Current Trends Cardiovascular Disease, Motor-Vehicle-Related Injury, and Use of Clinical Preventive Services -- Behavioral Risk Factor Surveillance System, 1989

CDC's Behavioral Risk Factor Surveillance System (BRFSS), a state-based method for risk factor surveillance, was implemented in 1984. By 1989, 39 states and the District of Columbia participated in monthly random-digit-dialed telephone interviews of adults greater than or equal to 18 years of age (1). A total of 66,867 interviews were conducted in 1989; state-specific sample sizes ranged from 1171 to 3415 (mean: 1672). This report summarizes results of the 1989 survey and compares them with 1988 for risk factors associated with cardiovascular disease, motor-vehicle-related injury, and use of clinical preventive services. Cardiovascular Diseases

In 1989, the prevalences of two risk factors--overweight and sedentary lifestyle--for cardiovascular disease varied widely by state (Table 1). The proportion of persons who reported being overweight (i.e., body mass index greater than or equal to 27.8 for males and greater than or equal to 27.3 for females) ranged from 15.6% in New Mexico to 26.6% in Pennsylvania (median: 20.4%). For three states (California, Missouri, and Wisconsin), the percentage of persons who reported being overweight was lower than in 1988 (p less than 0.05); for Iowa and Montana, this percentage was higher (p less than 0.05). The proportion of respondents who reported sedentary lifestyle ranged from 44.7% in New Hampshire to 74.7% in the District of Columbia (median: 58.7%). For New Hampshire and Rhode Island, the reported prevalence of sedentary lifestyle decreased in 1989 (p less than 0.05); for the District of Columbia, Idaho, Minnesota, and Oklahoma, it increased (p less than 0.05). Motor-Vehicle-Related Injuries

In almost all states, the prevalence of drinking and driving and of seatbelt nonuse declined or did not change in 1989 (Table 2). The proportion of persons who reported drinking and driving in 1989 ranged from 1.1% in Maryland to 5.9% in North Dakota (median: 2.9%). For Minnesota and North Carolina, this percentage was lower (p less than 0.05) in 1989 than in 1988. The proportion of persons who reported seatbelt nonuse ranged from 6.3% in Hawaii to 61.9% in South Dakota (median: 29.6%). For 11 states, this percentage was lower than in 1988 (p less than 0.05); for the District of Columbia, Nebraska, and Wisconsin, it was higher (p less than 0.05). Use of Clinical Preventive Services

BRFSS respondents were asked about cholesterol levels and about use of screening mammograms. The proportion of persons who reported ever having had their cholesterol level checked ranged from 48.0% in Alabama to 63.7% in Connecticut (median: 55.1%) (Table 3). For 24 of the 37 states for which data were available for both 1988 and 1989, the percentage of persons who reported ever having had their cholesterol level checked was higher in 1989 (p less than 0.05). The proportion of women greater than or equal to 40 years of age who reported ever having had a mammogram ranged from 52.0% in Nebraska to 79.0% in the District of Columbia (median: 62.6%) (Table 3). For three of the 17 states that collected data in 1988 (Indiana, Nebraska, and South Carolina), the reported prevalence of ever having had a mammogram increased in 1989 (p less than 0.05). Reported by the following state BRFSS coordinators: L Eldridge, Alabama; J Contreras, Arizona; W Wright, California; M Adams, Connecticut; M Rivo, District of Columbia; S Hoescherl, Florida; J Smith, Georgia; A Villafuerte, Hawaii; J Mitten, Idaho; B Steiner, Illinois; S Joseph, Indiana; S Schoon, Iowa; K Bramblett, Kentucky; J Sheridan, Maine; A Weinstein, Maryland; R Letterman, Massachusetts; J Thrush, Michigan; N Salem, Minnesota; J Jackson-Thompson, Missouri; M McFarland, Montana; S Spanhake, Nebraska; K Zaso, L Powers, New Hampshire; M Watson, New Mexico; J Marin, O Munshi, New York; C Washington, North Carolina; M Maetzold, North Dakota; E Capwell, Ohio; N Hann, Oklahoma; J Grant-Worley, Oregon; C Becker, Pennsylvania; R Cabral, Rhode Island; M Mace, South Carolina; S Moritz, South Dakota; D Ridings, Tennessee; J Fellows, Texas; L Post-Nilson, Utah; J Bowie, Virginia; K Tollestrup, Washington; R Barker, West Virginia; E Cautley, Wisconsin. Behavioral Surveillance Br, Office of Surveillance and Analysis, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note:

In 1989, the prevalences of self-reported behavioral risk factors varied widely among states participating in the BRFSS. This finding is consistent with previous reports (1-4) and underscores the need for state-specific data for establishing and measuring public health objectives at the state level.

Because of the well-documented changes in other cardiovascular disease risks, the static prevalences of overweight and sedentary lifestyle in 1989 are of particular concern. However, substantial reductions in the prevalences of overweight and sedentary lifestyle may be difficult to achieve because modification of these risk behaviors requires modification of a variety of related behaviors.

The modest reductions in drinking and driving from 1988 to 1989 are important because the risk for a fatal crash is eight times greater for an intoxicated driver (5). In addition, the current median prevalence of 2.9% for drinking and driving is lower than the 1981-1983 BRFSS estimate of 6.1% (6). The substantial increase in seatbelt use is most likely associated with increased awareness among adults of seatbelts preventing motor-vehicle-related injury and the passage of mandatory seatbelt-use laws by 29 of the 39 participating states and the District of Columbia.

The increased proportion of states in which the reported prevalence of persons ever having had cholesterol checked appears to extend a trend noted in 1987 (7) and is consistent with findings reported by the National Heart, Lung, and Blood Institute (8). Possible explanations for this increase include greater public and provider awareness of cholesterol as a modifiable risk factor for cardiovascular disease (8,9) and increased availability of screening services. Finally, the prevalence of women who had ever had a mammogram indicates progress in efforts to promote use of mammography screening as the most important measure for increasing breast cancer survival rates (10).

References

1. Anda RF, Waller MN, Wooten KG, et al. Behavioral risk factor surveillance, 1988. In: CDC surveillance summaries, June 1990. MMWR 1990;39(no. SS-2):1-21.

2. CDC. Behavioral risk factor surveillance in selected states--1985. MMWR 1986;35:441-4.

3. CDC. Behavioral risk factor surveillance--selected states, 1986. MMWR 1987;36:252-4.

4. CDC. Behavioral risk factor surveillance--selected states, 1987. MMWR 1989;38:469-73.

5. Fell JC. Alcohol involvement rates in fatal crashes: a focus of young drivers and female drivers. In: Proceedings of the 31st Annual Conference of the American Association for Automotive Medicine. Washington, DC: National Center for Statistics and Analysis, 1987.

6. Bradstock MK, Marks JS, Forman MR, et al. Drinking and driving and health lifestyle in the United States: behavioral risk factors survey. J Stud Alcohol 1987;48:147-52.

7. CDC. State-specific changes in cholesterol screening and awareness--United States, 1987-1988. MMWR 1990;39:304-5,311-14.

8. Schucker B, Bailey K, Heimback JT, et al. Change in public perspective on cholesterol and heart disease: results from two national surveys. JAMA 1987;258:3527-31.

9. Schucker B, Wittes JT, Cutler JA, et al. Change in physician perspective on cholesterol and heart disease: results from two national surveys. JAMA 1987;258:3521-6. 10. American Cancer Society. Facts and figures, 1991. Atlanta: American Cancer Society, 1991.

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