CALL TO ACTION

National Public Health Initiative on 

Diabetes and Women’s Health: A Progress Report 

We gratefully acknowledge the combined efforts of our cosponsors, 

American Diabetes Association, American Public Health Association, 

Association of State and Territorial Health Officials, and our many 

partners in identifying strategies to implement our national action 

plan—The National Agenda for Public Health Action. 

Suggested Citation: 

Department of Health and Human Services. Call to Action: The National Public Health Initiative on Diabetes 

and Women’s Health. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and 

Prevention, 2004. 

Contents 

I. Why the Call to Action? 1

A. The National Public Health Initiative on Diabetes and Women’s Health 1 

B. Conference Purpose and Agenda 2 

II. Where are we headed? 3 

 A. Our Vision 3

 B. Our Goals 3

 C. Our Guiding Principles 3

III. What actions are essential? 5 

IV. How should each action be pursued? 6 

 A. The Big Picture 6

 B. The Details 7

V. When can we begin? 21

 A. Taking the First Step 21

 B. The Long Haul 22 

VI. Who can make this happen? 23 

Attachment A: Staff Support 24 

Attachment B: Cosponsors’ Commitments to the National Agenda 26 
Attachment C: Glossary 32 

I. Why the Call to Action? 

A. The National Public Health Initiative on Diabetes and Women’s Health 

Diabetes is often preventable, yet more than 18 million Americans have this disease and more than half are 

women. This number is expected to increase, placing added demands on the health care delivery system and 

other sectors of society. The estimated annual cost of diabetes to the United States for direct health care and 

indirect expenditures is about $132 billion. 

As part of a comprehensive effort to improve women’s health, the Centers for Disease Control and Prevention 

(CDC) established the National Public Health Initiative on Diabetes and Women’s Health. The initiative has 

three phases. 

In Phase I, CDC prepared Diabetes & Women’s Health Across the Life Stages: A Public Health Perspective. 

Published in 2001, this report examines issues that make diabetes a serious public health problem for women; 

analyzes the epidemiologic, psychosocial, socioeconomic, and environmental dimensions of women and 

diabetes; and discusses public health implications. This landmark document explores the impact of diabetes on 

women’s lives by using a framework that defines the issues across various life stages—adolescent, 

reproductive, middle, and elder years. A complete copy is available on CDC’s Web site, at 

http://www.cdc.gov/diabetes/projects/women.htm. 

In Phase II, CDC joined forces with the American Diabetes Association (ADA), the American Public Health 

Association (APHA), and the Association of State and Territorial Health Officials (ASTHO) to convert the 

information contained in the 2001 report into action. Toward this end, the four cosponsoring agencies convened 

a task force in November 2001 with representatives of more than 40 organizations from the public, private, and 

voluntary sectors. Proposed recommendations from this meeting were published as the Interim Report: 

Proposed Recommendations for Action, and are available on CDC’s Web site, at 

http://www.cdc.gov/diabetes/pubs/action/index.htm. 

In Phase III, the proposed recommendations were examined by representatives from multidisciplinary 

agencies, including government, academic, voluntary, business, community-based, and professional 

organizations. In early 2003, the highest-priority recommendations and strategies for their implementation were 

published in the National Agenda for Public Health Action, available online at 

http://www.cdc.gov/diabetes/pubs/action/index.htm. More recently, in October 2003, these and many other 

organizations met to develop implementation plans for the National Agenda. This document reflects their 

deliberations during breakout sessions at the Call to Action Conference. The efforts of the Initiative and the 
results of the Call to Action Conference that are documented in this report are a work in progress and will 

evolve over the coming months. A complete copy is available on CDC’s Web site, at 

http://www.cdc.gov/diabetes/projects/women.htm. 

B. Conference Purpose and Agenda 

The Call to Action Conference was a true working meeting. Prior to the meeting, participants were given a 

premeeting survey and asked to identify recommendations in the National Agenda that were most compatible 

with their organizations’ mission, priorities, and expertise, and life stages of primary interest. This information 

was used to create small groups and help focus the discussion. 

To set the stage for the working group sessions, a plenary session was moderated by Ann Albright, PhD, RD. 

Participants heard presentations from Aranthan Jones of the Congressional Black Caucus, Michelle Owens, 

PhD, of CDC, and four health professionals who were managing successful programs for women at risk for or 

who have diabetes. Success stories were delivered by Marsha Henderson, MCRP, MPH, of the Food and Drug 

Administration; Captain Candace Jones, Acting Deputy Director, Office of Public Health, of the Indian Health 

Service; Edith Kieffer, PhD, MPH, of the University of Michigan School of Social Work; and Carolé Mensing, 

RN, MA, CDE, of the American Diabetes Association. The plenary concluded with a premiere viewing of the 

CDC-produced video, Women and Diabetes: Across the Life Stages. 

Participants then adjourned to their assigned small groups, each with a different focus: advocacy and policy, 

health care, media, state and community programs, and research and surveillance. 

Each group, led by a trained facilitator, was charged to the following: 

1. Identify the role participants’ organizations might play in implementing the National Agenda. 

2. Propose specific steps their organizations could take in the next 3–6 months, and in the next 6–12 months, 

to implement the National Agenda. 

3. Suggest other organizations that should be involved in implementing the National Agenda and ways to 

solicit support from these organizations. 

4. Recommend methods for coordinating activities and resources devoted to implementing the National 

Agenda, sustaining momentum, and monitoring progress. 

This document summarizes participants’ recommendations for implementing the National Agenda. It is a work 

in progress, that can be modified over time as additional organizations join the fight against diabetes among 

women. It is best used in tandem with the National Agenda, and supplements the commitments that the 

Initiative’s cosponsors have made to implementing the National Agenda (see Attachment B). This report builds 

on materials found in the National Agenda by identifying specific steps that partners of the Initiative have 

chosen to address issues related to women with diabetes across the life stages and those at risk. 

II. Where are we headed? 
The full Initiative and the National Agenda for Action are founded on a realistic vision and on specific and 

attainable goals. These are consistent with the framework of Healthy People 2010, which establishes national 

targets for the primary prevention of diabetes and its complications. 

A. Our Vision 

• Diabetes among women can and should be prevented or delayed whenever possible. 

• The families and communities of women at risk for diabetes can and should be informed and given the 

support they need to prevent or delay diabetes and its complications. 

• Appropriate diabetes care and management can and should be promoted among women across the life 

stages. 

