National Health Interview Survey Participants Research Articles

Disparities in Smoking and Heavy Drinking Behaviors by Disability Status and Age of Disability Onset: Secondary Analysis of National Health Interview Survey Data.

People with childhood-onset disabilities are living into adulthood, and the prevalence of smoking and illicit drug use among adults with disabilities is high. We evaluated the relationship between disability status and age of disability onset, current cigarette smoking status, and heavy alcohol drinking. We conducted a secondary data analysis of the National Health Interview Survey (NHIS), a US survey on illness and disability. Among 2020 NHIS participants aged 22-80 years (n = 28 225), we compared self-reported prevalence of current cigarette smoking and heavy alcohol drinking among those with and without disabilities and among those with childhood- versus adult-onset disabilities. We used adjusted logistic regression analysis to calculate the adjusted odds ratios (AORs) of current smoking and heavy alcohol drinking based on disability status and age of disability onset. Compared with adults without disabilities, adults with disabilities were significantly more likely to report current smoking (23.5% vs 11.2%; P < .001) and significantly less likely to report heavy alcohol drinking (5.3% vs 7.4%; P = .001). The prevalence of these behaviors did not vary significantly by age of disability onset. In adjusted logistic regression models, adults with disabilities had significantly higher odds of current smoking (AOR = 1.76; 95% CI, 1.53-2.03) and similar odds of heavy alcohol drinking (AOR = 0.82; 95% CI, 0.65-1.04) compared with adults without disabilities. The odds of these health behaviors did not vary significantly by age of disability onset. Adults with disabilities overall may be at high risk for these unhealthy behaviors, particularly smoking, regardless of age of disability onset. Routine screening and cessation counseling related to smoking and unhealthy alcohol use are important for all people with disabilities.

Association of cerebral palsy with autism spectrum disorder and attention-deficit/hyperactivity disorder in children: a large-scale nationwide population-based study

ObjectiveTo examine the association of cerebral palsy with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), providing evidence for interdisciplinary medical service for children with cerebral palsy.DesignA large-scale nationwide population-based...

Abstract P385: Comparison of Food Insecurity Classifications and Associations With Premature Cardiovascular Disease Mortality Among US Adults

Background: Food security is usually measured with the 10-item US Adult Food Security Survey Module (FSSM). Shorter 6- or 2-item tools may capture similar information, but this has not been validated with hard endpoints. Hypothesis: We hypothesize a 2-item food security instrument reflects the same premature mortality risk as 10- and 6-item instruments. Methods: We included 37,027 participants aged 20-74 years from the National Health and Nutrition Examination Survey (NHANES) 2004-2018, linked to the National Death Index with follow-up through 2019. Cardiovascular disease (CVD) mortality was ascertained by ICD-10 codes for heart disease or stroke. Food security was assessed by the 10-item FSSM, which can derive 6- and 2-item instruments. Multivariable Cox regression was used to assess the associations of food insecurity classifications with risks of premature all-cause and CVD mortality. We calculated C-statistics to estimate model discrimination. We repeated the analyses among 218,136 participants from the National Health Interview Survey (NHIS) 2011-2018. Results: During a mean 7.8-year follow-up, 2025 premature deaths (512 from CVD) were recorded in NHANES. In age-sex-race/ethnicity-adjusted models (Model 1), food insecurity with any classification was strongly associated with premature all-cause and CVD mortality (Table). After adjusting for confounders (Model 2), associations were attenuated but remained statistically significant. After further including potential mediators (Model 3), associations diminished, suggesting pathways by which food insecurity is associated with mortality. Hazard ratios and C-statistics were nearly identical comparing 10-, 6-, and 2-item instruments. Results were equivalent among NHIS participants during a mean 5.0-year follow-up including 7025 premature deaths (1711 from CVD). Conclusions: Among two independent samples of US adults, a 2-item food security instrument is equivalently associated with premature mortality compared with 10- and 6-item instruments.

