Wisconsin Department of Health ServicesJanuary 2014 P-00522X

Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Geography

GEOGRAPHY

Background• Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities

Report • Key points

Data• Demographic and socioeconomic data• Risk behaviors and health outcomes

References

Links to additional reports and resources

Contacts

Chapter Outline

Chapter outline

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Report Overview

• This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf

• The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included.

• Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations.

• Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

Report overview

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Report Format

Full Report• Format: PDF • Intended use: reference document

Chapters• Format: Annotated PowerPoint slide set• Intended uses: presentations to

– Decision-makers– Service providers– Community leaders– The public

Sample annotated slide

Report overview

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GEOGRAPHY

Report Outline

Executive Summary

Section 1: Introduction

Section 2: Demographic overview

Section 3: Health focus areas

Section 4: Infrastructure focus areas

Section 5: Data summaries by population

Section 6: Technical notes

Report overview

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GEOGRAPHY

Report Outline: Detail

Section 3: Health focus areas

• Alcohol and other drug use• Chronic disease prevention and management• Communicable diseases• Environmental and occupational health• Healthy growth and development• Injury and violence• Mental health• Nutrition and healthy foods• Oral health• Physical activity• Reproductive and sexual health• Tobacco use and exposure

Section 4: Infrastructure focus areas• Access to health services

Report overview

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Report Outline: Detail

Section 5: Data summaries by population

Racial/ethnic minority populationso American Indianso Asianso Blackso Hispanics

  People of lower socioeconomic status  People with disabilities  Lesbian, gay, bisexual, and transgender populations  Geography

Report overview

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Data notes

• Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

• The 95% confidence intervals are denoted by error bars. Where

confidence intervals do not overlap, as shown in the example on

the right, differences are statistically significant. Larger confidence

intervals may indicate less reliable estimates that should be

interpreted with caution.

• Population estimates that are considered unreliable are excluded.

• Misclassification of racial/ethnic groups may affect the accuracy of rates.

• Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non-Hispanic.

Report overview

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Factors that influence health

Social determinants

of health

Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach

Report overview

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Key Points

Compared to residents of Milwaukee County and non-metropolitan (rural) counties, residents of smaller metropolitan counties:

• Have higher socioeconomic status and greater access to health care.

• Have lower disease prevalence and higher rates of preventive testing.

• Fare better on most health indicators.

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Key points

GEOGRAPHY

Key Points

Compared to Milwaukee’s population, residents of non-metropolitan counties:

• Use health care at a lower rate.

• Have lower barriers to health care due to cost.

• Have rates of higher alcohol consumption.

• Have lower rates of asthma, frequent mental distress, and rates of STDs and HIV.

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Key points

GEOGRAPHY

Demographic and socioeconomic data

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Population by county, Wisconsin, 2010

Source: U.S. Census 2010.

Total Population

4,251 - 74,601

74,602 - 244,376

244,377 - 477,748

937,616

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Demographic and socioeconomic data

GEOGRAPHY

Counties by level of urbanization, Wisconsin, 2010

Source: American Community Survey, 2010.

Level of urbanizationMilwaukee County

Non-metropolitan counties

Non-metropolitan counties

Smaller metropolitan counties

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Level of urbanization

GEOGRAPHY

Level of urbanization of Wisconsin residents by race/ethnicity, 2007-2011

Source: American Community Survey, 2007-2011..

White Black American Indian Asian Hispanic0%

10%

20%

30%

40%

50%

60%

70%

80%

11% 67% 12% 24% 37%59% 28% 39% 66% 48%30% 4% 49% 10% 15%

Milwaukee County

Smaller metropolitan counties

Non-metropolitan counties

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Level of urbanization

GEOGRAPHY

Source: U.S. Census 2010

Median age

37.3 - 41.8

41.9 - 46.2

46.3 - 51.0

31.4 - 37.2

Median age by county, Wisconsin, 2010

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Demographic and socioeconomic data

GEOGRAPHY

Income distribution among Wisconsin adults by level of urbanization, 2007-2011

Source: American Community Survey, 2007-2011.

