North Carolina Adults Research Articles

Adverse Childhood Experiences and Cardiovascular Disease Risks: Implications for North Carolina and the Need for an Upstream Approach.

Adverse childhood experiences (ACEs) have a negative impact on people across the lifespan, including poorer health outcomes. Data have indicated that 60% of North Carolina adults have experienced at least one ACE, while concurrently heart disease is the leading cause of death. There is a need to study the linkages between the two, and researchers and leaders should take an upstream approach to doing so.

Influenza and Pneumonia Vaccinations among North Carolina Adults with Diabetes.

Objectives: In this study, we sought to elucidate the influenza and pneumonia vaccination practices of adults with diabetes in North Carolina. Methods: Using North Carolina Behavioral Risk Factor Surveillance System data, we examined 2011-2018 trend data and demographic and health factors (2014-2018) in influenza (influenza vaccine receipt in the past year among adults ages 18+ years) and pneumonia (lifetime pneumonia vaccination receipt for adults ages 65+ years) vaccination adherence. Results: Influenza and pneumonia vaccination adherence rates were consistently higher for adults with versus without diabetes and remained relatively stable over the study period for both groups. Among adults with diabetes, factors associated with higher influenza vaccination rates included non-Hispanic white race, age 65+ years, poorer health, having insurance, and being a non-smoker. Pneumonia vaccination rates among adults with diabetes were higher for non-Hispanic Whites and those in poorer health. Conclusions: Adults with diabetes may be more likely to receive influenza and pneumonia vaccinations compared to adults without diabetes, but these rates remain below recommended levels. African Americans, younger adults, those without health insurance and cigarette smokers are vulnerable to being non-compliant with vaccination recommendations that could reduce their risk of developing and suffering complications from these diseases.

1 in 5 North Carolina Adults are Caregivers: Addressing Unpaid Family Caregiver Burden with Supportive Services.

Medical advances paired with expanding home care technology and shorter hospital stays have placed increased responsibilities on family and friends. Yet, most caregivers report they are ill-prepared for their role. There are services and supports specifically designed to assist family caregivers.

Self-reported Health Literacy Among North Carolina Adults and Associations with Health Status and Chronic Health Conditions.

BACKGROUND Low health literacy is a recognized contributor to health disparities. Significant proportions of the adult population, especially the underserved, have low health literacy. The purpose of this study was to examine health literacy and its associations with health status and chronic health conditions among North Carolina adults.METHODS The 2016 North Carolina Behavioral Risk Factor Surveillance System included health literacy questions that focused on accessing and understanding health information. Using these self-reported data, we estimated the prevalence of low health literacy and assessed its associations with general health status and chronic health conditions after adjusting for sociodemographic characteristics and health care access.RESULTS Overall, 4.8% of adults reported having difficulty getting health information or advice, 7.5% understanding oral information from health professionals, and 8.3% understanding written health information; 14.8% reported having difficulty with at least one of these tasks. The adjusted odds of low health literacy were moderately higher for those who had been diagnosed with the following conditions compared to those not diagnosed: heart attack, coronary heart disease, or stroke (AOR = 1.81, 95% CI=1.33, 2.47); COPD (AOR = 1.67, 95% CI = 1.19, 2.34); arthritis (AOR = 1.68, 95% CI = 1.32, 2.15); depression (AOR = 1.95, 95% CI=1.52, 2.50); and kidney disease (AOR = 1.62, 95% CI = 1.02, 2.60).LIMITATIONS All data were self-reported.CONCLUSIONS A notable segment of the North Carolina adult population has low health literacy, and those who do are particularly vulnerable to adverse health status. Targeted efforts are needed to identify strategies to improve health literacy and decrease health disparities.

Dietary Pyrethroid Exposures and Intake Doses for 188 Duplicate-Single Solid Food Items Consumed by North Carolina Adults.

