UOP 486 Leading Health Indicators Discussion

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UOP 486 Leading Health Indicators Discussion

UOP 486 Leading Health Indicators Discussion

 

Post a total of 3 substantive responses over 2 separate days for full participation. This includes your initial post and 2 replies to other students.

Explore HealthyPeople.gov to familiarize yourself with an initiative aimed at promoting health through attaining four overarching goals.

After navigating the site, respond to the following in a minimum of 175 words:

How are the leading health indicators selected?

Which of the leading health indicator topic(s) is/are most important for your community or practice setting? Why?ackground
For four decades, Healthy People has provided a
comprehensive set of 10-year national goals and
objectives for improving the health of all Americans.
Healthy People 2020, the most recent iteration, tracks the
country’s health through more than 1,200 objectives that
span 42 topic areas.
The Leading Health Indicators are a select subset of 26
Healthy People 2020 objectives chosen to communicate
high-priority health issues and challenges. They address
determinants of health that promote quality of life,
healthy behaviors, and healthy development across all
life stages. The indicators are used to assess the health
of the country, facilitate collaboration across sectors, and
motivate action to improve health at the national, state,
and community levels.
The Leading Health Indicators were selected and
organized using a “Health Determinants and Health
Outcomes by Life Stages” conceptual framework. This
approach was intended to draw attention to both
individual and societal determinants that affect the
public’s health and contribute to health disparities from
infancy through old age, thereby highlighting strategic
opportunities to promote health and improve quality of
life for all Americans. The selection process was led by
the Healthy People 2020 Federal Interagency Workgroup
(FIW). In selecting the indicators, the FIW took into
consideration recommendations from the Institute of
Medicine of the National Academy of Sciences and the
Secretary’s Advisory Committee on National Health
Promotion and Disease Prevention Objectives for
2020. For more information on the development and
framework see “More Information” below.
Leading Health Indicator Topics
The Leading Health Indicators are organized into 12
topics. These topics are described briefly below, and
references are provided for readers interested in further
information about their public health significance.
Access to Health Services. Barriers to accessing health
services, such as lack of availability, high cost, and lack
of medical insurance, lead to unmet health care needs,
delays in receiving needed care, inability to obtain
preventive services, and preventable hospitalizations.1
Clinical Preventive Services. Services such as routine
disease screening and scheduled immunizations prevent
illnesses and detect diseases in their earlier, more
treatable stages, reducing the risk of illness, disability,
early death, and medical care costs.2
Environmental Quality. Approximately one-quarter
of the global disease burden is due to modifiable
environmental factors, which include exposure to toxic
substances and hazardous wastes in the air, water, soil,
and food.3
Injury and Violence. Intentional and unintentional
injuries are critical public health concerns in the United
States. They include homicide; intimate partner,
sexual, and school violence; child abuse and neglect;
suicide; motor vehicle crashes; and unintentional drug
overdoses.4
Maternal, Infant, and Child Health. Addressing the
health needs of women before, during, and after
pregnancy helps to improve not only their health but
also their children’s health. Healthy birth outcomes and
early identification and treatment of health conditions
among infants can prevent death or disability and enable
children to reach their full potential.5
Mental Health. Mental health is a component of a
person’s well-being, healthy family and interpersonal
relationships, and the ability to live a full and productive
life. Mental health disorders have a serious impact on
physical health and are associated with the prevalence,
progression, and outcome of chronic diseases such as
diabetes, heart disease, and cancer.6
Nutrition, Physical Activity, and Obesity. Good nutrition,
physical activity, and a healthy body weight can help
decrease the risk of developing serious health conditions,
such as high blood pressure, high cholesterol, diabetes,
heart disease, stroke, and cancer. In addition, to manage
existing health conditions to improve quality of life,
the 2015–2020 “Dietary Guidelines for Americans”
emphasize following a healthy eating pattern, engaging in
regular physical activity, and achieving and maintaining a
healthy weight.7
Oral Health. Oral diseases include dental caries (cavities),
periodontal (gum) disease, cleft lip and palate, oral and
facial pain, and oral and pharyngeal (mouth and throat)
cancers. Oral diseases, particularly gum disease, have
been linked to chronic diseases such as diabetes, heart
disease, and stroke. Many oral diseases can be prevented
with regular dental care.8
Reproductive and Sexual Health. Reproductive and
sexual health covers a broad range of health needs from
adolescence forward, including the reproductive system,
sexually transmitted diseases (STDs), HIV, and fertility.
