Importance It is important to document patterns of prescription drug use to inform both clinical practice and research. Objective To evaluate trends in prescription drug use among adults living in the United States. Design, Setting, and Participants Temporal trends in prescription drug use were evaluated using nationally representative data from the National Health and Nutrition Examination Survey (NHANES). Participants include 37,959 non-institutionalized US adults, aged 20 years and older. Seven NHANES cycles were included (1999–2000 to 2011–2012), and the sample size per cycle ranged from 4,861 to 6,212. Exposures Calendar year, as represented by continuous NHANES cycle. Main Outcome(s) and Measure(s) Within each NHANES cycle, use of prescription drugs in the prior 30 days was assessed overall and by drug class. Temporal trends across cycles were evaluated. Analyses were weighted to represent the US adult population. Results Results indicate an increase in overall use of prescription drugs among US adults between 1999–2000 and 2011–2012 with an estimated 51% of US adults reporting use of any prescription drugs in 1999–2000 and an estimated 59% reporting use in 2011–2012 (Difference: 8%; 95% CI: 3.8%–12%; p-trend<0.001). The prevalence of polypharmacy (use of ≥5 prescription drugs) increased from an estimated 8.2% in 1999–2000 to 15% in 2011–2012 (Difference: 6.6%; 95% CI: 4.4%–8.2%; p-trend<0.001). These trends remained statistically significant with age adjustment. Among the 18 drug classes used by more than 2.5% of the population at any point over the study period, the prevalence of use increased in 11 drug classes including antihyperlipidemic agents, antidepressants, prescription proton-pump inhibitors, and muscle relaxants. Conclusions and Relevance In this nationally representative survey, significant increases in overall prescription drug use and polypharmacy were observed. These increases persisted after accounting for changes in the age distribution of the population. The prevalence of prescription drug use increased in the majority of, but not all, drug classes.

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IMPORTANCE Prolonged sitting, particularly watching television or videos, has been associated with increased risk of multiple diseases and mortality. However, changes in sedentary behaviors over time have not been well described in the United States. OBJECTIVE To evaluate patterns and temporal trends in sedentary behaviors and sociodemographic and lifestyle correlates in the US population. DESIGN, SETTING, AND PARTICIPANTS A serial, cross-sectional analysis of the US nationally representative data from the National Health and Nutrition Examination Survey (NHANES) among children aged 5 through 11 years (2001-2016); adolescents, 12 through 19 years (2003-2016); and adults, 20 years or older (2003-2016). EXPOSURES Survey cycle. MAIN OUTCOMES AND MEASURES Prevalence of sitting watching television or videos for 2 h/d or more, computer use outside work or school for 1 h/d or more, and total sitting time (h/d in those aged Ն12 years). RESULTS Data on 51 896 individuals (mean, 37.2 years [SE, 0.19]; 25 968 [50%] female) were analyzed from 2001-2016 NHANES data, including 10 359 children, 9639 adolescents, and 31 898 adults. The estimated prevalence of sitting watching television or videos for 2 h/d or more was high among all ages (children,

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Background Glucosamine and chondroitin are products commonly used by older adults in the US and Europe. There is limited evidence that they have anti-inflammatory properties, which could provide risk reduction of several diseases. However, data on their long-term health effects is lacking. Objective To evaluate whether use of glucosamine and chondroitin are associated with cause-specific and total mortality. Design Participants (n = 77 510) were members of a cohort study of Washington State (US) residents aged 50–76 y who entered the cohort in 2000–2002 by completing a baseline questionnaire that included questions on glucosamine and chondroitin use. Participants were followed for mortality through 2008 (n = 5362 deaths). Hazard ratios for death adjusted for multiple covariates were estimated using Cox models. Results Current (baseline) glucosamine and chondroitin use were associated with a decreased risk of total mortality compared to never use. The adjusted hazard ratio (HR) associated with current use of glucosamine (with or without chondroitin) was 0.82 (95% CI 0.75–0.90) and 0.86 (95% CI 0.78–0.96) for chondroitin (included in two-thirds of glucosamine supplements). Current use of glucosamine was associated with a significant decreased risk of death from cancer (HR 0.87 95% CI 0.76–0.98) and with a large risk reduction for death from respiratory diseases (HR 0.59 95% CI 0.41–0.83). Conclusions Use of glucosamine with or without chondroitin was associated with reduced total mortality and with reductions of several broad causes of death. Although bias cannot be ruled out, these results suggest that glucosamine may provide some mortality benefit.

