Objective. —To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention. Participants. —A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented. Evidence. —The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles. Consensus Process. —Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise "public health message" was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine. Conclusion. —Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week. ( JAMA . 1995;273:402-407)

https://jamanetwork.com/journals/JAMA/articlepdf/386766/jama_273_5_029.pdf

Physical Activity and Public Health: A Recommendation From the Centers for Disease Control and Prevention and the American College of Sports Medicine

Context Obesity and diabetes are increasing in the United States. Objective To estimate the prevalence of obesity and diabetes among US adults in 2001. Design, Setting, and Participants Random-digit telephone survey of 195 005 adults aged 18 years or older residing in all states participating in the Behavioral Risk Factor Surveillance System in 2001. Main Outcome Measures Body mass index, based on self-reported weight and height and self-reported diabetes. Results In 2001 the prevalence of obesity (BMI ≥30) was 20.9% vs 19.8% in 2000, an increase of 5.6%. The prevalence of diabetes increased to 7.9% vs 7.3% in 2000, an increase of 8.2%. The prevalence of BMI of 40 or higher in 2001 was 2.3%. Overweight and obesity were significantly associated with diabetes, high blood pressure, high cholesterol, asthma, arthritis, and poor health status. Compared with adults with normal weight, adults with a BMI of 40 or higher had an odds ratio (OR) of 7.37 (95% confidence interval [CI], 6.39-8.50) for diagnosed diabetes, 6.38 (95% CI, 5.67-7.17) for high blood pressure, 1.88 (95% CI,1.67-2.13) for high cholesterol levels, 2.72 (95% CI, 2.38-3.12) for asthma, 4.41 (95% CI, 3.91-4.97) for arthritis, and 4.19 (95% CI, 3.68-4.76) for fair or poor health. Conclusions Increases in obesity and diabetes among US adults continue in both sexes, all ages, all races, all educational levels, and all smoking levels. Obesity is strongly associated with several major health risk factors.

https://jamanetwork.com/journals/jama/articlepdf/195663/jbr20304_76_79.pdf

Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001.

Socioeconomic status (SES) is consistently associated with health outcomes, yet little is known about the psychosocial and behavioral mechanisms that might explain this association. Researchers usually control for SES rather than examine it. When it is studied, only effects of lower, poverty-level SES are generally examined. However, there is evidence of a graded association with health at all levels of SES, an observation that requires new thought about domains through which SES may exert its health effects. Variables are highlighted that show a graded relationship with both SES and health to provide examples of possible pathways between SES and health end points. Examples are also given of new analytic approaches that can better illuminate the complexities of the SES-health gradient.

Socioeconomic status and health: The challenge of the gradient.

ContextRecent reports show that obesity and diabetes have increased in the
United States in the past decade.ObjectiveTo estimate the prevalence of obesity, diabetes, and use of weight control
strategies among US adults in 2000.Design, Setting, and ParticipantsThe Behavioral Risk Factor Surveillance System, a random-digit telephone
survey conducted in all states in 2000, with 184 450 adults aged 18 years
or older.Main Outcome MeasuresBody mass index (BMI), calculated from self-reported weight and height;
self-reported diabetes; prevalence of weight loss or maintenance attempts;
and weight control strategies used.ResultsIn 2000, the prevalence of obesity (BMI ≥30 kg/m2) was
19.8%, the prevalence of diabetes was 7.3%, and the prevalence of both combined
was 2.9%. Mississippi had the highest rates of obesity (24.3%) and of diabetes
(8.8%); Colorado had the lowest rate of obesity (13.8%); and Alaska had the
lowest rate of diabetes (4.4%). Twenty-seven percent of US adults did not
engage in any physical activity, and another 28.2% were not regularly active.
Only 24.4% of US adults consumed fruits and vegetables 5 or more times daily.
Among obese participants who had had a routine checkup during the past year,
42.8% had been advised by a health care professional to lose weight. Among
participants trying to lose or maintain weight, 17.5% were following recommendations
to eat fewer calories and increase physical activity to more than 150 min/wk.ConclusionsThe prevalence of obesity and diabetes continues to increase among US
adults. Interventions are needed to improve physical activity and diet in
communities nationwide.

https://jamanetwork.com/journals/jama/articlepdf/194179/JOC10856.pdf

The continuing epidemics of obesity and diabetes in the United States.

