Update: influenza-associated deaths reported among children aged <18 years--United States, 2003-04 influenza season

Since October, 42 influenza-associated deaths among children aged <18 years have been reported to CDC. All patients had influenza virus infection detected by rapid antigen testing or other laboratory testing methods. This report describes preliminary findings based on data provided from multiple states, as of December 17, 2003. To improve surveillance, CDC has requested that all influenza-associated deaths of children aged <18 years be reported to CDC through state health departments.     

Update: influenza-associated deaths reported among children aged <18 years--United States, 2003-04 influenza season

During the 2003-04 influenza season, CDC has received reports from state health departments regarding deaths among children with evidence of influenza virus infection. To help investigate these deaths, CDC has requested that all influenza-associated deaths among children aged <18 years be reported to CDC through state and local health departments during the 2003-04 season. This summary is based on preliminary data reported from 31 states as of January 6, 2004, and updates a previous report published in MMWR.     

Colorectal cancer test use among persons aged > or = 50 years--United States, 2001

Colorectal cancer is the second leading cause of cancer-related death in the United States. The lifetime risk for having colorectal cancer diagnosed is 6%. Screening measures decrease the incidence and mortality of colorectal cancer by detecting early disease and removing precancerous lesions. The U.S. Preventive Services Task Force recommends routine cancer screening for U.S. adults aged > or = 50 years with one or a combination of the following screening options: annual home fecal occult blood testing (FOBT), sigmoidoscopy every 5 years, colonoscopy every 10 years, or double contrast barium enema every 5 years. To estimate rates and evaluate trends for colorectal cancer test use among U.S. adults aged > or = 50 years, CDC analyzed data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS) on the use of FOBT and sigmoidoscopy/colonoscopy and compared the data for 2001 with those for 1997 and 1999. This report summarizes the results of that analysis, which indicate that despite small increases in the self-reported use of colorectal cancer tests, screening rates remain low. Efforts to increase awareness and encourage regular colorectal cancer screening should continue.     

Physical activity levels among children aged 9-13 years--United States, 2002

Three national health objectives for 2010 (objectives no. 22-6, 22-7, and 22-11) aim to increase levels of physical activity and reduce sedentary behavior among children and adolescents. To promote a healthy, more active lifestyle among U.S. youth, CDC developed the Youth Media Campaign (YMC), a national initiative to encourage children aged 9-13 years to engage in and maintain high levels of regular physical activity. To provide a baseline assessment of physical activity levels among children aged 9-13 years, CDC conducted the YMC Longitudinal Survey (YMCLS), a nationally representative survey of children aged 9-13 years and their parents. This report presents data from the survey, which indicate that 61.5% of children aged 9-13 years do not participate in any organized physical activity during their nonschool hours and that 22.6% do not engage in any free-time physical activity. Improving levels of physical activity among this population will require innovative solutions that motivate children and that address parents' perceived barriers to their children engaging in physical activity.     

Influenza and pneumococcal vaccination levels among persons aged > or = 65 years--United States, 2001

Two vaccine-preventable diseases, influenza and pneumococcal disease, contribute to the mortality of older persons in the United States. Influenza caused an average of 20,000 deaths per year during influenza epidemics in the United States from 1969 to 1996; persons aged > or = 65 years accounted for approximately 90% of these deaths. Pneumococcal disease caused approximately 3,400 deaths among persons aged > or = 65 years in the United States in 1998. National health objectives for 2010 include increasing influenza and pneumococcal vaccination levels to > or = 90% among persons aged > or = 65 years (objective nos. 14.29a and 14.29b, respectively). To assess progress toward achieving these objectives, CDC analyzed data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results, which indicate that the estimated point prevalences of influenza and pneumococcal vaccination were <80% among persons aged > or = 65 years in all reporting areas. Influenza vaccination levels during 2000-2001 decreased from 1998-1999 levels in 27 of 52 reporting areas; pneumococcal vaccination prevalence increased a median of 7 percentage points from 1999 to 2001. Continued efforts are needed to increase the proportion of older adults who receive influenza and pneumococcal vaccines; health-care providers should offer pneumococcal vaccine all year and should continue to offer influenza vaccine during December and throughout the influenza season, even after influenza activity has been documented in the community.     

