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Complete Health Indicator Report of Alcohol Consumption - Binge Drinking

Definition

'''''Binge drinking''''' is defined as a pattern of alcohol consumption that brings the blood alcohol concentration (BAC) level to 0.08% or above. This typically happens when men consume 5 or more drinks, and when women consume 4 or more drinks, in about 2 hours. It is listed as the percentage of survey respondents who reported binge drinking during the 30 days prior to the survey. [[img src ="https://www.cdc.gov/vitalsigns/alcohol-screening-counseling/images/problem1_970px.jpg" width = "652" height= "455"]]

Numerator

Number of survey respondents who reported binge drinking during the 30 days prior to the survey.

Denominator

Number of survey respondents excluding those with missing, "Don't know/Not sure", or "Refused" responses.

Data Interpretation Issues

To reduce bias and more accurately represent population data, the BRFSS survey methodology changed. In 2009, the survey began including surveys on cellular phones in addition to landline phones. And a new weighting methodology, known as "iterative proportional fitting" (raking) was implemented. More details about these changes can be found [https://ibis.health.utah.gov/pdf/opha/resource/brfss/RakingImpact2011.pdf here]. As with all surveys, some error results from nonresponse (e.g., refusal to participate in the survey or to answer specific questions), and measurement (e.g., social desirability or recall bias). Error was minimized by use of strict calling protocols, good questionnaire design, standardization of interviewer behavior, interviewer training, and frequent, on-site interviewer monitoring and supervision.

Why Is This Important?

'''''Binge drinking''''' is the most common pattern of excessive alcohol use in the United States and those who binge drink tend to do so frequently and with high intensity. According to the latest estimates from the Centers for Disease Control and Prevention, excessive alcohol use is responsible for '''88,000 deaths in the United States''' each year, including 1 in 10 deaths among working-age adults aged 20-64 years.^1^ Estimates also suggest that over '''700 Utahns''' die from alcohol-attributable causes each year and Utah is ranked seventh in the nation for alcohol poisoning deaths.^2^ Excessive alcohol use is also associated with many health and social harms, including '''liver cirrhosis, certain cancers, unintentional injuries, violence and fetal alcohol spectrum disorder'''. Excessive drinking cost the United States $249 billion in 2010.^3^ In 2014, the cost of excessive alcohol use in Utah was estimated to be $1.2 billion.^4^[[br]][[br]] ---- #Preventing Chronic Disease, 2014, Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States #Centers for Disease Control and Prevention. Alcohol Related Disease Impact (ARDI) application, 2013. Available at [http://www.cdc.gov/ARDI] #American Journal of Preventative Medicine, 2010, National and State Costs of Excessive Alcohol Consumption #Utah Department of Public Safety, Alcohol Abuse Tracking Committee, 2016 Report

Healthy People Objective SA-14.3:

Reduce the proportion of persons engaging in binge drinking during the past 30 days--adults aged 18 years and older
U.S. Target: 24.4 percent

How Are We Doing?

Using data from both landline and cell phones in 2016, it was estimated that '''12.5%''' (crude rate) of Utah adults binge drank at least once in the 30 days prior to the survey. Utah is '''well below the Healthy People 2020 objective of 24.4%''' for this measure.

How Do We Compare With the U.S.?

Estimates show that '''16.9% of U.S. adults''' reported binge drinking in the past 30 days in 2016 whereas '''12.5% of Utah adults''' reported binge drinking in 2016 (crude rates). The percentage of adults who reported binge drinking in the past 30 days was substantially lower in Utah than in the U.S. for all years reported between 1989-2016.

What Is Being Done?

The Utah Department of Health [http://health.utah.gov/vipp/ Violence and Injury Prevention Program] receives funding from the [https://www.cdc.gov/alcohol/index.htm Alcohol Program at the Centers for Disease Control (CDC)] for a full-time alcohol epidemiologist. With this additional capacity at the UDOH, it is now possible to conduct more monitoring and surveillance of excessive alcohol use and related harms. The [https://dsamh.utah.gov/ Utah Division of Substance Abuse and Mental Health] is the agency responsible for ensuring that substance abuse and mental health prevention and treatment services are available statewide. The Division also acts as a resource by providing general information, research, and statistics to the public regarding substances of abuse and mental health services.

