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1.
MMWR Morb Mortal Wkly Rep ; 70(5): 149-154, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33539330

RESUMO

Sexual minority persons experience health disparities associated with sexual stigma and discrimination and have a high prevalence of several health conditions that have been associated with severe coronavirus disease 2019 (COVID-19) (1,2). Current COVID-19 surveillance systems do not capture information about sexual orientation. To begin bridging the gap in knowledge about COVID-19 risk among sexual minority adults, CDC examined disparities between sexual minority and heterosexual adults in the prevalence of underlying conditions with strong or mixed evidence of associations with severe COVID-19-related illness (3), by using data from the 2017-2019 Behavioral Risk Factor Surveillance System (BRFSS).* When age, sex, and survey year are adjusted, sexual minority persons have higher prevalences than do heterosexual persons of self-reported cancer, kidney disease, chronic obstructive pulmonary disease (COPD), heart disease (including myocardial infarction, angina, or coronary heart disease), obesity, smoking, diabetes, asthma, hypertension, and stroke. Sexual minority adults who are members of racial/ethnic minority groups disproportionately affected by the pandemic also have higher prevalences of several of these health conditions than do racial/ethnic minority adults who are heterosexual. Collecting data on sexual orientation in COVID-19 surveillance and other studies would improve knowledge about disparities in infection and adverse outcomes by sexual orientation, thereby informing more equitable responses to the pandemic.


Assuntos
/etnologia , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Comorbidade , Feminino , Humanos , Masculino , Fatores de Risco , Estados Unidos/epidemiologia
2.
MMWR Morb Mortal Wkly Rep ; 70(3): 69-74, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33476311

RESUMO

According to the 2020-2025 Dietary Guidelines for Americans, persons should consume fruits and vegetables as part of a healthy eating pattern to reduce their risk for diet-related chronic diseases, such as cardiovascular disease, type 2 diabetes, some cancers, and obesity.* A healthy diet is important for healthy growth in adolescence, especially because adolescent health behaviors might continue into adulthood (1). The U.S. Department of Agriculture (USDA) recommends minimum daily intake of 1.5 cups of fruit and 2.5 cups of vegetables for females aged 14-18 years and 2 cups of fruit and 3 cups of vegetables for males aged 14-18 years.† Despite the benefits of fruit and vegetable consumption, few adolescents consume these recommended amounts (2-4). In 2013, only 8.5% of high school students met the recommendation for fruit consumption, and only 2.1% met the recommendation for vegetable consumption (2). To update the 2013 data, CDC analyzed data from the 2017 national and state Youth Risk Behavior Surveys (YRBSs) to describe the percentage of students who met intake recommendations, overall and by sex, school grade, and race/ethnicity. The median frequencies of fruit and vegetable consumption nationally were 0.9 and 1.1 times per day, respectively. Nationally, 7.1% of students met USDA intake recommendations for fruits (95% confidence interval [CI] = 4.0-10.3) and 2.0% for vegetables (upper 95% confidence limit = 7.9) using previously established scoring algorithms. State-specific estimates of the percentage of students meeting fruit intake recommendations ranged from 4.0% (Connecticut) to 9.3% (Louisiana), and the percentage meeting vegetable intake recommendations ranged from 0.6% (Kansas) to 3.7% (New Mexico). Additional efforts to expand the reach of existing school and community programs or to identify new effective strategies, such as social media approaches, might help address barriers and improve adolescent fruit and vegetable consumption.


