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Biomedical subjects

Ali H Mokdad

Publications and source records attributed to Ali H Mokdad.

At least 19 recordsLinked to original sources
PubMed2007

Increasing trends in waist circumference and abdominal obesity among US adults.

OBJECTIVE: Some studies have shown that abdominal obesity may be a better predictor than overall obesity for disease risks and all-cause mortality. This study sought to examine the recent trends in waist circumference (WC) among adults in the United States. RESEARCH METHODS AND PROCEDURES: Data from the National Health and Nutrition Examination Survey during 1988-1994, 1999-2000, 2001-2002, and 2003-2004 were analyzed to estimate the trends in the mean WC and the prevalence of abdominal obesity. Pooled t tests were used to test the differences in estimates between two time periods. RESULTS: Between the periods of 1988-1994 and 2003-2004, the age-adjusted mean WC increased from 96.0 cm to 100.4 cm among men (p < 0.001) and from 89.0 cm to 94.0 cm among women (p < 0.001); the age-adjusted prevalence of abdominal obesity increased from 29.5% to 42.4% among men (p < 0.001) and from 47.0% to 61.3% among women (p < 0.001). Between the periods of 1999-2000 and 2003-2004, a significant increase occurred in mean WC only among men (from 99.0 cm to 100.4 cm; p = 0.03) and in the prevalence of abdominal obesity among both men (from 37.0% to 42.2%; p = 0.03) and women (from 55.3% to 61.3%; p = 0.04). People with a BMI of 25 to 29 kg/m2 had a greater relative increase in abdominal obesity. DISCUSSION: The mean WC and the prevalence of abdominal obesity among U.S. adults have increased continuously during the past 15 years. Over one-half of U.S. adults had abdominal obesity in the period of 2003-2004.

Abdominal Fat↗
PubMed2007

Association of metabolic syndrome and insulin resistance with congestive heart failure: findings from the Third National Health and Nutrition Examination Survey.

OBJECTIVE: Congestive heart failure (CHF) has been associated with insulin resistance, but few studies have examined its relationship with metabolic syndrome (MetS). Little is known about whether insulin resistance explains the association between MetS and CHF. DESIGN: Population-based, cross-sectional surveys. SETTING: Third National Health and Nutrition Examination Survey (NHANES III). PARTICIPANTS: Data from 5549 men and non-pregnant women aged > or =40 years in NHANES III were analysed. RESULTS: About 4% of men and 3% of women had CHF between 1988 and 1994 in the US. The age-adjusted prevalence of CHF was significantly higher in African Americans (4.1%), in Mexican Americans (8.5%) and in those of other ethnic origin (6.7%) than in white people (2.5%). People with MetS had nearly twice the likelihood of self-reported CHF (adjusted odds ratio 1.8; 95% confidence interval 1.1 to 3.0) after adjustment for demographic and conventional risk factors such as sex, ethnicity, age, smoking, total cholesterol, left ventricular hypertrophy, and probable or possible myocardial infarction determined by electrocardiography. However, this association was attenuated after further adjustment for insulin resistance as measured by the homoeostasis model assessment (HOMA). >90% of the association between MetS and CHF was explained by the HOMA. CONCLUSIONS: MetS was associated with about a twofold increased likelihood of self-reported CHF and it may serve as a surrogate indicator for the association between insulin resistance and CHF.

Adult↗
PubMed2006

Association between the metabolic syndrome and its components and gait speed among U.S. adults aged 50 years and older: a cross-sectional analysis.

