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1.
MMWR Morb Mortal Wkly Rep ; 68(16): 365-368, 2019 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-31022164

RESUMO

Drinking alcohol during pregnancy can cause fetal alcohol spectrum disorders (FASDs), including birth defects that involve central nervous system impairment, behavioral disorders, and impaired intellectual development, which can lead to difficulties with school and employment. A recent study in four U.S. communities found a 1.1%-5.0% prevalence of FASDs among first-grade students (1). Drinking during pregnancy might also be a risk factor for other adverse pregnancy and birth outcomes, including miscarriage and stillbirth (2). CDC estimated the prevalence of self-reported current drinking (at least one alcohol drink in the past 30 days) and binge drinking (consuming four or more drinks on at least one occasion in the past 30 days) among pregnant women aged 18-44 years, using 2015-2017 data from the Behavioral Risk Factor Surveillance System (BRFSS). Current drinking and binge drinking in the past 30 days were reported by 11.5% and 3.9% of pregnant women, respectively. Among pregnant women who binge drink, the average frequency of binge drinking in the past 30 days was 4.5 episodes, and the average intensity of binge drinking (the average largest number of drinks reported consumed on any occasion among binge drinkers) was 6.0 drinks. Increased implementation of evidence-based community-level and clinic-level interventions, such as universal alcohol screening and brief counseling in primary and prenatal care, could decrease the prevalence of drinking during pregnancy, which might ultimately reduce the prevalence of FASDs and other adverse pregnancy and birth outcomes.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Bebedeira/epidemiologia , Gestantes/psicologia , Adolescente , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Estado Civil/estatística & dados numéricos , Gravidez , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
2.
Alcohol Clin Exp Res ; 43(6): 1199-1212, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30977899

RESUMO

BACKGROUND: Fetal alcohol syndrome (FAS) typically is observed among individuals with high prenatal alcohol exposures (PAE), but exposure histories obtained in clinical diagnostic settings are often inaccurate. The present analysis used the Lifestyle During Pregnancy Study (LDPS) to assess the potential effects of low-to-moderate average weekly alcohol consumption and binge drinking in early pregnancy on facial features associated with FAS among children 5 years of age. METHODS: The analysis is a prospective follow-up study of 670 women and their children sampled from the LDPS cohort based on maternal alcohol consumption during pregnancy. The 4-Digit Code FAS Facial Photographic Analysis Software was used to measure the magnitude of expression of the 3 diagnostic facial features of FAS from standardized digital photographs. Logistic regression was used to estimate the odds of presenting with the FAS/partial fetal alcohol syndrome (PFAS) facial phenotypes relative to different patterns of prenatal alcohol exposure. RESULTS: Ten children presented with the FAS/PFAS facial phenotypes. None of the children sampled met the central nervous system (CNS) criteria for FAS or PFAS at age 5 years. All remained at risk for PFAS since some types of CNS dysfunction associated with this diagnosis may only be assessed at older ages. The FAS/PFAS facial phenotypes were 8.5-fold more likely among children exposed to an average of 1 to 4 drinks/wk and 2.5-fold more likely among children with a single binge exposure in gestational weeks 3 to 4 compared to children with no such exposures. The magnitude of expression of the FAS facial phenotype was significantly correlated with all other diagnostic features of FAS: growth deficiency, microcephaly, and measures of CNS dysfunction. CONCLUSIONS: These findings suggest that low-to-moderate levels of PAE or isolated binge exposures may place some fetuses at risk for FAS/PFAS. Thus, conservative advice is still for women to abstain from alcohol consumption during pregnancy.

