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Watson KB, Croft JB, Wheaton AG, Liu Y, Punturieri A, Postow L, Carlson SA, Greenlund KJ. Risk of Chronic Obstructive Pulmonary Disease and Receipt of a Breathing Test in 26 States and the District of Columbia, 2017-2018. Prev Chronic Dis 2024; 21:E31. [PMID: 38723273 PMCID: PMC11086692 DOI: 10.5888/pcd21.230399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
We estimated the prevalence of respiratory symptoms, chronic obstructive pulmonary disease (COPD) risk level, and receipt of a breathing test among adults without reported COPD in 26 states and the District of Columbia by using 2017-2018 Behavioral Risk Factor Surveillance System data. Among adults without reported COPD, the 3 respiratory symptoms indicating COPD (chronic cough, phlegm or mucus production, shortness of breath) were common (each >10%). About 15.0% were at higher COPD risk (based on the number of symptoms, age, and smoking status); 41.4% of adults at higher risk reported receipt of a breathing test. Patient-provider recognition and communication of risk symptoms, appropriate screening, and follow-up are important for early diagnosis and treatment.
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Affiliation(s)
- Kathleen B Watson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341
| | - Janet B Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anne G Wheaton
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Antonello Punturieri
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Lisa Postow
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Susan A Carlson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Xu F, Carlson SA, Greenlund KJ. Understanding primary care providers' attitudes towards preventive screenings to patients with inflammatory bowel disease. PLoS One 2024; 19:e0299890. [PMID: 38662717 PMCID: PMC11045111 DOI: 10.1371/journal.pone.0299890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/16/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Preventive care is important for managing inflammatory bowel disease (IBD), yet primary care providers (PCPs) often face challenges in delivering such care due to discomfort and unfamiliarity with IBD-specific guidelines. This study aims to assess PCPs' attitudes towards, and practices in, providing preventive screenings for IBD patients, highlighting areas for improvement in guideline dissemination and education. METHODS Using a web-based opt-in panel of PCPs (DocStyles survey, spring 2022), we assessed PCPs' comfort level with providing/recommending screenings and the reasons PCPs felt uncomfortable (n = 1,503). Being likely to provide/recommend screenings for depression/anxiety, skin cancer, osteoporosis, and cervical cancer were compared by PCPs' comfort level and frequency of seeing patients with IBD. We estimated adjusted odd ratios (AORs) of being likely to recommend screenings and selecting responses aligned with IBD-specific guidelines by use of clinical practice methods. RESULTS About 72% of PCPs reported being comfortable recommending screenings to patients with IBD. The top reason identified for not feeling comfortable was unfamiliarity with IBD-specific screening guidelines (55%). Being comfortable was significantly associated with being likely to provide/recommend depression/anxiety (AOR = 3.99) and skin cancer screenings (AOR = 3.19) compared to being uncomfortable or unsure. Percentages of responses aligned with IBD-specific guidelines were lower than those aligned with general population guidelines for osteoporosis (21.7% vs. 27.8%) and cervical cancer screenings (34.9% vs. 43.9%), and responses aligned with IBD-specific guidelines did not differ by comfort level for both screenings. Timely review of guidelines specific to immunosuppressed patients was associated with being likely to provide/recommend screenings and selecting responses aligned with IBD-specific guidelines. CONCLUSIONS Despite a general comfort among PCPs in recommending preventive screenings for IBD patients, gaps in knowledge regarding IBD-specific screening guidelines persist. Enhancing awareness and understanding of these guidelines through targeted education and resource provision may bridge this gap.
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Affiliation(s)
- Fang Xu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Susan A. Carlson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kurt J. Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Liu Y, Carlson SA, Watson KB, Xu F, Greenlund KJ. Trends in the Prevalence of Chronic Obstructive Pulmonary Disease Among Adults Aged ≥18 Years - United States, 2011-2021. MMWR Morb Mortal Wkly Rep 2023; 72:1250-1256. [PMID: 37971940 PMCID: PMC10684355 DOI: 10.15585/mmwr.mm7246a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the United States. Overall COPD prevalence declined during 1999-2011. Trends in COPD prevalence during the previous decade have not been reported. CDC analyzed 2011-2021 Behavioral Risk Factor Surveillance System data to assess trends and differences in self-reported physician-diagnosed COPD prevalence among U.S. adults aged ≥18 years. Age-standardized prevalence of COPD did not change significantly from 2011 (6.1%) to 2021 (6.0%). Prevalence was stable for most states and subgroups; however, it decreased significantly among adults aged 18-44 years (average annual percent change [AAPC] = -2.0%) and increased significantly among those aged ≥75 years (AAPC = 1.3%), those living in micropolitan counties (0.8%), and among current (1.5%) or former (1.2%) smokers. COPD prevalence remained elevated in the following groups: women, adults aged ≥65 years, those with a lower education level, unable to work, living in rural areas, and who ever smoked. Evidence-based strategies, especially those tailored for adults disproportionately affected, can reduce COPD prevalence, and address the continued need for prevention, early diagnosis, treatment, and management.
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Carlson SA, Watson KB, Rockhill S, Wang Y, Pankowska MM, Greenlund KJ. Linking Local-Level Chronic Disease and Social Vulnerability Measures to Inform Planning Efforts: A COPD Example. Prev Chronic Dis 2023; 20:E76. [PMID: 37651645 PMCID: PMC10487786 DOI: 10.5888/pcd20.230025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Data are publicly available to identify geographic differences in health outcomes, including chronic obstructive pulmonary disease (COPD), and social vulnerability; however, examples of combining data across sources to understand disease burden in the context of community vulnerability are lacking. METHODS We merged county and census tract model-based estimates of COPD prevalence from PLACES (www.cdc.gov/PLACES) with social vulnerability measures from the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (https://www.atsdr.cdc.gov/placeandhealth/svi), including 4 themes (socioeconomic, household composition and disability, minority status and language, and housing type and transportation), and the overall Social Vulnerability Index (SVI). We used the merged data set to create vulnerability profiles by COPD prevalence, explore joint geographic patterns, and calculate COPD population estimates by vulnerability levels. RESULTS Counties and census tracts with high COPD prevalence (quartile 4) had high median vulnerability rankings (range: 0-1) for 2 themes: socioeconomic (county, 0.81; tract, 0.77) and household composition and disability (county, 0.75; tract, 0.81). Concordant high COPD prevalence and vulnerability for these themes were clustered along the Ohio and lower Mississippi rivers. The estimated number of adults with COPD residing in counties with high vulnerability was 2.5 million (tract: 4.7 million) for the socioeconomic theme and 2.3 million (tract: 5.0 million) for the household composition and disability theme (high overall SVI: county, 4.5 million; tract, 4.7 million). CONCLUSION Data from 2 publicly available tools can be combined, analyzed, and visualized to jointly examine local COPD estimates and social vulnerability. These analyses can be replicated with other measures to expand the use of these cross-cutting tools for public health planning.
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Affiliation(s)
- Susan A Carlson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S107-6, Atlanta, GA 30341
| | - Kathleen B Watson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah Rockhill
- Geospatial Research, Analysis, and Services Program, Office of Innovation and Analytics, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yan Wang
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Magdalena M Pankowska
- Oak Ridge Institute for Science and Education, Research Participation Program, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Pankowska MM, Lu H, Wheaton AG, Liu Y, Lee B, Greenlund KJ, Carlson SA. Prevalence and Geographic Patterns of Self-Reported Short Sleep Duration Among US Adults, 2020. Prev Chronic Dis 2023; 20:E53. [PMID: 37384831 DOI: 10.5888/pcd20.220400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
We estimated the prevalence of short sleep duration (<7 hours per day) among US adults aged 18 years or older by using 2020 Behavioral Risk Factor Surveillance System data. Nationally, 33.2% of adults reported short sleep duration. We identified disparities across sociodemographic characteristics, including age, sex, race and ethnicity, marital status, education, income, and urbanicity. Counties with the highest model-based estimates of short sleep duration clustered in the Southeast and along the Appalachian Mountains. These findings identified subgroups and geographic areas in which tailored strategies for promotion of optimal sleep duration (≥7 hours per night) are most needed.
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Affiliation(s)
- Magdalena M Pankowska
- Oak Ridge Institute for Science and Education, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S107-6, Atlanta, GA 30341
| | - Hua Lu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anne G Wheaton
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin Lee
- Oak Ridge Institute for Science and Education, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A Carlson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Lee B, Wang Y, Carlson SA, Greenlund KJ, Lu H, Liu Y, Croft JB, Eke PI, Town M, Thomas CW. National, State-Level, and County-Level Prevalence Estimates of Adults Aged ≥18 Years Self-Reporting a Lifetime Diagnosis of Depression - United States, 2020. MMWR Morb Mortal Wkly Rep 2023; 72:644-650. [PMID: 37318995 DOI: 10.15585/mmwr.mm7224a1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Depression is a major contributor to mortality, morbidity, disability, and economic costs in the United States (1). Examining the geographic distribution of depression at the state and county levels can help guide state- and local-level efforts to prevent, treat, and manage depression. CDC analyzed 2020 Behavioral Risk Factor Surveillance System (BRFSS) data to estimate the national, state-level, and county-level prevalence of U.S. adults aged ≥18 years self-reporting a lifetime diagnosis of depression (referred to as depression). During 2020, the age-standardized prevalence of depression among adults was 18.5%. Among states, the age-standardized prevalence of depression ranged from 12.7% to 27.5% (median = 19.9%); most of the states with the highest prevalence were in the Appalachian* and southern Mississippi Valley† regions. Among 3,143 counties, the model-based age-standardized prevalence of depression ranged from 10.7% to 31.9% (median = 21.8%); most of the counties with the highest prevalence were in the Appalachian region, the southern Mississippi Valley region, and Missouri, Oklahoma, and Washington. These data can help decision-makers prioritize health planning and interventions in areas with the largest gaps or inequities, which could include implementation of evidence-based interventions and practices such as those recommended by The Guide to Community Preventive Services Task Force (CPSTF) and the Substance Abuse and Mental Health Services Administration (SAMHSA).
