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Health Related Quality of Life

Mother playing with children CDC supports the development of national, state, and local surveillance for tracking health-related quality of life (HRQOL) among U.S. residents. HRQOL surveillance data are an important resource for population health assessment and includes a vast public database of findings and trends collected since 1993. The Agency also develops, validates, and refines health-related quality of life measurement techniques for use in prevention research at every stage of life. Health-related quality of life measures are included in surveys such as the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey (NHANES).

As a result of CDC’s surveillance efforts, frequent mental distress has emerged as an important mental health indicator. Data from BRFSS surveys for 1993-2001 indicated that the prevalence of frequent mental distress (FMD) percent reporting ≥ 14 mentally unhealthy days varied among racial/ethnic populations and increased substantially among whites and blacks. In addition, FMD was reported more frequently by women and by persons with low socioeconomic status within each racial/ethnic population.1 FMD is also associated with health behaviors relevant to chronic disease. Specifically, among adults aged 65 years or older, FMD has been associated with decreased likelihood of consuming five fruits or vegetables a day, participating in moderate-to-vigorous physical activity,2 sleep insufficiency,3 and continuing to smoke cigarettes.2 Notably, among U.S. adults attempting to quit smoking, FMD was associated with unsuccessful attempts at smoking cessation among men, but not women.4 These findings suggest that FMD is not only relevant to mental health, but also to behaviors vital to chronic disease prevention.


  1. Zahran HS, Kobau R, Moriarty DG, Zack MM, Giles WH, Lando J. Self-reported frequent mental distress among adults—United States, 1993–2001. Centers for Disease Prevention and Control, MMWR 2004;53(41):963–966.
  2. McGuire LC, Strine TW, Okoro CA. Ahluwalia IB, Ford ES. Modifiable characteristics of a healthy lifestyle in U.S. older adults with or without frequent mental distress: 2003 Behavioral Risk Factor Surveillance System. Am J Geriatr Psychiatry 2007;15:754-761.
  3. Strine TW, Chapman DP. Association of frequent sleep insufficiency with health-related quality of life and health behaviors. Sleep Med 2005;6:23-27.
  4. McClave AK, Dube SR, Strine TW, Mokdad AH. Associations between health-related quality of life and smoking among a large sample of U.S. adults. Prev Med 2009;48:173-179.

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