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Short-term effects of air pollution exposure on respiratory disease mortality are well established. However, few studies have examined the effects of long-term exposure, and among those that have, results are inconsistent.To evaluate long-term association between ambient ozone, fine particulate matter (PM2.5, particles with an aerodynamic diameter of 2.5 μm or less), and chronic lower respiratory disease (CLRD) mortality in the contiguous United States.We fit Bayesian hierarchical spatial Poisson models, adjusting for five county-level covariates (percentage of adults aged ≥65 years, poverty, lifetime smoking, obesity, and temperature), with random effects at state and county levels to account for spatial heterogeneity and spatial dependence.We derived county-level average daily concentration levels for ambient ozone and PM2.5 for 2001-2008 from the U.S. Environmental Protection Agency's down-scaled estimates and obtained 2007-2008 CLRD deaths from the National Center for Health Statistics. Exposure to ambient ozone was associated with an increased rate of CLRD deaths, with a rate ratio of 1.05 (95% credible interval, 1.01-1.09) per 5-ppb increase in ozone; the association between ambient PM2.5 and CLRD mortality was positive but statistically insignificant (rate ratio, 1.07; 95% credible interval, 0.99-1.14).This study links air pollution exposure data with CLRD mortality for all 3,109 contiguous U.S. counties. Ambient ozone may be associated with an increased rate of death from CLRD in the contiguous United States. Although we adjusted for selected county-level covariates and unobserved influences through Bayesian hierarchical spatial modeling, the possibility of ecologic bias remains.

Background There is a growing interest in using the 2010 U.S. Census data for age adjustment after the Census data are officially released. This report discusses the rationale, procedures, demonstrations, and caveats of age adjustment using the 2010 U.S. Census data. Methods Empirical data from the Behavioral Risk Factor Surveillance System and the 2010 U.S. Census age composition were used in demonstrations of computing the age-adjusted prevalence of diagnosed diabetes by race/ethnicity, across various geographic regions, and over time. Results The use of the 2010 U.S. Census data yielded higher age-adjusted prevalence of diagnosed diabetes than using the 2000 projected US population data. The differences persisted across geographic regions, among racial/ethnic groups, and over time. Sixteen age compositions were generated to facilitate the use of the 2010 Census data in age adjustment. The SAS survey procedures and SUDAAN software programs yielded similar age-adjusted prevalence estimates of diagnosed diabetes. Conclusions Using the 2010 U.S. Census data tends to yield a higher age-adjusted measure than using the 2000 projected U.S. population data. Consistent use of a standard population and age composition is recommended once they are chosen for age adjustment.

Background: The prevalence of chronic kidney disease as measured by biomarkers is increasing, but the recognition for this condition remains low in the USA. Little is known about the awareness of kidney disease at the state level. Methods: Data from 490,302 adults aged 18 years or older in all 50 states as well as the District of Columbia who participated in the 2011 Behavioral Risk Factor Surveillance System were analyzed. Kidney disease diagnosis, a measure of individual awareness, was ascertained by participants' self-report in the telephone survey. Prevalence ratios of self-reported kidney disease in subpopulations were estimated and tested using log-linear regression analyses with a robust variance estimator. Results: The unadjusted prevalence of self-reported kidney disease was estimated to be 2.5%. After adjustment for age and all other selected covariates, Hispanics had a higher prevalence than non-Hispanic whites (adjusted prevalence ratio 1.2, 95% CI 1.0-1.4). Persons who were unemployed (adjusted prevalence ratio 1.4, 95% CI 1.2-1.5) had a higher prevalence than those who were employed. Persons who had hypertension (adjusted prevalence ratio 1.9, 95% CI 1.7-2.1), diabetes (adjusted prevalence ratio 1.7, 95% CI 1.5-1.8), cardiovascular disease (coronary heart disease, myocardial infarction or stroke; adjusted prevalence ratio 1.5, 95% CI 1.4-1.6) or cancer (adjusted prevalence ratio 1.5, 95% CI 1.3-1.6) had a higher prevalence of self-reported kidney disease than those without these conditions. Conclusion: The overall awareness of kidney disease was low in the general population. Efforts are needed to promote the awareness and early detection of kidney disease in public health services and clinical practice.