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Carlson SA, Wheaton AG, Liu Y, Moore LV, Eke PI, Croft JB, Greenlund KJ, Thomas CW. Associations of self-reported chronic obstructive pulmonary disease with indicators of economic instability and stress - 16 states, 2017. Chronic Illn 2023; 19:327-338. [PMID: 34812655 PMCID: PMC10424003 DOI: 10.1177/17423953211059144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the association between chronic obstructive pulmonary disease status and indicators of economic instability and stress to better understand the magnitude of these issues in persons with chronic obstructive pulmonary disease. METHODS Analyzed 2017 Behavioral Risk Factor Surveillance System data from 16 states that administered the 'Social Determinants of Health' module, which included economic instability and stress measures (N = 101,461). Associations between self-reported doctor-diagnosed chronic obstructive pulmonary disease status and each measure were examined using multinomial logistic models. RESULTS Adults with chronic obstructive pulmonary disease were more likely (p < 0.001) than adults without to report not having enough money at month end (21.0% vs. 7.9%) or just enough money (44.9% vs. 37.2%); being unable to pay mortgage, rent, or utility bills (19.2% vs. 8.8%); and that often or sometimes food did not last or could not afford to eat balanced meals (37.9% vs. 20.6%), as well as stress all or most of the time (27.3% vs. 11.6%). Associations were attenuated although remained significant after adjustments for sociodemographic and health characteristics. DISCUSSION Financial, housing, and food insecurity and frequent stress were more prevalent in adults with chronic obstructive pulmonary disease than without. Findings highlight the importance of including strategies to address challenges related to economic instability and stress in chronic obstructive pulmonary disease management programs.
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Affiliation(s)
- Susan A Carlson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S107-6, Atlanta, GA 30341
| | - Anne G Wheaton
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S107-6, Atlanta, GA 30341
| | - Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S107-6, Atlanta, GA 30341
| | - Latetia V Moore
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S107-5, Atlanta, GA 30341
| | - Paul I Eke
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S107-6, Atlanta, GA 30341
| | - Janet B Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S107-6, Atlanta, GA 30341
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S107-6, Atlanta, GA 30341
| | - Craig W Thomas
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S107-6, Atlanta, GA 30341
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Hyde ET, Watson KB, Omura JD, Janz KF, Lee SM, Fulton JE, Carlson SA. Surveillance of Meeting the Youth Physical Activity Guideline: Impact of Including Vigorous-Intensity and Bone-Strengthening Activities. Res Q Exerc Sport 2022; 93:728-733. [PMID: 34709135 DOI: 10.1080/02701367.2021.1914303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/02/2021] [Indexed: 06/13/2023]
Abstract
Purpose: The US youth physical activity guideline recommends participation in four types of physical activity: moderate-to-vigorous intensity aerobic (MVPA), vigorous-intensity aerobic (VPA), muscle-strengthening, and bone-strengthening physical activity. Current national prevalence estimates of meeting the youth physical activity guideline are typically based on measures of the MVPA and muscle-strengthening components. This study sought to examine differences in prevalence estimates using this current approach and then including measures of all four components. Methods: Data from US high school student respondents to the 2010 National Youth Physical Activity and Nutrition Survey were analyzed (n = 10,596). Prevalence of students meeting the youth physical activity guideline were assessed and compared using 1) measures of MVPA and muscle-strengthening components only and 2) also including measures of the VPA and bone-strengthening components. Results: Overall, 15.2% students met the MVPA, 50.7% met the muscle-strengthening, 70.6% met the VPA, and 80.7% met the bone-strengthening components. In total, 12.1% (95% confidence interval: 10.9, 13.3) of students met both the MVPA and muscle-strengthening components, and 11.2% (95% confidence interval: 10.0, 12.4) met all four components. Conclusions: Incorporating additional measures of VPA and bone-strengthening activity into current surveillance systems may not meaningfully impact national estimates of meeting the youth physical activity guideline.
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Affiliation(s)
- Eric T Hyde
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
| | - Kathleen B Watson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
| | - John D Omura
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
| | | | - Sarah M Lee
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
| | - Janet E Fulton
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
| | - Susan A Carlson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
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Xu F, Carlson SA, Liu Y, Greenlund KJ. Urban-Rural Differences in Health Care Utilization for Inflammatory Bowel Disease in the USA, 2017. Dig Dis Sci 2022; 67:3601-3611. [PMID: 34633623 PMCID: PMC10478171 DOI: 10.1007/s10620-021-07264-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/27/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Urban-rural differences in IBD-specific health care utilization at the national level have not been examined in the USA. AIMS We compared urban and rural rates of IBD-related office visits and IBD-specific (Crohn's disease (CD) or ulcerative colitis (UC)) hospitalizations and emergency department (ED) visits. METHODS From multiple national data sources, we compared national rates using Z test and compared estimates of patient and hospital characteristics and hospitalization outcomes between urban and rural areas using Chi-square and t tests. RESULTS In 2015 and 2016, digestive disease-related office visit rates, per 100 adults, were 3.1 times higher in urban than in rural areas (8.7 vs 2.8, P < 0.001). In 2017, age-adjusted rates per 100,000 adults were significantly higher in rural than urban areas for CD-specific hospitalizations (26.3 vs 23.6, P = 0.03) and ED visits (49.3 vs 39.5, P = 0.002). Compared with their urban counterparts, rural adults hospitalized for CD or UC in 2017 were more likely to be older and non-Hispanic white, have lower household income, Medicare coverage, and an elective admission, and were discharged from hospitals that were large, non-federal government owned, and in the Midwest or South. There were no significant urban-rural differences in length of stay and 30-day readmission rate. CONCLUSIONS While IBD or digestive disease-related office visit rates were lower in rural compared to urban areas, CD-specific hospitalization and ED visit rates were higher. Strategies that improve office-based care among rural patients with IBD may help to avoid more costly forms of health care use.
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Affiliation(s)
- Fang Xu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA.
| | - Susan A Carlson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
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Watson KB, Carlson SA, Loustalot F, Town M, Eke PI, Thomas CW, Greenlund KJ. Chronic Conditions Among Adults Aged 18─34 Years — United States, 2019. MMWR Morb Mortal Wkly Rep 2022; 71:964-970. [PMID: 35900929 PMCID: PMC9345173 DOI: 10.15585/mmwr.mm7130a3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Xu F, deJong N, Kappelman MD, Greenlund KJ, Carlson SA. Primary Care Professionals' Attitudes Towards Vaccination Recommendation for Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2022; 29:726-734. [PMID: 35779060 DOI: 10.1093/ibd/izac129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Immunization among patients with inflammatory bowel disease (IBD) is suboptimal. We sought to characterize attitudes of US primary care professionals (PCPs) towards immunization practices for patients with IBD. METHODS Using a web-based opt-in panel of PCPs (DocStyles survey, spring 2021, cross-sectional study), we assessed likelihood of PCPs' recommending influenza, pneumococcal disease, herpes zoster, and human papilloma virus vaccinations for IBD patients by PCP characteristics and availability of clinical tools. Reasons for unlikelihood of recommending vaccines and approaches to improve vaccine recommendation were examined. RESULTS Among 1503 PCPs, 64% recommended all vaccines. Herpes zoster vaccine was most likely to be recommended (89.8%) and pneumococcal vaccine was least likely (74.0%). Clinical tools including decision support based on electronic health records (EHRs; 48.9%) and staff tracking of patients' vaccine needs (36.3%) were significantly associated with likelihood of recommending vaccines (P < .001). A greater likelihood of vaccine recommendation was observed for pediatricians vs other medical specialties, group outpatient clinic vs other worksites, and seeing >50 patients/week (P < .05). One-third of PCPs were unlikely to recommend ≥1 vaccine, and the top reason reported was unfamiliarity with vaccine guidelines for patients with IBD (48.0%). A review of guidelines or continued medical education (63.0%) and decision support from EHRs (51.2%) were the most frequently selected approaches identified to improve certainty of vaccine recommendation. CONCLUSIONS There is room for improvement of vaccination recommendations by PCPs. Promoting continuing education and use of clinical tools may help support PCP immunization practices for patients with IBD.
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Affiliation(s)
- Fang Xu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Neal deJong
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Michael D Kappelman
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Susan A Carlson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
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Abstract
Local-level data on the health of populations are important to inform and drive effective and efficient actions to improve health, but such data are often expensive to collect and thus rare. Population Level Analysis and Community EStimates (PLACES) (www.cdc.gov/places/), a collaboration between the Centers for Disease Control and Prevention (CDC), the Robert Wood Johnson Foundation, and the CDC Foundation, provides model-based estimates for 29 measures among all counties and most incorporated and census-designated places, census tracts, and ZIP Code tabulation areas across the US. PLACES allows local health departments and others to better understand the burden and geographic distribution of chronic disease-related outcomes in their areas regardless of population size and urban-rural status and assists them in planning public health interventions. Online resources allow users to visually explore health estimates geographically, compare estimates, and download data for further use and exploration. By understanding the PLACES overall approach and using the easy-to-use PLACES applications, practitioners, policy makers, and others can enhance their efforts to improve public health, including informing prevention activities, programs, and policies; identifying priority health risk behaviors for action; prioritizing investments to areas with the biggest gaps or inequities; and establishing key health objectives to achieve community health and health equity.