The Physical Activity Scale for the Elderly (PASE): development and evaluation.

Since 1981, the Centers for Disease Control has collaborated with State health departments and the District of Columbia to conduct random digit-dialed telephone surveys of adults concerning their health practices and behaviors. This State-based surveillance system, which yields data needed in planning, initiating, and supporting health promotion and disease prevention programs, is described in this paper. Standard methods and questionnaires were used to assess the prevalence of personal health practices and behaviors related to the leading causes of death, including seatbelt use, high blood pressure control, physical activity, weight control, cigarette smoking, alcohol use, drinking and driving, and preventive health practices. Between 1981 and 1983, 29 States (includes the District of Columbia) conducted one-time telephone surveys. Beginning in 1984, most States began collecting data continuously throughout the year, completing approximately 100 interviews per month (range 50-250), with an average of 1,200 completed interviews per year (range 600-3,000). The raw data were weighted to the age, race, and sex distribution for each State from the 1980 census data. This weighting accounts for the underrepresentation of men, whites, and younger persons (18-24 years) in the telephone surveys and, for many health practices, provides prevalence estimates comparable with estimates obtained from household surveys. Nearly all (86 percent) of the States distributed selected survey results to other State agencies, local health departments, voluntary organizations, hospitals, universities, State legislators, and the press. The majority (60 percent) of States used information from the surveys to set State health objectives, prepare State health planning documents, and plan a variety of programs concerning antismoking, the prevention of chronic diseases, and health promotion. Further, nearly two-thirds (65 percent) used results to support legislation, primarily related to the use of tobacco and seatbelts. Most of the States (84 percent) reported that alternative sources for such data (prevalence of behavioral risk factors) were unavailable. Currently in 1988, over 40 State health departments are conducting telephone surveys as part of the Behavioral Risk Factor Surveillance System. This system has proved to be (a) flexible--it provides data on emerging public health problems, such as smokeless tobacco use and AIDS, (b) timely--it provides results within a few months after the data are collected, and (c) affordable--it operates at a fraction of the cost of comparable statewide in-person surveys. The system enables State public health agencies to continue to plan,initiate, and guide statewide health promotion and disease prevention programs and monitor their progress over time.

/pdf/design-characteristics-and-usefulness-of-state-based-22d3h9mecr.pdf

Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981-87.

The behavioral risk factor surveys: II. Design, methods, and estimates from combined state data.

Based on the aggregate of behavioral risk factor surveys, almost one third of adults were smokers in 1982. Overall, significantly fewer Hispanics smoked compared with whites or blacks. Among young adults, however, the rate of smoking was highest among whites compared with blacks and Hispanics. Compared with nonsmokers, smokers—especially young women—had higher rates of other risk behaviors, including alcohol misuse and lack of seat-belt use. Since 1965, the rate of decline of smoking among women has not been as great as that among men, due in part to the high rate—more than 40%—of smoking among young white women. Despite continued decrease in the overall proportion of smokers, the high rate among young women emphasizes the need for continued efforts toward prevention and cessation, before the well-documented health consequences develop. (JAMA1985;253:2975-2978)

Current smoking trends in the United States. The 1981-1983 behavioral risk factor surveys.

The behavioral risk factor surveys: I. State-specific prevalence estimates of behavioral risk factors.

Although seat belt use could prevent thousands of highway deaths and save billions of dollars annually, most Americans do not routinely buckle up. To understand better this phenomenon and other health-related behaviors, 28 states, the District of Columbia, and the Centers for Disease Control, Atlanta, surveyed over 22,000 US adults from 1981 through 1983. Overall, 76% of US adults reported not using seat belts. Blacks, 18- to 24-year-olds, persons with no more than a high school education, and persons with other risk behaviors (especially drunk driving) were least likely to use seat belts. Legislation by the states and education by physicians can increase seat belt use and reduce morbidity and mortality due to motor vehicle collisions.

Eileen M. Gentry

Papers

Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981-87.

The behavioral risk factor surveys: II. Design, methods, and estimates from combined state data.

Current smoking trends in the United States. The 1981-1983 behavioral risk factor surveys.

The behavioral risk factor surveys: I. State-specific prevalence estimates of behavioral risk factors.

Failure to Use Seat Belts in the United States: The 1981-1983 Behavioral Risk Factor Surveys