Presidential promotion of health-related behaviors through words and example.

This article addresses a topic that is part of the public consciousness yet is seldom explored in the public health literature: presidential promotion of health-related behaviors through words and example. The article explores the history of what some American presidents, as individuals, have conveyed to the population about health through their own actions (presidential modeling of health behavior) and words. The nature of such messages and how they are received has changed with advances in technology and will likely continue to evolve.

Mental illness surveillance among adults in the United States.

Mental illnesses account for a larger proportion of disability in developed countries than any other group of illnesses, including cancer and heart disease. In 2004, an estimated 25% of adults in the United States reported having a mental illness in the previous year. The economic cost of mental illness in the United States is substantial, approximately $300 billion in 2002. Population surveys and surveys of health-care use measure the occurrence of mental illness, associated risk behaviors (e.g., alcohol and drug abuse) and chronic conditions, and use of mental health-related care and clinical services. Population-based surveys and surveillance systems provide much of the evidence needed to guide effective mental health promotion, mental illness prevention, and treatment programs. This report summarizes data from selected CDC surveillance systems that measure the prevalence and impact of mental illness in the U.S. adult population. CDC surveillance systems provide several types of mental health information: estimates of the prevalence of diagnosed mental illness from self-report or recorded diagnosis, estimates of the prevalence of symptoms associated with mental illness, and estimates of the impact of mental illness on health and well-being. Data from the CDC 2005-2008 National Health and Nutrition Examination Survey indicate that 6.8% of adults had moderate to severe depression in the 2 weeks before completing the survey. State-specific data from the CDC 2006 Behavioral Risk Factor Surveillance System (BRFSS), the most recent BRFSS data available, indicate that the prevalence of moderate to severe depression was generally higher in southeastern states compared with other states. Two other CDC surveys on ambulatory care services, the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, indicate that during 2007-2008, approximately 5% of ambulatory care visits involved patients with a diagnosis of a mental health disorder, and most of these were classified as depression, psychoses, or anxiety disorders. Future surveillance should pay particular attention to changes in the prevalence of depression both nationwide and at the state and county levels. In addition, national and state-level mental illness surveillance should measure a wider range of psychiatric conditions and should include anxiety disorders. Many mental illnesses can be managed successfully, and increasing access to and use of mental health treatment services could substantially reduce the associated morbidity.

Evaluating mental health after the 2010 Haitian earthquake.

Mental health is an important aspect of public health after a disaster. This article describes what is known and what remains to be learned regarding the mental health impact of the January 12, 2010, earthquake in Haiti. Public health surveillance efforts in Haiti and the United States in the first 2 months after the earthquake are described. Challenges in clinical assessment and public health surveillance are explored. Potential implications for survivors and public health officials are considered.

Achieving recognition that mental health is part of the mission of CDC.

For much of its history the U.S. Centers for Disease Control and Prevention (CDC) considered mental health to be outside of its mission. That assumption persisted even after CDC became a leading public health agency and began to face important mental health issues. This narrative describes how the organizational paradigm indicating that mental health was not mission related was challenged and superseded by a new paradigm recognizing mental health as part of CDC's public health mission. Even after the CDC Mental Health Work Group's establishment in 2000, CDC took eight more years to overcome powerful remnants of the old paradigm that had for so long excluded, minimized, or discouraged attention to mental health. The CDC Mental Health Work Group led the agency's mental health efforts without funding or dedicated staffing but with more than 100 CDC professionals from multiple disciplines and centers serving as voluntary members, in addition to their other CDC responsibilities.

Mental health disparities.

Mental health disparities have received increased attention in the literature in recent years. After considering 165 different health disparity conditions, the Federal Collaborative for Health Disparities Research chose mental health disparity as one of four topics warranting its immediate national research attention. In this essay, we describe the challenges and opportunities encountered in developing a research agenda to address mental health disparities in the United States. Varying definitions of mental health disparity, the heterogeneity of populations facing such disparity, and the power, complexity, and intertwined nature of contributing factors are among the many challenges. We convey an evolving interagency approach to mental health disparities research and guidance for further work in the field.

Geographic patterns of frequent mental distress: U.S. adults, 1993-2001 and 2003-2006.

