Prevalence of diabetes--U.S. Virgin Islands, 1999-2001

The U.S. Virgin Islands (USVI) comprises four islands (St. Croix, St. John, St. Thomas, and Water Island) (2000 population: 108,612) located 70 miles east of Puerto Rico. The median age of persons residing in USVI is 33.4 years (range: 0-110 years), and 87% are aged <60 years; the majority of the residents are either black (76.2%) or Hispanic (14.0%). In 1997, diabetes was the fifth leading cause of death in USVI. Historically, the prevalence of diabetes has been lower among blacks in USVI than among blacks in the 50 states. To characterize the prevalence of diabetes in USVI, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) for 1999-2001. This report summarizes the findings from the analysis, which indicate that approximately 8.0% of USVI residents aged >/=18 years have diagnosed diabetes, and the prevalence of diabetes among blacks and Hispanics in USVI is comparable to that among blacks and Hispanics in the 50 states. To prevent the burden of diabetes and diabetes-related complications in residents and to improve the quality of life for persons with diabetes, initiatives in USVI should target all persons with diabetes.     

Metabolic syndrome among Caribbean-born persons living in the U.S. Virgin Islands.

OBJECTIVES: To determine the frequency of the metabolic syndrome (MS) among four subpopulations in the United States Virgin Islands and to estimate the risk for the MS that is associated with waist circumference cutpoints among overweight and obese individuals. METHODS: In a study undertaken from 1995 to 1999, data on demographic characteristics, anthropometric measurements, blood pressure measurements, and a blood sample were obtained from a population-based cohort of 893 Caribbean-born persons from four population subgroups who were living on Saint Croix (the largest island of the U.S. Virgin Islands) and who did not have a history of diagnosed diabetes. The four subpopulations were: (1) Hispanic white, (2) Hispanic black, (3) non-Hispanic black born in the U.S. Virgin Islands, and (4) non-Hispanic black born elsewhere in the Caribbean. Fasting blood samples were analyzed for glucose, insulin, triglycerides, and high-density lipoprotein cholesterol (HDL-C). National Cholesterol Education Program Adult Treatment Panel III guidelines were used to identify the MS. Insulin resistance was estimated by the homeostasis model assessment (HOMA-IR) method. RESULTS: The overall prevalence of the MS in the sample was 20.5% (95% confidence interval (CI) = 15.3%-25.7%). Persons who had classified themselves as both Hispanic and black had the highest frequency (27.8% (95% CI = 16.3%-39.3%)) of the MS and the highest HOMA-IR scores. After controlling for lifestyle factors and HOMA-IR, Hispanic ethnicity was independently associated with an increased risk of having the MS (odds ratio (OR) = 1.82, (95% CI = 1.07-3.07)), high triglycerides (OR = 3.66 (95% CI = 2.18-6.15)), and low HDL-C (OR = 1.60 (95% CI = 1.04-2.45)). A waist circumference of > 88 cm was associated with an increased risk of metabolic abnormalities among overweight and obese women. CONCLUSIONS: The frequency of the MS among Caribbean-born persons in the U. S. Virgin Islands is comparable to the frequency of the MS among the general population on the mainland of the United States. Among Caribbean-born persons living in the U.S. Virgin Islands, those who are Hispanic blacks may have a greater risk of cardiovascular disease than do other groups.     

Cardiovascular Disease Among Black Americans: Comparisons Between the U.S. Virgin Islands and the 50 U.S. States

Objectives

Consistent findings show that black Americans have high rates of cardiovascular disease (CVD) and related behavioral risk factors. Despite this body of work, studies on black Americans are generally limited to the 50 U.S. states. We examined variation in CVD and related risk factors among black Americans by comparing those residing within the U.S. Virgin Islands (USVI) with those residing in the 50 U.S. states and Washington, D.C. (US 50/DC) and residing in different regions of the US 50/DC (Northeast, Midwest, South, and West).

Methods

Using data from the 2007 and 2009 Behavioral Risk Factor Surveillance System, we compared CVD and CVD risk factor prevalence in non—Hispanic black people (≥20 years of age) in the USVI and US 50/DC, examining the relative contributions of health behaviors, health insurance, and socioeconomic status (SES).

Results

Accounting for age, sex, education, health insurance, and health behaviors, US 50/DC black Americans were significantly more likely than USVI black people to report ever having a stroke and coronary heart disease, and to be hypertensive, diabetic, or obese. While there was heterogeneity by region, similar patterns emerged when comparing the USVI with different regions of the US 50/DC.

