2%28.8%33.8%9663,046
Some College or Tech. School29.4%27.3%21.7%1,0963,434
College Graduate25.0%23.2%26.9%1,1764,581

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 a household member with substance 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
Employed29.2%27.6%30.8%2,1977,428
Unemployed37.2%32.4%42.2%322830
Not in Work Force27.7%25.2%30.3%9213,560
Unable to Work39.8%33.8%46.2%254631

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 a household member with substance 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
<$15,00034.1%29.5%39.0%3591,041
$15,000-$24,99935.9%31.8%40.3%4731,401
$25,000-$49,00031.6%28.7%34.7%7402,397
$50,000-$74,00027.3%24.6%30.2%5431,941
$75,000+28.6%26.6%30.6%1,3134,545

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 a household member with substance 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
Poor39.6%34.3%45.2%317873
Near Poor36.1%32.5%39.9%5421,540
Middle/High29.8%28.3%31.3%2,2707,672

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 a household member with substance 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 Obese28.3%26.1%30.6%1,0873,966
Overweight30.0%27.8%32.2%1,3054,422
Obese33.2%30.9%35.6%1,2033,584

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 a household member with substance abuse, crude rate, by current smoker, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 2
Not current smoker27.2%25.8%28.6%2,7479,942
Current smoker42.7%39.6%45.9%9532,311

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 a household member with substance 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
Heterosexual33.2%31.8%34.6%3,44910,712
Gay, Lesbian, or Bisexual46.2%38.6%53.9%150315

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 a household member with substance 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 Present39.3%36.0%42.8%8492,198
Disability Absent28.5%27.1%29.9%2,8279,988

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 a household member with substance 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 AlaskansAnchorage28.4%25.9%30.9%6852,534
All AlaskansGulf Coast30.5%27.9%33.3%5791,892
All AlaskansInterior28.9%26.5%31.4%7212,615
All AlaskansMat-Su30.4%27.4%33.5%5271,828
All AlaskansNorthern34.3%29.1%40.0%200561
All AlaskansSoutheast33.6%30.9%36.5%6071,893
All AlaskansSouthwest29.2%25.1%33.6%4011,300
Alaska Native peopleAnchorage41.6%34.2%49.4%110263
Alaska Native peopleGulf Coast40.1%31.8%49.0%77192
Alaska Native peopleInterior40.2%33.7%47.1%150368
Alaska Native peopleMat-Su45.7%33.7%58.2%66155
Alaska Native peopleNorthern43.0%35.9%50.4%139338
Alaska Native peopleSoutheast45.4%38.4%52.6%120285
Alaska Native peopleSouthwest33.9%29.0%39.2%257720

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 a household member with substance 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 MSA28.8%26.9%30.9%1,2124,362
All AlaskansFairbanks North Star MSA29.4%26.7%32.3%5291,905
All AlaskansJuneau MicroSA34.0%29.8%38.5%267815
All AlaskansKetchikan Gateway MicroSA34.2%28.1%41.0%115350
All AlaskansRural (non-Metro/MicroSA)30.7%28.9%32.4%1,5975,191
Alaska Native peopleAnchorage MSA42.8%36.4%49.5%176418
Alaska Native peopleFairbanks North Star MSA46.3%37.3%55.6%78172
Alaska Native peopleJuneau MicroSA53.2%40.4%65.5%4483
Alaska Native peopleKetchikan Gateway MicroSA51.2%35.9%66.3%2657
Alaska Native peopleRural (non-Metro/MicroSA)37.5%34.2%41.0%5951,591

