# 19 {#section .Chapter-# .unnumbered}

# Nutrition and Overweight

#### Weight Status and Growth

19-1 Healthy weight in adults

19-2 Obesity in adults

19-3 Overweight or obesity in children and adolescents

19-3a Aged 6 to 11 years

19-3b Aged 12 to 19 years

19-3c Aged 6 to 19 years

19-4 Growth retardation in children

#### Food and Nutrient Consumption

19-5 Fruit intake

19-6 Vegetable intake

19-7 Grain product intake

19-8 Saturated fat intake

19-9 Total fat intake

19-10 Sodium intake

19-11 Calcium intake

#### Iron Deficiency and Anemia

19-12 Iron deficiency in young children and in females of childbearing
age

19-12a Children aged 1 to 2 years

19-12b Children aged 3 to 4 years

19-12c Nonpregnant females aged 12 to 49 years

19-13 Anemia in low-income pregnant females

19-14 Iron deficiency in pregnant females

#### Schools, Worksites, and Nutrition Counseling

19-15 Meals and snacks at school

19-16 Worksite promotion of nutrition education and weight management

19-17 Nutrition counseling for medical conditions

#### Food Security

19-18 Food security

### Weight Status and Growth

  ---------------------- ------------------------------------------------
  19-1. Increase the     
  proportion of adults   
  who are at a healthy   
  weight.                

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Behavioral Risk Factor Surveillance System
                         (BRFSS), CDC, NCCDPHP. (See Comments.)

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent (age adjusted---see Comments).

  **Baseline**           42 (1988--94).

  **Numerator**          Number of persons aged 20 years and older with a
                         BMI equal to or greater than 18.5 and less than
                         25.0.

  **Denominator**        Number of persons in the survey population aged
                         20 years and older.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           The NHANES obtains measured weights and heights
                         without shoes. BMI is calculated by dividing
                         weight in kilograms by the square of height in
                         meters.

                         The selection of a BMI cut-point to establish
                         the healthy weight range is based on the
                         relationship of overweight or obesity to disease
                         or death. A BMI of less than 25 has been
                         accepted by numerous groups as the upper limit
                         of the healthy weight range, because more
                         disease occurs in most populations at or above
                         this cut-point.**^1,\ 2,\ 3,\ 4^** The lower
                         cut-point for the healthy weight range (BMI of
                         18.5) was selected to be consistent with
                         national and international
                         recommendations.**^1,\ 3,\ 4^**

                         Data are age adjusted to the 2000 standard
                         population. Age-adjusted percents are weighted
                         sums of age-specific percents. For a discussion
                         of age adjustment, see Part A, section 5.

                         State-level data on self-reported heights and
                         weights are collected annually in BRFSS for
                         adults aged 18 years and older. This data source
                         enables States to estimate the proportion of the
                         population that reports heights and weights in
                         the healthy range and to track trends, although
                         the method of measurement (through telephone
                         interview) differs from the national measures.
                         Body weight prevalence estimates derived from
                         self-reported heights and weights tend to be
                         lower than those derived from measured height
                         and weight.

                         See Part C for a description of NHANES and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  19-2. Reduce the       
  proportion of adults   
  who are obese.         

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Behavioral Risk Factor Surveillance System
                         (BRFSS), CDC, NCCDPHP. (See Comments.)

  **Healthy People 2000  Adapted from 2.3 (Nutrition) (also 1.2, 15.10,
  Objective**            17.12).

  **Leading Health       Overweight and Obesity.
  Indicator**            

  **Measure**            Percent (age adjusted---see Comments).

  **Baseline**           23 (1988--94).

  **Numerator**          Number of persons aged 20 years and older with a
                         BMI at or above 30.0.

  **Denominator**        Number of persons in the survey population aged
                         20 years and older.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           NHANES obtains measured weights and heights
                         without shoes. BMI is calculated by dividing
                         weight in kilograms by the square of height in
                         meters.

                         BMI will be used as a proxy for overweight and
                         obesity in adults until a better measure of body
                         fat is developed. In 1997, a Consultation on
                         Obesity convened by the World Health
                         Organization recommended standardizing the
                         classification of overweight and obesity.**^5^**
                         Overweight was defined as a BMI of 25.0 or
                         greater and obesity was defined as a BMI of 30.0
                         or greater. Further classification of obesity
                         was made as follows: 30.0-34.9 was defined as
                         Class I obesity, 35.0-39.9 as Class II, and 40.0
                         or greater as Class III.

                         The Expert Panel on the Identification,
                         Evaluation, and Treatment of Overweight and
                         Obesity in Adults, convened by NIH, recently
                         adopted general concepts of the World Health
                         Organization classification system**^1,\ 5^**
                         and it has now been endorsed by more than 50
                         professional medical societies, consumer groups,
                         and government agencies. For this objective,
                         therefore, a BMI cutoff point of 30.0 was chosen
                         for adults aged 20 years and older. Since 1960,
                         essentially all of the increased prevalence of
                         overweight and obesity in adults in the United
                         States has occurred at a BMI greater than or
                         equal to 30.0.**^1,\ 5,\ 6^**

                         Data are age adjusted to the 2000 standard
                         population. Age-adjusted percents are weighted
                         sums of age-specific percents. For a discussion
                         of age adjustment, see Part A, section 5.

                         State-level data on self-reported heights and
                         weights are collected annually in BRFSS for
                         adults, but are not comparable to the national
                         statistics. These data enable States to estimate
                         the proportion of the population that reports
                         heights and weights in the obese range and to
                         track trends, although the method of measurement
                         (through telephone interview) differs from the
                         national measures. Body weight prevalence
                         estimates derived from self-reported heights and
                         weights tend to be lower than those derived from
                         measured height and weight.

                         This objective differs from Healthy People 2000
                         objective 2.3 (Nutrition), which defined
                         overweight as a BMI greater than or equal to
                         27.8 for men and 27.3 for women. The values used
                         for Healthy People 2000 corresponded with the
                         gender-specific 85th percentile of the 1976--80
                         NHANES II reference population 20 to 29 years of
                         age and were not age adjusted.

                         This objective is one of the measures used to
                         track the Overweight and Obesity Leading Health
                         Indicator. See Appendix H for a complete list.

                         See Part C for a description of NHANES and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

19-3. Reduce the proportion of children and adolescents who are
overweight or obese.

  ---------------------- ------------------------------------------------
  19-3a. Children aged 6 
  to 11 years.           

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 2.3 (Nutrition) (also 1.2, 15.10,
  Objective**            17.12).

  **Measure**            Percent.

  **Baseline**           11 (1988--94).

  **Numerator**          Number of children aged 6 to 11 years with a BMI
                         at or above the gender- and age-specific 95th
                         percentile from the CDC Growth Charts: United
                         States.

  **Denominator**        Number of children in the survey population aged
                         6 to 11 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           The NHANES obtains measured weights and heights
                         without shoes. BMI is calculated by dividing
                         weight in kilograms by the square of height in
                         meters.

                         BMI will be used as a proxy for overweight and
                         obesity in children and adolescents until a
                         better measure is developed.**^7^** There is a
                         prepubertal increase in subcutaneous fat that is
                         lost during adolescence in boys, while in girls
                         fat deposition continues. There also is a
                         differential increase in muscle (or lean body
                         mass) by gender during puberty. Thus, without
                         measures of sexual maturity, measures of body
                         fat and body weight are equally difficult to
                         interpret in preadolescents and adolescents.

                         In 2000, the 1977 NCHS Growth Charts were
                         revised to consider additional large, nationally
                         representative samples of children aged 2 to 20
                         years from the 1976--80 NHANES and the 1988--94
                         NHANES and to provide BMI for age in lieu of
                         weight for age.**^8^** When extrapolated to age
                         20 years, the gender- and age-specific 95th
                         percentile of BMI from the Revised CDC Growth
                         Charts approximates a BMI of 30. Thus, the 95th
                         percentiles of BMI for children aged 6 to 11
                         years and for adolescents aged 12 to 19 years
                         were chosen to estimate the prevalence of
                         overweight and obesity for this objective. The
                         CDC Growth Charts can be found on the Internet
                         at http://www.cdc.gov/growthcharts.

                         In addition to the revised measure, this
                         objective differs from Healthy People 2000
                         objective 2.3, which did not track overweight in
                         children aged 6 to 11 years.

                         See Part C for a description of NHANES and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  19-3b. Adolescents     
  aged 12 to 19 years.   

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 2.3 (Nutrition) (also 1.2, 15.10,
  Objective**            17.12).

  **Measure**            Percent.

  **Baseline**           11 (1988--94).

  **Numerator**          Number of adolescents aged 12 to 19 years with a
                         BMI at or above the gender- and age-specific
                         95th percentile from the CDC Growth Charts:
                         United States.

