Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-26 (of 26 Records) |
Query Trace: Kilmer G[original query] |
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Disparities in hepatitis C among people aged 12-59 with no history of injection drug use, United States, January 2013-March 2020
Ly KN , Barker LK , Kilmer G , Shing JZ , Jiles RB , Teshale E . Liver Int 2024 ![]() BACKGROUND AND AIMS: In the United States, hepatitis C virus (HCV) infection occurs primarily through injection drug use (IDU), but transmission also occurs through other ways. This study examined HCV prevalence and disparities among US residents aged 12-59 years with no IDU history. METHODS: We analysed 2013-March 2020 National Health and Nutrition Examination Survey data to calculate the HCV prevalence among people with no drug use history and only a non-IDU history, collectively referred to as no IDU history. These estimates were compared to those with an IDU history and stratified by sociodemographic and hepatitis A and hepatitis B serologic characteristics. RESULTS: The current HCV infection prevalence among people aged 12-59 was .7% overall, and specifically 17.2% among people with an IDU history, .9% among people with a non-IDU history and .2% among people with no drug use history. These rates represented 1.4 million people with current HCV infection, of whom, 730 000 had an IDU history, 262 000 had a non-IDU history and 309 000 had no drug use history. Among people with no drug use history, current HCV infection prevalence was higher for people born during 1954-1965 versus after 1965, had completed high school or less versus at least some college and had past/present hepatitis B versus vaccinated for hepatitis B. CONCLUSION: While the HCV infection burden was highest among people with an IDU history, we found a sizeable burden among people without such a history. These findings support policies and practices aimed at addressing disparities among people needing treatment. |
Changes in health indicators among caregivers - United States, 2015-2016 to 2021-2022
Kilmer G , Omura JD , Bouldin ED , Walker J , Spears K , Gore J , Ali AR , McGuire LC . MMWR Morb Mortal Wkly Rep 2024 73 (34) 740-746 Caregivers provide support to persons who might otherwise require placement in long-term care facilities. Approximately one in five U.S. adults provides care to family members or friends who have a chronic health condition or disability. Promoting the well-being of this large segment of the population is a public health priority as recognized by the 2022 National Strategy to Support Family Caregivers. Although negative associations between caregiving and caregiver health are known, changes in the health status of caregivers over time are not. Data from the 2015-2016 and 2021-2022 Behavioral Risk Factor Surveillance System were analyzed to compare changes in the prevalence of 19 health indicators among cross-sectional samples of caregivers and noncaregivers at different time points. Caregivers experienced improvements in prevalence of four health indicators, whereas six worsened. Some health indicators, such as cigarette smoking, improved for both caregivers and noncaregivers, although smoking prevalence remained higher for caregivers (16.6% versus 11.7%). Prevalence of lifetime depression increased for both groups and remained higher among caregivers (25.6%) than among noncaregivers (18.6%). During 2021-2022, age-adjusted estimates for caregivers were unfavorable for 13 of the 19 health indicators when compared with noncaregivers. Strategies for supporting caregivers are available, and integrating these with existing programs to address mental health and chronic diseases among this population might improve caregiver well-being. For example, many community organizations support caregivers by offering interventions designed to relieve caregiver strain, including skills training, support groups, and care coordination. |
Changes in illicit drug use among high school students in southeastern U.S. States-2009 to 2019
Kilmer G , Jones SE , Rico A , Houston A , Lim C , Leon-Nguyen M , Asher AK . J Prev (2022) 2024 To determine if decreasing lifetime use of methamphetamines, cocaine, ecstasy, and inhalants among high school students occurring from 2009 to 2019 in the U.S. also occurred in five southeastern states, Youth Risk Behavior Survey data representative of high school students in grades 9-12 in 2009 and 2019 were analyzed. In a classroom setting, lifetime use of methamphetamines, cocaine, ecstasy, and inhalants were self-reported. Students nationwide (n = 30,087) were compared to students in Alabama, Georgia, Louisiana, Mississippi, and South Carolina (n = 18,237). Lifetime methamphetamine use significantly increased from 4.8% in 2009 to 6.2% in 2019 in the southeast but decreased from 4.1 to 2.2% nationwide. Use of cocaine, ecstasy, and inhalants remained stable in the southeast while decreasing significantly nationwide from 2009 to 2019. During a period when use of methamphetamines, cocaine, ecstasy, and inhalants among high school students in the U.S. decreased, use in southeastern states did not change. Culturally specific programs and interventions may be needed to prevent illicit drug use in communities of southeastern states where youth remain at risk. |
Receipt of and satisfaction with school-based and virtual special education supports and therapeutic services during the COVID-19 pandemic
Spencer P , Verlenden JV , Kilmer G , Pampati S , Moore S , Rasberry CN , Claussen AH . J Online Learn Res 2024 10 (1) 91-112 The COVID-19 pandemic impacted school-based delivery of special educational supports and therapeutic services. This study describes student receipt of school-based supports/services and parent satisfaction by instruction modalities during the 2020-2021 academic year in the United States. Data were collected through the COVID Experiences Survey from parents of children ages 5-12 years, administered using NORC's AmeriSpeak panel. Most parents reported satisfaction with supports (88.4%) and services (93.2%). Dissatisfaction with special education supports and therapeutic services was more common among parents whose children received supports/services virtually than in person (special educational supports: aOR=12.00, 95% CI [1.49-96.89], p=0.020; therapeutic services: aOR=15.76, 95% CI [1.01-245.40], p=0.049). These findings suggest opportunities to improve design and delivery of online special education supports and therapeutic services as well as emergency preparedness by considering the needs of students with disabilities and their families. |
