Aspirin use among U.S. adults: Behavioral Risk Factor Surveillance System

BACKGROUND: The role of aspirin in prevention of cardiovascular disease (CVD) and cardiovascular complications among people with diabetes has been examined. A Healthy People 2010 objective calls for increasing the proportion of people with diabetes aged>or=40 years who take aspirin>or=15 times per month. METHODS: Data from 2003 Behavioral Risk Factor Surveillance System were used to examine (1) the prevalence of aspirin intake, (2) aspirin use among those with CVD, (3) aspirin use among those with diabetes, (4) current status with respect to Healthy People objective 5-16, and (5) changes in aspirin intake from 1999. RESULTS: Daily or every-other-day aspirin use was reported by 36.2% of participants in 2003. Aspirin intake among those with CVD and diabetes was 82.8% and 62.6%, respectively. The Healthy People 2010 objective of increasing the proportion of adults with diabetes aged>or=40 years who take aspirin to 30% was achieved. The prevalence of aspirin intake was higher in 2003 compared to 1999 among all participants, those with CVD, and those with diabetes (relative increase of about 20%, 12%, and 36%, respectively). Most participants (74%) reported cardiovascular reasons for aspirin use. Among those without CVD or diabetes, the prevalence of aspirin intake increased with the increasing number of CVD risk factors. CONCLUSIONS: Regular aspirin use increased over a 4-year period. Greater use of inexpensive and easily accessible interventions to prevent cardiovascular events is encouraging. Increased efforts to continue preventive uses of available treatment and reduction in risk by modifying other risk factors will help lower future disease burden.     

Primary sources of health care among LGBTQ+ veterans: Findings from the Behavioral Risk Factor Surveillance System

Objective

This study examined the primary source of health care between veterans with lesbian, gay, bisexual, queer and similar identities (LGBTQ+) and non-LGBTQ+ veterans.

Data Sources and Study Setting

Veterans (N = 20,497) from 17 states who completed the CDC's Behavioral Risk Factor Surveillance System from 2016 to 2020, including the Sexual Orientation and Gender Identity and Health Care Access modules.

Study Design

We used survey-weighted multiple logistic regression to estimate average marginal effects of the prevalence of utilization of Veteran's Health Administration (VHA)/military health care reported between LGBTQ+ and non-LGBTQ+ veterans. Prevalence estimates were adjusted for age group, sex, race and ethnicity, marital status, educational attainment, employment status, survey year, and US state.

Data Collection Methods

Study data were gathered via computer-assisted telephone interviews with probability-based samples of adults aged 18 and over. Data are publicly available.

Principal Findings

Overall, there was not a statistically significant difference in estimated adjusted prevalence of primary use of VHA/military health care between LGBTQ+ and non-LGBTQ+ veterans (20% vs. 23%, respectively, p = 0.13). When examined by age group, LGBTQ+ veterans aged 34 and younger were significantly less likely to report primary use of VHA/military health care compared to non-LGBTQ+ veterans (25% vs. 44%, respectively; p = 0.009). Similarly, in sex-stratified analyses, fewer female LGBTQ+ veterans than female non-LGBTQ+ veterans reported VHA/military health care as their primary source of care (13% vs. 29%, respectively, p = 0.003). Implications and limitations to these findings are discussed.

Conclusions

Female and younger LGBTQ+ veterans appear far less likely to use VHA/military for health care compared to their cisgender, heterosexual peers; however, because of small sample sizes, estimates may be imprecise. Future research should corroborate these findings and identify potential reasons for these disparities.     

Health professionals' advice to Iowa adults with hypertension using the 2002 Behavioral Risk Factor Surveillance System

PURPOSE: We investigated the prevalence of hypertension-lowering lifestyle-modification advice given to adults living in Iowa. We sought to determine if persons with high blood pressure and those who are overweight receive more advice than do persons with normal blood pressure and a desirable body weight. METHODS: By using the 2002 Behavioral Risk Factor Surveillance System, we asked Iowa adults with (N=1050) and without (N=2514) high blood pressure five questions relating to the most recent Joint National Committee guidelines on lowering blood pressure. Respondents with high blood pressure were placed into normal weight and overweight categories. Chi-square analysis revealed group differences in amount of advice received. To reflect the true Iowa population, data were weighted by SPSS software. RESULTS: Compared with persons without high blood pressure, those with high blood pressure received more lifestyle-modification advice (p < .001) for eating less high-fat or high-cholesterol foods (28.3% vs. 12.5%), eating more fruits and vegetables (35.7% vs. 20.0%), exercising more (37.6% vs. 20.8%), losing weight (19.3% vs. 9.3%), and quitting smoking (80.5% vs. 64.6%). CONCLUSIONS: Although persons with multiple chronic-disease risk factors are given more advice, the prevalence of advice given to individuals when lifestyle changes may reduce risk factors is still very low. Methods of translating research on lifestyle modifications into practice are discussed.     

