Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
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Trends in the prevalence of chronic obstructive pulmonary disease among adults aged ≥18 years - United States, 2011-2021
Liu Y , Carlson SA , Watson KB , Xu F , Greenlund KJ . MMWR Morb Mortal Wkly Rep 2023 72 (46) 1250-1256 Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the United States. Overall COPD prevalence declined during 1999-2011. Trends in COPD prevalence during the previous decade have not been reported. CDC analyzed 2011-2021 Behavioral Risk Factor Surveillance System data to assess trends and differences in self-reported physician-diagnosed COPD prevalence among U.S. adults aged ≥18 years. Age-standardized prevalence of COPD did not change significantly from 2011 (6.1%) to 2021 (6.0%). Prevalence was stable for most states and subgroups; however, it decreased significantly among adults aged 18-44 years (average annual percent change [AAPC] = -2.0%) and increased significantly among those aged ≥75 years (AAPC = 1.3%), those living in micropolitan counties (0.8%), and among current (1.5%) or former (1.2%) smokers. COPD prevalence remained elevated in the following groups: women, adults aged ≥65 years, those with a lower education level, unable to work, living in rural areas, and who ever smoked. Evidence-based strategies, especially those tailored for adults disproportionately affected, can reduce COPD prevalence, and address the continued need for prevention, early diagnosis, treatment, and management. |
Linking local-level chronic disease and social vulnerability measures to inform planning efforts: A COPD Example
Carlson SA , Watson KB , Rockhill S , Wang Y , Pankowska MM , Greenlund KJ . Prev Chronic Dis 2023 20 E76 INTRODUCTION: Data are publicly available to identify geographic differences in health outcomes, including chronic obstructive pulmonary disease (COPD), and social vulnerability; however, examples of combining data across sources to understand disease burden in the context of community vulnerability are lacking. METHODS: We merged county and census tract model-based estimates of COPD prevalence from PLACES (www.cdc.gov/PLACES) with social vulnerability measures from the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (https://www.atsdr.cdc.gov/placeandhealth/svi), including 4 themes (socioeconomic, household composition and disability, minority status and language, and housing type and transportation), and the overall Social Vulnerability Index (SVI). We used the merged data set to create vulnerability profiles by COPD prevalence, explore joint geographic patterns, and calculate COPD population estimates by vulnerability levels. RESULTS: Counties and census tracts with high COPD prevalence (quartile 4) had high median vulnerability rankings (range: 0-1) for 2 themes: socioeconomic (county, 0.81; tract, 0.77) and household composition and disability (county, 0.75; tract, 0.81). Concordant high COPD prevalence and vulnerability for these themes were clustered along the Ohio and lower Mississippi rivers. The estimated number of adults with COPD residing in counties with high vulnerability was 2.5 million (tract: 4.7 million) for the socioeconomic theme and 2.3 million (tract: 5.0 million) for the household composition and disability theme (high overall SVI: county, 4.5 million; tract, 4.7 million). CONCLUSION: Data from 2 publicly available tools can be combined, analyzed, and visualized to jointly examine local COPD estimates and social vulnerability. These analyses can be replicated with other measures to expand the use of these cross-cutting tools for public health planning. |
Prevalence and geographic patterns of self-reported short sleep duration among US adults, 2020
Pankowska MM , Lu H , Wheaton AG , Liu Y , Lee B , Greenlund KJ , Carlson SA . Prev Chronic Dis 2023 20 E53 We estimated the prevalence of short sleep duration (<7 hours per day) among US adults aged 18 years or older by using 2020 Behavioral Risk Factor Surveillance System data. Nationally, 33.2% of adults reported short sleep duration. We identified disparities across sociodemographic characteristics, including age, sex, race and ethnicity, marital status, education, income, and urbanicity. Counties with the highest model-based estimates of short sleep duration clustered in the Southeast and along the Appalachian Mountains. These findings identified subgroups and geographic areas in which tailored strategies for promotion of optimal sleep duration (≥7 hours per night) are most needed. |
National, state-level, and county-level prevalence estimates of adults aged 18 years self-reporting a lifetime diagnosis of depression - United States, 2020
Lee B , Wang Y , Carlson SA , Greenlund KJ , Lu H , Liu Y , Croft JB , Eke PI , Town M , Thomas CW . MMWR Morb Mortal Wkly Rep 2023 72 (24) 644-650 Depression is a major contributor to mortality, morbidity, disability, and economic costs in the United States (1). Examining the geographic distribution of depression at the state and county levels can help guide state- and local-level efforts to prevent, treat, and manage depression. CDC analyzed 2020 Behavioral Risk Factor Surveillance System (BRFSS) data to estimate the national, state-level, and county-level prevalence of U.S. adults aged ≥18 years self-reporting a lifetime diagnosis of depression (referred to as depression). During 2020, the age-standardized prevalence of depression among adults was 18.5%. Among states, the age-standardized prevalence of depression ranged from 12.7% to 27.5% (median = 19.9%); most of the states with the highest prevalence were in the Appalachian* and southern Mississippi Valley(†) regions. Among 3,143 counties, the model-based age-standardized prevalence of depression ranged from 10.7% to 31.9% (median = 21.8%); most of the counties with the highest prevalence were in the Appalachian region, the southern Mississippi Valley region, and Missouri, Oklahoma, and Washington. These data can help decision-makers prioritize health planning and interventions in areas with the largest gaps or inequities, which could include implementation of evidence-based interventions and practices such as those recommended by The Guide to Community Preventive Services Task Force (CPSTF) and the Substance Abuse and Mental Health Services Administration (SAMHSA). |