Untreated STDs can lead to serious long-term health
IV–4 HEALTHY PEOPLE 2020 MIDCOURSE REVIEW
consequences, especially for adolescent girls and young
women. These include reproductive health problems and
infertility, fetal and perinatal health problems, cancer, and
further sexual transmission of HIV and other STDs.9
Social Determinants. Individual and population health
are affected by a range of personal, social, economic,
and environmental factors. For example, access to parks
and safe sidewalks is associated with physical activity
in adults, and education is associated with improved
health and quality of life and health-promoting behaviors.
Although education is the Leading Health Indicator for
this topic, many Healthy People 2020 objectives address
social determinants as a means of improving population
health.9
Substance Abuse. Substance abuse—involving drugs,
alcohol, or both—is associated with a wide range
of detrimental social conditions, including family
disruptions, financial problems, lost productivity, failure
in school, domestic violence, child abuse, and crime.
Substance abuse contributes to a number of negative
health outcomes and public health problems, including
cardiovascular conditions, pregnancy complications,
teen pregnancy, HIV/AIDS, STDs, motor vehicle crashes,
homicide, and suicide.10,11
Tobacco. Tobacco use is the leading cause of preventable
disease, disability, and death in the United States. More
deaths are caused each year by tobacco use than from
HIV, illegal drug use, alcohol use, motor vehicle injuries,
suicides, and homicides combined. Tobacco use causes
several forms of cancer, heart disease, stroke, lung
diseases, pregnancy complications, gum disease, and
vision problems.12,13

Status of Leading Health Indicators
Figure IV–1. Midcourse Status of Leading Health Indicators
All 26 of the Leading Health Indicators were measurable
Healthy People 2020 objectives15,16 at midcourse
(Figure IV–1, Table IV–1). The midcourse status of these
objectives (Table IV–2) was as follows:
„ 8 objectives had met or exceeded their 2020 targets,17
„ 8 objectives were improving,18
„ 7 objectives had demonstrated little or no detectable
change,19 and
„ 3 objectives were getting worse.20
Selected Findings
Access to Health Services
„ The proportion of persons under age 65 with medical
insurance (AHS-1.1) increased from 83.2% in 2008 to
86.7% in 2014, moving toward the 2020 target (Table
IV–2).
» In 2014, there were statistically significant
disparities by sex, race and ethnicity, education,
family income, disability status, and geographic
location in the proportion of persons under age 65
with medical insurance (AHS-1.1, Table IV–3).
Chapter IV • Leading Health Indicators IV–5
(D-5.1, Table IV–3). The disparities by education,
family income, and disability status were not
statistically significant.
„ The percentage of children aged 19–35 months who
received the recommended doses of diphtheriatetanus-acellular pertussis (DTaP); polio; measles,
mumps, rubella (MMR); Haemophilus influenza B
(Hib); hepatitis B (HepB); varicella; and pneumococcal
conjugate vaccine (PCV) (IID-8) increased from 68.4%
in 2012 to 71.6% in 2014, moving toward the 2020
target (Table IV–2).
» In 2014, there were statistically significant
disparities by sex, mother’s education, and family
income in the percentage of children aged 19–35
months who received the recommended doses
of DTaP, polio, MMR, Hib, HepB, varicella, and
PCV (IID-8, Table IV–3). The disparities by race
and ethnicity and geographic location were not
statistically significant.
Environmental Quality
„ The number of days the Air Quality Index (AQI)
exceeded 100 (EH-1) decreased from 2,200,000,000
(weighted by population and AQI) in 2006–2008 to
982,186,972 in 2012–2014, exceeding the 2020 target
(Table IV–2).
„ The proportion of children aged 3–11 years who were
exposed to secondhand smoke (TU-11.1) decreased
from 52.2% in 2005–2008 to 41.3% in 2009–2012,
exceeding the 2020 target (Table IV–2).
» In 2009–2012, there were statistically significant
disparities by race and ethnicity and family income
in the proportion of children aged 3–11 years
exposed to secondhand smoke (TU-11.1, Table
IV–3). The disparity by sex was not statistically
significant.
