Contribution of Whole Grains to Total Grains Intake Among Adults Aged 20 and Over: United States, 2013–2016

July 9, 2019

New NCHS report provides estimates of the percentage of total grains intake consumed from whole grains sources, for U.S. adults aged 20 and over who reported consumption of grains (98.6%) on a given day during 2013–2016.

Findings:

  • During 2013–2016, whole grains accounted for 15.8% of total grains intake among adults on a given day. This percentage increased with age from 12.9% among adults aged 20–39 to 19.7% for adults 60 and over.
  • Overall, the contribution of whole grains to total grains intake was lower among men (14.8%) than women (16.7%).
  • The contribution of whole grains to total grains intake was lowest among Hispanic adults (11.1%) compared with non-Hispanic white (16.5%), non-Hispanic black (13.7%), and non-Hispanic Asian (18.3%) adults.
  • The contribution of whole grains to total grains intake on a given day increased with increasing family income.
  • From 2005–2006 to 2015–2016, the contribution of whole grains to total grains intake increased for adults overall, and for men and women.
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Strategies Used by Adults Aged 65 and Over to Reduce Their Prescription Drug Costs, 2016-2017

May 22, 2019

Questions for Robin Cohen, Ph.D. and Lead Author of “Strategies Used by Adults Aged 65 and Over to Reduce Their Prescription Drug Costs, 2016-2017

Q: Why did you decide to do a report on strategies used to reduce prescription drug costs in the United States?

RC: Although most adults aged 65 and over have prescription drug coverage through either Medicare Part D or some other source such as private health insurance Medicaid, or VA coverage, previous data indicate that some older adults may still use strategies to reduce prescription drug costs including not taking medication as prescribed or asking their doctor for a lower cost medication.


Q: Do you have data that directly corresponds with this report that goes back further than 2016-2017?

RC: We previously examined this topic using the 2013 National Health Interview Survey. However, this previous report was not solely focused on adults aged 65 and over.


Q: How did the data vary by age, sex and insurance coverage?

RC: In 2016–2017, among U.S. adults aged 65 and over who were prescribed medication in the past 12 months, the percentage who did not take their medication as prescribed or asked their doctor for a lower-cost medication to reduce their prescription drug costs varied by sex, age, insurance status, and poverty status. Among adults aged 65 and over, women, those aged 65–74, those with Medicare only, and those who were near poor were the most likely to not take their medication as prescribed. Adults aged 75 and over, those with Medicare and Medicaid coverage, and those who were not poor were the least likely to ask their doctor for a lower-cost medication.


Q: Was there a specific finding in your report that you did not expect?

RC: No, the findings in this report were similar to those previously published with earlier data. However in this report we were able to expand on previous research by focus on adults aged 65 and over and examine differences by sex, age group, health insurance status, and poverty status.


Q: What is the take home message for this report?

RC: Among adults aged 65 and over who were prescribed medication in the past 12 months, 4.8% did not take their medication as prescribed to reduce their prescription drug costs, and 17.7% asked their doctor for a lower-cost medication. Among adults aged 65 and over, women, those aged 65–74, those with Medicare only, and those who were near poor were the most likely to not take their medication as prescribed. Adults aged 75 and over, those with Medicare and Medicaid coverage, and those who were not poor were the least likely to ask their doctor for a lower-cost medication.

 


Strategies Used by Adults Aged 18–64 to Reduce Their Prescription Drug Costs, 2017

March 19, 2019

A new NCHS report examines changes over time in the percentage of adults aged 18–64 who were prescribed medication and reported using these selected strategies to reduce their prescription drug costs in the past 12 months.

Key Findings:

  • Among adults aged 18–64 who were prescribed medication in the past 12 months, the percentage who used selected strategies to reduce their prescription drug costs in the past 12 months decreased from 2013 through 2015 and then remained stable from 2015 through 2017.
  • In 2017, among adults aged 18–64 who were prescribed medication, women were more likely than men to use selected strategies to reduce their prescription drug costs.
  • In 2017, strategies for reducing prescription drug costs were most commonly practiced among those who were uninsured compared with those with private insurance or Medicaid, as 39.5% asked their doctor for a lower-cost medication, 33.6% did not take their medication as prescribed, and 13.9% used alternative therapies.