Walking trends among U.S. adults: the Behavioral Risk Factor Surveillance System, 1987-2000

OBJECTIVE: To examine trends in walking among adults in 31 states. METHODS: Trends by sociodemographic strata were analyzed from respondents who participated in the Behavioral Risk Factor Surveillance System (BRFSS). RESULTS: The prevalence of walking among men increased 3.8% (95% confidence interval [CI]=2.4-5.2), from 26.2% (95% CI=25.1-25.3) in 1987 to 30.1% (95% CI=29.4-30.8) in 2000. In women, walking increased 6.6% (95% CI=5.4-7.8), from 40.4% (95% CI=-39.4-41.1) to 46.9% (95% CI=46.2-47.6) during the same time period. However, the prevalence of walking three times a week for 30 minutes duration remained constant across all years. The largest increases occurred in minority subpopulations: 8.7% (95% CI=3.2-14.2) in Hispanic women, 8.5% (95% CI=4.4-12.6) non-Hispanic black women, and 7.0% (95% CI=2.3-11.7) in non-Hispanic black men. Walking was the most frequently reported activity among adults who met the national recommendations for regular physical activity (defined as five or more times a week for > or =30 minutes per session). CONCLUSIONS: Given the acceptability of walking across all sociodemographic subgroups, efforts to increase the frequency of walking could markedly increase the percentage of U.S. adults who engage in regular physical activity, a national priority identified in the Healthy People 2010 objectives for the nation.     

Comparability of contraceptive prevalence etimates for women from the 2002 Behavioral Risk Factor Surveillance System

OBJECTIVE: This article assesses the comparability of contraceptive use estimates for adult women obtained from the 2002 Behavioral Risk Factor Surveillance System (BRFSS), using the 2002 National Survey of Family Growth (NSFG) as a benchmark. The 2002 BRFSS uses data collection methods that are considerably different from the NSFG. METHOD: We compared demographic differences and national estimates of current contraceptive methods being used and reasons for nonuse. Variables were recoded in the BRFSS and NSFG systems to make the two samples comparable. RESULTS: Women in the NSFG and BRFSS were similar in age and race/ethnicity. Compared with the NSFG, the BRFSS sample was more educated and of higher income, less likely to be cohabiting, and more likely to be married. After adjusting for differences in the coding of hysterectomy, many BRFSS estimates for current contraceptive use were statistically similar to those from the NSFG. Small but statistically significant differences were found for vasectomy (7.7% and 6.3%), the pill (21.9% and 19.6%), rhythm (1.5% and 1.0%), the diaphragm (0.5% and 0.2%), and withdrawal (0.3% and 2.7%) for the BRFSS and NSFG, respectively. Major reasons for nonuse were similar: seeking pregnancy and currently pregnant. The percentage of women who were not currently sexually active was higher in the BRFSS (16.0%) compared with the NSFG (12.5%). CONCLUSIONS: The BRFSS is a useful source of population-based data on contraceptive use for reproductive health program planning; however, planners should be cognizant that lower-income women are not fully represented in telephone surveys.     

Trends in cigarette smoking among US adults with diabetes: findings from the Behavioral Risk Factor Surveillance System

BACKGROUND: Smoking substantially increases morbidity and mortality rates in people with diabetes. Previous studies have shown that the prevalence of smoking among people with diabetes is similar to that among people without diabetes. We sought to examine temporal trends in the prevalence of smoking among people with diabetes since 1990. METHODS: We analyzed data from the Behavioral Risk Factor Surveillance System for 1990-2001. RESULTS: The age-adjusted prevalence of smoking among adults with diabetes was 23.6% (men, 25.4%; women, 22.2%) in 1990 and 23.2% (men, 24.8%; women, 21.9%) in 2001. In comparison, the prevalence among participants without diabetes was 24.2% (men, 25.7%; women, 22.8%) in 1990 and 23.2% (men, 24.8%; women, 21.5%) in 2001. Thus, the prevalence of cigarette smoking was similar and remained stable from 1990 through 2001. Among participants with diabetes, significant decreases in the prevalence of smoking occurred among African Americans and those aged >/=65 years. CONCLUSIONS: New efforts and commitments to promote smoking cessation among people with diabetes are needed.     

