Journal Article•
Youth risk behavior surveillance--United States, 2003.
TL;DR: Results from the 2003 national Youth Risk Behavior Survey demonstrate that the majority of risk behaviors associated with these two causes of death are initiated during adolescence, and education and health officials at national, state, and local levels are using these data to improve policies and programs to reduce priority health-risk behaviors among youth.
Abstract: PROBLEM/CONDITION: Priority health-risk behaviors, which contribute to the leading causes of morbidity and mortality among youth and adults, often are established during youth, extend into adulthood, are interrelated, and are preventable. REPORTING PERIOD: This report covers data collected during February-December 2003. DESCRIPTION OF SYSTEM: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults--behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; unhealthy dietary behaviors; and physical inactivity--plus overweight. YRBSS includes a national school-based survey conducted by CDC as well as state and local school-based surveys conducted by education and health agencies. This report summarizes results from the national survey, 32 state surveys, and 18 local surveys conducted among students in grades 9-12 during February-December 2003. RESULTS AND INTERPRETATION: In the United States, 70.8% of all deaths among persons aged 10-24 years result from only four causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2003 national Youth Risk Behavior Survey demonstrated that, during the 30 days preceding the survey, numerous high school students engage in behaviors that increase their likelihood of death from these four causes: 30.2% had ridden with a driver who had been drinking alcohol; 17.1% had carried a weapon; 44.9% had drunk alcohol; and 22.4% had used marijuana. In addition, during the 12 months preceding the survey, 33.0% of high school students had been in a physical fight, and 8.5% had attempted suicide. Substantial morbidity and social problems among young persons also result from unintended pregnancies and STDs, including HIV infection. In 2003, 46.7% of high school students had ever had sexual intercourse; 37% of sexually active students had not used a condom at last sexual intercourse; and 3.2% had ever injected an illegal drug. Among adults aged > or =25 years, 62.9% of all deaths results from two causes: cardiovascular diseases and cancer. Results from the 2003 national Youth Risk Behavior Survey demonstrate that the majority of risk behaviors associated with these two causes of death are initiated during adolescence. In 2003, a total of 21.9% of high school students had smoked cigarettes during the 30 days preceding the survey; 78% had not eaten > or =5 servings/day of fruits and vegetables during the 7 days preceding the survey; 33.4% had participated in an insufficient amount of physical activity; and 13.5% were overweight. ACTIONS TAKEN: YRBSS data are being used to measure progress toward achieving 15 national health objectives for 2010 and three of the 10 leading health indicators. In addition, education and health officials at national, state, and local levels are using these YRBSS data to improve policies and programs to reduce priority health-risk behaviors among youth.
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Ludwig Institute for Cancer Research1, State University of Campinas2, University of Iowa3, University of Arizona4, University of New Mexico5, University of Washington6, SINTEF7, Karolinska Institutet8, Indiana University9, Johns Hopkins University School of Medicine10, University of Virginia11, McGill University12, Dartmouth College13, United States Military Academy14
TL;DR: In this paper, a double-blind placebo-controlled phase II study was done to assess the efficacy of a prophylactic quadrivalent vaccine targeting the human papillomavirus (HPV) types associated with 70% of cervical cancers (types 16 and 18) and with 90% of genital warts (types 6 and 11).
