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PubMed2004

Asian Americans' reports of their health care experiences. Results of a national survey.

OBJECTIVE: To examine how Asian race/ethnicity affects patients' health care experiences and satisfaction with care. DESIGN: Telephone interview using random-digit dialing, stratified to over-sample adults living in areas with disproportionately large numbers of minorities. PARTICIPANTS AND SETTING: White (N = 3,205) and Asian-American (N = 521) respondents, weighted to represent all such adults living in the continental U.S. in telephone households. MEASUREMENTS: Reports of health care experiences and trust in the doctor at the last visit, and overall satisfaction with care and desire to change doctors in the last 2 years. MAIN RESULTS: Asian Americans were less likely than whites to report that their doctors ever talked to them about lifestyle or mental health issues (P < or =.01). They were more likely to report that their regular doctors did not understand their background and values (P < or =.01). When asked about the last visit, they were more likely to report that their doctors did not listen, spend as much time, or involve them in decisions about care as much as they wanted (all P < or =.0001). In multivariable analyses, Asian Americans were less likely than whites to report that they were very satisfied with care (odds ratio [OR], 0.64, 95% confidence interval [CI], 0.42 to 0.99). However, they were not significantly less likely than whites to trust their doctors (OR, 0.79, 95% CI, 0.52 to 1.20), or to change doctors (OR, 0.93, 95% CI, 0.56 to 1.56). CONCLUSIONS: In a national survey, Asian Americans were less likely to receive counseling and less likely to report positive interactions with their doctors than white respondents. More research is needed to determine the reasons for these differences.

Adolescent↗
PubMed2003

Medical image security in a HIPAA mandated PACS environment.

Medical image security is an important issue when digital images and their pertinent patient information are transmitted across public networks. Mandates for ensuring health data security have been issued by the federal government such as Health Insurance Portability and Accountability Act (HIPAA), where healthcare institutions are obliged to take appropriate measures to ensure that patient information is only provided to people who have a professional need. Guidelines, such as digital imaging and communication in medicine (DICOM) standards that deal with security issues, continue to be published by organizing bodies in healthcare. However, there are many differences in implementation especially for an integrated system like picture archiving and communication system (PACS), and the infrastructure to deploy these security standards is often lacking. Over the past 6 years, members in the Image Processing and Informatics Laboratory, Childrens Hospital, Los Angeles/University of Southern California, have actively researched image security issues related to PACS and teleradiology. The paper summarizes our previous work and presents an approach to further research on the digital envelope (DE) concept that provides image integrity and security assurance in addition to conventional network security protection. The DE, including the digital signature (DS) of the image as well as encrypted patient information from the DICOM image header, can be embedded in the background area of the image as an invisible permanent watermark. The paper outlines the systematic development, evaluation and deployment of the DE method in a PACS environment. We have also proposed a dedicated PACS security server that will act as an image authority to check and certify the image origin and integrity upon request by a user, and meanwhile act also as a secure DICOM gateway to the outside connections and a PACS operation monitor for HIPAA supporting information.

California↗
PubMed1976

Microprocessors in health care: panacea or more effervescent technology?

The impact of microprocessors on medical instrumentation is explored, with particular reference to their role within a health care system that has finite resources. The authors present two examples of microprocessor use from their own experience and attempt to highlight both the merits and the disadvantages of the use of such technology by the hospital medical engineer.

Analog-Digital Conversion↗
PubMedDate not supplied

Diagnostic performance of a teleradiology system in primary health care.