  **Denominator**        Number of adolescents in the survey population
                         aged 12 to 19 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           State-level data on self-reported heights and
                         weights are collected biennially in the Youth
                         Risk Behavior Surveillance System (YRBSS) for
                         adolescents in grades 9 through 12. This data
                         source enables States to estimate the proportion
                         of this population that reports heights and
                         weights in the overweight and obese ranges and
                         to track trends, although the methods of
                         measurement differ from the national measure.
                         Body weight prevalence estimates derived from
                         self-reported heights and weights tend to be
                         lower than those derived from measured height
                         and weight.

                         See Comments provided with objective 19-3a for
                         more information on the methods of calculation.

                         This objective differs from Healthy People 2000
                         objective 2.3, which defined overweight for
                         adolescents based on modified age- and
                         gender-specific 85th percentile values of the
                         1976--80 NHANES II. For adolescents, overweight
                         was defined as a BMI equal to or greater than
                         23.0 for males aged 12 to 14 years, 24.3 for
                         males aged 15 to 17 years, 25.8 for males aged
                         18 to 19 years, 23.4 for females aged 12 to 14
                         years, 24.8 for females aged 15 to 17 years, and
                         25.7 for females aged 18 to 19 years.

                         See Part C for a description of NHANES and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  19-3c. Children and    
  adolescents aged 6 to  
  19 years.              

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 2.3 (Nutrition) (also 1.2, 15.10,
  Objective**            17.12).

  **Leading Health       Overweight and Obesity.
  Indicator**            

  **Measure**            Percent.

  **Baseline**           11 (1988--94).

  **Numerator**          Number of children and adolescents aged 6 to 19
                         years with a BMI at or above the gender- and
                         age-specific 95th percentile from the CDC Growth
                         Charts: United States.

  **Denominator**        Number of children and adolescents in the survey
                         population aged 6 to 19 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           See Comments provided with objective 19-3a for
                         more information on methods of calculation and
                         see objective 19-3b for more information on
                         State-level data.

                         This objective differs from Healthy People 2000
                         objective 2.3, which defined overweight for
                         adolescents based on modified age- and
                         gender-specific 85th percentile values of the
                         1976--80 NHANES II. For adolescents, overweight
                         was defined as a BMI equal to or greater than
                         23.0 for males aged 12 to 14 years, 24.3 for
                         males aged 15 to 17 years, 25.8 for males aged
                         18 to 19 years, 23.4 for females aged 12 to 14
                         years, 24.8 for females aged 15 to 17 years, and
                         25.7 for females aged 18 to 19 years.

                         This objective is one of the measures used to
                         track the Overweight and Obesity Leading Health
                         Indicator. See Appendix H for a complete list.

                         See Part C for a description of NHANES and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  19-4. Reduce growth    
  retardation among      
  low-income children    
  under age 5 years.     

  **National Data        Pediatric Nutrition Surveillance System
  Source**               (PedNSS), CDC, NCCDPHP.

  **State Data Source**  Pediatric Nutrition Surveillance System
                         (PedNSS), CDC, NCCDPHP.

  **Healthy People 2000  2.4 (Nutrition).
  Objective**            

  **Measure**            Percent.

  **Baseline**           8 (1997) (preliminary) (selected sites---see
                         Comments).

  **Numerator**          Number of low-income children under age 5 years
                         who are below the 5th percentile of height for
                         age.

  **Denominator**        Number of low-income children under age 5 years.

  **Population           Selected sites---see Comments.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           For the preliminary baseline estimates, growth
                         retardation is defined as height for age below
                         the 5th percentile in the age-gender-appropriate
                         reference population using the 1977 NCHS Growth
                         Charts (that is, data from the Fels Research
                         Institute and the 1971--74 NHANES).**^9^**

                         The 1997 baseline estimates were obtained from
                         PedNSS, which collects annual data from
                         participating States on growth retardation among
                         low-income children. These data are collected
                         from low-income, high-risk infants and children
                         who participate in publicly funded health,
                         nutrition, and food assistance programs such as
                         WIC; the Early Periodic Screening, Diagnosis,
                         and Treatment program; and clinics funded by
                         Maternal and Child Health Program Block Grants.

                         In 1997, 44 States, the District of Columbia,
                         and five Tribal governments provided data for
                         tracking growth retardation nationally. Data can
                         also be analyzed at clinic, county, and State
                         levels. Estimates from PedNSS are not based on a
                         nationally representative sample. Participation
                         in publicly funded programs in a State can vary
                         from year to year and can be affected by
                         fluctuating resources. Further, the number of
                         participating States and Tribal governments in
                         PedNSS has varied from year to year. The
                         fluctuations in the scope of surveillance can
                         affect the representation and comparability of
                         estimates.

                         The final national estimates used to track this
                         objective will differ from Healthy People 2000
                         objective 2.4 because they will be based on the
                         revised CDC Growth Charts and not the 1977 NCHS
                         Growth Charts.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

### Food and Nutrient Consumption

Objectives 19-5 to 19-11 address the proportion of the population that
consumes specified levels of foods (fruit, vegetables, grain products)
and nutrients (fat, sodium, and calcium), based on the recommendations
of the 2000 *Dietary Guidelines for Americans*.**^4^** Recommendations
for food and nutrient intake are not intended to be met every day, but
rather on average over a span of time. However, the national surveys
used to track these objectives have, in recent years, collected no more
than 2 days of dietary data. Accordingly, the baseline estimates for
these dietary intake objectives reflect either 2-day averages or the use
of statistical adjustment procedures to estimate usual intake for
population groups. It is also important to track and report mean intakes
by different population groups. Estimates of mean intakes provide a
measure of central tendency that is not conveyed by the proportion
meeting the objective and tend to be more stable. Optimally, tracking
data should also include an assessment of trends with regard to at-home
versus away-from-home eating.

For the food intake objectives, the 1994--96 CSFII was chosen to provide
baseline estimates because it contained the most recent national survey
data available for intake estimates that account for the contribution of
foods used as ingredients in mixtures. This survey was also chosen to
provide baseline estimates for the fat and saturated fat intake
objectives because it provided the most recent national estimates. In
contrast, the 1988--94 NHANES was chosen to provide baseline estimates
for the sodium and calcium objectives because it provides total nutrient
intake estimates that account for the contribution of dietary
supplements as well as other nonfood sources of these nutrients.

In the early 2000s, the dietary components of CSFII and NHANES will be
merged into one National Food and Nutrition Survey (NFNS). This survey
will be used to provide update estimates for all of the food and
nutrient consumption objectives, with the potential for annual updates
for larger population segments and multiyear updates for smaller
segments.

+---------------------+------------------------------------------------+
| 19-5. Increase the  |                                                |
| proportion of       |                                                |
| persons aged 2      |                                                |
| years and older who |                                                |
| consume at least    |                                                |
| two daily servings  |                                                |
| of fruit.           |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Continuing Survey of Food Intakes by           |
| Source**            | Individuals (CSFII), USDA, ARS.                |
+---------------------+------------------------------------------------+
| ###                 | Behavioral Risk Factor Surveillance System     |
| ### State Data Sour | (BRFSS), CDC, NCCDPHP and Youth Risk Factor    |
| ces {#state-data-so | Surveillance System (YRBSS), CDC, NCCDPDP.     |
| urces .Heading6THP} | (See Comments.)                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 2.6 (Nutrition) (also 16.8).      |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 28 (1994--96).                                 |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of persons aged 2 years and older who   |
|                     | report consuming two or more servings of fruit |
|                     | daily (based on a 2-day average).              |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons in the survey population     |
|                     | aged 2 years and older.                        |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1994--96 Continuing Survey of Food    |
| Obtain the National | Intakes by Individuals:                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | The 1994--96 CSFII included the collection of  |
|                     | 2 nonconsecutive days of dietary data through  |
|                     | in-person 24-hour recalls.**^10^** Each        |
|                     | respondent was asked to recall the kinds and   |
|                     | amounts of foods eaten at home and away from   |
|                     | home during the previous day. Amounts of foods |
|                     | reported in household measures were then       |
|                     | converted to gram amounts.                     |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The definitions for fruit and for serving      |
|                     | sizes were derived from the 1995 Dietary       |
|                     | Guidelines,**^11^** the Food Guide Pyramid     |
|                     | (http://www.usda.gov/cnpp;pyramid2.htm), and   |
|                     | related documentation, and estimates were      |
|                     | calculated using the USDA Pyramid Servings     |
|                     | Database. The intakes of fruit servings were   |
|                     | modified for children aged 2 to 3 years. The   |
|                     | modification was accomplished by multiplying   |
|                     | their daily servings intake by 1.5, equivalent |
|                     | to estimating that their requirement is        |
|                     | two-thirds that of persons over age 3 years.   |
|                     | Fruit ingredients from mixtures are included   |
|                     | in the total, and fractions of servings are    |
|                     | counted.**^12^**                               |
+---------------------+------------------------------------------------+
|                     | Pregnant or lactating women and breast-fed     |
|                     | children are excluded from the numerator and   |
|                     | denominator.                                   |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion of age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | State-level data on fruit and vegetable        |
|                     | consumption are collected biennially by BRFSS  |
|                     | for persons 18 years and older and YRBSS for   |
|                     | adolescents in grades 9 through 12. No         |
|                     | State-level data for younger children are      |
|                     | available from these surveillance systems.     |
|                     | These data enable States to track (1) the      |
|                     | proportion of the population that consumes     |
|                     | five or more servings of fruits and vegetables |
|                     | daily, (2) mean intakes and trends in          |
|                     | consumption, and (3) consumption of selected   |
|                     | fruit and vegetable items. However, the food   |
|                     | items and dietary data collection methods used |
|                     | in these surveillance systems differ from      |
|                     | those used by CSFII to track Healthy People    |
|                     | 2010 objective 19-5.                           |
+---------------------+------------------------------------------------+
|                     | This objective differs from Healthy People     |
|                     | 2000 objective 2.6, which only tracked the     |
|                     | proportion of the population that consumed     |
|                     | five or more daily servings of fruits and      |
|                     | vegetables and the mean number of servings     |
|                     | consumed, with a few exclusions of fruit and   |
|                     | vegetable products. Also, Healthy People 2000  |
|                     | estimates were not age adjusted.               |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of CSFII and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