Low income (<$25,000) Middle income ($25,000-$74,999)

High income ($75,000+)0%

10%

20%

30%

40%

50%

60%

29% 45% 26%20% 45% 35%26% 51% 24%

Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties

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Demographic and socioeconomic data

GEOGRAPHY

Educational attainment of Wisconsin adults, ages 25 and older, by level of urbanization, 2007-2011

Source: American Community Survey, 2007-2011. 18

Demographic and socioeconomic data

Less than high school High school graduate to some college

College graduate or more0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

15% 60% 25%8% 64% 27%13% 70% 17%

Milwaukee County

Smaller metropolitan counties

Non-metropolitan counties

GEOGRAPHY

Access to health care

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GEOGRAPHY

Lack of health insurance coverage and Medicaid enrollment among Wisconsin adults, by level of urbanization, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.

Access to health care

0%

10%

20%

30%

40%

50%

60%

13% 14%18% 18%

Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties

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GEOGRAPHY

Age-adjusted rate of use of and barriers to health care among Wisconsin adults, by level of urbanization, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.

Did not have a doctor's visit in past year

Do not have a personal doctor Unable to obtain medical care due to cost

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

28% 15% 14%34% 15% 11%37% 19% 11%

Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties

Access to health care

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GEOGRAPHY

Number of dentists per 100,000 people by level of urbanization, Wisconsin, 2010

Source: Wisconsin Department of Safety and Professional Services licensure lists; population estimates from Wisconsin Department of Health Services, Office of Health Informatics.

Licensed dentists0

10

20

30

40

50

60

70

62 65 47

Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties

Num

ber o

f den

tists

per

100

,000

pop

ula-

tion

Access to health care

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GEOGRAPHY

Number of full-time equivalent dentists needed to reduce significant shortages for Medicaid members, by county, 2009

Source: Wisconsin Department of Health Services, Primary Care Office, Shortage Designation Program.

Dentists needed to reduce significant shortages

≤0.0

>0.0 to 2.0

>2.0 to 8.1

35.3

Access to health care

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GEOGRAPHY

Age-adjusted rates of tooth removal and dental visits in the past year among Wisconsin adults, by level of urbanization, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Tooth removal question asked in 2008, 2010 and 2011. Dentist visit question asked in 2008 and 2010.

Had at least 1 permanent tooth removed Did not visit dentist within past year0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

45% 31%33% 26%40% 32%

Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties

Access to health care

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GEOGRAPHY

Number of full-time equivalent psychiatrists needed to remove significant shortages for the resident population, by county, 2011

Source: Wisconsin Department of Health Services, Primary Care Office, Shortage Designation Program.

Access to health care

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Psychiatrists needed toreduce significant shortages

≤0.0

>0.0 to <2.0

2.0 to <10.0

10.0 to 22.9

Not available

Not available

GEOGRAPHY

Risk factors and health outcomes

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Fair or poor health Physical health not good on any day during past month

Of those with at least one day of poor health, percent whose poor health limited usual activities on at least one day during past month

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

19% 43% 66%12% 34% 67%14% 36% 69%

Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties

Age-adjusted rates of physical health among Wisconsin adults by level of urbanization, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline only dataset

Note: Physical health and limited activities questions only asked 2009-2011.

Health status

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GEOGRAPHY

Age-adjusted rate of physical inactivity among Wisconsin adults, by level of urbanization, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset

Did not participate in any physical activity in past month, other than at job0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

28% 22% 26%

Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties

Physical activity

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GEOGRAPHY

Age-adjusted rates of binge drinking and heavy drinking among Wisconsin adults, by level of urbanization, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.

Binge drinking Heavy drinking0%

5%

10%

15%

20%

25%

30%

35%

40%

18% 8%25% 8%25% 9%

Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties

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Alcohol and other drug use

GEOGRAPHY

Alcohol outlet density, people per license, Wisconsin, 2011-2012

Source: Wisconsin Department of Health Services, Division of Mental Health and Substance Abuse Services, Bureau of Prevention, Treatment and Recovery; and the University of Wisconsin Law School, Resource Center on Impaired Driving, Wisconsin Alcohol Policy Project.

Statewide number ofpeople per license = 329

People per alcohol license

401 - 514

329 - 400

201 - 328

66 - 200

Alcohol and other drug use

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GEOGRAPHY

Age-adjusted rate of frequent mental distress among Wisconsin adults, by level of urbanization, 2009-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Question asked in 2009-2011.

