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Objectives. We sought to describe long-term adolescent and young adult smoking trends and patterns. Methods. We analyzed adolescent data from Monitoring the Future, 1976 to 2005, and young adult (aged 18-24 years) data from the National Health Interview Survey, 1974 to 2005, overall and in subpopulations to identify trends in current cigarette smoking prevalence. Results. Five metapatterns emerged: we found (1) a large increase and subsequent decrease in overall smoking over the past 15 years, (2) a steep decline in smoking among Blacks through the early 1990s, (3) a gender gap reversal among older adolescents and young adults who smoked over the past 15 years, (4) similar trends in smoking for most subgroups since the early 1990s, and (5) a large decline in smoking among young adults with less than a high school education. Conclusions. Long-term patterns for adolescent and young adult cigarette smoking were decidedly nonlinear, and we found evidence of a cohort effect among young adults. Continued strong efforts and a long-term societal commitment to tobacco use prevention are needed, given the unprecedented declines in smoking among most subpopulations since the mid- to late 1990s. (doi:10.2105/AJPH.2007.115931)

Objectives. We identified the mass media channels that reach the most cigarette smokers in an attempt to more effectively target smoking cessation messages. Methods. Reach estimates and index scores for smokers were taken from 2002-2003 ConsumerStyles and HealthStyles national surveys of adults (N = 11 660) to estimate overall and demographic-specific exposure measures for television, radio, newspapers, and magazines. Results. Smokers viewed more television, listened to more radio, and read fewer magazines and newspapers than did nonsmokers. Nearly one third of smokers were regular daytime or late-night television viewers. Selected cable television networks (USA, Lifetime, and Discovery Channel) and selected radio genres, such as classic rock and country, had high reach and were cost-efficient channels for targeting smokers. Conclusions. Certain mass media channels offer efficient opportunities to target smoking cessation messages so they reach relatively large audiences of smokers at relatively low cost. The approach used in this study can be applied to other types of health risk factors to improve health communication planning and increase efficiency of program media expenditures. (doi:10.2105/AJPH.2006.090340)

Objectives. Smokeless tobacco has many adverse health effects. We analyzed long-term national trends in smokeless tobacco use. Methods. We used 1987 to 2000 National Health Interview Survey data for adults aged 18 years and older, 1986 to 2003 data from Monitoring the Future surveys of adolescents, and 1991 to 2003 data from the Youth Risk Behavior Survey for 9th- to 12th-grade students to examine overall and demographic-specific trends. Results. Smokeless tobacco use among adult and adolescent females was low and showed little change. Smokeless tobacco use among men declined slowly (relative decline = 26%), with the largest declines among those aged 18 to 24 years or 65 years and older, Blacks, residents of the South, and persons in more rural areas. Overall and demographic-specific data for adolescent boys indicate that smokeless tobacco use increased for 12th-grade students from 1986 until the early 1990s, but has subsequently declined rapidly in all grades since then (range of relative overall declines = 43% to 48%). Conclusions. Smokeless tobacco use has declined sharply, especially among adolescent boys. Ongoing prevention and cessation efforts are needed to continue this trend.

Objectives. We analyzed state-specific uninsurance trends among US adults aged 18 to 64 years. Methods. We used logistic regression models to examine Behavioral Risk Factor Surveillance System data for uninsurance from 1992 to 2001 in 47 states. Results. Overall, uninsurance rates increased in 35 states and remained unchanged in 12 states. Increases were observed among people aged 30 to 49 years (in 34 states) and 50 to 64 years (in 24 states), and increases were also observed among individuals at middle and low income levels (in 39 states and 19 states, respectively), individuals employed for wages (in 33 states), and the self-employed (in 18 states). Conclusions. Among adults aged 18-64, rates of uninsurance increased in most states from 1992 through 2001. Decreased availability of employer-sponsored health insurance, rising health care costs, and state fiscal crises are likely to worsen the growing uninsurance problem.

Objectives. We estimated adult binge drinking prevalence in US metropolitan areas. Methods. We analyzed 1997 and 1999 Behavioral Risk Factor Surveillance System data for 120 metropolitan areas in 48 states and the District of Columbia. Results. The prevalence of binge drinking varied substantially across metropolitan areas, from 4.1% in Chattanooga, Tenn, to 23.9% in San Antonio, Tex, (median = 14.5%). Seventeen of the 20 metropolitan areas with the highest estimates were located in the upper Midwest, Texas, and Nevada. In 13 of these areas, at least one third of persons aged 18 to 34 years were binge drinkers. There were significant intrastate differences for binge drinking among metropolitan areas in New York, Tennessee, and Utah. Conclusions. Metropolitan-area estimates can be used to guide local efforts to reduce binge drinking. (Am J Public Health. 2004;94:663-671)

Objectives, The purpose of this study was to compare national estimates from the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS). Methods. The authors compared data from the 2 surveys on smoking, height, weight, body mass index, diabetes, hypertension, immunization, lack of insurance coverage, cost as a barrier to medical care. and health status. Results. Overall national estimates were similar for 13 of the 14 measures examined. Small differences according to demographic characteristics were found for height and body mass index, with larger differences for health status. Conclusions. Although estimates differed within subgroups, the BRFSS provided national estimates comparable to those of the NHIS. BRFSS national data could provide rapidly available information to guide national policy and program decisions.

