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2.
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
3.
BMC Public Health ; 19(1): 1190, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31554513

RESUMO

BACKGROUND: Due to the high prevalence of diabetes risk factors in rural areas, it is important to identify whether differences in diabetes screening rates between rural and urban areas exist. Thus, the purpose of this study is to examine if living in a rural area, rurality, has any influence on diabetes screening across the US. METHODS: Participants from the 2011, 2013, 2015, and 2017 nationally representative Behavioral Risk Factor Surveillance System (BRFSS) surveys who responded to a question on diabetes screening were included in the study (n = 1,889,712). Two types of marginal probabilities, average adjusted predictions (AAPs) and average marginal effects (AMEs), were estimated at the national level using this data. AAPs and AMEs allow for the assessment of the independent role of rurality on diabetes screening while controlling for important covariates. RESULTS: People who lived in urban, suburban, and rural areas all had comparable odds (Urban compared to Rural Odds Ratio (OR): 1.01, Suburbans compared to Rural OR: 0.95, 0.94) and probabilities of diabetes screening (Urban AAP: 70.47%, Suburban AAPs: 69.31 and 69.05%, Rural AAP: 70.27%). Statistically significant differences in probability of diabetes screening were observed between residents in suburban areas and rural residents (AMEs: - 0.96% and - 1.22%) but not between urban and rural residents (AME: 0.20%). CONCLUSIONS: While similar levels of diabetes screening were found in urban, suburban, and rural areas, there is arguably a need for increased diabetes screening in rural areas where the prevalence of diabetes risk factors is higher than in urban areas.


Assuntos
Diabetes Mellitus/epidemiologia , Programas de Rastreamento/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
4.
Maturitas ; 128: 36-42, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31561820

RESUMO

BACKGROUND: Health-related quality of life (HRQoL) provides an accurate measure of the health status of patients with coronary heart disease (CHD). However, few studies have examined the relationship between physical inactivity and HRQoL in CHD survivors. We evaluated this association in a cross-sectional study of 21,936 CHD participants in the 2015 Behavioral Risk Factor Surveillance System. METHODS: CHD diagnosis, HRQoL and physical activity were self-reported. Physical activity (PA) was categorized (1) based on intensity, into no PA, light to moderate PA and vigorous PA; and (2) based on duration and frequency, into no PA, insufficiently active and active. HRQoL was assessed by the CDC HRQoL questionnaire. Participants with 14+ physical or mental unhealthy days in a 30-day window were grouped into poor physical or mental HRQoL. We estimated the odd ratios (AOR) and 95% confidence intervals (CI) of poor HRQoL associated with PA after adjusting for age, sex, education, income level, social support, smoking status, ethnicity/race, BMI, chronic conditions, and CHD groups. RESULTS: Compared with vigorous PA, adults with no PA had higher odds (95% CI) of poor physical HRQoL [1.82 (1.58, 2.10)] and poor mental HRQoL [1.28 (1.05, 1.55)]. When compared with active adults, AOR (95% CI) for adults with no PA were 1.80 (1.55, 2.01) and 1.17 (0.97, 1.42) for poor physical and mental HRQoL, respectively. CONCLUSIONS: We found an association between physical inactivity and poor physical and mental HRQoL among CHD survivors. There is a need for longitudinal studies to determine the temporality of this association.


Assuntos
Doença das Coronárias/psicologia , Exercício/psicologia , Qualidade de Vida/psicologia , Comportamento Sedentário , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sistema de Vigilância de Fator de Risco Comportamental , Doença das Coronárias/fisiopatologia , Estudos Transversais , Exercício/fisiologia , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fumar/psicologia , Apoio Social , Inquéritos e Questionários , Adulto Jovem
5.
Cancer Causes Control ; 30(10): 1045-1055, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31428890

