Handgun carrying among White youth increasing in the United States: New evidence from the National Survey on Drug Use and Health 2002–2013

The objective of the present study was to examine trends and correlates of handgun carrying among adolescents ages 12–17 in the United States. Data was derived from the National Survey on Drug Use and Health (NSDUH) involving non-Hispanic White, African American, and Hispanic respondents ages 12–17 (n = 197,313) and spanning the years 2002–2013. Logistic regression was used to examine significance of trend year and correlates of previous 12-month handgun carrying. The overall self-reported prevalence of handgun carrying was 3.4%. The prevalence of handgun carrying during 2004–2005 was significantly higher for African-Americans (4.39%) compared to non-Hispanic Whites (3.03%). However, by 2012–2013, non-Hispanic Whites (4.08%) completely diverged and reported carrying handguns significantly more than both African-American (2.96%) and Hispanic (2.82%) youth. Male gender and a number of externalizing behaviors were significant correlates of handgun carrying; however, we also found evidence of differential correlates with regard to such factors as drug selling, parental affirmation, and income by race/ethnicity. To our knowledge, this is the largest study of handgun carrying among youth in the United States. Findings indicate that although at historically low levels handgun carrying is on the rise but only among non-Hispanic Whites. Differential correlates among racial/ethnic groups suggest prevention programming and policies may need modifications depending on group and geographic locale targeted.     

Prevalence of Musculoskeletal Symptoms Among Agricultural Workers in the United States: An Analysis of the National Health Interview Survey, 2004–2008

Ergonomic risks from agricultural tasks can compromise musculoskeletal health of workers. This study estimated prevalence of musculoskeletal symptoms in a sample representing almost 2 million US agricultural industry workers. This study used National Health Interview Survey data from 2004 to 2008. Weighted prevalence was calculated by demographic and employment factors. Prevalence ratios were calculated using generalized linear models with the Poisson distribution assumption. Prevalence rates of low back and neck pain in the previous 3 months were 24.3% and 10.5%, respectively, among agricultural workers. Monthly prevalence of joint pain was 17.0% for hips/knees, 9.8% for shoulders, 9.5% for wrists/hands, 5.4% for elbows, and 4.7% for ankles/toes. Agricultural workers had a significantly higher prevalence of shoulder pain than all other industry workers (prevalence ratios [PR] = 1.28, 95% confidence interval [CI]: 1.02–1.61). This study provides detailed national estimates of musculoskeletal symptom prevalence to understand the burden and the need for intervention among agricultural workers.     

Food Sources of Energy and Nutrients among Children in the United States: National Health and Nutrition Examination Survey 2003–2006

Background: Recent detailed analyses of data on dietary sources of energy and nutrients in US children are lacking. The objective of this study was to identify food sources of energy and 28 nutrients for children in the United States. Methods: Analyses of food sources were conducted using a single 24-h recall collected from children 2 to 18 years old (n = 7332) in the 2003–2006 National Health and Nutrition Examination Survey. Sources of nutrients contained in foods were determined using nutrient composition databases. Food grouping included ingredients from disaggregated mixtures. Mean energy and nutrient intakes from the total diet and from each food group were adjusted for the sample design using appropriate weights. Percentages of the total dietary intake that food sources contributed were tabulated by rank order. Results: The two top ranked food/food group sources of energy and nutrients were: energy—milk (7% of energy) and cake/cookies/quick bread/pastry/pie (7%); protein—milk (13.2%) and poultry (12.8%); total carbohydrate—soft drinks/soda (10.5%) and yeast bread/rolls (9.1%); total sugars—soft drinks/soda (19.2%) and yeast breads and rolls (12.7%); added sugars—soft drinks/soda (29.7%) and candy/sugar/sugary foods (18.6%); dietary fiber—fruit (10.4%) and yeast bread/rolls (10.3%); total fat—cheese (9.3%) and crackers/popcorn/pretzels/chips (8.4%); saturated fatty acids—cheese (16.3%) and milk (13.3%); cholesterol—eggs (24.2%) and poultry (13.2%); vitamin D—milk (60.4%) and milk drinks (8.3%); calcium—milk (33.2%) and cheese (19.4%); potassium—milk (18.8%) and fruit juice (8.0%); and sodium—salt (18.5%) and yeast bread and rolls (8.4%). Conclusions: Results suggest that many foods/food groupings consumed by children were energy dense, nutrient poor. Awareness of dietary sources of energy and nutrients can help health professionals design effective strategies to reduce energy consumption and increase the nutrient density of children’s diets.     

