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Member Health Survey

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Region Report and Highlights for 2008

The Kaiser Permanente Division of Research has prepared reports profiling the adult Health Plan membership aged 20 and over in the Northern California region. The statistics in this report are based on respondent data that have been weighted to the age and gender distribution of the medical center service population (MCSP) from which the respondents were drawn. Hence, the weighted data takes into account differences in the sizes of the MCSPs in the region. Larger MCSPs have greater influence on the final regional statistics than smaller MCSPs.

2008 Northern California Region Report

Highlights

Who are our members, and what is the status of their health? These highlights summarize the results of the 2008 Member Health Survey conducted by Kaiser Permanente’s Division of Research.

To create a health profile of our 2.3 million adult members in Northern California, we mailed surveys to stratified random samples of about 42,000 adult members in spring 2008. The overall response rate was 41 percent. However, this varied by age group (25 percent of ages 20-44, 42 percent of ages 45-64, and 69 percent of ages 65 and over. 

Statistics are based on self-reported data weighted to reflect the age, gender, and geographic composition of the adult membership at the time the survey was conducted. Tests for statistically significant differences were conducted using SAS® procedures for analyzing complex survey data. All differences indicated in the text are statistically significant at a minimum of P < 0.05. 

Overview of results

Compared with the 2005 survey results, the 2008 Member Health Survey found that:

  • The adult membership slowly continues to become more racially and ethnically diverse.
  • The prevalence of diabetes among adult members has not changed, but the prevalence of high blood pressure and high cholesterol has increased.
  • Higher percentages of adult members are eating at least three servings of fruits and vegetables per day and are trying to eat reduced fat foods.
  • Exercise frequency has not changed.
  • Cigarette smoking has not changed, but the percentage of those who smoke more than occasionally (sometimes or daily) has decreased.
  • Obesity (BMI ≥ 30) has not increased; however, the percentage of adult members who are very obese (BMI ≥35) shows a small but significant increase.
  • Member access to the Internet and email has increased; however, the percentage of members interested in using the Internet for health information and health education has not increased.

 In addition, the survey shows:

  • The percentage of adult members who are experiencing emotional difficulties is much higher than indicators of depression alone may suggest.
  • More than 80 percent of adult members believe that health behaviors/lifestyle (such as diet, obesity, and exercise) can greatly impact health.

Result highlights by category

Demographic characteristics

Race/Ethnic composition 

  • Our adult membership continues to become more diverse. The percentage of non-Hispanic white adult members decreased from 62 percent in 2005 to 60 percent in 2008. The percentage of adult Asian members increased from 17 percent to18 percent, and the percentage of adult Latino members increased from 12 percent to 13 percent. These changes are primarily occurring in the young and middle-aged cohorts. 
  • Learn more about race/ethnic characteristics

Educational attainment

  • Among members aged 25 and over, 44 percent are college graduates, and 82 percent have at least some college education.
  • Educational attainment declines with age.
  • Among seniors, men have higher educational attainment than women. Among other members, there is no gender difference in educational attainment.
  • There are significant race/ethnic disparities in educational attainment, especially among older members. Non-Hispanic whites are more likely than blacks and Latinos to be college graduates. Latinos are less likely than non-Hispanic whites and blacks to have attended any college.  
  • Learn more about educational attainment

Employment

  • In 2008, 83 percent of men and 76 percent of women aged 20-64 considered themselves to be part of the workforce: 75 percent of men and 54 percent of women were working 40 hours or more per week.
  • Approximately 2 percent of members aged 20-44 and 17 percent of those aged 45-64 were retired or unable to work due to health problems.
  • While the majority of men and women aged 65 and over were retired, 16 percent of men and 12 percent of women were still in the workforce. The majority of those still working were aged 65-74.

