U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

HEALTHY PEOPLE 2010

FINAL REVIEW
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National Center for Health Statistics.

Healthy People 2010 Final Review.

Hyattsville, MD. 2012.

Library of Congress Cataloging-in-Publication Data

Healthy People 2010 Final Review.

 p. ; cm. — (DHHS publication ; no. (PHS)2012–1038)

 Healthy People Two Thousand Ten

 “December 2012.”

 Includes bibliographical references and index.

 ISBN 0-8406-0654-0 (alk. paper)

 I. National Center for Health Statistics (U.S.) 

II. Title: Healthy People Two Thousand Ten. III. Series: 

DHHS publication ; no. (PHS)2012–1038. 0276–4733 

 [DNLM: 1. Healthy People 2010 (Group). 2. Healthy People 

Programs—United States. 3. Health Planning—United 

States. 4. Preventive Medicine—United States. 

5. Program Evaluation—United States. 6. Public Health—

United States. WA 525]

362.10973—dc23

2012026102

PHS Publication No. 2012–1038

For sale by Superintendent of Documents

U.S. Government Printing Office Washington, DC 20402
HEALTHY PEOPLE 2010

FINAL REVIEW
U.S. Department of Health and Human Services

Kathleen Sebelius

Secretary

Centers for Disease Control and Prevention

Thomas R. Frieden, M.D., M.P.H.

Director

National Center for Health Statistics

Edward J. Sondik, Ph.D.

Director
iii

Foreword

In the third decade of the Healthy People initiative, 

Healthy People 2010 continued to provide a framework 

to improve the nation’s health by identifying overarching 

goals and objectives around which the public, private 

organizations, and citizens alike could unite. Like its 

predecessors, the Healthy People 2010 framework was 

structured for planning and action and to set priorities for 

policies and programs. Healthy People 2010 also advanced 

the methodology by which progress toward the objectives 

and the reduction of disparities would be measured for 

a better understanding of what has been achieved and 

where more attention and effort must be directed.

The Healthy People 2010 Final Review provides analyzed 

data on 733 objectives—the total number of objectives 

with tracking data. The report shows that 23% of these 

objectives were met and another 48% were moving 

toward the Healthy People 2010 targets. In each of the 

Focus Areas, there were some objectives that moved 

toward, met, or exceeded their 2010 targets. For eight 

Focus Areas, more than 75% of the objectives with 

tracking data moved toward or achieved their targets. 

Further, there was substantial progress in the Heart 

Disease and Stroke Focus Area, for example, where 

the target of reducing cholesterol levels was met 

and progress continued on reducing smoking levels. 

I believe these results are reflected in the reduction in 

deaths from heart disease and stroke, the first and third 

leading causes of death in the United States.

Progress in meeting other objectives supports the Healthy 

People 2010 overarching goal of increasing the quality and 

years of healthy life. Since the launch of Healthy People 

2010, life expectancy at birth and at age 65 has increased 

for all U.S. population groups. But the core of Healthy 

People 2010 is to improve the quality of life, not only the 

length of life. The Healthy People development process 

recognized the complex interrelationship between health 

status and the prevalence and impact of disease and 

disability, and used innovative analytical techniques to 

define and measure quality of life. The ultimate goal is 

to make it possible for people to live the lives they want 

and to do the things they need to do for themselves, their 

families, and their communities.

Despite the well-documented progress in many areas—

as noted above, 71% of the evaluated objectives were 

either met or showed progress—the Healthy People 2010 

Final Review points to areas where progress has been 

slow or where there is no real improvement to report. 

A prime example is the Nutrition and Overweight 

Focus Area. The Final Review reports that obesity rates 

increased across all age groups. For children aged 6–11 

years, obesity rates rose 54.5%, whereas for adolescents 

aged 12–19 years, the obesity rate rose 63.6%. In 

addition, the proportion of adults who are obese rose 

47.8%. Another area showing limited progress was the 

Arthritis, Osteoporosis, and Chronic Back Conditions 

Focus Area, where less than 25% of the targets were met.

With respect to health disparities, Healthy People 2010 

set a goal to eliminate health disparities identified by 

race and ethnicity, sex, education, income, geographic 

location, disability status, or sexual orientation. 

This goal eclipsed in ambition the Healthy People 

2000 goal of reducing disparities. The Final Review

reveals a significant lack of progress in reducing or 

eliminating health disparities. Over the past decade, 

health disparities increased for an estimated 13% of 

the objectives and not changed for approximately 80% 

of the objectives. An important achievement, however, 

was the development of more informative models and 

approaches to measuring disparities. Advances in 

the methodology may yet lead to better approaches in 

closing the health gaps.

Another advance in the information foundation for 

Healthy People 2010 was the development of DATA2010, 

an interactive database system that compiles the 

monitoring data for tracking all the measurable 

objectives. Access to timely, accurate data is essential 

to the Healthy People process and to assessing and 

implementing Healthy People 2010 goals and objectives. 

Although much progress has been made developing and 

maintaining the data sources for Healthy People, some 

objectives were eliminated during Midcourse Review 

because of lack of data, and there were some objectives 

that could not be measured.

Healthy People 2020 is already well underway. It builds 

on the strengths of Healthy People 2010 but expands its 

scope and outreach. Healthy People 2010 had 28 subject 

matter areas; Healthy People 2020 has 42. Healthy 

People 2010 had two overarching goals of increasing 

the quality of life and eliminating health disparities; 

the 2020 program has four, adding a focus on creating 

social and physical environments that promote good 

health and on emphasizing quality of life and good 

health behavior over the entire span of life. I expect the 

progress we saw in data sources and monitoring will be 

enhanced with new sources of data and with advances 

in information technology, new ways of making the 

objectives and data measuring progress even more 

relevant and usable to communities and individuals, as 

well as public and private organizations at the national, 

state, and local levels. From the first Healthy People, 

the focus has been on measurable objectives. We have 

seen progress, documented through the many data 

sources consistently and accurately. This information 

is crucial to guide officials, the public, and individuals 

in developing the policies and programs to improve the 

health of Americans.

Edward J. Sondik, Ph.D.

Director, National Center for Health Statistics

v

Preface

The Healthy People 2010 Final Review presents a quantitative end-of-decade assessment of progress in achieving 

the Healthy People 2010 objectives and goals over the 

course of the decade. This publication was compiled 

by the National Center for Health Statistics (NCHS), 

Centers for Disease Control and Prevention (CDC), with 

considerable input from lead agencies of the Department 

of Health and Human Services (DHHS) for the Healthy 

People initiative. The Healthy People Federal Interagency 

Workgroup and the Office of Disease Prevention and 

Health Promotion served in a review capacity.

The Healthy People 2010 Final Review continues the series 

of profiles (previously referred to as Prevention Profiles) 

of the nation’s health objectives as an integral part of 

the DHHS disease prevention and health promotion 

initiative for the decade that began in 2000. 

The Healthy People 2010 initiative was unveiled in 

January 2000 by the Secretary of the Department of 

Health and Human Services, which, in November 2000, 

released the two-volume publication Healthy People 

2010, 2nd Edition, with Understanding and Improving 

Health and Objectives for Improving Health. The Healthy 

People 2010 Final Review presents a summary of progress 

toward achieving the Healthy People 2010 goals of:

1. Increasing quality and years of healthy life

2. Eliminating health disparities.

The Healthy People 2010 Final Review provides the 

final tracking data used to chart progress for the 969 

objectives in the 28 Healthy People 2010 Focus Areas. 

A Progress Chart for the Healthy People 2010 Leading 

Health Indicators also is presented.

The Healthy People 2010 Final Review incorporates the 

modifications to objectives from the Healthy People 2010 

Midcourse Review, which was published in December 

2006. It includes information about the status of each 

2010 objective over the course of the decade and a 

crosswalk that illustrates how Healthy People 2010 

objectives were transitioned to Healthy People 2020.
vi HEALTHY PEOPLE 2010 FINAL REVIEW

Acknowledgements

Overall responsibility for planning and coordinating the 

content of the Healthy People 2010 Final Review rested 

with the Health Promotion Statistics Branch (HPSB), 

Office of Analysis and Epidemiology (OAE), National 

Center for Health Statistics (NCHS), under the direction 

of Rebecca Hines. Production coordination was shared 

among the following HPSB staff: Lesley Dobrzynski, 

David Huang, Kimberly Hurvitz, Jeff Pearcy, Cheryl Rose, 

Makram Talih, and Sirin Yaemsiri.

Production was accomplished by several HPSB working 

teams which included: Lesley Dobrzynski, Bob Francis, 

Leda Gurley, David Huang, Kimberly Hurvitz, Elizabeth 

Jackson, Bruce Jonas, Deepthi Kandi, Insun Kim, Jeff 

Pearcy, Cheryl Rose, Asel Ryskulova, Makram Talih, Ritu 

Tuteja, and Jean Williams.

The section discussing the Healthy People 2010 goal of 

increasing quality and years of healthy life was written 

by Ritu Tuteja with substantial input from Michael 

Molla and technical contribution from Rebecca Hines, 

Richard Klein, and Makram Talih.

The section addressing the Healthy People 2010 goal 

of eliminating health disparities was written by David 

Huang and Makram Talih, with input from Rebecca 

Hines and Richard Klein.

Compilation of data used to assess progress of the 

Healthy People 2010 objectives (the “Progress Chart”) 

was conducted by the HPSB research team, particularly 

Lesley Dobrzynski, Leda Gurley, David Huang, Ken 

Keppel, Jeff Pearcy, Asel Ryskulova, Ritu Tuteja, and 

Makram Talih, with substantial input from Rebecca 

Hines and Richard Klein.

The presentation of health disparities (the "Health 

Disparities Table") in the Healthy People 2010 Final 

Review was developed by Ken Keppel and further refined 

by Makram Talih, with input from Lesley Dobrzynski, 

Leda Gurley, Rebecca Hines, David Huang, Kimberly 

Hurvitz, Elizabeth Jackson, Insun Kim, Richard Klein, 

Jeff Pearcy, Asel Ryskulova, and Ritu Tuteja.

Mary Anne Freedman of Jacaranda Consulting, LLC, 

provided significant support in the drafting process of 

the Focus Area chapters. In addition, the HPSB analysts 

each made significant contributions to all aspects of data 

compilation, verification, and text development for the 28 

Focus Areas as follows:

Access to Quality Health Services (Focus Area 1): David Huang

Arthritis, Osteoporosis, and Chronic Back Conditions (Focus Area 2): 

Kimberly Hurvitz

Cancer (Focus Area 3): David Huang

Chronic Kidney Disease (Focus Area 4): Asel Ryskulova

Diabetes (Focus Area 5): Lesley Dobrzynski

Disability and Secondary Conditions (Focus Area 6): Bruce Jonas

Educational and Community-Based Programs (Focus Area 7): Insun Kim

Environmental Health (Focus Area 8): Jeff Pearcy

Family Planning (Focus Area 9): Ritu Tuteja

Food Safety (Focus Area 10): Jeff Pearcy

Health Communication (Focus Area 11): Leda Gurley

Heart Disease and Stroke (Focus Area 12): Kimberly Hurvitz

HIV (Focus Area 13): Insun Kim

Immunization and Infectious Diseases (Focus Area 14): Insun Kim

Injury and Violence Prevention (Focus Area 15): Kimberly Hurvitz

Maternal, Infant, and Child Health (Focus Area 16): Elizabeth Jackson

Medical Product Safety (Focus Area 17): Ritu Tuteja

Mental Health and Mental Disorders (Focus Area 18): Bruce Jonas

Nutrition and Overweight (Focus Area 19): Kimberly Hurvitz

Occupational Safety and Health (Focus Area 20): Jeff Pearcy

Oral Health (Focus Area 21): Elizabeth Jackson

Physical Activity and Fitness (Focus Area 22): Asel Ryskulova

Public Health Infrastructure (Focus Area 23): Kate Brett/Jeff Pearcy

Respiratory Diseases (Focus Area 24): Kimberly Hurvitz

Sexually Transmitted Diseases (Focus Area 25): Leda Gurley

Substance Abuse (Focus Area 26): Elizabeth Jackson

Tobacco Use (Focus Area 27): Lesley Dobrzynski

Vision and Hearing (Focus Area 28): Asel Ryskulova

Substantial input and technical review were provided 

by Linda Bilheimer, Rebecca Hines, Richard Klein, 

Jennifer Madans, and Diane Makuc.

Publication management and editorial review were 

provided by: Raymond Cunningham, Ryan Dumas, 

Sarah Hinkle, Anthony Lipphardt, Kyung Park, Jennifer 

Reid, Tommy Seibert, Tammy Stewart-Prather, Barbara 

Wassell, and Danielle Woods. 

Keri Apostle, Eloesa McSorley, and Ashleigh Russell of 

Health Research and Analysis provided significant quality 

control support, particularly for the tables and figures.

Publication of the Healthy People 2010 Final Review 

would not have been possible without the contribution 

of staff members from the Office of Disease Prevention 

and Health Promotion, particularly Carter Blakey, 

Ellis Davis, Jeanette Guyton-Krishnan, Rachel Hayes, 

Yen Luong, Stacey McBryde, Kathryn McMurry, Holly 

McPeak, Deb Nichols, Emmeline Ochiai, Geri Tebo, 

and Kimber Wukitsch, as well as many staff members 

throughout NCHS, and the workgroup members from 

the Healthy People 2010 lead Federal agencies.
vii

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

List of Tables and Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

Health of the Nation

Healthy People 2010 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O-1

Healthy People 2010 Leading Health Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LHI-1

Reader’s Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . RG-1

Overview by Focus Area

1. Access to Quality Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1

2. Arthritis, Osteoporosis, and Chronic Back Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1

3. Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1

4. Chronic Kidney Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1

5. Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1

6. Disability and Secondary Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1

7. Educational and Community-Based Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

8. Environmental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1

9. Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1

10. Food Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1

11. Health Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-1

12. Heart Disease and Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-1

13. HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-1

14. Immunization and Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-1

15. Injury and Violence Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-1

16. Maternal, Infant, and Child Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-1

17. Medical Product Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-1

18. Mental Health and Mental Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-1

19. Nutrition and Overweight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-1

20. Occupational Safety and Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-1

21. Oral Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-1

22. Physical Activity and Fitness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-1

23. Public Health Infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-1

24. Respiratory Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-1

25. Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-1

26. Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-1

27. Tobacco Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-1

28. Vision and Hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-1

Appendices

Appendix A: Technical Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Appendix B: Published Issues of Healthy People Statistical Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1

Appendix C: Healthy People 2010 Lead Agencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-1

Appendix D: A Crosswalk Between Objectives From Healthy People 2010 to Healthy People 2020 . . . . . . . . . . . . . . . . . D-1

Appendix E: Evolution of Healthy People . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-1

Table of Contents
viii HEALTHY PEOPLE 2010 FINAL REVIEW

Overview

Tables

Table O-1. Healthy People 2010 Objectives: Summary of Progress by Focus Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O-9 

Table O-2. Healthy People 2010 Objectives: Summary of Progress for Population Groups . . . . . . . . . . . . . . . . . . . . O-12

Table O-3. Life Expectancy at Birth and at Age 65 (in Years) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O-13

Table O-4. Measures of Healthy Life Expectancy at Birth (in Years) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O-15

Table O-5. Measures of Healthy Life Expectancy at Age 65 (in Years) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O-16 

Figures 

Figure O-1. Healthy People 2010 Objectives: Status at the Final Review and Summary of

Progress Toward Target Attainment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O-7

Figure O-2. Healthy People 2010 Objectives: Status at the Final Review by Focus Area . . . . . . . . . . . . . . . . . . . . . . . . . O-8 

Figure O-3. Summary of Progress for Objectives with Tracking Data for Each Population Group . . . . . . . . . . . . . O-11 

Figure O-4. Life Expectancy at Birth and at Age 65, by Sex and Race, 2006–07 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O-14 

Figure O-5. Life Expectancy and Measures of Healthy Life Expectancy at Birth, 2006–07 . . . . . . . . . . . . . . . . . . . . O-17 

Figure O-6. Life Expectancy and Measures of Healthy Life Expectancy at Age 65, 2006–07 . . . . . . . . . . . . . . . . . . . O-17 

Figure O-7. Health Disparities at the Most Recent Time Point, by Race and Ethnicity . . . . . . . . . . . . . . . . . . . . . . . . O-19 

Figure O-8. Changes in Health Disparities from the Baseline to the Most Recent Time Points, 

by Population Characteristic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O-20 

Figure O-9. Health Disparities at the Most Recent Time Point, by Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O-21 

Figure O-10. Health Disparities at the Most Recent Time Point, by Education Level . . . . . . . . . . . . . . . . . . . . . . . . . . . O-22 

Figure O-11. Health Disparities at the Most Recent Time Point, by Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O-22 

Figure O-12. Health Disparities at the Most Recent Time Point, by Geographic Location . . . . . . . . . . . . . . . . . . . . . . O-23 

Figure O-13. Health Disparities at the Most Recent Time Point, by Disability Status . . . . . . . . . . . . . . . . . . . . . . . . . . . O-23 

Leading Health Indicators 

Table LHI-1. A Crosswalk Between the Healthy People 2010 and Healthy People 2020 

Leading Health Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LHI-11

Figure LHI-1. Progress Toward Target Attainment for Leading Health Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . LHI-17

Figure LHI-2. Health Disparities Table for Leading Health Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LHI-20

Reader’s Guide 

Figure RG-1. Legend for the Health Disparities Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . RG-5

Focus Area Chapters 

Chapter 1 

Figure 1-1. Progress Toward Target Attainment for Focus Area 1: Access to Quality Healthy Services . . . . . . . . 1-12 

Figure 1-2. Health Disparities Table for Focus Area 1: Access to Quality Health Services . . . . . . . . . . . . . . . . . . . . . 1-16 

Figure 1-3. Persons With Health Insurance (Age <65), 2008—Map. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-19 

List of Tables and Figures 
ix

Chapter 2 

Figure 2-1. Progress Toward Target Attainment for Focus Area 2:

Arthritis, Osteoporosis and Chronic Back Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8 

Figure 2-2. Health Disparities Table for Focus Area 2: Arthritis, Osteoporosis, and Chronic Back Conditions 2-10 

Figure 2-3. Activity Limitations due to Arthritis (Adults Aged 18+ With Diagnosed Arthritis), 2007—Map . . . 2-12 

Chapter 3 

Figure 3-1. Progress Toward Target Attainment for Focus Area 3: Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10 

Figure 3-2. Health Disparities Table for Focus Area 3: Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-12 

Figure 3-3. Overall Cancer Deaths, 2005–07—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-14 

Figure 3-4. Women who Received a Pap Test Within Past 3 Years (Age 18+), 2008—Map . . . . . . . . . . . . . . . . . . . . . 3-15 

Chapter 4 

Figure 4-1. Progress Toward Target Attainment for Focus Area 4: Chronic Kidney Disease . . . . . . . . . . . . . . . . . . . 4-8 

Figure 4-2. Health Disparities Table for Focus Area 4: Chronic Kidney Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-9 

Figure 4-3. Dialysis Patients Registered on Kidney Transplant Waiting List (Age <70), 2007—Map . . . . . . . . . . . 4-11 

Figure 4-4. Cumulative Percent of Persons Receiving a Kidney Transplant Within 3 Years of 

the Date of Renal Failure (Age <70), 2005—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-12 

Chapter 5 

Figure 5-1. Progress Toward Target Attainment for Focus Area 5: Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8 

Figure 5-2. Health Disparities Table for Focus Area 5: Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10 

Figure 5-3. Prevalence of Diabetes (Age 18+), 2008—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-12 

Chapter 6 

Figure 6-1. Progress Toward Target Attainment for Focus Area 6: Disability and Secondary Conditions . . . . . . 6-9 

Figure 6-2. Health Disparities Table for Focus Area 6: Disability and Secondary Conditions . . . . . . . . . . . . . . . . . . 6-11 

Chapter 7 

Figure 7-1. Progress Toward Target Attainment for Focus Area 7: 

Educational and Community-Based Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-11 

Figure 7-2. Health Disparities Table for Focus Area 7: Educational and Community-Based Programs . . . . . . . . 7-13 

Chapter 8 

Figure 8-1. Progress Toward Target Attainment for Focus Area 8: Environmental Health . . . . . . . . . . . . . . . . . . . . 8-14 

Figure 8-2. Health Disparities Table for Focus Area 8: Environmental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-18 

Chapter 9 

Figure 9-1. Progress Toward Target Attainment for Focus Area 9: Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . 9-10 

Figure 9-2. Health Disparities Table for Focus Area 9: Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-13 

Chapter 10 

Figure 10-1. Progress Toward Target Attainment for Focus Area 10: Food Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-9 

Figure 10-2. Health Disparities Table for Focus Area 10: Food Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-11

Chapter 11 

Figure 11-1. Progress Toward Target Attainment for Focus Area 11: Health Communication . . . . . . . . . . . . . . . . . . 11-9 

Figure 11-2. Health Disparities Table for Focus Area 11: Health Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-11 

Figure 11-3. Persons With Internet Access at Home (Age 18+), 2009—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-13 
x HEALTHY PEOPLE 2010 FINAL REVIEW

Chapter 12 

Figure 12-1. Progress Toward Target Attainment for Focus Area 12: Heart Disease and Stroke . . . . . . . . . . . . . . . 12-10 

Figure 12-2. Health Disparities Table for Focus Area 12: Heart Disease and Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-12 

Figure 12-3. Coronary Heart Disease Deaths, 2005–07—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-15 

Figure 12-4. Stroke Deaths, 2005–07—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-16 

Chapter 13 

Figure 13-1. Progress Toward Target Attainment for Focus Area 13: HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-9 

Figure 13-2. Health Disparities Table for Focus Area 13: HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-11 

Figure 13-3. New AIDS Cases (Age 13+), 2007—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-13 

Figure 13-4. HIV Infection Deaths, 2005–07—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-14 

Chapter 14 

Figure 14-1. Progress Toward Target Attainment for Focus Area 14: Immunization and Infectious Diseases . 14-15 

Figure 14-2. Health Disparities Table for Focus Area 14: Immunization and Infectious Diseases . . . . . . . . . . . . . 14-21 

Figure 14-3. Vaccination of Children 19–35 Months—3 Doses Hepatitis B (Hep B) Vaccine, 2008—Map . . . . . . 14-25 

Figure 14-4. Vaccination of Children 19–35 Months—1 Dose Measles-Mumps-Rubella (MMR) 

Vaccine, 2008—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-26 

Figure 14-5. Vaccination of Children 19–35 Months—4 Doses Pneumococcal Conjugate Vaccine (PCV), 

2008—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-27 

Chapter 15 

Figure 15-1. Progress Toward Target Attainment for Focus Area 15: Injury and Violence Prevention . . . . . . . . . 15-13 

Figure 15-2. Health Disparities Table for Focus Area 15: Injury and Violence Prevention . . . . . . . . . . . . . . . . . . . . . 15-17 

Figure 15-3. Deaths from Unintentional Injuries, 2005–07—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-21 

Figure 15-4. Deaths From Motor Vehicle Crashes, 2005–07—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-22 

Chapter 16 

Figure 16-1. Progress Toward Target Attainment for Focus Area 16: Maternal, Infant, and Child Health . . . . . 16-14 

Figure 16-2. Health Disparities Table for Focus Area 16: Maternal, Infant, and Child Health . . . . . . . . . . . . . . . . . 16-17 

Figure 16-3. Low Birth Weight (LBW) Births, 2006–08—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-22 

Figure 16-4. Preterm Live Births, 2006–08—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-23 

Chapter 17 

Figure 17-1. Progress Toward Target Attainment for Focus Area 17: Medical Product Safety . . . . . . . . . . . . . . . . . . . 17-7 

Figure 17-2. Health Disparities Table for Focus Area 17: Medical Product Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-8

Chapter 18 

Figure 18-1. Progress Toward Target Attainment for Focus Area 18: Mental Health and Mental Disorders . . . . 18-9 

Figure 18-2. Health Disparities Table for Focus Area 18: Mental Health and Mental Disorders . . . . . . . . . . . . . . . 18-10 

Figure 18-3. Suicide, 2005–07—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-12 

Chapter 19 

Figure 19-1. Progress Toward Target Attainment for Focus Area 19: Nutrition and Overweight . . . . . . . . . . . . . . 19-10 

Figure 19-2. Health Disparities Table for Focus Area 19: Nutrition and Overweight . . . . . . . . . . . . . . . . . . . . . . . . . . 19-12 

Figure 19-3. Obesity in Adults (Aged 20+), 2008—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-15 

Chapter 20 

Figure 20-1. Progress Toward Target Attainment for Focus Area 20: Occupational Safety and Health . . . . . . . . . 20-8 

Figure 20-2. Health Disparities Table for Focus Area 20: Occupational Safety and Health . . . . . . . . . . . . . . . . . . . . 20-10 
xi

Chapter 21 

Figure 21-1. Progress Toward Target Attainment for Focus Area 21: Oral Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-9 

Figure 21-2. Health Disparities Table for Focus Area 21: Oral Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-11 

Chapter 22 

Figure 22-1. Progress Toward Target Attainment for Focus Area 22: Physical Activity and Fitness . . . . . . . . . . . . 22-8 

Figure 22-2. Health Disparities Table for Focus Area 22: Physical Activity and Fitness . . . . . . . . . . . . . . . . . . . . . . . 22-10 

Figure 22-3. No Leisure Time Physical Activity Among Adults (Aged 18+), 2008—Map . . . . . . . . . . . . . . . . . . . . . . . 22-12 

Chapter 23 

Figure 23-1. Progress Toward Target Attainment for Focus Area 23: Public Health Infrastructure . . . . . . . . . . . . 23-9 

Chapter 24 

Figure 24-1. Progress Toward Target Attainment for Focus Area 24: Respiratory Diseases . . . . . . . . . . . . . . . . . . . 24-10 

Figure 24-2. Health Disparities Table for Focus Area 24: Respiratory Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-12 

Figure 24-3. Deaths from Chronic Obstructive Pulmonary Disease

(COPD, Excluding Asthma, Age 45+), 2005–07—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-15

Chapter 25 

Figure 25-1. Progress Toward Target Attainment for Focus Area 25: Sexually Transmitted Diseases . . . . . . . . . 25-11 

Figure 25-2. Health Disparities Table for Focus Area 25: Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . 25-13 

Figure 25-3. Chlamydia Infections (New Cases per 100,000 Population), 2009—Map . . . . . . . . . . . . . . . . . . . . . . . . . 25-15 

Figure 25-4. Gonorrhea (New Cases per 100,000 Population), 2009—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-16 

Figure 25-5. Domestic Transmission of Primary and Secondary Syphillis

(New Cases per 100,000 Population), 2009—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-17 

Chapter 26 

Figure 26-1. Progress Toward Target Attainment for Focus Area 26: Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . 26-11 

Figure 26-2. Health Disparities Table for Focus Area 26: Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-14 

Figure 26-3. Cirrhosis Deaths, 2005–07—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-18 

Chapter 27 

Figure 27-1. Progress Toward Target Attainment for Focus Area 27: Tobacco Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-11 

Figure 27-2. Health Disparities Table for Focus Area 27: Tobacco Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-14 

Figure 27-3. Tobacco Use by Adults—Cigarettes (Aged 18+), 2008—Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-17 

Chapter 28 

Figure 28-1. Progress Toward Target Attainment for Focus Area 28: Vision and Hearing . . . . . . . . . . . . . . . . . . . . . . 28-9 

Figure 28-2. Health Disparities Table for Focus Area 28: Vision and Hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-11 

Appendices 

Figure A-1. Legend for the Health Disparities Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-9 

Contents

Introduction....................................................................................O-3

Summary of Progress......................................................................O-7

Goal 1: Increase Quality and Years of Healthy Life.......................O-13

Goal 2: Eliminate Health Disparities ............................................O-18

Transitioning to Healthy People 2020: The Decade Ahead ..........O-25

References .....................................................................................O-26

Overview

Overview O-3

History of the Healthy People 

Initiative

In setting forth a vision for realizing improved health 

for all Americans, Healthy People 2010, initiated in 

November 2000, identified a set of 10-year health goals 

and objectives to be achieved during the first decade of 

the 21st century. Its two overarching goals—to increase 

quality and years of healthy life and to eliminate health 

disparities—were supported by specific objectives in 

28 Focus Areas. In this way, Healthy People 2010 built 

on initiatives that had been pursued over the previous 

few decades, beginning with the publication of Healthy 

People: The Surgeon General's Report on Health Promotion 

and Disease Prevention in 1979 [1]. That report led to 

the initiation of this decade-long, management-byobjective process with the publication of Promoting 

Health/Preventing Disease: Objectives for the Nation [2]. 

This 1980 initiative was followed by the publication of 

Healthy People 2000: National Health Promotion and 

Disease Prevention Objectives in 1991 [3]. Now, Healthy 

People 2020 will continue these efforts through the 

second decade of the 21st century. Appendix E provides 

a summary of the evolution of Healthy People over the 

past four decades.

Healthy People 2010

Through Healthy People 2010, the Department of Health 

and Human Services (DHHS) set out objectives that 

called for improvements in health status, risk reduction, 

public and professional awareness of prevention, delivery 

of health services, protective measures, surveillance, 

and evaluation, all expressed in specific metrics that 

allowed the measurement of progress over time toward 

targets that were to be achieved by the year 2010. Like 

its predecessors, Healthy People 2010 was developed 

through a broad collaborative process that drew on the 

best scientific knowledge available.

Full achievement of the goals and objectives of Healthy 

People 2010 was predicated on a health system accessible 

to all Americans that would integrate personal health 

care and population-based public health activities. 

The concept of healthy people in healthy communities, 

which is the foundation of the initiative, necessitates 

monitoring and tracking of data on broad-based 

prevention efforts beyond services provided within 

physicians' offices, clinics, and hospitals. The concept 

expands the traditional disease-centered medical care 

system to recognize the impact of health promotion 

and disease prevention efforts based in schools, 

neighborhoods, workplaces, and families in which 

people live their daily lives. These are the environments 

in which a large proportion of preventive action takes 

place.

The 28 Focus Areas of Healthy People 2010 were 

developed by Federal agencies that had the most 

relevant scientific expertise in each subject area. The 

development process drew on the collective expertise 

of the Healthy People Consortium—an alliance which, 

at the time, encompassed more than 350 national 

membership organizations and 250 State health, mental 

health, substance abuse, and environmental agencies. 

In addition, through a series of regional and national 

meetings, more than 11,000 public comments on the 

draft objectives were collected and considered. The 

Secretary's Council on National Health Promotion 

and Disease Prevention Objectives for 2010 also 

provided leadership and advice in the development and 

implementation of these national health objectives. More 

information is available from http://www.healthypeople.

gov/2010/data/midcourse/.

Healthy People 2010 Midcourse 

Review

Midway through the decade, staff of DHHS and other 

Federal agencies together with experts from across the 

nation assessed the status of the national objectives as 

they had developed over the first half of the decade. This 

midcourse review process involved an examination of 

trends in data that had become available by January 1, 

2005, and it took into account any pertinent new science. 

The review resulted in changes to some objectives that 

Introduction
O-4 HEALTHY PEOPLE 2010 FINAL REVIEW

were made to ensure that Healthy People 2010 remained 

current and accurate and kept abreast of emerging public 

health priorities. DHHS solicited and considered public 

comments on these midcourse changes to the Healthy 

People 2010 objectives. The results of this midcourse 

assessment were published in the Healthy People 2010 

Midcourse Review [4].

Changes to Healthy People 2010 

Objectives at the Midcourse 

Review

Midcourse changes to Healthy People 2010 objectives 

encompassed the following: rewordings of objectives; 

deletion of 66 objectives; additions of new objectives; 

revisions to baselines and targets; and establishment 

of baselines and targets for objectives that moved from 

“developmental” to “measurable,” as explained in the 

next paragraph. Changes were made to reflect the most 

current science, to reflect the data more accurately, or to 

provide a more logical or understandable presentation.

To be included in Healthy People 2010, an objective 

was required to have a national data source that 

provided a baseline and at least one additional data 

point for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered of 

sufficient national importance to be included in Healthy 

People. These were called developmental objectives; 

they provided a vision for a desired outcome or health 

status. Developmental objectives with no prospect of 

having a national (baseline) data source were deleted 

as part of the Midcourse Review. (At the Final Review, 

53 developmental objectives that were retained at the 

Midcourse Review still did not have baseline data.)

Measuring Healthy People 2010 

Progress Throughout the Decade

Progress Reviews

In addition to the Midcourse Review, progress reviews 

on the individual Focus Areas were conducted, one each 

month, until the full cycle of 28 had been completed. 

Two cycles of these reviews were held during the decade. 

The progress reviews were formal meetings, chaired by 

the Assistant Secretary for Health, at which the National 

Center for Health Statistics (NCHS), Centers for Disease 

Control and Prevention (CDC), DHHS, provided data 

updates for the Focus Area under review, and Federal 

lead agencies for the Focus Area reported on progress 

toward achieving Focus Area objectives and initiatives 

to help in accomplishing that purpose. More information 

is available from http://www.healthypeople.gov/2010/

data/PROGRVW/.

DATA2010

A critical part of Healthy People 2010 was measuring 

progress toward the targets for the year 2010. The 

compilation and management of current health data 

sources were central to assessing and implementing 

Healthy People 2010 goals and objectives. The data 

that provided the basis for the Midcourse Review and 

the Healthy People 2010 Final Review are available on 

DATA2010, developed by the Health Promotion Statistics 

Branch at NCHS. This is an interactive database system 

that compiled the monitoring data for tracking all the 

measurable objectives. These are primarily national 

data; selected state-based data are provided when 

available. Additional information is available from 

http://wonder.cdc.gov/data2010.

Healthy People 2010 Final Review

The Healthy People 2010 Final Review presents a 

quantitative summary assessment of progress in 

achieving the Healthy People 2010 objectives over 

the course of the decade. The Healthy People 2010 

Final Review, which incorporates the 2005 Midcourse 

Review modifications to the objectives, provides the 

final tracking data for the objectives in each of the 28 

Focus Areas. A Progress Chart included in each chapter 

provides a summary display of the progress of each 

objective for which there were at least two data points 

available during the decade. Also, a Health Disparities 

Table provides a summary of health disparities by race 

and ethnicity, sex, education level, income, geographic 

location, and disability status whenever data were 

available for each objective. Finally, the report includes 

a summary of progress for the Healthy People 2010 

Leading Health Indicators as well as a summary of 

progress toward achieving the Healthy People 2010 goals 

of: 1) increasing quality and years of healthy life, and 2) 

eliminating health disparities.
Overview O-5

Initiatives Related to Healthy 

People

Other Departmental Priorities and Healthy People

As the latest iteration of a long-running initiative, 

Healthy People 2020 follows the lead of Healthy People 

2010 in supporting a wide range of DHHS initiatives. 

Healthy People 2020 aligns with and plays a foundational 

and mutually supportive role with several other major 

DHHS undertakings, including the following:

〉 The National Prevention and Health Promotion 

Strategy (NPS), which was mandated by the March 

23, 2010, Patient Protection and Affordable Care 

Act. NPS aims to identify and prioritize national 

actions to reduce the incidence and burden of the 

leading causes of death and disability. NPS aims 

to move the nation toward a system of health care 

that features prevention as the cornerstone of 

care, by concentrating on the underlying drivers of 

chronic disease. NPS will promote actions aimed at 

prevention and healthy development and behavior 

throughout the stages of life, all of which will be 

directed toward its primary goal of achieving 

significant gains in Americans’ life expectancy at 

birth and age 65. The NPS targets reflect those of 

Healthy People 2020.

〉 First Lady Michelle Obama’s Let’s Move! Campaign, 

which began in 2010 and focuses on one ambitious 

goal: to halt and reverse the epidemic of childhood 

obesity within one generation, so that children today 

reach adulthood at a healthy weight. Over the past 

3 decades, childhood obesity rates in America have 

tripled, and today, nearly one in three children in 

America are overweight or obese. The Let’s Move!

initiative focuses on the reform of behavioral 

factors and environmental factors by promoting 

active lifestyles and healthy eating through 

community involvement by way of schools, parents, 

health care providers, and other agents of change. 

Implementation strategies are now in development 

for Healthy People 2020 objectives that relate to this 

initiative and support the Let’s Move! goal.

〉 The National HIV/AIDS Strategy, which the White 

House released in July 2010 and is the nation’s firstever comprehensive, coordinated HIV/AIDS roadmap 

with clear and measurable targets to be achieved by 

2015. Since 1980, more than 575,000 Americans have 

lost their lives to AIDS and, currently, more than 

1.1 million Americans are living with HIV. Among 

the 2015 goals of the National Strategy are to: lower 

the annual number of new infections by 25% and to 

increase from 79% to 90% the proportion of people 

living with HIV who know their serostatus. The 

objectives encompassed by the Healthy People 2020 

HIV Topic Area are consonant with and supportive 

of these and other goals of the National HIV/AIDS 

Strategy.

〉 The National Drug Control Strategy, which was 

inaugurated in 2010, updated yearly, and has set 

policy priorities of reducing prescription drug abuse 

and drugged driving and of promoting activities to 

prevent such abuse from occurring. Implementation 

of the National Strategy is centered in the White 

House Office of National Drug Control Policy 

and engages the energies of several other Federal 

agencies, as well, including the DHHS Substance 

Abuse and Mental Health Services Administration 

(SAMHSA). SAMHSA is the lead agency for the 

Healthy People 2020 Topic Area on Substance Abuse, 

which embraces a number of objectives that are 

directly supportive of the National Strategy. Although 

the Strategy is primarily a blueprint for the federal 

government, it is also proving useful in guiding State 

and local decisions.

〉 The President’s Food Safety Working Group, which

was created in 2009 to advise the President on how to 

upgrade the U.S. food safety system. Chaired jointly 

by the DHHS Secretary and Secretary of Agriculture, 

the Working Group recommended a public healthfocused approach to food safety based on three core 

principles: prioritizing prevention, strengthening 

surveillance and enforcement, and improving 

response and recovery. Taken together, the objectives 

of the Food Safety Topic Area of Healthy People 2020 

all serve to advance these principles.

〉 The DHHS Action Plan to Reduce Racial and 

Ethnic Health Disparities, which outlines goals and 

actions DHHS will take to reduce health disparities 

among racial and ethnic minorities. With the DHHS 

Disparities Action Plan, the Department commits 

to continuously assessing the impact of all policies 

and programs on racial and ethnic health disparities. 

It will promote integrated approaches, evidencebased programs and best practices to reduce these 

disparities. The DHHS Action Plan builds on the 

strong foundation of the Affordable Care Act and 

is aligned with programs and initiatives such as 

the First Lady Obama's Let's Move! initiative, the 

President's National HIV/AIDS Strategy, and Healthy 

People 2020.

〉 The new DHHS Tobacco Control Strategic Action 

Plan, which was presented in November 2010 and 

seeks to help smokers quit and stop others from 

starting to use tobacco. One high profile piece of the 

plan will result in bolder health warnings that must 

cover the upper half of the front and back of cigarette 
O-6 HEALTHY PEOPLE 2010 FINAL REVIEW

packages and at least 20% of tobacco product 

advertisements beginning in 2012. In June 2009, the 

Family Smoking Prevention and Tobacco Control 

Act had granted the Food and Drug Administration 

(FDA) the authority to regulate tobacco products. 

Under the law, the FDA now has sweeping new 

authorities related to the manufacture, marketing, 

and sale of tobacco products—authorities covered 

by a more expansive public health standard than 

had traditionally been granted to the agency. The 

objectives of the Healthy People 2020 Topic Area on 

Tobacco Use provide the data that underpin the Plan 

and give it direction toward the outcomes we hope to 

achieve by the end of the decade.

〉 The new Global Health Initiative (GHI), which the 

U.S. announced in February 2010 and which invests 

$63 billion over 6 years to help partner countries 

improve health outcomes through strengthened 

health systems and integrated services, with a 

particular focus on improving the health of women, 

newborns, and children. Other topics of particular 

concern in developing countries include HIV/

AIDS, malaria, tuberculosis, family planning and 

reproductive health, nutrition, safety of water 

supplies, and neglected tropical diseases. The GHI 

has set a number of targets for accomplishment in 

assisted countries, for example: reduction of maternal 

mortality by 30%, reduction of under-five mortality 

rates by 35%, reduction of child under-nutrition 

by 30%, and prevention of 54 million unintended 

pregnancies. Healthy People 2020 includes a Topic 

Area on Global Health, new in this decade.

Guide to Clinical Preventive Services

The Guide to Clinical Preventive Services includes 

U.S. Preventive Services Task Force (USPSTF) 

recommendations on screening, counseling, and 

preventive medication topics, as well as clinical 

considerations for each topic. Sponsored since 1998 

by the Agency for Healthcare Research and Quality 

(AHRQ), the USPSTF is an independent panel of experts 

in primary care and prevention that systematically 

reviews the evidence of effectiveness and develops 

recommendations for clinical preventive services. The 

task force rigorously evaluates clinical research to assess 

the merits of preventive measures. In the 2010–11 edition 

of the Guide, the recommended preventive services for 

adults are in the clinical categories of: cancer; heart, 

vascular, and respiratory diseases; infectious diseases; 

injury and violence; mental health conditions and 

substance abuse; metabolic, nutritional, and endocrine 

conditions; musculoskeletal conditions; obstetrics 

and gynecologic conditions; and vision disorders. 

Recommendations for children and adolescents are 

given in a separate section. More information is available 

from http://www.ahrq.gov/clinic/cps3dix.htm.

Guide to Community Preventive Services

The Guide to Community Preventive Services serves as a 

filter for scientific literature on specific health problems 

that can have a large-scale impact on groups of people 

who share a common community setting. This guide 

summarizes what is known about the effectiveness, 

economic efficiency, and feasibility of interventions 

to promote community health and prevent disease. 

The Task Force on Community Preventive Services, 

an independent decision-making body convened by 

DHHS, makes recommendations for the use of various 

interventions based on the evidence gathered in 

rigorous and systematic scientific reviews of published 

studies conducted by review teams for the guide. 

The findings from the reviews are published in peerreviewed journals and also are made available online. 

Over the last decade or so, the task force has published 

hundreds of findings across the following topic areas: 

adolescent health; alcohol; asthma; birth defects; cancer; 

diabetes; health communication; HIV/AIDS, other STIs 

and pregnancy; mental health; motor vehicle occupant 

injury; nutrition; obesity; oral health; physical activity; 

social environment; tobacco use; vaccines; violence; 

and worksites. Additional information is available from 

http://www.thecommunityguide.org.
Overview O-7

Healthy People Objectives

For the end-of-decade assessment of the Healthy People 

2010 objectives, the status of 969 specific objectives in 

28 Focus Areas was assessed. Progress was measured for 

objectives using the final tracking data available—that 

is, baseline data and at least one additional data point. 

For some objectives, although more recent data may 

have been available, the final Healthy People 2010 data 

year was selected to be consistent with the baseline year 

used for the new Healthy People 2020 objectives [5].

The status of the 969 objectives is shown on the lefthand side of Figure O-1. Based on an evaluation of each 

objective and comments received from the public as 

part of the Midcourse Review, 66 objectives were deleted 

because data were unavailable or because of a change 

in the science [6]. Tracking data were unavailable to 

assess progress for 170 objectives (17.5% of the total), 53 

of which lacked baseline data and, therefore, remained 

developmental.

Progress is assessed for 733 objectives with tracking 

data available, as seen in the right-hand side panel of 

Figure O-1.

〉 172 objectives (23%) met or exceeded the Healthy 

People 2010 targets.

〉 349 objectives (48%) moved toward the Healthy 

People 2010 targets.

〉 39 objectives (5%) demonstrated no change from the 

baseline.

〉 173 objectives (24%) moved away from the Healthy 

People 2010 targets.

Summary of Progress

Total objectives: N = 969 Objectives with tracking data: N = 733

Tracking data

available

75.6%

N = 733

Met or

exceeded target

23%

N = 172

Moved

toward target

48%

N = 349

Moved away

from target

24%

N = 173

6.9%

N = 66

5%

N = 39

Could not

be assessed

17.5%

N = 170

Deleted at

Midcourse

Review

Demonstrated

no change

Figure O-1. Healthy People 2010 Objectives: Status at the Final Review and Summary of Progress Toward 

Target Attainment
O-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure O-2 and Table O-1 show similar assessments for 

each of the 28 Focus Areas. In each Focus Area, some 

objectives moved toward, met, or exceeded their 2010 

targets. For 8 Focus Areas, Educational and CommunityBased Programs (Focus Area 7), Environmental Health 

(Focus Area 8), Health Communication (Focus Area 11), 

Heart Disease and Stroke (Focus Area 12), Immunization 

and Infectious Diseases (Focus Area 14), Mental Health 

and Mental Disorders (Focus Area 18), Occupational 

Safety and Health (Focus Area 20), and Tobacco Use 

(Focus Area 27) more than 75% of the objectives with 

tracking data available moved toward or achieved their 

targets. The proportion of objectives that were deleted 

at Midcourse Review or could not be assessed was more 

than 30% for Access to Quality Health Services (Focus 

Area 1), Disability and Secondary Conditions (Focus 

Area 6), Educational and Community-based Programs 

(Focus Area 7), Environmental Health (Focus Area 8), 

and Mental Health and Mental Disorders (Focus Area 

18). Two Focus Areas, Arthritis, Osteoporosis, and 

Chronic Back Conditions (Focus Area 2) and Nutrition 

and Overweight (Focus Area 19), moved toward or 

achieved less than 25% of their targets.

Figure O-2. Healthy People 2010 Objectives: Status at the Final Review by Focus Area

N = 969 Total objectives

0

20

40

60

80

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Number of objectives

Healthy People 2010 Focus Areas

Deleted at Midcourse Review

Could not be assessed

Moved away from target

Demonstrated no change

Moved toward target

Met or exceeded target
Overview O-9

Table O-1. Healthy People 2010 Objectives: Summary of Progress by Focus Area

Tracking data available Could not be assessed

Deleted at 

Midcourse 

Focus Area Review Total

Met or 

exceeded 

target

Moved 

toward 

target

Demonstrated 

no change

Moved away 

from target

Developmental†

No tracking 

data beyond 

baseline

1. Access to Quality Health Services 11 24 6 7 1 20 2 71

2. Arthritis, Osteoporosis, and Chronic 

Back Conditions

1 2 3 7 0 0 0 13

3. Cancer 2 11 1 4 0 7 0 25

4. Chronic Kidney Disease 3 3 0 3 0 0 0 9

5. Diabetes 5 5 2 2 0 1 2 17

6. Disability and Secondary Conditions 2 7 1 3 4 7 0 24

7. Educational and Community-Based 

Programs

1 12 2 2 2 22 15 56

8. Environmental Health 21 30 2 8 8 19* 5 93

9. Family Planning 8 9 2 13 6 1 0 39

10. Food Safety 5 11 0 6 1 0 15 38

11. Health Communication 5 9 0 2 0 2 0 18

12. Heart Disease and Stroke 4 8 0 3 2 2 0 19

13. HIV 4 7 0 4 6 0 4 25

14. Immunization and Infectious Diseases 33 32 1 14 2 4 1 87

15. Injury and Violence Prevention 8 24 2 9 0 3 0 46

16. Maternal, Child, and Infant Health 3 25 5 9 3 4 4 53

17. Medical Product Safety 3 2 1 2 0 1 2 11

18. Mental Health and Mental Disorders 6 4 0 1 0 6 0 17

19. Nutrition and Overweight 0 2 3 15 0 1 1 22

20. Occupational Safety and Health 14 5 0 3 0 0 0 22

21. Oral Health 4 13 0 7 0 2 0 26

22. Physical Activity and Fitness 0 12 1 4 0 1 0 18

23. Public Health Infrastructure 5 16 1 8 6 4 3 43

24. Respiratory Diseases 3 14 2 5 1 1 0 26

25. Sexually Transmitted Diseases 2 8 0 6 1 1 7 25

26. Substance Abuse 4 20 3 11 5 2 3 48

27. Tobacco Use 6 28 0 6 4 3 2 49

28. Vision and Hearing 9 6 1 9 0 4 0 29

Total 172 349 39 173 53 117 66 969

† Objectives that lacked baseline data remained developmental.

*

 One objective (8-11) did have tracking data beyond the baseline, but the final data point was statistically unreliable.
O-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Population Groups

In Figure O-3, progress is assessed for specific population 

groups. This assessment is limited to population-based 

objectives with tracking data for these groups. It does not 

include objectives that are not population-based, such 

as those based on states, worksites, or those monitored 

by the number of events. The number of objectives with 

tracking data varied according to the characteristic 

and, therefore, the bar’s length in Figure O-3 varies for 

each population group. For Healthy People 2010, most 

population-based objectives were monitored by race 

and ethnicity, but the availability of data for specific 

racial and ethnic populations varied. Comparisons 

by sex were not applicable to all population-based 

objectives because some applied only to females or only 

to males. Geographic location and disability status 

were optional characteristics included for monitoring 

selected objectives.

When possible, population-based objectives were also 

monitored either by education level or by income, as a 

measure of socioeconomic status. Most data systems 

used in Healthy People 2010 define income as a family’s 

income before taxes. To facilitate comparisons among 

groups and over time, while adjusting for family size and 

for inflation, Healthy People 2010 categorizes income 

using the poverty thresholds developed by the Census 

Bureau. Thus, the three categories of family income that 

are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate.

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within the 

same objective. The three categories of education level 

that are primarily used are:

〉 Less than high school

〉 High school graduate

〉 At least some college education.

Further information regarding population groups can be 

found in Healthy People 2010: General Data Issues, available from: http://www.cdc.gov/nchs/healthy_people.htm.

For each select population group, the number of 

objectives is shown for each of the following: moved away 

from the target, demonstrated no change, moved toward 

the target, and met or exceeded the target. Because 

a single target was set for all population groups, there 

were some instances where certain population groups 

had met the Healthy People 2010 target at baseline while 

other groups had not met the target.

In general, for each select population group, the number 

of objectives that moved toward, met, or exceeded the 

target surpassed the number that moved away from 

the target. For the American Indian or Alaska Native 

population, for example, 81 objectives moved toward, 

met, or exceeded their respective targets whereas 59 

moved away and 9 showed no change between the 

baseline and the final time points (Table O-2). For the 

Native Hawaiian and Other Pacific Islander population, 

more objectives moved away from the target (26 

objectives) than moved toward, met, or exceeded the 

target (21 objectives).

The progress for each objective with data beyond the 

baseline is shown in the Progress Chart in Focus Area 

chapters of this report. Health disparities between 

population groups and changes in disparities between 

the baseline and the most recent time point are examined 

in the section of this Overview that discusses Goal 2: 

Eliminate Health Disparities. When data are available, 

disparities are summarized in the Health Disparities 

Table in Focus Area chapters.
Overview O-11

Figure O-3. Summary of Progress for Objectives with Tracking Data for Each Population Group

American Indian or Alaska Native

Asian or Pacific Islander1

Asian

Native Hawaiian or Other Pacific Islander

Two or more races

Hispanic

Black, not Hispanic2

White, not Hispanic2

Sex

Female

Male

Education

Less than high school

High school graduate

At least some college

Income

Poor

Near poor

Middle/high income

Location

Urban or metropolitan

Rural or nonmetropolitan

Disability

Persons with disabilities

Persons without disabilities

Moved away

from target

Number of objectives

Demonstrated

no change 

Met or exceeded

target 

Moved toward

target

Race and Ethnicity

275 250 225 200 175 125 150 100 75 50 25 0 25 50 75 100 125 150 175 200 225 250 275

1

For some objectives, data are unavailable for the categories 'Asian' and 'Native Hawaiian or Other Pacific Islander'; these data are available for the 

combined 'Asian or Pacific Islander' population instead. See Healthy People 2010: General Data Issues, referenced above.

2

For some objectives, data include persons of Hispanic origin.
O-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Table O-2. Healthy People 2010 Objectives: Summary of Progress for Population Groups

Characteristics and Groups

Met or exceeded 

target

Moved

toward target

Demonstrated

no change

Moved away

from target Total

Race and Ethnicity

 American Indian or Alaska Native 18 63 9 59 149

 Asian or Pacific Islander1 18 11 3 21 53

 Asian 28 46 10 37 121

 Native Hawaiian or Other Pacific Islander 5 16 2 26 49

 Two or more races 14 37 9 29 89

 Hispanic 38 143 14 91 286

 Black, not Hispanic2 62 183 23 88 356

 White, not Hispanic2 90 155 23 112 380

Sex

 Female 67 151 15 96 329

 Male 55 169 14 86 324

Education

 Less than high school 8 55 6 37 106

 High school graduate 14 50 7 40 111

 At least some college 38 45 5 25 113

Income

 Poor 14 47 4 34 99

 Near poor 16 33 9 37 95

 Middle/high income 31 31 11 28 101

Location

 Urban or metropolitan 5 25 1 13 44

 Rural or nonmetropolitan 8 18 4 16 46

Disability

 Persons with disabilities 11 38 4 28 81

 Persons without disabilities 12 39 8 27 86

1

For some objectives, data are unavailable for the categories 'Asian' and 'Native Hawaiian or Other Pacific Islander'; these data are available for 

the combined 'Asian or Pacific Islander' population instead. See Healthy People 2010: General Data Issues, referenced above.

2

For some objectives, data include persons of Hispanic origin.
Overview O-13

GOAL 1:

Increase Quality and Years of Healthy Life

Healthy People 2010: Understanding and Improving 

Health highlighted the importance of maximizing and 

increasing both years of life and quality of life in the first 

overarching goal [6]. Progress toward achieving this goal 

is currently assessed by measuring life expectancy and 

three measures of healthy life expectancy: 1) Expected 

years in good or better health; 2) Expected years free 

of activity limitations; and 3) Expected years free of 

selected chronic diseases. These assessments result in 

the following conclusions:

〉 Life expectancy improved for the populations that 

could be assessed throughout the decade.

〉 Women had a longer life expectancy than men, and 

the white population had a longer life expectancy 

than the black population.

〉 Expected years in good or better health (at birth) 

and expected years free of activity limitations (at 

birth) increased; and expected years free of selected 

chronic conditions (at birth) decreased.

〉 Differences by race and sex were observed in all 

three healthy life expectancy measures (at birth)—

expected years in good or better health, expected 

years free of activity limitations, and expected years 

free of selected chronic diseases.

Life Expectancy

Life expectancy is the average number of years a 

hypothetical cohort of people born in a given year could 

be expected to live based on the age-specific death rates 

in that year. Since the launch of Healthy People 2010, 

life expectancy at birth and at age 65 have increased for 

all populations (Table O-3 and Figure O-4). In 2006–07, 

life expectancy for the total population was 77.8 years, 

an increase from 76.8 years in 2000–01. Improvements 

in overall life expectancy reflect improvements in 

disease-specific death rate objectives within the Healthy 

People 2010 Focus Areas. Death rates declined for many 

Healthy People 2010 cause-specific mortality objectives 

including: female breast cancer (objective 3-3), colorectal 

cancer (objective 3-5), prostate cancer (objective 3-7), 

coronary heart disease (objective 12-1), stroke (objective 

12-7), cardiovascular disease and diabetes-related 

deaths among persons with diabetes (objectives 5-6 

and 5-7) and HIV (objective 13-14). Even with these 

improvements, in 2007 the U.S. male life expectancy 

ranked 26th and female life expectancy ranked 25th out 

of 33 selected countries [7].

From 2000–01 to 2006–07, the percent increase in life 

expectancy was greater at age 65 (5.1%) than at birth 

(1.3%). In 2006–07, men (75.3 years) had a lower life 

expectancy at birth than women (80.3 years), and the 

black population (73.4 years) had a lower life expectancy 

at birth than the white population (78.3 years). However, 

from 2000–01 to 2006–07, the black population (2.1%) 

had a greater relative increase in life expectancy at birth 

than the white population (1.2%). Men (1.5%) also had a 

greater relative increase in life expectancy at birth than 

women (1.1%).

Table O-3. Life Expectancy at Birth and at Age 65 

(in Years)

Total Black White Women Men

Life 

expectancy

at birth

2000–01 76.8 71.9 77.4 79.4 74.2

2002–03 77.0 72.2 77.5 79.5 74.4

2004–05 77.4 72.8 77.9 79.9 74.9

2006–07 77.8 73.4 78.3 80.3 75.3

Life 

expectancy

at age 65

2000–01 17.7 16.1 17.8 19.0 16.1

2002–03 17.9 16.4 18.0 19.1 16.4

2004–05 18.3 16.8 18.3 19.5 16.8

2006–07 18.6 17.1 18.6 19.8 17.1

Source: National Vital Statistics System (NVSS), CDC, NCHS.

In this report, life expectancy for the periods 2000–01 

to 2006–07 is not presented for racial and ethnic 
O-14 HEALTHY PEOPLE 2010 FINAL REVIEW

groups other than the white population and the black 

population. Data quality problems have prevented the 

production of reliable U.S. life tables for all minority 

populations during this time period with the exception 

of data for the Hispanic population, which became 

available beginning in 2006. Two issues previously 

affected the quality of life expectancy data available for 

the Hispanic population: misclassification in reporting 

of race and ethnic origins on U.S. death certificates 

in comparison with the Census, surveys, and birth 

certificates; and misstatement of age at the oldest 

ages in both Census and vital statistics data. Recent 

research has shown that the classification of race and 

Hispanic origin on death certificates has improved and 

that a relatively minor adjustment is required to correct 

for the effects of the misclassification. In addition, the 

issue of age misstatement at the oldest ages can be 

addressed by recent research on Hispanic mortality 

patterns. Due to the improvement in data quality for 

the Hispanic population, complete period life tables for 

the total Hispanic population in 2006 became available 

in October 2010. However, additional data years for the 

Hispanic population were not available until September 

2011 and therefore life expectancy for the Hispanic 

population is not addressed in this report [8].

Much of the recent gain in life expectancy is concentrated 

in the older population, which is the age group that has 

the highest prevalence of functional limitations. As 

a result, measuring longevity is no longer sufficient to 

describe the health of a population. Preventing disabling 

conditions, improving function, relieving physical pain 

and emotional distress, and maximizing health across 

the lifespan have become important public health goals 

along with increasing life expectancy [9].

Measuring Quality and Years of 

Healthy Life

Given the multidimensional nature of health, assessing 

quality and healthy life is a much more complex 

process than measuring life expectancy, and the field 

is evolving. Various measures are used nationally and 

internationally to measure healthy life. These measures 

fall into three general categories:

〉 Self-assessments of overall health status by 

individuals or their proxies [10].

〉 Composite measures that include multiple 

dimensions of health. Scores on the various 

dimensions are combined into a single measure 

using a predetermined algorithm (for example, 

SF-36, Healthy Days) [11,12].

〉 Measures that combine death rates and health 

(where the health indicator can be either of the types 

described above or an indicator of a single dimension 

of health). These measures use years as the metric 

to quantify healthy life (for example, healthy life 

expectancy, Years of Healthy Life) [13].

Healthy People 2010: Understanding and Improving Health

mentioned several possible measures of population 

health: respondent-assessed health status; healthy days; 

and the measure used in Healthy People 2000, Years 

of Healthy Life (YHL) [6,13]. In response to the need to 

measure Goal 1 of Healthy People 2010, at the beginning 

of the decade, NCHS convened a workshop to select 

measures that best capture the complexity of assessing 

years of healthy life within the context of Healthy People 

2010 [14]. As a result of the workshop, three measures of 

healthy life expectancy that combine death rates with 

different measures of health were selected to track 

progress toward Goal 1 of Healthy People 2010. These 

healthy life expectancy measures represent the breadth 

of recommendations from the workshop. The three new 

measures are: 

1. Expected years in good or better health

2. Expected years free of activity limitations

3. Expected years free of selected chronic diseases. 

Two of the three new healthy life expectancy measures, 

years in good or better health and years free of activity 

limitation, evolved from the YHL measure used to track 

Figure O-4. Life Expectancy at Birth and at Age 65, 

by Sex and Race, 2006–07

0

10

20

30

40

50

60

70

80

Total Women Men White Black

Life expectancy at birth Life expectancy at age 65

Years

Source: National Vital Statistics System (NVSS), NCHS, CDC.
Overview O-15

the years and quality of life in Healthy People 2000. YHL 

combined information about death rates, self-rated 

health, and activity limitations into a single measure. 

