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.

Surveying Strategies for Hard-to-Survey Populations: Lessons From the Native Hawaiian and Pacific Islander National Health Interview Survey.

Calls for remedies for the persistent scarcity of accurate, reliable, national, disaggregated health statistics on hard-to-survey populations are common, but solutions are rare. Survey strategies used in community and clinical studies of hard-to-survey populations often cannot be, and generally are not, implemented at the national level.This essay presents a set of approaches, for use in combination with traditional survey methods in large-scale surveys of these populations, to overcome challenges in 2 domains: sampling and motivating respondents to participate. The first approach consists of using the American Community Survey as a frame, and the second consists of implementing a multifaceted community engagement effort.We offer lessons learned from implementing these strategies in a national survey, some of which are relevant to all survey planners. We then present evidence of the quality of the resulting data set. If these approaches were used more widely, hard-to-survey populations could become more visible and accurately represented to those responsible for setting national priorities for health research and services.

Asking about Sexual Identity on the National Health Interview Survey: Does Mode Matter?

Privacy, achieved through self-administered modes of interviewing, has long been assumed to be a necessary prerequisite for obtaining unbiased responses to sexual identity questions due to their potentially sensitive nature. This study uses data collected as part of a split-ballot field test embedded in the National Health Interview Survey (NHIS) to examine the association between survey mode (computer-assisted personal interviewing (CAPI) versus audio computer-assisted self-interviewing (ACASI)) and sexual minority identity reporting. Bivariate and multivariate quantitative analyses tested for differences in sexual minority identity reporting and non-response by survey mode, as well as for moderation of such differences by sociodemographic characteristics and interviewing environment. No significant main effects of interview mode on sexual minority identity reporting or nonresponse were found. Two significant mode effects emerged in subgroup analyses of sexual minority status out of 35 comparisons, and one significant mode effect emerged in subgroup analyses of item nonresponse. We conclude that asking the NHIS sexual identity question using CAPI does not result in estimates that differ systematically and meaningfully from those produced using ACASI.

Sleep duration, sleep quality, and sexual orientation: findings from the 2013-2015 National Health Interview Survey.

INTRODUCTION: This study identifies associations between sleep outcomes and sexual orientation net of sociodemographic and health-related characteristics, and produces estimates generalizable to the US adult population. PARTICIPANTS/METHODS: We used 2013-2015 National Health Interview Survey data (46,909 men; 56,080 women) to examine sleep duration and quality among straight, gay/lesbian, and bisexual US adults. Sleep duration was measured as meeting National Sleep Foundation age-specific recommendations for hours of sleep per day. Sleep quality was measured by 4 indicators: having trouble falling asleep, having trouble staying asleep, taking medication to help fall/stay asleep (all ≥4 times in the past week), and having woken up not feeling well rested (≥4 days in the past week). RESULTS: In the adjusted models, there were no differences by sexual orientation in the likelihood of meeting National Sleep Foundation recommendations for sleep duration. For sleep quality, gay men were more likely to have trouble falling asleep, to use medication to help fall/stay asleep, and to wake up not feeling well rested relative to both straight and bisexual men. Gay/lesbian women were more likely to have trouble staying asleep and to use medication to help fall/stay asleep relative to straight women. Finally, bisexual women were more likely to have trouble falling and staying asleep relative to straight women. CONCLUSIONS: Sexual minority women and gay men report poorer sleep quality compared with their straight counterparts.

Selected Health Conditions Among Native Hawaiian and Pacific Islander Adults: United States, 2014.

KEY FINDINGS: Although the Asian or Pacific Islander federal race category was split into two in 1997 (1), few reliable health statistics are available for the Native Hawaiian and Pacific Islander (NHPI) population. In 2014, the National Center for Health Statistics (NCHS) fielded a first-of-its-kind federal survey focused exclusively on NHPI population health. This report uses data from that survey, in combination with 2014 data from the annual National Health Interview Survey (NHIS), to highlight differences in the prevalence of selected health conditions between the NHPI population and the Asian population with whom they have historically been combined.

Sexual Orientation and Health Information Technology Use: A Nationally Representative Study of U.S. Adults.