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Affiliation(s)
- Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS S107-6, Atlanta GA 30341.
| | - Hua Lu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yan Wang
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kevin A Matthews
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer M LeClercq
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin Lee
- Oak Ridge Institute for Science and Education, Research Participation Program, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A Carlson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Wang Y, Tevendale H, Lu H, Cox S, Carlson SA, Li R, Shulman H, Morrow B, Hastings PA, Barfield WD. US county-level estimation for maternal and infant health-related behavior indicators using pregnancy risk assessment monitoring system data, 2016-2018. Popul Health Metr 2022; 20:14. [PMID: 35597940 PMCID: PMC9124401 DOI: 10.1186/s12963-022-00291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background There is a critical need for maternal and child health data at the local level (for example, county), yet most counties lack sustainable resources or capabilities to collect local-level data. In such case, model-based small area estimation (SAE) could be a feasible approach. SAE for maternal or infant health-related behaviors at small areas has never been conducted or evaluated. Methods We applied multilevel regression with post-stratification approach to produce county-level estimates using Pregnancy Risk Assessment Monitoring System (PRAMS) data, 2016–2018 (n = 65,803 from 23 states) for 2 key outcomes, breastfeeding at 8 weeks and infant non-supine sleeping position. Results Among the 1,471 counties, the median model estimate of breastfeeding at 8 weeks was 59.8% (ranged from 34.9 to 87.4%), and the median of infant non-supine sleeping position was 16.6% (ranged from 10.3 to 39.0%). Strong correlations were found between model estimates and direct estimates for both indicators at the state level. Model estimates for both indicators were close to direct estimates in magnitude for Philadelphia County, Pennsylvania. Conclusion Our findings support this approach being potentially applied to other maternal and infant health and behavioral indicators in PRAMS to facilitate public health decision-making at the local level.
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Affiliation(s)
- Yan Wang
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
| | - Heather Tevendale
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Hua Lu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Susan A Carlson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Rui Li
- Health Resources and Services Administration, Rockville, MD, 20857, USA
| | - Holly Shulman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Brian Morrow
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | | | - Wanda D Barfield
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
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Carlson SA, Wheaton AG, Watson KB, Liu Y, Croft JB, Greenlund KJ. Geographic Differences in Sex-Specific Chronic Obstructive Pulmonary Disease Mortality Rate Trends Among Adults Aged ≥25 Years - United States, 1999-2019. MMWR Morb Mortal Wkly Rep 2022; 71:613-618. [PMID: 35511711 PMCID: PMC9098243 DOI: 10.15585/mmwr.mm7118a1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Susan A Carlson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Anne G Wheaton
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Kathleen B Watson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Janet B Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Pollack Porter KM, Omura JD, Ballard R, Peterson EL, Carlson SA. Systematic Review on Quantifying Pedestrian Injury When Evaluating Changes to the Built Environment. Prev Med Rep 2022; 26:101703. [PMID: 35141117 PMCID: PMC8814639 DOI: 10.1016/j.pmedr.2022.101703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/02/2021] [Accepted: 01/15/2022] [Indexed: 11/25/2022] Open
Abstract
Making communities more walkable may have the added benefit of improving safety. Risk of pedestrian injury is one barrier to walking in public spaces. Pedestrian injury is mainly captured from police reports, which has limitations. Injury prevention practitioners can help identify appropriate data and measures.
Modifying the built environment to make communities more walkable remains one strategy to promote physical activity. These modifications may have the added benefit of reducing the risk of pedestrian injury; however, there is a gap in the physical activity literature regarding how best to measure pedestrian injury. Examining the measures that have been used and related data sources can help inform the use of pedestrian injury data to evaluate whether safety is optimized as walking increases. We conducted a systematic review of the literature to identify studies that evaluated changes to the built environment that support walking and measures impacts on pedestrian injury as a measure of safety. We searched PubMed, PsycInfo, and Web of Science to identify peer-review studies and websites of fifteen organizations to document studies from the grey literature published in English between January 1, 2010 and December 31, 2018. Our search identified twelve studies that met the inclusion criteria. The few studies that measured changes in pedestrian injury used crash data from police reports. Injury frequency was often reported, but not injury severity, and no studies reported injury risk based on walking exposure. We conclude that few studies have measured pedestrian injury in the context of creating more walkable communities. Future research would benefit from using well-characterized measures from existing studies to support consistency in measurement, and from more longitudinal and evaluation research to strengthen the evidence on additional benefits of walkability. Increased collaborations with injury prevention professionals could bolster use of valid and reliable measures.
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Omura JD, Kochtitzky CS, Galuska DA, Fulton JE, Shah S, Carlson SA. Public Health Representation on Active Transportation Bodies Across US Municipalities. J Public Health Manag Pract 2022; 28:E119-E126. [PMID: 32487920 PMCID: PMC10939047 DOI: 10.1097/phh.0000000000001170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Municipal bodies such as planning or zoning commissions and active transportation advisory committees can influence decisions made by local governments that support physical activity through active transportation. Public health professionals are encouraged to participate in and inform these processes. However, the extent of such collaboration among US municipalities is currently unknown. OBJECTIVE To estimate the prevalence of active transportation bodies among US municipalities and the proportion with a designated public health representative. DESIGN A cross-sectional survey administered from May through September 2014. SETTING Nationally representative sample of US municipalities with populations of 1000 or more people. PARTICIPANTS Respondents were the city or town manager, planner, or person with similar responsibilities (N = 2018). MAIN OUTCOME MEASURES The prevalence of planning or zoning commissions and active transportation advisory committees among municipalities and whether there was a designated public health representative on them. RESULTS Approximately 90.9% of US municipalities have a planning or zoning commission, whereas only 6.5% of these commissions have a designated public health representative. In contrast, while 16.5% of US municipalities have an active transportation advisory committee, 22.4% of them have a designated public health representative. These active transportation bodies are less common among municipalities that are smaller, rural, located in the South, and where population educational attainment is lower. Overall, few US municipalities have a planning or zoning commission (5.9%) or an active transportation advisory committee (3.7%) that also has a designated public health representative. CONCLUSIONS Approximately 9 in 10 US municipalities have a planning or zoning commission, whereas only 1 in 6 has an active transportation advisory committee. Public health representation on active transportation bodies across US municipalities is low. Increasing the adoption of active transportation advisory committees and ensuring a designated public health representative on active transportation bodies may help promote the development of activity-friendly communities across the United States.
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Affiliation(s)
- John D. Omura
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christopher S. Kochtitzky
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | - Deborah A. Galuska
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | - Janet E. Fulton
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sagar Shah
- American Planning Association, Washington, DC
| | - Susan A. Carlson
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
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Liu Y, Carlson SA, Wheaton AG, Greenlund KJ, Croft JB. Sleep Disorder Symptoms Among Adults in 8 States and the District of Columbia, 2017. Prev Chronic Dis 2021; 18:E105. [PMID: 34968172 PMCID: PMC8718121 DOI: 10.5888/pcd18.210305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sleep disorder symptoms (trouble falling asleep or staying asleep, unintentionally falling asleep, snoring loudly, and episodes of having stopped breathing) among US adults (N = 59,108) from 8 states and the District of Columbia were analyzed by using data from the 2017 Behavioral Risk Factor Surveillance System. We conducted a multivariable logistic regression to assess the association between the 4 symptoms and sociodemographic characteristics, risk behaviors, and chronic conditions. The 4 symptoms were prevalent and more likely to be reported among adults with any chronic condition(s) than their counterparts without symptoms and among those who slept fewer than 7 hours compared with those who slept 7 to 9 hours.
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Affiliation(s)
- Yong Liu
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia.,4770 Buford Hwy, MS-107-6, Atlanta, GA 30341.
| | - Susan A Carlson
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anne G Wheaton
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kurt J Greenlund
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet B Croft
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Matthews CE, Carlson SA, Saint-Maurice PF, Patel S, Salerno E, Loftfield E, Troiano RP, Fulton JE, Sampson JN, Tribby C, Keadle S, Berrigan D. Sedentary Behavior in U.S. Adults: Fall 2019. Med Sci Sports Exerc 2021; 53:2512-2519. [PMID: 34310489 PMCID: PMC8595506 DOI: 10.1249/mss.0000000000002751] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Higher levels of sedentary behavior are associated with early mortality, but the distribution of sedentary time by classes of behavior and demographic groups is poorly described in U.S. adults. To quantify the amount and sources of sedentary time in U.S. adults, we conducted a nationwide survey using a novel validated self-administered previous-day recall method and compared these values with a commonly used sitting time question. METHODS Participants from the AmeriSpeak panel 20 to 75 yr of age (N = 2640) completed up to two activities completed over time in 24 h (ACT24) previous-day recalls. Recalls were conducted on randomly selected days in October and November 2019. Survey sample designs were applied to reflect the U.S. population. RESULTS Mean age was 45.3 yr, 51% were female, 67% non-Hispanic White, and 37% had a body mass index of ≥30 kg·m-2. U.S. adults reported a mean 9.5 h·d-1 of sedentary time (95% confidence interval = 9.4, 9.7 h·d-1), which was 34% more than reported using a common surveillance measure (P < 0.01). Most daily sedentary time was accumulated in the leisure and work life domains, with leisure accounting for 47% (4.3 h·d-1, 95% confidence interval = 4.2, 4.5 h·d-1) of the total sedentary time. Eighty-two percent of leisure time was spent sedentary, mainly watching television/videos or engaged in Internet/computer use. CONCLUSIONS U.S. adults appear to spend more time in sedentary behavior than previously thought, and the majority of this time is accumulated at work and in leisure time. Reducing sedentary screen time during leisure in favor of physically active could be an important intervention target in the effort to increase physical activity in U.S. adults.