Comparing Lung Cancer Screening Strategies in a Nationally Representative US Population Using Transportability Methods for the National Lung Cancer Screening Trial

The National Lung Screening Trial (NLST) found that screening for lung cancer with low-dose computed tomography (CT) reduced lung cancer-specific and all-cause mortality compared with chest radiography. It is uncertain whether these results apply to a nationally representative target population. To extend inferences about the effects of lung cancer screening strategies from the NLST to a nationally representative target population of NLST-eligible US adults. This comparative effectiveness study included NLST data from US adults at 33 participating centers enrolled between August 2002 and April 2004 with follow-up through 2009 along with National Health Interview Survey (NHIS) cross-sectional household interview survey data from 2010. Eligible participants were adults aged 55 to 74 years, and were current or former smokers with at least 30 pack-years of smoking (former smokers were required to have quit within the last 15 years). Transportability analyses combined baseline covariate, treatment, and outcome data from the NLST with covariate data from the NHIS and reweighted the trial data to the target population. Data were analyzed from March 2020 to May 2023. Low-dose CT or chest radiography screening with a screening assessment at baseline, then yearly for 2 more years. For the outcomes of lung-cancer specific and all-cause death, mortality rates, rate differences, and ratios were calculated at a median (25th percentile and 75th percentile) follow-up of 5.5 (5.2-5.9) years for lung cancer-specific mortality and 6.5 (6.1-6.9) years for all-cause mortality. The transportability analysis included 51 274 NLST participants and 685 NHIS participants representing the target population (of approximately 5 700 000 individuals after survey-weighting). Compared with the target population, NLST participants were younger (median [25th percentile and 75th percentile] age, 60 [57 to 65] years vs 63 [58 to 67] years), had fewer comorbidities (eg, heart disease, 6551 of 51 274 [12.8%] vs 1 025 951 of 5 739 532 [17.9%]), and were more educated (bachelor's degree or higher, 16 349 of 51 274 [31.9%] vs 859 812 of 5 739 532 [15.0%]). In the target population, for lung cancer-specific mortality, the estimated relative rate reduction was 18% (95% CI, 1% to 33%) and the estimated absolute rate reduction with low-dose CT vs chest radiography was 71 deaths per 100 000 person-years (95% CI, 4 to 138 deaths per 100 000 person-years); for all-cause mortality the estimated relative rate reduction was 6% (95% CI, -2% to 12%). In the NLST, for lung cancer-specific mortality, the estimated relative rate reduction was 21% (95% CI, 9% to 32%) and the estimated absolute rate reduction was 67 deaths per 100 000 person-years (95% CI, 27 to 106 deaths per 100 000 person-years); for all-cause mortality, the estimated relative rate reduction was 7% (95% CI, 0% to 12%). Estimates of the comparative effectiveness of low-dose CT screening compared with chest radiography in a nationally representative target population were similar to those from unweighted NLST analyses, particularly on the relative scale. Increased uncertainty around effect estimates for the target population reflects large differences in the observed characteristics of trial participants and the target population.

Sociodemographic Factors, Leisure-Time Physical Activity and Mortality

Exploring sociodemographic effect modification is important to provide evidence for developing targeted recommendations and reducing health inequalities. This study evaluated how sociodemographic factors including age, sex, race/ethnicity and socioeconomic status (SES) modify the association between leisure-time physical activity (LTPA) and all-cause and major cause-specific mortality. The study sample included 471,992 people from the 1997-2018 National Health Interview Survey (NHIS) and 41,830 people from the 1999-2018 National Health and Nutrition Examination Survey (NHANES). Data were analyzed in December 2022. Mortality data from the National Death Index were available to December 31, 2019. Sufficient LTPA was defined as at least 150 minutes of moderate and/or vigorous intensity per week. There were 46,289 deaths in NHIS participants and 4,617 deaths in NHANES participants during a mean follow-up of 10 years. Individuals with sufficient LTPA had lower risk of all-cause (NHIS: hazard ratio, 0.74, 95% CI: [0.74-0.74]; NHANES: 0.73 [0.68-0.79]) and cardiovascular mortality (NHIS: 0.75 [0.75-0.75]; NHANES: 0.80 [0.69-0.93]) compared with inactive participants. The subgroup analysis showed significant interactions between LTPA and all sociodemographic factors. Associations between LTPA and mortality were weaker among younger individuals, males, Hispanic adults or those of low SES, respectively. Sociodemographic factors significantly modified the associations between LTPA and mortality. The health benefits of sufficient LTPA were smaller in younger individuals, males, Hispanic adults or those of low SES. These findings can help identify target populations for promotion of physical activity to reduce health inequalities and the development of physical activity guidelines.

