Characteristics of Registered Nurses in Rural Versus Urban Areas: Implications for Strategies to Alleviate Nursing Shortages in the United States

METHODS: This study compares characteristics of rural and urban registered nurses (RNs) in the United States using data from the 2000 National Sample Survey of Registered Nurses. RNs in 3 types of rural areas are examined using the rural-urban commuting area taxonomy. FINDINGS: Rural and urban RNs are similar in age and sex; nonwhites and Hispanics are underrepresented in both groups. Rural RNs have less nursing education, are less likely to work in hospitals, and are more likely to work full time and in public/community health than urban RNs. The more rural an RN's residence, the more likely he/she commutes to another area for work and the lower salary he/she receives. CONCLUSIONS: Strategies to reduce nurse shortages should consider differences in education, work patterns, and commuting behavior among rural and urban RNs. Solutions for rural areas require understanding of the impact of the workplace on these behaviors.     

Water pipe tobacco smoking in the United States: Findings from the National Adult Tobacco Survey

ObjectiveTo report prevalence and correlates of water pipe tobacco smoking (WTS) use among U.S. adults.MethodsData were from the 2009–2010 National Adult Tobacco Survey, a nationally representative sample of U.S. adults. Estimates of WTS ever and current use were reported overall, and by sex, age, race/ethnicity, educational attainment, annual household income, sexual orientation, and cigarette smoking status. State-level prevalence rates of WTS ever were reported using choropleth thematic maps for the overall population and by sex.ResultsThe national prevalence of WTS ever was 9.8% and 1.5% for current use. WTS ever was more prevalent among those who are male (13.4%), 18–24 years old (28.4%) compared to older adults, non-Hispanic White (9.8%) compared to non-Hispanic Black, with some college education (12.4%) compared to no high school diploma, and reporting sexual minority status (21.1%) compared to heterosexuals. States with highest prevalence included DC (17.3%), NV (15.8%), and CA (15.5%).ConclusionWTS is now common among young adults in the US and high in regions where cigarette smoking prevalence is the lowest and smoke-free policies have a longer history. To reduce its use, WTS should be included in smoke-free regulations and state and federal regulators should consider policy development in other areas, including taxes, labeling, and distribution.     

Cardiovascular health knowledge in the United States: Findings from the National Health Interview Survey, 1985

Knowledge of the risk precursors to cardiovascular disease is thought to be a key component of health decision making. Many intervention programs have been aimed at increasing the nation's general knowledge of risk factors for cardiovascular disease, although the determinants of the level of cardiovascular disease knowledge are not thoroughly understood. We examined cardiovascular knowledge in a nationally representative sample of the United States population with data from the 1985 Health Promotion and Disease Prevention supplement of the National Health Interview Survey. Interviews with 12,551 white women, 770 Hispanic women, 2,547 black women, 9,832 white men, 576 Hispanic men, and 1,440 black men were used in this analysis. We constructed a seven-item index for cardiovascular disease knowledge. After adjustment for age and education, white men and women scored higher on the cardiovascular disease knowledge index than either their Hispanic or black counterparts. We also examined the relationships of age, education, income, marital status, access to medical care, geographic region, and seven self-reported cardiovascular disease risk factors to the levels of cardiovascular disease knowledge. Education was the strongest predictor of cardiovascular disease knowledge. The variables examined accounted for a small portion of the variance in knowledge. Levels of cardiovascular disease knowledge were lower among respondents with less education and income, those who were not married, those with less access to medical care, and those who were smokers or physically inactive. Therefore, efforts to improve levels of cardiovascular disease knowledge should be directed toward subgroups.     

Metropolitan Versus Nonmetropolitan Differences in Functional Status and Self-care Practice: Findings from a National Sample of Community-dwelling Older Adults

