Major Accomplishments 2001

	On This Page • Reducing Risk Factors for Chronic Disease • Chronic Disease Prevention and Control • Maternal and Child Health • Comprehensive Approaches

Reducing Risk Factors for Chronic Disease

Preventing Tobacco Use 

In March 2001, the Surgeon General’s Report (SGR) Women and Smoking was released, presenting an update of the now massive body of evidence on the adverse effects of smoking on women’s health. Major findings show that, despite all that is known of the devastating health consequences of smoking, 22% of U.S. women smoked cigarettes in 1998, and 3 million women have died prematurely of smoking-related diseases since 1980. In addition, in 1987 lung cancer surpassed breast cancer as the leading cause of death among U.S. women. 

CDC’s involvement in a year-long communication plan for promoting the SGR and its findings yielded more than 1,500 national and local media stories about the report and an estimated 200 million audience impressions. In addition, the Internet search engine Yahoo! and HHS’s National Women’s Health Information Center launched new tobacco prevention Internet sites on the day of the SGR release. CDC also collaborated with the Oxygen television network to produce the video documentary Women and Tobacco: Seven Deadly Myths, hosted by Christy Turlington, a fashion model and antitobacco spokesperson, and featuring Dr. Virginia Ernster, senior scientific editor of the SGR. CDC is distributing the video and related resources to women’s groups across the country and worldwide to help them carry the messages of the SGR to their members.

Investing in Tobacco Control: A Satellite Video-Conference 

A precedent-setting national satellite video-conference entitled Investing in Tobacco Control: A Guide for State Decision Makers was held in February 2001; it was viewed at 312 sites in 47 states. The conference, which was a collaborative effort between CDC and the Public Health Training Network, enabled state and community leaders and public health professionals to share information on the importance and benefits of committing resources to comprehensive state tobacco control programs. About 3,000 viewers took part in the conference, including gubernatorial staff, state legislators and legislative staff, state health officials and health department staff, members and staff of state tobacco control foundations and commissions, partner organizations, officials involved in state budget issues, and community leaders. 

Investment in Tobacco Control: State Highlights 

One of the highlights of the video-conference was the release of Investment in Tobacco Control: State Highlights, 2001, a report on the prevalence of tobacco use, the health effects and costs associated with tobacco use, the funding for tobacco control, and tobacco excise taxes by state. The report, a tool for states to use in developing their own tobacco control programs, was the third State Highlights report released by CDC.

For the first time, the report included a compilation of states’ investments in tobacco control, specifically enabling states to compare their own efforts with those of other states. In addition to profiling funding amounts and sources for state tobacco control, the investment report looked at several other issues, including smoking prevalence among young people and adults, death rates from smoking, and per capita cigarette sales. 

Reaching Young People Through the Media 

As part of its efforts to improve health-related resources for parents, CDC launched a multimedia social marketing campaign called Got a Minute? Give It to Your Kid. The campaign is based on research that shows that certain parenting behaviors consistently build children’s ability to resist using tobacco and other drugs. The parenting kit includes print and radio advertisements, a parent education brochure, parenting tips and activity guides, and tips and resources for quitting smoking. It also features a PowerPoint presentation that focuses on ways parents can improve the odds that their children will say no to tobacco. It is designed for adaptation and use by state tobacco prevention specialists when they communicate with parents in their states and communities. CDC has begun developing an Hispanic version of the Got a Minute? campaign, which is being adapted to meet the unique needs and circumstances of Hispanic parents. 

Another CDC product is the Tobacco-Free Sports Playbook, a guide to help communities and youth sports officials pitch healthy lifestyles to children. It gives public health officials, youth coaches, and school administrators step-by-step advice on launching and sustaining campaigns to help kids say no to tobacco.

Spreading the Message Across Nations 

The National Tobacco Information On-line System (NATIONS) project is an electronically integrated information system containing country-specific information on a wide variety of tobacco control issues. A collaboration of CDC, the American Cancer Society, the World Health Organization, and the World Bank, the system includes profiles on 192 countries summarizing tobacco-related information on use prevalence, legislation, economics, agriculture, and other topics. NATIONS provides a standardized structure to monitor and assess the global effects of tobacco. It will assist in the design of international tobacco prevention and control initiatives, programs, and policies, and it will enhance future international tobacco surveillance and evaluation research. 