Relationships

  • In 2008, 78 percent of men and 72 percent of women aged 20 and over were married or in a marriage-like relationship; however, the percentage of women in such relationships declines with age.
  • Fewer than half of female members aged 65 and older are married or living as a couple.
  • Across all three age groups, black women are less likely to be married or in a marriage-like relationship than are non-Hispanic white women and Latinas. 
  • Learn more about demographic differences in relationships

Health status

Overall health

  • In 2008, 55 percent of adult members rated their health as “very good” or “excellent.” Further, 89 percent rated their health as “good” or better. These percentages declined with age. For example, 64 percent of members aged 20-44 reported “very good” or “excellent” health in contrast to 37 percent of those 65 and older.
  • Across all age groups, non-Hispanic Whites were more likely than blacks and Latinos to rate their health as “very good or excellent.”
  • There were no significant gender differences in rating of overall health status. 
  • Learn more about demographic differences in self-rated health status

Chronic conditions related to coronary heart disease (CHD)

  • In 2008, 11 percent of members aged 45-64 had diabetes, 34 percent had high blood pressure, and 30 percent had high cholesterol. The prevalence of all three conditions were higher among men. Among those aged 65 and over, 18 percent had diabetes, 61 percent had high blood pressure, and 48 percent had high cholesterol. Again, men had a higher prevalence of diabetes and high cholesterol.
  • Among 45-64 year olds, 22 percent had at least two of these chronic conditions. Among seniors, the prevalence increased to 42 percent. In both age groups, men were more likely than women to have at least two of these chronic conditions.
  • Among adults aged 45 and over, there were significant racial/ethnic differences in prevalence of diabetes and high blood pressure, but not high cholesterol.
    • Blacks and Latinos had a higher prevalence of diabetes than non-Hispanic whites.
    • Blacks had a higher prevalence of high blood pressure than non-Hispanic whites and Latinos.
  • Learn more about demographic differences in chronic CHD-related conditions

Pain

  • Severe or chronic pain: In 2008, 34 percent of women and 25 percent of men had experienced some kind of severe or frequent/chronic pain during the previous year. The prevalence of severe or frequent/chronic pain was similar across age groups and race/ethnic groups.
  • Musculoskeletal pain: 18 percent of members had experienced musculoskeletal pain in the form of severe back pain/sciatica or neck/shoulder pain. The prevalence of musculoskeletal pain was lower among young adults.
  • Headaches: The prevalence of severe headaches, including migraines, was twice as high for women as for men (15 percent vs. 6 percent). Among women, prevalence of severe headaches decreased with age, while age-related differences among men were much smaller.
  • Arthritis: Women 45 and older had higher prevalence of arthritis than men (20 percent vs. 12 percent).
  • Learn more about demographic differences in pain

Urinary incontinence (UI)

  • In 2008, 7 percent of adult members had experienced urine leaks at least once a week during the previous year. This problem increased with age and was more common among women than among men.
  • Among both middle-aged and senior women, non-Hispanic whites and Latinas were more likely than black women to report UI problems.
  • Among non-Hispanic white and Latina women, urine leakage was also associated with obesity.
  • Learn more about demographic differences in other health conditions in 2008

Health behavior/lifestyle risks

Smoking

  • In 2008, 10 percent of adult members smoked cigarettes at least occasionally—no significant change from 2005. However, the percentages of those who were smoking daily (7 percent) or more than occasionally (8 percent) were lower than in 2005. Decreases were seen across all age groups.
  • Young and middle-aged members were more likely to be smoking daily than older members.
  • Among women under 65, non-Hispanic white and black women were more likely to be regular smokers than Latinas.
  • Over half the people who had smoked during the year prior to the survey had either attempted to quit or were taking steps toward quitting.
  • About one-quarter of members aged 25-44 have ever smoked regularly. This is compared with approximately one-third of 45-64 year olds and nearly half of seniors.
  • Learn more about demographic differences in smoking

Obesity

  • In 2008, 26 percent of adult members were obese (BMI ≥30). In addition, 11 percent were moderately or severely obese (BMI ≥35).
  • Prevalence of obesity (BMI ≥ 30) did not differ by gender or age group. However, women were more likely than men to be moderately or severely obese (BMI ≥35).
  • Among members under 65, blacks and Latinos were more likely than non-Hispanic whites to be moderately or severely obese (BMI ≥35). 
  • Learn more about demographic differencees in obesity

Fruit and vegetable consumption

  • In 2008, 45 percent of adult members reported eating three or more servings of fruits and vegetables per day. Moreover, 13 percent were consuming five or more servings per day. This is a significant increase over the 43 percent and 11 percent reported in 2005. These changes were due primarily to increases in fruit and vegetable consumption among young adults.
  • Women were more likely than men to be consuming at least three servings of fruits and vegetables a day (53 percent vs. 35 percent) across all age groups.
  • Middle-aged and older women were more likely than young adult women to consume five or more servings per day (18 percent vs. 13 percent).
  • Among members under 65, blacks and Latinos were less likely than non-Hispanic whites to consume at least three servings of fruit and vegetables per day.
  • Learn more about demographic differences in fruit and vegetable consumption