PURPOSE: The purpose of this study was to compare the prevalence and odds of participation in online health-related activities among lesbian, gay, and bisexual adults and straight adults aged 18-64. METHODS: Primary data collected in the 2013 and 2014 National Health Interview Survey, a nationally representative household health survey, were used to examine associations between sexual orientation and four measures of health information technology (HIT) use. Data were collected through face-to-face interviews (some telephone follow-up) with 54,878 adults aged 18-64. RESULTS: Compared with straight men, both gay and bisexual men had higher odds of using computers to schedule appointments with healthcare providers, and using email to communicate with healthcare providers. Gay men also had significantly higher odds of seeking health information or participating in a health-related chat group on the Internet, and using computers to fill a prescription. No significant associations were observed between sexual orientation and HIT use among women in the multivariate analysis. CONCLUSIONS: Gay and bisexual men make greater use of HIT than their straight counterparts. Additional research is needed to determine the causal factors behind these group differences in the use of online healthcare, as well as the health implications for each group.

Health Conditions and Behaviors of Native Hawaiian and Pacific Islander Persons in the United States, 2014.

The body of nationally representative health statistics for the Native Hawaiian and Pacific Islander (NHPI) population is limited, because even the largest health surveys generally do not have an adequate NHPI sample to calculate reliable NHPI statistics. Using data from the Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS) from the National Center for Health Statistics (NCHS), this report fills this gap by presenting statistics on health conditions and behaviors for (a) the total NHPI population and the multiple- and singlerace NHPI populations, in comparison with other federal race groups and the total U.S. population; (b) single-race NHPI persons compared with multiple-race NHPI persons; and (c) detailed NHPI race groups in comparison with each other and the total U.S.

Health Care Access and Utilization Among Native Hawaiian and Pacific Islander Persons in the United States, 2014.

The body of nationally representative health statistics for the Native Hawaiian and Pacific Islander (NHPI) population is limited, because even the largest health surveys generally do not have an adequate NHPI sample to calculate reliable NHPI statistics. Using data from the Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS) from the National Center for Health Statistics (NCHS), this report fills this gap by presenting statistics on health care access and utilization for (a) the total NHPI population and the multiple- and single-race NHPI populations in comparison with other federal race groups and the total U.S. population; (b) single-race NHPI persons compared with multiple-race NHPI persons; and (c) detailed NHPI race groups in comparison with each other and the total U.S.

Data Quality Assessment of the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey.

The 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS) is the first federal survey designed exclusively to measure the health of the noninstitutionalized civilian NHPI population of the United States.

Barriers to Health Care Among Adults Identifying as Sexual Minorities: A US National Study.

OBJECTIVES: To assess the extent to which lesbian, gay, and bisexual (LGB) adults aged 18 to 64 years experience barriers to health care. METHODS: We used 2013 National Health Interview Survey data on 521 gay or lesbian (291 men, 230 women), 215 bisexual (66 men, 149 women), and 25 149 straight (11 525 men, 13 624 women) adults. Five barrier-to-care outcomes were assessed (delayed or did not receive care because of cost, did not receive specific services because of cost, delayed care for noncost reasons, trouble finding a provider, and no usual source of care). RESULTS: Relative to straight adults, gay or lesbian and bisexual adults had higher odds of delaying or not receiving care because of cost. Bisexual adults had higher odds of delaying care for noncost reasons, and gay men had higher odds than straight men of reporting trouble finding a provider. By contrast, gay or lesbian women had lower odds of delaying care for noncost reasons than straight women. Bisexual women had higher odds than gay or lesbian women of reporting 3 of the 5 barriers investigated. CONCLUSIONS: Members of sexual minority groups, especially bisexual women, are more likely to encounter barriers to care than their straight counterparts.

Selected Diagnosed Chronic Conditions by Sexual Orientation: A National Study of US Adults, 2013.

