Risk of Chronic Obstructive Pulmonary Disease and Receipt of a Breathing Test in 26 States and the District of Columbia, 2017-2018.

We estimated the prevalence of respiratory symptoms, chronic obstructive pulmonary disease (COPD) risk level, and receipt of a breathing test among adults without reported COPD in 26 states and the District of Columbia by using 2017-2018 Behavioral Risk Factor Surveillance System data. Among adults without reported COPD, the 3 respiratory symptoms indicating COPD (chronic cough, phlegm or mucus production, shortness of breath) were common (each >10%). About 15.0% were at higher COPD risk (based on the number of symptoms, age, and smoking status); 41.4% of adults at higher risk reported receipt of a breathing test. Patient-provider recognition and communication of risk symptoms, appropriate screening, and follow-up are important for early diagnosis and treatment.

Chronic Conditions Among Adults Aged 18─34 Years - United States, 2019.

Chronic conditions are common, costly, and major causes of death and disability.* Addressing chronic conditions and their determinants in young adulthood can help slow disease progression and improve well-being across the life course (1); however, recent prevalence estimates examining chronic conditions in young adults overall and by subgroup have not been reported. CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) to measure prevalence of 11 chronic conditions among adults aged 18-34 years overall and by selected characteristics, and to measure prevalence of health-related risk behaviors by chronic condition status. In 2019, more than one half (53.8%) of adults aged 18-34 years reported having at least one chronic condition, and nearly one quarter (22.3%) reported having more than one chronic condition. The most prevalent conditions were obesity (25.5%), depression (21.3%), and high blood pressure (10.7%). Differences in the prevalence of having a chronic condition were most noticeable between young adults with a disability (75.8%) and without a disability (48.3%) and those who were unemployed (62.3%) and students (45.8%). Adults aged 18-34 years with a chronic condition were more likely than those without one to report binge drinking, smoking, or physical inactivity. Coordinated efforts by public and private sectors might help raise awareness of chronic conditions among young adults and help improve the availability of evidence-based interventions, policies, and programs that are effective in preventing, treating, and managing chronic conditions among young adults (1).

Surveillance of Meeting the Youth Physical Activity Guideline: Impact of Including Vigorous-Intensity and Bone-Strengthening Activities.

Purpose: The US youth physical activity guideline recommends participation in four types of physical activity: moderate-to-vigorous intensity aerobic (MVPA), vigorous-intensity aerobic (VPA), muscle-strengthening, and bone-strengthening physical activity. Current national prevalence estimates of meeting the youth physical activity guideline are typically based on measures of the MVPA and muscle-strengthening components. This study sought to examine differences in prevalence estimates using this current approach and then including measures of all four components. Methods: Data from US high school student respondents to the 2010 National Youth Physical Activity and Nutrition Survey were analyzed (n = 10,596). Prevalence of students meeting the youth physical activity guideline were assessed and compared using 1) measures of MVPA and muscle-strengthening components only and 2) also including measures of the VPA and bone-strengthening components. Results: Overall, 15.2% students met the MVPA, 50.7% met the muscle-strengthening, 70.6% met the VPA, and 80.7% met the bone-strengthening components. In total, 12.1% (95% confidence interval: 10.9, 13.3) of students met both the MVPA and muscle-strengthening components, and 11.2% (95% confidence interval: 10.0, 12.4) met all four components. Conclusions: Incorporating additional measures of VPA and bone-strengthening activity into current surveillance systems may not meaningfully impact national estimates of meeting the youth physical activity guideline.

Walking and Other Common Physical Activities Among Adults with Arthritis - United States, 2019.

The numerous health benefits of physical activity include reduced risk for chronic disease and improved mental health and quality of life (1). Physical activity can improve physical function and reduce pain and fall risk among adults with arthritis, a group of approximately 100 conditions affecting joints and surrounding tissues (most commonly osteoarthritis, fibromyalgia, gout, rheumatoid arthritis, and lupus) (1). Despite these benefits, the 54.6 million U.S. adults currently living with arthritis are generally less active than adults without arthritis, and only 36.2% of adults with arthritis are aerobically active (i.e., meet aerobic physical activity guidelines*) (2). Little is known about which physical activities adults with arthritis engage in. CDC analyzed 2019 Behavioral Risk Factor Surveillance System (BRFSS) data to examine the most common nonwork-related physical activities among adults with arthritis who reported any physical activity during the past month, nationally and by state. In 2019, 67.2% of adults with arthritis reported engaging in physical activity in the past month; among these persons, the most commonly reported activities were walking (70.8%), gardening (13.3%), and weightlifting (7.3%). In 45 U.S. states, at least two thirds of adults with arthritis who engaged in physical activity reported walking. Health care providers can help inactive adults with arthritis become active and, by encouraging physical activity and referring these persons to evidence-based physical activity programs, improve their health and quality of life.

