Health Behavior Factors

A healthy community is one where residents take advantage of opportunities to make healthy lifestyle choices. The health behaviors measure evaluates the health impacts of residents’ diet, exercise, alcohol consumption, and more. It is also comprised of the infrastructure like grocery stores and exercise opportunities which promote and enable a healthy lifestyle. The health behavior factors measure is created by standardizing several components and then weighting them based on their importance.

Peer City Perspective

Louisville ranks 16th in terms of health behaviors, well below the peer city average. The graph shows an index of health behaviors where the vertical black line represents this average. The bars represent how many standard deviations from average each city is.

Physical Inactivity

Physical activity has significant health benefits, ranging from increased cardiovascular function to improved mental health and wellness. Estimating physical health is important in gauging the potential for physical health investment in a community.

Improved physical activity rates act as a preventive health measure, reducing negative outcomes such as type 2 diabetes, stroke, and obesity, and improving the overall physical health of a community.

Peer City Perspective

Louisville currently ranks 12th among its peer cities in the percent of adults 20 and older who report no physical activity in their leisure time (28%).

Louisville is in the bottom tier of its peer group according to a natural breaks algorithm. Cities in green are those that outperform their peers. Cities in yellow represent the middle cluster, and those in red lag behind their peers on this indicator.

Trends over Time

Louisville’s physical inactivity rate had been decreasing since 2010 but now appears to be on the rise again. It sits well above its peer rate of 24% and has recently landed in the bottom quartile among its peers. On average, the inactivity rate among Louisville’s peers has stayed relatively constant over the past decade.

Best and Worst Peer Performers

Over the past decade, Louisville has largely moved in tandem with the worst performer of the group, Indianapolis, which has seen its physical inactivity rate increase by nearly 3 percentage points since 2004. (Louisville’s rate has increased by 2 percentage points over the same period.) Nashville has performed the best since 2004, with a 1.5 percentage point decrease in its physical inactivity rate.

Differences by Sex

The physical inactivity rate among men and women increased year over year in the early 2000s until it started decreasing from 2010 onward. It now appears to be on an upward swing again. Since 2004, the physical inactivity rate among women has remained about 5 percentage points above that of men. The gap between men and women is narrower among Louisville’s peer cities.

Teen Births

Teen birth rates have seen a steady, nationwide decline in recent years. However, rates vary across the country along geographic and racial lines. Unplanned pregnancy often leads to decreased educational attainment and decreased lifetime earnings. Efforts to improve education and health — and reduce poverty — require tackling teen birth rates.

Peer City Perspective

Among its peer cities, Louisville currently ranks 9th in the number of births per 1,000 teens between the ages of 15 and 19, with a teen birth rate of 19.4 per 1,000.

Louisville is in the middle tier of its peer group, according to a natural breaks algorithm. Cities in green are those that outperform their peers. Cities in yellow represent the middle cluster, and those in red are the cities that lag behind their peers on this indicator.

Trends over Time

Teen birth rates have decreased steadily over the past decade. For much of that time, Louisville’s rate hovered above that of its peers. In recent years, however, Louisville has recorded a lower teen birth rate than its peers: 20.7 births per 1,000 women between the ages of 15 and 19, compared with 21.7 births among its peers.

Best and Worst Peer Performers

Louisville has outperformed its peers over the last decade, decreasing its teen birth rate by about 32 births per 1,000 women between the ages of 15 and 19. Over the same time period, Oklahoma City has decreased its teen birth rate the most: nearly 40 births per 1,000 women. That’s about 4 times better than St. Louis.

Differences by Race

A significant divide exists between the number of births among Black and Hispanic mothers and the number of births among White mothers. In Louisville, for much of the early 2010s, the teen birth rate among Black mothers was substantially higher than that of Hispanic mothers. That trend reversed in the middle of the previous decade. Currently, the teen birth rate in Louisville sits at about 50 births per 1,000 women between the ages of 15 and 19 for Hispanic mothers and 32 births for Black mothers.

