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1.
MMWR Morb Mortal Wkly Rep ; 69(2): 30-34, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31945030

RESUMO

Each year, excessive drinking accounts for one in 10 deaths among U.S. adults aged 20-64 years (1), and approximately 90% of adults who report excessive drinking* binge drink (i.e., consume five or more drinks for men or four or more drinks for women on a single occasion) (2). In 2015, 17.1% of U.S. adults aged ≥18 years reported binge drinking approximately once a week and consumed an average of seven drinks per binge drinking episode, resulting in 17.5 billion total binge drinks, or 467 total binge drinks per adult who reported binge drinking (3). CDC analyzed 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) data to assess trends in total annual binge drinks per adult who reported binge drinking in the United States overall and in the individual states. The age-adjusted† total annual number of binge drinks per adult who reported binge drinking increased significantly from 472 in 2011 to 529 in 2017. Total annual binge drinks per adult who reported binge drinking also increased significantly from 2011 to 2017 among those aged 35-44 years (26.7%, from 468 to 593) and 45-64 years (23.1%, from 428 to 527). The largest percentage increases in total binge drinks per adult who reported binge drinking during this period were observed among those without a high school diploma (45.8%) and those with household incomes <$25,000 (23.9%). Strategies recommended by the Community Preventive Services Task Force§ for reducing excessive drinking (e.g., regulating alcohol outlet density) might reduce binge drinking and related health risks.


Assuntos
Bebedeira/tendências , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Bebedeira/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
2.
Disabil Health J ; 13(1): 100834, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31427202

RESUMO

BACKGROUND: In the United States, approximately 10% of adults 18-64 years are disabled. However, there is scarce literature on the associations between disability and HIV risk. OBJECTIVE: To assess disability prevalence and its associations to health and HIV risk factors among low socioeconomic status (SES) (≤high school education or ≤ poverty guidelines) urban adults. METHODS: We assessed disability prevalence from a cross-sectional sample of low SES urban heterosexually active adults at risk for HIV participating in the 2016 National HIV Behavioral Surveillance (NHBS) and calculated crude and adjusted prevalence ratios and 95% confidence intervals of disability for health and HIV risk behaviors. RESULTS: In the NHBS sample, 39.6% of participants reported any disability. Disability was associated with health care utilization and risk behaviors, even when adjusting for demographics. Participants with disabilities were more likely to have condomless sex with a casual partner and engage in exchange sex. CONCLUSIONS: Low SES urban heterosexually active adults reported high prevalence of disabilities and differences in health, health care utilization, and risk factors. Disability might contribute to sexual risk behaviors that increase the likelihood of HIV infection. Further investigations into the intersection of disability and HIV risk are needed, especially in poor communities often excluded from national assessments.

3.
MMWR Morb Mortal Wkly Rep ; 68(40): 873-879, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31600183

RESUMO

Correct and consistent condom use and human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) are protective against sexual transmission of HIV (1,2). The incidence of HIV infection among Hispanic/Latino men who have sex with men (MSM) in the United States is increasing (3). HIV risk among Hispanic/Latino MSM differs based on their place of birth and years of U.S. residence (4). Data from CDC's National HIV Behavioral Surveillance (NHBS)* for 2011-2017 were analyzed to assess changes in sexual risk behaviors among Hispanic/Latino MSM by place of birth and years of U.S. residence. Overall, condomless anal sex during the previous 12 months increased from 63% in 2011 to 74% in 2017, and PrEP use during the previous 12 months increased from 3% in 2014 to 24% in 2017. Regardless of place of birth, nearly 75% of Hispanic/Latino MSM reported condomless anal sex during 2017. However, because of PrEP use, <60% of non-U.S.-born Hispanic/Latino MSM and <50% of U.S.-born Hispanic/Latino MSM reported unprotected anal sex (condomless anal sex and no PrEP use) during 2017. Results indicate that PrEP can be a vital tool for reducing HIV transmission among Hispanic/Latino MSM, especially those who have condomless anal sex. Interventions to prevent HIV acquisition, including increasing PrEP uptake, could address cultural and linguistic needs of Hispanic/Latino MSM, as well as other barriers to prevention of HIV infection typically faced by all MSM.


