William D. Kalsbeek

The Rising Prevalence of Chronic Low Back Pain

BACKGROUND National or state-level estimates on trends in the prevalence of chronic low back pain (LBP) are lacking. The objective of this study was to determine whether the prevalence of chronic LBP and the demographic, health-related, and health care-seeking characteristics of individuals with the condition have changed over the last 14 years. METHODS A cross-sectional, telephone survey of a representative sample of North Carolina households was conducted in 1992 and repeated in 2006. A total of 4437 households were contacted in 1992 and 5357 households in 2006 to identify noninstitutionalized adults 21 years or older with chronic (>3 months), impairing LBP or neck pain that limits daily activities. These individuals were interviewed in more detail about their health and health care seeking. RESULTS The prevalence of chronic, impairing LBP rose significantly over the 14-year interval, from 3.9% (95% confidence interval [CI], 3.4%-4.4%) in 1992 to 10.2% (95% CI, 9.3%-11.0%) in 2006. Increases were seen for all adult age strata, in men and women, and in white and black races. Symptom severity and general health were similar for both years. The proportion of individuals who sought care from a health care provider in the past year increased from 73.1% (95% CI, 65.2%-79.8%) to 84.0% (95% CI, 80.8%-86.8%), while the mean number of visits to all health care providers were similar (19.5 [1992] vs 19.4 [2006]). CONCLUSIONS The prevalence of chronic, impairing LBP has risen significantly in North Carolina, with continuing high levels of disability and health care use. A substantial portion of the rise in LBP care costs over the past 2 decades may be related to this rising prevalence.

Lifetime risk of symptomatic knee osteoarthritis

OBJECTIVE To estimate the lifetime risk of symptomatic knee osteoarthritis (OA), overall and stratified by sex, race, education, history of knee injury, and body mass index (BMI). METHODS The lifetime risk of symptomatic OA in at least 1 knee was estimated from logistic regression models with generalized estimating equations among 3,068 participants of the Johnston County Osteoarthritis Project, a longitudinal study of black and white women and men age >or=45 years living in rural North Carolina. Radiographic, sociodemographic, and symptomatic knee data measured at baseline (1990-1997) and first followup (1999-2003) were analyzed. RESULTS The lifetime risk of symptomatic knee OA was 44.7% (95% confidence interval [95% CI] 40.0-49.3%). Cohort members with history of a knee injury had a lifetime risk of 56.8% (95% CI 48.4-65.2%). Lifetime risk rose with increasing BMI, with a risk of 2 in 3 among those who were obese. CONCLUSION Nearly half of the adults in Johnston County will develop symptomatic knee OA by age 85 years, with lifetime risk highest among obese persons. These current high risks in Johnston County may suggest similar risks in the general US population, especially given the increase in 2 major risk factors for knee OA, aging, and obesity. This underscores the immediate need for greater use of clinical and public health interventions, especially those that address weight loss and self-management, to reduce the impact of having knee OA.

Fruit and vegetable consumption and prevention of cancer: the Black Churches United for Better Health project.

OBJECTIVES This study assessed the effects of the Black Churches United for Better Health project on increasing fruit and vegetable consumption among rural African American church members in North Carolina. METHODS Ten counties comprising 50 churches were pair matched and randomly assigned to either intervention or delayed intervention (no program until after the follow-up survey) conditions. A multicomponent intervention was conducted over approximately 20 months. A total of 2519 adults (77.3% response rate) completed both the baseline and 2-year follow-up interviews. RESULTS The 2 study groups consumed similar amounts of fruits and vegetables at baseline. AT the 2-year follow-up, the intervention group consumed 0.85 (SE = 0.12) servings more than the delayed intervention group (P < .0001). The largest increases were observed among people 66 years or older (1 serving), those with education beyond high school (0.92 servings), those widowed or divorced (0.96 servings), and those attending church frequently (1.3 servings). The last improvement occurred among those aged 18 to 37 years and those who were single. CONCLUSIONS The project was a successful model for achieving dietary change among rural African Americans.

John Henryism and blood pressure differences among Black men.

