particularly whole grain cereals, and fresh fruits and vegetables. Conclusion: Regional differenc... more particularly whole grain cereals, and fresh fruits and vegetables. Conclusion: Regional differences were attributed to differences in lifestyle, occupation and a shift from traditional food habits. Our understanding of the CVD disparities across various geographic regions is key to our effort in planning relevant intervention programs. Public health efforts should focus on obesity, physical inactivity and unhealthy dietary practices. The success of these interventions depends on governmental commitment, multisectoral partnership and a consideration of the sociocultural norms of the target population.
Questionnaires on the frequency of consumption of foods are commonly used to measure dietary inta... more Questionnaires on the frequency of consumption of foods are commonly used to measure dietary intake in epidemiologic research. To reduce the burden on respondents, questionnaires are often shortened by combining inquiries on similar foods into a single question. The effect of this practice on the reporting of dietary intake has never been investigated, however. To address this issue, we used two food frequency questionnaires in a telephone survey designed to rank adult residents of Alabama by their intake of dietary fat. One questionnaire included 29 questions about separate high-fat foods, whereas the other grouped these same foods into 14 questions. Compared with the 443 respondents interviewed using the 29-item separated-foods questionnaire, the 465 respondents responding to the 14-item grouped-foods questionnaire reported lower average intakes of the foods. In addition, a substantially higher percentage of respondents to the grouped-foods questionnaire reported never consuming the foods.
Purpose: Although the beneficial effects of participation in regular physical activity (PA) are w... more Purpose: Although the beneficial effects of participation in regular physical activity (PA) are widely accepted, dose-response relationships between PA and health-related quality of life (HRQOL) remain unclear. Methods: We examined relationships between frequency, duration, and intensity of PA and HRQOL among 175,850 adults using data from the 2001 BRFSS. Logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (CI) adjusted for age, gender, race/ethnicity, education, smoking status, and body mass index. Results: The age-standardized prevalence (standard error) of 14 or more unhealthy (physical or mental) days during the previous 30 d was 28.4% (0.50) among physically inactive adults, 16.7% (0.27) among those with insufficient levels of PA, and 14.7% (0.22) among adults who met recommended levels. Overall, participation in no moderate PA (OR: 2.02; 95% CI: 1.85-2.21) was associated with an increased likelihood of having 14 or more unhealthy days. Also for moderate PA, participation every day of the week (5-6 d·wk Ϫ1 as referent) (OR: 1.35; 1.26 -1.46) was associated with an increased likelihood of 14 or more unhealthy days, as was participation for periods Ͻ 20 min (OR: 1.43; 95% CI: 1.30 -1.58) or Ն 90 min (OR: 1.22; 95% CI: 1.14 -1.31) per day (30 -59 min·d Ϫ1 as referent). Similar associations were observed for participation in vigorous PA. Conclusion: Persons achieving recommended levels of PA were more likely to report fewer unhealthy days compared with inactive and insufficiently active persons; however, participation in daily moderate or vigorous PA and participation in very short (Ͻ20 min·d Ϫ1 ) or extended (Ն90 min·d Ϫ1 ) periods of PA was associated with poorer HRQOL. Further research examining the relationship between the dose of PA and HRQOL as well as other health outcomes is needed.
Background: Studies suggest that moderate drinkers have lower cardiovascular disease (CVD) mortal... more Background: Studies suggest that moderate drinkers have lower cardiovascular disease (CVD) mortality than nondrinkers and heavy drinkers, but there have been no randomized trials on this topic. Although most observational studies control for major cardiac risk factors, CVD is independently associated with other factors that could explain the CVD benefits ascribed to moderate drinking.
Background-Serum cholesterol concentrations have decreased in the US population. Whether the decl... more Background-Serum cholesterol concentrations have decreased in the US population. Whether the decline continued during the 1990s is unknown. Methods and Results-We used data from 4148 men and women aged Ն20 years who had a total cholesterol determination or reported using cholesterol-lowering medications and who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2000 (this is a cross-sectional health examination survey of the US population), and we compared the results with data from 15 719 participants in NHANES III (1988 to 1994). For all adults, the age-adjusted mean total cholesterol concentration decreased from 5.31 mmol/L (205 mg/dL) in NHANES III to 5.27 mmol/L (203 mg/dL) in NHANES 1999 to 2000 (Pϭ0.159). The age-adjusted mean total cholesterol concentration decreased by 0.02 mmol/L (0.7 mg/dL) among men (Pϭ0.605) and 0.06 mmol/L (2.3 mg/dL) among women (Pϭ0.130). Significant decreases were observed among men aged Ն75 years, black men, and Mexican-American women. Among participants who had a total cholesterol concentration Ն5.2 mmol/L (200 mg/dL) or who reported using cholesterol-lowering medications, 69.5% reported having had their cholesterol checked, 35.0% were aware that they had hypercholesterolemia, 12.0% were on treatment, and 5.4% had a total cholesterol concentration Ͻ5.2 mmol/L (200 mg/dL) after age adjustment. Conclusions-The mean serum total cholesterol concentration of the adult US population in 1999 to 2000 has changed little since 1988 to 1994. The low percentage of adults with controlled blood cholesterol concentration suggests the need for a renewed commitment to the prevention, treatment, and control of hypercholesterolemia. (Circulation. 2003;107: 2185-2189.)