Few studies have measured pyrethroid residue concentrations in food items consumed by adults in their daily environments. In a further analysis of study data, the objectives were to determine pyrethroid residue levels in single, solid food items consumed by adults and to estimate dietary pyrethroid exposures and intake doses per food item. A total of 50 adults collected 782 duplicate-diet solid food samples over a six-week monitoring period in North Carolina between 2009 and 2011. Of these samples, 188 contained a single, solid food item (i.e., lasagna). Levels of eight pyrethroids were quantified in the 188 food items using LC–MS/MS. At least one pyrethroid was detected in 39% of these food items. Cis-permethrin (17%), bifenthrin (15%), trans-permethrin (14%), and deltamethrin (14%) were detected the most often. Cyfluthrin, cyhalothrin, cypermethrin, and esfenvalerate were all detected in <6% of the samples. The highest residue level was found in a pizza sample containing both cis-permethrin (96.4 ng/g) and trans-permethrin (73.7 ng/g). For cis-permethrin, median residue levels (≥LOQ) were significantly higher (p = 0.001) in foods that contained a fruit/vegetable compared to foods that did not. For individual pyrethroids, the participants’ maximum dietary intake doses in the single food items ranged from 38.1 (deltamethrin) to 939 ng/kg/day (cis/trans-permethrin).

Prevalence of adults who are the targets of parental alienating behaviors and their impact

Estimating the prevalence of parental alienation is challenging because not all children who are exposed to parental alienating behaviors become alienated (Harman, Bernet, & Harman, 2019). The purpose of the current study was to determine whether the proportion of adults who indicate being alienated from a child will be similar to results from a previous poll of North Carolina adults (Harman, Leder-Elder, & Biringen, 2016) using three nationally representative on-line survey panels from United States and Canada, and to determine the mental health impact of parental alienating behaviors. Results from the first two polls indicate that the prevalence of parents who feel they are being alienated from their children is higher than originally estimated: 35.5% (of 273) in the U.S. and 32% (of 397) in Canada. Using another means of assessment for the third poll, 39.1% (of 594) of parents in the US are the non-reciprocating targets of parental alienating behaviors, which is over 22 million parents and confirms previous estimates that did not differentiate between reciprocating and non-reciprocating parents (Harman et al., 2016). Of these, 6.7% of the parents had children who were moderately to severely alienated, which is at least 1.3% of the US population. Alienated parents also had high levels of depression, trauma symptoms, and risk for suicide. Ramifications of these findings for researchers and practitioners are discussed.

Within- and Between-individual Temporal Variability in Spot Urine Caffeine and Caffeine Metabolite Concentrations in 50 North Carolina Adults over a Six-week Period (P06-019-19)

ObjectivesThe majority of studies examining caffeine as risk factor in human health rely upon dietary intake data to assess exposure. Intake variability associated with major dietary sources (e.g., coffee) as well as capturing intake from emerging sources (e.g., energy drinks) presents challenges. Measures of caffeine and caffeine metabolite excretion in the urine are associated with caffeine intake and may be suitable as caffeine intake biomarkers. Little is known regarding the temporal variability of these measures in spot urine samples, and better understanding of this behavior would help in determining the number of samples needed to accurately represent biomarker concentration over a given time period. MethodsWe measured spot urine caffeine and caffeine metabolites in 2292 surplus samples from the US EPA’s Pilot Study to Estimate Human Exposures to Pyrethroids using an Exposure Reconstruction Approach (Ex-R) Study, and calculated results by concentration, normalized by specific gravity (SG) and creatinine excretion (CR), and excretion rate. Samples were collected from 50 participants (age 19–59 y) residing near Chapel Hill, NC, over a 6-week period, consisting of bedtime, first-morning voids, and 24-h collections. We calculated intra-class correlations (ICCs) and other descriptive statistics, and used ICCs to determine whether a single spot urine sample may be sufficient to estimate the analyte concentration for the indicated timeframe (ICC ≥ 0.8). ResultsConcentration ICCs were highest for caffeine (0.79–0.89) and its metabolites theophylline (0.85–0.92) and paraxanthine (0.75–0.85) when measured over a given 24-h period; SG normalization increased ICCs for theophylline (0.89–0.96) and paraxanthine (0.79–0.92) but not for caffeine (0.80–0.87), with CR normalization and excretion rate yielding mixed results. The highest ICCs determined across the entire 6-week period were for CR normalized concentrations of 1-methyluric acid from bedtime (0.77) or 24-h (0.76) samples. ConclusionsBased on ICCs obtained from Ex-R study samples, it may be possible to estimate urine caffeine, theophylline, and paraxanthine concentrations over a 24-h period by use of a single spot urine sample, with more samples needed for longer timeframes. Funding SourcesUS EPA and CDC congressional appropriations.