The current set of healthy life expectancy measures 

separate the self-rated health component from the 

limitation of activities component to better track and 

understand change over time. For more detail on these 

measures, see the Technical Appendix.

Data for these three measures of healthy life expectancy 

were analyzed for the period 2000–01 through 2006–07 

for expected years in good or better health and expected 

years free of activity limitations and for the period 2002–

03 through 2006–07 for expected years free of selected 

chronic diseases. Prevalence data on physician- or health 

professional-diagnosed arthritis were unavailable for 

the years 2000 and 2001; therefore, the expected years 

free of selected chronic diseases was not analyzed for 

those years as arthritis is one of the chronic conditions 

included in the measure. Results of the analysis are 

mixed, with years in good or better health and years 

free of activity limitations showing an increase whereas 

years free of chronic conditions decreased during the 

decade.

Measures of Healthy Life 

Expectancy for Healthy People 

2010

The measures of healthy life expectancy are calculated 

using a life-table technique. This technique combines 

information about average health states and death rates 

to produce age-specific estimates of expected years of 

healthy life (see Technical Appendix for details on the 

methodology).

Expected years in good or better health is defined as 

the average number of years a person can expect to live 

in good or better health. This measure assesses healthy 

life using a single global assessment question which asks 

a person to rate his or her health as “excellent,” “very 

good,” “good,” “fair,” or “poor.”

Expected years free of activity limitations is defined as 

the average number of years a person can expect to live 

free from limitation in activities, the need for assistance 

in personal or routine care needs, or the need to use 

special equipment because of health problems.

Expected years free of selected chronic diseases is 

defined as the average number of years a person can 

expect to live without being diagnosed by a physician or 

health professional as having one or more of the following 

selected conditions for which nationally representative 

data are available annually: arthritis, asthma, cancer, 

diabetes, heart disease, high blood pressure, kidney 

disease, or stroke.

Healthy Life Expectancy at Birth

Table O-4 and Figure O-5 present healthy life expectancy 

at birth for each of the three measures. Life expectancy is 

included in Figure O–5 for comparison purposes. Based 

on data from the years 2006–07, individuals in the U.S. 

could expect to live 69.0 years in good or better health, 

66.2 years free of activity limitations, and 43.1 years free 

of selected chronic diseases. Expected years in good or 

better health increased 0.5 years and expected years 

free of activity limitations increased 0.7 years between 

2000–01 and 2006–07. Expected years free of selected 

chronic conditions declined 0.6 years between 2002–03 

and 2006–07.

Table O-4. Measures of Healthy Life Expectancy 

at Birth (in Years)

Total Black White Women Men

Expected 

years in

good or 

better

health

2000–01 68.5 59.8 69.7 70.2 66.6

2006–07 69.0 61.3 70.0 70.7 67.3

Expected 

years free 

of activity 

limitations

2000–01 65.5 59.3 66.1 67.2 63.8

2006–07 66.2 60.2 66.8 67.8 64.7

Expected 

years free 

of selected 

chronic 

diseases

2002–03 43.7 38.9 43.9 43.6 43.8

2006–07 43.1 38.6 43.4 43.5 42.7

Sources: National Health Interview Survey (NHIS), CDC, NCHS;

 National Vital Statistics System (NVSS), CDC, NCHS.

Women can expect to spend a slightly greater proportion 

of their lives in fair or poor health, with activity 

limitations, and with selected chronic conditions than 

their male counterparts. Based on data from years 

2006–07, women could expect to live 80.3 years (see 

Table O–3), of which 70.7 years would be in good or 

better health, 67.8 would be free of activity limitations 

and 43.5 would be free of selected chronic diseases. 

Women could, therefore, expect to spend approximately 

12% of their lives in fair or poor health:

80.3 – 70.7

× 100 =

9.6

× 100 = 12%.

80.3 80.3

Similarly, women could expect to spend 16% of their 

lives with activity limitations and 46% of their lives with 

one or more selected chronic conditions. In the years 
O-16 HEALTHY PEOPLE 2010 FINAL REVIEW

2006–07, men could expect to spend 11% of their lives 

in fair or poor health, 14% with activity limitations, and 

43% with one or more selected chronic conditions.

Compared with the white population, the black 

population could expect to spend a greater proportion 

of life in an unhealthy state. Based on data from years 

2006–07, the black population, at birth, could expect to 

spend 16% of life in fair or poor health, 18% of life with 

activity limitations, and 47% of life with one or more 

selected chronic conditions.

Healthy Life Expectancy at Age 65

Table O-5 and Figure O-6 present the three measures 

of healthy life expectancy at age 65. Life expectancy is 

included in Figure O–6 for comparison purposes. Based 

on 2006–07 data, individuals at age 65 could expect to 

live an additional 13.7 years in good or better health, 

11.8 years free of activity limitations, and 2.7 years free 

of selected chronic diseases. Between the years 2000–01 

and 2006–07, for those at age 65, expected years in good 

or better health and expected years free of activity 

limitations increased. From 2002–03 to 2006–07, 

expected years free of selected chronic diseases declined.

Table O-5. Measures of Healthy Life Expectancy 

at Age 65 (in Years)

Total Black White Women Men

Expected 

years in 

good or 

better health

2000–01 12.9 9.2 13.3 13.9 11.7

2006–07 13.7 10.5 13.9 14.5 12.6

Expected 

years free 

of activity 

limitations

2000–01 11.1 8.6 11.3 11.5 10.6

2006–07 11.8 9.3 12.0 12.1 11.5

Expected 

years free 

of selected 

chronic 

diseases

2002–03 2.8 2.0 2.9 2.9 2.7

2006–07 2.7 1.6 2.6 2.8 2.4

Sources: National Health Interview Survey (NHIS), CDC, NCHS;

 National Vital Statistics System (NVSS), CDC, NCHS.

Similar to the patterns at birth, women at age 65 could 

expect to live a greater number of years in a healthy 

life state, but they would spend a greater proportion 

of their lives with activity limitations or in fair or poor 

health. Based on data from years 2006–07, older women 

could expect to spend 39% of their remaining lives with 

activity limitations, whereas men could expect to spend 

33% of their remaining lives with activity limitations. 

It was expected that both older men and older women 

would spend a large proportion of their remaining lives 

with one or more selected chronic conditions (86% for 

men; 86% for women). Older men and older women were 

expected to spend similar proportions of their remaining 

lives in fair or poor health (26% for men; 27% for women).

Similar to the patterns at birth, the older black 

population could expect to spend a greater proportion 

of remaining life in an unhealthy state than the older 

white population. Based on data from the years 2006–07, 

the black population aged 65 could expect to live 39% of 

remaining life in fair or poor health, 46% with activity 

limitations, and 91% with one or more selected chronic 

conditions. From 2000–01 to 2006–07, the older black 

population experienced a greater increase in expected 

years in good or better health than the older white 

population. There was no statistically significant 

difference in the expected years free of activity 

limitations or the expected years free of selected chronic 

diseases between the older black and white populations.
Overview O-17

Figure O-5. Life Expectancy and Measures of Healthy Life Expectancy at Birth, 2006–07

0

10

20

30

40

50

60

70

80

Total Women Men White Black

Life expectancy In good or better health Free of activity limitations Free of selected chronic diseases

Years

Sources: National Health Interview Survey (NHIS), NCHS, CDC; National Vital Statistics System (NVSS), NCHS, CDC.

Total Women Men White Black

Life expectancy In good or better health Free of activity limitations Free of selected chronic diseases

0

5

10

15

20

Years

Figure O-6. Life Expectancy and Measures of Healthy Life Expectancy at Age 65, 2006–07

Sources: National Health Interview Survey (NHIS), NCHS, CDC; National Vital Statistics System (NVSS), NCHS, CDC. 
O-18 HEALTHY PEOPLE 2010 FINAL REVIEW

GOAL 2:

Eliminate Health Disparities

The second goal of Healthy People 2010 was to eliminate 

health disparities that occur by race and ethnicity, 

sex, education, income, geographic location, disability 

status, or sexual orientation. Findings for specific 

objectives and populations are presented in 27 of the 28 

Focus Area chapters. None of the objectives in Public 

Health Infrastructure (Focus Area 23) were tracked with 

population-based data. The findings concerning health 

disparities are summarized below.

Substantial health disparities were observed for many 

Healthy People 2010 objectives. Both increases and 

decreases in health disparities also were observed for 

specific objectives; however, most of the populationbased objectives with data to measure disparities had 

no change in health disparities on average. 

For specific population characteristics:

〉 Among 169 objectives with data for racial and ethnic 

groups, health disparities, on average, decreased for 

27 objectives and increased for 25.

〉 Among 216 objectives with data for males and 

females, health disparities decreased for 26 objectives 

and increased for 23. Females more often had better 

group rates than males.

〉 Among 132 objectives with data for education 

groups, health disparities, on average, decreased for 

7 objectives and increased for 20.

〉 Health disparities among income groups, as well as 

by geographic location and disability status did not 

change, with the exception of a few objectives.

In total, there were 469 population-based objectives for 

which health disparities could be measured. Presented 

as the second figure in each Focus Area chapter (except 

for chapter 23), the Health Disparities Table provides 

detailed information about health disparities for the 

objectives in that Focus Area. The Health Disparities 

Table provides information about the availability of data 

for each population, the size of health disparities relative 

to the group with the best rate for each characteristic, and 

the magnitude of changes in these disparities between 

the Healthy People 2010 baseline and the most recent 

time point for each objective. Data were not available 

for all populations for each objective, and tracking data 

were not always available to assess changes in disparity 

from the baseline.

Data by sexual orientation were unavailable for all 

Healthy People 2010 objectives.

In this Final Review, health disparities are measured 

using the “best” or most favorable (or least adverse) 

group rate as the reference point. “Best” is used to 

identify the population group with the most favorable 

(or least adverse) rate among the groups associated with 

a particular characteristic. “Best” does not imply that 

no further improvement is called for. Health disparities 

by race and ethnicity, for example, are measured using 

the rate for the racial and ethnic population with the 

best rate as the reference point. Health disparities are 

measured in relative terms as the percent difference 

between the rate for each population group and the best 

group rate for each characteristic. In the measurement 

of health disparities, objectives are generally expressed 

in terms of adverse events or conditions, such as death 

rates, to facilitate comparisons among them. Changes 

in disparities are measured by subtracting the percent 

difference from the best group rate at the baseline from 

the percent difference from the best group rate at the most 

recent time point. As a result, changes in disparities are 

expressed in percentage points. In addition, when more 

than two groups are associated with a characteristic 

(race and ethnicity, education, or income), a summary 

index is used to describe the average percent difference 

from the best group in the population overall. The 

summary index provides a basis for conclusions about 

changes in the average size of the disparities associated 

with these characteristics. A detailed description of the 

methods used to measure and evaluate disparities is 

provided in the Technical Appendix.
Overview O-19

Findings Concerning Disparities

Race and Ethnicity

Information about health disparities among racial and 

ethnic populations at the most recent time point based 

on the Health Disparities Table for each Focus Area is 

summarized in Figure O-7. The measurement of health 

disparities depends on the availability of data for each 

population. The number of objectives with data needed 

to measure health disparities varied from 38 for the 

Native Hawaiian or Other Pacific Islander population to 

354 for the non-Hispanic white population. 

American Indian or Alaska Native Population

Data needed to assess health disparities for the American 

Indian or Alaska Native population were available for 

157 objectives (Figure O-7). This population had the best 

group rate (i.e., least adverse) for 6% of these objectives. 

The American Indian or Alaska Native population had 

rates at least twice as high as the least adverse group rate 

(i.e.,100% or more range) for 26% of the 157 objectives, 

which is a larger proportion of health disparities in the 

100% or more range than any of the other racial and 

ethnic populations. 

Asian Population and Native Hawaiian or Other Pacific 

Islander Population

Data needed to assess health disparities for the Asian 

population (excluding the Native Hawaiian or Other 

Pacific Islander population) were available for 98 

objectives; see Figure O-7. The Asian population had 

the best group rate (i.e., least adverse) for 28% of these 

objectives. This population had rates at least twice as 

high as the least adverse group rate (100% or more range) 

for 9% of the 98 objectives.

Data for the Native Hawaiian or Other Pacific Islander 

population were available for 38 objectives (Figure O-7). 

Figure O-7. Health Disparities at the Most Recent Time Point, by Race and Ethnicity

29

34

13

7

31

71 76

60

44

21

6

12

28

119

91

71

33

7

6

3

10 32

40

17

41

9

9

2

10 35

69

25

0

20

40

60

80

100

American Indian

or Alaska Native

Asian Native Hawaiian

or Other Pacific

Islander

Asian or

Pacific

Islander

Two or more

races

Hispanic

or Latino

Black, not

Hispanic

White, not

Hispanic

Percent of objectives

Number of objectives

(157) (98) (38) (66) (96) (311) (345) (354)

100% or more

50% to 99%

10% to 49%

Less than 10%2

Best group rate

Percent difference

from the best

group rate1

10

27

4

42

17 54 68

181

1

Best group rate refers to least adverse group rate among racial and ethnic groups.

2

“Less than 10%” includes percent differences that were not statistically significant (when estimates of variability were available).
O-20 HEALTHY PEOPLE 2010 FINAL REVIEW

This population had a smaller percentage of best group 

rates (11%) and a larger percentage of health disparities 

of 100% or more (24%) than the Asian population.

Data were available for the combined Asian or Pacific 

Islander population for 66 objectives (Figure O-7). This 

combined population had the best group rate for 64% of 

these objectives. The Asian or Pacific Islander population 

had rates at least twice as high as the least adverse 

group rate (100% or more range) for two objectives: cases 

of hepatitis B in adults aged 19–24 (objective 14-3a) and 

cases of hepatitis A (objective 14-6).

Two or More Races

Data for individuals who identified with more than one 

race were available for 96 objectives (Figure O-7). The 

population of persons of two or more races had the best 

group rate for 18% of these objectives. This population 

had rates at least twice as high as the least adverse group 

rate (100% or more range) for 10% of the 96 objectives.

Hispanic Population

Data needed to assess health disparities for the Hispanic 

population were available for 311 objectives (Figure O-7). 

The Hispanic population had the best group rate for 17% 

of these objectives. This population had rates at least 

twice as high as the least adverse group rate (100% or 

more range) for 11% of the 311 objectives.

Non-Hispanic Black Population

Data needed to assess health disparities for the nonHispanic black population (or, in some cases, the black 

population, including persons of Hispanic origin) were 

available for 345 objectives (Figure O-7). This population 

had the best group rate for 20% of these objectives. This 

population had rates at least twice as high as the least 

adverse group rate (100% or more range) for 20% of the 

345 objectives, including most leading causes of death.

Figure O-8. Changes in Health Disparities from the Baseline to the Most Recent Time Points, by Population 

Characteristic

Number of objectives with changes in the summary index as the measure of disparity. Health disparities by income were not included for Focus 

Disparity decrease Disparity increase No change1 Total

Race and ethnicity2 117 169

Sex 167 216

Education2 107 132

Income2 64 75

Geographic location 23 33

Disability status 47 51

30

Disparity decrease Disparity increase

10–49

percentage

points

10–49

percentage

points

50–99 

percentage

points

50–99

percentage

points

100 percentage

points or more

1 

1

5 

23

15

3

3

5

1

1

7

3

4

6

18

19

18

1

2

1

3 

5

3

1

1 

2

100 percentage

points or more

30 25 20 15 10 5 50 10 15 20 25

Number of objectives

1

“No change” includes: changes of less than 10 percentage points, regardless of statistical significance; and all changes that were not statistically 

significant, when estimates of variability were available. See Technical Appendix.

Area 19 due to data limitations.

NOTES: Changes in disparity from the baseline to the most recent time points are only shown when they could be assessed. Changes could not be 

assessed for 54, 82, 4, 3, 10, and 17 objectives by race and ethnicity, sex, education, income, geographic location, and disability status, respectively. 

2
Overview O-21

Non-Hispanic White Population

Data needed to assess health disparities for the nonHispanic white population (or, in some cases, the white 

population, including persons of Hispanic origin) were 

available for 354 objectives (Figure O-7). This population 

had the best group rate for 51% of these objectives. This 

population had rates at least twice as high as the least 

adverse group rate (100% or more range) for 7% of the 

354 objectives.

Changes in Health Disparities Among Racial and 

Ethnic Groups

In addition to the findings for specific racial and ethnic 

groups, a summary index allows the evaluation of 

changes in overall health disparities by race and ethnicity 

over time. There was no change in health disparities 

among racial and ethnic populations for 111 (69%) of the 

169 objectives with data to calculate the summary index 

and assess its change over time. (“No change” includes 

changes of less than 10 percentage points, regardless of 

statistical significance, and all changes that were not 

statistically significant, when estimates of variability 

were available; see Technical Appendix.) The average 

percent difference from the best group rate decreased 

for 27 objectives and increased for 25 objectives (Figure 

O-8).

Sex

Data by sex were available for 318 objectives (Figure 

O-9). As noted below, trends in disparity could only 

be measured for 216 objectives. Health disparities by 

sex were not relevant to objectives that applied only 

to females or only to males, including those in Family 

Planning (Focus Area 9), and a number of objectives 

in other Focus Areas. Findings concerning health 

disparities by sex are summarized in Figure O-9.

Females had the better group rate (i.e., less adverse) for 

68% of the 318 objectives, compared with 42% for males. 

(Those two percentages, 68% and 42%, add to over 100% 

because there were a number of cases in which the two 

groups had the same rate; therefore, both were counted 

as having achieved the best group rate.) Females had a 

smaller percentage of objectives with adverse rates that 

were at least twice as high as those for males (100% or 

more range).

Changes in Disparities by Sex

Data needed to evaluate changes over time in health 

disparities by sex were available for 216 objectives. There 

was no change in disparity for 167 objectives, or 77% of 

the total with data. (“No change” includes changes of 

less than 10 percentage points, regardless of statistical 

significance, and all changes that were not statistically 

significant, when estimates of variability were available; 

see Technical Appendix.) Disparities decreased for 26 

objectives and increased for 23 (Figure O-8). In addition, 

there were 33 objectives for which changes in disparities 

could not be assessed because the group with the best 

rate changed (e.g., from males to females).

Education Level

Data needed to assess health disparities among 

populations by education level were available for 160 to 

161 objectives (Figure O-10). Education was not included 

as a characteristic in all Focus Areas. The population 

with at least some college education had the best rate 

(i.e., least adverse) for 88% of the objectives with data 

by education. The population with less than a high 

school education and high school graduates had the 

best group rate for 8% and 10% of the objectives with 

data by education, respectively. There were no objectives 

for which the disparity between the population with 

at least some college education and the group with 

the least adverse rate was 100% or more. High school 

graduates had rates at least twice as high as the least 

adverse group rate (100% or more range) for 18% of the 

Figure O-9. Health Disparities at the Most Recent 

Time Point, by Sex Percent of objectives

61

55

36

83

5

21

1

26

0

20

40

60

80

100

Female Male

Number of objectives

(318) (318)

100% or more

50% to 99%

10% to 49%

Less than 10%2

Best group rate

Percent difference

from the best

group rate1

215

133

1

Best group rate refers to less adverse group rate.

2

“Less than 10%” includes percent differences that were not 

statistically significant (when estimates of variability were available).
O-22 HEALTHY PEOPLE 2010 FINAL REVIEW

160 objectives, and the population with less than a high 

school education had rates at least twice as high as the 

least adverse group rate (100% or more range) for 24% of 

the 160 objectives.

Changes in Health Disparities by Education Level

In addition to the findings for individual populations, 

the summary index permits the evaluation of changes in 

overall health disparities over time by level of education. 

There was no change in health disparity among 

populations by education level for 107 objectives, or 81% 

of the 132 objectives with data to calculate the index 

and assess change over time. (“No change” includes 

changes of less than 10 percentage points, regardless of 

statistical significance, and all changes that were not 

statistically significant when estimates of variability 

were available; see Technical Appendix.) On average, 

disparities decreased for five objectives and increased 

for 20 (Figure O-8). There was 1 increase and 0 decreases 

of 100 percentage points or more.

Income

Income was not included as a characteristic in all Focus 

Areas. All of the objectives in Nutrition and Overweight 

(Focus Area 19) and six objectives in Immunization and 

Infectious Diseases (Focus Area 14) were excluded from 

the summary in Figure O-11 because data by income 

were available for only two population subgroups 

(persons with income at or below 130% of the Federal 

poverty level, and persons with income above 130% of 

the Federal poverty level). This summary is based on 95 

to 103 objectives with data by income (Figure O-11). The 

population with middle/high income (at or above 200% 

of the Federal poverty level) had the best rate for 74% of 

the objectives with data by income. The poor (below the 

Federal poverty level) and near-poor (100–199% of the 

Federal poverty level) populations each had the best rate 

(i.e., least adverse) for 21% and 19% of their objectives, 

respectively.

Figure O-10. Health Disparities at the Most Recent 

Time Point, by Education Level

0

20

40

60

80

100

Percent of objectives

Number of objectives

31

34

12

48

65

30

17

39

28

Less than

high school

High school

graduate

At least

some college

(160) (160) (161)

8

100% or more

50% to 99%

10% to 49%

Less than 10%2

Best group rate

Percent difference

from the best

group rate1

12 16

141

1

Best group rate refers to least adverse group rate by education level.

2

“Less than 10%” includes percent differences that were not 

statistically significant (when estimates of variability were available). 

Figure O-11. Health Disparities at the Most Recent 

Time Point, by Income

0

20

40

60

80

100

Percent of objectives

Number of objectives

33 42

20

20

24

5

16

9

10 8

Poor Near poor Middle/high

income

(100) (103) (95)

100% or more

50% to 99%

10% to 49%

Less than 10%2

Best group rate

Percent difference

from the best

group rate1

21 20

70

1

Best group rate refers to least adverse group rate by education level.

2

“Less than 10%” includes percent differences that were not 

statistically significant (when estimates of variability were available). 
Overview O-23

There were no objectives for which the health disparities 

between persons with middle/high incomes and the 

group with the least adverse rate were 100% or more. The 

near-poor population had rates at least twice as high as 

the least adverse group rate (100% or more range) for 8% 

of the objectives with data. The poor or lowest income 

population had rates at least twice as high as the least 

adverse group rate (100% or more range) for 10% of the 

objectives with data.

Changes in Health Disparities by Income

The summary index enables the evaluation of changes in 

disparity over time by income. Data needed to evaluate 

changes in disparity were available for 75 objectives 

(Figure O-8). There was little evidence of any change in 

disparity among populations by income. On average, 

disparities decreased for 3 objectives and increased for 

8 (Figure O-8).

Geographic Location

Geographic location was defined in different ways in 

Healthy People 2010. For some objectives, the distinction 

was between urban and rural areas, whereas for 

others, the distinction was between metropolitan and 

nonmetropolitan areas. Findings for health disparities 

by geographic location for 52 objectives are summarized 

in Figure O-12.

Urban or metropolitan areas had the better rate 

(i.e., less adverse) for 71% of the 52 objectives. Urban 

or metropolitan areas also had more objectives (4 

objectives) with health disparities of 100% or more than 

rural or nonmetropolitan areas (1 objective). Rural or 

nonmetropolitan areas had the better rate for 40% of the 

52 objectives. (Those two percentages, 71% and 40%, add 

to over 100% because there were a number of cases in 

which the two groups had the same rate; therefore, both 

were counted as having achieved the best group rate.)

Figure O-12. Health Disparities at the Most Recent 

Time Point, by Geographic Location

0

20

40

60

80

100

Percent of objectives

Number of objectives

9

18

2

10

4 2

1

Urban or

metropolitan

Rural or

nonmetropolitan

(52) (52)

100% or more

50% to 99%

10% to 49%

Less than 10%2

Best group rate

Percent difference

from the best

group rate1

37

21

1

Best group rate refers to less adverse group rate.

2

“Less than 10%” includes percent differences that were not 

statistically significant (when estimates of variability were available).

Figure O-13. Health Disparities at the Most Recent 

Time Point, by Disability Status

0

20

40

60

80

100

Percent of objectives

21

14

14

12 5

3 5

Persons with

disabilities

Persons without

disabilities

(77) (77)

Number of objectives

100% or more

50% to 99%

10% to 49%

Less than 10%2

Best group rate

Percent difference

from the best

group rate1

32

48

1

Best group rate refers to less adverse group rate.

2

“Less than 10%” includes percent differences that were not 

statistically significant (when estimates of variability were available).
O-24 HEALTHY PEOPLE 2010 FINAL REVIEW

Changes in Health Disparities by Geographic Location

Data needed to evaluate changes in health disparities 

between geographic areas were available for 33 

objectives. Health disparities from the better group rate 

declined for 2 objectives, and increased for 8 (Figure O-8).

Disability Status

Data for persons with disabilities and persons without 

disabilities were available for 77 objectives and are 

summarized in Figure O-13. Persons with disabilities 

had the better group rate (i.e., less adverse) for 42% of 

these objectives, and persons without disabilities had the 

better group rate for 62%. (Those two percentages, 42% 

and 62%, add to over 100% because there were a number 

of cases in which the two groups had the same rate; 

therefore, both were counted as having achieved the best 

group rate.) Persons with disabilities had adverse rates 

at least twice as high as for persons without disabilities 

(100% or more range) for 6% of the 77 objectives.

Changes in Health Disparities by Disability Status

Data needed to evaluate changes in health disparities 

between disability groups were available for 51 objectives 

(Figure O-8). There were few changes in disparities 

by disability status. Health disparities between these 

populations declined for 1 objective and increased for 3 

objectives.

Data Limitations

Several factors limited the number of objectives for 

which health disparities and changes in disparities 

could be assessed:

〉 This assessment is based only on data at the baseline 

and at the most recent time points; intervening data 

values were not considered.

〉 Some populations, such as the American Indian or 

Alaska Native, Asian, Hispanic, and Native Hawaiian 

or Other Pacific Islander populations, lacked data to 

assess disparities or changes in disparities.

〉 Some data systems lacked reliable or valid 

information about the persons on whom this 

assessment is based. For example, reporting of race 

and income was sometimes problematic.

〉 Assessments of the likelihood that health disparities 

or changes in disparities were due to random 

fluctuations in the data were limited by the lack 

of estimates of variability for some data. See the 

Technical Appendix for more information.
Overview O-25

Transitioning to Healthy People 2020:

The Decade Ahead

In December 2010, DHHS launched Healthy People 2020, 

the successor health promotion initiative for the second 

decade of the 21st century which builds on the strengths 

of Healthy People 2010 while breaking new ground in 

the scope, outreach, and scientific underpinning of the 

initiative. In contrast with the two goals of Healthy 

People 2010, Healthy People 2020 is grounded in four 

overarching goals to:

1. Attain high quality, longer lives free of preventable 

disease, disability, injury, and premature death.

2. Achieve health equity and eliminate disparities.

3. Create social and physical environments that 

promote good health for all.

4. Promote quality of life, healthy development, and 

healthy behaviors across all life stages.

The framework of Healthy People 2020 is organized into 

42 Topic Areas (formerly Focus Areas), with 13 new areas 

added:

〉 Adolescent Health

〉 Blood Disorders and Blood Safety

〉 Dementias, Including Alzheimer’s Disease

〉 Early and Middle Childhood

〉 Genomics

〉 Global Health

〉 Healthcare-Associated Infections

〉 Health-Related Quality of Life and Well-Being

〉 Lesbian, Gay, Bisexual, and Transgender Health

〉 Older Adults

〉 Preparedness

〉 Sleep Health

〉 Social Determinants of Health.

In addition, the 2010 Vision and Hearing Focus Area 

was split into two separate Topic Areas for 2020: Vision, 

and Hearing and Other Sensory or Communication 

Disorders.

The Healthy People 2020 Topic Areas encompass 

approximately 1,200 objectives as compared with 969 

objectives in Healthy People 2010. As of the Healthy 

People 2010 launch, 366 objectives have been carried 

over without change into Healthy People 2020; 358 

appear in modified form; 242 have been archived, that 

is, preserved on inactive but retrievable status on the 

strength of having at least one data point; and 84 have 

been discontinued because they had no prospect of 

acquiring a data source, an improved data source had 

been identified, or the science had changed. Appendix D, 

“A Crosswalk Between Objectives From Healthy People 

2010 to Healthy People 2020,” summarizes the changes 

between the two decades of objectives.

Innovations of Healthy People 

2020

Healthy People 2020 places a renewed focus on 

identifying, measuring, tracking, and reducing health 

disparities using a determinants of health approach. 

Health status and health behaviors are determined 

by influences at multiple levels, including personal 

(i.e., biological, psychological), organizational and 

institutional, environmental (i.e., both social and 

physical), and policy levels. Because significant and 

dynamic inter-relationships exist among these different 

levels of health determinants, interventions are most 

likely to be effective when they address determinants at 

all levels. Historically, many initiatives have focused on 

individual-level health determinants and interventions. 

Healthy People 2020 therefore expanded its focus 

from previous iterations to emphasize tracking and 

monitoring of health-enhancing social and physical 

environments. Integrating prevention into the 

continuum of education—from the earliest ages on—is 
O-26 HEALTHY PEOPLE 2010 FINAL REVIEW

an integral part of this ecological and determinants 

approach. Another important innovation in Healthy 

People 2020 is the expanded population template which 

will allow a more in-depth analysis of health disparities 

in comparison with Healthy People 2010.

As with Healthy People 2010, each Healthy People 2020 

objective has a:

〉 Reliable data source

〉 Baseline measure

〉 Target for specific improvements to be achieved by 

the year 2020.

Draft objectives have been prepared by experts from 

multiple lead federal agencies. The proposed objectives 

have then been reviewed through a public comment 

process and by the Healthy People Federal Interagency 

Workgroup, which used specific selection criteria to 

choose the final objectives.

Many objectives focus on interventions that are designed 

to reduce or eliminate illness, disability, and premature 

death among individuals and communities. Others 

focus on broader issues such as:

〉 Eliminating health disparities

〉 Addressing social determinants of health

〉 Improving access to quality health care

〉 Strengthening public health services

〉 Improving the availability and dissemination of 

health-related information.

Over the course of the decade, Foundation Health 

Measures will be used to monitor progress toward 

promoting health, preventing disease and disability, 

eliminating disparities, and improving quality of life. 

These broad, crosscutting measures include:

〉 General Health Status, as measured by such factors 

as life expectancy, healthy life expectancy, years 

of potential life lost, limitation of activity, chronic 

disease prevalence, self-assessed health status, and 

the CDC “Healthy Days Measures.”

〉 Health-Related Quality of Life and Well-Being, as 

measured in terms such as: physical, mental, and 

social health-related quality of life; well-being/

satisfaction; and participation in common activities.

〉 Determinants of Health, that is, a range of personal, 

economic, and environmental factors that influence 

health status, including factors such as biology, 

genetics, individual behavior, access to health 

services, and the particular environment(s) in which 

people may find themselves in the course of their 

lives or their daily round.

〉 Disparities and inequities in health status observed 

across race/ethnicity, sex, physical and mental 

ability, and geographical location.

Concurrent with the release of Healthy People 2020, a 

redesigned website (http://www.healthypeople.gov) was 

launched. Replacing the traditional print publication 

with an interactive website as the main vehicle for 

dissemination will expand the reach and accessibility 

of Healthy People and allow users to tailor information 

to their particular needs and explore evidence-based 

resources for implementation. Among the new features 

of the site are the following:

〉 An index to the Topic Areas and their objectives, with 

information about each objective’s baseline, target, 

and data source.

〉 A "Determinants of Health" section with an animated 

graphic to illustrate the range of personal, social, 

economic, and environmental factors that influence 

health status and often account for health-related 

disparities among population groups.

〉 A "Stay Connected" section with information about

signing up for the listserv and links to social 

networking sites. 

Plans for the future include adding capabilities for the 

website to disseminate research-based implementation 

strategies for Topic Areas and objectives and to receive 

public comments on the objectives during periods set 

aside for this purpose on an annual basis.

References

1. Department of Health, Education, and Welfare, 

Public Health Service. Healthy People: The Surgeon 

General’s Report on Health Promotion and Disease 

Prevention. Washington, D.C.: Government Printing 

Office. 1979.

2. Department of Health, Education, and Welfare, 

Public Health Service. Promoting Health/Preventing 

Disease: Objectives for the Nation. Washington, D.C.: 

Government Printing Office. 1980.

3. Department of Health and Human Services, Public 

Health Service. Healthy People 2000: National Health 

Promotion and Disease Prevention Objectives. 

Washington, D.C.: Government Printing Office. 1991.

4. Department of Health and Human Services. Healthy 

People 2010 Midcourse Review. Washington, D.C.: 

Government Printing Office. 2006.

5. Department of Health and Human Services. Healthy 

People 2020 Topics and Objectives. Available from 

http://www.HealthyPeople.gov.
Overview O-27

6. Department of Health and Human Services. Healthy 

People 2010. 2nd ed. With Understanding and 

Improving Health and Objectives for Improving 

Health. 2 vols. Washington, D.C.: Government 

Printing Office. November 2000.

7. National Center for Health Statistics. Health, United 

States, 2010. With Chartbook on Trends in the Health 

of Americans. Hyattsville, MD: 2010.

8. Arias E. United States life tables by Hispanic origin. 

National Center for Health Statistics. Vital Health 

Stat 2(152). 2010.

9. Molla MT, Wagener DK, Madans JH. Summary 

measures of population health: Methods for 

calculating healthy life expectancy. Healthy People 

Statistical Notes, no. 21. Hyattsville, MD: National 

Center for Health Statistics. August 2001.

10. World Health Organization (WHO). The World 

Health Organization Quality of Life Assessment 

(WHOQOL). Geneva, Switzerland: WHO, Division of 

Mental Health. 1995.

11. Centers for Disease Control and Prevention. More 

information available from http://www.cdc.gov/

hrqol/methods.htm; accessed October 31, 2006.

12. Ware JE, Sherbourne CD. The MOS 36-item ShortForm Health Survey (SF-36): I. Conceptual framework 

and item selection. Med Care 30, 473-83. 1992.

13. Erickson P, Wilson R, Shannon, I. Years of healthy life. 

Healthy People Statistical Notes, no. 7. Hyattsville, 

MD: National Center for Health Statistics. 1995.

14. Molla MT, Madans JH, Wagener DK, Crimmins EM. 

Summary measures of population health: Report of 

findings on methodologic and data issues. National 

Center for Health Statistics. Hyattsville, MD. 2003.

Leading Health 

Indicators

Co-Lead Agencies

Agency for Healthcare Research and Quality

Agency for Toxic Substances and Disease Registry

Centers for Disease Control and Prevention

Food and Drug Administration

Health Resources and Services Administration

National Institutes of Health

President’s Council on Physical Fitness and Sports

Substance Abuse and Mental Health Services Administration

Contents

Introduction.................................................................................LHI-3

Highlights ....................................................................................LHI-4

Summary of Progress...................................................................LHI-8

Transition to Healthy People 2020..............................................LHI-9

Leading Health Indicators Crosswalk ........................................LHI-11

Data Considerations...................................................................LHI-13

References and Notes.................................................................LHI-14

Comprehensive Summary of Objectives....................................LHI-15

Progress Chart............................................................................LHI-17

Health Disparities Table.............................................................LHI-20

Leading Health Indicators LHI-3

Introduction

The Healthy People 2010 Leading Health Indicators 

(LHIs) are a subset of the Healthy People 2010 objectives 

that reflect the major public health concerns in the U.S. 

They were chosen on the basis of their ability to motivate 

action, the availability of data to measure their progress, 

and their relevance as broad public health issues. These 

indicators reflect individual behaviors, physical and 

social environmental factors, and important health 

system issues that greatly affect the health of individuals 

and communities.

There are 10 Healthy People 2010 LHI topics, each 

monitored through one or more LHIs. At the launch of 

Healthy People 2010, there were 22 LHIs. Six supplemental 

LHIs were added since, for a total of 28 LHIs. 

The LHIs for Healthy People 2010 were:

〉 Physical Activity. Two LHIs tracked moderate or 

vigorous physical activity among adults and vigorous 

physical activity among adolescents (objectives 22-2 

and 22-7, respectively).

〉 Overweight and Obesity. Two LHIs tracked obesity 

in adults and in children and adolescents (objectives 

19-2 and 19-3c, respectively).

〉 Tobacco use. Two LHIs tracked cigarette smoking 

among adults and among adolescents (objectives 

27-1a and 27-2b, respectively).

〉 Substance Abuse. Three LHIs tracked adolescents 

not using illicit drugs (objective 26-10a), adults 

using illicit drugs (objective 26-10c), and adult binge 

drinking (objective 26-11c).

〉 Responsible Sexual Behavior. Five LHIs tracked 

condom use by sexually-active unmarried persons 

(objectives 13-6a and b) and adolescent sexual 

behavior (objectives 25-11a through c). The LHIs 

tracking condom use among sexually active 

unmarried males (objective 13-6b), adolescents 

who had sexual intercourse but not in the past 3 

months (objective 25-11b), and adolescents who used 

condoms at last intercourse (objective 25-11c) were 

supplemental LHIs.

〉 Mental Health. Two LHIs tracked suicides (objective 

18-1) and treatment of adults with depression 

(objective 18-9b). (Objective 18-1 was a supplemental 

LHI.)

〉 Injury and Violence. Two LHIs tracked deaths 

from motor vehicle crashes (objective 15-15a) and 

homicides (objective 15-32).

〉 Environmental Quality. Three LHIs tracked 

exposure to ozone (objective 8-1a), children’s 

exposure to tobacco smoke at home (objective 27-9), 

and nonsmoker exposure to tobacco smoke (objective 

27-10). (Objective 27-9 was a supplemental LHI.)

〉 Immunization. Three LHIs tracked fully-immunized 

young children (objective 14-24a) and influenza and 

pneumonia vaccination for older adults (objectives 

14-29a and b, respectively).

〉 Access to Health Care. Four LHIs tracked persons 

with health insurance (objective 1-1), persons 

with a source of ongoing care (objective 1-4a), 

hospitalizations for pediatric asthma (objective 1-9a), 

and the receipt of prenatal care beginning in the first 

trimester (objective 16-6a). (Objective 1-9a was a 

supplemental LHI.)

All Healthy People tracking data quoted in this chapter, 

along with technical information and operational 

definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about the Healthy People 2010 LHIs 

can be found in the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/html/uih/uih_bw/uih_4.htm.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

〉 Sondik EJ, Huang DT, Klein RJ, Satcher D. Progress 

Toward the Healthy People 2010 Goals and Objectives. 

Annu Rev of Public Health 31(1):271–81. 2010.
LHI-4 HEALTHY PEOPLE 2010 FINAL REVIEW

Highlights

〉 Substantial progress was achieved for the LHIs 

during the past decade [1]. Almost two-thirds (63%) 

of the LHIs with data to measure progress moved 

toward or achieved their Healthy People 2010 targets 

(Figure LHI-1). However, health disparities among 

select populations were observed (Figure LHI-2), 

some of which are discussed below [2].

Physical Activity

〉 There was little or no progress toward targets for the 

objectives monitoring this LHI topic. Between 1997 

and 2008, the proportion of adults engaging in regular 

moderate or vigorous physical activity (objective 

22-2) remained stable at 32%. The proportion of 

adolescents engaging in regular vigorous physical 

activity (objective 22-7) increased 4.6% between 

1999 and 2009, from 65% to 68%, moving toward 

the Healthy People 2010 target of 85%; however, this 

increase was not statistically significant.

Overweight and Obesity 

〉 Obesity in the U.S. population increased, moving 

away from Healthy People 2010 targets. Based on 

directly measured height and weight, from 1988–94 

to 2005–08 the proportion of adults aged 20 and over 

who were obese (objective 19-2) rose 47.8%, from 23% 

to 34% (age adjusted), moving away from the 2010 

target of 15%. During the same period, obesity in 

children and adolescents aged 6–19 years (objective 

19-3c) increased 63.6%, from 11% to 18%, moving 

away from the 2010 target of 5%.

Tobacco Use

Progress was observed for this LHI topic:

〉 The percentage of adults aged 18 and over who were 

current cigarette smokers (objective 27-1a) decreased 

12.5% between 1998 and 2008, from 24% to 21% (age 

adjusted), moving toward the 2010 target of 12%. 

However, from 2004 to 2008, the proportion of U.S. 

adults who were current cigarette smokers did not 

noticeably change. Moreover, health disparities were 

observed for a number of populations, for example:

 Among educational groups, adults aged 25 and 

over with at least some college education had 

the lowest (best) current cigarette smoking rate, 

15% (age adjusted) in 2008. Adults aged 25 and 

over with less than a high school education had a 

rate of 30% (age adjusted) in 2008, twice the best 

group rate [2].

〉 Adolescent use of cigarettes in the past month 

(objective 27-2b), decreased 45.7%, from 35% in 1999 

to 19% in 2009, moving toward the 2010 target of 16%.

 Among racial and ethnic groups, the nonHispanic black population had the lowest (best) 

adolescent cigarette smoking rate, 10% in 2009. 

The rate for the non-Hispanic white population 

was 22% in 2009, more than twice the best rate 

[2].

Substance Abuse

Progress for this LHI topic was mixed:

〉 The proportion of adolescents not using alcohol 

or illicit drugs in the past month (objective 26-10a) 

increased 5.1% between 2002 and 2008, from 78% to 

82%, moving toward the 2010 target of 91%.

〉 The proportion of adults using illicit drugs in the 

past month (objective 26-10c) did not change over the 

decade. As in 2002, the baseline year for this objective, 

7.9% of adults aged 18 and over used illicit drugs in 

the past month in 2008. Similarly, the proportion 

of adults who engaged in binge drinking in the 

past month (26-11c) changed very little, increasing 

2.5% over the same tracking period, from 24.3% 

to 24.9%, and moving away from the 2010 target of 

13.4%; however, this difference was not statistically 

significant.

Responsible Sexual Behavior

Four of the five objectives used to monitor this LHI topic 

moved toward their targets:

〉 Condom use among sexually active unmarried 

persons aged 18–44 increased, moving toward the 

2010 targets of 50% for females (objective 13-6a) 

and 54% for males (objective 13-6b). The proportion 

of females (or their partners) who used condoms 

increased 43.5% between 1995 and 2006–08, from 

23% to 33%, whereas the proportion of males (or their 

partners) who used condoms increased 4.8% between 

2002 and 2006–08, from 42% to 44%.

〉 The proportion of adolescents who had never had 

sexual intercourse (objective 25-11a) increased 8.0% 

between 1999 and 2009, from 50% to 54%, moving 

toward the 2010 target of 56%.

〉 Among adolescents who had had sexual intercourse, 

the proportion who were not sexually active in 

the last 3 months (objective 25-11b) declined 3.7% 

between 1999 and 2009, from 27% to 26%, moving 

away from the target of 30%. 
Leading Health Indicators LHI-5

〉 The proportion of adolescents who used condoms 

at last intercourse (objective 25-11c) increased 5.2% 

between 1999 and 2009, from 58% to 61%, moving 

toward the 2010 target of 65%.

Mental Health

Data to measure progress was available for one of the two 

objectives used to monitor this LHI topic, objective 18-1, 

suicide, which increased over the decade, moving away 

from the 2010 target. Only baseline data were available 

for objective 18-9b, treatment for adults with depression.

〉 The suicide rate (objective 18-1) increased 7.6% 

between 1999 and 2007, from 10.5 to 11.3 per 100,000 

population (age adjusted), moving away from the 

2010 target of 4.8 per 100,000. Health disparities 

were observed for a number of population groups, for 

example:

 Among racial and ethnic groups, the nonHispanic black population had the lowest (best) 

suicide rate, 5.1 per 100,000 population (age 

adjusted) in 2007. The rates for the American 

Indian or Alaska Native and the non-Hispanic 

white populations were 11.5 and 13.5 per 100,000 

(age adjusted), respectively. The rate for the 

American Indian or Alaska Native population 

was almost two and a half times the best rate 

(that for the non-Hispanic black population), 

whereas the rate for the non-Hispanic white 

population was more than two and a half times 

the best rate [2].

 The non-Hispanic white population had 

suicide rates of 12.0 per 100,000 population 

(age adjusted) in 1999 and 13.5 in 2007, whereas 

the non-Hispanic black population had rates 

of 5.7 in 1999 and 5.1 in 2007. The disparity 

between the non-Hispanic white and nonHispanic black populations increased 54 

percentage points between 1999 and 2007 [3].

 Females had a lower (better) suicide rate than 

males, 4.7 per 100,000 population (age adjusted) 

in 2007. The rate for males was 18.4 per 100,000 

(age adjusted), almost four times the rate for 

females [2].

 Males had suicide rates of 17.8 per 100,000 

population (age adjusted) in 1999 and 18.4 in 

2007, whereas females had rates of 4.0 in 1999 

and 4.7 in 2007. The disparity between males 

and females declined 53 percentage points 

between 1999 and 2007 [3].

 Among education groups, persons with at least 

some college education had the lowest (best) 

suicide rate, 9.9 per 100,000 population (age 

adjusted) in 2002, whereas high school graduates 

had a rate of 18.4 per 100,000 (age adjusted), 

almost twice the best group rate [2].

Injury and Violence

Progress for this LHI topic was mixed:

〉 Motor vehicle crash deaths per 100,000 population 

(objective 15-15a) declined 6.1% between 1999 and 

2007, from 14.7 to 13.8 (age adjusted), moving toward 

the 2010 target of 8.0.

 Among racial and ethnic groups, the combined 

Asian or Pacific Islander population had the 

lowest (best) rate of motor vehicle crash deaths, 

7.0 per 100,000 population (age adjusted) in 

2007. The American Indian or Alaska Native, 

non-Hispanic black, and non-Hispanic white 

populations had rates of 22.5, 14.1, and 14.2 per 

100,000 (age adjusted), respectively. The rate for 

the American Indian or Alaska Native population 

was more than three times the best rate (that 

for the Asian or Pacific Islander population). 

The rates for the non-Hispanic black and nonHispanic white populations were about twice the 

best rate [2].

 Females had a lower (better) motor vehicle crash 

death rate than males, 7.9 per 100,000 population 

(age adjusted) in 2007. The rate for males, 19.9 per 

100,000 (age adjusted), was approximately two 

and a half times that for females [2].

 Among education groups, persons aged 25–64 

with at least some college education had the 

lowest (best) rate of motor vehicle crash deaths, 

8.4 per 100,000 population (age adjusted) in 2002. 

High school graduates and persons with less 

than a high school education had rates of 22.3 

and 26.0 per 100,000 (age adjusted), respectively. 

The rate for high school graduates was more than 

two and a half times the best group rate, whereas 

the rate for persons with less than a high school 

education was more than three times the best 

group rate [2].

〉 The homicide rate (objective 15-32) did not change 

significantly over the decade. In 1999, the baseline 

year for this objective, the homicide rate was 6.0 per 

100,000 population (age adjusted), compared with a 

rate of 6.1 in 2007 [1].

 Among racial and ethnic groups, the combined 

Asian or Pacific Islander population had the 

lowest (best) rate of deaths from homicide, 2.3 

per 100,000 population (age adjusted) in 2007. 

The rates for the American Indian or Alaska 

Native, Hispanic or Latino, and non-Hispanic 

black populations were 6.5, 6.9, and 21.8 per 

100,000 (age adjusted), respectively. The rate for 

the American Indian or Alaska Native population 

was almost three times the best rate (that for 

the Asian or Pacific Islander population). The 

rate for the Hispanic or Latino population was 

three times the best rate, and the rate for the 
LHI-6 HEALTHY PEOPLE 2010 FINAL REVIEW

non-Hispanic black population was about nine 

and a half times the best rate [2].

 The non-Hispanic white population had the 

lowest (best) rate of deaths from homicide at 

baseline, 2.9 deaths per 100.000 (age adjusted) 

in 1999, whereas the combined Asian or Pacific 

Islander population had the best rate at the most 

recent data point, 2.3 per 100,000 (age adjusted) 

in 2007. The non-Hispanic black population had 

rates of 20.7 and 21.8 per 100,000 (age adjusted) 

in 1999 and 2007, respectively. Between 1999 and 

2007, the disparity between the non-Hispanic 

black population and the group with the best rate 

increased 234 percentage points [3].

 Females had a lower (better) homicide rate than 

males, 2.5 per 100,000 population (age adjusted) 

in 2007. The rate for males was 9.6 per 100,000 

(age adjusted), nearly four times the rate for 

females [2].

 Among education groups, persons aged 25–64 

with at least some college education had the 

lowest (best) rate of deaths from homicide, 2.6 

per 100,000 population (age adjusted) in 2002. 

The rates for high school graduates and persons 

with less than a high school education were 10.5 

and 16.0 per 100,000 (age adjusted), respectively. 

High school graduates had a rate that was 

approximately four times the best group rate 

(that for persons aged 25–64 with at least some 

college education); the rate for persons with less 

than a high school education was more than six 

times the best group rate [2].

Environmental Quality

There was substantial progress for this LHI topic. Two 

of the three environmental quality objectives exceeded 

their 2010 targets:

〉 The proportion of people living in counties that 

exceeded National Ambient Air Quality Standards 

(NAAQS) for ozone (objective 8-1a) declined 25% 

between 1997 and 2010, from 43% to 36%, moving 

toward the 2010 target of 0%. However, the final year 

for which data were available by race and ethnicity 

was 2004 and, at that time, disparities were observed 

for a number of population groups:

 Among racial and ethnic groups, the American 

Indian or Alaska Native population had the 

lowest (best) rate of living in counties that 

exceeded NAAQS for ozone (objective 8-1a), 23% 

in 2004, whereas the non-Hispanic white, Native 

Hawaiian or Other Pacific Islander, non-Hispanic 

black, Hispanic or Latino, and Asian populations 

had rates of 33%, 35%, 43%, 59%, and 67%, 

respectively.

 The rate for the non-Hispanic white population 

was almost one and a half times the best rate 

(that for the American Indian or Alaska Native 

population); the rate for the Native Hawaiian 

or Other Pacific Islander population was about 

one and a half times the best rate; the rate for 

the non-Hispanic black population was almost 

twice the best rate; the rate for the Hispanic or 

Latino population was more than two and a half 

times the best rate; and the rate for the Asian 

population was nearly three times the best rate 

[2].

 The rural or nonmetropolitan population had 

better rates of exposure to ozone (4% in 1997 

and 3% in 2004) than the urban or metropolitan 

population (52% in 1997 and 48% in 2004). In 

2004, the rate for the urban or metropolitan 

population was 16 times as high as the rate for the 

rural or nonmetropolitan population. Between 

1997 and 2004, the disparity in ozone exposure 

between the rural/nonmetropolitan and the 

urban/metropolitan populations increased 300 

percentage points [3].

〉 The percentage of children aged 6 years and under 

exposed to tobacco smoke at home (objective 27-9) 

decreased 70.4% between 1994 and 2005, from 27% 

to 8%, exceeding the 2010 target of 10%. However, 

disparities were observed among a number of 

population groups, for example:

 Among income groups, children aged six 

years and under living in middle/high-income 

households had the lowest (best) rates of exposure 

to tobacco smoke at home, 5% in 2005, whereas 

children living in poor or near-poor households 

had rates of 15% and 12%, respectively. The rate 

for children living in poor households was three 

times the best group rate, whereas the rate for 

children living in near-poor households was 

almost two and a half times the best group rate 

[2].

 Children living in poor households had rates of 

exposure to tobacco smoke of 38% in 1994 and 

15% in 2005; those living in near-poor households 

had rates of 33% in 1994 and 12% in 2005; 

whereas those living in middle/high-income 

households had rates of 19% in 1994 and 5% in 

2005. The disparity between children living in 

poor households and those living in middle/highincome households increased 100 percentage 

points between 1994 and 2005. During the same 

period, the disparity between children living in 

near-poor households and those living in middle/

high-income households increased 66 percentage 

points [3].

〉 The percentage of nonsmokers aged 4 years and over 

exposed to environmental tobacco smoke (objective 
Leading Health Indicators LHI-7

27-10) declined 51.2% from 1988–94 to 2005–08, from 

84% to 41% (age adjusted), exceeding the 2010 target 

of 56%.

Immunization

Progress was observed for the three objectives 

monitoring this LHI topic:

〉 The proportion of young children aged 19–35 

months who were fully immunized (objective 14-24a) 

increased 6.8% between 1998 and 2008, from 73% to 

78%, moving toward the 2010 target of 80%.

〉 Vaccination of noninstitutionalized high risk persons 

aged 65 and over for influenza and pneumonia both 

increased between 1998 and 2008, moving toward 

the 2010 targets of 90%. The proportion who had 

received an influenza vaccination in the past 12 

months (objective 14-29a) increased 4.7%, from 64% 

to 67%, and the proportion who had ever received 

a pneumococcal vaccination (objective 14-29b) 

increased 30.4%, from 46% to 60% over the tracking 

period.

Access to Health Care

Progress for this LHI topic was mixed:

〉 Rates of persons with health insurance (objective 

1-1) did not change over the decade. As in 1997, 

the baseline year for this objective, 83% of the U.S. 

population under age 65 had health insurance 

coverage in 2008. Disparities were observed for a 

number of population groups, for example:

 Among racial and ethnic groups, the nonHispanic white population had the highest (best) 

rate of health insurance coverage, 88% in 2008, 

whereas the American Indian or Alaska Native 

population and the Hispanic or Latino population 

had rates of 72% and 67%, respectively. When 

expressed as persons without health insurance, 

the rate for the American Indian or Alaska Native 

population was more than twice the best rate 

(that for the non-Hispanic white population). The 

rate for the Hispanic or Latino population was 

nearly three times the best rate [2].

 The American Indian or Alaska Native 

population had health insurance coverage rates 

of 62% in 1999 and 72% in 2008, whereas the 

non-Hispanic white population had a rate of 88% 

in both 1999 in 2008. When rates are expressed 

in terms of persons without health insurance, 

the disparity between the American Indian or 

Alaska Native population and the non-Hispanic 

white population decreased 83 percentage points 

between 1999 and 2008 [2,3].

 Among income groups, the middle/high-income 

population had the highest (best) rate of health 

insurance coverage, 89% in 2008, whereas the 

poor and near-poor populations had rates of 

71% and 69%, respectively. When expressed as 

persons without health insurance, the rate for the 

poor population was more than two and a half 

times the best rate (that for the middle/highincome population). The rate for the near-poor 

population was almost three times the best rate 

[2]. 

 The poor population had health insurance 

coverage rates of 66% in 1997 and 71% in 2008, 

whereas the middle/high-income population 

had rates of 90% in 1997 and 89% in 2008. When 

rates are expressed in terms of persons without 

health insurance, the disparity between the 

poor population and the middle/high-income 

population decreased 76 percentage points 

between 1997 and 2008 [2,3].

〉 The proportion of persons with a source of ongoing 

care (objective 1-4a) declined 1.1% between 1998 and 

2008, from 87% to 86%, moving away from the 2010 

target of 96%.

 Among racial and ethnic groups, the nonHispanic white population had the highest (best) 

rate, 89% in 2008, whereas the Hispanic or Latino 

population had a rate of 77%. When expressed as 

persons without a specific source of ongoing care, 

the rate for the Hispanic or Latino population 

was more than twice the best rate [2].

 Among income groups, the middle/high-income 

population had the highest rate, 90% in 2008, 

whereas the poor and near-poor populations 

had rates of 78% and 80%, respectively. When 

expressed as persons without a specific source of 

ongoing care, the rates for the poor and near-poor 

populations were about twice the best rate [2].

〉 Hospitalizations for pediatric asthma (objective 1-9a) 

declined 35.2% between 1996 and 2008, from 23.0 to 

14.9 admissions per 100,000 population aged under 

18 years, exceeding the 2010 target of 17.3 admissions 

per 100,000 population.

〉 The proportion of pregnant women who began 

prenatal care in the first trimester (objective 16-6a) 

increased 1.2% between 1998 and 2002, from 83% to 

84%, moving toward the 2010 target of 90%.

 Non-Hispanic white women had the highest 

(best) rate of prenatal care among racial and 

ethnic populations, 89% in 2002, whereas the 

American Indian or Alaska Native, Hispanic 

or Latino, and non-Hispanic black women had 

rates of 70%, 77%, and 75%, respectively. When 

expressed as women not receiving prenatal care, 

the rates for American Indian or Alaska Native, 
LHI-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Hispanic or Latino, and non-Hispanic black 

women were more than twice the best rate (that 

for non-Hispanic white women) [2].

 Women aged 20 and over with at least some 

college education had the best rate of prenatal 

care among education groups, 92% in 2002, 

whereas high school graduates and women with 

less than a high school education had rates of 

83% and 72%, respectively, among women aged 

20 and over. When expressed as women aged 20 

and over not receiving prenatal care, the rate for 

high school graduates was more than twice the 

best rate; and the rate for women with less than a 

high school education was three and a half times 

the best rate [2].

Summary of Progress

〉 Figure LHI-1 presents a quantitative assessment 

of progress [1] in achieving the Healthy People 

2010 LHIs. Data to measure progress toward target 

attainment were available for 27 objectives. Of these:

 Three objectives exceeded their Healthy People 

2010 targets (objectives 1-9a, 27-9, and 27-10).

 Fourteen objectives moved toward their targets. 

A statistically significant difference between the 

baseline and the final data points was observed 

for eight of these objectives (14-24a, 14-29a and 

b, 15-15a, 16-6a, 26-10a, 27-1a, and 27-2b). No 

significant difference was observed for one 

objective (22-7); and data to test the significance 

of the difference were unavailable for five 

objectives (8-1a, 13-6a and b, and 25-11a and c).

 Three objectives showed no change (objectives 

1-1, 22-2, and 26-10c).

 Seven objectives moved away from their targets. 

A statistically significant difference between 

the baseline and final data points was observed 

for four of these objectives (1-4a, 18-1, 19-2, and 

19-3c). No significant differences were observed 

for two objectives (15-32 and 26-11c); and data 

to test the significance of the difference were 

unavailable for one objective (25-11b).

〉 One objective had no follow-up data available to 

measure progress (objective 18-9b).

〉 Figure LHI-2 displays health disparities [2] for the 

LHIs from the best group rate for each characteristic 

at the most recent data point. It also displays changes 

in disparities from the baseline to the most recent 

data point [3].

 Twenty-four objectives had statistically significant racial and ethnic health disparities of 10% 

or more. In addition, one objective had racial 

and ethnic health disparities of 10% or more but 

lacked data to assess statistical significance. 

Of these 25 objectives, the non-Hispanic white 

population had the best rate for 12 objectives (1-1, 

1-4a, 14-29a and b, 16-6a, 18-9b, 19-2, 22-2, 22-7, 

25-11a and c, and 27-9). The non-Hispanic black 

population had the best rate for 6 objectives 

(13-6a and b, 18-1, 26-10a, 26-11c, and 27-2b); 

the Hispanic or Latino population had the best 

rate for 3 objectives (26-10c, 27-1a, and 27-10); the 

combined Asian or Pacific Islander population 

had the best rate for 2 objectives (15-15a and 

15-32); the American Indian or Alaska Native 

population had the best rate for 1 objective (8-1a); 

and persons of two or more races had the best 

rate for 1 objective (14-24a).

 Females had better rates for 12 of the 14 objectives 

with statistically significant health disparities 

of 10% or more by sex (objectives 1-1, 1-4a, 1-9a, 

14-29b, 15-15a, 15-32, 18-1, 18-9b, 26-10c, 26-11c, 

27-1a, and 27-10). Males had better rates for the 

remaining 2 objectives (22-7 and 25-11c).

 Persons with at least some college education had 

the best rate for all 12 objectives with statistically 

significant health disparities of 10% or more by 

education (objectives 13-6a and b, 14-29a and b, 

15-15a, 15-32, 16-16a, 18-1, 22-2, 26-10c, 27-1a, and 

27-10).

