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1.
MMWR Morb Mortal Wkly Rep ; 68(5): 101-106, 2019 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-31851653

RESUMEN

Heart disease is the leading cause of death in the United States (1). Heart attacks (also known as myocardial infarctions) occur when a portion of the heart muscle does not receive adequate blood flow, and they are major contributors to heart disease, with an estimated 750,000 occurring annually (2). Early intervention is critical for preventing mortality in the event of a heart attack (3). Identification of heart attack signs and symptoms by victims or bystanders, and taking immediate action by calling emergency services (9-1-1), are crucial to ensure timely receipt of emergency care and thereby improve the chance for survival (4). A recent report using National Health Interview Survey (NHIS) data from 2014 found that 47.2% of U.S. adults could state all five common heart attack symptoms (jaw, neck, or back discomfort; weakness or lightheadedness; chest discomfort; arm or shoulder discomfort; and shortness of breath) and knew to call 9-1-1 if someone had a heart attack (5). To assess changes in awareness and response to an apparent heart attack, CDC analyzed data from NHIS to report awareness of heart attack symptoms and calling 9-1-1 among U.S. adults in 2008, 2014, and 2017. The adjusted percentage of persons who knew all five common heart attack symptoms increased from 39.6% in 2008 to 50.0% in 2014 and to 50.2% in 2017. The adjusted percentage of adults who knew to call 9-1-1 if someone was having a heart attack increased from 91.8% in 2008 to 93.4% in 2014 and to 94.9% in 2017. Persistent disparities in awareness of heart attack symptoms were observed by demographic characteristics and cardiovascular risk group. Public health awareness initiatives and systematic integration of appropriate awareness and action in response to a perceived heart attack should be expanded across the health system continuum of care.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/prevención & control , Adolescente , Adulto , Anciano , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Estados Unidos , Adulto Joven
2.
Hypertension ; 74(6): 1324-1332, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31679429

RESUMEN

Despite the importance of antihypertensive medication therapy for blood pressure control, no single data system provides estimates of medication nonadherence rates across age groups and health insurance plans types. Using multiple administrative datasets and national survey data, we determined health insurance plan-specific and overall weighted national rates of nonadherence to antihypertensive medications among insured hypertensive US adults in 2015. We used 2015 prescription claims data from Medicare Part D and 3 IBM MarketScan databases (Commercial, Medicaid, Medicare Supplemental) to calculate medication nonadherence rates among hypertensive adults aged ≥18 years with public or private health insurance using the proportion of days covered algorithm. These findings, in combination with National Health Interview Survey findings, were used to project national weighted estimates of nonadherence. We included 23.8 million hypertensive adults who filled 265.8 million prescriptions for antihypertensive medications. Nonadherence differed by health insurance plan type (highest for Medicaid members, 55.4%; lowest for Medicare Part D members, 25.2%). The overall weighted national nonadherence rate was 31.0%, with greater nonadherence among women versus men, younger versus older adults (aged 18-34 years, 58.1%; aged 65-74 years, 24.4%), fixed-dose combination medication nonusers (31.2%) versus users (29.4%), and by pharmacy outlet type (retail only, 30.7%; any mail order, 19.8%). In 2015, almost one-third (≈16.3 million) of insured US adults with diagnosed hypertension were considered nonadherent to their antihypertensive medication regimen, and considerable disparities were evident. Public health and healthcare professionals can use available evidence-based interventions to address nonadherence and improve blood pressure control.

3.
Prev Chronic Dis ; 16: E78, 2019 06 20.
Artículo en Inglés | MEDLINE | ID: mdl-31228234

RESUMEN

INTRODUCTION: Early recognition of stroke symptoms and recognizing the importance of calling 9-1-1 improves the timeliness of appropriate emergency care, resulting in improved health outcomes. The objective of this study was to assess changes in awareness of stroke symptoms and calling 9-1-1 from 2009 to 2014. METHODS: We analyzed data among 27,211 adults from 2009 and 35,862 adults from 2014 using the National Health Interview Survey (NHIS). The NHIS included 5 questions in both 2009 and 2014 about stroke signs and symptoms and one about the first action to take when someone is having a stroke. We estimated the prevalence of awareness of each symptom, all 5 symptoms, the importance of calling 9-1-1, and knowledge of all 5 symptoms plus the importance of calling 9-1-1 (indicating recommended stroke knowledge). We assessed changes from 2009 to 2014 in the prevalence of awareness. Data analyses were conducted in 2016. RESULTS: In 2014, awareness of stroke symptoms ranged from 76.1% (sudden severe headache) to 93.7% (numbness of face, arm, leg, side); 68.3% of respondents recognized all 5 symptoms, and 66.2% were aware of all recommended stroke knowledge. After adjusting for sex, age, educational attainment, and race/ethnicity, logistic regression results showed a significant absolute increase of 14.7 percentage points in recommended stroke knowledge from 2009 (51.5%) to 2014 (66.2%). Among US adults, recommended stroke knowledge increased from 2009 to 2014. CONCLUSION: Stroke awareness among US adults has improved but remains suboptimal.