3.
Am J Prev Med ; 54(2): 173-180, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29241721

RESUMO

INTRODUCTION: Excessive alcohol use is associated with car crashes, violence, and multiple disease conditions, including fetal alcohol spectrum disorders. The U.S. Preventive Services Task Force (USPSTF) recommends that primary care providers screen all adults and conduct brief counseling interventions with those who misuse alcohol. The USPSTF prefers use of three screening tools that measure alcohol consumption (Alcohol Use Disorders Identification Test, Alcohol Use Disorders Identification Test-Consumption, and National Institute on Alcohol Abuse and Alcoholism Single Question) because these tools detect the full spectrum of alcohol misuse in adults. This study estimated the prevalence of primary care provider screening practices for alcohol misuse and examined factors associated with using a USPSTF-preferred screening tool. METHODS: In 2016, a cross-sectional analysis was conducted on self-reported 2016 DocStyles data to estimate the prevalence of different screening tools used by 1,506 primary care providers-family practitioners, internists, obstetrician/gynecologists, and nurse practitioners. Adjusted prevalence ratios were calculated using logistic regression to examine the association between provider attributes and use of USPSTF-preferred screening tools. RESULTS: In this study, 96% of providers reported screening patients for alcohol misuse. Among those that screened, 38% used a USPSTF-preferred screening tool. Provider specialty, awareness of USPSTF guidelines, and mode of administering screening tool were associated with using a preferred screening tool. CONCLUSIONS: Although most primary care providers reported screening for alcohol misuse, about two thirds did not use a tool capable of detecting the full spectrum of alcohol misuse. Using suitable screening tools will better identify patients who misuse alcohol and increase the opportunity for appropriate intervention, ultimately helping to reduce the burden from the many conditions associated with excessive alcohol consumption.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Alcoolismo/prevenção & controle , Programas de Rastreamento/organização & administração , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Adulto , Comitês Consultivos/normas , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Terapia Comportamental/estatística & dados numéricos , Aconselhamento/estatística & dados numéricos , Estudos Transversais , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Prevalência , Serviços Preventivos de Saúde/normas , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Autorrelato/estatística & dados numéricos , Estados Unidos
4.
MMWR Morb Mortal Wkly Rep ; 66(12): 313-319, 2017 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-28358798

RESUMO

Excessive and/or risky alcohol use* resulted in $249 billion in economic costs in 2010 (1) and >88,000 deaths in the United States every year from 2006 to 2010 (2). It is associated with birth defects and disabilities (e.g., fetal alcohol spectrum disorders [FASDs]), increases in chronic diseases (e.g., heart disease and breast cancer), and injuries and violence (e.g., motor vehicle crashes, suicide, and homicide).† Since 2004, the U.S. Preventive Services Task Force (USPSTF) has recommended alcohol misuse screening and brief counseling (also known as alcohol screening and brief intervention or ASBI) for adults aged ≥18 years (3).§ Among adults, ASBI reduces episodes of binge-level consumption, reduces weekly alcohol consumption, and increases compliance with recommended drinking limits in those who have an intervention in comparison to those who do not (3). A recent study suggested that health care providers rarely talk with patients about alcohol use (4). To estimate the prevalence of U.S. adults who reported receiving elements of ASBI, CDC analyzed 2014 Behavioral Risk Factor Surveillance System (BRFSS) data from 17 states¶ and the District of Columbia (DC). Weighted crude and age-standardized overall and state-level prevalence estimates were calculated by selected drinking patterns and demographic characteristics. Overall, 77.7% of adults (age-standardized estimate) reported being asked about alcohol use by a health professional in person or on a form during a checkup, but only 32.9% reported being asked about binge-level alcohol consumption (3). Among binge drinkers, only 37.2% reported being asked about alcohol use and advised about the harms of drinking too much, and only 18.1% reported being asked about alcohol use and advised to reduce or quit drinking. Widespread implementation of ASBI and other evidence-based interventions could help reduce excessive alcohol use in adults and related harms.


Assuntos
Alcoolismo/prevenção & controle , Aconselhamento/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Aconselhamento/métodos , District of Columbia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
5.
MMWR Morb Mortal Wkly Rep ; 65(4): 91-7, 2016 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-26845520

RESUMO

BACKGROUND: Alcohol is a teratogen.* Prenatal alcohol exposure is associated with a range of adverse reproductive outcomes and can cause fetal alcohol spectrum disorders (FASDs) characterized by lifelong physical, behavioral, and intellectual disabilities. FASDs are completely preventable if a woman does not drink alcohol while pregnant. METHODS: CDC analyzed data from the 2011-2013 National Survey of Family Growth to generate U.S. prevalence estimates of risk for an alcohol-exposed pregnancy for 4,303 nonpregnant, nonsterile women aged 15-44 years, by selected demographic and behavioral factors. A woman was considered at risk for an alcohol-exposed pregnancy during the past month if she had sex with a male, drank any alcohol, and did not (and her partner did not with her) use contraception in the past month; was not sterile; and had a partner (or partners) not known to be sterile. RESULTS: The weighted prevalence of alcohol-exposed pregnancy risk among U.S. women aged 15-44 years was 7.3%. During a 1-month period, approximately 3.3 million women in the United States were at risk for an alcohol-exposed pregnancy. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Alcohol use in pregnancy is associated with low birthweight, preterm birth, birth defects, and developmental disabilities. Women of reproductive age should be informed of the risks of alcohol use during pregnancy, and contraception should be recommended, as appropriate, for women who do not want to become pregnant. Women wanting a pregnancy should be advised to stop drinking at the same time contraception is discontinued. Health care providers should advise women not to drink at all if they are pregnant or there is any chance they might be pregnant. Alcohol misuse screening and behavioral counseling (also known as alcohol screening and brief intervention) is recommended for all adults in primary care, including reproductive-aged and pregnant women, as an evidenced-based approach to reducing alcohol consumption among persons who consume alcohol in excess of the recommended guidelines.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos do Espectro Alcoólico Fetal/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Gravidez , Prevalência , Risco , Estados Unidos/epidemiologia , Adulto Jovem
6.
Am J Prev Med ; 50(3): 380-383, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26520573