Injury and Violence
„ The age-adjusted rate of injury deaths (IVP-1.1) per
100,000 population decreased from 59.7 in 2007 to
58.8 in 2013, moving toward the 2020 target
(Table IV–2).
» In 2013, there were statistically significant
disparities by sex, race and ethnicity, and
geographic location in the age-adjusted rate of
injury deaths (IVP-1.1, Table IV–3).
„ The age-adjusted rate of homicides (IVP-29) per
100,000 population decreased from 6.1 in 2007 to 5.2
in 2013, exceeding the 2020 target (Table IV–2).
„ There was little or no detectable change (76.3% in
2007 and 76.5% in 2012) in the proportion of persons
with a usual primary care provider (AHS-3, Table
IV–2).
» In 2012, there were statistically significant
disparities by sex, race and ethnicity, education, and
family income in the proportion of persons with a
usual primary care provider (AHS-3, Table IV–3). The
disparity by geographic location was not statistically
significant.
Clinical Preventive Services
„ The age-adjusted proportion of adults aged 50–75
who had received a colorectal cancer screening based
on the most recent guidelines (C-16) increased from
52.1% in 2008 to 58.2% in 2013, moving toward the
2020 target (Table IV–2).
» In 2014, the age-adjusted proportion of adults aged
50–75 who received a colorectal cancer screening
based on the most recent guidelines varied by state
(Map IV–1).21
» In 2013, there were statistically significant
disparities by race and ethnicity, education, family
income, disability status, and geographic location in
the age-adjusted proportion of adults aged 50–75
who had received a colorectal cancer screening
based on the most recent guidelines (C-16, Table
IV–3). The disparity by sex was not statistically
significant.
„ The age-adjusted proportion of adults aged 18 and
over with hypertension whose blood pressure was
under control (HDS-12) increased from 43.7% in
2005–2008 to 48.9% in 2009–2012, moving toward the
2020 target (Table IV–2).
» In 2009–2012, there were statistically significant
disparities by sex, race and ethnicity, and disability
status in the age-adjusted proportion of adults with
hypertension whose blood pressure was under
control (HDS-12, Table IV–3). The disparities by
education and family income were not statistically
significant.
„ Between 2005–2008 and 2009–2012, there was
little or no detectable change in the age-adjusted
proportion of adults aged 18 and over with diagnosed
diabetes whose A1c value was greater than 9%
(18.0% and 21.0%, respectively) (D-5.1, Table IV–2).
» In 2009–2012, there were statistically significant
disparities by sex and race and ethnicity in the
age-adjusted proportion of adults with diagnosed
diabetes whose A1c value was greater than 9%
IV–6 HEALTHY PEOPLE 2020 MIDCOURSE REVIEW
» In 2013, there were statistically significant
disparities by sex, race and ethnicity, and
geographic location in the age-adjusted rate of
homicides (IVP-29, Table IV–3).
Maternal, Infant, and Child Health

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„ All infants deaths under age 1 year (MICH-1.3) per
1,000 live births decreased from 6.7 in 2006 to 6.0 in
2013, meeting the 2020 target (Table IV–2).
» Infant mortality rates (MICH-1.3) varied by state. In
2013, 24 states had met or exceeded the national
target for all infant deaths under age 1 year
(Map IV–2).
» In 2013, there were statistically significant
disparities by the infant’s sex and mother’s race and
ethnicity in the rate of all infant deaths under age 1
year (MICH-1.3, Table IV–3).
„ Total preterm live births born before 37 completed
weeks of gestation (MICH-9.1), decreased from 12.7%
in 2007 to 11.4% in 2013, meeting the 2020 target
(Table IV–2).
» Preterm births (MICH-9.1) varied by state. In 2013,
26 states had met or exceeded the national target
for total preterm live births of less than 37 weeks
gestation (Map IV–3).
» In 2013, there were statistically significant
disparities by the infant’s sex, mother’s race and
ethnicity, and geographic location in the proportion
of preterm live births of less than 37 weeks
gestation (MICH-9.1, Table IV–3).