Hepatitis B and Hepatitis C among Adults on Probation or Parole in the United States: 2015-2018
Kilmer G , Hughes E . J Health Care Poor Underserved 12/28/2021 32 (2) 671-679 BACKGROUND: Viral hepatitis is highly prevalent in U.S. prison populations, but prevalence has not been described among adults on probation/parole. METHODS: National Survey on Drug Use and Health data from 2015-2018 were pooled to estimate the prevalence of self-reported diagnosed hepatitis B or hepatitis C among adults reporting past-year parole vs. past-year probation only. RESULTS: About 6.4% of adults on parole reported a diagnosis of hepatitis B or hepatitis C, which was significantly higher than adults on probation only (3.2%). The prevalence for both these groups was significantly higher than for adults not on probation/parole (1.3%). CONCLUSIONS: Adults on probation/parole were more likely to self-report a medical diagnosis of hepatitis B or hepatitis C compared with adults not on probation/parole. This population may be challenging to reach, but viral hepatitis interventions could improve the health of a vulnerable group and prevent transmission from prison populations to the community. |
Overview and methods for the youth risk behavior surveillance system - United States, 2021
Mpofu JJ , Underwood JM , Thornton JE , Brener ND , Rico A , Kilmer G , Harris WA , Leon-Nguyen M , Chyen D , Lim C , Mbaka CK , Smith-Grant J , Whittle L , Jones SE , Krause KH , Li J , Shanklin SL , McKinnon I , Arrey L , Queen BE , Roberts AM . MMWR Suppl 2023 72 (1) 1-12 The Youth Risk Behavior Surveillance System (YRBSS) is the largest public health surveillance system in the United States, monitoring a broad range of health-related behaviors among high school students. The system includes a nationally representative Youth Risk Behavior Survey (YRBS) and separate school-based YRBSs conducted by states, tribes, territories, and local school districts. In 2021, these surveys were conducted during the COVID-19 pandemic. The pandemic underscored the importance of data in understanding changes in youth risk behaviors and addressing the multifaceted public health needs of youths. This overview report describes 2021 YRBSS survey methodology, including sampling, data collection procedures, response rates, data processing, weighting, and analyses. The 2021 YRBS participation map, survey response rates, and a detailed examination of student demographic characteristics are included in this report. During 2021, in addition to the national YRBS, a total of 78 surveys were administered to high school students across the United States, representing the national population, 45 states, two tribal governments, three territories, and 28 local school districts. YRBSS data from 2021 provided the first opportunity since the onset of the COVID-19 pandemic to compare youth health behaviors using long-term public health surveillance. Approximately half of all student respondents represented racial and ethnic minority groups, and approximately one in four identified as lesbian, gay, bisexual, questioning, or other (a sexual identity other than heterosexual) (LGBQ+). These findings reflect shifts in youth demographics, with increased percentages of racial and ethnic minority and LGBQ+ youths compared with previous YRBSS cycles. Educators, parents, local decision makers, and other partners use YRBSS data to monitor health behavior trends, guide school health programs, and develop local and state policy. These and future data can be used in developing health equity strategies to address long-term disparities so that all youths can thrive in safe and supportive environments. This overview and methods report is one of 11 featured in this MMWR supplement. Each report is based on data collected using methods presented in this overview. A full description of YRBSS results and downloadable data are available (https://www.cdc.gov/healthyyouth/data/yrbs/index.htm). |
Overview and methodology of the Adolescent Behaviors and Experiences Survey - United States, January-June 2021
Rico A , Brener ND , Thornton J , Mpofu JJ , Harris WA , Roberts AM , Kilmer G , Chyen D , Whittle L , Leon-Nguyen M , Lim C , Saba A , Bryan LN , Smith-Grant J , Underwood JM . MMWR Suppl 2022 71 (3) 1-7 Many U.S. schools closed nationwide in March 2020 to prevent the spread of COVID-19. School closures and online-only instruction have negatively affected certain students, with studies showing adverse effects of the pandemic on mental health. However, little is known about other experiences such as economic and food insecurity and abuse by a parent, as well as risk behaviors such as alcohol and drug use among youths across the United States during the pandemic. To address this gap, CDC developed the one-time, online Adolescent Behaviors and Experiences Survey (ABES), which was conducted during January-June 2021 to assess student behaviors and experiences during the COVID-19 pandemic among high school students, including unintentional injury, violence, tobacco product use, sexual behaviors, and dietary behaviors. This overview report of the ABES MMWR Supplement describes the ABES methodology, including the student questionnaire and administration, sampling, data collection, weighting, and analysis. ABES used a stratified, three-stage cluster probability-based sampling approach to obtain a nationally representative sample of students in grades 9-12 attending public and private schools. Teachers of selected classes provided students with access to the anonymous online survey while following local consent procedures. Data were collected using a 110-item questionnaire during January-June 2021 in 128 schools. A total of 7,998 students submitted surveys, and 7,705 of these surveys had valid data (i.e., ≥20 questions answered). The school response rate was 38%, the student response rate was 48%, and the overall response rate was 18%. Information on mode of instruction and school-provided equipment was also collected from all sampled schools. This overview report provides student- and school-level characteristics obtained from descriptive analyses, and the other reports in the ABES MMWR Supplement include information on substance use, mental health and suicidality, perceived racism, and disruptions to student life among high school students. Findings from ABES during the COVID-19 pandemic can help guide parents, teachers, school administrators, community leaders, clinicians, and public health officials in decision-making for student support and school health programs. |