RESUMO

PURPOSE: Previous studies suggesting that rural US women may be less likely to have a recent mammogram than urban women are limited in either scope or granularity. This study explored urban-rural disparities in US breast cancer-screening practices at the national, regional, and state levels. METHODS: We used data from the 2012, 2014, and 2016 Behavioral Risk Factor Surveillance Systems surveys. Logistic models were utilized to examine the impact of living in an urban/rural area on mammogram screening at three geographic levels while adjusting for covariates. We then calculated average adjusted predictions (AAPs) and average marginal effects (AMEs) to isolate the association between breast cancer screening and the urban/rural factor. RESULTS: At all geographic levels, AAPs of breast cancer screening were similar among urban, suburban, and rural residents. Regarding "ever having a mammogram" and "having a recent mammogram," urban women had small but significantly higher adjusted probabilities (AAP: 94.6%, 81.1%) compared to rural women (AAP: 93.5%, 80.2%). CONCLUSIONS: While urban-rural differences in breast cancer screening are small, they can translate into tens of thousands of rural women not receiving mammograms. Hence, there is a need to continue screening initiatives in these areas to reduce the number of breast cancer deaths.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade
6.
Med Care ; 57(10): 781-787, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31433313

RESUMO

BACKGROUND: Low-income adults in the United States have historically had limited access to dental coverage and poor dental health outcomes. OBJECTIVE: We examined the effects of the Affordable Care Act Medicaid expansions on dental visits among low-income adults focusing on the generosity of dental coverage and heterogeneity in effects by dentist supply. RESEARCH DESIGN: We used data from 2012, 2014, and 2016 Behavioral Risk Factor Surveillance System surveys. The main analytical sample included nearly 117,000 individuals <138% federal poverty level. We employed a quasi-experimental difference-in-differences design to identify the impact of the state Medicaid expansions on having a dental visit in the past 12 months by the generosity of dental coverage and dentist supply. RESULTS: Medicaid expansions were associated with a nearly 6 percentage-point increase in the likelihood of any dental visits in 2016 (over 10% increase from preexpansion rate) for individuals in Medicaid expanding states with extensive dental benefits. This increase, however, was concentrated in states with high dentist supply with no evidence of improvement in utilization in states with limited dental coverage or low dentist supply. CONCLUSIONS: Expanding Medicaid with generous dental coverage improved dental care use only in areas with high dentist supply with no evidence of benefits with low dentist supply or less generous coverage. Improving access to dental care may require both generous coverage and supply-side interventions to increase dentist availability.


Assuntos
Assistência Odontológica/estatística & dados numéricos , Odontólogos/provisão & distribução , Cobertura do Seguro/estatística & dados numéricos , Seguro Odontológico/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Medicaid/legislação & jurisprudência , Patient Protection and Affordable Care Act , Pobreza/estatística & dados numéricos , Estados Unidos
7.
Sleep Health ; 5(6): 621-629, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31377249

RESUMO

OBJECTIVES: Investigate sexual identity differences in sleep duration and the multiplicative effect of sexual identity and race/ethnicity among US adults. DESIGN: Cross-sectional. PARTICIPANTS: The sample consisted of 267,906 participants from the Behavioral Risk Factor Surveillance System. MEASUREMENTS: Sleep duration was categorized as very short (≤4 hours), short (5-6 hours), adequate (7-8 hours), or long (≥9 hours). Sex-stratified multinomial logistic regressions were used to examine sexual identity differences in sleep duration. We then examined sleep duration by comparing sexual minorities to (1) same-race/-ethnicity heterosexuals and (2) White participants with the same sexual identity. RESULTS: Sexual minority women had higher odds of very short sleep compared to heterosexual women, regardless of race/ethnicity. Black gay men had higher rates of very short sleep but lower rates of long sleep relative to Black heterosexual men. Latino and Asian/Pacific Islander bisexual men reported higher rates of short sleep than their heterosexual counterparts. Black lesbian and other-race bisexual women were more likely to have very short sleep than their heterosexual peers. Black lesbian women also had higher rates of long sleep. Analyses examining racial/ethnic differences by sexual identity found that Black and Latino gay men reported higher rates of very short sleep compared to White gay men. Black bisexual women had higher rates of short sleep duration than White bisexual women. CONCLUSIONS: More research is needed to understand how to promote sleep health among sexual minorities, particularly racial/ethnic minorities, and the impact of inadequate sleep duration on health outcomes in this population.