Trends in Serum Lipids and Hypertension Prevalence Among Non-Pregnant Reproductive-Age Women: United States National Health and Nutrition Examination Survey 1999–2008

Cardiovascular disease is one of the leading causes of death among reproductive-age women. In this study, we examine trends in the prevalence of dyslipidemia, hypertension, and related clinicians’ advice among reproductive-age women. We conducted trend analysis of these factors among non-pregnant women aged 20–49 years (n = 5,768) using National Health and Nutrition Examination Survey (NHANES) data obtained between 1999 and 2008. Multiple linear regression and logistic regression analyses were used to examine linear trends over a 10-year period after adjusting for covariates. A downward trend was observed for the proportion of women with abnormal levels of low density lipoprotein (LDL; P = 0.038) and high density lipoprotein (HDL; P = 0.008) cholesterol from 1999 to 2008. In contrast, no significant changes were observed in the prevalence of abnormal total cholesterol (P = 0.948) and triglyceride levels (P = 0.300), or hypertension (P = 0.632). Based on the self-reported data, upward trends were observed in the rates of cholesterol checking (P = 0.002), high cholesterol (P = 0.012), receiving clinicians’ advice to use lipid-lowering agents (P < 0.001) and patients’ compliance with their advice (P < 0.001). Although rates of self-reported hypertension did not change over time (P = 0.120), receiving clinicians’ advice to use antihypertensive medications (P = 0.003) and patients’ compliance with these medications (P = 0.015) also increased significantly. Overall improvements in LDL and HDL cholesterol over this time period could be due to increases in related awareness, receiving advice to use medications, and patients’ compliance with this advice. Use of antihypertensive medication has also increased among reproductive-age women in the US.     

Human papillomavirus vaccine uptake among males 11–26 years in United States: Findings from the National Health and Nutrition Examination Survey, 2011–2012

Anogenital human papillomavirus (HPV) infection is the leading sexually transmitted infection in the United States. In October 2011, the quadrivalent HPV vaccine (HPV4) was recommended for males in the U.S. We analyzed a subsample of 11–26 year old (N = 1012) males, from the National Health and Nutritional Examination Survey 2011–2012 dataset, to examine HPV vaccine uptake. The initiation rates in the 11–17 years and the 18–26 years age-groups were 10.7% (95% confidence interval (CI): 8.09–16.6%) and 5.5% (95%CI: 3.1–9.5%) respectively. The corresponding HPV vaccine completion rates were 39.3% (16.7–67.7%) for the 11–17 year old males and 59.1% (37.2–77.6) for the 18–26-year-old males. Despite a slight increase, HPV vaccine uptake remained low among males. These findings can help in HPV vaccination policy in the United States, with a focus on informational messages directed toward young males and their parents in order to increase uptake of HPV vaccine.     

