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Diabetes-specific preventive-care practices among adults in a managed-care population -- Colorado, Behavioral Risk Factor Surveillance System, 1995.

The prevalence of diagnosed diabetes in the United States is 3%; however, diabetes accounts for approximately 15% of total U.S. health-care expenditures. Preventive-care practices (e.g., glycemic control and regular foot and ophthalmic examinations) can reduce the occurrence and progression of diabetic complications. Although managed-care organizations (MCOs) have assessed the use of such practices through chart reviews, telephone surveys of MCO patients with diabetes are a less expensive method for collecting accurate data. The ongoing, state-based Behavioral Risk Factor Surveillance System (BRFSS) telephone survey can be used to assess levels of care provided by MCOs and self-care practices among persons with diabetes in MCO populations. In 1995, a Colorado-based MCO collaborated with the Colorado Diabetes Control Program (CDCP) to use the state-based BRFSS to assess care practices among MCO enrollees. This report presents findings from the CDCP analysis of data on MCO enrollees aged > or = 30 years who had diabetes; the findings indicate that, although approximately three fourths of enrollees reported most preventive-care practices, two thirds had never heard the term hemoglobin "A-one-C," one fourth had not had their feet examined during the preceding year, and nearly one fifth did not receive an annual dilated-eye examination.

Adult↗

Cardiovascular disease risk reduction in the Behavioral Risk Factor Surveillance System.

BACKGROUND: Cardiovascular disease (CVD) risk-reduction practices are suboptimal in populations at high risk for CVD, and this problem may be worse in women than in men. METHODS: In 2003, CVD risk-reduction practices were compared between men and women after stratification by CVD risk status (high, intermediate, low) in a cross-sectional analysis of the 1999 Behavioral Risk Factor Surveillance System (BRFSS), a random-digit telephone survey of state population-based samples of the civilian non-institutionalized population of adults. This analysis included persons aged >40 years who answered questions regarding lipid and blood pressure screening, recommendations for lifestyle modification, that is, exercise and reduced fat intake, and aspirin use. Risk status was defined according to Adult Treatment Panel III definitions. RESULTS: In the 97,387 adults included in this analysis, high CVD risk was associated with lipid and blood pressure screening, lifestyle modification, and aspirin use in both men and women compared to intermediate-risk and low-risk (p <0.001). Among high-risk adults, men and women reported similar frequency of blood pressure and cholesterol measurement and physician advice on lifestyle modification; among intermediate- and low-risk adults, women reported slightly more frequent screening and lifestyle modification than men (p <0.001). In all CVD risk categories, women reported significantly less aspirin use than in men (p <0.001). CONCLUSIONS: Among people at high risk for CVD, women report lifestyle modification more often than men, while men report use of aspirin more often than women. These findings may assist with targeting interventions to reduce CVD risk to the unique needs of men and women.

Aspirin↗

Dental service use and dental insurance coverage--United States, Behavioral Risk Factor Surveillance System, 1995.

In the United States, 94% of adults have evidence of past or current tooth decay, and only one third of adults aged 35-44 years have all of their permanent teeth. Dental insurance is associated with increased use of dental services and improved oral health status. This report summarizes state-specific and aggregated state data on both private and public sources of dental insurance coverage and the use of dental services among adults in 25 states who participated in the oral health module of the 1995 Behavioral Risk Factor Surveillance System (BRFSS). The findings indicate that nearly half (44.3%) of adults in this survey reported having no dental insurance coverage.

Adult↗

Prevalence of recommended levels of physical activity among women--Behavioral Risk Factor Surveillance System, 1992.

Regular physical activity provides important health benefits for women, including lower risks for coronary heart disease, some cancers, osteoporosis, and other leading causes of death and disability (1-3). Despite such benefits, the proportion of women in the United States reporting regular physical activity has been low (4). Because even moderately intense physical activity has substantial health benefits, public health recommendations for physical activity have been expanded to a broader spectrum of activity, including gardening, walking, and housework in addition to more vigorous aerobic exercise (e.g., jogging) (5,6). To improve estimates of the prevalence of participation in physical activity at levels associated with health benefits among adult women, data about leisure-time physical activity were analyzed from the 1992 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of these analyses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

State-specific prevalence of participation in physical activity--Behavioral Risk Factor Surveillance System, 1994.

