OBJECTIVE:This study examined the racial and ethnic differences in individuals with self-reported and doctor-diagnosed arthritis, severe joint pain, and provider counseling for physical activity among US adults with arthritis. METHODS:We estimated prevalence by race and ethnicity among 31,997 adults aged ≥18 years in the 2019 National Health Interview Survey. We used multiple logistic regression models to investigate associations between outcomes and race and ethnicity. RESULTS:Compared with non-Hispanic White adults (22.9%), we found a significantly higher age-adjusted prevalence of arthritis among American Indian/Alaska Native adults (30.3%). Among adults with arthritis, higher age-adjusted prevalence of severe joint pain among American Indian/Alaska Native (39.1%), non-Hispanic Black (36.4%), and Hispanic adults (35.7% vs 22.5% [White]) and higher provider counseling for physical activity among non-Hispanic Black adults (58.9% vs 52.1% [White]) were observed and could not be fully explained by differences in socioeconomic factors, body mass index, depression history, and comorbid conditions. Additional models also containing inability to pay medical bills and food insecurity did not explain racial and ethnic differences. CONCLUSION:Our findings highlight a need for multilevel interventions to mitigate social and environmental barriers to physical activity and eliminate disparities in individuals with arthritis and severe joint pain.

We estimated the prevalence of respiratory symptoms, chronic obstructive pulmonary disease (COPD) risk level, and receipt of a breathing test among adults without reported COPD in 26 states and the District of Columbia by using 2017-2018 Behavioral Risk Factor Surveillance System data. Among adults without reported COPD, the 3 respiratory symptoms indicating COPD (chronic cough, phlegm or mucus production, shortness of breath) were common (each >10%). About 15.0% were at higher COPD risk (based on the number of symptoms, age, and smoking status); 41.4% of adults at higher risk reported receipt of a breathing test. Patient-provider recognition and communication of risk symptoms, appropriate screening, and follow-up are important for early diagnosis and treatment.

Objectives To examine the association between chronic obstructive pulmonary disease status and indicators of economic instability and stress to better understand the magnitude of these issues in persons with chronic obstructive pulmonary disease. Methods Analyzed 2017 Behavioral Risk Factor Surveillance System data from 16 states that administered the ‘Social Determinants of Health’ module, which included economic instability and stress measures ( N = 101,461). Associations between self-reported doctor-diagnosed chronic obstructive pulmonary disease status and each measure were examined using multinomial logistic models. Results Adults with chronic obstructive pulmonary disease were more likely ( p < 0.001) than adults without to report not having enough money at month end (21.0% vs. 7.9%) or just enough money (44.9% vs. 37.2%); being unable to pay mortgage, rent, or utility bills (19.2% vs. 8.8%); and that often or sometimes food did not last or could not afford to eat balanced meals (37.9% vs. 20.6%), as well as stress all or most of the time (27.3% vs. 11.6%). Associations were attenuated although remained significant after adjustments for sociodemographic and health characteristics. Discussion Financial, housing, and food insecurity and frequent stress were more prevalent in adults with chronic obstructive pulmonary disease than without. Findings highlight the importance of including strategies to address challenges related to economic instability and stress in chronic obstructive pulmonary disease management programs.

Subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent memory loss or confusion, might be a symptom of early-stage dementia or future serious cognitive decline such as Alzheimer disease* or a related dementia (ADRD) (1). Established modifiable risk factors for ADRD include high blood pressure, inadequate physical activity, obesity, diabetes, depression, current cigarette smoking, and hearing loss (2). An estimated 6.5 million persons aged ≥65 years in the United States live with Alzheimer disease, the most common dementia (1). This number is projected to double by 2060, with the largest increase among non-Hispanic Black or African American (Black), and Hispanic or Latino (Hispanic) adults (1,3). Using data from the Behavioral Risk Factor Surveillance System (BRFSS), CDC assessed racial and ethnic, select demographic, and geographical differences in SCD prevalence, and prevalence of health care professional conversations among those reporting SCD. The age-adjusted prevalence of SCD during 2015-2020 was 9.6% among adults aged ≥45 years (5.0% of Asian or Pacific Islander [A/PI] adults, 9.3% of non-Hispanic White [White] adults, 10.1% of Black adults, 11.4% of Hispanic adults, and 16.7% of non-Hispanic American Indian or Alaska Native [AI/AN] adults). College education was associated with a lower prevalence of SCD among all racial and ethnic groups. Only 47.3% of adults with SCD reported that they had discussed confusion or memory loss with a health care professional. Discussing changes in cognition with a physician can allow for the identification of potentially treatable conditions, early detection of dementia, promotion of dementia risk reduction behaviors, and establishing a treatment or care plan to help adults remain healthy and independent for as long as possible.