A community probability sample of southern, working-class, black men (N=132)between 17 and 60 years of age was administered a scale to measure the degree to which they felt they could control their environment through hard work and determination. Since the legend of John Henry—the famous, black steeldriver of American folklore—can be understood as a cultural statement about how black Americans must often attempt to control behavioral Stressors through hard work and determination, items for the scale were developed to reflect the theme of John Henryism. It was hypothesized that men scoring below the median on education but above the median on John Henryism would have higher blood pressures than any other group. The data were in line with the prediction, in that men who scored low on education and high on John Henryism had significantly higher diastolic blood pressures than men who scored above the median on both measures. Study findings are discussed in terms of the meaning that education and John Henryism may have for raising or lowering autonomic arousal when individuals encounter behavioral Stressors in everyday life. Preliminary construct validity evidence for the John Henryism Scale is also presented.

Sample Design and Cohort Selection in the Hispanic Community Health Study/Study of Latinos

PURPOSE The Hispanic Community Health Study (HCHS)/Study of Latinos (SOL) is a multicenter, community-based cohort study of Hispanic/Latino adults in the United States. A diverse participant sample is required that is both representative of the target population and likely to remain engaged throughout follow-up. The choice of sample design, its rationale, and benefits and challenges of design decisions are described in this study. METHODS The study design calls for recruitment and follow-up of a cohort of 16,000 Hispanics/Latinos 18-74 years of age, with 62.5% (10,000) over 44 years of age and adequate subgroup sample sizes to support inference by Hispanic/Latino background. Participants are recruited in community areas surrounding four field centers in the Bronx, Chicago, Miami, and San Diego. A two-stage area probability sample of households is selected with stratification and oversampling incorporated at each stage to provide a broadly diverse sample, offer efficiencies in field operations, and ensure that the target age distribution is obtained. CONCLUSIONS Embedding probability sampling within this traditional, multisite cohort study design enables competing research objectives to be met. However, the use of probability sampling requires developing solutions to some unique challenges in both sample selection and recruitment, as described here.

Acute severe low back pain : a population-based study of prevalence and care-seeking

Study Design Telephone interviews were conducted with a random sample of adults in 4437 North Carolina households. The response rate was 79%. Objective The prevalence of low back pain and the correlates of care-seeking in a defined population were examined. Summary of Background Data Previous research on low back pain has used varying definitions of the illness of low back pain, and has admixed patients with acute and chronic low back pain. Acute low back pain was examined in this study as a distinct phenomenon separate from chronic low back pain. Methods Respondents completed a detailed interview regarding the occurrence of and care sought for back pain in 1991. Acute back pain was defined as functionally limiting pain lasting less than 3 months. Results From this sample, 485 individuals had at least one occurrence of acute severe low back pain in 1991, representing 7.6% of the adult population. Symptoms were reported less commonly in individuals older than age 60 years (5% vs. 8.5%) and in nonwhites compared with whites (5% vs. 8%). Thirty-nine percent of those with back pain sought medical care; 24% sought care initially from an allopathic physician, 13% from a chiropractor, and 2% from other providers. More prolonged pain, more severe pain, and sciatica were associated with care-seeking. Gender, income, age, rural residence, and health insurance status did not correlate with the decision to seek medical care. Younger age, male gender, and nonjob-related pain did correlate with the decision to seek care from a chiropractor. Conclusions Acute back pain is common. Care is often sought regardless of income and insurance status. Seeing a health care provider for acute back pain may not be discretionary from the perspective of the patient.

Prevalence of Low Sexual Desire and Hypoactive Sexual Desire Disorder in a Nationally Representative Sample of US Women