INTRODUCTION: Research is needed on chronic health conditions among lesbian, gay, and bisexual populations. The objective of this study was to examine 10 diagnosed chronic conditions, and multiple (≥2) chronic conditions (MCC), by sexual orientation among US adults. METHODS: The 2013 National Health Interview Survey was used to generate age-adjusted prevalence rates and adjusted odds ratios of diagnosed chronic conditions and MCC for civilian, noninstitutionalized US adults who identified as gay/lesbian, straight, or bisexual, and separately for men and women. Chronic conditions were selected for this study on the basis of previous research. RESULTS: Hypertension and arthritis were the most prevalent conditions for all groups. Gay/lesbian adults had a 4.7 percentage-point higher prevalence of cancer than bisexual adults, and a 5.6 percentage-point higher prevalence of arthritis and a 2.9 percentage point higher prevalence of hepatitis than straight adults. The prevalence of chronic obstructive pulmonary disease was 8.1 percentage points higher among bisexual adults than among gay/lesbian adults and 7.0 percentage points higher than among straight adults. These differences remained in the multivariate analyses. Additional differences were found in the sex-stratified analyses. No significant differences were found in MCC by sexual orientation. CONCLUSION: After age adjustment and controlling for sociodemographic characteristics, only a few significant health disparities for diagnosed chronic conditions were found by sexual orientation, and none for MCC. However, for conditions where differences were found, magnitudes were relatively large. Further examination of these differences among gay/lesbian and bisexual adults could yield a better understanding of why these disparities exist.

Collection and laboratory methods for dried blood spots for hemoglobin A1c and total and high-density lipoprotein cholesterol in population-based surveys.

BACKGROUND: The Health Measures at Home Study was a study designed to evaluate the feasibility of incorporating dried blood spots (DBS) collection into the National Health Interview Survey and to compare the proficiencies between field interviewers and health technicians in obtaining DBS. METHODS: DBS collection and venipuncture were attempted on 125 participants. The DBS were collected in the participant's home and venous blood was collected in the National Health and Nutrition Examination Survey (NHANES) mobile examination center. The DBS results were compared to venous results in the NHANES for the measurements of hemoglobin A1c (HbA1c) and total and high-density lipoprotein (HDL) cholesterol. RESULTS: Field interviewers and health technicians were able to collect the DBS for greater than 95% of participants. For DBS, health technicians and field interviewers were highly correlated for HbA1c (r=0.92) and total cholesterol (r=0.89), but not for HDL cholesterol (r=0.72). The DBS results of interviewers and health technicians compared to the venous method for HbA1c (r=0.90), but did not compare well for HDL cholesterol (r=0.64-0.66) and total cholesterol (r=0.65-0.67). CONCLUSION: DBS was comparable to venous HbA1c, but not for total and HDL cholesterol. Health technicians and field interviewers had similar performance for DBS methods, except HDL cholesterol.

Sexual orientation in the 2013 national health interview survey: a quality assessment.

Objective-This report presents a set of quality analyses of sexual orientation data collected in the 2013 National Health Interview Survey (NHIS). NHIS sexual orientation estimates are compared with those from the National Survey of Family Growth (NSFG) and the National Health and Nutrition Examination Survey (NHANES). Selected health outcomes by sexual orientation are compared between NHIS and NSFG. Assessments of item nonresponse, item response times, and responses to follow-up questions to the sexual orientation question are also presented. Methods-NHIS is a multipurpose health survey conducted continuously throughout the year by the Centers for Disease Control and Prevention's National Center for Health Statistics. Analyses in this report were based on NHIS data collected in 2013 from 34,557 adults aged 18 and over. Sampling weights were used to produce national estimates that are representative of the civilian noninstitutionalized U.S. adult population. Data from the 2006-2010 NSFG and 2009-2012 NHANES were used for the comparisons. Results-Based on the 2013 NHIS data, 96.6% of adults identified as straight, 1.6% identified as gay/lesbian, and 0.7% identified as bisexual. The remaining 1.1% of adults identified as ''something else,'' stated ''I don't know the answer,'' or refused to answer. Responses to follow-up questions suggest that the sexual orientation question is producing little classification error. In addition, largely similar patterns of association between sexual orientation and health were observed for NHIS and NSFG. Analyses of item nonresponse rates revealed few data quality issues, although item response times suggest possible shortcutting of the question and comprehension problems for select respondents.

Social peptides: measuring urinary oxytocin and vasopressin in a home field study of older adults at risk for dehydration.