 Persons with middle/high incomes had the 

best rate for seven of the nine objectives with 

statistically significant health disparities of 10% 

or more by income (objectives 1-1, 1-4a, 13-6a, 

19-2, 19-3c, 27-1a, and 27-9). Near-poor and poor 

persons had the best rate for one objective each 

(14-24a and 26-10a, respectively) 

 One objective had a statistically significant 

health disparity of 10% or more by geographic 

location and one had a health disparity of 10% 

or more by geographic location but lacked data 

to assess statistical significance. Persons living 

in urban or metropolitan areas had a better rate 

for one (objective 1-1), whereas persons living in 

rural or nonmetropolitan areas had a better rate 

for the other (objective 8-1a).

 Eight objectives had statistically significant 

health disparities of 10% or more by disability 

status. Persons with disabilities (objectives 

1-1, 1-4a, and 14-29a and b) and those without 

disabilities (objectives 13-6a, 19-2, 22-2, 27-1a) 

each had the best rate for the four of these 

objectives.

 Health disparities of 100% or more were observed 

for some objectives among racial and ethnic 

populations, as well as by sex, education level, 

income, and geographic location. Changes in 

disparities of 50 percentage points or more 

between the baseline and most recent data points 

also were observed. Many of these disparities are 

discussed in the Highlights, above.
Leading Health Indicators LHI-9

Transition to Healthy People 

2020

Moving from Healthy People 2010 (HP2010) to Healthy 

People 2020 (HP2020), the Leading Health Indicators 

(LHIs) have evolved to reflect the most recent federal 

policy recommendations, as well as a greater emphasis 

in HP2020 on the determinants of health. The differences 

between the HP2010 LHIs and the HP2020 LHIs are 

summarized below. 

More detailed information about the HP2020 LHIs can 

be found at the HP2020 website, available from http://

www.healthypeople.gov. 

〉 There are 12 HP2020 LHI topics, monitored through 

26 HP2020 LHIs. In comparison, the 10 HP2010 LHI 

topics were monitored through 28 HP2010 LHIs. This 

set of 28 includes the original 22 LHIs introduced at 

the launch of HP2010, as well as 6 supplemental LHIs 

which were added later. 

〉 The HP2010 LHI topics ‘Physical Activity’ and 

‘Overweight and Obesity’ were combined and 

expanded to form the HP2020 LHI topic ‘Nutrition, 

Physical Activity, and Obesity.’

 The objectives on obesity among adults 

(HP2010 objective 19-2) and among children 

and adolescents (HP2010 objective 19-3c) were 

retained as LHIs (HP2020 objectives NWS-9 and 

NWS-10.4, respectively). However, the age range 

for children and adolescents was changed from 

6–19 years in HP2010 to 2–19 years in HP2020.

 The objective on moderate physical activity 

among adults (HP2010 objective 22-2) was 

modified to reflect new physical activity 

guidelines (HP2020 objective PA-2.4) and 

retained as an LHI [4].

 The objective on rigorous physical activity 

among adolescents (HP2010 objective 22-7) was 

not retained as an LHI.

 An objective on vegetable consumption was 

added as an LHI (HP2020 objective NWS-15.1).

〉 The HP2010 LHI topic ‘Tobacco Use’ was renamed 

‘Tobacco’ in the HP2020 LHIs.

 The objectives on cigarette smoking among 

adults (HP2010 objective 27-1a) and adolescents 

(HP2010 objective 27-2b) were retained 

unmodified as LHIs (HP2020 objectives TU-1.1 

and TU-2.2, respectively) [4].

〉 The HP2010 LHI topic ‘Substance Abuse’ is also 

included in the HP2020 LHIs.

 The objective on adult binge drinking in the past 

month (HP2010 objective 26-11c) was modified 

to reflect a new definition for women (HP2020 

objective SA-14.3) and retained as an LHI. 

 The objective on adult illicit drug use in the 

past 30 days (HP2010 objective 26-10c) was not 

retained as an LHI. 

 The objective on adolescents not using alcohol or 

illicit drugs in the past 30 days (HP2010 objective 

26-10a) was modified to measure adolescents 

using alcohol or illicit drugs in the past 30 days 

(HP2020 objective SA-13.1) and retained as an 

LHI.

〉 The HP2010 LHI topic ‘Responsible Sexual Behavior’ 

was renamed ‘Reproductive and Sexual Health’ in 

the HP2020 LHIs.

 All five objectives (HP2010 objectives 13-6a and b, 

and 25-11a through c) were not retained as LHIs; 

instead, the proportion of sexually active females 

who received reproductive health services 

(HP2020 objective FP-7.1) was added as an LHI.

 A new objective on persons with HIV who know 

their serostatus (HP2020 objective HIV-13) was 

added as an LHI.

〉 The HP2010 LHI topic ‘Mental Health’ is also included 

in the HP2020 LHIs.

 The objective on suicide (HP2010 objective 18-1) 

was retained unmodified as an LHI (HP2020 

objective MHMD-1).

 The objective on treatment for adults with 

depression (HP2010 objective 18-9b) was not 

retained as an LHI.

 An objective on adolescents who experience 

major depressive episodes (HP2020 objective 

MHMD-4.1) was added as an LHI.

〉 The HP2010 LHI topic ‘Injury and Violence’ is also 

included in the HP2020 LHIs.

 The objective on homicides (HP2010 objective 15-

32) was retained unmodified as an LHI (HP2020 

objective IVP-29).

 The objective on deaths from motor vehicle 

crashes (HP2010 objective 15-15a) was not 

retained as an LHI.

 An objective on fatal injuries (HP2020 objective 

IVP-1.1) was added as an LHI.

〉 The HP2010 LHI topic ‘Environmental Quality’ is 

also included in the HP2020 LHIs.

 The objectives on exposure to ozone (HP2010 

objective 8-1a) and secondhand smoke (HP2010 

objective 27-10) were modified and retained as 

LHIs. The objective on exposure to ozone was 

modified and expanded to reflect new air quality 

guidelines (HP2020 objective EH-1), and the 
LHI-10 HEALTHY PEOPLE 2010 FINAL REVIEW

objective on secondhand smoke is now restricted 

to children aged 3–11 years (HP2020 objective 

TU-11.1) instead of ages 4 years and over.

 The objective on exposure to tobacco smoke at 

home among children (HP2010 objective 27-9) 

was not retained as an LHI.

〉 The HP2010 LHI topic ‘Immunization’ was expanded 

to form the HP2020 LHI topic ‘Clinical Preventive 

Services.’

 The objective on fully immunized young 

children (HP2010 objective 14-24a) was modified 

to reflect new immunization guidelines (HP2020 

objective IID-8) and retained as an LHI. 

 The two objectives on immunization of 

noninstitutionalized high-risk older adults 

(HP2010 objectives 14-29a and b) were not 

retained as LHIs.

 Objectives on colorectal cancer screening 

(HP2020 objective C-16), adults with hypertension who have their blood pressure under 

control (HP2020 objective HDS-12), and adults 

with diabetes with uncontrolled glycemia 

(HP2020 objective D-5.1) were added as LHIs.

〉 The HP2010 LHI topic ‘Access to Health Care’ was 

renamed ‘Access to Health Services’ in the HP2020 

LHIs.

 The objective on medical insurance (HP2010 

objective 1-1) was retained unmodified as an 

LHI (HP2020 objective AHS-1.1), though it was 

referred to as health insurance in Healthy People 

2010.

 The objectives on hospitalization for pediatric 

asthma (HP2010 objective 1-9a) and prenatal 

care beginning first trimester (objective 16-6a) 

were not retained as LHIs.

 The objective on source of ongoing care (HP2010 

objective 1-4a) was not retained as an LHI; 

instead, the objective on persons with a usual 

primary care provider (HP2020 objective AHS-3) 

was added as an LHI.

〉 There are three new LHI topics in HP2020, resulting 

in four new LHIs.

 ‘Maternal, Infant, and Child Health’ is monitored 

through two objectives: infant mortality (HP2020 

objective MICH-1.3) and preterm births (HP2020 

objective MICH-9.1).

 ‘Oral Health’ is monitored through one objective 

on persons who used the oral health care system 

in the past year (HP2020 objective OH-7).

 ‘Social Determinants’ is monitored through one 

objective on students who graduate with a regular 

diploma 4 years after starting 9th grade (HP2020 

objective AH-5.1).

Table LHI-1, “A Crosswalk Between the Healthy 

People 2010 and Healthy People 2020 Leading Health 

Indicators,” summarizes the Healthy People 2010 LHIs 

and the Healthy People 2020 LHIs as well as changes 

between the two sets of indicators.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes all changes between the two decades of objectives.
Leading Health Indicators LHI-11

Table LHI-1. A Crosswalk Between the Healthy People 2010 and 

Healthy People 2020 Leading Health Indicators

Healthy People 2010 Leading Health Indicators Healthy People 2020 Leading Health Indicators Change Between Sets

Physical 

Activity

22-2. Regular physical activity—

Moderate or vigorous (age adjusted, 

18+ years)

Nutrition, 

Physical 

Activity, and 

Obesity

PA-2.4. Adults meeting objectives 

for aerobic physical activity and for 

muscle-strengthening activity (18+ 

years)

Retained as an LHI 

and modified to reflect 

new physical activity 

guidelines

22-7. Vigorous physical activity in 

students (grades 9–12)

Not a Healthy People 2020 LHI Not retained as an LHI 

Overweight 

and Obesity

19-2. Obesity in adults (age adjusted, 

20+ years)

NWS-9. Obesity in adults (age adjusted, 

20+ years) 

Retained unmodified as 

an LHI 

19-3c. Obesity in children and 

adolescents (6–19 years)

NWS-10.4. Obesity in children and 

adolescents (2–19 years)

Retained as an LHI with 

modified age range

Not a Healthy People 2010 LHI NWS-15.1. Contribution of total 

vegetables to diets (2+ years)

New LHI 

Tobacco Use 27-1a. Cigarette use by adults (age 

adjusted, 18+ years)

Tobacco TU-1.1. Cigarette use by adults (age 

adjusted, 18+ years)

Retained unmodified as 

an LHI 

27-2b. Cigarette use in past month by 

students (grades 9–12)

TU-2.2. Cigarette use in past month by 

students (grades 9–12)

Retained unmodified as 

an LHI 

Substance 

Abuse

26-10a. Adolescents not using alcohol 

or illicit drugs in past 30 days (12–17 

years)

Substance 

Abuse

SA-13.1. Adolescents using alcohol 

or illicit drugs in past 30 days (12–17 

years)

Retained as an LHI and 

modified to measure 

converse

26-10c. Adults using illicit drugs in past 

30 days (18+ years)

Not a Healthy People 2020 LHI Not retained as an LHI 

26-11c. Adults binge drinking in the 

past month (18+ years)

SA-14.3. Adults binge drinking in the 

past month (18+ years)

Retained as an LHI and 

modified to reflect new 

definition for women

Responsible 

Sexual 

Behavior

13-6a. Condom use among sexually 

active unmarried persons—females 

(18–44 years)

Reproductive 

and Sexual 

Health

Not a Healthy People 2020 LHI Not retained as an LHI 

13-6b. Condom use among sexually 

active unmarried persons—males 

(18–44 years)

Not a Healthy People 2020 LHI Not retained as an LHI 

25-11a. Students who never had sexual 

intercourse (grades 9–12)

Not a Healthy People 2020 LHI Not retained as an LHI 

25-11b. Students who had sexual 

intercourse, but not in the past 3 

months (grades 9–12)

Not a Healthy People 2020 LHI Not retained as an LHI 

25-11c. Students who used condoms at 

last intercourse (grades 9–12)

Not a Healthy People 2020 LHI Not retained as an LHI 

Not a Healthy People 2010 LHI FP-7.1. Sexually active females who 

receive reproductive health services 

(15–44 years)

New LHI 

Not a Healthy People 2010 LHI HIV-13. Persons with HIV who know 

their serostatus (13+ years)

New LHI 
LHI-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Healthy People 2010 Leading Health Indicators Healthy People 2020 Leading Health Indicators Change Between Sets

Mental 

Health

18-1. Suicide (age adjusted, per 

100,000 population)

Mental 

Health

MHMD-1. Suicide (age adjusted, per 

100,000 population)

Retained unmodified as 

an LHI 

18-9b. Treatment for adults with 

depression (18+ years)

Not a Healthy People 2020 LHI Not retained as an LHI 

Not a Healthy People 2010 LHI MHMD-4.1. Adolescents who 

experience major depressive episodes 

(MDE) (12–17 years)

New LHI 

Injury and 

Violence

15-15a. Deaths from motor vehicle 

crashes (age adjusted, per 100,000 

population)

Injury and 

Violence

Not a Healthy People 2020 LHI Not retained as an LHI 

15-32. Homicides (age adjusted, per 

100,000 population)

IVP-29. Homicides (age adjusted, per 

100,000 population)

Retained unmodified as 

an LHI 

Not a Healthy People 2010 LHI IVP-1.1. Fatal injuries (age adjusted, per 

100,000 population)

New LHI 

Environmental 

Quality

8-1. Percent of persons exposed to 

ozone

Environmental 

Quality

EH-1. Number of days the Air Quality 

Index (AQI) exceeds 100

Retained as an LHI and 

modified to reflect new 

air quality guidelines

27-9. Exposure to tobacco smoke at 

home among children (≤6 years)

Not a Healthy People 2020 LHI Not retained as an LHI 

27-10. Exposure to environmental 

tobacco smoke among nonsmokers 

(age adjusted, 4+ years)

TU-11.1 Children exposed to 

secondhand smoke (3–11 years)

Retained as an LHI 

and modified to reflect 

new age range and 

secondhand smoke 

guidelines

Immunization 14-24a. Fully immunized young children 

(19–35 months)

Clinical 

Preventive 

Services

14-24a. Fully immunized young children 

(19–35 months)

Retained as an LHI and 

modified to reflect new 

immunization guidelines

14-29a. Vaccination of 

noninstitutionalized high-risk older 

adults—Influenza vaccine in past 12 

months (age adjusted, 65+ years)

Not a Healthy People 2020 LHI Not retained as an LHI 

14-29b. Vaccination of 

noninstitutionalized high-risk older 

adults—Pneumococcal vaccine ever 

received (age adjusted, 65+ years)

Not a Healthy People 2020 LHI Not retained as an LHI 

Not a Healthy People 2010 LHI C-16. Colorectal cancer screening 

based on most recent guidelines 

(50–75 years)

New LHI 

Not a Healthy People 2010 LHI HDS-12. Adults with hypertension 

whose blood pressure is under control 

(18+ years)

New LHI 

Not a Healthy People 2010 LHI D-5.1. Diabetic population with an A1c 

value greater than 9 percent

New LHI 

Table LHI-1. A Crosswalk Between the Healthy People 2010 and Healthy People 2020 Leading Health 

Indicators (continued)
Leading Health Indicators LHI-13

Table LHI-1. A Crosswalk Between the Healthy People 2010 and Healthy People 2020 Leading Health 

Indicators (continued)

Healthy People 2010 Leading Health Indicators Healthy People 2020 Leading Health Indicators Change Between Sets

Access to 

Health Care

1-1. Persons with health insurance 

(<65 years)

Access 

to Health 

Services

AHS-1.1. Persons with medical 

insurance (<65 years)

Retained unmodified as 

an LHI 

1-4a. Source of ongoing care AHS-3. Persons with a usual primary 

care provider

Changed to an alternate 

objective

1-9a. Hospitalization for pediatric 

asthma (admissions per 10,000 

population, <18 years)

Not a Healthy People 2020 LHI Not retained as an LHI 

16-6a. Prenatal care beginning in first 

trimester

Not a Healthy People 2020 LHI Not retained as an LHI 

Not a Healthy People 2010 LHI Maternal, 

Infant, and 

Child Health

MICH-1.3. Infant deaths (<1 year, per 

1,000 live births)

New LHI 

MICH-9.1. Preterm births New LHI 

Not a Healthy People 2010 LHI Oral Health OH-7. Persons who used the oral health 

care system in the past year (2+ years)

New LHI 

Not a Healthy People 2010 LHI Social 

Determinants

AH-5.1. Students who graduate with a 

regular diploma 4 years after starting 

9th grade.

New LHI 

Data Considerations

Beginning in 2003, education data for the mortality 

objectives 15-15a (motor vehicle crash deaths), 15-32 

(homicides), and 18-1 (suicide), and the natality objective 

16-6a (prenatal care), from the National Vital Statistics 

System, were suppressed. The educational attainment 

item was changed in the new U.S. Standard Certificates of 

Birth and Death in 2003 to be consistent with the Census 

Bureau data and to improve the ability to identify specific 

types of educational degrees. Many states, however, 

are still using the 1989 version of the U.S. Standard 

Certificate of Death, which focuses on highest school 

grade completed. As a result, educational attainment 

data collected using the 2003 version are not comparable 

with data collected using the 1989 version [5].

Data for objective 16-6a (early prenatal care) were based 

upon the information recorded on birth certificates and 

also collected by States and local vital records offices. 

Due to the desire to produce more robust information, 

the 2003 revision of the standard birth certificate 

introduced improved standards which produce noncomparable rates [6,7]. For Healthy People 2010, data 

obtained from the 1997 version of the standard birth 

certificate was used from baseline through 2002 to track 

this objective.

The data label used for objective 19-3c “overweight or 

obesity” in children and adolescents was revised since 

the Healthy People 2010 Midcourse Review and progress 

reviews to “obesity” even though the definition (BMI at 

or above the sex- and age-specific 95th percentile from 

the 2000 CDC Growth Charts) and interpretation are 

still the same. This change is consistent with revisions 

made by the American Academy of Pediatrics, the 

Institute of Medicine, and other organizations. Strictly 

speaking, overweight refers to weight in excess of a 

weight standard which could be due to a greater lean 

body mass, and obesity refers to excess body fatness. 

Because the indexes used are based on body mass rather 

than fatness, the original terminology of “overweight” 

for children at or above the 95th percentile was intended 

to clarify that this cut-off point should not be used 

as diagnostic criteria. Rather, these children may or 

may not have excess body fat and should, therefore, 

be screened for obesity. However, because body fat is 

difficult to measure and the majority of children with 

BMI at or above the 95th percentile have high adiposity, 

on a population-wide basis, high weight-for-height can 

be considered as an adequate indicator of obesity [8].

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 
LHI-14 HEALTHY PEOPLE 2010 FINAL REVIEW

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can 

be found in the Operational Definitions on the 

DATA2010 website, available from http://wonder.cdc.

gov/data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010.

References and Notes

1. Displayed in the Progress Chart (Figure LHI-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline 

and the final value was tested at the 0.05 level of 

significance. See the Figure LHI-1 footnotes, as well 

as the Technical Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure LHI-2). Disparity from the best group rate 

is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without 

health insurance (e.g., 100% – 72% = 28% of the 

American Indian or Alaska Native population under 

age 65 did not have any form of health insurance 

in 2008) when the disparity from the best group 

rate is calculated. See the Reader’s Guide for more 

information. When standard errors were available, 

the difference between the best group rate and each 

of the other group rates was tested at the 0.05 level of 

significance. See the Figure LHI-2 footnotes, as well 

as the Technical Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure LHI-2 footnotes, as well 

as the Technical Appendix, for more detail.

4. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were modified from Healthy 
Leading Health Indicators LHI-15

People 2010 had some change in the numerator 

or denominator definitions, the data source(s), or 

data collection methodology. Healthy People 2020 

objectives that were unmodified had no change in 

the numerator or denominator definitions, the data 

source(s), or data collection methodology.

5. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. 

Deaths: Final data for 2007. National vital statistics 

reports; vol 58 no 19. Hyattsville, MD: National Center 

for Health Statistics. 2010. Available from: http://

www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf.

6. Ogden CL, Flegal KM. Changes in terminology for 

childhood overweight and obesity. National health 

statistics reports; no 25. Hyattsville, MD: National 

Center for Health Statistics. 2010. Available from: 

http://www.cdc.gov/nchs/data/nhsr/nhsr025.pdf.

7. National Center for Health Statistics. 2003 revision 

of the U.S. Standard Certificate of Live Birth. 2003. 

Available from: http://www.cdc.gov/nchs/nvss/vital_

certificate_revisions.htm. 

8. National Center for Health Statistics. Report of the 

panel to evaluate the U.S. Standard Certificates and 

Reports. National Center for Health Statistics. 2000. 

Available from: http://www.cdc.gov/nchs/data/dvs/

panelreport_acc.pdf.

Comprehensive Summary of Objectives: Leading Health Indicators

Objective Description Data Source

1-1 Persons with health insurance (<65 years) National Health Interview Survey (NHIS), CDC, NCHS.

1-4a Source of ongoing care National Health Interview Survey (NHIS), CDC, NCHS.

1-9a Hospitalization for pediatric asthma (admissions per 10,000 

population, <18 years)

Healthcare Cost and Utilization Project (HCUP), AHRQ.

8-1a Percent of persons exposed to harmful air pollutants—Ozone Air Quality System (AQS), Environmental Protection Agency (EPA).

13-6a Condom use among sexually active unmarried persons 

(18–44 years)—Females

National Survey of Family Growth (NSFG), CDC, NCHS.

13-6b Condom use among sexually active unmarried persons 

(18–44 years)—Males

National Survey of Family Growth (NSFG), CDC, NCHS.

14-24a Fully immunized young children 19–35 months National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

14-29a Vaccination of noninstitutionalized high-risk older adults—

Influenza vaccine in past 12 months (age adjusted, 65+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

14-29b Vaccination of noninstitutionalized high-risk older adults—

Pneumococcal vaccine ever received (age adjusted, 65+ 

years)

National Health Interview Survey (NHIS), CDC, NCHS.

15-15a Deaths from motor vehicle crashes—Age adjusted, per 

100,000 population

National Vital Statistics System—Mortality (NVSS–M), CDC, NCHS.

15-32 Homicides (age adjusted, per 100,000 population) National Vital Statistics System—Mortality (NVSS–M), CDC, NCHS.

16-6a Prenatal care—Beginning in first trimester National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

18-1 Suicide (age adjusted, per 100,000 population) National Vital Statistics System—Mortality (NVSS–M), CDC, NCHS.

18-9b Treatment for adults with depression (18+ years) National Comorbidity Survey—Replication (NCS–R), NIH, NIMH.

19-2 Obesity in adults (age adjusted, 20+ years) National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

19-3c Obesity in children and adolescents 6–19 years National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

22-2 Regular physical activity—Moderate or vigorous (age 

adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.
LHI-16 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Leading Health Indicators (continued)

Objective Description Data Source

22-7 Vigorous physical activity in students (grades 9–12) Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP. 

25-11a Students who never had sexual intercourse (grades 9–12) Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

25-11b Students who had sexual intercourse, but not in the past 3 

months (grades 9–12)

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

25-11c Students who used condoms at last intercourse (grades 9–12) Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

26-10a Adolescents not using alcohol or illicit drugs in past 30 days 

(12–17 years)

National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-10c Adults using illicit drugs in past 30 days (18+ years) National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-11c Binge drinking in the past month—Adults (18+ years) National Survey on Drug Use and Health (NSDUH), SAMHSA.

27-1a Cigarette use by adults (age adjusted, 18+ years) National Health Interview Survey (NHIS), CDC, NCHS.

27-2b Cigarette use in past month by students (grades 9–12) Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP. 

27-9 Exposure to tobacco smoke at home among children (≤6 

years)

National Health Interview Survey (NHIS), CDC, NCHS.

27-10 Exposure to environmental tobacco smoke among 

nonsmokers (age adjusted, 4+ years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.
Leading Health Indicators LHI-17

Figure LHi-1. Progress toward target attainment for Leading Health indicators

Legend Moved away from target1 Moved toward target Met or exceeded target

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

Physical Activity

22-2. Regular physical activity—Moderate or 

vigorous (age adjusted, 18+ years) 

 0.0% 50% 32%

(1997)

32%

(2008)

0 No 0.0%

22-7. Vigorous physical activity in students 

(grades 9–12)

15.0% 85% 65%

(1999)

68%

(2009)

3 No 4.6%

Overweight and Obesity

19-2. Obesity in adults (age adjusted, 20+ 

years)

15% 23%

(1988–94)

34%

(2005–08)

11 Yes 47.8%

19-3c. Obesity in children and adolescents 

(6–19 years)

5% 11%

(1988–94)

18%

(2005–08)

7 Yes 63.6%

Tobacco Use

27-1a. Cigarette use by adults (age adjusted, 

18+ years)

25.0% 12% 24%

(1998)

21%

(2008)

-3 Yes -12.5%

27-2b. Cigarette use in past month by students 

(grades 9–12)

84.2% 16% 35%

(1999)

19%

(2009)

-16 Yes -45.7%

Substance Abuse

26-10a. Adolescents not using alcohol or illicit 

drugs in past 30 days (12–17 years) 

30.8% 91% 78%

(2002)

82%

(2008)

4 Yes 5.1%

26-10c. Adults using illicit drugs in past 30 days 

(18+ years)

 0.0% 3.2% 7.9%

(2002)

7.9%

(2008)

0.0 No 0.0%

26-11c. Adults binge drinking in the past month 

(18+ years)

13.4% 24.3%

(2002)

24.9%

(2008)

0.6 No 2.5%

Responsible Sexual Behavior

13-6. Condom use among sexually active 

unmarried persons (18–44 years)

a. Females 37.0% 50% 23%

(1995)

33%

(2006–08)

10 Not tested 43.5%

b. Males* 16.7% 54% 42%

(2002)

44%

(2006–08)

2 Not tested 4.8%

25-11a. Students who never had sexual 

intercourse (grades 9–12)

66.7% 56% 50%

(1999)

54%

(2009)

4 Not tested 8.0%

25-11b. Students who had sexual intercourse, but 

not in the past 3 months (grades 9–12)*

30% 27%

(1999)

26%

(2009)

-1 Not tested -3.7%

25-11c. Students who used condoms at last 

intercourse (grades 9–12)*

42.9% 65% 58%

(1999)

61%

(2009)

3 Not tested 5.2%
LHI-18 HEALTHY PEOPLE 2010 FINAL REVIEW

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

Mental Health

18-1. Suicide (age adjusted, per 100,000 

population)*

4.8 10.5

(1999)

11.3

(2007)

0.8 Yes 7.6%

Injury and Violence

15-15a. Deaths from motor vehicle crashes 

(age adjusted, per 100,000 population)

13.4% 8.0 14.7

(1999)

13.8

(2007)

-0.9 Yes -6.1%

15-32. Homicides (age adjusted, per 100,000 

population)

2.8 6.0

(1999)

6.1

(2007)

0.1 No 1.7%

Environmental Quality

8-1a. Percent of persons exposed to ozone 16.3% 0% 43%

(1997)

36%

(2010)

-7 Not tested -16.3%

27-9. Exposure to tobacco smoke at home 

among children (≤6 years)*

111.8% 10% 27%

(1994)

8%

(2005)

-19 Yes -70.4%

27-10. Exposure to environmental tobacco smoke 

among nonsmokers (age adjusted, 

4+ years)

153.6% 56% 84%

(1988–94)

41%

(2005–08)

-43 Yes -51.2%

Immunization

14-24a. Fully immunized young children 

19–35 months

71.4% 80% 73%

(1998)

78%

(2008)

5 Yes 6.8%

14-29. Vaccination of noninstitutionalized highrisk older adults (age adjusted, 65+ years) 

a. Infl uenza vaccine in past 12 months 11.5% 90% 64%

(1998)

67%

(2008)

3 Yes 4.7%

b. Pneumococcal vaccine ever received 31.8% 90% 46%

(1998)

60%

(2008)

14 Yes 30.4%

Access to Health Care

1-1. Persons with health insurance (<65 years) 0.0% 100% 83%

(1997)

83%

(2008)

0 No 0.0%

1-4a. Source of ongoing care 96% 87%

(1998)

86%

(2008)

-1 Yes -1.1%

1-9a. Hospitalization for pediatric asthma 

(admissions per 10,000 population, 

<18 years)*

142.1% 17.3 23.0

(1996)

14.9

(2008)

-8.1 Yes -35.2%

16-6a. Prenatal care beginning in fi rst trimester 14.3% 90% 83%

(1998)

84%

(2002)

1 Yes 1.2%
Leading Health Indicators LHI-19

Figure LHi-1. Progress toward target attainment for Leading Health indicators (continued)

NOTES

See the reader’s guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objective 18-9b.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See technical appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See technical appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

* Supplemental measure. See LHi chapter text for more information.

DATA SOURCES

1-1. National Health Interview Survey (NHIS), CDC, NCHS.

1-4a. National Health Interview Survey (NHIS), CDC, NCHS.

1-9a. Healthcare Cost and Utilization Project (HCUP), AHRQ.

8-1a. Air Quality System (AQS), Environmental Protection Agency (EPA).

13-6a–b. National Survey of Family Growth (NSFG), CDC, NCHS.

14-24a. National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

14-29a–b. National Health Interview Survey (NHIS), CDC, NCHS.

15-15a. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-32. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

16-6a. National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

18-1. National Vital Statistics System—Mortality (NVSS–M), CDC, NCHS.

19-2. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

19-3c. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

22-2. National Health Interview Survey (NHIS), CDC, NCHS.

22-7. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

25-11a–c. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

26-10a. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-10c. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-11c. National Survey on Drug Use and Health (NSDUH), SAMHSA.

27-1a. National Health Interview Survey (NHIS), CDC, NCHS.

27-2b. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

27-9. National Health Interview Survey (NHIS), CDC, NCHS.

27-10. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.
LHI-20 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure LHI-2. Health Disparities Table for Leading Health Indicators

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline to 

the most recent data point.

Race and Ethnicity Sex Education Income Location Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexUrban or metropolitanRural or nonmetropolitanPersons with disabilitiesPersons without disabilities

Physical Activity

22-2. Regular physical activity—Moderate or 

vigorous (age adjusted, 18+ years) 

(1997, 2008)1*

Bi B B B B

22-7. Vigorous physical activity in students 

(grades 9–12) (1999, 2009)* B B

Overweight and Obesity

19-2. Obesity in adults (age adjusted, 20+ years) 

(1988–94, 2005–08)2,3* ii B  B  B B

19-3c. Obesity in children and adolescents 6–19 

years (1988–94, 2005–08)3* ii Bi b B B

Tobacco Use

27-1a. Cigarette use by adults (age adjusted, 

18+ years) (1998, 2008)1* b B B  B  B   B

27-2b. Cigarette use in past month by students 

(grades 9–12) (1999, 2009)* Bi 





iii B

Substance Abuse

26-10a. Adolescents not using alcohol or illicit drugs 

in past 30 days (12–17 years) 

(2002, 2008)4*

b B B Bi

26-10c. Adults using illicit drugs in past 30 days 

(18+ years) (2002, 2008)* b B B B

26-11c. Adults binge drinking in the past month 

(18+ years) (2002, 2008)4* b B B B

Responsible Sexual Behavior

13-6a. Condom use among sexually active 

unmarried persons—females (18–44 years)

(1995, 2006–08)5‡

 Bi   B B B Bi iv B

b. Condom use among sexually active 

unmarried persons—males (18–44 years) 

(2002, 2006–08)5‡§

 B    B   B Bi B

25-11a. Students who never had sexual intercourse 

(grades 9–12) (1999, 2009)‡ B B Bi

25-11b. Students who had sexual intercourse, but 

not in the past 3 months (grades 9–12) 

(1999, 2009)‡§

B B

25-11c. Students who used condoms at last 

intercourse (grades 9–12) 

(1999, 2009)‡§

 Bi  B
Leading Health Indicators LHI-21

Figure LHI-2. Health Disparities Table for Leading Health Indicators (continued)

Race and Ethnicity Sex Education Income Location Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexUrban or metropolitanRural or nonmetropolitanPersons with disabilitiesPersons without disabilities

Mental Health

18-1. Suicide (age adjusted, per 100,000 

population) (1999, 2007)6*

§  v  B 

  B   B

18-9b. Treatment for adults with depression 

(18+ years) (2002)* B B B

Injury and Violence

15-15a. Deaths from motor vehicle crashes 

(age adjusted, per 100,000 population) 

(1999, 2007)6*

Bv  B    B 

15-32. Homicides (age adjusted, per 100,000 

population) (1999, 2007)6* Bi,v 









 B  B

Environmental Quality

8-1a. Percent of persons exposed to ozone 

(1997, 2010)7† B  B B







B

27-9. Exposure to tobacco smoke at home 

among children (≤6 years) 

(1994, 2005)8*

§

b B B









 B 

27-10. Exposure to environmental tobacco smoke 

among nonsmokers (age adjusted, 4+ 

years) (1988–94, 2005–08)*

Bii 

  B   B 

Immunization

14-24a. Fully immunized young children 19–35 

months (1998, 2008)9,10* b b Bi Bi B B

14-29a. Vaccination of noninstitutionalized high-risk older 

adults—Influenza vaccine in past 12 months 

(age adjusted, 65+ years) (1998, 2008)1

*

B iii Bi B B

b. Vaccination of noninstitutionalized high-risk older 

adults—Pneumococcal vaccine ever received 

(age adjusted, 65+ years) (1998, 2008)1

*

 B  Bi  B B

Access to Health Care

1-1. Persons with health insurance (<65 years) 

(1997, 2008)1* 

 B iii B   B  B B

1-4a. Source of ongoing care (1998, 2008)1*

B iii B  B  B B

1-9a. Hospitalization for pediatric asthma 

(admissions per 10,000 population, <18 

years) (1996, 2008)*§

B

16-6a. Prenatal care beginning in first trimester 

(1998, 2002)*  v B   B 
LHI-22 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure LHI-2. Health Disparities Table for Leading Health Indicators (continued)

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. 

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic 

(e.g., race and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by 

subtracting the disparity at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the 

summary index at baseline from the summary index at the most recent data point. See Technical Appendix for more information.

Legend

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See t a echnical ppendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% 

or more are displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are 

indicated by arrows when the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical 

Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. 

Nonetheless, disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix.

‡ Measures of variability were available only for the most recent data. Thus, the variability of best group rates was assessed only for the most recent 

data, and statistical significance was tested only for the most recent data. Disparities of 10% or more are displayed when the differences from the best 

group rate are statistically significant at the 0.05 level. Changes in disparities over time are displayed according to their magnitude, since measures of 

variability were not available at baseline and therefore statistical significance of changes in disparity could not be tested. See Technical Appendix.

§ Supplemental measure. See LHI chapter text for more information.

1 Baseline data by race and ethnicity are for 1999.

2 Baseline data by disability status are for 1991–94.

3 Data by income are categorized using only two groups: lower income (≤130% of Federal poverty level, displayed under "poor") and higher income 

(>130% of Federal poverty level, displayed under "middle/high income").

4 Baseline data by income are for 2005.

5 Data by education level are for persons aged 25–44 years.

6 Most recent data by education level are for 2002.

7 Most recent data by race and ethnicity, by sex, and by location, are for 2004.

8 Baseline data by race and ethnicity are for 2005.

9 Baseline data by race and ethnicity are for 2000.

10 Baseline data by income exclude "middle/high income" for comparability with most recent data year.
Leading Health Indicators LHI-23

Figure LHI-2. Health Disparities Table for Leading Health Indicators (continued)

FOOTNOTES (continued)

i The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. 

See Technical Appendix.

ii Data are for Mexican American.

iii Change in the summary index cannot be assessed. See Technical Appendix.

iv Reliability criterion for best group rate not met, or data available for only one group, at baseline. Change in disparity cannot be assessed. See Technical Appendix.

v Data are for Asian or Pacific Islander.

DATA SOURCES

1-1. National Health Interview Survey (NHIS), CDC, NCHS.

1-4a. National Health Interview Survey (NHIS), CDC, NCHS.

1-9a. Healthcare Cost and Utilization Project (HCUP), AHRQ.

8-1a. Air Quality System (AQS), Environmental Protection Agency (EPA).

13-6a–b. National Survey of Family Growth (NSFG), CDC, NCHS.

14-24a. National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

14-29a–b. National Health Interview Survey (NHIS), CDC, NCHS.

15-15a. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-32. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

16-6a. National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

18-1. National Vital Statistics System—Mortality (NVSS–M), CDC, NCHS.

18-9b. National Comorbidity Survey—Replication (NCS–R), NIH, NIMH.

19-2. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

19-3c. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

22-2. National Health Interview Survey (NHIS), CDC, NCHS.

22-7. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

25-11a–c. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

26-10a. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-10c. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-11c. National Survey on Drug Use and Health (NSDUH), SAMHSA.

27-1a. National Health Interview Survey (NHIS), CDC, NCHS.

27-2b. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

27-9. National Health Interview Survey (NHIS), CDC, NCHS.

27-10. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

Reader’s Guide

Contents

Focus Area Chapters .....................................................................RG-2

Measuring Progress Toward the Healthy People 2010 Targets ....RG-2

Measuring Health Disparities.......................................................RG-3

Displaying Data With Maps ..........................................................RG-5

References and Notes....................................................................RG-5
RG-2 HEALTHY PEOPLE 2010 FINAL REVIEW

Focus Area Chapters

Each of the 28 Healthy People 2010 Focus Areas is 

reviewed in a standalone chapter in the Healthy People 

2010 Final Review.

The Focus Area chapter begins with a brief introduction 

to the Focus Area.

The "Highlights" section describes the salient findings 

in relation to progress toward target attainment and to 

health disparities for selected objectives.

The "Summary of Progress" section provides a more indepth assessment of progress toward target attainment, 

and provides the reader with an inventory of objectives 

that have achieved their Healthy People 2010 targets, 

moved toward their targets, demonstrated no change, 

moved away from their targets, or lacked data to 

assess progress. The Progress Chart, which is the first 

figure in each Focus Area chapter, displays further 

quantitative information regarding progress toward 

target attainment for each objective for which data 

were available, including the percent of targeted change 

achieved. See Measuring Progress Toward the Healthy 

People 2010 Targets, below.

The Summary of Progress section also discusses progress toward the elimination of health disparities. The 

Health Disparities Table, which is the second figure in 

each Focus Area chapter (except for Chapter 23), displays 

detailed findings in relation to health disparities among 

select populations for the objectives for which data were 

available. Objectives based on schools, worksites, states, 

or those that were measured using the numbers of events 

are not included in the discussion of health disparities. 

See Measuring Health Disparities, below.

When data are available at the subnational level, 

selected objectives are mapped to display spatial 

variation in percents, rates, or counts. Subnational data 

are presented either at the state or Health Service Area 

(HSA) level. When maps are included they are shown in 

the Focus Area chapter. See Displaying Data with Maps, 

below.

Previous Healthy People 2010 publications stated that 

there were 467 objectives to track progress over the 

decade. However, many of these objectives consisted 

of multiple “subobjectives,” each with its own baseline 

data, data source, and target requiring separate 

analysis. The analyses in this report are based on a total 

of 969 objectives and subobjectives. For the purpose 

of discussion, both objectives and subobjectives are 

referred to in this report as objectives given that each 

receives equal analysis and treatment. 

The "Transition to Healthy People 2020" section of each 

chapter describes the framework of the Healthy People 

2020 Topic Area(s) and changes and modifications made 

to the corresponding Healthy People 2010 Focus Area(s) 

and objectives. Some Healthy People 2010 Focus Areas 

were split and new Healthy People 2020 Topic Areas 

were added. As a result, Healthy People 2020 has 42 Topic 

Areas. Appendix D, “A Crosswalk Between Objectives 

From Healthy People 2010 to Healthy People 2020,” 

summarizes the changes between the two decades of 

objectives.

Each Focus Area chapter in the Healthy People 2010 Final 

Review concludes with a "Data Considerations" section 

and a "Comprehensive Summary of Objectives" section 

that lists all objectives in that Focus Area with the 

corresponding data sources or objective status in those 

cases where an objective was not retained.

A description of the Progress Chart and a guide to the 

Health Disparities Table are presented below. The 

techniques used to develop these visuals are discussed 

in greater detail in the Technical Appendix. Further 

discussion of the issues involved in the measurement of 

progress and of health disparities in Healthy People 2010 

has been published elsewhere [1].

All Healthy People 2010 tracking data are available from 

http://wonder.cdc.gov/data2010 and are, therefore, not 

included in this report.

Measuring Progress Toward the 

Healthy People 2010 Targets

Progress toward the Healthy People 2010 targets at Final 

Review is shown in a Progress Chart for each Focus Area. 

The Progress Chart displays the percent of targeted 

change that was achieved for each objective. Targeted 

change is the difference between the baseline and the 

Healthy People 2010 (HP2010) target. The formula for the 

percent of targeted change achieved is as follows:

Percent of 

targeted 

change 

achieved 

= Final value – Baseline value × 100.

HP2010 target – Baseline value

The percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline and 

the Healthy People 2010 target. As such, it is a relative 

measure of progress toward attaining the Healthy 

People 2010 target, and it can be used to compare how 

much of the targeted change has been achieved for 

an objective relative to other objectives, though care 

must be exercised in its interpretation. In particular, 

movement away from the Healthy People 2010 target 

is not quantified using the percent of targeted change 

achieved, as it is more meaningful to examine the 
Read er's guide RG-3

difference between the final and the baseline values in 

such cases. See Technical Appendix for more information.

Although the Progress Chart was displayed in previous 

Healthy People publications, in this report several new 

columns have been added to provide more in-depth 

information on the movement that occurred for each 

objective for which there were at least two data points.

The Progress Chart is divided into three panels. Objective 

numbers and short descriptions are listed in the leftmost panel. The description of an objective includes in 

parentheses any applicable information regarding the 

age of the targeted population. Most Healthy People 2010 

objectives are measured using proportions, expressed 

in percents. If the unit of measure for an objective is 

anything other than a percent (e.g., rate per 100,000 

population), then this is also indicated in parentheses as 

part of the objective description. The 'percent of targeted 

change achieved' for each objective is displayed in a bar 

chart in the central panel of the Progress Chart. In the 

right-most panel of the Progress Chart, a table displays 

the Healthy People 2010 target, the baseline value and 

year, the final value and year, the difference between 

final and baseline values, its statistical significance at 

the 0.05 level, and the percent change between the final 

and baseline values.

The formula for the percent change is as follows:

Percent change 

between final 

and baseline 

values 

= Final value – Baseline value

× 100.

Baseline value

The percent of targeted change achieved is shown for 

each objective with data more recent than the baseline. 

The percent of targeted change achieved is color coded:

〉 Objectives that moved away from the target are in 

red.

〉 Objectives that moved toward the target are in light 

blue. 

〉 Objectives that met or exceeded the target are in 

dark blue. 

As mentioned earlier, movement away from the Healthy 

People 2010 target is not quantified using the percent of 

targeted change achieved in the Progress Chart. Instead, 

for such objectives, the reader should examine the 

difference between the final value and the baseline value 

to assess progress. See Technical Appendix.

Objectives for which progress could not be assessed are 

identified in the notes at the end of the Progress Chart. 

These notations occur in two general types of situations: 

(a) the objective was deleted at the Midcourse Review, 

or (b) the objective did not have a baseline, or had a 

baseline value but no follow-up data.

The following observations may be helpful to the 

interpretation of the percent of targeted change achieved 

by a specific objective and comparisons of progress 

among multiple objectives:

〉 The 'percent of targeted change achieved' measures 

the percent of the difference between the baseline 

and the 2010 target that was attained. For example, a 

value of 25% indicates that a quarter of the difference 

between the baseline and the 2010 target was 

achieved.

〉 The use and interpretation of the percent of targeted 

change achieved has limits. It is calculated using 

only the Healthy People 2010 target, the baseline data 

point, and the final data point. Furthermore, it does 

not take into account the number of years that are 

included nor any fluctuations that may occur during 

the intervening years. The number of years included, 

which varies by objective, may also vary within an 

objective based on the availability of population 

data. See Technical Appendix.

〉 There are situations in which the percent of targeted 

change achieved cannot be calculated or does not 

accurately reflect change in an objective. These 

situations include instances when the target was met 

at the baseline, when the amount of targeted change 

was small relative to the amount of actual change, or 

when the target was exceeded at the baseline. Such 

situations are footnoted on the applicable charts, and 

illustrated in the Technical Appendix.

Measuring Health Disparities

Information about health disparities among select 

populations is shown in a Health Disparities Table. 

Short descriptions of the population-based objectives 

are listed along the left side of the table. The baseline 

data year(s) are shown in parentheses and, when more 

recent data were available, the most recent data year(s) 

are also shown. The description of an objective generally 

also includes in parentheses any applicable information 

regarding the underlying measure (e.g., measurement 

unit) and the age of the targeted population.

Characteristics of the population (race and ethnicity, sex, 

education, income, geographic location, and disability 

status) are depicted across the top of the Health 

Disparities Table. In general, characteristics applicable 

to each objective were designated in the original Healthy 

People 2010 document [2].

Characteristics that were not designated for a particular 

objective are shaded in dark gray. When a characteristic 

is not applicable for any of the objectives in a Focus 

Area, it is omitted from the Health Disparities Table 
RG-4 HEALTHY PEOPLE 2010 FINAL REVIEW

for that Focus Area. When data are not available for a 

designated population or for a particular characteristic, 

the corresponding boxes are shaded in light gray (see 

the fourth section of the legend, reproduced below in 

Figure RG-1). If there are no characteristic-specific data 

available for an objective, the objective is excluded from 

the table and referenced in the notes.

Definition. Disparity from the best group rate is defined 

as the percent difference between the best group rate 

and each of the other group rates for a characteristic at 

the most recent data point.

For example, disparities by race and ethnicity are 

measured as the percent difference between the best 

racial and ethnic group rate and each of the other racial 

and ethnic group rates. Similarly, disparities by sex are 

measured as the percent difference between the better 

group rate (e.g., female) and the rate for the other group 

(e.g., male).

Formula. The formula for disparity from the best group 

rate for a group G is as follows:

Disparity 

for group G =

Rate for 

group G – Best group rate for characteristic

× 100.

Best group rate for characteristic

Some Healthy People 2010 objectives are expressed 

in terms of favorable events or conditions that are to 

be increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities across 

different objectives, disparity is measured only in terms 

of adverse events or conditions in Healthy People 2010 

[1]. Those objectives that are expressed in terms of 

favorable events or conditions are re-expressed using the 

adverse event or condition for the purpose of computing 

disparity, but they are not otherwise restated or changed. 

See Technical Appendix for more information.

Example. Healthy People 2010 objective 1-1, to increase 

the proportion of persons with health insurance (e.g., 

72% of the American Indian or Alaska Native population 

under age 65 had some form of health insurance in 

2008), is expressed in terms of the percentage of persons 

without health insurance (e.g., 100% – 72% = 28% of the 

American Indian or Alaska Native population under age 

65 did not have any form of health insurance in 2008) 

when the disparity from the best group rate is calculated.

As a result, the group identified as having the best rate for 

a given characteristic is always the group with the least 

adverse event or condition. Thus, disparities defined 

by the above formula remain nonnegative quantities, 

equal zero only when the group G for which disparity is 

being assessed has rate equal to the best group rate. See 

Technical Appendix for more information.

The group with the best or most favorable rate is identified 

for each characteristic in the Health Disparities Table 

by a "B". In the few instances when two groups had 

identical best rates, both groups are identified by a "B". 

In some cases, the most favorable rate is not sufficiently 

reliable to be used as the best rate. In these situations, 

a small letter "b" is included in the cell, and the next 

most favorable group rate with sufficient reliability is 

identified with a "B" as the best group. When there is only 

one group with sufficiently reliable data, a best group 

is not identified for purposes of measuring disparity, 

and the cells for all groups with data are left blank in 

the Health Disparities Table, indicating that disparities 

could not be assessed. These symbols are described in 

the first section of the legend that accompanies each of 

these figures (reproduced below in Figure RG-1).

A color gradient is used to represent the size of the 

percent difference from the best group rate for each 

group at the most recent data point. In some cases, 

baseline data might be the only data available. The color 

gradient is shown in the second section of the legend, 

reproduced below in Figure RG-1. When measures of 

variability are available, the variability of best group 

rates is assessed, and statistical significance is tested. 

For a given group G within a characteristic, a disparity 

of 10% or more is displayed when the difference from the 

best group rate (i.e., rate for group G minus best group 

rate) is statistically significant at the 0.05 level. See 

Technical Appendix.

Change in disparity over time is estimated by subtracting 

the disparity at the baseline from the disparity at the 

most recent data point. The change is expressed in 

percentage points: positive differences represent an 

increase in disparity, and negative differences represent 

a decrease in disparity. The magnitude of the change 

is indicated by the number of arrows. (See the third 

section of the legend, reproduced below in Figure RG-1.) 

Whenever data are available at both the baseline and 

most recent time points, changes in disparity over time 

are shown if the change is greater than or equal to 10 

percentage points and statistically significant, or when 

the change is greater than or equal to 10 percentage 

points and estimates of variability are not available. See 

Technical Appendix for a more in-depth discussion.

Footnotes indicate whether statistical testing was 

performed for either the differences from the best group 

rate at the most recent data point or the changes in 

disparities over time.

When there are more than two groups associated with 

a population characteristic (for example, race and 

ethnicity, education, and income), a summary index 

provides a way to determine whether the disparity 

from the best group rate has increased or decreased on 

average. The summary index used here is the average 

of percent differences between the best group rate and 
Reader's guide RG-5

each of the other group rates for a characteristic. These 

comparisons are made only when disparities data are 

available for exactly the same groups at the baseline and 

most recent data points

The statistical significance of the summary index at the 

most recent data point and changes in the index over 

time are assessed when possible. The magnitude of the 

summary index at the most recent data point, and the 

magnitude and direction of changes in the summary 

index over time, are indicated by the color gradient and 

the arrow symbols, respectively.

More detail on measuring, tracking, and summarizing, 

health disparities can be found in the Technical Appendix, 

as well as in a related publication [1].

Figure RG-1: Legend for the Health Disparities Table

L G NDe e

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

Displaying Data With Maps

When data are available at the subnational level, selected 

objectives are mapped to display spatial variation in 

percents, rates, or counts. Subnational data are presented 

either at the state or Health Service Area (HSA) level. 

HSAs are defined as “...one or more counties that are 

relatively self-contained with respect to the provision of 

routine hospital care” [3]. HSAs are contiguous but may 

span state boundaries. They frequently contain more 

than 1 county with an average of 4 and maximum of 

20 counties. Maps are presented as simple chloropleths 

and use either a Jenks or modified Jenks classification 

[4]. A Jenks classification is a method for grouping 

ordered data in such a way that within-group variance is 

minimized and between-group variance is maximized. 

When geographic units (states or HSAs) have values that 

meet the Healthy People 2010 target, the classification 

is modified by manually setting the “best” cut-point to 

the Healthy People 2010 target. The best cut-point is 

the highest cut-point for objectives that are expressed 

in terms of favorable events or conditions that are to be 

increased, and the lowest cut-point for objectives that 

are expressed in terms of adverse events or conditions 

that are to be reduced. In some instances where the 

number of geographic units meeting the target is large, 

a cut-point in the middle of the distribution is set to the 

target. See Technical Appendix for more information.

References and Notes

1. Keppel KG, Pearcy JN, Klein RJ. Measuring progress 

in Healthy People 2010. Statistical Notes, no. 25. 

Hyattsville, Maryland: National Center for Health 

Statistics. September 2004.

2. Characteristics for developmental objectives were 

not included in the original Healthy People 2010 

publication, but were added when data sources were 

identified and the objectives became measurable. 

Lists of characteristics for all currently measurable 

objectives can be found in DATA2010, an online 

database available from: http://wonder.cdc.gov/

data2010.
RG-6 HEALTHY PEOPLE 2010 FINAL REVIEW

3. Makuc DM, Haglund B, Ingram DD, et al. Health 

Service Areas for the United States. National Center 

for Health Statistics. Vital Health Stat (2)112. 1991.

4. Coulson MR. In the matter of class intervals for 

chloropleth maps: with particular reference to 

the work of George F Jenks. Cartographica: The 

International Journal for Geographic Information 

and Geovisualization. 24(2), 16-39. 2006.
Access to Quality 

Health Services

CHAPTER 1

Co-Lead Agencies

Agency for Healthcare Research and Quality

Health Resources and Services Administration

Contents

Goal ..................................................................................................1-3

Highlights ........................................................................................1-3

Summary of Progress.......................................................................1-4

Transition to Healthy People 2020..................................................1-5

Data Considerations.........................................................................1-6

References and Notes.......................................................................1-7

Comprehensive Summary of Objectives..........................................1-8

Progress Chart................................................................................1-12

Health Disparities Table.................................................................1-16

Persons With Health Insurance, 2008—Map................................1-19

1 • ACCESS TO QUALITY HEALTH SERVICES 1-3

GOAL:

Improve access to comprehensive, 

high-quality health care services.

Access to quality health services includes access to 

primary care, preventive services, and other health 

care services on a continuum of care in the health care 

delivery system. The objectives in this chapter monitor 

progress in four general areas:

〉 The first section monitors clinical preventive care

and includes objectives that track health insurance 

coverage and counseling about health behaviors.

〉 Objectives in the second section are concerned with 

primary care and examine source of ongoing care, 

having a usual primary care provider, difficulties and 

delays obtaining needed health care, cultural diversity 

and racial and ethnic representation in health 

professions, and hospitalization for ambulatory-caresensitive conditions.

〉 Emergency services, including delay or difficulty 

getting emergency care, rapid prehospital emergency 

care, trauma care systems, and special needs of 

children, are monitored in the third section.

〉 The final section tracks long-term care and 

rehabilitative services, including long-term care 

services and diagonsis of pressure ulcers among 

nursing home residents.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the Healthy 

People 2010 database, DATA2010, available from http://

wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in meeting 

objectives f or this Focus Area during the past decade 

[1]. Seventy-three percent of the Access to Quality 

Health Services objectives with data to measure 

progress moved toward or achieved their Healthy 

People 2010 targets (Figure 1-1). However, statistically 

significant health disparities of 10% or more were 

observed among racial and ethnic populations and 

income groups (Figure 1-2) [2].

〉 Rates of persons with health insurance (objective 

1-1) did not change over the decade. As in 1997, 

the baseline year for this objective, 83% of the U.S. 

population under age 65 had health insurance 

coverage in 2008. Disparities were observed for a 

number of population groups, for example:

 Among racial and ethnic groups, the nonHispanic white population had the highest (best) 

rate of health insurance coverage, 88% in 2008, 

whereas the American Indian or Alaska Native 

population and the Hispanic or Latino population 

had rates of 72% and 67%, respectively. When 

expressed as persons without health insurance, 

the rate for the American Indian or Alaska 

Native population was more than twice that for 

the non-Hispanic white population) [2]. The rate 

of coverage for the Hispanic or Latino population 

was nearly three times the non-Hispanic white 

rate.

 The American Indian or Alaska Native population 

had health insurance coverage rates of 62% in 1999 

and 72% in 2008, whereas the non-Hispanic white 

population had rates of 88% in both 1999 and 2008. 

When rates are expressed in terms of persons 

without health insurance, the disparity between 

the American Indian or Alaska Native population 

and the non-Hispanic white population decreased 

83 percentage points between 1999 and 2008 [2,3].
1-4 HEALTHY PEOPLE 2010 FINAL REVIEW

 Among income groups, the middle/high-income 

population had the highest (best) rate of health 

insurance coverage, 89% in 2008, whereas the 

poor and near-poor populations had rates of 

71% and 69%, respectively. When expressed as 

persons without health insurance, the rate for 

the poor population was more than two and 

a half times that for the middle/high-income 

population [2]. The rate of non coverage for the 

near-poor population was almost three times the 

rate for the middle/high-income population.

 The poor population had health insurance 

coverage rates of 66% in 1997 and 71% in 2008, 

whereas the middle/high-income population 

had rates of 90% in 1997 and 89% in 2008. When 

rates are expressed in terms of persons without

health insurance, the disparity between the 

poor population and the middle/high-income 

population decreased 76 percentage points 

between 1997 and 2008 [2,3].

〉 Health insurance coverage varied by state. Although 

no state had achieved the Healthy People 2010 target 

of total coverage, five states (Connecticut, Hawaii, 

Iowa, Massachusetts, and Minnesota) had rates of 

coverage over 88% in 2008. Texas, at 71%, had the 

lowest coverage rate (Figure 1-3).

〉 Statistically significant health disparities of 100% or 

more were observed for several other objectives, for 

example:

 Persons who had a specific source of ongoing 

care among all ages (objective 1-4a):

 Among racial and ethnic groups, the nonHispanic white population had the highest 

(best) rate, 89% in 2008, whereas the Hispanic 

or Latino population had a rate of 77%. When 

expressed as persons without a specific source 

of ongoing care, the rate for the Hispanic or 

Latino population was more than twice the 

non-Hispanic white rate [2].

 Among income groups, the middle/highincome population had the highest (best) 

rate, 90% in 2008, whereas the poor and 

near-poor populations had rates of 78% and 

80%, respectively. When expressed as persons 

without a specific source of ongoing care, the 

rates for the poor and near-poor populations 

were about twice the rate for the middle/highincome population [2].

 Persons who had a specific source of ongoing 

care among adults aged 18 and over (objective 

1-4c):

 Among racial and ethnic groups, the nonHispanic white population had the highest 

(best) rate, 87% in 2008, whereas the Hispanic 

or Latino population had a rate of 69%. When 

expressed as persons without a specific source 

of ongoing care, the rate for the Hispanic or 

Latino population was almost two and a half 

times the non-Hispanic white rate [2].

 Among income groups, the middle/highincome population had the best rate, 88% 

in 2008, whereas the near-poor and poor 

populations had rates of 76% and 71%, 

respectively. When expressed as persons 

without a specific source of ongoing care, the 

rate for the near-poor population was twice the 

rate, for the middle/high-income population, 

while the rate for the poor population was 

almost two and a half times the middle/highincome population rate [2].

 Persons who delayed or had difficulty in getting 

emergency medical care (objective 1-10):

 Among racial and ethnic groups, the rate for 

persons of two or more races (6.7% in 2001) was 

about three times the best group rate, that for 

the non-Hispanic white population (2.2% in 

2001).

 Among income groups, the rate for the poor 

population (4.5% in 2001) was more than twice 

that of the best group rate, that for the middle/

high-income population (2.0% in 2001).

 The rate for persons with disabilities (5.7% 

in 2001) was more than three times that for 

persons without disabilities (1.8% in 2001).

Summary of Progress

〉 Figure 1-1 presents a quantitative assessment of 

progress in achieving the Healthy People 2010 

objectives for Access to Quality Health Services [1]. 

Data to measure progress toward target attainment 

were available for 48 objectives. Of these:

 Eleven objectives (1-7a through d; 1-8b, f, j, n, and 

r; 1-9a; and 1-12) met or exceeded their Healthy 

People 2010 targets.

 Twenty-four objectives moved toward their 

targets. A statistically significant difference 

between the baseline and the final data points 

was observed for three of these objectives (1-3c, 

1-6, and 1-9c). Data to test the significance of the 

difference were unavailable for 21 objectives (1-3f; 

1-7e and g; 1-8a, d, e, g through i, l, p, q, s, and t; 

1-13a, b, e, f, and i; and 1-14a and b).

 Six objectives (1-1; 1-4b; 1-7f and h; and 1-8m and 

o) showed no change.

 Seven objectives moved away from their targets. 

A statistically significant difference between 

the baseline and final data points was observed 

for three objectives (1-4a and c, and 1-9b). No 

significant differences were observed for two 
1 • ACCESS TO QUALITY HEALTH SERVICES 1-5

objectives (1-5 and 1-16); and data to test the 

significance of the difference were unavailable 

for two objectives (1-8c and k).

〉 One objective (1-3g) remained developmental, and 20 

objectives (1-3a, b, d, h; 1-10; 1-11a through g; 1-13c, d, 

g, and h; and 1-15a through d) had no follow-up data 

available to measure progress [4]. Two objectives (1-2 

and 1-3e) were deleted at the Midcourse Review.

〉 Figure 1-2 displays health disparities in Access to 

Quality Health Services from the best group rate for 

each characteristic at the most recent data point [2]. 

It also displays changes in disparities from baseline 

to the most recent data point [3].