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 a household member with substance abuse, crude rate, by behavioral health systems 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 Muncipality28.4%25.9%30.9%6852,534
All AlaskansFairbanks North Star Borough29.7%27.0%32.6%5341,916
All AlaskansCity and Borough of Juneau34.0%29.8%38.5%267815
All AlaskansKenai Peninsula Borough31.2%28.2%34.5%4191,341
All AlaskansMatanuska-Susitna Borough30.4%27.4%33.5%5271,828
All AlaskansNorthwest Region34.3%29.1%40.0%200561
All AlaskansOther Interior Region25.9%22.4%29.8%265971
All AlaskansY-K Delta Region28.3%23.3%33.9%177590
All AlaskansSouthwest Region30.5%25.7%35.7%306989
All AlaskansOther Southeast Region33.3%29.8%37.0%3401,078
Alaska Native peopleAnchorage Muncipality41.6%34.2%49.4%110263
Alaska Native peopleFairbanks North Star Borough46.9%37.9%56.1%79173
Alaska Native peopleCity and Borough of Juneau53.2%40.4%65.5%4483
Alaska Native peopleKenai Peninsula Borough45.7%35.5%56.3%54117
Alaska Native peopleMatanuska-Susitna Borough45.7%33.7%58.2%66155
Alaska Native peopleNorthwest Region43.0%35.9%50.4%139338
Alaska Native peopleOther Interior Region30.8%23.4%39.2%82229
Alaska Native peopleY-K Delta Region31.4%25.5%38.0%131395
Alaska Native peopleSouthwest Region37.1%29.4%45.5%138366
Alaska Native peopleOther Southeast Region42.0%33.6%50.8%76202

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 a household member with substance 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 Borough30.1%16.6%48.2%32110
All AlaskansAleutians West CA22.0%14.2%32.6%55177
All AlaskansAnchorage Municipality28.4%25.9%30.9%6852,534
All AlaskansBethel CA30.7%24.4%37.8%130427
All AlaskansBristol Bay Borough27.4%17.8%39.8%3098
All AlaskansDenali Borough23.7%13.6%37.9%20104
All AlaskansDillingham CA33.1%24.3%43.2%73218
All AlaskansFairbanks North Star Borough29.7%27.0%32.6%5341,916
All AlaskansHaines Borough38.2%26.6%51.3%3199
All AlaskansHoonah-Angoon CA26.5%15.4%41.7%1561
All AlaskansJuneau City and Borough34.0%29.8%38.5%267815
All AlaskansKenai Peninsula Borough31.2%28.2%34.5%4191,341
All AlaskansKetchikan Gateway Borough34.2%28.1%41.0%115350
All AlaskansKodiak Island Borough31.0%24.0%39.0%82279
All AlaskansKusilvak CA23.2%16.0%32.4%47163
All AlaskansLake and Peninsula Borough45.3%23.0%69.6%34107
All AlaskansMatanuska-Susitna Borough30.4%27.4%33.5%5271,828
All AlaskansNome CA31.3%24.0%39.5%86256
All AlaskansNorth Slope Borough24.5%16.3%35.1%46139
All AlaskansNorthwest Arctic Borough48.8%38.5%59.2%68166
All AlaskansPetersburg Borough33.9%23.9%45.5%2999
All AlaskansPrince of Wales-Hyder CA35.6%26.0%46.5%43143
All AlaskansSitka City and Borough31.3%24.5%39.1%77223
All AlaskansSkagway Municipality**22
All AlaskansSoutheast Fairbanks CA21.0%15.8%27.5%81323
All AlaskansValdez-Cordova CA26.8%20.9%33.7%78272
All AlaskansWrangell City and Borough22.4%11.8%38.5%1255
All AlaskansYakutat City and Borough**26
All AlaskansYukon-Koyukuk CA32.2%24.9%40.5%86272
Alaska Native peopleAleutians East Borough44.5%22.1%69.4%2057
Alaska Native peopleAleutians West CA35.8%18.0%58.6%2353
Alaska Native peopleAnchorage Municipality41.6%34.2%49.4%110263
Alaska Native peopleBethel CA34.9%27.1%43.7%89253
Alaska Native peopleBristol Bay Borough**39
Alaska Native peopleDenali Borough**4
Alaska Native peopleDillingham CA37.9%26.1%51.4%46115
Alaska Native peopleFairbanks North Star Borough46.9%37.9%56.1%79173
Alaska Native peopleHaines Borough**13
Alaska Native peopleHoonah-Angoon CA**17
Alaska Native peopleJuneau City and Borough53.2%40.4%65.5%4483
Alaska Native peopleKenai Peninsula Borough45.7%35.5%56.3%54117
Alaska Native peopleKetchikan Gateway Borough51.2%35.9%66.3%2657
Alaska Native peopleKodiak Island Borough**41
Alaska Native peopleKusilvak CA25.7%17.8%35.7%42142
Alaska Native peopleLake and Peninsula Borough32.4%19.8%48.3%1861
Alaska Native peopleMatanuska-Susitna Borough45.7%33.7%58.2%66155
Alaska Native peopleNome CA37.0%27.2%47.9%61151
Alaska Native peopleNorth Slope Borough31.8%18.6%48.7%2373
Alaska Native peopleNorthwest Arctic Borough56.7%44.7%68.0%55114
Alaska Native peoplePetersburg Borough**10
Alaska Native peoplePrince of Wales-Hyder CA35.4%19.8%54.8%1250
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 CA32.0%22.4%43.3%56151