Leisure time physical activity throughout adulthood is associated with lower medicare costs: evidence from the linked NIH-AARP diet and health study cohort
Coughlan D , Saint-Maurice PF , Carlson SA , Fulton J , Matthews CE . BMJ Open Sport Exerc Med 2021 7 (1) e001038 BACKGROUND: There is limited information about the association between long-term leisure time physical activity (LTPA) participation and healthcare costs. The purpose of this study was to investigate the association between LTPA over adulthood with later life healthcare costs in the USA. METHODS: Using Medicare claims data (between 1999 and 2008) linked to the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study, we examined associations between nine trajectories of physical activity participation throughout adulthood with Medicare costs. RESULTS: Compared with adults who were consistently inactive from adolescence into middle age, average annual healthcare costs were significantly lower for maintainers, adults who maintained moderate (-US$1350 (95% CI: -US$2009 to -US$690) or -15.9% (95% CI: -23.6% to -8.1%)) or high physical activity levels (-US$1200 (95% CI: -US$1777 to -US$622) or -14.1% (95% CI: -20.9% to -7.3%)) and increasers, adults who increased physical activity levels in early adulthood (-US$1874 (95% CI: US$2691 to -US$1057) or -22.0% (95% CI: -31.6% to -12.4%)) or in middle age (-US$824 (95% CI: -US$1580 to -US$69 or -9.7% (95% CI -18.6% to -0.8%)). For the four trajectories where physical activity decreased, the only significant difference was for adults who increased physical activity levels during early adulthood with a decline in middle age (-US$861 (95% CI:-US$1678 to -US$45) or -10.1% (95% CI: -19.7% to -0.5%)). CONCLUSION: Our analyses suggest the healthcare cost burden in later life could be reduced through promotion efforts supporting physical activity participation throughout adulthood. |
Actions to Improve Physical Activity Surveillance in the United States
Pate RR , Berrigan D , Buchner DM , Carlson SA , Dunton G , Fulton JE , Sanchez E , Troiano RP , Whitehead J , Whitsel LP . NAM Perspect 2018 2018 Physical activity, which has been defined as “any bodily movement produced by skeletal muscles that results in energy expenditure” [1], provides important health benefits across the lifespan. However, a large percentage of Americans fail to meet current physical activity guidelines, and this deficiency accounts for a sizeable population health burden. | | A core function of public health, “surveillance” refers to “ongoing, systematic collection, analysis, and interpretation of outcome-specific data for use in the planning, implementation, and evaluation of public health practice” [2,3]. There are many different forms of physical activity, and physical activity is performed at varying intensities, in numerous settings, and for multiple reasons. Physical activity behavior is known to be influenced by personal, social, physical, environmental, institutional, community, and societal factors. Because physical activity is a complex behavior, physical activity surveillance is a complex, multicomponent process. |
Chronic conditions among adults aged 1834 years - United States, 2019
Watson KB , Carlson SA , Loustalot F , Town M , Eke PI , Thomas CW , Greenlund KJ . MMWR Morb Mortal Wkly Rep 2022 71 (30) 964-970 Chronic conditions are common, costly, and major causes of death and disability.* Addressing chronic conditions and their determinants in young adulthood can help slow disease progression and improve well-being across the life course (1); however, recent prevalence estimates examining chronic conditions in young adults overall and by subgroup have not been reported. CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) to measure prevalence of 11 chronic conditions among adults aged 18-34 years overall and by selected characteristics, and to measure prevalence of health-related risk behaviors by chronic condition status. In 2019, more than one half (53.8%) of adults aged 18-34 years reported having at least one chronic condition, and nearly one quarter (22.3%) reported having more than one chronic condition. The most prevalent conditions were obesity (25.5%), depression (21.3%), and high blood pressure (10.7%). Differences in the prevalence of having a chronic condition were most noticeable between young adults with a disability (75.8%) and without a disability (48.3%) and those who were unemployed (62.3%) and students (45.8%). Adults aged 18-34 years with a chronic condition were more likely than those without one to report binge drinking, smoking, or physical inactivity. Coordinated efforts by public and private sectors might help raise awareness of chronic conditions among young adults and help improve the availability of evidence-based interventions, policies, and programs that are effective in preventing, treating, and managing chronic conditions among young adults (1). |
Urban-rural differences in health care utilization for inflammatory bowel disease in the USA, 2017
Xu F , Carlson SA , Liu Y , Greenlund KJ . Dig Dis Sci 2022 67 (8) 3601-3611 BACKGROUND: Urban-rural differences in IBD-specific health care utilization at the national level have not been examined in the USA. AIMS: We compared urban and rural rates of IBD-related office visits and IBD-specific (Crohn's disease (CD) or ulcerative colitis (UC)) hospitalizations and emergency department (ED) visits. METHODS: From multiple national data sources, we compared national rates using Z test and compared estimates of patient and hospital characteristics and hospitalization outcomes between urban and rural areas using Chi-square and t tests. RESULTS: In 2015 and 2016, digestive disease-related office visit rates, per 100 adults, were 3.1 times higher in urban than in rural areas (8.7 vs 2.8, P < 0.001). In 2017, age-adjusted rates per 100,000 adults were significantly higher in rural than urban areas for CD-specific hospitalizations (26.3 vs 23.6, P = 0.03) and ED visits (49.3 vs 39.5, P = 0.002). Compared with their urban counterparts, rural adults hospitalized for CD or UC in 2017 were more likely to be older and non-Hispanic white, have lower household income, Medicare coverage, and an elective admission, and were discharged from hospitals that were large, non-federal government owned, and in the Midwest or South. There were no significant urban-rural differences in length of stay and 30-day readmission rate. CONCLUSIONS: While IBD or digestive disease-related office visit rates were lower in rural compared to urban areas, CD-specific hospitalization and ED visit rates were higher. Strategies that improve office-based care among rural patients with IBD may help to avoid more costly forms of health care use. |
