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Background Adversity experienced during childhood manifests deleteriously across the lifespan. This study provides updated frequency estimates of ACEs using the most comprehensive and geographically diverse sample to date. Methods ACEs data were collected via BRFSS (Behavioral Risk Factor Surveillance System). Data from a total of 211,376 adults across 34 states were analyzed. The ACEs survey is comprised of 8 domains: physical/emotional/sexual abuse, household mental illness, household substance use, household domestic violence, incarcerated household member, and parental separation/divorce. Frequencies were calculated for each domain and summed to derive mean ACE scores. Findings were weighted and stratified by demographic variables. Group differences were assessed by post-estimation F-tests. Results Most individuals experienced at least one ACE (57.8%) with 21.5% experiencing 3+ ACEs. F-tests showed females had significantly higher ACEs than males (1.64 to 1.46). Multiracial individuals had a significantly higher ACEs (2.39) than all other races/ethnicities, while White individuals had significantly lower mean ACE scores (1.53) than Black (1.66) or Hispanic (1.63) individuals. The 25-to-34 age group had a significantly higher mean ACE score than any other group (1.98). Generally, those with higher income/educational attainment had lower mean ACE scores than those with lower income/educational attainment. Sexual minority individuals had higher ACEs than straight individuals, with significantly higher ACEs in bisexual individuals (3.01). Conclusion Findings highlight that childhood adversity is common across sociodemographic, yet higher in certain categories. Identifying at-risk populations for higher ACEs is essential to improving the health outcomes and attainment across the lifespan.

Clinically severe or morbid obesity (body mass index (BMI) >40 or 50 kg m −2 ) entails far more serious health consequences than moderate obesity for patients, and creates additional challenges for providers. The paper provides time trends for extreme weight categories (BMI >40 and >50 kg m −2 ) until 2010, using data from the Behavioral Risk Factor Surveillance System. Between 2000 and 2010, the prevalence of a BMI >40 kg m −2 (type III obesity), calculated from self-reported height and weight, increased by 70%, whereas the prevalence of BMI >50 kg m −2 increased even faster. Although the BMI rates at every point in time are higher among Hispanics and Blacks, there were no significant differences in trends between them and non-Hispanic Whites. The growth rate appears to have slowed down since 2005. Adjusting for self-report biases, we estimate that in 2010 15.5 million adult Americans or 6.6% of the population had an actual BMI >40 kg m −2 . The prevalence of clinically severe obesity continues to be increasing, although less rapidly in more recent years than prior to 2005.

Background A very large body of research documents relationships between self-reported Adverse Childhood Experiences (srACEs) and adult health outcomes. Despite multiple assessment tools that use the same or similar questions, there is a great deal of inconsistency in the operationalization of self-reported childhood adversity for use as a predictor variable. Alternative conceptual models are rarely used and very limited evidence directly contrasts conceptual models to each other. Also, while a cumulative numeric ‘ACE Score’ is normative, there are differences in the way it is calculated and used in statistical models. We investigated differences in model fit and performance between the cumulative ACE Score and a ‘multiple individual risk’ (MIR) model that enters individual ACE events together into prediction models. We also investigated differences that arise from the use of different strategies for coding and calculating the ACE Score. Methods We merged the 2011–2012 BRFSS data ( N  = 56,640) and analyzed 3 outcomes. We compared descriptive model fit metrics and used Vuong’s test for model selection to arrive at best fit models using the cumulative ACE Score (as both a continuous or categorical variable) and the MIR model, and then statistically compared the best fit models to each other. Results The multiple individual risk model was a better fit than the categorical ACE Score for the ‘lifetime history of depression’ outcome. For the outcomes of obesity and cardiac disease, the cumulative risk and multiple individual risks models were of comparable fit, but yield different and complementary inferences. Conclusions Additional information-rich inferences about ACE-health relationships can be obtained from including a multiple individual risk modeling strategy. Results suggest that investigators working with large srACEs data sources could empirically derive the number of items, as well as the exposure coding strategy, that are a best fit for the outcome under study. A multiple individual risk model could also be considered in addition to the cumulative risk model, potentially in place of estimation of unadjusted ACE-outcome relationships.

