Sociodemographic and Geographic Variation in Awareness of Stroke Signs and Symptoms Among Adults - United States, 2017.

Stroke is the fifth leading cause of death in the United States (1). In 2017, on average, a stroke-related death occurred every 3 minutes and 35 seconds in the United States, and stroke is a leading cause of long-term disability (1). To prevent mortality or long-term disability, strokes require rapid recognition and early medical intervention (2,3). Common stroke signs and symptoms include sudden numbness or weakness of the face, arm, or leg, especially on one side; sudden confusion or trouble speaking; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, or loss of balance; and a sudden severe headache with no known cause. Recommended action at the first sign of a suspected stroke is to quickly request emergency services (i.e., calling 9-1-1) (2). Public education campaigns have emphasized recognizing stroke signs and symptoms and the importance of calling 9-1-1, and stroke knowledge increased 14.7 percentage points from 2009 to 2014 (4). However, disparities in stroke awareness have been reported (4,5). Knowledge of the five signs and symptoms of stroke and the immediate need to call emergency medical services (9-1-1), collectively referred to as "recommended stroke knowledge," was assessed among 26,076 adults aged ≥20 years as part of the 2017 National Health Interview Survey (NHIS). The prevalence of recommended stroke knowledge among U.S. adults was 67.5%. Stroke knowledge differed significantly by race and Hispanic origin (p<0.001). The prevalence of recommended stroke knowledge was highest among non-Hispanic White adults (71.3%), followed by non-Hispanic Black adults (64.0%) and Hispanic adults (57.8%). Stroke knowledge also differed significantly by sex, age, education, and urbanicity. After multivariable adjustment, these differences remained significant. Increasing awareness of the signs and symptoms of stroke continues to be a national priority. Estimates from this report can inform public health strategies for increasing awareness of stroke signs and symptoms.

Regional Variation in Private Dental Coverage and Care Among Dentate Adults Aged 18-64 in the United States, 2014-2017.

Routine dental care can promote oral health (1,2), and those with private dental insurance are more likely to visit a dentist than those with other types of dental coverage or no coverage (3,4). Geographical variation in dental coverage and care among adults under age 65 exists (5,6), as does the availability of dental health professionals (7). This report examines regional variation in dental coverage among dentate adults (i.e., adults who have not lost all permanent teeth) aged 18-64 who had private health insurance in the past year, their utilization of dental care, and unmet dental needs due to cost in the past year.

State Variation in Meeting the 2008 Federal Guidelines for Both Aerobic and Muscle-strengthening Activities Through Leisure-time Physical Activity Among Adults Aged 18-64: United States, 2010-2015.

This report presents national and state-level age-adjusted estimates of percentages of U.S. adults aged 18-64 who met the 2008 federal guidelines for both aerobic and muscle-strengthening activities during leisure-time physical activity (LTPA) in 2010-2015, by sex and work status (working compared with nonworking). State variation in work status, health status and difficulty in physical functioning, and occupational distributions for men and women were also considered.

Occupational Differences Among Employed Adults Who Met 2008 Federal Guidelines for Both Aerobic and Muscle-strengthening Activities: United States, 2008-2014.

OBJECTIVE: This report presents national estimates of occupational differences among employed adults meeting the 2008 federal guidelines for both aerobic and muscle-strengthening activities performed during leisure time from 2008 through 2014. METHODS: Using pooled data from the 2008­2014 National Health Interview Survey, age-adjusted percentages of currently employed adults aged 18­64 who met the 2008 federal physical activity guidelines for leisure-time aerobic and muscle-strengthening activities are shown by occupation, sex, race and Hispanic ethnicity, education, and hours worked in the week before the survey interview. RESULTS: Among all employed adults aged 18­64, those in production and related occupations were the least likely to meet the 2008 federal physical activity guidelines for both aerobic and muscle-strengthening activities performed during their leisure time. Across occupation categories, men were more likely than women to meet the guidelines. Non-Hispanic white adults in professional, teaching or social service, sales, and services occupations were more likely than non-Hispanic black or Hispanic adults in those occupations to meet the guidelines. In production and related occupations, Hispanic adults were less likely to meet the guidelines than non-Hispanic adults; in managerial occupations, by contrast, all adults were equally likely to meet the guidelines regardless of their race and ethnicity. The likelihood of meeting the guidelines uniformly increased as education increased across every occupation category. Lastly, employees in professional, services, and sales occupations who worked 50 hours or more in the last week were more likely to meet the guidelines than their counterparts who worked fewer hours. In production and related occupations, by contrast, the number of hours worked in the last week was unrelated to whether adults met the guidelines. CONCLUSION: Occupational differences in meeting the 2008 federal guidelines for both aerobic and muscle-strengthening activities by sex, race and ethnicity, and education suggest that disparities in leisure-time physical activities across occupations and socioeconomic strata exist.

