Obesity prevalence among low-income, preschool-aged children - United States, 1998-2008
Sharma AJ , Grummer-Strawn LM , Dalenius K , Galuska D , Anandappa M , Borland E , Mackintosh H , Smith R . MMWR Morb Mortal Wkly Rep 2009 58 (28) 769-73 Childhood obesity continues to be a leading public health concern that disproportionately affects low-income and minority children. Children who are obese in their preschool years are more likely to be obese in adolescence and adulthood and to develop diabetes, hypertension, hyperlipidemia, asthma, and sleep apnea. One of the Healthy People 2010 objectives (19-3) is to reduce to 5% the proportion of children and adolescents who are obese. CDC's Pediatric Nutrition Surveillance System (PedNSS) is the only source of nationally compiled obesity surveillance data obtained at the state and local level for low-income, preschool-aged children participating in federally funded health and nutrition programs. To describe progress in reducing childhood obesity, CDC examined trends and current prevalence in obesity using PedNSS data submitted by participating states, territories, and Indian tribal organizations during 1998-2008. The findings indicated that obesity prevalence among low-income, preschool-aged children increased steadily from 12.4% in 1998 to 14.5% in 2003, but subsequently remained essentially the same, with a 14.6% prevalence in 2008. Reducing childhood obesity will require effective prevention strategies that focus on environments and policies promoting physical activity and a healthy diet for families, child care centers, and communities. |
Change in the distribution of albuminuria according to estimated glomerular filtration rate in Pima Indians with type 2 diabetes
Pavkov ME , Mason CC , Bennett PH , Curtis JM , Knowler WC , Nelson RG . Diabetes Care 2009 32 (10) 1845-50 OBJECTIVE: We examined secular trends in the frequency distribution of albuminuria and estimated glomerular filtration rate (eGFR) in subjects with type 2 diabetes in 1982-1988 and 2001-2006, two periods associated with major changes in the management of diabetes. RESEARCH DESIGN AND METHODS: The cross-sectional study included Pima Indians > or =15 years old with type 2 diabetes and measures of serum creatinine and urinary albumin-to-creatinine ratios (ACR). The continuous probability density distributions of ACR and eGFR were compared for the two time periods. eGFR was calculated using the Modification of Diet in Renal Disease Study equation. RESULTS: The overall standardized distribution of ACR shifted toward lower values between time periods (P = 0.001), whereas the standardized distribution of eGFR did not (P = 0.45). In the first period, eGFR was <60 ml/min per 1.73 m(2) in 6.5% of the 837 subjects. Of these, 9.3% had normal ACR, 7.4% had microalbuminuria, and 83.3% had macroalbuminuria. In the second period, the prevalence of low eGFR was similar (6.6% of the 1,310 subjects). Among those with low eGFR, normal ACR prevalence doubled to 17.2%, microalbuminuria prevalence nearly tripled to 19.5%, and macroalbuminuria prevalence declined to 63.2%. Twice as many subjects in the second period received antihypertensive medicines and 30% more received hypoglycemic medicines than in the first period. CONCLUSIONS: The distribution of albuminuria changed significantly among diabetic Pima Indians over the past 20 years, as treatment with medicines to control hyperglycemia and hypertension increased. The distribution of eGFR, however, remained unchanged. Consequently, the frequency of chronic kidney disease characterized by normoalbuminuria and low eGFR doubled. |
Glycemic control in youth with diabetes: the SEARCH for diabetes in Youth Study
Petitti DB , Klingensmith GJ , Bell RA , Andrews JS , Dabelea D , Imperatore G , Marcovina S , Pihoker C , Standiford D , Waitzfelder B , Mayer-Davis E , SEARCH for Diabetes in Youth Study Group . J Pediatr 2009 155 (5) 668-72 e1-3 OBJECTIVE: To assess correlates of glycemic control in a diverse population of children and youth with diabetes. STUDY DESIGN: This was a cross-sectional analysis of data from a 6-center US study of diabetes in youth, including 3947 individuals with type 1 diabetes (T1D) and 552 with type 2 diabetes (T2D), using hemoglobin A(1c) (HbA(1c)) levels to assess glycemic control. RESULTS: HbA(1c) levels reflecting poor glycemic control (HbA(1c) >or= 9.5%) were found in 17% of youth with T1D and in 27% of those with T2D. African-American, American Indian, Hispanic, and Asian/Pacific Islander youth with T1D were significantly more likely to have higher HbA(1c) levels compared with non-Hispanic white youth (with respective rates for poor glycemic control of 36%, 52%, 27%, and 26% vs 12%). Similarly poor control in these 4 racial/ethnic groups was found in youth with T2D. Longer duration of diabetes was significantly associated with poorer glycemic control in youth with T1D and T2D. CONCLUSIONS: The high percentage of US youth with HbA(1c) levels above the target value and with poor glycemic control indicates an urgent need for effective treatment strategies to improve metabolic status in youth with diabetes. |
