Migration and substance use: evidence from the U.S. National Health Interview Survey

Representative data from the U.S. National Health Interview Survey are used to investigate the substance use patterns of immigrants and compare them to those of the native born populations. The information examined is from the 1991 supplementary Drug and Alcohol Use Data File, which examined the self-reported substance use behaviors of approximately 21,000 adults aged 18-44. Findings indicate that immigrants to the U.S. in the late twentieth century are less likely to use alcohol and other drugs than are native born citizens. Additional findings suggest assimilation processes by which exposure to mainstream American society leads to patterns of alcohol and illicit drug use among long term immigrants that approximates that of the native born population. The patterns of substance use observed among immigrants, however, are not consistent with acculturative stress mechanisms. These findings provide an important and representative profile of the substance use patterns of one of the largest international migration streams of the past one hundred years.     

The burden of atopic dermatitis in US adults: results from the 2013 National Health and Wellness Survey

Objectives: To characterize comorbidities, health-related quality-of-life (HRQoL), productivity, and healthcare resource use in adults with atopic dermatitis (AD) relative to those without AD, and to evaluate the impact of patient-reported AD severity on these outcomes.

Methods: Data were from the 2013 National Health and Wellness Survey (NHWS), which collected self-reported information on demographics, comorbidities, HRQoL (SF-36v2 Health Survey), productivity (Work Productivity and Impairment questionnaire [WPAI]), and healthcare utilization, which were weighted to the US general population. The AD cohort consisted of subjects who reported that they experienced AD within the past 12 months (n?=?428), and the non-AD cohort included all subjects who did not report experiencing AD (n?=?74,572); 366 AD subjects self-reported mild (n?=?182) or moderate/severe (n?=?184) disease. Univariable and multivariable analyses compared characteristics and outcomes between cohorts and between AD severity levels.

Results: The AD cohort was younger than non-AD cohort (44.3 vs. 46.6 years; P?=?0.0033), and had a higher proportion of females (64.4% vs. 51.8%; P?<?0.0001). Relative to the non-AD cohort, the AD cohort had a significantly higher prevalence of atopic conditions including nasal allergies (46.4% vs. 19.8%) and asthma (22.4% vs. 7.9%), and neuropsychiatric conditions such as anxiety (42.5% vs. 21.3%) and depression (37.2% vs. 20.9%) (all P?<?0.0001). Units of resource use (healthcare practitioner visits, emergency room, hospitalizations) were higher (all P?<?0.05) and HRQoL was poorer (P?<?0.0001) with AD. On the WPAI, AD employees reported almost twice as much lost work productivity as non-AD employees (30.0% vs. 16.3%; P?<?0.0001). No clear differences in outcomes were observed among patient-reported AD severity categories, except greater impairment of work productivity and daily activities in those with moderate/severe AD relative to mild.

Conclusions: The significant burden associated with AD relative to those without AD suggests an unmet need for more effective management strategies. There also appears to be a need for further characterization of disease severity and its impact on HRQoL.     

Erectile dysfunction with or without coexisting benign prostatic hyperplasia in the general US population: analysis of US National Health and Wellness Survey

Abstract

Objective:

Erectile dysfunction (ED) and benign prostatic hyperplasia (BPH) commonly affect older men. There is limited epidemiology information on coexisting ED and BPH. This study assessed self-reported prevalence of ED with or without a diagnosis of BPH (ED/DxBPH versus ED only) in US men.     

Neurobehavioral test performance in the third National Health and Nutrition Examination Survey

The third National Health and Nutrition Examination Survey (NHANES III) contained three computerized neurobehavioral tests from the Neurobehavioral Evaluation System (NES): simple reaction time, symbol–digit substitution and serial digit learning. The neurobehavioral data that were collected came from a nationally representative sample of adults 20–59 years old. Performance on the tests was related to sex, age, education level, family income and race-ethnicity. Performance decreased as age increased, and increased as education level and family income increased. Differences in performance between sexes, levels of education and racial-ethnic groups tended to decrease as family income increased. The relationship between age and performance on the symbol–digit substitution test varied by education level and by racial-ethnic group. The relationship between age and performance on the serial digit learning test varied by racial-ethnic group. Questionnaire variables that were related to performance on one or more of the tests included the reported amount of last night's sleep, energy level, computer or video game familiarity, alcoholic beverages within the last 3 h and effort. Persons who took the tests in English or Spanish performed differently on the symbol–digit substitution and serial digit learning tests. Performance on all the tests decreased as test room temperature increased.     

