StatChat: Using Data as a Non Data User
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Aditi Srivastav Bussells, MPH - ACE Coordinator, Children's Trust of South Carolina
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StatChat: Using Data as a Non Data User
- 1. StatChat: Using Data as a Non Data User Aditi Srivastav Bussells, MPH ACE Coordinator
- 2. Objectives • Recognize basic public health data types and terms • Learn about the Behavioral Risk Factor Surveillance System • Understand South Carolina’s Adverse Childhood Experiences (ACE) data • Apply ACE data to community efforts Children's Trust of South Carolina 2
- 3. Types of data • Identifying an individuals name or address • Demographic age, sex, race, ethnicity • Clinical diagnoses, signs, weight, height • Lab x-rays, MRIs • Risk Factor family history, smoking, diet • Source name, date, type of survey Children's Trust of South Carolina 3
- 4. ACE Data Source • Behavioral Risk Factor Surveillance Survey (BRFSS), SC Department of Health and Environmental Control – Sample size ~ 11,027 – Collected 2014-2016 • ACE Survey = 11 items –Sample size ~ 11,027 4
- 5. Behavioral Risk Factor Surveillance System • Established in 1984 by CDC • State-based system • Monitor health risk behaviors, preventive health practices, health care access health practices, health care access - Chronic diseases and injuries Chronic diseases and injuries • Conducted by Health Departments in all 50 states, District of Columbia, all 50 states, District of Columbia, Puerto Rico, U.S Virgin Islands and Puerto Rico, U.S Virgin Islands and Guam Children's Trust of South Carolina 5
- 6. BRFSS (Cont’d) • Telephone health interview survey (landline and cell phone) • Completed annually • Information from a representative sample of non-institutionalized adults aged 18 and older • Representative sample, which means we can apply data to entire South Carolina population Children's Trust of South Carolina 6
- 7. Examples of Questionnaire Content –Health Status – Demographics – Pregnancy – Smoking – Diabetes – Health Insurance – Routine checkup– Women’s Health– HIV/AIDS - Oral health– Hypertension – Alcohol– Injury – Cholesterol–Physical activity – Fruits & vegetables– Weight control– Cardiovascular health Children's Trust of South Carolina 7
- 8. BRFSS Questionnaire • Core components: questions asked every year or every other year • Optional modules supported by CDC: ACE questions • State added questions: Other related questions Children's Trust of South Carolina 8
- 9. Children's Trust of South Carolina 9
- 10. ACE Survey Items • Substance Abuse • Mental Illness • Domestic Violence • Separation/Divorce • Incarceration 10 • Physical Abuse • Emotional Abuse • Sexual Abuse
- 11. Children's Trust of South Carolina 11 ACE Questions 1. Did you live with anyone who was depressed, mentally ill, or suicidal? 2. Did you live with anyone who was a problem drinker or alcoholic? 3. Did you live with anyone who used illegal street drugs or who abused prescription medications? 4. Did you live with anyone who served time or was sentenced to serve time in a prison, jail, or other correctional facility? 5. Were your parents separated or divorced? 6. How often did your parents or adults in your home ever slap, hit, kick, punch, or beat each other up? 7. Before age 18, how often did a parent or adult in your home ever hit, beat, kick, or physically hurt you in any way? 8. How often did a parent or adult in your home ever swear at you, insult you, or put you down 9. How often did anyone at least five years older than you or an adult ever touch you sexually? 10. How often did anyone at least five years older than you or an adult try to make you touch them sexually? 11. How often did anyone at least five years older than you or an adult force you to have sex?
