Ann P. Rafferty

Knowledge of stroke risk factors and warning signs among Michigan adults.

Objective: To assess the knowledge of stroke risk factors and warning signs in a representative statewide sample of Michigan adults. Method: Respondents to the 1999 Michigan Behavioral Risk Factor Survey, a random-digit-dialed statewide survey of >2,500 adults, were asked to report up to three risk factors and warning signs for stroke. Predictors of inadequate knowledge (defined as not reporting any correct responses) of stroke risk factors and warning signs were identified using multiple logistic regression. Results: Eighty percent reported at least one correct risk factor for stroke, and 28% reported three. The most frequently mentioned risk factors were hypertension (32%), smoking (29%), and physical inactivity (26%). Sixty-nine percent reported at least one correct warning sign of stroke, but only 14% reported three. The most frequently mentioned warning signs were sudden weakness or numbness (46%) and sudden slurred speech, disorientation, or difficulty understanding (30%). Predictors for inadequate knowledge of both stroke risk factors and warning signs were similar and included age, race, sex, education, hypertension, and smoking. Conclusions: Knowledge of stroke risk factors and warning signs was moderate at best. One in five respondents was not aware of any stroke risk factors, and almost one in three was not aware of any stroke warning signs. Stroke knowledge was poorest among groups that have the highest risk of stroke.

Seasonal variation in adult leisure-time physical activity.

PURPOSE To determine the effect of season on self-reported leisure-time physical activity (LTPA) behaviors of Michigan adults. METHODS Data were obtained from the 1996 Michigan Behavioral Risk Factor Survey conducted throughout the year. Survey respondents were considered active if they reported participating in at least one LTPA during the past month. Complete information regarding type, frequency, and duration of up to two LTPA was available on 2843 adults (1635 women and 1208 men). Four seasons were defined as winter (January-March; N = 677), spring (April-June; N = 759), summer (July-September; N = 760), and fall (October-December; N = 647). Total weekly leisure-time energy expenditure was quantified (kcal x kg-1 x wk-1) from MET intensities, duration, and frequency of activity sessions per week. Seasonal differences were identified using ANOVA. RESULTS Average (+/-SEM) weekly leisure time energy expenditure was significantly greater (P < 0.001) during spring (17.5 +/- 0.8 kcal x kg-1 x wk-1) and summer (17.5 +/- 0.7 kcal.kg-1.wk-1) compared with winter (14.8 +/- 0.7 kcal x kg-1 x wk-1) and fall (15.0 +/- 0.7 kcal x kg-1 x wk-1). Duration of the first activity was significantly greater (P < 0.05) in summer (58.6 +/- 1.6 min) compared with winter (53.4 +/- 1.8 min). However, intensity (4.6 +/- 0.1 METs) and frequency (3.1 +/- 0.1 sessions per week) of the first activity did not differ among seasons. A second activity was performed by 1319 (46.4%) of active individuals and was more common in the spring (46.8%) and summer (54.5%) compared with fall (42.6%) and winter (39.4%) (chi2 = 31.0; P < 0.01). When both active and inactive subjects are considered, the Healthy People 2010 recommendation for moderate physical activity was met only during spring and summer. CONCLUSION Weekly leisure-time energy expenditure averaged approximately 15-20% higher during spring and summer. Much of this difference was due to active respondents participating in a second activity during these seasons.

Physical activity patterns among walkers and compliance with public health recommendations

PURPOSE Walking is the most common leisure-time physical activity (LTPA) among U.S. adults. The purpose of this study was to estimate the prevalence of walking for physical activity and the proportion of walkers who met current public health physical activity recommendations. METHODS We analyzed data from the 1998 Behavioral Risk Factor Surveillance System, a collection of state-based, random-digit-dialed telephone surveys of adults. Physical activity measures included the type, frequency, and duration of the two LTPAs in which respondents engaged most often during the previous month. We calculated the prevalence of walking and the prevalence of three physical activity patterns defined by combinations of walking duration and frequency. We also examined the effect on these patterns of participating in a second LTPA. RESULTS In 1998, an estimated 38.6% of U.S. adults walked for physical activity. Among walkers, 21.3% walked a minimum of 30 min five or more times per week. This approximates compliance with current physical activity recommendations. Compliance increased to 34.5% when the criteria were relaxed to include at least 150 min of walking per week accumulated over three or more occasions. Relaxing the criteria further to include a minimum of 150 min.wk(-1) regardless of frequency produced only a small increase in compliance (37.6%). However, compliance with each of these three activity patterns approximately doubled when a second LTPA was taken into account. CONCLUSIONS Less than 40% of walkers complied through walking with even our most liberal physical activity pattern (> or =150 min.wk(-1) regardless of frequency). For walkers to meet current public health recommendations, many need to walk more frequently and/or to engage in additional physical activities.