Distribution, variability, and predictors of urinary bisphenol A levels in 50 North Carolina adults over a six-week monitoring period

Bisphenol A (BPA) is commonly manufactured to make polycarbonate plastics and epoxy resins for use in consumer products and packaged goods. BPA has been found in several different types of environmental media (e.g., food, dust, and air). Many cross-sectional studies have frequently detected BPA concentrations in adult urine samples. However, limited data are available on the temporal variability and important predictors of urinary BPA concentrations in adults. In this work, the major objectives were to: 1) quantify BPA levels in duplicate-diet solid food, drinking water, hard floor surface wipe, and urine samples (first-morning void [FMV], bedtime, and 24-h) collected from adults over a six-week monitoring period; 2) determine the temporal variability of urinary BPA levels using concentration, specific gravity (SG) adjusted, creatinine (CR) adjusted, and excretion rate values, and; 3) examine associations between available study factors and urinary BPA concentrations. In 2009–2011, a convenience sample of 50 adults was recruited from residential settings in North Carolina. The participants completed diaries and collected samples during weeks 1, 2, and/or 6 of a six-week monitoring period. BPA was detected in 38%, 4%, and 99% of the solid food (n=775), drinking water (n=50), and surface wipe samples (n=138), respectively. Total BPA (free plus conjugated) was detected in 98% of the 2477 urine samples. Median urinary BPA levels were 2.07ng/mL, 2.20ng/mL-SG, 2.29ng/mg, and 2.31ng/min for concentration, SG-adjusted, CR-adjusted, and excretion rate values, respectively. The intraclass correlation coefficient (ICC) estimates for BPA showed poor reproducibility (≤0.35) for all urine sample types and methods over a day, week, and six weeks. CR-adjusted bedtime voids collected over six-weeks required the fewest, realistic number of samples (n=11) to obtain a reliable biomarker estimate (ICC=0.80). Results of linear mixed-effects models showed that sex, race, season, and CR-level were all significant predictors (p<0.05) of the adults' urinary BPA concentrations. BPA levels in the solid food and surface wipe samples did not contribute significantly to the participants' urinary BPA concentrations. However, a significant positive relationship was observed between solid food intake and urine-based estimates of BPA dose, when aggregated over 24-h periods. Ingestion of BPA via solid food explained only about 20% of the total dose (at the median of the dose distribution), suggesting that these adults were likely exposed to other major unknown (non-dietary) sources of BPA in their everyday environments.

Predictors of Urinary 3-Phenoxybenzoic Acid Levels in 50 North Carolina Adults.

