Healthy People 2000 Final Review

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

01-0304 (10/01)

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Suggested Citation

National Center for Health Statistics.

Healthy People 2000 Final Review.

Hyattsville, Maryland: Public Health

Service. 2001.

Library of Congress Catalog Card

Number 76–641496

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyattsville, Maryland

October 2001

DHHS Publication No. 01-0256

Department of Health and Human Services

Tommy G. Thompson

Secretary

Centers for Disease Control and Prevention

Jeffrey P. Koplan, M.D., M.P.H.

Director

National Center for Health Statistics

Edward J. Sondik, Ph.D.

Director

Preface

The Healthy People 2000 Final

Review is the seventh and last in a

series of profiles tracking the year 2000

objectives. This report was compiled by

the National Center for Health Statistics,

Centers for Disease Control and

Prevention (CDC), with considerable

input from the Department of Health

and Human Service’s lead agencies for

the year 2000 objectives, the Office of

Disease Prevention and Health

Promotion and the Office on Minority

Health. The Healthy People 2000

Steering Committee and the National

Committee on Vital and Health Statistics

served in a review capacity.

The Healthy People 2000 Review,

which replaced the Prevention Profiles

that monitored the 1990 national health

objectives, continued the series of

profiles of the Nation’s health objectives

as an integral part of the Department’s

disease prevention and health promotion

initiative for the year 2000. This

initiative was unveiled in September

1990 by the Secretary of the Department

of Health and Human Services with the

release of Healthy People 2000:

National Health Promotion and Disease

Prevention Objectives. This publication,

which incorporates the 1995 midcourse

review modifications to the objectives,

provides the latest available tracking

data for objectives and subobjectives in

all priority areas throughout the decade.

iii

Foreword

Since 1990, Healthy People 2000

has provided the national health

promotion agenda that guided

Americans toward living longer and

healthier lives. Healthy People 2000 not

only identified objectives to improve the

Nation’s health, but also set measurable

targets to monitor progress toward its

goals. The ability to quantify and assess

progress on health objectives is at the

heart of the Healthy People initiative.

This Healthy People 2000 Final Review

completes the series of Healthy People

2000 Reviews published to monitor and

evaluate the Nation’s progress toward

the year 2000 targets. As such, it

presents the final assessments of our

progress in the decade.

Healthy People 2000 was an

ambitious effort and invaluable in

setting 319 specific objectives for the

Nation. In fact, progress was achieved

on over 60 percent of the objectives.

Some of the major accomplishments

include surpassing the target for

reducing deaths from coronary heart

disease and cancer. The Nation also met

its targets for AIDS incidence, primary

and secondary syphilis cases,

mammography exams, and violent

(homicide, suicide, and firearm-related)

deaths. The tobacco-related mortality

targets were also met. Both infant

mortality and the number of children

with elevated blood lead levels nearly

met their targets as well. The Nation

also made progress toward the goal of

reducing health disparities for more than

one-half of the special population

objectives identified to be at increased

risk by Healthy People 2000. We can all

take pride in the fact that the past

decade saw substantial improvements in

the quality of life for many Americans.

Underlying and contributing to the

progress in preventing disease and

improving health are the advances in

health information. Healthy People 2000

was a catalyst at all levels of

government for the creation and

dissemination of quality, comparable

health data.

This final edition of the Healthy

People 2000 Review contains several

new data assessments that should prove

valuable for many of our constituents.

The first is an assessment of the

progress toward the second goal of

Healthy People 2000, reducing health

disparities. The assessment is based on

data collected for nine special

populations that are at increased health

risk: four race/ethnicity groups, women,

two age groupings, disability, and

socioeconomic status. Another is the

presentation of data for the 47 ‘‘sentinel

objectives’’ developed to represent the

scope and magnitude of Healthy People

2000. This includes data for each

sentinel objective at the national level

and State data for those objectives

where sources were available. Finally, in

addition to data that update the trends

shown in previous reports for the 18

Health Status Indicators, this report

shows data for the first time for the 16

Priority Data Needs developed at the

same time as the Health Status

Indicators but which lacked data for

assessment below the national level.

Although many gains in health

promotion and disease prevention have

been made, much remains to be done.

For 15 percent of the Healthy People

2000 objectives, the movement was

actually away from the targets. In

January 2000, Healthy People 2010 was

released, ushering the Healthy People

initiative into the new millennium. The

monitoring and assessment goals of

Healthy People 2010 are even more

ambitious than those that have directed

our efforts over the past decade. For

example, the Healthy People 2000 goal

to reduce health disparities has been

strengthened in Healthy People 2010 to

focus on eliminating health disparities.

Another important development for

the next decade is the publication

Tracking Healthy People 2010.Asa

guidebook on the statistics used for

Healthy People, it will assist programs

at the local, State, and national levels in

producing and using the requisite data

and, thereby, measurably advance the

information base available to enhance

the public’s health. Thanks to the solid

foundation laid by the accomplishments

of Healthy People 2000, Healthy People

2010 will be even stronger, as it builds

on the experiences of the last decade,

identifies our current health

opportunities and challenges, and

furthers the development of partnerships

among public and private organizations

to improve the health of the American

people.

Edward J. Sondik, Ph.D. Director,

National Center for Health Statistics

Acknowledgments

Overall responsibility for planning

and coordinating the content of the

Healthy People 2000 Final Review

rested with the Division of Health

Promotion Statistics (DHPS), Office of

Analysis, Epidemiology, and Health

Promotion (OAEHP), National Center

for Health Statistics (NCHS), under the

general direction of Diane K. Wagener

and Richard J. Klein.

Production coordination was shared

among DHPS analysts: John

Aberle-Grasse, Elizabeth W. Jackson,

Colleen M. Ryan, and Kathleen M.

Turczyn.

Production was accomplished by

several DHPS working teams, which

included John Aberle-Grasse, Manon

Boudreault, Lillie Featherstone, Tracy

Fenwick, Elizabeth W. Jackson, Kenneth

Keppel, Insun Kim, Richard J. Klein,

Michael Molla, Jeffrey N. Pearcy,

Suzanne E. Proctor, Cheryl V. Willis,

Colleen M. Ryan, Thomas C. Socey,

Kathleen M. Turczyn, Diane K.

Wagener, and Jean F. Williams.

The sections discussing the Healthy

People 2000 goals were developed with

substantial input by the Office of

Minority Health (OMH)—particularly

Olivia D. Carter-Pokras and Tuei

Doong, the Office of Disease Prevention

and Health Promotion (ODPHP)—

particularly Omar Passons, the Agency

for Healthcare Research and Quality

(AHRQ), and the Health Resources and

Services Administration (HRSA)—

particularly David Atkins, Melissa

Clarke, Paul Nannis, Kathryn Rickard,

and Lyman Van Nostrand.

The priority area chapters were

coordinated by DHPS analysts and

written by working teams as follows:

Priority Area 1: Carol Macera

(CDC) and Christine Spain (OPHS)

Priority Area 2: Carter Blakely

(ODPHP), Nancy T. Crane (FDA), and

Pamela E Starke-Reed (NIH)

Priority Area 3: Karil Bialostosky

(CDC)

Priority Area 4: James Colliver

(NIH), Wendy Davis (SAMHSA), Susan

Farrell (NIH), Ann Mahony (SAMSHA),

Beatrice Rouse (SAMSHA), and Dorita

Sewell (SAMHSA)

Priority Area 5: Evelyn Kappeler

(OPHS)

Priority Area 6: Michele Edwards

(SAMHSA), Doreen Koretz (NIMH),

Ann Maney (NIMH), and Dorita Sewell

(SAMHSA)

Priority Area 7: Mark Anderson

(CDC), Lee Annest (CDC), Alex Crosby

(CDC), Martha Highsmith (CDC), Tom

Simon (CDC), and Tim Thornton (CDC)

Priority Area 8: Melissa Clarke

(HRSA), Catherine Hutsell (CDC), and

Brick Lancaster (CDC)

Priority Area 9: Tim Groza (CDC)

Priority Area 10: Bob Castellan

(CDC), Dawn Castillo (CDC), Regina

Pana-Cryan (CDC), Bill Eschenbacher

(CDC), John Franks (CDC), Joe Hurrell

(CDC), Lynn Jenkins (CDC), Jay Jones

(CDC), Boris Lushniak (CDC), Mark

Mendell (CDC), Bob Roscoe (CDC),

Lee Sanderson (CDC), John Sestito

(CDC), and Rosie Sokas (CDC)

Priority Area 11: David Evans

(ATSDR), Paul Garbe (CDC), and John

Schelp (NIH)

Priority Area 12: Linda S. Brophy

(FDA) and Elisa Elliot (FDA)

Priority Area 13: Alice M. Horowitz

(NIH), Candace M. Jones (HRSA), and

Stuart Lockwood (CDC)

Priority Area 14: Charlotte

Dickinson (CDC), Renee Schwalberg

(CDC), Myra Tucker (CDC), and Stella

M. Yu (HRSA)

Priority Area 15: Matilde Alvarado

(NIH), James Cleeman (NIH), Janet B.

Croft (CDC), Karen Donato (NIH),

Robinson Fulwood (NIH), Wayne H.

Giles (CDC), Kurt Greenlund (CDC),

Jeanette Guyton-Krishnan (NIH), Mary

M. Hand (NIH), Greg Heath (CDC),

Keith Hewitt (NIH), Darwin Labarthe

(CDC), Terry Long (NIH), George A.

Mensah (CDC), Greg Morosco (NIH),

Linda Redman (CDC), Edward J.

Roccella (NIH), Nancy Watkins (CDC),

and Zhi-Jie Zheng (CDC)

Priority Area 16: Barry Portnoy

(NIH) and Karen Richard (CDC)

Priority Area 17: Stephanie

Benjamin (CDC), Ben Burton (NIH),

Bill Foster (NIH), Linda Geiss (CDC),

Ed Tierney (CDC), and Frank Vinicor

(CDC)

Priority Area 18: Dave Brownell

(CDC), Brenda Garza (CDC), Shelley

Gordon (HRSA), Stacie Greby (CDC),

Gena Hill (CDC), Joyce Neal (CDC),

Ida Onorato (CDC), and Eva Seiler

(CDC)

Priority Area 19: Susan C. Clark

(CDC), Melinda Flock (CDC), Joel R.

Greenspan (CDC), Dana M. Shelton

(CDC), and Jack N. Spencer (CDC)

Priority Area 20: Jennifer Brooks

(CDC), Sarah Foster (CDC), John

Seggerson (CDC), and Nicole Smith

(CDC)

Priority Area 21: David Atkins

(AHRQ), Melissa Clarke (HRSA), Paul

Nannis (HRSA), Kathryn Rickard

(AHRQ), and Lyman Van Nostrand

(HRSA)

Priority Area 22: Diane Wagener

(CDC)

Technical review was provided by

Jennifer Madans, NCHS Associate

Director for Science. Publications

management and editorial review were

provided by Gail V. Johnson and

Rolfe W. Larson. The designer was

Sarah M. Hinkle. Graphics were

produced by Dorothy Day and

supervised by Stephen L. Sloan.

Production was done by Annette F.

Holman. Electronic publishing was done

by Annette F. Holman, Christine Brown,

and Margaret Avery. Printing was

managed by Patty L Wilson and

Joan Burton.

Publication of Healthy People 2000

Final Review would not have been

possible without the contributions of

many staff members throughout NCHS

and numerous other agencies,

particularly Carter Blakey, Office of

Disease Prevention and Health

Promotion. These people gave

generously of their time and knowledge;

their cooperation and assistance are

gratefully acknowledged.

NOTE: Centers for Disease Control and

Prevention (CDC), Office of Public Health Service

(OPHS), Office of Disease Prevention and Health

Promotion (ODPHP), Food and Drug

Administration (FDA), National Institute of Health

(NIH), Substance Abuse and Mental Health

Services Administration (SAMHSA), National

Institute of Mental Health (NIMH), Health

Resources and Services Administration (HRSA),

Agency for Toxic Substances and Disease Registry

(ATSDR), Agency for Healthcare Research and

Quality (AHRQ).

Contents

Preface iii

Foreword

Acknowledgments v

List of Figures

List of Tables

Introduction 1

Background

Summary of Progress 2

Organization and Scope of this Review

Healthy People 2000 Goals

Goal 1: Increase the Span of Healthy Life 7

Life Expectancy at Birth

Fair or Poor Health 7

Healthy and Unhealthy Life

Goal 2: Reducing Health Disparities 8

Reducing Disparities: American Indian/Alaska Native

Reducing Disparities: Asian or Pacific Islander

Reducing Disparities: Black or African American 10

Reducing Disparities: Hispanic or Latino 10

Reducing Disparities: Women

Reducing Disparities: Adolescents and Young Adults 10

Reducing Disparities: Older Adults

Reducing Disparities: People with Disabilities

Reducing Disparities: People with Low Socioeconomic Status 11

Goal 3: Achieving Access to Preventive Services

Health Status Indicators and Priority Data Needs 19

Health Status Indicators

Priority Data Needs 19

Sentinel Objectives

National Data

State Data 30

Healthy People 2000 Priority Areas

1. Physical Activity and Fitness

2. Nutrition 76

3. Tobacco

4. Substance Abuse: Alcohol and Other Drugs 108

5. Family Planning 117

6. Mental Health and Mental Disorders

127

7. Violent and Abusive Behavior

137

8. Educational and Community-Based Programs 146

9. Unintentional Injuries

155

10. Occupational Safety and Health 167

11. Environmental Health

176

12. Food and Drug Safety 187

13. Oral Health

195

14. Maternal and Infant Health 206

15. Heart Disease and Stroke

217

16. Cancer

228

17. Diabetes and Chronic Disabling Conditions 238

18. HIV Infection

254

19. Sexually Transmitted Diseases 267

20. Immunization and Infectious Diseases

279

21. Clinical Preventive Services 294

22. Surveillance and Data Systems

305

Appendix 315

vii

List of Figures

A. Healthy People 2000 objectives: Summary of progress by priority area 3

B. Life expectancy at birth: United States, 1988–98

C. Percent of people with fair or poor health: United States, 1990–98 9

D. Expected years of healthy and unhealthy life: United States, 1998

E. Assessment of disparity for American Indian/Alaska Native objectives 11

F. Assessment of disparity for Asian or Pacific Islander objectives

G. Assessment of disparity for black or African American objectives 12

H. Assessment of disparity for Hispanic or Latino objectives

J. Assessment of disparity for women objectives 13

K. Assessment of disparity for adolescents and young adults objectives

L. Assessment of disparity for older adults objectives 14

M. Assessment of disparity for people with disabilities objectives

N. Assessment of disparity for people with low socioeconomic status objectives

O. Access to care: United States, 1988–99 15

P. Percent of people under 65 years without health insurance coverage: United States, 1998 16

Q. Objective 1.3–Percent of adults who participated in regular physical activity (5 or more times per week):

United States and each State, 1996 and 1998

R. Objective 1.5–Percent of adults who reported no leisure-time physical activity: United States and each State, 1996

and 1998

S. Objective 2.3–Percent of persons 18 years and older who were overweight: United States and each State, 1998

and 1999

T. Objective 3.4–Percent of persons 18 years and older who reported current cigarette smoking: United States and each

State, 1998 and 1999 35

U. Objective 4.1–Alcohol-related motor vehicle crash deaths per 100,000 population: United States and each State,

1997 and 1998

W. Objective 4.6–Percent of youth who currently use marijuana: United States and each State, 1999 37

Y. Objective 4.6–Percent of youth who currently smoke cigarettes: United States and each State, 1999

Z. Objective 5.1–Live birth rates for females 15–17 years old: United States and each State, 1997 39

AA. Objective 6.1–Age-adjusted death rates for suicide: United States and each State, 1997 and 1998

BB. Objective 7.1–Age-adjusted death rates for homicide: United States and each State, 1997 and 1998 41

CC. Objective 9.1–Age-adjusted death rates for unintentional injuries: United States and each State, 1997 and 1998

DD. Objective 9.12–Percent of persons wearing a safety belt while driving or riding in a car: United States and each

State, 1995 and 1997

EE. Objective 10.1–Work-related injury death rates: United States and each State, 1998 and 1999 44

FF. Objective 10.2–Nonfatal work-related injuries per 100 full-time workers in private industry: United States and

reporting States, 1997 and 1998

GG. Objective 11.5–Percent of persons in counties that have not exceeded the Environmental Protection Agency (EPA)

standards for air quality: United States and each State, 1997 and 1998

HH. Objective 14.1–Infant mortality rates: United States and each State, 1997 and 1998

JJ. Objective 14.5–Percent of live births of low birthweight: United States and each State, 1997 and 1998 48

KK. Objective 14.11–Percent of mothers who began prenatal care in the first trimester: United States and each State,

1997 and 1998

LL. Objective 15.1–Age-adjusted death rates for coronary heart disease: United States and each State, 1997 and 1998

MM. Objective 15.2–Age-adjusted death rates for stroke: United States and each State, 1997 and 1998 51

NN. Objective 16.1–Age-adjusted death rates for all cancers: United States and each State, 1997 and 1998

OO. Objective 16.11–Percent of women 50 years of age and older who received a mammogram and breast exam within

the last 2 years: United States and each State, 1998 and 1999

PP. Objective 16.12–Percent of women 18 years of age and older who had a Pap test during the last 3 years:

United States and each State, 1998 and 1999

QQ. Objective 16.13–Percent of persons 50 years of age and older who have had a fecal occult blood test during the last

2 years: United States and each State, 1997 and 1999

RR. Objective 16.13–Percent of persons 50 years of age and older who have ever had a sigmoidoscopy or proctoscopic

exam: United States and each State, 1997 and 1999

SS. Objective 17.9–Age-adjusted death rates for diabetes-related deaths: United States and each State, 1997 and 1998

TT. Objective 19.1–Reported incidence of gonorrhea per 100,000 population: United States and each State, 1998 and

1999

UU. Objective 19.3–Reported cases of primary and secondary syphilis per 100,000 population: United States and each

State, 1998 and 1999

WW. Objective 20.1–Reported cases of measles: United States and each State, 1998 and 1999 60

viii

YY. Objective 20.11–Estimated vaccination coverage with the 4DTP/3polio/1MMR series among children ages

19–35 months: United States and each State, 1998 and 1999

ZZ. Objective 21.4–Percent of persons under 65 years of age with no health insurance coverage: United States and each

State, 1998 and 1999

Priority Area Progress Figures

1. Final status of Physical Activity and Fitness objectives 66

2. Final status of Nutrition objectives

3. Final status of Tobacco objectives 94

4. Final status of Substance Abuse: Alcohol and Other Drugs objectives 109

5. Final status of Family Planning objectives

118

6. Final status of Mental Health and Mental Disorders objectives 128

7. Final status of Violent and Abusive Behavior objectives

138

8. Final status of Educational and Community-Based Programs objectives

150

9. Final status of Unintentional Injuries objectives 156

10. Final status of Occupational Safety and Health objectives 168

11. Final status of Environmental Health objectives

177

12. Final status of Food and Drug Safety objectives 188

13. Final status of Oral Health objectives

196

14. Final status of Maternal and Infant Health objectives

207

15. Final status of Heart Disease and Stroke objectives 218

16. Final status of Cancer objectives

229

17. Final status of Diabetes and Chronic Disabling Conditions objectives 239

18. Final status of HIV Infection objectives

255

19. Final status of Sexually Transmitted Diseases objectives 268

20. Final status of Immunization and Infectious Diseases objectives

280

21. Final status of Clinical Preventive Services objectives 295

22. Final status of Surveillance and Data Systems objectives

304

List of Tables

A. Life-stage objectives: United States, 1987–98 2

B. Health Status Indicators: United States, 1996–98

C. Health Status Indicators by race and Hispanic origin: United States, 1998

D. Priority Data Needs 22

E. An Assessment of Target Attainment for the Healthy People 2000 Sentinel Health Objectives for the United States

and Individual States

Priority Area Summary Tables

1. Physical Activity and Fitness objectives 70

2. Nutrition objectives

3. Tobacco objectives

100

4. Substance Abuse: Alcohol and Other Drugs objectives 112

5. Family Planning objectives

121

6. Mental Health and Mental Disorders objectives 132

7. Violent and Abusive Behavior objectives 142

8. Educational and Community-Based Programs objectives

150

9. Unintentional Injuries objectives

160

10. Occupational Safety and Health objectives 171

11. Environmental Health objectives

181

12. Food and Drug Safety objectives 192

13. Oral Health objectives

199

14. Maternal and Infant Health objectives 211

15. Heart Disease and Stroke objectives

221

16. Cancer objectives

231

17. Diabetes and Chronic Disabling Conditions objectives 244

18. HIV Infection objectives

259

19. Sexually Transmitted Diseases objectives 272

20. Immunization and Infectious Diseases objectives 285

21. Clinical Preventive Services objectives

298

22. Surveillance and Data Systems objectives

309

Introduction

Background

History of the Healthy People

Initiative

The Healthy People process began

in 1979 with the release of Healthy

People: The Surgeon General’s Report

on Health Promotion and Disease

Prevention (1), which provided national

goals for reducing premature deaths and

for preserving independence for older

adults. The five primary goals of the

1979 Surgeon General’s report were to

enhance the health of the U.S.

population in five major life stages

(infants, children, adolescents and young

adults, adults, and older adults).

Different focal points were targeted for

each age group, such as low birth-

weight and birth defects for infants, and

functional independence, influenza, and

pneumonia for older adults. Fifteen

priority areas were also identified as

keys to achievement of the overall

health status goals. In 1980, Promoting

Health/Preventing Disease: Objectives

for the Nation set forth 226 targeted

measurable health objectives for the

Nation to achieve over 10 years in 15

priority areas (2). This national agenda

for health proved its merit when, from

1979 to 1990, the infant mortality rate

decreased by nearly 35 percent and the

motor vehicle fatality rate for children

fell 28 percent. Promoting

Health/Preventing Disease: Objectives

for the Nation served as a model for the

development of Healthy People 2000

(3), which subsequently provided the

starting point for Healthy People 2010

(4).

Life-Stage Objectives

The five major life stages theme has

continued through the decades as part of

the Healthy People initiative. Healthy

People 2000 included targets for

reducing deaths among people under age

65, and for reducing the proportion of

people 70 years and over who have

difficulty performing two or more

activities of daily living. Healthy People

2000 contained four age-related

objectives.

Reduce the death rate for children

by 15 percent to no more than 28 per

100,000 children 1–14 years of age, and

for infants by approximately 30 percent

to no more than 7 per 1,000 live births.

Reduce the death rate for

adolescents and young adults by

15 percent to no more than 85 per

100,000 people 15–24 years.

Reduce the death rate for adults by

20 percent to no more than 340 per

100,000 people 25–64 years of age.

Reduce to no more than 90 per

1,000 people the proportion of all

people age 70 years and over who have

difficulty in performing two or more

personal care activities (a reduction of

about 19 percent), thereby preserving

independence.

As shown in table A, data for 1998

indicate that the targets for children and

adolescents and young adults have been

met. The 1998 infant mortality rates of

7.2 per 1,000 live births was very close

to meeting the year 2000 target.

However, the rate for older adults who

had difficulty performing two or more

personal care activities (bathing, eating,

dressing, using the toilet, or getting

in/out of chair/bed) moved away from

the target during the Healthy People

2000 tracking period.

Healthy People 2000

Healthy People 2000: National

Health Promotion and Disease

Prevention Objectives presented the

Nation’s health improvement agenda for

the last decade of the 20th century (3).

Released in 1990, it articulated goals

and objectives aimed at significantly

improving the health of all Americans

by the year 2000.

In developing its own strategy to

improve the health of all Americans,

Healthy People 2000 drew on the

experiences and knowledge gained

during the earlier Healthy People

endeavors. The Healthy People 2000

process was guided by three broad

goals: (1) increase the span of healthy

life, (2) reduce health disparities, and

(3) achieve access to preventive

services. To help meet these overarching

goals, it identified more than 300

national objectives addressing a broad

array of health issues. Forty-seven of

these objectives that were representative

of the scope and magnitude of Healthy

People 2000 were identified as

‘‘sentinel’’ objectives (see Sentinel

Objectives section).

The Healthy People 2000

objectives, each assigned a specific

target, were organized into 22 priority

areas. The activities of each priority area

were coordinated by at least one agency

of the Public Health Service. Addressing

special population groups at high risk of

poor health, Healthy People 2000 set

specific targets to narrow the gap

between the total population and those

groups with higher than average rates of

death, disease, and disability. In

addition, it included priority areas such

as HIV infection and cancer that were

not included in the 1990 objectives.

Underscoring the vital role of

partnerships, Healthy People 2000 was

the product of a cooperative effort

among government agencies, businesses,

nonprofit organizations, and the

scientific community. It was developed

in collaboration with 22 work groups of

experts, agencies of the Federal

government, the National Academy of

Sciences’ Institute of Medicine, and a

consortium of over 375 members

representing national voluntary

organizations and all the State health

departments. Regional and national

meetings provided input from a broad

cross section of citizens, families, and

communities. Moreover, following

extensive public review of and comment

on a draft document, the Healthy People

2000 objectives were revised and

refined.

Midcourse Modifications

Throughout the 1990s, a series of

reports tracked the progress of the

Nation in achieving the Healthy People

2000 objectives. Halfway through the

decade, the national commitment to

disease prevention and health promotion

was reaffirmed during the midcourse

review process, which allowed for the

modification and addition of objectives.

The midcourse review was a 2-year

process, culminating in the publication

of the Healthy People 2000 Midcourse

Review and 1995 Revisions (5) in 1995.

During the midcourse review, work

groups of the Public Health Service met

to consider new data, new information,

and new science that had become

available since the release of Healthy

People 2000 in 1990 (3). As a result, 19

new objectives were added to the

original 300 unduplicated main

objectives, bringing the total number of

objectives to 319. Additional data that

showed increased health risk or disparity

between the total population and people

in age, sex, racial, or ethnic minority

groups resulted in the addition of 111

new special population subobjectives

(bringing the total number of

subobjectives to 319). Including the

Healthy People 2000 Final Review 1

midcourse changes, Healthy People

2000 contained a total of 638 objectives

and subobjectives; because some priority

areas share identical objectives, the

number of objectives and subobjectives

including duplicates is 805. No changes

were made to the three broad goals of

Healthy People 2000 or to the

organization of the 22 priority areas.

The midcourse review also included

58 target revisions (29 objectives and 29

subobjectives), in almost all cases to

make the target more challenging. Text

changes were made to 75 existing

objectives, in some cases considerably

modifying the objective. All midcourse

review modifications are detailed in

Healthy People Statistical Note No. 13

(6).

The midcourse modifications

established baselines for all Healthy

People 2000 objectives for which data

were available. Most of these baselines

are the same as those established in the

original Healthy People 2000 report (3);

others were changed to reflect revisions

to the original baselines or were newly

created.

Healthy People 2010

Healthy People 2010: Objectives for

Improving Health (4), released in

January 2000, carries the Healthy People

initiative into the next decade as well as

into a new millennium. As the third

generation of 10–year goals for the

Nation, it builds on initiatives pursued

over the past two decades. Central to

Healthy People 2010 are its two broad

goals, which challenge the Nation to (1)

increase quality and years of healthy life

and (2) eliminate health disparities.

Providing a framework to achieve

these goals, Healthy People 2010

identifies 467 specific health promotion

and disease prevention objectives in 28

focus areas. Like its predecessors,

Healthy People 2010 is the product of

an extensive cooperative national

process involving both the public and

private sectors, including the Healthy

People Consortium, which by the end of

the 20th century had grown to include

some 350 national organizations and

250 State public health, mental health,

substance abuse, and environmental

agencies.

To facilitate tracking progress

toward the second goal of Healthy

People 2010—eliminating health

disparities—objectives that utilize

population-based measures display the

baseline status of multiple population

groups. The minimum breakout set of

groups includes race and ethnicity,

gender, and measures of socioeconomic

status. However, many objectives

include additional population groups

such as age, geographic location, health

insurance status, disability status, sexual

orientation, or people with a specific

health status or condition. Of the 396

measures in Healthy People 2010 that

listed population groups, baseline data

were available for nearly three quarters

of the over 6,000 data items for the

minimum set of groups (4).

Leading Health Indicators

Setting itself apart from previous

Healthy People efforts, Healthy People

2010 introduces for the first time a set

of 10 Leading Health Indicators (LHIs).

Intended to serve as a gauge of the

Nation’s well-being, the LHIs reflect

major public health priorities in the

United States at the beginning of the

21st century. They were selected

because of their importance as public

health issues, their ability to motivate

action, and the availability of data to

measure their progress. The 10 LHIs are

physical activity, overweight and

obesity, tobacco use, substance abuse,

responsible sexual behavior, mental

health, injury and violence,

environmental quality, immunization,

and access to health care. Each LHI will

be monitored using one or more of the

467 specific objectives, thus serving as a

link to the entire Heathy People 2010

initiative.

Through the LHIs, and through the

467 objectives, Healthy People 2010

continues an impressive tradition of

improving the Nation’s health through a

comprehensive process of setting goals

and measuring results. For more

information on Healthy People 2010,

visit the Web site at

http://www.health.gov/healthypeople.

Summary of Progress

Healthy People 2000 identifies 319

unduplicated main objectives. Because

some priority areas share identical

objectives, certain objectives are

presented in more than one priority area,

which increases the total number of

objectives to 376 including the

duplicates. Subobjectives for racial and

ethnic minorities and other special

populations were established to address

increased health risks or disparities

compared with the total population.

There are 319 subobjectives; with

duplicates, there are 429 (5).

Movement of an objective either

toward or away from the target was

assessed by the direction of the change

between the baseline and the most

recent data point for the measure(s) used

to track the objective. In most cases,

only measures with baselines and targets

were used for assessment; supplemental

data (no baseline or target) were used if

Table A. Life stage objectives: United States, 1987–98

Objectives

Baseline

1987 1991 1992 1993 1994 1995 1996 1997 1998

2000

Target

Infant mortality (per 1,000 live births) .......... 10.1 8.9 8.5 8.4 8.0 7.6 7.3 7.2 7.2 7

Children 1–14 years (total deaths per 100,000) . . . 33.7 30.7 28.8 29.8 28.5 27.8 26.5 25.1 24.0 28

Adolescents and young adults 15–24 years (total

deaths per 100,000) ...................... 97.8 100.1 95.6 98.5 98.0 95.3 89.6 86.2 82.3 85

Adults 25–64 years (total deaths per 100,000) . . . 426.9 400.7 394.7 400.1 398.6 397.3 382.0 368.1 364.0 340

People 70 years and over (difficulty in performing

two or more personal care activities per 1,000) . .

141 --- --- --- ---

163 --- --- --- 90

- - - Data not available.

1984–85 data.

1994–95 data

SOURCES: National Vital Statistics System, CDC, NCHS.

For people 65 years and over: National Health Interview Survey, CDC, NCHS; National Nursing Home Survey, CDC, NCHS.

2 Healthy People 2000 Final Review

measures with baseline and targets were

not available. Some of the changes

observed were relatively small and may

be within what could be expected on the

basis of sampling or random variation.

For objectives with more than one

measure (compound objectives), if data

showed movement in different

directions, progress was labeled as

‘‘mixed.’’ For compound objectives with

data not available for all measures,

progress was determined by the

direction of the measure(s) with data.

For example, objective 12.3 is tracked

using three measures. However,

sufficient tracking data are only

available for two of the three measures:

Refrigeration of perishable foods and

washing cutting boards with soap.

Progress for this objective is assessed

using these two measures. All measures

of a compound objective had to be met

for an objective to be considered met;

for example, a compound objective with

three measures meeting the target and

one measure progressing toward the

target would be considered moving

toward the target (objective 1.10). A few

objectives were very broad in scope and

tracking data were not available; in

these cases, the subobjectives were used

to track progress (for example, objective

17.14).

The following summary of progress,

based on the 319 unduplicated main

objectives, presents the final status for

the Healthy People 2000 objectives. The

most recent data indicate that 68

objectives (21 percent) met the year

2000 targets and an additional 129

(41 percent) showed movement toward

the targets. Data for 35 objectives

(11 percent) showed mixed results and 7

(2 percent) showed no change from the

baseline. Only 47 objectives (15 percent)

showed movement away from the

targets. The status of 32 objectives

(10 percent) could not be assessed.

Among these unassessed objectives, 23

have baseline data but no additional data

with which to evaluate progress (several

objectives in this category have

supplemental data that cannot be used

for determination of progress), and 9

objectives lacked baselines (see Priority

Area 22). Figure A shows the progress

of the objectives by priority area.

Progress for each individual objective is

shown in the priority area summary

tables (tables 1–22).

A number of Healthy People 2000

targets were revised during the

midcourse review process, in almost all

cases to make the target more

challenging (see section on Midcourse

Modifications). As a result, eight

objectives and nine subobjectives that

did not meet the targets in the final

assessment would have met their targets

if the original targets had not been

revised during the midcourse review.

1234567891011

Healthy People 2000

Priority Areas

12 13 14 15 16 17 18 19 20 21 22

Number of objectives

Cannot assess

Moved away from target

No change

Mixed progress

Moved toward target

Met

Healthy People 2000 Final Review 3

Figure A. Healthy People 2000 objectives: Summary of progress by

priority area

Area Met

Moved

toward

target

Mixed

progress

change

Moved

away

from

target

Cannot

assess

1............ 1 6 0 1 4 1

2............ 6 13 2 0 6 0

3............ 7 10 5 1 1 2

4............ 3 7 4 0 2 4

5............ 0 8 3 0 0 1

6............ 5 1 1 0 7 1

7............ 7 4 0 0 5 3

8............ 5 2 2 1 1 3

9............ 7 11 2 2 2 2

10........... 7 7 1 1 4 0

11........... 4 9 2 0 1 1

12........... 2 5 0 0 1 0

13........... 1 12 1 1 2 0

14........... 1 8 2 1 3 2

15........... 3 12 0 0 2 0

16........... 7 8 2 0 0 0

17........... 2 6 3 0 11 1

18........... 5 5 1 0 3 3

19........... 4 7 2 0 1 3

20........... 3 7 5 0 2 2

21........... 1 2 2 0 1 2

22........... 2 4 1 0 0 0

Total ......... 83 154 41 8 59 31

Organization and Scope of this

Review

This Review is organized into three

major sections and presents the final

data collected for the 376 objectives that

comprise Healthy People 2000 (3).

While the data for these individual

objectives are the basis for this Review,

the additional analyses presented

provide further insight into the Nation’s

progress in health improvement over the

last decade.

The Introduction provides a brief

discussion of the history of the Healthy

People initiative, the current effort, and

the transition to the next decade in

Healthy People 2010 (4). There is also a

summary of progress for the past decade

and a description of the organization

and scope of this Review.

The first section presents

information that cuts across the 22

Healthy People 2000 priority areas. The

first part of this section summarizes

progress regarding the three broad goals

set in Healthy People 2000: Goal

1—Increase the span of healthy life,

Goal 2—Reduce health disparities, and

Goal 3—Achieve access to preventive

services. The second part of this section

presents data for three summary lists:

the Health Status Indicators (a set of

indicators of community health status

relevant to public health practice); the

Priority Data Needs (important

indicators for evaluating the health of a

population but not necessarily available

at all levels of government); and the

Sentinel Objectives (objectives

representative of the scope and

magnitude of the changes envisioned by

Healthy People 2000). Each of these

parts provide information through text,

charts, and tables describing progress

over the last decade by focusing on

particular issues that generally address

the 22 priority areas.

The second section consists of 22

chapters providing a progress report for

each of the Healthy People 2000

priority areas. Each chapter contains a

progress quotient chart, presenting a

summary of progress for each objective;

a discussion of the objectives that

addresses the area’s public health

significance, data highlights, progress

for the objectives, major results,

transition to Healthy People 2010, and

data issues; a summary data table; and

the full text of the objectives.

Technical notes and tables comprise

the Appendix, the third section. The

technical notes present and discuss data

and analysis issues involved in

monitoring the objectives and

subobjectives. The appendix provides

additional information that may be

useful in understanding and interpreting

the data. Additional sources of

information on Healthy People 2000 are

also presented.

This report is available on the

Internet at http://www.cdc.gov/nchs/.

References

1. Department of Health, Education, and Welfare.

Healthy People: The Surgeon General’s Report on

Health Promotion and Disease Prevention. Public

Health Service. U.S. Government Printing Office.

Washington. 1979.

2. Department of Health and Human Services.

Promoting health/preventing disease: Objectives

for the nation. Washington: Public Health Service.

1980.

3. Department of Health and Human Services.

Healthy people: National health promotion and

disease prevention objectives. Washington: Public

Health Service. 1991.

4. Department of Health and Human Services.

Healthy People 2010. 2d ed. With understanding

and improving health and objectives for improving

health. 2 vols. Washington: U.S. Government

Printing Office. 2000.

5. Department of Health and Human Services.

Healthy People 2000 midcourse review and 1995

revisions. Washington: Public Health Service.

1995.

6. Turczyn KM and Ryan CM. Healthy People

2000 midcourse revisions: A compendium. Healthy

people statistical notes; no 13. Hyattsville,

Maryland: National Center for Health Statistics.

1997.

4 Healthy People 2000 Final Review

Healthy People 2000 Goals

Healthy People 2000

Goals

The purpose of Healthy People

2000 was to commit the Nation to the

attainment of three broad goals. These

goals were to increase the span of

healthy life, to reduce health disparities

among Americans, and to achieve access

to preventive services for all Americans.

Attaining these broad goals would bring

the Nation’s health to its full potential.

Goal 1: Increase the Span of

Healthy Life

In the 20th century, the population

of the United States underwent a

continuous period of health

improvement that is unparalleled in

history. At the turn of the century, the

population was characterized by a

mostly low standard of living, poor

hygiene, poor nutrition, and a high

prevalence of communicable and acute

diseases typical of a population with

high mortality and high fertility. It

finished the century with a mostly high

standard of living, good hygiene, good

nutrition, and health-related habits

typical of populations with low

mortality and low fertility. In addition,

there was a low frequency of

communicable diseases and acute

conditions that were major causes of

most of the premature deaths in the

earlier part of the century. As a

consequence of the dramatic fall in

mortality, the average expectation of life

at birth for the total population

increased from 47.3 years in 1900 to

76.8 years in 1998 (1), an increase of

62 percent or 3.6 months per year for

each of the 98 years.

The same population and health

transitions that have jointly propelled

the average life expectancy by nearly 30

years, however, are also responsible for

ushering an era of new challenges. The

population is aging at an unprecedented

rate, resulting in an increased prevalence

of diseases that are noncommunicable

and not always fatal, but degenerative

and chronic. This adds a new dimension

to measuring the health of the

population. Expectation of life, which is

a traditional measure of longevity, has

now effectively become a ‘‘partial’’

measure of health for an aging

population that expects to live a long

life with degenerative diseases and

chronic conditions.

For an aging population fast

approaching the theoretical maximum

life span, the fundamental issues involve

not only longevity, but quality of life as

well. Quality of life (QOL) is a

subjective appraisal of life (2), relating

to the ‘‘goodness’’ of life as assessed by

external conditions (3). It is a

multidimensional concept that can, in

the broadest sense, include material

comfort, work, health, and active

recreation (4). The World Health

Organization’s concept of QOL on the

other hand, is based on the assessment

of the six broad domains that are related

to physical, psychological,

environmental, spiritual, level of

independence, and social relationship

(5). Some of these domains are directly

health related and others are not.

Healthy People 2000 is primarily

concerned with health-related QOL (6).

The formulation of the concept of

health-related QOL began in the 1970s

with a limited focus on domains of

physical function for measuring

activities such as activities of daily

living (5). Since then, the concept has

been expanded to include other domains,

such as general health perception,

limitations in usual roles, activity

restrictions, symptoms, and cognitive

psychological function (7).

The first goal of Healthy People

2000, to increase the span of healthy

life, is monitored using three statistics.

Life expectancy at birth (a measure of

longevity), the percent of people

reporting that their general health status

is fair or poor (a measure of

health-related QOL), and expected years

of healthy and unhealthy life (a

summary measure incorporating both

mortality and morbidity, known as years

of healthy life or YHL).

Life Expectancy at Birth

The expectation of life at birth is

the number of years a newborn would

expect to live if that person experienced

the mortality schedule existing at the

time of birth. This measure is one of the

most commonly used measures to

summarize mortality and study trends in

the span of human life. Figure B

presents the life expectancy at birth for

the U.S. population by sex and race for

the decade monitored by Healthy People

2000. Between 1988 and 1998 the

expectation of life increased from 74.9

to 76.7 years, an increase of nearly 2

years (2.4 percent). Life expectancy has

increased for all four population

subgroups shown. The biggest gain,

however, was for black males (3.2 years

or 5.0 percent), the population subgroup

with the lowest life expectancy.

Consequently, the difference between

the highest (white females) and lowest

(black males) life expectancy declined

over the decade from 10.5 years to 9.1

years, an indication that the disparity in

expectation of life among the subgroups

decreased in the 10-year period.

Fair or Poor Health

Between 1990 and 1996, the

percent of people reporting fair or poor

health increased from 9.9 to 10.4 percent

(figure C). Beginning in 1997, there was

a change in the methodology used to

measure this statistic in the National

Health Interview Survey so that data

collected in 1997 and subsequent years

are not directly comparable to those for

1996 and prior years. Between 1997 and

1998, the percent decreased slightly,

from 9.2 to 9.1 percent. Figure C also

displays the percent of people reporting

fair or poor health by socioeconomic

status (SES): poor (family income less

than poverty level), near poor (100 to

199 percent of poverty level), and

middle/high income (at least 200 percent

of poverty level). There is a clear

association between poor health and

poverty. In 1990, 22 percent of poor

people reported fair or poor health, three

times that reported by middle or high

income people (7 percent). In 1998, the

difference was slightly greater

(22 percent compared with 6 percent).

During the 1997–98 period, the trend in

the percent of people reporting fair or

poor health increased for the poor

population but decreased for the middle

or high-income population, widening the

disparity.

Healthy and Unhealthy Life

The broad purpose of the 319

Healthy People 2000 objectives was to

improve the health of the population.

Consequently, all objectives, at least

indirectly, involve increasing the span of

healthy life. However, one specific

objective (8.1, also duplicated as 17.1

and 21.1), targets a single measure of

the span of healthy life. The objective

measures health-related quality of life

using the summary measure of health

known as YHL. This measure estimates

the average number of years expected to

Healthy People 2000 Final Review 7

be lived in a healthy state for people of

a specified population. As a summary

measure of population health, this

measure incorporates mortality and

morbidity into a single statistic ( 8,9).

The mortality component utilizes total

mortality, while the morbidity

component is evaluated using two

measures: respondent-assessed health

and activity and functional limitations

due to chronic conditions. Individuals

are classified into 30 groups according

to both measures and these groups are

then assigned a quality-of-life score

(based on a mathematical model)

indicating the quality-of-life for that

group relative to a healthy state (10).

The YHL is calculated using a life table

approach that incorporates the

age-specific mortality with the

age-specific health related quality-

of-life score. The resulting ‘‘average

years of healthy life’’ is equivalent to

the average years a person would live if

he or she lived in a healthy state.

In 1990 the YHL was 64.0 years.

By 1998, this increased by 1.2 years to

65.2 years— a rise that was comparable

to the increase in expected years of life

(1.3 years between 1990 and 1998).

Consequently, average YHL as a percent

of total expected years of life was

largely unchanged. Figure D presents the

expected years of healthy life and

unhealthy life of the U.S. population by

race and ethnicity in 1998. The Hispanic

population has the greatest YHL.

However, Hispanics also have the

smallest proportion of life spent

equivalently in healthy states, that is

66.3 years of the total 82.1 expected life

years (81 percent). Blacks have the

smallest YHL and also a small

proportion of life spent in healthy states

(81 percent). Among whites, 86 percent

of the expected life years are

equivalently spent in healthy states.

Goal 2: Reducing Health

Disparities

The population of the United States

grew by 13 percent over the last decade,

and has increased in diversity at an even

greater rate (11). The aging of our

population is well documented and the

trend will continue for at least several

decades. Racial and ethnic minority

populations are among the fastest

growing of all communities in the

United States. Yet, these populations in

many respects, have poorer health and

remain chronically underserved by the

health care system. In many cases, the

health gaps initially identified in the

1985 Task Force Report on Black and

Minority Health (12) have grown.

Differences in accessibility, utilization,

quality of care, or benefits derived from

medical care are factors contributing to

inequality (13).

Healthy People 2000 included over

200 special population subobjectives to

address the overarching goal of reducing

health disparities in special populations

at higher risk than the total population

for death, disease, or disability (14).

Targets for these subobjectives were set

requiring a greater percent change with

the aim of reducing the gap between

these special populations and the total

population. A few subobjectives were

also included where, although the

special population was not at increased

risk, there was a disparate trend (for

example, 16.2b, lung cancer for

women). The populations highlighted in

Healthy People 2000 included American

Indian/Alaska Native, Asian or Pacific

Islander, black, Hispanic, women,

adolescents and young adults, older

adults, people with disabilities, and

people with low SES.

The Healthy People 2000

Midcourse Review and 1995 Revisions

resulted in the addition of many

subobjectives for these special

populations for a total of 49 objectives

or subobjectives for American

Indian/Alaska Native, 19 for Asian or

Pacific Islander, 97 for black, 84 for

Hispanic, 187 for women, 243 for

adolescents, 173 for older adults, 89 for

people with disabilities, and 65 for

people with low SES.

The objectives used for the

assessment of disparities include the

Healthy People 2000 subobjectives for

each of the nine special population

groups as well as other objectives

related to these groups. A list of the

objectives for each group can be found

in Appendix table VII. Some objectives

have measures for more than one group.

Progress toward the target can be

measured for all of these objectives;

however, not all the objectives can be

used to measure disparity. For groups

other than the racial/ethnic groups, a

1988 19901989 1991 1992 1993 1994 1995 1996 1997 1998

Years

White female

Black female

White male

Black male

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998

White female . 78.9 79.2 79.4 79.6 79.8 79.5 79.6 79.6 79.7 79.9 80.0

Black female. . 73.2 73.3 73.6 73.8 73.9 73.7 73.9 73.9 74.2 74.7 74.8

White male . . . 72.2 72.5 72.7 72.9 73.2 73.1 73.3 73.4 73.9 74.3 74.5

Black male . . . 64.4 64.3 64.5 64.6 65.0 64.6 64.9 65.2 66.1 67.2 67.6

SOURCE: CDC/NCHS, National Vital Statistics System.

8 Healthy People 2000 Final Review

Figure B. Life expectancy at birth: United States, 1988–98

relatively small proportion of the

objectives are applicable for assessment

of disparity. This is because, for these

groups, most objectives target the group

directly and do not also target a

reference population that could be used

to assess disparity status. Disparity was

assessed by comparing the percent

change between the baseline and last

data point for the special population

subobjective with the percent change

observed for the total population used to

track the objective. (See section on

Disparity Measurement in the

Appendix.)

The 1990s saw significant

improvements in the ability to track

progress for Healthy People 2000

objectives by special populations.

Leading into the decade, in 1989,

Hispanic origin was included for the

first time on standard birth and death

certificates recommended for use by all

States. By the end of the decade, the

number of States that publish vital

statistics data by race and ethnicity

increased from 19 to 27—surpassing the

Healthy People 2000 target. Despite

these improvements, data were still

missing at the end of the decade to

assess progress for 6 percent of the

objectives for American Indian/Alaska

Native, 5 percent for Asian or Pacific

Islander, 2 percent for black, 8 percent

for Hispanic, 10 percent for women,

26 percent for adolescents, 10 percent

for older adults, 7 percent for people

with disabilities, and 6 percent for

people with low SES.

At the conclusion of the decade,

more than one-half of the special

population subobjectives showed a

narrowing or elimination of disparities.

In addition, progress for special

populations was made in a number of

areas. However, only 16 percent of the

year 2000 targets for the special

population subobjectives were met

compared with 22 percent of all 318

unduplicated objectives and

subobjectives.

One of the two overarching goals

for Healthy People 2010, launched in

January 2000, extends this goal from

reducing disparities to actually

eliminating health disparities. As a

result, Healthy People 2010 has the

same target for all population groups,

including racial and ethnic groups. As

noted during the public comment period

for Healthy People 2010, ‘‘the ambitious

goal of eliminating health disparities

demands broader and more

interdisciplinary remedies than those

previously considered.’’

The following sections discuss

progress toward reducing disparities and

progress toward the year 2000 targets

for each of the nine special population

groups addressed by Healthy People

2000. A summary of progress is

graphically shown for each group along

with text discussion of some specific

examples. The specific examples are

shown for illustrative purposes only, and

do not infer priority or importance. A

complete assessment of progress toward

the target and progress toward reducing

disparity for the objectives in each of

the nine special population groups is

shown in Appendix table VII.

Reducing Disparities: American

Indian/Alaska Native

Figure E demonstrates progress

made in reducing disparities in the

health status of American Indians/Alaska

Natives. Twenty-four (55 percent) of the

forty-four American Indian/Alaska

Native subobjectives showed a reduction

or elimination of disparities in health

status between this population and the

total population. Of these 24 objectives,

20 met or moved toward their year 2000

targets.

Hepatitis A (20.3j) and bacterial

meningitis (20.7a) showed remarkable

improvement— surpassing year 2000

targets and narrowing the gap. Diabetes

prevalence for American Indians and

Alaska Natives, however, increased,

although the gap narrowed (17.11a)

because the prevalence for the total

population increased at an even greater

rate. Diabetes-related deaths (17.9b) and

end-stage renal disease rates (17.10b)

increased and the gaps widened.

1990 1991 1992 1993 1994 1995 1996 1997 1998

Below poverty level

100-199% of poverty level

200% or more of poverty level

Percent

1990 1991 1992 1993 1994 1995 1996 1997 1998

Below poverty

level ........ 22.1% 22.8% 23.8% 24.2% 23.7% 23.7% 23.8% 21.4% 22.2%

100–199% of

poverty level . . 14.5% 14.7% 15.0% 15.7% 15.0% 15.5% 15.2% 14.6% 15.6%

200% or more of

poverty level . . 6.8% 6.8% 7.0% 6.8% 6.9% 6.7% 6.6% 6.1% 5.7%

SOURCE: CDC/NCHS, National Health Interview Survey.

NOTE: The survey was redesigned in 1997. Data for 1997 and 1998 may not be directly

comparable with those for previous years.

Healthy People 2000 Final Review 9

Figure C. Percent of people with fair or poor health:

United States, 1990–98

Reducing Disparities: Asian or

Pacific Islander

Figure F represents the disparity

status of the subobjectives for Asians or

Pacific Islanders. Twelve of the sixteen

subobjectives for this group showed a

reduction or elimination of disparities,

and all 12 subobjectives either met or

moved toward their targets.

For example, the year 2000 target

was met and disparity decreased for flu

vaccinations among the elderly (21.2).

Cigarette smoking decreased for

Southeast Asian males at the beginning

of the decade and the disparity narrowed

(3.4g). The number of Hepatitis B cases

among Asian or Pacific Islander children

dramatically decreased (20.3d) although

disparity was not assessed for this

objective because the measure for the

subobjective was different from that for

the main objective. One objective, new

tuberculosis cases (20.4a), showed a

widening of disparity.

Reducing Disparities: Black or

African American

Figure G depicts the status of

subobjectives to reduce disparities

between black Americans and the total

population. Elimination or reduction of

disparities occurred for 55 (62 percent)

of the 89 subobjectives. Of these 55

subobjectives, 50 either met or moved

toward their targets.

Objectives for which targets were

met and disparities were reduced

included cancer deaths (2.2a),

firearm-related deaths (7.3a),

unintentional injuries (9.2a), clinical

breast examination and mammography

(16.11e), and syphilis (19.3a).

Unfortunately, diabetes prevalence

(17.11e), diabetes-related deaths (17.9a),

lower extremity amputations (17.10c),

maternal mortality (14.3a) and fetal

alcohol syndrome (14.4b) increased and

the disparity gaps widened.

Reducing Disparities: Hispanic or

Latino

Figure H shows the status of the 76

subobjectives for Hispanic persons.

Forty (52 percent) of these subobjectives

showed a reduction in disparity between

Hispanics and the total population. It is

interesting to note that 10 of these 40

subobjectives moved away from their

targets but at a slower rate than the

objectives for total population.

Objectives for which targets were

met and disparities were reduced

included infant mortality for Puerto

Ricans (14.1c), use of clinical breast

examination and mammography among

Hispanic women over 50 years of age

(16.11c), and rates of congenital syphilis

(19.4b). Adolescent pregnancy (5.1b)

and high school completion rates (8.2a),

however, remained essentially the same.

Reducing Disparities: Women

Figure J depicts progress made in

reducing health disparities for women in

the United States. Of the 19 objectives

for which disparities between women

and the total population can be assessed,

9 objectives showed a reduction or

elimination of health status inequity. Of

these nine objectives, six either met or

moved toward their targets.

Progress was made in smoking

prevalence (3.4) and homicide rates

among African American women (7.1e).

Unfortunately, although new cases of

AIDS decreased in recent years, the rate

of decrease for women (18.1d) was less

than that for the total population.

Reducing Disparities: Adolescents

and Young Adults

The pie chart depicted in figure K

reflects changes in disparities between

adolescents and young adults and the

total population. Disparities in seven

subobjectives decreased or were

eliminated, while five widened. All

seven of the subobjectives that reduced

or eliminated the disparity either met or

moved toward their targets.

Motor vehicle crash death rates for

people 15–24 years (9.3b) and

drownings for males 15–34 years

decreased substantially and the

disparities gaps narrowed. However,

there were increases in disparities for

rape or attempted rape (7.7a) and

adolescent gonorrhea (19.1b).

Expected years of life

* Hispanic origin can be of any race.

Healthy

Total White Black Hispanic*

Unhealthy

Total White Black Hispanic*

Healthy life expectancy ........ 65.2 66.1 57.8 66.3

Unhealthy life expectancy ...... 11.5 11.2 13.5 15.8

Total life expectancy .......... 76.7 77.3 71.3 82.1

*Data are preliminary. Hispanic includes people of any race with Hispanic origin.

SOURCE: CDC/NCHS, National Vital Statistics System and National Health Interview Survey.

10 Healthy People 2000 Final Review

Figure D. Expected years of healthy and unhealthy life:

United States, 1998

Reducing Disparities: Older Adults

Figure L depicts progress on

subobjectives used to measure disparity

between older adults and the total

population. Eleven of the nineteen

subobjectives measured showed a

reduction or elimination in disparity, and

all of these either met or moved toward

their targets.

There was nearly a 20–percent

reduction in the rate of white male

suicide in the elderly population (6.1c),

narrowing the gap with the total

population. This reduction is reflected in

the increase in years of healthy life for

adults 65 years and over (8.1c). There

were, however, increases in the

disparities for death rates due to falls

(9.4a,b) and motor vehicle crashes

(9.3c).

Reducing Disparities: People with

Disabilities

Figure M shows progress made on

the six subobjectives among people with

disabilities for which disparity could be

measured. The graph indicates that

disparities have been reduced or

eliminated for one-half of the

subobjectives for people with

disabilities. One of these subobjectives

moved away from its target, although at

a slower rate than the total population,

thus reducing the disparity.

Data indicate that progress is being

made in reducing the percent of

overweight persons in the disabled

population (1.2e). In addition, disparities

in sedentary lifestyle between the

disabled and the total population are

being reduced (1.5b).

Reducing Disparities: People with

Low Socioeconomic Status

The chart shown in figure N

demonstrates the disparity status of the

36 subobjectives used to measure

disparities between people with low

socioeconomic status (SES) and the total

population. While nearly one-third of

the subobjectives showed a widening or

no change in disparity, 21 (58 percent)

improved. But of these 21 subobjectives,

3 moved away from their targets,

indicating that the total population

moved away from its target at a faster

rate than those with low SES.

Encouraging improvements were

seen in the areas of breast feeding

(2.11a) and the use of contraception

(5.12b,c). Conversely, there were

increases in the percent of overweight

persons (1.2a) and certain oral health

issues (for example, prevalence of

gingivitis, 13.5a).

Goal 3: Achieving Access to

Preventive Services

Access to health services—

including preventive care, primary care,

and tertiary care—often depends on two

independent factors: having health

insurance and having a regular source of

health care (15–18). Uninsured people

are less than half as likely as people

with health insurance to have a primary

care provider; to have received

appropriate preventive care, such as

recent mammograms or Pap tests; or to

have had any recent medical visits. Lack

of insurance also affects access to care

Disparity:

Eliminated/Narrowing

54% (N=24)

Cannot assess

7% (N=3)

Disparity:

Widening/No change

39% (N=17)

Number of objectives = 44

NOTE: Disparity is assessed by comparing the change for the special population with the change for

the total population. Not all objectives for the special population are applicable to disparity assessment.

(See Disparity Assessment section in the Appendix.)

Disparity:

Eliminated/Narrowing

75% (N=12)

Cannot assess

19% (N=3)

Disparity:

Widening/No change

6% (N=1)

Number of objectives = 16

NOTE: Disparity is assessed by comparing the change for the special population with the change for

the total population. Not all objectives for the special population are applicable to disparity assessment.

(See Disparity Assessment section in the Appendix.)

Healthy People 2000 Final Review 11

Figure E. Assessment of disparity for American Indian/Alaska

Native objectives

Figure F. Assessment of disparity for Asian or Pacific Islander

objectives

for relatively serious medical conditions.

Evidence suggests that lack of insurance

over an extended period significantly

increases the risk of premature death

and that death rates among hospitalized

patients without health insurance are

significantly higher than those with

insurance (19). Another study showed

that, among those without insurance,

chronically ill persons are even less

likely than those with acute conditions

to get health care services they need

(20). Beyond having health insurance,

access depends on the actual benefits

offered by the insurance plan. Many

plans do not offer adequate benefits for

some services such as mental health, eye

care, oral health, assistive devices, and

drugs. Medicaid expansions that increase

the proportion of a State’s population

eligible for Medicaid lead to increases

in enrollment, enhanced utilization of

medical services, and lower child death

rates (21).

More than 40 million persons in the

United States do not have a particular

doctor’s office, clinic, health center, or

other place where they usually go to

seek health care or health-related advice.

Even among privately insured persons, a

significant number lacked a usual source

of care or reported difficulty in

accessing needed care due to financial

constraints or insurance problems (15).

Barriers to obtaining health care can be

financial, structural, or personal.

Financial barriers include not having

health insurance, not having enough

health insurance to cover needed

services, or not having the financial

capacity to cover services outside a

health plan or insurance program.

Structural barriers include the lack of

primary care providers, medical

specialists, or other allied health care

professionals (including personal

assistants and caregivers) to meet

special needs; the lack of health care

facilities or exam equipment; or the lack

of transportation. Personal barriers

include cultural or spiritual differences,

language barriers (including sign

language), not knowing what to do or

when to seek care, or mistrust or

concerns about confidentiality or

discrimination.

The 1990s experienced a steady

increase in the delivery of certain

effective clinical preventive services,

including child and adult immunizations,

screening for cancer and risk factors for

heart disease, and counseling of smokers

to quit smoking. For the remaining

individual services, a variety of barriers

may have prevented most services from

achieving the Healthy People 2000

targets for delivery to the general

population. For most services, the

lowest delivery rates were observed

among specific racial and ethnic groups

and people with low income or less

education.

Two factors are consistently

associated with a greater likelihood of

receiving recommended preventive care:

health insurance and a usual source of

health care. Costs of preventive care can

be an important barrier, especially for

persons who may not perceive the

benefits of health care when they are

not sick. The substantial increase in the

coverage of preventive services by

insurers and health plans over the past

decade has reduced the costs of

prevention to individuals with insurance,

although deductibles and co-payments

may still deter some patients. Having a

Disparity:

Eliminated/Narrowing

62% (N=55)

Cannot assess

2% (N=2)

Disparity:

Widening/No change

36% (N=32)

Number of objectives = 89

NOTE: Disparity is assessed by comparing the change for the special population with the change for

the total population. Not all objectives for the special population are applicable to disparity assessment.

(See Disparity Assessment section in the Appendix.)

Disparity:

Eliminated/Narrowing

53% (N=40)

Cannot assess

10% (N=8)

Disparity:

Widening/No change

37% (N=28)

Number of objectives = 76

NOTE: Disparity is assessed by comparing the change for the special population with the change for

the total population. Not all objectives for the special population are applicable to disparity assessment.

(See Disparity Assessment section in the Appendix.)

12 Healthy People 2000 Final Review

Figure G. Assessment of disparity for black or African American

objectives

Figure H. Assessment of disparity for Hispanic or Latino

objectives

usual source of care, however, may be

as important as having health insurance.

Continuity of care makes it more likely

that persons in need of specific

preventive services will be identified,

that clinician recommendations will be

followed, and that patients will return

for services that need to be delivered

periodically.

Access to care, as measured by

having a usual source of health care

(21.3), increased from 78 percent in

1992 to 85 percent by 1998 for the

general population, although Hispanics,

American Indians/Alaska Natives, and

people below the poverty level lagged

behind (72–77 percent). First trimester

prenatal care also increased gradually,

but much more dramatic gains were

seen in the delivery of child

immunizations, where the proportion of

children who are fully immunized

climbed from 55 to 80 percent

(figure O).

Little progress, however, was

evident in reducing the number of

persons under 65 years without health

insurance (21.4)(figure P). The

population over 65 years in the United

States is assumed to be covered by

Medicare. Although rates of uninsured

people declined slightly from the middle

of the decade, they were higher for the

general population in 1998

(16.6 percent) than in 1989

(15.7 percent). Due to Medicaid

coverage of poor families and the State

Children’s Health Insurance Program

(SCHIP), children were less likely to be

uninsured than adults. Despite the

successes of these programs a

substantial proportion (12.7 percent)

continue to lack health insurance

coverage. Lack of health insurance is

most common in young adults, who are

less likely to have employer-based

insurance and more likely to decline

voluntary coverage.

References

1. National Center for Health Statistics. Health,

United States, 2000 With adolescent health

chartbook. Hyattsville, Maryland. 2000.

2. Kaplan RM, Andersen JP. The general health

policy model: An integral approach. In Spikler B

(ed). Quality of life assessments in clinical trials.

New York: Raven Press, Ltd. 1990.

3. Zautra A, Goodhart D. Quality of life

indicators: A review of the literature. Community

Ment Health Rev 4(1). 1979.

4. Freed MM. Quality of life: The physician’s

dilemma. Arch of Phys Med and Rehab

65:109–11.1984.

5. Murray CJL, Lopez AD. The global burden of

disease. World Health Organization: Harvard

University Press. 1996.

6. Torrance G. Utility approach to measuring

health-related quality of life. J Clin Dis

6:593–603. 1987.

7. Patrick DL, Erickson P. Health status and health

policy: Quality of life in health care evaluation

and resource allocation. New York: Oxford

University Press. 1993.

8. Fryback DG. Methodological issues in

measuring health status and health-related quality

of life for population health measures: A brief

overview of the ‘‘HALY’’ family of measures.

Washington: National Academy Press. 1998.

9. Institute of Medicine. Summarizing population

health: Directions for the development and

application of population metrics. Washington:

National Academy Press. 1998.

10. Erickson P, Wilson R, Shannon I. Years of

healthy life. Healthy people statistical notes; no 7.

Disparity:

Eliminated/Narrowing

47% (N=9)

Cannot assess

11% (N=2)

Disparity:

Widening/No change

42% (N=8)

Number of objectives = 19

NOTE: Disparity is assessed by comparing the change for the special population with the change for

the total population. Not all objectives for the special population are applicable to disparity assessment.

(See Disparity Assessment section in the Appendix.)

Disparity:

Eliminated/Narrowing

44% (N=7)

Cannot assess

25% (N=4)

Disparity:

Widening/No change

31% (N=5)

Number of objectives = 16

NOTE: Disparity is assessed by comparing the change for the special population with the change for

the total population. Not all objectives for the special population are applicable to disparity assessment.

(See Disparity Assessment section in the Appendix.)

Healthy People 2000 Final Review 13

Figure J. Assessment of disparity for women objectives

Figure K. Assessment of disparity for adolescents and young

adults objectives

Hyattsville, Maryland: National Center for Health

Statistics. 1995.

11. Census Bureau. Resident population of the 50

States, the District of Columbia, and Puerto Rico:

April 1, 2000 (Census 2000) and April 1, 1990

(1990 Census) and State Rank as of 2000 and

State Rank as of 1990.

http://www.census.gov/population/www/cen2000/

respop.html. 2001.

12. Department of Health and Human Services.

Report of the Secretary’s Task Force on Black and

Minority Health. Public Health Service. 1985.

13. National Center for Health Statistics. Health,

United States, 1998 with socioeconomic status and

health chartbook. Hyattsville, Maryland. 1998.

14. Department of Health and Human Services.

Healthy people 2000: National health promotion

and disease prevention objectives. Washington:

Public Health Service. 1991.

15. Department of Health and Human Services.

Healthy people 2010. 2d ed. With understanding

and improving health and objectives for improving

health. 2 vols. Washington: U.S. Government

Printing Office. November 2000.

16. CDC. Health insurance coverage and receipt of

preventive health services—United States, 1993.

MMWR 44:219–25. 1995.

17. Weissman JS, Epstein AM. The insurance gap:

Does it make a difference? Annual Review of

Public Health 14:243–70. 1993.

18. General Accounting Office. Health insurance:

Coverage leads to increased health care access for

children. GAO/HEHS–98–14. Washington:

General Accounting Office. 1998.

19. Reinhardt UE. Coverage and access in health

care reform. New Engl J of Med 330:1452–3.

1994.

20. Hafner-Eaton C. Physician utilization

disparities between the uninsured and insured:

Comparisons of the chronically ill, acutely ill, and

well nonelderly populations. JAMA 269:787–92.

1993.

21. Currie J, Gruber J. Health insurance eligibility,

utilization of medical care, and child health.

Quarterly J of Econ 111(2):431–66. 1996.

Disparity:

Eliminated/Narrowing

63% (N=11)

Cannot assess

5% (N=1)

Disparity:

Widening/No change

32% (N=7)

Number of objectives = 19

NOTE: Disparity is assessed by comparing the change for the special population with the change for

the total population. Not all objectives for the special population are applicable to disparity assessment.

(See Disparity Assessment section in the Appendix.)

Disparity:

Eliminated/Narrowing

50% (N=3)

Cannot assess

0% (N=0)

Disparity:

Widening/No change

50% (N=3)

Number of objectives = 6

NOTE: Disparity is assessed by comparing the change for the special population with the change for

the total population. Not all objectives for the special population are applicable to disparity assessment.

(See Disparity Assessment section in the Appendix.)

14 Healthy People 2000 Final Review

Figure L. Assessment of disparity for older adults objectives

Figure M. Assessment of disparity for people with disabilities

objectives

Disparity:

Eliminated/Narrowing

58% (N=21)

Cannot assess

11% (N=4)

Disparity:

Widening/No change

31% (N=11)

Number of objectives = 36

NOTE: Disparity is assessed by comparing the change for the special population with the change for

the total population. Not all objectives for the special population are applicable to disparity assessment.

(See Disparity Assessment section in the Appendix.)

1988 19901989 1991 1992 1993

Usual source of care

Year 2000 target

First trimester prenatal care

Childhood immunization

1994 1996 1997 19981995 1999

100

Percent

Healthy People 2000 Final Review 15

Figure N. Assessment of disparity for people with low

socioeconomic status objectives

Figure O. Access to care: United States, 1988–99

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Year

2000

target

First trimester prenatal

care ................. 75.9% 75.5% 75.8% 76.2% 77.7% 78.9% 80.2% 81.3% 81.9% 82.55% 82.8% 83.2% 90%

Childhood immunizations . . - - - - - - - - - - - - 55% 67% 68% 76% 78% 78% 81% 80% 90%

Usual source of care...... --- --- 80% --- 78% 83% 84% 85% 85% 84% 85% --- 90%

- - - Data not available.

Notes: Data for immunizations are for children 19–35 months receiving the 4 DTP:3 MMR:1 Polio series; data for usual source of care are for

people 18 years and over. 1999 data for early prenatal care are preliminary.

SOURCES: CDC/NCHS, National Vital Statistics System; CDC/NCHS, National Health Interview Survey; CDC/NCHS, CDC/NI, National

Immunization Survey.

Percent

All ages Under 18 18-24

Years

25-34 35-44 45-64

Year 2000 target = 0%

All ages

Under

18 years

18–24

years

25–34

years

35–44

years

45–64

years

People without health

insurance ............. 16.6% 12.7% 29.0% 22.2% 16.4% 12.2%

SOURCE: CDC/NCHS, National Health Interview Survey.

16 Healthy People 2000 Final Review

Figure P. Percent of people under 65 years without health

insurance coverage: United States, 1998

Health Status Indicators and Priority Data Needs

Health Status

Indicators and

Priority Data Needs

Health Status Indicators

Healthy People 2000 objective 22.1

called for the development of a set of

Health Status Indicators (HSIs)

appropriate for use by Federal, State,

and local health agencies (1). The

purpose of the HSIs was to make it

possible to compare health status

measures among national, State, and

local levels. Under the auspices of the

Centers for Disease Control and

Prevention, a group of public health

professionals, known as Committee

22.1, was convened, and through a

rigorous consensus process, a list of 18

Health Status Indicators was developed

(2). The HSI definitions are discussed in

detail in Healthy People Statistical

Notes, number 3, ‘‘Health Status

Indicators: Definitions and National

Data’’ (3).

Most of the HSIs are comparable to

specific Healthy People 2000 objectives.

However, several HSIs were defined

differently from corresponding

objectives in Healthy People 2000.

The International Classification of

Diseases, Ninth Revision (ICD–9) codes

used for the mortality indicators come

from established NCHS cause-of-death

lists. For three of the HSIs these codes

are different from ICD–9 codes used for

similar Healthy People 2000 objectives.

The HSI for homicide includes deaths

due to legal intervention (ICD–9:

E970–E978) while objective 7.1 is

based only on ICD–9 codes E960–E969.

The HSI for lung cancer deaths includes

cancer of the trachea (ICD–9: 162.0),

which is excluded from duplicate

objectives 3.2 and 16.2. The HSI for

heart disease deaths is based on ICD–9

codes 390–398, 402, and 404–429,

while duplicate objectives 1.1, 3.1, and

15.1 focus specifically on coronary heart

disease deaths (ICD–9: 402, 410–414,

and 429.2). With the exception of heart

disease, the differences in the death

rates between the HSIs and the

corresponding Healthy People 2000

objectives are relatively small.

The data source for the HSI and for

objective 10.1 for work-related injury

deaths is the Census of Fatal

Occupational Injuries, Bureau of Labor

Statistics, Department of Labor.

However, the HSI rate is for the total

population 16 years of age and over and

the denominator is obtained from the

Bureau of the Census. For objective

10.1, the rate is for full-time workers 16

years of age and over and the

denominator is provided by the Bureau

of Labor Statistics.

All of the HSIs were defined so that

the higher rate would indicate poorer

health status, contrary to several

corresponding Healthy People 2000

objectives. Prenatal care is measured by

the percent of mothers delivering live

infants who did not receive care during

the first trimester of pregnancy; air

quality is measured by the percent of

people living in counties exceeding U.S.

Environmental Protection Agency (EPA)

standards for air quality during the

previous year.

Three HSIs (total deaths, births to

adolescents, and childhood poverty)

have no corresponding Healthy People

2000 objective. Recent trend data and

data by race and Hispanic origin for the

18 HSIs are shown in tables B and C.

Two reports have been published in

the Statistical Notes series discussing

the national data for the Health Status

Indicators by race and Hispanic origin

(4) and an assessment of the HSIs for

each State (5).

Priority Data Needs

As part of their mandate to identify

a set of indicators of community health

status that would be relevant to public

health practice, Committee 22.1 also

produced a list of 16 Priority Data

Needs (PDNs) (5), for which State-level

data were not available at the time.

These measures included indicators of

processes affecting health, as well as

additional indicators of risk factors and

health outcomes. Most of the PDNs

generally correspond to objectives in

Healthy People 2000. However, because

of differences in the data systems used

at the national and State levels, there are

some differences in definition between

some of the PDNs and the

corresponding Healthy People 2000

objectives (6). These difference are

noted in table D. There were no specific

objectives for several PDN measures

(health care coverage for the population

under 18 years of age, regular source of

primary and dental care for children and

adolescents, and blood lead testing in

children under 5 years of age.)

National-level data for the

corresponding Healthy People 2000

objectives are also presented in table D.

As recommended by Committee

22.1, existing data collection systems

have been modified to address the

priority data needs, and State-level data

are now available for thirteen PDNs

from the data sources shown in table D.

There are still no sources of State-level

data on several PDNs (regular source of

primary care and dental services for

children and adolescents, overweight in

adolescents, blood lead levels in

children, incidence of Hepatitis B, and

prevalence of dental decay in children

and adolescents). These measures

remain on a list of data needs.

In the course of developing the

Healthy People 2010 objectives, a set of

Leading Health Indicators (LHIs) was

identified (see Introduction). The LHIs

focus on individual behaviors, physical

and social environmental factors, and

health system measures that are viewed

as determinants of health. Four of the

HSIs (motor vehicle crash deaths,

homicide, prenatal care, and air quality)

and seven of the PDNs (immunization

for children and elderly, health care

coverage, regular source of care,

smoking, alcohol misuse, and

overweight), for which both national and

State-level data are available, have been

incorporated in the LHIs.

References

1. U.S. Department of Health and Human

Services. Healthy people 2000: National health

promotion and disease prevention objectives.

Washington: Public Health Service. 1991.

2. Freedman, MA. Health Status Indicators for the

year 2000. Healthy people statistical notes; no 1.

Hyattsville, Maryland: National Center for Health

Statistics. 1991.

3. Klein, RJ, Hawk, SA. Health Status Indicators:

Definitions and national data. Healthy people

statistical notes; no 3. Hyattsville, Maryland:

National Center for Health Statistics. 1992.

4. Plepys C, Klein R. Health Status Indicators:

Differentials by race and Hispanic origin. Healthy

people statistical notes; no 10. Hyattsville,

Maryland: National Center for Health Statistics.

1995.

5. Keppel KG, Pearcy JN. Healthy people 2000:

An assessment based on the Health Status

Indicators for the United States and each State.

Healthy people statistical notes; no 19. Hyattsville,

Maryland: National Center for Health Statistics.

2000.

6. Kim I, Keppel KG. Priority Data Needs:

Sources of national, State, and local-level data and

data collection systems. Healthy people statistical

notes; no 15. Hyattsville, Maryland: National

Center for Health Statistics. 1997.

Healthy People 2000 Final Review 19

Table B. Health Status Indicators: United States, 1996–98

Health status indicators 1996 1997 1998

1 Race/ethnicity-specific infant mortality as measured by the rate (per 1,000 live births) of deaths among infants

under 1 year of age ................................................................... 7.3 7.2 7.2

White ............................................................................. 6.1 6.0 6.0

Black.............................................................................. 14.7 14.2 14.3

American Indian/Alaska Native

.......................................................... 10.0 8.7 9.3

Chinese

........................................................................... 3.2 3.1 4.0

Japanese

.......................................................................... *4.2 *5.3 *3.5

Filipino

............................................................................ 5.8 5.8 6.2

Hawaiian and part-Hawaiian

............................................................ * * *

Other Asian or Pacific Islander

.......................................................... 5.7 5.0 5.7

Hispanic origin

1,2

..................................................................... 6.1 6.0 5.8

2 Total deaths per 100,000 population (ICD–9 nos. 0–E999)

....................................... 491.6 479.1 471.7

3 Motor vehicle crash deaths per 100,000 population (ICD–9 nos. E810–E825)

........................ 16.2 15.9 15.6

4 Work-related injury deaths per 100,000 population

............................................. 3.1 3.0 2.9

5 Suicides per 100,000 population (ICD–9 nos. E950–E959)

...................................... 10.8 10.6 10.4

6 Homicides per 100,000 population (ICD–9 nos. E960–E978)

..................................... 8.5 8.0 7.3

7 Lung cancer deaths per 100,000 population (ICD–9 no. 162)

..................................... 37.9 37.4 37.0

8 Female breast cancer deaths per 100,000 females (ICD–9 no. 174)

............................... 20.2 19.4 18.8

9 Cardiovascular disease deaths per 100,000 population (ICD–9 nos. 390–448)

........................ 170.7 166.1 161.2

Heart disease deaths per 100,000 population (ICD–9 nos. 390–398, 402, 404–429)

................... 134.5 130.5 126.6

Stroke deaths per 100,000 population (ICD–9 nos. 430–438)

..................................... 26.4 25.9 25.1

10 Reported incidence (per 100,000 population) of acquired immunodeficiency syndrome

5,6

................ 27.8 23.1 19.5

11 Reported incidence (per 100,000 population) of measles......................................... 0.2 0.05 0.04

12 Reported incidence (per 100,000 population) of tuberculosis ...................................... 8.0 7.4 6.8

13 Reported incidence (per 100,000 population) of primary and secondary syphilis ....................... 4.3 3.2 2.6

14 Prevalence of low birth weight as measured by the percentage of live born infants weighing under 2,500

grams at birth ........................................................................ 7.4 7.5 7.6

15 Births to adolescents (10–17 years) as a percentage of total live births .............................. 5.1 4.9 4.6

16 Prenatal care as measured by the percentage of mothers delivering live infants who did not receive care

during the first trimester of pregnancy ...................................................... 18.1 17.5 17.2

17 Childhood poverty, as measured by the proportion of children under 15 years of age living in families at or

below the poverty level

Under 18 years ...................................................................... 20.5 19.9 18.9

Under 15 years ...................................................................... 21.1 20.5 19.5

5–17 years

......................................................................... 18.9 18.8 17.8

18 Proportion of persons living in counties exceeding U.S. Environmental Protection Agency standards for air

quality during the previous year

.......................................................... 18.7 21.1 23.5

*Infant mortality rates for groups with fewer than 10,000 births are considered unreliable. Infant mortality rates for groups with less than 7,500

births are considered highly unreliable and are not shown.

Rates based on a period-linked birth and infant death file using weighted data. See text for Priority Area 14.

Hispanic origin can be of any race.

Age adjusted to the 1940 U.S. standard population.

Data are for people 16 years and over.

By date of diagnosis. Adjusted for delays in reporting; not adjusted for underreporting.

Beginning with 1996, data are for people 13 years and over and methodology is changed. See text for Priority Area 18.

Related children in families.

Data based on 1990 county population estimates.

Health status indicators

Number Data source

1–3,5–9,14–16 National Vital Statistics System, CDC, NCHS.

4 Census of Fatal Occupational Injuries, DOL, BLS.

10 HIV/AIDS Surveillance System, CDC, NCHSTP.

11 National Notifiable Disease Surveillance System, CDC, EPO.

12 Tuberculosis Morbidity Data, CDC, NCHSTP.

13 Sexually Transmitted Disease Surveillance System, CDC, NCHSTP.

17 Current Population Survey, U.S. Bureau of the Census.

18 National Air Quality and Emission Trends Report, EPA, OAR.

20 Healthy People 2000 Final Review

Table C. Health Status Indicators by race and Hispanic origin: United States, 1998

Health status indictors

Race

Total White Black

American

Indian or

Alaska

Native

Asian or

Pacific

Islander

Hispanic

origin

1 Race/ethnicity-specific infant mortality as measured by the rate (per

1,000 live births) of deaths among infants under 1 year of age .... 7.2 6.0 14.3

9.3

5.5

5.8

2 Total deaths per 100,000 population (ICD–9 nos. 0–E999)

....... 471.7 450.3 690.9 458.1 264.6 342.8

3 Motor vehicle crash deaths per 100,000 population (ICD–9 nos.

E810–E825)

........................................ 15.7 15.7 16.6 31.8 8.6 14.9

4 Work-related injury deaths per 100,000 population

............. 2.9 2.9 2.4 1.7 1.9 3.4

5 Suicides per 100,000 population (ICD–9 nos. E950–E959)

...... 10.4 11.2 5.9 13.4 5.9 6.0

6 Homicides per 100,000 population (ICD–9 nos. E960–E978)

..... 7.3 4.3 25.2 9.9 3.7 9.9

7 Lung cancer deaths per 100,000 population (ICD–9 no. 162)

..... 37.0 36.8 44.6 25.1 17.2 13.6

8 Female breast cancer deaths per 100,000 females. (ICD–9 no.

174)

.............................................. 18.8 18.3 25.3 10.3 9.9 12.1

9 Cardiovascular disease deaths per 100,000 population (ICD–9

nos. 390–448)

....................................... 161.2 154.1 240.2 123.8 95.6 109.3

Heart disease deaths per 100,000 population (ICD–9 nos.

390–398, 402, 404–429)

............................... 126.7 122.0 183.3 97.1 67.5 84.2

Stroke deaths per 100,000 population (ICD–9 nos. 430–438)

..... 25.1 23.3 41.4 19.6 22.7 19.0

10 Reported incidence (per 100,000 population) of acquired

immunodeficiency syndrome

............................ 19.5

8.5

82.9 9.4 4.3 33.0

11 Reported incidence (per 100,000 population) of measles......... 0.04 - - - - - - - - - - - - - - -

12 Reported incidence (per 100,000 population) of tuberculosis ...... 6.8

2.3

17.8 12.6 36.6 13.6

13 Reported incidence (per 100,000 population) of primary and

secondary syphilis..................................... 2.6

0.5

17.1 2.8 0.4 1.5

14 Prevalence of low birth weight as measured by the percentage of

live born infants weighing under 2,500 grams at birth .......... 7.6 6.5 13.0 6.8 7.4 6.4

15 Births to adolescents (10–17 years) as a percentage of total live

births .............................................. 4.6 3.5 7.6 8.4 2.0 6.9

16 Prenatal care as measured by the percentage of mothers

delivering live infants who did not receive care during the first

trimester of pregnancy ................................. 17.2 15.2 26.7 31.2 16.9 25.7

17 Childhood poverty, as measured by the proportion of children

under 15 years of age living in families at or below the poverty

level

Under 18 years ...................................... 18.9 15.1 36.7 - - - - - - 34.4

Under 15 years ...................................... 19.5 15.5 38.4 - - - - - - 34.7

5–17 years

......................................... 17.8 - - - - - - - - - - - - - - -

18 Proportion of persons living in counties exceeding U.S.

Environmental Protection Agency standards for air quality during

the previous year

..................................... 23.5 22.6 24.9 18.9 44.9 43.8

- - - Data not available.

Hispanic origin can be of any race.

Rates based on a period linked birth and infant death file using weighted data. See text for Priority Area 14.

Age adjusted to the 1940 standard population.

Data are for people 16 years and over.

Beginning with 1996, data are for people 13 years and over and methodology is changed. See text for Priority Area 18.

Data are for the non-Hispanic population.

Related children in families.

Data based on 1990 county population estimates.

Health status indicators

Number Data source

1–3,5-9,14–16 National Vital Statistics System, CDC, NCHS.

4 Census of Fatal Occupational Injuries, DOL, BLS.

10 HIV/AIDS Surveillance System, CDC, NCHSTP.

11 National Notifiable Disease Surveillance System, CDC, EPO.

12 Tuberculosis Morbidity Data, CDC, NCHSTP.

13 Sexually Transmitted Disease Surveillance System, CDC, NCHSTP.

17 Current Population Survey, U.S. Bureau of the Census.

18 National Air Quality and Emission Trends Report, EPA, OAR.

Healthy People 2000 Final Review 21

Table D. Priority Data Needs

Priority Data Need

Objective

number

Duplicate

objective

number

1998

national

data

National

data

source

State data

source

Indicators of Processes:

1 Children 19–35 months of age who have been immunized

with 4-3-1 series ................................. 20.11

80% NIS NIS

2 Adults 65 years and over who have been immunized for

a. Pneumonia ................................. 20.11 46% NHIS BRFSS

b. Influenza................................... 20.11 63% NHIS BRFSS

3 Assessed rivers, lakes, and estuaries that support

a. Consumable fish

Rivers .................................... 11.10 88% NWQI NWQI

Lakes .................................... 11.10 59% NWQI NWQI

Estuaries.................................. 11.10 65% NWQI NWQI

b. Recreational activities

Rivers .................................... 11.10 72% NWQI NWQI

Lakes .................................... 11.10 80% NWQI NWQI

Estuaries.................................. 11.10 91% NWQI NWQI

4 Women 18 years and over receiving a Pap test in preceding

3 years ........................................ 16.12 79% NHIS BRFSS

5 Women 50 years and over receiving a mammogram in

preceding 2 years ................................

16.11

64% NHIS BRFSS

6 Population without health care coverage

a. Under 18 years .............................. ---

NHIS CPS

b. 18–64 years ................................ 21.4

16.6% NHIS BRFSS

7 Population with a regular source of

a. Primary care

5–17 years ................................ ---

NHIS - - -

18 years and over ........................... 21.3 85% NHIS BRFSS

b. Dental services (dental visit in past year)

5–17 years ................................ ---

MEPS - - -

18 years and over ........................... 13.14

65% NHIS BRFSS

Indicators of Risk Factors:

8 Cigarette smoking

a. Grades 9–12 ................................ 4.6 3.20

18.2% NHSDA YRBS

b. 18 years and over............................ 3.4 15.12, 16.6 24% NHIS BRFSS

9 Alcohol misuse

a. Grades 9–12 ................................ 4.7

1,7

30.8% MTF YRBS

b. 18 years and over............................ 4.7

1,8

40.0% MTF BRFSS

10 Overweight

a. 12–17 years ................................ 2.3 1.2, 15.10, 17.12

9,10

24% NHANES - - -

b. 18 years and over............................ 2.3 1.2, 15.10, 17.12

10,11

35% NHANES BRFSS

11 Hypertension awareness (18 years and over)............ 15.13

85% NHIS BRFSS

12 Hypercholesterolemia awareness (18 years and over) ..... 15.14

67% NHIS BRFSS

13 Confirmed abuse and neglect of children (per 1,000

children) ...................................... 7.4

41.9 NCANDS NCANDS

Indicators of Health Status Outcomes:

14 Children under 5 years of age who have been

a. Tested for blood lead levels..................... --- --- ---

b. Tested and have blood lead levels greater than

15 µg/dL .................................. 11.4

10,15

393,000 NHANES - - -

15 Incidence of hepatitis B (per 100,000 population) ......... 20.3

16.9 NNDSS NNDSS

16 Children with one or more decayed primary or permanent

teeth

a. 6–8 years .................................. 13.1

52% NHANES - - -

b. 15 years ................................... 13.1

61% NHANES - - -

- - - Not available.

1999 data.

Data are for clinical breast examination and mammogram.

Data are not shown. Not a Healthy People 2000 objective.

Preliminary data for persons under 65 years.

Data are for persons 35 years and over.

22 Healthy People 2000 Final Review

Data are for persons 12–17 years.

Data are for high school seniors.

Data are for college students.

Data are for persons 12–19 years.

1988–1994 data.

Data are for persons 20 years and over.

Data are for people who can state their blood pressure is high.

Data are for people who had their blood cholesterol checked in past 5 years.

1993 data.

Data are for persons 1–5 years of age.

Data source acronyms:

BRFSS Behavioral Risk Factor Surveillance System, CDC, NCCDPHP.

CPS Current Population Survey, U.S. Bureau of the Census.

MEPS Medical Expenditure Panel Survey, AHRQ.

MTF Monitoring the Future, NIH, NIDA

NHANES National Health and Nutrition Examination Survey, CDC, NCHS

NHIS National Health Interview Survey, CDC, NCHS

NHSDA National Household Survey on Drug Abuse, SAMHSA, OAS

NCANDS National Incidence of Child Abuse and Neglect Survey, Administration for Children and Families, NCCAN.

NIS National Immunization Survey, CDC, NIP and NCHS

NNDSS National Notifiable Disease Surveillance System, CDC, EPO

NWQI National Water Quality Inventory, EPA, Office of Water

YRBSS Youth Risk Behavior Surveillance System, CDC, NCCDPHP.

Healthy People 2000 Final Review 23

Sentinel Objectives

In the original Healthy People 2000

publication, objectives that were

representative of the scope and

magnitude of the improvements

envisioned in Healthy People 2000 were

identified as ‘‘sentinel objectives’’ (1).

Forty-seven objectives were selected

from the four categories of priority

areas—Health Promotion, Health

Protection, Preventive Services, and

Surveillance and Data Systems—and at

least one objective from each of the 22

priority areas was included. Sixteen

objectives were selected from the eight

Health Promotion Priority Areas, 10

objectives were selected from the 5

Health Protection Priority Areas, and 20

objectives were selected from the 8

Preventive Services Priority Areas. One

objective from the Surveillance and

Data Systems Priority Area, a

cross-cutting priority area that supports

each of the others, was also selected.

The sentinel objectives are listed in

table E.

A summary assessment of progress

toward achieving the objectives of

Healthy People 2000 based on the

sentinel objectives was published in

1995 (2). A similar summary based on

recent data is included here. Because the

success of Healthy People depends on

the combined efforts of governmental

agencies, professional associations, and

private and voluntary organizations

acting at the local level, this summary

includes data at the State level for those

objectives where sources of State data

are available.

National Data

A summary of target attainment

status for each of the sentinel objectives

in the United States is shown in table E.

For each objective, a progress quotient

of the targeted change achieved is

shown along with a color code

indicating the current status of progress

toward meeting the year 2000 target.

Calculation of the progress quotient is

described in the Measuring Progress

Toward the Healthy People 2000 Targets

section in the Appendix. One hundred

percent indicates that the target has been

met. Negative percentages indicate that

the change from the baseline to the most

recent value is moving away from the

year 2000 target. Dark green indicates

that the target has been met for 2 years

in a row or in two successive surveys.

Light green indicates that the target was

met in the most recent year or survey

cycle but not in the previous year or

survey cycle. Rose indicates that the

most recent value is between the

baseline and the target and, therefore,

progress has been made although the

target has not been met. Burgundy

indicates that the most recent value is

outside the baseline value, that is, the

most recent data are higher than the

baseline for objectives that targeted

reduction or lower than the baseline for

objectives that targeted an increase. In

these cases, the change from baseline to

most recent data is moving away from

the target.

Health Promotion Priority Areas

There are 19 measures associated

with the 16 sentinel objectives in the

Health Promotion Priority Areas

(table E). Data on the baselines and

most recent values for these objectives

are shown in the detailed tables for the

individual priority areas in the Healthy

People Priority Areas section of this

Review. Targets were met for 5 of the

19 measures or 5 of the 16 objectives in

the Health Promotion Priority Areas:

Increases in physical activity for adults,

reductions in suicide deaths, reductions

in people reporting stress, reductions in

homicide deaths, and increases in

workplaces with health promotion

programs. Movement toward the target

was evident for 10 measures associated

with 8 objectives. Percent changes

ranged from 7 percent for the objective

to increase the age of initiation of

smoking by youth to 93 percent for

reduction in alcohol-related motor

vehicle fatalities. Data for four measures

associated with four different objectives

were unchanged from the baseline or

moving in the wrong direction.

Compared with the baseline, the

proportion of the population with a

sedentary lifestyle did not change.

Change for three measures—reducing

overweight, reducing marijuana use by

youth, and reducing assault injuries—

was away from the target. Data are not

available to assess objective 8.4

concerning an increase in the proportion

of schools with health education

programs.

Health Protection Priority Areas

Eleven measures are associated with

the ten sentinel objectives in the Health

Protection Priority Areas. None of the

targets for these objectives were met.

On the other hand, all of these measures

moved toward the year 2000 targets.

Changes range from achieving

11 percent of the target to reduce the

proportion of children with dental caries

to reaching 97 percent of the target to

reduce the level of lead in children’s

blood.

Preventive Services Priority Areas

The Preventive Services Priority

Areas include 21 measures associated

with 20 sentinel objectives. Targets were

met for six objectives: reduction in

coronary heart disease deaths, reversal

in the rise in cancer deaths, increase in

breast exam and mammography,

reduction in HIV infection, reduction in

syphilis infection, and reduction in

epidemic-related pneumonia and

influenza deaths. Objective 16.1 targeted

a reduction in the age-adjusted cancer

death rate from 134 deaths per 100,000

population in 1987 to 130 per 100,000

in the year 2000. In 1998, an

age-adjusted cancer death rate of 124

per 100,000 was achieved. The

reduction of 10 deaths per 100,000 was

2½ times the targeted change of 4

deaths per 100,000. Compared with the

baseline, four objectives moved away

from the target: the percent of low

birthweight infants increased, the

percent of people limited in activity by

chronic conditions increased, the

diabetes-related death rate increased, and

the percent of the population with no

health insurance coverage increased.

Surveillance and Data Systems

Priority Area

Objective 22.1 called for the

development and implementation of a

set of common health status indicators

for use by Federal, State, and local

health agencies. A set of 18 indicators

was developed by consensus and

published in 1991 (3). These Health

Status Indicators have been broadly used

to monitor changes in health status over

time and to compare health status

among racial and ethnic groups (see

Health Status Indicators/Priority Data

Needs section). The Health Status

Indicators have also been used to

compare States (4) and to compare local

geographic areas within States (5).

Healthy People 2000 Final Review 27

Table E. An assessment of target attainment for the sentinel health objectivesHealthy People 2000

for the United States and individual States

United States Target status for States

Met Not met

Percent of

targeted

change

achieved

National

target

status

Between

national

baseline

and

target

"Worse"

than the

national

baseline

For 2

years or

2 surveys

Most

recent

year only

Priority areas and objectives

Met

Health Promotion Priority Areas

Physical Activity and Fitness

1.3 Moderate physical activity (5+ times a week)

100.0

Met

***

(7+ times a week)

28.6

NA NA NA NA

1.5 Sedentary lifestyle

0.0

001239

Nutrition

2.3 Overweight prevalence

-150.0

***

2.5 Dietary fat intake

33.3

NA NA NA NA

Tobacco

3.4 Cigarette smoking prevalence

35.7

1 0482

3.5 Smoking initiation

6.7

Substance Abuse: Alcohol and Other Drugs

4.1 Alcohol-related motor vehicle crash deaths

93.0

15 4266

4.6 Alcohol use by adolescents

68.8

NA NA NA NA

Marijuana use by adolescents

-131.8

***

Cocaine use by adolescents

66.7

NA NA NA NA

Cigarette use by adolescents

26.9

***

Family Planning

5.1 Adolescent pregnancy

40.6

NA NA NA NA

Live births to adolescents

15 32112

5.2 Unintended pregnancies

26.9

NA NA NA NA

Mental Health and Mental Disorders

6.1 Suicide

108.3

Met

12 71022

6.5 Adverse health effects from stress

114.1

Met

NA NA NA NA

Violent and Abusive Behavior

7.1 Homicide

107.7

Met

22 4614

7.6 Assault injuries

-50.0

NA NA NA NA

Educational and Community-Based Programs

8.4 Comprehensive school health education

CA CA

NA NA NA NA

8.6 Worksite health promotion activities

125.0

Met

NA NA NA NA

Health Protection Priority Areas

Unintentional Injuries

9.1 Unintentional injury deaths

85.2

19 1 9 22

9.12 Motor vehicle occupant protection systems

58.1

2 0 47 2

Occupational Safety and Health

10.1 Work-related injury deaths

75.0

15 2 17 17

10.2 Work-related injuries

88.2

Environmental Health

11.4 Blood lead levels in children

96.6

NA NA NA NA

11.5 Air quality

75.9

31 5 10 5

11.6 Homes with radon testing

34.3

NA NA NA NA

Food and Drug Safety

12.2 Salmonella enteriditis outbreaks

63.5

NA NA NA NA

Oral Health

13.1 Dental caries in children

10.5

NA NA NA NA

Adolescents 15 years

94.4

NA NA NA NA

13.4 Complete tooth loss in adults 65 years and over

43.8

NA NA NA NA

See objective 4.6 for cigarettes

28 Healthy People 2000 Final Review

Preventive Services Priority Areas

Maternal and Infant Health

14.1

Infant mortality

93.5

17 3283

14.5

Low birth weight

-36.8

001635

14.11

Prenatal care in first trimester

48.6

00474

Heart Disease and Stroke

15.1

Coronary heart disease deaths

108.6 Met

28 5180

15.2

Stroke deaths

51.0

2 2407

15.4

Controlled high blood pressure

46.2

NA NA NA NA

15.6

Mean serum cholesterol level

76.9

NA NA NA NA

Cancer

16.1

Cancer deaths

250.0

Met 26

799

16.11

Breast examination and mammogram

111.4

Met 47

210

16.12

Pap test

40.0 23

8190

16.13

Fecal occult blood test

34.8

***

Proctosigmoidoscopy

80.0 *

***

Diabetes and Chronic Disabling Conditions

17.2

Limitation in major activity due to chronic conditions

-42.9

NA NA NA

17.9

Diabetes-related deaths

-75.0

11629

HIV Infection

18.2

HIV infection prevalence

& Met

NA NA

Sexually Transmitted Diseases

19.1

Gonorrhea

83.5 26 0214

19.3

Primary and secondary syphilis

110.6 Met 38 112 0

Immunization and Infectious Diseases

20.1

Measles

97.1 20 12 19 0

20.2

Epidemic-related pneumonia and influenza deaths

102.5 Met

NA NA NA

20.11

Childhood immunization

71.4 0 2 49 0

Clinical Preventive Services

21.4

Financial barriers to receipt of clinical preventive

-11.5 0 0 24 27

services

Surveillance and Data Systems Priority Area

22.1

Develop health status indicators

100.0 Met CA

CA CA CA

Year 2000 target met for two years in a row or in two successive surveys.

Target met in the most recent year or survey cycle but not in the previous year or survey cycle.

Most recent data indicates change in the direction of the target.

Most recent data "worse" than the baseline for the United States.

* Data for States are not sufficiently comparable with data for the United States to permit assessment of

target attainment.

CA Cannot assess progress for this objective.

0.0 Quantity more than zero but less than 0.05.

NA Data for States are not available.

& This objective has met its target. A progress quotient could not be calculated.

Number of States that met the target for the two most recent years or the two most recent surveys.

Number of States that met the target for the most recent year only.

Number of States with most recent rates between the national target and the national baseline.

Number of States with most recent rates equal to or greater than the national baseline for objectives

with targeted reductions, or equal to or less than the baseline for objectives with targeted increases.

Based on data for 41 States.

Table E. An assessment of target attainment for the sentinel health objectives

for the United States and individual States-Con.

Healthy People 2000

Healthy People 2000 Final Review 29

State Data

The national Healthy People 2000

targets generally were set based on data

available at the national level. In order

to assess the attainment of these national

targets at the State level, comparable

sources of data are required. There are

18 sentinel objectives for which State

and national data are comparable

because they rely on the same sources.

There are six additional objectives for

which national and State data are based

on different sources but they are

sufficiently comparable to determine

which States have met the national

target. Finally, data for States are shown

for four other sentinel objectives for

which national and State data are not

comparable; for these objectives the data

provide a basis for comparison among

States, and States in the quartile with

the most favorable rates are identified.

Since the data are not comparable, no

assessment of target attainment at the

State level is made. Altogether,

State-level data are shown for 29 of the

47 sentinel objectives. State-level data

are shown for 31 measures associated

with these 29 objectives (figures Q–ZZ).

Attainment of the national target for

an objective at the State level requires

that the target be met for two successive

calendar years or for two successive

survey cycles. Attainment of the target

in a single year could be primarily a

function of the variability in rates.

Attainment for two successive years or

survey cycles provides some assurance

that attainment was not just a function

of year-to-year variability in rates. In the

tables and maps that follow, dark green

is used to indicate that the target was

met for two successive years or survey

cycles. Light green indicates that the

target was met only in the most recent

year or the most recent survey cycle.

For objectives that called for reduction,

rose indicates that the rate for the most

recent year was greater than the national

target and less than the national

baseline. The national baseline

represents the rate for the United States

at the beginning of the monitoring

decade. For objectives that targeted an

increase in rates, rose indicates that the

rate for the most recent year was less

than the national target and greater than

the baseline for the United States.

Burgundy identifies States for which

rates in the most recent year were worse

than the national baseline, that is, the

rate was greater than the national

baseline for objectives that targeted

reductions or less than the baseline for

objectives that targeted increases. A

similar analysis of target attainment for

the 18 Health Status Indicators

associated with objective 22.1 (discussed

in Health Status Indicators/Priority Data

Needs section) has been published

elsewhere (4).

Many States developed objectives

and set targets for their own

populations. These State-specific

objectives and targets may differ from

the Healthy People 2000 objectives for

the Nation. Use of the national target is

convenient because it provides a single

standard against which all States can be

compared, some States, however, had

already achieved the national target at

the beginning of the period. Other States

may have had rates so much worse than

those of the United States at the

baseline that they could not realistically

expect to achieve the national target. In

this section, when sufficiently

comparable sources of national and

State data are available, States are

assessed in terms of whether or not they

met the national target.

A summary of target attainment for

the sentinel objectives among States is

also shown in table E. The numbers of

States that met or did not meet the

national target are shown on the right.

Health Promotion Priority Areas

In the Health Promotion Priority

Areas, State-level data for six objectives

are sufficiently comparable to national

data to determine whether national

targets were met. For example, objective

7.1 to reduce the homicide death rate

was met by 26 States. More States met

this objective than any of the other

objectives in the health promotion

priority areas. State-specific data are

shown in figures Q–BB for 9 of the 16

objectives (or 10 of the 19 measures) in

the health promotion priority areas. Data

for States are shown for four measures

for which national and State data are not

strictly comparable. These measures are

identified by asterisks (*) in table E.

Objectives for which data at the State

level were not available (NA) are

identified in table E. No State-level data

were available to monitor the sentinel

objectives in the Educational and

Community-Based Programs priority

area.

Health Protection Priority Areas

State-level data for five of the

objectives in the Health Protection

Priority Areas are sufficiently

comparable to national data to determine

whether national targets were met in

States. Objective 11.5 to increase the

proportion of people in areas with good

air quality was met by more States (36

States) than any other objective in these

priority areas. State-level data are shown

in figures CC–GG for 5 of the 10

objectives in the Health Protection

Priority Areas. No State-level data were

available to monitor sentinel objectives

in the Food and Drug Safety and Oral

Health priority areas.

Preventive Services Priority Areas

In the Preventive Services Priority

Areas, State-level data for 14 objectives

are sufficiently comparable to national

data to determine whether national

targets were met in each State. More

States (49 States) met objective 16.11 to

increase the proportion of women who

had a clinical breast exam and

mammogram within the last 2 years (47

States) than any of the other objectives

in the Preventive Services Priority

Areas. In fact, more States met the

target for this objective than any of the

other sentinel objectives. State-specific

data are shown in figures HH–ZZ for 15

of the 20 objectives (or 16 of the 21

measures) in the Preventive Services

Priority Areas. Data for States are

included for two measures for which

national and State data are not strictly

comparable (*).

No suitable measure of the extent to

which States made use of the Health

Status Indicators was developed in

conjunction with objective 22.1.

Anecdotal evidence suggests that States

used the Health Status Indicators in their

own efforts to disseminate data at both

the State and local level (5).

References

1. Department of Health and Human Services.

Healthy people 2000: National health promotion

and disease prevention objectives. Washington:

Public Health Service. 1991.

2. McGinnis MJ, Lee PR. Healthy People 2000 at

mid-decade. JAMA. 273(14). 1995.

3. Freedman, MA. Health Status Indicators for the

year 2000. Healthy people statistical notes; vol 1

no 1. Hyattsville, Maryland: National Center for

Health Statistics. 1991.

30 Healthy People 2000 Final Review

4. Keppel KG, Pearcy JN. Healthy people 2000:

An assessment based on the health status

indicators for the United States and each State.

Healthy people statistical notes; no 19. Hyattsville,

Maryland: National Center for Health Statistics.

2000.

5. National Center for Health Statistics. Health

Status Indicator reports: ‘‘State of the art.’’

Statistics and surveillance; no 8. Hyattsville,

Maryland: Public Health Service. 1996.

6. Office of Applied Statistics. Summary of

findings from the 1999 National Household

Survey on Drug Abuse. Rockville, Maryland:

Substance Abuse and Mental Health Services

Administration. 2000.

Healthy People 2000 Final Review 31

Figure Q. Objective 1.3--Percent of adults who participated in regular physical activity (5 or more times

per week): United States and each State, 1996 and 1998

Percent of adults

1996 1998

United States (NHIS)

23.0

30.0

United States --

In 1998, based on data from the National Health

Interview Survey (NHIS), 30 percent of the population 18 74 years of age

Median of States (BRFSS)

21.0

20.4

participated in light to moderate physical activity 5 or more times per

Alabama

17.6

21.4

week. The national target (30 percent) for Objective 1.3 was, therefore,

Alaska

23.8

24.8

attained. The baseline in 1985 was 22 percent for people 18-64 years

Arizona

21.0

13.5

of age.

Arkansas

18.1

15.4

California

21.4

24.7

In 1998, based on data from the Behavioral Risk Factor

Colorado

25.1

24.1

Surveillance System (BRFSS), the median percent of the population

Connecticut

21.4

20.4

18 years and older who participated in regular and sustained physical

Delaware

16.1

17.2

activity (5 or more times per week, 30 or more minutes per session,

District of Columbia

20.0

20.3

regardless of intensity) for the States was 20.4.

Florida

21.0

20.5

Georgia

11.6

18.0

Hawaii

28.1

30.3

Idaho

25.1

27.1

Illinois

21.1

21.9

Indiana

13.5

19.5

Iowa

18.9

19.8

Kansas

17.9

14.3

States --

It is not appropriate to assess attainment of the national

Kentucky

12.4

13.0

target based on the BRFSS data because the NHIS and BRFSS are not

Louisiana

15.9

16.1

comparable and the national target was set based on data from the NHIS.

Maine

21.0

24.2

The 12 States in the highest quartile for the percent of the population

Maryland

13.3

25.0

18 years and older participating in regular and sustained physical activity

Massachusetts

24.2

22.0

in 1998 are identified below.

Michigan

22.8

23.6

Minnesota

24.1

21.7

Hawaii 30.3

Mississippi

17.0

19.2

Wyoming 28.2

Missouri

17.8

19.1

Utah 27.2

Montana

24.2

22.5

Idaho 27.1

Nebraska

20.2

19.1

Oregon 26.7

Nevada

24.7

25.6

New Mexico 25.8

New Hampshire

22.5

23.7

Nevada 25.6

New Jersey

22.4

19.1

Vermont 25.5

New Mexico

23.9

25.8

Washington 25.5

New York

20.0

19.7

Maryland 25.0

North Carolina

13.6

18.5

Alaska 24.8

North Dakota

16.8

18.7

California 24.7

Ohio

10.2

19.0

Oklahoma

16.4

15.7

SOURCE: CDC, NCCDPHP, Behavioral Risk Factor Surveillance System.

Oregon

25.7

26.7

Pennsylvania

20.4

19.4

Rhode Island

23.4

20.4

South Carolina

14.3

17.8

South Dakota

18.6

18.2

Tennessee

14.3

16.6

Texas

21.5

20.8

Utah

27.2

Vermont

24.7

25.5

Virginia

21.4

21.3

Washington

26.3

25.5

West Virginia

12.8

13.5

Wisconsin

22.1

20.2

Wyoming

28.4

28.2

1995 data.

32 Healthy People 2000 Final Review

Figure R. Objective 1.5--Percent of adults who reported no leisure-time physical activity: United States

and each State, 1996 and 1998

Percent of adults

Target

18 years and older

status

1996 1998

(15.0)

United States (NHIS) 23.0

24.0

United States --

In 1998, based on data from the National Health

Interview Survey (NHIS), 24 percent of the population 18 years and

Median of States (BRFSS) 27.8 27.7

older reported no leisure-time physical activities during the last 2

Alabama 32.4 29.7

weeks. The national target for Objective 1.5 had not been attained

Alaska 25.4 23.5

(15 percent). The baseline in 1985 was 24 percent.

Arizona 33.3 51.3

Arkansas 37.4 35.9

In 1998, based on data from the Behavioral Risk Factor

California 23.6 25.5

Surveillance System (BRFSS), the median percent of the population

Colorado 20.2 21.3

18 years and older who did not participate in any leisure-time physical

Connecticut 25.6 27.1

activity during the previous month for the States was 27.7.

Delaware 36.1 35.4

District of Columbia 30.3 38.5

Florida 27.1 31.1

Georgia 51.4 29.6

Hawaii 21.0 18.0

Idaho 20.6 20.4

Illinois 24.9 27.1

Indiana 31.0 27.1

Iowa 26.9 26.7

Kansas 36.4 38.3

Kentucky 45.6 42.7

Louisiana 34.9 32.2

Maine 34.0 27.7

Maryland 33.8 20.3

Massachusetts 23.0 25.4

Michigan 23.3 21.4

Minnesota 23.6 25.5

Mississippi

39.5 33.8

Missouri 30.2 27.9

Montana 21.2 25.2

Nebraska 22.9 26.1

Nevada 22.7 24.1

New Hampshire

25.5 24.9

New Jersey 26.3 32.6

New Mexico 27.7 23.0

In 1998 there were 12 States with rates greater than

New York 30.4 31.0

the year 2000 target (15.0) and less than the 1985

North Carolina 40.7 27.7

baseline (24.0).

North Dakota 33.9 33.1

Ohio 42.6 29.8

In 1998 there were 39 States with rates greater than or

Oklahoma 38.2 43.0

equal to the 1985 baseline (24.0).

Oregon 19.6 18.9

Pennsylvania 26.3 32.7

SOURCE: CDC, NCCDPHP, Behavioral Risk Factor Surveillance System.

Rhode Island 26.7 29.9

South Carolina 29.7 33.7

South Dakota 34.8 33.3

Tennessee 40.8 35.8

Texas 27.9 27.9

Utah 17.1 17.1

Vermont 21.5 26.0

Virginia 29.2 24.8

Washington 19.1 17.6

West Virginia 42.7 43.7

Wisconsin 22.1 23.4

Wyoming

1995 data.

20.4 21.1

States

Healthy People 2000 Final Review 33

Figure S. Objective 2.3--Percent of persons 18 years and older who were overweight: United States and

each State, 1998 and 1999

Percent of persons

18 years and older

1998 1999

United States (NHANES)

--- 35.0

United States --

Based on data from the National Health and Nutrition

Examination Survey (NHANES) for 1988 94, 35 percent of the population

Median of States (BRFSS) 32.4 33.7

18 years and older were overweight based on height and weight obtained

Alabama 35.8 37.5

in a physical examination. The year 2000 target for Objective 2.3

Alaska 36.2 37.7

(20 percent) had not been attained for the period 1988 94. The baseline

Arizona 22.5 22.9

for Objective 2.3 was 26 percent for 1976 80.

Arkansas 33.4 38.1

California 31.0 33.5

In 1999, based on data from the Behavioral Risk Factor

Colorado 27.2 26.7

Surveillance System (BRFSS), the median percent of the population 18

Connecticut 27.4 28.6

years and older who were overweight based on a body mass index

Delaware 32.8 32.0

computed from self-reported height and weight was 33.7.

District of Columbia 31.8 30.2

Florida 32.3 33.6

Georgia 33.3 35.9

Hawaii 27.8 28.8

Idaho 29.9 33.5

Illinois 33.5 36.0

Indiana 34.5 34.1

Iowa 34.6 36.6

Kansas 31.7 33.4

States --

It is not appropriate to assess attainment of the national target

Kentucky 35.8 36.7

based on the BRFSS data because the NHANES and BRFSS are not

Louisiana 36.1 37.7

comparable and the national target was set based on data from the

Maine 31.2 32.7

NHANES. The 12 States in the lowest quartile for the percent of the

Maryland 34.5 32.7

population who were overweight in 1999 based on the BRFSS are

Massachusetts 26.9 28.3

identified below.

Michigan 34.6 36.8

Minnesota 32.5 29.2

Arizona 22.9

Mississippi 37.5 41.8

Colorado 26.7

Missouri 35.6 35.5

New Hampshire 27.9

Montana 29.1 29.8

Massachusetts 28.3

Nebraska 32.3 35.7

Connecticut 28.6

Nevada 27.0 28.9

Hawaii 28.8

New Hampshire 28.7 27.9

Nevada 28.9

New Jersey 29.7 31.4

Minnesota 29.2

New Mexico 29.9 33.0

Montana 29.8

New York 28.6 31.9

Utah 30.0

North Carolina 32.7 34.9

District of Columbia 30.2

North Dakota 33.5 36.3

Vermont 31.1

Ohio 33.6 35.9

Oklahoma 32.4 37.2

SOURCE: CDC, NCCDPHP, Behavioral Risk Factor Surveillance System.

1988-94 data.

---Data not available.

Oregon 32.8 32.8

Pennsylvania 34.8 35.5

Rhode Island 30.3 32.3

South Carolina 34.6 37.3

South Dakota 30.5 36.1

Tennessee 32.4 34.5

Texas 34.9 36.1

Utah 28.8 30.0

Vermont 27.4 31.1

Virginia 31.8 35.0

Washington 32.3 31.8

West Virginia 37.8 41.3

Wisconsin 34.0 33.8

Wyoming 28.1 31.8

34 Healthy People 2000 Final Review

Figure T. Objective 3.4--Percent of persons 18 years and older who reported current cigarette smoking:

United States and each State, 1998 and 1999

Percent of persons

Target

18 years and older

status

1998 1999

(15.0)

United States (NHIS) 24.0 ---

United States

-- Based on data from the National Health Interview

Survey (NHIS), 24 percent of the population 18 years and older

Median of States (BRFSS) 22.9 22.8

reported current cigarette smoking. The baseline in 1987 was 29

Alabama 24.6 23.5

percent. Thirty-six percent of the change targeted by Objective 3.4

Alaska 26.1 27.3

had been achieved in 1998.

Arizona 21.9 20.1

Arkansas 25.9 27.2

Based on data from the Behavioral Risk Factor Surveillance

California 19.2 18.7

System (BRFSS), the median percent of persons 18 years and

Colorado 22.8 22.5

older who reported smoking every day or some days for the

Connecticut 20.9 22.8

States was 22.8.

Delaware 24.5 25.5

District of Columbia 21.6 20.6

Florida 22.0 20.6

Georgia 23.6 23.8

Hawaii 19.5 18.5

Idaho 20.3 21.5

Illinois 23.1 24.2

Indiana 26.0 27.0

Iowa 23.4 23.5

Kansas 21.1 21.0

Kentucky 30.8 29.7

Louisiana 25.5 23.5

Maine 22.4 23.3

Maryland 22.4 20.3

Massachusetts 20.9 19.3

Michigan 27.4 25.1

Minnesota 18.0 19.5

Mississippi 24.1 22.9

Missouri 26.4 27.1

Montana 21.5 20.2

Nebraska 22.0 23.2

Nevada 30.4 31.5

New Hampshire 23.3 22.3

New Jersey 19.1 20.6

States

New Mexico 22.6 22.5

Based on the BRFSS data, one State attained the

New York 24.1 21.8

national target for the year 2000 in both 1998 and

North Carolina 24.6 25.1

1999.

North Dakota 20.0 22.1

Ohio 26.1 27.6

48 In 1999, 48 States had rates greater than the year

Oklahoma 23.9 25.2

2000 target (15.0) and less than the 1987 baseline

Oregon 21.1 21.4

(29.0).

Pennsylvania 23.8 23.1

Rhode Island 22.6 22.3

In 1999 there were two States with rates greater than

South Carolina 24.7 23.6

or equal to the 1987 baseline (29.0).

South Dakota 27.2 22.5

Tennessee 26.1 24.8

SOURCE: CDC, NCCDPHP, Behavioral Risk Factor Surveillance System.

--- Data not available.

Texas 21.9 22.4

Utah 14.2 14.0

Vermont 22.3

21.7

Virginia 22.9 21.4

Washington 21.4 22.4

West Virginia 27.9 27.1

Wisconsin 23.4 23.7

Wyoming 22.8 23.9

Healthy People 2000 Final Review 35

Figure U. Objective 4.1--Alcohol-related motor vehicle crash deaths per 100,000 population: United

States and each State, 1997 and 1998

Death rate

Target

per 100,000

status

1997 1998

(5.5)

United States 6.0 5.9

United States --

The baseline rate for alcohol-related motor

vehicle crash deaths in 1987 was 9.8. The rate in 1998 was 5.9.

Alabama 10.9 9.3

Ninety-three percent of the targeted change in rates was, therefore,

Alaska 6.7 5.0

achieved in 1998.

Arizona 9.5 9.1

Arkansas 7.6 7.6

California 4.1 4.1

Colorado 5.6 5.8

Connecticut 4.7 4.3

Delaware 8.3 6.1

District of Columbia 6.6 5.2

Florida 6.4 6.2

Georgia 7.7 6.7

Hawaii 4.9 4.7

Idaho 8.4 7.3

Illinois 4.9 5.0

Indiana 5.3 6.4

Iowa 6.1 5.7

Kansas 5.5 6.6

Kentucky 7.1 7.2

Louisiana 9.7 9.8

Maine 5.2 4.3

Maryland 4.3 4.0

Massachusetts 3.4 3.1

Michigan 5.7 5.5

Minnesota 4.1 5.9

Mississippi 12.6 12.8

Missouri 9.4 9.7

Montana 13.7 11.8

Nebraska 6.3 7.2

Nevada 9.5 10.1

New Hampshire 5.1 5.1

New Jersey 3.5 3.3

New Mexico 12.8 11.1

Fifteen States attained the target in both 1997 and

New York 2.5 2.0

1998.

North Carolina 7.1 6.8

North Dakota 7.8 6.9

Four States attained the target in 1998 but not in

Ohio 4.3 4.1

1997.

Oklahoma 9.1 7.5

Oregon 7.0 7.1

In 1998, 26 States had rates greater than the year

Pennsylvania 5.3 5.2

2000 target (5.5) and less than the 1987 baseline

Rhode Island 4.2 3.5

(9.8).

South Carolina 8.4 7.9

South Dakota 8.3 9.1

In 1998, there were six States with rates greater than

Tennessee 9.2 9.2

or equal to the 1988 baseline (9.8).

Texas 9.0 9.1

Utah 3.6 2.4

SOURCE: Department of Transportation, National Highway Traffic Safety Administration,

Vermont 5.8 6.4

Fatality Analysis Reporting System.

Virginia 5.7 5.1

Washington 5.3 5.4

West Virginia 8.0 8.0

Wisconsin 6.3 5.8

Wyoming 9.0 14.1

States

36 Healthy People 2000 Final Review

Figure W. Objective 4.6--Percent of youth who currently use marijuana: United States and each State, 1999

Percent

of youth

1999

United States 7.7

United States --

In 1999, based on data from the National Household Survey

on Drug Abuse (NHSDA), 7.7 percent of youth ages 12 17 used marijuana

Alabama 5.6

during the past month.

Alaska 10.5

Arizona 7.5

The NHSDA has been used since 1988 to monitor trends in substance use among

Arkansas 7.6

youth. A consistent methodology was used for monitoring national trends. The

California 8.4

national estimates in table 4, Substance Abuse: Alcohol and other drugs, are

Colorado 10.8

based on this methodology. In 1999, the old methodology would produce an estimate

Connecticut 9.3

of 7 percent of youth ages 12 17 using marijuana during the past month. The

Delaware 14.5

corresponding estimate based on the new methodology is 7.7 percent as shown here.

District of Columbia 10.3

Florida 6.6

Georgia 6.6

Hawaii 8.5

Idaho 6.3

Illinois 10.0

Indiana 9.6

Iowa 5.5

Kansas 7.1

States -- It is not appropriate to assess whether or not States attained

Kentucky 5.8

the national target. The national trend data are based on a methodology

Louisiana 7.0

that has been used since 1988 to monitor this objective. Data for States are

Maine 8.0

available from the NHSDA for the first time for 1999. The State data

Maryland 9.3

are based on a new methodology that will be used to monitor trends from

Massachusetts 12.9

1999 onward. Data for most States are derived through model-based estimation

Michigan 8.5

procedures (6). The 12 States with percentages of 12 17 year olds who

Minnesota 10.8

reported using marijuana during the past month in the lowest quartile are

Mississippi 7.4

shown below.

Missouri 7.4

Montana 11.5

Iowa 5.5

Nebraska 6.8

Alabama 5.6

Nevada 12.3

Kentucky 5.8

New Hampshire 11.7

Tennessee 5.8

New Jersey 8.2

Virginia 6.0

New Mexico 9.9

Texas 6.1

New York 7.4

Utah 6.2

North Carolina 7.3

Idaho 6.3

North Dakota 8.0

Oklahoma 6.5

Ohio 7.6

Florida 6.6

Oklahoma 6.5

Georgia 6.6

Oregon 10.0

Nebraska 6.8

Pennsylvania 7.3

Rhode Island 11.7

SOURCE: Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Abuse.

