Health behaviors of adults: United States, 1999-2001

This report presents prevalence estimates for key indicators of alcohol use, cigarette smoking, leisure-time physical activity, and body weight status among U.S. adults, using data from the 1999-2001 National Health Interview Surveys (NHIS). The NHIS is conducted annually by the Centers for Disease Control and Prevention's National Center for Health Statistics. Estimates are shown for several sociodemographic subgroups for both sexes combined and for men and women separately. Subgroups are compared in terms of prevalence of healthy and unhealthy behaviors. Methods Data for the U.S. civilian noninstitutionalized population were collected using computer-assisted personal interviews (CAPI). Questions on health behaviors were asked in the Sample Adult component of the basic core questionnaire. All data were self-reported. This report is based on a total of 96,501 completed interviews with sample adults aged 18 years and over, representing an overall sample adult response rate of 71.8% for the 3 years combined. Statistics were age adjusted to the 2000 U.S. standard population. Results Overall, 6 in 10 U.S. adults were current drinkers in 1999-2001; about 1 in 4 adults (23.1%) were lifetime abstainers. About 1 in 4 adults (23.1%) were current smokers and over one-half of adults (54.3%) had never smoked cigarettes. About 6 in 10 adults engaged in at least some leisure-time physical activity with about 3 in 10 regularly engaging in such activities. About 6 in 10 adults were overweight or obese (BMI > or = 25), with 4 in 10 adults having a healthy weight.     

Tetanus surveillance --- United States, 2001-2008

Tetanus is a life-threatening but preventable disease caused by the toxin of Clostridium tetani, a ubiquitous, spore-forming, gram-positive bacillus found in high concentrations in soil and animal excrement. Reported tetanus cases have declined >95%, and deaths from tetanus have declined >99% in the United States since 1947, when the disease became reportable nationally. To update a previous report and to determine the populations at greatest risk for the disease, CDC analyzed cases reported to the National Notifiable Diseases Surveillance System (NNDSS) during 2001--2008. This report summarizes the results of that analysis, which found that 233 tetanus cases were reported during 2001--2008; among the 197 cases with known outcomes, the case-fatality rate was 13.2%. Average annual incidence during that period was 0.10 per 1 million population overall and 0.23 among persons aged ≥65 years. Incidence among Hispanics was nearly twice that among non-Hispanics, a difference accounted for by 16 cases among Hispanic injection drug users (IDUs). Among the 92 patients for whom tetanus toxoid-containing (TT) vaccination status was available, 37 (40.2%) had received no doses of TT vaccine. Thirty (15.4%) of 195 patients had diabetes, and 27 (15.3%) of 176 were IDUs. Of 51 patients with an acute wound and a surveillance report complete enough to evaluate tetanus prophylaxis, 49 (96.1%) had not received appropriate prophylaxis. Tetanus remains a rare but life-threatening disease in the United States. Health-care providers should ensure up-to-date TT vaccination of all their patients, especially persons aged ≥65 years, persons with diabetes, and injection drug users.     

Malignant mesothelioma mortality in the United States, 1999-2001

Malignant mesothelioma is strongly associated with asbestos exposure. This paper describes demographic, geographic, and occupational distributions of mesothelioma mortality in the United States, 1999-2001. The data (n = 7,524) were obtained from the National Center for Health Statistics multiple-cause-of-death records. Mortality rates (per million per year) were age-adjusted to the 2000 U.S. standard population, and proportionate mortality ratios (PMRs) were calculated by occupation and industry, and adjusted for age, sex, and race. The overall age-adjusted mortality rate was 11.52, with males (22.34) showing a sixfold higher rate than females (3.94). Geographic distribution of mesothelioma mortality is predominantly coastal. Occupations with significantly elevated PMRs included plumbers/pipefitters and mechanical engineers. Industries with significantly elevated PMRs included ship and boat building and repairing, and industrial and miscellaneous chemicals. These surveillance findings can be useful in generating hypotheses and developing strategies to prevent mesothelioma.     