Primary care professionals' attitudes towards vaccination recommendation for patients with inflammatory bowel disease
Xu F , deJong N , Kappelman MD , Greenlund KJ , Carlson SA . Inflamm Bowel Dis 2022 29 (5) 726-734 BACKGROUND: Immunization among patients with inflammatory bowel disease (IBD) is suboptimal. We sought to characterize attitudes of US primary care professionals (PCPs) towards immunization practices for patients with IBD. METHODS: Using a web-based opt-in panel of PCPs (DocStyles survey, spring 2021, cross-sectional study), we assessed likelihood of PCPs' recommending influenza, pneumococcal disease, herpes zoster, and human papilloma virus vaccinations for IBD patients by PCP characteristics and availability of clinical tools. Reasons for unlikelihood of recommending vaccines and approaches to improve vaccine recommendation were examined. RESULTS: Among 1503 PCPs, 64% recommended all vaccines. Herpes zoster vaccine was most likely to be recommended (89.8%) and pneumococcal vaccine was least likely (74.0%). Clinical tools including decision support based on electronic health records (EHRs; 48.9%) and staff tracking of patients' vaccine needs (36.3%) were significantly associated with likelihood of recommending vaccines (Pā <ā .001). A greater likelihood of vaccine recommendation was observed for pediatricians vs other medical specialties, group outpatient clinic vs other worksites, and seeing >50 patients/week (Pā <ā .05). One-third of PCPs were unlikely to recommend ≥1 vaccine, and the top reason reported was unfamiliarity with vaccine guidelines for patients with IBD (48.0%). A review of guidelines or continued medical education (63.0%) and decision support from EHRs (51.2%) were the most frequently selected approaches identified to improve certainty of vaccine recommendation. CONCLUSIONS: There is room for improvement of vaccination recommendations by PCPs. Promoting continuing education and use of clinical tools may help support PCP immunization practices for patients with IBD. | In a survey of 1503 primary care professionals, pneumococcal vaccines were the least likely to be recommended to patients with inflammatory bowel disease (IBD). Promoting continuing education and use of clinical practice tools may improve vaccination recommendations for IBD patients. | eng |
PLACES: Local data for better health
Greenlund KJ , Lu H , Wang Y , Matthews KA , LeClercq JM , Lee B , Carlson SA . Prev Chronic Dis 2022 19 E31 Local-level data on the health of populations are important to inform and drive effective and efficient actions to improve health, but such data are often expensive to collect and thus rare. Population Level Analysis and Community EStimates (PLACES) (www.cdc.gov/places/), a collaboration between the Centers for Disease Control and Prevention (CDC), the Robert Wood Johnson Foundation, and the CDC Foundation, provides model-based estimates for 29 measures among all counties and most incorporated and census-designated places, census tracts, and ZIP Code tabulation areas across the US. PLACES allows local health departments and others to better understand the burden and geographic distribution of chronic disease-related outcomes in their areas regardless of population size and urban-rural status and assists them in planning public health interventions. Online resources allow users to visually explore health estimates geographically, compare estimates, and download data for further use and exploration. By understanding the PLACES overall approach and using the easy-to-use PLACES applications, practitioners, policy makers, and others can enhance their efforts to improve public health, including informing prevention activities, programs, and policies; identifying priority health risk behaviors for action; prioritizing investments to areas with the biggest gaps or inequities; and establishing key health objectives to achieve community health and health equity. |
US county-level estimation for maternal and infant health-related behavior indicators using pregnancy risk assessment monitoring system data, 2016-2018
Wang Y , Tevendale H , Lu H , Cox S , Carlson SA , Li R , Shulman H , Morrow B , Hastings PA , Barfield WD . Popul Health Metr 2022 20 (1) 14 BACKGROUND: There is a critical need for maternal and child health data at the local level (for example, county), yet most counties lack sustainable resources or capabilities to collect local-level data. In such case, model-based small area estimation (SAE) could be a feasible approach. SAE for maternal or infant health-related behaviors at small areas has never been conducted or evaluated. METHODS: We applied multilevel regression with post-stratification approach to produce county-level estimates using Pregnancy Risk Assessment Monitoring System (PRAMS) data, 2016-2018 (n = 65,803 from 23 states) for 2 key outcomes, breastfeeding at 8 weeks and infant non-supine sleeping position. RESULTS: Among the 1,471 counties, the median model estimate of breastfeeding at 8 weeks was 59.8% (ranged from 34.9 to 87.4%), and the median of infant non-supine sleeping position was 16.6% (ranged from 10.3 to 39.0%). Strong correlations were found between model estimates and direct estimates for both indicators at the state level. Model estimates for both indicators were close to direct estimates in magnitude for Philadelphia County, Pennsylvania. CONCLUSION: Our findings support this approach being potentially applied to other maternal and infant health and behavioral indicators in PRAMS to facilitate public health decision-making at the local level. |
Geographic differences in sex-specific chronic obstructive pulmonary disease mortality rate trends among adults aged 25 years - United States, 1999-2019
