Abstract
Two new reports from the National Center for Health Statistics (NCHS), the Centers for Disease Control and Prevention, provide the latest national estimates of underweight, overweight, and obesity in children and teenagers. The first report from a new survey of prison health care was published. The latest “Health, United States” spotlight presents a data visualization from the annual report on health status and determinants.
Underweight, Overweight, and Obesity in Children and Teenagers
A new report from the NCHS, “Prevalence of Overweight and Obesity Among Children and Adolescents Aged 2-19 Years: United States, 1963-1965 through 2013-2014,” 1 examines the latest data from the National Health and Nutrition Examination Survey (NHANES). The survey collects data from a national sample of the civilian, noninstitutionalized population through standardized health examinations, interviews, and laboratory testing. The national findings on overweight and obesity were based on body mass index (BMI) measurements, expressed as weight in kilograms divided by height in meters squared (kg/m2). Children and adolescents with BMI values from the 85th to the <95th percentile of the growth charts are considered overweight, and those with a BMI value ≥95th percentile of the growth charts are considered obese. 2
In 2013-2014, an estimated 17.2% of US children and adolescents aged 2 to 19 years were obese, and 16.2% were overweight. The survey found that an estimated 16.4% of boys aged 2 to 19 years were overweight and 17.2% were obese. Of girls aged 2 to 19 years, 16.0% were overweight, and 17.1% were obese. These percentages show a marked increase from a 1971-1974 survey finding that 10.2% of children aged 2 to 19 years were overweight and 5.1% were obese. 1 The survey tracked a steady increase from the 1970s to 2013-2014.
NHANES documented differences in overweight and obesity by age and race/ethnicity. The 2013-2014 findings showed that 9.4% of children aged 2 to 5 years, 17.4% of children aged 6 to 11 years, and 20.6% of adolescents aged 12 to 19 years were obese. By race/ethnicity, obesity was most prevalent among Hispanic children and adolescents aged 2 to 19 years (20.6%), followed by non-Hispanic black (16.8%), non-Hispanic white (15.9%), and non-Hispanic Asian (12.1%) children and adolescents.
NHANES published data on underweight children and adolescents based on measured heights and weights in another new report, “Prevalence of Underweight Among Children and Adolescents Aged 2-19 Years: United States, 1963-1965 through 2013-2014.” 3 In 2013-2014, an estimated 3.8% of children and adolescents aged 2 to 19 years were underweight, which is a decrease from 1963 to 1965 when national estimates of underweight ranged from 5.8% for children aged 2 to 5 years to 5.3% for children aged 6 to 11 years and 4.7% for teenagers aged 12 to 19 years. However, little difference in underweight prevalence was found by age: 3.4% for children aged 2 to 5 years, 4.8% for children aged 6 to 11 years, and 3.2% for adolescents aged 12 to 19 years. About 3.6% of girls and 4.0% of boys were underweight.
Prison Health Care Survey
The NCHS and the Bureau of Justice Statistics conducted the National Survey of Prison Health Care (NSPHC), on health care resources and services in the nation’s state prisons, and published their findings in “National Survey of Prison Health Care: Selected Findings.” 4 For the NSPHC, semistructured telephone interviews were conducted with respondents from state departments of corrections and the Federal Bureau of Prisons. Responses were obtained from 45 states; not all respondents provided information on all survey items. Interviews were conducted in 2012 for calendar year 2011. NSPHC data collection began in October 2012 and continued through March 2013.
The report highlights data on several major survey categories, including testing for selected infectious diseases, mental health conditions, and cardiovascular risk factors conducted upon entry into the system; the location of health care service delivery (including general medical and mental health care, as well as specialty services); and the use of telemedicine for certain health services. The survey asked about admissions testing for hepatitis A, hepatitis B, hepatitis C, and tuberculosis. All 45 participating states indicated that they screened for tuberculosis. Thirty participating states tested at least some incoming prisoners for hepatitis A, 32 for hepatitis B, and 36 for hepatitis C. Not all prisoners, however, were tested during the admissions process. In 43 participating states, tuberculosis testing was required for all admissions, but testing for hepatitis varied. Some participating states provided universal testing; others tested on the basis of clinical symptoms; and some offered an opt-out provision.
All 45 participating states provided information on cardiovascular risk testing during the admissions process. Risk factors were elevated lipids, high blood pressure, and abnormal electrocardiogram readings. Thirty participating states indicated that they tested at least some prisoners for elevated lipids during the admissions process, and 44 reported testing for high blood pressure. Twenty-nine participating states reported that they conducted electrocardiograms on at least some prisoners during the admissions process. Only 3 participating states tested all admissions, whereas others tested prisoners according to history of heart disease or clinical indication. All 45 participating states screened at least some admissions for mental health or suicide risk, and 23 screened for traumatic brain injury.