Open health care needs proper basic radiological services. Teleradiology makes it possible to get the radiologist's consultation in rural and remote areas and allows the transmission of images between hospitals. A microcomputer-based teleradiology system using a 512 x 512 x 8 bit image matrix with image-processing capabilities and obtainable at a cost of US$ 20,000 was evaluated in daily practice. Images from 372 conventional roentgen examinations were digitized and transmitted via a 64 Kbits/s telephone line from a rural health center to a university hospital, where they were interpreted by two radiologists. The original radiographs were interpreted later and the two reports compared to evaluate the diagnostic performance of system. Slight deterioration of image quality was noticed, though the images were non-diagnostic only in a few cases. The image-processing capability of the system was assessed as useful. Major discrepancies between CRT and film readings were noted in 3.9% of the cases interpreted. The accuracy of CRT readings was about 2% poorer in chest examinations and 5% poorer in bone examinations than in film readings. The teleradiology system proved sufficient for consultation in most conventional radiographs in daily practice, although a system based on a 1024 x 1024 matrix is desirable.

Bone and Bones↗
PubMedDate not supplied

Telemedicine and teleradiology.

Inherent challenges accompany the rapidly increasing use of teleradiology and other telemedicine applications. These challenges include the complex interaction of multiple technologies as well as new operational procedures and changes in the way health care is delivered. This article focuses on the operational issues surrounding telemedicine, teleradiology and the transition to a digital department. The legal implications of telemedicine and government's role in regulating it are emphasized, along with telemedicine's impact on rural health care.

Fraud↗
PubMed1995

Prevalence of benign anorectal disease in a randomly selected population.

BACKGROUND: The prevalence of benign anorectal diseases (BAD) in the general population has been difficult to establish, either because the individual diseases themselves were difficult to characterize in surveys or because of bias in the selection of the survey population. Reported herein is a prevalence survey of BAD symptoms and treatment history of a sample of the general population, selected by random digit dialing. METHOD: A survey instrument that inquired into symptoms of BAD, BAD treatment history, and health-seeking behaviors was administered by telephone interview with 102 individuals, between the ages of 21 and 65 of both genders and all races, chosen by random digit dialing in the Joliet, Illinois area. For selected variables (gender, education level, obesity, previous BAD treatment, fiber supplementation, time for defecation and reading during defecation all related to BAD symptoms) odds ratios and 95 percent confidence intervals were calculated. RESULTS: Of the 102 individuals, 9 had been previously treated for hemorrhoids, 4 by surgery, and 5 medically. Twenty individuals currently have BAD symptoms, six of these have multiple symptoms frequently, implying established BAD, and four of these have been previously treated for hemorrhoids. Seven of eight individuals with rectal bleeding in the past year have not sought medical evaluation. Of the associations tested, statistical significance was found only between female gender and BAD symptoms (odds ratio = 4.6; 95 percent confidence interval = 1.3-20.4). CONCLUSIONS: History of hemorrhoidal treatment and current BAD symptomatology are highly prevalent in a randomly selected population, and 80 percent of the subjects with symptoms of BAD have not consulted a physician regarding BAD. Some previously held correlates of hemorrhoidal symptoms, such as obesity and extended time for defecation, showed no apparent association with hemorrhoid treatment history or current BAD symptoms. The best predictors of current BAD symptoms were female gender (odds ratio = 4.6; 95 percent confidence interval = 1.3-20.4) and previous hemorrhoid treatment (odds ratio = 3.9; 95 percent confidence interval = 0.7-20).

Adult↗
PubMed2000

Digital library research and application.

The last decade has seen an exponential rise in the amount and the nature of information that is available on the Internet. Internet and World Wide Web technology have raised many technical as well as social and economic issues. The paper begins with a description of the recent digital library research initiative funded by the U.S. federal government. Digital library research addresses a host of informatics issues relevant to the current Internet-based environment. The paper continues with a discussion of some problems in information access, including a discussion of the potential of the Unified Medical Language System for navigating among multiple biomedical information systems. Next, some issues in creating Web-accessible resources for health care consumers are addressed, with a focus on recent work at the National Library of Medicine, including a description of the MEDLINEplus system. The paper ends with a brief discussion of some implications of digital library research for the health informatics community.