BACKGROUND: To examine the relationship between the metabolic syndrome and its components and gait speed among older U.S. men and women. Whether these associations are independent of physical activity was also explored. METHODS: Eight hundred and thirty-five men and 850 women aged > or =50 years from the continuous National Health and Nutrition Examination Survey 1999-2002 were examined. We used the definition of the metabolic syndrome developed by the U.S. National Cholesterol Education Program Adult Treatment Panel III. Gait speed was measured with a 6.10-meter timed walk examination. RESULTS: The prevalence of the metabolic syndrome was 40.2% in men and 45.6% in women (P = .127). The prevalence of gait speed impairment was 29.3% in men and 12.5% in women (P < .001). No association was found between the metabolic syndrome and gait speed impairment. After including the individual components of the metabolic syndrome in a logistic model adjusted for age and leisure-time physical activity, abdominal obesity, low HDL cholesterol, and high fasting glucose were significantly associated with gait speed impairment among women (adjusted odds ratio [AOR] = 0.48, 95% confidence interval [CI] = 0.26 to 0.89; AOR = 2.26, 95% CI = 1.08 to 4.75; and AOR = 2.05, 95% CI = 1.12 to 3.74, respectively). Further adjustment for race/ethnicity, education, smoking status, alcohol consumption, arthritis status, and use of an assistive device attenuated these associations; among women, abdominal obesity and low HDL cholesterol remained significantly associated with gait speed impairment (AOR = 0.37, 95% CI = 0.18 to 0.76 and AOR = 2.45, 95% CI = 1.07 to 5.63, respectively) while the association between hyperglycemia and impaired gait speed attenuated to nonsignificance. CONCLUSION: Among women, gait speed impairment is associated with low HDL cholesterol and inversely with abdominal obesity. These associations may be sex-dependent and warrant further research.

Abdominal Fat↗
PubMed2006

Address-based versus random-digit-dial surveys: comparison of key health and risk indicators.

Use of random-digit dialing (RDD) for conducting health surveys is increasingly problematic because of declining participation rates and eroding frame coverage. Alternative survey modes and sampling frames may improve response rates and increase the validity of survey estimates. In a 2005 pilot study conducted in six states as part of the Behavioral Risk Factor Surveillance System, the authors administered a mail survey to selected household members sampled from addresses in a US Postal Service database. The authors compared estimates based on data from the completed mail surveys (n = 3,010) with those from the Behavioral Risk Factor Surveillance System telephone surveys (n = 18,780). The mail survey data appeared reasonably complete, and estimates based on data from the two survey modes were largely equivalent. Differences found, such as differences in the estimated prevalences of binge drinking (mail = 20.3%, telephone = 13.1%) or behaviors linked to human immunodeficiency virus transmission (mail = 7.1%, telephone = 4.2%), were consistent with previous research showing that, for questions about sensitive behaviors, self-administered surveys generally produce higher estimates than interviewer-administered surveys. The mail survey also provided access to cell-phone-only households and households without telephones, which cannot be reached by means of standard RDD surveys.

Adolescent↗
PubMed2006

Monitoring county-level vaccination coverage during the 2004-2005 influenza season.

BACKGROUND: During the 2004-2005 influenza season, the United States faced a sudden shortage of influenza vaccine. In response, the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommended prioritizing vaccination for persons aged 65 and older and others at high risk. To monitor subsequent vaccination coverage, several questions about influenza vaccination were added to the ongoing Behavioral Risk Factor Surveillance System (BRFSS). This study provided real-time county-level estimates of influenza vaccination coverage from the BRFSS each month from October 2004 through January 2005. METHOD: The methods used a variation of small area estimation procedures suitable for situations in which most small areas have few or no survey respondents, and rapid assessment is essential. Both model-based methods and nonparametric spatial-smoothing methods were used in a three-step procedure. RESULTS: The highest vaccination rates during the 2004-2005 influenza season were seen in the upper Midwest and the Southeast. Areas with the lowest vaccination rates were the intermountain West, southern California, portions of Washington and Oregon, and various areas across the Eastern United States, often coinciding with urban areas. Intrastate variations were especially pronounced in the Eastern United States, particularly in Georgia, Florida, Tennessee, Kentucky, North Carolina, Virginia, and New York. These states all had areas with low immunization rates as well as areas with high rates. CONCLUSIONS: The results showed that vaccination coverage varied significantly across states and substate regions. Our findings show that this methodology can provide estimates with reasonable reliability for planning during public health emergencies.

Adult↗
PubMed2006

Surveillance for certain health behaviors among states and selected local areas--behavioral risk factor surveillance system, United States, 2004.