Reduced-fat foods

  • More than 47 percent of our members reported that they usually tried to eat reduced fat foods most of the time. This was a significant increase over the 40 percent reporting this in 2005.
  • Compared to 2005, there was a significant increase in “reduced fat consciousness” among 25-44 year olds.
  • For both women and men, “reduced fat consciousness” increased with age.
  • Women were more likely than men to have integrated “reduced fat consciousness” into their lifestyle.
  • There were no significant race/ethnic differences in “reduced fat consciousness.”
  • Learn more about demographic differences in reduced fat eating

Multivitamins, calcium, and vitamin D 

  • Multivitamins: 56 percent of women and 46 percent of men took a multivitamin. Among women, blacks and Latinas were less likely to take multivitamins than non-Hispanic whites. Among men, Latinos were less likely to take multivitamins than non-Hispanic whites.
  • Calcium: 40 percent of women and 13 percent of men took a calcium supplement. Among women, blacks and Latinas were less likely to take calcium supplements than non-Hispanic whites.
  • Vitamin D: Almost all of those who took a calcium supplement were taking one that included vitamin D. On days when these respondents took their calcium supplements or a multivitamin, an estimated 65 percent of women and 49 percent of men were getting at least 400 IU of vitamin D. Latinos and blacks (with the exception of blacks under age 51) were less likely to be getting vitamin D from supplements than were non-Hispanic whites.
  • Learn more about demographic differences in supplementation use

Exercise

  • Approximately 17 percent of adults were sedentary (routinely getting exercise less than once a week). 59 percent were getting exercise at least three times a week. 26 percent were getting exercise five or more times a week. These statistic were not significantly different from in 2005.
  • Seniors were more likely than those under 65 to get exercise regularly three or more times a week. However, the cardiovascular value of that regular exercise differed by age. Seniors were more likely than non-seniors to be engaging in low impact exercise.
  • Among women under age 65, Latina women were more likely to lead a sedentary lifestyle than black and non-Hispanic white women.
  • Learn more about demographic differences in exercise

Alcohol consumption

  • Approximately 2 percent of men and 0.7 percent of women reported having had a problem with alcohol and/or drugs in the previous year. Further, 5 percent of men and 2 percent of women reported having any history of alcohol and/or drug problems.
  • If at-risk drinking is defined as having more than one drink at a time for women and more than two drinks at a time for men, 33 percent of women and 22 percent of men are at-risk drinkers. However, if defined as more than 7 drinks per week for women and more than 14 drinks per week for men, 8 percent of women and 7 percent of men are at-risk drinkers.
  • Nearly one-quarter of our members abstained from alcohol during the previous year.
  • More black seniors abstain from drinking alcohol (female: 54 percent; male: 48 percent) than do non-Hispanic white (female: 33 percent; male: 24 percent) and Latino (female: 36 percent; male: 32 percent) seniors.
  • Higher percentages of non-Hispanic white men have at least one drink five or more times a week (ages 25-64: 14.7 percent; ages 65-79: 25.3 percent) than do black and Latino men (age 25-64: 5.4 percent for both; ages 65-79: 6.2 percent and 10.5 percent, respectively).
  • Among senior women, higher percentages of non-Hispanic whites (11 percent) than blacks (3 percent) and Latinas (4 percent) are at-risk drinkers (defined as more than seven drinks per week).
  • Among senior men, higher percentages of non-Hispanic whites (9 percent) than Latinos (4 percent) are at-risk drinkers (defined as more than 14 drinks a week).
  • Learn more about demographic differences in alcohol consumption

Emotional health

  • Stress: In 2008, 18 percent of adult members reported feeling very stressed, tense, or anxious much of the time. Chronic stress was more prevalent among working age members, particularly women.
  • Depression: 13 percent of adult members had felt depressed for at least two weeks during the previous year or were taking antidepressant medication. Women were more likely to report depression or being treated for depression than men. Working-age women reported the highest prevalence of depression (17 percent).
  • Life dissatisfaction: 13 percent of adult members felt dissatisfied with their lives in general.
  • At-risk emotional health: Overall, 29 percent of adult members reported difficulties indicative of emotional health risks. There were no significant differences by race/ethnicity.
  • Learn more about demographic differences in emotional health risks