4.
Circ Cardiovasc Qual Outcomes ; 11(12): e004981, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30557047

RESUMEN

BACKGROUND: The clinical benefit of intravenous (IV) alteplase in acute ischemic stroke is time dependent. We assessed the overall temporal changes in door-to-needle (DTN) time and examine the factors associated with DTN time ≤60 and ≤45 minutes. METHODS AND RESULTS: A total of 496 336 acute ischemic stroke admissions were identified in the Paul Coverdell National Acute Stroke Program from 2008 to 2017. We used generalized estimating equations models to examine the factors associated with DTN time ≤60 and ≤45 minutes, and calculated adjusted odds ratios and 95% CI. Between 2008 and 2017, the percentage of acute ischemic stroke patients who received IV alteplase including those transferred, increased from 6.4% to 15.3%. After excluding those who received IV alteplase at an outside hospital, a total of 39 737 (8%) acute ischemic stroke patients received IV alteplase within 4.5 hours of the time the patient last known to be well. Significant increases were seen in DTN time ≤60 minutes (26.4% in 2008 to 66.2% in 2017, P<0.001), as well as DTN time ≤45 minutes (10.7% in 2008 to 40.5% in 2017, P<0.001). Patients aged 55 to 84 years were more likely to receive IV alteplase within 60 minutes, while those aged 55 to 74 years were more likely to receive IV alteplase within 45 minutes, as compared with those aged 18 to 54 years. Arrival by emergency medical service, and patients with severe stroke were more likely to receive IV alteplase within 60 and 45 minutes. Conversely, women, black patients as compared with white, and patients with a medical history of diseases associated with stroke were less likely to receive DTN time ≤60 or 45 minutes. CONCLUSIONS: Rapid improvements in DTN time were observed in the Paul Coverdell National Acute Stroke Program; however, opportunities to reduce disparities remain.


Asunto(s)
Isquemia Encefálica/tratamiento farmacológico , Fibrinolíticos/administración & dosificación , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Tiempo de Tratamiento , Activador de Tejido Plasminógeno/administración & dosificación , Administración Intravenosa , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico , Femenino , Fibrinolíticos/efectos adversos , Disparidades en Atención de Salud , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Terapia Trombolítica/efectos adversos , Factores de Tiempo , Activador de Tejido Plasminógeno/efectos adversos , Resultado del Tratamiento , Estados Unidos , Adulto Joven
5.
Am J Health Promot ; 32(6): 1357-1364, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29972073

RESUMEN

PURPOSE: To describe changes in consumer knowledge, attitudes, and behaviors related to sodium reduction from 2012 to 2015. DESIGN: A cross-sectional analysis using 2 online, national research panel surveys. SETTING: United States. PARTICIPANTS: A total of 7796 adults (18+ years). MEASURES: Sodium-related knowledge, attitudes, and behaviors. ANALYSIS: Data were weighted to match the US population survey proportions using 9 factors. Wald χ2 tests were used to examine differences by survey year and hypertensive status. RESULTS: Despite the lack of temporal changes observed in respondent characteristics (mean age: 46 years, 67% were non-Hispanic white, and 26% reported hypertension), some changes were found in the prevalence of sodium-related knowledge, attitudes, and behaviors. The percentage of respondents who recognized processed foods as the major source of sodium increased from 54% in 2012 to 57% in 2015 ( P = .04), as did the percentage of respondents who buy or choose low/reduced sodium foods, from 33% in 2012 to 37% in 2015 ( P = .016). In contrast, the percentage of self-reported receipt of health professional advice among persons with hypertension decreased from 59% in 2012 to 45% in 2015 ( P < .0001). Other sodium-related knowledge, attitudes, and behaviors did not change significantly during 2012 to 2015. CONCLUSION: In recent years, some positive changes were observed in sodium-related knowledge and behaviors; however, the decrease in reported health professional advice to reduce sodium among respondents with hypertension is a concern.


