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BACKGROUND: Obesity increases the risk for metabolic and cardiovascular disease, and this risk occurs at lower body mass index (BMI) thresholds in Asian adults than in White adults. The degree to which obesity prevalence varies across heterogeneous Asian American subgroups is unclear because most obesity estimates combine all Asian Americans into a single group. OBJECTIVE: To quantify obesity prevalence in Asian American subgroups among U.S. adults using both standard BMI categorizations and categorizations tailored to Asian populations. DESIGN: Cross-sectional. SETTING: United States, 2013 to 2020. PARTICIPANTS: The analytic sample included 2 882 158 adults aged 18 years or older in the U.S. Behavioral Risk Factor Surveillance System surveys (2013 to 2020). Participants self-identified as non-Hispanic White ([NHW] n = 2 547 965); non-Hispanic Black ([NHB] n = 263 136); or non-Hispanic Asian ([NHA] n = 71 057), comprising Asian Indian (n = 13 916), Chinese (n = 11 686), Filipino (n = 11 815), Japanese (n = 12 473), Korean (n = 3634), and Vietnamese (n = 2618) Americans. MEASUREMENTS: Obesity prevalence adjusted for age and sex calculated using both standard BMI thresholds (≥30 kg/m(2)) and BMI thresholds modified for Asian adults (≥27.5 kg/m(2)), based on self-reported height and weight. RESULTS: Adjusted obesity prevalence (by standard categorization) was 11.7% (95% CI, 11.2% to 12.2%) in NHA, 39.7% (CI, 39.4% to 40.1%) in NHB, and 29.4% (CI, 29.3% to 29.5%) in NHW participants; the prevalence was 16.8% (CI, 15.2% to 18.5%) in Filipino, 15.3% (CI, 13.2% to 17.5%) in Japanese, 11.2% (CI, 10.2% to 12.2%) in Asian Indian, 8.5% (CI, 6.8% to 10.5%) in Korean, 6.5% (CI, 5.5% to 7.5%) in Chinese, and 6.3% (CI, 5.1% to 7.8%) in Vietnamese Americans. The prevalence using modified criteria (BMI ≥27.5 kg/m(2)) was 22.4% (CI, 21.8% to 23.1%) in NHA participants overall and 28.7% (CI, 26.8% to 30.7%) in Filipino, 26.7% (CI, 24.1% to 29.5%) in Japanese, 22.4% (CI, 21.1% to 23.7%) in Asian Indian, 17.4% (CI, 15.2% to 19.8%) in Korean, 13.6% (CI, 11.7% to 15.9%) in Vietnamese, and 13.2% (CI, 12.0% to 14.5%) in Chinese Americans. LIMITATION: Body mass index estimates rely on self-reported data. CONCLUSION: Substantial heterogeneity in obesity prevalence exists among Asian American subgroups in the United States. Future studies and public health efforts should consider this heterogeneity. PRIMARY FUNDING SOURCE: National Heart, Lung, and Blood Institute.

BACKGROUND: Diabetes mellitus (DM) is a leading contributor to morbidity and mortality in the United States (US). Prior DM prevalence estimates in Asian Americans are predominantly from Asians aggregated into a single group, but the Asian American population is heterogenous. OBJECTIVE: To evaluate self-reported DM prevalence in disaggregated Asian American subgroups to inform targeted management and prevention. DESIGN: Serial cross-sectional analysis. PARTICIPANTS: Respondents to the US Behavioral Risk Factor Surveillance System surveys who self-identify as non-Hispanic Asian American (NHA, N=57,001), comprising Asian Indian (N=11,089), Chinese (N=9458), Filipino (N=9339), Japanese (N=10,387), and Korean Americans (N=2843), compared to non-Hispanic White (NHW, N=2,143,729) and non-Hispanic Black (NHB, N=215,957) Americans. MAIN MEASURES: Prevalence of self-reported DM. Univariate Satterthwaite-adjusted chi-square tests compared the differences in weighted DM prevalence by sociodemographic and health status. KEY RESULTS: Self-reported fully adjusted DM prevalence was 8.7% (95% confidence interval 8.2–9.3) in NHA, compared to 14.3% (14.0–14.6) in NHB and 10.0% (10.0–10.1) in NHW (p