Sexual Minority Health Disparities in Adult Men and Women in the United States: National Health and Nutrition Examination Survey, 2001–2010

Objectives. We used nationally representative data to investigate health disparities associated with sexual minority status among adults in the United States.Methods. We analyzed data from 11 114 adults who participated in the 2001 to 2010 waves of the National Health and Nutrition Examination Survey. Using multiple logistic regressions, we examined the prevalence of HIV, sexually transmitted infections, mental health problems, cigarette smoking, and alcohol and illicit drug use in sexual minorities and heterosexual adults.Results. After adjusting for sociodemographic characteristics, sexual minority men had greater odds of mental health problems, testing positive for HIV and herpes simplex virus type 2 and self-reported gonorrhea and chlamydia. Sexual minority women had greater odds of mental health problems, testing positive for hepatitis C, smoking, heavy drinking, and illicit drug use.Conclusions. Numerous health disparities continue to face sexual minority men and women in the United States. Notably, health disparities persisted beyond the role of sociodemographic factors, including access to insurance and primary care, suggesting that further research is warranted to identify the determinants of health inequity for sexual minorities.A recently published and widely cited report by the Institute of Medicine called for the greater prioritization of research on the health of sexual minorities (i.e., individuals who identify as lesbian, gay, bisexual, or nonheterosexual) in the United States.1 Although this seminal review demonstrated that much progress has been made in documenting sexual minority health disparities and elucidating their determinants, the Institute of Medicine committee noted a number of critical research challenges. For example, most empirical literature that examines sexual minority health has been conducted using convenience samples and local studies. To inform, implement, and achieve coordinated public health responses at the national level, the report recommended increased attention to and investigation of the health of sexual minority populations from nationally representative data.Despite the paucity of population-based sexual minority research, accumulated data from nonprobability samples provide evidence of health disparities between sexual minority and heterosexual populations in the United States. For example, sentinel surveillance data reported by the Centers for Disease Control and Prevention illustrated that the rates of chlamydia, gonorrhea, herpes, and genital warts infections have increased in previous years, with gay, bisexual, and other men who have sex with men experiencing the largest spike in cases.2 Recent data also indicated that human papillomavirus (HPV) infections account for most incident and prevalent sexually transmitted infections (STIs) for both men and women in the United States.3 In addition to the established increased risk of STIs and HIV among sexual minority men,1,4,5 observational studies have also demonstrated higher rates of STIs among women who have sex with women compared with women who have sex with men only.6–8 Notably, gender differences in STIs have also been observed among samples of heterosexual adults. Although most studies suggest that men have a higher incidence of most STIs than women,9,10 1 study found that women were more likely to have herpes simplex virus type 2 (HSV-2) compared with men.11 As such, it stands to reason that there may be important differences in STI rates by both sexual orientation and biological gender.An increased risk of mental health problems, hazardous alcohol use, and illicit drug use among sexual minority populations has also been found in previous research. Studies using probability sampling have documented disparities by sexual minority status in the prevalence of psychiatric disorders,12–15 tobacco use,16 drug use,17 health care access,17,18 violence and victimization,17 and chronic disease risk, including cardiovascular risk, asthma, and obesity.19,20 With few exceptions, a limited number of population-based health studies have explicitly examined variability within sexual minority populations, as many single-state or single-wave population studies lack sufficient sample size to examine differences by key sociodemographics such as gender.17To examine sexual minority health disparities at the national level, we analyzed data from the 2001 to 2010 waves of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of civilian, noninstitutionalized populations in the United States.21 Given the accumulating evidence for variability in health outcomes within sexual minority populations, we sought to describe trends separately for sexual minority men and sexual minority women compared with their heterosexual counterparts. Specifically, our aims were to utilize the NHANES to (1) investigate the prevalence of 5 of the most commonly reported STIs—gonorrhea, chlamydia, HSV-2, HIV, and HPV (as measured by reports of genital warts)—using a combination of biomarker and self-reported data; (2) assess prevalence of mental health and health behaviors, including number of poor mental health days, smoking, heavy drinking, and illicit drug use; and (3) examine disparities in health indicators between sexual minority men versus heterosexual men and sexual minority women versus heterosexual women.     

Obesity and contraceptive use among women 20–44 years of age in the United States: results from the 2011–15 National Survey of Family Growth (NSFG)

Objective

Obesity has increased dramatically in the United States in recent decades. Our objective was to explore associations of contraceptive choices of US women, aged 20–44 years, with body mass index (BMI) and relevant covariates.