Carlson SA , Wheaton AG , Watson KB , Liu Y , Croft JB , Greenlund KJ . MMWR Morb Mortal Wkly Rep 2022 71 (18) 613-618 Chronic obstructive pulmonary disease (COPD) accounts for the majority of deaths from chronic lower respiratory diseases, the fourth leading cause of death in the United States in 2019.* COPD mortality rates are decreasing overall. Although rates in men remain higher than those in women, declines have occurred among men but not women (1). To examine the geographic variation in sex-specific trends in age-adjusted COPD mortality rates among adults aged ≥25 years, CDC analyzed 1999-2019 death certificate data, by urban-rural status,(†) U.S. Census Bureau region,(§) and state. Among women, no significant change in overall COPD mortality occurred during this period; however, rates increased significantly in small metropolitan (average annual percent change [AAPC] = 0.6%), micropolitan (1.2%), and noncore (1.9%) areas and in the Midwest (0.6%). Rates decreased significantly in large central (-0.9%) and fringe metropolitan (-0.4%) areas (and in the Northeast (-0.5%) and West (-1.2%). Among men, rates decreased significantly overall (-1.3%), in all urban-rural areas (range = -1.9% [large central metropolitan] to -0.4% [noncore]) and in all regions (range = -2.0% [West] to -0.9% [Midwest]). Strategies to improve the prevention, treatment, and management of COPD are needed, especially to address geographic differences and improve the trend in women, to reduce COPD deaths. |
Systematic review on quantifying pedestrian injury when evaluating changes to the built environment
Pollack Porter KM , Omura JD , Ballard RM , Peterson EL , Carlson SA . Prev Med Rep 2022 26 101703 Modifying the built environment to make communities more walkable remains one strategy to promote physical activity. These modifications may have the added benefit of reducing the risk of pedestrian injury; however, there is a gap in the physical activity literature regarding how best to measure pedestrian injury. Examining the measures that have been used and related data sources can help inform the use of pedestrian injury data to evaluate whether safety is optimized as walking increases. We conducted a systematic review of the literature to identify studies that evaluated changes to the built environment that support walking and measures impacts on pedestrian injury as a measure of safety. We searched PubMed, PsycInfo, and Web of Science to identify peer-review studies and websites of fifteen organizations to document studies from the grey literature published in English between January 1, 2010 and December 31, 2018. Our search identified twelve studies that met the inclusion criteria. The few studies that measured changes in pedestrian injury used crash data from police reports. Injury frequency was often reported, but not injury severity, and no studies reported injury risk based on walking exposure. We conclude that few studies have measured pedestrian injury in the context of creating more walkable communities. Future research would benefit from using well-characterized measures from existing studies to support consistency in measurement, and from more longitudinal and evaluation research to strengthen the evidence on additional benefits of walkability. Increased collaborations with injury prevention professionals could bolster use of valid and reliable measures. |
Sleep Disorder Symptoms Among Adults in 8 States and the District of Columbia, 2017
Liu Y , Carlson SA , Wheaton AG , Greenlund KJ , Croft JB . Prev Chronic Dis 2021 18 E105 Sleep disorder symptoms (trouble falling asleep or staying asleep, unintentionally falling asleep, snoring loudly, and episodes of having stopped breathing) among US adults (N = 59,108) from 8 states and the District of Columbia were analyzed by using data from the 2017 Behavioral Risk Factor Surveillance System. We conducted a multivariable logistic regression to assess the association between the 4 symptoms and sociodemographic characteristics, risk behaviors, and chronic conditions. The 4 symptoms were prevalent and more likely to be reported among adults with any chronic condition(s) than their counterparts without symptoms and among those who slept fewer than 7 hours compared with those who slept 7 to 9 hours. |
Associations of self-reported chronic obstructive pulmonary disease with indicators of economic instability and stress - 16 states, 2017
Carlson SA , Wheaton AG , Liu Y , Moore LV , Eke PI , Croft JB , Greenlund KJ , Thomas CW . Chronic Illn 2021 19 (2) 17423953211059144 OBJECTIVES: To examine the association between chronic obstructive pulmonary disease status and indicators of economic instability and stress to better understand the magnitude of these issues in persons with chronic obstructive pulmonary disease. METHODS: Analyzed 2017 Behavioral Risk Factor Surveillance System data from 16 states that administered the 'Social Determinants of Health' module, which included economic instability and stress measures (N = 101,461). Associations between self-reported doctor-diagnosed chronic obstructive pulmonary disease status and each measure were examined using multinomial logistic models. RESULTS: Adults with chronic obstructive pulmonary disease were more likely (p < 0.001) than adults without to report not having enough money at month end (21.0% vs. 7.9%) or just enough money (44.9% vs. 37.2%); being unable to pay mortgage, rent, or utility bills (19.2% vs. 8.8%); and that often or sometimes food did not last or could not afford to eat balanced meals (37.9% vs. 20.6%), as well as stress all or most of the time (27.3% vs. 11.6%). Associations were attenuated although remained significant after adjustments for sociodemographic and health characteristics. DISCUSSION: Financial, housing, and food insecurity and frequent stress were more prevalent in adults with chronic obstructive pulmonary disease than without. Findings highlight the importance of including strategies to address challenges related to economic instability and stress in chronic obstructive pulmonary disease management programs. |
Differences in park plans and policies across U.S. municipalities