Prevalence of Complementary and Alternative Medicine Use: State-Specific Estimates From the 2001 Behavioral Risk Factor Surveillance System

Use of complementary and alternative medicine (CAM) among adults in the United States is prevalent and increasing,1,2 although estimates vary as to the exact level of its use.3,4 The Behavioral Risk Factor Surveillance System (BRFSS) is an established system that provides timely, state-specific estimates of risk factors and healthful behaviors related to the leading causes of morbidity and mortality. We investigated the feasibility of using this ongoing surveillance system to estimate the prevalence of CAM use among Michigan adults.

Changes in Knowledge of Stroke Risk Factors and Warning Signs among Michigan Adults

Background: Increasing the public’s awareness of stroke is a public health priority. Our objective was to assess changes in the public’s knowledge of stroke risk factors and warning signs in Michigan during a 5-year period characterized by a sustained statewide public education effort. Methods: Questions regarding knowledge of stroke risk factors and warning signs were included in the 1999 and 2004 Michigan Behavioral Risk Factor Surveys – random-digit-dialed statewide surveys of adults. Respondents were asked to report up to 3 risk factors and warning signs for stroke. Results: Between 1999 and 2004, the proportion of respondents who reported 3 correct stroke warning signs increased substantially from 14.3 to 27.6% (p < 0.001), whereas the proportion reporting 3 correct risk factors remained almost unchanged (27.9 vs. 29.1%). The reporting of 2 warning signs in particular increased substantially over the 5-year period; ‘any weakness or numbness’ increased from 45.7 to 65.6%, while ‘confusion, trouble speaking or understanding’ increased from 29.9 to 46.5%. Knowledge of stroke warning signs increased across nearly all demographic subgroups, but remained poor for several high-risk groups including the elderly, minorities and those with less education. Conclusions: Knowledge of warning signs increased during this period while there was little change in knowledge of risk factors. The results suggest that these changes occurred in response to the public education campaign which focused primarily on warning signs. The findings further emphasize the need to target those subgroups who are at highest risk of stroke and where knowledge remains poorest.

Lack of Association Between Stroke Symptom Knowledge and Intent to Call 911. A Population-Based Survey

Background and Purpose— Excessive prehospital delay between acute stroke onset and hospital arrival is an ongoing problem. Translating knowledge of stroke warning signs into appropriate action is critical to decrease prehospital delay. Our objectives were to estimate the proportion of Michigan adults who would react appropriately by calling 911 when presented with hypothetical stroke-related scenarios and to examine the association between knowledge of warning signs and calling 911. Methods— In 2004, questions regarding initial response to health-related scenarios were added to the Michigan Behavioral Risk Factor Survey, a population-based telephone survey of adults. We calculated the proportion of respondents who would call 911 in response to 3 stroke-related scenarios and examined the association between stroke warning sign knowledge and 911 activation. Results— Among 4841 adults, 27.6% (95% CI, 26.2 to 29.0) had adequate knowledge of stroke warning signs (defined as reporting 3 correct warning signs), and 14.0% (95% CI, 12.9 to 15.1) reported they would call 911 for all 3 stroke-related scenarios. Knowledge of specific stroke warning signs was only modestly associated with calling 911 in response to medical scenarios that involved the same stroke symptom (OR, 1.17 to 1.39). Even among those with adequate knowledge of stroke warning signs, only 17.6% (95% CI, 15.5 to 20.0) would call 911 for all 3 stroke scenarios. Conclusions— In this population-based survey, stroke symptom knowledge was not associated with the intent to call 911 for stroke. This study emphasizes the critical role of motivation in addition to symptom knowledge to reducing delay time to hospital arrival for stroke.