The objective of this study was to use a recent national probability survey of the noninstitutionalized older adult population to compare the functional status and self-care practices of older adults residing in metropolitan and nonmetropolitan communities and to identify differences associated with residential location. The survey used in this study was the National Survey of Self-care and Aging (NSSCA). A cross-sectional design was employed using weighted bivariate and multivariate logistic regression analyses to examine the relationship between metropolitan and nonmetropolitan residential location and self-reported ability to perform basic, mobility, and instrumental activities of daily living (ADLs), as well as to assess the degree to which the levels and types of functional limitations affect metropolitan versus nonmetropolitan older adults' performance of self-care activities. The bivariate logistic analyses pointed to modest, often insignificant metropolitan versus nonmetropolitan differences in the ability to perform functional tasks. However, larger positive effects of nonmetropolitan residence were generally observed once other factors likely to account for some of these differences were taken into account. Older adults from nonmetropolitan areas were more likely to report being able to perform functional activities but also were more likely to report performing self-care activities both in the presence and absence of disability. This study, therefore, concluded that nonmetropolitan older adults may discount the significance of declining functional status, thus normalizing the trajectory of aging in a different way than do their metropolitan counterparts. If this process occurs, it may affect how nonmetropolitan persons use primary health care and/or long-term care services, challenging the economists' concept of demand, the clinicians' concept of need, and the policy analysts' concept of equity. Additional work is required to assess whether such a normalization process actually occurs and, if so, to explore its distribution, causes, correlates, and consequences.     

Natural Environments,Obesity, and Physical Activity in Nonmetropolitan Areas of the United States

Purpose: To assess the associations of the natural environment with obesity and physical activity in nonmetropolitan areas of the United States among representative samples by using 2 indices of outdoor activity potential (OAP) at the county level. Methods: We used the data from 457,820 and 473,296 noninstitutionalized adults aged over 18 years for obesity and physical activity, respectively, from the 2000‐2006 Behavioral Risk Factor Surveillance System. The OAP indices were (1) a recreational opportunity index based on 24 variables related to outdoor physical activity, such as the number of facilities available for walking, biking, hiking, and swimming derived from the 1997 National Outdoor Recreation Supply Information System; and (2) a natural amenities index which was based on physical and social environmental characteristics, such as climate, topographic relief, land cover, and tourism. We fitted logistic regression models using generalized estimating equations to control for county level intracorrelation and tested each index separately to assess its relationship with obesity and physical activity. Findings: Recreational opportunities were higher in areas with greater natural amenities. After controlling for individual‐level socioeconomic and demographic characteristics, the prevalence of obesity decreased and propensity for physical activity increased with increasing levels of both recreational opportunities and natural amenities. Conclusions: Multiple indices of OAP based on characteristics of the built, natural and social environments were associated with decreased obesity and increased physical activity in nonmetropolitan areas. Public health interventions should consider the opportunities and limitations offered by the natural environment for promoting physical activity and reducing obesity in rural areas.     

Current Tobacco Use Among Adults in the United States: Findings From the National Adult Tobacco Survey

Objectives. We assessed the prevalence and sociodemographic correlates of tobacco use among US adults.Methods. We used data from the 2009–2010 National Adult Tobacco Survey, a national landline and cell phone survey of adults aged 18 years and older, to estimate current use of any tobacco; cigarettes; cigars, cigarillos, or small cigars; chewing tobacco, snuff, or dip; water pipes; snus; and pipes. We stratified estimates by gender, age, race/ethnicity, education, income, sexual orientation, and US state.Results. National prevalence of current use was 25.2% for any tobacco; 19.5% for cigarettes; 6.6% for cigars, cigarillos, or small cigars; 3.4% for chewing tobacco, snuff, or dip; 1.5% for water pipes; 1.4% for snus; and 1.1% for pipes. Tobacco use was greatest among respondents who were male, younger, of non-Hispanic “other” race/ethnicity, less educated, less wealthy, and lesbian, gay, bisexual, or transgender. Prevalence ranged from 14.1% (Utah) to 37.4% (Kentucky).Conclusions. Tobacco use varies by geography and sociodemographic factors, but remains prevalent among US adults. Evidence-based prevention strategies are needed to decrease tobacco use and the health and economic burden of tobacco-related diseases.Tobacco use remains the single largest preventable cause of disease and premature death among both men and women in the United States.1 Health effects associated with tobacco use include heart disease, many types of cancer, pulmonary disease, adverse reproductive outcomes, and the exacerbation of multiple chronic health conditions.2 Cigarette smoking alone has been estimated to cause 443 000 deaths per year in the United States, including approximately 49 400 deaths attributed to secondhand smoke exposure.3 In addition, cigarette smoking has been estimated to cost the United States $96 billion in direct medical expenses and $97 billion in lost productivity per year.3 Despite significant progress over the past several decades,4 declines in the prevalence of cigarette smoking and the use of other tobacco products among US adults have stalled in recent years.5,6Monitoring the extent of the tobacco epidemic can assist in guiding decisions about tobacco control strategies for the overall population and high-risk subpopulations. The World Health Organization recognizes that monitoring tobacco use is an important and effective tobacco control approach in its MPOWER model and encourages the collection of data on tobacco use prevalence and consumption by demographic subdivisions, both nationally and regionally.7 In the United States, the report Key Outcome Indicators for Evaluating Comprehensive Tobacco Control Programs (KOI report) identified valid and reliable measures for tobacco-related indicators and provided a guide for tobacco control surveillance at the national, state, and local levels.8The National Adult Tobacco Survey (NATS) is the first adult tobacco use survey designed within the framework of the KOI report.9 NATS establishes a comprehensive standard for assessing the prevalence of tobacco use and the factors promoting and impeding tobacco use at both the national and state levels. We analyzed NATS data to determine the national prevalence and sociodemographic correlates of tobacco use among US adults, both overall and for multiple tobacco products. We also calculated state-specific estimates for overall tobacco use and for cigarette smoking.     

