CHICAGO -- Americans are buckling up but chugging down, getting cancer screening tests yet still smoking too much, according to government research showing mixed results when it comes to healthy habits nationwide.
State-by-state surveys of adult health trends in the 1990s reveal disturbing increases in binge drinking -- rising in more than a third of states and falling in only three. Most states showed increases in seat-belt use, mammography and even adult vaccinations, yet smoking increased in almost a third and declined in only one.
"It's a mix of good and bad news," said Dr. David Nelson, who helped conduct the research for the federal Centers for Disease Control and Prevention.
Improvements in insurance coverage for some cancer screening tests may explain some results, but reasons for other changes are unclear, Nelson said, calling the study "a jumping-off point for people to answer the 'why' questions."
Results appear in today's issue of the Journal of the American Medical Association.
In a JAMA editorial, Dr. J. Michael McGinnis of The Robert Wood Johnson Foundation called the findings "a reality check," indicating a need for stronger public health measures.
"It is easier to deliver services than to change behavior," McGinnis said.
As might be expected, the study found obesity has increased in all 47 states surveyed on the topic and "just confirms that this has been a nationwide problem," Nelson said.
Among the most surprising findings was the rise in binge-drinking, defined as downing five or more alcoholic beverages at least once in the past month, said Nelson, now with the National Cancer Institute.
Increases were concentrated in the South and Midwest, where Wisconsin had the highest amount of binge drinking in 1999 -- 19.6 percent, compared with 16.4 percent in 1991. Illinois had the greatest increase during the study, jumping from 7.3 percent to 13.9 percent.
Illinois' public health chief, Dr. John Lumpkin, called the increase a concern but was unsure of its cause. State programs have addressed binge drinking on college campuses, and more efforts are planned once the state's budget crunch eases, Lumpkin said.
Psychiatrist Dr. Daniel Angres, who heads an alcohol and drug dependency program at Chicago's Rush-Presbyterian-St. Luke's Medical Center, said one reason may be that young adults, especially in the Midwest, tend to view alcohol as "the lesser of two evils" and more acceptable than harder drugs.
Also, Angres said, as women have become more equal in the workplace, many have turned to "the drinking culture," where doing business over drinks is part of the office dynamic.
Minnesota was one of just three states that saw binge drinking decline, perhaps due to extensive programs to reduce drinking and driving, fetal alcohol exposure and adolescent drinking, the researchers said.
The researchers compiled results from monthly state telephone surveys of adults ages 18 and over, collected randomly from 1991 to 2000.
Participants were asked about 11 health behaviors: smoking, drinking, physical inactivity, obesity, seat-belt use, mammograms, Pap tests, colorectal cancer and cholesterol screenings, and flu and pneumococcal vaccines.
The total yearly number of participants increased from 87,846 in 1991 to 182,444 and were weighted statistically to represent state populations, Nelson said.
Data were incomplete for some measures and some years, and were not available for Wyoming and Washington, D.C.
New York showed the overall best results, with improvements in eight measures. Three states tied for the most declines: Iowa, North Dakota and South Dakota each worsened in four measures.