Assuntos
Hispano-Americanos/psicologia , Homossexualidade Masculina/etnologia , Assunção de Riscos , Sexo sem Proteção/etnologia , Adolescente , Adulto , Infecções por HIV/etnologia , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
4.
MMWR Morb Mortal Wkly Rep ; 68(37): 801-806, 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31536484

RESUMO

In 2017, preliminary data show that gay, bisexual, and other men who have sex with men (MSM) accounted for 67% of new diagnoses of human immunodeficiency virus (HIV) infection, that MSM who inject drugs accounted for an additional 3%, and that African American/black (black) and Hispanic/Latino (Hispanic) MSM were disproportionately affected (1). During 2010-2015, racial/ethnic disparities in HIV incidence increased among MSM; in 2015, rates among black and Hispanic MSM were 10.5 and 4.9 times as high, respectively, as the rate among white MSM (compared with 9.2 and 3.8 times as high, respectively, in 2010) (2). Increased use of preexposure prophylaxis (PrEP), which reduces the risk for sexual acquisition of HIV infection by approximately 99% when taken daily as prescribed,* would help to reduce these disparities and support the Ending the HIV Epidemic: A Plan for America initiative† (3). Although PrEP use has increased among all MSM since 2014 (4), racial/ethnic disparities in PrEP use could increase existing disparities in HIV incidence among MSM (5). To understand racial/ethnic disparities in PrEP awareness, discussion with a health care provider, and use (steps in the HIV PrEP continuum of care) (6), CDC analyzed 2017 National HIV Behavioral Surveillance (NHBS) data. Black and Hispanic MSM were significantly less likely than were white MSM to be aware of PrEP, to have discussed PrEP with a health care provider, or to have used PrEP within the past year. Among those who had discussed PrEP with a health care provider within the past year, 68% of white MSM, 62% of Hispanic MSM, and 55% of black MSM, reported PrEP use. Prevention efforts need to increase PrEP use among all MSM and target eliminating racial/ethnic disparities in PrEP use.§.


Assuntos
Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Disparidades em Assistência à Saúde/etnologia , Homossexualidade Masculina/etnologia , Profilaxia Pré-Exposição/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
5.
MMWR Morb Mortal Wkly Rep ; 68(27): 597-603, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31298662

RESUMO

In February 2019, the U.S. Department of Health and Human Services proposed a strategic initiative to end the human immunodeficiency (HIV) epidemic in the United States by reducing new HIV infections by 90% during 2020-2030* (1). Phase 1 of the Ending the HIV Epidemic initiative focuses on Washington, DC; San Juan, Puerto Rico; and 48 counties where the majority of new diagnoses of HIV infection in 2016 and 2017 were concentrated and on seven states with a disproportionate occurrence of HIV in rural areas relative to other states.† One of the four pillars in the initiative is protecting persons at risk for HIV infection using proven, comprehensive prevention approaches and treatments, such as HIV preexposure prophylaxis (PrEP), which is the use of antiretroviral medications that have proven effective at preventing infection among persons at risk for acquiring HIV. In 2014, CDC released clinical PrEP guidelines to health care providers (2) and intensified efforts to raise awareness and increase the use of PrEP among persons at risk for infection, including gay, bisexual, and other men who have sex with men (MSM), a group that accounted for an estimated 68% of new HIV infections in 2016 (3). Data from CDC's National HIV Behavioral Surveillance (NHBS) were collected in 20 U.S. urban areas in 2014 and 2017, covering 26 of the geographic areas included in Phase I of the Ending the HIV Epidemic initiative, and were compared to assess changes in PrEP awareness and use among MSM. From 2014 to 2017, PrEP awareness increased by 50% overall, with >80% of MSM in 17 of the 20 urban areas reporting PrEP awareness in 2017. Among MSM with likely indications for PrEP (e.g., sexual risk behaviors or recent bacterial sexually transmitted infection [STI]), use of PrEP increased by approximately 500% from 6% to 35%, with significant increases observed in all urban areas and in almost all demographic subgroups. Despite this progress, PrEP use among MSM, especially among black and Hispanic MSM, remains low. Continued efforts to improve coverage are needed to reach the goal of 90% reduction in HIV incidence by 2030. In addition to developing new ways of connecting black and Hispanic MSM to health care providers through demonstration projects, CDC has developed resources and tools such as the Prescribe HIV Prevention program to enable health care providers to integrate PrEP into their clinical care.§ By routinely testing their patients for HIV, assessing HIV-negative patients for risk behaviors, and prescribing PrEP as needed, health care providers can play a critical role in this effort.