100 Black Men of America 

The “Nutrition and Physical Activity: the 100 Way” project is a curriculum-based intervention developed to complement the 100 Black Men of America (BMOA) curriculum guide. The goal of the project is to 1) educate and empower 11- to 18-year-old African American boys and young men who participate in 100 BMOA’s mentoring program and 2) assess and modify behavioral and environmental factors that put young black men at risk of engaging in inadequate physical activity and eating an inadequate amount of fruits and vegetables. 

To implement this project, CDC formed partnerships with the 100 BMOA, the Department of Agriculture’s Food and Nutrition Service, and the California Adolescent Nutrition and Fitness Program. In FY2001, the project was successfully piloted and evaluated at the Los Angeles, Dallas, and DeKalb County (Georgia) chapters of 100 BMOA.

The “Nutrition and Physical Activity: the 100 Way” curriculum guide will be disseminated to the 100 BMOA chapters, and training will be conducted during 100 BMOA’s Training for Mentors. 

National Blueprint: Increasing Physical Activity Among Adults Aged 50 or Older 

A national plan for increasing physical activity among adults aged 50 or older was released in May 2001. The press covered the release in 45 major media markets, which reach an audience of more than 6 million people. National Blueprint: Increasing Physical Activity Among Adults Aged 50 or Older grew out of the need for a framework for planning, collaborative action, and social change for organizations and agencies involved in physical activity or aging. Six partner organizations (American Association of Retired Persons, American College of Sports Medicine, American Geriatrics Society, National Institute on Aging, The Robert Wood Johnson Foundation, and CDC) worked to create the guidelines. National Blueprint is based on presentations and discussions at a conference held in October 2000, and it contains input and recommendations from about 50 interested organizations. National Blueprint suggests about 60 strategies for increasing physical activity in the home, community, and workplace. It also suggests topics for research and strategies for increasing physical activity through medical systems, policy change, and advocacy. A follow-up meeting of the participant organizations is planned for 2003 with a goal of assessing and promoting progress in implementing National Blueprint’s strategies. 

CDC is focusing on several strategies recommended in National Blueprint, mainly through partnerships. These strategies include

• Funding an evidence-based review of the literature of the health effects of physical activity on older adults.
• Disseminating information on evidence-based physical activity programs.
• Developing initiatives to assist health insurance plans in promoting physical activity among older people through such approaches as physician counseling.
• Working closely with The Robert Wood Johnson Foundation’s initiative to promote physical activity among older adults.
• Cosponsoring, with Health Canada, a major international conference on communication strategies to promote physical activity.

Developing a National Nutrition and Physical Activity Program 

During FY2001, CDC developed a national nutrition and physical activity program for preventing chronic diseases and obesity. Principal areas of increased activity were in support of state programs and of extramural applied research activities. CDC now provides support to 12 states for planning statewide nutrition and physical activity programs and conducting demonstration interventions, particularly through population-based strategies such as policy change, environmental support, and social marketing. Six new states received funds in FY2001: Colorado, Florida, Michigan, Montana, Pennsylvania, and Washington. State activities include 1) development of a plan for a selected priority population, 2) establishment of partnerships to carry out the plan, and 3) development, implementation, and evaluation of nutrition and physical activity intervention projects for the selected priority population. 

CDC funded a number of extramural applied research projects at CDC Prevention Research Centers and academic institutions. Research topics include 1) state-specific direct medical costs of obesity and physical activity, 2) strategies for a comprehensive nutrition and physical activity surveillance system, 3) use of the PRIZM software system to identify and profile high-risk lifestyle clusters related to unhealthy eating habits, and 4) a survey of communities to learn whether they are easy and safe places in which to walk or bicycle. During the year, a network of Prevention Research Centers was organized to explore the development of innovative nutrition and physical activity approaches to preventing chronic diseases and obesity.

CDC sponsored a 1-day meeting on August 20–21 entitled Designing State Comprehensive Nutrition and Physical Activity Programs. The meeting was attended by representatives from 48 states and by a number of external partners with interests in state physical activity and nutrition programs. During the meeting, workgroups met to discuss a series of questions related to the vision, goals, strategies, expertise, and collaborations necessary for a comprehensive program. The major themes from the discussion groups have been summarized and will serve as one of the components for planning future initiatives for nutrition and physical activity in state health departments.