Self-reported falls and fall-related injuries among persons aged > or =65 years--United States, 2006

Each year, an estimated one third of older adults fall, and the likelihood of falling increases substantially with advancing age. In 2005, a total of 15,802 persons aged > or =65 years died as a result of injuries from falls. However, the number of older adults who fall and are not injured or who sustain minor or moderate injuries and seek treatment in clinics or physician offices is unknown. To estimate the percentage of older adults who fell during the preceding 3 months, CDC analyzed data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated that approximately 5.8 million persons aged > or =65 years, or 15.9% of all U.S. adults in that age group, fell at least once during the preceding 3 months, and 1.8 million (31.3%) of those who fell sustained an injury that resulted in a doctor visit or restricted activity for at least 1 day. The percentages of women and men who fell during the preceding 3 months were similar (16.4% versus 15.2%, respectively), but women reported significantly more fall-related injuries than men (35.7% versus 24.6%, respectively). The effect these injuries have on the quality of life of older adults and on the U.S. health-care system reinforces the need for broader use of scientifically proven fall-prevention interventions.     

Methods of suicide among persons aged 10-19 years--United States, 1992-2001

In 2001, suicide was the third leading cause of death among persons aged 10-19 years. The most common method of suicide in this age group was by firearm (49%), followed by suffocation (mostly hanging) (38%) and poisoning (7%). During 1992-2001, although the overall suicide rate among persons aged 10-19 years declined from 6.2 to 4.6 per 100,000 population, methods of suicide changed substantially. To characterize trends in suicide methods among persons in this age group, CDC analyzed data for persons living in the United States during 1992-2001. This report summarizes the results of that analysis, which indicated a substantial decline in suicides by firearm and an increase in suicides by suffocation in persons aged 10-14 and 15-19 years. Beginning in 1997, among persons aged 10-14 years, suffocation surpassed firearms as the most common suicide method. The decline in firearm suicides combined with the increase in suicides by suffocation suggests that changes have occurred in suicidal behavior among youths during the preceding decade. Public health officials should develop intervention strategies that address the challenges posed by these changes, including programs that integrate monitoring systems, etiologic research, and comprehensive prevention activities.     

Racial disparities in diabetes mortality among persons aged 1-19 years--United States, 1979-2004

Diabetes is a chronic disease with a U.S. prevalence of 18 cases per 10,000 youths aged <20 years. With proper management and access to care, morbidity and mortality from diabetes are preventable, particularly in the pediatric population. Although diabetes is more common among non-Hispanic white youths, some studies report higher death rates among racial/ethnic minorities and among those in lower socioeconomic strata. In 2004, age-adjusted diabetes death rates for black persons in the United States were approximately twice those for white persons. However, no recent studies on racial disparities that focus specifically on the pediatric population have been conducted. To assess racial disparities in diabetes mortality among youths, CDC analyzed data on deaths with an underlying cause of diabetes among persons aged 1-19 years for the period 1979-2004. This report summarizes the results of that analysis, which determined that, during 1979-2004, diabetes death rates for black youths were approximately twice those for white youths. During 2003-2004, the annual average diabetes death rate per 1 million youths was 2.46 for black youths and 0.91 for white youths. Further study is needed to discern the specific reasons for increased diabetes mortality in black youths. Better identification and management of the disease among youths, especially among black youths, might help decrease racial disparities and prevent deaths from diabetes.     

Strength training among adults aged >/=65 years--United States, 2001

Strength training (also referred to as resistance training) enables adults to improve their overall health and fitness by increasing muscular strength, endurance, and bone density and by improving their insulin sensitivity and glucose metabolism. For older adults (i.e., persons aged >/=65 years), strength-training exercises are recommended to decrease the risk for falls and fractures and to promote independent living. The American College of Sports Medicine recommends that adults include strength training as part of a comprehensive physical activity program. A national health objective for 2010 is to increase to 30% the proportion of adults who perform, >/=2 days per week, physical activities that enhance and maintain muscular strength and endurance. To determine the percentage and characteristics of older adults who perform strength training consistent with this objective, CDC analyzed data from the 2001 National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which indicated that approximately 12% of persons aged 65-74 years and 10% of persons aged >/=75 years met the strength-training objective. These findings underscore the need for programs that encourage older adults to incorporate strength training into their lives along with regular physical activity.     