PROBLEM: Continuous monitoring of behaviors that increase the risk for chronic diseases and use of preventive practices are essential for the development, implementation, and evaluation of health promotion programs and policies, and other intervention strategies to prevent morbidity and mortality. Data from states/territories, selected metropolitan and micropolitan statistical areas (MMSAs), and counties provide the impetus for policymakers and other stakeholders to develop and promote the improvement of their community's overall health status. REPORTING PERIOD COVERED: Data in this report were collected during January 1-December 31, 2004, from states/territories, MMSAs, and counties that participated in the 2004 Behavioral Risk Factor Surveillance System (BRFSS). DESCRIPTION OF THE SYSTEM: BRFSS is an ongoing, state-based, random-digit--dialed telephone survey that employs a multistage cluster design. BRFSS collects information on health risk behaviors and preventive health practices related to the leading causes of death from the U.S. civilian, noninstitutionalized population aged > or =18 years. During 2004, a total of 49 states, the District of Columbia (DC), Puerto Rico, and the U.S. Virgin Islands participated in BRFSS. Among these states and territories, completed surveys were collected from a selection of 134 MMSAs and 199 counties. RESULTS: Prevalence of high-risk behaviors for chronic diseases, awareness of specific medical conditions, screening for certain cancers, and use of preventive health services varied substantially by state/territory, MMSA, and county. The proportion of the population that achieved Healthy People 2010 (HP 2010) objectives also varied by state/territory, MMSA, and county. In 2004, HP 2010 objectives for 100% health-care coverage and vaccination for pneumonia and influenza among persons aged > or =65 years were not achieved by any state/territory, MMSA, or county. Twelve states/territories, 47 MMSAs, and 74 counties achieved the HP 2010 objective of < or =20% of adults engaged in no leisure-time physical activity or exercise. The HP 2010 objective to reduce the proportion of adults who currently smoke cigarettes to < or =12% was achieved by two states/territories, four MMSAs, and six counties. One MMSA and one county achieved the HP 2010 target of < or =6% who engage in binge drinking during the month preceding the survey. The HP 2010 target of < or =15% of adults who are obese was obtained by one MMSA and eight counties. The HP 2010 objective to reduce the proportion to <20% for older adults who have had all of their natural teeth extracted was achieved by 23 states/territories, 51 MMSAs, and 45 counties. The HP 2010 target for adults aged > or =50 years who have ever received a sigmoidoscopy is 50%. BRFSS measured both sigmoidoscopy and colonoscopy. Using this measure, 38 states, 110 MMSAs, and 154 counties achieved the 50% goal. Four counties achieved the HP 2010 objective of 50% for adults who received a blood stool test within the previous 2 years. The HP 2010 objective to increase the proportion of women aged > or =18 years who had a Papanicolaou (Pap) test within the preceding 3 years is 90%. Twenty-four MMSAs and 49 counties achieved this objective. The HP 2010 objective for women aged > or =40 years who have received a mammogram within the preceding 2 years is 70%. Thirty-nine states, 112 MMSAs, and 168 counties achieved the objective. This report includes several risk behaviors and conditions that, although not included in HP 2010 goals, are important public health problems. These include self-reported fair-to-poor health status, heavy alcohol consumption, asthma, diabetes, and prostate cancer screening. The 2004 BRFSS data indicate great variability in the prevalence of self-reported fair-to-poor health status (5.7%-34.8%) and use of prostate cancer screening (34.7%-65.2%) by states/territories, MMSAs, and counties. Among these areas, the prevalence of current asthma ranged from 4.1% to 12.4%, and the prevalence of diabetes ranged from 3.2% to 12.5%. INTERPRETATION: The findings in this report indicate variations in health risk behaviors and use of preventive health screenings and health services among adults at the state, local, and county levels. These variations substantiate the continued need for public health surveillance in designing, implementing, monitoring, and evaluating public health policies and health-care use programs to reduce morbidity and mortality from the effect of high-risk health behaviors and subsequent chronic disease outcomes. PUBLIC HEALTH ACTION: Data from BRFSS are essential for monitoring prevalence of high-risk health behaviors, specific diseases, and use of preventive health services; dictating the design, focus, implementation, and evaluation of prevention health programs and strategies; and monitoring progress toward obtaining local, state, and national health objectives. Data from the 2004 BRFSS indicate a continual necessity to initiate and implement health promotion strategies for identifying specific health risk behaviors and practices and for assessing progress toward achieving disease prevention and health promotion objectives at state and local levels throughout the United States.