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Chronic Disease Prevention and Control

Guidelines for Preventing Skin Cancer 

CDC is currently completing Guidelines for School Programs to Prevent Skin Cancer. The guidelines summarize strategies likely to reduce the risk for skin cancer among students aged 5 through 18 years. They focus on reducing risk through policy changes; environmental changes; and the education of children, adolescents, and their families. The Division of Cancer Prevention and Control and the Office on Smoking and Health work closely on this project. Input from various national partners also will be incorporated into revisions of the final document. The school guidelines focus on the following activities: 

• Educating young people through programs that are age-appropriate, linked to opportunities for practice, and part of comprehensive health education so that knowledge, attitudes, and behavioral skills about skin cancer prevention are improved. 
• Involving family members who can assist and support sun safety. 
• Providing professional development opportunities related to skin cancer prevention for administrators, teachers, coaches, and nurses. 
• Offering school health services that complement and support skin cancer prevention education (e.g., permission slips, reminders for sun safety). 
• Evaluating the process, impact, and outcomes of skin cancer prevention education in schools in order to improve the quality of programs and ensure accountability.

National Breast and Cervical Cancer Early Detection Program 

Data suggest mammography rescreening rates are low among National Breast and Cervical Cancer Early Detection Program (NBCCEDP) enrollees, despite their access to free examinations. Improving rescreening rates is difficult because the demographic, psychosocial, programmatic, and medical history factors that contribute to low rates are poorly understood. The Survey on Mammography Rescreening project was designed to accomplish two objectives: obtain valid estimates of mammography rescreening rates in the NBCCEDP and identify key risk factors for failure to rescreen on schedule. A retrospective cohort design with two cohorts was used to obtain study data. 

A total of 2,000 women (500 each from Maryland, New York, Ohio, and Texas) with a mammography result of negative or benign and a total of 500 women (125 from each of the four states) with a mammography result of probably benign were randomly sampled and invited to complete a telephone interview at least 30 months after their mammography in 1997. Mammography records were reviewed to confirm rescreening dates provided by the women during their interviews. All 2,500 interviewees were randomly selected from the NBCCEDP data files of the four states. Eligible interviewees were 50–69 years old in 1997 when they had an NBCCEDP-funded index mammography. 

The primary outcome measures are rescreening status 18 and 30 months after the mammography. Risk factors reviewed include the following: age, race/ethnicity, education, income, marital status, geographic mobility, social support, and mammography experiences. The 18-month rescreening rate among women with a negative or benign mammography was about 74%. Age, income, and marital status were not significant risk factors. Race/ethnicity, education, geographic mobility, and social support (including having received a rescreening reminder) were all associated with rescreening status. Several aspects of the mammography experience were also associated with having been rescreened, including reports that the radiologist was respectful, reassuring, and gentle.

NBCCEDP rescreening rates are comparable with those reported by other breast screening programs, but one of every four women was not rescreened within 18 months. Risk factor data 1) suggest subgroups of women who are less likely to be rescreened on schedule and 2) identify aspects of the index mammography experience that may influence women’s rescreening behavior. More analyses of data from this study are under way, and additional results are expected.

Healthy Aging 

The goal of CDC’s Aging States Project is to bring together the respective strengths and expertise of the public health and aging networks. Begun in spring 2001, this project is a cooperative activity of the Association of State and Territorial Chronic Disease Program Directors and the National Association of State Units on Aging, with assistance and joint funding provided by CDC and the Administration on Aging (AoA). Information gathered on health-related needs, activities, and partnerships related to older adults in state health departments and state units on aging will be used to guide AoA and CDC in charting critical next steps to address the health challenges of older adults.

To improve the health and quality of life of older Americans, CDC awarded nearly $900,000 in cooperative agreements with the National Council on Aging, National Institute for the Future of Aging Services, Older Women’s League, National Safety Council, American Association for Active Lifestyles and Fitness, and American Society on Aging. In partnership with CDC, these national organizations will establish a broad national strategy that brings together public health and the aging networks in order to promote healthy behaviors among older adults, decrease the effects of their injuries and chronic disease, and help them maintain function and independence. To accomplish these goals, special emphasis will be placed on strengthening the collaboration between state and local health departments and community organizations, identifying programmatic best practices in community-based health promotion and disease prevention, and developing consumer education tools and strategies that improve the health of older adults. 

Expanding the Arthritis Program 

Arthritis remains the leading cause of reported disability among adults. This year CDC’s Arthritis Program provided funds for arthritis programs at 29 state health departments, including four that had not previously received CDC funding. Working with the Center for Health Studies (a health services research division of Group Health of Puget Sound), we developed a systems change pilot project to improve disease management of people with arthritis—including self-management. 