• Diabetes complications among women can and should be prevented, delayed, or minimized. 

B. Our Goals 

• Garner the national attention of policymakers, public health professionals, other advocates for women’s 

issues, researchers, and the public to make diabetes a prominent public health issue. 

• Develop consensus among key stakeholders about the need to establish priority strategies, policies, and 

research to improve diabetes and women’s health. 

• Delineate the public health role in diabetes and women’s health at national, state, and 

community levels, and improve the capacity of these public health sectors to fulfill that role. 

• Unite partners from multiple sectors of society in a coordinated strategy to prevent and manage diabetes 

among women. 

• Empower women to adopt prevention strategies that improve their health and delay or prevent diabetes 

and its complications. 

C. Our Guiding Principles 

The guiding principles underlying the National Public Health Initiative on Diabetes and Women’s Health are 

equally important. 

• A public health approach to diabetes among women should be adopted. This approach aims to 

improve the health and quality of life for all women, primarily through prevention, and focuses on all 

factors—physical, behavioral, psychological, and socioeconomic--—that influence health status. 

• Collaboration within and among multiple sectors of society is essential for success. These sectors 

include public and private health care organizations, business and industry, education and environment, 

communication and media, and policymakers. 

• Strategies and policies must fully consider and take into account the unique needs of women in different 

life stages in all racial, ethnic, religious, and cultural groups. 

• Women and grassroots organizations should be fully engaged as active partners in policy decisions and 

in program planning, implementation, and evaluation. Men’s strong involvement and support should 

also be sought. 

• Leadership of state and community agencies and groups must share accountability for adopting 

approaches to improve the health status of women. 

• Actions should be based on sound research from all relevant scientific fields, and additional 

public health research should focus on filling gaps in scientific knowledge. Assessment must guide 

policy and program development. 

• Measurable outcomes for programs and policies should be established so progress and impact can be 

evaluated and approaches can be modified as needed. 

• Strategies and policies must be sustainable and integrated over time, not one-time interventions. New 

initiatives should build on existing resources, services, and natural links among local, state, and federal 

agencies and organizations in the public and private sectors. 
III. What actions are essential? 

In the National Agenda, 10 priorities are recommended for improving the health and well being of women who 

have or who are at risk for diabetes. For each recommendation, strategic actions are proposed to expediently 

achieve the Initiative’s goals. Some actions can be implemented immediately and accomplished in a relatively 

short time (6-12 months); others will require more time and/or resources. 

Ten Priority Actions 

1. Encourage and support diabetes prevention and control programs in state health departments to 

develop prevention and management efforts for all women, and establish links to services and programs for 

women at risk of type 2 diabetes. 

2. Expand community-based health promotion education, activities, and incentives for all ages in a wide 

variety of settings—schools, workplaces, senior centers, churches, civic organizations, and other locations 

where women live, learn, work, and play. 

3. Fortify community programs for women with sufficient support, training, tools, materials, and other 

forms of support. 

4. Strengthen advocacy on behalf of women who have or who are at risk for diabetes. 

5. Expand population-based surveillance to monitor and understand (a) variations in the distribution of 

diagnosed and undiagnosed diabetes, impaired fasting glucose and impaired glucose tolerance within and 

between groups, and (b) the factors—cultural, racial, ethnic, geographic, demographic, socioeconomic, and 

genetic—that influence the risk for diabetes and complications among women at all life stages. 

6. Educate community leaders about diabetes and its management and the value of healthy environments. 

7. Encourage health care providers to promote risk assessment, quality care, and self-management for 

diabetes and its complications in their practice settings. 

8. Ensure access to trained health care providers who offer quality services consistent with established 

health care guidelines. 

9. Encourage health care coverage and incentives for recommended diabetes prevention and management 

practices. 

10. Conduct public health research to further knowledge of the epidemiologic, socioenvironmental, 

behavioral, translational, and biomedical factors that influence diabetes and women’s health. 

IV. How should each action be pursued? 
A. The Big Picture 

Several key values underlie the details of the National Agenda. 

1. See the faces 

Keeping the faces of women front and center will help ground this Initiative in compassion and empathy. 

Women who have and who are at risk for diabetes must negotiate competing priorities each day of their lives. 

We must be ever mindful that most diabetes interventions add more to a woman’s list of daily tasks with no 

obvious and immediate benefits. This is compounded by the fact that diabetes is seen as a silent disease—one 

that does not generate fear, particularly in its early stages. Messages and interventions must take these 

complexities into account and address consumers with appropriate language, life stage, health literacy, and 

cultural context, among other factors. They must accommodate factors that bear on the burden of diabetes 

among women, take advantage of missed opportunities for prevention and control, preserve health behaviors 

that are protective (particularly among recent immigrants), and create new opportunities that fit relatively easily 

into a woman’s natural lifestyle. 

2. Embrace partners 

Tackling this complex chronic disease requires the expertise and resources of multiple sectors and disciplines. 

Existing partnerships should be energized and new alliances forged. Communication and coordination are key, 

through listservs, meetings, casual and formal conversations, and joint activities. We must reduce the creation 

of “silos” that duplicate effort, and design links to share information. Groups should focus on strategies they are 

uniquely or best positioned to accomplish, and resources should be leveraged wherever possible. A wealth of 

resources is available to accomplish the Initiative’s vision, but tapping them requires a willingness among many 

(individually and collectively) to accept the premise that one must give in order to receive. 

3. Lead boldly 

Leadership to move the Initiative forward rests with the CDC and the partnering cosponsors: ADA, APHA, and 

ASTHO. These agencies have delineated a shared vision and with this National Agenda have laid the 

groundwork to translate that vision into reality. Bold and creative steps are required to secure sufficient support 

and resources, assure proper stewardship and oversight, advocate foundational policies and legislation, and set 

standards of excellence for the work of future generations. 

4. Build on evidence 

Much is known about how to prevent, delay, and manage diabetes. Yet, sufficient networks or systems are 

lacking to organize that information, make it accessible for widespread use, and help avoid duplicated effort. At 

the same time, there are significant gaps in the knowledge base. Formative research is critical to exploring 

alternative approaches, identifying best practices, and ultimately issuing more women-specific standards and 

practice guidelines. Women and their families should be involved in that research, from the early planning 

stages through implementation, evaluation, and dissemination of results. 

5. Be creative yet accountable 
As we proceed, we should think outside the box but be ever mindful of the larger societal context of the 

Initiative. We need to make every dollar count, coordinating methodologies and resources as often as possible. 