Influenza and pneumococcal vaccination coverage among persons aged > or = 65 years--United States, 2004-2005

Vaccination of persons at increased risk for complications from influenza and pneumococcal disease is a key public health strategy in the United States. During the 1990-1999 influenza seasons, approximately 36,000 deaths were attributed annually to influenza infection, with approximately 90% of deaths occurring among adults aged > or = 65 years. In 1998, an estimated 3,400 adults aged > or = 65 years died as a result of invasive pneumococcal disease. One of the Healthy People 2010 objectives is to achieve 90% coverage of noninstitutionalized adults aged > or = 65 years for both influenza and pneumococcal vaccinations (objective 14-29). To assess progress toward this goal, this report examines vaccination coverage for persons interviewed in the 2004 and 2005 Behavioral Risk Factor Surveillance System (BRFSS) surveys. The 2004-05 influenza season was characterized by an influenza vaccine shortage. As a result, the Advisory Committee on Immunization Practices (ACIP) issued recommendations that influenza vaccine be reserved for persons in priority groups, including persons aged > or = 65 years, and that others should defer vaccination until supply was sufficient. The results of this assessment indicated that, overall, influenza vaccination coverage was lower in the 2005 survey year than in 2004, whereas pneumococcal vaccination coverage was nearly unchanged from 2004 to 2005. In both years, influenza and pneumococcal vaccination coverage varied from state to state. Continued measures are needed to increase the proportion of older adults who receive influenza and pneumococcal vaccines; health-care providers should offer pneumococcal vaccine all year and should continue to offer influenza vaccine during December and throughout the influenza season, even after influenza activity has been documented in the community.     

Diagnosed diabetes among American Indians and Alaska Natives aged <35 years--United States, 1994-2004

Diabetes disproportionately affects American Indians/Alaska Natives (AI/ANs), and the prevalence of diabetes is increasing among young persons in certain AI/AN populations. To examine trends in the prevalence of diagnosed diabetes among AI/ANs aged <35 years, CDC analyzed patient data collected by the Indian Health Service (IHS) during 1994-2004. This report summarizes the results of that analysis, which indicated that the age-adjusted prevalence of diagnosed diabetes increased from 8.5 to 17.1 per 1,000 population among AI/ANs aged <35 years who use IHS health-care services. Because young persons with diabetes have more years of disease and greater risk for costly and disabling complications early in life, diabetes prevention programs targeting younger age groups have become increasingly important in AI/AN communities.     

Public health and aging: hospitalizations for stroke among adults aged >/=65 years--United States, 2000

Stroke is the third leading cause of death in the United States and a major cause of serious, long-term disability among adults; the projected cost of stroke during 2003 is $51 billion, including $12 billion in nursing home costs. During 1988-1997, the rate of hospital admissions for stroke increased 18.6%, from approximately 560 per 100,000 population in 1988 to 664 in 1997. To assess the burden of stroke hospitalizations and discharge status after hospitalization among U.S. residents aged >/=65 years, CDC analyzed Medicare hospital claims for persons with stroke during 2000 for the 50 states and the District of Columbia (DC). This report summarizes the results of that analysis, which indicate that geographic variation exists in both rates of hospitalization for stroke and patient discharge status. Reducing the burden of stroke in the United States will require primary prevention and control of risk factors, public education, early evaluation and treatment of persons with acute stroke, and effective secondary prevention among persons living with stroke.     

State-specific prevalence of cigarette smoking among adults and quitting among persons aged 18-35 years--United States, 2006

Each year, cigarette smoking in the United States causes approximately 438,000 deaths and results in an estimated $167 billion in health-care costs plus lost productivity attributed to premature deaths. Although smoking cessation has major and immediate health benefits for persons of all ages, the benefit is greater the earlier in life a person quits. Persons who quit before the age of 35 years have a life expectancy similar to that of those who never smoked. To assess the prevalence of current smoking among all adults and among those aged 18-35 years, and to assess the proportion of smokers aged 18-35 years who have quit or attempted to quit, CDC analyzed state and area data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated substantial variation in current cigarette smoking prevalence among the 50 states, the District of Columbia (DC), Puerto Rico (PR), and the U.S. Virgin Islands (USVI) (range: 9.1%-28.6%). The majority of current smokers aged 18-35 years reported that they had attempted to quit smoking during the past year (median: 58.6%; range: 48.0% [Nevada] to 69.2% [New Mexico]), and the median proportion of ever smokers aged 18-35 years who had quit smoking was 34.0% (range: 27.0% [Louisiana] to 47.9% [Utah]). Effective, comprehensive tobacco-use prevention and control programs should be continued and expanded to further reduce smoking initiation by young persons and to encourage cessation as early in life as possible.     