Availability of pediatric services and equipment in emergency departments: United States, 2002-03

OBJECTIVES: This report presents estimates on the availability of pediatric services, expertise, and supplies for treating pediatric emergencies in U.S. hospitals. METHODS: The Emergency Pediatric Services and Equipment Supplement (EPSES) was a self-administered questionnaire added to the 2002-03 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS samples non-Federal, short-stay and general hospitals in the United States. The EPSES content was based on the 2001 guidelines for pediatric services, medical expertise, small-sized supplies, and equipment for emergency departments (EDs) developed by the American Academy of Pediatrics (AAP) and the American College of Emergency Physicians (ACEP). Combined response rate for both years was 86 percent. Estimates were weighted to produce average annual estimates of pediatric services, expertise, and equipment availability in EDs. RESULTS: One-half of hospitals (52.9 percent) admitted pediatric patients, but did not have a specialized inpatient pediatric ward. One-third (38.3 percent) admitted pediatric patients and had a separate pediatric ward; the remainder did not admit pediatric patients. Among those that did not admit pediatric cases, 30.4 percent were in counties that had a children's hospital. One-quarter of EDs had access 24 hours and 7 days a week to a board-certified pediatric emergency medicine attending physician. Only 5.5 percent had all recommended pediatric supplies, but one-half had greater than 85 percent of recommended supplies. Most hospitals without pediatric trauma service (90.7 percent) or pediatric intensive care units (97.5 percent) transferred critical pediatric patients to hospitals with these services. EDs in hospitals with specialized inpatient facilities for children were more likely to meet the AAP and ACEP guidelines for pediatric ED services, expertise, and supplies.     

Racial/ethnic disparities in preschool immunizations: United States, 1996-2001

OBJECTIVES: We examined current racial/ethnic differences in immunization coverage rates among US preschool children. METHODS: Using National Immunization Survey data from 1996 through 2001, we compared vaccination coverage rates between non-Hispanic White, non-Hispanic Black, Hispanic, and Asian preschool children. RESULTS: During the 6-year study period, the immunization coverage gap between White and Black children widened by an average of 1.1% each year, and the gap between White and Hispanic children widened by an average of 0.5% each year. The gap between White and Asian children narrowed by an average of 0.8% each year. CONCLUSIONS: Racial/ethnic disparities in preschool immunization coverage rates have increased significantly among some groups; critical improvements in identifying, understanding, and addressing race/ethnicity-specific health care differences are needed to achieve the Healthy People 2010 goal of eliminating disparities.     

Antimicrobial drug prescription in ambulatory care settings,United States, 1992-2000

During the 1990s, as antimicrobial resistance increased among pneumococci, many organizations promoted appropriate antimicrobial use to combat resistance. We analyzed data from the National Ambulatory Medical Care Survey, an annual sample survey of visits to office-based physicians, and the National Hospital Ambulatory Medical Care Survey, an annual sample survey of visits to hospital emergency and outpatient departments, to describe trends in antimicrobial prescribing from 1992 to 2000 in the United States. Approximately 1,100-1,900 physicians reported data from 21,000-37,000 visits; 200-300 outpatient departments reported data for 28,000-35,000 visits; approximately 400 emergency departments reported data for 21,000-36,000 visits each year. In that period, the population- and visit-based antimicrobial prescribing rates in ambulatory care settings decreased by 23% and 25%, respectively, driven largely by a decrease in prescribing by office-based physicians. Antimicrobial prescribing rates changed as follows: amoxicillin and ampicillin, -43%; cephalosporins, -28%; erythromycin, -76%; azithromycin and clarithromycin, +388%; quinolones, +78%; and amoxicillin/clavulanate, +69%. This increasing use of azithromycin, clarithromycin, and quinolones warrants concern as macrolide- and fluoroquinolone-resistant pneumococci are increasing.     

Antimicrobial resistance among Campylobacter strains, United States, 1997-2001

We summarize antimicrobial resistance surveillance data in human and chicken isolates of Campylobacter. Isolates were from a sentinel county study from 1989 through 1990 and from nine state health departments participating in National Antimicrobial Resistance Monitoring System for enteric bacteria (NARMS) from 1997 through 2001. None of the 297 C. jejuni or C. coli isolates tested from 1989 through 1990 was ciprofloxacin-resistant. From 1997 through 2001, a total of 1,553 human Campylobacter isolates were characterized: 1,471 (95%) were C. jejuni, 63 (4%) were C. coli, and 19 (1%) were other Campylobacter species. The prevalence of ciprofloxacin-resistant Campylobacter was 13% (28 of 217) in 1997 and 19% (75 of 384) in 2001; erythromycin resistance was 2% (4 of 217) in 1997 and 2% (8 of 384) in 2001. Ciprofloxacin-resistant Campylobacter was isolated from 10% of 180 chicken products purchased from grocery stores in three states in 1999. Ciprofloxacin resistance has emerged among Campylobacter since 1990 and has increased in prevalence since 1997.     