Mental health

Frequent mental distress0%

5%

10%

15%

20%

25%

30%

35%

40%

14% 9% 9%

Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties

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GEOGRAPHY

Age-adjusted rate of four or more Adverse Childhood Experiences (ACEs) among Wisconsin adults, by level of urbanization, 2010 and 2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Question asked in 2010 and 2011.

Mental health

Four or more ACEs0%

5%

10%

15%

20%

25%

30%

35%

40%

17% 16% 13%

Milwaukee County

Smaller metropolitan counties

Non-metropolitan counties

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GEOGRAPHY

Estimated prevalence of smoking among Wisconsin adults, by county, 2006-2008

Source: Wisconsin Department of Health Services, Division of Public Health, Tobacco Prevention and Control Program. The Burden of Tobacco in Wisconsin, 2010.

Tobacco use and exposure

Estimated prevalence of adult smoking

Statewide = 19.5%

13.4% - 16%

16.1% - 19.5%

19.6% - 30.9%

44.3%

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GEOGRAPHY

Rates of secondhand smoke exposure among Wisconsin adults, by level of urbanization, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: The “smoking at work” question was only asked in 2009 and 2010.

Tobacco use and exposure

Smoking allowed at home Exposed to others' smoke at home

Smoking permitted at work0%

10%

20%

30%

40%

50%

60%

30% 18% 17%22% 13% 11%25% 15% 15%

Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties

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GEOGRAPHY Injury and violence

Intentional injury deaths by county, age-adjusted rates per 100,000, Wisconsin, 2008-2010

Suicide Homicide

Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.

Statewide rate = 13 per 100,000

Statewide rate = 3 per 100,000

Homicide fatalitiesage-adjusted rate per 100,000

1 - 2

3

4 - 9

10 - 20

Number too small to determine rateNumber too small to determine rate

Suicide fatalitiesage-adjusted rate per 100,000

2 - 5

6 - 13

14 - 21

22 - 35

35

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GEOGRAPHY

Age-adjusted rates of asthma among Wisconsin adults, by level of urbanization, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.

Have ever been told you have asthma Currently have asthma0%

5%

10%

15%

20%

25%

30%

14% 11%15% 10%11% 8%

Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties

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Environmental health

GEOGRAPHY

Counties exceeding the statewide age-adjusted rates per 10,000 of asthma hospitalizations and emergency department visits, Wisconsin, 2008-2010

Source: 2008-2010 Wisconsin hospital inpatient discharge file; 2008-2010 Wisconsin emergency department visit file.37

Environmental health

Asthma health care utilization

Both hospitalization and emergencydepartment rates exceed state rates

Neither hospitalization or emergency department rate exceeds state rates

Hospitalization rate exceeds staterate (9 per 10,000)

Emergency department rate exceeds state rate (38 per 10,000)

GEOGRAPHY

Percentage of lead poisoning (10 mcg/dL or greater) among tested children under age six, by county, Wisconsin, 2010

Source: Wisconsin Department of Health Services, Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP).

Elevated blood lead level

0% - 0.3%

0.4% - 0.7%

0.8% - 1.3%

1.4% - 2.4%

Statewide = 1.3%

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Environmental health

GEOGRAPHY

Reported cases of chlamydia, rate per 100,000, Milwaukee County and Wisconsin excluding Milwaukee County, 2001-2010

Source: Wisconsin Department of Health Services, Sexually Transmitted Disease Program.

2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

200

400

600

800

1,000

1,200Milwaukee County Wisconsin (excluding Milwaukee County)

Year

Ra

te p

er

10

0,0

00

po

pu

lati

on

Reproductive and sexual health

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GEOGRAPHY

Rates of HIV testing and age-adjusted risk behaviors among Wisconsin adults, by level of urbanization, 2008-2011

Reproductive and sexual health

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Testing rates are not age-adjusted; rates of exposure to high-risk situations are age-adjusted.