Initial evaluation activities of the Arthritis Program focus on developing and improving the state arthritis programs. Working with our partners at the state programs, we developed an evaluation framework to measure resources, available data and data sources, partnership activities, and the state arthritis program’s plans. 

Improving Quality of Life for People with Epilepsy 

In many parts of the world, cysticercosis (an infection caused by the pork tapeworm) is recognized as the most common identifiable and preventable cause of epilepsy. Limited, preliminary studies in several American cities suggest that this may be an emerging problem in parts of the United States as well. In FY2001, CDC, in collaboration with National Center for Infectious Diseases, began epidemiologic studies of cysticercosis in selected communities in order to assess the associated risk of epilepsy and to develop primary prevention programs. 

In January 2001, an MMWR article reported on health-related quality of life issues for adults with epilepsy, according to data from the Behavioral Risk Factor Surveillance System in Texas. Respondents with epilepsy reported 4.4 more physically unhealthy days, 5.2 more mentally unhealthy days, and 6.4 more overall unhealthy days than those without epilepsy. Consequently, CDC expanded a cooperative agreement with the National Epilepsy Foundation to conduct a multifaceted public education and awareness campaign focusing on adolescents with epilepsy and their peers. The overarching goal of this activity is to fight stigma and to help children and teenagers with epilepsy to make a healthy adjustment to their condition and achieve a better quality of life. 

Heart Disease and Stroke 

In 2001, CDC convened the First National CDC Prevention Conference on Heart Disease and Stroke on August 22–24, 2001, in Atlanta, Georgia. In attendance were more than 400 participants, representing state health departments, federal agencies, national partners, and six countries. The focus was on building and expanding comprehensive state-based cardiovascular health programs with an overarching emphasis on partnership-building and environmental and policy interventions.

Also in 2001, the first funds were used for a stroke prevention activity at CDC: the Paul Coverdell National Acute Stroke Registry. Four stroke registry prototypes are being developed in Michigan, Massachusetts, Georgia, and Ohio to improve the quality of care provided to patients with acute stroke. 

Other new stroke activities at CDC include assessing public awareness of stroke symptoms through CDC’s database HealthStyles (September 2001); developing a map of geographic variations in stroke mortality for the CDC Web site and for dissemination to national and state partners during May 2001 (National Stroke Month); changing the focus of the Cardiovascular Health Branch from cardiovascular disease prevention to prevention of heart disease and stroke; supporting the Tri-State Stroke Network in North Carolina, South Carolina, and Georgia; and participating in several national and regional stroke-prevention conferences. CDC has also sponsored a National Stroke Association workshop for state health departments and other key partners who will meet in May 2002 to develop a national stroke-prevention plan.

Prevention Research Centers

In 2001, two new Prevention Research Centers (PRCs) were funded through an open, peer-reviewed competition. The two new research centers are at Boston University (theme: “improving the well-being of public housing residents”) and the University of Pittsburgh (theme: “promoting health among older adults”). Thanks to continued support for this program, the number of PRCs has reached 26. Thirty-six new Special Interest Projects (SIPs) were funded through PRC cooperative agreements for a total of $7.4 million. These SIPs support health promotion and disease prevention activities in the areas of aging, asthma, cardiovascular disease, maternal and child health, nutrition, ovarian and prostate cancer, physical activity, and public health services research. In collaboration with the Association of Schools of Public Health, the Prevention Research Centers Program has established a 2-year fellowship for doctoral students from ethnic or racial minorities. This fellowship offers promising public health professionals hands-on experience with projects directed by the PRCs, exposure to state-of-the-art prevention research, and the opportunity to translate and apply their knowledge to real situations that need public health research and intervention. This fellowship program expands the cadre of future public health professionals uniquely qualified to work with distinct ethnic or racial groups.

Reducing Racial and Ethnic Health Disparities

CDC awarded cooperative agreements to seven new community coalitions to implement and evaluate their Community Action Plans through the REACH (Racial and Ethnic Approaches to Community Health) 2010 demonstration program. This brings the number of REACH 2010 community projects to 33, which includes two projects funded by the California Endowment. Of these projects, 22 address cardiovascular disease or diabetes, 5 address breast and cervical cancer screening and management, 2 address HIV/AIDS, 2 address infant mortality, and 2 address adult or childhood immunizations. About 90% of the projects serve African Americans or Hispanics, and the rest serve Asians, Pacific Islanders, or American Indians.

