State-specific prevalence of selected health behaviors, by race and ethnicity--Behavioral Risk Factor Surveillance System, 1997.

PROBLEM/CONDITION: In the United States, disparities in risks for chronic disease (e.g., diabetes, cardiovascular disease, and cancer) and injury exist among racial and ethnic groups. This report summarizes findings from the 1997 Behavioral Risk Factor Surveillance System (BRFSS) of the distribution of access to health care, health-status indicators, health-risk behaviors, and use of clinical preventive services across five racial and ethnic groups (i.e., whites, blacks, Hispanics, American Indians or Alaska Natives, and Asians or Pacific Islanders) and by state. REPORTING PERIOD COVERED: 1997. DESCRIPTION OF SYSTEM: The BRFSS is a state-based telephone survey of the civilian, noninstitutionalized, adult (i.e., persons aged > or = 18 years) population. In 1997, all 50 states, the District of Columbia, and Puerto Rico participated in the BRFSS. RESULTS: Variations in risk for chronic disease and injury among racial and ethnic groups exist both within states and across states. For example, in Arizona, 11.0% of whites, 26.2% of Hispanics, and 50.5% of American Indians or Alaska Natives reported having no health insurance. Across states, the median percentage of adults who reported not having this insurance ranged from 10.8% for whites to 24.5% for American Indians or Alaska Natives. Other findings are as follows. Blacks, Hispanics, American Indians or Alaska Natives, and Asians or Pacific Islanders were more likely than whites to report poor access to health care (i.e., no health-care coverage and cost as a barrier to obtaining health care). Blacks, Hispanics, and American Indians or Alaska Natives were more likely than whites and Asians or Pacific Islanders to report fair or poor health status, obesity, diabetes, and no leisure-time physical activity. Blacks were substantially more likely than other racial or ethnic groups to report high blood pressure. Among all groups, American Indians or Alaska Natives were the most likely to report cigarette smoking. Except for Asians or Pacific Islanders, the median percentage of adults who reported not always wearing a safety belt while driving or riding in a car was > or = 30%. The Papanicolaou test was the most commonly reported screening measure: > or = 81% of white, black, and Hispanic women with an intact uterine cervix reported having had one in the past 3 years. Among white, black, and Hispanic women aged > or = 50 years, > or = 63% reported having had a mammogram in the past 2 years. Approximately two thirds of white, black, and Hispanic women aged > or = 50 years reported having had both a mammogram and a clinical breast examination in the past 2 years; this behavior was least common among Hispanics and most common among blacks. Screening for colorectal cancer was low among whites, blacks, and Hispanics aged > or = 50 years: in each racial or ethnic group, < or = 20% reported having used a home-kit blood stool test in the past year, and < or = 30% reported having had a sigmoidoscopy within the last 5 years. INTERPRETATION: Differences in median percentages between racial and ethnic groups, as well as between states within each racial and ethnic group, are likely mediated by various factors. According to published literature, socioeconomic factors (e.g., age distribution, educational attainment, employment status, and poverty), lifestyle behaviors (e.g., lack of physical activity, alcohol intake, and cigarette smoking), aspects of the social environment (e.g., educational and economic opportunities, neighborhood and work conditions, and state and local laws enacted to discourage high-risk behaviors), and factors affecting the health-care system (e.g., access to health care, and cost and availability of screening for diseases and health-risk factors) may be associated with these differences. ACTION TAKEN: States will continue to use the BRFSS to collect information about health-risk behaviors among various racial and ethnic groups. (ABSTRACT TRUNCATED)

State- and sex-specific prevalence of selected characteristics--Behavioral Risk Factor Surveillance System, 1996 and 1997.