Language spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics

Objectives. We examined self-reported health status, health behaviors, access to care, and use of preventive services of the US Hispanic adult population to identify language-associated disparities.Methods. We analyzed 2003 to 2005 Behavioral Risk Factor Surveillance System data from 45 076 Hispanic adults in 23 states, who represented 90% of the US Hispanic population, and compared 25 health indicators between Spanish-speaking Hispanics and English-speaking Hispanics.Results. Physical activity and rates of chronic disease, obesity, and smoking were significantly lower among Spanish-speaking Hispanics than among English-speaking Hispanics. Spanish-speaking Hispanics reported far worse health status and access to care than did English-speaking Hispanics (39% vs 17% in fair or poor health, 55% vs 23% uninsured, and 58% vs 29% without a personal doctor) and received less preventive care. Adjustment for demographic and socioeconomic factors did not mitigate the influence of language on these health indicators.Conclusions. Spanish-language preference marks a particularly vulnerable subpopulation of US Hispanics who have less access to care and use of preventive services. Priority areas for Spanish-speaking adults include maintenance of healthy behaviors, promotion of physical activity and preventive health care, and increased access to care.More than 1 in 10 US residents now speak Spanish at home, and approximately half of these persons report an ability to speak English less than “very well.”¹ Language preference and English language proficiency have previously been associated with health-related behaviors, disease prevalence, and receipt of health care services among Hispanics,^2–6 but lack of sufficient individual-level population-based data on ethnicity, socioeconomic position, acculturation, and language has limited our ability to document the extent of language-associated disparities or to understand their component causes.⁷The utility of national surveys in monitoring health disparities and informing public health interventions relies upon methodologic adaptation to the increasing diversity of the US population.⁸ One of the most important sources of national data for identifying emerging health problems, developing public health policies and targeted prevention programs, and tracking progress toward meeting the Healthy People 2010 objectives is the Behavioral Risk Factor Surveillance System (BRFSS) sponsored by the Centers for Disease Control and Prevention.⁹ The BRFSS has included an optional Spanish-language survey instrument since 1987, but until recently, few states conducted Spanish-language interviews. Spanish-language survey data are now available from 23 states, which together represent approximately 90% of the total US Hispanic population. Thus, it is newly possible to describe rates of common population health indicators for a nationally representative sample of Spanish-speaking adults and to broadly examine language-associated disparities within the US Hispanic population.We sought to (1) provide a broad, national overview of the current US Spanish-speaking population, examining chronic disease prevalence, risk factors, self-reported health status, access to care, and receipt of preventive health services; (2) assess the extent to which language is associated with these health indicators among US Hispanics; and (3) examine regional variation in these health indicators among Spanish-speaking Hispanics. Comparative indicators for English-speaking Hispanic respondents are given to provide a context for evaluating and responding to the health risks and health care needs of the Spanish-speaking population.     

Self-reported short sleep duration among US adults by disability status and functional disability type: Results from the 2016 Behavioral Risk Factor Surveillance System

BackgroundShort sleep duration is associated with an increased risk of chronic disease and all-cause death. A better understanding of sleep disparities between people with and without disabilities can help inform interventions designed to improve sleep duration among people with disabilities.ObjectiveTo examine population-based prevalence estimates of short sleep duration by disability status and disability type among noninstitutionalized adults aged ≥18 years.MethodsData from the 2016 Behavioral Risk Factor Surveillance System were used to assess prevalence of short sleep duration among adults without and with disabilities (serious difficulty with cognition, hearing, mobility, or vision; any difficulty with self-care or independent living). Short sleep duration was defined as <7 h per 24-h period. We used log-binomial regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) while adjusting for socioeconomic and health-related characteristics.ResultsAdults with any disability had a higher prevalence of short sleep duration than those without disability (43.8% vs. 31.6%; p < .001). After controlling for selected covariates, short sleep was most prevalent among adults with multiple disabilities (PR 1.40, 95% CI: 1.36–1.43), followed by adults with a single disability type (range: PR 1.13, 95% CI: 1.03–1.24 [for independent living disability] to PR 1.25, 95% CI: 1.21–1.30 [for mobility disability]) compared to adults without disability.ConclusionsPeople with disabilities had a higher likelihood of reporting short sleep duration than those without disabilities. Assessment of sleep duration may be an important component in the provision of medical care to people with disabilities.     