  ---------------------- ----------------------------------------------------
  19-6. Increase the     
  proportion of persons  
  aged 2 years and older 
  who consume at least   
  three daily servings   
  of vegetables, with at 
  least one-third of     
  them being dark green  
  or orange vegetables.  

  **National Data        Continuing Survey of Food Intakes by Individuals
  Source**               (CSFII), USDA, ARS.

  **State Data Sources** Behavioral Risk Factor Surveillance System (BRFSS),
                         CDC, NCCDPHP and Youth Risk Behavior Surveillance
                         System (YRBSS), CDC, NCCDPHP. (See Comments.)

  **Healthy People 2000  Adapted from 2.6 (Nutrition) (also 16.8).
  Objective**            

  **Measure**            Percent (age adjusted---see Comments).

  **Baseline**           3 (1994--96).

  **Numerator**          Number of persons who report consuming three or more
                         servings of vegetables daily, of which at least
                         one-third are dark green or orange vegetables (based
                         on a 2-day average).

  **Denominator**        Number of persons in the survey population aged 2
                         years and older.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    See Questions Used To Obtain the National Data
  Obtain the National    provided with objective 19-5.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           The definitions for dark green and orange vegetables
                         and for serving sizes were derived from the 1995
                         Dietary Guidelines
                         (http://www.health.gov/dietaryguidelines),**^11^**
                         the Food Guide Pyramid
                         (http://www.usda.gov/cnpp/pyramid2.htm), and related
                         documentation, and estimates were calculated using
                         the USDA Pyramid Servings Database. The goal of
                         one-third of servings from dark green or orange
                         vegetables was based on an assessment of the variety
                         of vegetable consumption needed to obtain nutrient
                         adequacy in the development of the Food Guide
                         Pyramid. The intakes of vegetable servings were
                         modified for children aged 2 to 3 years. The
                         modification was accomplished by multiplying their
                         daily servings intake by 1.5, equivalent to
                         estimating that their requirement is two-thirds that
                         of persons over age 3 years. Vegetable ingredients
                         from mixtures are included in the total, and
                         fractions of servings are counted.**^12^**

                         Pregnant or lactating women and breast-fed children
                         are excluded from the numerator and denominator.

                         Two component measures will also be tracked: (1)
                         age-adjusted percent of persons that report
                         consuming three or more servings of vegetables daily
                         (based on a 2-day average), and (2) age-adjusted
                         percent of persons that report consuming at least
                         one-third of their vegetables as dark green or
                         orange vegetables (based on a 2-day average).

                         Data are age adjusted to the 2000 standard
                         population. Age-adjusted percents are weighted sums
                         of age-specific percents. For a discussion of age
                         adjustment, see Part A, section 5.

                         State-level data on fruit and vegetable consumption
                         are collected biennially by BRFSS for persons 18
                         years and older and YRBSS for adolescents in grades
                         9 through 12. No State-level data for younger
                         children are available from these surveillance
                         systems. These data enable States to track (1) the
                         proportion of the population that consumes five or
                         more servings of fruits and vegetables daily, (2)
                         mean intakes and trends in consumption, and (3)
                         consumption of selected fruit and vegetable items.
                         However, the food items and dietary data collection
                         methods used in these surveillance systems differ
                         from those used by CSFII to track Healthy People
                         2010 objective 19-6.

                         The objective differs from Healthy People 2000
                         objective 2.6, which tracked only the proportion of
                         the population that consumed five or more servings
                         daily of fruits and vegetables and the mean number
                         of servings consumed, with a few exclusions of fruit
                         and vegetable products. Also, Healthy People 2000
                         estimates were not age adjusted.

                         See Part C for a description of CSFII and Appendix A
                         for focus area contact information.
  ---------------------- ----------------------------------------------------

  

  ---------------------- ----------------------------------------------------
  19-7. Increase the     
  proportion of persons  
  aged 2 years and older 
  who consume at least   
  six daily servings of  
  grain products, with   
  at least three being   
  whole grains.          

  **National Data        Continuing Survey of Food Intakes by Individuals
  Source**               (CSFII), USDA, ARS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 2.6 (Nutrition) (also 16.8).
  Objective**            

  **Measure**            Percent (age adjusted---see Comments).

  **Baseline**           7 (1994--96).

  **Numerator**          Number of persons aged 2 years and older who report
                         consuming six or more servings of grain products per
                         day, including three or more servings of whole-grain
                         products (based on 2-day average).

  **Denominator**        Number of persons in the survey population aged 2
                         years and older.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    See Questions Used To Obtain the National Data
  Obtain the National    provided with objective 19-5.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           The definitions for grain products and for serving
                         sizes were derived from the 1995 Dietary Guidelines
                         (http://www.health.gov/dietaryguidelines),**^11^**
                         the Food Guide Pyramid
                         (http://www.usda.gov/cnpp/pyramid2.htm), and related
                         documentation. Estimates were calculated using the
                         USDA Pyramid Servings Database, which provided data
                         on total and whole grain consumption.**^12,\ 13^**

                         The goal of three servings from whole-grain products
                         was based on an assessment of the variety of grain
                         product consumption needed to obtain nutrient
                         adequacy in the development of the Food Guide
                         Pyramid. The intakes of grain servings were modified
                         for children aged 2 to 3 years. The modification was
                         accomplished by multiplying their daily servings
                         intake by 1.5, equivalent to estimating that their
                         requirement is two-thirds that of persons over age 3
                         years. Grain ingredients from mixtures are included
                         in the total, and fractions of servings are counted.

                         Pregnant or lactating women and breast-fed children
                         are excluded from the numerator and denominator.

                         Two component measures will also be tracked: (1)
                         age-adjusted percent of persons who consumed six or
                         more servings of grain products per day (based on
                         2-day average), and (2) age-adjusted percent of
                         persons who consumed three or more servings of
                         whole-grain products (based on 2-day average).

                         Data are age adjusted to the 2000 standard
                         population. Age-adjusted percents are weighted sums
                         of age-specific percents. For a discussion of age
                         adjustment, see Part A, section 5.

                         This objective differs from Healthy People 2000
                         objective 2.6, which tracked the proportion of the
                         population who consumed six or more servings of
                         grain products daily and the mean number of servings
                         consumed, with no exclusions. Also, Healthy People
                         2000 estimates were not age adjusted.

                         See Part C for a description of CSFII and Appendix A
                         for focus area contact information.
  ---------------------- ----------------------------------------------------

  

  -----------------------------------------------------------------------
  19-8. Increase the     
  proportion of persons  
  aged 2 years and older 
  who consume less than  
  10 percent of calories 
  from saturated fat.    
  ---------------------- ------------------------------------------------
  **National Data        Continuing Survey of Food Intakes by Individuals
  Source**               (CSFII), USDA, ARS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 2.5 (Nutrition) (also 15.9 and
  Objective**            16.7).

  **Measure**            Percent (age adjusted---see Comments).

  **Baseline**           36 (1994--96).

  **Numerator**          Number of persons aged 2 years and older who
                         report consuming less than 10.0 percent of
                         calories from saturated fat (based on 2-day
                         average).

  **Denominator**        Number of persons in the survey population aged
                         2 years and older.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    From the 1994--96 Continuing Survey of Food
  Obtain the National    Intakes by Individuals:
  Data**                 

                         CSFII included the collection of 2
                         nonconsecutive days of dietary data through
                         in-person 24-hour recalls.**^10^** Each
                         respondent was asked to recall the kinds of
                         amounts of foods eaten at home and away from
                         home during the previous day. Amounts of foods
                         reported in household measures were then
                         converted to gram amounts, and saturated fat
                         intake estimated with the use of food
                         composition files.