Progress in immunization information systems - United States, 2010

Immunization information systems (IIS) are confidential, computerized, population-based systems that collect and consolidate vaccination data from vaccination providers and provide important tools for designing and sustaining effective immunization strategies at the provider and immunization program levels. These tools include clinical decision support, vaccination coverage reports, interoperability with electronic health record systems, vaccine inventory management, and the ability to generate reminder and recall messages. In 2010, based on strong evidence of effectiveness, the Task Force on Community Preventive Services recommended IIS use as a means of increasing vaccination rates. A?Healthy People 2020 target (IID-18) is to increase to 95% the proportion of children aged <6 years whose immunization records are in fully operational, population-based IIS. To monitor progress toward program goals, CDC annually surveys 56 immunization program grantees (50 states, five cities, and the District of Columbia) using the IIS Annual Report (IISAR). Results from the 2010 IISAR (completed by 54 grantees) indicate that 82% (18.8 million) of U.S. children aged <6 years participated in IIS, as defined by having at least two recorded vaccinations, an increase from 78% (18.0 million) in 2009. Among 52 grantees who responded to questions about the Vaccine Tracking System (VTrckS), CDC's new national vaccine ordering and inventory management system for publicly purchased vaccine, 38 (73%) indicated their intention to use the IIS in their state or city to interface with VTrckS. Use of IIS to interface with VTrckS might provide additional incentive for vaccination providers to participate in IIS and enhance IIS utility by supporting efficient and effective methods for providers to order vaccine and track inventory and by promoting greater accountability of publicly purchased vaccine.     

Molecular epidemiology of measles viruses in the United States, 1997-2001

From 1997 to 2001, sequence data from 55 clinical specimens were obtained from confirmed measles cases in the United States, representing 21 outbreaks and 34 sporadic cases. Sequence analysis indicated the presence of 11 of the recognized genotypes. The most common genotypes detected were genotype D6, usually identified from imported cases from Europe, and genotype D5, associated with importations from Japan. A number of viruses belonging to genotype D4 were imported from India and Pakistan. Overall, viral genotypes were determined for 13 chains of transmission with an unknown source of virus, and seven different genotypes were identified. Therefore, the diversity of Measles virus genotypes observed in the United States from 1997 to 2001 reflected multiple imported sources of virus and indicated that no strain of measles is endemic in the United States.     

Immunization information systems progress - United States, 2005

Immunization registries are confidential, computerized information systems that collect and consolidate vaccination data from multiple health-care providers, generate reminder and recall notifications, and assess vaccination coverage within a defined geographic area. A registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and linkages with electronic data sources, is called an immunization information system (IIS). This report summarizes data from CDC's 2005 Immunization Information System Annual Report (IISAR), a survey of grantees in 50 states, five cities, and the District of Columbia (DC) that receive funding under section 317b of the Public Health Service Act. These data indicated that approximately 56% of U.S. children aged <6 years participated in an IIS, an increase from 48% in 2004. Moreover, 75% percent of public vaccination provider sites and 44% of private vaccination provider sites submitted vaccination data to an IIS during July-December 2005. These findings underscore the need to increase the number of participating children, from the current 13 million to approximately 21 million, to assure 95% participation of children aged <6 years and improve the effectiveness of U.S. immunization programs.     

Societal cost of workplace homicides in the United States, 1992-2001

BACKGROUND: The Census of Fatal Occupational Injuries (CFOI) reported 8,672 workplace homicide victims between 1992 and 2001. Although rarely calculated, cost estimates are important for prevention and research efforts. METHODS: Societal costs were estimated using the cost-of-illness approach applied to CFOI data. The cost calculation model incorporated medical expenses, future earnings summed from the year of death until the year the decedent would have been 67, and household production losses (includes activities such as child care and housework). RESULTS: Workplace homicide had a total cost of nearly 6.5 billion dollars and a mean cost of 800,000 dollars between 1992 and 2001. The retail trade industry division had the highest number of homicides and total cost, 2.1 billion dollars, for males and 556,000 dollars for females. CONCLUSIONS: Estimates of the cost of work-related homicides can be used to improve occupational injury prevention and control program planning, policy analysis, evaluation of safety and health interventions, and advocacy for a safer work environment.     