Behavioral Risk Factor Surveillance System↗
PubMed2006

Chronic disease in health emergencies: in the eye of the hurricane.

INTRODUCTION: Inadequately controlled chronic diseases may present a threat to life and well-being during the emergency response to natural disasters. An estimate of the possible numbers of people who may require treatment for chronic diseases should help in planning a response, but such information for local areas is not easily accessible. We explored how a current surveillance system could be used to provide estimates of the potential needs for emergency treatment of chronic diseases in the wake of a natural disaster. METHODS: We used data from adults aged 18 years or older who participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 2004 to estimate the prevalence and numbers of people with diabetes, heart disease, stroke, hypertension, and current asthma who lived in the New Orleans-Metairie-Kenner, La, metropolitan statistical area. RESULTS: About 9.0% of participants had diabetes, 4.6% had angina or coronary heart disease, 3.0% had had a myocardial infarction, 2.0% had had a stroke, and 6.3% had current asthma. About 25.4% adults had at least one of the above conditions. CONCLUSION: A surveillance system such as the BRFSS can provide potentially useful baseline information about the numbers of people with chronic diseases and the treatment that they receive; this information can assist the medical and public health community in assessing the needs of people with chronic diseases after disasters and in planning relief efforts.

Adolescent↗
PubMed2006

Emotional and behavioral difficulties and impairments in everyday functioning among children with a history of attention-deficit/hyperactivity disorder.

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) affects 3% to 7% of school-aged children and has been associated with a variety of comorbid mental illnesses and functional impairments, largely in clinical samples. However, little is known about the spectrum of emotional and behavioral problems and areas of impairment among children with a history of ADHD in nonclinical, nationally representative samples. METHODS: Data were analyzed from the 2003 National Health Interview Survey, an ongoing, computer-assisted, random-sample, personal-interview survey of the noninstitutionalized U.S. population. We examined the associations between history of parent-reported ADHD diagnosis and levels of parent-reported emotional and behavioral difficulties and related impairments among a nationally representative sample of U.S. children aged 4 to 17 years (n = 8681). The extended version of the Strengths and Difficulties Questionnaire was used to measure and score levels of difficulty and impairment. RESULTS: Approximately 5.9% of children had a history of ADHD diagnosis. Children with a history of ADHD were 6 times as likely as those without ADHD to have a high level of overall difficulties including emotional, conduct, and peer problems and were 9 times as likely to manifest a high level of impairment including interference with home life, friendships, classroom learning, and leisure activities. CONCLUSION: This study documents the significant level of current emotional and behavioral difficulties and impairments in everyday functioning experienced by children with a history of ADHD diagnosis, suggesting that people involved with the care of children--parents, health care providers, and teachers--need to be informed about the signs, symptoms, and appropriate treatment of ADHD and other comorbid disorders.

Adolescent↗
PubMed2006

Health care access among U.S. adults who drink alcohol excessively: missed opportunities for prevention.

INTRODUCTION: Excessive alcohol consumption kills approximately 75,000 people annually in the United States. Although alcohol screening among primary care patients is recommended by the U.S. Preventive Services Task Force, it is rarely performed. It is unclear whether low screening rates are due to limited access to health care, missed screening opportunities during patient visits, or both. METHODS: Data came from the 2002 Behavioral Risk Factor Surveillance System, a population-based telephone survey of noninstitutionalized U.S. adults. Current health insurance status and a history of a recent medical checkup (within 2 years) were assessed in relation to alcohol consumption status. Excessive drinkers included those who reported binge drinking (consuming five or more drinks on one or more occasions in the past month), heavy drinking (consuming more than 60 drinks in the past month for men or more than 30 for women), or both. RESULTS: The prevalence of excessive drinking among the general population (17%) was only slightly higher than the prevalence among those with current health insurance (15%) or a recent checkup (14%). Among excessive drinkers, 79% had current health insurance and 78% had a recent checkup. Although excessive drinkers were somewhat less likely to have health insurance or a recent checkup compared with nonexcessive drinkers and nondrinkers, these differences were less pronounced after stratifying by age. Excessive drinkers with the lowest rates of health insurance were young, Hispanic, less educated, and unemployed. However, most excessive drinkers who lacked insurance or a checkup were employed. CONCLUSION: Most excessive drinkers were insured and had a recent medical checkup, suggesting that low screening rates among excessive drinkers are mostly due to missed screening opportunities rather than a lack of screening opportunities. Systems approaches to address these missed opportunities should be aggressively implemented.