South Carolina 7.8

South Dakota 7.2

Tennessee 5.8

Texas 6.1

Utah 6.2

Vermont 8.8

Virginia 6.0

Washington 10.3

West Virginia 7.1

Wisconsin 9.0

Wyoming 8.0

Healthy People 2000 Final Review 37

Figure Y. Objective 4.6--Percent of youth who currently smoke cigarettes: United States and each

State, 1999

Percent

of youth

1999

United States (NHSDA) 14.9

United States --

In 1999, based on data from the National Household

Survey on Drug Abuse (NHDSA), 14.9 percent of youth ages 12-17 smoked

Alabama 17.3

cigarettes during the past month.

Alaska 16.6

Arizona 14.5

Arkansas 20.2

California 9.0

The NHSDA has been used since 1988 to monitor trends in substance use among

Colorado 15.7

youth. A consistent methodology was used for monitoring national trends. The

Connecticut 16.0

national estimates in table 4, Substance Abuse: Alcohol and other drugs, are based

Delaware 19.5

on this methodology. In 1999, the old methodology would produce an estimate of

District of Columbia 10.7

15.9 percent of youth ages 12 17 smoking cigarettes during the past month. The

Florida 11.5

corresponding estimate based on the new methodology is 14.9 percent as shown here.

Georgia 14.5

Hawaii 10.2

Idaho 13.1

Illinois 17.6

Indiana 18.3

Iowa 18.2

Kansas 15.7

States --

It is not appropriate to assess whether or not States attained

Kentucky 23.9

the national target. The national trend data are based on a methodology

Louisiana 16.9

that has been used since 1988 to monitor this objective. The State data

Maine 16.7

are based on a new methodology that will be used to monitor trends from

Maryland 13.8

1999 onward. Data for most States are derived through model-based estimation

procedures (6). The 12 States with percentages of 12 17 year olds who

Massachusetts 16.7

reported smoking cigarettes during the past month in the lowest quartile

Michigan 16.2

are shown below.

Minnesota 20.8

Mississippi 18.8

California 9.0

Missouri 16.7

Hawaii 10.2

Montana 19.8

Utah 10.3

Nebraska 14.1

District of Columbia 10.7

Nevada 17.4

Florida 11.5

New Hampshire 15.1

New Jersey 11.9

New York 12.9

New Mexico 15.3

Idaho 13.1

New York 12.9

Texas 13.4

North Carolina 19.2

Maryland 13.8

North Dakota 22.4

Nebraska 14.1

Ohio 18.1

Washington 14.4

Oklahoma 17.4

Oregon 15.2

SOURCE: Substance Abuse and Mental Health Services Administration, National Household Survey

on Drug Abuse.

Pennsylvania 17.5

Rhode Island 14.8

South Carolina 19.5

South Dakota 18.9

Tennessee 17.2

Texas 13.4

Utah 10.3

Vermont 14.7

Virginia 14.7

Washington 14.4

West Virginia

22.5

Wisconsin 18.2

Wyoming 15.9

38 Healthy People 2000 Final Review

Objective 5.1 monitors the live birth rate for females 15 17 years old, however, there was no target specified. The target for the pregnancy rate for females 15 17 called for a 38 percent

reduction from a baseline of 80.3 to a target of 50 live births per 1,000 women in the year 2000. Assuming that a similar 38 percent reduction would apply to each of the three components of

the pregnancy rate (live births, fetal deaths, and abortions) a target was derived by reducing the live birth rate for females 15 17 in 1990 (37.5) by 38 percent. The resulting target is 23.3 live

births per 1,000 females ages 15 17 in the year 2000.

Figure Z. Objective 5.1--Live birth rates for females 15 17 years old: United States and each State, 1997

and 1998

Live birth rates

per 1,000 females

Target

ages 15 17

status

1997 1998

(23.3)

United States

32.1 30.4

United States --

The live birth rate for females 15 17 years old

was 37.5 in 1990. The rate in 1998 was 30.4. Fifty percent of the

Alabama 43.4 40.7

change required to attain the target for this part of Objective 5.1

Alaska 25.1 24.8

had been achieved in 1998.

Arizona 44.0 45.2

Arkansas 42.9 41.4

California 36.2 33.4

Colorado 29.9 29.0

Connecticut 22.5 21.4

Delaware 36.8 33.9

District of Columbia 65.9 65.5

Florida 35.1 33.3

Georgia 44.0 40.3

Hawaii 25.3 29.5

Idaho 23.3 24.5

Illinois 34.4 32.7

Indiana 32.1 28.9

Iowa 20.1 18.6

Kansas 27.5 24.8

Kentucky 35.4 31.5

Louisiana 42.1 40.4

Maine 15.4 14.9

Maryland 28.2 26.4

Massachusetts 19.1 18.2

Michigan 25.4 23.9

Minnesota 17.8 16.5

Mississippi 50.2 47.2

Missouri 29.6 28.6

Montana 20.1 19.8

Nebraska 21.3 20.5

Nevada 42.2 38.2

New Hampshire 14.0 13.1

New Jersey 21.3 20.2

States

New Mexico 44.4 44.2

Fifteen States attained the target in both 1997 and

New York 23.4 22.4

1998.

North Carolina 37.7 36.2

North Dakota 14.3 16.1

Three States attained the target in 1998 but not in

Ohio 28.6 26.7

1997.

Oklahoma 37.3 35.0

Oregon 27.0 26.3

In 1998, 21 States had rates greater than the year

Pennsylvania 21.9 21.8

2000 target (23.3) and less than the 1990 baseline

Rhode Island 27.6 24.4

(37.5).

South Carolina 40.0 39.6

South Dakota 21.8 19.6

In 1998, 12 States had rates greater than 37.5, the

Tennessee 38.5 37.7

baseline rate for the United States in 1990.

Texas 47.1 45.2

Utah 23.7 22.2

SOURCE: CDC, NCHS, National Vital Statistics System.

Vermont 12.1 11.4

Virginia 26.1 24.3

Washington 24.5 23.2

West Virginia 27.5 26.2

Wisconsin 21.4 19.6

Wyoming 23.3 22.8

Healthy People 2000 Final Review 39

Figure AA. Objective 6.1--Age-adjusted death rates for suicide: United States and each State, 1997 and 1998

Age-adjusted

death rate

Target

per 100,000

status

1997 1998

(10.5)

United States 10.6 10.4

United States --

The age-adjusted suicide death rate for the United

States was 11.7 per 100,000 population at baseline in 1987. In

Alabama 10.7 12.0

1998 the rate (10.4) was lower than the target for the year 2000 (10.5).

Alaska 21.3 22.1

The United States, therefore, attained the target for objective 6.1.

Arizona 15.7 16.0

Arkansas 13.4 13.1

California 9.9 9.6

Colorado 14.9 14.2

Connecticut 7.1 7.2

Delaware 10.8 8.0

District of Columbia 7.0 7.3

Florida 12.4 12.6

Georgia 11.2 10.0

Hawaii 11.0 9.2

Idaho 16.8 15.2

Illinois 7.1 8.1

Indiana 11.6 11.1

Iowa 11.6 10.7

Kansas 11.7 11.9

Kentucky 11.3 11.8

Louisiana 11.6 10.4

Maine 10.1 14.5

Maryland 9.3 8.9

Massachusetts 7.4 7.5

Michigan 9.5 9.1

Minnesota 9.4 9.4

Mississippi 11.7 11.5

Missouri 12.1 12.1

Montana 19.7 16.3

Nebraska 10.0 11.6

Nevada 22.0 21.2

New Hampshire 10.6 12.7

New Jersey 6.6 6.4

States

New Mexico 17.2 16.4

Twelve States attained the target in both 1997 and

New York 7.1 6.9

1998.

North Carolina 11.5 10.4

North Dakota 12.3 10.6

Seven States attained the target in 1998 but not in

Ohio 9.3 9.0

1997.

Oklahoma 14.3 13.1

Oregon 14.7 14.8

In 1998, 10 States had rates greater than the year

Pennsylvania 10.8 10.4

2000 target (10.5) and less than the 1987 baseline

Rhode Island 7.1 8.1

(11.7).

South Carolina 10.7 10.7

South Dakota 16.6 15.4

In 1998, 22 States had age-adjusted suicide death rates

Tennessee 12.4 12.6

greater than 11.7, the baseline rate for the United States

Texas 10.7 10.3

in 1987.

Utah 15.0 16.6

Vermont 10.9 12.9

SOURCE: CDC, NCHS, National Vital Statistics System.

Virginia 10.4 11.0

Washington 12.1 11.4

West Virginia 12.8 11.5

Wisconsin 10.3 10.7

Wyoming 18.4 16.8

40 Healthy People 2000 Final Review

Figure BB. Objective 7.1--Age-adjusted death rates for homicide: United States and each State, 1997

and 1998

Age-adjusted

death rate

Target

per 100,000

status

1997

1998

(7.2)

United States 7.8 7.1

United States --

At baseline in 1987 the age-adjusted homicide

death rate was 8.5 per 100,000. The age-adjusted homicide rate for

Alabama 12.2 10.8

the United States was 7.8 in 1997 and 7.1 in 1998. The target (7.2)

Alaska 8.6 7.8

was, therefore, attained for the first time in 1998.

Arizona 9.8 10.0

Arkansas 11.9 9.7

California 9.3 7.7

Colorado 4.6 5.1

Connecticut 4.6 5.0

Delaware 4.6 3.9

District of Columbia 61.5 44.6

Florida 8.4 7.9

Georgia 8.7 8.9

Hawaii 4.1 2.2

Idaho 3.5 2.7

Illinois 10.8 10.3

Indiana 7.7 7.2

Iowa 2.5 2.4

Kansas 6.5 6.5

Kentucky 6.8 6.4

Louisiana 17.0 14.4

Maine 2.1 2.3

Maryland 11.9 12.3

Massachusetts 2.5 2.3

Michigan 8.5 8.4

Minnesota 3.0 2.7

Mississippi 14.6 13.1

Missouri 8.4 8.4

Montana 4.6 3.2

Nebraska 3.9 3.6

Nevada 10.7 10.3

New Hampshire 2.2 *

New Jersey 5.1 4.4

States

New Mexico 9.7 9.9

Twenty-two States attained the target in both 1997

New York 6.8 5.8

and 1998.

North Carolina 9.3 9.3

North Dakota * *

Four States attained the target in 1998 but not in

Ohio 4.6 4.2

1997.

Oklahoma 9.1 6.7

Oregon 4.2 4.4

In 1998, six States had rates greater than 7.2 (the year

Pennsylvania 7.4 6.0

2000 target) and less than the 1987 baseline (8.5).

Rhode Island 3.1 2.6

South Carolina 9.5 9.2

Fourteen States had rates greater than 8.5, the baseline

South Dakota 3.2 *

rate for the United States in 1987.

Tennessee 10.7 9.5

Texas 7.7 7.4

Homicide rates were based on too few cases to be

Utah 2.9 2.9

considered reliable for these States in 1998.

Vermont * *

Virginia 7.8 6.5

SOURCE: CDC, NCHS, National Vital Statistics System.

Washington 4.8 4.3

West Virginia 5.5 4.9

Wisconsin 4.3 3.9

Wyoming 4.7 *

*Figure does not meet standards of reliability or precision.

Healthy People 2000 Final Review 41

Figure CC. Objective 9.1--Age-adjusted death rates for unintentional injuries: United States and each

State, 1997 and 1998

Age-adjusted

death rate

Target

per 100,000

status

1997 1998

(29.3)

United States 30.1 30.1

United States --

The age-adjusted death rate for unintentional

injuries was 34.7 at baseline in 1987. The United States had not

Alabama 45.9 43.2

attained the objective in 1998. However, 85 percent of the

Alaska 46.0 40.7

targeted change had been achieved.

Arizona

40.6 40.7

Arkansas

46.0 42.3

California 25.1 25.1

Colorado 31.6 32.8

Connecticut 23.9 24.5

Delaware 33.0 31.8

District of Columbia 24.6 31.5

Florida 32.1 33.3

Georgia 36.6 35.9

Hawaii 23.9 21.0

Idaho 40.3 39.4

Illinois

24.5 27.4

Indiana 29.8 30.7

Iowa 27.7 27.5

Kansas 31.9 34.9

Kentucky 38.4 36.9

Louisiana 39.3 39.9

Maine 25.8 27.1

Maryland 22.0 22.2

Massachusetts 15.0 15.5

Michigan 27.2 27.2

Minnesota 26.2 26.4

Mississippi 50.9 54.4

Missouri 36.4 35.8

Montana 45.4 42.1

Nebraska 31.0 31.6

Nevada 36.5 35.1

New Hampshire 21.1 23.3

New Jersey

23.9 21.7

States

New Mexico 52.4 51.2

Nineteen States attained the target in both 1997 and

New York 22.3 20.4

1998.

North Carolina 35.2 36.9

North Dakota 30.1 34.0

One State attained the target in 1998 but not in 1997.

Ohio 24.7 24.9

Oklahoma 40.6 39.5

In 1998, nine States had rates greater than the year

Oregon 33.6 34.9

2000 target (29.3) and less than the 1987 baseline

Pennsylvania 31.2 29.2

(34.7).

Rhode Island 19.0 17.3

South Carolina 40.2 41.1

In 1998, there were 22 States with rates greater than

South Dakota 34.4 39.8

or equal to the 1987 baseline (34.7).

Tennessee

39.8 41.0

Texas 33.5 33.7

SOURCE: CDC, NCHS, National Vital Statistics System.

Utah 30.4 30.6

Vermont 24.6 29.2

Virginia

28.2 27.7

Washington 28.6 28.5

West Virginia 35.4 37.1

Wisconsin

27.3

27.7

Wyoming 45.1 42.4

42 Healthy People 2000 Final Review

Figure DD. Objective 9.12--Percent of persons wearing a safety belt while driving or riding in a car:

United States and each State, 1995 and 1997

Percent of persons

Target

status

19971995

(85.0)

United States (NOPUS) 69.0

67.0

United States --

In 1999, based on the National Occupant

Protection Use Survey (NOPUS), 67.0 percent of persons were

Median of States (BRFSS) 66.7 69.3

observed to be using seat belts. At the baseline in 1988, 42

Alabama 67.4 66.2

percent of persons were observed to be using seat belts. The United

Alaska 66.3 65.3

States had, therefore, achieved 58 percent of the change required

Arizona 74.0 80.5

to meet the year 2000 target for objective 9.12 (85 percent).

Arkansas 67.2 65.5

California 85.1 87.2

In 1997, based on the Behavioral Risk Factor Surveillance System

Colorado 64.4 71.4

(BRFSS), the median percent of persons 18 and older who reported

Connecticut 69.0 69.1

that they always use seat belts when they drive or ride in a car for

Delaware 70.9 69.9

the States was 69.3. These data are limited to persons 18 and older--

District of Columbia --- 78.0

a part of the overall target population.

Florida 75.6 76.1

Georgia 63.9 75.4

Hawaii 87.3 87.1

Idaho 57.4 59.6

Illinois 69.1 68.1

Indiana 56.5 61.9

Iowa 62.7 67.2

Kansas 57.6 53.8

Kentucky 65.2 65.4

Louisiana 67.1 74.3

Maine 51.2 69.5

Maryland 74.5 76.1

Massachusetts 58.0 62.7

Michigan 70.3 72.3

Minnesota 58.7 59.7

Mississippi

58.1 56.5

Missouri

63.8 61.9

Montana 56.6 57.6

Nebraska 53.0 57.7

Nevada 71.5 73.7

New Hampshire 52.9 58.2

New Jersey 68.3 72.2

States

New Mexico 84.4 83.5

Based on BRFSS data, two States attained the

New York 73.4 73.8

national target in two consecutive surveys, 1995 and

North Carolina 85.9 84.7

1997.

North Dakota 41.5 40.2

Ohio 68.2 70.0

In 1997, 47 States had rates less than the year 2000

Oklahoma 54.0 63.1

target (85) and greater than the 1987 baseline (42).

Oregon 82.8 84.0

Pennsylvania 60.7 67.3

In 1997, there were two States with rates less than or

Rhode Island 50.0 56.8

equal to the 1988 baseline (42).

South Carolina

76.8 80.5

South Dakota 43.0 42.0

SOURCE: CDC, NCCDPHP, Behavioral Risk Factor Surveillance System.

1999 data.

1998 data.

---Data not available.

Tennessee 61.5 66.4

Texas 77.6 81.2

Utah 60.2 65.0

Vermont 71.1 73.7

Virginia 72.2 71.7

Washington 77.9 75.8

West Virginia

69.9 70.6

Wisconsin 56.1 61.3

Wyoming

47.7

50.2

Healthy People 2000 Final Review 43

Figure EE. Objective 10.1--Work-related injury death rates: United States and each State, 1998 and 1999

Death rate per

Target

100,000 workers

status

1998 1999

(4.0)

United States 4.5 4.5

United States -- The baseline for the work-related injury death rate

was 6.0 for 1983 87. The rate was 4.5 in both 1998 and 1999.

Seventy-five percent of the targeted change for the year 2000

had, therefore, been achieved.

Alabama 6.5 6.0

Alaska 14.4 14.2

Arizona 3.4 3.1

Arkansas 7.5 6.5

California 4.1 3.8

Colorado 3.6 4.5

Connecticut 3.5 2.3

Delaware 2.9 3.7

District of Columbia 5.3 5.3

Florida 5.5 4.9

Georgia 5.3 5.8

Hawaii 2.2 5.7

Idaho 8.2 6.9

Illinois 3.6 3.4

Indiana 5.2 5.7

Iowa 4.5 5.2

Kansas 7.2 5.8

Kentucky 6.4 6.4

Louisiana 8.2 7.2

Maine 4.2 5.0

Maryland 3.0 3.1

Massachusetts 1.4 2.6

Michigan 3.7 3.7

Minnesota 3.4 2.7

Mississippi 9.4 10.6

Missouri 5.3 6.0

Montana 13.2 10.9

Nebraska 6.3 7.3

Nevada 6.8 6.3

New Hampshire 3.6 2.2

New Jersey 2.6 2.6

States

New Mexico 6.2 5.1

Fifteen States attained the target in two consecutive years, 1998

New York 2.9 2.9

and 1999.

North Carolina 6.2 5.9

North Dakota 7.2 6.8

Two States attained the target only in 1999.

Ohio 3.4 4.0

Oklahoma 4.9 6.2

Seventeen States had rates in 1999 greater than the target and less

Oregon 4.3 4.2

than the baseline (6.0).

Pennsylvania 4.2 3.9

Rhode Island 2.5 2.3

In 1999, 17 States had rates greater than or equal to the baseline for

South Carolina 5.9 7.4

the United States in 1983 87 (6.0).

South Dakota 7.3 11.6

Tennessee 5.7 5.7

SOURCE: Department of Labor, Bureau of Labor Statistics, Census of Fatal Occupational Injuries.

Texas 5.4 4.8

Utah 6.6 5.2

Vermont 5.0 4.3

Virginia 5.2 4.5

Washington 3.9 3.0

West Virginia 7.7 7.5

Wisconsin 3.4 3.7

Wyoming 13.5 12.9

The rates for the United States were calculated based on denominators that were adjusted to include military personnel. The rates for States were calculated without any adjustment for

military personnel. The rates for States are, therefore, overestimates and comparisons among States may be affected by differences in the proportion of military personnel.

44 Healthy People 2000 Final Review

Figure FF. Objective 10.2--Nonfatal work-related injuries per 100 full-time workers in private industry:

United States and reporting States, 1997 and 1998

Nonfatal injury

rate per 100

Target

full-time workers

status

1997 1998

(6.0)

United States 6.6 6.2

United States --

The baseline for nonfatal work-related injuries

per 100 full-time workers in private industry was 7.7 for 1983 87.

Alabama 7.5 6.9

In 1998, the comparable rate was 6.2. The United States had

Alaska 7.9 7.2

achieved 88 percent of the change required to meet the year

2000 target.

Arizona 6.2 5.9

Arkansas 7.0 6.4

California 6.2 5.9

Colorado --- ---

Connecticut 6.2 6.2

Delaware 5.3 5.1

District of Columbia --- ---

Florida 6.3 5.7

Georgia 5.1 5.4

Hawaii 6.6 6.3

Idaho --- ---

Illinois --- 6.6

Indiana 8.4 7.8

Iowa 8.5 8.0

Kansas 7.8 7.7

Kentucky 8.5 7.6

Louisiana 4.7 4.9

Maine 7.1 7.8

Maryland 5.0 4.8

Massachusetts 5.4 5.5

Michigan 8.0 7.5

Minnesota 6.9 7.0

Mississippi --- ---

Missouri 7.1 7.0

Montana 7.6 7.4

Nebraska 8.3 7.6

Nevada 7.7 7.1

New Hampshire --- ---

New Jersey 5.7 4.7

New Mexico 6.2 6.0

Ten States attained the target in both 1997 and 1998.

New York 4.2 4.0

North Carolina 5.9 5.7

North Dakota --- ---

Five States attained the target only in 1998.

Ohio --- ---

Oklahoma 6.7 7.0

In 1998, 20 States had rates greater than the year 2000

Oregon 7.2 6.5

target (6.0) and less than the 1987 baseline (7.7).

Pennsylvania --- ---

Rhode Island 7.5 6.5

South Carolina 5.7 5.5

In 1998 there were six States with rates greater than or equal to

South Dakota --- ---

the 1983 87 baseline (7.7).

Tennessee 7.0 7.0

Texas 5.2 4.9

There were no data for 10 States.

Utah 7.8 7.2

Vermont 6.3 6.6

SOURCE: Department of Labor, Bureau of Labor Statistics, Annual Survey of Occupational

Virginia 6.1 5.4

Injuries and Illnesses.

---Data not available.

Washington 9.1 8.7

West Virginia --- 7.4

Wisconsin 9.0 8.5

Wyoming --- ---

States

Healthy People 2000 Final Review 45

Figure GG. Objective 11.5--Percent of persons in counties that have not exceeded the Environmental

Protection Agency (EPA) standards for air quality: United States and each State, 1997 and 1998

Percent in counties

not exceeding EPA

Target

air quality standards

status

1997 1998

(85.0)

United States

78.9 76.5

United States --

The percent of persons living in counties that

did not exceed EPA Air Quality Standards at baseline in 1988 was

Alabama 100.0 72.1

49.7. In 1998, the comparable percent was 76.5, although the

Alaska 85.9 85.9

percent had been higher in intervening years. Based on the

Arizona 42.1 42.1

estimate for 1998, the United States had achieved about 76 percent

Arkansas 100.0 100.0

of the targeted improvement in the percent of persons in counties

California 42.6 16.4

that have not exceeded EPA air quality standards. The air quality

Colorado 99.7 100.0

data should be interpreted with caution because they are subject

Connecticut 8.4 46.5

to the effects of weather patterns.

Delaware 16.7 17.0

District of Columbia 100.0 100.0

Florida 100.0 91.6

Georgia 80.8 70.3

Hawaii 100.0 100.0

Idaho 99.3 100.0

Illinois 97.8 97.8

Indiana 97.3 95.3

Iowa 100.0 88.2

Kansas 100.0 100.0

Kentucky 99.1 98.8

Louisiana 83.2 90.5

Maine 64.1 96.2

Maryland 38.3 72.1

Massachusetts 90.0 100.0

Michigan 100.0 90.6

Minnesota 100.0 100.0

Mississippi 100.0 100.0

Missouri 94.4 89.5

Montana 100.0 100.0

Nebraska 73.6 100.0

Nevada 38.1 38.1

New Hampshire 77.8 100.0

New Jersey 62.0 87.3

New Mexico 100.0 100.0

Thirty-one States attained the target in both 1997 and

New York 79.7 82.3

1998.

North Carolina 98.3 89.6

North Dakota 100.0 100.0

Five States attained the target only in 1998.

Ohio 100.0 98.1

Oklahoma 100.0 100.0

In 1998, there were 10 States with percents greater

Oregon 100.0 90.2

than the national baseline (49.7) and less than the

Pennsylvania 61.6 74.7

year 2000 target (85.0).

Rhode Island 100.0 100.0

South Carolina 100.0 91.0

In 1998, five States had percents less than or

South Dakota 100.0 100.0

equal to the baseline for the United States in 1988

Tennessee 87.2 66.9

(49.7).

Texas 54.6 69.2

Utah 100.0 100.0

SOURCE: Environmental Protection Agency, AIRS, OAR, National Air Quality and Emissions

Vermont 100.0 100.0

Trends Report.

Virginia 96.2 83.5

Washington 100.0 57.0

West Virginia 100.0 92.6

Wisconsin 76.8 74.2

Wyoming 100.0 100.0

States

46 Healthy People 2000 Final Review

Figure HH. Objective 14.1--Infant mortality rates: United States and each State, 1997 and 1998

Infant deaths

Target

per 1,000 live births

status

1997 1998

(7.0)

United States 7.2 7.2

United States --

The infant mortality rate at baseline in 1987 was

10.1 infant deaths per 1,000 live births. The rate in 1997 and 1998

Alabama 9.5 10.2

was 7.2. The United States has, therefore, achieved 94 percent of

Alaska 7.5 5.9

the targeted reduction in infant mortality rates.

Arizona 7.1 7.5

Arkansas 8.7 8.9

California 5.9 5.8

Colorado 7.0 6.7

Connecticut 7.2 7.0

Delaware 7.8 9.6

District of Columbia 13.2 12.5

Florida 7.1 7.2

Georgia 8.6 8.5

Hawaii 6.6 6.9

Idaho 6.8 7.2

Illinois 8.4 8.4

Indiana 8.2 7.6

Iowa 6.2 6.6

Kansas 7.4 7.0

Kentucky 7.3 7.5

Louisiana 9.5 9.1

Maine 5.1 6.3

Maryland 8.8 8.6

Massachusetts 5.2 5.1

Michigan 8.2 8.2

Minnesota 5.9 5.9

Mississippi 10.6 10.1

Missouri 7.6 7.7

Montana 6.9 7.4

Nebraska 7.4 7.3

Nevada 6.5 7.0

New Hampshire 4.3 4.4

New Jersey 6.3 6.4

New Mexico 6.1 7.2

Seventeen States attained the target in 1997 and 1998.

New York 6.7 6.3

North Carolina 9.2 9.3

Three States attained the target only in 1998.

North Dakota 6.2 8.6

Ohio 7.8 8.0

In 1998, 28 States had rates greater than the year 2000

Oklahoma 7.5 8.5

target (7.0) and less than the 1987 baseline (10.1).

Oregon 5.8 5.4

Pennsylvania 7.6 7.1

In 1998, there were three States with rates greater than or

Rhode Island 7.0 7.0

equal to the 1987 baseline (10.1).

South Carolina 9.6 9.6

South Dakota 7.7 9.1

SOURCE: CDC, NCHS, National Vital Statistics System.

Tennessee 8.6 8.2

Texas 6.4 6.4

Utah 5.8 5.6

Vermont 6.1 7.0

Virginia 7.8 7.7

Washington 5.6 5.7

West Virginia 9.6 8.0

Wisconsin 6.5 7.2

Wyoming 5.8 7.2

States

Healthy People 2000 Final Review 47

Figure JJ. Objective 14.5--Percent of live births of low birthweight: United States and each State,

1997 and 1998

Percent

Target

low birthweight

status

1997 1998

(5.0)

United States

7.5

7.6

United States --

The target for this objective has not been

attained. The percent low birthweight was 7.6 in 1998. The percent

Alabama

9.2

9.3

low birthweight has risen steadily since 1987 when the baseline was

Alaska

5.9

6.0

6.9 percent.

Arizona

6.9

6.8

Arkansas

8.4

8.9

California

6.2

Colorado

8.8

8.6

Connecticut

7.3

7.8

Delaware

8.7

8.4

District of Columbia

13.4

13.1

Florida

8.0

8.1

Georgia

8.8

8.5

Hawaii

7.2

7.5

Idaho

6.3

6.0

Illinois

7.9

8.0

Indiana

7.7

7.9

Iowa

6.4

Kansas

6.9

7.0

Kentucky

7.8

8.1

Louisiana

10.2

10.1

Maine

5.9

5.8

Maryland

8.8

8.7

Massachusetts

7.0

6.9

Michigan

7.7

7.8

Minnesota

5.9 5.8

Mississippi

10.1

Missouri

7.7

7.8

Montana

6.3

7.0

Nebraska

7.0

6.5

Nevada

7.6

New Hampshire

5.8

5.7

New Jersey 7.9 8.0

New Mexico 7.8 7.6

In 1998, 16 States had rates greater than the year

New York 7.8 7.8

2000 target (5.0) and less than the 1987 baseline (6.9).

North Carolina 8.8 8.8

North Dakota 6.2 6.5

In 1998, there were 35 States with rates greater than or

Ohio 7.7 7.7

equal to the 1987 baseline (6.9).

Oklahoma 7.3 7.2

Oregon 5.5 5.4

SOURCE: CDC, NCHS, National Vital Statistics System.

Pennsylvania 7.6 7.6

Rhode Island 7.4 7.6

South Carolina 9.2 9.5

South Dakota 5.5 5.8

Tennessee 8.8 9.1

Texas 7.3 7.4

Utah 6.6 6.7

Vermont 6.3 6.5

Virginia 7.7 7.9

Washington 5.6 5.7

West Virginia 8.3 8.0

Wisconsin 6.4 6.5

Wyoming 9.0 8.9

States

48 Healthy People 2000 Final Review

Figure KK. Objective 14.11--Percent of mothers who began prenatal care in the first trimester:

United States and each State, 1997 and 1998

Percent

beginning care

Target

in first trimester

status

1997 1998

(90.0)

United States 82.5 82.8

United States --

The United States has achieved about 49

percent of the targeted change in the percent of women beginning

Alabama 82.2 82.4

prenatal care in the first trimester of pregnancy. The baseline in

Alaska 80.4 81.4

1987 was 76 percent.

Arizona 75.4 75.1

Arkansas 75.7 77.8

California 81.8 82.4

Colorado 82.9 82.2

Connecticut 89.2 88.0

Delaware 82.5 83.4

District of Columbia 66.6 72.0

Florida 83.9 83.6

Georgia 85.8 86.4

Hawaii 83.4 85.4

Idaho 78.6 78.7

Illinois 82.4 82.7

Indiana 80.1 79.9

Iowa 87.4 87.3

Kansas 85.6 85.8

Kentucky 85.8 86.4

Louisiana 81.3 82.2

Maine 88.9 88.9

Maryland 88.8 87.8

Massachusetts 88.9 89.5

Michigan 84.2 84.3

Minnesota 84.1 84.5

Mississippi 80.1 80.6

Missouri 86.0 86.1

Montana 82.6 82.3

Nebraska 83.9 83.9

Nevada 76.1 74.6

New Hampshire 89.6 89.7

New Jersey 81.3 81.6

New Mexico 70.2 67.6

In 1998, 47 States had rates between the year 2000

New York 80.6 81.2

target (90.0) and the 1987 baseline (76.0).

North Carolina 83.9 84.5

North Dakota 84.8 85.6

In 1998, there were four States with rates lower than the

Ohio 85.1 85.5

1987 baseline (76.0).

Oklahoma 78.5 78.6

Oregon 81.1 80.2

Pennsylvania 83.8 84.8

Rhode Island 89.5 89.7

South Carolina 80.5 81.4

South Dakota 82.1 82.7

Tennessee 83.7 84.1

Texas 78.5 79.3

Utah 83.7 82.1

Vermont 88.0 87.4

Virginia 85.1 85.2

Washington

83.3 83.0

West Virginia 82.0 83.7

Wisconsin 84.6 84.3

Wyoming 82.5 81.3

SOURCE: CDC, NCHS, National Vital Statistics System.

States

Healthy People 2000 Final Review 49

Figure LL. Objective 15.1--Age-adjusted death rates for coronary heart disease: United States and each

State, 1997 and 1998

Age-adjusted

death rate

Target

per 100,000

status

1997 1998

(100.0)

United States 100.1 96.8

United States --

The United States attained the Year 2000 target

(an age-adjusted rate of 100 coronary heart disease deaths per

Alabama 92.3 88.8

100,000 population) for the first time in 1998. The baseline in 1987

Alaska 67.2 70.0

was an age-adjusted rate of 135 deaths per 100,000.

Arizona 87.1 86.3

Arkansas 108.4 106.4

California 95.4 94.3

Colorado 69.5 66.4

Connecticut 87.3 83.2

Delaware 109.5 98.0

District of Columbia 112.6 125.1

Florida 97.9 97.4

Georgia 97.8 95.5

Hawaii 65.2 62.6

Idaho 80.1 71.3

Illinois 103.1 101.3

Indiana 102.0 97.9

Iowa 101.7 97.5

Kansas 82.8 80.4

Kentucky 113.5 106.3

Louisiana 115.5 113.9

Maine 96.5 89.3

Maryland 100.1 97.1

Massachusetts 80.1 75.1

Michigan 111.6 109.1

Minnesota 67.3 63.8

Mississippi 129.4 128.2

Missouri 110.7 108.0

Montana 75.3 69.5

Nebraska 75.1 68.0

Nevada 101.8 101.9

New Hampshire 94.9 93.9

New Jersey 97.3 94.4

New Mexico 78.9 75.3

Twenty-eight States attained the target in 1997

New York 122.6 114.7

and 1998.

North Carolina 104.9 100.9

North Dakota 87.6 80.2

Ohio 106.5 103.4

Oklahoma 119.2 115.9

Oregon 77.0 72.3

Pennsylvania 101.6 96.0

Rhode Island 108.3 101.6

South Carolina 106.8 101.8

South Dakota 87.4 84.4

Tennessee 126.3 123.2

Texas 106.4 100.9

Utah 64.1 58.8

Vermont 95.2 82.9

Virginia 87.9 87.0

Washington 78.8 79.3

West Virginia 119.4 119.6

Wisconsin 85.1 84.3

Wyoming 83.0 82.0

States

Five States attained the target in 1998 but not in 1997.

In 1998, eighteen States had rates greater than the year

2000 target (100.0) and less than the 1987 baseline

(135.0).

SOURCE: CDC, NCHS, National Vital Statistics System.

50 Healthy People 2000 Final Review

Figure MM. Objective 15.2--Age-adjusted death rates for stroke: United States and each State,

1997 and 1998

Age-adjusted

death rate

Target

per 100,000

status

1997 1998

(20.0)

United States 25.8 25.1

United States --

The United States has achieved about half

(51 percent) of the targeted reduction in stroke deaths. The

Alabama 31.1 30.6

baseline in 1987 was an age-adjusted stroke death rate of 30.4

Alaska 22.7 25.2

and the comparable rate in 1998 was 25.1.

Arizona 23.3 22.5

Arkansas 38.2 35.3

California 25.9 25.0

Colorado 22.2 21.8

Connecticut 20.5 20.9

Delaware 22.0 23.2

District of Columbia 31.2 28.4

Florida 22.3 22.0

Georgia 34.0 31.6

Hawaii 28.2 24.1

Idaho 25.5 24.7

Illinois 26.2 25.4

Indiana 27.9 28.1

Iowa 23.1 23.1

Kansas 23.2 24.7

Kentucky 27.8 27.6

Louisiana 30.0 30.0

Maine 23.0 22.6

Maryland 25.2 25.1

Massachusetts 19.9 18.6

Michigan 26.2 25.9

Minnesota 24.4 21.9

Mississippi 35.1 33.4

Missouri 26.2 27.3

Montana 23.7 23.2

Nebraska 22.9 25.2

Nevada 26.0 25.3

New Hampshire 24.4 20.5

New Jersey 21.2 21.1

New Mexico 21.5 19.6

Two States attained the target in 1997 and 1998.

New York 19.2 18.3

North Carolina 32.0 33.1

Two States attained the target only in 1998.

North Dakota 23.6 22.5

Ohio 25.6 24.3

Forty States had rates between the year 2000 target

Oklahoma 28.5 27.7

(20.0) and the 1987 baseline (30.4) in 1998.

Oregon 28.9 29.0

Pennsylvania 24.4 23.5

In 1998, seven States had rates greater than the baseline

Rhode Island 23.1 20.0

for the United States in 1987 (30.4).

South Carolina 38.7 37.0

South Dakota 25.4 24.3

SOURCE: CDC, NCHS, National Vital Statistics System.

Tennessee 33.5 32.6

Texas 27.8 26.4

Utah 24.3 22.0

Vermont 23.7 23.2

Virginia 29.7 27.2

Washington 25.5 25.6

West Virginia 25.0 24.7

Wisconsin 26.3 26.0

Wyoming 21.4 26.2

States

Healthy People 2000 Final Review 51

Figure NN. Objective 16.1--Age-adjusted death rates for all cancers: United States and each State,

1997 and 1998

Age-adjusted

death rate

Target

per 100,000

status

1997 1998

(130.0)

United States 125.4

123.5

United States --

The age-adjusted death rate for all cancers in

1987 was 134 per 100,000. The rate in 1998 was 123.5. The United

Alabama 136.0 135.6

States has, therefore, achieved the target of 130 cancer deaths per

Alaska 116.4 116.6

100,000.

Arizona 113.1 110.6

Arkansas 138.6 133.2

California 114.3 110.6

Colorado 101.4 101.9

Connecticut 120.3 119.1

Delaware 141.5 138.9

District of Columbia 154.9 154.3

Florida 125.6 122.6

Georgia 131.8 129.8

Hawaii 95.0 100.5

Idaho 107.4 110.4

Illinois 129.6 128.4

Indiana 130.4 133.4

Iowa 116.5 117.3

Kansas 118.0 112.9

Kentucky 145.7 141.9

Louisiana 146.4 143.9

Maine 135.9 130.8

Maryland 133.8 131.3

Massachusetts 126.5 126.1

Michigan 127.2 124.7

Minnesota 115.3 112.6

Mississippi 141.1 141.3

Missouri 131.1 132.9

Montana 114.1 112.2

Nebraska 112.4 114.0

Nevada 128.5 133.9

New Hampshire 134.8 134.3

New Jersey 130.2 126.8

New Mexico 108.0 104.2

Twenty-six States attained the target in 1997 and 1998.

New York 122.4 119.7

North Carolina 130.6 128.6

Seven States attained the target only in 1998.

North Dakota 107.2 113.3

Ohio 131.8 131.5

Nine States had rates between the year 2000 target

Oklahoma 130.2 126.4

(130) and the 1987 baseline (134).

Oregon 121.2 123.4

Pennsylvania 131.4 127.7

Nine States had rates in 1998 higher than the baseline

Rhode Island 136.3 132.0

for the United States in 1987 (134).

South Carolina 133.4 130.5

South Dakota 116.5 116.7

SOURCE: CDC, NCHS, National Vital Statistics System.

Tennessee 139.9 138.9

Texas 122.7 120.2

Utah 84.6 93.5

Vermont 131.4 124.9

Virginia 130.2 126.8

Washington 117.9 117.8

West Virginia 140.3 139.1

Wisconsin 119.5 121.3

Wyoming 113.5 112.3

States

52 Healthy People 2000 Final Review

Figure OO. Objective 16.11--Percent of women 50 years of age and older who received a mammogram

and breast exam within the last 2 years: United States and each State, 1998 and 1999

Percent of women

Target

50 years and older

status

1998 1999

(60.0)

United States (NHIS) 64.0 ---

United States --

Based on data from the National Health

Interview Survey (NHIS) for 1998, 64 percent of women 50 and older

Median of States (BRFSS)

67.8 68.5

reported that they had a clinical breast exam and a mammogram

Alabama 69.9 65.3

within the last 2 years. The year 2000 target of 60 percent was,

Alaska 74.1 73.1

therefore, exceeded. The baseline in 1987 was 25 percent.

Arizona 81.0 76.9

Arkansas 57.0 61.1

In 1999, based on data from the Behavioral Risk Factor Surveillance

California 69.4 ---

System (BRFSS), the median percent of women 50 years of age and

Colorado 70.1 66.1

older who reported receiving both a mammogram and a clinical

Connecticut 69.4 77.8

breast exam within the last 2 years for the States was 68.5.

Delaware 77.1 77.2

District of Columbia 85.2 78.2

Florida 68.9 76.1

Georgia 64.1 66.2

Hawaii 69.7 69.5

Idaho 63.5 63.2

Illinois 62.1 67.9

Indiana 63.9 60.7

Iowa 64.0 68.7

Kansas 66.3 71.5

Kentucky 63.7 68.3

Louisiana 63.5 65.0

Maine 73.6 80.1

Maryland 70.7 75.6

Massachusetts 74.8 77.7

Michigan 69.8 76.5

Minnesota 60.0 69.0

Mississippi 60.1 59.3

Missouri 66.6 64.9

Montana 69.0 66.4

Nebraska 59.5 68.9

Nevada 62.4 64.7

New Hampshire 71.6 80.4

New Jersey 65.1 68.0

New Mexico 66.3 66.3

Based on BRFSS data, 47 States attained the target

New York 68.7 71.0

in both 1998 and 1999.

North Carolina 74.1 76.9

North Dakota 68.3 71.3

Two States attained the target in 1999 but not in 1998.

Ohio 68.1 71.0

Oklahoma 62.5 64.7

Mississippi attained the target in 1998 but not in 1999.

Oregon 67.8 69.3

Pennsylvania 66.5 67.9

Data for California were not available in 1999.

Rhode Island 70.2 74.8

South Carolina 66.9 72.6

SOURCE: CDC, NCCDPHP, Behavioral Risk Factor Surveillance System.

--- Data not available.

South Dakota 69.5 68.2

Tennessee 70.9 67.9

Texas 63.0 65.3

Utah 61.5 67.7

Vermont 67.1 70.0

Virginia 68.1 68.0

Washington 70.2 67.4

West Virginia 68.9 65.7

Wisconsin 66.8 68.8

Wyoming 60.5 64.1

States

Healthy People 2000 Final Review 53

Figure PP. Objective 16.12--Percent of women 18 years of age and older who had a Pap test during the

last 3 years: United States and each State, 1998 and 1999

Percent of women

Target

18 years and older

status

1998 1999

(85.0)

United States (NHIS)

79.0 ---

United States --

Based on data from the National Health

Interview Survey (NHIS) for 1998, 79 percent of women 18 years of

Median of States (BRFSS) 81.5 85.4

age and older reported that they had a Pap test within the last 3

Alabama 85.3 86.6

years. The baseline in 1987 was 75 percent. Forty percent of the

Alaska 89.5 90.9

change required to meet the year 2000 target was achieved.

Arizona 81.7 86.1

Arkansas 78.9 82.6

In 1999, based on data from the Behavioral Risk Factor Surveillance

California 82.3 ---

System (BRFSS), the median percent of women 18 years of age and

Colorado 87.0 87.4

older who reported having a Pap test during the last 3 years for

Connecticut 86.2 88.3

the States was 85.4.

Delaware 87.1 87.7

District of Columbia 93.9 90.8

Florida 85.9 85.3

Georgia 86.1 88.0

Hawaii 86.3 87.1

Idaho 82.5 79.3

Illinois 84.5 84.9

Indiana 80.9 82.4

Iowa 84.5 85.3

Kansas 85.6 87.4

Kentucky 84.3 83.4

Louisiana 84.8 85.4

Maine 85.0 89.5

Maryland 89.2 89.2

Massachusetts 87.7 86.2

Michigan 88.1 85.8

Minnesota 85.0 87.5

Mississippi 84.4 84.1

Missouri 85.4 84.6

Montana 80.6 85.2

Nebraska 82.4 84.8

Nevada 85.1 78.5

New Hampshire 84.2 88.4

New Jersey 81.4 84.3

New Mexico 82.6 83.7

Based on data from the BRFSS, 23 States attained

New York 83.8 84.2

the national target in both 1998 and in 1999.

North Carolina 87.7 90.9

North Dakota 85.5 86.6

Eight States attained the target in 1999 but not in 1998.

Ohio 84.2 85.5

Oklahoma 84.8 83.8

In 1999, there were 19 States where 78.5 to 84.9

Oregon 83.7 87.6

percent of women 18 and older reported having a Pap

Pennsylvania 83.8 83.6

test during the last 3 years.

Rhode Island 85.2 86.0

South Carolina 85.0 87.0

Data for California were not available in 1999.

South Dakota 86.3 85.4

Tennessee 86.1 85.1

SOURCE: CDC, NCCDPHP, Behavioral Risk Factor Surveillance System.

--- Data not available.

Texas 81.5 82.7

Utah 78.4 80.8

Vermont 86.0 88.4

Virginia 84.9 85.5

Washington 85.4 85.9

West Virginia 81.0 80.7

Wisconsin 83.4 84.7

Wyoming 82.0 83.8

States

54 Healthy People 2000 Final Review

Figure QQ. Objective 16.13--Percent of persons 50 years of age and older who have had a

fecal occult blood test during the last 2 years: United States and each State, 1997 and 1999

Percent of adults

50 years and older

1997 1999

United States (NHIS) --- 35.0

United States --

In 1998, based on data from the National Health

Interview Survey (NHIS), 35 percent of the population 50 years and

Median of States (BRFSS) 25.6 26.2

older had a fecal occult blood test during the last 2 years. The

Alabama 19.2 17.6

baseline in 1987 was 27 percent. Thirty-five percent of the change

Alaska 25.0 17.3

required to meet the year 2000 target was achieved.

Arizona 29.3 32.9

Arkansas 21.3 22.9

In 1999, based on data from the Behavioral Risk Factor Surveillance

California 24.8 23.0

System (BRFSS), the median percent of the population 50 years and

Colorado 32.2 29.7

older who had a fecal occult blood test during the last 2 years for

Connecticut 31.1 36.8

the States was 26.2.

Delaware 30.5 29.0

District of Columbia 37.8 43.0

Florida 30.1 32.4

Georgia 27.8 21.7

Hawaii 32.2 28.7

Idaho 25.4 23.1

Illinois 24.9 25.8

Indiana 22.2 22.4

Iowa 28.0 33.0

Kansas 31.5 26.1

States -- It is not appropriate to assess attainment of the national

Kentucky 26.1 23.9

target based on the BRFSS data because the NHIS and BRFSS are not

Louisiana 23.3 23.8

comparable and the national target was set based on data from the NHIS.

Maine 35.0 35.9

The twelve States in the highest quartile for the percent of the population

Maryland 32.1 37.8

50 years and older who reported having a fecal occult blood test during

Massachusetts 34.2 35.2

the last two years in 1999 are shown below.

Michigan 31.0 33.1

Minnesota 32.3 26.2

District of Columbia 43.0

Mississippi 13.5 17.8

New Hampshire 40.7

Missouri 25.1 25.0

North Carolina 38.5

Montana 24.0 26.4

Maryland 37.8

Nebraska 24.4 27.4

Vermont 37.4

Nevada 16.0 20.0

Connecticut 36.8

New Hampshire 33.9 40.7

Maine 35.9

New Jersey 28.5 35.4

Washington 35.7

New Mexico 21.7 23.9

New Jersey 35.4

New York 31.9 29.2

Massachusetts 35.2

North Carolina 36.5 38.5

Michigan 33.1

North Dakota 22.7 24.5

Iowa 33.0

Ohio 29.4 30.9

Oklahoma 14.3 23.3

SOURCE: CDC, NCCDPHP, Behavioral Risk Factor Surveillance System.

--- Data not available.

1998 data.

Oregon 34.6 32.2

Pennsylvania 28.8 31.0

Rhode Island 26.5 31.4

South Carolina 24.0 26.4

South Dakota 21.7 25.2

Tennessee 22.3 23.3

Texas 25.0 23.0

Utah 22.0 19.8

Vermont 35.1 37.4

Virginia 25.9 26.2

Washington 35.9 35.7

West Virginia 18.0 19.1

Wisconsin 25.4 21.3

Wyoming 19.3

18.4

Healthy People 2000 Final Review 55

Figure RR. Objective 16.13--Percent of persons 50 years of age and older who have ever had a

sigmoidoscopy or procotoscopic exam: United States and each State, 1997 and 1999

Percent of adults

50 and older

1997 1999

United States (NHIS) --- 37.0

United States --

In 1998, based on data from the National Health

Interview Survey (NHIS), 37 percent of the population 50 years and

Median of States (BRFSS) 40.8 43.6

older reported having ever had a proctosigmoidoscopy. The

Alabama 43.0 41.2

baseline in 1987 was 25 percent. Eighty percent of the change

Alaska 41.0 50.4

required to meet the year 2000 target was achieved.

Arizona 39.2 36.8

Arkansas 34.4 42.1

In 1999, based on data from the Behavioral Risk Factor Surveillance

California 46.6 48.2

System (BRFSS), the median percent of the population 50 years and

Colorado 43.5 44.2

older who ever had a sigmoidoscopy or proctoscopic exam for

Connecticut 45.0 48.7

the States was 43.6.

Delaware 47.8 56.0

District of Columbia 49.2 48.4

Florida 45.8 45.0

Georgia 48.1 47.4

Hawaii 51.6 44.2

Idaho 38.4 41.3

Illinois 40.3 43.9

Indiana 38.5 43.4

Iowa 40.7 46.4

Kansas 37.5 38.8

States --

It is not appropriate to assess attainment of the national

Kentucky 34.2 34.7

target based on the BRFSS data because the NHIS and BRFSS are not

Louisiana 37.0 36.7

comparable and the national target was set based on data from the NHIS.

Maine 42.4 42.4

The 12 States in the highest quartile for the percent of the population

Maryland 37.1 50.5

50 years and older who ever had a sigmoidoscopy or proctoscopic exam

Massachusetts 41.3 43.9

in 1999 are shown below.

Michigan 47.8 49.5

Minnesota 50.9 47.5

Delaware 56.0

Mississippi 35.8 37.4

Wisconsin 52.4

Missouri 41.1 38.0

Washington 50.8

Montana 39.7 43.2

Maryland 50.5

Nebraska 38.2 33.7

Alaska 50.4

Nevada 42.3 43.1

Michigan 49.5

New Hampshire 42.8 46.8

Connecticut 48.7

New Jersey 39.6 44.0

Rhode Island 48.7

New Mexico 39.4 43.1

District of Columbia 48.4

New York 43.7 42.2

California 48.2

North Carolina 39.2 39.1

Minnesota 47.5

North Dakota 44.9 42.0

Georgia

47.4

Ohio 37.5 40.7

Oklahoma 22.3 37.7

SOURCE: CDC, NCCDPHP, Behavioral Risk Factor Surveillance System.

---Data not available.

1998 data.

Oregon 46.1 47.1

Pennsylvania 40.2 39.7

Rhode Island 42.6 48.7

South Carolina 29.2 41.8

South Dakota 37.6 45.5

Tennessee 34.2 39.3

Texas 38.2 44.3

Utah 45.1 44.1

Vermont 40.2 42.2

Virginia 47.6 44.2

Washington 44.0 50.8

West Virginia 34.4 34.9

Wisconsin 50.3 52.4

Wyoming

45.3 46.5

56 Healthy People 2000 Final Review

Figure SS. Objective 17.9--Age-adjusted death rates for diabetes-related deaths: United States

and each State, 1997 and 1998

Age-adjusted

death rate

Target

per 100,000

status

1997 1998

(34.0)

United States 40.6 40.9

United States --

At baseline in 1986, the age-adjusted diabetes-

related death rate was 38 per 100,000 population. In 1998, the rate

Alabama 38.1 39.9

was 40.9. Instead of declining by 4 deaths per 100,000, the rate

Alaska 38.1 36.6

increased by 2.9 deaths per 100,000. In this case the rate moved

Arizona 29.3 30.6

away from the target.

Arkansas 33.2 34.5

California 44.9 45.8

Colorado 29.6 31.1

Connecticut 36.9 37.5

Delaware 48.4 48.5

District of Columbia 59.4 59.1

Florida 28.6 29.1

Georgia 38.7 39.1

Hawaii 41.4 42.2

Idaho 32.8 34.4

Illinois 40.5 40.6

Indiana 42.2 41.4

Iowa 36.7 37.1

Kansas 33.8 35.0

Kentucky 40.3 38.9

Louisiana 43.4 45.6

Maine 42.5 42.0

Maryland 54.3 54.2

Massachusetts 34.2 33.7

Michigan 43.3 43.8

Minnesota 34.4 34.8

Mississippi 51.0 51.3

Missouri 42.5 42.7

Montana 29.4 32.2

Nebraska 35.3 35.3

Nevada 31.9 33.6

New Hampshire 42.1 41.4

New Jersey 38.2 36.1

New Mexico 34.6 35.2

Five States attained the target in 1997 and 1998.

New York 35.5 35.2

North Carolina 49.7 52.0

One State attained the target only in 1998.

North Dakota 33.7 38.1

Ohio 52.3 51.2

In 1998, 16 States had rates between the year

Oklahoma 40.9 39.6

2000 target (34) and the 1987 baseline (38).

Oregon 39.3 42.8

Pennsylvania 46.1 45.3

In 1998, 29 States had rates greater than the baseline for

Rhode Island 45.3 43.7

the United States in 1987 (38).

South Carolina 49.0 49.0

South Dakota 32.4 36.4

SOURCE: CDC, NCHS, National Vital Statistics System.

Tennessee 42.2 44.4

Texas 46.1 45.9

Utah 33.8 36.1

Vermont 46.1 42.5

Virginia 39.6 38.7

Washington 35.4 36.1

West Virginia 54.3 56.1

Wisconsin 36.8 36.9

Wyoming 32.0 35.1

States

Healthy People 2000 Final Review 57

Figure TT. Objective 19.1--Reported incidence of gonorrhea per 100,000 population: United States

and each State, 1998 and 1999

Reported cases

per 100,000

Target

population

status

1998 1999

(100)

United States 131.6 132.0

United States --

In 1989, there were 300 gonorrhea cases per

100,000 population. The objective for the year 2000 was 100 cases

Alabama 292.7 249.2

per 100,000. In 1999 there were 133 cases per 100,000. Eighty-four

Alaska 53.9 48.7

percent of the target for the year 2000 had been achieved in 1999.

Arizona 90.2 89.8

Arkansas 155.7 126.4

California 59.7 56.3

Colorado 51.2 62.3

Connecticut 97.0 101.2

Delaware 209.3 220.6

District of Columbia 861.7 681.3

Florida 127.9 151.8

Georgia 270.4 272.8

Hawaii 42.4 39.1

Idaho 14.8 7.1

Illinois 180.4 191.7

Indiana 106.9 102.5

Iowa 56.5 47.6

Kansas 99.7 100.4

Kentucky 96.9 84.6

Louisiana 286.1 301.7

Maine 5.4 6.6

Maryland 219.2 201.7

Massachusetts 36.7 39.7

Michigan 166.6 161.3

Minnesota 57.3 59.3

Mississippi 388.4 376.0

Missouri 174.0 149.7

Montana 6.2 6.0

Nebraska 72.4 88.3

Nevada 82.7 72.0

New Hampshire 7.7 9.6

New Jersey 96.8 96.4

New Mexico 55.1 56.0

Twenty-six States attained the target in both 1998 and

New York 104.9 109.0

1999.

North Carolina 254.8 253.9

North Dakota 12.5 13.1

In 1999, 21 States had rates between the year 2000

Ohio 163.0 161.2

target (100) and the 1989 baseline (300).

Oklahoma 156.7 119.7

Oregon 26.8 27.2

In 1999, four States had rates greater than the baseline

Pennsylvania 97.6 110.8

for the United States in 1989 (300).

Rhode Island 43.5 60.7

South Carolina 301.7 387.0

SOURCE: CDC, NCHSTP, Sexually Transmitted Disease Surveillance System.

South Dakota 29.9 26.2

Tennessee 218.0 207.3

Texas 166.2 164.2

Utah 11.2 11.9

Vermont 6.4 8.8

Virginia 136.4 136.8

Washington 34.2 37.0

West Virginia 50.8 32.3

Wisconsin 121.6 126.9

Wyoming 7.5 9.0

States

58 Healthy People 2000 Final Review

Figure UU. Objective 19.3--Reported cases of primary and secondary syphilis per 100,000 population:

United States and each State, 1998 and 1999

Reported cases

per 100,000

Target

population

status

1998 1999

(4.0)

United States 2.6 2.4

United States --

In 1989, there were 18.1 cases of primary and

secondary syphilis per 100,000 population. The objective for the

Alabama 6.3 4.6

year 2000 was 4 cases per 100,000. In 1999, there were 2.5 cases

Alaska 0.2 0.2

per 100,000. More than 100 percent (111 percent) of the targeted

Arizona 4.0 4.4

change had been achieved in 1999.

Arkansas 4.3 3.4

California 0.9 0.9

Colorado 0.3 0.2

Connecticut 0.8 0.5

Delaware 2.8 1.3

District of Columbia 15.5 8.7

Florida 2.0 2.5

Georgia 4.4 5.5

Hawaii 0.3 0.3

Idaho 0.2 0.1

Illinois 3.5 3.5

Indiana 3.6 7.6

Iowa 0.2 0.3

Kansas 0.5 0.5

Kentucky 2.7 2.5

Louisiana 9.8 7.0

Maine 0.1 0.0

Maryland 12.6 6.6

Massachusetts 0.7 0.6

Michigan 2.1 2.5

Minnesota 0.2 0.2

Mississippi 9.5 7.0

Missouri 2.0 1.8

Montana 0.0 0.1

Nebraska 0.5 0.4

Nevada 0.9 0.3

New Hampshire 0.2 0.1

New Jersey 1.3 0.8

New Mexico 0.8 0.7

Thirty-eight States attained the target in both 1998 and 1999.

New York 0.7 0.8

North Carolina 9.6 6.1

North Dakota 0.0 0.0

One State attained the target only in 1999.

Ohio 1.2 0.8

Oklahoma 2.9 5.6

In 1999, 12 States had rates between the year 2000

Oregon 0.2 0.2

target (4.0) and the 1989 baseline (18.1).

Pennsylvania 0.8 0.7

Rhode Island 0.1 0.3

SOURCE: CDC, NCHSTP, Sexually Transmitted Disease Surveillance System.

South Carolina 7.1 6.9

South Dakota 0.1 0.0

Tennessee 10.4 11.7

Texas 2.2 2.4

Utah 0.2 0.1

Vermont 0.7 0.5

Virginia 2.2 2.2

Washington 0.8 1.3

West Virginia 0.2 0.3

Wisconsin 1.1 0.8

Wyoming

0.0 Quantity more than zero but less than 0.05.

0.2 0.0

States

Healthy People 2000 Final Review 59

Figure WW. Objective 20.1--Reported cases of measles: United States and each State, 1998 and 1999

Number of cases

1998 1999

United States 100 100

United States --

The United States did not attain the target of

zero cases of measles in 1998 or 1999. The number of measles

Alabama 1 0

cases was reduced by 97 percent from 3,396 in 1988 to 100 in both

Alaska 33 0

1998 and 1999.

Arizona 11 1

Arkansas 0 5

California 9 17

Colorado 0 0

Connecticut 0 2

Delaware 1 0

District of Columbia 0 0

Florida 2 2

Georgia 2 0

Hawaii 0 3

Idaho 0 0

Illinois 1 2

Indiana 3 2

Iowa 0 0

Kansas 0 0

Kentucky 0 2

Louisiana 0 0

Maine 0 0

Maryland 1 0

Massachusetts 2 8

Michigan 10 6

Minnesota 0 1

Mississippi 0 0

Missouri 0 0

Montana 0 0

Nebraska 0 0

Nevada 0 1

New Hampshire 0 1

New Jersey 8 0

New Mexico 0 0

Twenty States attained the target in both 1998 and 1999.

New York 4 5

North Carolina 1 0

Twelve States attained the target in 1999 but not in 1998.

North Dakota 0 0

Ohio 1 0

Nineteen States did not attain the target in 1998 or in 1999.

Oklahoma 0 0

Oregon 0 12

Pennsylvania 4 0

SOURCE: CDC, EPO, National Notifiable Disease Surveillance System.

Rhode Island 0 0

South Carolina 0 0

South Dakota 0 0

Tennessee 1 0

Texas 0 7

Utah 0 0

Vermont 1 0

Virginia 2 18

Washington 1 5

West Virginia 0 0

Wisconsin 1 0

Wyoming 0 0

States

Target

status

(0)

60 Healthy People 2000 Final Review

Figure YY. Objective 20.11--Estimated vaccination coverage with the 4DTP/3polio/1MMR series

among children ages 19-35 months: United States and each State, 1998 and 1999

Target

Percent

status

1998

1999

(90)

United States 80.6 79.9

United States --

In 1992, the vaccination coverage with the 4:3:1

series was 55 percent. In 1999, coverage had reached 80 percent,

Alabama 84.0 79.7

therefore, 71 percent of the targeted increase in immunization had

Alaska 82.7 82.2

been achieved in 1999.

Arizona 77.8 73.9

Arkansas 74.8 78.5

California 77.7 78.3

Colorado 78.2 77.2

Connecticut 90.7 87.1

Delaware 80.6 80.0

District of Columbia 73.7 78.5

Florida 80.9 82.0

Georgia 81.1 83.1

Hawaii 81.7 82.8

Idaho 76.4 70.0

Illinois 79.1 78.8

Indiana 78.9 75.4

Iowa 83.4 84.5

Kansas 83.6 79.7

Kentucky 83.0 88.6

Louisiana 79.7 76.9

Maine 89.0 84.1

Maryland 78.8 80.5

Massachusetts 87.4 87.3

Michigan 78.9 75.9

Minnesota 83.1 87.0

Mississippi 83.7 81.7

Missouri 85.8 75.5

Montana 82.8 84.8

Nebraska 78.0 83.7

Nevada 78.5 73.4

New Hampshire 85.1 84.5

New Jersey 85.0 80.9

New Mexico 73.3 75.6

Two States attained the target in 1999.

New York 85.7 83.4

North Carolina 84.1 81.8

Forty-nine States did not attain the target in 1998 and 1999

North Dakota 79.8 83.0

or in 1999.

Ohio 78.6 79.1

Oklahoma 78.5 74.0

SOURCE: CDC, NCHS and NIP, National Immunization Survey.

Oregon 75.5 73.2

Pennsylvania 84.0 86.6

Rhode Island 87.3 90.4

South Carolina 88.4 81.1

South Dakota 75.1 83.4

Tennessee 82.6 79.5

Texas 74.8 74.7

Utah 76.8 81.7

Vermont 87.3 90.7

Virginia 82.0 81.6

Washington 81.1 76.5

West Virginia 82.7 82.1

Wisconsin 79.3 85.4

Wyoming 80.4 83.5

4 or more doses of DTP/DT (diphtheria, tetanus, pertussis), 3 or more doses of polio, 1 or more doses of MMR (measles, mumps, rubella).

States

Healthy People 2000 Final Review 61

Figure ZZ. Objective 21.4--Percent of persons under 65 years of age with no health insurance coverage:

United States and each State, 1998 and 1999

Percent with no

health care

Target

coverage

status

1998 1999

(0)

United States (NHIS) 16.6 ---

United States --

In 1998, based on data from the National Health

Interview Survey (NHIS), 16.6 percent of the population under 65

United States (CPS) 18.4 17.4

years of age had no health insurance coverage (age adjusted). The

Alabama 19.5 16.2

baseline in 1989 was 15.7 percent. The proportion without health

Alaska 17.9 20.0

insurance coverage was greater in 1998 than it was in 1989.

Arizona 26.9 24.0

Arkansas 21.7 16.9

In 1999, based on data from the Current Population Survey (CPS),

California 24.4 22.3

17.4 percent of the population under 65 years of age had no health

Colorado 16.4 18.3

insurance coverage.

Connecticut 14.3 11.3

Delaware 17.1 12.8

District of Columbia 19.2 17.6

Florida 21.1 22.8

Georgia 19.4 17.9

Hawaii 11.3 12.3

Idaho 19.7 21.6

Illinois 16.6 15.7

Indiana 16.1 12.3

Iowa 10.9 9.5

Kansas 12.2 13.9

Kentucky 16.0 16.3

Louisiana 21.3 25.0

Maine 14.6 13.2

Maryland 18.9 13.5

Massachusetts 11.6 11.8

Michigan 14.9 12.4

Minnesota 10.3 8.9

Mississippi 22.9 18.9

Missouri 12.1 9.6

Montana 21.9 21.0

Nebraska 10.2 12.3

Nevada 23.7 22.8

New Hampshire 12.5 11.3

New Jersey 18.0 15.0

States

New Mexico 24.0 29.4

Based on the CPS data, 24 States had proportions of

New York 19.7 18.5

persons with no health insurance coverage greater

North Carolina 17.0 17.3

than the national target for the year 2000 (0) and

North Dakota 16.5 13.8

less than the national baseline in 1989 (15.7).

Ohio 11.7 12.5

Oklahoma 21.2 20.4

Oregon 16.0 16.4

In 1999, 27 States had proportions of persons

Pennsylvania 12.1 11.0

with no health insurance coverage greater than or equal

Rhode Island 7.6 8.1

to the national baseline in 1989 (15.7).

South Carolina 17.4 20.1

South Dakota 16.3 13.5

SOURCE: U.S. Census Bureau, Current Population Survey.

--Data not available.

Tennessee 14.3 12.6

Texas 26.9 25.7

NOTE: The NHIS data are age adjusted and refer to coverage at the time of the survey. The CPS

data are not age adjusted and refer to coverage during the previous calendar year. Despite these

differences, target attainment is assessed based on the CPS data because the objective was to

reduce the percent of the population without health insurance coverage to zero.

Utah 15.1 15.3

Vermont 11.0 13.6

Virginia 15.8 15.8

Washington 13.4 17.5

West Virginia 20.8 20.5

Wisconsin

Wyoming

13.2

18.8

12.2

17.8

62 Healthy People 2000 Final Review

Healthy People 2000 Priority Areas

Priority Area 1

Physical Activity and

Fitness

Background

The importance of physical activity,

fitness, and exercise spans a spectrum of

public health issues ranging from

disease prevention and enhancement of

a healthy lifestyle for all age groups to

the maintenance of an independent

lifestyle in the later stages of life (1).

Research has demonstrated that virtually

all individuals can benefit from regular

physical activity, whether they

participate in vigorous exercise or some

type of moderate health-enhancing

physical activity (2).

The importance of physical activity

in reducing morbidity and mortality

from chronic diseases has been well

established. A 1990 study showed that

14 percent of all deaths in the United

States were attributed to diet and

activity patterns (3). A more recent

study linked sedentary lifestyles to

23 percent of deaths from the major

chronic diseases (4). For example,

physical activity has been shown to

reduce the risk of developing or dying

from heart disease, diabetes, colon

cancer, and high blood pressure (2).

Some evidence suggests that physical

activity may also protect against lower

back pain and some forms of cancer (for

example, breast cancer) (5,6). On

average, people who are physically

active outlive those who are inactive (4,

7–10). However, most adults and many

children are not active enough to

achieve these health benefits, and the

prevalence of physical activity has

changed only slightly in the past decade

(2). Only 30 percent of adults spend

sufficient time in moderate activity and

only 14 percent are vigorously active at

the suggested levels.

The economic burden of physical

inactivity is substantial. One study

estimated that increasing regular

moderate physical activity among the

more than 88 million inactive Americans

over the age of 15 years might reduce

the annual national direct medical costs

by as much as $76.6 billion in 2000

dollars (11).

Data Summary

Highlights

More than one-half of the physical

activity and fitness objectives either

achieved or moved toward the year

2000 targets. The age-adjusted death

rate from coronary heart disease (1.1)

for the population as a whole declined

to a level that exceeded the year 2000

target, dropping from 156 deaths per

100,000 persons in 1987 to 87 per

100,000 in 1998. Among blacks, the

coronary heart disease death rate also

dropped but fell short of meeting the

year 2000 target.

Gains were made in increasing the

proportion of worksites that offer

physical fitness programs (1.10). By

1999, three of the four size groupings

for worksites (those with 50–99

employees, 100–249 employees, and

250–749 employees) had exceeded their

year 2000 targets, while worksites with

750 and more employees moved toward

but did not meet the target.

Participation in moderate (1.3)

physical activity five or more times per

week increased over the decade, meeting

the year 2000 target of 30 percent,

whereas the proportion of adults

participating in physical activity seven

or more times per week moved toward,

but did not meet the 30–percent target.

Regular participation in strengthening

and stretching exercises (1.6) among

students in grades 9–12 met the year

2000 target of 40 percent, while

participation among persons ages 18–64

years increased to 19 percent for weight

lifting and 32 percent for stretching. A

small improvement was also seen in the

proportion of persons participating in

vigorous (1.4) physical activity.

Some objectives moved away from

the year 2000 targets. The prevalence of

overweight (1.2) increased across all

population groups with the greatest

increase occurring among adolescents

ages 12–19 years. The proportion of

both male and female adults reporting

the use of sound weight loss practices

(1.7) decreased as did the proportion of

students participating in daily physical

education at school (1.8), and the

number of people 70 years and over

(1.13) needing help with self care.

Summary of Progress

Of the 13 objectives that address

physical activity and fitness, 1 objective

(1.1) surpassed the year 2000 target.

Another six objectives (1.3, 1.4, 1.6,

1.9, 1.10, and 1.12) moved toward their

targets, and four objectives (1.2, 1.7,

1.8, and 1.13) moved away from their

targets. One objective (1.5) showed no

change, and data are not available to

measure progress for the remaining

objective (1.11). See table 1 for the

tracking data for the objectives in this

priority area and figure 1 for a

quantitative assessment of progress.

Discussion

While 7 of the 13 objectives related

to physical activity and fitness showed

improvement by the end of the decade,

greater progress could be realized if

certain barriers are overcome. Moving

the Nation’s population into a more

active lifestyle is complicated and

requires changes at many levels

including individual behavior,

environmental features, policy issues,

social norms, and family supports. For

example, in spite of evidence that

suggests active children are likely to

become active adults, schools no longer

require daily physical education. School,

however, may be the best opportunity

for children to be active because most

children do not walk or ride a bike to

school and many spend the time after

school in sedentary activities (for

example, homework or watching

television). Similarly, worksites that

provide facilities and other supports for

an active lifestyle may offer the best

opportunities for adults.

Because physical inactivity is a risk

factor for many diseases and conditions,

making physical activity an integral part

of daily life is crucial. To achieve the

physical activity and fitness objectives,

public health programs will need to

develop comprehensive approaches that

provide for participation in physical

activities at many levels. Such

approaches should include

environmentally based strategies aimed

at increasing access to facilities as well

as efforts that promote family and

community activities (for example, at

schools, worksites, and communities).

Transition to Healthy People

2010

In Healthy People 2010, the focus

of the physical activity and fitness

objectives has been expanded to include

a broader range of activities than those

Healthy People 2000 Final Review 65

-100 -80 -60 -40 -20 0

Percent of target achieved

20 40 60 80 100

1.1 Coronary heart disease deaths

1.2 Overweight prevalence: 20-74 years

Male

Female

Adolescents 12-19 years

1.3 Light-to-moderate physical activity:

5 or more times per week

7 or more times per week

1.4 Vigorous physical activity 18 years and over

Students in grades 9-12

1.5 Sedentary lifestyle

1.6 Strengthening exercises: Grades 9-12

People 18-64 years

Stretching exercises: Grades 9-12

People 18-64 years

1.7 Weight loss practices: Overweight males

Overweight females

1.8 Daily school physical education: Grades 9-12

1.9 Active physical education: 21 or more minutes,

3-5 times per week

30 or more minutes, 1 time per week

1.10 Worksite fitness: 50-99 employees

100-249 employees

250-749 employees

750 or more employees

1.13 Difficulty with self-care: 70 years and over

Moved away from target Moved toward target Met target

* This objective has moved away from its target. A progress quotient could not be calculated.

NOTE: Complete tracking data are shown in table 1. Progress quotients are not calculated for objectives 1.11 and 1.12.

See the section on Measuring Progress Toward the

Healthy People 2000

Targets in the Appendix for more information.

109%

-150%

-250%

-143%

-40%

-43%

54%

28%

29%

25%

Away*

No change

39%

-60%

-163%

100%

400%

158%

133%

66 Healthy People 2000 Final Review

Figure 1. Final status of Physical Activity and Fitness objectives

presented in Healthy People 2000.To

avoid duplication of objectives across

chapters, some topics previously

included in the Healthy People 2000

Physical Activity and Fitness chapter are

only in the Healthy People 2001 focus

areas that were considered their

‘‘primary homes’’ (for example, the

objectives for coronary heart disease

deaths and overweight prevalence are

located only in the Heart Disease and

Stroke and the Nutrition and Overweight

chapters, respectively).

The Healthy People 2010 Physical

Activity and Fitness chapter is organized

into four sections: physical activity in

adults, muscular strength/endurance and

flexibility, physical activity in children

and adolescents, and access. The

Healthy People 2010 objectives continue

to reflect the importance of moderate

activity in achieving and maintaining a

healthy lifestyle. For example, the 2010

objectives include measures of walking

and bicycling, and public access to local

school facilities after hours. These

objectives replace the unmeasured

Healthy People 2000 objective assessing

community fitness facilities (1.11)by

encouraging a combination of individual

behavior (walking or bicycling) and

community support for activity.

Attention on activity patterns among

children and adolescents is highlighted

in its own section, which includes

objectives on moderate and vigorous

physical activity, as well as school-based

policy objectives. A new objective

calling for a limit on television viewing

has been included in Healthy People

2010. This emphasis on children and

adolescents is particularly appropriate

considering that the health benefits of

physical activity are not limited to

adults and that patterns adopted early in

life may continue into adulthood.

The objective on physician

counseling regarding exercise (1.12) has

been combined with other counseling

behaviors to create a new objective in

the Healthy People 2010 chapter on

Access to Quality Health Services.

Likewise, a Healthy People 2010

objective on the importance of teaching

physical activity in health classes is in

the Educational and Community-Based

Programs chapter. Because physical

activity affects many other health

conditions, related objectives have been

identified from 23 other chapters.

Physical activity is the topic of 1 of

the 10 Leading Health Indicators (LHIs),

which Healthy People 2010 introduces

to serve as a barometer of the Nation’s

health. Two objectives from the Healthy

People 2010 Physical Activity and

Fitness focus area—the proportion of

adolescents who engage in vigorous

physical activity that promotes

cardiorespiratory fitness 3 or more days

per week for 20 or more minutes per

occasion and the proportion of adults

who engage regularly, preferably daily,

in moderate physical activity for at least

30 minutes per day—are used to

measure this LHI.

Appendix table III, a crosswalk

between Healthy People 2000 and

Healthy People 2010 objectives,

summarizes the changes between the

two decades of objectives, reflecting

new knowledge and direction for this

area.

Data Issues

Definitions

Operational definitions and data

collection specifications for all Healthy

People 2000 objectives in Priority Area

1 have been published in the National

Center for Health Statistics’ Healthy

People Statistical Notes series (12). Data

issues are discussed and references are

cited for expanded discussions of the

data systems that provide data for the

national objectives. Where appropriate,

the text of the questionnaire items used

to measure the objectives is also

provided. See the Appendix for further

information.

Coronary heart disease deaths (1.1)

are defined by ICD–9 codes 402,

410–414, and 429.2. These codes are

different from the codes used to define

the category ‘‘Diseases of heart,’’ which

often appears in published tables (see

the Appendix and Appendix table II).

When the Healthy People 2000

objectives were released in 1990 (13),

physical activity as a recognized benefit

for health outcomes was still a relatively

new concept; this newness contributed

to difficulties in tracking some

objectives with appropriate operational

definitions. Calculations vary from

simple counts (for example,

weight-training three or more times a

week) to complex formulas (for

example, calculating average kilocalories

expended per kilogram per day) (14).

Because of the growing appreciation of

the benefits of regular physical activity,

the intent of objective 1.3

(light-to-moderate physical activity) was

to generate calorie-burning activity by

emphasizing the importance of regular

physical activity that can be sustained

throughout the lifespan. The sum of all

physical activities performed at least 30

minutes per occasion five or more or

seven or more times a week regardless

of the intensity has been defined as

measuring this objective.

To measure the proportion of adults

performing vigorous physical activity

(1.4), the predicted maximum

cardiorespiratory capacity was estimated

using age- and sex-based regression

equations and then multiplying by

50 percent. Next, all the activities that

were performed for at least 20 minutes

that had a kilocalorie value that was

equal to or greater than that 50 percent

level were counted (15,16). The

estimated number of people who

exercise vigorously were respondents

who performed these activities three or

more times per week.

Overweight (1.2) for adults is

defined as a body mass index (BMI) at

or above the sex-specific 85th percentile

of the 1976–80 Second National Health

and Nutrition Examination Survey

(NHANES II) reference population

20–29 years of age. For adolescents,

overweight is the sex- and age-specific

85th percentile from NHANES II. BMI

cutoff points for adults are 27.8

kilograms per meter squared for males,

and 27.3 kilograms per meter squared

for females. Healthy People 2010

defines the upper limit of the healthy

weight range as a BMI of less than 25

because chronic disease risk increases in

most populations at or above this

cut-point (1). See the Nutrition chapter

(Priority Area 2) for additional

information.

The 1984–85 baseline figures for

objective 1.13 were derived by

combining estimates for the

noninstitutionalized population from the

1984 National Health Interview Survey

(NHIS) Supplement on Aging (SOA)

with data for those in nursing homes

from the 1985 National Nursing Home

Survey (NNHS). The 1984 SOA asked

about seven specific personal care

activities, also referred to as activities of

daily living (ADLs) for persons 65 years

and over. Because of the way the

questions were asked on the NNHS,

only five ADLs (bathing, dressing, using

the toilet, getting in and out of bed or

chair, and eating) were used for tracking

this objective. The numerator included

respondents to the SOA who said they

Healthy People 2000 Final Review 67

had ‘‘any difficulty’’ performing at least

two ADLs combined with patients for

whom administrators reported to the

NNHS as ‘‘receiving assistance’’ with at

least two ADLs. The denominator for

the baseline was the civilian,

noninstitutionalized population 65 years

and over plus the nursing home

population 65 years and over. The

update for this objective is derived from

combined data from the 1994 NHIS

Second Supplement on Aging (SOA II)

and data from the 1995 NNHS using the

same questions as were used for the

baseline. However, the 1994–95 update

is for persons 70 years and over. The

1984–85 data were also computed for

ages 70 years and over to provide a

comparison with the 1994–95 update.

Data Comparability

Overweight (1.2) was tracked with

two data sources. The primary data

source is the NHANES, which provided

baseline data for most of the overweight

objectives and the 1988–94 updates;

these data are derived from measured

height and weight. The second data

source is the NHIS. This survey

provides interim estimates shown in an

earlier publication (17), updates for

Hispanic females and American

Indians/Alaska Natives, and all data for

people with disabilities. NHIS estimates

are based on self-reported heights and

weights and are not comparable with the

actual measured data from NHANES:

Prevalence estimates of overweight from

self-reported height and weight are

lower. Trends from the NHIS self-report

measures, like those from NHANES,

show a steady increase in prevalence of

overweight; this increase, however, is

different in magnitude from that

observed in the data derived from

measured height and weight.

Objective 1.3 (light-to-moderate

physical activity) was tracked with the

NHIS. The list of activities asked on the

NHIS has not been identical from year

to year. The 1985 and 1990 surveys did

not ask about some activities for people

65 years and over; thus, the data shown

are for people 18–64 years of age. The

1991, 1995, and 1998 surveys asked

about some different activities than the

previous surveys, but people of all age

groups were asked the same questions.

Because of these differences, data from

1985 and 1990 are not comparable to

later data.

The 1985 and 1992 data for

objective 1.10 are from the National

Survey of Worksite Health Promotion

Activities, which were telephone surveys

of nongovernment worksites. Worksites

were sampled because different

worksites within the same company

could have different sets of health

promotion activities. Both active

methods (such as classes) and passive

methods (such as brochures) were

counted as worksite health promotion

activities. The 1995 update is from the

CDC-sponsored Worksite Benchmark

Survey, which used a methodology very

similar to the 1992 survey but did not

include passive methods of health

promotion (18,19). The 1998–99 data

are from the National Worksite Health

Promotion Survey, which randomly

sampled nongovernmental worksites of

50 or more employees in a particular

geographic location. This telephone

survey included questions regarding the

offering of some types of physical

activity or fitness facility for employees

at the workplace or through the

company’s health plans (20). The

1998–99 data are not comparable to the

data that were collected earlier, although

sponsored by the University of Florida.

The 1986 baseline for internists is from

the American College of Physicians

(ACP) Membership Survey of

Prevention Practices in Adult Medicine.

The sampling frame for internists in the

1992 Primary Care Provider Surveys

(PCPS) contained a random stratified

sample of ACP members drawn from

four geographic regions with

oversampling of female members,

yielding an initial sample of 1,200

internists. Additional provider groups

sampled in the 1992 PCPS included

pediatricians, nurse practitioners,

obstetricians/gynecologists, and family

physicians. Response rates varied from

50 to 80 percent across these groups.

The PCPS data on inquiry for objective

3.16 refer to the proportion of providers

who routinely provided service to

81–100 percent of their clients. Data on

counseling about smoking cessation

represent the proportion of providers

who routinely delivered these services to

81–100 percent of their clients who

needed the intervention. Reporting of

counseling could have been independent

of the assessment made by the clinician.

The American College of

Physicians’ Prevention in Primary Care

Study (PPCS) was conducted in

1997–98 to update data from the 1992

PCPS. The design and items included in

the 1997–98 study were similar to the

PCPS, but a slightly different sampling

frame was used and some items

included in the 1992 surveys were not

included in the PPCS. The providers

were sampled from listings of all

licensed, active practitioners in the

United States whose practices were at

least 50 percent primary care. Because

of low response rates from the other

provider groups, updates are available

only for nurse practitioners.

Data Comparability

Information on objective 3.9

(smokeless tobacco use by males ages

12–24 years) was tracked by two

surveys. Males ages 12–17 years were

tracked by the NHSDA. In this survey,

smokeless tobacco use was defined as

any use of snuff or chewing tobacco in

the preceding month. For males ages

18–24 years, information was obtained

from the NHIS. The NHIS defines a

smokeless tobacco user as someone who

has used either snuff or chewing

tobacco at least 20 times and who

currently uses either of these substances

every day or some days, at the time of

the survey. Information for males ages

18–25 years was also available from the

NHSDA using the same definition as for

those ages 12–17 years. According to

the NHSDA, smokeless tobacco use

among males ages 18–24 years showed

a downward trend similar to that

observed from the NHIS. The smokeless

98 Healthy People 2000 Final Review

tobacco use prevalence estimate from

NHSDA was higher than the NHIS

estimate (11.7 percent compared with

8.2 percent, respectively, in 1992).

Differences between the NHSDA and

the NHIS may be due to differences in

the definition of smokeless tobacco use

between the two surveys and/or

methodological differences in survey

administration.

References

1. Department of Health and Human Services.

Reducing tobacco use: A report of the Surgeon

General. Atlanta, Georgia: Centers for Disease

Control and Prevention, National Center for

Chronic Disease Prevention and Health Promotion,

Office on Smoking and Health. 2000.

2. Centers for Disease Control and Prevention.

Smoking-attributable mortality and years of

potential life lost—United States, 1990. MMWR

42(33):645–9. 1993.

3. Centers for Disease Control and Prevention.

Achievements in Public Health, 1900–1999:

Tobacco use—United States, 1900–1999. MMWR

48(43):986. 1999.

4. Centers for Disease Control and Prevention.

Smoking-attributable mortality and years of

potential life lost—United States, 1984 (with

editorial note, 1997). MMWR 46(20):444–51.

1997.

5. Centers for Disease Control and Prevention.

Medical-care expenditures attributable to cigarette

smoking, United States, 1993. MMWR

43(26):469–72. 1994.

6. Herdman R, Hewitt M, Laschober M.

Smoking-related deaths and financial costs: Office

of Technology Assessment estimates for 1990

(Congressional Testimony). Washington: Office of

Technology Assessment. 1993.

7. Centers for Disease Control and Prevention.

Medical-care expenditures attributable to cigarette

smoking during pregnancy—United States, 1995.

MMWR 46(44):1048–50. 1997.

8. Department of Health and Human Services. The

health benefits of smoking cessation. Atlanta,

Georgia: Centers for Disease Control and

Prevention, National Center for Chronic Disease

Prevention and Health Promotion, Office on

Smoking and Health. 1990.

9. Fingerhut LA, Kleinman JC, Kendrick JS.

Smoking before, during, and after pregnancy. Am

J Public Health 80:541–4. 1990.

10. Chomitz VR, Cheung LW, Lieberman E. The

role of lifestyle in preventing low birth weight.

Future Child 5(1):121–38. 1995.

11. U.S. Environmental Protection Agency.

Respiratory health effects of passive smoking:

Lung cancer and other disorders. Washington: U.S.

Environmental Protection Agency, Office of

Research and Development, Office of Air and

Radiation. 1992.

12. Centers for Disease Control and Prevention.

Trends in Cigarette Smoking Among High School

Students United States, 1991–1999. MMWR

49(33):755. 2000.

13. Centers for Disease Control and Prevention.

Tobacco Use Among Middle and High School

Students United States, 1999. MMWR 48(3):

49–53. 2000.

14. Department of Health and Human Services.

Healthy people 2010. 2d ed. With understanding

and improving health and objectives for improving

health. 2 vols. Washington: U.S. Government

Printing Office. 2000.

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United States. Tobacco Control 1993; 2

(Supplement): S3–S10. 1993.

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Preventing tobacco use among young people: A

report of the Surgeon General. Atlanta, Georgia:

Public Health Service, Centers for Disease Control

and Prevention, National Center for Chronic

Disease Prevention and Health Promotion, Office

on Smoking and Health. 1994.

17. Department of Health and Human Services.

Substance Abuse and Mental Health

Administration, Center for Substance Abuse

Prevention. Substance Abuse Prevention and

Treatment Block Grant Program, State Annual

Synar Reports. 1998–99.

18. Kvale K, Glysch RL, Gothard M, et al. Trends

in smoking during pregnancy, Wisconsin 1990 to

1996. Wisconsin Med J 99(2):63–7. 2000.

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Tobacco use among U.S. racial/ethnic minority

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Georgia: Centers for Disease Control and

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Prevention and Health Promotion, Office on

Smoking and Health. 1998.

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(SS–3). 1994.

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46(20):433–40. 1997.

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Healthy People 2000 Final Review 99

Table 3. Tobacco objectives

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

3.1* Coronary heart disease deaths (age

adjusted per 100,000) ................. 1987 135 122 118 114 114 110 108 105 100 97 - - - 100

a. Black ........................... 1987 168 158 156 151 154 147 147 140 136 133 - - - 115

3.2* Slow the rise in lung cancer deaths (age

adjusted per 100,000) ................. 1987 38.5 39.9 39.6 39.3 39.3 38.7 38.3 37.8 37.3 36.9 - - - 42

a. Female.......................... 1990 25.6 . . . 25.8 26.3 26.5 26.6 26.9 26.8 26.9 27.0 - - - 27

b. Black male ....................... 1990 86.1 . . . 83.1 81.2 80.7 77.6 75.7 73.4 70.5 68.5 - - - 91

3.3 Slow the rise in chronic obstructive

pulmonary disease deaths (age adjusted

per 100,000) ........................ 1987 18.9 19.7 20.1 19.9 21.4 21.0 20.8 21.0 21.1 21.3 - - - 25

3.4* Cigarette smoking prevalence

People 18 years and over ............... 1987 29% 25% 26%

27% 25% 26% 25% - - -

‡

25%

‡

24% - - - 15%

Male ............................. 1987 31% 28% 28%

29% 28% 28% 27% - - -

‡

28%

‡

26% - - - 15%

Female ........................... 1987 27% 23% 23%

25% 22% 23% 23% - - -

‡

22%

‡

22% - - - 15%

a. People with high school education or

less

20 years and over ................ 1987 34% 31% 31%

32% 30% 31% 30% - - -

‡

31%

‡

31% - - - 20%

b Blue-collar workers 18 years and over . . 1987 41% 36% 36%

36% 34% 39% 36% - - -

‡

37%

‡

36% - - - 20%

c. Military personnel .................. 1988 42% - - - - - -

35% --- --- 32% --- --- 30% --- 20%

d. Black 18 years and over ............. 1987 33% 26% 29%

28% 26% 27% 26% - - -

‡

27%

‡

25% - - - 18%

e. Hispanic 18 years and over .......... 1987 24% 23% 20%

21% 20% 20% 18% - - -

‡

20%

‡

19% - - - 15%

f. American Indian/Alaska Native 18 years

and over ....................... 1979-87

42-70% 38% 31%

40% 39% 40% 35% - - -

‡

32%

‡

37% - - - 20%

g. Southeast Asian male ............... 1984-88 55%

35%

36-41% - - - - - - - - - - - - - - - - - - - - - - - - 20%

h. Females of reproductive age

(18-44 years) .................... 1987 29% 26% 27%

28% 26% 27% 26% - - -

‡

26%

‡

25% - - - 12%

i. Pregnant females .................. 1985 25% 19% 20% - - - 20% - - - 18% 14% 13% 13% - - - 10%

j. Females who use oral contraceptives . . . 1983 36%

26% --- --- --- --- 24% --- --- --- --- 10%

3.5 Smoking initiation by children and

adolescents (proxy 20-24 years) ........ 1987 30% 26% 24% 28% 27% 30% 26% - - -

‡

31%

‡

29% - - - 15%

a. Lower socioeconomic status people

20-24 years

.................... 1987 40% 35% 33% 38% 38% 39% 31% - - -

‡

44%

‡

42% - - - 18%

3.6 Smoking cessation attempts ........... 1986 34% - - - 56% 46% 47% 46% 46% - - -

‡

44%

‡

42% - - - 50%

3.7 Smoking cessation during pregnancy

(18-49 years) ....................... 1985

3 9 % --- 1 6 % --- --- --- --- --- --- 1 4 % --- 6 0 %

a. Females with less than a high school

education ....................... 1985

28% - - -

--- --- --- --- --- --- ---

--- --- 45%

3.8* Children’s exposure to smoke at home

(6 years and under) .................. 1986 39% - - - 32% - - - 27% 27% - - - - - - - - - 20% - - - 20%

3.9* Smokeless tobacco use

Male 12-17 years ..................... 1988 6.6% - - - 5.3% 4.8% 3.9% 5.1% 4.9% 3.5% 3.7% 2.2% - - - 4%

Male 18-24 years ..................... 1987 8.9% - - - 9.9% 8.2% 7.8% 6.9% - - - - - - - - - 6.9% - - - 4%

a. American Indian/Alaska Native

18-24 years ...................... 1986-87

18-64% - - -

---

--- --- --- ---

--- --- 10%

See footnotes and key at end of table.

100 Healthy People 2000 Final Review

Table 3. Tobacco objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

3.10 Tobacco-use prevention education and

tobacco-free schools

School districts providing tobacco-free

environments .......................

1988 17% - - - - - - - - - - - -

36.5% - - - - - - - - - - - - - - - 100%

School districts providing anti-smoking

education

High school ........................ 1988 78% - - - - - - - - - - - - 90.7% - - - - - - - - - - - - - - - 100%

Middle school ...................... 1988 81% - - - - - - - - - - - - 82.5% - - - - - - - - - - - - - - - 100%

Elementary school................... 1988 75% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 100%

3.11 Worksites with smoking policies

Policy that bans smoking or limits it to

separately ventilated areas

50 or more employees ................. 1985 27% - - - - - - 59% - - - - - - - - - - - - - - - - - -

79% 100%

Any smoking policy

Medium and large companies .......... 1987 54% - - - 85% - - - - - - - - - - - - - - - - - - - - - - - - 100%

50 or more employees................ ... --- --- --- 86% --- --- 87% --- --- --- --- ...

3.12 Number of States with comprehensive

laws for clean indoor air

Private workplaces .................... 1995

1 ... ... ... ... ... ... 1 1 1 --- 51

Public workplaces ..................... 1995

9 ... ... ... ... ... ... 9 12 13 --- 51

Restaurants ......................... 1995 2 . . . . . . . . . . . . . . . . . . 3 3 3 - - - 51

Public transportation ................... 1995

17 ... ... ... ... ... ... 17 17 16 --- 51

Hospitals............................ 1995

8 ... ... ... ... ... ... 8 8 --- --- 51

Day care centers ..................... 1995 21 . . . . . . . . . . . . . . . . . . 21 21 22 - - - 51

Grocery stores ....................... 1995

4 ... ... ... ... ... ... 4 4 4 --- 51

3.13 Number of States with tobacco product

sale and distribution to youth laws

.... 1990 45 . . . 50 50 51 51 51 51 51 51 51 51

Number of States enforcing laws to achieve

buy rates no higher than 20 percent ...... ... --- --- --- --- --- --- --- ---

4 --- --- ...

3.14 Number of States with plans to reduce

tobacco use........................ 1989 12 - - - - - -

35 ---

39 ---

51 51

3.15 Tobacco product advertising and

promotion to youth ..................

1990

Minimal

restrictions . . . - - - - - - - - - - - - - - - - - - - - - - - - - - -

Eliminate

or severely

restrict

3.16 Cessation counseling and followup by

clinicians

Percent of clinicians routinely providing

service to at least 75% of patients

Inquiry about smoking

General dentists .................... 1986 26% - - - - - - - - - - - - 32.8% - - - - - - - - - - - - - - - 75%

Advised patients about smoking (among

patients reporting smoking)

General dentists .................... 1986 35% - - - - - - - - - - - - 64.8% - - - - - - - - - - - - - - - 75%

Internists (including sub-specialists) ...... 1986 52% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 75%

See footnotes and key at end of table.

Healthy People 2000 Final Review 101

Table 3. Tobacco objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Inquiry about smokeless tobacco use

General dentists .................... ... --- --- --- --- --- 14.4% - - - - - - - - - - - - - - - . . .

Advised patients about smokeless tobacco

use (among patients reporting smokeless

tobacco use)

General dentists .................... ... --- --- --- --- --- 75.0% - - - - - - - - - - - - - - - . . .

Percent of clinicians routinely providing

service to 81–100% of patients

Inquiry about tobacco use

Pediatricians ....................... ... --- --- --- 33% --- --- --- --- ---

12,13

--- --- 75%

Nurse practitioners .................. ... --- --- --- 51% --- --- --- --- ---

66% - - - 75%

Obstetricians/gynecologists ............ ... --- --- --- 49% --- --- --- --- ---

12,13

--- --- 75%

Internists .......................... ... --- --- --- 75% --- --- --- --- ---

12,13

--- --- 75%

Family physicians ................... ... --- --- --- 59% --- --- --- --- ---

12,13

--- --- 75%

Discussion of strategies to quit smoking .... ---

Pediatricians ....................... ... --- --- --- 19% --- --- --- --- ---

12,13

--- --- 75%

Nurse practitioners .................. ... --- --- --- 20% --- --- --- --- ---

39% - - - 75%

Obstetricians/gynecologists ............ ... --- --- --- 28% --- --- --- --- ---

12,13

--- --- 75%

Internists .......................... ... --- --- --- 50% --- --- --- --- ---

12,13

--- --- 75%

Family physicians ................... ... --- --- --- 43% --- --- --- --- ---

12,13

--- --- 75%

3.17 Oral cancer deaths (per 100,000)

Male 45–74 years ..................... 1987 13.6 13.4 12.7 12.2 12.1 11.1 11.0 10.7 10.3 10.4 - - - 10.5

Female 45–74 years ................... 1987 4.8 4.6 4.6 4.3 4.2 4.0 3.9 3.5 3.5 3.4 - - - 4.1

a. Black male 45–74 years ............. 1990 29.4 . . . 26.9 27.3 26.2 25.2 23.4 22.6 20.6 21.0 - - - 26.0

b. Black female 45–74 years ............ 1990 6.9 . . . 6.9 6.0 5.8 5.7 6.4 5.0 5.2 4.6 - - - 6.9

3.18 Stroke deaths (age adjusted per 100,000) . . 1987 30.4 27.7 26.8 26.2 26.5 26.5 26.7 26.4 25.9 25.1 - - - 20.0

a. Black ........................... 1987 52.5 48.4 46.8 45.0 45.0 45.4 45.0 44.2 42.5 41.4 - - - 27.0

3.19 Average age of first use (adolescents

12-17 years)

Cigarettes ........................... 1988 11.6 11.5 11.5 11.7 11.7 12.2 12.3 12.4 12.4 12.4 - - - 12.6

Alcohol ............................. 1988 13.1 12.8 12.6 13.0 12.9 12.8 12.6 13.1 13.1 13.1 - - - 14.1

Marijuana ........................... 1988 13.4 13.4 13.5 13.8 13.9 14.1 13.8 14.4 13.7 13.7 - - - 14.4

3.20 Use in past month by adolescents and

young adults

Alcohol

12-17 years ....................... 1988 33.4% 32.5% 27.0% 20.9% 23.9% 21.6% 21.1% 18.8% 20.5% 19.1% - - - 12.6%

18-20 years ....................... 1994 54.6% . . . . . . . . . . . . . . . 54.1% 50.1% 53.4% 53.5% - - - 29.0%

Hispanic 12-17 years ................ 1988 31.9% 24.2% 28.3% 20.3% 22.0% 18.3% 18.7% 19.9% 18.8% 18.9% - - - 12.0%

Marijuana

12-17 years ....................... 1988 5.4% 4.4% 3.6% 3.4% 4.0% 6.0% 8.2% 7.1% 9.4% 8.3% - - - 3.2%

18-25 years ....................... 1988 15.3% 12.7% 12.9% 10.9% 11.1% 12.1% 12.0% 13.2% 12.8% 13.8% - - - 7.8%

See footnotes and key at end of table.

102 Healthy People 2000 Final Review

Table 3. Tobacco objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Cocaine

12-17 years ....................... 1988 1.2% 0.6% 0.4% 0.3% 0.4% 0.3% 0.8% 0.6% 1.0% 0.8% - - - 0.6%

18-25 years ....................... 1988 4.8% 2.3% 2.2% 2.0% 1.6% 1.2% 1.3% 2.0% 1.2% 2.0% - - - 2.3%

Hispanic 12-17 years ................ 1988 1.4% 2.0% 1.4% 1.3% 1.1% 0.7% 0.8% 1.1% 1.0% 1.4% - - - 0.6%

Hispanic 18-25 years ................ 1994 2.2% . . . . . . . . . . . . . . . 1.1% 2.1% 1.5% 2.7% - - - 1.0%

Cigarettes

12-17 years ....................... 1988

22.7% 22.4% 20.9% 18.4% 18.5% 18.9% 20.2% 18.3% 19.9% 18.2% - - - 6.0%

3.21 Perception of social disapproval by high

school seniors

Heavy use of alcohol .................. 1989 56.4% 59.0% 58.1% 60.8% 58.5% 59.1% 58.0% 57.8% 56.4% 55.5% 57.6% 70%

Occasional use of marijuana ............. 1989 71.1% 76.4% 75.8% 79.2% 73.8% 69.1% 65.4% 63.1% 59.9% 60.4% 61.6% 85%

Trying cocaine once or twice............. 1989 88.9% 90.5% 91.8% 92.2% 91.1% 91.4% 91.1% 89.2% 87.3% 88.8% 88.7% 95%

Smoking one or more packs of cigarettes

perday............................ 1987 74.2% 75.3% 74.0% 76.2% 71.8% 72.4% 69.2% 69.3% 68.5% 69.0% 71.2% 95%

3.22 Perception of harm by high school

seniors

Heavy use of alcohol .................. 1989 44.0% 47.1% 48.6% 49.0% 48.3% 46.5% 45.2% 49.5% 43.0% 43.8% 43.1% 70%

Regular use of marijuana ............... 1989 77.5% 77.8% 78.6% 76.5% 72.5% 65.0% 60.8% 59.9% 58.1% 58.5% 57.4% 90%

Trying cocaine once or twice............. 1989 54.9% 59.4% 59.4% 56.8% 57.6% 57.2% 53.7% 54.2% 53.6% 54.6% 52.1% 80%

Smoking one or more packs of cigarettes

perday............................ 1987 68.6% 68.2% 69.4% 69.2% 69.5% 67.6% 65.6% 68.2% 68.7% 70.8% 70.8% 95%

Using smokeless tobacco regularly ........ 1987

30.0% 34.2% 37.4% 35.5% 38.9% 36.6% 33.2% 37.4% 38.6% 40.9% 41.1% 95%

3.23 Tobacco excise tax (percent of retail price)

Cigarettes ........................... 1993 31.4% . . . . . . . . . . . . 31.0% 31.6% 30.5% 31.5% 28.2% 22.1% 50%

Smokeless tobacco.................... 1993 11.8% . . . . . . . . . . . . - - - 13.8% - - -

13.0% - - - - - - 50%

3.24 Treatment for nicotine addiction

Health plans offering treatment ........... 1985 11% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 100%

3.25 Preemptive clean indoor air laws

States with laws .................... 1995 17 . . . . . . . . . . . . . . . . . . 17 17 17 17 0

3.26 Number of States with laws banning

cigarette vending machines in areas

accessible to minors

................ 1995

12 ... ... ... ... ... ... 14 19 20 21 51

- - - Data not available. Final objective status:

. . . Category not applicable.

Baseline has been revised.

‡

The NHIS was redesigned in 1997. Data may not be comparable with previous years; see Technical Notes.

In 1992, the definition of ‘‘current’’ changed to include ‘‘some days’’ (intermittent smoking).

Estimates for different tribes.

Vietnamese males only.

1988 data.

Among people 20-24 years with a high school education or less.

Baseline for white females 20-24 years.

Data are unreliable. Relative standard error is greater than 30 percent.

Middle/junior high and senior high schools only.

1998-99 data.

Includes the District of Columbia.

1996-97 data.

Met

Toward

Mixed/ no change

Away

Cannot assess

Healthy People 2000 Final Review 103

1997-98 data.

Response rate for this group was too low to produce reliable estimates.

In 1994, estimates for drug use were restricted to a core set of questions in contrast to the coding procedure in prior years. The trend data have been recalculated to adjust for these

differences and to produce comparable estimates from 1988 to 1998.

Method of calculation modified in 1997.

NOTE: Data include revisions and, therefore, may differ from data previously published.

Objective number Data source

3.1*, 3.1a National Vital Statistics System, CDC, NCHS.

3.2*, 3.2a, b National Vital Statistics System, CDC, NCHS.

3.3 National Vital Statistics System, CDC, NCHS.

3.4*, 3.4a, b, d, e, h National Health Interview Survey, CDC, NCHS.

3.4c Baseline, 1992, and 1995 updates: Worldwide Survey of Substance Abuse and Health Behaviors Among Military Personnel, DoD, OASD.

1998 update: DoD Survey of Health Related Behaviors, Research Triangle Institute.

3.4f Baseline: CDC.

Updates: National Health Interview Survey, CDC, NCHS.

3.4g Baseline: Local surveys.

1990 update: Jenkins CH. Cancer risks and prevention practices among Vietnamese refugees. Western J Med 153:34–9. 1990.

1991 update: Jenkins CNH, et al. Tobacco use in Vietnam: Prevalence, predictors, and the role of the transnational tobacco corporations. JAMA

227(21):1726–31. 1997; Jenkins CNH, et al. The effectiveness of a media-led intervention to reduce smoking among Vietnamese-American men. AJPH

87(6):1031–4. 1997.

3.4i Baseline and 1991 update: National Health Interview Survey, CDC, NCHS.

1993 update: National Health and Pregnancy Survey, NIH, NIDA.

1995 update: National Survey of Family Growth, CDC, NCHS.

1996–98 updates: National Vital Statistics System, CDC, NCHS.

3.4j Baseline and 1988 update: Behavioral Risk Factor Surveillance System, CDC, NCCDPHP.

1995 update: National Survey of Family Growth, CDC, NCHS.

3.5, 3.5a National Health Interview Survey, CDC, NCHS.

3.6 Baseline: Adult Use of Tobacco Survey, CDC, NCCDPHP.

Updates: National Health Interview Survey, CDC, NCHS.

3.7, 3.7a National Health Interview Survey, CDC, NCHS.

3.8* Baseline: Adult Use of Tobacco Survey, CDC, NCCDPHP.

Updates: National Health Interview Survey, CDC, NCHS.

3.9* For males 18–24 years, National Health Interview Survey, CDC, NCHS.

For males 12–17 years, National Household Survey on Drug Abuse, SAMHSA, OAS.

3.9a Baseline: National Medical Expenditure Survey of American Indians/Alaska Natives, PHS, NCHSR.

Updates: National Health Interview Survey, CDC, NCHS.

3.10 Baseline: National Survey of School Districts’ Nonsmoking Policies, NSBA, ACS, ALA, and AHA.

Updates: School Health Policies and Programs Study, CDC, NCCDPHP.

3.11* Baseline, 1991, and 1992 updates for worksites with 50 or more employees: National Survey of Worksite Health Promotion Activities, OPHS, ODPHP.

1995 data: Business Responds to AIDS Benchmark Survey, CDC, NCHSTP.

1998–99 data: National Worksite Health Promotion Survey, OPHS, ODPHP.

For medium and large companies: Nationwide Survey on Smoking in the Workplace, CDC, OSH; Bureau of National Affairs; American Society for

Personnel Administration.

3.12* Office on Smoking and Health Legislative Tracking System, CDC, NCCDPHP.

3.13 Baseline: Association of State and Territorial Health Officials Reporting System: Cancer and Cardiovascular Diseases Survey, PHF.

104 Healthy People 2000 Final Review

Objective number Data source

Updates: Office on Smoking and Health Legislative Tracking System, CDC, NCCDPHP.

1997 data for States enforcing laws: Synar Regulation Implementation: ‘‘Report to Congress on FY 1997 State Compliance,’’ SAMHSA, February 1998.

3.14 Baseline: Association of State and Territorial Health Officials Reporting System: Cancer and Cardiovascular Diseases Survey, PHF.

1992 and 1994 updates: Association of State and Territorial Health Officials Survey of State Activities on Tobacco Prevention and

1996 update: Office on Smoking and Health, CDC, NCCDPHP; Public Health Applications Branch, NIH, NCI; California Department of Health Services.

3.15 Federal Trade Commission data reported by Office on Smoking and Health, CDC, NCCDPHP.

3.16 Baseline for internists: Wells, et al. Physicians Practice Study, AJPH 76:1009–13. 1986.

Baseline for dentists: Secker-Walker, et al. Statewide Survey of Dentists’ Smoking Cessation Advice. JADA 118:37–40. 1989.

Updates for dentists: National Survey of Dentists’ and Hygienists’ Tobacco Control Activities, University of Florida.

1992 data for primary care providers: Primary Care Provider Surveys, OPHS, ODPHP.

1997–98 data for primary care providers: Prevention in Primary Care Study, American College of Preventive Medicine.

3.17*, 3.17a-b National Vital Statistics System, CDC, NCHS.

3.18*, 3.18a National Vital Statistics System, CDC, NCHS.

3.19* National Household Survey on Drug Abuse, SAMHSA, OAS.

3.20* National Household Survey on Drug Abuse, SAMHSA, OAS.

3.21* Monitoring the Future, NIH, NIDA.

3.22* Monitoring the Future, NIH, NIDA.

3.23 ‘‘The Tax Burden on Tobacco,’’ The Tobacco Institute, 1995, and the Office on Smoking and Health, CDC, NCCDPHP.

3.24 Gelb BD. Preventive Medicine and Employee Productivity. Harvard Business Review 64(2): 12. 1985.

3.25* Office on Smoking and Health Legislative Tracking System, CDC, NCCDPHP.

3.26 Office on Smoking and Health Legislative Tracking System, CDC, NCCDPHP.

* Duplicate objective.

Healthy People 2000 Final Review 105

Tobacco Objectives

3.1*: Reduce coronary heart disease

deaths to no more than 100 per 100,000

people.

Duplicate objectives: 1.1, 2.1, and 15.1

3.1a*: Reduce coronary heart

disease deaths among blacks to no

more than 115 per 100,000 people.

Duplicate objectives: 1.1a, 2.1a, and

15.1a

3.2*: Slow the rise in lung cancer deaths

to achieve a rate of no more than 42 per

100,000 people.

Duplicate objective: 16.2

3.2a*: Slow the rise in lung cancer

deaths among females to no more

than 27 per 100,000.

Duplicate objective: 16.2a

3.2b*: Slow the rise in lung cancer

deaths among black males to no

more than 91 per 100,000.

Duplicate objective: 16.2b

3.3: Slow the rise in deaths from

chronic obstructive pulmonary disease to

achieve a rate of no more than 25 per

100,000 people.

3.4*: Reduce cigarette smoking to a

prevalence of no more than 15 percent

among people aged 18 and older.

Duplicate objectives: 15.12 and 16.6

3.4a*: Reduce cigarette smoking to

a prevalence of no more than

20 percent among people with a

high school education or less aged

20 and older.

Duplicate objectives: 15.12a and

16.6a

3.4b*: Reduce cigarette smoking to

a prevalence of no more than

20 percent among blue-collar

workers aged 18 and older.

Duplicate objectives: 15.12b and

16.6b

3.4c*: Reduce cigarette smoking to

a prevalence of no more than

20 percent among military

personnel.

Duplicate objectives: 15.12c and

16.6c

3.4d*: Reduce cigarette smoking to

a prevalence of no more than

18 percent among blacks aged 18

and older.

Duplicate objectives: 15.12d and

16.6d

3.4e*: Reduce cigarette smoking to

a prevalence of no more than

15 percent among Hispanics aged

18 and older.

Duplicate objectives: 15.12e and

16.6e

3.4f*: Reduce cigarette smoking to

a prevalence of no more than

20 percent among American Indians

and Alaska Natives.

Duplicate objectives: 15.12f and

16.6f

3.4g*: Reduce cigarette smoking to

a prevalence of no more than

20 percent among Southeast Asian

men.

Duplicate objectives: 15.12g and

16.6g

3.4h*: Reduce cigarette smoking to

a prevalence of no more than

12 percent among women of

reproductive age.

Duplicate objectives: 15.12h and

16.6h

3.4i*: Reduce cigarette smoking to

a prevalence of no more than

10 percent among pregnant women.

Duplicate objectives: 15.12i and

16.6i

3.4j*: Reduce cigarette smoking to

a prevalence of no more than

10 percent among women who use

oral contraceptives.

Duplicate objectives: 15.12j and

16.6j

3.5: Reduce the initiation of cigarette

smoking by children and youth so that

no more than 15 percent have become

regular cigarette smokers by age 20.

3.5a: Reduce the initiation of

cigarette smoking by lower

socioeconomic status youth so that

no more than 18 percent have

become regular cigarette smokers

by age 20.

3.6: Increase to at least 50 percent the

proportion of cigarette smokers aged 18

and older who stopped smoking

cigarettes for at least one day during the

preceding year.

3.7: Increase smoking cessation during

pregnancy so that at least 60 percent of

women who are cigarette smokers at the

time they become pregnant quit smoking

early in pregnancy and maintain

abstinence for the remainder of their

pregnancy.

3.7a: Increase smoking cessation

during pregnancy so that at least

45 percent of women with less than

a high school education who are

cigarette smokers at the time they

become pregnant quit smoking early

in pregnancy and maintain

abstinence for the remainder of their

pregnancy.

3.8*: Reduce to no more than 20 percent

the proportion of children aged 6 and

younger who are regularly exposed to

tobacco smoke at home.

Duplicate objective: 11.17

3.9*: Reduce smokeless tobacco use by

males aged 12–24 to a prevalence of no

more than 4 percent.

Duplicate objective: 13.17

3.9a*: Reduce smokeless tobacco

use by American Indian and Alaska

Native youth to a prevalence of no

more than 10 percent.

Duplicate objective: 13.17a

3.10: Establish tobacco-free

environments and include tobacco-use

prevention in the curricula of all

elementary, middle, and secondary

schools, preferably as part of

comprehensive school health education.

3.11*: Increase to 100 percent the

proportion of worksites with a formal

smoking policy that prohibits or

severely restricts smoking at the

workplace.

Duplicate objective: 10.18

3.12*: Enact in 50 States and the

District of Columbia comprehensive

laws on clean indoor air that prohibit

smoking or limit it to separately

ventilated areas in the workplace and

enclosed public places.

Duplicate objective: 10.19

3.13: Enact in 50 States and the District

of Columbia laws prohibiting the sale

and distribution of tobacco products to

youth younger than age 18. Enforce

106 Healthy People 2000 Final Review

these laws so that the buy rate in

compliance checks conducted in all 50

States and the District Columbia is no

higher than 20 percent.

3.14: Establish in 50 States and the

District of Columbia plans to reduce

tobacco use, especially among youth.

3.15: Eliminate or severely restrict all

forms of tobacco product advertising

and promotion to which youth younger

than age 18 are likely to be exposed.

3.16: Increase to at least 75 percent the

proportion of primary care and oral

health care providers who routinely

advise cessation and provide assistance

and followup for all of their

tobacco-using patients.

3.17*: Reduce deaths due to cancer of

the oral cavity and pharynx to no more

than 10.5 per 100,000 men aged 45–74

and 4.1 per 100,000 women aged

45–74.

Duplicate objectives: 13.7 and 16.17

3.17a*: Reduce deaths due to

cancer of the oral cavity and

pharynx to no more than 26.0 per

100,000 among black males aged

45–74.

Duplicate objectives: 13.7a and

16.17a

3.17b*: Reduce deaths due to

cancer of the oral cavity and

pharynx to no more than 26.0 per

100,000 among black females aged

45–74.

Duplicate objectives: 13.7b and

16.17b

3.18*: Reduce stroke deaths to no more

than 20 per 100,000 people.

Duplicate objectives: 2.22 and 15.2

3.18a*: Reduce stroke deaths

among blacks to no more than 27

per 100,000.

Duplicate objectives: 2.22a and

15.2a

3.19*: Increase by at least 1 year the

average age of ﬁrst use of cigarettes,

alcohol, and marijuana by adolescents

aged 12–17.

Duplicate objective: 4.5

3.20*: Reduce the proportion of young

people who have used alcohol,

marijuana, and cocaine, or cigarettes in

the past month as follows:

2000 target

Substance and age (percent)

Alcohol:

12–17 years 12.6

18–20 years 29.0

Marijuana:

12–17 years 3.2

18–25 years 7.8

Cocaine:

12–17 years 0.6

18–25 years 2.3

Use in past month 2000 target

(percent)

Alcohol:

Hispanic 12–17 years 12.0

Cocaine:

Hispanic 12–17 years 0.6

Hispanic 18–25 years 1.0

Cigarettes:

12–17 years 6.0

Duplicate objective: 4.6

3.21*: Increase the proportion of high

school seniors who perceive social

disapproval of heavy use of alcohol,

occasional use of marijuana, and

experimentation with cocaine, or regular

use of tobacco, as follows:

2000 target

(percent)

Heavy use of alcohol 70

Occasional use of marijuana 85

Trying cocaine once or twice 95

Smoking one or more packs of

cigarettes per day 95

Duplicate objective: 4.9

3.22*: Increase the proportion of high

school seniors who associate physical or

psychological harm with the heavy use

of alcohol, occasional use of marijuana,

experimentation with cocaine, or regular

use of tobacco, as follows:

2000 target

(percent)

Heavy use of alcohol 70

Regular use of marijuana 90

Trying cocaine once or twice 80

Smoking one or more packs of

cigarettes per day 95

Using smokeless tobacco

regularly 95

Duplicate objective: 4.10

3.23: Increase the average (State and

Federal combined) tobacco excise tax to

at least 50 percent of the average retail

price of all cigarettes and smokeless

tobacco.

3.24: Increase to 100 percent the

proportion of health plans that offer

treatment of nicotine addiction (e.g.,

tobacco use cessation counseling by

health care providers, tobacco use

cessation classes, prescriptions for

nicotine replacement therapies, and/or

other cessation services).

3.25*: Reduce to zero the number of

States that have clean indoor air laws

preempting stronger clean indoor air

laws on the local level.

Duplicate objective: 10.20

3.26: Enact in 50 States and the District

of Columbia laws banning cigarette

vending machines except in places

inaccessible to minors.

* Duplicate objective.

Healthy People 2000 Final Review 107

Priority Area 4

Substance Abuse:

Alcohol and Other

Drugs

Background

Substance abuse and its related

problems are among society’s most

pervasive health and social concerns.

Each year, about 100,000 deaths in the

United States are related to alcohol

consumption (1). Illicit drug abuse and

related acquired immunodeficiency

syndrome (AIDS) deaths account for at

least another 12,000 deaths. In 1995, the

economic cost of alcohol and drug

abuse was $276 billion (2). This

represents more than $1,000 for every

man, woman, and child in the United

States to cover the costs of health care,

motor vehicle crashes, crime, lost

productivity, and other adverse outcomes

of alcohol and drug abuse.

Data Summary

Highlights

Three of the 20 Healthy People

2000 objectives have been met or

surpassed. By 1996, all 50 States had

established and were monitoring

comprehensive plans to ensure that

underserved populations had access to

alcohol and drug treatment programs

(4.12). In 1995, more than 90 percent of

the worksites with 50 or more

employees had adopted policies on

alcohol and drugs (4.14), which exceeds

the target of 60 percent.

Alcohol-related motor vehicle crash

deaths (4.1) have declined dramatically

from 9.8 deaths per 100,000 persons in

1987, when the baseline was

established, to 5.8 per 100,000 in 1999.

However, the target, which was revised

downward from 8.5 to 5.5 during the

1995 Healthy People Midcourse Review

(3), was not met. This reduction has

been attributed in part to the passage of

State laws mandating administrative

license revocation (4.15) and setting

maximum blood alcohol concentration

(BAC) levels of 0.08 percent for drivers

21 years and older and establishing zero

tolerance for alcohol in the blood of

drivers under the age of 21 years (4.18).

The cirrhosis death rate (4.2) has

declined to an age-adjusted rate of 7.2

deaths per 100,000 persons, although the

age-adjusted rate for American

Indians/Alaska Natives remains

significantly higher than that of other

racial and ethnic groups. Progress has

also been made on increasing the age of

first use of cigarettes (4.5).

Past month use of illegal substances

showed mixed results. Alcohol use by

adolescents 12–17 years has declined

substantially from 33.4 percent in 1988,

when the baseline was established, to

19.1 percent in 1998 (4.6). Marijuana

use for youths 12–17 years is more

prevalent now than it was a decade ago,

although use by this age group has been

decreasing since 1997 (4.6). The

problem of heavy drinking (4.7) persists

among high school students in the

30–percent range and in the 40–percent

range for college students.

Trends in the perceived harmfulness

of different substances are also mixed

(4.10). In recent years, high school

seniors’ perception of harm from regular

marijuana use has declined substantially,

moving away from the target despite

initial improvements. While high school

seniors’ perception of harm from heavy

alcohol use (4.10) increased somewhat

in the early 1990s, it has subsequently

declined, ending the decade largely

unchanged from the baseline.

High school seniors’ perception of

social disapproval for heavy alcohol use

has increased, while perceptions of

social disapproval for regular use of

marijuana, trying cocaine once or twice,

smoking one or more packs of cigarettes

per day, and using smokeless tobacco

are generally moving away from their

respective targets (4.9), resulting in a

mixed assessment for this objective.

For the total population, rates of

drug-related deaths (4.3) and drug

abuse-related emergency department

visits have increased (4.4).

Summary of Progress

Data to assess trends toward the

year 2000 targets are available for 16 of

the 20 objectives in the Substance

Abuse priority area. The target for one

objective (4.12) was met and the targets

for two objectives (4.11 and 4.14) have

been surpassed. Progress toward targets

is shown for seven objectives (4.1, 4.2,

4.5, 4.7, 4.8, 4.15, and 4.18). Trends are

generally moving away from targets for

two objectives (4.3 and 4.4). Mixed

results are shown for four objectives

(4.6, 4.9, 4.10, and 4.19). No updates

are available for four objectives (4.13,

4.16, 4.17, and 4.20). See table 4 for the

tracking data for the objectives in this

priority area and figure 4 for a

quantitative assessment of progress.

Discussion

Twice in the 20th century, in the

1970s and again in the 1990s, drug use

rose. In the later part of the 1980s, drug

use fell, although illegal drug use never

disappeared entirely. Beginning around

1990, teens and preteens began to adopt

more permissive attitudes toward drugs.

Soon thereafter, actions followed

perceptions and the use of illegal drugs

increased among young people 12–17

years. Supplemental data from 1999

indicate that 6.7 percent or 14.8 million

Americans 12 years and over were

current users of illicit drugs. This is

down from 1979, when 14.1 percent of

the U.S. population 12 years and over

were current drug users (4) . By

historical standards, present drug rates

are relatively low. The fluctuation in

trends reinforces the need for education

as a continuous process for parents,

communities, and policymakers, as well

as for children.

The direct and indirect public health

impact of substance abuse is

widespread. Alcohol abuse and drug

abuse among youth are strongly

associated with risk-taking behavior,

including sexual risk-taking behavior

(5). Intravenous drug use is a major

vector for the transmission of infectious

diseases, including HIV/AIDS, hepatitis

B and hepatitis C (6).

Alcohol consumption has significant

adverse consequences for public health.