Unintentional strangulation deaths from the "choking game" among youths aged 6-19 years--United States, 1995-2007

The "choking game" is defined as self-strangulation or strangulation by another person with the hands or a noose to achieve a brief euphoric state caused by cerebral hypoxia. Participants in this activity typically are youths. Serious neurologic injury or death can result if strangulation is prolonged. In recent years, news media reports have described numerous deaths among youths attributed to the choking game. Because no traditional public health dataset collects mortality data on this practice, CDC used news media reports to estimate the incidence of deaths from the choking game. This report describes the results of that analysis, which identified 82 probable choking-game deaths among youths aged 6-19 years, during 1995-2007. Seventy-one (86.6%) of the decedents were male, and the mean age was 13.3 years. Parents, educators, and health-care providers should become familiar with warning signs that youths are playing the choking game.     

Nonfatal self-inflicted injuries among adults aged > or = 65 years--United States, 2005

In 2005, an estimated 372,722 persons in the United States were treated in hospital emergency departments (EDs) for intentional, nonfatal self-inflicted injuries. Nonfatal self-inflicted injuries are most common among adolescents and young adults; few studies have investigated these types of injuries among adults aged > or =65 years. However, older adults are one of the fastest-growing population groups in the United States and can require more extensive and more costly medical treatment than younger adults. To characterize ED visits for nonfatal self-inflicted injuries among U.S. adults aged > or =65 years, CDC analyzed ED visits for 2005 using data from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP). This report summarizes the results of that analysis, which indicated that, in 2005, adults aged > or =65 years made an estimated 7,105 visits to EDs (i.e., 19.3 visits per 100,000 population) for nonfatal self-inflicted injuries, and ED health-care providers attributed 80.4% of these visits to suicidal behavior. In addition, a significantly higher percentage of adults aged > or =65 years compared with younger adults were hospitalized after ED visits for suicidal behavior. Comprehensive prevention strategies that combine community outreach, crisis intervention, and clinical management are needed to decrease morbidity and mortality from suicidal behavior among older adults.     

National vaccination coverage among adolescents aged 13-17 years--United States, 2006

Before 2005, vaccines were administered during adolescence to "catch up" children with vaccinations not received at a younger age, with the exception of the tetanus and diphtheria (Td) booster. However, since 2005, three new vaccines specifically for older children have been licensed and recommended in the United States: meningococcal conjugate vaccine (MCV4) for those aged 11-12 years and 15 years; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine for those aged 11-12 years (or at ages 13-18 years if not received at ages 11-12 years); and human papillomavirus (HPV) vaccine for girls aged 11-12 years (or at ages 13-18 years if not received at 11-12 years). Since 1996, the Advisory Committee on Immunization Practices (ACIP) and professional organizations, including the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Medical Association (AMA), have recommended a health-care visit at ages 11-12 years for receipt of recommended vaccinations. In addition, a Healthy People 2010 objective (14-27) is to achieve > or =90% vaccination coverage among adolescents aged 13-15 years for certain vaccines. In 2006, for the first time, the National Immunization Survey (NIS) collected provider-reported vaccination information for adolescents aged 13-17 years (NIS-Teen). This report describes the results of that survey, which indicated that the Healthy People 2010 target has not been met for any of the vaccines analyzed. HPV vaccination coverage is not included in this report because NIS-Teen was conducted before HPV vaccination recommendations were published in March 2007. Routine health-care visits for adolescents should be encouraged, with emphasis on a visit at ages 11-12 years, and providers should continue to assess the need for vaccinations at every opportunity. NIS-Teen will be conducted annually to monitor coverage with recommended vaccines during ages 11-17 years and to identify groups with lower coverage.     

Racial/ethnic disparities in influenza and pneumococcal vaccination levels among persons aged > or =65 years--United States, 1989-2001

Influenza and pneumococcal diseases are key causes of mortality among persons aged > or =65 years, accounting for approximately 36,000 and 3,400 deaths per year, respectively, during 1990-1999. Substantial racial/ethnic disparities in adult vaccination have been documented in national surveys. Although the national health objective for 2000 of 60% receipt of influenza vaccination during the preceding 12 months by persons aged > or =65 years (objective no. 20.11) was met in 1997, and the objective of 60% for pneumococcal vaccination was nearly met in 2000, vaccine coverage levels among non-Hispanic blacks and Hispanics were 31% and 30%, respectively, compared with 57% for non-Hispanic whites. To characterize these disparities, CDC analyzed data from the 2000 and 2001 National Health Interview Surveys (NHIS) and examined trends in NHIS results for 1989-2001. This report summarizes the results of these analyses, which indicate that marked differences in vaccination coverage by race/ethnicity are observed even among persons most likely to be vaccinated (e.g., persons with the highest education level and persons with frequent visits to health-care providers). Racial/ethnic disparities in influenza and pneumococcal vaccination coverage have persisted over time. Several approaches to reduce these disparities are needed, including increasing demand for vaccination among racial/ethnic minority populations and the use of standing orders and other systems changes that promote vaccination.     