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Affiliation(s)
- Charles E. Matthews
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Susan A. Carlson
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Pedro F. Saint-Maurice
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Shreya Patel
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Elizabeth Salerno
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Erikka Loftfield
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Richard P. Troiano
- Risk Factor Assessment Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Janet E. Fulton
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control, Atlanta, GA
| | - Joshua N. Sampson
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Calvin Tribby
- Department of Geography, University of Hong Kong, Hong Kong, China
| | - Sarah Keadle
- Department of Kinesiology, California Polytechnic State University, San Luis Obispo, CA
| | - David Berrigan
- Health Behaviors Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Carlson SA, Whitfield GP, Davis RT, Peterson EL, Fulton JE, Berrigan D. Associations between Perceptions and Measures of Weather and Walking, United States-2015. Int J Environ Res Public Health 2021; 18:8398. [PMID: 34444148 PMCID: PMC8392542 DOI: 10.3390/ijerph18168398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Weather can be a barrier to walking. Understanding how perceptions of weather as a barrier and measured temperature are associated with walking can inform monitoring and promotion strategies. The objective of this study is to examine the association between perceptions of weather as a barrier to walking and measured weather with the volume of leisure and transportation walking. METHODS The 2015 National Health Interview Survey (NHIS) assessed participation in and volume of walking (transportation, leisure) in the past week and frequency of reporting weather as a barrier to walking. Data were collected over the entire year. In 2019, we merged month-specific temperature data from the PRISM climate group with individual NHIS records. We examined associations using logistic (participation) and linear regression models (volume). RESULTS Participation in walking increased as frequency of reporting weather as a barrier to walking decreased, from 'almost always' (transportation: 23%, leisure: 42%) to 'a little of the time' (transportation: 40%, leisure: 67%). Among adults reporting walking, walking volume increased as frequency of reporting weather as a barrier decreased from 'almost always' (transportation: 51 min/week, leisure: 64 min/week) to 'never' (transportation: 69 min/week, leisure: 98 min/week). Month-specific temperature was significantly associated with leisure walking with lower participation at the lowest and highest temperature quintiles, although the strength of the association differed by frequency of reporting weather as a barrier. CONCLUSIONS In general, prevalence and volume of leisure and transportation walking decreased as the perception of weather as a barrier increased. Low and high temperature conditions were also associated with leisure walking participation, particularly among adults with increased perceptions of weather as a barrier. Our findings highlight the importance of including strategies to help adults overcome perceived and actual weather-related barriers in walking promotion efforts.
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Affiliation(s)
- Susan A. Carlson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (S.A.C.); (G.P.W.); (E.L.P.); (J.E.F.)
| | - Geoffrey P. Whitfield
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (S.A.C.); (G.P.W.); (E.L.P.); (J.E.F.)
| | - Ryan T. Davis
- Geospatial Research, Analysis, and Services Program, Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry, Atlanta, GA 30341, USA;
| | - Erin L. Peterson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (S.A.C.); (G.P.W.); (E.L.P.); (J.E.F.)
| | - Janet E. Fulton
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (S.A.C.); (G.P.W.); (E.L.P.); (J.E.F.)
| | - David Berrigan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA
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Omura JD, Whitfield GP, Chen TJ, Hyde ET, Ussery EN, Watson KB, Carlson SA. Surveillance of Physical Activity and Sedentary Behavior Among Youth and Adults in the United States: History and Opportunities. J Phys Act Health 2021; 18:S6-S24. [PMID: 34465651 PMCID: PMC11008739 DOI: 10.1123/jpah.2021-0179] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Surveillance is a core function of public health, and approaches to national surveillance of physical activity and sedentary behavior have evolved over the past 2 decades. The purpose of this paper is to provide an overview of surveillance of physical activity and sedentary behavior in the United States over the past 2 decades, along with related challenges and emerging opportunities. METHODS The authors reviewed key national surveillance systems for the assessment of physical activity and sedentary behavior among youth and adults in the United States between 2000 and 2019. RESULTS Over the past 20 years, 8 surveillance systems have assessed physical activity, and 5 of those have assessed sedentary behavior. Three of the 8 originated in nonpublic health agencies. Most systems have assessed physical activity and sedentary behavior via surveys. However, survey questions varied over time within and also across systems, resulting in a wide array of available data. CONCLUSION The evolving nature of physical activity surveillance in the United States has resulted in both broad challenges (eg, balancing content with survey space; providing data at the national, state, and local level; adapting traditional physical activity measures and survey designs; and addressing variation across surveillance systems) and related opportunities.
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Affiliation(s)
- John D. Omura
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Geoffrey P. Whitfield
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tiffany J. Chen
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric T. Hyde
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily N. Ussery
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Susan A. Carlson
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Whitfield GP, Hyde ET, Carlson SA. Participation in Leisure-Time Aerobic Physical Activity Among Adults, National Health Interview Survey, 1998-2018. J Phys Act Health 2021; 18:S25-S36. [PMID: 34465654 PMCID: PMC10886427 DOI: 10.1123/jpah.2021-0014] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adults should perform ≥150 minutes per week of moderate-intensity equivalent physical activity for substantial health benefits and >300 minutes per week for additional benefits. The authors analyzed 21 years of National Health Interview Survey data to better understand trends in aerobic physical activity participation among US adults. METHODS The authors estimated the annual prevalence (1998-2018) of self-reported leisure-time physical inactivity, insufficient activity, meeting only the minimal aerobic guideline, and meeting the high aerobic guideline overall and by selected characteristics. Prevalence differences between 1998 and 2018 were compared across subgroups and periods of significant change were identified using JoinPoint regression. RESULTS The prevalence of inactivity decreased from 40.5% (1998) to 25.6% (2018) while the prevalence of meeting the high aerobic guideline increased from 26.0% to 37.4%. Increases in meeting the high guideline were similar across age groups, racial/ethnic groups, levels of education, and Census regions. Increases in insufficient activity and meeting the minimal guideline were statistically significant but of relatively small magnitude. CONCLUSIONS The prevalence of inactivity decreased and meeting the high aerobic guideline increased overall and for all subgroups from 1998 to 2018. Physical activity promotion strategies may aim to continue these trends while also narrowing persistent disparities in participation across subgroups.
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Hyde ET, Whitfield GP, Omura JD, Fulton JE, Carlson SA. Trends in Meeting the Physical Activity Guidelines: Muscle-Strengthening Alone and Combined With Aerobic Activity, United States, 1998-2018. J Phys Act Health 2021; 18:S37-S44. [PMID: 34465652 PMCID: PMC11000248 DOI: 10.1123/jpah.2021-0077] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The National Health Interview Survey is unique among US federal surveillance systems with over 20 years of consistent assessment of muscle-strengthening and aerobic activity. The authors examined trends in the prevalence of US adults who met the muscle-strengthening (2 or more days per week) and the combined muscle-strengthening and aerobic physical activity (at least 150 min/wk of moderate-intensity equivalent activity) guidelines from 1998 to 2018. METHODS The 1998-2018 National Health Interview Survey data were analyzed. Age-adjusted prevalence of meeting the muscle-strengthening and combined aerobic and muscle-strengthening guidelines by selected respondent characteristics were estimated for each year and linear and higher-order trends were assessed. RESULTS From 1998 to 2018, prevalence of meeting the muscle-strengthening guideline increased from 17.7% to 27.6%, and meeting the combined aerobic and muscle-strengthening guidelines increased from 14.4% to 24.0%. All subgroups demonstrated significant increases in meeting both guideline measures over this period although trends varied across the 21 years; increasing trends were more commonly sustained in the second decade of monitoring. CONCLUSIONS Although increasing trends in prevalence of meeting the muscle-strengthening and combined guidelines are encouraging, current prevalence estimates remain low. Opportunities exist for the continued promotion of muscle-strengthening activity using evidence-based approaches.
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Ussery EN, Whitfield GP, Fulton JE, Galuska DA, Matthews CE, Katzmarzyk PT, Carlson SA. Trends in Self-Reported Sitting Time by Physical Activity Levels Among US Adults, NHANES 2007/2008-2017/2018. J Phys Act Health 2021; 18:S74-S83. [PMID: 34465647 PMCID: PMC8477754 DOI: 10.1123/jpah.2021-0221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/11/2021] [Accepted: 06/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND High levels of sedentary behavior and physical inactivity increase the risk of premature mortality and several chronic diseases. Monitoring national trends and correlates of sedentary behavior and physical inactivity can help identify patterns of risk in the population over time. METHODS The authors used self-reported data from the National Health and Nutrition Examination Surveys (2007/2008-2017/2018) to estimate trends in US adults' mean daily sitting time, overall, and stratified by levels of leisure-time and multidomain physical activity, and in the joint prevalence of high sitting time (>8 h/d) and physical inactivity. Trends were tested using orthogonal polynomial contrasts. RESULTS Overall, mean daily sitting time increased by 19 minutes from 2007/2008 (332 min/d) to 2017/2018 (351 min/d) (Plinear < .05; Pquadratic < .05). The highest point estimate occurred in 2013/2014 (426 min/d), with a decreasing trend observed after this point (Plinear < .05). Similar trends were observed across physical activity levels and domains, with one exception: an overall linear increase was not observed among sufficiently active adults. The mean daily sitting time was lowest among highly active adults compared with less active adults when using the multidomain physical activity measure. CONCLUSIONS Sitting time among adults increased over the study period but decreased in recent years.