Evidence suggests that high-risk lifestyle behaviors exacerbate the health of cancer survivors and increase cancer mortality. This study examined the prevalence of lifestyle-related risk factors among female breast cancer survivors by duration of survivorship in the United States.We analyzed data from 7,443 women aged ≥18 years who participated in the 2009 Behavioral Risk Factor Surveillance System and reported having ever-diagnosed breast cancer. Adjusted prevalence with 95 % confidence interval for lifestyle-related risk factors (including current smoking, excessive alcohol drinking, obesity, engaging in physical activity ≥150 min/week, and consuming fruits and vegetables ≥5 times/day) was estimated using log-linear regression while controlling for confounders.Overall, the prevalence estimates for lifestyle-related risk factors were 10.2 % for current smoking, 6.8 % for excessive alcohol drinking, 24.7 % for obesity, 53.8 % for engaging in physical activity ≥150 min/week, and 33.9 % for consuming fruits and vegetables ≥5 times/day among female breast cancer survivors. After adjustment for covariates, with increasing years of survivorship, a linearly increasing trend was observed for current smoking (P = 0.038), and quadratic trends were observed for excessive alcohol drinking (P 0.001) and obesity (P = 0.048). The adjusted prevalence estimates for engaging in physical activity ≥150 min/week and consuming fruits and vegetables ≥5 times/day did not vary significantly by duration of survivorship.Continuing efforts on counseling and encouraging breast cancer survivors to adopt healthy lifestyles are needed to improve their health.Understanding the trends of modifiable lifestyle-related risk factors among breast cancer survivors with varying duration of survivorship may assist health care providers to provide appropriate counseling for breast cancer patients to improve their health. Clinical and public health intervention programs should seek to maximize the number of recommended healthy behaviors especially in those women who are at high risk for failing to comply with the healthy lifestyle guidelines.

OBJECTIVE To estimate the prevalence of diagnosed cancer according to duration of diagnosed diabetes and current insulin use among U.S. adults with diagnosed diabetes. RESEARCH DESIGN AND METHODS We analyzed data from 25,964 adults aged ≥18 years with diagnosed diabetes who participated in the 2009 Behavioral Risk Factor Surveillance System. RESULTS After adjustment for potential confounders, we found that the greater the duration of diagnosed diabetes, the higher the prevalence of diagnosed cancers (P < 0.0001 for linear trend). Among adults with diagnosed type 2 diabetes, the prevalence estimate for cancers of all sites was significantly higher among men (adjusted prevalence ratio 1.6 [95% CI 1.3–1.9]) and women (1.8 [1.5–2.1]) who reported being diagnosed with diabetes ≥15 years ago than among those reporting diabetes diagnosis CONCLUSIONS Our results suggest that there is an increased burden of diagnosed cancer among adults with a longer duration of diagnosed diabetes and among type 2 diabetic adults who currently use insulin.

Using data from the 2008 Behavioral Risk Factor Surveillance System on 281,303 adults aged 18-64 years in the United States, we examined the relationship between HIV risk behaviors and binge drinking of alcoholic beverages and the frequency of binge drinking among a subgroup of 41,073 respondents who were acknowledged binge drinkers (bingers), based on reported drinking behavior in the year preceding survey. Our findings show that the weighted prevalence of HIV risk behaviors (including injection drug use, exchange of sex for money/drugs, and anal sex without a condom) among binge drinkers [corrected] [7.0%, 95% confidence interval (95% CI): 6.4-7.6%] is twice that among nonbingers (2.9%, 95% CI: 2.7-3.0%). The highest prevalence of HIV risk behaviors is among the bingers aged 18-20 years (14%, 95% CI: 11.2-18.2%). After adjusting for covariates, bingers are 1.77 (95% CI: 1.58-2.00) times more likely than nonbingers to report HIV risk behaviors. Risk increases in bingers with the number of episodes. Compared with bingers reporting 1-2 binge episodes in the month proceeding survey, the adjusted odds of reporting HIV risk behaviors among bingers are 1.27 (1.08-1.49), 1.68 (1.35-2.10), 1.67 (1.08-2.57), and 1.70 (1.34-2.16), respectively for bingers with 3-4, 5-6, 7-8, and ≥9 episodes in the same period. Our results suggest that HIV risk behaviors are strongly linked with binge drinking and its frequency. Effective measures to prevent binge drinking are essential to HIV prevention, especially among youth aged 18-20 years.