Assuntos
Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Sono , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Estados Unidos , Adulto Jovem
8.
Am J Public Health ; 109(9): 1233-1235, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31318586

RESUMO

Objectives. To evaluate the effect of the Affordable Care Act (ACA) on US veterans' access to care.Methods. We used US Behavioral Risk Factor Surveillance System data to compare measures of veterans' coverage and access to care, including primary care, for 3-year periods before (2011-2013) and after (2015-2017) ACA coverage provisions went into effect. We used difference-in-differences analyses to compare changes in Medicaid expansion states with those in nonexpansion states.Results. Coverage increased and fewer delays in care were reported in both expansion and nonexpansion states after 2014, with larger effects among low socioeconomic status (SES) and poor health subgroups. Coverage increases were significantly larger in expansion states than in nonexpansion states. Reports of cost-related delays, no usual source of care, and no checkup within 12 months generally improved in expansion states relative to nonexpansion states, but improvements were small; changes were mixed among veterans with low SES or poor health.Conclusions. Increases in insurance coverage among nonelderly veterans after ACA coverage expansions did not consistently translate into improved access to care. Additional study is needed to understand persisting challenges in veterans' access to care.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Patient Protection and Affordable Care Act/estatística & dados numéricos , Veteranos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
9.
MMWR Morb Mortal Wkly Rep ; 68(28): 621-626, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31318853

RESUMO

From 1965 to 2017, the prevalence of cigarette smoking among U.S. adults aged ≥18 years decreased from 42.4% to 14.0%, in part because of increases in smoking cessation (1,2). Increasing smoking cessation can reduce smoking-related disease, death, and health care expenditures (3). Increases in cessation are driven in large part by increases in quit attempts (4). Healthy People 2020 objective 4.1 calls for increasing the proportion of U.S. adult cigarette smokers who made a past-year quit attempt to ≥80% (5). To assess state-specific trends in the prevalence of past-year quit attempts among adult cigarette smokers, CDC analyzed data from the 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys for all 50 states, the District of Columbia (DC), Guam, and Puerto Rico. During 2011-2017, quit attempt prevalence increased in four states (Kansas, Louisiana, Virginia, and West Virginia), declined in two states (New York and Tennessee), and did not significantly change in the remaining 44 states, DC, and two territories. In 2017, the prevalence of past-year quit attempts ranged from 58.6% in Wisconsin to 72.3% in Guam, with a median of 65.4%. In 2017, older smokers were less likely than younger smokers to make a quit attempt in most states. Implementation of comprehensive state tobacco control programs and evidence-based tobacco control interventions, including barrier-free access to cessation treatments, can increase the number of smokers who make quit attempts and succeed in quitting (2,3).


Assuntos
Abandono do Hábito de Fumar/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/psicologia , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fumar/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
10.
BMC Public Health ; 19(1): 875, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272444

RESUMO

BACKGROUND: Hearing loss is among the leading causes of disability in persons 65 years and older worldwide and is known to have an impact on quality of life as well as social, cognitive, and physical functioning. Our objective was to assess statewide prevalence of self-reported hearing ability in Arizona adults and its association with general health, cognitive decline, diabetes and poor psychosocial health. METHODS: A self-report question on hearing was added to the 2015 Behavioral Risk Factor Surveillance System (BRFSS), a telephone-based survey among community-dwelling adults aged > 18 years (n = 6462). Logistic and linear regression were used to estimate the associations between self-reported hearing loss and health outcomes. RESULTS: Approximately 1 in 4 adults reported trouble hearing (23.2, 95% confidence interval: 21.8, 24.5%), with responses ranging from "a little trouble hearing" to being "deaf." Adults reporting any trouble hearing were at nearly four times higher odds of reporting increased confusion and memory loss (OR 3.92, 95% CI: 2.94, 5.24) and decreased odds of reporting good general health (OR = 0.50, 95% CI: 0.40, 0.64) as compared to participants reporting no hearing difficulty. Those reporting any trouble hearing also reported an average 2.5 more days of poor psychosocial health per month (ß = 2.52, 95% CI: 1.64, 3.41). After adjusting for sex, age, questionnaire language, race/ethnicity, and income category the association between diabetes and hearing loss was no longer significant. CONCLUSIONS: Self-reported hearing difficulty was associated with report of increased confusion and memory loss and poorer general and psychosocial health among Arizona adults. These findings support the feasibility and utility of assessing self-reported hearing ability on the BRFSS. Results highlight the need for greater inclusion of the full range of hearing disability in the planning process for public health surveillance, programs, and services at state and local levels.