Mental Health
„ The age-adjusted rate of suicide per 100,000
population (MHMD-1) increased from 11.3 in 2007 to
12.6 in 2013, moving away from the baseline and 2020
target (Table IV–2).
» In 2013, there were statistically significant
disparities by sex, race and ethnicity, and
geographic location in the age-adjusted suicide rate
(MHMD-1, Table IV–3).
„ The proportion of adolescents aged 12–17 with a
major depressive episode in the past 12 months
(MHMD-4.1) increased from 8.3% in 2008 to 10.7% in
2013, moving away from the baseline and 2020 target
(Table IV–2).
» In 2013, there were statistically significant
disparities by sex, race and ethnicity, family income,
and geographic location in the proportion of
adolescents aged 12–17 with a major depressive
episode in the past 12 months (MHMD-4.1,
Table IV–3).
Nutrition, Physical Activity, and Obesity
„ The age-adjusted proportion of adults aged 18 and
over who met the physical activity guidelines for
both aerobic (150 minutes or more of light/moderate
or 75 minutes or more of vigorous physical activity
per week or equivalent combination) and musclestrengthening physical activity (at least twice a week)
(PA-2.4) increased from 18.2% in 2008 to 21.3% in
2014, exceeding the 2020 target (Table IV–2).
» In 2013, the age-adjusted proportion of adults who
met the guidelines for both aerobic exercise and
muscle-strengthening physical activity varied by
state (Map IV–4).22
» In 2014, there were statistically significant
disparities by sex, education, family income,
disability status, and geographic location in the
age-adjusted proportion of adults who met the
physical activity guidelines for both aerobic exercise
and muscle-strengthening physical activity (PA-2.4,
Table IV–3). The disparity by race and ethnicity was
not statistically significant.
„ There was little or no detectable change (33.9% in
2005–2008 and 35.3% in 2009–2012) in the ageadjusted proportion of adults aged 20 and over with
obesity (NWS-9, Table IV–2).
» In 2013, age-adjusted self-reported obesity rates for
adults aged 20 and over varied by state (Map IV–5).23
» In 2009–2012, there were statistically significant
disparities by race and ethnicity, education, family
income, and disability status in the age-adjusted
proportion of adults aged 20 and over with obesity
(NWS-9, Table IV–3). The disparity by sex was not
statistically significant.
„ There was little or no detectable change (16.1% in
2005–2008 and 16.9% in 2009–2012) in the proportion
of children and adolescents aged 2–19 years with
obesity (NWS-10.4, Table IV–2).
» In 2009–2012, there were statistically significant
disparities by race and ethnicity and family income
in the proportion of children and adolescents aged
2–19 years with obesity (NWS-10.4, Table IV–3). The
disparity by sex was not statistically significant.
„ Between 2005–2008 and 2009–2012, there was
little or no detectable change (0.76 and 0.77 cup
equivalents per 1,000 calories, respectively) in the
Chapter IV • Leading Health Indicators IV–7
age-adjusted mean daily intake of total vegetables by
persons aged 2 years and over (NWS-15.1, Table IV–2).
» In 2009–2012, there were statistically significant
disparities by sex, race and ethnicity, education,
family income, and disability status in the ageadjusted mean daily intake of total vegetables by
persons aged 2 years and over (NWS-15.1, Table
IV–3).
Oral Health
„ The age-adjusted proportion of persons aged 2 years
and over who visited a dentist in the past year (OH-7)
decreased from 44.5% in 2007 to 42.1% in 2012,
moving away from the baseline and 2020 target
(Table IV–2).
» In 2012, there were statistically significant
disparities by sex, race and ethnicity, education,
family income, disability status, and geographic
location in the age-adjusted proportion of persons
age 2 years and over who visited a dentist in the
past year (OH-7, Table IV–3).
Reproductive and Sexual Health
„ There was little or no detectable change (78.6% in
2006–2010 and 77.3% in 2011–2013) in the proportion
of sexually active females aged 15–44 who had
received reproductive health services in the past year
(FP-7.1, Table IV–2).
» In 2011–2013, there were statistically significant
disparities by race and ethnicity and geographic
location in the proportion of sexually active females
aged 15–44 who had received reproductive health
services in the past year (FP-7.1, Table IV–3). The
disparities by education, family income, and
disability status were not statistically significant.