 Of the 10 objectives with statistically significant 

health disparities of 10% or more by race and 

ethnicity, the non-Hispanic white population had 

the best rate for seven objectives (1-1, 1-3c, 1-4a 

and c, 1-5, 1-10, and 1-16). The non-Hispanic black 

population had the best rate for two objectives (1-

3a and b), and the Hispanic or Latino population 

had the best rate for one objective (1-6).

 Females had better rates than males for eight of 

the nine objectives with statistically significant 

health disparities of 10% or more by sex 

(objectives 1-1, 1-3c, 1-4a and c, 1-5, 1-9a and b, 

and 1-16). Males had a better rate than females 

for the remaining objective (1-6).

 Persons with at least some college education 

had the best rate for the three objectives with 

statistically significant health disparities of 10% 

or more by education level (objectives 1-3h, 1-5, 

and 1-10).

 Persons with middle/high incomes had the 

best rate for all six objectives with statistically 

significant health disparities of 10% or more by 

income (objectives 1-1, 1-3h, 1-4a and c, 1-6, and 

1-10).

 Persons living in rural or nonmetropolitan 

areas had better rates than persons living in 

urban or metropolitan areas for two of the three 

objectives with statistically significant health 

disparities of 10% or more by geographic location 

(objectives 1-4c and 1-5). Persons living in urban 

or metropolitan areas had a better rate for the 

third objective (1-1).

 Persons with disabilities had better rates than 

persons without disabilities for 7 of the 10 

objectives with statistically significant health 

disparities of 10% or more by disability status 

(objectives 1-1, 1-3a through c, 1-4a and c, and 

1-5). Persons without disabilities had better rates 

for the remaining three objectives (1-3h, 1-6, and 

1-10).

 Health disparities of 100% or more were observed 

for four objectives: health insurance coverage 

(objective 1-1), source of ongoing care among 

all ages and among adults (objective 1-4a and c, 

respectively), and delay or difficulty in getting 

emergency care (objective 1-10). These disparities 

are discussed in the Highlights, above.

 As indicated in the Highlights, increases in 

disparity over time between select population 

groups and income groups were observed for 

health insurance coverage.

Transition to Healthy People 2020

For Healthy People 2020, the Access to Health Services 

(AHS) Topic Area uses a new organizational approach 

based on two major components of health services 

delivery: access to health services and quality of health 

services. See HealthyPeople.gov for a complete list of 

Healthy People 2020 topics and objectives.

Objectives that appear in the Healthy People 2020 AHS 

Topic Area focus on the first component only, access 

to health services, whereas objectives that pertain to 

the second component, quality of health services, have 

been shifted into the appropriate disease- or conditionspecific Topic Area and are, therefore, spread throughout 

Healthy People 2020.

The Healthy People 2010 Focus Area name was changed 

from “Access to Quality Health Services” to “Access to 

Health Services” for Healthy People 2020 to be consistent 

with the new organizational structure. To capture the 

objectives that are related to quality of health services, a 

crosswalk will be created, consisting of objectives found 

in the other Healthy People 2020 chapters (e.g., cancer 

screening rates and primary care counseling services) 

that are aligned with the annual National Health Quality 

Report (NHQR) [5].

The Healthy People 2020 AHS Topic Area objectives can 

be grouped into several sections:

〉 Coverage

〉 Workforce

〉 Utilization and Services

〉 Timeliness.

The differences between the Healthy People 2010 and 

Healthy People 2020 objectives are summarized below:

〉 The Healthy People 2020 AHS Topic Area has a total 

of 26 objectives, 16 of which are developmental, 

whereas the Healthy People 2010 Focus Area had 

71 objectives [4]. In transitioning to Healthy People 

2020, some objectives were deleted at the Midcourse 

Review or were removed during the Healthy People 
1-6 HEALTHY PEOPLE 2010 FINAL REVIEW

2020 planning process. Many other objectives were 

archived due to the shift in Topic Area focus, as well 

as for data-related issues such as lack of viable data 

sources and successful attainment of 2010 targets [6].

〉 Four Healthy People 2010 objectives were retained “as 

is”: health (medical) insurance (objective 1-1), specific 

source of ongoing care for all ages and for children 

and adolescents aged 17 and under (objectives 1-4a 

and b, respectively), and usual primary care provider 

(objective 1-5) [7].

〉 Two Healthy People 2010 objectives were modified 

[8]. The objective on source of ongoing care for adults 

aged 18 and over (objective 1-4c) was split into adults 

aged 18–64 and adults aged 65 and over; and the 

objective on difficulties or delays in receiving needed 

health care (objective 1-6) was modified to measure 

individuals instead of families and was split by type 

of care or service (all, medical care, dental care, and 

prescription medicines).

〉 Two Healthy People 2010 objectives, the population 

covered by basic and advanced life support 

(objectives 1-11a and b respectively), were reverted to 

developmental status in 2020 due to a lack of baseline 

data.

〉 One Healthy People 2010 objective on prevention of 

sexually transmitted diseases (objective 1-3g) that 

remained developmental was removed during the 

Healthy People 2020 planning process. Counseling 

about vehicle restraints and bicycle helmets 

(objective 1-3e) was deleted at the Midcourse Review. 

Health insurance coverage for clinical preventive 

services (objective 1-2) was deleted at the Midcourse 

Review but then retained as developmental for 2020.

〉 The remaining 60 Healthy People 2010 AHS objectives 

were archived or moved to other Healthy People 2020 

Topic Areas, including new Topic Areas related to 

age groups: Early and Middle Childhood, Adolescent 

Health, and Older Adults. These objectives cover the 

following topics: counseling about health behaviors 

(objectives 1-3a through d, f, and h); health professions 

training on health promotion, disease prevention, 

and cultural diversity (objectives 1-7a through h); 

racial and ethnic representation in health professions 

(objectives 1-8a through t); hospitalization for 

specific conditions (objectives 1-9a through c); 

emergency care (objectives 1-10 and 1-11c through g); 

poison control (objectives 1-12); trauma care systems 

(objectives 1-13a through i); special needs of children 

(objectives 1-14a and b); and access to long-term care 

services (objectives 1-15a through d, and 1-16).

 In many cases, objectives were dropped or moved 

to other Topic Areas due to the revised focus of 

the AHS Topic Area, while in other cases the 

target was met or objectives no longer had viable 

data sources.

 For example, the objective that tracks physician 

counseling about physical activity (objective 1-3a) 

was moved into the Healthy People 2020 Physical 

Activity Topic Area and modified to include 

objectives on physician counseling and education 

related to exercise.

〉 Thirteen new objectives were added to the Healthy 

People 2020 AHS Topic Area:

 The health insurance coverage objective was 

expanded from one to three objectives covering 

medical insurance (retained from Healthy People 

2010), dental insurance (developmental), and 

prescription drug insurance (developmental).

 Four new objectives related to the workforce were 

added. These developmental objectives will track 

practicing primary care providers in the following 

professions: medical doctor, doctor of osteopathy, 

physician assistant, and nurse practitioner.

 One new developmental objective will track 

persons who receive appropriate evidence-based 

clinical services. 

 Six new developmental objectives track hospital 

emergency department visits for which wait time 

to see an emergency department clinician exceeds 

the recommended timeframe.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Data on health professions, training on health promotion, 

disease prevention, and cultural diversity (objectives 1-7a 

through h) and racial and ethnic representation in health 

professions (objectives 1-8a through t) had definitional 

issues that resulted in difficulties in interpreting trends 

for certain objectives during the Healthy People 2010 

tracking decade. For example, objectives 1-7e and f used 

a different survey in 2008 than for the 1999 baseline, 

which may result in data for those objectives not being 

comparable over time. The baseline survey data for 

objectives 1-7g and h did not include the D.N.P. degree 

as a response option, whereas the 2008 survey data did 

include that degree. Finally, objectives 1-8a through d, 

racial and ethnic representation for health professions, 

do not include data for dental professionals for the final 

year of data (2009) because those data were not available 

at the time of publication.
1 • ACCESS TO QUALITY HEALTH SERVICES 1-7

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Figure 1-3 (Persons With Health Insurance) presents 

state-level data from the Behavioral Risk Factor 

Surveillance System (BRFSS). National data for these 

objectives come from the National Health Interview 

Survey (NHIS) and are the basis for setting the targets. 

BRFSS data may not be comparable with the national 

data from NHIS.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

References and Notes

1. Displayed in the Progress Chart (Figure 1-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 1-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities 

Table (Figure 1-2). Disparity from the best group 

rate is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 
1-8 HEALTHY PEOPLE 2010 FINAL REVIEW

group rates was tested at the 0.05 level of significance. 

See the Figure 1-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 1-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides a 

baseline and at least one additional data point for 

tracking progress. Some objectives lacked baseline 

data at the time of their development but had a 

potential data source and were considered of sufficient 

national importance to be included in Healthy People. 

These are called “developmental” objectives. When 

data become available, a developmental objective is 

moved to measurable status and a Healthy People 

target can be set.

5. Agency for Healthcare Research and Quality. National 

Healthcare Quality Report 2010 [online]. Washington, 

D.C.: Agency for Healthcare Research and Quality. 

2010. (AHRQ publication no. 11–0004). Available from 

http://www.ahrq.gov/qual/qrdr10.htm.

6. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.

7. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or the 

data collection methodology. These include objectives 

that were developmental in Healthy People 2010 and 

are developmental in Healthy People 2020, and for 

which no numerator information is available.

8. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went from 

developmental in Healthy People 2010 to measurable 

in Healthy People 2020, or vice versa.

Comprehensive Summary of Objectives: Access to Quality Health Services

Objective Description Data Source or Objective Status

1-1 Persons with health insurance (< 65 years) National Health Interview Survey (NHIS), CDC, NCHS.

1-2 Health insurance coverage for clinical preventive services Deleted at the Midcourse Review.

1-3a Counseling about physical activity or exercise (age adjusted, 18+ 

years)

National Health Interview Survey (NHIS), CDC, NCHS.

1-3b Counseling about diet and nutrition (age adjusted, 18+ years) National Health Interview Survey (NHIS), CDC, NCHS.

1-3c Counseling about smoking cessation (age adjusted, smokers 18+ 

years)

National Health Interview Survey (NHIS), CDC, NCHS.

1-3d Counseling about risky drinking (age adjusted, 18+ years) National Health Interview Survey (NHIS), CDC, NCHS.

1-3e Counseling about childhood injury prevention (≤17 years) Deleted at the Midcourse Review.

1-3f Counseling about unintended pregnancy (females 15–44 

years)

National Survey of Family Growth (NSFG), CDC, NCHS.

1-3g Counseling about prevention of sexually transmitted diseases 

(15–44 years)

Developmental.

1-3h Counseling about management of menopause (females 45–57 

years)

National Health Interview Survey (NHIS), CDC, NCHS.

1-4a Source of ongoing care—All ages National Health Interview Survey (NHIS), CDC, NCHS.

1-4b Source of ongoing care—Children and adolescents (<18 

years)

National Health Interview Survey (NHIS), CDC, NCHS.
1 • ACCESS TO QUALITY HEALTH SERVICES 1-9

Comprehensive Summary of Objectives: Access to Quality Health Services (continued)

Objective Description Data Source or Objective Status

1-4c Source of ongoing care—Adults (18+ years) National Health Interview Survey (NHIS), CDC, NCHS.

1-5 Persons with a usual primary care provider Medical Expenditure Panel Survey (MEPS), AHRQ.

1-6 Difficulties or delays in obtaining needed health care (families) Medical Expenditure Panel Survey (MEPS), AHRQ.

1-7a Medical doctor (M.D. degree)—Counseling for health 

promotion and disease prevention

Liaison Committee on Medical Education (LCME) Annual Medical 

School Questionnaire, Association of American Medical Colleges.

1-7b Medical doctor (M.D. degree)—Cultural diversity Liaison Committee on Medical Education (LCME) Annual Medical 

School Questionnaire, Association of American Medical Colleges.

1-7c Osteopathic medical doctor (D.O. degree)—Counseling for 

health promotion and disease prevention

Annual Report on Osteopathic Medical Education, American 

Association of Colleges of Osteopathic Medicine.

1-7d Osteopathic medical doctor (D.O. degree)—Cultural diversity Annual Report on Osteopathic Medical Education, American 

Association of Colleges of Osteopathic Medicine.

1-7e Baccalaureate-level nurse (B.S.N., B.A., or B.S. degree)—

Counseling for health promotion and disease prevention

Special Healthy People Survey of Entry-Level Baccalaureate Nursing 

School Curriculum, formerly Survey on Women's Health in the 

Entry-Level Baccalaureate Nursing School Curriculum, American 

Association of Colleges of Nursing.

1-7f Baccalaureate-level nurse (B.S.N., B.A., or B.S. degree)— 

Cultural diversity

Special Healthy People Survey of Entry-Level Baccalaureate Nursing 

School Curriculum, formerly Survey on Women's Health in the 

Entry-Level Baccalaureate Nursing School Curriculum, American 

Association of Colleges of Nursing.

1-7g Nurse Practitioner (M.S., M.S.N., or D.N.P. degree)—

Counseling for health promotion and disease prevention

Collaborative Curriculum Survey, American Association of Colleges 

of Nursing and National Organization of Nurse Practitioner Faculties.

1-7h Nurse Practitioner (M.S., M.S.N., or D.N.P. degree)—Cultural 

diversity

Collaborative Curriculum Survey, American Association of Colleges 

of Nursing and National Organization of Nurse Practitioner Faculties.

1-8a Racial and ethnic representation in health professions—

American Indian or Alaska Native

Survey of Predoctoral Dental Educational Institutions, American 

Dental Association; Profile of Pharmacy Students, American 

Association of Colleges of Pharmacy; AAMC Data Book, Association 

of American Medical Colleges; Annual Data Report, Association of 

Schools of Public Health.

1-8b Racial and ethnic representation in health professions—Asian 

or Pacific Islander

Survey of Predoctoral Dental Educational Institutions, American 

Dental Association; Profile of Pharmacy Students, American 

Association of Colleges of Pharmacy; AAMC Data Book, Association 

of American Medical Colleges; Annual Data Report, Association of 

Schools of Public Health.

1-8c Racial and ethnic representation in health professions—Black 

or African American

Survey of Predoctoral Dental Educational Institutions, American 

Dental Association; Profile of Pharmacy Students, American 

Association of Colleges of Pharmacy; AAMC Data Book, Association 

of American Medical Colleges; Annual Data Report, Association of 

Schools of Public Health.

1-8d Racial and ethnic representation in health professions—

Hispanic or Latino

Survey of Predoctoral Dental Educational Institutions, American 

Dental Association; Profile of Pharmacy Students, American 

Association of Colleges of Pharmacy; AAMC Data Book, Association 

of American Medical Colleges; Annual Data Report, Association of 

Schools of Public Health.

1-8e Racial and ethnic representation in Nursing—American Indian 

or Alaska Native

Annual Survey of RN (Registered Nurse) Programs, National 

League for Nursing, Center for Research in Nursing Education and 

Community Health.

1-8f Racial and ethnic representation in Nursing—Asian or Pacific 

Islander

Annual Survey of RN (Registered Nurse) Programs, National 

League for Nursing, Center for Research in Nursing Education and 

Community Health.
1-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Access to Quality Health Services (continued)

Objective Description Data Source or Objective Status

1-8g Racial and ethnic representation in Nursing—Black or African 

American

Annual Survey of RN (Registered Nurse) Programs, National 

League for Nursing, Center for Research in Nursing Education and 

Community Health.

1-8h Racial and ethnic representation in Nursing—Hispanic or 

Latino

Annual Survey of RN (Registered Nurse) Programs, National 

League for Nursing, Center for Research in Nursing Education and 

Community Health.

1-8i Racial and ethnic representation in Medicine—American 

Indian or Alaska Native

AAMC Data Book: Statistical Information Related to Medical 

Schools and Teaching Hospitals, Association of American Medical 

Colleges.

1-8j Racial and ethnic representation in Medicine—Asian or 

Pacific Islander

AAMC Data Book: Statistical Information Related to Medical 

Schools and Teaching Hospitals, Association of American Medical 

Colleges.

1-8k Racial and ethnic representation in Medicine—Black or 

African American

AAMC Data Book: Statistical Information Related to Medical 

Schools and Teaching Hospitals, Association of American Medical 

Colleges.

1-8l Racial and ethnic representation in Medicine—Hispanic or 

Latino

AAMC Data Book: Statistical Information Related to Medical 

Schools and Teaching Hospitals, Association of American Medical 

Colleges.

1-8m Racial and ethnic representation in Dentistry—American 

Indian or Alaska Native

Survey of Predoctoral Dental Educational Institutions, American 

Dental Association.

1-8n Racial and ethnic representation in Dentistry—Asian or 

Pacific Islander

Survey of Predoctoral Dental Educational Institutions, American 

Dental Association.

1-8o Racial and ethnic representation in Dentistry—Black or 

African American

Survey of Predoctoral Dental Educational Institutions, American 

Dental Association.

1-8p Racial and ethnic representation in Dentistry—Hispanic or 

Latino

Survey of Predoctoral Dental Educational Institutions, American 

Dental Association.

1-8q Racial and ethnic representation in Pharmacy—American 

Indian or Alaska Native

Profile of Pharmacy Students, American Association of Colleges of 

Pharmacy.

1-8r Racial and ethnic representation in Pharmacy—Asian or 

Pacific Islander

Profile of Pharmacy Students, American Association of Colleges of 

Pharmacy.

1-8s Racial and ethnic representation in Pharmacy—Black or 

African American

Profile of Pharmacy Students, American Association of Colleges of 

Pharmacy.

1-8t Racial and ethnic representation in Pharmacy—Hispanic or 

Latino

Profile of Pharmacy Students, American Association of Colleges of 

Pharmacy.

1-9a Hospitalization for pediatric asthma (admissions per 10,000 

population, <18 years)

Healthcare Cost and Utilization Project (HCUP), AHRQ.

1-9b Hospitalization for uncontrolled diabetes (admissions per 

10,000 population, 18–64 years)

Healthcare Cost and Utilization Project (HCUP), AHRQ. 

1-9c Hospitalization for immunization—preventable pneumonia or 

influenza (admissions per 10,000 population, 65+ years)

Healthcare Cost and Utilization Project (HCUP), AHRQ.

1-10 Delay or difficulty in getting emergency care (age adjusted, 

18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

1-11a Rapid pre-hospital emergency care—Population covered by 

basic life support

National Assessment of State Trauma System Development, 

Emergency Medical Services Resources, Disaster Readiness for 

Mass Casualty Events, HRSA.

1-11b Rapid pre-hospital emergency care—Population covered by 

advanced life support

National Assessment of State Trauma System Development, 

Emergency Medical Services Resources, Disaster Readiness for 

Mass Casualty Events, HRSA.
1 • ACCESS TO QUALITY HEALTH SERVICES 1-11

Comprehensive Summary of Objectives: Access to Quality Health Services (continued)

Objective Description Data Source or Objective Status

1-11c Rapid pre-hospital emergency care—Population covered by 

helicopter

National Assessment of State Trauma System Development, 

Emergency Medical Services Resources, Disaster Readiness for 

Mass Casualty Events, HRSA.

1-11d Rapid pre-hospital emergency care—Pre-hospital access to 

online medical control

National Assessment of State Trauma System Development, 

Emergency Medical Services Resources, Disaster Readiness for 

Mass Casualty Events, HRSA.

1-11e Rapid pre-hospital emergency care—Population covered by 

basic 9-1-1

National Assessment of State Trauma System Development, 

Emergency Medical Services Resources, Disaster Readiness for 

Mass Casualty Events, HRSA.

1-11f Rapid pre-hospital emergency care—Population covered by 

enhanced 9-1-1

National Assessment of State Trauma System Development, 

Emergency Medical Services Resources, Disaster Readiness for 

Mass Casualty Events, HRSA.

1-11g Rapid pre-hospital emergency care—Population living in an 

area with two-way communication between hospitals

National Assessment of State Trauma System Development, 

Emergency Medical Services Resources, Disaster Readiness for 

Mass Casualty Events, HRSA.

1-12 Single toll-free number for poison control centers American Association of Poison Control Centers Survey, U.S. Poison 

Control Centers.

1-13a Trauma care systems (no. States and D.C.)—Presence of 

active multidisciplinary trauma advisory committee

Federal Trauma–EMS Systems Program Survey, HRSA.

1-13b Trauma care systems (no. States and D.C.)—Defined process 

for designing trauma centers

Federal Trauma–EMS Systems Program Survey, HRSA.

1-13c Trauma care systems (no. States and D.C.)—Use of ACS 

standards for trauma center verification

Federal Trauma–EMS Systems Program Survey, HRSA.

1-13d Trauma care systems (no. States and D.C.)—Use of on-site 

survey teams for trauma center verification

Federal Trauma–EMS Systems Program Survey, HRSA.

1-13e Trauma care systems (no. States and D.C.)—Pre-hospital 

triage criteria allowing for the bypass of non-designated 

hospitals

Federal Trauma–EMS Systems Program Survey, HRSA.

1-13f Trauma care systems (no. States and D.C.)—Standardized 

inter-hospital transfer protocols

Federal Trauma–EMS Systems Program Survey, HRSA.

1-13g Trauma care systems (no. States and D.C.)—Policies 

describing the types of patients who should be transferred

Federal Trauma–EMS Systems Program Survey, HRSA.

1-13h Trauma care systems (no. States and D.C.)—Process to 

monitor and evaluate trauma system outcomes

Federal Trauma–EMS Systems Program Survey, HRSA.

1-13i Trauma care systems (no. States and D.C.)—Trauma system 

plan

Federal Trauma–EMS Systems Program Survey, HRSA.

1-14a Special needs of children (no. States and D.C.)—Pediatric 

protocols for online medical direction

Emergency Medical Services for Children Annual Grantees Survey, 

HRSA.

1-14b Special needs of children (no. States and D.C.)—Pediatric 

guidelines for emergency and critical care

Emergency Medical Services for Children Annual Grantees Survey, 

HRSA.

1-15a Lack of access to home health care among persons with longterm care needs (age adjusted, 65+ years)National Health Interview Survey (NHIS), CDC, NCHS.

1-15b Lack of access to adult day care among persons with longterm care needs (age adjusted, 65+ years)National Health Interview Survey (NHIS), CDC, NCHS.

1-15c Lack of access to assisted living among persons with longterm care needs (age adjusted, 65+ years)National Health Interview Survey (NHIS), CDC, NCHS.

1-15d Lack of access to nursing home care services among persons 

with long-term care needs (aged adjusted, 65+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

1-16 Pressure ulcers among nursing home residents (current 

diagnoses per 1,000 residents)

National Nursing Home Survey (NNHS), CDC, NCHS.
1-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 1-1. Progress Toward Target Attainment for Focus Area 1: Access to Quality Health Services

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

1-1. Persons with health insurance (<65 years) 0.0% 100% 83%

(1997)

83%

(2008)

0 No 0.0%

1-3c. Counseling about smoking cessation 

(age adjusted, smokers 18+ years) 

30.8% 66% 53%

(2000)

57%

(2005)

4 Yes 7.5%

1-3f. Counseling about unintended pregnancy 

(females 15–44 years)

 6.5% 50% 19%

(1995)

21%

(2006–08)

2 Not tested 10.5%

1-4. Source of ongoing care

a. All ages 96% 87%

(1998)

86%

(2008)

-1 Yes -1.1%

b. Children and adolescents (<18 years) 0.0% 97% 94%

(1998)

94%

(2008)

0 No 0.0%

c. Adults (18+ years) 96% 85%

(1998)

84%

(2008)

-1 Yes -1.2%

1-5. Persons with a usual primary care provider 85% 77%

(1996)

76%

(2007)

-1 No -1.3%

1-6. Diffi culties or delays in obtaining needed 

health care (families)

25.0% 9% 21%

(2002)

18%

(2007)

-3 Yes -14.3%

1-7. Medical doctor (M.D. degree)

a. Counseling for health promotion and 

disease prevention

200.0% 87% 79%

(2003–04)

95%

(2007–08)

16 Not tested 20.3%

b. Cultural diversity 133.3% 96% 87%

(1999–2000)

99%

(2007–08)

12 Not tested 13.8%

Osteopathic medical doctor (D.O. degree)

c. Counseling for health promotion and 

disease prevention

100.0% 100% 95%

(2003–04)

100%

(2009)

5 Not tested 5.3%

d. Cultural diversity 1,525.0% 39% 35%

(2003–04)

96%

(2009)

61 Not tested 174.3%

Baccalaureate-level nurse (B.S.N., B.A., 

or B.S. degree)

e. Counseling for health promotion and 

disease prevention

88.9% 100% 91%

(1999)

99%

(2008)

8 Not tested 8.8%

f. Cultural diversity 0.0% 100% 98%

(1999)

98%

(2008)

0 Not tested 0.0%

Nurse Practitioner (M.S., M.S.N., 

or D.N.P. degree)

g. Counseling for health promotion and 

disease prevention

33.3% 100% 94%

(2000–01)

96%

(2008)

2 Not tested 2.1%

h. Cultural diversity 0.0% 100% 97%

(2000–01)

97%

(2008)

0 Not tested 0.0%

Moved away from target LEGEND 1 Moved toward target Met or exceeded target
1 • ACCESS TO QUALITY HEALTH SERVICES 1-13

Figure 1-1. Progress Toward Target Attainment for Focus Area 1: Access to Quality Health Services (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

1-8. Racial and ethnic representation in 

health professions

a. American Indian or Alaska Native 25.0% 1.0% 0.6%

(1996–97)

0.7%

(2008–09)

0.1 Not tested 16.7%

b. Asian or Pacifi c Islander Target exceeded at 

baseline and fi nal 4.0% 16.3%

(1996–97)

21.2%

(2008–09)

4.9 Not tested 30.1%

c. Black or African American 13.0% 6.5%

(1996–97)

6.4%

(2008–09)

-0.1 Not tested -1.5%

d. Hispanic or Latino 8.8% 12.0% 5.2%

(1996–97)

5.8% 

(2008–09)

0.6 Not tested 11.5%

Racial and ethnic representation 

in Nursing

e. American Indian or Alaska Native 66.7% 1.0% 0.7%

(1995–96)

0.9%

(2006–07)

0.2 Not tested 28.6%

f. Asian or Pacifi c Islander 262.5% 4.0% 3.2%

(1995–96)

5.3%

(2006–07)

2.1 Not tested 65.6%

g. Black or African American 65.6% 13.0% 6.9%

(1995–96)

10.9%

(2006–07)

4.0 Not tested 58.0%

h. Hispanic or Latino 36.0% 12.0% 3.4%

(1995–96)

6.5%

(2006–07)

3.1 Not tested 91.2%

Racial and ethnic representation 

in Medicine

i. American Indian or Alaska Native 33.3% 1.0% 0.7%

(1996–97)

0.8% 

(2008–09)

0.1 Not tested 14.3%

j. Asian or Pacifi c Islander Target exceeded at 

baseline and fi nal 4.0% 16.0%

(1996–97)

21.1%

(2008–09)

5.1 Not tested 31.9%

k. Black or African American 13.0% 7.0%

(1996–97)

6.5%

(2008–09)

-0.5 Not tested -7.1%

l. Hispanic or Latino 16.4% 12.0% 5.9%

(1996–97)

6.9%

(2008–09)

1.0 Not tested 16.9%

Racial and ethnic representation 

in Dentistry

m. American Indian or Alaska Native 0.0% 1.0% 0.5%

(1996–97)

0.5%

(2007–08)

0.0 Not tested 0.0%

n. Asian or Pacifi c Islander Target exceeded at 

baseline and fi nal 4.0% 19.5%

(1996–97)

23.4%

(2007–08)

3.9 Not tested 20.0%

o. Black or African American 0.0% 13.0% 5.1%

(1996–97)

5.1%

(2007–08)

0.0 Not tested 0.0%

p. Hispanic or Latino 11.9% 12.0% 5.3%

(1996–97)

6.1%

(2007–08)

0.8 Not tested 15.1%
1-14 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 1-1. Progress Toward Target Attainment for Focus Area 1: Access to Quality Health Services (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

Racial and ethnic representation 

in Pharmacy

q. American Indian or Alaska Native 33.3% 1.0% 0.4%

(1996–97)

0.6%

(2008–09)

0.2 Not tested 50.0%

r. Asian or Pacifi c Islander Target exceeded at 

baseline and fi nal 4.0% 17.5%

(1996–97)

21.2% 

(2008–09)

3.7 Not tested 21.1%

s. Black or African American 8.2% 13.0% 5.7%

(1996–97)

6.3%

(2008–09)

0.6 Not tested 10.5%

t. Hispanic or Latino 6.0% 12.0% 3.6%

(1996–97)

4.1%

(2008–09)

0.5 Not tested 13.9%

1-9a. Hospitalization for pediatric asthma 

(admissions per 10,000 population, 

<18 years) 

142.1% 17.3 23.0

(1996)

14.9

(2008)

-8.1 Yes -35.2%

1-9b. Hospitalization for uncontrolled diabetes 

(admissions per 10,000 population, 

18–64 years)

5.4 7.2

(1996)

8.7

(2008)

1.5 Yes 20.8%

1-9c. Hospitalization for immunization-preventable pneumonia or infl uenza (admissions 

per 10,000 population, 65+ years)

61.5% 7.9 10.5

(1996)

8.9

(2008)

-1.6 Yes -15.2%

1-12. Single toll-free number for poison 

control centers

100.0% 100% 15%

(1999)

100%

(2005)

85 Not tested 566.7%

1-13. Trauma care systems (no. States and D.C.)

a. Presence of active multidisciplinary 

trauma advisory committee 

77.3% 51 29

(2002)

46

(2005)

17 Not tested 58.6%

b. Defi ned process for designing trauma 

 centers 

29.4% 51 34

(2002)

39

(2005)

5 Not tested 14.7%

e. Pre-hospital triage criteria allowing for 

the bypass of non-designated hospitals 

16.7% 51 27

(2002)

31

(2005)

4 Not tested 14.8%

f. Standardized inter-hospital transfer 

protocols 

28.6% 51 23

(2002)

31

(2005)

8 Not tested 34.8%

i. Trauma system plan 78.9% 51 32

(2002)

47

(2005)

15 Not tested 46.9%

1-14. Special needs of children (no. States 

and D.C.)

a. Pediatric protocols for online 

medical direction

78.8% 51 18

(1997)

44

(2002)

26 Not tested 144.4%

b. Pediatric guidelines for emergency and 

critical care 

75.0% 51 11

(1997)

41

(2003)

30 Not tested 272.7%

1-16. Pressure ulcers among nursing home 

residents (current diagnoses per 

1,000 residents) 

8 16

(1997)

20

(2004)

4 No 25.0%
1 • ACCESS TO QUALITY HEALTH SERVICES 1-15

Figure 1-1. Progress Toward Target Attainment for Focus Area 1: Access to Quality Health Services (continued)

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 1-3a, 1-3b, 1-3d, 1-3g, 1-3h, 1-10, 1-11a through g, 1-13c, 1-13d, 1-13g, 1-13h, and 1-15a 

through d. Objectives 1-2 and 1-3e were deleted at the Midcourse Review.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

DATA SOURCES

1-1. National Health Interview Survey (NHIS), CDC, NCHS.

1-3c. National Health Interview Survey (NHIS), CDC, NCHS. 

1-3f. National Survey of Family Growth (NSFG), CDC, NCHS.

1-4a–c. National Health Interview Survey (NHIS), CDC, NCHS.

1-5–1-6. Medical Expenditure Panel Survey (MEPS), AHRQ.

1-7a–b. Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaire, Association of American Medical Colleges.

1-7c–d. Annual Report on Osteopathic Medical Education, American Association of Colleges of Osteopathic Medicine.

1-7e–f. Special Healthy People Survey of Entry-Level Baccalaureate Nursing School Curriculum, formerly Survey on Women’s Health in the 

Entry-Level Baccalaureate Nursing School Curriculum, American Association of Colleges of Nursing.

1-7g–h. Collaborative Curriculum Survey, American Association of Colleges of Nursing and National Organization of Nurse Practitioner 

Faculties.

1-8a–d. Survey of Predoctoral Dental Educational Institutions, American Dental Association; Profi le of Pharmacy Students, American 

Association of Colleges of Pharmacy; AAMC Data Book, Association of American Medical Colleges; Annual Data Report, Association of 

Schools of Public Health.

1-8e–h. Annual Survey of RN (Registered Nurse) Programs, National League for Nursing, Center for Research in Nursing Education and 

Community Health.

1-8i–l. AAMC Data Book: Statistical Information Related to Medical Schools and Teaching Hospitals, Association of American Medical Colleges.

1-8m–p. Survey of Predoctoral Dental Educational Institutions, American Dental Association.

1-8q–t. Profi le of Pharmacy Students, American Association of Colleges of Pharmacy.

1-9a–c. Healthcare Cost and Utilization Project (HCUP), AHRQ.

1-12. American Association of Poison Control Centers Survey, U.S. Poison Control Centers.

1-13a–b. Federal Trauma-EMS Systems Program Survey, HRSA.

1-13e–f. Federal Trauma-EMS Systems Program Survey, HRSA.

1-13i. Federal Trauma-EMS Systems Program Survey, HRSA.

1-14a–b. Emergency Medical Services for Children Annual Grantees Survey, HRSA.

1-16. National Nursing Home Survey (NNHS), CDC, NCHS.
1-16 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 1-2. Health Disparities Table for Focus Area 1: Access to Quality Health Services

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Income Location Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexUrban or metropolitanRural or nonmetropolitanPersons with disabilitiesPersons without disabilities

1-1. Persons with health insurance (<65 

years) (1997, 2008)1 

 B ii B   B  B B

1-3a. Counseling about physical activity or 

exercise (age adjusted, 18+ years) 

(2001)

B B B B B B B

1-3b. Counseling about diet and nutrition (age 

adjusted, 18+ years) (2001) B B B B B B

1-3c. Counseling about smoking cessation 

(age adjusted, smokers 18+ years) 

(2000, 2005)

b B B Bi B B B B

1-3d. Counseling about risky drinking (age 

adjusted, 18+ years) (2001) B B B B B B B

1-3f. Counseling about unintended pregnancy (females 15–44 years) (1995, 

2006–08)2

Bi Bi B

1-3h. Counseling about management of 

menopause (females 45–57 years) 

(2001)

B B B B B B

1-4a. Source of ongoing care— 

All ages (1998, 2008)1 B ii B  B  B B

b. Source of ongoing care— 

Children and adolescents (<18 years) 

(1998, 2008)1

Bi

c. Source of ongoing care— 

Adults (18+ years) (1998, 2008)1   B B   B  B B

1-5. Persons with a usual primary care 

provider (1996, 2007)3 B B B B Biii ii

1-6. Difficulties or delays in obtaining needed 

health care (families) (2002, 2007) b B B B Bi iii Biii

1-9a. Hospitalization for pediatric asthma [admissions per 10,000 population (pop.), 

<18 years] (1996, 2008)

B

1-9b. Hospitalization for uncontrolled diabetes 

(admissions per 10,000 pop., 18–64 

years) (1996, 2008)

B

1-9c. Hospitalization for immunization-preventable 

pneumonia or influenza (admissions per 

10,000 pop., 65+ years) (1996, 2008)

B 

1-10. Delay or difficulty in getting emergency 

care (age-adjusted, 18+ years) (2001) B B B B B B
1 • ACCESS TO QUALITY HEALTH SERVICES 1-17

Figure 1-2. Health Disparities Table for Focus Area 1: Access to Quality Health Services (continued)

Race and Ethnicity Sex Education Income Location Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexUrban or metropolitanRural or nonmetropolitanPersons with disabilitiesPersons without disabilities

1-15a. Lack of access to home health care 

among persons with long-term care 

needs (age adjusted, 65+ years) (2001)

1-15b. Lack of access to adult day care among 

persons with long-term care needs (age 

adjusted, 65+ years) (2001)

1-15c. Lack of access to assisted living among 

persons with long-term care needs (age 

adjusted, 65+ years) (2001)

1-15d. Lack of access to nursing home care 

among persons with long-term care 

needs (age adjusted, 65+ years) (2001)

1-16. Pressure ulcers among nursing home 

residents (current diagnoses per 1,000 

residents) (1997, 2004)4

iv B B iv v v

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 1-3g, 

1-7a through h, 1-8a through t, 1-11a through g, 1-12, 1-13a through i, and 1-14a and b. Objectives 1-2 and 1-3e were deleted at Midcourse Review.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

Measures of variability were available for all objectives in this table. Thus, the variability of best group rates was assessed, and statistical significance was tested. 

Disparities of 10% or more are displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time 

are indicated by arrows when the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

LEGEND

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.
1-18 HEALTHY PEOPLE 2010 FINAL REVIEW

FOOTNOTES

1 Baseline data by race and ethnicity are for 1999.

2 Baseline data by disability status are for 2006–08. 3 Baseline data by race and ethnicity are for 2002. 4 Baseline data by disability status are for 2004. i

 The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

ii Change in the summary index cannot be assessed. See Technical Appendix. iiiFor this objective, only activity limitations are considered as disabilities.

iv Reliability criterion for best group rate not met, or data available for only one group, at baseline. Change in disparity cannot be assessed. See Technical Appendix. v For this objective, only severe disabilities are considered as disabilities.

DATA SOURCES

1-1. National Health Interview Survey (NHIS), CDC, NCHS.

1-3a–d. National Health Interview Survey (NHIS), CDC, NCHS.

1-3f. National Survey of Family Growth (NSFG), CDC, NCHS.

1-3h. National Health Interview Survey (NHIS), CDC, NCHS.

1-4a–c. National Health Interview Survey (NHIS), CDC, NCHS.

1-5–1-6. Medical Expenditure Panel Survey (MEPS), AHRQ.

1-9a–c. Healthcare Cost and Utilization Project (HCUP), AHRQ.

1-10. National Health Interview Survey (NHIS), CDC, NCHS.

1-15a–d. National Health Interview Survey (NHIS), CDC, NCHS.

1-16. National Nursing Home Survey (NNHS), CDC, NCHS.

Figure 1-2. Health Disparities Table for Focus Area 1: Access to Quality Health Services (continued)
1 • ACCESS TO QUALITY HEALTH SERVICES 1-19 Figure 1-3. Persons With Health Insurance (Age <65), 2008 Healthy People 2010 objective 1-1 • Target = 100 percent Perce

No sta

NOTES: Data are age adjusted to the 2000 standard population. Rates are displayed by a Jenks classification for U.S. states. National data for the objective come from the Nand are the basis for setting the target. State data from BRFSS may not be comparable with national data from NHIS. The U.S. rate in 2008 from NHIS was 83.3%. The rate fo2008 was 82.0%. SOURCE: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP. 

Arthritis, Osteoporosis, 

and Chronic Back 

Conditions

CHAPTER 2

Co-Lead Agencies

Centers for Disease Control and Prevention

National Institutes of Health

Contents

Goal ..................................................................................................2-3

Highlights ........................................................................................2-3

Summary of Progress.......................................................................2-4

Transition to Healthy People 2020..................................................2-5

Data Considerations.........................................................................2-5

Notes................................................................................................2-6

Comprehensive Summary of Objectives..........................................2-7

Progress Chart..................................................................................2-8

Health Disparities Table.................................................................2-10

Activity Limitations due to Arthritis, 2007—Map........................2-12

2 • Arthritis, Osteoporosis, and Chronic Bac k Conditions 2-3

GOAL:

Prevent illness and disability related to 

arthritis and other rheumatic conditions, 

osteoporosis, and chronic back conditions.

The objectives in this chapter measure the prevention of 

illness and disability related to arthritis, osteoporosis, and 

chronic back conditions. The arthritis objectives track 

a variety of pain, function, and intervention measures. 

The osteoporosis objectives track bone mineral 

density, a measure of the major risk factor for fractures. 

Hospitalizations for osteoporosis-related vertebral 

fractures are also monitored. Activity limitation due to 

chronic back conditions is used to measure the effects 

of chronic back pain.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this focus area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Some progress was made for objectives in this Focus 

Area during the past decade [1]. Twenty-three percent 

of the Arthritis, Osteoporosis, and Chronic Back 

Conditions objectives with data to measure progress 

moved toward or achieved their Healthy People 2010 

targets (Figure 2-1). However, statistically significant 

health disparities of 100% or more were observed 

among education and income groups (Figure 2-2), as 

discussed below [2].

Arthritis

〉 The proportion of overweight and obese adults aged 

18 and over with arthritis who received counseling 

for weight reduction (objective 2-4a) increased 

17.1% between 2002 and 2006, from 35% to 41% (age 

adjusted), moving toward the Healthy People 2010 

target of 46%.

〉 Statistically significant disparities of 100% or more 

were observed in the unemployment rate among 

adults with arthritis (objective 2-5a).

 Among education groups, persons with at 

least some college education had the lowest 

(best) unemployment rate among persons with 

arthritis aged 25–64, 27% (age adjusted) in 2008, 

whereas the rate for persons with less than a 

high school education was 61% (age adjusted). 

The rate for the population with less than a high 

school education was nearly two and a half times 

the best group rate [2].

 Among income groups, the middle/high-income 

population had the lowest (best) unemployment 

rate among persons aged 18–64 with arthritis, 

23% (age adjusted) in 2008, whereas the poor and 

near-poor populations had rates of 69% and 51% 

(age adjusted), respectively. The rate for the poor 

population was three times the best group rate 

(that for the middle/high-income population), 

whereas the rate for the near-poor population 

was more than twice the best rate [2].

〉 Statistically significant disparities of 100% or more 

were also observed in the effect of arthritis on paid 

work among adults with arthritis (objective 2-5b).
2-4 HEALTHY PEOPLE 2010 FINAL REVIEW

 Among education groups, persons with at least 

some college education had the lowest (best) rate 

of effect of arthritis on paid work among persons 

with arthritis aged 25–64, 25% (age adjusted) in 

2006. The rate for persons with less than a high 

school education was 53% (age adjusted), more 

than twice the best group rate [2].

 Among income groups, the middle/high-income 

population had the lowest (best) rate of effect 

of arthritis on paid work among persons with 

arthritis aged 18–64, 24% (age adjusted) in 2006. 

The poor population had a rate of 58% (age 

adjusted), almost two and a half times the best 

group rate [2].

〉 Activity limitations due to arthritis (objective 2-2) 

varied by geographic area. In 2007, the states of 

Connecticut, Delaware, Hawaii, Illinois, Iowa, New 

Jersey, North Dakota, Pennsylvania, Rhode Island, 

Virginia, Utah, and Wyoming had rates that met or 

exceeded the Healthy People 2010 target. Alabama, 

Alaska, Georgia, Kentucky, Tennessee, and West 

Virginia had the highest rates (Figure 2-3).

Osteoporosis

〉 The prevalence of osteoporosis among adults aged 

50 and over (objective 2-9) declined 50.0% between 

1988–94 and 2005–08, from 12% to 6% (age adjusted), 

exceeding the Healthy People 2010 target of 10%.

Chronic Back Conditions

〉 Statistically significant disparities of 100% or more 

were observed for activity limitations among adults 

aged 18 and over with chronic back conditions 

(objective 2-11).

 Among racial and ethnic populations, the 

Hispanic or Latino population had the lowest 

(best) rate of activity limitations among adults 

with chronic back conditions, 26% (age adjusted) 

in 2008. Persons of two or more races had a rate 

of 80% (age adjusted), more than three times the 

best group rate [2].

 Among education groups, persons aged 25 and 

over with at least some college had the lowest 

(best) rate of activity limitations among adults 

with chronic back conditions, 27% (age adjusted) 

in 2008. The rate for persons with less than a high 

school education was 56% (age adjusted), more 

than twice the best group rate [2].

 Among income groups, the middle/high-income 

population had the lowest (best) rate of activity 

limitations among adults with chronic back 

conditions, 22% (age adjusted) in 2008, whereas 

the rates for the poor and near-poor populations 

were 72% and 49% (age adjusted), respectively. 

The rate for the poor population was nearly three 

and a half times the best group rate (that for the 

middle/high-income population), whereas the 

rate for the near-poor population was more than 

twice the best group rate [2].

Summary of Progress

〉 Figure 2-1 presents a quantitative assessment of 

progress in achieving the Healthy People 2010 

objectives for Arthritis, Osteoporosis, and Chronic 

Back Conditions [1]. Data to measure progress toward 

target attainment were available for all 13 objectives, 

although most objectives were only monitored over 4 

to 6 years. Of these:

 One objective (2-9) exceeded the Healthy People 

2010 target.

 Two objectives moved toward their targets. A 

statistically significant difference between the 

baseline and the final data points was observed 

for one of these objectives (2-4a); no significant 

difference was observed for the second objective 

(2-11).

 Three objectives (2-1, 2-4b, and 2-8) showed no 

change.

 Seven objectives moved away from their targets. 

A statistically significant difference between the 

baseline and the final data points was observed 

for two of these objectives (2-6 and 2-10). No 

significant differences were observed for the 

remaining five objectives (2-2, 2-3, 2-5a and b, 

and 2-7).

〉 Figure 2-2 displays health disparities in Arthritis, 

Osteoporosis, and Chronic Back Conditions from 

the best group rate for each characteristic at the 

most recent data point [2]. It also displays changes 

in disparities from baseline to the most recent data 

point [3].

 Of the seven objectives with statistically 

significant racial and ethnic health disparities of 

10% or more, the non-Hispanic white population 

had the best rate for three objectives (2-5b, 2-6, 

and 2-7). The Hispanic or Latino population had 

the best rate for two objectives (2-4b and 2-11); 

and the Asian (objective 2-1) and non-Hispanic 

black (objective 2-4a) populations had the best 

rate for one objective each.

 Females had better rates than males for three of 

the four objectives with statistically significant 

health disparities of 10% or more by sex (objectives 

2-4a, 2-4b, and 2-7). Males had a better rate than 

females for the fourth objective (2-5a).
2 • Arthritis, Osteoporosis, and Chronic Back Conditions 2-5

 Persons with at least some college education had 

the best rate for all five of the objectives with 

statistically significant health disparities of 10% 

or more by education level (objectives 2-1, 2-2, 

2-5a and b, and 2-11).

 Persons with middle/high incomes had the best 

rate for five of the six objectives with statistically 

significant health disparities of 10% or more by 

income (objectives 2-1, 2-2, 2-5a and b, and 2-11). 

The poor and near-poor populations both had 

the best rate for the sixth objective (2-4a).

 Health disparities of 100% or more were observed 

for three objectives: the unemployment rate 

among adults with arthritis (objective 2-5a), the 

effect of arthritis on paid work among adults with 

arthritis (objective 2-5b), and activity limitations 

due to chronic back conditions (objective 2-11). 

These disparities are discussed in the Highlights, 

above.

Transition to Healthy People 

2020

For Healthy People 2020, the focus of the Arthritis, 

Osteoporosis, and Chronic Back Conditions Topic 

Area has been expanded to include more arthritisspecific activity limitations and other health outcomes 

associated with arthritis and osteoporosis. Consistent 

with Healthy People 2010, the primary goal of the 

Healthy People 2020 objectives is to prevent illness 

and disability related to arthritis and other rheumatic 

conditions, osteoporosis, and chronic back conditions. 

See HealthyPeople.gov for a complete list of Healthy 

People 2020 topics and objectives.

The Healthy People 2020 Arthritis, Osteoporosis, and 

Chronic Back Conditions Topic Area objectives can be 

grouped into four sections:

〉 Arthritis-related pain and impact

〉 Arthritis health system interventions

〉 Osteoporosis

〉 Chronic back conditions.

The differences between the Healthy People 2010 

objectives and those included in Healthy People 2020 are 

summarized below:

〉 The Healthy People 2020 Arthritis, Osteoporosis, and 

Chronic Back Condition Topic Area has a total of 18 

objectives, whereas the Healthy People 2010 Focus 

Area had 13 objectives.

 Eleven Healthy People 2010 objectives were 

retained “as is” [4]. Among adults with arthritis, 

retained objectives tracked joint pain (objective 

2-1), activity limitations due to arthritis (objective 

2-2), personal care limitations (objective 2-3), 

counseling for weight reduction (objective 2-4a), 

counseling for physical activity or exercise 

(objective 2-4b), unemployment (objective 2-5a), 

effect of arthritis on paid work (objective 2-5b), 

and arthritis education (objective 2-8). Other 

retained objectives include seeing a health care 

provider for chronic joint symptoms (objective 

2-7), prevalence of osteoporosis (objective 2-9), 

and activity limitations due to chronic back 

conditions (objective 2-11).

 Two Healthy People 2010 objectives were 

archived: racial disparity in total knee 

replacements (objective 2-6) and hospitalization 

for osteoporosis-associated vertebral fractures 

(objective 2-10) [5].

 Two objectives (15-28a and b) that track 

hospitalizations for hip fractures among older 

adults (separately for females and males) were 

moved from the Healthy People 2010 Injury and 

Violence Prevention Focus Area to the Healthy 

People 2020 Arthritis, Osteoporosis, and Chronic 

Back Conditions Topic Area.

〉 Five new objectives were added to the Healthy People 

2020 Arthritis, Osteoporosis, and Chronic Back 

Conditions Topic Area:

 Four new objectives assess difficulty in 

performing specific joint-related activities 

among adults with arthritis: walking a quarter 

of a mile; walking up 10 steps without resting; 

stooping, bending or kneeling; and using fingers 

to grasp or handle small objects.

 A new objective assesses serious psychosocial 

distress among adults with arthritis.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Figure 2-3 (Activity Limitations due to Arthritis) 

presents state-level data from the Behavioral Risk Factor 

Surveillance System (BRFSS). National data for these 

objectives come from the National Health Interview 

Survey (NHIS) and are the basis for setting the targets. 

BRFSS data may not be comparable with the national 

data from NHIS.

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 
2-6 HEALTHY PEOPLE 2010 FINAL REVIEW

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below, for additional information.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

Notes

1. Displayed in the Progress Chart (Figure 2-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 2-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities 

Table (Figure 2-2). Disparity from the best group 

rate is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28%) of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 2-2 footnotes, as well as the Technical 

Appendix, for more detail.
2 • Arthritis, Osteoporosis, and Chronic Back Conditions 2-7

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 2-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

5. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.

Comprehensive Summary of Objectives: Arthritis, Osteoporosis, and 

Chronic Back Conditions

Objective Description Data Source or Objective Status

2-1 Mean level of joint pain among adults with arthritis (age 

adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

2-2 Activity limitations due to arthritis (age adjusted, 18+ years) National Health Interview Survey (NHIS), CDC, NCHS.

2-3 Personal care limitations in adults with arthritis (age adjusted, 

18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

2-4a Overweight and obese adults with arthritis who receive 

counseling for weight reduction (age adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

2-4b Adults with arthritis who receive counseling for physical activity 

or exercise (age adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

2-5a Unemployment rate among adults with arthritis (age adjusted, 

18–64 years)

National Health Interview Survey (NHIS), CDC, NCHS.

2-5b Effect of arthritis on paid work among adults with arthritis (age 

adjusted, 18–64 years)

National Health Interview Survey (NHIS), CDC, NCHS.

2-6 Racial disparity in total knee replacement (black vs. white, 65+ 

years)

Medicare data, CMS.

2-7 Adults with chronic joint symptoms who saw a health care 

provider for their symptoms (age adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

2-8 Arthritis education among adults with arthritis (age adjusted, 

18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

2-9 Prevalence of osteoporosis (age adjusted, 50+ years) National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

2-10 Hospitalization for osteoporosis-associated vertebral fractures 

(age adjusted, per 10,000 population, 65+ years)

National Hospital Discharge Survey (NHDS), CDC, NCHS.

2-11 Activity limitations due to chronic back conditions (age 

adjusted, per 1,000 population, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.
2-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 2-1. progress toward target Attainment for Focus Area 2: Arthritis, Osteoporosis and Chronic 

Back Conditions

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

2-1. Mean level of joint pain among adults with 

arthritis (age adjusted, 18+ years)

 0.0% 5.3 5.6

(2002)

5.6

(2006)

0 No 0.0%

2-2. Activity limitations due to arthritis 

(age adjusted, 18+ years)

33% 36%

(2002)

39%

(2008)

3 No 8.3%

2-3. Personal care limitations in adults with 

arthritis (age adjusted, 18+ years)

1.5% 2.1%

(2002)

2.7%

(2008)

0.6 No 28.6%

2-4a. Overweight and obese adults with arthritis 

who receive counseling for weight 

reduction (age adjusted, 18+ years)

54.5% 46% 35%

(2002)

41%

(2006)

6 Yes 17.1%

2-4b. Adults with arthritis who receive 

counseling for physical activity or exercise 

(age adjusted, 18+ years)

 0.0% 67% 52%

(2002)

52%

(2006)

0 No 0.0%

2-5a. Unemployment rate among adults with 

arthritis (age adjusted, 18–64 years)

27% 33%

(2002)

35%

(2008)

2 No 6.1%

2-5b. Effect of arthritis on paid work among 

adults with arthritis (age adjusted, 

18–64 years)

23% 30%

(2002)

33%

(2006)

3 No 10.0%

2-6. Racial disparity in total knee replacement 

(black vs. white, 65+ years)

0.0% -35.9%

(2002)

-38.4%

(2006)

-2.5 Yes 7.0%

2-7. Adults with chronic joint symptoms who 

saw a health care provider for their 

symptoms (age adjusted, 18+ years)

77% 73%

(2002)

72%

(2008)

-1 No -1.4%

2-8. Arthritis education among adults with 

arthritis (age adjusted, 18+ years)

 0.0% 13% 11%

(2002)

11%

(2006)

0 No 0.0%

2-9. Prevalence of osteoporosis (age adjusted, 

50+ years)

300.0% 10% 12%

(1988–94)

6%

(2005–08)

-6 Yes -50.0%

2-10. Hospitalization for osteoporosis-associated 

vertebral fractures (age adjusted, per 

10,000 population, 65+ years)

14.0 17.5

(1998)

23.4

(2007)

5.9 Yes 33.7%

2-11. Activity limitations due to chronic back 

conditions (age adjusted, per 1,000 

population, 18+ years)

14.3% 25 32

(1997)

31

(2008)

-1 No -3.1%

Moved away from target LeGend 1 Moved toward target Met or exceeded target
2 • Arthritis, Osteoporosis, and Chronic Back Conditions 2-9

Figure 2-1. progress toward target Attainment for Focus Area 2: Arthritis, Osteoporosis and Chronic 

Back Conditions (continued)

NOTES

See the reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 

tracking data.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See technical Appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See technical Appendix for more information. 

5 Final value – Baseline value Percent change = × 100.

Baseline value

DATA SOURCES

2-1–2-3. National Health Interview Survey (NHIS), CDC, NCHS.

2-4a–b. National Health Interview Survey (NHIS), CDC, NCHS.

2-5a–b. National Health Interview Survey (NHIS), CDC, NCHS.

2-6. Medicare data, CMS.

2-7–2-8. National Health Interview Survey (NHIS), CDC, NCHS.

2-9. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

2-10. National Hospital Discharge Survey (NHDS), CDC, NCHS.

2-11. National Health Interview Survey (NHIS), CDC, NCHS.
2-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 2-2. Health Disparities Table for Focus Area 2: Arthritis, Osteoporosis, and Chronic Back Conditions

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Income

Population-based objectiveAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary index

2-1. Mean level of joint pain among adults 

with arthritis (age adjusted, 18+ years) 

(2002, 2006)

Bi ii B  B  B

2-2. Activity limitations due to arthritis (age 

adjusted, 18+ years) (2002, 2008) b Bi B B B B

2-3. Personal care limitations in adults with 

arthritis (age adjusted, 18+ years) 

(2002, 2008)

2-4a. Overweight and obese adults with arthritis 

who receive counseling for weight reduction 

(age adjusted, 18+ years) (2002, 2006)

B ii B  Bi B Bi

2-4b. Adults with arthritis who receive counseling for physical activity or exercise (age 

adjusted, 18+ years) (2002, 2006)

Bi ii B Bi B B

2-5a. Unemployment rate among adults with 

arthritis (age adjusted, 18–64 years) 

(2002, 2008)

 B ii B B B

2-5b. Effect of arthritis on paid work among 

adults with arthritis (age adjusted, 

18–64 years) (2002, 2006)

b B B B B

2-6. Racial disparity in total knee replacement (black vs. white, 65+ years) 

(2000, 2006)

B

2-7. Adults with chronic joint symptoms who saw 

a health care provider for their symptoms 

(age adjusted, 18+ years) (2002, 2008)

b b Bi B  Bi B Bi B

2-8. Arthritis education among adults with 

arthritis (age adjusted, 18+ years) 

(2002, 2006)

Bi Bi B Bi B

2-9. Prevalence of osteoporosis (age 

adjusted, 50+ years) (1988–94, 

2005–08)

 iii,

iv b B

2-10. Hospitalization for osteoporosis-associated 

vertebral fractures (age adjusted, per 10,000 

population, 65+ years) (1998, 2007)

v v

2-11. Activity limitations due to chronic back 

conditions (age adjusted, per 1,000 

population, 18+ years) (1997, 2008)1

b B B B B

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. 

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.
2 • Arthritis, Osteoporosis, and Chronic Back Conditions 2-11

Figure 2-2. Health Disparities Table for Focus Area 2: Arthritis, Osteoporosis, and Chronic Back Conditions (continued)

Measures of variability were available for all objectives in this table. Thus, the variability of best group rates was assessed, and statistical significance was tested. 

Disparities of 10% or more are displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time 

are indicated by arrows when the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

L Ge end

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

1 Baseline data by race and ethnicity are for 1999. 

i The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

ii Change in the summary index cannot be assessed. See Technical Appendix. iiiData are for Mexican American. 

iv Reliability criterion for best group rate not met, or data available for only one group, at baseline. Change in disparity cannot be assessed. See Technical Appendix. v Data include persons of Hispanic origin.

DATA SOURCES

2-1–2-3. National Health Interview Survey (NHIS), CDC, NCHS.

2-4a–b. National Health Interview Survey (NHIS), CDC, NCHS.

2-5a–b. National Health Interview Survey (NHIS), CDC, NCHS.

2-6. Medicare data, CMS.

2-7–2-8. National Health Interview Survey (NHIS), CDC, NCHS.

2-9. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

2-10. National Hospital Discharge Survey (NHDS), CDC, NCHS.

2-11. National Health Interview Survey (NHIS), CDC, NCHS.
HEALTHY PEOPLE 2010 FINAL REVIEW 2-12Figure 2-3. Activity Limitations due to Arthritis (Adults Aged 18+ With Diagnosed Arthritis), 2007 Healthy People 2010 objective 2-2 • Target = 33 percent Percen

Lowest states 

NOTES: Data are age adjusted to the 2000 standard population. The denominator for rates is adults aged 18 and over with doctor-diagnosed arthritis. Rates are displayed bU.S. states. National data for the objective come from the National Health Interview Survey (NHIS) and are the basis for setting the target. State data from BRFSS may not bNHIS. The U.S. rate in 2007 from NHIS was 39.0%. The rate for all states combined from BRFSS in 2007 was 36.8%. SOURCE: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP. 
Cancer

CHAPTER 3

Co-Lead Agencies

Centers for Disease Control and Prevention

National Institutes of Health

Contents

Goal ..................................................................................................3-3

Highlights ........................................................................................3-3

Summary of Progress.......................................................................3-4

Transition to Healthy People 2020..................................................3-5

Data Considerations.........................................................................3-6

References and Notes.......................................................................3-7

Comprehensive Summary of Objectives..........................................3-8

Progress Chart................................................................................3-10

Health Disparities Table.................................................................3-12

Overall Cancer Deaths, 2005–07—Map........................................3-14

Women who Received a Pap Test Within Past 3 Years,

2008—Map ................................................................................3-15

3 • Cancer 3-3

GOAL:

Reduce the number of new cancer cases, as 

well as the illness, disability, and death caused 

by cancer.

This chapter includes objectives that track cancer death 

rates, survival after diagnosis, provider counseling for 

preventive behaviors such as smoking cessation, limiting 

sun exposure, the use of effective cancer screening tests, 

and the availability of statewide cancer registries.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in objectives for 

this Focus Area during the past decade [1]. Over 

70% of the Cancer objectives with data to measure 

progress moved toward or achieved their Healthy 

People 2010 targets (Figure 3-1). However, for a 

number of objectives, statistically significant health 

disparities of 10% or more were observed among 

racial and ethnic populations, as well as by sex and 

education level (Figure 3-2) [2].