- 12. How we describe ACE data • Prevalence – Individual – Overall – Demographics • Cumulative • Associations (Relationship to ACEs) • Interrelatedness Children's Trust of South Carolina 12
- 13. Prevalence • The current burden of ACEs in South Carolina’s population; the frequency of current ACEs • Prevalence helps in our prevention planning efforts and resource allocation Children's Trust of South Carolina 13
- 14. Individual The type of ACEs reported by individuals 14
- 15. Individual ACE Types in South Carolina Children's Trust of South Carolina 15 DIVORCE/ SEPARATION 30% INCARCERATION 9% SEXUAL ABUSE 14% DOMESTIC VIOLENCE 20% MENTAL ILLNESS 16% PHYSICAL ABUSE 16% EMOTIONAL ABUSE 30% SUBSTANCE USE 28%
- 16. Prevalence in South Carolina Children's Trust of South Carolina 16 62% have ACEs 38% don’t have ACEs
- 17. Cumulative • The number of ACEs reported by an individual – None – One – Two – Three – Four or more • Cumulative helps us understand trends and overall risk Children's Trust of South Carolina 17
- 18. Risk Factors • Risk factors commonly associated with ACEs: – Smoking and Alcohol Consumption – Chronic Conditions (asthma, kidney disease, heart disease, COPD) – Mental Health – Health Care Access and Use Children's Trust of South Carolina 18
- 19. Physical Health Children's Trust of South Carolina 19 Condition No ACE ACE 4+ ACE Heart disease 44% 56% 13% Arthritis 38% 62% 19% Asthma 32% 68% 24% COPD 32% 68% 26% Diabetes 43% 57% 14% Heart attack 44% 56% 14% Kidney disease 35% 65% 18% Skin cancer 51% 49% 10% Stroke 41% 59% 18%
- 20. Mental Health Children's Trust of South Carolina 20 Condition No ACE ACE 4+ ACE Depressive Disorder 21% 79% 33% General health Excellent 43% 57% 13% Very Good 41% 59% 14% Good 37% 63% 18% Fair 32% 68% 21% Poor 32% 68% 23%
- 21. Behavioral Risk Children's Trust of South Carolina 21 Risk No ACE ACE 4+ ACE Current smoker 24% 76% 30% Ever smoked 32% 68% 22% Binge drinker 29% 71% 23% Never use seatbelt 32% 68% 19%
- 22. Healthcare Access Children's Trust of South Carolina 22 Utilization No ACE ACE 4+ ACE No Health Coverage 24% 76% 25% Medical Cost Barrier 19% 81% 35% No Personal Care Provider 29% 71% 22% Checkup Over 2 Years Ago 34% 66% 19% Checkup Never 28% 72% 18%
- 23. Associations • Observe trends and relationships between ACEs and different kind of outcomes – Trend= pattern over time? – Relationship= yes/no, positive/negative • Helps us in making an argument for WHY ACEs are important • Correlation does not equal causation! Children's Trust of South Carolina 23
- 24. Children's Trust of South Carolina 24 We can’t predict cause, just that there is an association!
- 25. 25 14% have 4+ ACEs 18% have 4+ ACEs ACEs and Gender 60% have ACES 63% have ACEs
- 26. Race/Ethnicity and ACEs: The Importance of Correlation 26 29% 53% 35% 21% 41% 71% 47% 65% 79% 59% 1% 1% 25% 4% 68% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% American Indian Asian Black Hispanic White No ACE ACE Total Population
- 27. Your Turn: Education and ACEs Children's Trust of South Carolina 27 53% of college graduates have ACEs 63% of high school graduates have ACEs 68% of people with some high school have ACEs
- 28. Your Turn: ACEs and Income 70% 68% 63% 57% 30% 32% 37% 43% 0-$9,000 $20-24,999 $35-49,999 $75,000 + 0% 10% 20% 30% 40% 50% 60% 70% 80% ACEs No ACEChildren's Trust of South Carolina 28
- 29. Your Turn: ACEs and Health Care Children's Trust of South Carolina 29 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% No Health Coverage Medical Cost Barrier No Personal Care Provider Checkup Over 2 Years Ago Checkup Never No ACE ACE
- 30. Interrelatedness • Interrelated means “to occur together” • To examine the co-occurrence of ACEs, we look at: – the prevalence – and odds that exposure to an individual ACE was associated with exposure to another individual ACE Children's Trust of South Carolina 30
- 31. ACEs and Outcomes ACEs Physical Health Health Care Access Mental Health Behavioral Risk Children's Trust of South Carolina 31 Prevention Primary Care System Health Insurance System Education and Social Systems Across young adulthood
- 32. But what about the relationship BETWEEN ACEs and Prevention Efforts? Emotional Abuse Physical Abuse Sexual Abuse Mental Illness Domestic Violence Incarceration Substance Use Divorce/ Separation Prevention
- 33. Of the population that reports incarceration of a parent, Children's Trust of South Carolina 33 48% report 4+ ACEs