Asian Americans are one of the fastest growing races in the US. The objectives of this report were to assess self-reported hypertension prevalence and treatment among Asian Americans. Merging 2013, 2015, and 2017 Behavioral Risk Factor Surveillance System data, we estimated self-reported hypertension and antihypertensive medication use among non-Hispanic Asian Americans (NHA) and compared estimates between NHA and non-Hispanic whites (NHW), and by NHA subgroup (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese/other). The prevalence of hypertension was 20.8% and 33.5%, respectively, for NHAs and NHWs (p

Background Hypertension is a major risk factor for cardiovascular disease. Achieving hypertension control requires multiple supportive inventions, including self-measured blood pressure (SMBP) monitoring. The objective of this study is to report the use of SMBP among US adults. Methods Behavioral Risk Factor Surveillance System data were used for this study. The 2019 survey included, for the first time, an optional SMBP module. Twenty states and the District of Columbia (N = 159,536) opted to include the module, which assessed whether participants were advised by a healthcare professional to use SMBP, and if they used SMBP monitoring. Among those using SMBP, additional questions assessed the location of SMBP monitoring and whether SMBP readings were shared with a healthcare professional. Results Among adults in the study population, 33.9% (95% confidence interval 33.4%–34.5%) reported having hypertension (N = 66,869). Among them, nearly 70% were recommended to use SMBP by their healthcare professional and approximately 61% reported SMBP use regardless of recommendation. The most common location of SMBP was the home (85.6%). Overall, >80% shared their SMBP reading with their healthcare professional, 74% and 7% were shared in person and via the internet or email, respectively. There were differences in healthcare professional recommendations, use of SMBP, and SMBP information sharing across demographic characteristics and state of residency. Conclusions SMBP recommendation was common practice among healthcare professionals, as reported by US adults with hypertension. Data from this study can be used to guide interventions to promote hypertension self-management and control.

Asian Americans are one of the fastest growing races in the US. The objectives of this report were to assess self-reported hypertension prevalence and treatment among Asian Americans. Merging 2013, 2015, and 2017 Behavioral Risk Factor Surveillance System data, we estimated self-reported hypertension and antihypertensive medication use among non-Hispanic Asian Americans (NHA) and compared estimates between NHA and non-Hispanic whites (NHW), and by NHA subgroup (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese/other). The prevalence of hypertension was 20.8% and 33.5%, respectively, for NHAs and NHWs (p 0.001). Among those with hypertension, the prevalence of antihypertensive medication use was 71.6% and 78.2%, respectively, for NHAs and NHWs (p 0.001). Among NHA subgroups, a wide range of hypertension prevalence and medication use was found. Overall NHA had a lower reported prevalence of hypertension and use of antihypertensive medication than NHW. Certain NHA subgroups had a burden comparable to high-risk disparate populations.

Stroke is a leading cause of mortality and disability in the United States (1,2). Approximately 800,000 American adults experience a stroke each year (2,3). Currently, approximately 6 million stroke survivors live in the United States (2). Participation in stroke rehabilitation (rehab), which occurs in diverse settings (i.e., in-hospital, postacute care, and outpatient settings), has been determined to reduce stroke recurrence and improve functional outcomes and quality of life (3,4). Despite longstanding national guidelines recommending stroke rehab, it remains underutilized, especially in the outpatient setting. Professional associations and evidence-based guidelines support the increasing stroke rehab use in health systems and are promoted by the public health community (3-6). An analysis of 2005 Behavioral Risk Factor Surveillance System (BRFSS) data revealed that 30.7% of stroke survivors reported participation in outpatient rehab for stroke after hospital discharge in 21 states and the District of Columbia (DC) (7). To update these estimates, 2013 and 2015 BRFSS data were analyzed to assess outpatient rehab use among adult stroke survivors. Overall, outpatient rehab use was 31.2% (20 states and DC) in 2013 and 35.5% (four states) in 2015. Disparities were evident by sex, race, Hispanic origin, and level of education. Focused attention on system-level interventions that ensure participation is needed, especially among disparate populations with lower levels of participation.