CDC consulted with federal partners to design a comprehensive evaluation logic model to guide the evaluation of the REACH 2010 program. The logic model has five distinct stages: 1) capacity building, 2) targeted action, 3) community and systems change, and change among change agents, 4) widespread risk or protective behavior change, and 5) health disparity reduction.

During the past year, one contractor worked with 21 communities collecting data about risk and protective behaviors, resulting in more than 5,000 completed interviews so far. A second contractor was selected to assist communities in warehousing qualitative data related to stages 1 through 3 (i.e., capacity building; development of targeted actions; and community and systems level change, and change among change agents). The data warehouse tool, to be developed by the contractor, will be an Internet interactive system that will help with local data collection, systematic data storage, and data retrieval by CDC and the grantees.

In addition to the 33 REACH 2010 projects, under a new program, CDC awarded cooperative agreements to five organizations that serve American Indians and Alaskan Natives. Through this new program, selected American Indian and Alaskan Native communities have the opportunity to build core capacity and to augment existing programs to reduce disparities in health outcomes in one or more of the designated health areas (i.e., cardiovascular disease, diabetes, breast and cervical cancer screening and management, HIV/AIDS, infant mortality, and immunization).

In addition to working through REACH to eliminate racial and ethnic disparities in health, CDC has directed that each CDC program work toward eliminating such disparities associated with the particular health problem that program is working to prevent or control. For example, one goal of the Office on Smoking and Health is to eliminate disparities in the health effects of tobacco use, and one goal of the National Breast and Cervical Cancer Early Detection Program is to eliminate disparities in the incidence of breast and cervical cancer. 

Reducing the Burden of Asthma

CDC has expanded programs to enable the nation’s schools to reduce the burden of asthma among young people. The following are the major objectives: 

• To build partnerships among relevant national, state, and local governmental agencies and nongovernmental organizations.
• To enable the nation’s schools to implement interventions to prevent asthma.
• To focus especially on large urban school districts where at least 75% of the students belong to a racial or ethnic minority.
• To reduce classroom absences due to asthma.
• To reduce the growing burden of asthma. 

The Youth Media Campaign

In FY2001, CDC expanded state and local education agency programs to include media messages to improve the health of schoolchildren; increase the time preteenagers spend in physical activity; and increase the number of adults who participate with preteenagers in positive activities. CDC was also able to expand partnerships with eight national nongovernmental organizations in order to build a broad national strategy to help schools and communities nationwide implement activities that reinforce Youth Media Campaign messages and promote healthy activity (especially physical activity) among young people. Listed below are the funded organizations: 

• Association of State and Territorial Health Officials.
• Comprehensive Health Education Foundation.
• Inner-City Games Foundation.
• National Association for Sport and Physical Education.
• National Coalition for Promoting Physical Activity.
• National Recreation and Parks Association.
• Pedestrian and Bicycle Information Center.

School Health Policies and Programs Study 2000

On September 19, 2001, CDC released the results of its School Health Policies and Programs Study 2000 (SHPPS 2000), the largest and most comprehensive assessment of school health programs ever undertaken. SHPPS 2000 measured the characteristics of eight school health program components: 

• Health education.
• Physical education and activity.
• Food service.
• Health services.
• Mental health and social services.
• School policy and environment.
• Faculty and staff health promotion.
• Family and community involvement. 

Data were collected from all 50 states. Included are data from a national sample of school districts; a national sample of elementary, middle/junior high, and senior high schools; and national samples of required health education and physical education classes and courses. SHPPS 2000 data are being used to measure progress toward seven Healthy People 2010 objectives and to assess national education goals. The data will also support public and private school health programs while helping parents and educators determine how their school health policies and programs compare with schools nationwide. SHPPS 2000 data were released in a special issue of the Journal of School Health that comprises 10 articles, a state-by-state summary of school health policies, and 10 fact sheets. More information about SHPPS 2000 can be found on the Internet at http://www.cdc.gov/shpps.

School Health Guidelines to Prevent Unintentional Injuries and Violence

More than two-thirds of all deaths of children and adolescents (5–19 years old) result from injury-related causes: motor vehicle crashes, other unintentional incidents, homicide, and suicide. Therefore, schools must prevent injuries from occurring on school property and at school-sponsored events, and they must teach lifelong skills that promote safety and prevent unintentional injuries, violence, and suicide while at home, at work, at play, and in the community. 