Depression is a major contributor to mortality, morbidity, disability, and economic costs in the United States (1). Examining the geographic distribution of depression at the state and county levels can help guide state- and local-level efforts to prevent, treat, and manage depression. CDC analyzed 2020 Behavioral Risk Factor Surveillance System (BRFSS) data to estimate the national, state-level, and county-level prevalence of U.S. adults aged ≥18 years self-reporting a lifetime diagnosis of depression (referred to as depression). During 2020, the age-standardized prevalence of depression among adults was 18.5%. Among states, the age-standardized prevalence of depression ranged from 12.7% to 27.5% (median = 19.9%); most of the states with the highest prevalence were in the Appalachian* and southern Mississippi Valley† regions. Among 3,143 counties, the model-based age-standardized prevalence of depression ranged from 10.7% to 31.9% (median = 21.8%); most of the counties with the highest prevalence were in the Appalachian region, the southern Mississippi Valley region, and Missouri, Oklahoma, and Washington. These data can help decision-makers prioritize health planning and interventions in areas with the largest gaps or inequities, which could include implementation of evidence-based interventions and practices such as those recommended by The Guide to Community Preventive Services Task Force (CPSTF) and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Abstract As the proportion of family and friends in the U.S. providing informal care increases, it is important to understand how this may impact certain demographic groups. Millennials and older adults are two generational segments of caregivers of interest given the complexities associated with these groups. Millennials can be sandwiched between a growing older population of parents or grandparents while also raising young children, often providing care for both. Similarly, older adults frequently balance caring for spouses, themselves, and grandchildren. We characterized these two groups of caregivers using 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS) data from the Caregiver Optional Module administered in 44 states, D.C., and Puerto Rico. Among 246,223 Module respondents, 21.3% reported providing care for a family member or friend. Among caregivers, 12.4% were identified as Millennials (aged 18-38 years), and 19.7% were older adults (aged≥65 years). About one-in-three Millennial caregivers reported providing care to a parent and half to another relative, such as a child or grandparent. While less than 4% of Millennial caregivers reported providing care for a spouse, nearly one-in-five older adult caregivers did. Although their care recipients may differ, both groups reported high intensity of care, with 30% of caregivers in each group providing 20 hours of care or more weekly. Caregiving among older adults can be further complicated by their own health difficulties, with over half of older adult caregivers reporting having two or more chronic conditions and one-third reporting a disability. BRFSS data may inform planning efforts pertaining to these caregiving groups.

Caregiving provides numerous benefits to both caregivers and care recipients; however, it can also negatively affect caregivers' mental and physical health (1-4), and caregiving tasks often require physical exertion (1). Approximately 44% of adults with arthritis report limitations attributable to arthritis, including trouble doing daily activities (5). These limitations might affect caregivers' ability to provide care, but little is known about arthritis among caregivers. To assess arthritis among caregivers of a family member or friend, CDC examined data from 17 states that administered both the arthritis and caregiving modules as part of the Behavioral Risk Factor Surveillance System (BRFSS) in either 2017 or 2019. Approximately one in five adults (20.6%) was a caregiver. Prevalence of arthritis was higher among caregivers (35.1%) than noncaregivers (24.5%). Compared with caregivers without arthritis, those with arthritis provided similar types of care and were more likely to have provided care for ≥5 years and for ≥40 hours per week. In addition, higher proportions of caregivers with arthritis reported disabilities compared with those without arthritis, including mobility issues (38.0% versus 7.3%). Arthritis among caregivers might affect their own health as well as the care they can provide. Caregivers can discuss their arthritis and related limitations with a health care professional to identify ways to increase their physical activity and participation in lifestyle management programs.* Such interventions might ease arthritis pain and related limitations and might support them in their ongoing caregiving role. Public health professionals can implement strategies to support caregivers throughout the caregiving process.†.

