Objectives: 1) TO compare overall national trends in suicide rates to Wisconsin trends in suicide rates from 1984 to 1998; 2) to examine suicide rates in Wisconsin sub-groups (age, gender and race) 1984-1998; and 3) to assess progress toward Wisconsin's Public Health Agenda for the Year 2000 suicide mortality goals.

Methods: National Center for Injury Control and Prevention data on suicide mortality were accessed for the United Stated and Wisconsin using WISQARS data extraction system. Mean suicide rates were calculated for two 5-year spans (1984-1988 and 1994-1998). Average numbers of deaths and percent change between mortality rates were calculated for the two 5-year spans.

Results: From 1984-1998, mean suicide mortality rates decreased 8% national and 14% in Wisconsin. Various trends are occurring between genders and ages. The current declines in teens 15-19 and elderly 75-84 may indicate reversals of previous trends. Rates for women decreased for nearly all age groups, continuing previously documented declines. While it appears progress has been made toward Wisconsin Public Health Agenda goals, it appears unlikely the overall objective of 8 per 100,000 will be met.

Data from the National Health Interview Survey (NHIS) show a larger-than-expected increase in mean BMI between 1996 and 1997. Proxy-reports of height and weight were discontinued as part of the 1997 NHIS redesign, suggesting that the sharp increase between 1996 and 1997 may be artifactual.

Methods

We merged NHIS data from 1976–2002 into a single database consisting of approximately 1.7 million adults aged 18 and over. The analysis consisted of two parts: First, we estimated the magnitude of BMI differences by reporting status (i.e., self-reported versus proxy-reported height and weight). Second, we developed a procedure to correct biases in BMI introduced by reporting status.

Results

Our analyses confirmed that proxy-reports of weight tended to be biased downward, with the degree of bias varying by race, sex, and other characteristics. We developed a correction procedure to minimize BMI underestimation associated with proxy-reporting, substantially reducing the larger-than-expected increase found in NHIS data between 1996 and 1997.

Conclusion

It is imperative that researchers who use reported estimates of height and weight think carefully about flaws in their data and how existing correction procedures might fail to account for them. The development of this particular correction procedure represents an important step toward improving the quality of BMI estimates in a widely used source of epidemiologic data.

DATA: Incidence data for Wisconsin were provided by the Wisconsin Cancer Reporting System Bureau of Health Information, within the Wisconsin Department of Health and Family Services, while US data were extracted using SEER*Stat 3.0. Mortality data for both Wisconsin and the US were compiled using CDC WONDER.

RESULTS: Wisconsin malignant melanoma incidence rates rose 25% from 1979 to 1998, compared to a US increase of 132%. For mortality rates, however, both Wisconsin (22%) and the US (15%) exhibited only modest increases. Between the mid-1980s and mid-1990s, the largest increases in both incidence and mortality (over 70%) occurred among males over age 65. In contrast, declines of 30% to 40% were found for males age 0-34. Patterns were less consistent among females.

CONCLUSIONS: Since the mid-1980s, malignant melanoma incidence in Wisconsin appears to have increased sharply among males and females over age 65, with a corresponding rise in mortality among males in this age group. These trends should be a source of concern for clinicians and policy makers alike. Because current evidence on the effectiveness of early treatment is inconclusive, it is especially important to take preventive measures now--such as educational and community-based interventions--to reduce future incidence.

Objectives: The main goal of this study is to examine how educational attainment is related to diabetes trends in the state of Utah over the period 1996-2007.

Methods: We used Utah data from the Behavioral Risk Factor Surveillance System (BRFSS) to calculate the prevalence of diabetes by sex and educational attainment for three time periods (1996-1999, 2000-2003, and 2004-2007). To investigate how educational attainment and other possible determinants influence the odds of diabetes, we examined a series of logistic regression models that were stratified by sex.