Alcohol use has been linked with a

substantial portion of injuries and deaths

from motor vehicle crashes, falls, fires,

and drownings (7). It is also a factor in

homicide, suicide, marital violence, and

child abuse (8). Excessive drinking has

consequences for virtually every part of

the body. Heavy alcohol use increases

risk for cirrhosis and other liver

disorders. Drinking also may increase

the risk for developing cancer of the

colon and rectum (9). Women’s risk of

developing breast cancer increases

slightly if they drink two or more drinks

per day (10).

The problem of heavy drinking

persists among high school students and

for college students. Recently enacted

Federal law requires the withholding of

108 Healthy People 2000 Final Review

4.1 Alcohol-related motor vehicle deaths

4.2 Cirrhosis deaths

4.3 Drug-related deaths

4.4 Drug abuse-related emergency room visits

4.5 Average age of first use, 12-17 years: Cigarettes

Alcohol

Marijuana

4.6 Use in past month: Alcohol, 12-17 years

Alcohol, 18-20 years

Marijuana, 12-17 years

Marijuana, 18-25 years

Cocaine, 12-17 years

Cocaine, 18-25 years

College students

Occasional marijuana use

4.9 High school seniors' perception of disapproval:

Heavy alcohol use

4.8 Alcohol consumption (gallons per capita)

Cocaine use once or twice

Cigarette, 12-17 years

4.7 Heavy drinking in past 2 weeks: High school seniors

Smoking one or more packs of cigarettes a day

4.10 High school seniors' perception of harm:

Heavy alcohol use

Cocaine use once or twice

Regular marijuana use

Smoking one or more packs of cigarettes a day

4.12 Number of States with access to treatment programs

4.11 Anabolic steroid use: Male high school seniors

4.14 Alcohol policies at worksites with 50 or more employees

Using smokeless tobacco regularly

4.15 States with administrative license suspension/revocation laws

Other drug policies

4.18 States with blood alcohol tolerance levels:

.02% or less, under 21 years

0.8%, 21 years and over

Moved away from target Moved toward target Met target

NOTE: Complete tracking data are shown in table 4. Progress quotients are not calculated for objectives 4.13, 4.16, 4.17, 4.19, and 4.20.

See the section on Measuring Progress Toward the

Healthy People 2000

Targets in the Appendix for more information.

22%

80%

No change

-68%

-14%

-3%

-4%

-11%

30%

69%

20%

67%

44%

18%

67%

17%

55%

21%

Percent of target achieved

-100 -80 -60 -40 -20

20 40 60 80 100

93%

112%

27%

112%

100%

-132%

Healthy People 2000 Final Review 109

Figure 4. Final status of Substance Abuse: Alcohol and Other Drug objectives

Federal highway funds from States that

do not adopt a BAC of 0.08 percent as

the standard for driving while

intoxicated. Beginning in 2004, a

gradually increasing percent of these

funds (up to a maximum of 8 percent)

will be withheld from States that fail to

comply (11). In 1998, 16 States and the

District of Columbia had 0.08 as their

threshold BAC tolerance level for

driving while alcohol-impaired.

Transition to Healthy People

2010

Healthy People 2010 increases the

number of objectives related to

substance abuse from 20 in Healthy

People 2000 to 25. Many of the

objectives in Healthy People 2000 are

retained in Healthy People 2010,

including objectives on alcohol-related

motor vehicle crashes (4.1), cirrhosis

deaths (4.2), drug-related (drug-induced)

deaths (4.3), drug-related hospital

emergency department visits (4.4),

average age of first use (4.5), past

month use of illicit substances by

adolescents (4.6), binge drinking (4.7),

alcohol consumption (4.8), peer

disapproval of substance abuse (4.9),

perception of risk (4.10), steroid use

(4.11), administrative license revocation

laws (4.15), and blood alcohol

concentration levels (4.18).

Objectives related to the prevention

of tobacco use included in the Healthy

People 2000 priority area have been

reorganized into the Tobacco Use focus

area in Healthy People 2010. Such a

move, however, is not intended to lessen

the understanding that the prevention

and treatment of substance abuse

requires that all abused substances be

addressed—from tobacco and alcohol to

marijuana and other illicit drugs.

In addition, several objectives have

been added to Healthy People 2010.

They include objectives dealing with

drug-related motor vehicle crash deaths,

injuries caused by alcohol-related motor

vehicle crashes, injuries caused by

drug-related motor vehicle crashes,

alcohol-related emergency department

visits, adolescents riding in a car with a

driver who has been drinking, alcohol-

and drug-related violence, lost

productivity, adults exceeding guidelines

for low-risk drinking, and inhalant use

by adolescents. Also added are

objectives related to the treatment gap

for illicit drugs, treatment in correctional

institutions, treatment for injection drug

use, treatment gap for problem alcohol

use, hospital emergency department

referrals, and communities using

partnerships or coalition models to

conduct substance abuse prevention

efforts.

Several objectives included in other

focus areas of Healthy People 2010 are

directly related to the objectives

included in the Substance Abuse focus

area. For example, school health

education and community health

promotion programs (Educational and

Community-Based Programs), AIDS

among persons who inject drugs (HIV),

deaths from unintentional injuries

(Injury and Violence Prevention), fetal

alcohol syndrome (Maternal, Infant, and

Child Health), and primary care

screening and assessment (Mental

Health and Mental Disorders). All 21

objectives in the focus area on Tobacco

Use are related to the Substance Abuse

chapter, especially the objectives on

adolescent tobacco use, initiation of

tobacco use, age at first tobacco use,

smoking cessation by adolescents, and

adolescent disapproval of smoking.

Substance Abuse is one of the 10

Leading Health Indicators (LHIs), which

Healthy People 2010 introduces to serve

as a barometer of the Nation’s health.

Three objectives from the Substance

Abuse focus area—adolescent use of

alcohol or any illicit drug, adult use of

any illicit drug, and binge drinking by

adults—are used to measure this LHI.

Appendix table III, a crosswalk

between Healthy People 2000 and

Healthy People 2010 objectives,

summarizes the differences between the

two decades of objectives, reflecting

new knowledge and directions in this

area.

Data Issues

Definitions

All deaths attributed to chronic liver

disease and cirrhosis (whether or not

they are specified as alcohol related) are

tracked in objective 4.2 as an indicator

of abusive alcohol consumption. The

entries on death certificates are often not

specific enough to identify all

alcohol-related liver disease deaths.

Estimates of the proportion of the total

chronic liver disease and cirrhosis

deaths that are alcohol-related range

from 41 to 95 percent (12).

Data from the National Vital

Statistics System are used to track

drug-related deaths (4.3). Although the

objective discusses drug-related deaths,

it is tracked by a category of deaths that

is more accurately termed

‘‘drug-induced deaths.’’ The category

includes deaths whose underlying cause

was drug dependence, nondependent use

of drugs, and poisoning from drugs, all

of which may include medically

prescribed drugs. It excludes

unintentional injuries, homicides, and

other causes indirectly related to drug

use. See Appendix table IV for a list of

specific ICD–9 codes. This objective

will continue to be tracked in Healthy

People 2010 with the more accurate title

‘‘drug-induced deaths.’’

Objectives 4.7, 4.9, and 4.10 refer

to recent heavy drinking and heavy

alcohol use. Heavy alcohol use is

defined as having five or more drinks

on one occasion. Recent heavy drinking

is having five or more drinks on one

occasion in the past 2 weeks.

Data Sources

Alcohol-related motor vehicle

crashes (4.1) are tracked using data from

the Department of Transportation’s

Fatality Analysis Reporting System

(formerly the Fatal Accident Reporting

System) (FARS). The FARS

supplements death certificate data with

information on the circumstances of the

death to determine whether the death

was alcohol related. The National Vital

Statistics System does not specify

alcohol-related motor vehicle crashes.

The 1992 baselines for objective

4.14 are from the National Survey of

Worksite Health Promotion Activities,

which was a telephone survey of

nongovernment worksites. Worksites

were sampled, because different

worksites within the same company

could have different sets of health

promotion activities. Both active (for

example, classes) and passive (for

example, brochures) methods were

counted as worksite health promotion

activities. The 1995 update is from the

Centers for Disease Control and

Prevention (CDC) sponsored Worksite

Benchmark Survey, which used a

methodology very similar to the 1992

survey, but did not include passive

methods of health promotion (13,14).

The 1992 data on inquiry about

alcohol consumption and other drug

abuse for objective 4.19 are from

Primary Care Provider Surveys (PCPS).

110 Healthy People 2000 Final Review

The sample was drawn from the

membership rolls of professional

organizations for pediatricians, nurse

practitioners, family physicians,

obstetricians/gynecologists, and

internists. Response rates varied from 50

to 80 percent across these groups. The

data on inquiry (from PCPS) about

work-related risks represent the

proportion of providers who routinely

queried 81–100 percent of their patients

about these risks. The data on

counseling refer to the proportion of

providers who routinely provided these

services to patients who needed the

services. The Prevention in Primary

Care Study (PPCS) was conducted in

1997–98. The design and items included

in the 1997–98 study were similar to the

PCPS, but the sampling frame was

slightly different and some items

included in the 1992 surveys were not

included in the PPCS. The professionals

were sampled from listings of all

licensed, active practitioners in the

United States whose practices were at

least 50 percent primary care. Because

of low response rates from the other

provider groups, updates are available

only for nurse practitioners.

Data Comparability

The National Household Survey on

Drug Abuse (NHSDA) is used to

measure objectives 4.5 and 4.6

regarding substance use among

adolescents and young people. The

targets for objective 4.6 are consistent

with the goals established by the Office

of the National Drug Control Policy,

Executive Office of the President.

Beginning in 1991, the NHSDA was

expanded to include college students

living in residence halls. Thus, results

for people 18–25 years for marijuana

and cocaine use and people 18–20 years

for alcohol use are not directly

comparable with measures from

previous years. Additionally, improved

questionnaire and editing procedures

were introduced with the 1994 survey,

which restricted determination of drug

use to a core set of questions in contrast

to a broader coding procedure in prior

years. The trend data for all substances

in objective 4.6 have been recalculated

to adjust for these differences and to

produce comparable estimates from

1988 to 1998.

References

1. McGinnis JM, Foege WH. Actual causes of

death in the United States. JAMA 270:2207–12.

1993.

2. Harwood H, Fountain D, Livermore G. The

economic costs of alcohol and drug abuse in the

United States, 1992. Rockville, Maryland:

National Institutes of Health. 1998.

3. Department of Health and Human Services.

Healthy people 2000 midcourse review and 1995

revisions. Washington, DC: Public Health Service.

1996.

4. Office of National Drug Control Policy.

National drug control strategy 2001 annual report.

Washington, DC: Government Printing Office.

2001.

5. Rahdert E, Czechowicz D. (eds). Adolescent

drug abuse: Clinical assessment and therapeutic

interventions. NIDA Research Monograph No.

156. NIH Publication No. 95–3908. Rockville,

Maryland: National Institutes of Health. 1995.

6. Garfein R.S, Vlahov D, Galai N, et al. Viral

infections in short-term injection drug users; the

prevalence of the hepatitis B, hepatitis C, human

immunodeficiency, human T-lymphotropic virus.

Am J Public Health 88:655–61. 1996.

7. National Institute on Alcohol Abuse and

Alcoholism. Ninth special report to the U.S.

Congress on alcohol and health from the Secretary

of Health and Human Services. Rockville,

Maryland: National Institutes of Health. 1997.

8. Roizen J. Issues in the epidemiology of alcohol

and violence. In: Martin S, ed. Alcohol and

interpersonal violence: Fostering multidisciplinary

perspectives. Rockville, Maryland: National

Institutes of Health. 1993.

9. National Institute on Alcohol Abuse and

Alcoholism. Alcohol and cancer. Alcohol Alert. No

21. Rockville, Maryland: National Institutes of

Health. 1993.

10. Reichmann ME. Alcohol and breast cancer.

Alcohol Health and Research World. 18(3):182–4.

1994.

11. Center for Science in the Public Interest.

Action Alerts, Oct. 4, 2000.

http://www.cspinet.org/booze/08_update2.htm.

12. National Institute on Alcohol Abuse and

Alcoholism. County alcohol problem indicators

1979–85. U.S. Alcohol epidemiologic data

reference manual; vol 3, 3d ed. Washington:

Department of Health and Human Services. 1991.

13. Centers for Disease Control and Prevention

Cancer screening offered by worksites—United

States, 1992 and 1995. MMWR 46(19):421–4.

1997.

14. Survey: Technical report. Atlanta: Public

Health Service, Centers for Disease Control and

Prevention. 1996.

Healthy People 2000 Final Review 111

Table 4. Substance Abuse: Alcohol and Other Drugs objectives

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

4.1* Alcohol-related motor vehicle deaths (per 100,000). . 1987 9.8 8.9 7.9 7.0 6.8 6.4 6.6 6.5 6.1 5.9 5.8 5.5

a. American Indian/Alaska Native male ............ 1987 40.4 34.3 32.2 31.4 26.8 28.0 - - - - - - - - - - - - - - - 35.0

b. People 15-24 years ........................ 1987

20.9 18.6 17.2 14.2 13.2 13.0 12.8 12.9 11.7 11.7 11.5 12.5

4.2 Cirrhosis deaths (age adjusted per 100,000) ........ 1987 9.2 8.6 8.3 8.0 7.9 7.9 7.6 7.5 7.4 7.2 - - - 6

a. Black male ............................... 1987 22.6 20.0 17.4 17.2 16.1 15.9 14.7 13.8 12.9 12.3 - - - 12

b. American Indian/Alaska Native ................ 1987 20.5 19.8 20.4 21.6 21.0 21.4 24.3 20.7 20.6 22.0 - - - 10

c. Hispanic

................................ 1990

14.2 . . . 13.8 13.5 13.4 13.7 12.9 12.6 12.0 11.7 - - - 10

4.3 Drug-related deaths (age adjusted per 100,000) ..... 1987 3.8 3.6 3.8 4.3 4.8 5.0 5.1 5.2 5.6 5.9 - - - 3

a. Black ................................... 1990 5.7 . . . 6.6 6.8 8.3 8.6 8.5 8.0 8.2 8.1 - - - 3

b. Hispanic

................................ 1990 4.3 . . . 3.9 5.6 6.4 6.0 6.0 5.9 5.7 5.9 - - - 3

4.4 Drug abuse-related emergency room visits

(per 100,000) ............................... 1991 175.8 . . . . . . 191.4 203.9 225.2 222.5 207.2 221.5 225.4 228.2 140.6

4.5* Average age of first use (adolescents 12-17 years) . .

Cigarettes ................................... 1988 11.6 11.5 11.5 11.7 11.7 12.2 12.3 12.4 12.4 12.4 - - - 12.6

Alcohol ..................................... 1988 13.1 12.8 12.6 13.0 12.9 12.8 12.6 13.1 13.1 13.1 - - - 14.1

Marijuana ................................... 1988 13.4 13.4 13.5 13.8 13.9 14.1 13.8 14.4 13.7 13.7 - - - 14.4

4.6* Use in past month by adolescents and young

adults

Alcohol

12-17 years ............................... 1988 33.4% 32.5% 27.0% 20.9% 23.9% 21.6% 21.1% 18.8% 20.5% 19.1% - - - 12.6%

18-20 years ............................... 1994 54.6% . . . . . . . . . . . . . . . 54.1% 50.1% 53.4% 53.5% - - - 29.0%

Hispanic 12-17 years ........................ 1988 31.9% 24.2% 28.3% 20.3% 22.0% 18.3% 18.7% 19.9% 18.8% 18.9% - - - 12.0%

Marijuana

12-17 years ............................... 1988 5.4% 4.4% 3.6% 3.4% 4.0% 6.0% 8.2% 7.1% 9.4% 8.3% - - - 3.2%

18-25 years ............................... 1988 15.3% 12.7% 12.9% 10.9% 11.1% 12.1% 12.0% 13.2% 12.8% 13.8% - - - 7.8%

Cocaine

12-17 years ............................... 1988 1.2% 0.6% 0.4% 0.3% 0.4% 0.3% 0.8% 0.6% 1.0% 0.8% - - - 0.6%

18-25 years ............................... 1988 4.8% 2.3% 2.2% 2.0% 1.6% 1.2% 1.3% 2.0% 1.2% 2.0% - - - 2.3%

Hispanic 12-17 years ........................ 1988 1.4% 2.0% 1.4% 1.3% 1.1% 0.7% 0.8% 1.1% 1.0% 1.4% - - - 0.6%

Hispanic 18-25 years ........................ 1994 2.2% . . . . . . . . . . . . . . . 1.1% 2.1% 1.5% 2.7% - - - 1.0%

Cigarettes

12-17 years ............................... 1988 22.7% 22.4% 20.9% 18.4% 18.5% 18.9% 20.2% 18.3% 19.9% 18.2% - - - 6.0%

4.7 Heavy drinking in past 2 weeks

High school seniors ........................... 1989 33.0% 32.2% 29.8% 27.9% 27.5% 28.2% 29.8% 30.2% 31.3% 31.5% 30.8% 28.0%

College students .............................. 1989 41.7% 41.0% 42.8% 41.4% 40.2% 40.0% 40.0% 38.3% 40.7% 38.9% 40.0% 32.0%

4.8 Alcohol consumption (gallons per capita, persons

14 years and over) ........................... 1987 2.54 2.45 2.31 2.31 2.25 2.21 2.17 2.19 2.18 - - - - - - 2.0

4.9* Perception of social disapproval by high school

seniors

Heavy use of alcohol .......................... 1989 56.4% 59.0% 58.1% 60.8% 58.5% 59.1% 58.0% 57.8% 56.4% 55.5% 57.6% 70%

Occasional use of marijuana ..................... 1989 71.1% 76.4% 75.8% 79.2% 73.8% 69.1% 65.4% 63.1% 59.9% 60.4% 61.6% 85%

Trying cocaine once or twice..................... 1989 88.9% 90.5% 91.8% 92.2% 91.1% 91.4% 91.1% 89.2% 87.3% 88.8% 88.7% 95%

Smoking one or more packs of cigarettes per day..... 1987 74.2% 75.3% 74.0% 76.2% 71.8% 72.4% 69.2% 69.3% 68.5% 69.0% 71.2% 95%

See footnotes and key at end of table.

112 Healthy People 2000 Final Review

Table 4. Substance Abuse: Alcohol and Other Drugs objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

4.10* Perception of harm by high school seniors

Heavy use of alcohol .......................... 1989 44.0% 47.1% 48.6% 49.0% 48.3% 46.5% 45.2% 49.5% 43.0% 43.8% 43.1% 70%

Regular use of marijuana ....................... 1989 77.5% 77.8% 78.6% 76.5% 72.5% 65.0% 60.8% 59.9% 58.1% 58.5% 57.4% 90%

Trying cocaine once or twice..................... 1989 54.9% 59.4% 59.4% 56.8% 57.6% 57.2% 53.7% 54.2% 53.6% 54.6% 52.1% 80%

Smoking one or more packs of cigarettes per day..... 1987 68.6% 68.2% 69.4% 69.2% 69.5% 67.6% 65.6% 68.2% 68.7% 70.8% 70.8% 95%

Using smokeless tobacco regularly ................ 1987

30.0% 34.2% 37.4% 35.5% 38.9% 36.6% 33.2% 37.4% 38.6% 40.9% 41.1% 95%

4.11 Anabolic steroid use

Male high school seniors........................ 1989 4.7% 5.0% 3.6% 3.5% 3.5% 3.8% 3.8% 3.2% 4.1% 2.8% - - - 3.0%

4.12 Number of States with access to treatment

programs.................................. 1996 50 . . . . . . . . . . . . . . . . . . . . . 50 50 50 50

4.13 Alcohol and drug education in schools........... 1996 86% . . . . . . . . . . . . . . . . . . . . . - - - - - - - - - 100%

Provided students with some instruction ............ 1987 63% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 100%

Provided students with counseling................. 1987 39% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 100%

Referred students for clinical assessments .......... 1987 23% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 100%

Provided students with instruction in at least one

course

Middle/junior and senior high schools ............ ... --- --- --- --- --- 90.4% - - - - - - - - - - - - - - - 100%

4.14 Worksite alcohol and drug policies 50 or more

employees ................................. ... --- --- --- --- --- --- --- --- --- --- --- 60%

Alcohol ..................................... 1992 88% . . . . . . . . . - - - - - - 92% - - - - - - - - - - - - 60%

Other drugs ................................. 1992 89% . . . . . . . . . - - - - - - 96% - - - - - - - - - - - - 60%

4.15 Number of States with administrative license

suspension/revocation laws

.................. 1990 29 . . . 30 - - - 35 38 - - - - - - 40 41 - - - 51

4.16 Number of States with policies to reduce minors’

access to alcohol ........................... 1996 46 . . . . . . . . . . . . . . . . . . . . . - - - - - - - - - 50

4.17 Number of States with restrictions on promotion

of alcohol to children and adolescents .......... 1996 13 . . . . . . . . . . . . . . . . . . . . . - - - - - - - - - 20

4.18 Number of States with blood alcohol concentration

tolerance levels

Zero tolerance (0.02% or less) for people under

21 years ................................... 1993 9 . . . . . . . . . . . .

21 ---

50 - - - 50

0.08% for people 21 years and over ............... 1993 7 . . . . . . . . . . . . 11 - - - 14 15 16 - - - 50

4.19 Screening, counseling, and referral by clinicians ... ... --- --- --- --- --- --- --- --- --- --- --- 75%

Percent of clinicians routinely providing service

to 81–100% of patients

Inquiry about alcohol consumption (12 years and over)

Pediatricians ............................... 1992 29% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

Nurse practitioners .......................... 1992 45% . . . . . . . . . - - - - - - - - - - - - - - -

52% - - - 75%

Obstetricians/gynecologists .................... 1992 34% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

Internists .................................. 1992 63% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

Family physicians ........................... 1992 39% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

See footnotes and key at end of table.

Healthy People 2000 Final Review 113

Table 4. Substance Abuse: Alcohol and Other Drugs objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Inquiry about other drug use (12 years and over)

Pediatricians ............................... 1992 28% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

Nurse practitioners .......................... 1992 43% . . . . . . . . . - - - - - - - - - - - - - - -

36% - - - 75%

Obstetricians/gynecologists .................... 1992 32% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

Internists .................................. 1992 34% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

Family physicians ........................... 1992 23% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

Referral to alcohol treatment

Pediatricians ............................... 1992 26% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

Nurse practitioners .......................... 1992 19% . . . . . . . . . - - - - - - - - - - - - - - -

22% - - - 75%

Obstetricians/gynecologists .................... 1992 24% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

Internists .................................. 1992 33% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

Family physicians ........................... 1992 28% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

Referral to drug abuse treatment

Pediatricians ............................... 1992 32% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

Nurse practitioners .......................... 1992 19% . . . . . . . . . - - - - - - - - - - - - - - -

25% - - - 75%

Obstetricians/gynecologists .................... 1992 28% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

Internists .................................. 1992 35% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

Family physicians ........................... 1992 28% . . . . . . . . . - - - - - - - - - - - - - - -

5,6

--- --- 75%

4.20 Number of States with Hospitality Resource

Panels .................................... 1994 8 . . . . . . . . . . . . . . . - - - - - - - - - - - - - - - 30

- - - Data not available. Final objective status:

. . . Category not applicable.

Baseline has been revised.

Excludes data from States lacking an Hispanic-origin item on their death certificate or for which Hispanic-origin data were not of sufficient quality. See Appendix.

In 1994, estimates for drug use were restricted to a core set of questions in contrast to the coding procedure in prior years. The trend data have been recalculated to adjust for these

differences and to produce comparable estimates from 1988 to 1997.

Recent heavy drinking is defined as having 5 or more drinks on 1 occasion in the previous 2-week period as monitored by self-reports.

Includes the District of Columbia.

1997–98 data.

Response rate for this group was too low to produce reliable estimates.

NOTE: Data include revisions and, therefore, may differ from data previously published in these reports and other publications.

Met

Toward

Mixed/ no change

Away

Cannot assess

114 Healthy People 2000 Final Review

Objective number Data source

4.1*, 4.1b Fatality Analysis Reporting System, DOT, NHTSA.

4.1a Fatality Analysis Reporting System, DOT, NHTSA and National Vital Statistics System, CDC, NCHS.

4.2, 4.2a–c National Vital Statistics System, CDC, NCHS.

4.3, 4.3a–b National Vital Statistics System, CDC, NCHS.

4.4 Drug Abuse Warning Network, SAMHSA, OAS.

4.5* National Household Survey on Drug Abuse, SAMHSA, OAS.

4.6* National Household Survey on Drug Abuse, SAMHSA, OAS.

4.7 Monitoring the Future, NIH, NIDA.

4.8 Alcohol Epidemiology Data System, NIH, NIAAA.

4.9* Monitoring the Future, NIH, NIDA.

4.10* Monitoring the Future, NIH, NIDA.

4.11 Monitoring the Future, NIH, NIDA.

4.12 Substance Abuse Prevention and Treatment Block Grant Applications, SAMHSA, CSAT.

4.13 1987 baseline: Report to Congress and the White House on the Nature and Effectiveness of Federal, State, and Local Drug Prevention Education

Programs. DOE. 1987.

1996 baseline: Substance Abuse Prevention and Treatment Block Grant Applications, SAMHSA, CSAT.

1994 data: School Health Policies and Programs Study, CDC, NCCDPHP.

4.14 Baseline: National Survey of Worksite Health Promotion Activities, OPHS, ODPHP.

Update: Business Responds to AIDS Benchmark Survey, CDC, NCHSTP.

4.15 Baseline: Office of Alcohol and State Programs, DOT, NHTSA.

Updates: Office of Safety Recommendations, DOT, NHTSA.

4.16 Substance Abuse Prevention and Treatment Block Grant Applications, SAMHSA, CSAT.

4.17 Substance Abuse Prevention and Treatment Block Grant Applications, SAMHSA, CSAT.

4.18 Baseline: Office of Alcohol and State Programs, DOT, NHTSA.

Updates: Office of Safety Recommendations, DOT, NHTSA.

4.19 Baseline: Primary Care Provider Surveys, OPHS, ODPHP.

Update: Prevention in Primary Care Study, American College of Preventive Medicine.

4.20 California Coordinating Council on Responsible Beverage Service, National Survey Report.

* Duplicate objective.

Healthy People 2000 Final Review 115

Substance Abuse:

Alcohol and Other

Drugs Objectives

4.1*: Reduce deaths caused by

alcohol-related motor vehicle crashes to

no more than 5.5 per 100,000 people.

Duplicate objective: 9.23

4.1a*: Reduce deaths among

American Indian and Alaska Native

men caused by alcohol-related

motor vehicle crashes to no more

than 35.0 per 100,000.

Duplicate objective: 9.23a

4.1b*: Reduce deaths among people

aged 15–24 caused by

alcohol-related motor vehicle

crashes to no more than 12.5 per

100,000.

Duplicate objective: 9.23b

4.2: Reduce cirrhosis deaths to no more

than 6 per 100,000 people.

4.2a: Reduce cirrhosis deaths

among black men to no more than

12 per 100,000.

4.2b: Reduce cirrhosis deaths

among American Indians and

Alaska Natives to no more than 10

per 100,000.

4.2c: Reduce cirrhosis deaths

among Hispanics to no more than

10 per 100,000.

4.3: Reduce drug-related deaths to no

more than 3 per 100,000 people.

4.3a: Reduce drug-related deaths

among blacks to no more than 3 per

100,000.

4.3b: Reduce drug-related deaths

among Hispanics to no more than 3

per 100,000.

4.4: Reduce drug abuse-related hospital

emergency department visits by at least

20 percent.

4.5*: Increase by at least 1 year the

average age of ﬁrst use of cigarettes,

alcohol, and marijuana by adolescents

aged 12–17.

Duplicate objective: 3.19

4.6*: Reduce the proportion of young

people who have used alcohol,

marijuana, and cocaine, or cigarettes in

the past month as follows:

2000 target

Substance and age (percent)

Alcohol:

12–17 years 12.6

18–20 years 29.0

Marijuana:

12–17 years 3.2

18–25 years 7.8

Cocaine:

12–17 years 0.6

18–25 years 2.3

Use in past month 2000 target

(percent)

Alcohol:

Hispanic 12–17 years 12.0

Cocaine:

Hispanic 12–17 years 0.6

Hispanic 18–25 years 1.0

Cigarettes:

12–17 years 6.0

Duplicate objective: 3.20

4.7: Reduce the proportion of high

school seniors and college students

engaging in recent occasions of heavy

drinking of alcoholic beverages to no

more than 28 percent of high school

seniors and 32 percent of college

students.

4.8: Reduce alcohol consumption by

people aged 14 and older to an annual

average of no more than 2 gallons of

ethanol per person.

4.9*: Increase the proportion of high

school seniors who perceive social

disapproval of heavy use of alcohol,

occasional use of marijuana, and

experimentation with cocaine, or regular

use of tobacco, as follows:

2000 target

(percent)

Heavy use of alcohol 70

Occasional use of marijuana 85

Trying cocaine once or twice 95

Smoking one or more packs of

cigarettes per day 95

Duplicate objective: 3.21

4.10*: Increase the proportion of high

school seniors who associate physical or

psychological harm with the heavy use

of alcohol, occasional use of marijuana,

experimentation with cocaine, or regular

use of tobacco, as follows:

Heavy use of alcohol 70

Regular use of marijuana 90

Trying cocaine once or twice 80

Smoking one or more packs of

cigarettes per day 95

Using smokeless tobacco

regularly 95

Duplicate objective: 3.22

4.11: Reduce to no more than 3 percent

the proportion of male high school

seniors who use anabolic steroids.

4.12: Establish and monitor in 50 States

comprehensive plans to ensure access to

alcohol and drug treatment programs for

traditionally underserved people.

4.13: Provide to children in all school

districts and private schools primary and

secondary school educational programs

on alcohol and other drugs, preferably

as part of comprehensive school health

education.

4.14: Extend adoption of alcohol and

drug policies for the work environment

to at least 60 percent of worksites with

50 or more employees.

4.15: Extend to 50 States administrative

driver’s license suspension/revocation

laws or programs of equal effectiveness

for people determined to have been

driving under the inﬂuence of

intoxicants.

4.16: Increase to 50 the number of

States that have enacted and enforce

policies, beyond those in existence in

1989, to reduce access to alcoholic

beverages by minors.

4.17: Increase to at least 20 the number

of States that have enacted statutes to

restrict promotion of alcoholic beverages

that are focused principally on young

audiences.

4.18: Extend to 50 States legal blood

alcohol concentration tolerance levels of

.08 percent for motor vehicle drivers

aged 21 and older and zero tolerance

(.02 percent and lower) for those

younger than age 21.

4.19: Increase to at least 75 percent the

proportion of primary care providers

who screen for alcohol and other drug

use problems and provide counseling

and referral as needed.

4.20: Increase to 30 the number of

States with Hospitality Resource Panels

(including representatives from State

regulatory, public health, and highway

safety agencies, law enforcement,

insurance associations, alcohol retail and

licensed beverage associations) to ensure

a process of management and server

training and deﬁne standards of

responsible hospitality.

*Duplicate objective.

116 Healthy People 2000 Final Review

Priority Area 5

Family Planning

Background

Family planning provides

individuals with the information and

means to exercise personal choice in

determining whether and when to

become parents (1). Family planning

entails both the prevention of

unintended pregnancies and the

achievement of planned, wanted

pregnancies—important for improving

birth outcomes, women’s health, and the

health of families. Family planning has

had a significant impact on the health

and well-being of persons in the United

States through the promotion of

reproductive health education and

services (2).

While adolescent females receive

considerable attention in family planning

initiatives, all women of childbearing

age require assistance with family

planning. The goal of reducing

unintended pregnancy is a significant

public health concern in the United

States. Each year, publicly subsidized

contraceptive services help women

avoid an estimated 1.3 million

unintended pregnancies (3). Access to

family planning services is an important

determinant of prenatal outcomes

generally, and unintended pregnancies

affect healthy starts for children. Women

who did not want to become pregnant

are less likely to have prenatal care in

the first trimester, compared with

women who wanted a child at the time

they became pregnant (4).

To the extent that effective family

planning widens the intervals between

births and ensures that pregnancies are

intended, babies will be born healthier.

Problems attendant to poor family

planning exact serious health and social

costs. Low birthweight (5), high rates of

infant mortality (6), and inadequate

monetary and family support (7) are

some of the consequences of poor

family planning. Research suggests that

educating young potential parents about

the financial, welfare, and social costs

of pregnancy may improve

decisionmaking, which, in turn, may

reduce the likelihood of an unintended

pregnancy (8).

Despite advances in contraceptive

technology and demonstrated

effectiveness of prevention initiatives,

nearly one-half of all pregnancies in the

United States are unintended (9). While

data show a decline in the rates of

unintended pregnancy (which may be

attributable to higher rates of

contraceptive use and improved quality

of contraceptives) (10), more needs to

be done to insure that all pregnancies

are intended (7). Promoting the use of

effective contraceptive methods and

improving the effectiveness with which

all methods are used could help

significantly in further reducing the

levels of unintended pregnancy (10, 11).

Data Summary

Highlights

Teenage pregnancy rates (5.1) have

declined considerably in the 1990s. The

teenage pregnancy rate was 98.7 per

1,000 women ages 15–19 years in 1996,

down 15 percent from its high point of

116.5 in 1991. The pregnancy rate was

67.8 for women ages 15–17 years in

1996, down from its high point of 80.3

in 1990. Data for objective 5.2 show

that in 1995, 49 percent of pregnancies

were unintended, a decrease of

13 percent since 1988, but still short of

the year 2000 target of 30 percent.

The proportions of both males and

females 15 years of age who engaged in

sexual intercourse during the past 3

months (5.5) have declined, although

both were short of the year 2000 targets.

The proportion of females 15–19 years

using contraception at first intercourse

(5.6) have increased between 1988 and

1995 from 65 to 76 percent. However,

use of contraception during most recent

intercourse decreased just as

dramatically from 78 to 71 percent over

the same time period for females of the

same age group.

The proportion of teens that have

discussed sexuality with their parents

(5.8) increased significantly, from

66 percent in 1986 to 80 percent in

1995, although it did not meet the year

2000 target of 85 percent. It should be

noted that more recent 1998 data from

the National Health Interview Survey

(NHIS) for adolescents 10–17 years

show a loss of some of the progress

made earlier, as reported from 1994

NHIS data.

Summary of Progress

Of the 12 family planning Healthy

People 2000 objectives, progress was

made in eight objectives (5.1–5.3, 5.5,

5.7, 5.8, 5.11, and 5.12), although none

reached their targets. Progress was

mixed for three objectives (5.4, 5.6, and

5.10). Progress for objective 5.10 is

based on limited updates showing only

nurse practitioner data. Data were not

available to update one objective (5.9).

See table 5 for the tracking data for the

objectives in this priority area and

figure 5 for a quantitative assessment of

progress.

Discussion

Although short of the year 2000

targets, decreases in adolescent

pregnancy (5.1) were promising. Among

the factors accounting for the overall

falling teenage pregnancy rates are

decreases in sexual activity, increases in

condom use, and the adoption of

injectable and implant contraceptives

(12). Objective 5.4 sought to reduce the

proportion of adolescents who have

engaged in sexual intercourse to no

more than 15 percent by age 15 and no

more than 40 percent by age 17. The

progress was mixed with declines in

proportions of all females, males, and

black males age 15. There was a slight

increase for all females age 17 and a

decrease for all black females age 17.

The pregnancy rates for non-Hispanic

black and Hispanic teenagers were about

twice as high as the rates for

non-Hispanic white teenagers. The lower

pregnancy rates for non-Hispanic white

teenagers is due to both the lower

proportion sexually active and the lower

pregnancy rate among those who are

sexually active. In 1995 about one out

of three sexually active black and

Hispanic teenagers became pregnant

compared with about one out of six

sexually active non-Hispanic white

teenagers (12).

Substantial decreases occurred in

unintended pregnancy rates (5.2) and,

correspondingly, the use of

contraceptives among females 15–44

years of age at risk for unintended

pregnancy increased (5.12). For black

females 15–44 years of age, the rate of

unintended pregnancies declined from

78 percent in 1988 to 72 percent in

1995, and the use of contraceptives for

this population increased from

78.9 percent in 1982 to 89.9 percent in

1995. Also, the pregnancy rate for

females using a contraceptive method

declined (5.7); this may have

contributed to the decline in unintended

Healthy People 2000 Final Review 117

5.1 Adolescent pregnancy

5.2 Unintended pregnancy

5.3 Infertility

5.4 Adolescents who ever had sexual intercourse:

Female 15 years

Male 15 years

Female 17 years

Male 17 years

5.5 Adolescent abstinence from sexual intercourse in

past 3 months: Female 15-17 years

Male 15-17 years

5.6 Contraception use: First intercourse female 15-19 years

First intercourse male 15-19 years

Recent intercourse female 15-19 years

Pill and condom use, recent intercourse female 15-19 years

5.7 Failure of contraceptive: Female 15-44 years

5.12 Contraception use: Female 15-44 years

5.8 Discussed sexuality with parents 13-18 years

Pill and condom use, recent intercourse in-school

male 15-17 years

Pill and condom use, last intercourse male 17-19 years

Moved away from target Moved toward target Met target

NOTE: Complete tracking data are shown in table 5. Progress quotients are not calculated for objectives 5.9, 5.10, and 5.11.

See the section on Measuring Progress Toward the

Healthy People 2000

Targets in the Appendix for more information.

41%

27%

57%

-58%

-10%

42%

33%

50%

57%

44%

29%

63%

Percent of target achieved

-100 -80 -60 -40 -20

20 40 60 80 100

21%

74%

118 Healthy People 2000 Final Review

Figure 5. Final status of Family Planning objectives

pregnancies. Overall, the rate of

unintended pregnancies in the United

States is still higher than other

developed countries. Canada’s rate is

39 percent, and the Netherlands’ rate is

only 6 percent (10).

Early sexual intercourse among

American adolescents represents a

significant public health problem.

Reduction of sexual activity at early

ages is an important public health

objective because sexual activity at early

ages is associated with more partners

and more frequent intercourse and the

concomitant risks of sexually

transmitted diseases, including HIV, and

unintended pregnancy (13). Although

other developed countries have similar

rates of early sexual intercourse, the

United States has one of the highest

teenage pregnancy rates in the world

(14). Abstinence from sexual intercourse

by adolescents increased (5.5), as did

their use of contraceptives (5.6).

Adolescents are now more likely to use

contraceptives, especially condoms, at

first intercourse than they were at the

beginning of the decade; black

adolescent females are particularly likely

to use injectable and implant

contraceptives (15).

Transition to Healthy People

2010

Many of the topics covered in the

Healthy People 2000 priority area on

Family Planning have been retained in

Healthy People 2010, with an emphasis

on increasing the proportion of

pregnancies that are intended, as well as

reducing adolescent pregnancy. In light

of the serious consequences of

unintended pregnancies, in 1995, the

Institute of Medicine issued a

comprehensive report supporting actions

to establish a new national norm in

which all pregnancies should be

intended, that is consciously and clearly

desired at the time of conception (5).

The importance of developing this norm

is supported in Healthy People 2010.In

a departure from Healthy People 2000,

which focused primarily on adolescent

pregnancy, Healthy People 2010 adopts

the broader perspective that every

pregnancy should be intended and

highlights improvement opportunities to

achieve this goal.

In addition, some new topics have

been included to address key issues such

as adequate spacing between

pregnancies, male involvement in

pregnancy prevention and reproductive

health, access to emergency

contraception and insurance coverage

for contraception. A new objective has

been added that addresses encouraging

females of all ages to space their

pregnancies adequately in order to lower

their risk of adverse perinatal outcomes.

A new developmental objective (an

objective without current baseline data)

has been included to increase the

proportion of health care providers who

provide emergency contraception. The

U.S. Guide to Clinical Preventive

Services (16) identifies postcoital

administration of emergency

contraceptive pills (ECP) after

unprotected intercourse as an effective

means of reducing subsequent

pregnancy. Increased public awareness,

including culturally and linguistically

competent education about ECP as well

as direct access to and insurance

reimbursement for ECP, would

contribute significantly toward

attainment of this objective and

reductions in the rates of unintended

pregnancies.

The Healthy People 2010 Family

Planning chapter also includes a new

developmental objective addressing male

involvement in pregnancy prevention

and family planning efforts. The next

cycle of the National Survey of Family

Growth (NSFG), which is expected to

be conducted in 2002, is being expanded

to include questions directed to males,

providing an avenue for

institutionalizing data collection about

male fertility that will be reflected in the

Healthy People 2010 objectives.

Another developmental objective

seeks to increase the proportion of

health insurance policies that cover

contraceptive supplies and services. In a

1995 report, the Institute of Medicine

concluded that among the reasons for

high rates of unintended pregnancy in

the United States was lack of

contraceptive coverage by private health

insurance (7). Both newer managed care

insurance plans and traditional

fee-for-service insurance plans are more

likely to pay for general gynecological

services than they are to cover

contraceptive services or supplies (17).

A 1993 survey conducted by the Alan

Guttmacher Institute found that half of

indemnity plans and 7 percent of health

maintenance organizations (HMOs) do

not cover nonpermanent contraception.

The survey also found that plans that do

cover contraceptive services and/or

supplies are often inconsistent in which

methods they cover and have a

pronounced bias toward covering

permanent surgical methods (18).

The Healthy People 2010 objective

to increase the proportion of adolescents

who abstain from sexual intercourse or

use condoms if currently sexually active

included in the Sexually Transmitted

Diseases focus area was adapted from

several family planning objectives in

Healthy People 2000. This objective has

been designated as a measure of one of

the Leading Health Indicators (LHI).

Abstinence is the only method of

complete protection from unintended

pregnancy and sexually transmitted

diseases. Condoms, if used correctly and

consistently, can help prevent both as

well. The LHIs are discussed in further

detail in the Introduction.

Appendix table III, a crosswalk

between Healthy People 2000 and

Healthy People 2010, summarizes the

differences between the two decades of

objectives, reflecting new knowledge

and direction in this area.

Data Issues

Definitions

Data for objective 5.3 (infertility) is

from the NSFG. Infertility is defined as

the failure of a couple to conceive after

12 months of sexual intercourse without

contraception.

Data Sources

Data for objective 5.1 (adolescent

pregnancy) are based on three outcomes

of pregnancy: live births, fetal losses,

and abortions. Data on live births are

collected annually through the National

Vital Statistics System. For Hispanic

births, it should be noted that the

number of States reporting Hispanic

origin data in their vital statistics has

increased during the monitoring period

(see Appendix). Data for estimates on

fetal losses come from the NSFG, which

is conducted at multiyear intervals; the

most recent data available are from

1995. The 1995 data showed higher

rates than reported by this source for the

1988 NSFG. Fetal loss rates are affected

by the degree to which losses are

detected at very early gestations; it is

believed that these estimates reflect

more complete reporting, rather than a

‘‘real’’ increase in the fetal loss rate.

More information is provided in Vital

Healthy People 2000 Final Review 119

and Health Statistics Report series 21

no. 56 (12).

Estimates of the number of

abortions comes from the Abortion

Provider Survey, conducted by the Alan

Guttmacher Institute (AGI), a

nongovernment organization. The

estimation of the number of abortions is

complex. Nationally, valid data on

abortion are available from only two

sources and the methods of data

collection differ. The Centers for

Disease Control and Prevention (CDC)

collects annual information primarily

through reports from State health

agencies, which vary in completeness,

and the AGI collects data from a direct

survey of all known abortion providers,

which is conducted on a periodic basis.

As a result, the number of abortions

reported by CDC tend to be lower than

the numbers published by AGI. The data

from the Abortion Provider Survey are

adjusted using demographic

characteristics of women obtaining

abortions (in States that report abortions

to CDC) to produce national estimates.

More details are provided in Vital and

Health Statistics series 21 no. 56 (12).

The diversity of sources and the

variability of reporting intervals

complicate tracking of this objective.

The baseline data on inquiry about

family planning for objective 5.10

(counseling by clinicians) are from the

Primary Care Provider Surveys (PCPS)

and refer to the proportion of providers

who routinely provided counseling to

81–100 percent of their female clients of

childbearing age. The sample for the

study was drawn from the membership

rolls of provider organizations for

pediatricians, family physicians,

obstetricians/gynecologists, nurse

practitioners, and internists. Response

rates varied from 50–80 percent across

provider groups. The Prevention in

Primary Care Study (PPCS) was

conducted in 1997–98 to update data

from the PCPS. The design and items

included in the 1997–98 study were

similar to the PCPS, but a slightly

different sampling frame was used and

some items included in the 1992 surveys

were not included in the PPCS. The

professionals were sampled from listings

of all licensed, active practitioners in the

United States whose practices were at

least 50 percent primary care. Because

of low response rates from the other

provider groups, updates are available

only for nurse practitioners.

Data Comparability

Baseline and the 1995 data for ‘‘all

females’’ for objectives 5.4 (adolescent

postponement of sexual intercourse), 5.5

(adolescent abstinence), and 5.6

(contraception use) are from the NSFG.

Baseline and the 1995 data for ‘‘all

males’’ for objectives 5.4, 5.5, and 5.6

are from the National Survey of

Adolescent Males (NSAM). Additional

tracking data for 1990–99 from the

Youth Risk Behavior Survey (YRBS)

are also displayed for these objectives,

but are not directly comparable to the

baselines or targets. The YRBS surveys

adolescents in schools and reports data

by grade rather than age. The NSFG and

the NSAM surveys include all

adolescents regardless of their school

enrollment status. Data from the 1992

National Health Interview Survey

(NHIS) suggest that sexual intercourse

is more common and condom use is less

common among out-of-school youth

14–19 years of age, than among

in-school youth in the same age group.

However, estimates for in-school youth

were very close to those for the total

youth population (19).

The baseline for objective 5.8

(human sexuality discussion) came from

a one-time study by the Planned

Parenthood Foundation that provided

data on persons 13–18 years of age who

had discussed sexuality with their

parents. The 1994 and 1998 data came

from the NHIS, a population-based

survey that provided data on persons

10–17 years of age; 1995 data came

from the NSFG, which provided data on

females 18–19 years old.

References

1. Department of Health and Human Services.

Healthy people 2000: National health promotion

and disease prevention objectives. Washington:

Public Health Service. 1991.

2. Center for Disease Control and Prevention.

Achievements in public health, 1990–99: Family

planning. MMWR 48(47);1073–80.

3. Forrest JD, Samara R. Impact of publicly

funded contraceptive services on unintended

pregnancies and implications for medicaid

expenditures. Fam Plann Perspect 28:188–95.

1996.

4. Kost K, Landry D, Darroch J. Predicting

maternal behaviors during pregnancy: Does

intention status matter? Fam Plann Perspect

30(20):79–88. 1998.

5. Institute of Medicine, NAS. Preventing low

birthweight. Washington. 1985.

6. Centers for Disease Control and Prevention.

Infant mortality by marital status of mother.

United States, 1983. MMWR 39(30):521–2. 1990.

7. Brown SS, Eisenberg L, eds. The best

intentions, unintended pregnancy and the

well-being of children and families. Washington,

DC: National Academy Press.1995.

8. Jarman BJ. Enhancing social and life skills:

Preventing pregnancy among middle school

students. Presentation at what works conference.

University of Indiana. Nov. 1994.

9. Data are from the National Survey of Family

Growth, Centers for Disease Control and

Prevention, National Center for Health Statistics.

1995.

10. Henshaw SK. Unintended pregnancy in the

U.S. Family Planning Perspectives 30(1) 24–69.

1998.

11. Fu J, Darroch JE, Hass, T, et.al. Contraceptive

failure rates: new estimates from the 1995 national

survey of family growth. Fam Plann Perspect

31(2):56–63. 1999.

12. Ventura SJ, Mosher WD, Curtin SC, et.al.

Trends in pregnancies and pregnancy rates by

outcome: Estimates from the United States,

1976–96. National Center for Health Statistics.

Vital Health Stat 21(56):2, 56–57. 2000.

13. Department of Health and Human Services.

Trends in the well-being of America’s children

and youth:1997. Washington: Office of the

Assistant Secretary for Planning and Evaluation.

1997.

14. Singh S, Darroch JE. Adolescent pregnancy

and childbearing: levels and trends in developed

countries. Fam Plann Perspect 32:14–23. 2000.

15. Ventura S, Curtin SC, Matthews TJ. Teenage

births in the United States: National and state

trends 1990–96. National Vital Statistics System.

Hyattsville, Maryland: National Center for Health

Statistics. 1998.

16. Department of Health and Human Services.

Guide to clinical prevention services. 2nd ed.

Washington: Department of Health and Human

Services. 1995.

17. Landry DJ, Forrest JD. Private physicians’

provision of contraceptive services. Fam Plann

Perspect 28(5):203–9. 1996.

18. The Alan Guttmacher Institute. Uneven and

unequal: Insurance coverage and reproductive

health services. New York: the Institute. 1994.

19. Centers for Disease Control and Prevention.

Health risk behaviors among adolescents who do

and do not attend school: United States, 1992.

MMWR 43:129–32. 1994.

120 Healthy People 2000 Final Review

Table 5. Family Planning objectives

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

5.1 Adolescent pregnancy

Pregnancies (per 1,000)

Female 10-14 years ......................... 1990

3.5 . . . 3.4 3.4 3.3 3.3 3.0 2.8 - - - - - - - - - . . .

Female 15-17 years ......................... 1990

80.3 . . . 79.8 77.3 76.8 75.5 71.7 67.8 - - - - - - - - - 50

Live births (per 1,000)

Female 10-14 years ...................... 1990

1.4 . . . 1.4 1.4 1.4 1.4 1.3 1.2 1.1 1.0 - - - . . .

Female 15-17 years ...................... 1990

37.5 . . . 38.7 37.8 37.8 37.6 36.0 33.8 32.1 30.4 - - - . . .

Abortions (per 1,000)

Female 10-14 years ...................... 1990

1.5 . . . 1.4 1.5 1.4 1.3 1.2 1.1 - - - - - - - - - . . .

Female 15-17 years ...................... 1990

26.5 . . . 24.3 23.1 22.5 21.4 19.9 19.0 - - - - - - - - - . . .

Fetal losses (per 1,000)

Female 10-14 years ...................... 1990

0.5 . . . 0.5 0.5 0.5 0.6 0.5 0.5 - - - - - - - - - . . .

Female 15-17 years ...................... 1990

16.2 . . . 16.8 16.4 16.5 16.5 15.9 15.0 - - - - - - - - - . . .

a. Pregnancies, black adolescents (per 1,000)

Female 15-19 years ...................... 1990

215 . . . 215 211 205 195 178 178 - - - - - - - - - 120

Female 15-17 years ...................... 1990

161 . . . 160 156 153 146 133 128 - - - - - - - - - . . .

Live births (per 1,000)

Female 15-19 years ...................... 1990

113 . . . 116 112 109 105 96 94 88 85 - - - . . .

Female 15-17 years ...................... 1990

82 . . . 84 81 80 76 70 67 61 57 - - - . . .

Abortions (per 1,000)

Female 15–19 years

..................... 1990

80 ... 77 76 75 70 63 66 --- --- --- ...

Female 15-17 years ...................... 1990

5 5 ... 5 3 5 2 5 1 4 8 4 4 4 4 --- --- --- ...

Fetal losses (per 1,000)

Female 15-19 years

..................... 1990

2 2 ... 2 2 2 2 2 1 2 1 1 9 1 8 --- --- --- ...

Female 15-17 years ...................... 1990

2 3 ... 2 3 2 3 2 2 2 1 1 9 1 8 --- --- --- ...

b. Pregnancies, Hispanic adolescents (per 1,000)

Female 15-19 years ...................... 1990

156 . . . 165 168 166 167 163 157 - - - - - - - - - 105

Live births (per 1,000)

Female 15-19 years

..................... 1990

100 . . . 107 107 107 108 107 102 97 94 - - - . . .

Abortions (per 1,000)

Female 15-19 years ...................... 1990

3 9 ... 4 0 4 3 4 2 4 2 3 9 3 7 --- --- --- ...

Fetal losses (per 1,000)

Female 15-19 years ...................... 1990

1 7 ... 1 8 1 8 1 8 1 8 1 8 1 7 --- --- --- ...

5.2 Unintended pregnancy (female 15-44 years) ....... 1988 56% - - - - - - - - - - - - - - - 49% - - - - - - - - - - - - 30%

a. Black female (15-44 years) .................. 1988 78% - - - - - - - - - - - - - - - 72% - - - - - - - - - - - - 40%

b. Hispanic female (15-44 years) ................ 1988 55% - - - - - - - - - - - - - - - 48% - - - - - - - - - - - - 30%

5.3 Infertility

Married couples with wives 15-44 years ............ 1988 7.9% - - - - - - - - - - - - - - - 7.1% - - - - - - - - - - - - 6.5%

a. Black couples with wives 15-44 years .......... 1988 12.1% - - - - - - - - - - - - - - -

10.5% - - - - - - - - - - - - 9%

b. Hispanic couples with wives 15-44 years ........ 1988 12.4% - - - - - - - - - - - - - - - 7.0% - - - - - - - - - - - - 9%

See footnotes and key at end of table.

Healthy People 2000 Final Review 121

Table 5. Family Planning objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

5.4* Adolescents who ever engaged in sexual

intercourse

Adolescents 15 years

All females ................................ 1988 27% - - - - - - - - - - - - - - - 22% - - - - - - - - - - - - 15%

In-school females.......................... ... --- 35% 36% --- 37% --- 38% --- 44% --- 43% ...

All males .................................. 1988 33% - - - - - - - - - - - - - - - 27% - - - - - - - - - - - - 15%

In-school males ........................... ... --- 48% 44% --- 45% --- 42% --- 42% --- 34% ...

a. All black males ............................ 1988 69% - - - - - - - - - - - - - - - 58% - - - - - - - - - - - - 15%

In-school non-Hispanic black males .......... ... --- --- 79% --- 82% --- 77% --- 75% --- 68% ...

Adolescents 17 years

All females ................................ 1988 50% - - - - - - - - - - - - - - - 51% - - - - - - - - - - - - 40%

In-school females.......................... ... --- 62% 66% --- 66% --- 67% --- 62% --- 40% ...

All males .................................. 1988 66% - - - - - - - - - - - - - - - 53% - - - - - - - - - - - - 40%

In-school males ........................... ... --- 73% 68% --- 68% --- 65% --- 60% --- 44% ...

b. All black males ............................ 1988 90% - - - - - - - - - - - - - - - 79% - - - - - - - - - - - - 40%

In-school non-Hispanic black males .......... ... --- --- 90% --- 92% --- 88% --- 85% --- 82% ...

c. All black females 15-17 years ................. 1988 66% - - - - - - - - - - - - - - -

4 8 % --- --- --- --- 4 0 %

In-school non-Hispanic black females ......... ... --- --- 8 4 % --- 8 0 % --- 7 5 % --- 7 3 % --- 7 3 % ...

5.5* Adolescent abstinence from sexual intercourse for

previous 3 months

All sexually active females 15-17 years ............ 1988 23.6% - - - - - - - - - - - - - - - 27% - - - - - - - - - - - - 40%

In-school sexually active females 15-17 years ...... ... --- 2 4 % 2 5 % --- 2 5 % --- 2 3 % --- 2 3 % --- 2 5 % ...

All sexually active males 15-17 years .............. 1988 33% - - - - - - - - - - - - - - - 37% - - - - - - - - - - - - 40%

In-school sexually active males 15-17 years ....... ... --- 3 0 % 3 6 % --- 3 3 % --- 3 4 % --- 3 2 % --- 3 2 % ...

5.6 Contraception use by sexually active adolescents

Female

First intercourse (15-19 years) ................... 1988 65% - - - - - - - - - - - - - - - 76% - - - - - - - - - - - - 90%

Recent intercourse (15-19 years) ................. 1988 78% - - - - - - - - - - - - - - - 71% - - - - - - - - - - - - 90%

Recent intercourse (In school, 15-17 years) ......... ... --- 7 8 % 8 1 % --- 8 3 % --- 8 3 % --- 8 5 % --- 8 3 % ...

Oral contraceptive and the condom at most

recent intercourse (15-19 years) ................. 1988 2% - - - - - - - - - - - - - - - 8% - - - - - - - - - - - - 90%

Male

Contraception use at most recent intercourse

(15-19 years) ............................... 1990 78% . . . - - - - - - - - - - - - 79% - - - - - - - - - - - - 90%

Contraception use at most recent intercourse

(In school, 15-17 years) ....................... ... --- --- 8 3 % --- 8 4 % --- 8 5 % --- 8 1 % --- 8 6 % ...

Birth control pills and condoms at most recent

intercourse (In school, 15-17 years) .............. 1990

2.0% . . . 3.3% - - - 2.9% - - - 3.6% - - - 4.8% - - - 4.2% 90%

Condom and pill use at last intercourse

(17-19 years) ............................... 1988 15% - - - - - - - - - - - - - - - 16% - - - - - - - - - - - - 90%

Condom and pill use at last intercourse

(In school, 17 years and over)................... ... --- 2% 3% --- 4% --- 7% --- 5% --- 6% ...

See footnotes and key at end of table.

122 Healthy People 2000 Final Review

Table 5. Family Planning objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

5.7 Failure of contraceptive method for females

15-44 years ................................ 1988 14% - - - - - - - - - - - - - - - 12% - - - - - - - - - - - - 7%

a. Black female 15-44 years .................... 1988 18% - - - - - - - - - - - - - - - 19% - - - - - - - - - - - - 8%

b. Hispanic female 15-44 years ................. 1988 16% - - - - - - - - - - - - - - - 15% - - - - - - - - - - - - 8%

5.8 Persons ages 13–18 years who have discussed

sexuality with parents........................ 1986 66% - - - - - - - - - - - -

73%

8 0 % --- --- --- --- 8 5 %

Persons ages 10-17 who have discussed human

sexuality with parents, church, or school ........... ... --- --- --- --- --- 8 9 %

9 8 % --- --- 9 2 % --- ...

5.9 Family planning counseling .................... 1984 60% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 90%

5.10* Age-appropriate preconception counseling by

clinicians .................................. ... --- --- --- --- --- --- --- --- --- --- --- 6 0 %

Percent of clinicians routinely providing service

to 81-100% of patients

Inquiry about family planning (female, childbearing age)

Pediatricians ............................... 1992 18% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 60%

Nurse practitioners .......................... 1992 53% . . . . . . . . . - - - - - - - - - - - - - - -

42% - - - 60%

Obstetricians/gynecologists .................... 1992 48% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 60%

Internists .................................. 1992 24% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 60%

Family physicians ........................... 1992 28% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 60%

Counseling about family planning

Pediatricians ............................... 1992 36% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 60%

Nurse practitioners .......................... 1992 53% . . . . . . . . . - - - - - - - - - - - - - - -

40% - - - 60%

Obstetricians/gynecologists .................... 1992 65% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 60%

Internists .................................. 1992 26% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 60%

Family physicians ........................... 1992 36% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 60%

5.11* Clinic services for HIV and other sexually

transmitted diseases

Family planning clinics ......................... 1989 40% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 50%

Title X funded family planning clinics

STD testing (excluding HIV).................... ... --- --- --- --- --- 95% --- --- --- --- --- ...

STD counseling (excluding HIV) ................ ... --- --- --- --- --- 98% --- --- --- --- --- ...

STD treatment (excluding HIV) ................. ... --- --- --- --- --- 93% --- --- --- --- --- ...

Gonorrhea

Client testing

............................. ... --- 97% --- --- --- --- --- --- --- --- --- ...

Client treatment............................. ... --- 82% --- --- --- --- --- --- --- --- --- ...

Partner notification

......................... ... --- 23% --- --- --- --- --- --- --- --- --- ...

Partner testing.............................. ... --- 60% --- --- --- --- --- --- --- --- --- ...

Partner treatment ........................... ... --- 62% --- --- --- --- --- --- --- --- --- ...

Syphilis

Client testing

............................. ... --- 86% --- --- --- --- --- --- --- --- --- ...

Client treatment............................. ... --- 48% --- --- --- --- --- --- --- --- --- ...

Partner notification

......................... ... --- 29% --- --- --- --- --- --- --- --- --- ...

Partner testing.............................. ... --- 57% --- --- --- --- --- --- --- --- --- ...

Partner treatment ........................... ... --- 40% --- --- --- --- --- --- --- --- --- ...

See footnotes and key at end of table.

Healthy People 2000 Final Review 123

Table 5. Family Planning objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Chlamydia

Client testing

............................. ... --- 66% --- --- --- --- --- --- --- --- --- ...

Client treatment............................. ... --- 73% --- --- --- --- --- --- --- --- --- ...

Partner notification

......................... ... --- 15% --- --- --- --- --- --- --- --- --- ...

Partner testing.............................. ... --- 29% --- --- --- --- --- --- --- --- --- ...

Partner treatment ........................... ... --- 50% --- --- --- --- --- --- --- --- --- ...

HIV

Client pretest counseling ...................... ... --- 66% --- --- --- 82% --- --- --- --- --- ...

Client testing ............................... ... --- 60% --- --- --- 74% --- --- --- --- --- ...

5.12 Contraception use

Female 15-44 years ........................... 1982 88.2%

90.1% - - - - - - - - - - - - 92.5% - - - - - - - - - - - - 95%

a. Black female 15-44 years .................... 1982 78.9%

84.7% - - - - - - - - - - - - 89.9% - - - - - - - - - - - - 95%

b. Female 15-44 years under 100% poverty ........ 1982 79.6%

80.2% - - - - - - - - - - - - 92.1% - - - - - - - - - - - - 95%

c. Female 15-19 years under 200% poverty ........ 1982 67.4%

74.9% - - - - - - - - - - - - 84.8% - - - - - - - - - - - - 95%

- - - Data not available. Final objective status:

. . . Category not applicable.

Baseline has been revised.

Pregnancy rates are calculated from the number of births, fetal losses, and abortions.

Nonwhite adolescents.

Excludes data from States lacking an Hispanic-origin item on their birth or death certificate.

Data for non-Hispanic black females.

Data represent the proportion of people 10-17 years who had discussed human sexuality with parents. Proportions for school and church were 76 percent and 32 percent, respectively.

1995 data are for females 18–19 years who have ever discussed birth control methods, how pregnancy occurs, or STDs with a parent, or have had a sex educat ion class on birth control

methods, STDs, safe sex, or abstinence.

1995 data are for females 18–19 years who have ever discussed birth control methods, how pregnancy occurs, or STDs with a parent.

1997–98 data.

Response rate for this group was too low to produce reliable estimates.

Includes testing at initial visit, at annual visit, or if symptomatic.

By family planning clinic staff via telephone or mail.

1988 data.

NOTES: Data include revisions and, therefore, may differ from data previously published in these reports and other publications. STD is sexually transmitted disease. HIV is human

immunodeficiency virus.

Met

Toward

Mixed/ no change

Away

Cannot assess

124 Healthy People 2000 Final Review

Objective number Data source

5.1, 5.1a, b Abortion Provider Survey, Alan Guttmacher Institute; National Vital Statistics System, CDC, NCHS; National Survey of Family Growth, CDC, NCHS.

National Vital Statistics System, CDC, NCHS.

National Survey of Family Growth, CDC, NCHS.

5.2, 5.2a, b National Survey of Family Growth, CDC, NCHS.

5.3, 5.3a, b National Survey of Family Growth, CDC, NCHS.

5.4* Baseline and updates for all females and all black females: National Survey of Family Growth, CDC, NCHS.

Baseline and updates for all males and all black males: National Survey of Adolescent Males, NIH, NICHD.

1990–99 data for in-school females and males: Youth Risk Behavior Survey, CDC, NCCDPHP.

5.5* Baseline and update for all females: National Survey of Family Growth, CDC, NCHS.

Baseline and update for all males: National Survey of Adolescent Males, NIH, NICHD.

1990–99 data for in-school females and males: Youth Risk Behavior Survey, CDC, NCCDPHP.

5.6 All females: National Survey of Family Growth, CDC, NCHS.

All males: National Survey of Adolescent Males, NIH, NICHD.

1990–99 data for in-school females and males: Youth Risk Behavior Survey, CDC, NCCDPHP.

5.7, 5.7a, b National Survey of Family Growth, CDC, NCHS.

5.8 Baseline: Planned Parenthood Federation of America, Inc., 1986.

1994 and 1998 updates: National Health Interview Survey, CDC, NCHS.

1995 update: National Survey of Family Growth, CDC, NCHS.

5.9 Baseline: Mech EB. Unpublished. Orientation of Pregnancy Counselors toward Adoption. 1984.

5.10* Baseline: Primary Care Provider Surveys, OPHS, ODPHP.

Update: Prevention in Primary Care Study, American College of Preventive Medicine.

5.11* Baseline: State Family Planning Directors.

1990 data: National Questionnaire on Provision of STD and HIV Services by Family Planning Clinics, OPA.

1994 data: The Urban Institute. Family Planning Clinics: Current status and recent changes in services, clients, staffing, and income sources. March 1994.

5.12, 5.12a–c Forrest JD and Singh S. The Sexual and Reproduction Behavior of American Women, 1982–88. Family Planning Perspectives 22(5):206–14. 1 990.

1995 updates: National Survey of Family Growth, CDC, NCHS.

* Duplicate objective. See full text of objective following this table.

Healthy People 2000 Final Review 125

Family Planning

Objectives

5.1: Reduce pregnancies among females

aged 15–17 to no more than 50 per

1,000 adolescents.

5.1a: Reduce pregnancies among

black adolescent females aged

15–19 to no more than 120 per

1,000.

5.1b: Reduce pregnancies among

Hispanic adolescent females aged

15–19 to no more than 105 per

1,000.

5.2: Reduce to no more than 30 percent

the proportion of all pregnancies that are

unintended.

5.2a: Reduce to no more than

40 percent the proportion of all

pregnancies among black females

that are unintended.

5.2b: Reduce to no more than

30 percent the proportion of all

pregnancies among Hispanic

females that are unintended.

5.3: Reduce the prevalence of infertility

to no more than 6.5 percent.

5.3a: Reduce the prevalence of

infertility among black couples to

no more than 9 percent.

5.3b: Reduce the prevalence of

infertility among Hispanic couples

to no more than 9 percent.

5.4*: Reduce the proportion of

adolescents who have engaged in sexual

intercourse to no more than 15 percent

by age 15 and no more than 40 percent

by age 17.

Duplicate objectives: 18.3 and 19.9

5.4a*: Reduce the proportion of

black males aged 15 years who

have engaged in sexual intercourse

to no more than 15 percent.

Duplicate objectives: 18.3a and

19.9a

5.4b*: Reduce the proportion of

black males aged 17 years who

have engaged in sexual intercourse

to no more than 40 percent.

Duplicate objectives: 18.3b and

19.9b

5.4c*: Reduce the proportion of

black females aged 17 years who

have engaged in sexual intercourse

to no more than 40 percent.

Duplicate objectives: 18.3c and

19.9c

5.5*: Increase to at least 40 percent the

proportion of ever sexually active

adolescents aged 17 and younger who

have not had sexual intercourse during

the previous 3 months.

Duplicate objectives: 18.15 and 19.16

5.6: Increase to at least 90 percent the

proportion of sexually active, unmarried

people aged 15–24 who use

contraception, especially combined

method contraception that both

effectively prevents pregnancy and

provides barrier protection against

disease.

5.7: Increase the effectiveness with

which family planning methods are

used, as measured by a decrease to no

more than 7 percent in the proportion of

women experiencing pregnancy despite

use of a contraceptive method.

5.7a: Increase the effectiveness with

which family planning methods are

used, as measured by a decrease to

no more than 8 percent in the

proportion of black females

experiencing pregnancy in the last

year despite use of a contraceptive

method.

5.7b: Increase the effectiveness with

which family planning methods are

used, as measured by a decrease to

no more than 8 percent in the

proportion of Hispanic females

experiencing pregnancy in the last

year despite use of a contraceptive

method.

5.8: Increase to at least 85 percent the

proportion of people aged 10–18 who

have discussed human sexuality,

including correct anatomical names,

sexual abuse, and values surrounding

sexuality, with their parents and/or have

received information through another

parentally endorsed source, such as

youth, school, or religious programs.

5.9: Increase to at least 90 percent the

proportion of family planning counselors

who offer accurate information about all

options, including prenatal care and

delivery, infant care, foster care, or

adoption and pregnancy termination to

their patients with unintended

pregnancies.

5.10*: Increase to at least 60 percent the

proportion of primary care providers

who provide age-appropriate

preconception care and counseling.

Duplicate objective: 14.12

5.11*: Increase to at least 50 percent the

proportion of family planning clinics,

maternal and child health clinics,

sexually transmitted disease clinics,

tuberculosis clinics, drug treatment

centers, and primary care clinics that

provide on site primary prevention and

provide or refer for secondary

prevention services for HIV infection

and bacterial sexually transmitted

diseases (gonorrhea, syphilis, and

Chlamydia) to high-risk individuals and

their sex or needle-sharing partners.

Duplicate objectives: 18.13 and 19.11

5.12: Increase to at least 95 percent the

proportion of all females aged 15–44 at

risk of unintended pregnancy who use

contraception.

5.12a: Increase to at least

95 percent the proportion of black

females aged 15–44 at risk of

unintended pregnancy who use

contraception.

5.12b: Increase to at least

95 percent the proportion of females

aged 15–44 with income less than

100 percent of poverty at risk of

unintended pregnancy who use

contraception.

5.12c: Increase to at least 95 percent

the proportion of females aged

15–19 years under 200 percent of

poverty at risk of unintended

pregnancy who use contraception.

*Duplicate objective.

126 Healthy People 2000 Final Review

Priority Area 6

Mental Health and

Mental Disorders

Background

Major mental disorders continue to

affect large numbers of persons in the

United States. Suicide is one of the most

serious consequences of these disorders,

but other physical, emotional, social,

and economic costs occur as well—not

only for individuals but also for

families, communities, and government.

The most common disorders include

forms of anxiety, panic, agoraphobia,

social phobia, simple phobia,

post-traumatic stress and generalized

anxiety, mood disorders, major

depressive episodes, and manic episodes

or dysthymia. Other major conditions

that significantly affect quality of life

include schizophrenia and other

nonaffective psychoses, conduct

disorders, and antisocial personality

disorders.

In 1992, nearly 40 million persons

in the United States between the ages of

15 and 54 years experienced a major

mental disorder, approximately

24 percent of the population, slightly

more than the number experiencing

cardiovascular disorders. The lifetime

estimate of the prevalence of mental

illness is even higher (49 percent) (1,2).

Individuals affected by major mental

disorders are at unusually high risk for

suicide, as well as for social disabilities,

risk-laden life trajectories, and the

development of other disorders, mental

and physical. The costs precipitated by

these major disorders in the United

States approximated $150 billion in

1996. Treatment costs accounted for $69

billion, including approximately $37

billion from public funds; lost

productivity or premature death

accounted for another $75 billion; and

criminal justice involvement with the

mentally ill and property destruction

cost some $6 billion (3).

In 1990, more than 5 million people

were admitted to mental health facilities

for treatment; about 62 percent were

treated on an outpatient basis in

hospitals, mental health clinics, and

other facilities, with self-help and

human service organizations providing

most supplementary and alternative care

(4). Public insurance pays for treatment

of roughly 48 percent of those admitted

for inpatient treatment and 35 percent of

those admitted as outpatients (5).

Despite the volume of persons who

received treatment, only 40 percent of

those who experience mental illness

receive treatment (6), and only

one-quarter of these receive care from

the mental health sector (1).

Among people with early onset

disorders, the probability of no lifetime

treatment contact or delay in contact is

unusually high. This is particularly

likely for those with childhood-onset

mood or anxiety disorders, which are

also more severe and disabling than

later onset disorders. However, the

majority of persons who experience

other major disorders eventually do seek

treatment. On average, this takes place

between 6 and 14 years later, depending

on the disorder. Comorbidity appears to

be part of this treatment-seeking

process, increasing the likelihood of

both 12-month (34 percent) and lifetime

(42 percent) treatment contact (1).

Altogether, when severity and

persistence of the disorder or level of

associated role impairment is taken into

account (among persons 18–54 years of

age), the likelihood of comorbid

substance use, service use, frequent

service use, and service use in the

mental health specialty sector and in

self-help groups increases markedly.

Given these facts, avoiding

disabling outcomes of the major mental

disorders, intervening early in their

course, and preventing their onset all

become important strategies for

improving the health of the Nation.

Advances in research, such as those

reviewed in a recent Institute of

Medicine report (7), have provided

additional impetus for this complex

undertaking. Numerous conditions,

biologic and genetic vulnerabilities,

acute or chronic physical dysfunction,

insecure attachment styles, personality

characteristics, and a range of

environments, have been found to affect

both mental disorders and mental health.

Addressing this array of contingencies

through preventive interventions requires

a mix of minimizing risk factors and

maximizing protective factors in a

combination of preventive and treatment

interventions.

Data Summary

Highlights

By the end of the decade, progress

in achieving objectives was most

remarkable for those concerned with

enhancing protective factors and those

concerned with reducing

mortality/physical morbidity linked to

disorder.

The enhancements involved both

system development and individual

action. Mutual help clearinghouses

became available to all 50 States (6.12).

The number of adults seeking help with

their emotional and personal problems

(6.8) increased as anticipated and moved

toward the target for those with

disabilities (6.8a). The use of

community support among people with

severe mental disorders (6.6) also

increased past the targeted 30 percent.

The reductions in mortality and

morbidity linked to disorder involved

both suicide and physical illness.

Suicide rates overall, and in particular

among males ages 65 years and over,

and among adolescents 15–19 years of

age, declined below the target (6.1, 6.1c,

and 6.1a); suicide rates among males

20–34 years of age moved toward the

target (6.1b). Adverse health effects

from stress declined as anticipated

among adults in general (6.5) and

moved toward the target for those with

disabilities (6.5a).

On the other hand, significant

reversals were seen specific to

objectives involving interventions in

high-risk environments and suicidality

among adolescents. Objectives regarding

the number of States meeting nationally

recognized prison suicide prevention

standards (6.8) and adults not taking

steps to control stress (6.9) lost ground.

Objectives concerning suicide attempts

among adolescents (14–17 years of age)

and among female adolescents (6.2,

6.2a) also lost ground.

Summary of Progress

Year 2000 targets were met for five

objectives (6.1, 6.5, 6.6, 6.8, and 6.12).

One objective moved toward its target

(6.4), although progress was based on

estimated data from the prior decade.

Seven objectives moved away from their

targets (6.2, 6.7, 6.9, 6.10, 6.11, 6.14,

and 6.15).Two of these objectives (6.7

and 6.15) had very slight changes and

have not been updated since a 1990–92

Healthy People 2000 Final Review 127

6.1 Suicide

6.2 Suicide attempts among adolescents

6.5 People with adverse health effects from stress

6.6 Use of community support among people with

severe mental disorders

6.8 People seeking help with emotional problems

6.9 People not taking steps to control stress

6.11 Worksite stress management programs

6.12 States with mutual help clearinghouses

6.10 States meeting prison suicide prevention standards

Moved away from target Moved toward target Met target

NOTE: Complete tracking data are shown in table 6. Progress quotients are not calculated for objectives 6.3, 6.4, 6.7, 6.13, 6.14, and 6.15.

See the section on Measuring Progress Toward the

Healthy People 2000

Targets in the Appendix for more information.

-12%

-2%

-4%

Percent of target achieved

-100 -80 -60 -40 -20 0 20 40 60 80 100

114%

108%

131%

125%

100%

-167%

128 Healthy People 2000 Final Review

Figure 6. Final status of Mental Health and Mental Disorders objectives

estimate. Another two objectives (6.10

and 6.11) that appeared to move away

from targets did show progress based on

supplemental data. Objective (6.13)

showed mixed results. Progress for 6.13

and 6.14 was based on data limited to

nurse practitioners only. No national

data were available for one objective

(6.3). Details regarding measurement

issues are available in the following

section on data issues. See table 6 for

the tracking data for the objectives in

this priority area and figure 6 for a

quantitative assessment of progress.

Discussion

The 1990s saw a tremendous

increase in awareness of mental health

issues with the recognition that mental

health in part reflects a healthy

community. This is reflected in several

of the objectives that obtained the

targets set for the year 2000; a rise in

people seeking help with emotional

problems (6.8), a rise in the use of

community support among people with

severe mental disorders (6.6), a decline

in people with adverse health effects

from stress (6.5), a decline in suicide

(6.1), and all States being covered by

mutual help clearinghouses (6.12).

In 1999, the end of the ‘‘Decade of

the Brain’’ saw the first Surgeon

General’s Report on Mental Health (3),

which called attention to the body of

research testing effective treatments and

service delivery models and their

implications for advancing the state of

mental health in the Nation. Factors

influencing trends in mental health

include: increased third-party financing

and the provision of services through

managed care, an international

recognition of the ‘‘burden of disease’’

that documents depression as the leading

cause of disability worldwide among

persons 5 years of age and older, and a

rising concern with the translation of

resilience research into services research

and practice.

Other national events that have

provided guidance for mental health

concerns at the end of the decade (1999)

include:

The White House Conference on

Mental Health

National antistigma campaign

The Surgeon General’s Call to

Action on Suicide Prevention

The Surgeon General’s conference

on Children’s Mental Health

Inclusion of the treatment of

recognized depression as a National

Leading Health Indicator for the

decade 2000–2010

Transition to Healthy People

2010

Data development, increasing access

to services, eliminating disparities, and

providing for mental health needs across

the life span continue as themes into the

new decade for Healthy People 2010.

There are 14 objectives included in the

Mental Health and Mental Disorders

chapter for Healthy People 2010,

presented in terms of mental health

status improvement, treatment

expansion, and State activities. Only two

objectives are taken directly from

Healthy People 2000, suicide (6.1) and

suicide attempts among adolescents (6.2)

(with suicide age-adjusted to the 2000

population). Treatment of depression

among adults (6.7) appears in Healthy

People 2010 as well as Healthy People

2000, although the objective has been

expanded to monitor other serious

mental illnesses such as anxiety

disorders and schizophrenia as well. The

objective to track the percent of

worksites that have stress management

programs (6.11) has also been included

in Healthy People 2010; it has been

relocated in the Occupational Health and

Safety chapter.

The Healthy People 2010 objective

for adults with recognized depression

who receive treatment, which was

retained from Healthy People 2000

(with a different data source and age

group), has been designated as a

measure of one of the Leading Health

Indicators (LHI). The LHIs are

discussed in further detail in the

Introduction.

Four new objectives were added to

Healthy People 2010, they include:

reduce the proportion of homeless adults

who have serious mental illness,

increase the proportion of persons with

serious mental illness who are

employed, increase the number of States

that track satisfaction with the mental

health services received, and increase

the number of States with an operational

mental health plan that addresses mental

health crisis interventions, ongoing

screening, and treatment services for the

elderly.

In addition, seven new

developmental objectives (objectives

without current baseline data) appear for

mental health in Healthy People 2010.

They include: reduce the relapse rates

for persons with eating disorders,

increase the number of persons seen in

primary health care who receive mental

health screening and assessment,

increase the proportion of children with

mental health problems who receive

treatment, increase the proportion of

juvenile justice facilities that screen new

admissions for mental health problems,

increase the proportion of persons with

co-occurring substance abuse and mental

disorders who receive treatment for both

disorders, increase the proportion of

local governments with

community-based jail diversion

programs for adults with serious mental

illness, and increase the number of

States with an operational mental health

plan that addresses cultural competence.

Baseline data are expected to be

developed for these objectives by 2004.

Appendix table III, a crosswalk

between Healthy People 2000 and

Healthy People 2010 objectives,

summarizes the changes between the

two decades of objectives, reflecting

new knowledge and direction for this

area.

Data Issues

Definitions

Operational definitions and data

collection specifications for all Healthy

People 2000 objectives in Priority Area

6 have been published in the National

Center for Health Statistics’ Healthy

People Statistical Notes series (8). Data

issues are discussed and references are

cited for expanded discussions of the

data systems that provide data for the

national objectives. Where appropriate,

the text of the questionnaire items used

to measure the objectives is also

provided. See Appendix table VII for

further information.

Objective 6.1 (suicide) is monitored

using data from the National Vital

Statistics System (NVSS). The data are

compiled from death certificates

submitted by the States. Differentiating

suicide deaths from accidental deaths

relies heavily on judgment by the

medical legal officer (for example,

coroner or medical examiner). A key

element of this determination is the

establishment of intent by the deceased.

This determination may be based on

information about prior suicide attempts,

a statement or note by the deceased

Healthy People 2000 Final Review 129

indicating their intent to commit suicide,

or other clinical information (for

example, serious mental illness) (9).

Objective 6.2 (adolescent suicide

attempts) is monitored with data from

the Youth Risk Behavior Survey

(YRBS), a school-based survey. Suicide

attempts are self-reported and are

limited to those that required medical

attention in the last 12 months. The

exclusion of adolescents not in school

from the data used to monitor objective

6.2 may underestimate the actual

number of suicide attempts (10). Data

from the 1992 National Health Interview

Survey (NHIS) youth supplement

suggest that other types of violent

behavior (weapons-carrying and

fighting) are higher among youth (14–19

years of age) not in school than among

those in school; the estimates for

fighting and weapons-carrying for

in-school youth were very close to

estimates for the total population. (The

NHIS youth supplement did not include

questions on suicide attempts.) Reliance

on self-report of suicide attempts that

resulted in hospitalization, without

validation from medical sources, may

also affect the accuracy of estimates.

However, a recent study by the Centers

for Disease Control and Prevention

(CDC) indicates that estimates among

in-school youth are highly reliable (11).

The wording and baseline data for

objective 6.10 (suicide prevention in

jails) were established using States as

the organizational level for monitoring

and implementing suicide prevention

protocols in jails. However, jails are

usually under the jurisdiction of counties

or municipalities. State-level data on

jails are limited; the alternative data

track the objective using jails as the unit

of analysis. Data from the National

Census of Jails, conducted by the

Bureau of Justice Statistics, are only

available for 1993 but later updates are

expected. Additional data are from the

American Correctional Association’s

(ACA) list of jails, which are ACA

accredited; their accreditation requires

that suicide prevention policies and

training be implemented in the jail.

However, not all jails seek ACA

accreditation; this selection bias suggests

that these data may not be nationally

representative.

Data Sources

Data for objective 6.9 (people not

taking steps to control stress) are from

the Prevention Index, Rodale Press. Data

are collected from a random sample

telephone survey weighted to census

data for sex, race, education, and region

of the country.

Baseline data for objectives 6.13

(clinical review of childhood mental

functions) and 6.14 (clinical review of

adult mental functions) are from the

Primary Care Providers Surveys (PCPS).

The samples for the surveys were drawn

from the membership rolls of provider

organizations for family physicians,

nurse practitioners, internists,

obstetricians/gynecologists, and

pediatricians (6.14). Response rates

ranged from 50 to 80 percent. The data

on assessment and screening represent

the proportion of providers who

routinely queried 81–100 percent of their

patients about a particular type of

mental function. Data on treatment and

referral refer to the proportion of

providers who provided or referred

patients who needed the services. The

Prevention in Primary Care Study

(PPCS) was conducted in 1997–98 to

update data from the PCPS. The design

and items included in the 1997–98 study

were similar to the PCPS, but a slightly

different sampling frame was used and

some items included in the 1992 surveys

were not included in the PPCS. The

professionals were sampled from listings

of all licensed, active practitioners in the

United States whose practices were at

least 50 percent primary care. Because

of low response rates from the other

provider groups, updates are available

only for nurse practitioners. These

updates are based on a partial

characterization of medical screening

activity and may not fully represent the

primary care provider community.

Data Comparability

Baselines for objectives 6.4 (adult

mental disorders), 6.7 (treatment for

depression), and 6.15 (prevalence of

depression) came from the National

Institute for Mental Health (NIMH)

Epidemiologic Catchment Area (ECA)

studies conducted in five metropolitan

areas during the early 1980s. This

household survey used the Diagnostic

Interview Schedule (DIS) and the

Diagnostic and Statistical Manual of

Mental Disorders (DSM-III) criteria to

estimate 1-month prevalences, which

were used to set the baseline and target.

The updates for these objectives come

from the National Comorbidity Survey

(NCS), which is a national survey that

collects prevalence data using the

Composite International Diagnostic

Interview (CIDI) and DSM-IIIR and IV

criteria. Planned monitoring of the

objectives originally involved reanalysis

of ECA data to produce 1-year

prevalence estimates and recoding of

NCS data to reflect DSM-III categories.

Subsequent conduct of an

NCS-replication in the year 2000 will

provide comparative data more

appropriate to the decade, the currently

used diagnostic scheme, and

generalization to the national population.

These prevalence and treatment findings

will be available in 2001.

Data for objective 6.11 (worksite

stress management programs) are from

the National Survey of Worksite Health

Promotion Activities, which were

telephone surveys of nongovernment

worksites. Some of the businesses

surveyed had multiple worksites with

different health promotion activities.

Additionally, both active (for example,

classes) and passive (for example,

brochures) methods were counted as

worksite health promotion activities.

References

1. Kessler R, et al. Lifetime and 12-month

prevalence of DSM-IIIR psychiatric disorders in

the U.S. Arch Gen Psychiatry 51:8–19. 1994.

2. National Advisory Mental Health Council.

Health care reform for Americans with severe

mental illness: Report of the National Advisory on

Mental Health Council. Am J Psychiatry 150:

1447–64. 1993.

3. Department of Health and Human Services.

Mental Health: A report of the Surgeon General.

Rockville, Maryland: Department of Health and

Human Services, Substance Abuse and Mental

Health Services Administration, Center for Mental

Health Services, National Institutes of Health,

National Institute of Mental Health. 1999.

4. Rouse BA (ed). Substance abuse and mental

health statistical sourcebook. Rockville, Maryland:

Substance Abuse and Mental Health Services

Administration, 180–4. 1997.

5. Frank RG, et al. Paying for mental health and

substance abuse care. Health Aff 13: 237–42.

1994.

6. Robins LN, et al. An overview of psychiatric

disorders in America. In: Robins LN, Regier DA,

eds. Psychiatric disorders in America: The

Epidemiologic Catchment Area Study. New York:

Free Press. 1991.

7. Mrazek PJ, Haggery RJ, eds. Reducing risks for

mental disorders. Washington: Institutes of

Medicine, National Academy Press. 1994.

8. Seitz F, Jonas B. Operational definitions for

year 2000 objectives: Priority area 6, Mental

health and mental disorders. Healthy people

130 Healthy People 2000 Final Review

statistical notes; no 16. Hyattsville, Maryland:

National Center for Health Statistics. 1998.

9. Rosenberg M, et al. Operational criteria for the

determination of suicide. J Forensic Sci

33:1445–6. 1988.

10. Centers for Disease Control and Prevention.

Health risk behaviors among adolescents who do

and do not attend school: United States, 1992.

MMWR 43:129–32. 1994.

11. Brener N, et al. Reliability of the Youth Risk

Behavior Survey questionnaire. Paper presented at

the annual meeting of the American Public Health

Association, Oct 1994.

Healthy People 2000 Final Review 131

Table 6. Mental Health and Mental Disorders objectives

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

6.1* Suicide (age adjusted per 100,000) ............... 1987 11.7 11.5 11.4 11.1 11.3 11.2 11.2 10.8 10.6 10.4 - - - 10.5

a. Adolescents 15-19 years (per 100,000) ......... 1987 10.2 11.1 11.0 10.8 10.9 11.1 10.5 9.7 9.5 8.9 - - - 8.2

b. Male 20-34 years (per 100,000) ............... 1987 25.2 25.1 25.1 24.5 25.5 26.5 26.3 24.2 23.4 22.9 - - - 21.4

c. White male 65 years and over (per 100,000)...... 1987 46.7 44.4 42.7 41.0 40.9 38.9 38.7 37.8 36.1 38.2 - - - 39.2

d. American Indian/Alaska Native male

(age adjusted per 100,000) ................. 1987 20.1 21.0 19.2 17.9 18.7 23.8 20.1 20.0 21.3 21.4 - - - 17.0

6.2* Suicide attempts among adolescents 14–17 years . . 1990 2.1% . . . 1.7% - - - 2.7% - - - 2.8% - - - 2.6% - - - 2.6% 1.8%

a. Female 14-17 years ........................ 1991 2.5% . . . . . . - - - 3.8% - - - 3.4% - - - 3.3% - - - 3.1% 2.0%

6.3 Mental disorders

Children and adolescents 18 years and under ........ 1988 20% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 17%

6.4 Mental disorders among adults 18–54 years

(1-month prevalence) ......................... 1981–85 12.6% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10.7%

Mental disorders among adults 18-54 years

(1-year prevalence) ........................... ... ---

20.4% - - -

16.0% - - - - - - - - - - - - - - - - - - - - - . . .

6.5 Adverse health effects from stress for people

18 years and over ........................... 1985 44.2% 40.6% - - - - - - 39.2% - - - 33.9% - - - - - - 33.7% - - - 35%

a. People 18 years and over with disabilities........ 1985 53.5% 54.2% - - - - - - 54.9% - - - 49.1% - - - - - - - - - - - - 40%

6.6 Use of community support among people 18 years

and over with severe mental disorders .......... 1986 15% - - - - - - - - - - - -

34.6% - - - - - - - - - - - - - - - 30%

6.7 Treatment for depression among people

18–54 years (6-month services) ................. 1981-85 31% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 54%

Treatment for depression among people 18–54 years

(1-year services) ............................ ... ---

34.7% - - -

34.2% - - - - - - - - - - - - - - - - - - - - - . . .

6.8 People 18 years and over seeking help with

emotional/personal problems .................. 1985 11.1% 12.5% - - - - - - 14.3% - - -

18.9% - - - - - - 22.2% - - - 20%

a. People 18 years and over with disabilities........ 1985 14.7% 17.0% - - - - - - 19.8% - - -

26.6% - - - - - - - - - - - - 30%

6.9 People 18 years and over not taking steps to

control stress .............................. 1985

31% --- 33% --- 36% 34% 34% --- --- --- --- 5%

6.10* Suicide prevention in jails

Number of States meeting nationally recognized suicide

prevention standards.......................... 1992

2 ... ... ... --- --- 2 1 --- --- --- 50

Proportion of jails with suicide policies.............. ... --- --- --- --- 79.5% - - - - - - - - - - - - - - - - - - . . .

Proportion of jails with ACA accreditation............ ... --- 1% 1% 1% 2% 2% 2% --- --- --- 3% ...

6.11 Worksite stress management programs .......... 1985 26.6% - - - - - - 37.0% - - - - - - - - - - - - - - - - - -

26.0% 40%

6.12 Mutual self-help network

Number of States with mutual help clearinghouses .... 1995 8 . . . . . . . . . . . . . . . . . . - - - - - - - - - - - - 50

Number of Federal clearinghouses ................ 1995

2 ... ... ... ... ... ... --- --- --- --- ...

6.13 Clinician review of patients’ mental functioning .... ... --- --- --- --- --- --- --- --- --- --- --- 60%

Percent of clinicians routinely providing service to

81-100% of patients

Inquiry about cognitive functioning

Nurse practitioners .......................... 1992 35% . . . . . . . . . - - - - - - - - - - - - - - -

19% - - - 60%

Obstetricians/gynecologists .................... 1992 9% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 60%

See footnotes and key at end of table.

132 Healthy People 2000 Final Review

Table 6. Mental Health and Mental Disorders objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Internists .................................. 1992 18% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 60%

Family physicians ........................... 1992 7% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 60%

Inquiry about emotional/behavioral functioning

Nurse practitioners .......................... 1992 40% . . . . . . . . . - - - - - - - - - - - - - - -

26% - - - 60%

Obstetricians/gynecologists .................... 1992 12% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 60%

Internists .................................. 1992 25% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 60%

Family physicians ........................... 1992 13% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 60%

Treatment/referral for cognitive problems

Nurse practitioners .......................... 1992 20% . . . . . . . . . - - - - - - - - - - - - - - -

24% - - - 60%

Obstetricians/gynecologists .................... 1992 20% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 60%

Internists .................................. 1992 27% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 60%

Family physicians ........................... 1992 21% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 60%

Treatment/referral for emotional/behavioral problems

Nurse practitioners .......................... 1992 23% . . . . . . . . . - - - - - - - - - - - - - - -

33% - - - 60%

Obstetricians/gynecologists .................... 1992 23% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 60%

Internists .................................. 1992 35% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 60%

Family physicians ........................... 1992 27% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 60%

6.14 Clinician review of children’s mental functioning ... ... --- --- --- --- --- --- --- --- --- --- --- 75%

Percent of clinicians routinely providing service to

81–100% of patients

Inquiry about cognitive functioning

Pediatricians ................................ 1992 62% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 75%

Inquiry about emotional/behavioral functioning

Pediatricians ............................... 1992 47% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 75%

Treatment/referral for cognitive problems

Pediatricians ............................... 1992 51% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 75%

Treatment/referral for emotional/behavioral problems

Pediatricians ............................... 1992 45% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 75%

Inquiry about parent-child relationship

Pediatricians ............................... 1992 55% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 75%

Nurse practitioners .......................... 1992 55% . . . . . . . . . - - - - - - - - - - - - - - -

51% - - - 75%

Family physicians ........................... 1992 36% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 75%

Treatment/referral for parent-child interaction problems

Pediatricians ............................... 1992 34% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 75%

Nurse practitioners .......................... 1992 24% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 75%

Family physicians ........................... 1992 29% . . . . . . . . . - - - - - - - - - - - - - - -

7,8

--- --- 75%

See footnotes and key at end of table.

Healthy People 2000 Final Review 133

Table 6. Mental Health and Mental Disorders objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

6.15 Prevalence of depression in people 18–54 years

(1-month prevalence) ......................... 1981-85 5.1% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4.3%

Prevalence of depression in people 18–54 years

(1-year prevalence)........................... ... ---

10.9% - - -

11.1% - - - - - - - - - - - - - - - - - - - - - . . .

a. Female 18-54 years (1-month prevalence) ....... 1981-85 6.6% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5.5%

Female 18-54 years (1-year prevalence) ........ ... ---

14.2% - - -

13.1% - - - - - - - - - - - - - - - - - - - - - . . .

- - - Data not available. Final objective status:

. . . Category not applicable.

Baseline has been revised.

1981-85 data. Data are for noninstitutionalized, nonrural, white, black, or Hispanic people 18–54 years.

1990-92 data. Data are for noninstitutionalized, nonrural, white, black, or Hispanic people 18–54 years.

Estimate represents the proportion of people with mental disorders (excluding substance disorders only) in the past year which interfered with their ability to work or find work and who sought

help from community mental health services.

Estimate represents the proportion of people who sought help from a family member, therapist, or minister/rabbi. Individual values were: family members, 15.6 percent (21.0 percent for people

with disabilities), therapist, 6.8 percent (11.8 percent for people with disabilities), and minister/rabbi, 4.4 percent (6.9 percent for people with disabilities).

1998-99 data. Only 26 percent of worksites had onsite stress management programs, but 48 percent offered stress management either onsite or through t he health plan.

Clearinghouses provide coverage for all 50 states, establishing the required network.

1997-98 data.

Response rate for this group was too low to produce reliable estimates.

NOTE: Data include revisions and, therefore, may differ from data previously published in these reports and other publications.

Met

Toward

Mixed/ no change

Away

Cannot assess

134 Healthy People 2000 Final Review

Objective number Data source

6.1*, 6.1a-d National Vital Statistics System, CDC, NCHS.

6.2, 6.2a* Youth Risk Behavior Survey, CDC, NCCDPHP.

6.3 Bird HR. Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. Archives of Gen Psychiatry 45:1120–26. 1988 .

Costello EJ, et al. Psychiatric disorders in pediatric primary care: Prevalence risk factors.

Archives of Gen Psychiatry 45:1107–16. 1988.

6.4 Baseline: Epidemiologic Catchment Area Study, NIH, NIMH.

1990 and 1992 data: National Comorbidity Survey, University of Michigan.

6.5, 6.5a National Health Interview Survey, CDC, NCHS.

6.6 Baseline: National Institute of Mental Health Community Support Program Client Follow-up Study, SAMHSA.

1994 data: National Health Interview Survey, CDC, NCHS.

6.7 Baseline: Epidemiologic Catchment Area Study, NIH, NIMH.

Updates: National Comorbidity Survey, University of Michigan.

6.8, 6.8a National Health Interview Survey, CDC, NCHS.

6.9 Prevention Index, Rodale Press, Inc.

6.10* Baseline and updates (States): National Study of Jails, National Center on Institutions and Alternatives.

Baseline (suicide policies): National Census of Jails, DOJ, BJS.

Baseline and update (ACA accreditation): American Correctional Association.

6.11 National Survey of Worksite Health Promotion Activities, OPHS, ODPHP; 1998–99 update: National Worksite Health Promotion Survey, OPHS, ODPHP .

6.12 SAMHSA.

6.13 Baseline: Primary Care Provider Surveys, OPHS, ODPHP.

Update: Prevention in Primary Care Study, American College of Preventive Medicine.

6.14 Baseline: Primary Care Provider Surveys, OPHS, ODPHP.

Update: Prevention in Primary Care Study, American College of Preventive Medicine.

6.15 Baseline: Epidemiologic Catchment Area Study, NIH, NIMH.

1990 and 1992 data: National Comorbidity Survey, University of Michigan.

* Duplicate objective. See full text of objective following this table.

Healthy People 2000 Final Review 135

Mental Health and

Mental Disorders

Objectives

6.1*: Reduce suicides to no more than

10.5 per 100,000 people.

Duplicate objective: 7.2

6.1a*: Reduce suicides among

youth aged 15–19 to no more than

8.2 per 100,000.

Duplicate objective: 7.2a

6.1b*: Reduce suicides among men

aged 20–34 to no more than 21.4

per 100,000.

Duplicate objective: 7.2b

6.1c*: Reduce suicides among white

men aged 65 and older to no more

than 39.2 per 100,000.

Duplicate objective: 7.2c

6.1d*: Reduce suicides among

American Indian and Alaska Native

men to no more than 17.0 per

100,000.

Duplicate objective: 7.2d

6.2*: Reduce to 1.8 percent the

incidence of injurious suicide attempts

among adolescents aged 14–17.

Duplicate objective: 7.8

6.2a*: Reduce to 2.0 percent the

incidence of injurious suicide

attempts among female adolescents

aged 14–17.

Duplicate objective: 7.8a

6.3: Reduce to less than 17 percent the

prevalence of mental disorders among

children and adolescents.

6.4: Reduce the prevalence of mental

disorders (exclusive of substance abuse)

among adults living in the community to

less than 10.7 percent.

6.5: Reduce to less than 35 percent the

proportion of people aged 18 and older

who report adverse health effects from

stress within the past year.

6.5a: Reduce to less than 40 percent

the proportion of people with

disabilities who report adverse

health effects from stress within the

past year.

6.6: Increase to at least 30 percent the

proportion of people aged 18 and older

with severe, persistent mental disorders

who use community support programs.

6.7: Increase to at least 54 percent the

proportion of people with major

depressive disorders who obtain

treatment.

6.8: Increase to at least 20 percent the

proportion of people aged 18 and older

who seek help in coping with personal

and emotional problems.

6.8a: Increase to at least 30 percent

the proportion of people with

disabilities who seek help in coping

with personal and emotional

problems.

6.9: Decrease to no more than 5 percent

the proportion of people aged 18 and

older who report experiencing

signiﬁcant levels of stress who do not

take steps to reduce or control their

stress.

6.10*: Increase to 50 the number of

States with officially established

protocols that engage mental health,

alcohol and drug, and public health

authorities with corrections authorities to

facilitate identiﬁcation and appropriate

intervention to prevent suicide by jail

inmates.

Duplicate objective: 7.18

6.11: Increase to at least 40 percent the

proportion of worksites employing 50 or

more people that provide programs to

reduce employee stress.

6.12: Establish a network to facilitate

access to mutual self-help activities,

resources, and information by people

and their family members who are

experiencing emotional distress resulting

from mental or physical illness.

6.13: Increase to at least 60 percent the

proportion of primary care providers

who routinely review with patients their

patients’ cognitive, emotional, and

behavioral functioning and the resources

available to deal with any problems that

are identiﬁed.

6.14: Increase to at least 75 percent the

proportion of providers of primary care

for children who include assessment of

cognitive, emotional, and parent-child

functioning with appropriate counseling,

referral, and followup, in their clinical

practices.

6.15: Reduce the prevalence of

depressive (affective) disorders among

adults living in the community to less

than 4.3 percent.

6.15a: Reduce the prevalence of

depressive (affective) disorders

among women living in the

community to less than 5.5 percent.

*Duplicate objective.

136 Healthy People 2000 Final Review

Priority Area 7

Violent and Abusive

Behavior

Background

Injuries and deaths due to violence

and abusive behavior continue to be

pervasive in the United States and cost

the Nation over $200 billion annually.

Violence claims the lives of many of the

Nation’s youth and threatens the health

and well-being of persons of all ages.

Each year approximately 50,000 persons

in the United States die from

violence-related injuries. On an average

day, 53 persons die from homicide, and

a minimum of 18,000 persons survive

interpersonal assaults, 84 persons

complete suicide, and as many as 3,000

persons attempt suicide (1).

The United States has the highest

rates of lethal childhood violence when

compared to other industrialized

countries (2). In 1997, nearly 19,000

children 19 years of age and under died

of injuries, one-third from violence and

two-thirds from unintentional injury (3).

Of all homicide victims in 1997,

37 percent were 24 years of age and

under (4). Homicide remains the second

leading cause of death for young

persons 15–24 years of age and the

leading cause of death for African

Americans in this age group (5).

Data from 1979 through 1993

indicate that the total homicide rate

increased due to increases in

firearm-related homicides (6,7).

Furthermore, for each of the 32,436

persons killed by a gunshot wound in

the United States in 1997,

approximately 2 more people were

treated for nonfatal wounds in hospital

emergency departments (8).

Suicide is the eighth leading cause

of death in the United States. In 1997

suicide was the third leading cause of

death for children 10–14 years of age

and young persons 15–24 years of age

(5). The economic costs of suicide

among young persons 15–24 years of

age has been estimated at over $2.26

billion per year and, when attempted

suicide is considered, this cost increases

to over $3.19 billion (9).

Unfortunately, youth continue to be

involved as both perpetrators and

victims of violence. In 1998, 5,506

young people 15–24 years of age were

victims of homicide, an average of 15

youth homicide victims per day.

Homicide is second only to motor

vehicle crashes as a cause of injury

deaths for persons 15–24 years of age

(10). For each death there are at least

100 nonfatal violence-related injuries.

For adolescents 12 years of age and

older, physical assault victimization

occurred twice as often as in the general

population. Additionally, according to a

report by the U.S. Department of

Justice, assaults were significantly

higher among males. The report also

states that the number of assaults were

higher for those with lower household

incomes (less than $7,500) when

compared to the rates of assault

victimization of households with greater

annual incomes (more than $35,000)

(11).

Intimate partner violence and sexual

assault threaten people of all walks of

life. Even though both females and

males experience these types of

violence, male victimization of females

is more common in intimate partner

violence and sexual assault. Although

most assault victims survive, they suffer

physically and emotionally. In 1995,

almost 5,000 females in the United

States were murdered. In those cases for

which the Federal Bureau of

Investigation had data on the

relationship between the offender and

the victim, 85 percent were killed by

someone they knew. In 1994, more than

500,000 females were seen in hospital

emergency departments for violence-

related injuries, and 37 percent of those

females were there for injuries inflicted

by spouses, ex-spouses, or nonmarital

partners (12).

Child maltreatment continues to be

a major concern. In 1997, an estimated

1,196 fatalities were due to child

maltreatment in the 50 States and the

District of Columbia. In the same year,

the rate of child victims was 13.9 per

1,000 children in the general population.

Based on information from 39 States,

75.4 percent of the perpetrators were the

victim’s parents, 10.2 percent were

relatives, and 1.9 percent were

individuals in other caretaking

relationships (13).

Data Summary

Highlights

While violent and abusive behaviors

continue to be major causes of death,

injury, and stress in the United States,

during the last decade there were many

indications of progress. All three violent

mortality objectives met their year 2000

targets. The age-adjusted homicide rate

for the total population (7.1) decreased

to 7.1 per 100,000 persons in 1998,

surpassing the year 2000 target of 7.2

per 100,000. Additionally, homicide

rates decreased for young adult black

and Hispanic males and all American

Indian/Alaska Natives, and to below the

year 2000 target for black females.

Suicide rates (7.2) in the total

population (age adjusted) fell to 10.4 per

100,000 in 1998, below the year 2000

target of 10.5. Suicide rates also

declined for adolescents 15–19 years of

age, males 20–34 years of age, and

white males 65 years of age and over.

On the other hand, suicide rates for

American Indian/Alaska Native males

increased from 20.1 per 100,000 persons

in 1987 to 21.4 per 100,000 in 1998.

Firearm-related deaths (7.3) declined for

the total population (age adjusted). The

rate in 1998 was 11.3 per 100,000

persons, which was below the year 2000

target of 11.6.

The incidence of rape and attempted

rape for females 12 years of age and

over (7.7) declined substantially, from

332 per 100,000 in 1992 to 160 in 1998,

even though it fell short of its year 2000

target of 108.

There was progress for two

objectives related to adolescent

behaviors, physical fighting (7.9) and

weapon-carrying (7.10) among

adolescents 14–17 years of age. The

incidence of physical fighting and

weapon-carrying among youth is

measured by the number of incidents

per 100 students per month. The number

of incidents of physical fighting

decreased from 137 in 1991 to 106 in

1999, surpassing the year 2000 target of

110. The incidence of weapon-carrying

decreased from 107 incidents in 1991 to

68 in 1999, which surpassed the year

2000 target of 86.

Another objective that surpassed the

year 2000 target was the implementation

in States of child death review systems

for unexplained child deaths (7.13). The

number of States (including the District

of Columbia) increased from 33 in 1991

to 48 in 1996, above the year 2000

target of 45.

Two objectives moved dramatically

away from the year 2000 targets. The

objectives were (7.6) reduce assault

injuries among people 12 years of age

Healthy People 2000 Final Review 137

7.1 Homicide

7.2 Suicide

7.3 Firearm-related deaths

7.8 Suicide attempts among adolescents

7.7 Rape and attempted rape

7.6 Assault injuries

7.9 Physical fighting among adolescents

7.10 Weapon-carrying by adolescents

7.11 Firearms in the home stored loaded and unlocked

7.16 Conflict resolution in a required course

7.18 States meeting prison suicide prevention standards

7.19 States with firearm storage laws

7.15 Battered women turned away from shelters

7.13 States with child death review systems

Moved away from target Moved toward target Met target

NOTE: Complete tracking data are shown in table 7. Progress quotients are not calculated for objectives 7.4, 7.5, 7.12, 7.14, and 7.17.

See the section on Measuring Progress Toward the

Healthy People 2000

Targets in the Appendix for more information.

-50%

-2%

Percent of target achieved

-100 -80 -60 -40 -20 0 20 40 60 80 100

108%

110%

108%

115%

186%

125%

100%

35%

25%

77%

-167%

-87%

138 Healthy People 2000 Final Review

Figure 7. Final status of Violent and Abusive Behavior objectives

and older and (7.8) reduce injurious

suicide attempts by adolescents.

Disturbingly, injurious suicide attempts

among adolescents 14–17 years of age

increased from 2.1 percent in 1990 to

2.6 percent in 1997.

Summary of Progress

The priority area of Violent and

Abusive Behavior contained a total of

19 objectives. Seven objectives, (7.1,

7.2, 7.3, 7.9, 7.10, 7.13, and 7.16) met

their respective year 2000 targets. Four

(7.5, 7.7, 7.11, and 7.19) progressed

toward the year 2000 targets. Five

objectives (7.4, 7.6, 7.8, 7.15, and 7.18)

moved away from the year 2000 target,

although three of these (7.4, 7.15, and

7.18) had definitional issues making

monitoring difficult (see Data Issues).

Three objectives (7.12, 7.14, and 7.17)

remained without baselines. See table 7

for the tracking data for the objectives

in this priority area and figure 7 for a

quantitative assessment of progress.

Discussion

As the 21st century begins, the

public, private, and government sectors

must work together to prevent violence.

Studies have demonstrated

interrelationships between risk factors

for different types of violence but much

more research is needed. Intervention

evaluations have demonstrated a limited

number of effective programs for

violence prevention. Further, some

interventions appear to be effective but

their ability to reduce morbidity and

mortality needs to be evaluated (14).

Given the diversity of communities and

circumstances, many more types of

prevention programs and interventions

need to be developed and evaluated.

The reasons for decline in many of

the measures of violence-related

objectives during the last decade are not

well understood. The decline

demonstrated in the latter part of the

decade may be due to multiple risk and

protective factors. Factors that may have

influenced the decline are changes in

prevention activities, demographics, the

economy, and the prevalence of

substance abuse.

Measurement of progress within the

area of family and intimate violence

prevention had three objectives (7.5, 7.6,

and 7.7) for which measurements were

affected by the redesign of the National

Crime Victimization Survey in 1992.

The revised questions elicited higher

rates for rape and other sex offenses, as

well as crimes committed by relatives

and acquaintances. The sensitive nature

of this issue makes it difficult to study.

Therefore, knowledge is limited about

the factors that affect the likelihood that

males will behave violently toward

females, the factors that endanger or

protect females from violence, and the

physical and emotional consequences of

such violence for families and their

children.

In the area of child maltreatment,

data systems are needed to identify new

cases and to characterize associated

causes of maltreatment. While some

long-term studies on home-visitation

programs for young mothers have

shown potential for preventing child

abuse and neglect, other existing

interventions and their effectiveness

need to be evaluated.

Developing data to measure

progress is critical for many of the areas

in injury and violence prevention. While

many reliable data sources have

remained constant over time, major

information gaps still exist, especially

for race, ethnicity, and special

populations. Addressing these gaps

poses a major challenge for the next

decade.

Transition to Healthy People

2010

The structure of Healthy People

changed significantly for Priority Area

7—Violent and Abusive Behavior and

Priority Area 9—Unintentional Injuries.

For several reasons, these two areas

were combined into one Healthy People

2010 Focus Area titled ‘‘Injury and

Violence Prevention.’’ One consideration

for merging the two subjects was having

all of the unintentional injury and

violence-related objectives in one place

to facilitate a better focus on the entire

injury area. Another consideration was

that many injuries produce the same

outcome but result from different causal

factors. For example, a nonfatal spinal

cord injury can be caused by an

unintentional event, such as a motor

vehicle crash, or by a violence-related

event, such as a domestic dispute or

attempted robbery. Finally, the same

interventions can reduce injuries for

both unintentional and violence-related

injuries. For instance, efforts to promote

proper storage of firearms in homes can

help reduce the risk of unintentional and

intentionally self-inflicted, or assaultive

firearm-related injuries in the home.

Overall, there are fewer objectives

for the two subject areas. The Healthy

People 2000 had 45 objectives in the

Unintentional Injuries and Violent and

Abusive Behavior chapters compared

with 39 objectives in Healthy People

2010 Injury and Violence Prevention

chapter. For unintentional injuries

Healthy People 2000 had 29 objectives

compared with 19 objectives in the

Healthy People 2010 edition. Violent

and Abusive Behaviors had 19

objectives in Healthy People 2000

compared with 8 objectives in Healthy

People 2010. The Healthy People 2010

chapter has a new section titled ‘‘Injury

Prevention’’ containing 12 objectives

that relate to both subject areas (for

example, nonfatal head injuries and

nonfatal spinal cord injuries, child

fatality review, emergency department

and hospital discharge surveillance

systems).

Additionally, some Healthy People

2000 objectives were eliminated because

they either lacked baseline data, a

national data source, progress, standard

definitions, or were too multifaceted and

could not be tracked. Some objectives

were revised for Healthy People 2010.

For example, objective 7.13

(unexplained child death review

systems) exceeded the year 2000 target

but was revised as a developmental

objective (an objective without current

baseline data) for Healthy People 2010.

The revised objective is more specific

and will measure State-level child

fatality reviews of deaths for children 14

years of age and under. The year 2000

objective was more general and did not

state a specific age group. In general for

Healthy People 2010, there is greater

specificity and also a better sense of the

potential for baseline data and

continuous tracking for the next decade.

Also, for Healthy People 2010, all age-

adjusted rates use a year 2000 standard

population.

Many injuries and injury-related

deaths occur in specific population

groups (such as infants, children, and

the elderly) where the intentionality of

the injury is unknown and requires more

detailed investigation. Examination of

these cases, documentation of the

events, and surveillance efforts can help

communities to better understand the

causes and to develop interventions to

Healthy People 2000 Final Review 139

prevent injuries which are a growing

public health concern for the Nation.

The Healthy People 2010 objective

for homicide, which was retained from

Healthy People 2000 (with a minor

variation), has been designated as a

measure of one of the Leading Health

Indicators (LHI). Homicide data are the

most accurate violent crime data

collected and as such are a reliable

indicator of violent crime in general.

The LHIs are discussed in further detail

in the Introduction.

Two objectives were transferred to

Focus Area 18—Mental Health and

Mental Disorders: Suicides, and

adolescent suicide attempts.

Healthy People 2010 contains 19

other related objectives within 6 other

focus areas. Those related areas are:

Focus Area 1, Access to Quality Health

Services, with three related objectives;

Focus Area 7, Educational and

Community-Based Programs, with one

objective; Focus Area 8, Environmental

Health, with three objectives; Focus

Area 18, Mental Health and Mental

Disorders, with two related objectives;

Focus Area 20, Occupational Safety and

Health, with four objectives; and Focus

Area 26, Substance Abuse, with six

related objectives.

Appendix table III, a crosswalk

between Healthy People 2000 and

Healthy People 2010 objectives,

summarizes the changes between the

two decades of objectives, reflecting

new knowledge and direction for this

area.

Data Issues

Definitions

Objective 7.1 (homicide) is

monitored using data from the National

Vital Statistics System (NVSS) and

excludes homicides attributed to legal

intervention. It should be noted that the

number of States reporting Hispanic

origin data in their vital statistics has

varied from year to year (see Appendix).

The data on spousal homicide (7.1b) are

from the Federal Bureau of

Investigation; the 1993 and 1994 data

are for spouses 15 years of age and over

and are not directly comparable to

previous data.

Objective 7.2 (suicide) is monitored

using data from the NVSS. The data are

compiled from death certificates

submitted by the States. Differentiating

suicide deaths from accidental deaths

relies heavily on judgment by the

medical legal officer (for example,

coroner or medical examiner). A key

element of this determination is the

establishment of intent by the deceased.

This determination may be based on

information about prior suicide attempts,

a statement or note by the deceased

indicating their intent to commit suicide,

or other clinical information (for

example, serious mental illness) (15).

Update data for objective 7.4 were

collected using a different

definition—the endangerment

standard—than the baseline, so the data

points are not directly comparable.

The baseline and target for

objective 7.5 (partner abuse) were

established using the National Institute

of Mental Health’s survey of family

violence, which measured incidents of

violence among couples. This survey

will not be repeated, so the objective is

monitored using data from the Bureau

of Justice Statistics’ National Crime

Victimization Survey that is tracking

violence between intimates (for

example, spouses, ex-spouses, or

boyfriends). The data used to track the

objective report incidents per 1,000

women, which reflects the intent of the

objective.

Data for objectives 7.6 (assault

injuries) and 7.7 (rape and attempted

rape) come from the National Crime

Victimization Survey, which provides

self-reported victimizations. The

numbers of offenses reported in this

survey generally exceed those reported

to police and other law enforcement

agencies. However, because of their

personal nature, some offenses such as

rape are underreported in the crime

survey (16). The data for objective 7.6

include injuries from completed rapes,

attempted and completed robberies with

injury, and completed aggravated and

simple assaults with injury. In 1992, the

Survey was redesigned; the revised

questions elicit higher rates for rape,

other sex offenses, and crimes

committed by relatives and

acquaintances. The baseline for

objective 7.7 has been revised using the

1992 data to reflect this measurement

change.

Data for objectives 7.8 (adolescent

suicide attempts), 7.9 (physical fighting

among adolescents), and 7.10 (weapon

carrying) are measured using the

school-based Youth Risk Behavior

Survey (YRBS) and rely on student

self-report. Self-reported suicide

attempts are limited to those that

occurred in the last 12 months and

required medical attention. Data from

the 1992 National Health Interview

Survey (NHIS) youth supplement

indicate higher levels of

weapon-carrying and fighting among

youth (14–19 years of age) not in school

than among youth the same age in

school, although the estimates for

in-school youth were very close to the

estimates for the total population (17).

The NHIS supplement did not include

questions on suicide attempts. Because

YRBS data are used for ongoing

monitoring of objective 7.8, the

exclusion of adolescents not in school

may underestimate youth suicide

attempts. The reliance on self-report

without external validation of

weapon-carrying, suicide attempts, and

fighting may affect the validity of these

estimates, although a study by the

Centers for Disease Control and

Prevention indicated that the results are

highly reliable (18).

Objective 7.11 (inappropriate

firearm storage) is measured using data

from the NHIS. The numerator is the

number of people who have a firearm in

or around the house that is stored loaded

and unlocked. The denominator is the

number of people who report having a

firearm in or around the house. Data on

the proportion of the total population

having a firearm in or around the house

are also footnoted in the summary table.

Objective 7.19 (handgun storage

laws) relates to State laws that vary

across States in populations targeted,

penalties, and liability.

Data Comparability

The update for objective 7.15

(shelter availability for battered women)

comes from the same source (National

Coalition Against Domestic Violence) as

the baseline, but was collected

differently and is not directly

comparable.

A reliable source of data for

objective 7.18 (suicide prevention in

jails) was not developed. The wording

and baseline data for the objective were

established with States as the

organizational level for monitoring and

implementing suicide prevention

protocols in jails. Jails are usually under

the jurisdiction of counties or

municipalities. State-level data on jails

are limited; the alternative data track the

objective using jails as the unit of

analysis. Data from the National Census

of Jails, conducted by the Bureau of

Justice Statistics, were only available for

140 Healthy People 2000 Final Review

1993. Additional data are from the

American Correctional Association’s

(ACA) list of jails that are

ACA-accredited; their accreditation

requires that suicide prevention policies

and training be implemented in the jail.

However, not all jails seek ACA

accreditation; this selection bias suggests

that these data may not be nationally

representative.

Data Availability

Data are not currently available for

objectives 7.12 (emergency room

protocols), 7.14 (followup on abused

children), and 7.17 (comprehensive

violence prevention programs). No

update was obtained for objective 7.16

(conflict resolution), which met its target

at baseline.

References

1. Moscicki EK, O’Carroll PW, Rae DS, et al.

Suicide ideation and attempts: The Epidemiologic

Catchment Area Study. In: Report of the

Secretary’s Task Force on Youth Suicide. Vol 4.

Washington: Department of Health and Human

Services. 1989.

2. Centers for Disease Control and Prevention.

Rates of homicide, suicide, and firearm-related

death among children—26 industrialized countries,

1950–93. MMWR 46(5):101. 1995.

3. National Center for Injury Prevention and

Control. U.S. Injury Mortality Statistics. Centers

for Disease Control and Prevention. 1997.

http:\\www.cdc.gov/ncipc/osp/usmort.htm.

4. National Center for Health Statistics. National

vital statistics system, general mortality table,

numbers of deaths. 1997. Hyattsville, Maryland:

Public Health Service. 2000.

5. Hoyert DL, Kochanek KD, Murphy SL. Deaths:

Final Data for 1997. National vital statistics

reports; vol 47 no 19. Hyattsville, Maryland:

National Center for Health Statistics. 1999.

6. Fingerhut LA, Ingram DD, Feldman JJ. Firearm

and nonfirearm homicide among persons 15–19

years of age: Differences by level of urbanization.

United States 1979–89. JAMA 267(22): 3048–53.

1992.

7. Fingerhut LA, Ingram DD, Feldman JJ.

Homicide rates among U.S. teenagers and young

adults: Differences by mechanism, level of

urbanization, race, and sex, 1987 through 1995.

JAMA 280(5): 423–7. 1998.

8. Centers for Disease Control and Prevention.

Nonfatal and fatal firearm-related injuries—United

States, 1993–1997. MMWR 48(45): 1029–34.

1999.

9. Weinstein MC, Saturno, PJ. Economic impact

of youth suicides and suicide attempts. In: Report

of the Secretary’s task force on youth suicide. Vol

4. Washington: Department of Health and Human

Services. 1989.

10. National Center for Health Statistics. Health,

United States, 2000 with Adolescent Health

Chartbook. Hyattsville, Maryland: 2000.

11. Bureau of Justice Statistics. Criminal

Victimization 1998: Changes 1997–98 with trends,

1993–98. Washington: Department of Justice.

1999.

12. Bureau of Justice Statistics. Violence-related

injuries treated in hospital emergency departments.

Washington: Department of Justice. 1997.

13. Department of Health and Human Services,

Administration on Children, Youth, and Families.