Sexually Transmitted Infections

Sexually transmitted infections are becoming more common in the U.S. Infections can lead to long-term health issues like recurrent dysfunction, dementia, infertility, and even death. This analysis focuses on chlamydia because it is a common and easily transmitted infection that is often asymptomatic (presents no outward symptoms). Chlamydia is also of particular concern for women because it can lead to infertility.

Peer City Perspective

Louisville currently ranks 6th among its peer cities in the number of newly diagnosed chlamydia cases per 100,000 people.

On this metric, Louisville is in the top tier of its peer group according to a natural breaks algorithm. Cities in green are those that outperform their peers. Cities in yellow represent the middle cluster, and those in red lag behind their peers on this indicator.

Trends over Time

Generally, across Louisville’s peer cities, the number of chlamydia cases per 100,000 people has risen steadily over the last two decades.  In Louisville, the rate started to plateau toward the beginning of the last decade. It now sits at a rate that is roughly equivalent to the average of all of its peers.

Best and Worst Peer Performers

Memphis has seen the greatest increase in its annual number of chlamydia cases per 100,000 people over the last two decades. Cases in Memphis began to decrease toward the beginning of the 2010s but are back on the rise again. The best performer, Grand Rapids, has seen an increase of 200 in its annual number of chlamydia cases per 100,000 people. Louisville has outperformed its peers, on average.

Access to Exercise Opportunities

Access to exercise opportunities promotes physical fitness and increased preventative health options. Public places supporting exercise also promote community involvement and connection, creating safe spaces that allow for neighborhood interaction.

Peer City Perspective

Louisville ranks 3rd among its peer cities in rates of access to exercise opportunities with 95.3% of adults within range of a location for physical activity.

On this metric, Louisville ranks among the top tier of its peer group according to a natural breaks algorithm. Cities in green are those that outperform their peers, cities in yellow represent the middle cluster, and those in red are a group that lags behind its peers on this indicator.

Adult Obesity

Obesity is a growing national problem in America. Defined by the CDC as a body mass index (BMI) of 30.0 or higher, obesity is highly correlated with an increased risk of type 2 diabetes. It also can lead to significant increases in healthcare costs. Obesity is particularly prevalent in areas of concentrated poverty. It increases overall economic and health-related burdens on both individuals and the community.

Peer City Perspective

Among its peer cities, Louisville currently ranks 5th in the percent of adults who are 20 and older and are in the obese range — 31.1%.

On this metric, Louisville ranks in the middle tier of its peer group according to a natural breaks algorithm. Cities in green are those that outperform their peers. Cities in yellow represent the middle cluster, and those in red lag behind their peers on this indicator.

Trends over Time

In Louisville, the obesity rate among adults 20 and older reached a peak around 2010. Since that point, it has decreased and leveled off, where it now sits just a few tenths of a percentage point above the average rate of its peers. Overall, across peer cities, the average obesity rate has generally increased over the last decade.

Best and Worst Peer Performers

Generally, the obesity rate among adults 20 and older has increased over the last decade. That is why even the best performer of the group, Cincinnati, saw an increase in its obesity rate: by about 5 percentage points. Meanwhile, the worst peer performer, Greensboro, saw its adult obesity rate climb by more than 11 percentage points. Louisville’s obesity rate has risen and fallen over the period, but it has ultimately risen less than the rate of its peers.

Differences by Sex

The adult obesity rate in Louisville among men and women has largely risen and fallen in tandem since 2004. However, in recent years, the rates have diverged. The male obesity rate appears to be on a downward trajectory while the female obesity rate appears to be staying relatively constant.

Continue Exploring with Related Data

Food Deserts

Health Behavior Factors

Physical Inactivity

Racial Geography

Food Environment Index

The food environment index is a metric that aggregates access to food within a reasonable distance and general access to healthy food options. Significant evidence has demonstrated the importance of healthy food choices in preventing negative health outcomes such as obesity and improving overall physical health performance.