Designing for Dissemination Among Public Health Researchers: Findings From a National Survey in the United States

Objectives. We have described the practice of designing for dissemination among researchers in the United States with the intent of identifying gaps and areas for improvement.Methods. In 2012, we conducted a cross-sectional study of 266 researchers using a search of the top 12 public health journals in PubMed and lists available from government-sponsored research. The sample involved scientists at universities, the National Institutes of Health, and the Centers for Disease Control and Prevention in the United States.Results. In the pooled sample, 73% of respondents estimated they spent less than 10% of their time on dissemination. About half of respondents (53%) had a person or team in their unit dedicated to dissemination. Seventeen percent of all respondents used a framework or theory to plan their dissemination activities. One third of respondents (34%) always or usually involved stakeholders in the research process.Conclusions. The current data and the existing literature suggest considerable room for improvement in designing for dissemination.The effective dissemination of information on priorities, health risks, and evidence-based interventions in public health is a formidable challenge.1,2 Dissemination is an active approach of spreading evidence-based information to the target audience via determined channels using planned strategies.3 Studies from both clinical and public health settings suggest that evidence-based practices are not being disseminated effectively.4–6 For example, in a study of US adults, only 55% of overall care received was based on what is recommended in the scientific literature.7 In a study of US public health departments, an estimated 58% of programs and policies were reported as “evidence-based.”8To illustrate the dissemination challenges and possible solutions, research on evidence-based interventions has now taught us several important lessons:

1. dissemination generally does not occur spontaneously and naturally4;
2. passive approaches to dissemination are largely ineffective9,10;
3. single-source prevention messages are generally less effective than comprehensive, multilevel approaches11,12;
4. stakeholder involvement in the research or evaluation process is likely to enhance dissemination (so-called practice-based research)13–19;
5. theory and frameworks for dissemination are beneficial20,21; and
6. the process of dissemination needs to be tailored to specific audiences.22

The difficulty in dissemination is the result of differing priorities.23,24 For researchers, the priority is often on discovery (not application) of new knowledge, whereas for practitioners and policymakers, the priority is often on practical ways for applying these discoveries for their settings.25 The chasm between researchers and practitioners was illustrated in a “Designing for Dissemination” workshop sponsored by the US National Cancer Institute.26 In this workshop, all participants acknowledged the importance of dissemination. Researchers reported their role was to identify effective interventions, but that they were not responsible for dissemination of research findings. Similarly, practitioners did not believe they were responsible for dissemination.It has been recommended that researchers should identify dissemination partners before conducting discovery research, so that those who might adopt the discoveries will see the research process and results in a collaborative manner.24,27 Ultimately, we need to better understand how to design interventions with the elements most critical for external validity in mind,28–30 addressing these issues during early, developmental phases, and not near the end of a project.24,31 To date, few studies have evaluated the extent to which researchers are designing their studies for dissemination and how the design process may differ by researcher background and setting of research.In the present study, we described the practice of designing for dissemination (D4D) among researchers in the United States with the intent of identifying gaps and areas for improvement.     