  **Expected             Annual.
  Periodicity**          

  **Comments**           This objective tracks the proportion of the
                         population that meets recommendations for
                         saturated fat consumption in the 2000 Dietary
                         Guidelines for Americans.**^4^** Additional
                         tracking of saturated fat intake expressed in
                         grams may also help in interpreting how much
                         progress has been made, since a decrease in
                         saturated fat intake as a percentage of calories
                         may not reflect a decrease in grams of saturated
                         fat if, for example, carbohydrate intake has
                         increased.

                         Pregnant or lactating women and breast-fed
                         children are excluded from the numerator and
                         denominator.

                         Data are age adjusted to the 2000 standard
                         population. Age-adjusted percents are weighted
                         sums of age-specific percents. For a discussion
                         of age adjustment, see Part A, section 5.

                         This objective differs from Healthy People 2000
                         objective 2.5, which tracked the proportion of
                         the population who consumed less than 10 percent
                         of calories from saturated fat, as well as the
                         mean saturated fat intake of population groups;
                         the tracking data were not age adjusted.

                         See Part C for a description of CSFII and
                         Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  

  ---------------------- ------------------------------------------------
  19-9. Increase the     
  proportion of persons  
  aged 2 years and older 
  who consume no more    
  than 30 percent of     
  calories from total    
  fat.                   

  **National Data        Continuing Survey of Food Intakes by Individuals
  Source**               (CSFII), USDA, ARS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 2.5 (Nutrition) (also 15.9 and
  Objective**            16.7).

  **Measure**            Percent (age adjusted---see Comments).

  **Baseline**           33 (1994--96).

  **Numerator**          Number of persons aged 2 years and older who
                         report consuming less than or equal to 30
                         percent of calories from total fat (based on
                         2-day average).

  **Denominator**        Number of persons in the survey population aged
                         2 years and older.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    See Questions Used To Obtain the National Data
  Obtain the National    provided with objective 19-8.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           This objective tracks the proportion of the
                         population that meets recommendations for total
                         fat consumption in the 2000 Dietary Guidelines
                         for Americans.^**4**^ Additional tracking of fat
                         intake expressed in grams may also help in
                         interpreting how much progress has been made,
                         because a decrease in fat intake as a percent of
                         calories may not reflect a decrease in grams of
                         fat if, for example, carbohydrate intake has
                         increased.

                         Pregnant or lactating women and breast-fed
                         children are excluded from the numerator and
                         denominator.

                         Data are age adjusted to the 2000 standard
                         population. Age-adjusted percents are weighted
                         sums of age-specific percents. For a discussion
                         of age adjustment, see Part A, section 5.

                         This objective differs from Healthy People 2000
                         objective 2.5, which tracked the mean fat intake
                         of population groups and the proportion of the
                         population who consumed 30 percent or fewer
                         calories from fat; the tracking data were not
                         age adjusted.

                         See Part C for a description of CSFII and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

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|   |                    | . |                                              |   |
+---+--------------------+---+----------------------------------------------+---+
| * |                    | F |                                              |   |
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| o |                    | 9 |                                              |   |
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|   |                    | : |                                              |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    | F |                                              |   |
|   |                    | o |                                              |   |
|   |                    | o |                                              |   |
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|   |                    | s |                                              |   |
|   |                    | : |                                              |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    | N |                                              |   |
|   |                    | H |                                              |   |
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+---+--------------------+---+----------------------------------------------+---+
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+---+--------------------+---+----------------------------------------------+---+
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+---+--------------------+---+----------------------------------------------+---+
|   |                    | - |                                              |   |
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|   |                    | a |                                              |   |
|   |                    | l |                                              |   |
|   |                    | r |                                              |   |
|   |                    | e |                                              |   |
|   |                    | a |                                              |   |
|   |                    | d |                                              |   |
|   |                    | y |                                              |   |
|   |                    |   |                                              |   |
|   |                    |   |                                              |   |
|   |                    |   |                                              |   |
|   |                    |   |                                              |   |
|   |                    | m |                                              |   |
|   |                    | e |                                              |   |
|   |                    | n |                                              |   |
|   |                    | t |                                              |   |
|   |                    | i |                                              |   |
|   |                    | o |                                              |   |
|   |                    | n |                                              |   |
|   |                    | e |                                              |   |
|   |                    | d |                                              |   |
|   |                    | . |                                              |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | \[If yes:\]                                  |   |
|   |                    |   |                                              |   |
|   |                    |   | -   May I see the containers for all of the  |   |
|   |                    |   |     (vitamins and minerals/prescription      |   |
|   |                    |   |     medicines) ([Person]{.underline}) took   |   |
|   |                    |   |     in the past month?                       |   |
|   |                    |   |                                              |   |
|   |                    |   |     Enter complete name of vitamin/mineral   |   |
|   |                    |   |     from label, or probe respondent.         |   |
|   |                    |   |                                              |   |
|   |                    |   |     Container seen\                          |   |
|   |                    |   |     Container not seen\                      |   |
|   |                    |   |     Product furnished by respondent\         |   |
|   |                    |   |     Product name not on container\           |   |
|   |                    |   |     Enter manufacturer's or distributor's    |   |
|   |                    |   |     name and address (city and State)        |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | -   How often did ([Person]{.underline})     |   |
|   |                    |   |     take (product) in the past month?        |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | -   How much ([product]{.underline}) did     |   |
|   |                    |   |     ([Person]{.underline}) take each time    |   |
|   |                    |   |     ([Person]{.underline}) took it?          |   |
|   |                    |   |                                              |   |
|   |                    |   |     Number of capsules, tablet/pills;        |   |
|   |                    |   |     teaspoons; tablespoons; fluid            |   |
|   |                    |   |     ounces/ounces; drops/droppers;           |   |
|   |                    |   |     packets/packs/packages; ml.; wafers;     |   |
|   |                    |   |     other.                                   |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | -   For how long has ([Person]{.underline})  |   |
|   |                    |   |     been taking this type of product?        |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | Tap water:                                   |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | -   How much plain drinking water do you     |   |
|   |                    |   |     usually drink in a 24-hour period?       |   |
|   |                    |   |     Include only plain tap or spring water.  |   |
|   |                    |   |                                              |   |
|   |                    |   |     Number of glasses or cups\               |   |
|   |                    |   |     Number of ounces per glass or cup        |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | -   Does your home drinking water have a     |   |
|   |                    |   |     water softening or conditioning system?  |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | Salt use at the table:                       |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | -   What type of salt (do you/does           |   |
|   |                    |   |     [Person]{.underline}) usually add to     |   |
|   |                    |   |     (your/his/her) food at the table?        |   |
|   |                    |   |                                              |   |
|   |                    |   |     None\                                    |   |
|   |                    |   |     Ordinary salt\                           |   |
|   |                    |   |     Lite salt\                               |   |
|   |                    |   |     Salt substitute                          |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | -   How often (do you/does                   |   |
|   |                    |   |     [Person]{.underline}) add (type of salt) |   |
|   |                    |   |     to (your/his/her) food at the table? Is  |   |
|   |                    |   |     it rarely, occasionally, or very often?  |   |
+---+--------------------+---+----------------------------------------------+---+
|   | **Expected         |   | Annual, beginning with 1999 data.            |   |
|   | Periodicity**      |   |                                              |   |
+---+--------------------+---+----------------------------------------------+---+
|   | **Comments**       |   | The baseline estimates include consideration |   |
|   |                    |   | of several sources of sodium intake: foods,  |   |
|   |                    |   | dietary supplements, tap water, and salt use |   |
|   |                    |   | at the table but do not include sodium       |   |
|   |                    |   | intake from antacids and other medications.  |   |
|   |                    |   | In addition, a statistical procedure was     |   |
|   |                    |   | used to remove the within-person variation   |   |
|   |                    |   | in daily sodium intakes from food,**^15^**   |   |
|   |                    |   | and thus provide better estimates of usual   |   |
|   |                    |   | intake of sodium with the use of dietary     |   |
|   |                    |   | data per individual (that is, 1 day of       |   |
|   |                    |   | dietary data for all NHANES respondents and  |   |
|   |                    |   | 2-day dietary data for a subset).            |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | It is possible that update estimates for     |   |
|   |                    |   | certain population segments may be available |   |
|   |                    |   | annually for this objective, whereas         |   |
|   |                    |   | estimates for smaller subgroups will require |   |
|   |                    |   | multiyear data.                              |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | Regarding salt use at table, sea salt,       |   |
|   |                    |   | flavored salts such as garlic, onion, and    |   |
|   |                    |   | celery salt, and seasoning salts were        |   |
|   |                    |   | counted as ordinary salts. Lite salt was     |   |
|   |                    |   | labeled as such and has a reduced sodium     |   |
|   |                    |   | content. Salt substitutes do not contain     |   |
|   |                    |   | sodium. To obtain a daily amount for each    |   |
|   |                    |   | person, the amount of sodium depending on    |   |
|   |                    |   | salt type was multiplied by the frequency    |   |
|   |                    |   | value. (Sodium in type of salt x frequency   |   |
|   |                    |   | amount of sodium from table salt added per   |   |
|   |                    |   | day.)                                        |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | Type of salt: A zero sodium value was        |   |
|   |                    |   | assigned for "none" and "salt substitute."   |   |
|   |                    |   | For "ordinary salt," 290 mg (for "very       |   |
|   |                    |   | often" code) was assigned for persons aged 2 |   |
|   |                    |   | to 19 years, and 580 mg was assigned for     |   |
|   |                    |   | persons aged 20 years and older. For "lite"  |   |
|   |                    |   | salt, 145 mg was assigned for persons aged 2 |   |
|   |                    |   | to 19 years, and 290 mg was assigned for     |   |
|   |                    |   | persons aged 20 years and older. For missing |   |
|   |                    |   | values, a default of "ordinary salt" was     |   |
|   |                    |   | assigned.                                    |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | Frequency of salt use: for "rarely," sodium  |   |
|   |                    |   | value was multiplied by 1/4; for             |   |
|   |                    |   | "occasionally," sodium value was multiplied  |   |
|   |                    |   | by 1/2; for "very often," sodium value was   |   |
|   |                    |   | multiplied by 1; for missing values,         |   |
|   |                    |   | "occasionally" was used as the default.      |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | Drinking water: If home drinking water had a |   |
|   |                    |   | water softening or conditioning system,      |   |
|   |                    |   | ounces of water consumed were multiplied by  |   |
|   |                    |   | 3 mg per fluid ounce; otherwise, water was   |   |
|   |                    |   | counted as unsoftened; 1 mg per fluid ounce  |   |
|   |                    |   | was used for "regular" municipal water based |   |
|   |                    |   | on the USDA food composition database. To    |   |
|   |                    |   | get daily sodium from drinking water, the mg |   |
|   |                    |   | of sodium per fluid ounce was multiplied by  |   |
|   |                    |   | the number of fluid ounces.                  |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | Dietary supplements: Sodium from dietary     |   |
|   |                    |   | supplements reported in the survey was       |   |
|   |                    |   | calculated. If supplement data were missing, |   |
|   |                    |   | then it was assumed that no sodium was       |   |
|   |                    |   | provided by supplements but the individual   |   |
|   |                    |   | was kept in the calculation.                 |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | Breast-feeding children aged 2 years and     |   |
|   |                    |   | older were excluded from the analysis.       |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | Data are age adjusted to the 2000 standard   |   |
|   |                    |   | population. Age-adjusted percents are        |   |
|   |                    |   | weighted sums of age-specific percents. For  |   |
|   |                    |   | a discussion of age adjustment, see Part A,  |   |
|   |                    |   | section 5.                                   |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | This objective differs from Healthy People   |   |
|   |                    |   | 2000 objective 2.9, which also tracked       |   |
|   |                    |   | individual behaviors associated with the     |   |
|   |                    |   | reduction of salt and sodium intake. The     |   |
|   |                    |   | measures included avoidance of salt use in   |   |
|   |                    |   | food preparation at home, avoidance of salt  |   |
|   |                    |   | use at the table, and regular purchase of    |   |
|   |                    |   | foods modified in sodium, but did not        |   |
|   |                    |   | measure actual sodium intake. The Healthy    |   |
|   |                    |   | People 2000 tracking data were not age       |   |
|   |                    |   | adjusted.                                    |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | See Part C for a description of NHANES and   |   |
|   |                    |   | Appendix A for focus area contact            |   |
|   |                    |   | information.                                 |   |
+---+--------------------+---+----------------------------------------------+---+