Assuntos
Dieta/estatística & dados numéricos , Frutas , Recomendações Nutricionais , Verduras , Adolescente , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Masculino , Estados Unidos
3.
MMWR Morb Mortal Wkly Rep ; 69(42): 1512-1516, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33090980

RESUMO

Valley fever (coccidioidomycosis) is endemic in the southwestern United States and caused by inhalation of Coccidioides spp. fungal spores from soil or dust; 97% of U.S. Valley fever cases are reported from Arizona and California (1). In California, Valley fever incidence increased 213% from 2014 to 2018 (2). In 2016, the California Department of Public Health (CDPH) added three questions to the adult California Behavioral Risk Factor Surveillance System (BRFSS) survey to better understand whether Californians had heard of Valley fever, knew the environmental risk where they live, and knew who is at risk for severe disease. A total of 2,893 BRFSS respondents aged ≥18 years answered at least one Valley fever question. Using the weighted California population, 42.4% of respondents reported general awareness of Valley fever; awareness was lowest among adults aged 18-44 years (32.9%) and Hispanic persons (26.4%). In addition, despite higher percentages reporting awareness of Valley fever, only 25.0% of persons living in a high-incidence region and 3.0% of persons living in a moderate-incidence region were aware that they lived in areas where Coccidioides spp. exist. Among persons with one or more risk factors for severe disease, 50.8% reported having heard about Valley fever, but only 3.5% knew they were at increased risk for severe disease. The findings from this survey helped to inform a statewide Valley fever awareness campaign implemented during 2019-2020 and to guide outreach to persons living in high- and moderate-incidence regions in California and potentially other southwestern states or who are at risk for severe disease.


Assuntos
Coccidioidomicose , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , California/epidemiologia , Coccidioidomicose/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Medição de Risco , Adulto Jovem
6.
BMC Public Health ; 20(1): 1327, 2020 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-32907569

RESUMO

BACKGROUND: Adversity experienced during childhood manifests deleteriously across the lifespan. This study provides updated frequency estimates of ACEs using the most comprehensive and geographically diverse sample to date. METHODS: ACEs data were collected via BRFSS (Behavioral Risk Factor Surveillance System). Data from a total of 211,376 adults across 34 states were analyzed. The ACEs survey is comprised of 8 domains: physical/emotional/sexual abuse, household mental illness, household substance use, household domestic violence, incarcerated household member, and parental separation/divorce. Frequencies were calculated for each domain and summed to derive mean ACE scores. Findings were weighted and stratified by demographic variables. Group differences were assessed by post-estimation F-tests. RESULTS: Most individuals experienced at least one ACE (57.8%) with 21.5% experiencing 3+ ACEs. F-tests showed females had significantly higher ACEs than males (1.64 to 1.46). Multiracial individuals had a significantly higher ACEs (2.39) than all other races/ethnicities, while White individuals had significantly lower mean ACE scores (1.53) than Black (1.66) or Hispanic (1.63) individuals. The 25-to-34 age group had a significantly higher mean ACE score than any other group (1.98). Generally, those with higher income/educational attainment had lower mean ACE scores than those with lower income/educational attainment. Sexual minority individuals had higher ACEs than straight individuals, with significantly higher ACEs in bisexual individuals (3.01). CONCLUSION: Findings highlight that childhood adversity is common across sociodemographic, yet higher in certain categories. Identifying at-risk populations for higher ACEs is essential to improving the health outcomes and attainment across the lifespan.


Assuntos
Experiências Adversas da Infância/estatística & dados numéricos , Divórcio , Características da Família , Transtornos Mentais , Prisões , Transtornos Relacionados ao Uso de Substâncias , Violência , Adolescente , Adulto , Afro-Americanos , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Criança , Pré-Escolar , Grupos Étnicos , Feminino , Hispano-Americanos , Humanos , Masculino , Pessoa de Meia-Idade , Pais , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
7.
MMWR Morb Mortal Wkly Rep ; 69(36): 1244-1249, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32914769

RESUMO

Certain underlying medical conditions are associated with higher risks for severe morbidity and mortality from coronavirus disease 2019 (COVID-19) (1). Prevalence of these underlying conditions among workers differs by industry and occupation. Many essential workers, who hold jobs critical to the continued function of infrastructure operations (2), have high potential for exposure to SARS-CoV-2, the virus that causes COVID-19, because their jobs require close contact with patients, the general public, or coworkers. To assess the baseline prevalence of underlying conditions among workers in six essential occupations and seven essential industries, CDC analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) surveys, the most recent data available.* This report presents unadjusted prevalences and adjusted prevalence ratios (aPRs) for selected underlying conditions. Among workers in the home health aide occupation and the nursing home/rehabilitation industry, aPRs were significantly elevated for the largest number of conditions. Extra efforts to minimize exposure risk and prevent and treat underlying conditions are warranted to protect workers whose jobs increase their risk for exposure to SARS-CoV-2.