Objectives. This study compared health behavior variables for all US households and households with telephones to measure the potential impact of telephone coverage on estimates from telephone surveys. Methods. Data were derived from the 1991 through 1994 versions of the National Health Interview Survey. Results. Ninety-five percent of respondents lived in households with telephones. Differences in health indicators were small ([is less than] 1%) in comparisons between all households and those with telephones. Results were similar when only respondents below the poverty level were included. Conclusions. Telephone noncoverage effects appear to be small, supporting the use of telephone surveys for health risk behavior surveillance with most population groups. (Am J Public Health. 1998;88:1392-1395)

Objectives. Variations among states in household exposure to firearms, loaded firearms, and handguns were examined. Methods. Data from the Behavioral Risk Factor Surveillance System in 22 states were used to estimate the prevalence of adults and children exposed to household firearms. Results. The prevalence of adults living in households with firearms ranged from 12% to 57%; the corresponding ranges were 1% to 23% for loaded firearms and 5% to 36% for handguns. The prevalence of children less than 18 years of age living in households with loaded firearms ranged from 2% to 12%. Conclusions. Important variations among states exist in the prevalence of adults and children living in households with firearms, loaded firearms, and handguns. (Am J Public Health. 1998;88:969-972)

Objectives. This study examined trends in safety belt use by age, sex, race/ethnicity, education, and type of safety belt law. Methods. We analyzed Behavioral Risk Factor Surveillance System data on safety belt use from 33 states for 1987 through 1993 and used linear regression models to determine trends in prevalence. Results. Asian/Pacific Islanders and Hispanics had the highest safety belt use among racial/ethnic groups. Prevalence varied little from age 25 through 64 years in all years, but averaged 25 percentage points higher in states with primary laws than in states with no belt laws. Overall safety belt use increased by an average of 2.7 [+ or -] 0.1 percentage points per year and varied little across most demographic groups, but there was no significant increase for Black males aged 18 through 29 years. Conclusions. The generally consistent increase in safety belt use across demographic groups is in sharp contrast to trends in other health-risk behaviors. States should enact primary safety belt laws and focus safety belt use efforts towards young Black males. (Am J Public Health. 1998;88:245-249)

Objectives. This study examined whether there are systematic differences between the Behavioral Risk Factor Surveillance System (BRFSS) and the Current Population Survey (CPS) for state cigarette smoking prevalence estimates. Methods. BRFSS telephone survey estimates were compared with estimates from the US Census CPS tobacco-use supplements (the CPS sample frame includes persons in households without telephones). Weighted overall and sex- and race-specific BRFSS and CPS state estimates of adult smoking were analyzed for 1985, 1989, and 1992/ 1993. Results. Overall estimates of smoking prevalence from the BRFSS were slightly lower than estimates from CPS (median difference: -2.0 percentage points in 1985, -0.7 in 1989, and - 1.9 in 1992/1993; P [is less than] .05 for all comparisons), but there was variation among states. Differences between BRFSS and CPS estimates were larger among men than among women and larger among Blacks than among Hispanics or Whites; for most states, these differences were not significant. Conclusions. The BRFSS generally provides state estimates of smoking prevalence similar to those obtained from CPS, and these are appropriate for ongoing state surveillance of smoking prevalence. (Am J Public Health. 1997;87: 1665-1669)

objectives. This study determined the validity of self-reported data on selected health insurance characteristics. Methods. We obtained telephone survey data on the presence of health insurance, source of insurance, length of time insured, and type of insurance (managed care or fee-for-service) from a random sample of 351 adults in 3 Wisconsin counties and compared findings with data from respondents' health insurers. Results. More than 97% of the respondents correctly reported that they were currently insured. For source of insurance among persons aged 18 to 64 years, sensitivity was high for those covered through private health insurance (93.8%) but low for those covered through public insurance (6.7%). Only 33.1% of the respondents accurately categorized length of enrollment in their current plan. Overall estimates for managed care enrollment were similar for the 2 sources, but individual validity was low: 84.2% of those in fee-for-service believed that they were in managed care. Conclusions. Information obtained from the general population about whether they have health insurance is valid, but self-reported data on source of insurance, length of time insured, and type of insurance are suspect and should be used cautiously. (Am J Public Health. 2000;90:924-928)

Objectives. The purpose of this study was to document and describe Behavioral Risk Factor Surveillance System (BRFSS) data use patterns, benefits, and barriers from 1993 to 1997. Methods. Data use information was gathered via a Medline database search and a telephone survey of BRFSS program directors (n = 54). Results. The database search uncovered 109 BRFSS-based reports. Program directors indicated that BRFSS data frequently were used to support health policies regarding diabetes, physical activity, and smoking. Frequent data use barriers included insufficient special population data, insufficient city- or county-specific data, and insufficient staff. Conclusions. Use of BRFSS data, which aid several state health activities, increased from 1993 to 1997. (Am J Public Health. 2000;90:774-776)

Objectives. This study examined trends in perceived cost as a barrier to medical care. Methods. The Behavioral Risk Factor Surveillance System was used to analyze monthly telephone survey data from 45 states. Results. Overall, the percentage of persons perceiving cost as a barrier to medical care increased from 1991 until early 1993 and then declined to baseline values in late 1996. Perceived cost was a greater barrier in 1996 than in 1991 for persons with low incomes and for those who were unemployed and uninsured. For self-employed persons, percentages increased until mid-1993 and then remained constant. Conclusions. Further efforts are needed to improve access to medical care for socially disadvantaged populations. (Am J Public Health. 1999;89: 1410-1413)