Conclusion

USVI black people have lower CVD and risk factor prevalence than US 50/DC black people. These lower rates are not explained by differences in health behaviors or SES. Understanding health in this population may provide important information on the etiology of racial/ethnic variation in health in the U.S. and elsewhere, and highlight relevant public health policies to reduce racial/ethnic group disparities.Consistent findings show that black Americans have the highest rates of cardiovascular disease (CVD) compared with any other racial/ethnic group in the United States, seriously diminishing life expectancy and physical, social, and economic well-being throughout the life course.^1,2 Despite this large and rapidly growing body of work, studies on black Americans are largely limited to the 50 U.S. states and District of Columbia (hereafter called US 50/DC). Importantly, black Americans also reside in U.S. territories, and including these populations in health studies may provide a more thorough and nuanced picture of the factors associated with health and well-being among black Americans.Previous research has shown that examining the association between race/ethnicity and health in sites outside of the US 50/DC allows us to better understand how race and context intersect to explain health.^3–5 Prior research indicates that CVD risk factor prevalence among individuals of African origin varies across regions of the U.S. and throughout the world.^3–15 For example, in a well-known international collaborative study on CVD of populations in the African diaspora (collected from 1991 to 1995), large variations in the prevalence of diabetes, body mass index (BMI), and hypertension were found.^6,11 Geographic variation in hypertension and stroke among black people in the US 50/DC has also been examined.^9,16 However, this work has not been extended to study black Americans in U.S. territories. We sought to fill an important gap in the literature by providing a comparative study of black Americans in the US 50/DC and the U.S. Virgin Islands (USVI).Although the health of individuals of African origin in the US 50/DC is often compared with individuals of African origin born and/or living outside of U.S. boundaries, such as Nigeria and Jamaica, little is known about the health of black Americans residing in the USVI. This comparison group might help to refine our understanding of racial disparities in CVD within the U.S. context.The USVI is a U.S. territory located in the Caribbean, and residents are predominantly black (76.2%).^17–20 Similar to the US 50/DC, many USVI black people are the descendants of slaves. However, unlike the rest of the U.S., slaves in the USVI were freed in 1848 following a slave revolt (while under the rule of Denmark), 17 years prior to emancipation in the U.S. The USVI was sold to the U.S. by Denmark in 1917.²¹ The USVI comprises three main islands—St. Croix, St. Thomas, and St. John—with approximately 106,405 residents according to 2010 U.S. Census data.²² Despite being U.S. citizens, the USVI population and its health have been largely overlooked in research, as well as in national policy and public health initiatives. In this study, we sought to answer two questions: (1) How does the CVD prevalence of black Americans in the US 50/DC compare with that of black Americans in the USVI?; and (2) If there are differences in CVD prevalence, what are the behavioral and sociodemographic mechanisms underlying these differences? Specifically, we examined the explanatory role of health behaviors, health insurance, and socioeconomic status (SES).Our findings may provide some insight into the health of an understudied population that, while sharing a racial designation and national identity with black Americans in the US 50/DC, has significant cultural and historical differences. Furthermore, comparing U.S. populations that share racial characteristics but not necessarily sociocultural ones may illuminate the role of social context and place in physical health statuses and their determinants.     

Awareness of stroke warning symptoms--13 States and the District of Columbia, 2005

Although the number of deaths from stroke has declined substantially since the 1960s, in 2004, stroke remained the third leading cause of death in the United States, after heart disease and cancer. Approximately 54% of U.S. stroke deaths in 2004 occurred outside of a hospital. Intravenous administration of tissue plasminogen activator has clinical benefits for patients with acute ischemic stroke; however, treatment should begin within 3 hours of symptom onset for these benefits to be realized. For hemorrhagic stroke, immediate surgery (e.g., aneurysm repair) is crucial to prevent rebleeding that results in serious impairment or death in 40% to 60% of cases. A revised objective of Healthy People 2010 is to increase to 83% the proportion of persons who are aware of the warning symptoms of stroke and the need to telephone 9-1-1 immediately if someone appears to be having a stroke (objective no. 12-8). To assess public awareness of stroke warning symptoms and the importance of seeking emergency care, CDC analyzed data from an optional module of the 2005 Behavioral Risk Factor Surveillance System (BRFSS) survey that was used in 13 states and the District of Columbia (DC). The results indicated that the percentages of respondents who recognized all five correct symptoms, identified an incorrect symptom, and recognized the need to telephone 9-1-1 was low; the percentage who met all three measures was 16.4%. In addition, disparities were observed by race/ethnicity, sex, and education level. Public health agencies, clinicians, and educators should continue to stress the importance of learning to recognize stroke symptoms and the need to telephone 9-1-1 when someone appears to be having a stroke.     