The association between health insurance coverage and diabetes care; data from the 2000 Behavioral Risk Factor Surveillance System

OBJECTIVE: To describe the association between type of health insurance coverage and the quality of care provided to individuals with diabetes in the United States. DATA SOURCE: The 2000 Behavioral Risk Factor Surveillance System. STUDY DESIGN: Our study cohort included individuals who reported a diagnosis of diabetes (n=11,647). We performed bivariate and multivariate logistic regression analyses by age greater or less than 65 years to examine the association of health insurance coverage with diabetes-specific quality of care measures, controlling for the effects of race/ethnicity, annual income, gender, education, and insulin use. PRINCIPAL FINDINGS: Most individuals with diabetes are covered by private insurance (39 percent) or Medicare (44 percent). Among persons under the age of 65 years, 11 percent were uninsured. The uninsured were more likely to be African American or Hispanic and report low incomes. The uninsured were less likely to report annual dilated eye exams, foot examinations, or hemoglobin A1c (HbA1c) tests and less likely to perform daily blood glucose monitoring than those with private health insurance. We found few differences in quality indicators between Medicare, Medicaid, or the Department of Veterans Affairs (VA) as compared with private insurance coverage. Persons who received care through the VA were more likely to report taking a diabetes education class and HbA1c testing than those covered by private insurance. CONCLUSIONS: Uninsured adults with diabetes are predominantly minority and low income and receive fewer preventive services than individuals with health insurance. Among the insured, different types of health insurance coverage appear to provide similar levels of care, except for higher rates of diabetes education and HbA1c testing at the VA.     

Associations between minimum wage policy and access to health care: evidence from the Behavioral Risk Factor Surveillance System, 1996-2007