Internet↗
PubMed1993

Assessment of quality of life as observed from the baseline data of the Studies of Left Ventricular Dysfunction (SOLVD) trial quality-of-life substudy.

The improvement of aspects of a patient's quality of life may be as important as prolonging survival in evaluating clinical trials of heart failure. The purpose of this study was to analyze the psychometric properties of the baseline measures from the quality-of-life substudy from the Studies of Left Ventricular Dysfunction (SOLVD) trial. The measures included the 6-Minute Walk Test, Dyspnea Scale, Living with Heart Failure, Physical Limitations, Psychologic Distress and Health Perceptions, as reported by both patients and staff. Cognitive functioning, such as Vocabulary, Digit Span and Trails Making, was also assessed. Patients were classified as New York Heart Association class I (n = 158) versus II or III (n = 150). The internal consistencies (i.e., reliabilities) of the self-report measures were high, except for the Health Perceptions of Class II or III patients. Reliability of the SOLVD quality-of-life battery was confirmed by significantly better life quality among New York Heart Association class I patients versus class II or III patients combined on the Walk Test, Physical Limitations, Dyspnea, Living with Heart Failure, Psychologic Distress and staff perceptions of patient health. In accordance with prior studies, the measures were uncorrelated with left ventricular ejection fraction. By demonstrating strong internal consistencies, reliability based on physician reports, and independence of ejection fraction levels, use of this quality-of-life assessment battery in this and other clinical trials of compromised ventricular functioning is supported.

Attitude to Health↗
PubMed2006

Knowledge of Medicaid coverage and effectiveness of smoking treatments.

BACKGROUND: Tobacco dependence has enormous health and financial repercussions in the United States, particularly among Medicaid enrollees, where a disproportionate share of the population smokes (36% compared to 23% in the general population). This paper examines two factors associated with the use of tobacco-dependence treatments (TDTs) in the Medicaid population: knowledge of TDT coverage and perceived effectiveness of TDTs. METHODS: Medicaid-enrolled smokers and recent quitters in four areas in the United States with comprehensive coverage of TDTs were interviewed as part of a random-digit-dial telephone survey in September 2003. Information was collected on demographics, health status, smoking history, knowledge of Medicaid coverage of TDTs (nicotine replacement patch and gum, Zyban, and counseling), and perceived effectiveness of TDTs. Logistic regression models were estimated to explain variation in enrollee use of TDTs as a function of knowledge of covered benefits and perceived effectiveness of the treatments. RESULTS: Both knowledge of TDT coverage and the perceived effectiveness of TDTs are positively associated with the use of TDTs in the Medicaid population. However, a majority of Medicaid smokers do not know that Medicaid covers TDTs, and the perceived effectiveness of TDTs is often at odds with findings from the scientific literature. CONCLUSIONS: Knowledge of Medicaid coverage and the perceived effectiveness of TDTs are associated with increased use of TDTs in the Medicaid population. Additional research is needed to better inform Medicaid smokers of their coverage and the effectiveness of TDTs in ways that encourage them to use these treatments to assist quit attempts.

Adolescent↗
PubMedDate not supplied

Evaluation strategies for midwifery education linked to digital media and distance delivery technology.

The goal of the teaching and learning process for health professionals is the acquisition of a fundamental core of knowledge, the demonstration of critical thinking ability, and the demonstration of competency in the performance of clinical skills. Teaching and learning in distance education programs require that the administration, teachers, and students be creative in developing evaluation strategies that can be adapted to the challenges of the cyberspace on-line educational environment. Evaluation standards for distance education programs recently have been delineated by federal agencies, private organizations, and academic accreditation associations. These standards are linked to principles of sound education practice that promote program quality, high levels of student-faculty interaction, and support effective teaching and learning in the distance education context. A growing body of evidence supports the conclusion that technology-enhanced teaching is equivalent in effectiveness compared with traditional methods when student-learning outcomes are the focus of measurement. An allied body of literature offers model approaches that can be useful to educators who must also conduct the evaluation of clinical skills, provide feedback, and promote socialization to the nurse-midwifery/midwifery role for students being educated in whole or in part through instruction delivered at a distance.