Childlessness in the United States: estimates from the National Survey of Family Growth

Using a representative sample of about 17,000 ever married women 15 to 44 years of age, this article presents national estimates of the prevalence and correlates of voluntary, involuntary, and temporary childlessness in the United States. These three groups of childless couples are compared with the parents of small planned families and other parents on a number of social, economic, marital, and family characteristics. When viewed cross sectionally, voluntarily childless couples constitute between 1.3% and 1.8% of currently married couples, depending on the definitions used. They are a distinctive but rare population. Their future prevalence depends primarily on the decisions of the large group of temporarily childless couples.     

Serum retinol distributions in residents of the United States: third National Health and Nutrition Examination Survey, 1988-1994

BACKGROUND: Inadequate vitamin A status has been a potential nutritional problem for some segments of the US population, particularly children and the poor. OBJECTIVE: We evaluated serum retinol concentration by using population-representative data from 16058 participants aged 4 to >/=90 y in the third National Health and Nutrition Examination Survey, 1988-1994. DESIGN: We used multivariate regression to examine the simultaneous associations of sociodemographic, biologic, and behavioral factors with serum retinol concentration. RESULTS: In children, serum retinol concentrations were greater with greater age, body mass index, serum lipids, and the use of supplements containing vitamin A. In adults, male sex, serum lipids, alcohol consumption, and age were positively associated with serum retinol concentration in most racial/ethnic strata. Household income was not associated with serum retinol concentration in children; associations were inconsistent in adults. The prevalence of serum retinol <0.70 micromol/L was very low in all strata; the prevalence of serum retinol <1.05 micromol/L was 16.7-33.9% in children aged 4-8 y and 3.6-14.2% in children aged 9-13 y, depending on sex and racial/ethnic group. The prevalence of serum retinol<1.05 micromol/L was higher in non-Hispanic black and Mexican American children than in non-Hispanic white children; these differences remained significant (P < 0.0001) after covariates were controlled for. Among adults, nonwhite women were significantly (P < 0.0001) more likely than white women to have serum retinol <1.05 micromol/L after covariates were controlled for. CONCLUSIONS: Clinically low serum retinol concentration is uncommon in US residents aged > or = 4 y, although racial/ethnic and socioeconomic differences in serum retinol concentration still exist.     

Population determinants of serum lycopene concentrations in the United States: data from the Third National Health and Nutrition Examination Survey, 1988-1994

Serum lycopene is inversely related to the risk for cancer and cardiovascular diseases. We used data from the Third National Health and Nutrition Examination Survey, 1988-1994, to investigate the relation between serum lycopene concentrations and sex, age, geographical location, race-ethnicity, education, alcohol, smoking, BMI, blood pressure, serum total cholesterol and triacylglycerol, and intakes of fat, tomatoes and tomato-based products in 3413 individuals aged 17-90 y. Multivariate adjusted mean lycopene concentrations were 48.3% lower in individuals > or =70 y old than in those 17 to <30 y old (P < 0.0001), 7.6% lower in women than in men (P = 0.0045), 15.1% lower in people living in the South than those in the West (P < 0.0001), 10.3 and 61.0% lower in the 1st quartile than in the 4th quartile for dietary fat intake (P = 0.0173) and serum cholesterol (P < 0.0001), respectively, 11.1% lower in tomato noneaters than those who ate tomatoes > or =31 times/mo (P = 0.0085), 13.5% lower in pizza noneaters than those who ate pizza > or =16 times/mo (P = 0.0016), and 20.6% lower in pasta noneaters than those who ate pasta (with tomato sauce) > or =16 times/mo (P < 0.0001). Race-ethnicity, alcohol, BMI, blood pressure, and consumption of non-tomato vegetables, and fruits and juices had no association with serum lycopene concentrations. Sex, age, geographical region, socioeconomic status, serum total cholesterol, smoking, and intakes of fat, tomatoes, pizza, and pasta were significant determinants of serum lycopene concentrations in the United States.     

Vitamin C deficiency and depletion in the United States: the Third National Health and Nutrition Examination Survey, 1988 to 1994

OBJECTIVES: We sought to determine prevalence rates of vitamin C deficiency and depletion in the United States. METHODS: We used data from the Third National Health and Nutrition Examination Survey to assess intake of dietary, supplemental, and serum vitamin C. RESULTS: Mean intakes and serum levels of vitamin C were normal; however, vitamin C deficiency and depletion were common (occurring among 5%-17% and 13%-23% of respondents, respectively). Smokers, those who did not use supplements, and non-Hispanic Black males had elevated risks of vitamin C deficiency, while Mexican Americans had lower risks. CONCLUSIONS: Health professionals should recommend consumption of vegetables and fruits rich in vitamin C and should recommend supplementation for individuals at risk of vitamin C deficiency.     

