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State of Alaska

Complete Health Indicator Report of Adverse Childhood Experiences: Emotional and Verbal Abuse

Definition

Percentage of adults 18 years of age and older who responded "More than once" on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the question: "How often did a parent or adult in your home ever swear at you, insult you, or put you down?"

Numerator

Weighted number of adults (18+) who responded "More than once" on the BRFSS to the question: "How often did a parent or adult in your home ever swear at you, insult you, or put you down?"

Denominator

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

Data Interpretation Issues

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

Rates of child abuse are high and are a major public health concern in Alaska. Although the visible signs of emotional abuse in children can be difficult to detect, the hidden scars of this type of abuse manifest in numerous behavioral ways, including insecurity, poor self-esteem, destructive behavior, angry acts (such as fire setting and animal cruelty), withdrawal, poor development of basic skills, alcohol or drug abuse, suicide, difficulty forming relationships, and unstable job histories. Emotionally abused children often grow up thinking they are deficient in some way.^2^ The impacts of overwhelming stress on the brain 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. If emotionally abused children start families of their own, they can perpetuate ACEs for another generation.^3^ For example, a study found that 80% of 21-year-olds who reported childhood abuse met the criteria for at least one psychological disorder.^4^ 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.^5^ 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. American Humane Association. Stop child abuse, emotional abuse. [http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/emotional-abuse.html]. Accessed April 26, 2016. 3. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Adverse childhood experiences - overcoming ACEs in Alaska. [http://dhss.alaska.gov/abada/ace-ak/Documents/ACEsReportAlaska.pdf]. Published January 2015. Accessed April 26, 2016. 4. 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. 5. 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, 32.1% of Alaska adults reported having experienced childhood verbal and emotional abuse. Alaska Native adults had higher, but not significantly different, prevalence than all Alaska adults. Employment status was also associated with prevalence of verbal and emotional abuse: 32.7% of employed adults had been verbally or emotionally abused but 42.5% of those unable to work were exposed to this ACE. Rates of emotional and verbal 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 three-year averages by body mass index, current smoking, sexual orientation, and disability. Significant differences were evident in these contrasts. Rates of childhood emotional and verbal abuse 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.^6^ When compared to the five states, Alaska reported higher than the mean of the total states and was the second highest in rates of adults who had experienced childhood emotional and verbal abuse. Compared to rate of 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 physical abuse was higher.^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. 6. 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://dhss.alaska.gov/ocs/Pages/families/default.aspx Strengthening Families Protective Factors] framework in family programs. 3. Expand home visiting programs. 4. Expand and strengthen quality early childhood programs. 5. Train providers on brain development, adverse childhood experiences (ACEs), and resiliency.^7^ Alaska has many groups working on preventing childhood trauma and easing the effects of damage already done. Here are a few examples (as of early 2015):^8^ Statewide, teachers and public health nurses provide teens with information on healthy relationships and life skills. They have partnered with the Alaska departments of Health and Social Services and Education and Early Development, the [http://www.dps.alaska.gov/cdvsa/ Council on Domestic Violence and Sexual Assault], and the [http://www.andvsa.org/ Alaska Network on Domestic Violence and Sexual Assault] on an evidenced-based curriculum for the 7th-9th grade called [https://education.alaska.gov/tls/schoolhealth/fourth.html "the Fourth R for Healthy Relationships."] The Division of Public Health partnered with the Alaska Native Tribal Health Consortium and the [http://dhss.alaska.gov/dph/chronic/pages/injuryprevention/akfvpp/default.aspx Alaska Family Violence Prevention Project] to develop a teen safety card, a gender-neutral resource developed for Alaska teens with guidance from Alaska teens. The card provides information about healthy and unhealthy relationship characteristics, what consent looks and sounds like, and where to get help, if needed. Another safety card was designed specifically for women.^9^ The Division of Behavioral Health has promoted trauma-informed care for several years. Efforts include development of "Trauma 101" and "Trauma 201" curriculum for behavioral health providers, used around the state. [http://tundrapeace.org/programs/taav/ Teens Acting Against Violence (TAAV)] is a violence-prevention and youth empowerment program at the [http://tundrapeace.org/ Tundra Women's Coalition] for teenagers living in Bethel. Participation is voluntary and open for any interested teens age 12-18.^10^[[br]] [[br]] ---- {{class .SmallerFont 7. Alaska Department of Health and Social Services. Healthy Alaskans 2020. [http://hss.state.ak.us/ha2020/]. Accessed April 26, 2016. 8. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Adverse childhood experiences - overcoming ACEs in Alaska. [http://dhss.alaska.gov/abada/aceak/ Documents/ACEsReportAlaska.pdf]. Published January 2015. Accessed April 26, 2016. 9. Alaska Native Tribal Health Consortium. Getting together - teen relationship safety card. [http://www.anthctoday.org/epicenter/healthyfamilies/teenCard_111014.pdf]. Accessed April 26, 2016. 10. Teens Acting Against Violence. Tundra Women's Coalition - Crisis Line - 1-800-478-7799 or 907-543-3456 website. [http://tundrapeace.org/programs/taav/]. Accessed April 26, 2016. }}