School Health Guidelines to Prevent Unintentional Injuries and Violence, to be released in the near future, summarizes school health recommendations for preventing unintentional injury, violence, and suicide among young people. The guidelines were developed by CDC in collaboration with experts from universities and from national, federal, state, local, and voluntary agencies and organizations. The guidelines include recommendations related to eight aspects of school health programs to prevent unintentional injury, violence, and suicide:

• A social environment that promotes safety.
• A safe physical environment. 
• Health education curricula and instruction. 
• Safe physical education, sports, and recreational activities. 
• Health, counseling, psychological, and social services for students. 
• Appropriate crisis and emergency response. 
• Involvement of families and communities. 
• Staff development to promote safety and prevent unintentional injuries, violence, and suicide.

Responding to Childhood Diabetes: The SEARCH for Diabetes in Youth 

SEARCH for Diabetes in Youth is a 5-year, multicenter study to develop a uniform population-based approach in the United States to diabetes among children and adolescents aged 0–19 years old at diagnosis. It will include finding out the number of children with diabetes and the type of diabetes they have. SEARCH is sponsored by CDC and supported by the National Institute of Diabetes and Digestive and Kidney Diseases. Key elements of the 5-year study are the diversity of the population and uniformity of type classification. Combined, the centers have a target population of about 4.5 million children (about 6% of all American children), more than 6,000 existing cases, and about 800 new cases a year. Six clinical centers were chosen to conduct the study under a cooperative agreement. The objectives of SEARCH are as follows: 

• To develop efficient and practical approaches to classifying diabetes type.
• To determine the magnitude of diabetes and the various types of diabetes (type 1, type 2, or other type).
• To determine the risk factors for microvascular complications (those that affect the smallest blood vessels such as those in the eye) and macrovascular complications (those that affect large blood vessels such as those in the heart).
• To determine the presence of acute complications (those that begin abruptly and last a short time) and chronic complications (those that last a long time).
• To describe health care use, processes of care, and the quality of life of children and adolescents with diabetes.

The United States and Mexico Binational Diabetes Collaborative Project

The project involves four U.S. and six Mexican states along the border. Diabetes program representatives for all 10 U.S. or Mexican states met in August 1998 in Juarez, Mexico, to agree on the protocols to conduct a household diabetes surveillance study along the U.S.-Mexico border. The project goal is to reduce the burden of diabetes among people living in that region. This region has been identified as an epidemiologic unit that stretches 100 kilometers (60 miles) from each side of the frontier. The project is in phase I, during which a household survey is being conducted on diabetes, risk-factor lifestyle choices, and health-seeking behaviors of the population. The findings will serve as the baseline for program-planning evaluation for phase II, during which community-intervention pilot projects will be set up in communities along the U.S.-Mexico border. This project is a collaboration among CDC; the Mexico Health Ministry; the Office of International and Refugee Health, Pan American Health Organization (through their field office in El Paso, Texas); state diabetes control programs; community organizations; and Texas and California foundations.

Diabetes and Women’s Health

CDC recently published a monograph entitled Diabetes & Women’s Health Across the Life Stages: A Public Health Perspective, which focuses on the issues that make diabetes a serious public health problem for women. This landmark document examines the influence of psychosocial, socioeconomic, and environmental factors on the health behaviors and health outcomes of women with diabetes during their adolescent years, reproductive years, middle years, and elder years. Now joined by the American Diabetes Association, the American Public Health Association, and the Association of State and Territorial Health Officials, CDC works with a task force of organizations from the public, private, and voluntary sectors to develop a national public health action plan for diabetes and women. The plan will outline approaches for responding to the health, social, and environmental challenges that face women of all ages with diabetes. The plan is intended to garner the attention of policy makers, health professionals, the public health community, women’s health advocates, and the general public. 

Management Information System

The Diabetes Management Information System enables CDC project officers, state officials, and other interested parties to share information on diabetes and related programs. The system’s central Internet interface generates reports, answers queries, standardizes reporting procedures, consolidates program information, and fosters continuity throughout the diabetes community. Depending on need, the system allows users varying degrees of access, from limited read-only access to full recording privileges. The system will ensure that stored information is accessible yet secure. It also provides users with detailed search capabilities to develop reports using key words. The system can also analyze reports and 1) provide data on the performance of individual diabetes control programs, 2) provide data on the overall performance of all diabetes control programs, and 3) allow an individual program to compare its results with the overall results. 

