Introduction:This report presents the most recent depression prevalence estimates in adolescents and adults, ages 12 years and older, based on the August 2021-August 2023 National Health and Nutrition Examination Survey (NHANES). Depression symptoms are measured using the Patient Health Questionnaire. Methods:Prevalence of depression was estimated using August 2021-August 2023 NHANES data. Depression was defined by score of 10 or greater on the Patient Health Questionnaire (PHQ-9), a validated screening instrument used to assess depression symptoms in the past 2 weeks. Standard errors of percentages were estimated using Taylor series linearization. A t statistic was used to test for differences between groups. Linear and nonlinear trends were evaluated using the orthogonal polynomials. The significance level for statistical testing was p < 0.05. Key findings:During August 2021-August 2023, depression prevalence was 13.1% in adolescents and adults ages 12 years and older and decreased with increasing age. Depression prevalence decreased with increasing family income overall and in males and females. From 2013-2014 to August 2021-August 2023, the prevalence of depression increased overall, and in males and females. Among adolescents and adults with depression, 87.9% reported at least some difficulty with work, home, or social activities due to their depression symptoms, and a higher percentage of females (43.0%) than males (33.2%) reported receiving therapy or counseling in the past 12 months.

INTRODUCTION:The prevalence of cigarette smoking is high among U.S. Department of Housing and Urban Development (HUD) assistance recipients, putting others at risk for secondhand smoke (SHS) exposure. We evaluated the burden of SHS exposure among HUD-assisted children, adolescents, and adults. AIMS AND METHODS:Using 2007-2018 National Health and Nutrition Examination Survey (NHANES) data linked with HUD administrative data, we assessed SHS exposure prevalence, defined using serum cotinine, among non-tobacco, non-nicotine-using, HUD-assisted children and adolescents (ages 3-17 years, n = 955) and adults (ages ≥ 18 years, n = 878) and among low-income, HUD-unassisted children and adolescents (n = 5788) and adults (n = 8027). Time trends were evaluated. Unadjusted and adjusted multivariable logistic regression models were created to assess SHS exposure by HUD assistance status. RESULTS:The prevalence of SHS exposure during 2015-2018 was 73.2% (95% CI = 63.2% to 81.7%) among HUD-assisted children and adolescents and 50.1% (95% CI = 40.1% to 60.1%) among HUD-assisted adults. Decreases in SHS exposure among HUD-assisted individuals from 2007-2010 through 2015-2018 were significant only for ages 12-17 years (78.6% [95% CI = 68.0% to 87.0%] to 64.3% [95% CI = 52.5% to 74.9%]; p = .04). Among low-income individuals, SHS exposure was higher during 2007-2018 among HUD-assisted than HUD-unassisted children and adolescents (OR = 3.39 [95% CI = 2.58 to 4.47]) and adults (2.11 [95% CI = 1.66 to 2.68]). Results remained significant after adjusting for social, demographic, and housing characteristics. CONCLUSIONS:HUD-assisted children, adolescents, and adults had higher exposure to SHS than those not receiving HUD assistance. SHS exposure among HUD-assisted individuals was high for all years studied, compared to published estimates for the general US population, but did decrease among children and adolescents aged 12-17 years. IMPLICATIONS:This study is the first to provide biomarker-derived prevalence estimates of SHS exposure among recipients of HUD assistance within a nationally representative sample of the United States. The findings suggest that HUD-assisted children, adolescents, and adults are an at-risk population for SHS exposure, independent of known confounding social and demographic factors.

BACKGROUND:Depression is a common mental health disorder. OBJECTIVE:The objective of this study was to explore the association between diet quality, as measured by the Healthy Eating Index 2020 (HEI-2020), and depression symptoms among US adolescents and young adults aged 12 to 29 years. DESIGN:The study design was a cross-sectional secondary data analysis. PARTICIPANTS:Data from the first 24-hour dietary recall for adolescents and young adults aged 12 to 29 years in the National Health and Nutrition Examination Survey from 2015 to March 2020 (n = 4750) were analyzed. MAIN OUTCOME MEASURE:Depression was defined as a score ≥10 on the Patient Health Questionnaire, reflecting moderate or severe symptoms in the previous 2 weeks. STATISTICAL ANALYSES PERFORMED:HEI-2020 total (range, 0-100) and component scores were calculated for those with and without depression. Predicted HEI-2020 scores were estimated from linear regression models, adjusting for age, gender, race and Hispanic origin, family income, and seeing a mental health professional in the past year. Statistical analyses accounted for the complex sample design. RESULTS:The prevalence of depression among adolescents and young adults was 7.8% (95% CI 6.3% to 9.5%). Total HEI-2020 score was 45.9 (95% CI 45.0 to 46.7) out of 100 on a given day during 2015 to March 2020. Among young people with depression, total HEI-2020 score was lower than among those without depression (41.7 vs 46.2; P < .001). After adjustment for covariates, the difference was attenuated, but remained significant. In adjusted analyses, HEI-2020 component scores were lower for those with depression compared with those without depression for the adequacy components: total fruits (1.4 vs 1.7; P = .03), whole fruits (1.2 vs 1.7; P < .01), total vegetables (2.1 vs 2.6; P < .01), greens and beans (0.8 vs 1.2; P < .01), and total protein foods (3.6 vs 4.0; P = .02) out of a maximum score of 5. There were no statistically significant differences observed for whole grains, dairy, seafood and plant proteins, fatty acids, saturated fats, refined grains, sodium, or added sugars. CONCLUSIONS:Overall diet quality is low among young people. Diet quality, especially consumption of fruits, vegetables, and protein foods was lower among young people with depression compared with those without depression.