Cost–related medication nonadherence in US adults with asthma: The National Health Interview Survey, 2013-2020

BackgroundAsthma is a chronic disease that needs long-term control for secondary prevention. Health-related expenditures resulting from asthma are rising in the United States, and medication nonadherence is associated with adverse health outcomes in patients with asthma. ObjectiveTo estimate the prevalence and risk factors of cost–related medication nonadherence (CRN) in individuals with asthma in the United States. MethodsWe identified patients aged above or equal to 18 years with a history of asthma in nationally representative cross-sectional data, the National Health Interview Survey 2013 to 2020. Participants were considered to have experienced CRN if at any time in the 12 months they reported skipping doses, taking less medication, or delaying filling a prescription to save money. The weighted prevalence of CRN was estimated overall and by subgroups. Logistic regression was used to identify CRN-related characteristics. ResultsOf the 26,539 National Health Interview Survey participants with a history of asthma, 4360 (15.77%; representing 3.92 million of the US population) reported CRN, with 10.12% (weighted 2.51 million) of patients skipping doses to save money, 10.82% (weighted 2.69 million) taking less medication to save money, and 13.35% (weighted 3.31 million) delaying filling a prescription to save money. The subgroups young, women, low income, no health insurance, currently smoking, and with comorbidities had a higher prevalence of CRN. The results of this sensitivity analysis did not differ from the overall results. ConclusionIn the United States, 1 in 6 adults with a history of asthma is nonadherence with medications due to costs. Removing financial barriers to accessing medication can improve medication adherence in patients with asthma.

Cost-Related Medication Nonadherence in Adults With Diabetes in the United States: The National Health Interview Survey 2013-2018.

Health-related expenditures resulting from diabetes are rising in the U.S. Medication nonadherence is associated with worse health outcomes among adults with diabetes. We sought to examine the extent of reported cost-related medication nonadherence (CRN) in individuals with diabetes in the U.S. We studied adults age ≥18 years with self-reported diabetes from the National Health Interview Survey (NHIS) (2013-2018), a U.S. nationally representative survey. Adults reporting skipping doses, taking less medication, or delaying filling a prescription to save money in the past year were considered to have experienced CRN. The weighted prevalence of CRN was estimated overall and by age subgroups (<65 and ≥65 years). Logistic regression was used to identify sociodemographic characteristics independently associated with CRN. Of the 20,326 NHIS participants with diabetes, 17.6% (weighted 2.3 million) of those age <65 years reported CRN, compared with 6.9% (weighted 0.7 million) among those age ≥65 years. Financial hardship from medical bills, lack of insurance, low income, high comorbidity burden, and female sex were independently associated with CRN across age groups. Lack of insurance, duration of diabetes, current smoking, hypertension, and hypercholesterolemia were associated with higher odds of reporting CRN among the nonelderly but not among the elderly. Among the elderly, insulin use significantly increased the odds of reporting CRN (odds ratio 1.51; 95% CI 1.18, 1.92). In the U.S., one in six nonelderly and one in 14 elderly adults with diabetes reported CRN. Removing financial barriers to accessing medications may improve medication adherence among these patients, with the potential to improve their outcomes.