Overview and methods for the Youth Risk Behavior Surveillance System - United States, 2019
Underwood JM , Brener N , Thornton J , Harris WA , Bryan LN , Shanklin SL , Deputy N , Roberts AM , Queen B , Chyen D , Whittle L , Lim C , Yamakawa Y , Leon-Nguyen M , Kilmer G , Smith-Grant J , Demissie Z , Jones SE , Clayton H , Dittus P . MMWR Suppl 2020 69 (1) 1-10 Health risk behaviors practiced during adolescence often persist into adulthood and contribute to the leading causes of morbidity and mortality in the United States. Youth health behavior data at the national, state, territorial, tribal, and local levels help monitor the effectiveness of public health interventions designed to promote adolescent health. The Youth Risk Behavior Surveillance System (YRBSS) is the largest public health surveillance system in the United States, monitoring a broad range of health-related behaviors among high school students. YRBSS includes a nationally representative Youth Risk Behavior Survey (YRBS) and separate state, local school district, territorial, and tribal school-based YRBSs. This overview report describes the surveillance system and the 2019 survey methodology, including sampling, data collection procedures, response rates, data processing, weighting, and analyses presented in this MMWR Supplement. A 2019 YRBS participation map, survey response rates, and student demographic characteristics are included. In 2019, a total of 78 YRBSs were administered to high school student populations across the United States (national and 44 states, 28 local school districts, three territories, and two tribal governments), the greatest number of participating sites with representative data since the surveillance system was established in 1991. The nine reports in this MMWR Supplement are based on national YRBS data collected during August 2018-June 2019. A full description of 2019 YRBS results and downloadable data are available (https://www.cdc.gov/healthyyouth/data/yrbs/index.htm).Efforts to improve YRBSS and related data are ongoing and include updating reliability testing for the national questionnaire, transitioning to electronic survey administration (e.g., pilot testing for a tablet platform), and exploring innovative analytic methods to stratify data by school-level socioeconomic status and geographic location. Stakeholders and public health practitioners can use YRBS data (comparable across national, state, tribal, territorial, and local jurisdictions) to estimate the prevalence of health-related behaviors among different student groups, identify student risk behaviors, monitor health behavior trends, guide public health interventions, and track progress toward national health objectives. |
Dating violence, sexual violence, and bullying victimization among high school students -Youth Risk Behavior Survey, United States, 2021
Clayton HB , Kilmer G , DeGue S , Estefan LF , Le VD , Suarez NA , Lyons BH , Thornton JE . MMWR Suppl 2023 72 (1) 66-74 Experiences of teen dating violence (TDV), sexual violence, and bullying during adolescence are all forms of interpersonal violence victimization (IVV) and are associated with health and behavioral issues during adulthood. Data from the nationally representative 2011-2021 Youth Risk Behavior Surveys were used to estimate the 2021 prevalence of IVV reported by U.S. high school students. IVV included past-year sexual TDV, physical TDV, sexual violence by anyone, electronic bullying, being bullied on school property, and lifetime forced sex and was analyzed by demographic characteristics and sex of sexual contacts. This report also explored trends in IVV over this 10-year period among U.S. high school students. In 2021, a total of 8.5% of students reported physical TDV, 9.7% reported sexual TDV, 11.0% reported sexual violence by anyone (with 59.5% of those also reporting sexual TDV), 15.0% reported bullying on school property, and 15.9% reported electronic bullying victimization during the past 12 months; 8.5% also reported experiencing forced sex in their lifetime. Disparities were observed for each form of IVV assessed for females and for most forms of IVV among racial and ethnic minority students; students who identified as lesbian, gay, bisexual, questioning, or other (LGBQ+); and students who reported their sexual contacts as same sex only or both sexes. Trend analyses indicated that physical TDV, sexual TDV, any physical or sexual TDV, and both physical and sexual TDV victimization decreased from 2013 to 2021 (although sexual TDV increased from 2019 to 2021). Any bullying victimization decreased from 2011 to 2021. Lifetime forced sexual intercourse decreased from 2011 to 2015, then increased from 2015 to 2021. Being bullied on school property was unchanged from 2011 to 2017, then decreased from 2017 to 2021. Sexual violence by anyone increased from 2017 to 2021. This report highlights disparities in IVV and provides the first national estimates among Native Hawaiian or other Pacific Islander youths. Findings, including trend analyses indicating recent increases in certain forms of IVV, point to the continued urgency of violence prevention efforts for all U.S. youths and especially those who are disproportionately affected by IVV. |
Prevalence and Correlates of Non-Dating Sexual Violence, Sexual Dating Violence, and Physical Dating Violence Victimization among U.S. High School Students during the COVID-19 Pandemic: Adolescent Behaviors and Experiences Survey, United States, 2021.
