Prescription opioid analgesic use among adults: United States, 1999-2012.

Prescription opioid analgesics are used to treat pain from surgery, injury, and health conditions such as cancer. Opioid dependence and opioid-related deaths are growing public health problems. Opioid analgesic sales (in kilograms per 10,000) quadrupled from 1999 to 2010 (1), and from 1999 to 2012, opioid-related deaths (per 100,000) more than tripled (2). During 1999­2002, 4.2% of persons aged 18 and over used a prescription opioid analgesic in the past 30 days (3). This report provides updated estimates and trends in prescription opioid analgesic use among adults aged 20 and over, overall and by selected subgroups.

Comparison of dried blood spot to venous methods for hemoglobin A1c, glucose, total cholesterol, high-density lipoprotein cholesterol, and C-reactive protein.

BACKGROUND: Compared to venipuncture, dried blood spots (DBS) can be collected by non-phlebotomists in non-clinical settings, is relatively inexpensive, more easily transported and stored conveniently. Disadvantages of DBS include difficult assay development and validation. This study compared DBS to venous methods for hemoglobin A1c, glucose, total cholesterol, high-density lipoprotein cholesterol, and C-reactive protein (CRP). METHODS: DBS collection and venipuncture were performed on 401 participants. The DBS were collected on Whatman 903 protein saver card. For analysis, 3.2mm blood punches were placed into a 96-well microtiter plate for elution and then analyzed. RESULTS: The Pearson squared correlation coefficients were high for hemoglobin A1c (0.92), CRP (0.84) and glucose (0.81) and low for total cholesterol (0.34) and high-density lipoprotein (HDL) cholesterol (0.30). Sensitivity (>82%) and specificity (>90%) were high for CRP, glucose and hemoglobin A1c at selected clinical cut-points. Low sensitivity (<41%) and high specificity (>87%) were seen for total and HDL cholesterol. CONCLUSIONS: The hemoglobin A1c, glucose and CRP correlated well between DBS and venous methods (r(2)>0.80), but there was a poor correlation for total and HDL cholesterol (r(2)<0.34). This resulted in low sensitivity of DBS methods for total and HDL cholesterol.

National health and nutrition examination survey: plan and operations, 1999-2010.

Background-Starting in 1999, the National Health and Nutrition Examination Survey (NHANES) became a continuous, ongoing annual survey of the noninstitutionalized civilian resident population of the United States. A continuous survey allowed content to change to meet emerging needs. Objective-This report describes how NHANES for 1999-2010 was designed and implemented. NHANES is a national survey designed to provide national estimates on various health-related topics. Methods-The survey used in-person face-to-face interviews and physical examinations for data collection. Approximately 5,000 people per year participated in NHANES. The 5,000 people surveyed each year are representative of the entire U.S. population.

Infectious disease prevalence in Los Angeles county--a comparison to national estimates, 1999-2004 birth rates for U.S. teenagers reach historic lows for all age and ethnic groups.

This is the first time seroprevalence of antibody to these nine infectious diseases have been available for LAC. Differences in the race and ethnicity distribution of the United States and LAC were observed. Because disease prevalence varies by race and ethnicity, in some instances these demographic differences affected the population differences seen between the United States and LAC in the seroprevalence of the infectious diseases reported in this study. Seroprevalence for HAV was higher in LAC as compared with the United States among the total population and among the Mexican-American population. California is 1 of 11 states in which routine vaccination of children was recommended in 1999 by the Advisory Committee on Immunization Practices (ACIP) because mean incidence rates in these states were at least twice the national mean from 1987­1997 (9). Seroprevalence to CMV and T. gondii have been shown to be higher among Mexican-American persons then other race and ethnicity groups (1,3). The higher seropositivity for CMV and T. gondii among persons from LAC is due to the higher proportion of Mexican-American persons in the LAC population. No differences in seropositivity were observed when comparing Mexican-American persons in the United States and LAC for these two outcomes. No significant differences in seroprevalence between the United States and LAC were seen for measles, mumps, rubella, varicella, HSV-1, and HSV-2. Estimates of seropositivity from immunization or disease for LAC may assist in policy development, program planning, and measuring health disparities.