Limited data are available on the non-chemical stressors that impact adult exposures to pyrethroid insecticides based on urinary biomonitoring. The urinary metabolite, 3-phenoxybenzoic acid (3-PBA), is commonly used to assess human exposure to a number of pyrethroids. In a further analysis of published study data, we quantified urinary 3-PBA levels of 50 adults over a single, 24-h sampling period and examined the associations between the biomarker measurements and selected non-chemical stressors (demographic, lifestyle, and dietary factors). A convenience sample of 50 adults was recruited in North Carolina in 2009–2011. Participants collected individual urine voids (up to 11) and filled out activity, food, and pesticide use diaries over a 24-h sampling period. Urine voids (n = 326) were analyzed for 3-PBA concentrations using high-performance liquid chromatography-tandem mass spectrometry. 3-PBA was detected in 98% of the 24-h composited urine samples. The geometric mean urinary 3-PBA level was 1.68 ng/mL in adults. Time spent outside (p = 0.0006) was a highly significant predictor of natural log-transformed (ln) urinary 3-PBA levels, while consumption of coffee (p = 0.007) and breads (p = 0.019) and ln creatinine levels (p = 0.037) were significant predictors of urinary 3-PBA levels. In conclusion, we identified specific factors that substantially increased adult exposures to pyrethroids in their everyday environments.

Physical activity in older adults: Planning, delivering, and evaluation plan for the Eat Better Move More Intervention

Among North Carolina adults, greater than 50% do not engage in the recommended amount of physical activity. More than 75% eat fewer than the recommended five or more servings of fruits and vegetables daily, and 60% are overweight or obese. An intervention was developed for older adults in North Carolina. The purpose of this article is to describe the process for establishing the Eat Better Move More intervention for older adults in North Carolina.

Associations between neighborhood-level factors related to a healthful lifestyle and dietary intake, physical activity, and support for obesity prevention polices among rural adults.

We examined cross-sectional associations among neighborhood- and individual-level factors related to a healthful lifestyle and dietary intake, physical activity (PA), and support for obesity prevention polices in rural eastern North Carolina adults. We examined perceived neighborhood barriers to a healthful lifestyle, and associations between neighborhood barriers to healthy eating and PA, participants' support for seven obesity prevention policies, and dependent variables of self-reported dietary and PA behaviors, and measured body mass index (BMI) (n = 366 study participants). We then used participants' residential addresses and Geographic Information Systems (GIS) software to assess neighborhood-level factors related to access to healthy food and PA opportunities. Correlational analyses and adjusted linear regression models were used to examine associations between neighborhood-level factors related to a healthful lifestyle and dietary and PA behaviors, BMI, and obesity prevention policy support. The most commonly reported neighborhood barriers (from a list of 18 potential barriers) perceived by participants included: not enough bicycle lanes and sidewalks, not enough affordable exercise places, too much crime, and no place to buy a quick, healthy meal to go. Higher diet quality was inversely related to perceived and GIS-assessed neighborhood nutrition barriers. There were no significant associations between neighborhood barriers and PA. More perceived neighborhood barriers were positively associated with BMI. Support for obesity prevention policy change was positively associated with perceptions of more neighborhood barriers. Neighborhood factors that promote a healthful lifestyle were associated with higher diet quality and lower BMI. Individuals who perceived more neighborhood-level barriers to healthy eating and PA usually supported policies to address those barriers. Future studies should examine mechanisms to garner such support for health-promoting neighborhood changes.

Chronic Obstructive Pulmonary Disease and Asthma–Patient Characteristics and Health Impairment

Background: Persons with chronic obstructive pulmonary disease (COPD) and/or asthma have great risk for morbidity. There has been sparse state-specific surveillance data to estimate the impact of COPD or COPD with concomitant asthma (overlap syndrome) on health-related impairment. Methods: The North Carolina (NC) Behavioral Risk Factor Surveillance System (BRFSS) was used to assess relationships between COPD and asthma with health impairment indicators. Five categories [COPD, current asthma, former asthma, overlap syndrome, and neither] were defined for 24,073 respondents. Associations of these categories with health impairments (physical or mental disability, use of special equipment, mental or physical distress) and with co-morbidities (diabetes, coronary heart disease, stroke, arthritis, and high blood pressure) were assessed. Results: Fifteen percent of NC adults reported a COPD and/or asthma history. The overall age-adjusted prevalence of any self-reported COPD and current asthma were 5.6% and 7.6%, respectively; 2.4% reported both. In multivariable analyses, adults with overlap syndrome, current asthma only, and COPD only were twice as likely as those with neither disease to report health impairments (p < 0.05). Compared to those with neither disease, adults with overlap syndrome and COPD were more likely to have co-morbidities (p < 0.05). The prevalence of the five co-morbid conditions was highest in overlap syndrome; comparisons with the other groups were significant (p < 0.05) only for diabetes, stroke, and arthritis. Conclusions: The BRFSS demonstrates different levels of health impairment among persons with COPD, asthma, overlap syndrome, and those with neither disease. Persons reporting overlap syndrome had the most impairment and highest prevalence of co-morbidities.