Assuntos
Doença Crônica/epidemiologia , Indústrias/estatística & dados numéricos , Ocupações/estatística & dados numéricos , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Prevalência , Medição de Risco , Estados Unidos/epidemiologia , Adulto Jovem
8.
MMWR Morb Mortal Wkly Rep ; 69(36): 1238-1243, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32914770

RESUMO

Frequent mental distress, defined as 14 or more self-reported mentally unhealthy days in the past 30 days,* is associated with adverse health behaviors, increased use of health services, mental disorders (e.g., diagnosis of major depressive disorder), chronic diseases, and functional limitations (1). Adults with disabilities more often report depression and anxiety (2), reduced health care access (3), and health-related risk behaviors (4) than do adults without disabilities. CDC analyzed 2018 Behavioral Risk Factor Surveillance System (BRFSS) data to compare the prevalence of frequent mental distress among adults with disabilities with that among adults without disabilities and to identify factors associated with mental distress among those with disabilities. Nationwide, an estimated 17.4 million adults with disabilities reported frequent mental distress; the prevalence of reported mental distress among those with disabilities (32.9%) was 4.6 times that of those without disabilities (7.2%). Among adults with disabilities, those with both cognitive and mobility disabilities most frequently reported mental distress (55.6%). Adults with disabilities who reported adverse health-related characteristics (e.g., cigarette smoking, physical inactivity, insufficient sleep, obesity, or depressive disorders) or an unmet health care need because of cost also reported experiencing more mental distress than did those with disabilities who did not have these characteristics. Adults living below the federal poverty level reported mental distress 70% more often than did adults in higher income households. Among states, age-adjusted prevalence of mental distress among adults with disabilities ranged from 25.2% (Alaska) to 42.9% (New Hampshire). Understanding the prevalence of mental distress among adults with disabilities could help health care providers, public health professionals, and policy makers target interventions and inform programs and policies to ensure receipt of mental health screening, care, and support services to reduce mental distress among adults with disabilities.


Assuntos
Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Angústia Psicológica , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
9.
Med Care ; 58(10): 861-866, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32732785

RESUMO

BACKGROUND: A key goal of the Patient Protection and Affordable Care Act (ACA) was to increase health insurance coverage for people with chronic disease. Little is known about progress toward this goal over the first 5 years of ACA implementation. OBJECTIVE: The objective of this study was to assess changes in coverage for nonelderly adults with and without chronic disease over the first 5 years of ACA implementation, and the effects of state-level Medicaid eligibility expansions on coverage for these populations. RESEARCH DESIGN: Multivariable and difference-in-differences regression models. PARTICIPANTS: A total of 2,007,271 adults aged 18-64 years in the nationally representative Behavioral Risk Factor Surveillance System 2011-2018 data. MEASURES: Self-reported insurance coverage. RESULTS: Over the first 5 years of ACA implementation, coverage increased among nonelderly adults with versus without chronic disease by 6.9 versus 5.4 percentage points, respectively (95% confidence interval: 6.1-7.6, P<0.001, and 4.4-6.3, P<0.001, respectively). State-level Medicaid eligibility expansions were associated with a coverage increase among people with chronic disease of 2.8 percentage points (95% confidence interval: 1.7-3.8, P<0.001). After ACA implementation diminished in 2017, coverage gains for people with chronic disease declined by 0.9 percentage points (P<0.001). CONCLUSIONS: Coverage significantly improved for people with chronic disease during the first 5 years of ACA implementation, with ACA Medicaid expansions increasing coverage further. After ACA implementation diminished in 2017, coverage gains decreased.