RESUMO

INTRODUCTION: The U.S. Preventive Services Task Force recommends for adults alcohol screening and brief behavioral counseling interventions in primary care settings. However, there is a paucity of population-based data on the prevalence of alcohol screening. This study examines adherence to this U.S. Preventive Services Task Force recommendation by estimating the prevalence of alcohol screening by demographic characteristics and binge drinking. METHODS: A cross-sectional analysis was conducted in 2013 and 2014 on data from the 2013 fall wave of the ConsumerStyles survey. ConsumerStyles is drawn from an Internet panel randomly recruited by probability-based sampling to be representative of the U.S. POPULATION: Data from 2,592 adult respondents who visited primary care physicians in the last year were analyzed to determine the prevalence of alcohol screening. RESULTS: Only 24.7% of respondents reported receiving alcohol screening. The prevalence of screening was similar among women (24.9%) and men (24.5%). Black non-Hispanics reported a significantly lower prevalence of screening than white non-Hispanics (16.2% vs 26.9%, prevalence ratio=0.60, 95% CI=0.40, 0.90). College graduates reported a significantly higher prevalence of screening than respondents with a high school degree or less (28.1% vs 20.8%, prevalence ratio=1.35, 95% CI=1.08, 1.69). CONCLUSIONS: Only about one in four respondents who visited a primary care physician in the last year reported being screened for alcohol misuse. Therefore, many men and women who misuse alcohol are unlikely to be identified. Increased screening may help reduce alcohol misuse and related negative health outcomes.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Aconselhamento , Programas de Rastreamento/métodos , Autorrelato , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Distribuição por Sexo , Estados Unidos , Adulto Jovem
7.
MMWR Morb Mortal Wkly Rep ; 64(37): 1042-6, 2015 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-26401713

RESUMO

Excessive alcohol use is risk factor for a wide range of health and social problems including liver cirrhosis, certain cancers, depression, motor vehicle crashes, and violence. Alcohol use during pregnancy can lead to fetal alcohol spectrum disorders (FASDs) and other adverse birth outcomes . Community studies estimate that as many as 2% to 5% of first grade students in the United States might have an FASD, which include physical, behavioral, or learning impairments. In 2005, the Surgeon General reissued an advisory urging women who are or might be pregnant to abstain from alcohol consumption to eliminate the risk for FASDs or other negative birth outcomes. To estimate current prevalences of any alcohol use and binge drinking (consuming four or more drinks on an occasion) among pregnant and nonpregnant women aged 18-44 years in the United States, CDC analyzed 2011-2013 Behavioral Risk Factor Surveillance System (BRFSS) data. Among pregnant women, the prevalences of any alcohol use and binge drinking in the past 30 days were 10.2% and 3.1%, respectively. Among nonpregnant women, the prevalences of any alcohol use and binge drinking in the past 30 days were 53.6% and 18.2%, respectively. Among binge drinkers, pregnant women reported a significantly higher frequency of binge drinking than nonpregnant women (4.6 and 3.1 episodes, respectively); the largest amount consumed during binge drinking was also higher among pregnant women than nonpregnant women (7.5 versus 6.0 drinks), although this difference was not statistically significant. Implementation of evidence-based clinical and community-level strategies would be expected to reduce binge drinking among pregnant women and women of childbearing age, and any alcohol consumption among women who are or might be pregnant. Healthcare professionals can support these efforts by implementing alcohol screening and brief interventions in their primary care practices, and informing women that there is no known safe level of alcohol consumption when they are pregnant or might be pregnant.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Bebedeira/epidemiologia , Gestantes/psicologia , Adolescente , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Gravidez , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
8.
Med Res Arch ; 2(2)2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27933317

RESUMO

This study examined the effects of maternal alcohol consumption and binge drinking during pregnancy on children's Draw-A-Person (DAP) scores. Participants were 1,533 5-year-olds from the Danish National Birth Cohort. Regression analyses revealed an adverse effect of nine or more drinks per week. A drop in mean DAP score of 6.26 (95 % CI: -12.24; -0.39) was observed in the fully adjusted model. A significant interaction between average weekly consumption and binge episodes also was observed. Findings suggest that prenatal exposure to moderate weekly doses of alcohol and binge drinking episodes are associated with lowered scores on the DAP.