Human papillomavirus vaccination coverage among females and males,National Health and Nutrition Examination Survey,United States, 2007–2016

BackgroundHuman papillomavirus (HPV) vaccination has been routinely recommended at age 11–12 years in the United States for females since 2006 and males since 2011. Coverage can be estimated using self/parent-reported HPV vaccination collected in the National Health and Nutrition Examination Survey (NHANES) for a wider age range than other national surveys. We assessed vaccination coverage in 2015–2016, temporal trends by age, and the validity of self/parent-reported vaccination status.MethodsParticipants aged 9–59 years completed an interview collecting demographic and vaccination information. Weighted coverage was estimated for two-year NHANES cycles by age group for 2007–2008 to 2015–2016 for females (N = 14318) and 2011–2012 to 2015–2016 for males (N = 7847). Temporal trends in coverage were assessed from 2007–2008 to 2011–2012 for females and from 2011–2012 to 2015–2016 for both sexes. Sensitivity and specificity of self/parent-reported vaccination were assessed using provider-verified vaccination records from a pilot study in 14–29 year-olds.ResultsIn 2015–2016, ≥1 dose coverage among females was highest in 14–19 (54.7%) and 20–24 (56.0%) year-olds and lower in successively older age groups. Among males, ≥1 dose coverage was highest in 14–19 year-olds (39.5%) and lower at older ages. Coverage was similar in 9–13 year-old females and males. Between 2007–2008 and 2011–2012, there were increases among females younger than 30 years. Between 2011–2012 and 2015–2016, there were increases among female age groups including 20–39 year-olds; male coverage increased among ages 9–13, 14–19, and 20–24 years. Self/parent-reported receipt of ≥1 dose had a sensitivity and specificity of 87.0% and 83.3%. Performance was lower for 3 doses.ConclusionsWhile overall HPV vaccination coverage remains low, it is higher in females than males, except in 9–13 year-olds. There have been increases in coverage among many age groups, but coverage has stalled in younger females. Adequate validity was demonstrated for self/parent-reported vaccination of ≥1 dose, but not 3 doses, in a pilot study.     

A demographic,clinical, and behavioral typology of obesity in the United States: an analysis of National Health and Nutrition Examination Survey 2011–2012

Purpose

Public health reporting, randomized trials, and epidemiologic studies of obesity tend to consider it as a homogeneous entity. However, obesity may represent a heterogeneous condition according to demographic, clinical, and behavioral factors. We assessed the heterogeneity of individuals with obesity in the United States.

Increasing uptake of live attenuated influenza vaccine among children in the United States, 2008–2014

The Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for all persons in the United States aged ≥6 months. On June 25, 2014, ACIP preferentially recommended live attenuated influenza vaccine (LAIV) for healthy children aged 2–8 years [1]. Little is known about national LAIV uptake. To determine uptake of LAIV relative to inactivated influenza vaccine, we analyzed vaccination records from six immunization information system sentinel sites (approximately 10% of US population). LAIV usage increased over time in all sites. Among children 2–8 years of age vaccinated for influenza, exclusive LAIV usage in the collective sentinel site area increased from 20.1% (2008–09 season) to 38.0% (2013–14). During 2013–14, at least half of vaccinated children received LAIV in Minnesota (50.0%) and North Dakota (55.5%). Increasing LAIV usage suggests formulation acceptability, and this preexisting trend offers a favorable context for implementation of ACIP's preferential recommendation.     