〉 Cancer deaths (objectives 3-1 through 3-8) declined 

for all cancer mortality objectives except melanoma 

deaths (objective 3-8). Prostate cancer deaths 

(objective 3-7) declined 24.9% between 1999 and 

2007, from 31.1 to 23.5 per 100,000 population (age 

adjusted), exceeding the 2010 target of 28.2 per 

100,000. The overall cancer death rate (objective 

3-1) declined 11.2% from 200.8 to 178.4 per 100,000 

population (age adjusted) over the same tracking 

period. The melanoma death rate rose 3.8% from 2.6 

to 2.7 per 100,000 population (age adjusted) over the 

same tracking period, moving away from the 2010 

target of 2.3 per 100,000. Disparities were observed 

for a number of population groups:

 Among racial and ethnic groups, the Asian or 

Pacific Islander population had the lowest (best) 

cancer death rates for five of the eight cancer 

mortality objectives (3-1, 3-3 through 3-5, and 

3-7). The Hispanic or Latino population had the 

best group rate for lung cancer (objective 3-2) 

and oropharyngeal cancer deaths (objective 3-6). 

The non-Hispanic black population had the best 

group rate for melanoma deaths (objective 3-8).

〉 With the exception of melanoma deaths (objective 

3-8), the non-Hispanic black population had rates 

that were at least 100% higher than the best rate 

for all cancer mortality objectives (objectives 3-1 

through 3-8) [2].

〉 The non-Hispanic white population had rates that 

were at least 100% higher than the best group rate for 

four mortality objectives: lung cancer (objective 3-2), 

female breast cancer (objective 3-3), prostate cancer 

(objective 3-7), and melanoma (objective 3-8) deaths 

[2].

〉 The American Indian or Alaska Native population 

had a melanoma death rate (1.0 death per 100,000 

population in 2007, age adjusted) that was twice 

the best group rate (that for the non-Hispanic black 

population, 0.5 deaths per 100,000, age adjusted) [2].
3-4 HEALTHY PEOPLE 2010 FINAL REVIEW

 Females had lower death rates than males for all 

five non-sex-specific cancer mortality objectives 

(objectives 3-1, 3-2, 3-5, 3-6, and 3-8). Male rates 

for oropharyngeal cancer (objective 3-6) and 

melanoma (objective 3-8) deaths were at least 

100% higher than the female rates.

 Among education groups, persons with at least 

some college education had the lowest (best) 

cancer death rates for six of the eight cancer 

mortality objectives (3-1, 3-2, and 3-4 through 

3-7). Persons with less than a high school 

education had the best rates for female breast 

cancer (objective 3-3) and melanoma (objective 

3-8) deaths. Persons with less than a high school 

education and high school graduates had rates 

of lung cancer (objective 3-2), cervical cancer 

(objective 3-4), and oropharyngeal cancer (objective 3-6) deaths that were at least 100% higher 

than the rates for persons with at least some 

college education.

〉 Overall cancer mortality (objective 3-1) varied by 

geographic region. Death rates for the period 2005–07 

were lower in the West than in the Midwest and 

Eastern U.S. Many of the health service areas with high 

death rates were in the South and in the Mississippi 

River Valley (Figure 3-3).

〉 The proportion of persons aged 50 and over who 

had ever received a proctoscopy, colonoscopy, or 

sigmoidoscopy (objective 3-12b) increased 48.6% 

between 1998 and 2008, from 37% to 55%, exceeding 

the Healthy People 2010 target of 50%.

〉 The proportion of women aged 18 and over who had 

ever received a Pap test (objective 3-11a) increased 

1.1% between 1998 and 2008, from 92% to 93%, 

moving toward the Healthy People 2010 target of 97%. 

However, the proportion who had been tested within 

the past 3 years (objective 3-11b) declined 3.8%, from 

79% to 76%, over the same tracking period, moving 

away from the 2010 target of 90%. Disparities were 

observed for a number of population groups, for 

example:

 Among racial and ethnic groups, the populations 

of non-Hispanic white women and of women of 

two or more races both had the highest (best) 

rate of ever receiving a Pap test, 95% each in 

2008, whereas the populations of American 

Indian or Alaska Native, Hispanic or Latino, and 

Asian women had rates of 90%, 89%, and 79%, 

respectively. When expressed as women who had 

never received a Pap test, the rate for American 

Indian or Alaska Native women was twice the 

rate for non-Hispanic white women; the rate for 

Hispanic or Latino women was more than twice 

that rate; and the rate for Asian women was more 

than four times that rate [2].

 Among education groups, women with at least 

some college education had the highest (best) 

rate of ever receiving a Pap test, 97% in 2008, 

whereas women with less than a high school 

education had a rate of 91%. When expressed as 

women who had never received a Pap test, women 

with less than a high school education had a rate 

that was three times the rate for women with at 

least some college education [2].

〉 The proportion of women who received a Pap test 

within the past 3 years varied by state. Delaware, 

Georgia, Massachusetts, and North Carolina had 

the highest proportions in 2008, whereas Arkansas, 

Illinois, Louisiana, Oklahoma, and a contiguous 

group of western states (Idaho, Montana, Nevada, 

Utah, and Wyoming) had the lowest proportions 

(Figure 3-4). No state met the Healthy People 2010 

target.

〉 Mammogram screening (objective 3-13) did not 

change between 1998 (baseline) and 2008 (most 

recent data point); in both years, 67% of women aged 

40 and over had received a mammogram within the 

past 2 years, below the Healthy People 2010 target of 

70%.

Summary of Progress

〉 Figure 3-1 presents a quantitative assessment of 

progress in achieving the Healthy People 2010 

objectives for Cancer [1]. Data to measure progress 

toward target attainment were available for 18 

objectives. Of these:

 Two objectives (3-7 and 3-12b) exceeded their 

Healthy People 2010 targets.

 Eleven objectives moved toward their targets. A 

statistically significant difference between the 

baseline and the final data points was observed 

for nine of these objectives (3-1 through 3-6, 

3-9b, 3-11, and 3-15). No significant difference 

was observed for one objective (3-9a), and data 

to test the significance of the difference were 

unavailable for one objective (3-14).

 One objective (3-13) showed no change.

 Four objectives moved away from their targets. 

A statistically significant difference between the 

baseline and final data points was observed for 

three of these objectives (3-8, 3-11b, and 3-12a). 

No significant difference was observed for the 

remaining objective (3-10h).

〉 Follow-up data were unavailable to measure progress 

for seven objectives (3-10a through g).

〉 Figure 3-2 displays health disparities in Cancer from 

the best group rate for each characteristic at the 
3 • Cancer 3-5

most recent data point [2]. It also displays changes 

in disparities from baseline to the most recent data 

point [3].

 Of the 14 objectives with statistically significant 

racial and ethnic health disparities of 10% or 

more, the Asian or Pacific Islander population 

had the best rate for five objectives (3-1, 3-3 

through 3-5, and 3-7), and the non-Hispanic 

white population for four objectives (3-11a, 3-12b, 

3-13, and 3-15). The non-Hispanic black and the 

Hispanic or Latino populations each had the best 

rate for three objectives (3-8, 3-11b, and 3-13; and 

3-2, 3-6, and 3-9b, respectively).

 Females had better rates than males for six of 

the seven objectives with statistically significant 

health disparities of 10% or more by sex 

(objectives 3-1, 3-2, 3-5, 3-6, 3-8, and 3-9b). Males 

had a better rate than females for the objective 

on ever receiving a proctoscopy, colonoscopy, or 

sigmoidoscopy (objective 3-12b).

 Of the 13 objectives with statistically significant 

health disparities of 10% or more by education 

level, persons with at least some college education 

had the best rate for 11 objectives (3-1, 3-2, 3-4 

through 3-7, 3-9b, 3-11a and b, 3-12b, and 3-13). 

Persons with less than a high school education 

had the lowest (best) rate for female breast 

cancer (objective 3-3) and melanoma (objective 

3-8) deaths.

 Persons with middle/high incomes had the best 

rates for all four objectives with statistically 

significant health disparities of 10% or more by 

income (objectives 3-11a and b, 3-12b, and 3-13).

 Persons living in urban or metropolitan areas had 

better rates than those living in rural areas for 

the two objectives with statistically significant 

health disparities of 10% or more by geographic 

location (objectives 3-11b and 3-13).

 Persons without disabilities had better rates 

than persons with disabilities for two of the 

three objectives with statistically significant 

health disparities of 10% or more by disability 

status (objectives 3-11b and 3-13). Persons 

with disabilities had a better rate than persons 

without disabilities for adults who used 

protective measures to protect against skin 

cancer (objective 3-9b).

 Health disparities of 100% or more were observed 

for several objectives among racial and ethnic 

populations, as well as by sex and education level. 

These are described in the Highlights, above.

Transition to Healthy People 

2020

For Healthy People 2020, the Cancer objectives have 

been expanded to include a broader range of measures 

than those presented in Healthy People 2010, reflecting 

the latest trends in cancer prevention and diagnosis. 

In addition to objectives on mortality, screening, 

counseling, survival, and cancer registries, the Healthy 

People 2020 Cancer Topic Area includes new objectives 

on cancer incidence, quality of life for cancer survivors, 

prevalence of sunburn, and use of artificial sources 

of ultraviolet light for tanning. See HealthyPeople.gov

for a complete list of Healthy People 2020 topics and 

objectives.

The Healthy People 2020 Cancer Topic Area objectives 

can be grouped into several sections:

〉 Mortality

〉 Incidence

〉 Registries

〉 Survivorship

〉 Screening and counseling.

The differences between the Healthy People 2010 

objectives and those included in Healthy People 2020 are 

summarized below:

〉 The Healthy People 2020 Cancer Topic Area has a 

total of 27 objectives, five of which are developmental, 

whereas the Healthy People 2010 Cancer Focus Area 

had 25 objectives [4].

〉 Seven Healthy People 2010 objectives, including six of 

the eight cancer mortality objectives (3-1, 3-3, 3-4, 3-6 

through 3-8) and the objective on adult protection 

against skin cancer (objective 3-9b), were retained 

“as is” [5].

〉 Thirteen Healthy People 2010 objectives were 

modified to create 11 Healthy People 2020 objectives 

[6].

 The objectives on lung cancer (objective 3-2) and 

colorectal cancer (objective 3-5) mortality were 

revised to match Surveillance Epidemiology and 

End Results (SEER) cause-of-death recodes [7].

 The objectives on adolescent protection against 

skin cancer (objective 3-9a), provider counseling 

on cancer screening (objectives 3-10f and g), 

cervical cancer screening (objective 3-11b), 

mammogram screening (objective 3-13), 

population-based cancer registries (objective 
3-6 HEALTHY PEOPLE 2010 FINAL REVIEW

3-14), and cancer survivorship (objective 3-15) 

were all modified to match the most recent 

available data or the latest screening guidelines.

 The objectives on fecal occult blood test 

(FOBT) (objective 3-12a) and sigmoidoscopy, 

colonoscopy, and proctoscopy (objective 3-12b) 

were combined into one objective on colorectal 

cancer screening (FOBT, sigmoidoscopy, and 

colonoscopy) to match the latest screening 

guidelines.

 Similarly, the objectives on provider counseling 

for FOBT (objective 3-10d) and sigmoidoscopy, 

colonoscopy, and proctoscopy (objective 3-10e) 

were combined into one objective on provider 

counseling for colorectal cancer screening.

〉 Five Healthy People 2010 Cancer objectives were 

either moved to other Healthy People 2020 topic 

areas or archived [8]. Counseling on smoking 

cessation (objectives 3-10a through c) and counseling 

on physical activity (objective 3-10h) were moved to 

the Healthy People 2020 Tobacco Use and Physical 

Activity topic areas, respectively. The objective on 

Pap tests ever received (objective 3-11a) was archived 

to match the latest screening guidelines.

〉 Nine new objectives were added to the Healthy 

People 2020 Cancer Topic Area:

 One developmental objective addresses the 

physical health-related quality of life of cancer 

survivors.

 Three new objectives track the incidence of 

certain cancers, namely invasive colorectal 

cancer, invasive uterine cervical cancer, and latestage breast cancer.

 One developmental objective addresses the 

proportion of men who have discussed with their 

health care provider whether to have a prostatespecific antigen (PSA) test to screen for prostate 

cancer.

 Two new objectives monitor the prevalence of 

sunburn, one for adolescents and one for adults.

 Two developmental objectives focus on use of 

artificial sources of ultraviolet light for tanning, 

one for adolescents and one for adults.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Figure 3-4 (Pap test received within past 3 years) 

presents state-level data from the Behavioral Risk 

Factor Surveillance System (BRFSS). National data for 

this objective come from the National Health Interview 

Survey (NHIS) and are the basis for setting the targets. 

BRFSS data may not be comparable with the national 

data from NHIS.

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Beginning in 2003, education data for mortality objectives 

3-1 through 3-8 from the National Vital Statistics System 

have been suppressed. The educational attainment item 

was changed in the new U.S. Standard Certificate of 

Death in 2003 to be consistent with the Census Bureau 

data and to improve the ability to identify specific types 

of educational degrees. Many states, however, are still 

using the 1989 version of the U.S. Standard Certificate of 

Death, which focuses on highest school grade completed. 

As a result, educational attainment data collected using 

the 2003 version are not comparable with data collected 

using the 1989 version [9].
3 • Cancer 3-7

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

References and Notes

1. Displayed in the Progress Chart (Figure 3-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 3-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities 

Table (Figure 3-2). Disparity from the best group 

rate is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 3-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 3-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

5. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

6. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.
3-8 HEALTHY PEOPLE 2010 FINAL REVIEW

7. Cancer mortality data in Healthy People 2020 have 

been recoded for consistency with cancer incidence 

and mortality data reported by U.S. Cancer Statistics 

(USCS), CDC and SEER, NIH, NCI, resulting in slight 

changes to definitions for lung and colorectal cancer 

between Healthy People 2010 and Healthy People 

2020. Specifications for the cancer mortality recodes 

can be found on the SEER website, available from 

http://seer.cancer.gov/codrecode.

8. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.

9. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. 

Deaths: Final data for 2007. National vital statistics 

reports; vol 58 no 19. Hyattsville, MD: National Center 

for Health Statistics. 2010. Available from http://www.

cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf.

Comprehensive Summary of Objectives: Cancer

Objective Description Data Source or Objective Status

3-1 Overall cancer deaths (age adjusted, per 100,000 population) National Vital Statistics System—Mortality (NVSS-M), CDC, 

NCHS.

3-2 Lung cancer deaths (age adjusted, per 100,000 population) National Vital Statistics System—Mortality (NVSS-M), CDC, 

NCHS.

3-3 Female breast cancer deaths (age adjusted, per 100,000 

population)

National Vital Statistics System—Mortality (NVSS-M), CDC, 

NCHS.

3-4 Cervical cancer deaths (age adjusted, per 100,000 

population)

National Vital Statistics System—Mortality (NVSS-M), CDC, 

NCHS.

3-5 Colorectal cancer deaths (age adjusted, per 100,000 

population)

National Vital Statistics System—Mortality (NVSS-M), CDC, 

NCHS.

3-6 Oropharyngeal cancer deaths (age adjusted, per 100,000 

population)

National Vital Statistics System—Mortality (NVSS-M), CDC, 

NCHS.

3-7 Prostate cancer deaths (age adjusted, per 100,000 

population)

National Vital Statistics System—Mortality (NVSS-M), CDC, 

NCHS.

3-8 Melanoma deaths (age adjusted, per 100,000 population) National Vital Statistics System—Mortality (NVSS-M), CDC, 

NCHS.

3-9a Sun exposure and skin cancer—Students who use protective 

measures (grades 9–12)

Youth Risk Behavior Surveillance System (YRBSS), CDC, 

NCCDPHP.

3-9b Sun exposure and skin cancer—Adults who use protective 

measures (age adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

3-10a Internist counseling about smoking cessation Survey of Physicians’ Attitudes and Practices in Early Cancer 

Detection, American Cancer Society.

3-10b Family physician counseling about smoking cessation Survey of Physicians’ Attitudes and Practices in Early Cancer 

Detection, American Cancer Society.

3-10c Dentist counseling about smoking cessation Survey of Current Issues in Dentistry, American Dental 

Association.

3-10d Primary care provider counseling about blood stool tests National Survey of Primary Care Physicians’ Recommendations 

and Practice for Breast, Cervical, Colorectal, and Lung Cancer 

Screening, NIH, NCI.

3-10e Primary care provider counseling about proctoscopic 

examinations

Survey of Physicians’ Attitudes and Practices in Early Cancer 

Detection, American Cancer Society.

3-10f Primary care provider counseling about mammograms National Survey of Primary Care Physicians’ Recommendations 

and Practice for Breast, Cervical, Colorectal, and Lung Cancer 

Screening, NIH, NCI.
3 • Cancer 3-9

Comprehensive Summary of Objectives: Cancer (continued)

Objective Description Data Source or Objective Status

3-10g Primary care provider counseling about Pap tests National Survey of Primary Care Physicians’ Recommendations 

and Practice for Breast, Cervical, Colorectal, and Lung Cancer 

Screening, NIH, NCI.

3-10h Primary care provider counseling about physical activity National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS.

3-11a Women receiving a Pap test—Ever received (age adjusted, 

18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

3-11b Women receiving a Pap test—Received within past 3 years 

(age adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

3-12a Colorectal cancer screening—Fecal occult blood test (FOBT) 

within past 2 years (age adjusted, 50+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

3-12b Colorectal cancer screening—Proctoscopy, colonoscopy, or 

sigmoidoscopy ever received (age adjusted, 50+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

3-13 Women receiving a mammogram within past 2 years (age 

adjusted, 40+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

3-14 Statewide cancer registries (no. States and D.C.) National Program of Cancer Registries (NPCR), CDC, NCCDPHP.

3-15 Persons living 5+ years after a diagnosis of cancer Surveillance, Epidemiology, and End Results (SEER) Program, NIH, 

NCI.
3-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 3-1. Progress Toward Target attainment for Focus area 3: Cancer

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

3-1. Overall cancer deaths (age adjusted, 

per 100,000 population)

53.1% 158.6 200.8

(1999)

178.4

(2007)

-22.4 Yes -11.2%

3-2. Lung cancer deaths (age adjusted, 

per 100,000 population) 

40.2% 43.3 55.5

(1999)

50.6

(2007)

-4.9 Yes -8.8%

3-3. Female breast cancer deaths (age 

adjusted, per 100,000 population)

69.8% 21.3 26.6

(1999)

22.9

(2007)

-3.7 Yes -21.1%

3-4. Cervical cancer deaths (age adjusted, 

per 100,000 population)

50.0% 2.0 2.8

(1999)

2.4

(2007)

-0.4 Yes -14.3%

3-5. Colorectal cancer deaths (age adjusted, 

per 100,000 population)

55.6% 13.7 20.9

(1999)

16.9

(2007)

-4.0 Yes -19.1%

3-6. Oropharyngeal cancer deaths (age 

adjusted, per 100,000 population)

66.7% 2.4 2.7

(1999)

2.5

(2007)

-0.2 Yes -7.4%

3-7. Prostate cancer deaths (age adjusted, 

per 100,000 population)

251.6% 28.2 31.1

(1999)

23.5

(2007)

-7.6 Yes -24.9%

3-8. Melanoma deaths (age adjusted, 

per 100,000 population)

2.3 2.6

(2000)

2.7

(2007)

0.1 Yes 3.8%

3-9. Sun exposure and skin cancer 

a. Students who use protective measures 

(grades 9–12) 

25.0% 28% 24%

(2005)

25%

(2007)

1 No 4.2%

b. Adults who use protective measures

(age adjusted, 18+ years) 

10.0% 85% 65%

(2005)

67%

(2008)

2 Yes 3.1%

3-10h. Primary care provider counseling about 

physical activity

85% 12%

(1998)

10%

(2007)

-2 No -16.7%

3-11. Women receiving a Pap test

a. Ever received (age adjusted, 18+ years) 20.0% 97% 92%

(1998)

93%

(2008)

1 Yes 1.1%

b. Received within past 3 years 

(age adjusted, 18+ years)

90% 79%

(1998)

76%

(2008)

-3 Yes -3.8%

3-12. Colorectal cancer screening

a. Fecal occult blood test (FOBT) within past 

2 years (age adjusted, 50+ years)

33% 24%

(2000)

15%

(2008)

-9 Yes -37.5%

b. Proctoscopy, colonoscopy, or 

sigmoidoscopy ever received 

(age adjusted, 50+ years)

138.5% 50% 37%

(1998)

55%

(2008)

18 Yes 48.6%

3-13. Women receiving a mammogram within 

past 2 years (age adjusted, 40+ years)

 0.0% 70% 67%

(1998)

67%

(2008)

0 No 0.0%

3-14. Statewide cancer registries (no. States 

and D.C.)

60.0% 45 30

(1999)

39

(2006)

9 Not tested 30.0%

3-15. Persons living 5+ years after a diagnosis 

of cancer

81.8% 70% 59%

(1989–95)

68%

(2000–06)

9 Yes 15.3%

LeGenD Moved away from target1 Moved toward target Met or exceeded target
3 • Cancer 3-11

Figure 3-1. Progress Toward Target attainment for Focus area 3: Cancer (continued)

NOTES

See the reader’s Guide for more information on how to read this figure. See DATA 2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 

tracking data. Tracking data are not available for objectives 3-10a through g.

FOOTNOTES

1

 Movement away from target is not quantified using the percent of targeted change achieved. See Technical appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Difference = Final value – Baseline value. Differences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical significance of the difference between the final value and the baseline value is assessed at 

the 0.05 level. See Technical appendix for more information.

Final value – Baseline value

Baseline value

DATA SOURCES

3-1–3-8. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

3-9a. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

3-9b. National Health Interview Survey (NHIS), CDC, NCHS.

3-10h. National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS. 

3-11a–b. National Health Interview Survey (NHIS), CDC, NCHS.

3-12a–b. National Health Interview Survey (NHIS), CDC, NCHS.

3-13. National Health Interview Survey (NHIS), CDC, NCHS.

3-14. National Program of Cancer Registries (NPCR), CDC, NCCDPHP.

3-15. Surveillance, Epidemiology, and End Results (SEER) Program, NIH, NCI.

5

 Percent change = × 100.
3-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 3-2. Health Disparities Table for Focus Area 3: Cancer

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Income Location Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexUrban or metropolitanRural or nonmetropolitanPersons with disabilitiesPersons without disabilities

3-1. Overall cancer deaths (age adjusted, per 

100,000 population) (1999, 2007)1 Bi B B

3-2. Lung cancer deaths (age adjusted, per 

100,000 population) (1999, 2007)1 i B   B    B 

3-3. Female breast cancer deaths (age 

adjusted, per 100,000 population) 

(1999, 2007)1

Bi Bii

3-4. Cervical cancer deaths (age adjusted, 

per 100,000 population) (1999, 

2007)1

Bi, ii B

3-5. Colorectal cancer deaths (age adjusted, 

per 100,000 population) (1999, 

2007)1

Bi   B B

3-6. Oropharyngeal cancer deaths (age 

adjusted, per 100,000 population) 

(1999, 2007)1

i B  B   B

3-7. Prostate cancer deaths (age adjusted, 

per 100,000 population) (1999, 

2007)1

Bi B

3-8. Melanoma deaths (age adjusted, per 

100,000 population) (1999, 2007)1 bi Bii B B 

3-9a. Sun exposure and skin cancer— 

Students who use protective measures 

(grades 9–12) (2005, 2007)

B B

b. Sun exposure and skin cancer—

Adults who use protective measures (age 

adjusted, 18+ years) (2005, 2008)

b Bii B B B B Bii B

3-11a. Women receiving a Pap test—Ever 

received (age adjusted, 18+ years) 

(1998, 2008)2

B 

 B iii B  B iv B

b. Women receiving a Pap test—Received 

within past 3 years (age adjusted, 18+ 

years) (1998, 2008)2



  B iii  B B B  B

3-12a. Colorectal cancer screening—Fecal occult blood test (FOBT) within past 2 years 

(age adjusted, 50+ years) (2000, 2008)

Bii Bii iii Bii  B B B B

b. Colorectal cancer screening—Proctoscopy, 

colonoscopy, or sigmoidoscopy ever received (age adjusted, 50+ years) (1998, 2008)3

  B iii B   B    B  B B

3-13. Women receiving a mammogram within 

past 2 years (age adjusted, 40+ years) 

(1998, 2008)2

 B B iii B B B  B

3-15. Persons living 5+ years after a diagnosis of cancer (1989–95, 2000–06) v Bv B Bii
3 • Cancer 3-13

Figure 3-2. Health Disparities Table for Focus Area 3: Cancer (continued)

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 3-10a 

through h, and 3-14.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information..

Measures of variability were available for all objectives in this table. Thus, the variability of best group rates was assessed, and statistical significance was tested. 

Disparities of 10% or more are displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time 

are indicated by arrows when the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

L G De en

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical ppendixa .

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

1 Most recent data by education level are for 2002.

2 Baseline data by race and ethnicity are for 1999. 3 Baseline data by race and ethinicity are for 2000.

i Data are for Asian or Pacific Islander. ii The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

iiiChange in the summary index cannot be assessed. See Technical Appendix. iv Reliability criterion for best group rate not met, or data available for only one group, at baseline. Change in disparity cannot be assessed. See Technical Appendix. v Data include persons of Hispanic origin.

DATA SOURCES

3-1–3-8. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

3-9a. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

3-9b. National Health Interview Survey (NHIS), CDC, NCHS.

3-11a–b. National Health Interview Survey (NHIS), CDC, NCHS.

3-12a–b. National Health Interview Survey (NHIS), CDC, NCHS.

3-13. National Health Interview Survey (NHIS), CDC, NCHS.

3-15. Surveillance, Epidemiology, and End Results (SEER) Program, NIH, NCI.
HEALTHY PEOPLE 2010 FINAL REVIEW 3-14 Figure 3-3. Overall Cancer Deaths, 2005–07 Healthy People 2010 objective 3-1 • Target = 158.6 per 100,000 

Rate p

Lowest categohealth service 

NOTES: Data are for ICD-10 codes C00–C97 reported as underlying cause. Data are age adjusted to the 2000 standard population. Rates are displayed by a modified Jenks careas. SOURCE: National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.
3 • Can

cer 3-15

Figure 3-4. Women who Received a Pap Test Within Past 3 Years (Age 18+), 2008Healthy People 2010 objective 3-11b • Target = 90 percent

NOTES: Data are age adjusted to the 2000 standard population. Rates are displayed by a modified Jenks classification for U.S. states. National data for the objective come froSurvey (NHIS) and are the basis for setting the target. State data from BRFSS may not be comparable with national data from NHIS. The U.S. rate in 2008 from NHIS was 75from BRFSS in 2008 was 79.2%.SOURCE: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP. 

No states 

Percent

67788

Chronic Kidney 

Disease

CHAPTER 4

Lead Agency

National Institutes of Health

Contents

Goal ..................................................................................................4-3

Highlights ........................................................................................4-3

Summary of Progress.......................................................................4-4

Transition to Healthy People 2020..................................................4-4

Data Considerations.........................................................................4-5

References and Notes.......................................................................4-5

Comprehensive Summary of Objectives..........................................4-7

Progress Chart..................................................................................4-8

Health Disparities Table...................................................................4-9

Dialysis Patients Registered on Kidney Transplant 

Waiting List, 2007—Map...........................................................4-11

Cumulative Percent of Persons Receiving a Kidney Transplant

Within 3 Years of the Date of Renal Failure, 2005—Map .........4-12

4 • Chronic Kidney Disease 4-3

GOAL:

Reduce new cases of chronic kidney disease 

and its complications, disability, death, and 

economic costs.

This chapter includes objectives that monitor new cases 

of Chronic Kidney Disease (CKD) and End Stage Renal 

Disease (ESRD), death and disability associated with 

ESRD, and treatments (including kidney transplantation) 

for CKD and ESRD and associated conditions.

All tracking data quoted in this chapter, along with 

technical information and Operational Definitions, can 

be found in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved for the objectives 

in this Focus Area over the course of the past decade 

[1]. Two thirds of the CKD objectives with data to 

measure progress moved toward or achieved their 

Healthy People 2010 targets (Figure 4-1). However, 

most objectives exhibited statistically significant 

health disparities of 10% or more by sex and among 

racial and ethnic population groups (Figure 4-2) [2].

〉 Cardiovascular disease deaths among persons 

with chronic kidney failure (objective 4-2) declined 

31.6% between 1997 and 2008, from 93.7 to 64.1 per 

1,000 patient-years at risk. This decline exceeded 

the Healthy People 2010 target of 66.1 per 1,000 

patient-years at risk. New cases of ESRD (objective 

4-1) increased 12.1% between 1997 and 2008, from 

313 to 351 per million population (adjusted for age, 

sex, and race), moving away from the Healthy People 

2010 target of 230 per million population.

〉 New cases of ESRD due to diabetes (objective 4-7) 

also increased 10.9% between 1997 and 2008, from 

138 to 153 per million population (adjusted for age, 

sex, and race), moving away from the Healthy People 

2010 target of 100 per million population.

〉 The cumulative proportion of persons receiving a 

kidney transplant within 3 years of the date of renal 

failure (objective 4-6) declined 13.5% between 1998 

and 2005, from 20.0% to 17.3%, moving away from the 

Healthy People 2010 target of 29.5%.

〉 In 2005, Idaho and Utah, the Upper-Midwest 

(Minnesota, North and South Dakota, and 

Wisconsin), and Vermont had the highest cumulative 

proportions of persons receiving a kidney transplant 

within 3 years of the date of renal failure (objective 

4-6). These states achieved the Healthy People 2010 

target. On the other hand, California, the Southwest 

(New Mexico, Louisiana, and Texas), and the 

Southeast (Alabama, Georgia, and North and South 

Carolina) had the lowest cumulative proportions of 

persons receiving a kidney transplant within 3 years 

of the date of renal failure (Figure 4-3).

〉 The registration of dialysis patients under age 70 

for kidney transplantation (objective 4-5) varied by 

geographic area. In 2007, Delaware, Massachusetts, 

Pennsylvania, South Dakota, Vermont, and 

Wisconsin had the highest proportions of patients 

placed on the transplant waiting list within 1 year 

of an ESRD diagnosis. These states achieved the 

Healthy People 2010 target of 24.8% (Figure 4-4).
4-4 HEALTHY PEOPLE 2010 FINAL REVIEW

Summary of Progress

〉 Figure 4-1 presents a quantitative assessment of 

progress in achieving the Healthy People 2010 

objectives for CKD [1]. Data to measure progress 

toward target attainment were available for all nine 

objectives. Of these:

 Three objectives exceeded the Healthy People 

2010 targets (objectives 4-2, and 4-8a and b).

 Three objectives moved toward their targets 

(objectives 4-3, 4-4, and 4-5). A statistically 

significant difference between the baseline and 

the final data points was observed for all these 

objectives.

 Three objectives moved away from their targets 

(objectives 4-1, 4-6, and 4-7). A statistically 

significant difference between the baseline 

and final data points was observed for all these 

objectives.

〉 Figure 4-2 provides a quantitative assessment of 

health disparities in CKD from the best group rate for 

each characteristic at the most recent data point [2]. 

It also displays changes in disparities from baseline 

to the most recent data point [3].

 Of the seven objectives with statistically 

significant racial and ethnic health disparities 

of 10% or more, the Asian population (objectives 

4-2 and 4-5), non-Hispanic white population 

(objectives 4-4 and 4-6), and the population 

of persons of two or more races (objectives 

4-1 and 4-7), each had the best group rate for 

two objectives. The combined Asian or Pacific 

Islander population had the best group rate for 

one objective (4-8a).

 Health disparities of 100% or more relative to 

the group with the best rate were observed for 

two objectives: new cases of ESRD (objective 

4-1) and new ESRD cases due to diabetes 

(objective 4-7).

 Increases in disparities of 100 percentage 

points or more were observed for the same two 

objectives.

 Females had better rates than males for two of 

the three objectives with statistically significant 

health disparities of 10% or more by sex 

(objectives 4-1 and 4-7). Males had a better rate 

than females for new hemodialysis patients who 

use arteriovenous fistulas (objective 4-4).

Transition to Healthy People 

2020

The Healthy People 2020 Chronic Kidney Disease Topic 

Area features a broader range of objectives than those 

included in Healthy People 2010. See HealthyPeople.gov

for a complete list of Healthy People 2020 topics and 

objectives.

The Healthy People 2020 objectives can be grouped into 

several sections:

〉 CKD process and treatment

〉 CKD outcomes

〉 ESRD process and treatment

〉 ESRD outcomes.

The differences between the Healthy People 2010 and 

Healthy People 2020 CKD objectives are summarized 

below:

〉 The Healthy People 2020 CKD Topic Area has 24 

objectives, whereas the Healthy People 2010 Focus 

Area had 9 objectives.

〉 One Healthy People 2010 objective, new cases of 

ESRD (objective 4-1), was retained “as is” [4].

〉 Eight Healthy People 2010 objectives (4-2 through 

4-7, and 4-8a and b) were modified [5]. Some were 

extended to include new measures of CKD and ESRD 

treatment and outcomes.

〉 Fifteen new objectives were added to the Healthy 

People 2020 Topic Area:

 Five CKD and ESRD mortality objectives were 

added, namely: the total death and cardiovascular 

death rates for persons on dialysis; the death rate 

for dialysis patients within the first 3 months of 

initiating therapy; the total and cardiovascular 

death rates for persons who have had a kidney 

transplant; and the death rate for persons with 

CKD. (Objective 4-2, the Healthy People 2010 

objective measuring cardiovascular death 

in patients with chronic kidney failure, was 

retained.)

 Two objectives were added to the Healthy 

People 2010 objective on arteriovenous fistulas, 

monitoring the use of arteriovenous fistulas and 

the use of incident catheters.

 Two new objectives focus on improving 

cardiovascular care in persons with CKD: blood 

pressure and hyperlipidemia control.

 Objectives measuring the proportion of the U.S. 
4 • Chronic Kidney Disease 4-5

population with CKD and the proportion of 

persons with CKD who know they have impaired 

function were added to increase awareness of 

CKD among health professionals and the general 

public.

 Three new objectives address recommended 

medical evaluation and treatment of patients 

with diabetes and CKD.

 An objective measuring follow-up renal evaluation after acute kidney injury was included to 

emphasize the importance of timely evaluation 

in CKD prevention.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Many of the objectives in this chapter are tracked using 

data from the United States Renal Data System (USRDS), 

which uses data collected by the Centers for Medicare 

& Medicaid Services. Since 1996, health care providers 

have been required to provide patient information on 

all persons with ESRD, regardless of health insurance. 

Therefore, incidence rates reflect the universe of ESRD 

cases in the U.S.

There is some lag in reporting new cases of ESRD. As a 

result, each year’s USRDS Annual Data Report includes 

re-estimates of rates from earlier years [6]. Data for 

some racial and ethnic groups have not been collected 

or reported for all years from the Healthy People 2010 

baseline to the most recent data point. For example, data 

in the category “two or more races” for objectives 4-1 and 

4-7 were not available until 2006. Therefore, due to the 

re-estimation method used by the Annual Data Report, 

data for these groups might not be directly comparable 

with other racial and ethnic groups.

The USRDS data, data collection procedures, calculation 

methods, and other technical information are included 

in the USRDS Annual Data Report [6].

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

References and Notes

1. Displayed in the Progress Chart (Figure 4-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 4-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities 

Table (Figure 4-2). Disparity from the best group 

rate is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 
4-6 HEALTHY PEOPLE 2010 FINAL REVIEW

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 4-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 4-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

5. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went from 

developmental in Healthy People 2010 to measurable 

in Healthy People 2020, or vice versa.

6. United States Renal Data System (USRDS). 2010 

Annual Data Report: Atlas of End-Stage Renal 

Disease in the United States. Bethesda, MD: National 

Institutes of Health, National Institute of Diabetes 

and Digestive and Kidney Diseases, 2010. Available 

from http://www.usrds.org/adr.htm.
4 • Chronic Kidney Disease 4-7

Comprehensive Summary of Objectives: Chronic Kidney Disease

Objective Description Data Source or Objective Status

4-1 New cases of end-stage renal disease (ESRD) (per million 

population, adjusted for age, sex, and race)

United States Renal Data System (USRDS), NIH, NIDDK.

4-2 Cardiovascular disease deaths in persons with chronic kidney 

failure (per 1,000 patient years at risk)

United States Renal Data System (USRDS), NIH, NIDDK.

4-3 Pre-ESRD care from a nephrologist United States Renal Data System (USRDS), NIH, NIDDK.

4-4 New hemodialysis patients who use arteriovenous fistulas 

(20+ years)

Centers for Medicare and Medicaid Services Clinical Performance 

Measures (CPM) project, CMS.

4-5 Dialysis patients registered on kidney transplant waiting list 

(<70 years)

United States Renal Data System (USRDS), NIH, NIDDK.

4-6 Cumulative percent of persons receiving a kidney transplant 

within 3 years of the date of renal failure (<70 years)

United States Renal Data System (USRDS), NIH, NIDDK.

4-7 New cases of ESRD due to diabetes (per million population, 

adjusted for age, sex, and race)

United States Renal Data System (USRDS), NIH, NIDDK.

4-8a Medical evaluation for persons with type 1 or type 2 diabetes 

and chronic kidney disease

Centers for Medicare & Medicaid Services Standard Analytic Files 

(SAF), CMS; United States Renal Data System (USRDS), NIH, 

NIDDK.

4-8b Medical treatment for persons with type 1 or type 2 diabetes 

and chronic kidney disease

Centers for Medicare and Medicaid Services Standard Analytic 

Files (SAF), CMS; United States Renal Data System (USRDS), NIH, 

NIDDK.
4-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 4-1. Progress Toward Target attainment for Focus area 4: Chronic Kidney disease

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

4-1. New cases of end-stage renal disease 

(ESRD) (per million population, adjusted 

for age, sex, and race) 

230 313

(1997)

351

(2008)

38 Yes 12.1%

4-2. Cardiovascular disease deaths in persons 

with chronic kidney failure (per 1,000 

patient-years at risk)

107.2% 66.1 93.7

(1997)

64.1

(2008)

-29.6 Yes -31.6%

4-3. Pre-ESRD care from a nephrologist 33.3% 34% 25%

(2005)

28%

(2008)

3 Yes 12.0%

4-4. New hemodialysis patients who use 

arteriovenous fi stulas (20+ years)

78.9% 45% 26%

(1998)

41%

(2007)

15 Yes 57.7%

4-5. Dialysis patients registered on kidney 

transplant waiting list (<70 years) 

19.8% 24.8% 15.2%

(1998)

17.1%

(2007)

1.9 Yes 12.5%

4-6. Cumulative percent of persons receiving 

a kidney transplant within 3 years of the 

date of renal failure (<70 years)

29.5% 20.0%

(1998)

17.3%

(2005)

-2.7 Yes -13.5%

4-7. New cases of ESRD due to diabetes 

(per million population, adjusted for age, 

sex, and race)

100 138

(1997)

153

(2008)

15 Yes 10.9%

4-8a. Medical evaluation for persons with 

type 1 or type 2 diabetes and chronic 

kidney disease

325.0% 25% 21%

(2000)

34%

(2008)

13 Yes 61.9%

4-8b. Medical treatment for persons with 

type 1 or type 2 diabetes and chronic 

kidney disease

250.0% 71% 69%

(2000)

74%

(2006)

5 No 7.2%

LeGend Moved away from target1 Moved toward target Met or exceeded target

NOTES

See the reader’s Guide for more information on how to read this fi gure. See DATA 2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 

tracking data.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

DATA SOURCES

4-1–4-3. United States Renal Data System (USRDS), NIH, NIDDK. 

4-4. Centers for Medicare & Medicaid Services Clinical Performance Measures (CPM) project, CMS.

4-5–4-7. United States Renal Data System (USRDS), NIH, NIDDK.

4-8a–b. Centers for Medicare & Medicaid Services Standard Analytic Files (SAF), CMS; United States Renal Data System (USRDS), NIH, NIDDK.
4 • Chronic Kidney Disease 4-9

Figure 4-2. Health Disparities Table for Focus Area 4: Chronic Kidney Disease

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Income

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMalePoorNear poorMiddle/high incomeSummary index

4-1. New cases of end-stage renal disease 

(ESRD) (per million population, adjusted for 

age, gender, and race) (1997, 2008)§













Bi 











ii B 

4-2. Cardiovascular disease deaths in persons 

with chronic kidney failure (per 1,000 

patient-years at risk) (1997, 2008)

 B  ii Bi

4-3. Pre-ESRD care from a nephrologist 

(2005, 2008) Bi Bi

4-4. New hemodialysis patients who use 

arteriovenous fistulas (20+ years) 

(1998, 2007)

b iii Bi B

4-5. Dialysis patients registered on kidney 

transplant waiting list (<70 years) 

(1998, 2007)

B  ii B

4-6. Cumulative percent of persons receiving a 

kidney transplant within 3 years of the date 

of renal failure (<70 years) (1998, 2005)

B ii B

4-7. New cases of ESRD due to diabetes 

(per million population, adjusted for age, 

sex, and race) (1997, 2008)§







Bi 











ii B 

4-8a. Medical evaluation for persons with type 

1 or type 2 diabetes and chronic kidney 

disease (2000, 2008)

Biii iv iv Bi

4-8b. Medical treatment for persons with type 

1 or type 2 diabetes and chronic kidney 

disease (2000, 2006)

NOTES 

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

Measures of variability were available for all objectives in this table. Thus, the variability of best group rates was assessed, and statistical significance was tested. 

Disparities of 10% or more are displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time 

are indicated by arrows when the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.
4-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 4-2. Health Disparities Table for Focus Area 4: Chronic Kidney Disease (continued)

L Ge end

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical ppendixa .

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

§ Data for “two or more races” were not available until 2006; therefore, these data may not be directly comparable with other groups. See Data Considerations section 

for more information.

i The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

ii Change in the summary index cannot be assessed. See Technical Appendix. iiiData are for Asian or Pacific Islander.

ivData include persons of Hispanic origin.

DATA SOURCES

4-1–4-3. United States Renal Data System (USRDS), NIH, NIDDK.

4-4. Centers for Medicare & Medicaid Services Clinical Performance Measures (CPM) project, CMS.

4-5–4-7. United States Renal Data System (USRDS), NIH, NIDDK.

4-8a–b. Centers for Medicare & Medicaid Services Standard Analytic Files (SAF), CMS; United States Renal Data System (USRDS), NIH, NIDDK.
4 • Chroni

c Kidney Disease 4-11

Figure 4-3. Dialysis Patients Registered on Kidney Transplant Waiting List (Age <70), 2007Healthy People 2010 objective 4-5 • Target = 24.8 percent

NOTES: Data are for dialysis patients under age 70 registered on the kidney transplant waiting list within 1 year of the date of ESRD. Rates are displayed by a modified Jenks USRDS data, data collection procedures, calculation methods, and other technical information are included in the USRDS Annual Data Report, available from http://www.uSOURCE: United States Renal Data System (USRDS), NIH, NIDDK. 

Percent

Highest shows s
HEALTHY PEOPLE 2010 FINAL REVIEW 4-12 Figure 4-4. Cumulative Percent of Persons Receiving a Kidney Transplant Within 3 Years of the Date of Renal Failure (Age <70), 

Healthy People 2010 objective 4-6 • Target = 29.5 percent NOTES: Data are for patients with treated chronic kidney failure who receive a transplant within 3 years of registration on the waiting list. Rates are displayed by a modified 

USRDS data, data collection procedures, calculation methods, and other technical information are included in the USRDS Annual Data Report, available from http://www.uSOURCE: United States Renal Data System (USRDS), NIH, NIDDK. 7.3–13.

13.5–1717.7–2222.5–229.5–3

Percent Highest category 

shows states tha
Diabetes

CHAPTER 5

Co-Lead Agencies

Centers for Disease Control and Prevention

National Institutes of Health, National Institute of Diabetes and 

Digestive and Kidney Diseases

Contents

Goal ..................................................................................................5-3

Highlights ........................................................................................5-3

Summary of Progress.......................................................................5-4

Transition to Healthy People 2020..................................................5-5

Data Considerations.........................................................................5-5

References and Notes.......................................................................5-6

Comprehensive Summary of Objectives..........................................5-7

Progress Chart..................................................................................5-8

Health Disparities Table.................................................................5-10

Prevalence of Diabetes, 2008—Map .............................................5-12

5 • Diabetes 5-3

GOAL:

Through prevention programs, reduce the 

disease and economic burden of diabetes, and 

improve the quality of life for all persons who 

have or are at risk for diabetes.

This chapter includes objectives that track new cases 

of diabetes, diabetes-related deaths, the diagnosis 

and treatment of diabetes and related conditions, and 

diabetes education.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved for the objectives 

in this Focus Area during the past decade [1]. 

Seventy-one percent of the Diabetes objectives with 

data to measure progress moved toward or achieved 

their Healthy People 2010 targets (Figure 5-1). Most of 

the health disparities observed by race and ethnicity, 

sex, education level, and disability status ranged 

from 10% to 99% in magnitude; larger disparities are 

discussed below (Figure 5-2) [2].

〉 The rate of new cases of diabetes (objective 5-2) 

increased 45.5% from 1997–99 to 2006–08, from 5.5 

to 8.0 per 1,000 population aged 18–84 (age adjusted), 

moving away from the Healthy People 2010 target of 

3.8 per 1,000. Disparities were observed for a number 

of population groups, for example:

 Among education groups, persons with at least 

some college education had the lowest (best) rate 

of new cases of diabetes, 6.9 per 1,000 population 

aged 25–84 (age adjusted) in 2006–08. Persons 

with less than a high school education had a 

rate of 14.0 per 1,000 population aged 25–84 (age 

adjusted). The rate for persons with less than a 

high school education was about twice the best 

group rate [2].

 Among disability status groups, persons without 

disabilities had the lowest (best) rate of new 

cases of diabetes, 6.3 per 1,000 population aged 

18–84 (age adjusted) in 2006–08. Persons with 

disabilities had a rate of 18.5 per 1,000 population 

aged 18–84 (age adjusted), nearly three times the 

best group rate [2].

〉 The prevalence of diabetes (objective 5-3) increased 

47.5% between 1997 and 2008, from 40 to 59 per 1,000 

population (age adjusted), moving away from the 

2010 target of 25 per 1,000. Disparities were observed 

for a number of population groups, for example:

 Among racial and ethnic groups, the nonHispanic white population had the lowest (best) 

diabetes prevalence rate, 52 per 1,000 population 

(age adjusted) in 2008, whereas the American 

Indian or Alaska Native population had a rate 

of 109 per 1,000 population (age adjusted). The 

rate for the American Indian or Alaska Native 

population was more than twice the best group 

rate [2].
5-4 HEALTHY PEOPLE 2010 FINAL REVIEW

 Among disability status groups, persons without 

disabilities had the lowest (best) diabetes 

prevalence rate, 43 per 1,000 population (age 

adjusted) in 2008. Persons with disabilities had 

a rate of 120 per 1,000 population (age adjusted), 

almost three times the best group rate [2].

〉 The prevalence of diabetes varied by geographic 

region. West Virginia and several southern states 

(Alabama, Georgia, Louisiana, Mississippi Tennessee, 

and Texas) had the highest rates of diabetes (Figure 

5-3).

〉 The proportion of persons aged 20 and over with 

diabetes whose condition had been diagnosed 

(objective 5-4) increased 20.3% from 1988–94 to 

2005–08, from 64% to 77% (age adjusted), moving 

toward the 2010 target of 78%.

〉 The diabetes-related death rate among the total 

population (objective 5-5) declined 5.2% between 

1999 and 2007, from 77 to 73 per 100,000 population 

(age adjusted), moving toward the 2010 target of 46 

per 100,000. Disparities were observed for a number 

of population groups, for example:

 Among racial and ethnic groups, the combined 

Asian or Pacific Islander population had the 

lowest (best) rate of diabetes-related deaths, 54 

per 100,000 population (age adjusted) in 2007. 

The non-Hispanic black population had a rate of 

127 per 100,000 population (age adjusted), nearly 

two and a half times the best group rate [2].

〉 The rate of lower extremity amputation in persons 

with diabetes (objective 5-10) declined 47.0% from 

1997–99 to 2005–07, from 6.6 to 3.5 per 1,000 

population (age adjusted), moving toward the 2010 

target of 2.9 per 1,000. 

 Females had a lower (better) rate of lower 

extremity amputations than males. The rate 

for females was 2.2 per 1,000 population (age 

adjusted) in 2005–07. The rate for males was 4.8 

per 1,000 population (age adjusted), more than 

twice the rate for females [2].

〉 No change was observed in the percentage of 

persons with diabetes who received annual foot 

examinations (objective 5-14) or annual dental 

examinations (objective 5-15). The percentage of 

persons with diabetes aged 18 and over who received 

an annual foot examination was 68% (age adjusted) 

in both 1998 and 2008. The percentage of persons 

with diabetes aged 2 years and over who had annual 

dental examinations was 56% (age adjusted) in both 

1997 and 2008.

Summary of Progress

〉 Figure 5-1 presents a quantitative assessment of 

progress in achieving the Healthy People 2010 

objectives for Diabetes [1]. Data to measure progress 

toward target attainment were available for 14 

objectives. Of these:

 Five objectives (5-6, 5-7, 5-11, 5-12, and 5-17) met 

or exceeded the Healthy People 2010 targets.

 Five objectives moved toward their targets. A 

statistically significant difference between the 

baseline and the final data points was observed 

for four of these objectives (5-1, 5-4, 5-5, and 5-10); 

no significant difference was observed for the 

remaining objective (5-13).

 Two objectives (5-14 and 5-15) showed no change.

 Two objectives (5-2 and 5-3) moved away from 

their targets. A statistically significant difference 

between the baseline and final data point was 

observed for both of these objectives.

〉 Follow-up data were unavailable to measure progress 

for one objective (5-16). Two objectives (5-8 and 5-9) 

were deleted at the Midcourse Review.

〉 Figure 5-2 displays health disparities in Diabetes 

from the best group rate for each characteristic at the 

most recent data point [2]. It also displays changes 

in disparities from baseline to the most recent data 

point [3].

 Of the 11 objectives with statistically significant 

racial and ethnic health disparities of 10% or 

more, the non-Hispanic white population had the 

unique best rate for six objectives (5-1 through 

5-3, 5-12, 5-13, and 5-16). The combined Asian or 

Pacific Islander population had the best rate for 

two objectives (5-5 and 5-11) and the Hispanic 

or Latino population and non-Hispanic black 

population each had the unique best rate for one 

objective (5-7 and 5-14, respectively). In addition, 

the non-Hispanic black and non-Hispanic white 

populations were tied for the best rate for one 

objective (5-17).

 For all five objectives with statistically significant 

health disparities of 10% or more by sex, females 

had better rates than males (objectives 5-5 

through 5-7, 5-10, and 5-17).

 Persons with at least some college education 

had the best rate for 9 of the 10 objectives with 

statistically significant health disparities of 10% 

or more by education level (objectives 5-1 through 

5-3, 5-5, 5-7, 5-12, and 5-13 through 5-15). Persons 

with less than a high school education had the 

best rate for one objective (5-17).
5 • Diabetes 5-5

 Persons without disabilities had better rates than 

persons with disabilities for the two objectives 

with statistically significant health disparities of 

10% or more by disability status (objectives 5-2 

and 5-3; see Highlights).

 Health disparities of 100% or more were observed 

for four objectives (5-2, 5-3, 5-5, and 5-10; see 

Highlights).

Transition to Healthy People 

2020

For Healthy People 2020, the focus of the Diabetes Topic 

Area has been expanded to include more objectives on 

diabetes prevention and control. See HealthyPeople.gov

for a complete list of Healthy People 2020 topics and 

objectives.

The differences between the Healthy People 2010 

objectives and those included in Healthy People 2020 are 

summarized below:

〉 The Healthy People 2020 Diabetes Topic Area includes 

20 objectives, three of which are developmental, 

whereas the Healthy People 2010 Diabetes Focus 

Area had 17 objectives, including two (objectives 5-8 

and 5-9) that were deleted at the Midcourse Review 

[4].

〉 Nine Healthy People 2010 objectives, including 

diabetes incidence (objective 5-2), diabetes-related 

deaths (objective 5-5), lower extremity amputations 

(objective 5-10), annual urinary microalbumin 

measurement (objective 5-11), A1C test at least 

two times a year (objective 5-12), annual dilated 

eye examination (objective 5-13), annual foot 

examination (objective 5-14), annual dental 

examination (objective 5-15), and self blood-glucose 

monitoring (objective 5-17) were retained “as is” [5].

〉 Two Healthy People 2010 objectives were modified [6]. 

The objectives tracking diabetes education (objective 

5-1) and persons with diagnosed diabetes (objective 

5-4) will be measured differently in Healthy People 

2020.

〉 Four Healthy People 2010 objectives were archived: 

the prevalence of diabetes (objective 5-3), two 

objectives related to deaths among persons with 

diabetes (objectives 5-6 and 5-7), and aspirin therapy 

(objective 5-16) [7].

〉 Nine new objectives were added to the Healthy 

People 2020 Diabetes Topic Area:

 Four new objectives on control of diabetes and 

its complications include the proportion of the 

diabetic population with hemoglobin A1C test 

values greater than 9%, and A1C less than 7%, 

as well as blood pressure control and cholesterol 

control among the population with diabetes.

 Three new objectives on diabetes prevention 

focus on persons at high risk for diabetes with 

pre-diabetes who report increasing physical 

activity, trying to lose weight, and reducing fat or 

calories in the diet.

 Two new objectives were added to replace the 

archived mortality objectives: total mortality 

among the population with diabetes, and 

cardiovascular disease deaths in persons with 

diabetes.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Figure 5-3 presents state-level data for diabetes 

prevalence (objective 5-3) from the Behavioral Risk 

Factor Surveillance System (BRFSS). National data for 

this objective come from the National Health Interview 

Survey (NHIS) and are the basis for setting targets. BRFSS 

data may not be comparable with the national data from 

NHIS. The BRFSS state rates are for the population aged 

18 and over. The NHIS national rate includes all ages.

Beginning in 2003, education data for mortality 

objectives 5-5, 5-6, and 5-7 from the National Vital 

Statistics System have been suppressed. The educational 

attainment item was changed in the new U.S. Standard 

Certificate of Death in 2003 to be consistent with 

the Census Bureau data and to improve the ability to 

identify specific types of educational degrees. Many 

states, however, are still using the 1989 version of the 

U.S. Standard Certificate of Death, which focuses on 

highest school grade completed. As a result, educational 

attainment data collected using the 2003 version are not 

comparable with data collected using the 1989 version 

[8].

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 
5-6 HEALTHY PEOPLE 2010 FINAL REVIEW

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

References and Notes

1. Displayed in the Progress Chart (Figure 5-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 5-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 5-2). Disparity from the best group rate is 

defined as the percent difference between the best 

group rate and each of the other group rates for a 

characteristic. For example, racial and ethnic health 

disparities are measured as the percent difference 

between the best racial and ethnic group rate and each 

of the other racial and ethnic group rates. Similarly, 

disparities by sex are measured as the percent 

difference between the better group rate (e.g., female) 

and the rate for the other group (e.g., male). Some 

objectives are expressed in terms of favorable events 

or conditions that are to be increased, while others are 

expressed in terms of adverse events or conditions that 

are to be reduced. To facilitate comparison of health 

disparities across different objectives, disparity is 

measured only in terms of adverse events or conditions. 

For comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are not 

otherwise restated or changed. For example, objective 

1-1, to increase the proportion of persons with health 

insurance (e.g., 72% of the American Indian or Alaska 

Native population under age 65 had some form of 

health insurance in 2008), is expressed in terms of the 

percentage of persons without health insurance (e.g., 

100% - 72% = 28% of the American Indian or Alaska 

Native population under age 65 did not have any form 

of health insurance in 2008) when the disparity from 

the best group rate is calculated. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the best group rate 

and each of the other group rates was tested at the 0.05 

level of significance. See the Figure 5-2 footnotes, as 

well as the Technical Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 5-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

5. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

6. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went from 

developmental in Healthy People 2010 to measurable 

in Healthy People 2020, or vice versa.
5 • Diabetes 5-7

7. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.

8. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. 

Deaths: Final data for 2007. National vital statistics 

reports; vol 58 no 19. Hyattsville, MD: National Center 

for Health Statistics. 2010. Available from http://www.

cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf.

Comprehensive Summary of Objectives: Diabetes

Objective Description Data Source or Objective Status

5-1 Diabetes education (age adjusted, 18+ years) National Health Interview Survey (NHIS), CDC, NCHS.

5-2 New cases of diabetes (3-year average, age adjusted, per 

1,000 population, 18–84 years) 

National Health Interview Survey (NHIS), CDC, NCHS.

5-3 Prevalence of diabetes (age adjusted, per 1,000 population) National Health Interview Survey (NHIS), CDC, NCHS.

5-4 Proportion of persons with diagnosed diabetes (age adjusted, 

20+ years)

National Health and Nutrition Examination Survey (NHANES), 

CDC, NCHS.

5-5 Diabetes-related deaths (age adjusted, per 100,000 

population) 

National Vital Statistics System—Mortality (NVSS-M), CDC, 

NCHS.

5-6 Diabetes-related deaths among persons with diabetes (age 

adjusted, per 1,000 population)

National Vital Statistics System—Mortality (NVSS-M), CDC, 

NCHS; National Health Interview Survey (NHIS), CDC, NCHS.

5-7 Cardiovascular disease deaths among persons with diabetes 

(age adjusted, per 100,000 population)

National Vital Statistics System—Mortality (NVSS-M), CDC, 

NCHS; National Health Interview Survey (NHIS), CDC, NCHS.

5-8 Gestational diabetes among pregnant women Deleted at the Midcourse Review.

5-9 Foot ulcers among persons with diabetes Deleted at the Midcourse Review.

5-10 Lower extremity amputations in persons with diabetes (3-year 

average, age adjusted, per 1,000 population)

National Hospital Discharge Survey (NHDS), CDC, NCHS;

National Health Interview Survey (NHIS), CDC, NCHS.

5-11 Annual urinary microalbumin measurement among Medicare 

beneficiaries with diabetes

United States Renal Data System (USRDS), NIH, NIDDK.

5-12 A1C Test, at least twice a year among persons with diabetes 

(age adjusted, 18+ years)

Behavioral Risk Factor Surveillance System (BRFSS), CDC, 

NCCDPHP.

5-13 Annual dilated eye examinations among persons with diabetes 

(age adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

5-14 Annual foot examinations among persons with diabetes (age 

adjusted, 18+ years)

Behavioral Risk Factor Surveillance System (BRFSS), CDC, 

NCCDPHP.

5-15 Annual dental examinations among persons with diabetes (age 

adjusted, 2+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

5-16 Aspirin intake 15+ times per month among persons with 

diabetes (age adjusted, 40+ years)

National Health and Nutrition Examination Survey (NHANES), 

CDC, NCHS.