Hypertension is a major cardiovascular disease risk factor (1,2). Advice given by health professionals can result in lower sodium intake and lower blood pressure (3).The 2017 Hypertension Guideline released by the American College of Cardiology and the American Heart Association emphasizes nonpharmacologic approaches, including sodium reduction, as important components of hypertension prevention and treatment (4). Data from 50,576 participants in the sodium module of the 2015 Behavioral Risk Factor Surveillance System (BRFSS) in nine states and Puerto Rico were analyzed to determine the prevalence of reported sodium reduction advice and action among participants with and without self-reported hypertension. Among participants with self-reported hypertension, adjusted prevalence of receiving sodium reduction advice from a health professional was 41.9%, compared with 12.8% among participants without hypertension. Among those with hypertension, adjusted prevalence of reported action to reduce sodium intake was 80.9% among participants who received advice and 55.7% among those who did not receive advice. Among participants without hypertension, adjusted prevalence of taking action to reduce sodium intake was 72.7% among those who received advice and 46.9% among those who did not receive advice. The provision of advice on sodium reduction by health professionals is associated with respondent action to watch or reduce sodium intake. Fewer than half of patients with hypertension received this advice from their health professionals, a circumstance that represents a substantial missed opportunity to promote hypertension prevention and treatment.

Heart disease is the leading cause of death in the United States (1). Each year, approximately 790,000 adults have a myocardial infarction (heart attack), including 210,000 that are recurrent heart attacks (2). Cardiac rehabilitation (rehab) includes exercise counseling and training, education for heart-healthy living, and counseling to reduce stress. Cardiac rehab provides patients with education regarding the causes of heart attacks and tools to initiate positive behavior change, and extends patients' medical management after a heart attack to prevent future negative sequelae (3). A systematic review has shown that after a heart attack, patients using cardiac rehab were 53% (95% confidence interval [CI] = 41%-62%) less likely to die from any cause and 57% (95% CI = 21%-77%) less likely to experience cardiac-related mortality than were those who did not use cardiac rehab (3). However, even with long-standing national recommendations encouraging use of cardiac rehab (4), the intervention has been underutilized. An analysis of 2005 Behavioral Risk Factor Surveillance System (BRFSS) data found that only 34.7% of adults who reported a history of a heart attack also reported subsequent use of cardiac rehab (5). To update these estimates, CDC used the most recent BRFSS data from 2013 and 2015 to assess the use of cardiac rehab among adults following a heart attack. Overall use of cardiac rehab was 33.7% in 20 states and the District of Columbia (DC) in 2013 and 35.5% in four states in 2015. Cardiac rehab use was underutilized overall and differences were evident by sex, age, race/ethnicity, level of education, cardiovascular risk status, and by state. Increasing use of cardiac rehab after a heart attack should be encouraged by health systems and supported by the public health community.

From 95,196 sample adults in the combined 2010, 2013, and 2015 U.S. National Health Interview Survey, we estimated the association between histories of epilepsy and heart disease after accounting for sociodemographic characteristics and behavioral risk factors. Adults 18 years old or older with an epilepsy history reported heart disease (21%) about nine percentage points more often than those without such a history (12%), overall and within levels of characteristics and risk factors. These increases in heart disease history for adults with an epilepsy history compared with adults without such a history were greater in those 45–64 years old or at the lowest family income levels. These increases of heart disease in adults with an epilepsy history highlight two needs—to prevent the occurrence of heart disease and to reduce its consequences. Because comorbidity from heart disease can complicate epilepsy management, physicians caring for those with epilepsy should be aware of these increased risks, identify risk factors for heart disease, and recommend to their patients with epilepsy ways to diminish these risks.

Heart disease is the leading cause of death in the United States (1). Heart attacks (also known as myocardial infarctions) occur when a portion of the heart muscle does not receive adequate blood flow, and they are major contributors to heart disease, with an estimated 750,000 occurring annually (2). Early intervention is critical for preventing mortality in the event of a heart attack (3). Identification of heart attack signs and symptoms by victims or bystanders, and taking immediate action by calling emergency services (9-1-1), are crucial to ensure timely receipt of emergency care and thereby improve the chance for survival (4). A recent report using National Health Interview Survey (NHIS) data from 2014 found that 47.2% of U.S. adults could state all five common heart attack symptoms (jaw, neck, or back discomfort; weakness or lightheadedness; chest discomfort; arm or shoulder discomfort; and shortness of breath) and knew to call 9-1-1 if someone had a heart attack (5). To assess changes in awareness and response to an apparent heart attack, CDC analyzed data from NHIS to report awareness of heart attack symptoms and calling 9-1-1 among U.S. adults in 2008, 2014, and 2017. The adjusted percentage of persons who knew all five common heart attack symptoms increased from 39.6% in 2008 to 50.0% in 2014 and to 50.2% in 2017. The adjusted percentage of adults who knew to call 9-1-1 if someone was having a heart attack increased from 91.8% in 2008 to 93.4% in 2014 and to 94.9% in 2017. Persistent disparities in awareness of heart attack symptoms were observed by demographic characteristics and cardiovascular risk group. Public health awareness initiatives and systematic integration of appropriate awareness and action in response to a perceived heart attack should be expanded across the health system continuum of care.