  

+---------------------+------------------------------------------------+
| 19-11. Increase the |                                                |
| proportion of       |                                                |
| persons aged 2      |                                                |
| years and older who |                                                |
| meet dietary        |                                                |
| recommendations for |                                                |
| calcium.            |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health and Nutrition Examination      |
| Source**            | Survey (NHANES), CDC, NCHS.                    |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 2.8 (Nutrition).                  |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 46 (1988--94).                                 |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of persons aged 2 years and older who   |
|                     | report calcium intake at or above approximated |
|                     | mean requirements.                             |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons in the survey population     |
|                     | aged 2 years and older.                        |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1988--94 National Health and          |
| Obtain the National | Nutrition Examination Survey:                  |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | Foods:                                         |
+---------------------+------------------------------------------------+
|                     | The NHANES included the collection of 1 day of |
|                     | dietary data for all respondents through       |
|                     | in-person 24-hour recalls and 2-day dietary    |
|                     | data on a small subset through telephone       |
|                     | 24-hour recalls. Each respondent was asked to  |
|                     | recall the kinds and amounts of foods and      |
|                     | beverages consumed at home and away from home  |
|                     | during the previous day (midnight to           |
|                     | midnight). Amounts of foods and beverages      |
|                     | reported in household measures were then       |
|                     | converted to gram amounts, and calcium intake  |
|                     | from foods and beverages was estimated with    |
|                     | the use of food composition files. Additional  |
|                     | questions used to assess total calcium intake  |
|                     | include:                                       |
+---------------------+------------------------------------------------+
|                     | \[Dietary supplement use:\]                    |
+---------------------+------------------------------------------------+
|                     | -   Has ([Person]{.underline}) taken any       |
|                     |     vitamins or minerals in the past month?    |
|                     |     Please include those that are prescribed   |
|                     |     by a doctor or dentist and those that are  |
|                     |     not prescribed.                            |
+---------------------+------------------------------------------------+
|                     | -   Has ([Person) taken or used any medicines  |
|                     |     for which a doctor's or                    |
|                     |     dentist's]{.underline} prescription is     |
|                     |     needed, in the past month? This includes   |
|                     |     any products which cannot be obtained      |
|                     |     without a doctor's or dentist's            |
|                     |     prescription. Include those medicines you  |
|                     |     may have already mentioned.                |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   May I see the containers for all of the    |
|                     |     (vitamins and minerals/prescription        |
|                     |     medicines) ([Person]{.underline}) took in  |
|                     |     the past month?                            |
|                     |                                                |
|                     |     Enter complete name of vitamin/mineral     |
|                     |     from label, or probe respondent.           |
|                     |                                                |
|                     |     Container seen\                            |
|                     |     Container not seen\                        |
|                     |     Product furnished by respondent\           |
|                     |     Product name not on container\             |
|                     |     \[Enter manufacturer's or distributor's    |
|                     |     name and address (city and State)\]        |
+---------------------+------------------------------------------------+
|                     | -   How often did ([Person]{.underline}) take  |
|                     |     ([produc]{.underline}t) in the past month? |
+---------------------+------------------------------------------------+
|                     | -   How much ([product]{.underline}) did       |
|                     |     ([Person]{.underline}) take each time      |
|                     |     (Person) took it?\                         |
|                     |     Number of capsules, tablet/pills;          |
|                     |     teaspoons; tablespoons; fluid              |
|                     |     ounces/ounces; drops/droppers;             |
|                     |     packets/packs/packages; ml.; wafers;       |
|                     |     other.                                     |
+---------------------+------------------------------------------------+
|                     | -   For how long has ([Person]{.underline})    |
|                     |     been taking this type of product?          |
+---------------------+------------------------------------------------+
|                     | \[Antacid use:\]                               |
+---------------------+------------------------------------------------+
|                     | Enter complete name of antacid from label or   |
|                     | probe respondent:                              |
|                     |                                                |
|                     | Antacid seen\                                  |
|                     | Antacid not seen. Product name furnished by    |
|                     | respondent                                     |
+---------------------+------------------------------------------------+
|                     | -   How often did you take (antacid) in the    |
|                     |     past month?                                |
+---------------------+------------------------------------------------+
|                     | -   How much ([antacid]{.underline}) did you   |
|                     |     take each time you took it?                |
+---------------------+------------------------------------------------+
|                     | -   For how long have you been taking this     |
|                     |     antacid?                                   |
+---------------------+------------------------------------------------+
| **Expected          | Annual, beginning with 1999 data.              |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Approximated mean calcium requirements are     |
|                     | defined as 77 percent of the recommendations   |
|                     | by the Institute of Medicine for adequate      |
|                     | intakes for calcium.**^16,\ 17^** The          |
|                     | prepublication recommendations for adequate    |
|                     | intakes of calcium are 500 mg per day for      |
|                     | children aged 1 to 3 years, 800 mg for         |
|                     | children aged 4 to 8 years, 1,300 mg for       |
|                     | adolescents aged 9 to 18 years, 1,000 mg for   |
|                     | adults aged 19 to 50 years, and 1,200 mg for   |
|                     | adults aged 51 years and older.**^17^**        |
+---------------------+------------------------------------------------+
|                     | Persons were classified as consuming calcium   |
|                     | at or above the approximated mean requirements |
|                     | if the total daily calcium intake was within   |
|                     | this range. To determine total calcium intake, |
|                     | several sources of calcium were considered,    |
|                     | including foods, dietary supplements, and      |
|                     | antacids, but not including calcium from       |
|                     | drinking water.                                |
+---------------------+------------------------------------------------+
|                     | A statistical procedure was used to remove the |
|                     | within-person variation in daily calcium       |
|                     | intakes from food**^15^** and thus provide     |
|                     | better estimates of usual intake of calcium    |
|                     | with the use of a limited number of days of    |
|                     | dietary data per individual (1 day of dietary  |
|                     | data for all NHANES respondents and 2-day      |
|                     | dietary data for a subset).                    |
+---------------------+------------------------------------------------+
|                     | Calcium from calcium-containing antacids       |
|                     | reported as taken 24 times or more was used in |
|                     | the calculation. If antacids data were         |
|                     | missing, it was assumed that no calcium was    |
|                     | provided by antacids, but the individual was   |
|                     | kept in the calculation.                       |
+---------------------+------------------------------------------------+
|                     | Breast-feeding children aged 2 years and older |
|                     | were excluded from the analysis.               |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion of age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | State-level data on self-reported consumption  |
|                     | of milk are collected biennially by the Youth  |
|                     | Risk Behavioral Surveillance System (YRBSS),   |
|                     | for adolescents in grades 9 through 12.        |
+---------------------+------------------------------------------------+
|                     | This objective differs from Healthy People     |
|                     | 2000 objective 2.8, which only tracked the     |
|                     | proportion of the population who consumed the  |
|                     | recommended number of servings of milk and     |
|                     | milk products; the 2000 objective did not      |
|                     | consider calcium intake from other foods,      |
|                     | dietary supplements, and antacids. Given that  |
|                     | significant sources of calcium are not limited |
|                     | to milk products and not all persons choose to |
|                     | consume them, the Healthy People 2010          |
|                     | objective aims to increase total calcium       |
|                     | intake. However, because consumption of milk   |
|                     | products is low relative to recommendations    |
|                     | for adolescents and other groups who would     |
|                     | especially benefit from increased consumption  |
|                     | of calcium-rich foods, it is still often       |
|                     | desirable to track milk product consumption at |
|                     | the national and State levels as supplementary |
|                     | data, as well as to track the contribution of  |
|                     | other sources of total calcium intake. The     |
|                     | Healthy People 2000 tracking data were not age |
|                     | adjusted.                                      |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHANES and     |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