PROBLEM/CONDITION: High-risk behaviors (e.g., physical inactivity, cigarette smoking, and drinking and driving) and lack of preventive health care (e.g., screening for cancer) are associated with morbidity and mortality from chronic disease and injury. The Behavioral Risk Factor Surveillance System (BRFSS) collects state-specific information to determine the prevalence of such behaviors and preventive practices. By using the BRFSS, states can gain a better understanding of the factors that have a major affect on the health of their adult populations. The BRFSS is also used to monitor progress toward national health objectives. REPORTING PERIOD COVERED: 1996 and 1997. DESCRIPTION OF SYSTEM: The BRFSS is a state-based telephone survey of the civilian, noninstitutionalized, adult (i.e., persons aged 18 years) population. In both 1996 and 1997, 50 states, the District of Columbia, and the Commonwealth of Puerto Rico participated in the BRFSS. RESULTS: As in previous years, state- and sex-specific variations occurred in the prevalence of high-risk behaviors, awareness of certain medical conditions, use of preventive health services, and health-care coverage. For example, in 1997, the percentage of adults who reported being current cigarette smokers ranged from 13.8% to 30.7% among states (median: 23.2%), and the percentage of adults who reported driving after drinking too much alcohol ranged from 0.6% to 5.3% (median: 1.9%). Binge drinking varied substantially not only by state (range: 6.3%-23.3%; median: 14.5%) but also by sex (men: 22.3%; women: 6.7%). Similarly, the prevalence of overweight varied considerably by sex: 62.2% of men and 44.5% of women were overweight in 1997. INTERPRETATION: The 1996 and 1997 BRFSS data demonstrate that U.S. adults engage in behaviors that are detrimental to their health. The data also demonstrate that many adults are making efforts to prevent chronic disease and injury. The prevalence of certain behaviors and health practices differs between states and between men and women. The reasons for these differences by state and sex are subjects for further analysis, but only through continued surveillance can the areas that need further study be identified. PUBLIC HEALTH ACTIONS: Data from the BRFSS are useful in developing and guiding public health programs and policies. For many states, the BRFSS is the only source of state-level data on behaviors and practices related to chronic disease and injury; therefore, BRFSS data are vital for effective decision-making at the local level. States will continue to use these data to help prevent premature morbidity and mortality among their adult population and to assess progress toward national health objectives.

Health care coverage and use of preventive services among the near elderly in the United States.

OBJECTIVES: It has been proposed that individuals aged 55 to 64 years be allowed to buy into Medicare. This group is more likely than younger adults to have marginal health status, to be separating from the workforce, to face high premiums, and to risk financial hardship from major medical illness. The present study examined prevalence of health insurance coverage by demographic characteristics and examined how lack of insurance may affect use of preventive health services. METHODS: Data were obtained from the Behavioral Risk Factor Surveillance System, an ongoing telephone survey of adults conducted by the 50 states and the District of Columbia. RESULTS: Many near-elderly adults least likely to have health care coverage were Black or Hispanic, had less than a high school education and incomes less than $15,000 per year, and were unemployed or self-employed. Health insurance coverage was associated with increased use of clinical preventive services even when sex, race/ethnicity, marital status, and educational level were controlled. CONCLUSIONS: Many near-elderly individuals without insurance will probably not be able to participate in a Medicare buy-in unless it is subsidized in some way.

State-and sex-specific prevalence of selected characteristics--behavioral risk factor surveillance system, 1994 and 1995.

PROBLEM/CONDITION: High-risk behaviors (e.g., cigarette smoking, excessive alcohol consumption, and physical inactivity) and lack of preventive health care (e.g., screening for cancer) are associated with chronic disease- and injury-related morbidity and mortality. States use the Behavioral Risk Factor Surveillance System (BRFSS) to collect data about these modifiable health behaviors and to monitor trends and changes in the prevalence of behavioral risk factors in state populations. BRFSS data also are used to monitor progress toward the year 2000 national health objectives. REPORTING PERIOD: 1994 and 1995. DESCRIPTION OF SYSTEM: The BRFSS is a state-based telephone survey of the civilian, noninstitutionalized, adult (persons > or =18 years of age) population. In 1994, 49 states and the District of Columbia participated in the BRFSS; in 1995, 50 states participated. RESULTS: As in previous years, there were state-specific variations in the prevalences of high-risk behaviors, awareness of certain medical conditions, use of preventive health services, and health-care coverage. Selected findings for 1995 were that 22.4% of adults reported being current cigarette smokers (range: 13.2%-27.8%); the percentage of adults who reported driving after drinking too much alcohol ranged from 0.6% to 5.2% (median: 2.3%); and among adults aged > or =65 years, 36.8% (range: 11.4%-46.6%) reported ever having had a pneumococcal vaccination and 59.2% (range: 44.2%-70.0%) reported having had an influenza vaccination within the past 1 year. INTERPRETATION: State-specific variations in prevalence may reflect differences in population composition, socioeconomic factors, state laws enacted to discourage high-risk behaviors, levels of effort to screen for certain diseases and physiological conditions, and other factors. ACTION TAKEN: States continue to use the BRFSS to monitor risk factors associated with chronic disease- and injury-related morbidity and mortality and to develop public health programs and policies to address these problems. BRFSS data continue to be important in assessing progress toward national year 2000 and state health objectives.

Female labor force participation and suicide.