Background:Most ischemic heart disease (IHD) prevention programs that promote physical activity (PA) have focused on overweight/obese populations. Persons with normal body mass index (BMI) may mistakenly think that they are not at risk for IHD and remain physically inactive. Studies exploring the risk of IHD and PA level among adults aged 45 years and older with normal weight are limited.Methods:Cross-sectional study to examine the prevalence of IHD and PA level among 94455 respondents aged 45 years and older with normal BMI using the 2007 Behavioral Risk Factor Surveillance System data.Results:Approximately 50% of respondents reported low/inactive PA. The prevalence of IHD among persons with inactive, low, medium, and high PA was 16.6% (95% CI = 15.1−18.1%), 9.6% (8.9−10.3%), 8.9% (8.3−9.6%), and 5.4% (4.9−5.9%). The adjusted odds ratios of IHD among persons with low, medium, and high PA compared with those with inactive PA was 0.68 (95% CI = 0.59−0.79), 0.63 (0.54−0.73), and 0.49 (0.42−0.57).Conclusions:The percentage of respondents with low or inactive PA among populations aged 45 years and older with BMI 18 to

Objective. Ischemic heart disease (IHD) is one of the most common health threats to the adult population of the U.S. and other countries. The objective of this study was to examine the association between exposure to elevated annual average levels of Particulate matter 2.5 (PM2.5) air quality index (AQI) and IHD in the general population. Methods. We combined data from the Behavioral Risk Factor Surveillance System and the U.S Environmental Protection Agency air quality database. We analyzed the data using SUDAAN software to adjust the effects of sampling bias, weights, and design effects. Results. The prevalence of IHD was 9.6% among respondents who were exposed to an annual average level of PM2.5 AQI >60 compared with 5.9% among respondents exposed to an annual average PM2.5 AQI ≤60. The respondents with higher levels of PM2.5 AQI exposure were more likely to have IHD (adjusted odds ratio 5 1.72, 95% confidence interval 1.11, 2.66) than respondents with lower levels of exposure after adjusting for age, gender, race/ethnicity, education, smoking, body mass index, diabetes, hypertension, and hypercholesterolemia. Conclusions. Our study suggested that exposure to relatively higher levels of average annual PM2.5 AQI may increase the likelihood of IHD. In addition to encouraging health-related behavioral changes to reduce IHD, efforts should also focus on implementing appropriate measures to reduce exposure to unhealthy AQI levels.

Regular physical activity elicits multiple health benefits in the prevention and management of chronic diseases. We examined the mortality risks associated with levels of leisure-time aerobic physical activity and muscle-strengthening activity based on the 2008 Physical Activity Guidelines for Americans among US adults.We analysed data from the 1999 to 2004 National Health and Nutrition Examination Survey with linked mortality data obtained through 2006. Cox proportional HRs with 95% CIs were estimated to assess risks for all-causes and cardiovascular disease (CVD) mortality associated with aerobic physical activity and muscle-strengthening activity.Of 10 535 participants, 665 died (233 deaths from CVD) during an average of 4.8-year follow-up. Compared with participants who were physically inactive, the adjusted HR for all-cause mortality was 0.64 (95% CI 0.52 to 0.79) among those who were physically active (engaging in ≥150 min/week of the equivalent moderate-intensity physical activity) and 0.72 (95% CI 0.54 to 0.97) among those who were insufficiently active (engaging in0 to150 min/week of the equivalent moderate-intensity physical activity). The adjusted HR for CVD mortality was 0.57 (95% CI 0.34 to 0.97) among participants who were insufficiently active and 0.69 (95% CI 0.43 to 1.12) among those who were physically active. Among adults who were insufficiently active, the adjusted HR for all-cause mortality was 44% lower by engaging in muscle-strengthening activity ≥2 times/week.Engaging in aerobic physical activity ranging from insufficient activity to meeting the 2008 Guidelines reduces the risk of premature mortality among US adults. Engaging in muscle-strengthening activity ≥2 times/week may provide additional benefits among insufficiently active adults.

