Major Accomplishments

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Adolescent and School Health

Curriculum Analysis Tools

CDC developed a prototype for a comprehensive approach to an effective school curriculum designed to prevent students from engaging in unhealthy behaviors. This comprehensive approach will include curriculum analysis tools (CATs) for health education and physical education, self-assessment checklists for state or district curriculum committees, expert reviews of curricula based on CAT criteria, and rigorously evaluated research findings on those curricula.

Major School Health Program Publications

Since the 1990s, CDC has worked to produce science-based guidance in other health-related areas, such as injury and violence prevention, food safety, and asthma management. Listed below are some of this year’s publications:

• The second edition of the School Health Index: A Self-Assessment and Planning Guide. The first edition focused on physical activity and nutrition. The new edition includes tobacco use prevention, which means that the School Health Index now addresses each of the three behaviors associated with chronic disease.

New Middle School Science Curriculum

CDC began developing activity-driven lesson plans for science teachers who want to give their students background material on epidemiology, biostatistics, and outbreak investigation as a way of preparing them for the case studies that are the cornerstone of CDC’s education program for schools. Teacher reviews of the draft middle school curriculum are uniformly enthusiastic, as are comments from students. Long term, this material will contribute directly to remedying deficiencies in science and mathematics education.

School Health Programs and Policies

CDC funded several programs that enable schools to implement school health programs and policies. For example, CDC provided funds to

• Education agencies in 48 states, 7 territories, and 18 large cities to plan, carry out, and evaluate HIV prevention programs.
• 22 states to establish and run programs for coordinated school health programs. These programs address a range of health issues: many focus on reducing chronic disease risk factors, such as tobacco use, poor nutrition, physical inactivity, and asthma.
• 23 U.S. communities for activities related to Steps to a HealthierUS, which allows school health programs to expand their range of activities.
• National nongovernmental organizations to work with CDC’s adolescent and school health programs to develop and adopt model policies. As a result, many state, city, and tribal education agencies updated their policies or adopted the model policies.

Youth Media Campaign: VERB™. It’s what you do

CDC launched VERB™. It’s what you do: a national multicultural campaign to promote healthy lifestyles among “tweens” (9- to 13-year-olds) in 2002. The goal of the campaign is to increase and maintain physical activities among tweens through media, public and private sector partnerships, and community efforts with the support and involvement of parents and adult and teen role models. In 2003, the campaign built awareness and affinity for the VERB brand among tweens. The VERB campaign exceeded CDC’s 1-year awareness target (that 9- to 13-year-olds have seen the campaign and know what it is about). Seventy-four percent of the national population of tweens are aware of the VERB brand and tell us that VERB is “cool.” This positive acceptance of VERB positions the campaign to motivate tweens to get and stay physically active. Through contests, tours, sweepstakes, and online, VERB has directly touched almost 5 million children and parents. The campaign has been seen 46 million times nationwide, with 147 broadcast, print, and online placements. Audience research is conducted continuously to ensure the ads resonate with youth and parents.

Learn More about CDC's Youth Media Campaign and Adolescent and School Health Program.

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Aging

Healthy Aging

To promote healthy aging, CDC supported programs at the American Society for the Aging, the National Council on the Aging, the Institute for the Future of Aging Services, the National Safety Council, and the American Association of Active Lifestyles and Fitness. Accomplishments include increased availability of health-related information on older adults for health professionals and for other professionals who specialize in age-related issues, enhanced efforts to increase physical activity and reduce fall-related injuries, and strengthened collaboration on aging-related issues throughout the public health and aging-related networks.

Healthy Aging Network

CDC supported the Prevention Research Centers’ Healthy Aging Network, a unique group of academic institutions that conduct prevention research with a specific focus on the development and dissemination of community-based strategies to promote health and prevent disease and injury among older adults.

MMWR’s Special Series on Public Health and Aging

This is the first series of articles by a variety of CDC programs that highlight health issues related to aging and discuss the health and economic effect of a rapidly aging population. In addition to dissemination through the standard MMWR distribution lists, these articles were widely disseminated to the public health and aging networks through CDC’s Healthy Aging list-serve, CDC’s Web site on aging, partners’ newsletters, and multiple conference presentations.

State Programs on Aging

CDC supported 10 state health departments to implement projects designed to promote health and prevent disease among older adults. This initiative, jointly funded with the Administration on Aging and administered through the Chronic Disease Directors and the National Association of State Units on Aging, addresses such issues as increasing physical activity and caregiver support.

Summit on Aging

In collaboration with the Center for the Advancement of Health, CDC convened the surveillance summit “Making Health Count for Older Americans.” The summit brought together a diverse group of leaders in public health and aging to discuss the utility and design of a report card on elder health. As a result, CDC will partner with the Merck Institute of Aging and Health and the Gerontological Society of America to create an easily referenced report card that will include key health indicators for older adults, national and state aging-related data, and a narrative on critical health issues for older adults.

Learn more about CDC's Health Aging Program.

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Arthritis

Capacity Building at State Programs

CDC funded 36 state arthritis programs: 8 states were funded to further implement their plans and improve their arthritis prevention and control activities, and 28 states were funded to begin planning for a state arthritis program.

Prevalence Projections

CDC used current prevalence estimates to project that the prevalence of arthritis among adults aged 65 or older will nearly double by 2030, or rise from 21 million people to 41 million people.