Emergency Department Visits, Related Hospitalizations, and Reasons for Emergency Department Utilization After Traumatic Spinal Cord Injury

ObjectiveTo identify the self-reported frequency of emergency department (ED) visits, ED-related hospitalizations, and reasons for ED visits among people with traumatic spinal cord injury (SCI) and compare them with general population data from the same geographic area. DesignCross-sectional. SettingA specialty hospital in the Southeastern United States. ParticipantsThe participants (N=648) were community-dwelling adults (18 years and older) with a traumatic SCI, who were at least 1 year postinjury. A comparison group of 9728 individuals from the general population was retrieved from the 2017 National Health Interview Survey (NHIS). InterventionsNot applicable. Main Outcome MeasuresParticipants completed self-report assessments on ED visits, ED hospitalizations, and reasons for ED visits in the past 12 months using items from the NHIS. ResultsA total of 37% of participants with SCI reported at least 1 ED visit, and 18% reported at least 1 ED hospitalization in the past 12 months. Among those having at least 1 ED visit, 49% were admitted to hospitals. After controlling for sex, age, and race/ethnicity, participants with SCI were 151% more likely to visit the ED (odds ratio [OR], 2.51) and 249% more likely to have at least 1 ED hospitalization than the NHIS sample (OR, 3.49). Persons with SCI had a higher percentage of ED visits because of severe health conditions, reported an ED was the closest provider, and were more likely to arrive by ambulance. NHIS participants were more likely to visit the ED because no other option was available. ConclusionsCompared with those in the general population, individuals with SCI have substantially higher rates of ED visits, yet ED visits are not regularly assessed within the SCI Model Systems. ED visits may indicate the need for intervention beyond the acute condition leading directly to the ED visits and an opportunity to link individuals with resources needed to maintain function in the community.

Cost-Related Medication Nonadherence in a Nationally Representative US Population with Self-Reported Glaucoma

To determine the rates of cost-related nonadherence to medications among US adults with glaucoma and to determine if participants with glaucoma have more cost-related medication nonadherence than those without glaucoma. Cross-sectional study. Participants in the 2016-2017 National Health Interview Survey (NHIS), a cross-sectional survey regarding health topics that is administered annually to a nationally representative sample of noninstitutionalized adults in the United States. We calculated proportions of NHIS participants with and without self-reported glaucoma who reported cost-related nonadherence over the previous 12 months. We analyzed responses to 7 survey items that dealt with medication cost-related issues to any/all of a participants' medication: couldn't afford a prescribed medication; skipped medication doses to save money; took less medicine to save money; delayed filling a prescription to save money; asked doctor for lower cost medication to save money; bought prescription drugs from another country to save money; used alternative therapies to save money. We performed univariable and multivariable logistic regression to evaluate the association between self-reported glaucoma diagnosis and responses to these selected questions. Proportion of participants with and without self-reported glaucoma who reported cost-related nonadherence. Participants with glaucoma reported they could not afford prescribed medication more frequently than participants without glaucoma (8.2% vs. 6.4% P= 0.024). Adjusted predicted proportions from a multivariable model demonstrated that participants with glaucoma responded that they had greater cost-related barriers to medication access. In this nationally representative sample of the US population, after adjustment for confounding variables, participants with glaucoma more frequently reported cost-related nonadherence to medications compared with participants without glaucoma. Providers prescribing medication to patients with glaucoma should be aware of these findings and consider the impact of medication cost on their patients' ability to adhere to therapy.