Assuntos
Epidemias/prevenção & controle , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/psicologia , Profilaxia Pré-Exposição/estatística & dados numéricos , População Urbana , Adolescente , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Infecções por HIV/epidemiologia , Infecções por HIV/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
6.
Artigo em Inglês | MEDLINE | ID: mdl-31136416

RESUMO

CONTEXT: Excessive alcohol use is responsible for 88 000 deaths in the United States annually and cost the United States $249 billion in 2010. There is strong scientific evidence that regulating alcohol outlet density is an effective intervention for reducing excessive alcohol consumption and related harms, but there is no standard method for measuring this exposure. PROGRAM: We overview the strategies available for measuring outlet density, discuss their advantages and disadvantages, and provide examples of how they can be applied in practice. IMPLEMENTATION: The 3 main approaches for measuring density are container-based (eg, number of outlets in a county), distance-based (eg, average distance between a college and outlets), and spatial access-based (eg, weighted distance between town center and outlets). EVALUATION: While container-based measures are the simplest to calculate and most intuitive, distance-based or spatial access-based measures are unconstrained by geopolitical boundaries and allow for assessment of clustering (an amplifier of certain alcohol-related harms). Spatial access-based measures can also be adjusted for population size/demographics but are the most resource-intensive to produce. DISCUSSION: Alcohol outlet density varies widely across and between locations and over time, which is why it is important to measure it. Routine public health surveillance of alcohol outlet density is important to identify problem areas and detect emerging ones. Distance- or spatial access-based measures of alcohol outlet density are more resource-intensive than container-based measures but provide a much more accurate assessment of exposure to alcohol outlets and can be used to assess clustering, which is particularly important when assessing the relationship between density and alcohol-related harms, such as violent crime.

7.
Prev Chronic Dis ; 15: E151, 2018 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-30522582

RESUMO

Limited information exists about the effectiveness of interventions to enforce laws prohibiting alcohol sales to intoxicated patrons in licensed establishments. New Mexico Behavioral Risk Factor Surveillance System data were used to evaluate an intervention on binge drinking intensity in licensed (eg, bars) versus unlicensed (eg, homes) locations. The proportion of binge drinkers in licensed locations who consumed 8 or more drinks on a binge drinking occasion decreased from 42.1% in 2004-2005 to 22.6% in 2007-2008 (adjusted odds ratio, 0.4; 95% confidence interval, 0.2-0.9), while the proportion in unlicensed locations was essentially unchanged. Enhanced enforcement of overservice laws may reduce excessive drinking in licensed establishments.


Assuntos
Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Bebedeira/epidemiologia , Comércio , Adolescente , Adulto , Distribuição por Idade , Bebidas Alcoólicas/economia , Sistema de Vigilância de Fator de Risco Comportamental , Bebedeira/prevenção & controle , Estudos Transversais , Feminino , Humanos , Licenciamento , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , Fatores de Risco , Distribuição por Sexo , Adulto Jovem
8.
Int J Health Geogr ; 17(1): 23, 2018 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-29945619

RESUMO

OBJECTIVE: To assess spatial accessibility measures to on-premise alcohol outlets at census block, census tract, county, and state levels for the United States. METHODS: Using network analysis in a geographic information system, we computed distance-based measures (Euclidean distance, driving distance, and driving time) to on-premise alcohol outlets for the entire U.S. at the census block level. We then calculated spatial access-based measures, specifically a population-weighted spatial accessibility index and population-weighted distances (Euclidean distance, driving distance, and driving time) to alcohol outlets at the census tract, county, and state levels. A multilevel model-based sensitivity analysis was conducted to evaluate the associations between different on-premise alcohol outlet accessibility measures and excessive drinking outcomes. RESULTS: The national average population-weighted driving time to the nearest 7 on-premise alcohol outlets was 5.89 min, and the average population-weighted driving distance was 2.63 miles. At the state level, population-weighted driving times ranged from 1.67 min (DC) to 15.29 min (Arizona). Population-weighted driving distances ranged from 0.67 miles (DC) to 7.91 miles (Arkansas). At the county level, population-weighted driving times and distances exhibited significant geographic variations, and averages for both measures increased by the degree of county rurality. The population-weighted spatial accessibility indexes were highly correlated to respective population-weighted distance measures. Sensitivity analysis demonstrated that population weighted accessibility measures were more sensitive to excessive drinking outcomes than were population weighted distance measures. CONCLUSIONS: These results can be used to assess the relationship between geographic access to on-premise alcohol outlets and health outcomes. This study demonstrates a flexible and robust method that can be applied or modified to quantify spatial accessibility to public resources such as healthy food stores, medical care providers, and parks and greenspaces, as well as, quantify spatial exposure to local adverse environments such as tobacco stores and fast food restaurants.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Bebidas Alcoólicas , Comércio/métodos , Mapeamento Geográfico , Prática de Saúde Pública , Características de Residência , Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/tendências , Bebidas Alcoólicas/economia , Comércio/economia , Comércio/tendências , Recursos em Saúde/economia , Recursos em Saúde/tendências , Humanos , Prática de Saúde Pública/economia , Estados Unidos/epidemiologia
9.
Am J Prev Med ; 54(4): 486-496, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29555021