Evidence-based Practices

The Community Preventive Services Task Force recommends evidence based strategies to reduce excessive alcohol consumption in [http://www.thecommunityguide.org/alcohol/index.html The Community Guide]. These strategies include: # Increasing alcoholic beverage costs # Limiting the number of retail alcohol outlets that sell alcoholic beverages in a given area # Holding alcohol retailers responsible for the harms caused by their underage or intoxicated patrons (dram shop liability) # Restricting access to alcohol by maintaining limits on the days and hours of alcohol retail sales # Consistent enforcement of laws against underage drinking and alcohol-impaired driving # Screening and counseling for alcohol misuse. [[br]] [[br]] ''The Community Preventive Services task force is an independent body of prevention and public health experts.''

Available Services

Services include: ====Alcohol Screening and Brief Intervention==== Alcohol Screening and Brief Intervention (A-SBI) is a preventive service like hypertension or cholesterol screening that can occur as part of a patient's wellness visit. It identifies and helps individuals who are drinking too much. A-SBI is recommended by the U.S. Preventive Services Task Force (USPSTF), the Community Preventive Services Task Force (Community Guide), the Centers for Disease Control and Prevention (CDC), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), Substance Abuse and Mental Health Services Administration (SAMHSA), and the World Health Organization (WHO). For more information on A-SBI, please visit the CDC vital signs [http://www.cdc.gov/vitalsigns/alcohol-screening-counseling/index.html website]. ====Substance Abuse Helplines==== '''National''': The U.S. Department of Health and Human Services (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) has a toll-free referral helpline. The number is: 1-800-662-HELP (4357). '''Utah''': Dial 2-1-1 for state and community service information. Code 2-1-1 can now be accessed from anywhere in the state of Utah. 211 Info Bank, a program of Community Services Council, is a free information and referral line for health, human and community services. 211 provides information and referral on many topics.

Health Program Information

A drink of alcohol is equivalent to a '''12-ounce beer, a 5-ounce glass of wine, or a drink with one shot of liquor'''.[[br]] ====A Standard Drink ==== [[img src="https://www.niaaa.nih.gov/sites/default/files/introduction-standard-drink-sidebar.png"]] Knowing standard drink sizes and the number of drinks per container can help you make informed decisions about your drinking. Find a '''standard drink size calculator tool''' from the National Institute of Alcohol Abuse and Alcoholism [https://www.rethinkingdrinking.niaaa.nih.gov/tools/Calculators/drink-size-calculator.aspx here].


Related Indicators

Relevant Population Characteristics

In Utah, for 2016, binge drinking did vary by certain population characteristics. * Binge drinking is '''''more common among males'''''. * The prevalence of reported binge drinkers '''''decreases with increasing age'''''. * Binge drinking prevalence is '''''not significantly different among income groups'''''. * '''''Hispanics report higher rates of binge drinking''''' than Non-Hispanics. * Utahns with a '''''high school degree or lower report binge drinking significantly more''''' than those with some post high school education or a college degree.

Related Relevant Population Characteristics Indicators:


Health Care System Factors

Excessive alcohol use is strongly associated with unintentional injury. At least 6,685 emergency department (ED) visits and 3,164 hospitalizations occurred in 2014 because of direct alcohol-attributable causes.

Related Health Care System Factors Indicators:


Risk Factors

People experiencing poor mental health are more likely to drink excessively.

Related Risk Factors Indicators:


Health Status Outcomes

Excessive alcohol use is associated with many health and social harms, including liver cirrhosis, certain cancers, unintentional injuries, violence and fetal alcohol spectrum disorder.