Alcohol Drinking↗
PubMed2006

Aspirin use among U.S. adults: Behavioral Risk Factor Surveillance System.

BACKGROUND: The role of aspirin in prevention of cardiovascular disease (CVD) and cardiovascular complications among people with diabetes has been examined. A Healthy People 2010 objective calls for increasing the proportion of people with diabetes aged>or=40 years who take aspirin>or=15 times per month. METHODS: Data from 2003 Behavioral Risk Factor Surveillance System were used to examine (1) the prevalence of aspirin intake, (2) aspirin use among those with CVD, (3) aspirin use among those with diabetes, (4) current status with respect to Healthy People objective 5-16, and (5) changes in aspirin intake from 1999. RESULTS: Daily or every-other-day aspirin use was reported by 36.2% of participants in 2003. Aspirin intake among those with CVD and diabetes was 82.8% and 62.6%, respectively. The Healthy People 2010 objective of increasing the proportion of adults with diabetes aged>or=40 years who take aspirin to 30% was achieved. The prevalence of aspirin intake was higher in 2003 compared to 1999 among all participants, those with CVD, and those with diabetes (relative increase of about 20%, 12%, and 36%, respectively). Most participants (74%) reported cardiovascular reasons for aspirin use. Among those without CVD or diabetes, the prevalence of aspirin intake increased with the increasing number of CVD risk factors. CONCLUSIONS: Regular aspirin use increased over a 4-year period. Greater use of inexpensive and easily accessible interventions to prevent cardiovascular events is encouraging. Increased efforts to continue preventive uses of available treatment and reduction in risk by modifying other risk factors will help lower future disease burden.

Adult↗
PubMed2006

Distribution of serum concentrations of alpha-tocopherol and gamma-tocopherol in the US population.

BACKGROUND: Although the population distribution of serum concentrations of alpha-tocopherol has been described in the United States, little is known about the distribution of gamma-tocopherol or the ratio of alpha-tocopherol to gamma-tocopherol. OBJECTIVE: Our aim was to describe the distribution of serum concentrations of alpha-tocopherol and gamma-tocopherol in a nationally representative sample of US adults. DESIGN: We reviewed data from 4087 adults aged >/=20 y who participated in the National Health and Nutrition Examination Survey (1999-2000). Concentrations of alpha-tocopherol and gamma-tocopherol were measured by using HPLC with ultraviolet-visible wavelength detection. RESULTS: The arithmetic mean (+/-SEM) of serum concentrations of alpha-tocopherol was 30.09 +/- 0.45 micromol/L, the median was 25.94 micromol/L, and the geometric mean (+/-SEM) was 27.39 +/- 0.38 micromol/L. The arithmetic mean of serum concentrations of gamma-tocopherol was 5.74 +/- 0.22 micromol/L, the median was 5.25 micromol/L, and the geometric mean was 4.79 +/- 0.18 micromol/L. The median ratio of alpha-tocopherol to total cholesterol was 4.93 micromol/mmol, that of gamma-tocopherol to total cholesterol was 1.03 micromol/mmol, and that of alpha-tocopherol to gamma-tocopherol was 4.53 micromol/mmol. Concentrations of alpha-tocopherol increased significantly (P for trend < 0.001) with age and were significantly (P = 0.015) lower in men than in women. African Americans and Mexican Americans had significantly (P < 0.001) lower concentrations of alpha-tocopherol than did whites. The median concentrations of gamma-tocopherol showed a trend with respect to age, did not differ significantly between men and women, and were slightly but nonsignificantly lower in white participants than in African American or Mexican American participants. CONCLUSION: Sociodemographic variations in serum concentrations of alpha-tocopherol and gamma-tocopherol exist among US adults.