Child maltreatment 1997: Reports from the states

to the national child abuse and neglect data

system. Washington: U.S. Government Printing

Office. 1999.

14. National Center for Injury Prevention and

Control. Best practices for preventing violence by

children and adolescents: A source book. Atlanta,

Georgia: National Center for Injury Prevention and

Control. 1999.

15. Rosenberg M, et al. Operational criteria for the

determination of suicide. J Forensic Sci

33:1445–6. 1988.

16. Department of Justice, Bureau of Justice

Statistics. The crime of rape. Washington. 1985.

17. Centers for Disease Control and Prevention.

Health risk behaviors among adolescents who do

and do not attend school: United States, 1992.

MMWR 43:129–32. 1994.

18. Brener N, et al. Reliability of the Youth Risk

Behavior Survey questionnaire. Paper presented at

the annual meeting of the American Public Health

Association. Oct 1994.

Healthy People 2000 Final Review 141

Table 7. Violent and Abusive Behavior objectives

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

7.1 Homicide (age adjusted per 100,000).............. 1987 8.5 10.1 10.8 10.3 10.6 10.1 9.2 8.3 7.8 7.1 - - - 7.2

a. Children 3 years and under (per 100,000)........ 1987 3.9 4.4 4.9 4.5 4.9 4.6 4.5 4.5 4.3 4.4 - - - 3.1

b. Spouses 15-34 years (per 100,000) ............ 1987 1.7

1.5

1.1

1.0 --- --- --- --- --- 1.4

c. Black male 15-34 years (per 100,000) .......... 1987 91.1 130.5 140.8 134.2 140.5 133.8 114.6 105.7 97.6 84.9 - - - 72.4

d. Hispanic male 15-34 years (per 100,000)

....... 1987 41.3 53.2 55.7 56.8 52.4 52.2 49.7 39.2 34.9 33.5 - - - 33.0

e. Black female 15-34 years (per 100,000) ......... 1987 20.2 22.1 24.1 22.7 23.7 21.0 18.5 16.1 14.4 13.3 - - - 16.0

f. American Indian/Alaska Native (age adjusted

per 100,000) ............................. 1987 11.2 10.7 12.2 10.3 10.7 11.8 11.5 9.9 10.8 9.5 - - - 9.0

7.2* Suicide (age adjusted per 100,000) ............... 1987 11.7 11.5 11.4 11.1 11.3 11.2 11.2 10.8 10.6 10.4 - - - 10.5

a. Adolescents 15-19 years (per 100,000) ......... 1987 10.2 11.1 11.0 10.8 10.9 11.1 10.5 9.7 9.5 8.9 - - - 8.2

b. Male 20-34 years (per 100,000) ............... 1987 25.2 25.1 25.1 24.5 25.5 26.5 26.3 24.2 23.4 22.9 - - - 21.4

c. White male 65 years and over (per 100,000)...... 1987 46.7 44.4 42.7 41.0 40.9 38.9 38.7 37.8 36.1 38.2 - - - 39.2

d. American Indian/Alaska Native male (age

adjusted per 100,000) ...................... 1987 20.1 21.0 19.2 17.9 18.7 23.8 20.1 20.0 21.3 21.4 - - - 17.0

7.3 Firearm-related deaths (age adjusted per 100,000) . . . 1990 14.6 . . . 15.2 14.9 15.6 15.1 13.9 12.9 12.2 11.3 - - - 11.6

a. Black ................................... 1990 33.4 . . . 35.4 34.4 37.6 35.5 30.3 28.5 25.7 22.7 - - - 30.0

7.4 Child abuse and neglect (per 1,000).............. 1986 22.6 - - - - - - - - - 41.9 - - - - - - - - - - - - - - - - - - Less

than 2

Incidence of types of maltreatment

a. Physical abuse ............................ 1986 4.9 - - - - - - - - -

9.1 - - - - - - - - - - - - - - - - - - Less

than 4

b. Sexual abuse ............................. 1986 2.1 - - - - - - - - -

4.5 - - - - - - - - - - - - - - - - - - Less

than 2

c. Emotional abuse........................... 1986 3.0 - - - - - - - - -

7.9 - - - - - - - - - - - - - - - - - - Less

than 3

d. Neglect.................................. 1986 14.6 - - - - - - - - -

4,5

29.2 - - - - - - - - - - - - - - - - - - Less

than 1

7.5 Partner abuse (per 1,000 couples)................ 1985 30.0 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 27.0

Assaults by intimates (per 1,000 females 12 years

and over)

.................................. ... --- --- --- 8.8 9.8 9.1 8.6 7.5 --- 7.2 --- ...

7.6 Assault injuries (per 1,000 people 12 years

and over)

.................................. 1986 9.7 10.3 11.0 9.3 12.3 12.7 11.7 10.5 - - - 10.2 - - - 8.7

7.7 Rape and attempted rape (per 100,000)

Female 12 years and over ...................... 1992

332 . . . . . . . . . 267 273 193 144 156 160 - - - 108

a. Female 12-34 years ........................ 1992

607 . . . . . . . . . 477 527 374 249 349 - - - - - - 225

Sexual assaults (per 100,000 females 12 years

and over) .................................. 1992 184 . . . . . . . . . 138 96 84 84 102 110 - - - . . .

7.8* Suicide attempts among adolescents 14–17 years . . 1990 2.1% . . . 1.7% - - - 2.7% - - - 2.8% - - - 2.6% - - - 2.6% 1.8%

a. Female 14-17 years ........................ 1991 2.5% . . . . . . - - - 3.8% - - - 3.4% - - - 3.3% - - - 3.1% 2.0%

7.9 Physical fighting among adolescents 14–17 years

(incidents per 100 students per month) ............ 1991 137 . . . . . . - - - 137 - - - 128 - - - 115 - - - 106 110

a. Non-Hispanic black male 14-17 years .......... 1991 207 . . . . . . - - - 203 - - - 181 - - - 175 - - - 159 160

See footnotes and key at end of table.

142 Healthy People 2000 Final Review

Table 7. Violent and Abusive Behavior objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

7.10 Weapon-carrying by adolescents 14–17 years

(incidents per 100 students per month) ............ 1991 107 . . . . . . - - - 92 - - - 81 - - - 74 - - - 68 86

a. Non-Hispanic black adolescents 14–17 .......... 1991 134 . . . . . . - - - 117 - - - 85 - - - 84 - - - 71 105

7.11 Proportion of people 18 years and over with

firearms in the home that are stored loaded and

unlocked .................................. 1994

20% ... ... ... ... ... --- --- ---

19% - - - 16%

7.12 Emergency room protocols for victims of

violence ................................... ... --- --- --- --- --- --- --- --- --- --- --- 90%

7.13 Number of States with child death review

systems ................................... 1991 33 . . . . . . 32 - - - 40 - - -

48 --- --- --- 45

7.14 Number of States that followup abused children ... ... --- --- --- --- --- --- --- --- --- --- --- 30

7.15 Battered women turned away from shelters ....... 1987 40% - - - - - - - - - - - - - - - - - - 66% - - - - - - - - - 10%

7.16 Conflict resolution in a required course

Proportion of middle/junior and senior high schools .... 1994 58.3% . . . . . . . . . . . . . . . - - - - - - - - - - - - - - - 50%

7.17 Local comprehensive violence prevention

programs.................................. ... --- --- --- --- --- --- --- --- --- --- --- 80%

7.18* Suicide prevention in jails

Number of States meeting nationally recognized suicide

prevention standards.......................... 1992

2 ... ... ... --- --- 2 1 --- --- --- 50

Proportion of jails with suicide policies.............. ... --- --- --- --- 79.5% - - - - - - - - - - - - - - - - - - . . .

Proportion of jails with ACA accreditation............ ... --- 1% 1% 1% 2% 2% 2% --- --- --- 3% ...

7.19* Number of States with firearm storage laws ....... 1989

1 1 5 8 11 13 15 15 15 15 18 50

- - - Data not available. Final objective status:

. . . Category not applicable.

Baseline has been revised.

1989 data.

Includes married men and women aged 15 and older. Data include deaths from legal intervention (E970–E978) in addition to E960–E969 and are not compara ble to other data for this

objective.

Excludes data from States lacking Hispanic-origin item on their death certificates or for which Hispanic-origin data were not of sufficient quality. See appendix.

Rates were computed using the Endangerment Standard.

Rate includes both physically and emotionally neglected children.

The victimization survey was redesigned in 1992. The revised questions elicit higher rates for rape, other sex offenses, and crimes committed by relatives and acquaintances.

In 1994, 37.4 percent reported having a firearm in or around the home; in 1998, this number decreased to 35 percent.

Number includes State teams in 38 States and the District of Columbia, and 9 additional States where county/local teams serve the majority of the population at risk.

NOTE: Data include revisions and, therefore, may differ from data previously published in these reports and other publications.

Met

Toward

Mixed/ no change

Away

Cannot assess

Healthy People 2000 Final Review 143

Objective number Data source

7.1, 7.1a-f National Vital Statistics System, CDC, NCHS.

7.1b Numerator obtained from DOJ, FBI.

7.2*, 7.2a-d National Vital Statistics System, CDC, NCHS.

7.3 National Vital Statistics System, CDC, NCHS.

7.4, 7.4a-d National Incidence of Child Abuse and Neglect Survey, Administration for Children and Families, NCCAN.

7.5 Baseline: National Family Violence Survey, NIH, NIMH.

1992–96 and 1998 data: National Crime Victimization Survey, DOJ, BJS.

7.6 National Crime Victimization Survey, DOJ, BJS.

7.7, 7.7a National Crime Victimization Survey, DOJ, BJS.

7.8,7.8a* Youth Risk Behavior Survey, CDC, NCCDPHP.

7.9 Youth Risk Behavior Survey, CDC, NCCDPHP.

7.10 Youth Risk Behavior Survey, CDC, NCCDPHP.

7.11 National Health Interview Survey, CDC, NCHS.

7.13 Baseline: Annual 50-State Survey, National Committee for Prevention of Child Abuse.

Updates: National Incidence of Child Abuse and Neglect Survey, Administration for Children and Families, NCCAN.

7.15 Domestic Violence Statistical Survey, National Coalition Against Domestic Violence.

7.16 School Health Policies and Programs Study, CDC, NCCDPHP.

7.18* Baseline and updates (States): National Study of Jails, National Center on Institutions and Alternatives.

Baseline (suicide policies): National Census of Jails, DOJ, BJS.

Baseline and update (ACA accreditation): American Correctional Association.

7.19* Office of Planning, Evaluation and Legislation, CDC, NCIPC; National Conference of State Legislatures.

* Duplicate objective. See full text of objective following this table.

144 Healthy People 2000 Final Review

Violent and Abusive

Behavior Objectives

7.1: Reduce homicides to no more than

7.2 per 100,000 people.

7.1a: Reduce homicides among

children aged 3 and younger to no

more than 3.1 per 100,000 children.

7.1b: Reduce homicides among

spouses aged 15–34 to no more

than 1.4 per 100,000.

7.1c: Reduce homicides among

black men aged 15–34 to no more

than 72.4 per 100,000.

7.1d: Reduce homicides among

Hispanic men aged 15–34 to no

more than 33.0 per 100,000.

7.1e: Reduce homicides among

black women aged 15–34 to no

more than 16.0 per 100,000.

7.1f: Reduce homicides among

American Indians and Alaska

Natives to no more than 9.0 per

100,000.

7.2*: Reduce suicides to no more than

10.5 per 100,000 people.

Duplicate objective: 6.1

7.2a*: Reduce suicides among

youth aged 15–19 to no more than

8.2 per 100,000.

Duplicate objective: 6.1a

7.2b*: Reduce suicides among men

aged 20–34 to no more than 21.4

per 100,000.

Duplicate objective: 6.1b

7.2c*: Reduce suicides among white

men aged 65 and older to no more

than 39.2 per 100,000.

Duplicate objective: 6.1c

7.2d*: Reduce suicides among

American Indian and Alaska Native

men to no more than 17.0 per

100,000.

Duplicate objective: 6.1d

7.3: Reduce ﬁrearm-related deaths to no

more than 11.6 per 100,000 people from

major causes.

7.3a: Reduce ﬁrearm-related deaths

among blacks to no more than 30.0

per 100,000 people from major

causes.

7.4: Reverse to less than 22.6 per 1,000

children the rising incidence of

maltreatment of children younger than

age 18.

7.4a: Reverse to less than 4.9 per

1,000 children the rising incidence

of maltreatment of children younger

than age 18.

7.4b: Reverse to less than 2.1 per

1,000 children the rising incidence

of sexual abuse of children younger

than age 18.

7.4c: Reverse to less than 3.0 per

1,000 children the rising incidence

of emotional abuse of children

younger than age 18.

7.4d: Reverse to less than 14.6 per

1,000 children the rising incidence

of neglect of children younger than

age 18.

7.5: Reduce physical abuse directed at

women by male partners to no more

than 27 per 1,000 couples.

7.6: Reduce assault injuries among

people aged 12 and older to no more

than 8.7 per 1,000.

7.7: Reduce rape and attempted rape of

women aged 12 and older to no more

than 108 per 100,000 women.

7.7a: Reduce rape and attempted

rape of women aged 12–34 to no

more than 225 per 100,000.

7.8*: Reduce to 1.8 percent the

incidence of injurious suicide attempts

among adolescents aged 14–17.

Duplicate objective: 6.2

7.8a*: Reduce to 2.0 percent the

incidence of injurious suicide

attempts among female adolescents

aged 14–17.

Duplicate objective: 6.2a

7.9: Reduce to 110 per 100 the incidents

of physical ﬁghting among adolescents

aged 14–17.

7.9a: Reduce to 160 per 100 the

incidents of physical ﬁghting among

black males aged 14–17.

7.10: Reduce to 86 per 100 the incidents

of weapon-carrying by adolescents aged

14–17.

7.10a: Reduce to 105 per 100 the

incidents of weapon-carrying by

blacks aged 14–17.

7.11: Reduce by 20 percent the

proportion of people who possess

weapons that are inappropriately stored

and therefore dangerously available.

7.12: Extend protocols for routinely

identifying, treating, and properly

referring suicide attempters, victims of

sexual assault, and victims of spouse,

elder, and child abuse to at least

90 percent of hospital emergency

departments.

7.13: Extend to at least 45 States

implementation of unexplained child

death review systems.

7.14: Increase to at least 30 the number

of States in which at least 50 percent of

children identiﬁed as neglected or

physically or sexually abused receive

physical and mental evaluation with

appropriate followup as a means of

breaking the intergenerational cycle of

abuse.

7.15: Reduce to less than 10 percent the

proportion of battered women and their

children turned away from emergency

housing due to lack of space.

7.16: Increase to at least 50 percent the

proportion of elementary and secondary

schools that teach nonviolent conﬂict

resolution skills, preferably as a part of

comprehensive school health education.

7.17: Extend coordinated,

comprehensive violence prevention

programs to at least 80 percent of local

jurisdictions with populations over

100,000.

7.18*: Increase to 50 the number of

States with officially established

protocols that engage mental health,

alcohol and drug, and public health

authorities with corrections authorities to

facilitate identiﬁcation and appropriate

intervention to prevent suicide by jail

inmates.

Duplicate objective: 6.10

7.19*: Enact in 50 States and the

District of Columbia laws requiring that

ﬁrearms be properly stored to minimize

access and the likelihood of discharge

by minors.

Duplicate objective: 9.25

*Duplicate objective.

Healthy People 2000 Final Review 145

Priority Area 8

Educational and

Community-Based

Programs

Background

Educational and community-based

programs are instrumental in creating an

environment that is conducive to leading

a healthy lifestyle. These programs,

designed to reach people outside of the

traditional health care setting, are

fundamental to promoting health and

increasing the quality of life by

producing a supportive social and

physical environment capable of

reinforcing positive behaviors and

changing negative behaviors that

contribute to many of today’s leading

health threats.

Health and quality of life rely on

much more than a well-functioning

health and medical care system; they

depend on the community to encourage

and provide leadership, collaboration,

and initiatives that are fundamental to

progress. To successfully address health

and quality of life issues, communities

must draw on many components

including public health, health care,

civic, voluntary health, and faith

organizations; local governments;

schools; park and recreation

departments; and other interested groups

as well as private citizens. Working

within existing systems or networks,

such as schools or park departments,

community efforts can yield results that

can improve the health and lives of a

large segment of the population. While

some community-based programs

address a single risk factor or prominent

health problem, others are taking a more

comprehensive, holistic approach to

health and healthy communities.

Data Summary

Highlights

The average number of years of

healthy life for the total population (8.1)

increased from a baseline of 64 years in

1990 to 65.2 years in 1998, exceeding

the Healthy People 2000 target. Among

special populations targeted by the

objective, Hispanics met the year 2000

target, while progress was made for

blacks and older adults.

High school completion rates (8.2)

remained relatively stable compared

with their 1992 baselines. Worksites

with 50 or more employees that

provided employee health promotion

programs (8.6) saw significant growth

and exceeded the year 2000 target,

while the participation of blue-collar

employees 18 years of age and over in

these programs (8.7) declined from the

1994 baseline, yet still met their target.

The proportion of hospitals offering

community health promotion programs

(8.12) also met its target. Family

discussion of health issues with children

10 years of age and over (8.9) moved

away from its target.

Summary of Progress

Of the 14 Educational and

Community-Based Programs objectives,

4 met (8.1, 8.6, 8.7, and 8.13) and 2

progressed (8.12 and 8.14) toward the

year 2000 targets. One objective (8.8)

showed no change from baseline while

two objectives (8.3 and 8.9) showed

mixed progress. Two objectives (8.2 and

8.3) moved away from the year 2000

targets. Five objectives could not be

assessed because they either lacked data

beyond the baseline data (8.4, 8.5, 8.8,

and 8.11) or because they had proxy

data but lacked baseline data (8.10). See

table 8 for the tracking data for the

objectives in this priority area and

figure 8 for a quantitative assessment of

progress.

Discussion

In the past decade, the Nation has

seen progress in a number of areas—but

greater achievements are needed in the

areas of educational and

community-based programs. To make

further headway in this area, health

promotion programs need to be sensitive

to the diverse cultural norms and beliefs

of the people for whom the programs

are intended. Achieving such sensitivity

is a continuing challenge as the Nation’s

population becomes increasingly diverse.

To ensure that interventions are

culturally appropriate, linguistically

competent, and appropriate for the needs

of all groups (racial, ethnic, gender,

sexual orientation, disability status, and

age) within the community, members of

the populations served, and gatekeepers

must be involved in the community

assessment and planning process (1).

Community assessment helps to

identify the cultural traditions and

beliefs of the community and the

education, literacy level, and language

preferences necessary for the

development of appropriate materials

and programs. In addition, a community

assessment can help identify levels of

social capital and community capacity.

Such assessments help identify the

skills, resources, and abilities needed to

manage health improvement programs in

communities (2,3).

Educational and community-based

programs must be supported by

accurate, appropriate, and accessible

information derived from a science base.

Increasing evidence supports the

efficacy and effectiveness of health

education and health promotion in

schools, worksites, health care facilities,

and community-based programming (4).

Gaps in research include the

dissemination and diffusion of effective

programs, new technologies, policies,

relationships between settings, and

approaches to disadvantaged and special

populations (5).

Communities need to be involved as

partners in conducting research ensuring

that the content of the prevention efforts

developed is tailored to meet the needs

of the communities and populations

being served. Communities also need to

be involved as equal partners in research

to enhance the appropriateness and

sustainability of science-based

interventions and prevention programs

and ensure that the lessons of research

are transferred back to the community.

Sustainability is necessary for successful

research to be translated into programs

of lasting benefit to communities.

The impact of social ecology on

behavior and the successes of

environmental and policy approaches to

health promotion and disease prevention

need further documentation. Techniques

to evaluate community processes and

community health improvement methods

and models need to be refined and

disseminated so that other communities

can learn from and duplicate successful

strategies. Issues of partnering and the

role of collaborative efforts to increase

the capacity of individuals and

communities to achieve long-term

outcomes and improvements in health

status are not fully understood (2) and

should be evaluated. Mechanisms need

to be developed to share what is learned

in an appropriate and timely manner

with communities.

146 Healthy People 2000 Final Review

8.1 Years of healthy life

8.2 Completion of high school

8.3 Preschool child development programs:

Eligible children offered Head Start

8.8 Health promotion programs for older adults

8.7 Participation in worksite health promotion

activities, hourly workers 18 years and over

8.6 Worksite health promotion activities:

50 or more employees

8.9 Family discussion of health issues

Discussion on HIV/AIDS (grades 9-12)

8.12 Hospital-based patient education: Registered hospitals

Immunizations

Prenatal care

Primary care

8.14 Effective public health systems, health assurance:

Health education

Hospital-based community health promotion:

Community hospitals

Moved away from target Moved toward target Met target

NOTE: Complete tracking data are shown in table 8. Progress quotients are not calculated for objectives 8.4, 8.5, 8.10, 8.11, and 8.13.

See the section on Measuring Progress Toward the

Healthy People 2000

Targets in the Appendix for more information.

-25%

Percent of target achieved

-100 -80 -60 -40 -20 0 20 40 60 80 100

125%

120%

175%

100%

12%

16%

No change

43%

55%

63%

Healthy People 2000 Final Review 147

Figure 8. Final status of Educational and Community-Based Programs objectives

Transition to Healthy People

2010

The Healthy People 2010 focus area

on Educational and Community-Based

Programs has been reorganized to

emphasize four major settings—schools

(including colleges and universities),

worksites, health care sites, and the

community; and three major intervention

strategies, educational, policy, and

environmental. The four settings serve

as channels to reach desired audiences

as well as apply strategies in as broad a

population as possible. Among the more

effective community health promotion

programs are those that implement

comprehensive intervention plans with

multiple intervention strategies, such as

educational, policy, and environmental

within these various settings. These

settings also provide major social

structures for intervening at the policy

level to facilitate healthful choices (3).

Thus in Healthy People 2010, the

objectives are organized by setting, with

objectives addressing special populations

included in the community setting. The

objectives also reflect a mix of

educational, policy, and environmental

strategies. In the school setting, the

objective addressing high school

completion was retained as was the

objective addressing school health

education, but because of measurement

difficulties, health behaviors that

account for the majority of morbidity

and mortality were emphasized rather

than a comprehensive school health

education. Health risk behavior

information for colleges and universities

was also retained. A new objective

regarding the school nurse to student

ratio was added to address the rapidly

increasing number of children who need

health care during the school day.

Under the worksite setting,

objectives addressing the provision of

worksite health promotion and employee

participation in worksite health

promotion activities were both retained.

Under the health care setting, the

objective on hospital-based patient

education and community health

promotion was expanded to three

separate objectives, with some

modifications. The three objectives

address the provision of patient and

family education, satisfaction with

patient and family education received,

and finally, on health care organizations

sponsorship of community health

promotion activities. The focus on

health care organizations expands the

previous focus on hospitals. Health care

organizations are defined to include

hospitals, managed care organizations,

home health organizations, long-term

care facilities, and community-based

health care organizations.

Under the community setting, the

objective measuring community health

promotion programs addressing Healthy

People focus areas was retained

targeting multiple healthy focus areas

instead of a specific number. The

objective addressing culturally

appropriate and linguistically competent

community health promotion was

modified to reflect the new Healthy

People focus areas. The objective

addressing older adult participation in

health promotion activities was also

retained.

Objectives addressing years of

healthy life, preschool child

development programs, family

discussion of health issues, television

partnerships with community

organizations for health promotion, and

effective public health systems were

dropped. A modified version of the

latter objective was retained in the new

Healthy People focus area called Public

Health Infrastructure. Appendix table III,

a crosswalk between Healthy People

2000 and Healthy People 2010

objectives, summarizes the differences

between the two decades of objectives,

reflecting new knowledge and directions

in this area.

Data Issues

Years of Healthy Life

Years of healthy life is a summary

measure of health that combines

mortality (quantity of life) and

morbidity and disability (quality of life)

into a single measure. The concept of

increasing the span of healthy life is one

of the three Healthy People 2000 goals

and a specific measure has been

developed to track this objective in three

priority areas (8.1, 17.1, and 21.1). The

data used to track the objective come

from the National Vital Statistics System

(mortality) and the National Health

Interview Survey (NHIS) (morbidity).

The NHIS was redesigned in 1997 and,

therefore, data for 1997–98 may not be

comparable with those from previous

years. See the Appendix for a discussion

of the changes to the NHIS. The

methodology for the Healthy People

2000 years of healthy life measure,

developed by NCHS and outside

consultants, is published in Healthy

People Statistical Notes series (6).

Definitions

Objective 8.4 does not include a

definition of comprehensive school

health education. However, the Centers

for Disease Control and Prevention

(CDC) uses an operational definition

that includes eight elements (2). Data

for the variables from the 1994 School

Health Policies and Programs Study

(SHPPS) used to measure these

elements are shown in table 8. Schools

must have addressed all elements of the

operational definition to meet the

criteria for comprehensive school health

education. In 1994, only 2.3 percent of

schools included all eight elements.

Objective 8.7 asks for the

proportion of hourly workers who

participated regularly in

employer-sponsored health promotion

activities. The 1994 baseline indicates

the number of people who participated

in employer-sponsored health promotion

programs in the past year in the

following occupational categories:

Precision production, craft, and

repair occupations

Operators, fabricators, and laborers

Transportation and material moving

occupations

Handlers, equipment cleaners,

helpers, and laborers

Family discussions of health issues

(8.9) are defined as discussions in the

past month among family members 10

years of age and over about the

following topics: nutrition, exercise,

safety, tobacco use, sexual

behavior/sexually transmitted diseases,

or illegal drugs. In 1994, 83 percent of

people had discussed at least one of

these topics with family members in the

month prior to interview. This exceeds

the year 2000 target of 75 percent.

Data Sources

The data used to track objectives

8.2 (completion of high school) and 8.3

(preschool child development programs)

come from the National Center for

Education Statistics (NCES) (7). Both

objectives 8.2 and 8.3 are consistent

with the National Education Goals. The

data for objective 8.2 include those who

received high school diplomas as well

as those who received alternative

credentials, such as a General Education

148 Healthy People 2000 Final Review

Development (GED) certiﬁcate. Data for

1992 and 1993 are for persons 19–20

years of age. Beginning with data for

1994, ﬁgures for high school completion

are available only for people 18–24

years of age.

Data for objective 8.6 (worksite

health promotion programs) are from the

National Survey of Worksite Health

Promotion Activities, which were

telephone surveys of nongovernment

worksites. Some of the businesses

surveyed had multiple worksites with

different health promotion activities.

Additionally, both active (for example,

classes) and passive (for example,

brochures) methods were counted as

worksite health promotion activities.

Proxy Data and Data Availability

Proxy data for 1992–93 from the

National Association of City and County

Health Officials are shown for objective

8.10. These data show the percent of the

43 reporting States in which at least

90 percent of local health departments

reported providing services that

addressed three or more Healthy People

2000 priority areas. The data represent

the local health departments’ report of

whether a program or service existed.

The survey did not determine whether

the program or service was a health

promotion effort that involved citizen

participation, included community

assessment, or had measurable

objectives. Information on the

proportion of the State population

reached by the services or programs was

not available.

Objective 8.11 is measured using

proxy data from the local health

departments obtained through the

National Proﬁle of Local Health

Departments, NACCHO. The objective

was developed to track the proportion of

counties that have established culturally

and linguistically appropriate community

health promotion programs for racial

and ethnic minority populations.

Local health department refers to

any local component of the public

health system, deﬁned as an

administrative and service unit of local

or State government concerned with

health and carrying some responsibility

for the health of a jurisdiction smaller

than a State. Baseline data for objective

8.11 represent the proportion of local

health departments who indicated they

provided programs or interventions in

the past year that were adapted to meet

the special language and cultural needs

of any racial/ethnic minority population

served. Local health departments

included are those in which a racial or

ethnic minority group constitutes more

than 10 percent of the population. Data

shown are the proportion of local health

departments providing culturally and

linguistically appropriate programs by

Healthy People 2000 priority area.

The Media Health Partnerships

Survey was developed by CDC to

measure partnerships between network

television affiliates and community

health organizations (objective 8.13).

The survey, conducted September

1995–January 1996, determined that all

television network affiliates in the top

20 media markets devote a substantial

effort to health promotion and disease

prevention through partnerships with

community groups, organizations, and/or

agencies. Based on these ﬁndings,

objective 8.13 has been achieved and

the survey will not be repeated.

Objective 8.14, which focuses on

the proportion of people served by local

health departments, is being monitored

by the proportion of health departments

carrying out the core functions of public

health. The core functions of public

health have been deﬁned as assessment,

policy development, and assurance.

Local health department refers to any

local component of the public health

system, deﬁned as an administrative and

service unit of local or State government

concerned with health and carrying

some responsibility for the health of a

jurisdiction smaller than a State.

References

1. Department of Health and Human Services.

Healthy people 2010. 2d ed. Washington: U.S.

Government Printing Office. 2000.

2. Steckler A, Allegrante JP, Altman D, et al.

Health education intervention strategies:

Recommendations for future research. Health Educ

Q 22:307–28. 1995.

3. Kreuter MW, Lezin NA, Young LA.

Community-based collaborative mechanisms:

Implications for practitioners. Health Promotion

Practice 1(1):2000.

4. King AC, Jeffrey RW, Fridinger F, et al.

Environmental and policy approaches to

cardiovascular disease prevention through physical

activity: Issues and opportunities. Health Educ Q

22:499–511. 1995.

5. Mullen PD, Evans D, Forster J, et al. Settings

as an important dimension in health

education/promotion policy, programs, and

research. Health Educ Q 22:329–45. 1995.

6. Erickson P, Wilson R, Shannon I. Years of

Healthy Life. Healthy people statistical notes no 7.

Hyattsville, Maryland: National Center for Health

Statistics. 1995.

7. National Education Goals Panel. The national

education goals report: Building a nation of

learners. Washington: U.S. Government Printing

Office. 1996.

Healthy People 2000 Final Review 149

Table 8. Educational and Community-Based Programs objectives

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

8.1* Years of healthy life .......................... 1990 64.0 . . . 63.9 63.7 63.5 63.8 63.9 64.2

‡

64.8

‡

65.2 - - - 65

a. Black ................................... 1990 56.0 . . . 56.0 55.6 55.2 55.6 56.0 56.5

‡

57.4

‡

57.8 - - - 60

b. Hispanic

................................ 1990 64.8 . . . 63.6

64.0 63.2 64.2 64.0 64.7

‡

65.8

‡

66.3 - - - 65

c. People 65 years and over

................... 1990 11.9 . . . 11.8 11.9 11.9 12.1 12.0 12.2

‡

12.0

‡

12.2 - - - 14

8.2 Completion of high school (18-24 years) .......... 1992

86% . . . . . . . . . 86% 86% 85% 86% 86% 85% - - - 90%

a. Hispanic ................................. 1992

62% . . . . . . . . . 64% 62% 63% 67% 67% 63% - - - 90%

b. Black ................................... 1992

82% . . . . . . . . . 82% 83% 84% 82% 82% 81% - - - 90%

8.3 Preschool child development programs

Eligible children 4 years afforded opportunity to enroll in

Head Start ................................. 1990 47% . . . 55% - - - - - - - - - - - - - - - 40% 48% - - - 100%

Low-income children receiving 1 year of Head Start

services prior to entering kindergarten or first grade . . . . . - - - - - - - - - 58% 57% 58% 54% 49% - - - - - - - - - . . .

Disabled children 3-5 years enrolled in preschool ..... ... --- --- 5 6 % --- 5 6 % --- 6 3 % 6 2 % --- --- 7 3 % ...

8.4 Schools with comprehensive school health

education

All eight criteria met ........................... 1994 2.3% . . . . . . . . . . . . . . . - - - - - - - - - - - - - - - 75%

A documented, sequential program .............. 1994

48% ... ... ... ... ... --- --- --- --- --- ...

At least one health education course ............. 1994

77% ... ... ... ... ... --- --- --- --- --- ...

Instruction in six key behavioral areas ............ 1994

47% ... ... ... ... ... --- --- --- --- --- ...

Focus on skill development .................... 1994

39% ... ... ... ... ... --- --- --- --- --- ...

Health education teachers adequately trained ...... 1994 53% . . . . . . . . . . . . . . . - - - - - - - - - - - - - - - . . .

Designated coordinator for health education ....... 1994 38% . . . . . . . . . . . . . . . - - - - - - - - - - - - - - - . . .

Involvement of parents, health professionals, and

other concerned community members ........... 1994

31% ... ... ... ... ... --- --- --- --- --- ...

Evaluation of health education program during the

past 2 years .............................. 1994

67% ... ... ... ... ... --- --- --- --- --- ...

8.5 Health promotion in post-secondary institutions

Higher education institutions offering health promotion

activities ................................... 1989–90 20% . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - 50%

College students 18-24 years who report receiving

information from their college or university on:

Tobacco use prevention....................... ... --- --- --- --- --- --- 32% --- --- --- --- ...

Alcohol and other drug use prevention............ ... --- --- --- --- --- --- 59% --- --- --- --- ...

Violence prevention .......................... ... --- --- --- --- --- --- 38% --- --- --- --- ...

Injury prevention and safety.................... ... --- --- --- --- --- --- 26% --- --- --- --- ...

Suicide prevention........................... ... --- --- --- --- --- --- 21% --- --- --- --- ...

Pregnancy prevention ........................ ... --- --- --- --- --- --- 34% --- --- --- --- ...

Sexually transmitted disease prevention .......... ... --- --- --- --- --- --- 53% --- --- --- --- ...

AIDS or HIV infection prevention ................ ... --- --- --- --- --- --- 58% --- --- --- --- ...

Dietary behaviors and nutrition ................. ... --- --- --- --- --- --- 34% --- --- --- --- ...

Physical activity and fitness .................... ... --- --- --- --- --- --- 40% --- --- --- --- ...

See footnotes and key at end of table.

150 Healthy People 2000 Final Review

Table 8. Educational and Community-Based Programs objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

8.6 Worksite health promotion activities

Worksites with 50 or more employees (using 1985

analysis) ................................... 1985 65% - - - - - - 81% - - - - - - - - - - - - - - - - - - 90% 85%

Worksites with 50 or more employees (using 1992

analysis) ................................... ... --- --- --- 92% --- --- --- --- --- --- --- ...

Medium and large companies having a wellness

program ................................... 1987 63% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 85%

8.7 Hourly workers 18 years and over participating in

health promotion activities .................... 1994

23% ... ... ... ... ... --- --- --- 20% --- 20%

8.8 Health promotion programs for older adults

People 65 years and over participating in at least one

health promotion program through a facility serving

older adults................................. 1995 12% . . . . . . . . . . . . . . . . . . - - - - - - 12% - - - 90%

8.9 Family discussion of health issues—persons

10 years and over ........................... 1994 83% . . . . . . . . . . . . . . . - - - - - - - - - 69% - - - 75%

Nutrition .................................. ... --- --- --- --- --- 67% --- --- --- 54% --- ...

Physical activity............................. ... --- --- --- --- --- 66% --- --- --- 48% --- ...

Sexual behavior............................. ... --- --- --- --- --- 39% --- --- --- 22% --- ...

Tobacco .................................. ... --- --- --- --- --- 47% --- --- --- 33% --- ...

Alcohol ................................... ... --- --- --- --- --- 38% --- --- --- 26% --- ...

Illegal drugs................................ ... --- --- --- --- --- 33% --- --- --- 22% --- ...

Safety .................................... ... --- --- --- --- --- 50% --- --- --- 41% --- ...

Among 9th–12th grade students engaging in family

discussion of HIV/AIDS ........................ 1989 54% 53% 61% - - - 66% - - - 63% - - - 63% - - - - - - 75%

8.10 Number of States with community health programs

addressing at least three Healthy People 2000

objectives that reach 40% of State population .... ... --- --- --- --- --- --- --- --- --- --- --- 50

Proportion of States with 90 percent of local health

departments providing services that address three or

more Healthy People 2000 priority areas........... ... --- --- --- ---

81% --- --- --- --- --- --- ...

8.11 Counties with programs for racial/ethnic minority

groups .................................... ... --- --- --- --- --- --- --- --- --- --- --- 50%

Percent of local health departments providing culturally

and linguistically appropriate services

Health promotion

Physical activity and fitness .................. 1996-97 21% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Nutrition ................................. 1996-97 44% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Tobacco ................................. 1996-97 24% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Alcohol and other drugs ..................... 1996-97 26% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Family planning ........................... 1996-97 42% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Mental health and mental disorders ............ 1996-97 18% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Violent and abusive behavior ................. 1996-97 25% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Education and community-based programs ...... 1996-97 33% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

See footnotes and key at end of table.

Healthy People 2000 Final Review 151

Table 8. Educational and Community-Based Programs objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Health protection

Unintentional injuries ....................... 1996-97 19% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Occupational safety and health ............... 1996-97 13% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Environmental health ....................... 1996-97 22% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Food and drug safety ....................... 1996-97 18% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Oral health ................................ 1996-97 25% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Preventive services

Maternal and infant health ................... 1996-97 47% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Heart disease and stroke .................... 1996-97 28% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Cancer .................................. 1996-97 30% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Diabetes and other chronic disabling conditions . . . 1996-97 26% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

HIV infection ............................. 1996-97 45% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Sexually transmitted diseases ................ 1996-97 41% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Immunization and infectious diseases........... 1996-97 48% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Clinical preventive services .................. 1996-97 35% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

Surveillance and data systems ................. 1996-97 14% . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - 50%

8.12 Hospital-based patient education and community

health promotion

Patient education programs

Registered hospitals ......................... 1987 68% 86% - - - - - - 90% - - - - - - - - - - - - - - - 80% 90%

Health maintenance organizations ............... ... --- --- --- --- 90% --- --- --- --- --- --- 90%

Health education classes .................... ... ---

75% --- 84% ... --- --- --- --- --- --- ...

Nutrition counseling ........................ ... ---

85% --- 87% ... --- --- --- --- --- --- ...

Smoking cessation classes................... ... --- --- --- 67% ... --- --- --- --- --- --- ...

Community health promotion programs

Community hospitals ....................... 1987 60% 77% - - - - - - 90% - - - - - - - - - - - - - - - - - - 90%

8.13 Television partnerships with community

organizations for health promotion ............. 1995-96 100% . . . . . . . . . . . . . . . . . . . . . - - - - - - - - - 75%

8.14 Effective public health systems

Local health departments reporting:

Health assessment

Behavioral risk assessment .................... 1990 33% . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - 90%

Morbidity data .............................. 1990 49% . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - 90%

Reportable disease .......................... 1990 87% . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - 90%

Vital records and statistics ..................... 1990 64% . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - 90%

Surveillance — chronic disease ................. 1990 55% . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - 90%

Surveillance — communicable disease ........... 1990 92% . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - 90%

Policy development functions and services

Health code development and enforcement ........ 1990 59% . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - 90%

Health planning ............................. 1990 57% . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - 90%

See footnotes and key at end of table.

152 Healthy People 2000 Final Review

Table 8. Educational and Community-Based Programs objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Health assurance

Health education ............................ 1990 74% . . . - - - - - -

84% --- --- --- --- --- --- 90%

Child health................................ 1990 84% . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - 90%

Immunizations .............................. 1990 92% . . . - - - - - -

96% --- --- --- --- --- --- 90%

Prenatal care............................... 1990 59% . . . - - - - - -

64% --- --- --- --- --- --- 90%

Primary care ................................. 1990 22% . . . - - - - - -

30% --- --- --- --- --- --- 90%

- - - Data not available. Final objective status:

. . . Category not applicable.

Baseline has been revised.

‡

The NHIS was redesigned in 1997. Data may not be comparable with previous years; see Appendix.

Estimate based on preliminary data. Excludes mortality data from States lacking a Hispanic-origin item on their death certificate or for which Hispanic-origin data were not of sufficient quality.

See Appendix.

Estimate derived from 1991-93 health status data and 1992 mortality data.

Years of healthy life remaining for those surviving to age 65.

1992–1993 data. Data are from 43 States and represent local health department’s report of whether a program or service existed.

1988 data.

NOTES: Data include revisions and, therefore, may differ from data previously published in these reports and other publications. HIV is human immunodeficiency virus. AIDS is acquired

immunodeficiency syndrome.

Objective number Data source

8.1*, 8.1a-c National Vital Statistics System, CDC, NCHS.

National Health Interview Survey, CDC, NCHS.

8.2, 8.2a-b National Center for Education Statistics, National Education Goals Panel.

8.3 Head Start data: Head Start Bureau: Administration on Children, Youth, and Families.

Data on disabled children: National Center for Education Statistics, National Education Goals Panel.

8.4 School Health Policies and Programs Study, CDC, NCCDPHP.

8.5 Baseline: Health Promotion on Campus Survey and Directory, American College Health Association.

Data for college students: National College Health Risk Behavior Survey, CDC, NCCDPHP.

8.6 Baseline and updates for worksites with 50 or more employees : National Survey of Worksite Health Promotion Activities OPHS, ODPHP.

Baseline for medium and large companies: Health Research Institute Biennial Survey, Health Research Institute.

8.7 National Health Interview Survey, CDC, NCHS.

8.8 National Health Interview Survey, CDC, NCHS.

8.9 1989 baseline: Secondary School Student Health Risk Survey, CDC, NCCDPHP.

1990–97 data: Youth Risk Behavior Survey, CDC, NCCDPHP.

1994 and 1998 data: National Health Interview Survey, CDC, NCHS.

8.10 National Profile of Local Health Departments, National Association of City and County Health Officials.

8.11 National Profile of Local Health Departments, National Association of City and County Health Officials.

8.12 Annual Survey of Hospitals, AHA.

HMO Industry Profile, Group Health Association of America, Inc.

8.13 Media Health Partnerships Survey, CDC, NCCDPHP.

8.14 National Profile of Local Health Departments, National Association of City and County Health Officials.

* Duplicate objective. See full text of objective following this table.

Met

Toward

Mixed/ no change

Away

Cannot assess

Healthy People 2000 Final Review 153

Educational and

Community-Based

Programs Objectives

8.1*: Increase years of healthy life to at

least 65 years.

Duplicate objectives: 17.1 and 21.1

8.1a*: Increase years of healthy life

among black persons to at least 60

years.

Duplicate objectives: 17.1a and

21.1a

8.1b*: Increase years of healthy life

among Hispanics to at least 65

years.

Duplicate objectives: 17.1b and

21.1b

8.1c*: Increase years of healthy life

among people aged 65 and older to

at least 14 years remaining at age

65.

Duplicate objectives: 17.1c and

21.1c

8.2: Increase the high school graduation

rate to at least 90 percent, thereby

reducing risks for multiple problem

behaviors and poor mental and physical

health.

8.2a: Increase the high school

graduation rate among Hispanics to

at least 90 percent, thereby reducing

risks for multiple problem behaviors

and poor mental and physical

health.

8.2b: Increase the high school

graduation rate among blacks to at

least 90 percent, thereby reducing

risks for multiple problem behaviors

and poor mental and physical

health.

8.3: Achieve for all disadvantaged

children and children with disabilities

access to high quality and

developmentally appropriate preschool

programs that help prepare children for

school, thereby improving their

prospects with regard to school

performance, problem behaviors, and

mental and physical health.

8.4: Increase to at least 75 percent the

proportion of the Nation’s elementary

and secondary schools that provide

planned and sequential kindergarten–

12th grade comprehensive school health

education.

8.5: Increase to at least 50 percent the

proportion of postsecondary institutions

with institution-wide health promotion

programs for students, faculty, and staff.

8.6: Increase to at least 85 percent the

proportion of workplaces with 50 or

more employees that offer health

promotion activities for their employees,

preferably as part of a comprehensive

employee health promotion program.

8.7: Increase to at least 20 percent the

proportion of hourly workers who

participate regularly in

employer-sponsored health promotion

activities.

8.8: Increase to at least 90 percent the

proportion of people aged 65 and older

who had the opportunity to participate

during the preceding year in at least one

organized health promotion program

through a senior center, lifecare facility,

or other community-based setting that

serves older adults.

8.9: Increase to at least 75 percent the

proportion of people aged 10 and older

who have discussed issues related to

nutrition, physical activity, sexual

behavior, tobacco, alcohol, other drugs,

or safety with family members on at

least one occasion during the preceding

month.

8.10: Establish community health

promotion programs that separately or

together address at least three of the

Healthy People 2000 priorities and reach

at least 40 percent of each State’s

population.

8.11: Increase to at least 50 percent the

proportion of counties that have

established culturally and linguistically

appropriate community health promotion

programs for racial and ethnic minority

populations.

8.12: Increase to at least 90 percent the

proportion of hospitals, health

maintenance organizations, and large

group practices that provide patient

education programs, and to at least

90 percent the proportion of community

hospitals that offer community health

promotion programs addressing the

priority health needs of their

communities.

8.13: Increase to at least 75 percent the

proportion of local television network

affiliates in the top 20 television markets

that have become partners with one or

more community organizations around

one of the health problems addressed by

the Healthy People 2000 objectives.

8.14: Increase to at least 90 percent the

proportion of people who are served by

a local health department that is

effectively carrying out the core

functions of public health.

*Duplicate objective.

154 Healthy People 2000 Final Review

Priority Area 9

Unintentional

Injuries

Background

Unintentional injuries are the fifth

leading cause of death in the United

States, accounting for more than 97,000

deaths in 1998 (1). They are a major

cause of disabilities and hospitalization;

in 1998 there were nearly 29 million

visits to emergency rooms because of

unintentional injuries (2). Unintentional

injuries have a significant impact on

health care costs; in 1998 alone, medical

expenses attributable to unintentional

injuries were estimated at nearly $80

billion; when costs for losses of income

and productivity, insurance and legal

administration, motor-vehicle damage,

fire loss and losses by employers are

included, the estimate climbs to $480.5

billion (3).

Motor vehicle injuries remain the

most costly and fatal of unintentional

injuries. The National Safety Council

estimates motor vehicle crashes cost the

United States $169 billion in lost wages,

medical expenses, and administrative

costs. However, efforts to reduce motor

vehicle-related injuries show promise.

The National Highway Traffic Safety

Administration (NHTSA) estimates that

if all occupants in passenger vehicles

had used their safety belts, nearly

one-half of the 41,000 motor vehicle

deaths in 1996 could have been

prevented (4). Teens are overrepresented

among motor vehicle deaths. While

constituting 10 percent of the total

population, teenagers account for

15 percent of motor vehicle deaths (5).

Implementation of graduated licensing

programs may help reduce the number

of teenage motor vehicle deaths (6).

Motorcyclists are also

disproportionally represented among

motor vehicle deaths; per mile traveled,

16 motorcyclists are killed for each

automobile occupant (5). Motorcycle

helmet use is associated with less severe

injuries and lower health care costs (7).

In 1995 alone, 791 lives would have

been saved if all motorcyclists wore

helmets (8). While States requiring

helmet use increased during the early

1990’s, the number began declining in

1997.

Alcohol use has long been

recognized as contributing to motor

vehicle deaths and injuries. The rate of

alcohol-related motor vehicle deaths has

declined between 1987 and 1999. In

part, this may be attributed to

improvements in the engineering and

safety of motor vehicles. However,

NHTSA has also highlighted the impact

of the passage and enforcement of laws

limiting drinking to 21 years of age and

over (9).

Although less visible, fall-related

injury and death rates among older

persons in the United States are

increasing. Falls and fall-related injuries

are the second leading cause of injury

deaths among people 65–84 years of age

and the leading cause for people 85

years of age and over (1).

Data Summary

Highlights

Significant progress has been seen

in the past decade regarding deaths due

to unintentional injuries. The overall

age-adjusted rate of deaths from

unintentional injuries (9.1) decreased,

from 34.7 per 100,000 persons in 1987

to 30.1 in 1998, as did the rates for

special populations. The targeted

components of unintentional injuries

including motor-vehicle crashes (9.3),

drowning (9.5), and fire (9.6) also

decreased.

Particularly noteworthy were

objectives that targeted motor vehicle

fatalities and use of vehicle occupant

restraints. The rate of deaths caused by

motor vehicle crashes (9.3) decreased

from 2.4 per 100 million vehicle miles

traveled in 1987 to 1.6 in 1998. The rate

of deaths from motor vehicle crashes

per 100,000 persons also declined, from

19.2 in 1987 to 15.3 in 1998. The death

rate for motorcyclists involved in

collisions decreased from 42.5 per 100

million vehicle miles traveled in 1987 to

22.3 in 1998, surpassing the Healthy

People 2000 target of 25.6. The rate of

motorcyclists’ deaths per 100,000

persons declined from 1.7 in 1987 to 0.8

in 1998, also surpassing the target of

0.9. For pedestrians struck by motor

vehicles, the death rate decreased from

2.8 per 100,000 persons in 1987 to 1.8

in 1999, exceeding the objective target

of 2.0.

Corresponding to the decrease in

motor vehicle deaths, the use of safety

belts by motor vehicle occupants (9.12)

increased from 42 percent in 1988 to 67

in 1999. Use of helmets by

motorcyclists (9.13) increased from

60 percent in 1988 to 67 in 1998. The

number of States with laws requiring the

use of safety belts for all ages (9.14)

increased from 33 in 1989 to 49 in

1999. The number of States having a

graduated driver licensing system for

novice drivers and riders under the age

of 18 (9.26) increased from zero in 1994

to 23 in 1999.

The rate of nonfatal head injuries

(9.9) decreased from 118 per 100,000

persons in 1988 to 61 in 1998, far

surpassing the year 2000 target of 106.

The rate of nonfatal spinal cord injuries

(9.10) decreased from 5.3 per 100,000

persons in 1988 to 4.5 in 1998, also

exceeding the year 2000 target of 5.0.

The rate of nonfatal poisonings

requiring emergency department

treatment (9.8) decreased from 104

visits per 100,000 persons in 1986 to 33

in 1999, well below the year 2000 target

of 88. The rate for children 4 years of

age and under decreased from 664 in

1986 to 418 in 1999 also surpassing the

target of 520.

The rate of hospitalizations for

nonfatal injuries (9.2) decreased from

832 hospitalizations per 100,000 persons

in 1988 to 564 in 1998, surpassing by

34 percent the year 2000 target of 754.

For black males, the rate declined from

1,007 in 1991 to 628 in 1998,

surpassing the target of 856 by

36 percent.

Moving in the other direction, the

hospitalization rate for hip fractures

among people 65 years of age and over

(9.7) increased from 714 hospitalizations

per 100,000 persons in 1988 to 863 in

1998. However, the rate for hip fractures

for white women 85 years of age and

over, the group at highest risk,

decreased marginally from 2,721 in

1988 to 2,690 in 1998.

Summary of Progress

By the end of the decade, targets

had been met for seven objectives: 9.2,

9.6, 9.8–9.10 , 9.18, and 9.22. Eleven

objectives made substantial progress:

9.1, 9.3, 9.5, 9.12, 9.13, 9.16, 9.19,

9.23, and 9.24–9.26 . The two measures

used to track one objective (9.14)

showed mixed progress. Objective 9.21

also showed mixed progress, although

this was based on data only for nurse

practitioners (see Data Issues). Two

objectives (9.7 and 9.17) moved away

from the Healthy People 2000 target.

However, more recent supplemental data

Healthy People 2000 Final Review 155

9.1 Unintentional injury deaths

9.2 Unintentional injury hospitalizations

9.3 Motor vehicle deaths: Per 100 million miles traveled

Per 100,000 population

9.4 Fall-related deaths

9.5 Drowning deaths

9.6 Residential fire deaths

9.7 Hip fractures among older adults

9.8 Nonfatal poisoning

9.9 Nonfatal head injuries

9.10 Nonfatal spinal cord injuries

9.12 Motor vehicle occupant protection systems

9.13 Helmet use: Motorcyclists

9.15 States with handguns designed to protect children

Bicyclists

Motorcycle helmet laws

9.14 States with: Safety belt laws

9.17 Residences with smoke detectors

9.18 Injury prevention instruction in required course

9.19 Use of protective equipment: Baseball - headgear

Baseball - mouth guard

Football - headgear

Soccer - headgear

Soccer - mouth guard

9.22 States with linked EMS and trauma systems

Football - mouth guard

9.23 Alcohol-related motor vehicle deaths

9.24 States with bicycle helmet laws

9.25 States with firearm storage laws

9.26 States with graduated licensing systems

Moved away from target Moved toward target Met target

NOTE: Complete tracking data are shown in table 9. Progress quotients are not calculated for objectives 9.11, 9.16, 9.20, and 9.21.

See the section on Measuring Progress Toward the

Healthy People 2000

Targets in the Appendix for more information.

78%

63%

-4%

-5%

58%

19%

18%

14%

No change

15%

35%

66%

Percent of target achieved

-100 -80 -60 -40 -20 0 20 40 60 80 100

344%

140%

444%

475%

267%

100%

108%

24%

35%

-139%

94%

89%

85%

93%

156 Healthy People 2000 Final Review

Figure 9. Final status of Unintentional Injuries objectives

for objective 9.17 (smoke detectors)

does show progress in the proportion of

people with a working smoke detector

on each floor of their residence,

88 percent in 1998 (see Data Issues).

Two objectives showed no change (9.4

and 9.15). Data sources were never

developed for two objectives (9.11 and

9.20). See table 9 for the tracking data

for the objectives in this priority area

and figure 9 for a quantitative

assessment of progress.

Discussion

The decline in the rate of deaths

from motor vehicle crashes can be

attributed to a combination of factors;

raising the legal drinking age to 21,

increased use of safety belts and child

restraint seats, zero tolerance for

drinking and driving by youth, stricter

law enforcement, administrative license

revocation, graduated driver licensing

systems, and stiffer penalties upon

conviction for drunk driving (10).

Alcohol continues to be a major

risk factor for all unintentional injuries,

contributing to an estimated 38 percent

of motor vehicle-related deaths (11).

Raising the minimum legal drinking age

to 21 years was accompanied by

reduced alcohol consumption, traffic

crashes, and related fatalities among

young persons under age 21 years.

Reductions in alcohol-related traffic

crashes are associated with many policy

and program measures, among them,

administrative revocation of licenses for

drinking and driving and lower legal

blood alcohol limits for youth and

adults. Community programs involving

multiple city departments and private

citizens have reduced driving after

drinking and traffic deaths and injuries.

In addition, a combination of

community mobilization, media

advocacy, and enhanced law

enforcement has been shown to reduce

alcohol-related traffic crashes and sales

of alcohol to minors. Alcohol

consumption has also been linked with a

substantial proportion of injuries and

deaths from falls, fires, and drowning.

Smoke alarms reduce by half the

risk of dying from a fire, while home

sprinkler systems decrease the risk of

death by 65 percent and property loss by

48 percent (10). As a result, operable

residential smoke alarms can be highly

effective in preventing fire-related

deaths. It is important to understand that

any smoke alarm will offer adequate

warning for escape, provided that the

alarm is listed by an independent testing

laboratory and is properly installed and

maintained. Fire safety initiatives

targeted at the home and at increased

smoke alarm use remain the key to any

reductions in residential fire deaths. Five

major strategies are: first, continued

widespread public fire safety education

is needed discussing fire prevention and

how to avoid serious injury or death if

fire occurs. Second, more people must

use and maintain smoke alarms and

develop and practice escape plans.

Third, wider use of residential sprinklers

must be aggressively pursued. Fourth,

additional ways must be developed to

make home products fire safe.

Regulations requiring child-resistant

lighters are a good example. The wider

use of upholstered furniture and

mattresses that are more resistant to

cigarette ignitions are examples of

changes that have already accomplished

much. Fifth, the special fire safety needs

of population groups at high risk, such

as the young, older adults, and the

disadvantaged need to be addressed

(12,13).

Child-resistant packaging, product

reformulation and interventions by

poison control centers and health

professionals all helped reduce the

childhood poison-related death rate by

38 percent from 1987 to 1998 (14).

Also, prescription drug interactions

contribute to frailty and loss of visual

acuity in the elderly and, consequently,

to their high incidence of falls and

resultant fractures. The death rate from

falls among those 85 years and over is

almost eight times the rate for those

65–84 years of age and has increased by

almost 21 percent over the past decade.

Wearing a bicycle helmet reduces

the risk of head injury by as much as

85 percent (15). Increases in usage may

be possible with the introduction of

multisport helmets and the help of the

media to institutionalize the wearing of

these helmets.

Transition to Healthy People

2010

Most of the topics covered in the

Healthy People 2000 priority areas on

Unintentional Injuries (Priority Area 9)

and Violent and Abusive Behavior

(Priority Area 7) were reorganized into

one Focus Area: Injury and Violence

Prevention in Healthy People 2010. The

rationale for combining these two focus

areas was that many injuries produce the

same outcome although they may result

from different factors. For example, a

nonfatal spinal cord injury produces the

same outcome whether it is caused by

an unintentional motor vehicle crash or

an attempted suicide. Understanding

injuries allows for development and

implementation of effective prevention

interventions. Some interventions can

reduce injuries from both unintentional

and violence-related episodes. For

instance, efforts to promote proper

storage of firearms in homes can help

reduce the risk of assault with a firearm

and intentional self-inflicted and

unintentional firearm-related injuries in

the home (16). Higher taxes on

alcoholic beverages are associated with

lower death rates from motor vehicle

crashes and lower rates for some

categories of violent crime, including

rape (17,18).

Many injuries and injury-related

deaths occur in some population groups

(such as younger children from birth to

age 4 years) where the intentionality of

the injury is unknown and requires more

detailed investigation. As these cases are

examined, interventions can be

developed to address ways injuries

occur. An example of this, which is

emerging as a growing public health

concern, is poisonings in children.

Overall there are fewer objectives

for the two subject areas. Healthy

People 2000 had 45 objectives in the

Unintentional Injuries and Violence and

Abusive Behaviors chapters compared

with 39 objectives in the Healthy People

2010 Injury and Violence Prevention

chapter. For unintentional injuries

Healthy People 2000 had 29 objectives

compared with 19 objectives in the

Healthy People 2010 edition. Violence

had 19 objectives in Healthy People

2000 compared with 8 objectives in

Healthy People 2010. The Healthy

People 2010 chapter has a new section

titled ‘‘Injury Prevention’’ containing 12

objectives that relate to both subject

areas (for example, nonfatal head

injuries and nonfatal spinal cord injuries,

child fatality review, emergency

department and hospital discharge

surveillance systems).

The Healthy People 2010 objective

for deaths due to motor vehicle crashes,

which was retained from Healthy People

2000 (with a minor variation), has been

designated as a measure of one of the

Leading Health Indicators (LHI). Motor

Healthy People 2000 Final Review 157

vehicle crashes are the most common

cause of serious injury and so provide

an indication of overall serious injury

rates. The LHIs are discussed in further

detail in the Introduction.

Some of the objectives contained in

the unintended injury priority area of

Healthy People 2000 have been

transferred to more specific focus areas

in Healthy People 2010. These are listed

as related objectives in Healthy People

2010.

Appendix

table III, a crosswalk

between Healthy People 2000 and

Healthy People 2010 objectives,

summarizes the changes between the

two decades of objectives, reflecting

new knowledge and direction for this

area.

Data Issues

Definitions

Objective 9.2 (nonfatal

unintentional injuries) is tracked with

data from the National Hospital

Discharge Survey (NHDS) maintained

by the National Center for Health

Statistics (NCHS), Centers for Disease

Control and Prevention (CDC). The

ICD–9 codes designated for this

objective include both unintentional and

intentional injuries (see Appendix

table V). The two types of injuries

cannot be distinguished at the national

level because currently only 22 States

mandate the use of E-codes (external

causes) on hospital discharge forms.

NCHS is working with States to

increase the use of E-codes.

Data for objective 9.6 (residential

fire deaths) include all fire-related

deaths. While 90 percent occur at home,

a small proportion occur elsewhere. The

1990 baseline data for fire-related deaths

for Puerto Ricans (9.6g) have been

revised. The original baseline published

in the Midcourse Review and 1995

Revisions (19) included data for 45

States and the District of Columbia. It

did not include data for New York City

where about 40 percent of the U.S.

Puerto Rican population resides. The

revised baseline, which includes data for

47 States (including New York) and the

District of Columbia, is considerably

lower than originally published and, in

fact, has met the year 2000 target for

this subobjective. The number of States

reporting Hispanic origin data on birth

and death certificates has varied from

year to year; see the Appendix for more

information.

Objective 9.7 (hip fractures among

older adults) is also monitored with data

from the NHDS. These rates are based

on extremely small numbers and must

be interpreted cautiously. Data on race

are not reported by many hospitals

because of omission of a race field on

hospital discharge reporting forms. More

hospitals have automated their discharge

systems in recent years and are using

these forms (UB–82 and UB–92). A

comparison of NHDS data with the

National Health Interview Survey

(NHIS) data for people who reported

being hospitalized (NHIS data were

adjusted to exclude hospitalizations of 1

day or less) indicated that

underreporting for whites was roughly

22 percent in 1991; the difference for

blacks was negligible (20).

Objective 9.11 refers to secondary

conditions, which occur as a result of a

spinal cord injury and include a

pathology, an impairment, a functional

limitation, or a disability.

Objectives 9.14 (safety belt and

motorcycle helmet laws), 9.15 (handgun

design laws), 9.22 (trauma linking

systems), 9.24 (bicycle helmet laws),

9.25 (handgun storage laws), and 9.26

(graduated driver licensing) all relate to

State laws or programs that vary across

States in populations targeted, penalties,

and liability.

The baseline and target for

objective 9.17 (smoke detectors) are

based on estimates of the proportion of

homes with working smoke detectors;

this is somewhat different from the

intent of the objective, which focuses on

working smoke detectors on each

habitable floor. Findings from a 1993

survey conducted by the Consumer

Product Safety Commission (CPSC)

indicate that 52 percent of households

had at least one functional smoke

detector on each floor (21). Data from

the 1993 NHIS did not specify a

working smoke detector. The 1994 and

1998 supplemental data on the

proportion of homes with working

smoke detectors are from the NHIS, a

different source than that used for the

baseline.

Data Sources

Data for objective 9.3 (motor

vehicle crash deaths) and the

subobjectives (except d and g) are crude

rates from the Department of

Transportation’s Fatality Analysis

Reporting System (formerly the Fatal

Accident Reporting System) (FARS).

See the Appendix for a discussion of

crude and age-adjusted rates and the

chapter on Priority Area 4 for a

description of FARS. The rates for 9.3d

(American Indian/Alaska Native) and

9.3g (Mexican American) are

age-adjusted data from the National

Vital Statistics System.

Baseline data for objective 9.21

(injury prevention counseling) are from

the Primary Care Provider Surveys

(PCPS). The sample for the survey was

drawn from the membership rolls of

professional associations of internists,

family physicians, nurse practitioners,

pediatricians, and obstetricians/

gynecologists. Response rates from these

groups varied from 50–80 percent. The

data on inquiry about seat-belt use and

falls in the home represent the

proportion of practitioners who routinely

queried 81–100 percent of their patients

about these risks. The data on

counseling about these issues represent

the proportion of providers who

routinely provided these services to their

patients who needed the services. The

basis for counseling may be independent

of the inquiry made by the clinicians.

The Prevention in Primary Care

Study (PPCS) was conducted in

1997–98 to update data from the PCPS.

The design and items included in the

1997–98 study were similar to the

PCPS, but a slightly different sampling

frame was used and some items

included in the 1992 surveys were not

included in the PPCS. The professionals

were sampled from listings of all

licensed, active practitioners in the

United States whose practices were at

least 50 percent primary care. Because

of low response rates from the other

provider groups, updates are available

only for nurse practitioners.

Alcohol-related motor vehicle

crashes (9.23) are tracked using data

from FARS. The FARS supplements

death certificate data with information

on the circumstances of the death to

determine whether the death was alcohol

related. The National Vital Statistics

System does not specify alcohol-related

motor vehicle crashes.

Data Comparability

Data for 9.8 (nonfatal poisonings)

are from the National Electronic Injury

Surveillance System (NEISS), which is

maintained by the CPSC. This system

158 Healthy People 2000 Final Review

does not utilize ICD–9 or other

conventional injury coding mechanisms.

Injuries reported in the system are

limited to those related to products

regulated by CPSC in a given year.

Therefore, variation in the numbers and

types of products affect the number of

injuries reported in the system. The

baseline and estimates were again

revised in 1997 to accommodate a new

sampling design.

In 1992, data collection for

objectives 9.12 (motor vehicle occupant

protection systems) and 9.13 (helmet use

by motorcyclists and bicyclists) was

expanded from 19 metropolitan areas to

all 50 States. The data collection

methods (direct observation) were

unchanged.

Proxy Data

Tracking data for 9.16 (fire

suppression systems) are from the U.S.

Fire Administration’s National Fire

Incident Reporting System (NFIRS) and

indicate the proportion of fires in

residential properties that have

automatic suppression systems. Data on

localities for this objective are not

available.

Regarding objective 9.19 (protective

sports equipment), use of protective

equipment in college sports is required

by the National Collegiate Athletic

Association. The additional data are

from the NHIS and represent the

proportions of children playing baseball,

softball, football, or soccer who use

headgear or mouthguards.

References

1. National Vital Statistics System. Centers for

Disease Control and Prevention, National Center

for Health Statistics. 1999.

2. McCaig LF. National Hospital Ambulatory

Medical Care Survey: 1998 Emergency department

summary. Advance data from vital and health

statistics; no.313. Hyattsville, Maryland: National

Center for Health Statistics. 2000.

3. National Safety Council. Injury facts.

Washington. July 2000.

4. National Highway Traffic Safety

Administration. Occupant protection facts.

Washington: Department of Transportation. 1996.

5. Fatality Analysis Reporting System. Department

of Transportation, National Highway Traffic Safety

Administration. 1997.

6. National Highway Traffic Safety

Administration. Traffic safety facts 1996: Young

drivers. Washington: Department of

Transportation. 1997.

7. Hertz ES. The effect of helmet law repeal on

motorcycle fatalities: A four-year update. Research

Notes. Washington: National Center for Statistics

and Analysis, National Highway Traffic Safety

Administration. 1990.

8. Rowland J, et al. Motorcycle helmet use and

injury outcome and hospitalization costs from

crashes in Washington State. Am J Public Health

86(1):41–5. 1996.

9. National Highway Traffic Safety

Administration. Fatal Accident Reporting System,

1989. A review of information on fatal traffic

crashes in the United States, 1989. Washington:

Department of Transportation. 1991.

10. Healthy People 2000 Progress Review:

Unintentional injuries. Aug. 5, 1999.

11. National Highway Traffic Safety

Administration. Traffic safety facts 1998: Alcohol.

Washington: National Highway Traffic Safety

Administration. 1999.

12. Hall JR. Patterns of civilian fire casualties in

home fires by age and sex, 1993–97. Quincy:

National Fire Protection Association. Apr. 2000.

13. Fahy RF, Miller AL. How Being Poor Affects

Fire Risk. Fire Journal 83(1):28. 1989.

14. National Safe Kids Campaign. Poison.

Washington. 1999.

15. National Safe Kids Campaign. Preventing a

fall, protecting a child. Washington. 1999.

16. Cummings P, Grossman DC, Rivara FP, et al.

State gun storage laws and child mortality due to

firearms. JAMA 278 (13). 1997.

17. Chaloupka FJ, Saffer H, Grossman M. Alcohol

control policies and motor vehicle fatalities.

Journal of Legal Studies 22:161–86. 1993.

18. Cook PJ, Moor MJ. Economic perspectives on

reducing alcohol-related violence. In: Martin SE,

ed. Alcohol and interpersonal violence: Fostering

multidisciplinary perspectives. Based on a

workshop on alcohol-related violence sponsored

by National Institute on Alcohol Abuse and

Alcoholism, May 14–15, 1992. Rockville,

Maryland: National Institutes of Health. 1993.

19. Department of Health and Human Services.

Healthy people 2000 midcourse review and 1995

revisions. Washington: Public Health Service.

1995.

20. Kozak LJ. Underreporting of race in the

National Hospital Discharge Survey. Hyattsville,

Maryland: National Center for Health Statistics.

1995.

21. Smith CL. Smoke detector operability survey

report on findings. Directorate for Economic

Analysis. Consumer Product Safety Commission.

1994.

Healthy People 2000 Final Review 159

Table 9. Unintentional Injuries objectives

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

9.1 Unintentional injury deaths (age adjusted

per 100,000) ........................ 1987 34.7 32.5 31.0 29.4 30.3 30.3 30.5 30.4 30.1 30.1 - - - 29.3

a. American Indian/Alaska Native ......... 1987 66.0 59.0 58.3 57.3 58.1 58.3 56.7 57.6 58.5 55.6 - - - 53.0

b. Black male ........................ 1987

68.0 62.4 61.0 56.7 59.8 58.5 57.6 55.7 54.2 54.4 - - - 51.9

c. White male ........................ 1987

49.8 46.4 43.9 41.9 42.7 42.7 43.0 42.4 42.0 42.2 - - - 42.9

d. Mexican American male

............. 1990

53.1 . . . 47.2 46.5 48.6 46.1 44.6 45.4 43.0 44.2 - - - 43.0

9.2 Unintentional injury hospitalizations

(per 100,000)

........................ 1988

832 780 764 714 699 654 635 612 582 564 - - - 754

a. Black male ........................ 1991 1,007 . . . . . . 969 893 847 911 730 637 628 - - - 856

9.3 Motor vehicle crash deaths

Per 100 million vehicle miles traveled (VMT) . . 1987 2.4 2.1 1.9 1.7 1.7 1.7 1.7 1.7 1.6 1.6 1.6 1.5

Per 100,000 population .................. 1987 19.2 17.9 16.5 15.4 15.6 15.6 15.9 15.9 15.7 15.4 15.3 14.2

a. Children 14 years and under (per

100,000) ......................... 1987 6.3 5.3 5.1 4.8 4.9 5.1 4.9 4.8 4.6 4.4 4.2 4.4

b. People 15–24 years (per 100,000) ...... 1987 36.3 33.4 31.4 28.0 28.5 28.9 29.9 28.9 27.4 26.7 27.2 26.8

c. People 70 years and over (per 100,000) . . 1987 22.9 22.9 22.3 21.9 22.9 23.4 23.3 23.3 23.9 23.3 22.4 20

d. American Indian/Alaska Native (age

adjusted per 100,000) ............... 1987 37.7 33.2 33.4 32.0 32.3 31.4 33.1 34.0 32.3 31.8 - - - 32.0

e. Motorcyclists (per 100 million VMT) ..... 1987

42.5 33.8 30.6 25.1 24.7 22.7 22.7 21.8 20.9 22.3 - - - 25.6

(per 100,000) ........... 1987 1.7 1.3 1.1 0.9 0.9 0.9 0.9 0.8 0.8 0.8 0.8 0.9

f. Pedestrians (per 100,000) ............. 1987 2.8 2.6 2.3 2.2 2.2 2.1 2.1 2.0 2.0 1.9 1.8 2.0

g. Mexican American (age adjusted per

100,000)

........................ 1990 20.9 . . . 18.9 17.5 18.1 18.7 17.7 18.0 17.0 16.7 - - - 18.0

9.4 Fall-related deaths (age adjusted per

100,000) ......................... 1987 2.7 2.7 2.6 2.5 2.5 2.5 2.6 2.7 2.7 2.7 - - - 2.3

a. People 65–84 years (per 100,000) ...... 1987 18.1 17.8 18.0 17.6 17.8 18.3 18.5 19.9 20.7 21.5 - - - 14.4

b. People 85 years and over (per 100,000) . . 1987 133.0 143.1 147.5 147.3 149.5 147.0 152.0 159.6 160.3 162.7 - - - 105.0

c. Black male 30–69 years (per 100,000) . . . 1987 8.1 6.8 6.2 5.3 5.5 5.4 4.8 5.3 4.5 4.9 - - - 5.6

d. American Indian/Alaska Native (age

adjusted per 100,000) ............... 1990 3.2 . . . 3.1 3.1 4.3 3.2 3.8 2.9 4.0 3.5 - - - 2.8

9.5 Drowning deaths (age adjusted per

100,000) ............................ 1987 2.1 1.9 1.9 1.6 1.7 1.5 1.7 1.5 1.5 1.6 - - - 1.3

a. Children 4 years and under (per

100,000) ......................... 1987

4.3 3.4 3.6 3.2 3.2 2.8 3.7 2.8 2.7 2.9 - - - 2.3

b. Male 15–34 years (per 100,000) ........ 1987 4.5 4.0 4.1 3.4 3.6 3.1 4.6 3.0 3.2 3.4 - - - 2.5

c. Black male (age adjusted per 100,000) . . . 1987 6.6 5.0 5.8 4.1 4.3 4.0 4.1 3.9 3.5 4.4 - - - 3.6

d. American Indian/Alaska Native (age

adjusted per 100,000) ............... 1990 4.3 . . . 3.8 4.0 4.3 4.3 3.5 3.3 3.8 3.0 - - - 2.0

9.6 Residential fire deaths

Fire-related deaths (age adjusted per

100,000)

........................... 1987

1.7 1.5 1.5 1.4 1.3 1.4 1.2 1.2 1.1 1.0 - - - 1.2

a. Children 4 years and under (per

100,000) ......................... 1987

4.5 3.5 3.8 3.4 3.6 3.5 2.6 2.4 2.1 1.6 - - - 3.3

See footnotes and key at end of table.

160 Healthy People 2000 Final Review

Table 9. Unintentional Injuries objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

b. People 65 years and over (per 100,000) . . 1987

4.9 4.1 3.9 3.7 3.7 3.5 3.6 3.8 3.5 3.2 - - - 3.3

c. Black male (age adjusted per 100,000) . . . 1987

6.4 5.2 5.1 4.9 4.6 4.5 4.2 3.9 3.4 3.1 - - - 4.3

d. Black female (age adjusted per 100,000). . 1987

3.3 2.7 2.6 2.3 2.6 2.4 2.4 2.1 2.0 1.8 - - - 2.6

e. Residential fire deaths caused by

smoking.......................... 1987

20% 19% 16% 18% 16% 16% 17% 17% - - - - - - - - - 8%

f. American Indian/Alaska Native (age

adjusted per 100,000) ............... 1990 2.1 . . . 2.3 2.5 2.5 3.1 3.1 1.9 2.0 1.8 - - - 1.4

g. Puerto Rican (age adjusted per 100,000). . 1990

1.8 . . . 1.4 1.4 1.0 1.1 1.3 1.6 1.2 1.0 - - - 2.0

9.7 Hip fractures among adults 65 years and

over (per 100,000) .................... 1988 714 776 814 757 841 815 818 934 879 863 - - - 607

a. White female 85 years and over ........ 1988 2,721 3,075 3,091 2,368 3,035 2,815 2,604 2,804 2,879 2,690 - - - 2,177

9.8 Nonfatal poisoning (per 100,000) ......... 1986

104 68 64 61 52 43 43 41 41 38 33 88

a. Children 4 years and under (per 100,000) . . 1986

664 705 638 626 597 518 499 470 460 450 418 520

9.9 Nonfatal head injuries (per 100,000) ....... 1988 118 110 104 92 90 84 87 79 75 61 - - - 106

9.10 Nonfatal spinal cord injuries (per 100,000). . 1988 5.3 4.4 6.4 3.6 4.7 3.9 4.6 4.8 4.8 4.5 - - - 5.0

a. Male............................. 1988 9.6 6.9 9.8 4.8 6.7 7.1 6.9 6.5 6.1 7.4 - - - 7.1

9.11 Incidence of secondary conditions

associated with traumatic spinal cord

injuries............................. ... --- --- --- --- --- --- --- --- --- --- ---

20%

reduction

9.12 Motor vehicle occupant protection

systems ............................ 1988 42% 49% 59% 62% 66% 67% 68% 68% 69% 69% 67% 85%

a. Children 4 years and under............ 1988 48% 50% 55% - - - 60% 60% - - - 61% - - - 92% - - - 70%

9.13 Helmet use by motorcyclists and bicyclists

Motorcyclists.......................... 1988 60% 60% 62% - - - - - - 63% - - - 64% 67% 67% - - - 80%

Bicyclists............................. 1988 8% - - - 18% - - - - - - - - - - - - - - - - - - - - - - - - 50%

9.14 Safety belt and helmet use laws

Number of States with safety belt laws

..... 1989 33 36 41 44 45 48 49 49 49 49 - - - 50

Number of States with motorcycle helmet use

laws

.............................. 1989 22 23 24 24 25 25 25 25 22 22 21 50

9.15 Number of States with handgun design to

protect children...................... 1989 0 0 - - - - - - - - - - - - - - - - - - - - - - - - - - - 50

9.16 Fire suppression sprinkler installation

codes (number of localities) ............. 1989 700 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2,000

Proportion of residential fires with suppression

equipment........................... ... ---

2.4% 2.5% 2.7% 2.6% - - - - - - - - - - - - - - - - - - . . .

9.17 Smoke detectors

In inhabited residential dwellings ........... 1985 81% 82% - - - - - - 80% - - - - - - - - - - - - - - - - - - 100%

At least one on each habitable floor....... ... --- --- --- --- 52% --- --- --- --- --- --- 100%

Proportion of people with at least one

detector ............................ ... ---

68.5% - - - - - - 87.6% 92.7% - - - - - - - - - - - - - - - . . .

At least one on each floor .............. ... --- --- --- --- 66% 87% --- --- --- 88% --- ...

See footnotes and key at end of table.

Healthy People 2000 Final Review 161

Table 9. Unintentional Injuries objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

9.18 Injury prevention instruction in required

course

Proportion of middle/junior and senior high

schools ............................. 1994 66.2% . . . . . . . . . . . . . . . - - - - - - - - - - - - - - - 50%

9.19* Protective equipment in sporting and

recreation events .................... ... --- --- --- --- --- --- --- --- --- --- --- 100%

National Collegiate Athletic Association

Football ............................ 1988 Required - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . .

Hockey ............................ 1988 Required - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . .

Lacrosse ........................... 1988 Required - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . .

High school football .................... 1988 Required - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . .

Amateur boxing........................ 1988 Required - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . .

Amateur ice hockey .................... 1988 Required - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . .

Use of protective headgear and mouth guards

among children who play sports

Baseball/softball

Headgear......................... ... --- --- 35% --- --- --- --- --- --- 47% --- ...

Mouth guard ...................... ... --- --- 7% --- --- --- --- --- --- 12% --- ...

Football

Headgear......................... ... --- --- 72% --- --- --- --- --- --- 77% --- ...

Mouth guard ...................... ... --- --- 72% --- --- --- --- --- --- 76% --- ...

Soccer

Headgear......................... ... --- --- 4% --- --- --- --- --- --- 9% --- ...

Mouth guard ...................... ... --- --- 7% --- --- --- --- --- --- 14% --- ...

9.20 Number of States with design standards for

roadway safety ...................... ... --- --- --- --- --- --- --- --- --- --- --- 50

9.21 Injury prevention counseling by primary

care providers ....................... ... --- --- --- --- --- --- --- --- --- --- --- 50%

Percent of clinicians routinely providing service

to 81–100% of patients

Inquiry about seat belt/child seat use

Pediatricians ........................ 1992 45% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 50%

Nurse practitioners ................... 1992 29% . . . . . . . . . - - - - - - - - - - - - - - -

8,10

39% - - - 50%

Obstetricians/gynecologists ............. 1992 6% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 50%

Internists ........................... 1992 11% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 50%

Family physicians .................... 1992 16% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 50%

Inquiry about hazards for falls in the home

(65 years and over)

Nurse practitioners ................... 1992 15% . . . . . . . . . - - - - - - - - - - - - - - -

14% - - - 50%

Internists ........................... 1992 10% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 50%

Family physicians .................... 1992 7% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 50%

See footnotes and key at end of table.

162 Healthy People 2000 Final Review

Table 9. Unintentional Injuries objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Advice about seat belt/child seat use

Pediatricians ........................ 1992 58% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 50%

Nurse practitioners ................... 1992 32% . . . . . . . . . - - - - - - - - - - - - - - -

8,11

30% - - - 50%

Obstetricians/gynecologists ............. 1992 18% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 50%

Internists ........................... 1992 15% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 50%

Family physicians .................... 1992 29% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 50%

Advice about prevention of falls in the home

(65 years and over)

Nurse practitioners ................... 1992 17% . . . . . . . . . - - - - - - - - - - - - - - -

18% - - - 50%

Internists ........................... 1992 17% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 50%

Family physicians .................... 1992 15% . . . . . . . . . - - - - - - - - - - - - - - -

8,9

--- --- 50%

9.22 Number of States with linked emergency

medical services and trauma systems .... 1993 7 . . . . . . . . . . . . - - - - - - - - - - - - 21 - - - 20

9.23* Alcohol-related motor vehicle deaths

(per 100,000) ........................ 1987 9.8 8.9 7.9 7.0 6.8 6.4 6.6 6.5 6.1 5.9 5.8 5.5

a. American Indian/Alaska Native male ..... 1987 40.4 34.3 32.2 31.4 26.8 28.0 - - - - - - - - - - - - - - - 35.0

b. People 15–24 years ................. 1987

20.9 18.6 17.2 14.2 13.7 13.0 12.8 12.9 11.7 11.7 11.5 12.5

9.24 Number of States with bicycle helmet

laws ............................... 1994 9 . . . . . . . . . . . . . . . 13 14 15 15 - - - 50

9.25* Number of States with firearm storage

laws ............................... 1989

1 1 5 8 11 13 15 15 15 15 18 50

9.26 Number of States with graduated licensing

systems ............................ 1993

0 ... ... ... ... --- --- --- 11 --- 23 35

- - - Data not available. Final objective status:

. . . Category not applicable.

Baseline has been revised.

Excludes data from States lacking Hispanic-origin item on their death certificates or for which Hispanic-origin data were not of sufficient quality. See appendix.

Data include intentional and unintentional injuries and injuries where the intent was not known.

Includes all deaths due to fires and flames regardless of location.

The District of Columbia, Puerto Rico, and other U.S. possessions also have a safety belt law.

The District of Columbia and Puerto Rico also have a motorcycle helmet law.

1989 data.

1985 data.

1997–98 data.

Response rate for this group was too low to produce reliable estimates.

Data represent the proportion of nurse practitioners who inquired about child safety seat use only. Seventeen percent of the nurse practitioners inquired about seat belt use.

Data represent the proportion of nurse practitioners who provided advice about child safety seat use only. Data on advice on seat-belt use were not available.

NOTE: Data include revisions and, therefore, may differ from data previously published in these reports and other publications.

Objective number Data source

9.1, 9.1a–d National Vital Statistics System, CDC, NCHS.

9.2 National Hospital Discharge Survey, CDC, NCHS.

9.3, 9.3a–c, e, f Fatality Analysis Reporting System, DOT, NHTSA.

9.3d, g National Vital Statistics System, CDC, NCHS.

Met

Toward

Mixed/ no change

Away

Cannot assess

Healthy People 2000 Final Review 163

Objective number Data source

9.4, 9.4a–d National Vital Statistics System, CDC, NCHS.

9.5, 9.5a–d National Vital Statistics System, CDC, NCHS.

9.6, 9.6a–d, f, g National Vital Statistics System, CDC, NCHS.

9.6e National Fire Incident Reporting System, FEMA, U.S. Fire Administration.

9.7, 9.7a National Hospital Discharge Survey, CDC, NCHS.

9.8, 9.8a National Electronic Injury Surveillance System, CPSC, Directorate for Epidemiology.

9.9 National Hospital Discharge Survey, CDC, NCHS.

9.10, 9.10a National Hospital Discharge Survey, CDC, NCHS.

9.12 Baseline and 1989–91 updates: 19 Cities Survey, DOT, NHTSA.

1992–97 updates: Population Weighted State Surveys, DOT, NHTSA.

1998–99 updates: National Occupant Protection Use Survey, DOT, NHTSA.

9.12a Baseline: 19 Cities Survey, DOT, NHTSA.

1992–93 updates: Population Weighted State Surveys, DOT, NHTSA.

1994–98 updates: National Occupant Protection Use Survey, DOT, NHTSA.

9.13 Baseline: 19 Cities Survey, DOT, NHTSA.

Updates: National Occupant Protection Use Survey , DOT, NHTSA.

9.14 DOT, NHTSA.

9.15 Telephone Survey on Handgun Laws, CDC, NCIPC.

9.16 Baseline (localities): Fire Suppression Sprinkler Codes, FEMA, U.S. Fire Administration.

1990–93 data: National Fire Incident Reporting System, FEMA, U.S. Fire Administration.

9.17 Baseline and 1990–93 updates: Prevention Index, Rodale Press for Inhabited residential dwellings.

1993 data: Smoke Detector Operability Survey, Consumer Product Safety Commission for inhabited residential dwellings on each habitable floor.

Proportion of people with smoke detectors: National Health Interview Survey, CDC, NCHS.

Proportion of people with one on each floor: National Health Interview Survey, CDC, NCHS.

9.18 School Health Policies and Programs Study, CDC, NCCDPHP.

9.19* 1988 baseline: CDC, NCPS; NIH, NIDR.

1991 data: National Health Interview Survey, CDC, NCHS.

9.21 Baseline: Primary Care Provider Surveys, OPHS, ODPHP.

Update: Prevention in Primary Care Study, American College of Preventive Medicine.

9.22 CDC, NCIPC.

9.23*, 9.23b Fatality Analysis Reporting System, DOT, NHTSA.

9.23a Fatality Analysis Reporting System, DOT, NHTSA; National Vital Statistics System, CDC, NCHS.

9.24 National SAFEKIDS Campaign.

9.25* Office of Planning, Evaluation and Legislation, CDC, NCIPC; National Conference of State Legislatures.

9.26 Insurance Institute for Highway Safety.

*Duplicate objective. See full text of objective following this table.

164 Healthy People 2000 Final Review

Unintentional

Injuries Objectives

9.1: Reduce deaths caused by

unintentional injuries to no more than

29.3 per 100,000 people.

9.1a: Reduce deaths among

American Indians and Alaska

Natives caused by unintentional

injuries to no more than 53.0 per

100,000 people.

9.1b: Reduce deaths among black

males caused by unintentional

injuries to no more than 51.9 per

100,000 people.

9.1c: Reduce deaths among white

males caused by unintentional

injuries to no more than 42.9 per

100,000.

9.1d: Reduce deaths among

Mexican–American males caused by

unintentional injuries to no more

than 43.0 per 100,000.

9.2: Reduce nonfatal unintentional

injuries so that hospitalizations for this

condition are no more than 754 per

100,000 people.

9.2a: Reduce nonfatal unintentional

injuries among black males so that

hospitalizations for this condition

are no more than 856 per 100,000

people.

9.3: Reduce deaths caused by motor

vehicle crashes to no more than 1.5 per

100 million vehicle miles traveled and

14.2 per 100,000 people.

9.3a: Reduce deaths among children

aged 14 and younger caused by

motor vehicle crashes to no more

than 4.4 per 100,000.

9.3b: Reduce deaths among youth

aged 15–24 caused by motor

vehicle crashes to no more than

26.8 per 100,000.

9.3c: Reduce deaths among people

aged 70 and older caused by motor

vehicle crashes to no more than 20

per 100,000.

9.3d: Reduce deaths among

American Indians and Alaska

Natives caused by motor vehicle

crashes to no more than 32 per

100,000.

9.3e: Reduce deaths among

motorcyclists caused by motor

vehicle crashes to no more than

25.6 per 100 million vehicle miles

traveled and 0.9 per 100,000.

9.3f: Reduce deaths among

pedestrians caused by motor vehicle

crashes to no more than 2.0 per

100,000.

9.3g: Reduce deaths among

Mexican-Americans caused by

motor vehicle crashes to no more

than 18 per 100,000.

9.4: Reduce deaths from falls and

fall-related injuries to no more than 2.3

per 100,000 people.

9.4a: Reduce deaths among people

aged 65–84 from falls and

fall-related injuries to no more than

14.4 per 100,000.

9.4b: Reduce deaths among people

aged 85 and older from falls and

fall-related injuries to no more than

105 per 100,000.

9.4c: Reduce deaths among black

men aged 30–69 from falls and

fall-related injuries to no more than

5.6 per 100,000.

9.4d: Reduce deaths among

American Indians and Alaska

Natives from falls and fall-related

injuries to no more than 2.8 per

100,000.

9.5: Reduce drowning deaths to no more

than 1.3 per 100,000 people.

9.5a: Reduce drowning deaths

among children aged 4 and younger

to no more than 2.3 per 100,000.

9.5b: Reduce drowning deaths

among men aged 15–34 to no more

than 2.5 per 100,000.

9.5c: Reduce drowning deaths

among black males to no more than

3.6 per 100,000.

9.5d: Reduce drowning deaths

among American Indians and

Alaska Natives to no more than 2.0

per 100,000.

9.6: Reduce residential ﬁre deaths to no

more than 1.2 per 100,000 people.

9.6a: Reduce residential ﬁre deaths

among children aged 4 and younger

to no more than 3.3 per 100,000.

9.6b: Reduce residential ﬁre deaths

among people aged 65 and older to

no more than 3.3 per 100,000.

9.6c: Reduce residential ﬁre deaths

among black males to no more than

4.3 per 100,000.

9.6d: Reduce residential ﬁre deaths

among black females to no more

than 2.6 per 100,000.

9.6e: Reduce residential ﬁre deaths

from residential ﬁres caused by

smoking to no more than 8 percent.

9.6f: Reduce residential ﬁre deaths

among American Indians and

Alaska Natives to no more than 1.4

per 100,000.

9.6g: Reduce residential ﬁre deaths

among Puerto Ricans to no more

than 2.0 per 100,000.

9.7: Reduce hip fractures among people

aged 65 and older so that

hospitalizations for this condition are no

more than 607 per 100,000 people.

9.7a: Reduce hip fractures among

white women aged 85 and older so

that hospitalizations for this

condition are no more than 2,177

per 100,000.

9.8: Reduce nonfatal poisoning to no

more than 88 emergency department

treatments per 100,000 people.

9.8a: Reduce nonfatal poisoning

among children aged 4 and younger

to no more than 520 emergency

department treatments per 100,000.

9.9: Reduce nonfatal head injuries so

that hospitalizations for this condition

are no more than 106 per 100,000

people.

9.10: Reduce nonfatal spinal cord

injuries so that hospitalizations for this

condition are no more than 5 per

100,000 people.

9.10a: Reduce nonfatal spinal cord

injuries among males so that

hospitalizations for this condition

are no more than 7.1 per 100,000.

9.11: Reduce by 20 percent the

incidence of secondary conditions (i.e.,

pressure sores) associated with traumatic

spinal cord injuries.

9.12: Increase use of safety belts and

child safety seats to at least 85 percent

of motor vehicle occupants.

Healthy People 2000 Final Review 165

9.12a: Increase use of child restraint

systems among children aged 4 and

younger involved in potentially fatal

crashes to 70 percent.

9.13: Increase use of helmets to at least

80 percent of motorcyclists and at least

50 percent of bicyclists.

9.14: Extend to 50 States laws requiring

safety belt and motorcycle helmet use

for all ages.

9.15: Enact in 50 States laws requiring

that new handguns be designed to

minimize the likelihood of discharge by

children.

9.16: Extend to 2,000 local jurisdictions

the number whose codes address the

installation of ﬁre suppression sprinkler

systems in those residences at highest

risk for ﬁres.

9.17: Increase the presence of functional

smoke detectors to at least one on each

habitable ﬂoor of all inhabited

residential dwellings.

9.18: Provide academic instruction on

injury prevention and control, preferably

as part of comprehensive school health

education, in at least 50 percent of

public school systems (grades K–12).

9.19*: Extend requirement of the use of

effective head, face, eye, and mouth

protection to all organizations, agencies,

and institutions sponsoring sporting and

recreation events that pose risks of

injury.

Duplicate objective: 13.16

9.20: Increase to at least 50 the number

of States that have design standards for

markings, signing, and other

characteristics of the roadway

environment to improve the visual

stimuli and protect the safety of older

drivers and pedestrians.

9.21: Increase to at least 50 percent the

proportion of primary care providers

who routinely provide age–appropriate

counseling on safety precautions to

prevent unintentional injury.

9.22: Extend to 20 States the capability

to link emergency medical services,

trauma systems, and hospital data.

9.23*: Reduce deaths caused by

alcohol-related motor vehicle crashes to

no more than 5.5 per 100,000 people.

Duplicate objective: 4.1

9.23a*: Reduce deaths among

American Indian and Alaska Native

men caused by alcohol-related

motor vehicle crashes to no more

than 35.0 per 100,000.

Duplicate objective: 4.1a

9.23b*: Reduce deaths among

people aged 15–24 caused by

alcohol-related motor vehicle

crashes to no more than 12.5 per

100,000.

Duplicate objective: 4.1b

9.24: Extend to 50 States laws requiring

helmets for bicycle riders.

9.25*: Enact in 50 States and the

District of Columbia laws requiring that

ﬁrearms be properly stored to minimize

access and the likelihood of discharge

by minors.

Duplicate objective: 7.19

9.26: Increase to 35 the number of

States having a graduated driver

licensing system for novice drivers and

riders under the age of 18.

*Duplicate objective.

166 Healthy People 2000 Final Review

Priority Area 10

Occupational Safety

and Health

Background

Workplace injuries and illness

continue to place an enormous burden

on the Nation’s workers and economy.

Each day, an average of 137 persons die

from work-related illness (1,2) and an

additional 17 die from work-related

injuries (3). Each year, about 70

adolescent workers 17 years of age and

under die from work-related injuries (4).

In 1992, the estimated economic burden

for occupational illnesses and injuries

was $171 billion (5), while in 1998, the

estimated societal cost of occupational

injuries alone was $125.1 billion (6).

In 1999, highway crashes continued

to be the leading cause of occupational

death, accounting for 25 percent of

work-related fatalities (3). During the

same year and for the first time in the

decade, an increase in falls and a

simultaneous decline in homicides

resulted in falls becoming the second

and homicides the third leading cause of

death in the workplace (3). The highest

occupational fatality rates are observed

in mining, agriculture, forestry and

fishing, and construction (3).

Data Summary

Highlights

Since the development of Healthy

People 2000, the Nation has experienced

marked success in meeting the targets in

several areas of occupational safety and

health. The rate of work-related

homicides per 100,000 workers (10.16)

met its target level of 0.5 in 1998. The

number of workers who became infected

with hepatitis B virus through

occupational exposure (10.5) was

reduced to 243 cases in 1999, well

beyond the target level of 623 cases.

Both the percent of worksites with

safety and health programs (10.12) and

the percent of worksites with back

injury prevention and rehabilitation

programs (10.13) exceeded their target

by 1999. In addition, the age-adjusted

fatality rate for occupational lung

disease per million workers 15 years of

age and older (10.17) was reduced to

6.6 in 1998, beyond the target rate of

7.7.

Occupational lung disease exposure

standards (10.11) are applicable in all 50

States and the District of Columbia, the

target level, up from 15 in 1970. The

number of States with programs for

small business safety and health (10.14)

also increased to the target level of 50

States and the District of Columbia.

In other areas, progress toward the

Healthy People 2000 targets was made.

The rate of work-related injury deaths

per 100,000 workers (10.1) decreased to

4.5 in 1999 from the 1983–87 baseline

average rate of 6, the rate of nonfatal

work-related injuries per 100,000

workers (10.2) was 6.2 in 1998, down

from 7.7 in 1983–87, and the percent of

businesses that ban smoking (10.18)

increased from 27 percent in 1985 to

79 percent in 1999. The target for this

objective (10.18) was raised from

75 percent to 100 percent at the

midcourse review.

Moving substantially in the other

direction, that is, away from their

targets, were cumulative trauma

disorders (10.3), worksite occupant

protection systems (10.6), occupational

noise exposure (10.7), and occupational

lead exposure (10.8). For objective 10.8

the number of States reporting has

increased over the last decade, which

makes the raw number of cases reported

understate the progress made; the rate of

cases per million population has steadily

decreased since 1995.

Summary of progress

Of the 20 occupational safety and

health objectives, 7 (10.5, 10.11–10.14,

10.16, and 10.17) have achieved their

targets. Seven objectives (10.1, 10.2,

10.4, 10.9, 10.10, 10.15, and 10.18)

moved toward the year 2000 targets.

Progress for objective 10.15 was toward

the year 2000 target, but is based on

limited data from nurse practitioners

only (see Data Issues). Four objectives

(10.3, and 10.6–10.8) moved away from

the targets. Progress for the compound

objective (10.19) was mixed. One

objective (10.20) showed no change

from the baseline level. See table 10 for

the tracking data for the objectives in

this priority area and figure 10 for a

quantitative assessment of progress.

Discussion

The barriers to achieving the

Healthy People 2000 objectives vary;

however, there are a number of common

themes. Numerous

conditions—including hepatitis B,

occupational lead exposure, and

occupational injuries—are preventable,

but the lack of public awareness of

prevention measures or the view that

these conditions are an ‘‘acceptable

risk’’ of employment interfere with basic

prevention. Gaps in scientific knowledge

also present a barrier to achieving the

objectives. For instance, in the case of

cumulative trauma and other

musculoskeletal disorders, limitations in

the amount of technological and

scientific information inhibit precise

assessment of risks in some jobs with

complex and multiple exposures to

several risk factors. Difficulties in

systematically evaluating the

effectiveness of interventions also

impeded progress toward the Healthy

People 2000 targets.

In addition, there is a lack of

cost-benefit studies in occupational

safety and health that would help

motivate companies to institute and

maintain occupational safety and health

programs, such as back injury and

hearing loss prevention programs.

Moreover, difficulties in diagnosing and

establishing the work relatedness of

some conditions, such as occupational

skin disorders/diseases and low back

injuries, also serve as a barrier to

progress.

The national occupational safety

and health community is pursuing a

number of strategies to address these

and other barriers. Such efforts include

health education and communication

campaigns, academic training, research

on intervention effectiveness and health

services, and surveillance strategic

planning. In addition, the National

Institute for Occupational Safety and

Health (NIOSH) is working with

partners to track occupational injury and

illness disparities among population

subgroups. In all of these areas,

partnerships among industry, labor,

government, academia, and professional

organizations are enhancing the Nation’s

ability to target resources and expertise.

Also addressing the barriers to

achieving the Healthy People 2000

objectives is the National Occupational

Research Agenda (NORA), a framework

to guide occupational safety and health

research into the 21st century.

Approximately 500 organizations and

individuals provided input into the

development of the agenda. The NORA

process resulted in a consensus about a

Healthy People 2000 Final Review 167

10.1 Work-related injury deaths

10.2 Nonfatal work-related injuries

10.3 Cumulative trauma disorders

10.4 Occupational skin disorders

10.5 Hepatitis B infection among exposed workers

10.6 Worksite occupant protection systems

10.7 Occupational noise exposure

10.8 Occupational lead exposure

10.9 Hepatitis B immunization among exposed workers

10.10 States with occupational health and safety plans

10.11 States with occupational lung disease standards

10.14 States with small business safety/health programs

10.12 Worksite health and safety programs

10.13 Worksite back injury prevention programs

10.16 Work-related homicides

10.17 Occupational lung disease deaths

10.18 Worksite smoking policies: Bans

10.19 States with clean indoor air laws: Private workplaces

Restaurants

Public transportation

Public workplaces

Hospitals

Day care centers

Grocery stores

10.20 States with preemptive clean indoor air laws

Moved away from target Moved toward target Met target

NOTE: Complete tracking data are shown in table 10. Progress quotients are not calculated for objective 10.15.

See the section on Measuring Progress Toward the

Healthy People 2000

Targets in the Appendix for more information.

44%

75%

-3%

33%

57%

71%

10%

No change

Percent of target achieved

-100 -80 -60 -40 -20

20 40 60 80 100

115%

342%

114%

100%

138%

100%

-390%

-281%

-463%

-104%

88%

168 Healthy People 2000 Final Review

Figure 10. Final status of Occupational Safety and Health objectives

set of top 21 research priorities. The

priority areas are organized under the

more general categories of Disease and

Injury, Work Environment and

Workforce, and Research Tools and

Approaches. Because of the significant

overlap between the NORA research

priority areas and the Healthy People

2000 objectives, NORA was

instrumental in moving the Nation

toward the year 2000 targets and will

likewise serve as a catalyst for

advancing the objectives established in

Healthy People 2010 (7) over the next

decade.

Transition to Healthy People

2010

Many of the Healthy People 2000

occupational safety and health objectives

are included in the new set of objectives

for Healthy People 2010, with baselines

and targets adjusted to reflect gains

made, as well as changes in data

systems. Several new objectives have

been added to address work organization

issues, health care worker hazards, and

engineering interventions in agriculture.

In addition, several Healthy People 2000

objectives that cannot be tracked

reliably or that have low relative value

for monitoring improved outcomes in

worker safety and health have been

revised, replaced, or dropped from the

Healthy People 2010 objectives.

Objectives on work-related injury

deaths and work-related injuries are

continued in Healthy People 2010 and

are addressed by the NORA priority

area of Traumatic Injuries. Also, the

objective on overexertion or repetitive

motion which is addressed by NORA’s

Low Back Disorders and

Musculoskeletal Disorders of the Upper

Extremities and the objective on

occupational skin diseases or disorders,

addressed by NORA’s Allergic and

Irritant Dermatitis, are included in the

next decade. A number of other health

outcomes are continued in Healthy

People 2010 including: work-related

noise-induced hearing loss, addressed by

NORA’s Hearing Loss; elevated blood

lead levels from work exposure,

addressed by NORA’s Fertility and

Pregnancy Abnormalities; work-related

homicides and work-related assaults,

addressed by NORA’s Traumatic

Injuries; and, pneumoconiosis deaths,

addressed by NORA’s Asthma and

Chronic Obstructive Pulmonary

Diseases. Finally, two Healthy People

2010 objectives are new: worksite stress

reduction programs, addressed by

NORA’s Organization of Work; and

needlestick injuries, addressed by

NORA’s Infectious Diseases.

Seven of the Healthy People 2000

objectives were not included in Healthy

People 2010: worksite occupant

protection system mandates; State

occupational safety and health plans;

occupational lung disease exposure

standards; worksite safety and health

programs; worksite injury prevention

and rehabilitation programs; State

programs for small business safety and

health; and clinician assessment of

occupational health exposures.

Healthy People 2000 objectives on

hepatitis B infections and hepatitis B

immunizations are addressed by Healthy

People 2010 objectives in the

Immunization and Infectious Diseases

chapter. In addition, Healthy People

2000 objectives on worksites with

smoking policies, States with

comprehensive laws for clean indoor air,

and preemptive clean indoor air laws are

addressed by Healthy People 2010

objectives in the Tobacco Use chapter.

Appendix table III, a crosswalk

between Healthy People 2000 and

Healthy People 2010 objectives,

summarizes the changes between the

two decades of objectives, reflecting

new knowledge and direction for this

area.

Data Issues

Definitions

Objective 10.20 seeks to reduce the

number of States with preemptive clean

indoor air laws. Preemptive laws prevent

local jurisdictions from enacting more

stringent restrictions than the State law

or restrictions that vary from the State

law (8).

Data Sources

Since 1992, the data for objective

10.1 (work-related injury deaths) have

come from the Census for Fatal

Occupational Injuries (CFOI), Bureau of

Labor Statistics (BLS). Prior to 1992,

the data came from the Annual Survey

on Occupational Injuries and Illnesses

(ASOII). ASOII relied on a single data

source to capture occupational fatalities:

a survey of employer logs of

occupational deaths in approximately

50,000 workplaces. The survey

undercounted occupational fatalities by

as much as 60 percent (9). The CFOI

uses a minimum of two data sources to

identify occupational deaths. The

primary sources are death certificates;

State workers’ compensation reports;

coroner, medical examiner, or autopsy

reports; and Occupational Safety and

Health Administration (OSHA) reports.

The rates for 1993 were rounded to

whole numbers by BLS. National

Traumatic Occupational Fatalities

Surveillance System (NTOF) data

(reported by NIOSH) can also be used

to monitor this objective, but NTOF

uses only death certificates and may

underestimate some categories of

work-related injury deaths. CFOI and

NTOF are also used to track objective

10.16 on workplace homicides.

The subobjective on adolescent

work injuries (10.2f) is tracked with

data from the National Electronic Injury

Surveillance System (NEISS) under an

interagency agreement between NIOSH

and the Consumer Product Safety

Commission (CPSC) and does not

utilize ICD–9 codes or other

conventional injury reporting

mechanisms. The data are collected in

hospital emergency rooms and are

limited to injuries attributable to a

specific list of regulated products and

devices. Hence, the data collected are

subject to annual variations in what is

specified in product safety or regulatory

codes. The baseline for adolescent

worker injuries is an extrapolation of

data from the last 6 months of calendar

year 1992 and is limited to workers ages

15–17 years. The updates for 1996 and

1997 are for fiscal years; the 1998 data

are for the calendar year. The main

objective and the other subobjectives for

10.2 are tracked using data from ASOII.

The data used to report on the

status of objective 10.7 (occupational

noise exposure) come from the U.S. Air

Force Hearing Conservation Database.

The data report exposures for civilian

and military employees in a wide range

of industrial and service occupations.

NIOSH is currently developing the

Sentinel Event Notification System for

Occupational Risk (SENSOR) and the

Occupational Hearing and Conservation

database and has issued guidelines and

sponsored Worksite Benchmark Survey,

which used a methodology very similar

to the 1992 survey but did not include

passive methods of health promotion

(23,24).

References

1. Centers for Disease Control and Prevention.

Declines in death from heart disease and

stroke—United States, 1990–99. MMWR

48(30):649–55. 1999.

2. National Heart Lung and Blood Institute.

Morbidity and mortality: 2000 chartbook on

cardiovascular, lung, and blood disease. Bethesda,

Maryland: National Institutes of Health, Public

Health Service. 2000.

3. Murphy SL. Deaths: Final data for 1998.

National vital statistics reports; vol 48 no 11.

Hyattsville, Maryland: National Center for Health

Statistics. 2000.

4. Department of Health and Human Services.

Healthy people 2010. 2nd ed. With understanding

and improving health and objectives for improving

health. 2 vols. Washington: US Government

Printing Office. 2000.

5. National Heart, Lung, and Blood Institute. Fact

book fiscal year 1999. Bethesda, Maryland:

National Institutes of Health, Public Health

Service. 2000.

6. National Heart, Lung, and Blood Institute. Fact

book fiscal year 1996. Bethesda, Maryland:

National Institutes of Health, Public Health

Service. 1997.

7. Roccella EJ, Horan MJ. The National High

Blood Pressure Education Program: Measuring

progress and assessing its impact. Health Psychol

(Suppl.7): 237–303. 1998.

8. Long-Term Intervention with Pravastatin in

Ischaemic Disease (LIPID) Study Group.

Prevention of cardiovascular events and death with

pravastatin in patients with coronary heart disease

and a broad range of initial cholesterol levels.

New Engl J Med 339(19): 1349–57. 1998.

9. National Center for Health Statistics. Health,

United States, 2000. Hyattsville, Maryland: Public

Health Service. 2000.

10. The Health Benefits of Smoking Cessation. A

report of the Surgeon General. Atlanta, Georgia:

Department of Health and Human Services, Public

Health Service, Centers for Disease Control and

Prevention, National Center for Disease Prevention

and Health Promotion, Office on Smoking and

Health. 1990.

11. He J, Whelton PK, Appel LJ, et al. Long-term

effects of weight loss and dietary sodium

reduction on incidence of hypertension.

Hypertension 35(2): 544–9. 2000.

12. Mokdad AH, Serdula MK, Dietz WH, et al.

The spread of the obesity epidemic in the United

States, 1991–1998. JAMA 282 (16): 1519–22.

1999.

13. National Heart Attack Alert Program

coordination committee: Working group report on

educational strategies to prevent prehospital delay

in patients at high risk for acute myocardial

infarction. Bethesda, Maryland: National Institutes

of Health, National Heart, Lung and Blood

Institute. 1997.

14. National High Blood Pressure Education

Program: National High Blood Pressure Education

Program Working Group Report on Primary

Prevention of Hypertension. Bethesda, Maryland:

National Institutes of Health, National Heart, Lung

and Blood Institute. 1993.

15. Cleeman JI and Lenfant C. The National

Cholesterol Education Program: Progress and

prospects. JAMA 280 (24): 2099–2104. 1998.

16. Koplan JP, Dietz WH. Caloric imbalance and

public health policy. JAMA 282 (16):1579–81.

1999.

17. Centers for Disease Control and Prevention.

Missed opportunities in preventive counseling for

cardiovascular disease—United States 1995.

MMWR 47(5): 91–5. 1998.

18. Reikes ST. Trends in end-stage renal disease.

Epidemiology, morbidity, and mortality. Postgrad

Med 108(1):124–6, 129–31, 135–6. 2000.

19. Johnson CL, et al. Declining serum total

cholesterol levels among U.S. adults. JAMA

269(23):3002–23. 1993.

20. Flegal KM, Carroll MD, Kuczmarski RJ, et al.

Overweight and obesity in the United States:

Prevalence and trends, 1960–94. Int J Obes

22(1)39–47. 1998.

21. Kuczmarski RJ, Carroll MD, Flegal KM, et al.

Varying body mass index cutoff points to describe

overweight prevalence among U.S. adults:

NHANES III (1988–94). Obesity Research

5(6):542–8. 1997.

22. National Center for Health Statistics. Healthy

people 2000 review, 1992. Hyattsville, Maryland:

Public Health Service. 1993.

23. Department of Health and Human Services.

Business Responds to AIDS Benchmark Survey:

Technical report. Atlanta, Georgia: Public Health

Service, Centers for Disease Control and

Prevention. 1996.

24. Centers for Disease Control and Prevention.

Cancer screening offered by worksites—United

States, 1992 and 1995. MMWR 46(19):421–4.

1997.

220 Healthy People 2000 Final Review

Table 15. Heart Disease and Stroke objectives

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

15.1* Coronary heart disease deaths (age adjusted

per 100,000) ........................... 1987 135 22 118 114 114 110 108 105 100 97 - - - 100

a. Black .............................. 1987 168 158 156 151 154 147 147 140 136 133 - - - 115

15.2* Stroke deaths (age adjusted per 100,000) ..... 1987 30.4 27.7 26.8 26.2 26.5 26.5 26.7 26.4 25.9 25.1 - - - 20.0

a. Black .............................. 1987 52.5 48.4 46.8 45.0 45.0 45.4 45.0 44.2 42.5 41.4 - - - 27.0

15.3 End-stage renal disease (per 100,000) ....... 1987 14.4 19.2 21.4 23.4 24.1 28.8 27.8 28.7 30.8 32.0 - - - 13.0

a. Black .............................. 1987 34.0 47.8 52.7 57.2 59.5 69.6 69.1 71.5 72.3 75.4 - - - 30.0

15.4* Controlled high blood pressure

People with high blood pressure 18–74 years . . . 1976–80 11% - - - - - - - - - - - -

23% --- --- --- --- --- 50%

a. Males with high blood pressure 18–74 years. 1976–80 6% - - - - - - - - - - - -

17% --- --- --- --- --- 40%

b. Mexican Americans with high blood pressure

18–74 years........................ 1988–94

14% ... ... ... ... ... --- --- --- --- --- 50%

c. Females with high blood pressure 70 years

and over .......................... 1988–94

19% ... ... ... ... ... --- --- --- --- --- 50%

15.5 Taking action to control blood pressure

People with high blood pressure 18 years

and over .............................. 1985 79% 80% - - - - - - - - - 87% - - - - - - - - - 89% - - - 90%

a. White hypertensive male 18–34 years...... 1985 51% 54% - - - - - - - - - 64% - - - - - - - - - 57% - - - 80%

b. Black hypertensive male 18–34 years ...... 1985 63% 56% - - - - - - - - - 70% - - - - - - - - - 67% - - - 80%

15.6* Mean serum cholesterol level (mg/dL)

People 20–74 years ...................... 1976–80 213 - - - - - - - - - - - -

203 --- --- --- --- --- 200

Male 20–74 years ........................ 1976–80 211 - - - - - - - - - - - -

202 --- --- --- --- --- 200

Female 20–74 years ...................... 1976–80 215 - - - - - - - - - - - -

204 --- --- --- --- --- 200

15.7* High blood cholesterol prevalence

People 20–74 years ...................... 1976–80 27% - - - - - - - - - - - -

19% --- --- --- --- --- 20%

Male 20–74 years ........................ 1976–80 25% - - - - - - - - - - - -

18% --- --- --- --- --- 20%

Female 20–74 years ...................... 1976–80 29% - - - - - - - - - - - -

20% --- --- --- --- --- 20%

15.8 Awareness of high blood cholesterol

condition

Adults 18 years and over with high blood

cholesterol ............................ 1988 30% 44% - - - - - - - - - - - - 60% - - - - - - - - - - - - 60%

15.9* Dietary fat intake among people 2 years and

over

National Health and Nutrition Examination Survey

Average percent of calories from total fat..... 1976–80

36% --- --- --- ---

34% --- --- --- --- --- 30%

Average percent of calories from saturated fat . 1976–80

13% --- --- --- ---

12% --- --- --- --- --- 10%

Percent who met goal for total fat .......... 1988–94

27% ... ... ... ... ... --- --- --- --- --- 50%

Percent who met goal for saturated fat ...... 1988–94

29% ... ... ... ... ... --- --- --- --- --- 50%

Continuing Survey of Food Intakes by Individuals

Average percent of calories from total fat .... 1989–91 34% . . . . . . - - - - - - 33% 33% 33% - - - - - - - - - 30%

Average percent of calories from saturated fat . 1989–91 12% . . . . . . - - - - - - 11% 11% 11% - - - - - - - - - 10%

Percent who met goal for total fat .......... 1989–91 22% . . . . . . - - - - - - 32% 33% 34% - - - - - - - - - 50%

Percent who met goal for saturated fat ...... 1989–91 21% . . . . . . - - - - - - 34% 35% 36% - - - - - - - - - 50%

See footnotes and key at end of table.

Healthy People 2000 Final Review 221

Table 15. Heart Disease and Stroke objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

15.10* Overweight prevalence (based on measured

height and weight unless otherwise indicated)

Adults 20–74 years ....................... 1976–80 26% - - - - - - - - - - - -

1,4

35% --- --- --- --- --- 20%

Male ................................ 1976–80 24% - - - - - - - - - - - -

1,4

34% --- --- --- --- --- 20%

Female .............................. 1976–80 27% - - - - - - - - - - - -

1,4

37% --- --- --- --- --- 20%

Adolescents 12–19 years .................. 1976–80 15% - - - - - - - - - - - -

24% --- --- --- --- --- 15%

a. Low-income female 20–74 years.......... 1976–80 37% - - -

47% --- --- --- --- --- --- --- --- 25%

b. Black female 20–74 years............... 1976–80 44% - - - - - - - - - - - -

1,4

52% --- --- --- --- --- 30%

c. Hispanic female 20–74 years ............ ... --- --- --- --- --- --- --- --- --- --- --- 25%

Hispanic female 20 years and over

(self-reported) ..................... ... --- 33% 32% 32% 33% 32% 35% ---

‡

44%

‡

46% --- ...

Mexican American female 20–74 years . . . 1982–84 39% - - - - - - - - - - - -

1,4

50% --- --- --- --- --- ...

Cuban female 20–74 years............ 1982–84 34% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . .

Puerto Rican female 20–74 years ....... 1982–84 37% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . .

d. American Indian/Alaska Native 20 years and

over .............................. 1984–88 29–75% - - -

40%

36%

48%

34%

43% - - -

‡,6

46%

‡,6

45% - - - 30%

e. People with disabilities 20 years and over

(self-reported) ....................... 1985 36% - - - 38% 37% 38% 38% 40% - - - - - - - - - - - - 25%

f. Females with high blood pressure 20–74

years .............................. 1976–80 50% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 41%

g. Males with high blood pressure 20–74 years. 1976–80 39% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 35%

h. Mexican American male 20–74 years ...... 1982–84 30% - - - - - - - - - - - -

1,4

37% --- --- --- --- --- 25%

15.11* Light-to-moderate physical activity

People 6 years and over................... ... --- --- --- --- --- --- --- --- --- --- --- 30%

People 18 years and over

5 or more times per week ................ 1985

22%

23%

24% --- --- --- 23% --- --- 30% --- 30%

7 or more times per week ................ 1985

16%

17% --- --- --- 16% --- --- 20% --- 30%

a. Hispanic 18 years and over

5 or more times per week.............. 1991 20% . . . . . . - - - - - - - - - 22% - - - - - - 29% - - - 25%

15.12* Cigarette smoking prevalence

People 18 years and over .................. 1987 29% 25% 26%

27% 25% 26% 25% - - -

‡

25%

‡

24% - - - 15%

Male .................................. 1987 31% 28% 28%

29% 28% 28% 27% - - -

‡

28%

‡

26% - - - 15%

Female ................................ 1987 27% 23% 23%

25% 22% 23% 23% - - -

‡

22%

‡

22% - - - 15%

a. People with high school education or less

20 years and over ................... 1987 34% 31% 31%

32% 30% 31% 30% - - -

‡

31%

‡

31% - - - 20%

b. Blue-collar workers 18 years and over ..... 1987 41% 36% 36%

36% 34% 39% 36% - - -

‡

37%

‡

36% - - - 20%

c. Military personnel ..................... 1988 42% - - - - - -

35% --- --- 32% --- --- 30% --- 20%

d. Black 18 years and over 1987 33% 26% 29%

28% 26% 27% 26% - - -

‡

27%

‡

25% - - - 18%

e. Hispanic 18 years and over ............. 1987 24% 23% 20%

21% 20% 20% 18% - - -

‡

20%

‡

19% - - - 15%

f. American Indian/Alaska Native 18 years and

over ............................... 1979–87

42–70% 38% 31%

40% 39% 40% 35% - - -

‡

32%

‡

37% - - - 20%

g. Southeast Asian male .................. 1984–88 55%

35%

36–41 - - - - - - - - - - - - - - - - - - - - - - - - 20%

h. Females of reproductive age (18–44 years) . 1987 29% 26% 27%

28% 26% 27% 26% - - -

‡

26%

‡

25% - - - 12%

i. Pregnant females...................... 1985 25% 19% 20% - - - 20% - - - 18% 14% 13% 13% - - - 10%

j. Females who use oral contraceptives....... 1983 36%

26% --- --- --- --- 24% --- --- --- --- 10%

222 Healthy People 2000 Final Review

Table 15. Heart Disease and Stroke objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

15.13 Knowledge of blood pressure values

People given blood pressure values .......... 1985 61% 76% - - - - - - - - - - - - - - - - - - - - - - - - - - - 90%

People who can state blood pressure is high,

low, or normal .......................... ... --- --- 84% --- 85% 84% --- --- --- 85% --- ...

a. Mexican American male 18 years and over . . 1991 69% . . . . . . - - - 68% 68% - - - - - - - - - 62% - - - 90%

15.14 Blood cholesterol checked in past 5 years

People 18 years and over .................. 1993 66% . . . . . . . . . . . . - - - - - - - - - - - - 67% - - - 75%

Ever checked ......................... 1988 59% 65% 63% - - - 71% - - - 75% - - - - - - 72% - - - . . .

Within past 2 years ..................... 1988 52% - - - 50% - - - 54% - - - - - - - - - - - - 57% - - - . . .

Ever checked

a. Black 18 years and over ................ 1991 56% . . . . . . - - - 68% - - - - - - - - - - - - 67% - - - 75%

b. Mexican American 18 years and over ...... 1991 42% . . . . . . - - - 55% - - - - - - - - - - - - 48% - - - 75%

c. American Indian/Alaska Native 18 years and

over .............................. 1991 46% . . . . . . - - - 60% - - - - - - - - - - - - 53% - - - 75%

Within past two years

d. Mexican American 18 years and over 1991 33% . . . . . . - - - 38% - - - - - - - - - - - - 38% - - - 75%

e. American Indian/Alaska Native 18 years and

over .............................. 1991 38% . . . . . . - - - 50% - - - - - - - - - - - - 42% - - - 75%

f. Asians/Pacific Islander 18 years and over . . . 1991 45% . . . . . . - - - 44% - - - - - - - - - - - - 54% - - - 75%

15.15

Primary care providers who provide

appropriate therapy for high blood

cholesterol ........................... ... --- --- --- --- --- --- --- --- --- --- --- 75%

Median cholesterol level when diet therapy is

initiated (mg/dL) ........................ 1986 240–259 200–219 - - - - - - - - - - - - 200–219 - - - - - - - - - - - - . . .

Median cholesterol level when drug therapy is

initiated (mg/dL) ........................ 1986 300–319 240–259 - - - - - - - - - - - - 240–259 - - - - - - - - - - - - . . .

15.16

Worksite blood pressure/cholesterol

education programs

High blood pressure and/or cholesterol activity . . 1992 35.0% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 50%

High blood pressure activity ................ 1985 16.5% - - - - - -

29% --- --- --- --- --- --- --- ...

Nutrition education activity ................. 1985 16.8% - - - - - - 31% - - - - - - - - - - - - - - - - - - - - - . . .