Asunto(s)
Comportamiento del Consumidor , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud/métodos , Promoción de la Salud/tendencias , Hipertensión/prevención & control , Sodio en la Dieta/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Estados Unidos
6.
MMWR Surveill Summ ; 67(5): 1-11, 2018 03 30.
Artículo en Inglés | MEDLINE | ID: mdl-29596406

RESUMEN

PROBLEM/CONDITION: Heart disease is the leading cause of death in the United States. In 2015, heart disease accounted for approximately 630,000 deaths, representing one in four deaths in the United States. Although heart disease death rates decreased 68% for the total population from 1968 to 2015, marked disparities in decreases exist by race and state. PERIOD COVERED: 1968-2015. DESCRIPTION OF SYSTEM: The National Vital Statistics System (NVSS) data on deaths in the United States were abstracted for heart disease using diagnosis codes from the eighth, ninth, and tenth revisions of the International Classification of Diseases (ICD-8, ICD-9, and ICD-10) for 1968-2015. Population estimates were obtained from NVSS files. National and state-specific heart disease death rates for the total population and by race for adults aged ≥35 years were calculated for 1968-2015. National and state-specific black-white heart disease mortality ratios also were calculated. Death rates were age standardized to the 2000 U.S. standard population. Joinpoint regression was used to perform time trend analyses. RESULTS: From 1968 to 2015, heart disease death rates decreased for the total U.S. population among adults aged ≥35 years, from 1,034.5 to 327.2 per 100,000 population, respectively, with variations in the magnitude of decreases by race and state. Rates decreased for the total population an average of 2.4% per year, with greater average decreases among whites (2.4% per year) than blacks (2.2% per year). At the national level, heart disease death rates for blacks and whites were similar at the start of the study period (1968) but began to diverge in the late 1970s, when rates for blacks plateaued while rates for whites continued to decrease. Heart disease death rates among blacks remained higher than among whites for the remainder of the study period. Nationwide, the black-white ratio of heart disease death rates increased from 1.04 in 1968 to 1.21 in 2015, with large increases occurring during the 1970s and 1980s followed by small but steady increases until approximately 2005. Since 2005, modest decreases have occurred in the black-white ratio of heart disease death rates at the national level. The majority of states had increases in black-white mortality ratios from 1968 to 2015. The number of states with black-white mortality ratios >1 increased from 16 (40%) to 27 (67.5%). INTERPRETATION: Although heart disease death rates decreased both for blacks and whites from 1968 to 2015, substantial differences in decreases were found by race and state. At the national level and in most states, blacks experienced smaller decreases in heart disease death rates than whites for the majority of the period. Overall, the black-white disparity in heart disease death rates increased from 1968 to 2005, with a modest decrease from 2005 to 2015. PUBLIC HEALTH ACTION: Since 1968, substantial increases have occurred in black-white disparities of heart disease death rates in the United States at the national level and in many states. These increases appear to be due to faster decreases in heart disease death rates for whites than blacks, particularly from the late 1970s until the mid-2000s. Despite modest decreases in black-white disparities at the national level since 2005, in 2015, heart disease death rates were 21% higher among blacks than among whites. This study demonstrates the use of NVSS data to conduct surveillance of heart disease death rates by race and of black-white disparities in heart disease death rates. Continued surveillance of temporal trends in heart disease death rates by race can provide valuable information to policy makers and public health practitioners working to reduce heart disease death rates both for blacks and whites and disparities between blacks and whites.


Asunto(s)
Afroamericanos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Disparidades en el Estado de Salud , Cardiopatías/etnología , Cardiopatías/mortalidad , Adulto , Causas de Muerte , Femenino , Humanos , Masculino , Estados Unidos/epidemiología
8.
MMWR Morb Mortal Wkly Rep ; 66(35): 933-939, 2017 Sep 08.
Artículo en Inglés | MEDLINE | ID: mdl-28880858

RESUMEN

INTRODUCTION: The prominent decline in U.S. stroke death rates observed for more than 4 decades has slowed in recent years. CDC examined trends and patterns in recent stroke death rates among U.S. adults aged ≥35 years by age, sex, race/ethnicity, state, and census region. METHODS: Trends in the rates of stroke as the underlying cause of death during 2000-2015 were analyzed using data from the National Vital Statistics System. Joinpoint software was used to identify trends in stroke death rates, and the excess number of stroke deaths resulting from unfavorable changes in trends was estimated. RESULTS: Among adults aged ≥35 years, age-standardized stroke death rates declined 38%, from 118.4 per 100,000 persons in 2000 to 73.3 per 100,000 persons in 2015. The annual percent change (APC) in stroke death rates changed from 2000 to 2015, from a 3.4% decrease per year during 2000-2003, to a 6.6% decrease per year during 2003-2006, a 3.1% decrease per year during 2006-2013, and a 2.5% (nonsignificant) increase per year during 2013-2015. The last trend segment indicated a reversal from a decrease to a statistically significant increase among Hispanics (APC = 5.8%) and among persons in the South Census Region (APC = 4.2%). Declines in stroke death rates failed to continue in 38 states, and during 2013-2015, an estimated 32,593 excess stroke deaths might not have occurred if the previous rate of decline could have been sustained. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Prior declines in stroke death rates have not continued in recent years, and substantial variations exist in timing and magnitude of change by demographic and geographic characteristics. These findings suggest the importance of strategically identifying opportunities for prevention and intervening in vulnerable populations, especially because effective and underused interventions to prevent stroke incidence and death are known to exist.