We need to create products that our audiences (the media, the consumer, the professional) will want and use. 

Messages should be channeled toward action-oriented results. Successes should be documented and applauded; 

positive outcomes should be publicized and celebrated. Funders and supporters should be apprised of progress, 

outcomes, and lessons learned. 

B. The Details 

This section presents the recommended action steps and partnering organizations that emerged from the Call to 

Action Conference. To generate this listing, participants were asked to select specific action steps in the 

National Agenda that they felt were most important. These priority action steps are noted in bold type in the 

first column below. Following each bolded action step are more detailed suggestions for activities that could 

help implement the action step. 

The action steps are not ranked by priority; they reflect the group’s notes and discussions. Some steps apply to 

a specific life stage, others pertain more broadly to several or all life stages. Furthermore, because the list of 

action steps was generated solely by conference attendees, it is shaped by their interests and areas of expertise 

and is neither comprehensive nor exhaustive. 

Similarly, the list of partnering organizations includes those that participants felt to be relevant to their 

respective action steps and activities. The organizations are listed alphabetically and grouped beside the action 

step or set of activities to which they correspond. 

1. Encourage and support diabetes prevention and control programs in state health departments to develop 

prevention programs for all women and establish efficient links to services and programs for women at risk 

for type 2 diabetes. 

Action Steps 

Enhance support and resources to state health agencies to establish and maintain leadership on behalf of women 

who have or who are at risk for diabetes. 

Provide information to educate women’s health advocates and policymakers. 

Prepare and support representatives from various participating organizations to visit Capitol Hill and their 

elected representatives to discuss women and diabetes issues. 

Continue to sponsor and use ASTHO’s lobbyist. 

Advocate policies and increased funding that support state-level programs in women’s health. 

Urge one-time support of community activities to enhance women’s health agenda. 

Engage other private partners. 

Share information and data as resources. 

Partnering Organizations 
Academia, ADA, AMCHP, APHA, ASTHO, ASTPHND, CDC, managed care 

organizations, OWH, Region IV, sororities 

Action Steps 

Develop messages and quality support for DPCPs and Steps to a Healthier US Initiative (STEPS) and 

strengthen links between them. 

Partnering Organizations 

ADA, ASTHO 

Several organizations, noted in italics, were not represented at the meeting but are viewed as potential partners that could 

significantly advance the Initiative. Acronyms are spelled out in the Glossary (Attachment C). 

Action Steps 

Support strong leadership to facilitate organized and consistent efforts between and among departments 

of state and local public health agencies that address diabetes and women’s health issues. 

Use champions. 

Build on existing relationships. 

Start new relationships. 

Sponsor prevention staff liaisons in different DHHS regions. 

Encourage Regional Health Officers through: 

• Leadership institute. 

• Sections, committees, affiliates. 

• Centers of excellence. 

Highlight racial/ethnic disparities. 

Partnering Organizations 

AMCHP, APHA, ASTHO, ASTPHND, OWH, OWH Leadership groups and committees 

Action Steps 

Revisit and reinvigorate ADA’s Diabetes Coalition, with added organizations of women’s groups. 

Partnering Organizations 

ADA 

Action Steps 
Maintain leadership of CDC and Initiative cosponsors through annual meetings and other monitoring and 

support efforts. 

Partnering Organizations 

ADA, APHA, ASTHO, CDC 

Action Steps 

Integrate chronic disease programs in state health departments. 

• Identify examples of strong integration among different programs in state health departments (e.g., Steps 

to a Healthier US, etc.). 

• Review all CDC chronic disease program grant language to eliminate limitations or unintended barriers to 

integration and to promote such 

integration where possible. 

• Encourage and support efforts of state health agencies to integrate with other women’s health efforts. 

Partnering Organizations 

Chronic Disease Directors, CDC (Futures Initiative, Office on Women’s Health) 

Action Steps 

Encourage state and local coalitions and other consortiums to coordinate plans, policies, and activities 

through regular communication and priority-setting processes. 

Bring partners together. 

Emphasize a community-based focus.

Partnering Organizations 

Academic institutions, ADA, AMCHP, faith-based organizations, OWH, private insurers, RWJ, unions 

2. Expand community-based health promotion education, activities, and incentives for all ages in a wide 

variety of settings. 

Action Steps 

Identify and develop links with community agencies that interface with women at greatest risk in all life 

stages, including those in nonhealth-related sectors. 

Identify organizations that communicate with large bases of constituents. 

• Tap into networks of organizations that already participate. 

• Work with other nontraditional (nonhealth) organizations. 

• Collaborate with organizations that can get to local/community-based organizations. 

Identify gaps and underrepresented groups and try to reach them to build a broader base. 
Create a network communication strategy to disseminate information. 

Further develop links by informing organizations and their constituents about the Initiative and try to reach 

them to build a broader base. 

Create a network communication strategy to disseminate information. 

Further develop links by informing organizations and their constituents about the Initiative and ways they can 

participate. 

Partnering Organizations 

ADA, APHA, ASTHO, CDC 

Action Steps 

Design a social marketing campaign that integrates current diabetes-related messages aimed at women 

and their families regarding nutrition, cardiovascular disease, smoking, and physical activity. 

Work with and through business, industry, and media partners to reach women and influence them to 

adopt healthy behaviors. 

Work with Diabetes Detection Initiative (DDI). 

Partnering Organizations 

DPCPs, OWH, primary care associations, regional women’s health coordinators, regional health administrators, 

state women’s health coordinators 

Action Steps 

Use web site www.4girls.gov; link with other sites and sponsor Frequently Asked Questions. 

Partnering Organizations 

4Girls website, OWH, Young Women Summits in regions 

Action Steps 

Implement awareness programs by including specific requirements in Request for Proposals. 

Partnering Organizations 

CCOEs (NWICH, PYPTH), COE 

Action Steps 

Continue to support intergovernmental efforts through small contracts to community-based organizations. 

Offer incentives to communities with federal and state support that promote development of healthy 

environments. 

Partnering Organizations 

CCOEs (NWICU, PYPTH), COE, Steps to a Healthier US 
Action Steps 

Publicize best practices in targeted journals and in consumer-friendly relative risk fact sheets or purse cards. 

Maintain web site to display current, proactive information; be usable and offer messages such as “Change your 

mind, change your life.” 