Blood pressure screening .................. ... --- --- --- 32% --- --- 16% --- --- --- --- ...

15.17 Laboratory accuracy in cholesterol

measurement.......................... 1985 53%

84% --- --- --- --- --- --- --- --- --- 90%

- - - Data not available. Final objective status:

. . . Category not applicable.

Baseline has been revised.

‡

The NHIS was redesigned in 1997. Data may not be comparable with previous years; see Appendix.

1988–94 data.

Estimates are from 1-, 2-, or 3-day dietary data.

For people 2–74 years.

People 20 years and over.

1988–91 data.

Estimate derived from self-reported height and weight.

Data are for people 18–64 years of age.

Operational definition changed from previous tracking data.

Met

Toward

Mixed/ no change

Away

Cannot assess

Healthy People 2000 Final Review 223

In 1992, the deﬁnition of ‘‘current’’ changed to include ‘‘some days’’ (intermittent smoking).

Estimates for different tribes.

Vietnamese males only.

1988 data.

Includes classes, individual counseling, and resource materials.

1987 data.

NOTE: Data may include revisions and, therefore, may differ from data previously published in these reports and other publications.

Objective number Data source

15.1*, 15.1a National Vital Statistics System, CDC, NCHS.

15.2*, 15.2a National Vital Statistics System, CDC, NCHS.

15.3, 15.3a United States Renal Data System, NIH.

15.4*, 15.4a–c National Health and Nutrition Examination Survey, CDC, NCHS.

15.5, 15.5a, b National Health Interview Survey, CDC, NCHS.

15.6* National Health and Nutrition Examination Survey, CDC, NCHS.

15.7* National Health and Nutrition Examination Survey, CDC, NCHS.

15.8 Baseline: Health and Diet Survey, FDA.

Update: Cholesterol Awareness Survey, NIH, NHLBI.

15.9* 1976–80 baselines and 1988–94 data: National Health and Nutrition Examination Survey, CDC, NCHS.

1989–91 baselines and 1994–96 updates: Continuing Survey of Food Intakes by Individuals, USDA.

15.10*, 15.10a, b, f, g National Health and Nutrition Examination Survey, CDC, NCHS.

15.10c, h Data for Hispanic: National Health Interview Survey, CDC, NCHS.

Baseline for Mexican American, Cuban, Puerto Rican: Hispanic Health and Nutrition Examination Survey, CDC, NCHS.

Updates for Mexican American: National Health and Nutrition Examination Survey, CDC, NCHS.

15.10d Baseline: IHS, OPEL.

Updates: National Health Interview Survey, CDC, NCHS.

15.10e National Health Interview Survey, CDC, NCHS.

15.11*, 15.11a National Health Interview Survey, CDC, NCHS.

15.12*, 15.12a, b, d, e, h National Health Interview Survey, CDC, NCHS.

15.12c Baseline, 1992, and 1995 updates: Worldwide Survey of Substance Abuse and Health Behaviors Among Military Personnel, DoD, OASD.

1998 update: DoD Survey of Health Related Behaviors, Research Triangle Institute.

15.12f Baseline: CDC, 1987.

Updates: National Health Interview Survey, CDC, NCHS.

15.12g Baseline: Local surveys.

1990 update: Jenkins CH. Cancer risks and prevention practices among Vietnamese refugees. Western J of Med 153:34–9. 1990.

1991 update: Jenkins CNH, et al. Tobacco use in Vietnam: Prevalence, predictors, and the role of the transnational tobacco corporations. JAMA

227(21):1726-31. 1997; Jenkins CNH, et al. The effectiveness of a media-led intervention to reduce smoking among Vietnamese-American men. AJPH

87(6):1031–4. 1997.

15.12i Baseline and 1991 update: National Health Interview Survey, CDC, NCHS.

1993 update: National Health and Pregnancy Survey, NIH, NIDA.

1995 update: National Survey of Family Growth, CDC, NCHS.

1996–98 updates: National Vital Statistics System, CDC, NCHS.

15.12j 1983 and 1988 data: Behavioral Risk Factor Surveillance System, CDC, NCCDPHP.

1995 update: National Survey of Family Growth, CDC, NCHS.

15.13 National Health Interview Survey, CDC, NCHS.

224 Healthy People 2000 Final Review

Objective number Data source

15.14 Baseline: Health and Diet Survey, FDA.

1991 and 1993 updates: National Health Interview Survey, CDC, NCHS.

1995 update: Cholesterol Awareness Survey, NIH, NHLBI.

15.15 Cholesterol Awareness Physicians Survey, NIH, NHLBI.

15.16 1985 and 1992 data: National Survey of Worksite Health Promotion Activities, OPHS, ODPHP.

1995 data: Business Responds to AIDS Benchmark Survey, CDC, NCHSTP.

15.17 Comprehensive Chemistry Survey of Laboratories Using Enzymatic Methods, College of American Pathologists.

* Duplicate objective. See full text of objective following this table.

Healthy People 2000 Final Review 225

Heart Disease and

Stroke Objectives

15.1*: Reduce coronary heart disease

deaths to no more than 100 per 100,000

people.

Duplicate objectives: 1.1, 2.1, and 3.1

15.1a*: Reduce coronary heart

disease deaths among blacks to no

more than 115 per 100,000 people.

Duplicate objectives: 1.1a, 2.1a, and

3.1a

15.2*: Reduce stroke deaths to no more

than 20 per 100,000 people.

Duplicate objectives: 2.22 and 3.18

15.2a*: Reduce stroke deaths

among blacks to no more than 27

per 100,000.

Duplicate objectives: 2.22a and

3.18a

15.3: Reverse the increase in end-stage

renal disease (requiring maintenance

dialysis or transplantation) to attain an

incidence of no more than 13 per

100,000.

15.3a: Reverse the increase in

end-stage renal disease (requiring

maintenance dialysis or

transplantation) among black

persons to attain an incidence of no

more than 30 per 100,000.

15.4*: Increase to at least 50 percent the

proportion of people with high blood

pressure whose blood pressure is under

control.

Duplicate objective: 2.26

15.4a*: Increase to at least

40 percent the proportion of men

with high blood pressure whose

blood pressure is under control.

Duplicate objective: 2.26a

15.4b*: Increase to at least

50 percent the proportion of

Mexican-Americans with high blood

pressure whose blood pressure is

under control.

Duplicate objective: 2.26b

15.4c*: Increase to at least

50 percent the proportion of women

70 years and older with high blood

pressure whose blood pressure is

under control.

Duplicate objective: 2.26c

15.5: Increase to at least 90 percent the

proportion of people with high blood

pressure who are taking action to help

control their blood pressure.

15.5a: Increase to at least

80 percent the proportion of white

hypertensive men aged 18–34 who

are taking action to help control

their blood pressure.

15.5b: Increase to at least

80 percent the proportion of black

hypertensive men aged 18–34 who

are taking action to help control

their blood pressure.

15.6*: Reduce the mean serum

cholesterol level among adults to no

more than 200 mg/dL.

Duplicate objective: 2.27

15.7*: Reduce the prevalence of blood

cholesterol levels of 240 mg/dL or

greater to no more than 20 percent

among adults.

Duplicate objective: 2.25

15.8: Increase to at least 60 percent the

proportion of adults with high blood

cholesterol who are aware of their

condition and are taking action to

reduce their blood cholesterol to

recommended levels.

15.9*: Reduce dietary fat intake to an

average of 30 percent of calories or less

and average saturated fat intake to less

than 10 percent of calories among

people aged 2 and older. In addition,

increase to at least 50 percent the

proportion of people aged 2 and older

who meet the Dietary Guidelines’

average daily goal of no more than

30 percent of calories from fat, and

increase to at least 50 percent the

proportion of people aged 2 and older

who meet the average daily goal of less

than 10 percent of calories from

saturated fat.

Duplicate objectives: 2.5 and 16.7

15.10*: Reduce overweight to a

prevalence of no more than 20 percent

among people aged 20 and older and no

more than 15 percent among adolescents

aged 12–19.

Duplicate objectives: 1.2, 2.3, and 17.12

15.10a*: Reduce overweight to a

prevalence of no more than

25 percent among low-income

women aged 20 and older.

Duplicate objectives: 1.2a, 2.3a, and

17.12a

15.10b*: Reduce overweight to a

prevalence of no more than

30 percent among black women

aged 20 and older.

Duplicate objectives: 1.2b, 2.3b, and

17.12b

15.10c*: Reduce overweight to a

prevalence of no more than

25 percent among Hispanic women

aged 20 and older.

Duplicate objectives: 1.2c, 2.3c, and

17.12c

15.10d*: Reduce overweight to a

prevalence of no more than

30 percent among American Indians

and Alaska Natives.

Duplicate objectives: 1.2d, 2.3d, and

17.12d

15.10e*: Reduce overweight to a

prevalence of no more than

25 percent among people with

disabilities.

Duplicate objectives: 1.2e, 2.3e, and

17.12e

15.10f*: Reduce overweight to a

prevalence of no more than

41 percent among women with high

blood pressure.

Duplicate objectives: 1.2f, 2.3f, and

17.12f

15.10g*: Reduce overweight to a

prevalence of no more than

35 percent among men with high

blood pressure.

Duplicate objectives: 1.2g, 2.3g, and

17.12g

15.10h*: Reduce overweight to a

prevalence of no more than

25 percent among

Mexican-American men.

Duplicate objectives: 1.2h, 2.3h, and

17.12h

15.11*: Increase to at least 30 percent

the proportion of people aged 6 and

older who engage regularly, preferably

daily, in light-to-moderate physical

activity for at least 30 minutes per day.

Duplicate objectives: 1.3 and 17.13

15.11a*: Increase to at least

25 percent the proportion of

Hispanics aged 18 and older who

engage regularly, preferably daily,

226 Healthy People 2000 Final Review

in light to moderate physical

activity for at least 30 minutes per

day 5 or more times per week.

Duplicate objectives: 1.3a and

17.13a

15.12*: Reduce cigarette smoking to a

prevalence of no more than 15 percent

among people aged 18 and older.

Duplicate objectives: 3.4 and 16.6

15.12a*: Reduce cigarette smoking

to a prevalence of no more than

20 percent among people aged 20

and older with a high school

education or less.

Duplicate objectives: 3.4a and 16.6a

15.12b*: Reduce cigarette smoking

to a prevalence of no more than

20 percent among blue-collar

workers aged 18 and older.

Duplicate objectives: 3.4b and 16.6b

15.12c*: Reduce cigarette smoking

to a prevalence of no more than

20 percent among military

personnel.

Duplicate objectives: 3.4c and 16.6c

15.12d*: Reduce cigarette smoking

to a prevalence of no more than

18 percent among blacks aged 18

and older.

Duplicate objectives: 3.4d and 16.6d

15.12e*: Reduce cigarette smoking

to a prevalence of no more than

15 percent among Hispanics aged

18 and older.

Duplicate objectives: 3.4e and 16.6e

15.12f*: Reduce cigarette smoking

to a prevalence of no more than

20 percent among American Indians

and Alaska Natives.

Duplicate objectives: 3.4f and 16.6f

15.12g*: Reduce cigarette smoking

to a prevalence of no more than

20 percent among Southeast Asian

men.

Duplicate objectives: 3.4g and 16.6g

15.12h*: Reduce cigarette smoking

to a prevalence of no more than

12 percent among women of

reproductive age.

Duplicate objectives: 3.4h and 16.6h

15.12i*: Reduce cigarette smoking

to a prevalence of no more than

10 percent among pregnant women.

Duplicate objectives: 3.4i and 16.6i

15.12j*: Reduce cigarette smoking

to a prevalence of no more than

10 percent among women who use

oral contraceptives.

Duplicate objectives: 3.4j and 16.6j

15.13: Increase to at least 90 percent the

proportion of adults who have had their

blood pressure measured within the

preceding 2 years and can state whether

their blood pressure was normal or high.

15.13a: Increase to at least

90 percent the proportion of

Mexican-American men who have

had their blood pressure measured

within the preceding 2 years and

can state whether their blood

pressure was normal or high.

15.14: Increase to at least 75 percent the

proportion of adults who have had their

blood cholesterol checked within the

preceding 5 years.

15.14a: Increase to at least

75 percent the proportion of blacks

who have ever had their blood

cholesterol checked.

15.14b: Increase to at least

75 percent the proportion of

Mexican-Americans who have ever

had their blood cholesterol checked.

15.14c: Increase to at least

75 percent the proportion of

American Indians/Alaska Natives

who have ever had their blood

cholesterol checked.

15.14d: Increase to at least

75 percent the proportion of

Mexican-Americans who have had

their blood cholesterol checked

within the preceding 2 years.

15.14e: Increase to at least

75 percent the proportion of

American Indians/Alaska Natives

who have had their blood

cholesterol checked within the

preceding 2 years.

15.14f: Increase to at least

75 percent the proportion of

Asian/Paciﬁc Islanders who have

had their blood cholesterol checked

within the preceding 2 years.

15.15: Increase to at least 75 percent the

proportion of primary care providers

who initiate diet and, if necessary, drug

therapy at levels of blood cholesterol

consistent with current management

guidelines for patients with high blood

cholesterol.

15.16: Increase to at least 50 percent the

proportion of worksites with 50 or more

employees that offer high blood pressure

and/or cholesterol education and control

activities to their employees.

15.17: Increase to at least 90 percent the

proportion of clinical laboratories that

meet the recommended accuracy

standard for cholesterol measurement.

*Duplicate objective.

Healthy People 2000 Final Review 227

Priority Area 16

Cancer

Background

Cancer is the second leading cause

of death in the United States, accounting

for nearly one out of every four deaths

(1). An estimated 1,220,000 Americans

are expected to be diagnosed with

cancer in 2000 and approximately

552,000 are expected to die of cancer.

These estimates are based on an

increase in the number of older

Americans who are at higher risk for

developing the disease (2); one-half of

the new cases occur in persons 65 years

and over (3). Although cancer remains a

major health problem in the United

States, there is evidence that the

prospects of preventing and surviving

cancer continue to improve. Specifically,

perhaps as much as 50 percent or more

of cancer incidence can be prevented

through smoking cessation and changed

dietary habits (4). The scientific

evidence for smoking as a cause of

cancer has been recognized for over 40

years. The evidence for diet has

emerged over the past decade and has

progressed to the extent that

recommendations for prudent dietary

changes, such as less fat and more fruits

and vegetables, can now be made.

Data Summary

Highlights

Trends for most objectives related

to cancer mortality (16.1–16.5, and

16.17) improved for the total population

in 1998. For all cancers (16.1) the

mortality rate in 1998 surpassed the year

2000 target. For lung cancer mortality,

objective 16.2 met the target that was

set to slow the rise in the rate; until

1990 the trend for lung cancer mortality

had been rising at a rate that would

have exceeded the target. However, the

rate actually declined in 1991 for the

first time in at least 50 years and again

in 1992. Lung cancer mortality remained

level in 1993, then dropped again in

1994–98. In 1998 the age-adjusted death

rate for colorectal cancer (16.5)

continued to decline and surpassed the

year 2000 target. However, the rate of

improvement in cancer mortality for the

total population was not observed for all

population subgroups. Improvement was

also observed in cancer risk factors such

as smoking (16.6) and dietary fat intake

(16.7). Data for 1998 indicate that

substantial progress was made in

increasing the numbers of women

receiving breast exams and

mammograms in the past two years

(16.11). The proportions of people who

have received other cancer screening

tests such as Pap tests (16.12), fecal

occult blood tests and

proctosigmoidoscopy exams (16.13), and

oral exams (16.14) also increased over

the last decade.

Summary of Progress

Seven objectives (16.1–16.3, 16.5,

16.11, 16.15 and 16.17) met the year

2000 targets. Progress toward the year

2000 targets was made for 8 of the 17

objectives (16.4, 16.6–16.8, 16.10,

16.12, 16.13 and 16.16). It should be

noted that in many cases the actual

improvement is small. Progress for two

objectives (16.9 and 16.14) was mixed.

See table 16 for the tracking data for the

objectives in this priority area and

figure 16 for a quantitative assessment

of progress.

Discussion

Cancer death rates vary by gender,

race, and ethnicity. Age-adjusted male

and female cancer death rates peaked in

1990 at 164.7 and 111.7 per 100,000,

respectively. After the peak year,

through 1998, male cancer deaths for all

sites decreased on average by

1.5 percent per year, and female deaths

decreased on average by 0.8 percent per

year.

While there has been significant

progress in reaching the year 2000

targets, all population groups have not

benefitted equally. African Americans

are about 34 percent more likely to die

of cancer than are whites and more than

two times as likely to die of cancer as

Asian/Pacific Islanders, American

Indians, or Hispanics. However, some

specific forms of cancer affect other

ethnic groups at rates higher than the

national average (for example, stomach

and liver cancers among Asian

American populations and colon and

rectum cancers among Alaska Natives).

Also, certain racial and ethnic groups

have lower survival rates than whites for

most cancers. The challenge to

understanding these differences between

the races provides an opportunity to

reduce illness and death and to improve

survival rates.

The growing knowledge in

behavioral and population research and

cancer control science is allowing the

Nation to better understand and address

the burden of cancer. By studying

patterns of cancer, searching for its

causes, more fully comprehending the

behaviors of individuals and

communities, and understanding the

impact of the public health and medical

systems—the tools to effectively reduce

that burden are being created. In

addition, the increased understanding of

cancer’s disproportionate effect on some

population groups is paving the way for

effective interventions.

Transition to Healthy People

2010

Most of the Healthy People 2000

objectives were retained in Healthy

People 2010, some with new targets that

will further challenge the United States

to achieve even better health. Reducing

the number of new cases and deaths

from cancer remains a challenge for

Healthy People 2010. Further

improvement in the cancer risk

behaviors and cancer screening

utilization are important objectives to

achieve reduced cancer.

Several new objectives were

developed in Healthy People 2010.

Prostate and melanoma cancer deaths

have risen rapidly, so new objectives

were introduced. Also, the importance of

following life-long healthy behaviors is

emphasized by adding a focus on

adolescent cancer risk behaviors to

complement the adult risk behavior

objectives. Improving long-term survival

rates is included as a new objective in

Healthy People 2010. To evaluate this,

improved data will be required from

State cancer registries. Therefore,

increasing the number of these registries

is also a new objective.

Some of the topics covered in the

Healthy People 2000 priority area on

Cancer were reorganized into other

focus area chapters in Healthy People

2010. The rationale for this change was

to eliminate duplication of similar

objectives in separate focus areas.

Several objectives in the Cancer focus

area for Healthy People 2000 were

moved to other chapters, including

228 Healthy People 2000 Final Review

-100 -80 -60 -40 -20

20 40 60 80 100

16.1 Cancer deaths

16.2 Lung cancer deaths

16.3 Female breast cancer deaths

16.4 Cervical cancer deaths

16.5 Colorectal cancer deaths

16.6 Cigarette smoking prevalence: 18 years and over

Male

Female

16.7 Total dietary fat: Average percent of calories

Met goal for fat

Saturated fat: Average percent of calories

Met goal for saturated fat

16.8 Average servings: Vegetables/fruits

Grain products

Met guidelines: Vegetables/fruits

Use sun screen

16.9 Protection from sun, 18 years and older:

Limit sun exposure

Grain products

Wear protective clothes

16.11 Breast exam/mammogram: 50 years and over

16.12 Pap test, 18 years and over: Ever

Past 3 years

16.13 Colon screening, 50 years and older:

Fecal occult blood test (past 2 years)

Sigmoidoscopy (ever)

16.14 Screening in past year, 50 years and over: Oral exam

Skin exam

16.15 Pap test quality: Monitoring labs

Digital rectal exam

16.16 FDA certified mammography facilities

16.17 Oral cancer deaths: Male 45-74 years

Female 45-74 years

Moved away from target Moved toward target Met target

*This objective has met its target. A progress quotient could not be calculated.

NOTES: Complete tracking data are shown in table 16. Progress quotients are not calculated for objective 16.10.

See the section on Measuring Progress Toward the

Healthy People 2000

Targets in the Appendix for more information.

FDA is Food and Drug Administration.

250%

550%

120%

100%

111%

103%

200%

180%

175%

Met*

-13%

-18%

80%

35%

40%

42%

71%

13%

54%

55%

43%

25%

36%

33%

50%

52%

67%

29%

31%

-4%

Percent of target achieved

Healthy People 2000 Final Review 229

Figure 16. Final status of Cancer objectives

Nutrition and Overweight, Oral Health

and Tobacco Use.

Appendix table III, a crosswalk

between Healthy People 2000 and

Healthy People 2010 objectives,

summarizes the differences between the

two decades of objectives, reflecting

new knowledge and direction for this

area.

Data Issues

The death rates shown in objectives

16.1–16.5 are age adjusted to the 1940

U.S. population. (See Appendix for

more information on age adjustment.)

The National Cancer Institute age

adjusts cancer deaths to the 1970 U.S.

population. When the 1970 standard

population is used, the equivalent

baseline, interim, and target rates are all

somewhat higher than those generated

using the 1940 population. However, the

trends are very similar.

Definitions

Beginning in 1992, the definition of

current smoker (16.6) was modified to

specifically include persons who smoked

only ‘‘some days.’’ Prior to 1992, a

current smoker was defined by the

questions ‘‘Have you ever smoked 100

cigarettes in your lifetime?’’ and ‘‘Do

you smoke now?’’ In 1992, cigarette

smoking data were collected for a

half-sample of the National Health

Interview Survey with half the

respondents (one-quarter sample) using

these two smoking questions and the

other half of respondents (one-quarter

sample) using a revised smoking

question: ‘‘Do you smoke everyday,

some days, or not at all?’’ in place of

the second question. The 1992 estimate

combines data collected using both sets

of questions. Updates after 1992 are

based completely on the revised

definition, which is considered a more

complete estimate of smoking

prevalence. The effect of the new

definition is a small increase in the

number of smokers.

Estimates for objective 16.8 (fruit,

vegetable, and grain intakes) exclude

fruits and vegetables eaten as part of

potato chips, condiments, fruit-flavored

candies, jellies, and jams.

Two subobjectives in this chapter,

16.11b (mammograms) and 16.12d (Pap

tests), target women with low income.

Prior to 1993, these subobjectives were

tracked with data for women with

annual family incomes of less than

$10,000. Because of changes in the

poverty level over time, beginning with

data for 1993, these subobjectives were

tracked with data for women with

annual family incomes below the census

poverty threshold (see Appendix for

more information).

Data from the Health Care

Financing Administration indicate that

virtually all laboratories meet the

standards set by the Clinical Laboratory

Improvements Act (16.15). In 1993–96,

only 8 of 3,200 laboratories were cited

with deficiencies and terminated from

medical payments until the deficiencies

were corrected. Therefore, the year 2000

target of 100 for this objective is

considered met.

Data Sources

Data for 1992 for objective 16.10

(tobacco, diet, and cancer screening and

counseling) are from the Primary Care

Provider Surveys (PCPS). The data on

formulation of a diet/nutrition plan

represent the proportion of providers

who routinely queried 81–100 percent of

their patients about these risks. The data

on strategies to quit smoking refer to the

proportion of providers who routinely

provided these services to patients who

needed the services. The sample was

drawn from the membership rolls of

professional organizations for

pediatricians, nurse practitioners, family

physicians, obstetricians/gynecologists,

and internists. Response rates varied

from 50 to 80 percent across these

groups. The data on counseling refer to

the proportion of providers who

routinely provided these services to

patients who needed the services.

The Prevention in Primary Care

Study (PPCS) was conducted in

1997–98 to update data from the PCPS.

The design and items included in the

1997–98 study were similar to the

PCPS, but a slightly different sampling

frame was used and some items

included in the 1992 surveys were not

included in the PPCS. The professionals

were sampled from listings of all

licensed, active practitioners in the

United States whose practices were at

least 50 percent primary care. Because

of low response rates from the other

provider groups, updates are available

only for nurse practitioners.

Data Comparability

For objective 16.16, 1990 baseline

and 1992 update data represent the

proportion of mammography facilities

that were certified by the American

College of Radiology. The 1995–97

updates measure how well the 4,200

facilities performing mammograms met

the Mammogram Quality Standards Act

(MQSA) quality standards. ‘‘No

noncompliances’’ means the facility was

in full compliance with MQSA. Level 1

findings are the most serious and

facilities with level 1 findings receive a

warning letter from the Food and Drug

Administration (FDA) and must respond

to it. Although level 2 and level 3

findings are considered less serious, they

also must be corrected. Information on

the types of violations included in these

levels has been published by FDA (5).

References

1. American Cancer Society. Cancer facts and

figures, 2000. Atlanta, Georgia: American Cancer

Society, Inc. 2000.

2. American Cancer Society. Cancer facts and

figures, 1994. Atlanta, Georgia: American Cancer

Society, Inc. 1994.

3. Reis LAG, Kosary CL, Hankey BF, et al. SEER

Cancer Statistics Review, 1973–1996. Bethesda,

Maryland: National Cancer Institute. 1999.

4. National Cancer Institute, Division of Cancer

Prevention and Control. Fiscal Year 1994 Annual

Report. Rockville, Maryland: National Institutes of

Health. 1994.

5. Center for Devices and Radiological Health.

Mammography matters; vol 2 issue 3. Columbia,

Maryland: Food and Drug Administration. 1995.

230 Healthy People 2000 Final Review

Table 16. Cancer objectives

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

16.1* Cancer deaths (age adjusted per

100,000) ....................... 1987 134 135 135 133 133 132 130 128 126 124 - - - 130

a. Black ....................... 1990 182 . . . 179 178 177 174 172 168 165 161 - - - 175

16.2* Slow the rise in lung cancer deaths

(age adjusted per 100,000) ......... 1987 38.5 39.9 39.6 39.3 39.3 38.7 38.3 37.8 37.3 36.9 - - - 42

a. Female...................... 1990 25.6 . . . 25.8 26.3 26.5 26.6 26.9 26.8 26.9 27.0 - - - 27

b. Black male ................... 1990 86.1 . . . 83.1 81.2 80.7 77.6 75.7 73.4 70.5 68.5 - - - 91

16.3 Female breast cancer deaths (age

adjusted per 100,000) ............. 1987 23.0 23.1 22.7 21.9 21.5 21.3 21.0 20.2 19.4 18.8 - - - 20.6

a. Black female.................. 1990 27.5 . . . 27.7 27.0 27.1 26.9 27.5 26.5 26.7 25.3 - - - 25

16.4 Cervical cancer deaths (age adjusted

per 100,000) .................... 1987 2.8 2.8 2.7 2.7 2.6 2.7 2.5 2.5 2.5 2.3 - - - 1.3

a. Black female.................. 1990 5.9 . . . 5.7 6.1 5.7 5.0 5.2 4.7 4.8 4.4 - - - 3

b. Hispanic female

.............. 1977-83 3.6 3.3 3.0 3.4 3.1 3.5 3.1 3.1 3.0 2.5 - - - 2

16.5* Colorectal cancer deaths (age

adjusted per 100,000) ............. 1987 14.7 13.8 13.5 13.2 13.1 13.0 12.8 12.3 12.1 12.0 - - - 13.2

a. Black ....................... 1990 18.1 . . . 17.5 17.3 17.6 17.3 17.4 16.9 16.9 16.8 - - - 16.5

16.6* Cigarette smoking prevalence

People 18 years and over ........... 1987 29% 25% 26%

27% 25% 26% 25% - - -

‡

25%

‡

24% - - - 15%

Male ......................... 1987 31% 28% 28%

29% 28% 28% 27% - - -

‡

28%

‡

26% - - - 15%

Female ....................... 1987 27% 23% 23%

25% 22% 23% 23% - - -

‡

22%

‡

22% - - - 15%

a. People with high school education

or less 20 years and over ....... 1987 34% 31% 31%

32% 30% 31% 30% - - -

‡

31%

‡

31% - - - 20%

b. Blue-collar workers 18 years and

over........................ 1987 41% 36% 36%

36% 34% 39% 36% - - -

‡

37%

‡

36% - - - 20%

c. Military personnel .............. 1988 42% - - - - - -

35% --- --- 32% --- --- 30% --- 20%

d. Black 18 years and over ......... 1987 33% 26% 29%

28% 26% 27% 26% - - -

‡

27%

‡

25% - - - 18%

e. Hispanic 18 years and over ...... 1987 24% 23% 20%

21% 20% 20% 18% - - -

‡

20%

‡

19% - - - 15%

f. American Indian/Alaska Native

18 years and over ............. 1979-87

42–70% 38% 31%

40% 39% 40% 35% - - -

‡

32%

‡

37% - - - 20%

g. Southeast Asian male ........... 1984-88 55%

35%

36–41% - - - - - - - - - - - - - - - - - - - - - - - - 20%

h. Females of reproductive age

(18–44 years) ................ 1987 29% 26% 27%

28% 26% 27% 26% - - -

‡

26%

‡

25% - - - 12%

i. Pregnant females............... 1985 25% 19% 20% - - - 20% - - - 18% 14% 13% 13% - - - 10%

j. Females who use oral

contraceptives ................ 1983 36%

26% --- --- --- --- 24% --- --- --- --- 10%

16.7* Dietary fat intake among people

2 years and over

National Health and Nutrition

Examination Survey

Average percent of calories from

total fat ...................... 1976-80

3 6 % --- --- --- ---

34% --- --- --- --- --- 30%

See footnotes and key at end of table.

Healthy People 2000 Final Review 231

Table 16. Cancer objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Average percent of calories from

saturated fat .................. 1976-80

13% --- --- --- ---

12% --- --- --- --- --- 10%

Percent who met goal for total fat . . . 1988-94

27% ... ... ... ... ... --- --- --- --- --- 50%

Percent who met goal for saturated

f a t.......................... 1988-94

29% ... ... ... ... ... --- --- --- --- --- 50%

Continuing Survey of Food Intakes by

Individuals

Average percent of calories from

total fat ...................... 1989-91 34% . . . . . . - - - - - - 33% 33% 33% - - - - - - - - - 30%

Average percent of calories from

saturated fat .................. 1989-91 12% . . . . . . - - - - - - 11% 11% 11% - - - - - - - - - 10%

Percent who met goal for fat ....... 1989-91 22% . . . . . . - - - - - - 32% 33% 34% - - - - - - - - - 50%

Percent who met goal for saturated

f a t.......................... 1989-91 21% . . . . . . - - - - - - 34% 35% 36% - - - - - - - - - 50%

16.8* Average daily intake of vegetables,

fruits, and grain products among

people 2 years and over

Average number of servings

Vegetables and fruits ............. 1989-91 4.1 . . . . . . - - - - - - 4.6 4.7 4.7 - - - - - - - - - 5.0

Grain products.................. 1989-91 5.8 . . . . . . - - - - - - 6.7 6.8 6.9 - - - - - - - - - 6.0

Proportion who met Dietary Guidelines

goal

Vegetables and fruits ............. 1989-91 29% . . . . . . - - - - - - 36% 37% 35% - - - - - - - - - 50%

Grain products.................. 1989-91 40% . . . . . . - - - - - - 50% 53% 52% - - - - - - - - - 50%

16.9 Actions to limit sun exposure

Among people 18 years and over those

very likely to:

Limit sun exposure .............. 1992

32% ... ... ... --- --- --- --- --- 27% --- 60%

Use sun screen ................. 1992

29% ... ... ... --- --- --- --- --- 31% --- 60%

Wear protective clothing .......... 1992 28% . . . . . . . . . - - - - - - - - - - - - - - - 24% - - - 60%

Avoid artificial ultraviolet light....... ... --- --- --- --- --- --- --- --- --- --- --- 60%

16.10 Tobacco, diet, and cancer screening

and counseling by clinicians

Smoking patients ................. 1986

52%

9,10

96% --- --- --- --- --- --- --- --- --- 75%

Digital rectal ..................... ... ---

49% --- --- --- --- --- --- --- --- --- 75%

Blood stool ...................... ... ---

56% --- --- --- --- --- --- --- --- --- 75%

Proctoscopic exam ................ ... ---

23% --- --- --- --- --- --- --- --- --- 75%

Breast physical ................... ... ---

78% --- --- --- --- --- --- --- --- --- 75%

Mammogram .................... ... ---

37% --- --- --- --- --- --- --- --- --- 75%

Pap test ........................ ... ---

55% --- --- --- --- --- --- --- --- --- 75%

Percent of clinicians routinely providing

service to 81–100% of patients

See footnotes and key at end of table.

232 Healthy People 2000 Final Review

Table 16. Cancer objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Formulation of diet/nutrition plan

Pediatricians ................... ... --- --- --- 31% --- --- --- --- ---

11,12

--- --- 75%

Nurse practitioners .............. ... --- --- --- 31% --- --- --- --- ---

31% - - - 75%

Obstetricians/gynecologists ........ ... --- --- --- 19% --- --- --- --- ---

11,12

--- --- 75%

Internists ...................... ... --- --- --- 33% --- --- --- --- ---

11,12

--- --- 75%

Family physicians ............... ... --- --- --- 24% --- --- --- --- ---

11,12

--- --- 75%

Discussion of strategies to quit smoking

Pediatricians ................... ... --- --- --- 19% --- --- --- --- ---

11,12

--- --- 75%

Nurse practitioners .............. ... --- --- --- 20% --- --- --- --- ---

39% - - - 75%

Obstetricians/gynecologists ........ ... --- --- --- 28% --- --- --- --- ---

11,12

--- --- 75%

Internists ...................... ... --- --- --- 50% --- --- --- --- ---

11,12

--- --- 75%

Family physicians ............... ... --- --- --- 43% --- --- --- --- ---

11,12

--- --- 75%

16.11 Breast examination and mammogram

Female 50 years and over (preceding

1–2 years) ..................... 1987 25% 49% - - - 51% 55% 56% - - - - - - - - - 64% - - - 60%

a. Hispanic female 50 years and over . 1987 18% 42% - - - 47% 47% 50% - - - - - - - - - 60% - - - 60%

b. Low-income female 50 years and

over (annual family income less

than $10,000)

............... 1987 15% 32% - - - 32% 39% 38% - - - - - - - - - 48% - - - 60%

c. Female 50 years and over with less

than high school education ...... 1987 16% 35% - - - 35% 42% 42% - - - - - - - - - 51% - - - 60%

d. Female 70 years and over ....... 1987 18% 39% - - - 39% 44% 45% - - - - - - - - - 56% - - - 60%

e. Black female 50 years and over . . . 1987 19% 43% - - - 48% 54% 56% - - - - - - - - - 62% - - - 60%

16.12 Pap test

Ever received .................... 1987 88% - - - - - - 93% 95% 94% - - - - - - - - - 93% - - - 95%

a. Hispanic female 18 years and over . 1987 75% - - - - - - 88% 88% 91% - - - - - - - - - 85% - - - 95%

b. Female 70 years and over ....... 1987 76% - - - - - - 86% 91% 90% - - - - - - - - - 88% - - - 95%

c. Female 18 years and over with less

than high school education ...... 1987 79% - - - - - - 87% 91% 91% - - - - - - - - - 86% - - - 95%

d. Low-income female 18 years and

over (annual family income less

than $10,000)

............... 1987 80% - - - - - - 89% 89% 91% - - - - - - - - - 86% - - - 95%

Received within preceding 3 years .... 1987 75% - - - - - - 74% 78% 77% - - - - - - - - - 79% - - - 85%

a. Hispanic female 18 years and over . 1987 66% - - - - - - 74% 77% 74% - - - - - - - - - 75% - - - 80%

b. Female 70 years and over ....... 1987 44% - - - - - - 46% 54% 53% - - - - - - - - - 56% - - - 70%

c. Female 18 years and over with less

than high school education ...... 1987 58% - - - - - - 58% 64% 62% - - - - - - - - - 66% - - - 75%

d. Low-income female 18 years and

over (annual family income less

than $10,000)

............... 1987 64% - - - - - - 65% 71% 72% - - - - - - - - - 70% - - - 80%

See footnotes and key at end of table.

Healthy People 2000 Final Review 233

Table 16. Cancer objective status—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

16.13 Fecal occult blood test and

proctosigmoidoscopy (50 years and

over)

Received fecal occult blood testing

within preceding 2 years ...........

1987 27% - - - - - - 30% - - - - - - - - - - - - - - - 35% - - - 50%

Ever received proctosigmoidoscopy . . . 1987 25% - - - - - - 33% - - - - - - - - - - - - - - - 37% - - - 40%

People 65 years and over with routine

checkup in past 2 years who had a

fecal occult blood test .............

... --- --- 36% --- --- --- --- --- --- --- --- ...

16.14 Oral, skin, and digital rectal

examinations

People 50 years and over (during past

year)..........................

... --- --- --- --- --- --- --- --- --- --- --- 40%

Oral.......................... ... --- --- --- 9% --- --- --- --- --- 13% --- ...

Skin ......................... ... --- --- --- 17% --- --- --- --- --- 16% --- ...

Digital rectal ................... 1987 27% - - - - - - 38% - - - - - - - - - - - - - - - 34% - - - . . .

16.15 Pap test quality

Monitoring cytology laboratory ........ 1988-92

100% . . . . . . . . . - - - - - - - - -

16,17

100% - - - - - - - - - 100%

16.16 Monitoring and certifying

mammography facilities

Certified by FDA .................. 1990 18–21% . . . - - - 64% - - - - - - - - - - - - - - - - - - - - - 100%

Mammogram Quality Standards Act

compliance

No non-compliances . . . - - - - - - - - - - - - - - - - - - 31.9% 48.2% 56.4% - - - - - - . . .

Level 3 findings ................. ... --- --- --- --- --- --- 47.1% 38.6% 28.6% - - - - - - . . .

Level 2 findings ................. ... --- --- --- --- --- --- 18.8% 11.9% 13.9% - - - - - - . . .

Level 1 findings ................. ... --- --- --- --- --- --- 2.2% 1.4% 1.1% - - - - - - . . .

16.17* Oral cancer deaths (per 100,000)

Male 45-74 years ................. 1987 13.6 13.4 12.7 12.2 12.1 11.1 11.0 10.7 10.3 10.4 - - - 10.5

Female 45-74 years ............... 1987 4.8 4.6 4.6 4.3 4.2 4.0 3.9 3.5 3.5 3.4 - - - 4.1

a. Black male 45-74 years ......... 1990 29.4 . . . 26.9 27.3 26.2 25.2 23.4 22.6 20.6 21.0 - - - 26.0

b. Black female 45-74 years ........ 1990 6.9 . . . 6.9 6.0 5.8 5.7 6.4 5.0 5.2 4.6 - - - 6.9

- - - Data not available. Final objective status:

. . . Category not applicable.

Baseline has been revised.

‡

The NHIS was redesigned in 1997. Data may not be comparable with previous years; see Appendix.

Updates for 1990-98 exclude data from States lacking an Hispanic-origin item on their death certificate or for which Hispanic-origin data were not of sufficient quality.

In 1992, the definition of ‘‘current’’ changed to include ‘‘some days’’ (intermittent smoking).

Estimates for different tribes.

Vietnamese males only.

1988 data.

Estimates are from 1-, 2-, or 3-day dietary data.

For people 2-74 years.

1988-94 data.

Data reflect tobacco screening and counseling only.

1989 data.

Met

Toward

Mixed/ no change

Away

Cannot assess

234 Healthy People 2000 Final Review

1997-98 data.

Response rate for this group was too low to produce reliable estimates.

Beginning with 1993, data are for women with family incomes below the Census poverty threshold.

Includes women without a uterine cervix.

15 of 3,200 laboratories closed or limited in cytology testing.

1993-96 data.

8 of 3,200 laboratories terminated from medical payments until differences corrected.

NOTE: Data include revisions and, therefore, may differ from data previously published in these reports and other publications.

Objective number Data source

16.1*, 16.1a National Vital Statistics System, CDC, NCHS.

16.2*, 16.2a, b National Vital Statistics System, CDC, NCHS.

16.3, 16.3a National Vital Statistics System, CDC, NCHS.

16.4, 16.4a National Vital Statistics System, CDC, NCHS.

16.4b Baseline: Surveillance, Epidemiology, and End Results, NIH, NCI.

Updates: National Vital Statistics System, CDC, NCHS.

16.5*, 16.5a National Vital Statistics System, CDC, NCHS.

16.6*,16.6a, b, d, e, h National Health Interview Survey, CDC, NCHS.

16.6c Baseline, 1992, and 1995 updates: Worldwide Survey of Substance Abuse and Health Behaviors Among Military Personnel, DoD, OASD.

1998 update: DoD Survey of Health Related Behaviors, Research Triangle Institute.

16.6f Baseline: CDC.

Updates: National Health Interview Survey, CDC, NCHS.

16.6g Baseline: Local surveys.

1990 update: Jenkins CH. Cancer risks and prevention practices among Vietnamese refugees. Western J of Med 153:34–9. 1990.

1991 update: Jenkins CNH, et al. Tobacco use in Vietnam: Prevalence, predictors, and the role of the transnational tobacco corporations.

JAMA 227(21):1726–31. 1997; Jenkins CNH, et al. The effectiveness of a media-led intervention to reduce smoking among Vietnamese-American men.

AJPH 87(6):1031–4. 1997.

16.6i Baseline and 1991 update: National Health Interview Survey, CDC, NCHS.

1993 update: National Health and Pregnancy Survey, NIH, NIDA.

1995 update: National Survey of Family Growth, CDC, NCHS.

1996–98 updates: National Vital Statistics System, CDC, NCHS.

16.6j 1983 baseline and 1988 update: Behavioral Risk Factor Surveillance System, CDC, NCCDPHP.

1995 update: National Survey of Family Growth, CDC, NCHS.

16.7* 1976–80 and 1988–94 data: National Health and Nutrition Examination Survey, CDC, NCHS.

1989–91 baselines and 1994–96 updates: Continuing Survey of Food Intakes by Individuals, USDA.

16.8* Continuing Survey of Food Intakes by Individuals, USDA.

16.9 National Health Interview Survey, CDC, NCHS.

16.10 1986 baseline: Physician Practice Study, University of Chicago.

1989 updates: Survey of Physician’s Attitudes and Practices in Early Cancer Detection, NIH, NCI.

1992 data: Primary Care Provider Surveys, OPHS, ODPHP.

1997–98 data: Prevention in Primary Care Study, American College of Preventive Medicine.

16.11, 16.11a-d National Health Interview Survey, CDC, NCHS.

16.12, 16.12a-d National Health Interview Survey, CDC, NCHS.

16.13 National Health Interview Survey, CDC, NCHS.

16.14 National Health Interview Survey, CDC, NCHS.

16.15 Clinical Laboratory Improvements Act, HCFA.

16.16 Baseline and 1992 update: American College of Radiology. 1995–97 data: Mammography Quality Assurance Program, FDA.

16.17*, 16.17a,b National Vital Statistics System, CDC, NCHS.

* Duplicate objective.

Healthy People 2000 Final Review 235

Cancer Objectives

16.1*: Reverse the rise in cancer deaths

to achieve a rate of no more than 130

per 100,000 people.

Duplicate objective: 2.2

16.1a*: Reverse the rise in cancer

deaths among blacks to achieve a

rate of no more than 175 per

100,000 people.

Duplicate objective: 2.2a

16.2*: Slow the rise in lung cancer

deaths to achieve a rate of no more than

42 per 100,000 people.

Duplicate objective: 3.2

16.2a*: Slow the rise in lung cancer

deaths among females to no more

than 27 per 100,000.

Duplicate objective: 3.2a

16.2b*: Slow the rise in lung cancer

deaths among black males to no

more than 91 per 100,000.

Duplicate objective: 3.2b

16.3: Reduce breast cancer deaths to no

more than 20.6 per 100,000 women.

16.3a: Reduce breast cancer deaths

among black females to no more

than 25 per 100,000 women.

16.4: Reduce deaths from cancer of the

uterine cervix to no more than 1.3 per

100,000 women.

16.4a: Reduce deaths from cancer

of the uterine cervix among black

females to no more than 3 per

100,000 women.

16.4b: Reduce deaths from cancer

of the uterine cervix among

Hispanic females to no more than 2

per 100,000 women.

16.5*: Reduce colorectal cancer deaths

to no more than 13.2 per 100,000

people.

Duplicate objective: 2.23

16.5a*: Reduce colorectal cancer

deaths among blacks to no more

than 16.5 per 100,000 people.

Duplicate objective: 2.23a

16.6*: Reduce cigarette smoking to a

prevalence of no more than 15 percent

among people aged 18 and older.

Duplicate objectives: 3.4 and 15.12

16.6a*: Reduce cigarette smoking

to a prevalence of no more than

20 percent among people aged 20

and older with a high school

education or less.

Duplicate objectives: 3.4a and

15.12a

16.6b*: Reduce cigarette smoking

to a prevalence of no more than

20 percent among blue-collar

workers aged 18 and older.

Duplicate objectives: 3.4b and

15.12b

16.6c*: Reduce cigarette smoking to

a prevalence of no more than

20 percent among military

personnel.

Duplicate objectives: 3.4c and

15.12c

16.6d*: Reduce cigarette smoking

to a prevalence of no more than

18 percent among blacks aged 18

and older.

Duplicate objectives: 3.4d and

15.12d

16.6e*: Reduce cigarette smoking to

a prevalence of no more than

15 percent among Hispanics aged

18 and older.

Duplicate objectives: 3.4e and

15.12e

16.6f*: Reduce cigarette smoking to

a prevalence of no more than

20 percent among American Indians

and Alaska Natives.

Duplicate objectives: 3.4f and

15.12f

16.6g*: Reduce cigarette smoking

to a prevalence of no more than

20 percent among Southeast Asian

men.

Duplicate objectives: 3.4g and

15.12g

16.6h*: Reduce cigarette smoking

to a prevalence of no more than

12 percent among women of

reproductive age.

Duplicate objectives: 3.4h and

15.12h

16.6i*: Reduce cigarette smoking to

a prevalence of no more than

10 percent among pregnant women.

Duplicate objectives: 3.4i and

15.12i

16.6j*: Reduce cigarette smoking to

a prevalence of no more than

10 percent among women who use

oral contraceptives.

Duplicate objectives: 3.4j and

15.12j

16.7*: Reduce dietary fat intake to an

average of 30 percent of calories or less

and average saturated fat intake to less

than 10 percent of calories among

people aged 2 and older. In addition,

increase to at least 50 percent the

proportion of people aged 2 and older

who meet the Dietary Guidelines’

average daily goal of no more than

30 percent of calories from fat, and

increase to at least 50 percent the

proportion of people aged 2 and older

who meet the average daily goal of less

than 10 percent of calories from

saturated fat.

Duplicate objectives: 2.5 and 15.9

16.8*: Increase complex carbohydrate

and ﬁber-containing foods in the diets of

adults to ﬁve or more daily servings for

vegetables (including legumes) and

fruits, and to six or more daily servings

for grain products. In addition, increase

to at least 50 percent the proportion of

people aged 2 and older who meet the

Dietary Guidelines’ average daily goal

of 5 or more servings of

vegetables/fruits, and increase to at least

50 percent the proportion who meet the

goal of 6 or more servings of grain

products.

Duplicate objective: 2.6

16.9: Increase to at least 60 percent the

proportion of people of all ages who

limit sun exposure, use sunscreens and

protective clothing when exposed to

sunlight, and avoid artiﬁcial sources of

ultraviolet light (e.g., sun lamps, tanning

booths).

16.10: Increase to at least 75 percent the

proportion of primary care providers

who routinely counsel patients about

tobacco-use cessation, diet modiﬁcation,

and cancer screening

recommendations,which includes

providing information on the potential

beneﬁt or harm attributed to the various

screening modalities and discussion of

risk factors associated with breast,

prostate, cervical, colorectal, and lung

cancers.

16.11: Increase to at least 60 percent

those women aged 50 and older who

have received a clinical breast

236 Healthy People 2000 Final Review

examination and a mammogram within

the preceding 1 to 2 years.

16.11a: Increase to at least

60 percent Hispanic women aged 50

and older who have received a

clinical breast examination and a

mammogram within the preceding 2

years.

16.11b: Increase to at least

60 percent low-income women aged

50 and older who have received a

clinical breast examination and a

mammogram within the preceding 2

years.

16.11c: Increase to at least

60 percent women aged 50 and

older with less than high school

education who have received a

clinical breast examination and a

mammogram within the preceding 2

years.

16.11d: Increase to at least

60 percent women aged 70 and

older who have received a clinical

breast examination and a

mammogram within the preceding 2

years.

16.11e: Increase to at least

60 percent black women aged 50

and older who have received a

clinical breast examination and a

mammogram within the preceding 2

years.

16.12: Increase to at least 95 percent the

proportion of women aged 18 and older

who have ever received a Pap test, and

to at least 85 percent those who received

a Pap test within the preceding 1 to 3

years.

16.12a: Increase to at least

95 percent the proportion of

Hispanic women aged 18 and older

who have ever received a Pap test,

and to at least 80 percent those who

received a Pap test within the

preceding 3 years.

16.12b: Increase to at least

95 percent the proportion of women

aged 70 and older who have ever

received a Pap test, and to at least

70 percent those who received a

Pap test within the preceding 3

years.

16.12c: Increase to at least

95 percent the proportion of women

aged 18 and older with less than a

high school education who have

ever received a Pap test, and to at

least 75 percent those who received

a Pap test within the preceding 3

years.

16.12d: Increase to at least

95 percent the proportion of

low-income women (annual family

income less than $10,000) aged 18

and older who have ever received a

Pap test, and to at least 80 percent

those who received a Pap test

within the preceding 3 years.

16.13: Increase to at least 50 percent the

proportion of people aged 50 and older

who have received fecal occult blood

testing within the preceding 1 to 2

years, and to at least 40 percent those

who have ever received

proctosigmoidoscopy.

16.14: Increase to at least 40 percent the

proportion of people aged 50 and older

visiting a primary care provider in the

preceding year who have received oral,

skin, and digital rectal examinations

during one such visit.

16.15: Ensure that Pap tests meet quality

standards by monitoring and certifying

all cytology laboratories.

16.16: Ensure that mammograms meet

quality standards by inspecting and

certifying 100 percent of mammography

facilities according to the requirements

of the Mammography Quality Standards

Act.

16.17*: Reduce deaths due to cancer of

the oral cavity and pharynx to no more

than 10.5 per 100,000 men aged 45–74

and 4.1 per 100,000 women aged

45–74.

Duplicate objectives: 3.17 and 13.7

16.17a*: Reduce deaths due to

cancer of the oral cavity and

pharynx to no more than 26.0 per

100,000 among black males aged

45–74.

Duplicate objectives: 3.17a and

13.7a

16.17b*: Reduce deaths due to

cancer of the oral cavity and

pharynx to no more than 6.9 per

100,000 among black females aged

45–74.

Duplicate objectives: 3.17b and

13.7b

*Duplicate objective.

Healthy People 2000 Final Review 237

Priority Area 17

Diabetes and

Chronic Disabling

Conditions

Background

Diabetes and chronic disabling

conditions continue to pose a significant

challenge to the public health of the

Nation. As the population of the United

States ages, more people are expected to

be affected by these conditions. These

conditions can impinge on quality of life

and lead to physical, emotional, social,

and economic costs, not only for

individuals, but also for their families

and the Nation. Chronic disabling

conditions that significantly affect the

quality of life encompass diabetes,

chronic kidney disease, arthritis,

deformities or orthopedic impairments,

and mental retardation. Other conditions

include asthma, hearing and visual

impairments, overweight, and peptic

ulcer disease. (1–4).

Some 800,000 new cases of

diabetes are diagnosed each year, or

2,200 each day (5,6). The prevalence of

diabetes, as well as diabetes-related

complications, is increasing in the

United States (5–7). End stage renal

disease (ESRD) among persons with

diabetes has almost tripled in the past

decade (8). The number of persons with

diabetes increased steadily during the

1990’s; 1988–94 data showed that 10.5

million persons had been diagnosed with

diabetes, while 5.5 million persons

estimated to have the disease were

undiagnosed (1). Furthermore, because

diabetes is most common among

persons over 60 years of age (9), the

number of persons with diabetes is

expected to rise as the population ages.

Diabetes remains the seventh leading

cause of death (10).

An estimated 54 million persons in

the United States, or nearly 20 percent

of the population, are living with some

level of disability (11). The direct

medical and indirect annual costs

associated with disability are more than

$300 million, or 4 percent of the gross

national product (12).

Asthma is a serious and growing

health problem. An estimated 14.9

million persons in the United States

have asthma (13). The number of people

with asthma increased by 102 percent

between the years 1979–80 and 1993–94

(14). Asthma is responsible for about

500,000 hospitalizations (13), 5,000

deaths (13), and 134 million days of

restricted activity a year (14). Yet most

of the problems caused by asthma could

be averted if persons with asthma and

their health care providers managed the

disease according to established

guidelines. Effective management of

asthma comprises four major

components: controlling exposure to

factors that trigger asthma episodes,

adequately managing asthma with

medicine, monitoring the disease by

using objective measures of lung

function, and educating asthma patients

to become partners in their own care

(15,16). Such prevention efforts are

essential to interrupt the progression

from disease to functional limitation and

disability and to improve the quality of

life for persons with asthma.

The various forms of arthritis—the

leading cause of disability in the United

States (17)—affect more than 15 percent

of the total U.S. population (43 million

persons) and more than 20 percent of

the adult population (18–21). Other

musculoskeletal conditions can also lead

to disability. About 13–18 percent of

women 50 years of age and over and

3–6 percent of men 50 years of age and

over have osteoporosis (22), a reduction

in bone mass or density that leads to

deterioration or fragile bones, whose

major health consequence is an

increased risk of fractures. Chronic back

conditions are also common and can be

debilitating. In the United States, back

pain is the most frequent cause of

activity limitation in people under 45

years of age (23,24), the second most

frequent reason for physician visits, the

fifth ranking reason for hospitalization,

and the third most common reason for

surgical procedures (25).

Data Summary

Highlights

By the end of the 20th century,

notable strides had been made in

improving the lives of people with

diabetes and chronic disabling

conditions. The average number of years

of healthy life for the total population

(17.1) increased from a baseline of 64

years in 1990 to 65.2 years in 1998,

exceeding the Healthy People 2000

target. Among special populations

targeted by the objective, Hispanics

have met the year 2000 target, while

progress was made for blacks and older

adults. Assuming full compliance with

the Americans with Disabilities Act of

1990, that prohibits employers from

discriminating against disabled

individuals, all worksites had policies or

programs for hiring people with

disabilities (17.19).

Several other measures of chronic

disability improved over the decade. The

rates of both significant hearing

impairments (17.6) and significant visual

impairments (17.7) decreased.

Participation in moderate (17.13)

physical activity five or more times per

week increased over the decade, meeting

the year 2000 target of 30 percent,

whereas the proportion of adults

participating in physical activity seven

or more times per week moved toward,

but did not meet the 30–percent target.

The proportion of perimenopausal

women receiving counseling about

estrogen replacement therapy (17.18)

increased from 80 percent in 1994 to

89 percent in 1998. A greater proportion

of people with diabetes had dilated eye

exams (17.23) in 1998 than in 1989, an

8-percent increase.

In other areas, however, measures

moved away from the year 2000 targets.

The rate of activity limitation due to

chronic back conditions (17.5) increased

from 21.9 per 1,000 persons in 1986–88

to 27.9 per 1,000 persons in 1994–96.

Both the incidence and prevalence of

diabetes (17.11) increased as did the rate

of diabetes-related deaths (17.9). The

prevalence of peptic ulcer (17.21)

increased from the 1991 baseline of

20 percent to 28 percent in 1998.

Summary of Progress

Data are available to assess the

progress of 22 of the 23 objectives that

address diabetes and chronic disabling

conditions. Two objectives (17.1 and

17.19) met their year 2000 targets. Six

objectives (17.6, 17.7, 17.13, 17.18,

17.22, and 17.23) moved toward the

year 2000 targets. Eleven objectives

(17.2–17.5, 17.8, 17.9, 17.11, 17.12,

17.15, 17.16, and 17.21) moved away

from their targets. See table 17 for the

tracking data for the objectives in this

priority area and figure 17 for a

quantitative assessment of progress.

For three objectives (17.10, 17.14,

and 17.17), progress among the multiple

measures used for tracking was mixed.

Progress could not be assessed for one

238 Healthy People 2000 Final Review

-100 -80 -60 -40 -20

20 40 60 80 100

17.1 Years of healthy life

17.2 Limitation in major activity

17.3 Difficulty with self-care: 70 years and over

17.4 People with asthma with activity limitation

17.5 Activity limitation due to chronic back conditions

17.6 Significant hearing impairment

17.7 Significant visual impairment

17.8 Serious mental retardation: Children 10 years, IQ <50

17.9 Diabetes-related deaths

17.10 Diabetes related complications: End-stage

renal disease

Blindness

Lower extremity amputation

17.11 Diabetes: Incidence

Male

17.12 Overweight prevalence: 20-74 years

Prevalence

Female

Adolescents 12-19 years

17.13 Light-to-moderate physical activity:

5 or more times per week

7 or more times per week

17.14 Patient education: People with diabetes

People with asthma

17.16 Early detection hearing impairment in children

17.18 Perimenopausal females counseled about estrogen

replacement therapy: Female 40-60 years

Female 50-60 years

Female 40-49 years

17.19 Worksites with policies for hiring people

with disabilities

17.21 Prevalence of peptic ulcer

17.23 People with diabetes who had a dilated eye

exam in the past year

Moved away from target Moved toward target Met target

* This objective has moved away from its target. A progress quotient could not be calculated.

NOTE: Complete tracking data are shown in table 17. Progress quotients are not calculated for objective 17.15, 17.17, 17.20, and 17.22.

See the section on Measuring Progress Toward the

Healthy People 2000

Targets in the Appendix for more information.

120%

100%

166%

-50%

-75%

-45%

-43%

-2%

-43%

23%

29%

79%

90%

19%

55%

No change

Away*

-13%

-2%

-411%

-143%

-250%

-150%

-367%

-207%

-1,800%

Percent of target achieved

Healthy People 2000 Final Review 239

Figure 17. Final status of Diabetes and Chronic Disabling Conditions objectives

objective (17.20) because it lacked

baseline data.

Discussion

Several factors account for what is

considered to be a diabetes epidemic,

including the following: behavioral

elements (improper nutrition, for

example, increased fat consumption;

decreased physical activity; obesity);

demographic changes (aging, increased

growth of at-risk populations); improved

ascertainment and surveillance systems

that more completely capture the actual

burden of diabetes; and the relative

weakness of interventions to change

individual, community, or organizational

behaviors (5,7,26,27). Several other

interrelated factors influence the impact

of diabetes, including genetics, cultural

and community traditions, and

socioeconomic status. In addition,

unanticipated scientific breakthroughs,

the characteristics of the health care

system, and the level of patient

knowledge and empowerment all have a

great impact on the disease burden

associated with diabetes.

Increased insulin resistance and

gradual deterioration in the function of

insulin-producing cells may explain the

high prevalence of diabetes among older

people. The rise in diabetes among

teenagers may be due to obesity,

improper nutrition, and lack of physical

activity, the latter of which has been

linked to increased television viewing

(1).

Particularly within certain racial and

ethnic groups, four potential individual

reasons account for a greater burden of

diabetes:

Increased number of cases of

diabetes, which is expected to lead to

more amputations, death, and other

complications.

Increased seriousness of diabetes,

for example, the presence of

hyperglycemia or other serious

comorbid conditions, such as high blood

pressure or elevated blood lipids.

Inadequate access to proper diabetes

prevention and control programs.

Unfortunately, many diabetes at-risk

groups reside in medically underserved

areas or are without adequate insurance

and thus do not receive these types of

preventive services.

Improper quality of care, which can

result in ineffective diabetes prevention

programs.

Identifying the reasons for

disparities in diabetes health outcomes is

important in tailoring programs to those

specific areas where deficiencies exist.

Collection of racial and ethnic health

services data for all health activities is

critical to designate the reason for the

greater disease burden.

Scientific research has led to greater

asthma control than was available in the

early 1980s (6). Effective management

of asthma includes four components:

avoiding or controlling the factors that

may make asthma worse (for example,

environmental and occupational

allergens and irritants), taking

appropriate medications tailored to the

severity of the disease, objective

monitoring of the disease by the patient

and the health care professional, and

actively involving the patient in

managing the disease (16). Effective

asthma management reduces the need

for hospitalizations and urgent care

visits (in either an emergency

department or physician’s office) and

enables patients to enjoy normal

activities (28,29).

Advances in human genetics related

to asthma are expected to provide better

information about the contribution of

genetic variation to the development of

disease when people are exposed to

certain environmental factors and

variation in individual response to

therapy. The use of this genetic

information will improve targeted

disease prevention and health

management strategies for respiratory

diseases.

Genetic research may soon identify

persons at high risk for certain types of

arthritis and thereby offer a better target

for interventions. Current medical care

offers considerable relief from pain and

other symptoms for all types of arthritis.

Available interventions often are not

used, however, because of the popular

belief that arthritis is part of normal

aging, which a person can do nothing

about, and that arthritis affects only

older persons. However, early diagnosis

and aggressive treatment of rheumatoid

arthritis with disease-modifying drugs,

for example, appear to reduce its

symptoms and related disability (30–35).

Educational and behavioral

interventions also can relieve symptoms

and reduce disability. Telephone contacts

with clinicians and several land-based

and water-based exercise programs have

had beneficial outcomes (36–39). The

Arthritis Self-Help Course, a 6-week,

2-hour per week educational

intervention, has been shown to reduce

pain up to 20 percent beyond outcomes

achieved through conventional medical

care (40). The course has the additional

benefit of reducing medical care costs

by reducing the number of physician

visits for arthritis (40,41). These and

other effective interventions currently

are underused, with some interventions

reaching less than 1 percent of target

populations (42). Countering myths

about arthritis and applying available

interventions can help reduce the impact

of this health problem (1).

A wide range of interventions

prevent or reduce lower back problems.

These interventions may include

activities designed to reduce the

physical demands of work activities by

redesigning the task or to address the

individual’s specific needs, such as

strength or endurance training or

counseling for nutrition and lifestyle

changes. Ergonomic interventions that

are directed at changing the job or work

environment have proved effective in

reducing risk of occupational low back

pain (1). Thus, it is reasonable to

assume that ergonomic approaches

would be effective in preventing chronic

lower back pain (LBP) as well. Even in

a nonwork environment, using

ergonomic principles can reduce the

physical demands of an activity.

Interventions involving training in

proper lifting techniques, physical

conditioning, and weight loss have been

investigated in programmatically

oriented studies. These have shown that

workplace interventions may have an

effect on low back disorders (43). The

overall benefits of exercise, nutrition,

and lifestyle changes on an individual’s

health and well-being would certainly

justify efforts in this area. Also,

interventions directed at improving

strength and endurance may have an

important impact on reducing activity

limitations due to chronic LBP.

Transition to Healthy People

2010

Several topics covered in the

Healthy People 2000 priority area on

Diabetes and Chronic Disabling

Conditions were reorganized into

separate focus area chapters in Healthy

People 2010. Providing for greater

emphasis on individual conditions,

Healthy People 2010 contains several

240 Healthy People 2000 Final Review

new chapters—including Arthritis,

Osteoporosis, and Chronic Back

Conditions; Chronic Kidney Disease;

Diabetes; Respiratory Diseases;

Disability and Secondary Conditions;

and Vision and Hearing.

In Healthy People 2010, Chronic

Kidney Disease has a revised measure

to track end-stage renal disease (ESRD)

incidence. The Healthy People 2010

focus area has also added measures that

address cardiovascular disease deaths

among persons with ESRD, counseling

for persons with chronic kidney failure,

kidney transplantation waiting lists,

kidney failure due to diabetes, and

medical therapy for persons with

diabetes and proteinuria.

Diabetes has expanded its area to

track the proportion of persons with

diabetes that have been diagnosed with

the disease, diabetes death rates among

persons with diabetes, cardiovascular

disease deaths among persons with

diabetes, gestational diabetes, and foot

ulcers. In addition to the receipt of

annual dilated eye exams among persons

with diabetes, there are several measures

in Healthy People 2010 that address

secondary and tertiary prevention of

complications associated with diabetes

including annual urinary microalbumin

measurements, annual glycosylated

hemoglobin measurements, annual foot

examinations, annual dental

examinations, aspirin therapy, as well as

self-blood-glucose-monitoring.

As a section in the Respiratory

Diseases focus area, asthma patient

education continues to be measured in

Healthy People 2010, with other

measures continued from Healthy

People 2000, such as asthma

hospitalizations and activity limitation

due to asthma. Asthma has several new

measures in Healthy People 2010, which

include asthma deaths, emergency

department visits for asthma, school or

work days missed by persons with

asthma due to asthma, appropriate

asthma care, and surveillance systems

for the collection of asthma-related data.

In Healthy People 2010, both the

Vision and Hearing focus area and

Disability and Secondary Conditions

focus area expand on the objectives

included in Healthy People 2000. The

disability focus area deals with

promoting health and preventing disease

among persons with disabilities, rather

than preventing disabling conditions.

The Vision and Hearing focus area

covers screening, visual impairments

and hearing loss and the appropriate

treatments, as well as protective devices

to keep hearing and vision intact.

Appendix table III, a crosswalk

between Healthy People 2000 and

Healthy People 2010 objectives,

summarizes the differences between the

two decades of objectives, reflecting

new knowledge and directions in these

areas.

Data Issues

Years of Healthy Life

Years of healthy life is a summary

measure of health that combines

mortality (quantity of life) and

morbidity and disability (quality of life)

into a single measure. The concept of

increasing the span of healthy life is one

of the three Healthy People 2000 goals

and a specific measure has been

developed to track this objective in three

priority areas (8.1, 17.1, and 21.1). The

data used to track the objective come

from the National Vital Statistics System

(mortality) and the National Health

Interview Survey (NHIS) (morbidity).

The NHIS was redesigned in 1997 and,

therefore, data for 1997–98 may not be

comparable with those from previous

years. See the Appendix for a discussion

of the changes to the NHIS. The

methodology for the Healthy People

2000 years of healthy life measure,

developed by NCHS and outside

consultants, is published in Healthy

People Statistical Notes series (44).

Definitions

Subobjective 17.2a (limitation in

major activity due to chronic conditions)

targets people with low income.

Originally, this subobjective was tracked

with data for people with annual family

incomes of less than $10,000. Because

of changes in the poverty level over

time, data are also shown for people

with family incomes below Census

poverty threshold (see Appendix).

The 1984–85 baseline figures for

objective 17.3 were derived by

combining estimates for the

noninstitutionalized population from the

1984 NHIS Supplement on Aging

(SOA) with data for those in nursing

homes from the 1985 National Nursing

Home Survey (NNHS). The 1984 SOA

asked about seven specific personal care

activities, also referred to as activities of

daily living (ADLs) for persons 65 years

of age and over. Because of the way the

questions were asked on the NNHS,

only five ADLs (bathing, dressing, using

the toilet, getting in and out of bed or

chair, and eating) were used for tracking

this objective. The numerator included

respondents to the SOA who said they

had ‘‘any difficulty’’ performing at least

two ADLs combined with patients for

whom administrators reported to the

NNHS as ‘‘receiving assistance’’ with at

least two ADLs. The denominator for

the baseline was the civilian,

noninstitutionalized population 65 years

of age and over plus the nursing home

population 65 years of age and over.

The update for this objective is derived

from combined data from the 1994

NHIS Second Supplement on Aging

(SOA II) and data from the 1995 NNHS

using the same questions as were used

for the baseline. However, because of

the way data were collected in the SOA

II, the 1994–95 update is for persons 70

years of age and over. The 1984–85 data

were also computed for ages 70 years of

age and over to provide a comparison

with the 1994–95 update. For objective

17.4, activity limitation refers to any

self-reported limitation in activity

attributed to asthma.

The 1990 baseline data for

diabetes-related deaths for Puerto Ricans

(17.9d) have been revised. The original

baseline published in the Midcourse

Review and 1995 Revisions (45)

included data for 45 States and the

District of Columbia. It did not include

data for New York where more than

one-half of the U.S. Puerto Rican

population resides. The revised baseline,

which includes data for 47 States and

the District of Columbia (including New

York), is considerably lower than

originally published and, in fact, has

met the year 2000 target for this

subobjective. The number of States

reporting Hispanic origin data on their

birth and death certificates has varied

from year to year; see Appendix for

more information.

Overweight (17.12) for adults is

defined as a body mass index (BMI) of

27.8 kilograms per meter squared for

males, and 27.3 kilograms per meter

squared for females. For adolescents,

overweight is the sex- and age-specific

85th percentile from NHANES II

(46,47). See the Nutrition chapter

(Priority Area 2) for additional

information.

Objective 17.22 addresses the

development and implementation of a

Healthy People 2000 Final Review 241

national process to identify signiﬁcant

gaps in the Nation’s disease prevention

and health promotion data. Progress was

made, although it is difficult to quantify.

See objective 22.4 in the Data and

Surveillance chapter (Priority Area 22)

for additional information.

Data Sources

Data for objective 17.6 (signiﬁcant

hearing impairment) are from the NHIS,

and are based on self-reported hearing

impairment (that is, deafness in one or

both ears or any trouble hearing in one

or both ears). These data are a proxy

measure for signiﬁcant hearing

impairment. Hearing impairment covers

the range of hearing deﬁcits from mild

loss in one ear to profound loss in both

ears. Generally, inability to hear sounds

at levels softer (less intense) than 20

decibels (dB) constitutes abnormal

hearing. Signiﬁcant hearing impairment

is deﬁned as having hearing thresholds

for speech poorer than 25 dB.

Signiﬁcant visual impairment (17.7)

is also measured using the NHIS.

Signiﬁcant visual impairment is

generally deﬁned as a permanent

reduction in visual acuity and/or ﬁeld of

vision that is not correctable with

eyeglasses or contact lenses. Severe

visual impairment is deﬁned as inability

to read ordinary newsprint even with

corrective lenses. For this objective,

self-reported blindness in one or both

eyes and other self-reported visual

impairments (that is, any trouble seeing

with one or both eyes even when

wearing glasses or color blindness) from

the NHIS is used as a proxy measure

for signiﬁcant visual impairment.

Diabetes-related mortality data

(17.9) are derived from the

multiple-cause-of-death ﬁles. Data

include all mentions of diabetes on the

death certiﬁcate, whether as an

underlying or contributing cause of

death. Diabetes is approximately three

times as likely to be listed as a

contributing cause of death than as the

underlying cause.

Data on lower extremity amputation

for objective 17.10–17.10c come from

the National Hospital Discharge Survey

(NHDS) maintained by the National

Center for Health Statistics (NCHS),

Centers for Disease Control and

Prevention (CDC). Data for the survey

are obtained from approximately 480

hospitals throughout the United States.

Data on race are not reported by many

hospitals due to omission of a race ﬁeld

on hospital discharge reporting forms.

Automation of the hospital discharge

systems has led to an increase in the use

of these forms (UB–82 and UB–92) in

recent years. A comparison of NHDS

data with those who reported being

hospitalized in the NHIS (NHIS data

were adjusted to exclude hospitalizations

of 1 day or less) indicated that

underreporting for whites is roughly

22 percent in 1991; the difference in

reporting for blacks was negligible (48).

Data for diabetes prevalence (17.11

and 17.11e) were tracked using the

NHIS. Due to the NHIS redesign that

was implemented in 1997, data collected

in 1996 and earlier are not comparable

with data from the redesigned NHIS,

starting with 1997 (see Appendix).

American Indian/Alaska Native data for

1996 for objective 17.11a are from the

Indian Health Service (IHS) Patient

Comprehensive Care ﬁle. The ﬁle

excludes data from 25 of the 166 IHS

service units (representing 11 percent of

the population served by IHS) because

data were incomplete.

Baseline data for objectives 17.15

and 17.17 (clinical assessment of

childhood development and cognitive

assessment of older adults) are from the

Primary Care Provider Surveys (PCPS).

The data on testing/evaluation-inquiry

represent the proportion of providers

who routinely queried 81–100 percent of

their patients about speciﬁc functioning.

The data on treatment/referral refer to

the proportion of providers who

routinely provided these services to

patients who needed the services. The

sample was drawn from the membership

rolls of professional organizations for

pediatricians, nurse practitioners, family

physicians, obstetricians/gynecologists,

and internists. Response rates varied

from 50 to 80 percent across these

groups. The Prevention in Primary Care

Study (PPCS) was conducted in

1997–98 to update data from the PCPS.

The design and items included in the

1997–98 study were similar to the

PCPS, but a slightly different sampling

frame was used and some items

included in the 1992 surveys were not

included in the PPCS. The professionals

were sampled from listings of all

licensed, active practitioners in the

United States whose practices were at

least 50 percent primary care. Because

of low response rates from the other

provider groups, updates are available

only for nurse practitioners.

Data Comparability

The baseline data for 17.8 (mental

retardation) were revised to be

comparable with data from the

Metropolitan Atlanta Developmental

Disabilities Surveillance Program, which

uses school counts of children classiﬁed

as mentally retarded.

Overweight (17.12) was tracked

with two data sources. The primary data

source is the NHANES, which provided

baseline data for most of the overweight

objectives and the 1988–94 updates;

these data are derived from measured

height and weight. The second data

source is the NHIS. This survey

provides interim estimates shown in an

earlier publication (49), updates for

Hispanic females and American

Indians/Alaska Natives, and all data for

people with disabilities. NHIS estimates

are based on self-reported heights and

weights and are not comparable with the

actual measured data from NHANES;

prevalence estimates of overweight from

self-reported height and weight are

lower. Trends from the NHIS self-report

measures, like those from NHANES,

show a steady increase in prevalence of

overweight; this increase however, is

different in magnitude from that

observed in the data derived from

measured height and weight.

Objective 17.13 (light-to-moderate

physical activity) is being tracked with

the NHIS. The list of activities asked by

the NHIS has not been identical from

year to year. The 1985 and 1990 surveys

did not ask about some activities for

people 65 years of age and over; thus,

the data shown are for people 18–64

years of age. The 1991, 1995, and 1998

surveys asked about some activities

different from the previous surveys, but

people of all age groups were asked the

same questions. Because of these

differences, 1985 and 1990 data are not

comparable to later data. (See Priority

Area 1 for more information.)

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Healthy People 2000 Final Review 243

Table 17. Diabetes and Chronic Disabling Conditions objectives

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

17.1* Years of healthy life .................... 1990 64.0 . . . 63.9 63.7 63.5 63.8 63.9 64.2

‡

64.8

‡

65.2 - - - 65

a. Black ............................. 1990 56.0 . . . 56.0 55.6 55.2 55.6 56.0 56.5

‡

57.4

‡

57.8 - - - 60

b. Hispanic

.......................... 1990 64.8 . . . 63.6

64.0 63.2 64.2 64.0 64.7

‡

65.8

‡

66.3 - - - 65

c. People 65 years and over

............. 1990 11.9 . . . 11.8 11.9 11.9 12.1 12.0 12.2

‡

12.0

‡

12.2 - - - 14

17.2 Limitation in major activity due to chronic

conditions ........................... 1988 9.4% 9.3% 9.6% 10.3% 10.6% 10.3% 10.1% 10.0% - - - - - - - - - 8%

a. Low-income people

Annual family income less than $10,000. . 1988 18.9% 19.2% 19.6% 20.2% 20.9% 21.1% 21.4% 22.7% - - - - - - - - - 15%

Below poverty level ................. ... --- 14.6% 15.5% 16.2% 16.5% 16.8% 17.1% 17.5% - - - - - - - - - . . .

b. American Indian/Alaska Native .......... 1983–85 13.4%

12.3%

12.0%

12.6%

12.4%

13.3%

13.5%

14.9% - - - - - - - - - 11%

c. Black ............................. 1988 11.2% 10.7% 11.0% 12.2% 12.6% 12.5% 12.2% 12.5% - - - - - - - - - 9%

d. Puerto Rican ....................... 1989–91 11.7% . . . . . .

12.0%

12.7%

13.4%

13.0% - - - - - - - - - 10%

17.3* People with difficulty performing self-care

activities (per 1,000)

People 65 years and over ................. 1984–85 111 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 90

People 70 years and over ................. 1984–85

141 --- --- --- --- ---

163 --- --- --- --- 90

a. People 85 years and over.............. 1984–85 371 - - - - - - - - - - - - - - -

471 --- --- --- --- 325

b. Black 65 years and over ............... 1984–85

132 --- --- --- --- --- --- --- --- --- --- 98

Black 70 years and over ............... 1984–85

166 --- --- --- --- ---

218 --- --- --- --- 98

17.4 People with asthma with activity limitation

due to asthma ........................ 1986–88 19.4%

20.4%

21.8%

22.5%

22.0%

20.7%

19.6 - - - - - - - - - 10%

a. Black ............................. 1989–91 30.5% . . . . . .

30.3%

32.1%

31.5%

29.1%

27.0 - - - - - - - - - 19%

b. Puerto Ricans

..................... ... --- --- --- --- --- --- --- --- --- --- --- 22%

17.5 Activity limitation due to chronic back

conditions (per 1,000) .................. 1986–88 21.9

23.7

25.1

25.3

27.3

28.1

28.8

27.9 - - - - - - - - - 19

17.6 Significant hearing impairment (per 1,000) . . 1986–88 88.9

89.5

89.7

93.5

93.6

91.9

89.0

85.1 - - - - - - - - - 82

a. People 45 years and over.............. 1986–88 203

206.2

205.2

215.7

213.2

207.4

200.4

195.9 - - - - - - - - - 180

17.7 Significant visual impairment (per 1,000) .... 1986–88 34.5

32.5

31.7

32.8

34.8

35.1

34.0

31.3 - - - - - - - - - 30

a. People 65 years and over.............. 1986–88 87.7

81.8

78.0

79.8

87.4

88.3

84.6

84.2 - - - - - - - - - 70

17.8* Serious mental retardation (per 1,000)

Children 10 years with IQ less than 50 ....... 1985–87

3.1 --- ---

3.6 --- --- --- --- --- --- --- 2

17.9 Diabetes-related deaths (age adjusted per

100,000) ............................. 1986 38 38 38 38 40 40 40 41 41 41 - - - 34

a. Black ............................. 1986 67 71 71 71 74 73 76 76 76 76 - - - 58

b. American Indian/Alaska Native .......... 1986 46 53 51 57 60 58 63 63 66 66 - - - 41

c. Mexican American

.................. 1990

55.7 . . . 50.3 51.1 56.6 55.6 56.7 60.1 62.6 60.7 - - - 50

d. Puerto Rican

...................... 1990

40.7 . . . 47.2 48.7 48.5 57.8 63.2 58.5 51.7 49.1 - - - 42

17.10 Diabetes-related complications

People with diabetes

End-stage renal disease (ESRD) (per 1,000) . 1987 1.5 2.5 2.5 2.7 2.4 3.3 3.4 4.1

‡

3.2

‡

3.3 - - - 1.4

Blindness (age adjusted per 1,000) ........ 1987 2.2 2.5 2.4 2.3 2.1 2.2 - - - - - - - - - - - - - - - 1.4

Lower extremity amputation (per 1,000) ..... 1987 8.2 8.6 6.2 7.8 7.3 8.6 9.4 11.1

‡

8.1

‡

8.1 - - - 4.9

Perinatal mortality (among infants of females

with established diabetes) .............. 1988 5% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2%

See footnotes and key at end of table.

244 Healthy People 2000 Final Review

Table 17. Diabetes and Chronic Disabling Conditions objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Major congenital malformations............... 1988 8% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4%

ESRD due to diabetes (per 1,000)

a. Black with diabetes..................... 1983–86 2.2

3.1 --- ---

5.7

5.0

5.2

5.5 - - -

‡,20

5.7 - - - 2.0

b. American Indian/Alaska Native in Indian

Health Service areas with diabetes

....... 1983–86 2.1 4.2 4.4 5.4 - - - - - - - - - - - - - - - - - - - - - 1.9

Lower extremity amputations due to diabetes

(per 1,000)

c. Black with diabetes ..................... 1987

9.0 8.0 11.1 8.6 8.6 9.1 10.2 10.1

‡

9.1

‡

11.7 - - - 6.1

17.11* Diabetes incidence and prevalence

Total population (per 1,000)

Incidence of diabetes..................... 1986–88 2.9

2.6

2.5

2.4

2.8

3.1

3.4

3.1 --- --- --- 2.5

Prevalence of diabetes ................... 1986–88 28

‡

---

‡

--- --- 25

Prevalence of diabetes (per 1,000)

a. American Indian/Alaska Native 15 years and

over in Indian Health Service areas ........ 1987 69 - - - - - - - - - - - - - - - - - -

90 --- --- --- 62

b. Puerto Rican (ages 20–74 years) .......... 1982–84 55 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 49

c. Mexican American (ages 20–74 years) ...... 1982–84 54 - - - - - - - - - - - -

66 --- --- --- --- --- 49

d. Cuban American (ages 20–74 years) ....... 1982–84 36 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 32

e. Black (all ages)........................ 1986–88 36

‡

---

‡

--- --- 32

17.12* Overweight prevalence (Based on measured

height and weight unless otherwise indicated)

Adults 20–74 years ........................ 1976–80 26% - - - - - - - - - - - -

21,23

3 --- --- --- --- --- 20%

Male ................................. 1976–80 24% - - - - - - - - - - - -

21,23

3 --- --- --- --- --- 20%

Female ............................... 1976–80 27% - - - - - - - - - - - -

21,23

3 --- --- --- --- --- 20%

Adolescents 12–19 years ................... 1976–80 15% - - - - - - - - - - - -

24% --- --- --- --- --- 15%

a. Low-income female 20–74 years........... 1976–80 37% - - -

47% --- --- --- --- --- --- --- --- 25%

b. Black female 20–74 years................ 1976–80 44% - - - - - - - - - - - -

21,23

5 --- --- --- --- --- 30%

c. Hispanic female 20–74 years ............. ... --- --- --- --- --- --- --- --- --- --- --- 25%

Hispanic female 20 years and over

(self-reported)

...................... ... --- 33% 32% 32% 33% 32% 35% ---

‡

44%

‡

46% --- ...

Mexican American female 20–74 years..... 1982–84 39% - - - - - - - - - - - -

21,23

50% --- --- --- --- --- ...

Cuban female 20–74 years ............. 1982–84 34% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . .

Puerto Rican female 20–74 years......... 1982–84 37% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . .

d. American Indian/Alaska Native 20 years and

over ............................... 1984–88 29–75% - - -

40%

36%

48%

34%

43% - - -

‡,25

45 - - - 30%

e. People with disabilities 20 years and over

(self-reported)

....................... 1985 36% - - - 38% 37% 38% 38% 40% - - - - - - - - - - - - 25%

f. Females with high blood pressure 20–74

years ............................... 1976-80 50% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 41%

g. Males with high blood pressure 20–74 years. . 1976–80 39% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 35%

h. Mexican American male 20–74 years ....... 1982–84 30% - - - - - - - - - - - -

21,23

3 --- --- --- --- --- 25%

17.13* Light to moderate physical activity

People 6 years and over.................... ... --- --- --- --- --- --- --- --- --- --- --- 30%

See footnotes and key at end of table.

Healthy People 2000 Final Review 245

Table 17. Diabetes and Chronic Disabling Conditions objectives—Con

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

People 18 years and over

5 or more times per week ................ 1985

22%

23%

24% --- --- --- 23% --- --- 30% --- 30%

7 or more times per week ................ 1985

16%

17% --- --- --- 16% --- --- 20% --- 30%

a. Hispanic 18 years and over

5 or more times per week ................ 1991 20% . . . . . . - - - - - - - - - 22% - - - - - - 29% - - - 25%

17.14 Patient education for people with chronic and

disabling conditions ....................

... --- --- --- --- --- --- --- --- --- --- --- 40%

a. People with diabetes (classes) ........... 1983-84 32%

3 3 % 3 9 % --- 4 3 % --- --- --- --- 4 2 % --- 7 5 %

People with diabetes (counseling) ......... 1983-84 68% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . .

b. People with asthma (classes) ............ 1991 9% . . . . . . - - - 10% - - - - - - - - - - - - 8% - - - 50%

c. Black with diabetes (classes) ............ 1991 34% . . . . . . - - - 50% - - - - - - - - - - - - 45% - - - 75%

d. Hispanic with diabetes (classes) .......... 1991 27% . . . . . . - - - 26% - - - - - - - - - - - - 31% - - - 75%

17.15 Clinician assessment of childhood

development ..........................

... --- --- --- --- --- --- --- --- --- --- --- 80%

Percent of clinicians routinely providing service to

81–100% of patients (children)

Visual acuity testing (3 years and over)

Pediatricians .......................... 1992 55% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Nurse practitioners ..................... 1992 49% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Family physicians ...................... 1992 30% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Hearing testing (3 years and over)

Pediatricians .......................... 1992 47% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Nurse practitioners ..................... 1992 46% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Family physicians ...................... 1992 19% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Evaluation of speech

Pediatricians .......................... 1992 65% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 80%

Nurse practitioners ..................... 1992 51% . . . . . . . . . - - - - - - - - - - - - - - -

49% - - - 80%

Family physicians ...................... 1992 39% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 80%

Evaluation of motor development

Pediatricians .......................... 1992 72% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 80%

Nurse practitioners ..................... 1992 56% . . . . . . . . . - - - - - - - - - - - - - - -

53% - - - 80%

Family physicians ...................... 1992 45% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 80%

Treatment/referral for vision problems

Pediatricians .......................... 1992 67% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Nurse practitioners ..................... 1992 35% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Family physicians ...................... 1992 56% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Treatment/referral for hearing problems

Pediatricians .......................... 1992 66% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Nurse practitioners ..................... 1992 35% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Family physicians ...................... 1992 55% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Treatment/referral for speech problems

Pediatricians .......................... 1992 62% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Nurse practitioners ..................... 1992 34% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Family physicians ...................... 1992 48% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

See footnotes and key at end of table.

246 Healthy People 2000 Final Review

Table 17. Diabetes and Chronic Disabling Conditions objectives—Con

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Treatment/referral for motor problems

Pediatricians .......................... 1992 55% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Nurse practitioners ..................... 1992 33% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

Family physicians ...................... 1992 49% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 80%

17.16 Early detection of significant hearing

impairment in children (average age in

months)

............................. 1988 24–30 - - - 27 - - - - - - - - - - - - - - - - - - 29 - - - 12

a. Black

............................. ... --- --- --- --- --- --- --- --- --- --- --- 12

17.17 Clinician assessment of cognitive and other

functioning in older adults

Percent of clinicians routinely providing service to

81–100% of patients (adults aged 65 years and

over)

Visual acuity testing

Nurse practitioners ..................... 1992 24% . . . . . . . . . - - - - - - - - - - - - - - -

19% - - - 60%

Obstetricians/gynecologists ............... 1992 3% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Internists ............................. 1992 15% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Family physicians ...................... 1992 12% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Hearing acuity testing

Nurse practitioners ..................... 1992 16% . . . . . . . . . - - - - - - - - - - - - - - -

13% - - - 60%

Obstetricians/gynecologists ............... 1992 2% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Internists ............................. 1992 9% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Family physicians ...................... 1992 7% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Evaluation of physical mobility

Nurse practitioners ..................... 1992 41% . . . . . . . . . - - - - - - - - - - - - - - -

35% - - - 60%

Obstetricians/gynecologists ............... 1992 18% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Internists ............................. 1992 42% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Family physicians ...................... 1992 26% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Evaluation for dementia

Nurse practitioners ..................... 1992 28% . . . . . . . . . - - - - - - - - - - - - - - -

22% - - - 60%

Obstetricians/gynecologists ............... 1992 9% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Internists ............................. 1992 23% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Family physicians ...................... 1992 13% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Inquiry about urinary incontinence

Nurse practitioners ..................... 1992 33% . . . . . . . . . - - - - - - - - - - - - - - -

24% - - - 60%

Obstetricians/gynecologists ............... ... --- --- --- --- --- --- --- --- ---

29,30

--- --- 60%

Internists ............................. 1992 30% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Family physicians ...................... 1992 15% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Treatment/referral for vision problems

Nurse practitioners ..................... 1992 33% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 60%

Obstetricians/gynecologists ............... 1992 35% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 60%

Internists ............................. 1992 63% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 60%

Family physicians ...................... 1992 54% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 60%

See footnotes and key at end of table.

Healthy People 2000 Final Review 247

Table 17. Diabetes and Chronic Disabling Conditions objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Treatment/referral for hearing problems

Nurse practitioners ..................... 1992 30% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 60%

Obstetricians/gynecologists ............... 1992 34% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 60%

Internists ............................. 1992 52% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 60%

Family physicians ...................... 1992 46% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 60%

Prescription of mobility aids/modification of living

environment to improve mobility

Nurse practitioners ..................... 1992 18% . . . . . . . . . - - - - - - - - - - - - - - -

25% - - - 60%

Obstetricians/gynecologists ............... 1992 15% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Internists ............................. 1992 31% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Family physicians ...................... 1992 25% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Investigation of/referral for treatable causes of

dementia

Nurse practitioners ..................... 1992 31% . . . . . . . . . - - - - - - - - - - - - - - -

28% - - - 60%

Obstetricians/gynecologists ............... 1992 27% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Internists ............................. 1992 54% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Family physicians ...................... 1992 40% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Treatment/referral for urinary incontinence

Nurse practitioners ..................... 1992 31% . . . . . . . . . - - - - - - - - - - - - - - -

28% - - - 60%

Obstetricians/gynecologists ............... 1992 56% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Internists ............................. 1992 37% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

Family physicians ...................... 1992 31% . . . . . . . . . - - - - - - - - - - - - - - -

29,30

--- --- 60%

17.18 Perimenopausal females counseled about

estrogen replacement therapy

Female 40–60 years .................... 1994 80% . . . . . . . . . . . . . . . - - - - - - - - - 89% - - - 90%

Female 40–49 years .................. 1994 76% . . . . . . . . . . . . . . . - - - - - - - - - 87% - - - 90%

Female 50–60 years .................. 1994 83% . . . . . . . . . . . . . . . - - - - - - - - - 90% - - - 90%

17.19 Worksites with policies for hiring people with

disabilities

Worksites with a voluntary policy............. 1986 37% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 75%

17.20 Service systems for children with or at risk of

chronic and disabling conditions (number of

States) ............................... ... --- --- --- --- --- --- --- --- --- --- --- 50

17.21 Prevalence of peptic ulcer (per 1,000)

People 18 years and over .................. 1991 19.9 . . . . . . 23.7 24.4 23.0 22.0 21.2

‡

30.4

‡

27.7 - - - 18

17.22* Identify gaps in health data ............... 1990 None

identified

--- --- --- ---

---

--- ...

Establish mechanisms to meet needs ......... 1990 None

established

--- --- --- ---

---

--- ...

17.23 People with diabetes who had a dilated eye

exam in the past year

People 18 years and over .................. 1989 49% - - -

52% --- --- --- --- --- --- 53% --- 70%

- - - Data not available. Final objective status:

. . . Category not applicable.

Met

Toward

Mixed/ no change

Away

Cannot assess

248 Healthy People 2000 Final Review

Baseline has been revised.

‡

The NHIS was redesigned in 1997. Data may not be comparable with previous years; see Appendix.

Estimate based on preliminary data. Excludes mortality data from States lacking an Hispanic-origin item on their death certiﬁcate or for which Hispanic-origin data were not of sufficient quality.

See Appendix.

Estimate derived from 1991–93 health status data and 1992 mortality data.

Years of healthy life remaining for those surviving to age 65.

1988–90 data.

1989–91 data.

1990–92 data.

1991–93 data.

1992–94 data.

1993–95 data.

1994–96 data.

1994–95 data.

Data are unreliable. Relative standard error is greater than 30%.

1991–92 data.

Excludes data from States lacking an Hispanic-origin item on their death certiﬁcates or for which Hispanic-origin data were not of sufficient quality. See appendix.

1986–89 data.

1990–93 data.

1991–94 data.

1992–95 data.

1993–96 data.

1995–98 data.

Data are for people 20 years and over.

Crude data from 1988–94.

1988–94 data.

1988–91 data.

Estimate derived from self-reported height and weight.

Data are for people 18–64 years.

Operational deﬁnition changed from previous tracking data.

1989 data.

1997–98 data.

Response rate for this group was too low to produce reliable estimates.

Among hearing-impaired children 4–6 years.

Assuming full compliance, achieved through passage of the Americans with Disabilities Act of 1990.

Includes stomach, duodenal, and peptic ulcers.

The National Committee on Vital and Health Statistics established a Subcommittee on State and Community Health Statistics. The Subcommittee’s charge (in part) is to work with Federal

and State agencies and appropriate private agencies to review and identify gaps in current health statistics.

The Healthy People 2000 Midcourse Review added 111 additional subobjectives for major population groups at highest risk for disease, injury, and disability.

As part of the planning process for 2010, data gaps are being identiﬁed and mechanisms to address these gaps are being considered.

Healthy People 2010 is addressing data gaps by requiring data for race, ethnicity, socioeconomic status, and disability measures for population-based objectives and by listing developmental

objectives.

NOTE: Data may include revisions and, therefore, may differ from data previously published.

Objective number Data source

17.1*, 17.1a–c National Vital Statistics System, CDC, NCHS; National Health Interview Survey, CDC, NCHS.

17.2, 17.2a–c National Health Interview Survey, CDC, NCHS.

17.3*, 17.3a, b National Health Interview Survey, CDC, NCHS; National Nursing Home Survey, CDC, NCHS.

17.4 National Health Interview Survey, CDC, NCHS.

17.5 National Health Interview Survey, CDC, NCHS.

17.6, 17.6a National Health Interview Survey, CDC, NCHS.

17.7, 17.7a National Health Interview Survey, CDC, NCHS.

17.8* Baseline: Metropolitan Atlanta Developmental Disabilities Study, CDC, NCEH.

Update: Metropolitan Atlanta Developmental Disabilities Surveillance Program, CDC, NCEH.

17.9, 17.9a, b National Vital Statistics System, CDC, NCHS.

Healthy People 2000 Final Review 249

Objective number Data source

17.10 For blindness: Massachusetts Blind Registry, Massachusetts Commission on the Blind.

For perinatal mortality and congenital malfunctions: Clinical series and selected State data.

For ESRD:

Denominator: National Health Interview Survey, CDC, NCHS;

Numerator: United States Renal Data System, NIH.

For amputation:

Denominator: National Health Interview Survey, CDC, NCHS;

Numerator: National Hospital Discharge Survey, CDC, NCHS.

17.10a Denominator: National Health Interview Survey, CDC, NCHS;

Numerator: United States Renal Data System, NIH.

17.10b IHS, OPEL.

17.10c Denominator: National Health Interview Survey, CDC, NCHS;

Numerator: National Hospital Discharge Survey, CDC, NCHS.

17.11*, 17.11e National Health Interview Survey, CDC, NCHS.

17.11a Ambulatory Utilization Data, IHS.

17.11b–d Baseline: Hispanic Health and Nutrition Examination Survey, CDC, NCHS.

Update for Mexican American: National Health and Nutrition Examination Survey, CDC, NCHS.

17.12*, 17.12a,

b, f, g

National Health and Nutrition Examination Survey, CDC, NCHS.

17.12c, h Data for Hispanic: National Health Interview Survey, CDC, NCHS.

Baselines for Mexican American, Cuban, Puerto Rican: Hispanic Health and Nutrition Examination Survey, CDC, NCHS.

Updates for Mexican American: National Health and Nutrition Examination Survey, CDC, NCHS.

17.12d Baseline: IHS, OPEL.

Updates: National Health Interview Survey, CDC, NCHS.

17.12e National Health Interview Survey, CDC, NCHS.

17.13*, 17.13a National Health Interview Survey, CDC, NCHS.

17.14a 1983–84 baseline: Halpern M. The impact of diabetes education in Michigan. Diabetes 38(2):151A, 1989.

1991 baseline and updates: National Health Interview Survey, CDC, NCHS.

17.14b National Health Interview Survey, CDC, NCHS.

17.15 Baseline: Primary Care Provider Surveys, OPHS, ODPHP.

Update: Prevention in Primary Care Study, American College of Preventive Medicine.

17.16 1988 baseline: Annual Survey of Hearing Impaired Children and Youth, Commission on Education of the Deaf.

1991 baseline and updates: National Health Interview Survey, CDC, NCHS.

17.17 Baseline: Primary Care Provider Surveys, OPHS, ODPHP.

Update: Prevention in Primary Care Study, American College of Preventive Medicine.

17.18 National Health Interview Survey, CDC, NCHS.

17.19 Baseline: Survey of Persons with Disability, International Center for the Disabled.

Updates: Americans with Disabilities Act of 1990.

17.21 National Health Interview Survey, CDC, NCHS.

17.22* Subcommittee on State and Community Health Statistics, NCVHS; CDC, NCHS; OPHS, ODPHP.

17.23 Baseline: National Health Interview Survey, CDC, NCHS.

Update: National Health and Nutrition Examination Survey, CDC, NCHS.

* Duplicate objective. See full text of objective following this table.

250 Healthy People 2000 Final Review

Diabetes and

Chronic Disabling

Conditions

Objectives

17.1*: Increase years of healthy life to

at least 65 years.

Duplicate objectives: 8.1 and 21.1

17.1a*: Increase years of healthy

life among blacks to at least 60

years.

Duplicate objectives: 8.1a and 21.1a

17.1b*: Increase years of healthy

life among Hispanics to at least 65

years.

Duplicate objectives: 8.1b and 21.1b

17.1c*: Increase years of healthy

life among people aged 65 and

older to at least 14 more years of

healthy life.

Duplicate objectives: 8.1c and 21.1c

17.2: Reduce to no more than 8 percent

the proportion of people who experience

a limitation in major activity due to

chronic conditions.

17.2a: Reduce to no more than

15 percent the proportion of

low-income people (annual family

income of less than $10,000 in

1988) who experience a limitation

in major activity due to chronic

conditions.

17.2b: Reduce to no more than

11 percent the proportion of

American Indians and Alaska

Natives who experience a limitation

in major activity due to chronic

conditions.

17.2c: Reduce to no more than

9 percent the proportion of blacks

who experience a limitation in

major activity due to chronic

conditions.

17.2d: Reduce to no more than

10 percent the proportion of Puerto

Ricans who experience a limitation

in major activity due to chronic

conditions.

17.3*: Reduce to no more than 90 per

1,000 people the proportion of all

people aged 65 and older who have

difficulty in performing two or more

personal care activities, thereby

preserving independence.

Duplicate objective: 1.13 and age-related

objective for people aged 65 and older

17.3a*: Reduce to no more than

325 per 1,000 people the proportion

of all people aged 85 and older who

have difficulty in performing two or

more personal care activities,

thereby preserving independence.

Duplicate objective: 1.13a

17.3b*: Reduce to no more than 98

per 1,000 people the proportion of

blacks aged 65 and older who have

difficulty in performing two or more

personal care activities, thereby

preserving independence.

Duplicate objective: 1.13b

17.4: Reduce to no more than 10 percent

the proportion of people with asthma

who experience activity limitation.

17.4a: Reduce to no more than

19 percent the proportion of blacks

with asthma who experience activity

limitation.

17.4b: Reduce to no more than

22 percent the proportion of Puerto

Ricans with asthma who experience

activity limitation.

17.5: Reduce activity limitation due to

chronic back conditions to a prevalence

of no more than 19 per 1,000 people.

17.6: Reduce signiﬁcant hearing

impairment to a prevalence of no more

than 82 per 1,000 people.

17.6a: Reduce signiﬁcant hearing

impairment among people aged 45

and older to a prevalence of no

more than 180 per 1,000.

17.7: Reduce signiﬁcant visual

impairment to a prevalence of no more

than 30 per 1,000 people.

17.7a: Reduce signiﬁcant visual

impairment among people aged 65

and older to a prevalence of no

more than 70 per 1,000.

17.8*: Reduce the prevalence of serious

mental retardation among school-aged

children to no more than 2 per 1,000

children.

Duplicate objective: 11.2

17.9: Reduce diabetes-related deaths to

no more than 34 per 100,000.

17.9a: Reduce diabetes-related

deaths among blacks to no more

than 58 per 100,000.

17.9b: Reduce diabetes-related

deaths among American Indians and

Alaska Natives to no more than 48

per 100,000.

17.9c: Reduce diabetes-related

deaths among Mexican-Americans

to no more than 50 per 100,000.

17.9d: Reduce diabetes-related

deaths among Puerto Ricans to no

more than 42 per 100,000.

17.10: Reduce the most severe

complications of diabetes as follows:

Complications among

people with diabetes: 2000 target

End-stage renal disease 1.4 per 1,000

Blindness 1.4 per 1,000

Lower extremity amputation 4.9 per

1,000

Perinatal mortality

2 percent

Major congenital malformation 4 percent

Among infants of women with established

diabetes.

17.10a: Reduce end-stage renal

disease due to diabetes among black

persons with diabetes to no more

than 2 per 1,000.

17.10b: Reduce end-stage renal

disease due to diabetes among

American Indians and Alaska

Natives with diabetes to no more

than 1.9 per 1,000.

17.10c: Reduce lower extremity

amputations due to diabetes among

blacks with diabetes to no more

than 6.1 per 1,000.

17.11*: Reduce diabetes to an incidence

of no more than 2.5 per 1,000 people

and a prevalence of no more than 25 per

1,000 people.

Duplicate objective: 2.24

17.11a*: Reduce diabetes among

American Indians and Alaska

Natives to a prevalence of no more

than 62 per 1,000.

Duplicate objective: 2.24a

17.11b*: Reduce diabetes among

Puerto Ricans to a prevalence of no

more than 49 per 1,000.

Duplicate objective: 2.24b

17.11c*: Reduce diabetes among

Mexican-Americans to a prevalence

of no more than 49 per 1,000.

Healthy People 2000 Final Review 251

Duplicate objective: 2.24c

17.11d*: Reduce diabetes among

Cuban Americans to a prevalence of

no more than 32 per 1,000.

Duplicate objective: 2.24d

17.11e*: Reduce diabetes among

blacks to a prevalence of no more

than 32 per 1,000.

Duplicate objective: 2.24e

17.12*: Reduce overweight to a

prevalence of no more than 20 percent

among people aged 20 and older and no

more than 15 percent among adolescents

aged 12–19.

Duplicate objectives: 1.2, 2.3, and 15.10

17.12a*: Reduce overweight to a

prevalence of no more than

25 percent among low-income

women aged 20 and older.

Duplicate objectives: 1.2a, 2.3a, and

15.10a

17.12b*: Reduce overweight to a

prevalence of no more than

30 percent among black women

aged 20 and older.

Duplicate objectives: 1.2b, 2.3b, and

15.10b

17.12c*: Reduce overweight to a

prevalence of no more than

25 percent among Hispanic women

aged 20 and older.

Duplicate objectives: 1.2c, 2.3c, and

15.10c

17.12d*: Reduce overweight to a

prevalence of no more than

30 percent among American Indians

and Alaska Natives.

Duplicate objectives: 1.2d, 2.3d, and

15.10d

17.12e*: Reduce overweight to a

prevalence of no more than

25 percent among people with

disabilities.

Duplicate objectives: 1.2e, 2.3e, and

15.10e

17.12f*: Reduce overweight to a

prevalence of no more than

41 percent among women with high

blood pressure.

Duplicate objectives: 1.2f, 2.3f, and

15.10f

17.12g*: Reduce overweight to a

prevalence of no more than

35 percent among men with high

blood pressure.

Duplicate objectives: 1.2g, 2.3g, and

15.10g

17.12h*: Reduce overweight to a

prevalence of no more than

35 percent among

Mexican-American men.

Duplicate objectives: 1.2h, 2.3h, and

15.10h

17.13*: Increase to at least 30 percent

the proportion of people aged 6 and

older who engage regularly, preferably

daily, in light-to-moderate physical

activity for at least 30 minutes per day.

Duplicate objectives: 1.3 and 15.11

17.13a*: Increase to at least

25 percent the proportion of

Hispanics aged 18 and older who

engage regularly, preferably daily,

in light to moderate physical

activity for at least 30 minutes per

day 5 or more times per week.

Duplicate objectives: 1.3a and

15.11a

17.14: Increase to at least 40 percent the

proportion of people with chronic and

disabling conditions who receive formal

patient education including information

about community and self-help

resources as an integral part of the

management of their condition.

17.14a: Increase to at least

75 percent the proportion of people

with diabetes who receive formal

patient education including

information about community and

self-help resources as an integral

part of the management of their

condition.

17.14b: Increase to at least

50 percent the proportion of people

with asthma who receive formal

patient education including

information about community and

self-help resources as an integral

part of the management of their

condition.

17.14c: Increase to at least

75 percent the proportion of blacks

with diabetes who receive formal

patient education including

information about community and

self-help resources as an integral

part of the management of their

condition.

17.14d: Increase to at least

75 percent the proportion of

Hispanics with diabetes who receive

formal patient education including

information about community and

self-help resources as an integral

part of the management of their

condition.

17.15: Increase to at least 80 percent the

proportion of providers of primary care

for children who routinely refer or

screen infants and children for

impairments of vision, hearing, speech

and language, and assess other

developmental milestones as part of

well-child care.

17.16: Reduce the average age at which

children with signiﬁcant hearing

impairment are identiﬁed to no more

than 12 months.

17.16a: Reduce the average age at

which black children with

signiﬁcant hearing impairment are

identiﬁed to no more than 12

months.

17.17: Increase to at least 60 percent the

proportion of providers of primary care

for older adults who routinely evaluate

people aged 65 and older for urinary

incontinence and impairments of vision,

hearing, cognition, and functional status.

17.18: Increase to at least 90 percent the

proportion of perimenopausal women

who have been counseled about the

beneﬁts and risks of estrogen

replacement therapy (combined with

progestin, when appropriate) for

prevention of osteoporosis.

17.19: Increase to at least 75 percent the

proportion of worksites with 50 or more

employees that have a policy or

program for the hiring of people with

disabilities.

17.20: Increase to 50 the number of

States that have service systems for

children with or at risk of chronic and

disabling conditions, as required by

Public Law 101–239.

17.21: Reduce the prevalence of peptic

ulcer disease to no more than 18 per

1,000 people aged 18 and older by

preventing its recurrence.

17.22*: Develop and implement a

national process to identify signiﬁcant

gaps in the Nation’s disease prevention

and health promotion data, including

data for racial and ethnic minorities,

people with low incomes, and people

252 Healthy People 2000 Final Review

with disabilities, and establish

mechanisms to meet these needs.

Duplicate objective: 22.4

17.23: Increase to 70 percent the

proportion of people with diabetes who

have an annual dilated eye exam.

*Duplicate objective.

Healthy People 2000 Final Review 253

Priority Area 18

HIV Infection

Background

The epidemic of human

immunodeficiency virus (HIV) and

acquired immunodeficiency syndrome

(AIDS) presents social, economic, and

public health challenges to individuals

in the United States and globally.

Although significant progress has been

made in understanding the disease and

developing both prevention strategies

and treatments since the first AIDS case

was discovered in the United States in

1981, HIV remains a deadly infection

for which there are only limited

treatments; no vaccine or cure exists.

HIV/AIDS has been reported in virtually

every racial and ethnic group, every age

group, and every socioeconomic group

in every State and most large cities in

the United States. Since the early 1980s

four distinct populations have been

identified to be at greatest risk: men

who have sex with men (MSM);

injection drug users (IDUs);

heterosexual persons in certain racial

and ethnic populations (African

Americans and Hispanics); and infants

who are susceptible to perinatal

transmission caused by undetected or

untreated HIV infection in pregnant

women (1–3). The proportion of

different population groups affected by

HIV/AIDS has changed over time.

Comparing the 1980s to the 1990s, the

proportion of AIDS cases among white

MSM declined while the proportion of

AIDS cases among women and men

increased in select racial and ethnic

groups, especially among African

Americans and Hispanics. Moreover,

increases among all women have

occurred. Reported AIDS cases among

women have increased steadily since the

1980’s and accounted for nearly

18 percent of cases reported in 1999 (4).

By the end of 1999, more than 733,000

cases of AIDS had been reported, and

over 430,000 persons had died of AIDS.

Estimates of the number of people

infected with HIV in the United States

range from 800,000 to 900,000. (4–6).

Transmission of HIV infection can be

prevented through changes in high-risk

behaviors. Prevention is an important

cost-effective component of the control

of HIV infection. Two biomedical

interventions have demonstrated

possibilities in reducing the spread of

this deadly disease. First, antiretroviral

combination therapy lowers viral load,

which may translate to lower infectivity

and, second, evidence suggests that

treatment of other sexually transmitted

diseases (STDs) can reduce the spread

of heterosexually transmitted HIV

infection. Despite advances in

prevention and medical treatment to

improve survival among infected

persons, HIV infection remains a major

public health threat in the United States.

Data Summary

Highlights

By the end of the 20th century,

successes had been achieved in the HIV

Infection priority area. The publication,

dissemination, and implementation of

specific guidelines to test donated blood

for HIV has resulted in a reduction in

transfusion-related AIDS (18.7). The

estimated risk of transfusion-transmitted

HIV dropped from 1 case per

40,000–150,000 units of donated blood

in 1989 to 1 per 625,000 units in 1997.

Assuming full compliance with the

Occupational Safety and Health

Administration bloodborne pathogen

standard promulgated in 1991,

100 percent of worksites had regulations

to protect workers from occupational

exposure to bloodborne infections,

including HIV (18.14) (5,7). Several

other measures related to HIV infection

status improved over the decade. For

example, AIDS incidence continues to

decrease and has met its year 2000

target. The estimated number of AIDS

cases per 100,000 population by year of

diagnosis decreased between 1997 and

1998 (18.1) (see Data Issues). The

number of cases diagnosed in 1998

among MSM (18.1a) and IDUs (18.1c)

also decreased compared with the

number of cases in 1997. Since 1992,

HIV incidence in the United States has

been relatively stable, with an estimated

40,000 new HIV infections expected to

occur each year. The latest estimates of

HIV infection (18.2) indicated that

800,000 to 900,000 persons are infected

with HIV (4–6).

In 1999, among in-school male and

female adolescents 15 years of age, 34

and 43 percent, respectively, engaged in

sexual intercourse (18.3), whereas

68 percent among black adolescent

males in this age group engaged in

sexual intercourse. Among 17 year olds,

the proportion of adolescents engaging

in sexual intercourse decreased in all

groups (44 percent, 40 percent, and

82 percent, respectively). In addition, the

proportion of condoms used at last

sexual intercourse by the partners of

sexually active unmarried females 15–44

years of age (18.4) increased from

19 percent to 25 percent between 1988

and 1995. Between 1997 and 1999, the

proportion of in-school sexually active

females (15–17 years of age) abstaining

from sexual intercourse for the previous

3 months (18.15) improved from

23 percent to 25 percent. About a quarter

of a million people in the United States

are unaware that they are infected with

AIDS (8); knowledge of serostatus is

key to HIV-positive people benefiting

from prevention and treatment. The

proportion of HIV-positive persons who

knew their serostatus (18.8) decreased

over the decade. Between 1995 and

1998, the proportion of individuals who

tested positive for HIV infection and

returned for counseling decreased from

83 percent to 63 percent. Some

78 percent of persons who were tested at

a publicly funded site completed posttest

counseling sessions in 1998 (8).

Knowledge of HIV status is a critical

prevention strategy and essential for

entry into care services. Once rapid HIV

tests are available, test results can be

provided in the same day, eliminating

the need for a person to return for test

results.

Summary of Progress

Data to assess progress are available

for 14 of the 17 objectives in this

priority area. Five objectives have met

(18.10, and 18.14) or exceeded (18.1,

18.2, and 18.7) the year 2000 targets.

Objective 18.10 (HIV and other STD

education curricula) was met at baseline,

however, supplemental data for the

objective indicate a trend that could be

moving in the wrong direction. Data

show progress toward the year 2000

targets for an additional five objectives

(18.4, 18.5, 18.6, 18.13, and 18.15).

Objectives 18.8, 18.9, and 18.12 moved

away from the year 2000 targets. For

one objective (18.3), progress among the

multiple measures used for tracking was

mixed. Data beyond baseline are not

available for assessing the status of two

objectives (18.11 and 18.16). Baseline

data are not available for one objective

(18.17). See table 18 for the tracking

data for the objectives in this priority

254 Healthy People 2000 Final Review

18.1 AIDS incidence

18.2 HIV prevalence

18.3 Adolescents who ever had sexual intercourse:

Female 15 years

18.4 Condom use at last intercourse:

Female 15-44 years

Female 17 years

Male 17 years

Male 15 years

18.5 Injecting drug users enrolled in treatment

18.6 Injecting drug users not in treatment who did

not share needles

18.7 Risk of transfusion-transmitted HIV infection

18.14 Regulations to protect workers from occupational

exposure to bloodborne infections, including HIV

18.15 Adolescent abstinence from sexual intercourse in

past 3 months: Female 15-17 years

Male 15-17 years

18.12 Outreach HIV programs for drug users

18.8 HIV-infected people who know their serostatus

Moved away from target Moved toward target Met target

* This objective has met its target. A progress quotient could not be calculated.

NOTES: Complete tracking data are shown in table 18. Progress quotients are not calculated for objectives 18.9, 18.10, 18.11, 18.13, 18.16,

and 18.17. See the section on Measuring Progress Toward the

Healthy People 2000

Targets in the Appendix for more information.

AIDS is aquired immunodeficiency syndrome. HIV is human immunodeficiency virus.

-10%

-6%

Percent of target achieved

-100 -80 -60 -40 -20

20 40 60 80 100

Met*

131%

100%

57%

21%

66%

59%

42%

33%

50%

19%

-127%

For explanation, see Data Comparability in chapter text.

Healthy People 2000 Final Review 255

Figure 18. Final status of HIV Infection objectives

area and figure 18 for a quantitative

assessment of progress.

Discussion

Historically, AIDS incidence data

have served as the basis for assessing

needs for prevention and treatment

programs. However, because of the

effect of potent antiretroviral therapies,

AIDS incidence no longer can provide

unbiased information on HIV incidence

patterns. Rather, persons reported with

AIDS will increasingly represent

persons who were diagnosed too late for

them to benefit from treatments, persons

who either did not seek or had no

access to care, or persons who failed

treatment (4,5). A nationwide system of

HIV reporting is needed to better track

where HIV infections are occurring. By

the end of 1999, 34 States had adopted

some type of HIV reporting for adults

and adolescents. AIDS incidence rates

for minority populations, particularly

African Americans and Hispanics,

continue to increase, revealing the

continuing trend of racial minority

groups being disproportionately

impacted by the epidemic. In 1998, an

estimated 17,847 AIDS cases were

diagnosed among MSM (18.1a). This

was a decrease from 1997 and part of a

continuing trend. The decline is a result

of prevention activities and the impact

of and access to potent antiretroviral

therapies that are delaying progression

to AIDS in many HIV-infected

individuals. During the next decade,

increased emphasis will be placed on

increasing the number of people who

know their HIV serostatus. For

HIV-infected persons and those not

infected but at increased risk for HIV,

linkages with appropriate medical,

prevention, and other supportive services

increases the likelihood of maintaining

health, enhancing longevity and quality

of life, and reducing the risk of

transmitting or acquiring HIV. Thus,

learning one’s status is an important

element of prevention.

In the 21st century, strategies for

reducing HIV transmission will continue

to evolve. Future strategies will continue

to focus on the disproportionate impact

of HIV/AIDS among certain

racial/ethnic groups; prevention

strategies for populations that are

particularly high risk (for example,

IDUs and incarcerated persons);

increasing the number of persons who

learn their HIV status; and providing

access to highly active antiretroviral

therapy (HAART), thereby reducing

deaths and HIV-associated illnesses and

infections of others. The effect of

treatment on AIDS incidence and the

shift in emphasis from AIDS to HIV

require new ways of thinking about

surveillance data. With respect to AIDS

data, year-to-year changes reflect

differences in the historic pattern of

HIV infection and differences in access

to and utilization of care. Until the

estimated proportion of new HIV

diagnoses is available, the number and

characteristics of persons living with

diagnosed HIV infection and those

living with AIDS will be helpful in

planning for prevention, treatment, and

other services needed to further reduce

transmission and to improve survival

and quality of life for infected persons.

The next few years will represent a time

of transition. AIDS incidence will

continue to be affected by therapy; at

the same time, HIV reporting will

gradually be implemented by an

increasing number of States (4,5,9).

Transition to Healthy People

2010

The HIV Infection focus area was

changed for Healthy People 2010 to

reflect improvements in HIV/AIDS

treatment, surveillance, and medical

knowledge. In order to better track the

rise in incidence of AIDS cases in

particular populations in the United

States, the AIDS incidence objective in

Healthy People 2000 has been expanded

into five separate objectives in Healthy

People 2010: AIDS incidence for

adolescents and adults (13 years of age

and older), AIDS cases among MSM,

AIDS cases among persons who inject

drugs (IDUs), and AIDS cases among

men who have sex with men and who

also inject drugs. A developmental

objective, adapted from Healthy People

2000, is included in Healthy People

2010 that will monitor new cases of

HIV infection among the adolescent and

adult population. This objective is

expected to be tracked once HIV case

surveillance is implemented nationwide.

There is an objective modified from

Healthy People 2000 to monitor the

proportion of substance abuse treatment

facilities that offer HIV/AIDS education,

counseling, and support. Two new

objectives were developed to track

HIV/AIDS activities among the

incarcerated population, including

comprehensive HIV/AIDS, STD, and

TB education and voluntary HIV

counseling and testing. An additional

two objectives to track tuberculosis

among HIV-positive persons and another

to track perinatally acquired HIV

infection were added.

As new therapies continue to be

developed and as more people with

HIV/AIDS are living longer lives,

HIV-infected persons need access to

life-enhancing treatments. Therefore, an

objective regarding treatment guidelines

was added to Healthy People 2010 to

reflect the need for equal access to

appropriate care and treatment services

to maintain a healthy life. New

objectives on AIDS-related deaths, the

interval between HIV infection and

AIDS diagnosis, and the interval

between AIDS diagnosis and death from

AIDS were developed to identify

populations who are not benefitting

from current treatment therapies and to

guide where to direct resources.

There is a modification of the

Healthy People 2000 objective that

tracks the proportion of positive HIV

tests for which persons return for

counseling. This modified measure in

Healthy People 2010 will track the

number of HIV-positive persons who

know their serostatus.

The Healthy People 2000 objective

on sexual activity and abstinence in the

past 3 months among adolescents is split

into two objectives in Healthy People

2010: Focus Area 25, Sexually

Transmitted Diseases has an objective to

increase the proportion of adolescents,

grades 9–12, who abstain from sexual

intercourse or use condoms if currently

sexually active and Focus Area 13, HIV

Infection has an objective to increase

the proportion of sexually active

persons, 18–44 years of age, who use

condoms. These objectives were

included in 1 of the 10 Leading Health

Indicators for Healthy People 2010,

Responsible Sexual Behavior.

Appendix table III, a crosswalk

between Healthy People 2000 and

Healthy People 2010 objectives,

summarizes the differences between the

two decades of objectives, reflecting

new knowledge and directions in this

area.

Data Issues

In January 1993, an expanded AIDS

case (18.1) definition was implemented

256 Healthy People 2000 Final Review

for the HIV/AIDS Surveillance System

(6). The expanded definition added

pulmonary tuberculosis, recurrent

pneumonia, and invasive cervical cancer

to the list of diseases that indicate that

AIDS has fully developed among

HIV-infected people (6). In addition, the

new definition included HIV-infected

people with a CD4 cell count below 200

cells per microliter of blood, regardless

of whether those persons have

opportunistic infections, neoplasms, or

any other symptoms of HIV infection.

These changes resulted in cases being

diagnosed earlier in the course of the

disease and effected a temporary

increase in the number of cases reported

after January 1, 1993. The expanded

definition increased the number of cases

diagnosed in 1992 and 1993 because it

applied to cases diagnosed in earlier

years if they were reported after the

expanded definition was implemented in

1993. The decline in 1994 and 1995

represented the continued but waning

effect of the change in AIDS reporting

criteria. In 1995, the Centers for Disease

Control and Prevention (CDC) published

estimates of the incidence of cases of

AIDS opportunistic illnesses (including

HIV dementia and wasting syndrome)

by year of diagnosis (10). This

improved comparability for trend

purposes. In 1999, CDC published

recommendations for a nationwide

system for reporting cases of HIV

infection (5). The expansion of the

surveillance system to include all

persons who have been diagnosed with

HIV will enhance knowledge of the

scope and impact of the epidemic.

The National Household Survey on

Drug Abuse (NHSDA) provides updates

to monitor objective 18.5 on the

proportion of injecting drug users in the

past year who were enrolled in any drug

abuse treatment program in the past year

(11). For 1991 through 1993, persons

defined as IDUs in the past year were

those who used any drug with a needle

for nonmedical reasons. For 1994,

persons defined as IDUs in the past year

were those who used a needle to inject

cocaine, heroin, a stimulant, or an

anabolic steroid in the past year. For

1995, persons defined as IDUs in the

past year were those who used a needle

to inject cocaine, heroin, or a stimulant

in the past year. Enumeration of IDUs is

difficult because of the illegality of the

behavior. Therefore, the number of

IDUs may be underestimated using this

data source. In addition, the NHSDA

will miss an unknown proportion of

injecting drug users who are homeless,

institutionalized, or difficult to locate.