Introduction Early recognition of stroke symptoms and recognizing the importance of calling 9-1-1 improves the timeliness of appropriate emergency care, resulting in improved health outcomes. The objective of this study was to assess changes in awareness of stroke symptoms and calling 9-1-1 from 2009 to 2014. Methods We analyzed data among 27,211 adults from 2009 and 35,862 adults from 2014 using the National Health Interview Survey (NHIS). The NHIS included 5 questions in both 2009 and 2014 about stroke signs and symptoms and one about the first action to take when someone is having a stroke. We estimated the prevalence of awareness of each symptom, all 5 symptoms, the importance of calling 9-1-1, and knowledge of all 5 symptoms plus the importance of calling 9-1-1 (indicating recommended stroke knowledge). We assessed changes from 2009 to 2014 in the prevalence of awareness. Data analyses were conducted in 2016. Results In 2014, awareness of stroke symptoms ranged from 76.1% (sudden severe headache) to 93.7% (numbness of face, arm, leg, side); 68.3% of respondents recognized all 5 symptoms, and 66.2% were aware of all recommended stroke knowledge. After adjusting for sex, age, educational attainment, and race/ethnicity, logistic regression results showed a significant absolute increase of 14.7 percentage points in recommended stroke knowledge from 2009 (51.5%) to 2014 (66.2%). Among US adults, recommended stroke knowledge increased from 2009 to 2014. Conclusion Stroke awareness among US adults has improved but remains suboptimal.

Healthy People 2020, the primary initiative that develops objectives monitoring the nation’s health, has called for increased awareness of the early warning signs and symptoms of a heart attack and the importance of accessing emergency care by dialing 9-1-1 [(1)][1]. Poor knowledge of the signs

While commonly used quality-of-life instruments assess perceived epilepsy-associated limitations in life domains and formally document patient concerns, less is known of community-dwelling adults with epilepsy about their satisfaction with broader life domains, such as satisfaction with housing, education, neighborhood, ability to help others, and achievement of goals. The purpose of this study was to examine satisfaction with life domains in a representative sample of community-dwelling adults with self-reported epilepsy from the 2008 HealthStyles survey. Following adjustment for sex, age group, race/ethnicity, education, and income, people with epilepsy were more likely to report frustration in the domains of achievement (e.g., dissatisfaction with education and life goals), compromised social interactions (dissatisfaction with family life, friends, and social life), and compromised physical capability (dissatisfaction with health and energy level). Life satisfaction and other well-being domains can supplement health indicators to guide treatment and program services for people with epilepsy to maximize their well-being.

Healthy People 2020 identified health-related quality of life and well-being (WB) as indicators of population health for the next decade. This study examined the measurement properties of the NIH PROMIS® Global Health Scale, the CDC Healthy Days items, and associations with the Satisfaction with Life Scale. A total of 4,184 adults completed the Porter Novelli’s HealthStyles mailed survey. Physical and mental health (9 items from PROMIS Global Scale and 3 items from CDC Healthy days measure), and 4 WB factor items were tested for measurement equivalence using multiple-group confirmatory factor analysis. The CDC items accounted for similar variance as the PROMIS items on physical and mental health factors; both factors were moderately correlated with WB. Measurement invariance was supported across gender and age; the magnitude of some factor loadings differed between those with and without a chronic medical condition. The PROMIS, CDC, and WB items all performed well. The PROMIS items captured a broad range of functioning across the entire continuum of physical and mental health, while the CDC items appear appropriate for assessing burden of disease for chronic conditions and are brief and easily interpretable. All three measures under study appear to be appropriate measures for monitoring several aspects of the Healthy People 2020 goals and objectives.