Systemic Lupus Erythematosus

CDC funded two states (Michigan and Georgia) to develop population-based registries for systemic lupus erythematosus (SLE). These registries will define and monitor both the incidence and prevalence of the condition over time and improve characterization of people with SLE.

Learn more about CDC's Arthritis Program.

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Cancer

Colorectal Cancer Screening

In collaboration with the Harvard School of Public Health and the RAND Corporation, CDC completed a study to develop and test the feasibility of a measure of colorectal cancer screening for the Health Plan Employer Data and Information Set (HEDIS), the leading system for performance measurement for health plans in the United States. On the basis of this work, the National Committee for Quality Assurance adopted the measure for HEDIS 2004, which should lead to increased use of screening by the 70 million Americans enrolled in health plans that collect and report HEDIS data.

Comprehensive Cancer Control

• CDC expanded from 26 to 51 the number of grantees that received funds through its National Comprehensive Cancer Control Program. Included among the new grantees were several tribal areas.
• CDC’s 2003 cancer conference, entitled “Comprehensive Approaches to Cancer Control: The Public Health Role,” held September 15–18, 2003, attracted close to 1,200 people, which is an increase of 50% over 2001. The topic of cancer survivorship was added to the agenda, which brought additional people to the audience and new partners to help plan the conference and make presentations. Plenary sessions, concurrent topic discussions, short courses, abstract and poster presentations, exhibits, and computer demonstrations provided numerous opportunities for participants to expand their knowledge and skills related to cancer control as well as to network and build new partnerships.

Report to the Nation on Cancer

CDC was the lead agency for the annual report to the nation on the status of cancer, an annual collaboration among CDC, the National Cancer Institute, the North American Association of Central Cancer Registries, and the American Cancer Society. This year’s report has updates to the trends in the top four cancers. It also has extensive state data for cancer prevention and control: measures of tobacco use and lung cancer statistics; mammography use, early-stage breast cancer, and breast cancer statistics; prostate-specific antigen testing and prostate cancer statistics; and use of fecal occult blood test or colonoscopy and colorectal cancer statistics.

School Programs to Prevent Cancer

CDC provided funds to Colorado, North Carolina, and Michigan state education agencies to collaborate with their departments of public health to conduct demonstration projects implementing the Guidelines for School Programs to Prevent Skin Cancer. The guidelines contain recommendations for a variety of interventions to reduce skin cancer risk, including recommendations for policies that 1) reduce the extent of students’ exposure to the sun, 2) create school environments that support sun-safety practices, and 3) educate students, their families, and school staff in sun protection practices.

Screening for Prostate Cancer

Sharing the Decision The overall goals of this CDC slide presentation are 1) to increase primary care providers’ understanding of the uncertainty about the evidence of the effectiveness of prostate cancer screening and the benefits and harms of screening, 2) to encourage shared decision making, and 3) to provide information about how physicians can engage in shared decision making. After viewing this slide show, physicians will have a better understanding of the risks of prostate cancer and its natural history, the potential benefits and possible harms of screening for and treating early-stage prostate cancer, and the best ways of engaging in shared decision making with patients to help them decide whether to be screened for prostate cancer. CDC encourages health care providers to download and present these slides to their colleagues. The knowledge gained from this presentation will help primary care providers to engage their patients in shared decision making.

Learn more about CDC's Cancer Prevention and Control Program.

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Diabetes

Diabetes Detection Initiative

The Department of Health and Human Services established the Diabetes Detection Initiative: Finding the Undiagnosed (DDI) to address the growing diabetes epidemic in the United States. CDC played a key role in planning, implementing, and evaluating the DDI, which is a broad-based community activity. The DDI encourages people to determine their own risk for undiagnosed diabetes using a paper risk-assessment tool adapted from one used by the American Diabetes Association. This risk-assessment tool also gives users a clear message about the appropriate blood tests needed to confirm the results. A finger stick/capillary blood test will be part of the medical assessment that is done at a health care site; the result, combined with other information, will inform the health care provider of the need for further testing to diagnose diabetes. The self-administered tests will be distributed through a variety of community channels, including retail outlets and social-service, religious, grass-roots, and fraternal organizations. The DDI is being piloted in 10 communities throughout the country and will eventually be expanded to other locations.

Diabetes Forecasting Models

CDC developed forecasting models to produce projections of the number of people with diabetes by age, race, sex, and related cost for the next 50 years. CDC also completed collection of baseline data for the Diabetes Translation Research Study (TRIAD) on more than 11,000 patients in the largest cohort study designed to monitor delivery of efficacious preventive care services and identify modifiable barriers to optimal care. CDC also completed the protocol for an ancillary study on socioeconomic status as a risk factor for diabetes. In conjunction with the National Institutes of Health, CDC funded the first study to evaluate modifiable environmental factors that contribute to inappropriate weight gain in children, adolescents, and adults. In addition, the two agencies established the first international meta-analysis of more than 40 major studies on abdominal obesity and risk for type 2 diabetes. CDC also conducted a pilot study of the prevalence and causes of visual impairment and quality of eye care among people with diabetes in managed care settings. In addition, CDC established a research agenda for eye health, which involves partnerships with nonprofit and volunteer organizations.