Benchmarking↗
PubMed2002

Closing the digital divide in HIV/AIDS care: development of a theory-based intervention to increase Internet access.

Advances in information technology are revolutionizing medical patient education and the Internet is becoming a major source of information for people with chronic medical conditions, including HIV/AIDS. However, many AIDS patients do not have equal access to the Internet and are therefore at an information disadvantage, particularly minorities, persons of low-income levels and individuals with limited education. This paper describes the development and pilot testing of a workshop-style intervention designed to close the digital divide in AIDS care. Grounded in the Information-Motivation-Behavioral Skills (IMB) model of health behaviour change, we developed an intervention for persons with no prior history of using the Internet. The intervention included instruction in using hardware and search engines, motivational enhancement to increase interest and perceived relevance of the Internet, and skills for critically evaluating and using health information accessed via the Internet. Participants were also introduced to communication and support functions of the Internet including e-mail, newsgroups and chat groups. Pilot testing demonstrated feasibility, acceptability and promise for closing the digital divide in HIV/AIDS care using a relatively brief and intensive theory-based intervention that could be implemented in community settings.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Is alcohol intake associated with breast cancer in Hispanic women? The New Mexico Women's Health Study.

OBJECTIVE: Previous studies have shown an increased breast cancer risk associated with modest or high alcohol intake, however, few of these studies have included Hispanic women. The alcohol/breast cancer association was investigated in a New Mexico (NM) statewide bi-ethnic study. DESIGN: A population-based, case-control study. METHODS: Incident breast cancer cases (N = 712), aged 30-74 years, were ascertained by the New Mexico Tumor Registry (NMTR). Controls (N = 844) were identified by random digit dialing and were frequency-matched for ethnicity, age-group, and health planning district. Data were collected via in-person interview, which included questions regarding recent and past alcohol intake and breast cancer risk factors. RESULTS: The highest level of recent alcohol intake, compared to no intake, was associated with breast cancer risk for postmenopausal Hispanic women (odds ratio [OR] = 2.0 95%, confidence interval [CI] 0.8-5.1, 42+ grams/ week) and postmenopausal non-Hispanic White women (OR = 2.2, 95% Cl 1.0-5.0, 148+ grams/week), although estimates were unstable and statistically non-significant. Lower recent alcohol intake (< 148 grams/week) was associated with reduced risk for non-Hispanic Whites (OR = 0.49, 95% Cl 0.35-0.69). This pattern was independent of hormone-receptor status and was present for both premenopausal (OR = 0.29, 95% Cl 0.15-0.56) and postmenopausal women (OR = 0.56, 95% Cl 0.35-0.90). Results for past alcohol intake and breast cancer association did not demonstrate any trends and were non-significant. CONCLUSIONS: Alcohol intake does not appear to have a consistent or significant association with breast cancer in Hispanic women.

Adult↗
PubMed2006

BC Walks: replication of a communitywide physical activity campaign.