9.
Matern Child Health J ; 19(4): 776-82, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24996954

RESUMO

Non-pregnant women can avoid alcohol-exposed pregnancies (AEPs) by modifying drinking and/or contraceptive practices. The purpose of this study was to estimate the number and characteristics of women in the United States who are at risk of AEPs. We analyzed data from in-person interviews obtained from a national probability sample (i.e., the National Survey of Family Growth) of reproductive-aged women conducted from January 2002 to March 2003. To be at risk of AEP, a woman had to have met the following criteria in the last month: (1) was drinking; (2) had vaginal intercourse with a man; and (3) did not use contraception. During a 1-month period, nearly 2 million U.S. women were at risk of an AEP (95 % confidence interval 1,760,079-2,288,104), including more than 600,000 who were binge drinking. Thus, 3.4 %, or 1 in 30, of all non-pregnant women were at risk of an AEP. Most demographic and behavioral characteristics were not clearly associated with AEP risk. However, pregnancy intention was strongly associated with AEP risk (prevalence ratio = 12.0, P < 0.001) because women often continued to drink even after they stopped using contraception. Nearly 2 million U.S. women are at AEP risk and therefore at risk of having children born with fetal alcohol spectrum disorders. For pregnant women and women intending a pregnancy, there is an urgent need for wider implementation of prevention programs and policy approaches that can reduce the risk for this serious public health problem.


Assuntos
Alcoolismo/complicações , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Feminino , Transtornos do Espectro Alcoólico Fetal/epidemiologia , Transtornos do Espectro Alcoólico Fetal/etiologia , Humanos , Masculino , Gravidez , Complicações na Gravidez/psicologia , Prevalência , Fatores de Risco , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
10.
MMWR Morb Mortal Wkly Rep ; 63(1): 16-22, 2014 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-24402468

RESUMO

INTRODUCTION: Excessive alcohol use accounted for an estimated 88,000 deaths in the United States each year during 2006-2010, and $224 billion in economic costs in 2006. Since 2004, the U.S. Preventive Services Task Force (USPSTF) has recommended alcohol misuse screening and behavioral counseling (also known as alcohol screening and brief intervention [ASBI]) for adults to address excessive alcohol use; however, little is known about the prevalence of its implementation. ASBI will also be covered by many health insurance plans because of the Affordable Care Act. METHODS: CDC analyzed Behavioral Risk Factor Surveillance System (BRFSS) data from a question added to surveys in 44 states and the District of Columbia (DC) from August 1 to December 31, 2011, about patient-reported communication with a health professional about alcohol. Elements of ASBI are traditionally delivered via conversation. Weighted state-level prevalence estimates of this communication were generated for 166,753 U.S. adults aged ≥18 years by selected demographic characteristics and drinking behaviors. RESULTS: The prevalence of ever discussing alcohol use with a health professional was 15.7% among U.S. adults overall, 17.4% among current drinkers, and 25.4% among binge drinkers. It was most prevalent among those aged 18-24 years (27.9%). However, only 13.4% of binge drinkers reported discussing alcohol use with a health professional in the past year, and only 34.9% of those who reported binge drinking ≥10 times in the past month had ever discussed alcohol with a health professional. State-level estimates of communication about alcohol ranged from 8.7% in Kansas to 25.5% in DC. CONCLUSIONS: Only one of six U.S. adults, including binge drinkers, reported ever discussing alcohol consumption with a health professional, despite public health efforts to increase ASBI implementation. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Increased implementation of ASBI, including systems-level changes such as integration into electronic health records processes, might reduce excessive alcohol consumption and the harms related to it. Routine surveillance of ASBI by states and communities might support monitoring and increasing its implementation.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Comunicação , Relações Médico-Paciente , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Sistema de Vigilância de Fator de Risco Comportamental , Bebedeira/epidemiologia , Bebedeira/prevenção & controle , District of Columbia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Estados Unidos/epidemiologia , Adulto Jovem
11.
Alcohol Clin Exp Res ; 38(1): 214-26, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23905882