Meditation and Cardiovascular Health in the US

The 2017 American Heart Association Scientific Statement on meditation and cardiovascular risk suggested that meditation may be considered as an adjunct to guideline-directed cardiovascular risk-reduction interventions. Meditation could potentially increase physical and mental relaxation, leading to improved outcomes after a major cardiovascular event. We hypothesized that meditation is associated with lower cardiovascular risk in the US general population. Using data from the 2012 and 2017 National Health Interview Survey, we identified all patients with hypercholesterolemia, systemic hypertension (SH), diabetes mellitus (DM), stroke, and coronary artery disease (CAD), as well as those who reported that they meditate. Multivariable logistic regression analyses were performed to evaluate the association between meditation and risk of hypercholesterolemia, SH, DM, stroke, and CAD, adjusting for potential confounders. Of 61,267 the National Health Interview Survey participants, 5,851 (9.6%) participated in some form of meditation. After adjusting for age, gender, body mass index, race, marital status, cigarette smoking, sleeping duration, and depression, meditation was independently associated with a lower prevalence of hypercholesterolemia (odds ratio [OR] 0.65; 95% confidence interval [CI] 0.54 to 0.79; p = 0.001), SH (OR 0.86; 95% CI 0.75 to 0.99; p = 0.04), diabetes (OR 0.70; 95% CI 0.59 to 0.84; p = 0.0001), stroke (OR 0.76; 95% CI 0.58 to 0.99; p = 0.04), or CAD (OR 0.51; 95% CI 0.39 to 0.66; p <0.001), compared with those who did not meditate. In conclusion, using a large national database, we found that meditation is associated with a lower prevalence of cardiovascular risks factors and disease.

Associations of Food Allergy and Other Allergic Conditions with Attention Deficit/Hyperactivity Disorder in US Children (P16-032-19)

ObjectivesAssociation between allergic conditions and attention deficit/hyperactivity disorder (ADHD) is still debated. Although there are several studies confirmed associations between ADHD and allergic rhinitis and asthma, little is known about the association between food allergy and ADHD. We examined the association of food allergy and other allergic conditions with ADHD in US children. MethodsWe analyzed data from the National Health Interview Survey (NHIS), a nationally representative annual survey of US population. We included 192,349 children aged 4–17 years old among NHIS participants from 1997 to 2017. Food allergy, respiratory allergy, skin allergy, and ADHD was defined based on an affirmative response in the questionnaire. Logistic regression with sample weights was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of ADHD. ResultsThe prevalence of ADHD was higher among children with allergic conditions: 12.64% versus 7.98% among children with and without food allergy (P < 0.001); 12.17% versus 7.62% among children with and without respiratory allergy; and 11.42% versus 7.8% among children with and without skin allergy. After adjustment for age, sex, race/ethnicity, family highest education level, family income level, geographical region, and mutually for other allergic conditions, the OR of ADHD was 1.52 (1.38–1.69) (P < 0.001) among children with versus without food allergy, 1.42 (1.34–1.50) (P < 0.001) among children with versus without respiratory allergy, and 1.57 (1.48–1.68) (P < 0.001) among children with versus without skin allergy. ConclusionsIn a nationally representative sample of US children, we found a significant and positive association of common allergic conditions, in particular food allergy, with ADHD. Funding SourcesNone.

PB1735 POSTDIAGNOSIS SMOKING WITH RISK OF ALL‐CAUSE AND CANCER MORTALITY AMONG LEUKEMIA SURVIVORS: A PROSPECTIVE COHORT STUDY

Background:Smoking is associated with higher leukemia risk, but smoking and risk of all‐cause and cancer mortality among leukemia survivors is unclear.Aims:To evaluate more thoroughly the risk of all‐cause and cancer mortality between cigarette smoking and leukemiaMethods:We identified 316 subjects who were diagnosed with leukemia from National Health Interview Survey participants≥18 years of age from 13 cross‐sectional waves conducted during 1997 to 2009 (linked to mortality data in 2015) at baseline. Cox proportional hazards regression models were used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the risk of all‐cause and cancer mortality caused by smoking exposure.Results:After a median follow‐up of 13 years, 141 (50%) were alive and 141 (50%) died due to all‐cause mortality during the follow‐up. Of all the patients who died, 70 (50%) died due to cancer and 20 (14%) died due to cardiovascular disease (CVD). Compared to never smokers, former smoking could increase the risk of cancer mortality (HR, 1.95; 95%CI, 1.04‐3.68), especially for those who quit smoking recently (HR, 2.59; 95%CI, 1.17‐5.74). For cancer mortality, dose relationship was obvious among former smokers who had quit more recently than for those who had quit earlier with a “U” shaped curve (Ptrend &lt; 0.05). Current smokers who smoke less than 10 cigarettes per day had higher risk of cancer mortality (HR, 3.72; 95%CI, 1.01‐13.73) than never smoking when patients with a history of CVD were excluded.Summary/Conclusion:This study adds to the existing evidence that cigarette smoking is associated with higher cancer mortality among leukemia patients, especially for former smokers.image