Partnering Organizations 

PorFits, US Department of Agriculture Extension - 4H Clearinghouse 

CMS national and regional offices; QUO, USDA Cooperative Extension Educators 

Action Steps 

Tap partners of CMS and regional offices and Quality Improvement Organizations that operate in each state and 

have extensive state networks. 

Partnering Organizations 

Teens Teaching Internet Skills Program 

Action Steps 

Share messages via satellite studio broadcasts. 

Partnering Organizations 

ALA, PLA 

Action Steps 

Develop a tiered campaign to promote awareness of worsening of diabetes or modifiable risk behaviors that 

foster development. 

Promote access to resources for information, medical care, and lifestyle modification. 

Create cross-industry coalitions to improve care for the diabetic community. 

Partnering Organizations 

Pharmaceuticals with government agencies (to leverage existing campaigns/materials) 

Action Steps 

Promote prevention through lifestyle modification. 

Partnering Organizations 

HMOs (to develop better patient education programs/materials) 

Action Steps 
Explore alternative approaches to messaging (e.g., cell phones and conduct market research to test 

messages for optimal impact). 

Prepare and sponsor written articles directed to teens, perhaps written by them, and promote their publication in 

such journals as Forecast in its Just for Teens column. 

Partnering Organizations 

Schools and peer groups (as avenues to get 

students involved in campaigns), universities 

Action Steps 

Seek people with diabetes who are willing to reach out via print, radio, and Internet. 

Use the power of the Internet by designing and updating sites specifically for women. 

Sponsor moderated chats and message boards, with health professionals serving as moderators. 

Partnering Organizations 

Nonprofits such as universities, hospitals, 

medical centers, or government 

Action Steps 

Charge existing racial/ethnic minority workgroups of NDEP to take ethnic-specific diabetes prevention 

messages to the respective communities within their customary purview and beyond (that is, expand 

messages to respective racial/ethnic communities in other regions of country). 

Partnering Organizations 

CDC, existing racial/ethnic organizations, NIH (NIDDK) 

Action Steps 

Develop broadcast messages that are linguistically and culturally appropriate to specific racial/ethnic 

populations. 

Ensure that DDI includes all diabetes-related 

activities in DHHS. 

Partnering Organizations 

Journalists for print articles, racial/ethnic minority media 

Action Steps 

For adolescent years: 

Structure and deliver educational messages to encourage female adolescents who have and who are at risk for 

diabetes to engage in regular physical activity, make good nutritional choices, and avoid or stop smoking. 
Create positive, rewarding forums that promote healthy eating and physical activity among 

adolescent females at risk for type 2 diabetes. 

Approach Rhode Island and other state 

Departments of Education to serve as pilot sites based on funding obtained from national organizations with 

educational message for schools, families and communities. 

Connect with National Association of School Nurses. 

Find other national organizations and identify local funding and resources. 

Partnering Organizations 

NASN (National Association of School Nurses), Rhode Island Department of Education 

Action Steps 

Identify media partners to disseminate culturally competent, age appropriate, linguistically appropriate 

messages. 

Partnering Organizations 

NASN, Rhode Island Department of Education 

Action Steps 

Research existing education literature and Best Practices programs. 

Partnering Organizations 

Media 

Action Steps 

Develop diabetes education and communication programs. 

Make tools available for needs assessment to identify gaps. 

Conduct a needs assessment. 

Identify target communities. 

Find out what materials are available. 

Partner with churches and workplaces. 

Explore civic/community organizations such as libraries. 

Environment – creative use of space that is available 

Partnering Organizations 

AADE, CDC and other partners (could 

serve as clearinghouse for education and 
dissemination), DCPC, DHHS, fraternal and faith-based organizations, government, 

hospitals, NAACP, parks and recreation, Urban League 

Action Steps 

Use existing approved web sites geared to young girls. 

Partnering Organizations 

OPHS, GPI coordinating committee, Girl Power 

Action Steps 

Community health centers can help publicize positive outcomes for diabetes management. 

Partnering Organizations 

Diabetes Collaborative, Community health centers 

Action Steps 

Promote Take a Loved One to the Doctor Day, September 2004. 

Translate Be Smart About Your Heart. Control the ABC’s (HBA1C, Blood Pressure, Cholesterol) of 

Diabetes campaign into other languages. 

Use ethnic media spokespersons. 

Partnering Organizations 

Anticipated continued partnership with ABC Radio, ASPA, Closing the Gap newsletter, OMH, OMHRC, 

RadioUnica and additional ethnic broadcast media, ROs 

3. Strengthen advocacy on behalf of women who have or who are at risk for diabetes. 

Educate and document the potential for prevention and best practices, stressing the components that related to policy and 

policymakers 

Action Steps 

Educate and document the potential for prevention and best practices, stressing components related to policy 

and policymakers. 

Partnering Organizations 

DHPE (identify best policy practices and components) 

4. Fortify community programs for women with sufficient support, training, tools, and materials. 

Action Steps 
Share information on available resources: commonalities and differences. 

Identify needs and resource gaps. 

Support additional products that establish continuity of care. 

Redirect money and resources away from redundant practices.

Partnering Organizations 

CDC, FDA, NDEP 

5. Expand population-based surveillance to monitor and understand influencing factors. 

Action Steps 

Establish more effective and efficient links between programs with communities. 

Better integrate DHHS initiatives to reduce duplication and inappropriate use of resources. 

Increase behavioral research with particular attention to behavior modification. 

Ensure attention across DHHS to the unique or distinct disproportionate burden of diabetes for women. 

Establish a research coordination component for the Diabetes Detection Initiative (DDI). 

Commit to follow-up and monitoring of how research recommendations are implemented as components of 

DHHS programs. 

Develop a focused research agenda for women’s health, associated with DDI .

Partnering Organizations 

DHHS, employers, industry (grocers, pharmaceuticals, etc.), insurers, NDEP, professional associations 

6. Educate community leaders about diabetes and its management and about the value of healthy 

environments 

Action Steps 

For adolescent years: Educate school system personnel. 

Build partnerships. 

Engage departments of education in Rhode Island and other states as laboratories for developing models

Partnering Organizations 

Girl Scouts of America, national organizations of school boards, sororities 

7. Encourage health care providers to promote risk assessment, quality care, and self-management for 

diabetes and its complications in their practice settings. 

Action Steps 
Develop and disseminate best practice guidelines for providers in various clinical and nonclinical 

settings. 