Late HIV testing - 34 states, 1996-2005
Shouse RL , Hall HI , Valleroy L . MMWR Morb Mortal Wkly Rep 2009 58 (24) 661-5 Without effective antiretroviral therapy, most persons infected with human immunodeficiency virus (HIV) will progress to acquired immunodeficiency syndrome (AIDS) in approximately 10 years (1). Testing, diagnosis, and medical care soon after HIV infection and before developing AIDS can prevent unnecessary morbidity and mortality and reduce further HIV transmission. Persons who receive an AIDS diagnosis concurrently or soon after receiving their initial HIV diagnosis (e.g., <or=3 years) represent missed opportunities for prevention and treatment (2). A Healthy People 2010 developmental objective is to increase the proportion of new HIV infections diagnosed before progression to AIDS. To characterize late HIV testing, CDC examined data from 1996-2005 from 34 states with confidential name-based HIV and AIDS reporting (the most recent data available) to determine the percentage of persons who received an AIDS diagnosis <or= 3 years after receiving their initial HIV diagnosis. The results indicated that, within 1 year of their HIV diagnosis, 38.3% of patients had received an AIDS diagnosis; another 6.7% received an AIDS diagnosis from 1 to 3 years after their HIV diagnosis. Compared with whites, greater percentages of persons of all other racial/ethnic populations received an AIDS diagnosis <or=3 years after their initial HIV diagnosis. These findings underscore the need for comprehensive HIV testing programs that include both routine screening of persons aged 13-64 years and more frequent testing for persons at increased risk and, therefore, in greater need of periodic HIV testing. |
Deaths related to 2009 pandemic influenza A (H1N1) among American Indian/Alaska Natives - 12 states, 2009
Castrodale L , McLaughlin J , Komatsu K , Wells E , Landen M , Selvage D , Sewell M , Smelser C , Thompson D , Bradley K , McDonald C , Leman R , Powell M , Miller T , VanderBusch L , Kightlinger L , Boulton R , Lofy K , Marfin AA , McClinton R , Hoopes M , Kim T , Hayes JM , Mahal Z , Chao E , Weiser T , Cheek JE , Redd JT , Bryan R , Jhung M , Morrison M , O'Leary D , Nichols M . MMWR Morb Mortal Wkly Rep 2009 58 (48) 1341-4 Indigenous populations from Australia, Canada, and New Zealand have been found to have a three to eight times higher rate of hospitalization and death associated with infection with the 2009 pandemic influenza A (H1N1) virus. In October, two U.S. states (Arizona and New Mexico) observed a disproportionate number of deaths related to H1N1 among American Indian/Alaska Natives (AI/ANs). These observations, plus incomplete reporting of race/ethnicity at the national level, led to formation of a multidisciplinary workgroup comprised of representatives from 12 state health departments, the Council of State and Territorial Epidemiologists, tribal epidemiology centers, the Indian Health Service, and CDC. The workgroup assessed the burden of H1N1 influenza deaths in the AI/AN population by compiling surveillance data from the states and comparing death rates. The results indicated that, during April 15-November 13, AI/ANs in the 12 participating states had an H1N1 mortality rate four times higher than persons in all other racial/ethnic populations combined. Reasons for this disparity in death rates are unknown and need further investigation; however, they might include a high prevalence of chronic health conditions (e.g., diabetes and asthma) among AI/ANs that predisposes them to influenza complications, poverty (e.g., poor living conditions), and delayed access to care. Efforts are needed to increase awareness among AI/ANs and their health-care providers of the potential severity of influenza and current recommendations regarding the timely use of antiviral medications. Efforts to promote the use of 2009 H1N1 influenza monovalent vaccine in AI/AN populations should be expanded. |
National, state, and local area vaccination coverage among adolescents aged 13-17 years--United States, 2008