Krause KH , DeGue S , Kilmer G , Niolon PH . J Interpers Violence 2022 38 8862605221140038 The COVID-19 pandemic created an environment of disruption and adversity for many adolescents. We sought to establish the prevalence of non-dating sexual violence, sexual dating violence, and physical dating violence victimization among adolescents during the COVID-19 pandemic and to investigate whether experiences of disruption and adversity placed adolescents at greater risk for these forms of interpersonal violence. We conducted a secondary analysis of data from the Adolescent Behavior and Experiences Survey, collected January to June 2021 from a nationally representative sample of U.S. high school students (N = 7,705). Exposures included abuse by a parent; economic, housing, and food and nutrition insecurity; interpersonal connectedness; and personal well-being. Among female students, 8.0% experienced non-dating sexual violence; 12.5% experienced sexual dating violence; and 7.7% experienced physical dating violence. Among male students, 2.2% experienced non-dating sexual violence; 2.4% experienced sexual dating violence; and 4.9% experienced physical dating violence. Among female students, both emotional and physical abuse by a parent was related to non-dating sexual violence, emotional abuse was related to sexual dating violence, and physical abuse was related to physical dating violence. Among males, emotional abuse by a parent was related to physical dating violence and physical abuse by a parent was related to sexual dating violence. Hunger was associated with sexual and physical dating violence among female students and homeless was associated with physical dating violence among male students. Although there were differences by sex, abuse by a parent, hunger, and homelessness created precarity that may have increased the likelihood that adolescents would be exposed to risky peer or dating relationships. Adolescents need support that stops and prevents experiences of non-dating sexual and dating violence connected to interventions that address adversities experienced during the COVID-19 pandemic. |
Gun carrying among youths, by demographic characteristics, associated violence experiences, and risk behaviors - United States, 2017-2019
Simon TR , Clayton HB , Dahlberg LL , David-Ferdon C , Kilmer G , Barbero C . MMWR Morb Mortal Wkly Rep 2022 71 (30) 953-957 Suicide and homicide are the second and third leading causes of death, respectively, among youths aged 14-17 years (1); nearly one half (46%) of youth suicides and most (93%) youth homicides result from firearm injuries (1). Understanding youth gun carrying and associated outcomes can guide prevention initiatives (2). This study used the updated measure of gun carrying in the 2017 and 2019 administrations of CDC's Youth Risk Behavior Survey* (YRBS) to describe the national prevalence of gun carrying for reasons other than hunting or sport among high school students aged <18 years and to examine the associations between gun carrying and experiencing violence, suicidal ideation or attempts, or substance use. Gun carrying during the previous 12 months was reported by one in 15 males and one in 50 females. Gun carrying was significantly more likely among youths with violence-related experiences (adjusted prevalence ratio [aPR] range = 1.5-10.1), suicidal ideation or attempts (aPR range = 1.8-3.5), or substance use (aPR range = 4.2-5.6). These results underscore the importance of comprehensive approaches to preventing youth violence and suicide, including strategies that focus on preventing youth substance use and gun carrying (3). |
Medicaid expansion and contraceptive use among female high-school students
Kilmer G , Leon-Nguyen M , Smith-Grant J , Brittain AW , Rico A , Adkins SH , Lim C , Szucs LE . Am J Prev Med 2022 63 (4) 592-602 INTRODUCTION: Access to effective contraception prevents unintended pregnancies among sexually active female youth. Potentially impacted by the Affordable Care Act's Medicaid-related policies, contraception use increased among sexually active high-school students from 2013 to 2019. METHODS: Analyses conducted in 2021 assessed state-level Youth Risk Behavior Survey data among female students in grades 9-12 who reported being sexually active. States that expanded Medicaid were compared with other states in 2013 (baseline) and 2019 (after expansion). Measured outcomes included self-reported use of moderately effective or highly effective, long-acting reversible contraception at last sex. Long-acting reversible contraception included intrauterine devices and implants. Moderately effective contraception included birth control pills, injectables, patches, or rings. Results were weighted and adjusted for age and race/ethnicity. RESULTS: Students in Medicaid expansion states (n=27,564) did not differ significantly from those in nonexpansion states (n=6,048) at baseline or after expansion with respect to age, age at first sex, or the number of sexual partners in the past 3 months; however, race/ethnicity population characteristics changed over time. Postexpansion increased use of intrauterine devices/implants was greater in Medicaid expansion states than in nonexpansion states (238.1% increase vs 120.0% increase, adjusted p=0.047). For those aged 16-17 years, Medicaid expansion states had a 283.3% increase in intrauterine device/implant use compared with an increase of 69.7% in nonexpansion states (adjusted p=0.004). CONCLUSIONS: Medicaid expansion was associated with a greater population-level increase in intrauterine device/implant use among sexually active female high-school students aged 16-17 years. These findings point to the possibility that the Affordable Care Act's Medicaid-related policies played a role in young women's use of intrauterine devices/implants. |
Electronic versus paper and pencil survey administration mode comparison: 2019 Youth Risk Behavior Survey
Bryan LN , Smith-Grant J , Brener N , Kilmer G , Lo A , Queen B , Underwood JM . J Sch Health 2022 92 (8) 804-811 BACKGROUND: Since the inception of the Youth Risk Behavior Surveillance System in 1991, all surveys have been conducted in schools, using paper and pencil instruments (PAPI). For the 2019 YRBSS, sites were offered the opportunity to conduct their surveys using electronic data collection. This study aimed to determine whether differences in select metrics existed between students who completed the survey electronically versus using PAPI. METHODS: Thirty risk behaviors were examined in this study. Data completeness, response rates and bivariate comparisons of risk behavior prevalence between administration modes were examined. RESULTS: Twenty-nine of 30 questions examined had more complete responses among students using electronic surveys. Small differences were found for student and school response rates between modes. Twenty-five of 30 adolescent risk behaviors showed no mode effect. CONCLUSIONS: Seven of 44 states and DC participated electronically. Because survey data were more complete; school and student response rates were consistent; and minor differences existed in risk behaviors between modes, the acceptability of collecting data electronically was demonstrated. |
Annual STI testing among sexually active adolescents
Liddon N , Pampati S , Dunville R , Kilmer G , Steiner RJ . Pediatrics 2022 149 (5) OBJECTIVES: National guidelines call for annual testing for certain sexually transmitted infections (STIs) among specific adolescent populations, yet we have limited population-based data on STI testing prevalence among adolescents. With inclusion of a new item in the 2019 national Youth Risk Behavior Survey, we provide generalizable estimates of annual STI testing among sexually active high school students. METHODS: We report weighted prevalence estimates of STI testing (other than HIV) in the past 12 months among sexually active students (n = 2501) and bivariate associations between testing and demographic characteristics (sex, age, race and ethnicity, sexual identity, and sex of sexual contact). Multivariable models stratified by sex and adjusted for demographics examine the relationships between testing and sexual behaviors (age of initiation, number of sex partners, condom nonuse at last sexual intercourse, and substance use at last sexual intercourse). RESULTS: One-fifth (20.4%) of sexually active high school students reported testing for an STI in the previous year. A significantly higher proportion of female (26.1%) than male (13.7%) students reported testing. Among female students, prevalence differed by age (15 years = 12.6%, age 16 = 22.8%, age 17 = 28.5%, or 18 years = 36.9%). For male students, there were no differences by demographic characteristics, including sexual identity, but most sexual risk behaviors were associated with increased likelihood of STI testing (adjusted prevalence ratios ranging from 1.48 to 2.47). CONCLUSIONS: Low prevalence of STI testing suggests suboptimal adherence to national guidelines, particularly for sexually active adolescent females and young men who have sex with men who should be tested for Chlamydia and gonorrhea annually. |
Risk Behaviors and Experiences Among Youth Experiencing Homelessness-Youth Risk Behavior Survey, 23 U.S. States and 11 Local School Districts,2019
Smith-Grant J , Kilmer G , Brener N , Robin L , Underwood JM . J Community Health 2022 47 (2) 324-333 Youth experiencing homelessness experience violence victimization, substance use, suicide risk, and sexual risk disproportionately, compared with their stably housed peers. Yet few large-scale assessments of these differences among high school students exist. The youth risk behavior survey (YRBS) is conducted biennially among local, state, and nationally representative samples of U.S. high school students in grades 9-12. In 2019, 23 states and 11 local school districts included a measure for housing status on their YRBS questionnaire. The prevalence of homelessness was assessed among states and local sites, and relationships between housing status and violence victimization, substance use, suicide risk, and sexual risk behaviors were evaluated using logistic regression. Compared with stably housed students, students experiencing homelessness were twice as likely to report misuse of prescription pain medicine, three times as likely to be threatened or injured with a weapon at school, and three times as likely to report attempting suicide. These findings indicate a need for intervention efforts to increase support, resources, and services for homeless youth. |
Adolescent Mental Health, Connectedness, and Mode of School Instruction During COVID-19.