Abstract: Summary Background A randomised double-blind placebo-controlled phase II study was done to assess the efficacy of a prophylactic quadrivalent vaccine targeting the human papillomavirus (HPV) types associated with 70% of cervical cancers (types 16 and 18) and with 90% of genital warts (types 6 and 11). Methods 277 young women (mean age 20·2 years [SD 1·7]) were randomly assigned to quadrivalent HPV (20 μg type 6, 40 μg type 11, 40 μg type 16, and 20 μg type 18) L1 virus-like-particle (VLP) vaccine and 275 (mean age 20·0 years [1·7]) to one of two placebo preparations at day 1, month 2, and month 6. For 36 months, participants underwent regular gynaecological examinations, cervicovaginal sampling for HPV DNA, testing for serum antibodies to HPV, and Pap testing. The primary endpoint was the combined incidence of infection with HPV 6, 11, 16, or 18, or cervical or external genital disease (ie, persistent HPV infection, HPV detection at the last recorded visit, cervical intraepithelial neoplasia, cervical cancer, or external genital lesions caused by the HPV types in the vaccine). Main analyses were done per protocol. Findings Combined incidence of persistent infection or disease with HPV 6, 11, 16, or 18 fell by 90% (95% CI 71–97, p Interpretation A vaccine targeting HPV types 6, 11, 16, 18 could substantially reduce the acquisition of infection and clinical disease caused by common HPV types. Published online April 7, 2005 DOI 10.1016/S1470-2045(05)70101-7
1,627 citations
01 Nov 2005
TL;DR: The number of drugs per 100 population in the United States has changed little since records began in 1991, but the number of medications prescribed has increased significantly since then, particularly in the past decade.
Abstract: Number of drugs per 100 population 4 Total number of drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . 400.3 604.3 321.1 502.1 475.6 701.9 Antidepressants (depression and related disorders). . . . . . . 13.8 30.2 9.1 20.0 18.2 40.0 NSAID 6 (pain relief) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.9 30.1 16.0 25.4 23.7 34.7 Antiasthmatics/bronchodilators (asthma, breathing) . . . . . . . 13.0 24.7 11.7 21.4 14.3 27.9 Hyperlipidemia (high cholesterol) . . . . . . . . . . . . . . . . . . . . 5.4 23.7 5.4 24.0 5.4 23.4 Hypertension control drugs, not otherwise specified (high blood pressure) . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.0 23.6 4.1 20.5 7.8 26.6 Nonnarcotic analgesics (pain relief) . . . . . . . . . . . . . . . . . . 14.4 23.6 13.0 21.9 15.7 25.3 Antihistamines (allergies) . . . . . . . . . . . . . . . . . . . . . . . . . 13.7 22.7 10.8 17.3 16.4 27.9 Acid/peptic disorders (gastrointestinal reflux, ulcers). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.0 21.4 9.8 18.3 14.1 24.3 Blood glucose/sugar regulators (diabetes) . . . . . . . . . . . . . 9.5 19.8 8.6 19.1 10.4 20.6 Vitamins/minerals (dietary supplements) . . . . . . . . . . . . . . . 9.2 16.8 3.4 10.3 14.8 23.1 ACE inhibitors (high blood pressure, heart disease). . . . . . . 9.6 16.8 9.0 16.5 10.2 17.0 Narcotic analgesics (pain relief) . . . . . . . . . . . . . . . . . . . . . 11.2 16.7 10.3 13.4 12.2 19.9 Diuretics (high blood pressure, heart disease). . . . . . . . . . . 10.2 16.6 7.8 13.4 12.6 19.6 Penicillins (bacterial infections) . . . . . . . . . . . . . . . . . . . . . 16.6 13.1 15.5 12.6 17.7 13.6 Estrogens/progestins (menopause, hot flashes) . . . . . . . . . . . . . . . . . . . . . 19.8 14.9
1,360 citations
TL;DR: Improvements in early hemorrhage control and resuscitation and the prevention and aggressive treatment of coagulopathy appear to have the greatest potential to improve outcomes in severely injured trauma patients.
Abstract: The world-wide impact of traumatic injury and associated hemorrhage on human health and well-being cannot be overstated. Twelve percent of the global disease burden is the result of violence or accidental injury. Hemorrhage is responsible for 30 to 40% of trauma mortality, and of these deaths, 33 to 56% occur during the prehospital period. Among those who reach care, early mortality is caused by continued hemorrhage, coagulopathy, and incomplete resuscitation. The techniques of early care, including blood transfusion, may underlie late mortality and long-term morbidity. While the volume of blood lost cannot be measured, physiologic and chemical measures and the number of units of blood given are readily recorded and analyzed. Improvements in early hemorrhage control and resuscitation and the prevention and aggressive treatment of coagulopathy appear to have the greatest potential to improve outcomes in severely injured trauma patients.