Assuntos
Doença Crônica , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Patient Protection and Affordable Care Act/estatística & dados numéricos , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Humanos , Medicaid , Pessoa de Meia-Idade , Autorrelato , Estados Unidos
10.
Cancer Causes Control ; 31(10): 951-964, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32833199

RESUMO

PURPOSE: Although few studies have examined screening uptake among sexual minorities (lesbian, gay, bisexual, queer), almost none have examined it in the specific context of rural populations. Therefore, our objective was to assess how cancer screening utilization varies by residence and sexual orientation. METHODS: Publicly available population-level data from the 2014 and 2016 Behavioral Risk Factor Surveillance System were utilized. Study outcomes included recommended recent receipt of breast, cervical, and colorectal cancer screening. Independent variables of interest were residence (rural/urban) and sexual orientation (heterosexual/gay or lesbian/bisexual). Weighted proportions and multivariable logistic regressions were used to assess the association between the independent variables and the outcomes, adjusting for demographic, socioeconomic, and healthcare utilization factors. RESULTS: Rates for all three cancer screenings were lowest in rural areas and among sexual minority populations (cervical: rural lesbians at 64.8% vs. urban heterosexual at 84.6%; breast: rural lesbians at 66.8% vs. urban heterosexual at 80.0%; colorectal for males: rural bisexuals at 52.4% vs. urban bisexuals at 81.3%; and colorectal for females: rural heterosexuals at 67.2% vs. rural lesbians at 74.4%). In the multivariate analyses for colorectal screening, compared to urban heterosexual males, both rural gay and rural heterosexual males were less likely to receive screening (aOR = 0.45; 95% = 0.24-0.73 and aOR = 0.79; 95% = 0.72-0.87, respectively) as were rural heterosexual females (aOR = 0.87; 95% = 0.80-0.94) compared to urban heterosexual females. For cervical screening, lesbians were less likely to receive screening (aOR = 0.62; 95% = 0.41-0.94) than heterosexuals, and there were no differences for breast screening. CONCLUSION: We found that rural sexual minorities may experience disparities in cancer screening utilization associated with the compounding barriers of rural residence and sexual minority status, after adjusting for demographic, socioeconomic, and healthcare utilization factors. Further work is needed to identify factors influencing these disparities and how they might be addressed.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , População Rural/estatística & dados numéricos , Comportamento Sexual , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
Cancer Causes Control ; 31(11): 1039-1048, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32862301

RESUMO

BACKGROUND: Out-of-pocket costs may significantly dampen patients' willingness to adopt preventive procedures. This is especially true for colonoscopies, which typically involved relatively high cost-sharing requirements prior to the Affordable Care Act (ACA) implementation in 2011. PURPOSE: We aim to examine the effects of income-related disparities in colonoscopy use in the years prior to and immediately after the implementation of the ACA. Further, we quantify the contributions of different factors in explaining the disparities in the use of colonoscopies among elderly population with health insurance coverage. METHODS: Five cycles (2008, 2010, 2012, 2014, and 2016) of Behavioral Risk Factor Surveillance System data were utilized. To examine income-related disparities in the use of CRC, individuals aged 65-75 were included, and the concentration index (CI) was calculated before and after the implementation of ACA. To identify and quantify the contribution of different factors, a decomposition analysis of CI was conducted. RESULTS: CIs decreased from 0.1935 in pre-ACA years to 0.1813 in the post-ACA years among the elderly, indicating that the disparities in the use of colonoscopy was relatively low and the disparities index declined after the implementation of ACA. Decomposition analyses showed that whereas decreases in disparities derived largely from income and educational level, higher level of income and educational attainment were major contributors to the observed disparities in colonoscopy use. CONCLUSIONS: Our findings indicate that the ACA's removal of financial barriers may have contributed toward the reduction in disparities of colonoscopy use. More direct interventions, e.g., improved knowledge, better access and lower indirect cost will be helpful in improving screening among low-income and low-educational attainment households.