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 a household member with substance 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: 22
All AlaskansAleutians and Pribilofs24.8%17.3%34.1%87287
All AlaskansAnchorage/Mat-Su28.8%26.9%30.9%1,2124,362
All AlaskansArctic Slope25.1%16.5%36.3%43125
All AlaskansBristol Bay34.6%25.8%44.5%139429
All AlaskansCopper R/Prince William Snd.26.3%20.6%33.0%80283
All AlaskansInterior29.0%26.6%31.5%7172,596
All AlaskansKenai Peninsula31.2%28.2%34.5%4191,341
All AlaskansKodiak Area31.0%24.0%39.0%82279
All AlaskansNorthwest Arctic47.4%37.4%57.6%71177
All AlaskansNorton Sound31.3%24.0%39.5%86256
All AlaskansSoutheast33.6%30.9%36.5%6071,893
All AlaskansYukon-Kuskokwim28.4%23.4%34.0%177595
Alaska Native peopleAleutians and Pribilofs40.4%24.7%58.4%43110
Alaska Native peopleAnchorage/Mat-Su42.8%36.4%49.5%176418
Alaska Native peopleArctic Slope35.0%20.4%53.0%2262
Alaska Native peopleBristol Bay36.7%28.1%46.3%84219
Alaska Native peopleInterior40.7%34.1%47.6%148359
Alaska Native peopleKenai Peninsula45.7%35.5%56.3%54117
Alaska Native peopleNorthwest Arctic54.2%42.5%65.4%56123
Alaska Native peopleNorton Sound37.0%27.2%47.9%61151
Alaska Native peopleSoutheast45.4%38.4%52.6%120285
Alaska Native peopleYukon-Kuskokwim31.3%25.5%37.9%132400

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 Health and Social Services. Substance Abuse Prevention Program. [http://dhss.alaska.gov/dbh/Pages/Prevention/programs/substanceabuse/default.aspx]. Accessed April 26, 2016. 3. U.S. Department of Health and Human Services. Protecting Children in Families Affected by Substance Use Disorders. [https://www.childwelfare.gov/pubPDFs/substanceuse.pdf]. Published 2009. Accessed April 26, 2016. 4. Alaska Department of Health and Social Services. Healthy Alaskans 2020. [http://hss.state.ak.us/ha2020/]. 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/ace-k/Documents/State_Interagency_Prevention_2015.pdf]. Accessed April 26, 2016. 6. 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. 7. 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. 8. Alaska Strategic Prevention Framework State Incentive Grant. [http://alaskaspfsig.org/]. Accessed 4/26/2016. 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. 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.

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 Thu, 21 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 10:26:17 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 Thu, 21 February 2019 18:43:08 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 10:26:17 AKDT