Hertz MarciF , Kilmer Greta , Verlenden Jorge , Liddon Nicole , Rasberry CatherineN , Barrios LisaC , Ethier KathleenA . J Adolesc Health 2022 70 (1) 57-63 BACKGROUND: Because COVID-19 was declared a pandemic in March 2020, nearly 93% of U.S. students engaged in some distance learning. These school disruptions may negatively influence adolescent mental health. Protective factors, like feeling connected to family or school may demonstrate a buffering effect, potentially moderating negative mental health outcomes. The purpose of the study is to test our hypothesis that mode of school instruction influences mental health and determine if school and family connectedness attenuates these relationships. METHODS: The COVID Experiences Survey was administered online or via telephone from October to November 2020 in adolescents ages 1319 using National Opinion Research Centers AmeriSpeak Panel, a probability-based panel recruited using random addressbased sampling with mail and telephone nonresponse follow-up. The final sample included 567 adolescents in grades 712 who received virtual, in-person, or combined instruction. Unadjusted and adjusted associations among four mental health outcomes and instruction mode were measured, and associations with school and family connectedness were explored for protective effects. RESULTS: Students attending school virtually reported poorer mental health than students attending in-person. Adolescents receiving virtual instruction reported more mentally unhealthy days, more persistent symptoms of depression, and a greater likelihood of seriously considering attempting suicide than students in other modes of instruction. After demographic adjustments school and family connectedness each mitigated the association between virtual versus in-person instruction for all four mental health indicators. CONCLUSION: As hypothesized, mode of school instruction was associated with mental health outcomes, with adolescents receiving in-person instruction reporting the lowest prevalence of negative mental health indicators. School and family connectedness may play a critical role in buffering negative mental health outcomes. |
Trends in Asthma-Related School Health Policies and Practices in the US States
Qin X , Zahran HS , Leon-Nguyen M , Kilmer G , Collins P , Welch P , Malilay J . J Sch Health 2021 92 (3) 252-260 BACKGROUND: Asthma is one of the leading causes of school absenteeism. Schools can play an important role in coordinating asthma care. The purpose of this study was to assess the implementation of asthma-related school health policies and practices across states and how they have changed over time. METHODS: Data were analyzed from 36 states that conducted School Health Profiles surveys during 2008 to 2018. Trends in 6 topics were analyzed by logistic regression and JointPoint trend test. RESULTS: Trends in efforts to identify and track students with asthma and improve students' and parents' knowledge about asthma were stable or increased. Interest among lead health education teachers in receiving professional development on asthma trended downward in 35 of 36 states. CONCLUSIONS: Stable to upward trends suggest that a majority of schools have maintained or improved their efforts to identify and track students with asthma and increase the knowledge of students and parents about asthma. However, further improvement is needed in referral of students with asthma to health care professionals and encouraging asthma-related professional development of lead health education teachers. |
Health Insurance Status of Adults with Hepatitis in the United States: Implications of Results from the National Health Interview Survey, 2013-2018
Kilmer GA , Ly KN , Moorman AC . Popul Health Manag 2021 24 (6) 651-653 The recently released US Viral Hepatitis National Strategic Plan: A Roadmap to Elimination designed to achieve disease elimination goals for 2021–20251 promotes screening to identify and treatment for the more than 3 million Americans with hepatitis B or C. Chronic hepatitis B and C together comprise a significant proportion of all hepatitis diagnoses in the United States given the current estimates of nearly 900,000 infected with chronic hepatitis B and 2.4 million infected with chronic hepatitis C, with new hepatitis C infections related to the opioid epidemic on the rise. Guidance from the US Centers for Disease Control and Prevention (CDC) updated in 2020 now recommends a universal 1-time hepatitis C virus (HCV) test for all adults as well as testing during each pregnancy.2 |
Association of Children's Mode of School Instruction with Child and Parent Experiences and Well-Being During the COVID-19 Pandemic - COVID Experiences Survey, United States, October 8-November 13, 2020.