RESUMO

INTRODUCTION: Binge drinking (four or more drinks for women, five or more drinks for men on an occasion) accounts for more than half of the 88,000 U.S. deaths resulting from excessive drinking annually. Adult binge drinkers do so frequently and at high intensity; however, there are known disparities in binge drinking that are not well characterized by any single binge-drinking measure. A new measure of total annual binge drinks was used to assess these disparities at the state and national levels. METHODS: Behavioral Risk Factor Surveillance System 2015 data (analyzed in 2016) were used to estimate the prevalence, frequency, intensity, and total binge drinks among U.S. adults. Total annual binge drinks was calculated by multiplying annual binge-drinking episodes by binge-drinking intensity. RESULTS: In 2015, a total of 17.1% of U.S. adults (37.4 million) reported an annual average of 53.1 binge-drinking episodes per binge drinker, at an average intensity of 7.0 drinks per binge episode, resulting in 17.5 billion total binge drinks, or 467.0 binge drinks per binge drinker. Although binge drinking was more common among young adults (aged 18-34 years), half of the total binge drinks were consumed by adults aged ≥35 years. Total binge drinks per binge drinker were substantially higher among those with lower educational levels and household incomes than among those with higher educational levels and household incomes. CONCLUSIONS: U.S. adult binge drinkers consume about 17.5 billion total binge drinks annually, or about 470 binge drinks/binge drinker. Monitoring total binge drinks can help characterize disparities in binge drinking and help plan and evaluate effective prevention strategies.


Assuntos
Bebidas Alcoólicas/estatística & dados numéricos , Sistema de Vigilância de Fator de Risco Comportamental , Bebedeira/epidemiologia , Disparidades nos Níveis de Saúde , Fatores Socioeconômicos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estados Unidos/epidemiologia , Adulto Jovem
10.
Am J Prev Med ; 53(3S1): S14-S20, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28818241

RESUMO

INTRODUCTION: Carcinogen exposure and unhealthy habits acquired in young adulthood can set the stage for the development of cancer at older ages. This study measured the current prevalence of several cancer risk factors among young adults to assess opportunities to intervene to change the prevalence of these risk factors and potentially reduce cancer incidence. METHODS: Using 2015 National Health Interview Survey data (analyzed in 2016), the prevalence of potential cancer risk factors was estimated among U.S. adults aged 18-44 years, based on responses to questions about diet, physical activity, tobacco product use, alcohol, indoor tanning, sleep, human papillomavirus vaccine receipt, and obesity, stratified by sex, age, and race/ethnicity. RESULTS: The prevalence of some risk factors varied by age and race/ethnicity. Obesity (one in four people) and insufficient sleep (one in three people) were common among men and women. Physical inactivity (one in five men, one in four women); binge drinking (one in four men, one in eight women); cigarette smoking (one in five men, one in seven women); and frequent consumption of red meat (one in four men, one in six women) also were common. More than half of the population of adults aged 18-44 years consumed sugar-sweetened beverages daily and processed meat at least once a week. Most young adults had never had the human papillomavirus vaccine. CONCLUSIONS: Findings can be used to target evidence-based environmental and policy interventions to reduce the prevalence of cancer risk factors among young adults and prevent the development of future cancers.