Alzheimer disease,* the most common cause of dementia, affects an estimated 6.5 million persons aged ≥65 years in the United States (1). A growing body of evidence has identified potential modifiable risk factors for Alzheimer disease and related dementias (ADRD) (1-3). In 2021, the National Plan to Address Alzheimer's Disease (National Plan) introduced a new goal to "accelerate action to promote healthy aging and reduce risk factors for Alzheimer's disease and related dementias" to help delay onset or slow the progression of ADRD (3). To assess the status of eight potential modifiable risk factors (i.e., high blood pressure, not meeting the aerobic physical activity guideline, obesity, diabetes, depression, current cigarette smoking, hearing loss, and binge drinking), investigators analyzed data from the cognitive decline module that was administered to adults aged ≥45 years in 31 states and the District of Columbia (DC)† in the 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey. Among the risk factors, prevalence was highest for high blood pressure (49.9%) and lowest for binge drinking (10.3%) and varied by selected demographic characteristics. Adults with subjective cognitive decline (SCD),§ an early indicator of possible future ADRD (4), were more likely to report four or more risk factors than were those without SCD (34.3% versus 13.1%). Prevalence of SCD was 11.3% overall and increased from 3.9% among adults with no risk factors to 25.0% among those with four or more risk factors. Implementing evidence-based strategies to address modifiable risk factors can help achieve the National Plan's new goal to reduce risk for ADRD while promoting health aging.¶,*.

Abstract Unpaid caregivers are people who provide support to a family member or friend with a health condition or disability. While there are benefits to caregiving, it can negatively affect caregivers’ physical and mental health. Arthritis and caregiving affect 58.5 million and 53 million U.S. adults, respectively, and these numbers are expected to increase with increasing numbers of older adults. Little is known about the experience of caregivers with arthritis.Data from the 2017 and 2019 BRFSS were combined for all states that administered the optional Caregiving and the core Arthritis modules (17 states; n=91,224). Analyses accounted for the complex sampling design using SUDAAN (version 11.0; RTI International). Statistical significance was determined at α=0.05.Overall, 20.6% of respondents were caregivers, among whom 35.1% had arthritis compared with 24.5% of non-caregivers (p < 0.001). Arthritis among caregivers was higher in all 17 states compared to non-caregivers. Among adults with arthritis, caregivers were more likely to be younger, female, White, and more physically active than non-caregivers. Caregivers were also more likely to experience arthritis-related activity and work limitations than non-caregivers. Arthritis-related limitation outcomes varied at the individual state levels.Among caregivers, those with arthritis provided more care in weekly hours and duration (years) and were more likely to report difficulty walking or climbing stairs, dressing or bathing, and doing errands alone than caregivers without arthritis. Given the disparities between caregivers with and without arthritis, it is crucial for public health to collect data on the experience of caregivers with arthritis.

Introduction: More than 3 of 5 U.S. adults who have ever smoked cigarettes have quit. This study assesses the latest estimates of smoking cessation among U.S. adults with and without chronic obstructive pulmonary disease who have ever smoked cigarettes (ever smokers). Methods: Data from 161,233 ever smokers (12.8% with chronic obstructive pulmonary disease) in the 2018 Behavioral Risk Factor Surveillance System were analyzed in 2020. Weighted percentages of quit ratios (percentage of ever smokers who quit smoking), past-year quit attempts (>= 1 day), and recent successful cessation (quit >= 6 months ago) by self-reported physician-diagnosed chronic obstructive pulmonary disease status were obtained from multivariable logistic regression analyses, with adjustment for sociodemographic characteristics, health risk behaviors, depression, and asthma. Results: Adults with chronic obstructive pulmonary disease who smoked had greater age-adjusted past-year quit attempts (68.8% vs 64.3%) but lower recent successful cessation (4.5% vs 5.8%) and quit ratio (53.2% vs 63.9%) than those without chronic obstructive pulmonary disease. After adjusting for covariates, adults with chronic obstructive pulmonary disease who smoked had a significantly higher percentage of past-year quit attempts but similar recent successful cessation and a significantly lower lifetime quit ratio than their counterparts without chronic obstructive pulmonary disease. Conclusions: These findings suggest that individuals with chronic obstructive pulmonary disease who try to quit smoking may be less likely to succeed than those without chronic obstructive pulmonary disease. Evidence-based treatments for smoking cessation remain an important component of a comprehensive approach to helping all adults to quit and are a particularly important element of chronic obstructive pulmonary disease management and care. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.