Background Cigarette smoking is a leading risk factor for morbidity and premature mortality in the United States, yet information about smoking prevalence and trends is not routinely available below the state level, impeding local-level action. Methods We used data on 4.7 million adults age 18 and older from the Behavioral Risk Factor Surveillance System (BRFSS) from 1996 to 2012. We derived cigarette smoking status from self-reported data in the BRFSS and applied validated small area estimation methods to generate estimates of current total cigarette smoking prevalence and current daily cigarette smoking prevalence for 3,127 counties and county equivalents annually from 1996 to 2012. We applied a novel method to correct for bias resulting from the exclusion of the wireless-only population in the BRFSS prior to 2011. Results Total cigarette smoking prevalence varies dramatically between counties, even within states, ranging from 9.9% to 41.5% for males and from 5.8% to 40.8% for females in 2012. Counties in the South, particularly in Kentucky, Tennessee, and West Virginia, as well as those with large Native American populations, have the highest rates of total cigarette smoking, while counties in Utah and other Western states have the lowest. Overall, total cigarette smoking prevalence declined between 1996 and 2012 with a median decline across counties of 0.9% per year for males and 0.6% per year for females, and rates of decline for males and females in some counties exceeded 3% per year. Statistically significant declines were concentrated in a relatively small number of counties, however, and more counties saw statistically significant declines in male cigarette smoking prevalence (39.8% of counties) than in female cigarette smoking prevalence (16.2%). Rates of decline varied by income level: counties in the top quintile in terms of income experienced noticeably faster declines than those in the bottom quintile. Conclusions County-level estimates of cigarette smoking prevalence provide a unique opportunity to assess where prevalence remains high and where progress has been slow. These estimates provide the data needed to better develop and implement strategies at a local and at a state level to further reduce the burden imposed by cigarette smoking.

Background People with long COVID report prolonged, multisystem involvement and significant disability. This study aimed to determine long COVID prevalence and factors associated with it among US adults using nationally representative data. Methods This cross-sectional analysis utilized data from 2022 Behavioral Risk Factor Surveillance System survey, a nationally representative telephone survey conducted among noninstitutionalized adults aged ≥ 18 years residing in the United States. Age-adjusted prevalence of long COVID was calculated using weighted survey analysis. Poisson regression was employed to assess adjusted prevalence ratios (aPRs) associated with long COVID across various demographic, socioeconomic and health-related characteristics. Results Among 390,233 participants, 120,178 reported COVID-19, with 25,582 experiencing long COVID. Age-adjusted prevalence of self-reported COVID-19 and long COVID were estimated at 34.1% (95% CI, 33.7–34.4%) and 7.2% (95% CI, 7.0–7.4%) as of 2022, respectively. Among adults reporting COVID-19, 20.9% (95% CI, 20.5–21.4%) had ever experienced long COVID. An inverted U-shaped association was observed between long COVID risk and age, with the highest prevalence (23.5%) in the 45–54 age group. Long COVID was more prevalent among women (aPR, 1.40 [95% CI, 1.34–1.47]), individuals without a spouse (aPR, 1.06 [95% CI, 1.00–1.13]), uninsured (aPR, 1.16 [95% CI, 1.06–1.27]), and those with a high school education (aPR, 1.17 [95% CI, 1.12–1.23]), cardiovascular disease (aPR, 1.17 [95% CI, 1.09–1.25]), depressive disorder (aPR, 1.41 [95% CI, 1.34–1.48]), chronic obstructive pulmonary disease (aPR, 1.33 [95% CI, 1.24–1.43]), asthma (aPR, 1.28 [95% CI, 1.21–1.35]), and kidney disease (aPR, 1.11 [95% CI, 1.01–1.21]). Long COVID was less prevalent among non-Hispanic Black (aPR, 0.87 [95% CI, 0.81–0.95]), students (aPR, 0.87 [95% CI, 0.76–0.99]) or retired individuals (aPR, 0.89 [95% CI, 0.82–0.98]), and those with household incomes ≥$100,000 (aPR, 0.85 [95% CI, 0.79–0.92]). Conclusions Long COVID affects 7.2% of US adults, with higher vulnerability among women, middle-aged individuals, White individuals, socioeconomically disadvantaged groups, and those with chronic conditions. These findings underscore the need for targeted public health strategies to address disparities in long COVID burden and support high-risk populations.

Understanding the COVID-19 pandemic's effect on alcohol sales and consumption is critical in mitigating alcohol abuse and morbidity. We sought to determine how the onset of the COVID-19 pandemic and changes in viral incidence affected alcohol sales and consumption in the United States. We conducted a retrospective observational analysis regressing National Institute on Alcohol Abuse and Alcoholism (NIAAA) alcohol sales data and Behavioral Risk Factor Surveillance System (BRFSS) survey data for 14 states for 2017 to 2020 with COVID-19 incidence in 2020 in the United States. The onset of the pandemic was associated with higher monthly alcohol sales per capita of 1.99 standard drinks (95% Confidence Interval: 0.63 to 3.34, p = 0.007). Increases of one COVID-19 case per 100 were associated with lower monthly alcohol sales per capita of 2.98 standard drinks (95% CI: −4.47 to −1.48, p = 0.001) as well as broad decreases in alcohol consumption, notably 0.17 fewer days per month with alcohol use (95% CI: −0.31 to −0.23, p = 0.008) and 0.14 fewer days per month of binge drinking (95% CI: −0.23 to −0.052, p < 0.001). The COVID-19 pandemic is associated with increased monthly average alcohol purchases, but higher viral incidence is linked to lower alcohol purchases and consumption. Continued monitoring is needed to mitigate the effects of higher population alcohol use during the pandemic. •The onset of COVID-19 was linked with higher alcohol sales, driven by an increase in spirits sales.•The pandemic was associated with fewer average drinks per day but no change in days per month with use or binge drinking.•Increases of one COVID-19 case per 100 were linked with lower monthly alcohol sales.•Increases of one COVID-19 case per 100 were associated with lower alcohol use.•Wine sales were unaffected by the pandemic or changes in viral incidence.