Assuntos
Colonoscopia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Patient Protection and Affordable Care Act , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Colonoscopia/economia , Feminino , Gastos em Saúde , Humanos , Renda , Masculino , Programas de Rastreamento/economia , Pobreza , Estados Unidos
12.
BMC Public Health ; 20(1): 1226, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787830

RESUMO

BACKGROUND: Diabetes is a leading cause of death and disability in the United States, and its precursor, pre-diabetes, is estimated to occur in one-third of American adults. Understanding the geographic disparities in the distribution of these conditions and identifying high-prevalence areas is critical to guiding control and prevention programs. Therefore, the objective of this study was to investigate clusters of pre-diabetes and diabetes risk in Florida and identify significant predictors of the conditions. METHODS: Data from the 2013 Behavioral Risk Factor Surveillance System were obtained from the Florida Department of Health. Spatial scan statistics were used to identify and locate significant high-prevalence local clusters. The county prevalence proportions of pre-diabetes and diabetes and the identified significant clusters were displayed in maps. Logistic regression was used to identify significant predictors of the two conditions for individuals living within and outside high-prevalence clusters. RESULTS: The study included a total of 34,186 respondents. The overall prevalence of pre-diabetes and diabetes were 8.2 and 11.5%, respectively. Three significant (p < 0.05) local, high-prevalence spatial clusters were detected for pre-diabetes, while five were detected for diabetes. The counties within the high-prevalence clusters had prevalence ratios ranging from 1.29 to 1.85. There were differences in the predictors of the conditions based on whether respondents lived within or outside high-prevalence clusters. Predictors of both pre-diabetes and diabetes regardless of region or place of residence were obesity/overweight, hypertension, and hypercholesterolemia. Income and physical activity level were significant predictors of diabetes but not pre-diabetes. Arthritis, sex, and marital status were significant predictors of diabetes only among residents of high-prevalence clusters, while educational attainment and smoking were significant predictors of diabetes only among residents of non-cluster counties. CONCLUSIONS: Geographic disparities of pre-diabetes and diabetes exist in Florida. Information from this study is useful for guiding resource allocation and targeting of intervention programs focusing on identified modifiable predictors of pre-diabetes and diabetes so as to reduce health disparities and improve the health of all Floridians.


Assuntos
Diabetes Mellitus/epidemiologia , Disparidades nos Níveis de Saúde , Estado Pré-Diabético/epidemiologia , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Florida/epidemiologia , Geografia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
13.
Emerg Infect Dis ; 26(9)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32620181

RESUMO

We updated estimates of adults at risk for coronavirus disease complications on the basis of data for China by using recent US hospitalization data. This update to our previous publication substitutes obesity for cancer as an underlying condition and increases adults reporting any of the conditions from 45.4% to 56.0%.


Assuntos
Betacoronavirus , Doença Crônica/epidemiologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Fatores de Risco , Estados Unidos/epidemiologia
14.
Public Health Rep ; 135(4): 492-500, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32511939

RESUMO

OBJECTIVES: Evidence is needed for designing interventions to address health literacy-related issues among adults with prediabetes to reduce their risk of developing type 2 diabetes. This study assessed health literacy and behaviors among US adults with prediabetes and the mediating role of health literacy on health behaviors. METHODS: We used data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) (N = 54 344 adults). The BRFSS health literacy module included 3 questions on levels of difficulty in obtaining information, understanding health care providers, and comprehending written information. We defined low health literacy as a response of "somewhat difficult" or "very difficult" to at least 1 of these 3 questions. Respondents self-reported their prediabetes status. We included 3 health behavior indicators available in the BRFSS survey-current smoking, physical inactivity, and inadequate sleep, all measured as binary outcomes (yes/no). We used a path analysis to examine pathways among prediabetes, health literacy, and health behaviors. RESULTS: About 1 in 5 (19.0%) adults with prediabetes had low health literacy. The rates of physical inactivity (31.0% vs 24.6%, P < .001) and inadequate sleep (38.8% vs 33.5%, P < .001) among adults with prediabetes were significantly higher than among adults without prediabetes. The path analysis showed a significant direct effect of prediabetes and health literacy on health behaviors. The indirect effect of prediabetes through health literacy on health behaviors was also significant. CONCLUSION: BRFSS data from 2016 showed that rates of low health literacy and unhealthy behaviors were higher among adults with prediabetes than among adults without prediabetes. Interventions are needed to assist adults with prediabetes in comprehending, communicating about, and managing health issues to reduce the risk of type 2 diabetes.