The NHSDA data are not comparable to

the baseline measure, which was

estimated from various sources.

Recent data on the proportion of

IDUs not in treatment who use

uncontaminated injecting equipment

(18.6) are available from the

Cooperative Agreement for AIDS

Community-Based Outreach and

Intervention Research Program from the

National Institute on Drug Abuse

(NIDA). Baseline data were from a

similar research project, the National

AIDS Demonstration Research Program,

also from NIDA. Data from both data

sources are from selected cities and are

not nationally representative. The

measure to monitor this objective is the

proportion of current injecting drug

users who did not share needles during

the last 30 days. Injecting drug users are

newly recruited study participants who

report injecting drugs during the past 30

days and whose drug-using behavior is

confirmed by observation of track marks

or positive urine tests.

Data Sources

Data for objective 18.1 on the

number of AIDS cases by year of

diagnosis are available from the CDC’s

HIV/AIDS Surveillance System and are

adjusted for both delayed and

incomplete reporting (12). Data on

AIDS cases are more often published by

year of report than by year of diagnosis.

Approximately 20 percent of AIDS cases

are reported more than a year after

diagnosis. The estimated number of

AIDS cases by year of diagnosis

changes as new data become available

because AIDS cases diagnosed in

previous years continue to be reported

and because the adjustment factor for

delays in reporting changes as new data

become available. The adjustment factor

for underreporting is based on the

assumption that 90 percent of all AIDS

cases are eventually reported (13).

Healthy People 2000 data from this

surveillance system cover the 50 States

and the District of Columbia only. The

data usually published by the AIDS

Surveillance System also include United

States dependencies, possessions, and

nations in free association with the

United States.

The baseline data on counseling to

prevent HIV and other STD’s for

objective 18.9 are from the Primary

Care Provider Surveys (PCPS). The

sample was drawn from the membership

rolls of professional organizations for

pediatricians, nurse practitioners, family

physicians, obstetricians/gynecologists,

and internists. Response rates varied

from 50 to 80 percent across these

groups. The data on counseling refer to

the proportion of providers who

routinely delivered these services to

81–100 percent of their patients who

needed the services.

The Prevention in Primary Care

Study (PPCS) was conducted in

1997–98 to update data from the PCPS.

The design and items included in the

1997–98 study were similar to the

PCPS, but a slightly different sampling

frame was used and some items

included in the 1992 surveys were not

included in the PPCS. The professionals

were sampled from listings of all

licensed, active practitioners in the

United States whose practices were at

least 50 percent primary care. Because

of low response rates from the other

provider groups, updates are available

only for nurse practitioners.

Data for objective 18.16 are from

the CDC-sponsored Worksite

Benchmark Survey, which was a

telephone survey of nongovernment

worksites. Worksites were sampled

because different worksites within the

same company could have different sets

of health promotion activities. Active

methods (for example, classes) were

counted as worksite health promotion

activities; passive methods (for example,

brochures) were not included (14,15).

Data Comparability

Beginning with data for 1996, the

incidence of AIDS cases (18.1)is

computed for the age group 13 years

and over. For previous years, the age

group 18 years and over was used. In

addition, the methodology for

determining AIDS incidence has

changed. Because of the impact of new

combination therapies, researchers can

no longer reliably predict the number of

people who will be diagnosed with

AIDS opportunistic infections each year.

There is no longer a way to determine

the length of time it takes an infected

individual on treatment to develop an

opportunistic infection because treatment

has slowed the progression of disease

for many individuals and the duration of

the effects of these drugs are not certain.

Moreover, after 1996, AIDS incidence

will no longer provide an indication of

Healthy People 2000 Final Review 257

trends in HIV transmission. Therefore,

estimates of AIDS incidence from 1986

to 1996 are presented to assess the

direction of the epidemic before the

impact of new combination therapies.

Also beginning with 1996 data, the

number of AIDS cases for MSM’s

excludes those who were also IDU’s

and the number of cases of IDU’s

excludes those who also were MSM’s.

In 1996, the number of AIDS cases

among those who were both IDU’s and

MSM’s was 2,680.

Baseline and 1995 data for ‘‘all

females’’ for objective 18.3 (adolescent

postponement of sexual intercourse), for

females 15–44 years of age and 15–19

years of age for objective 18.4 (condom

use at last sexual intercourse), and for

‘‘all females’’ for objective 18.15

(adolescent abstinence) are from the

NSFG. Baseline and 1995 data for ‘‘all

males’’ for these objectives are from the

National Survey of Adolescent Males

(NSAM). Biennial tracking data from

the Youth Risk Behavior Survey

(YRBS) are also displayed for these

objectives, but are not directly

comparable to the baselines or the

targets. The YRBS is a school-based

survey and thus does not include

teenagers who are not in school and

who are potentially at higher risk of

these behaviors (16). YRBS data, shown

by age in this report, are published by

grade only in other publications. (See

text for Priority Area 5 for more

information.)

The update for objective 18.7

comes from Lackritz et al., who

obtained data from the American Red

Cross on donations collected between

January 1992 through December 1993

(17). The more sensitive screening

enzyme immunosorbent assay antibody

test introduced in 1992 is one possible

reason for the estimated risk decreasing

remarkably between 1990 and 1992–93.

Proxy Data

Objective 18.8 targets an increase in

the proportion of HIV-infected people

who know their serostatus. A reported

posttest counseling session from a

publicly funded site is used as a

measure for knowledge of serostatus.

This objective is being measured by the

percent of positive HIV tests for which

tested people returned for counseling.

Some people who were tested and

returned for counseling may have had

more than one test during the year. CDC

believes that because of numerous

operational difficulties, posttest

counseling is under-reported by publicly

funded sites. These numbers, therefore,

are probably an underestimate, and

represent the lowest possible percent.

Data Availability

No national data are routinely

available that directly measure HIV

seroprevalence among the general

population (18.2). Estimates of the

prevalence of HIV infection in the U.S.

population as a whole are based on

mathematical models using back

calculation, a statistical method that

estimates the number of prior HIV

infections that would account for the

number of AIDS cases that have

subsequently occurred (12) as well as

serostatus data from the Survey on

Childbearing Women and from the

National Health and Nutrition

Examination Survey III (18,19).

Nationally representative estimates of

HIV seroprevalence among high-risk

groups are not available. Information on

the proportion infected among men who

have sex with men and injecting drug

users has been obtained from

seroprevalence studies conducted in

clinical settings as part of a sentinel

surveillance system conducted by CDC

in collaboration with State and local

health departments (20). The

surveillance system covers various

clinical settings in selected metropolitan

areas. Seroprevalence estimates for men

who have sex with men are based on

anonymous surveys conducted in STD

clinics. For injecting drug users,

estimates are based on surveys among

drug users entering treatment programs.

Clients attending STD clinics and drug

treatment programs are not

representative of all persons with these

high-risk behaviors.

References

1. Centers for Disease Control and Prevention.

Update: Trends in AIDS incidence, deaths, and

prevalence—United States, 1996. MMWR

46:165–93. 1997.

2. Centers for Disease Control and Prevention.

HIV/AIDS Surveillance Report, 1998; vol 10 no 2.

1998.

3. Lindegren ML, Byers RH, Thomas P, et al.

Trends in perinatal transmission of HIV/AIDS in

the United States. JAMA 282:531–8. 1999.

4. Centers for Disease Control and Prevention.

HIV/AIDS Surveillance Report, 1999; vol 11 no 2.

1999.

5. Centers for Disease Control and Prevention.

Guidelines for national human immunodeficiency

virus case surveillance, including monitoring for

human immunodeficiency virus infection and

acquired immunodeficiency syndrome. MMWR

48(RR–13). 1999.

6. Centers for Disease Control and Prevention.

1993 revised classification system for HIV

infection and expanded surveillance case definition

for AIDS among adolescents and adults. MMWR

41(RR 17):1–19. 1992.

7. Occupational exposure to bloodborne

pathogens; final rules (29 CFR 1910.1030).

Federal Register: 56:64004–182. Dec. 6, 1991.

8. Department of Health and Human Services.

Healthy people 2010. 2d ed. With understanding

and improving health and objectives for improving

health. 2 vols. Washington: U.S. Government

Printing Office. 2000.

9. Fleming PL, Whortley PM, Karon JM, et al.

Tracking the HIV epidemic: Current issues, future

challenges. AJPH 90:1037–41. 2000.

10. Centers for Disease Control and Prevention.

Surveillance for AIDS-defining opportunistic

illnesses, 1992–1997. In CDC Surveillance

Summaries, April 16, 1999. MMWR 48(SS–2).

1999.

11. Unpublished estimates from the National

Household Survey on Drug Abuse. Prevalence

Branch, Substance Abuse and Mental Health

Services Administration. 1997.

12. Centers for Disease Control and Prevention.

HIV/AIDS Surveillance Report 9(2):1–39. 1998.

13. Rosenblum L, Buehler JW, Morgan MW, et al.

The completeness of AIDS case reporting, 1988: A

multisite collaborative surveillance project. AJPH

82:1495–9. 1992.

14. Department of Health and Human Services.

Business Responds to AIDS Benchmark Survey:

Technical report. Atlanta, Georgia: Public Health

Service. Centers for Disease Control and

Prevention. 1996.

15. Centers for Disease Control and Prevention.

Cancer screening offered by worksites—United

States, 1992 and 1995. MMWR 46(19): 421–4.

1997.

16. Centers for Disease Control and Prevention.

Health risk behaviors among adolescents who do

and do not attend schools: United States, 1992.

MMWR 43:129–32. 1994.

17. Lackritz EM, Satten GA, Aberle-Grasse J, et

al. Estimated risk of transmission of the human

immunodeficiency virus by screened blood in the

United States. N Engl J Med 333(26):1721–5.

1995.

18. Karon JM, Rosenberg PS, McQuillan G, et al.

Prevalence of HIV infection in the United States,

1984–92. JAMA 276:126–31. 1996.

19. Karon JM. Methods for estimating HIV

prevalence in the United States. Washington:

Department of Health and Human Services,

National AIDS Clearinghouse. 1996.

20. Centers for Disease Control and Prevention.

National HIV serosurveillance summary, vol 3.

Results through 1992. HIV/NCID/11–93/036.

Atlanta, Georgia: Department of Health and

Human Services. 1994.

258 Healthy People 2000 Final Review

Table 18. HIV Infection objectives

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

18.1 Slow the rise in incidence of AIDS

cases (per 100,000 population

18 years and over) ............... 1989 17.0 20.9 25.2 33.1 32.8 29.8 28.6

27.8

23.1

19.5 - - - 43

a. Men who have sex with men

(number of cases) ............. 1989 27,000 28,574 34,005 42,706 39,326 34,146 30,696

1,2

23,420

1,2

21,341

1,2

17,847 - - - 48,000

b. Black (non-Hispanic)............ 1989 44.4 59.0 73.0 100.8 107.8 102.9 100.5

110.9

98.1

82.9 - - - 136

c. Hispanic ..................... 1989 34.9 33.1 39.9 51.5 53.7 49.4 47.1

48.4

40.5

33.0 - - - 76

d. Female...................... 1989 3.5 5.3 6.9 9.9 11.1 10.9 11.2

11.6

10.4

8.8 - - - 13

e. Injecting drug users (number of

cases) ...................... 1989 10,300 12,466 15,696 21,899 23,399 20,734 19,100

1,3

15,583

1,3

15,697

1,3

12,099 - - - 25,000

18.2 Slow the rise in prevalence of HIV

infection (per 100,000 population

13 years and over) ............... 1989 400 400 - - - 310–420 - - - - - - - - - - - - - - - - - - - - - 400

a. Men who have sex with men

(15 years and over)

........... 1989

15,000–

61,800

17,400–

60,900 - - -

3,900–

47,400 - - - - - - - - - - - - - - - - - - - - - 20,000

b. Injecting drug users (15 years and

over)

...................... 1989

0–48,200 0–49,300 - - -

600–

52,900 - - - - - - - - - - - - - - - - - - - - - 40,000

c. Females giving birth to live-born

infants (15–44 years) ........... 1989 160 160 170 170 160 160 - - - - - - - - - - - - - - - 100

18.3* Adolescents who ever engaged in

sexual intercourse

Adolescents 15 years

All females .................... 1988 27% - - - - - - - - - - - - - - - 22% - - - - - - - - - - - - 15%

In-school females.............. ... --- 35% 36% --- 37% --- 38% --- 44% --- 43% ...

All males ...................... 1988 33% - - - - - - - - - - - - - - - 27% - - - - - - - - - - - - 15%

In-school males ............... ... --- 48% 44% --- 45% --- 42% --- 42% --- 34% ...

a. All black males ................ 1988 69% - - - - - - - - - - - - - - - 58% - - - - - - - - - - - - 15%

In-school non-Hispanic black

males...................... ... --- --- 79% --- 82% --- 77% --- 75% --- 68% ...

Adolescents 17 years

All females .................... 1988 50% - - - - - - - - - - - - - - - 51% - - - - - - - - - - - - 40%

In-school females.............. ... --- 62% 66% --- 66% --- 67% --- 62% --- 40% ...

All males ...................... 1988 66% - - - - - - - - - - - - - - - 53% - - - - - - - - - - - - 40%

In-school males ............... ... --- 73% 68% --- 68% --- 65% --- 60% --- 44% ...

b. All black males ................ 1988 90% - - - - - - - - - - - - - - - 79% - - - - - - - - - - - - 40%

In-school non-Hispanic black

males...................... ... --- --- 90% --- 92% --- 88% --- 85% --- 82% ...

c. All black females 15–17 years..... 1988 66% - - - - - - - - - - - - - - -

48% --- --- --- --- 40%

In-school non-Hispanic black

females .................... ... --- --- 84% --- 80% --- 75% --- 73% --- 73% ...

18.4* Condom use at last sexual

intercourse

Sexually active unmarried females

15–44 years (by their partners) ...... 1988 19% - - - - - - - - - - - - - - - 25% - - - - - - - - - - - - 50%

See footnotes and key at end of table.

Healthy People 2000 Final Review 259

Table 18. HIV Infection objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

a. Sexually active females

15–19 years (by their partners) . . . 1988 26% - - - - - - - - - - - - - - - 37% - - - - - - - - - - - - 60%

Sexually active females 15–19

years in grades 9–12 (by their

partners) .................. ... --- 40% 38% --- 46% --- 49% --- 51% --- 51% ...

b. Sexually active males 15–19 years . 1988 57% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 75%

Sexually active males 15–19

years in grades 9–12 ........ ... --- 49% 54% --- 59% --- 61% --- 63% --- 66% ...

c. Injecting drug users ............ 1992

34% ... ... ... --- --- --- --- --- --- --- 75%

d. Black female 15–44 years (by their

partners) .................... 1988 12.4% - - - - - - - - - - - - - - -

25% --- --- --- --- 75%

18.5 Injecting drug users enrolled in

treatment ...................... 1989 11% - - - 28.7% 29.8% 45.9% 47.8% 34.1% - - - - - - - - - - - - 50%

18.6 Injecting drug users not in treatment

who did not share needles (in

previous 30 days) ................ 1991 30.8% . . . . . . - - -

57.7%

60.6%

60.0% - - - - - - - - - - - - 75%

18.7 Risk of transfusion-transmitted

HIV infection (per units of

blood) ......................... 1989

1 per

40,000–

150,000

1 per

221,000 - - - - - -

1 per

450,000–

660,000 - - - - - - - - -

1 per

625,000 - - - - - -

1 per

250,000

18.8 HIV-infected people who know their

serostatus

Percent of positive HIV tests for which

people returned for counseling ...... 1990 72.5% . . . - - - - - - - - - - - - 83% 74% - - - 63% - - - 80%

18.9* Clinician counseling to prevent HIV

and other sexually transmitted

diseases ...................... 1987

10% --- --- --- --- --- --- --- --- --- --- 75%

Percent of clinicians routinely providing

service to 81–100% of patients

a. Providers practicing in high

incidence areas ............... ... --- --- --- --- --- --- --- --- --- --- --- 90%

b. Family physicians .............. 1992 27% . . . . . . . . . - - - - - - - - - - - - - - -

14,15

--- --- 75%

c. Internists..................... 1992 30% . . . . . . . . . - - - - - - - - - - - - - - -

14,15

--- --- 75%

d. Nurse practitioners ............. 1992 50% . . . . . . . . . - - - - - - - - - - - - - - -

45% - - - 75%

e. Obstetricians/gynecologists....... 1992 46% . . . . . . . . . - - - - - - - - - - - - - - -

14,15

--- --- 75%

f. Pediatricians .................. 1992 46% . . . . . . . . . - - - - - - - - - - - - - - -

14,15

--- --- 75%

g. Mental health care providers...... ... --- --- --- --- --- --- --- --- --- --- --- 75%

18.10* HIV and other STD education

curricula

Schools offering at least one STD

class.......................... 1988 95% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 95%

Proportion of middle and senior high

schools:

With HIV prevention in required

courses ...................... ... --- --- --- --- --- 86% --- --- --- --- --- ...

See footnotes and key at end of table.

260 Healthy People 2000 Final Review

Table 18. HIV Infection objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

With STD prevention in required

courses ...................... ... --- --- --- --- --- 84% --- --- --- --- --- ...

18.11* HIV and STD education for students

at colleges and universities

Students 18 years and over given:

AIDS or HIV infection prevention

information ................... 1995 49.1% . . . . . . . . . . . . . . . . . . - - - - - - - - - - - - 90%

STD prevention information ........ 1995 43.4% . . . . . . . . . . . . . . . . . . - - - - - - - - - - - - 90%

Students 18 years and over taught

about AIDS or HIV in a college class. . 1995 41.4% . . . . . . . . . . . . . . . . . . - - - - - - - - - - - - 90%

18.12 Outreach HIV programs for drug

users (cities with populations greater

than 100,000) ................... 1991 35% . . . . . . 32% - - - - - - - - - - - - - - - - - - - - - 90%

18.13 Clinic services for HIV and other

sexually transmitted diseases ..... ... --- --- --- --- --- --- --- --- --- --- --- 50%

Family planning clinics ............. 1989 40% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . .

Title X funded family planning clinics

STD testing (excluding HIV)........ ... --- --- --- --- --- 95% --- --- --- --- --- ...

STD counseling (excluding HIV) .... ... --- --- --- --- --- 98% --- --- --- --- --- ...

STD treatment (excluding HIV) ..... ... --- --- --- --- --- 93% --- --- --- --- --- ...

Gonorrhea

Client testing

................. ... --- 97% --- --- --- --- --- --- --- --- --- ...

Client treatment................. ... --- 82% --- --- --- --- --- --- --- --- --- ...

Partner notification

............. ... --- 23% --- --- --- --- --- --- --- --- --- ...

Partner testing.................. ... --- 60% --- --- --- --- --- --- --- --- --- ...

Partner treatment ............... ... --- 62% --- --- --- --- --- --- --- --- --- ...

Syphilis

Client testing

................. ... --- 86% --- --- --- --- --- --- --- --- --- ...

Client treatment................. ... --- 48% --- --- --- --- --- --- --- --- --- ...

Partner notification

............. ... --- 29% --- --- --- --- --- --- --- --- --- ...

Partner testing.................. ... --- 57% --- --- --- --- --- --- --- --- --- ...

Partner treatment ............... ... --- 40% --- --- --- --- --- --- --- --- --- ...

Chlamydia

Client testing

................. ... --- 66% --- --- --- --- --- --- --- --- --- ...

Client treatment................. ... --- 73% --- --- --- --- --- --- --- --- --- ...

Partner notification

............. ... --- 15% --- --- --- --- --- --- --- --- --- ...

Partner testing.................. ... --- 29% --- --- --- --- --- --- --- --- --- ...

Partner treatment ............... ... --- 50% --- --- --- --- --- --- --- --- --- ...

HIV

Client pretest counseling .......... ... --- 66% --- --- --- 82% --- --- --- --- --- ...

Client testing ................... ... --- 60% --- --- --- 74% --- --- --- --- --- ...

See footnotes and key at end of table.

Healthy People 2000 Final Review 261

Table 18. HIV Infection objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

18.14 Regulations to protect workers from

occupational exposure to

bloodborne infections, including

HIV

Proportion of work places ........... 1992 100% . . . . . . . . . 100% 100% 100% 100% 100% 100% 100% 100%

18.15* Adolescent abstinence from sexual

intercourse for previous 3 months

All sexually active females

15–17 years .................... 1988 23.6% - - - - - - - - - - - - - - - 27% - - - - - - - - - - - - 40%

In-school sexually active females

15–17 years .................... ... --- 24% 25% --- 25% --- 23% --- 23% --- 25% ...

All sexually active males 15–17 years . . 1988 33% - - - - - - - - - - - - - - - 37% - - - - - - - - - - - - 40%

In-school sexually active males 15–17

years ......................... ... --- 30% 36% --- 33% --- 34% --- 32% --- 32% ...

18.16 Comprehensive HIV/AIDS workplace

programs

Proportion of businesses with policies,

management training, and employee

education:

Small businesses (15–49

employees) ................... 1995 2% . . . . . . . . . . . . . . . . . . - - - - - - - - - - - - 10%

Medium businesses (50–749

employees) ................... ... --- --- --- --- --- --- 7% --- --- --- --- ...

Large businesses (750 or more

employees) ................... 1995 25% . . . . . . . . . . . . . . . . . . - - - - - - - - - - - - 50%

Proportion of businesses with policies:

Small businesses (15–49

employees) ................... ... --- --- --- --- --- --- 18% --- --- --- --- ...

Medium businesses (50–749

employees) ................... ... --- --- --- --- --- --- 42% --- --- --- --- ...

Large businesses (750 or more

employees) ................... ... --- --- --- --- --- --- 79% --- --- --- --- ...

Proportion of businesses with

management training:

Small businesses (15–49

employees) ................... ... --- --- --- --- --- --- 18% --- --- --- --- ...

Medium businesses (50–749

employees) ................... ... --- --- --- --- --- --- 41% --- --- --- --- ...

Large businesses (750 or more

employees) ................... ... --- --- --- --- --- --- 77% --- --- --- --- ...

Proportion of businesses with employee

education:

Small businesses (15–49

employees) ................... ... --- --- --- --- --- --- 6% --- --- --- --- ...

See footnotes and key at end of table.

262 Healthy People 2000 Final Review

Table 18. HIV Infection objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Medium businesses (50–749

employees) ................... ... --- --- --- --- --- --- 16% --- --- --- --- ...

Large businesses (750 or more

employees) ................... ... --- --- --- --- --- --- 32% --- --- --- --- ...

Federal government departments and

agencies ....................... 1995 80% . . . . . . . . . . . . . . . . . . - - - - - - - - - - - - 100%

18.17 Linkages between substance abuse

treatment programs and primary

care clinics

Federally funded primary care clinics . . . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 40%

Federally funded substance abuse

treatment programs............... ... --- --- --- --- --- --- --- --- --- --- --- 40%

- - - Data not available. Final objective status:

. . . Category not applicable.

Baseline has been revised.

Beginning with 1996, data are for people 13 years and over and methodology is changed. See text for Priority Area 18.

Beginning with 1996 data, excludes men who are also injecting drug users. See text for Priority Area 18.

Beginning with 1996 data, excludes men who also had sex with men. See text for Priority Area 18.

Range of clinic-specific HIV prevalence rates among men who have sex with men attending sexually transmitted disease clinics participating in CDC’s National Serosurveillance Program.

1991–92 data.

Range of clinic-specific HIV prevalence rates among injecting drug users attending sexually transmitted disease clinics participating in CDC’s National Serosurveillance Program.

Data are for non-Hispanic black females.

Data are for male and female injecting drug users (married and unmarried) who report having vaginal sex within the last 6 months and reported using a condom ‘‘always’’ or ‘‘sometimes.’’

Data are for January 1992 through April 1993.

Data are for May 1993 through December 1995.

Data are for January 1992 through July 1996.

1992–93 data.

Data are for new patients only.

1997–98 data.

Response rate for this group was too low to produce reliable estimates.

Includes testing at initial visit, at annual visit, or if symptomatic.

By family planning clinic staff via telephone or mail.

NOTES: Data include revisions and, therefore, may differ from data previously published in these reports and other publications. AIDS is acquired immunodeficiency syndrome. HIV is human

immunodeficiency virus. STD is sexually transmitted disease.

Objective number Data source

18.1,18.1a–e HIV/AIDS Surveillance System, CDC, NCHSTP.

18.2, 18.2a–c Baseline and 1990 update: CDC, NCHSTP.

1992 update for total population: Karon JM, et. al. Prevalence of HIV infection in the United States, 1984 to 1992. JAMA 276(2):126–31. 1996.

18.3* Baseline and updates for all females and all black females: National Survey of Family Growth, CDC, NCHS.

Baseline and updates for all males and all black males: National Survey of Adolescent Males, NIH, NICHD.

1990–99 data for in-school females and males: Youth Risk Behavior Survey, CDC, NCCDPHP.

18.4*, 18.4d National Survey of Family Growth, CDC, NCHS.

18.4a Baseline: National Survey of Family Growth, CDC, NCHS.

1990–99 data for in-school females and males: Youth Risk Behavior Survey, CDC, NCCDPHP.

18.4b Baseline: National Survey of Adolescent Males, NIH, NICHD.

Met

Toward

Mixed/ no change

Away

Cannot assess

Healthy People 2000 Final Review 263

Objective number Data source

1990–99 data for in-school females and males: Youth Risk Behavior Survey, CDC, NCCDPHP.

18.4c National AIDS Demonstration Research Program, NIH, NIDA.

18.5 Baseline: NIH, NIDA.

Updates: National Household Survey on Drug Abuse, SAMHSA, OAS.

18.6 Baseline: National AIDS Demonstration Research Program, NIH, NIDA.

Updates: Cooperative Agreement for AIDS Community-based Outreach/Intervention Research Program, NIH, NIDA.

18.7 Baseline: American Association of Blood Banks.

1990 update: Comprehensive Blood Donations Data Set, CDC, NCHSTP.

1992–93 update: Lackritz EM, et al. Estimated risk of transmission of the human immunodeﬁciency virus by screened blood in the United States. NEJM

333(26):1721–5. 1995.

1997 update: Busch MP and Kleinman SH. Nucleic acid ampliﬁcation testing of blood donors for transfusion-transmitted infectious diseases. Transfusion

40:143–59. 2000.

18.8 HIV Counseling and Testing Data Sites System, CDC, NCHSTP.

18.9* 1987 baseline: Sexual history-taking and counseling practices of primary care physicians, Lewis CE and Freeman HE. Western Journal of Medicine 147:

165–7. 1987.

1992 baseline: Primary Care Provider Surveys, OPHS, ODPHP.

Update: Prevention in Primary Care Study, American College of Preventive Medicine.

18.10* Baseline: AIDS education: Public school programs require more student information and teacher training. GAO, 1990.

1994 data: School Health Policies and Programs Study, CDC, NCCDPHP.

18.11 National College Health Risk Behavior Survey, CDC, NCCDPHP.

18.12 CDC, NCHSTP.

18.13* Baseline: State Family Planning Directors.

1990 data: National Questionnaire on Provision of STD and HIV Services by Family Planning Clinics, OPA.

1994 data: The Urban Institute. Family planning clinics: Current status and recent changes in services, clients, staffing and income sources. March 1994.

18.14 Occupational exposure to bloodborne pathogens; ﬁnal rule (29 CFR 1910, 1030). Federal Register 56:64004–182. December 6, 1991.

18.15* Baseline and update for all females: National Survey of Family Growth, CDC, NCHS.

Baseline and update for all males: National Survey of Adolescent Males, NIH, NICHD.

1990–99 data for in-school females and males: Youth Risk Behavior Survey, CDC, NCCDPHP.

18.16 Businesses: Business Responds to AIDS Benchmark Survey, CDC, NCHSTP.

Federal government: CDC.

* Duplicate objective. See full text of objective following this table.

264 Healthy People 2000 Final Review

HIV Infection

Objectives

18.1: Conﬁne annual incidence of

diagnosed AIDS cases to no more than

43 per 100,000 population.

18.1a: Conﬁne annual incidence of

diagnosed AIDS cases among men

who have sex with men to no more

than 48,000 cases.

18.1b: Conﬁne annual incidence of

diagnosed AIDS cases among

blacks to no more than 136 per

100,000 population.

18.1c: Conﬁne annual incidence of

diagnosed AIDS cases among

Hispanics to no more than 76 per

100,000 population.

18.1d: Conﬁne annual incidence of

diagnosed AIDS cases among

women to no more than 13 per

100,000 population.

18.1e: Conﬁne annual incidence of

diagnosed AIDS cases among

injecting drug users to no more than

25,000.

18.2: Conﬁne the prevalence of HIV

infection to no more than 400 per

100,000 people.

18.2a: Conﬁne the prevalence of

HIV infection among men who

have sex with men to no more than

20,000 per 100,000.

18.2b: Conﬁne the prevalence of

HIV infection among injecting drug

users to no more than 40,000 per

100,000.

18.2c: Conﬁne the prevalence of

HIV infection among women giving

birth to live-born infants to no more

than 100 per 100,000.

18.3*: Reduce the proportion of

adolescents who have engaged in sexual

intercourse to no more than 15 percent

by age 15 and no more than 40 percent

by age 17.

Duplicate objectives: 5.4 and 19.9

18.3a*: Reduce the proportion of

black males aged 15 years who

have engaged in sexual intercourse

to no more than 15 percent.

Duplicate objectives: 5.4a and 19.9a

18.3b*: Reduce the proportion of

black males aged 17 years who

have engaged in sexual intercourse

to no more than 40 percent.

Duplicate objectives: 5.4b and 19.9b

18.3c*: Reduce the proportion of

black females aged 17 years who

have engaged in sexual intercourse

to no more than 40 percent.

Duplicate objectives: 5.4c and 19.9c

18.4*: Increase to at least 50 percent the

proportion of sexually active, unmarried

people who used a condom at last

sexual intercourse.

Duplicate objective: 19.10

18.4a*: Increase to at least

60 percent the proportion of

sexually active, unmarried young

women aged 15–19 whose partners

used a condom at last sexual

intercourse.

Duplicate objective: 19.10a

18.4b*: Increase to at least

75 percent the proportion of

sexually active, unmarried young

men aged 15–19 who used a

condom at last sexual intercourse.

Duplicate objective: 19.10b

18.4c*: Increase to at least

75 percent the proportion of

injecting drug users who used a

condom at last sexual intercourse.

Duplicate objective: 19.10c

18.4d*: Increase to at least

75 percent the proportion of black

women aged 15–44 whose partners

used a condom at last sexual

intercourse.

Duplicate objective: 19.10d

18.5: Increase to at least 50 percent the

estimated proportion of all injecting

drug users who are in drug abuse

treatment programs.

18.6: Increase to at least 75 percent the

estimated proportion of active injecting

drug users who use only new or

properly decontaminated syringes,

needles, and other drug paraphernalia

(‘‘works’’).

18.7: Reduce to no more than 1 per

250,000 units of blood and blood

components the risk of transfusion-

transmitted HIV infection.

18.8: Increase to at least 80 percent the

proportion of HIV-infected people who

know their serostatus.

18.9*: Increase to at least 75 percent the

proportion of primary care and mental

health care providers who provide

appropriate counseling on the prevention

of HIV and other sexually transmitted

diseases.

Duplicate objective: 19.14

18.9a*: Increase to at least

90 percent the proportion of primary

care and mental health care

providers who practice in areas of

high AIDS and sexually transmitted

disease incidence, who provide

appropriate counseling on the

prevention of HIV and other

sexually transmitted diseases.

Duplicate objective: 19.14a

18.9b*: Increase to at least

75 percent the proportion of family

physicians who provide appropriate

counseling on the prevention of

HIV and other sexually transmitted

diseases.

Duplicate objective: 19.14b

18.9c*: Increase to at least

75 percent the proportion of

internists who provide appropriate

counseling on the prevention of

HIV and other sexually transmitted

diseases.

Duplicate objective: 19.14c

18.9d*: Increase to at least

75 percent the proportion of nurse

practitioners who provide

appropriate counseling on the

prevention of HIV and other

sexually transmitted diseases.

Duplicate objective: 19.14d

18.9e*: Increase to at least

75 percent the proportion of

obstetricians/gynecologists who

provide appropriate counseling on

the prevention of HIV and other

sexually transmitted diseases.

Duplicate objective: 19.14e

18.9f*: Increase to at least

75 percent the proportion of

pediatricians who provide

appropriate counseling on the

prevention of HIV and other

sexually transmitted diseases.

Duplicate objective: 19.14f

Healthy People 2000 Final Review 265

18.9g*: Increase to at least

75 percent the proportion of mental

health care providers who provide

appropriate counseling on the

prevention of HIV and other

sexually transmitted diseases.

Duplicate objective: 19.14g

18.10*: Increase to at least 95 percent

the proportion of schools that have

appropriate HIV and other STD

education curricula for students in

4th–12th grade, preferably as part of

comprehensive school health education,

based upon scientiﬁc information that

includes the way HIV and other STDs

are prevented and transmitted.

Duplicate objective: 19.12

18.11*: Increase to at least 90 percent

the proportion of students who received

HIV and other STD information,

education, or counseling on their college

or university campus.

Duplicate objective: 19.17

18.12: Increase to at least 90 percent the

proportion of cities with populations

over 100,000 that have outreach

programs to contact drug users

(particularly injecting drug users) to

deliver HIV-risk-reduction messages.

18.13*: Increase to at least 50 percent

the proportion of family planning

clinics, maternal and child health clinics,

sexually transmitted disease clinics,

tuberculosis clinics, drug treatment

centers, and primary care clinics that

provide on site primary prevention and

provide or refer for secondary

prevention services for HIV infection

and bacterial sexually transmitted

diseases (gonorrhea, syphilis, and

chlamydia) to high-risk individuals and

their sex or needle-sharing partners.

Duplicate objectives: 5.11 and 19.11

18.14: Extend to all facilities where

workers are at risk for occupational

transmission of HIV regulations to

protect workers from exposure to blood

borne infections, including HIV

infection.

18.15*: Increase to at least 40 percent

the proportion of ever sexually active

adolescents aged 17 and younger who

have not had sexual intercourse for the

previous 3 months.

Duplicate objectives: 5.5 and 19.16

18.16: Increase to at least 50 percent the

proportion of large businesses and to

10 percent the proportion of small

businesses that implemented a

comprehensive HIV/AIDS workplace

program. Increase to 100 percent the

proportion of Federal Government

departments and agencies that

implemented a comprehensive

HIV/AIDS workplace program.

18.17: Increase to at least 40 percent the

number of federally funded primary care

clinics that have formal established

linkages with substance abuse treatment

programs and increase to at least

40 percent the number of federally

funded substance abuse treatment

programs that have formal established

linkages with primary care clinics.

*Duplicate objective.

266 Healthy People 2000 Final Review

Priority Area 19

Sexually Transmitted

Diseases

Background

Sexually transmitted diseases

(STDs) refer to the more than 25

infectious organisms transmitted

primarily through sexual activity. STD

rates have declined substantially in the

United States since 1936 when programs

for their prevention and control were

established through collaborative efforts

of Federal, State, and local health

authorities. Throughout the 1990s,

considerable progress was realized as

programs continued and were expanded

(1). Nevertheless, STDs remain at

epidemic levels in this country, and the

United States continues to record the

highest STD rates in the industrialized

world (2). STDs disproportionately

affect women, infants, adolescents, and

communities of color (1). Syphilis

remains one of the most glaring

examples of racial disparities in health;

1999 rates among African Americans

were 30 times those among white

Americans (3). Gonorrhea and

chlamydia rates are highest among

adolescents and young adults. More than

65 million Americans are currently

living with an incurable viral STD such

as genital herpes or human

papillomavirus infection (HPV) (4).

Overall, an estimated 15 million new

cases of non-HIV STDs, such as

syphilis, chlamydia, gonorrhea, herpes,

hepatitis B, and HPV infection, occur at

an annual direct and indirect cost of at

least $10 billion. Approximately

25 percent of new STD cases occur

among adolescents (2). These infections

frequently cause severe, life-long

consequences, especially among women,

adolescents, and infants. The

consequences of STDs include

involuntary infertility, potentially fatal

tubal pregnancy, other adverse

pregnancy outcomes such as stillbirths

and newborn (congenital) infections,

increased risk of HIV transmission, and

cervical and liver cancers (1).

STD transmission is sustained by

the complex interaction of biological,

social, and behavioral factors (1). For

example, STDs are frequently

asymptomatic or can be so mild as to be

unrecognized by infected persons. This

factor helps sustain transmission to

others. Frequently there is a very long

lag time between infection and

complications such as cervical cancer

(from HPV infection) or infertility (from

chlamydia or gonorrhea). Often people

do not recognize the connection between

an earlier STD and a resulting health

problem. Women are at higher risk than

men for most STDs and often suffer

more severe consequences (2). STDs

disproportionately affect disenfranchised

persons, especially those who are in

social networks where high-risk sexual

behaviors are common or access to

high-quality health care is limited (5).

Access to health care is essential for

early detection, treatment, and

behavior-change counseling for STDs.

Groups with the highest rates of STDs

are often the same groups in which

access to health services is most limited.

Complicating matters is the continued

stigma associated with STDs and

Americans’ general discomfort with

openly discussing intimate aspects of

life, especially those related to sex. The

latter two factors greatly impede efforts

to change sexual behaviors on the part

of parents, educators, and health care

providers.

Because of the challenging

dynamics of STD transmission, STD

prevention efforts must use diverse,

multifactorial interventions (1).

Behavioral interventions are essential.

They can help people abstain from

sexual intercourse, delay initiation of

intercourse, reduce the number of sex

partners, and increase the use of

effective physical barriers such as

condoms. Biological interventions are

equally important. They include

screening, diagnosis, treatment, and

early antimicrobial prophylaxis of sex

partners.

Data Summary

Highlights

During the 1990s, notable progress

was made in reducing the incidence and

complications associated with common

bacterial STDs. From 1985 to 1996,

rates of gonorrhea (19.1) decreased

nearly 10 percent annually. Rates

stabilized between 1996 and 1997, and,

between 1997 and 1999, gonorrhea rates

increased by 9 percent. The 1999

gonorrhea rate of 133 per 100,000

population approached, but did not

meet, the Healthy People 2000 target of

100. Gonorrhea rates remain high

among adolescents, young adults, and

African Americans.

In the 1990s, chlamydia (19.2)

emerged as the most commonly reported

notifiable infectious disease in the

United States (6). An estimated 3

million people contract chlamydia each

year, a decline from more than 4 million

cases per year in the early 1980s (4).

The Healthy People 2000 objective of

less than 5 percent chlamydia positivity

in women tested in family planning

clinics was achieved for women 20–24

years of age (4.5 percent positivity in

1999). Positivity declined in women

15–19 years of age, from 12.2 percent in

1988 to 6.6 percent in 1999.

Untreated gonorrhea and chlamydia

infection in women can lead to pelvic

inflammatory disease (PID). As

gonorrhea and chlamydia morbidity

declined through the 1990s, so did the

incidence of PID. There were steady

declines in PID hospitalizations and PID

visits to physicians (19.6). PID

hospitalizations decreased from a

baseline of 311 per 100,000 females

15–44 years of age to a rate of 155 in

1998. Visits to physicians for PID

decreased from 431,000 visits per year

in 1988 to 251,000 in 1999. This

exceeded the Healthy People 2000

target of 290,000.

The 1990s began with the United

States experiencing one of the highest

rates of primary and secondary (P&S)

syphilis (19.3) (20.3 per 100,000

population) since the 1940s. Remarkable

progress occurred during the past

decade. The 1999 P&S syphilis rate was

the lowest since reporting began in

1941. The P&S syphilis rate declined by

88 percent since 1990 to a 1999 rate of

2.5 cases per 100,000 for the general

population. The Healthy People 2000

target of less than 4 per 100,000 was

achieved. The Healthy People 2000

target for African Americans of less than

30 per 100,000 was also achieved with a

reported rate of 15 per 100,000 in 1999.

Congenital syphilis (19.4) occurs when

infants acquire syphilis from their

mothers during pregnancy. The

congenital syphilis rate in the United

States peaked in 1991 at 107 cases per

100,000 live births and declined by

87 percent to 14 per 100,000 in 1999.

The Healthy People 2000 objectives for

congenital syphilis were achieved for

the general population (14.3 per 100,000

live births in 1999 versus Healthy

People 2000 target of 40), African

Healthy People 2000 Final Review 267

19.1 Gonorrhea

19.2 Chlamydia: Female 15-19 years

Female 20-24 years

19.3 Primary and secondary syphilis

19.4 Congenital syphilis

19.5 Annual number: Genital herpes

Genital warts

19.6 Pelvic inflammatory disease, female 15-44 years:

Hospitalizations

Initial visits to physicians

19.7 Sexually transmitted Hepatitis B (number of cases)

19.8 Repeat gonorrhea infection

19.9 Adolescents who ever had sexual intercourse:

Female 15 years

Male 15 years

19.10 Condom use at last intercourse:

Female 15-44 years

Male 15-17 years

19.16 Adolescent abstinence from sexual intercourse

in past 3 months: Female 15-17 years

Female 17 years

Male 17 years

Moved away from target Moved toward target Met target

NOTE: Complete tracking data are shown in table 19. Progress quotients are not calculated for objectives 19.11, 19.12, 19.13, 19.14, 19.15,

and 19.17. See the section on Measuring Progress Toward the

Healthy People 2000

Targets in the Appendix for more information.

78%

-10%

50%

33%

42%

56%

19%

57%

Percent of target achieved

-100 -80 -60 -40 -20 0 20 40 60 80 100

75%

21%

150%

111%

114%

115%

128%

135%

-249%

84%

268 Healthy People 2000 Final Review

Figure 19. Final status on Sexually Transmitted Diseases objectives

Americans (57.9 in 1999 versus 175),

and Hispanics (20.4 in 1999 versus 50).

Fewer first-time health care

consultations for genital warts (19.5)

(240,000 consultations) were seen in

1999 compared with 1988 (290,000).

The Healthy People 2000 target of

fewer than 246,500 genital warts

consultations was achieved. The

opposite trend occurred for genital

herpes (19.5), with 163,000

consultations recorded in 1988 and

224,000 recorded in 1999. The number

of cases of sexually transmitted hepatitis

B infection (19.7) declined, with

reported cases decreasing from 48,000

in 1987 to 25,000 in 1999, thus

surpassing the year 2000 target of fewer

than 30,500 cases.

Some progress was made in

reducing the proportion of adolescents

engaging in sexual intercourse and for

increasing condom use at last

intercourse (19.10b). All groups of

in-school male and female teenagers

(except 15-year-old females) reported a

lower proportion of having engaged in

sexual intercourse in 1999 compared

with 1990. Condom use at last

intercourse by partners of sexually

active in-school females 15–19 years of

age increased from 40 percent in 1990

to 51 percent in 1999. Sexually active

in-school males 15–19 years of age

increased condom use at last intercourse

from 49 percent in 1990 to 66 percent in

1999.

Summary of Progress

Data to assess trends are available

for 14 of 17 objectives in this priority

area. Three objectives (19.3, 19.4, and

19.7) have met or exceeded the year

2000 targets, including all of the special

population targets. Seven objectives

(19.1, 19.2, 19.6, 19.8, 19.10, 19.11, and

19.16) moved toward their targets. One

objective (19.12) was met at baseline;

however, supplemental data for the

objective indicate a trend that could be

moving in the wrong direction. Progress

was mixed for objectives 19.5 and 19.9.

Update data were obtained for objective

19.14 for nurse practitioners only and

indicated that the objective is moving

away from its target. The status for

three objectives (19.13, 19.15, and

19.17) could not be assessed because

data subsequent to the baseline measures

are unavailable. See table 19 for the

tracking data for the objectives in this

priority area and figure 19 for a

quantitative assessment of progress.

Discussion

The STD achievements of the 1990s

demonstrate that STD prevention

programs are highly effective. When

programs are expanded to meet demand,

new technologies can be quickly

adopted, and program efforts are

consistently combined with policies to

expand clinical and community

partnerships for prevention.

Chlamydia declined throughout

much of the 1990s, mainly because of

increased efforts to screen and treat

women. However, from 1997 to 1999,

chlamydia test positivity in family

planning clinics actually increased in 8

out of 10 regions. These reported

increases are most likely due to changes

in newly available and better laboratory

tests and expanded screening programs

to populations with higher levels of

disease. Efforts to create a dedicated

infertility prevention program focusing

on chlamydia and gonorrhea began in

1994 after the success of pilot programs

involving family planning clinics and

public health laboratories and wide

availability of new, cost-effective

diagnostic technologies. Since then,

chlamydia screening has become

increasingly available in publicly funded

family planning and STD clinics. From

1988 to 1999, the Pacific Northwest

experienced a 62 percent decline in

infection among women tested for

chlamydia in family planning clinics (8).

The percentage of women testing

positive for chlamydia—chlamydia

positivity—in family planning clinics by

State provides a good indication of

where the disease remains most

widespread. The highest level of

infection tends to be in areas where

screening and treatment have not been

widely implemented. The greatest

declines generally have been in areas

with the most effective and prolonged

screening programs. Future challenges

will include expanded screening in

women to meet regional demand,

expanded screening programs for men,

and expanded venues in which high-risk

persons can be screened.

In 1999, 79 percent of U.S. counties

reported no P&S syphilis; 25 counties

were responsible for 50 percent of new

cases (3). The unprecedented low rate of

syphilis overall, combined with the

well-documented geographic

concentration of new cases, has created

a unique opportunity to eliminate

syphilis in the United States. In October

1999, the Public Health Service

launched the National Plan to Eliminate

Syphilis from the United States (8). The

elimination effort will expand and

enhance strategies that worked in the

1990s to reduce syphilis to record low

levels: strengthening community

involvement and partnerships, enhancing

syphilis surveillance, conducting rapid

outbreak investigations, expanding

clinical and laboratory services, and

enhancing health promotion.

Landmark studies and improved

testing technology in the 1990s greatly

increased knowledge of the incidence

and prevalence of genital herpes and

HPV. These viral STDs affect far more

Americans than were documented by

Healthy People 2000 baselines in 1988

(163,000 first-time consultations for

genital herpes and 290,000 first-time

consultations for genital warts). An

estimated 45 million Americans—more

than one in five adults—are infected

with genital herpes (9). Herpes

prevalence increased by 30 percent from

the late 1970s to the early 1990s. An

estimated 1 million Americans acquire

genital herpes infections annually (4).

Preliminary data suggest that the

number of persons infected with genital

herpes has remained relatively stable

during the 1990s (10). Recent data

suggest that HPV is much more

common than originally believed and is

likely the most common STD among

young, sexually active persons. Concern

about HPV has increased in recent years

after studies showed that some types of

HPV infection cause cervical cancer. An

estimated 5.5 million Americans become

infected with HPV each year (4). An

estimated 20 million Americans are

currently infected. Research indicates

that about 1 percent of sexually active

adults in the United States have genital

warts caused by HPV (11).

Transition to Healthy People

2010

Healthy People 2010 contains 19

objectives in the Sexually Transmitted

Diseases focus area. Overall, Healthy

People 2010 health status objectives are

similar to Healthy People 2000

objectives. There is expanded emphasis

on reducing STD complications

affecting women (including infertility

and heterosexually transmitted HIV

infection) and reducing neonatal

consequences of maternal STD infection

Healthy People 2000 Final Review 269

(including chlamydia pneumonia,

gonococcal and chlamydial eye

infections, laryngeal papillomatosis,

neonatal herpes, and preterm birth and

low birthweight associated with bacterial

vaginosis). Behavioral objectives include

those for increased responsible

adolescent sexual behavior (abstinence

or condom use) and for responsible

sexual behavior messages on television.

Because expanded services and venues

for STD prevention proved successful in

the 1990s, Healthy People 2010

objectives call for administration of

hepatitis B vaccine in STD clinics,

increased screening for STDs among

high-risk persons in youth detention

facilities and jails, and closer ties

between public STD clinics and

community managed-care organizations.

Personal health services objectives for

Healthy People 2010 are similar to

those for Healthy People 2000. Greater

emphasis is placed on annual screening

of sexually active young women for

chlamydia and on STD testing of

pregnant women during prenatal visits.

The link between STDs and other

preventable health outcomes strengthens

the relationship between the Healthy

People 2010 STD chapter and objectives

in other chapters, such as: Access to

Quality Health Services (e.g., counseling

about health behaviors; clinical skills for

providers); Cancer (e.g., cervical cancer

deaths; Pap tests); Family Planning

(e.g., abstinence among adolescents;

dual protection against pregnancy and

STDs; infertility services); HIV (e.g.,

condom use; STD services in HIV

clinics); Immunization and Infectious

Diseases (e.g., expanded hepatitis B

immunization); Injury and Violence

Prevention (e.g., sexual assault); and

Maternal, Infant, and Child Health (e.g.,

fetal deaths; prenatal care; low

birthweight; pre-term birth). These links

are highlighted as related objectives at

the end of the STD chapter in Healthy

People 2010.

Responsible sexual behavior is the

topic of 1 of the 10 Leading Health

Indicators (LHIs), which Healthy People

2010 introduces to serve as a barometer

of the Nation’s health. One objective

from the Sexually Transmitted Diseases

focus area—adolescents who abstain

from sexual intercourse or use condoms

if currently sexually active—is used to

measure this LHI.

Appendix table III, a crosswalk

between Healthy People 2000 and

Healthy People 2010 objectives,

summarizes the differences between the

two decades of objectives, reflecting

new knowledge and directions in this

area.

Data Issues

Definitions

In January 1988, the Centers for

Disease Control and Prevention (CDC)

issued new guidelines for classifying

and reporting cases of congenital

syphilis (19.4). The new surveillance

case definition is more useful for public

health surveillance; the previous

definition involved physical

examination, laboratory and radiographic

results, and follow-up serological data

(12). Followup information was often

difficult to obtain and led to delayed

and incomplete reporting. In addition,

the clinical criteria excluded stillbirths

to mothers with untreated syphilis. The

new case definition includes criteria for

presumptive and confirmed cases of

syphilis in infants and children and

includes stillbirths. A presumptive case

includes all infants whose mothers have

untreated or inadequately treated

syphilis at delivery (13). The number of

cases increased dramatically during

1989–91, partly as a result of the new

case definition. The case definition was

fully implemented in all States on

January 1, 1992; trends after this point

more accurately reflect changes in the

true incidence of congenital syphilis.

For objective 19.15, provider

referral (previously called contact

tracing) is the process whereby health

department personnel directly notify the

sexual partners of infected individuals of

their exposure to an infected individual

for the purpose of education, counseling,

and referral to health care services.

Data Sources

Data for objective 19.6 come from

the National Hospital Discharge Survey

(NHDS) maintained by the National

Center for Health Statistics, CDC. Data

for the survey are obtained from

approximately 480 hospitals throughout

the United States. Data on race are not

reported by many hospitals due to

omission of a race field on hospital

discharge reporting forms (UB–82 and

UB–92). Automation of the hospital

discharge systems has led to an increase

in the use of these forms in recent years.

A comparison of NHDS data with

National Health Interview Survey

(NHIS) data for people who reported

being hospitalized indicated that

underreporting for whites was roughly

22 percent in 1991; the difference in

reporting for blacks was negligible

(NHIS data were adjusted to exclude

hospitalizations of 1 day or less) (14).

The baseline data on counseling to

prevent HIV and other STDs for

objective 19.14 are from the Primary

Care Provider Surveys (PCPS). The

sample was drawn from the membership

rolls of professional organizations for

pediatricians, nurse practitioners, family

physicians, obstetricians/gynecologists,

and internists. Response rates varied

from 50 to 80 percent across these

groups. The data on counseling refer to

the proportion of providers who

routinely delivered these services to

81–100 percent of their patients who

needed the services.

The Prevention in Primary Care

Study (PPCS) was conducted in

1997–98 to update data from the PCPS.

The design and items included in the

1997–98 study were similar to the

PCPS, but a slightly different sampling

frame was used and some items

included in the 1992 surveys were not

included in the PPCS. The professionals

were sampled from listings of all

licensed, active practitioners in the

United States whose practices were at

least 50–80 percent primary care.

Because of low response rates from the

other provider groups, updates are

available only for nurse practitioners.

Data Comparability

Estimates of chlamydia prevalence

among females 15–24 years of age

(19.2) are obtained from the Sexually

Transmitted Disease Surveillance

System. Surveillance of chlamydial

infections is incomplete in many areas

of the United States; however,

surveillance is improving and, in 1994,

chlamydia became a nationally

notifiable condition (12). Baseline and

update data differ in data collection

methodology, which has improved, and

in the number of regions from which

rates are derived, which has increased.

Baseline and 1995 data for ‘‘all

females’’ for objective 19.9 (adolescent

postponement of sexual intercourse), for

‘‘females 15–44 years of age’’ and for

‘‘sexually active females 15–19 years of

age’’ for objective 19.10 (condom use at

last sexual intercourse), and for ‘‘all

females’’ for objective 19.16 (adolescent

270 Healthy People 2000 Final Review

abstinence) are from the National

Survey of Family Growth (NSFG).

Baseline and 1995 data for ‘‘all males’’

for these objectives are from the

National Survey of Adolescent Males

(NSAM). Biennial tracking data from

the Youth Risk Behavior Survey

(YRBS) are also displayed for these

objectives, but are not directly

comparable to the baselines or the

targets. The YRBS is a school-based

survey and thus does not include

teenagers who are not in school and

who are potentially at higher risk of

these behaviors (15). YRBS data, shown

by age in this report, are published by

grade only in other publications. (See

text for Priority Area 5 for more

information.)

References

1.Department of Health and Human Services.

Healthy People 2010. 2d ed. Washington: U.S.

Government Printing Office. Nov. 2000.

2. Institute of Medicine. Eng TR, Butler WT, eds.

The Hidden Epidemic: Confronting sexually

transmitted diseases. Washington: National

Academy Press. 1997.

3. Centers for Disease Control and Prevention,

Division of STD Prevention. Sexually transmitted

disease surveillance, 1999. Atlanta, Georgia:

Department of Health and Human Services, Public

Health Service. 2000.

4. American Social Health Association. Sexually

transmitted diseases in America: How many cases

and at what cost? Menlo Park, California: Kaiser

Family Foundation. 1998.

5. Wasserheit, J.N, Aral, SO. The dynamic

topology of sexually transmitted disease

epidemics. J Inf Dis 174 (suppl 2):201–13. 1996.

6. Centers for Disease Control and Prevention. Ten

leading national notifiable infectious

diseases—United States, 1995. MMWR 41:883–4.

1996.

7. Division of STD Prevention. Sexually

Transmitted Disease Surveillance, 1999.

Department of Health and Human Services,

Atlanta: Centers for Disease Control and

Prevention (CDC), Sept. 2000.

8. Centers for Disease Control and Prevention,

Division of STD Prevention. National plan to

eliminate syphilis from the United States. Atlanta,

Georgia: Department of Health and Human

Services, Public Health Service. 1999.

9. Fleming DT, McQuillan GM, Johnson RE, et al.

Herpes simplex virus type 2 in the United States,

1976 to 1994. N Engl J Med 337:1105–11. 1997.

10. McQuillan GM. Implications of a national

survey for STDs: Results from the NHANES

survey. Paper presented at the 2000 Infectious

Disease Society of America Conference. Sept.

7–10, New Orleans. 2000.

11. Koutsky L. Epidemiology of genital human

papillomavirus infection. Am J Med 102(suppl

5A):3–8. 1997.

12. Zenker P. New case definition for congenital

syphilis reporting. Sex Transm Dis 18:44–5. 1991.

13. Centers for Disease Control and Prevention.

Health risk behaviors among adolescents who do

and do not attend schools: United States, 1992.

MMWR 43:129–32. 1994.

14. Kozak LJ. Underreporting of race in the

National Hospital Discharge Survey. Advance data

from vital and health statistics; no 265.

Hyattsville, Maryland: National Center for Health

Statistics. 1995.

15. Centers for Disease Control and Prevention.

Youth Risk Behavior Surveillance—United States,

1999. MMWR 49:(SS–5). 2000.

Healthy People 2000 Final Review 271

Table 19. Sexually Transmitted Diseases objectives

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

19.1 Gonorrhea (per 100,000) ........ 1989 300 277 247 197 173 166 149 124 123 133 133 100

a. Black (non-Hispanic)......... 1989 1,990 1,941 1,714 1,408 1,175 1,163 1,046 817 802 851 849 650

b. Adolescents 15-19 years ..... 1989 1,123 1,114 1,031 869 728 734 671 544 522 547 534 375

c. Female 15-44 years ......... 1989 501 495 417 364 309 316 299 259 252 282 283 175

19.2 Chlamydia prevalence among

females 15–24 years

Female 15-19 years ............ 1988 12.2% - - - - - - - - - - - - - - - 6.7% 5.4% - - -

6.9% 6.6% 5%

Female 20-24 years ............ 1988 8.5% - - - - - - - - - - - - - - - 4.2% 3.4% - - -

4.4% 4.5% 5%

19.3 Primary and secondary syphilis

(per 100,000) ................ 1989 18.1 20.3 17.0 13.3 10.3 7.9 6.3 4.3 3.2 2.6 2.5 4

a. Black .................... 1989 118 143 122 97 75 57 45 30 22 17 15 30

19.4 Congenital syphilis among infants

aged less than 1 year (per

100,000 live births) ............ 1990 91.0 . . . 107.3 94.7 80.9 55.8 47.6 32.9 27.7 21.6 14.3 40

a. Black .................... 1992

415.9 . . . . . . . . . 373.2 252.8 213.5 148.8 122.4 90.3 57.9 175

b. Hispanic .................. 1992

134.6 . . . . . . . . . 101.6 73.8 61.6 38.5 33.4 28.7 20.4 50

19.5 Annual number of first time

consultations

Genital herpes ................ 1988 163,000

172,000 235,000 139,000 172,000 142,000 160,000 208,000 176,000 188,000 224,000 138,500

Genital warts ................. 1988 290,000

275,000 282,000 218,000 167,000 238,000 253,000 191,000 145,000 211,000 240,000 246,500

19.6 Pelvic inflammatory disease

Hospitalizations per 100,000 females

15-44 years ................. 1988 311 261 233 212 196 177 162 164 157 153 - - - 100

Initial visits to physicians (number of

visits)

..................... 1988 430,800 357,522 376,540 334,793 386,860 312,000 262,000 286,000 261,000 234,000 251,000 290,000

Hospitalizations per 100,000 females

a. Black 15-44 years .......... 1988 655 567 523 539 399 378 296 320 281 266 - - - 150

b. Adolescents 15-19 years ..... 1988 342 279 239 205 159 184 141 168 186 158 - - - 110

19.7* Sexually transmitted Hepatitis B

(number of cases)............. 1987 47,593 47,811 58,393 52,882 35,849 35,077 29,446 36,794 34,568 32,700

24,527 30,500

19.8 Repeat gonorrhea infection ..... 1987 20% - - - - - - 16.7% 16.1% 13.8% 18.4% 18.5% 17.0% 17.5% 17.2% 15%

a. Black .................... 1992 21.3% . . . . . . . . . 19.9% 15.6% 20.1% 19.8% 18.3% 18.6% 19.2% 17%

19.9* Adolescents who ever engaged in

sexual intercourse

Adolescents 15 years

All females ................. 1988 27% - - - - - - - - - - - - - - - 22% - - - - - - - - - - - - 15%

In-school females........... ... --- 35% 36% --- 37% --- 38% --- 44% --- 43% ...

All males ................... 1988 33% - - - - - - - - - - - - - - - 27% - - - - - - - - - - - - 15%

In-school males ............ ... --- 48% 44% --- 45% --- 42% --- 42% --- 34% ...

a. All black males ............ 1988 69% - - - - - - - - - - - - - - - 58% - - - - - - - - - - - - 15%

In-school non-Hispanic black

males................... ... --- --- 79% --- 82% --- 77% --- 75% --- 68% ...

Adolescents 17 years

All females ................. 1988 50% - - - - - - - - - - - - - - - 51% - - - - - - - - - - - - 40%

In-school females........... ... --- 62% 66% --- 66% --- 67% --- 62% --- 40% ...

See footnotes and key at end of table.

272 Healthy People 2000 Final Review

Table 19. Sexually Transmitted Diseases objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

All males ................... 1988 66% - - - - - - - - - - - - - - - 53% - - - - - - - - - - - - 40%

In-school males ............ ... --- 73% 68% --- 68% --- 65% --- 60% --- 44% ...

b. All black males ............. 1988 90% - - - - - - - - - - - - - - - 79% - - - - - - - - - - - - 40%

In-school non-Hispanic black

males ................. ... --- --- 90% --- 92% --- 88% --- 85% --- 82% ...

c. All black females 15-17 years . 1988 66% - - - - - - - - - - - - - - -

4 8 % --- --- --- --- 4 0 %

In-school non-Hispanic black

females................ ... --- --- 84% --- 80% --- 75% --- 73% --- 73% ...

19.10 Condom use at last sexual

intercourse

Sexually active unmarried females

15-44 years (by their partners) . . . 1988 19% - - - - - - - - - - - - - - - 25% - - - - - - - - - - - - 50%

a. Sexually active females

15–19 years (by their

partners) ................. 1988 26% - - - - - - - - - - - - - - - 37% - - - - - - - - - - - - 60%

Sexually active females 15-19 years

in grades 9-12 (by their partners) . . . . - - - 40% 38% - - - 46% - - - 49% - - - 51% - - - 51% . . .

b. Sexually active males

15-19 years .............. 1988 57% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 75%

Sexually active males 15-19 years

in grades 9-12................ ... --- 49% 54% --- 59% --- 61% --- 63% --- 66% ...

c. Injecting drug users ......... 1992

34% ... ... ... --- --- --- --- --- --- --- 75%

d. Black females 15-44 years (by

their partners) ............. 1988 12.4% - - - - - - - - - - - - - - -

25% --- --- --- --- 75%

19.11* Clinic services for HIV and other

sexually transmitted diseases . . ... --- --- --- --- --- --- --- --- --- --- --- 50%

Family planning clinics .......... 1989 40% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . .

Title X funded family planning clinics

STD testing (excluding HIV)..... ... --- --- --- --- --- 95% --- --- --- --- --- ...

STD counseling (excluding HIV) . . . . - - - - - - - - - - - - - - - 98% - - - - - - - - - - - - - - - . . .

STD treatment (excluding HIV) . . . . . - - - - - - - - - - - - - - - 93% - - - - - - - - - - - - - - - . . .

Gonorrhea

Client testing

............... ... --- 97% --- --- --- --- --- --- --- --- --- ...

Client treatment.............. ... --- 82% --- --- --- --- --- --- --- --- --- ...

Partner notification

........... ... --- 23% --- --- --- --- --- --- --- --- --- ...

Partner testing............... ... --- 60% --- --- --- --- --- --- --- --- --- ...

Partner treatment ............ ... --- 62% --- --- --- --- --- --- --- --- --- ...

Syphilis

Client testing

................. ... --- 86% --- --- --- --- --- --- --- --- --- ...

Client treatment.............. ... --- 48% --- --- --- --- --- --- --- --- --- ...

Partner notification

........... ... --- 29% --- --- --- --- --- --- --- --- --- ...

Partner testing............... ... --- 57% --- --- --- --- --- --- --- --- --- ...

Partner treatment ............ ... --- 40% --- --- --- --- --- --- --- --- --- ...

See footnotes and key at end of table.

Healthy People 2000 Final Review 273

Table 19. Sexually Transmitted Diseases objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Chlamydia

Client testing

............... ... --- 66% --- --- --- --- --- --- --- --- --- ...

Client treatment.............. ... --- 73% --- --- --- --- --- --- --- --- --- ...

Partner notification

........... ... --- 15% --- --- --- --- --- --- --- --- --- ...

Partner testing............... ... --- 29% --- --- --- --- --- --- --- --- --- ...

Partner treatment ............ ... --- 50% --- --- --- --- --- --- --- --- --- ...

HIV

Client pretest counseling ....... ... --- 66% --- --- --- 82% --- --- --- --- --- ...

Client testing ................ ... --- 60% --- --- --- 74% --- --- --- --- --- ...

19.12* HIV and other STD education

curricula

Schools offering at least one STD

class....................... 1988 95% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 95%

Proportion of middle and senior high

schools:

With HIV prevention in required

courses ................... ... --- --- --- --- --- 86% --- --- --- --- --- ...

With STD prevention in required

courses ................... ... --- --- --- --- --- 84% --- --- --- --- --- ...

19.13 Correct management of sexually

transmitted disease cases by

primary care providers ........ 1988 70% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 90%

19.14* Clinician counseling to prevent

HIV and other sexually

transmitted diseases.......... 1987

10% --- --- --- --- --- --- --- --- --- --- 75%

Percent of clinicians routinely

providing service to 81-100% of

patients

a. Providers practicing in high

incidence areas ............ ... --- --- --- --- --- --- --- --- --- --- --- 90%

b. Family physicians ........... 1992 27% . . . . . . . . . - - - - - - - - - - - - - - -

10,11

--- --- 75%

c. Internists.................. 1992 30% . . . . . . . . . - - - - - - - - - - - - - - -

10,11

--- --- 75%

d. Nurse practitioners .......... 1992 50% . . . . . . . . . - - - - - - - - - - - - - - -

45% - - - 75%

e. Obstetricians/gynecologists.... 1992 46% . . . . . . . . . - - - - - - - - - - - - - - -

10,11

--- --- 75%

f. Pediatricians ............... 1992 46% . . . . . . . . . - - - - - - - - - - - - - - -

10,11

--- --- 75%

g. Mental health care providers. . . . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 75%

19.15 Partner notification of exposure to

sexually transmitted diseases

Patients with bacterial sexually

transmitted diseases ........... 1988 20% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 50%

19.16* Adolescent abstinence from

sexual intercourse for previous

3 months

All sexually active females 15-17

years ....................... 1988 23.6% - - - - - - - - - - - - - - - 27% - - - - - - - - - - - - 40%

See footnotes and key at end of table.

274 Healthy People 2000 Final Review

Table 19. Sexually Transmitted Diseases objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

In-school sexually active females

15-17 years ............... ... --- 2 4 % 2 5 % --- 2 5 % --- 2 3 % --- 2 3 % --- 2 5 % ...

All sexually active males 15-17

years ...................... 1988 33% - - - - - - - - - - - - - - - 37% - - - - - - - - - - - - 40%

In-school sexually active males

15-17 years ................. ... --- 3 0 % 3 6 % --- 3 3 % --- 3 4 % --- 3 2 % --- 3 2 % ...

19.17* HIV and STD education for

students at colleges and

universities

Students 18 years and over given:

AIDS or HIV infection prevention

information ................ 1995 49.1% . . . . . . . . . . . . . . . . . . - - - - - - - - - - - - 90%

STD prevention information....... 1995 43.4% . . . . . . . . . . . . . . . . . . - - - - - - - - - - - - 90%

Students 18 years and over taught

about AIDS or HIV in a college

class....................... 1995 41.4% . . . . . . . . . . . . . . . . . . - - - - - - - - - - - - 90%

- - - Data not available. Final objective status:

. . . Category not applicable.

Baseline has been revised.

Positivity measure is not adjusted for changes in laboratory test methods and associated increases in the test sensitivity.

As measured by first-time visits to physicians’ offices.

1989 data.

Data are provisional.

Data are for non-Hispanic black females.

Includes testing at initial visit, at annual visit, or if symptomatic.

By family planning clinic staff via telephone or mail.

Data are for new patients.

1997–98 data.

Response rate for this group was too low to produce reliable estimates.

NOTES: Data include revisions and, therefore, may differ from data previously published in these reports and other publications. HIV is human immunodeficiency virus. STD is sexually

transmitted disease.

Objective number Data source

19.1, 19a-c Sexually Transmitted Disease Surveillance System, CDC, NCHSTP.

19.2 Sexually Transmitted Disease Surveillance System, CDC, NCHSTP.

19.3, 19.3a Sexually Transmitted Disease Surveillance System, CDC, NCHSTP.

19.4 Sexually Transmitted Disease Surveillance System, CDC, NCHSTP.

19.5 National Disease and Therapeutic Index, IMS America, Ltd.

19.6, 19.6a-b For hospitalizations, National Hospital Discharge Survey, CDC, NCHS.

For number of visits, National Disease and Therapeutic Index, IMS America, Ltd.

19.7* Viral Hepatitis Surveillance System, CDC, NCID.

19.8 Gonococcal Isolate Surveillance Project, CDC, NCHSTP.

Met

Toward

Mixed/ no change

Away

Cannot assess

Healthy People 2000 Final Review 275

Objective number Data source

19.9* Baseline and updates for all females and all black females: National Survey of Family Growth, CDC, NCHS.

Baseline and updates for all males and all black males: National Survey of Adolescent Males, NIH, NICHD.

1990–99 data for in-school females and males: Youth Risk Behavior Survey, CDC, NCCDPHP.

19.10*, 19.10d National Survey of Family Growth, CDC, NCHS.

19.10a Baseline: National Survey of Family Growth, CDC, NCHS.

1990–99 data for in-school females and males: Youth Risk Behavior Survey, CDC, NCCDPHP.

19.10b Baseline: National Survey of Adolescent Males, NIH, NICHD.

1990–99 data for in-school males and females: Youth Risk Behavior Survey, CDC, NCCDPHP.

19.10c National AIDS Demonstration Research Program, NIH, NIDA.

19.11* Baseline:State Family Planning Directors.

1990 data: National Questionnaire on Provision of STD and HIV Services by Family Planning Clinics, OPA.

1994 data: The Urban Institute. Family planning clinics: Current status and recent changes in services, clients, staffing, and income sources. March 1994.

19.12* Baseline: AIDS education: Public school programs require more student information and teacher training, GAO, 1990.

1994 data: School Health Policies and Programs Study, CDC, NCCDPHP.

19.13 National Disease and Therapeutic Index, IMS America, Ltd.

19.14* 1987 baseline: Sexual history-taking and counseling practices of primary care physicians, Lewis CE and Freeman HE. Western Journal of Medicine,

147: 165–7. 1987.

1992 baseline: Primary Care Provider Surveys, OPHS, ODPHP.

Update: Prevention in Primary Care Study, American College of Preventive Medicine.

19.15 Sexually Transmitted Disease Surveillance System, CDC, NCHSTP.

19.16* Baseline and update for all females: National Survey of Family Growth, CDC, NCHS.

Baseline and update for all males: National Survey of Adolescent Males, NIH, NICHD.

1990–99 data for in-school females and males: Youth Risk Behavior Survey, CDC, NCCDPHP.

19.17* National College Health Risk Behavior Survey, CDC, NCCDPHP.

* Duplicate objective. See full text of objective following this table.

276 Healthy People 2000 Final Review

Sexually Transmitted

Diseases Objectives

19.1: Reduce gonorrhea to an incidence

of no more than 100 cases per 100,000

people.

19.1a: Reduce gonorrhea among

blacks to an incidence of no more

than 650 cases per 100,000.

19.1b: Reduce gonorrhea among

adolescents aged 15–19 to an

incidence of no more than 375

cases per 100,000.

19.1c: Reduce gonorrhea among

women aged 15–44 to an incidence

of no more than 175 cases per

100,000.

19.2: Reduce the prevalence of

Chlamydia trachomatis infections among

young women (under the age of 25

years) to no more than 5 percent.

19.3: Reduce primary and secondary

syphilis to an incidence of no more than

4 cases per 100,000 people.

19.3a: Reduce primary and

secondary syphilis among blacks to

an incidence of no more 30 cases

per 100,000.

19.4: Reduce congenital syphilis to an

incidence of no more than 40 cases per

100,000 live births.

19.4a: Reduce congenital syphilis

among blacks to an incidence of no

more than 175 cases per 100,000

live births.

19.4b: Reduce congenital syphilis

among Hispanics to an incidence of

no more than 50 cases per 100,000

live births.

19.5: Reduce genital herpes and genital

warts, as measured by a reduction to

138,500 and 246,500, respectively, in

the annual number of ﬁrst-time

consultations with a physician for the

conditions.

19.6: Reduce the incidence of pelvic

inﬂammatory disease, as measured by a

reduction in hospitalizations for pelvic

inﬂammatory disease, to no more than

100 per 100,000 women aged 15–44

and a reduction in the number of initial

visits to physicians for pelvic

inﬂammatory disease to no more than

290,000.

19.6a: Reduce the incidence of

pelvic inﬂammatory disease among

blacks, as measured by a reduction

in hospitalizations for pelvic

inﬂammatory disease, to no more

than 150 per 100,000 women aged

15–44.

19.6b: Reduce the incidence of

pelvic inﬂammatory disease among

adolescents, as measured by a

reduction in hospitalizations for

pelvic inﬂammatory disease, to no

more than 110 per 100,000 females

aged 15–19.

19.7*: Reduce sexually transmitted

hepatitis B infection to no more than

30,500 cases.

Duplicate objectives: 20.03b and 20.03c,

combined

19.8: Reduce the rate of repeat

gonorrhea infection to no more than

15 percent within the previous year.

19.8a: Reduce the rate of repeat

gonorrhea infection among blacks to

no more than 17 percent within the

previous year.

19.9*: Reduce the proportion of

adolescents who have engaged in sexual

intercourse to no more than 15 percent

by age 15 and no more than 40 percent

by age 17.

Duplicate objectives: 5.4 and 18.3

19.9a*: Reduce the proportion of

black males aged 15 years who

have engaged in sexual intercourse

to no more than 15 percent.

Duplicate objectives: 5.4a and 18.3a

19.9b*: Reduce the proportion of

black males aged 17 years who

have engaged in sexual intercourse

to no more than 40 percent.

Duplicate objectives: 5.4b and 18.3b

19.9c*: Reduce the proportion of

black females aged 17 years who

have engaged in sexual intercourse

to no more than 40 percent.

Duplicate objectives: 5.4c and 18.3c

19.10*: Increase to at least 50 percent

the proportion of sexually active,

unmarried people who used a condom at

last sexual intercourse.

Duplicate objective: 18.4

19.10a*: Increase to at least

60 percent the proportion of

sexually active, unmarried young

women aged 15–19 whose partner

used a condom at last sexual

intercourse.

Duplicate objective: 18.4a

19.10b*: Increase to at least

75 percent the proportion of

sexually active, unmarried young

men aged 15–19 who used a

condom at last sexual intercourse.

Duplicate objective: 18.4b

19.10c*: Increase to at least

60 percent the proportion of

intravenous drug users who used a

condom at last sexual intercourse.

Duplicate objective: 18.4c

19.10d*: Increase to at least

75 percent the proportion of black

women aged 15–44 whose partner

used a condom at last sexual

intercourse.

Duplicate objective: 18.4d

19.11*: Increase to at least 50 percent

the proportion of family planning

clinics, maternal and child health clinics,

sexually transmitted disease clinics,

tuberculosis clinics, drug treatment

centers, and primary care clinics that

provide on site primary prevention and

provide or refer for secondary

prevention services for HIV infection

and bacterial sexually transmitted

diseases (gonorrhea, syphilis, and

Chlamydia) to high-risk individuals and

their sex or needle-sharing partners.

Duplicate objectives: 5.11 and 18.13

19.12*: Increase to at least 95 percent

the proportion of schools that have

appropriate HIV and other STD

education curricula for students in

4th–12th grade, preferably as part of

comprehensive school health education,

based upon scientiﬁc information that

includes the way HIV and other STDs

are prevented and transmitted. Duplicate

objective: 18.10

19.13: Increase to at least 90 percent the

proportion of primary care providers

treating patients with sexually

transmitted diseases who correctly

manage cases, as measured by their use

of appropriate types and amounts of

therapy.

19.14*: Increase to at least 75 percent

the proportion of primary care and

mental health care providers who

provide appropriate counseling on the

Healthy People 2000 Final Review 277

prevention of HIV and other sexually

transmitted diseases.

Duplicate objective: 18.9

19.14a*: Increase to at least

90 percent the proportion of primary

care and mental health care

providers who practice in areas of

high AIDS and sexually transmitted

disease incidence who provide

appropriate counseling on the

prevention of HIV and other

sexually transmitted diseases.

Duplicate objective: 18.9a

19.14b*: Increase to at least

75 percent the proportion of family

physicians who provide appropriate

counseling on the prevention of

HIV and other sexually transmitted

diseases.

Duplicate objective: 18.9b

19.14c*: Increase to at least

75 percent the proportion of

internists who provide appropriate

counseling on the prevention of

HIV and other sexually transmitted

diseases.

Duplicate objective: 18.9c

19.14d*: Increase to at least

75 percent the proportion of nurse

practitioners who provide

appropriate counseling on the

prevention of HIV and other

sexually transmitted diseases.

Duplicate objective: 18.9d

19.14e*: Increase to at least

75 percent the proportion of

obstetricians/gynecologists who

provide appropriate counseling on

the prevention of HIV and other

sexually transmitted diseases.

Duplicate objective: 18.9e

19.14f*: Increase to at least

75 percent the proportion of

pediatricians who provide

appropriate counseling on the

prevention of HIV and other

sexually transmitted diseases.

Duplicate objective: 18.9f

19.14g*: Increase to at least

75 percent the proportion of mental

health care providers who provide

appropriate counseling on the

prevention of HIV and other

sexually transmitted diseases.

Duplicate objective: 18.9g

19.15: Increase to at least 50 percent the

proportion of all patients with bacterial

sexually transmitted diseases (gonorrhea,

syphilis, and chlamydia) who are offered

provider referral services.

19.16*: Increase to at least 40 percent

the proportion of ever sexually active

adolescents aged 17 and younger who

have not had sexual intercourse for the

previous 3 months.

Duplicate objective: 5.5 and 18.15

19.17*: Increase to at least 90 percent

the proportion of students who received

HIV and other STD information,

education, or counseling on their college

or university campus.

Duplicate objective: 18.11

*Duplicate objective.

278 Healthy People 2000 Final Review

Priority Area 20

Immunization and

Infectious Diseases

Background

During the 20th century, the United

States made great strides in the

reduction in incidence of infectious

disease, yet, despite the progress,

infectious diseases remain an important

cause of illness and death in the United

States. Each of the causative agents of

infectious diseases, even those that are

currently rare, poses a potential threat of

producing disease, as evidenced by the

resurgence of tuberculosis (TB) that was

complicated by multiple-drug resistance.

The emergence of drug resistance to TB

and other infectious diseases threatens to

reverse the progress prompted by the

discovery of penicillin and other miracle

drugs. Even with these miracle drugs,

infectious diseases are a leading cause

of death worldwide, and serious

infections were the third leading cause

of death in the United States in 1992

(1).

The development and widespread

use of vaccines, combined with

increased funding and enhancement of

infrastructure, have been instrumental in

reducing the incidence of many

infectious diseases, particularly

childhood diseases. Approximately

80 percent of childhood vaccine doses

are recommended for administration

before the second birthday; and

vaccination coverage among children in

the United States is at record high levels

(2). Protecting children against

vaccine-preventable diseases has become

a national priority. One of the greatest

challenges the country faces is

extending the success in immunization

of children to the adult population. The

public health and financial burdens due

to the occurrence of vaccine-preventable

diseases among adults in the United

States is staggering; for example,

moderately severe outbreaks of

influenza may cost society more than

$10 billion (3). Although the severity of

influenza seasons varies, an annual

average of approximately 20,000 deaths

and 110,000 pneumonia and influenza

(P&I) hospitalizations result from

influenza infections (4–6). In addition,

over 6,000 deaths occur annually from

invasive pneumococcal infections, and

an estimated 13,000 adults die every

year from chronic liver disease related

to hepatitis B virus (HBV) infection or

hepatitis C virus (HCV) infection.

Data Summary

Highlights

Vaccination levels among children

are the highest ever recorded in the

United States (20.11). The proportion of

children 19–35 months fully vaccinated

against Haemophilus influenza type b

(Hib) increased to 94 percent in 1999

from 2 percent in 1991 when the

recommendations were published; the

proportion of children vaccinated against

polio increased 76 percent between 1991

(53 percent) and 1999 (90 percent). The

proportion of children who have

received a series of vaccinations

measured by having four doses of

diphtheria-tetanus-pertussis vaccine,

three doses of polio vaccine, and one

dose of measles-containing vaccine

(MCV) increased from 55 percent in

1992 to 80 percent in 1999. From 1989

to 1998, influenza and pneumococcal

vaccination levels among people 65

years of age and over (20.11) also

continued to increase for the total

population, African Americans (20.11a),

and Hispanics (20.11b). However, racial

and ethnic disparities in vaccination

levels persist among Hispanics and

non-Hispanic African Americans (7).

The incidence of almost all

vaccine-preventable diseases (20.1)in

children continued to be low during

1999. There were no cases of diphtheria

or polio due to wild virus, fewer than 6

cases of tetanus among persons 25 years

of age and under, and only 6 cases of

reported congenital rubella syndrome.

The number of rubella cases in 1999

(267) dropped 76 percent from the

number of cases reported in 1990

(1,125). An interruption of indigenous

measles transmission likely occurred in

the fall of 1993, although importation of

the virus resulted in moderate measles

outbreaks in 1994 primarily among

groups that refused vaccination. The

number of measles cases decreased

99.6 percent from 1990 (26,527) to 1999

(100). However, pertussis incidence,

which had declined by 15 percent in

1994 from the 20–year high reported in

1993, increased to an even higher level

in 1996, with 7,796 cases, and remained

high in 1999 (7,298).

The incidence rate of hepatitis B

(HBV) (20.3) has continued to decline

since the start of the decade, and in

1999 was far below the baseline rate

reported in 1987 and far below the

target rate set for the year 2000.

Although cases of HBV infection in

children have become rare, as a result of

high levels of hepatitis B vaccine

coverage in younger age groups, a

substantial number (estimated 180,000)

of adults continue to be infected with

HBV because of low levels of vaccine

coverage in older age groups. The rate

of hepatitis A (20.3) has decreased by

approximately 50 percent since 1995,

and in 1999 was the lowest yet

recorded, reflecting dramatic declines in

the rates of disease among Native

Americans (20.3j) and other high-risk

groups. A dramatic decline of more than

80 percent in the incidence of hepatitis

C (HCV) (20.3) has occurred since 1989

and is associated with a decrease in

cases occurring among injecting-drug

users.

The incidence of tuberculosis (20.4)

declined after 1992 to 6.4 cases per

100,000 persons in 1999, well below the

1988 baseline of 9.1. Also by 1999, the

percent of multi-drug resistant

tuberculosis cases was reduced to

1.1 percent from a 1992 high of almost

3 percent.

In 1998, preliminary data show that

the surgical wound infection rate (20.5)

targets were surpassed for all groups

except low-risk patients.

The rate of infection with bacterial

meningitis (20.7) decreased from 6.5

cases per 100,000 persons in 1986 to

2.2 in 1999, far surpassing the year

2000 target of 4.7. Among Alaska

Natives (20.7a), a group particularly at

risk, the infection rate fell from 33 cases

per 100,000 in 1987 to 5.7 in 1999, also

surpassing the target of 8 cases per

100,000.

The number of restricted activity

days due to ear infections per 100

children 4 years and under (20.9)

dropped to 103.4 in 1996, a rate below

the Healthy People 2000 target of 105.0

restricted activity days per 100 children.

Summary of Progress

Data are available to assess progress

for 17 of the 19 objectives in the

Immunization and Infectious Diseases

Priority Area. Three objectives (20.2,

20.7, and 20.9) met or exceeded the

year 2000 targets. For seven objectives

(20.3, 20.4, 20.11, 20.13, 20.14, 20.16,

Healthy People 2000 Final Review 279

20.1 Vaccine-preventable disease: Diphtheria

Tetanus

Polio (wild-type virus)

Measles

Rubella

Congenital Rubella Syndrome

Mumps

Pertussis

20.2 Epidemic-related pneumonia and influenza deaths

20.3 Viral hepatitis: Hepatitis B

Hepatitis A

Hepatitis C

20.4 Tuberculosis cases

Urinary tract infections: Medical/coronary ICUs

20.5 Surgical wound/nosocomial infections,

via bloodstream: Medical/coronary ICUs

Pediatric ICUs

Surgical/medical-surgical ICUs

Pediatric ICUs

Pneumonia: Medical/coronary ICUs

Surgical/medical-surgical ICUs

Pediatric ICUs

Medium-low risk patients

Medium-high risk patients

20.6 Illness international travelers: Typhoid fever

High-risk patients

Surgical wound infection rates: Low-risk patients

Hepatitis A

Malaria

20.7 Bacterial meningitis cases

20.9 Ear infections

Moved away from target Moved toward target Met target

Chart continues onto next page- see notes at the end of the chart.

78%

-80%

-67%

-19%

-73%

No change

11%

Percent of target achieved

-100 -80 -60 -40 -20 0 20 40 60 80 100

100%

103%

157%

327%

391%

300%

492%

233%

167%

367%

507%

239%

105%

103%

198%

346%

48%

83%

-157%

-120%

-600%

97%

84%

280 Healthy People 2000 Final Review

Figure 20. Final status of Immunization and Infectious Diseases objectives

Figure 20. Final status of Immunization and Infectious Diseases objectives—Con.

20.10 Pneumonia-related restricted activity days,

persons 65 years and over

Children 4 years and under

20.11 Basic Immunization Series, children 19-35 months:

DTP (3 or more doses)

Polio (3 or more doses)

Measles-containing

Hib (3 or more doses)

Hep B (3 or more doses)

4DTP/3Polio/1MMR

Pneumococcal vaccine - Institutionalized

chronically ill or older people

Pneumococcal vaccine - Noninstitutionalized

65 years and over

Influenza immunization - Institutionalized chronically ill

or older people

Influenza immunization - Noninstitutionalized

65 years and over

20.12 Post exposure rabies treatments

20.13 Immunization laws

20.15 Financial barriers to immunization: Conventional

insurance plans

PPOs

HMOs

20.16 Public health department provision of

immunizations: Pneumococcal vaccine

Influenza vaccine

20.19 Lab-diagnosed influenza: Tertiary care hospital labs

20.18 Infected people completing tuberculosis therapy

Secondary care hospital labs

HMO labs

Moved away from target Moved toward target Met target

NOTES: Complete tracking data are shown in table 20. Progress quotients are not calculated for objectives 20.8, 20.14, and 20.17.

See the section on Measuring Progress Toward the

Healthy People 2000

Targets in the Appendix for more information.

ICU is intensive care unit. DTP is diphtheria-tetanus-pertussis. Hib is

Haemophilus influenzae

type b vaccine. MMR is measles-mumps-rubella.

PPO is preferred provider organization. HMO is health maintenance organization.

50%

58%

15%

-9%

No change

21%

20%

18%

Percent of target achieved

-100 -80 -60 -40 -20 0 20 40 60 80 100

228%

129%

100%

125%

105%

111%

103%

69%

16%

10%

71%

-133%

-150%

-1,540%

97%

85%

Healthy People 2000 Final Review 281

and 20.19), progress was made toward

achieving the targets. The progress of

objective 20.14 is based on nurse

practitioner data only. Trends for two

objectives (20.12 and 20.18) indicate

movement away from the year 2000

targets. Mixed results are shown for five

objectives (20.1, 20.5, 20.6, 20.10, and

20.15). Data are not available to provide

measures after baseline for two

objectives (20.8 and 20.17). See table 20

for the tracking data for the objectives

in this priority area and figure 20 for a

quantitative assessment of progress.

Discussion

The reduction in incidence of

infectious diseases is a significant public

health achievement of the 20th century.

Record levels of vaccination coverage

have greatly contributed to this

reduction. For instance, the dramatic

decrease in cases of bacterial meningitis

is due to the licensure of Hib

polysaccharide-protein conjugate

vaccines in 1988. Since the vaccines

were licensed, the number of reported

Hib invasive disease among children

under 5 years of age has declined

99 percent.

High levels of hepatitis B

vaccination coverage in children have

resulted in decreasing rates of hepatitis

B among younger age groups, reducing

the burden of chronic liver disease due

to childhood HBV infection and

eventually resulting in decreases in the

overall rate of hepatitis B. However,

until there is a nationwide program to

vaccinate adults at increased risk for

HBV infection, transmission cannot be

eliminated and disease rates will most

likely remain elevated for decades.

The sharp decrease in hepatitis A

rates among high-risk populations such

as Native Americans is attributed to the

implementation of hepatitis A

vaccination programs in those

populations. However, cyclic peaks in

hepatitis A rates have been observed

approximately every 10 years and future

increases in rates may yet occur.

Widespread hepatitis A vaccination of

children, particularly in States and

communities with consistently elevated

rates of hepatitis A, is needed to achieve

sustained reductions in hepatitis A rates.

Although the incidence of HCV

infection has decreased dramatically

over the decade, 1988–94

seroprevalence data indicate that

approximately 4 million people in the

United States have been infected with

HCV, most of whom are chronically

infected (8). Reducing the burden of

HCV infection and HCV-related disease

in the United States requires

implementation of primary prevention

activities to reduce the risk for

contracting HCV infection and

secondary prevention activities to reduce

the risk of liver and other chronic

diseases in HCV-infected persons.

High vaccination coverage levels

have been achieved for children ages

19–35 months. In 1991, in an attempt to

achieve 90 percent coverage by the year

2000, Congress required States to

prepare Immunization Action Plans that

focused on expanding the public health

infrastructure for vaccination service

delivery and allowed Federal grant

funds to support both service delivery

(for example, salaries of nurses and

clinic supplies) and vaccine costs. In

1994, the Vaccines for Children (VFC)

program was initiated. VFC is an

entitlement program that has removed

vaccine cost as a barrier to vaccination

for America’s neediest children, and

provides a more secure source of

funding. Seventy-five percent of

preschool-aged children in the United

States are vaccinated in one of the

50,000 provider sites participating in

this program. As a result of increased

vaccination coverage levels, the

incidence of vaccine-preventable

diseases decreased. While vaccination

levels have progressed toward and

reached many of the year 2000 coverage

goals, continued diligence is needed to

sustain and improve our progress.

Timely, age-appropriate delivery of

vaccines to infants and children is the

backbone of the Nation’s immunization

program. Yet, despite recent dramatic

gains in childhood vaccination coverage,

more than 20 percent of 2 year olds in

the United States have still not received

all recommended doses of vaccine. The

addition of new and improved vaccines

to an already complex childhood

vaccination schedule makes it

increasingly challenging to ensure

complete and age-appropriate

vaccination.

While an increasing number of

adults 65 years of age and over have

taken advantage of the health benefits of

vaccines against influenza and

pneumococcal disease, more work needs

to be done to protect older Americans

from these preventable diseases,

particularly to eliminate racial and

ethnic disparities, and to ensure high

levels of coverage among seniors who

live in nursing homes.

From a rate of 9.1 cases per

100,000 persons in the 1988 baseline

year, the United States tuberculosis case

rate rose to 10.5 in 1992. The national

resurgence of tuberculosis between 1985

and 1992 was associated with the HIV

epidemic, imported cases among

immigrants from tuberculosis-endemic

areas, and the occurrence of multi-drug

resistant strains of the disease. The

resurgence necessitated a rebuilding of

the network for diagnosis, treatment,

and follow-up of tuberculosis cases and

contacts. As a consequence, there has

been a renewed decline in the United

States case rate that was reduced to 6.4.

per 100,000 by 1999. Although the 1999

rate is still almost twice the year 2000

target of 3.5 cases per 100,000 persons,

it is an historic low annual rate for the

United States since nationwide reporting

began in 1953. In 1999, the rate for

blacks was 16.8, for Hispanics 12.4, for

American Indians/Alaska Natives 11.8,

for Asians and Pacific Islanders 35.3;

rates for all of these groups are now

below their 1988 baselines. The targets

for each of these population groups was

10.0, 5.0, 5.0, and 15.0, respectively.

The proportion of persons who

completed a prescribed course of

treatment for latent tuberculosis

infection has changed little since the

1987 baseline of 66.3 percent and the

latest report was 64.6 percent in 1998.

During and after the resurgence of

tuberculosis, many health departments

necessarily placed priority on controlling

outbreaks, finding cases, ensuring the

completion of therapy by patients,

examining exposed persons, and halting

the spread of infection. Resources were

not adequate in many areas to identify

persons with latent TB infection and

ensure completion of preventive therapy.

Transition to Healthy People

2010

Although there has been notable

progress in efforts to prevent and

control infectious diseases, reemerging

and antimicrobial resistant infectious

diseases present major public health

issues. There is a continuing need to

improve the capacity to address the

challenges posed by infectious diseases.

The scope of the Healthy People 2010

Immunization and Infectious Diseases

282 Healthy People 2000 Final Review

chapter (Focus Area 14) has been

expanded from Healthy People 2000 to

reflect new prevention opportunities

resulting from new scientific knowledge

and technology. Healthy People 2010

includes the addition of objectives to

encourage appropriate use of

antimicrobials and prophylaxis, plus

new vaccines such as varicella. The

chapter also places a greater emphasis

on preventing disease among high-risk

persons of all ages. For example, in

recognition of the vaccine-preventable

disease burden among adolescents and

adults, several Healthy People 2010

immunization-related objectives address

these age groups.

Several of the immunization-related

objectives will continue to be measured

in Healthy People 2010. These include

incidence of vaccine-preventable

diseases and vaccination coverage levels

for specific vaccines. Some new

objectives have also been added,

including one to assess how well the

service delivery system is meeting the

vaccination needs of young children and

adolescents. Other new objectives

include increasing the proportion of

providers who measure coverage levels

in their practice and increasing the

proportion of children under 6 years of

age who participate in fully operational,

State- and population-based

immunization registries. Two vaccine

safety-related objectives have also been

included in Healthy People 2010,

reducing vaccine-associated adverse

events, and increasing the number of

persons under active surveillance for

vaccine safety via large linked

databases.

In order to better track progress in

preventing and controlling viral hepatitis

in the United States, the one hepatitis

objective in Healthy People 2000 (20.3)

has been expanded into six objectives in

Healthy People 2010. To better assess

the disease burden due to HCV, Healthy

People 2010 includes a developmental

objective to increase the proportion of

persons with chronic HCV infection

identified by health departments. Several

of the infectious diseases objectives

from Healthy People 2000 were revised

to reflect a growing problem of

antimicrobial resistance. Recognizing

that completion of therapy helps to

reduce the TB case rate by preventing

transmission of infection as well as

outbreaks and development and spread

of multi-drug resistant TB, an objective

has been added, which seeks to increase

the percent of all tuberculosis patients

who complete therapy for tuberculosis

disease within 12 months.

Immunizations is the topic of 1 of

the 10 Leading Health Indicators

(LHIs), which Healthy People 2010

introduces to serve as a barometer of the

Nation’s health. Two objectives from the

Immunizations and Infectious Diseases

focus area—pneumococcal and influenza

vaccinations of adults at high risk and

fully vaccinated young children—are

used to measure this LHI.

Appendix table III, a crosswalk

between Healthy People 2000 and

Healthy People 2010 objectives,

summarizes the differences between the

two decades of objectives, reflecting

new knowledge and directions in this

area.

Data Issues

Definitions

Operational definitions and data

collection specifications for all Healthy

People 2000 objectives in Priority Area

20 have been published in the National

Center for Health Statistics, Healthy

People Statistical Notes series (9). Data

issues are discussed and references are

cited for expanded discussions of the

data systems that provide data for the

national objectives. When appropriate,

the text of questionnaire items used to

measure the objectives is also provided.

See Appendix table VI for more

information.

For objective 20.2, epidemic-related

pneumonia and influenza deaths are

defined as those that occur above and

beyond the normal yearly fluctuations of

mortality. Because of the extreme

variability in epidemic-related deaths

from year to year, the objective was

measured using a 3-year average. The

data cannot be obtained directly from

published mortality figures. Each year

expected numbers of pneumonia and

influenza deaths are calculated through a

cyclical regression model using data for

previous years but excluding data for

the periods when mortality was known

to be raised by influenza epidemics (5).

Epidemic-related deaths are defined as

those that exceed the predicted number

during epidemic periods based on the

model.

Data Sources

The National Notifiable Disease

Surveillance System (NNDSS) is the

data source for tracking cases of

vaccine-preventable diseases (20.1).

Detailed epidemiologic analyses of data

from NNDSS are sometimes published

in special surveillance reports. Data in

these reports may not agree exactly with

reports published in the Morbidity and

Mortality Weekly Report because of

differences in timing or refinements in

case definitions. The NNDSS is the data

source for specific disease surveillance

systems, such as the Tuberculosis

Morbidity Data System (20.4).

Additional hepatitis surveillance data

besides that provided through NNDSS

are collected through the Viral Hepatitis

Surveillance Program and the Sentinel

Counties Study of Acute Viral Hepatitis

(20.3). Although cases of congenital

rubella syndrome are reported through

NNDSS, the actual source of the data is

the National Congenital Rubella

Syndrome Registry (NCRSR).

The baseline data on provision of

immunizations by physicians for

objective 20.14 are from the Primary

Care Provider Surveys (PCPS). The

sample was drawn from the membership

rolls of professional organizations for

pediatricians, nurse practitioners, family

physicians, obstetricians/gynecologists,

and internists. The data show the

proportion of primary care providers

who provided vaccination to

81–100 percent of their patients. The

Prevention in Primary Care Study

(PPCS) was conducted in 1997–98 to

update data from the PCPS. The design

and items included in the 1997–98 study

were similar to the PCPS, but a slightly

different sampling frame was used and

some items included in the 1992 surveys

were not included in the PPCS. The

providers were sampled from listings of

all licensed, active practitioners in the

United States whose practices were at

least 50 percent primary care. Because

of low response rates from the other

provider groups, updates are available

only for nurse practitioners.

Baseline data for objective 20.17 is

based on data from the local health

departments collected by the National

Profile of Local Health Departments,

NACCHO. Local health department

refers to any local component of the

public health system, defined as an

administrative and service unit of local

or State government concerned with

health and carrying some responsibility

for the health of a jurisdiction smaller

than a State.

Healthy People 2000 Final Review 283

Data Comparability

Data sources on vaccination

coverage levels have changed over the

years. The childhood vaccination

baseline data (20.11) were obtained from

the 1985 United States Immunization

Survey (USIS) and show the range of

antigen-speciﬁc vaccination levels at the

time of the interview among children

24–35 months of age. From 1991 to

1994, the source of the data was the

National Health Interview Survey

(NHIS) and the age included in the data

set was expanded to children 19–35

months of age. In 1992, the NHIS

questions on childhood immunizations

were modiﬁed. Therefore, the 1991 data

are not directly comparable to data for

subsequent years. The 1992 data are

now considered the baseline data for

estimates from the NHIS. The 1994

NHIS data have been provider-veriﬁed

and adjusted. Providers were contacted

and asked to provide vaccination

information for each child in the sample.

One of the limitations of the NHIS

is that it provides only national

estimates. In contrast, the National

Immunization Survey (NIS) provides

comparable national, State, and local

vaccination coverage estimates.

Therefore, since 1995, vaccination

coverage data have been obtained from

the NIS. The NIS, ﬁrst ﬁelded in 1994,

is an ongoing survey that provides the

ﬁrst population-based State and urban

area-speciﬁc estimates of vaccination

coverage by a standard methodology for

the United States for children 19–35

months of age.

For inﬂuenza and pneumococcal

vaccination (20.11), baseline data for the

noninstitutionalized population were

obtained from the NHIS starting in

1989; for the institutionalized

population, national estimates were ﬁrst

available from the National Nursing

Home Survey (NNHS) in 1995. NHIS

estimates are based on self-report (not

provider-veriﬁed), while the NNHS

estimates are based on records available

to nursing home staff completing the

survey, and may be incomplete.

The baseline data for objective

20.11 (hepatitis immunizations among

occupationally exposed workers) were

collected by OSHA’s Regulatory Impact

Analysis; the updates are from CDC’s

National Center for Infectious Diseases.

References

1. Pinner RW, Teutsch SM, Simonsen L, et al.

Trends in infectious diseases mortality in the

United States. JAMA 1996; 275:189–93.

2. Centers for Disease Control and Prevention.

Reported Vaccine-Preventable Diseases—United

States, 1993, and the Childhood Immunization

Initiative. MMWR 43(4):57–60. 1994.

3. National Vaccine Advisory Committee. Adult

Immunization. Atlanta, GA: Centers for Disease

Control and Prevention, National Immunization

Program. Jan. 1994.

4. Simonson L, Schonberger LB, Stroup DF, et al.

The impact of inﬂuenza on mortality in the USA.

In: Brown LE, Hampson AW, Webster RB, eds.

Options for the control of inﬂuenza III.

Amsterdam, The Netherlands: Elsevier Science

BV, 26–33. 1996.

5. Lui K-J, Kendal AP. Impact of inﬂuenza

epidemics on mortality in the United States from

October 1972 to May 1985. Am J Public Health

77:712–6. 1987.

6. Simonsen L, Fukuda K, Schonberger LB, et al.

The impact of inﬂuenza epidemics on

hospitalizations. J Infect Dis 2000;181:831–7.

7. Centers for Disease Control and Prevention.

Inﬂuenza and pneumococcal vaccination levels

among adults aged greater than or equal to 65

years, United States. MMWR 47(38):797–802.

1998.

8. Alter ML, Kruszon-Moran D, Nainan O, et al.

Prevalence of hepatitis C virus infection in the

United States: Results of the third National Health

and Nutrition Examination Survey (NHANES III)

1988–1994. N Engl J Med. 341:556–62. 1999.

9. Ryan C, Schober S, Turczyn K. Operational

deﬁnitions for year 2000 objectives: Priority area

20, immunization and infectious diseases. Healthy

people statistical notes; no 11. Hyattsville,

Maryland: National Center for Health Statistics.

1997.

284 Healthy People 2000 Final Review

Table 20. Immunization and Infectious Diseases objectives

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

20.1 Vaccine-preventable diseases (number

of cases)

Diphtheria among people 25 years and

under .........................

1988 1 223020031 00

Tetanus among people 25 years and

under .........................

1988 3 647455399 50

Polio (wild-type virus) .............. 1988 0 000000000 00

Measles ........................ 1988

3,396 26,527 9,411 2,237 312 963 309 508 138 100 100 0

Rubella......................... 1988 225 1,125 1,401 160 192 227 128 238 181 364 267 0

Congenital Rubella Syndrome ........ 1988 6 11 47 11 576457 60

Mumps ......................... 1988 4,866 5,292 4,264 2,572 1,692 1,537 906 751 683 666 387 500

Pertussis........................ 1988 3,450 4,570 2,719 4,083 6,586 4,617 5,137 7,796 6,564 7,405 7,298 1,000

20.2 Epidemic-related pneumonia and

influenza deaths among people

65 years and over (per 100,000) .... 1979-87

19.9

22.6

18.6

20.0

15.7

21.0

19.2

17.3

15.8 - - - - - - 15.9

20.3* Viral hepatitis cases (per 100,000)

Hepatitis B ...................... 1987 63.5 50.6 42.6 37.7 30.9 28.7 25.0 23.9 23.6 22.5 16.9 40.0

Hepatitis A ...................... 1987 33.0 37.9 29.0 27.2 28.2 30.9 36.4 31.1 33.9 25.8 18.8 16.1

Hepatitis C ...................... 1987 18.3 13.1 8.3 5.6 4.4 4.1 2.7 2.9 2.4 2.4 - - - 13.7

Hepatitis B (number of cases)

a. Injecting drug users ............ 1987 44,348 17,615 12,666 10,576 15,136 14,180 10,216 9,199 11,132 11,506

8,630 7,932

b. Heterosexually active people ..... 1987 33,995 33,971 43,795 46,152 26,289 25,375 19,831 25,659 23,436 21,800

16,351 22,663

c. Men who have sex with men...... 1987 13,598 13,840 14,598 6,730 9,560 9,702 9,615 11,135 11,132 10,900

8,176 4,568

d. Children of Asians/Pacific Islanders. 1987 10,817 8,807 7,514 6,730 5,576 5,224 4,207 4,440 4,347 4,281 3,211 1,500

e. Occupationally exposed workers . . . 1987 3,090 1,258 2,576 1,923 727 506 407 391 383 377 243 623

f. Infants (chronic infections) ....... 1987 6,012 3,003 2,235 2,464 2,464 1,682 1,682 1,682 1,046 1,046 1,046 1,111

g. Alaska Native (number of new

carriers)..................... 1987 15 15 15 15 100000 01

Hepatitis B (cases per 100,000)

h. Black ....................... 1992 52.8 . . . . . . . . . 57.0 52.3 45.3 41.5 39.5 32.4 24.7 40

Hepatitis A (cases per 100,000)

i. Hispanic ..................... 1992 53.8 . . . . . . . . . 50.6 61.9 44.9 62.9 72.6 41.0 37.9

26.9

j. American Indian/Alaska Native..... 1992 256.0 . . . . . . . . . 192.7 363.7 240.7 142.3 69.4 30.0 19.7 128

Hepatitis C (cases per 100,000)

k. Hispanic ..................... 1992 17.2 . . . . . . . . . 11.1 6.7 3.9 7.7

---

13.7

20.4 Tuberculosis new cases (per 100,000) 1988 9.1 10.3 10.4 10.5 9.8 9.4 8.7 8.0 7.4 6.8 6.4 3.5

a. Asians/Pacific Islanders ......... 1988 36.3 41.6 41.8 46.6 44.5 45.3 45.9 41.6 40.6 36.6 35.3 15.0

b. Black ....................... 1988 28.3 33.0 31.9 31.7 29.1 26.8 23.9 22.3 20.5 17.8 16.8 10.0

c. Hispanic ..................... 1988 18.3 21.4 22.8 22.4 20.6 19.5 18.0 16.0 14.4 13.6 12.4 5.0

d. American Indian/Alaska Native .... 1988 18.1 18.9 16.3 16.3 14.6 17.4 16.5 14.5 13.4 12.6 11.8 5.0

20.5 Surgical wound and nosocomial

infections

See footnotes and key at end of table.

Healthy People 2000 Final Review 285

Table 20. Immunization and Infectious Diseases objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Device-associated nosocomial infection

rates in ICU patients (per 1,000

device-days)

Bloodstream Infections

Medical/coronary ICUs .......... 1986-90 6.9 . . . - - - 6.5 5.9 5.4 5.7 5.7 5.9 5.8

5.0 6.2

Surgical/medical-surgical ICUs .... 1986-90 5.3 . . . - - - 5.8 4.9 4.6 4.3 4.9 5.4 5.7

5.0 4.8

Pediatric ICUs ................ 1986-90 11.4 . . . - - - 7.9 8.3 8.0 7.8 7.5 7.8 7.8

6.4 10.3

Urinary Tract Infections

Medical/coronary ICUs .......... 1986-90 10.7 . . . - - - 10.1 8.5 7.9 7.3 6.9 6.7 6.4

5.7 9.6

Surgical/medical-surgical ICUs .... 1986-90 7.6 . . . - - - 6.3 5.9 5.8 4.9 5.1 4.9 5.2

5.4 6.8

Pediatric ICUs ................ 1986-90 5.8 . . . - - - 5.4 5.1 5.2 5.9 4.9 4.9 5.3

4.1 5.2

Pneumonia

Medical/coronary ICUs .......... 1986-90 12.8 . . . - - - 9.0 9.5 8.6 10.1 9.2 7.5 6.4

6.6 11.5

Surgical/medical-surgical ICUs .... 1986-90 17.6 . . . - - - 15.1 14.1 13.6 12.9 12.7 13.7 13.4

12.7 15.8

Pediatric ICUs ................ 1986-90 4.7 . . . - - - 6.7 5.8 5.7 5.5 5.3 5.5 5.3

3.9 4.2

Surgical wound infection rates (per

100 operations)

Low-risk patients .............. 1986-90 1.1 . . . - - - 1.2 1.2 1.1 1.2 1.0 1.6 1.7

1.4 1.0

Medium-low risk patients ........ 1986-90 3.2 . . . - - - 3.2 3.2 3.1 3.4 3.2 2.7 2.7

2.3 2.9

Medium-high risk patients........ 1986-90 6.3 . . . - - - 6.4 5.8 6.1 5.9 5.8 4.6 4.1

3.9 5.7

High-risk patients .............. 1986-90 14.4 . . . - - - 12.1 11.0 11.0 10.1 10.3 6.4 7.3

5.7 13.0

20.6 Illness among international travelers

(number of cases)

Typhoid fever .................... 1987 280 386 351 299 308 309 258 352 279 306 277 140

Hepatitis A ...................... 1987 4,475 3,962 3,814 3,814 4,581 6,602 7,815 6,331 6,575 6,411 4,112 1,119

Malaria ......................... 1987 932 1,098 1,046 910 1,275 1,014 1,167 1,392 1,544 1,225 1,065 750

20.7 Bacterial meningitis cases (per

100,000) ....................... 1986 6.5 - - - - - - - - - - - - - - - 1.9 2.3 2.1 1.9 2.2 4.7

a. Alaska Native ................. 1987 33 22 17 6.5 7.4 6.2 3.1 6.0 6.9 6.7

5.7 8

20.8 Infectious diarrhea among children in

child care centers

Children 0–5 years ................ 1991 32% . . . . . . - - - - - - - - - - - - - - - - - - - - - - - - 24%

Children 0–3 years ................ 1991 38% . . . . . . - - - - - - - - - - - - - - - - - - - - - - - - 28%

20.9 Ear infections among children 4 years

and under (restricted activity days

per 100 children)................. 1987 135.4 125.0 155.7 155.2 196.3 137.0 134.4 103.4 - - - - - - - - - 105.0

20.10 Pneumonia-related restricted activity

days (per 100 people)

People 65 years and over ........... 1987 19.1 46.2 78.5 63.5 45.1 71.3 58.8 80.7 - - - - - - - - - 15.1

Children 4 years and under.......... 1987 29.4 51.3

24.1

19.4

22.5 39.5

23.2

17.1 - - - - - - - - - 24.0

20.11 Immunization (percent immunized)

Basic immunization series among

children

See footnotes and key at end of table.

286 Healthy People 2000 Final Review

Table 20. Immunization and Infectious Diseases objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Children 2 years and under ........ 1985

13,14

54–

65% --- --- --- --- --- --- --- --- --- --- 90%

Children 19-35 months

Diphtheria-tetanus-pertussis (3 or

more doses)................. ... --- --- 69% 83% 88% 90% 95% 95% 95% 96% 96% ...

Polio (3 or more doses) ......... ... --- --- 53% 72% 79% 79% 88% 91% 91% 91% 90% ...

Measles-containing ............ ... --- --- 82% 83% 84% 90% 90% 91% 91% 92% 92% ...

Haemophilus influenzae type b (3 or

more doses)................. ... --- --- 2% 28% 55% 75% 92% 92% 93% 93% 94% ...

Hepatitis B (3 or more doses). . . . . . - - - - - - - - - - - - 16% 34% 68% 82% 84% 87% 88% . . .

4DTP/3Polio/1MMR ............ ... --- --- --- 55% 67% 68% 76% 78% 78% 81% 80% ...

Children in licensed child care

facilities

13,14

................... 1987-88

94–

95%

94–

96%

94–

96%

94–

96%

95–

98%

97–

98%

98–

99%

95%

93–

95%

93–

96%

93–

95% 95%

Children in kindergarten through

postsecondary education

institutions

13,14

................. 1987-88

97–

98%

97–

98%

96–

98%

96–

98%

92–

94%

93–

94%

94–

95%

98–

99%

95–

98%

95–

97%

96–

99% 95%

Hepatitis B immunizations

Infants of antigen-positive mothers. . . 1991 40% . . . . . . 71% 71% 78% 78% 79% 82% 81% - - - 90%

Occupationally exposed workers

. . . 1989 37% - - - - - - 50% - - - 67% - - - - - - - - - - - - - - - 90%

Injecting drug users in drug treatment

programs..................... ... --- --- --- --- --- --- --- --- --- --- --- 50%

Men who have sex with men ....... 1992-93 3% . . . . . . . . . . . . - - - - - - - - - - - -

9% - - - 50%

Pneumococcal immunizations

Institutionalized chronically ill people

or older people ................ 1995

22% ... ... ... ... ... ... ---

28% --- --- 80%

Noninstitutionalized people 65 years

and over ..................... 1989

15% - - - 21% - - - 28% 30% 34% - - - 43% 46% - - - 60%

a. Black 65 years and over ..... 1989

6% - - - 14% - - - 14% 15% 23% - - - 22% 26% - - - 60%

b. Hispanic 65 years and over . . . 1989

11% - - - 12% - - - 12% 14% 23% - - - 23% 23% - - - 60%

Influenza immunizations (in last 12

months)

Institutionalized chronically ill people

or older people............... 1995

61% ... ... ... ... ... ... ---

64% --- --- 80%

Noninstitutionalized people

65 years and over ............ 1989

33% - - - 42% - - - 52% 55% 58% - - - 63% 63% - - - 60%

a. Black 65 years and over ..... 1989

20% - - - 27% - - - 33% 39% 40% - - - 45% 46% - - - 60%

b. Hispanic 65 years and over . . . 1989

28% - - - - - - - - - 47% 38% 50% - - - 53% 50% - - - 60%

20.12 Postexposure rabies treatments

(number)....................... 1987 18,000 - - - 18,800 24,700 25,000– 22,000– - - - 16,000– 20,000– - - - - - - 9,000

43,000 43,000 39,000 40,000

20.13 Immunization laws (number of

States)

....................... 1989 10-49 - - - - - - 34–50 - - - - - -

42–50 - - -

44–50 - - - 44–50 50

20.14 Provision of immunizations by

clinicians ...................... ... --- --- --- --- --- --- --- --- --- --- --- 90%

See footnotes and key at end of table.

Healthy People 2000 Final Review 287

Table 20. Immunization and Infectious Diseases objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Percent of clinicians routinely providing

service to 81-100% of patients

Children:

DTP vaccination

Pediatricians ................... 1992 86% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Nurse practitioners .............. 1992 76% . . . . . . . . . - - - - - - - - - - - - - - -

78% - - - 90%

Family physicians ............... 1992 89% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Oral polio vaccination

Pediatricians ................... 1992 87% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Nurse practitioners .............. 1992 76% . . . . . . . . . - - - - - - - - - - - - - - -

79% - - - 90%

Family physicians ............... 1992 89% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Tetanus-diphtheria booster (under

18 years)

Pediatricians ................... 1992 79% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Nurse practitioners .............. 1992 71% . . . . . . . . . - - - - - - - - - - - - - - -

72% - - - 90%

Family physicians ............... 1992 70% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Hib vaccination

Pediatricians ................... 1992 85% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Nurse practitioners .............. 1992 68% . . . . . . . . . - - - - - - - - - - - - - - -

74% - - - 90%

Family physicians ............... 1992 74% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Tetanus-diphtheria booster (18 years

and over)

Nurse practitioners .............. 1992 38% . . . . . . . . . - - - - - - - - - - - - - - -

40% - - - 90%

Obstetricians/gynecologists ........ 1992 4% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Internists ...................... 1992 29% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Family physicians ............... 1992 28% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Influenza vaccination (65 years and

over)

Nurse practitioners .............. 1992 42% . . . . . . . . . - - - - - - - - - - - - - - -

47% - - - 90%

Obstetricians/gynecologists ........ 1992 6% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Internists ...................... 1992 49% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Family physicians ............... 1992 31% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Pneumococcal vaccination (65 years

and over)

Nurse practitioners .............. 1992 33% . . . . . . . . . - - - - - - - - - - - - - - -

43% - - - 90%

Obstetricians/gynecologists ........ 1992 5% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Internists ...................... 1992 40% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

Family physicians ............... 1992 25% . . . . . . . . . - - - - - - - - - - - - - - -

35,36

--- --- 90%

20.15 Financial barriers to immunization

Employment-based insurance plans that

provide coverage for immunizations

Conventional insurance plans ...... 1989 45% 47% - - - 53% - - - - - - - - - - - - - - - - - - - - - 100%

See footnotes and key at end of table.

288 Healthy People 2000 Final Review

Table 20. Immunization and Infectious Diseases objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Preferred Provider Organization

plans ........................ 1989 62% 65% - - - 65% - - - - - - - - - - - - - - - - - - - - - 100%

Health Maintenance Organization

plans ........................ 1989 98% 98% - - - 95% - - - - - - - - - - - - - - - - - - - - - 100%

20.16

Public health department provision of

immunizations

Pneumococcal vaccine............. 1990 37% . . . - - - - - -

48% --- --- --- --- --- --- 90%

Influenza vaccine ................. 1990 60% . . . - - - - - -

91% --- --- --- --- --- --- 90%

Tetanus/Diphtheria vaccine .......... 1990 70% . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - 90%

Tetanus ....................... ... --- --- --- ---

85% --- --- --- --- --- --- 90%

Diphtheria ..................... ... --- --- --- ---

77% --- --- --- --- --- --- 90%

Hepatitis B vaccine ................ 1992-93 77% . . . . . . . . . . . . - - - - - - - - - - - - - - - - - - 90%

20.17

Local health department programs

that identify tuberculosis cases .... 1992-93 80% . . . . . . . . . . . . - - - - - - - - - - - - - - - - - - 90%

20.18

Preventive therapy for tuberculosis

(percent of infected people completing

therapy) ....................... 1987 66.3% 63.0% 64.9% 66.3% 65.3% 65% 65.4% 65.2% 62.2% 64.6% - - - 85%

20.19

Laboratory capability for influenza

diagnosis

Tertiary care hospital laboratories . . . 1993 52% . . . . . . . . . . . . - - - 57% - - - 58% - - -

64% 85%

Secondary care hospital

laboratories ................... 1993 45% . . . . . . . . . . . . - - - 46% - - - 46% - - -

51% 50%

Health maintenance organization

laboratories ................... 1993

68% ... ... ... ... --- 56% --- 68% ---

67% 50%

- - - Data not available. Final objective status:

. . . Category not applicable.

Baseline and/or target have been revised.

Preliminary data.

1979–80 influenza season through 1986-87 influenza season.

1987–88 influenza season through 1989-90 influenza season.

1988–89 influenza season through 1990-91 influenza season.

1989–90 influenza season through 1991-92 influenza season.

1990–91 influenza season through 1992-93 influenza season.

1991–92 influenza season through 1993-94 influenza season.

1992–93 influenza season through 1994-95 influenza season.

1993–94 influenza season through 1995-96 influenza season.

1994–95 influenza season through 1996-97 influenza season.

Data are unreliable. Number of cases is too small to make reliable estimates.

Data are based on cases of Haemophilus influenzae type b and Streptococcus pneumoniae only.

Data are unreliable. Numerator has a relative standard error of more than 30%.

Range of antigen-specific immunization levels.

Three or more doses for DTP and polio.

1987-88 school year.

1989-90 school year.

1990-91 school year

1991-92 school year.

1992-93 school year.

1993-94 school year.

Met

Toward

Mixed/ no change

Away

Cannot assess

Healthy People 2000 Final Review 289

1994-95 school year.

1995-96 school year.

1996-97 school year.

1997-98 school year.

1998-99 school year.

Health care workers only.

1994–98 data.

43% of nursing home residents surveyed in 1995 had unknown pneumococcal vaccination status and were counted as unvaccinated.

44% of nursing home residents surveyed in 1997 had unknown pneumococcal vaccination status and were counted as unvaccinated.

21% of nursing home residents surveyed in 1995 had unknown influenza vaccination status and were counted as unvaccinated.

22% of nursing home residents surveyed in 1997 had unknown influenza vaccination status and were counted as unvaccinated.

Data represent the range in the number of States with laws on each of the nine antigen types (diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, and Haemophilus) and by the

two types of facilities (schools with grades K-12 and day care centers). Hepatitis B vaccine in schools with grades K-12 and day care centers are not included in the range. The number of

States with Hepatitis B immunization laws for grades K-12 was 2 in 1994–95 and 9 in 1998-99.

1994-95 data.

1996-97 data.

1997-98 data.

Response rate for this group was too low to produce reliable estimates.

NOTES: Data include revisions and, therefore, may differ from those previously published in these reports and other publications. ICU is intensive care unit. DTP is diphtheria-tetanus-pertusis.

MMR is measles-mumps, rubella. Hib is Haemophilus influenzae type b.

Objective number Data source

20.1 National Notifiable Disease Surveillance System, CDC, EPO.

20.2 CDC, NCID.

National Vital Statistics System, CDC, NCHS.

20.3*, 20.3a-c, i-k National Notifiable Disease Surveillance System, CDC, EPO.

Sentinel Counties Study of Acute Viral Hepatitis, Viral Hepatitis Surveillance Program, CDC, NCID.

20.3d CDC, NCID.

20.3e National Notifiable Disease Surveillance System, CDC, EPO.