Assuntos
Neoplasias/epidemiologia , Neoplasias/prevenção & controle , Infecções por Papillomavirus/prevenção & controle , Uso de Tabaco/epidemiologia , Adulto , Fatores Etários , Carcinógenos , Grupos de Populações Continentais/estatística & dados numéricos , Exposição Ambiental/efeitos adversos , Etanol/efeitos adversos , Grupos Étnicos/estatística & dados numéricos , Exercício , Comportamento Alimentar , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Incidência , Masculino , Neoplasias/etiologia , Inquéritos Nutricionais/estatística & dados numéricos , Vacinas contra Papillomavirus/uso terapêutico , Prevalência , Carne Vermelha/efeitos adversos , Fatores de Risco , Edulcorantes/efeitos adversos , Uso de Tabaco/efeitos adversos , Uso de Tabaco/prevenção & controle , Estados Unidos/epidemiologia , Adulto Jovem
11.
MMWR Morb Mortal Wkly Rep ; 66(18): 474-478, 2017 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-28493857

RESUMO

Excessive drinking accounted for approximately 4,300 deaths each year among persons aged <21 years during 2006-2010,* and underage drinking cost the United States $24.3 billion in 2010 (1). CDC analyzed data from the national Youth Risk Behavior Survey (YRBS) for the years 1991-2015 to examine trends in drinking by U.S. high school students, and from the 2015 YRBS to assess the usual source of alcohol consumed† and binge drinking intensity (i.e., the average number of drinks consumed per binge drinking occasion).§ During 1991-2007, the prevalence of current drinking¶ among high school students declined significantly, from 50.8% (1991) to 44.7% (2007), and then significantly declined to 32.8% in 2015. The prevalence of binge drinking** increased from 31.3% in 1991 to 31.5% in 1999, and then significantly declined to 17.7% in 2015. Most high school students who drank were binge drinkers (57.8%), and 43.8% of binge drinkers consumed eight or more drinks in a row. Despite progress, current drinking and binge drinking are common among high school students, and many students who binge drink do so at high intensity (i.e., eight or more drinks in a row). Widespread use of evidence-based strategies for preventing excessive drinking (e.g., increasing alcohol taxes, regulating alcohol outlet density, and having commercial host liability laws) could help reduce underage drinking and related harms.††.


Assuntos
Bebedeira/epidemiologia , Estudantes/psicologia , Consumo de Álcool por Menores/estatística & dados numéricos , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Assunção de Riscos , Estudantes/estatística & dados numéricos , Estados Unidos/epidemiologia
12.
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
13.
MMWR Surveill Summ ; 66(5): 1-8, 2017 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-28151923

RESUMO

PROBLEM/CONDITION: Persons living in rural areas are recognized as a health disparity population because the prevalence of disease and rate of premature death are higher than for the overall population of the United States. Surveillance data about health-related behaviors are rarely reported by urban-rural status, which makes comparisons difficult among persons living in metropolitan and nonmetropolitan counties. REPORTING PERIOD: 2013. DESCRIPTION OF SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health-risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services related to the leading causes of death and disability. BRFSS data were analyzed for 398,208 adults aged ≥18 years to estimate the prevalence of five self-reported health-related behaviors (sufficient sleep, current nonsmoking, nondrinking or moderate drinking, maintaining normal body weight, and meeting aerobic leisure time physical activity recommendations) by urban-rural status. For this report, rural is defined as the noncore counties described in the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties. RESULTS: Approximately one third of U.S. adults practice at least four of these five behaviors. Compared with adults living in the four types of metropolitan counties (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan), adults living in the two types of nonmetropolitan counties (micropolitan and noncore) did not differ in the prevalence of sufficient sleep; had higher prevalence of nondrinking or moderate drinking; and had lower prevalence of current nonsmoking, maintaining normal body weight, and meeting aerobic leisure time physical activity recommendations. The overall age-adjusted prevalence of reporting at least four of the five health-related behaviors was 30.4%. The prevalence among the estimated 13.3 million adults living in noncore counties was lower (27.0%) than among those in micropolitan counties (28.8%), small metropolitan counties (29.5%), medium metropolitan counties (30.5%), large fringe metropolitan counties (30.2%), and large metropolitan centers (31.7%). INTERPRETATION: This is the first report of the prevalence of these five health-related behaviors for the six urban-rural categories. Nonmetropolitan counties have lower prevalence of three and clustering of at least four health-related behaviors that are associated with the leading chronic disease causes of death. Prevalence of sufficient sleep was consistently low and did not differ by urban-rural status. PUBLIC HEALTH ACTION: Chronic disease prevention efforts focus on improving the communities, schools, worksites, and health systems in which persons live, learn, work, and play. Evidence-based strategies to improve health-related behaviors in the population of the United States can be used to reach the Healthy People 2020 objectives for these five self-reported health-related behaviors (sufficient sleep, current nonsmoking, nondrinking or moderate drinking, maintaining normal body weight, and meeting aerobic leisure time physical activity recommendations). These findings suggest an ongoing need to increase public awareness and public education, particularly in rural counties where prevalence of these health-related behaviors is lowest.