Disability in U.S. Households, 2000-2010: Findings from the National Health Interview Survey.

Understanding the demographic structure of households containing members with disabilities is of key importance in policy planning for populations with disabilities at state and national levels. Yet, most, but not all, previous family-level studies of disability have excluded persons living alone or with unrelated persons (e.g., a housemate or an unmarried partner) because they are not considered families. To address this gap, the authors utilize National Health Interview Survey data to produce household-level estimates of disability using a detailed household type variable that includes households omitted from previous reports. Findings indicate that one-person households made up 24.7% of all households with an adult aged 18-64 with a disability, and 42.9% of all households with an adult aged 65 or older with a disability. Including nonfamily households provides a clearer picture of the association between living arrangements and disability in the U.S.

Racial and Ethnic Disparities in Men's Use of Mental Health Treatments.

KEY FINDINGS: • Nearly 9% of men (8.5%) had daily feelings of anxiety or depression. Less than one-half of them (41.0%) took medication for these feelings or had recently talked to a mental health professional. • Racial and ethnic differences were observed only for men aged 18-44. • Among men aged 18-44, non-Hispanic black and Hispanic men (6.1%) were less likely than non-Hispanic white men (8.5%) to report daily feelings of anxiety or depression. • Among men aged 18-44 who had daily feelings of anxiety or depression, non-Hispanic black and Hispanic men (26.4%) were less likely than non-Hispanic white men (45.4%) to have used mental health treatments. • The significant racial and ethnic disparity in treatment utilization was associated with lack of health insurance coverage.

Modeling receipt of influenza A(H1N1)pdm09 vaccinations among US children during the 2009-2010 flu season: findings from the 2010 National Health Interview Survey.

OBJECTIVE: Using 32 weeks of data from the 2010 National Health Interview Survey, factors associated with receipt of influenza A(H1N1)pdm09 vaccinations among US children during October 2009 through February 2010 are examined. METHODS: Logistic models estimated receipt of first dose by January 1, 2010 for all children aged 4.5 months through 17 years and receipt of second dose by February 1, 2010 for children aged 6 months through 9 years who received a first dose, using demographic characteristics and measures of family structure, parental education, family income, access to health care, and chronic condition status. All analyses were weighted to yield nationally representative results for the US child population. RESULTS: Receipt of a seasonal influenza vaccination in the 12 months before October 2009 as well as race/ethnicity, family structure, and various measures representing family socioeconomic status were statistically significant correlates of receipt of the first pH1N1 dose, whereas children's asthma and chronic condition status were not. CONCLUSIONS: In the event of future pandemics, public health officials may utilize these findings to target particular segments of the US child population that may have been underserved during the 2009 influenza pandemic.

Summary health statistics for U.S. adults: national health interview survey, 2012.

OBJECTIVES: This report presents detailed tables from the 2012 National Health Interview Survey (NHIS) for the civilian noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, education, current employment status, family income, poverty status, health insurance coverage, marital status, and place and region of residence. Estimates (frequencies and percentages) are presented for selected chronic conditions and mental health characteristics, functional limitations, health status, health behaviors, health care access and utilization, and human immunodeficiency virus testing. Percentages and percent distributions are presented in both age-adjusted and unadjusted versions. DATA SOURCE: NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2012, data were collected on 34,525 adults in the Sample Adult questionnaire. The conditional response rate was 79.7%, and the final response rate was 61.2%. The health information for adults in this report was obtained from one randomly selected adult per family. HIGHLIGHTS: In 2012, 61% of adults aged 18 and over had excellent or very good health. Eleven percent of adults had been told by a doctor or other health professional that they had heart disease, 24% had been told on two or more visits that they had hypertension, 9% had been told that they had diabetes, and 21% had been told that they had some for of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia. Eighteen percent of adults were current smokers and 21% were former smokers. Based on estimates of body mass index, 35% of adults were overweight and 28% were obese.

Family structure and children's health in the United States: findings from the National Health Interview Survey, 2001-2007.