Asunto(s)
Accidente Cerebrovascular/mortalidad , Estadísticas Vitales , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Estados Unidos/epidemiología
9.
Am J Prev Med ; 53(3S1): S55-S62, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28818247

RESUMEN

Excessive or risky alcohol use is a preventable cause of significant morbidity and mortality in the U.S. and worldwide. Alcohol use is a common preventable cancer risk factor among young adults; it is associated with increased risk of developing at least six types of cancer. Alcohol consumed during early adulthood may pose a higher risk of female breast cancer than alcohol consumed later in life. Reducing alcohol use may help prevent cancer. Alcohol misuse screening and brief counseling or intervention (also called alcohol screening and brief intervention among other designations) is known to reduce excessive alcohol use, and the U.S. Preventive Services Task Force recommends that it be implemented for all adults aged ≥18 years in primary healthcare settings. Because the prevalence of excessive alcohol use, particularly binge drinking, peaks among young adults, this time of life may present a unique window of opportunity to talk about the cancer risk associated with alcohol use and how to reduce that risk by reducing excessive drinking or misuse. This article briefly describes alcohol screening and brief intervention, including the Centers for Disease Control and Prevention's recommended approach, and suggests a role for it in the context of cancer prevention. The article also briefly discusses how the Centers for Disease Control and Prevention is working to make alcohol screening and brief intervention a routine element of health care in all primary care settings to identify and help young adults who drink too much.


Asunto(s)
Consumo de Bebidas Alcohólicas/efectos adversos , Trastornos Relacionados con Alcohol/prevención & control , Tamizaje Masivo/métodos , Neoplasias/prevención & control , Atención Primaria de Salud/métodos , Adulto , Factores de Edad , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Trastornos Relacionados con Alcohol/complicaciones , Trastornos Relacionados con Alcohol/diagnóstico , Trastornos Relacionados con Alcohol/epidemiología , Consejo/métodos , Etanol/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Neoplasias/etiología , Guías de Práctica Clínica como Asunto , Prevalencia , Servicios Preventivos de Salud/métodos , Servicios Preventivos de Salud/normas , Atención Primaria de Salud/normas , Factores de Riesgo , Estados Unidos/epidemiología , Adulto Joven
10.
Nutrients ; 9(8)2017 Aug 04.
Artículo en Inglés | MEDLINE | ID: mdl-28777339

RESUMEN

We examined temporal changes in consumer attitudes toward broad-based actions and environment-specific policies to limit sodium in restaurants, manufactured foods, and school and workplace cafeterias from the 2012 and 2015 SummerStyle surveys. We used two online, national research panel surveys to conduct a cross-sectional analysis of 7845 U.S. adults. Measures included self-reported agreement with broad-based actions and environment-specific policies to limit sodium in restaurants, manufactured foods, school cafeterias, workplace cafeterias, and quick-serve restaurants. Wald Chi-square tests were used to examine the difference between the two survey years and multivariate logistic regression was used to obtain odds ratios. Agreement with broad-based actions to limit sodium in restaurants (45.9% agreed in 2015) and manufactured foods (56.5% agreed in 2015) did not change between 2012 and 2015. From 2012 to 2015, there was a significant increase in respondents that supported environment-specific policies to lower sodium in school cafeterias (80.0% to 84.9%; p < 0.0001), workplace cafeterias (71.2% to 76.6%; p < 0.0001), and quick-serve restaurants (70.8% to 76.7%; p < 0.0001). Results suggest substantial agreement and support for actions to limit sodium in commercially-processed and prepared foods since 2012, with most consumers ready for actions to lower sodium in foods served in schools, workplaces, and quick-serve restaurants.