Assuntos
Perda Auditiva/epidemiologia , Perda Auditiva/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arizona/epidemiologia , Sistema de Vigilância de Fator de Risco Comportamental , Cognição , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Nível de Saúde , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Prevalência , Autorrelato , Adulto Jovem
11.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde, LIS-bvsms | ID: lis-LISBR1.1-46630

RESUMO

O Vigitel compõe o sistema de Vigilância de Fatores de Risco para doenças crônicas não transmissíveis (DCNT) do Ministério da Saúde, juntamente com outros inquéritos, como os domiciliares e os voltados para a população escolar.


Assuntos
Sistema de Vigilância de Fator de Risco Comportamental , Vigilância em Saúde Pública
12.
Qual Life Res ; 28(10): 2799-2811, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31183603

RESUMO

PURPOSE: To investigate whether emotional and physical reactions to perceived discrimination are associated with health-related quality of life (HRQOL) among whites and Latinos (by language preference) in Arizona. METHODS: A cross-sectional analysis using the Arizona Behavioral Risk Factor Surveillance System (2012-2014) was restricted to non-Hispanic white and Latino (grouped by English- or Spanish-language preference) participants who completed the Reactions to Race optional module (N = 14,623). Four core items from the Centers for Disease Control and Prevention's Healthy Days Measures were included: self-rated health; physically unhealthy, mentally unhealthy; and functionally limited days. Poisson regression models estimated prevalence ratios and 95% confidence intervals (CIs) for poor self-rated health. Multinomial logistic models estimated odds ratios and 95% CI for poor mental, physical, and functionally limited days (defined as 14 + more days). Models were adjusted for sociodemographics, health behaviors, and multimorbidity. RESULTS: Reports of emotional and physical reactions to perceived discrimination were highest among Spanish-language preference Latinos. Both Spanish- and English-language preference Latinos were more likely to report poor self-rated health in comparison to whites. In separate fully adjusted models, physical reactions were positively associated with each HRQOL measure. Emotional reactions were only associated with reporting 14 + mental unhealthy (aOR 3.16; 95% CI 1.82; 5.48) and functionally limited days (aOR 1.93; 95% CI 1.04, 3.58). CONCLUSIONS: Findings from this study suggest that physical and emotional reactions to perceived discrimination can manifest as diminished HRQOL. Consistent collection of population-based measures of perceived discrimination is warranted to track and monitor differential health vulnerability that affect Latinos.


Assuntos
Sistema de Vigilância de Fator de Risco Comportamental , Grupo com Ancestrais do Continente Europeu/psicologia , Hispano-Americanos/psicologia , Linguagem , Vigilância da População/métodos , Qualidade de Vida/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
13.
Disabil Health J ; 12(4): 594-601, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31231021

RESUMO

BACKGROUND: Existing research has documented adverse health outcomes among parents with disabilities relative to parents without disabilities, but little is known about whether parenthood adds unique stress and health consequences for people with disabilities. Less is known about whether the effects of parenthood differ between mothers and fathers with disabilities. OBJECTIVES: This paper examined health-related quality of life, obesity, and health behaviors between US parents and nonparents with and without disabilities. We also explored differences in health outcomes separately for men and women by one's parental and disability status. METHODS: An analytic sample of parents and nonparents aged 18-64, with and without disabilities, were derived from the 2016 Behavioral Risk Factor Surveillance System (9,117 parents and 33,961 nonparents with disabilities). Multivariate logistic regression analyses were applied, controlling for individuals' socio-demographic characteristics and their history of chronic conditions. RESULTS: Parents with disabilities, compared to parents without disabilities and nonparents with and without disabilities, were at higher risk of reporting frequent physical distress, obesity, smoking, and insufficient sleep. Among those with disabilities, fathers were more likely than nonfathers to report poor or fair health, frequent physical and mental distress, and obesity; these differences were not evident between mothers and nonmothers with disabilities. CONCLUSIONS: The findings suggest the urgent need for policies and programs to address the health-related needs of parents with disabilities, as well as the need for targeted programs to support fathers with disabilities.