INTRODUCTION: Individuals not engaging in recommended amounts of moderate-intensity physical activity are deemed insufficiently active and are at greater risk of chronic disease. Social marketing strategies may promote positive changes in physical activity levels among insufficiently active individuals. METHODS: A quasi-experimental design was used to determine whether the results of a previous communitywide physical activity social marketing campaign conducted in Wheeling, WVa (population, 31,420) could be replicated in the larger community of Broome County, New York (population, 200,536). BC Walks promoted 30 minutes or more of moderate-intensity daily walking among insufficiently active residents of Broome County, New York, aged 40 to 65 years. Promotion activities included paid advertising, media relations, and community health activities. Impact was determined by preintervention and postintervention random-digit-dial cohort telephone surveys in intervention and comparison counties. We assessed demographics, walking behavior, moderate and vigorous physical activity, and campaign awareness. RESULTS: The paid advertising included 4835 television and 3245 radio gross rating points and 10 quarter-page newspaper advertisements. News media relations resulted in 28 television news stories, 5 radio stories, 10 newspaper stories, and 125 television news promotions. Exposure to the campaign was reported by 78% of Broome County survey respondents. Sixteen percent of Broome County participants changed from nonactive to active walkers; 11% changed from nonactive to active walkers in the comparison county (adjusted odds ratio, 1.71; 95% confidence interval, 0.99-2.95). Forty-seven percent of Broome County respondents reported any increase in total weekly walking time, compared with 36% for the comparison county (adjusted odds ratio, 1.66; 95% confidence interval, 1.14-2.44). CONCLUSION: The BC Walks campaign replicated the earlier Wheeling Walks initiative, although increases in walking were smaller in the BC Walks campaign.

Adult↗
PubMed2002

Periarterial sympathectomy in scleroderma patients: intermediate-term follow-up.

The use of periarterial sympathectomy (PAS) to manage chronic digital ischemia caused by scleroderma remains controversial. The duration of efficacy of PAS in managing scleroderma symptoms was evaluated by examining microvascular physiology, health-related quality of life, and patient satisfaction. Twenty-two patients (29 hands) with scleroderma, chronic vascular insufficiency, and a history of nonhealing digital ulcers unresponsive to nonsurgical treatment were evaluated. Isolated cold stress testing and laser Doppler fluxmetry measurements were used to evaluate microvascular perfusion before surgery and after a mean follow-up period of 31 months (range, 7-108 months). Digital temperatures did not change after surgery, but microvascular perfusion had increased significantly at a mean of 31 months in 22 hands. Health-related quality-of-life data were collected at a mean of 46 months (range, 11-108 months) after surgery. Subjective improvement (fewer ulcers, faster ulcer healing, and decreased pain) was reported for 18 of 22 patients (24 of 29 hands) at a mean follow-up period of 46 months; 6 patients remained ulcer free. Follow-up of scleroderma patients after PAS documented improved microvascular perfusion as evaluated by laser Doppler fluxmetry and by variable clinical results.

Adult↗
PubMed2001

Smokers' beliefs about "Light" and "Ultra Light" cigarettes.

OBJECTIVE: To assess beliefs about the tar and nicotine delivery characteristics and health benefits of Light and Ultra Light cigarettes among cigarette smokers. DESIGN: Random digit dialed telephone survey conducted in September 1999. SUBJECTS: Daily smokers (n = 2120) of Regular (46%), Light (39%), and Ultra Light (15%) cigarettes in the USA. The sample was weighted to match the US smoker population on age, sex, and ethnicity. MAIN OUTCOME MEASURES: Beliefs about Light and Ultra Light cigarettes were summarised on three dimensions: Safety (reduced health risk), Delivery (lowered tar and nicotine delivery), and Sensation (less harsh). RESULTS: Most smokers believed Lights and Ultra Lights were less harsh and delivered less tar and nicotine. On average, smokers believed that Lights afforded a 25% reduction in risk, and Ultra Lights a 33% reduction in risk. Light and Ultra Light cigarette smokers evaluated the risks of their own cigarette types more favourably. Light smokers had greater interest in quitting than Ultra Light smokers. Quitting intention was modestly related to beliefs about these cigarettes. Believing that Lights and Ultra Lights delivered less tar and nicotine and that they were less harsh each independently contributed to the belief that these cigarettes were safer. CONCLUSIONS: Many Light and Ultra Light smokers believe that smoking these cigarettes impart a substantial health benefit, due in part to their experience that these cigarettes are less harsh and the belief that these cigarettes deliver less tar.

Adult↗
PubMed2004

Testing for prostate and colorectal cancer: comparison of self-report and medical record audit.