Disseminate the model of multidisciplinary teams for diabetes management and encourage its use in 

clinical settings. 

Bolster training and continuing education for health care providers and diabetes community health 

workers. 

Develop and disseminate best practice guidelines,such as: 

• Train-the-Trainer primarily for CVH and CMS. 

• QIOs ADA guidelines. 

• PDA-based guidelines. 

• Get With The Guidelines. 

• Guidelines Applied in Practice. 

• HRSA’s Health Disparities Collaboratives. 

• CMS posters for Take Your Shoes Off; Feet Can Last a Lifetime. 

Partnering Organizations 

ACC, ADA, AHA, AWHONN, CMS/QIOs, 

federally funded centers, HRSA, HRSA/BPHC, 

state diabetes prevention and control programs 

Action Steps 

Inventory venues for continuing education on diabetes and women’s health, considering: 

• Pharmacy continuing education for diabetic eye disease. 

• May as Healthy Vision Month. 

• Web sites to pool resources for women and diabetes. 

• Compendium update to include women and diabetes issues. 

Partnering Organizations 

NIH, APTA, AWHONN 

Action Steps 

Compile environmental scan of training and continuing 

education via web site. 

Partnering Organizations 

CDC 

8. Ensure access to trained health care providers who offer quality services consistent with established 

health care guidelines. 
Action Steps 

Convene subgroups of multiple disciplines, government, nonprofit agencies, and advocacy groups to embrace 

this message and produce intergenerational material. 

Create a private/governmental grant mechanism by combining funds from OWH and other sources to support 

state and local efforts aimed at testing and demonstrating recommendations for quality services. 

Encourage use of current models: Take Time to Care, Take a Loved One to the Doctor, monthly disease 

observations, and others. 

Partnering Organizations 

ADA, APHA, CDC, DHHS, FDA, NDEP, OWH 

Action Steps 

Focus on older women by: 

• Reviewing workplace policies and guidelines. 

• Reviewing faith-based initiatives. 

Partnering Organizations 

AoA, OWH 

9. Encourage health care coverage and incentives for recommended diabetes prevention and management 

practices. 

Action Steps 

Address legislatively mandated programs, such as: 

• CHIP. 

• Medicare. 

• Medicaid. 

• WISEWOMAN. 

Partnering Organizations 

CDC, program leaders, regional federal agencies, Women’s Health Council 

Action Steps 

Work at the “margins” by extending age eligibility and types of coverage. 

Address volunteer or Stop-Gap Coverage Programs at worksites/businesses and in communities. 

Develop success stories and best practices. 

Market and showcase effective models.

Partnering Organizations 
BIG, Medical Alliance Society, medical societies 

Action Steps 

Develop the business case for care management with diabetes, using data developed from the Medicaid/NGA 

study. 

Partnering Organizations 

Washington Business Group on Health 

Action Steps 

Continue to support the Community Guide and disseminate findings of relevant chapters. 

Partnering Organizations 

CDC 

10. Conduct public health research to further knowledge about the epidemiologic, socioenvironmental, 

behavioral, translational, and biomedical factors that influence diabetes and women’s health. 

Action Steps 

For older years: 

To what extent does use of multiple medications influence quality of life and affect women’s ability to 

manage diabetes? 

Identify existing datasets that allow evaluation of: 

• The impact of interventions on quality of life. 

• Appropriate medication use. 

• Costs associated with medication and/or 

disease management. 

Increase awareness of these datasets among the 

scientific community so data can be better used and explored in simulation studies and other research. 

Raise specific questions for analysis. 

Suggest possible interagency agreements between federal agencies and issue joint Requests for Applications to 

fund these studies. 

Coordinate research activities in DHHS to avoid duplication whenever possible. 

Disseminate models based on results.

Partnering Organizations 

Interagency partnerships (AHRQ MEPS database, CDC TRIAD, etc.), managed care organizations 
V. When can we begin? 

A. Taking the First Step 

Implementing the entire action plan is a daunting task, and the first steps may be the most difficult. It is 

important to recognize, however, that a solid foundation has already been laid. Much hard work has been 

invested in diabetes and women’s health over the past few years, and the positive results of these efforts are 

beginning to show. The task ahead is to build on these successes and work together toward our shared vision 

and goals. 

To this end, participants recommended that we: 

Be clear about what we know. 

Share that knowledge with women, their families, and their health care providers. 

Incorporate that knowledge into program design and delivery. 

Advocate policies that enhance access to quality care. 

Specific advice on next steps included: 

Analyze existing material to identify and capitalize on the good news we have about diabetes prevention and 

control among women. 

Amass a collection of positive stories and examples to solicit and energize supporters.

Establish a clearinghouse or other information portal. 

Publish what is known about diabetes and women’s health—both best and worst examples. 

Emphasize prevention in diabetes literature. 

Adopt a universal tagline such as “change your mind, change your life.” 

Collate existing data for physicians and patients and assure centralized and easy access; advertise this 

valuable tool and build in links to other information, services, and resources. 

Establish a central repository of programs for specific audiences (e.g., young girls, pregnant women, the 

elderly). 

Promote action based on information. 

Activate advocates to tackle payment and other barriers to screening. 

Urge women to become advocates for quality family health care. 
B. The Long Haul 

Participants recognized the risk of starting strong, only to be delayed or derailed by competing interests and 

challenges. They pledged collectively to do their utmost to sustain momentum and to stay in touch by: 

Designing and maintaining a listserv and/or email group to keep conference participants connected, and to: 

• Share information, materials, relevant issues, etc. 

• Prepare a calendar of upcoming events pertinent to diabetes and women (e.g., November’s diabetes 

month and March’s screening day). 

• Identify additional group members and issue invitations to join the effort. 

Solidifying the membership of the ADA-sponsored Diabetes Coalition. 

Making a personal commitment to take information learned and generated at the conference home to 

communities and colleagues and to use that information to empower women to take charge of their health and 

their lives. 

Monitoring implementation of priority actions and providing feedback to participants on progress and 

roadblocks through upcoming partner update meetings, larger national annual meetings, and regular phone 

conferences. 

VI. Who can make this happen? 

Approximately 158 organizations were invited to the Call to Action Conference; 75 participated in conference 

deliberations. These partners, listed below, should be applauded for their commitment to the Initiative and 

for their willingness to continue the fight for the health of women and their families affected by or at risk for 

diabetes. Over the coming months and years, the number of partners engaged in the Initiative is expected to 

grow significantly as we work together until our goals are met and our vision becomes a reality. 