Related Health Status Outcomes Indicators:




Graphical Data Views

Binge Drinking in the Past 30 Days, Utah and U.S., 2009-2016

::chart - missing::
confidence limits

BRFSS Utah vs. U.S.YearCrude Percentage of AdultsLower LimitUpper Limit
Record Count: 14
UT New Methodology200910.4%9.5%11.3%
UT New Methodology201010.4%9.7%11.2%
UT New Methodology201112.0%11.1%12.9%
UT New Methodology201211.2%10.3%12.0%
UT New Methodology201312.3%11.5%13.1%
UT New Methodology201411.4%10.7%12.1%
UT New Methodology201511.6%10.9%12.5%
UT New Methodology201612.5%11.6%13.5%
US New Methodology201118.3%18.1%18.6%
US New Methodology201217.0%16.7%17.2%
US New Methodology201316.5%16.3%16.8%
US New Methodology201416.0%15.8%16.2%
US New Methodology201516.3%
US New Methodology201616.9%

Prevalence of Binge Drinking Among Adults, BRFSS, United States, 2010

supplemental image
The figure above shows the age-adjusted prevalence of binge drinking among adults in the United States during 2010, as determined from the Behavioral Risk Factor Surveillance System combined landline and cellular telephone developmental dataset. Overall, states with the highest age-adjusted prevalence of adult binge drinking were in the Midwest and New England, and included the District of Columbia, Alaska, and Hawaii. The Utah 2010 age-adjusted prevalence of binge drinking was 10.9 percent, placing it among the states with the lowest rates.


Data Notes

Items to note regarding the data: * U.S. data are the average value for all states and the District of Columbia; they do not include U.S. territories. * The rates shown in the data table and on the line graph are crude rates, not age-adjusted, given that the Healthy People 2020 Objective is based on crude rates. * Rates shown on the U.S. map are age-adjusted to the 2000 U.S. Census standard population. * Starting in 2006, the definition of binge drinking changed to consuming five or more drinks on an occasion for men, or four or more drinks on an occasion for women one or more times during the past 30 days. From 1989-2005, binge drinking on the BRFSS was defined as consuming five or more drinks of alcohol on an occasion one or more times during the past 30 days for both males and females. [[br]]

Data Sources

  • Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health
  • U.S. Data: Behavioral Risk Factor Surveillance System (BRFSS), Division of Behavioral Surveillance, CDC Office of Surveillance, Epidemiology, and Laboratory Services


Binge Drinking Frequency in the Past 30 Days by Year, Utah and U.S., 2009-2016

::chart - missing::
confidence limits

The frequency and intensity of binge drinking are measures used to examine the adverse health effects for this pattern of alcohol consumption. '''Binge drinking frequency''' is defined as the '''number of binge drinking occasions in the past month'''. The frequency of binge drinking is also associated with '''poor health-related quality of life'''.^5^ Among binge drinkers in Utah (2016), the frequency of binge drinking was '''4.7 episodes per month'''. In the U.S. (2016), the frequency was '''4.4 episodes per month'''. Unlike the overall prevalence of binge drinking, where Utah rates are much lower than the national average, in Utah, the frequency of binge drinking is very similar to the national average. [[br]][[br]] ---- 5. American Journal of Preventive Medicine, 2004, Binge drinking and health-related quality of life: do popular perceptions match reality?
BRFSS Utah vs. U.S.YearAverage Number of Binge-drinking Episodes per MonthLower LimitUpper Limit
Record Count: 14
UT New Methodology20094.33.84.8
UT New Methodology20104.33.94.8
UT New Methodology20114.33.84.7
UT New Methodology20123.93.54.3
UT New Methodology20134.64.25.0
UT New Methodology20144.64.25.1
UT New Methodology20154.23.84.6
UT New Methodology20164.74.15.2
US New Methodology20114.14.04.2
US New Methodology20124.24.14.3
US New Methodology20134.34.24.4
US New Methodology20144.24.14.3
US New Methodology20154.34.24.4
US New Methodology20164.44.34.5

Data Notes

The rates shown in the data table and on the line graph are crude rates, not age-adjusted.