Community Perspectives on Contraception in the Context of the Zika Virus in the U.S. Virgin Islands: Implications for Communication and Messaging

BackgroundBetween January and October 2016, 575 symptomatic confirmed cases of Zika virus infection were reported in the U.S. Virgin Islands (USVI). Zika virus infection during pregnancy can cause serious birth defects. Preventing unintended pregnancy among women who choose to delay or avoid pregnancy is a primary strategy to reduce these adverse outcomes.MethodsA rapid assessment, using one men's and five women's focus groups (N = 43), was conducted to inform communication efforts to increase awareness of contraception as a means for preventing unintended pregnancy in the context of a Zika outbreak in the USVI.ResultsFindings showed that people of reproductive age were aware of the relationship between Zika virus infection during pregnancy and adverse birth outcomes. However, when discussing methods for prevention, participants did not include preventing unintended pregnancy as a strategy to reduce these adverse outcomes. When asked about family planning in the USVI, participants discussed that, for some, planning pregnancies is not common. Participants wanted communications about contraception to include available methods, side effects, costs, and safety. Optimal communication channels included social media and local spokespersons. Participants identified health care providers as a trusted information source.ConclusionsFindings from this assessment informed the design of a culturally appropriate communication strategy to raise awareness of the prevention of unintended pregnancy as a primary strategy to reduce Zika-related adverse birth outcomes in the USVI.     

Trends in U.S. health care spending, 2001

U.S. health care spending grew 8.7 percent to $5,035 per capita in 2001. Total public funding continued to accelerate, increasing 9.4 percent and exceeding private funding growth by 1.2 percentage points. This acceleration was due in part to increased Medicaid spending in the midst of a recession and payment increases for Medicare providers. Prompted by sluggish economic growth and by faster-paced health spending, health spending's share of GDP spiked 0.8 percentage points in 2001 to 14.1 percent.     

Disease and illness in U.S. mining, 1983-2001

OBJECTIVES: We describe inconsistencies in disease and illness reporting in U.S. mining, identify under-reporting of disease and illness in U.S. mining, and summarize selected disease and illness in U.S. mining from 1983 through 2001. METHODS: We summarized information on mining-related disease and illness data for the years 1983-2001 from the Mining Safety and Health Administration database (MSHA). RESULTS: Discrepancies exist in types of information collected by the Centers for Disease and Control, the National Institute for Occupational Safety and Health, and the Mining Safety and Health Administration database. Several factors, including a worker's fear of losing his or her job, health insurance, or other job-related benefits contribute to under-reporting of disease and illness information in the US mining industry. CONCLUSIONS: Since 1997, both number of workers employed in mining and disease and illness rates have decreased; however, the highest disease and illness rates in mining continue to be coal worker's pneumoconiosis and hearing loss.     

Pesticide exports from U.S. ports, 2001-2003

Analysis of U.S. Custom Service records for 2001-2003 indicates that nearly 1.7 billion pounds of pesticide products were exported from U.S. ports, a rate >32 tons/hour. Exports included >27 million pounds of pesticides whose use is forbidden in the United States. WHO Class 1a and 1b pesticides were exported at an average rate of >16 tons/day. Pesticide exports included >500,000 pounds of known or suspected carcinogens, with most going to developing countries; pesticides associated with endocrine disruption were exported at an average rate of >100 tons/day. Although the rate of export of banned products declined, as did exports of pesticides included in global conventions on Prior Informed Consent and Persistent Organic Pollutions, substantial quantities of hazardous products remain in trade. These products pose unacceptable risks in countries where unsafe use and storage practices are prevalent. Policy makers, growers, and scientists must undertake more aggressive efforts to foster sustainable agricultural practices globally.     

