Temporal changes in the physical fitness of US Army recruits

Sports Medicine

Volumn 36, Issue 7, 2006, Pages 613-634

  Knapik, Joseph J ^a   Sharp, Marilyn A ^b   Darakjy, Salima ^c   Jones, Sarah B ^c   Hauret, Keith G ^a   Jones, Bruce H ^a  

^a U S ARMY CENTER FOR HEALTH PROMOTION AND PREVENTIVE MEDICINE   (United States)

^b U S ARMY RESEARCH INSTITUTE OF ENVIRONMENTAL MEDICINE   (United States)

^c OAK RIDGE INSTITUTE FOR SCIENCE AND EDUCATION   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AEROBIC EXERCISE; ARMY; BODY COMPOSITION; BODY FAT; BODY MASS; BODY WEIGHT; CALORIC INTAKE; DEMOGRAPHY; ENVIRONMENTAL FACTOR; EXERCISE; FITNESS; HEART FUNCTION; HEIGHT; MEDICAL LITERATURE; MOTIVATION; MUSCLE FUNCTION; MUSCLE STRENGTH; OXYGEN CONSUMPTION; PHYSICAL STRESS; RESPIRATORY FUNCTION; REVIEW; RUNNING; TASK PERFORMANCE; TIME PERCEPTION;

BODY COMPOSITION; BODY MASS INDEX; HUMANS; MILITARY MEDICINE; MILITARY PERSONNEL; MUSCLE, SKELETAL; PHYSICAL ENDURANCE; PHYSICAL FITNESS; TIME FACTORS; UNITED STATES;

EID: 33745589226     PISSN: 01121642     EISSN: 01121642     Source Type: Journal    
DOI: 10.2165/00007256-200636070-00005     Document Type: Review

References (148)

1. McCaig RH, Gooderson CY. Ergonomic and physiological aspects of military operations in a cold wet climate. Ergonomics 1986; 29: 849-57
2. Dubik JM, Fullerton TD. Soldier overloading in Grenada. Mil Rev 1987; 67: 38-47
3. Nye RH. The challenge of command. Wayne (NJ): Avery Publishing Group, 1986
4. Knapik JJ, Daniels W, Murphy M, et al. Physiological factors in infantry operations. Eur J Appl Physiol 1990; 60: 233-8
5. Sharp DS, Wright JE, Vogel JA, et al. Screening for physical capacity in the US Army: an analysis of measures predictive of strength and stamina. Natick (MA): US Army Research Institute of Environmental Medicine; 1980. Technical report no.: T8/80
6. Rayson M, Holliman D, Belyavin A. Development of a physical selection procedure for the British Army: phase 2: relationship between physical performance tests and criterion tasks. Ergonomics 2000; 43: 73-105
7. Jones BH, Bovee MW, Harris JM, et al. Intrinsic risk factors for exercise-related injuries among male and female army trainees. Am J Sports Med 1993; 21: 705-10
8. Jones BH, Cowan DN, Tomlinson JP, et al. Epidemiology of injuries associated with physical training among young men in the army. Med Sci Sports Exerc 1993; 25: 197-203
9. Knapik JJ, Sharp MA, Canham-Chervak M, et al. Risk factors for training-related injuries among men and women in basic combat training. Med Sci Sports Exerc 2001; 33: 946-54
10. Knapik JJ, Hauret KG, Lange JL, et al. Retention in service of recruits assigned to the army physical fitness test enhancement program in basic combat training. Mil Med 2003; 168: 490-2
11. Knapik JJ, Canham-Chervak M, Hauret K, et al. Discharges during US Army basic combat training: injury rates and risk factors. Mil Med 2001; 166: 641-7
12. McCook A. US teens far from health, nutrition targets: survey. New York: Reuters Health Information, 2002: 1-2
13. McHugh J. The shape of the future. Army Times 1997; 57: 12-3
14. Wendland-Bowyer W, Higgins L. Kid's physical education: gym class not strong in many schools. Detroit (MI): Detroit Free Press, 2002
15. Bowman T. House task force finds new military concerns. Baltimore (MD): The Sun, 1997: 8A
16. Defense Market Research. June 2003 Youth Poll 5: an estimate of the enlisted supply. Washington, DC: Defense Market Research Executive Notes; 2003. Technical report no.: 16
17. Flegal KM, Carroll MD, Kuczmarski RJ, et al. Overweight and obesity in the United States: prevalence and trends, 1960-1994. Int J Obes Relat Metab Disord 1998; 22: 39-47
18. Flegal KM, Troiano RP. Changes in the distribution of body mass index of adults and children in the US population. Int J Obes Relat Metab Disord 2000; 24: 807-18
19. Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999-2000. JAMA 2002; 288: 1723-7
20. Ogden CL, Flegal KM, Carroll MD, et al. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 2002; 288: 1728-32
21. Harlan WR, Landis JR, Flegal KM, et al. Secular changes in body mass in the United States 1960-1980. Am J Epidemiol 1988; 128: 1065-74
22. Hunsicker P, Reiff G. Youth fitness report 1958-1965-1975. J Phys Educ Recr 1977; 48: 31-3
23. Corbin CB, Pangrazi RP. Are American children and youth fit? Res Q Exerc Sport 1992; 63: 96-106
24. Updyke WF. Report summary: physical fitness trends in American youth 1980-1989. Washington, DC: Willard Intercontinental, 1989
25. Eisenmann JC, Malina RM. Secular trends in peak oxygen consumption among United States Youth in the 20th Century. Am J Hum Biol 2002; 14: 699-706
26. Tomkinson GR, Leger LA, Olds TS, et al. Secular trends in the performance of children and adolescents (1980-2000). Sports Med 2003; 33: 285-300
27. Pate RR. A new definition of youth fitness. Phys Sportsmed 1983; 11: 77-83
28. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise and physical fitness: definitions, and distinctions for health-related research. Pub Health Rep 1985; 100: 126-31
29. Vogel JA. A review of fitness as it pertains to the military service. Natick (MA): US Army Research Institute of Environthe mental Medicine; 1985. Technical report no.: T14/85
30. Hopkins WG, Walker NP. The meaning of 'physical fitness'. Prev Med 1988; 17: 764-73
31. Bouchard C, Shephard RJ, Stephens T, et al. Exercise, fitness and health: the consensus statement. In: Bouchard C, Shephard RJ, Stephens T, et al., editors. Exercise fitness and health: a consensus of current knowledge. Champaign (IL): Human Kinetics, 1990
32. Gutin B. A model of physical fitness and dynamic health. J Phys Educ Recr 1980; 51: 48-51
33. Daniels WL, Vogel JA, Kowal SM. Guidelines for aerobic fitness training in the US Army. Natick (MA): US Army Research Institute of Environmental Medicine; 1979. Technical report no.: T5/79
34. McArdle WD, Katch FI, Katch VL. Exercise Physiology: energy, nutrition and human performance. Philadelphia (PA): Lea & Febiger, 1991
35. Fleishman EA. The structure and measurement of physical fitness. Englewood Cliffs (NJ): Prentice-Hall Inc., 1964
36. Fleishman EA, Quaintance MK. Taxonomies of human performance. New York: Academic Press Inc., 1984
37. Hogan J. The structure of physical performance in occupational tasks. J Appl Psychol 1991; 76: 495-507
38. Gollnick PD, Hermansen L. Biochemical adaptations to exercise: anaerobic metabolism. In: Wilmore JH, editor. Exercise and sport science reviews. New York: Academic Press, 1973: 1-43
39. Holloszy JO. Biochemical adaptations to exercise: aerobic metabolism. In: Wilmore JH, editor. Exercise and sport science reviews. New York: Academic Press, 1973: 45-71
40. Wilmore JH, Costill DL. Physiology of sports and exercise. Champaign (IL): Human Kinetics, 1994
41. Hempel WE, Fleishman EA. A factor analysis of physical proficiency and manipulative skill. J Appl Psychol 1955; 39: 12-6
42. Fleishman EA. Factor analysis of physical fitness tests. Educ Psychol Meas 1963; 23: 647-51
43. Brady JI, Knight DR, Berghage TE. Relationship between measures of body fat and gross motor proficiency. J Appl Psychol 1977; 62: 224-9
44. Myers DC, Gebhardt DL, Crump CE, et al. The dimensions of human physical performance: factor analysis of strength, stamina, flexibility, and body composition measures. Hum Performance 1993; 6: 309-44
45. Marsh HW. The multidimensional structure of physical fitness: invariance over age and gender. Res Q Exerc Sport 1993; 64: 256-73
46. McCloy CH. The measurement of general motor capacity and general motor ability. Res Q 1934; 5: 46-61
47. Wendler AJ. A critical analysis of test elements used in physical education. Res Q 1938; 9: 64-76