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Chen TJ, Watson KB, Michael SL, Carlson SA. Sex-Stratified Trends in Meeting Physical Activity Guidelines, Participating in Sports, and Attending Physical Education Among US Adolescents, Youth Risk Behavior Survey 2009-2019. J Phys Act Health 2021; 18:S102-S113. [PMID: 34465644 PMCID: PMC10035360 DOI: 10.1123/jpah.2021-0263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/20/2021] [Accepted: 06/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND During the past decade, guidelines for youth aerobic and muscle-strengthening physical activity remained unchanged. Active People, Healthy NationSM highlighted school and youth strategies (eg, sports and physical education [PE]) to increase physical activity. Sex, grade, and race/ethnicity disparities exist. This study examines sex-specific trends and differences by grade and race/ethnicity for the prevalence of 5 youth physical activity behaviors from 2009 to 2019. METHODS The national Youth Risk Behavior Survey assesses adolescents (grades 9-12) meeting the aerobic, muscle-strengthening, and both guidelines (2011-2019) and sports participation and daily PE (2009-2019). Sex-stratified logistic regression assessed trends and 2009 or 2011-2019 differences by grade and racial/ethnic subgroups. RESULTS Decreases in meeting the aerobic, muscle-strengthening, and both guidelines were observed for nearly all male subgroups by grade and race/ethnicity, whereas female subgroups exhibited declines or no change to low prevalence. Sports and PE participation remained mostly constant; select subgroups showed decreases (ie, Hispanic males [sports]; Black males and ninth-grade females [PE]). CONCLUSIONS Past decade prevalence and patterns suggest that school-based and other strategies for all adolescents and tailored interventions for sex-specific subgroups may be needed to supplement sports and PE in promoting high school youth physical activity.
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Watson KB, Whitfield GP, Bricka S, Carlson SA. Purpose-Based Walking Trips by Duration, Distance, and Select Characteristics, 2017 National Household Travel Survey. J Phys Act Health 2021; 18:S86-S93. [PMID: 34465646 PMCID: PMC8743872 DOI: 10.1123/jpah.2021-0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/14/2021] [Accepted: 05/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND New or enhanced activity-friendly routes to everyday destinations is an evidence-based approach for increasing physical activity. Although national estimates for some infrastructure features surrounding where one lives and the types of nearby destinations are available, less is known about the places where individuals walk. METHODS A total of 5 types of walking trips (N = 54,034) were defined by whether they began or ended at home (home based [HB]) and trip purpose (HB work, HB shopping, HB social/recreation, HB other, and not HB trip) (2017 National Household Travel Survey). Differences and trends by subgroups in the proportion of each purpose-oriented trip were tested using pairwise comparisons and polynomial contrasts. RESULTS About 14% of U.S. adults reported ≥1 walking trip on a given day. About 64% of trips were HB trips. There were few differences in prevalence for each purpose by subgroup. For example, prevalence of trips that were not HB decreased significantly with increasing age and increased with increasing education and household income. CONCLUSIONS Given age-related and socioeconomic differences in walking trips by purpose, planners and other professionals may want to consider trip origin and destination purposes when prioritizing investments for the creation of activity-friendly routes to everyday destinations where people live, work, and play.
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Whitfield GP, Ussery EN, Saint-Maurice PF, Carlson SA. Trends in Aerobic Physical Activity Participation Across Multiple Domains Among US Adults, National Health and Nutrition Examination Survey 2007/2008 to 2017/2018. J Phys Act Health 2021; 18:S64-S73. [PMID: 34225255 PMCID: PMC10911582 DOI: 10.1123/jpah.2021-0173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/13/2021] [Accepted: 05/28/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Understanding how participation is changing across domains of physical activity is important for monitoring progress and informing promotion efforts. The authors examined changes in physical activity participation in the National Health and Nutrition Examination Survey 2007/2008 to 2017/2018. METHODS The prevalence of inactivity, insufficient activity, and meeting the aerobic physical activity guideline in multidomain physical activity and each domain (leisure time, occupational/household, and transportation) was estimated for each cycle and stratified by selected characteristics. The authors tested trends over time and overall changes (2017/2018 vs 2007/2008). RESULTS For multidomain physical activity, the prevalence of inactivity decreased linearly; meeting the aerobic guideline increased nonmonotonically, and the 2017/2018 prevalence (68.1%) was higher than 2007/2008 (64.1%). Similar findings were observed for adults aged ≥65 years, non-Hispanic Blacks, Hispanics, high school graduates, and adults with obesity. Domain-specific results varied, but decreasing trends in inactivity and increasing trends in meeting the guideline were consistently observed across subgroups for occupational/household activity. Meeting the guideline through transportation activity was rare. CONCLUSIONS Increases in meeting the guideline and decreases in inactivity in multidomain activity and selected domains are encouraging results, especially among subgroups historically reporting low activity participation. Activity promotion efforts are important to maintain progress, and the transportation domain may be an underutilized source of physical activity.
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Xu F, Carlson SA, Liu Y, Greenlund KJ. Prevalence of Inflammatory Bowel Disease Among Medicare Fee-For-Service Beneficiaries - United States, 2001-2018. MMWR Morb Mortal Wkly Rep 2021; 70:698-701. [PMID: 33983913 PMCID: PMC8118152 DOI: 10.15585/mmwr.mm7019a2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Fang Xu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Susan A Carlson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Omura JD, Watson KB, Loustalot F, Fulton JE, Carlson SA. Types of Physical Activity Recommended by Primary Care Providers for Patients at Risk for Cardiovascular Disease. Prev Chronic Dis 2021; 18:E43. [PMID: 33964123 PMCID: PMC8139457 DOI: 10.5888/pcd18.200545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Primary care providers (PCPs) are uniquely positioned to promote physical activity for cardiovascular health. We sought to determine the types of physical activity that PCPs most often recommend to patients at risk for cardiovascular disease (CVD) and how these recommendations vary by PCPs’ physical activity counseling practices. We examined the types of physical activity (walking, supervised exercise sessions, or other) PCPs most often suggested for CVD prevention among respondents to the 2018 DocStyles survey (N = 1,088). Most PCPs (80.0%) suggested walking to their patients at risk for CVD; however, PCPs who infrequently discussed physical activity with their patients at risk for CVD suggested walking less often than those who more frequently discussed physical activity. Walking is an easy and low-cost form of physical activity, and opportunities exist for certain PCPs to promote walking as part of their physical activity counseling practices for CVD prevention.
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Affiliation(s)
- John D Omura
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, MS S-107, Atlanta, GA 30341. E-mail:
| | - Kathleen B Watson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet E Fulton
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A Carlson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Xu F, Carlson SA, Wheaton AG, Greenlund KJ. COVID-19 Hospitalizations Among U.S. Medicare Beneficiaries With Inflammatory Bowel Disease, April 1 to July 31, 2020. Inflamm Bowel Dis 2021; 27:1166-1169. [PMID: 33904584 PMCID: PMC8135589 DOI: 10.1093/ibd/izab041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Fang Xu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Address correspondence to: Fang Xu, PhD, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop S107-6, Atlanta, GA 30341 ()
| | - Susan A Carlson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anne G Wheaton
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Coughlan D, Saint-Maurice PF, Carlson SA, Fulton J, Matthews CE. Leisure time physical activity throughout adulthood is associated with lower medicare costs: evidence from the linked NIH-AARP diet and health study cohort. BMJ Open Sport Exerc Med 2021; 7:e001038. [PMID: 33768963 PMCID: PMC7938970 DOI: 10.1136/bmjsem-2021-001038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 01/12/2023] Open
Abstract
Background There is limited information about the association between long-term leisure time physical activity (LTPA) participation and healthcare costs. The purpose of this study was to investigate the association between LTPA over adulthood with later life healthcare costs in the USA. Methods Using Medicare claims data (between 1999 and 2008) linked to the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study, we examined associations between nine trajectories of physical activity participation throughout adulthood with Medicare costs. Results Compared with adults who were consistently inactive from adolescence into middle age, average annual healthcare costs were significantly lower for maintainers, adults who maintained moderate (–US$1350 (95% CI: –US$2009 to –US$690) or −15.9% (95% CI: −23.6% to −8.1%)) or high physical activity levels (–US$1200 (95% CI: –US$1777 to –US$622) or −14.1% (95% CI: −20.9% to −7.3%)) and increasers, adults who increased physical activity levels in early adulthood (–US$1874 (95% CI: US$2691 to –US$1057) or −22.0% (95% CI: −31.6% to −12.4%)) or in middle age (–US$824 (95% CI: –US$1580 to –US$69 or −9.7% (95% CI −18.6% to −0.8%)). For the four trajectories where physical activity decreased, the only significant difference was for adults who increased physical activity levels during early adulthood with a decline in middle age (–US$861 (95% CI:–US$1678 to –US$45) or −10.1% (95% CI: −19.7% to −0.5%)). Conclusion Our analyses suggest the healthcare cost burden in later life could be reduced through promotion efforts supporting physical activity participation throughout adulthood.