Preventable measles among U.S. residents, 2001-2004

Elimination of endemic measles has been achieved in the United States; however, measles continues to be imported from areas of the world where the disease remains endemic, resulting in substantial morbidity and expenditure of local, state, and federal public health resources. Measles among U.S. residents results from returning residents who become infected while living or traveling abroad, from contact or association with an infected traveler, or from an unknown source. This report summarizes surveillance data reported to CDC by state and local health departments regarding confirmed measles cases among U.S. residents during 2001-2004; an illustrative case report is included. The majority of measles cases occurring among U.S. residents can be prevented by following current recommendations for vaccination, including specific guidelines for travelers.     

Pesticide Exports from U.S. Ports, 2001–2003

Abstract

Analysis of U.S. Custom Service records for 2001-2003 indicates that nearly 1.7 billion pounds of pesticide products were exported from U.S. ports, a rate >32 tons/hour. Exports included >27 million pounds of pesticides whose use is forbidden in the United States. WHO Class la and Ib pesticides were exported at an average rate of >16 tons/day. Pesticide exports included >500,000 pounds of known or suspected carcinogens, with most going to developing countries; pesticides associated with endocrine disruption were exported at an average rate of >100 tons/day. Although the rate of export of banned products declined, as did exports of pesticides included in global conventions on Prior Informed Consent and Persistent Organic Pollutions, substantial quantities of hazardous products remain in trade. These products pose unacceptable risks in countries where unsafe use and storage practices are prevalent. Policy makers, growers, and scientists must undertake more aggressive efforts to foster sustainable agricultural practices globally.     

Weight-control practices among U.S. adults, 2001-2002

BACKGROUND: Approximately $50 billion a year is spent by Americans on weight-loss products and services. Despite the high cost, few national studies have described specific weight-loss and weight-maintenance practices among U.S. adults. This analysis describes the use of specific practices by U.S. adults who tried to lose weight or tried only not to gain weight during the previous 12 months. METHODS: Data were analyzed from the 2001-2002 National Health and Nutrition Examination Survey (NHANES) conducted on a nationally representative sample of the U.S. population. This study focused on adults aged 20 years or older who were both interviewed and examined (n =5027). RESULTS: Fifty-one percent of U.S. adults tried to control their weight in the previous 12 months, including those who tried to lose weight (34% of men, 48% of women) and those who tried only not to gain weight (11% vs 10%, respectively). Among 2051 adults who tried to control their weight, the top four practices were the same: ate less food (65% among those who tried to lose weight, 52% among those who tried only not to gain weight); exercised (61% vs 46%, respectively); ate less fat (46% vs 42%); and switched to foods with lower calories (37% vs 36%). Less than one fourth combined caloric restriction with the higher levels of physical activity (300 or more minutes per week) recommended in the 2005 dietary guidelines by the U.S. Department of Health and Human Services and U.S. Department of Agriculture. CONCLUSIONS: Although weight control is a common concern, most people who try do not use recommended combinations of caloric restriction and adequate levels of physical activity.     

Trends in U.S. health insurance coverage, 2001-2003

Against the backdrop of a sluggish economy and rapidly rising health insurance premiums, the proportion of Americans under age 65 covered by employer-sponsored insurance fell dramatically from 67 percent to 63 percent between 2001 and 2003. Although the decline in employer coverage could have spurred a large increase in the uninsured, the proportion of Americans without health insurance did not increase significantly, according to findings from the Center for Studying Health System Change's (HSC) Community Tracking Study Household Survey. Expansion of public health insurance--including Medicaid and the State Children's Health Insurance Program (SCHIP)--forestalled a significant increase in the uninsured, as the proportion of the under-65 population enrolled in public coverage increased from 9 percent to 12 percent.     

Human Papillomavirus Vaccination Awareness and Acceptability Among U.S.-Born and U.S. Foreign-Born Women Living in California

We examined human papillomavirus vaccine awareness and acceptance between U.S.-born and U.S. foreign-born women by utilizing California Health Interview Survey data from 1,672 women (ages 18–27) and 2,994 mothers (ages 28–65). Foreign-born women and mothers had lower vaccine awareness. Foreign-born young adult Latinas had greater vaccine acceptance than U.S.-born Latinas. Other factors associated with young adult women's vaccine acceptability were being younger, unmarried, and sexually active in the past year; having poorer self-reported health; and having heard of the vaccine. Variables associated with mothers’ vaccine acceptability were being White, insured, and unmarried; having had a Pap test in past 3 years; being less educated; and being impoverished.