Verlenden JV , Pampati S , Rasberry CN , Liddon N , Hertz M , Kilmer G , Viox MH , Lee S , Cramer NK , Barrios LC , Ethier KA . MMWR Morb Mortal Wkly Rep 2021 70 (11) 369-376 In March 2020, efforts to slow transmission of SARS-CoV-2, the virus that causes COVID-19, resulted in widespread closures of school buildings, shifts to virtual educational models, modifications to school-based services, and disruptions in the educational experiences of school-aged children. Changes in modes of instruction have presented psychosocial stressors to children and parents that can increase risks to mental health and well-being and might exacerbate educational and health disparities (1,2). CDC examined differences in child and parent experiences and indicators of well-being according to children's mode of school instruction (i.e., in-person only [in-person], virtual-only [virtual], or combined virtual and in-person [combined]) using data from the COVID Experiences nationwide survey. During October 8-November 13, 2020, parents or legal guardians (parents) of children aged 5-12 years were surveyed using the NORC at the University of Chicago AmeriSpeak panel,* a probability-based panel designed to be representative of the U.S. household population. Among 1,290 respondents with a child enrolled in public or private school, 45.7% reported that their child received virtual instruction, 30.9% in-person instruction, and 23.4% combined instruction. For 11 of 17 stress and well-being indicators concerning child mental health and physical activity and parental emotional distress, findings were worse for parents of children receiving virtual or combined instruction than were those for parents of children receiving in-person instruction. Children not receiving in-person instruction and their parents might experience increased risk for negative mental, emotional, or physical health outcomes and might need additional support to mitigate pandemic effects. Community-wide actions to reduce COVID-19 incidence and support mitigation strategies in schools are critically important to support students' return to in-person learning. |
Susceptibility to hepatitis A virus infection in the United States, 2007-2016
Yin S , Barker L , Ly KN , Kilmer G , Foster MA , Drobeniuc J , Jiles RB . Clin Infect Dis 2020 71 (10) e571-e579 BACKGROUND: Despite national immunization efforts, including universal childhood hepatitis A (HepA) vaccination recommendations in 2006, hepatitis A virus (HAV)-associated outbreaks have increased in the United States. Unvaccinated or previously uninfected persons are susceptible to HAV infection, yet the susceptibility in the U.S. population is not well known. METHODS: Using National Health and Nutrition Examination Survey 2007-2016 data, we estimated HAV susceptibility prevalence (total HAV antibody negative) among persons aged >/=2 years. Among U.S.-born adults aged >/=20 years, we examined prevalence, predictors, and age-adjusted trends of HAV susceptibility by sociodemographic characteristics. We assessed HAV susceptibility and self-reported non-vaccination to HepA among risk groups and the "immunization cohort" (those born in or after 2004). RESULTS: Among U.S.-born adults aged >/=20 years, HAV susceptibility prevalence was 74.1% (95% CI: 72.9-75.3%) during 2007-2016. Predictors of HAV susceptibility were age group 30-49 years, non-Hispanic white/black, 130% above the poverty level, and no health insurance. Prevalences of HAV susceptibility and non-vaccination to HepA, respectively, were 72.9% and 73.1% among persons who reported injection drug use, 67.5% and 65.2% among men who had sex with men, 55.2% and 75.1% among persons with hepatitis B or hepatitis C, and 22.6% and 25.9% among the immunization cohort. Susceptibility and non-vaccination decreased over time among the immunization cohort, but remained stable among risk groups. CONCLUSION: During 2007-2016, approximately three-fourths of U.S.-born adults remained HAV susceptible. Enhanced vaccination efforts are critically needed, particularly targeting adults at highest risk for HAV infection, to mitigate the current outbreaks. |
Self-reported prevalence of HIV testing among those reporting having been diagnosed with selected sexually transmitted infections or hepatitis C, United States, 2005-2016
Patel SN , Delaney KP , Pitasi MA , Oraka E , Tao G , Van Handel M , Kilmer G , DiNenno EA . Sex Transm Dis 2020 47 S53-S60 BACKGROUND: Persons with sexually transmitted infections (STIs) or hepatitis C virus (HCV) infection often have indicators of HIV risk. We used weighted data from six cycles of the National Health and Nutrition Examination Survey (NHANES) to assess the proportion of persons who reported ever being diagnosed with a selected STI or HCV infection and who reported that they were ever tested for HIV. METHODS: Persons aged 20-59 years with prior knowledge of HCV infection before receiving NHANES HCV RNA positive results (2005-2012) or reporting ever being told by a doctor that they had HCV infection (2013-2016), or ever had genital herpes, or had chlamydia or gonorrhea in the past 12 months, were categorized as having had a selected STI or HCV infection. Weighted proportions and 95% confidence intervals were estimated for reporting ever being tested for HIV for those who did and did not report a selected STI or HCV infection. RESULTS: A total of 19,102 respondents had non-missing data for STI and HCV diagnoses and HIV testing history; 44.4% reported ever having been tested for HIV and 5.2% reported being diagnosed with a selected STI or HCV infection. The proportion reporting an HIV test was higher for the group that reported a STI or HCV infection than the group that did not. CONCLUSION: Self-reported HIV testing remains low in the United States, even among those who reported a previous selected STI or HCV infection. Ensuring HIV tests are conducted routinely for those with overlapping risk factors can help facilitate diagnosis of HIV infections. |
Hepatitis B vaccination and screening among foreign-born women of reproductive age in the United States: 2013-2015