Purpose We determined the proportion of cancer survivors who met each of five health behavior guidelines recommended by the American Cancer Society (ACS), including consuming fruits and vegetables at least five times/day, maintaining a body mass index (BMI) < 30 kg/m 2 , engaging in 150 min or more of physical activity weekly, not currently smoking, and not excessively drinking alcohol. Methods Using data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS), 42,727 survey respondents who reported a previous diagnosis of cancer (excluding skin cancer) were included. Weighted percentages with 95% confidence intervals (95% CI) were estimated for the five health behaviors accounting for BRFSS’ complex survey design. Results The weighted percentage of cancer survivors who met ACS guidelines was 15.1% (95%CI: 14.3%, 15.9%) for fruit and vegetable intake; 66.8% (95%CI: 65.9%, 67.7%) for BMI < 30 kg/m 2 ; 51.1% (95%CI: 50.1%, 52.1%) for physical activity; 84.9% (95%CI: 84.1%, 85.7%) for not currently smoking; and 89.5% (95%CI: 88.8%, 90.3%) for not drinking excessive alcohol. Adherence to ACS guidelines among cancer survivors generally increased with increasing age, income, and education. Conclusions While the majority of cancer survivors met the guidelines for not smoking and limiting alcohol drinking, one-third had elevated BMI, almost half did not meet recommended physical activity levels, and the majority had inadequate fruit and vegetable intake. Implications for Cancer Survivors Adherence to guidelines was lowest among younger cancer survivors and those with lower income and education, suggesting these may be populations where resources could be targeted to have the greatest impact.

Keywords: Prostate cancer, Racial disparities, PSA screening, SEER, BRFSS, Health equity, Metastasis, US health system, UK health system

This study draws on symbolic empowerment theory to examine the mental health significance of Donald Trump’s unexpected presidential election victory in fall 2016 for white male veterans. Some whites, including military veterans, gravitated toward Trump’s messaging of restoring traditional power structures and defending white masculine cultural and economic dominance. The authors hypothesized that white male veterans would experience improved mental health after Donald Trump’s installation as president and commander in chief. The authors also ™hypothesized that white male veteran mental health after the 2016 election could depend on state-level sociopolitical contexts. With nationally representative survey data from the Behavioral Risk Factor Surveillance System, the authors tested these hypotheses by predicting poor mental health days white male veterans experienced preelection and postelection in fall 2016. The authors found no time period main effects. However, veterans living in Trump-won states reported .38 fewer poor mental health days postelection, whereas those living in Clinton-won states reported .54 more poor mental health days postelection. Additionally, veterans in states where Trump’s popular vote advantage was high experienced fewer poor mental health days postelection. These findings suggest that symbolic empowerment theory may provide a unique framework for understanding health outcomes in the context of political geography and sociopolitical change.

The prevalence of prostate-specific antigen (PSA) testing has consistently fallen for several years. This study explored how the decreasing trend differs by selected variables and reasons for taking the PSA test. Analyses involved men, aged 40 years or older, who completed the Behavior Risk Factor Surveillance System (BRFSS) survey in even number years from 2008 through 2022. Trends in PSA testing rates within the past year declined by 46% from 2008 to 2020 and then increased 21% from 2020 to 2022. The greatest changes corresponded with the years of new USPSTF guidelines. Declining PSA testing rates occurred across the levels of all variables considered but were more pronounced in younger men and men never married, less educated, and without health care coverage. After adjusting for these variables, declining PSA testing rates did not significantly differ between racial/ethnic groups or between income groups. The level of several variables influenced the decline, as a function of perceived risk, accessibility, and desire for the test. Inconsistencies with the USPSTF’s guidelines were seen in higher PSA testing in older and more educated men. The distribution of main reasons for taking the test (part of a routine exam [72%], prostate problem/cancer [12%], family history [6%], and other [10%]) remained constant. PSA testing as part of a routine exam (vs. no PSA test) increased with age and was higher in non-Hispanic Blacks, married (or cohabitating), and in men with higher education, higher income, and health care coverage. PSA testing because of a prostate problem/cancer or family history of prostate cancer according to these variables are also described in this study.