48. Metheny E. Studies of the Johnson Test as a test of motor educability. Res Q 1938; 9: 105-27
49. Larson LA. A factor analysis of motor ability variables and tests, with tests for college men. Res Q 1941; 12: 499-517
50. Cumbee FZ, Harris CW. The composite criterion and its relation to factor analysis. Res Q 1953; 24: 127-34
51. Cumbee FZ. A factorial analysis of motor coordination. Res Q 1954; 15: 412-28
52. Bass RI. An analysis of the components of tests of semicircular canal function and of static and dynamic balance. Res Q 1939; 10: 33-52
53. Cumbee FZ, Meyers M, Peterson G. Factorial analysis of motor coordination variables for third and fourth grade girls. Res Q 1957; 28: 100-8
54. Ismail AH, Cowell CC. Factor analysis of motor aptitude of preadolescent boys. Res Q 1961; 32: 507-13
55. Carpenter A. An analysis of the relationship of the factors of velocity, strength, and dead weight to athletic performance. Res Q 1941; 12: 34-9
56. Harris JE. The differential measurement of force and velocity for junior high school girls. Res Q 1937; 8: 114-21
57. Larson LA. A factor and validity analysis of strength variables and tests with a test combination of chinning, dipping and vertical jump. Res Q 1940; 11: 82-96
58. Phillips M. Study of a series of physical education tests by factor analysis. Res Q 1949; 20: 60-71
59. Rarick L. An analysis of the speed factor in simple athletic activities. Res Q 1937; 8: 89-105
60. Sills FD. A factor analysis of somatotypes and of their relationship to achievement in motor skills. Res Q 1950; 21: 424-37
61. Jackson AS. Factor analysis of selected muscular strength and motor performance tests. Res Q 1971; 42: 164-72
62. Jackson AS, Pollock ML, Ward A. Generalized equations for predicting body density of women. Med Sci Sports Exerc 1980; 12: 175-82
63. Jackson AS, Frankiewicz RJ. Factorial expressions of muscular strength. Res Q 1976; 46: 206-17
64. Hutto LE. Measurement of the velocity factor and of athletic power in high school boys. Res Q 1938; 9: 109-28
65. McCloy E. Factor analysis methods in the measurement of physical abilities. Res Q 1935; 6: 114-21
66. Coleman JW. The differential measurement of the speed factor in large muscle activity. Res Q 1937; 8: 123-30
67. Barry AJ, Cureton TK. Factorial analysis of physique and performance in prepubescent boys. Res Q 1961; 32: 283-95
68. Cousins GF. A factor analysis of selected wartime fitness tests. Res Q 1955; 26: 277-88
69. McCloy CH. A factor analysis of tests of endurance. Res Q 1956; 27: 213-6
70. Highmore G. A factor analysis of athletic ability. Res Q 1956; 27: 1-11
71. Ikai M, Fukunaga T. Calculation of muscle strength per unit of cross-sectional area of human muscle by means of ultrasonic measurement. Int Z Angew Physiol 1968; 26: 26-32
72. Ikai M, Fukungaga T. A study on training effect on strength per unit cross-sectional area of muscle by means of ultrasonic measurement. Int Z Angew Physiol 1970; 28: 173-80
73. Maughan RJ. Relationship between muscle strength and cross-sectional area. Sports Med 1984; 1: 263-9
74. Maughan RJ, Watson JS, Weir J. Strength and cross-sectional area of human skeletal muscle. J Physiol 1983; 1983: 37-49
75. Vogel JA, Friedl KE. Army data: body composition and physical performance. In: Marriott BM, Grumstrup-Scott J, editors. Body composition and physical performance: applications for military services. Washington, DC: National Academy Press, 1992
76. Henry FM. Factorial structure of speed and static strength in a lateral arm movement. Res Q 1960; 31: 440-7
77. McCraw LW. A factor analysis of motor learning. Res Q 1949; 20: 316-35
78. Zuidema MA, Baumgartner TA. Second factor analysis study of physical fitness tests. Res Q 1974; 42: 247-56
79. Baumgartner TA, Zuidemia MA. Factor analysis of physical fitness tests. Res Q 1972; 43: 443-50