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.^3^ The [http://www.cssp.org/ Center for the Study of Social Policy] spent two years researching and identifying five protective factors that prevent child abuse and neglect. These are: parental resilience, social connections, concrete support in times of need, knowledge of parenting and child development, and social and emotional competence of children. Research studies support the common-sense notion that when these protective factors are well established in a family, the likelihood of child abuse and neglect diminishes. Research shows that these protective factors are also "promotive" factors that build family strengths and a family environment that promotes optimal child and youth development.^12^[[br]] [[br]] ---- {{class .SmallerFont 3. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Adverse childhood experiences - overcoming ACEs in Alaska. [http://dhss.alaska.gov/abada/ace-ak/Documents/ACEsReportAlaska.pdf]. Published January 2015. Accessed April 26, 2016. 11. Child Welfare Information Gateway. Trauma-focused cognitive behavioral therapy for children affected by sexual abuse or trauma. [https://www.childwelfare.gov/pubPDFs/trauma.pdf]. Accessed April 26, 2016. 12. Alaska Department of Health and Social Services. Office of Children's Services. Strengthening families. [http://dhss.alaska.gov/ocs/Pages/families/default.aspx]. Accessed April 26, 2016. }}


Related Indicators

Related Relevant Population Characteristics Indicators:


Related Health Care System Factors Indicators:


Related Risk Factors Indicators:


Related Health Status Outcomes Indicators:




Graphical Data Views

Percentage of adults (18+) who experienced emotional and/or verbal 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 Alaskans32.1%30.7%33.5%3,42511,179
Alaska Native people34.3%31.0%37.6%6451,947

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 emotional and/or verbal 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
Males31.7%29.8%33.6%1,5075,078
Females32.5%30.5%34.5%1,9186,101

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 emotional and/or verbal 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
18-2436.7%31.7%41.9%223669
25-3433.5%30.0%37.2%4531,414
35-4434.4%31.0%37.9%5551,639
45-6432.7%30.8%34.7%1,6374,888
65+21.6%19.2%24.1%5414,278

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 emotional and/or verbal 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)34.3%31.0%37.6%3451,947
Asian (non-Hispanic)21.8%14.6%31.3%37204
Black (non-Hispanic)27.3%19.2%37.2%40146
Native Hawaiian/Other Pacific Islander (non-Hispanic)22.1%10.8%40.1%1156
White (non-Hispanic)32.6%31.0%34.2%2,5158,280
Multiracial/Other (non-Hisp.)35.4%22.2%51.2%2969
Hispanic (alone or multi)35.5%28.0%43.8%94282

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 emotional and/or verbal 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/Latino36.3%29.2%44.0%116325
Non-Hispanic/Latino31.9%30.5%33.3%3,26510,726

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 emotional and/or verbal 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
Married28.6%27.0%30.2%1,7616,136
Widowed25.0%20.4%30.3%195897
Divorced/Separated38.0%34.6%41.6%6871,862
Never Married34.2%30.7%37.8%5571,746
Living with a Partner46.7%40.1%53.4%201461

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 emotional and/or verbal abuse, crude rate, by education, all Alaskans, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Percentage of 3dultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 4
Less than High School34.7%28.6%41.4%160536
High School Graduate or GED32.2%29.5%35.0%7842,617
Some College or Tech. School32.3%29.9%34.7%9943,075
College Graduate28.5%26.6%30.6%1,2534,221

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 emotional and/or verbal 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
Employed32.7%30.9%34.4%2,1046,631
Unemployed34.7%30.0%39.7%258711
Not in Work Force28.2%25.5%31.0%8073,184
Unable to Work42.5%36.1%49.1%233548

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 emotional and/or verbal 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
<$15,00034.4%29.5%39.7%308875
$15,000-$24,99938.0%33.5%42.8%4011,224
$25,000-$49,00033.8%30.7%37.1%6482,130
$50,000-$74,00031.7%28.6%35.0%5371,763
$75,000+30.6%28.5%32.8%1,2994,219

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 emotional and/or verbal 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
Poor34.7%29.0%40.8%245754
Near Poor35.4%31.6%39.3%4751,378
Middle/High30.5%28.9%32.1%2,1557,172