OBJECTIVES: This report presents statistics from the 2001-2007 National Health Interview Survey (NHIS) on selected measures of physical health and limitations, access to or utilization of health care, and behavior or emotional well-being for children under age 18 by family structure, sex, age, race, Hispanic origin, parent's education, family income, poverty status, home tenure status, health insurance coverage, place of residence, and region. SOURCE OF DATA: NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics, and is representative of the civilian noninstitutionalized population of the United States. Information about one randomly selected child per family is collected in a face-to-face interview with an adult proxy respondent familiar with the child's health. HIGHLIGHTS: Children in nuclear families were generally less likely than children in nonnuclear families to be in good, fair, or poor health; to have a basic action disability; to have leaming disabilities or attention deficit hyperactivity disorder; to lack health insurance coverage; to have had two or more emergency room visits in the past 12 months; to have receipt of needed prescription medication delayed during the past 12 months due to lack of affordability; to have gone without needed dental care due to cost in the past 12 months; to be poorly behaved; and to have definite or severe emotional or behavioral difficulties during the past 6 months. Children living in single-parent families had higher prevalence rates than children in nuclear families for the various health conditions and indicators examined in this report. However, when compared with children living in other nonnuclear families, children in single-parent families generally exhibited similar rates with respect to child health, access to care, and emotional or behavioral difficulties.

Socioeconomic status and utilization of health care services in Canada and the United States: findings from a binational health survey.

OBJECTIVES: Building on Andersen's behavioral model for the utilization of health care services, we examined factors associated with utilization of physician and hospital services among adults in Canada and the United States, with a focus on socioeconomic status (enabling resources in Andersen's framework). METHODS: Using the 2002-2003 Joint Canada/United States Survey of Health, we conducted country-specific multivariate logistic regressions predicting doctor contacts/visits and overnight hospitalizations in the past year, controlling for predisposing characteristics, enabling resources, and several factors representing perceived need for health care. All analyses were appropriately weighted to yield nationally representative results. RESULTS: Several measures of socioeconomic status-having a regular medical doctor, education, and, in the US income and insurance coverage-were associated with doctor contacts or visits in both countries, along with various predisposing and need factors. However, these same measures were not associated with hospitalizations in either country. Instead, only the individual's predisposing characteristics (eg, age and sex) and his/her need for health care predicted utilization of hospital services in Canada and the United States. Insurance coverage status in the United States became a significant predictor of hospitalizations when count data were analyzed via Poisson regression. CONCLUSIONS: Given our particular outcome measures, adults in Canada and the United States exhibited similar patterns of hospital utilization, and socioeconomic status played no explanatory role. However, relative to Canadian adults, we found disparities in doctor contacts among US adults-between those with more income and those with less, between those with health insurance and those without-after adjusting for health care needs and predisposing characteristics.

Women's compliance with public health guidelines for mammograms and pap tests in Canada and the United States: an analysis of data from the Joint Canada/United States Survey Of Health.

OBJECTIVES: We use the Joint Canada/United States Survey of Health (JCUSH) to examine use of mammograms and Pap tests among Canadian and US women during 2002 and 2003. Unlike previous data, the JCUSH data are bi-nationally comparable, in that the same instrument was used for interviewing both Canadian and US respondents at the same time. Furthermore, when appropriately weighted, these data are representative of the populations of both countries. METHODS: Descriptive statistics were used to provide a basic profile of screening practices among women in Canada and the United States. Logistic regression was then used to examine the determinants of compliance with mammogram and Pap test guidelines in the 2 countries, statistically controlling for demographic and socioeconomic characteristics, health status, and other indicators suggested from previous research. To increase comparability, these analyses were restricted to the age ranges covered in common by the screening guidelines of both countries. RESULTS: Among women covered by the guidelines in both countries, screening rates were higher in the United States than in Canada at all ages, which is puzzling given the existence of Canada's universal health care system. Multivariate analyses revealed that whether a woman had had a mammogram within the last 2 years (when predicting last Pap test) or had had a Pap test within the last 3 years (when predicting last mammogram) were the strongest and most consistent predictors of compliance in both countries. Race/ethnicity, nativity, marital status, socioeconomic status, insurance coverage in the United States, and various health status indicators also predicted compliance in some, but not all, models.

Comparing health and health care use in Canada and the United States.

Results from the Joint Canada/United States Survey of Health (2002-2003) reveal that health status is relatively similar in the two countries, but income-related health disparities exist. Americans in the poorest income quintile are more likely to have poor health than their Canadian counterparts; there were no differences between the rich. In general, Canadians were more like insured Americans regarding access to services, and Canadians experienced fewer unmet needs overall. Despite higher U.S. levels of spending on health care, residents in the two countries have similar health status and access to care, although there are higher levels of inequality in the United States.