Peterson EL , Carlson SA , Ussery EN , Dunn I , Brown DR , Galuska DA . J Park Recreat Admi 2021 39 (4) Park planning documents may be valuable tools in order to promote policies and direct resources toward parks. However, the prevalence of such planning documents and policies specific to parks across municipal characteristics is not well known. This study compares the presence of parks and recreation plans and policies that address park safety and maintenance by municipality characteristics. Na-tionally representative data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living were analyzed (n=2005, response rate: 45%). About 7 out of 10 U.S. municipalities with a population of at least 1,000 reported having a parks and recreation plan. Prevalence of specific park or outdoor recreation policies was 78% for lighting, 85% for patrols by police and security, and 87% for maintenance of green space and equipment. The prevalence of a parks and recreation plan and of specific park or outdoor recreation policies were significantly lower in the smaller communities examined in this study. Most communities with at least 1,000 residents have park planning documents and policies, and opportunities may exist for practitioners to leverage the planning process to better engage residents. Future studies could in-vestigate the role and importance of using planning documents, policies, or bud-get provisions to address park access and quality in less populous municipalities. © 2020 Sagamore-Venture Publishing. |
Surveillance of Meeting the Youth Physical Activity Guideline: Impact of Including Vigorous-Intensity and Bone-Strengthening Activities
Hyde ET , Watson KB , Omura JD , Janz KF , Lee SM , Fulton JE , Carlson SA . Res Q Exerc Sport 2021 93 (4) 1-6 PURPOSE: The US youth physical activity guideline recommends participation in four types of physical activity: moderate-to-vigorous intensity aerobic (MVPA), vigorous-intensity aerobic (VPA), muscle-strengthening, and bone-strengthening physical activity. Current national prevalence estimates of meeting the youth physical activity guideline are typically based on measures of the MVPA and muscle-strengthening components. This study sought to examine differences in prevalence estimates using this current approach and then including measures of all four components. METHODS: Data from US high school student respondents to the 2010 National Youth Physical Activity and Nutrition Survey were analyzed (n = 10,596). Prevalence of students meeting the youth physical activity guideline were assessed and compared using 1) measures of MVPA and muscle-strengthening components only and 2) also including measures of the VPA and bone-strengthening components. RESULTS: Overall, 15.2% students met the MVPA, 50.7% met the muscle-strengthening, 70.6% met the VPA, and 80.7% met the bone-strengthening components. In total, 12.1% (95% confidence interval: 10.9, 13.3) of students met both the MVPA and muscle-strengthening components, and 11.2% (95% confidence interval: 10.0, 12.4) met all four components. CONCLUSIONS: Incorporating additional measures of VPA and bone-strengthening activity into current surveillance systems may not meaningfully impact national estimates of meeting the youth physical activity guideline. |
A new decade of Healthy People: Considerations for comparing youth physical activity across 2 surveillance systems
Chen TJ , Watson KB , Michael SL , Minnaert JJ , Fulton JE , Carlson SA . J Phys Act Health 2021 18 S94-s101 BACKGROUND: Healthy People 2030 includes objectives to increase meeting the aerobic physical activity guideline for ages 6-13 years (of ages 6-17 y, monitored by National Survey of Children's Health [NSCH]) and grades 9 to 12 (mostly aged 14-18+ y, monitored by Youth Risk Behavior Survey [YRBS]). This study compares methodologies, prevalence, and patterns of meeting the guideline, particularly for overlapping ages 14-17 years. METHODS: Nationally representative surveys, 2016-2017 NSCH (adult proxy report, 6-17 y) and 2015 and 2017 YRBS (self-report, grades 9-12), assess meeting the guideline of ≥60 minutes of daily moderate to vigorous physical activity. Prevalence and odds ratios were estimated by age group and demographics. RESULTS: For youth aged 14-17 years, 17.4% (95% confidence interval [CI], 16.1-18.7; NSCH) and 27.0% (95% CI, 25.6-28.5; YRBS) met the guideline. 25.9% (95% CI, 24.8-27.2) aged 6-13 years (NSCH) and 26.6% (95% CI, 25.3-28.0) in grades 9 to 12 (YRBS) met the guideline. Across surveys, fewer females (P < .001) and Asian youth (P < .001 except among NSCH 14-17 y) met the guideline. CONCLUSIONS: Neither methodology nor estimates for meeting the aerobic guideline are similar across surveys, so age continuity between juxtaposed estimates should not be assumed by magnitude nor age for separate Healthy People 2030 youth physical activity objectives. |
Sex-stratified trends in meeting physical activity guidelines, participating in sports, and attending physical education among US adolescents, Youth Risk Behavior Survey 2009-2019
Chen TJ , Watson KB , Michael SL , Carlson SA . J Phys Act Health 2021 18 S102-s113 BACKGROUND: During the past decade, guidelines for youth aerobic and muscle-strengthening physical activity remained unchanged. Active People, Healthy NationSM highlighted school and youth strategies (eg, sports and physical education [PE]) to increase physical activity. Sex, grade, and race/ethnicity disparities exist. This study examines sex-specific trends and differences by grade and race/ethnicity for the prevalence of 5 youth physical activity behaviors from 2009 to 2019. METHODS: The national Youth Risk Behavior Survey assesses adolescents (grades 9-12) meeting the aerobic, muscle-strengthening, and both guidelines (2011-2019) and sports participation and daily PE (2009-2019). Sex-stratified logistic regression assessed trends and 2009 or 2011-2019 differences by grade and racial/ethnic subgroups. RESULTS: Decreases in meeting the aerobic, muscle-strengthening, and both guidelines were observed for nearly all male subgroups by grade and race/ethnicity, whereas female subgroups exhibited declines or no change to low prevalence. Sports and PE participation remained mostly constant; select subgroups showed decreases (ie, Hispanic males [sports]; Black males and ninth-grade females [PE]). CONCLUSIONS: Past decade prevalence and patterns suggest that school-based and other strategies for all adolescents and tailored interventions for sex-specific subgroups may be needed to supplement sports and PE in promoting high school youth physical activity. |
Trends in meeting the physical activity guidelines: Muscle-strengthening alone and combined with aerobic activity, United States, 1998-2018