Asunto(s)
Comportamiento del Consumidor , Dieta Hiposódica/tendencias , Ambiente , Conocimientos, Actitudes y Práctica en Salud , Legislación Alimentaria/tendencias , Ingesta Diaria Recomendada/tendencias , Sodio en la Dieta/administración & dosificación , Adolescente , Adulto , Distribución de Chi-Cuadrado , Estudios Transversales , Femenino , Manipulación de Alimentos/legislación & jurisprudencia , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Ingesta Diaria Recomendada/legislación & jurisprudencia , Restaurantes/legislación & jurisprudencia , Restaurantes/tendencias , Instituciones Académicas/legislación & jurisprudencia , Instituciones Académicas/tendencias , Autoinforme , Sodio en la Dieta/efectos adversos , Encuestas y Cuestionarios , Factores de Tiempo , Estados Unidos , Lugar de Trabajo/legislación & jurisprudencia , Adulto Joven
11.
Matern Child Health J ; 21(5): 1079-1084, 2017 05.
Artículo en Inglés | MEDLINE | ID: mdl-28054156

RESUMEN

Objectives Vitamin K deficiency bleeding (VKDB) in infants is a coagulopathy preventable with a single dose of injectable vitamin K at birth. The Tennessee Department of Health (TDH) and Centers for Disease Control and Prevention (CDC) investigated vitamin K refusal among parents in 2013 after learning of four cases of VKDB associated with prophylaxis refusal. Methods Chart reviews were conducted at Nashville-area hospitals for 2011-2013 and Tennessee birthing centers for 2013 to identify parents who had refused injectable vitamin K for their infants. Contact information was obtained for parents, and they were surveyed regarding their reasons for refusing. Results At hospitals, 3.0% of infants did not receive injectable vitamin K due to parental refusal in 2013, a frequency higher than in 2011 and 2012. This percentage was much higher at birthing centers, where 31% of infants did not receive injectable vitamin K. The most common responses for refusal were a belief that the injection was unnecessary (53%) and a desire for a natural birthing process (36%). Refusal of other preventive services was common, with 66% of families refusing vitamin K, newborn eye care with erythromycin, and the neonatal dose of hepatitis B vaccine. Conclusions for Practice Refusal of injectable vitamin K was more common among families choosing to give birth at birthing centers than at hospitals, and was related to refusal of other preventive services in our study. Surveillance of vitamin K refusal rates could assist in further understanding this occurrence and tailoring effective strategies for mitigation.


Asunto(s)
Padres/psicología , Negativa del Paciente al Tratamiento/psicología , Vitamina K/uso terapéutico , Adulto , Centros de Asistencia al Embarazo y al Parto/organización & administración , Centros de Asistencia al Embarazo y al Parto/estadística & datos numéricos , Femenino , Humanos , Recién Nacido , Masculino , Estudios Retrospectivos , Encuestas y Cuestionarios , Tennessee , Negativa del Paciente al Tratamiento/estadística & datos numéricos , Vitamina K/farmacología , Sangrado por Deficiencia de Vitamina K/tratamiento farmacológico
12.
MMWR Morb Mortal Wkly Rep ; 65(39): 1082-1085, 2016 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-27711041

RESUMEN

Zika virus is an emerging mosquito-borne flavivirus that typically causes an asymptomatic infection or mild illness, although infection during pregnancy is a cause of microcephaly and other serious brain abnormalities. Guillain-Barré syndrome and other neurologic complications can occur in adults after Zika virus infection. However, there are few published reports describing postnatally acquired Zika virus disease among children. During January 2015-July 2016, a total of 158 cases of confirmed or probable postnatally acquired Zika virus disease among children aged <18 years were reported to CDC from U.S. states. The median age was 14 years (range = 1 month-17 years), and 88 (56%) were female. Two (1%) patients were hospitalized; none developed Guillain-Barré syndrome, and none died. All reported cases were travel-associated. Overall, 129 (82%) children had rash, 87 (55%) had fever, 45 (29%) had conjunctivitis, and 44 (28%) had arthralgia. Health care providers should consider a diagnosis of Zika virus disease in children who have an epidemiologic risk factor and clinically compatible illness, and should report cases to their state or local health department.


Asunto(s)
Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/transmisión , Virus Zika/aislamiento & purificación , Adolescente , Artralgia/virología , Niño , Preescolar , Conjuntivitis/virología , Exantema/virología , Femenino , Fiebre/virología , Humanos , Lactante , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Factores de Tiempo , Viaje , Estados Unidos , Infección por el Virus Zika/terapia
13.
MMWR Morb Mortal Wkly Rep ; 65(31): 793-8, 2016 Aug 12.
Artículo en Inglés | MEDLINE | ID: mdl-27513070