BACKGROUND: Mental illnesses and other mental health problems often lead to prolonged, disabling, and costly mental distress. Yet little is known about the geographic distribution of such mental distress in the U.S. METHODS: Since 1993, the CDC has tracked self-perceived mental distress through the Behavioral Risk Factor Surveillance System (BRFSS). In 2007 and 2008, analysis was performed on BRFSS data reported by 2.4 million adults from 1993-2001 and 2003-2006 to map and describe the prevalence of frequent mental distress (FMD)-defined as having >or=14 mentally unhealthy days during the previous 30 days-for all states and for counties with at least 30 respondents. RESULTS: The adult prevalence of FMD for the combined periods was 9.4% overall, ranging from 6.6% in Hawaii to 14.4% in Kentucky. From 1993-2001 to 2003-2006, the mean prevalence of FMD increased by at least 1 percentage point in 27 states and by more than 4 percentage points in Mississippi, Oklahoma, and West Virginia. Most states showed internal geographic variations in FMD prevalence. The Appalachian and the Mississippi Valley regions had high and increasing FMD prevalence, and the upper Midwest had low and decreasing FMD prevalence. CONCLUSIONS: Geographic areas were identified with consistently high and consistently low FMD prevalence, as well as areas in which FMD prevalence changed substantially. Further evaluation of the causes and implications of these patterns is warranted. Surveillance of mental distress may be useful in identifying unmet mental health needs and disparities and in guiding health-related policies and interventions.

Psychological distress and mental health treatment among persons with and without active duty military experience, Behavioral Risk Factor Surveillance System, United States, 2007.

OBJECTIVES: To examine self-reported psychological distress (K-6 scale) and mental health treatment among persons with and without active duty U.S. military experience (ADME) currently residing in private residences in the U.S. METHODS: Analysis of 2007 Behavioral Risk Factor Surveillance System data from 35 states, District of Columbia, and Puerto Rico (n = 202,029 for those answering all K-6 questions, the treatment question, and the ADME question) RESULTS: Adjusting for age, sex, race/ethnicity, and education, overall mean K-6 scores of those with and without ADME were similar (p = 0.3223); however, more of those with, vs. without, ADME reported current mental health treatment (11.7 % vs. 9.6 %, p = 0.0001). Those with ADME receiving such treatment had a higher mean K-6 score (7.7) than those without ADME receiving such treatment (6.9) (p = 0.0032). CONCLUSIONS: Community-dwelling persons with ADME have similar demographically-adjusted mean K-6 psychological distress scores, but greater likelihood of recent mental health treatment, compared to those without ADME.

Trends in psychotropic medication use among U.S. adults.

PURPOSE: To examine trends and prevalence of prescription psychotropic medication use among noninstitutionalized US adults. METHODS: Prescription medication data from the third National Health and Nutrition Examination Survey (NHANES; 1988-1994; n = 20 050) and the 1999-2002 NHANES (n = 12 060), two nationally representative cross-sectional health examination surveys, were examined for persons aged > or =17 years. RESULTS: The age-adjusted prevalence of psychotropic medication use increased from 6.1% in 1988-1994 to 11.1% in 1999-2002 (p < 0.001). This was due to more than a three-fold increase in antidepressant use (2.5%, 1988-1994 vs. 8.1%, 1999-2002 (p < 0.001)). Significant increases between time periods for antidepressant use were seen for all age, gender, and race-ethnic groups although increases were less pronounced for males than females and non-Hispanic blacks and Mexican Americans than non-Hispanic whites. Prevalence of use remained relatively constant from 1988-1994 to 1999-2002 for anxiolytic/sedative/hypnotic (ASH) medications (3.5-3.8%), antipsychotics (0.8-1.0%), and antimanic agents (0.3-0.4%). The age-adjusted prevalence of multiple psychotropic medication use increased from 1.2% in 1988-1994 to 3.1% in 1999-2002 (p < 0.001). CONCLUSIONS: Psychotropic medication use among US adults increased since 1988-1994, specifically of antidepressants. Increases varied by gender and race-ethnicity indicating under-utilization for non-Hispanic blacks and Mexican Americans compared to non-Hispanic whites for both males and females.

A Preliminary analysis of medical expenditures among active and sedentary US adults with mental disorders.