BACKGROUND: Self-reported data are often used to determine cancer screening test utilization, but self-report may be inaccurate. METHODS: We interviewed members of three health maintenance organizations and reviewed their medical records for information on digital rectal exam (DRE), prostate-specific antigen (PSA) test, fecal occult blood test (FOBT), sigmoidoscopy, and colonoscopy (response rate 65%). We calculated the sensitivity, specificity, concordance, and kappa statistic to compare the two sources for black men (n = 363), white and other men (n = 847), and women (n = 920) by study location. RESULTS: For DRE, FOBT, sigmoidoscopy, and colonoscopy, testing rates determined by self-report were higher than those in medical records. Kappa statistics showed fair to good agreement (0.40-0.80) for PSA, sigmoidoscopy, and colonoscopy among most subgroups. For DRE and FOBT, the agreement was poor except among participants from one HMO. Sensitivity was > or = 80% for sigmoidoscopy among most subgroups, and > or = 85% for endoscopy (sigmoidoscopy and colonoscopy), >75% for DRE, and > or = 63% for PSA among all subgroups. Specificity exceeded 80% for FOBT and colonoscopy among all subgroups. Agreement was lower among older age groups. For all tests, agreement was poor between the reasons for testing. CONCLUSION: Overreporting for some cancer tests should be considered when using self-reported data to evaluate progress towards reaching national goals for prevention behaviors.

Aged↗
PubMedDate not supplied

Chronic neurobehavioral effects of Tokyo subway sarin poisoning in relation to posttraumatic stress disorder.

Chronic neurobehavioral effects of acute sarin poisoning were evaluated in 9 male and 9 female patients who were exposed to sarin poisoning in the Tokyo subway incident in Japan. The investigators used nine neurobehavioral tests, as well as a posttraumatic stress disorder checklist, 6-8 mo after the poisoning occurred. Serum cholinesterase activity in patients on the day of poisoning (i.e., March 20, 1995) ranged from 13 to 131 IU/l (mean=72.1 IU/l). The results of analysis covariance, in which age, education level, alcohol consumption, and smoking status (covariates) were controlled in 18 sarin cases and in 18 controls, showed that the score on the digit symbol (psychomotor performance) test was significantly lower in the sarin cases than in controls. Nonetheless, the scores for the General Health Questionnaires, fatigue of Profile of Mood States, and posttraumatic stress disorder checklist were significantly higher in the sarin cases than controls. The investigators added posttraumatic stress disorder to the covariates, and only the score on the digit symbol test was significantly lower in sarin cases. In addition, the results of stepwise multiple regression analysis in 18 sarin cases revealed that scores for the General Health Questionnaires, fatigue of Profile of Mood States (i.e., fatigue, tension-anxiety, depression, and anger-hostility)-together with the paired-associate learning test-were associated significantly with posttraumatic stress disorder. The association did not remain significant for the digit symbol test score. Perhaps a chronic effect on psychomotor performance was caused directly by acute sarin poisoning; on the other hand, the effects on psychiatric symptoms (General Health Questionnaire) and fatigue (Profile of Mood States) appeared to result from posttraumatic stress disorder induced by exposure to sarin.

Adult↗
PubMed2006

Surveillance for certain health behaviors among states and selected local areas--behavioral risk factor surveillance system, United States, 2004.