National Diabetes Education Program (NDEP)

• The NDEP (sponsored by CDC and the National Institutes of Health) began a new campaign to prevent type 2 diabetes: “Small Steps, Big Rewards.” In addition to producing television and print public service announcements, the campaign produced the GAMEPLAN kit (Goals, Accountability, Monitoring and Effectiveness: Prevention through a Lifestyle of Activity and Nutrition) for health care providers to help them counsel patients about primary prevention. This kit has several features: a summary of the findings of the diabetes prevention program trial, a decision pathway for diagnosis, a motivational interviewing section, and a guide for teaching patients to use a food and activity tracker and a fat and calorie counter as steps toward behavior change.
   
• Helping Students with Diabetes Succeed: A Guide for School Personnel (published in 2003) is a comprehensive guide designed to help school personnel, parents, and students to ensure that all students with diabetes have a safe learning environment and equal access to educational opportunities. The Guide includes a diabetes primer for school personnel, tools for effective diabetes management, and school responsibilities under federal law.
   
• NDEP began a new campaign (Move It!) to reach American Indian/Alaska Native (AI/AN) teenagers. A kit including a poster of AI/AN teenagers having fun engaging in physical activities was mailed to more than 600 schools with a large Native American student body. The kit also contains fact sheets on diabetes among young American Indians and Alaska Natives, easily reproduced print advertisements, resource lists, and ideas for school programs to increase physical activity and awareness of diabetes. NDEP is developing a set of best practices based on the interventions prompted by Move It! that can be sent with future mailings to a larger audience.

National Diabetes Prevention Center (NDPC)

• CDC funded this center in New Mexico to work with American Indian communities. CDC also has formal partnerships with the National Indian Council on Aging, the American Indian Higher Education Consortium, the Association of American Indian Physicians, and the Native American Diabetes Program, University of New Mexico.
   
• NDPC developed the American Indian/Alaska Native Interactive Diabetes Atlas using Geographic Information Systems mapping technology. The Atlas is a new tool for portraying and understanding data useful to decision makers such as tribal leaders, community planners, health care providers, and staff of diabetes prevention programs.
   
• NDPC’s Tribal College Initiative is a collaboration with the American Indian Higher Education Consortium that specifically addresses White House Executive Order 13270, which directs federal agencies to work in partnership with tribal colleges and universities.

Primary Prevention of Type 2 Diabetes

• Through the Diabetes Collaborative, CDC works with the Bureau of Primary Health Care and the Institute for Healthcare Improvement to improve diabetes and pre-diabetes measures by improving health care delivery. The Diabetes Collaborative worked 1) to identify people at highest risk for developing diabetes and 2) to provide evidenced-based lifestyle interventions to prevent or delay the progression to diabetes. Preliminary findings indicate that the methods used to identify people with pre-diabetes are effective. Lifestyle interventions are being tested for their effect on having people with pre-diabetes achieve a weight loss of more than 7% and an exercise regimen of more than 150 minutes per week.
   
• CDC continued its collaboration with the Diabetes Prevention Program cohort and is currently undertaking a comprehensive economic evaluation of the economic evolution of primary prevention of diabetes. To further this effort, CDC convened a meeting of national and international experts to examine screening for diabetes and strategies for detecting the people at high risk for diabetes who could most benefit from primary prevention interventions.
   
• CDC began the Cues to Action in Diabetes Risk Education project (CADRE). CADRE assesses the effect of teaching people about impaired glucose tolerance on their likelihood of altering their health-related behavior. Results will influence the design of future screening, education, and intervention programs.

Women’s Health and Diabetes

• CDC’s National Public Health Initiative on Diabetes and Women’s Health had two important publications in 2003: National Agenda for Public Health Action and The Evolution of the National Public Health Initiative on Diabetes and Women’s Health: A Model Process.
   
• CDC obtained the support of three major organizations to serve as cosponsors of the Diabetes and Women’s Health initiative: the American Diabetes Association, the American Public Health Association, and the Association of State and Territorial Health Officials. Together, they formed a task force of individuals from public, private, and volunteer organizations to propose recommendations for needed strategies, policies, surveillance, and research to improve the lives of women with diabetes or at risk for the disease. CDC and its cosponsors prepared and published an interim report that outlines the proposed recommendations suggested by the task force; the report contains an overview of the burden of diabetes and recommendations for action.

Learn more about CDC's Diabetes Public Health and National Diabetes Education Programs.

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Epilepsy

Education

CDC supported the Epilepsy Foundation in a multifaceted public education and awareness campaign that focuses on teenagers and adolescents with epilepsy, their peers, and older adults with epilepsy.

Framework for Epilepsy Programs

CDC published The Role of Public Health in Addressing Lower Prevalence Chronic Conditions: The Example of Epilepsy. This report, produced in collaboration with the Association of State and Territorial Chronic Disease Program Directors, outlines a recommended framework for state epilepsy programs. It will serve as a model for other programs that address low-prevalence chronic conditions.

Research

CDC developed a method for identifying epilepsy among patients of managed care organizations and conducted extramural research to determine the incidence and prevalence of epilepsy in five diverse populations and settings.

Learn more about CDC's Epilepsy Program.

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Healthy Workplaces

The HealthierUS initiative (announced by President Bush through Executive Order) calls for public and private employers to set up programs that will encourage employees to follow four key principles for good health: 1) be physically active every day, 2) eat nutritious food, 3) get preventive screenings, and 4) make healthy choices.