OBJECTIVE: To determine whether leisure-time physical activity is associated with lower direct annual medical expenditures among a sample of adults with mental disorders. METHODS: Using the 1995 National Health Interview Survey and 1996 Medical Expenditure Panel Survey, differences between medical expenditures for sedentary and active persons were analyzed using t-tests. RESULTS: The per capita annual direct medical expenditure was US 2785 dollars higher for sedentary than for active persons (P<0.05). The total expenditure associated with sedentary behavior was US 31.7 billion dollars (US 19.1 billion dollars in men; US 12.6 billion dollars in women). CONCLUSIONS: Physical activity is associated with a reduced economic burden among people with mental disorders.

Sad, blue, or depressed days, health behaviors and health-related quality of life, Behavioral Risk Factor Surveillance System, 1995-2000.

BACKGROUND: Mood disorders are a major public health problem in the United States as well as globally. Less information exists however, about the health burden resulting from subsyndromal levels of depressive symptomatology, such as feeling sad, blue or depressed, among the general U.S. population. METHODS: As part of an optional Quality of Life survey module added to the U.S. Behavioral Risk Factor Surveillance System, between 1995-2000 a total of 166,564 BRFSS respondents answered the question, "During the past 30 days, for about how many days have you felt sad, blue, or depressed?" Means and 95% confidence intervals for sad, blue, depressed days (SBDD) and other health-related quality of life (HRQOL) measures were calculated using SUDAAN to account for the BRFSS's complex sample survey design. RESULTS: Respondents reported a mean of 3.0 (95% CI = 2.9-3.1) SBDD in the previous 30 days. Women (M = 3.5, 95% CI = 3.4-3.6) reported a higher number of SBDD than did men (M = 2.4, 95% CI = 2.2-2.5). Young adults aged 18-24 years reported the highest number of SBDD, whereas older adults aged 60-84 reported the fewest number. The gap in mean SBDD between men and women decreased with increasing age. SBDD was associated with an increased prevalence of behaviors risky to health, extremes of body mass index, less access to health care, and worse self-rated health status. Mean SBDD increased with progressively higher levels of physically unhealthy days, mentally unhealthy days, unhealthy days, activity limitation days, anxiety days, pain days, and sleepless days. CONCLUSION: Use of this measure of sad, blue or depressed days along with other valid mental health measures and community indicators can help to assess the burden of mental distress among the U.S. population, identify subgroups with unmet mental health needs, inform the development of targeted interventions, and monitor changes in population levels of mental distress over time.

Prescription psychotropic medication use among the U.S. adult population: results from the third National Health and Nutrition Examination Survey, 1988-1994.

OBJECTIVE: We estimated prescription psychotropic medication use among US adults. METHODS: We examined household interview data from the third National Health and Nutrition Examination Survey (1988-1994) for persons 17 years and older (n=20,050). STUDY DESIGN AND SETTING: An estimated 10 million adults (5.5%) reported psychotropic medication use during a 1-month period. The use of anxiolytics, sedatives, and hypnotics (ASH) was most common (3.2%), followed by antidepressants (2.3%), antipsychotics (0.7%), and antimanics (0.1%). Psychotropic medication use was more prevalent among women than men (P<.001), non-Hispanic whites than non-Hispanic blacks (P<.001) and Mexican Americans (P<.001), and older rather than younger age groups (P<.001). Psychotropic medication use was also most common among those below the federal poverty level, those with no high school education, and among insured persons. Only 1% of adults used two or more psychotropic medications monthly. CONCLUSION: Many adults use psychotropic medications on a monthly basis. ASH users comprised the largest proportion of psychotropic medication users. Patterns of use varied by several socio-demographic factors.

Anthrax and the mail: the making of an educational video for mail workers.

The anthrax bioterrorist attacks in 2001 affected millions of people who process, sort, and deliver mail. To more effectively communicate information intended to protect the health of these workers, the Centers for Disease Control and Prevention produced a short-format educational video in December 2001 that targets this diverse group. This report illustrates how an educational video can be rapidly produced to translate and disseminate public health recommendations as part of a public health emergency response.

Implementing program evaluation and accountability for population health: progress of a national diabetes control effort.

Diabetes affects some 16 million Americans at a cost estimated at $100 billion. The Centers for Disease Control and Prevention funds a diabetes control program (DCP) in every state as part of the National Diabetes Control Program (NDCP). In 1999, a new policy added emphasis on evaluation and made NDCP and its DCPs accountable for achieving impacts related to the health of populations with diabetes. The article reports on the experiences of the NDCP in implementing a performance-based program evaluation paradigm. It also discusses potential future directions for national diabetes-control efforts.