Summary health statistics for U.S. children: National Health Interview Survey, 2000.

OBJECTIVES: This report presents statistics from the 2000 National Health Interview Survey on selected health measures for children under 18 years of age, classified by sex, age, race, Hispanic origin, family structure, parent's education, family income, poverty status, health insurance coverage, residence, region, and health status. The topics covered are asthma, allergies, learning disability, Attention Deficit Hyperactivity Disorder (ADHD), prescription medication, respondent-assessed health status, school-loss days, usual place of health care, time since last contact with a health care professional, unmet dental need, time since last dental contact, and selected measures of health care access. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized population of the United States. Data are collected during face-to-face interviews with adults present at the interview. Information about children is collected for one randomly selected child per family in face-to-face interviews with an adult proxy respondent familiar with the child's health. SELECTED HIGHLIGHTS: In 2000 most U.S. children under 18 years of age enjoyed excellent or very good health (83%). However, 12% had no health insurance coverage, and 6% had no usual place of health care. Twelve percent of children had ever been diagnosed with asthma. Eight percent of children 3-17 years of age had a learning disability, and 7% of children in this age group had ADHD. Lastly, 11% of children in single-mother families had two or more visits to an emergency room in the past year compared with 6% in two-parent families.

Summary health statistics for the U.S. population: National Health Interview Survey, 1999.

OBJECTIVES: This report presents health statistics from the 1999 National Health Interview Survey (NHIS) for the civilian noninstitutionalized population of the United States, classified by age, sex, race and Hispanic origin, poverty status, family income, education, place of residence, region of residence, and, where appropriate, health insurance coverage. The topics covered are health status and limitations of activity, injuries and poisonings, health care access and utilization, and health insurance coverage. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), and is representative of the civilian noninstitutionalized U.S. population. Data are collected during face-to-face interviews with adults present at the time of interview. Information about children and absent adults is obtained from an adult proxy respondent. SELECTED HIGHLIGHTS: Nearly 40% of Americans reported having excellent health in 1999, while almost 9% reported having either fair or poor health. Fourteen percent of the U.S. population did not have any health insurance coverage in 1999. Eighteen percent of single race non-Hispanic black persons and 32% of Hispanics were uninsured in 1999, compared with 11% of single race non-Hispanic white persons. Further, 47% of poor Hispanics and 43% of near poor Hispanics under age 65 years were uninsured; percents of uninsurance among poor and near poor single race non-Hispanic white and black persons under age 65 years were much lower. Eighty percent of single race non-Hispanic white persons under age 65 years had private health insurance coverage, compared with 57% of single race non-Hispanic blacks and 49% of Hispanics in this same age category.

Summary health statistics for U.S. children: National Health Interview Survey, 1999.

OBJECTIVES: This report presents statistics from the 1999 National Health Interview Survey (NHIS) on selected health measures for children under 18 years of age, classified by sex, age, race/ethnicity, family structure, parent's education, family income, poverty status, health insurance coverage, place of residence, region, and current health status. The topics covered are asthma, allergies, learning disability, attention deficit disorder, use of medication, respondent-assessed health status, school-loss days, usual place of medical care, time since last contact with a health care professional, selected health care risk factors, and time since last dental contact. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized population of the United States. Basic information is collected during face-to-face interviews with adults present at the time of interview. Information about children is collected about one randomly selected child per family in face-to-face interviews with an adult proxy respondent familiar with the child's health. SELECTED HIGHLIGHTS: In 1999 most U.S. children under 18 years of age enjoyed excellent or very good health (83%). However, 12% of children had no health insurance coverage, and 6% of children had no usual place of medical care. Eleven percent of children had ever been diagnosed with asthma. An estimated 7% of children 3-17 years of age had a learning disability, and an estimated 6% of children had Attention Deficit Disorder (ADD). Lastly, 9% of children in single mother families had two or more visits to an emergency room in the past year, compared with 4% of children in two parent families.

Summary health statistics for U.S. adults: National Health Interview Survey, 1997.