RESUMEN

Cardiovascular disease (CVD) accounts for one of every three deaths in the United States, making it the leading cause of mortality in the country (1). The American Heart Association established seven ideal cardiovascular health behaviors or modifiable factors to improve CVD outcomes in the United States. These cardiovascular health metrics (CHMs) are 1) not smoking, 2) being physically active, 3) having normal blood pressure, 4) having normal blood glucose, 5) being of normal weight, 6) having normal cholesterol levels, and 7) eating a healthy diet (2). Meeting six or all seven CHMs is associated with a lower risk for all-cause, CVD, and ischemic heart disease mortalities compared with the risk to persons who meet none or only one CHM (3). Fewer than 2% of U.S. adults meet all seven of the American Heart Association's CHMs (4). Cardiovascular morbidity and mortality account for an estimated annual $120 billion in lost productivity in the workplace; thus, workplaces are viable settings for effective health promotion programs (5). With over 130 million employed persons in the United States, accounting for about 55% of all U.S. adults, the working population is an important demographic group to evaluate with regard to cardiovascular health status. To determine if an association between occupation and CHM score exists, CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) industry and occupation module, which was implemented in 21 states. Among all occupational groups, community and social services employees (14.6%), transportation and material moving employees (14.3%), and architecture and engineering employees (11.6%) had the highest adjusted prevalence of meeting two or fewer CHMs. Transportation and material moving employees also had the highest prevalence of "not ideal" ("0" [i.e., no CHMs met]) scores for three of the seven CHMs: physical activity (54.1%), blood pressure (31.9%), and weight (body mass index [BMI]; 75.5%). Disparities in cardiovascular health status exist among U.S. occupational groups, making occupation an important consideration in employer-sponsored health promotion activities and allocation of prevention resources.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Disparidades en el Estado de Salud , Ocupaciones/estadística & datos numéricos , Adolescente , Adulto , Anciano , Sistema de Vigilancia de Factor de Riesgo Conductual , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estados Unidos/epidemiología , Adulto Joven
14.
Prev Chronic Dis ; 13: E99, 2016 07 28.
Artículo en Inglés | MEDLINE | ID: mdl-27468158

RESUMEN

INTRODUCTION: The American Heart Association established 7 cardiovascular health metrics as targets for promoting healthier lives. Cardiovascular health has been hypothesized to play a role in individuals' perception of quality of life; however, previous studies have mostly assessed the effect of cardiovascular risk factors on quality of life. METHODS: Data were from the 2013 Behavioral Risk Factor Surveillance System, a state-based telephone survey of adults 18 years or older (N = 347,073). All measures of cardiovascular health and health-related quality of life were self-reported. The 7 ideal cardiovascular health metrics were normal blood pressure, cholesterol, body mass index, not having diabetes, not smoking, being physically active, and having adequate fruit or vegetable intake. Cardiovascular health was categorized into meeting 0-2, 3-5, or 6-7 ideal cardiovascular health metrics. Logistic regression models examined the association between cardiovascular health, general health status, and 3 measures of unhealthy days per month, adjusting for age, sex, race/ethnicity, education, and annual income. RESULTS: Meeting 3 to 5 or 6 to 7 ideal cardiovascular health metrics was associated with a 51% and 79% lower adjusted prevalence ratio (aPR) of fair/poor health, respectively (aPR = 0.49, 95% confidence interval [CI] [0.47-0.50], aPR = 0.21, 95% CI [0.19-0.23]); a 47% and 72% lower prevalence of ≥14 physically unhealthy days (aPR = 0.53, 95% CI [0.51-0.55], aPR = 0.28, 95% CI [0.26-0.20]); a 43% and 66% lower prevalence of ≥14 mentally unhealthy days (aPR = 0.57, 95% CI [0.55-0.60], aPR = 0.34, 95% CI [0.31-0.37]); and a 50% and 74% lower prevalence of ≥14 activity limitation days (aPR = 0.50, 95% CI [0.48-0.53], aPR = 0.26, 95% CI [0.23-0.29]) in the past 30 days. CONCLUSION: Achieving a greater number of ideal cardiovascular health metrics may be associated with less impairment in health-related quality of life.


Asunto(s)
Sistema de Vigilancia de Factor de Riesgo Conductual , Enfermedades Cardiovasculares/prevención & control , Conductas Relacionadas con la Salud , Estado de Salud , Adolescente , Adulto , Distribución por Edad , Anciano , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipercolesterolemia/epidemiología , Hipertensión/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Calidad de Vida , Factores de Riesgo , Autoinforme , Distribución por Sexo , Factores Socioeconómicos , Estados Unidos/epidemiología , Adulto Joven
15.
Am J Prev Med ; 50(1): 30-39, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26163171