RESUMO

BACKGROUND: The objective of this review is to evaluate the literature on the association between mild, moderate, and binge prenatal alcohol exposure and child neurodevelopment. METHODS: Meta-analysis with systematic searches of MEDLINE (1970 through August 2012), EMBASE (1988 through August 2012), and PsycINFO(®) (1970 through August 2012) and examination of selected references. RESULTS: From 1,593 articles, we identified 34 presenting data from cohort studies that met our inclusion criteria. Information on study population, outcomes, measurement instruments, timing and quantification of alcohol exposure, covariates, and results was abstracted. Outcomes included academic performance, attention, behavior, cognition, language skills, memory, and visual and motor development. The quality of each article was assessed by 2 researchers using the Newcastle-Ottawa Scale. Based on 8 studies of 10,000 children aged 6 months through 14 years, we observed a significant detrimental association between any binge prenatal alcohol exposure and child cognition (Cohen's d [a standardized mean difference score] -0.13; 95% confidence interval [CI], -0.21, -0.05). Based on 3 high-quality studies of 11,900 children aged 9 months to 5 years, we observed a statistically significant detrimental association between moderate prenatal alcohol exposure and child behavior (Cohen's d -0.15; 95% CI, -0.28, -0.03). We observed a significant, albeit small, positive association between mild-to-moderate prenatal alcohol exposure and child cognition (Cohen's d 0.04; 95% CI, 0.00, 0.08), but the association was not significant after post hoc exclusion of 1 large study that assessed mild consumption nor was it significant when including only studies that assessed moderate alcohol consumption. None of the other completed meta-analyses resulted in statistically significant associations between mild, moderate, or binge prenatal alcohol exposure and child neuropsychological outcomes. CONCLUSIONS: Our findings support previous findings suggesting the detrimental effects of prenatal binge drinking on child cognition. Prenatal alcohol exposure at levels less than daily drinking might be detrimentally associated with child behavior. The results of this review highlight the importance of abstaining from binge drinking during pregnancy and provide evidence that there is no known safe amount of alcohol to consume while pregnant.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Bebedeira/complicações , Comportamento Infantil/psicologia , Testes Neuropsicológicos , Efeitos Tardios da Exposição Pré-Natal/psicologia , Consumo de Bebidas Alcoólicas/epidemiologia , Bebedeira/diagnóstico , Bebedeira/epidemiologia , Estudos de Casos e Controles , Criança , Estudos de Coortes , Feminino , Humanos , Gravidez , Efeitos Tardios da Exposição Pré-Natal/diagnóstico
12.
J Womens Health (Larchmt) ; 21(7): 720-9, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22559934

RESUMO

OBJECTIVE: At-risk drinking, cigarette smoking, obesity, diabetes, and frequent mental distress, as well as their co-occurrence in childbearing aged women, are risk factors for adverse pregnancy outcomes. This study estimated the prevalence of these five risk factors individually and in combination among nonpregnant women aged 18-44 years by demographic and psychosocial characteristics, with a focus on racial and ethnic disparities. METHODS: Data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) on nonpregnant women aged 18-44 years (n=54,612) were used to estimate the prevalences of five risk factors, pairs of co-occurring risk factors, and multiple risk factors for poor pregnancy outcomes. RESULTS: The majority of women had at least one risk factor, and 18.7% had two or more risk factors. Having two or more risk factors was highest among women who were American Indian and Alaska Native (34.4%), had less than a high school education (28.7%), were unable to work (50.1%), were unmarried (23.3%), and reported sometimes, rarely, or never receiving sufficient social and emotional support (32.8%). The most prevalent pair of co-occurring risk factors was at-risk drinking and smoking (5.7%). CONCLUSIONS: The high proportion of women of childbearing age with preconception risk factors highlights the need for preconception care. The common occurrence of multiple risk factors suggests the importance of developing screening tools and interventions that address risk factors that can lead to poor pregnancy outcomes. Increased attention should be given to high-risk subgroups.


Assuntos
Comportamentos Relacionados com a Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Disparidades em Assistência à Saúde/etnologia , Cuidado Pré-Concepcional/normas , Assunção de Riscos , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/etnologia , Consumo de Bebidas Alcoólicas/psicologia , Sistema de Vigilância de Fator de Risco Comportamental , Diabetes Mellitus/etnologia , Feminino , Humanos , Transtornos Mentais , Obesidade/etnologia , Obesidade/psicologia , Gravidez , Resultado da Gravidez/etnologia , Resultado da Gravidez/psicologia , Prevalência , Fatores de Risco , Fumar/etnologia , Fumar/psicologia , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos/epidemiologia
13.
Alcohol Clin Exp Res ; 36(5): 807-14, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-21995343

