Last data update: Dec 23, 2024. (Total: 48419 publications since 2009)
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Chronic disease indicators: 2022-2024 refresh and modernization of the web tool
Watson KB , Carlson SA , Lu H , Wooten KG , Pankowska MM , Greenlund KJ . Prev Chronic Dis 2024 21 E46 Easy access and display of state-level estimates of the prevalence of chronic diseases and their risk factors can guide evidence-based decision-making, policy development, and tailored efforts to improve population health outcomes; however, these estimates are often presented across multiple websites and reports. The Chronic Disease Indicators (CDI) web tool (www.cdc.gov/cdi) disseminates state-level data compiled from various data sources, including surveys, vital records, and administrative data, and applies standardized definitions to estimate and track a wide range of key indicators of chronic diseases and their risk factors. In 2022-2024, the indicators were refreshed to include 113 measures across 21 topic areas, and the web tool was modernized to enhance its key features and functionalities, including standardized indicator definitions; interactive charts, graphs, and maps that present data in a visually appealing format; an easy-to-use web-based interface for users to query and extract the data they need; and state comparison reports to identify geographic variations in disease and risk factor prevalence. National and state-level estimates are provided for the overall population and, where applicable, by sex, race and ethnicity, and age. We review the history of CDIs, describe the 2022-2024 refresh process, and explore the interactive features of the CDI web tool with the goal of demonstrating how practitioners, policymakers, and other users can easily examine and track a wide range of key indicators of chronic diseases and their risk factors to support state-level public health action. |
Racial and ethnic differences in subjective cognitive decline - United States, 2015-2020
Wooten KG , McGuire LC , Olivari BS , Jackson EMJ , Croft JB . MMWR Morb Mortal Wkly Rep 2023 72 (10) 249-255 Subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent memory loss or confusion, might be a symptom of early-stage dementia or future serious cognitive decline such as Alzheimer disease* or a related dementia (ADRD) (1). Established modifiable risk factors for ADRD include high blood pressure, inadequate physical activity, obesity, diabetes, depression, current cigarette smoking, and hearing loss (2). An estimated 6.5 million persons aged ≥65 years in the United States live with Alzheimer disease, the most common dementia (1). This number is projected to double by 2060, with the largest increase among non-Hispanic Black or African American (Black), and Hispanic or Latino (Hispanic) adults (1,3). Using data from the Behavioral Risk Factor Surveillance System (BRFSS), CDC assessed racial and ethnic, select demographic, and geographical differences in SCD prevalence, and prevalence of health care professional conversations among those reporting SCD. The age-adjusted prevalence of SCD during 2015-2020 was 9.6% among adults aged ≥45 years (5.0% of Asian or Pacific Islander [A/PI] adults, 9.3% of non-Hispanic White [White] adults, 10.1% of Black adults, 11.4% of Hispanic adults, and 16.7% of non-Hispanic American Indian or Alaska Native [AI/AN] adults). College education was associated with a lower prevalence of SCD among all racial and ethnic groups. Only 47.3% of adults with SCD reported that they had discussed confusion or memory loss with a health care professional. Discussing changes in cognition with a physician can allow for the identification of potentially treatable conditions, early detection of dementia, promotion of dementia risk reduction behaviors, and establishing a treatment or care plan to help adults remain healthy and independent for as long as possible. |
Unmet needs for assistance related to subjective cognitive decline among community-dwelling middle-aged and older adults in the US: prevalence and impact on health-related quality of life
Bouldin ED , Taylor CA , Knapp KA , Miyawaki CE , Mercado NR , Wooten KG , McGuire LC . Int Psychogeriatr 2020 33 (7) 1-14 OBJECTIVES: To estimate the prevalence of unmet needs for assistance among middle-aged and older adults with subjective cognitive decline (SCD) in the US and to evaluate whether unmet needs were associated with health-related quality of life (HRQOL). DESIGN: Cross-sectional. SETTING: US - 50 states, District of Columbia, and Puerto Rico. PARTICIPANTS: Community-dwelling adults aged 45 years and older who completed the Cognitive Decline module on the 2015--2018 Behavioral Risk Factor Surveillance System reported experiencing SCD and always, usually, or sometimes needed assistance with day-to-day activities because of SCD (n = 6,568). MEASUREMENTS: We defined SCD as confusion or memory loss that was happening more often or getting worse over the past 12 months. Respondents with SCD were considered to have an unmet need for assistance if they sometimes, rarely, or never got the help they needed with day-to-day activities. We measured three domains of HRQOL: (1) mental (frequent mental distress, ≥14 