INTRODUCTION: Binge drinking (men, ≥5 drinks, women, ≥4 on an occasion) accounts for more than half of the 79,000 annual deaths due to excessive alcohol use in the United States. The frequency of binge drinking is associated with poor health-related quality of life (HRQOL), but the association between binge drinking intensity and HRQOL is unknown. Our objective was to examine this association. METHODS: We used 2008-2010 Behavioral Risk Factor Surveillance System data and multivariate linear regression models to examine the association between binge drinking intensity (largest number of drinks consumed on any occasion) among US adult binge drinkers and 2 HRQOL indicators: number of physically and mentally unhealthy days. RESULTS: Among binge drinkers, the highest-intensity binge drinkers (women consuming ≥7 drinks and men consuming ≥8 drinks on any occasion) were more likely to report poor HRQOL than binge drinkers who reported lower levels of intensity (women who consumed 4 drinks and men who consumed 5 drinks on any occasion). On average, female binge drinkers reported more physically and mentally unhealthy days (2.8 d and 5.1 d, respectively) than male binge drinkers (2.5 d and 3.6 d, respectively). After adjustment for confounding factors, women who consumed ≥7 drinks on any occasion reported more mentally unhealthy days (6.3 d) than women who consumed 4 drinks (4.6 d). Compared with male binge drinkers across the age groups, female binge drinkers had a significantly higher mean number of mentally unhealthy days. CONCLUSION: Our findings underscore the importance of implementing effective population-level strategies to prevent binge drinking and improve HRQOL. Language: en

Objective. Some studies show an association between asthma and obesity, but it is unknown whether exposure to mold will increase the risk of asthma attacks among obese people. This study examined whether obese adults have a higher risk of asthma attacks than non-obese adults when exposed to indoor mold. Methods. We used data from the 2005 Behavioral Risk Factor Surveillance System to conduct a cross-sectional analysis among 9,668 respondents who reported exposure to indoor mold. Results. With exposure to indoor mold, weighted prevalence of asthma attacks among obese respondents was 11.4% (95% confidence interval [CI] 6.0, 20.6], which was 2.3 times as high as among the exposed non-obese respondents (5.0%, 95% CI 2.8, 8.8). This ratio was almost the same as the ratio of 2.0:1 between the obese respondents (5.7%, 95% CI 4.6, 7.2) and the non-obese respondents (2.8%, 95% CI 2.3, 3.9) when neither group had exposure to mold. The odds ratio of asthma attack among obese people was 3.10 (95% CI 1.10, 8.67) for those with exposure to mold and 2.21 (95% CI 1.54, 3.17) for those without exposure to mold after adjusting for age, sex, race/ethnicity, and smoking status. Conclusion. Our study suggests that obese adults who have been exposed to indoor mold may not necessarily have a higher risk of asthma attack than obese adults who have not been exposed, even though obesity and exposure to indoor mold are both major risk factors for asthma attack. Medical professionals should not only incorporate weight-control or weight-reduction measures as the components of asthma treatment plans, but also advise asthma patients to avoid exposure to indoor mold.

Media alerts of air quality index (AQI) were designed to inform the public the need to avoid harmful air pollution by changing their outdoor activities. The relationship between AQI media alerts and change in outdoor activities among people with asthma is unknown. Our objective is to examine this relationship. Data were analyzed in a cross-sectional study from 33,888 adults, in six states, who responded to the questions in the 2005 Behavioral Risk Factor Surveillance System (BRFSS) about reductions/changes in outdoor activity. The prevalence of change in outdoor activity due to media alerts was 31% among adults with lifetime asthma and 16% without asthma. The prevalence of outdoor activity change increased to 75% among those with lifetime asthma and to 68% without asthma, when the combined the effects of media alerts and individual perception were examined. The odds of activity change based on the media alerts was 2.30 (Adjusted odds ratio [aOR] = 2.16, 95% Confidence interval [CI]: 1.61, 2.90) among those with lifetime asthma and 1.72 (aO R = 1.72, 95% CI: 1.50, 1.98) without asthma, compared to those unaware of media alerts, after adjustment for demographic variables and covariates. This study shows that awareness of media alerts as well as health professional advice may be associated with reported changes in outdoor activities. Therefore, along with consistent efforts to improve the air quality, government agencies, health professionals, and community leaders should implement measures to effectively inform the public about air quality and educate them to take appropriate actions accordingly.

Long-term exposure to ground-level ozone is associated with increased risk of morbidity and mortality. The association remains uncertain between long-term exposure to ozone and life expectancy. We assessed the associations between seasonal mean daily 8-hour maximum (8-hr max) ozone concentrations measured during the ozone monitoring seasons and life expectancy at birth in 3109 counties of the conterminous U.S. during 2002 to 2008. We used latent class growth analysis to identify latent classes of counties that had distinct mean levels and rates of change in ozone concentrations over the 7-year period and used linear regression analysis to determine differences in life expectancy by ozone levels. We identified 3 classes of counties with distinct seasonal mean daily 8-hr max ozone concentrations and rates of change. When compared with the counties with the lowest ozone concentrations, the counties with the highest ozone concentrations had 1.7- and 1.4-year lower mean life expectancy in males and females (both P