Assuntos
Sistema de Vigilância de Fator de Risco Comportamental , Comportamentos Relacionados com a Saúde , Letramento em Saúde/estatística & dados numéricos , Letramento em Saúde/tendências , Estado Pré-Diabético/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Assunção de Riscos , Estados Unidos , Adulto Jovem
15.
Public Health Rep ; 135(4): 501-510, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32579861

RESUMO

OBJECTIVES: HIV testing identifies persons living with HIV and can lead to treatment, decreased risk behaviors, and reduced transmission. The objective of our study was to describe state-level trends in HIV testing in the general US adult population aged 18-64 years, for both ever tested for HIV and tested for HIV in the previous 12 months. METHODS: Using 2011-2017 Behavioral Risk Factor Surveillance System data, we estimated the percentage of the state population, plus the District of Columbia, aged 18-64 years ever tested for HIV and tested for HIV in the previous 12 months. The 50 states and the District of Columbia were grouped according to the estimated prevalence of HIV in 2011. We used orthogonal contrasts to calculate P values for linear trends. RESULTS: The percentage of the population ever tested for HIV increased significantly in 23 states during 2011-2017, whereas the percentage tested for HIV in the previous 12 months increased significantly in 8 states. In 2017, the mean percentage ever tested for HIV in states with a high prevalence of HIV was 8.6 percentage points higher than the mean percentage in states with a low prevalence of HIV (48.5% vs 39.9%); the mean increase in the percentage ever tested was highest (11.4%) in states with a low prevalence of HIV. CONCLUSION: Enhanced efforts by states to make HIV testing simple, accessible, and routine are needed to reduce the number of persons who are not aware of their infection.


Assuntos
Sistema de Vigilância de Fator de Risco Comportamental , Infecções por HIV/epidemiologia , Programas de Rastreamento/estatística & dados numéricos , Programas de Rastreamento/tendências , Adolescente , Adulto , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Estados Unidos/epidemiologia , Adulto Jovem
16.
BMC Public Health ; 20(1): 936, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32539708

RESUMO

BACKGROUND: The United States experienced severe mental health budget cuts in many states across the nation during the years of the largest recession since the Great Depression. Illinois had one of the hardest hit mental health budgets in the country. The massive mental health funding cuts in Illinois, combined with the state's budget impasse, left fewer facilities available to provide treatment and support to those in need. Many of Illinois's most vulnerable populations either had reduced access, or no access to care. Serious spillover effects were felt by emergency rooms, community hospitals, and the criminal justice system. Therefore, the purpose of this research is to examine disparities in Health Related Quality of Life for those with depression after the funding cuts in Illinois. METHODS: Data from the 2017 Behavior Risk Factor Surveillance System was analyzed by using multivariate logistic regression models of the Health Related Quality of Life measures for Illinoisans diagnosed with depressive disorders. RESULTS: According to the regression models in this study, disparities exist in HRQOL for Illinoisans with depressive disorders. In all of the HRQOL models, income was associated with a reduction in HRQOL. Additionally, disparities exist in HRQOL for certain age groups and those who are unemployed. Interestingly, the models did not show any racial disparities as anticipated. CONCLUSION: Without the basic policy-level deficiencies addressed, disparities in Health Related Quality of Life for Illinois's most vulnerable populations will continue to exist as will costly economic spillover effects.