Partners 

Administration on Aging 

Agency for Healthcare Research and Quality 

American Association of Diabetes Educators 

American College of Nurse-Midwives 

American Geriatrics Society 

American Heart Association 

American Osteopathic Association 

American Pharmaceutical Association 

American Pharmacists Association 

American Physical Therapy Association 

American Psychological Association 

Association of State & Territorial Public Health Nutrition Directors 
Association of American Indian Physicians 

Association of American Medical Colleges 

Association of Maternal and Child Health Programs 

Association of State and Territorial Chronic Disease Program Directors 

Association of Women’s Health 

Association of Women’s Health, Obstetric and Neonatal Nurses 

Centers for Medicare and Medicaid Services 

Chronic Disease Directors 

Congress of National Black Churches 

Congressional Black Caucus Foundation 

Constella Health Sciences 

Department of Health and Human Services, Office of Minority Health 

Department of Health and Human Services, Office on Women’s Health, Regions I, III, IV, VII, X 

Diabetes Exercise and Sports Association 

Directors of Health Promotion and Education 

EyeCare America 

Food and Drug Administration, Office of Women’s Health 

Grey Healthcare Group 

Health Resources and Services Administration 

Health Resources and Services Administration, Office of Women’s Health 

Juvenile Diabetes Research Foundation 

MedStar Health 

National Alliance for Hispanic Health 

National Association for Women’s Health 

National Association of City and County Health Officials 

National Association of Nurse Practitioners in Women’s Health 

National Association of School Nurses 

National Association of State Medicaid Directors 

National Council on the Aging 

National Eye Institute 

National Heart, Lung, and Blood Institute 

National Organization for Women 

National WIC (Women, Infants and Children) Association 

National Women’s Health Resource Center 

New Hampshire Minority Health Coalition 

Ohio Diabetes Prevention and Control Program 

Project DIRECT 

Rhode Island Department of Education 

Richland Family Practice Center 

Society for Women’s Health Research 

SPRY Foundation 

St. Louis University 

Templeton Consulting Group 

University of Southern California/Women & Children’s Hospital 

University of Connecticut Health Center 

University of Michigan School of Social Work 

Washington State Department of Health 

Women’s Health Institute 
Attachment A: Staff Support 

American Diabetes Association 

Lee Barona 

Director 

National Call Center 

Bronwyn Reynolds 

Manager 

Special Projects 

American Public Health Association 

Barbara Hatcher, PhD, MPH, RN 

Director 

Scientific and Professional Affairs 

Monica Lathan, MPH 

Scientific and Professional Affairs 

Association of State and Territorial Health 

Officials 

Jennifer Jimenez, MPH 

Prevention Policy Analyst 

Kathleen Nolan, MPH 

Senior Director 

Prevention Policy 

Kristen Tertzakian, MPH 

Senior Analyst 

Tobacco Control Policy 

Centers for Disease Control and Prevention 

Ana Alfaro-Correa, ScD, MA 

Program Development Office 

Division of Diabetes Translation 

Gloria Beckles, MD, MSc 

Epidemiologist 

Division of Diabetes Translation 

Chris Benjamin, JD, MPA 
Program Development Consultant 

Division of Diabetes Translation 

Barbara Bowman, PhD 

Associate Director for Policy Studies 

Division of Diabetes Translation 

Leslye Colvin, MA 

Health Communications Intern 

Division of Diabetes Translation 

Stephanie Dopson, MPH, MSW 

Public Health Advisor 

Division of Diabetes Translation 

Kathy Gallagher, MPH 

Public Health Analyst 

Office of the Director 

National Center for Chronic Disease Prevention and 

Health Promotion 

Yvonne Green, RN, MSN, CNM 

Associate Director for Women’s Health 

Office of Women’s Health 

Angela Green-Phillips, MPA 

Chief, Office of Policy and Program Information 

Division of Diabetes Translation 

Regina Hardy, MS 

Public Health Educator 

Division of Diabetes Translation 

Sabrina M. Harper, MS 

Public Health Advisor 

Division of Diabetes Translation 

Leandris Liburd, PhD 

Chief, Community Intervention Section 

Division of Diabetes Translation 

Norma Loner 

Management Specialist 

Division of Diabetes Translation 

Qaiser Mukhtar, PhD 

Epidemiologist 

Division of Diabetes Translation 
Dara Murphy, MPH 

Chief, Program Development Branch 

Division of Diabetes Translation 

Michelle D. Owens, PhD 

Behavioral Scientist 

Division of Diabetes Translation 

Kathy Rufo, MPH 

Deputy Director 

Division of Diabetes Translation 

Arlene Sherman, CMP 

Committee Management Specialist 

Division of Diabetes Translation 

Nancy Silver, MS 

Health Communications Specialist 

Division of Diabetes Translation 

Mary Kay Sones 

Health Communications Specialist 

Office of the Director/Office of Communications 

Attachment B 

CALL TO ACTION: 

Cosponsors’ Commitments to the National Agenda 

Who are the cosponsors of the National Public Health Initiative on Diabetes and Women’s Health? 

The American Diabetes Association (ADA) is the nation’s leading nonprofit health organization providing 

diabetes research, information, and advocacy. Founded in 1940, the ADA conducts programs in all 50 states and 

the District of Columbia, reaching hundreds of communities. The ADA’s mission is to prevent and cure 

diabetes and improve the lives of all people affected by diabetes. To fulfill this mission, the ADA funds 

research; publishes scientific findings; provides information, and other services to people with diabetes, their 

families, health care professionals, and the public; and advocates scientific research and the rights of people 

with diabetes. The moving force behind the ADA’s work is a network of more than 1 million volunteers, 

including a membership of more than 400,000 diabetes patients and their families, and a professional society of 

more than 20,000 researchers and health care providers. 

The American Public Health Association (APHA) is the oldest and largest organization of public health 

professionals in the nation, representing more than 50,000 members in more than 75 disciplines in public health 

and related fields. APHA’s mission is to improve the public’s health, promote the scientific and professional 
foundation of public health practice and policy, advocate conditions for a healthy global society, emphasize 

prevention, and enhance the ability of members to promote and protect environmental and community health. 

In this regard, the association influences policies and sets priorities on a broad set of issues, including injury 

control and prevention, children’s health, environment and health, managed care, public health infrastructure, 

disease control, international health activities, tobacco control, state and federal funding for health programs, 

and professional education in public health. 