5-17 Self blood-glucose monitoring at least once daily among 

persons with diabetes (age adjusted, 18+ years)

Behavioral Risk Factor Surveillance System (BRFSS), CDC, 

NCCDPHP.
5-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 5-1. Progress toward target attainment for Focus area 5: Diabetes

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

5-1. Diabetes education (age adjusted, 

18+ years)

66.7% 60% 45%

(1998)

55%

(1999)

10 Yes 22.2%

5-2. New cases of diabetes (3-year average,

age adjusted, per 1,000 population,

18–84 years) 

3.8 5.5

(1997–99)

8.0

(2006–08)

2.5 Yes 45.5%

5-3. Prevalence of diabetes (age adjusted,

per 1,000 population)

25 40

(1997)

59

(2008)

19 Yes 47.5%

5-4. Proportion of persons with diagnosed 

diabetes (age adjusted, 20+ years)

92.9% 78% 64%

(1988–94)

77%

(2005–08)

13 Yes 20.3%

5-5. Diabetes-related deaths (age adjusted, 

per 100,000 population) 

12.9% 46 77

(1999)

73

(2007)

-4 Yes -5.2%

5-6. Diabetes-related deaths among persons 

with diabetes (age adjusted, per 1,000 

population) 

250.0% 7.8 8.8

(1999)

6.3

(2007)

-2.5 Yes -28.4%

5-7. Cardiovascular disease deaths among 

persons with diabetes (age adjusted, 

per 100,000 population)

384.8% 299 332

(1999)

205

(2007)

-127 Yes -38.3%

5-10. Lower extremity amputations in persons 

with diabetes (3-year average, age 

adjusted, per 1,000 population)

83.8% 2.9 6.6

(1997–99)

3.5

(2005–07)

-3.1 Yes -47.0%

5-11. Annual urinary microalbumin measurement among Medicare benefi ciaries 

with diabetes

1,100.0% 14% 12%

(2000)

34%

(2007)

22 Yes 183.3%

5-12. A1C Test, at least twice a year among 

persons with diabetes (age adjusted, 

18+ years) 

100.0% 65% 59%

(2000)

65%

(2008)

6 Yes 10.2%

5-13. Annual dilated eye examinations among 

persons with diabetes (age adjusted, 

18+ years)

14.8% 76% 49%

(1998)

53%

(2008)

4 No 8.2%

5-14. Annual foot examinations among persons 

with diabetes (age adjusted, 18+ years)

 0.0% 91% 68%

(1998)

68%

(2008)

0 No 0.0%

5-15. Annual dental examinations among 

persons with diabetes (age adjusted, 

2+ years) 

 0.0% 71% 56%

(1997)

56%

(2008)

0 No 0.0%

5-17. Self blood-glucose monitoring at least 

once daily among persons with diabetes 

(age adjusted, 18+ years)

116.7% 61% 43%

(1998)

64%

(2008)

21 Yes 48.8%

LeGeND Moved away from target1 Moved toward target Met or exceeded target
5 • Diabetes 5-9

Figure 5-1. Progress toward target attainment for Focus area 5: Diabetes (continued)

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA 2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 

tracking data. Tracking data are not available for objective 5-16. Objectives 5-8 and 5-9 were deleted at the Midcourse Review.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See technical appendix for more information.

2

 Percent of targeted change achieved = Final value – Baseline value × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See technical appendix for more information.

5

 Percent change = Final value – Baseline value × 100.

Baseline value

DATA SOURCES

5-1–5-3. National Health Interview Survey (NHIS), CDC, NCHS.

5-4. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. 

5-5. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS. 

5-6–5-7. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS; National Health Interview Survey (NHIS), CDC, NCHS. 

5-10. National Hospital Discharge Survey (NHDS), CDC, NCHS; National Health Interview Survey (NHIS), CDC, NCHS. 

5-11. United States Renal Data System (USRDS), NIH, NIDDK. 

5-12. Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP. 

5-13. National Health Interview Survey (NHIS), CDC, NCHS. 

5-14. Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP. 

5-15. National Health Interview Survey (NHIS), CDC, NCHS. 

5-17. Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.
5-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 5-2. Health Disparities Table for Focus Area 5: Diabetes

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Location Disability

Population-based objectiveAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexUrban or metropolitanRural ornonmetropolitanPersons with disabilitiesPersons without disabilities

5-1. Diabetes education (age adjusted, 18+ 

years) (1998, 1999)1 B B B B Bi

5-2. New cases of diabetes (3-year average, 

age adjusted, per 1,000 population, 

18–84 years) (1997–99, 2006–08)2

B B B B B

5-3. Prevalence of diabetes (age adjusted, 

per 1,000 population) (1997, 2008)1  B ii Bi B Bi B

5-4. Proportion of persons with diagnosed 

diabetes (age adjusted, 20+ years) 

(1988–94, 2005–08)3

iii

5-5. Diabetes-related deaths (age adjusted, 

per 100,000 population) (1999, 

2007)4

 Biv   B    B 

5-6. Diabetes-related deaths among persons 

with diabetes (age adjusted, per 1,000 

population) (1999, 2007)4

b B B

5-7. Cardiovascular disease deaths among 

persons with diabetes (age adjusted, per 

100,000 population) (1999, 2007)4

B   B   B 

5-10. Lower extremity amputations in persons with 

diabetes (3-year average, age adjusted, per 

1,000 population) (1997–99, 2005–07)

v v B

5-11. Annual urinary microalbumin measurement among Medicare beneficiaries with 

diabetes (2000, 2007)

 Biv B

5-12. A1C Test, at least twice a year among 

persons with diabetes (age adjusted, 

18+ years) (2000, 2008)5

b b b B B  B 

5-13. Annual dilated eye examinations among 

persons with diabetes (age adjusted, 

18+ years) (1998, 2008)1

B ii Bi B

5-14. Annual foot examinations among persons with diabetes (age adjusted, 18+ 

years) (1998, 2008)5



 Bi ii Bi B B

5-15. Annual dental examinations among 

persons with diabetes (age adjusted, 2+ 

years) (1997, 2008)1

B Bi B B

5-16. Aspirin intake 15+ times per month 

among persons with diabetes (age 

adjusted, 40+ years) (1999–2002)

iii B B B

5-17. Self blood-glucose monitoring at least once 

daily among persons with diabetes (age 

adjusted, 18+ years) (1998, 2008)5

b Bi B B Bi   
5 • Diabetes 5-11

Figure 5-2. Health Disparities Table for Focus Area 5: Diabetes (continued)

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Objectives 5-8 and 5-9 were deleted at Midcourse Review. 

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

Measures of variability were available for all objectives in this table. Thus, the variability of best group rates was assessed, and statistical significance was tested. 

Disparities of 10% or more are displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time 

are indicated by arrows when the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

L G NDe e

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See t a echnical ppendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

1 Baseline data by race and ethnicity are for 1999.

2 Baseline data by race and ethnicity are for 1999–2001. 3 Baseline data by disability status are for 1991–94.

4 Most recent data by education level are for 2002.

5 Baseline data for race and ethnicity are for 2001. i The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

ii Change in the summary index cannot be assessed. See Technical Appendix. iiiData are for Mexican American.

ivData are for Asian or Pacific Islander.

v Data include persons of Hispanic origin.

DATA SOURCES

5-1–5-3. National Health Interview Survey (NHIS), CDC, NCHS.

5-4. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

5-5. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

5-6–5-7. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS; National Health Interview Survey (NHIS), CDC, NCHS. 

5-10. National Hospital Discharge Survey (NHDS), CDC, NCHS; National Health Interview Survey (NHIS), CDC, NCHS.

5-11. United States Renal Data System (USRDS), NIH, NIDDK.

5-12. Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.

5-13. National Health Interview Survey (NHIS), CDC, NCHS.

5-14. Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.

5-15. National Health Interview Survey (NHIS), CDC, NCHS.

5-16. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

5-17. Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.
HEALTHY PEOPLE 2010 FINAL REVIEW 5-12 Figure 5-3. Prevalence of Diabetes (Age 18+), 2008 Healthy People 2010 objective 5-3 • Target = 25 per 1,000† NOTES: Data are age adjusted to the 2000 standard population. Rates are displayed by a Jenks classification for U.S. states. National data for the objective come from the Na

and are the basis for setting the target. State data from BRFSS may not be comparable with national data from NHIS. The U.S. rate in 2008 was 59 per 1,000 population of all from BRFSS in 2008 was 83.5 per 1,000 population aged 18 and over.† BRFSS state-based rates are for population aged 18 and over; NHIS national rate is for all ages. SOURCE: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.

Rate pe
Disability and 

Secondary 

Conditions

CHAPTER 6

Co-Lead Agencies

Centers for Disease Control and Prevention

National Institute on Disability and Rehabilitation Research, 

Department of Education

Contents

Goal ..................................................................................................6-3

Highlights ........................................................................................6-3

Summary of Progress.......................................................................6-4

Transition to Healthy People 2020..................................................6-5

Data Considerations.........................................................................6-6

Notes................................................................................................6-6

Comprehensive Summary of Objectives..........................................6-7

Progress Chart..................................................................................6-9

Health Disparities Table.................................................................6-11

6 • Disability and Secondary Conditions 6-3

GOAL :

Promote the health of people with disabilities, 

prevent secondary conditions, and eliminate 

disparities between people with and without 

disabilities in the U.S. population.

The objectives in this chapter include measures of life 

satisfaction among people with disabilities, barriers to 

their participation in everyday life, and the availability 

of public health programs to support these individuals 

and their caregivers. The objectives also track the use of 

congregate care, as well as the availability of surveillance 

systems that identify persons with disabilities.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.gov/

2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved for the objectives 

in this Focus Area during the past decade [1]. 

Over two-thirds of the Disability and Secondary 

Conditions objectives with data to measure progress 

moved toward or achieved their Healthy People 2010 

targets (Figure 6-1). However, health disparities of 

50% to 99% were observed among racial and ethnic 

populations, education groups, and income groups 

(Figure 6-2), as highlighted below [2].

〉 The number of states and the District of Columbia 

(D.C.) with public health surveillance systems for 

persons with disabilities (objective 6-13a) increased 

from 14 in 1999 to 51 in 2009, meeting the 2010 target 

of 51. During the same time period, the number 

of states and D.C. with surveillance systems for 

caregivers of persons with disabilities (objective 

6-13e) increased from 0 to 51, also meeting the target 

of 51.

〉 A statistically significant downward trend was 

observed during the past decade in the number of 

adults in congregate care facilities (objective 6-7a) 

[3]. The number dropped 36.2% between 1997 and 

2009, from 93,362 to 59,604, moving toward the 2010 

target of 46,681. However, the number of children and 

young adults in congregate care facilities (objective 

6-7b) increased 11.0% between 1997 and 2008, from 

26,028 to 28,890, moving away from the target of 

0. The proportion of children and youth aged 6–21 

years with disabilities who are enrolled in regular 

education programs (objective 6-9) increased 28.9% 

from 1995–96 to 2008–09, from 45% to 58%, moving 

toward the 2010 target of 60%.

〉 Sadness or depression among children and 

adolescents aged 4–17 years with disabilities 

(objective 6-2) decreased 25.8% between 1997 and 

2007, from 31% to 23%, moving toward the 2010 

target of 17%.

〉 The employment rate among adults aged 18–64 with 

disabilities (objective 6-8) declined 14.0% between 

1997 and 2008, from 43% to 37%, moving away from 

the 2010 target of 80%. Disparities were observed for 

a number of population groups, for example:
6-4 HEALTHY PEOPLE 2010 FINAL REVIEW

 Among racial and ethnic groups, non-Hispanic 

white adults with disabilities had the highest 

(best) employment rate, 41% in 2008, whereas 

Hispanic or Latino and non-Hispanic black 

adults with disabilities had rates of 29% and 27%, 

respectively. When expressed as unemployment

rates among adults with disabilities, the rate 

for Hispanic or Latino adults was 20% higher 

than the rate for non-Hispanic white adults and 

the rate for non-Hispanic black adults was 24% 

higher than the non-Hispanic white rate. [2].

 Among educational groups, persons with 

disabilities and at least some college education 

had the highest (best) employment rate, 52% in 

2008, whereas the rate for persons with disabilities 

who had less than a high school education was 

22%. When expressed as unemployment rates 

among persons with disabilities, the rate for 

persons with less than a high school education 

was more than one and a half times that for 

persons with at least some college education [2].

〉 Disparities among racial and ethnic groups were 

observed for several objectives, for example:

 The non-Hispanic white population had 

the lowest (best) proportion of persons with 

disabilities reporting barriers to participation 

in community activities (objective 6-12d), 11% in 

2002. Persons of two or more races had a rate of 

24%, more than twice the best group rate [2].

 The non-Hispanic white population had the 

highest (best) proportion of persons with 

disabilities reporting access to health and 

wellness programs (objective 6-10), 54% in 2002, 

whereas the rate for the Hispanic or Latino 

population was 27%. When expressed as persons 

with disabilities reporting no access to health and 

wellness programs, the rate for the Hispanic or 

Latino population was more than one and a half 

times that for the non-Hispanic white population 

[2].

 The non-Hispanic white population had the 

highest (best) proportion of sufficient emotional 

support among adults with disabilities (objective 

6-5), 73% in 2008, whereas the American Indian 

or Alaska Native, Asian, and non-Hispanic black 

populations had rates of 59%, 58%, and 58%, 

respectively. When expressed as persons with 

disabilities without sufficient emotional support, 

the rates for the American Indian or Alaska Native, 

Asian, and non-Hispanic black populations were 

all about one and a half times the rate for the nonHispanic white population [2].

Summary of Progress

〉 Figure 6-1 presents a quantitative assessment of 

progress in achieving the Healthy People 2010 

objectives for Disability and Secondary Conditions [1]. 

Data to measure progress toward target attainment 

were available for 13 objectives. Of these:

 Two objectives (6-13a and e) met their Healthy 

People 2010 targets.

 Seven objectives moved toward their targets. A 

statistically significant difference between the 

baseline and the final data points was observed 

for two of these objectives (6-5 and 6-6). No 

significant difference was observed for one 

objective (6-2); and data to test the significance of 

the difference were unavailable for four objectives 

(6-1, 6-7a, 6-9, and 6-13c).

 One objective showed no change (6-13g).

 Three objectives moved away from their targets. 

A statistically significant difference between 

the baseline and final data points was observed 

for two objectives (6-3 and 6-8); data to test the 

significance of the difference were unavailable 

for one objective (6-7b).

〉 Four objectives remained developmental (objectives 

6-13b, d, f, and h) and seven had no follow-up data 

available to measure progress (objectives 6-4, 6-10, 

6-11, and 6-12a through d) [4].

〉 Figure 6-2 displays health disparities in Disability 

and Secondary Conditions from the best group 

rate for each characteristic at the most recent data 

point [2]. It also displays changes in disparities from 

baseline to the most recent data point [5].

 Of the seven objectives with statistically 

significant racial and ethnic health disparities of 

10% or more, the non-Hispanic white population 

had the best rate for six objectives (6-4, 6-5, 6-8, 

6-10, and 6-12a and d). The Hispanic or Latino 

population had the best rate for one objective 

(6-6).

 One health disparity of 100% or more 

was observed: barriers to participation in 

community activities were lowest among the 

non-Hispanic white population; the rate for 

persons of two or more races was more than 

twice the best group rate (objective 6-12d; see 

Highlights).

 Males had better rates for five of the six objectives 

with statistically significant health disparities of 

10% or more by sex (objectives 6-3, 6-8, 6-11, and 

6-12a and d). Females had better rates for the 

remaining objective (6-4).
6 • Disability and Secondary Conditions 6-5

 Persons with at least some college education 

had the best rate for the seven objectives with 

statistically significant health disparities of 10% 

or more by education level (objective 6-3 through 

6-6, 6-8, 6-10, and 6-11).

 Health disparities of 50% to 99% between 

persons with less than a high school education 

and persons with at least some college 

education were observed for five objectives (6-4 

through 6-6, 6-8, and 6-10).

 Persons with middle/high incomes had the best 

rates for the six objectives with statistically 

significant health disparities of 10% or more by 

income (objectives 6-3, 6-4, 6-10, 6-11, and 6-12a 

and d).

 Health disparities of 50% to 99% between 

low-income (poor) persons and middle/

high-income persons were observed for four 

objectives (6-3, 6-4, 6-10, and 6-12d).

Transition to Healthy People 

2020

For Healthy People 2020, the Healthy People 2010 

Disability and Secondary Conditions Focus Area was 

expanded to include a broader range of objectives, 

with increased emphasis on health determinants. 

Consequently, the Healthy People 2020 Topic Area name 

was changed from “Disability and Secondary Conditions” 

to “Disability and Health.” See HealthyPeople.gov for 

a complete list of Healthy People 2020 topics and 

objectives.

The differences between the Healthy People 2010 

objectives and those included in Healthy People 2020 are 

summarized below:

〉 The Healthy People 2010 Disability and Secondary 

Conditions Focus Area had 24 objectives, whereas 

the Healthy People 2020 Disability and Health Topic 

Area has a total of 28 objectives. 

〉 Three Healthy People 2010 objectives were retained 

“as is” [6]. These include the inclusion of children and 

youth in regular education programs, tribal disability 

surveillance, and tribal caregiver surveillance 

(objectives 6-9, and 6-13b and f).

〉 Nineteen of the Healthy People 2010 objectives were 

modified [7].

 Identifying people with disabilities in 

“surveillance instruments” was reworded to 

clarify “population data systems” (objective 6-1).

 Two objectives on depressive symptoms among 

children and adults with disabilities were 

combined so that the age groups could be better 

reflected in a demographic template (objectives 

6-2 and 6-3).

 Social participation among adults with 

disabilities was reworded to reflect all ages and 

a broader range of social activities (objective 6-4).

 Emotional support among adults with disabilities 

was reworded to include “social support” as well 

(objective 6-5).

 Two objectives on congregate care among 

children/youth and adults with disabilities were 

reworded to reflect residences that serve people 

instead of facilities with “beds” (objectives 6-7a 

and b).

 Employment among adults with disabilities was 

reworded to include youth with disabilities in the 

new measurement (objective 6-8).

 Two objectives on access to health and wellness 

programs and not having needed assistive 

devices and technology were both reworded to 

reflect barriers (objectives 6-10 and 6-11).

 Four objectives on “reported environmental 

barriers” to participation in home, school, work, 

or community activities were reworded to reflect 

“encountering barriers” (objectives 6-12a through 

d).

 Five objectives on state or tribal health 

surveillance and health promotion among 

people with disabilities and their caregivers were 

reworded to specify state “health departments” 

with at least “one” program (objectives 6-13c 

through e, and 6-13g through h).

〉 Two Healthy People 2010 objectives were archived 

[8]. Due to relatively high reported rates and lack of 

specific public health interventions, life satisfaction 

among adults with disabilities (objective 6-6) 

was archived. After meeting the target for several 

consecutive years, state disability surveillance 

(objective 6-13a) was archived.

〉 Nine new objectives were added to the Healthy 

People 2020 Disability and Health Topic Area. These 

objectives address:

 Delays in receiving preventive care among 

persons with disabilities

 Transition planning from pediatric to adult 

health care for youth with disabilities

 The receipt of appropriate medical care for 

persons with epilepsy

 Use of inappropriate medications among older 

adults with disabilities

 Unemployment among persons with disabilities

 Unintentional injury among persons with 

disabilities
6-6 HEALTHY PEOPLE 2010 FINAL REVIEW

 Early intervention services for children with 

disabilities

 Master of Public Health programs that offer 

courses in disability and health

 Homes and residential buildings that have 

visitable features (e.g., no-step entrance to the 

home).

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

Notes

1. Displayed in the Progress Chart (Figure 6-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 6-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities 

Table (Figure 6-2). Disparity from the best group 

rate is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 
6 • Disability and Secondary Conditions 6-7

Indian or Alaska Native population under age 65 had 

health insurance in 2008), is expressed in terms of the 

percentage of persons without health insurance (e.g., 

100% – 72% = 28% of the American Indian or Alaska 

Native population under age 65 did not have health 

insurance in 2008) when the disparity from the 

best group rate is calculated. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the best group rate 

and each of the other group rates was tested at the 

0.05 level of significance. See the Figure 6-2 footnotes, 

as well as the Technical Appendix, for more detail.

3. The presence of a monotonic increasing or decreasing 

trend in the underlying measure was tested with the 

nonparametric Mann-Kendall test, then the slope of 

a linear trend was estimated with the nonparametric 

Sen’s method. See Technical Appendix for more 

information.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

5. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 1-2 footnotes, as well as 

the Technical Appendix, for more detail.

6. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

7. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa

8. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.

Comprehensive Summary of Objectives: Disability and Secondary 

Conditions

Objective Description Data Source or Objective Status

6-1 Standard questions to identify people with disabilities in data 

sets

CDC, NCBDDD.

6-2 Sadness or depression among children and adolescents with 

disabilities (4–17 years)

National Health Interview Survey (NHIS), CDC, NCHS.

6-3 Negative feelings interfering with activities among adults with 

disabilities (age adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

6-4 Social participation among adults with disabilities (age 

adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

6-5 Sufficient emotional support among adults with disabilities 

(age adjusted, 18+ years)

Behavioral Risk Factor Surveillance System (BRFSS), CDC, 

NCCDPHP.

6-6 Satisfaction with life among adults with disabilities (age 

adjusted, 18+ years)

Behavioral Risk Factor Surveillance System (BRFSS), CDC, 

NCCDPHP.

6-7a Congregate care of adults with disabilities (number of persons, 

22+ years)

Survey of State Developmental Disabilities Directors, University of 

Minnesota.
6-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Disability and Secondary Conditions (continued)

Objective Description Data Source or Objective Status

6-7b Congregate care of children and young adults with disabilities 

(number of persons, ≤21 years)

Survey of State Developmental Disabilities Directors, University of 

Minnesota.

6-8 Employment rate among adults with disabilities (18–64 years) National Health Interview Survey (NHIS), CDC, NCHS.

6-9 Inclusion of children and youth with disabilities in regular 

education programs (6–21 years)

Data Analysis System (DANS), Department of Education.

6-10 Access to health and wellness programs among adults with 

disabilities (age adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

6-11 Lack of assistive devices and technology among adults with 

disabilities (age adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

6-12a Environmental barriers affecting participation in activities at 

home among adults with disabilities (age adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

6-12b Environmental barriers affecting participation in activities 

at school among adults with disabilities (age adjusted, 18+ 

years)

National Health Interview Survey (NHIS), CDC, NCHS.

6-12c Environmental barriers affecting participation in activities at 

work among adults with disabilities (age adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

6-12d Environmental barriers affecting participation in community 

activities among adults with disabilities (age adjusted, 18+ 

years)

National Health Interview Survey (NHIS), CDC, NCHS.

6-13a Surveillance for persons with disabilities (no. States and D.C.) CDC, NCDBBB, DH-Team.

6-13b Surveillance for persons with disabilities (Tribes) Developmental.

6-13c Health promotion programs for persons with disabilities (no. 

States and D.C.)

CDC, NCDBBB, DH-Team.

6-13d Health promotion programs for persons with disabilities 

(Tribes)

Developmental.

6-13e Surveillance for caregivers (no. States and D.C.) CDC, NCDBBB, DH-Team.

6-13f Surveillance for caregivers (Tribes) Developmental.

6-13g Health promotion programs for caregivers (no. States and 

D.C.)

CDC, NCDBBB, DH-Team.

6-13h Health promotion programs for caregivers (Tribes) Developmental.
6 • Disability and Secondary Conditions 6-9

Figure 6-1. Progress toward target attainment for Focus area 6: Disability and secondary conditions

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

6-1. Standard questions to identify people with 

disabilities in data sets

33.0% 100% 0%

(1999)

33%

(2009)

33 Not tested *

6-2. Sadness or depression among children 

and adolescents with disabilities 

(4–17 years)

57.1% 17% 31%

(1997)

23%

(2007)

-8 No -25.8%

6-3. Negative feelings interfering with 

activities among adults with disabilities 

(age adjusted, 18+ years)

7% 28%

(1997)

32%

(2008)

4 Yes 14.3%

6-5. Suffi cient emotional support among adults 

with disabilities (age adjusted, 18+ years)

15.4% 80% 67%

(2005)

69%

(2008)

2 Yes 3.0%

6-6. Satisfaction with life among adults with 

disabilities (age adjusted, 18+ years) 

15.4% 97% 84%

(2005)

86%

(2008)

2 Yes 2.4%

6-7a. Congregate care of adults with disabilities 

(number of persons, 22+ years) 

72.3% 46,681 93,362

(1997)

59,604

(2009)

-33,758 Not tested -36.2%

6-7b. Congregate care of children and young 

adults with disabilities (number of persons, 

≤21 years)

0 26,028

(1997)

28,890

(2008)

2,862 Not tested 11.0%

6-8. Employment rate among adults with 

disabilities (18–64 years)

80% 43%

(1997)

37%

(2008)

-6 Yes -14.0%

6-9. Inclusion of children and youth with 

disabilities in regular education programs 

(6–21 years) 

86.7% 60% 45%

(1995–96)

58%

(2008–09)

13 Not tested 28.9%

6-13a. Surveillance for persons with disabilities 

(no. States and D.C.)

100.0% 51 14

(1999)

51

(2009)

37 Not tested 264.3%

6-13c. Health promotion programs for persons 

with disabilities (no. States and D.C.) 

5.4% 51 14

(1999)

16

(2009)

2 Not tested 14.3%

6-13e. Surveillance for caregivers (no. States 

and D.C.) 

100.0% 51 0

(1999)

51

(2009)

51 Not tested *

6-13g. Health promotion programs for caregivers 

(no. States and D.C.)

 0.0% 51 0

(1999)

0

(2009)

0 Not tested *

leGenD Moved away from target1 Moved toward target Met or exceeded target
6-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 6-1. Progress toward target attainment for Focus area 6: Disability and secondary conditions (continued)

NOTES

See the reader’s Guide for more information on how to read this fi gure. See DATA 2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 

tracking data. Tracking data are not available for objectives 6-4, 6-10, 6-11, 6-12a through d, 6-13b, 6-13d, 6-13f, and 6-13h.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See technical appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See technical appendix for more information.

* Percent change cannot be calculated. See technical appendix for more information.

DATA SOURCES

6-1. CDC, NCBDDD.

6-2–6-3. National Health Interview Survey (NHIS), CDC, NCHS.

6-5–6-6. Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.

6-7a–b. Survey of State Developmental Disabilities Directors, University of Minnesota.

6-8. National Health Interview Survey (NHIS), CDC, NCHS.

6-9. Data Analysis System (DANS), Department of Education.

6-13a. CDC, NCDBBB, DH-Team.

6-13c. CDC, NCDBBB, DH-Team.

6-13e. CDC, NCDBBB, DH-Team.

6-13g. CDC, NCDBBB, DH-Team.

5 Final value – Baseline value Percent change = × 100.

Baseline value
6 • Disability and Secondary Conditions 6-11

Figure 6-2. Health Disparities Table for Focus Area 6: Disability and Secondary Conditions

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Income Location

Population-based objectiveAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexUrban or metropolitanRural ornonmetropolitan

6-2. Sadness or depression among children and 

adolescents with disabilities (4–17 years) (1997, 

2007)1

6-3. Negative feelings interfering with activities among 

adults with disabilities (age adjusted, 18+ years) 

(1997, 2008)1

b b B B B B B

6-4. Social participation among adults with disabilities 

(age adjusted, 18+ years) (2001) b B B B B B

6-5. Sufficient emotional support among adults with disabilities (age adjusted, 18+ years) (2005, 2008)  B B B

6-6. Satisfaction with life among adults with disabilities 

(age adjusted, 18+ years) (2005, 2008) b Bi  B  B 

6-8. Employment rate among adults with disabilities 

(18–64 years) (1997, 2008)1 b  B B B

6-10. Access to health and wellness programs among 

adults with disabilities (age adjusted, 18+ years) 

(2002)

B B B B B

6-11. Lack of assistive devices and technology among 

adults with disabilities (age adjusted, 18+ years) 

(2002)

b B B B B

6-12a. Environmental barriers affecting participation in 

activities at home among adults with disabilities 

(age adjusted, 18+ years) (2002)

B B b B B

6-12b. Environmental barriers affecting participation in 

activities at school among adults with disabilities 

(age adjusted, 18+ years) (2002)

6-12c. Environmental barriers affecting participation in 

activities at work among adults with disabilities (age 

adjusted, 18+ years) (2002)

6-12d. Environmental barriers affecting participation in 

community activities among adults with disabilities 

(age adjusted, 18+ years) (2002)

b B B b B B

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 6-1, 

6-7a and b, 6-9, and 6-13a through h.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

Measures of variability were available for all objectives in this table. Thus, the variability of best group rates was assessed, and statistical significance was tested. 

Disparities of 10% or more are displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time 

are indicated by arrows when the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.
6-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 6-2. Health Disparities Table for Focus Area 6: Disability and Secondary Conditions (continued)

G Dle en

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See t a echnical ppendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

1 Baseline data by race and ethnicity are for 1999. i

 The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

DATA SOURCES

6-2–6-4. National Health Interview Survey (NHIS), CDC, NCHS.

6-5–6-6. Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.

6-8. National Health Interview Survey (NHIS), CDC, NCHS.

6-10–6-11. National Health Interview Survey (NHIS), CDC, NCHS.

6-12a–d. National Health Interview Survey (NHIS), CDC, NCHS.
Educational and 

Community-Based 

Programs

CHAPTER 7

Co-Lead Agencies

Centers for Disease Control and Prevention

Health Services and Resources Administration

Contents

Goal ..................................................................................................7-3

Highlights ........................................................................................7-3

Summary of Progress.......................................................................7-4

Transition to Healthy People 2020..................................................7-4

Data Considerations.........................................................................7-6

Notes................................................................................................7-6

Comprehensive Summary of Objectives..........................................7-7

Progress Chart................................................................................7-11

Health Disparities Table.................................................................7-13

7 • Educational and Community-Based Programs 7-3

GOAL:

Increase the quality, availability, and 

effectiveness of educational and communitybased programs designed to prevent disease 

and improve health and quality of life.

This chapter monitors a number of school-related 

objectives, including high school completion, healthrelated educational programs in schools, and the 

availability of school nurses. In addition, objectives 

track health promotion programs in worksites, as well as 

community-based programs established by local health 

departments. The number of older adults participating in 

organized health promotion activities is also monitored.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved for the objectives 

in this Focus Area during the past decade [1]. Seventysix percent of the Educational and Community-Based 

Programs objectives with data to measure progress 

moved toward or achieved their Healthy People 2010 

targets (Figure 7-1). However, statistically significant 

health disparities were observed by race and 

ethnicity, sex, and education level, some of which are 

highlighted below (Figure 7-2) [2].

〉 The high school completion rate among persons 

aged 18–24 (objective 7-1) increased 4.7% between 

1998 and 2007, from 85% to 89%, moving toward the 

Healthy People 2010 target of 90%. Disparities were 

observed for racial and ethnic groups as follows:

 Among racial and ethnic groups, the nonHispanic white population had the highest (best) 

rate of high school completion, 93% in 2006, 

whereas the Hispanic or Latino population, the 

non-Hispanic black population, and persons of 

two or more races had rates of 71%, 85%, and 

90%, respectively. When expressed as persons 

not completing high school, the rate for the 

Hispanic or Latino population was more than 

four times the rate for the non-Hispanic white 

population [2]. The rate for the non-Hispanic 

black population was more than twice the nonHispanic white rate, and the rate for persons 

of two or more races was nearly one and a half 

times the non-Hispanic white rate.

〉 The proportion of schools with a nurse-to-student 

ratio of at least 1 nurse for every 750 students (1:750 

ratio) increased for all types of schools (objectives 

7-4a through d). Nationally, middle and junior high 

schools (objective 7-4c) met the 2010 target of 50% 

exactly in 2006. There was a 46.2% increase in the 

proportion of senior high schools with a 1:750 nurseto-student ratio (objective 7-4b) between 1994 and 

2006, from 26% to 38%. Although the proportion of 

elementary schools with a 1:750 nurse-to-student 

ratio (objective 7-4d) increased 7.1% between 2000 

and 2006, from 42% to 45%, the increase was not 

statistically significant.

〉 School health education programs increased in a 

number of areas. Examples of statistically significant 

increases include: education programs focusing 

on unintentional injuries (objective 7-2b), which 
7-4 HEALTHY PEOPLE 2010 FINAL REVIEW

increased 21.2% between 1994 and 2006, from 66% 

to 80%; and programs addressing violence (objective 

7-2c), which increased 32.8% between 1994 and 2006, 

from 58% to 77%.

Summary of Progress

〉 Figure 7-1 presents a quantitative assessment of 

progress in achieving the Healthy People 2010 

objectives for Educational and Community-Based 

Programs [1]. Data to measure progress toward target 

attainment were available for 17 objectives. Of these:

 One objective (7-4c, middle and junior high 

schools with a nurse-to-student ratio of at least 

1 nurse for every 750 students) met the Healthy 

People 2010 target.

 Twelve objectives moved toward their targets. A 

statistically significant difference between the 

baseline and the final data points was observed 

for six of these objectives (7-1, 7-2a through c, 

and 7-4a and b). No significant differences were 

observed for five objectives (7-2d, e, g, and i; and 

7-4d); and data to test the significance of the 

difference were unavailable for one objective 

(7-3).

 Two objectives (7-2h and j) showed no change.

 Two objectives (7-2f and 7-6) moved away from 

their targets. A statistically significant difference 

between the baseline and final data points was 

observed for one objective (7-6, participation in 

employer sponsored health promotion activities). 

No significant difference was observed for the 

other objective (7-2f, school health education on 

alcohol and other drug use in middle/junior and 

senior high schools).

〉 No data were available to measure progress for the 

following 39 objectives:

 Two objectives (7-5a and 7-10) remained 

developmental [3].

 Twenty-two objectives (7-5b through f; 7-11c, g 

through i, m through o, q through v, y, z, aa; and 

7-12) had baseline data only.

 Fifteen objectives (7-7 through 7-9; 7-11a, b, d 

through f, j through l, p, w, x, and bb) were deleted 

at the Midcourse Review.

〉 Figure 7-2 displays health disparities in Educational 

and Community-Based Programs from the best 

group rate for each characteristic at the most recent 

data point [2]. It also displays changes in disparities 

from baseline to the most recent data point [4].

 Three objectives (7-1, 7-3, and 7-12) had racial and 

ethnic health disparities of 10% or more. For each 

of these three objectives, a different group had 

the best rate, including the non-Hispanic white 

(objective 7-1), the non-Hispanic black (objective 

7-3), and the Asian or Pacific Islander populations 

(objective 7-12).

 Females had a better rate of high school 

completion than males (objective 7-1). When 

expressed as persons not completing high school, 

the rate for females (9%) was significantly lower 

than the rate for males (13%).

Transition to Healthy People 

2020

The Healthy People 2020 Educational and CommunityBased Programs Topic Area has expanded from Healthy 

People 2010 to include objectives that track core clinical 

prevention and population health content in the 

training of health care professionals. See HealthyPeople.

gov for a complete list of Healthy People 2020 topics and 

objectives.

The Healthy People 2020 Educational and CommunityBased Programs Topic Area objectives can be grouped 

into several sections:

〉 School settings

〉 Worksite settings

〉 Health care settings

〉 Community settings and select populations

〉 Training of health care professionals.

The differences between the Healthy People 2010 

objectives and those included in Healthy People 2020 are 

summarized below:

〉 The Healthy People 2020 Educational and 

Community-Based Programs Topic Area has a total 

of 94 objectives, 18 of which are developmental, 

whereas the Healthy People 2010 Educational and 

Community-Based Programs Focus Area had 56 

objectives, two of which remained developmental [3].

〉 Four Healthy People 2010 objectives, including high 

school completion (objective 7-1), nurse-to-student 

ratio in senior high schools and in elementary schools 

(objective 7-4b and d, respectively), and worksite 

health promotion program in worksites with fewer 

than 50 employees (objective 7-5a), were retained “as 

is” [5].
7 • Educational and Community-Based Programs 7-5

〉 Twenty Healthy People 2010 objectives were modified 

[6]:

 School health education objectives (7-2a through 

j) were modified to include elementary schools. 

Currently, objective 7-2 addresses middle and 

senior high schools. Adding elementary schools 

expands this objective to all grades K–12 

(elementary, middle, and senior high schools), 

thus providing comprehensive information on 

health education in the nation’s schools.

 The nurse-to-student ratio in all schools (objective 

7-4a) was modified to include elementary schools 

because elementary schools were added to the 

2006 School Health Policies and Programs Study 

(SHPPS). The nurse-to-student ratio in middle 

and junior high schools (objective 7-4c) was 

modified to be limited to middle schools only 

because the language, “junior high schools,” is no 

longer used in SHPPS.

 Most worksite setting objectives were reverted to 

developmental status because the data sources 

used over the last decade are no longer available. 

New data sources have been identified but 

currently lack baseline data. The objectives that 

are now developmental include:

 Culturally appropriate and linguistically 

competent community health promotion and 

disease prevention programs in educational 

and community-based programs (objective 

7-11g)

 Worksite health promotion programs in worksites with 50 or more employees, (objectives 

7-5b through f), and employer-sponsored health 

promotion activities (objective 7-6).

 One community settings and select populations 

objective (7-10, community health promotion 

programs), which was developmental, was 

modified. The objective expanded to nine 

objectives addressing population-based primary 

prevention services in the following priority 

areas: injury, violence, mental illness, tobacco 

use, substance abuse, unintended pregnancy, 

chronic disease programs, nutrition, and physical 

activity.

 The Healthy People 2010 objective on culturally 

appropriate and linguistically competent 

community health promotion programs in 

educational and community-based programs 

(objective 7-11g) was retained as developmental. 

The data source used in Healthy People 2010 no 

longer identifies or tracks culturally appropriate 

or linguistically competent programs, and a new 

data source is being sought in coordination with 

the Office of Minority Health within the U.S. 

Department of Health and Human Services.

〉 The following 17 objectives were archived [7]:

 School health education in environmental health 

(objective 7-2j) was archived because information 

about the topic is no longer collected by the data 

source (SHPPS).

 Sixteen community setting and select 

populations objectives were archived because 

the data sources used for the past decade no 

longer collect the data:

 Fifteen objectives that address culturally 

appropriate and linguistically competent 

community health promotion and disease 

prevention programs (objectives 7-11c, h, i, m, 

n, o, q through v, y, z and aa) were archived 

because they are no longer tracked by the 

National Profile of Local Health Departments.

 One objective that addresses older adults 

who have participated in organized health 

promotion activities (objective 7-12) was 

archived because the questions used to collect 

the data are no longer included in the National 

Health Interview Survey.

〉 The following 15 objectives were deleted at the 

Midcourse Review due to either lack of a national 

data source or a shift in program priority:

 All three health care setting objectives: patient 

and family education (objective 7-7), satisfaction 

with patient education (objective 7-8), and health 

care organization sponsorship of community 

health promotion activities (objective 7-9).

 Twelve of the community setting and select 

populations objectives were deleted due to lack 

of a national data source: culturally appropriate 

and linguistically competent community health 

promotion programs (objectives 7-11a, b, d 

through f, j through l, p, w, x, and bb).

〉 Sixty-two new objectives were added to the Healthy 

People 2020 Educational and Community-Based 

Programs Topic Area:

 Nine developmental objectives address 

preschools and Early Head Start programs in 

select priority areas.

 Seven objectives address school health education 

based on the National Health Education 

Standards.

 Seven objectives address school health education 

that promotes personal health and wellness.

 Nine objectives address college and university 

students who receive information from their 

institution on select priority health risk behavior 

areas.

 Thirty new objectives addressing the training 

of health care professionals were added. These 
7-6 HEALTHY PEOPLE 2010 FINAL REVIEW

include six objectives that focus on training in 

core clinical prevention and population health 

content for each of the following professions:

 Doctor of Medicine (M.D.)

 Doctor of Osteopathy (D.O.)

 Undergraduate nursing 

 Nurse Practitioner

 Physician Assistant.

The Healthy People 2020 objectives reflect the ongoing 

importance of Educational and Community-Based 

Programs. For objectives that were deleted due to lack of 

data, the U.S. Department of Health and Human Services 

and the agencies that serve as the leads for the Healthy 

People 2020 initiative will consider ways to ensure that 

these public health issues retain prominence despite the 

lack of data to monitor them.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People tracking data can be found in the 

Healthy People 2010 database, DATA2010, available 

from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

Notes

1. Displayed in the Progress Chart (Figure 7-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 7-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities 

Table (Figure 7-2). Disparity from the best group 

rate is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 
7 • Educational and Community-Based Programs 7-7

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 7-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

4. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 7-2 footnotes, as well as 

the Technical Appendix, for more detail.

5. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy 

People 2010 and are developmental in Healthy People 

2020, and for which no numerator information is 

available.

6. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

7. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.

Comprehensive Summary of Objectives: Educational and CommunityBased Programs

Objective Description Data Source or Objective Status

7-1 High school completion (18–24 years) Current Population Survey (CPS), Department of Commerce, 

Census Bureau.

7-2a School health education—All priority areas (middle/junior, 

senior high schools)

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

7-2b School health education—Unintentional injury (middle/junior, 

senior high schools)

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

7-2c School health education—Violence (middle/junior, senior high 

schools)

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

7-2d School health education—Suicide (middle/junior, senior high 

schools)

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

7-2e School health education—Tobacco use and addiction (middle/

junior, senior high schools)

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.
7-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Educational and Community-Based Programs (continued)

Objective Description Data Source or Objective Status

7-2f School health education—Alcohol and other drug use 

(middle/junior, senior high schools)

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

7-2g School health education—Unintended pregnancy, HIV/AIDS, 

and STD infection (middle/junior, senior high schools)

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

7-2h School health education—Unhealthy dietary patterns (middle/

junior, senior high schools)

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

7-2i School health education—Inadequate physical activity 

(middle/junior, senior high schools)

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

7-2j School health education—Environmental health (middle/

junior, senior high schools)

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

7-3 Health-risk behavior information for college and university 

students

National College Health Risk Behavior Survey, CDC, NCCDPHP.

7-4a School nurse-to-student ratio of at least 1:750—All middle/

junior and senior high schools

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

7-4b School nurse-to-student ratio of at least 1:750—Senior high 

schools

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

7-4c School nurse-to-student ratio of at least 1:750—Middle and 

junior high schools

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

7-4d School nurse-to-student ratio of at least 1:750— Elementary 

schools

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

7-5a Worksite health promotion programs—Worksites with fewer 

than 50 employees

Developmental.

7-5b Worksite health promotion programs—Worksites with 50 or 

more employees

National Worksite Health Promotion Survey (NWHPS), Association 

for Worksite Health Promotion (AWHP) and OPHS, ODPHP.

7-5c Worksite health promotion programs—Worksites with 50 to 

99 employees

National Worksite Health Promotion Survey (NWHPS), Association 

for Worksite Health Promotion (AWHP) and OPHS, ODPHP.

7-5d Worksite health promotion programs—Worksites with 100 to 

249 employees

National Worksite Health Promotion Survey (NWHPS), Association 

for Worksite Health Promotion (AWHP) and OPHS, ODPHP.

7-5e Worksite health promotion programs—Worksites with 250 to 

749 employees

National Worksite Health Promotion Survey (NWHPS), Association 

for Worksite Health Promotion (AWHP) and OPHS, ODPHP.

7-5f Worksite health promotion programs—Worksites with 750 or 

more employees

National Worksite Health Promotion Survey (NWHPS), Association 

for Worksite Health Promotion (AWHP) and OPHS, ODPHP.

7-6 Participation in employer-sponsored health promotion 

activities (age adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

7-7 Health care organizations that provide patient and family 

education

Deleted at the Midcourse Review.

7-8 Satisfaction with patient education Deleted at the Midcourse Review.
7 • Educational and Community-Based Programs 7-9

Comprehensive Summary of Objectives: Educational and Community-Based Programs (continued)

Objective Description Data Source or Objective Status

7-9 Hospital and managed care organization sponsorship of 

community health promotion activities

Deleted at the Midcourse Review.

7-10 Community health promotion programs addressing Healthy 

People 2010 focus areas

Developmental.

7-11a Culturally appropriate and linguistically competent community 

health promotion programs—Access to quality health 

services

Deleted at the Midcourse Review.

7-11b Culturally appropriate and linguistically competent community 

health promotion programs—Arthritis, osteoporosis, and 

chronic back conditions

Deleted at the Midcourse Review.

7-11c Culturally appropriate and linguistically competent community 

health promotion programs—Cancer

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

7-11d Culturally appropriate and linguistically competent community 

health promotion programs—Chronic kidney disease

Deleted at the Midcourse Review.

7-11e Culturally appropriate and linguistically competent community 

health promotion programs—Diabetes

Deleted at the Midcourse Review.

7-11f Culturally appropriate and linguistically competent community 

health promotion programs—Disability and secondary 

conditions

Deleted at the Midcourse Review.

7-11g Culturally appropriate and linguistically competent community 

health promotion programs—Educational and communitybased programs

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

7-11h Culturally appropriate and linguistically competent community 

health promotion programs—Environmental health 

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

7-11i Culturally appropriate and linguistically competent community 

health promotion programs—Family planning

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

7-11j Culturally appropriate and linguistically competent community 

health promotion programs—Food safety

Deleted at the Midcourse Review.

7-11k Culturally appropriate and linguistically competent community 

health promotion programs—Medical product safety

Deleted at the Midcourse Review.

7-11l Culturally appropriate and linguistically competent community 

health promotion programs—Health communication

Deleted at the Midcourse Review.

7-11m Culturally appropriate and linguistically competent community 

health promotion programs—Heart disease and stroke

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).
7-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Educational and Community-Based Programs (continued)

Objective Description Data Source or Objective Status

7-11n Culturally appropriate and linguistically competent community 

health promotion programs—HIV

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

7-11o Culturally appropriate and linguistically competent community 

health promotion programs—Immunization and infectious 

diseases

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

7-11p Culturally appropriate and linguistically competent community 

health promotion programs—Injury and violence prevention

Deleted at the Midcourse Review.

7-11q Culturally appropriate and linguistically competent community 

health promotion programs— Maternal, infant (and child) 

health

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

7-11r Culturally appropriate and linguistically competent community 

health promotion programs—Mental health (and mental 

disorders) 

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

7-11s Culturally appropriate and linguistically competent community 

health promotion programs—Nutrition and overweight

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

7-11t Culturally appropriate and linguistically competent community 

health promotion programs—Occupational safety and health

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

7-11u Culturally appropriate and linguistically competent community 

health promotion programs—Oral health

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

7-11v Culturally appropriate and linguistically competent community 

health promotion programs—Physical activity and fitness

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

7-11w Culturally appropriate and linguistically competent community 

health promotion programs—Public health infrastructure 

Deleted at the Midcourse Review.

7-11x Culturally appropriate and linguistically competent community 

health promotion programs—Respiratory diseases

Deleted at the Midcourse Review.

7-11y Culturally appropriate and linguistically competent community 

health promotion programs—Sexually transmitted diseases

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

7-11z Culturally appropriate and linguistically competent community 

health promotion programs—Substance abuse (alcohol and 

other drugs)

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

7-11aa Culturally appropriate and linguistically competent community 

health promotion programs—Tobacco use

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

7-11bb Culturally appropriate and linguistically competent community 

health promotion programs—Vision and hearing

Deleted at the Midcourse Review.

7-12 Participation in community health promotion activities (age 

adjusted, 65+ years)

National Health Interview Survey (NHIS), CDC, NHCS.
7 • Educational and Community-Based Programs 7-11

Figure 7-1. Progress toward target attainment for Focus area 7: Educational and community-Based 

Programs

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

7-1. High school completion (18–24 years) 80.0% 90% 85%

(1998)

89%

(2007)

4 Yes 4.7%

7-2. School health education

a. All priority areas (middle/junior, senior 

high schools)

22.0% 83% 33%

(1994)

44%

(2006)

11 Yes 33.3%

b. Unintentional injury (middle/junior, senior 

high schools)

58.3% 90% 66%

(1994)

80%

(2006)

14 Yes 21.2%

c. Violence (middle/junior, senior high 

schools)

86.4% 80% 58%

(1994)

77%

(2006)

19 Yes 32.8%

d. Suicide (middle/junior, senior high schools) 22.7% 80% 58%

(1994)

63%

(2006)

5 No 8.6%

e. Tobacco use and addiction (middle/junior, 

senior high schools) 

11.1% 95% 86%

(1994)

87%

(2006)

1 No 1.2%

f. Alcohol and other drug use (middle/junior, 

senior high schools)

95% 90%

(1994)

87%

(2006)

-3 No -3.3%

g. Unintended pregnancy, HIV/AIDS, and 

STD infection (middle/junior, senior high 

schools)

8.0% 90% 65%

(1994)

67%

(2006)

2 No 3.1%

h. Unhealthy dietary patterns (middle/junior, 

senior high schools)

 0.0% 95% 84%

(1994)

84%

(2006)

0 No 0.0%

i. Inadequate physical activity (middle/junior, 

senior high schools)

8.3% 90% 78%

(1994)

79%

(2006)

1 No 1.3%

j. Environmental health (middle/junior, senior 

high schools)

 0.0% 80% 60%

(1994)

60%

(2000)

0 No 0.0%

7-3. Health-risk behavior information for college and university students

68.4% 25% 6%

(1995)

19%

(2008)

13 Not tested 216.7%

7-4. School nurse-to-student ratio of at least 

1:750

a. All middle/junior and senior high schools 77.3% 50% 28%

(1994)

45%

(2006)

17 Yes 60.7%

b. Senior high schools 50.0% 50% 26%

(1994)

38%

(2006)

12 Yes 46.2%

c. Middle and junior high schools 100.0% 50% 32%

(1994)

50%

(2006)

18 Yes 56.3%

d. Elementary schools 50.0% 48% 42%

(2000)

45%

(2006)

3 No 7.1%

7-6. Participation in employer-sponsored 

health promotion activities (age adjusted, 

18+ years)

88% 67%

(1994)

59%

(1998)

-8 Yes -11.9%

lEgEnd Moved away from target1 Moved toward target Met or exceeded target
7-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 7-1. Progress toward target attainment for Focus area 7: Educational and community-Based Programs

(continued)

NOTES

See the reader’s guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 7-5a through f, 7-10, 7-11c, 7-11g through i, 7-11m through o, 7-11q through v, 7-11y, 

7-11z, 7-11aa, and 7-12. Objectives 7-7, 7-8, 7-9, 7-11a, 7-11b, 7-11d through f, 7-11j through l, 7-11p, 7-11w, 7-11x, and 7-11bb were deleted at the 

Midcourse Review. 

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See technical appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See technical appendix for more information.

DATA SOURCES

7-1. Current Population Survey (CPS), Department of Commerce, Census Bureau.

7-2a–j. School Health Policies and Programs Study (SHPPS), CDC, NCCDPHP.

7-3. National College Health Risk Behavior Survey, CDC, NCCDPHP.

7-4a–d. School Health Policies and Programs Study (SHPPS), CDC, NCCDPHP.

7-6. National Health Interview Survey (NHIS), CDC, NCHS.

5 Final value – Baseline value Percent change = × 100.

Baseline value
7 • Educational and Community-Based Programs 7-13

Figure 7-2. Health Disparities Table for Focus Area 7: Educational and Community-Based Programs

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Income Location Disability

Population-based objectiveAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexUrban or metropolitanRural ornonmetropolitanPersons with disabilitiesPersons without disabilities

7-1. High school completion (18–24 years) 

(1998, 2007)1,2* i 

 B ii B

7-3. Health-risk behavior information for 

college and university students (1995, 

2008)†

B B

7-6. Participation in employer-sponsored 

health promotion activities (age adjusted, 18+ years) (1994, 1998)3*

b B B B Biii b B B

7-12. Participation in community health 

promotion activities among older adults 

(age adjusted, 65+ years) (1998)*

Bi B B B B

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 7-2a 

through j, 7-4a through d, 7-5a through f, 7-10, and 7-11c, g, h, i, m, n, o, q through v, y, z, and aa. Objectives 7-7 through 7-9, and 7-11a, b, d, e, f, j, k, l, p, w, x, and bb 

were deleted at Midcourse Review.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

lEgEnd

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See technical appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.
7-14 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 7-2. Health Disparities Table for Focus Area 7: Educational and Community-Based Programs (continued)

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. Nonetheless, 

disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix. 1 Most recent data by race and ethnicity are for 2006.

2 Baseline data by disability status are for 1995. 3 Baseline data by race and ethnicity are for 1998. 

i

 Data are for Asian or Pacific Islander.

ii Change in the summary index cannot be assessed. See Technical Appendix.

iiiThe group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

DATA SOURCES

7-1. Current Population Survey (CPS), Department of Commerce, Census Bureau.

7-3. National College Health Risk Behavior Survey, CDC, NCCDPHP.

7-6. National Health Interview Survey (NHIS), CDC, NCHS.

7-12. National Health Interview Survey (NHIS), CDC, NCHS.
Environmental 

Health

CHAPTER 8

Co-Lead Agencies

Agency for Toxic Substances and Disease Registry

Centers for Disease Control and Prevention

National Institutes of Health

Contents

Goal ..................................................................................................8-3

Highlights ........................................................................................8-3

Summary of Progress.......................................................................8-4

Transition to Healthy People 2020..................................................8-5

Data Considerations.........................................................................8-7

Notes................................................................................................8-8

Comprehensive Summary of Objectives..........................................8-9

Progress Chart................................................................................8-14

Health Disparities Table.................................................................8-18

8 • Environmental Health 8-3

GOAL :

Promote health for all through a healthy 

environment.

This chapter includes objectives that monitor progress 

in six general Healthy People areas:

〉 The Outdoor Air Quality area monitors the 

proportion of persons exposed to air containing 

harmful pollutants.

〉 The Surface and Ground Water Quality area 

tracks contaminants in drinking water, fish, and 

recreational water.

〉 The Toxics and Waste area monitors exposures to 

toxic substances and hazardous waste.

〉 The Healthy Homes and Healthy Communities area 

focuses on environmental factors in homes, schools, 

and worksites.

〉 Infrastructure and Surveillance addresses the availability of methods to detect environmental hazards 

(e.g., chemical, biological, and other factors that may 

adversely affect health), exposures to these hazards, 

and the diseases potentially caused by these hazards.

〉 Global Environmental Health objectives address the 

global burden of disease due to poor water quality, 

sanitation, personal and domestic hygiene, and the 

proportion of the population in the U.S.–Mexico 

border region that has adequate drinking water and 

sanitation facilities.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from: 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in objectives 

for this Focus Area during the past decade [1]. 

Eighty-four percent of the Environmental Health 

objectives with data to measure progress moved 

toward or achieved their Healthy People 2010 

targets (Figure 8-1). However, health disparities 

were observed among racial and ethnic populations 

in their exposure to harmful air pollutants (Figure 

8-2) [2]. Similar disparities were observed between 

populations residing in urban and rural locations.

〉 Between 1997 and 2010, exposure to harmful air 

pollutants (objectives 8-1a through g) declined for all 

pollutants tracked. The proportion of persons living 

in counties that exceed National Ambient Air Quality 

Standards (NAAQS) for carbon monoxide (objective 

8-1c) declined from 20% to 0%; the proportion for 

nitrogen dioxide (objective 8-1d) declined from 5% 

to 0%; the proportion for sulfur dioxide (objective 

8-1e) declined from 2% to 0%; and the proportion 

for lead (objective 8-1f) declined from less than 1% 

to 0% in 2010, all meeting the Healthy People 2010 

targets of 0% for those pollutants. Although the 

2010 targets were not met for ozone (objective 8-1a) 

and particulate matter (objective 8-1b), air quality 

for these pollutants improved, declining 16.3% and 

25.0%, respectively. The data presented here do not 

reflect tighter standards that were issued after the 

targets had been set.

〉 The proportion of people living in counties that 

exceeded NAAQS for ozone (objective 8-1a) declined 

25.0% between 1997 and 2010, from 43% to 36%, 
8-4 HEALTHY PEOPLE 2010 FINAL REVIEW

moving toward the 2010 target of 0%. However, the 

final data year by race and ethnicity was 2004, and at 

that time, disparities were observed for a number of 

population groups:

 Among racial and ethnic groups, the American 

Indian or Alaska Native population had the 

lowest (best) rate of living in counties that 

exceeded NAAQS for ozone (objective 8-1a), 23% 

in 2004, whereas the non-Hispanic white, Native 

Hawaiian or Other Pacific Islander, non-Hispanic 

black, Hispanic or Latino, and Asian populations 

had rates of 33%, 35%, 43%, 59%, and 67%, 

respectively. The rate for the non-Hispanic white 

population was almost one and a half times the 

best group rate (that for the American Indian or 

Alaska Native population); the rate for the Native 

Hawaiian or Other Pacific Islander population 

was about one and a half times the best group rate; 

the rate for the non-Hispanic black population 

was almost twice the best group rate; the rate for 

the Hispanic or Latino population was more than 

two and a half times the best group rate; and the 

rate for the Asian population was nearly three 

times the best group rate [2].

 The rural or nonmetropolitan population had 

better rates of exposure to ozone (4% in 1997 

and 3% in 2004) than the urban or metropolitan 

population (52% in 1997 and 48% in 2004). In 

2004, the rate for the urban or metropolitan 

population was 16 times the rate for the rural 

or nonmetropolitan population. Between 1997 

and 2004, the disparity in ozone exposure 

between the rural/nonmetropolitan and the 

urban/metropolitan populations increased 300 

percentage points [3].

〉 The proportion of people living in counties that 

exceeded NAAQS for particulate matter (objective 

8-1b) declined 25.0% between 1997 and 2010, from 

12% to 9%. However, the final data year by race and 

ethnicity also was 2004 and, at that time, disparities 

were observed for a number of population groups.

 Among racial and ethnic groups, the nonHispanic black population had the lowest (best) 

rate of particulate matter exposure (objective 

8-1b), 6% in 2004. The American Indian or 

Alaska Native population had a rate of 13%, more 

than twice the best rate. The Asian and Native 

Hawaiian or Other Pacific Islander populations 

each had a rate of 22%, over three and a half times 

the best rate. The Hispanic or Latino population 

had a rate of 28%, more than four and a half times 

the best rate [2].

 The rural or nonmetropolitan population had 

lower (better) rates of exposure to particulate 

matter (1% in 1997 and 2004) than the urban 

or metropolitan population (15% in 1997 and 

13% in 2004). In 2004, the rate for the urban or 

metropolitan population was 13 times the rate 

for the rural or nonmetropolitan population. 

Between 1997 and 2004, the disparity in 

particulate matter between the rural/

nonmetropolitan and the urban/metropolitan 

populations decreased 200 percentage points [3].

〉 The use of alternate modes of transportation 

increased. Trips made by transit (objective 8-2c) 

increased 116.7% between 1995 and 2009, from 1.8% 

to 3.9%, exceeding the 2010 target of 3.6%. Trips made 

by walking (objective 8-2b) increased 92.6%, from 

5.4% to 10.4%, almost achieving the 2010 target of 

10.8%. Smaller gains were made for trips by bicycle 

(objective 8-2a) and telecommuting (objective 8-2d), 

which increased 11.1% and 40.0% respectively.

〉 The proportion of persons served by water systems 

that met safe drinking water standards (objective 

8-5) increased 9.5% between 1995 and 2008, from 

84% to 92%, moving toward the 2010 target of 95%. 

The number of waterborne disease outbreaks 

(objective 8-6) declined 83.3% from 1987–96 to 

2008, from 6 outbreaks to 1, exceeding the target of 

2 outbreaks. However, there was little progress in 

water conservation (objective 8-7). Between 1995 and 

2005, the daily per capita gallons of domestic water 

usage declined only 2%.

〉 The risks posed by hazardous sites on the National 

Priority Sites List (objective 8-12a) declined 11.8% 

between 1998 and 2008, from 1,290 to 1,138 sites, 

exceeding the 2010 target of 1,176 sites.

〉 Progress was made in exposure to environmental 

pesticides and chemicals (objectives 8-24 and 8-25). 

Four of the 15 objectives with data to measure 

progress met or exceeded their 2010 targets: exposure 

to propoxur (objective 8-24d) declined from 1.1 μg/gm 

of creatinine for the 90th percentile of the population 

aged 6–59 years to below the level of detection (0.4 

μg); o-Phenylphenol (objective 8-25g) declined 

40.0%; diazinon (objective 8-25i) was below the level 

of detection in 1999–2000 (0.58 μg) and 2001–02 

(0.5 μg); and mercury in females aged 16–49 years 

(objective 8-25q) declined 35.3%. Eight objectives 

made progress toward their targets. However, three 

moved away from their targets, including exposure to 

chlorpyrifos (objective 8-24c) which increased 10.8%, 

cadmium (objective 8-25b) which increased 14.3%, 

and DDT (objective 8-25o) which increased 1.6%.