Hyde ET , Whitfield GP , Omura JD , Fulton JE , Carlson SA . J Phys Act Health 2021 18 S37-s44 BACKGROUND: The National Health Interview Survey is unique among US federal surveillance systems with over 20 years of consistent assessment of muscle-strengthening and aerobic activity. The authors examined trends in the prevalence of US adults who met the muscle-strengthening (2 or more days per week) and the combined muscle-strengthening and aerobic physical activity (at least 150 min/wk of moderate-intensity equivalent activity) guidelines from 1998 to 2018. METHODS: The 1998-2018 National Health Interview Survey data were analyzed. Age-adjusted prevalence of meeting the muscle-strengthening and combined aerobic and muscle-strengthening guidelines by selected respondent characteristics were estimated for each year and linear and higher-order trends were assessed. RESULTS: From 1998 to 2018, prevalence of meeting the muscle-strengthening guideline increased from 17.7% to 27.6%, and meeting the combined aerobic and muscle-strengthening guidelines increased from 14.4% to 24.0%. All subgroups demonstrated significant increases in meeting both guideline measures over this period although trends varied across the 21 years; increasing trends were more commonly sustained in the second decade of monitoring. CONCLUSIONS: Although increasing trends in prevalence of meeting the muscle-strengthening and combined guidelines are encouraging, current prevalence estimates remain low. Opportunities exist for the continued promotion of muscle-strengthening activity using evidence-based approaches. |
Trends in meeting the aerobic physical activity guideline among adults with and without select chronic health conditions, United States, 1998-2018
Omura JD , Hyde ET , Imperatore G , Loustalot F , Murphy L , Puckett M , Watson KB , Carlson SA . J Phys Act Health 2021 18 S53-s63 BACKGROUND: Physical activity is central to the management and control of many chronic health conditions. The authors examined trends during the past 2 decades in the prevalence of US adults with and without select chronic health conditions who met the minimal aerobic physical activity guideline. METHODS: The 1998-2018 National Health Interview Survey data were analyzed. Prevalence of meeting the minimal aerobic physical activity guideline among adults with and without 6 chronic health conditions was estimated across 3-year intervals. Linear and higher-order trends were assessed overall and by age group. RESULTS: During the past 2 decades, prevalence of meeting the aerobic guideline increased among adults with diabetes, hypertension, coronary heart disease, stroke, cancer, and arthritis. However, the absolute increase in prevalence was lower among adults with hypertension, coronary heart disease, and arthritis compared to counterparts without each condition, respectively. Prevalence was persistently lower among those with most chronic health conditions, except cancer, and among older adults compared to their counterparts. CONCLUSIONS: Although rising trends in physical activity levels among adults with chronic health conditions are encouraging for improving chronic disease management, current prevalence remains low, particularly among older adults. Increasing physical activity should remain a priority for chronic disease management and control. |
Surveillance of physical activity and sedentary behavior among youth and adults in the United States: History and opportunities
Omura JD , Whitfield GP , Chen TJ , Hyde ET , Ussery EN , Watson KB , Carlson SA . J Phys Act Health 2021 18 S6-s24 BACKGROUND: Surveillance is a core function of public health, and approaches to national surveillance of physical activity and sedentary behavior have evolved over the past 2 decades. The purpose of this paper is to provide an overview of surveillance of physical activity and sedentary behavior in the United States over the past 2 decades, along with related challenges and emerging opportunities. METHODS: The authors reviewed key national surveillance systems for the assessment of physical activity and sedentary behavior among youth and adults in the United States between 2000 and 2019. RESULTS: Over the past 20 years, 8 surveillance systems have assessed physical activity, and 5 of those have assessed sedentary behavior. Three of the 8 originated in nonpublic health agencies. Most systems have assessed physical activity and sedentary behavior via surveys. However, survey questions varied over time within and also across systems, resulting in a wide array of available data. CONCLUSION: The evolving nature of physical activity surveillance in the United States has resulted in both broad challenges (eg, balancing content with survey space; providing data at the national, state, and local level; adapting traditional physical activity measures and survey designs; and addressing variation across surveillance systems) and related opportunities. |
Trends in self-reported sitting time by physical activity levels among US adults, NHANES 2007/2008-2017/2018
Ussery EN , Whitfield GP , Fulton JE , Galuska DA , Matthews CE , Katzmarzyk PT , Carlson SA . J Phys Act Health 2021 18 S74-s83 BACKGROUND: High levels of sedentary behavior and physical inactivity increase the risk of premature mortality and several chronic diseases. Monitoring national trends and correlates of sedentary behavior and physical inactivity can help identify patterns of risk in the population over time. METHODS: The authors used self-reported data from the National Health and Nutrition Examination Surveys (2007/2008-2017/2018) to estimate trends in US adults' mean daily sitting time, overall, and stratified by levels of leisure-time and multidomain physical activity, and in the joint prevalence of high sitting time (>8 h/d) and physical inactivity. Trends were tested using orthogonal polynomial contrasts. RESULTS: Overall, mean daily sitting time increased by 19 minutes from 2007/2008 (332 min/d) to 2017/2018 (351 min/d) (Plinear < .05; Pquadratic < .05). The highest point estimate occurred in 2013/2014 (426 min/d), with a decreasing trend observed after this point (Plinear < .05). Similar trends were observed across physical activity levels and domains, with one exception: an overall linear increase was not observed among sufficiently active adults. The mean daily sitting time was lowest among highly active adults compared with less active adults when using the multidomain physical activity measure. CONCLUSIONS: Sitting time among adults increased over the study period but decreased in recent years. |