The survey asked about the provision and location of mental and medical care services. Forty-four participating states delivered outpatient mental health care exclusively on-site, and 27 delivered inpatient mental health care exclusively on-site. For inpatient medical services, 38 participating states indicated delivering care both on-site and off-site, depending on the severity of the health problem or the expertise required. Thirty-seven participating states provided dental care services on-site and off-site. Twenty-nine participating states indicated that some level of emergency care was available on-site, although their prison systems sent most emergencies off-site. Fifteen participating states sent all emergency care off-site. No participating states delivered emergency care exclusively on-site. Thirty-one participating states provided all care for prisoners with common chronic diseases on-site, and 13 delivered care both on-site and off-site. Thirty participating states reported using telemedicine for at least 1 specialty health or diagnostic service in their system. The report details a complex mix of on-site and off-site locations for long-term care services, including hospice and nursing home care.
The report also documented the provision of specialty health services, including those in cardiology, psychiatry, dialysis, oral surgery, gynecology, obstetrics, optometry, ophthalmology, orthopedics, and oncology. Diagnostic services included cardiac catheterization, sigmoidoscopy, colonoscopy, colposcopy, computer tomography, electrocardiogram, mammography, magnetic resonance imaging, and ultrasound. This survey is the first step in understanding the structure and provision of prison health care, and the findings are expected to be used to design future research activities.
“Health, United States” Spotlight
“Health, United States” is the annual report on health, produced by the NCHS and submitted by the secretary of the Department of Health and Human Services to the president and Congress. The report uses data from government sources, as well as private and global sources, to present an overview of national health trends. An infographic featuring 4 indicators (causes of death, diabetes, substance abuse, and asthma and allergies) of health status and health determinants is posted on the NCHS website. 5
The spring spotlight presents data on the top 5 causes of death for adults aged 25 to 44 years and 45 to 64 years. The top 5 causes of death for those aged 25 to 44 years (ie, unintentional injuries, cancer, heart disease, suicide, and homicide) accounted for 69.4% of all deaths. For adults aged 45 to 64 years, the top 5 causes of death (ie, cancer, heart disease, unintentional injuries, liver disease and cirrhosis, and chronic obstructive pulmonary disease) accounted for 66.8% of all deaths. The spotlight presents 2 measurements of diabetes among adults aged ≥20 years: (1) prevalence of both undiagnosed and physician-diagnosed diabetes and (2) percentage of each type of diabetes by age group. The total prevalence of diabetes increased steadily with age, from 4.0% for adults aged 20 to 44 years to 16.6% for adults aged 45 to 64 years to 26.3% for adults aged ≥65 years. The 20- to 44-year-olds were more likely to have undiagnosed diabetes (35%) than adults aged 45 to 64 years (25%) and ≥65 years (16%).
The spotlight also presents trends in the use of illicit drugs, alcohol, and tobacco among adolescents aged 12 to 17 years. Illicit drugs includes the nonmedical use of marijuana and hashish, cocaine and crack, heroin, hallucinogens, inhalants, and psychotherapeutic drugs. Findings showed that in 2014, 16.5% of teens aged 16 to 17 years used illicit drugs during the previous 30 days, compared with 7.9% of teens aged 14 to 15 years and 3.4% of adolescents aged 12 to 13 years. Use of tobacco products (ie, cigarettes, smokeless tobacco, cigars, and pipe tobacco but not e-cigarettes) declined for each age group from 2004 to 2014. In 2014, 14.4% of teens aged 16 to 17 years, 5.1% of teens aged 14 to 15 years, and 1.1% of adolescents aged 12 to 13 years used tobacco.
Also included in the spotlight are trends (2003-2005 to 2012-2014) in the prevalence of asthma attacks and allergic reactions in the previous year among children and teenagers aged 5 to 17 years. Spotlight documented some changes during this period: asthma attacks dropped from 5.8% to 5.6%; food allergies rose from 3.6% to 5.5%; skin allergies rose from 9.1% to 11.2%; and respiratory allergies declined from 20.0% to 18.4%. NCHS data systems provided the data on causes of death, diabetes, and allergies; the National Survey on Drug Use and Health was the source of data on drug, tobacco, and alcohol use. The data sources and methodology are described in the spotlight.