Adult↗
PubMed2006

Recent trends in waist circumference and waist-height ratio among US children and adolescents.

OBJECTIVES: Abdominal obesity may be a better predictor than overall obesity for the risk of cardiovascular disease and type 2 diabetes. Waist circumference and waist-height ratio are 2 simple, yet effective, surrogate measures of abdominal obesity. We sought to examine the recent trends in mean waist circumference and waist-height ratio and prevalence of abdominal obesity among children and adolescents aged 2 to 19 years in the United States. METHODS: Representative samples of the civilian, noninstitutionalized US population from the National Health and Nutrition Examination Survey conducted during 4 time periods, 1988-1994 (ie, National Health and Nutrition Examination Survey III), 1999-2000, 2001-2002, and 2003-2004, were examined to estimate the mean waist circumference and waist-height ratio of boys and girls in 4 different age groups. Data from the 3 most recent National Health and Nutrition Examination Surveys were combined to establish a National Health and Nutrition Examination Survey 1999-2004 category. RESULTS: Categorized by age group, the unadjusted mean waist circumference for boys increased between National Health and Nutrition Examination Survey III and National Health and Nutrition Examination Survey 1999-2004 from 50.7 cm (aged 2-5 years), 61.9 cm (aged 6-11 years), 76.8 cm (aged 12-17 years), and 81.3 cm (aged 18-19 years) to 51.9, 64.5, 79.8, and 86.6 cm, respectively. During the same time periods and within the same age groups, the unadjusted mean waist circumference for girls increased from 51.0, 61.7, 75.0, and 77.7 cm to 51.8, 64.7, 78.9, and 83.9 cm, respectively. The relative change in waist-height ratio was similar to waist circumference at each age group for both boys and girls. Using the 90th percentile values of waist circumference for gender and age, the prevalence of abdominal obesity increased by 65.4% (from 10.5% to 17.4%) and 69.4% (from 10.5% to 17.8%) for boys and girls, respectively. CONCLUSIONS: Mean waist circumference and waist-height ratio and the prevalence of abdominal obesity among US children and adolescents greatly increased between 1988-1994 and 1999-2004.

Adolescent↗
PubMed2006

Trends in hyperinsulinemia among nondiabetic adults in the U.S.

OBJECTIVE: Insulin resistance and compensatory hyperinsulinemia have been proposed as increasing risk for a variety of abnormalities and clinical syndromes, including type 2 diabetes and cardiovascular disease. Our aim was to assess the trends in the mean concentrations of fasting serum insulin and the prevalence of hyperinsulinemia among nondiabetic adults during the periods of 1988-1994 and 1999-2002 in the U.S. RESEARCH DESIGN AND METHODS: We conducted analyses of data among men and nonpregnant women without diabetes aged >/=20 years from the Third National Health and Nutrition Examination Survey (NHANES III; 1988-1994; n = 7,926) and NHANES 1999-2002 (n = 2,993). Both surveys were designed to represent the noninstitutionalized civilian U.S. population. We calculated age-adjusted mean concentrations of fasting insulin and the prevalence of hyperinsulinemia defined using the 75th percentile of fasting insulin among nondiabetic individuals as the cutoff value. RESULTS: The geometric mean concentrations of fasting insulin increased by approximately 5% from 1988-1994 to 1999-2002 among nondiabetic adults aged >/=20 years in the U.S. Mexican-American men, men and women aged 20-39 years, and non-Hispanic white women had a greater relative increase in the mean concentrations of fasting insulin than their counterparts. The prevalence of hyperinsulinemia increased by 35.1% overall (38.3% among men and 32.1% among women). CONCLUSIONS: In parallel with the obesity epidemic, concentrations of fasting insulin and prevalence of hyperinsulinemia have increased remarkably among nondiabetic U.S. adults.

Adult↗
PubMed2005

Race, ethnicity, and linguistic isolation as determinants of participation in public health surveillance surveys.

