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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 203-209

Prevalence of behavioral risk factor in the United States of America adult population: A concise review of the findings from the behavioral risk factor surveillance system, 2001–2017


Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy

Date of Submission14-Jan-2020
Date of Decision07-May-2020
Date of Acceptance16-Apr-2020
Date of Web Publication27-Jul-2020

Correspondence Address:
Dr. Chidiebere Emmanuel Okechukwu
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_116_19

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  Abstract 


Adult citizens of the United States of America (US) have lesser life expectancy compared to inhabitants of the rest of the developed countries. The objective of this review was to evaluate the prevalence of behavioral risk factors, which are physical inactivity, weight gain, prevalence of smoking, hypertension, hypercholesterolemia, poor diet and heavy alcohol consumption, in all the US states including Washington DC and all the territories from 2001 to 2009, and 2011–2017 using data obtained from the behavioral risk factor surveillance system (BRFSS) database. Studies that investigated on lifestyle behaviors and behavioral risk factor among US citizens obtainable up to August 2019 were evaluated. PubMed database was used. The MeSH system was used to extract relevant research studies from PubMed. Data from the survey of behavioral risk factors for all the US States, including Washington DC and all territories was obtained from The BRFSS database. The findings from the Surveys on US adult's physical activity, entails participation in aerobic and muscle strengthening exercises to meet recommendations shows that from 2013 to 2017 a significant proportion of the US adult population did not meet up with physical activity guidelines for US adults. However, the results of the surveys on the consumption of fruits and vegetables among US adults at least 5 or more times/day from 2002 to 2009 shows that a significant proportion of the US adult population eats fruits and vegetables <5 servings/day which is below the advocated amounts of fruits and vegetables.

Keywords: Americans, assessment, behavior problems, cardiovascular risk factors, screening, sociodemographic


How to cite this article:
Okechukwu CE. Prevalence of behavioral risk factor in the United States of America adult population: A concise review of the findings from the behavioral risk factor surveillance system, 2001–2017. Int J Health Allied Sci 2020;9:203-9

How to cite this URL:
Okechukwu CE. Prevalence of behavioral risk factor in the United States of America adult population: A concise review of the findings from the behavioral risk factor surveillance system, 2001–2017. Int J Health Allied Sci [serial online] 2020 [cited 2020 Oct 25];9:203-9. Available from: https://www.ijhas.in/text.asp?2020/9/3/203/290705




  Introduction Top


Adult citizens of the United States of America (US) have smaller life expectancy compared to citizens of the rest of the developed nations, adopting a healthy routine might decrease early death and extend life expectancy among US adults.[1] The disease burden in the US, are mostly the consequences of tobacco smoking, poor diet, sedentary lifestyle, obesity, excessive alcohol consumption, high blood pressure (BP), and hyperlipidemia, the rise in the frequency of chronic diseases in the US are as a result of the increase in chronic disease risk factors.[2] Health interventions that recommend physical activity is vital, followed by recommendations to eat fruits and vegetables and reduce carbohydrate intake, most especially excessive sugar consumption and smoking cessation should be encouraged.[3] However, a mobile phone based study on cardiovascular health risk factors was effective in promoting physical activity.[4]

A considerable number of cancer incidence and mortalities among US white citizens could be avoided by discontinuing cigarette smoking, minimizing excessive alcohol use, keeping a moderate body mass index (BMI), and training at a moderate intensity for at least 150 min or at a vigorous intensity for at least 75 min/week, or a combination of both.[5] Among individuals with coronary heart disease, the utilization of lifestyle based short messaging service compared to normal treatment caused a decrease in low-density lipoprotein cholesterol (LDL-C) level.[5] Lifestyle interventions were discreetly effective in improving health outcomes, such as decrease in total cholesterol, LDL-C and triglycerides levels, and an increase in high-density lipoprotein cholesterol level, reductions in Systolic BP and diastolic BP.[6],[7]