RESUMO

BACKGROUND: To examine the effects of low to moderate alcohol consumption during pregnancy on child motor function at age 5. METHODS: A prospective follow-up study of 685 women and their children sampled from the Danish National Birth Cohort based on maternal alcohol consumption during pregnancy. At 5 years of age, the children were tested with the "Movement Assessment Battery for Children" (MABC). Parental education, maternal IQ, prenatal maternal smoking, the child's age at testing, and gender of child were considered core confounders, while the full model also controlled for prenatal maternal binge drinking episodes, age, maternal prepregnancy body mass index, parity, home environment, postnatal parental smoking, health status, and indicators for hearing and vision impairment. RESULTS: There were no systematic or significant differences in motor function between children of mothers reporting low to moderate levels of average alcohol consumption during pregnancy and children of mothers who abstained. CONCLUSIONS: In this study, we found no systematic association between low to moderate maternal alcohol intake during pregnancy and child motor function at age 5.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Depressores do Sistema Nervoso Central/toxicidade , Etanol/toxicidade , Efeitos Tardios da Exposição Pré-Natal , Transtornos Psicomotores/induzido quimicamente , Adulto , Pré-Escolar , Feminino , Humanos , Masculino , Gravidez , Estudos Prospectivos
14.
Prev Chronic Dis ; 8(4): A78, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21672402

RESUMO

INTRODUCTION: Health-related quality of life (HRQOL) refers to a person's or group's perceived physical and mental health over time. Coronary heart disease (CHD) affects HRQOL and likely varies among groups. This study examined disparities in HRQOL among adults with self-reported CHD. METHODS: We examined disparities in HRQOL by using the unhealthy days measurements among adults who self-reported CHD in the 2007 Behavioral Risk Factor Surveillance System state-based telephone survey. CHD was based on self-reported medical history of heart attack, angina, or coronary heart disease. We assessed differences in fair/poor health status, 14 or more physically unhealthy days, 14 or more mentally unhealthy days, 14 or more total unhealthy days (total of physically and mentally unhealthy days), and 14 or more activity-limited days. Multivariate logistic regression models included age, race/ethnicity, sex, education, annual household income, household size, and health insurance coverage. RESULTS: Of the population surveyed, 35,378 (6.1%) self-reported CHD. Compared with non-Hispanic whites, Native Americans were more likely to report fair/poor health status (adjusted odds ratio [AOR], 1.7), 14 or more total unhealthy days (AOR, 1.6), 14 or more physically unhealthy days (AOR, 1.7), and 14 or more activity-limited days (AOR, 1.9). Hispanics were more likely than non-Hispanic whites to report fair/poor health status (AOR, 1.5) and less likely to report 14 or more activity-limited days (AOR, 0.5), and Asians were less likely to report 14 or more activity-limited days (AOR, 0.2). Non-Hispanic blacks did not differ in unhealthy days measurements from non-Hispanic whites. The proportion reporting 14 or more total unhealthy days increased with increasing age, was higher among women than men, and was lower with increasing levels of education and income. CONCLUSION: There are sex, racial/ethnic, and socioeconomic disparities in HRQOL among people with CHD. Tailoring interventions to people who have both with CHD and poor HRQOL may assist in the overall management of CHD.


Assuntos
Grupos de Populações Continentais , Doença das Coronárias/etnologia , Grupos Étnicos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Vigilância da População/métodos , Qualidade de Vida , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Doença das Coronárias/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
15.
Prev Sci ; 11(2): 197-206, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19937383

RESUMO

This study was conducted to provide nationally representative findings on the prevalence and distribution of concurrent alcohol use or heavier use of alcohol and cigarette smoking among women of childbearing age with accessible health care. For the years 2003-2005, a total of 20,912 women 18-44 years of age who participated in the National Health Interview Survey (NHIS) reported that during the study period, there was a place where they would usually go for health care when sick or in need of advice about their health. The prevalence and distribution of concurrent alcohol use or heavier use of alcohol and cigarette smoking reported by such women was calculated. Logistic regression analysis was used to evaluate the "most often visited health care place" among concurrent users who reported having seen or talked to a health care provider during the previous 12 months. Among surveyed women with accessible health care, 12.3% reported concurrent alcohol use and cigarette smoking, and 1.9% reported concurrent heavier use of alcohol and cigarette smoking during the study period. Of women who reported either type of concurrent use, at least 84.4% also indicated having seen or talked to one or more health care providers during the previous 12 months. Such women were more likely than non-concurrent users to indicate that the "most often visited health care place" was a "hospital emergency room or outpatient department or some other place" or a "clinic or health center," as opposed to an "HMO or doctor's office." Concurrent alcohol use or heavier use of alcohol and cigarette smoking among women of childbearing age is an important public health concern in the United States. The findings of this study highlight the importance of screening and behavioral counseling interventions for excessive drinking and cigarette smoking by health care providers in both primary care and emergency department settings.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Acesso aos Serviços de Saúde , Fumar/epidemiologia , Adolescente , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Estados Unidos/epidemiologia , Adulto Jovem
16.
J Hypertens ; 26(4): 641-7, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18327071