Assuntos
Transtorno Depressivo/economia , Transtorno Depressivo/terapia , Acesso aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Saúde Mental/economia , Qualidade da Assistência à Saúde/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sistema de Vigilância de Fator de Risco Comportamental , Transtorno Depressivo/epidemiologia , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Illinois/epidemiologia , Masculino , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/estatística & dados numéricos , Qualidade de Vida , Adulto Jovem
17.
JAMA Netw Open ; 3(6): e206039, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32520358

RESUMO

Importance: In response to increasing public support for cannabis legalization, understanding associations of state and federal policy changes related to cannabis legalization with patterns of cannabis use is important. A challenge for public health monitoring and research is significant variation in data availability related to cannabis use behaviors and perceptions across and within states and over time, including the availability of prelegalization vs postlegalization data. Objective: To review data available on cannabis use and related behaviors over time in Massachusetts and the US. Design, Setting, and Participants: This case series examined state and national surveys on public health and related behaviors and outcomes to review availability of cannabis-related data for Massachusetts for 8 key indicators over time. Additionally, the Behavioral Risk Factor Surveillance System (BRFSS) and Youth Risk Behavior Surveillance System for all states were reviewed. The analysis was conducted between February 1, 2019, and March 18, 2020. Exposures: Surveys that enable state-level estimation of cannabis use and related behaviors. Main Outcomes and Measures: Eight key indicators related to cannabis use behaviors and perceptions: lifetime cannabis use, age of initiation, frequency of use, location of use, method of use, source of cannabis, perceptions of cannabis, and reason for use (ie, medical vs nonmedical). Results: There were 7 surveys that monitored cannabis use and related behaviors in Massachusetts for adolescents and adults. No surveys monitored all 8 indicators of interest, and availability over time was limited. In the most recent BRFSS, 24 states asked cannabis-related questions, meaning BRFSS data on cannabis use was lacking for more than half of the US adult population. In the Youth Risk Behavior Surveillance System, 36 states asked standard cannabis questions; most other states had at least 1 question related to cannabis use and frequency. Conclusions and Relevance: These findings of limitations of existing surveys, and particularly the lack of national questions in the BRFSS and Youth Risk Behavior Surveillance System, suggest that available data have substantial limitations for monitoring cannabis use. As cannabis policy changes continue, there is a need to remain focused on the availability of high-quality data sources that allow for critical public health research.


Assuntos
Comportamentos Relacionados com a Saúde/fisiologia , Fumar Maconha/legislação & jurisprudência , Saúde Pública/legislação & jurisprudência , Inquéritos e Questionários/estatística & dados numéricos , Adolescente , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Cannabis/efeitos adversos , Criança , Humanos , Fumar Maconha/epidemiologia , Massachusetts/epidemiologia , Percepção , Formulação de Políticas , Vigilância da População/métodos , Prevalência , Saúde Pública/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
18.
J Environ Public Health ; 2020: 9498124, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32405306

RESUMO

Objectives: To identify the distribution of asthma education programs that are currently active in Texas and examine whether there is a geographical disparity between asthma prevalence and locations of asthma education programs in the Public Health Regions (PHRs) of Texas. Methods: The data for adult asthma prevalence in PHRs was obtained from the Texas Department of State and Health Services (DSHS) 2015 Texas Behavioral Risk Factor Surveillance System (BRFSS) Public Use Data File. The Geographic Information System (GIS) program was used to show the distribution of asthma education programs and visually identify the isolated areas for asthma education programs on the maps. To examine the areas covered by the asthma education programs, we illustrated 50 miles and 70 miles of buffer zones from each program by proximity (multiple ring buffer) functions in GIS. Results: We identified that 27 asthma education programs are active in Texas as of July 2019. The analysis showed that PHRs 1, 2, and 7 had the highest rate of asthma prevalence but had fewer asthma education programs. Also, the distribution of asthma education programs is concentrated around major cities, leading to a regional imbalance between asthma prevalence and locations of asthma education programs. The central and western areas of Texas proved to be marginalized areas for asthma education programs, particularly PHRs 2 and 9 because they may not be covered by the buffer zones of 70 miles from any asthma education programs. Discussion. This study revealed the marginalized regions in Texas lacking asthma education programs. The findings could help policymakers and health care professionals enhance opportunities to develop asthma education programs using different venues in isolated areas and prioritize these regions, for funds, to establish new asthma education programs.