INTRODUCTION: To plan, implement, and evaluate programs designed to improve health conditions among racial and ethnic minority populations in the United States, public health officials and researchers require valid and reliable health surveillance data. Monitoring chronic disease and behavioral risk factors among such populations, however, is challenging. This study assesses the effects of race, ethnicity, and linguistic isolation on rates of participation in the Behavioral Risk Factor Surveillance System (BRFSS). METHODS: County-level data from the 2003 BRFSS survey and 2000 U.S. census were used to examine the effects of race, ethnicity, and linguistic isolation on six measures of survey participation (i.e., rates of resolution, screening, cooperation, response, language barriers, and refusal). RESULTS: Participation rates were significantly lower in counties with higher percentages of black people and people who did not speak English. Response rates decreased by 4.6% in counties with the highest concentration of black residents compared with counties with few black residents. Likewise, response rates decreased by approximately 7% in counties in which a larger percentage of the population spoke only Spanish or another Indo-European language compared with counties in which all residents spoke English. CONCLUSION: The negative relationship between the percentage of Spanish-only-speaking households and participation rates is troubling given that the BRFSS is conducted in both Spanish and English. The findings also indicate that more needs to be done to improve participation among other minorities. Researchers are investigating several ways of addressing disparities in participation rates, such as using postsurvey adjustments, developing more culturally appropriate data-collection procedures, and offering surveys in multiple languages.

Adolescent↗
PubMed2005

Brief communication: The prevalence of high intake of vitamin E from the use of supplements among U.S. adults.

BACKGROUND: People who consume at least 400 IU of vitamin E per day from supplements may be at slightly increased risk for premature mortality. OBJECTIVE: To estimate the percentage of U.S. adults age 20 years or older who consume at least 400 IU of vitamin E per day through the use of vitamins, minerals, or other dietary supplements. DESIGN: Cross-sectional analysis. SETTING: The 1999-2000 National Health and Nutrition Examination Survey. PATIENTS: Representative sample of the civilian, noninstitutionalized U.S. population. MEASUREMENTS: Participants answered questions about the use of vitamins, minerals, or other dietary supplements. RESULTS: Among 4609 adults, 11.3% (95% CI, 9.7% to 13.1%) consumed at least 400 IU of vitamin E per day from supplements. Such intake increased with age, was about equal for men and women, and was more common among white persons (14.1%; CI, 11.9% to 16.7%) than African-American (3.7% [CI, 2.6% to 5.2%]) or Mexican-American persons (3.9% [CI, 2.8% to 5.4%]). The median dietary intake of vitamin E was 8.8 IU per day. LIMITATIONS: Information about vitamin E intake was self-reported. CONCLUSIONS: The use of vitamin E supplements in dosages of at least 400 IU per day is common among U.S. adults.

Adult↗
PubMed2005

State of disparities in cardiovascular health in the United States.

BACKGROUND: Reducing health disparities remains a major public health challenge in the United States. Having timely access to current data on disparities is important for policy and program development. Accordingly, we assessed the current magnitude of disparities in cardiovascular disease (CVD) and its risk factors in the United States. METHODS AND RESULTS: Using national surveys, we determined CVD and risk factor prevalence and indexes of morbidity, mortality, and overall quality of life in adults > or =18 years of age by race/ethnicity, sex, education level, socioeconomic status, and geographic location. Disparities were common in all risk factors examined. In men, the highest prevalence of obesity (29.2%) was found in Mexican Americans who had completed a high school education. Black women with or without a high school education had a high prevalence of obesity (47.3%). Hypertension prevalence was high among blacks (39.8%) regardless of sex or educational status. Hypercholesterolemia was high among white and Mexican American men and white women in both groups of educational status. Ischemic heart disease and stroke were inversely related to education, income, and poverty status. Hospitalization was greater in men for total heart disease and acute myocardial infarction but greater in women for congestive heart failure and stroke. Among Medicare enrollees, congestive heart failure hospitalization was higher in blacks, Hispanics, and American Indians/Alaska Natives than among whites, and stroke hospitalization was highest in blacks. Hospitalizations for congestive heart failure and stroke were highest in the southeastern United States. Life expectancy remains higher in women than men and higher in whites than blacks by approximately 5 years. CVD mortality at all ages tended to be highest in blacks. CONCLUSIONS: Disparities in CVD and related risk factors remain pervasive. The data presented here can be invaluable for policy development and in the planning, implementation, and evaluation of interventions designed to eliminate health disparities.

Adult↗