Results: The prevalence of diabetes among adults in Utah increased by 44% during the period of observation in this study (from 4.37% in 1996-1999 to 6.30% in 2004-2007). In models controlling for age and educational status, the odds of diabetes were 60% higher among men and 44% higher among women in 2004-2007 than in 1996-1999. These models also showed significant inverse associations between educational attainment and the odds of diabetes. For instance, women with a college education were 27% less likely than women with a high school education to have diabetes. However, interaction effects between educational attainment and period of observation were not statistically significant, indicating that these disparities have neither diminished nor widened from 1996-2007. Sociodemographic and health-related factors accounted for most of the observed differences in the odds of diabetes among different educational groups.

Conclusion: The prevalence of diabetes is increasing in Utah. Well-educated men and women exhibit lower rates of diabetes than those with less education, but these disparities have not changed appreciably over the past decade. To reduce disparities in diabetes among different educational groups, policymakers and other public health stakeholders should take measures to reduce high school dropout rates, encourage labor force participation, ameliorate poverty, and promote healthy lifestyles that are associated with weight maintenance.

Results of multilevel regression analyses showed that black women had an age-adjusted BMI score three points higher than non-black women. Individual SES (income, education, assets) was negatively associated with BMI in women, but it only reduced the association between race and BMI from 2.99 to 2.50. Adding community socioeconomic disadvantage index further reduced the race coefficient slightly from 2.50 to 2.21. Nevertheless, living in communities with higher socioeconomic disadvantage was associated with higher BMI net of age, race, individual SES, smoking, physical activity, stress, and social support. Community income inequality (Gini) had an independent positive association with BMI, but did not substantially reduce racial differences among women. Community percent black was not associated with BMI. Results for men demonstrated no statistically significant racial differences in BMI, and no association between BMI and either individual SES or community disadvantage.

Although individual SES and community socioeconomic disadvantage each partly explained the higher average BMI among black women, clear racial disparities persisted. Moreover, race, individual SES, community socioeconomic disadvantage, and individual health behaviors were each independent predictors of BMI among women. Unexplained within- and between-community variance in BMI remained among both women and men, with most unexplained variation due to within-community variance. Because our evidence for women suggests that the determinants of obesity are multiple and multilevel, attempts to address this growing social problem will similarly require a multi-faceted and multilevel approach.

Objectives: The main goals of this study were to assess the magnitude of racial/ethnic disparities in rates of AIDS incidence in the metropolitan statistical area of Salt Lake City-Ogden, Utah and determine how those disparities have changed over the period 1990-2000.

Methods: Incidence rates were calculated using data from the AIDS Public Information Data Set (numerators) and US Census Bureau (denominators). Rates of AIDS incidence were produced for broad demographic groups (e.g., Hispanics) in Salt Lake City-Ogden. In addition, age-standardized incidence rates were produced for groups defined by age, sex and race/ethnicity, permitting careful examination of trends in racial/ethnic disparities.

Results: In Salt Lake City-Ogden’s general population, AIDS incidence dropped from 11.23 per 100,000 in 1990 to 7.99 per 100,000 in 2000—a decline of about 29%. AIDS incidence rates also dropped for populations of non-Hispanic Blacks (-15.12%) and non-Hispanic Whites (-36.72%), but climbed among Hispanics (11.89%). Of all groups examined, Hispanic females experienced the largest increase in AIDS incidence over this period (58.27%). Rate ratios indicate that racial/ethnic disparities in AIDS incidence widened during the 1990s, both between non-Hispanic Whites and non-Hispanic Blacks (up 33.75%) and between non-Hispanic Whites and Hispanics (up 76.59%). Perhaps the most striking finding is the 113.35% increase in the disparity in AIDS incidence between non-Hispanic White and Hispanic females. Although racial/ ethnic disparities in AIDS incidence generally widened between 1990 and 2000, it is encouraging to note that the disparity between non-Hispanic White and non- Hispanic Black females declined by almost 6%.

Conclusion: Despite progress in reducing rates of AIDS incidence in Salt Lake City- Ogden’s general population, racial/ethnic disparities widened considerably between 1990 and 2000.