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Affiliation(s)
- Diarmuid Coughlan
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Surveillance Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Pedro F Saint-Maurice
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Susan A Carlson
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet Fulton
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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Carlson SA, Ussery EN, Watson KB, Cornett KA, Fulton JE. Perceived Importance of Physical Activity and Walkable Neighborhoods Among US Adults, 2017. Prev Chronic Dis 2020; 17:E168. [PMID: 33416470 PMCID: PMC7787367 DOI: 10.5888/pcd17.200262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The importance of physical activity and community-level promotion strategies are well established, but little is known about adult perception of the importance of physical activity. In a nationwide sample of US adults, we examined self-reported importance of regular physical activity and the importance of living in walkable neighborhoods. About 55% of adults strongly agreed that regular physical activity is important, 40% strongly agreed that living in a walkable neighborhood is important, and 31% strongly agreed that both are important. Separately for each measure, estimates were lower among adults with lower education levels and who did not meet the aerobic physical activity guideline. Opportunities exist to improve the perception of the importance of physical activity and the importance of walkable neighborhoods.
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Affiliation(s)
- Susan A Carlson
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-77, Atlanta, GA 30341.
| | - Emily N Ussery
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen B Watson
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kelly A Cornett
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet E Fulton
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Omura JD, Brown DR, McGuire LC, Taylor CA, Fulton JE, Carlson SA. Cross-sectional association between physical activity level and subjective cognitive decline among US adults aged ≥45 years, 2015. Prev Med 2020; 141:106279. [PMID: 33035548 PMCID: PMC10941305 DOI: 10.1016/j.ypmed.2020.106279] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 11/17/2022]
Abstract
Subjective cognitive decline (SCD) is the self-reported experience of worsening or more frequent confusion or memory loss within the previous 12 months and can be one of the earliest symptoms of Alzheimer's disease. Regular physical activity can contribute to the primary, secondary, and tertiary prevention of cognitive decline. At the national level, prevalence estimates of SCD by physical activity level in the United States are currently unknown. The purpose of this study is to examine the prevalence of SCD and resulting functional limitations by physical activity level among US adults aged ≥45 years. Data from 33 states and the District of Columbia participating in the 2015 Behavioral Risk Factor Surveillance System (N = 128,925) were analyzed. We estimated the prevalence of SCD (a positive response to a question about worsening or more frequent confusion or memory loss within the previous 12 months) and resulting functional limitations overall and by self-reported physical activity level based on current guidelines (i.e., active, insufficiently active, and inactive). Odds ratios were estimated using logistic regression models adjusting for respondent characteristics. Overall, 11.3% of US adults aged ≥45 years reported SCD. Prevalence of SCD increased as physical activity level decreased (active: 8.8%; insufficiently active: 11.4%; inactive: 15.7%). Among those with SCD, the prevalence of functional limitations also increased as physical activity level decreased (active: 40.5%; insufficiently active: 50.0%; inactive: 57.4%). These differences largely remained after adjusting for respondent characteristics. Findings highlight the potential public health impact nationally of efforts to promote physical activity for cognitive health.
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Affiliation(s)
- John D Omura
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-5, Atlanta, GA 30341, USA.
| | - David R Brown
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-5, Atlanta, GA 30341, USA.
| | - Lisa C McGuire
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S106-7, Atlanta, GA 30341, USA.
| | - Christopher A Taylor
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S106-7, Atlanta, GA 30341, USA.
| | - Janet E Fulton
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-5, Atlanta, GA 30341, USA.
| | - Susan A Carlson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-5, Atlanta, GA 30341, USA; Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S106-7, Atlanta, GA 30341, USA.
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Hyde ET, Omura JD, Fulton JE, Lee SM, Piercy KL, Carlson SA. Disparities in Youth Sports Participation in the U.S., 2017-2018. Am J Prev Med 2020; 59:e207-e210. [PMID: 32741540 DOI: 10.1016/j.amepre.2020.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/20/2020] [Accepted: 05/13/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION In 2019, the National Youth Sports Strategy was released and called for regular analysis, interpretation, and dissemination of U.S. youth sports surveillance data. The purpose of this study is to provide the recent national estimates of U.S. youth aged 6-17 years who participate in sports and examine the differences in participation by demographic characteristics, overall and across age groups. METHODS Nationally representative data on parent-reported youth sports participation from the 2017-2018 National Survey of Children's Health (n=36,779) were analyzed in 2019. The prevalence and 95% CIs of youth sports participation were estimated by demographic characteristics, overall and by age group. Investigators assessed the significant (p<0.05) differences and trends in participation using pairwise t-tests and orthogonal polynomial contrasts and effect modification by age group using logistic regression models. RESULTS Overall, 57.7% (95% CI=56.6, 58.9) of U.S. youth participated in sports. Participation was highest among youth who were aged 10-13 years, male, and white, non-Hispanic and increased with increasing parent/caregiver education and household income (all p<0.05). Differences in participation by demographic characteristics were more pronounced among younger youth. For example, prevalence by household income level ranged from 32.7% to 79.9% among children aged 6-9 years and from 41.6% to 67.2% among youth aged 14-17 years. CONCLUSIONS Although nearly 6 in 10 U.S. youth participate in sports, substantial disparities exist, especially among younger children. Identifying and overcoming the barriers may help increase youth sports participation in the U.S.
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Affiliation(s)
- Eric T Hyde
- Oak Ridge Institute for Science and Education Research Participation Program, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - John D Omura
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet E Fulton
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah M Lee
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katrina L Piercy
- Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Rockville, Maryland
| | - Susan A Carlson
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
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Whitfield GP, Ussery EN, Carlson SA. Combining Data From Assessments of Leisure, Occupational, Household, and Transportation Physical Activity Among US Adults, NHANES 2011-2016. Prev Chronic Dis 2020; 17:E117. [PMID: 33006543 PMCID: PMC7553230 DOI: 10.5888/pcd17.200137] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Physical activity occurs in 4 domains (leisure, occupational, household, and transportation), but US surveillance often focuses on leisure-time only. We compared estimates of self-reported leisure-time physical activity and estimates of all-domain activity among adults in the National Health and Nutrition Examination Survey for 2011-2016. During the study period, 38.6% met the aerobic physical activity guideline in leisure-time, 58.5% in leisure-time and occupational/household activity, and 63.7% in all domains. Differences within most subgroups when using all domains were similar to differences when using leisure-time activity only, except that we observed no urban/rural differences in the multidomain assessment. Assessment of multiple domains of activity instead of leisure-time-only activity affects prevalence estimates to a greater extent than it affects subgroup differences.
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Affiliation(s)
- Geoffrey P Whitfield
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS S107-5, Atlanta, GA 30341.
| | - Emily N Ussery
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A Carlson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Whitfield GP, McKenzie B, Graff KA, Carlson SA. Monitoring State-Level Changes in Walking, Biking, and Taking Public Transit to Work - American Community Survey, 2006 and 2017. Prev Chronic Dis 2020; 17:E115. [PMID: 33006545 PMCID: PMC7553222 DOI: 10.5888/pcd17.200097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Active commuting to work is one way people can be physically active and can be influenced by state-level initiatives. The American Community Survey (ACS) is a potential data source to evaluate changes in active commuting at the state level, but state-level changes have not been well documented. We examined state-level changes in estimates of walking, biking, and taking transit to work (combined and separately) among employed persons between 2006 and 2017. Methods Data were from the ACS, a nationally representative annual household survey from the US Census Bureau. We estimated state-level prevalence of walking, bicycling, or taking transit to work (separately and in combination) in 2006 and 2017 and tested differences by year. Results The prevalence of active commuting to work varied widely among states (2017 range: 1.7% in Alabama and Mississippi to 35.0% in New York). Changes from 2006 to 2017 also varied, with 8 states exhibiting a significant increase (Massachusetts [2.7 percentage points], New York [2.2], Hawaii [1.6], Illinois [1.3], Washington [1.3], New Jersey [1.2], Virginia [0.9], and Michigan [0.4]), and 12 exhibiting a significant decrease (South Dakota [−1.9], Idaho [−1.3], New Hampshire [−1.3], Wisconsin [−1.1], Maryland [−1.0], Nevada [−0.9], Ohio [−0.8], Mississippi [−0.6], Texas [−0.6], Florida [−0.5], Georgia [−0.4], and Indiana [−0.4]). The contributions of walking, bicycling, and taking transit also varied by state. Conclusion Active commuting remains relatively rare across states. States pursuing initiatives to support active transportation may consider using ACS to monitor and evaluate changes in active commuting.
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Affiliation(s)
- Geoffrey P Whitfield
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-5, Atlanta, GA 30341.
| | - Brian McKenzie
- Journey to Work and Migration Statistics Branch, US Census Bureau, Washington, District of Columbia
| | - Kaitlin A Graff
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A Carlson
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Omura JD, Carlson SA, Brown DR, Hopkins DP, Kraus WE, Staffileno BA, Thomas RJ, Lobelo F, Fulton JE. Built Environment Approaches to Increase Physical Activity: A Science Advisory From the American Heart Association. Circulation 2020; 142:e160-e166. [PMID: 32787451 PMCID: PMC10959241 DOI: 10.1161/cir.0000000000000884] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Engaging in regular physical activity is one of the most important things people can do to improve their cardiovascular health; however, population levels of physical activity remain low in the United States. Effective population-based approaches implemented in communities can help increase physical activity among all Americans. Evidence suggests that built environment interventions offer one such approach. These interventions aim to create or modify community environmental characteristics to make physical activity easier or more accessible for all people in the places where they live. In 2016, the Community Preventive Services Task Force released a recommendation for built environment approaches to increase physical activity. This recommendation is based on a systematic review of 90 studies (search period, 1980-June 2014) conducted using methods outlined by the Guide to Community Preventive Services. The Community Preventive Services Task Force found sufficient evidence of effectiveness to recommend combined built environment strategies. Specifically, these strategies combine interventions to improve pedestrian or bicycle transportation systems with interventions to improve land use and environmental design. Components of transportation systems can include street pattern design and connectivity, pedestrian infrastructure, bicycle infrastructure, and public transit infrastructure and access. Components of land use and environmental design can include mixed land use, increased residential density, proximity to community or neighborhood destinations, and parks and recreational facility access. Implementing this Community Preventive Services Task Force recommendation in communities across the United States can help promote healthy and active living, increase physical activity, and ultimately improve cardiovascular health.