RESUMEN

INTRODUCTION: Excessive sodium intake is a key modifiable risk factor for hypertension and cardiovascular disease. Although 95% of U.S. adults exceed intake recommendations, knowledge is limited regarding whether doctor or health professional advice motivates patients to reduce intake. Our objectives were to describe the prevalence and determinants of taking action to reduce sodium, and to test whether receiving advice was associated with action. METHODS: Analyses, conducted in 2014, used data from the 2013 Behavioral Risk Factor Surveillance System, a state-based telephone survey representative of non-institutionalized adults. Respondents (n=173,778) from 26 states, the District of Columbia, and Puerto Rico used the new optional sodium module. We estimated prevalence ratios (PRs) based on average marginal predictions, accounting for the complex survey design. RESULTS: Fifty-three percent of adults reported taking action to reduce sodium intake. Prevalence of action was highest among adults who received advice (83%), followed by adults taking antihypertensive medications, adults with diabetes, adults with kidney disease, or adults with a history of cardiovascular disease (range, 73%-75%), and lowest among adults aged 18-24 years (29%). Overall, 23% of adults reported receiving advice to reduce sodium intake. Receiving advice was associated with taking action (prevalence ratio=1.59; 95% CI=1.56, 1.61), independent of sociodemographic and health characteristics, although some disparities were observed across race/ethnicity and BMI categories. CONCLUSIONS: Our results suggest that more than half of U.S. adults in 26 states and two territories are taking action to reduce sodium intake, and doctor or health professional advice is strongly associated with action.


Asunto(s)
Consejo Dirigido/estadística & datos numéricos , Hipertensión/prevención & control , Relaciones Médico-Paciente , Sodio en la Dieta/administración & dosificación , Adolescente , Adulto , Anciano , Sistema de Vigilancia de Factor de Riesgo Conductual , Dieta/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Autoinforme , Estados Unidos , Adulto Joven
16.
MMWR Morb Mortal Wkly Rep ; 64(47): 1305-11, 2015 Dec 04.
Artículo en Inglés | MEDLINE | ID: mdl-26633047

RESUMEN

A high blood level of low-density lipoprotein cholesterol (LDL-C) remains a major risk factor for atherosclerotic cardiovascular disease (ASCVD), although data from 2005 through 2012 has shown a decline in high cholesterol (total and LDL cholesterol) along with an increase in the use of cholesterol-lowering medications. The most recent national guidelines (published in 2013) from the American College of Cardiology and the American Heart Association (ACC/AHA) expand previous recommendations for reducing cholesterol to include lifestyle modifications and medication use as part of complete cholesterol management and to lower risk for ASCVD. Because changes in cholesterol treatment guidelines might magnify existing disparities in care and medication use, it is important to describe persons currently eligible for treatment and medication use, particularly as more providers implement the 2013 ACC/AHA guidelines. To understand baseline estimates of U.S. adults on or eligible for cholesterol treatment, as well as to identify sex and racial/ethnic disparities, CDC analyzed data from the 2005-2012 National Health and Nutrition Examination Surveys (NHANES). Because the 2013 ACC/AHA guidelines focus on initiation or continuation of cholesterol treatment, adults meeting the guidelines' eligibility criteria as well as adults who were currently taking cholesterol-lowering medication were assessed as a group. Overall, 36.7% of U.S. adults or 78.1 million persons aged ≥21 years were on or eligible for cholesterol treatment. Within this group, 55.5% were currently taking cholesterol-lowering medication, and 46.6% reported making lifestyle modifications, such as exercising, dietary changes, or controlling their weight, to lower cholesterol; 37.1% reported making lifestyle modifications and taking medication, and 35.5% reported doing neither. Among adults on or eligible for cholesterol-lowering medication, the proportion taking cholesterol-lowering medication was higher for women than men and for non-Hispanic whites (whites) than Mexican-Americans and non-Hispanic blacks (blacks). Further efforts by clinicians and public health practitioners are needed to implement complementary and targeted patient education and disease management programs to reduce sex and racial/ethnic disparities among adults eligible for treatment of cholesterol.