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Ever been tested for HIV Ever been in any HIV high-risk situations in past year0%

10%

20%

30%

40%

50%

60%

43%

4%

31%2%

28%3%

Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties

GEOGRAPHY

References

1. University of Wisconsin Population Health Institute. County Health Rankings, 2013. http://www.countyhealthrankings.org/our-approach

2. Center for Urban Population Health. Milwaukee Health Report, 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf

3. LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf

4. Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/

5. Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf

6. Centers for Disease Control and Prevention (CDC). Health Care: See Why Being Insured Matters. http://www.cdc.gov/features/vitalsigns/HealthcareAccess/

7. Cheung PT, Wiler JL, Lowe RA, Ginde AA (2012). National Study of Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries. Annals of Emergency Medicine. 60(1). http://www.annemergmed.com/webfiles/images/journals/ymem/FA-PTCheung.pdf

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References

GEOGRAPHY

8. CDC. Regular Check-Ups Are Important. http://www.cdc.gov/family/checkup/9. The Henry Kaiser Foundation. State Health Facts. http://kff.org/statedata/10. DHS. Wisconsin Primary Care Office: Number of Dentists Needed to Reduce

Significant Shortages for Medicaid Members. http://www.dhs.wisconsin.gov/publications/p0/p00368.pdf

11. DHS. Wisconsin Primary Care Office: Number of Psychiatrist FTEs Needed to Reduce Significant Shortages for the Resident Population. http://www.dhs.wisconsin.gov/publications/p0/p00376.pdf

12. CDC: Physical Activity. http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html

13. CDC. Alcohol Use and Health. http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm

14. CDC. BRFS Prevalence and Trends Data. http://apps.nccd.cdc.gov/BRFSS/15. CDC. Preventing Excessive Alcohol Consumption: Regulation of Alcohol Outlet

Density. http://www.thecommunityguide.org/alcohol/outletdensity.html16. Wisconsin Department of Health Services (DHS). Alcohol License Overview for

Wisconsin. http://www.dhs.wisconsin.gov/substabuse/docs/AlcDensity/AlcoholOutletReport-Wisconsin.pdf

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References

GEOGRAPHY

17. CDC. Self-Reported Frequent Mental Distress Among Adults --- United States, 1993—2001. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5341a1.htm

18. CDC. Adverse Childhood Experiences Study. http://www.cdc.gov/ace/19. O’Connor C, Finkbiner C, & Watson L (2012). Adverse Childhood Experiences in

Wisconsin: Findings from the 2010 Behavioral Risk Factor Survey. Madison, Wisconsin: Wisconsin Children’s Trust Fund and Child Abuse Prevention Fund of Children’s Hospital & Health System. http://wichildrenstrustfund.org/index.php?section=adverse-childhood

20. DHS. Burden of Tobacco in Wisconsin, 2010. http://sep.uwcarbone.wisc.edu/downloads/Documents/programbriefs/The%20Burden%20of%20Tobacco%20Report%202010.pdf

21. CDC. Smoking and Tobacco Use: Secondhand Smoke Facts. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm

22. Centers for Disease Control and Prevention (CDC). Asthma. http://www.cdc.gov/asthma/faqs.htm

23. DHS. Burden of Asthma in Wisconsin 2010: http://www.dhs.wisconsin.gov/eh/asthma/pdf/BurdenofAsthma2010Web.pdf

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References

GEOGRAPHY

24. DHS. Sexually Transmitted Diseases in Wisconsin, 2010. http://www.dhs.wisconsin.gov/communicable/std/Statistics/AnnualData/2010data/2010WisconsinSummaryReport.pdf

25. CDC. 2010 Sexually Transmitted Diseases Surveillance. Cases of Sexually Transmitted Diseases Reported by State Health Departments and Rates per 100,000 Population, United States, 1941-2010. http://www.cdc.gov/std/stats10/tables/1.htm

26. CDC. 2010 Sexually Transmitted Diseases Surveillance. National Profiles – Chlamydia. http://www.cdc.gov/std/stats10/chlamydia.htm

27. CDC. 2010 Sexually Transmitted Diseases Surveillance. National Profiles – Gonorrhea. http://www.cdc.gov/std/stats10/gonorrhea.htm

28. CDC. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm

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References

GEOGRAPHY

Links to additional reports and resources

• Centers for Disease Control and Prevention, Minority Health, Other At-Risk Populations, Geography: http://www.cdc.gov/minorityhealth/populations/atrisk.html

• National Rural Health Association: http://www.ruralhealthweb.org/

• Wisconsin Office of Rural Health: http://www.worh.org/

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Links

GEOGRAPHY

Contacts

Karl Pearson, DemographerWisconsin Division of Public Health, Office of Health InformaticsE-mail: KarlT.Pearson@dhs.wisconsin.gov

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Contacts