Trends in Meeting the Aerobic Physical Activity Guideline Among Adults With and Without Select Chronic Health Conditions, United States, 1998-2018.

BACKGROUND: Physical activity is central to the management and control of many chronic health conditions. The authors examined trends during the past 2 decades in the prevalence of US adults with and without select chronic health conditions who met the minimal aerobic physical activity guideline. METHODS: The 1998-2018 National Health Interview Survey data were analyzed. Prevalence of meeting the minimal aerobic physical activity guideline among adults with and without 6 chronic health conditions was estimated across 3-year intervals. Linear and higher-order trends were assessed overall and by age group. RESULTS: During the past 2 decades, prevalence of meeting the aerobic guideline increased among adults with diabetes, hypertension, coronary heart disease, stroke, cancer, and arthritis. However, the absolute increase in prevalence was lower among adults with hypertension, coronary heart disease, and arthritis compared to counterparts without each condition, respectively. Prevalence was persistently lower among those with most chronic health conditions, except cancer, and among older adults compared to their counterparts. CONCLUSIONS: Although rising trends in physical activity levels among adults with chronic health conditions are encouraging for improving chronic disease management, current prevalence remains low, particularly among older adults. Increasing physical activity should remain a priority for chronic disease management and control.

Cross-sectional study of changes in physical activity behavior during the COVID-19 pandemic among US adults.

BACKGROUND: Physical activity (PA) provides numerous health benefits relevant to the COVID-19 pandemic. However, concerns exist that PA levels may have decreased during the pandemic thus exacerbating health disparities. This study aims to determine changes in and locations for PA and reasons for decreased PA during the pandemic. METHODS: Reported percentage of changes in and locations for PA and reasons for decreased PA were examined in 3829 US adults who completed the 2020 SummerStyles survey. RESULTS: Overall, 30% reported less PA, and 50% reported no change or no activity during the pandemic; percentages varied across subgroups. Adults who were non-Hispanic Black (Black) or Hispanic (vs. non-Hispanic White, (White)) reported less PA. Fewer Black adults (vs. White) reported doing most PA in their neighborhood. Concern about exposure to the virus (39%) was the most common reason adults were less active. CONCLUSIONS: In June 2020, nearly one-third of US adults reported decreased PA; 20% reported increased PA. Decreased activity was higher among Black and Hispanic compared to White adults; these two groups have experienced disproportionate COVID-19 impacts. Continued efforts are needed to ensure everyone has access to supports that allow them to participate in PA while still following guidance to prevent COVID-19 transmission.

Associations between the National Walkability Index and walking among US Adults - National Health Interview Survey, 2015.

The Environmental Protection Agency created the National Walkability Index (Index) to compare and analyze walkability among US communities. Index elements include design, distance to transit, and diversity of land uses. Associations between the Index and walking behavior have not been examined. This study describes associations between the Index and transportation and leisure walking among US adults. Past week self-reported participation in transportation and leisure walking among adults (n = 33,672) was obtained from the 2015 Cancer Control Supplement of the National Health Interview Survey (NHIS) and analysis completed in 2019. Index scores were linked to NHIS data based on the respondent's residence and classified into least, below average, above average, and most walkable communities. Associations between Index categories and walking were examined with regression models. Overall, the Index was associated with a higher likelihood of walking, especially for transportation. Transportation walking was more common in areas with higher walkability (21.6%-51.6%, least to most walkable). Leisure walking was also more common with greater walkability (48.4%-56.5%, least to most walkable). Transportation and leisure walking by Index categories in urban areas were similar to the overall population; however, it was not associated with walking in rural areas. US adults living in more walkable areas report more transportation and leisure walking, especially among urban areas. Consistent with elements in the Index, associations were stronger for transportation than leisure walking. Findings support the use of the Walkability Index by researchers, professionals, and other relevant stakeholders as a viable indicator of walkability.