Assuntos
Pessoas com Deficiência , Disparidades nos Níveis de Saúde , Pais , Qualidade de Vida , Adolescente , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Doença Crônica , Pessoas com Deficiência/psicologia , Pai/psicologia , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Modelos Logísticos , Masculino , Transtornos Mentais/etiologia , Pessoa de Meia-Idade , Mães/psicologia , Obesidade/etiologia , Pais/psicologia , Fatores Sexuais , Transtornos do Sono-Vigília/etiologia , Fumar , Estresse Psicológico/etiologia , Estados Unidos , Adulto Jovem
14.
MMWR Morb Mortal Wkly Rep ; 68(25): 561-567, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31246940

RESUMO

Since 2006, CDC has recommended universal screening for human immunodeficiency virus (HIV) infection at least once in health care settings and at least annual rescreening of persons at increased risk for infection (1,2), but data from national surveys and HIV surveillance demonstrate that these recommendations have not been fully implemented (3,4). The national Ending the HIV Epidemic initiative* is intended to reduce the number of new infections by 90% from 2020 to 2030. The initiative focuses first on 50 local jurisdictions (48 counties, the District of Columbia, and San Juan, Puerto Rico) where the majority of new diagnoses of HIV infection in 2016 and 2017 were concentrated and seven states with a disproportionate occurrence of HIV in rural areas relative to other states (i.e., states with at least 75 reported HIV diagnoses in rural areas that accounted for ≥10% of all diagnoses in the state).† This initial geographic focus will be followed by wider implementation of the initiative within the United States. An important goal of the initiative is the timely identification of all persons with HIV infection as soon as possible after infection (5). CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS)§ to assess the percentage of adults tested for HIV in the United States nationwide (38.9%), in the 50 local jurisdictions (46.9%), and in the seven states (35.5%). Testing percentages varied widely by jurisdiction but were suboptimal and generally low in jurisdictions with low rates of diagnosis of HIV infection. To achieve national goals and end the HIV epidemic in the United States, strategies must be tailored to meet local needs. Novel screening approaches might be needed to reach segments of the population that have never been tested for HIV.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Disparidades nos Níveis de Saúde , Programas de Rastreamento/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adolescente , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Epidemias/prevenção & controle , Humanos , Estados Unidos/epidemiologia
15.
MMWR Morb Mortal Wkly Rep ; 68(24): 533-538, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31220055

RESUMO

Cigarette smoking is the leading cause of chronic obstructive pulmonary disease (COPD) in the United States; however, an estimated one fourth of adults with COPD have never smoked (1). CDC analyzed state-specific Behavioral Risk Factor Surveillance System (BRFSS) data from 2017, which indicated that, overall among U.S. adults, 6.2% (age-adjusted) reported having been told by a health care professional that they had COPD. The age-adjusted prevalence of COPD was 15.2% among current cigarette smokers, 7.6% among former smokers, and 2.8% among adults who had never smoked. Higher prevalences of COPD were observed in southeastern and Appalachian states, regardless of smoking status of respondents. Whereas the strong positive correlation between state prevalence of COPD and state prevalence of current smoking was expected among current and former smokers, a similar relationship among adults who had never smoked suggests secondhand smoke exposure as a potential risk factor for COPD. Continued promotion of smoke-free environments might reduce COPD among both those who smoke and those who do not.


Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fumar/epidemiologia , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fumar/efeitos adversos , Estados Unidos/epidemiologia , Adulto Jovem
16.
BMC Public Health ; 19(1): 651, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138239

RESUMO

BACKGROUND: The HIV/AIDS epidemic continues to threaten the health and wellbeing of millions in the United States and worldwide. Syndemic theory suggests that HIV/AIDS can cooccur with other afflictions. As close to 20% of US adults live with a mental health condition, it is critical to understand the correlation between HIV risk behaviors and mental health needs, as well as protective factors such as social support in intervening the association between mental distress and HIV risk behaviors. Furthermore, as past research has shown mixed results concerning the function of social support on HIV risks by gender, it is important to conduct a gender-specific analysis. METHODS: To assess the relationship between mental health needs, social support, and HIV risk behaviors, and to assess if social support can be a buffer, weakening the effect of mental health needs on HIV risk, in 2018, we analyzed representative, cross-sectional data from 2016 BRFSS collected from 33,705 individuals from four states in the United States, stratified by gender. Weighted logistic regression analyses, adjusted for age, race, marital status, education, and annual income, assessed the correlation between mental health needs, social support, and HIV risk behaviors. Furthermore, interaction analyses were performed to see if social support modifies the slope of mental health needs as a function of HIV risk behaviors. RESULTS: For both genders, the odds of participating in HIV risk behaviors increase with mental health needs and decrease with the level of social support. Furthermore, social support mitigates the association between mental health needs and HIV risk behavior involvement for males, as males receiving high level of social support have least odds of HIV risk behaviors relative to males receiving low level of social support. Notably, for females, social support does not serve as a buffer against HIV risk behaviors when their mental health needs increase. CONCLUSION: The study contributes to the knowledge base of HIV prevention and highlights the important role of mental health and social support against HIV risk behaviors when developing gender-specific prevention strategies.