Asunto(s)
Anticolesterolemiantes/uso terapéutico , Determinación de la Elegibilidad/estadística & datos numéricos , Hipercolesterolemia/tratamiento farmacológico , Hipercolesterolemia/epidemiología , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Americanos Mexicanos/estadística & datos numéricos , Persona de Mediana Edad , Prevalencia , Estados Unidos/epidemiología , Adulto Joven
17.
MMWR Morb Mortal Wkly Rep ; 64(25): 695-8, 2015 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-26135590

RESUMEN

Excess sodium intake is a major risk factor for hypertension, and subsequently, heart disease and stroke, the first and fifth leading causes of U.S. deaths, respectively. During 2011-2012, the average daily sodium intake among U.S. adults was estimated to be 3,592 mg, above the Healthy People 2020 target of 2,300 mg. To support strategies to reduce dietary sodium intake, 2013 Behavioral Risk Factor Surveillance System (BRFSS) data from states and territories that implemented the new sodium-related behavior module were assessed. Across 26 states, the District of Columbia (DC), and Puerto Rico, 39%-73% of adults reported taking action (i.e., watching or reducing sodium intake) (median = 51%), and 14%-41% reported receiving advice from a health professional to reduce sodium intake (median = 22%). Compared with adults without hypertension, a higher percentage of adults with self-reported hypertension reported taking action and receiving advice to reduce sodium intake. For states that implemented the module, these results can serve as a baseline to monitor the effects of programs designed to reduce sodium intake.


Asunto(s)
Dieta/psicología , Hipertensión/epidemiología , Sodio en la Dieta/administración & dosificación , Adulto , Sistema de Vigilancia de Factor de Riesgo Conductual , Consejo Dirigido/estadística & datos numéricos , District of Columbia/epidemiología , Humanos , Relaciones Médico-Paciente , Puerto Rico/epidemiología , Autoinforme , Sodio en la Dieta/efectos adversos , Estados Unidos/epidemiología
18.
J Acad Nutr Diet ; 114(8): 1203-7, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24200653

RESUMEN

In the United States, about 25% of women choose not to initiate breastfeeding, yet little is known about how opinions of individuals in a woman's support network influence her decision to breastfeed. In the 2005-2007 Infant Feeding Practices Study II, women completed questionnaires from the last trimester of pregnancy until 12 months postpartum. Mothers indicated prenatally their family members' and health care providers' opinion on how newborns should be fed: breastfed only, formula fed only, breast and formula fed, or no opinion/don't know. Breastfeeding initiation was determined by asking mothers around 4 weeks postpartum (n=2,041) whether they ever breastfed. Logistic regression was used to examine the association between mothers' perception of family members' and health care providers' opinion on how to feed the infant and the initiation of breastfeeding, adjusting for sociodemographic characteristics. Nearly 14% of mothers surveyed did not initiate breastfeeding. Mothers who believed their family members or health care providers preferred breastfeeding only were least likely not to initiate breastfeeding. Never breastfeeding was significantly associated with the following perceptions: the infant's father (odds ratio [OR]=110.4; 95% CI 52.0 to 234.4) or maternal grandmother (OR=15.9; 95% CI 7.0 to 36.0) preferred only formula feeding; the infant's father (OR=3.2; 95% CI 1.7 to 5.9) or doctor (OR=2.7; 95% CI 1.2 to 6.2) preferred both breast and formula feeding; and the infant's father (OR=7.6; 95% CI 4.5 to 12.7), maternal grandmother (OR=5.4; 95% CI 2.6 to 11.0), or doctor (OR=1.9; 95% CI 1.0 to 3.7) had no opinion/didn't know their feeding preference. The prenatal opinions of family members and health care providers play an important role in a woman's breastfeeding decisions after the infant's birth.


Asunto(s)
Lactancia Materna , Familia , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Adolescente , Adulto , Femenino , Humanos , Modelos Logísticos , Estudios Longitudinales , Madres , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
19.
Early Child Res Q ; 28(2): 379-387, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23459591

RESUMEN

In this study, observed maternal positive engagement and perception of work-family spillover were examined as mediators of the association between maternal nonstandard work schedules and children's expressive language outcomes in 231 African American families living in rural households. Mothers reported their work schedules when their child was 24 months of age and children's expressive language development was assessed during a picture book task at 24 months and with a standardized assessment at 36 months. After controlling for family demographics, child, and maternal characteristics, maternal employment in nonstandard schedules at the 24 month timepoint was associated with lower expressive language ability among African American children concurrently and at 36 months of age. Importantly, the negative association between nonstandard schedules and children's expressive language ability at 24 months of age was mediated by maternal positive engagement and negative work-family spillover, while at 36 months of age, the association was mediated only by negative work-family spillover. These findings suggest complex links between mothers' work environments and African American children's developmental outcomes.

20.
J Appl Dev Psychol ; 34(2): 73-81, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23483822

RESUMEN

Fathers' vocabulary to infants has been linked in the literature to early child language development, however, little is known about the variability in fathers' language behavior. This study considered associations between fathers' work characteristics and fathers' vocabulary among a sample of employed African American fathers of 6-month old infants who were living in low-income rural communities. After controlling for family and individual factors, we found that fathers who worked nonstandard shifts and reported more job flexibility used more diverse vocabulary with their infants.

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