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McKnight-Eily L.R.,National Center for Chronic Disease Prevention and Health Promotion | Liu Y.,National Center for Chronic Disease Prevention and Health Promotion | Brewer R.D.,National Center for Chronic Disease Prevention and Health Promotion | Kanny D.,National Center for Chronic Disease Prevention and Health Promotion | And 4 more authors.
Morbidity and Mortality Weekly Report | Year: 2014

Introduction: Excessive alcohol use accounted for an estimated 88,000 deaths in the United States each year during 2006-2010, and $224 billion in economic costs in 2006. Since 2004, the U.S. Preventive Services Task Force (USPSTF) has recommended alcohol misuse screening and behavioral counseling (also known as alcohol screening and brief intervention [ASBI]) for adults to address excessive alcohol use; however, little is known about the prevalence of its implementation. ASBI will also be covered by many health insurance plans because of the Affordable Care Act. Methods: CDC analyzed Behavioral Risk Factor Surveillance System (BRFSS) data from a question added to surveys in 44 states and the District of Columbia (DC) from August 1 to December 31, 2011, about patient-reported communication with a health professional about alcohol. Elements of ASBI are traditionally delivered via conversation. Weighted state-level prevalence estimates of this communication were generated for 166,753 U.S. adults aged ≥18 years by selected demographic characteristics and drinking behaviors. Results: The prevalence of ever discussing alcohol use with a health professional was 15.7% among U.S. adults overall, 17.4% among current drinkers, and 25.4% among binge drinkers. It was most prevalent among those aged 18-24 years (27.9%). However, only 13.4% of binge drinkers reported discussing alcohol use with a health professional in the past year, and only 34.9% of those who reported binge drinking ≥10 times in the past month had ever discussed alcohol with a health professional. State-level estimates of communication about alcohol ranged from 8.7% in Kansas to 25.5% in DC. Conclusions: Only one of six U.S. adults, including binge drinkers, reported ever discussing alcohol consumption with a health professional, despite public health efforts to increase ASBI implementation. Implications for Public Health Practice: Increased implementation of ASBI, including systems-level changes such as integration into electronic health records processes, might reduce excessive alcohol consumption and the harms related to it. Routine surveillance of ASBI by states and communities might support monitoring and increasing its implementation.

Breiding M.J.,National Center for Injury Prevention and Control | Thompson W.W.,National Center for Birth Defects and Developmental Disabilities | Dhingra S.S.,National Center for Chronic Disease Prevention and Health Promotion | Parks S.E.,National Center for Chronic Disease Prevention and Health Promotion
American Journal of Preventive Medicine | Year: 2015

Background Adverse childhood experiences (ACEs), including child abuse and family dysfunction, are linked to leading causes of adult morbidity and mortality. Most prior ACE studies were based on a nonrepresentative patient sample from one Southern California HMO. Purpose To determine if ACE exposure increases the risk of chronic disease and disability using a larger, more representative sample of adults than prior studies. Methods Ten states and the District of Columbia included an optional ACE module in the 2010 Behavioral Risk Factor Surveillance Survey, a national cross-sectional, random-digit-dial telephone survey of adults. Analysis was conducted in November 2012. Respondents were asked about nine ACEs, including physical, sexual, and emotional abuse and household member mental illness, alcoholism, drug abuse, imprisonment, divorce, and intimate partner violence. An ACE score was calculated for each subject by summing the endorsed ACE items. After controlling for sociodemographic variables, weighted AORs were calculated for self-reported health conditions given exposure to zero, one to three, four to six, or seven to nine ACEs. Results Compared to those who reported no ACE exposure, the adjusted odds of reporting myocardial infarction, asthma, fair/poor health, frequent mental distress, and disability were higher for those reporting one to three, four to six, or seven to nine ACEs. Odds of reporting coronary heart disease and stroke were higher for those who reported four to six and seven to nine ACEs; odds of diabetes were higher for those reporting one to three and four to six ACEs. Conclusions These findings underscore the importance of child maltreatment prevention as a means to mitigate adult morbidity and mortality.