Sentinel Counties Study of Acute Viral Hepatitis, Viral Hepatitis Surveillance Program, CDC, NCID.

20.3f National Notifiable Disease Surveillance System, CDC, EPO.

Margolis, HS. Estimates and reported cases of hepatitis B infection and its sequelae in Alaskan Natives.

Lancet (1987) 2: 1134-6.

20.3g Alaskan Registry, IHS.

20.3h National Notifiable Disease Surveillance System, CDC, EPO.

20.4, 20.4a-d Tuberculosis Morbidity Data, CDC, NCHSTP.

20.5 National Nosocomial Infection Surveillance System, CDC, NCID.

20.6 Typhoid Surveillance System, CDC, NCID.

Sentinel Counties Study of Acute Viral Hepatitis, Viral Hepatitis Surveillance Program, CDC, NCID; National Notifiable Disease Surveillance System, CDC,

EPO.

Malaria Surveillance System, CDC, NCID.

20.7 Bacterial Meningitis Surveillance System, CDC, NCID.

20.7a Arctic Investigations Laboratory, CDC, NCID.

20.8 National Health Interview Survey, CDC, NCHS.

20.9 National Health Interview Survey, CDC, NCHS.

20.10 National Health Interview Survey, CDC, NCHS.

290 Healthy People 2000 Final Review

Objective number Data source

20.11 Basic immunization series among children:

Baseline for children 2 years and under: United States Immunization Survey, CDC, NCHSTP.

Children 19–35 months: 1991–1994 data: National Health Interview Survey, CDC, NCHS.

1995–96 data: National Immunization Survey, CDC, NIP.

Immunizations among children in licensed child care facilities and in schools: State Immunization Survey, CDC, NCHSTP.

Hepatitis B immunizations among infants of antigen-positive women:

Perinatal Hepatitis B Prevention Program, CDC, NIP.

Hepatitis B immunizations among occupationally exposed workers:

Baseline: Regulatory Impact Analysis of OSHA Final Rule on Occupational Exposure to Bloodborne Pathogens, DOL, OSHA, ORA.

Updates: CDC, NCID.

Hepatitis B immunizations among men who have sex with men:

Baseline: Young Men’s Survey, San Francisco Department of Public Health. MMWR Vol. 45 No.10: March 15, 1996.

Update: Young Men’s Survey, CDC, NCHSTP.

Pneumococcal and influenza immunizations among noninstitutionalized people:

National Health Interview Survey, CDC, NCHS.

Pneumococcal and influenza immunizations among institutionalized people:

National Nursing Home Survey, CDC, NCHS.

20.11a, b National Health Interview Survey, CDC, NCHS.

20.12 Rabies Vaccine and Immune Globulin Manufacturers Sales Data, CDC, NCID.

20.13 Survey of Immunization Laws, CDC, NIP.

20.14 Baseline: Primary Care Provider Surveys, OPHS, ODPHP.

Update: Prevention in Primary Care Study, American College of Preventive Medicine.

20.15 Health Insurance Association of America Employer Survey, Health

Insurance Association of America.

20.16 Baseline: Immunization Grant Program Profiles, CDC, NCPS.

Update: National Profile of Local Health Departments, National Association of County and City Health Officials.

20.17 National Profile of Local Health Departments, National Association of County and City Health Officials.

20.18 Tuberculosis Program Management Report Data on Completion of Preventive Therapy, CDC, NCHSTP.

20.19 Survey of Laboratories using Rapid Viral Diagnosis of Influenza, CDC, NCID.

* Duplicate objective. See full text of objective following this table.

Healthy People 2000 Final Review 291

Immunization and

Infectious Diseases

Objectives

20.1: Reduce indigenous cases of

vaccine-preventable diseases as follows:

Disease 2000 target

Diphtheria among people

aged 25 and younger 0

Tetanus among people

aged 25 and younger 0

Polio (wild-type virus) 0

Measles (indigenous) 0

Rubella 0

Congenital Rubella

Syndrome 0

Mumps 500

Pertussis 1,000

20.2: Reduce epidemic-related

pneumonia and inﬂuenza deaths among

people aged 65 and older to no more

than 15.9 per 100,000 people.

20.3*: Reduce viral hepatitis as follows:

Hepatitis B: 40 per 100,000 people

Hepatitis A: 16.1 per 100,000 people

Hepatitis C: 13.7 cases per 100,000

people

20.3a: Reduce hepatitis B among

injecting drug users to no more than

7,932 cases.

20.3b*: Reduce hepatitis B among

heterosexually active people to no

more than 22,663 cases.

Duplicate objective: 19.7

20.3c*: Reduce hepatitis B among

men who have sex with men to no

more than 4,568 cases.

Duplicate objective: 19.7

20.3d: Reduce hepatitis B among

children of Asian and Paciﬁc

Islanders to no more than 1,500

cases.

20.3e*: Reduce hepatitis B among

occupationally exposed workers to

no more than 623 cases.

Duplicate objective: 10.5

20.3f: Reduce hepatitis B among

infants to no more than 1,111

chronic infections.

20.3g: Reduce hepatitis B among

Alaska Natives to no more than 1

new chronic infection.

20.3h: Reduce hepatitis B among

blacks to no more than 40 cases per

100,000 people.

20.3i: Reduce hepatitis A among

Hispanics to no more than 26.9

cases per 100,000 people.

20.3j: Reduce hepatitis A among

American Indians and Alaska

Natives to no more than 128 cases

per 100,000 people.

20.3k: Reduce hepatitis C among

Hispanics to no more than 13.7

cases per 100,000 people.

20.4: Reduce tuberculosis to an

incidence of no more than 3.5 cases per

100,000 people.

20.4a: Reduce tuberculosis among

Asians and Paciﬁc Islanders to an

incidence of no more than 15 cases

per 100,000 people.

20.4b: Reduce tuberculosis among

blacks to an incidence of no more

than 10 cases per 100,000 people.

20.4c: Reduce tuberculosis among

Hispanics to an incidence of no

more than 5 cases per 100,000

people.

20.4d: Reduce tuberculosis among

American Indians and Alaska

Natives to an incidence of no more

than 5 cases per 100,000 people.

20.5: Reduce by at least 10 percent the

incidence of surgical wound infections

and nosocomial infections in intensive

care patients.

20.6: Reduce selected illness among

international travelers, as follows:

Typhoid fever: 140 cases

Hepatitis A: 1,119 cases

Malaria: 750 cases

20.7: Reduce bacterial meningitis to no

more than 4.7 cases per 100,000 people.

20.7a: Reduce bacterial meningitis

among Alaska Natives to no more

than 8 cases per 100,000 people.

20.8: Reduce infectious diarrhea by at

least 25 percent among children in

licensed child care centers and children

in programs that provide an

Individualized Education Program (IEP)

or Individualized Health Plan (IHP).

20.9: Reduce acute middle ear infections

among children aged 4 and younger, as

measured by days of restricted activity

or school absenteeism, to no more than

105 days per 100 children.

20.10: Reduce pneumonia-related days

of restricted activity as follows:

15.1 days per 100 people aged 65

and older

24 days per 100 children aged 4

and younger

20.11: Increase immunization levels as

follows:

Basic immunization series among

children under age 2: at least 90 percent.

Basic immunization series among

children in licensed child care facilities

and kindergarten through post-secondary

education institutions: at least

95 percent.

Hepatitis B immunization among

high-risk populations, including infants

of hepatitis B surface antigen-positive

mothers to at least 90 percent;

occupationally exposed workers to at

least 90 percent; injecting drug users in

drug treatment programs to at least

50 percent; and men who have sex with

men to at least 50 percent.

Pneumococcal pneumonia and inﬂuenza

immunization among institutionalized

chronically ill or older people: at least

80 percent.

Pneumococcal pneumonia and inﬂuenza

immunization among

noninstitutionalized, high-risk

populations, as deﬁned by the

Immunization Practices Advisory

Committee: at least 60 percent.

Duplicate objective for occupationally

exposed workers: 10.9

20.11a: Increase pneumococcal

pneumonia and inﬂuenza

immunization among blacks aged

65 years and older to 60 percent.

20.11b: Increase pneumococcal

pneumonia and inﬂuenza

immunization among Hispanics

aged 65 years and older to

60 percent.

20.12: Reduce postexposure rabies

treatments to no more than 9,000 per

year.

20.13: Expand immunization laws for

schools, preschools, and day care

settings to all States for all antigens.

20.14: Increase to at least 90 percent the

proportion of primary care providers

who provide information and counseling

292 Healthy People 2000 Final Review

about immunizations and offer

immunizations as appropriate for their

patients.

20.15: Improve the ﬁnancing and

delivery of immunizations for children

and adults so that virtually no American

has a ﬁnancial barrier to receiving

recommended immunizations.

20.16: Increase to at least 90 percent the

proportion of public health departments

that provide adult immunization for

inﬂuenza, pneumococcal disease,

hepatitis B, tetanus, and diphtheria.

20.17: Increase to at least 90 percent the

proportion of local health departments

that have ongoing programs for actively

identifying cases of tuberculosis and

latent infection in populations at high

risk for tuberculosis.

20.18: Increase to at least 85 percent the

proportion of people found to have

tuberculosis infection who completed

courses of preventive therapy.

20.19: Increase to at least 85 percent the

proportion of tertiary care hospital

laboratories and to at least 50 percent

the proportion of secondary care

hospital and health maintenance

organization laboratories possessing

technologies for rapid viral diagnosis of

inﬂuenza.

*Duplicate objective.

Healthy People 2000 Final Review 293

Priority Area 21

Clinical Preventive

Services

Background

Achieving access to preventive

services for all Americans was one of

three overarching goals of Healthy

People 2000. The Clinical Preventive

Services priority area directly addresses

this goal and covers a range of

recommended screening services

delivered to individuals in a health care

setting. The services include

immunizations, screening for the early

detection of disease or risk factors,

clinician counseling about modifiable

risk factors such as smoking and

physical activity, and use of medication

to prevent disease in healthy individuals.

Clinical preventive services are not only

an essential component of national

efforts to reduce disease and disability,

but also are an important barometer of

the effectiveness and functioning of the

Nation’s health care system. Failure to

receive recommended, needed

immunizations or screening tests often

reflects fundamental problems in access

to essential health care services or in the

quality of available care. The objectives

in this priority area acknowledge the

importance of specific barriers in the

Nation’s efforts to improve the

preventive care and the overall health of

our population. Lack of health insurance

remains a fundamental problem for a

substantial number of persons, and

uninsured patients are less likely to get

needed services and more likely to

suffer poor health. Having insurance,

however, is not sufficient to ensure that

individuals get the preventive care they

need. Having a regular source of care

may be an equally important factor for

prevention. Promoting regular

preventive care will require steps to

ensure an adequate number of health

care providers, especially for

underserved rural and urban areas, along

with efforts to expand health care

coverage.

Health insurance, access to care,

and receipt of preventive care are

especially a problem in racial and ethnic

minority populations (1), as well as

other unserved or underserved

populations. One important step toward

improving care for these populations is

to improve their representation among

those individuals entering the health

professions.

Over the last decade, there has been

a growing recognition among clinicians,

patients, and policymakers of the

importance of preventive services as a

part of primary health care. Much of

this awareness can be attributed to the

increasing evidence of the effectiveness

of clinical preventive services in

improving health outcomes and the cost-

effectiveness of a range of identified

services, including immunizations,

screening for cancer and cardiovascular

risk factors, and counseling about

smoking and other important behavioral

risk factors (2,3).

Data Summary

Highlights

Substantial progress has been made

in the delivery of effective preventive

care to Americans. The average number

of years of healthy life for the total

population (21.1) increased from a

baseline of 64 years in 1990 to 65.2

years in 1998, exceeding the Healthy

People 2000 target. Among special

populations targeted by the objective,

the Hispanics have met the year 2000

target, while progress was made for

blacks and older adults. Receipt of

individual preventive services (21.2)

increased steadily across a variety of

service and patient populations, and

reached the year 2000 targets for several

in 1998. Of the five universally

recommended childhood immunizations,

four had rates that exceeded the year

2000 target of 90 percent and narrowly

missed the target for the fifth

immunization series, hepatitis B, with a

rate of 88 percent. Receipt of

mammograms and clinical breast exams

in the past 2 years was reported by

64 percent of women over 50 years of

age, up from 51 percent in 1992, and

63 percent of adults over 65 years of

age received an influenza immunization.

By 1998, additional services made

important progress toward the year 2000

targets: rates of pneumococcal

immunization in older persons more

than doubled to 46 percent, rates of

recent tetanus booster, cholesterol

screening, and Pap test increased to

57 percent, 67 percent, and 79 percent,

respectively.

The proportion of the adult

population with a usual source of care

increased from 80 percent in 1991 to

85 percent in 1998 (21.3). Gains were

evident in all targeted racial and ethnic

groups and among persons of low

income.

Little progress was made in rates of

insurance coverage (21.4), although

promising recent trends are evident for

children under 18 years of age. Overall,

the proportion of adults under 65 years

of age without health care coverage

increased slightly from 15.7 percent in

1989 to 16.6 percent in 1998. Rates for

uninsured persons among Hispanics

under 65 years of age (34 percent) and

those below the poverty level

(33 percent) were close to double that of

the general population. Similar

disparities exist in access to a usual

source of care.

Summary of Progress

Data are available to assess the

progress for six of the eight objectives

for Clinical Preventive Services. One

objective (21.1) met its year 2000 target.

Two objectives (21.3 and 21.8) moved

toward the year 2000 targets. One

objective (21.4) moved away from its

target. Progress was mixed for two

objectives (21.2 and 21.6). For objective

21.6, the assessment of progress is

based on nurse-practitioner data only.

Data beyond baseline are not available

for two objectives (21.5 and 21.7). See

table 21 for the tracking data for the

objectives in this priority area and

figure 21 for a quantitative assessment

of progress.

Discussion

Important progress has been made

in delivering effective preventive

services to persons in the United States.

This is reflected in generally increasing

delivery rates for individual services,

better coverage of preventive services

by public and private insurers, and

growing attention to prevention within

the clinical community and the public.

At the same time, substantial barriers

remain. While insurance coverage of

preventive services has increased

significantly, a substantial and steady

number of persons have no health care

coverage and/or no usual source of care.

One isolated pocket of recent progress,

however, is insurance for children. Over

the past 2 years, the Child Health

Insurance Program, through Federal

support to States, has reduced the

294 Healthy People 2000 Final Review

21.1 Years of healthy life

21.2 Receipt of recommended services Children

19-35 months:Basic immunization series, 3DTP

3Polio

1MMR

3Hib

3HepB

4DTP/3Polio/1MMR

Adults: Routine checkup, 18-64 years

Cholesterol screened in past 5 years, 18 years and over

Cholesterol ever screened, 18 years and over

Cholesterol screened in past 2 years, 18 years and over

Tetanus booster, 18 years and over

Influenza vaccination, 65 years and over

Pneumococcal vaccination, 65 years and over

Pap test in past 3 years, 18 years and over

Breast exam and mammography in past 2 years,

50 years and over

Screening questions at routine checkup,

18 years and over

21.3 Usual source of care

21.4 No health insurance

21.8 Racial/ethnic representation in health

professions, degrees: Black

Hispanic

American Indian/Alaska Native

Enrolled in nursing school: Black

Hispanic

Asian or Pacific Islander

American Indian/Alaska Native

Moved away from target Moved toward target Met target

NOTES: Complete tracking data are shown in table 21. Progress quotients are not calculated for objectives 21.5, 21.6, and 21.7.

See the section on Measuring Progress Toward the

Healthy People 2000

Targets in the Appendix for more information.

DTP is diphtheria-tetanus-pertussis. Hib is

Haemophilus influenzae

type b vaccine. MMR is measles-mumps-rubella.

-12%

71%

12%

47%

75%

28%

50%

64%

46%

33%

41%

70%

44%

52%

No change

Percent of target achieved

-100 -80 -60 -40 -20

20 40 60 80 100

97%

107%

117%

129%

100%

186%

120%

144%

100%

83%

Healthy People 2000 Final Review 295

Figure 21. Final status of Clinical Preventive Services objectives

proportion of children under 18 years of

age without insurance. Insurance

coverage for counseling services such as

smoking cessation continues to lag far

behind that for screening tests. Finally,

although several measures have been

shown consistently to improve

preventive care—reminder systems for

patients and clinicians, audit, and

feedback to clinicians, and reducing

financial barriers for patients

(2–5)—only a minority of clinicians

practice in health systems where these

measures can be easily implemented

through integrated data systems and

computerized medical records.

An important potential force for

change is the drive to make health plans

accountable for delivering quality care,

including appropriate preventive care.

The National Committee for Quality

Assurance (NCQA), through its Health

Plan Employer Data and Information Set

(HEDIS) (6), collects data on the

provision of a number of clinical

preventive services, including child and

adult immunizations, smoking cessation

advice, and breast and cervical cancer

screening (2,3). The expectation,

supported in part by preliminary data, is

that increasing accountability among

competing health plans will encourage

them to invest in improving preventive

care and in building the information

infrastructure that could facilitate further

gains (2,3,6). At the same time,

however, these efforts are impeded by

increasing turnover of patients within

plans, fragmentation of care, and

heightened economic pressures on the

health care system.

Transition to Healthy People

2010

The 1990s were marked by growing

attention to improving the quality of

health care and reducing medical errors

(7). Several issues emerged that will

demand the efforts of the public health

community over the next decade, for

example, monitoring and reporting on

health care quality (8). Other issues that

surfaced, particularly with respect to

increasing access to needed services,

include fostering community-based,

integrated systems of care that better

respond to the community’s needs and

supporting the development of a health

work force that reflects and responds to

the cultural diversity of populations

served.

To address these issues, Healthy

People 2010 focus area 1, Access to

Quality Health Services, expands on the

Healthy People 2000 priority area on

clinical preventive services. The revised

focus area aims to track access to

services for four important sectors of the

health care system—clinical preventive

care, primary care, emergency services,

and long-term care and rehabilitative

services.

In addition, some objectives

covering clinical preventive care have

been moved to other Healthy People

2010 focus areas: focus area 14,

Immunization and Infectious Diseases

includes objectives on childhood

immunizations, adult immunizations;

focus area 12, Heart Disease and Stroke

addresses cholesterol screening; and

focus area 3, Cancer covers women’s

receipt of breast exams and

mammograms and Pap tests as well as

primary care provider counseling about

mammograms and Pap tests.

Two objectives from the access to

quality health services focus area (health

insurance coverage and usual source of

care) are used to measure the Healthy

People 2010 Leading Health Indicator

on access to health care.

Appendix table III, a crosswalk

between Healthy People 2000 and

Healthy People 2010 objectives,

summarizes the differences between the

two decades of objectives, reflecting

new knowledge and directions in this

area.

Data Issues

Years of Healthy Life

Years of healthy life is a summary

measure of health that combines

mortality (quantity of life) and

morbidity and disability (quality of life)

into a single measure. The concept of

increasing the span of healthy life is one

of the three Healthy People 2000 goals

and a specific measure has been

developed to track this objective in three

priority areas (8.1, 17.1, and 21.1). The

data used to track the objective come

from the National Vital Statistics System

(mortality) and the National Health

Interview Survey (NHIS) (morbidity).

The NHIS was redesigned in 1997 and,

therefore, data for 1997–98 may not be

comparable with those from previous

years. See the Appendix for a discussion

of the changes to the NHIS. The

methodology for the Healthy People

2000 years of healthy life measure,

developed by NCHS and outside

consultants is published in Healthy

People Statistical Notes series (9).

Definitions

Operational definitions and data

collection specifications for all Healthy

People 2000 objectives in Priority Area

21 have been published in the National

Center for Health Statistics, Healthy

People Statistical Notes series (10). Data

issues are discussed and references are

cited for expanded discussions of the

data systems that provide data for the

national objectives. When appropriate,

the text of questionnaire items used to

measure the objectives is also provided.

See Appendix table VI for more

information.

Data to determine the level of

receipt of clinical preventive services

among adults (21.2) are obtained

through periodic supplements to the

National Health Interview Survey

(NHIS). The supplements provide

limited information on counseling, and

recommendations for high-risk groups

are not addressed. Respondents were

asked if they had been asked about at

least one behavior that indicates the

need for counseling at their last routine

checkup. A positive response was used

as an indication that the person had

received at least one recommended

counseling service.

For objective 21.7, a local health

department refers to any local

component of the public health system,

defined as an administrative and service

unit of local or State government

concerned with health and carrying

some responsibility for the health of a

jurisdiction smaller than a State.

Data Sources

Baseline data for objective 21.6

(provision of recommended services) are

from the Primary Care Provider Surveys

(PCPS). The sample was drawn from

the membership rolls of professional

organizations for pediatricians, nurse

practitioners, family physicians,

obstetricians/gynecologists, and

internists. Response rates varied from 50

to 80 percent across these groups. The

data on provision of recommended

services represent the proportion of

providers who report that they routinely

provided 81–100 percent of eligible

patients with the recommended services.

The Prevention in Primary Care Study

296 Healthy People 2000 Final Review

(PPCS) was conducted in 1997–98 to

update data from the PCPS. The design

and items included in the 1997–98 study

were similar to the PCPS, but a slightly

different sampling frame was used and

some items included in the 1992 surveys

were not included in the PPCS. The

professionals were sampled from listings

of all licensed, active practitioners in the

United States whose practices were at

least 50 percent primary care. Because

of low response rates from the other

provider groups, updates are available

only for nurse practitioners.

Data Comparability

Data on the proportion of people

who have a usual source of care (21.3)

are obtained from the NHIS. In 1991

and 1992, information on source of

primary care was received from one

adult randomly selected from among

household members. Beginning in 1993,

a knowledgeable adult respondent

provided information for all members of

the household.

Data on the proportion of people

under 65 years of age who do not have

health care coverage (21.4) are from the

NHIS. The 1989 baseline data and

tracking data from 1992 through 1994

are not directly comparable because of

questionnaire changes. Also, beginning

with 1995 data, persons receiving public

assistance other than Medicaid are

considered to have health care coverage.

Prior to 1995 they were considered to

not have health care coverage. In 1996,

0.4 percent of the population under 65

years of age were covered by public

assistance other than Medicaid.

Proxy Data

The proportion of the U.S.

population under 65 years of age

(age-adjusted to the 1970 U.S. civilian

noninstitutionalized population) that

does not have health care coverage

(private insurance, Medicare, Medicaid,

or a military plan) is used to measure

progress for objective 21.4, financial

barriers to receiving recommended

clinical preventive services. This is only

a partial measure. Many health

insurance plans do not provide full

coverage for preventive health care;

however, overall coverage for preventive

care services is improving. In 1997,

89 percent of employer-sponsored health

insurance plans covered periodic

physical examinations, 88 percent

covered well-baby care, and 92 percent

covered periodic gynecological

examinations (11).

Beginning with 1996 data, persons

receiving public assistance other than

Medicaid are considered to have health

care coverage. Prior to 1996, they were

considered to not have health care

coverage. In 1996, the age-adjusted

percent of the population under 65 years

of age covered by Medicaid was

11.3 percent, and 0.4 percent were

covered by other public assistance (12).

References

1. Weinick RM, Zuvekas SH, Drilea SK. Access

to health care—sources and barriers, 1996. MEPS

Research Findings No. 3. Rockville, Maryland:

Agency for Health Care Policy and Research.

1997.

2. U.S. Preventive Services Task Force. Guide to

clinical preventive services: An assessment of the

effectiveness of 169 interventions. Report of the

U.S. Preventive Services Task Force. Baltimore,

Maryland: Williams and Wilkins. 1989.

3. U.S. Preventive Services Task Force. Guide to

clinical preventive services, 2d ed. Baltimore,

Maryland: Williams and Wilkins. 1996.

4. Centers for Disease Control and Prevention.

Vaccine-preventable diseases: Improving

vaccination coverage in children, adolescents, and

adults. A report on recommendations of the Task

Force on Community Preventive Services.

MMWR 48(RR–8):1–16. 1999.

5. National Health Service, Center for Reviews

and Dissemination. Getting evidence into practice.

Effective Health Care 5(1). 1999.

6. National Committee on Quality Assurance.

Health Plan Employer Data and Information Set

(HEDIS 3.0). Washington: National Committee on

Quality Assurance. 1997.

7. Kohn L, Corrigan J, Donaldson M, eds.

Committee on Quality of Health Care in America.

To err is human: Building a safer health system.

Washington: Institute of Medicine. 1999.

8. President’s Advisory Commission on Consumer

Protection and Quality in the Health Care Industry.

Quality first: Better health care for all Americans:

Final report to the President of the United States.

Washington: U.S. Government Printing Office.

1998.

9. Erickson P, Wilson R, Shannon I. Years of

Healthy Life. Healthy people statistical notes no 7.

Hyattsville, Maryland: National Center for Health

Statistics. 1995.

10. Ryan C, Klein R, Wagener D. Operational

definitions for year 2000 objectives: Priority area

21, clinical preventive services. Healthy people

statistical notes no 17. Hyattsville, Maryland:

National Center for Health Statistics. 1998.

11. Partnership for Prevention/William Mercer

Survey of Employer-Sponsored Health Plans.

Washington, DC. 1999.

12. National Center for Health Statistics. Health,

United States, 1998, with socioeconomic status

and health chartbook. Hyattsville, Maryland:

Public Health Service. 1998.

Healthy People 2000 Final Review 297

Table 21. Clinical Preventive Services objectives

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

21.1* Years of healthy life ..................... 1990 64.0 . . . 63.9 63.7 63.5 63.8 63.9 64.2

‡

64.8

‡

65.2 - - - 65

a. Black .............................. 1990 56.0 . . . 56.0 55.6 55.2 55.6 56.0 56.5

‡

57.4

‡

57.8 - - - 60

b. Hispanic

........................... 1990 64.8 . . . 63.6

64.0 63.2 64.2 64.0 64.7

‡

65.8

‡

66.3 - - - 65

c. People 65 years and over

.............. 1990 11.9 . . . 11.8 11.9 11.9 12.1 12.0 12.2

‡

12.0

‡

12.2 - - - 14

21.2 Receipt of recommended services

Children 19-35 months

Basic immunization series.................. ... --- --- --- --- --- --- --- --- --- --- --- 90%

DTP (3 or more doses) .................. 1992 83% . . . . . . . . . 88% 90% 95% 95% 95% 96% 96% . . .

Polio (3 or more doses) .................. 1992 72% . . . . . . . . . 79% 79% 88% 91% 91% 91% 90% . . .

Measles/Mumps/Rubella (1 dose) .......... 1992 83% . . . . . . . . . 84% 90% 90% 91% 91% 92% 92% . . .

Haemophilus influenza type b (3 or more

doses) .............................. 1992 28% . . . . . . . . . 55% 75% 92% 92% 93% 93% 94% . . .

Hepatitis B (3 or more doses) ............. 1993 16% . . . . . . . . . . . . 34% 68% 82% 84% 87% 88% . . .

4DTP/3Polio/1MMR ..................... 1992 55% . . . . . . . . . 67% 68% 76% 78% 78% 81% 80% . . .

People 18 years and over

Routine checkup, people 18–64 years

...... 1991 74% . . . . . . - - - 78% 70% 81% - - - - - - 76% - - - 91%

Routine checkup, people 65 years and over . . 1991 67% . . . . . . - - - 73% 62% 74% - - - - - - 77% - - - . . .

Cholesterol checked in last 5 years........... 1993 60% . . . . . . . . . . . . - - - - - - - - - - - - 67% - - - 75%

Cholesterol ever checked .................. 1991 63% . . . . . . - - - 71% - - - - - - - - - - - - 72% - - - . . .

People with low income

................. 1991 46% . . . . . . - - - 55% - - - - - - - - - - - - 55% - - - . . .

Black................................ 1991 56% . . . . . . - - - 72% - - - - - - - - - - - - 67% - - - . . .

Hispanic ............................. 1991 51% . . . . . . - - - 62% - - - - - - - - - - - - 56% - - - . . .

American Indian/Alaska Native ............ 1991 46% . . . . . . - - - 60% - - - - - - - - - - - - 53% - - - . . .

Cholesterol checked in last 2 years........... 1991 50% . . . . . . - - - 54% - - - - - - - - - - - - 57% - - - . . .

People with low income

................. 1991 37% . . . . . . - - - 41% - - - - - - - - - - - - 43% - - - . . .

Hispanic ............................. 1991 42% . . . . . . - - - 47% - - - - - - - - - - - - 45% - - - . . .

Asian/Pacific Islander ................... 1991 45% . . . . . . - - - 44% - - - - - - - - - - - - 54% - - - . . .

American Indian/Alaska Native ............ 1991 38% . . . . . . - - - 49% - - - - - - - - - - - - 42% - - - . . .

Tetanus booster in last 10 years ............. 1991 52% . . . . . . - - - 57% 56% 59% - - - - - - 57% - - - 62%

People 65 years and over ................ 1991 29% . . . . . . - - - 34% 32% 40% - - - - - - 41% - - - . . .

Hispanic ............................. 1991 45% . . . . . . - - - 48% 51% 51% - - - - - - 48% - - - . . .

Asian/Pacific Islander ................... 1991 40% . . . . . . - - - 45% 43% 40% - - - - - - 45% - - - . . .

People with disabilities................... 1991 47% . . . . . . - - - 51% 52% 56% - - - - - - - - - - - - . . .

Pneumococcal vaccine in lifetime (people

65 years and over) ...................... 1991 21% . . . . . . - - - 28% 30% 34% - - -

‡

42%

‡

46% - - - 60%

People with low income

................. 1991 17% . . . . . . - - - 18% 19% 25% - - -

‡

31%

‡

34% --- ...

Black................................ 1991 14% . . . . . . - - - 14% 15% 23% - - -

‡

22%

‡

26% --- ...

Hispanic ............................. 1991 12% . . . . . . - - - 13% 14% 23% - - -

‡

23%

‡

23% --- ...

Asian/Pacific Islander ................... 1991 15% . . . . . . - - - 21% 14% 22% - - -

‡

26%

‡

37% --- ...

Influenza vaccine in last 12 months (people

65 years and over) ...................... 1991 42% . . . . . . - - - 52% 55% 58% - - -

‡

63%

‡

63% - - - 60%

People with low income

................. 1991 36% . . . . . . - - - 41% 44% 46% - - -

‡

52%

‡

54% --- ...

Black................................ 1991 27% . . . . . . - - - 33% 39% 40% - - -

‡

45%

‡

46% --- ...

See footnotes and key at end of table.

298 Healthy People 2000 Final Review

Table 21. Clinical Preventive Services objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Hispanic ............................. 1991 34% . . . . . . - - - 47% 38% 50% - - -

‡

53%

‡

50% --- ...

Asian/Pacific Islander ................... 1991 29% . . . . . . - - - 54% 43% 51% - - -

‡

53%

‡

68% --- ...

Pap test in last 3 years (female 18 years and

over)................................. 1992 74% . . . . . . . . . 78% 77% - - - - - - - - - 79% - - - 85%

Females 65 years and over ............... 1992 51% . . . . . . . . . 58% 57% - - - - - - - - - 64% - - - . . .

Asian/Pacific Islander ................... 1992 62% . . . . . . . . . 69% 66% - - - - - - - - - 68% - - - . . .

American Indian/Alaska Native ............ 1992 64% . . . . . . . . . 78% 73% - - - - - - - - - 75% - - - . . .

Females with disabilities ................. 1992 65% . . . . . . . . . 69% 69% - - - - - - - - - - - - - - - . . .

Breast exam and mammogram in past 2 years

(female 50 years and over) ................ 1992 51% . . . . . . . . . 55% 56% - - - - - - - - - 64% - - - 60%

Females 65 years and over ............... 1992 43% . . . . . . . . . 49% 49% - - - - - - - - - 58% - - - . . .

Females with low income

................ 1992 30% . . . . . . . . . 39% 38% - - - - - - - - - 48% - - - . . .

Asian/Pacific Islander ................... 1992 38% . . . . . . . . . 53% 46% - - - - - - - - - 55% - - - . . .

American Indian/Alaska Native ............ 1992 31% . . . . . . . . . 38% 53% - - - - - - - - -

--- --- ...

Females with disabilities ................. 1992 44% . . . . . . . . . 51% 50% - - - - - - - - - - - - - - - . . .

Asked at least one screening question at routine

checkup

.............................. 1991 56% . . . . . . - - - 63% 56% - - - - - - - - - 76% - - - 80%

People 65 years and over ................ 1991 42% . . . . . . - - - 48% 38% - - - - - - - - - 77% - - - . . .

Asian/Pacific Islander ................... 1991 51% . . . . . . - - - 60% 48% - - - - - - - - - 76% - - - . . .

21.3 Usual source of care

Total population (18 years and over) .......... 1991 80% . . . . . . 78% 83% 84% 85% 85%

‡

84%

‡

85% - - - 95%

a. Hispanic ............................ 1991 63% . . . . . . 64% 71% 71% 74% 73%

‡

71%

‡

72% - - - 95%

Mexican American .................... 1991 57% . . . . . . 62% 69% 69% 72% 70%

‡

66%

‡

66% - - - 95%

b. Black .............................. 1991 78% . . . . . . 75% 79% 82% 82% 83%

‡

81%

‡

83% - - - 95%

c. Low-income people (family income below

poverty level)........................ 1991 71% . . . . . . 71% 72% 73% 76% 76%

‡

75%

‡

76% - - - 95%

d. American Indian/Alaska Native ........... 1991 70% . . . . . . 85% 82% 81% 84% 83%

‡

83%

‡

77% - - - 95%

e. Asian/Pacific Islander .................. 1991 70% . . . . . . 71% 74% 78% 81% 79%

‡

80%

‡

80% - - - 95%

21.4 Financial barriers to receipt of clinical

preventive services

Proportion of people under 65 years without

health care coverage

(age adjusted) ........ 1989

15.7% - - - - - - 17.2% 17.3% 17.8% 15.6% 16.1%

‡

17.5%

‡,p

16.6 - - - 0%

a. American Indian/Alaska Native ........... 1989

36.1% - - - - - - - - - 34.2% 39.0% 33.9% 33.9%

‡

38.1%

‡,p

38.7 - - - 0%

b. Hispanic ............................ 1989

31.3% - - - - - - 34.0% 34.2% 32.9% 30.8% 31.6%

‡

34.5%

‡,p

34.1 - - - 0%

Mexican American .................... 1989

38.1% - - - - - - 37.8% 39.5% 37.2% 35.4% 36.7%

‡

39.4%

‡,p

40.1 - - - 0%

Puerto Rican ........................ 1989

21.4% - - - - - - 18.3% 21.0% 17.4% 17.8% 14.4%

‡

19.0%

‡,p

18.9 - - - 0%

Cuban ............................. 1989

20.7% - - - - - - 20.1% 16.9% 27.4% 21.6% 17.6%

‡

21.1%

‡,p

18.5 - - - 0%

c. Black .............................. 1989 22.0% - - - - - - 22.3% 23.2% 21.5% 17.9% 19.0%

‡

20.1%

‡,p

20.4 - - - 0%

See footnotes and key at end of table.

Healthy People 2000 Final Review 299

Table 21. Clinical Preventive Services objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

21.5 Clinical preventive services from publicly

funded programs (proportion of eligible

people)

Federal programs

Screening .......................... 1991-92 10-100% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 90%

Counseling.......................... 1991-92 40-100% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 90%

Immunizations ....................... 1991-92 10-100% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - 90%

21.6 Provision of recommended services by

primary care providers .................. ... --- --- --- --- --- --- --- --- --- --- --- 50%

Percent of clinicians routinely providing service to

81–100% of patients

Preventive services for children:

Hemoglobin/hematocrit

Pediatricians .......................... 1992 78% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - . . .

Nurse practitioners ..................... 1992 77% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - . . .

Family physicians ...................... 1992 52% . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - . . .

Eye exam (for strabismus and amblyopia)

Pediatricians .......................... 1992 64% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Nurse practitioners ..................... 1992 67% . . . . . . . . . - - - - - - - - - - - - - - -

51% --- ...

Family physicians ...................... 1992 53% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Blood pressure

Pediatricians .......................... 1992 78% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Nurse practitioners ..................... 1992 71% . . . . . . . . . - - - - - - - - - - - - - - -

65% --- ...

Family physicians ...................... 1992 42% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Height and weight

Pediatricians .......................... 1992 96% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Nurse practitioners ..................... 1992 88% . . . . . . . . . - - - - - - - - - - - - - - -

85% --- ...

Family physicians ...................... 1992 89% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

DTP vaccination

Pediatricians .......................... 1992 86% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Nurse practitioners ..................... 1992 76% . . . . . . . . . - - - - - - - - - - - - - - -

78% --- ...

Family physicians ...................... 1992 89% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Oral polio vaccination

Pediatricians .......................... 1992 87% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Nurse practitioners ..................... 1992 76% . . . . . . . . . - - - - - - - - - - - - - - -

79% --- ...

Family physicians ...................... 1992 89% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Tetanus-diphtheria booster

Pediatricians .......................... 1992 79% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Nurse practitioners ..................... 1992 71% . . . . . . . . . - - - - - - - - - - - - - - -

72% --- ...

Family physicians ...................... 1992 70% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Hib vaccination

Pediatricians .......................... 1992 85% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Nurse practitioners ..................... 1992 68% . . . . . . . . . - - - - - - - - - - - - - - -

74% --- ...

Family physicians ...................... 1992 74% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

300 Healthy People 2000 Final Review

Table 21. Clinical Preventive Services objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

Preventive services for adults:

Tetanus-diphtheria booster (18 years and over)

Nurse practitioners ..................... 1992 38% . . . . . . . . . - - - - - - - - - - - - - - -

40% --- ...

Obstetricians/gynecologists ............... 1992 4% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Internists ............................. 1992 29% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Family physicians ...................... 1992 28% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Influenza vaccination (65 years and over)

Nurse practitioners ..................... 1992 42% . . . . . . . . . - - - - - - - - - - - - - - -

47% --- ...

Obstetricians/gynecologists ............... 1992 6% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Internists ............................. 1992 49% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Family physicians ...................... 1992 31% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Pneumococcal vaccination (65 years and over)

Nurse practitioners ..................... 1992 33% . . . . . . . . . - - - - - - - - - - - - - - -

43% --- ...

Obstetricians/gynecologists ............... 1992 5% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Internists ............................. 1992 40% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Family physicians ...................... 1992 25% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Blood pressure

Nurse practitioners ..................... 1992 82% . . . . . . . . . - - - - - - - - - - - - - - -

90% --- ...

Obstetricians/gynecologists ............... 1992 88% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Internists ............................. 1992 92% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Family physicians ...................... 1992 89% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Cholesterol level

Nurse practitioners ..................... 1992 45% . . . . . . . . . - - - - - - - - - - - - - - -

55% --- ...

Obstetricians/gynecologists ............... 1992 36% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Internists ............................. 1992 80% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Family physicians ...................... 1992 61% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Breast exam (by clinician)

Nurse practitioners ..................... 1992 78% . . . . . . . . . - - - - - - - - - - - - - - -

67% --- ...

Obstetricians/gynecologists ............... 1992 92% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Internists ............................. 1992 76% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Family physicians ...................... 1992 62% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Pap smear

Nurse practitioners ..................... 1992 77% . . . . . . . . . - - - - - - - - - - - - - - -

65% --- ...

Obstetricians/gynecologists ............... 1992 92% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Internists ............................. 1992 67% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Family physicians ...................... 1992 62% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Mammogram

Nurse practitioners 1992 63% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Patients 40-49 years .................. ... --- --- --- --- --- --- --- --- ---

58% --- ...

Patients 50 years and over.............. ... --- --- --- --- --- --- --- --- ---

60% --- ...

Obstetricians/gynecologists ............... 1992 85% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Internists ............................. 1992 67% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

Family physicians ...................... 1992 53% . . . . . . . . . - - - - - - - - - - - - - - -

6,9

--- --- ...

See footnotes and key at end of table.

Healthy People 2000 Final Review 301

Table 21. Clinical Preventive Services objectives—Con.

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

21.7 Local health department assurance of access

to essential clinical preventive services

Proportion of people served ................ ... --- --- --- --- --- --- --- --- --- --- --- 90%

Proportion of local health departments that:

Assess the extent to which screening,

immunization, and counseling services are

provided to the local population ........... 1992-93 76% . . . . . . . . . . . . - - - - - - - - - - - - - - - - - - . . .

Collect data to document the number of

providers of clinical preventive services in

their jurisdiction ....................... 1992-93 45% . . . . . . . . . . . . - - - - - - - - - - - - - - - - - - . . .

Evaluate to determine whether a gap exists

between available clinical preventive services

and the need for those services ........... 1992-93 57% . . . . . . . . . . . . - - - - - - - - - - - - - - - - - - . . .

(Of those that assess gaps) Provide clinical

preventive services to fill gaps ............ 1992-93 83% . . . . . . . . . . . . - - - - - - - - - - - - - - - - - - . . .

21.8 Racial/ethnic minority representation in the

health professions

Degrees awarded:

Black................................ 1985–86 5.0% - - -

5.7%

5.9%

6.0

6.6

6.7

7.1 - - - 8.0%

Hispanic ............................. 1985–86 3.0% - - -

4.3%

4.8%

4.3%

4.1

3.8

4.0

4.4 - - - 6.4%

American Indian/Alaska Native ............ 1985–86 0.3% - - -

0.4%

0.5%

0.4%

0.4

0.5

0.6

0.6 - - - 0.6%

a. Enrolled in schools of nursing:

Black ..............................

1991–

92 9.1% . . . . . . . . .

8.6%

8.7%

9.0%

9.4 - - - - - - - - - 10.0%

Hispanic............................

1991–

92 3.1% . . . . . . . . .

3.0%

3.2%

3.5 - - - - - - - - - 4.0%

Asian/Pacific Islander ..................

1991–

92 2.9% . . . . . . . . .

3.2%

3.3%

3.6%

4.0 - - - - - - - - - 5.0%

American Indian/Alaska Native ...........

1991–

92 0.7% . . . . . . . . .

0.6%

0.7%

0.7 - - - - - - - - - 1.0%

- - - Data not available. Final objective status:

. . . Category not applicable.

Baseline has been revised.

Preliminary data.

‡

The NHIS was redesigned in 1997. Data may not be comparable with previous years; see Appendix.

Estimate based on preliminary data. Excludes mortality data from States lacking an Hispanic-origin item on their death certificate or for which Hispanic-origin data were not of sufficient quality.

See Appendix.

Estimate derived from 1991-93 health status data and 1992 mortality data.

Years of healthy life remaining for those surviving to age 65.

In the last 3 years for people 18-64 and in the last year for people 65 years and over.

Data are for persons with family incomes below the Census poverty threshold.

Response rates for this group were too low to produce reliable estimates.

For people 18-64 years, a screening question was asked during a routine checkup in the past 3 years on at least one of the following: diet, physical activ ity, tobacco use, alcohol use, drug

use, sexually transmitted diseases, or contraceptive use. For people 65 years and over, a screening question was asked during a routine checkup in the past year about at least one of the

following: diet, physical activity, tobacco use, or alcohol use.

Beginning with 1996 data, persons receiving public assistance other than Medicaid are considered to have health care coverage. Prior to 1996 they were considered not to have health care

coverage.

1997-98 data.

Met

Toward

Mixed/ no change

Away

Cannot assess

302 Healthy People 2000 Final Review

Academic year 1990-91.

Academic year 1991-92.

Academic year 1992-93.

Academic year 1993-94.

Academic year 1994-95.

Academic year 1995-96.

Academic year 1996-97.

Academic year 1997-98.

NOTE: Data include revisions and, therefore, may differ from those previously published in these reports and other publications. DTP is diphtheria-tetanus-pertusis. MMR is measles-mumps-

rubella. Hib is Haemophilus influenzae type B.

Objective number Data source

21.1*, 21.1a-c National Vital Statistics System, CDC, NCHS; National Health Interview Survey, CDC, NCHS.

21.2 Excluding basic immunization series among children: National Health Interview Survey, CDC, NCHS.

Basic immunization series among children:

Baseline for children 2 years and under: United States Immunization Survey, CDC, NCHSTP.

Children 19–35 months: 1991–1994 data: National Health Interview Survey, CDC, NCHS.

1995–1999 data: National Immunization Survey, CDC, NIP.

21.3, 21.3a-e National Health Interview Survey, CDC, NCHS.

21.4, 21.4a-c National Health Interview Survey, CDC, NCHS.

21.5 For Community/Migrant Health Centers: Bureau of Primary Health Care Survey, HRSA, OPEL

For other publicly funded programs: Survey of Federal Programs, HRSA, OPEL.

21.6 Baseline: Primary Care Providers Survey, OPHS, ODPHP.

Update: Prevention in Primary Care Study, American College of Preventive Medicine.

21.7 National Profile of Local Health Departments, National Association of County and City Health Officials.

21.8 Minorities and Women in the Health Fields, HRSA, BHPr.

21.8a National League for Nursing, Nursing Data Source.

*Duplicate objective. See full text of objective following this table.

Healthy People 2000 Final Review 303

Clinical Preventive

Services Objectives

21.1*: Increase years of healthy life to

at least 65 years.

Duplicate objectives: 8.1 and 17.1

21.1a*: Increase years of healthy

life among blacks to at least 60

years.

Duplicate objectives: 8.1 and 17.1a

21.1b*: Increase years of healthy

life among Hispanics to at least 65

years.

Duplicate objectives: 8.1b and 17.1b

21.1c*: Increase years of healthy

life among people aged 65 and

older to at least 14 years remaining.

Duplicate objectives: 8.1c and 17.1c

21.2: Increase the proportion of people

who have received selected clinical

preventive screening and immunization

services and at least one of the

counseling services appropriate for their

age and gender as recommended by the

U.S. Preventive Services Task Force.

Receipt of selected clinical 2000

preventive and counseling target

services (percent)

Basic Immunization Series 90

Routine check-up 91

Cholesterol checked in last 5 years 75

Cholesterol ever checked 75

Cholesterol checked in last 2 years 75

Tetanus booster in last 10 years 62

Pneumococcal vaccine in lifetime

(aged 65 and over) 60

Inﬂuenza vaccine in last year

(aged 65 and over) 60

Pap test in last 3 years 85

Breast exam and mammogram in

past 2 years 60

Counseling services 80

21.3: Increase to at least 95 percent the

proportion of people who have a

speciﬁc source of ongoing primary care

for coordination of their preventive and

episodic health care.

21.3a: Increase to at least

95 percent the proportion of

Hispanics and the proportion of

Mexican-Americans who have a

speciﬁc source of ongoing primary

care for coordination of their

preventive and episodic health care.

21.3b: Increase to at least

95 percent the proportion of blacks

who have a speciﬁc source of

ongoing primary care for

coordination of their preventive and

episodic health care.

21.3c: Increase to at least 95 percent

the proportion of low-income

people who have a speciﬁc source

of ongoing primary care for

coordination of their preventive and

episodic health care.

21.3d: Increase to at least

95 percent the proportion of

American Indians and Alaska

Natives who have a speciﬁc source

of ongoing primary care for

coordination of their preventive and

episodic health care.

21.3e: Increase to at least 95 percent

the proportion of Asians and Paciﬁc

Islanders who have a speciﬁc source

of ongoing primary care for

coordination of their preventive and

episodic health care.

21.4: Improve ﬁnancing and delivery of

clinical preventive services so that

virtually no American has a ﬁnancial

barrier to receiving, at a minimum, the

screening, counseling, and immunization

services recommended by the U.S.

Preventive Services Task Force.

21.4a: Decrease to 0 percent the

proportion of American Indians and

Alaska Natives under 65 years

without health care coverage.

21.4b: Decrease to 0 percent the

proportion of Hispanics under 65

years, and Mexican-Americans,

Puerto Ricans, and Cubans under 65

years without health care coverage.

21.4c: Decrease to 0 percent the

proportion of blacks under 65 years

without health care coverage.

21.5: Ensure that at least 90 percent of

people for whom primary care services

are provided directly by publicly funded

programs are offered, at a minimum, the

screening, counseling, and immunization

services recommended by the U.S.

Preventive Services Task Force.

21.6: Increase to at least 50 percent the

proportion of primary care providers

who provide their patients with the

screening, counseling, and immunization

services recommended by the U.S.

Preventive Services Task Force.

21.7: Increase to at least 90 percent the

proportion of people who are served by

a local health department that assesses

and assures access to essential clinical

preventive services.

21.8: Increase the proportion of all

degrees in the health professions and

allied and associated health profession

ﬁelds awarded to members of

underrepresented racial and ethnic

minority groups as follows:

2000 target

Degrees awarded to— (percent)

Blacks 8.0

Hispanics 6.4

American Indians and

Alaska Natives 0.6

21.8a: Increase the proportion of

individuals from underrepresented

racial and ethnic minority groups

enrolled in U.S. schools of nursing.

2000

Proportion enrolled target

in fall academic year (percent)

Blacks 10

Hispanics 4

Asians and Paciﬁc

Islanders 5

American Indians and

Alaska Natives 1

*Duplicate objective.

304 Healthy People 2000 Final Review

Priority Area 22

Surveillance and

Data Systems

Background

Public health surveillance is the

systematic collection, analysis, and use

of health information. It is essential to

understanding the health status of a

population and to planning effective

programs and interventions. The

Institute of Medicine identifies

surveillance as one of the core functions

of public health (1). Surveillance and

health data systems provide information

on illness, disability, and death from

acute to chronic conditions; injuries,

personal, environmental, and

occupational risk factors; preventive and

treatment services; and costs. To be

most useful, public health data must be

accessible, accurate, timely, and clearly

stated and must adhere to strict

confidentiality standards. Surveillance or

health data systems must be linked with

other data systems as well as linked and

integrated at Federal, Tribal, State, and

local levels.

While the collection of national

public health data usually rests with

Federal agencies, data collection,

analysis, and use depend on the active

involvement of many partners including

Tribal, State, and local agencies. For

example, the Vital Statistics Cooperative

program (VSCP) collects information on

births, deaths, marriages, and divorces

from many sources in local

communities, including hospitals,

funeral directors, medical examiners,

coroners, hospitals, religious authorities,

and justices of the peace. VSCP gets

information from all 50 States, the

District of Columbia, Puerto Rico, the

U.S. Virgin Islands, and Guam. Other

data collection systems, based on sample

surveys rather than reports, depend on

the participation of thousands of private

citizens nationwide. Still others rely on

the administrative records of public and

private health care organizations.

Having appropriate surveillance and

data systems in place also provides the

ability to measure the health status of

special populations. Morbidity, mortality,

health behaviors, and access to and use

of health services vary markedly by age,

race, sex, and socioeconomic status.

There are 319 Healthy People 2000

subobjectives that are targeted toward

racial and ethnic minorities, elderly

people, people with chronic disabilities,

people with less than a high school

education, people with low incomes, and

others.

At the beginning of the 1990s,

23 percent of the Healthy People 2000

objectives could not be assessed because

of the unavailability of national data.

The lack of data at the State and local

levels was of even greater concern.

During the decade, almost all the States

adopted their own State plans or

objectives. Data have been needed to

monitor progress toward achieving those

objectives and to compare that progress

with the national progress. Thus, several

objectives in Priority Area 22 were

directed toward enhancing data systems

in States and communities. Similarly,

some objectives addressed the

identification of and response to data

gaps related to minorities and other

special populations.

Data Summary

Two (22.1 and 22.6) of the seven

objectives in the Surveillance and Data

Systems priority area have been met.

Four (22.2–22.5) objectives moved

toward the target, and one objective

(22.7) showed mixed progress.

Objective 22.1, to develop and

establish use of Health Status Indicators

(HSI’s), has been achieved. The first

part of the objective was achieved early

in the decade when the consensus set of

18 indicators was published in July

1991 (2). National data for the HSI’s

were first published in October 1992

(3). National trends in the HSI data for

the past 3 years are shown in the Health

Status Indicators/Priority Data Needs

section in table B. Table C presents the

indicators for the major racial and ethnic

groups for 1998, the most recent data

year. A detailed discussion of HSI

differentials by race and Hispanic origin

was published in September 1995 (4).

An assessment of the progress achieved

by each State and the United States was

published in November 2000 (5).

National data for Priority Data Needs

(6), a set of indicators of community

health status identified as important for

evaluating the health of a population but

lacking data at all levels of government,

are presented in table D.

The achievement of the second part

of this objective, to establish use of the

HSI’s in at least 40 States, was

measured by tracking their use by State

and local health departments. All States,

including the District of Columbia, are

monitoring some of the HSI’s. At least

nine States have published the HSI data

for county, region, or health department

district (an update of Statistics and

Surveillance number 8) (7). The 1997

State and Local Capacity Survey

developed and administered by the

Public Health Foundation found that 41

of 42 responding States provided

information about some HSI’s to local

health departments (8). Thirty-nine of

forty-six responding States have

produced a report that includes over

one-half the HSI’s and 31 of these

States indicated that the reports included

information specific to areas within the

State (such as counties, regions, and

health districts). HSI data by State can

be accessed via FTP (file transfer

protocol) on the Internet at

http://ftp.cdc.gov/pub/Health_Statistics/

NCHS/Datasets/Healthy_People_2000.

See the section on Health Status

Indicators/Priority Data Needs for more

information.

Objective 22.2 was almost achieved

with 97 percent of all Healthy People

2000 objectives having ongoing data

sources. Overall, nine objectives lacked

baseline data (7.12, 7.14, 7.17, 9.11,

9.20, 14.14, 14.16, 17.20, and 18.17).

By 1997, 32 of the 44 States and the

District of Columbia with Healthy

People 2000 plans had included

surveillance and data systems objectives

in their plans.

Objective 22.3 has three parts:

developing, disseminating, and

incorporating into Public Health Service

data collection systems the procedures

for collecting comparable data for each

of the Healthy People 2000 national

health objectives among Federal, State,

and local agencies. The baseline shows

the percent of objectives that are tracked

with vital statistics data, which are

comparable at all levels of measurement.

Comparable procedures for monitoring

population-based nutrition objectives

among Federal surveys were included

for 1992. Objectives measured by

systems that have comparable data at

the Federal, State, or local levels such

as those monitored with the Youth Risk

Behavior Surveillance System (YRBSS),

the National Notifiable Disease

Surveillance System, the Fatality

Analysis Reporting System (formerly

the Fatal Accident Reporting System),

and several other national systems that

Healthy People 2000 Final Review 305

Figure 22. Final status of Surveillance and Data Systems objectives

22.1 Health status indicators: Develop

Establish use

22.2 National data sources

BRFSS data

22.5 Analysis/publication of data: Vital statistics

22.3 Comparable data collection procedures

Hospital discharge data

YRBSS data

22.6 Data transfer systems: NETSS

22.7 Timely release of national data:

Within 1 year of collection

Between 1-2 years of collection

DATA2000

PHLIS

Moved away from target Moved toward target Met target

NOTES: Complete tracking data are shown in table 22. Progress quotients are not calculated for objective 22.4.

See the section on Measuring Progress Toward the

Healthy People 2000

Targets in the Appendix for more information.

BRFSS is Behavioral Risk Factor Surveillance System. YRBSS is Youth Risk Behavior Surveillance System. NETSS is National Electronic

Telecommunications System for Surveillance. PHLIS is Public Health Laboratory Information System.

Percent of target achieved

-100 -80 -60 -40 -20

20 40 60 80 100

100%

20%

69%

79%

10%

87%

-106%

306 Healthy People 2000 Final Review

depend on State data were included for

1994. Objectives monitored with the

National Health Interview Survey were

also included in 1994 if the State

Behavioral Risk Factor Surveillance

System (BRFSS) asked questions that

were similar in wording and conceptual

approach (some objectives, for example,

physical activity and current smoking,

are being monitored by the BRFSS but

not with methods comparable with

national methods).

The denominator for the proportion

of objectives with comparable data is

the total number of objectives, which

underrepresents Federal-State-local

objective measurement comparability.

Some objectives are out of scope for the

purposes of tracking objective 22.3,

including most Services and Protection

objectives, which do not involve

traditional data collection comparability

issues, although they may involve what

is considered appropriate protocol.

These objectives include patient

education and counseling, employer- and

community-based prevention programs,

development and implementation of

quality standards, conformance with

national guidelines, and enactment of

national or State laws. Therefore, the

1994 estimate of 21 percent is an

underestimate of the actual proportion of

all objectives with comparable data

collection procedures.

Developing and disseminating

comparable data collection procedures

involves systematically documenting the

methods that are currently being used

and accepted (as well as changes in

measurement methods over time). A

series of reports was initiated as part of

the Healthy People Statistical Notes

series that documented methods for

objectives in specific priority areas of

Healthy People 2000. For a priority

area, the report describes how each

objective is being measured at the

Federal level and the relevant data

issues involved. Six of these Statistical

Notes were published (see Appendix

table VI). For Healthy People 2010,a

separate report, Tracking Healthy People

2010, was published in November 2000

(9). This report contains operational

definitions for the Healthy People 2010

objectives that have baseline data (595

of 824 measures—72 percent—have

complete baseline data and operational

definitions). The report also provides

information on the major national data

sources and State data sources (if

available) used for Healthy People 2010

objectives and discusses cross-cutting

statistical issues.

Objective 22.4 (duplicated as

objective 17.22 during the midcourse

review) addresses the development and

implementation of a national process to

identify significant gaps in the Nation’s

disease prevention and health promotion

data. Progress was made, although it is

difficult to quantify. There are two parts

to this objective: the identification of

data gaps in broad areas of public health

where insufficient data exist to develop

objectives, and the identification of data

gaps connected with special populations.

In 1993, first steps to identify significant

gaps in broad areas of the Nation’s

disease prevention and health promotion

data were taken. The National

Committee on Vital and Health Statistics

Subcommittee on State and Community

Health Statistics recommended the

development of a coordinated Federal,

State, and community health statistics

system that should include the following

data sets in order to carry out the

functions of assessment and policy

development: vital statistics, in-patient

hospitalization utilization, ambulatory

care, long-term care, incidence and

prevalence of disease and disability,

health care resources, health care costs

and expenditures, demographic profiles

of populations served, access to basic

health care and preventive services,

health risk behaviors and attitudes, and

environmental health risks.

The process of the Healthy People

2000 midcourse review (10) brought the

Nation closer to achieving the latter part

of objective 22.4. During the midcourse

review, considerable attention was given

to population groups that are at highest

risk for premature death, disease, or

disability, and 120 new subobjectives

were proposed by the lead PHS

agencies; 111 new subobjectives were

eventually added (see the section on the

midcourse review in the Appendix).

The importance of identifying data

gaps connected with special populations

is further emphasized in Healthy People

2010 where objectives that utilize

population-based measures display the

baseline status of multiple population

groups. The minimum breakout set of

groups includes race and ethnicity,

gender, and measures of socioeconomic

status. However, many objectives

include additional population groups

such as age, geographic location, health

insurance status, disability status, sexual

orientation, or people with specific

health conditions. Baseline data were

available for 74 percent of the 396

measures in Healthy People 2010 that

listed population groups (11).

Progress toward objective 22.5, the

number of States that periodically

analyze and publish data needed to

measure progress toward the national

health objectives, was assessed by the

number of States that publish data from

major databases including vital statistics,

the BRFSS, hospital discharge systems,

and the YRBSS. The Health Care Cost

and Utilization Project (HCUP) has been

developed to build comparable hospital

discharge data sets among States; HCUP

contains a subset of the States reporting

inpatient hospital discharge data. In

1997, 22 States participated in the

national database (12); 26 participated in

1999. The number of States with at least

one racial or ethnic group that

comprises at least 10 percent of their

population that publish vital statistics

data for each of these groups is also

being tracked. There are 27 States

whose populations include at least

10 percent racial and ethnic minorities.

In 1999, data on major racial and ethnic

groups were published for all of these

States, exceeding the Healthy People

2000 target of 25 States.

Data to measure objective 22.6 (to

expand in all States systems for the

transfer of year 2000 data among

Federal, State, and local agencies) are

available for three data systems. All

three data systems have met the Healthy

People 2000 target of providing

electronic data transfer systems for all

States. The National Electronic

Telecommunications System for

Surveillance (NETSS) is operating in all

States and the District of Columbia. In

1995, the Public Health Laboratory

Information System (PHLIS) became

available in all States and the District of

Columbia as well. Electronic access to

national monitoring data for Healthy

People was provided through

DATA2000 on the Centers for Disease

Control and Prevention WONDER

system from 1995 to 2000. In 2000,

DATA2000 was replaced on the CDC

WONDER system by DATA2010.

DATA2010 provides national and State

data to monitor Healthy People 2010

objectives and represents the expanded

data monitoring agenda of the next

decade.

The National Center for Health

Statistics Internet homepage contains

Healthy People 2000 Final Review 307

links to State data for a number of

Healthy People 2000 objectives

(http://www.cdc.gov/nchs). Since 1997,

mortality data have been available

through the CDC FTP server; in 1998

Healthy People 2000 data for natality

objectives by State became available.

Since 2000, mortality data by State for

the years 1989–97 are available in the

Data Warehouse section reached through

the NCHS homepage

(http://www.cdc.gov/nchs/datawh/ftpserv/

hstatus/hstatus.htm); race and ethnicity

data are provided for 19 causes of death

targeted in Healthy People 2000 and for

HIV mortality; and natality data are

available from 1993 to 1997. The

National Center for Chronic Disease

Prevention and Health Promotion has

made State data available on the Internet

from the BRFSS

(http://www2.cdc.gov/nccdphp/brfss/

index.asp). Much of these data relate to

Healthy People 2000 objectives.

Achieving the timely release of

national surveillance and survey data to

measure progress toward the national

health objectives (22.7), is measured by

percent of objectives with data released

within 1 year and between 1 and 2 years

of data collection. The actual

measurement of this objective involves

counting the objectives that have

updates for a particular year. For the

Healthy People 2000 Final Review, data

collected in 1998 or later are counted as

being released within 1 year. Data for

1997 are counted as being released

between 1 and 2 years of data

collection.

Because all objectives are included

in the denominator, the data monitoring

objective 22.7 represents an

underestimate of the ‘‘true’’ percent of

objectives with timely data. Some

objectives are not applicable because of

achievement through legislation or some

other means earlier in the decade,

leading to an underestimate of

timeliness. In addition, the measurement

of progress for this objective is also

affected by the periodicity of data

collection. Some objectives are tracked

with data available annually, such as

data from the National Vital Statistics

System for objectives targeting mortality

rates and the National Notifiable

Disease Surveillance System for

vaccine-preventable diseases (objective

20.1). Other objectives are tracked with

biennial data, such as data from the

YRBSS for objectives targeting

adolescents. Other objectives are

monitored with data from periodic

surveys such as the National Health and

Nutrition Examination Surveys for

measures of overweight and prevalence

of high blood cholesterol. For these

surveys, data are counted as timely for

years close to the years of data

collection only, even though the data

may have been released soon after

collection.

See table 22 for the tracking data

for the objectives in this priority area

and figure 22 for a quantitative

assessment of progress.

Transition to Healthy People

2010

The Healthy People initiative is

now in its third decade with the

publication of Healthy People 2010

(11). Healthy People activities during

the 1980s and 1990s have demonstrated

the central role of data, focused

attention on what is important to

measure, and stimulated the

development of new data systems. The

past 20 years in monitoring and

reporting on the Healthy People

objectives have provided a means for

assessing improvements in national

health data systems (13). The focus on

data and information systems continues

in Healthy People 2010 as a pivotal part

of improving the Nation’s public health

infrastructure, that is, the resources

needed to deliver the essential public

health services to every community.

Seven objectives in the Data and

Information Systems section of the

Healthy People 2010 Public Health

Infrastructure chapter focus on data

issues. The need for data on special

population groups, availability of data at

subnational levels on important

indicators, regular collection and

publication of data, and timely release

of data are continued as objectives for

Healthy People 2010. New objectives

have been added that focus on the use

of geocoding to promote nationwide use

of geographic information systems

(GIS), and the provision of Internet and

e-mail access to public health

employees.

Appendix table III, a crosswalk

between Healthy People 2000 and

Healthy People 2010 objectives,

summarizes the differences between the

two decades of objectives, reflecting

new knowledge and direction in the area

of surveillance and data systems.

References

1. Institute of Medicine. The future of public

health. Washington: National Academy Press.

1988.

2. Centers for Disease Control and Prevention.

Consensus set of health indicators for the general

assessment of community health status, United

States. MMWR 40(27):449–51. 1991.

3. Klein RJ, Hawk SA. Health status indicators:

Definitions and national data. Healthy People

statistical notes; vol 1 no 3. Hyattsville, Maryland:

National Center for Health Statistics. 1992.

4. Plepys C, Klein R. Health status indicators:

Differentials by race and Hispanic origin. Healthy

People statistical notes; no 10. Hyattsville,

Maryland: National Center for Health Statistics.

1995.

5. Keppel KG and Pearcy JN. Healthy People

2000: An assessment based on the health status

indicators for the United States and each state.

Healthy people statistical notes; no 19. Hyattsville,

Maryland: National Center for Health Statistics.

2000.

6. Kim I and Keppel KG. Priority data needs:

Sources of national, state, and local-level data and

data collection systems. Healthy people statistical

notes; no 15. Hyattsville, Maryland: National

Center for Health Statistics. 1997.

7. National Center for Health Statistics. Healthy

people statistics and surveillance; no 8.

Hyattsville, Maryland: National Center for Health

Statistics. 1996.

8. Public Health Foundation. Measuring health

objectives and indicators: 1997 state and local

capacity survey. Washington, D.C. 1998.

9. Department of Health and Human Services.

Tracking healthy people 2010. Washington: U.S.

Government Printing Office. 2000.

10. Department of Health and Human Services.

Healthy people 2000 midcourse review and 1995

revisions. Washington: Public Health Service.

1995.

11. Department of Health and Human Services.

Healthy People 2010. 2d ed. With understanding

and improving health and objectives for improving

health. 2 vols. Washington: U.S. Government

Printing Office. 2000.

12. For information on the Healthcare Cost and

Utilization Project (HCUP–3), see

http://www.ahrq.gov or contact the Agency for

Healthcare Research and Quality at (301)

594–1400.

13. Maiese DR. Data challenges and successes

with healthy people. Healthy people statistics and

surveillance; no 9. Hyattsville, Maryland: National

Center for Health Statistics. 1998.

308 Healthy People 2000 Final Review

Table 22. Surveillance and Data Systems objectives

Final

status Objective

Baseline

year Baseline 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Target

2000

22.1 Health status indicators (HSI)

Develop (indicators selected) .................... 1991 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Establish use (number of States)

Monitoring some indicators .................... ... --- --- --- 48

51 40

Providing HSI data to local health departments ..... ... --- --- --- 36 --- --- --- --- 39 --- --- 40

22.2 National data sources......................... 1990

77% ... --- --- 93% 93%

96% 97%

97%

97% 100%

a. State level data for at least two-thirds of State

objectives (number of States)

1,5

............... 1995 42 . . . . . . . . . . . . . . . . . . - - - 45 - - - - - - 50

22.3 Comparable data collection procedures

Federal, State, and local agencies ................ 1990 12% . . . - - - 14% - - - 21% - - - - - - - - - - - - - - - 100%

Publication of operational definitions and sources for

national data................................ ... --- --- --- --- --- --- --- ---

29% - - -

72% . . .

22.4* Identify gaps in health data .................... 1990

None

identified - - - - - - - - - - - -

---

--- ...

Establish mechanisms to meet needs .............. 1990

None

established - - - - - - - - - - - -

---

--- ...

22.5 Periodic analysis and publication of data

(number of States) ............................ 1989 20 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 50

Vital statistics

............................... ... ---

51 51 51 51 51 51 51 51 51 51 50

Behavioral Risk Factor Surveillance System data

..... ... ---

40 - - - 49 50 51 51 51 51 51 51 50

Hospital discharge data

....................... ... ---

22 --- --- 39 39 39 --- --- --- 44 50

Youth Risk Behavior Survey data

................. ... --- 24 27 --- 41 ... 41 ... 39 ... 42 50

a. Analysis for racial and ethnic groups

(number of States)

1,14

.......................... 1992

19 ... ... ...

23 --- --- 22 --- ---

27 25

22.6 Number of States with data transfer system data

.. 1989 30 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 50

National Electronic Telecommunications System for

Surveillance (NETSS)

........................ ... --- --- --- 51 51 51 51 51 51 51 51 50

Public Health Laboratory Information System (PHLIS) . . . . . - - - - - - - - - 37

51 50

DATA2000 on CDC WONDER/PC

................ ... --- --- --- --- --- --- 51 51 51 51 51 50

22.7 Timely release of national data (percent of

objectives)

Data released within 1 year of collection ............ 1994 65% . . . . . . . . . . . . . . . 67% 46% 49% 23% 28% 100%

Data released between 1–2 years of collection ....... 1994 24% . . . . . . . . . . . . . . . 24% 16% 18% 31% 39% . . .

- - - Data not available. Final objective status:

. . . Category not applicable.

Includes the District of Columbia.

Total number of objectives is 300.

Number of objectives changed from 300 to 319 during the midcourse review.

Baselines were not obtained for 9 of 319 objectives.

States that have adopted Healthy People 2000 plans.

6of21Statistical Notes have been published. See appendix table VIII.

Tracking Healthy People 2010 includes 823 measures, 595 of which have complete baseline data and operational definitions.

The National Committee on Vital and Health Statistics established a Subcommittee on State and Community Health Statistics. The Subcommittee’s charge (in part) is to work with Federal and

State agencies and appropriate private agencies to review and identify gaps in current health statistics.

The Healthy People 2000 Midcourse Review added 111 additional subobjectives for major population groups at highest risk for disease, injury, and disability.

As part of the planning process for 2010, data gaps are being identified and mechanisms to address these gaps are being considered.

Met

Toward

Mixed/ no change

Away

Cannot assess

Healthy People 2000 Final Review 309

Healtlhy People 2010 is addressing data gaps by requiring data for race, ethnicity, socioeconomic status, and disability measures for population-based objectives and by listing developmental

objectives.

1989 data.

States that collect inpatient hospital discharge data. The number of States with legislative mandates to collect hospital discharge data was 33 in 1999.

Twenty-seven States have at least one racial/ethnic group comprising at least 10 percent of their population; data show number of States that published vital statistics data for these

racial/ethnic groups.

Number of all States that published vital statistics data for racial/ethnic groups; racial/ethnic groups may comprise less than 10 percent of State population.

Twenty-seven State Health Proﬁles provide race/ethnic data for some vital statistics measures.

NOTE: Data include revisions and, therefore, may differ from data previously published in these reports and other publications.

Objective number Data source

22.1 CDC, NCHS.

22.2, 22.2a Baseline: National data: OPHS, ODPHP.

State data: Public Health Foundation.

Updates: CDC, NCHS; OPHS, ODPHP.

22.3 CDC, NCHS.

22.4* Subcommittee on State and Community Health Statistics, NCVHS.

CDC, NCHS; OPHS, ODPHP.

22.5 1990 data: PHF.

1989 baselines and updates:

Vital statistics: CDC, NCHS.

Behavioral Risk Factor Surveillance System: CDC, NCCDPHP.

Hospital discharge data: National Association of Health Data Organizations.

Youth Risk Behavior Survey: CDC, NCCDPHP.

22.5a CDC, NCHS.

22.6 1989 baseline: PHF.

1992–97 data:

NETSS: CDC, EPO.

PHLIS: CDC, NCID.

CDC WONDER: CDC, EPO; CDC, NCHS.

22.7 CDC, NCHS.

*Duplicate objective. See full text of objectives following this table.

310 Healthy People 2000 Final Review

Surveillance and

Data Systems

Objectives

22.1: Develop a set of health status

indicators appropriate for Federal, State,

and local health agencies, and establish

use of the set in at least 40 States.

22.2: Identify, and create where

necessary, national data sources to

measure progress toward each of the

year 2000 national health objectives.

22.2a: Identify, and create where

necessary, State-level data for at

least two-thirds of the objectives in

State year 2000 plans in all 50

States.

22.3: Develop and disseminate among

Federal, State, and local agencies

procedures for collecting comparable

data for each of the year 2000 national

health objectives and incorporate these

into Public Health Service data

collection systems.

22.4*: Develop and implement a

national process to identify signiﬁcant

gaps in the Nation’s disease prevention

and health promotion data, including

data for racial and ethnic minorities,

people with low incomes, and people

with disabilities, and establish

mechanisms to meet these needs.

Duplicate objective: 17.22

22.5: Implement in all States periodic

analysis and publication of data needed

to measure progress toward objectives

for at least 10 of the priority areas of

the national health objectives.

22.5a: Implement in 25 States

periodic analysis and publication of

data needed to measure State

progress toward the national or

State-speciﬁc health objectives for

each racial or ethnic group that

makes up at least 10 percent of the

State population.

22.6: Expand in all States systems for

the transfer of health information related

to the national health objectives among

Federal, State, and local agencies.

22.7: Achieve timely release of national

surveillance and survey data needed by

health professionals and agencies to

measure progress toward the national

health objectives.

Healthy People 2000 Final Review 311

Appendix

Contents

Technical Notes 316

Age Adjustment 316

Cause-of-Death Terminology and Codes

316

Census Poverty Threshold

316

Data Source Comparability 316

Disparity Measurement

316

Geographic Coverage 317

Hispanic Vital Statistics 317

Measuring Progress Toward the Healthy People 2000 Targets

317

Mortality Data by Race and Hispanic Origin

318

National Health Interview Survey Redesign 318

Sources of Monitoring Data and Information

319

Appendix Tables

I. Healthy People 2010 Lead Agencies and Work Group Coordinators 320

II. Acronyms used in Healthy People 2000 Final Review

328

III. Crosswalk between objectives from Healthy People 2000 to Healthy People 2010

330

IV. Mortality objective cause-of-death categories

340

V. Morbidity codes used for objectives tracked by the National Hospital Discharge Survey

342

VI. Published issues of Healthy People Statistical Notes

343

VII. Special population objectives included in Healthy People 2000

344

Healthy People 2000 Final Review 315

Appendix

Technical Notes

Age Adjustment

Most of the baselines and

monitoring data for the population-based

Healthy People 2000 mortality

objectives are derived from the National

Vital Statistics System (NVSS) operated

by the Centers for Disease Control and

Prevention’s (CDC) National Center for

Health Statistics (NCHS) and are age

adjusted to the 1940 population (see

Appendix table III) (1). Exceptions are

objectives 4.1, 9.3 (except 9.3d), 10.1,

and 10.16. Data for 4.1 and 9.3 (except

9.3d) are crude rates from the National

Highway and Traffic Safety

Administration’s Fatality Analysis

Reporting System (formerly the Fatal

Accident Reporting System—FARS).

Data for 10.1 are crude rates from the

Department of Labor’s Annual Survey

of Occupational Injuries and Illnesses

and Census of Fatal Occupational

Injuries. Baseline data for 10.16,an

objective added during the midcourse

review, are crude rates from the

National Traumatic Occupational

Fatality Surveillance System, CDC.

Update data are crude rates from the

Census of Fatal Occupational Injuries.

For Healthy People 2010, data for

most of the population-based objectives

(including mortality) are age adjusted to

the year 2000 standard population.

Because this is a different standard than

what was used in Healthy People 2000,

it is difficult to compare the

age-adjusted data in Healthy People

2010 objectives to Healthy People 2000

objectives with data that are otherwise

comparable. A complete discussion on

age adjustment to the 2000 standard is

available in Tracking Healthy People

2010 (2).

Cause-of-Death Terminology and

Codes

Twenty-six objectives (excluding

duplicates) in Healthy People 2000 are

tracked using mortality data. For most

of these objectives, the cause-of-death

terminology used in Healthy People

2000 is different from that used in

Health, United States; Vital Statistics of

the United States, Mortality, and other

NCHS publications; in some cases, the

International Classification of Diseases;

Ninth Revision (ICD–9) codes are

different as well (3) (see Appendix

table III).

For five objectives, the terminology

and the codes are different from those

used for similar cause-of-death

categories in NCHS publications. One

example, objective 7.1, concerns

reduction of homicides. Progress toward

this objective is measured using ICD–9

codes E960–E969. NCHS generally uses

‘‘homicide and legal intervention’’

(ICD–9 codes E960–E978), which

includes ‘‘legal intervention’’ or ‘‘police

action.’’ For 14 objectives, only the

terminology differs; the defining ICD–9

identifying codes are the same. For

example, objective 15.2 calls for

reduction in mortality from ‘‘stroke’’;

NCHS tabulation lists use the term

‘‘cerebrovascular diseases’’ (both use

ICD–9 numbers 430–438). Only one

objective, suicide, has the same title and

the same code structure in both uses.

The remaining six mortality objectives

have no comparable category in NCHS

publications. With the exception of heart

disease, the differences between

mortality rates defined by the Healthy

People 2000 ICD–9 categories and those

defined by NCHS rubrics are relatively

small, if not trivial.

Healthy People 2010 baselines use

the International Classification of

Diseases; Ninth Revision (ICD–9,

ICD–9–CM) codes to define baseline

measures. Future tracking data for

Healthy People 2010 will incorporate

the International Classification of

Diseases; Tenth Revision (ICD–10,

ICD–10–CM). Once implemented,

revised coding guidelines, training

materials, and crosswalks between

ICD–9/ICD–9–CM and

ICD–10/ICD–10–CM will be made

available on the NCHS Web site

(http://www.cdc.gov/nchs).

Census Poverty Threshold

Data for subobjectives targeting

family income below the poverty level

are based on definitions originally

developed by the Social Security

Administration. They include a set of

income thresholds that vary by family

size and composition. Families or

individuals with income below the

appropriate thresholds are classified as

below the poverty level. These

thresholds are updated annually by the

U.S. Bureau of the Census. The

weighted-average poverty threshold for

a family of four was $14,335 in 1992,

$14,764 in 1993, $15,141 in 1994,

$15,569 in 1995, $16,036 in 1996,

$16,400 in 1997, $16,660 in 1998, and

$17,029 in 1999 (4).

Data Source Comparability

For some objectives the baseline

data source differs from the source used

to monitor progress. Comparability

between different data sources or even

within the same data source for different

years is not ensured. Comparability can

be compromised by changes in survey

questions, survey systems, survey

methodology, operational definitions,

and analytic techniques. Some of the

most important comparability issues

related to specific objectives are

discussed in the Data Issues section of

the priority area chapters. Other issues

related to tracking the objectives are

addressed in Healthy People Statistical

Notes Number 4, Issues Related to

Monitoring the Year 2000 Objectives

(5). The data source for each Healthy

People 2000 objective is shown at the

end of the summary data table in each

priority area chapter.

Disparity Measurement

A major goal of Healthy People

2000 is to reduce disparity in health

status between special populations (SP)

at high risk for death, disease, or

disability, and the population as a

whole. As appropriate, the 319 main

objectives identified these special

populations as subobjectives. During the

midcourse review and 1995 revisions,

additional SP objectives were included

(6). For these special population

subobjectives, the statistic used to track

the overall objective is, then, considered

the measure for the reference population

(RP). Disparity is a function of the

difference between the relative rates of

change for the SP and RP. In many

instances, different targets were set for

the SP and RP. These targets were set

with the aim of reducing the gap

between these racial and ethnic groups

and the total population, that is,

targeting a greater percent change for

the SP.

A method for measuring disparity

and change in disparity was not

specified in Healthy People 2000 (7). In

preparation for this Final Review,a

working group of agency representatives

from the U.S. Department of Health and

Human Services evaluated several

methods for measuring change in

disparity. In some instances the work

316 Healthy People 2000 Final Review

group found that different methods used

for the same data yielded different

conclusions regarding the widening or

narrowing of disparity.

Ultimately, the ratio of percent

changes was chosen to measure the

change in disparity for several reasons.

As noted above, the targets for SP and

RP were chosen to decrease disparity.

Therefore, if both targets were attained,

the ratio of the percent changes would

be less than 1.0 and the disparity would

be narrowed. The ratio was also chosen

because it is widely used to describe

relative change between two

populations. In measuring disparity for

the special population groups, objectives

that were duplicated in more than one

chapter were counted only once.

The ratio of percent change is

calculated as:

冉

most recent

–RP

baseline

冊

冉

most recent

–SP

baseline

冊

The ratio of percent change is not a

measure of the direction of change; it is

a measure of relative change.

Consequently, the ratio can be less than

1.0, indicating a narrowing of the

disparity, if data for the SP indicate that:

SP is moving toward the SP target

at a relative rate greater than the RP is

moving toward the RP target;

SP progress is toward the SP target

but RP is moving away from the RP

target; or

SP is moving away from the SP

target at a relative rate less than the RP

movement.

A conclusion of a widening

disparity, that is, a ratio greater than 1.0,

can result if data for the SP indicate

that:

SP is moving away from the SP

target although the RP is moving toward

the RP target;

SP is moving toward the SP target

at a relative rate less than the RP

movement; or

SP is moving away from the SP

target at a relative rate larger than the

RP movement.

Some special population objectives

or subobjectives were not constructed to

assess disparity. In these cases, disparity

measurement was not applicable. These

include:

SP measure was part of a main

objective and had no RP. Examples of

this include attempting to measure

disparities for women when the main

objective targeted only women, such as

mammogram screening. There is no

reference population.

SP was better than RP at baseline.

In most cases, these objectives are

excluded from the disparity assessment.

Some of these objectives did show a

disparity at the end of the decade.

These disparities will be tracked by

Healthy People 2010 in support of its

goal to eliminate health disparities.

For the other special population

objectives or subobjectives, disparity

measurement was applicable, but in

several instances could not be assessed

(due to data limitations):

SP or RP measure had missing or

incomplete baseline, update, and/or

target data;

RP measure was not comparable to

the SP measure.

To obtain a full picture of the

progress of the SP subobjectives, the

disparity measure can be combined with

the progress quotient calculated for the

subobjective separately. This combined

picture is presented for each SP in the

charts of the ‘‘Reducing Disparity’’

section of the Review. In that section,

the summary of progress is presented

for nine of the special populations:

adolescents and young adults, American

Indian/Alaska Native, Asian or Pacific

Islander, black or African American,

Hispanic or Latino, older adults, people

with disabilities, people with low

socioeconomic status, and women. In

each chart, the pie indicates the

proportion of objectives for which the

disparity of the special population was

eliminated or narrowing, showed no

change, was widening, or could not be

assessed using the ratio of percent

change statistic. Progress toward or

away from the target was then assessed

for those objectives in which the

disparity was either eliminated or

narrowing. The progress is displayed in

the chart as a bar showing the

proportion of these objectives for which

data indicate the special population met

its target, moved either toward or away

from the target, or made no change.

Geographic Coverage

Data used to track the Healthy

People 2000 objectives are, where

available, for the 50 States and the

District of Columbia. In cases where

complete U.S. data are not available,

subnational data (if they exist) are used

as a proxy. For all objectives, data for

U.S. territories are excluded.

Hispanic Vital Statistics

There are nine subobjectives

targeting mortality reduction for

Hispanic populations (4.2c, 4.3b, 7.1d,

9.1d, 9.3g, 9.6g, 16.4b, 17.9c, and

17.9d). For objective 7.1d, the only

subobjective with pre-1990 data, the

1987–89 baseline and tracking data are

based on deaths to residents of selected

States that had data that were at least

90 percent complete on a

place-of-occurrence basis and considered

to be sufficiently comparable. Beginning

with data for 1990 for all Hispanic

subobjectives, the criterion was changed

to include States with data that were at

least 80 percent complete. The number

of States in the mortality reporting area

increased from 18 States and the District

of Columbia in 1987 to 49 States and

the District of Columbia in 1993.

Hispanic origin data for low/very

low birth weight (14.5c,d) and prenatal

care in the first trimester (14.11c) are

based on States that reported Hispanic

parentage on the birth certificate. The

number of States in the natality

reporting area increased from 23 States

and the District of Columbia in 1987 to

all 50 States and the District of

Columbia in 1993. The reporting area

for infant mortality data from the

national linked file of live births and

infant deaths for Puerto Ricans (14.1c, f,

and j) increased from 23 States and the

District of Columbia in 1984 to 49

States and the District of Columbia in

1991. Since 1991, only Oklahoma does

not report Hispanic origin for deaths.

A listing of the States included in

the reporting areas for each year and

more information can be found in

another publication (8).

Measuring Progress Toward the

Healthy People 2000 Targets

A primary purpose of the Healthy

People 2000 Final Review is reporting

the progress the 319 objectives made in

reaching their year 2000 targets by the

end of the decade. The priority area

chapters in this Review contain a bar

chart illustrating the status of each

objective measure in reference to its

year 2000 target. Progress in these

charts is measured using the percentage

of targeted change that was achieved, or

Healthy People 2000 Final Review 317

the ‘‘progress quotient.’’ This is the

same progress measure used in the

Healthy People 2000 Midcourse Review

and 1995 Revisions (6).

The formula for the progress

quotient is:

冉

most recent value – baseline value

year 2000 target – baseline value

冊

⳯ 100

The progress quotient allows for

comparisons to be made between

objectives and between priority areas

regarding the degree of change attained

compared with the change desired, as

reflected in the target set in 1990. There

are, however, some limitations to the

interpretation of these statistics. The

progress quotient reflects the difference

between the data for the baseline year

and the most recent data year only; thus,

fluctuations in the measure over the

decade are not reflected. Also, the

amount of change required to attain the

target differed among objectives.

Therefore, equal progress quotients do

not reflect equal percent changes from

the baseline, which would be calculated

using only the baseline data in the

denominator. Finally, because

information on variability of the

measures was not available for all

objectives, the actual change toward the

target is used to determine progress.

Some of these changes are relatively

small and could be within what could be

expected on the basis of sampling or

random variation. This is particularly

true for small subpopulations, such as

Asians and Pacific Islanders and

American Indians/Alaska Natives.

The priority area bar charts display

progress quotients for each objective

measure. If more than one measure was

used to evaluate an objective, the status

of each measure is displayed separately.

Depending on the data, bar charts depict

progress in one of the following ways:

When the most recent data were the

same as the data from the baseline year,

there was no progress and the progress

quotient is 0 percent. This is noted in

the bar charts as ‘‘no change.’’

When the most recent data fall

between the baseline year data and the

year 2000 target, there was progress,

although the target was not attained. In

this case, the progress quotient is

between 0 and 100 percent, and the bar

is displayed as light green.

When the most recent data are

equal to or better than the year 2000

target, the objective was met or

exceeded. In this case, the progress

quotient is at least 100 percent, and the

bar is displayed as dark green. If the

progress quotient is greater than

100 percent, the actual percent is printed

on the bar; however, graphically the bar

is drawn as 100 percent.

When the most recent data are

worse than the baseline data, the

objective changed in a direction away

from the target, and the progress

quotient is negative. In this case, the bar

is displayed as burgundy. If the negative

change is less than 100 percent, the

actual percent is printed on the bar;

graphically, however, the bar is drawn

as –100 percent.

In several situations, the progress

quotient was not calculated. These

include when:

The baseline year data and/or more

recent data were not available.

Objectives have targets stated as

‘‘slow the rise’’ of the rate of a

particular condition or equal to the

baseline rate. In these cases, a

meaningful progress quotient could not

be calculated; however, in the bar chart

such measures are labeled as ‘‘met’’ or

‘‘away’’ depending on the direction of

the change.

Objectives had a baseline value that

was already ‘‘better’’ than the target

value.

Objectives contained multiple parts

for which data were unavailable. For

instance, for the objectives tracking

clinical counseling, data more recent

than the baseline were available only for

nurse practitioners. Tracking data were

unavailable for the other provider

specialities.

Specific discussion of some of the

objectives for which progress quotients

were not calculated can be found in the

Data Issues section of each priority area

chapter.

Mortality Data by Race and

Hispanic Origin

Death rates by race and Hispanic

origin are based on information from

death certificates (numerators of the

rates) and on population estimates from

the Census Bureau (denominator). Race

and ethnicity information on the death

certificate are reported by the funeral

director as provided by an informant,

often the surviving next of kin, or, in

the absence of an informant, on the

basis of observation. Race and ethnicity

information from the census is by

self-report. To the extent that race and

Hispanic origin are inconsistent between

these two data sources, death rates will

be biased. Studies have shown that

persons self-reported as American

Indian, Asian, or Hispanic on census

and survey records may sometimes be

reported as white or non-Hispanic on

the death certificate, resulting in an

underestimation of deaths and death

rates for the American Indian, Asian,

and Hispanic groups. Bias also results

from undercounts of some population

groups in the census, particularly young

black and white males and elderly

persons, resulting in an overestimation

of death rates. The net effects of

misclassification and under coverage

result in overstated death rates for the

white population and the black

population are estimated to be 1 percent

and 5 percent, respectively; understated

death rates for other population groups

are estimated as follows: American

Indians, 21 percent; Asian or Pacific

Islanders, 11 percent; and Hispanics,

2 percent (9).

Vital event rates for the American

Indian/Alaska Native population shown

in this book are based on the total U.S.

resident population of American Indians

and Alaska Natives as enumerated by

the U.S. Bureau of Census. In contrast

the Indian Health Service calculates

vital event rates for this population

based on U.S. Bureau of Census county

data for American Indians and Alaska

Natives who reside on or near

reservations.

Racial and ethnic classification for

infant deaths is substantially improved

by using the linked birth and infant

death file, which uses the race of the

mother as self-reported on the birth

certificate instead of the race of child as

reported on the death certificate. The

infant mortality rates for Puerto Ricans

and American Indians/Alaska Natives

shown in objectives 14.1b, c, f, i, and j

used data from the linked file.

National Health Interview Survey

Redesign

The National Health Interview

Survey (NHIS) is a continuing

nationwide sample survey in which data

are collected through personal household

interviews. The NHIS is the primary

data source for Healthy People 2000,

tracking 20 percent of the objectives.

In 1997, the collection methodology

changed from paper and pencil

questionnaires to computer-assisted

personal interviewing (CAPI). The

318 Healthy People 2000 Final Review

NHIS questionnaire was also revised

extensively in 1997. The survey changed

from two components (Core and Topic

Supplements) to now consisting of three

components (Family Core, Sample Adult

Core, Sample Child Core) and periodic

and topical modules. In some instances,

basic concepts measured in the NHIS

changed and in other instances the same

concepts were measured in a different

way. While some questions remain the

same over time, they may be preceded

by different questions or topics. For

some questions, there was a change in

the reference period for reporting an

event or condition (8).

Because of this extensive redesign

of the questionnaire in 1997 and the

introduction of the CAPI method of data

collection, data from 1997 and later

years may not be comparable with

earlier years. When data are not

comparable because of these survey

revisions, the data from 1997 and later

years have been omitted and denoted

with a footnote ‘‘‡.’’

Sources of Monitoring Data and

Information

Relevant Internet sites include the

following:

The Healthy People 2000 home

page

(http://odphp.osophs.dhhs.gov/pubs/

hp2000): Contains connections to many

activities related to Healthy People 2000

including lead agency contacts for the

priority areas, progress review reports,

the Healthy People 2000 Consortium,

and more.

The National Health Information

Center (NHIC) home page

(http://nhic-nt.health.org): Serves as a

health information referral service that

enables health professionals and

consumers who have health questions to

contact organizations that are best able

to provide answers. Many documents

related to Healthy People 2000 can be

located at this site. NHIC was

established in 1979 by the Office of

Disease Prevention and Health

Promotion (ODPHP), Office of Public

Health and Science, Office of the

Secretary, U.S. Department of Health

and Human Services.

The NCHS home page

(http://www.cdc.gov/nchs) and the

NCHS Healthy People home page

(http://www.cdc.gov/nchs/hphome.htm):

The NCHS site provides statistical

information on vital events as well as

information on health status, lifestyle

and exposure to unhealthy influences,

the onset and diagnosis of illness and

disability, and the use of health care.

The NCHS Healthy People site provides

links to previous Healthy People 2000

Reviews, data presentations from past

Healthy People 2000 Progress Reviews,

and provides other related links to

organizations and data systems

associated with monitoring Healthy

People 2000. Data for recent years are

available for the Health Status Indicators

(HSIs) and the Priority Data Needs

(PDNs) in files that can be downloaded

through the CDC FTP-server at

http://www.cdc.gov/nchswww/datawh/

datawh.htm.

The Healthy People 2010 home

page

(http://www.health.gov/healthypeople):

Contains links to many Healthy People

2010 activities including related

publications (Healthy People 2010 with

Understanding and Improving Health

and Objectives for Improving Health,

and Tracking Healthy People 2010),

Leading Health Indicators, lead agency

contacts for the focus areas, and the

Healthy People Consortium.

The DATA2010 home page

(http://wonder.cdc.gov/data2010):

Contains the most recent data tracking

the Healthy People 2010 objectives,

provides data by State, race and

ethnicity, gender, socioeconomic status,

disability status, and geographic

location.

A valuable resource for public

health professionals wishing to measure

and track data comparable to the

national Healthy People 2000 objectives

is presented as a series of publications

entitled Healthy People Statistical

Notes. This series contains information

on the HSIs, monitoring issues,

operational definitions, and other issues

related to tracking the Healthy People

2000 objectives. For a list of these

publications, see Appendix table VI. The

full text of Healthy People Statistical

Notes numbers 6 through the present

can be found on the NCHS Healthy

People home page

(http://www.cdc.gov/nchs/products/pubs/

pubd/hp2k/hp2k.htm#Statistical Notes).

NCHS has also presented a course

entitled ‘‘Measuring the Healthy People

2000 Objectives’’ through the Applied

Statistics Training Institute (ASTI) in

several locations around the country.

This course targeted health professionals

and others working in areas of public

health in government agencies and

private organizations, addressed specific

measurement issues related to

monitoring progress toward selected

Healthy People 2000 objectives and

HSIs. A number of objectives that

presented unusual problems or required

the use of complex algorithms were

discussed (for example, years of healthy

life; light, moderate, vigorous physical

activity; overweight prevalence; and air

quality). Data comparability, the

International Classification of Disease

(ICD) codes for mortality data,

computation of age-adjusted death rates,

and a demonstration of using statistical

data on the Internet were also included.

References

1. Curtain LR, Klein RJ. Direct standardization

(age-adjusted death rates). Healthy people

statistical notes; no 6. Hyattsville, Maryland:

National Center for Health Statistics. 1995.

2. Department of Health and Human Services.

Tracking healthy people 2010. Washington: U.S.

Government Printing Office. 2000.

3. World Health Organization. Manual of the

International Statistical Classification of Diseases,

Injuries, and Causes of Death, based on the

recommendations of the Ninth Revision

Conference, 1975. Geneva: World Health

Organization. 1977.

4. Bureau of the Census. Current population

reports, Series P60. Income, poverty, and

validation of non-cash benefits. Washington.

Published annually.

5. Wilson R, Freedman MA, Klein RJ. Issues

related to monitoring the healthy people 2000

objectives. Healthy people statistical notes; no 4.

Hyattsville, Maryland: National Center for Health

Statistics. 1993.

6. Department of Health and Human Services.

Healthy people 2000 midcourse review and 1995

revisions. Washington: Public Health Service.

1995.

7. Department of Health and Human Services.

Healthy people 2000: National health promotion

and disease prevention objectives. Washington:

Public Health Service. 1991.

8. National Center for Health Statistics. Health,

United States, 2000. Hyattsville, Maryland: Public

Health Service. 2000.

9. Rosenberg HM, Maurer JD, Sorlie PD, Johnson

NJ, et al. Quality of death rates by race and

Hispanic origin: A summary of current research,

1999. National Center for Health Statistics. Vital

Health Stat 2(128). 1999.

Healthy People 2000 Final Review 319

Table I. Healthy People 2010 Lead Agencies and Work Group Coordinators

1. Access to Quality Health Services

David Atkins, M.D., M.P.H.

Medical Officer

Center for Practice and Technology Assessment

Agency for Healthcare Research and Quality

6010 Executive Boulevard, Suite 300

Rockville, MD 20852

(301) 594-4016/Fax (301) 594-4027

E-mail: [email protected]

Melissa Clarke, M.P.A.

Senior Health Policy and Program Analyst

Healthy People 2000/2010 Coordinator

Office of Planning, Evaluation, and Legislation

Health Resources and Services Administration

Parklawn Building, Room 14-33

5600 Fishers Lane

Rockville, MD 20857

(301) 443-5277/Fax (301) 443-9270

E-mail: [email protected]

Paul Nannis, M.S.W.

Director

Office of Planning, Evaluation and Legislation

Health Resources and Services Administration

Parklawn Building, Room 14-33

5600 Fishers Lane

Rockville, MD 20857

(301) 443-2460/Fax (301) 443-9270

E-mail: [email protected]

Kathryn Rickard, M.P.A.

Program Analyst

Center for Practice and Technology Assessment

Agency for Healthcare Research and Quality

6010 Executive Boulevard, Suite 300

Rockville, MD 20852

(301) 594-2431/Fax (301) 594-4027

E-mail: [email protected]

2. Arthritis, Osteoporosis, and Chronic Back Conditions

Charles G. Helmick, M.D.

Medical Epidemiologist

Health Care and Aging Studies Branch

Division of Adult and Community Health

National Center for Chronic Disease Prevention and Health Promotion

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K45

Atlanta, GA 30341

(770) 488-5456/Fax (770) 488-5964

E-mail: [email protected]

Reva Lawrence, M.P.H.

Epidemiologist/Data Systems Program Officer

National Institute of Arthritis and Musculoskeletal and Skin Diseases

National Institutes of Health

45 Center Drive, MS 6500 Bethesda, MD 20892

(301) 594-5014/Fax (301) 402-2406

E-mail: [email protected]

320 Healthy People 2000 Final Review

Paul Scherr, Ph.D., D.Sc.

Supervisory Epidemiologist

National Center for Chronic Disease

Prevention and Health Promotion

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K45

Atlanta, GA 30341

(770) 488-5454/Fax (770) 488-5964

E-mail: [email protected]

3. Cancer

Barry Portnoy, Ph.D.

Cancer Planning and Program Officer

National Cancer Institute

National Institutes of Health

Building 31, Room 10A49

31 Center Drive, MSC 2580

Bethesda, MD 20892-2580

(301) 496-9569/Fax (301) 496-9931

E-mail: [email protected]

Karen Richard, M.P.A.

Public Health Advisor

National Center for Chronic Disease

Prevention and Health Promotion

Division of Cancer Prevention and Control

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K64

Atlanta, GA 30341

(770) 488-4737/Fax (770) 488-4760

E-mail: [email protected]

4. Chronic Kidney Disease

Lawrence Agodoa, M.D.

Program Director

Division of Kidney Urologic and Hematologic Diseases

National Institute of Diabetes and Digestive and Kidney

Diseases

National Institutes of Health

Building 45, Room 6AS-13B

45 Center Drive

Bethesda, MD 20892-6600

(301) 594-7717/Fax (301) 480-3510

E-mail: [email protected]

5. Diabetes

Benjamin Burton, Ph.D.

Emeritus Scientist

National Institute of Diabetes and Digestive and Kidney

Diseases

National Institutes of Health

Building 45, Room 6AN38J

45 Center Drive

Bethesda, MD 20892

(301) 594-8867/Fax (301) 480-4237

Email: [email protected]

Table I. Healthy People 2010 Lead Agencies and Work Group Coordinators—Con.

Bill Foster, M.D.

Senior Staff Physician

National Institute of Diabetes and Digestive and Kidney

Diseases

National Institutes of Health

Building 31, Room 9A21

45 Center Drive

Bethesda, MD 20892

(301) 435-2991/Fax (301) 396-2830

E-mail: [email protected]

Frank M. Vinicor, M.D.

Director

Division of Diabetes Translation

National Center for Chronic Disease

Prevention and Health Promotion

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K10

Atlanta, GA 30341-3724

(770) 488-5000/Fax (770) 488-5966

E-mail: [email protected]

6. Disability and Secondary Conditions

Chris Kochtitzky, M.S.P.

Policy Analyst

National Center for Environmental Health

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS F29

Atlanta, GA 30341-3724

(770) 488-7114/Fax (770) 488-7024

E-mail: [email protected]

Don Lollar, Ed.D.

Director

Office on Disability and Health

National Center for Environmental Health

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS F29

Atlanta, GA 30341-3724

(770) 488-7094/Fax (770) 488-7075

E-mail: [email protected]

Katherine Seelman, Ph.D.

Director

National Institute on Disability and Rehabilitation Research

U.S. Department of Education

Switzer Building, Room 3060

330 C Street, S.W.

Washington, DC 20202

(202) 205-8134/Fax (202) 205-8997

E-mail: [email protected]

Lisa Sinclair, M.P.H.

Health Policy Analyst

Office on Disability and Health

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS F29

Atlanta, GA 30341-3724

(770) 488-7667

Email: [email protected]

Healthy People 2000 Final Review 321

7. Educational and Community-Based Programs

Melissa Clarke, M.P.A.

Senior Health Policy and Program Analyst

Healthy People 2000/2010 Coordinator

Office of Planning, Evaluation and Legislation

Health Resources and Services Administration

Parklawn Building, Room 14-33

5600 Fishers Lane

Rockville, MD 20857

(301) 443-5277/Fax (301) 443-9270

E-mail: [email protected]

Catherine A. Hutsell, M.P.H.

Health Education Specialist

Community Health and Program Services

National Center for Chronic Disease

Prevention and Health Promotion

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K30

Atlanta, GA 30341-3717

(770) 488-5438/FAX (770) 488-5974

E-mail: [email protected]

Brick Lancaster, M.A., CHES

Associate Director for Health Education

Practice and Policy

National Center for Chronic Disease Prevention and Health

Promotion

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K45

Atlanta, GA 30341-3724

(770) 488-5269/Fax (770) 488-5964

E-mail: [email protected]

Paul Nannis, M.S.W.

Director

Office of Planning, Evaluation, and Legislation

Health Resources and Services Administration

Parklawn Building, Room 14-33

5600 Fishers Lane

Rockville, MD 20857

(301) 443-2460/Fax (301) 443-9270

E-mail: [email protected]

8. Environmental Health

David Evans

Senior Program Analyst

Office of Policy and External Affairs

Agency for Toxic Substances and Disease Registry

1600 Clifton Road, N.E., MS E60

Atlanta, GA 30333

(404) 639-0500/Fax (404) 639-0522

E-mail: [email protected]

David Homa, Ph.D., M.P.H.

Epidemiologist

Air Pollution and Respiratory Health Branch

Division of Environmental Hazards and Health Effects

National Center for Environmental Health

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS E17

Atlanta, GA 30333

(404) 639-2544/Fax (404) 639-2560

E-mail: [email protected]

Table I. Healthy People 2010 Lead Agencies and Work Group Coordinators—Con.

William Jirles, M.P.H.

Program Analyst

Office of Policy, Planning, and Evaluation

National Institute of Environmental Health Sciences

National Institutes of Health

Building 101, Room B224

111 Alexander Drive, MS B2-08

Research Triangle Park, NC 27709

(919) 541-2637/Fax (919) 541-4737

E-mail: [email protected]

Chris Kochtitzky, M.S.P.

Policy Analyst

Office of Planning, Evaluation, and Legislation

National Center for Environmental Health

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS F29

Atlanta, GA 30341-3724

(770) 488-7114/Fax (770) 488-7024

E-mail: [email protected]

Mark McClanahan, Ph.D.

Health Studies Branch

Division of Environmental Hazards and Health Effects

National Center for Environmental Health

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS E23

Atlanta, GA 30333

(404) 639-2562/Fax (404) 639-2565

E-mail: [email protected]

Sheila Newton, Ph.D.

Director

Office of Policy, Planning, and Evaluation

National Institute of Environmental Health Sciences

National Institutes of Health

Building 101, Room B250

111 Alexander Drive, MS B2-08

Research Triangle Park, NC 27709

(919) 541-3484/Fax (919) 541-4737

E-mail: [email protected]

Carol Pertowski, M.D.

Associate Director for Science

Division of Environmental Hazards and Health Effects

National Center for Environmental Health

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS G317

Atlanta, GA 30333

(404) 639-2500/Fax (404) 639-2555

E-mail: [email protected]

John Schelp, M.P.A.

Office of Policy, Planning, and Evaluation

National Institute of Environmental Health Sciences

National Institutes of Health

Building 101, Room B218

111 Alexander Drive, MS B2-08

Research Triangle Park, NC 27709

(919) 541-5723/Fax (919) 541-2260

E-mail: [email protected]

322 Healthy People 2000 Final Review

9. Family Planning

Evelyn Kappeler

Senior Policy Analyst

Office of Population Affairs

Office of Public Health and Science

Suite 200 West

4350 East West Highway

Bethesda, MD 20814

(301) 594-7608/Fax (301) 594-5980

E-mail: [email protected]

10. Food Safety

Elisa L. Elliot, Ph.D.

Microbiologist

Center for Food Safety and Applied Nutrition

Food and Drug Administration

200 C Street, S.W., HFS-615

Washington, DC 20204

(202) 205-4018/Fax (202) 260-0136

E-mail: [email protected]

Ruth Etzel, M.D., Ph.D.

Director

Division of Epidemiology and Risk Assessment

Food Safety and Inspection Service

U.S. Department of Agriculture

Franklin Court Building, Room 3718

1400 Independence Avenue, S.W.

Washington, DC 20250

(202) 501-7373/Fax (202) 501-6982

E-mail: [email protected]

11. Health Communication

Cynthia Baur, Ph.D.

Policy Advisor, Interactive Health

Communication

Office of Disease Prevention and Health Promotion

Office of Public Health and Science

200 Independence Avenue, S.W., Room 738G

Washington, DC 20201

(202) 205-2311/Fax (202) 205-0463

E-mail: [email protected]

Mary Jo Deering, Ph.D.

Director

Health Communication and Telehealth Staff

Office of Disease Prevention and Health Promotion

Office of Public Health and Science

200 Independence Avenue, S.W., Room 738G

Washington, DC 20201

(202) 260-2652/Fax (202) 205-0463

E-mail: [email protected]

Table I. Healthy People 2010 Lead Agencies and Work Group Coordinators—Con.

12. Access to Quality Health Services

Robinson Fulwood, Ph.D., M.S.P.H.

Senior Manager for Public Health Program Development

Office of Prevention, Education, and Control

National Heart, Lung, and Blood Institute

National Institutes of Health

Building 31, Room 4A03

31 Center Drive MSC 2480

Bethesda, MD 20892-2480

(301) 496-0554/Fax (301) 480-4907

E-mail: [email protected]

Kurt Greenlund, Ph.D.

National Center for Chronic Disease

Prevention and Health Promotion

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K47

Atlanta, GA 30341-3717

(770) 488-2572/Fax (770) 488-8151

E-mail: [email protected]

Claude Lenfant, M.D.

Director

National Heart, Lung, and Blood Institute

National Institutes of Health

31 Center Drive MSC 2486

Bethesda, MD 20892-2486

(301) 496-5166/Fax (301) 480-4907

Zhi-Jie Zheng, M.D., Ph.D.

National Center for Chronic Disease

Prevention and Health Promotion

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K47

Atlanta, GA 30341-3717

(770) 488-8058/Fax (770) 488-8151

E-mail: [email protected]

13. HIV

Emily DeCoster, M.P.H.

Office of Policy and Program Development

HIV/AIDS Bureau

Health Resources and Services Administration

Parklawn Building, Room 7-20

5600 Fishers Lane

Rockville, MD 20857

(301) 443-1381/Fax (301) 443-3323

E-mail: [email protected]

Gena Hill, M.P.H.

Program Analyst

Office of Planning, Policy, and Coordination

National Center for HIV, STD, and TB Prevention

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS E07

Atlanta, GA 30333

(404) 639-8008/Fax (404) 639-8600

E-mail: [email protected]

Healthy People 2000 Final Review 323

Eva Margolies-Seiler

Associate Director for Planning, Policy, and Coordination

National Center for HIV, STD, and TB Prevention

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS E07

Atlanta, GA 30333

(404) 639-8008/Fax (404) 639-8600

E-mail: [email protected]

14. Immunization and Infectious Diseases

Jennifer Brooks, M.P.H.

Program Analyst

Office of Policy, Planning, and Legislation

National Center for Infectious Diseases

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS C12

Atlanta, GA 30333

(404) 639-4915/Fax (404) 639-2715

E-mail: [email protected]

James Hughes, M.D.

Director

National Center for Infectious Diseases

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS C12

Atlanta, GA 30333

(404) 639-3401/Fax (404) 639-3039

E-mail: [email protected]

Martin Landry

Associate Director

Planning, Evaluation, and Legislation

National Immunization Program

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS E05

Atlanta, GA 30333

(404) 639-8200/Fax (404) 639-8626

E-mail: [email protected]

Walter Orenstein, M.D.

Director

National Immunization Program

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS E05

Atlanta, GA 30333

(404) 639-8200/Fax (404) 639-8626

E-mail: [email protected]

Rosemary Ramsey

Associate Director

Policy, Planning, and Legislation

National Center for Infectious Diseases

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS C12

Atlanta, GA 30333

(404) 639-3484/Fax (404) 639-2715

E-mail: [email protected]

Table I. Healthy People 2010 Lead Agencies and Work Group Coordinators—Con.

Nicole Smith, M.P.H., M.P.P.

Program Analyst

Office of Planning, Evaluation, and Legislation

National Immunization Program

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS E05

Atlanta, GA 30333

(404) 639-8711/Fax (404) 639-8626

E-mail: [email protected]

15. Injury and Violence Prevention

LaTanya Butler

Deputy Director

Division of Unintentional Injury

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K63

Atlanta, GA 30341-3724

(770) 488-4652/Fax (770) 488-1317

E-mail: [email protected]

Alex Crosby, M.D., M.P.H.

Medical Epidemiologist

Division of Violence Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K60

Atlanta, GA 30341

(770) 488-4272/Fax (770) 488-4349

E-mail: [email protected]

Tim W. Groza, M.P.A.

Public Health Advisor

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K63

Atlanta, GA 30341-3724

(770) 488-4676/Fax (770) 488-1317

E-mail: [email protected]

Martha Highsmith

Program Analyst

Division of Violence Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K60

Atlanta, GA 30341-3724

(770) 488-4276/Fax (770) 488-4349

E-mail: [email protected]

Laura Yerdon Martin

Assistant Deputy for Policy and Planning

Division of Violence Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K60

Atlanta, GA 30341-3724

(770) 488-4276/Fax (404) 488-4349

E-mail: [email protected]

324 Healthy People 2000 Final Review

16. Maternal, Infant, and Child Health

Isabella Danel, M.D., M.Sc.

Deputy Chief

Pregnancy and Infant Health Branch

Division of Reproductive Health

National Center for Chronic Disease Prevention and Health

Promotion

4770 Buford Highway, N.E.

Atlanta, GA 30341

(770) 488-5187/Fax (770) 488-5628

E-mail: [email protected]

Charlotte Dickinson, Ph.D.

Planning and Communications Officer

National Center for Environmental Health

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS F34

Atlanta, GA 30341-3724

(770) 488-7155/Fax (770) 488-7156

E-mail: [email protected]

Stella Yu, Sc.D., M.P.H.

Statistician

Maternal and Child Health Bureau

Health Resources and Services Administration

Parklawn Building, Room 18A-55

5600 Fishers Lane

Rockville, MD 20857

(301) 443-0695/Fax (301) 443-4842

E-mail: [email protected]

17. Medical Product Safety

Linda Brophy, R.N., M.N., M.P.H.

Special Assistant

Office of Post-Marketing Drug Risk Assessment

Center for Drug Evaluation and Research

Food and Drug Administration

Parklawn Building, MS HFD 400

5600 Fishers Lane

Rockville, MD 20857

(301) 827-3193/Fax (301) 443-9664

E-mail: brophyl@cder.fda.gov

18. Mental Health and Mental Disorders

Michele Edwards, M.S., A.C.S.W.

Healthy People Coordinator

Center for Mental Health Services

Substance Abuse and Mental Health Services Administration

Parklawn Building, Room 17C-06

5600 Fishers Lane

Rockville, MD 20857

(301) 443-7790 x8/Fax (301) 443-7912

E-mail: [email protected]

Table I. Healthy People 2010 Lead Agencies and Work Group Coordinators—Con.

Doreen S. Koretz, Ph.D.

Associate Director for Prevention

Chief, Developmental Psychopathology

and Prevention Research Branch

National Institute of Mental Health

National Institutes of Health

Neuroscience Center Building, Room 6196

6001 Executive Boulevard

Bethesda, MD 20892-9617

(301) 443-5944/Fax (301) 480-4415

E-mail: [email protected]

19. Nutrition and Overweight

Nancy T. Crane, M.S., M.P.H., R.D.

Nutritionist

Division of Nutrition Science and Policy

Office of Nutritional Products, Labeling, and

Dietary Supplements (HFS-830)

Center for Food Safety and Applied Nutrition

Food and Drug Administration

200 C Street, S.W.

Washington, DC 20204

(202) 205-5615/Fax (202) 205-5532

E-mail: [email protected]

Van S. Hubbard, M.D., Ph.D.

Director, NIH Division of Nutrition

Research Coordination, and Chief,

Nutritional Sciences Branch

National Institute of Diabetes and

Digestive and Kidney Diseases

National Institutes of Health

Rockledge 1, Suite 8048

6705 Rockledge Drive MSC 7973

Bethesda, MD 20892-7973

(301) 594-8822/Fax (301) 480-3768

E-mail: [email protected] or [email protected]

Christine J. Lewis, Ph.D., R.D.

Director

Office of Nutritional Products, Labeling, and

Dietary Supplements (HFS-800)

Center for Food Safety and Applied Nutrition

Food and Drug Administration

200 C Street, S.W.

Washington, DC 20204

(202) 205-4561/Fax (202) 205-5295

E-mail: [email protected]

Pamela E. Starke-Reed, Ph.D.

Deputy Director

NIH Division of Nutrition Research

Coordination

National Institute of Diabetes and Digestive

and Kidney Diseases

National Institutes of Health

Rockledge 1, Suite 8048

6705 Rockledge Drive, MSC 7973

Bethesda, MD 20892-7973

(301) 594-8805/Fax (301) 480-3768

E-mail: [email protected]

Healthy People 2000 Final Review 325

20. Occupational Safety and Health

Regina Pana-Cryan

Senior Service Fellow

Office of Policy and Legislation

National Institute for Occupational Safety and Health

Centers for Disease Control and Prevention

200 Independence Avenue, S.W., Room 715H

Washington, DC 20201

(202) 401-3741/Fax (202) 260-4464

E-mail: [email protected]

21. Oral Health

Alice M. Horowitz, Ph.D.

Senior Scientist

National Institute of Dental and Craniofacial Research

National Institutes of Health

Building 45, Room 3AN-44B

45 Center Drive, MSC 6401

Bethesda, MD 20892-6401

(301) 594-5391/Fax (301) 480-8254

E-mail: [email protected]

Candace M. Jones, M.P.H.

Health Resources and Services Administration

Parklawn Building, Room 6A-30

5600 Fishers Lane

Rockville, MD 20857

(301) 443-1106/Fax (301) 594-6610

E-mail: [email protected]

Stuart A. Lockwood, D.M.D., M.P.H.

Dental Officer

Surveillance Investigation Research Branch

Division of Oral Health

National Center for Chronic Disease

Prevention and Health Promotion

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS F10

Atlanta, GA 30341

(770) 488-6067/Fax (770) 488-6080

E-mail: [email protected]

22. Physical Activity and Fitness

Carol Macera, Ph.D.

Senior Epidemiologist

Division of Nutrition and Physical Activity

National Center for Chronic Disease Prevention and Health

Promotion

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K46

Atlanta, GA 30341-3724

(770) 488-5018/Fax (770) 488-5473

E-mail: [email protected]

Christine Spain

Director

Research, Planning, and Special Projects

President’s Council on Physical Fitness and Sports

Office of Public Health and Science

200 Independence Avenue, S.W., Room 731

Washington, DC 20201

(202) 690-5148/Fax (202) 690-5211

E-mail: [email protected]

Table I. Healthy People 2010 Lead Agencies and Work Group Coordinators—Con.

23. Public Health Infrastructure

Carol Roddy, J.D.

Senior Advisor to the Administrator

Center for Public Health Practice

Health Resources and Services Administration

Parklawn Building, Room 14-15

5600 Fishers Lane

Rockville, MD 20857

(301) 443-4034/Fax (301) 443-0192

E-mail: [email protected]

Diane Rodill, Ph.D.

Center for Public Health Practice

Health Resources and Services Administration

Parklawn Building, Room 14-15

5600 Fishers Lane

Rockville, MD 20857

(301) 443-0062/Fax (301) 443-0192

E-mail: [email protected]

Pomeroy Sinnock, Ph.D.

Division of Public Health

Public Health Practice Program Office

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K39

Atlanta, GA 30341-3724

(770) 488-2469/Fax (770) 488-2489

E-mail: [email protected]

24. Respiratory Diseases

Robinson Fulwood, Ph.D., M.S.P.H.

Senior Manager for Public Health Program Development

Office of Prevention, Education, and Control

National Heart, Lung, and Blood Institute

National Institutes of Health

Building 31, Room 4A03

31 Center Drive MSC 2480

Bethesda, MD 20892-2480

(301) 496-0554/Fax (301) 480-4907

E-mail: [email protected]

William Jirles, M.P.H.

Office of Policy, Planning, and Evaluation

National Institute of Environmental Health Sciences

National Institutes of Health

Building 101, Room B224

111 Alexander Drive, MS B2-08

Research Triangle Park, NC 27709

(919) 541-2637/Fax (919) 541-4737

E-mail: [email protected]

Carol Johnson, M.P.H.

Air Pollution and Respiratory Health Branch

Division of Environmental Hazards and Health Effects

National Center for Environmental Health

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS E17

Atlanta, GA 30333

(404) 639-2556/Fax (404) 639-2560

E-mail: [email protected]

326 Healthy People 2000 Final Review

Marshall Plaut, M.D.

Chief

Allergic Mechanisms Section

Division of Allergy, Immunology, and Transplantation

National Institute of Allergy and Infectious Diseases

National Institutes of Health

6700-B Rockledge Drive, Room 5146

Bethesda, MD 20892-7640

(301) 496-8973/Fax (301) 402-2571

E-mail: [email protected]

Stephen Redd, M.D.

Chief

Air Pollution and Respiratory Health Branch

Division of Environmental Hazards and Health Effects

National Center for Environmental Health

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS E17

Atlanta, GA 30341

(404) 639-2549/Fax (404) 639-2560

E-mail: [email protected]

Daniel Rotrosen, M.D.

Director

Division of Allergy, Immunology, and Transplantation

National Institute of Allergy and Infectious Diseases

National Institutes of Health

6700-B Rockledge Drive, Room 5142

Bethesda, MD 20892-7640

(301) 496-1886/Fax (301) 402-2571

E-mail: [email protected]

25. Sexually Transmitted Diseases

Dana M. Shelton

Assistant Director for Policy, Planning, and External Relations

Division of STD Prevention

National Center for HIV, STD, and TB Prevention

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS E02

Atlanta, GA 30333

(404) 639-8260/Fax (404) 639-8608

E-mail: [email protected]

26. Substance Abuse

Wendy Davis

Special Assistant to the Director

Office of Policy and Planning

Center for Substance Abuse Prevention

Substance Abuse and Mental Health Services Administration

Rockwall II Building, Room 950

5600 Fishers Lane

Rockville, MD 20857

(301) 443-9913/Fax (301) 443-6394

E-mail: [email protected]

Susan Farrell, Ph.D.

Acting Deputy Director

Division of Biometry and Epidemiology

National Institute on Alcohol Abuse and Alcoholism

National Institutes of Health

Willco Building, Room 514

6000 Executive Boulevard

Bethesda, MD 20892-7005

(301) 443-1274/Fax (301) 443-7043

E-mail: [email protected]

Table I. Healthy People 2010 Lead Agencies and Work Group Coordinators—Con.

James D. Colliver, Ph.D.

Epidemiology Research Branch, DESPR

National Institute on Drug Abuse

National Institutes of Health

Suite 5153 MSC 9589

6001 Executive Boulevard

Bethesda, MD 20892-9589

(301) 402-1846/Fax (301) 443-2636

E-mail: [email protected]

Ann Mahony, M.P.H.

Senior Program Management Officer

Office of Policy, Coordination, and Planning

Center for Substance Abuse Treatment

Substance Abuse and Mental Health

Services Administration

Rockwall II Building, Room 619

5600 Fishers Lane

Rockville, MD 20857

(301) 443-7924/Fax (301) 480-6077

E-mail: [email protected]

27. Tobacco Use

Karil Bialostosky, M.S.

Senior Health Policy Analyst

Office on Smoking and Health

Centers for Disease Control and Prevention

200 Independence Ave, S.W., Room 317-B

Washington, DC 20201

(202) 205-9231/Fax (202) 205-8313

E-mail: [email protected]

28. Vision and Hearing

Marin P. Allen, Ph.D.