Healthy lifestyle behavior was related to a lesser risk of stroke.[8] Inspiring patients to change their lifestyle behavior is very difficult to achieve in the US, there is need to design healthy lifestyle strategies personalized for the patients and regular monitoring and follow up.[9],[10] Keeping a low BMI, exercising regularly, and avoiding cigarette smoking are related to increased cardiorespiratory fitness throughout an adult life span.[11]

In the US, many individuals with chronic diseases share mutual lifestyle behaviors, mostly cigarette smoking, poor diet, sedentariness, and obesity, physical inactivity and these factors are associated with total deaths in the US.[12] Among individuals aged 70–90 years, commitment to a mediterranean diet and healthy lifestyle was related to lower mortality rate.[13] Individuals with high BP, can lower their BP through lifestyle modification.[14] Cigarette smoking and excessive weight gain are risk factors for pneumonia among men and women.[15] A physical activity intervention was effective in improving cardiorespiratory fitness, and reducing BP among inactive healthy adults.[16] Behavioral intervention in clinical settings was associated with a decrease in waist circumference among obese individuals.[17]

The objective of this review was to evaluate the prevalence of behavioral risk factors, which are physical inactivity, overweight, obesity, smoking, hypertension, hypercholesterolemia, poor diet, and heavy alcohol consumption among US adults in all the US states including Washington DC and all the territories from 2001 to 2009, and 2011–2017 using data obtained from the behavioral risk factor surveillance system (BRFSS) database managed by the Centers for Disease Control and Prevention (CDC).


  Materials and Methods Top


Relevant studies that reported on the prevalence of behavioral risk factors among US citizens obtainable up to august 2019 were evaluated. PubMed database was used. The MeSH system was used to extract relevant research studies from PubMed using the following keywords; Behavior problems, Assessment, Screening, Tobacco use, Smoking prevention, Cardiovascular Risk Factors, Sociodemographic, Americans, Physical Activity Level, and Racial Difference. All the selected articles were published in English.

Data from the survey of behavioral risk factors for all the US States, including Washington DC and all Territories was extracted from The BRFSS database.[18] BRFSS is a state-run-based investigation system that collects data on many activities and situations that puts US adults (age ≥18 years) at risk for chronic diseases. Skilled assessors collect data every month by means of an unbiased probability sample of households through telephone calls.


  Findings Top


Symbols

% = percent, CI = 95% confidence interval, N or n = “Sample Size,” this means the number of US states included in the survey. **= Median value signifies reported with no confidence intervals.

Survey on the United States of America Adults physical activity levels, accumulation of up to 30 min and above of moderate physical activity 5 or more days/week, or vigorous physical activity for 20 min 3 or more days/week (2001, 2003, 2005, 2007, 2009)

The outcome of this surveys in [Table 1], shows that in the year 2001, a proportion of 46.1% (yes), of a percentage of total US adult population accumulated up to 30 min and above of moderate physical activity 5 or more days/week, or vigorous intensity physical activity for 20 min 3 or more days/week, while 54.0% (no) did not. In the year 2003, a proportion of 47.2% (yes), of a percentage of total US adult population accumulated up to 30 min and above of moderate physical activity 5 or more days/week, or vigorous intensity physical activity for 20 min 3 or more days/week, while 52.8 (no) did not. In the year 2005, a proportion of 48.7% (yes), of a percentage of total US adult population accumulated up to 30 min and above of moderate physical activity 5 or more days/week, or vigorous intensity physical activity for 20 min 3 or more days/week while 51.3 (no) did not. In the year 2007, a proportion of 49.2% (yes), of a percentage of total US adult population accumulated up to 30 min and above of moderate physical activity 5 or more days/week, or vigorous intensity physical activity for 20 min 3 or more days/week while 50.8% (no) did not. In the year 2009, a proportion of 50.6% (yes), of a percentage of total US adult population accumulated up to 30 min and above of moderate physical activity 5 or more days/week, or vigorous intensity physical activity for 20 min 3 or more days/week while 49.4% (no) did not. These results demonstrated a steady rise in physical activity level among a proportion of the US adult population from 2001 to 2009, though US adults have not met up with the recommended dose of physical activity.
Table 1: United states of America adults physical activity level, accumulation of up to 30 min and above of moderate physical activity 5 or more days/week, or vigorous physical activity for 20 min 3 or more days/week (2001, 2003, 2005, 2007, 2009)