Summary of Progress

〉 Figure 8-1 presents a quantitative assessment of 

progress in achieving the Healthy People objectives 

for Environmental Health. Data to measure progress 
8 • Environmental Health 8-5

toward target attainment were available for 61 

objectives [1]. Of these:

 Twenty-one objectives met or exceeded the 

Healthy People 2010 targets (objectives 8-1c 

through f; 8-2c; 8-6; 8-12a; 8-19; 8-24d; 8-25g, i, 

and q; 8-27d and e; and 8-30a, e through i, and l).

 Thirty objectives moved toward their targets. A 

statistically significant difference between the 

baseline and final data points was observed for 

one objective (8-22). Data to test the significance 

of the difference between the baseline and 

final data points were unavailable for all the 

remaining objectives (8-1a b, and g; 8-2a, b, and 

d; 8-3 through 5; 8-7; 8-9; 8-13; 8-15; 8-23; 8-24b; 

8-25c, e, m, n, p, r, and s; 8-27a through c, i, and 

o; and 8-29).

 Two objectives showed no change (objectives 

8-27g and 8-30b).

 Eight objectives moved away from their targets 

(objectives 8-10a and b, 8-24c, 8-25b and o, 8-27h, 

and 8-30j and l). Data to test the significance of 

the difference between the baseline and final 

data points were unavailable for any of these 

objectives.

〉 Eight objectives (8-14a and b; 8-17; 8-25d, h, and j 

through l) remained developmental and 18 objectives 

had no follow-up data available to measure progress 

(objectives 8-8a and b; 8-12b through d; 8-16a through 

c; 8-18; 8-20; 8-21; 8-25a and f; 8-27f, j and k; and 8-30c 

and d) [4]. Five objectives (8-24a, 8-27l through n, and 

8-28) were deleted at the Midcourse Review. Data for 

one objective (8-11) became statistically unreliable.

〉 Figure 8-2 displays health disparities in 

Environmental Health from the best group rate for 

each characteristic at the most recent data point [2]. 

It also displays changes in disparities from baseline 

to the most recent data point [3].

 One objective (8-22) had statistically significant 

racial and ethnic health disparities of 10% or 

more. Five other objectives (8-1a through c, e, 

and g) had racial and ethnic health disparities of 

10% or more but lacked data to assess statistical 

significance. Of these six objectives, the American 

Indian or Alaska Native, Native Hawaiian or 

Other Pacific Islander, and non-Hispanic black 

populations each had the best group rate for 

one objective. The non-Hispanic black and nonHispanic white populations were tied for the best 

group rate for objective 8-1c (exposure to carbon 

monoxide); persons of two or more races and the 

non-Hispanic black populations were tied for 

the best group rate for objective 8-22 (persons in 

pre-1950s homes tested for lead paint). All racial 

and ethnic populations except for the Native 

Hawaiian or Other Pacific Islander population 

were tied for the best group rate for objective 8-1e 

(exposure to sulfur dioxide).

 Females had a better rate than males for the one 

objective with health disparities of 10% or more 

by sex (8-1b, exposure to particulate matter).

 Persons living in rural or nonmetropolitan areas 

had better rates than persons living in urban or 

metropolitan areas for all four objectives (8-1a 

through c, and g) with health disparities of 10% 

or more by geographic location.

 Several objectives with health disparities of 100% 

or more by race and ethnicity and by geographic 

location were observed, as were objectives with 

changes in health disparities of 100 percentage 

points or more over time. These objectives were 

discussed in the Highlights, above.

Transition to Healthy People 

2020

The Healthy People 2020 Environmental Health Topic 

Area has fewer objectives than those included in Healthy 

People 2010. See HealthyPeople.gov for a complete list of 

Healthy People 2020 topics and objectives.

The Healthy People 2020 objectives can be grouped into 

several sections:

〉 Outdoor air quality

〉 Surface and ground water quality

〉 Toxics and waste

〉 Healthy homes and healthy communities

〉 Infrastructure and surveillance

〉 Global environmental health.

The differences between the Healthy People 2010 and 

Healthy People 2020 objectives are summarized below:

〉 The Healthy People 2020 Environmental Health 

Topic Area has a total of 67 objectives, whereas the 

Healthy People 2010 Environmental Health Focus 

Area had 93 objectives.

〉 Twenty-seven Healthy People 2010 objectives were 

retained “as is” [5]:

 Increase the proportion of persons served by 

community water systems who receive a supply 

of drinking water that meets the regulations of 

the Safe Drinking Water Act (objective 8-5).

 Reduce waterborne disease outbreaks arising 
8-6 HEALTHY PEOPLE 2010 FINAL REVIEW

from water intended for drinking among persons 

served by community water systems (objective 

8-6).

 Eliminate elevated blood lead levels in children 

(objective 8-11).

 Minimize the risks to human health and the 

environment posed by hazardous sites: National 

Priority List sites (objective 8-12a).

 Reduce pesticide exposures that result in visits to 

a health care facility (objective 8-13).

 Increase recycling of municipal solid waste 

(objective 8-15).

 Reduce the proportion of occupied housing units 

that have moderate or severe physical problems 

(objective 8-22).

 Reduce exposure to pesticides as measured by 

urine concentrations of metabolites:

 Paranitrophenol (methyl parathion and 

parathions) (objective 8-24b)

 3,4,6-trichloro-2-pyridinol (chlorpyrifos) (objective 8-24c).

 Reduce exposure to selected environmental 

chemicals in the population, as measured by 

blood and urine concentrations of the substances 

or their metabolites:

 Arsenic (objective 8-25a)

 Cadmium (objective 8-25b)

 Lead (objective 8-25c)

 Mercury, children aged 1–5 years (objective 

8-25e)

 Mercury, females aged 16–49 years (objective 

8-25q)

 Chlordane (Oxychlordane) (objective 8-25m)

 DDT (DDE) (objective 8-25o)

 Beta-hexacyclochlorohexane or beta-HCH (objective 8-25p)

 cis- and trans-Permethrin (objective 8-25h)

 Dioxins (objective 8-25k).

 Improve the utility, awareness, and use of 

existing information systems for environmental 

health (objective 8-26).

 Increase the number of territories, tribes, and 

states (including the District of Columbia) that 

monitor diseases or conditions that can be 

caused by exposure to environmental hazards:

 Lead poisoning (objective 8-27a)

 Pesticide poisoning (objective 8-27b)

 Mercury poisoning (objective 8-27c)

 Arsenic poisoning (objective 8-27d)

 Cadmium poisoning (objective 8-27e)

 Acute chemical poisoning (objective 8-27g)

 Carbon monoxide poisoning (objective 8-27h).

 Twenty-one Healthy People 2010 objectives 

were modified, expanded, and retained, 

resulting in 35 objectives in Healthy People 2020 

[6].

 In Healthy People 2010, there were seven 

objectives (8-1a through g) that tracked air 

quality separately for each of six criteria air 

pollutants (ozone, carbon monoxide, nitrogen 

dioxide, particulate matter, sulfur dioxide, and 

lead), and the total population exposed to any 

of these. In Healthy People 2020, air quality is 

tracked by a single objective (Air Quality Index), 

which is a composite measure of criteria air 

pollutants.

 The objectives (8-2a through d) to increase use 

of alternative modes of transportation for work 

commutes, to reduce motor vehicle emissions 

and improve the nation’s air quality, has a new, 

more timely data source.

 The objective to reduce air toxic emissions to 

decrease the risk of adverse health effects caused 

by airborne toxics (objective 8-4) was split into 

three objectives by source type.

 The objective for school policies to protect 

against environmental hazards (objective 8-20) 

was split into nine objectives to separately track 

specific policies.

 Other objectives had changes in operational 

definition.

〉 Thirty-six Healthy People 2010 objectives were 

archived [7]. These include objectives addressing: 

cleaner alternative fuels (objective 8-3); water bodies 

safe for fishing and recreation (objectives 8-8a and 

b); fish consumption advisories (objectives 8-10a and 

b); risks posed by hazardous sites (objectives 8-12b 

through d); indoor allergens (objectives 8-16a and 

b); proportion of persons living in homes tested for 

radon (objective 8-18); disaster preparedness plans, 

protocols, and exercises (objective 8-21); exposure 

to pesticides (objectives 8-24d, and 8-25f, g, i, n, r, 

and s); monitoring environmentally related diseases 

(objectives 8-27f, i through k, and o); and water 

quality in the U.S.–Mexico border region (objectives 

8-30a through l).

 In general, these objectives were archived 

because the data source could not produce 

consistent, comparable data. In the case of 

cleaner alternative fuels, it was not clear what 

negative externalities would be associated with 

the increased use of these fuels. Objectives 

related to monitoring exposure to environmental 

chemicals were archived because the measures 

used to monitor them were below the limits of 
8 • Environmental Health 8-7

detection, or because the public health concern 

could be tracked by a related chemical or was 

not deemed a significant public health concern 

by CDC.

〉 Five Healthy People 2010 objectives were deleted at 

the Midcourse Review:

 Exposure to pesticides—Urine concentrations 

in μg/g creatinine—1-naphthol (carbaryl) (aged 

6 years and over) (objective 8-24a) was deleted 

because it was an inadequate environmental 

marker.

 Monitoring environmentally related diseases—

Skin cancer (objective 8-27l) was deleted because 

it was being tracked by objective 3-14 (cancer 

registries).

 Monitoring environmentally related diseases—

Malignant melanoma (objective 8-27m) was 

deleted because it was tracked by objective 3-14 

(cancer registries).

 Monitoring environmentally related diseases—

Other skin cancer (objective 8-27n) was deleted 

because it was tracked by objective 3-14 (cancer 

registries).

 Local agencies using surveillance data for vector 

control (objective 8-28) was deleted due to the 

lack of a national data source.

〉 Four Healthy People 2010 objectives that remained 

developmental were removed during the Healthy 

People 2020 planning process, due to lack of a data 

source, or because data was never produced by the 

data source, or because the measure was consistently 

below the level of detection, or because the measure 

was an inadequate environmental marker.

 Production-related waste released by the 

business sector (objective 8-14a)

 Office building air quality—Number of buildings 

that are managed using good indoor air quality 

practices (objective 8-17)

 Exposure to pesticides, heavy metals, and 

selected environmental chemicals—Manganese 

(objective 8-25d)

 Exposure to pesticides, heavy metals, and 

selected environmental chemicals—Furans 

(objective 8-25l).

〉 Five new objectives were added for Healthy People 

2020:

 Exposure to potential endocrine disruptors—

Bisphenol A

 Exposure to potential endocrine disruptors—

Perchlorate

 Exposure to potential endocrine disruptors—

Mono-n-butyl phthalate

 Exposure to potential endocrine disruptors—

BDE 47 (2,2’,4,4’-tetrabromodiphenyl ether)

 Reduce the number of new schools sited within 

500 feet of an interstate or Federal or State 

highway.

Appendix D, “A Crosswalk between Objectives from 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

U.S. Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

Information on data issues is available from the following 

sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.
8-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Notes

1. Displayed in the Progress Chart (Figure 8-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 8-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities 

Table (Figure 8-2). Disparity from the best group 

rate is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference between 

the best group rate and each of the other group rates 

was tested at the 0.05 level of significance. See the 

Figure 8-2 footnotes, as well as the Technical Appendix, 

for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 8-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

5. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

6. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

7. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.
8 • Environmental Health 8-9

Comprehensive Summary of Objectives: Environmental Health

Objective Description Data Source or Objective Status

8-1a Percent of persons exposed to harmful air pollutants—Ozone Air Quality System (AQS), Environmental Protection Agency (EPA).

8-1b Percent of persons exposed to harmful air pollutants—

Particulate matter (≤10 μm in diameter)

Air Quality System (AQS), Environmental Protection Agency (EPA).

8-1c Percent of persons exposed to harmful air pollutants—Carbon 

monoxide

Air Quality System (AQS), Environmental Protection Agency (EPA).

8-1d Percent of persons exposed to harmful air pollutants—

Nitrogen dioxide

Air Quality System (AQS), Environmental Protection Agency (EPA).

8-1e Percent of persons exposed to harmful air pollutants—Sulfur 

dioxide

Air Quality System (AQS), Environmental Protection Agency (EPA).

8-1f Percent of persons exposed to harmful air pollutants—Lead Air Quality System (AQS), Environmental Protection Agency (EPA).

8-1g Number of persons (thousands) exposed to any harmful air 

pollutants

Air Quality System (AQS), Environmental Protection Agency (EPA).

8-2a Alternative modes of transportation—Trips made by bicycling National Household Travel Survey (NHTS), formerly Nationwide 

Personal Transportation Survey (NPTS), Department of 

Transportation (DOT).

8-2b Alternative modes of transportation—Trips made by walking National Household Travel Survey (NHTS), formerly Nationwide 

Personal Transportation Survey (NPTS), Department of 

Transportation (DOT).

8-2c Alternative modes of transportation—Trips made by transit National Household Travel Survey (NHTS), formerly Nationwide 

Personal Transportation Survey (NPTS), Department of 

Transportation (DOT).

8-2d Alternative modes of transportation—Persons who 

telecommute

National Household Travel Survey (NHTS), formerly Nationwide 

Personal Transportation Survey (NPTS), Department of 

Transportation (DOT).

8-3 Cleaner alternative fuels Alternatives to Traditional Transportation Fuels, Department of 

Energy, (DOE).

8-4 Airborne toxins (million tons) National Emissions Inventory (NEI), Environmental Protection Agency 

(EPA).

8-5 Safe drinking water Potable Water Surveillance System (PWSS) and Safe Drinking Water 

Information System (SDWIS), Environmental Protection Agency 

(EPA).

8-6 Waterborne disease outbreaks (average no. per year) State Reporting Systems, CDC, NCID.

8-7 Water conservation (gallons of domestic water usage per 

capita per day)

Estimated Use of Water in the United States, Department of Interior 

(DOI).

8-8a Water bodies safe for fishing and recreation—Rivers and 

streams 

National Water Quality Inventory (NWQI), Environmental Protection 

Agency (EPA). 

8-8b Water bodies safe for fishing and recreation—Lakes, ponds, 

and reservoirs

National Water Quality Inventory (NWQI), Environmental Protection 

Agency (EPA). 

8-9 Beach open and safe for swimming (percent of days during 

beach season)

Beaches Environmental Assessment, Closure and Health Program 

(BEACH), Environmental Protection Agency (EPA).

8-10a Fish consumption advisories—Rivers National Listing of Fish Advisories, Environmental Protection Agency 

(EPA).
8-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Environmental Health (continued)

Objective Description Data Source or Objective Status

8-10b Fish consumption advisories—Lakes National Listing of Fish Advisories, Environmental Protection Agency 

(EPA).

8-11 Elevated blood lead levels in children 1–5 years (≥10 μg/dL) National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

8-12a Risks posed by hazardous sites—National Priority List sites Comprehensive Environmental Response and Cleanup Liability 

Information System (CERCLIS), Environmental Protection Agency 

(EPA).

8-12b Risks posed by hazardous sites—Resource Conservation and 

Recovery Act facilities

Resource Conservation Recovery Act Info (RCRAInfo), Environmental 

Protection Agency (EPA).

8-12c Risks posed by hazardous sites—Leaking underground 

storage facilities

Environmental Protection Agency (EPA).

8-12d Risks posed by hazardous sites—Brownfield properties Environmental Protection Agency (EPA).

8-13 Pesticide exposures resulting in visits to a health care facility 

(no. of visits per year)

Toxic Exposure Surveillance System (TESS), American Association 

of Poison Control Centers.

8-14a Production-related waste released by the business sector (per 

unit of production) 

Developmental.

8-14b Toxic chemicals released by the business sector (per unit of 

production)

Developmental.

8-15 Recycled municipal solid waste (percent of total municipal 

solid waste)

Municipal Solid Waste in the United States, Environmental 

Protection Agency (EPA).

8-16a Indoor allergens—Group 1 dust mite allergens >2 μg/g of 

dust in bed

National Survey of Lead and Allergens in Housing: NIH, NIEHS; 

Department of Housing and Urban Development (HUD).

8-16b Indoor allergens—Group 1 dust mite allergens >10 μg/g of 

dust in bed 

National Survey of Lead and Allergens in Housing: NIH, NIEHS; 

Department of Housing and Urban Development (HUD).

8-16c Indoor allergens—German cockroach allergens >0.1 unit/g of 

dust in the bed

National Survey of Lead and Allergens in Housing: NIH, NIEHS; 

Department of Housing and Urban Development (HUD).

8-17 Office buildings that are managed using good indoor air 

quality practices (no. of buildings)

Developmental.

8-18 Proportion of persons living in homes tested for radon (age 

adjusted)

National Health Interview Survey (NHIS), CDC, NCHS.

8-19 Radon-resistant new home construction (no. of homes) National Association of Home Builders Research Center Survey, 

National Association of Home Builders.

8-20 School policies to protect against environmental hazards School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

8-21 Disaster preparedness plans, protocols, and exercises (no. 

States and D.C.)

Association of State and Territorial Health Officials (ASTHO); CDC, 

Division of State and Local Readiness (DSLR).

8-22 Proportion of persons in pre-1950s homes tested for leadbased paint (age adjusted, 18+ years)National Health Interview Survey (NHIS), CDC, NCHS.

8-23 Substandard housing (percent of homes with moderate or 

severe physical problems)

American Housing Survey (AHS), Department of Commerce, Census 

Bureau.

8-24a Pesticide exposure—Urine concentrations (μg/g creatinine, 

6–59 years)—1 naphthol (carbaryl) (μg/g creatinine) 

Deleted at the Midcourse Review.
8 • Environmental Health 8-11

Comprehensive Summary of Objectives: Environmental Health (continued)

Objective Description Data Source or Objective Status

8-24b Pesticide exposure—Urine concentrations (μg/g creatinine, 

6–59 years)—Paranitrophenol (methyl parathion and 

parathions) (μg/g creatinine)

National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-24c Pesticide exposure—Urine concentrations (μg/g creatinine, 

6–59 years)—3, 5, 6-trichloro-2-pyridinol (chlorpyrifos) (μg/g 

creatinine)

National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-24d Pesticide exposure—Urine concentrations (μg/g creatinine, 

6–59 years)—Isopropoxyphenol (propoxur) (μg/g creatinine)

National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-25a Exposure to Arsenic National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-25b Exposure to Cadmium—Blood concentration (μg/L blood) National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-25c Exposure to Lead—Blood concentration (μg/L blood) National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-25d Exposure to Manganese Developmental.

8-25e Mercury in children aged 1–5 years—Blood concentration 

(μg/L blood)

National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-25f Exposure to 2, 4-Dichlorophenoxyacetic acid (μg/g creatinine) National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-25g Exposure to o-Phenylphenol—Urine concentration (μg/g 

creatinine)

National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-25h Exposure to cis- and trans-Permethrin Developmental.

8-25i Exposure to Diazinon—Urine concentration (μg/g creatinine) National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-25j Exposure to Polychlorinated biphenyls Developmental.

8-25k Exposure to Dioxins Developmental.

8-25l Exposure to Furans Developmental.

8-25m Exposure to Chlordane/Oxychlordane—Serum concentration 

(ng/g lipid)

National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-25n Exposure to Dieldrin—Serum concentration (ng/g lipid) National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-25o Exposure to DDT/DDE—Serum concentration (ng/g lipid) National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.
8-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Environmental Health (continued)

Objective Description Data Source or Objective Status

8-25p Exposure to Lindane/beta-HCH—Serum concentration (ng/g 

lipid)

National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-25q Exposure to Mercury in females aged 16–49 years—Blood 

concentration (μg/L)

National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-25r Exposure to Chlordane/trans-Nonachlor—Serum 

concentration (ng/g lipid)

National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-25s Exposure to Chlordane/Heptachlor epoxide—Serum 

concentration (ng/g lipid)

National Report on Human Exposure to Environmental Chemicals, 

CDC, NCEH; National Health and Nutrition Examination Survey 

(NHANES), CDC, NCHS.

8-26 Information systems used for public health (no. States) National Environmental Public Health Tracking Network (EPHT), 

CDC, NCEH.

8-27a Monitoring environmentally related diseases (no. States and 

D.C.)—Lead poisoning

State Reportable Conditions Assessment (SRCA), Council of State 

and Territorial Epidemiologists (CSTE).

8-27b Monitoring environmentally related diseases (no. States and 

D.C.)—Pesticide poisoning

State Reportable Conditions Assessment (SRCA), Council of State 

and Territorial Epidemiologists (CSTE).

8-27c Monitoring environmentally related diseases (no. States and 

D.C.)—Mercury poisoning

State Reportable Conditions Assessment (SRCA), Council of State 

and Territorial Epidemiologists (CSTE).

8-27d Monitoring environmentally related diseases (no. States and 

D.C.)—Arsenic poisoning

State Reportable Conditions Assessment (SRCA), Council of State 

and Territorial Epidemiologists (CSTE).

8-27e Monitoring environmentally related diseases (no. States and 

D.C.)—Cadmium poisoning

State Reportable Conditions Assessment (SRCA), Council of State 

and Territorial Epidemiologists (CSTE).

8-27f Monitoring environmentally related diseases (no. States and 

D.C.)—Methemoglobinemia

Periodic surveys, Public Health Foundation (PHF) and Council of 

State and Territorial Epidemiologist (CSTE).

8-27g Monitoring environmentally related diseases (no. States and 

D.C.)—Acute chemical poisoning by nonmedicinal chemicals 

not identified above

State Reportable Conditions Assessment (SRCA), Council of State 

and Territorial Epidemiologists (CSTE).

8-27h Monitoring environmentally related diseases (no. States and 

D.C.)—Carbon monoxide poisoning

State Reportable Conditions Assessment (SRCA), Council of State 

and Territorial Epidemiologists (CSTE).

8-27i Monitoring environmentally related diseases (no. States and 

D.C.)—Asthma

State Reportable Conditions Assessment (SRCA), Council of State 

and Territorial Epidemiologists (CSTE).

8-27j Monitoring environmentally related diseases (no. States and 

D.C.)—Hyperthermia

Periodic surveys, Public Health Foundation (PHF) and Council of 

State and Territorial Epidemiologists (CSTE).

8-27k Monitoring environmentally related diseases (no. States and 

D.C.)—Hypothermia

Periodic surveys, Public Health Foundation (PHF) and Council of 

State and Territorial Epidemiologists (CSTE).

8-27l Monitoring environmentally related diseases (no. States and 

D.C.)—Skin cancer

Deleted at the Midcourse Review.

8-27m Monitoring environmentally related diseases (no. States and 

D.C.)—Malignant melanoma

Deleted at the Midcourse Review.

8-27n Monitoring environmentally related diseases (no. States and 

D.C.)—Other skin cancer

Deleted at the Midcourse Review.

8-27o Monitoring environmentally related diseases (no. States and 

D.C.)—Birth defects

State Reportable Conditions Assessment (SRCA), Council of State 

and Territorial Epidemiologists (CSTE).

8-28 Local agencies using surveillance data for vector control Deleted at the Midcourse Review.
8 • Environmental Health 8-13

Comprehensive Summary of Objectives: Environmental Health (continued)

Objective Description Data Source or Objective Status

8-29 Global burden of disease (no. deaths in thousands) Global Burden of Disease Project, World Health Organization (WHO).

8-30a Proportion of population in U.S.–Mexico border region with 

wastewater sewer service—Ciudad Acuña

Environmental Protection Agency (EPA); Mexico's Comisión Nacional 

del Agua; State and Local Health Departments; American Water 

Works Association; Rural Water Association; U.S.–Mexico Border 

Health Commission.

8-30b Proportion of population in U.S.–Mexico border region with 

wastewater sewer service—Matamoros

Environmental Protection Agency (EPA); Mexico's Comisión Nacional 

del Agua; State and Local Health Departments; American Water 

Works Association; Rural Water Association; U.S.–Mexico Border 

Health Commission.

8-30c Proportion of population in U.S.–Mexico border region with 

wastewater sewer service—Mexicali

Environmental Protection Agency (EPA); Mexico's Comisión Nacional 

del Agua; State and Local Health Departments; American Water 

Works Association; Rural Water Association; U.S.–Mexico Border 

Health Commission.

8-30d Proportion of population in U.S.–Mexico border region with 

wastewater sewer service—Nogales, Sonora

Environmental Protection Agency (EPA); Mexico's Comisión Nacional 

del Agua; State and Local Health Departments; American Water 

Works Association; Rural Water Association; U.S.–Mexico Border 

Health Commission.

8-30e Proportion of population in U.S.–Mexico border region with 

wastewater sewer service—Piedras Negras

Environmental Protection Agency (EPA); Mexico's Comisión Nacional 

del Agua; State and Local Health Departments; American Water 

Works Association; Rural Water Association; U.S.–Mexico Border 

Health Commission.

8-30f Proportion of population in U.S.–Mexico border region with 

wastewater sewer service—Reynosa

Environmental Protection Agency (EPA); Mexico's Comisión Nacional 

del Agua; State and Local Health Departments; American Water 

Works Association; Rural Water Association; U.S.–Mexico Border 

Health Commission.

8-30g Proportion of population in U.S.–Mexico border region with 

wastewater treatment service—Ciudad Acuña

Environmental Protection Agency (EPA); Mexico's Comisión Nacional 

del Agua; State and Local Health Departments; American Water 

Works Association; Rural Water Association; U.S.–Mexico Border 

Health Commission.

8-30h Proportion of population in U.S.–Mexico border region with 

wastewater treatment service—Matamoros

Environmental Protection Agency (EPA); Mexico's Comisión Nacional 

del Agua; State and Local Health Departments; American Water 

Works Association; Rural Water Association; U.S.–Mexico Border 

Health Commission.

8-30i Proportion of population in U.S.–Mexico border region with 

wastewater treatment service—Mexicali

Environmental Protection Agency (EPA); Mexico's Comisión Nacional 

del Agua; State and Local Health Departments; American Water 

Works Association; Rural Water Association; U.S.–Mexico Border 

Health Commission.

8-30j Proportion of population in U.S.–Mexico border region with 

wastewater treatment service—Nogales, Sonora

Environmental Protection Agency (EPA); Mexico's Comisión Nacional 

del Agua; State and Local Health Departments; American Water 

Works Association; Rural Water Association; U.S.–Mexico Border 

Health Commission.

8-30k Proportion of population in U.S.–Mexico border region with 

wastewater treatment service—Piedras Negras

Environmental Protection Agency (EPA); Mexico's Comisión Nacional 

del Agua; State and Local Health Departments; American Water 

Works Association; Rural Water Association; U.S.–Mexico Border 

Health Commission.

8-30l Proportion of population in U.S.–Mexico border region with 

wastewater treatment service—Reynosa

Environmental Protection Agency (EPA); Mexico's Comisión Nacional 

del Agua; State and Local Health Departments; American Water 

Works Association; Rural Water Association; U.S.–Mexico Border 

Health Commission.
8-14 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 8-1. Progress toward target attainment for Focus area 8: Environmental Health

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

8-1. Percent of persons exposed to harmful 

air pollutants

a. Ozone 16.3% 0% 43%

(1997)

36%

(2010)

-7 Not tested -16.3%

b. Particulate matter (≤10 μm in diameter) 25.0% 0% 12%

(1997)

9%

(2010)

-3 Not tested -25.0%

c. Carbon monoxide 100.0% 0% 20%

(1997)

0%

(2010)

-20 Not tested -100.0%

d. Nitrogen dioxide 100.0% 0% 5%

(1997)

0%

(2010)

-5 Not tested -100.0%

e. Sulfur dioxide 100.0% 0% 2%

(1997)

0%

(2010)

-2 Not tested -100.0%

f. Lead 100.0% 0% <1%

(1997)

0%

(2010)

>-1 Not tested -100.0%

8-1g. Number of persons (thousands) exposed 

to any harmful air pollutants

21.2% 0 137,019

(1997)

107,991

(2010)

-29,028 Not tested -21.2%

8-2. Alternative modes of transportation

a. Trips made by bicycling 11.1% 1.8% 0.9%

(1995)

1.0%

(2009)

0.1 Not tested 11.1%

b. Trips made by walking 92.6% 10.8% 5.4%

(1995)

10.4%

(2009)

5.0 Not tested 92.6%

c. Trips made by transit 116.7% 3.6% 1.8%

(1995)

3.9%

(2009)

2.1 Not tested 116.7%

d. Persons who telecommute 40.0% 4.0% 2.0%

(2001)

2.8%

(2009)

0.8 Not tested 40.0%

8-3. Cleaner alternative fuels 45.8% 8.0% 0.8%

(1997)

4.1%

(2008)

3.3 Not tested 412.5%

8-4. Airborne toxins (million tons) 57.4% 2.0 8.1

(1993)

4.6

(2002)

-3.5 Not tested -43.2%

8-5. Safe drinking water 72.7% 95% 84%

(1995)

92%

(2008)

8 Not tested 9.5%

8-6. Waterborne disease outbreaks 

(average no. per year)

125.0% 2 6

(1987–96)

1

(2006)

-5 Not tested -83.3%

8-7. Water conservation (gallons of domestic 

water usage per capita per day)

19.8% 91 101

(1995)

99

(2005)

-2 Not tested -2.0%

8-9. Beach open and safe for swimming 

(percent of days during beach season)

25.0% 98% 94%

(2002)

95%

(2008)

1 Not tested 1.1%

8-10. Fish consumption advisories

a. Rivers 13.8% 15.3%

(2002)

24.0%

(2004)

8.7 Not tested 56.9%

b. Lakes 29.6% 32.9%

(2002)

35.0%

(2004)

2.1 Not tested 6.4%

lEGEnD Moved away from target1 Moved toward target Met or exceeded target
8 • Environmental Health 8-15

Figure 8-1. Progress toward target attainment for Focus area 8: Environmental Health (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

8-12a. Risks posed by hazardous sites—

National Priority List sites

133.3% 1,176 1,290

(1998)

1,138

(2008)

-152 Not tested -11.8%

8-13. Pesticide exposures resulting in visits to a 

health care facility (no. of visits per year)

69.1% 11,398 22,933

(1997)

14,963

(2008)

-7,970 Not tested -34.8%

8-15. Recycled municipal solid waste (percent of 

total municipal solid waste)

54.5% 38% 27%

(1996)

33%

(2008)

6 Not tested 22.2%

8-19. Radon-resistant new home construction 

(no. of homes)

114.9% 978,750 652,500

(1997)

1,027,500

(2007)

375,000 Not tested 57.5%

8-22. Proportion of persons in pre-1950s homes 

tested for lead-based paint (age adjusted, 

18+ years)

14.7% 50% 16%

(1998)

21%

(2002)

5 Yes 31.3%

8-23. Substandard housing (percent of 

homes with moderate or severe 

physical problems)

38.2% 3.1% 6.5%

(1995)

5.2%

(2007)

-1.3 Not tested -20.0%

8-24. Pesticide exposure—Urine concentrations 

(μg/g creatinine, 6–59 years)

b. Paranitrophenol (methyl parathion and 

parathions) (μg/g creatinine)

81.8% 2.7 3.8

(1988–94)

2.9

(2001–02)

-0.9 Not tested -23.7%

c. 3, 5, 6-trichloro-2-pyridinol (chlorpyrifos) 

(μg/g creatinine)

5.8 8.3

(1988–94)

9.2

(2001–02)

0.9 Not tested 10.8%

d. Isopropoxyphenol (propoxur) 

(μg/g creatinine)

Target exceeded 

at fi nal† 1.1 1.6

(1988–94)

BLOD6

(2001-02)

* Not tested *

8-25. Exposure to environmental chemicals

b. Cadmium—Blood concentration 

(μg/L blood)

1.0 1.4

(1999–2000)

1.6

(2003–04)

0.2 Not tested 14.3%

c. Lead—Blood concentration (μg/L blood) 53.3% 3.5 5.0

(1988–94)

4.2

(2003–04)

-0.8 Not tested -16.0%

e. Mercury in children aged 1–5 years—

Blood concentration (μg/L blood)

71.4% 1.6 2.3

(1999–2000)

1.8

(2003–04)

-0.5 Not tested -21.7%

g. o-Phenylphenol—Urine concentration 

(μg/g creatinine)

133.3% 2.1 3.0

(1999–2000)

1.8

(2001–02)

-1.2 Not tested -40.0%

i. Diazinon—Urine concentration 

(μg/g creatinine)

Target met at 

baseline and fi nal BLOD6 BLOD6

(1999–2000)

BLOD6

(2001–02)

BLOD6 Not tested *

m. Chlordane/Oxychlordane—Serum 

concentration (ng/g lipid)

53.0% 31.4 44.8

(1999–2000)

37.7

(2003–04)

-7.1 Not tested -15.8%

n. Dieldrin—Serum concentration 

(ng/g lipid)

21.3% 14.2 20.3

(2001–02)

19.0

(2003–04)

-1.3 Not tested -6.4%

o. DDT/DDE—Serum concentration 

(ng/g lipid)

1,281 1,830

(1999–2000)

1,860

(2003–04)

30 Not tested 1.6%

p. Lindane/beta-HCH—

Serum concentration (ng/g lipid)

59.9% 48.2 68.9

(1999–2000)

56.5

(2003–04)

-12.4 Not tested -18.0%

q. Mercury in females aged 16–49 years—

Blood concentration (μg/L)

119.0% 5.0 7.1

(1999–2000)

4.6

(2001–02)

-2.5 Not tested -35.2%

r. Chlordane/trans-Nonachlor—

Serum concentration (ng/g lipid)

46.6% 55.6 79.4

(1999–2000)

68.3

(2003–04)

-11.1 Not tested -14.0%

s. Chlordane/Heptachlor epoxide—

Serum concentration (ng/g lipid)

70.8% 16.8 24.0

(1999–2000)

18.9

(2003–04)

-5.1 Not tested -21.3%
8-16 HEALTHY PEOPLE 2010 FINAL REVIEW

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

8-26. Information systems used for public health 

(no. States)

51.7% 30 1

(2008)

16

(2010)

15 Not tested 1,500.0%

8-27. Monitoring environmentally related 

diseases (no. States and D.C.)

a. Lead poisoning 13.8% 51 22

(2007)

26

(2010)

4 Not tested 18.2%

b. Pesticide poisoning 21.4% 25 11

(2007)

14

(2009)

3 Not tested 27.3%

c. Mercury poisoning 33.3% 20 14

(2007)

16

(2010)

2 Not tested 14.3%

d. Arsenic poisoning 100.0% 15 12

(2007)

15

(2010)

3 Not tested 25.0%

e. Cadmium poisoning 125.0% 15 11

(2007)

16

(2010)

5 Not tested 45.5%

g.Acute chemical poisoning by nonmedicinal 

chemicals not identifi ed above

 0.0% 15 9

(2008)

9

(2009)

0 Not tested 0.0%

h. Carbon monoxide poisoning 51 10

(2007)

9

(2009)

-1 Not tested -10.0%

i. Asthma 4.3% 25 2

(2007)

3

(2009)

1 Not tested 50.0%

o. Birth defects 4.4% 51 6

(2007)

8

(2009)

2 Not tested 33.3%

8-29. Global burden of disease (no. deaths 

in thousands)

87.8% 2,135.0 2,668.2

(1990)

2,200.0

(2004)

-468.2 Not tested -17.5%

8-30. Proportion of population in U.S.–Mexico 

border region with wastewater sewer 

service

a. Ciudad Acuña 360.0% 49% 39%

(1997)

75%

(2002)

36 Not tested 92.3%

b. Matamoros 0.0% 57% 47%

(1997)

47%

(2002)

0 Not tested 0.0%

e. Piedras Negras 200.0% 90% 80%

(1997)

100%

(2002)

20 Not tested 25.0%

f. Reynosa 180.0% 67% 57%

(1997)

75%

(2002)

18 Not tested 31.6%

g. Ciudad Acuña 890.0% 10% 0%

(1997)

89%

(2009)

89 Not tested *

h. Matamoros 870.0% 10% 0%

(1997)

87%

(2010)

87 Not tested *

i. Mexicali 230.0% 82% 72%

(1997)

95%

(2010)

23 Not tested 31.9%

j. Nogales, Sonora 100% 100%

(1997)

89%

(2010)

-11 Not tested -11.0%

k. Piedras Negras 980.0% 10% 0%

(1997)

98%

(2010)

98 Not tested *

l. Reynosa 100% 100%

(1997)

89%

(2010)

-11 Not tested -11.0%

Figure 8-1. Progress toward target attainment for Focus area 8: Environmental Health (continued)
8 • Environmental Health 8-17

Figure 8-1. Progress toward target attainment for Focus area 8: Environmental Health (continued)

NOTES

See the reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 8-8a, 8-8b, 8-12b through d, 8-14a, 8-14b, 8-16a through c, 8-17, 8-18, 8-20, 8-21, 8-25a, 

8-25d, 8-25f, 8-25h, 8-25j through l, 8-27f, 8-27j, 8-27k, 8-30c,and 8-30d. Final tracking data for objective 8-11 are not statistically reliable. Objectives 

8-24a, 8-27l through n, and 8-28 were deleted at the Midcourse Review. 

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See technical appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed 

at the 0.05 level. See technical appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

6

 Below level of detection (BLOD).

* Diff erence and/or percent change cannot be calculated. See technical appendix for more information.

† Percent of targeted change cannot be calculated. See technical appendix for more information.

DATA SOURCES

8-1a–g. Air Quality System (AQS), Environmental Protection Agency (EPA).

8-2a–d. National Household Travel Survey (NHTS), formerly Nationwide Personal Transportation Survey (NPTS), Department of 

Transportation (DOT). 

8-3. Alternatives to Traditional Transportation Fuels, Department of Energy (DOE).

8-4. National Emissions Inventory (NEI), Environmental Protection Agency (EPA).

8-5. Potable Water Surveillance System (PWSS) and Safe Drinking Water Information System (SDWIS), Environmental Protection 

Agency (EPA).

8-6. State Reporting Systems, CDC, NCID.

8-7. Estimated Use of Water in the United States, Department of Interior (DOI).

8-9. Beaches Environmental Assessment, Closure and Health Program (BEACH), Environmental Protection Agency (EPA).

8-10a–b. National Listing of Fish Advisories, Environmental Protection Agency (EPA).

8-12a. Comprehensive Environmental Response and Cleanup Liability Information System (CERCLIS), Environmental Protection 

Agency (EPA).

8-13. Toxic Exposure Surveillance System (TESS), American Association of Poison Control Centers.

8-15. Municipal Solid Waste in the United States, Environmental Protection Agency (EPA).

8-19. National Association of Home Builders Research Center Survey, National Association of Home Builders.

8-22. National Health Interview Survey (NHIS), CDC, NCHS.

8-23. American Housing Survey (AHS), Department of Commerce, Census Bureau.

8-24b–d. National Report on Human Exposure to Environmental Chemicals, CDC, NCEH; National Health and Nutrition Examination 

Survey (NHANES), CDC, NCHS.

8-25b–c. National Report on Human Exposure to Environmental Chemicals, CDC, NCEH; National Health and Nutrition Examination 

Survey (NHANES), CDC, NCHS.

8-25e. National Report on Human Exposure to Environmental Chemicals, CDC, NCEH; National Health and Nutrition Examination 

Survey (NHANES), CDC, NCHS.

8-25g. National Report on Human Exposure to Environmental Chemicals, CDC, NCEH; National Health and Nutrition Examination 

Survey (NHANES), CDC, NCHS.

8-25i. National Report on Human Exposure to Environmental Chemicals, CDC, NCEH; National Health and Nutrition Examination 

Survey (NHANES), CDC, NCHS.

8-25m–s. National Report on Human Exposure to Environmental Chemicals, CDC, NCEH; National Health and Nutrition Examination 

Survey (NHANES), CDC, NCHS.

8-26. National Environmental Public Health Tracking Network (EPHT), CDC, NCEH.

8-27a–e. State Reportable Conditions Assessment (SRCA), Council of State and Territorial Epidemiologists (CSTE).

8-27g–i. State Reportable Conditions Assessment (SRCA), Council of State and Territorial Epidemiologists (CSTE). 

8-27o. State Reportable Conditions Assessment (SRCA), Council of State and Territorial Epidemiologists (CSTE).

8-29. Global Burden of Disease Project, World Health Organization (WHO).

8-30a–b. Environmental Protection Agency (EPA), Mexico’s Comisión Nacional del Agua; State and Local Health Departments; American 

Water Works Association; Rural Water Association; U.S.–Mexico Border Health Commission.

8-30e–l. Environmental Protection Agency (EPA), Mexico’s Comisión Nacional del Agua; State and Local Health Departments; American 

Water Works Association; Rural Water Association; U.S.–Mexico Border Health Commission.
8-18 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 8-2. Health Disparities Table for Focus Area 8: Environmental Health

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Income Location

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMalePoorNear poorMiddle/high incomeSummary indexUrban or metropolitanRural or nonmetropolitan

8-1a. Percent of persons exposed to harmful 

air pollutants—Ozone (1997, 2010)1† B  B B







B

b. Percent of persons exposed to harmful 

air pollutants—Particulate matter (≤10 

μm in diameter) (1997, 2010)1†

 













 B  B







B

c. Percent of persons exposed to harmful 

air pollutants—Carbon monoxide 

(1997, 2010)1†



























Bi B







B B







B

d. Percent of persons exposed to harmful 

air pollutants—Nitrogen dioxide (1997, 

2010)1†

Bi Bi Bi Bi Bi B B B B Bi B

e. Percent of persons exposed to harmful 

air pollutants—Sulfur dioxide (1997, 

2010)1†

B B B B Bi Bi  B B

f Percent of persons exposed to harmful 

air pollutants—Lead (1997, 2010)1† B B B B B B B B B Bi B

8-1g. Number of persons (thousands) 

exposed to any harmful air pollutants 

(1997, 2010)1†









B





















 B







B

8-11. Elevated blood lead levels in children 

1–5 years (≥10 μg/dL) (1991–94, 

2005–08)*

ii ii

8-18. Proportion of persons living in homes 

tested for radon (age adjusted) (1998)* B B B

8-22. Proportion of persons in pre-1950s 

homes tested for lead-based paint (age 

adjusted, 18+ years) (1998, 2002)2*

B B B B Bi

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 8-2a 

through d, 8-3 through 8-7, 8-8a and b, 8-9, 8-10a and b, 8-12a through d, 8-13, 8-14a and b, 8-15, 8-16a through c, 8-17, 8-19 through 8-21, 8-23, 8-24b through d, 8-25a 

through s, 8-26, 8-27a through k, 8-27o, 8-29, and 8-30a through l. Objectives 8-24a, 8-27l through n, and 8-28 were deleted at Midcourse Review.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.
8 • Environmental Health 8-19

Figure 8-2. Health Disparities Table for Focus Area 8: Environmental Health (continued)

EGE Dl n

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See t a echnical ppendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. Nonetheless, 

disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix. 1 Most recent data by race and ethnicity, sex, and location are for 2004.

2 Baseline data by race and ethnicity are for 2002. i

 The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix. ii Data are for Mexican American.

DATA SOURCES

8-1a–g. Air Quality System (AQS), Environmental Protection Agency (EPA).

8-11. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

8-18. National Health Interview Survey (NHIS), CDC, NCHS.

8-22. National Health Interview Survey (NHIS), CDC, NCHS.

Family Planning

CHAPTER 9

Lead Agency

Office of Population Affairs

Contents

Goal ..................................................................................................9-3

Highlights ........................................................................................9-3

Summary of Progress.......................................................................9-4

Transition to Healthy People 2020..................................................9-4

Data Considerations.........................................................................9-5

References and Notes.......................................................................9-6

Comprehensive Summary of Objectives..........................................9-7

Progress Chart................................................................................9-10

Health Disparities Table.................................................................9-13

9 • Family Planning 9-3

GOAL:

Improve family planning and spacing and 

prevent unintended pregnancy.

This chapter includes objectives that track intended 

pregnancies, birth spacing, infertility, and adolescent 

pregnancies. Contraceptive use and family planning 

clinic visits among adolescents and persons at risk 

of unintended pregnancy are also monitored, as is 

instruction on reproductive health issues for adolescents.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, (DATA2010), available 

from http://wonder.cdc.gov/data2010/.

More information about this focus area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Progress was achieved in objectives for this Focus 

Area during the past decade [1]. About one half 

(53%) of the Family Planning objectives with data to 

measure progress moved toward or achieved their 

Healthy People 2010 targets (Figure 9-1). However, 

health disparities were observed among racial and 

ethnic population groups, as well as by income 

and by disability status (Figure 9-2). Some of these 

disparities are highlighted below [2].

〉 Although several Family Planning objectives did 

not meet the Healthy People 2010 targets overall, 

some objectives met or even exceeded their targets 

for certain population groups. For example, in order 

for intended pregnancy (objective 9-1), considered as 

the principal objective of the Family Planning Focus 

Area, to have met the 2010 target, this objective 

would have had to increase from 52% to 70%. This 

targeted increase was not achieved, and no progress 

was made during the decade overall. Nonetheless, 

married women did meet the 2010 target: 73% of 

their pregnancies were intended in 2002. Differential 

progress by marital status and income continues to 

be observed.

〉 Contraceptive failure, the proportion of women aged 

15–44 who experienced pregnancy within 12 months 

of continuous contraceptive use (objective 9-4), 

declined 20% between 1995 and 2002, from 15% to 

12%, moving toward the 2010 target of 8%. Although 

the 2010 target was not met overall, middle/highincome women almost met the target with an 8.4% 

failure rate in 2002. However, the failure rate for poor 

women was 20%, which was almost double the overall 

population rate of 12%. Moreover, health disparities 

by income increased, as seen below [3].

 Middle/high-income women had the lowest 

(best) rates of contraceptive failure among 

income groups, 12% in 1995 and 8.4% in 2002; 

whereas near-poor women had rates of 17% 

in 1995 and 18% in 2002, and poor women had 

rates of 26% in 1995 and 20% in 2002. In 2002, 

the rate for near-poor women was more than 

twice the best group rate (that for middle/highincome women), while the rate for poor women 

was almost two and a half times the best group 

rate [2]. Between 1995 and 2002, the disparity 

between near-poor and middle/high-income 

women increased 83 percentage points [3].

 Among racial and ethnic groups, non-Hispanic 

white women had the lowest (best) rate of 

contraceptive failure, 10% in 2002. The rate for 

non-Hispanic black women was 21%, more than 

twice that of non-Hispanic white women [2].

〉 Adolescent pregnancy among females aged 15–17 

(objective 9-7) declined 37% between 1996 and 2005, 
9-4 HEALTHY PEOPLE 2010 FINAL REVIEW

from 63 to 40 per 1,000 females, moving toward the 

2010 target of 39 per 1,000.

 Among racial and ethnic groups, non-Hispanic 

white females aged 15–17 had the lowest (best) 

adolescent pregnancy rate, 22 per 1,000 in 2005. 

Hispanic or Latino and non-Hispanic black 

females aged 15–17 had rates of 85 and 88 per 

1,000 in, respectively. The rate for Hispanic 

or Latino females aged 15–17 was almost four 

times the best group rate (that for non-Hispanic 

white females aged 15–17), whereas the rate for 

non-Hispanic black females aged 15–17 was four 

times the best group rate [2].

 Non-Hispanic white females aged 15–17 had 

adolescent pregnancy rates of 40 per 1,000 in 

1996 and 22 per 1,000 in 2005, whereas Hispanic 

or Latino females aged 15–17 had rates of 109 per 

1,000 in 1996 and 80 per 1,000 in 2005. Between 

1996 and 2005, the disparity between Hispanic 

or Latino and non-Hispanic white females aged 

15–17 increased 91 percentage points [3].

Summary of Progress

〉 Figure 9-1 presents a quantitative assessment of 

progress in achieving the Healthy People 2010 

objectives for Family Planning [1]. Data to measure 

progress toward target attainment were available for 

32 objectives. Of these:

 Eight objectives (9-8a, 9-10c through h, and 9-11i) 

met or exceeded the Healthy People 2010 targets.

 Nine objectives moved toward their targets. A 

statistically significant difference between the 

baseline and the final data points was observed 

for one of these objectives (9-9a). No significant 

differences were observed for two objectives (9-

11a and o); and data to test the significance of the 

difference were unavailable for the remaining six 

objectives (9-4, 9-7, 9-8b, 9-9b, 9-10b, and 9-12).

 Two objectives (9-6a and 9-11k) showed no 

change.

 Thirteen objectives moved away from their 

targets. A statistically significant difference 

between the baseline and final data points was 

observed for two of these objectives (9-3 and 

9-6b). No significant differences were observed 

for eight objectives (9-6c; 9-10a; and 9-11b through 

d, j, l, and p). Data to test the significance of the 

difference were unavailable for three objectives 

(9-1, 9-2, and 9-5).

〉 Six objectives (9-11e through h, m, and n) remained 

developmental [4]. Follow-up data were unavailable 

to measure progress for one objective (9-13).

〉 Figure 9-2 displays health disparities in Family 

Planning from the best group rate for each 

characteristic at the most recent data point [2]. It 

also displays changes in disparities from baseline to 

the most recent data point [3].

 Statistically significant racial and ethnic health 

disparities of 10% or more were observed for 

seven objectives (9-6b; 9-10c and d; and 9-11j 

through l, and p); three additional objectives 

(9-1, 9-4, and 9-7) had racial and ethnic health 

disparities of 10% or more but no data to assess 

statistical significance. Of these 10 objectives, 

the non-Hispanic white population had the 

best group rate for eight objectives (9-1, 9-4, 9-7, 

9-10c and d, and 9-11j through l). The Hispanic 

or Latino population and the non-Hispanic black 

population each had the best group rate for the 

two remaining objectives (9-6b and 9-11p).

 Statistically significant health disparities of 

10% or more by income were observed for five 

objectives (9-2, 9-3, and 9-11c, d, and k); two 

additional objectives (9-1 and 9-4) had a health 

disparity of 10% or more by income but no data 

to assess statistical significance. Persons with 

middle/high incomes had the best group rate for 

all seven of these objectives.

 Two objectives (9-4 and 9-7) had health 

disparities of 100% or more among racial and 

ethnic populations and/or income groups, as 

well as changes in disparities of 50 percentage 

points or more over time. These disparities are 

discussed in the Highlights, above.

Transition to Healthy People 

2020

The focus of the Healthy People 2020 Family Planning 

Topic Area—increasing the proportion of pregnancies 

that are intended, improving pregnancy planning and 

spacing, and preventing unintended pregnancy—is 

consistent with that of the Healthy People 2010 Focus 

Area. As publicly funded family planning services 

prevent 1.94 million unintended pregnancies, including 

400,000 teen pregnancies each year, new objectives 

addressing services provided by publicly funded family 

planning clinics have been added to the Healthy People 

2020 Topic Area [5]. See HealthyPeople.gov for a complete 

list of Healthy People 2020 topics and objectives. 

The Healthy People 2020 Family Planning objectives can 

be grouped into four sections:

〉 Proportion of pregnancies that are intended and the 

rate of adolescent pregnancy
9 • Family Planning 9-5

〉 Receipt of reproductive health services

〉 Effective use of contraception for pregnancy prevention and protection against disease

〉 Receipt of education on prevention of sexually 

transmitted diseases (STD) and unwanted pregnancy.

The differences between the Healthy People 2010 and 

Healthy People 2020 objectives are summarized below:

〉 The Healthy People 2020 Family Planning Topic Area 

has 40 objectives, one of which is developmental, 

whereas the Healthy People 2010 Focus Area had 39 

objectives, six of which were developmental [4].

〉 Twenty-one Healthy People 2010 objectives (9-1, 9-4, 

9-9a and b, 9-11a through p, and 9-13) were retained 

“as is” [6]. These include objectives that focus on 

the proportion of pregnancies that are intended, 

contraceptive failure within 12 months of continuous 

use, abstinence among adolescents, insurance 

coverage for contraceptive supplies and services, 

and reproductive health and disease prevention 

education. Data are not shown in the DATA2010 

database for six of these objectives (including formal 

and informal instruction on HIV/AIDS prevention 

and formal instruction on sexually transmitted 

diseases), but data are available in Healthy People 

2020.

〉 One Healthy People 2010 objective, the rate of 

adolescent pregnancy (objective 9-7), was retained 

“as is” for ages 15–17 in Healthy People 2020 [6]. An 

additional objective on adolescent pregnancy also 

was added to Healthy People 2020 and focuses on 

ages 18–19.

〉 Thirteen Healthy People 2010 objectives (9-2, 

9-3, 9-5, 9-8a and b, and 9-10a through h) were 

modified, including the objectives on birth 

spacing, contraceptive use among females at risk of 

unintended pregnancy, emergency contraception, 

abstinence before age 15, pregnancy prevention, and 

STD protection [7,8].

〉 One objective (9-12) addressing problems in 

becoming pregnant and maintaining a pregnancy 

was modified and moved to the Maternal, Infant, and 

Child Health Topic Area [7].

〉 Three Healthy People 2010 objectives (9-6a through 

c) that focused on male involvement in pregnancy 

prevention were archived [9]. Other objectives on 

male involvement in family planning are spread 

throughout the Healthy People 2020 Topic Area.

〉 Five new objectives were added to the Healthy People 

2020 Topic Area:

 One objective tracks the proportion of publicly 

funded family planning clinics that offer a full 

range of FDA-approved contraceptive methods 

on-site.

 Two objectives track the proportion of sexually 

active persons who receive reproductive health 

services.

 One objective monitors the number of states 

that set the income eligibility level for Medicaidcovered family planning services to at least 

the same level used to determine eligibility for 

Medicaid-covered pregnancy-related care.

 One objective tracks the proportion of females 

in need of publicly supported contraceptive 

services and supplies who receive those services 

and supplies.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

Information on data issues is available from the following 

sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.
9-6 HEALTHY PEOPLE 2010 FINAL REVIEW

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

References and Notes

1. Displayed in the Progress Chart (Figure 9-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 9-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities 

Table (Figure 9-2). Disparity from the best group 

rate is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 9-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 9-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

5. Guttmacher Institute. In Brief: Facts on Publicly 

Funded Contraceptive Services in the United States.

Washington, D.C.: Guttmacher Institute. April 2010. 

Available from http://www.guttmacher.org/pubs/

fb_contraceptive_serv.pdf.

6. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

7. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

8. Objectives 9-8a and b (abstinence before age 15) are 

defined as abstinence by age 15 in Healthy People 

2020. 

9. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.
9 • Family Planning 9-7

Comprehensive Summary of Objectives: Family Planning

Objective Description Data Source or Objective Status

9-1 Intended pregnancy (females 15–44 years) National Survey of Family Growth (NSFG), CDC, NCHS; National 

Vital Statistics System—Natality (NVSS-N), CDC, NCHS; Abortion 

Provider Survey, Guttmacher Institute; Abortion Surveillance Data, 

CDC, NCCDPHP.

9-2 Births occurring within 24 months of a previous birth (females 

15–44 years)

National Survey of Family Growth (NSFG), CDC, NCHS.

9-3 Contraceptive use—Females at risk of unintended pregnancy 

(15–44 years)

National Survey of Family Growth (NSFG), CDC, NCHS.

9-4 Contraceptive failure within 12 months of continuous use—

Females experiencing pregnancy (15–44 years)

National Survey of Family Growth (NSFG), CDC, NCHS; Abortion 

Provider Survey, Guttmacher Institute.

9-5 Emergency contraception provided by family planning 

agencies

Guttmacher Institute.

9-6a Involvement in pregnancy prevention among unmarried males 

15–24 years—Family planning clinic visit with female partner 

in last 12 months

National Survey of Family Growth (NSFG), CDC, NCHS.

9-6b Involvement in pregnancy prevention among unmarried males 

15–24 years—Family planning clinic visit for himself in last 

12 months

National Survey of Family Growth (NSFG), CDC, NCHS.

9-6c Involvement in pregnancy prevention among unmarried males 

15–24 years—Advice/counseling from a doctor on birth 

control in last 12 months

National Survey of Family Growth (NSFG), CDC, NCHS.

9-7 Adolescent pregnancy (per 1,000 population, 15–17 years) National Survey of Family Growth (NSFG), CDC, NCHS; National 

Vital Statistics System—Natality (NVSS-N), CDC, NCHS; Abortion 

Provider Survey, Guttmacher Institute; Abortion Surveillance Data, 

CDC, NCCDPHP.

9-8a Abstinence before age 15—Females (15–19 years) National Survey of Family Growth (NSFG), CDC, NCHS.

9-8b Abstinence before age 15—Males (15–19 years) National Survey of Adolescent Males (NSAM), Urban Institute; 

National Survey of Family Growth (NSFG), CDC, NCHS.

9-9a Abstinence among adolescents 15–17 years—Females National Survey of Family Growth (NSFG), CDC, NCHS.

9-9b Abstinence among adolescents 15–17 years—Males National Survey of Adolescent Males (NSAM), Urban Institute; 

National Survey of Family Growth (NSFG), CDC, NCHS.

9-10a Pregnancy prevention and STD protection in unmarried 

adolescents 15–17 years—Condom use (partner) at first 

intercourse, females

National Survey of Family Growth (NSFG), CDC, NCHS.

9-10b Pregnancy prevention and STD protection in unmarried 

adolescents 15–17 years—Condom use at first intercourse, 

males

National Survey of Adolescent Males (NSAM), Urban Institute; 

National Survey of Family Growth (NSFG), CDC, NCHS.

9-10c Pregnancy prevention and STD protection in unmarried 

adolescents 15–17 years—Condom use (partner) and 

hormonal method use at first intercourse, females

National Survey of Family Growth (NSFG), CDC, NCHS.

9-10d Pregnancy prevention and STD protection in unmarried 

adolescents 15–17 years—Condom use and hormonal 

method (partner) at first intercourse, males

National Survey of Adolescent Males (NSAM), Urban Institute; 

National Survey of Family Growth (NSFG), CDC, NCHS.
9-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Family Planning (continued)

Objective Description Data Source or Objective Status

9-10e Pregnancy prevention and STD protection in unmarried 

adolescents 15–17 years—Condom use (partner) at last 

intercourse, females

National Survey of Family Growth (NSFG), CDC, NCHS.

9-10f Pregnancy prevention and STD protection in unmarried 

adolescents 15–17 years—Condom use at last intercourse, 

males

National Survey of Adolescent Males (NSAM), Urban Institute; 

National Survey of Family Growth (NSFG), CDC, NCHS.

9-10g Pregnancy prevention and STD protection in unmarried 

adolescents 15–17 years—Condom use (partner) and 

hormonal method at last intercourse, females

National Survey of Family Growth (NSFG), CDC, NCHS.

9-10h Pregnancy prevention and STD protection in unmarried 

adolescents 15–17 years—Condom use and hormonal 

method (partner) at last intercourse, males

National Survey of Adolescent Males (NSAM), Urban Institute; 

National Survey of Family Growth (NSFG), CDC, NCHS.

9-11a Reproductive health and disease prevention education among 

young adults 15–19 years—Formal education on abstinence, 

females

National Survey of Family Growth (NSFG), CDC, NCHS.

9-11b Reproductive health and disease prevention education among 

young adults 15–19 years—Formal education on abstinence, 

males

National Survey of Family Growth (NSFG), CDC, NCHS.

9-11c Reproductive health and disease prevention education among 

young adults 15–19 years—Formal education on birth control 

methods, females

National Survey of Family Growth (NSFG), CDC, NCHS.

9-11d Reproductive health and disease prevention education among 

young adults 15–19 years—Formal education on birth control 

methods, males

National Survey of Family Growth (NSFG), CDC, NCHS.

9-11e Reproductive health and disease prevention education among 

young adults 15–19 years—Formal education on HIV/AIDS 

prevention, females

Developmental.

9-11f Reproductive health and disease prevention education among 

young adults 15–19 years—Formal education on HIV/AIDS 

prevention, males

Developmental.

9-11g Reproductive health and disease prevention education among 

young adults 15–19 years—Formal education on sexually 

transmitted diseases, females

Developmental.

9-11h Reproductive health and disease prevention education among 

young adults 15–19 years—Formal education on sexually 

transmitted diseases, males

Developmental.