Resting pulse rate reference data for children, adolescents, and adults: United States, 1999-2008.

OBJECTIVE: This report presents national reference data on resting pulse rate (RPR), for all ages of the U.S. population, from 1999-2008. METHODS: During 1999-2008, 49,114 persons were examined. From this, a normative sample comprising 35,302 persons was identified as those who did not have a current medical condition or use a medication that would affect the RPR. RPR was obtained after the participant had been seated and had rested quietly for approximately 4 minutes. RESULTS: RPR is inversely associated with age. There is a mean RPR of 129 beats per minute (standard error, or SE, 0.9) at less than age 1 year, which decreases to a mean RPR of 96 beats/min (SE 0.5) by age 5, and further decreases to 78 beats/min (SE 0.3) in early adolescence. The mean RPR in adulthood plateaus at 72 beats/min (SE 0.2) (p < 0.05 for trend). In addition, there is a significant gender difference, with the male pulse rate plateauing in early adulthood, while the female resting pulse plateaus later when middle-aged. There are two exceptions, that is, infants under age 1 year and adults aged 80 and over, when the mean RPR is statistically and significantly higher in females than in males (females under age 20 have an RPR of 90 beats/min, SE 0.3, and males under age 20 have an RPR of 86 beats/min, SE 0.3, p <0.05; females aged 20 and over have an RPR of 74 beats/min, SE 0.2, and males aged 20 and over have an RPR of 71 beats/min, SE 0.3, p <0.05). After controlling for age effects, non-Hispanic black males have a significantly (p <0.001) lower mean RPR (74 beats/min) than non-Hispanic white males (77 beats/min) and Mexican-American males (76 beats/min). Among females, non-Hispanic black females (79 beats/min) and Mexican-American females (79 beats/min) had statistically and significantly (p < 0.01) lower mean RPRs compared with non-Hispanic white females (80 beats/min). Among males, the prevalence of clinically defined tachycardia (abnormally fast heart rate, RPR 100 beats/min) is 1.3% (95% CI = 1.1-1.7), and the prevalence of clinically defined bradycardia (abnormally slow heart rate, RPR < 60 beats/min) is 15.2% (95% CI = 14.1-16.4). For adult females, these prevalences are 1.9% (95% CI = 1.6-2.3) for clinical tachycardia and 6.9% (95% CI = 6.2-7.8) for clinical bradycardia. Controlling for age, males have higher odds (2.43, 95% CI = 2.09-2.83) of having bradycardia, and notably lower odds (0.71, 95% CI = 0.52-0.97) of having tachycardia than women. CONCLUSIONS: The data provides current, updated population-based percentiles of RPR, which is one of the key vital signs routinely measured in clinical practice.

Health of adults in Los Angeles County: findings from the National Health and Nutrition Examination Survey, 1999-2004.

OBJECTIVE: Los Angeles County has the largest population of any county in the nation. Population-based estimates of health conditions for Los Angeles County are based primarily on telephone surveys, which are known to underestimate conditions of public health importance. This report presents the prevalence of selected health conditions for civilian noninstitutionalized adults aged 20 and over living in Los Angeles County households and group quarters, based on survey data using direct physical measurements. METHODS: Combined data from the 1999-2000, 2001-2002, and 2003-2004 National Health and Nutrition Examination Surveys (NHANES), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, were used for this report. Sample weights were recalculated for participants examined in Los Angeles County using population totals provided by the Los Angeles County Department of Public Health, excluding the institutionalized population. RESULTS: Compared with the nation as a whole, adults in Los Angeles County had similar rates of health conditions even after age and age-race adjustment, with a few exceptions. A significantly smaller proportion of Los Angeles County adults were obese (age-adjusted rate, 23.8%) compared with the United States (31.0%); this difference held after age-race adjustment. The age-adjusted rate of diagnosed diabetes for men was higher in Los Angeles County (9.1%) than in the nation (7.3%); however, this difference did not hold after age-race adjustment. The rates of total diabetes adjusted for age and age-race were similar for men in Los Angeles County and the United States. CONCLUSIONS: The rates of selected health conditions in this report were similar for adults in Los Angeles County compared with adults in the United States, with the exception of obesity. The rates of obesity adjusted for age and age-race were lower among Los Angeles County adults compared with national rates. Health estimates based on direct physical measurements can be useful for local public health programs and prevention efforts.