Assuntos
Comportamentos Relacionados com a Saúde , Vigilância da População , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Doença Crônica , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Assunção de Riscos , Estados Unidos/epidemiologia , Adulto Jovem
14.
Prev Chronic Dis ; 13: E70, 2016 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-27236381

RESUMO

INTRODUCTION: Five key health-related behaviors for chronic disease prevention are never smoking, getting regular physical activity, consuming no alcohol or only moderate amounts, maintaining a normal body weight, and obtaining daily sufficient sleep. The objective of this study was to estimate the clustering of these 5 health-related behaviors among adults aged 21 years or older in each state and the District of Columbia and to assess geographic variation in clustering. METHODS: We used data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) to assess the clustering of the 5 behaviors among 395,343 BRFSS respondents aged 21 years or older. The 5 behaviors were defined as currently not smoking cigarettes, meeting the aerobic physical activity recommendation, consuming no alcohol or only moderate amounts, maintaining a normal body mass index (BMI), and sleeping at least 7 hours per 24-hour period. Prevalence of having 4 or 5 of these behaviors, by state, was also examined. RESULTS: Among US adults, 81.6% were current nonsmokers, 63.9% obtained 7 hours or more sleep per day, 63.1% reported moderate or no alcohol consumption, 50.4% met physical activity recommendations, and 32.5% had a normal BMI. Only 1.4% of respondents engaged in none of the 5 behaviors; 8.4%, 1 behavior; 24.3%, 2 behaviors; 35.4%, 3 behaviors; and 24.3%, 4 behaviors; only 6.3% reported engaging in all 5 behaviors. The highest prevalence of engaging in 4 or 5 behaviors was clustered in the Pacific and Rocky Mountain states. Lowest prevalence was in the southern states and along the Ohio River. CONCLUSION: Additional efforts are needed to increase the proportion of the population that engages in all 5 health-related behaviors and to eliminate geographic variation. Collaborative efforts in health care systems, communities, work sites, and schools can promote all 5 behaviors and produce population-wide changes, especially among the socioeconomically disadvantaged.


Assuntos
Índice de Massa Corporal , Doença Crônica/prevenção & controle , Exercício , Comportamentos Relacionados com a Saúde , Estilo de Vida , Fumar/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Sistema de Vigilância de Fator de Risco Comportamental , Análise por Conglomerados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Sono , Estados Unidos/epidemiologia , Adulto Jovem
15.
Prev Chronic Dis ; 12: E194, 2015 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-26564010

RESUMO

INTRODUCTION: Excessive alcohol consumption was responsible for approximately 4,300 annual deaths in the United States among people younger than 21 from 2006 through 2010. Underage drinking cost the United States $24.6 billion in 2006. Previous studies have shown that liquor is the most common type of alcohol consumed by high school students. However, little is known about the types of liquor consumed by youth or about the mixing of alcohol with energy drinks. METHODS: The 2011 Michigan Youth Tobacco Survey was used to assess usual alcohol beverage consumption and liquor consumption and the mixing of alcohol with energy drinks by Michigan high school students. Beverage preferences were analyzed by demographic characteristics and drinking patterns. RESULTS: Overall, 34.2% of Michigan high school students consumed alcohol in the past month, and 20.8% reported binge drinking. Among current drinkers, liquor was the most common type of alcohol consumed (51.2%), and vodka was the most prevalent type of liquor consumed by those who drank liquor (53.0%). The prevalence of liquor consumption was similar among binge drinkers and nonbinge drinkers, but binge drinkers who drank liquor were significantly more likely than nonbinge drinkers to consume vodka and to mix alcohol with energy drinks (49.0% vs 18.2%, respectively). CONCLUSIONS: Liquor is the most common type of alcoholic beverage consumed by Michigan high school students; vodka is the most common type of liquor consumed. Mixing alcohol and energy drinks is common, particularly among binge drinkers. Community Guide strategies for reducing excessive drinking (eg, increasing alcohol taxes) can reduce underage drinking.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Bebidas Alcoólicas/estatística & dados numéricos , Bebidas Energéticas/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adolescente , Bebidas Alcoólicas/classificação , Feminino , Humanos , Masculino , Michigan/epidemiologia , Inquéritos e Questionários
16.
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
17.
Prev Chronic Dis ; 12: E84, 2015 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-26020548