The Association of State and Territorial Health Officials (ASTHO) is a national nonprofit organization that 

represents state and territorial public health agencies of the United States, the U.S. Territories, and the District 

of Columbia. ASTHO’s members, the chief health officials of these jurisdictions, are dedicated to formulating 

and influencing sound public health policy and assuring excellence in state-based public health practice. 

The Centers for Disease Control and Prevention (CDC) is the lead federal agency for protecting people’s 

health and safety at home and abroad, providing credible information to enhance health decisions, and 

promoting health through strong partnerships. CDC is the national focus for developing and applying disease 

prevention and control, environmental health, and health promotion and education activities designed to 

improve the health of the people of the United States. The agency’s mission is to promote health and quality of 

life by preventing and controlling disease, injury, and disability. 

Why have we chosen to cosponsor the Initiative? 

ADA wants to address the special role of women as gatekeepers for family health care decisions. Today, 

about 18 million Americans, including just over 9 million women, have diabetes. Although diabetes can be 

especially hard on this population, many do not know they have the disease. Recognizing that diabetes has 

an enormous impact on America’s health and economy, the association aims to raise awareness of the unique 

impact that diabetes has on women and educate policymakers and others about this important topic. 

APHA believes that, from a public health perspective, obesity and diabetes are two of the most important 

public health issues facing the nation. Immediate intervention is critical because the rates of these two 

diseases are increasing nationally at an alarming rate, especially among minorities, and recent data suggest 

that both conditions may be prevented or reduced through lifestyle changes. 

ASTHO is excited to be a cosponsor of the National Public Health Initiative on Diabetes and Women’s 

Health. The prevalence of diabetes is on the rise, as is its impact on women, their families, and their 

communities. State health departments are already implementing evidence-based programs that improve 

women’s ability to prevent diabetes and avoid complications through provider and clinician education, 

public education campaigns, screening efforts, provision of technical assistance to ensure community-based 

efforts that reflect the latest research, and other efforts and programs. ASTHO looks forward to enhancing 

ongoing state efforts through a strong national agenda with numerous, broad-based partners. The agenda will 

serve as a guide for future state diabetes policy and education activities. 

CDC responded to the growing U.S. diabetes epidemic by developing the National Public Health Initiative 

on Diabetes and Women’s Health. Its purpose is to examine the burden of diabetes and its impact on 

women’s health, to develop a plan for addressing these issues, and to collaborate with organizations that can 
intervene on behalf of women who have and who are at risk for diabetes. The Initiative complements CDC’s 

mission by working with numerous partners from the public, private, and voluntary sectors to improve the 

lives of women who have diabetes and those who are at risk. The Initiative has followed CDC’s mission by 

assessing the burden of diabetes as it relates to women’s health, identifying priority recommendations to 

address this burden, and developing sound public health strategies for action. 

Which recommendations in the National Agenda for Public Health Action are most closely aligned with 

our organizational priorities? 

ADA’s commitment to the three pillars of research, information, and advocacy best align with the following 

priorities: 

• Encourage and support diabetes prevention and control programs. 

• Expand community-based health promotion education, activities, and incentives for all ages. Serve 

as a resource for information. 

• Strengthen advocacy on behalf of women who have, or who are at risk for diabetes. 

• Educate community leaders about diabetes and its management, and the value of healthy 

environments. 

• Encourage health care providers to promote risk assessment, quality care, and self-management for 

diabetes and its complications in their practice settings. 

• Conduct public health research on factors that influence diabetes and women’s health. 

APHA priorities and goals include: 

• Advancing public health advocacy and stimulating public support for public health. 

• Improving public health practice. 

• Emphasizing prevention. 

• Eliminating racial and ethnic disparities. 

• Improving access to care. 

• Building a sound public health infrastructure. 

• Improving children’s health. 

• Working on aging issues. 

• Protect environmental and community health. 

• Encourage public health research. 

We support all the recommendations in the National Agenda but commit particularly to those dealing with 

diabetes prevention, health promotion, strengthening advocacy, access to care, and health coverage. 
ASTHO has established channels through numerous affiliated organizations representing directors of divisions 

in state health departments and long-standing relationships with other partner organizations. ASTHO will use 

these existing relationships to educate other organizations on the issue and to garner support in state health 

departments. 

CDC 

• Encourage and support diabetes prevention and control programs in state health departments to 

develop 

prevention programs for all women and establish links for women at risk for type 2 diabetes. 

• Expand community-based health promotion education, activities, and incentives. 

• Expand population-based surveillance to monitor and understand variations in distribution of 

diagnosed and undiagnosed diabetes and of impaired glucose tolerance in and among groups, and 

factors that influence the risk for diabetes and complications among women at all life stages. 

• Educate community leaders about diabetes, its management, and the value of healthy environments. 

Increase diabetes awareness programs and materials in workplaces, health care settings, the media, 

and the community. 

• Encourage health care providers to promote risk assessment, quality care, and self-management for 

diabetes and its complications in their practice settings. 

• Ensure access to trained health care providers who offer quality services. 

• Encourage health care coverage and incentives for recommended diabetes prevention and 

management practices. 

• Conduct public health research to further knowledge about the epidemiologic, socioenvironmental, 

behavioral, translational, and biomedical factors that influence diabetes and women’s health. 

What specific steps will we plan to take to support the National Agenda? 

ADA 

The American Diabetes Association’s Annual Meeting and Scientific Sessions is the largest diabetes meeting 

in the world. With more than 13,000 attendees, it is a unique opportunity for scientists, health care providers, 

and others to learn about the latest research, treatment options, and advocacy efforts spearheaded by the 

ADA. 

The association is also the world’s largest publisher of diabetes related-materials; its publications include 

scientific journals, Diabetes, Diabetes Spectrum, Diabetes Care, and a myriad of books relating to diabetes 

treatment and lifestyle issues surrounding diabetes. 

In addition to the journals and general information books, the ADA also publishes Diabetes Forecast, a 

monthly lifestyle magazine for people with diabetes. Diabetes Forecast has more than 450,000 subscribers 

and addresses that include topics that readers help readers with an information exchange, articles featuring 

the latest medicines available, and recipes that encourage healthy eating habits. 
The ADA is currently developing many initiatives that will have an impact on women and diabetes. From 

research findings to information to advocacy efforts, the ADA is committed to making a difference for 

people with diabetes and their families. 