Data Sources

  • Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health
  • U.S. Data: Behavioral Risk Factor Surveillance System (BRFSS), Division of Behavioral Surveillance, CDC Office of Surveillance, Epidemiology, and Laboratory Services


Binge Drinking Intensity in the Past 30 Days by Year, Utah and U.S., 2009-2016

::chart - missing::
confidence limits

The frequency and intensity of binge drinking are measures used to examine the adverse health effects for this pattern of alcohol consumption. '''Binge drinking intensity''' is defined as the '''average largest number of drinks consumed on occasion'''. The risk of adverse outcomes (e.g., unintentional injuries) increases with the number of drinks consumed or with progressively higher blood alcohol concentrations.^6^ Among binge drinkers in Utah (2016), the intensity of binge drinking was '''8.2 drinks per occasion'''. In the U.S. (2016), the intensity was '''7.4 drinks per occasion'''. Unlike the overall prevalence of binge drinking, where Utah rates are much lower than the national average, in Utah, intensity of binge drinking has been much more similar to the national average in recent years and was '''significantly higher than the national average in 2016'''.[[br]][[br]] ---- 6. Journal of Studies on Alcohol, 2003, A population-based case-crossover and case-control study of alcohol and the risk of injury.
BRFSS Utah vs. U.S.YearAverage Largest Number of DrinksLower LimitUpper Limit
Record Count: 14
UT New Methodology20097.77.28.2
UT New Methodology20108.37.88.9
UT New Methodology20118.68.19.1
UT New Methodology20127.97.48.3
UT New Methodology20138.37.88.7
UT New Methodology20148.17.78.6
UT New Methodology20157.67.28.1
UT New Methodology20168.27.78.8
US New Methodology20117.77.67.8
US New Methodology20127.57.47.6
US New Methodology20137.67.57.7
US New Methodology20147.67.57.7
US New Methodology20157.37.27.4
US New Methodology20167.47.37.5

Intensity of Binge Drinking Among Adults, BRFSS, United States, 2010

supplemental image
The figure above shows the intensity of binge drinking among adults in the United States during 2010, as determined from the Behavioral Risk Factor Surveillance System combined landline and cellular telephone developmental dataset. States with the highest intensity of adult binge drinking generally were located in the southern Mountain states and Midwest, and included some states (e.g., Louisiana, Mississippi, New Mexico, South Carolina, and Utah) that had a lower prevalence of binge drinking. Utah's 2010 intensity of binge drinking was 7.9 drinks per occasion, placing it '''among the states with the highest rates'''.


Data Notes

The rates shown in the data table and on the line graph are crude rates, not age-adjusted. Rates shown on the U.S. map are age-adjusted to the 2000 U.S. Census standard population.

Data Sources

  • Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health
  • U.S. Data: Behavioral Risk Factor Surveillance System (BRFSS), Division of Behavioral Surveillance, CDC Office of Surveillance, Epidemiology, and Laboratory Services


Binge Drinking in the Past 30 Days by Age Group and Sex, Utah, 2016

::chart - missing::
confidence limits

Males vs. FemalesAge GroupPercentage of AdultsLower LimitUpper Limit
Record Count: 8
Male18-3423.4%20.5%26.6%
Male35-4918.7%15.8%22.1%
Male50-6411.8%9.6%14.5%
Male65+2.3%1.5%3.4%
Female18-3413.0%10.6%15.9%
Female35-498.6%6.8%10.9%
Female50-645.6%4.3%7.3%
Female65+1.2%0.7%1.9%

Data Notes

These rates are crude rates, not age-adjusted, given that the Healthy People 2020 Objective is based on crude rates.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health


Binge Drinking in the Past 30 Days by Education, Utah, 2016

::chart - missing::
confidence limits

Education LevelCrude Percentage of Adults 25+Lower LimitUpper Limit
Record Count: 4
Less Than High School14.0%10.1%19.1%
H.S. Grad or G.E.D.16.5%14.6%18.7%
Some Post High School12.1%10.6%13.8%
College Graduate9.1%7.8%10.5%

Data Notes

These rates are crude rates, not age-adjusted, given that the Healthy People 2020 Objective is based on crude rates.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health