RESUMO

INTRODUCTION: Regulating alcohol outlet density is an evidence-based strategy for reducing excessive drinking. However, the effect of this strategy on violent crime has not been well characterized. A reduction in alcohol outlet density in the Buckhead neighborhood of Atlanta from 2003 through 2007 provided an opportunity to evaluate this effect. METHODS: We conducted a community-based longitudinal study to evaluate the impact of changes in alcohol outlet density on violent crime in Buckhead compared with 2 other cluster areas in Atlanta (Midtown and Downtown) with high densities of alcohol outlets, from 1997 through 2002 (preintervention) to 2003 through 2007 (postintervention). The relationship between exposures to on-premises retail alcohol outlets and violent crime were assessed by using annual spatially defined indices at the census block level. Multilevel regression models were used to evaluate the relationship between changes in exposure to on-premises alcohol outlets and violent crime while controlling for potential census block-level confounders. RESULTS: A 3% relative reduction in alcohol outlet density in Buckhead from 1997-2002 to 2003-2007 was associated with a 2-fold greater reduction in exposure to violent crime than occurred in Midtown or Downtown, where exposure to on-premises retail alcohol outlets increased. The magnitude of the association between exposure to alcohol outlets and violent crime was 2 to 5 times greater in Buckhead than in either Midtown or Downtown during the postintervention period. CONCLUSIONS: A modest reduction in alcohol outlet density can substantially reduce exposure to violent crime in neighborhoods with high density of alcohol outlets. Routine monitoring of community exposure to alcohol outlets could also inform the regulation of alcohol outlet density, consistent with Guide to Community Preventive Services recommendations.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Bebidas Alcoólicas/estatística & dados numéricos , Comércio/métodos , Crime/estatística & dados numéricos , Violência/estatística & dados numéricos , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/prevenção & controle , Criança , Pré-Escolar , Análise por Conglomerados , Pesquisa Participativa Baseada na Comunidade , Crime/etnologia , Crime/tendências , Grupos Étnicos/psicologia , Grupos Étnicos/estatística & dados numéricos , Georgia/epidemiologia , Regulamentação Governamental , Humanos , Lactente , Recém-Nascido , Licenciamento , Estudos Longitudinais , Pobreza/estatística & dados numéricos , Pobreza/tendências , Características de Residência , Análise Espacial , Violência/etnologia , Violência/tendências , Adulto Jovem
18.
Drug Alcohol Depend ; 147: 46-52, 2015 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-25555622

RESUMO

BACKGROUND: Men who have sex with men (MSM) represent over half of new HIV infections in the United States. It is important to understand the factors associated with engaging in risky sexual behavior to develop effective prevention interventions. Binge drinking (≥5 drinks on ≥1 occasion) is the most common form of excessive alcohol consumption. This study examines the relationship between binge drinking and sexual risk behaviors among MSM who are current drinkers and who were either HIV-negative or unaware of their HIV status. METHODS: Using the 2011 National HIV Behavioral Surveillance system and multivariable Poisson models with robust error estimates, we assessed the association between binge drinking and sexual risk behaviors among current drinkers. Prevalence ratios (PR) and 95% confidence intervals (CI) are presented. RESULTS: Overall, 85% of MSM were current drinkers, and 59% of MSM who drank reported ≥1 episode of binge drinking in the preceding 30 days. In multivariable models, binge drinking was associated with condomless anal intercourse (CAI) at last sex with an HIV-positive or unknown status partner (receptive: PR 1.3, 95% CI 1.1-1.6; insertive: PR 1.2, 95% CI 1.0-1.4), having exchanged sex for money or drugs at last sex (PR: 1.4, 95% CI 1.1-1.7), having concurrent partners in the past year (PR: 1.1, 95% CI 1.1-1.2), and having more CAI partners in the past year (PR: 1.2, 95% CI 1.0-1.4) compared to non-binge drinkers. CONCLUSIONS: Evidence-based strategies for reducing binge drinking could help reduce risky sexual behavior among MSM.