Background: It is well established that smoking has detrimental effects on physical health, but i... more Background: It is well established that smoking has detrimental effects on physical health, but its associations with health-related quality of life (HRQOL) and a variety of health behaviors have not been widely investigated in the U.S. population.
The latter half of the 20 th century has witnessed rapid advances in medicine. Concurrently, secu... more The latter half of the 20 th century has witnessed rapid advances in medicine. Concurrently, secular trends in lifestyle practices in our increasingly sedentary society have led to burgeoning rates of obesity, metabolic syndrome, and type 2 diabetes. The number of Americans with type 2 diabetes more than doubled between 1980 and 2004 and the prevalence increases with age. Potential causes of this growing epidemic include changes in dietary patterns, physical inactivity, and obesity but may also include as yet unidentified genetic and environmental determinants. In this regard, experimental data provide evidence for a direct link between obesity and subclinical inflammation and support the concept that the metabolic syndrome and type 2 diabetes are, at least in part, inflammatory conditions. Furthermore, elevated levels of inflammatory biomarkers are not only associated with the development of future diabetes but cardiovascular disease as well. These findings suggest that subclinical inflammation may be a contributing factor not only to the etiology of these metabolic disorders but also their cardiovascular complications.
We evaluated the use of a six-item telephone questionnaire to estimate fruit and vegetable intake... more We evaluated the use of a six-item telephone questionnaire to estimate fruit and vegetable intakes in five diverse populations. Researchers administered the telephone questionnaire to persons who had previously undergone more extensive dietary assessment. The study population included 553 middle-aged and older adults in Beaver Dam, WI; 252 middle-aged and older women throughout Wisconsin; 150 parents of school children in Augusta, GA; 73 low-income, Hispanic mothers in Chicago, IL; and 51 older adults in Arizona. Spearman correlation coefficients between total fruit and vegetable intakes measured by the brief telephone survey and by more extensive food frequency questionnaires were 0.47 (Augusta), 0.48 (Arizona), 0.56 (Wisconsin), and 0.57 (Beaver Dam). Correlations between intakes measured by the brief telephone survey and by multiple diet records or recalls were 0.29 (Arizona), 0.46 (Chicago), and 0.54 (Beaver Dam). With the exception of Arizona, mean daily fruit and vegetable intakes measured by the telephone survey were similar to intakes estimated by multiple diet records or recalls and lower than those estimated by extensive food frequency questionnaires. Although caution may be needed in interpreting dietary reports from some ethnic subgroups, this brief telephone questionnaire may be useful for surveillance of fruit and vegetable intake in the United States.
Background-Reducing health disparities remains a major public health challenge in the United Stat... more Background-Reducing health disparities remains a major public health challenge in the United States. Having timely access to current data on disparities is important for policy and program development. Accordingly, we assessed the current magnitude of disparities in cardiovascular disease (CVD) and its risk factors in the United States. Methods and Results-Using national surveys, we determined CVD and risk factor prevalence and indexes of morbidity, mortality, and overall quality of life in adults Ն18 years of age by race/ethnicity, sex, education level, socioeconomic status, and geographic location. Disparities were common in all risk factors examined. In men, the highest prevalence of obesity (29.2%) was found in Mexican Americans who had completed a high school education. Black women with or without a high school education had a high prevalence of obesity (47.3%). Hypertension prevalence was high among blacks (39.8%) regardless of sex or educational status. Hypercholesterolemia was high among white and Mexican American men and white women in both groups of educational status. Ischemic heart disease and stroke were inversely related to education, income, and poverty status. Hospitalization was greater in men for total heart disease and acute myocardial infarction but greater in women for congestive heart failure and stroke. Among Medicare enrollees, congestive heart failure hospitalization was higher in blacks, Hispanics, and American Indians/Alaska Natives than among whites, and stroke hospitalization was highest in blacks. Hospitalizations for congestive heart failure and stroke were highest in the southeastern United States. Life expectancy remains higher in women than men and higher in whites than blacks by Ϸ5 years. CVD mortality at all ages tended to be highest in blacks.