Chief

Office of Health Communication

and Public Liaison

National Institute on Deafness

and Other Communication Disorders

National Institutes of Health

Building 31, Room 3C35

31 Center Drive, MSC 2320

Bethesda, MD 20892-2320

(301) 496-7243 or 402-0252/Fax (301) 402-0018

Email: [email protected]

Judith Cooper, Ph.D.

Chief, Scientific Programs Branch

National Institute on Deafness and Other

Communication Disorders

National Institutes of Health

EPS400C, MSC 7180

6120 Executive Boulevard

Bethesda, MD 20892-7180

(301) 496-5061/Fax (301) 402-6251

E-mail: [email protected]

Michael Davis

Associate Director for Science Policy and Legislation

National Eye Institute

National Institutes of Health

Building 31, Room 6A23

9000 Rockville Pike

Bethesda, MD 20892-2510

(301) 496-4308/Fax (301) 402-3799

E-mail: [email protected]

Healthy People 2000 Final Review 327

Rosemary Janiszewski, M.S., CHES.

Chief

Scientific Programs Branch

National Eye Institute

National Institutes of Health

Building 31, Room 6A32

9000 Rockville Pike

Bethesda, MD 20892-2510

(301) 496-5248/Fax (301) 402-1065

E-mail: [email protected]

Adolescent Health

Trina Anglin, M.D., Ph.D.

Chief, Office of Adolescent Health

Maternal and Child Health Bureau

Health Resources and Services Administration

Parklawn Building, Room 18A-39

5600 Fishers Lane

Rockville, MD 20857

(301) 443-4291/Fax (301) 443-1296

Email: [email protected]

Casey Hannan, M.P.H.

Health Education Specialist

Division of Adolescent and School Health

National Center for Chronic Disease

Prevention and Health Promotion

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K29

Atlanta, GA 30341-3724

(770) 488-3190/Fax (770) 488-3110

Email: [email protected]

Lloyd J. Kolbe, Ph.D.

Director, Division of Adolescent and School Health

National Center for Chronic Disease

Prevention and Health Promotion

Centers for Disease Control and Prevention

4770 Buford Highway, N.E., MS K29

Atlanta, GA 30341-3724

(770) 488-3254/Fax (770) 488-3110

Email: [email protected]

Women’s Health

Theresa Brown

Staff Assistant

DHHS Office on Women’s Health

200 Independence Avenue, S.W., Room 728F

Washington, DC 20201

(202) 690-7650/Fax (202) 260-6537

Email: [email protected]

Miryam Granthon

Healthy People Consortium Coordinator

Office of Disease Prevention and Health Promotion

200 Independence Avenue, S.W., Room 738G

Washington, DC 20201

(202) 690-6245/Fax (202) 205-9478

Email: [email protected]

Suzanne Haynes, Ph.D.

Assistant Director for Science

DHHS Office on Women’s Health

200 Independence Avenue, S.W., Room 728F

Washington, DC 20201

(202) 690-7650/Fax (202) 260-6537

Email: [email protected]

Table II. Acronyms used in Healthy People 2000 Final Review

Acronyms Agency/Organization

ACS................................ American Cancer Society

AHA................................ American Hospital Association

AIRS................................ Aerometric Information Retrieval System

ALA ................................ American Lung Association

ATSDR .............................. Agency for Toxic Substances and Disease Registry

BHPr ............................... Bureau of Health Professions

BJS ................................ Bureau of Justice Statistics

BLS ................................ Bureau of Labor Statistics

CDC................................ Centers for Disease Control and Prevention

CFSAN.............................. Center for Food Safety and Applied Nutrition

CPSC ............................... Consumer Product Safety Commission

CSAT............................... Center for Substance Abuse Treatment

DoD................................ Department of Defense

DOJ................................ Department of Justice

DOL................................ Department of Labor

DOT................................ Department of Transportation

EPA................................ Environmental Protection Agency

EPO................................ Epidemiology Program Office

FARS............................... Fatality and Analysis Reporting System

FDA................................ Food and Drug Administration

FEMA ............................... Federal Emergency Management Administration

GAO................................ Government Accounting Office

HCFA............................... Health Care Financing Administration

HRSA ............................... Health Resources and Services Administration

IHS................................. Indian Health Service

IRMO ............................... Information Resources Management Office

NCCAN ............................. National Center for Child Abuse and Neglect

NCCDPHP ........................... National Center for Chronic Disease Prevention and Health Promotion

NCEH............................... National Center for Environmental Health

NCHS............................... National Center for Health Statistics

NCHSR ............................. National Center for Health Services Research

NCHSTP............................. National Center for HIV, STD, and TB Prevention

NCI................................. National Cancer Institute

NCID ............................... National Center for Infectious Disease

NCIPC .............................. National Center for Injury Prevention and Control

NCPS ............................... National Center for Prevention Services

NCVHS.............................. National Committee on Vital and Health Statistics

NHLBI .............................. National Heart, Lung, and Blood Institute

NHTSA.............................. National Highway Traffic Safety Administration

NIAAA .............................. National Institute on Alcoholism and Alcohol Abuse

NICHD .............................. National Institute for Child Health and Human Development

NIDA ............................... National Institute on Drug Abuse

NIDR ............................... National Institute of Dental Research

NIH................................. National Institutes of Health

NIMH ............................... National Institute for Mental Health

NIOSH .............................. National Institute for Occupational Safety and Health

NIP................................. National Immunization Program

NSBA ............................... National School Boards Association

OAR................................ Office of Air and Radiation

OAS................................ Office of the Assistant Secretary

OASD............................... Office of the Assistant Secretary of Defense

OASH............................... Office of the Assistant Secretary for Health

ODPHP ............................. Office of Disease Prevention and Health Promotion

OPA................................ Office of Population Affairs

OPEL ............................... Office of Planning, Evaluation, and Legislation

OPHS............................... Office of Public Health and Science

OPPTS.............................. Office of Pollution, Prevention, and Toxic Substance

ORA................................ Office of Research and Analysis

OSH................................ Office of the Secretary of Health

328 Healthy People 2000 Final Review

Table II. Acronyms used in Healthy People 2000 Final Review—Con.

Acronyms Agency/Organization

OSHA............................... Occupational Safety and Health Administration

OSWER ............................. Office of Solid Waste Enforcement and Remediation

PHF................................ Public Health Foundation

PHS................................ Public Health Service

SAMHSA ............................ Substance Abuse and Mental Health Services Administration

USDA ............................... United States Department of Agriculture

Healthy People 2000 Final Review 329

Table III. Crosswalk between objectives from Healthy People 2000

to Healthy People 2010

Healthy People 2000 Healthy People 2010

Objective

number

Duplicate objective

number(s)

Objective

number

Priority Area 1: Physical Activity and Fitness

1.1 2.1, 3.1, 15.1 12-1*

1.2 2.3, 15.10, 17.12 19-2,* 19-3*

1.3 15.11, 17.13 22-6*

1.3 15.11, 17.13 22-2*

1.4 22-3*

1.4 22-7*

1.5 22-1*

1.6 22-4*

1.6 22-5*

1.7 2.7

1.8 22-9

1.8

1.9 22-10

1.1 22-13*

1.11

1.12 1-3a*

1.12 3-10h*

1.13 17.3

Priority Area 2: Nutrition

2.1 1.1, 3.1, 15.1 12-1*

2.2 16.1 3-1*

2.3 1.2, 15.10, 17.12 19-2*

2.3 1.2, 15.10, 17.12 19-3a-c*

2.4 19-4

2.5 15.9, 16.7 19-8*

2.5 19-9*

2.6 16.8 19-5*

2.6 16.8 19-6*

2.6 16.8 19-7*

2.7 1.7

2.8 19-11*

2.9 19-10*

2.10 19-12a-c*

2.10 19-13*

2.11 14.9 16-19a-b

2.11 14.9 16-19c*

2.12 13.11

2.13

2.14

2.15

2.16

2.17 19-15*

2.18

2.19 7-2h*

2.20 19-16*

2.21 19-17*

2.21 1-3b*

2.22 3.18, 15.2 12-7*

2.23 16.5 3-5*

2.24 17.11 5-2*

2.24 17.11 5-3*

2.25 15.7 12-14*

2.26 15.4 12-10*

2.27 15.6 12-13*

330 Healthy People 2000 Final Review

Table III. Crosswalk between objectives from Healthy People 2000

to Healthy People 2010—Con.

Healthy People 2000 Healthy People 2010

Objective

number

Duplicate objective

number(s)

Objective

number

Priority Area 3: Tobacco

3.1 1.1, 2.1, 15.1 12-1*

3.2 16.2 3-2*

3.3 24-10*

3.4 15.12, 16.6 27-1a*

3.5 27-3*

3.6 27-5*

3.7 27-6*

3.7 27-7

3.8 11.17 27-9

3.9 13.17 27-2a*

3.9 13.17 27-2c*

3.10 27-11

3.11 10.18 27-12*

3.12 10.19 27-13a-e

3.12 10.19 27-13f*

3.13 27-14a-b*

3.14

3.15

3.16 1-3c*

3.16 3-10a-c*

3.17 13.7, 16.17 3-6*

3.18 2.22, 15.2 12-7*

3.19 4.5 26-9a

3.19 4.5 26-9b

3.19 4.5 26-10a,c

3.19 4.5 27-4a

3.19 4.5 27-4b*

3.20 4.6 26-10b

3.20 4.6 27-2a*

3.20 4.6 27-2b*

3.21 4.9 26-16a-f*

3.21 4.9 27-17a-b*

3.21 4.9 27-17c

3.22 4.10 26-17a-c

3.23 27-21a-b*

3.24 27-8a-c*

3.25 10.20 27-19*

3.26

Priority Area 4: Substance Abuse: Alcohol and Other Drugs

4.1 9.23 26-1a

4.2 26-2*

4.3 26-3*

4.4 26-4*

4.5 3.19 26-9a-b

4.5 3.19 26-10a,c

4.5 3.19 27-4a

4.6 3.20 26-10b

4.6 3.20 27-2b

4.7 26-11a-b

4.7 26-11c-d*

4.8 26-12

4.9 3.21 26-16a-f*

4.9 3.21 27-17a-b*

4.9 3.21 27-17c

4.10 3.22 26-17a-c

Healthy People 2000 Final Review 331

Table III. Crosswalk between objectives from Healthy People 2000

to Healthy People 2010—Con.

Healthy People 2000 Healthy People 2010

Objective

number

Duplicate objective

number(s)

Objective

number

4.11 26-14a-c*

4.12

4.13

4.14

4.15 26-24

4.16

4.17

4.18 26-25

4.19 1-3d*

4.20

Priority Area 5: Family Planning

5.1 9-7

5.2 9-1*

5.3 9-12*

5.4 18.3, 19.9 9-8a*

5.4 18.3, 19.9 9-8b*

5.4 18.3, 19.9 9-9a*

5.4 18.3, 19.9 9-9b*

5.5 18.15, 19.16 25-11*

5.6 9-10a-d, g-h

5.6 25-11*

5.7 9-4

5.8 9-11a-c*

5.9

5.10 14.12 1-3f*

5.11 18.13, 19.11

5.12 9-3

Priority Area 6: Mental Health and Mental Disorders

6.1 7.2 18-1*

6.2 7.8 18-2

6.3

6.4

6.5

6.6

6.7 18-9b*

6.8

6.9

6.10 7.18

6.11 20-9

6.12

6.13

6.14

6.15

Priority Area 7: Violent and Abusive Behavior

7.1 15-32*

7.2 6.1 18-1*

7.3 15-3*

7.4 15-33a–b*

7.5 15-34*

7.6 15-37*

7.7 15-35*

7.8 6.2 18-2

7.9 15-38*

7.10 15-39*

7.11 15-4*

332 Healthy People 2000 Final Review

Table III. Crosswalk between objectives from Healthy People 2000

to Healthy People 2010—Con.

Healthy People 2000 Healthy People 2010

Objective

number

Duplicate objective

number(s)

Objective

number

7.12

7.13

7.14

7.15

7.16

7.17

7.18 6.10

7.19 9.25

Priority Area 8: Educational and Community-Based Programs

8.1 17.1, 21.1

8.2 7-1

8.3

8.4 7-2a-j*

8.5 7-3

8.6 7-5a-f*

8.7 7-6*

8.8 7-12

8.9

8.10 7-10*

8.11 7-11a-b, d-f, j-l, p-q, z, bb*

8.11 7-11c, g-i, m-o, r, t-v, y, aa

8.12 7-7*

8.12 7-9*

8.13

8.14

Priority Area 9: Unintentional Injuries

9.1 15-13*

9.2 15-14*

9.3 15-15a*

9.3 15-15b

9.3f 15–16

9.4 15-27*

9.5 15-29*

9.6 15-25*

9.7 15-28a-b*

9.8 15-7*

9.9 15-1*

9.10 15-2*

9.11

9.12 15-19

9.12 15-20

9.13 15-21

9.13 15-23

9.14

9.15

9.16

9.17 15-26a-b*

9.18

9.19 13.16 15-31*

9.20

9.21 1-3e*

9.22

9.23 4.1 26-1a

9.24 15-24

9.25 7.19

9.26 15-22

Healthy People 2000 Final Review 333

Table III. Crosswalk between objectives from Healthy People 2000

to Healthy People 2010—Con.

Healthy People 2000 Healthy People 2010

Objective

number

Duplicate objective

number(s)

Objective

number

Priority Area 10: Occupational Safety and Health

10.1 20-1a

10.1a 20-1b

10.1b 20-1c

10.1c 20-1d

10.1d 20-1e

10.2 20-2a

10.2 20-2g*

10.2a 20-2b

10.2b 20-2c

10.2c 20-2d

10.2d 20-2e

10.2 20-2f

10.2f 20-2h

10.3 20-3

10.4 20-8

10.5 20.3e 14-3g

10.6

10.7 20-11*

10.8 20-7*

10.9 20.11 14-28c*

10.10

10.11

10.12

10.13

10.14

10.15

10.16 20-5

10.17 20-4

10.18 3.11 27-12*

10.19 3.12 27-13b*

10.20 3.25 27-19*

Priority Area 11: Environmental Health

11.10 24-2a-c*

11.1b 1.9a

11.2 17.8

11.3 8-6

11.4 8-11*

11.5 8-1a-g*

11.6 8-18*

11.7 8-4*

11.8 8-15*

11.9 8-5*

11.10 8-8*

11.11 8-22*

11.12 8-19*

11.13

11.14 8-12a*

11.15

11.16 8-27a-j

11.17 3.8 27-9

Priority Area 12: Food and Drug Safety

12.1 10-1a-d

12.2 10-2a*

12.2 10-2b

12.3 10-5*

334 Healthy People 2000 Final Review

Table III. Crosswalk between objectives from Healthy People 2000

to Healthy People 2010—Con.

Healthy People 2000 Healthy People 2010

Objective

number

Duplicate objective

number(s)

Objective

number

12.4

12.5

12.6 17-3*

12.7

12.8 17-4*

12.8 17-5a*

12.8 17-5b*

Priority Area 13: Oral Health

13.1 21-1a*

13.1 21-1b

13.1 21-1c

13.2 21-2a,d*

13.2 21-2b-c

13.3 21-3

13.4 21-4*

13.5 21-5a*

13.6 21-5b*

13.7 3.17, 16.17 3-6*

13.8 21-8a

13.8 21-8b*

13.9 21-9

13.10

13.11 2.12

13.12

13.13

13.14 21-10*

13.15 21-15*

13.16 9.19 15-31

13.17 3.9 27-2c*

Priority Area 14: Maternal and Infant Health

14.1 16-1c

14.1d 16-1d

14.1g 16-1

14.2 16-1a

14.3 16-4

14.4 16-18*

14.5 16-10a

14.5 16-10b

14.6 16-12*

14.7 16-5a*

14.8a 16-9a*

14.8b 16-9b*

14.9 2.11 16-19a-b

14.9 2.11 16-19c*

14.10 16-17a-b, d*

14.10 16-17c

14.11 16-6a

14.12 5.1 1-3f*

14.13

14.14 16-8*

14.15 16-20a-c*

14.16

14.17 16-15*

Healthy People 2000 Final Review 335

Table III. Crosswalk between objectives from Healthy People 2000

to Healthy People 2010—Con.

Healthy People 2000 Healthy People 2010

Objective

number

Duplicate objective

number(s)

Objective

number

Priority Area 15: Heart Disease and Stroke

15.1 1.1, 2.1, 3.1 12-1*

15.2 2.22, 3.18 12-7*

15.3

15.4 2.26 12-10*

15.5 12-11*

15.6 2.27 12-13

15.7 2.25 12-14

15.8

15.9 2.5, 16.7 19.8

15.1 1.2, 2.3, 17.12 19-2, 19-3*

15.11 1.3, 17.13 22-6*

15.12 3.4, 16.6

15.13 12-12*

15.14 12-15*

15.15

15.16 7-5b

15.17

Priority Area 16: Cancer

16.1 2.2 3-1*

16.2 3.2 3-2*

16.3 3-3*

16.4 3-4*

16.5 2.23 3-5*

16.6 3.4, 15.12

16.7 2.5, 15.9 19-8

16.8 2.6 19-5

16.8 2.6 19-6

16.8 2.6 19-7

16.9 3-9b*

16.10 3-10a-h*

16.11 3-13*

16.12 3-11a*

16.12 3-11b*

16.13 3-12a*

16.13 3-12b*

16.14 21-7*

16.15

16.16

16.17 3.17, 13.7 3-6*

Priority Area 17: Diabetes and Chronic Disabling Conditions

17.1 8.1, 21.1

17.2

17.3 1.13

17.4 24-4*

17.5

17.6

17.7 28-4*

17.8 11.2

17.9 5-5*

17.10 4-7*

17.10 5-10*

17.10 28-5

17.11 2.24 5-2*

336 Healthy People 2000 Final Review

Table III. Crosswalk between objectives from Healthy People 2000

to Healthy People 2010—Con.

Healthy People 2000 Healthy People 2010

Objective

number

Duplicate objective

number(s)

Objective

number

17.11 2.24 5-3*

17.12 1.2, 2.3, 15.10 19-2, 19-3*

17.13 1.3, 15.11 22-6

17.14 5-1*

17.14 24-6*

17.15

17.16

17.17

17.18 1-3h*

17.19

17.20 16-23*

17.21 14-17*

17.22 22.4

17.23 5-13*

Priority Area 18: HIV Infection

18.1

18.2 13-1

18.2 13-4*

18.2 13-5*

18.2a 13-2

18.2b 13-3

18.3 5.4, 19.9 9-8a*

18.3 5.4, 19.9 9-8b*

18.3 5.4, 19.9 9-9a*

18.3 5.4, 19.9 9-9b*

18.4 19.10 13-6*

18.4 19.10 25-11*

18.4a 19.10a 9-10e*

18.4b 19.10b 9-10f*

18.5

18.6

18.7

18.8 13-7*

18.9 19.14 1-3g

18.10 19.12 7-2g*

18.11 19.17 7-3*

18.12

18.13 5.11, 19.11 25-18*

18.14

18.15 5.5, 19.16 25-11*

18.16

18.17

Priority Area 19: Sexually Transmitted Diseases

19.1 25-2

19.2 25-1a-c*

19.3 25-3

19.4 25-9

19.5 25-4*

19.5 25-5*

19.6 25-6*

19.7 20.3b–c 14-3e-f

19.8

19.9 5.4, 18.3 9-8a*

19.9 5.4, 18.3 9-8b*

19.9 5.4, 18.3 9-9a*

19.9 5.4, 18.3 9-9b*

Healthy People 2000 Final Review 337

Table III. Crosswalk between objectives from Healthy People 2000

to Healthy People 2010—Con.

Healthy People 2000 Healthy People 2010

Objective

number

Duplicate objective

number(s)

Objective

number

19.10 18.4 13-6

19.10a 18.4a 9-10e*

19.10b 18.4b 9-10f*

19.11 5.11, 18.13

19.12 18.10 7-2g*

19.13 25-18*

19.14 18.9 1-3g*

19.15 25-15*

19.15 25-19*

19.16 5.5, 18.15 25-11*

19.17 18.11 7-3*

Priority Area 20: Immunization and Infectious Diseases

20.1 14-1a, e-f, h-i

20.1 14-1b-d, g, j*

20.2

20.3 10.5 14-3a-c*

20.3 10.5 14-6*

20.3 10.5 14-9

20.3a 14-3d

20.3b 19.7 14-3e

20.3c 19.7 14-3f

20.3 10.5 14-3g

20.3f 14-2

20.4 14-11

20.5 14-20a-e*

20.5 14-21*

20.6 14-15*

20.7 14-4*

20.7 14-7*

20.8

20.9 14-18*

20.10 14-5a-d*

20.11 14-22a-e*

20.11 14-23a–c,f-h

20.11 14-24a*

20.11 14-27a-d*

20.11 14-28b

20.11 10.9 14-28c

20.11 14-29a-f*

20.12

20.13

20.14

20.15

20.16

20.17

20.18 14-13*

20.19

338 Healthy People 2000 Final Review

Table III. Crosswalk between objectives from Healthy People 2000

to Healthy People 2010—Con.

Healthy People 2000 Healthy People 2010

Objective

number

Duplicate objective

number(s)

Objective

number

Priority Area 21: Clinical Preventive Services

21.1 8.1, 17.1

21.2 20.11 †

21.3 1-4a*

21.3 1-4b*

21.3 1-4c

21.4 1-1*

21.4 1-2*

21.5

21.6

21.7

21.8 1-8a-d

21.8 1-8i-t*

21.8a 1-8e-h*

Priority Area 22: Surveillance and Data Systems

22.1

22.2

22.3

22.4 17.22

22.5

22.6

22.7 23-7*

Healthy People 2000 Final Review 339

* Healthy People 2010 objective is modified from the comparable Healthy People 2000 objective;

see Tracking Healthy People 2010, Part B: Operational Definitions for a description of changes.

†This is a compound Healthy People 2000 objective with several measures. In Healthy People

2010, these measures were separated and reassigned to appropriate focus areas. See chapter

21, section ‘‘Transition to Healthy People 2010’’ for more information.

Table IV. Mortality objective cause-of-death categories

Objective

number

Healthy People 2000 Mortality tabulation lists

Cause of death

ICD-9 identifying codes Cause of death ICD-9 identifying codes

1.1 Coronary heart disease 402, 410-414, 429.2 Diseases of heart 390-398, 402, 404-429

2.1 See 1.1

2.2 Cancer (all sites) 140-208 Malignant neoplasms, including

neoplasms of lymphatic hematopoietic

tissues

(Same as HP2000)

2.22 Stroke 430-438 Cerebrovascular diseases (Same as HP2000)

2.23 Colorectal cancer 153.0-154.3, 154.8, 159.0 Malignant neoplasms of colon, rectum, 153, 154

rectosigmoid junction, and anus

3.1 See 1.1

3.2 Lung cancer 162.2-162.9 Malignant neoplasms of trachea,

bronchus, and lung

162

3.3 Chronic obstructive pulmonary disease 490-496 Chronic obstructive pulmonary diseases

and allied conditions

(Same as HP2000)

3.17 Cancer of the oral cavity and pharynx 140-149 Malignant neoplasms of lip, oral cavity,

and pharynx

(Same as HP2000)

3.18 See 2.22

4.1 Alcohol-related motor vehicle crashes E810-E819

No comparable category . . .

4.2 Cirrhosis 571 Chronic liver disease and cirrhosis (Same as HP2000)

4.3 Drug-related deaths 292, 304, 305.2-305.9, Drug-induced causes (Same as HP2000)

E850-E858, E950.0–

E950.5, E962.0, E980.0–

E980.5

6.1 Suicides E950–E959 (Same as HP2000) (Same as HP2000)

7.1 Homicides E960–E969 Homicide and legal intervention E960-E978

7.2 See 6.1

7.3 Firearm-related deaths E922.0–E922.3, E922.8– Injury by firearms (Same as HP2000)

E922.9, E955.0-E955.4,

E965.0–E965.4, E970,

E985.0–E985.4

9.1 Unintentional injuries E800–E949 Accidents and adverse effects (Same as HP2000)

9.3, 9.3a–c, e–f Motor vehicle crashes E810–E819 Motor vehicle traffic accidents (Same as HP2000)

9.3d,g Motor vehicle crashes E810–E825 Motor vehicle accidents (Same as HP2000)

9.4 Falls and fall-related injuries E880–E888 Accidental falls (Same as HP2000)

9.5 Drowning E830, E832, E910 Accidental drowning and submersion E910

9.6 Residential fires E890–E899 Accidents caused by fire and flames (Same as HP2000)

9.23 See 4.1

10.1 Work-related injuries

E800–E999 No comparable category . . .

10.16 Work-related homicides E960–E969 No comparable category . . .

10.17 Occupational lung diseases

500–505 No comparable category . . .

13.7 See 3.17

14.3 Maternal mortality 630–676 Complications of pregnancy, childbirth,

and the puerperium or maternal

mortality

(Same as HP2000)

See footnotes and key at end of table.

340 Healthy People 2000 Final Review

Table IV. Mortality objective cause-of-death categories—Con.

Objective

number

Healthy People 2000 Mortality tabulation lists

Cause of death

ICD–9 identifying codes Cause of death ICD–9 identifying codes

15.1 See 1.1

15.2 See 2.22

16.1 See 2.2

16.2 See 3.2

16.3 Breast cancer in women 174 Malignant neoplasm of female breast (Same as HP2000)

16.4 Cancer of the uterine cervix 180 Malignant neoplasm of cervix uteri (Same as HP2000)

16.5 See 2.23

16.17 See 3.17

17.9 Diabetes-related deaths

250 Diabetes mellitus (Same as HP2000)

20.2 Epidemic-related pneumonia

and influenza deaths for ages 65 years

and over

480-487 No comparable category . . .

. . . Category not applicable.

Unless otherwise specified, Healthy People 2000 uses underlying cause-of-death data.

Includes only those deaths assigned to E810–E819 that were alcohol related; see Priority Area 4, Substance Abuse: Alcohol and Other Drugs.

Healthy People 2000 uses multiple cause-of-death data.

Healthy People 2000 Final Review 341

Table V. Morbidity codes used for objectives tracked by the National Hospital Discharge Survey

Objective

number Subject ICD-9-CM diagnosis codes Comment

9.2 All nonfatal injuries 800-959 Because of limited reporting of external causes (E-codes) in hospital

discharge systems, the data include injuries that are unintentional,

intentional, and where the intent is unknown.

9.7 Hip fractures 820

9.9 Nonfatal head injuries 800-801, 803-804, 850-854,

870-873, 925

9.10 Nonfatal spinal cord injuries 806, 952

11.1 Asthma 493

14.7 Severe complications of pregnancy 630-634, 636-677 First listed code cannot equal V27 (which would indicate a delivery)

14.8 Cesarean births — total V27 Procedure code 74, excluding 74.3 and 74.91

14.8a Cesarean births — primary V27 first listed and 654.2 not listed Procedure code 74, excluding 74.3 and 74.91

14.8b Cesarean births — repeat V27 first listed and 654.2 (any listed) Procedure code 74, excluding 74.3 and 74.91

17.10 Lower extremity amputation 250 (any listed) and Procedure codes 84.11–84.12

among people with diabetes 895-897 are not listed

19.16 Pelvic inflammatory disease 614.0-614.5, 614.7-614.9,

615.0, 615.1, 615.9, 98.10

098.16, 098.17, 098.30,

098.36-098.37, 098.39,

098.86 (any listed)

First listed diagnoses are used for all objectives, unless otherwise stated. Because of the hierarchical nature of ICD–9–CM coding, three digit code s (such as 493) include all the more detailed

four- and five-digit codes with the same first three digits (for example, 493 includes 493.0-493.9).

342 Healthy People 2000 Final Review

Table VI. Published issues of Healthy People Statistical Notes

Number Title Date of Issue

Healthy People 2000

1 Health Status Indicators for the Year 2000 Fall 1991

2 Infant Mortality Winter 1991

3 Health Status Indicators: Definitions and National Data Spring 1992

4 Issues Related to Monitoring the Year 2000 Objectives Summer 1993

5 Revisions to Healthy People 2000 Baselines July 1993

6 Direct Standardization (Age-Adjusted Death Rates) March 1995

7 Years of Healthy Life April 1995

8 Evaluating Public Health Data Systems: A Practical Approach June 1995

9 Monitoring Air Quality in Healthy People 2000 September 1995

10 Health Status Indicators: Differentials by Race and Hispanic Origin September 1995

11 Operational Definitions for Year 2000 Objectives: Priority Area 20, Immunization and Infectious

Diseases February 1997

12 Operational Definitions for Year 2000 Objectives: Priority Area 13, Oral Health May 1997

13 Healthy People 2000 Midcourse Revisions: A Compendium August 1997

14 Operational Definitions for Year 2000 Objectives: Priority Area 14, Maternal and Infant Health December 1997

15 Priority Data Needs: Sources of National, State, and Local-level Data and Data Collection Systems December 1997

16 Operational Definitions for Year 2000 Objectives: Priority Area 6, Mental Health and Mental Disorders February 1998

17 Operational Definitions for Year 2000 Objectives: Priority Area 21, Clinical Preventive Services December 1998

18 Operational Definitions for Year 2000 Objectives: Priority Area 1, Physical Activity and Fitness December 1998

19 Healthy People 2000: An Assessment Based on the Health Status Indicators for the United States

and Each State November 2000

Healthy People 2010

20 Age Adjustment Using the 2000 Projected U.S. Population January 2001

Healthy People 2000 Final Review 343

Table VII. Special population objectives included in Healthy People 2000

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

American Indian/Alaska Native

1.2d 2.3d, 15.10d, 17.12d Overweight prevalence: 20 years and over Narrowing Toward

1.5f Sedentary lifestyle: 18 years and over Narrowing Toward

2.10d Anemia prevalence: Children 1-5 years Not applicable Away

2.11d 14.9d Breastfeeding: During early postpartum period Narrowing Toward

2.11d 14.9d Breastfeeding: At age 6 months Widening Away

2.12b 13.11b Baby bottle tooth decay Cannot assess Cannot assess

2.24a 17.11a Diabetes prevalence: 15 years and over Narrowing Away

3.4f 15.12f, 16.6f Cigarette smoking prevalence: 18 years and over Narrowing Toward

3.9a 13.17a Smokeless tobacco use: 18-24 years Cannot assess Cannot assess

4.1a 9.23a Alcohol-related motor vehicle deaths: Male Widening Met

4.2b Cirrhosis deaths Widening Away

6.1d 7.2d Suicide: Male Widening Away

7.1f Homicide Widening Toward

8.11 Counties with programs for racial/ethnic minority

groups Not applicable Cannot assess

9.1a Unintentional injury deaths Narrowing Toward

9.3d Motor vehicle crash deaths Widening Met

9.4d Fall-related deaths Widening Away

9.5d Drowning deaths Narrowing Toward

9.6f Residential fire deaths Widening Toward

13.1b Dental caries: Children 6-8 years Widening Away

13.1d Dental caries: Adolescents 15 years Widening Toward

13.2b Untreated dental caries: Children 6-8 years Widening Away

13.2f Untreated dental caries: Adolescents 15 years Narrowing Toward

13.4b Complete tooth loss: 65 years and over Eliminate Toward

13.5b Gingivitis: 35-44 years Narrowing Away

14.1b Infant mortality Narrowing Toward

14.1i Postneonatal mortality Narrowing Toward

14.4a Fetal alcohol syndrome Narrowing Away

14.11b Prenatal care in the first trimester Narrowing Toward

15.14c Blood cholesterol checked: Ever, 18 years and over Widening Toward

15.14e Blood cholesterol checked: Past 2 years, 18 years

and over Narrowing Toward

17.2b Limitation in major activity due to chronic conditions Widening Away

17.9b Diabetes-related deaths Widening Away

17.10b End-stage renal disease due to diabetes Widening Away

17.22 22.4 Identify gaps in health data Not applicable Toward

17.22 22.4 Establish mechanisms to meet data needs Not applicable Toward

20.3g Hepatitis B cases Cannot assess Met

20.3j Hepatitis A cases Narrowing Met

20.4d Tuberculosis new cases Narrowing Toward

20.7a Bacterial meningitis cases Narrowing Met

21.2 Receipt of recommended services: Cholesterol ever

checked, adults 18 years and over Narrowing Toward

21.2 Receipt of recommended services: Cholesterol

checked in last 2 years, adults 18 years and over Widening Toward

21.2 Receipt of recommended services: Pap test in last

3 years, women 18 years and over Narrowing Toward

21.2 Receipt of recommended services: Breast exam and

mammogram in past 2 years, women 50 years and

over Narrowing Toward

21.3d Usual source of care: 18 years and over Narrowing Toward

21.4a People without health care coverage: Under 65 years Narrowing Away

344 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

American Indian/Alaska Native—Con.

21.8 Racial/ethnic minority representation in the health

professions: Degrees awarded Not applicable Met

21.8a Racial/ethnic minority representation in the health

professions: Enrolled in schools of nursing No change No change

22.5a Periodic analysis and publication of data for racial

and ethnic group Narrowing

Met

* For method of calculation, see Appendix Technical Notes.

Special population objectives included in Healthy People 2000: American Indian/Alaska Native

Objective status

Disparity Measure

Eliminated

Narrowing

gap

change

Widening

gap

Cannot

assess

Disparity

total

Not a disparity

measure

Overall

total

Met..................... 0 3 0 2 1 6 1 7

Toward .................. 1 16 0 5 0 22 2 24

Mixed/No change .......... 0 0 1 0 0 1 0 1

Away ................... 0 4 0 9 0 13 1 14

Cannot assess ............ 0 0 0 0 2 2 1 3

TOTAL.................. 1 23 1 16 3 44 5 49

Healthy People 2000 Final Review 345

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Asian/Pacific Islander

2.4d Growth retardation: Low-income children 1 year Cannot assess Met

2.4e Growth retardation: Low-income children 2-4 years Cannot assess Met

3.4g 15.12g, 16.6g Cigarette smoking prevalence: Male 18 years and

over Narrowing Toward

8.11 Counties with programs for racial/ethnic minority

groups Not applicable Cannot assess

15.14f Blood cholesterol checked: Past 2 years, 18 years

and over Narrowing Toward

17.22 22.4 Identify gaps in health data Not applicable Toward

17.22 22.4 Establish mechanisms to meet data needs Not applicable Toward

20.3d Hepatitis B cases: Children Cannot assess Toward

20.4a Tuberculosis new cases Widening Toward

21.2 Receipt of recommended services, adults 18 years

and over: Cholesterol checked in last 2 years Narrowing Toward

21.2 Receipt of recommended services, adults 18 years

and over: Tetanus booster in last 2 years Narrowing Toward

21.2 Receipt of recommended services, adults 65 years

and over: Pneumococcal vaccine in lifetime Narrowing Toward

21.2 Receipt of recommended services, adults 65 years

and over: Influenza vaccine in last 12 months Eliminate Met

21.2 Receipt of recommended services, women 18 years

and over: Pap test in last 3 years Narrowing Toward

21.2 Receipt of recommended services, women 50 years

and over: Breast exam and mammogram in past

2 years Narrowing Toward

21.2 Receipt of recommended services, adults 18 years

and over: Asked at least one screening question at

routine checkup Narrowing Toward

21.3e Usual source of care: 18 years and over Narrowing Toward

21.8a Racial/ethnic minority representation in the health

professions: Enrolled in schools of nursing Narrowing Toward

22.5a Periodic analysis and publication of data for racial

and ethnic groups Narrowing

Met

* For method of calculation, see Appendix Technical Notes.

Special population objectives included in Healthy People 2000: Asian/Pacific Islander

Objective status

Disparity Measure

Eliminated

Narrowing

gap

change

Widening

gap

Cannot

assess

Disparity

total

Not a disparity

measure

Overall

total

Met..................... 1 1 0 0 2 4 0 4

Toward .................. 0 10 0 1 1 12 2 14

Mixed/No change .......... 0 0 0 0 0 0 0 0

Away ................... 0 0 0 0 0 0 0 0

Cannot assess ............ 0 0 0 0 0 0 1 1

TOTAL.................. 1 11 0 1 3 16 3 19

346 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Black or African American

1.1a 2.1a, 3.1a, 15.1a Coronary heart disease deaths Widening Toward

1.2b 2.3b, 15.10b, 17.12b Overweight prevalence: Female Narrowing Away

1.4b Vigorous physical activity: 18 years and over Not applicable Away

1.5d Sedentary lifestyle: 18 years and over Widening Away

1.13b 17.3b Difficulty performing self-care activities: 70 years and

over Widening Away

2.2a 16.1a Cancer deaths Narrowing Met

2.4a Growth retardation: Low-income children under

1 year Cannot assess No change

2.10e Anemia prevalence: Low-income pregnant female Not applicable Away

2.11b 14.9b Breastfeeding: During early postpartum period Narrowing Toward

2.11b 14.9b Breastfeeding: At age 6 months Narrowing Toward

2.12c 13.11c Baby bottle tooth decay Narrowing Toward

2.22a 3.18a, 15.2a Stroke deaths Narrowing Toward

2.23a 16.5a Colorectal cancer deaths Widening Toward

2.24e 17.11 Diabetes prevalence Widening Away

3.2b 16.2b Slow the rise in lung cancer deaths: Male Narrowing Met

3.4d 15.12d, 16.6d Cigarette smoking prevalence: 18 years and over Narrowing Toward

3.17a 13.7a, 16.17a Oral cancer deaths: Male 45-74 years Narrowing Met

3.17b 13.7b, 16.17b Oral cancer deaths: Female 45-74 years Narrowing Met

4.2a Cirrhosis deaths: Male Narrowing Toward

4.3a Drug-related deaths Narrowing Away

5.1a Adolescent pregnancy: 15-19 years Narrowing Toward

5.2a Unintended pregnancy: 15-44 years Widening Toward

5.3a Infertility: Married couples with wives 15-44 years Narrowing Toward

5.4a 18.3a,19.9a Adolescents who ever engaged in sexual

intercourse: Male 15 years Widening Toward

5.4b 18.3b,19.9b Adolescents who ever engaged in sexual

intercourse: Male 17 years Widening Toward

5.4c 18.3c, 19.9c Adolescents who ever engaged in sexual

intercourse: Female 15-17 years Eliminate Toward

5.7a Failure of contraceptive method: Female 15-44 years Widening Away

5.12a Contraception use: Female 15-44 years Narrowing Toward

7.1c Homicide: Male 15-34 years Widening Toward

7.1e Homicide: Female 15-34 years Narrowing Met

7.3a Firearm related deaths Narrowing Met

7.9a Physical fighting: Adolescent male 14-17 years Narrowing Met

7.10a Weapon-carrying: Adolescent 14-17 years Narrowing Met

8.1a 17.1a, 21.1a Years of healthy life Narrowing Toward

8.2b Completion of high school: 18-24 years Widening Away

8.11 Counties with programs for racial/ethnic minority

groups Not applicable Cannot assess

9.1b Unintentional injury deaths: Male Narrowing Toward

9.2a Unintentional injury hospitalizations: Male Narrowing Met

9.4c Fall-related deaths: Male 30–69 years Narrowing Met

9.5c Drowning deaths: Male Narrowing Toward

9.6c Residential fire deaths: Male Narrowing Met

9.6d Residential fire deaths: Female Narrowing Met

11.1a Asthma hospitalizations Widening Toward

11.4a Blood lead levels: Inner-city low-income children

6 months to 5 years, Levels exceeding 15 ug/dL Widening Toward

11.4a Blood lead levels: Inner-city low-income children

6 months to 5 years, Levels exceeding 25 ug/dL Widening Toward

13.1c Dental caries: Children 6-8 years Eliminate Toward

13.2c Untreated dental caries: Children 6-8 years Narrowing Toward

Healthy People 2000 Final Review 347

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Black or African American—Con.

13.2g Untreated dental caries: Adolescents 15 years Narrowing Toward

13.8a Protective sealants: Children 8 years Narrowing Toward

13.8b Protective sealants: Adolescents 14 years Widening Toward

13.12a Visited the dentist in the past year: Children 5 years Narrowing Toward

13.14c Regular dental visits: 35 years and over Narrowing Toward

14.1a Infant mortality Widening Toward

14.1e Neonatal mortality Widening Toward

14.1h Postneonatal mortality Widening Toward

14.2a Fetal deaths Widening Toward

14.3a Maternal mortality Widening Away

14.4b Fetal alcohol syndrome Widening Away

14.5a Lowbirth weight Narrowing No change

14.5b Very low birthweight Narrowing Away

14.7a Severe complications of pregnancy Widening Toward

14.11a Prenatal care in the first trimester Narrowing Toward

14.15 Newborn screening: Sickle cell anemia Not applicable Toward

15.3a End-stage renal disease Narrowing Away

15.5b Taking action to control blood pressure: Hypertensive

male 18-34 years Widening Toward

15.14a Blood cholesterol checked: ever, 18 years and over Widening Toward

16.3a Female breast cancer deaths Widening Toward

16.4a Cervical cancer deaths Narrowing Toward

16.11e Breast exam and mammogram within past 2 years:

50 years and over Narrowing Met

17.2c Limitation in major activity due to chronic conditions Widening Away

17.4a People with asthma with activity limitation due to

asthma Narrowing Toward

17.9a Diabetes-related deaths Widening Away

17.10a End-stage renal disease due to diabetes Widening Away

17.10c People with diabetes: Lower extremity amputations Widening Away

17.14c Patient education for people 18 years and over with

diabetes Not applicable Toward

17.16a Early detection of significant hearing impairment in

children Cannot assess Cannot assess

17.22 22.4 Identify gaps in health data Not applicable Toward

17.22 22.4 Establish mechanisms to meet data needs Not applicable Toward

18.1b Acquired immunodeficiency syndrome (AIDS)

incidence: 18 years and over Widening Met

18.4d 19.10d Condom use at last sexual intercourse: Female

15-44 years Narrowing Toward

19.1a Gonorrhea Narrowing Toward

19.3a Primary and secondary syphilis Narrowing Met

19.4a Congenital syphilis: Infants under 1 year Narrowing Met

19.6a Pelvic inflammatory disease hospitalizations:

15-44 years Narrowing Toward

19.8a Repeat gonorrhea infection Widening Toward

20.3h Hepatitis B cases Not applicable Met

20.4b Tuberculosis new cases Narrowing Toward

20.11a Pneumococcal immunizations: Noninstitutionalized

people 65 years and over Narrowing Toward

20.11a Influenza immunizations: Noninstitutionalized people

65 years and over Narrowing Toward

21.2 Receipt of recommended services: Cholesterol ever

checked, adults 18 years and over Narrowing Toward

21.2 Receipt of recommended services: Pneumococcal

vaccine in lifetime, adults 65 years and over Widening Toward

348 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Black or African American—Con.

21.2 Receipt of recommended services: Influenza vaccine

in last 12 months, adults 65 years and over Narrowing Toward

21.3b Usual source of care: 18 years and over Narrowing Toward

21.4c People without health care coverage: Under 65 years Narrowing Toward

21.8 Racial/ethnic minority representation in the health

professions: Degrees awarded Narrowing Toward

21.8a Racial/ethnic minority representation in the health

professions: Enrolled in schools of nursing Narrowing Toward

22.5a Periodic analysis and publication of data for racial

and ethnic groups Narrowing

Met

* For method of calculation, see Appendix Technical Notes.

Special population objectives included in Healthy People 2000: Black or African American

Objective status

Disparity Measure

Eliminated

Narrowing

gap

change

Widening

gap

Cannot

assess

Disparity

total

Not a disparity

measure

Overall

total

Met..................... 0 16 0 1 0 17 1 18

Toward .................. 2 32 0 20 0 54 4 58

Mixed/No change .......... 0 1 0 0 1 2 0 2

Away ................... 0 4 0 11 0 15 2 17

Cannot assess ............ 0 0 0 0 1 1 1 2

TOTAL.................. 2 53 0 32 2 89 7 97

Healthy People 2000 Final Review 349

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Hispanic or Latino

1.2c 2.3c, 15.10c, 17.12c Overweight prevalence: Mexican American female Narrowing Away

1.2h 2.3h, 15.10h, 17.12h Overweight prevalence: Mexican American male Narrowing Away

1.3a 15.11a, 17.13a Light to moderate physical activity, 5 or more times

per week: 18 years and over Narrowing Met

1.4c Vigorous physical activity: 18 years and over Widening Away

1.5e Sedentary lifestyle: 18 years and over Widening Away

1.7a 2.7a Sound weight loss practices: Overweight male

18 years and over Narrowing Away

1.7b 2.7b Sound weight loss practices: Overweight female

18 years and over Narrowing Away

2.4b Growth retardation: Low-income children under

1 year Cannot assess Met

2.4c Growth retardation: Low-income children 1 year Cannot assess Met

2.11c 14.9c Breastfeeding: During early postpartum period Eliminate Toward

2.11c 14.9c Breastfeeding: At age 6 months Narrowing Toward

2.12d 13.11d Baby bottle tooth decay Widening Toward

2.24b 17.11b Diabetes prevalence: Puerto Rican 20-74 years Cannot assess Cannot assess

2.24c 17.11c Diabetes prevalence: Mexican American 20-74 years Narrowing Away

2.24d 17.11d Diabetes prevalence: Cuban American 20-74 years Cannot assess Cannot assess

2.26b 15.4b Controlled high blood pressure: Mexican American

with high blood pressure 18-74 years

Cannot assess Cannot assess

3.4e 15.12e, 16.6e Cigarette smoking prevalence: 18 years and over Not applicable Toward

3.20 4.6 Use in past month: Alcohol, 12-17 years Not applicable Toward

3.20 4.6 Use in past month: Cocaine, 12-17 years Widening No change

3.20 4.6 Use in past month: Cocaine, 18-25 years Widening Away

4.2c Cirrhosis deaths Widening Toward

4.3b Drug-related deaths Eliminate Away

5.1b Adolescent pregnancy: 15-19 years Widening Away

5.2b Unintended pregnancy: 15-44 years Not applicable Toward

5.3b Infertility: Married couples with wives 15-44 years Eliminate Met

5.7b Failure of contraceptive method: Female 15-44 years Widening Toward

7.1d Homicide: Male 15-34 years Narrowing Toward

8.1b 17.1b, 21.1b Years of healthy life Not applicable Met

8.2a Completion of high school: 18-24 years Narrowing Toward

8.11 Counties with programs for racial/ethnic minority

groups

Not applicable Cannot assess

9.1d Unintentional injury deaths: Mexican American male Narrowing Toward

9.3g Motor vehicle crash deaths: Mexican American Widening Met

9.6g Residential fire deaths: Puerto Rican Eliminate Met

13.2d Untreated dental caries: Children 6-8 years Widening Away

13.2h Untreated dental caries: Adolescents 15 years Narrowing Toward

13.5c Gingivitis: Mexican American 35-44 years Narrowing Toward

13.5c Gingivitis: Cuban 35-44 years Cannot assess Cannot assess

13.5c Gingivitis: Puerto Rican 35-44 years Cannot assess Cannot assess

13.8c Protective sealants: Children 8 years Widening Away

13.8d Protective sealants: Adolescents 14 years Widening Toward

13.12b Visited the dentist in the past year: Children 5 years Narrowing Toward

13.14d Regular dental visits: Mexican American 35 years

and over

Narrowing Toward

13.14e Regular dental visits: Puerto Rican 35 years and

over

Widening Toward

14.1c Infant mortality: Puerto Rican Narrowing Met

14.1f Neonatal mortality: Puerto Rican Narrowing Met

14.1j Postneonatal mortality: Puerto Rican Narrowing Met

14.5c Low birthweight: Puerto Rican Narrowing Away

350 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Hispanic or Latino—Con.

14.5d Very low birthweight: Puerto Rican Widening Away

14.11c Prenatal care in the first trimester Narrowing Toward

15.13a Know blood pressure values: Mexican American

male 18 years and over Widening Away

15.14b Blood cholesterol checked: ever, Mexican American

18 years and over Widening Toward

15.14d Blood cholesterol checked: Past 2 years: Mexican

American 18 years and over Narrowing Toward

16.4b Cervical cancer deaths Narrowing Toward

16.11a Breast exam and mammogram within past 2 years:

50 years and over Narrowing Met

16.12a Pap test ever: 18 years and over Narrowing Toward

16.12a Pap test within past 3 years: 18 years and over Narrowing Toward

17.2d Limitation in major activity due to chronic conditions:

Puerto Rican Widening Away

17.4b People with asthma with activity limitation due to

asthma: Puerto Rican Cannot assess Cannot assess

17.9c Diabetes-related deaths: Mexican American Widening Away

17.9d Diabetes-related deaths: Puerto Rican Widening Away

17.14d Patient education for people 18 years and over with

diabetes Widening Toward

17.22 22.4 Identify gaps in health data Not applicable Toward

17.22 22.4 Establish mechanisms to meet data needs Not applicable Toward

18.1c AIDS incidence: 18 years and over Narrowing Met

19.4b Congenital syphilis Narrowing Met

20.11b Influenza immunizations: Noninstitutionalized people

65 years and over Widening Toward

20.11b Pneumococcal immunizations: Noninstitutionalized

people 65 years and over Widening Toward

20.3i Hepatitis A cases Widening Toward

20.3k Hepatitis C cases Not applicable Met

20.4c Tuberculosis new cases Narrowing Toward

21.2 Receipt of recommended services: Cholesterol ever

checked, adults 18 years and over Widening Toward

21.2 Receipt of recommended services: Cholesterol

checked in last 2 years, adults 18 years Widening Toward

21.2 Receipt of recommended services: Tetanus booster

in last 10 years Widening Toward

21.2 Receipt of recommended services: Pneumococcal

vaccine in lifetime, adults 65 years and over Widening Toward

21.2 Receipt of recommended services: Influenza vaccine

in last 12 months, adults 65 years and over Widening Toward

21.3a Usual source of care: Mexican American 18 years

and over Narrowing Toward

21.3a Usual source of care: 18 years and over Narrowing Toward

21.4b People without health care coverage: Under 65 years Narrowing Away

21.4b People without health care coverage: Mexican

American under 65 years Narrowing Away

21.4b People without health care coverage: Puerto Rican

under 65 years Narrowing Toward

21.4b People without health care coverage: Cuban under

65 years Narrowing Away

21.8 Racial/ethnic minority representation in the health

professions: Degrees awarded Narrowing Toward

21.8a Racial/ethnic minority representation in the health

professions: Enrolled in schools of nursing Narrowing Toward

Healthy People 2000 Final Review 351

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

American Indian/Alaska Native—Con.

21.8 Racial/ethnic minority representation in the health

professions: Degrees awarded Not applicable Met

21.8a Racial/ethnic minority representation in the health

professions: Enrolled in schools of nursing No change No change

22.5a Periodic analysis and publication of data for racial

and ethnic group Narrowing

Met

* For method of calculation, see Appendix Technical Notes.

Special population objectives included in Healthy People 2000: American Indian/Alaska Native

Objective status

Disparity Measure

Eliminated

Narrowing

gap

change

Widening

gap

Cannot

assess

Disparity

total

Not a disparity

measure

Overall

total

Met..................... 0 3 0 2 1 6 1 7

Toward .................. 1 16 0 5 0 22 2 24

Mixed/No change .......... 0 0 1 0 0 1 0 1

Away ................... 0 4 0 9 0 13 1 14

Cannot assess ............ 0 0 0 0 2 2 1 3

TOTAL.................. 1 23 1 16 3 44 5 49

Healthy People 2000 Final Review 345

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Women

1.2 2.3, 15.10, 17.12 Overweight prevalence Widening Away

1.2a 2.3a, 15.10a, 17.12a Overweight prevalence: Low-income 20–74 years Narrowing Away

1.2b 2.3b, 15.10b, 17.12b Overweight prevalence: Black Narrowing Away

1.2c 2.3c, 15.10c, 17.12c Overweight prevalence: Mexican American Narrowing Away

1.2f 2.3f, 15.10f, 17.12f Overweight prevalence: Females with high blood

pressure 20–74 years Cannot assess Cannot assess

1.7 2.7 Sound weight loss practices: Overweight, 18 years

and over Not applicable Away

1.7b 2.7b Sound weight loss practices: Overweight, Hispanic

18 years and over Not applicable Away

2.8 Consumption of foods rich in calcium: Pregnant and

lactating Not applicable Away

2.8a Consumption of foods rich in calcium: Meeting

average daily goal, 11–24 years Widening Away

2.10 Iron deficiency prevalence Not applicable Away

2.10 Iron deficiency prevalence: 20–44 years Not applicable Away

2.10c Iron deficiency prevalence: Low-income 20–44 years Not applicable Away

2.10e Anemia prevalence: Black, low-income, pregnant Not applicable Away

2.11 14.9 Breastfeeding: During early postpartum period Not applicable Toward

2.11a 14.9a Breastfeeding: During early postpartum period,

low-income Not applicable Toward

2.11b 14.b Breastfeeding: During early postpartum period, Black Not applicable Toward

2.11c 14.9c Breastfeeding: During early postpartum period,

Hispanic Not applicable Toward

2.11d 14.9d Breastfeeding: During early postpartum period,

American Indian/Alaska Native Not applicable Toward

2.11 14.9 Breastfeeding: At age 6 months Not applicable Toward

2.11a 14.9a Breastfeeding: At age 6 months, low-income Not applicable Toward

2.11b 14.9b Breastfeeding: At age 6 months, Black Not applicable Toward

2.11c 14.9c Breastfeeding: At age 6 months, Hispanic Not applicable Toward

2.11d 14.9d Breastfeeding: At age 6 months, American

Indian/Alaska Native Not applicable Away

2.25 15.7 High blood cholesterol prevalence: 20-74 years Narrowing Met

2.26c 15.4c Controlled high blood pressure: 70 years and over Cannot assess Cannot assess

2.27 15.6 Mean serum cholesterol level: 20-74 years Narrowing Toward

3.2a 16.2a Slow the rise in lung cancer deaths Widening Met

3.4 15.12, 16.6 Cigarette smoking prevalence: 18 years and over Not applicable Toward

3.4h 15.12h, 16.6h Cigarette smoking prevalence: 18-44 years Not applicable Toward

3.4i 15.12i, 16.6i Cigarette smoking prevalence: Pregnant Not applicable Toward

3.4j 15.12j, 16.6j Cigarette smoking prevalence: Use oral

contraceptives Eliminate Toward

3.7 Smoking cessation during pregnancy Not applicable Away

3.7a Smoking cessation during pregnancy: Less than a

high school education Not applicable Cannot assess

3.17 13.7, 16.17 Oral cancer deaths: 45-74 years Not applicable Met

3.17b 13.7b, 16.17b Oral cancer deaths: Black: 45-74 years Not applicable Met

5.1 Adolescent pregnancy: 15-17 years Not applicable Toward

5.1a Adolescent pregnancy: Black 15-19 years Not applicable Toward

5.1b Adolescent pregnancy: Hispanic 15-19 years Not applicable Away

5.2 Unintended pregnancy: 15-44 years Not applicable Toward

5.2a Unintended pregnancy: Black 15-44 years Not applicable Toward

5.2b Unintended pregnancy: Hispanic 15-44 years Not applicable Toward

5.3 Infertility: Married couples with wives 15-44 years Not applicable Toward

5.3a Infertility: Married couples with wives 15-44 years,

Black Not applicable

Toward

Healthy People 2000 Final Review 353

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Women—Con

5.3b Infertility: Married couples with wives 15–44 years,

Hispanic Not applicable Met

5.4 18.3, 19.9 Adolescents who ever engaged in sexual

intercourse: 15 years Not applicable Toward

5.4 18.3, 19.9 Adolescents who ever engaged in sexual

intercourse: 17 years Not applicable Away

5.4c 18.3c, 19.9c Adolescents who ever engaged in sexual

intercourse: Black 15-17 years Not applicable Toward

5.5 18.15, 19.16 Adolescent abstinence from sexual intercourse for

previous 3 months: Sexually active 15-17 years Not applicable Toward

5.6 Contraception use: First intercourse,15-19 years Not applicable Toward

5.6 Contraception use: Recent intercourse,15-19 years Not applicable Away

5.6 Contraception use: Oral contraceptive and the

condom at most recent intercourse, 15-19 years Not applicable Toward

5.7 Failure of contraceptive method: 15-44 years Not applicable Toward

5.7a Failure of contraceptive method: Black 15-44 years Not applicable Away

5.7b Failure of contraceptive method: Hispanic

15-44 years Not applicable Toward

5.8 Persons 13-18 years who have discussed sexuality

with parents Not applicable Toward

5.9 Family planning counseling Not applicable Cannot assess

5.10 14.12 Age-appropriate preconception counseling by

clinicians: Inquiry about family planning, nurse

practitioners Not applicable Away

5.10 14.12 Age-appropriate preconception counseling by

clinicians: Counseling about family planning, nurse

practitioners Not applicable Away

5.10 14.12 Age-appropriate preconception counseling by

clinicians: Counseling about family planning,

obstetricians/gynecologists Not applicable Met

5.11 18.13, 19.11 Clinic services for human immunodeficiency virus

(HIV) and other sexually transmitted diseases

(STDs): HIV client pretest counseling Not applicable Toward

5.11 18.13, 19.11 Clinic services for HIV and other STDs: HIV client

testing Not applicable Toward

5.12 Contraception use: 15-44 years Not applicable Toward

5.12a Contraception use: Black 15-44 years Not applicable Toward

5.12b Contraception use: 15-44 years, under 100%

poverty Not applicable Toward

5.12c Contraception use: 15-19 years, under 200%

poverty Not applicable Toward

6.2a 7.8a Suicide attempts: 14–17 years Widening Away

6.15a Prevalence of depression: 18–54 years (1-year

prevalence) Not applicable Toward

7.1e Homicide: Black 15–34 years Narrowing Met

7.5 Partner abuse Not applicable Toward

7.7 Rape and attempted rape: 12 years and over Not applicable Toward

7.7a Rape and attempted rape: 12–34 years Not applicable Toward

7.7 Sexual assaults: 12 years and over Not applicable Toward

7.12 Emergency room protocols for victims of violence Not applicable Cannot assess

7.15 Battered women turned away from shelters Not applicable Away

9.6d Residential fire deaths: Black Narrowing Met

9.7a Hip fractures: White 85 years and over Narrowing Toward

11.1c Asthma hospitalizations: 25 years and over Widening Toward

14.1 Infant mortality Not applicable Toward

14.1a Infant mortality: Black Not applicable Toward

14.1b Infant mortality: American Indian/Alaska Native Not applicable Toward

354 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Women—Con.

14.1c Infant mortality: Puerto Rican Not applicable Met

14.1d Neonatal mortality Not applicable Toward

14.1e Neonatal mortality: Black Not applicable Toward

14.1f Neonatal mortality: Puerto Rican Not applicable Met

14.1g Postneonatal mortality Not applicable Met

14.1h Postneonatal mortality: Black Not applicable Toward

14.1i Postneonatal mortality: American Indian/Alaska

Native Not applicable Toward

14.1j Postneonatal mortality: Puerto Rican Not applicable Met

14.2 Fetal deaths Not applicable Toward

14.2a Fetal deaths: Black Not applicable Toward

14.3 Maternal mortality Not applicable Away

14.3a Maternal mortality: Black Not applicable Away

14.4 Fetal alcohol syndrome Not applicable Away

14.4a Fetal alcohol syndrome: American Indian/Alaska

Native Not applicable Away

14.4b Fetal alcohol syndrome: Black Not applicable Away

14.5 Low birthweight Not applicable Away

14.5 Very low birthweight Not applicable Away

14.5a Low birthweight: Black Not applicable No change

14.5b Very low birthweight: Black Not applicable Away

14.5c Low birthweight: Puerto Rican Not applicable Away

14.5d Very low birthweight: Puerto Rican Not applicable Away

14.6 Recommended weight gain during pregnancy Not applicable Toward

14.7 Severe complications of pregnancy Not applicable Met

14.7a Severe complications of pregnancy: Black Not applicable Toward

14.8 Cesarean delivery Not applicable Toward

14.8a Cesarean delivery: Primary Not applicable Toward

14.8b Cesarean delivery: Repeat Not applicable Toward

14.10 Abstinence during pregnancy: Tobacco Not applicable Toward

14.10 Abstinence during pregnancy: Alcohol Not applicable Toward

14.10 Abstinence during pregnancy: Cocaine Not applicable No change

14.10 Abstinence during pregnancy: Marijuana Not applicable Away

14.11 Prenatal care in the first trimester Not applicable Toward

14.11a Prenatal care in the first trimester: Black Not applicable Toward

14.11b Prenatal care in the first trimester: American

Indian/Alaska Native Not applicable Toward

14.11c Prenatal care in the first trimester: Hispanic Not applicable Toward

14.13 Screening for fetal abnormalities Not applicable Toward

14.14 Pregnant women and infants receiving

risk-appropriate care Not applicable Cannot assess

14.15 Newborn screening: Sickle cell anemia Not applicable Toward

14.15 Newborn screening: Sickle cell anemia, black Not applicable Toward

14.15 Newborn screening: Galactosemia Not applicable Met

14.15 Newborns diagnosed positive for sickle cell anemia

receiving treatment Not applicable Met

14.15 Newborns diagnosed positive for galactosemia

receiving treatment Not applicable Met

14.16 Babies receiving primary care Not applicable Cannot assess

14.17 Spina bifida and other neural tube defects Not applicable No change

15.4 18.3, 19.9 Controlled high blood pressure: 18–74 years Not applicable Toward

16.3 Female breast cancer deaths Not applicable Met

16.3a Female breast cancer deaths: Black Not applicable Toward

16.4 Cervical cancer deaths Not applicable Toward

16.4a Cervical cancer deaths: Black Not applicable Toward

Healthy People 2000 Final Review 355

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Women—Con.

16.4b Cervical cancer deaths: Hispanic Not applicable Toward

16.11 Breast exam and mammogram within past 2 years:

50 years and over Not applicable Met

16.11a Breast exam and mammogram within past 2 years:

Hispanic 50 years and over Not applicable Met

16.11b Breast exam and mammogram within past 2 years:

Annual family income less than $10,000, 50 years

and over Not applicable Toward

16.11c Breast exam and mammogram within past 2 years:

Less than high school education, 50 years and over Not applicable Toward

16.11d Breast exam and mammogram within past 2 years:

70 years and over Not applicable Toward

16.11e Breast exam and mammogram within past 2 years:

Black 50 years and over Not applicable Met

16.12 Pap test ever: 18 years and over Not applicable Toward

16.12a Pap test ever: Hispanic 18 years and over Not applicable Toward

16.12b Pap test ever: 70 years and over Not applicable Toward

16.12c Pap test ever: Less than high school education,

18 years and over Not applicable Toward

16.12d Pap test ever: Annual family income less than

$10,000, 18 years and over Not applicable Toward

16.12 Pap test within past 3 years: 18 years and over Not applicable Toward

16.12a Pap test within past 3 years: Hispanic 18 years and

over Not applicable Toward

16.12b Pap test within past 3 years: 70 years and over Not applicable Toward

16.12c Pap test within past 3 years: Less than high school

education, 18 years and over Not applicable Toward

16.12d Pap test within past 3 years: Annual family income

less than $10,000, 18 years and over Not applicable Toward

16.15 Pap test quality: Monitoring cytology laboratory Not applicable Met

16.16 FDA-certified mammography facilities Not applicable Toward

17.18 Counseled about estrogen replacement therapy:

40-60 years Not applicable Toward

17.18 Counseled about estrogen replacement therapy:

40-49 years Not applicable Toward

17.18 Counseled about estrogen replacement therapy:

50-60 years Not applicable Met

18.1d AIDS incidence: 18 years and over Widening Met

18.2c HIV prevalence: females 15-44 years, giving birth to

live-born infants No change No change

18.4 19.10 Condom use at last sexual intercourse: 15-44 years Not applicable Toward

18.4a 19.10a Condom use at last sexual intercourse: 15-19 years Not applicable Toward

18.4d 19.10d Condom use at last sexual intercourse: Black

15-44 years Not applicable Toward

19.1c Gonorrhea: 15-44 years Widening Toward

19.2 Chlamydia prevalence: 15-19 years Not applicable Toward

19.2 Chlamydia prevalence: 20-24 years Not applicable Met

19.6 Pelvic inflammatory disease hospitalizations:

15-44 years Not applicable Toward

19.6a Pelvic inflammatory disease hospitalizations: Black

15-44 years Not applicable Toward

19.6b Pelvic inflammatory disease hospitalizations:

15-19 years Not applicable Toward

19.6 Pelvic inflammatory disease initial visits to physicians Not applicable Met

21.2 Receipt of recommended services: Pap test in last

3 years, 18 years and over Not applicable Toward

356 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Women—Con.

21.2 Receipt of recommended services: Pap test in last

3 years, 65 years and over Not applicable Toward

21.2 Receipt of recommended services: Pap test in last

3 years, Asian/Pacific Islander 18 years and over Not applicable Toward

21.2 Receipt of recommended services: Pap test in last

3 years, American Indian/Alaska Native 18 years

and over Not applicable Toward

21.2 Receipt of recommended services: Pap test in last

3 years, females with disabilities 18 years and over Not applicable Toward

21.2 Receipt of recommended services: Breast exam and

mammogram in past 2 years, 50 years and over Not applicable Met

21.2 Receipt of recommended services: Breast exam and

mammogram in past 2 years, 65 years and over Not applicable Toward

21.2 Receipt of recommended services: Breast exam and

mammogram in past 2 years, females with low

income 50 years and over Not applicable Toward

21.2 Receipt of recommended services: Breast exam and

mammogram in past 2 years, Asian/Pacific

Islander 50 years and over Not applicable Toward

21.2 Receipt of recommended services: Breast exam and

mammogram in past 2 years, American

Indian/Alaska Native 50 years and over Not applicable Toward

21.2 Receipt of recommended services: Breast exam and

mammogram in past 2 years, females with

disabilities 50 years and over Not applicable Toward

21.6 Provision of recommended services: Breast exam,

nurse practitioners Not applicable Away

21.6 Provision of recommended services: Breast exam,

obstetricians/gynecologists Not applicable Cannot assess

21.6 Provision of recommended services: Breast exam,

internists Not applicable Cannot assess

21.6 Provision of recommended services: Breast exam,

family physicians Not applicable Cannot assess

21.6 Provision of recommended services: Pap smear,

nurse practitioners Not applicable Away

21.6 Provision of recommended services: Pap smear,

obstetricians/gynecologists Not applicable Cannot assess

21.6 Provision of recommended services: Pap smear,

internists Not applicable Cannot assess

21.6 Provision of recommended services: Pap smear,

family physicians Not applicable Cannot assess

21.6 Provision of recommended services: Mammogram,

nurse practitioners Not applicable Cannot assess

21.6 Provision of recommended services: Mammogram,

nurse practitioners, patients 40–49 years Not applicable Cannot assess

21.6 Provision of recommended services: Mammogram,

nurse practitioners, patients 50 years and over Not applicable Cannot assess

21.6 Provision of recommended services: Mammogram,

obstetricians/gynecologists Not applicable Cannot assess

21.6 Provision of recommended services: Mammogram,

internists Not applicable Cannot assess

21.6 Provision of recommended services: Mammogram,

family physicians Not applicable

Cannot assess

* For method of calculation, see Appendix Technical Notes.

Healthy People 2000 Final Review 357

Special population objectives included in Healthy People 2000: Women

Objective status

Disparity Measure

Eliminated

Narrowing

gap

change

Widening

gap

Cannot

assess

Disparity

total

Not a disparity

measure

Overall

total

Met..................... 0 3 0 2 0 5 21 26

Toward .................. 1 2 0 2 0 5 98 103

Mixed/No change .......... 0 0 1 0 0 1 3 4

Away ................... 0 3 0 3 0 6 29 35

Cannot assess ............ 0 0 0 0 2 2 17 19

TOTAL.................. 1 8 1 7 2 19 168 187

358 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

People with low socioeconomic status

1.2a, 2.3a, 15.10a Overweight prevalence: Female 20–74 years Narrowing Away

1.4a Vigorous physical activity: 18 years and over Narrowing Toward

1.5c Sedentary lifestyle: 18 years and over Narrowing Toward

2.4 Growth retardation: Children 5 years and under Not applicable Met

2.4a Growth retardation: Black children under 1 year Not applicable No change

2.4b Growth retardation: Hispanic children under 1 year Not applicable Met

2.4c Growth retardation: Hispanic children 1 year Not applicable Met

2.4d Growth retardation: Asian/Pacific Islander children

1 year Not applicable Met

2.4e Growth retardation: Asian/Pacific Islander children

2-4 years Not applicable Met

2.10a Iron deficiency prevalence: Children 1-2 years Cannot assess Toward

2.10b Iron deficiency prevalence: Children 3-4 years Cannot assess Toward

2.10c Iron deficiency prevalence: Female 20-44 years Narrowing Away

2.10e Anemia prevalence: Black pregnant female Not applicable Away

2.11a 14.9a Breastfeeding: During early postpartum period Narrowing Toward

2.11a 14.9a Breastfeeding: At age 6 months Narrowing Toward

2.12a 13.11a Baby bottle tooth decay: Less than high school

education Widening Toward

3.4a 15.12a Cigarette smoking prevalence: People with high

school education or less, 18 years and over Widening Toward

3.4b 15.12b Cigarette smoking prevalence: Blue-collar workers

18 years and over Widening Toward

3.5a Smoking initiation: Ages 20-24 years with high

school education or less Cannot assess Away

3.7a Smoking cessation during pregnancy: Less than high

school education Cannot assess Cannot assess

4.12 States with access to treatment programs,

underserved Not applicable Met

5.12b Contraception use: Female 15-44 years under 100%

of poverty Narrowing Toward

5.12c Contraception use: Female 15-19 years under 200%

of poverty Narrowing Toward

8.2 Completion of high school: 18-24 years Not applicable Away

8.2a Completion of high school: Hispanic 18-24 years Not applicable Toward

8.2b Completion of high school: Black 18-24 years Not applicable Away

8.3 Eligible children 4 years afforded opportunity to enroll

in Head Start Not applicable Toward

8.3 Low-income children receiving 1 year of Head Start

services prior to entering kindergarten or first grade Not applicable Away

8.7 Hourly workers participating in health promotion

activities: 18 years and over Not applicable Met

11.4a Blood lead levels: Inner-city low-income black

children 6 months-5 years, levels exceeding

15ug/dL Widening Toward

11.4a Blood lead levels: Inner-city low-income black

children 6 months-5 years, levels exceeding

25ug/dL Widening Toward

13.1a Dental caries: Parents who have less than a high

school education, children 6-8 years Narrowing Toward

13.2a Untreated dental caries: Parents who have less than

a high school education, children 6-8 years Narrowing Away

13.2e Untreated dental caries: Parents who have less than

high school education, adolescents 15 years Narrowing Toward

13.4a Complete tooth loss: Annual family income less than

$15,000, 65 years and over Widening Toward

Healthy People 2000 Final Review 359

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

People with low socioeconomic status—Con.

13.5a Gingivitis: Annual family income less than $12,500,

35-44 years Widening Away

16.11b Breast exam and mammogram within past 2 years:

Annual family income less than $10,000, 50 years

and over Narrowing Toward

16.11c Breast exam and mammogram within past 2 years:

Less than high school education, 50 years and over Narrowing Toward

16.12c Pap test ever: Less than high school education,

18 years and over Narrowing Toward

16.12d Pap test ever: Annual family income less than

$10,000, 18 years and over Narrowing Toward

16.12c Pap test within past 3 years: Less than high school

education,18 years and over Narrowing Toward

16.12d Pap test within past 3 years: Annual family income

less than $10,000, 18 years and over Narrowing Toward

17.2a Limitation in major activity due to chronic conditions:

Annual family income less than $10,000, 18 years

and over Widening Away

17.2a Limitation in major activity due to chronic conditions:

Below poverty level Widening Away

17.22 22.4 Identify gaps in health data Not applicable Toward

17.22 22.4 Establish mechanisms to meet data needs Not applicable Toward

20.15 Employment-based conventional insurance plans for

immunizations Not applicable Toward

20.15 Employment-based preferred provider organization

plans for immunizations Not applicable Toward

20.15 Employment-based health maintenance organization

plans for immunizations Not applicable Away

21.2 Receipt of recommended services, adults 65 years

and over: Pneumococcal vaccine in lifetime Widening Toward

21.2 Receipt of recommended services, adults 18 years

and over: Cholesterol ever checked Narrowing Toward

21.2 Receipt of recommended services, women 50 years

and over: Breast exam and mammogram in past

2 years Narrowing Toward

21.2 Receipt of recommended services, adults 65 years

and over: Influenza vaccine in 12 months No change Toward

21.2 Receipt of recommended services, adults 18 years

and over: Cholesterol checked in last 2 years Narrowing Toward

21.3c Usual source of care, 18 years and over: Family

income below poverty line Narrowing Toward

21.4 People without health care coverage: Under 65 years Not applicable Away

21.4a People without health care coverage: American

Indian/Alaska Native, under 65 years Not applicable Away

21.4b People without health care coverage: Hispanic, under

65 years Not applicable Away

21.4b People without health care coverage: Mexican

American, under 65 years Not applicable Away

21.4b People without health care coverage: Puerto Rican,

under 65 years Not applicable Toward

21.4b People without health care coverage: Cuban, under

65 years Not applicable Away

21.4c People without health care coverage: Black, under

65 years Not applicable Toward

21.5 Clinical preventive services from Federal programs:

Immunizations Not applicable

Cannot assess

360 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

People with low socioeconomic status—Con.

21.5 Clinical preventive services from Federal programs:

Counseling Not applicable Cannot assess

21.5 Clinical preventive services from Federal programs:

Screening Not applicable

Cannot assess

* For method of calculation, see Appendix Technical Notes.

Special population objectives included in Healthy People 2000: People with low socioeconomic

status

Objective status

Disparity Measure

Eliminated

Narrowing

gap

change

Widening

gap

Cannot

assess

Disparity

total

Not a disparity

measure

Overall

total

Met..................... 0 0 0 0 0 0 7 7

Toward .................. 0 18 1 7 2 28 8 36

Mixed/No change .......... 0 0 0 0 0 0 1 1

Away ................... 0 3 0 3 1 7 10 17

Cannot assess ............ 0 0 0 0 1 1 3 4

TOTAL.................. 0 21 1 10 4 36 29 65

Healthy People 2000 Final Review 361

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

People with disabilities

1.2e 2.3e, 15.10e, 17.12e Overweight prevalence: 20 years and over Narrowing Away

1.5b Sedentary lifestyle: 18 years and over Narrowing Toward

1.13 17.3 Difficulty performing self-care activities: 70 years and

over Not applicable Away

1.13a 17.3a Difficulty performing self-care activities: 85 years and

over Not applicable Away

1.13b 17.3b Difficulty performing self-care activities: Black 70

years and over Not applicable Away

6.5a Adverse health effects from stress: 18 years and

over Widening Toward

6.6 Use of community support among people 18 years

and over with severe mental disorders Not applicable Met

6.7 Treatment for depression: 18–54 years Not applicable Away

6.8a People 18 and over seeking help with

emotional/personal problems Not applicable Toward

6.15 Prevalence of depression: 18–54 years Not applicable Away

6.15a Prevalence of depression: Female 18–54 years Not applicable Toward

8.1 17.1, 21.1 Years of healthy life Not applicable Met

8.1a 17.1a, 21.1a Years of healthy life: Black Not applicable Toward

8.1b 17.1b, 21.1b Years of healthy life: Hispanic Not applicable Met

8.1c 17.1c, 21.1c Years of healthy life: 65 years and over Not applicable Toward

8.3 Preschool child development programs: Children 3–5

years enrolled in preschool Not applicable Toward

9.9 Nonfatal head injuries Not applicable Met

9.10 Nonfatal spinal cord injuries Not applicable Met

9.10a Nonfatal spinal cord injuries: Male Not applicable Toward

9.11 Incidence of secondary conditions associated with

traumatic spinal cord injuries Not applicable Cannot assess

9.22 States with linked emergency medical services and

trauma systems Not applicable Met

11.2 17.8 Serious mental retardation: Children 10 years with IQ

less than 50 Not applicable Away

14.4 Fetal alcohol syndrome Not applicable Away

14.4a Fetal alcohol syndrome: American Indian/Alaska

Native Not applicable Away

14.4b Fetal alcohol syndrome: Black Not applicable Away

14.15 Newborn screening: Sickle cell anemia Not applicable Toward

14.15 Newborn screening: Sickle cell anemia, black Not applicable Toward

14.15 Newborn screening: Galactosemia Not applicable Met

14.15 Newborns diagnosed positive for galactosemia

receiving treatment Not applicable Met

14.15 Newborns diagnosed positive for sickle cell anemia

receiving treatment Not applicable Met

14.17 Spina bifida and other neural tube defects Not applicable No change

17.2 Limitation in major activity due to chronic conditions Not applicable Away

17.2a Limitation in major activity due to chronic conditions:

Annual family income less than $10,000 Not applicable Away

17.2a Limitation in major activity due to chronic conditions:

Below poverty level Not applicable Away

17.2b Limitation in major activity due to chronic conditions:

American Indian/Alaska Native Not applicable Away

17.2c Limitation in major activity due to chronic conditions:

Black Not applicable Away

17.2d Limitation in major activity due to chronic conditions:

Puerto Rican Not applicable

Away

362 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

People with disabilities—Con.

17.4 People with asthma with activity limitation due to

asthma Not applicable Away

17.4a People with asthma with activity limitation due to

asthma: Black Not applicable Toward

17.4b People with asthma with activity limitation due to

asthma: Puerto Ricans Not applicable Cannot assess

17.5 Activity limitation due to chronic back conditions Not applicable Away

17.6 Significant hearing impairment Not applicable Toward

17.6a Significant hearing impairment: People 45 years and

over Not applicable Toward

17.7 Significant visual impairment Not applicable Toward

17.7a Significant visual impairment: People 65 years and

over Not applicable Toward

17.10 Diabetes-related complications: End-stage renal

disease Not applicable Away

17.10 People with diabetes: Blindness Not applicable No change

17.10 People with diabetes: Lower extremity amputation Not applicable Toward

17.10a End-stage renal disease due to diabetes: Black with

diabetes Not applicable Away

17.10b End-stage renal disease due to diabetes: American

Indian/Alaska Native with diabetes Not applicable Away

17.10c Lower extremity amputations due to diabetes: Black Not applicable Away

17.14a Patient education for people 18 years and over with

diabetes Not applicable Toward

17.14b Patient education for people 18 years and over with

asthma Not applicable Away

17.14c Patient education for people 18 years and over with

diabetes: Black Not applicable Toward

17.14d Patient education for people 18 years and over with

diabetes: Hispanic Not applicable Toward

17.15 Clinician assessment of childhood development,

nurse practitioners Not applicable Away

17.16 Early detection of significant hearing impairment in

children Not applicable Away

17.16a Early detection of significant hearing impairment in

children: Black Not applicable Cannot assess

17.17 Clinician assessment in adults 65 years and over:

Visual acuity testing, nurse practitioners Not applicable Away

17.17 Clinician assessment in adults 65 years and over:

Prescription of mobility aids/modification, nurse

practitioners Not applicable Toward

17.19 Worksites with policies for hiring people with

disabilities Not applicable Met

17.20 Service systems for children with or at risk of chronic

and disabling conditions Not applicable Cannot assess

17.22 22.4 Identify gaps in health data Not applicable Toward

17.22 22.4 Establish mechanisms to meet data needs Not applicable Toward

17.23 People with diabetes who had a dilated eye exam in

the past year Not applicable Toward

20.11 Basic immunization series among children: Children

2 years and under Not applicable Cannot assess

20.11 Basic immunization series among children

19–35 months: Diphtheria-tetanus-pertussis Not applicable Met

20.11 Basic immunization series among children

19–35 months: Polio Not applicable Met

20.11 Basic immunization series among children

19–35 months: Measles-containing Not applicable Met

Healthy People 2000 Final Review 363

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

People with disabilities—Con.

20.11 Basic immunization series among children

19–35 months: Haemophilus influenza type b Not applicable Met

20.11 Basic immunization series among children

19–35 months: Hepatitis B Not applicable Toward

20.11 Basic immunization series among children

19–35 months: 4DTP/3Polio/1MMR Not applicable Toward

20.11 Basic immunization series among children: Children

in licensed child care facilities Not applicable Met

20.11 Basic immunization series among children: Children

in kindergarten through postsecondary education

institutions Not applicable Met

20.11 Hepatitis B immunizations: Infants of antigen-positive

mothers Not applicable Toward

20.11 Hepatitis B immunizations: Occupationally exposed

workers Not applicable Toward

20.11 Hepatitis B immunizations: Injecting drug users in

drug treatment programs Not applicable Cannot assess

20.11 Hepatitis B immunizations: Men who have sex with

men Not applicable Toward

20.11 Pneumococcal immunizations: Institutionalized

chronically ill people or older people Not applicable Toward

20.11 Pneumococcal immunizations: Noninstitutionalized

people 65 years and over Not applicable Toward

20.11a Pneumococcal immunizations, noninstitutionalized

people 65 years and over: Black Not applicable Toward

20.11b Pneumococcal immunizations, noninstitutionalized

people 65 years and over: Hispanic Not applicable Toward

20.11 Influenza immunizations: Institutionalized chronically

ill people or older people Not applicable Toward

20.11 Influenza immunizations: Noninstitutionalized people

65 years and over Not applicable Met

20.11a Influenza immunizations, noninstitutionalized people

65 years and over: Black Not applicable Toward

20.11b Influenza immunizations, noninstitutionalized people

65 years and over: Hispanic Not applicable Toward

21.2 Receipt of recommended services: Tetanus booster

in last 10 years, 18 years and over Narrowing Toward

21.2 Receipt of recommended services: Pap test in last

3 years, women 18 years and over Widening Toward

21.2 Receipt of recommended services: Breast exam and

mammogram in past 2 years, women 50 years and

over Widening

Toward

* For method of calculation, see Appendix Technical Notes.

Special population objectives included in Healthy People 2000: People with disabilities

Objective status

Disparity Measure

Eliminated

Narrowing

gap

change

Widening

gap

Cannot

assess

Disparity

total

Not a disparity

measure

Overall

total

Met..................... 0 0 0 0 0 0 17 17

Toward .................. 0 2 0 3 0 5 33 38

Mixed/No change .......... 0 0 0 0 0 0 2 2

Away ................... 0 1 0 0 0 1 25 26

Cannot assess ............ 0 0 0 0 0 0 6 6

TOTAL.................. 0 3 0 3 0 6 83 89

364 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Older adults

1.1 2.1, 3.1, 15.1 Coronary heart disease deaths Not applicable Met

1.1a 2.1a, 3.1a, 15.1a Coronary heart disease deaths: Black Not applicable Toward

1.2 2.3, 15.10, 17.12 Overweight prevalence Not applicable Away

1.2 2.3, 15.10, 17.12 Overweight prevalence: Male Not applicable Away

1.2 2.3, 15.10, 17.12 Overweight prevalence: Female Not applicable Away

1.2a 2.3a, 15.10a, 17.12a Overweight prevalence: Low-income female

20–74 years Not applicable Away

1.2b 2.3b, 15.10b, 17.12b Overweight prevalence: Black female Not applicable Away

1.2c 2.3c, 15.10c, 17.12c Overweight prevalence: Mexican American female Not applicable Away

1.2d 2.3d, 15.10d, 17.12d Overweight prevalence: American Indian/Alaska

Native 20 years and over Not applicable Toward

1.2e 2.3e, 15.10e, 17.12e Overweight prevalence: People with disabilities

20 years and over Not applicable Away

1.2f 2.3f, 15.10f, 17.12f Overweight prevalence: Females with high blood

pressure 20–74 years Not applicable Cannot assess

1.2g 2.3g, 15.10g, 17.12g Overweight prevalence: Males with high blood

pressure 20–74 years Not applicable Cannot assess

1.2h 2.3h, 15.10h, 17.12h Overweight prevalence: Mexican American male Not applicable Away

1.3 15.11, 17.13 Light to moderate physical activity, 5 or more times

per week: 18 years and over Not applicable Met

1.3 15.11, 17.13 Light to moderate physical activity, 7 or more times

per week: 18 years and over Not applicable Toward

1.3a 15.11a, 17.13a Light to moderate physical activity, 5 or more times

per week: Hispanic 18 years Not applicable Met

1.5a Sedentary lifestyle: 65 years and over Eliminate Met

1.13 17.3 Difficulty performing self-care activities: 70 years and

over Not applicable Away

1.13a 17.3a Difficulty performing self-care activities: People

85 years and over Widening Away

1.13b 17.3b Difficulty performing self-care activities: Black

70 years and over Not applicable Away

2.2 16.1 Cancer deaths Not applicable Met

2.2a 16.1a Cancer deaths: Black Not applicable Met

2.5 15.9, 16.7 Dietary fat intake, National Health and Nutrition

Examination Survey (NHANES): Average percent of

calories from total fat Not applicable Toward

2.5 15.9, 16.7 Dietary fat intake, NHANES: Average percent of

calories from saturated fat Not applicable Toward

2.5 15.9, 16.7 Dietary fat intake, Continuing Survey of Food Intakes

by Individuals (CSFII): Average percent of calories

from total fat Not applicable Toward

2.5 15.9, 16.7 Dietary fat intake, CSFII: Met goal for fat Not applicable Toward

2.5 15.9, 16.7 Dietary fat intake, CSFII: Average percent of calories

from saturated fat Not applicable Toward

2.5 15.9, 16.7 Dietary fat intake, CSFII: Met goal for saturated fat Not applicable Toward

2.6 16.8 Average daily intake of vegetables, fruits, and grain

products Not applicable Toward

2.6 16.8 Average number of daily servings: Vegetables and

fruits Not applicable Toward

2.6 16.8 Average number of daily servings: Grain products Not applicable Met

2.6 16.8 Met Dietary Guidelines goal: Vegetables and fruits Not applicable Toward

2.6 16.8 Met Dietary Guidelines goal: Grain products Not applicable Met

2.8 Consumption of foods rich in calcium: 25 years

and over Not applicable No change

2.18 Receipt of home-delivered meals: People 65 years

and over in need Not applicable

Toward

Healthy People 2000 Final Review 365

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Older adults—Con.

2.22 3.18, 15.2 Stroke deaths Not applicable Toward

2.22a 3.18a, 15.2a Stroke deaths: Black Not applicable Toward

2.23 16.5 Colorectal cancer deaths Not applicable Met

2.23a 16.5a Colorectal cancer deaths: Black Not applicable Toward

2.24 17.11 Diabetes incidence Not applicable Away

2.24 17.11 Diabetes prevalence Not applicable Away

2.24a 17.11a Diabetes prevalence: American Indian/Alaska Native

15 years and over Not applicable Away

2.24b 17.11b Diabetes prevalence: Puerto Rican 20–74 years Not applicable Cannot assess

2.24c 17.11c Diabetes prevalence: Mexican American 20–74 years Not applicable Away

2.24d 17.11d Diabetes prevalence: Cuban American 20–74 years Not applicable Cannot assess

2.24e 17.11e Diabetes prevalence: Black Not applicable Away

2.26c 15.4c Controlled high blood pressure: Females with high

blood pressure 70 years and over Cannot assess Cannot assess

3.2 16.2 Slow the rise in lung cancer deaths Not applicable Met

3.2a 16.2a Slow the rise in lung cancer deaths: Female Not applicable Met

3.2b 16.2b Slow the rise in lung cancer deaths: Black male Not applicable Met

3.17 13.7, 16.17 Oral cancer deaths: Male 45–74 years Not applicable Met

3.17 13.7, 16.17 Oral cancer deaths: Female 45–74 years Not applicable Met

3.17a 13.7a, 16.17a Oral cancer deaths: Black male 45–74 years Not applicable Met

3.17b 13.7b, 16.17b Oral cancer deaths: Black female 45–74 years Not applicable Met

6.1c 7.2c Suicide: White male 65 years and over Narrowing Met

8.1 17.1, 21.1 Years of healthy life Not applicable Met

8.1a 17.1a, 21.1a Years of healthy life: Black Not applicable Toward

8.1b 17.1b, 21.1b Years of healthy life: Hispanic Not applicable Met

8.1c 17.1c, 21.1c Years of healthy life: 65 years and over Narrowing Toward

8.8 Health promotion programs for adults 65 years and

over Not applicable No change

9.3c Motor vehicle crash deaths: 70 years and over Widening Toward

9.4a Fall-related deaths: 65–84 years Widening Away

9.4b Fall-related deaths: 85 years and over Widening Away

9.6b Residential fire deaths: 65 years and over Widening Met

9.7 Hip fractures: 65 years and over Not applicable Away

9.7a Hip fractures: White females 85 years and over Narrowing Toward

12.6 Providers reviewing medication, maintenance of

current medication list: Nurse practitioners Not applicable Toward

12.6 Providers reviewing medication, review of

medications when prescribing: Nurse practitioners Not applicable Toward

13.4 Complete tooth loss: 65 years and over Not applicable Toward

13.4a Complete tooth loss: Annual family income less than

$15,000, 65 years and over Not applicable Toward

13.4b Complete tooth loss: American Indian/Alaska Native

65 years and over Not applicable Toward

13.13 Oral health care at institutional facilities: Nursing

facilities Not applicable Toward

13.14 Regular dental visits: 35 years and over Not applicable Toward

13.14a Regular dental visits: Edentulous people, 35 years

and over Not applicable Toward

13.14b Regular dental visits: 65 years and over Narrowing Toward

13.14c Regular dental visits: Black 35 years and over Not applicable Toward

13.14d Regular dental visits: Mexican American 35 years

and over Not applicable Toward

13.14e Regular dental visits: Puerto Rican 35 years and

over Not applicable Toward

16.3 Female breast cancer deaths Not applicable Met

366 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Older adults—Con.

16.3a Female breast cancer deaths: Black Not applicable Toward

16.4 Cervical cancer deaths Not applicable Toward

16.4a Cervical cancer deaths: Black Not applicable Toward

16.4b Cervical cancer deaths: Hispanic Not applicable Toward

16.11 Breast exam and mammogram within past 2 years:

50 years and over Not applicable Met

16.11a Breast exam and mammogram within past 2 years:

Hispanic 50 years and over Not applicable Met

16.11b Breast exam and mammogram within past 2 years:

Annual family income less than $10,000, 50 years

and over Not applicable Toward

16.11c Breast exam and mammogram within past 2 years:

Less than high school education, 50 years and over Not applicable Toward

16.11d Breast exam and mammogram within past 2 years:

70 years and over Not applicable Toward

16.11e Breast exam and mammogram within past 2 years:

Black 50 years and over Not applicable Met

16.12b Pap test ever: 70 years and over Narrowing Toward

16.12b Pap test within past 3 years: 70 years and over Narrowing Toward

16.13 Colon screen, fecal occult blood test within past

2 years: 50 years and over Not applicable Toward

16.13 Colon screen sigmoidoscopy ever: 50 years and over Not applicable Toward

16.14 Oral exam within past year: 50 years and over Not applicable Toward

16.14 Skin exam within past year: 50 years and over Not applicable Away

16.14 Digital rectal exam within past year: 50 years and

over Not applicable Toward

17.2 Limitation in major activity due to chronic conditions Not applicable Away

17.2a Limitation in major activity due to chronic conditions:

Annual family income less than $10,000 Not applicable Away

17.2a Limitation in major activity due to chronic conditions:

Below poverty level Not applicable Away

17.2b Limitation in major activity due to chronic conditions:

American Indian/Alaska Native Not applicable Away

17.2c Limitation in major activity due to chronic conditions:

Black Not applicable Away

17.2d Limitation in major activity due to chronic conditions:

Puerto Rican Not applicable Away

17.4 People with asthma with activity limitation due to

asthma Not applicable Away

17.4a People with asthma with activity limitation due to

asthma: Black Not applicable Toward

17.4b People with asthma with activity limitation due to

asthma: Puerto Rican Not applicable Cannot assess

17.5 Activity limitation due to chronic back conditions Not applicable Away

17.6 Significant hearing impairment Not applicable Toward

17.6a Significant hearing impairment: People 45 years and

over Widening Toward

17.7 Significant visual impairment Not applicable Toward

17.7a Significant visual impairment: People 65 years and

over Widening Toward

17.9 Diabetes-related deaths Not applicable Away

17.9a Diabetes-related deaths: Black Not applicable Away

17.9b Diabetes-related deaths: American Indian/Alaska

Native Not applicable Away

17.9c Diabetes-related deaths: Mexican American Not applicable Away

17.9d Diabetes-related deaths: Puerto Rican Not applicable Met

Healthy People 2000 Final Review 367

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Older adults—Con.

17.10 People with diabetes: End-stage renal disease Not applicable Away

17.10 People with diabetes: Blindness Not applicable No change

17.10 People with diabetes: Lower extremity amputation Not applicable Toward

17.10a End-stage renal disease due to diabetes: Black Not applicable Away

17.10b End-stage renal disease due to diabetes: American

Indian/Alaska Native Not applicable Away

17.10c Lower extremity amputations due to diabetes: Black Not applicable Away

17.17 Clinician assessment in adults 65 years and over:

Visual acuity testing, nurse practitioners Not applicable Away

17.17 Clinician assessment in adults 65 years and over:

Prescription of mobility aids/modification, nurse

practitioners Not applicable Toward

17.18 Counseled about estrogen replacement therapy:

Female 40-60 years Not applicable Toward

17.18 Counseled about estrogen replacement therapy:

Female 40-49 years Not applicable Toward

17.18 Counseled about estrogen replacement therapy:

Female 50-60 years Not applicable Met

20.2 Epidemic-related pneumonia and influenza deaths:

65 years and over Not applicable Met

20.10 Pneumonia-related restricted activity days: 65 years

and over Not applicable Away

20.11 Pneumococcal immunizations: Institutionalized

chronically ill people or older people Not applicable Toward

20.11 Pneumococcal immunizations: Noninstitutionalized

people 65 years and over Not applicable Toward

20.11 Influenza immunizations: Institutionalized chronically

ill people or older people Not applicable Toward

20.11 Influenza immunizations: Noninstitutionalized people

65 years and over Not applicable Met

20.11a Pneumococcal immunizations: Noninstitutionalized

black people 65 years and over Not applicable Toward

20.11b Pneumococcal immunizations: Noninstitutionalized

Hispanic people 65 years and over Not applicable Toward

20.11a Influenza immunizations: Noninstitutionalized black

people 65 years and over Not applicable Toward

20.11b Influenza immunizations: Noninstitutionalized

Hispanic people 65 years and over Not applicable Toward

20.14 Influenza vaccination: Nurse practitioners Not applicable Toward

20.14 Influenza vaccination: Obstetricians/gynecologists Not applicable Cannot assess

20.14 Influenza vaccination: Internists Not applicable Cannot assess

20.14 Influenza vaccination: Family physicians Not applicable Cannot assess

20.14 Pneumococcal vaccination: Nurse practitioners Not applicable Toward

20.14 Pneumococcal vaccination:

Obstetricians/gynecologists Not applicable Cannot assess

20.14 Pneumococcal vaccination: Internists Not applicable Cannot assess

20.14 Pneumococcal vaccination: Family physicians Not applicable Cannot assess

21.2 Receipt of recommended services: Routine check-up Not applicable Toward

21.2 Receipt of recommended services, adults 65 years

and over: Tetanus booster in last 10 years Narrowing Toward

21.2 Receipt of recommended services, adults 65 years

and over: Pneumococcal vaccine in lifetime Not applicable Toward

21.2 Receipt of recommended services, adults 65 years

and over: Pneumococcal vaccine in lifetime, people

with low income Not applicable Toward

21.2 Receipt of recommended services, pneumococcal

vaccine in lifetime, adults 65 years and over: Black Not applicable Toward

368 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Older adults—Con.

21.2 Receipt of recommended services, pneumococcal

vaccine in lifetime, adults 65 years and over:

Hispanic Not applicable Toward

21.2 Receipt of recommended services, pneumococcal

vaccine in lifetime, adults 65 years and over:

Asian/Pacific Islander Not applicable Toward

21.2 Receipt of recommended services, adults 65 years

and over: Influenza vaccine in last 12 months Not applicable Met

21.2 Receipt of recommended services: Influenza vaccine

in last 12 months, People with low income Not applicable Toward

21.2 Receipt of recommended services, influenza vaccine

in last 12 months, adults 65 years and over: Black Not applicable Toward

21.2 Receipt of recommended services, influenza vaccine

in last 12 months, adults 65 years and over:

Hispanic Not applicable Toward

21.2 Receipt of recommended services, influenza vaccine

in last 12 months, adults 65 years and over:

Asian/Pacific Islander Not applicable Met

21.2 Receipt of recommended services, women 18 years

and over: Pap test in last 3 years Narrowing Toward

21.2 Receipt of recommended services, women 50 years

and over: Breast exam and mammogram in past

2 years Not applicable Met

21.2 Receipt of recommended services, women 65 years

and over: Breast exam and mammogram in past

2 years Narrowing Toward

21.2 Receipt of recommended services: Breast exam and

mammogram in past 2 years, females with low

income 50 years and over Not applicable Toward

21.2 Receipt of recommended services, women 50 years

and over, breast exam and mammogram in past

2 years: Asian/Pacific Islander Not applicable Toward

21.2 Receipt of recommended services, women 50 years

and over, breast exam and mammogram in past 2

years: American Indian/Alaska Native Not applicable Toward

21.2 Receipt of recommended services, women 50 years

and over, breast exam and mammogram in past

2 years: Females with disabilities Not applicable Toward

21.2 Receipt of recommended services: Asked at least

one screening question at routine checkup Eliminate Toward

21.6 Provision of recommended services, adults 65 years

and over: Influenza vaccination nurse practitioners Not applicable Toward

21.6 Provision of recommended services, adults 65 years

and over: Influenza vaccination, obstetricians/

gynecologists Not applicable Cannot assess

21.6 Provision of recommended services, adults 65 years

and over: Influenza vaccination, internists Not applicable Cannot assess

21.6 Provision of recommended services, adults 65 years

and over: Influenza vaccination, family physicians Not applicable Cannot assess

21.6 Provision of recommended services, adults 65 years

and over: Pneumococcal vaccination, nurse

practitioners Not applicable Toward

21.6 Provision of recommended services, adults 65 years

and over: Pneumococcal vaccination,

obstetricians/gynecologists Not applicable Cannot assess

21.6 Provision of recommended services, adults 65 years

and over: Pneumococcal vaccination, internists Not applicable

Cannot assess

Healthy People 2000 Final Review 369

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Older adults—Con.

21.6 Provision of recommended services, adults 65 years

and over: Pneumococcal vaccination, family

physicians Not applicable

Cannot assess

* For method of calculation, see Appendix Technical Notes.

Special population objectives included in Healthy People 2000: Older adults

Objective status

Disparity Measure

Eliminated

Narrowing

gap

change

Widening

gap

Cannot

assess

Disparity

total

Not a disparity

measure

Overall

total

Met..................... 1 1 0 1 0 3 28 31

Toward .................. 1 8 0 3 0 12 71 83

Mixed/No change .......... 0 0 0 0 0 0 3 3

Away ................... 0 0 0 3 0 3 35 38

Cannot assess ............ 0 0 0 0 1 1 17 18

TOTAL.................. 2 9 0 7 1 19 154 173

370 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Adolescents and young adults

1.2 2.3, 15.10, 17.12 Overweight prevalence Cannot assess Away

1.3 15.11,17.13 Light to moderate physical activity: 5 or more times

per week Not applicable Met

1.3 15.11,17.13 Light to moderate physical activity: 7 or more times

per week Not applicable Toward

1.4 Vigorous physical activity: 10-17 years Not applicable Cannot assess

1.4 Vigorous physical activity: Grades 9-12 Not applicable Toward

1.6 Strengthening 4 or more times per week: Grades

9–12 Cannot assess Met

1.6 Stretching 4 or more times per week: Grades 9-12 Cannot assess Met

1.8 Daily school physical education: Grades 1-12 Not applicable Cannot assess

1.8 Daily school physical education: Grades 9-12 Not applicable Away

1.9 Active physical education class time: Grades 9-12,

21 or more minutes, 3-5 times per week Not applicable Toward

1.9 Active physical education class time: Grades 9-12,

30 or more minutes, 1 or more times per week Not applicable Toward

1.9 Active physical education class time: All students Not applicable Cannot assess

2.8 Consumption of foods rich in calcium: 11-24 years Not applicable Away

2.8 Consumption of foods rich in calcium: Pregnant and

lactating females Not applicable Away

2.8a Consumption of foods rich in calcium: Meeting

average daily goal, female 11-24 years Not applicable Away

2.13 Use of food labels: 18 years and over Not applicable Toward

3.5 Smoking initiation: Proxy 20-24 years Not applicable Toward

3.5a Smoking initiation: Proxy 20-24 years with a high

school education or less Not applicable Away

3.9 13.17 Smokeless tobacco use: Male 12-17 years Not applicable Met

3.9 13.17 Smokeless tobacco use: Male 18-24 years Not applicable Toward

3.9a 13.17a Smokeless tobacco use: American Indian/Alaska

Native 18-24 years Not applicable Cannot assess

3.15 Tobacco product advertising and promotion to youth Not applicable Cannot assess

3.19 4.5 Average age of first use: Cigarettes Not applicable Toward

3.19 4.5 Average age of first use: Alcohol Not applicable No change

3.19 4.5 Average age of first use: Marijuana Not applicable Toward

3.20 4.6 Use in past month: Alcohol, 12-17 years Not applicable Toward

3.20 4.6 Use in past month: Alcohol, 18-20 years Not applicable Toward

3.20 4.6 Use in past month: Alcohol, Hispanic 12-17 years Not applicable Toward

3.20 4.6 Use in past month: Marijuana, 12-17 years Not applicable Away

3.20 4.6 Use in past month: Marijuana, 18-25 years Not applicable Toward

3.20 4.6 Use in past month: Cocaine, 12-17 years Not applicable Toward

3.20 4.6 Use in past month: Cocaine, 18-25 years Not applicable Met

3.20 4.6 Use in past month: Cocaine, Hispanic 12-17 years Not applicable No change

3.20 4.6 Use in past month: Cocaine, Hispanic 18-25 years Not applicable Away

3.20 4.6 Use in past month: Cigarettes, 12-17 years Not applicable Toward

3.21 4.9 Perception of social disapproval by high school

seniors: Heavy use of alcohol Not applicable Toward

3.21 4.9 Perception of social disapproval by high school

seniors: Occasional use of marijuana Not applicable Away

3.21 4.9 Perception of social disapproval by high school

seniors: Trying cocaine once or twice Not applicable Away

3.21 4.9 Perception of social disapproval by high school

seniors: Smoking one or more packs of cigarettes

per day Not applicable Away

3.22 4.10 Perception of harm by high school seniors: Heavy

use of alcohol Not applicable

Away

Healthy People 2000 Final Review 371

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Adolescents and young adults—Con.

3.22 4.10 Perception of harm by high school seniors: Regular

use of marijuana Not applicable Away

3.22 4.10 Perception of harm by high school seniors: Trying

cocaine once or twice Not applicable Away

3.22 4.10 Perception of harm by high school seniors: Smoking

one or more packs of cigarettes per day Not applicable Toward

3.22 4.10 Perception of harm by high school seniors: Using

smokeless tobacco regularly Not applicable Toward

4.1b 9.23 Alcohol-related motor vehicle deaths: 15-24 years Narrowing Met

4.7 Heavy drinking in past 2 weeks: High school seniors Not applicable Toward

4.7 Heavy drinking in past 2 weeks: College students Not applicable Toward

4.8 Alcohol consumption: 14 years and over Not applicable Toward

4.11 Anabolic steroid use: Male high school seniors Not applicable Met

4.13 Alcohol and drug education in schools Not applicable Cannot assess

4.18 States with zero tolerance blood alcohol levels:

Under 21 years Not applicable Met

5.1 Pregnancy: 15-17 years Not applicable Toward

5.1a Pregnancy: Black 15-19 years Not applicable Toward

5.1b Pregnancy: Hispanic 15-19 years Not applicable Away

5.4 18.3, 19.9 Ever engaged in sexual intercourse: Female

15 years Not applicable Toward

5.4 18.3, 19.9 Ever engaged in sexual intercourse: Male 15 years Not applicable Toward

5.4 18.3, 19.9 Ever engaged in sexual intercourse: Female

17 years Not applicable Away

5.4 18.3, 19.9 Ever engaged in sexual intercourse: Male 17 years Not applicable Toward

5.4a 18.3a,19.9a Ever engaged in sexual intercourse: Black male

15 years Not applicable Toward

5.4b 18.3b,19.9b Ever engaged in sexual intercourse: Black male

17 years Not applicable Toward

5.4c 18.3c,19.9c Ever engaged in sexual intercourse: Black female

15-17 years Not applicable Toward

5.5 18.15,19.16 Abstinence from sexual intercourse for previous

3 months: Female 15-17 years Not applicable Toward

5.5 18.15,19.16 Abstinence from sexual intercourse for previous

3 months: Male 15-17 years Not applicable Toward

5.6 Contraception use: First intercourse, female

15-19 years Not applicable Toward

5.6 Contraception use: Recent intercourse, female

15-19 years Not applicable Away

5.6 Contraception use: Oral contraceptive and condom

at most recent intercourse, female 15-19 years Not applicable Toward

5.6 Contraception use: First intercourse, male

15-19 years Not applicable Toward

5.6 Contraception use: Birth control pills and condoms at

most recent intercourse, in school, male

15-17 years Not applicable Toward

5.6 Contraception use: Condom and pill use at last

intercourse, male 17-19 years Not applicable Toward

5.8 Persons 13-18 years who have discussed sexuality

with parents Not applicable Toward

5.10 14.12 Age-appropriate preconception counseling by

clinicians: Inquiry about family planning, nurse

practitioners Not applicable Away

5.10 14.12 Age-appropriate preconception counseling by

clinicians: Counseling about family planning, nurse

practitioners Not applicable

Away

372 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Adolescents and young adults—Con.

5.10 14.12 Age-appropriate preconception counseling by

clinicians: Counseling about family planning,

obstetricians/gynecologists Not applicable Met

5.12 Contraception use: Female 15-44 years Not applicable Toward

5.12c Contraception use: Under 200% poverty, female

15-19 years Narrowing Toward

6.1a 7.2a Suicide: 15-19 years Not applicable Toward

6.1b 7.2b Suicide: Male 20-34 years Widening Toward

6.2 7.8 Suicide attempts:14-17 years Not applicable Away

6.2a 7.8a Suicide attempts: Female 14-17 years Not applicable Away

6.3 Mental disorders: 18 years and under Not applicable Cannot assess

6.8 People 18 years and over seeking help with

emotional/personal problems Not applicable Met

7.1b Homicide: Spouse 15-34 years Not applicable Met

7.1c Homicide: Black male 15-34 years Widening Toward

7.1d Homicide: Hispanic male 15-34 years Narrowing Toward

7.1e Homicide: Black female 15-34 years Narrowing Met

7.4 Child abuse and neglect Not applicable Away

7.4a Child abuse and neglect: Physical abuse Not applicable Away

7.4b Child abuse and neglect: Sexual abuse Not applicable Away

7.4c Child abuse and neglect: Emotional abuse Not applicable Away

7.4d Child abuse and neglect: Neglect Not applicable Away

7.7a Rape and attempted rape: Female 12-34 years Widening Toward

7.9 Physical fighting: 14-17 years Not applicable Met

7.9a Physical fighting: Non-Hispanic black male

14-17 years Not applicable Met

7.10 Weapon-carrying: 14-17 years Not applicable Met

7.10a Weapon-carrying: Non-Hispanic black 14-17 years Not applicable Met

7.16 Conflict resolution in a required course: Middle/junior

and senior high schools Not applicable Cannot assess

8.2 Completion of high school: 18-24 years Not applicable Away

8.2a Completion of high school: Hispanic 18-24 years Not applicable Toward

8.2b Completion of high school: Black 18-24 years Not applicable Away

8.4 Schools with comprehensive school health education:

All eight criteria met Not applicable Cannot assess

8.5 Health promotion in postsecondary institutions:

Higher education institutions Not applicable Cannot assess

8.9 Family discussion of health issues: 10 years and

over Not applicable Away

8.9 Family discussion of health issues: Engaging in

family discussion of HIV/AIDS, grades 9-12 Not applicable Toward

8.10 States with community health programs addressing

at least three Healthy People 2000 objectives Not applicable Cannot assess

8.13 Television partnerships with community organizations

for health promotion Not applicable Met

9.3b Motor vehicle crash deaths: 15-24 years Narrowing Toward

9.5b Drowning deaths: Male 15-34 years Narrowing Toward

9.18 Injury prevention instruction in required course:

Middle/junior and senior high schools Not applicable Met

9.19 13.16 Protective equipment: Baseball/softball, Mouth guard Not applicable Toward

9.19 13.16 Protective equipment: Baseball/softball, Headgear Not applicable Toward

9.19 13.16 Protective equipment: Football, Mouth guard Not applicable Toward

9.19 13.16 Protective equipment: Football, Headgear Not applicable Toward

9.19 13.16 Protective equipment: Soccer, Mouth guard Not applicable Toward

9.19 13.16 Protective equipment: Soccer, Headgear Not applicable Toward

10.2f Nonfatal work-related injuries: 15-17 years Not applicable Toward

Healthy People 2000 Final Review 373

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Adolescents and young adults—Con.

11.1b Asthma hospitalizations: 14 years and under Widening Toward

13.1 Dental caries: 15 years Not applicable Toward

13.1d Dental caries: American Indian/Alaska Native

15 years

Not applicable Toward

13.2 Untreated dental caries: 15 years Not applicable Toward

13.2e Untreated dental caries: Parents who have less than

a high school education, 15 years

Not applicable Toward

13.2f Untreated dental caries: American Indian/Alaska

Native 15 years

Not applicable Toward

13.2g Untreated dental caries: Black 15 years Not applicable Toward

13.2h Untreated dental caries: Hispanic 15 years Not applicable Toward

13.8 Protective sealants: 14 years Not applicable Toward

13.8b Protective sealants: Black 14 years Not applicable Toward

13.8d Protective sealants: Hispanic 14 years Not applicable Toward

17.20 Service systems for children with or at risk of chronic

and disabling conditions Not applicable Cannot assess

17.22 22.4 Identify gaps in health data Not applicable Toward

17.22 22.4 Establish mechanisms to meet data needs Not applicable Toward

18.1 AIDS incidence: 18 years and over Not applicable Met

18.1b AIDS incidence: Black (non-Hispanic) 18 years and

over Not applicable Met

18.1c AIDS incidence: Hispanic 18 years and over Not applicable Met

18.1d AIDS incidence: Female 18 years and over Not applicable Met

18.2 HIV prevalence: 13 years and over Not applicable Met

18.2c HIV prevalence: Females 15–44 years giving birth to

live-born infants Not applicable No change

18.4a 19.10a Condom use at last sexual intercourse: Female

15-19 years Not applicable Toward

18.4b 19.10b Condom use at last sexual intercourse: Male

15-19 years Not applicable Cannot assess

18.4d 19.10d Condom use at last sexual intercourse: Black female

15-44 years Not applicable Toward

18.10 19.12 HIV and other STD education curricula: Schools

offering at least one STD class Not applicable Met

18.10 19.12 HIV and other STD education curricula: Middle and

senior high schools, HIV prevention in required

courses Not applicable Cannot assess

18.10 19.12 HIV and other STD education curricula: Middle and

senior high schools, STD prevention required

courses Not applicable Cannot assess

18.11 19.17 HIV and STD education for students at colleges and

universities: Given AIDS or HIV infection prevention

information Not applicable Cannot assess

18.11 19.17 HIV and STD education for students at colleges and

universities: Given STD prevention information Not applicable Cannot assess

18.11 19.17 HIV and STD education for students at colleges and

universities: AIDS or HIV in a college class Not applicable Cannot assess

19.1b Gonorrhea: 15-19 years Widening Toward

19.1c Gonorrhea: Female 15-44 years Not applicable Toward

19.2 Chlamydia prevalence: Female 15-19 years Not applicable Toward

19.2 Chlamydia prevalence: Female 20-24 years Not applicable Met

19.3 Primary and secondary syphilis Not applicable Met

19.3a Primary and secondary syphilis: Black Not applicable Met

19.4 Congenital syphilis in infants under 1 year Not applicable Met

19.4a Congenital syphilis in infants under 1 year: Black Not applicable Met

19.4b Congenital syphilis in infants under 1 year: Hispanic Not applicable Met

374 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Adolescents and young adults—Con.

19.5 First time consultations: Genital herpes Not applicable Away

19.5 First time consultations: Genital warts Not applicable Met

19.6 Pelvic inflammatory disease hospitalizations:

15-44 years Not applicable Toward

19.6 Pelvic inflammatory disease initial visits to physicians Not applicable Met

19.6a Pelvic inflammatory disease hospitalizations: Black

15-44 years Not applicable Toward

19.6b Pelvic inflammatory disease hospitalizations:

15-19 years Narrowing Toward

19.7 20.3b, 20.3c Sexually transmitted Hepatitis B Not applicable Met

19.8 Repeat gonorrhea infection Not applicable Toward

19.8a Repeat gonorrhea infection: Black Not applicable Toward

20.1 Vaccine-preventable diseases: Diphtheria 25 years

and under Not applicable Met

20.1 Vaccine-preventable diseases: Tetanus 25 years and

under Not applicable Away

20.1 Vaccine-preventable diseases: Polio Not applicable Met

20.1 Vaccine-preventable diseases: Measles Not applicable Toward

20.1 Vaccine-preventable diseases: Rubella Not applicable Away

20.1 Vaccine-preventable diseases: Congenital Rubella

Syndrome Not applicable No change

20.1 Vaccine-preventable diseases: Mumps Not applicable Met

20.1 Vaccine-preventable diseases: Pertussis Not applicable Away

20.11 Basic immunization series among children in

kindergarten through postsecondary education

institutions Cannot assess Met

21.3 Usual source of care: 18 years and over Not applicable Toward

21.3a Usual source of care: Hispanic 18 years and over Not applicable Toward

21.3a Usual source of care: Mexican American 18 years

and over Not applicable Toward

21.3b Usual source of care: Black 18 years and over Not applicable Toward

21.3c Usual source of care: Low-income people 18 years

and over Not applicable Toward

21.3d Usual source of care: American Indian/Alaska Native

18 years and over Not applicable Toward

21.3e Usual source of care: Asian/Pacific Islander 18 years

and over Not applicable Toward

21.4 People without health care coverage: Under 65 years Not applicable Away

21.4a People without health care coverage: American

Indian/Alaska Native under 65 years Not applicable Away

21.4b People without health care coverage: Hispanic under

65 years Not applicable Away

21.4b People without health care coverage: Mexican

American under 65 years Not applicable Away

21.4b People without health care coverage: Puerto Rican

under 65 years Not applicable Toward

21.4b People without health care coverage: Cuban under

65 years Not applicable Away

21.4c People without health care coverage: Black under

65 years Not applicable Toward

21.5 Clinical preventive services from Federal programs:

Screening Not applicable Cannot assess

21.5 Clinical preventive services from Federal programs:

Counseling Not applicable Cannot assess

21.5 Clinical preventive services from Federal programs:

Immunizations Not applicable Cannot assess

Healthy People 2000 Final Review 375

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Adolescents and young adults—Con.

21.6 Provision of recommended services, children:

Hemoglobin/hematocrit, Pediatricians Not applicable Cannot assess

21.6 Provision of recommended services, children:

Hemoglobin/hematocrit, Nurse practitioners Not applicable Cannot assess

21.6 Provision of recommended services, children:

Hemoglobin/hematocrit, Family physicians Not applicable Cannot assess

21.6 Provision of recommended services, children: Eye

exam, Pediatricians Not applicable Cannot assess

21.6 Provision of recommended services, children: Eye

exam, Nurse practitioners Not applicable Away

21.6 Provision of recommended services, children: Eye

exam, Family physicians Not applicable Cannot assess

21.6 Provision of recommended services, children: Blood

pressure, Pediatricians Not applicable Cannot assess

21.6 Provision of recommended services, children: Blood

pressure, Nurse practitioners Not applicable Away

21.6 Provision of recommended services, children: Blood

pressure, Family physicians Not applicable Cannot assess

21.6 Provision of recommended services, children: Height

and weight, Pediatricians Not applicable Cannot assess

21.6 Provision of recommended services, children: Height

and weight, Nurse practitioners Not applicable Away

21.6 Provision of recommended services, children: Height

and weight, Family physicians Not applicable Cannot assess

21.6 Provision of recommended services, children:

Diphtheria-tetanus-pertussis (DTP) vaccination,

Pediatricians Not applicable Cannot assess

21.6 Provision of recommended services, children: DTP

vaccination, Nurse practitioners Not applicable Toward

21.6 Provision of recommended services, children: DTP

vaccination, Family physicians Not applicable Cannot assess

21.6 Provision of recommended services, children: Oral

polio vaccination, Pediatricians Not applicable Cannot assess

21.6 Provision of recommended services, children: Oral

polio vaccination, Nurse practitioners Not applicable Toward

21.6 Provision of recommended services, children: Oral

polio vaccination, Family physicians Not applicable Cannot assess

21.6 Provision of recommended services, children:

Tetanus-diphtheria booster, Pediatricians Not applicable Cannot assess

21.6 Provision of recommended services, children:

Tetanus-diphtheria booster, Nurse practitioners Not applicable Toward

21.6 Provision of recommended services, children:

Tetanus-diphtheria booster, Family physicians Not applicable Cannot assess

21.6 Provision of recommended services, children:

Haemophilus influenzae type b (Hib) vaccination,

Pediatricians Not applicable Cannot assess

21.6 Provision of recommended services, children: Hib

vaccination, Nurse practitioners Not applicable Toward

21.6 Provision of recommended services, children: Hib

vaccination, Family physicians Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Tetanus-diphtheria booster, Nurse

practitioners Not applicable Toward

21.6 Provision of recommended services, adults 18 years

and over: Tetanus-diphtheria booster,

Obstetricians/gynecologists Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Tetanus-diphtheria booster, Internists Not applicable

Cannot assess

376 Healthy People 2000 Final Review

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Adolescents and young adults—Con.

21.6 Provision of recommended services, adults 18 years

and over: Tetanus-diphtheria booster, Family

physicians Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Blood pressure, Nurse practioners Not applicable Toward

21.6 Provision of recommended services, adults 18 years

and over: Blood pressure,

Obstetrician/gynecologists Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Blood pressure, Internists Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Blood pressure, Family physians Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Cholesterol level, Nurse practitioners Not applicable Toward

21.6 Provision of recommended services, adults 18 years

and over: Cholesterol level,

Obstetricians/gynecologists Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Cholesterol level, Internists Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Cholesterol level, Family physicians Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Breast exam, Nurse practitioners Not applicable Away

21.6 Provision of recommended services, adults 18 years

and over: Breast exam,

Obstetricians/gynecologists Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Breast exam, Internists Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Breast exam, Family physicians Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Pap smear, Nurse practitioners Not applicable Away

21.6 Provision of recommended services, adults 18 years

and over: Pap smear, Obstetricians/gynecologists Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Pap smear, Internists Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Pap smear, Family physicians Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Mammogram, Nurse practitioners Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Mammogram, Obstetricians/gynecologists Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Mammogram, Internists Not applicable Cannot assess

21.6 Provision of recommended services, adults 18 years

and over: Mammogram, Family physicians Not applicable Cannot assess

21.7 Local health department assurance of access to

essential clinical preventive services: Proportion of

people served Not applicable Cannot assess

21.7 Local health department assurance of access to

essential clinical preventive services: Assess

services provided to the local population Not applicable Cannot assess

21.7 Local health department assurance of access to

essential clinical preventive services: Collect data Not applicable Cannot assess

21.7 Local health department assurance of access to

essential clinical preventive services: Evaluate

whether a gap exists Not applicable Cannot assess

Healthy People 2000 Final Review 377

Table VII. Special population objectives included in Healthy People 2000—Con.

Objective

Number

Duplicate

objective Short objective text

Disparity

assessment in

relation to

reference

population*

Objective

status in

relation to

target

Adolescents and Young adults—Con.

21.7 Local health department assurance of access to

essential clinical preventive services: Provide Not applicable Cannot assess

22.2 Objectives with national data sources Not applicable Toward

22.2a State level data for at least two-thirds of State

objectives Not applicable

Toward

* For method of calculation, see Appendix Technical Notes.

Special population objectives included in Healthy People 2000: Adolescents and Young adults

Objective status

Disparity Measure

Eliminated

Narrowing

gap

change

Widening

gap

Cannot

assess

Disparity

total

Not a disparity

measure

Overall

total

Met..................... 0 2 0 0 3 5 32 37

Toward .................. 0 5 0 5 0 10 87 97

Mixed/No change .......... 0 0 0 0 0 0 4 4

Away ................... 0 0 0 0 1 1 42 43

Cannot assess ............ 0 0 0 0 0 0 62 62

TOTAL.................. 0 7 0 5 4 16 227 243

378 Healthy People 2000 Final Review