OBJECTIVES: We present the novel urine collection method used during in-home interviews of a large population representative of older adults in the United States (aged 62-91, the National Social Life, Health and Aging Project). We also present a novel assay method for accurately measuring urinary peptides oxytocin (OT) and vasopressin (AVP), hormones that regulate social behaviors, stress, and kidney function. METHOD: Respondents in a randomized substudy (N = 1,882) used airtight containers to provide urine specimens that were aliquoted, stored under frozen refrigerant packs and mailed overnight for frozen storage (-80 °C). Assays for OT, AVP, and creatinine, including freeze-thaw cycles, were refined and validated. Weighted values estimated levels in the older U.S. population. RESULTS: Older adults had lower OT, but higher AVP, without the marked gender differences seen in young adults. Mild dehydration, indicated by creatinine, specific gravity, acidity, and AVP, produced concentrated urine that interfered with the OT assay, yielding falsely high values (18% of OT). Creatinine levels (≥ 1.4 mg/ml) identified such specimens that were diluted to solve the problem. In contrast, the standard AVP assay was unaffected (97% interpretable) and urine acidity predicted specimens with low OT concentrations. OT and AVP assays tolerated 2 freeze-thaw cycles, making this protocol useful in a variety of field conditions. DISCUSSION: These novel protocols yielded interpretable urinary OT and AVP values, with sufficient variation for analyzing their social and physiological associations. The problem of mild dehydration is also likely common in animal field studies, which may also benefit from these collection and assay protocols.

Sexuality and physical contact in National Social Life, Health, and Aging Project Wave 2.

INTRODUCTION: Wave 2 of the National Social Life, Health, and Aging Project (NSHAP) includes new measures of sexual interest and behavior, as well as new measures of the context of sexual experience and the frequency and appeal of physical contact. This is the first time many of these constructs have been measured in a nationally representative sample. METHOD: We describe the new measures and compare the distributions of each across gender and age groups, in some cases by partnership status. RESULTS: Two components of sexuality decrease with age among both men and women: frequency of finding an unknown person sexually attractive and receptivity to a partner's sexual overtures. In contrast, the inclination to make one's self sexually attractive to others was a more complicated function of partner status, gender, and age: partnered women and unpartnered men made the most effort, with the more effortful gender's effort decreasing with age. Both men and women find nonsexual physical contact appealing but sexual physical contact is more appealing to men than women. Finally, two fifths of men and women report dissatisfaction with their partner's frequency of caring behaviors that make later sexual interactions pleasurable, and a fifth of women and a quarter of men who had vaginal sex in the past year report dissatisfaction with amount of foreplay. DISCUSSION: These data offer the opportunity to characterize sexual motivation in older adulthood more precisely and richly and to examine how the context of sexual experience and the nonsexual aspects of physical intimacy correlate with sexual behavior, enjoyment, and problems.

Sexual orientation and health among U.S. adults: national health interview survey, 2013.

OBJECTIVE: To provide national estimates for indicators of health-related behaviors, health status, health care service utilization, and health care access by sexual orientation using data from the 2013 National Health Interview Survey (NHIS). METHODS: NHIS is an annual multipurpose health survey conducted continuously throughout the year. Analyses were based on data collected in 2013 from 34,557 adults aged 18 and over. Sampling weights were used to produce national estimates that are representative of the civilian noninstitutionalized U.S. adult population. Differences in health-related behaviors, health status, health care service utilization, and health care access by sexual orientation were examined for adults aged 18-64, and separately for men and women. RESULTS: Based on the 2013 NHIS data, 96.6% of adults identified as straight, 1.6% identified as gay or lesbian, and 0.7% identified as bisexual. The remaining 1.1% of adults identified as ''something else,'' stated ''I don't know the answer,'' or refused to provide an answer. Significant differences were found in health-related behaviors, health status, health care service utilization, and health care access among U.S. adults aged 18-64 who identified as straight, gay or lesbian, or bisexual. CONCLUSION: NHIS sexual orientation data can be used to track progress toward meeting the Healthy People 2020 goals and objectives related to the health of lesbian, gay, and bisexual persons. In addition, the data can be used to examine a wide range of health disparities among adults identifying as straight, gay or lesbian, or bisexual.

Comparison of in-home collection of physical measurements and biospecimens with collection in a standardized setting: the health measures at home study.