This report presents health statistics from the 1997 National Health Interview Survey for the civilian noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, poverty status, region of residence, and where appropriate, education, income, health insurance coverage, marital status, and place of residence. The topics covered are health status and limitations in activity, health care access and utilization, health behaviors and lifestyle, chronic condition prevalence, and knowledge and attitudes toward the Acquired Immunodeficiency Syndrome (AIDS). Source of Data The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized U.S. population. Data are collected during face-to-face interviews. Highlights Among adults 18 years of age or over, 12% had ever been told by a doctor or health professional that they had heart disease, 6% had ever been told they had coronary heart disease, and 19% had been told on two visits or more that they had hypertension. Nearly a quarter of adults were current smokers, 23% were former smokers, and 52% had never smoked. Sixty-one percent did not engage in any leisure-time vigorous physical activity, while approximately 24% engaged in such activity three times or more per week. Based on estimates of body mass index, 4% of adults were underweight, 42% were at a healthy weight, 35% were overweight, and 19% were obese.

Summary health statistics for the U.S. population: National Health Interview Survey, 1997.

OBJECTIVES: This report presents health statistics from the 1997 National Health Interview Survey for the civilian noninstitutionalized population of the United States, classified by age, gender, race and Hispanic origin, poverty status, income, education, place of residence, region of residence, and, where appropriate, health insurance coverage. The topics covered are health status and limitations of activity, injuries and poisonings, health care access and utilization, and health insurance coverage. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized U.S. population. Data are collected during face-to-face interviews with adults present at the time of interview. Information about children and absent adults is obtained from an adult proxy respondent. HIGHLIGHTS: Nearly 40% of Americans reported having excellent health in 1997, while almost 10% reported having either fair or poor health. Regarding health insurance coverage, 16% of the U.S. population did not have any health insurance coverage in 1997. Nineteen percent of non-Hispanic black persons and 33% of Hispanics were uninsured in 1997 as opposed to 12% of non-Hispanic white persons. Further, 45% of poor Hispanics and 43% of near poor Hispanics under age 65 years were uninsured, while among persons ages 65 years and over, 7% of poor Hispanics were uninsured. Lastly, 78% of non-Hispanic white persons under age 65 years had private health insurance coverage as opposed to 55% non-Hispanic black persons and 46% of Hispanics in this same age category.

Summary health statistics for the U.S. population: National Health Interview Survey, 1998.

OBJECTIVES: This report presents health statistics from the 1998 National Health Interview Survey (NHIS) for the civilian, noninstitutionalized population of the United States, classified by age, sex, race and Hispanic origin, poverty status, family income, education, place of residence, region of residence, and, where appropriate, health insurance coverage. The topics covered are health status and limitations of activity, injuries and poisonings, health care access and utilization, and health insurance coverage. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized U.S. population. Data are collected during face-to-face interviews with adults present at the time of interview. Information about children and absent adults is obtained from an adult proxy respondent. HIGHLIGHTS: Nearly 40% of Americans reported having excellent health in 1998, while almost 9% reported having either fair or poor health. Fifteen percent of the U.S. population did not have any health insurance coverage in 1998. Nineteen percent of non-Hispanic black persons and 33% of Hispanics were uninsured in 1998, as opposed to 11% of non-Hispanic white persons. Further, 46% of poor Hispanics and 44% of near-poor Hispanics under age 65 years were uninsured; percents of uninsurance among poor and near poor non-Hispanic white and black persons under age 65 years were much lower. Lastly, 80% of non-Hispanic white persons under age 65 years had private health insurance coverage, as opposed to 55% of non-Hispanic black persons and 49% of Hispanics in this same age category.

Summary health statistics for U.S. children: National Health Interview Survey, 1998.

OBJECTIVES: This report presents statistics from the 1998 National Health Interview Survey (NHIS) on selected health measures for children under 18 years of age, classified by sex, age, race/ethnicity, family structure, parent's education, family income, poverty status, health insurance coverage, place of residence, region, and current health status. The topics covered are asthma, allergies, learning disabilities, Attention Deficit Disorder, use of medication, respondent-assessed health status, school-loss days, usual place of medical care, time since last contact with a health care professional, selected health care risk factors, and time since last dental contact. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized population of the United States. Data are collected during face-to-face interviews with adults present at the time of interview. Information about children is collected for one randomly selected child per family in face-to-face interviews with an adult proxy respondent familiar with the child's health. HIGHLIGHTS: In 1998 most U.S. children under 18 years of age enjoyed excellent or very good health (84%). However, 12% of children had no health insurance coverage, and 6% of children had no usual place of medical care. Twelve percent of children had ever been diagnosed with asthma. An estimated 8% of children 3-17 years of age had a learning disability, and an estimated 6% of children had Attention Deficit Disorder (ADD). Lastly, 11% of children in single mother families had two or more visits to an emergency room in the past year compared with 6% of children in two-parent or single-father families.