Background Toxoplasma gondii and Toxocara are common parasites that infect humans globally. Our aim was to examine the relationship between T. gondii and Toxocara infection and cognition. Methods Multivariate logistic regression was used to test the association of T. gondii and Toxocara seropositivity on indices of cognitive function (a word list learning trial with delayed recall from the Consortium to Establish a Registry for Alzheimer’s Disease, an animal fluency test (AFT) and a digit symbol substitution test (DSST)) among 2643 adults aged 60 years and older in the 2011–2014 National Health and Nutrition Examination Survey. Results Seropositivity to T. gondii or Toxocara were both associated with lower scores in all three cognitive function measures examined in univariate analyses. Except for the DSST, these associations were not significant after adjustment for age, gender, race and Hispanic origin, poverty level, education, US birth status, depression and hypertension. On stratification to account for significant interactions, Toxocara seropositivity was associated with worse scores on the AFT among those born outside the USA, worse scores on the DSST among those aged 60–69 years, female, Hispanic and with a high school diploma or less. Lower DSST scores with Toxocara infection was greater for adults living below compared with at or above the poverty level. Conclusions Seropositivity to these parasites, particularly to Toxocara , may be associated with diminished cognitive performance in certain subgroups of older adults.

Mental health encompasses a range of mental, emotional, social, and behavioral functioning and occurs along a continuum from good to poor. Previous research has documented that mental health among children and adolescents is associated with immediate and long-term physical health and chronic disease, health risk behaviors, social relationships, education, and employment. Public health surveillance of children's mental health can be used to monitor trends in prevalence across populations, increase knowledge about demographic and geographic differences, and support decision-making about prevention and intervention. Numerous federal data systems collect data on various indicators of children's mental health, particularly mental disorders. The 2013-2019 data from these data systems show that mental disorders begin in early childhood and affect children with a range of sociodemographic characteristics. During this period, the most prevalent disorders diagnosed among U.S. children and adolescents aged 3-17 years were attention-deficit/hyperactivity disorder and anxiety, each affecting approximately one in 11 (9.4%-9.8%) children. Among children and adolescents aged 12-17 years, one fifth (20.9%) had ever experienced a major depressive episode. Among high school students in 2019, 36.7% reported persistently feeling sad or hopeless in the past year, and 18.8% had seriously considered attempting suicide. Approximately seven in 100,000 persons aged 10-19 years died by suicide in 2018 and 2019. Among children and adolescents aged 3-17 years, 9.6%-10.1% had received mental health services, and 7.8% of all children and adolescents aged 3-17 years had taken medication for mental health problems during the past year, based on parent report. Approximately one in four children and adolescents aged 12-17 years reported having received mental health services during the past year. In federal data systems, data on positive indicators of mental health (e.g., resilience) are limited. Although no comprehensive surveillance system for children's mental health exists and no single indicator can be used to define the mental health of children or to identify the overall number of children with mental disorders, these data confirm that mental disorders among children continue to be a substantial public health concern. These findings can be used by public health professionals, health care providers, state health officials, policymakers, and educators to understand the prevalence of specific mental disorders and other indicators of mental health and the challenges related to mental health surveillance.

Secondhand smoke (SHS) exposure results when smoke from burning tobacco products is inhaled by nonsmokers (1,2). Acute respiratory effects, coronary heart disease, stroke, lung cancer, and premature death are associated with SHS exposure (2,3). There is no risk-free level of SHS exposure (1). The prevalence of SHS exposure declined by 71.2% from 1988 to 2014 (4). This report examines the prevalence of SHS exposure among nonsmoking U.S. adults in 2015-2018 based on blood levels of cotinine, a metabolite of nicotine. Trends in SHS exposure are also presented.