To act as a model for other work sites, CDC plans to make its workplace the healthiest among the agencies of the Department of Health and Human Services. NCCDPHP is taking the lead on this initiative. The new work site program will use the best of CDC’s current employee health program and add new elements. Among the elements of CDC’s present program are free use of a gym with state-of-the-art equipment, free classes in health and nutrition, free counseling and referral for further services, and a free lipid screening program. To encourage employees to walk, CDC launched the StairWELL program, which involves making stairwells attractive places that employees enjoy. For example, stairwells that are carpeted, painted in bright colors, and decorated with large colorful pictures encourage employees to use them. Piped-in music is an additional incentive. In 2003, the CDC Healthy Work Site project began a comprehensive needs assessment, planned for HealthCalc (a Web-based health promotion site for CDC employees), and started several demonstration projects, which include lactation rooms for new mothers, promotion of healthy foods in the cafeteria, and improving walking paths between buildings on the CDC campuses.

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Heart Disease and Stroke

Action Plan

CDC released A Public Health Action Plan to Prevent Heart Disease and Stroke, which charts a course for CDC, collaborating public health agencies, and other partners to prevent heart disease and stroke, during the next two decades and beyond. The Action Plan was developed with input from a broad range of partners.

Acute Stroke Registry

CDC funded eight prototypes of the Paul Coverdell National Acute Stroke Registry. The prototype registries collected data on 15,216 patients at 158 hospitals and developed and implemented data-based quality improvement plans for acute stroke care.

Atlas of Stroke Mortality

CDC released the Atlas of Stroke Mortality: Racial, Ethnic, and Geographic Disparities in the United States to inform policymakers and to increase national and state awareness of the burden of stroke in the southeastern United States. The Atlas of Stroke Mortality is the third in a series of CDC atlases related to cardiovascular disease, which have been published through a collaboration between CDC, West Virginia University, and the University of South Florida. This Atlas provides an extensive series of national and state maps that show local disparities in stroke death rates for the five largest racial and ethnic groups in the United States (i.e., American Indians and Alaska Natives, Asians and Pacific Islanders, blacks, Hispanics, and whites).

State Programs to Prevent Stroke

CDC added three new states (Kansas, North Dakota, and Washington) to the number to which it provides funds for stroke prevention programs. The total is now 32 states plus the District of Columbia. Of those, 22 were given funds to build capacity and 3 (Montana, Utah, and West Virginia) received funding for basic implementation.

Learn more about CDC's Cardiovascular Health Program.

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Hemochromatosis

Online Training Course

As a first step toward addressing undiagnosed hemochromatosis in the United States, CDC launched an educational campaign for health care providers to increase awareness of, early detection for, and early treatment for hemochromatosis. In collaboration with experts throughout the United States, CDC developed the online training course Hemochromatosis: What Every Clinician and Other Health Care Professional Needs to Know, which focuses on recognition of hemochromatosis symptoms, diagnoses, phlebotomy treatment, and counseling patients about the importance of family-based detection. The course includes downloadable, colorful patient educational materials and physician letters that can easily be customized to provide information for patients to pass on to family members. Links to additional resources are also available, including links to articles from the scientific literature.

Learn more about CDC's Iron Overload and Hemochromatosis Program.

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Micronutrient Malnutrition

Collaboration with the Global Alliance for Improved Nutrition (GAIN)

CDC and GAIN are in the last stages of adopting a memorandum of understanding to formalize their collaboration. GAIN was established in 2002 as an alliance of public, private, and civil society organizations to support food fortification and other sustainable nutrition strategies for eliminating vitamin and mineral deficiencies. Founding donors of GAIN are the Bill and Melinda Gates Foundation, the United States Agency for International Development, the Canadian International Agency, the Micronutrient Initiative, the Government of Netherlands, and the Government of Germany. Given their synergistic missions and objectives, this close collaboration between CDC and GAIN will be mutually beneficial and further strengthen international micronutrient deficiency interventions.

Iron Supplements

To evaluate the health effects of iron supplements during pregnancy among women with initially adequate iron stores, CDC funded and collaborated with investigators on two randomized control trials in Ohio and North Carolina. Compared with placebo, iron supplementation (30 mg daily) from enrollment to 28 weeks gestation among low-income women in Ohio (N = 215) led to a significantly higher mean birth weight (206g), a significantly lower incidence of low-birth- weight infants (4% compared with 17%) and a significantly lower incidence of preterm low-birth-weight infants (3% compared with 10%). Similarly, among low-income women in North Carolina (N = 429), iron supplements also led to a higher mean birth weight (108g) and a lower rate of preterm delivery (7.5% among women randomized to iron supplements versus 13.9% among women randomized to placebos). Results of these two trials provide evidence that iron supplements for all pregnant women prevent adverse outcomes.

Flour Fortification Initiative

The Flour Fortification Initiative (FFI) began in June 2002 with sponsorship by CDC, the Micronutrient Initiative, and UNICEF. The aim of FFI is to enable the flour industry to fortify the flour produced by large roller mills and make fortification a normal part of flour production. FFI wants to expand routine fortification of flour to all countries where flour is consumed in quantity by a substantial proportion of the population. So far, the International Association of Operative Millers has adopted a resolution in support of FFI, and Seaboard Corporation (which owns and operates flour mills in some of the poorest countries in Africa and Latin America) has a corporate policy on FFI. The Wheat Foods Council and Fleishman-Hillard, Inc. convened an industry meeting to form a group to provide communication and public relations expertise on FFI. The overwhelmingly positive response from the industry has led to far greater progress on FFI than originally expected.