The Burden of Heart Disease Among North Carolina Adults with Disabilities

Data from the North Carolina Behavioral Risk Factor Surveillance System survey show that, from 2005-2010, cardiovascular disease (CVD) was approximately 3 times more prevalent among adults with disabilities than among those without disabilities. Likelihood of having multiple CVD risk factors was also increased. Early intervention to prevent CVD in people with disabilities is warranted.

Seasonal modification of the association between temperature and adult emergency department visits for asthma: a case-crossover study

BackgroundThe objective of this study is to characterize the effect of temperature on emergency department visits for asthma and modification of this association by season. This association is of interest in its own right, and also important to understand because temperature may be an important confounder in analyses of associations between other environmental exposures and asthma. For example, the case-crossover study design is commonly used to investigate associations between air pollution and respiratory outcomes, such as asthma. This approach controls for confounding by month and season by design, and permits adjustment for potential confounding by temperature through regression modeling. However, such models may fail to adequately control for confounding if temperature effects are seasonal, since case-crossover analyses rarely account for interactions between matching factors (such as calendar month) and temperature.MethodsWe conducted a case-crossover study to determine whether the association between temperature and emergency department visits for asthma varies by season or month. Asthma emergency department visits among North Carolina adults during 2007–2008 were identified using a statewide surveillance system. Marginal as well as season- and month-specific associations between asthma visits and temperature were estimated with conditional logistic regression.ResultsThe association between temperature and adult emergency department visits for asthma is near null when the overall association is examined [odds ratio (OR) per 5 degrees Celsius = 1.01, 95% confidence interval (CI): 1.00, 1.02]. However, significant variation in temperature-asthma associations was observed by season (chi-square = 18.94, 3 degrees of freedom, p <0.001) and by month of the year (chi-square = 45.46, 11 degrees of freedom, p <0.001). ORs per 5 degrees Celsius were increased in February (OR = 1.06, 95% CI: 1.02, 1.10), July (OR = 1.16, 95% CI: 1.04, 1.29), and December (OR = 1.04, 95% CI: 1.01, 1.07) and decreased in September (OR = 0.92, 95% CI: 0.87, 0.97).ConclusionsOur empirical example suggests that there is significant seasonal variation in temperature-asthma associations. Epidemiological studies rarely account for interactions between ambient temperature and temporal matching factors (such as month of year) in the case-crossover design. These findings suggest that greater attention should be given to seasonal modification of associations between temperature and respiratory outcomes in case-crossover analyses of other environmental asthma triggers.

Medical Care Costs for Diabetes Associated With Health Disparities Among Adult Medicaid Enrollees in North Carolina

