Phone Surveys Monitor Health Trends and Risks

Health officials in California, 24 other states and the District of Columbia, using telephone surveys, are gathering results from a new nationwide system of monitoring health risks faced by Americans.

California Department of Health Services officials have started to notice a variety of potentially important trends in the ways Californians are modifying--or, in some cases, not modifying--their life styles to take account of new concerns over health, said Frank Capell, director of the state segment of the program.

California is also examining the ramifications of multiple risk factors for people who may be at risk for behavior-related disease, Capell said. Among the first results of this portion of the study is a conclusion that people who report one of five potential risk factors stand twice the normal chance of having a stroke, Capell said.

However, if the same person reports two of the five risks, the chance of stroke rises to 17 times normal and, if there are three or more risk factors, the stroke danger catapults to 26 1/2 times normal, Capell said. The risk factors involved include smoking, high blood pressure, lack of exercise, going on drinking binges and living alone, Capell said.

Complete national data is only now starting to be analyzed, but officials of the federal government’s Centers for Disease Control believe the program, which started in 1984, already has identified regional differences.

Mormon-dominated Utah is apparently the state where overall life-style habits are most healthful, said Gary Hogelin, head of the CDC program. Data from 1984 and 1985, however, identifies states in the Southeast and some in the upper West as areas where people have taken the least heed of the possible risks of such habits as smoking, excess alcohol consumption, drinking and driving, leading a sedentary life style and failing to wear seat belts, Hogelin said.

California’s results show the state has achieved only an average risk factor record in the last few years. Hogelin said the first two years of data indicates seat-belt use is up significantly--apparently as a result of the passage of state mandatory seat-belt-use laws--and that drunk driving may be down in many states.

Calls Due to Increase

The new program involves what amounts to the establishment of telephone public opinion polling departments in participating state health agencies, Hogelin and Capell said. Each month, interviewers call between 100 and 200 (150 in California now, due to increase to 200 shortly) households at random and ask questions about risk-related behavior, Hogelin and Capell said.

Capell said interviewers do not obtain the names of people they survey and that telephone numbers of households called are confidential. Capell said interviewers occasionally have to reassure subjects that information they obtain will not be provided to agencies controlling welfare and Medi-Cal benefits.

In addition to creating the capability to continuously monitor health risk behavior statewide, the opinion survey offices provide an important weapon for public health officials in times of crisis, Hogelin and Capell said. For instance, if the California polling operation had been fully operational in July of last year, the telephone survey department could have helped determine the regional extent of distribution of watermelon possibly tainted by the pesticide Aldicarb, Capell said.

Similarly, if the nationwide capability had existed earlier, it would have been possible to determine far earlier the extent and gravity of the initial outbreaks in 1980 of Toxic Shock Syndrome and the distribution patterns of tampons eventually linked to the disorder, Hogelin said. Capell said the 1976 outbreak of Legionnaire’s Disease in Philadelphia--the nature, patterns and danger of which was unknown for several critical days--could possibly have been pinpointed earlier if the system had existed then.

Significant Observations

Among significant and possibly significant California observations so far, Capell said, are these:

- Seat-belt use rose between 1984 and 1985, while the proportion of people who said they seldom or never use their seat belts went down from 37% to 30%.

- The proportion of state residents who smoke stayed constant, at 25.6%, but there were possibly important shifts in smoking patterns. Smoking among people 18 to 24 declined, from 26.7% to 20.4%, but went up, from 23.1% to 28.5%, in the 25 to 34 age bracket. Smoking among men in general dropped from 28% in 1984 to 26.3% in 1985, but increased among women in general, from 23.3% to 24.9%.

- Smoking among Anglos was virtually unchanged, but smoking among Latinos and blacks increased, from 21.3% to 24%. Anglo men recorded the largest drop in smoking, from 29.4% to 25.7%, and white women showed an increase from 24.3% to 26.9%. Smoking among Latino and black women, however, was nearly the same, with smoking among Latino and black men up--though Capell cautioned that small sample size may have skewed that particular result.

- The proportion of Californians admitting to binge drinking (five drinks or more at one time, once or more a month) dropped from 20.4% to 17.3%, as did the proportion of people admitting they drove while drunk, down from 4.3% to 3.3%.

- Combining results from the two years, white people in California classified their own health as excellent or good significantly more often than non-whites. Twice as many non-whites--22.6% compared to 11.5%--as whites said their health was only “fair.” Nonwhites reported a greater incidence of frequent headaches.

On National Level

Nationally, according to Hogelin and the Centers for Disease Control, the survey made these observations:

- Data was collected in only 15 states in 1984, but in 25 plus the District of Columbia in 1985. Rankings of states and many comparisons between them are not possible, Hogelin said. He said seat-belt use was apparently up across the country, with Ohio, North Carolina and Illinois reporting significant increases ranging from 10.4% to 18.6%.

- In 14 or 15 states gathering data in both years, there was a slight decrease in driving under the influence of alcohol, but in one--South Carolina--the proportion rose slightly. Twelve of 15 states reported decreases in binge drinking, but three states showed increases.

- In both years, Utah recorded some of the best rates in regard to obesity, sedentary life style, smoking, constantly heavy drinking and seat-belt use. Several states showed poor results, including North Dakota, which had the highest seatbelt nonuse and drinking and driving rates in the country.