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 emotional and/or verbal 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 Obese30.1%27.6%32.6%9873,535
Overweight32.2%29.9%34.6%1,1843,955
Obese35.2%32.7%37.7%1,1413,246

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 emotional and/or verbal 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 smoker29.7%28.2%31.3%2,6259,088
Current smoker41.3%38.0%44.7%7852,029

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 emotional and/or verbal 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
Heterosexual31.6%30.2%33.1%3,19710,505
Gay, Lesbian, or Bisexual51.1%43.2%58.9%142312

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 emotional and/or verbal 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 Present44.4%40.8%48.0%8331,998
Disability Absent29.5%28.1%31.0%2,5519,047

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 emotional and/or verbal 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 AlaskansAnchorage32.2%29.6%35.0%6892,211
All AlaskansGulf Coast31.7%28.9%34.6%5381,704
All AlaskansInterior31.2%28.6%33.9%6832,345
All AlaskansMat-Su34.9%31.6%38.4%5451,643
All AlaskansNorthern29.6%24.1%35.7%141478
All AlaskansSoutheast32.4%29.5%35.4%5271,693
All AlaskansSouthwest27.1%22.7%32.1%3021,105
Alaska Native peopleAnchorage33.6%26.2%41.9%81218
Alaska Native peopleGulf Coast37.3%28.4%47.0%59167
Alaska Native peopleInterior37.7%30.8%45.2%111308
Alaska Native peopleMat-Su42.7%30.1%56.3%56143
Alaska Native peopleNorthern29.7%23.0%37.5%84274
Alaska Native peopleSoutheast38.0%30.7%45.8%91241
Alaska Native peopleSouthwest25.9%21.2%31.2%163596

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 emotional and/or verbal 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 MSA32.9%30.7%35.2%1,2343,854
All AlaskansFairbanks North Star MSA31.7%28.7%34.8%5021,715
All AlaskansJuneau MicroSA32.6%28.3%37.3%242726
All AlaskansKetchikan Gateway MicroSA36.6%29.2%44.7%96305
All AlaskansRural (non-Metro/MicroSA)30.1%28.3%32.0%1,3514,579
Alaska Native peopleAnchorage MSA36.7%30.0%44.0%137361
Alaska Native peopleFairbanks North Star MSA47.3%37.5%57.3%65146
Alaska Native peopleJuneau MicroSA39.8%27.4%53.5%3074
Alaska Native peopleKetchikan Gateway MicroSA**42
Alaska Native peopleRural (non-Metro/MicroSA)29.5%26.1%33.0%3981,324

Data Notes

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

Data Source

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


Percentage of adults (18+) who experienced emotional and/or verbal abuse, crude rate, by behavioral health areas, all Alaskans and Alaska Natvies, 2013-2015 (3-year average)

::chart - missing::
confidence limits

Alaska ComparisonsPercentage of adultsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 20
All AlaskansAnchorage Muncipality32.2%29.6%35.0%6892,211
All AlaskansFairbanks North Star Borough31.6%28.7%34.7%5041,722
All AlaskansCity and Borough of Juneau32.6%28.3%37.3%242726
All AlaskansKenai Peninsula Borough33.2%29.8%36.7%3911,210
All AlaskansMatanuska-Susitna Borough34.9%31.6%38.4%5451,643
All AlaskansNorthwest Region29.6%24.1%35.7%141478
All AlaskansOther Interior Region30.4%26.2%34.9%257871
All AlaskansY-K Delta Region25.3%20.1%31.3%143500
All AlaskansSouthwest Region27.0%22.2%32.4%228851
All AlaskansOther Southeast Region32.2%28.3%36.3%285967
Alaska Native peopleAnchorage Muncipality33.6%26.2%41.9%81218
Alaska Native peopleFairbanks North Star Borough46.8%37.0%56.7%65147
Alaska Native peopleCity and Borough of Juneau39.8%27.4%53.5%3074
Alaska Native peopleKenai Peninsula Borough40.7%30.0%52.4%40100
Alaska Native peopleMatanuska-Susitna Borough42.7%30.1%56.3%56143
Alaska Native peopleNorthwest Region29.7%23.0%37.5%84274
Alaska Native peopleOther Interior Region24.4%17.6%32.8%53191
Alaska Native peopleY-K Delta Region25.2%19.4%32.2%90322
Alaska Native peopleSouthwest Region29.3%21.8%38.1%85311
Alaska Native peopleOther Southeast Region37.1%28.4%46.8%61167