### Iron Deficiency and Anemia

19-12. Reduce iron deficiency among young children and females of
childbearing age.

  ---------------------- ------------------------------------------------
  19-12a. Children aged  
  1 to 2 years.          

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified (see Comments).

  **Healthy People 2000  Adapted from 2.10 (Nutrition).
  Objective**            

  **Measure**            Percent.

  **Baseline**           9 (1988--94).

  **Numerator**          Number of children aged 1 to 2 years with
                         abnormal results for two or more of the
                         following tests: serum ferritin, free
                         erythrocyte protoporphyrin, or transferrin
                         saturation.**^18,\ 19^**

  **Denominator**        Number of children in the survey population aged
                         1 to 2 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           Blood was collected by phlebotomy. Transferrin
                         saturation was calculated by dividing serum iron
                         by total iron binding capacity. Serum iron and
                         total iron binding capacity were measured
                         colorimetrically (by Alpkem RFA analyzer,
                         Clackamas, OR), and 1 percent thiourea was added
                         to complex copper to prevent copper
                         interference.**^20^** Free erythrocyte
                         protoporphyrin was measured via fluorescence
                         extraction,**^21^** and serum ferritin was
                         measured with the BioRad Quantimmune IRMA kit
                         (BioRad Laboratories, Hercules, CA).

                         Iron deficiency is defined as abnormal results
                         for two or more of the following tests: serum
                         ferritin, free erythrocyte protoporphyrin, or
                         transferrin saturation. The basis of the use for
                         two of three abnormal tests was the finding that
                         populations with only one abnormal test of these
                         three had scarcely more anemia than those with
                         all normal test results. The prevalence of
                         anemia was substantially elevated in those who
                         had two or three abnormal tests.**^19,\ 22^**
                         The selection of threshold values for abnormal
                         results were based on those derived for the
                         previous NHANES (1976--80) by an expert
                         panel,**^19,\ 23^** except where (1) evidence
                         existed for changes in assay methods or in
                         changes in other confounding factors like blood
                         lead; and (2) an evaluation of the iron status
                         indicator distribution in a reference group of
                         healthy persons from the 1988--94 NHANES
                         supported a change in the 1976--80 NHANES
                         thresholds.**^18^**

                         Threshold values for abnormal results on iron
                         tests vary by age. Abnormal values for serum
                         ferritin concentration are defined as less than
                         10 μg/L for children aged 1 to 4 years and less
                         than 12 μg/L for females aged 12 to 49 years.
                         Abnormal values for free erythrocyte
                         protoporphyrin are greater than 1.42 μmol/L for
                         children aged 1 to 2 years (80 μg/dL of red
                         blood cells), and greater than 1.24 μmol/L (70
                         μg/dL of red blood cells) for other persons.
                         Abnormal values for transferrin saturation are
                         less than 10 percent for children aged 1 to 2
                         years, less than 12 percent for children aged 3
                         to 4 years, less than 14 percent for females
                         aged 12 to 15 years, and less than 15 percent
                         for females aged 16 years and older.

                         The terms anemia, iron deficiency, and iron
                         deficiency anemia are often used
                         interchangeably, but are not equivalent. Anemia
                         can be caused by many factors other than iron
                         deficiency, including other nutrient
                         deficiencies, infection, inflammation, and
                         hereditary anemias. When the prevalence of iron
                         deficiency is high, such as during the third
                         trimester of pregnancy, anemia is a good
                         predictor of iron deficiency. When the
                         prevalence of iron deficiency is low, such as
                         among white, non-Hispanic children aged 3 to 4
                         years in the United States, the majority of
                         anemia is due to other causes.

                         No comparable data source is available to
                         measure iron deficiency at the State level. The
                         Pediatric Nutrition Surveillance System is used
                         to monitor the percent of anemia (low hemoglobin
                         or hematocrit) among low-income children aged 1
                         to 4 years participating in public health
                         programs.

                         Anemia is used for monitoring risk of iron
                         deficiency at the State and local levels because
                         of its cost and feasibility for use in the
                         clinic setting. Changes in the prevalence of
                         anemia over time at the State and local levels
                         can be used to evaluate the effectiveness of
                         programs to decrease the prevalence iron
                         deficiency.

                         This objective differs from Healthy People 2000
                         objective 2.10, which defined iron deficiency as
                         abnormal results for two or more of the
                         following tests: mean cell volume, free
                         erythrocyte protoporphyrin, and transferrin
                         saturation. For Healthy People 2010 objective
                         19-12, serum ferritin replaces mean cell volume
                         in the definition of iron deficiency. Serum
                         ferritin is a more sensitive measure of iron
                         deficiency.**^24^**

                         See Part C for a description of NHANES and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

+---------------------+------------------------------------------------+
| 19-12b. Children    |                                                |
| aged 3 to 4 years.  |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health and Nutrition Examination      |
| Source**            | Survey (NHANES), CDC, NCHS.                    |
+---------------------+------------------------------------------------+
| **State Data        | Not identified (see Comments).                 |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 2.10 (Nutrition).                 |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 4 (1988--94).                                  |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of children aged 3 to 4 years with      |
|                     | abnormal results for two or more of the        |
|                     | following tests: serum ferritin, free          |
|                     | erythrocyte protoporphyrin, or transferrin     |
|                     | saturation.**^18,\ 19^**                       |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of children in the survey population    |
|                     | aged 3 to 4 years.                             |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| ###### Questi       | Not applicable.                                |
| ons Used To Obtain  |                                                |
| the National Data { |                                                |
| #questions-used-to- |                                                |
| obtain-the-national |                                                |
| -data .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual, beginning with 1999 data.              |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 19-12a    |
|                     | for more information on the measurement of     |
|                     | this objective.                                |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHANES and     |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

  ---------------------- ------------------------------------------------
  19-12c. Nonpregnant    
  females aged 12 to 49  
  years.                 

  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 2.10 (Nutrition).
  Objective**            

  **Measure**            Percent.

  **Baseline**           11 (1988--94).

  **Numerator**          Number of females aged 12 to 49 years with
                         abnormal results for two or more of the
                         following tests: serum ferritin, free
                         erythrocyte protoporphyrin, or transferrin
                         saturation.**^18,\ 19^**

  **Denominator**        Number of females in the survey population aged
                         12 to 49 years.

  **Population           U.S. civilian noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999 data.
  Periodicity**          

  **Comments**           See Comments provided with objective 19-12a for
                         more information on the measurement of this
                         objective.