Abstract Previous studies have noted an inverse association between depression and cognitive functioning. The objective of this research is to explore this relationship with data from a nationally representative survey containing validated measures of cognition, depression, and other health conditions. The study population was respondents aged 60 and over who completed the examination component of the 2011-2014 National Health and Nutrition Examination Survey (NHANES) (N=3,472). Cognitive tests included the CERAD word list learning trials, measuring immediate and delayed memory, and the Digit Symbol Substitution test (DSST), measuring attention and processing speed. The presence of depressive symptoms was based on a score of 10 or higher out of 27 from the Patient Health Questionnaire (PHQ-9). Statistical analyses included regression models with low cognitive performance (scoring in the lowest 25th percentile) as the dependent variable. Results from regression models showed that having depressive symptoms significantly increased the odds of scoring in the lowest 25th percentile of both the DSST (OR = 3.4) and the CERAD test (OR = 1.7), controlling for age, sex, and race and Hispanic origin. Adding in a measure of heart disease showed an independent effect of heart disease on low cognitive performance (OR = 1.7 for DSST and OR = 1.3 for CERAD test), while the effect of depression was lessened but still statistically significant. In this study, depression is associated with cognitive functioning, but its effect may be attenuated by the presence of other chronic health conditions.

In 2018, an estimated 7.2% of American adults had a major depressive episode in the past year (1). Depression is associated with diminished quality of life and increased disability (2). Antidepressants are one of the primary treatments for depression (3) and are among the most frequently used therapeutic medications in the United States (4). This data brief provides recent prevalent estimates for antidepressant use among U.S. adults aged 18 and over, by age, sex, race and Hispanic origin, and education. Trends in antidepressant use over the decade from 2009-2010 through 2017-2018 are described.

Secondhand smoke (SHS) exposure comes from the inhalation of smoke from burning cigarettes, cigars, and pipes (1). SHS can cause sudden infant death syndrome, respiratory and ear infections, and asthma attacks in youth (1,2). Decreases in tobacco smoking, awareness of SHS health risks, and smokefree policies may have contributed to a reduction in SHS exposure since the late 1980s (3,4). However, in recent years, the percentage of youth with SHS exposure has remained steady (5). This report describes the prevalence of SHS exposure among nonsmoking youth in 2013-2016, as defined by serum cotinine, a metabolite of nicotine.

Background: The CDC recommends a targeted strategy for childhood blood lead screening based on participation in federal programs, such as Medicaid and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Yet, there is scarcity of data on blood lead levels (BLLs) among WIC participants. Objective: Our objective was to investigate whether children participating in WIC and not enrolled in Medicaid, who have not been targeted in the historical Medicaid-focused screening strategy, have higher BLLs than children in neither of these programs. Methods: The analysis included 3,180 children 1–5 y of age in the National Health and Nutrition Examination Surveys conducted in 2007–2014. Log-binomial regression, which allows direct estimation of prevalence ratios, was used to examine associations between WIC participation (in conjunction with Medicaid enrollment) and having BLLs ≥5μg/dL with adjustment for age (1–2 vs. 3–5 y). Results: The percentage of children participating in “WIC only,” “Medicaid only,” “both WIC and Medicaid,” and “neither” were 18.9%, 10.8%, 25.4%, and 44.9%, respectively. “WIC only,” “Medicaid only,” and “both WIC and Medicaid” children were more likely to have BLLs ≥5μg/dL than children who were not enrolled in either program, with adjusted prevalence ratios of 3.29 [95% confidence interval (CI): 1.19, 9.09], 4.56 (95% CI: 2.18, 9.55), and 2.58 (95% CI: 1.18, 5.63). Conclusions: Children participating in WIC but not Medicaid were more likely to have BLLs ≥5μg/dL than children who were not enrolled in either program. These findings may inform public health recommendations and clinical practice guidelines. https://doi.org/10.1289/EHP2384

Major depression is a common and treatable mental disorder characterizedby changes in mood, and cognitive and physical symptoms over a 2-weekperiod (1). It is associated with high societal costs (2) and greater functionalimpairment than many other chronic diseases, including diabetes and arthritis(3). Depression rates differ by age, sex, income, and health behaviors (4).This report provides the most recent national estimates of depression amongadults. Prevalence of depression is based on scores from the Patient HealthQuestionnaire (PHQ-9), a symptom-screening questionnaire that allows forcriteria-based diagnoses of depressive disorders (5). Estimates for non-HispanicAsian persons are presented for the first time.

