CNMI NCD Hybrid Survey Report 2016

CNMI
NonCommunicable Disease & Risk Factor

Hybrid Survey Results Workshop
Becky Robles
NCD Bureau Administrator
Legislative Breakfast
Kanoa Resort
Saipan, MP
November 16, 2016
Thank You!
Development of hybrid survey

Initial site visit in December 2014
No baseline adult NCD data in CNMI
Attempts at previous surveys unsuccessful due to lack of staff,
ongoing technical support, and epidemiological capacity
BRFSS-like survey attempted previously, but methodological issues
prevented data use, and phone survey was challenging dues to
technological infrastructure issues and overall coverage
STEPS plans initiated, but never followed through on
Some various funds available, but unsure how to bring them together
Ongoing CNMI Behavioral Health Survey (CBHS) conducted in 2011,
2013, 2015 was a potential for collaboration
This all led us to think How can we do

business differently?!
Lets Work Together!

Within CNMI:
NCD Unit: staff
Behavioral Health Unit: staff, collaboration with CBHS
Northern Marianas College Cooperative Research Extension and
Education Program (NMC CREES): staff, anthropometric training,
supplies
Department of Commerce: logistical support, data management
Outside Partners
University of Hawaii (UH) Children for Health Living (CHL) Program:
anthropometric standardization
PIHOA: TA
SAMHSA: financial support for CBHS
CDC: financial support, TA
WHO: financial support
CNMI NCD & Risk Factor Hybrid

Survey Results
BEHAVIORAL RISK FACTORS
Alcohol
Tobacco/betel nut
Physical Activity
Nutrition
Sugar Sweetened Beverage
Processed Meat
ALCOHOL
Binge Drank in the Past 30 Days
Binge Drinking
100
90
77.0
80
Percent (%)
70
60
50
40
30
23.0
20
10
0
Yes
No
Adults in the CNMI who binge drank alcohol

in the past 30 days, 2016
100
90
80
70
60
50
40
30
20
10
0
23.0
22.9
16.0
CNMI
2016
GUAM
2014
US
2014
Binge drinking by ethnicity
TOBACCO
Cigarette Smoking Frequency
Cigarette Use-Smoking
100
35
Percent (%)
90
80
74.8
30
70
60
25
50
20
40
30
20.4
20
4.8
10
Some Days
25.2
18.1
15
10
5
0
No Days
29.3
Every day
Frequency of cigarette smoking in the past 30

days among adults in the CNMI, 2016
0
CNMI
GUAM
US
2016
2010
2014
Cigarette smoking by ethnicity

Ethnic Group
100
Percent (%)
80
60
40
34.3
36.3
20
18.4
19.4
21.3
Filipino
Other Asian
Other
Ethnicity
Chamorro/
Carolinian
Other Pacific
Islander
BETEL NUT
Betel Nut Chewing
Betel Nut Chewing Frequency
20
100
Percent (%)
90
16.2
80.9
80
15
70
10.6
60
10
50
40
30
16.2
20
10
5
?
2.9
0
No Days
Some Days
Every day
Frequency of betel nut chewing in the past 30 days

among CNMI adults, 2016
0
CNMI
GUAM
2016
2010
US
Betel nut chewing by ethnicity
Ethnic Group
100
Percent (%)
80
56.2
60
40.6
40
20
2.5
2.1
0.0
Filipino
Other Asian
Other
Ethnicity
Chamorro/
Carolinian
Other
Pacific
Islander
PHYSICAL ACTIVITY
Participation in any physical activity or exercise during the past month among adults in the
CNMI, 2016
NUTRITION
<5 Servings of Fruit & Vegetables Per Day
Fruit & Vegetable Servings Per Day

60
Percent (%)
50
40
30
26.1
25.4
24.6
20.3
20
10
0.8
2.7
0
None
One
Two
Three
Four
Fruit and vegetable servings per day

Five or
more
90
80
70
60
50
40
30
20
10
0
76.6
75.4
75.7
CNMI
GUAM
US
2016
2009
2009
PROCESSED MEAT
Processed meat servings per day among CNMI adults, 2016
SUGAR SWEETENED BEVERAGES