To develop and psychometrically evaluate the brief Public Health Surveillance Well-Being Scale (PHS-WB) that captures mental, physical, and social components of well-being. Using data from 5,399 HealthStyles survey respondents, we conducted bi-factor, item response theory, and differential item functioning analyses to examine the psychometric properties of a pool of 34 well-being items. Based on the statistical results and content considerations, we developed a brief 10-item well-being scale and assessed its construct validity through comparisons of demographic subgroups and correlations with measures of related constructs. Based on the bi-factor analyses, the items grouped into both an overall factor and individual domain-specific factors. The PHS-WB scale demonstrated good internal consistency (alpha = 0.87) and correlated highly with scores for the entire item pool (r = 0.94). The well-being scale scores differed as expected across demographic groups and correlated with global and domain-specific measures of similar constructs, supporting its construct validity. The 10-item PHS-WB scale demonstrates good psychometric properties, and its high correlation with the item pool suggests minimal loss of information with the use of fewer items. The brief PHS-WB allows for well-being assessment on national surveys or in other situations where a longer form may not be feasible.

Introduction Among veterans, having been selected into the military and having easy access to medical care during and after military service may reduce premature mortality but not morbidity from mental distress and may not improve health-related quality of life. The objective of this study was to determine whether veterans in different racial/ethnic groups differ in their health-related quality of life from each other and from their civilian counterparts. Methods Among 800,000 respondents to the 2007–2009 Behavioral Risk Factor Surveillance System surveys, approximately 110,000 identified themselves as veterans and answered questions about their sociodemographic characteristics, self-rated health, and recent health-related quality of life. Nonoverlapping 95% confidence intervals of means distinguished veterans and civilians of different racial/ethnic groups. Results Veteran and civilian American Indians/Alaska Natives reported more physically unhealthy days, mentally unhealthy days, and recent activity limitation days than their veteran and civilian counterparts in other racial/ethnic groups. Non-Hispanic white veterans and Hispanic veterans reported more physically unhealthy days, mentally unhealthy days, and recent activity limitation days than their civilian counterparts. Conclusion Unlike findings in other studies, our findings show that veterans’ health-related quality of life differs from that of civilians both within the same racial/ethnic group and among different racial/ethnic groups. Because once-healthy soldiers may not be as healthy when they return to civilian life, assessing their health-related quality of life over time may identify those who need help to regain their health.

To examine the association between female adolescents in high school who use illicit drugs and seriously consider attempting suicide.Data were analyzed from the 2003 Youth Risk Behavioral Surveillance System. Variables for suicidal thought, illicit drugs, and covariables were chosen to explore the association.Seriously considering attempting suicide was associated with Hispanics, suburban youth, use of marijuana, inhalants, methamphetamines, and steroids without MD's prescription.Greater effort may be necessary to raise awareness about the physical and mental health status of Hispanic adolescents and to ensure good mental health programs are available.

Background Well-being is now accepted as one of four cross-cutting measures in gauging progress for Healthy People 2020. This shift to population indicators of well-being redresses notions of health that have focused on absence of illness (negative health) as a primary or sufficient indicator of positive functioning. The purpose of this study was to estimate mental, social, and physical well-being in three US states using new measures piloted on the 2010 Behavioral Risk Factor Surveillance Survey System (BRFSS). Baseline estimates were provided for states overall, and within states for demographic subgroups, those with chronic health conditions or disabilities, and those with behavioral risk factors. Methods Ten validated questions designed to assess mental (e.g., satisfaction with life, satisfaction with life domains, happiness), physical (e.g., satisfaction with energy level), and social dimensions (e.g., frequency of social support) of well-being were selected with state input for inclusion on BRFSS. 18,622 individuals responded to the BRFSS surveys administered by New Hampshire (N = 3,139), Oregon (N = 2,289), and Washington (N = 13,194). Multivariate adjusted proportions of positive responses to well-being items were examined. Results After adjustment for confounders, about 67% of adults in these states had high levels of well-being, including >80% reporting experiencing happiness. Most adults were satisfied with their work, neighborhood, and education, but significant differences were seen in subgroups. Well-being differed by demographic characteristics such as marital status, health behaviors, chronic conditions, and disability status, with those who reported a disability and smokers consistently experiencing the worst well-being. Conclusions Well-being is accepted as one of four cross-cutting measures in gauging progress for Healthy People 2020. Well-being differs by important sociodemographic factors and health conditions (e.g., age, employment, smoking, disability status). These findings provide baseline estimates for the three states to use in gauging improvements in well-being and can serve as a model for other state-level or national surveillance systems. These findings also assist states in identifying vulnerable subgroups who may benefit from potential interventions such as those in the National Prevention Strategy that focus on enhancing well-being where such disparities exist.