Participation in physical activity on a regular basis provides important health benefits, including reduced risk for heart disease, colon cancer, diabetes, and high blood pressure. Regular physical activity also helps control weight; contributes to development and maintenance of healthy bones, muscles, and joints; and reduces symptoms of anxiety and depression. Recent recommendations have emphasized moderate intensity activities nearly every day for those who are unable to maintain the previously recommended program of strenuous activity three times a week. To determine the proportion of adults who are participating in regular physical activity, regardless of the level of intensity, CDC analyzed data from the 1994 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicates that, in every state surveyed, most adults are not participating in regular physical activity.

Adult↗

Using the U.S. Behavior Risk Factor Surveillance System's health related quality of life survey tool in a Canadian city.

As responsibility for health funding shifts from central to local governments, providers find themselves in decision-making roles or asked to give guidance in allocation of resources. To develop a picture of a population's health, data are needed about the effects that illness and disability have on a person's ability to function and thus on quality of life. This study assessed the validity in a Canadian city, of a Health-related Quality of Life (HRQoL) instrument developed by the US Centers for Disease Control and used in the US Behavioral Risk Factor Surveillance System. The HRQoL was administered to a random sample of 1,042 adults. The patterns of association among the HRQoL questions, and the direction of the relationships among independent variables and HRQoL were consistent with those hypothesized. The accumulating evidence for validity of the HRQoL support its use in monitoring the performance of local health initiatives in Canada.

Activities of Daily Living↗

State-specific prevalence estimates of uninsured and underinsured persons--Behavioral Risk Factor Surveillance System, 1995.

In the United States, cost of health-care services is a barrier to accessibility of health care, and persons often do not seek medical care because of concerns about cost, regardless of whether they have health insurance. In addition, three fourths of persons in the United States who have difficulties paying their medical bills have some type of health insurance. Although the affordability of health care among persons without health insurance has been described, characterization of affordability among persons who are underinsured is limited. To determine state-specific estimates of the prevalence of persons aged 18-64 years who are either uninsured or underinsured using an experiential definition of underinsurance, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which document variations in state-specific rates for adequate insurance coverage.

Adult↗

Preventive-care knowledge and practices among persons with diabetes mellitus -- North Carolina, Behavioral Risk Factor Surveillance System, 1994-1995.

Diabetes mellitus is the leading cause of lower-extremity amputation, end-stage renal disease, and blindness among persons aged 18-65 years in the United States. Diabetes preventive care resulting in improved self-care, better glycemic control, and regular foot and eye examinations can substantially reduce the complications of diabetes. Assessment of the level of preventive care among persons with diabetes can assist in targeting public health efforts to reduce complications. To estimate the prevalence of diabetes and the levels of preventive-care knowledge and practices among persons with diabetes in North Carolina, the North Carolina Office of Epidemiology and the state Diabetes Control Program (DCP), in collaboration with CDC, analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) for 1994-1995. This report summarizes the results of that analysis, which indicate a low level of diabetes preventive-care knowledge and practices among persons with diabetes in North Carolina.

Adult↗

Health-related quality of life among adults with arthritis--behavioral risk factor surveillance system, 11 states, 1996-1998.

Arthritis and other rheumatic conditions are the leading cause of disability in the United States, affecting 43 million persons in 1998 and-with the aging of the "baby boom" generation-are projected to affect an estimated 60 million by 2020. In 1992, these conditions cost $65 billion in medical care and lost productivity and were associated with 744,000 hospitalizations and 44 million ambulatory-care visits in 1997. Because arthritis and other rheumatic conditions seldom cause death but have a substantial impact on health, health-related quality of life (HRQOL) measures are better indicators of their impact than related mortality rates. This report examines data from 11 states that included an arthritis module in the 1996-1998 Behavioral Risk Factor Surveillance System (BRFSS); findings indicate that persons with arthritis have worse HRQOL than persons without arthritis, regardless of sex, age, or education level.

Adult↗

Behavioral Risk Factor Surveillance System--Michigan, 1987-1991.

A national health objective for the year 2000 is to implement periodic analysis and publication of each state's progress toward the objectives for each racial/ethnic group that constitutes at least 10% of the state's population (objective 22.5a). In Michigan (1990 population: 9.3 million), blacks represent approximately 12% of the adult population*; prevalence estimates for risk factors for the black population derived from the Behavioral Risk Factor Surveillance System (BRFSS) have varied in consistency because of the limitations of small sample sizes. To improve the precision of risk factor prevalence estimates for blacks in Michigan and to improve measurement of the state's progress toward the national year 2000 objectives for blacks, in 1993, the Michigan Department of Public Health (MDPH) aggregated annual state BRFSS data for 1989-1991. This report summarizes the findings of this analysis and compares them with an analysis of annual state BRFSS data for 1987-1991.