RESUMO

OBJECTIVE: We examined health-related quality of life measures by hypertension status, awareness, treatment, and control. METHODS: Five unfavorable health-related quality of life measures were analyzed among 8303 adults aged 20 years or older who participated in the 2001--2004 National Health and Nutrition Examination Survey. Multivariable logistic regression analyses examined differences in health-related quality of life with adjustment for age, race, sex, healthcare coverage, and other medical conditions. RESULTS: The 30% of respondents with hypertension were more likely to report fair or poor health status (adjusted odds ratio 1.72, 95% confidence interval 1.44-2.05), 14 or more unhealthy days in the past 30 days (1.23, 1.06-1.43), 14 or more physically unhealthy days (1.39, 1.15-1.67), and 14 or more activity-limited days (1.55, 1.17-2.04) than those without hypertension. Among adults with hypertension, the 73.2% who were aware of their condition were more likely to report fair or poor health status (2.19, 1.54-3.12), 14 or more unhealthy days (1.53, 1.12-2.09), 14 or more physically unhealthy days (1.49, 1.10-2.03), 14 or more mentally unhealthy days (1.70, 1.05-2.75), and 14 or more activity-limited days (2.38, 1.39-4.05) than those who were unaware. Among those aware they had hypertension, 14 or more physically unhealthy days (0.50, 0.28-0.90) was associated with current treatment. Health-related quality of life measures did not differ by blood pressure control status. CONCLUSIONS: Having hypertension and being aware of it was related to lower health-related quality of life. Antihypertensive medication was associated with more physically unhealthy days, while there were no differences in health-related quality of life by control status. Further study is needed to examine these differences including: disease severity, sex and racial/ethnic differences, comorbidities not examined, and impact of health-related quality of life and its changes on outcomes.


Assuntos
Anti-Hipertensivos/uso terapêutico , Nível de Saúde , Hipertensão , Inquéritos Nutricionais , Qualidade de Vida , Adulto , Grupo com Ancestrais do Continente Africano/psicologia , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etnologia , Hipertensão/psicologia , Seguro/estatística & dados numéricos , Modelos Logísticos , Masculino , Americanos Mexicanos/psicologia , Americanos Mexicanos/estatística & dados numéricos , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
17.
Ethn Dis ; 17(4): 686-92, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18072380

RESUMO

OBJECTIVES: To estimate the prevalence of disabilities among older American Indians and Alaska Natives (AIANs) and compare these estimates with those of other major racial/ ethnic groups. To estimate, within the population with disabilities, the health-risk behaviors, obesity, and chronic conditions of older AIANs and compare them with estimates for other racial/ethnic groups. DESIGN: State-based surveillance system that collects data on a monthly basis using an independent probability sample of households with telephones among the noninstitutionalized population aged > or =18 years. METHODS: We analyzed data on 434,972 noninstitutionalized adults aged > or =50 years from the 2003-2005 Behavioral Risk Factor Surveillance System. RESULTS: Among older AIAN adults, the unadjusted prevalence of disability (38.4%) was higher than among Whites (29.7%), Blacks (33.5%), Asians (15.6%), and Hispanics (26.9%). Among older adults with disabilities, AIANs were younger than their counterparts in other groups and were as likely to be male as female. After adjustment for age and self-rated health, both AIAN men and women with disabilities had the highest prevalence of current smoking, heart disease, and asthma. CONCLUSIONS: Efforts to prevent, delay, and reduce disabilities and associated secondary conditions in persons with disabilities must be culturally sensitive and targeted toward reducing racial/ethnic disparities in health-risk behaviors and chronic conditions.


