Up-to-Date Breast, Cervical, and Colorectal Cancer Screening Test Use in the United States, 2021.

INTRODUCTION: We examined national estimates of breast, cervical, and colorectal cancer (CRC) screening test use and compared them with Healthy People 2030 national targets. Test use in 2021 was compared with prepandemic estimates. METHODS: In 2022, we used 2021 National Health Interview Survey (NHIS) data to estimate proportions of adults up to date with US Preventive Services Task Force recommendations for breast (women aged 50-74 y), cervical (women aged 21-65 y), and CRC screening (adults aged 50-75 y) across sociodemographic and health care access variables. We compared age-standardized estimates from the 2021 and 2019 NHIS. RESULTS: Percentages of adults up to date in 2021 were 75.7% (95% CI, 74.4%-76.9%), 75.2% (95% CI, 73.9%-76.4%), and 72.2% (95% CI, 71.2%-73.2%) for breast, cervical, and CRC screening, respectively. Estimates were below 50% among those without a wellness check in 3 years (all screening types), among those without a usual source of care or insurance (aged <65 y) (breast and CRC screening), and among those residing in the US for less than 10 years (CRC screening). Percentages of adults who were up to date with breast and cervical cancer screening and colonoscopy were similar in 2019 and 2021. Fecal occult blood/fecal immunochemical test (FOBT/FIT) use was modestly higher in 2021 (P < .001). CONCLUSIONS: In 2021, approximately 1 in 4 adults of screening age were not up to date with breast, cervical, and CRC screening recommendations, and Healthy People 2030 national targets were not met. Disparities existed across several characteristics, particularly those related to health care access. Breast, cervical, and colonoscopy test use within recommended screening intervals approximated prepandemic levels. FOBT/FIT estimates were modestly higher in 2021.

Issues in Developing Multidimensional Indices of State-level Health Inequalities: National Health Interview Survey, 2013-2015.

To describe methodological issues that arise in the construction and design-based estimation of multidimensional indices that aggregate state-specific inequalities in core health measures, using data from the National Health Interview Survey (NHIS).

Human Papillomavirus Vaccination Coverage in Children Ages 9-17 Years: United States, 2022.

Human papillomavirus (HPV) is the most common sexually transmitted infection in men and women in the United States (1). Vaccination prevents and controls HPV infection and associated outcomes, including genital warts, precancerous lesions, and certain cancers, such as cervical, vaginal, vulvar, anal, penile, and oropharyngeal (2,3). HPV vaccination in the United States has been recommended for girls since 2006 and for boys since 2011 and requires multiple doses (2,3). This vaccine, targeted for children ages 11-12 years, may be started at age 9. This report uses parent-reported data from the 2022 National Health Interview Survey to describe the percentage of children ages 9-17 years who received at least one dose of the HPV vaccine by selected sociodemographic and health characteristics.

Norms, attitudes, and sex behaviors among women with incarcerated main partners.

Incarceration has been extensively linked with HIV and sexually transmitted infections (STIs). While a great deal of attention has been given to the risk behaviors of people who have been incarcerated, examination of the behaviors of partners of incarcerated individuals is also needed to understand the direct and indirect links between incarceration and HIV and to identify prevention avenues. In the present study, we hypothesize that incarceration is associated with risk behavior through attitudes and norms. The purpose of this paper is: (1) to describe the attitudes and norms about sexual behaviors that women have when a sexual partner is incarcerated; and (2) to examine the association between attitudes and norms with the behavior of having other sex partners while a main partner is incarcerated. In our sample (n = 175), 50 % of women reported having other sex partners while their partner was incarcerated. Our findings show that attitudes, descriptive norms (i.e., norms about what other people do), and injunctive norms (i.e., norms about what others think is appropriate) were associated with having other partners. Interventions designed for couples at pre- and post-release from prison are needed to develop risk reduction plans and encourage HIV/STI testing prior to their reunion.

Telemedicine Use Among Adults: United States, 2021.

Telemedicine is a way for health care providers to deliver clinical health care to patients remotely through a computer or telephone, without an in-person office visit (1). The demonstrated benefits of telemedicine include improved access to care, convenience, and slowing spread of infection (1,2). During the COVID-19 pandemic, legislation expanded coverage for telemedicine health care services (3). This report uses 2021 National Health Interview Survey (NHIS) data to describe the percentage of adults who used telemedicine in the past 12 months by sociodemographic and geographic characteristics.

Telemedicine Use in Children Aged 0-17 Years: United States, July-December 2020.

Objective-This report presents national estimates of telemedicine use for U.S. children in the 12 months before the interview, and because of the coronavirus pandemic.

Chlamydia trachomatis infection among 15- to 35-year-olds in Baltimore, MD.