National-level environmental perceptions and walking among urban and rural residents: Informing surveillance of walkability.

Built environments that provide activity-friendly routes (e.g., sidewalks) to everyday destinations (e.g., shops) can increase physical activity. Surveillance of supports and destinations is important, and identifying which are associated with walking could prioritize surveillance questions. Our purpose was to identify the significant associations between supports and destinations with walking among a nationally-representative sample of urban- and rural-dwelling adults. Participants in the 2015 National Health Interview Survey, Cancer Control Supplement (n = 29,925) reported the near-home presence of walkable supports (roads, sidewalks, paths, or trails; sidewalks on most streets), destinations (shops; transit; movies, libraries, or churches; relaxing places), and past-week walking for leisure or transportation. We used stepwise logistic regression to quantify associations between supports and destinations and walking, including by urban/rural residence. We calculated the prevalence of walking across counts of reported elements by urban/rural residence. Among all participants, roads, sidewalks, paths, or trails and relaxing destinations were associated with leisure walking. Among urban residents, sidewalks on most streets and all four destination types were associated with transportation walking; among rural residents, roads, sidewalks, paths, or trails; movies, libraries, or churches; and relaxing destinations were associated with transportation walking. Walking was more common when more environmental elements were reported. To improve efficiency, communities may match surveillance priorities to behavioral priorities (i.e., leisure versus transportation walking) and environmental context (i.e., urban/rural areas). Surveillance of environments supporting leisure walking might focus on recreation-oriented spaces. Surveillance of environments supporting transportation walking might differ for urban and rural areas, and assessing destinations may be particularly important.

Racial and ethnic differences in perceived safety barriers to walking, United States National Health Interview Survey - 2015.

Barriers to safe walking may prevent people from being physically active, and previous reports have identified differences in barriers to safe walking across racial and ethnic groups. The purpose of this research was to determine the role demographic characteristics play on racial/ethnic differences in perceived barriers to safe walking and determine if racial/ethnic differences vary by urban/rural residence and Census region. Participants in the 2015 National Health Interview Survey Cancer Control Supplement (n = 31,433 adults ≥18 years) reported perceived barriers to safe walking (traffic, crime, and animals) and demographic characteristics. Urban/rural residence and Census region were based on home addresses. We calculated adjusted prevalence of barriers by race/ethnicity using logistic regression; geographic differences in barriers across racial/ethnic groups were examined via interaction terms. After adjustment for demographic characteristics, non-Hispanic blacks (blacks) and Hispanics reported crime and animals as barriers more frequently than non-Hispanic whites (whites) (crime: blacks, 22.2%; Hispanics, 16.7%; whites, 9.0%; animals: blacks, 18.0%; Hispanics, 12.4%; whites, 8.5%). Racial/ethnic differences in perceived crime as a barrier were more pronounced in the Northeast and Midwest than in the South and West. Urban-dwelling blacks (all regions) and Hispanics (Midwest and South) reported animals as barriers more frequently than whites. Racial/ethnic differences in perceived barriers to safe walking remained after adjusting for demographic characteristics and varied by geographic location. Addressing perceived crime and animals as barriers to walking could help reduce racial/ethnic differences in physical activity, and several barriers may need to be assessed to account for geographic variation.

Worksite Food and Physical Activity Environments and Wellness Supports Reported by Employed Adults in the United States, 2013.

PURPOSE: To examine the workplace food and physical activity (PA) environments and wellness culture reported by employed United States adults, overall and by employer size. DESIGN: Cross-sectional study using web-based survey on wellness policies and environmental supports for healthy eating and PA. SETTING: Worksites in the United States. PARTICIPANTS: A total of 2101 adults employed outside the home. MEASURES: Survey items were based on the Centers for Disease Control and Prevention Worksite Health ScoreCard and Checklist of Health Promotion Environments and included the availability and promotion of healthy food items, nutrition education, promotion of breast-feeding, availability of PA amenities and programs, facility discounts, time for PA, stairwell signage, health promotion programs, and health risk assessments. ANALYSIS: Descriptive statistics were used to examine the prevalence of worksite environmental and facility supports by employer size (<100 or ≥100 employees). Chi-square tests were used to examine the differences by employer size. RESULTS: Among employed respondents with workplace food or drink vending machines, approximately 35% indicated the availability of healthy items. Regarding PA, 30.9% of respondents reported that their employer provided opportunities to be physically active and 17.6% reported worksite exercise facilities. Wellness programs were reported by 53.2% working for large employers, compared to 18.1% for smaller employers. CONCLUSION: Employee reports suggested that workplace supports for healthy eating, PA, and wellness were limited and were less common among smaller employers.