OBJECTIVES: Collection of physical measurements and biospecimens in the home may be an efficient way to obtain objective health measurements. This study assesses differences between collection in the home and a standardized setting. METHODS: Participants had physical measurements and biospecimens taken in the National Health and Nutrition Examination Survey mobile examination center (MEC). Then, they had height and weight measured in the MEC using portable equipment. In the home, participants had height, weight, and blood pressure measured and dried blood spots collected using portable equipment. Two complete examinations were done in the home: one by a health technician and one by a field interviewer. RESULTS: Home environments were less standardized and presented more challenges to examiners. Correlations between all four height measurements and all four weight measurements were higher than 99%. Mean differences in height (0.3 cm) and weight (0.4 kg) were small but statistically significant. The home measurements perfectly or near-perfectly classified participants as obese relative to the standardized MEC examination. CONCLUSIONS: The selected physical measurements can be collected in the home by field interviewers using portable equipment. Before adding home collection of physical measurements to household interview surveys, further research should be done to examine the impact of these changes on interviewer training, participant recruitment, and participant response rates.

Sexual activity and psychological health as mediators of the relationship between physical health and marital quality.

OBJECTIVES: The pathways linking spousal health to marital quality in later life have been little examined at the population level. We develop a conceptual model that links married older adults' physical health and that of their spouse to positive and negative dimensions of marital quality via psychological well-being of both partners and their sexual activity. METHODS: We use data from 1,464 older adults in 732 marital dyads in the 2010-2011 wave of the National Social Life Health and Aging Project. RESULTS: We find that own fair or poor physical health is linked to lower positive and higher negative marital quality, spouse's health to positive quality, and that own and spouse's mental health and more frequent sex are associated with higher positive and lower negative marital quality. Further, we find that (a) sexual activity mediates the association between own and partner's physical health and positive marital quality, (b) own mental health mediates the association between one's own physical health and both positive and negative marital quality, and (c) partner's mental health mediates the associations of spouse's physical health with positive marital quality. These results are robust to alternative specifications of the model. DISCUSSION: The results suggest ways to protect marital quality among older adults who are struggling with physical illness in themselves or their partners.

Relationship commitment, perceived equity, and sexual enjoyment among young adults in the United States.

Very little is known about how enjoyment of sexual behavior is linked to the relationship context of the behavior among young adults in the United States. To examine this association, multivariate logistic and ordered logistic regression analyses were conducted using data from Wave III of the National Longitudinal Study of Adolescent Health, collected when the participants were 18 to 26 years old (N = 2,970). Analyses explored the associations between four measures of sexual enjoyment and three measures of relationship context. Perceived equity was associated with sexual enjoyment, but the pattern of associations differed by gender. Perceiving oneself to be underbenefited was associated with less enjoyment for all four measures of sexual enjoyment among women, but for only one measure among men. Perceiving oneself to be overbenefited was associated with less enjoyment for three of the sexual enjoyment measures among men, but for only two among women. Most of these associations were no longer significant when subjective relationship commitment was added to the models. Among both young adult men and women, subjective relationship commitment was associated with all four measures of sexual enjoyment. In contrast, formal relationship status was not consistently associated with any of the sexual enjoyment measures. Young adults perceiving that they are in more-committed relationships enjoy their partnered sexual acts more, on average, than those in less-committed relationships. Anticipation of higher sexual enjoyment could be used by public health campaigns to motivate young adults to engage in fewer, more-committed sexual partnerships.

Is collective efficacy age graded? The development and evaluation of a new measure of collective efficacy for older adults.

Objectives. Community processes are key determinants of older adults' ability to age in place, but existing scales measuring these constructs may not provide accurate, unbiased measurements among older adults because they were designed with the concerns of child-rearing respondents in mind. This study examines the properties of a new theory-based measure of collective efficacy (CE) that accounts for the perspectives of older residents. Methods. Data come from the population-based Chicago Neighborhood Organization, Aging and Health study (N = 1,151), which surveyed adults aged 65 to 95. Using descriptive statistics, correlations, and factor analysis, we explored the acceptability, reliability, and validity of the new measure. Results. Principal component analysis indicated that the new scale measures a single latent factor. It had good internal consistency reliability, was highly correlated with the original scale, and was similarly associated with neighborhood exchange and disorder, self-rated health, mobility, and loneliness. The new scale also showed less age-differentiated nonresponse compared to the original scale. Discussion. The older adult CE scale has reliability and validity equivalent to that of the existing measure but benefits from a more developed theoretical grounding and reduced likelihood of age-related differential nonresponse.