1,209 citations
TL;DR: Clinical and public health approaches to the reduction in youth suicide and recommendations for further research will be discussed.
Abstract: This review examines the descriptive epidemiology, and risk and protective factors for youth suicide and suicidal behavior A model of youth suicidal behavior is articulated, whereby suicidal behavior ensues as a result of an interaction of socio-cultural, developmental, psychiatric, psychological, and family-environmental factors On the basis of this review, clinical and public health approaches to the reduction in youth suicide and recommendations for further research will be discussed
1,179 citations
Cites background or result from "Youth risk behavior surveillance--U..."
...The point prevalence of suicidal ideation in adolescence is approximately 15–25%, ranging in severity from thoughts of death and passive ideation to specific suicidal ideation with intent or plan (Grunbaum et al., 2004)....
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...This is in contrast with suicidal ideation and suicide attempts, where females havemuch higher rates than males after puberty (Fergusson, Woodward, & Horwood, 2000; Grunbaum et al., 2004)....
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...Although Hispanic youth in the USA are not disproportionately represented among suicide completers (Demetriades et al., 1998), they show higher rates of suicidal ideation and attempted suicide (Grunbaum et al., 2004)....
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...Annual suicide attempt rates among adolescents requiring medical attention are on the order of 1–3% (Grunbaum et al., 2004)....
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TL;DR: In the heat of passion, in the presence of peers, on the spur of the moment, in unfamiliar situations, when trading off risks and benefits favors bad long-term outcomes, and when behavioral inhibition is required for good outcomes, adolescents are likely to reason more poorly than adults do.
Abstract: Crime, smoking, drug use, alcoholism, reckless driving, and many other unhealthy patterns of behavior that play out over a lifetime often debut during adolescence. Avoiding risks or buying time can set a different lifetime pattern. Changing unhealthy behaviors in adolescence would have a broad impact on society, reducing the burdens of disease, injury, human suffering, and associated economic costs. Any program designed to prevent or change such risky behaviors should be founded on a clear idea of what is normative (what behaviors, ideally, should the program foster?), descriptive (how are adolescents making decisions in the absence of the program?), and prescriptive (which practices can realistically move adolescent decisions closer to the normative ideal?). Normatively, decision processes should be evaluated for coherence (is the thinking process nonsensical, illogical, or self-contradictory?) and correspondence (are the outcomes of the decisions positive?). Behaviors that promote positive physical and mental health outcomes in modern society can be at odds with those selected for by evolution (e.g., early procreation). Healthy behaviors may also conflict with a decision maker's goals. Adolescents' goals are more likely to maximize immediate pleasure, and strict decision analysis implies that many kinds of unhealthy behavior, such as drinking and drug use, could be deemed rational. However, based on data showing developmental changes in goals, it is important for policy to promote positive long-term outcomes rather than adolescents' short-term goals. Developmental data also suggest that greater risk aversion is generally adaptive, and that decision processes that support this aversion are more advanced than those that support risk taking. A key question is whether adolescents are developmentally competent to make decisions about risks. In principle, barring temptations with high rewards and individual differences that reduce self-control (i.e., under ideal conditions), adolescents are capable of rational decision making to achieve their goals. In practice, much depends on the particular situation in which a decision is made. In the heat of passion, in the presence of peers, on the spur of the moment, in unfamiliar situations, when trading off risks and benefits favors bad long-term outcomes, and when behavioral inhibition is required for good outcomes, adolescents are likely to reason more poorly than adults do. Brain maturation in adolescence is incomplete. Impulsivity, sensation seeking, thrill seeking, depression, and other individual differences also contribute to risk taking that resists standard risk-reduction interventions, although some conditions such as depression can be effectively treated with other approaches. Major explanatory models of risky decision making can be roughly divided into (a) those, including health-belief models and the theory of planned behavior, that adhere to a "rational" behavioral decision-making framework that stresses deliberate, quantitative trading off of risks and benefits; and (b) those that emphasize nondeliberative reaction to the perceived gists or prototypes in the immediate decision environment. (A gist is a fuzzy mental representation of the general meaning of information or experience; a prototype is a mental representation of a standard or typical example of a category.) Although perceived risks and