Research suggests that long-chain omega-3 polyunsaturated fatty acids (LC-PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have anti-neoplastic properties, yet evidence for association between LC-PUFAs and colorectal cancer (CRC) remains inconsistent. Using the VITamins And Lifestyle (VITAL) cohort, we evaluated how EPA/DHA intake, and its primary sources, fish oil supplement use and dark fish consumption, relate to CRC risk. A total of 68,109 Washington residents aged 50-76 completed a questionnaire between 2000-2002 and were followed for CRC through 2008 (n=488). Persons using fish oil supplements on 4+days/week for 3+years experienced 49% lower CRC risk than non-users (HR:0.51; 95% CI:0.26-1.00; p-trend=0.06). The association between fish oil use and decreased CRC risk was primarily observed for men (p-interaction=0.02; p-trend men=0.02; p-trend women=0.88) and for colon cancer (p-difference=0.05; p-trend colon=0.03; p-trend rectum=0.87). While dark fish and total EPA+DHA intake were not associated with CRC risk overall, these associations varied by genetic risk (p-interaction=0.009 and 0.02, respectively), with inverse associations observed among low-moderate genetic risk groups and positive associations observed among high risk groups. Results suggest that associations between LC-PUFA intake and CRC may vary by gender, subsite, and genetic risk, providing additional insight into the potential role of LC-PUFAs in cancer prevention.

Objective Adult obesity and inflammation have been associated with risk of colorectal cancer (CRC); however, less is known about how adolescent body mass index (BMI) and inflammation, as measured by erythrocyte sedimentation rate (ESR), relate to CRC risk. We sought to evaluate these associations in a cohort of 239,658 Swedish men who underwent compulsory military enlistment examinations in late adolescence (ages 16–20 years). Design At the time of the conscription assessment (1969–1976), height and weight were measured and erythrocyte sedimentation rate was assayed. By linkage to the national cancer registry, these conscripts were followed for CRC through January 1, 2010. Over an average of 35 years of follow-up, 885 cases of CRC occurred, including 501 colon cancers and 384 rectal cancers. Cox regression was used to estimate adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs). Results Compared with normal weight (BMI: 18.5-<25kg/m2) in late adolescence, upper overweight (BMI: 27.5-<30 kg/m2) was associated with a 2.08-fold higher risk of CRC (95% CI: 1.40, 3.07) and obesity (BMI: 30+ kg/m2) was associated with a 2.38-fold higher risk of CRC (95% CI: 1.51, 3.76) (p-trend:<0.001). Male adolescents with ESR(15+ mm/hr) had a 63% higher risk of CRC (HR: 1.63; 95% CI: 1.08, 2.45) than those with low ESR (<10 mm/hr) (p-trend:0.006). Associations did not significantly differ by anatomic site. Conclusion Late-adolescent BMI and inflammation, as measured by ESR, may be independently associated with future CRC risk. Further research is needed to better understand how early-life exposures relate to CRC.

Although much research has been conducted on the role adult body mass index (BMI) plays in mortality, there have been fewer studies that evaluated the associations of BMI in young adulthood and adult weight trajectory with mortality, and it remains uncertain whether associations differ by race or sex. We prospectively examined the relationships of BMI in young adulthood (21 years of age) and adult obesity trajectory with later-life mortality rates among 75,881 men and women in the Southern Community Cohort Study. Study participants were enrolled between 2002 and 2009 at ages 40-79 years and were followed through December, 2011. Multivariable Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals. There were 7,301 deaths in the 474,970 person-years of follow-up. Participants who reported being overweight or obese as young adults had mortality rates that were 19% (95% confidence interval: 12, 27) and 64% (95% confidence interval: 52, 78) higher, respectively, than those of their normal weight counterparts. The results did not significantly differ by race or sex. Participants who reported being obese in young adulthood only or in both young and middle adulthood experienced mortality rates that were 40%-90% higher than those of participants who were nonobese at either time. These results suggest that obesity in young adulthood is associated with higher mortality risk regardless of race, sex, and obesity status in later life.