Assuntos
Bebedeira/epidemiologia , Soronegatividade para HIV , Homossexualidade Masculina , Sexo sem Proteção , População Urbana , Adolescente , Adulto , Bebedeira/prevenção & controle , Bebedeira/psicologia , Cidades/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Assunção de Riscos , Comportamento Sexual/psicologia , Estados Unidos/epidemiologia , Sexo sem Proteção/prevenção & controle , Sexo sem Proteção/psicologia , Adulto Jovem
19.
MMWR Morb Mortal Wkly Rep ; 63(53): 1238-42, 2015 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-25577989

RESUMO

BACKGROUND: Alcohol poisoning is typically caused by binge drinking at high intensity (i.e., consuming a very large amount of alcohol during an episode of binge drinking). Approximately 38 million U.S. adults report binge drinking an average of four times per month and consuming an average of eight drinks per episode. METHODS: CDC analyzed data for 2010­2012 from the National Vital Statistics System to assess average annual alcohol poisoning deaths and death rates (ICD-10 codes X45 and Y15; underlying cause of death) in the United States among persons aged ≥15 years, by sex, age group, race/ethnicity, and state. RESULTS: During 2010­2012, an annual average of 2,221 alcohol poisoning deaths (8.8 deaths per 1 million population) occurred among persons aged ≥15 years in the United States. Of those deaths, 1,681 (75.7%) involved adults aged 35­64 years, and 1,696 (76.4%) involved men. Although non-Hispanic whites accounted for the majority of alcohol poisoning deaths (67.5%; 1,500 deaths), the highest age-adjusted death rate was among American Indians/Alaska Natives (49.1 per 1 million). The age-adjusted rate of alcohol poisoning deaths in states ranged from 5.3 per 1 million in Alabama to 46.5 per 1 million in Alaska. CONCLUSIONS: On average, six persons, mostly adult men, die from alcohol poisoning each day in the United States. Alcohol poisoning death rates vary substantially by state. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Evidence-based strategies for preventing excessive drinking (e.g., regulating alcohol outlet density and preventing illegal alcohol sales in retail settings) could reduce alcohol poisoning deaths by reducing the prevalence, frequency, and intensity of binge drinking.


Assuntos
Bebedeira/mortalidade , Etanol/envenenamento , Adolescente , Adulto , Idoso , Causas de Morte/tendências , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Estatísticas Vitais , Adulto Jovem
20.
Prev Chronic Dis ; 11: E206, 2014 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-25412029

RESUMO

INTRODUCTION: Excessive alcohol consumption is responsible for 88,000 deaths annually and cost the United States $223.5 billion in 2006. It is often assumed that most excessive drinkers are alcohol dependent. However, few studies have examined the prevalence of alcohol dependence among excessive drinkers. The objective of this study was to update prior estimates of the prevalence of alcohol dependence among US adult drinkers. METHODS: Data were analyzed from the 138,100 adults who responded to the National Survey on Drug Use and Health in 2009, 2010, or 2011. Drinking patterns (ie, past-year drinking, excessive drinking, and binge drinking) were assessed by sociodemographic characteristics and alcohol dependence (assessed through self-reported survey responses and defined as meeting ≥3 of 7 criteria for dependence in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). RESULTS: Excessive drinking, binge drinking, and alcohol dependence were most common among men and those aged 18 to 24. Binge drinking was most common among those with annual family incomes of $75,000 or more, whereas alcohol dependence was most common among those with annual family incomes of less than $25,000. The prevalence of alcohol dependence was 10.2% among excessive drinkers, 10.5% among binge drinkers, and 1.3% among non-binge drinkers. A positive relationship was found between alcohol dependence and binge drinking frequency. CONCLUSION: Most excessive drinkers (90%) did not meet the criteria for alcohol dependence. A comprehensive approach to reducing excessive drinking that emphasizes evidence-based policy strategies and clinical preventive services could have an impact on reducing excessive drinking in addition to focusing on the implementation of addiction treatment services.


Assuntos
Consumo de Bebidas Alcoólicas , Alcoolismo/epidemiologia , Adolescente , Adulto , Idoso , Coleta de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estados Unidos/epidemiologia , Adulto Jovem
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