A retrospective cohort study on the risk of stroke in relation to a priori health knowledge level among people with type 2 diabetes mellitus in Taiwan

BackgroundIntervention of diabetes care education with regular laboratory check-up in outpatient visits showed long-term benefits to reduce the risk of macrovascular complications among people with type 2 diabetes. However, research on the level of a priori health knowledge to the prevention of diabetic complications in community settings has been scarce. We therefore aimed to investigate the association of health knowledge and stroke incidence in patients with type 2 diabetes in Taiwan.MethodsA nationally representative sample of general Taiwanese population was selected using a multistage systematic sampling process from Taiwan National Health Interview Survey (NHIS) in 2005. Subjects were interviewed by a standardized face-to-face questionnaire in the survey, obtaining information of demographics, socioeconomic status, family medical history, obesity, health behaviors, and 15-item health knowledge assessment. The NHIS dataset was linked to Taiwan National Health Insurance claims data to retrieve the diagnosis of type 2 diabetes in NHIS participants at baseline and identify follow-up incidence of stroke from 2005 to 2013. Univariate and multivariate Cox regressions were used to estimate the effect of baseline health knowledge level to the risk of stroke incidence among this group of people with type 2 diabetes.ResultsA total of 597 diabetic patients with a mean age of 51.28 years old and nearly half of males were analyzed. During the 9-year follow-up period, 65 new stroke cases were identified among them. Kaplan–Meier curves comparing the three groups of low/moderate/high knowledge levels revealed a statistical significance (p-value of log-rank test <0.01). After controlling for potential confounders, comparing to the group of low health knowledge level, the relative risk of stroke was significantly lower for those with moderate (adjusted hazard ratio [AHR] = 0.63; 95% CI, 0.33–1.19; p-value = 0.15) and high level of health knowledge (AHR = 0.43; 95% CI, 0.22–0.86; p-value = 0.02), with a significant linear trend (p-value = 0.02).ConclusionsAn exposure-response gradient of moderate to high health knowledge levels to the prevention of stroke incidence among people with type 2 diabetes in community was found with 9 years of follow-up in Taiwan. Development and delivery of health education on stroke prevention to people with type 2 diabetes are warranted.

Toward Enhancing Treatment for Pregnant Smokers: Laying the Groundwork for the Use of Complementary and Alternative Medicine Approaches.

Although effective treatments exist, most women who smoke during pregnancy neither seek nor receive treatment. Complementary and alternative medicine (CAM) treatments (eg, mindfulness, yoga, and acupuncture) may be attractive, low-cost options that can be used to assist a large proportion of pregnant women with smoking cessation. This study examined participant characteristics and treatment utilization among pregnant smokers in the National Survey on Drug Use and Health (NSDUH) and the National Health Interview Survey (NHIS) in order to explore the prevalence and predictors of CAM use for any purpose within this population. Results indicated that a considerable proportion (6.9%-29.1%) of pregnant smokers are already accessing CAM, particularly Whites and those of greater socioeconomic status. Use of yoga, meditation, and massage increased across study waves. NSDUH participants were most likely to report seeking chiropractic or massage therapy; NHIS participants most frequently reported use of herbs/supplements, deep breathing, and meditation. Up to roughly a quarter of women endorsed traditional/conventional and CAM treatment use, suggesting that some pregnant smokers are open to trying a variety of approaches to promote health. Further research is needed to validate CAM treatments for smoking cessation and to guide safety and treatment recommendations during pregnancy. CAM treatments may be an attractive treatment alternative for pregnant smokers. However, no previous investigations have examined whether pregnant smokers seek out these treatments. Using nationally representative survey data, the present study aimed to explore whether pregnant smokers use CAM treatments. We found that approximately 7%-29% of pregnant smokers reported using a variety of CAM methods, suggesting the need for further investigation into the efficacy and dissemination of CAM for smoking in pregnancy.