                         See Part C for a description of NHANES and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  19-13. Reduce anemia   
  among low-income       
  pregnant females in    
  their third trimester. 

  **National Data        Pregnancy Nutrition Surveillance System (PNSS),
  Source**               CDC, NCCDPHP.

  **State Data Source**  State Pregnancy Nutrition Surveillance System
                         (PNSS), CDC, NCCDPHP.

  **Healthy People 2000  Adapted from 2.10e (Nutrition).
  Objective**            

  **Measure**            Percent.

  **Baseline**           29 (1996) (Selected sites---see Comments).

  **Numerator**          Number of pregnant females participating in
                         public programs in their third trimester with
                         abnormal results for either hemoglobin (less
                         than 11 g/dL) or hematocrit (less than 33
                         percent).**^25^**

  **Denominator**        Number of pregnant females participating in
                         public programs in their third trimester.

  **Population           Selected sites---see Comments.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           PNSS is used to monitor anemia among low-income
                         women participating in public health programs.
                         In 1996, 21 States, the District of Columbia,
                         and two Tribal governments
                         participated.**^25,\ 26^** The threshold for
                         anemia during pregnancy is based on clinical
                         studies of European women who had taken iron
                         supplementation during
                         pregnancy.**^27,\ 28,\ 29,\ 30,\ 31^** This
                         threshold is advocated by CDC**^25^** and the
                         World Health Organization.**^32^**

                         See the Comments section with iron deficiency
                         objective 19-12 for a discussion of the
                         differences between iron deficiency and anemia.
                         Nationally representative data are unavailable
                         for monitoring the percent of iron deficiency
                         during pregnancy.

                         This objective differs from Healthy People 2000
                         objective 2.10e, which targeted black,
                         low-income pregnant females only.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  -----------------------------------------------------------------------
  19-14. (Developmental) 
  Reduce iron deficiency 
  among pregnant         
  females.               
  ---------------------- ------------------------------------------------
  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national data source is the National
                         Health and Nutrition Examination Survey
                         (NHANES).

                         See Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

### Schools, Worksites, and Nutrition Counseling

  ---------------------- ------------------------------------------------
  19-15. (Developmental) 
  Increase the           
  proportion of children 
  and adolescents aged 6 
  to 19 years whose      
  intake of meals and    
  snacks at school       
  contributes to good    
  overall dietary        
  quality.               

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         Proposed national data sources are the
                         Continuing Survey of Food Intakes by Individuals
                         (CSFII), USDA, ARS; the National Food and
                         Nutrition Survey, USDA, ARS and CDC, NCHS; or
                         the National Health and Nutrition Examination
                         Survey (NHANES), CDC, NCHS. A proposed State
                         data source for adolescents (students in grades
                         9 through 12) is the Youth Risk Behavior
                         Surveillance System (YRBSS).

                         This objective is adapted from Healthy People
                         2000 objective 2.17, which tracked the
                         proportion of schools offering breakfasts and
                         lunches with 30 percent or less of calories from
                         total fat, the proportion of schools offering
                         breakfasts and lunches with less than 10 percent
                         of calories from saturated fat, and the
                         proportion of schools with initiatives to reduce
                         fat.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

+---------------------+------------------------------------------------+
| 19-16. Increase the |                                                |
| proportion of       |                                                |
| worksites that      |                                                |
| offer nutrition or  |                                                |
| weight management   |                                                |
| classes or          |                                                |
| counseling.         |                                                |
+---------------------+------------------------------------------------+
| **National Data     | 1999 National Worksite Health Promotion Survey |
| Source**            | (NWHPS), Association for Worksite Health       |
|                     | Promotion (AWHP) and OPHS, ODPHP.              |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 2.20 (Nutrition).                 |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 55 (1998--99).                                 |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of worksites with 50 or more employees  |
|                     | that offered nutrition or weight management    |
|                     | classes or counseling at the worksite or       |
|                     | through their health plans.                    |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of worksites with 50 or more employees  |
|                     | in nongovernmental organizations.              |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1999 National Worksite Health         |
| Obtain the National | Promotion Survey:                              |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   During the last 12 months, did you offer   |
|                     |     \[see below\] to your employees at the     |
|                     |     worksite?                                  |
|                     |                                                |
|                     |     1\) Nutrition or cholesterol education\    |
|                     |     2) Weight management classes or counseling |
+---------------------+------------------------------------------------+
|                     | -   During the last 12 months, did you offer   |
|                     |     \[see below\] to your employees through    |
|                     |     one of your health plans?                  |
|                     |                                                |
|                     |     1\) Nutrition or cholesterol education\    |
|                     |     2) Weight management classes or counseling |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Responses to the two questions on nutrition or |
|                     | cholesterol education and weight management    |
|                     | classes or counseling are combined for         |
|                     | tracking this objective.**^33^**               |
+---------------------+------------------------------------------------+
|                     | This objective differs from Healthy People     |
|                     | 2000 objective 2.20, which was tracked with    |
|                     | three surveys that differed in sponsors and    |
|                     | the questions asked and did not provide        |
|                     | comparable data. The 1995 data were from the   |
|                     | CDC-sponsored Worksite Benchmark               |
|                     | Survey.**^34^** This survey asked about        |
|                     | provision of nutrition or cholesterol group    |
|                     | classes, workshops, or lectures and weight     |
|                     | management group classes, workshops, or        |
|                     | lectures. Classes and counseling provided by   |
|                     | health plans offered by the employer were not  |
|                     | included.                                      |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NWHPS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

+---------------------+------------------------------------------------+
| 19-17. Increase the |                                                |
| proportion of       |                                                |
| physician office    |                                                |
| visits made by      |                                                |
| patients with a     |                                                |
| diagnosis of        |                                                |
| cardiovascular      |                                                |
| disease, diabetes,  |                                                |
| or hyperlipidemia   |                                                |
| that include        |                                                |
| counseling or       |                                                |
| education related   |                                                |
| to diet and         |                                                |
| nutrition.          |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Ambulatory Medical Care Survey        |
| Source**            | (NAMCS), CDC, NCHS.                            |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 2.21 (Nutrition).                 |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 42 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of visits by ambulatory patients to     |
|                     | non-Federal physicians in office-based         |
|                     | practice with diagnosis of cardiovascular      |
|                     | disease (ICD-9-CM codes 391-392.0, 393-398,    |
|                     | 401, 402, 404, 410-416, 420-429), diabetes     |
|                     | mellitus (ICD-9-CM code 250), or               |
|                     | hyperlipidemia (ICD-9-CM codes 272.0-272.4),   |
|                     | in which diet and nutrition counseling or      |
|                     | education was ordered or provided.             |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of visits by ambulatory patients to     |
|                     | non-Federal physicians in office-based         |
|                     | practice with diagnosis of cardiovascular      |
|                     | disease, diabetes mellitus, or hyperlipidemia  |
|                     | (as defined above).                            |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Ambulatory Medical Care |
| Obtain the National | Survey patient record:                         |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[Item 16:\]                                   |
|                     |                                                |
|                     | -   Physician's diagnoses for this visit - as  |
|                     |     specifically as possible, list diagnoses   |
|                     |     related to this visit including chronic    |
|                     |     conditions (e.g., depression, obesity,     |
|                     |     asthma, etc.) \[Up to three diagnoses may  |
|                     |     be reported.\]                             |
+---------------------+------------------------------------------------+
|                     | \[Item 18:\]                                   |
|                     |                                                |
|                     | -   Therapeutic and preventive services -      |
|                     |     check all ordered or provided at this      |
|                     |     visit. Exclude medications: \[Under the    |
|                     |     subheading "Counseling/education" a check  |
|                     |     box is provided for "Diet/Nutrition."\]    |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Because certain questions are rotated, update  |
|                     | estimates may be available on a periodic       |
|                     | rather than an annual basis.                   |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion of age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | This objective differs from Healthy People     |
|                     | 2000 objective 2.21, which was measured by the |
|                     | 1992 Primary Care Provider Survey and the      |
|                     | 1997--98 Prevention in Primary Care Study.     |
|                     | These surveys addressed the proportion of      |
|                     | primary care providers who provided nutrition  |
|                     | assessment and counseling to their patients.   |
|                     | Referral to qualified nutritionists or         |
|                     | dieticians, although part of the Healthy       |
|                     | People 2000 objective, was never measured.     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NAMCS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