especially benefits predict behavioral intentions and risk-taking behavior, behavioral willingness is an even better predictor of susceptibility to risk taking-and has unique explanatory power-because adolescents are willing to do riskier things than they either intend or expect to do. Dual-process models, such as the prototype/willingness model and fuzzy-trace theory, identify two divergent paths to risk taking: a reasoned and a reactive route. Such models explain apparent contradictions in the literature, including different causes of risk taking for different individuals. Interventions to reduce risk taking must take into account the different causes of such behavior if they are to be effective. Longitudinal and experimental research are needed to disentangle opposing causal processes-particularly, those that produce positive versus negative relations between risk perceptions and behaviors. Counterintuitive findings that must be accommodated by any adequate theory of risk taking include the following: (a) Despite conventional wisdom, adolescents do not perceive themselves to be invulnerable, and perceived vulnerability declines with increasing age; (b) although the object of many interventions is to enhance the accuracy of risk perceptions, adolescents typically overestimate important risks, such as HIV and lung cancer; (c) despite increasing competence in reasoning, some biases in judgment and decision making grow with age, producing more "irrational" violations of coherence among adults than among adolescents and younger children. The latter occurs because of a known developmental increase in gist processing with age. One implication of these findings is that traditional interventions stressing accurate risk perceptions are apt to be ineffective or backfire because young people already feel vulnerable and overestimate their risk. In addition, research shows that experience is not a good teacher for children and younger adolescents, because they tend to learn little from negative outcomes (favoring the use of effective deterrents, such as monitoring and supervision), although learning from experience improves considerably with age. Experience in the absence of negative consequences may increase feelings of invulnerability and thus explain the decrease in risk perceptions from early to late adolescence, as exploration increases. Finally, novel interventions that discourage deliberate weighing of risks and benefits by adolescents may ultimately prove more effective and enduring. Mature adults apparently resist taking risks not out of any conscious deliberation or choice, but because they intuitively grasp the gists of risky situations, retrieve appropriate risk-avoidant values, and never proceed down the slippery slope of actually contemplating tradeoffs between risks and benefits.
1,173 citations
References
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Book•
01 Jan 1956
TL;DR: This is the revision of the classic text in the field, adding two new chapters and thoroughly updating all others as discussed by the authors, and the original structure is retained, and the book continues to serve as a combined text/reference.
Abstract: This is the revision of the classic text in the field, adding two new chapters and thoroughly updating all others. The original structure is retained, and the book continues to serve as a combined text/reference.
35,552 citations
Journal Article•
TL;DR: Created with improved data and statistical curve smoothing procedures, the United States growth charts represent an enhanced instrument to evaluate the size and growth of infants and children.
Abstract: Objectives—This report presents the revised growth charts for the United States. It summarizes the history of the 1977 National Center for Health Statistics (NCHS) growth charts, reasons for the revision, data sources and statistical procedures used, and major features of the revised charts. Methods—Data from five national health examination surveys collected from 1963 to 1994 and five supplementary data sources were combined to establish an analytic growth chart data set. A variety of statistical procedures were used to produce smoothed percentile curves for infants (from birth to 36 months) and older children (from 2 to 20 years), using a two-stage approach. Initial curve smoothing for selected major percentiles was accomplished with various parametric and nonparametric procedures. In the second stage, a normalization procedure was used to generate z-scores that closely match the smoothed percentile curves. Results—The 14 NCHS growth charts were revised and new body mass index-for-age (BMI-for-age) charts were created for boys and girls (http://www.cdc.gov/growthcharts). The growth percentile curves for infants and children are based primarily on national survey data. Use of national data ensures a smooth transition from the charts for infants to those for older children. These data better represent the racial/ethnic diversity and the size and growth patterns of combined breast- and formula-fed infants in the United States. New features include addition of the 3rd and 97th percentiles for all charts and extension of all charts for children and adolescents to age 20 years. Conclusion—Created with improved data and statistical curve smoothing procedures, the United States growth charts represent an enhanced instrument to evaluate the size and growth of infants and children.