BACKGROUND: Chlamydia trachomatis (Ct) is the most frequently reported infectious disease in the United States. This article reports population and subpopulation prevalence estimates of Ct and correlates of infection among 15- to 35-year-olds in Baltimore, MD. METHODS: The Monitoring STIs Survey Program (MSSP) monitored sexually transmitted infection (STI) prevalence among probability samples of residents of Baltimore, a city with high STI rates. MSSP respondents completed telephone audio computer-assisted self-interviews and provided biospecimens for STI testing. RESULTS: Among 2120 Baltimore residents aged 15 to 35 years, the estimated prevalence of chlamydia was 3.9% (95% confidence interval [CI]: 2.8, 5.0). Prevalence was 5.8% (95% CI: 4.1, 7.6) among black MSSP respondents versus 0.7% (95% CI: 0.0, 1.4) among nonblack respondents; all but 4 infections detected were among black respondents. Sexual behaviors and other factors associated with infection were far more prevalent among black than nonblack Baltimore residents. Racial disparities persisted after adjustment for sociodemographic, behavioral, and health factors. CONCLUSION: The MSSP highlights a higher Ct prevalence among young people in Baltimore than in the United States overall, with notable racial disparities in infection and associated risk behaviors. Public health efforts are needed to improve the diagnosis and treatment of asymptomatic infections in this population.

Selected Financial Burdens of Health Care Among Families With Older Adults, by Family Composition: United States, 2017-2018.

Objective-This report describes how problems paying medical bills and forgone medical care vary by family composition among families with at least one older adult (aged 65 and over). Methods-Data from families in the 2017-2018 National Health Interview Survey that included at least one older adult were analyzed (n = 19,471). Bivariate and multivariate analyses, adjusted for selected family characteristics that may put families at financial risk, were conducted for both outcome measures and shown by family composition. The family compositions examined were one older adult living alone, two older adults, one younger (aged 18-64) and one older adult, three or more adults (where at least one was an older adult), and two or more adults (where at least one was an older adult) and at least one child (under age 18 years). Results-About 8.6% of families with older adults experienced problems paying medical bills, and 8.9% had forgone medical care. The most common composition for older-adult families was one older adult living alone (39.7%). Older-adult families consisting of only two older adults were the least likely to have experienced problems paying medical bills (4.0%) and to have forgone medical care (3.8%) compared with other family compositions. Older-adult families with at least one child were the most likely to experience problems paying medical bills (21.3%) and to have forgone medical care (18.4%). After adjusting for selected family characteristics in multivariate analyses, the odds of experiencing problems paying medical bills and forgone medical care weakened for all family compositions but remained significantly lower for families with two older adults. Conclusion-Among families with older adults, financial burdens of medical care vary based on family composition.

Health of American Indian and Alaska Native Adults, by Urbanization Level: United States, 2014-2018.

Historically, the American Indian and Alaska Native (AIAN) population in the United States has faced health disparities including greater prevalence of physical and mental health problems and high uninsured rates when compared with the non-AIAN population (1). Almost 80% of the AIAN population resides outside of reservations or land trusts and about 40% reside in rural areas (2). Rural Americans are more likely to die from preventable or selfmanageable conditions (3), and risk factors and health conditions may vary by urbanization level (4). This report examines differences in the percentage of selected health status and conditions by urbanization level between AIAN adults and all U.S. adults.

Heavy Drinking Among U.S. Adults, 2018.

Heavy drinking is defined as the average consumption of more than 7 drinks per week for women and more than 14 drinks per week for men in the past year (1). Heavy drinking is associated with an increased risk of alcohol use disorders, suicide, interpersonal violence, traffic injuries, liver disease, certain cancers and infectious diseases, and adverse birth outcomes in pregnant women (1,2). This report describes adult alcohol use in the United States and presents the prevalence of heavy drinking by demographic characteristics, select mental health indicators, and select measures of health care access and utilization.

Symptoms of Depression Among Adults: United States, 2019.

Depression is characterized by the presence of feelings of sadness, emptiness, or irritability, accompanied by bodily and cognitive changes lasting at least 2 weeks that significantly affect the individual's capacity to function (1). The eight-item Patient Health Questionnaire (PHQ-8) is a validated diagnostic and severity measure of symptoms of depressive disorders (2,3). Adults with scores of 0-4 are considered to have no or minimal symptoms of depression, while those with scores of 5-9, 10-14, or 15-24 are considered to have mild, moderate, or severe symptoms, respectively (2,3). This report examines the percentage of adults aged 18 and over with symptoms of depression in the past 2 weeks in 2019, by symptom severity and select demographic characteristics, using the PHQ-8 scale.