Educational Attainment of Mothers Aged 25 Years and Over: United States, 2017

February 21, 2019

Questions for Brady E. Hamilton, Ph.D., Demographer, Statistician, and Lead Author of “Educational Attainment of Mothers Aged 25 Years and Over: United States, 2017.”

Q: Why study education attainment of mothers in the United States?

BH: Educational attainment of the mother is considered an important measure of socioeconomic status. Maternal education has been shown to be associated with the number of births per woman, timing of childbearing, contraceptive use, and risk of adverse birth outcomes. Women with higher educational attainment have been shown to be more likely to desire and give birth to fewer children and are less likely to engage in behaviors detrimental to their health and pregnancy.


Q: How did you obtain data on educational attainment of mothers?

BH: Information on the educational attainment of mother shown in the report is based on data from 100% of the birth certificates filed in the states and District of Columbia in 2017. The birth certificate includes a question on the highest degree or level of school completed by the mother at the time of delivery. Data collected from the birth certificates on this and other items are provided to the National Center for Health Statistics.


Q: How did educational attainment of mother vary by race and state in 2017?

BH: Large differences in maternal educational attainment are observed by race and Hispanic origin and by state. For example, for mothers aged 25 and over with a Bachelor’s or advanced degree in 2017,  levels ranged from a low of 12.7% and 13.2% for non-Hispanic American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander mothers to a high of 67.9% for non-Hispanic Asian mothers. By state, the percentage of births to mothers aged 25 and over with a Bachelor’s or advanced degree ranged from a low of 26.6% for Nevada to a high of 58.5% for the District of Columbia.


Q: Do you have trend data on educational attainment of mothers that goes back 10 or 20 years?

BH: No, this report is the first to present information on the educational attainment of mothers in the United States in more than 20 years. During this time, comparable data on the education level of mothers were not available for all of the states and District of Columbia and so national data could not be produced. Comparable national data on the education level became available only recently, in 2016. The last report to present national data on the educational attainment was published in 1997 (https://www.cdc.gov/nchs/data/mvsr/supp/mv45_10s.pdf .


Q: Was there a specific finding in your report that surprised you?

BH: The range in the mean number of live births by level of educational attainment is certainly noteworthy. The difference in the mean between women with less than a 12th grade education with no diploma and women with an advanced degree is nearly 1 whole birth. In addition, the wide range in the percentage of births by educational attainment for the race and Hispanic origin groups and state, mentioned above, were also notable.


Mortality in the United States, 2017

November 29, 2018

Questions and Answers from the authors of the recently released 2017 mortality data.  The data can be found in the following reports, “Mortality in the United States, 2017, ” “Drug Overdose Deaths in the United States, 1999–2017, ” and “Suicide Mortality in the United States, 1999–2017.”

Q: Why did life expectancy decline in 2017?

A: Mortality rates increased for 7 out of the 10 leading causes of death in the U.S., including a 5.9% increase in the flu/pneumonia death rate, a 4.2% increase in the accidental/unintentional injury death rate, and 3.7% in the suicide rate. Many of the accidental/unintentional deaths were from drug overdoses, which continued to increase in 2017.


Q: Isn’t this the third straight year that life expectancy declined?

A: Estimated life expectancy at birth in 2017 was 0.3 years lower than in 2014 and 0.1 years lower than in 2016. The 2016 life expectancy estimate was revised to 78.7 years, up from an estimated 78.6 years, which was reported a year ago. This means that the 2016 life expectancy estimate is the same as the 2015 estimate, which also was revised to 78.7 years, down from an estimated 78.8 years, originally reported two years ago. As a routine matter, for the highest degree of accuracy, NCHS blends Medicare data for people ages 66 and over with our vital statistics data to estimate life expectancy. However, the two data sets are released on different schedules. When Medicare data for a year aren’t available at the time we release our final mortality statistics, we use the most recent Medicare data available at the time. We later revise life expectancy estimates when updated Medicare data become available.


Q: How many deaths in 2017 were attributed to opioids?

A: In 2017, 47,600 drug overdose deaths mentioned involvement of any type of opioid, including heroin and illicit opioids, representing over two-thirds of all overdose deaths (68%).


Q: Why is the 70,237 number of overdose deaths smaller than what CDC has previously reported for 2017?