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Survey on the United States of America Adults physical activity levels, participation in sufficient aerobic and muscle strengthening exercises to meet recommendations (2013, 2016, 2017)

The outcome of this surveys which was illustrated in [Table 2], shows that in the year 2013, 20.4% (yes), of a proportion of the US adult population carried out aerobic and muscle strengthening exercises to meet recommendations, while 79.6% (no), did not. In 2015, 20.3% (yes), of a proportion of the US adult population participated in enough aerobic and muscle strengthening exercises to meet guidelines, while 79.7% (no) did not in 2017, 20.3% (yes), of a proportion of the US adult population participated in enough Aerobic and Muscle Strengthening exercises to meet guidelines, while 79.7% (no) did not. These results show that from 2013 to 2017 a significant percentage of a proportion of the US adult population did not achieve the physical activity recommendations for US adults.
Table 2: United states of America adults physical activity level, participation in enough aerobic and muscle strengthening exercises to meet guidelines (2013, 2016, 2017)

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Weight classification by body mass index of the United States of America adult population (2011–2017)

[Table 3] shows Weight classification by BMI among the US adult population. The results shows that a near significant percentage of a proportion of the US adult population from 2011 to 2017 was overweight.
Table 3: Weight classification by body mass index of the United states of America adult population (2011-2017)

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Four level smoking status in the United States of America adult population (2011–2017)

[Table 4] shows the smoking status and frequency in the US adult population classified into four status smoke every day, smoke some days, former smoke, and never smoked. These results shows that from 2011 to 2017 a significant percentage of a proportion of the US adult population has never smoked, whereas a large proportion were former smokers.
Table 4: Four level smoking status in the United states of America adult population (2011-2017)

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Prevalence of high blood pressure in the United States of America adult population (2011, 2013, 2015, 2017)

[Table 5] shows the outcomes of the surveys on the incidence of high BP in a proportion of US adult population, from 2011 to 2017. These results show a high but not significant occurrence of hypertension in a proportion of the US adult population from 2011 to 2017.
Table 5: Prevalence of high blood pressure in the United states of America adult population (2011, 2013, 2015, 2017)

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Incidence of hypercholesterolemia in the United States of America adult population (2011, 2013, 2015)

[Table 6] shows the outcome of surveys on the prevalence of hypercholesterolemia in a proportion of the US adult population, from 2011 to 2015. These results demonstrated a high but not significant prevalence of hypercholesterolemia in a proportion of US adult population from 2011 to 2017.
Table 6: Prevalence of hypercholesterolemia in the United states of America adult population (2011, 2013,2015)

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Prevalence of heavy alcohol consumption in the United States of America adult population (2015–2017)

[Table 7] shows the outcome of the surveys on prevalence of heavy alcohol consumption among a proportion of the US adult population from 2015 to 2017. Heavy drinking was characterised by men drinking more than 14 times/week, and women drinking more than 7 times/week. These results show that a high percentage of a proportion of the US adult population did not reach the criteria for heavy drinking from 2015 to 2017.
Table 7: Prevalence of heavy alcohol consumption in the United states of America adult population (2015-2017)

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Prevalence of E-cigarette use in the United States of America adult population (2017)

[Table 8] shows the outcome of the survey on prevalence of E-cigarette use in a proportion of the US adult population in 2017. In the survey, US adult population was categorized into; current E-cigarette user-every day, current E-cigarette user-some days, former E-cigarette use and never used E-cigarettes. These results show that a very high percentage of a proportion of the US adult population had never used E-cigarettes in 2017.
Table 8: Prevalence of E.cigarette use in the United states of America adult population (2017)

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Eating of fruits and vegetables at least 5 or more times/day in United States of America adult population (2002, 2003, 2005, 2007, 2009)

In the surveys on the consumption of fruits and vegetables among a proportion of US adult population at least 5 or more times/day from 2002 to 2009, US adults were categorized into “Eat 5 or more times per day” and “Eat less than 5 times per day.” The results of the surveys show that a significant percentage of a proportion of US adult population consumes fruits and vegetables <5 servings/day from 2002 to 2009.