Kilmer GA , Barker LK , Ly KN , Jiles RB . Clin Infect Dis 2018 68 (2) 256-265 Background: Mother-to-child transmission of hepatitis B can be prevented with vaccination and screening. Foreign-born women living in the United States may have lower vaccination coverage and greater lifetime exposure to hepatitis B virus than US-born women. Objective: To determine if self-reported hepatitis B vaccination and screening differ between US-born and foreign-born women of reproductive age and examine predictors. Methods: National Health Interview Survey data from 2013-2015 were pooled to estimate prevalence of lifetime history of hepatitis B vaccination and screening self-reported by women aged 18-44 years who were born in the United States or elsewhere (foreign-born). Significance of world region of birth, birth cohort, and immigration-related characteristics were considered. Results: Among women of reproductive age (n= 24,216), reported hepatitis B vaccination was 33% lower for foreign-born (27.3%) than US-born (40.9%) women (t-test P < .05). Vaccination coverage was low for women who were born in Mexico and other parts of Central America, including the Caribbean islands (18.4%), South America (25.3%), and the Indian subcontinent (31.7%). Factors associated with vaccination in both groups included education, income, and health insurance coverage. Screening was reported by 28.5% of foreign-born vs. 31.9% of US-born women (t-test P < .05). The lowest reported screening prevalence occurred among foreign-born Hispanic or Latina Mexican (21.0%) and Puerto Rican (21.9%) women. Factors associated with screening prevalence among foreign-born women included English fluency, recent US residency, and citizenship. Conclusions: Foreign-born women of reproductive age had lower hepatitis B vaccination and screening coverage compared to US-born women of reproductive age. |
Diabetes and prediabetes screening and prevalence among adults with coronary heart disease
Kilmer G , Hughes E , Zhang X , Elam-Evans L . Am J Prev Med 2011 40 (2) 159-65 BACKGROUND: Clinical performance measures recommend that nondiabetic patients with coronary heart disease (CHD) be screened for diabetes every 3 years. PURPOSE: The purpose of this study is to report the prevalence of diabetes and prediabetes among U.S. adults aged ≥35 years with CHD and to determine factors associated with not receiving recommended diabetes screenings. METHODS: The Behavioral Risk Factor Surveillance System (BRFSS) is an annual state-based telephone survey of non-institutionalized U.S. adults. Information on prediabetes prevalence was collected for 33 states in 2008; data analysis was conducted in 2009. The prevalence of diabetes and prediabetes among adults aged ≥35 years with CHD (n=20,618) and prevalence of diabetes screening among nondiabetic adults with CHD (n=14,335) were assessed. Multivariate logistic regression was used to calculate the odds of not being screened for diabetes in the past 3 years while controlling for other factors. RESULTS: Among adults with CHD, 30.7% (95% CI=29.4%, 32.1%) reported being diagnosed with diabetes and 10.0% (95% CI=9.2%, 10.8%) reported prediabetes. Among nondiabetic adults with CHD, 25.4% (95% CI=23.9%, 26.9%) reported not being screened for diabetes in the past 3 years. Those with no recent routine checkup and those with no health insurance had the highest odds of no recent diabetes screening. CONCLUSIONS: The prevalence of diabetes and prediabetes is substantial among adults with CHD and likely underestimated because of suboptimal screening. One of four nondiabetic adults with CHD reported not being screened for diabetes in the past 3 years. |
Gene polymorphisms in association with self-reported stroke in US adults.
Fan AZ , Fang J , Yesupriya A , Chang MH , Kilmer G , House M , Hayes D , Ned RM , Dowling NF , Mokdad AH . Appl Clin Genet 2010 3 23-8 ![]() PURPOSE: Epidemiologic studies suggest that several gene variants increase the risk of stroke, and population-based studies help provide further evidence. We identified polymorphisms associated with the prevalence of self-reported stroke in US populations using a representative sample. METHODS: Our sample comprised US adults in the Third National Health and Nutrition Examination (NHANES III) DNA bank. We examined nine candidate gene variants within ACE, F2, F5, ITGA2, MTHFR, and NOS3 for associations with self-reported stroke. We used multivariate regression and Cox proportional hazards models to test the association between these variants and history of stroke. RESULTS: In regression models, the rs4646994 variant of ACE (I/I and I/D genotypes) was associated with higher prevalence adjusted prevalence odds ratio [APOR] = 2.66 [1.28, 5.55] and 2.23 [1.30, 3.85], respectively) compared with the D/D genotype. The heterozygous genotype of MTHFR rs1801131 (A/C) was associated with lower prevalence of stroke (APOR = 0.48 [0.25, 0.92]) compared with A/A and C/C genotypes. For rs2070744 of NOS3, both the C/T genotype (APOR = 1.91 [1.12, 3.27]) and C/C genotype (APOR = 3.31 [1.66, 6.60]) were associated with higher prevalence of stroke compared with the T/T genotype. CONCLUSION: Our findings suggest an association between the prevalence of self-reported stroke and polymorphisms in ACE, MTHFR, and NOS3 in a population-based sample. |
Surveillance for certain health behaviors among states and selected local areas - United States, 2008
Hughes E , Kilmer G , Li Y , Valluru B , Brown J , Colclough G , Geathers S , Roberts H , Elam-Evans L , Balluz L . MMWR Surveill Summ 2010 59 (10) 1-221 PROBLEM: Chronic diseases (e.g., diabetes, cancer, heart disease, and stroke) are the leading causes of morbidity and mortality in the United States. Data on health risk behaviors that increase the risk for chronic diseases and use of preventive practices are essential for the development, implementation, and evaluation of health promotion programs, policies, and intervention strategies to decrease or prevent the leading causes of morbidity and mortality. Surveillance data from states and territories, selected metropolitan and micropolitan areas, and counties are vital components of these various prevention and intervention strategies. REPORTING PERIOD: January-December 2008 DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit--dialed telephone survey of noninstitutionalized adults residing in the United States. BRFSS collects data on health risk behaviors, preventive health services and practices, and access to health care related to the leading causes of death and disability in the United States. This report presents results for 2008 for all 50 states, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, 177 metropolitan and micropolitan statistical areas (MMSAs), and 266 counties. RESULTS: In 2008, the