Assuntos
Infecções por HIV/psicologia , Necessidades e Demandas de Serviços de Saúde , Transtornos Mentais/psicologia , Assunção de Riscos , Apoio Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sistema de Vigilância de Fator de Risco Comportamental , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Fatores Sexuais , Estados Unidos , Adulto Jovem
17.
Cancer Control ; 26(1): 1073274819845874, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31067985

RESUMO

BACKGROUND: Prior data suggests that breast cancer screening rates are lower among women in the Appalachian region of the United States. This study examined the changes in breast cancer screening before and after the implementation of the Affordable Care Act Medicaid expansion, in Appalachia and non-Appalachia states. METHODS: Data from the Behavioral Risk Factor Surveillance System between 2003 and 2015 were analyzed to evaluate changes in breast cancer screening in the past 2 years among US women aged 50-74 years. Multivariable adjusted logistic regression and generalized estimating equation models were utilized, adjusting for sociodemographic, socioeconomic, and health-care characteristics. Data were analyzed for 2 periods: 2003 to 2009 (pre-expansion) and 2011 to 2015 (post-expansion) comparing Appalachia and non-Appalachia states. RESULTS: The prevalence for of self-reported breast cancer screening in Appalachia and non-Appalachia states were 83% and 82% ( P < .001), respectively. In Appalachian states, breast cancer screening was marginally higher in non-expanded versus expanded states in both the pre-expansion (relative risk [RR]: 1.002, 95% confidence interval [CI]: 1.002-1.003) and post-expansion period (RR: 1.001, 95% CI: 1.001-1.002). In non-Appalachian states, screening was lower in non-expanded states versus expanded states in both the pre-expansion (RR: 0.98, 95% CI: 0.97-0.98) and post-expansion period (RR: 0.95, 95% CI: 0.95-0.96). There were modest 3% to 4% declines in breast cancer screening rates in the pos-texpansion period regardless of expansion and Appalachia status. CONCLUSIONS: Breast cancer screening rates were higher in Appalachia versus non-Appalachia US states and higher in expanded versus nonexpanded non-Appalachia states. There were modest declines in breast cancer screening rates in the post-expansion period regardless of expansion and Appalachia status, suggesting that more work may be needed to reduce administrative, logistical, and structural barriers to breast cancer screening services.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Patient Protection and Affordable Care Act/estatística & dados numéricos , Idoso , Região dos Apalaches , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Fatores de Risco , Classe Social , Estados Unidos
18.
Public Health Rep ; 134(4): 404-416, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31095441

RESUMO

OBJECTIVES: Cardiovascular disease (CVD) is the leading cause of mortality in the United States. The risk for developing CVD is usually calculated and communicated to patients as a percentage. The calculation of heart age-defined as the predicted age of a person's vascular system based on the person's CVD risk factor profile-is an alternative method for expressing CVD risk. We estimated heart age among adults aged 30-74 in New York City and examined disparities in excess heart age by race/ethnicity and sex. METHODS: We applied data from the 2011, 2013, and 2015 New York State Behavioral Risk Factor Surveillance System to the non-laboratory-based Framingham risk score functions to calculate 10-year CVD risk and heart age by sex, race/ethnicity, and selected sociodemographic groups and risk factors. RESULTS: Of 6117 men and women in the study sample, the average heart age was 5.7 years higher than the chronological age, and 2631 (43%) adults had a predicted heart age ≥5 years older than their chronological age. Mean excess heart age increased with age (from 0.7 year among adults aged 30-39 to 11.2 years among adults aged 60-74) and body mass index (from 1.1 year among adults with normal weight to 11.8 years among adults with obesity). Non-Latino white women had the lowest mean excess heart age (2.3 years), and non-Latino black men and women had the highest excess heart age (8.4 years). CONCLUSIONS: Racial/ethnic and sex disparities in CVD risk persist among adults in New York City. Use of heart age at the population level can support public awareness and inform targeted programs and interventions for population subgroups most at risk for CVD.