  Discussion Top


Morbid obesity is definitely comorbid with high BP and type 2 diabetes mellitus in the US, there are high rates of morbid obesity in the US predominantly among African American women, therefore there is need for effective behavioral risk factor surveillance in the US.[19] A planned, moderate-intensity physical activity regimen compared to a health education intervention minimized mobility frailty among older US adults.[20] A nutrition and exercise intervention decreased the rate of self-reported functional decline among older US adults, who are survivors of colorectal, breast, and prostate cancer.[21] However, workers exposed to a workplace fitness and wellness program reported improvements in health behaviors.[22] A lifestyle intervention program integrating weight loss therapy, problem-solving rehabilitation, and antidepressant pills into a single regimen significantly improved weight loss and depressive symptoms likened to usual treatment among adults with obesity and depression.[23]

The outcome of the BRFSS surveys on physical activity among US adults, demonstrates that from 2013 to 2017 a significant percentage of a proportion of the US adult population did not reach the physical activity guidelines for US adults, therefore youth coaches should encourage physical activity and help to promote exercise and healthy behaviors that could be maintained until old age.[24] The outcome of the surveys on weight status of US adults shows that a near significant percentage of a proportion of the US adult population from 2011 to 2017 were overweight, therefore US clinicians should recommend an intensive, integrated behavioral interventions for adults with a BMI of 30 and above.[25],[26]

The outcome of the survey on dietary intake, show that a significant percentage of a proportion of the US adult population eats fruits and vegetables <5 servings/day from 2002 to 2009. However, the dietary patterns of US adults with hypertension has small pact with the Dietary Approaches to Stop Hypertension trial (DASH) dietary pattern, and the dietary quality of adults with hypertension has worsened from the time when DASH diet was introduced.[27]

There are very little evidence on the effectiveness of behavioral interventions over a long period of time, further researches are needed to evaluate the efficacy and adherence to lifestyle interventions for chronic disease prevention over a protracted period of time.[28] Health-care specialists treating sedentary US adults should highlight the need to maintain a healthy lifestyle over a long period of time.[29] BRFSS is piloted by the CDC, it extended its services to 50 states in the US by 1994.[18],[30] The BRFSS was meant for the assessment of data on the prevalence of behavioral risk factors among US adults at the state level, for surveillance tenacities such as predicting, observing, and assessment. Data collection is the duty of each state health division and hence it is regionalized, the BRFSS acquires data through telephone surveys within each US state.[31],[32],[33],[34]


  Conclusion Top


The findings from the Surveys on US adults physical activity levels, carried out by evaluating the rate of participation in aerobic and Muscle Strengthening exercises to meet US physical activity guiding principle, proved that from 2013 to 2017 a significant percentage of a proportion of the US adult population did not meet up with physical activity guidelines for US adults according to the recommended dose by the US department of health and human services.[35] However, this calls for more actions and improvements in physical activity and health promotion strategies and interventions which will enable majority of US adults to attain the endorsed dose of physical activity and even more than the recommended dose. The results on the surveys of weight classification by BMI of US adult population, demonstrated that a near significant percentage of a proportion of the US adult population from 2011 to 2017 were overweight, this can be reversed through an increase in physical activity and health promotion interventions and strategies to encourage weight loss across the US.

The result of the surveys on the consumption of fruits and vegetables in a proportion of US adult population at least 5 or more times/day from 2002 to 2009, show that a significant percentage of a proportion of the US adult population eats fruits and vegetables <5 servings/day from 2002 to 2009 which is less than the suggested amount of fruits and vegetables.[36] However, the US adult citizens should be encouraged to consume more fruits and vegetables. Nutritionists and health promoters have a vital role to play to ensure that every US adult citizen adheres to this recommendation. Moreover, an effective, well-planned, and lifetime behavioral intervention could modify the health risks associated with these factors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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