Disclaimer

The educational activity presented above may involve simulated, case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient, whether living or deceased, is intended or should be inferred.

The material presented here does not necessarily reflect the views of Medscape, LLC, or any individuals or commercial entities that support companies that support educational programming on medscape.org. These materials may include discussion of therapeutic products that have not been approved by the US Food and Drug Administration, off-label uses of approved products, or data that were presented in abstract form. These data should be considered preliminary until published in a peer-reviewed journal. Readers should verify all information and data before treating patients or employing any therapies described in this or any educational activity. A qualified healthcare professional should be consulted before using any therapeutic product discussed herein.

MMWR Morb Mortal Wkly Rep. 2023;72(3):55-62. © 2023  Centers for Disease Control and Prevention (CDC)

*https://www.cdc.gov/ncbddd/fasd/alcohol-use.html
^†https://www.cdc.gov/brfss/
^§Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, District of Columbia, Georgia, Illinois, Kansas, Maryland, Minnesota, Montana, Nebraska, Nevada, New Hampshire, North Carolina, Oklahoma, Rhode Island, South Carolina, Tennessee, Utah, and Wisconsin.
^¶https://www.cdc.gov/brfss/questionnaires/modules/category2017.htm; https://www.cdc.gov/brfss/questionnaires/modules/category2019.htm
**Self-reported pregnancy was based on responses to the question, "To your knowledge, are you now pregnant?" This question was asked if the respondent's sex was female and the respondent was aged <49 years.
^††Race and ethnicity was defined as non-Hispanic Black or African American, Hispanic or Latino, non-Hispanic White, and Other (including non-Hispanic American Indian or Alaska Native, non-Hispanic Asian, non-Hispanic Native Hawaiian or other Pacific Islander, and non-Hispanic multiracial).
^§§Self-reported education level was based on computed levels as follows: "Did not graduate High School," "Graduated High School," "Attended College or Technical School," and "Graduated from College or Technical School." Responses to "Attended College or Technical School" and "Graduated from College or Technical School" were combined to a variable of "Some college or more."
^¶¶Employment status included employed for wages or self-employed. Unemployment status included being out of work for ≥1 year, out of work for <1 year, a homemaker, a student, retired, or unable to work.
***Disability was defined as an affirmative response to any of the following questions: "Are you deaf or have serious difficulty hearing?," "Are you blind or have serious difficulty seeing, even when wearing glasses?," "Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?," "Do you have serious difficulty walking or climbing stairs?," "Do you have difficulty dressing or bathing?," and "Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping?"
^†††Respondents were classified as reporting behaviors that might increase the risk for HIV transmission if they reported at least one of the following: 1) injection of any drug other than one prescribed in the past year, 2) being treated for a sexually transmitted disease in the past year, 3) having given or received money or drugs in exchange for sex in the past year, 4) had anal sex without a condom in the past year, or 5) had four or more sexual partners in the past year.
^§§§Frequent mental distress was based on responses to the question, "Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?" where ≥14 days was considered frequent mental distress.
^¶¶¶Chronic condition was defined as ever having been told by a health care provider that the person had a heart attack, angina, coronary heart disease, stroke, hypertension (including gestational hypertension), diabetes (including gestational diabetes), arthritis, asthma, chronic obstructive pulmonary disease, emphysema, chronic bronchitis, depression, any cancer, or chronic kidney disease.
****Health insurance status was based on responses to the question, "Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare, or Indian Health Service?"
^††††Having a usual health care provider was based on responses to the question, "Do you have one person you think of as your personal doctor or health care provider?" where one or more was included.
^§§§§States were included that had expanded Medicaid before 2017 or 2019, depending on the year or years each state was included in the BRFSS ASBI module survey. https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/
^¶¶¶¶Cigarette use was based on responses to the questions, "Have you smoked at least 100 cigarettes in your entire life?" and "Do you now smoke cigarettes every day, some days, or not at all?" Responses of "every day" and "some days" were combined to create a dichotomous variable of cigarette use, and persons who responded "no" to the question, "Have you smoked at least 100 cigarettes in your entire life?" were combined with persons who reported "not at all."
*****Self-reported alcohol use was based on the BRFSS calculated variable of "Adults who reported having had at least one drink of alcohol in the past 30 days."
^{†††††}Self-reported binge drinking was based on the BRFSS calculated variable of "Considering all types of alcoholic beverages, how many times during the past 30 days did you have 5 or more drinks [for men] or 4 or more drinks [for women] on an occasion?"
^§§§§§Alcohol screening was based on responses to the question, "You told me earlier that your last routine checkup was [within the past 2 years]. At that checkup, were you asked in person or on a form if you drink alcohol?"
^¶¶¶¶¶Among participants who responded "yes" to the question "You told me earlier that your last routine checkup was [within the past 2 years]. At that checkup, were you asked in person or on a form if you drink alcohol?," brief intervention was based on responses to the questions, "Were you offered advice about what level of drinking is harmful or risky for your health?" and "At your last routine checkup, were you advised to reduce or quit your drinking?"
******https://wonder.cdc.gov/
^{††††††}45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.
^§§§§§§https://www.thecommunityguide.org/findings/alcohol-excessive-consumption-electronic-screening-and-brief-interventions-e-sbi
*With 95% CIs indicated by error bars.
^†Brief intervention was based on responses to the questions, "Were you offered advice about what level of drinking is harmful or risky for your health?" and "At your last routine checkup, were you advised to reduce or quit your drinking?" These questions are only asked if participants responded "Yes" to the question, "You told me earlier that your last routine checkup was [within the past 2 years]. At that checkup, were you asked in person or on a form if you drink alcohol?" Because of survey design, it could not be determined whether the health care provider screened for alcohol use and gave a brief intervention before or after the patient reported alcohol use, or if the patient was using alcohol at the time of the health care visit. Self-reported current drinking was based on the BRFSS calculated variable of "Adults who reported having had at least one drink of alcohol in the past 30 days."