5,160 citations
"Youth risk behavior surveillance--U..." refers methods in this paper
...BMI values were compared with sex- and age-specific reference data from the 2000 CDC growth charts (20)....
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Book•
01 Jan 1979
TL;DR: The introductory text as mentioned in this paper provides students with a conceptual understanding of basic statistical procedures, as well as the computational skills needed to complete them, focusing on concepts critical to understanding current statistical research such as power and sample size, multiple comparison tests, multiple regression, and analysis of covariance.
Abstract: This introductory text provides students with a conceptual understanding of basic statistical procedures, as well as the computational skills needed to complete them. The clear presentation, accessible language, and step-by-step instruction make it easy for students from a variety of social science disciplines to grasp the material. The scenarios presented in chapter exercises span the curriculum, from political science to marketing, so that students make a connection between their own area of interest and the study of statistics. Unique coverage focuses on concepts critical to understanding current statistical research such as power and sample size, multiple comparison tests, multiple regression, and analysis of covariance. Additional SPSS coverage throughout the text includes computer printouts and expanded discussion of their contents in interpreting the results of sample exercises. 1. Introduction. 2. Organizing and Graphing Data. 3. Describing Distributions: Individual Scores, Central Tendency, and Variation. 4. The Normal Distribution. 5. Correlation: A Measure of Relationship. 6. Linear Regression: Prediction. 7. Sampling, Probability, and Sampling Distributions. 8. Hypothesis Testing: One-Sample Case for the Mean. 9. Estimation: One-Sample Case for the Mean. 10. Hypothesis Testing: One-Sample Case for Other Statistics. 11. Hypothesis Testing: Two-Sample Case for the Mean. 12. Hypothesis Testing: Two-Sample Case for Other Statistics. 13. Determining Power and Sample Size. 14. Hypothesis Testing, K-Sample Case: Analysis of Variance, One-Way Classification. 15. Multiple-Comparison Procedures. 16. Analysis of Variance, Two-Way Classification. 17. Linear Regression: Estimation and Hypothesis Testing. 18. Multiple Linear Regression. 19. Analysis of Covariance. 20. Other Correlation Coefficients. 21. Chi-Square (X2) Tests for Frequencies. 22. Other Nonparametric Tests.
4,010 citations
"Youth risk behavior surveillance--U..." refers methods in this paper
...In addition, for the national YRBS data, t tests were used to determine pairwise differences between subpopulations (23)....
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...Logistic regression analyses were used to account for all available estimates; control for sex, grade, and racial/ethnic changes over time; and assess long-term linear and quadratic trends (23)....
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TL;DR: Three STDs accounted for 88% of all new cases of STD among 15-24-year-olds in 2000 and emphasize the toll that STDs have on American youth.
Abstract: CONTEXT In the United States, young people aged 15–24 represent 25% of the sexually experienced population. However, the incidence and prevalence of sexually transmitted diseases (STDs) among this age-group are unknown.
METHODS Data from a variety of sources were used to estimate the incidence and prevalence of STDs among 15–24-year-olds in the United States in 2000. The quality and reliability of the estimates were categorized as good, fair or poor, depending on the quality of the data source.
RESULTS Approximately 18.9 million new cases of STD occurred in 2000, of which 9.1 million (48%) were among persons aged 15–24. Three STDs (human papillomavirus, trichomoniasis and chlamydia) accounted for 88% of all new cases of STD among 15–24-year-olds.
CONCLUSIONS These estimates emphasize the toll that STDs have on American youth. More representative data are needed to help monitor efforts at lowering the burden of these infections.
1,661 citations
TL;DR: Overall, students appeared to report health risk behaviors reliably over time, but several items need to be examined further to determine whether they should be revised or deleted in future versions of the YRBS.
1,040 citations
"Youth risk behavior surveillance--U..." refers background in this paper
...Information about the reliability of the standard questionnaire has been published elsewhere (18,19)....
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...Second, the extent of underreporting or overreporting of health-related behaviors cannot be determined, although the survey questions demonstrate good test-retest reliability (18,19)....
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