Symptoms of Generalized Anxiety Disorder Among Adults: United States, 2019.

Generalized anxiety disorder (GAD) is characterized by excessive worry that is difficult to control accompanied by physical symptoms including restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, or sleep disturbance (1). The GAD-7 scale is a validated brief selfreport measure to screen for GAD and assess the severity of symptoms (2). Adults with GAD-7 scores of 0-4 are considered to have no or minimal symptoms of GAD, while those with scores of 5-9, 10-14, or 15-21 are considered to have mild, moderate, or severe symptoms, respectively (2). This report examines the percentage of adults aged 18 and over who experienced symptoms of anxiety in the past 2 weeks, by severity of symptoms and select demographic characteristics, using the GAD-7 scale.

Electronic Cigarette Use Among U.S. Adults, 2018.

In 2018, an estimated 8.1 million U.S. adults were current electronic cigarette (e-cigarette) users (1). E-cigarette use is a public health concern (2), and it has been linked to a recent outbreak of lung injury and deaths among adults (3). Although the potential long-term health risks of e-cigarettes are not yet as well-known as they are with cigarettes, e-cigarettes usually contain nicotine, and nicotine is highly addictive (2). Moreover, the most common tobacco product combination among adults is e-cigarettes and cigarettes (4). This report examines e-cigarette use among U.S. adults aged 18 and over by selected sociodemographic characteristics and in relation to cigarette smoking status.

Regional Variation in Private Dental Coverage and Care Among Dentate Adults Aged 18-64 in the United States, 2014-2017.

Routine dental care can promote oral health (1,2), and those with private dental insurance are more likely to visit a dentist than those with other types of dental coverage or no coverage (3,4). Geographical variation in dental coverage and care among adults under age 65 exists (5,6), as does the availability of dental health professionals (7). This report examines regional variation in dental coverage among dentate adults (i.e., adults who have not lost all permanent teeth) aged 18-64 who had private health insurance in the past year, their utilization of dental care, and unmet dental needs due to cost in the past year.

Eye Disorders and Vision Loss Among U.S. Adults Aged 45 and Over With Diagnosed Diabetes, 2016-2017.

Diabetes increases with age. In 2017, the prevalence of diagnosed diabetes increased from 13.2% among adults aged 45-64 to 20.1% among those aged 65-74 and 19.8% among those aged 75 and over (1). Compared with adults without diabetes, adults with diabetes are more likely to develop eye disorders and vision loss from eye disorders (2,3). Moreover, duration of diabetes is a risk factor for the progression of visual problems (3,4). This report compares the age-adjusted percentages of adults aged 45 and over with diagnosed diabetes who were told by a doctor or other health professional that they had cataracts, diabetic retinopathy, glaucoma, or macular degeneration and vision loss due to these disorders, by years since their diabetes diagnosis.

Vaccination Coverage Among Adults With Diagnosed Diabetes: United States, 2015.

KEY FINDINGS: Data from the National Health Interview Survey •Among adults aged 18 and over with diagnosed diabetes, 61.6% had an influenza vaccine in the past year. •A total of 52.6% of adults with diagnosed diabetes had a pneumococcal vaccine and 17.1% had the 3-dose vaccination schedule for hepatitis B at some point in the past. •Among adults aged 60 and over with diagnosed diabetes, 27.2% had ever had a shingles vaccine. •Among those with diagnosed diabetes, the vaccination coverage for influenza, pneumococcal, and shingles was lowest among poor adults, increased with age, and varied by race and ethnicity. •Hepatitis B vaccination coverage was lowest among poor adults, and it decreased with age. Persons with diabetes are at an increased risk for complications from vaccine-preventable infections (1-3). Several vaccines are recommended for adults with diabetes, including annual vaccination for influenza and at least a one-time dose of pneumococcal vaccine, regardless of age; a shingles vaccine starting at age 60; and a hepatitis B vaccine soon after diabetes diagnosis among those aged 19-59, and based on clinical discretion thereafter (4). This report describes the receipt of select vaccinations among adults with diagnosed diabetes by sex, age, race and ethnicity, and poverty status.

Health Insurance Continuity and Health Care Access and Utilization, 2014.

KEY FINDINGS: Data from the National Health Interview Survey •During 2014, 78.1% of adults aged 18-64 were insured at the time of interview and had been insured for more than a year. •About 6.4% of adults were insured at the time of interview but had a period of no insurance in the past year. •About 12.3% of adults were uninsured at the time of interview and had been uninsured for more than a year, and 3.2% were uninsured at the time of interview but had a period of insurance coverage in the past year. •Those insured at the time of interview and insured for more than a year were more likely than those with any period of no insurance to have a usual place of care, visited a health care provider, received a flu vaccine, and were less likely to have had an unmet medical need due to cost.