Binge Drinking in the Past 30 Days by Ethnicity, Utah, 2016

::chart - missing::
confidence limits

Hispanic EthnicityCrude Percentage of AdultsLower LimitUpper Limit
Record Count: 2
Hispanic16.5%13.1%20.5%
Non-Hispanic12.0%11.0%13.0%

Data Notes

These rates are crude rates, not age-adjusted, given that the Healthy People 2020 Objective is based on crude rates.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health


Binge Drinking in the Past 30 Days by Race, Utah, 2014-2016

::chart - missing::
confidence limits

RaceCrude Percentage of AdultsLower LimitUpper Limit
Record Count: 5
American Indian/Native Alaskan18.3%13.9%23.8%
Asian9.7%6.3%14.5%
Black14.0%9.5%20.3%
Pacific Islander13.4%8.6%20.3%
White11.5%11.0%12.0%

Data Notes

These rates are crude rates, not age-adjusted, given that the Healthy People 2020 Objective is based on crude rates.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health


Binge Drinking in the Past 30 Days by Local Health District, Utah, 2014-2016

::chart - missing::
confidence limits

Local Health DistrictCrude percentage of AdultsLower LimitUpper LimitNote
Record Count: 14
Bear River7.9%6.5%9.7%
Central6.7%5.3%8.5%
Davis County9.2%8.0%10.5%
Salt Lake County15.6%14.7%16.5%
San Juan11.9%5.4%24.5%*
Southeast12.7%9.9%16.0%
Southwest9.2%7.8%10.8%
Summit18.5%15.2%22.2%
Tooele12.7%10.0%16.0%
TriCounty11.6%9.4%14.2%
Utah County7.0%6.1%8.0%
Wasatch14.4%10.0%20.4%
Weber-Morgan13.8%12.3%15.5%
State of Utah11.9%11.4%12.3%

Data Notes

*Use caution in interpreting rate for San Juan; the estimate has a coefficient of variation >30% and is therefore deemed unreliable by Utah Department of Health standards. These rates are crude rates, not age-adjusted, given that the Healthy People 2020 Objective is based on crude rates.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health