Peer City Perspective

Louisville currently ranks 4th among its peer cities on the food environment index with z-score of 6.9.

On this metric, Louisville is in the middle tier of its peer city group according to a natural breaks algorithm. Cities in green are those that outperform their peers, cities in yellow represent the middle cluster, and those in red are a group that lags behind its peers on this indicator.

Adult Smoking

Considering the numerous health risks and resulting costs, addressing smoking in communities is vital to effective social investment. The CDC estimates that 1 in 5 deaths are attributed to smoking related complications. More than 90% of all lung cancer cases and more than 80% of all chronic obstructive pulmonary disease are attributed to smoking.

Peer City Perspective

Louisville currently ranks 17th among its peer cities in rates of adult smoking with 22.3% of adults smoking cigarettes.

On this metric, Louisville is in the bottom tier of its peer group according to a natural breaks algorithm. Cities in green are those that outperform their peers, cities in yellow represent the middle cluster, and those in red are a group that lags behind its peers on this indicator.

Alcohol-Impaired Driving Deaths

Alcohol-impaired driving accounts for almost one third of all motor vehicle deaths in the United States. Alcohol-impaired driving is an important issue for communities to address in order to reduce premature deaths for both perpetrator and victim.

Peer City Perspective

Louisville currently ranks 8th among its peer cities in percentage of Alcohol-Impaired driving deaths with 31.3% of driving deaths due to alcohol-impairment.

Louisville ranks among the middle tier of its peer group according to a natural breaks algorithm. Cities in green are those that outperform their peers, cities in yellow represent the middle cluster, and those in red are a group that lags behind its peers on this indicator.

Excessive Drinking

Excessive drinking is defined by the CDC as consuming 5 or more drinks for men and 4 or more drinks for women in a single occasion. Binge drinking is a serious health issue leading to a variety of detrimental health outcomes and is the fourth leading cause of death in the United States. Long-term, excessive drinking can lead to chronic health issues such as liver disease, pancreatitis, and even brain damage.

Peer City Perspective

Louisville currently ranks 13th among its peer cities in percentage of people reporting excessive drinking incidents with 18.6% of adults reporting excessive drinking in the past 30 days.

Louisville is in the middle tier of its peer group according to a natural breaks algorithm. Cities in green are those that outperform their peers, cities in yellow represent the middle cluster, and those in red are a group that lags behind its peers on this indicator.

Natural Breaks Algorithm

For each indicator, Greater Louisville Project assigns cities into one of three groups (high-performing, middle-of-the-pack, and low-performing) based on how they compare to other cities. The assignment is based on how cities naturally cluster on that indicator. Sometimes, the differences between cities are very small, and the difference between a city ranked 5th and 6th could simply be a matter of the sampling error that arises from using survey data. Thus, rather than always make a division that declares the top 5 to be the top tier, we use a natural breaks algorithm to look for a cluster of cities that is outperforming the rest, a cluster that is about average, and a cluster that is lagging. This clustering gives us a better indication of where Louisville is thriving and where Louisville has room to learn from cities that are doing better.

Z-Scores

Z-scores (or standardization) is a way to combine data with different units of measurement into a single index. The z-score is a measure of how far away a city (or census tract, etc.) is from the average city. In order to be comparable across different units of measurement, the z-score is the distance from the mean measured in standard deviations (e.g. if Louisville has a z-score of 1 it means Louisville is 1 standard deviation above the mean of its peer cities).

Data from the Robert Wood Johnson Foundation's County Health Rankings use z-scores and all z-scores are relative to the mean of Louisville's peer cities. (On the County Health Rankings site z-scores are relative to all the counties in each state - thus z-scores reported by GLP will be different, because we are using a different reference group). The Greater Louisville Project also uses z-scores in our multidimensional poverty index, which compares each census tract to the mean of all census tracts in Louisville.