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 emotional and/or verbal 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 Borough13.8%6.9%26.0%1592
All AlaskansAleutians West CA29.3%18.4%43.2%44148
All AlaskansAnchorage Municipality32.2%29.6%35.0%6892,211
All AlaskansBethel CA28.0%21.5%35.4%114372
All AlaskansBristol Bay Borough30.2%18.8%44.8%2485
All AlaskansDenali Borough33.6%21.5%48.3%2698
All AlaskansDillingham CA31.8%22.0%43.5%55188
All AlaskansFairbanks North Star Borough31.6%28.7%34.7%5041,722
All AlaskansHaines Borough31.1%19.8%45.2%2488
All AlaskansHoonah-Angoon CA36.1%22.6%52.2%1857
All AlaskansJuneau City and Borough32.6%28.3%37.3%242726
All AlaskansKenai Peninsula Borough33.2%29.8%36.7%3911,210
All AlaskansKetchikan Gateway Borough36.6%29.2%44.7%96305
All AlaskansKodiak Island Borough24.6%18.5%31.9%69246
All AlaskansKusilvak CA19.4%12.0%29.8%29128
All AlaskansLake and Peninsula Borough39.8%15.4%70.6%2192
All AlaskansMatanuska-Susitna Borough34.9%31.6%38.4%5451,643
All AlaskansNome CA34.9%25.8%45.3%60213
All AlaskansNorth Slope Borough23.8%15.1%35.3%36122
All AlaskansNorthwest Arctic Borough28.3%19.9%38.6%45143
All AlaskansPetersburg Borough20.0%12.2%31.0%1895
All AlaskansPrince of Wales-Hyder CA32.6%22.7%44.3%36128
All AlaskansSitka City and Borough29.2%22.3%37.1%69207
All AlaskansSkagway Municipality**19
All AlaskansSoutheast Fairbanks CA29.4%22.2%37.9%88289
All AlaskansValdez-Cordova CA32.3%25.2%40.3%78248
All AlaskansWrangell City and Borough**46
All AlaskansYakutat City and Borough**22
All AlaskansYukon-Koyukuk CA27.2%20.2%35.5%65236
Alaska Native peopleAleutians East Borough15.6%5.9%35.0%847
Alaska Native peopleAleutians West CA24.8%11.4%45.7%1444
Alaska Native peopleAnchorage Municipality33.6%26.2%41.9%81218
Alaska Native peopleBethel CA28.6%20.9%37.9%66212
Alaska Native peopleBristol Bay Borough**36
Alaska Native peopleDenali Borough**3
Alaska Native peopleDillingham CA32.8%20.3%48.4%3097
Alaska Native peopleFairbanks North Star Borough46.8%37.0%56.7%65147
Alaska Native peopleHaines Borough**12
Alaska Native peopleHoonah-Angoon CA**15
Alaska Native peopleJuneau City and Borough39.8%27.4%53.5%3074
Alaska Native peopleKenai Peninsula Borough40.7%30.0%52.4%40100
Alaska Native peopleKetchikan Gateway Borough41.8%24.9%60.9%1542
Alaska Native peopleKodiak Island Borough37.2%18.5%60.8%1237
Alaska Native peopleKusilvak CA19.3%11.7%30.2%24110
Alaska Native peopleLake and Peninsula Borough28.3%15.1%46.5%1250
Alaska Native peopleMatanuska-Susitna Borough42.7%30.1%56.3%56143
Alaska Native peopleNome CA34.5%23.1%48.0%38119
Alaska Native peopleNorth Slope Borough25.8%14.5%41.8%1960
Alaska Native peopleNorthwest Arctic Borough27.0%17.5%39.1%2795
Alaska Native peoplePetersburg Borough**9
Alaska Native peoplePrince of Wales-Hyder CA**39
Alaska Native peopleSitka City and Borough**30
Alaska Native peopleSkagway Municipality**1
Alaska Native peopleSoutheast Fairbanks CA**36
Alaska Native peopleValdez-Cordova CA**30
Alaska Native peopleWrangell City and Borough**9
Alaska Native peopleYakutat City and Borough**10
Alaska Native peopleYukon-Koyukuk CA22.5%14.4%33.4%33122