Adult↗

Quality of life as a new public health measure--Behavioral Risk Factor Surveillance System, 1993.

A fundamental goal of the year 2000 national health objectives is to increase the span of healthy life for all persons in the United States. Public health programs, improved social conditions, and private medical care have contributed to the prolongation of life expectancy of U.S. residents at birth from 47 years in 1900 to 75 years in 1989. However, for some persons, increased life expectancy includes periods of diminished health and function (i.e., lowered health-related quality of life [HR-QOL]). Because population-based surveillance of good health has been limited, questions to assess HR-QOL were added to the 1993 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the preliminary findings about HR-QOL from the 1993 BRFSS and describes an index used to identify population subgroups with high and low HR-QOL.

Adult↗

State-specific changes in cholesterol screening--behavioral risk factor surveillance system, 1988-1991.

High blood cholesterol (HBC) is an important risk factor for coronary heart disease (1)--the leading cause of death in the United States. To reduce the prevalence of elevated cholesterol levels in the United States, in 1985 the National Heart, Lung, and Blood Institute initiated the National Cholesterol Education Program (NCEP). The NCEP recommends that all adults aged > or = 20 years be screened for HBC at least once every 5 years. One of the national health objectives for the year 2000 is to increase to 75% the percentage of adults screened for HBC within the preceding 5 years (objective 15.14). To measure progress toward this objective, data from CDC's Behavioral Risk Factor Surveillance System (BRFSS) were used to examine state-specific trends in cholesterol screening from 1988 through 1991. This report summarizes the results of this analysis and provides a projected estimate of the 1994 screening rates for HBC in each state.

Adult↗

Physical activity patterns among adults in Georgia: results from the 1990 Behavioral Risk Factor Surveillance System.

Regular physical activity increases a person's ability to perform daily activities more efficiently, reduces the risk of specific chronic diseases, including coronary artery disease, and lowers death rates in general. The Healthy People 2000 Physical Activity and Fitness Objectives underscored the importance of monitoring and tracking the prevalence of physical activity and fitness in the United States population for the purpose of planning, implementing, and evaluating efforts to improve the public's physical activity habits. This report examines the prevalence of self-reported leisure-time physical activity (LTPA) among southeastern adults aged 18 years and older living in the state of Georgia. Using data from the 1990 Behavioral Risk Factor Surveillance System (BRFSS) surveys from Georgia, we describe the LTPA patterns of Georgia adults aged 18 years and older. A total of 1,723 adults were interviewed during 1990. Results show the following: women are less active than men, blacks are less active than whites, persons of lower socioeconomic status (SES) are less active than those of higher SES, and older adults are less active than younger adults. These results suggest that a more concerted effort needs to be made in promoting physical activity for women, persons of lower SES, and older adults.

Adolescent↗

Diabetes mellitus and health-related quality of life among older adults. Findings from the behavioral risk factor surveillance system (BRFSS).

The aim of the present study was to examine associations between the presence of diabetes mellitus and health-related quality of life (HRQOL) among older adults. Using data from 37,054 adults aged 50 years or older who participated in the 2001 BRFSS, we examined the independent association between diabetes and four measures of HRQOL developed by the U.S. Centers for Disease Control and Prevention. Multivariate logistic regression was used to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CIs). On average, older adults with diabetes reported nearly twice as many unhealthy days (physical or mental) as those without the condition (mean: 10.1 [S.E.: 0.32] versus 5.7 [0.43]) after age adjustment. The proportion of older adults reporting 14 or more unhealthy days (physical or mental) was significantly higher among those with diabetes (n = 4032; 11%) compared to those without the condition (OR: 1.64; 95% CI: 1.20, 2.23) after multivariate adjustment. Among older diabetic adults, the adjusted relative odds of having 14 or more unhealthy days (physical or mental) was 1.71 (95% CI: 1.31, 2.22) times greater for those treated with insulin compared to those not treated with insulin. Diabetes is independently associated with lower levels of HRQOL among older adults. These results reinforce the importance of preventing diabetes and its complications through health education messages stressing a balanced diet and increased physical activity.

Aged↗