A: The 70,237 number is a final, official number of overdose deaths among U.S. residents for 2017 whereas the previously reported (and slightly higher) numbers were provisional estimates. In August of 2017, CDC began calculating monthly provisional data on counts of drug overdose deaths as a rapid response to this public health crisis, in order to provide a more accurate, closer to “real-time” look at what is happening both nationally and at the state level. These monthly totals are provisional counts, and they include all deaths occurring in the U.S. – which include deaths among non-residents (i.e., visitors here on business or leisure, students from abroad, etc). These counts also do not include deaths that are still under investigation. As a result, the monthly numbers are provisional or very preliminary, and the final 2017 number of 70,237 deaths is an official number that only include deaths among U.S. residents and account for any previously unresolved deaths that were under investigation.


Q: Does this mean that the 70,237 total does not include deaths to undocumented immigrants here in the U.S.?

A: We don’t get immigration status off the death certificates, so we wouldn’t know how many of the deaths were to undocumented immigrants.


Q: In comparing the 2017 numbers with 2016 and past years, is the crisis of drug overdose deaths growing or about the same?

A: From 2016 to 2017, the number of drug overdose deaths increased from 63,632 deaths to 70,237, a 10% increase, which is a smaller increase compared to the 21% increase from 2015 to 2016, when the number of drug overdose deaths increased from 52,404 deaths to 63,632 deaths. Over a longer period of time, from 1999 through 2017, the age-adjusted rate of drug overdose deaths increased on average by 10% per year from 1999 to 2006, by 3% per year from 2006 to 2014, and by 16% per year from 2014 to 2017. So the trend is continuing, although the increase in 2017 was not as large as in previous years.


Q: Are there any other trends of significance when looking at the types of drugs attributed to overdose deaths?

A: The rate of drug overdose deaths involving synthetic opioids other than methadone, which include drugs such as fentanyl, fentanyl analogs, and tramadol, increased 45% in one year, from 6.2 per 100,000 in 2016 to 9.0 per 100,000 in 2017. In 2017, 40%(?) of all drug overdose deaths mentioned involvement of a synthetic opioid other than methadone.


Q: Has fentanyl overtaken heroin as the major cause of overdose death?

A: The data brief on drug overdose deaths does not specifically address fentanyl. However the rate of drug overdose deaths involving synthetic opioids other than methadone, which includes fentanyl, increased 45% 2016 and 2017 whereas the overdose death rate from heroin did not change (4.9 deaths per 100,000).


Q: There is a lot of stark news in these three reports. Are there any positives to report?

A: The cancer mortality rate declined between 2016 and 2017, and although estimated life expectancy declined in 2017, life expectancy for people at age 65 actually increased. Also, regarding drug overdose deaths, the rate of increase in drug overdose deaths slowed between 2016 and 2017, although the increases that occurred were still very significant.


Trends in Fertility and Mother’s Age at First Birth Among Rural and Metropolitan Counties: United States, 2007–2017

October 17, 2018

Questions for Danielle Ely, Health Statistician and Lead Author of “Trends in Fertility and Mother’s Age at First Birth Among Rural and Metropolitan Counties: United States, 2007–2017

Q: Why did you decide to look at fertility rates and mother’s age at first birth among rural and metropolitan U.S. counties?

DE: Rural and metropolitan counties have a variety of differences related to general health, birth outcomes, and mortality rates. However, we noticed that recent research did not focus on the overall fertility differences in these areas or maternal age, which can affect birth outcomes. Looking at these items can help us understand why we might see differences between rural and metro counties in births and birth outcomes.


Q: How did the findings vary by race?

DE: Patterns for total fertility rates were similar by race and Hispanic origin. There were higher total fertility rates in rural counties than in metropolitan counties among the three race and Hispanic origin groups in 2007. In 2017, this pattern was the same for non-Hispanic white and Hispanic women, but non-Hispanic black women had higher total fertility rates in small or medium metro counties compared with rural and large metro counties. Hispanic women had the highest total fertility rates for each urbanization level in both 2007 and 2017

Non-Hispanic white, non-Hispanic black and Hispanic women had lower ages at first birth in rural counties compared with both metro county types. This was true in both 2007 and 2017, and differences between county types widened over this time.