Assuntos
Afro-Americanos/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Hipertensão/epidemiologia , Obesidade/epidemiologia , Adulto , Fatores Etários , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos
19.
Artigo em Inglês | MEDLINE | ID: mdl-31126042

RESUMO

There is evidence that sexual minority populations have a potentially heightened risk of poor health outcomes due in part to the discrimination they may face. In the present study, we examined whether overweightness and obesity vary by sexual minority subgroup using a large, nationally representative sample. Data were drawn from 2014-2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys (n = 716,609). We grouped participants according to sexual identity (straight, lesbian or gay, bisexual, and other/don't know/not sure). The propensity score matching technique was used to address covariate imbalance among sexual identity groups. In addition, subgroup analyses were performed for both males and females. Compared to straight adults, lesbian females had significantly higher odds of being overweight (OR (odds ratio) 1.33; 95% CI (confidence interval) 1.17-1.53), whereas gay males had significantly lower odds (OR 0.66; 95% CI 0.59-0.73). Similarly, lesbians were more likely to be obese (OR 1.49; 95% CI 1.31-1.70), whereas gay men had significantly lower odds of obesity (OR 0.77; 95% CI 0.69-0.86) when compared to straight adults. Bisexual females had significantly higher odds of being overweight (OR 1.21; 95% CI 1.10-1.34) and obese (OR 1.43; 95% CI 1.29-1.59), whereas bisexual males showed no significant difference. Our results strengthen previous findings and further highlight the need for research by sexual minority subgroup.


Assuntos
Bissexualidade/estatística & dados numéricos , Homossexualidade Feminina/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
20.
BMC Public Health ; 19(1): 374, 2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30943942

RESUMO

BACKGROUND: Accounting for nearly one-third of all deaths, cardiovascular disease is the leading cause of mortality and morbidity in the United States. Adverse health behaviors are major determinants of this high incidence of disease. Examining local food and physical activity environments and population characteristics in a poor, rural state may highlight underlying drivers of these behaviors. We aimed to identify demographic and environmental factors associated with both obesity and overall poor cardiovascular health (CVH) behaviors in Maine counties. METHODS: Our cross-sectional study analyzed 40,398 Behavioral Risk Factor Surveillance System (BRFSS) 2011-2014 respondents alongside county-level United States Department of Agriculture (USDA) Food Environment Atlas 2010-2012 measures of the built environment (i.e., density of restaurants, convenience stores, grocery stores, and fitness facilities; food store access; and county income). Poor CVH score was defined as exhibiting greater than 5 out of the 7 risk factors defined by the American Heart Association (current smoking, physical inactivity, obesity, poor diet, hypertension, diabetes, and high cholesterol). Multivariable logistic regression models described the contributions of built environment variables to obesity and overall poor CVH score after adjustment for demographic controls. RESULTS: Both demographic and environmental factors were associated with obesity and overall poor CVH. After adjustment for demographics (age, sex, personal income, and education), environmental characteristics most strongly associated with obesity included low full-service restaurant density (OR 1.34; 95% CI 1.24-1.45), low county median household income (OR 1.31; 95% CI 1.21-1.42) and high convenience store density (OR 1.21; 95% CI 1.12-1.32). The strongest predictors of overall poor CVH behaviors were low county median household income (OR 1.30; 95% CI 1.13-1.51), low full-service restaurant density (OR 1.38; 95% CI 1.19-1.59), and low fitness facility density (OR 1.27; 95% CI 1.11-1.46). CONCLUSIONS: In a rural state, both demographic and environmental factors predict overall poor CVH. These findings may help inform communities and policymakers of the impact of both social determinants of health and local environments on health outcomes.


Assuntos
Doenças Cardiovasculares/etiologia , Dieta , Meio Ambiente , Exercício , Comportamentos Relacionados com a Saúde , Obesidade/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sistema de Vigilância de Fator de Risco Comportamental , Doenças Cardiovasculares/epidemiologia , Comércio , Estudos Transversais , Fast Foods , Feminino , Humanos , Renda , Maine , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População Rural , Estados Unidos , Adulto Jovem
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