Prevalence of work-site injuries and relationship between obesity and injury among U.S. workers: NHIS 2004–2012

Introduction: Studies have reported associations between obesity and injury in a single occupation or industry. Our study estimated the prevalence of work-site injuries and investigated the association between obesity and work-site injury in a nationally representative sample of U.S. workers. Methods: Self-reported weight, height, and injuries within the previous three months were collected annually for U.S. workers in the National Health Interview Survey (NHIS) from 2004–2012. Participants were categorized as normal weight (BMI: 18.5–24.9kg/m2), overweight (BMI: 25.0–29.9), obese I (BMI: 30.0–34.9), and obese II (BMI: 35+). The prevalence of injury and prevalence ratios from fitted logistic regression models was used to assess relationships between obesity and injury after adjusting for covariates. Sampling weights were incorporated using SUDAAN software. Results: During the 9-year study period from 2004 to 2012, 1120 workers (78 workers per 10,000) experienced a work-related injury during the previous three months. The anatomical sites with the highest prevalence of injury were the back (14.3/10,000±1.2), fingers (11.5±1.3), and knees (7.1±0.8). The most common types of injuries were sprains/strains/twists (41.5% of all injuries), cuts (20.0%), and fractures (11.8%). Compared to normal weight workers, overweight and obese workers were more likely to experience work-site injuries [overweight: PR=1.25 (95% CI=1.04–1.52); obese I: 1.41 (1.14–1.74); obese II: 1.68 (1.32–2.14)]. These injuries were more likely to affect the lower extremities [overweight: PR=1.48, (95% CI=1.03–2.13); obese I: 1.70 (1.13–2.55); obese II: 2.91 (1.91–4.41)] and were more likely to be due to sprains/strains/twists [overweight: PR=1.73 (95% CI=1.29–2.31); obese I: PR=2.24 (1.64–3.06); obese II: PR=2.95 (2.04–4.26)]. Conclusions: Among NHIS participants, overweight and obese workers were 25% to 68% more likely to experience injuries than normal weight workers. Practical applications: Weight reduction policies and management programs may be effectively targeted towards overweight and obese groups to prevent or reduce work-site injuries.

Impact of Maternal Vitamin D Insufficiency on Neonatal Bone and Fat Mass

Impact of Maternal Vitamin D Insufficiency on Neonatal Bone and Fat Mass

Treat or Eat: Food Insecurity, Cost-related Medication Underuse, and Unmet Needs

BackgroundAdults with chronic disease are often unable to meet medication and food needs, but no study has examined the relationship between cost-related medication underuse and food insecurity in a nationally representative sample. We examined which groups most commonly face unmet food and medication needs. MethodsCross-sectional analysis of data from chronically ill participants (self-report of arthritis, diabetes mellitus, cancer, asthma, chronic obstructive pulmonary disease, stroke, hypertension, coronary heart disease, or presence of a “psychiatric problem”) aged ≥20 years, in the 2011 National Health Interview Survey. We fit logistic regression models to identify factors associated with food insecurity, cost-related medication underuse, or both. ResultsThere were 9696 adult National Health Interview Survey (NHIS) participants who reported chronic illness; 23.4% reported cost-related medication underuse; 18.8% reported food insecurity; and 11% reported both. Adults who reported food insecurity were significantly more likely to report cost-related medication underuse (adjusted odds ratio [aOR] 4.03). Participants with both cost-related medication underuse and food insecurity were more likely to be Hispanic (aOR 1.58), non-Hispanic black (aOR 1.58), and have more chronic conditions (aOR per additional chronic condition 1.56) than patients reporting neither. They also were less likely to have public, non-Medicare insurance (aOR 0.70) and report participation in the Special Supplemental Nutrition Assistance Program for Woman, Infants, and Children (aOR 0.39). ConclusionsApproximately 1 in 3 chronically ill NHIS participants are unable to afford food, medications, or both. WIC and public health insurance participation are associated with less food insecurity and cost-related medication underuse.