Purpose-based walking trips by duration, distance, and select characteristics, 2017 National Household Travel Survey
Watson KB , Whitfield GP , Bricka S , Carlson SA . J Phys Act Health 2021 18 S86-s93 BACKGROUND: New or enhanced activity-friendly routes to everyday destinations is an evidence-based approach for increasing physical activity. Although national estimates for some infrastructure features surrounding where one lives and the types of nearby destinations are available, less is known about the places where individuals walk. METHODS: A total of 5 types of walking trips (N = 54,034) were defined by whether they began or ended at home (home based [HB]) and trip purpose (HB work, HB shopping, HB social/recreation, HB other, and not HB trip) (2017 National Household Travel Survey). Differences and trends by subgroups in the proportion of each purpose-oriented trip were tested using pairwise comparisons and polynomial contrasts. RESULTS: About 14% of U.S. adults reported ≥1 walking trip on a given day. About 64% of trips were HB trips. There were few differences in prevalence for each purpose by subgroup. For example, prevalence of trips that were not HB decreased significantly with increasing age and increased with increasing education and household income. CONCLUSIONS: Given age-related and socioeconomic differences in walking trips by purpose, planners and other professionals may want to consider trip origin and destination purposes when prioritizing investments for the creation of activity-friendly routes to everyday destinations where people live, work, and play. |
Participation in leisure-time aerobic physical activity among adults, National Health Interview Survey, 1998-2018
Whitfield GP , Hyde ET , Carlson SA . J Phys Act Health 2021 18 S25-s36 BACKGROUND: Adults should perform ≥150 minutes per week of moderate-intensity equivalent physical activity for substantial health benefits and >300 minutes per week for additional benefits. The authors analyzed 21 years of National Health Interview Survey data to better understand trends in aerobic physical activity participation among US adults. METHODS: The authors estimated the annual prevalence (1998-2018) of self-reported leisure-time physical inactivity, insufficient activity, meeting only the minimal aerobic guideline, and meeting the high aerobic guideline overall and by selected characteristics. Prevalence differences between 1998 and 2018 were compared across subgroups and periods of significant change were identified using JoinPoint regression. RESULTS: The prevalence of inactivity decreased from 40.5% (1998) to 25.6% (2018) while the prevalence of meeting the high aerobic guideline increased from 26.0% to 37.4%. Increases in meeting the high guideline were similar across age groups, racial/ethnic groups, levels of education, and Census regions. Increases in insufficient activity and meeting the minimal guideline were statistically significant but of relatively small magnitude. CONCLUSIONS: The prevalence of inactivity decreased and meeting the high aerobic guideline increased overall and for all subgroups from 1998 to 2018. Physical activity promotion strategies may aim to continue these trends while also narrowing persistent disparities in participation across subgroups. |
Trends in aerobic physical activity participation across multiple domains among US adults, National Health and Nutrition Examination Survey 2007/2008 to 2017/2018
Whitfield GP , Ussery EN , Saint-Maurice PF , Carlson SA . J Phys Act Health 2021 18 S64-s73 BACKGROUND: Understanding how participation is changing across domains of physical activity is important for monitoring progress and informing promotion efforts. The authors examined changes in physical activity participation in the National Health and Nutrition Examination Survey 2007/2008 to 2017/2018. METHODS: The prevalence of inactivity, insufficient activity, and meeting the aerobic physical activity guideline in multidomain physical activity and each domain (leisure time, occupational/household, and transportation) was estimated for each cycle and stratified by selected characteristics. The authors tested trends over time and overall changes (2017/2018 vs 2007/2008). RESULTS: For multidomain physical activity, the prevalence of inactivity decreased linearly; meeting the aerobic guideline increased nonmonotonically, and the 2017/2018 prevalence (68.1%) was higher than 2007/2008 (64.1%). Similar findings were observed for adults aged ≥65 years, non-Hispanic Blacks, Hispanics, high school graduates, and adults with obesity. Domain-specific results varied, but decreasing trends in inactivity and increasing trends in meeting the guideline were consistently observed across subgroups for occupational/household activity. Meeting the guideline through transportation activity was rare. CONCLUSIONS: Increases in meeting the guideline and decreases in inactivity in multidomain activity and selected domains are encouraging results, especially among subgroups historically reporting low activity participation. Activity promotion efforts are important to maintain progress, and the transportation domain may be an underutilized source of physical activity. |
Priorities and indicators for economic evaluation of built environment interventions to promote physical activity