BACKGROUND We sought to estimate the prevalence of low sexual desire and hypoactive sexual desire disorder (HSDD) in US women, focusing on their menopausal status. METHODS We performed a cross-sectional study. From a probability sample of households, 2207 US women aged 30 to 70 years and in stable relationships (>or=3 months) were interviewed by telephone. The analysis focused on 755 premenopausal women and 552 naturally and 637 surgically menopausal women. Low sexual desire was defined using the Profile of Female Sexual Function desire domain, and HSDD was defined using the Profile of Female Sexual Function and the Personal Distress Scale. RESULTS Prevalence of low sexual desire ranged from 26.7% among premenopausal women to 52.4% among naturally menopausal women. The prevalence of HSDD was highest among surgically menopausal women (12.5%). Compared with premenopausal women and adjusting for age, race/ethnicity, educational level, and smoking status, the prevalence ratios for HSDD were 2.3 (95% confidence interval, 1.2-4.5) for surgically menopausal women and 1.2 (0.5-2.8) for naturally menopausal women; the prevalence ratios for low sexual desire were 1.3 (0.9-1.9) and 1.5 (1.0-2.2) for surgically and naturally menopausal women, respectively. CONCLUSIONS Prevalence of low sexual desire is elevated among surgically and naturally menopausal women vs premenopausal women. Distress about low desire (HSDD) appears to be more than twice as prevalent among surgically menopausal women vs premenopausal women, although the estimate is fairly imprecise.

Internet and Web use in the U.S.

to base critical business decisions. A variety of studies have suggested that the demographic characteristics of individuals are highly correlated with their use of the Internet. For example, previous research suggests that Internet use is related to gender, education, income, race, occupation, and even geographic region and that males are generally more likely than females to use the Net, people with higher socioeconomic status are more likely to use the Net, and whites are more likely to use the Net [21, 22]. Recent research also suggests that the demographics of Internet use are shifting, so the Internet appears to be going more “mainstream” in its demographic makeup, and that this trend is likely to continue as the Internet moves toward critical mass as a commercial medium [9]. Our objectives in this article are twofold:

Care-seeking Among Individuals With Chronic Low Back Pain

Study Design. This was a stratified, random telephone survey of adults in North Carolina. Objective To determine the prevalance of chronic low back pain and the extent to which treatment is sought for this condition. Summary of Background Data Chronic low back pain is a major problem. Previous studies often have comb ined acute and chronic back pain. Methods Telephone interviews regarding back pain were conducted with 4437 North Caroliona adults during 1992. Results Chronic back pain affects 3.9% of the North Carolina population. Thirty-four percent considered themselves permanently disabled and 52% assessed their overall health as fair or poor. The median number of bed-disability days per year was three. Seventy-three percent saw a health care provider Of those who sought care, 91% saw a medical doctore, 29% saw a physical therapist, and 25% saw a chiropractor, Use of technology was extensive: 37% received a computed tomography scan, 25% received a magnetic resonance imaging scan, and 10.4% underwent surgery. Conclusions Chronic back pain is common, and the level of care-seeking and costs of care among those afflicted are extremely high.

One in four people may develop symptomatic hip osteoarthritis in his or her lifetime

OBJECTIVE To estimate the lifetime risk of symptomatic hip osteoarthritis (OA). DESIGN We analyzed data from the Johnston County Osteoarthritis Project [a longitudinal population-based study of OA in North Carolina, United States (n=3068)]. The weighted baseline sample comprised 18% blacks and 54% women, and the mean age was 63 years (range=45-93). Symptomatic hip OA was defined as a Kellgren-Lawrence (K-L) radiographic score of ≥ 2 (anterior-posterior pelvis X-rays) and pain, aching or stiffness on most days, or groin pain, in the same hip. Lifetime risk, defined as the proportion who developed symptomatic hip OA in at least one hip by age 85, among people who live to age 85, was modeled using logistic regression with repeated measures (through generalized estimating equations). RESULTS Lifetime risk of symptomatic hip OA was 25.3% [95% confidence interval (CI)=21.3-29.3]. Lifetime risk was similar by sex, race, highest educational attainment, and hip injury history. We studied lifetime risk by body mass index (BMI) in three forms: at age 18; at baseline and follow-up; and at age 18, baseline and follow-up and found no differences in estimates. CONCLUSION The burden of symptomatic hip OA is substantial with one in four people developing this condition by age 85. The similar race-specific estimates suggest that racial disparities in total hip replacements are not attributable to differences in disease occurrence. Despite increasing evidence that obesity predicts an increased risk of both hip OA and joint replacement, we found no association between BMI and lifetime risk.