Contraceptive failure in the United States: estimates from the 1982 National Survey of Family Growth

A multivariate life-table analysis of national survey data from 1982 indicates that among currently married women, the pill and IUD have the lowest use-failure rates. During the first year of use, about three percent of pill users and six percent of IUD users experience an unintended pregnancy. Failure rates for the remaining methods range from 14 percent for the condom to 22 percent for spermicides; between these lie rhythm and natural family planning (16 percent), the diaphragm (17 percent) and other methods, mainly withdrawal, douche and abstinence. Married women using no contraceptive method experience an unintended pregnancy rate of 40 percent during the first year of unprotected intercourse. A woman's age, pregnancy intention (either to delay or to prevent births), parity and income all have significant effects on the risk of unintended pregnancy. The risk generally declines with age, except for women attempting to prevent an unwanted pregnancy, among whom women under 20 have lower failure rates than do those 20-29 years of age. As expected, women attempting to prevent an unwanted pregnancy have lower failure rates than do those seeking to delay a wanted pregnancy, with the difference being greatest for women under 20 years of age and smallest for 20-29-year-olds. Use-failure rates among low-income women are higher than those among women with larger family incomes, while low-parity women have lower failure rates than do women of higher parity. On average, standardized use-failure rates for single women are lower than those for married women, probably because of a lower average level of intercourse among single women. In addition, these rates are understated because of the substantial underreporting of abortion among single women; if abortion reporting were complete, failure rates would be about 1.4 times as high as they appear here, and thus would be close to those of married women. Differences in the risk of unintended pregnancy among single women show a number of similarities with those seen among married women: Use of the pill and IUD is associated with the lowest failure rates, reliance on the condom is associated with intermediate failure rates, and use of spermicides is linked with the highest failure rates. However, while rhythm and the diaphragm exhibit use-failure rates that are among the highest found for single women, failure rates for these methods are at intermediate levels among married women.(ABSTRACT TRUNCATED AT 400 WORDS)     

Fertility and family planning in the United States: insights from the National Survey of Family Growth

A review of about 50 studies based on the 1982 National Survey of Family Growth (NSFG) illustrates the ways in which the survey sheds new light on trends and differentials in such areas as fertility, contraceptive use, infertility and the use of family planning services in the United States. The total fertility rate declined by nearly 50 percent between 1960 and 1973, from 3.6 to 1.9 births per woman, and changed little from then until 1982. It would appear that growing use of the pill, the IUD and sterilization--but principally the pill--is the prime factor in the dramatic decline in unwanted and mistimed births among married couples. Their increasing reliance on sterilization between 1973 and 1982 reduced the proportion of unwanted births at ages 35 or older by half, but had little impact on overall birthrates because only about five percent of all births occurred at those ages in 1981. Although overall fertility has declined, the rate of premarital pregnancy has risen since the early 1960s. Research based on the NSFG suggests that this is a result both of the rapid increase in the percentage of women who have premarital intercourse and of the increasing length of exposure to premarital pregnancy. The latter trend is probably related both to earlier intercourse and to delayed marriage. Despite the increasing levels of premarital exposure, however, there was actually a decline in teenage birthrates in the 1970s, which was due in part to the rising abortion rates among teenagers. Finally, although racial differences in fertility have narrowed, black women still have higher fertility than whites. The 1982 NSFG data suggest that four factors are principally responsible for the higher birthrates of black women: Blacks begin having intercourse earlier than whites; black women are one-third less likely to use contraceptives at first intercourse; they are more likely to be currently exposed to the risk of unplanned pregnancy and not using a method; and they have higher pregnancy rates when they are using no contraceptives or less-effective methods, such as the condom, rhythm and withdrawal.     

Sexual Assaulters in the United States: Prevalence and Psychiatric Correlates in a National Sample

This study presents sociodemographic characteristics and psychiatric correlates of a representative sample of sexual assaulters in the United States. Data were drawn from a nationally representative survey, the National Epidemiologic Survey on Alcohol and Related Conditions. Face-to-face interviews of more than 43,000 adults were conducted between the 2001–2002 period, based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. The prevalence of committing sexual assault in the U.S. was 0.15 %. Sexual assaulters had significantly lower education than their counterparts. Sexual assaulters were significantly more likely to report a wide range of antisocial behaviors. Multivariate logistic regression analyses indicated strong associations between sexual assault and lifetime psychiatric disorders often associated with impaired impulse control, such as antisocial personality disorder, conduct disorder, and cocaine use disorder. In addition, psychotic disorders were consistently associated with sexual assault. Our findings indicate that sexual assault could represent a behavioral manifestation of a broader spectrum, including impairment of impulse control and psychotic disorders.     