Learn more about CDCs International Micronutrient Malnutrition Prevention and Control Program.

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Nutrition, Physical Activity and Obesity

State-Based Nutrition and Physical Activity Programs

The Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases accomplished a great deal in FY 2004 in its efforts to support the development and implementation of interventions in 28 funded states. (Seven basic implementation states are evaluating the effectiveness of existing obesity prevention approaches, developing new ones, and helping other state and local efforts to prevent obesity and other chronic diseases. The 21 states in the formative capacity-building stage are gathering data, building partnerships, creating statewide health plans, and developing interventions.) These accomplishments took many forms, from the creation of a national-level monitoring system that improved the Division of Nutrition, Physical Activity and Obesity's (DNPAO) overall ability to assist state obesity-reduction efforts, to new tools and program evaluations that allow individual states to better plan and execute their interventions. All were part of an integrated approach to obesity prevention and control using nutrition and physical activity strategies.

The Progress Monitoring Report

DNPAO developed a monitoring system called the Progress Monitoring Report (PMR) for the Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases. This system facilitates the collection of information from funded states to help them manage and improve their programs. The information is designed to answer key questions about: 1) the development of comprehensive nutrition, physical activity, and obesity prevention state plans, 2) the selection and implementation of evidence-based interventions, 3) the impact of interventions, and 4) the overall evaluation of state programs. The PMR uses improved information technology to make reporting easier for state participants and to track program progress over time. Using a Web-based system, many questions can be answered with a simple check box, while others require brief written answers.

The PMR is a useful management tool. Project officers use it to monitor states’ activities and measure their progress toward establishing supportive environments for healthier eating and increased physical activity. The PMR also is used by DNPAO to tailor technical assistance to the states’ demonstrated needs, for example, supporting communities in establishing standards and policies to increase healthy eating and physical activity. In addition, the information collected and reported in the PMR allows the tracking and review of specific interventions and accomplishments.

The State Plan Index

States that receive CDC funding for nutrition, physical activity, and obesity prevention are required to work with public and private partners as well as members of the general population to develop and implement a comprehensive nutrition and physical activity state plan. Each state is expected to regularly review the progress and impact of its plan and interventions, and periodically update the plan as needed.

The State Plan Index (SPI) was developed by DNPAO in collaboration with more than 100 public health experts in government and academia. The SPI provides a standard template that all funded states can use to develop new plans for chronic disease prevention or evaluate and revise existing plans.

The SPI is available to all 28 funded states. At the Association of State and Territorial Public Health Nutrition Directors meeting in June 2004, DNPAO provided SPI training for plan development as well as for updating and modifying existing plans. The training focused specifically on topics such as integration strategies with other programs, selecting populations and strategies for interventions, and stakeholders. Based on materials used in a special training session, a technical assistance manual keyed to the SPI is currently being developed.

Learn more about CDC's Nutrition and Physical Activity Programs and Resources.

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Oral Health

Guidelines for Infection Control in Dental Health Care

CDC completed and published Guidelines for Infection Control in Dental Health-Care Settings. This document updates previous CDC recommendations and sets the standard for dental office infection control practice both in the United States and throughout the world. The new two-part publication also contains a review of the scientific evidence regarding dental infection control issues. The Guidelines will be distributed to practitioners, dental and allied dental education programs, state boards of dental examiners, and dental laboratories. The publication will be translated into several languages. CDC is also preparing a slide presentation for training dental personnel, a companion workbook, and six Web-based training modules.

National Call to Action to Promote Oral Health

CDC was a major partner and contributor to the development and release of A National Call to Action to Promote Oral Health, a public-private partnership under the leadership of the Office of the Surgeon General. Released at the National Oral Health Conference in April 2003, this document builds upon the framework for action called for in the Surgeon General’s report Oral Health in America. The overall aim of the Call to Action is to stimulate initiatives and expand public and private activities to improve oral health and quality of life and eliminate health disparities. Information on the Call to Action is at http://www.cdc.gov/OralHealth/publications/factsheets/call_to_action.htm.

Proven and Promising Practices for Oral Health Programs

One result of a CDC 5-year cooperative agreement with the Association of State and Territorial Dental Directors (ASTDD) is the development of the ASTDD best practices project. Informed by the earlier document Building Infrastructure and Capacity in State and Territorial Oral Health Programs, the purpose of this project is to encourage the development of more effective state, territorial, and community oral health programs. The project is committed to building a system that will support development of best practices by advancing the science for successful implementation of a supportive environment to nurture innovative and promising practices. During the past 2 years, state dental program personnel were surveyed to identify and rank best practice criteria; more than 340 successful practices and underlying public health strategies were identified. Materials now available include Best Practice Approach Reports, which describes dental public health strategies, summarizes supporting evidence, and uses current practices to illustrate successful implementation methods. A Web site (http://www.astdd.org/index.php?template=bestpractices.html*) has descriptive summaries of dental public health activities that can be searched by topic and state. This project was led by a group that includes state and local dental directors and representatives of CDC, the Health Resources and Services Administration, the American Dental Association, and Oral Health America.

Learn more about CDC's Oral Health Resources.