Sleep

  • In 2008, 21 percent of adult members were regularly getting six or fewer hours of sleep per 24-hour period. Nearly 7 percent were getting less than six hours.
  • Higher percentages of members aged 45-64 were getting six or fewer hours of sleep than younger adults and seniors (25 percent vs. 20 percent and 17 percent, respectively).
  • The percentages of black members who usually get six or fewer hours of sleep are higher than those for non-Hispanic whites and Latinos (ages 20-44: 32 percent vs. 16 percent and 21 percent, respectively; ages 45-64: 44 percent vs. 20 percent and 27 percent; and 65 and over: 31 percent vs. 15 percent and 21 percent).
  • Nearly 11 percent of adults have frequent problems with sleep. There is also a higher prevalence among women than men (13 percent vs. 9 percent). Yet there is no significant differences by race/ethnicity.
  • Prevalence of frequent sleep problems increases with age (among women: 20-44, 5 percent; 45-64, 15 percent; 65 and over, 19 percent; among men: 20-44, 6 percent; 45-64, 11 percent; 65 and over, 14 percent).
  • Approximately 40 percent of those with frequent sleep problems take prescription or over the counter medicine.
  • Learn more about demographic differences in sleep

Belief about relationship of health behaviors and lifestyle with health

  • In 2008, 83 percent of members believed that habits/lifestyle (like diet, exercise, and weight) have a large impact on health.
  • Members under age 65 are more likely than seniors to believe that health habits/lifestyle can have a large impact (84 percent vs. 77 percent).
  • Non-Hispanic whites are more likely than blacks and Latinos to believe that health habits/lifestyle can have a large impact on health (Ages 20-64: 89 percent vs. 83 percent and 80 percent, respectively; ages 65-79: 81 percent vs. 75 percent and 60 percent, respectively).
  • The perceived importance of health habits/lifestyle for health is also associated with educational attainment. (For example, this belief is held by 57 percent of non-high school graduates, 73 percent of high school graduates, 83 percent of those with some college, and 88 percent of college graduates).
  • Learn more about health behavior/lifestyle risks

Efforts to maintain or improve health 

  • Exercise: In 2008, 47 percent of our members indicated they tried to get moderate or vigorous exercise most days. 24 percent tried to take daily walks or work on 10,000 steps. There was no significant differences by age or gender.
  • Healthy foods: Nearly three-quarters (72 percent) of our members were trying to eat mostly healthy foods. But there were gender differences among those under age 65: 77 percent of women (no age difference), 64 percent of men aged 20-64 and 74 percent of men aged 65 and over.
  • Weight loss: Approximately 43 percent (52 percent of women, 39 percent of men under age 65 and 30 percent of seniors) were trying to lose weight by exercising and/or dieting. Among obese members (BMI ≥30), 63 percent of women and 55 percent of men aged 25-64 and 44 percent of seniors were trying to lose weight by making these lifestyle changes.
  • Managing stress: Nearly one-half of adult members under 65 (55 percent of women, 41 percent of men) and 30 percent of seniors (34 percent of women, 24 percent of men) were trying to manage stress effectively.
  • Sleep: Approximately 70 percent under age 65 (74 percent of women, 65 percent of men) and 75 percent of seniors (no gender difference) were trying to get enough sleep to feel well-rested.
  • Enjoyable activities: Approximately two-thirds of adult members try to do enjoyable activities at least once a week.
  • Aspirin use: Approximately 41 percent of members aged 55 and over take low dose aspirin to try to prevent heart attack or stroke.
  • Flu shot: Approximately 62 percent of members aged 50 and over got a flu shot for the 2007-08 flu season: 48 percent of men and 53 percent of women aged 50-64, and 80 percent of women and men aged 65 and over (no gender difference). Black members were less likely than non-Hispanic whites and Latinos to have been immunized against the flu.
  • Dental exam: 77 percent of adult members reported having had a dental exam in the past 12 months. Among middle-aged and older members, black women and Latinas were less likely than non-Hispanic white women to have had a dental exam.
  • Learn more about dental exams

Use of complementary and alternative medicine (CAM)

Members under 65 make much greater use of CAM than seniors, except for prayer and spiritual practice, where the prevalence of use is similar. Unless otherwise specified, the following highlights describe the use of CAM during the 12 months preceding the survey by members under 65.