„ The proportion of HIV-positive persons aged 13 and
over who were aware of their HIV infection status
(HIV-13) increased from 80.9% in 2006 to 87.2% in
2012, moving toward the 2020 target (Table IV–2).
» The proportion of HIV-positive persons aged 13 and
over who knew their serostatus (HIV-13) varied by
state. In 2012, 11 states had met or exceeded the
national target (Map IV–6).
» In 2012, the disparities by sex and race in the
proportion of HIV-positive persons aged 13 and
over who were aware of their HIV infection status
were not tested for statistical significance (HIV-13,
Table IV–3).
Social Determinants
„ The proportion of students who graduated from
high school 4 years after starting 9th grade (AH-5.1)
increased from 79% in 2010–2011 to 81% in 2012–
2013, moving toward the 2020 target (Table IV–2).
» The proportion of students who graduated from
high school 4 years after starting 9th grade (AH-5.1)
varied by state. In 2012–2013, nine states met the
national 2020 target (Map IV–7).
» In 2012–2013, the disparity by race and ethnicity in
the proportion of students who graduated from
high school 4 years after starting 9th grade was not
tested for statistical significance (AH-5.1, Table IV–3).
Substance Abuse
„ The proportion of adolescents aged 12–17 who had
used alcohol or illicit drugs in the past 30 days (SA13.1) decreased from 18.4% in 2008 to 15.9% in 2013,
exceeding the 2020 target (Table IV–2).
» In 2013, there were statistically significant
disparities by race and ethnicity and family income
in the proportion of adolescents aged 12–17 who
had used alcohol or illicit drugs in the past 30 days
(SA-13.1, Table IV–3). The disparities by sex and
geographic location were not statistically significant.
„ There was little or no detectable change (27.1% in
2008 and 26.9% in 2013) in the proportion of adults
aged 18 and over who engaged in binge drinking in
the past 30 days (SA-14.3, Table IV–2).
» The proportion of adults aged 18 and over who
engaged in binge drinking in the past 30 days (SA14.3) varied by state. In 2010–2013, 10 states had
met or exceeded the national target (Map IV–8).
» In 2013, there were statistically significant
disparities by sex, race and ethnicity, education,
family income, and geographic location in the
proportion of adults aged 18 and over who had
engaged in binge drinking in the past 30 days
(SA-14.3, Table IV–3).
Tobacco
„ The age-adjusted proportion of adults aged 18 and
over who were current cigarette smokers (TU-1.1)
decreased from 20.6% in 2008 to 17.0% in 2014,
moving toward the 2020 target (Table IV–2).
» In 2013, the age-adjusted proportion of adults aged
18 and over who were current cigarette smokers
varied by state (Map IV–9).
24
IV–8 HEALTHY PEOPLE 2020 MIDCOURSE REVIEW
» In 2014, there were statistically significant
disparities by sex, race and ethnicity, education,
family income, disability status, and geographic
location in the age-adjusted proportion of adults
who were current cigarette smokers (TU-1.1,
Table IV–3).
„ The proportion of students in grades 9–12 who
smoked cigarettes in the past 30 days decreased from
19.5% in 2009 to 15.7% in 2013, exceeding the 2020
target (TU-2.2, Table IV–2).
» State-level data on cigarette smoking in the past 30
days among students in grades 9–12 (TU-2.2) were
available for 41 states in 2013. Thirty-two states had
met or exceeded the national target (Map IV–10).
» In 2013, there was a statistically significant
difference by race and ethnicity in the proportion of
students in grades 9–12 who smoked cigarettes in
the past 30 days (TU-2.2, Table IV–3). The disparity
by sex was not statistically significant.
More Information
Readers interested in more detailed information about
the Leading Health Indicators are invited to visit the
HealthyPeople.gov website, where extensive substantive
and technical information is available:
„ For the background and importance of the Leading
Health Indicators, see: http://www.healthypeople.
gov/2020/Leading-Health-Indicators
„ For information on a specific Leading Health Indicator
Topic, see: https://www.healthypeople.gov/2020/
leading-health-indicators/2020-LHI-Topics
„ For data details for each indicator, including
definitions, numerators, denominators, calculations,
and data limitations, see: https://www.healthypeople.
gov/2020/topics-objectives
Select and click on a topic area from the list. Then
select the “Objectives” tab, select an objective, and
then click on the “DATA2020” icon or “Data Details” icon.