To test the role conflict and role enhancement hypotheses, this paper examines the link between female labor force participation and suicide. Using a special tabulation of age/sex-specific suicide data for metropolitan areas in the United States, we estimate separate multivariate regression models for women and men in 1970 and 1980. Our findings show that in 1970 the level of female labor force participation among married women with small children is not related to the female suicide rate but is related to the male suicide rate in a positive direction. By 1980 the relationship between female labor force participation and the male and female suicide rate is negative, suggesting that the well-being of both men and women is enhanced by role accumulation among women.

Development, methods, and response characteristics of the 1986 National Mortality Followback Survey.

This report describes the methods employed in the 1986 National Mortality Followback Survey. This survey is based on information obtained from relatives of decedents and from health care facilities used by the decedents in their last year of life.

The quality of life in the year before death.

OBJECTIVES: Most Americans wish to live a long healthy life, but fear disease and dependency in their last years. Until recently, little has been known about the prevalence of opposite extremes of health in old age, particularly in the period leading up to death. METHODS: We used results from the 1986 National Mortality Follow-back Survey to estimate proportions of elderly decedents who were "fully functional" or "severely restricted" in the last year of life. Estimates were based on responses from proxies to questions regarding the decedent's functional status, mental awareness, and time spent in institutions. RESULTS: Approximately 14% of all decedents aged 65 years and older were defined as fully functional in the last year of life; 10% were defined as severely restricted. Proportions varied with the decedent's age and sex, the underlying cause of death, and the presence of other preexisting conditions. CONCLUSIONS: Results from this survey and future surveys can be used to learn more about "successful agers"--their medical histories, their life-styles, and whether their relative number is increasing or decreasing overtime.

The time interval between death and next-of-kin contact and its effects on response rates and data quality.

The relation of the interval of time between death and next-of-kin contact to outcome variables including response rates and data quality was examined in a nationally representative sample of 17,713 deaths of persons 25 years of age or older that occurred in the United States in 1986. For most of the outcome variables examined, the length of time had little effect, although there was a small decrease in the response rate and a small increase in the refusal rate for contact 40 or more weeks after death. The small decrease in the response rate and small increase in the refusal rate for the longest interval examined held for most decedent background characteristics examined (age, race, cause of death, and type of informant.) Authorizations to contact health care facilities signed by the respondents decreased slightly as the interval increased. The rate of returned mailed questionnaires passing quality and consistency edits increased slightly with time since death. Substantive responses (versus blanks, don't knows, etc.) decreased as time since death increased. Certain questions such as those on income and birth control pill use showed a decrease in response with time since death. Overall, the effects of longer time intervals between death and next-of-kin contact were less than expected on response rates and data quality, although our findings may reflect the high overall response rate, 90.5%, leaving little opportunity for significant areas of nonresponse.

Life expectancies of cigarette smokers and nonsmokers in the United States.

This research employs the National Health Interview and the National Mortality Followback Surveys to calculate life expectancies by age and sex for white nonsmokers, former smokers, and current smokers in the United States in 1986. In general, life expectancies are higher for never smokers than for former smokers, and higher for former smokers than for current smokers. Heavy smokers have lower life expectancies than persons with all other smoking statuses; indeed, compared to never smokers, heavy smokers at age 25 can expect at least a 25% shorter life. Gender differences in life expectancies were found to persist even with the elimination of smoking. Differences in life expectancy by sex thus appear to be due, in part, to cigarette smoking, but also to occupational, environmental, and sociodemographic factors.

Race of parents and infant birthweight in the United States.

Detailed 1977 national natality data are used to investigate social, demographic, and genetic effects on birthweight differentials. Analysis of birthweight differences among infants with white, black, and mixed black-white parents indicates that a portion of the observed weight differentials appear to be due to biologic factors. Infants with a black mother and father have the lowest mean birthweights, while infants with two white parents have the highest weights. Newborns with mixed-race parents have intermediate birthweight distributions. Multivariate analysis suggests that the effects of parental race on birthweight are not the result of maternal/obstetric differences among parents of the same or mixed race.

Trends in infant deaths from congenital anomalies: results from England and Wales, Scotland, Sweden and the United States.

Major strides have been made in reducing infant mortality in many parts of the world. As the number of infants dying from infectious diseases has declined, further reductions will require progress in reducing mortality in less tractable causes of death. As a result, the proportion of infant deaths attributable to congenital anomalies has been rising. Mortality due to different types of congenital anomalies is examined for the period 1976-1985 in the United States, England and Wales, Scotland and Sweden.

A comparison of gestational age reporting methods based on physician estimate and date of last normal menses from fetal death reports.