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 emotional and/or verbal 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 Pribilofs23.9%16.2%33.8%59240
All AlaskansAnchorage/Mat-Su32.9%30.7%35.2%1,2343,854
All AlaskansArctic Slope24.7%15.7%36.7%36111
All AlaskansBristol Bay33.0%23.1%44.6%102370
All AlaskansCopper R/Prince William Snd.32.2%25.2%40.0%81258
All AlaskansInterior31.2%28.6%33.9%6782,329
All AlaskansKenai Peninsula33.2%29.8%36.7%3911,210
All AlaskansKodiak Area24.6%18.5%31.9%69246
All AlaskansNorthwest Arctic27.3%19.2%37.3%45152
All AlaskansNorton Sound34.9%25.8%45.3%60213
All AlaskansSoutheast32.4%29.5%35.4%5271,693
All AlaskansYukon-Kuskokwim25.9%20.7%31.9%143503
Alaska Native peopleAleutians and Pribilofs19.8%10.9%33.3%2291
Alaska Native peopleAnchorage/Mat-Su36.7%30.0%44.0%137361
Alaska Native peopleArctic Slope27.8%15.4%44.7%1952
Alaska Native peopleBristol Bay30.4%21.3%41.2%52186
Alaska Native peopleCopper R/Prince William Snd.**32
Alaska Native peopleInterior38.3%31.3%45.8%110301
Alaska Native peopleKenai Peninsula40.7%30.0%52.4%40100
Alaska Native peopleKodiak Area**37
Alaska Native peopleNorthwest Arctic26.0%16.9%37.8%27102
Alaska Native peopleNorton Sound34.5%23.1%48.0%38119
Alaska Native peopleSoutheast38.0%30.7%45.8%91241
Alaska Native peopleYukon-Kuskokwim25.2%19.3%32.1%90325

Data Notes

** = Data not available due to fewer than 50 respondents in the denominator. Geographic descriptions of the tribal health organization regions can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_thr.aspx].

Data Source

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

References and Community Resources

'''References:''' 1. U.S. Centers for Disease Control and Prevention (CDC). Adverse Childhood Experiences (ACE) Study. [http://www.cdc.gov/violenceprevention/acestudy/index.html]. Updated April 1, 2016. Accessed April 26, 2016. 2. American Humane Association. Stop child abuse, emotional abuse. [http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/emotional-abuse.html]. Accessed April 26, 2016. 3. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Adverse childhood experiences - overcoming ACEs in Alaska. [http://dhss.alaska.gov/abada/ace-ak/Documents/ACEsReportAlaska.pdf]. Published January 2015. Accessed April 26, 2016. 4. 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. 5. 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. 6. 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. 7. Alaska Department of Health and Social Services. Healthy Alaskans 2020. [http://hss.state.ak.us/ha2020/]. Accessed April 26, 2016. 8. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Adverse childhood experiences - overcoming ACEs in Alaska. [http://dhss.alaska.gov/abada/aceak/ Documents/ACEsReportAlaska.pdf]. Published January 2015. Accessed April 26, 2016. 9. Alaska Native Tribal Health Consortium. Getting together - teen relationship safety card. [http://www.anthctoday.org/epicenter/healthyfamilies/teenCard_111014.pdf]. Accessed April 26, 2016. 10. Teens Acting Against Violence. Tundra Women's Coalition - Crisis Line - 1-800-478-7799 or 907-543-3456 website. [http://tundrapeace.org/programs/taav/]. Accessed April 26, 2016. 11. Child Welfare Information Gateway. Trauma-focused cognitive behavioral therapy for children affected by sexual abuse or trauma. [https://www.childwelfare.gov/pubPDFs/trauma.pdf]. Accessed April 26, 2016. 12. Alaska Department of Health and Social Services. Office of Children's Services. Strengthening families. [http://dhss.alaska.gov/ocs/Pages/families/default.aspx]. Accessed April 26, 2016.

More Resources and Links

Alaska and national goals may be found at the following sites:

Alaska health promotion resources may be found at the following site:

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Maps of health indicators for various subdivisions of Alaska may be found at the following site:

Additional indicator data by state and county may be found on these Websites:

Medical literature can be queried at the PubMed website.

For an on-line medical dictionary, click on this Dictionary link.

AK-IBIS Web Citation

Use and reproduction of the information published on this website are encouraged and may be done without permission. The following citation should accompany information from this website whenever it is used, reproduced, or published:

AK-IBIS Indicator Citation:
"[Indicator name]. Retrieved on [insert date] from Alaska Department of Health and Social Services, Indicator-Based Information System for Public Health (AK-IBIS) website: http://ibis.dhss.alaska.gov/.

Example:
Diabetes Prevalence. Retrieved on March 25, 2016, from Alaska Department of Health and Social Services, Indicator-Based Information System for Public Health (AK-IBIS) website: http://ibis.dhss.alaska.gov/.

Page Content Updated On 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 Mon, 16 September 2019 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health web site: http://ibis.dhss.alaska.gov ".

Content updated: Tue, 31 Oct 2017 10:19:03 AKDT
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Mon, 16 September 2019 14:17:10 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 10:19:03 AKDT