Objective: We examined the associations among physical activity, sedentary behavior, and metaboli... more Objective: We examined the associations among physical activity, sedentary behavior, and metabolic syndrome in a representative sample of U.S. adults.Research Methods and Procedures: A total of 1626 men and women ≥20 years old from National Health and Nutrition Examination Survey 1999 to 2000 who attended the morning examination were evaluated. The metabolic syndrome was defined by using the definition from the National Cholesterol Education Program.Results: In unadjusted analysis, participants who did not engage in any moderate or vigorous physical activity during leisure time had almost twice the odds of having metabolic syndrome [odds ratio (OR), 1.90; 95% confidence interval (CI), 1.22 to 2.97] as those who reportedly engaged in ≥150 min/wk of such activity. Adjustment for age, sex, race or ethnicity, educational status, smoking status, and alcohol use attenuated the OR (OR, 1.46; 95% CI, 0.87 to 2.45). Compared with participants who watched television or videos or used a computer <1 h/d outside of work, the adjusted ORs for having metabolic syndrome were 1.41 (95% CI 0.80 to 2.51) for 1 h/d, 1.37 (95% CI 0.85 to 2.20) for 2 h/d, 1.70 (95% CI 0.92 to 3.14) for 3 h/d, and 2.10 (95% CI 1.27 to 3.47) for ≥4 h/d. Additional adjustment for physical activity or sedentary behavior minimally affected the ORs.Discussion: Sedentary behavior is an important potential determinant of the prevalence of the syndrome. Efforts to lessen the amount of time that U.S. adults spend watching television or videos or using a computer, especially if coupled to increases in physical activity, could result in substantial decreases in the prevalence of metabolic syndrome.
Objective. This study aimed to examine the correfiable CHD risk factors in their populations to r... more Objective. This study aimed to examine the correfiable CHD risk factors in their populations to reduce spondence between seven established risk factors for CHD mortality. ᭧1998 American Health Foundation and Academic coronary heart disease (CHD) and CHD mortality Press among the states in the United States. An ecologic anal-Key Words: coronary heart disease; mortality; toysis relating CHD risk factor prevalences to CHD morbacco; obesity; physical activity. tality rates among 49 states was undertaken in 1991-1992.
LI, CHAOYANG, EARL S. FORD, LISA C. MCGUIRE, AND ALI H. MOKDAD. Increasing trends in waist circum... more LI, CHAOYANG, EARL S. FORD, LISA C. MCGUIRE, AND ALI H. MOKDAD. Increasing trends in waist circumference and abdominal obesity among U.S. adults. Obesity. 2007;15:216 -224. Objective: Some studies have shown that abdominal obesity may be a better predictor than overall obesity for disease risks and all-cause mortality. This study sought to examine the recent trends in waist circumference (WC) among adults in the United States. were analyzed to estimate the trends in the mean WC and the prevalence of abdominal obesity. Pooled t tests were used to test the differences in estimates between two time periods. Results: Between the periods of 1988 -1994 and 2003-2004, the age-adjusted mean WC increased from 96.0 cm to 100.4 cm among men (p Ͻ 0.001) and from 89.0 cm to 94.0 cm among women (p Ͻ 0.001); the age-adjusted prevalence of abdominal obesity increased from 29.5% to 42.4% among men (p Ͻ 0.001) and from 47.0% to 61.3% among women (p Ͻ 0.001). Between the periods of 1999 -2000 and 2003-2004, a significant increase occurred in mean WC only among men (from 99.0 cm to 100.4 cm; p ϭ 0.03) and in the prevalence of abdominal obesity among both men (from 37.0% to 42.2%; p ϭ 0.03) and women (from 55.3% to 61.3%; p ϭ 0.04). People with a BMI of 25 to 29 kg/m 2 had a greater relative increase in abdominal obesity. Discussion: The mean WC and the prevalence of abdominal obesity among U.S. adults have increased continuously during the past 15 years. Over one-half of U.S. adults had abdominal obesity in the period of 2003-2004.