PROBLEM: Continuous monitoring of behaviors that increase the risk for chronic diseases and use of preventive practices are essential for the development, implementation, and evaluation of health promotion programs and policies, and other intervention strategies to prevent morbidity and mortality. Data from states/territories, selected metropolitan and micropolitan statistical areas (MMSAs), and counties provide the impetus for policymakers and other stakeholders to develop and promote the improvement of their community's overall health status. REPORTING PERIOD COVERED: Data in this report were collected during January 1-December 31, 2004, from states/territories, MMSAs, and counties that participated in the 2004 Behavioral Risk Factor Surveillance System (BRFSS). DESCRIPTION OF THE SYSTEM: BRFSS is an ongoing, state-based, random-digit--dialed telephone survey that employs a multistage cluster design. BRFSS collects information on health risk behaviors and preventive health practices related to the leading causes of death from the U.S. civilian, noninstitutionalized population aged > or =18 years. During 2004, a total of 49 states, the District of Columbia (DC), Puerto Rico, and the U.S. Virgin Islands participated in BRFSS. Among these states and territories, completed surveys were collected from a selection of 134 MMSAs and 199 counties. RESULTS: Prevalence of high-risk behaviors for chronic diseases, awareness of specific medical conditions, screening for certain cancers, and use of preventive health services varied substantially by state/territory, MMSA, and county. The proportion of the population that achieved Healthy People 2010 (HP 2010) objectives also varied by state/territory, MMSA, and county. In 2004, HP 2010 objectives for 100% health-care coverage and vaccination for pneumonia and influenza among persons aged > or =65 years were not achieved by any state/territory, MMSA, or county. Twelve states/territories, 47 MMSAs, and 74 counties achieved the HP 2010 objective of < or =20% of adults engaged in no leisure-time physical activity or exercise. The HP 2010 objective to reduce the proportion of adults who currently smoke cigarettes to < or =12% was achieved by two states/territories, four MMSAs, and six counties. One MMSA and one county achieved the HP 2010 target of < or =6% who engage in binge drinking during the month preceding the survey. The HP 2010 target of < or =15% of adults who are obese was obtained by one MMSA and eight counties. The HP 2010 objective to reduce the proportion to <20% for older adults who have had all of their natural teeth extracted was achieved by 23 states/territories, 51 MMSAs, and 45 counties. The HP 2010 target for adults aged > or =50 years who have ever received a sigmoidoscopy is 50%. BRFSS measured both sigmoidoscopy and colonoscopy. Using this measure, 38 states, 110 MMSAs, and 154 counties achieved the 50% goal. Four counties achieved the HP 2010 objective of 50% for adults who received a blood stool test within the previous 2 years. The HP 2010 objective to increase the proportion of women aged > or =18 years who had a Papanicolaou (Pap) test within the preceding 3 years is 90%. Twenty-four MMSAs and 49 counties achieved this objective. The HP 2010 objective for women aged > or =40 years who have received a mammogram within the preceding 2 years is 70%. Thirty-nine states, 112 MMSAs, and 168 counties achieved the objective. This report includes several risk behaviors and conditions that, although not included in HP 2010 goals, are important public health problems. These include self-reported fair-to-poor health status, heavy alcohol consumption, asthma, diabetes, and prostate cancer screening. The 2004 BRFSS data indicate great variability in the prevalence of self-reported fair-to-poor health status (5.7%-34.8%) and use of prostate cancer screening (34.7%-65.2%) by states/territories, MMSAs, and counties. Among these areas, the prevalence of current asthma ranged from 4.1% to 12.4%, and the prevalence of diabetes ranged from 3.2% to 12.5%. INTERPRETATION: The findings in this report indicate variations in health risk behaviors and use of preventive health screenings and health services among adults at the state, local, and county levels. These variations substantiate the continued need for public health surveillance in designing, implementing, monitoring, and evaluating public health policies and health-care use programs to reduce morbidity and mortality from the effect of high-risk health behaviors and subsequent chronic disease outcomes. PUBLIC HEALTH ACTION: Data from BRFSS are essential for monitoring prevalence of high-risk health behaviors, specific diseases, and use of preventive health services; dictating the design, focus, implementation, and evaluation of prevention health programs and strategies; and monitoring progress toward obtaining local, state, and national health objectives. Data from the 2004 BRFSS indicate a continual necessity to initiate and implement health promotion strategies for identifying specific health risk behaviors and practices and for assessing progress toward achieving disease prevention and health promotion objectives at state and local levels throughout the United States.

Behavioral Risk Factor Surveillance System↗