Q: How did the findings vary by mean age of mothers at first birth?

DE: Mean age at first birth was lower in rural counties than small or medium metro counties and large metro counties from 2007-2017. Each of the three race and Hispanic origin groups had lower mean age at first birth in rural counties compared with metropolitan counties.


Q: Is there any comparable trend data prior to 2007?

DE: We have not computed trend data on total fertility rates or mean age at first birth by urbanization level prior to 2007.


Q: What is the take home message in this report?

DE: The important message in this report is that there are differences in the fertility rates and mean age at first birth between rural and metro areas, and these differences have gotten larger over time. These trends are generally the same by race and Hispanic origin. Information on differences in birth rates and maternal age by urbanization level can inform decisions on resource allocation and ultimately lead to improvement in infant and maternal health.


Fast Food Consumption Among Adults in the United States, 2013-2016

October 3, 2018

Questions for Cheryl Fryar, M.S.P.H., Health Statistician and Lead Author of “Fast Food Consumption Among Adults in the United States, 2013-2016

Q: Of all the types of food that Americans eat, what made you decide to focus on fast food for this study?

CF: We focused on fast food for this report because fast food has played an important role in the American diet in recent decades. Fast food has been associated with poor diet and increased risk of obesity. In a previous report, we analyzed and described the percentage of calories consumed from fast food among adults. This current study looks at fast food consumption in a different way. We describe who is eating fast food on a given day. Specifically in this new report, we look at the percentage of adults who consume fast food overall as well as by sex, age group, race and Hispanic origin, family income level and eating occasion.


Q: Your new report measures fast food consumption “on a given day.” What does that mean exactly?

CF: Fast food consumption “on a given day” reflects the way respondents in the National Health and Nutrition Examination Survey reported all the foods and beverages they consumed in the previous 24 hours. The survey is designed to be representative of people anywhere in the United States at any time of the year, so “on a given day” refers to any day—so for example, on any day in the United States, approximately 37% of U.S. adults consume some fast food.

“Fast food” is defined as any food a respondent reported getting from a “restaurant fast food/pizza” outlet in the 2013-2016 National Health and Nutrition Examination Survey – often known as NHANES.


Q: What type of trend data do you have on eating fast food in the United States; for example, how has the consumption of fast food changed in the United States over the last 10 to 20 years?

CF: While we did not look at trend data for this report, dietary data collected from the National Health and Nutrition Examination Survey is a joint effort between the U.S. Department of Health and Human Services and the U.S. Department of Agriculture (USDA). The USDA has tables with calories (or energy) consumed from quick service restaurants – which includes fast food along with cafeterias and food trucks. These tables show that in 2015-2016, 15% of calories was from quick service restaurants compared to 16% in 2011-2012.


Q: Was there a finding in this new report on fast food that you hadn’t expected and that really surprised you?

CF:  While there really wasn’t anything in this report that I hadn’t expected to see or that was surprising to me, this report’s analysis does offer some new information. Results from this study were similar to what we found for youth in 2011-2012, where 34% of youth consumed fast food. A new contribution from this new research is reporting fast food consumption among non-Hispanic Asian American adults in comparison to other groups. A notable finding is that non-Hispanic Asian American adults consumed a lower percentage of fast food (30.6%) compared to non-Hispanic white (37.6%) and non-Hispanic black (42.4%) adults.


Q: What differences or similarities did you see between or among various demographic groups in this analysis of fast food consumption?

CF: We found some differences in the percentage of U.S. adults who consume fast food. For example, fast food consumption decreased with age and increased with increasing income. About 45% of young adults consumed fast food compared to just over 24% of older adults. About 32% of adults in the lowest income group consumed fast food compared to 42% of adults in the highest income group. And a lower percentage of non-Hispanic Asian adults (30.6%) consumed fast food compared to non-Hispanic white (37.6%) and non-Hispanic black (42.4%) adults.

Also, among those who consumed fast food, men were more likely than women to eat fast food at lunch, but women were more likely than men to report eating fast food as a snack.


Q: What would you say is the take-home message of this report?

CF: The take-home message of this report is that overall more than one-third of U.S. adults and 45% of young adults consume fast food on a given day. Fast food restaurants can vary, though consumers can find nutritional information, such as calories, on the menu in most fast food establishments and restaurants.