80. Seashore HG. Some relationships of fine and gross motor abilities. Res Q 1942; 13: 259-74
81. Westerblad H, Allen DG, Lannergren J. Muscle fatigue: lactic acid or inorganic phosphate the major cause. News Physiol Sci 2002; 17: 17-21
82. Myers J, Ashley E. Dangerous curves: a perspective on exercise, lactate and the anaerobic threshold. Chest 1997; 111: 787-95
83. Brooks GA. Lactate doesn't necessarily cause fatigue: why are we surprised? J Physiol 2001; 536: 1
84. Powers S, Howley ET. Exercise physiology. New York: McGraw-Hill, 2001
85. Bassett DR, Howley ET. Limiting factors for maximal oxygen uptake and determinates of endurance performance. Med Sci Sports Exerc 2000; 32: 70-84
86. Knapik JJ. The army physical fitness test (APFT): a review of the literature. Mil Med 1989; 154: 326-9
87. Strickland MK, Petersen SR, Bouffard M. Prediction of maximal aerobic power from the 20-m multi-stage shuttle run test. Can J Appl Physiol 2003; 28: 272-82
88. Burke EJ. Validity of selected laboratory and field tests of physical working capacity. Res Q 1976; 47: 95-104
89. Harman E, Frykman P, Kraemer W. Maximal cycling force and power at 40 and 100 RPM [abstract]. J Strength Cond Res 1986; 8: 71
90. Harman EA, Frykman PN. The relationship of body size and composition to the performance of physically demanding military tasks. In: Marriott BM, Grumstrup-Scott J, editors. Body composition and physical performance. Washington, DC: National Academy Press, 1992
91. Cureton KJ. Effects of experimental alterations in excess weight on physiological responses to exercise and physical performance. In: Marriott BM, Grumstrup-Scott J, editors. Body composition and physical performance: applications for military services. Washington, DC: National Academy Press, 1992
92. Roche AF, Heymsfield SB, Lohman TG. Human body composition. Champaign (IL): Human Kinetics, 1996
93. Going SB. Densitometry. In: Roche AF, Heymsfield SB, Lohman TG, editors. Human body composition. Champaign (IL): Human Kinetics, 1996
94. Dempster P, Aitkens S. A new air displacement method for the determination of human body composition. Med Sci Sports Exerc 1995; 27: 1692-7
95. Lohman TG. Dual energy x-ray aborptiometry. In: Roche AF, Heymsfield SB, Lohman TG, editors. Human body composition. Champaign (IL): Human Kinetics, 1996
96. Jackson AS, Pollock ML. Generalized equations for predicting body density of men. Br J Nutr 1978; 40: 497-504
97. Vogel JA, Kirkpatrick JW, Fitzgerald PI, et al. Derivation of anthropometry based body fat equations for the Army's weight control program. Natick (MA): US Army Research Institute of Environmental Medicine; 1988. Technical report no.: 17-88
98. Knapik JJ, Burse RL, Vogel JA. Height, weight, percent body fat and indices of adiposity for young men and women entering the US Army. Aviat Space Environ Med 1983; 54: 223-31
99. Roche AF, Siervogel RM, Chumlea WM, et al. Grading body fatness from limited anthropometric data. Am J Clin Nutr 1981; 34: 2831-8
100. Keys A, Findanza F, Karvonen MJ, et al. Indices of relative weight and obesity. J Chronic Dis 1972; 25: 329-43
101. Baumgartner RN. Electrical impedance and total body electrical conductivity. In: Roche AF, Heymsfield SB, Lohman TG, editors. Human body composition. Champaign (IL): Human Kinetics, 1996
102. Kowal DM. Nature and causes of injuries in women resulting from an endurance training program. Am J Sports Med 1980; 8: 265-9
103. Knapik JJ, Wright J, Kowal D, et al. The influence of US Army basic initial entry training on the muscular strength of men and women. Aviat Space Environ Med 1980; 51: 1086-90
104. Sharp MA, Patton JF, Knapik JJ, et al. A comparison of the physical fitness of men and women entering the US Army during the years 1978-1998. Med Sci Sports Exerc 2002; 34: 356-63