Health information correlates of fruit and vegetable intake and of knowledge of the fruit and veg... more Health information correlates of fruit and vegetable intake and of knowledge of the fruit and vegetable recommendations were examined using bivariate and multivariate regressions with data from the 2007-2008 U.S. National Cancer Institute's Health Information National Trends Survey in the United States and in Puerto Rico. Residents from Puerto Rico had the lowest reported fruit and vegetable intake and the lowest knowledge of the recommended servings of fruits and vegetables to maintain good health, compared with U.S. Hispanics, non-Hispanic Whites, and Blacks. Sixty-seven percent of Puerto Rican residents and 62% of U.S. Hispanics reported never seeking information on health or medical topics. In multivariate analysis, those who never sought information on health or medical topics reported significantly lower fruit and vegetable intake (coefficient ¼ À0.24; 95% CI [À0.38, À0.09]), and were less likely to know the fruit and vegetable recommendations (OR ¼ 0.32; 95% CI [0.20, 0.52]), compared with those who obtained information from their health care providers. Health promotion initiatives in the United States and Puerto Rico have invested in mass media campaigns to increase consumption of and knowledge about fruit and vegetables, but populations with the lowest intake are less likely to seek information. Strategies must be multipronged to address institutional, economic, and behavioral constraints of populations who do not seek out health information from any sources.
FORD, EARL S., ALI H. MOKDAD, AND WAYNE H. GILES. Trends in waist circumference among U.S. adults... more FORD, EARL S., ALI H. MOKDAD, AND WAYNE H. GILES. Trends in waist circumference among U.S. adults. Obes Res. 2003;11:1223-1231. Objective: Waist circumference has been proposed as a measure of obesity or as an adjunct to other anthropometric measures to determine obesity. Our objective was to examine temporal trends in waist circumference among adults in the U.S. Results: The unadjusted waist circumference increased from 95.3 (age-adjusted, 96.0 cm) to 98.6 (age-adjusted, 98.9 cm) cm among men and from 88.7 (age-adjusted 88.9 cm) to 92.2 (age-adjusted 92.1 cm) cm among women. The percentiles from the two surveys suggest that much of the waist circumference distribution has shifted. Statistically significant increases occurred among all age groups and racial or ethnic groups except men 30 to 59 years old, women 40 to 59 and Ն70 years old, and women who were Mexican American or of "other" race or ethnicity. Discussion: These results demonstrate the rapid increase in obesity, especially abdominal obesity, among U.S. adults. Unless measures are taken to slow the increase in or reverse the course of the obesity epidemic, the burden of obesityassociated morbidity and mortality in the U.S. can be expected to increase substantially in future years.
Context Modifiable behavioral risk factors are leading causes of mortality in the United States. ... more Context Modifiable behavioral risk factors are leading causes of mortality in the United States. Quantifying these will provide insight into the effects of recent trends and the implications of missed prevention opportunities.
Jama-journal of The American Medical Association, 2004
Context Modifiable behavioral risk factors are leading causes of mortality in the United States. ... more Context Modifiable behavioral risk factors are leading causes of mortality in the United States. Quantifying these will provide insight into the effects of recent trends and the implications of missed prevention opportunities.
To examine the health-related behaviors of women physicians compared with those of other women of... more To examine the health-related behaviors of women physicians compared with those of other women of high and not high socioeconomic status and with national goals. We examined the results of a questionnaire-based survey of a stratified random sample, the Women Physicians&amp;amp;amp;amp;amp;amp;amp;amp;#39; Health Study, and a US telephone survey (Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention, Atlanta, Ga). We analyzed 3 samples of women aged 30 to 70 years: (1) respondents from the Women Physicians&amp;amp;amp;amp;amp;amp;amp;amp;#39; Health Study (n = 4501); (2) respondents from the Behavioral Risk Factor Surveillance System (n = 1316) of the highest socioeconomic status; and (3) all other respondents from the Behavioral Risk Factor Surveillance System (n = 35,361). Women physicians were more likely than other women of high socioeconomic status and even more likely than other women not to smoke. The few physicians (3.7%) who smoked reported consuming fewer cigarettes per day, and physicians who had stopped smoking reported quitting at a younger age than women in the general population. Women physicians were less likely to report abstaining from alcohol, but those who drank reported consuming less alcohol per episode than other women and were less likely to report binging on alcohol than women in the general population. Unlike women in the general population and even other women of high socioeconomic status, women physicians&amp;amp;amp;amp;amp;amp;amp;amp;#39; reported behaviors exceeded national goals for the year 2000 in all examined behaviors and screening habits. Women physicians report having generally good health habits even when compared with other socioeconomically advantaged women and report exceeding all examined national goals for personal screening practices and other personal health behaviors. Women physicians&amp;amp;amp;amp;amp;amp;amp;amp;#39; behaviors may provide useful standards for other women in the United States.
particularly whole grain cereals, and fresh fruits and vegetables. Conclusion: Regional differenc... more particularly whole grain cereals, and fresh fruits and vegetables. Conclusion: Regional differences were attributed to differences in lifestyle, occupation and a shift from traditional food habits. Our understanding of the CVD disparities across various geographic regions is key to our effort in planning relevant intervention programs. Public health efforts should focus on obesity, physical inactivity and unhealthy dietary practices. The success of these interventions depends on governmental commitment, multisectoral partnership and a consideration of the sociocultural norms of the target population.