Assuntos
Asma/epidemiologia , Educação em Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Adulto , Asma/prevenção & controle , Sistema de Vigilância de Fator de Risco Comportamental , Sistemas de Informação Geográfica , Educação em Saúde/organização & administração , Humanos , Prevalência , Texas/epidemiologia
19.
J Womens Health (Larchmt) ; 29(7): 910-918, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32357078

RESUMO

Background: Limited surveillance of preconception care (PCC) impedes states' ability to monitor access and provision of quality PCC. In response, we describe PCC indicators and the evaluation process used to identify a set of PCC indicators for state use. Materials and Methods: The Surveillance and Research Workgroup and Clinical Workgroup of the National Preconception Health and Health Care Initiative used a systematic process to identify, evaluate, and prioritize PCC indicators from nationwide public health surveillance systems that Maternal and Child Health (MCH) programs can use for state-level surveillance using the Pregnancy Risk Assessment Monitoring System (PRAMS) and Behavioral Risk Factor Surveillance System (BRFSS). For each indicator, we assessed target population, prevalence, measurement simplicity, data availability, clinical utility, and whether it was related to the 10 prioritized preconception health indicators. We also assessed relevance to clinical recommendations, Healthy People (HP)2020 objectives, and the National Quality Forum measures. Lastly, we considered input from stakeholders and subject matter experts. Results: Eighty potential PCC indicators were initially identified. After conducting evaluations, obtaining stakeholder input, and consulting with subject matter experts, the list was narrowed to 30 PCC indicators for states to consider using in their MCH programs to inform the need for new strategies and monitor programmatic activities. PRAMS is the data source for 27 of the indicators, and BRFSS is the data source for three indicators. Conclusions: The identification and evaluation of population-based PCC indicators that are available at the state level increase opportunities for state MCH programs to document, monitor, and address PCC in their locales.


Assuntos
Vigilância da População/métodos , Cuidado Pré-Concepcional/normas , Vigilância em Saúde Pública , Medição de Risco/métodos , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Necessidades e Demandas de Serviços de Saúde , Nível de Saúde , Indicadores Básicos de Saúde , Humanos , Qualidade de Vida , Estados Unidos
20.
J Urol ; 204(3): 564-569, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32267200

RESUMO

PURPOSE: Implementation of survivorship care plans has been emphasized as a key component to improving care for cancer survivors. Our objective was to determine the prevalence of survivorship care plan receipt for survivors of genitourinary malignancy including kidney, prostate and bladder cancer, and evaluate whether receipt was associated with a measurable health benefit. MATERIALS AND METHODS: Data from the Behavioral Risk Factor Surveillance System Cancer Survivorship modules in 2012, 2014, 2016 and 2017 were analyzed. The proportion of patients with bladder, kidney or prostate cancer receiving a survivorship care plan was calculated. Complex samples multivariable logistic regressions were performed to determine the association of survivorship care plan receipt with sociodemographic variables, and assess the relationship between survivorship care plan receipt and self-reported health status (general, physical and mental). RESULTS: Survivorship care plan distribution increased from 27.5% in 2012 to 39.5% in 2017. Patients with low income, less formal education and extremes of age were less likely to receive a survivorship care plan. Those receiving a survivorship care plan were less likely to report poor physical health (OR 0.70, CI 0.52-0.96, p=0.026). Subanalysis showed a similar result for physical health of patients with prostate cancer (OR 0.68, CI 0.48-0.96, p=0.030) and general health of patients with kidney cancer (OR 0.37, CI 0.19-0.75, p=0.006). CONCLUSIONS: Distribution of survivorship care plans to genitourinary malignancy survivors has increased since 2012 in response to advocacy from national organizations. Nonetheless, utilization is low and there is heterogeneity in the populations likely to receive a survivorship care plan. There is a measurable association between survivorship care plans and improved health status but further study is needed to determine causality.


Assuntos
Sobreviventes de Câncer , Nível de Saúde , Planejamento de Assistência ao Paciente , Neoplasias Urogenitais/terapia , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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