Chronic obstructive pulmonary disease (COPD) accounts for the majority of deaths from chronic lower respiratory diseases, the fourth leading cause of death in the United States in 2019.* COPD mortality rates are decreasing overall. Although rates in men remain higher than those in women, declines have occurred among men but not women (1). To examine the geographic variation in sex-specific trends in age-adjusted COPD mortality rates among adults aged ≥25 years, CDC analyzed 1999-2019 death certificate data, by urban-rural status,† U.S. Census Bureau region,§ and state. Among women, no significant change in overall COPD mortality occurred during this period; however, rates increased significantly in small metropolitan (average annual percent change [AAPC] = 0.6%), micropolitan (1.2%), and noncore (1.9%) areas and in the Midwest (0.6%). Rates decreased significantly in large central (-0.9%) and fringe metropolitan (-0.4%) areas (and in the Northeast (-0.5%) and West (-1.2%). Among men, rates decreased significantly overall (-1.3%), in all urban-rural areas (range = -1.9% [large central metropolitan] to -0.4% [noncore]) and in all regions (range = -2.0% [West] to -0.9% [Midwest]). Strategies to improve the prevention, treatment, and management of COPD are needed, especially to address geographic differences and improve the trend in women, to reduce COPD deaths.

Abstract Recent studies report that older minorities have a higher prevalence of subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent memory loss or confusion, than older non-Hispanic Whites. This study describes the prevalence of SCD by race/ethnicity and select demographic and social characteristics among U.S. adults aged ≥45 years and whether those reporting symptoms of SCD talked with a health care professional about them. Data collected from 215,406 respondents by the Behavioral Risk Factor Surveillance System (BRFSS) in 2015-2020 were used in the analyses. Statistical comparisons were made using chi-square tests and p value of < 0.05. SCD was reported by nearly 10% of the study population. Asian/Pacific Islanders (5.0%) were least likely to report experiences of SCD and American Indian/Alaska Natives (16.7%) were most likely to report the experience compared to other racial/ethnic groups. Among adults with SCD, Asian/Pacific Islander (34.5%) and Hispanic (40.5%) adults were less likely to talk with a health care professional about their SCD symptoms compared to non-Hispanic White (48.5), non-Hispanic Black (49.5%), and American Indian/Alaska Native (50.5%) adults. Early detection of SCD symptoms can be important to identify early signs of dementia or other potentially treatable conditions and establish a care plan to help people remain as healthy and independent for as long as possible. Health care professionals, especially those working with groups with increased prevalence of SCD, could consider initiating discussions with adults as young as 45 years of age to identify early signs of dementia-like symptoms.

Arthritis is associated with joint pain, disability, and physical inactivity, potentially resulting in poor quality of life. The Centers for Disease Control and Prevention analyzed 2019 Behavioral Risk Factor Surveillance System data to estimate state-specific arthritis prevalence and, among adults with arthritis, the prevalence of physical inactivity, fair/poor self-rated health status, and severe joint pain. Among adults with arthritis, age-standardized prevalences of physical inactivity, fair/poor health status, and severe joint pain were high in all states and highest in southeastern states. Increased promotion and use of evidence-based public health interventions for arthritis may improve health-promoting behaviors and health outcomes among adults with arthritis.

Generalized Linear Mixed Model (GLMM) has been widely used in small area estimation for health indicators. Bayesian estimation is usually used to construct statistical intervals, however, its computational intensity is a big challenge for large complex surveys. Frequentist approaches, such as bootstrapping, and Monte Carlo (MC) simulation, are also applied but not evaluated in terms of the interval magnitude, width, and the computational time consumed. The 2013 Florida Behavioral Risk Factor Surveillance System data was used as a case study. County-level estimated prevalence of three health-related outcomes was obtained through a GLMM; and their 95% confidence intervals (CIs) were generated from bootstrapping and MC simulation. The intervals were compared to 95% credential intervals through a hierarchial Bayesian model. The results showed that 95% CIs for county-level estimates of each outcome by using MC simulation were similar to the 95% credible intervals generated by Bayesian estimation and were the most computationally efficient. It could be a viable option for constructing statistical intervals for small area estimation in public health practice.