days of poor mental health in the past 30 days), (2) physical (frequent physical distress, ≥14 days of poor physical health in the past 30 days), and (3) social (SCD always, usually, or sometimes interfered with the ability to work, volunteer, or engage in social activities outside the home). We used log-binomial regression models to estimate prevalence ratios (PRs). All estimates were weighted. RESULTS: In total, 40.2% of people who needed SCD-related assistance reported an unmet need. Among respondents without depression, an unmet need was associated with a higher prevalence of frequent mental distress (PR = 1.55, 95% CI: 1.12-2.13, p = 0.007). Frequent physical distress and social limitations did not differ between people with met and unmet needs. CONCLUSIONS: Middle-aged and older adults with SCD-related needs for assistance frequently did not have those needs met, which could negatively impact their mental health. Interventions to identify and meet the unmet needs among people with SCD may improve HRQOL. |
Qualitative exploration of cross-sector perspectives on the contributions of local health departments in land-use and transportation policy
Sreedhara M , Goins KV , Aytur SA , Lyn R , Maddock JE , Riessman R , Schmid TL , Wooten H , Lemon SC . Prev Chronic Dis 2017 14 E118 INTRODUCTION: Transportation and land-use policies can affect the physical activity of populations. Local health departments (LHDs) are encouraged to participate in built-environment policy processes, which are outside their traditional expertise. Cross-sector collaborations are needed, yet stakeholders' perceptions of LHD involvement are not well understood. The objective of this study was to describe the perceived value of LHD participation in transportation and land-use decision making and potential contributions to these processes among stakeholders. METHODS: We analyzed qualitative data from 49 semistructured interviews in 2015. Participants were professionals in 13 US states and 4 disciplines: land-use planning (n = 13), transportation/public works (n = 11), public health (n = 19), and other (municipal administration and bike and pedestrian advocacy [n = 6]). Two analysts conducted directed content analysis. RESULTS: All respondents reported that LHDs offer valuable contributions to transportation and land-use policy processes. They identified 7 contributions (interrater agreement 91%): 1) physical activity and health perspective (n = 44), 2) data analysis and assessment (n = 41), 3) partnerships in the community and across sectors (n = 35), 4) public education (n = 27), 5) knowledge of the public health evidence base and best practices (n = 23), 6) resource support (eg, grant writing, technical assistance) (n = 20), and 7) health equity (n = 8). CONCLUSION: LHDs can leverage their strengths to foster cross-sector collaborations that promote physical activity opportunities in communities. Our results will inform development of sustainable capacity-building models for LHD involvement in built-environment decision making. |
A case of abrin toxin poisoning, confirmed via quantitation of L-abrine (N-methyl-L-tryptophan) biomarker
Wooten JV , Pittman CT , Blake TA , Thomas JD , Devlin JJ , Higgerson RA , Johnson RC . J Med Toxicol 2014 10 (4) 392-4 INTRODUCTION: The seeds of Abrus precatorius contain the highly toxic plant protein abrin. There is no antidote for abrin poisoning. Management, largely supportive, may consist of administering intravenous fluids, anti-emetics, and activated charcoal depending on the time of exposure. We report the presentation of a single case of unintentional abrin poisoning confirmed by the quantitation of L-abrine biomarker. CASE REPORT: A previously healthy 22-month-old, 11.5-kg female presented to the hospital after ingesting approximately 20 rosary peas (A. precatorius) sold as a "peace bracelet". Her primary manifestations were episodes of forceful emesis that included food particles progressing to clear gastric fluid. The patient was tachycardic (HR = 134 bpm) but had brisk capillary refill and normal blood pressure (96/60 mmHg). Laboratory testing revealed elevated blood urea nitrogen (16 mg/dL) and serum creatinine (0.4 mg/dL). In the emergency department, the patient was resuscitated with 40 mL/kg normal saline via peripheral IV and received ondansetron (0.15 mg/kg IV) to control retching. The patient was discharged well 24 h after the ingestion. DISCUSSION: This is the first case of human abrin toxin poisoning confirmed by the quantitation of L-abrine as a biomarker. Quantifying the levels of abrin toxin in the body after exposure can help clinicians make informed decisions when managing patients with symptomatic exposures to seeds of A. precatorius. |
Stability of ricinine, abrine, and alpha-amanitin in finished tap water
