Peer Reviewed: Obesity and Diabetes in Jordan: Findings From the Behavioral Risk Factor Surveillance System, 2004

Introduction

Chronic diseases are the leading cause of morbidity and mortality in Jordan. The Jordanian Ministry of Health, in collaboration with the Centers for Disease Control and Prevention, established a behavioral risk factor surveillance system to monitor the behavioral risk factors associated with chronic diseases.

Methods

We used a multistage sampling design to select households from which we then randomly selected and interviewed one adult aged 18 years or older. A random subsample of the adults interviewed were then invited to visit the local health clinic, where we obtained medical measurements, including blood lipids (low-density lipoprotein, high-density lipoprotein, and triglycerides) and fasting blood glucose.

Results

Approximately 9% of the participants in the subsample who underwent medical testing reported having been diagnosed with diabetes previously, compared with 16.9% diagnosed in our laboratory testing. About 12.3% of the participants were glucose intolerant, and about 35% were obese. Obesity was significantly associated with diabetes, high blood pressure, high cholesterol, and asthma. Compared with adults of normal weight, obese adults had an adjusted odds ratio of 3.27 (95% CI, 1.58–6.76) for diabetes, 3.69 (95% CI, 2.13–6.39) for high blood pressure, 3.45 (95% CI, 1.68–7.10) for high cholesterol, and 5.12 (95% CI, 1.53–17.19) for asthma.

Discussion

Obesity, poor diet, and physical inactivity create a major chronic disease burden in Jordan that is likely to increase substantially in the next few years. Our findings argue for establishment of a more preventive orientation in health care and public health systems in Jordan.     

Smoking cessation and body weight: evidence from the Behavioral Risk Factor Surveillance Survey

Objective

To investigate the role of smoking cessation in body weight.

Data Sources

2004–2005 and 2009–2010 Behavioral Risk Factor Surveillance Surveys (BRFSS) (N = 349,000), Centers for Disease Control and Prevention; Tax Burden on Tobacco (Orzechowski and Walker 2010).

Study Design

The Gaussian treatment effect model is estimated for three age categories by gender. Treatment effects of quitting smoking on body mass index (BMI) by quit length are calculated.

Principal Findings

Quitting is found to be endogenous. Differentiated effects of quitting smoking on BMI are found among quitters by gender, between age groups, and by length of time since quitting smoking, and positive association between smoking cessation and body weight confirmed. Declining smoking rates have only a modest effect in the overweight population. The effects of quitting on BMI are considerably lower among younger men and women.

Conclusion

The price that must be paid, in terms of weight gain, to enjoy the health benefits of smoking cessation is trivial even for the obese population.     

PEER REVIEWED: An Innovative Approach to Enhancing the Surveillance Capacity of State-based Diabetes Prevention and Control Programs: The Diabetes Indicators and Data Sources Internet Tool (DIDIT)

The Diabetes Indicators and Data Sources Internet Tool (DIDIT) is an interactive Web-based resource with information on 38 diabetes indicators (e.g., diabetes-associated complications, care, lifestyle) and 12 associated data sources frequently used by state diabetes prevention and control programs. This tool is designed to strengthen the ability of states to conduct diabetes surveillance and to promote consistency in defining and tracking indicators across states. In this way, the DIDIT supports one of the 10 essential public health services: the timely and accurate assessment of public health.

In addition to serving as a central repository of information on diabetes surveillance, the DIDIT also allows users to share experiences of using these indicators and data sources in their diabetes surveillance activities, data analysis, and tracking of diabetes-related objectives stated by Healthy People 2010. The DIDIT is an innovative approach to enhancing public health surveillance at the state and national levels.

     

Age-related disparities in cancer screening: analysis of 2001 Behavioral Risk Factor Surveillance System data

PURPOSE: Although few studies have explored age-related health care disparities, some researchers have asserted such disparities uniformly disfavor the elderly and are largely attributable to ageism in the health care system. We compared age-related patterns of screening for colorectal cancer with those for breast and prostate cancer in persons aged 50 years and older. METHODS: We analyzed data for all adults aged 50 years and older (N = 88,213) in the 2001 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative, telephone-administered survey of personal health behaviors. Main outcome measures were adjusted prevalence by 5-year age-groups of colorectal cancer screening using fecal occult blood testing, flexible sigmoidoscopy, or colonoscopy for men and women; rates of mammography screening for women; and rates of prostate-specific antigen (PSA) screening for men. RESULTS: After adjustment for race/ethnicity, education level, income, health insurance, and self-rated health, predicted reported colorectal cancer screening (all modalities) increased significantly from when patients reached age 50 years until 70 to 74 years (66.0%, standard error [SE] 0.8%), remained constant until age 80 years, and then declined. The age-related gain in colorectal cancer screening was confined to whites among patients older than 60 years. Reported PSA screening increased until age 75 to 79 years (79.3%, SE 1.1%) and then declined, whereas reported mammography screening peaked at age 55 to 59 years (83.3%, SE 1.2%) and then declined. CONCLUSIONS: Significant age-related disparities appear to exist for both evidence-based and non-evidence-based cancer-screening interventions. The issue of age-related disparities in cancer screening is complex, with the direction of disparity favoring the elderly for some services yet disfavoring them for others.     