The ADA will: 

• Continue its advocacy work on federal and state levels to effect positive changes in the law for people 

with diabetes; this includes lobbying for increased funding for the NIH and CDC. 

• Serve as a convening organization to host advocacy meetings/initiatives on behalf and in support of 

the CDC’s Women and Diabetes National Initiative. 

• Cover the CDC’s Women and Diabetes National Initiative in an upcoming issue of Diabetes Forecast 

magazine, offering a platform for people outside Washington, DC to learn about the initiative. 

• Continue to look for additional opportunities to inform our partners of this important initiative. 

APHA 

• The APHA annual meeting brings together more than 12,000 public health professionals and is the 

largest public health conference in the world. At the meeting, more than 1000 sessions provide the 

latest basic and applied scientific information. This meeting is an opportunity to present papers, 

share ideas, and keep in touch with public health researchers, practitioners, and policymakers. 

• Among APHA’s national and international publications is the American Journal of Public Health, 

the prestigious, peer-reviewed monthly journal of original research, program evaluation, and special 

reports. 

• Each month, The Nation’s Health, APHA’s official newspaper, delivers the latest public health news, 

findings, and information to more than 50,000 readers, including APHA members, the media, and 

members of Congress. 

• APHA has a number of sections, special public interest groups, and caucuses that include a Food and 

Nutrition Section, Gerontological Health Section, Maternal and Child Health, Medical Care, Public Health 

Education and Health Promotion, Public Health Nursing, and the diabetes caucus. 

• APHA has 53 affiliates that work in their own states and communities to improve public health. APHA 

frequently gives grants to affiliates. Thanks to Pfizer Inc., APHA is offering affiliates mini-grants to 

develop or update their websites to focus attention on the increased and associated risks of being 

overweight and obese, with special emphasis on overweight children and on type 2 diabetes. 

• APHA is developing an obesity initiative that will highlight the relationship and health consequences of 

obesity and diabetes. 

APHA will: 

• Continue working with its affiliates. 

• Sponsor sessions at its annual meeting on diabetes, diabetes prevention, and health effects of diabetes. 

• Reach out to a variety of public health associations that serve racial and ethnic populations to improving 

education and health promotion. 
• Strengthen alliances with organizations that serve older Americans. 

• Continue to focus attention on diabetes through The Nation’s Health and the American Journal of Public 

Health. 

ASTHO 

As the organization representing state health officials and their respective agencies, ASTHO will focus its 

efforts on the National Agenda’s first recommendation, which addresses state diabetes control programs. 

Several ongoing ASTHO activities lend themselves to implementing strategies outlined in the National Agenda. 

Chronic disease as a public health issue continues to be a major part of ASTHO’s advocacy agenda, with a 

focus on increasing federal funding for all chronic disease programs. In addition, diabetes prevention has been a 

focal point of ASTHO’s Prevention Policy Committee. This committee works diligently to educate 

policymakers on the effects state programs can have on diabetes and to emphasize the need for increased 

funding. 

ASTHO hopes the National Agenda is just the first step in a long-term, sustained effort to reduce diabetes and 

its complications among women. ASTHO looks forward to continuing to partner with the CDC, the APHA, and 

the ADA to expand our reach into the broader public health community and beyond. 

CDC 

CDC’s Division of Diabetes Translation is a multifaceted, science-driven public health program that monitors 

the extent of the diabetes problem in the United States through surveillance, translates research findings into 

clinical and public health practice, conducts state-based diabetes control programs, and provides information to 

increase public awareness on how to control diabetes. With the support of state diabetes control programs and 

other numerous partners, CDC has resources to implement several recommendations outlined in the National 

Agenda. 

CDC will: 

• Continue to work with its numerous partners. 

• Continue serving as the lead organization to organize and plan meetings related to implementation of the 

National Agenda. 

• Assume lead responsibility for one to three priority strategies. 

Attachment C: Glossary 

ACC – American College of Cardiology 

ADA – American Diabetes Association 

AHA – American Heart Association 

AHRQ – Agency for Healthcare Research and Quality 

ALA – American Library Association 

AMCHP – Association of Maternal and Child Health Programs 

AoA – Administration on Aging 

APHA – American Public Health Association 

APTA – American Physical Therapy Association 

ASTHO – Association of State and Territorial Health Officials 
ASTPHND – Association of State and Territorial Public Health Nutrition Directors 

AWHONN – Association of Women’s Health, Obstetric and Neonatal Nurses 

BIG – Blacks in Government 

BPHC – Bureau of Primary Health Care 

CCOE – Community Centers of Excellence 

CDC – Centers for Disease Control and Prevention 

CMS – Center for Medicare and Medicaid Services 

COE – Centers of Excellence 

DHHS – Department of Health and Human Services 

DHPE – Directors of Health Promotion and Education 

DPCP – Diabetes Prevention and Control Programs 

FDA – Food and Drug Administration 

HMO – Health Maintenance Organizations 

HRSA – Health Resources and Services Administration 

MEPS – Medical Expenditure Panel Survey 

NDEP – National Diabetes Education Program 

NIDDK – National Institute of Diabetes & Digestive & Kidney Diseases 

NIH – National Institutes of Health 

NWICH – National Women’s Health Information Center 

OPHS – Office of Public Health and Science (DHHS) 

OMHRC – Office of Minority Health Research Center 

OWH – Office of Women’s Health 

PLA – Public Library Association 

PYPTH – Pick Your Path to Health 

QIO – Quality Improvement Organizations 

RWJ – The Robert Wood Johnson Foundation 

TRIAD – Translating Research Into Action for Diabetes 

USDA – United States Department of Agriculture 

CDC 

Division of Diabetes Translation 

Public Inquiries/Publications 

For Public Inquiries & Publications 

CDC-INFO Contact Center 

Phone: 1-800-CDC-INFO (232-4636) 

1-888-232-6348 TTY 

E-Mail: cdcinfo@cdc.gov 
In English, en Espanol 

24 Hours/Day, 7 Days/Week 

For Other Information 

Division of Diabetes Translation 

National Center for Chronic Disease Prevention and Health Promotion 

Centers for Disease Control and Prevention 

4770 Buford Highway NE, Mailstop K-10, Atlanta, GA 30341-3717 

Telephone 770-488-5000; Fax 770-488-5966 

Department of Health and Human Services 

Centers for Disease Control and Prevention 

SAFER • HEALTHIER • PEOPLE