- 34. Prevalence of ACEs & co-occurrence of additional ACEs Children's Trust of South Carolina 34 Of the Population that Reported this ACE…. 0 ≥1 ≥2 ≥3 ≥4 Divorce/Separation 30% 19% 16% 12% 24% Emotional Abuse 16% 19% 19% 15% 30% Substance Use 15% 19% 21% 15% 30% Domestic Violence 8% 15% 18% 18% 40% Mental Illness 12% 15% 16% 15% 42% Physical Abuse 5% 10% 16% 19% 50% Sexual Abuse 13% 16% 16% 14% 42% Incarceration 5% 15% 16% 14% 48%
- 35. Interrelatedness Compare the relative odds (probability) that one type of ACE will occur given exposure to another type of ACE i.e. Odd Ratio = 5 An individual who experienced physical abuse is at 5x greater odds of experiencing mental illness than those who did not experience physical abuse 35 Odds Ratios
- 36. Child Abuse ACE and Odds of Other ACEs Children's Trust of South Carolina 36 Physical Abuse 17x greater odds to have emotional abuse 11x greater odds to have household domestic violence 5x times greater odds to have substance use in the household 6x greater odds to have sexual abuse
- 37. Your Turn! Children's Trust of South Carolina 37 Household Substance Use OR: 5 physical abuse OR: 7 domestic violence OR: 10 household incarceration OR: 6 household mental illness
- 38. Children's Trust of South Carolina 38 Parental Incarceration OR: 10 Substance Use OR: 5 domestic violence OR: 4 Mental illness in the household OR: 4 divorce/separation Your Turn!
- 39. Applying Data in Your Community Audience: School Board Ask: Get teachers trained in a trauma informed curriculum, requires money and time What data would you use? Children's Trust of South Carolina 39
- 40. Applying Data in Your Community • Audience: Prevention Grant • Ask: To develop a program that helps at risk youth from engaging in substance use, prevents domestic violence, improves foster care system What data would you use? Children's Trust of South Carolina 40
- 41. Applying Data in Your Community • Audience: Your family and friends • Ask: Explain why ACEs are important in a way that makes sense What data would you use? Children's Trust of South Carolina 41
- 42. scChildren.org Thank you! Aditi Srivastav Bussells ACE Coordinator 803-622-7062 ASrivastav@scChildren.org Children's Trust of South Carolina 42
Hinweis der Redaktion
- What is the BRFSS/History of BRFSS? The Behavioral Risk Factor Surveillance System (BRFSS) is the nation's premier system of health-related telephone surveys that collect state data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services. Established in 1984 with 15 states, BRFSS now collects data in all 50 states as well as the District of Columbia and three U.S. territories. BRFSS completes more than 400,000 adult interviews each year, making it the largest continuously conducted health survey system in the world. Who participates? Adults 18 years or older are asked to take part in the survey. Participants are not compensated monetarily but should know that they are taking part in a rewarding endeavor that helps improve the health of U.S. residents. The number of interviews within each state will vary based on funding and the size of regions, such as health districts, within each state. But aren’t we asking some questions about childhood experiences? Why are we asking adults? Yes, the ACE questions do concern childhood experiences. However, we are asking adults to retrospectively recall whether they experienced these things. Because we are also asking about adult outcomes including current health conditions and risk factors, it makes sense to administer the BRFSS to adults. Additionally, there are potential issues with consent and validity associated with surveying children over the phone. How are participants contacted? The survey is conducted year-round using Random Digit Dialing (RDD) techniques on both landlines and cell phones. Who is in charge of the survey? On a national level, the CDC (Centers for Disease Control and Prevention) are in charge of the BRFSS. In South Carolina, the survey is administered by DHEC (Department of Health and Environmental Control). What gets asked in the BRFSS? National modules: Health status, healthcare access, exercise, chronic health conditions (including physical and mental illnesses), oral health, demographics, tobacco use, immunization, falls (only for respondents 45 or older), seatbelt use, drinking and driving, breast and cervical cancer (only for female respondents), prostate cancer screening (only for male respondents 39 or older), colorectal cancer screening (only for respondents 49 and older), HIV/AIDS Additional SC modules: diabetes, healthcare access, pre-diabetes, Adverse Childhood Experiences (ACEs) questions Sample sizes are the total number of South Carolinians that were asked questions – responses to each individual questions may vary.