Health disparities for many diseases are large and long-standing in North Carolina and the nation. This study examines medical care costs for diabetes associated with health disparities among adults (age, > or =78 years) enrolled in Medicaid in North Carolina during state fiscal year (SFY) 2007-2008 (i.e., July 7, 2007, through June 30, 2008). North Carolina Medicaid paid claims and enrollment data were used to calculate the prevalence of and medical care expenditures for diabetes among adult Medicaid enrollees overall and by white, African American, and American Indian race. The impacts of racial and economic health disparities on medical care costs for diabetes were determined by first calculating the proportionate differences between the diabetes prevalence for whites, African Americans, and American Indians enrolled in Medicaid and the diabetes prevalence among all whites in North Carolina. Then it was assumed that medical care costs for white, African American, and American Indian Medicaid recipients could be reduced by the same proportion if the overall prevalence among whites was achieved. The diabetes prevalence among adult Medicaid enrollees was 75.7%, compared with 9.1% for all North Carolina adults. During SFY 2007-2008, the state Medicaid program in North Carolina spent $525 million for diabetes-related medical care and prescription drugs among adults. An estimated $225 million in diabetes-related expenditures could be saved each year by the North Carolina Medicaid program if both racial and economic disparities in the diabetes prevalence were eliminated. We did not have data on non-Medicaid paid health care expenditures for the Medicaid enrollees in our study. The costs of interventions to eliminate health disparities associated with diabetes are not included in the calculation of the potential savings. The diabetes prevalence in the Medicaid population is much greater than that for all North Carolinians, and the Medicaid costs associated with this elevated prevalence are large. North Carolina health-policy makers and health-program managers should carefully evaluate investments in interventions to reduce these race- and economic-based differences in diabetes prevalence, which could potentially reduce Medicaid costs.

Health-related quality of life and chronic obstructive pulmonary disease in North Carolina.

Background:Comparisons of health-related quality of life (HRQOL) between persons with chronic obstructive pulmonary disease (COPD) and adults in the general population are not well described.Aims:To examine associations between COPD and four measures of HRQOL in a population-based sample.Patients & Methods:These relationships were examined using data from 13,887 adults aged >18 years who participated in the 2007 Behavioral Risk Factor Surveillance System (BRFSS) conducted in North Carolina (NC). Logistic regression was used to obtain adjusted relative odds (aOR).Results:The age-adjusted prevalence of COPD among NC adults was 5.4% (standard error 0.27). Nearly half of adults with COPD reported fair/poor health compared with 15% of those without the condition (age-aOR, 5.5; 95% confidence interval [ CI] , 4.4 to 6.8). On average, adults with COPD reported twice as many unhealthy days (physical/mental) as those without the condition. The age-adjusted prevalence of >14 unhealthy days during the prior 30 days was 45% for adults with COPD and 17% for those without. The aOR of >14 unhealthy days was 1.7 (95% CI, 1.4 to 2.2) times greater among adults with COPD compared with those without.Conclusions:These results suggest COPD is independently associated with lower levels of HRQOL and reinforce the importance of preventing COPD and its complications through health education messages stressing efforts to reduce total personal exposure to tobacco smoke, occupational dusts and chemicals, and other indoor and outdoor air pollutants linked to COPD and early disease recognition. Our findings represent one of the few statewide efforts in the US and provide guidance for disease management and policy decision making.

Attitudes about Tobacco Policies among North Carolina Parents

While tobacco use reduction remains a major public health goal, little evidence exists on how citizens in North Carolina view policy issues related to tobacco control. This research examines attitudes toward tobacco policies among North Carolina parents. Randomly selected North Carolina adults with a child living in his or her household were invited to participate in the Child Health Assessment and Monitoring Program (CHAMP) telephone survey. A sample of 3,973 parents or guardians was interviewed in 2005. Support for tobacco prevention and policies was analyzed by demographic characteristics. Of the 86% of initial respondents who were eligible to participate, 83% completed the 2005 CHAMP survey. Most parents in North Carolina (90.1%) support stronger policies for tobacco prevention. Parents also strongly support restrictions on tobacco in schools (85.6%) and recreational areas and fast food restaurants (83.9%). While many parents report being well prepared to talk to their children about smoking (97.6%) and report talking about the dangers of smoking monthly (84.7%), few report that their child currently smokes (3.9% of high school students and 0.6% of middle school students). Because the CHAMP survey is telephone-based the results are limited to North Carolina parents who have a land-line telephone. Despite the states historical ties to tobacco, the overwhelming majority of North Carolina parents are in favor of stronger efforts at tobacco use prevention, including increased policy measures. These results suggest that prevention efforts should be expanded and that policy makers who take a stronger stance against tobacco will most likely receive broad support by North Carolina parents.