Questionnaires on the frequency of consumption of foods are commonly used to measure dietary inta... more Questionnaires on the frequency of consumption of foods are commonly used to measure dietary intake in epidemiologic research. To reduce the burden on respondents, questionnaires are often shortened by combining inquiries on similar foods into a single question. The effect of this practice on the reporting of dietary intake has never been investigated, however. To address this issue, we used two food frequency questionnaires in a telephone survey designed to rank adult residents of Alabama by their intake of dietary fat. One questionnaire included 29 questions about separate high-fat foods, whereas the other grouped these same foods into 14 questions. Compared with the 443 respondents interviewed using the 29-item separated-foods questionnaire, the 465 respondents responding to the 14-item grouped-foods questionnaire reported lower average intakes of the foods. In addition, a substantially higher percentage of respondents to the grouped-foods questionnaire reported never consuming the foods.
Purpose: Although the beneficial effects of participation in regular physical activity (PA) are w... more Purpose: Although the beneficial effects of participation in regular physical activity (PA) are widely accepted, dose-response relationships between PA and health-related quality of life (HRQOL) remain unclear. Methods: We examined relationships between frequency, duration, and intensity of PA and HRQOL among 175,850 adults using data from the 2001 BRFSS. Logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (CI) adjusted for age, gender, race/ethnicity, education, smoking status, and body mass index. Results: The age-standardized prevalence (standard error) of 14 or more unhealthy (physical or mental) days during the previous 30 d was 28.4% (0.50) among physically inactive adults, 16.7% (0.27) among those with insufficient levels of PA, and 14.7% (0.22) among adults who met recommended levels. Overall, participation in no moderate PA (OR: 2.02; 95% CI: 1.85-2.21) was associated with an increased likelihood of having 14 or more unhealthy days. Also for moderate PA, participation every day of the week (5-6 d·wk Ϫ1 as referent) (OR: 1.35; 1.26 -1.46) was associated with an increased likelihood of 14 or more unhealthy days, as was participation for periods Ͻ 20 min (OR: 1.43; 95% CI: 1.30 -1.58) or Ն 90 min (OR: 1.22; 95% CI: 1.14 -1.31) per day (30 -59 min·d Ϫ1 as referent). Similar associations were observed for participation in vigorous PA. Conclusion: Persons achieving recommended levels of PA were more likely to report fewer unhealthy days compared with inactive and insufficiently active persons; however, participation in daily moderate or vigorous PA and participation in very short (Ͻ20 min·d Ϫ1 ) or extended (Ն90 min·d Ϫ1 ) periods of PA was associated with poorer HRQOL. Further research examining the relationship between the dose of PA and HRQOL as well as other health outcomes is needed.
Background: Studies suggest that moderate drinkers have lower cardiovascular disease (CVD) mortal... more Background: Studies suggest that moderate drinkers have lower cardiovascular disease (CVD) mortality than nondrinkers and heavy drinkers, but there have been no randomized trials on this topic. Although most observational studies control for major cardiac risk factors, CVD is independently associated with other factors that could explain the CVD benefits ascribed to moderate drinking.
Background-Serum cholesterol concentrations have decreased in the US population. Whether the decl... more Background-Serum cholesterol concentrations have decreased in the US population. Whether the decline continued during the 1990s is unknown. Methods and Results-We used data from 4148 men and women aged Ն20 years who had a total cholesterol determination or reported using cholesterol-lowering medications and who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2000 (this is a cross-sectional health examination survey of the US population), and we compared the results with data from 15 719 participants in NHANES III (1988 to 1994). For all adults, the age-adjusted mean total cholesterol concentration decreased from 5.31 mmol/L (205 mg/dL) in NHANES III to 5.27 mmol/L (203 mg/dL) in NHANES 1999 to 2000 (Pϭ0.159). The age-adjusted mean total cholesterol concentration decreased by 0.02 mmol/L (0.7 mg/dL) among men (Pϭ0.605) and 0.06 mmol/L (2.3 mg/dL) among women (Pϭ0.130). Significant decreases were observed among men aged Ն75 years, black men, and Mexican-American women. Among participants who had a total cholesterol concentration Ն5.2 mmol/L (200 mg/dL) or who reported using cholesterol-lowering medications, 69.5% reported having had their cholesterol checked, 35.0% were aware that they had hypercholesterolemia, 12.0% were on treatment, and 5.4% had a total cholesterol concentration Ͻ5.2 mmol/L (200 mg/dL) after age adjustment. Conclusions-The mean serum total cholesterol concentration of the adult US population in 1999 to 2000 has changed little since 1988 to 1994. The low percentage of adults with controlled blood cholesterol concentration suggests the need for a renewed commitment to the prevention, treatment, and control of hypercholesterolemia. (Circulation. 2003;107: 2185-2189.)