105. Sharp MA, Knapik JJ, Patton JF, et al. Physical fitness of soldiers entering and leaving Basic Combat Training. Natick (MA): US Army Research Institute of Environmental Medicine; 2000. Technical report no.: T00-13
106. Teves MA, Wright JE, Vogel JA. Performance on selected candidate screening test procedures before and after army basic and advanced individual training. Natick (MA): US Army Research Institute of Environmental Medicine; 1985. Technical report no. T13/85
107. Westphal KA, Friedl KE, Sharp MA, et al. Health, performance and nutritional status of US Army women during basic combat training. Natick (MA): US Army Research Institute of Environmental Medicine; 1995. Technical report no.: T96-2
108. Ramos MU, Knapik JJ. Instrumentation and techniques for the measurement of muscular strength and endurance in the human body. Natick (MA): US Army Research Institute of Environmental Medicine; 1979. Technical report no.: T2-80
109. Knapik JJ, Wright JE, Vogel JA. Measurement of isometric strength in an upright pull of 38 cm. Natick (MA): US Army Research Institute of Environmental Medicine; 1981. Technical report no.: T3/81
110. Cowan D, Jones BH, Tomlinson JP, et al. The epidemiology of physical training injuries in the US Army infantry trainees: methodology, population and risk factors. Natick (MA): United States Army Research Institute of Environmental Medicine; 1988. Technical report no.: T4/89
111. Sharp MA, Nindl BC, Westphal KA, et al. The physical performance of female army basic trainees who pass and fail the army body weight and percent body fat standards. In: Aghazadeh F, editor. Advances in industrial ergonomics and safety VI. London: Taylor and Francis, 1994
112. Sharp MA. Physical fitness and occupational performance of women in the US Army. Work 1994; 4: 80-92
113. Jones BH, Bovee MW, Knapik JJ. Associations among body composition, physical fitness, and injuries in men and women army trainees. In: Marriott BM, Grumstrup-Scott J, editors. Body composition and physical performance. Washington, DC: National Academy Press, 1992
114. Bell NS, Mangione TW, Hemenway D, et al. High injury rates among female army trainees: a function of gender? Am J Prev Med 2000; 18 Suppl. 3: 141-6
115. Popovich RM, Gardner JW, Potter R, et al. Effect of rest from running on overuse injuries in army basic training. Am J Prev Med 2000; 18 Suppl. 3: 147-55
116. Snoddy RO, Henderson JM. Predictors of basic infantry success. Mil Med 1994; 159: 616-22
117. Reynolds K, Cline A, White J, et al. Injury and illness incidence and risk factors in female enlisted basic trainees and female officer basic trainees. Natick (MA): US Army Research Institute of Environmental Medicine; 1998. Technical report no.: T98-13
118. Knapik JJ, Cuthie J, Canham M, et al. Injury incidence, injury risk factors, and physical fitness of US Army basic trainees at Ft Jackson SC, 1997. Aberdeen Proving Ground (MD): US Army Center for Health Promotion and Preventive Medicine; 1998. Technical report no.: 29-HE-7513-98
119. Knapik JJ, Hauret KG, Arnold S, et al. Injury and fitness outcomes during implementation of physical readiness training. Int J Sports Med 2003; 24: 372-81
120. Knapik JJ, Darakjy S, Scott S, et al. Evaluation of two army fitness programs: the TRADOC Standardized Physical Training Program for Basic Combat Training and the Fitness Assessment Program. Aberdeen Proving Ground (MD): US Army Center for Health Promotion and Preventive Medicine; 2004. Technical report no.: 12-HF-5772B-04
121. Physical Fitness Training. US Army field manual (FM) 21-20. Washington, DC: Headquarters, Department of the Army, 1992
122. Vogel JA, Ramos MU, Patton JF. Comparison of aerobic power and muscle strength between men and women entering the army [abstract]. Med Sci Sports Exerc 1977; 9: 58
123. Patton JF, Daniels WL, Vogel JA. Aerobic power and body fat of men and women during army basic training. Aviat Space Environ Med 1980; 51: 492-6
