OBJECTIVE:This study aimed to examine the correspondence between seven established risk factors for coronary heart disease (CHD) and CHD mortality among the states in the United States. An ecologic analysis relating CHD risk factor prevalences to CHD mortality rates among 49 states was undertaken in 1991-1992.METHODS:Approximately 68,000 men and women ages 45-74 were randomly sampled and interviewed by telephone in surveys conducted in 49 states in 1991 and 1992. From these interviews, we estimated state-specific prevalences of smoking, overweight, physical inactivity, hypertension, elevated cholesterol, diabetes, and alcohol abstinence. These seven CHD risk factors were also combined to create a CHD risk index for each state. The main outcome measures were mortality rates from CHD (ICD9 codes 410.0-414.9) in each of 49 states in 1991-1992 for men and women ages 45-74. The analysis was based on multiple linear regression and Spearman's rank-order correlations between the CHD risk factor prevalences, the combined CHD risk index, and the CHD mortality rates among the 49 states.RESULTS:The prevalences of most of the CHD risk factors correlated with CHD mortality rates in the expected directions, and correlations were similar for men and women. The CHD risk index correlated strongly with CHD mortality for both men (r = 0.75) and women (r = 0.80).CONCLUSION:About 60% of the variance in CHD mortality between the states in the United States (56% for men and 64% for women) is attributable to differences between the states in the prevalences of seven established risk factors for CHD. As state health agencies prioritize resources for chronic disease prevention programs, they should consider the potential benefits of increased efforts to reduce the prevalences of modifiable CHD risk factors in their populations to reduce CHD mortality.

Clinical research has established that increases in physical activity cause weight loss among the obese, but less is known about the influence of physical activity on longer-term weight change in the general population. Data from the NHANES-I Epidemiologic Follow-up Study (1971-1975 to 1982-1984) were used to examine the relationship between self-reported recreational physical activity level (low, medium, high) and measured weight change after ten years among 3515 men and 5810 women aged 25-74 years. Cross-sectional analyses at both the baseline and follow-up surveys revealed that recreational physical activity was inversely related to body weight. Low recreational physical activity reported at the follow-up survey was strongly related to major weight gain (>13 kg) that had occurred during the preceding ten years. The estimated relative risk of major weight gain for those in the low activity level at the follow-up survey compared to those in the high activity level was 3.1 (95% CI = 1.6-6.0) in men and 3.8 (2.3-6.5) in women. In addition, the relative risk for persons whose activity level was low at both the baseline and follow-up surveys was 2.3 (0.9-5.8) in men and 7.1 (2.2-23.3) in women. However, no relationship was found between baseline physical activity level and subsequent weight gain among either men or women. The lack of a relationship may be due to mis-specification of physical activity because of changes in activity over time. These findings suggest that low physical activity may be both a cause and a consequence of weight gain. Prospective studies with more frequent measurement of both physical activity and body weight are needed to better describe the temporal relationship between physical activity and weight change in the general population.

To examine trends in alcohol consumption among pregnant women, we examined data collected from 21 states participating in the Behavioral Risk Factor Surveillance System for 4 consecutive years: 1985 through 1988. Overall, 429 (25%) of 1712 pregnant women and 19,903 (55%) of 36,057 nonpregnant women 18 to 45 years of age reported using alcohol in the previous month. Pregnant women who used any alcohol reported consuming a median of four drinks per month, whereas nonpregnant women who used any alcohol reported nine. The prevalence of alcohol consumption among pregnant women declined steadily, from 32% in 1985 to 20% in 1988, but the median number of drinks per month for pregnant women who drank did not change. No decline was observed among the less educated or those under the age of 25 years. In 1988, the prevalence of alcohol use among pregnant women remained highest among smokers (37%) and the unmarried (28%). Although the overall consumption of alcohol by pregnant women in the United States appears to be declining, special efforts are needed to reduce alcohol use among pregnant women who are smokers, unmarried, less educated, or younger, women who may already be at high risk of a poor pregnancy outcome.