Background: It is well established that smoking has detrimental effects on physical health, but i... more Background: It is well established that smoking has detrimental effects on physical health, but its associations with health-related quality of life (HRQOL) and a variety of health behaviors have not been widely investigated in the U.S. population.
The latter half of the 20 th century has witnessed rapid advances in medicine. Concurrently, secu... more The latter half of the 20 th century has witnessed rapid advances in medicine. Concurrently, secular trends in lifestyle practices in our increasingly sedentary society have led to burgeoning rates of obesity, metabolic syndrome, and type 2 diabetes. The number of Americans with type 2 diabetes more than doubled between 1980 and 2004 and the prevalence increases with age. Potential causes of this growing epidemic include changes in dietary patterns, physical inactivity, and obesity but may also include as yet unidentified genetic and environmental determinants. In this regard, experimental data provide evidence for a direct link between obesity and subclinical inflammation and support the concept that the metabolic syndrome and type 2 diabetes are, at least in part, inflammatory conditions. Furthermore, elevated levels of inflammatory biomarkers are not only associated with the development of future diabetes but cardiovascular disease as well. These findings suggest that subclinical inflammation may be a contributing factor not only to the etiology of these metabolic disorders but also their cardiovascular complications.
We evaluated the use of a six-item telephone questionnaire to estimate fruit and vegetable intake... more We evaluated the use of a six-item telephone questionnaire to estimate fruit and vegetable intakes in five diverse populations. Researchers administered the telephone questionnaire to persons who had previously undergone more extensive dietary assessment. The study population included 553 middle-aged and older adults in Beaver Dam, WI; 252 middle-aged and older women throughout Wisconsin; 150 parents of school children in Augusta, GA; 73 low-income, Hispanic mothers in Chicago, IL; and 51 older adults in Arizona. Spearman correlation coefficients between total fruit and vegetable intakes measured by the brief telephone survey and by more extensive food frequency questionnaires were 0.47 (Augusta), 0.48 (Arizona), 0.56 (Wisconsin), and 0.57 (Beaver Dam). Correlations between intakes measured by the brief telephone survey and by multiple diet records or recalls were 0.29 (Arizona), 0.46 (Chicago), and 0.54 (Beaver Dam). With the exception of Arizona, mean daily fruit and vegetable intakes measured by the telephone survey were similar to intakes estimated by multiple diet records or recalls and lower than those estimated by extensive food frequency questionnaires. Although caution may be needed in interpreting dietary reports from some ethnic subgroups, this brief telephone questionnaire may be useful for surveillance of fruit and vegetable intake in the United States.
Background-Reducing health disparities remains a major public health challenge in the United Stat... more Background-Reducing health disparities remains a major public health challenge in the United States. Having timely access to current data on disparities is important for policy and program development. Accordingly, we assessed the current magnitude of disparities in cardiovascular disease (CVD) and its risk factors in the United States. Methods and Results-Using national surveys, we determined CVD and risk factor prevalence and indexes of morbidity, mortality, and overall quality of life in adults Ն18 years of age by race/ethnicity, sex, education level, socioeconomic status, and geographic location. Disparities were common in all risk factors examined. In men, the highest prevalence of obesity (29.2%) was found in Mexican Americans who had completed a high school education. Black women with or without a high school education had a high prevalence of obesity (47.3%). Hypertension prevalence was high among blacks (39.8%) regardless of sex or educational status. Hypercholesterolemia was high among white and Mexican American men and white women in both groups of educational status. Ischemic heart disease and stroke were inversely related to education, income, and poverty status. Hospitalization was greater in men for total heart disease and acute myocardial infarction but greater in women for congestive heart failure and stroke. Among Medicare enrollees, congestive heart failure hospitalization was higher in blacks, Hispanics, and American Indians/Alaska Natives than among whites, and stroke hospitalization was highest in blacks. Hospitalizations for congestive heart failure and stroke were highest in the southeastern United States. Life expectancy remains higher in women than men and higher in whites than blacks by Ϸ5 years. CVD mortality at all ages tended to be highest in blacks.