Assuntos
Doença Crônica , Pessoas com Deficiência/estatística & dados numéricos , Comportamentos Relacionados com a Saúde/etnologia , Índios Norte-Americanos/etnologia , Inuítes/etnologia , Idoso , Alaska/epidemiologia , Alaska/etnologia , Sistema de Vigilância de Fator de Risco Comportamental , Doença Crônica/epidemiologia , Doença Crônica/etnologia , Feminino , Humanos , Estilo de Vida/etnologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/etnologia , Prevalência , Vigilância de Evento Sentinela , Fatores Sexuais
18.
J Diabetes Complications ; 19(4): 201-6, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-15993353

RESUMO

OBJECTIVE: To determine whether disabled diabetic persons have a higher prevalence of risk factors for heart disease and stroke than do diabetic persons without disability. RESEARCH, DESIGN, AND METHODS: Data were analyzed for noninstitutionalized adults in 27 states and the District of Columbia that participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 2001 and/or 2003. Logistic regression analysis was used to estimate the adjusted prevalence and odds ratios of disabled diabetic persons, by sociodemographic characteristics. The logit form of each model was used to estimate conditional marginal probabilities of risk factors for heart disease and stroke among diabetic persons, by disability status. RESULTS: Diabetic persons with disability were more likely than those without disability to have more risk factors for heart disease and stroke, including insufficient leisure-time physical activity or inactivity (adjusted prevalence: 75.2% vs. 63.3%; P<.001), obesity (58.9% vs. 43.3%; P<.001), hypercholesterolemia (52.6% vs. 48.4%; P=.038), and hypertension (63.9% vs. 56.6%; P<.001). They were also more likely to have one or more, two or more, three or more, and four or more risk factors (97.2% vs. 95.6%, 83.5% vs. 74.0%, 56.5% vs. 41.1%, and 22.2% vs. 13.6%, respectively; P< or =.005). CONCLUSIONS: Diabetic persons with disability are more likely than those without disability to have clusters of risk factors for heart disease and stroke. Health care guidelines specifically targeting diabetic patients with disability may be needed to aid health care providers in addressing these risk factors.


Assuntos
Angiopatias Diabéticas/complicações , Pessoas com Deficiência , Cardiopatias/etiologia , Acidente Vascular Cerebral/etiologia , Adulto , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
19.
Am J Public Health ; 95(5): 825-7, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15855458

RESUMO

We compared prevalence estimates of chronic disease risk factors and health status between American Indian/Alaska Native (AIAN) and White elders. We used 2001 and 2002 Behavioral Risk Factor Surveillance System data to estimate the prevalence of smoking, physical inactivity, obesity, diagnosed diabetes, and general health status. For all health behavior and status measures, American Indians/Alaska Natives reported greater risk than did Whites. Risk factors among AIAN elders need to be addressed to eliminate disparities in chronic diseases.


Assuntos
Doença Crônica/epidemiologia , Comportamentos Relacionados com a Saúde , Índios Norte-Americanos , Inuítes , Vigilância da População/métodos , Alaska/epidemiologia , Diabetes Mellitus/epidemiologia , Grupo com Ancestrais do Continente Europeu , Exercício , Feminino , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Fatores de Risco , Fumar/epidemiologia
20.
Am J Prev Med ; 29(5 Suppl 1): 81-7, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16389131

RESUMO

An effective state heart disease and stroke prevention program must be able to monitor changes in heart disease and stroke risk factors of the state population. The Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey, has been an important source for monitoring health-related factors and evaluating the success of programs. The BRFSS currently includes modules on hypertension and cholesterol screening and awareness, cardiovascular disease preventive practices, and recognition of the signs and symptoms of heart attack and stroke as well as relevant modules on fruit and vegetable intake, physical activity, tobacco use, and diabetes. Publication topics included monitoring risk factors and clinical services, assessing progress toward national goals, assessing health disparities, and health status and health-related quality of life issues. States have used the BRFSS data for monitoring health risks in the state, assessing state and national health objectives, determining and providing data for public health campaigns, providing information for legislative proposals, and providing information that helps to initiate collaboration. Major methodologic issues involve validating self-reported data against direct measurement and assessing the effects of changes in telecommunications. As Centers for Disease Control's (CDC) national heart disease and stroke prevention program and each state health department program develop, state and even local level data will become more important to measure the burden of disease and program impact. State heart disease and stroke prevention programs are encouraged to work closely with state BRFSS coordinators to obtain vital information to measure the burden of heart disease and stroke in their state and to be able to measure program impact on addressing the first and third leading causes of death in the U.S.


Assuntos
Sistema de Vigilância de Fator de Risco Comportamental , Cardiopatias/prevenção & controle , Prevenção Primária , Acidente Vascular Cerebral/prevenção & controle , Programas Gente Saudável , Humanos , Estados Unidos
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