Public Awareness and Use of Direct-to-Consumer Genetic Tests: Results From 3 State Population-Based Surveys, 2006

We conducted population-based surveys on direct-to-consumer nutrigenomic testing in Michigan, Oregon, and Utah as part of the 2006 Behavioral Risk Factor Surveillance System. Awareness of the tests was highest in Oregon (24.4%) and lowest in Michigan (7.6%). Predictors of awareness were more education, higher income, and increasing age, except among those 65 years or older. Less than 1% had used a health-related direct-to-consumer genetic test. Public health systems should increase consumer and provider education and continue surveillance on direct-to-consumer genetic tests.

Prevalence of hearing loss and work-related noise-induced hearing loss in Michigan.

Objective: This study assessed the prevalence of self-reported hearing loss (HL) and work-related noise-induced hearing loss (NIHL) in Michigan. Methods: Questions related to HL and NIHL were added to the 2003 Behavioral Risk Factor Surveillance System in Michigan, a national telephone survey-based surveillance system of health conditions among adults. Results: An estimated 19% reported HL; the proportion with HL increased steeply with age. Among those with HL, 29.9% reported that their HL was related to noise at work. Associations were found between HL/NIHL and current cigarette smoking and elevated cholesterol. Conclusions: Self-reported HL is common in Michigan. Almost 30% of this loss was attributed to noise exposure at work, a preventable condition. Prevalence estimates from this study were higher than previously published estimates. Better surveillance and prevention programs are recommended.

Prevalence of work-related asthma in Michigan, Minnesota, and Oregon.

Introduction. Adults who have asthma that is caused or aggravated by triggers at work experience a reduced quality of life. In this study, the authors sought to estimate the proportion of asthma that is associated with work using a state-based survey of adults with asthma. Methods. In 2005, Michigan, Minnesota, and Oregon piloted the Behavioral Risk Factor Surveillance System Adult Asthma Call-Back Survey, with sample sizes of 867, 469, and 1072, respectively. Six questions addressing work-related asthma (WRA) were analyzed to generate estimates of the proportion of adult asthma that is work-related and compare those with and without WRA. Results. Over half of all adults with asthma (53%) reported that their asthma was caused or made worse by any job they ever had, and among these respondents reporting WRA, only 21.5% to 25.1% reported ever telling or being told by a health professional that their asthma was work-related. Additionally, adults with WRA consistently reported poorer asthma control and higher health care utilization than adults with non-WRA. Conclusions. WRA is a common but frequently unrecognized health problem, and this lack of recognition might contribute to poorer asthma control among adults with WRA. Because early recognition, treatment, and management of WRA are crucial for improving long-term prognosis, clinicians need to include assessment of workplace triggers in both their diagnostic and treatment plans for adult patients with asthma.

Knowledge of Tissue Plasminogen Activator for Acute Stroke Among Michigan Adults

Background and Purpose— Although tissue plasminogen activator (tPA) is an effective therapy for acute ischemic stroke, treatment rates remain low. Efforts to address the underuse of tPA include public education to increase the recognition of stroke symptoms and the awareness of tPA treatment. Our objective was to determine the level of knowledge about tPA treatment for acute stroke among a representative sample of Michigan adults. Methods— The Michigan Behavioral Risk Factor Survey (BRFS) is a random-digit-dial telephone survey of adults conducted annually as part of the national BRFS. Questions regarding tPA treatment for acute stroke were included in the 2004 Michigan BRFS. We examined the prevalence of awareness using &khgr;2 tests and generated multivariable logistic regression models. Results— Among 4724 respondents, only 32.2% (95% CI=30.8 to 33.8%) were aware of the existence of tPA treatment for acute stroke, of whom 52.7% (50.0 to 55.4%) knew that it needed to be administered within 3 hours of symptom onset. Awareness of tPA was higher among middle aged adults, females, whites, and those with higher education and income. Awareness of the time window for tPA was higher among middle aged adults and whites. Conclusions— In this population-based survey only a third of the public were aware of tPA as a treatment for stroke, and only 1 in 6 were aware that the treatment exists and needs to be given within 3 hours of symptom onset. Continuing efforts are necessary to increase public knowledge about tPA treatment for acute stroke.