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Prevention Research Centers

Evaluation for Prevention Research Centers (PRCs)

CDC completed the first phase of Developing an Evaluation Framework: Insuring National Excellence (Project DEFINE I), which is designed to ensure that each PRC has the capacity to promote health within its community and to contribute to the excellence of the national program. CDC’s Framework for Program Evaluation in Public Health (1999) served as the model for the process. This activity resulted in the development of a PRC national conceptual framework that organizes and captures, in visual format, the inputs, activities, outputs, and desired outcomes of the PRC Program.

PRC Fellowship Program

In collaboration with the Association of Schools of Public Health, CDC supported the 2-year PRC fellowship program for doctoral students from ethnic or racial minorities. Now in its second year, this fellowship program offers promising public health professionals hands-on experience in projects directed by the PRCs, exposure to state-of-the-art prevention research, and the opportunity to translate and apply their knowledge to real situations needing public health research and intervention.

PRC Grants

CDC completed the first round of a two-stage competition for awarding funds for the next 5-year grant cycle. The first round was limited to competition among the 28 current centers; the second round (scheduled for 2004) will be an open competition among all eligible applicants (including applicants not successful in the first round). This two-round strategy allows the PRC program the opportunity to maintain its high level of scientific integrity while making effective use of funds to promote long-term relationships required for community-based participatory research.

Learn more about CDC's Prevention Research Centers.

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Preventive Health and Health Services Block Grant Program

Improved Efficiency of Funding Applications

CDC developed a 3-year plan for developing a Web-based system that will enable CDC to 1) to evaluate funding applications and annual reports electronically and 2) provide timely feedback and guidance to grantees. CDC also began developing the Web-based Compliance Review Tracking for 2004.

State Programs

• To reduce tooth decay, California (where only 17% of the water is fluoridated) used $200,000 in funding from CDC to leverage $15 million from the California Endowment. More than half of all school-aged children in California have untreated tooth decay; the percentage of 6- to 8-year olds with untreated decay is more than twice as high in California as in the United States as a whole. Among 10th graders in California, 21% are in urgent need of dental care for extensive decay, pain, or infection. It is estimated that this blockgrant funded program will be instrumental in increasing fluoridated water from 17% to 66% by 2006 and will result in an associated decrease in dental caries of from 20% to 40%.
   
• CDC enabled New Jersey to promote healthy aging among older adults by being the sole source of funding for the New Jersey Department of Health and Social Services’ introduction of the “Live Long, Live Well” walking program for older adults at the New Jersey Senior Olympics. The goal of this program is to increase physical activity among seniors, thereby reducing their risk for chronic diseases and helping them maintain functional independence.
   
• CDC enabled Rhode Island to implement an innovative, but practical, idea as part of the state’s “Rhode to Health” activities: the Fast Food Prompt visual aid was developed to help people compare the calorie counts of food items at seven national fast food chains. This simple tool, designed to fit on the visor of an automobile for easy and timely reference, facilitates healthy decision-making related to nutrition, a key factor in people’s risk for obesity and chronic disease.

Learn more about CDC's Preventive Health and Health Services Block Grant Program.

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Racial and Ethnic Approaches to Community Health (REACH) 2010

Program Evaluation

In one community, the disparities in cholesterol screenings and glycosolated hemoglobin were almost eliminated. Projects in other communities have demonstrated success in each of the stages identified on the REACH 2010 Evaluation Logic Model, including capacity building, targeted action, and behavioral risk factor change.

Horizon Award for Health Education

The REACH 2010 Program received the Horizon Award for Health Education given by CDC’s Public Health Education and Promotion Network to programs less than 5 years old that have made significant contributions to the field of health education. The substantial cash award provided with this formal recognition will be used to further health education projects within the REACH program.

Risk Factor Survey

CDC released REACH Risk Factor Survey data to 21 community projects that address diabetes, cardiovascular health, and breast and cervical cancer. These data not only inform the REACH 2010 program of widespread risk and protective behavior changes in participating communities, but they also enable communities to have and use data specific to their local areas and needs.

REACH IN

CDC developed the REACH Information Network (REACH IN), a customized, interactive Web-based application designed to help all REACH grantees document their actions, intervention activities, community or systems changes, and other indicators of progress. REACH IN will allow grantees to create on-demand graphs and reports on their actions and accomplishments in an ongoing, systematic manner.

Learn more about CDC's Racial and Ethnic Approaches to Community Health (REACH 2010).

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Safe Motherhood

Afghanistan

In collaboration with the Afghan Ministry of Health, CDC and the World Health Organization Collaborating Center on Reproductive Health began work to support Ministry of Health activities in the area of women’s reproductive health. So far, activities have focused on developing surveillance systems for maternal and child health, helping clinical staff obtain the skills to provide quality care to women and newborns, and promoting the use of infection control measures in maternity settings. CDC also provides technical support for activities at Rabia-Balkhi Hospital (Kabul). The Afghan project is funded in part by the CDC Foundation and the Bill and Melinda Gates Foundation.

Partnerships

CDC established a special office for the purpose of strengthening partnerships and creating new partnerships to promote the health of women before, during, and after pregnancy. A principal task for the new office is to translate research findings into effective prevention programs.

Preventing Preterm Births

CDC worked with the March of Dimes on issues related to preterm delivery and supported an Institute of Medicine study of the health and economic consequences of preterm birth. CDC is working to find 1) methods of improving our understanding of the social and biomedical mediators of low birth weight and 2) interventions to counteract those mediators.