### Food Security

+---------------------+------------------------------------------------+
| 19-18. Increase     |                                                |
| food security among |                                                |
| U.S. households and |                                                |
| in so doing reduce  |                                                |
| hunger.             |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Food Security Supplement to the Current        |
| Source**            | Population Survey (CPS), DOC, U.S. Census      |
|                     | Bureau.                                        |
+---------------------+------------------------------------------------+
| **State Data        | Food Security Supplement to the Current        |
| Source**            | Population Survey (CPS), DOC, U.S. Census      |
|                     | Bureau.                                        |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 88 (1995).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of U.S. households that did not report  |
|                     | experiencing food insecurity over a 12-month   |
|                     | period.                                        |
+---------------------+------------------------------------------------+
|                     | A proposed supplemental data source is the     |
|                     | National Food and Nutrition Survey (NFNS), HHS |
|                     | and USDA, beginning in 2001. The NFNS          |
|                     | questions will be identical to those asked by  |
|                     | the Food Security Supplement to CPS.           |
|                     |                                                |
|                     | Although the NFNS will have a smaller sample   |
|                     | size than the CPS Supplement, it will allow    |
|                     | greater opportunities to explore relationships |
|                     | between food security and additional variables |
|                     | such as body mass index and specific diseases  |
|                     | and health conditions.                         |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of U.S. households during a 12-month    |
|                     | period.                                        |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used to | From the 1995 Food Security Supplement to the  |
| Obtain the National | Current Population Survey:                     |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   (I/we) worried whether our food would run  |
|                     |     out before (I/we) got money to buy more.   |
|                     |     Was that often, sometimes, or never true   |
|                     |     for you in the last 12 months?             |
+---------------------+------------------------------------------------+
|                     | -   The food that I/we bought just didn\'t     |
|                     |     last, and (I/we) didn\'t have money to get |
|                     |     more. Was that often, sometimes or never   |
|                     |     true for you in the last 12 months?        |
+---------------------+------------------------------------------------+
|                     | -   (I/we) couldn\'t afford to eat balanced    |
|                     |     meals. Was that often, sometimes, or never |
|                     |     true for you in the last 12 months?        |
+---------------------+------------------------------------------------+
|                     | -   (I/we) relied on only a few kinds of       |
|                     |     low-cost food to feed the children because |
|                     |     I/we were running out of money to buy      |
|                     |     food. Was that often, sometimes, or never  |
|                     |     true for you in the last 12 months?        |
+---------------------+------------------------------------------------+
|                     | -   In the last 12 months, did you or other    |
|                     |     adults in your household ever cut the size |
|                     |     of your meals or skip meals because there  |
|                     |     wasn\'t enough money for food?             |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   How often did this happen - almost every   |
|                     |     month, some months but not every month, or |
|                     |     in only 1 or 2 months?                     |
+---------------------+------------------------------------------------+
|                     | -   (I/we) couldn\'t feed the children a       |
|                     |     balanced meal because (I/we) couldn\'t     |
|                     |     afford that. Was that often, sometimes, or |
|                     |     never true for you in the last 12 months?  |
+---------------------+------------------------------------------------+
|                     | -   In the last 12 months, did you ever eat    |
|                     |     less than you felt you should because      |
|                     |     there wasn\'t enough money to buy food?    |
+---------------------+------------------------------------------------+
|                     | -   The children were not eating enough        |
|                     |     because (I/we) just couldn\'t afford       |
|                     |     enough food. Was that often, sometimes, or |
|                     |     never true for you in the last 12 months?  |
+---------------------+------------------------------------------------+
|                     | -   In the last 12 months, were you ever       |
|                     |     hungry but didn\'t eat because you         |
|                     |     couldn\'t afford enough food?              |
+---------------------+------------------------------------------------+
|                     | -   Sometimes people lose weight because they  |
|                     |     don\'t have enough to eat. In the last 12  |
|                     |     months, did you lose weight because there  |
|                     |     wasn\'t enough food?                       |
+---------------------+------------------------------------------------+
|                     | -   In the last 12 months, did you ever cut    |
|                     |     the size of any of the children\'s meals   |
|                     |     because there wasn't enough money for      |
|                     |     food?                                      |
+---------------------+------------------------------------------------+
|                     | -   In the last 12 months, did you or other    |
|                     |     adults in your household ever not eat for  |
|                     |     a whole day because there wasn\'t enough   |
|                     |     money for food?                            |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   How often did this happen - almost every   |
|                     |     month, some months but not every month, or |
|                     |     in only 1 or 2 months?                     |
+---------------------+------------------------------------------------+
|                     | -   In the last 12 months, were the children   |
|                     |     ever hungry but you just couldn\'t afford  |
|                     |     more food?                                 |
+---------------------+------------------------------------------------+
|                     | -   In the last 12 months, did any of the      |
|                     |     children ever skip a meal because there    |
|                     |     wasn\'t enough money for food?             |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   How often did this happen - almost every   |
|                     |     month, some month but not every month, or  |
|                     |     in only 1 or 2 months?                     |
+---------------------+------------------------------------------------+
|                     | -   In the last 12 months, did any of the      |
|                     |     children ever not eat for a whole day      |
|                     |     because there wasn\'t enough money for     |
|                     |     food?                                      |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The 1995 Food Security Supplement to the       |
|                     | Current Population Survey is a set of          |
|                     | questions developed by an interagency working  |
|                     | group led jointly by USDA's Food and Nutrition |
|                     | Service and HHS's National Center for Health   |
|                     | Statistics.**^35,\ 36^** All of the indicators |
|                     | of food insecurity in the Supplement focus     |
|                     | explicitly on food insufficiency and hunger,   |
|                     | at adult and child levels, resulting from      |
|                     | inadequate household resources. Other sources  |
|                     | of food insecurity, such as child              |
|                     | abuse/neglect or loss of function or mobility  |
|                     | (particularly relevant to the elderly          |
|                     | population) are not distinguished by the       |
|                     | measure.                                       |
+---------------------+------------------------------------------------+
|                     | The Food Security Supplement questions were    |
|                     | asked of about 45,000 households as part of    |
|                     | the 1995 Current Population Survey (a          |
|                     | nationally representative sample selected and  |
|                     | interviewed by the Census Bureau). This        |
|                     | supplement was fielded for the first time in   |
|                     | April 1995 and repeated in September 1996,     |
|                     | April 1997, August 1998, and April 1999.       |
+---------------------+------------------------------------------------+
|                     | A statistical analysis of the survey responses |
|                     | identified a set of 18 core questions that     |
|                     | were used to identify households with food     |
|                     | insecurity.**^37^** Two separate measurement   |
|                     | scales were developed: one for food insecurity |
|                     | during a 12-month period and another for       |
|                     | insecurity for the past 30 days. The 12-month  |
|                     | scale, which covers a broader range of food    |
|                     | insecurity, was used for this objective.       |
|                     | Households were classified as food secure if   |
|                     | fewer than three of the questions were         |
|                     | answered affirmatively or if only one or two   |
|                     | questions were answered affirmatively.         |
|                     | Otherwise, the household was classified as     |
|                     | food insecure. An affirmative answer included  |
|                     | "yes," "often," or "sometimes."                |
+---------------------+------------------------------------------------+
|                     | The Food Security Supplement also provides     |
|                     | State-level estimates of food insecurity,      |
|                     | which generally will be reported by the USDA   |
|                     | based on 2- or 3-year averages.**^38^** The    |
|                     | prevalence of hunger can also be tracked at    |
|                     | the national and State levels.                 |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

## References

1\. National Institutes of Health. Clinical guideline on the
identification, evaluation and treatment of overweight and obesity in
adults - The Evidence Report. NIH. *Obesity Research 6* (Suppl.
2):51S-209S, 1998.

2\. World Health Organization (WHO) Expert Committee. *Physical Status:
The Use and Interpretation of Anthropometry. Report of a WHO Expert
Committee.* WHO Technical Report Series: 854, 1992. Geneva, Switzerland:
World Health Organization, 1995.

3\. U.S. Department of Agriculture (USDA) and U.S. Department of Health
and Human Services (HHS). *Dietary Guidelines for Americans.* 5th ed.
USDA Home and Garden Bulletin No. 232, 2000.

4\. Dietary Guidelines Advisory Committee. *Report of the Dietary
Guidelines Advisory Committee on the Dietary Guidelines for Americans,
2000.* Washington DC: USDA. \<http://www.ars.usda.gov/dgac\>April 2000.

5\. WHO. *Obesity: Preventing and Managing the Global Epidemic.* Report
of a WHO Consultation on Obesity, Geneva, June 1997. Geneva,
Switzerland: WHO, 1998.

6\. Flegal, K.M.; Carroll, M.D.; Kuczmarski, R.J.; et al. Overweight and
obesity in the United States: Prevalence and trends, 1960--1994.
*International Journal of Obesity* 22:39-47, 1998.

7\. Troiano, R.P., and Flegal, K.M. Overweight children and adolescents:
Description, epidemiology, and demographics. *Pediatrics* 101:497-504,
1998.

8\. Kuczmarski, R.J.; Ogden, C.L.; Grummer-Strawn, L.M.; et al. *CDC
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