„ For indicator data by population group (e.g., sex,
race and ethnicity, or family income), including
rates, percentages, or counts for multiple years,
see: http://www.healthypeople.gov/2020/
Leading-Health-Indicators
Select and click on a Topic listed in the left-hand
column. Then select and click on an indicator listed in
the body of the text. When the objective box appears,
click on the “Data2020” icon.
Readers interested in more detailed information about
the Healthy People Topic Areas mentioned in this chapter
are invited to visit the Healthy People 2020 Midcourse
Review home page, where links to Topic Area chapters
can be found: https://www.cdc.gov/nchs/healthy_
people/hp2020/hp2020_midcourse_review.htm
Data for the Healthy People 2020 Leading Health
Indicator objectives in this chapter were from the
following data sources:
„ Air Quality System: https://www.epa.gov/aqs
„ Behavioral Risk Factor Surveillance System:
http://www.cdc.gov/brfss/
„ Bridged-race Population Estimates:
http://www.cdc.gov/nchs/nvss/bridged_race.htm
„ Common Core of Data: https://nces.ed.gov/ccd/
„ Linked Birth and Infant Death Data Set:
http://www.cdc.gov/nchs/nvss/linked-birth.htm
„ Medical Expenditure Panel Survey:
http://meps.ahrq.gov/mepsweb/
„ National Health and Nutrition Examination Survey:
http://www.cdc.gov/nchs/nhanes/
„ National Health Interview Survey:
http://www.cdc.gov/nchs/nhis/
„ National HIV Surveillance System:
http://www.cdc.gov/hiv/statistics/
„ National Immunization Surveys: http://www.cdc.gov/
vaccines/imz-managers/nis/index.html
„ National Survey of Family Growth:
http://www.cdc.gov/nchs/nsfg/
„ National Survey on Drug Use and Health:
https://nsduhweb.rti.org/respweb/homepage.cfm
„ National Vital Statistics System–Mortality:
http://www.cdc.gov/nchs/nvss/deaths.htm
„ National Vital Statistics System–Natality:
http://www.cdc.gov/nchs/nvss/births.htm
„ Youth Risk Behavioral Surveillance System:
http://www.cdc.gov/healthyyouth/data/yrbs/index.htm
Footnotes
1Agency for Healthcare Research and Quality. National
Healthcare Disparities Report, 2013. Chapter 10: Access
to Health Care. AHRQ Publication No. 14-0006. Rockville,
MD. 2014. Available from: http://www.ahrq.gov/
research/findings/nhqrdr/nhdr13/chap10.html.
Chapter IV • Leading Health Indicators IV–9
2Agency for Healthcare Research and Quality.Guide to
Clinical Preventive Services, 2014. Recommendations of
the U.S. Preventive Services Task Force. Available from:
http://www.ahrq.gov/professionals/clinicians-providers/
guidelines-recommendations/guide/index.html.
3 Prüss-Üstün A, Corvalán C. Preventing Disease Through
Healthy Environments. World Health Organization.
2006. Available from: http://www.who.int/quantifying_
ehimpacts/publications/preventingdisease.pdf.
4Doll LS, Bonzo SE, Mercy JA, Sleet DA , editors.
Handbook of Injury and Violence Prevention. New York,
NY: Springer Science+Buisness Media, LLC. 2007.
5U.S. Department of Health and Human Services. Healthy
People 2010: Understanding and Improving Health
2nd ed. Washington, DC: Government Printing Office.
November 2000.
6Chapman DP, Perry GS, Strine TW. The Vital Link
Between Chronic Disease and Depressive Disorders. Prev
Chronic Dis 2(1):A14. 2005. Available from:
http://www.cdc.gov/pcd/issues/2005/jan/04_0066.htm.
7U.S. Department of Health and Human Services and
U.S. Department of Agriculture. Dietary Guidelines for
Americans 2015–2020. 8th ed. 2015. Available from:
http://health.gov/dietaryguidelines/2015/guidelines/.
8US Department of Health and Human Services, Public
Health Service, Office of the Surgeon General. Oral health
in America: A report of the Surgeon General. Rockville,
MD: National Institutes of Health, National Institute of
Dental and Craniofacial Research; 2000. Available from:
http://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/
sgr/home.htm.