Learn more about CDC's Reproductive Health Information Source.

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Steps Program

Through technical assistance and funding, CDC supports 7 states representing 25 small cities/rural communities, 12 large cities/urban communities, and 3 tribal entities. These diverse communities across the country are showing how local initiatives can address the burden of chronic diseases such as obesity, diabetes, and asthma by encouraging people to be more physically active, eat a healthy diet, and not use tobacco. The Steps community action plans build on existing local, state, and federal programming efforts and include a special focus on populations with disproportionate burden of disease and disparities in access to preventive services.

Organized community, environmental, educational, media, and policy interventions are being implemented in schools, neighborhoods, health care settings, and work sites. For example, Steps to a Healthier Seattle in Washington reduced emergency use for patients with diabetes who did not already have a primary care provider by providing these patients with case management services and connecting them to primary care providers. Steps to a Healthier Austin in Texas reduced employee absences and health care costs by partnering with the city's transit authority to implement a work site wellness program where employees receive customized health assessments. Steps to a Healthier Cherokee Nation in Oklahoma helped in getting approval for 24/7 tobacco-free campus policies by implementing CDC’s School Health Index: A Self-Assessment and Planning Guide at schools with predominantly American Indian student populations. Steps to a HealthierFL-Pinellas County increased the fruit and vegetable intake of more than 3,700 students and staff by implementing a nationally-recognized program that provides healthy lunch selections in school cafeterias. Steps to A HealthierNY–Rockland County improved asthma control in children by implementing Steps to Better Breathing, a home care program for children with asthma that teaches parents and children about asthma and how to use asthma medications correctly. In addition, the Steps Program has partnered with the YMCA of the USA to increase its reach and impact at the local level. Local YMCAs that are located in or partnered with a Steps community receive mini-grants to create projects that support Steps programs.

Learn more about community success stories at CDC's Steps Program.

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Surveillance and Epidemiology

Behavioral Risk Factor Surveillance System (BRFSS)

• In response to the demand for local data, CDC analyzed the 2002 BRFSS data for metropolitan and micropolitan statistical areas (MMSA). This new project, called Selected Metropolitan/ Micropolitan Area Risk Trends (SMART), yielded prevalence estimates for 98 MMSAs. CDC will also produce data for many of the counties within those MMSAs. This is the first time that MMSA data will be available across the country with consistent weighting. Preliminary analyses suggest dramatic differences in health behaviors between MMSA and state data, and among MMSAs in a state. This information provides state and local public health officials and policy makers with an important new tool for public health planning. CDC also increased the timeliness, rate, specificity, and utility of reports through expedited analysis and release of BRFSS data. For example, CDC released 2002 data for nine states in January 2003 and had released data for all states by March 2003.
   
• To determine options and recommendations to best meet future BRFSS challenges, a 2-day strategy workshop was held for survey-research specialists. The workshop featured presentations on the current system; emerging technology challenges; telephone surveying techniques; program perspectives of CDC, partner organizations, and states; and recommendations for change. The report, which summarizes the recommendations resulting from that workshop, is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5209a1.htm.

Global Student Health Surveillance

Since 2001, CDC has worked with the World Health Organization and agencies of the United Nations to develop the Global School-Based Student Health Survey (GSHS). In 2003, this surveillance system was launched. The purpose of the GSHS is to produce accurate data on health-related behaviors and protective factors among students:

• To help countries develop priorities, establish programs, and advocate for resources for school health and youth health programs and policies.
• To allow international agencies, countries, and others to compare the prevalence of health-related behaviors and protective factors across countries.
• To learn of trends in the prevalence of health-related behaviors and protective factors, by country, for use in evaluating school health programs and promoting healthy behaviors among young people.

National Diabetes Surveillance System

This system is intended to provide timely data on the burden of diabetes in the United States and to update those data as new data sets become available. It provides data on the prevalence and incidence of diabetes in the United States and describes the complications and co-morbid conditions among people with the disease. Recent findings include the following: 1) the prevalence of diabetes is increasing; 2) diabetes preventive care practices that can prevent or delay the complications of diabetes are improving; 3) rates of increases in some diabetes complications are slowing; and 4) CDC provides timely data to help identify health disparities among populations and areas where programs and interventions can improve the quality of diabetes care. CDC continues to strengthen this national diabetes surveillance system to provide periodic and representative data about diabetes in the United States. Over the next few years, the diabetes surveillance system will undergo a major redesign. Changes to the system will include new data sources (a redesigned National Health Interview Survey, National Inpatient Sample), new topics (projections of diabetes prevalence and risk factors, complications of diabetes), modified topics, new methods, extensive modification of computer programming, and revised and new products. New surveillance topics introduced this year include the prevalence of cardiovascular disease, age at diagnosis of diabetes, and level of amputation. The program also prepares and presents articles for MMWR to highlight National Diabetes Awareness Month. This is an ongoing project. More information is available at http://www.cdc.gov/diabetes/statistics/index.htm.

Pediatric Nutrition Surveillance System (PedNSS) and Pregnancy Nutrition Surveillance System (PNSS)

CDC is using Web broadcasting and technology to disseminate information about changes in the redesigned PedNSS and PNSS as well as CDC systems that collect data on maternal and child health indicators among low-income populations in the United States. Training for state professionals involved with these surveillance systems is also provided via the Internet. Evaluations of Web casts are overwhelmingly positive. The annual national PedNSS and PNSS data tables are being published on the Web along with an Internet-based training module that provides guidance and case studies.