124. Friedl KE, Westphal KA, Marchitelli LJ, et al. Evaluation of anthropometric equations to assess body-composition changes in young women. Am J Clin Nutr 2001; 73: 268-75
125. Durnin JV, Womersley J. Body fat assessed from total body density and its estimate from skinfold thickness: measurements on 481 men and women aged 16 to 72 years. Br J Nutr 1974; 32: 77-97
126. Knapik JJ, Sharp MA, Jones BH, et al. Secular tends in the physical fitness of American youth, young adults and army recruits. Aberdeen Proving Ground (MD): US Army Center for Health Promotion and Preventive Medicine; 2004. Technical report no.: 12-HF-01Q9B-04
127. Ham SA, Yore MM, Fulton JE, et al. Prevalence of no leisure-time physical activity: 35 states and the District of Columbia, 1988-2002. MMWR Morb Mortal Wkly Rep 2004; 53: 82-6
128. Caspersen CJ, Merritt RM. Physical activity trends among 26 states 1986-1990. Med Sci Sports Exerc 1995; 27: 713-20
129. Stephens T. Secular trends in adult physical activity: exercise boom or bust? Res Q Exerc Sport 1987; 58: 94-105
130. Jacobs ER, Hahn LP, Folsom AR, et al. Time trends in leisure-time physical activity in the Upper Midwest 1957-1987: University of Minnesota studies. Epidemiology 1991; 2: 8-15
131. Kuntzleman CT, Reiff GG. The decline in American children's fitness levels. Res Q Exerc Sport 1992; 63: 107-11
132. Ribisl PM, Kachadorian WA. Maximal oxygen intake prediction in young and middle-aged males. J Sports Med Phys Fitness 1969; 9: 17-22
133. Ritchie LD, Ivey SL, Woodward-Lopez G, et al. Alarming trends in pediatric overweight in the United States. Soz Praventivmed 2003; 48: 168-77
134. Centers for Disease Control and Prevention. Chartbook on trends in the health of America. Hyattsville (MD): Centers for Disease Control and Prevention, 2003
135. Kyle UG, Genton L, Pichard C. Body composition: what's new? Curr Opin Clin Nutr Metab Care 2002; 5: 427-33
136. Friedl KE. Can you be large and not obese? The distinction between body weight, body fat, and abdominal fat in occupational standards. Diabetes Technol Ther 2004; 6: 732-49
137. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance, United States 2003. MMWR Morb Mortal Wkly Rep 2004; 53: 1-96
138. Blair SN. Are American children and youth fit? The need for better data. Res Q Exerc Sport 1992; 63: 120-3
139. Brooks C. Adult physical activity behavior: a trend analysis. J Clin Epidemiol 1988; 41: 385-92
140. Lee IM, Paffenbarger RS, Hsieh CC. Time trends in physical activity among college alumni. Am J Epidemiol 1992; 135: 915-25
141. Nielsen SJ, Popkin BM. Patterns and trends in food portion sizes 1977-1998. JAMA 2003; 289: 450-3
142. Nielsen SJ, Siega-Riz SM, Popkin BM. Trends in food locations and sources among adolescents and young adults. Prev Med 2002; 35: 107-13
143. Nielsen SJ, Siegr-Riz AM, Popkin BM. Trends in energy intake in US between 1977 and 1996: similar shifts seen across age groups. Obes Res 2002; 10: 370-8
144. Harnack LJ, Jeffery RW, Boutelle KN. Temporal trends in energy intake in the United States: an ecological perspective. Am J Clin Nutr 2000; 71: 1478-84
145. Clark KL, Mahmoud RA, Krauss MR, et al. Reducing medical attrition: the role of the Accessions Medical Standards Analysis and Research Activity. Mil Med 1999; 164: 485-7
146. Knapik JJ, Canham-Chervak M, Hoedebecke E, et al. The fitness training unit in basic combat training: physical fitness, training outcomes, and injuries. Mil Med 2001; 166: 356-61
147. Eitelberg MJ, Laurence JH, Waters BK, et al. Screening for service: aptitude and educational criteria for military entrance. Alexandria (VA): Human Resources Research Organization; 1984. Technical report no.: FR-PRD-83-24
148. Behavioral Risk Factor Surveillance Survey [online]. Available from URL: https://apps.nccd.gov/brfss/trends [Accessed 2005 Jun 11]