  • Approximately 18 percent of men and women had used herbal or homeopathic supplements or remedies.
  • 31 percent of members with arthritis had used glucosamine (no gender or age differences).
  • Approximately 10 percent had used chiropractic care, 4 percent acupuncture, 2 percent acupressure, and 19 percent massage therapy.
  • Among those who had experienced musculoskeletal pain in the past year, approximately 23 percent had used chiropractic care, 9 percent acupuncture, 3 percent acupressure, and 30 percent massage therapy.
  • 20 percent of women and 11 percent of men had used mind-body medicine techniques (relaxation training, mindfulness or other meditation, visualization, or hypnosis).
  • 15 percent of women and 5 percent of men did yoga, and approximately 2 percent of men and women did tai chi or other kinds of movement.
  • 22 percent of women and 13 percent of men used prayer or a spiritual practice to improve or maintain their health. Black women and men were more likely to use prayer or spiritual practice for health-related reasons than were non-Hispanic whites and Latinos.
  • Learn more about use of CAM

Internet access and preferred methods for receiving health education

Internet and email access

  • In 2008, 89 percent of adult members had access to the Internet from home or another location. 85 percent had email access. These were both significant increases from 2005. The increase in Internet and email access was statistically significant across all age groups. The largest increase was among seniors (55 percent to 63 percent).
  • Internet access is greater among younger and middle-aged members than among seniors. Approximately 96 percent of those aged 20-44 and 91 percent of those aged 45-64 have Internet access, with no significant gender difference.
  • Among seniors, there are age and gender differences in access. For example: 83 percent of men and 76 percent of women aged 65-69; 64 percent of men and 52 percent of women aged 75-79.
  • Internet access is associated with educational attainment. Among members aged 25-64, there is a 15 percentage point difference in Internet access between high school graduates and college graduates. Among those aged 65-79, the percentage point difference is 30 percent.
  • Among middle-aged and senior members, blacks and Latinos are less likely to have Internet and email access than non-Hispanic whites. Even after adjusting for educational attainment and household income this hold true. The age gap in Internet and email access is wider among African-Americans and Latinos.
  • Learn more about Internet and e-mail access

Preferred methods for receiving health information and education

  • Preference for using the Internet to obtain health information does not differ by gender. But it does differ by age, educational attainment, race/ethnicity, and, for our oldest members, by access to the Internet.
    • Age: Among members aged 25-64, 32 percent prefer to obtain health information from websites. This preference steadily declines with age, dropping to a low of 8 percent for 80-85 year olds.
    • Education: Among members aged 25-64 and 65-79, there is a 15 percentage point spread in preference for web-based health information between high school graduates and college graduates.
    • Race/Ethnicity: Among 25-64 year olds, interest in obtaining health information from websites is higher among non-Hispanic whites than among African-Americans and Latinos, both overall and when restricted to those with Internet access. Among 65-79 year olds, African-Americans are less likely to prefer health information from websites than are the other racial/ethnic groups.
  • The percentage of members under 65 who are interested in using multi-session email/web-based programs (approximately 9 percent) is only slightly higher than the percentage interested in in-person classes (7 percent). Among seniors, interest in email/web-based programs is much lower (3 percent overall, and 4 percent of those with Internet access).
  • Across all age groups, the most popular ways to receive health education are mailed health newsletters, printed media, and individual counseling from a health educator
  • The least popular way to receive health education is through multi-session classes by phone.
  • Interactive programs using a computer are more popular than both email/web-based programs and multi-session classes.
  • Our members prefer individual in-person counseling with a health educator to brief counseling sessions with a health educator by phone. Both of these options are more popular than classes or media-based programs. Small group appointments are less popular than individual counseling, but more popular than classes, workshops, and other multi-session structured program options.
  • Learn more about IT access, use and health education preferences

Printed materials (handouts, newsletters) and audiovisual tools (DVD, TV shows) are more popular than podcasts. Among seniors, they are more popular than obtaining information from websites.