Background: Epilepsy is associated with a high prevalence of sleep disturbance. However, population-based studies on the burden of sleep disturbance in people with epilepsy are limited. This study assessed sleep duration and sleep quality by epilepsy status in the general U.S. adult population aged > 18 years. Methods: We pooled data of cross-sectional National Health Interview Surveys in 2013, 2015, and 2017 to compare the prevalence of sleep duration and quality among those without epilepsy (N = 93,126) with those with any epilepsy (a history of physician-diagnosed epilepsy) (N = 1774), those with active epilepsy (those with a history of physician-diagnosed epilepsy who were currently taking medication to control it, had one or more seizures in the past year, or both) (N = 1101), and those with inactive epilepsy (those with a history of physician-diagnosed epilepsy who were neither taking medication for epilepsy nor had had a seizure in the past year) (N = 673). We also compared these measures between those with active and those with inactive epilepsy. The prevalences were adjusted for sociodemographics, behaviors, and health covariates, with multivariable logistic regression. We used Z-tests to compare prevalences of sleep duration and quality at the statistical significance level of 0.05. Results: Adults with any epilepsy reported significantly higher adjusted prevalences of short sleep duration (<7 h) (36.0% vs. 31.8%) and long sleep duration (>9 h per day) (6.7% vs. 3.7%) but a lower prevalence of healthy sleep duration (7-9 h per day) (57.4% vs.64.6%) than those without epilepsy. In the past week, adults with any epilepsy reported significantly higher adjusted prevalences than adults without epilepsy of having trouble falling asleep (25.0% vs. 20.3%), staying asleep (34.4% vs. 26.3%), nonrestorative sleep (adults did not wake up feeling well rested) (>3 days) (50.3% vs. 44.3%), and taking medication to help themselves fall asleep or stay asleep (>1 times) (20.9% vs. 13.5%). However, adults with active epilepsy did not differ from adults with inactive epilepsy with respect to these sleep duration and quality measures. Conclusions: Adults with epilepsy reported more short or long sleep duration and worse sleep quality than those without epilepsy. Neither seizure occurrence nor antiepileptic drug use accounted for these differences in sleep duration and quality. Careful screening for sleep complaints as well as identifying and intervening on the modifiable risk factors associated with sleep disturbances among people with epilepsy could improve epilepsy outcomes and quality of life. (c) 2021 Published by Elsevier Inc.

Purpose: To examine primary care providers' (PCPs) physical activity assessment and recommendation behaviors for adults with arthritis. Design: Cross-sectional. Setting: 2018 DocStyles online national market research survey of US physicians and nurse practitioners. Sample: 1,389 PCPs seeing adults with arthritis. Measures: 2 independent behaviors (assessment and recommendation) as 3 non-mutually exclusive groups: “always assesses,” “always recommends,” and “both” (“always assesses and recommends”). Analysis: Calculated percentages of each group (overall and by PCP characteristics), and multivariable-adjusted prevalence ratios (PRs) using binary logistic regression. Results: Among PCPs, 49.2% always assessed and 57.7% always recommended physical activity; 39.7% did both. Across all 3 groups, percentages were highest for seeing ≥20 adults with arthritis weekly (“both”: 56.4%; “always assesses”: 66.7%; “always recommends”: 71.3%) and lowest among obstetrician/gynecologists (“both”: 26.9%; “always assesses”: 36.8%; “always recommends”: 40.7%). Multivariable-adjusted associations were strongest for seeing ≥20 adults with arthritis weekly (referent: 1-9 adults) and each of “always assesses” (PR = 1.5 [95% confidence interval (CI): 1.3−1.8] and “both” (PR = 1.6 [95% CI: 1.4−1.9]). Conclusions: Approximately 40% of PCPs sampled always engaged in both behaviors (assessing and recommending physical activity) with adults with arthritis; seeing a high volume of adults with arthritis was consistently related to engaging in each behavior. Evidence-based approaches to support PCP counseling include offering provider education and training, raising awareness of available resources, and using health system supports.

Sleep disorder symptoms (trouble falling asleep or staying asleep, unintentionally falling asleep, snoring loudly, and episodes of having stopped breathing) among US adults (N = 59,108) from 8 states and the District of Columbia were analyzed by using data from the 2017 Behavioral Risk Factor Surveillance System. We conducted a multivariable logistic regression to assess the association between the 4 symptoms and sociodemographic characteristics, risk behaviors, and chronic conditions. The 4 symptoms were prevalent and more likely to be reported among adults with any chronic condition(s) than their counterparts without symptoms and among those who slept fewer than 7 hours compared with those who slept 7 to 9 hours.