Learn more about CDC's Surveillance and Epidemiology Efforts:

• Behavioral Risk Factor Surveillance System (BRFSS)
• Diabetes Surveillance System
• Global School-based Student Health Survey (GSHS)*
• Pediatric Nutrition Surveillance System (PedNSS)
• Pregnancy Nutrition Surveillance System (PNSS)

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Tobacco Control and Prevention

Best Practices in Countermarketing

CDC made significant progress toward developing best practices in tobacco countermarketing. CDC, the American Legacy Foundation, and the World Health Organization sponsored a global tobacco countermarketing conference in New York City. The conference brought together tobacco control experts, scientists, and marketing professionals to develop a set of principles and practices on countermarketing for tobacco control professionals across the world. As a result of the conference, a countermarketing Web site and other resources are being produced to help tobacco control workers translate best practices from around the globe into effective local and regional campaigns. To assist states with the planning, implementation, and evaluation of their countermarketing programs, CDC produced an 11-chapter countermarketing manual. This manual, Designing and Implementing an Effective Tobacco Countermarketing Campaign, is a comprehensive resource. In addition, CDC produced CDCynergy for Tobacco Prevention and Control. This CD-ROM is a tobacco-specific planning tool that can be used to systematically plan, implement, and evaluate tobacco use prevention and control programs.

Framework Convention on Tobacco Control (FCTC)

The FCTC is a framework for countries to help them protect their citizens from the health, social, environmental, and economic consequences of tobacco use and exposure to tobacco smoke. Since 1999, CDC has served as a member of the U.S. delegation to the FCTC and has provided scientific support and guidance. Among its many measures, the FCTC requires countries to impose restrictions on tobacco advertising, sponsorship, and promotion; establish new rules for packaging and labeling tobacco products; establish clean indoor air controls; and strengthen legislation to clamp down on tobacco smuggling. The World Health Organization (WHO)/CDC-sponsored Global Youth Tobacco Survey, which is active in 166 of the 191 member states of WHO, is the standard public health surveillance system in the world to monitor tobacco use among young people and will be essential in tracking and evaluating the FCTC.

Pathways to Freedom: Winning the Fight Against Tobacco

National concern about high rates of smoking in the African American population and the absence of available program materials inspired the initial development and current revision of this guidance. This publication was produced in partnership with key segments of the African American community, including churches, service organizations, and educational institutions. It addresses many issues that are specific to African Americans, such as targeted advertising campaigns and historical, cultural, and socioeconomic influences. It also offers advice on proven strategies for anyone who wants to quit, how friends and family can help, and how the community and its leaders can promote the benefits of living tobacco free. The National Medical Association endorses this report and urges all persons concerned with the well-being of African Americans to use these materials, support their distribution, and make them part of all health programs and services intended for African Americans.

Preventing Young People from Smoking

CDC and the American Legacy Foundation published a report of the 2002 National Youth Tobacco Survey data. This report shows a continuing downward trend in tobacco use among high school students, consistent with data reported by other surveys. Nearly 23% of high school students reported having smoked at some time during the 30 days preceding the survey, a significant reduction from 28% in 2000. As a result, CDC has already met the 2003 goal of reducing to 26.5% the percentage of young people (grades 9–12) who smoke. Increases in the retail price of cigarettes, broad implementation of school-based health programs to reduce tobacco use and addiction, and increased exposure of young people to mass media antismoking campaigns contributed to this success.

Sustaining States’ Investment in Tobacco Control

A priority for CDC during the last 2 years was helping states protect their tobacco control infrastructure from serious budget challenges. As many states slashed funding for tobacco control, a study conducted by CDC, Research Triangle Institute, and the University of Illinois- Chicago found double the decrease in cigarette sales in states that spend more on comprehensive tobacco control programs than in the United States as a whole. Between 1990 and 2000, sales fell an average of 43% in four states with large program expenditures (Arizona, California, Massachusetts, and Oregon) compared with 20% for all states. Program funding levels accounted for a substantial portion of the difference, above and beyond the effect of cigarette excise tax hikes, with increasing expenditures producing bigger and faster declines in sales. CDC promoted this study to its state and other partners as the best evidence to date that investment in tobacco control pays huge dividends.

Learn more about CDC's Tobacco Information and Prevention Source.

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WISEWOMAN

The American Journal of Preventive Medicine published a special supplement on WISEWOMAN (Well-Integrated Screening and Evaluation for Women Across the Nation). The supplement contained 15 articles written by staff from CDC, state WISEWOMAN programs, Prevention Research Centers, the Health Resources and Services Administration, Research Triangle Institute, and Mathematica. Topics included analyses of available data from the minimum data elements provided by WISEWOMAN projects, descriptions and evaluations of lifestyle intervention methods such as provider counseling, descriptions of the process of redesigning ethnically relevant educational materials for the WISEWOMAN priority population, and an analysis of the effects of staff attitudes, beliefs, and barriers on participant outcomes.

Learn more about CDC's WISEWOMAN Program.

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* Links to non-Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organization Web pages found at this link.

Page last reviewed: February 12, 2007
Page last modified: April 8, 2008
Content source: National Center for Chronic Disease Prevention and Health Promotion