State trends in health risk factors and receipt of clinical preventive services among US adults during the 1990s

JAMA. 2002 May;287(20):2659-67. doi: 10.1001/jama.287.20.2659.


Context: Monitoring trends is essential for evaluating past activities and guiding current preventive health program and policy efforts. Although tracking progress toward national health goals is helpful, use of national estimates is limited because most preventive health care activities, policies, and other efforts occur at the state or community level. There may be important state trends that are obscured by national data.

Objective: To estimate state-specific trends for 5 health risk factors and 6 clinical preventive services.

Design: Telephone surveys were conducted from 1991 through 2000 as part of the Behavioral Risk Factor Surveillance System.

Setting and participants: Randomly selected adults aged 18 years or older from 49 US states. Annual state sample sizes ranged from 1188 to 7543.

Main outcome measures: Statistically significant changes (P<.01) in state prevalences of cigarette smoking, binge alcohol use, physical inactivity, obesity, safety belt use, and mammography; screening for cervical cancer, colorectal cancer, and cholesterol levels; and receipt of influenza and pneumococcal disease vaccination.

Results: There were statistically significant increases in safety belt use for 39 of 47 states and receipt of mammography in the past 2 years for women aged 40 years or older for 43 of 47 states. For persons aged 65 years or older, there were increases in receipt of influenza vaccination for 44 of 49 states and ever receiving pneumococcal vaccination for 48 of 49 states. State trends were mixed for binge alcohol use (increasing in 19 of 47 states and declining in 3), physical inactivity (increasing in 3 of 48 states and declining in 11), and cholesterol screening (increasing in 13 of 47 states and decreasing in 5). Obesity increased in all states and smoking increased in 14 of 47 states (declining only in Minnesota). Cervical cancer screening increased in 8 of 48 states and colorectal cancer screening increased in 13 of 49 states. New York experienced improvements for 8 of 11 measures, while 7 of 11 measures improved in Delaware, Kentucky, and Maryland; in contrast, Alaska experienced improvements for no measures and at least 4 of 11 measures worsened in Iowa, North Dakota, and South Dakota.

Conclusions: Most states experienced increases in safety belt use, mammography, and adult vaccinations. Trends for smoking and binge alcohol use are disturbing, and obesity data support previous findings. Trend data are useful for targeting state preventive health efforts.

MeSH terms

  • Adult
  • Alcoholic Intoxication / epidemiology
  • Colorectal Neoplasms / prevention & control
  • Data Collection
  • Ethanol / poisoning
  • Exercise
  • Female
  • Health Behavior*
  • Humans
  • Hypercholesterolemia / prevention & control
  • Influenza Vaccines
  • Influenza, Human / prevention & control
  • Male
  • Mammography / statistics & numerical data
  • Mass Screening / trends
  • Models, Statistical
  • Obesity / epidemiology
  • Pneumococcal Infections / prevention & control
  • Pneumococcal Vaccines
  • Population Surveillance*
  • Preventive Medicine / statistics & numerical data
  • Preventive Medicine / trends*
  • Seat Belts / statistics & numerical data
  • Smoking / epidemiology
  • United States / epidemiology
  • Uterine Cervical Neoplasms / prevention & control
  • Vaccination / statistics & numerical data


  • Influenza Vaccines
  • Pneumococcal Vaccines
  • Ethanol