The relationships between blood lead levels and serum follicle stimulating hormone and luteinizing hormone in the National Health and Nutrition Examination Survey 1999-2002

The relationships between blood lead levels and serum follicle stimulating hormone and luteinizing hormone were assessed in a nationally representative sample of women, 35-60 years old, from the National Health and Nutrition Examination Survey 1999-2002. The blood lead levels of the women ranged from 0.2 to 17.0 μg/dL. The estimated geometric mean was 1.4 μg/dL, and the estimated arithmetic mean was 1.6 μg/dL. As the blood lead level increased, the concentration of serum follicle stimulating hormone increased in post-menopausal women, women who had both ovaries removed, and pre-menopausal women. The concentration of luteinizing hormone increased as blood lead level increased in post-menopausal women and women who had both ovaries removed. The lowest concentrations of blood lead at which a relationship was detected were 0.9 μg/dL for follicle stimulating hormone and 3.2 μg/dL for luteinizing hormone. Lead may act directly or indirectly at ovarian and non-ovarian sites to increase the concentrations of follicle stimulating hormone and luteinizing hormone.     

Study of cardiovascular disease biomarkers among tobacco consumers. Part 3: evaluation and comparison with the US National Health and Nutrition Examination Survey

Abstract

Cardiovascular disease (CVD) biomarkers of biological effect (BoBE), including hematologic biomarkers, serum lipid-related biomarkers, other serum BoBE, and one physiological biomarker, were evaluated in adult cigarette smokers (SMK), smokeless tobacco consumers (STC), and non-consumers of tobacco (NTC). Data from adult males and females in the US National Health and Nutrition Examination Survey and a single site, cross-sectional study of healthy US males were analyzed and compared. Within normal clinical reference ranges, statistically significant differences were observed consistently for fibrinogen, C-reactive protein (CRP), hematocrit, mean cell volume, mean cell hemoglobin, hemoglobin, white blood cells, monocytes, lymphocytes, and neutrophils in comparisons between SMK and NTC; for CRP, white blood cells, monocytes, and lymphocytes in comparisons between SMK and STC; and for folate in comparisons with STC and NTC. Results provide evidence for differences in CVD BoBE associated with the use of different tobacco products, and provide evidence of a risk continuum among tobacco products and support for the concept of tobacco harm reduction.     

Alcohol dependence in the 1990 US National Alcohol Survey: operationalizing and comparing two nosological systems

The criteria for alcohol dependence in both the ICD-10 and DSM-III-R nosologies were measured in a national general population survey, using 24 stem items and follow-ups. For current (12-month) dependence (at the criterion of 3+ components), the rate was 3.2% according to DSM-III-R criteria, and 5.4% according to ICD-10. The Kappa coefficient of agreement between the two systems for classification of individuals as currently dependent was 0.62, and for lifetime diagnosis the Kappa coefficient was 0.68. Prevalence for the individual components of each diagnosis and for the underlying items are given, and the contribution of each component to the overall dependence score is examined. Implications of the results for future epidemiological work with the two classifications are discussed.     

Predicted coronary risk for adults with coronary heart disease and low HDL-C: an analysis from the US National Health and Nutrition Examination Survey

ABSTRACT

Purpose: To assess the national prevalence of low levels of high-density lipoprotein cholesterol (HDL-C) among adults with coronary heart disease (CHD) and the relationship between low HDL-C and predicted rates of recurrent CHD events.

Methods: This study used data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) to examine the prevalence of risk factors for recurrent CHD events among survey respondents with existing CHD. The predicted probability of recurrent CHD events in the next 10 years was estimated using published Framingham Heart Study equations for secondary CHD prevention. All data analyses were weighted to produce national estimates using the NHANES sampling weights.

Results: This study included 1291 survey participants aged?≥?40 years who self-reported having coronary heart disease, angina, or heart attack. Of the study subjects with available HDL-C data, the percentage of respondents who had low HDL-C (<?40?mg/dL), intermediate HDL-C (40 to < 60?mg/dL), and high HDL-C (≥?60?mg/dL) was 29%, 50%, and 21%, respectively, based on the national weighted population estimate. For respondents with low HDL-C, the prevalence of diabetes in men and the prevalence of smoking in women were significantly higher than those with high HDL-C (?p?<?0.05). The predicted 10-year coronary risk for subjects with low HDL-C was considerably higher than for subjects with intermediate and high HDL-C. Although subjects with low HDL-C comprised only 29% of the population, they contributed approximately 38% of the subjects with predicted CHD events.

Limitations: The assessment of certain CHD risk factors and the existence of CHD in the NHANES surveys relied on self-reports, which are subject to recall bias.

Conclusions: Study results showed that US adults with CHD and low HDL-C will likely contribute a disproportionately high percentage to total CHD events in the next 10 years, suggesting the need for greater awareness of the consequences of low HDL-C.