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Watson KB, Whitfield GP, Thomas JV, Berrigan D, Fulton JE, Carlson SA. Associations between the National Walkability Index and walking among US Adults - National Health Interview Survey, 2015. Prev Med 2020; 137:106122. [PMID: 32389677 PMCID: PMC8544176 DOI: 10.1016/j.ypmed.2020.106122] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
The Environmental Protection Agency created the National Walkability Index (Index) to compare and analyze walkability among US communities. Index elements include design, distance to transit, and diversity of land uses. Associations between the Index and walking behavior have not been examined. This study describes associations between the Index and transportation and leisure walking among US adults. Past week self-reported participation in transportation and leisure walking among adults (n = 33,672) was obtained from the 2015 Cancer Control Supplement of the National Health Interview Survey (NHIS) and analysis completed in 2019. Index scores were linked to NHIS data based on the respondent's residence and classified into least, below average, above average, and most walkable communities. Associations between Index categories and walking were examined with regression models. Overall, the Index was associated with a higher likelihood of walking, especially for transportation. Transportation walking was more common in areas with higher walkability (21.6%-51.6%, least to most walkable). Leisure walking was also more common with greater walkability (48.4%-56.5%, least to most walkable). Transportation and leisure walking by Index categories in urban areas were similar to the overall population; however, it was not associated with walking in rural areas. US adults living in more walkable areas report more transportation and leisure walking, especially among urban areas. Consistent with elements in the Index, associations were stronger for transportation than leisure walking. Findings support the use of the Walkability Index by researchers, professionals, and other relevant stakeholders as a viable indicator of walkability.
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Affiliation(s)
- Kathleen B Watson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
| | - Geoffrey P Whitfield
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - John V Thomas
- Community Assistance and Research Division, Office of Community Revitalization, US Environmental Protection Agency, United States of America
| | - David Berrigan
- Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, MD, United States of America
| | - Janet E Fulton
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Susan A Carlson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Ussery EN, Hyde ET, Bombard JM, Juhl AL, Kim SY, Carlson SA. Physical Activity Before and During Pregnancy, Colorado Pregnancy Risk Assessment Monitoring System, 2012-2015. Prev Chronic Dis 2020; 17:E55. [PMID: 32644923 PMCID: PMC7367063 DOI: 10.5888/pcd17.190366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We used 2012-2015 data from the Colorado Pregnancy Risk Assessment Monitoring System to describe changes in self-reported physical activity (PA) before and during pregnancy and used logistic regression to examine factors associated with regular PA. The prevalence of regular PA (ie, 30 or more minutes per day on 5 or more days per week) was 19.1% before pregnancy and decreased to 10.2% during pregnancy. At both times, adjusted odds of regular PA were lower among women who were overweight or had obesity before pregnancy than among those with normal weight. Findings suggest that most women with a recent live birth in Colorado, particularly those who are overweight or have obesity, are not obtaining many health benefits of PA either before or during pregnancy.
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Affiliation(s)
- Emily N Ussery
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-77, Atlanta, Georgia 30341.
| | - Eric T Hyde
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer M Bombard
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ashley L Juhl
- Health Statistics and Evaluation Branch, Center for Health and Environmental Data, Colorado Department of Public Health and Environment, Denver, Colorado
| | - Shin Y Kim
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A Carlson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Hyde ET, Omura JD, Fulton JE, Lee SM, Piercy KL, Carlson SA. Youth Sports Participation In The United States, 2016-2017. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000680592.79201.4c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Paluch AE, Carnethon MR, Janet FE, Carlson SA, Lewis CE, Schreiner PJ, Sidney S, Sternfeld B, Whitaker KM, Siddique J, Gabriel KP. Association Of Steps Per Day With Premature Mortality: RESULTS From The Cardia Study. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000679972.94677.a5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Chen TJ, Watson KB, Michael SL, Fulton JE, Carlson SA. National Monitoring Of Youth Physical Activity With Two Surveillance Systems: Healthy People 2030. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000680596.15771.cd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hall KS, Hyde ET, Bassett DR, Carlson SA, Carnethon MR, Ekelund U, Evenson KR, Galuska DA, Kraus WE, Lee IM, Matthews CE, Omura JD, Paluch AE, Thomas WI, Fulton JE. Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia. Int J Behav Nutr Phys Act 2020; 17:78. [PMID: 32563261 PMCID: PMC7305604 DOI: 10.1186/s12966-020-00978-9] [Citation(s) in RCA: 156] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/28/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Daily step counts is an intuitive metric that has demonstrated success in motivating physical activity in adults and may hold potential for future public health physical activity recommendations. This review seeks to clarify the pattern of the associations between daily steps and subsequent all-cause mortality, cardiovascular disease (CVD) morbidity and mortality, and dysglycemia, as well as the number of daily steps needed for health outcomes. METHODS A systematic review was conducted to identify prospective studies assessing daily step count measured by pedometer or accelerometer and their associations with all-cause mortality, CVD morbidity or mortality, and dysglycemia (dysglycemia or diabetes incidence, insulin sensitivity, fasting glucose, HbA1c). The search was performed across the Medline, Embase, CINAHL, and the Cochrane Library databases from inception to August 1, 2019. Eligibility criteria included longitudinal design with health outcomes assessed at baseline and subsequent timepoints; defining steps per day as the exposure; reporting all-cause mortality, CVD morbidity or mortality, and/or dysglycemia outcomes; adults ≥18 years old; and non-patient populations. RESULTS Seventeen prospective studies involving over 30,000 adults were identified. Five studies reported on all-cause mortality (follow-up time 4-10 years), four on cardiovascular risk or events (6 months to 6 years), and eight on dysglycemia outcomes (3 months to 5 years). For each 1000 daily step count increase at baseline, risk reductions in all-cause mortality (6-36%) and CVD (5-21%) at follow-up were estimated across a subsample of included studies. There was no evidence of significant interaction by age, sex, health conditions or behaviors (e.g., alcohol use, smoking status, diet) among studies that tested for interactions. Studies examining dysglycemia outcomes report inconsistent findings, partially due to heterogeneity across studies of glycemia-related biomarker outcomes, analytic approaches, and sample characteristics. CONCLUSIONS Evidence from longitudinal data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and CVD morbidity and mortality in adults, and that health benefits are present below 10,000 steps per day. However, the shape of the dose-response relation is not yet clear. Data are currently lacking to identify a specific minimum threshold of daily step counts needed to obtain overall health benefit.
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Affiliation(s)
- Katherine S. Hall
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC USA
- Claude D. Pepper Older Americans Independence Center, Duke Aging Center, and the Department of Medicine, Duke University, Durham, NC USA
| | - Eric T. Hyde
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - David R. Bassett
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, TN USA
| | - Susan A. Carlson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway and Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, Chapel Hill, NC USA
| | - Deborah A. Galuska
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - William E. Kraus
- Claude D. Pepper Older Americans Independence Center, Duke Aging Center, and the Department of Medicine, Duke University, Durham, NC USA
| | - I-Min Lee
- Brigham and Women’s Hospital, Harvard Medical School; Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Charles E. Matthews
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD USA
| | - John D. Omura
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Amanda E. Paluch
- Department of Kinesiology, Institute for Applied Life Sciences, University of Massachusetts, Amherst, MA USA
| | - William I. Thomas
- Office of Library Science, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Janet E. Fulton
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
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Omura JD, Hyde ET, Whitfield GP, Hollis ND, Fulton JE, Carlson SA. Differences in perceived neighborhood environmental supports and barriers for walking between US adults with and without a disability. Prev Med 2020; 134:106065. [PMID: 32194096 PMCID: PMC10962532 DOI: 10.1016/j.ypmed.2020.106065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/13/2020] [Accepted: 03/14/2020] [Indexed: 11/25/2022]
Abstract
People with disabilities are at increased risk of chronic diseases, many of which physical activity can help prevent and manage. Certain environmental features can support or hinder participation in important activities like walking, particularly for people with disabilities. The purpose of this study is to examine differences in the prevalence of perceived neighborhood environmental supports and barriers for walking, by disability status, among US adults. Participants in the 2015 National Health Interview Survey Cancer Control Supplement (N = 15,280) reported their disability status (mobility disability, non-mobility disability, or no disability) and perceptions of neighborhood environmental supports (walkable roads, sidewalks, paths, trails; sidewalks on most streets; and walkable shops; transit; movies, libraries, churches; relaxing places) and barriers (traffic, crime, animals) for walking. Adjusted models conducted in 2019 included demographic characteristics. Prevalence of most supports was lower among adults with mobility or non-mobility disabilities versus no disability. For example, 54.9% and 57.5% of adults with mobility and non-mobility disabilities respectively reported sidewalks on most streets, compared to 64.1% of adults with no disability. After adjustment, significant differences remained when comparing adults with a mobility disability versus no disability for two supports (roads, sidewalks, paths, trails; relaxing places). All perceived barriers were significantly more common among adults with any disability versus no disability, regardless of adjustment. In the United States, adults with disabilities perceive fewer neighborhood environmental supports and more barriers for walking than their counterparts. Strategies that increase supports and address barriers for walking may help promote physical activity among adults with disabilities.