Smoking, alcohol use, and illicit drug use reported by adolescents aged 12-17 years: United States, 1999-2004.

OBJECTIVE: This report presents national prevalence estimates for self-reported health risk behaviors of smoking, alcohol use, and illicit drug use by U.S. adolescents aged 12-17 years in the National Health and Nutrition Examination Surveys (NHANES). METHODS: Data in this report are from 6 years (1999-2004) of NHANES, which is conducted on a complex, stratified, multistage probability sample of the civilian, noninstitutionalized U.S. population. RESULTS: The tables included in this report present weighted percentages and standard errors for smoking, alcohol, and illicit drug use behaviors in U.S. adolescents, by sex, race/ethnicity, education, and poverty level (when sufficient data are available). Selected highlights are presented from information included in the tables.

Drug use and sexual behaviors reported by adults: United States, 1999-2002.

This report presents prevalence estimates for self-reported adult drug use and sexual behaviors in the United States. Data are from the National Health and Nutrition Examination Survey (NHANES) collected from 1999 to 2002. NHANES surveys a stratified multistage probability sample of the civilian noninstitutionalized population of the United States. Tables included in this report present estimates for use of cocaine, including crack or freebase, or other street drugs, and sexual behavior by selected sociodemographic characteristics among adults 20-59 years of age.

Consent for genetic research in a general population: an update on the National Health and Nutrition Examination Survey experience.

PURPOSE: The study determines the consent rates for storage of biologic samples for future research with and without genetic studies and describes trends in sociodemographic factors associated with consent. METHODS: We performed an analysis of the characteristics of consenting individuals participating in three data cycles of the National Health and Nutrition Examination Survey, a nationally representative survey of the U.S. population. RESULTS: In the 1999 to 2000 and the 2001 and 2002 surveys, 84.8% and 90.1% of eligible participants, respectively, consented to have their biologic samples including DNA stored in a national repository. Female and non-Hispanic black participants were least likely to consent when genetic studies and DNA were included. In the 2003 to 2004 survey, with the discontinuation of the DNA collection, 98.4% signed the consent document and these race/gender differences were no longer observed. CONCLUSION: Females and non-Hispanic blacks consistently had lower consent rates during the survey years when genetic studies were mentioned in the consent, but once DNA collection was discontinued these differences disappeared. These findings demonstrate wide acceptance among survey participants for allowing storage of specimens for future studies but indicate the need to explore race/gender issues with the collection and storage of DNA for genetic research.

Consent for genetic research in a general population: the NHANES experience.

PURPOSE: To determine the sociodemographic factors associated with consent for storage of DNA for future genetic research. METHODS: Analysis of the characteristics of consenting individuals participating in the National Health and Nutrition Examination Survey, a nationally representative survey of the US household population. RESULTS: In 1999, 84% (95% confidence interval 82.4-85.6) of eligible participants consented to have their blood samples included in a national repository for genetic research. In 2000, 85.3% (95% confidence interval 84.0-86.6) consented. Females and black participants in both years were least likely to consent (1999, 82.2% and 73.2%; 2000, 83.6% and 81.3%, respectively). An assessment by logistic regression demonstrated that in both years only non-Hispanic black race/ethnicity was a significant independent predictor for not consenting to future genetic research. CONCLUSION: Although non-Hispanic black individuals have overall response rates similar to those of the other racial/ethnic groups, they are less likely to agree to have a blood sample saved for future genetic research. In balance, however, these findings demonstrate wide acceptance among survey participants for allowing storage of specimens for future genetic research across many demographic variables.