Gary C. Hogelin

Trends and Disparities in Coronary Heart Disease, Stroke, and Other Cardiovascular Diseases in the United States Findings of the National Conference on Cardiovascular Disease Prevention

A workshop was held September 27 through 29, 1999, to address issues relating to national trends in mortality and morbidity from cardiovascular diseases; the apparent slowing of declines in mortality from cardiovascular diseases; levels and trends in risk factors for cardiovascular diseases; disparities in cardiovascular diseases by race/ethnicity, socioeconomic status, and geography; trends in cardiovascular disease preventive and treatment services; and strategies for efforts to reduce cardiovascular diseases overall and to reduce disparities among subpopulations. The conference concluded that coronary heart disease mortality is still declining in the United States as a whole, although perhaps at a slower rate than in the 1980s; that stroke mortality rates have declined little, if at all, since 1990; and that there are striking differences in cardiovascular death rates by race/ethnicity, socioeconomic status, and geography. Trends in risk factors are consistent with a slowing of the decline in mortality; there has been little recent progress in risk factors such as smoking, physical inactivity, and hypertension control. There are increasing levels of obesity and type 2 diabetes, with major differences among subpopulations. There is considerable activity in population-wide prevention, primary prevention for higher risk people, and secondary prevention, but wide disparities exist among groups on the basis of socioeconomic status and geography, pointing to major gaps in efforts to use available, proven approaches to control cardiovascular diseases. Recommendations for strategies to attain the year 2010 health objectives were made.

Alcohol use and health behavior lifestyles among U.S. women: the behavioral risk factor surveys

Alcohol use is a complex behavior, occurring in the context of an overall health lifestyle. We used data from a nationally representative telephone survey (N = 12,467 women) to examine associations between binge drinking, chronic drinking, and other health behaviors. Certain health-risk behaviors (e.g., smoking, drunk driving, and seatbelt nonuse) tend to cluster with alcohol misuse. These may act synergistically, thus augmenting the negative health effects of alcohol misuse. Conversely, some health behaviors (e.g., eating or exercising, particularly in response to stress) are negatively associated with alcohol misuse and may serve similar functions for some women. Finally, binge drinking occurs more frequently among women who may have relatively restrictive eating behaviors and higher levels of interpersonal stress. Our findings suggest that alcohol prevention and treatment programs should address sociodemographic and health lifestyle factors that initially predispose an individual to engage in health-risk behaviors and should recognize the interdependent patterns of behaviors associated with alcohol misuse. This approach will help prevent substitutions, recurrence, or induction of detrimental behaviors and will identify potentially negative interactions between existing concurrent health-risk behaviors.