Knaack Jennifer S , Pittman Christopher T , Wooten Joe V , Jacob Justin T , Magnuson Matthew , Silvestri Erin , Johnson Rudolph C . Anal Methods 2013 5 (20) 5804-5811 Ricinine and abrine are potential indicators of drinking water contamination by ricin and abrin, respectively. Simultaneous detection of ricinine and abrine, along with -amanitin, another potential biotoxin water contaminant, is reportable through the use of automated sample preparation via solid phase extraction and detection using liquid chromatography/tandem- mass spectrometry. Performance of the method was characterized over eight analytical batches with quality control samples analyzed over 10 days. For solutions of analytes prepared with appropriate preservatives, the minimum reporting level (MRL) was 0.50 g L-1 for ricinine and abrine and 2.0 g L-1 for -amanitin. Among the analytes, the accuracy of the analysis ranged between 93 and 100% at concentrations of 1-2.5x the MRL, with analytical precision ranging from 4 to 8%. Five drinking waters representing a range of water quality parameters and disinfection practices were fortified with the analytes and analyzed over a 28 day period to determine their storage stability in these waters. The analytical signal from ricinine was observed to be stable for 28 days after being spiked into all tap waters investigated. The analytical signal for abrine and -amanitin decreased within 5 h after these analytes were spiked into some drinking waters, but afterwards, remained stable for 28 days. The magnitude of the decrease correlated with common water quality parameters potentially related to sorption of contaminants onto dissolved and colloidal components within the particular water. Even with the decrease, the detectability offered by the method may be 100-1000 times greater than potential toxicological benchmarks, suggesting the utility of the method for all three analytes, with additional quality control precautions for abrine and -amanitin. 2013 The Royal Society of Chemistry. |
Perceptions matter: beliefs about influenza vaccine and vaccination behavior among elderly white, black and Hispanic Americans
Wooten KG , Wortley PM , Singleton JA , Euler GL . Vaccine 2012 30 (48) 6927-34 BACKGROUND: Knowledge and beliefs about influenza vaccine that differ across racial or ethnic groups may promote racial or ethnic disparities in vaccination. OBJECTIVE: To identify associations between vaccination behavior and personal beliefs about influenza vaccine by race or ethnicity and education levels among the U.S. elderly population. METHODS: Data from a national telephone survey conducted in 2004 were used for this study. Reponses for 3875 adults ≥65 years of age were analyzed using logistic regression methods. RESULTS: Racial and ethnic differences in beliefs were observed. For example, whites were more likely to believe influenza vaccine is very effective in preventing influenza compared to blacks and Hispanics (whites, 60%; blacks, 47%, and Hispanics, 51%, p<0.01). Among adults who believed the vaccine is very effective, self-reported vaccination was substantially higher across all racial/ethnic groups (whites, 93%; blacks, 76%; Hispanics, 78%) compared to adults who believed the vaccine was only somewhat effective (whites 67%; blacks 61%, Hispanics 61%). Also, vaccination coverage differed by education level and personal beliefs of whites, blacks, and Hispanics. CONCLUSIONS: Knowledge and beliefs about influenza vaccine may be important determinants of influenza vaccination among racial/ethnic groups. Strategies to increase coverage should highlight the burden of influenza disease in racial and ethnic populations, the benefits and safety of vaccinations and personal vulnerability to influenza disease if not vaccinated. For greater effectiveness, factors associated with the education levels of some communities may need to be considered when developing or implementing new strategies that target specific racial or ethnic groups. |
Developing an integrated strategy to reduce ethnic and racial disparities in the delivery of clinical preventive services for older Americans
Shenson D , Adams M , Bolen J , Wooten K , Clough J , Giles WH , Anderson L . Am J Public Health 2012 102 (8) e44-50 OBJECTIVES: To determine the optimum strategy for increasing up-to-date (UTD) levels in older Americans, while reducing disparities between White, Black, and Hispanic adults, aged 65 years and older. METHODS: Data were analyzed from the 2008 Behavioral Risk Factor Surveillance System, quantifying the proportion of older Americans UTD with influenza and pneumococcal vaccinations, mammograms, Papanicolaou tests, and colorectal cancer screening. A comparison of projected changes in UTD levels and disparities was ascertained by numerically accounting for UTD adults lacking 1 or more clinical preventive services (CPS). Analyses were performed by gender and race/ethnicity. RESULTS: Expanded provision of specific vaccinations and screenings each increased UTD levels. When those needing only vaccinations were immunized, there was a projected decrease in racial/ethnic disparities in UTD levels (2.3%-12.2%). When those needing only colorectal cancer screening, mammography, or Papanicolaou test were screened, there was an increase in UTD disparities (1.6%-4.5%). CONCLUSIONS: A primary care and public health focus on adult immunizations, in addition to other CPS, offers an effective strategy to reduce disparities while improving UTD levels. (Am J Public Health. Published online ahead of print June 14, 2012: e1-e7. doi:10.2105/AJPH.2012.300701). |
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