Alcohol Consumption and Mortality Risks in the USA

To estimate all-cause and cause-specific mortality risks by alcohol consumption level for the US population. The survival analysis of data from National Health Interview Survey participants from 1997 to 2004 who were followed for mortality through 2006. Hazard ratios (HRs) adjusted for available demographic and health characteristics were calculated by alcohol consumption level for all-cause mortality and for mortality from circulatory and external causes. Alcohol consumption levels were generally defined as 'never drinker' (<12 drinks in life), 'former drinker' (0 drinks during last year), 'infrequent drinker' (<12 drinks in any year), 'light drinker' (1 drink per drinking day), 'moderate drinker'(2 drinks) and 'heavy drinker' (3+ drinks). Adjusted mortality hazards for lifetime infrequent drinkers were much lower than the hazards for never drinkers among women, so lifetime infrequent drinkers were used as the reference category in survival analysis to estimate the mortality effects of alcohol consumption. Estimated all-cause mortality HRs for moderate drinkers were generally somewhat lower when compared with infrequent drinkers [HR for male moderate drinkers = 0.87, 95% confidence interval (CI) = 0.75-1.01 and HR for female occasional moderate drinkers = 0.80, 95% CI = 0.69-0.93]. Former drinkers and regular heavy drinkers had higher mortality hazards among both men and women. US light to moderate drinkers may have reduced mortality risks, but some portion of their previously observed lower mortality may be due to factors other than alcohol consumption such as medical care and social integration, particularly among women. Alcohol consumption among former and heavy drinkers appears to have increased their mortality risks.

Assessing measurement error in Medicare coverage from the National Health Interview Survey.

Using linked administrative data, to validate Medicare coverage estimates among adults aged 65 or older from the National Health Interview Survey (NHIS), and to assess the impact of a recently added Medicare probe question on the validity of these estimates. Linked 2005 NHIS and Master Beneficiary Record and Payment History Update System files from the Social Security Administration (SSA). We compared Medicare coverage reported on NHIS with "benchmark" benefit records from SSA. With the addition of the probe question, more reports of coverage were captured, and the agreement between the NHIS-reported coverage and SSA records increased from 88% to 95%. Few additional overreports were observed. Increased accuracy of the Medicare coverage status of NHIS participants was achieved with the Medicare probe question. Though some misclassification remains, data users interested in Medicare coverage as an outcome or correlate can use this survey measure with confidence.

Record linkage research and informed consent: who consents?

BackgroundLinking computerized health insurance records with routinely collected survey data is becoming increasingly popular in health services research. However, if consent is not universal, the requirement of written informed consent may introduce a number of research biases. The participants of a national health survey in Taiwan were asked to have their questionnaire results linked to their national health insurance records. This study compares those who consented with those who refused.MethodsA national representative sample (n = 14,611 adults) of the general adult population aged 20 years or older who participated in the Taiwan National Health Interview Survey (NHIS) and who provided complete survey information were used in this study. At the end of the survey, the respondents were asked if they would give permission to access their National Health Insurance records. Information given by the interviewees in the survey was used to analyze who was more likely to consent to linkage and who wasn't.ResultsOf the 14,611 NHIS participants, 12,911 (88%) gave consent, and 1,700 (12%) denied consent. The elderly, the illiterate, those with a lower income, and the suburban area residents were significantly more likely to deny consent. The aborigines were significantly less likely to refuse. No discrepancy in gender and self-reported health was found between individuals who consented and those who refused.ConclusionThis study is the first population-based study in assessing the consent pattern in a general Asian population. Consistent with people in Western societies, in Taiwan, a typical Asian society, a high percentage of adults gave consent for their health insurance records and questionnaire results to be linked. Consenters differed significantly from non-consenters in important aspects such as age, ethnicity, and educational background. Consequently, having a high consent rate (88%) may not fully eliminate the possibility of selection bias. Researchers should take this source of bias into consideration in their study design and investigate any potential impact of this source of bias on their results.