Cradock AL , Buchner D , Zaganjor H , Thomas JV , Sallis JF , Rose K , Meehan L , Lawson M , Lavinghouze R , Fenton M , Devlin HM , Carlson SA , Bhattacharya T , Fulton JE . J Phys Act Health 2021 18 (9) 1-9 BACKGROUND: Built environment approaches to promoting physical activity can provide economic value to communities. How best to assess this value is uncertain. This study engaged experts to identify a set of key economic indicators useful for evaluation, research, and public health practice. METHODS: Using a modified Delphi process, a multidisciplinary group of experts participated in (1) one of 5 discussion groups (n = 21 experts), (2) a 2-day facilitated workshop (n = 19 experts), and/or (3) online surveys (n = 16 experts). RESULTS: Experts identified 73 economic indicators, then used a 5-point scale to rate them on 3 properties: measurement quality, feasibility of use by a community, and influence on community decision making. Twenty-four indicators were highly rated (≥3.9 on all properties). The 10 highest-rated "key" indicators were walkability score, residential vacancy rate, housing affordability, property tax revenue, retail sales per square foot, number of small businesses, vehicle miles traveled per capita, employment, air quality, and life expectancy. CONCLUSION: This study identified key economic indicators that could characterize the economic value of built environment approaches to promoting physical activity. Additional work could demonstrate the validity, feasibility, and usefulness of these key indicators, in particular to inform decisions about community design. |
Associations between perceptions and measures of weather and walking, United States2015
Carlson SA , Whitfield GP , Davis RT , Peterson EL , Fulton JE , Berrigan D . Int J Environ Res Public Health 2021 18 (16) Introduction: Weather can be a barrier to walking. Understanding how perceptions of weather as a barrier and measured temperature are associated with walking can inform monitor-ing and promotion strategies. The objective of this study is to examine the association between perceptions of weather as a barrier to walking and measured weather with the volume of leisure and transportation walking. Methods: The 2015 National Health Interview Survey (NHIS) assessed participation in and volume of walking (transportation, leisure) in the past week and frequency of reporting weather as a barrier to walking. Data were collected over the entire year. In 2019, we merged month-specific temperature data from the PRISM climate group with individual NHIS records. We examined associations using logistic (participation) and linear regression models (volume). Re-sults: Participation in walking increased as frequency of reporting weather as a barrier to walking decreased, from ‘almost always’ (transportation: 23%, leisure: 42%) to ‘a little of the time’ (transporta-tion: 40%, leisure: 67%). Among adults reporting walking, walking volume increased as frequency of reporting weather as a barrier decreased from ‘almost always’ (transportation: 51 min/week, leisure: 64 min/week) to ‘never’ (transportation: 69 min/week, leisure: 98 min/week). Month-specific temperature was significantly associated with leisure walking with lower participation at the lowest and highest temperature quintiles, although the strength of the association differed by frequency of reporting weather as a barrier. Conclusions: In general, prevalence and volume of leisure and transportation walking decreased as the perception of weather as a barrier increased. Low and high temperature conditions were also associated with leisure walking participation, particularly among adults with increased perceptions of weather as a barrier. Our findings highlight the importance of including strategies to help adults overcome perceived and actual weather-related barriers in walking promotion efforts. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. |
Sedentary behavior in United States adults: Fall 2019
Matthews CE , Carlson SA , Saint-Maurice PF , Patel S , Salerno E , Loftfield E , Troiano RP , Fulton JE , Sampson JN , Tribby C , Keadle S , Berrigan D . Med Sci Sports Exerc 2021 53 (12) 2512-2519 PURPOSE: Higher levels of sedentary behavior are associated with early mortality, but the distribution of sedentary time by classes of behavior and demographic groups is poorly described in United States (US) adults. To quantify the amount and sources of sedentary time in US adults we conducted a nationwide survey using a novel validated self-administerd previous-day recall method and compare these values with a commonly used sitting time question. METHODS: Participants from the AmeriSpeak panel aged 20 to 75 years (N = 2,640) completed up to two Activities Completed over Time in 24 Hours (ACT24) previous day recalls. Recalls were conducted on randomly selected days in October and November 2019. Survey sample design were applied to reflect the US population. RESULTS: Mean age was 45.3 years, 51% were female, 67% non-Hispanic white, and 37% had a body mass index of ≥30 kg/m2. US adults reported a mean 9.5 hrs/d of sedentary time (95% confidence interval [CI] 9.4, 9.7 hrs/d), which was 34% more than reported using a common surveillance measure (p < 0.01). Most daily sedentary time was accumulated in the leisure and work life domains, with leisure accounting for 47% (4.3 hrs/d [95%CI 4.2, 4.5 hrs/d]) of the total sedentary time. Eighty-two percent of leisure time was spent sedentary, mainly watching television/videos or engaged in internet/computer use. CONCLUSIONS: US adults appear to spend more time in sedentary behavior than previously thought and the majority of this time is accumulated at work and in leisure-time. Reducing sedentary screen-time during leisure in favor of physically active could be an important intervention target in the effort to increase physical activity in US adults. |
Types of Physical Activity Recommended by Primary Care Providers for Patients at Risk for Cardiovascular Disease
Omura JD , Watson KB , Loustalot F , Fulton JE , Carlson SA . Prev Chronic Dis 2021 18 E43 Primary care providers (PCPs) are uniquely positioned to promote physical activity for cardiovascular health. We sought to determine the types of physical activity that PCPs most often recommend to patients at risk for cardiovascular disease (CVD) and how these recommendations vary by PCPs' physical activity counseling practices. We examined the types of physical activity (walking, supervised exercise sessions, or other) PCPs most often suggested for CVD prevention among respondents to the 2018 DocStyles survey (N = 1,088). Most PCPs (80.0%) suggested walking to their patients at risk for CVD; however, PCPs who infrequently discussed physical activity with their patients at risk for CVD suggested walking less often than those who more frequently discussed physical activity. Walking is an easy and low-cost form of physical activity, and opportunities exist for certain PCPs to promote walking as part of their physical activity counseling practices for CVD prevention. |
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