Objectives. We examined whether minimum wage policy is associated with access to medical care among low-skilled workers in the United States.Methods. We used multilevel logistic regression to analyze a data set consisting of individual-level indicators of uninsurance and unmet medical need from the Behavioral Risk Factor Surveillance System and state-level ecological controls from the US Census, Bureau of Labor Statistics, and several other sources in all 50 states and the District of Columbia between 1996 and 2007.Results. Higher state-level minimum wage rates were associated with significantly reduced odds of reporting unmet medical need after control for the ecological covariates, substate region fixed effects, and individual demographic and health characteristics (odds ratio = 0.853; 95% confidence interval = 0.750, 0.971). Minimum wage rates were not significantly associated with being uninsured.Conclusions. Higher minimum wages may be associated with a reduced likelihood of experiencing unmet medical need among low-skilled workers, and do not appear to be associated with uninsurance. These findings appear to refute the suggestion that minimum wage laws have detrimental effects on access to health care, as opponents of the policies have suggested.Minimum wage laws have long been advanced as policy mechanisms to improve the economic conditions of the working poor. Recently, questions have been raised about the true net benefit of such policies for low-skilled workers. Although income gains arising from minimum wage increases are clearly beneficial, these policies may also have secondary effects that could negatively affect low-skilled workers.The adverse effect most commonly considered is a potential contraction of employment in the low-wage sector as firms employ fewer workers or limit hours to offset the added payroll. Of particular interest in the realm of public health, however, is the possibility that minimum wage laws may substantially reduce access to health care. Research has yet to clarify this relationship.Competing hypotheses have been advanced that describe both positive and negative effects of minimum wage increases on health care access. Proponents of higher minimum wage laws suggest that the direct income-increasing effect of such interventions may be improvements in access to care, as workers are better able to afford out-of-pocket health care expenses such as insurance premiums, deductibles, and copayments. With greater disposable income available following wage hikes, affected workers would then be less likely to experience cost-related barriers to accessing medical care. These hypotheses, building on recent empirical literature documenting associations between higher income and better access to health care,^1–5 propose that increases in workers'' hourly wage will bolster their health care access.Alternatively, opponents of the policies warn that higher minimum wages will lead to unintended effects that will directly and indirectly weaken access to care for the working poor. Some economists have argued that employers may offset increases in the minimum wage directly by cutting health insurance benefits or by offering less generous benefit plans.^6–8 Minimum wage opponents have also argued that increases in the minimum wage depress employment, which could result in a net worsening in access to health care and in the economic conditions of vulnerable populations through a reduction in low-wage employment opportunities.After remaining at $5.15 since 1997, the federal minimum wage increased to $5.85 in July 2007 as part of a 3-step increase to the current $7.25 rate. During the 10 years between increases, the real value of the minimum wage had eroded to equal its lowest point in the preceding 50 years, whether defined in real terms or as a proportion of average wages.⁹ In many areas of the United States, even this newly increased minimum wage was not enough to keep workers and their dependents out of poverty, as the $12 168 earned by a full-time minimum wage earner in 2007 represented only 70% of the federal poverty limit of $17 170 for a family of three.¹⁰In response to the diminishing real value of the federal standard between 1997 and 2007, many states and municipalities enacted policies mandating higher minimum wages for workers in their jurisdictions. At the time of the 2007 federal wage hike, 31 states and the District of Columbia had passed laws setting higher wage standards, none of which was surpassed by the federal increase.⁹At this intersection of poverty and health care access, the minimum wage may be a policy tool with potential implications for health outcomes, but little empirical evidence currently exists to clearly determine whether access to care for low-skilled workers will be helped or harmed by changes to minimum wage policy. Although the employment effects of minimum wage laws have been extensively researched, the exact nature of the relationship between the policies and employment opportunities is hotly debated among economists. Whereas some researchers have found that minimum wage hikes lead to a rise in unemployment,^11–15 others have found that they enhance employment.^16–20Far less empirical attention has been paid to other effects of minimum wages, such as the potential effect on access to health care. Simon and Kaestner²¹ used data from the 1979–2000 Current Population Survey (CPS) to investigate the association between the minimum wage and workers'' receipt of fringe benefits such as health insurance and pensions. They found that increased minimum wages were associated with an increased probability of receiving health insurance and pensions, but concluded that the absence of a consistent differential effect between low- and high-skilled workers suggested “that the minimum wage had no causal effect on low-wage workers'' fringe benefit receipt.”^21(p52)Simon and Kaestner''s study appears to be the only one published to directly examine the association between minimum wages and provision of employer-sponsored health insurance, and to our knowledge none has examined other measures of health care access. We sought to extend this line of empirical research into the effects of the minimum wage and fill the gap in the literature by building on prior works in several important ways.First, we employed more recent data that capitalize on the proliferation of state-level minimum wage laws between 2000 and 2007 to capture greater variance in minimum wage rates throughout the United States. Second, whereas earlier work focused on receipt of health insurance as a fringe benefit, we focused our analysis more directly on access to care by examining both a broader measure of health insurance coverage and an additional direct measure of access: reporting cost-related barriers to receiving needed medical care. Finally, we included more comprehensive sets of individual and state-level covariates in addition to state and regional fixed effects and time trends.Using 12 years of data from the Behavioral Risk Factor Surveillance System (BRFSS)²² and several additional sources, we examined associations between state-level minimum wage policies and respondent-level indicators of access to health care. Given the competing hypotheses about the potential effects of minimum wage policy, this analysis provides unique empirical evidence on an important policy whose theoretical effects have been hotly contested.     

Health Disparities by Sexual Orientation: Results and Implications from the Behavioral Risk Factor Surveillance System

Until recently, population-based data for monitoring sexual minority health have been limited, making it difficult to document and address disparities by sexual orientation. The primary objective of this study was to examine differences by sexual orientation in an array of health outcomes and health risk factors using one of the nation’s largest health surveys. Data for this study came from 8290 adults who identified as lesbian, gay, or bisexual (LGB) and 300,256 adults who identified as heterosexual in the 2014–2015 Behavioral Risk Factor Surveillance System (BRFSS). Logistic regression models were used to compare physical and mental health outcomes, health condition diagnoses, and health risk factors by sexual orientation, controlling for demographic and socioeconomic status. Controlling for sociodemographic characteristics, gay and bisexual men reported higher odds of frequent mental distress [odds ratio (OR) 1.71, P?=?0.001; OR 2.33, P?<?0.001] and depression (OR 2.91, P?<?0.001; OR 2.41, P?<?0.001), compared with heterosexual men. Lesbian and bisexual women had higher odds of frequent mental distress (OR 1.53, P?<?0.001; OR 2.08, P?<?0.001) and depression (OR 1.93, P?<?0.01; OR 3.15, P?<?0.001), compared to heterosexual women. Sexual minorities also faced higher odds of poor physical health, activity limitations, chronic conditions, obesity, smoking, and binge drinking, although these risks differed by sexual orientation and gender. This study adds to the mounting evidence of health disparities by sexual orientation. Community health practitioners and policymakers should continue to collect data on sexual orientation in order to identify and address root causes of sexual orientation-based disparities, particularly at the community-level.     