Building a Program to Strengthen State Oral Health Core Capacity

In FY2001, to reduce health disparities, CDC developed a new program designed to strengthen core state oral health infrastructure and capacity as well as support programs targeting prevention of tooth decay in high-risk groups to reduce health disparities. This program responds to the findings in the Association of State and Territorial Dental Directors’ (ASTDD) report Building Infrastructure and Capacity in State and Territorial Oral Health Programs, which found serious weaknesses in states’ capacity to perform core public health functions and reach the Healthy People 2010 oral health objectives. Along with Oral Health in America: A Report of the Surgeon General, the ASTDD report recommended developing or enhancing core capacity, including oral health program leadership and additional staff in order to monitor oral health behaviors and status, improve public health services, and evaluate prevention programs within state, territorial, or tribal health departments. 

“Support State Oral Disease Prevention Programs” is a CDC project that provides $1.2 million in 5-year cooperative agreements to five states (Arkansas, Illinois, Michigan, Nevada, and New York) and one territory (The Republic of Palau) to strengthen their oral health programs and reduce inequalities in the oral health of their residents. Arkansas received additional funding to improve community water fluoridation, and Nevada received funding for school-based/school-linked dental sealant programs. The program is a model for building state infrastructure and capacity to provide preventive oral health service; it will be used to develop a national strategy for comprehensive state oral health programs.

Building the Science Base for Fluoride Use, and Promoting Prevention Methods

“Recommendations for the Use of Fluoride to Prevent and Control Dental Caries in the United States” was published as an MMWR Report and Recommendation (MMWR 2001;50, RR-14) on August 17, 2001. The recommendations provide guidance to dental and other health care providers, public health officials, policy makers, and the public on the use of fluoride to achieve maximum protection against dental decay, while using resources efficiently and reducing the risk for enamel fluorosis. 

Also published in 2001 were two articles reporting the cost-effectiveness of water fluoridation. They show that, in communities with populations larger than 20,000, every $1 spent on community water fluoridation saves $38, on average, in dental treatment. In states with a higher prevalence of fluoridation, some benefit also extends to people in nonfluoridated communities. 

The Task Force on Community Preventive Services issued a strong recommendation for two interventions: community water fluoridation and school dental sealant programs. Together, these newest publications provide a solid foundation of evidence for fluoride-related prevention interventions.

National Oral Health Surveillance System 

The Internet-based National Oral Health Surveillance System (NOHSS) was implemented in January 2001 to provide some oral health data for each of the 50 states. Previously, there was an almost complete lack of state data on oral health. Working with the Association of State and Territorial Dental Directors (ASTDD), CDC designed NOHSS to help public health programs monitor the burden of oral disease, the use of the oral health care delivery system, and the status of community water fluoridation on a state and national level. This integrated system includes information on four of the eight basic oral health surveillance indicators that were approved by the Council of State and Territorial Epidemiologists. Data are obtained from five sources: the Behavioral Risk Factor Surveillance System, the National Health and Nutrition Examination Survey III, the National Health Interview Survey, the Fluoridation Census, and ASTDD’s Annual Synopses of State Dental Programs. The NOHSS Web site also has links to other important oral health information. 

CDC continued to work with ASTDD and CDC’s Information Resources Management Office to improve the Water Fluoridation Reporting System (WFRS), a Web-based component of NOHSS, which allows state dental directors and water system managers to track the quality of their water fluoridation programs. A major software update was launched in April 2001 to increase accessibility to this system. The updated features allow users to monitor water system quality by region within their jurisdiction and to create new types of reports that will improve management of the water systems. Using year-end funding, CDC began building a public access Internet site for some data from the WFRS database. This public site is scheduled for launch in 2002. 

These new Web systems allow states to collect standardized information on the oral health status of their populations and will assist in tracking some Healthy People 2010 objectives on oral health. Having these tools available through the Internet not only provides wide access to key indicators of health status and public health programs, but also facilitates comparisons between states. It is expected that these major instruments will have profound effects on oral health. Because they are key steps in promoting surveillance, they may even encourage states 1) to emulate the states with the highest standards in oral health and 2) to strive to attain the status of the leading states in oral health.