Binge Drinking in the Past 30 Days by Utah Small Area, 2014-2016

::chart - missing::
confidence limits

Utah Small Areas with significantly higher binge drinking rates than the state for the period 2014-2016: *SLC (Downtown), Murray, South Salt Lake, SLC (Glendale), Midvale, West Jordan (West)/Copperton, Millcreek, West Valley (East) V2, Summit County, SLC (Avenues), Cottonwood, West Jordan (SE), Ben Lomond
Utah Small AreasCrude Percentage of AdultsLower LimitUpper LimitNote
Record Count: 66
Brigham City7.5%4.7%11.8%
Box Elder Co (Other)5.5%3.1%9.7%
Logan8.9%6.7%11.7%
Cache Co (Oth)/Rich Co (All)7.9%5.1%12.0%
Ben Lomond15.9%12.6%19.8%
Morgan Co (All)/Weber Co (E)12.4%9.4%16.1%
Ogden (Downtown)13.2%9.8%17.7%
South Ogden15.0%11.1%20.1%
Roy/Hooper13.4%10.1%17.5%
Riverdale11.2%7.6%16.3%
Clearfield/Hill AFB12.1%9.3%15.5%
Layton10.1%7.9%13.0%
Syracuse/Kaysville6.6%4.6%9.5%
Farmington/Centerville5.8%3.5%9.4%
Woods Cross/North Salt Lake7.4%4.7%11.4%
Bountiful11.2%7.7%15.8%
SLC (Rose Park)14.6%10.1%20.7%
SLC (Avenues)18.2%13.0%24.7%
SLC (Foothill/U of U)15.9%11.4%21.7%
Magna15.2%10.0%22.2%
SLC (Glendale)20.2%14.0%28.3%
West Valley (West)13.3%10.4%16.8%
West Valley (East) V218.9%13.7%25.5%
SLC (Downtown)24.2%19.9%29.0%
South Salt Lake21.1%15.2%28.4%
Millcreek19.2%15.4%23.8%
Holladay15.1%11.0%20.4%
Cottonwood18.0%13.8%23.1%
Kearns V213.8%9.7%19.3%
Taylorsville (E)/Murray (W)13.6%10.0%18.3%
Taylorsville (West)12.8%9.2%17.6%
Murray22.7%17.1%29.5%
Midvale19.8%13.9%27.5%
West Jordan (NE) V210.0%6.7%14.8%
West Jordan (SE)16.9%12.6%22.2%
West Jordan (W)/Copperton19.7%15.1%25.3%
South Jordan9.2%6.6%12.8%
Sandy (Center)15.5%11.8%20.1%
Sandy (NE)13.5%9.2%19.4%
Sandy (SE)14.0%9.1%20.9%
Riverton/Draper10.2%7.9%13.1%
Tooele Co12.7%10.0%16.0%
Lehi/Cedar Valley9.3%6.9%12.3%
American Fork/Alpine4.2%2.4%7.1%
Pleasant Grove/Lindon5.0%3.2%7.8%
Orem (North)8.6%5.4%13.5%
Orem (West)10.0%6.4%15.2%
Orem (East)3.4%1.3%8.5%*
Provo (North)/BYU5.1%3.0%8.6%
Provo (South)6.1%4.1%9.0%
Springville/Spanish Fork7.8%5.7%10.5%
Utah Co (South)9.0%5.6%14.1%
Summit Co18.5%15.2%22.2%
Wasatch Co14.4%10.0%20.4%
TriCounty LHD11.6%9.4%14.2%
Juab/Millard/Sanpete Co6.4%4.7%8.7%
Sevier/Piute/Wayne Co7.4%5.0%10.7%
Carbon/Emery Co11.5%8.5%15.2%
Grand County17.2%11.2%25.6%
San Juan County11.9%5.4%24.5%*
St George9.9%7.6%12.9%
Washington Co (Other)8.4%6.1%11.5%
Cedar City9.2%6.1%13.7%
Southwest LHD (Other)8.8%5.9%12.8%
State11.9%11.4%12.3%

Data Notes

Notes regarding small area data: *Use caution in interpreting rates for Orem (East) and San Juan County; the estimates have a relative standard error greater than 30% and do not meet UDOH standards for reliability. *A description of the Utah Small Areas may be found on [http://ibis.health.utah.gov/resource/Help.html IBIS].

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

References and Community Resources

'''National:''' [[br]] *The U.S. Department of Health and Human Services (HHS) Substance Abuse and Mental Health Services Administration (SAMSA) Substance Abuse Treatment Facility Locator: [http://findtreatment.samhsa.gov/] *[http://www.niaaa.nih.gov National Institutes of Health: National Institute on Alcohol Abuse and Alcoholism] *[http://www.cdc.gov/alcohol/ Centers for Disease Control and Prevention, Alcohol and Public Health] This site includes fact sheets, online tool kits, data and recently published literature. *The CDC also publishes the Prevention Status Reports (PSR), which highlight, for all 50 states and the District of Columbia, the status of public health policies and practices designed to address important public health problems and concerns. The 2015 PSR for excessive alcohol use can be found [https://wwwn.cdc.gov/psr/?state=Utah here]. *More information on the Behavioral Risk Factor Surveillance System may be found on the website of the [http://www.cdc.gov/brfss/ Centers for Disease Control and Prevention][[br]] [[br]] '''Utah:'''[[br]] Utah Department of Human Services[[br]] Division of Substance Abuse and Mental Health[[br]] 195 North 1950 West[[br]] Salt Lake City, Utah 84116[[br]] Phone: (801) 538- 3939[[br]] Fax: (801) 538-9892[[br]] [https://dsamh.utah.gov/]

More Resources and Links

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

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.

Page Content Updated On 10/24/2017, Published on 11/13/2017
The information provided above is from the Department of Health's Center for Health Data IBIS-PH web site (http://ibis.health.state.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Sun, 17 December 2017 6:41:58 from Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.gov ".

Content updated: Mon, 13 Nov 2017 11:23:26 MST