Utilizing 10,587 cases from the 1980 National Center for Health Statistics Fetal Death Statistics File, we examined the comparability of two methods of determining the gestational age of a fetal death, the calculated interval from date of last normal menses (DLNM) and the physician's estimate. The physician estimated gestational age distribution exhibits even number digit preference and a distinct clustering at the 40-week value. The DLNM distribution appears more smoothly distributed but with a more pronounced post-term tail. An exact agreement between the two methods is observed in only 27.9 per cent of the cases. A 1.7 week mean difference between the methods indicates a systematic underestimation by physician reported gestational age when compared to that calculated from the DLNM, potentially biasing gestational age distributions when the physician estimate is substituted for cases with a missing DLNM. Over 8 per cent of cases 20+ weeks by DLNM are estimated as less than 20 weeks by the physician. This underestimation has important implications for the completeness of reporting of fetal deaths on vital records and the comparability of fetal death rates. Further, it may limit investigations of the completeness of reporting of less than 500 gram live births.

Variations in the reporting of gestational age at induced termination of pregnancy.

Utilizing the 1980 Induced Abortion File maintained by the National Center for Health Statistics, we compared gestational age from date of last normal menses and the physician-based estimate of gestational age. An average .51 week difference between the two methods was observed. Beyond seven weeks gestation, the date of last normal menses value was underestimated by the physician-based estimate with a markedly greater divergence after 20 weeks. A relatively greater underestimation of the date of last normal menses interval by the physician estimate was apparent for Whites after 13 weeks. The data of last normal menses value for non-state residents was overestimated across the entire range of the date of last normal menses gestational age distribution until 21 weeks.

Experiences with linked birth and infant death certificates from the NIMS project.

The National Infant Mortality Surveillance (NIMS) project aggregated data provided by 53 vital statistics reporting areas--50 States, New York City, the District of Columbia, and Puerto Rico (subsequently called States)--from their files of linked birth and death certificates and compared individual States' total infant mortality experiences for the 1980 birth cohort by age at death, race, birth weight, and plurality. Therefore, it was essential to achieve maximum uniformity among the separate data sets and to specify when this uniformity could not be obtained. In working with these multiple sources, we identified five key issues that relate to data from linked birth and death certificates: Variations in definitions of variables are often embedded in data that have been gathered from several independent sources. (For NIMS, the sources were 53 reporting areas and the National Center for Health Statistics.) Variations in States' linking procedures--these are based on an individual State's primary purpose for linking the data--affect the completeness and comparability of the 1980 resident birth cohorts used for NIMS. Variations in the recording of some pregnancy outcomes as fetal deaths or live births are known to be a problem in vital statistics data that particularly affects data for events among infants weighing less than 500 g at birth. Ambiguities occur frequently in unknowns or zero values. For NIMS this effect was most pronounced for the pregnancy history variables. Examination of the values reported for unknown or zero categories helps in uncovering problems with and improving quality of data. (e) Analysis from a new perspective may reveal unexpected data problems. These problems tend to surface only during a reexamination of underlying data that is prompted by unusual findings.Continued alertness to these issues may improve further the quality of data in files of linked birth and death certificates and assure the integrity of analysis based on these data.

PIP: The authors analyze the quality of data in the files of linked birth and death certificates from the U.S. National Infant Mortality Surveillance (NIMS) project. The project compared individual states' total infant mortality experiences for the 1980 cohort. Uniformity among the separate data sets is considered essential. Variations in definitions, variations in states' linking procedures, variations in the recording of some pregnancy outcomes, ambiguous treatment of unknowns or zero values, and unexpected data problems are discussed

A closer examination of neonatal mortality rates among the Texas Spanish surname population.

Considering the poor socioeconomic status of the Spanish surnamed population in Texas, the Spanish surname neonatal mortality rate seems surprisingly low. During five of the last 10 years, the neonatal mortality rate for Texas Spanish surnamed population was actually lower than for Anglos. It is often suggested that the low Spanish surname neonatal mortality rate is due in part to reporting problems peculiar to the Spanish surname population in Texas. Linked birth and neonatal death records of Texas residents are examined for evidence of underreporting or misreporting of Spanish surnamed neonatal deaths. It is found that discrepancies in coding race on the birth and death records cause a minor deflation of Spanish surname neonatal and infant mortality rates. Indirect evidence indicates that there may be a substantial amount of underreporting of Spanish surname neonatal deaths. This underreporting appears to be associated with the presence of a large number of Mexican nationals misidentified as Texas residents, and the greater reliance upon lay midwives by the Spanish surname population in Texas. Reasons proposed to explain a reluctance to report neonatal deaths include fear of contact with authorities, and fear that a reported death would diminish the value of the birth certificate.