Video game play, child diet, and physical activity behavior change a randomized clinical trial.

BACKGROUND: Video games designed to promote behavior change are a promising venue to enable children to learn healthier behaviors. PURPOSE: Evaluate outcome from playing "Escape from Diab" (Diab) and "Nanoswarm: Invasion from Inner Space" (Nano) video games on children's diet, physical activity, and adiposity. DESIGN: Two-group RCT; assessments occurred at baseline, immediately after Diab, immediately after Nano, and 2 months later. Data were collected in 2008-2009, and analyses were conducted in 2009-2010. SETTING/PARTICIPANTS: 133 children aged 10-12 years, initially between 50th percentile and 95th percentile BMI. INTERVENTION: Treatment group played Diab and Nano in sequence. Control Group played diet and physical activity knowledge-based games on popular websites. MAIN OUTCOME MEASURES: Servings of fruit, vegetable, and water; minutes of moderate to vigorous physical activity. At each point of assessment: 3 nonconsecutive days of 24-hour dietary recalls; 5 consecutive days of physical activity using accelerometers; and assessment of height, weight, waist circumference, and triceps skinfold. RESULTS: A repeated measures ANCOVA was conducted (analyzed in 2009-2010). Children playing these video games increased fruit and vegetable consumption by about 0.67 servings per day (p<0.018) but not water and moderate-to-vigorous physical activity, or body composition. CONCLUSIONS: Playing Diab and Nano resulted in an increase in fruit and vegetable intake. Research is needed on the optimal design of video game components to maximize change.

The impact of goal attainment on behavioral and mediating variables among low income women participating in an Expanded Food and Nutrition Education Program intervention study.

This study examined the relationships between participant goal attainment and changes in mediating variables and food choice outcomes from a modified curriculum for the Texas Expanded Food and Nutrition Education Program (EFNEP) promoting healthy home food environments and parenting skills related to obesity prevention. EFNEP participants in 54 intervention classes received a goal sheet after each of 6 classes. Participants recorded goal attainment and returned at the next class, Diet and mediating variables were measured at baseline, immediate post, and 4 months later. Mixed model regression analysis over time assessed whether goal attainment was associated with the outcomes at post or follow-up, controlling for baseline assessment. Participants who reported attaining more goals reported greater self-efficacy for planning/encouraging fruit and vegetable consumption and making fruit and vegetables available, menu planning skills, improvement in the food preparation practices and higher home availability for regular vegetables. At post, those who reported attaining more fiber, vegetable, and water goals reported consuming more of these items. Goal attainment was related to some changes in food choice and mediating variables in an at risk population. Further research into the use and efficacy of goal setting and attainment in this population is warranted.

Creating healthful home food environments: results of a study with participants in the expanded food and nutrition education program.

OBJECTIVE: To evaluate a modified curriculum for the 6-session Texas Expanded Food and Nutrition Education Program (EFNEP) promoting healthful home food environments and parenting skills related to obesity prevention. DESIGN: Two-group randomized control trial; intervention versus usual EFNEP curriculum. SETTING: Texas EFNEP classes. PARTICIPANTS: 1,104 EFNEP clients in 100 classes. INTERVENTION: Six short videos, with goal setting, problem solving, guided discussion, and handouts, incorporated into existing EFNEP classes. MAIN OUTCOME MEASURES: Body mass index (BMI), diet, psychosocial variables with baseline measurements, immediately post, and 4 months later. ANALYSIS: Mixed-model repeated measures analysis of variance. RESULTS: 100 classes were randomized (54 intervention/46 comparison), with 1,006 participants at baseline (582 intervention, 424 comparison, 97% women, 89% Hispanic). Significant improvements over time were found for both groups' consumption of most food items and nutrients, and nearly all psychosocial variables, regardless of study group. Only the intervention group had a significant BMI decrease at post. Fidelity to the intervention class session structure was high, and comments from intervention staff and clients were positive. CONCLUSION AND IMPLICATIONS: Existing EFNEP programs in local communities could have a significant impact on family dietary behaviors for populations at risk of obesity. Replication with similar populations is warranted.