Reducing bias in telephone survey estimates of the prevalence of drug use: a randomized trial of telephone audio-CASI.

AIM: To assess the impact of telephone audio computer-assisted self-interviewing (T-ACASI) on reporting of alcohol use, alcohol problems and illicit drug use in telephone surveys of the general population. Prior research suggests that illicit drug use is underreported in traditional, interviewer-administered, telephone surveys. DESIGN: Randomized experiment embedded in telephone survey of probability samples of populations of USA and Baltimore, MD. Survey respondents were randomly assigned to be interviewed either by human telephone interviewers or by T-ACASI after household screening, recruitment, and informed consent procedures were completed. SETTING: Respondents were interviewed by telephone in their homes. PARTICIPANTS: Probability samples of 1543 English-speaking adults ages 18-45 residing in telephone-accessible households in USA and 744 similarly defined adults residing in Baltimore, MD, USA. MEASUREMENTS: Nine questions on alcohol, marijuana, cocaine, and injection drug use adapted from 1994 NHSDA and four CAGE questions on alcohol problems. Crude odds ratios and odds ratios controlling for demographic factors calculated to test for differences between responses obtained by T-ACASI and human interviewers. FINDINGS: T-ACASI had mixed effects on reporting of alcohol use, but it did increase reporting of one of four CAGE alcohol problems: feeling guilty about drinking (23.0% in T-ACASI vs. 17.6% in T-IAQ, OR = 1.4, P < 0.01). T-ACASI also obtained significantly more frequent reporting of marijuana, cocaine, and injection drug use. The impact of T-ACASI was most pronounced for reporting of recent use of 'harder' drugs. Thus T-ACASI respondents were more likely to report marijuana use in the past month (10.0% vs. 5.7%, crude OR = 1.9, P < 0.001), cocaine use in the past month (2.1% vs. 0.7%, crude 3.2, P < 0.001) and injection drug use in the past five years (1.6% vs. 0.3%, crude OR = 4.8, P < 0.01). CONCLUSIONS: Telephone survey respondents were more likely to report illicit drug use and one alcohol problem when interviewed by T-ACASI rather than by human telephone interviews.

Strategies used by adults to reduce their prescription drug costs: United States, 2013.

Among U.S. adults aged 18-64, strategies for reducing prescription drug costs were more commonly practiced by those who were uninsured than those who had public or private coverage. Lack of health insurance coverage and poverty are recognized risk factors for not taking medication as prescribed due to cost. This cost-saving strategy may result in poorer health status and increased emergency room use and hospitalizations, compared with adults who follow their recommended pharmacotherapy. It is unknown whether adverse health outcomes and higher health care costs are also associated with the cost-reduction strategies of alternative therapy use or obtaining prescription drugs from abroad. Among adults aged 65 and over, those covered by both Medicare and Medicaid were more likely to have not taken their medication as prescribed to save money, but were less likely to have asked their doctor for a lower-cost prescription, than those who had private insurance coverage. Differences in cost-saving strategies by insurance coverage may be interrelated with socioeconomic and other patient characteristics. Belief that the recommended pharmacotherapy is needed, and an understanding of the recommended treatment, have been found to be lower among older adults who are economically vulnerable, compared with those with higher income. Income was also associated with the use of cost-reduction strategies. Among adults aged 65 and over, those living with incomes at 139%-400% FPL were more likely than adults living in lower or higher income thresholds to have asked their provider for a lower-cost prescription to save money. These patterns in the estimates by insurance status and poverty level are similar to those previously reported using the 2011 NHIS data.

Health care utilization among U.S. adults with diagnosed diabetes, 2013.

KEY FINDINGS: Data from the National Health Interview Survey, 2013. Nine percent of adults aged 18 and over have diagnosed diabetes, and more than 8 in 10 of these adults had contact with a doctor or health care professional in the past 6 months. The percentage of adults with diagnosed diabetes who were taking any medication to control their glucose levels increased with age. The percentage of adults with diagnosed diabetes who had contact with an eye or foot care specialist in the past 12 months increased with age. Among adults with diagnosed diabetes, those aged 18-39 were the least likely to have had their blood pressure or blood cholesterol checked by a doctor, nurse, or other health professional during the past 12 months. Diabetes is a chronic medical condition that affects 1 in 10 adults in the United States (1). Diabetes can affect multiple organs and lead to serious health complications (2). Ongoing medical care is recommended for persons of any age who have diabetes in order to manage levels of glucose, obtain preventive care services, and treat diabetes-related complications (2,3). This report describes differences by age in the utilization of selected medical care services among adults aged 18 and over with diagnosed diabetes, based on data from the 2013 National Health Interview Survey (NHIS).