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Affiliation(s)
- John D Omura
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Bufford Highway NE, MS S107-5, Atlanta, GA 30341, USA.
| | - Eric T Hyde
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Bufford Highway NE, MS S107-5, Atlanta, GA 30341, USA.
| | - Geoffrey P Whitfield
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Bufford Highway NE, MS S107-5, Atlanta, GA 30341, USA.
| | - NaTasha D Hollis
- Division of Human Development and Disability, National Center For Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Bufford Highway NE, MS E-88, Atlanta, GA 30341, USA.
| | - Janet E Fulton
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Bufford Highway NE, MS S107-5, Atlanta, GA 30341, USA.
| | - Susan A Carlson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Bufford Highway NE, MS S107-5, Atlanta, GA 30341, USA.
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Saint-Maurice PF, Troiano RP, Bassett DR, Graubard BI, Carlson SA, Shiroma EJ, Fulton JE, Matthews CE. Association of Daily Step Count and Step Intensity With Mortality Among US Adults. JAMA 2020; 323:1151-1160. [PMID: 32207799 PMCID: PMC7093766 DOI: 10.1001/jama.2020.1382] [Citation(s) in RCA: 299] [Impact Index Per Article: 74.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE It is unclear whether the number of steps per day and the intensity of stepping are associated with lower mortality. OBJECTIVE Describe the dose-response relationship between step count and intensity and mortality. DESIGN, SETTING, AND PARTICIPANTS Representative sample of US adults aged at least 40 years in the National Health and Nutrition Examination Survey who wore an accelerometer for up to 7 days ( from 2003-2006). Mortality was ascertained through December 2015. EXPOSURES Accelerometer-measured number of steps per day and 3 step intensity measures (extended bout cadence, peak 30-minute cadence, and peak 1-minute cadence [steps/min]). Accelerometer data were based on measurements obtained during a 7-day period at baseline. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular disease (CVD) and cancer mortality. Hazard ratios (HRs), mortality rates, and 95% CIs were estimated using cubic splines and quartile classifications adjusting for age; sex; race/ethnicity; education; diet; smoking status; body mass index; self-reported health; mobility limitations; and diagnoses of diabetes, stroke, heart disease, heart failure, cancer, chronic bronchitis, and emphysema. RESULTS A total of 4840 participants (mean age, 56.8 years; 2435 [54%] women; 1732 [36%] individuals with obesity) wore accelerometers for a mean of 5.7 days for a mean of 14.4 hours per day. The mean number of steps per day was 9124. There were 1165 deaths over a mean 10.1 years of follow-up, including 406 CVD and 283 cancer deaths. The unadjusted incidence density for all-cause mortality was 76.7 per 1000 person-years (419 deaths) for the 655 individuals who took less than 4000 steps per day; 21.4 per 1000 person-years (488 deaths) for the 1727 individuals who took 4000 to 7999 steps per day; 6.9 per 1000 person-years (176 deaths) for the 1539 individuals who took 8000 to 11 999 steps per day; and 4.8 per 1000 person-years (82 deaths) for the 919 individuals who took at least 12 000 steps per day. Compared with taking 4000 steps per day, taking 8000 steps per day was associated with significantly lower all-cause mortality (HR, 0.49 [95% CI, 0.44-0.55]), as was taking 12 000 steps per day (HR, 0.35 [95% CI, 0.28-0.45]). Unadjusted incidence density for all-cause mortality by peak 30 cadence was 32.9 per 1000 person-years (406 deaths) for the 1080 individuals who took 18.5 to 56.0 steps per minute; 12.6 per 1000 person-years (207 deaths) for the 1153 individuals who took 56.1 to 69.2 steps per minute; 6.8 per 1000 person-years (124 deaths) for the 1074 individuals who took 69.3 to 82.8 steps per minute; and 5.3 per 1000 person-years (108 deaths) for the 1037 individuals who took 82.9 to 149.5 steps per minute. Greater step intensity was not significantly associated with lower mortality after adjustment for total steps per day (eg, highest vs lowest quartile of peak 30 cadence: HR, 0.90 [95% CI, 0.65-1.27]; P value for trend = .34). CONCLUSIONS AND RELEVANCE Based on a representative sample of US adults, a greater number of daily steps was significantly associated with lower all-cause mortality. There was no significant association between step intensity and mortality after adjusting for total steps per day.
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Affiliation(s)
- Pedro F. Saint-Maurice
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Richard P. Troiano
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - David R. Bassett
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville
| | - Barry I. Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Susan A. Carlson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric J. Shiroma
- Epidemiology and Population Science Laboratory, National Institute on Aging, Bethesda, Maryland
| | - Janet E. Fulton
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charles E. Matthews
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Abstract
The updated Physical Activity Guidelines for Americans (2nd edition) removes the requirement that physical activity should occur in bouts lasting 10 minutes or more to count toward the minimum aerobic guideline. Using self-reported data from the 2017 Behavioral Risk Factor Surveillance System (N = 386,960), we examined differences in national physical activity estimates with and without this requirement. Overall, 1.9% of adults reported activities in short bouts (<10 minutes). When excluding short bouts, 29.9% were inactive, 20.7% were insufficiently active, and 49.4% were active. When including short bouts, 29.1% were inactive, 21.4% were insufficiently active, and 49.5% were active. Eliminating the 10-minute-bout requirement had little effect on physical activity estimates.
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Affiliation(s)
- Emily N Ussery
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F77, Atlanta, GA 30341.
| | - Kathleen B Watson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A Carlson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Hyde ET, Omura JD, Fulton JE, Weldy A, Carlson SA. Physical Activity Surveillance Using Wearable Activity Monitors: Are US Adults Willing to Share Their Data? Am J Health Promot 2020; 34:672-676. [PMID: 31957481 DOI: 10.1177/0890117119900587] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Wearable activity monitors (wearables) have generated interest for national physical activity (PA) surveillance; however, concerns exist related to estimates obtained from current users willing to share data. We examined how limiting data to current users who are willing to share data associated with PA estimates in a nationwide sample. DESIGN Cross-sectional web-based survey. SETTING US adults. SUBJECTS In total, 942 respondents. MEASURES The 2018 Government & Academic Omnibus Survey assessing current wearable use, willingness to share data with various people or organizations, and PA levels. ANALYSIS Estimated the prevalence of current wearable use; current users' willingness to share data with various people or organizations; and PA levels overall, among current users, and among current users willing to share their data. RESULTS Overall, 21.7% (95% confidence interval [CI]: 19.1-24.5) of US adults reported currently using a wearable. Among current users, willingness to share ranged from 40.1% with a public health agency to 76.3% with their health-care provider. Overall, 62.2% (95% CI: 58.9-65.3) of adults were physically active. These levels were similar between current users (75.0%, 95% CI: 68.3-80.7) and current users willing to share their data (75.3%, 95% CI: 67.9-81.5). CONCLUSION Our findings suggest that using data from wearable users may overestimate PA levels, although reported willingness to share the data may not compound this issue.
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Affiliation(s)
- Eric T Hyde
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John D Omura
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janet E Fulton
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andre Weldy
- FHI 360 Social Marketing and Communication, Washington, DC, USA
| | - Susan A Carlson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
PURPOSE Step It Up! The Surgeon General's Call to Action to Promote Walking and Walkable Communities (Call to Action) presents goals and supporting strategies to promote walking. We assessed the presence and prioritization of 4 community supports for walking related to the goals of the Call to Action from the perspective of US adults. DESIGN Cross-sectional web-based survey. SETTING US adults. PARTICIPANTS A total of 4043 respondents. MEASURES SummerStyles 2016 survey assessing the reported presence and prioritization of 4 community supports for walking. ANALYSIS Estimated prevalence of the presence of supports overall and by demographic characteristics, and prevalence and adjusted prevalence ratios of their prioritization. RESULTS The most commonly reported community supports for walking were access to walkable locations (46.5%) and safe streets (29.2%), followed by walking groups (12.9%) and promotional campaigns (9.6%). Access to walkable locations (60.0%) and safe streets (50.6%) were most often prioritized by respondents, followed by promotional campaigns (23.6%) and walking groups (18.8%). Many differences in prioritization by demographic characteristics remained significant after adjusting for presence and other demographic characteristics, such as increased prioritization of all supports with older age groups. CONCLUSIONS Presence and prioritization of community supports for walking varied widely by type of support and by demographic characteristics. Opportunities exist to improve access and public sentiment related to these supports to promote walking in the United States.
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Affiliation(s)
- Eric T Hyde
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John D Omura
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kathleen B Watson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janet E Fulton
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan A Carlson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Whitfield GP, Carlson SA, Ussery EN, Fulton JE, Galuska DA, Petersen R. Trends in Meeting Physical Activity Guidelines Among Urban and Rural Dwelling Adults - United States, 2008-2017. MMWR Morb Mortal Wkly Rep 2019; 68:513-518. [PMID: 31194722 PMCID: PMC6613551 DOI: 10.15585/mmwr.mm6823a1] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Geoffrey P Whitfield
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Susan A Carlson
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Emily N Ussery
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Janet E Fulton
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Deborah A Galuska
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Ruth Petersen
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Watson KB, Whitfield GP, Thomas JV, Berrigan D, Fulton JE, Carlson SA. Association between the National Walkability Index and Walking Among U.S. Adults. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561417.31401.c7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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