Objective: We examined the associations among physical activity, sedentary behavior, and metaboli... more Objective: We examined the associations among physical activity, sedentary behavior, and metabolic syndrome in a representative sample of U.S. adults.Research Methods and Procedures: A total of 1626 men and women ≥20 years old from National Health and Nutrition Examination Survey 1999 to 2000 who attended the morning examination were evaluated. The metabolic syndrome was defined by using the definition from the National Cholesterol Education Program.Results: In unadjusted analysis, participants who did not engage in any moderate or vigorous physical activity during leisure time had almost twice the odds of having metabolic syndrome [odds ratio (OR), 1.90; 95% confidence interval (CI), 1.22 to 2.97] as those who reportedly engaged in ≥150 min/wk of such activity. Adjustment for age, sex, race or ethnicity, educational status, smoking status, and alcohol use attenuated the OR (OR, 1.46; 95% CI, 0.87 to 2.45). Compared with participants who watched television or videos or used a computer <1 h/d outside of work, the adjusted ORs for having metabolic syndrome were 1.41 (95% CI 0.80 to 2.51) for 1 h/d, 1.37 (95% CI 0.85 to 2.20) for 2 h/d, 1.70 (95% CI 0.92 to 3.14) for 3 h/d, and 2.10 (95% CI 1.27 to 3.47) for ≥4 h/d. Additional adjustment for physical activity or sedentary behavior minimally affected the ORs.Discussion: Sedentary behavior is an important potential determinant of the prevalence of the syndrome. Efforts to lessen the amount of time that U.S. adults spend watching television or videos or using a computer, especially if coupled to increases in physical activity, could result in substantial decreases in the prevalence of metabolic syndrome.
Objective. This study aimed to examine the correfiable CHD risk factors in their populations to r... more Objective. This study aimed to examine the correfiable CHD risk factors in their populations to reduce spondence between seven established risk factors for CHD mortality. ᭧1998 American Health Foundation and Academic coronary heart disease (CHD) and CHD mortality Press among the states in the United States. An ecologic anal-Key Words: coronary heart disease; mortality; toysis relating CHD risk factor prevalences to CHD morbacco; obesity; physical activity. tality rates among 49 states was undertaken in 1991-1992.
LI, CHAOYANG, EARL S. FORD, LISA C. MCGUIRE, AND ALI H. MOKDAD. Increasing trends in waist circum... more LI, CHAOYANG, EARL S. FORD, LISA C. MCGUIRE, AND ALI H. MOKDAD. Increasing trends in waist circumference and abdominal obesity among U.S. adults. Obesity. 2007;15:216 -224. Objective: Some studies have shown that abdominal obesity may be a better predictor than overall obesity for disease risks and all-cause mortality. This study sought to examine the recent trends in waist circumference (WC) among adults in the United States. were analyzed to estimate the trends in the mean WC and the prevalence of abdominal obesity. Pooled t tests were used to test the differences in estimates between two time periods. Results: Between the periods of 1988 -1994 and 2003-2004, the age-adjusted mean WC increased from 96.0 cm to 100.4 cm among men (p Ͻ 0.001) and from 89.0 cm to 94.0 cm among women (p Ͻ 0.001); the age-adjusted prevalence of abdominal obesity increased from 29.5% to 42.4% among men (p Ͻ 0.001) and from 47.0% to 61.3% among women (p Ͻ 0.001). Between the periods of 1999 -2000 and 2003-2004, a significant increase occurred in mean WC only among men (from 99.0 cm to 100.4 cm; p ϭ 0.03) and in the prevalence of abdominal obesity among both men (from 37.0% to 42.2%; p ϭ 0.03) and women (from 55.3% to 61.3%; p ϭ 0.04). People with a BMI of 25 to 29 kg/m 2 had a greater relative increase in abdominal obesity. Discussion: The mean WC and the prevalence of abdominal obesity among U.S. adults have increased continuously during the past 15 years. Over one-half of U.S. adults had abdominal obesity in the period of 2003-2004.