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Maternal and Child Health

The National Summit on Safe Motherhood: Investing in the Health of Women

CDC convened this national meeting on women’s health and pregnancy. More than 300 participants from academic institutions, clinical practice, advocacy groups, professional organizations, businesses, and health departments attended the meeting. The Summit featured presentations and discussions on complex issues that could be addressed through CDC’s Safe Motherhood program. The Executive Planning Committee for the conference included more than 50 representatives of governmental and nongovernmental organizations, including professionals and advocates involved in research and policy making. 

Initial responses to the Summit included requests for long- and short-term partnerships in research and program development. Evolving partnerships support the development of recommendations for pregnant women who are exposed to Bacillus anthracis (the organism that causes anthrax) as well as technical assistance requests from programs dealing with the aftermath of acts of terrorism. Postsummit activities are being planned to develop a comprehensive research agenda for Safe Motherhood in the 21st century. 

Expanding the Pregnancy Risk Assessment Monitoring System

Funding from the Child Health Act of 2000 enabled CDC to expand the Pregnancy Risk Assessment Monitoring System (PRAMS), which monitors of the health of women before, during, and after pregnancy. Six states received funds for the core PRAMS program (Michigan, Minnesota, New Jersey, Oregon, Rhode Island, and Texas). Three other projects are expanding state capacity (Colorado) or conducting point-in-time surveys (Montana and North Dakota). With this expansion, PRAMS data collection activities cover 62% of U.S. births. PRAMS data continued to be used effectively in FY2001: for example, Alaska used PRAMS data to examine unintended pregnancy, resulting in decisions to expand family planning services in specific areas of the state and to focus on specific groups of women. 

Global Health: Reproductive Health Surveys and Scientific Assistance

During FY2001, CDC provided a great deal of assistance to other nations through agreements with USAID and other organizations. For example, the CDC WHO Collaborating Center for Reproductive Health produced the Healthy Newborn Manual, a reference manual for program managers. This manual, currently in press, provides technical and scientific information needed by managers of women’s health and pediatric programs in developing nations. CDC also assisted the Russian Federation in conducting a study on congenital syphilis among women who give birth in maternity houses. Results of these studies are leading to policy reforms for prenatal care and collaboration among health professionals. In Pakistan, CDC researchers provided scientific assistance to investigate mortality among women in an Afghan refugee program. This study provided new insights concerning the reproductive health of Afghan women of childbearing age both before and during the time they were refugees.

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Comprehensive Approaches

Behavioral Risk Factor Surveillance System

On June 25, 2001, CDC’s Behavioral Surveillance Branch (BSB) received the Outstanding Scientific Contribution to Public Health Award. This is a new category within the Charles C. Shepard Award program, and BSB was the first recipient. This award recognized 1) the collaboration between BSB and all 50 states in monitoring health risk behaviors, clinical preventive health practices, and health care access—primarily related to U.S. adults’ risk for chronic disease or injury and 2) the significant effect of data obtained through the joint collaboration on public health practice. 

The Behavioral Risk Factor Surveillance System (BRFSS) was implemented in 1984, when awards totaling $750,000 were issued to 19 states. In FY2000, the number of programs in the BRFSS grew to 54, to include all states, the District of Columbia, the Virgin Islands, Puerto Rico, and Guam; the total awarded was $6,137,500. With a new budget period beginning on October 1, 2001, awards of $8,606,182 were provided to 54 surveillance programs. 

Important databases were established or will be on-line prior to the end of FY2001: 

• The BRFSS Historical Question Database (http://apps.nccd.cdc.gov/BRFSSQuest/) includes all research questions for the BRFSS surveys from 1984 to the present. Information in the database includes exact wording of questions, response categories, and changes over time. Researchers can search this site for questions used on the core and official modules in a variety of topic areas: activity limitations, alcohol, arthritis, asthma, cardiovascular disease, cancer, demographics, diabetes, health care access, immunization, exercise, and nutrition. Through a link, users can contact state BRFSS coordinators for information about questions added to the survey by the states. Through an additional set of links, users can contact specialists at CDC to get information on questions specific to a program area such as diabetes or cancer. 
• The BRFSS Interviewer Training is designed to provide a distance learning opportunity for interviewers in every BRFSS state and territory. The first section of the training introduces the role of the interviewer in survey research and describes how the data are used. Three additional sections set out the interviewer’s responsibilities, describe the requirements for high-quality data collection, and offer ideas for dealing with interviewing problems.

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This page last reviewed August 17, 2004

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