Trends in tobacco use among US adults with chronic health conditions: National Survey on Drug Use and Health 2005–2013

Introduction: Chronic conditions are among the most common and costly of all health problems. Addressing tobacco use among adults with chronic conditions is a public health priority due to high prevalence as well as greater potential harm from continued use. Methods: Data were drawn from 9 years (2005–2013) of the U.S. National Survey on Drug Use and Health. Adult (≥ 18 years) tobacco use included any past 30-day use of cigarettes, cigars, pipes, or smokeless tobacco. Chronic conditions examined included anxiety, asthma, coronary heart disease, depression, diabetes, hepatitis, HIV, hypertension, lung cancer, stroke, and substance abuse. Controlling for sociodemographics, trends in product use for most conditions and a composite of any condition among those with chronic conditions were compared to respondents with no condition in weighted logistic regression analyses. Results: Cigarette smoking declined significantly over time among adults with no chronic condition. Adults with one or more chronic condition showed no comparable decrease, with cigarette smoking remaining especially high among those reporting anxiety, depression, and substance abuse. Cigar and pipe use remained stable and more prevalent among those with any chronic condition, with the exception of pipe use declining among those with heart disease. Smokeless tobacco use increased over time, with higher prevalence among those with asthma, mental health, and substance abuse conditions. Conclusions: These findings have tobacco control and regulatory implications for addressing higher tobacco use among adults with chronic conditions. Provider advice and cessation resources targeting tobacco use among those with chronic conditions are recommended.     

Estimated Latent Tuberculosis Infection Prevalence and Tuberculosis Reactivation Rates Among Non-U.S.-Born Residents in the United States,from the 2011–2012 National Health and Nutrition Examination Survey

Journal of Immigrant and Minority Health - Increased testing and treatment of latent tuberculosis infection (LTBI) among US-residents who were born (or lived) in countries with high rates of TB can...     

Change in Obesity Prevalence among New York City Adults: the NYC Health and Nutrition Examination Survey, 2004 and 2013–2014

The objective of this study was to measure change in obesity prevalence among New York City (NYC) adults from 2004 to 2013–2014 and assess variation across sociodemographic subgroups. We used objectively measured height and weight data from the NYC Health and Nutrition Examination Survey to calculate relative percent change in obesity (≥?30 kg/m²) between 2004 (n =?1987) and 2013–2014 (n =?1489) among all NYC adults and sociodemographic subgroups. We also examined changes in self-reported proxies for energy imbalance. Estimates were age-standardized and statistical significance was evaluated using two-tailed T tests and multivariable regression (p <?0.05). Between 2004 and 2013–2014, obesity increased from 27.5 to 32.4% (p =?0.01). Prevalence remained stable and high among women (31.2 to 32.8%, p =?0.53), but increased among men (23.4 to 32.0%, p =?0.002), especially among non-Latino White men and men age ≥?65 years. Black adults had the highest prevalence in 2013–2014 (37.1%) and Asian adults experienced the largest increase (20.1 to 29.2%, p =?0.06), especially Asian women. Foreign-born participants and participants lacking health insurance also had large increases in obesity. We observed increases in eating out and screen time over time and no improvements in physical activity. Our findings show increases in obesity in NYC in the past decade, with important sociodemographic differences.     

Vitamin D Status and Acute Respiratory Infection: Cross Sectional Results from the United States National Health and Nutrition Examination Survey, 2001–2006

Vitamin D is a promising, though under-explored, potential modifiable risk factor for acute respiratory infections (ARIs). We sought to investigate the association of vitamin D status with ARI in a large, nationally-representative sample of non-institutionalized individuals from the United States. We analyzed 14,108 individuals over 16 years of age in the National Health and Nutrition Survey (NHANES) 2001–2006 in this cross-sectional study. We used locally weighted scatterplot smoothing (LOWESS) to depict the relationship between increasing 25-hydroxyvitamin D (25OHD) levels and ARI. We then performed a multivariable regression analysis to investigate the association of 25OHD levels with ARI, while adjusting for known confounders. The median serum 25OHD level was 21 (IQR 15–27) ng/mL. Overall, 4.8% (95% CI: 4.5–5.2) of participants reported an ARI within 30 days before their participation in the national survey. LOWESS analysis revealed a near-linear relationship between vitamin D status and the cumulative frequency of ARI up to 25OHD levels around 30 ng/mL. After adjusting for season, demographic factors, and clinical data, 25OHD levels <30 ng/mL were associated with 58% higher odds of ARI (OR 1.58; 95% CI: 1.07–2.33) compared to levels ≥30 ng/mL. Among the 14,108 participants in NHANES 2001–2006, 25OHD levels were inversely associated with ARI. Carefully designed, randomized, controlled trials are warranted to determine the effect of optimizing vitamin D status on the risk of ARI.     