Willingness to use instant home HIV tests: data from the California Behavioral Risk Factor Surveillance Survey

OBJECTIVE: Although home collection HIV tests are available in the United States, home HIV tests providing instant results are not available. The objective of this study was to examine willingness to use instant home HIV tests and what test characteristics are most important to individuals. METHODS: Six questions were added to the 1999 California Behavioral Risk Factor Surveillance Survey (BRFSS) (n =2964). This state-representative survey is part of the ongoing, 50-state BRFSS sponsored by the Centers for Disease Control and Prevention. Chi-square tests and logistic regression were used to examine willingness to use instant home HIV tests and preferences for HIV test characteristics. RESULTS: Over one third (37%) of respondents would consider using an instant home HIV test. Respondents willing to use instant home tests were more likely to be Hispanic (odds ratio [OR]=1.55; confidence interval [CI]=1.03-2.34); to have not previously been tested for HIV (OR=1.72; CI=1.20-2.45); to be more likely to plan to be tested in the next 12 months (OR=1.17; CI=1.00-1.37); and to prefer urine sample collection (OR=1.56; CI=1.03-2.37). CONCLUSION: Over one third of respondents in a large, state-representative sample would consider using an instant home HIV test. Hispanics, individuals who planned to be tested in the next 12 months, and individuals who had never been tested were more willing to use instant home tests.     

Peer Reviewed: Tracking Chronic Disease and Risk Behavior Prevalence as Survey Participation Declines: Statistics From the Behavioral Risk Factor Surveillance System and Other National Surveys

Introduction

Response rates for the Behavioral Risk Factor Surveillance System (BRFSS) have declined in recent years. The response rate in 1993 was approximately 72%; in 2006, the response rate was approximately 51%. To assess the impact of this decline on the quality of BRFSS estimates, we compared selected health and risk factor estimates from BRFSS with similar estimates from the National Health Interview Survey (NHIS) and the National Health and Nutrition Examination Survey (NHANES).

Methods

We reviewed questionnaires from the 3 surveys and identified a set of comparable measures related to smoking prevalence, alcohol consumption, medical conditions, vaccination, health status, insurance coverage, cost barriers to medical care, testing for human immunodeficiency virus, and body measurements (height and weight).We compared weighted estimates for up to 15 outcome measures, including overall measures and measures for 12 population subgroups. We produced design-appropriate point estimates and carried out statistical tests of hypotheses on the equality of such estimates. We then calculated P values for comparisons of NHIS and NHANES estimates with their BRFSS counterparts.

Results

Although BRFSS and NHIS estimates were statistically similar for 5 of the 15 measures examined, BRFSS and NHANES estimates were statistically similar for only 1 of 6 measures. The observed differences for some of these comparisons were small, however.

Conclusion

These surveys produced similar estimates for several outcome measures, although we observed significant differences as well. Many of the observed differences may have limited consequences for implementing related public health programs; other differences may require more detailed examination. In general, the range of BRFSS estimates examined here tends to parallel those from NHIS and NHANES, both of which have higher rates of participation.     

Smoking status and health-related quality of life: as findings from the 2001 Behavioral Risk Factor Surveillance System data

PURPOSE: To examine the relationship between smoking status and health-related quality of life (HRQOL). DESIGN: Our study used a cross-sectional analysis with self-reported data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS). SETTING: United States. SUBJECTS: Subjects were a representative sample of noninstitutionalized adults aged 18 years and older. After excluding respondents who reported being pregnant and for whom smoking status could not be determined, we included 209,031 respondents. MEASURES: Multiple logistic regressions were performed to examine the associations of smoking status with the four HRQOL items, controlling for demographic and health-related characteristics. RESULTS: Current smokers had a higher likelihood of reporting poor general health status compared with nonsmokers and ex-smokers. Compared with nonsmokers, current smokers had a higher likelihood of reporting > or = 14 days of poor physical health (odds ratio [OR] = 1.64, 95% confidence interval [CI] = 1.51-1.77), poor mental health (OR = 1.99, 95% Cl = 1.84-2.16), and activity limitations (OR = 1.80, 95% Cl = 1.63-2.00). Similarly, compared with ex-smokers, current smokers had a higher likelihood of reporting > or = 14 days of poor physical health (OR = 1.30, 95% CI = 1.19-1.42), poor mental health (OR = 1.65, 95% CI = 1.50-1.81), and activity limitations (OR = 1.48, 95% CI = 1.32-1.65). Age, income, and presence of comorbidities also significantly explained variation in HRQOL. CONCLUSIONS: Our study reaffirms the significant association between smoking and HRQOL in a large nationally representative sample. Poor health associated with smoking persists as a major public health problem, and effective preventive and smoking cessation efforts should be undertaken.     

Multiple healthy behaviors and optimal self-rated health: Findings from the 2007 Behavioral Risk Factor Surveillance System Survey

ObjectiveThe aim of this study was to examine the association between the number of healthy behaviors (i.e., not currently smoking, not currently drinking excessively, physically active, and consuming fruits and vegetables five or more times per day) and optimal self-rated health (SRH) among U.S. adults or adults with cardiovascular diseases (CVDs) or diabetes.MethodsWe estimated the age-standardized prevalence of optimal SRH among a total of 430,912 adults who participated in the 2007 Behavioral Risk Factor Surveillance System (BRFSS). Prevalence ratios were produced with multivariate Cox regression models using number of healthy behaviors as a predictor; status of optimal SRH was used as an outcome variable while controlling for sociodemographic and health risk factors.ResultsThe age-standardized prevalence of reporting optimal SRH was 83.5%, 55.6%, and 56.3% among adults overall, and adults with CVDs or diabetes, respectively. Also in the aforementioned order, adults who reported having four healthy behaviors had 33%, 85%, and 87% increased likelihoods of reporting optimal SRH, when compared to their counterparts who reported none of these behaviors.ConclusionThe findings of this study indicate that number of healthy behaviors is associated with optimal SRH among adults, especially adults with CVDs or diabetes. These findings reinforce the support for identifying and implementing clinical and population-based intervention strategies that effectively promote multiple healthier lifestyle behaviors among adults.