Stokley S , Dorell C , Yankey D . MMWR Morb Mortal Wkly Rep 2009 58 (36) 997-1001 In recent years, the Advisory Committee on Immunization Practices (ACIP) has recommended three newly licensed vaccines: meningococcal conjugate vaccine (MCV4; 1 dose); tetanus, diphtheria, acellular pertussis vaccine (Tdap; 1 dose); and (for girls) quadrivalent human papillomavirus vaccine (HPV4; 3 doses). ACIP also recommends that adolescents receive recommended vaccinations that were missed during childhood: measles, mumps, rubella vaccine (MMR; 2 doses); hepatitis B vaccine (HepB; 3 doses); and varicella vaccine (VAR; 2 doses). Since 2006, CDC has conducted the National Immunization Survey-Teen (NIS-Teen) to estimate vaccination coverage from a national sample of adolescents aged 13-17 years. This report summarizes results from the 2008 NIS-Teen and, for the first time, includes estimates for each of the 50 states and selected local areas. Nationally, vaccination coverage for the three most recently recommended adolescent vaccinations and one childhood vaccination increased from 2007 to 2008: MCV4 (from 32.4% to 41.8%), Tdap (from 30.4% to 40.8%), ≥1 dose of HPV4 (from 25.1% to 37.2%), and ≥2 doses of VAR among those without disease history (from 18.8% to 34.1%). However, substantial variability in vaccination coverage was observed in 2008 among state and local areas and by race/ethnicity and poverty status. For the first time, the Healthy People 2010 target of 90% coverage among adolescents aged 13-15 years was met for MMR and HepB. Public health agencies should continue annual monitoring of adolescent vaccination coverage levels to identify trends and differences by geographic area, race/ethnicity, and poverty status. |
Development of a flexible sigmoidoscopy training program for rural nurse practitioners and physician assistants to increase colorectal cancer screening among Alaska native people
Redwood D , Joseph DA , Christensen C , Provost E , Peterson VL , Espey D , Sacco F . J Health Care Poor Underserved 2009 20 (4) 1041-8 At the Alaska Native Medical Center in Anchorage, colorectal cancer screening rates improved dramatically with the initiation of a dedicated flexible sigmoidoscopy screening program staffed by mid-level providers. We describe the development and implementation of a program to train rural nurse practitioners and physician assistants in flexible sigmoidoscopy. |
Sexual and reproductive health of persons aged 10-24 years - United States, 2002-2007
Gavin L , MacKay AP , Brown K , Harrier S , Ventura SJ , Kann L , Rangel M , Berman S , Dittus P , Liddon N , Markowitz L , Sternberg M , Weinstock H , David-Ferdon C , Ryan G . MMWR Surveill Summ 2009 58 (6) 1-58 This report presents data for 2002-2007 concerning the sexual and reproductive health of persons aged 10-24 years in the United States. Data were compiled from the National Vital Statistics System and multiple surveys and surveillance systems that monitor sexual and reproductive health outcomes into a single reference report that makes this information more easily accessible to policy makers, researchers, and program providers who are working to improve the reproductive health of young persons in the United States. The report addresses three primary topics: 1) current levels of risk behavior and health outcomes; 2) disparities by sex, age, race/ethnicity, and geographic residence; and 3) trends over time. The data presented in this report indicate that many young persons in the United States engage in sexual risk behavior and experience negative reproductive health outcomes. In 2004, approximately 745,000 pregnancies occurred among U.S. females aged <20 years. In 2006, approximately 22,000 adolescents and young adults aged 10-24 years in 33 states were living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and approximately 1 million adolescents and young adults aged 10-24 years were reported to have chlamydia, gonorrhea, or syphilis. One-quarter of females aged 15-19 years and 45% of those aged 20-24 years had evidence of infection with human papillomavirus during 2003-2004, and approximately 105,000 females aged 10--24 years visited a hospital emergency department (ED) for a nonfatal sexual assault injury during 2004-2006. Although risks tend to increase with age, persons in the youngest age group (youths aged 10--14 years) also are affected. For example, among persons aged 10-14 years, 16,000 females became pregnant in 2004, nearly 18,000 males and females were reported to have sexually transmitted diseases (STDs) in 2006, and 27,500 females visited a hospital ED because of a nonfatal sexual assault injury during 2004-2006. Noticeable disparities exist in the sexual and reproductive health of young persons in the United States. For example, pregnancy rates for female Hispanic and non-Hispanic black adolescents aged 15-19 years are much higher (132.8 and 128.0 per 1,000 population) than their non-Hispanic white peers (45.2 per 1,000 population). Non-Hispanic black young persons are more likely to be affected by AIDS: for example, black female adolescents aged 15-19 years were more likely to be living with AIDS (49.6 per 100,000 population) than Hispanic (12.2 per 100,000 population), American Indian/Alaska Native (2.6 per 100,000 population), non-Hispanic