Vital Signs: Leading Causes of Death,Prevalence of Diseases and Risk Factors,and Use of Health Services Among Hispanics in the United States — 2009–2013

Background

Hispanics and Latinos (Hispanics) are estimated to represent 17.7% of the U.S. population. Published national health estimates stratified by Hispanic origin and nativity are lacking.

Methods

Four national data sets were analyzed to compare Hispanics overall, non-Hispanic whites (whites), and Hispanic country/region of origin subgroups (Hispanic origin subgroups) for leading causes of death, prevalence of diseases and associated risk factors, and use of health services. Analyses were generally restricted to ages 18–64 years and were further stratified when possible by sex and nativity.

Results

Hispanics were on average nearly 15 years younger than whites; they were more likely to live below the poverty line and not to have completed high school. Hispanics showed a 24% lower all-cause death rate and lower death rates for nine of the 15 leading causes of death, but higher death rates from diabetes (51% higher), chronic liver disease and cirrhosis (48%), essential hypertension and hypertensive renal disease (8%), and homicide (96%) and higher prevalence of diabetes (133%) and obesity (23%) compared with whites. In all, 41.5% of Hispanics lacked health insurance (15.1% of whites), and 15.5% of Hispanics reported delay or nonreceipt of needed medical care because of cost concerns (13.6% of whites). Among Hispanics, self-reported smoking prevalences varied by Hispanic origin and by sex. U.S.-born Hispanics had higher prevalences of obesity, hypertension, smoking, heart disease, and cancer than foreign-born Hispanics: 30% higher, 40%, 72%, 89%, and 93%, respectively.

Conclusion

Hispanics had better health outcomes than whites for most analyzed health factors, despite facing worse socioeconomic barriers, but they had much higher death rates from diabetes, chronic liver disease/cirrhosis, and homicide, and a higher prevalence of obesity. There were substantial differences among Hispanics by origin, nativity, and sex.

Implications for Public Health

Differences by origin, nativity, and sex are important considerations when targeting health programs to specific audiences. Increasing the proportions of Hispanics with health insurance and a medical home (patient-centered, team-based, comprehensive, coordinated health care with enhanced access) is critical. A feasible and systematic data collection strategy is needed to reflect health diversity among Hispanic origin subgroups, including by nativity.     

HIV Diagnoses and Prevalence in the Southern Region of the United States, 2007–2010

On a number of leading health indicators, including HIV disease, individuals in the southern states of the United States fare worse than those in other regions. We analyzed data on adults and adolescents diagnosed with HIV infection through December 2010, and reported to the Centers for Disease Control and Prevention (CDC) through June 2011 from 46 states with confidential name-based HIV reporting since January 2007 to describe the impact of HIV in the South. In 2010 46.0 % of all new diagnoses of HIV infection occurred in the South. Compared to other regions, a higher percentage of diagnoses in the South were among women (23.8 %), blacks/African Americans (57.2 %), and among those in the heterosexual contact category (15.0 % for males; 88.5 % for females). From 2007 to 2010 the estimated number and rate of diagnoses of HIV infection decreased significantly in the South overall (estimated annual percentage change [EAPC] = ?1.5 % [95 %CI ?2.3 %, ?0.7 %] and ?2.1 % [95 % CI ?4.0 %, ?0.2 %], respectively) and among most groups of women, but there was no change in the number or rate of diagnoses of HIV infection among men overall. Significant decreases in men 30–39 and 40–49 years of age were offset by increases in young men 13–19 and 20–29 years of age. A continued focus on this area of high HIV burden is needed to yield success in the fight against HIV disease.