Health information correlates of fruit and vegetable intake and of knowledge of the fruit and veg... more Health information correlates of fruit and vegetable intake and of knowledge of the fruit and vegetable recommendations were examined using bivariate and multivariate regressions with data from the 2007-2008 U.S. National Cancer Institute's Health Information National Trends Survey in the United States and in Puerto Rico. Residents from Puerto Rico had the lowest reported fruit and vegetable intake and the lowest knowledge of the recommended servings of fruits and vegetables to maintain good health, compared with U.S. Hispanics, non-Hispanic Whites, and Blacks. Sixty-seven percent of Puerto Rican residents and 62% of U.S. Hispanics reported never seeking information on health or medical topics. In multivariate analysis, those who never sought information on health or medical topics reported significantly lower fruit and vegetable intake (coefficient ¼ À0.24; 95% CI [À0.38, À0.09]), and were less likely to know the fruit and vegetable recommendations (OR ¼ 0.32; 95% CI [0.20, 0.52]), compared with those who obtained information from their health care providers. Health promotion initiatives in the United States and Puerto Rico have invested in mass media campaigns to increase consumption of and knowledge about fruit and vegetables, but populations with the lowest intake are less likely to seek information. Strategies must be multipronged to address institutional, economic, and behavioral constraints of populations who do not seek out health information from any sources.
FORD, EARL S., ALI H. MOKDAD, AND WAYNE H. GILES. Trends in waist circumference among U.S. adults... more FORD, EARL S., ALI H. MOKDAD, AND WAYNE H. GILES. Trends in waist circumference among U.S. adults. Obes Res. 2003;11:1223-1231. Objective: Waist circumference has been proposed as a measure of obesity or as an adjunct to other anthropometric measures to determine obesity. Our objective was to examine temporal trends in waist circumference among adults in the U.S. Results: The unadjusted waist circumference increased from 95.3 (age-adjusted, 96.0 cm) to 98.6 (age-adjusted, 98.9 cm) cm among men and from 88.7 (age-adjusted 88.9 cm) to 92.2 (age-adjusted 92.1 cm) cm among women. The percentiles from the two surveys suggest that much of the waist circumference distribution has shifted. Statistically significant increases occurred among all age groups and racial or ethnic groups except men 30 to 59 years old, women 40 to 59 and Ն70 years old, and women who were Mexican American or of "other" race or ethnicity. Discussion: These results demonstrate the rapid increase in obesity, especially abdominal obesity, among U.S. adults. Unless measures are taken to slow the increase in or reverse the course of the obesity epidemic, the burden of obesityassociated morbidity and mortality in the U.S. can be expected to increase substantially in future years.
Context Modifiable behavioral risk factors are leading causes of mortality in the United States. ... more Context Modifiable behavioral risk factors are leading causes of mortality in the United States. Quantifying these will provide insight into the effects of recent trends and the implications of missed prevention opportunities.
Jama-journal of The American Medical Association, 2004
Context Modifiable behavioral risk factors are leading causes of mortality in the United States. ... more Context Modifiable behavioral risk factors are leading causes of mortality in the United States. Quantifying these will provide insight into the effects of recent trends and the implications of missed prevention opportunities.
To examine the health-related behaviors of women physicians compared with those of other women of... more To examine the health-related behaviors of women physicians compared with those of other women of high and not high socioeconomic status and with national goals. We examined the results of a questionnaire-based survey of a stratified random sample, the Women Physicians&amp;amp;amp;amp;amp;amp;amp;amp;#39; Health Study, and a US telephone survey (Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention, Atlanta, Ga). We analyzed 3 samples of women aged 30 to 70 years: (1) respondents from the Women Physicians&amp;amp;amp;amp;amp;amp;amp;amp;#39; Health Study (n = 4501); (2) respondents from the Behavioral Risk Factor Surveillance System (n = 1316) of the highest socioeconomic status; and (3) all other respondents from the Behavioral Risk Factor Surveillance System (n = 35,361). Women physicians were more likely than other women of high socioeconomic status and even more likely than other women not to smoke. The few physicians (3.7%) who smoked reported consuming fewer cigarettes per day, and physicians who had stopped smoking reported quitting at a younger age than women in the general population. Women physicians were less likely to report abstaining from alcohol, but those who drank reported consuming less alcohol per episode than other women and were less likely to report binging on alcohol than women in the general population. Unlike women in the general population and even other women of high socioeconomic status, women physicians&amp;amp;amp;amp;amp;amp;amp;amp;#39; reported behaviors exceeded national goals for the year 2000 in all examined behaviors and screening habits. Women physicians report having generally good health habits even when compared with other socioeconomically advantaged women and report exceeding all examined national goals for personal screening practices and other personal health behaviors. Women physicians&amp;amp;amp;amp;amp;amp;amp;amp;#39; behaviors may provide useful standards for other women in the United States.
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