Using the Behavioral Risk Factor Surveillance System to monitor year 2000 objectives among American Indians.

The Behavioral Risk Factor Surveillance System, a data set based on telephone surveys that have been conducted by States in collaboration with the Centers for Disease Control, has been used to estimate the prevalence of behavioral risk factors for adults in the United States so health objectives can be set and progress towards accomplishing them measured. Data for adult American Indians in this regard have not been available generally. The use of these data to estimate behavioral risk prevalence for American Indians by geographic region was examined and the results compared with those for white Americans. In addition, data from the system were compared with other data sets, including the results of selected surveys in American Indian communities, to explore the validity of the system as a tool for evaluating the behavioral risks of Indians. Behavioral Risk Factor Surveillance System data for the period 1985 to 1988 were used. During this period, the 1,055 American Indian respondents constituted 0.63 percent of those responding under the system and 0.70 percent of the population of the participating States. Separate (sex-specific) behavioral risk prevalence estimates were derived for Indians and whites for four geographic regions--Southwest, Plains, West Coast, and Other States. The system's behavioral risk estimates for the Plains region were compared with available data from behavioral risk surveys done in three American Indian communities in Montana (Blackfeet, Fort Peck, and Great Falls) from 1987 to 1989. The behavioral risk factors compared include use of automobile seatbelts, current smoking, current use of smokeless tobacco, heavy drinking, drinking and driving, overweight, hypertension, and sedentary lifestyle. Although large regional differences in the prevalence of these risk factors were found, the magnitude and direction of the differences are frequently similar among American Indians and whites living in the same geographic regions.(ABSTRACT TRUNCATED AT 250 WORDS)     

Surveillance for use of preventive health-care services by older adults, 1995-1997.

PROBLEM/CONDITION: In 1995, a total of 55 million persons aged > or =55 years lived in the United States. The members of this large and growing segment of the population are major consumers of health care. Their access to medical and dental preventive services contributes to their likelihood of healthy later years and influences their long-term impact on the health-care delivery system. REPORTING PERIOD: 1995-1997. DESCRIPTION OF SYSTEMS: This report summarizes data from the National Health Interview Survey (NHIS), the state-based Behavioral Risk Factor Surveillance System (BRFSS), and the Medicare Current Beneficiary Study (MCBS) to describe national, regional, and state-specific patterns of access to and use of preventive services among persons aged > or =55 years. RESULTS: During 1995-1997, approximately 90% of persons aged > or =55 years living in the United States reported having a regular source of health-care services. However, only 75%-80% reported receiving a routine checkup during the preceding 2 years. The estimated percentage of persons who reported not being able to receive medical care because of cost was highest for those aged 55-64 years. Within this age group, the percentage was highest among Hispanics (4%) and persons without a high school diploma. Approximately 11% of Medicare beneficiaries reported delaying care be cause of cost or because they had no particular source of care. Percentage estimates varied according to age, race/ethnicity, and sociodemographic status. Approximately 95% of persons aged > or =55 years reported having their blood pressure checked during the preceding 2 years, but only 85%-88% had received a cholesterol evaluation during the preceding 5 years. The percentage of women receiving breast and cervical cancer screening decreased with increasing age, and the percentage of persons aged > or =55 years who had received some form of screening for colorectal cancer was low approximately 25% for fecal occult blood testing (FOBT) and 45% for endoscopy. State-specific rates of compliance with vaccination recommendations among persons aged > or =65 years were higher for influenza vaccine (range: 54%-74%) than for pneumococcal vaccine (range: 32%-59%), and compliance increased with advancing age. State-specific estimates of the percentage of annual dental visits varied 40%-75%, and 41%-88% of persons aged > or =65 years reported not having dental insurance. INTERPRETATION: Access to medical services among adults living in the United States is greater for persons aged > or =65 years, compared with those aged <65 years, presumably because of Medicare coverage. In contrast, use of dental services decreased, despite increased need for preventive and restorative dental care. Although Medicare covers many medical services for older adults, financial, personal, and physical barriers to both medical and dental care create racial, regional, and sociodemographic disparities in health status and use of health services in the United States. PUBLIC HEALTH ACTION: Continued surveillance of access to and use of health services among older adults (i.e., persons aged > or =65 years), as well as among persons aged 55-64 years, will help health-care providers target underserved groups, make Medicare coverage decisions, and develop public health programs to ensure equitable access to services and improve the health of older adults.