9Office of the Surgeon General National Prevention
Council. National Prevention Strategy. 2011. Available
from: http://www.surgeongeneral.gov/priorities/
prevention/strategy/report.pdf.
10 National Institute on Drug Abuse. Medical
Consequences of Drug Abuse. Available from:
https://www.drugabuse.gov/related-topics/medicalconsequences-drug-abuse.
11National Institute on Drug Abuse. Drug Abuse and
Addiction: One of America’s Most Challenging Public
Health Problems. 2005. Available from:
https://archives.drugabuse.gov/about/welcome/
aboutdrugabuse/index.html.
12 U.S. Department of Health and Human Services. The
Health Consequences of Smoking—50 Years of Progress:
A Report of the Surgeon General. 2014.
13 Centers for Disease Control and Prevention. Smokingattributable Mortality, Years of Potential Life Lost, and
Productivity Losses—United States, 2000–2004. MMWR
57(45):1226–8. 2008. Available from: http://www.cdc.
gov/mmwr/preview/mmwrhtml/mm5745a3.htm.
14 Office of Disease Prevention and Health Promotion.
Leading Health Indicators Development and Framework.
Available from: https://www.healthypeople.gov/2020/
leading-health-indicators/Leading-Health-IndicatorsDevelopment-and-Framework.
15More on understanding and interpreting Midcourse
Review data, including a step-by-step guide to the tables,
can be found in the Reader’s Guide. The Technical Notes
provide more information on Healthy People 2020
statistical methods and issues.
16Measurable objectives had a national baseline value.
17 Target met or exceeded—One of the following, as
specified in the Midcourse Progress Table:
» At baseline the target was not met or exceeded and
the midcourse value was equal to or exceeded the
target. (The percentage of targeted change achieved
was equal to or greater than 100%.)
» The baseline and midcourse values were equal to
or exceeded the target. (The percentage of targeted
change achieved was not assessed.)
18 Improving—One of the following, as specified in the
Midcourse Progress Table:
» Movement was toward the target, standard errors
were available, and the percentage of targeted change
achieved was statistically significant.
» Movement was toward the target, standard errors
were not available, and the objective had achieved
10% or more of the targeted change.
19 Little or no detectable change—One of the following,
as specified in the Midcourse Progress Table:
» Movement was toward the target, standard errors
were available, and the percentage of targeted change
achieved was not statistically significant.
» Movement was toward the target, standard errors
were not available, and the objective had achieved less
than 10% of the targeted change.
» Movement was away from the baseline and target,
standard errors were available, and the percentage
change relative to the baseline was not statistically
significant.
» Movement was away from the baseline and target,
standard errors were not available, and the objective
had moved less than 10% relative to the baseline.
» There was no change between the baseline and the
midcourse data point.
IV–10 HEALTHY PEOPLE 2020 MIDCOURSE REVIEW
20Getting worse—One of the following, as specified in the
Midcourse Progress Table:
» Movement was away from the baseline and target,
standard errors were available, and the percentage
change relative to the baseline was statistically
significant.
» Movement was away from the baseline and target,
standard errors were not available, and the objective
had moved 10% or more relative to the baseline.
21 The state data shown are from the Behavioral Risk
Factor Surveillance System (BRFSS), while the national
data, used to set the national target, are from the
National Health Interview Survey (NHIS). National and
state data may not be directly comparable, and therefore,
the national target may not be applicable to the state
data.
22 The state data shown are from BRFSS, while the
national data, used to set the national target, are from
NHIS. National and state data may not be directly
comparable, and therefore, the national target may not
be applicable to the state data.
23 The obesity rates shown for states in the map are based
on self-reported weight and height and are from the
Behavioral Risk Factor Surveillance System. The national
data for NWS-9 are based on measured weight and height
from the National Health and Nutrition Examination
Survey and are the basis for setting the national target.
National and state data may not be directly comparable,
and therefore, the national target may not be applicable
to the state data.
24 The state data shown are from BRFSS, while the
national data, used to set the national target, are from
NHIS. National and state data may not be directly
comparable, and therefore the national target may not be
applicable to the state data

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