Methods. A cross-sectional analysis was conducted using the 1996 National Longitudinal Study of Adolescent Health, a nationally representative sample of adolescents in grades 7 to 12 during the 1994–1995 school year, and 4743 adolescents with direct measures of height and weight. Using Centers for Disease Control and Prevention growth charts to determine percentiles, we used 5 body mass categories. Underweight was at or below the 5th percentile, normal BMI was between the 5th and 85th percentiles, at risk for overweight was between the 85th and 95th percentiles, overweight was between the 95th and 97th percentiles + 2 BMI units, and obese was at or above the 97th percentile + 2 BMI units. Four dimensions of health-related quality of life were measured: general health (self-reported general health), physical health (absence or presence of functional limitations and illness symptoms), emotional health (the Center for Epidemiologic Studies Depression Scale and Rosenberg's self-esteem scale), and a school and social functioning scale.

Results. We found a statistically significant relationship between BMI and general and physical health but not psychosocial outcomes. Adolescents who were overweight had significantly worse self-reported health (odds ratio [OR]: 2.17; 95% confidence interval [CI]: 1.34–3.51), as did obese adolescents (OR: 4.49; 95% CI: 2.87–7.03). Overweight (OR: 1.81; 95% CI: 1.22–2.68) and obese (OR: 1.91; 95% CI: 1.24–1.95) adolescents were also more likely to have a functional limitation. Only among the youngest adolescents (ages 12–14) did we find a significant deleterious impact of overweight and obesity on depression, self-esteem, and school/social functioning.

Conclusions. Using a nationally representative sample, we found that obesity in adolescence is linked with poor physical quality of life. However, in the general population, adolescents with above normal body mass did not report poorer emotional, school, or social functioning.

Objectives: The main goals of this study were to assess the magnitude of racial/ethnic disparities in rates of Acquired Immune Deficiency Syndrome (AIDS) incidence in the metropolitan statistical area of Milwaukee, Wis, and determine how those disparities have changed over the period 1990-2000.

Methods: Incidence rates were calculated using data from the AIDS Public Information Data Set (numerators) and US Census Bureau (denominators). Rates of AIDS incidence were produced for broad demographic groups (eg, Hispanics) in Milwaukee. In addition, age-standardized incidence rates were produced for groups defined by age, sex, and race/ethnicity, permitting careful examination of trends in racial/ethnic disparities.

Results: In Milwaukee's general population, AIDS incidence dropped from 7.6 per 100,000 in 1990 to 6.4 per 100,000 in 2000 - a decline of over 15%. AIDS incidence rates also dropped for Hispanics (-41.0%) and non-Hispanic whites (-52.1%), but climbed among non-Hispanic blacks (51.1%). Disparities in AIDS incidence between non-Hispanic blacks and non-Hispanic whites increased between 136% (young adult males) and 428% (young adult females) over the period.

Conclusion: Despite progress in reducing rates of AIDS incidence in Milwaukee's general population, racial/ethnic disparities widened substantially between 1990 and 2000.

Objective: The primary objective of this study is to assess changes in the association between education and premature adult mortality in Wisconsin, 1990-2000.

Design, Setting, and Subjects: Wisconsin death records (numerators) and US Census data (denominators) were compiled to estimate mortality rates among adults (25-64 years) in 1990 and 2000. Information on the educational status, sex, racial identification, and age of subjects was gathered from these sources.

Main Outcome and Measure: The effect of education on mortality rate ratios in 1990 and 2000 was assessed while adjusting for age, sex, and racial identification.

Results: Education exhibited a graded effect on mortality rates, which declined most among college graduates from 1990 to 2000. The relative rate of mortality among persons with less than a high school education compared to persons with a college degree increased from 2.4 to 3.1 from 1990-2000-an increase of 29%. Mortality disparities also increased, although to a lesser extent, among other educational groups.

Conclusion: Despite renewed calls for the elimination of health disparities, evidence suggests that educational disparities in mortality increased from 1990 to 2000.