Trends in Up-to-Date Status in Colorectal Cancer Screening, North Carolina, 1998-2002

Rates of colorectal cancer (CRC) screening are rising nationwide. Our purpose was to determine the proportion of North Carolina adults who were up-to-date with CRC screening in 1998-2002 and analyze trends by socio-demographic subgroups. We examined data from the North Carolina Behavioral Risk Factor Surveillance System. For 1998, 1999, 2001, and 2002, we determined the proportion of respondents 50 years old and older who were up-to-date, defined as a home fecal occult blood test (FOBT) in the past 12 months and/or a sigmoidoscopy or colonoscopy in the past five years. We examined trends in up-to-date status in all respondents and in selected socio-demographic subgroups. We also examined the characteristics of respondents who were up-to-date in 2001-2002. From 1998-2002, the percentage of respondents 50 years old or older who were up-to-date with CRC screening increased from 46.1% to 54.0% (test for trend, p < 0.0001). The proportion who were up-to-date increased among those 50-74 years old, those with a high school or college education, and those with incomes less than dollar 25,000. Proportions that were up-to-date did not significantly increase among African Americans and respondents with less than a high school education. In 2001-2002, we found low percentages that were up-to-date among adults 50-54 years old Hispanics, and the uninsured The proportion of North Carolina adults who are up-to-date with CRC screening is increasing but not across all socio-demographic groups. These results indicate that there are subgroups that need to be reached with screening programs. Efforts to educate the public and providers about CRC screening should continue.

Health-related Quality of Life among North Carolina Adults with Diabetes Mellitus

Previous research on health-related quality of life among people with diabetes used subgroups of diabetics who were not representative of a larger population and long questionnaires that are not practical for surveillance. To identify people with diabetes in North Carolina who are at risk for a poor quality of lift based on demographic and medical characteristics using surveillance data. Analysis of Behavior Risk Factor Surveillance System data from North Carolina, years 1998 through 2001, to examine associations between demographic and medical characteristics among people with diabetes and four different health-related quality-of-life outcome indicators, including general health status, physically unhealthy mentally unhealthy and functionally limited days. The demographic and medical characteristics studiedwere age, sex, ethnicity marital status, education, income, health insurance, obesity duration of diabetes, and insulin use. These same characteristics were also tested for independent associations with functionally limited days. Ethnicity and gender were not associated with any of the quality-of-life measures among people with diabetes. Those younger than age 65 were more likely to have mentally unhealthy days, but age was not related to the other outcomes. A household income of less than 20,000 dollars was related to poor general health and greater than one week each of physically unhealthy mentally unhealthy and functionally limited days. Subjects with a high school education or less, no health insurance, and those not married or cohabiting had at least one poor health-related quality-of-life outcome. Obesity duration of diabetes often or more years, and insulin use were also associated with at least one poor quality-of-life outcome. The only characteristic that was independently related to the number of functionally limited days was income. People with diabetes of working age and with low incomes were more likely to have greater than one week of functionally limited days (aOR = 10.3; 95% CI = 4.9-21.5). Our results suggest an association between poor quality of life and low-socioeconomic status among people with diabetes in North Carolina.

Eighteen-month incidence of tooth loss among older adults in North Carolina.

This study investigated tooth loss in North Carolina adults 65 years of age or older. A random sample of 335 Blacks and 284 Whites participated in dental examinations and interviews at baseline and again after 18 months. Blacks were more likely than Whites to lose at least one tooth (36% vs 19%), and they lost more teeth on average (1.0 vs 0.4). Several oral disease conditions and symptoms were related to tooth loss, but many other hypothesized factors were not. Risk models were inconclusive in the identification of factors related to risk of tooth loss.