- ACEs Survey Item Categories and Corresponding Questions: -Substance Abuse: Lived with alcoholic? OR Lived with drug user? -Mental illness: Lived with anyone who was depressed/mentally ill/suicidal? -Domestic Violence: Physical abuse among parents? -Divorce: Parents separated or divorced? -Incarceration: Lived with anyone who served time in prison? -Physical Abuse: Parental physical abuse? -Emotional Abuse: Parental verbal abuse? -Sexual Abuse: Ever touch you sexually? OR Ever make you touch them sexually? OR Force you to have sex? But aren’t we asking some questions about childhood experiences? Why are we asking adults? Yes, the ACE questions do concern childhood experiences. However, we are asking adults to retrospectively recall whether they experienced these things. Because we are also asking about adult outcomes including current health conditions and risk factors, it makes sense to administer the BRFSS to adults. Additionally, there are potential issues with consent and validity associated with surveying children over the phone.
- We’re concerned about cumulative impact, and exposure.
- We’re particularly interested in prevalence, or the number of people who have experienced ACEs in their life. You can see in your data packet that over 60% or 62% of South Carolina’s adults have experienced ACEs. That’s 6 out of ten people. Well over the majority. Similarly, only 38% have not experienced ACEs, that’s roughly 4 out of ten people.
- Asthma, COPD, kidney disease: 69% reported an ACE COPD: 27% had 4+ ACEs Asthma and kidney disease: 25% had 4+ ACEs ACEs adult chronic disease Health costs projected to increase to $4.2 trillion annually
- ACEs prevalent among those reporting a depressive disorder and low QofL ACEs prevention can impact mental health and well-being Mental health is closely linked to productivity and can impact many facets of life, including intergenerationally
- ACEs are common and are associated with risk behaviors Smokers and binge/heavy drinkers had higher rates of ACEs compared to non-smokers/drinkers Reduction in ACEs could potentially reduce risk behaviors and negative outcomes associated with risk behaviors
- South Carolinians who experienced ACEs had low rates of healthcare coverage frequently reported medical cost as a barrier to care low rates of having a medical home low rates of preventative care decreased access to healthcare among South Carolina adults who experienced ACEs Improving access to healthcare for those with ACEs is key to reducing ACEs in the community Using healthcare settings as a way to educate families about ACEs may help prevent future ACEs Educating primary care providers on the impact of ACEs and healthcare use is important to develop better screening and treatment
- Important to integrate the impact of social disadvantage and stress linked with race/ethnicity on childhood adversity Need to better understand contextual factors that cause higher rates of ACEs in certain racial groups Race/ethnicity analysis can provide insight on ways to develop better frameworks and programs
- Income is not always a protective factor, but we do see a slight decrease in ACEs as income rises. May be connected to access.
- A wealth of research has documented the relationship between exposure to adversity in childhood and negative health and social outcomes in adulthood Early studies focused on the long-term health and social impacts of a single type of adversity Health and social impact of childhood adversity may best be understood by examining the co-occurrence of types of adversity compared to a single type of adversity, as adversities tend to be related to one another This information has important implications for both prevention efforts and intervention and treatment of adversity