Antidepressants are one of the three most commonly used therapeutic drug classes in the United States (1). While the majority of antidepressants are taken to treat depression, antidepressants can also be taken to treat other conditions, like anxiety disorders. This Data Brief provides the most recent estimates of antidepressant use in the U.S. noninstitutionalized population, including prevalence of use by age, sex, race and Hispanic origin, and length of use. This report also describes trends in the prevalence of antidepressant use from 1999–2002 to 2011–2014.

BACKGROUNDHigh fractional exhaled nitric oxide (FeNO) is an indicator of poor asthma control and has been proposed as a non-invasive assessment tool to guide asthma management.OBJECTIVEWe aimed to describe the prevalence of and factors associated with high FeNO among US youth with asthma.METHODSData from 716 children and adolescents with asthma ages 6-19 years who participated in the 2007-2012 National Health and Nutrition Examination Survey were analyzed. Using American Thoracic Society guidelines, high FeNO was defined as >50ppb for ages 12-19 years and >35ppb for ages 6-11 years. Multivariate logistic regression examined associations between high FeNO and age, sex, race/Hispanic origin, income status, weight status, tobacco smoke exposure, and other factors associated with asthma control (recent use of inhaled corticosteroids, recent respiratory illness, asthma-related respiratory signs/symptoms, and spirometry).RESULTSAbout 16.5% of youth with asthma had high FeNO. The prevalence of high FeNO was higher among non-Hispanic black (27%, P<0.001) and Hispanic (20.2%, P=0.002) youth than non-Hispanic white (9.7%) youth. Differences in high FeNO prevalence by sex (girls<boys), weight status (obese<normal weight), tobacco smoke exposure (smokers<home exposure<no exposure), and FEV1/FVC (normal<abnormal) were also observed. No differences were noted between categories for the remaining covariates.CONCLUSIONHigh FeNO was observed to be associated with sex, race/Hispanic origin, weight status, tobacco smoke exposure, and abnormal FEV1/FVC, but was not associated with asthma-related respiratory symptoms. These findings may help inform future research and clinical practice guidelines on the use of high FeNO in the assessment of asthma control.

Analyses of the Third National Health and Nutrition Examination Survey (NHANES III) in 1988 to 1994 found an association of increasing blood lead levels < 10 μg/dL with a higher risk of cardiovascular disease (CVD) mortality. The potential need to correct blood lead for hematocrit/hemoglobin and adjust for biomarkers for other metals, for example, cadmium and iron, had not been addressed in the previous NHANES III-based studies on blood lead-CVD mortality association. We analyzed 1999 to 2010 NHANES data for 18,602 participants who had a blood lead measurement, were ≥ 40 years of age at the baseline examination and were followed for mortality through 2011. We calculated the relative risk for CVD mortality as a function of hemoglobin- or hematocrit-corrected log-transformed blood lead through Cox proportional hazard regression analysis with adjustment for serum iron, blood cadmium, serum C-reactive protein, serum calcium, smoking, alcohol intake, race/Hispanic origin, and sex. The adjusted relative risk for CVD mortality was 1.44 (95% confidence interval = 1.05, 1.98) per 10-fold increase in hematocrit-corrected blood lead with little evidence of nonlinearity. Similar results were obtained with hemoglobin-corrected blood lead. Not correcting blood lead for hematocrit/hemoglobin resulted in underestimation of the lead-CVD mortality association while not adjusting for iron status and blood cadmium resulted in overestimation of the lead-CVD mortality association. In a nationally representative sample of U.S. adults, log-transformed blood lead was linearly associated with increased CVD mortality. Correcting blood lead for hematocrit/hemoglobin and adjustments for some biomarkers affected the association.

In 2014, Ebola virus disease (EVD) in West Africa was first reported during March in 3 southeastern prefectures in Guinea; from there, the disease rapidly spread across West Africa. We describe the epidemiology of EVD cases reported in Guinea's capital, Conakry, and 4 surrounding prefectures (Coyah, Dubreka, Forecariah, and Kindia), encompassing a full year of the epidemic. A total of 1,355 EVD cases, representing ≈40% of cases reported in Guinea, originated from these areas. Overall, Forecariah had the highest cumulative incidence (4× higher than that in Conakry). Case-fatality percentage ranged from 40% in Conakry to 60% in Kindia. Cumulative incidence was slightly higher among male than female residents, although incidences by prefecture and commune differed by sex. Over the course of the year, Conakry and neighboring prefectures became the EVD epicenter in Guinea.