Markets and medical care: the United States, 1993-2005

Many studies arguing for or against markets to finance medical care investigate "market-oriented" measures such as cost sharing. This article looks at the experience in the American medical marketplace over more than a decade, showing how markets function as institutions in which participants who are self-seeking, but not perfectly rational, exercise power over other participants in the market. Cost experience here was driven more by market power over prices than by management of utilization. Instead of following any logic of efficiency or equity, system transformations were driven by beliefs about investment strategies. At least in the United States' labor and capital markets, competition has shown little ability to rationalize health care systems because its goals do not resemble those of the health care system most people want.     

Motorcycle-related hospitalizations in the United States, 2001

OBJECTIVES: To estimate the prevalence of motorcycle-related hospitalization in the United States in 2001 and to describe the demographic, clinical, hospital, and financial characteristics associated with these injuries. METHODS: Cross-sectional analysis of the 2001 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was conducted in 2003. RESULTS: There were an estimated 30,505 (confidence interval=26,566-34,445) motorcycle-related hospital discharges in 2001. Approximately 62% of cases were aged > or =30 years, and males accounted for 89% of cases. The most common principal diagnoses were fractures of the lower limb (29.4%), fractures of the upper limb (13.1%), and intracranial injuries (12.3%). The mean length of stay was 5 days, the median hospital charge was $15,404, and the total estimated hospital charges were >$841 million. The majority of patients (56.5%) were admitted to large urban teaching hospitals, and these hospitals accounted for nearly 70% of all hospital charges. Approximately 26% of cases were self-pay or listed public insurance as the expected payer. CONCLUSIONS: These findings shed light on the substantial morbidity and financial impact of motorcycle-related injuries. Renewed and strengthened prevention efforts are warranted.     

Fall injury episodes among noninstitutionalized older adults: United States, 2001-2003

OBJECTIVE: This report presents national estimates of fall injury episodes for noninstitutionalized U.S. adults aged 65 years and over, by selected characteristics. Circumstances surrounding the fall injury and activity limitations and utilization of health care resulting from the fall injury are also presented. METHODS: Combined data from the 2001-2003 National Health Interview Surveys (NHIS), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS), were analyzed to produce estimates for the U.S. civilian noninstitutionalized population. Data on nonfatal medically attended fall injuries occurring within the 3 months preceding the interview were obtained from an adult family member. RESULTS: The annualized rate of fall injury episodes for noninstitutionalized adults aged 65 years and over in 2001-2003 was 51 episodes per 1,000 population. Rates of fall injuries increased with age, and were higher for women compared with men. Non-Hispanic white older adults had higher rates of fall injuries compared with non-Hispanic black older adults. Older adults with certain chronic conditions and activity limitations had higher rates of fall injuries compared with older adults without these conditions. The most common cause of fall injuries among older adults was slipping, tripping, or stumbling, and most fall injuries occurred inside or around the outside of the home. Nearly 60 percent of older adults who experienced a fall injury visited an emergency room for treatment or advice. Nearly one-third of older adults experiencing a fall injury needed help with activities of daily living as a result, and over one-half of these persons expected to need this help for at least 6 months. A similar percentage experienced limitation in instrumental activities of daily living as a result of fall injuries. CONCLUSION: Fall injuries remain very prevalent among older adults and result in high health care utilization and activity limitations. Rates of fall injuries vary by demographic and health characteristics of older noninstitutionalized adults.     

Heat-related deaths--Chicago,Illinois, 1996-2001, and United States, 1979-1999

Heat waves (i.e., >/=3 consecutive days of air temperatures >/=90 degrees F [>/=32.2 degrees C]) are meteorologic events that contribute significantly to heat-related deaths. Exposure to excessive heat can cause illness, injury, and death. This report describes four cases of heat-related deaths, as reported by the Office of the Medical Examiner, Cook County, Chicago, that occurred during 1996-2001; summarizes total heat-related deaths in Chicago during 1996-2001; and compares the number of heat-related deaths during the 1995 and 1999 Chicago heat waves. This report also summarizes trends in the United States during 1979-1999, describes risk factors associated with heat-related deaths and symptoms, and outlines preventive measures for heat-related illness, injury, and death. Persons at risk for heat-related death should reduce strenuous outdoor activities, drink water or nonalcoholic beverages frequently, and seek air conditioning.