% of the population that consumes
one or more SSBs per day
80
70
60
50
40
30
20
10
0
Sugar sweetened beverage servings per day
74.2
50.6
?
CNMI
GUAM
US
2016
2010
2010
METABOLIC RISK FACTORS
Overweight/Obesity
Hypertension
Cholesterol
OVERWEIGHT/OBESITY
Overweight & Obesity
70
64.3
63.4
65
GUAM
2014
US
2014
60
50
40
30
20
10
0
Distribution of weight
among adults in the CNMI, 2016
CNMI
2016
Overweight/obesity
Ethnic disparities
HYPERTENSION
Adults in the CNMI with hypertension using combined self-reported and biochemical measure method,
2016
HYPERTENSION
Ethnic disparities
Adults in the CNMI with hypertension by ethnicity, 2016
Ethnic Group
Chamorro/ Carolinian
Percent (%)
58.6
Other Pacific Islander
53.8
Filipino
61.2
Other Asian
35.5
Other Ethnicity
37.0
70
60
50
40
30
20
10
0
58.6
61.2
53.8
35.5
37
CHOLESTEROL
Adults in the CNMI with high cholesterol using combined self-reported and
biochemical measure method, 2016
CHOLESTEROL
Ethnic disparities
CMI
Percent (%)
22.8
8.3
Filipino
15.3
Other Asian
11.8
Other Ethnicity
23.6
25
20
15
10
5
0
23.6
22.8
15.3
8.3
11.8
DIABETES
14
12.6
12.5
12
11
10
8
6
4
2
0
Pre-diabetic and diabetic adults in the CNMI
using combined self-reported and biochemical measure
method, 2016
CNMI
2016
GUAM
2010
US
2014
DIABETES
Ethnic disparities
Ethnic Group
Percent (%)
25
20
20.0
15.4
Filipino
8.7
15
10
5
0
Other Asian
5.4
Other Ethnicity
8.6
20
15.4
8.7
8.6
5.4
Now What?
Effective interventions;
Policy, Systems and
Environmental Changes (PSEs)
Making the healthy choice easy

PSE interventions and strategies are prevention
interventions and strategies that aim to improve
policies, systems and environments to promote
health.
Where you live affects how you live. Environment
affects choice.
Major health problems will not be solved solely by
individual actions and choices
Programs vs. PSE change

Programs are:
1. Activities, individual or group instruction, curricula, counseling, and
training
2. Services targeted to individuals that teach behavioral skills
Personal choices are made in context of larger environment.
Many health and social problems are related to conditions outside the
individuals control.
Recently there is a growing sense of importance of broader societal
trends and policies that affect behaviors.
While programs can lead to behavior changes in individuals and/or
communities during course of programs, unless scaled up and instituted
through formal and informal PSE changes, programs may not be
sustainable.
Programs vs. PSE Change

Characteristics of
Events/Programs
One time
Additive: often results in
only short-term behavior
Individual level
Not part of ongoing plan
Short term
Non-sustaining
Characteristics of PSE
Change
Ongoing
Foundational: often
produces behavior change
over time
Policy level
Part of an ongoing plan
Long term
Sustaining
Example from schools
Effective PSE Interventions

Address one or more NCD risk factors
Are population-based versus individual-based;
Are evidence-based or practice-based, data-driven and
grounded in community;
Politically, financially and legally feasible;
Implementation and enforcement are clear;
Address health disparities;
Change norms and expectations;
Have associated evaluation outcomes.
Examples
Legislation
Parks, walking pathways, bike lanes
Current examples
Smoke free air act
REACH Biba healthy restaurant program
Stores healthy food sections
Thank You!
Contact information
Becky Robles
CHCC, NCD Bureau Administrator
236-8719
broblesncdb@gmail.com
Patty Coleman
NMC CREES Program Manager
patricia.coleman@marianas.edu

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CNMI

NonCommunicable Disease & Risk Factor

Development of hybrid survey

This all led us to think How can we do

Lets Work Together!

CNMI NCD & Risk Factor Hybrid

Binge Drank in the Past 30 Days

Adults in the CNMI who binge drank alcohol

Binge drinking by ethnicity

Cigarette Smoking Frequency

Frequency of cigarette smoking in the past 30

Cigarette smoking by ethnicity

Betel Nut Chewing Frequency

Frequency of betel nut chewing in the past 30 days

Betel nut chewing by ethnicity

Fruit & Vegetable Servings Per Day

Fruit and vegetable servings per day

Processed meat servings per day among CNMI adults, 2016

SUGAR SWEETENED BEVERAGES

METABOLIC RISK FACTORS

Other Pacific Islander

Other Pacific Islander

Other Pacific Islander

Making the healthy choice easy

Programs vs. PSE change

Programs vs. PSE Change

Example from schools

Effective PSE Interventions

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