Public health and aging: influenza vaccination coverage among adults aged > or =50 years and pneumococcal vaccination coverage among adults aged > or =65 years--United States, 2002

Vaccination of persons at risk for complications from influenza and pneumococcal disease is a key public health strategy in preventing morbidity and mortality in the United States. During the 1990-1999 influenza seasons, approximately 36,000 deaths were attributed annually to influenza infection, with approximately 90% of deaths occurring among adults aged > or =65 years. In 1998, an estimated 3,400 adults aged > or =65 years died as a result of invasive pneumococcal disease. One of the national health objectives for 2010 is to achieve 90% coverage of noninstitutionalized adults aged > or =65 years for both influenza and pneumococcal vaccinations (objective no. 14.29). In 2000, the Advisory Committee on Immunization Practices (ACIP) broadened the universal recommendations for influenza vaccination to include adults aged 50-64 years in addition to adults aged > or =65 years. To assess progress toward achieving the 2010 national health objective and implementing the ACIP recommendations, CDC analyzed data from the 2002 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicate that influenza and pneumococcal vaccination levels among adults aged > or =65 years and influenza vaccination levels among adults aged 50-64 years varied widely among states/areas and racial/ethnic populations. Innovative approaches are needed to increase vaccination coverage, particularly among certain populations.     

Use of mammograms among women aged > or = 40 years--United States, 2000-2005

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer-related death (after lung and bronchial cancer) among women in the United States. In 2002, at least 182,125 women in the United States had a diagnosis of invasive breast cancer, and 41,514 died from the disease. Screening mammography can reduce mortality from breast cancer by approximately 20%-35% in women aged 50-69 years and approximately 20% in women aged 40-49 years. Organizations including the American Medical Association, American College of Obstetricians and Gynecologists, and American Cancer Society support mammography screening beginning at age 40 years, although these groups vary in their recommendations regarding intervals for rescreening. The U.S. Preventive Services Task Force, an independent panel of private-sector experts in prevention and primary care convened by the Department of Health and Human Services, recommends that women aged < or = 40 years be screened for breast cancer with a mammogram every 1-2 years. Although mammogram use increased substantially during the 1990s, results from a recent cohort study of health maintenance organization members revealed declining screening rates during 1999-2002. This report describes Behavioral Risk Factor Surveillance System (BRFSS) findings that indicate a similar decreasing trend in self-reported use of mammograms among women aged < or = 40 years during 2000-2005. Continued declines in mammography use might result in increased breast cancer mortality.     

Use of cessation methods among smokers aged 16-24 years--United States, 2003

Smoking cessation among adolescent smokers is relatively rare, with approximately 15.6% of smokers aged 12-19 years quitting smoking in a 4-year period (approximately 4% per year). Rates for failed quitting attempts among younger smokers are higher than those for adults (43%), with approximately 58% of high-school smokers having tried to quit at least once for 1 day or longer in the preceding year. To track the history of quitting behavior among smokers aged 16-24 years, Roswell Park Cancer Institute (Buffalo, New York) initiated the 2-year longitudinal National Youth Smoking Cessation Survey (NYSCS) in 2003. This report summarizes key findings from the survey regarding lifetime use of smoking-cessation methods. The findings indicated that smokers aged 16-24 years who had tried to quit were more likely to use unassisted quitting methods than assisted quitting methods; none of the unassisted methods are recommended by the Public Health Service (PHS) clinical guidelines for treatment of tobacco use and dependence, whereas most of the assisted methods are recommended for adults and have been determined to be effective. Many youths aged 16-24 years are trying to quit smoking but often underestimate the rapid progression to tobacco dependence; therefore, PHS clinical practice guidelines for treating tobacco use and dependence recommend that certain clinical interventions proven to be effective among adults be used in youth-based approaches to cessation. In addition, other components of comprehensive tobacco-control programs also increase smoking cessation and should be implemented at CDC-recommended levels to lower tobacco use among youths and adults.