Pfeiffer C.M.,National Center for Environmental Health | Hughes J.P.,National Center for Health Statistics | Lacher D.A.,National Center for Health Statistics | Bailey R.L.,U.S. National Institutes of Health | And 6 more authors.
Journal of Nutrition | Year: 2012

The NHANES has monitored folate status of the U.S. population from prefortification (1988-1994) to postfortification (1999-2010) bymeasuring serumand RBC folate concentrations. The Bio-Rad radioassay (BR)was used from1988 to 2006, and the microbiologic assay (MBA) was used from 2007 to 2010. The MBA produces higher concentrations than the BR and is considered to be more accurate. Thus, to bridge assay differences and to examine folate trends over time, we adjusted the BR results to be comparable to theMBA results. Postfortification, assay-adjusted serumand RBC folate concentrationswere 2.5 times and 1.5 times prefortification concentrations, respectively, and showed a significant linear trend (P < 0.001) to slightly lower concentrations during 1999-2010. The postfortification prevalence of low serum (<10 nmol/L) or RBC (<340 nmol/L) folate concentrations was ≤1%, regardless of demographic subgroup, compared with 24% for serum folate and 3.5% for RBC folate prefortification, with substantial variation among demographic subgroups. The central 95% reference intervals for serum and RBC folate varied by demographic subgroup during both pre- and postfortification periods. Age and dietary supplement use had the greatest effects on prevalence estimates of low folate concentrations during the prefortification period. In summary, the MBA-equivalent blood folate concentrations in the U.S. population showed first a sharp increase from pre- to postfortification, then showed a slight decrease (17% for serum and 12%for RBC folate) during the 12-y postfortification period. TheMBA-equivalent pre- and postfortification reference concentrationswill inform countries that plan folic acid fortification or that need to evaluate its impact. © 2012 American Society for Nutrition.

Shapiro A.D.,Indiana Hemophilia and Thrombosis Center | Soucie J.M.,National Center for Birth Defects and Developmental Disabilities | Peyvandi F.,University of Milan | Aschman D.J.,American Thrombosis and Hemostasis Network | Dimichele D.M.,U.S. National Institutes of Health
American Journal of Preventive Medicine | Year: 2011

Rare coagulation disorders (RCDs) present a considerable and multifaceted public health risk. Although inherited RCDs affect a minor segment of any local healthcare delivery system, their global impact is major and highlight the challenges of delivering healthcare services to any rare disease population. These include but are not limited to: (1) a general lack of knowledge about and familiarity with the genetic and clinical implications of the disorder among affected patients, and both urgent and specialty care providers; (2) the potential for preventable morbidity and mortality related to delayed diagnosis and treatment; (3) the lack of safe and effective therapies; and (4) minimal research activity to establish and improve standards of care. A multiagency national partnership has established an approach to address these problems through development of a clinical, genetic, and treatment-related web-based data-collection tool that will: (1) generate a reliable, sufficient knowledge base for these disorders; (2) facilitate new product licensure through subject identification and access to comparative historical treatment data; and (3) serve as an effective tool for outcomes research and post-licensure product surveillance. To maximize impact, this database is being harmonized with a European data-collection effort. Database development and harmonization is in progress. A resource library was completed and disseminated to major national and international bleeding disorder websites to provide state-of-the-art patient and provider education on each RCD. We believe that this model is effective and adaptable to other rare conditions. © 2011 American Journal of Preventive Medicine.

Drews-Botsch C.,Emory University | Schieve L.A.,National Center for Birth Defects and Developmental Disabilities | Kable J.,Emory University | Coles C.,Emory University
Reviews on Environmental Health | Year: 2011

Background: Studies of small for gestational age (SGA) birth and subsequent childhood cognitive outcomes are inconsistent. Few studies have assessed whether effects varied by socioeconomic status (SES). Objective: To assess child cognitive and behavioral outcomes according to SGA and severe SGA (<10th and <5th percentiles) and SES. Methods: We followed 474 infants initially selected for a case-control study assessing SGA vs. appropriate-for-gestational age (AGA). The infants were born at two hospitals: a public hospital serving a low-income, African-American population and a private hospital serving a predominantly white, middle-class population. At age 54 months, a psychologist administered the Differential Abilities Scales (DAS), and Vineland Adaptive Behavior Scales (VABS). The mother completed the Child Behavior Checklist (CBCL). Associations were analyzed using multiple linear regression. Results: Among AGA children, the mean DAS score was >1 standard deviation lower for children born at the public vs. the private hospital (75.2 vs. 95.7 among boys; 76.3 vs. 101.8 among girls). Being SGA had a weaker effect on DAS scores, overall. Severe SGA had a significant effect on DAS scores of children born at the private hospital (average reduction 8.0±2.5 points), but not on children born at the public hospital (average reduction 1.1±2.2 points). In the latter group, severe SGA was associated with a lower VABS score (average reduction 9.2±2.5 points). Conclusions: Poor fetal growth influences neurodevelopment, but this influence is modified by postnatal environment. Adverse effects associated with low SES might mask or attenuate associations between prenatal exposures and developmental outcomes in some populations. © 2011 by Walter de Gruyter.

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