Contraceptive failure in the United States: revised estimates from the 1982 National Survey of Family Growth

It is estimated that only about half of all abortions occurring during the period covered by the 1982 National Survey of Family Growth were actually reported in the survey; thus, contraceptive failure rates calculated from these data are almost certainly inaccurate. An attempt to correct for the underreporting of abortion indicates that actual 12-month use-failure rates are more than one-third higher than those calculated without taking abortion underreporting into account, with rates ranging from six percent for the pill to 14-16 percent for the condom, diaphragm and rhythm and to 26 percent for spermicides. Patterns of contraceptive failure are similar to those found in earlier studies.     

Work-family conflict and mental disorders in the United States: cross-sectional findings from The National Comorbidity Survey

BACKGROUND: Work-family conflict (WFC) may have negative effects on workers' health and productivity. The objective of this analysis was to assess the association between WFC and mental disorders that occurred in the past month. METHODS: Data from the U.S. National Comorbidity Survey were used. The 1-month prevalence of mental disorders was estimated by levels of WFC and by gender. RESULTS: Compared to participants who reported low WFC, those who reported high WFC had a significantly higher prevalence of mental and/or substance use related disorders in the past month. Working hours and domestic roles did not have significant impacts on the association between WFC and mental disorders, irrespective of gender. CONCLUSIONS: Work and family roles and the balance between the two are important for workers' mental health. The influence of WFC on mental health should be investigated in conjunction with important work environment characteristics in longitudinal studies.     

The need for prenatal care in the United States: evidence from the 1980 National Natality Survey

Seventy-eight percent of U.S. mothers begin prenatal care during the first three months of pregnancy; 18 percent wait until the second three months; and five percent wait until the third trimester or receive no care at all. Patterns of prenatal care vary widely among population subgroups: Mothers younger than 18 and unmarried mothers are the least likely to obtain first-trimester care (49 percent and 56 percent, respectively), and the most likely to obtain care only in the third trimester or none at all (about 12 percent of each group). Women aged 18-19, blacks, Hispanics, poor women and women with little education also have disproportionately high levels of very late or no care (7-9 percent). Married, white, nonpoor women, in contrast, obtain the most timely prenatal care: In 1980, only two percent initiated care in the third trimester or received no care. Compared with this subgroup of women, the population as a whole has two times the risk of obtaining inadequate care. Unmarried women run the highest relative risk (five times the risk for married, white, nonpoor women), followed by teenagers, Hispanic women, women with little education, poor women and blacks (who have from three to more than four times the risk of the comparison group).     

Findings from the latest National Diet and Nutrition Survey

The National Diet and Nutrition Survey (NDNS) of adults aged 19-64 years, carried out in 2000-1, is part of the NDNS programme, a series of cross-sectional surveys aiming to provide detailed quantitative information on the diet, nutritional status and related characteristics of the British population. The programme is split into four surveys of different population age-groups, conducted at approximately three-yearly intervals. In the survey of adults food consumption data were collected from 1724 respondents using a 7 d weighed-intake dietary record. Other components included: height, weight, waist and hip circumference and blood pressure measurements; a 24 h urine sample; a blood sample; a record of physical activity. Results have been published in four volumes covering food consumption, energy and macronutrient intakes, micronutrient intakes and nutritional status, including physical measurements and physical activity. The results have shown that, based on a comparison of nutrient intakes with the UK dietary reference values, adults in Britain are generally getting sufficient nutrients from their diets. However, younger adults (particularly women) and those in lower socio-economic groups are more likely to have low micronutrient intakes and lower levels of some nutritional status indices. The proportion of food energy derived from total fat has fallen since the last survey of this age-group in 1986-7 and is close to the dietary reference value, while the proportion of energy derived from saturated fatty acids and non-milk extrinsic sugars exceeds the dietary reference values. The prevalence of overweight and obesity has increased since 1986-7 and physical activity levels are low.