estimated prevalence of high-risk behaviors, chronic diseases and conditions, screening practices, and use of preventive health-care services varied substantially by state and territory, MMSA, and county. The following is a summary of results listed by BRFSS question topic. Each set of proportions refers to the range of estimated prevalence for the disease, condition, or behavior as reported by the survey respondent. Adults reporting good or better health: 68% to 89% for states and territories and 69% to 93% for selected MMSAs and counties. Health care insurance coverage: 72% to 96% for states and territories, 61% to 97% for MMSAs, and 61% to 98% for counties. Teeth extractions among persons aged ≥65 years: 10% to 38% for states and territories, 5% to 36% for MMSAs, and 4% to 34% for counties. Adults who had a checkup during the preceding 12 months: 56% to 81% for states and territories, 51% to 85% for MMSAs, and 51% to 89% for counties. Influenza vaccination among persons aged ≥65 years: 31% to 78% for states and territories, 52% to 82% for MMSAs, and 51% to 86% for counties. Pneumococcal vaccination among persons aged ≥65 years: 28% to 73% for states and territories, 46% to 82% for MMSAs, and 41% to 83% for counties. Adults aged ≥50 years who had a sigmoidoscopy/colonoscopy: 38% to 74% for states and territories, 45% to 78% for selected MMSAs, and 45% to 80% for counties. Adults aged ≥50 years who had a blood stool test during the preceding 2 years: 8% to 29% for states and territories, 7% to 51% for MMSAs, and 7% to 40% for counties. Among women aged ≥18 years who had a Papanicolaou test during the preceding 3 years: 67% to 89% for states and territories, 66% to 93% for selected MMSAs, and 66% to 96% for counties. Women aged ≥40 years who had a mammogram during the preceding 2 years: 64% to 85% for states and territories, and 61% to 88% for MMSAs and counties. Men aged ≥40 years who had a Prostate-Specific Antigen (PSA) test during the preceding 2 years: 34% to 66% for states and territories, 39% to 70% for MMSAs, and 37% to 71% for counties. Current cigarette smoking among adults aged ≥18 years: 6% to 27% for states and territories, 5% to 31% for MMSAs, and 5% to 30% for counties. Adults who reported binge drinking during the preceding month: 8% to 23% for states and territories, 3% to 25% for selected MMSAs, and 3% to 26% for counties. Heavy drinking among adults during the preceding month: 3% to 8% for states and territories, <1% to 10% for MMSAs, and 1% to 11% for counties. Adults who reported no leisure-time physical activity: 18% to 47% for states and territories, 12% to 40% for MMSAs, and 10% to 40% for selected counties. Adults who were overweight (BMI ≥25.0 and <30.0): 33% to 40% for states and territories, 31% to 46% for selected MMSAs, and 28% to 50% for counties. Adults aged ≥20 years who were obese (BMI ≥30.0): 20% to 34% for states and territories, 15% to 40% for MMSAs, and 13% to 40% for counties. Asthma among adults: 5% to 11% for states and territories, 4% to 13% for MMSAs, and 4% to 15% for counties. Diabetes among adults: 6% to 12% for states and territories, 3% to 17% for selected MMSAs, and 3% to 14% for counties. Adults aged ≥18 years who had limited activity because of physical, mental, or emotional problems: 10% to 30% for states and territories, 13% to 33% for MMSAs, and 12% to 31% for counties. Adults who required use of special equipment: 4% to 11% for states and territories, 3% to 12% for MMSAs, and 2% to 13% for counties. Angina and coronary heart disease among adults aged ≥45 years: 5% to 19% for states and territories, 6% to 22% for MMSAs, and 4% to 22% for counties. Adults aged ≥45 years with a history of stroke: 3% to 7% for states and territories, 2% to 11% for selected MMSAs, and 1% to 12% for counties. INTERPRETATION: The findings in this report indicate substantial variation in health-risk behaviors, chronic diseases and conditions, and use of preventive health-care services among U.S. adults at the state and territory, MMSA, and county level. The findings underscore the continued need for surveillance of health-risk behaviors, chronic diseases and conditions, and the use of preventive health services. PUBLIC HEALTH ACTION: Healthy People 2010 objectives have been established to monitor health behaviors and the use of preventive health services. Local and state health departments and federal agencies use BRFSS data to identify populations at high risk for certain health behaviors, chronic diseases and conditions, and to evaluate the use of preventive services. In addition, BRFSS data are used to direct, implement, monitor, and evaluate public health programs and policies that can lead to a reduction in morbidity and mortality from adverse effects of health-risk behaviors and subsequent chronic conditions. |
Access to and use of eye care services in rural Arkansas
Kilmer G , Bynum L , Balamurugan A . J Rural Health 2010 26 (1) 30-5 CONTEXT: Rural residents are more likely to be uninsured and have low income. PURPOSE: To determine if rural residents in Arkansas have decreased access to eye care services and use them less frequently than urban residents. METHODS: Data from the 2006 Visual Impairment and Access to Eye Care Module from the Arkansas Behavioral Risk Factor Surveillance System (BRFSS) were used in the analysis. Adults age 40 years and older were included (n = 4,289). Results were weighted to reflect the age, race, and gender distribution of the population of Arkansas. Multiple logistic regression was used to adjust for demographic differences between rural and urban populations. FINDINGS: Significantly fewer rural residents (45%) reported having insurance coverage for eye care services compared with residents living in urban areas (55%). Rural residents were less likely (45%) than urban residents (49%) to have had a dilated eye exam within the past year. Among residents aged 40-64, those from rural areas were more likely than their urban counterparts to report cost/lack of insurance as the main reason for not having a recent eye care visit. CONCLUSIONS: In 2006, rates of eye care insurance coverage were significantly lower for rural residents while use of eye care services differed slightly between rural and urban residents. Rural residents in Arkansas age 40-64 would benefit from having increased access to eye care insurance and/or low cost eye care services. |
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