white (2.5 per 100,000 population) and Asian/Pacific Islander (1.3 per 100,000 population) adolescents. In 2006, among young persons aged 10-24 years, rates for chlamydia, gonorrhea, and syphilis were highest among non-Hispanic blacks for all age groups. The southern states tend to have the highest rates of negative sexual and reproductive health outcomes, including early pregnancy and STDs. Although the majority of negative outcomes have been declining for the past decade, the most recent data suggest that progress might be slowing, and certain negative sexual health outcomes are increasing. For example, birth rates among adolescents aged 15-19 years decreased annually during 1991-2005 but increased during 2005-2007, from 40.5 live births per 1,000 females in 2005 to 42.5 in 2007 (preliminary data). The annual rate of AIDS diagnoses reported among males aged 15-19 years has nearly doubled in the past 10 years, from 1.3 cases per 100,000 population in 1997 to 2.5 cases in 2006. Similarly, after decreasing for >20 years, gonorrhea infection rates among adolescents and young adults have leveled off or had modest fluctuations (e.g., rates among males aged 15-19 years ranged from 285.7 cases per 100,000 population in 2002 to 250.2 cases per 100,000 population in 2004 and then increased to 275.4 cases per 100,000 population in 2006), and rates for syphilis have been increasing (e.g., rates among females aged 15-19 years increased from 1.5 cases per 100,000 population in 2004 to 2.2 cases per 100,000 population in 2006) after a significant decrease during 1997-2005. |
Alcohol and suicide among racial/ethnic populations - 17 states, 2005-2006
Crosby C , Espitia-Hardeman V , Hill HA , Ortega L , Clavel-Arcas C . MMWR Morb Mortal Wkly Rep 2009 58 (23) 637-41 During 2001-2005, an estimated annual 79,646 alcohol-attributable deaths (AAD) and 2.3 million years of potential life lost (YPLL) were attributed to the harmful effects of excessive alcohol use. An estimated 5,800 AAD and 189,667 YPLL were associated annually with suicide. The burden of suicide varies widely among racial and ethnic populations in the United States, and limited data are available to describe the role of alcohol in suicides in these populations. To examine the relationship between alcohol and suicide among racial/ethnic populations, CDC analyzed data from the National Violent Death Reporting System (NVDRS) for the 2-year period 2005-2006 (the most recent data available). This report summarizes the results of that analysis, which indicated that the overall prevalence of alcohol intoxication (i.e., blood alcohol concentration [BAC] at or above the legal limit of 0.08 g/dL) was nearly 24% among suicide decedents tested for alcohol, with the highest percentage occurring among American Indian/Alaska Natives (AI/ANs) (37%), followed by Hispanics (29%) and persons aged 20-49 years (28%). These results indicate that many populations can benefit from comprehensive and culturally appropriate suicide-prevention strategies that include efforts to reduce alcohol consumption, especially programs that focus on persons aged <50 years. |
Cigarette smoking among adults and trends in smoking cessation - United States, 2008
Dube SR , Asman K , Malarcher A , Carabollo R . MMWR Morb Mortal Wkly Rep 2009 58 (44) 1227-32 Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in the United States. Full implementation of population-based strategies and clinical interventions can educate adult smokers about the dangers of tobacco use and assist them in quitting. To assess progress toward the Healthy People 2010 objective of reducing the prevalence of cigarette smoking among adults to <12% (objective 27-1a), CDC analyzed data from the 2008 National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which indicated that during 1998-2008, the proportion of U.S. adults who were current cigarette smokers declined 3.5% (from 24.1% to 20.6%). However, the proportion did not change significantly from 2007 (19.8%) to 2008 (20.6%). In 2008, adults aged >or=25 years with low educational attainment had the highest prevalence of smoking (41.3% among persons with a General Educational Development certificate [GED] and 27.5% among persons with less than a high school diploma, compared with 5.7% among those with a graduate degree). Adults with education levels at or below the equivalent of a high school diploma, who comprise approximately half of current smokers, had the lowest quit ratios (2008 range: 39.9% to 48.8%). Evidence-based programs known to be effective at reducing smoking should be intensified among groups with lower education, and health-care providers should take education level into account when communicating about smoking hazards and cessation to these patients. |
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