9-11i Reproductive health and disease prevention education 

among young adults 15–19 years—Informal education on 

abstinence, females

National Survey of Family Growth (NSFG), CDC, NCHS.

9-11j Reproductive health and disease prevention education 

among young adults 15–19 years—Informal education on 

abstinence, males

National Survey of Family Growth (NSFG), CDC, NCHS.

9-11k Reproductive health and disease prevention education among 

young adults 15–19 years—Informal education on birth 

control methods, females

National Survey of Family Growth (NSFG), CDC, NCHS.
9 • Family Planning 9-9

Comprehensive Summary of Objectives: Family Planning (continued)

Objective Description Data Source or Objective Status

9-11l Reproductive health and disease prevention education among 

young adults 15–19 years—Informal education on birth 

control methods, males

National Survey of Family Growth (NSFG), CDC, NCHS.

9-11m Reproductive health and disease prevention education among 

young adults 15–19 years—Informal education on HIV/AIDS 

prevention, females

Developmental.

9-11n Reproductive health and disease prevention education among 

young adults 15–19 years—Informal education on HIV/AIDS 

prevention, males

Developmental.

9-11o Reproductive health and disease prevention education among 

young adults 15–19 years—Informal education on sexually 

transmitted diseases, females

National Survey of Family Growth (NSFG), CDC, NCHS.

9-11p Reproductive health and disease prevention education among 

young adults 15–19 years—Informal education on sexually 

transmitted diseases, males

National Survey of Family Growth (NSFG), CDC, NCHS.

9-12 Problems becoming pregnant and maintaining a pregnancy—

Wives of married couples (15–44 years)

National Survey of Family Growth (NSFG), CDC, NCHS.

9-13 Insurance coverage for contraceptive supplies and services Guttmacher Institute.
9-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 9-1. Progress Toward Target attainment for Focus area 9: Family Planning

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

9-1. Intended pregnancy (females 15–44 years) 70% 52%

(1995)

51%

2002

-1 Not tested -1.9%

9-2. Births occurring within 24 months of a previous birth (females 15–44 years)

6% 11%

(1995)

16%

(2006–08)

5 Not tested 45.5%

9-3. Contraceptive use—Females at risk of 

unintended pregnancy (15–44 years)

100% 93%

(1995)

89%

(2006–08)

-4 Yes -4.3%

9-4. Contraceptive failure within 12 months of 

continuous use—Females experiencing 

pregnancy (15–44 years)

42.9% 8% 15%

(1995)

12%

(2002)

-3 Not tested -20.0%

9-5. Emergency contraception provided by 

family planning agencies

90% 80%

(1999)

79%

(2003)

-1 Not tested -1.3%

9-6. Involvement in pregnancy prevention 

among unmarried males 15–24 years 

a. Family planning clinic visit with female 

partner in last 12 months 

 0.0% 22% 21%

(2002)

21%

(2006–08)

0 No 0.0%

b. Family planning clinic visit for himself in 

last 12 months

37% 31%

(2002)

25%

(2006–08)

-6 Yes -19.4%

c. Advice/counseling from a doctor on birth 

control in last 12 months

37% 21%

(2002)

20%

(2006–08)

-1 No -4.8%

9-7. Adolescent pregnancy (per 1,000 

population, 15–17 years) 

95.8% 39 63

(1996)

40

(2005)

-23 Not tested -36.5%

9-8. Abstinence before age 15

a. Females (15–19 years) 114.3% 88% 81%

(1995)

89%

(2006–08)

8 Not tested 9.9%

b. Males (15–19 years) 66.7% 88% 79%

(1995)

85%

(2006–08)

6 Not tested 7.6%

9-9. Abstinence among adolescents 

15–17 years 

a. Females 76.9% 75% 62%

(1995)

72%

(2006–08)

10 Yes 16.1%

b. Males 77.8% 75% 57%

(1995)

71%

(2006–08)

14 Not tested 24.6%

lEgEnD Moved away from target1 Moved toward target Met or exceeded target
9 • Family Planning 9-11

Figure 9-1. Progress Toward Target attainment for Focus area 9: Family Planning (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

9-10.Pregnancy prevention and STD protection 

in unmarried adolescents 15–17 years

a. Condom use (partner) at fi rst intercourse, 

females

75% 69%

(1995)

62%

(2006–08)

-7 No -10.1%

b. Condom use at fi rst intercourse, males 72.7% 83% 72%

(1995)

80%

(2006–08)

8 Not tested 11.1%

c. Condom use (partner) and hormonal method 

use at fi rst intercourse, females 

200.0% 9% 7%

(1995)

11%

(2006–08)

4 No 57.1%

d. Condom use and hormonal method (partner) 

at fi rst intercourse, males

366.7% 11% 8%

(1995)

19%

(2006–08)

11 Not tested 137.5%

e. Condom use (partner) at last intercourse, 

females

220.0% 49% 39%

(1995)

61%

(2006–08)

22 Yes 56.4%

f. Condom use at last intercourse, males 166.7% 79% 70%

(1995)

85%

(2006–08)

15 Not tested 21.4%

g. Condom use (partner) and hormonal method 

at last intercourse, females

225.0% 11% 7%

(1995)

16%

(2006–08)

9 Yes 128.6%

h. Condom use and hormonal method (partner) 

at last intercourse, males

525.0% 20% 16%

(1995)

37%

(2006–08)

21 Not tested 131.3%

9-11.Reproductive health and disease prevention 

education among young adults 15–19 years

a. Formal education on abstinence, females 50.0% 88% 86%

(2002)

87%

(2006–08)

1 No 1.2%

b. Formal education on abstinence, males 85% 83%

(2002)

81%

(2006–08)

-2 No -2.4%

c. Formal education on birth control methods, 

females

73% 70%

(2002)

69%

(2006–08)

-1 No -1.4%

d. Formal education on birth control 

methods, males

70% 66%

(2002)

62%

(2006–08)

-4 No -6.1%

i. Informal education on abstinence, females 120.0% 62% 57%

(2002)

63%

(2006–08)

6 Yes 10.5%

j. Informal education on abstinence, males 49% 45%

(2002)

42%

(2006–08)

-3 No -6.7%

k. Informal education on birth control 

methods, females 

 0.0% 57% 51%

(2002)

51%

(2006–08)

0 No 0.0%

l. Informal education on birth control 

methods, males

38% 33%

(2002)

31%

(2006–08)

-2 No -6.1%

o. Informal education on sexually transmitted 

diseases, females

44.4% 60% 51%

(2002)

55%

(2006–08)

4 No 7.8%

p. Informal education on sexually transmitted 

diseases, males

57% 52%

(2002)

49%

(2006–08)

-3 No -5.8%

9-12.Problems becoming pregnant and 

maintaining a pregnancy—Wives of 

married couples (15–44 years)

66.7% 10% 13%

(1995)

11%

(2006–08)

-2 Not tested -15.4%
9-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 9-1. Progress Toward Target attainment for Focus area 9: Family Planning (continued)

NOTES

See the Reader’s guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 9-11e through h, 9-11m, 9-11n, and 9-13. 

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed 

at the 0.05 level. See Technical appendix for more information.

DATA SOURCES

9-1. National Survey of Family Growth (NSFG), CDC, NCHS; National Vital Statistics System—Natality (NVSS-N), CDC, NCHS; 

Abortion Provider Survey, Guttmacher Institute; Abortion Surveillance Data, CDC, NCCDPHP.

9-2–9-3. National Survey of Family Growth (NSFG), CDC, NCHS.

9-4. National Survey of Family Growth (NSFG), CDC, NCHS; Abortion Patient Survey, Guttmacher Institute.

9-5. Guttmacher Institute.

9-6a–c. National Survey of Family Growth (NSFG), CDC, NCHS.

9-7. National Survey of Family Growth (NSFG), CDC, NCHS; National Vital Statistics System—Natality (NVSS-N), CDC, NCHS; 

Abortion Provider Survey, Guttmacher Institute; Abortion Surveillance Data, CDC, NCCDPHP.

9-8a. National Survey of Family Growth (NSFG), CDC, NCHS.

9-8b. National Survey of Adolescent Males (NSAM), Urban Institute; National Survey of Family Growth (NSFG), CDC, NCHS.

9-9a. National Survey of Family Growth (NSFG), CDC, NCHS.

9-9b. National Survey of Adolescent Males (NSAM), Urban Institute; National Survey of Family Growth (NSFG), CDC, NCHS.

9-10a. National Survey of Family Growth (NSFG), CDC, NCHS.

9-10b. National Survey of Adolescent Males (NSAM), Urban Institute; National Survey of Family Growth (NSFG), CDC, NCHS.

9-10c. National Survey of Family Growth (NSFG), CDC, NCHS.

9-10d. National Survey of Adolescent Males (NSAM), Urban Institute; National Survey of Family Growth (NSFG), CDC, NCHS.

9-10e. National Survey of Family Growth (NSFG), CDC, NCHS.

9-10f. National Survey of Adolescent Males (NSAM), Urban Institute; National Survey of Family Growth (NSFG), CDC, NCHS.

9-10g. National Survey of Family Growth (NSFG), CDC, NCHS.

9-10h. National Survey of Adolescent Males (NSAM), Urban Institute; National Survey of Family Growth (NSFG), CDC, NCHS.

9-11a–d. National Survey of Family Growth (NSFG), CDC, NCHS.

9-11i–l. National Survey of Family Growth (NSFG), CDC, NCHS.

9-11o–p. National Survey of Family Growth (NSFG), CDC, NCHS.

9-12. National Survey of Family Growth (NSFG), CDC, NCHS.

5 Final value – Baseline value Percent change = × 100.

Baseline value
9 • Family Planning 9-13

Figure 9-2. Health Disparities Table for Focus Area 9: Family Planning

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Income Disability

Population-based objectiveAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexPoorNear poorMiddle/high incomeSummary indexPersons with disabilitiesPersons without disabilities

9-1. Intended pregnancy (females 15–44 years) (1995, 2002)†

i Bi  B 

9-2. Births occurring within 24 months of a previous birth 

(females 15–44 years) (1995, 2006–08)1‡ 





 B 

 B

9-3. Contraceptive use—Females at risk of unintended pregnancy (15–44 years) (1995, 2006–08)1* B

9-4. Contraceptive failure within 12 months of continuous use—

Females experiencing pregnancy (15–44 years) (1995, 

2002)†

  B   

 B 

9-6a. Involvement in pregnancy prevention among unmarried 

males 15–24 years—Family planning clinic visit with female 

partner in last 12 months (2002, 2006–08)*

B Bii B

b. Involvement in pregnancy prevention among unmarried 

males 15–24 years—Family planning clinic visit for himself 

in last 12 months (2002, 2006–08)*

Bii Bii B iii

c. Involvement in pregnancy prevention among unmarried 

males 15–24 years—Advice/counseling from a doctor on 

birth control in last 12 months (2002, 2006–08)*

B Bii

9-7. Adolescent pregnancy (per 1,000 population, 15–17 years) 

(1996, 2005)† 

  B 

9-8a. Abstinence before age 15—Females (15–19 years) (1995, 

2006–08)1‡ iii B

b. Abstinence before age 15—Males (15–19 years) (1995, 

2006–08)1,2‡

9-9a. Abstinence among adolescents 15–17 years—Females 

(1995, 2006–08)1*

b. Abstinence among adolescents 15–17 years—Males 

(1995, 2006–08)1,2‡

9-10a. Pregnancy prevention and STD protection in unmarried 

adolescents 15–17 years—Condom use (partner) at first 

intercourse, females (1995, 2006–08)1

*

b. Pregnancy prevention and STD protection in unmarried 

adolescents 15–17 years—Condom use at first intercourse, 

males (1995, 2006–08)1,2‡

c. Pregnancy prevention and STD protection in unmarried adolescents 15–17 years—Condom use (partner) and hormonal 

method use at first intercourse, females (1995, 2006–08)1

*

Bii Bii

d. Pregnancy prevention and STD protection in unmarried adolescents 15–17 years—Condom use and hormonal method 

(partner) at first intercourse, males (1995, 2006–08)1,2‡



iv Bii iv B v
9-14 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 9-2. Health Disparities Table for Focus Area 9: Family Planning (continued)

Race and Ethnicity Income Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexPoorNear poorMiddle/high incomeSummary indexPersons with disabilitiesPersons without disabilities

e. Pregnancy prevention and STD protection in unmarried 

adolescents 15–17 years—Condom use (partner) at last 

intercourse, females (1995, 2006–08)1

*

f. Pregnancy prevention and STD protection in unmarried 

adolescents 15–17 years—Condom use at last intercourse, 

males (1995, 2006–08)1,2‡

g. Pregnancy prevention and STD protection in unmarried adolescents 15–17 years—Condom use (partner) and hormonal 

method at last intercourse, females (1995, 2006–08)1

*

h. Pregnancy prevention and STD protection in unmarried adolescents 15–17 years—Condom use and hormonal method 

(partner) at last intercourse, males (1995, 2006–08)1,2‡

9-11a. Reproductive health and disease prevention education 

among young adults 15–19 years—Formal education on 

abstinence, females (2002, 2006–08)*

b. Reproductive health and disease prevention education 

among young adults 15–19 years—Formal education on 

abstinence, males (2002, 2006–08)*

c. Reproductive health and disease prevention education 

among young adults 15–19 years—Formal education on 

birth control methods, females (2002, 2006–08)*

B B

d. Reproductive health and disease prevention education 

among young adults 15–19 years—Formal education on 

birth control methods, males (2002, 2006–08)*

B B B

9-11i. Reproductive health and disease prevention education 

among young adults 15–19 years—Informal education on 

abstinence, females (2002, 2006–08)*

b B Bii

j. Reproductive health and disease prevention education 

among young adults 15–19 years—Informal education on 

abstinence, males (2002, 2006–08)*

B Bii B

k. Reproductive health and disease prevention education 

among young adults 15–19 years—Informal education on 

birth control methods, females (2002, 2006–08)*

B B

l. Reproductive health and disease prevention education 

among young adults 15–19 years—Informal education on 

birth control methods, males (2002, 2006–08)*

B B

9-11o. Reproductive health and disease prevention education among 

young adults 15–19 years—Informal education on sexually 

transmitted diseases, females (2002, 2006–08)*

Bii b Bii

p. Reproductive health and disease prevention education among 

young adults 15–19 years—Informal education on sexually 

transmitted diseases, males (2002, 2006–08)*



iv B iv iv Bii

9-12. Problems becoming pregnant and maintaining a pregnancy—Wives of married couples (15–44 years) (1995, 

2006–08)1‡

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 9-5, 

9-11e through h, 9-11m and n, and 9-13.
9 • Family Planning 9-15

Figure 9-2. Health Disparities Table for Focus Area 9: Family Planning (continued)

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

E E Dl g n

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical ppendixa .

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. Nonetheless, 

disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix. 

‡ Measures of variability were available only for the most recent data. Thus, the variability of best group rates was assessed only for the most recent data, and 

statistical significance was tested only for the most recent data. Disparities of 10% or more are displayed when the differences from the best group rate are 

statistically significant at the 0.05 level. Changes in disparities over time are displayed according to their magnitude, since measures of variability were not available 

at baseline and therefore statistical significance of changes in disparity could not be tested. See Technical Appendix. 

1 Baseline data by disability status are for 2002. Measures of variability were available for disability, see footnote * above.

2

 Baseline data by income are for 2002. Measures of variability were available for income, see footnote * above.

i Data include persons of Hispanic origin.

ii The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

iiiReliability criterion for best group rate not met, or data available for only one group, at baseline. Change in disparity cannot be assessed. See Technical Appendix.

ivAt baseline, persons reported only one race or reported more than one race and identified one primary race. Therefore, disparities at the most recent and the 

baseline data points may not be directly comparable.

v Change in the summary index cannot be assessed. See Technical Appendix.

DATA SOURCES

9-1. National Survey of Family Growth (NSFG), CDC, NCHS; National Vital Statistics System—Natality (NVSS-N), CDC, NCHS; Abortion Provider Survey, 

Guttmacher Institute; Abortion Surveillance Data, CDC, NCCDPHP.

9-2–9-3. National Survey of Family Growth (NSFG), CDC, NCHS.

9-4. National Survey of Family Growth (NSFG), CDC, NCHS; Abortion Patient Survey, Guttmacher Institute.

9-6a–c. National Survey of Family Growth (NSFG), CDC, NCHS.

9-7. National Survey of Family Growth (NSFG), CDC, NCHS; National Vital Statistics System—Natality (NVSS-N), CDC, NCHS; Abortion Provider Survey, 

Guttmacher Institute; Abortion Surveillance Data, CDC, NCCDPHP.

9-8a. National Survey of Family Growth (NSFG), CDC, NCHS.

9-8b. National Survey of Adolescent Males (NSAM), Urban Institute; National Survey of Family Growth (NSFG), CDC, NCHS.

9-9a. National Survey of Family Growth (NSFG), CDC, NCHS.
9-16 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 9-2. Health Disparities Table for Focus Area 9: Family Planning (continued)

9-9b. National Survey of Adolescent Males (NSAM), Urban Institute; National Survey of Family Growth (NSFG), CDC, NCHS.

9-10a. National Survey of Family Growth (NSFG), CDC, NCHS.

9-10b. National Survey of Adolescent Males (NSAM), Urban Institute; National Survey of Family Growth (NSFG), CDC, NCHS.

9-10c. National Survey of Family Growth (NSFG), CDC, NCHS.

9-10d. National Survey of Adolescent Males (NSAM), Urban Institute; National Survey of Family Growth (NSFG), CDC, NCHS.

9-10e. National Survey of Family Growth (NSFG), CDC, NCHS.

9-10f. National Survey of Adolescent Males (NSAM), Urban Institute; National Survey of Family Growth (NSFG), CDC, NCHS.

9-10g. National Survey of Family Growth (NSFG), CDC, NCHS.

9-10h. National Survey of Adolescent Males (NSAM), Urban Institute; National Survey of Family Growth (NSFG), CDC, NCHS.

9-11a–d. National Survey of Family Growth (NSFG), CDC, NCHS.

9-11i–l. National Survey of Family Growth (NSFG), CDC, NCHS.

9-11o–p. National Survey of Family Growth (NSFG), CDC, NCHS.

9-12. National Survey of Family Growth (NSFG), CDC, NCHS.
Food Safety

CHAPTER 10

Co-Lead Agencies

Food and Drug Administration

Food Safety and Inspection Service, Department of Agriculture

Contents

Goal ................................................................................................10-3

Highlights ......................................................................................10-3

Summary of Progress.....................................................................10-4

Transition to Healthy People 2020................................................10-4

Data Considerations.......................................................................10-5

Notes..............................................................................................10-6

Comprehensive Summary of Objectives........................................10-7

Progress Chart................................................................................10-9

Health Disparities Table...............................................................10-11

10 • Food Safety 10-3

GOAL:

Reduce foodborne illnesses.

This chapter addresses the rate of disease caused by 

microorganisms commonly transmitted by food, such 

as Salmonella and Campylobacter. Specific objectives 

monitor new cases of infections caused by important 

foodborne pathogens, as well as the food safety practices 

of consumers and of retail food establishments.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in objectives for 

this Focus Area during the past decade [1]. Almost 

three-quarters (73%) of the Food Safety Focus Area 

objectives moved toward or achieved their Healthy 

People 2010 targets (Figure 10-1). With the exception 

of one objective (10-5), data on health disparities by 

race and ethnicity were unavailable [2]. However, 

most objectives exhibited health disparities of 10% or 

more by sex (Figure 10-2).

〉 Statistically significant downward trends were 

observed in the rates of foodborne infections from 

Campylobacter species and Shiga toxin-producing 

Escherichia coli O157 (STEC O157) (objectives 

10-1a and b) [3]. Between 1997 and 2009, the rate of 

Campylobacter species infections decreased 47.6%, 

from 24.6 to 12.9 per 100,000 population, moving 

toward the Healthy People 2010 target of 12.3 per 

100,000; the rate of STEC O157 infections decreased 

52.4%, from 2.1 to 1.0 per 100,000 population, meeting 

the 2010 target of 1.0 per 100,000. In addition, the rate 

of Listeria monocytogenes infections (objective 10-1c) 

declined 36.2% between 1997 and 2009, from 0.47 

to 0.30, moving toward the 2010 target of 0.24 per 

100,000 population.

〉 The proportion of non-Typhi Salmonella from 

humans (percent of isolates) resistant to gentamicin 

(objective 10-3c) and ampicillin (objective 10-3d) 

declined. Gentamicin-resistant isolates declined 

51.7% between 1997 and 2008, from 2.9% to 1.4%, 

exceeding the 2010 target of 2.9%. Ampicillinresistant isolates declined 49.2% between 1997 and 

2008, from 18.3% to 9.3%, exceeding the 2010 target 

of 18.3%.

〉 Progress in outbreaks of foodborne infections 

was mixed. Outbreaks due to Salmonella serotype 

Enteritidis (objective 10-2b) decreased 44.9% 

between 1997 and 2008, from 49 to 27, achieving 

88.0% of the 2010 target of 24 outbreaks. However, 

outbreaks due to Escherichia coli O157:H7 (objective 

10-2a) increased between 1997 and 2008, from 10 to 

32 outbreaks, moving away from the 2010 target of 

five outbreaks.

〉 Consumer food safety practices (objective 10-5) 

improved 4.2% between 1998 and 2006, from 72% 

to 75%, moving toward the 2010 target of 79% of the 

population following safe food practices.

〉 Food safety practices in retail establishments 

(objectives 10-6a through i) increased in all nine 

categories, moving toward or exceeding the 2010 

targets.

 Safe retail food preparation in meat and poultry 

departments (objective 10-6g) increased 8.6% 

between 1998 and 2008, from 81% to 88%, 

exceeding the 2010 target of 86%.
10-4 HEALTHY PEOPLE 2010 FINAL REVIEW

 Safe retail food preparation in produce 

departments (objective 10-6h) increased 10.5% 

between 1998 and 2008, from 76% to 84%, 

exceeding the 2010 target of 82%.

Summary of Progress

〉 Figure 10-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for Food Safety [1]. Data to measure 

progress toward target attainment were available for 

22 objectives. Of these:

 Five objectives met or exceeded their Healthy 

People 2010 targets (objectives 10-1b, 10-3c and d, 

and 10-6f and g).

 Eleven objectives moved toward their targets. A 

statistically significant difference between the 

baseline and the final data points was observed 

for one of these objectives (10-5, consumer food 

safety practices). No significant differences were 

observed for seven objectives (10-6a through f, 

and i); and data to test the significance of the 

difference were unavailable for three objectives 

(10-1a and c, and 10-2b).

 Six objectives moved away from their targets. 

No statistically significant differences between 

the baseline and final data points were observed 

for one objective (10-4b). Data to test the 

significance of the difference were unavailable 

for five objectives (10-1d and f, 10-2a, and 10-3a 

and b).

〉 Fifteen objectives were deleted at the Midcourse 

Review (objectives 10-1e and g, 10-3e through p, and 

10-7). One objective (10-4a) remained developmental 

[4].

〉 Figure 10-2 displays health disparities in the Food 

Safety Focus Area objectives from the best group 

rate for each characteristic at the most recent data 

point [2]. It also displays changes in disparities from 

baseline to the most recent data point [5].

 The non-Hispanic white population had the best 

group rate for one objective with statistically 

significant racial and ethnic health disparities of 

10% or more (objective 10-5).

 One objective had statistically significant health 

disparities by sex of 10% or more (objective 10-5). 

Four additional objectives had health disparities 

by sex of 10% or more but lacked data to measure 

variability (objectives 10-1a through c, and f). 

Males were the better group for three of these 

five objectives (10-1b, c, and f). Females were the 

better group for two objectives (10-1a and 10-5).

Transition to Healthy People 

2020

The Healthy People 2020 Food Safety Topic Area has 

fewer objectives than those included in Healthy People 

2010. See HealthyPeople.gov for a complete list of Healthy 

People 2020 topics and objectives.

The Healthy People 2020 objectives can be grouped into 

several sections:

〉 Food-related infections

〉 Antimicrobial resistance

〉 Consumer food safety practices

〉 Retail food safety practices.

The differences between the Healthy People 2010 and 

Healthy People 2020 objectives are summarized below:

〉 The Healthy People 2020 Food Safety Topic Area has 

28 objectives, whereas the Healthy People 2010 Focus 

Area had 38 objectives.

〉 Eight Healthy People 2010 objectives were retained 

“as is” [6].

 Infections caused by microorganisms 

transmitted commonly by food:

 Campylobacter species (objective 10-1a)

 Shiga toxin-producing Escherichia coli O157 

(objective 10-1b)

 Listeria monocytogenes (objective 10-1c)

 Salmonella species (objective 10-1d)

 Cases of postdiarrheal hemolytic uremic 

syndrome (HUS) in children under age 5 years 

(HUS) (objective 10-1f).

 Non-Typhi Salmonella from humans (percent of 

isolates) resistant to:

 Gentamicin (objective 10-3c)

 Ampicillin (objective 10-3d).

 Severe allergic reactions to food among adults 

aged 18 and over with food allergy diagnosis 

(objective 10-4b).

〉 Three Healthy People 2010 objectives were modified 

and expanded to six Healthy People 2020 objectives 

[7]. Non-Typhi Salmonella from humans (percent 

of isolates) resistant to fluoroquinolones (objective 

10-3a) and third-generation cephalosporins (objective 

10-3b) will be tracked in Healthy People 2020 with 

nalidixic acid and ceftriaxone, respectively. The 

consumer food safety practices objective (10-5) was 

modified by subdividing the existing composite 
10 • Food Safety 10-5

objective into four discrete objectives to track specific 

consumer practices.

〉 Nine objectives for improving food safety practices 

in retail and food service establishments were 

measurable in Healthy People 2010 but are 

developmental in Healthy People 2020 (objectives 

10-6a through i) [4]. Actual measures and targets for 

improvement will be modified but will continue to 

be based on observed levels of compliance in select 

retail establishment types.

〉 Two Healthy People 2010 objectives were archived 

[8]. These include: outbreaks of foodborne infections 

due to Escherichia coli O157:H7 (objective 10-2a) and 

Salmonella serotype Enteritidis (objective 10-2b).

〉 Fifteen Healthy People 2010 objectives were deleted at 

the Midcourse Review. Two of these were determined 

not to be a significant public health concern 

(objectives 10-1e and 10-7). One did not have a national 

data source (objective 10-1g). Twelve objectives 

(10-3e through p) were dependent upon data from 

a regulatory program of the U.S. Department of 

Agriculture’s Food Safety and Inspection Service 

that was not designed to estimate prevalence and, 

therefore, could not be used to establish measurable 

objectives.

〉 One Healthy People 2010 objective (10-4a, food allergy 

deaths) that remained developmental was removed 

during the Healthy People 2020 planning process 

because the data source did not reliably track the 

actual number of cases of anaphylaxis mortality.

〉 Nine new objectives were added for Healthy People 

2020. These will track the number of infections 

caused by Vibrio species and Yersinia species; the 

number of outbreak-associated infections caused by 

food commodity group for beef, dairy, fruits and nuts, 

leafy vegetables, and poultry; prevention of non-Typhi 

Salmonella occurring in humans (percent of isolates) 

resistant to three or more classes of antimicrobial 

agents; and prevention of Campylobacter jejuni from 

occurring in humans (percent of isolates) resistant to 

erythromycin.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below, for additional information.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.
10-6 HEALTHY PEOPLE 2010 FINAL REVIEW

Notes

1. Displayed in the Progress Chart (Figure 10-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 10-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 10-2). Disparity from the best group rate 

is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 10-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The presence of a monotonic increasing or decreasing 

trend in the underlying measure was tested with the 

nonparametric Mann-Kendall test, then the slope of 

a linear trend was estimated with the nonparametric 

Sen’s method. See Technical Appendix for more 

information.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

5. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 10-2 footnotes, as well as 

the Technical Appendix, for more detail.

6. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy 

People 2010 and are developmental in Healthy People 

2020, and for which no numerator information is 

available.

7. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

8. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.
10 • Food Safety 10-7

Comprehensive Summary of Objectives: Food Safety

Objective Description Data Source or Objective Status

10-1a Foodborne infections—Campylobacter species (per 100,000 

population)

Foodborne Disease Active Surveillance Network (FoodNet): CDC, 

NCEZID; FDA, CFSAN; Department of Agriculture (USDA); State 

agencies.

10-1b Foodborne infections—Escherichia coli O157:H7 (per 

100,000 population)

Foodborne Disease Active Surveillance Network (FoodNet): CDC, 

NCEZID; FDA, CFSAN; Department of Agriculture (USDA); State 

agencies.

10-1c Foodborne infections—Listeria monocytogenes (per 100,000 

population)

Foodborne Disease Active Surveillance Network (FoodNet): CDC, 

NCEZID; FDA, CFSAN; Department of Agriculture (USDA); State 

agencies.

10-1d Foodborne infections—Salmonella species (per 100,000 

population)

Foodborne Disease Active Surveillance Network (FoodNet): CDC, 

NCEZID; FDA, CFSAN; Department of Agriculture (USDA); State 

agencies.

10-1e Foodborne infections—Cyclospora cayetanensis (per 100,000 

population)

Deleted at the Midcourse Review.

10-1f Foodborne infections—Cases of postdiarrheal hemolytic 

uremic syndrome (HUS) (per 100,000 population <5 years)

Foodborne Disease Active Surveillance Network (FoodNet): CDC, 

NCEZID; FDA, CFSAN; Department of Agriculture (USDA); State 

agencies.

10-1g Foodborne infections—Congenital Toxoplasma gondii Deleted at the Midcourse Review.

10-2a Outbreaks of foodborne infections—Escherichia coli O157:H7 Foodborne Disease Outbreak Surveillance System, CDC, NCEZID.

10-2b Outbreaks of foodborne infections—Salmonella serotype 

Enteritidis

Foodborne Disease Outbreak Surveillance System, CDC, NCEZID.

10-3a Non-Typhi Salmonella from humans (percent of isolates) 

resistant to fluoroquinolones

National Antimicrobial Resistance Monitoring System: Enteric 

Bacteria-Salmonella (NARMS: Enteric Bacteria), CDC, NCEZID; 

FDA, CVM; Department of Agriculture (USDA). Foodborne Disease 

Active Surveillance Network (FoodNet): CDC, NCEZID; FDA, 

CFSAN; Department of Agriculture (USDA); State agencies.

10-3b Non-Typhi Salmonella from humans (percent of isolates) 

resistant to third-generation cephalosporins

National Antimicrobial Resistance Monitoring System: Enteric 

Bacteria-Salmonella (NARMS: Enteric Bacteria), CDC, NCEZID; 

FDA, CVM; Department of Agriculture (USDA). Foodborne Disease 

Active Surveillance Network (FoodNet): CDC, NCEZID; FDA, 

CFSAN; Department of Agriculture (USDA); State agencies.

10-3c Non-Typhi Salmonella from humans (percent of isolates) 

resistant to gentamicin

National Antimicrobial Resistance Monitoring System: Enteric 

Bacteria-Salmonella (NARMS: Enteric Bacteria), CDC, NCEZID; 

FDA, CVM; Department of Agriculture (USDA). Foodborne Disease 

Active Surveillance Network (FoodNet): CDC, NCEZID; FDA, 

CFSAN; Department of Agriculture (USDA); State agencies.

10-3d Non-Typhi Salmonella from humans (percent of isolates) 

resistant to ampicillin

National Antimicrobial Resistance Monitoring System: Enteric 

Bacteria-Salmonella (NARMS: Enteric Bacteria), CDC, NCEZID; 

FDA, CVM; Department of Agriculture (USDA). Foodborne Disease 

Active Surveillance Network (FoodNet): CDC, NCEZID; FDA, 

CFSAN; Department of Agriculture (USDA); State agencies.

10-3e Non-Typhi Salmonella from cattle at slaughter (percent of 

isolates) resistant to fluoroquinolones

Deleted at the Midcourse Review.

10-3f Non-Typhi Salmonella from cattle at slaughter (percent of 

isolates) resistant to third-generation cephalosporins

Deleted at the Midcourse Review.

10-3g Non-Typhi Salmonella from cattle at slaughter (percent of 

isolates) resistant to gentamicin

Deleted at the Midcourse Review.
10-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Food Safety (continued)

Objective Description Data Source or Objective Status

10-3h Non-Typhi Salmonella from cattle at slaughter (percent of 

isolates) resistant to ampicillin

Deleted at the Midcourse Review.

10-3i Non-Typhi Salmonella from poultry at slaughter (percent of 

isolates) resistant to fluoroquinolones

Deleted at the Midcourse Review.

10-3j Non-Typhi Salmonella from poultry at slaughter (percent of 

isolates) resistant to third-generation cephalosporins

Deleted at the Midcourse Review.

10-3k Non-Typhi Salmonella from poultry at slaughter (percent of 

isolates) resistant to gentamicin

Deleted at the Midcourse Review.

10-3l Non-Typhi Salmonella from poultry at slaughter (percent of 

isolates) resistant to ampicillin

Deleted at the Midcourse Review.

10-3m Non-Typhi Salmonella from swine at slaughter (percent of 

isolates) resistant to fluoroquinolones

Deleted at the Midcourse Review.

10-3n Non-Typhi Salmonella from swine at slaughter (percent of 

isolates) resistant to third-generation cephalosporins

Deleted at the Midcourse Review.

10-3o Non-Typhi Salmonella from swine at slaughter (percent of 

isolates) resistant to gentamicin

Deleted at the Midcourse Review.

10-3p Non-Typhi Salmonella from swine at slaughter (percent of 

isolates) resistant to ampicillin

Deleted at the Midcourse Review.

10-4a Deaths from food-induced anaphylaxis Developmental.

10-4b Severe allergic reactions to food among adults with food 

allergy diagnosis (18+ years)

Food Safety Survey (FSS), FDA, CFSAN; and Department of 

Agriculture (USDA).

10-5 Consumer food safety practices (18+ years) Food Safety Survey (FSS), FDA, CFSAN; and Department of 

Agriculture (USDA).

10-6a Safe retail food preparation—Hospitals Retail Food Database of Foodborne Illness Risk Factors, FDA, 

CFSAN.

10-6b Safe retail food preparation—Nursing homes Retail Food Database of Foodborne Illness Risk Factors, FDA, 

CFSAN.

10-6c Safe retail food preparation—Elementary schools Retail Food Database of Foodborne Illness Risk Factors, FDA, 

CFSAN.

10-6d Safe retail food preparation—Fast food restaurants Retail Food Database of Foodborne Illness Risk Factors, FDA, 

CFSAN.

10-6e Safe retail food preparation—Full-service restaurants Retail Food Database of Foodborne Illness Risk Factors, FDA, 

CFSAN.

10-6f Safe retail food preparation—Deli departments Retail Food Database of Foodborne Illness Risk Factors, FDA, 

CFSAN.

10-6g Safe retail food preparation—Meat/poultry departments Retail Food Database of Foodborne Illness Risk Factors, FDA, 

CFSAN.

10-6h Safe retail food preparation—Produce departments Retail Food Database of Foodborne Illness Risk Factors, FDA, 

CFSAN.

10-6i Safe retail food preparation—Seafood departments Retail Food Database of Foodborne Illness Risk Factors, FDA, 

CFSAN.

10-7 Human exposure to organophosphate pesticide from food Deleted at the Midcourse Review.
10 • Food Safety 10-9

Figure 10-1. Progress toward target attainment for Focus area 10: Food Safety

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

10-1. Foodborne infections 

(per 100,000 population)

a. Campylobacter species 95.1% 12.3 24.6

(1997)

12.9

(2009)

-11.7 Not tested -47.6%

b. Escherichia coli O157:H7 100.0% 1.0 2.1

(1997)

1.0

(2009)

-1.1 Not tested -52.4%

c. Listeria monocytogenes 73.9% 0.24 0.47

(1997)

0.30

(2009)

-0.17 Not tested -36.2%

d. Salmonella species 6.8 13.6

(1997)

15.0

(2009)

1.4 Not tested 10.3%

f. Cases of postdiarrheal hemolytic uremic 

syndrome (HUS) (<5 years)

0.90 1.80

(2000)

2.03

(2006)

0.23 Not tested 12.8%

10-2. Outbreaks of foodborne infections

a. Escherichia coli O157:H7 5 10

(1997)

32

(2008)

22 Not tested 220.0%

b. Salmonella serotype Enteritidis 88.0% 24 49

(1997)

27

(2008)

-22 Not tested -44.9%

10-3. Non-Typhi Salmonella from humans 

(percent of isolates) resistant to:

a. Fluoroquinolones 0.0% 0.0%

(1997)

0.1%

(2008)

0.1 Not tested *

b. Third-generation cephalosporins 0.1% 0.1%

(1997)

0.3%

(2008)

0.2 Not tested 200.0%

c. Gentamicin Target met at baseline 

and exceeded at fi nal 2.9% 2.9%

(1997)

1.4%

(2008)

-1.5 Not tested -51.7%

d. Ampicillin Target met at baseline 

and exceeded at fi nal 18.3% 18.3%

(1997)

9.3%

(2008)

-9.0 Not tested -49.2%

10-4b.Severe allergic reactions to food among 

adults with food allergy diagnosis 

(18+ years)

21% 26%

(2001)

29%

(2006)

3 No 11.5%

10-5. Consumer food safety practices (18+ years) 42.9% 79% 72%

(1998)

75%

(2006)

3 Yes 4.2%

LeGeNd Moved away from target1 Moved toward target Met or exceeded target
10-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 10-1. Progress toward target attainment for Focus area 10: Food Safety (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

10-6 Safe retail food preparation

a. Hospitals 20.0% 85% 80%

(1998)

81%

(2008)

1 No 1.3%

b. Nursing homes 20.0% 87% 82%

(1998)

83%

(2008)

1 No 1.2%

c. Elementary schools 80.0% 85% 80%

(1998)

84%

(2008)

4 No 5.0%

d. Fast food restaurants 57.1% 81% 74%

(1998)

78%

(2008)

4 No 5.4%

e. Full-service restaurants 40.0% 70% 60%

(1998)

64%

(2008)

4 No 6.7%

f. Deli departments 14.3% 80% 73%

(1998)

74%

(2008)

1 No 1.4%

g. Meat/poultry departments 140.0% 86% 81%

(1998)

88%

(2008)

7 No 8.6%

h. Produce departments 133.3% 82% 76%

(1998)

84%

(2008)

8 No 10.5%

i. Seafood departments 75.0% 87% 83%

(1998)

86%

(2008)

3 No 3.6%

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objective 10-4a. Objectives 10-1e, 10-1g, 10-3e through p, and 10-7 were deleted at the Midcourse 

Review.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See technical appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See technical appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

* Percent change cannot be calculated. See technical appendix for more information.

DATA SOURCES

10-1a–d. Foodborne Disease Active Surveillance Network (FoodNet): CDC, NCEZID; FDA, CFSAN; Department of Agriculture (USDA); 

State agencies. 

10-1f. Foodborne Disease Active Surveillance Network (FoodNet): CDC, NCEZID; FDA, CFSAN; Department of Agriculture (USDA); 

State agencies. 

10-2a–b. Foodborne Disease Outbreak Surveillance System, CDC, NCEZID.

10-3a–d. National Antimicrobial Resistance Monitoring System: Enteric Bacteria-Salmonella (NARMS: Enteric Bacteria), CDC, NCEZID; FDA, 

CVM; Department of Agriculture (USDA). Foodborne Disease Active Surveillance Network (FoodNet): CDC, NCEZID; FDA, CFSAN, 

Department of Agriculture, USDA; State agencies.

10-4b. Food Safety Survey (FSS), FDA, CFSAN; and Department of Agriculture (USDA).

10-5. Food Safety Survey (FSS), FDA, CFSAN; and Department of Agriculture (USDA).

10-6a–i. Retail Food Database of Foodborne Illness Risk Factors, FDA, CFSAN.
10 • Food Safety 10-11

Figure 10-2. Health Disparities Table for Focus Area 10: Food Safety

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Income Disability

Population-based objectiveAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexPersons with disabilitiesPersons without disabilities

10-1a. Foodborne infections—Campylobacter

species (per 100,000 population) (1997, 

2009)†

B

b. Foodborne infections—Escherichia coli 

O157:H7 (per 100,000 population) (1997,

2009)†

 B

c. Foodborne infections—Listeria monocytogenes (per 100,000 population) (1997, 

2009)†

Bi

d. Foodborne infections—Salmonella species 

(per 100,000 population) (1997, 2009)† Bi

f. Foodborne infections—Cases of postdiarrheal hemolytic uremic syndrome (HUS) (per

100,000 population <5 years) (2000, 2006)†



 B

10-4b. Severe allergic reactions to food among 

adults with food allergy diagnosis (18+ 

years) (2001, 2006)*

10-5. Consumer food safety practices (18+ years) 

(1998, 2006)* B ii B Bi Bi

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 10-2a 

and b, 10-3a through d, 10-4a, and 10-6a through i. Objectives 10-1e and g, 10-3e through p, and 10-7, were deleted at Midcourse Review.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.
10-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 10-2. Health Disparities Table for Focus Area 10: Food Safety (continued)

L G Ne e d

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See t a echnical ppendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. Nonetheless, 

disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix. 

i

 The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

ii Change in the summary index cannot be assessed. See Technical Appendix.

DATA SOURCES

10-1a–d. Foodborne Disease Active Surveillance Network (FoodNet): CDC, NCEZID; FDA, CFSAN; Department of Agriculture (USDA); State agencies.

10-1f. Foodborne Disease Active Surveillance Network (FoodNet): CDC, NCEZID; FDA, CFSAN; Department of Agriculture (USDA); State agencies.

10-4b. Food Safety Survey (FSS), FDA, CFSAN; and Department of Agriculture (USDA).

10-5. Food Safety Survey (FSS), FDA, CFSAN; and Department of Agriculture (USDA).
Health 

Communication

CHAPTER 11

Lead Agency

Office of Disease Prevention and Health Promotion

Contents

Goal ................................................................................................11-3

Highlights ......................................................................................11-3

Summary of Progress.....................................................................11-4

Transition to Healthy People 2020................................................11-5

Data Considerations.......................................................................11-6

Notes..............................................................................................11-6

Comprehensive Summary of Objectives........................................11-8

Progress Chart................................................................................11-9

Health Disparities Table...............................................................11-11

Persons With Internet Access at Home, 2009—Map....................11-13

11 • HEALTH COMMUNICATION 11-3

GOAL:

Use communication strategically to improve 

health.

The objectives in this chapter monitor the availability of 

Internet access, health literacy, and the characteristics 

of health communication campaigns and health-related 

websites. The number of Centers for Excellence in 

Health Communication and patient perception of health 

provider communication skills are also tracked.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this focus area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in objectives for 

this Focus Area during the past decade [1]. Fourteen 

of the 16 Health Communication objectives with data 

to measure progress moved toward or achieved their 

Healthy People 2010 targets (Figure 11-1). However, 

health disparities of 10% or more were observed 

for a number of population groups (Figure 11-2), as 

highlighted below [2].

〉 The proportion of adults with Internet access at 

home (objective 11-1) increased 165.4% between 

1998 and 2009, from 26% to 69%, moving toward the 

Healthy People 2010 target of 80%.

 Among racial and ethnic groups, the Asian 

population had the highest (best) rate of Internet 

access at home, 80% in 2009, whereas the 

American Indian or Alaska Native, Hispanic or 

Latino, and non-Hispanic black populations each 

had a rate of 53%. When expressed as persons 

without Internet access at home, the rates for 

these three populations were almost two and a 

half times the rate for the Asian population [2].

 Among education groups, persons with at least 

some college education had the highest (best) 

rates of Internet access at home, 31% in 1998 and 

82% in 2009, whereas high school graduates had 

rates of 16% in 1998 and 57% in 2009, and persons 

with less than a high school education had rates 

of 5% in 1998 and 32% in 2009. 

 In 2009, when expressed as persons without

Internet access at home, the rate for high 

school graduates was almost two and a half 

times the rate for persons with at least some 

college education, whereas the rate for persons 

with less than a high school education was 

nearly four times that rate [2].

 Between 1998 and 2009, the disparity between 

high school graduates and persons with at 

least some college education increased 117 

percentage points, whereas the disparity 

between persons with less than a high school 

education and those with at least some college 

education increased 240 percentage points [3].

〉 Internet access at home varied by geographic area. 

In 2009, the proportion of adults with Internet 

access at home was highest in the states of Alaska, 

Connecticut, Massachusetts, New Hampshire, New 

Jersey, Oregon, Utah, and Washington. The states 

with the lowest proportion of adults with Internet 

access at home were Alabama, Arkansas, Mississippi, 

and South Carolina (Figure 11-3).

〉 The proportion of health websites disclosing 

information that could be used to assess the quality 
11-4 HEALTHY PEOPLE 2010 FINAL REVIEW

of the site (objectives 11-4a through g) increased for 

all categories. The Healthy People 2010 targets were 

exceeded for four objectives:

 The proportion of websites that disclosed their 

purpose, uses, and limitations (objective 11-4b) 

increased 20.0% between 2006 and 2009, from 

35% to 42%, exceeding the target of 40%.

 The proportion of websites that disclosed their 

privacy policies (objective 11-4d) increased 

13.3% between 2006 and 2009, from 75% to 85%, 

exceeding the target of 80%.

 The proportion of websites that provided user 

feedback options (objective 11-4e) increased 

49.2% between 2006 and 2009, from 59% to 88%, 

exceeding the target of 64%. 

 The proportion of websites that met at least three 

of the six disclosure criteria (objective 11-4g) 

increased 116.7% between 2006 and 2009, from 

24% to 52%, exceeding the target of 29%.

〉 Health disparities of 100% or more in the proportion 

of persons with below-basic health literacy skills 

(objective 11-2b) were observed for a number of 

population groups:

 Among racial and ethnic groups, the nonHispanic white population had the lowest (best) 

rate of persons with below-basic health literacy, 

9% in 2003, whereas the non-Hispanic black, 

American Indian or Alaska Native, and Hispanic 

or Latino populations had rates of 24%, 25%, and 

41%, respectively. The rate for the non-Hispanic 

black population was more than two and a half 

times the best rate (that for the non-Hispanic 

white population); the rate for the American 

Indian or Alaska Native population was almost 

three times the best rate; and the rate for the 

Hispanic or Latino population was more than 

four and a half times the best rate [2].

 Among education groups, persons with at least 

some college education had the lowest (best) 

rate of persons with below-basic health literacy, 

5% in 2003. High school graduates and persons 

with less than a high school education had rates 

of 15% and 54%, respectively. The rate for high 

school graduates was three times the best group 

rate (that for persons with at least some college 

education), whereas the rate for persons with less 

than a high school education was nearly 11 times 

the best group rate [2].

 Persons without disabilities had a lower (better) 

rate of persons with below-basic health literacy 

than persons with disabilities, 10% in 2003. The 

rate for persons with disabilities was 23%, nearly 

two and a half times the rate for persons without 

disabilities [2].

Summary of Progress

〉 Figure 11-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for Health Communication. Data to 

measure progress toward target attainment were 

available for 16 objectives [1]. Of these:

 Five objectives (11-4b, d, e, and g; and 11-5) 

exceeded the Healthy People 2010 targets.

 Nine objectives moved toward their targets. A 

statistically significant difference between the 

baseline and the final data points was observed 

for six of these objectives (11-1; 11-4c and f; and 

11-6a, c, and d). No significant differences were 

observed for two objectives (11-4a and 11-6b); 

and data to test the significance of the difference 

were unavailable for one objective (11-3c). 

 Two objectives moved away from their 

targets (objectives 11-3a and b). Data to test 

the significance of the difference between 

the baseline and the final data points were 

unavailable for either of these objectives.

〉 Follow-up data were unavailable to measure progress 

for two objectives (11-2a and b).

〉 Figure 11-2 displays health disparities in Health 

Communication from the best group rate for each 

characteristic at the most recent data point [2]. It 

also displays changes in disparities from baseline to 

the most recent data point [3].

 Of the seven objectives with statistically 

significant racial and ethnic health disparities of 

10% or more, the non-Hispanic black population 

had the best rate for four objectives (11-6a 

through d). The Asian population had the best 

rate for two objectives (11-1 and 11-2b), and the 

non-Hispanic white population had the best rate 

for one objective (11-2b).

 Males had better rates than females for two of 

the three objectives with statistically significant 

health disparities of 10% or more by sex 

(objectives 11-1 and 11-6a). Females had a better 

rate for objective 11-2b.

 Of the seven objectives with statistically 

significant health disparities of 10% or more by 

education level, high school graduates had the 

best rate for three objectives (11-6a, c, and d), 

and persons with at least some college education 

also had the best rate for three objectives (11-1a, 

and 11-2a and b). The population of high school 

graduates and the population of persons with at 

least some college education both had the best 

group rate for one objective (persons reporting 

that their health care providers explained things 

so they could understand, objective 11-6b).
11 • HEALTH COMMUNICATION 11-5

 Residents of urban or metropolitan areas had 

a better group rate for the one objective with 

statistically significant health disparities of 10% 

or more by geographic location (persons with 

Internet access at home; objective 11-1).

 Persons without disabilities had a better group 

rate for all three objectives with statistically 

significant health disparities of 10% or more by 

disability status (objectives 11-2b, and 11-6b and 

c).

 As discussed in the Highlights, above, health 

disparities of 100% or more were observed for 

two objectives (11-1 and 11-2b). Changes in health 

disparities of 100 percentage points or more were 

observed for one objective (11-1).

Transition to Healthy People 

2020

For Healthy People 2020, the focus of the Health 

Communication and Health Information Technology (IT) 

Topic Area has been expanded to include more objectives 

that are shaped by the communication processes and 

the information technology that people interact with 

every day. The Healthy People 2010 Focus Area name 

was changed from Health Communication to Health 

Communication and Health IT to strategically combine 

health IT tools and effective health communication 

processes. See HealthyPeople.gov for a complete list of 

Healthy People 2020 topics and objectives.

The Healthy People 2020 Health Communication and 

Health IT objectives are geared toward:

〉 Providing personalized self-management tools and 

resources

〉 Building social support networks

〉 Delivering accurate, accessible, and actionable 

health information that is targeted or tailored

〉 Facilitating the meaningful use of health IT and 

exchange of health information among health care 

and public health professionals

〉 Enabling quick and informed response to health 

risks and public health emergencies

〉 Increasing health literacy skills

〉 Providing new opportunities to connect with 

culturally diverse and hard-to-reach populations

〉 Providing a trained workforce for the design of 

programs and interventions that result in healthier 

behaviors

〉 Increasing Internet and mobile access.

The differences between the Healthy People 2010 and 

Healthy People 2020 objectives are summarized below:

〉 The Healthy People 2020 Health Communication 

and Health IT Topic Area has a total of 24 objectives, 

10 of which are developmental, whereas the Healthy 

People 2010 Health Communication Focus Area had 

18 objectives [4].

〉 Four Healthy People 2010 objectives were retained 

“as is” [5]. These objectives address patient reports 

of health care provider communication skills 

(objectives 11-6a through d).

〉 Two Healthy People 2010 objectives were modified 

[6]. These objectives include Internet access at home 

(objective 11-1) and health websites that disclose at 

least three criteria (objective 11-4g) [6].

〉 Twelve Healthy People 2010 objectives were 

archived [7]. These objectives include: persons with 

proficient health literacy (objective 11-2a); persons 

with below basic health literacy (objective 11-2b); 

health communication campaigns sponsored by the 

Department of Health and Human Services (DHHS) 

that include formative evaluation (objective 11-3a); 

health communication campaigns sponsored by 

DHHS that include process evaluation (objective 

11-3b); health communication campaigns sponsored 

by DHHS that include outcome evaluation (objective 

11-3c); health websites that disclose the identity of 

the responsible persons or organizations (objective 

11-4a); health websites that disclose the purpose, 

uses, and limitations of the sites (objective 11-4b); 

health websites that disclose content development 

practices and policies on the sites (objective 11-4c); 

health websites that disclose privacy policy and 

protection on the sites (objective 11-4d); health 

websites that disclose user feedback and evaluation 

on the sites (objective 11-4e); health websites that 

disclose content creation on the sites (objective 

11-4f); and the number of Centers for Excellence in 

Health Communication (objective 11-5).

〉 Seventeen new objectives were added to the Healthy 

People 2020 Topic Area:

 Three new health literacy objectives monitor 

the proportion of persons who report that their 

health care provider always provides them with 

easy-to-understand instructions about how to 

address their illness or health condition; that 

their health care provider always asks them to 

describe how they will follow the instructions; 

and that their health care provider’s office always 

offers help with filling out a form.

 Three new social marketing objectives track the 

proportion of state health departments using 
11-6 HEALTHY PEOPLE 2010 FINAL REVIEW

social marketing in health promotion and disease 

prevention programs; schools of public health 

and accredited master of public health (MPH) 

programs that offer one or more courses in social 

marketing; and schools of public health and 

accredited MPH programs that offer workforce 

development activities in social marketing for 

public health practitioners.

 Two new Internet access objectives track the 

proportion of persons with broadband access to 

the Internet and the proportion of persons who 

use mobile devices.

 Two new electronic personal health management 

tools objectives target the proportion of persons 

who use the Internet to keep track of personal 

health information, such as care received, test 

results, or upcoming medical appointments; and 

persons who use the Internet to communicate 

with their provider.

 The remaining seven new objectives track the 

proportion of:

 Persons who report that their health care 

providers always involve them in decisions 

about their health care as much as they want

 Patients whose doctor recommends 

personalized health information resources to 

help them manage their health

 Adults who report having friends or family 

members whom they talk with about their 

health

 Online health information seekers who report 

easily accessing health information

 Medical practices that use electronic health 

records

 Meaningful users of health IT

 Crisis and emergency risk messages intended 

to protect the public’s health that demonstrate 

the use of best practices.

The Healthy People 2020 objectives continue to reflect 

the importance of the use of health communication 

strategies and health IT to improve population health 

outcomes and health care quality, and to achieve health 

equity. For objectives that were archived, DHHS and the 

agencies that serve as the leads for the Healthy People 

2020 initiative will consider ways to ensure that these 

public health issues retain prominence.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

Notes

1. Displayed in the Progress Chart (Figure 11-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 11-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 
11 • HEALTH COMMUNICATION 11-7

(Figure 11-2). Disparity from the best group rate 

is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 11-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 11-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

5. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy 

People 2010 and are developmental in Healthy People 

2020, and for which no numerator information is 

available.

6. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

7. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.
11-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Health Communication

Objective Description Data Source

11-1 Persons with Internet access at home (18+ years) Internet Use Supplement to the Current Population Survey (CPS): 

Department of Commerce, Census Bureau; Department of Labor 

(DOL), Bureau of Labor Statistics (BLS). 

11-2a Persons with proficient health literacy (16+ years) National Assessment of Health Literacy (NAAL), Department of 

Education, National Center for Education Statistics (NCES).

11-2b Persons with below-basic health literacy (16+ years) National Assessment of Health Literacy (NAAL), Department of 

Education, National Center for Education Statistics (NCES).

11-3a DHHS-sponsored health communication campaigns that 

include formative evaluation

DHHS, Office of Disease Prevention and Health Promotion.

11-3b DHHS-sponsored health communication campaigns that 

include process evaluation

DHHS, Office of Disease Prevention and Health Promotion.

11-3c DHHS-sponsored health communication campaigns that 

include outcome evaluation

DHHS, Office of Disease Prevention and Health Promotion.

11-4a Health websites that disclose identity of responsible persons/

organization

DHHS, Office of Disease Prevention and Health Promotion.

11-4b Health websites that disclose purpose/uses/limitations DHHS, Office of Disease Prevention and Health Promotion.

11-4c Health websites that disclose content development practices/

policies

DHHS, Office of Disease Prevention and Health Promotion.

11-4d Health websites that disclose privacy policy/protection DHHS, Office of Disease Prevention and Health Promotion.

11-4e Health websites that disclose user feedback/evaluation DHHS, Office of Disease Prevention and Health Promotion.

11-4f Health websites that disclose content creation/updating DHHS, Office of Disease Prevention and Health Promotion.

11-4g Health websites that disclose three or more of the above 

criteria

DHHS, Office of Disease Prevention and Health Promotion.

11-5 Centers for Excellence in Health Communication NIH, NCI.

11-6a Patients reporting that doctors or other health providers 

always listen carefully to them (18+ years)

Medical Expenditure Panel Survey (MEPS), AHRQ.

11-6b Patients reporting that doctors or other health providers 

always explain things so they can understand (18+ years)

Medical Expenditure Panel Survey (MEPS), AHRQ.

11-6c Patients reporting that doctors or other health providers 

always show respect for what they have to say (18+ years)

Medical Expenditure Panel Survey (MEPS), AHRQ.

11-6d Patients reporting that doctors or other health providers 

always spend enough time with them (18+ years)

Medical Expenditure Panel Survey (MEPS), AHRQ.
11 • HEALTH COMMUNICATION 11-9

Figure 11-1. Progress Toward Target Attainment for Focus Area 11: Health Communication

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

11-1. Persons with Internet access at home 

(18+ years)

79.6% 80% 26%

(1998)

69%

(2009)

43 Yes 165.4%

11-3. DHHS-sponsored health communication 

campaigns that include

a. Formative evaluation 100% 95%

(2005)

80%

(2009)

-15 Not tested -15.8%

b. Process evaluation 89% 81%

(2005)

68%

(2009)

-13 Not tested -16.0%

c. Outcome evaluation 83.3% 65% 59%

(2005)

64%

(2009)

5 Not tested 8.5%

11-4. Health websites that disclose

a. Identity (responsible persons/organization)6 22.2% 19% 10%

(2006)

12%

(2009)

2 No 20.0%

b. Purpose/uses/limitations 140.0% 40% 35%

(2006)

42%

(2009)

7 No 20.0%

c. Content development practices/policies6 33.3% 10% 1%

(2006)

4%

(2009)

3 Yes 300.0%

d. Privacy policy/protection 200.0% 80% 75%

(2006)

85%

(2009)

10 No 13.3%

e. User feedback/evaluation 580.0% 64% 59%

(2006)

88%

(2009)

29 Yes 49.2%

f. Content creation/updating6 66.7% 10% 1%

(2006)

7%

(2009)

6 Yes 600.0%

g. Three or more of the above criteria 560.0% 29% 24%

(2006)

52%

(2009)

28 Not tested 116.7%

11-5. Centers for Excellence in Health 

Communication

200.0% 6 4

(2003)

8

(2006)

4 Not tested 100.0%

11-6. Patients (18+ years) reporting that doctors 

or other health providers always

a. Listen carefully to them 25.0% 65% 57%

(2000)

59%

(2007)

2 Yes 3.5%

b. Explain things so they can understand 14.3% 66% 59%

(2000)

60%

(2007)

1 No 1.7%

c. Show respect for what they have to say 42.9% 66% 59%

(2000)

62%

(2007)

3 Yes 5.1%

d. Spend enough time with them 42.9% 53% 46%

(2000)

49%

(2007)

3 Yes 6.5%

LEGEND Moved away from target1 Moved toward target Met or exceeded target
11-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 11-1. Progress Toward Target Attainment for Focus Area 11: Health Communication (continued)

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 11-2a and 11-2b.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

6

 Baseline data are statistically unreliable. Values are shown to allow assessment of full criteria set. Refer to Operational Defi nition for more information.

DATA SOURCES

11-1. Internet Use Supplement to the Current Population Survey (CPS): Department of Commerce, Census Bureau; Department of Labor 

(DOL), Bureau of Labor Statistics (BLS). 

11-3a–c. DHHS, Offi ce of Disease Prevention and Health Promotion.

11-4a–g. DHHS, Offi ce of Disease Prevention and Health Promotion.

11-5. NIH, NCI.

11-6a–d. Medical Expenditure Panel Survey (MEPS), AHRQ.
11 • HEALTH COMMUNICATION 11-11

Figure 11-2. Health Disparities Table for Focus Area 11: Health Communication

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Location Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexUrban or metropolitanRural or nonmetropolitanPersons with disabilitiesPersons without disabilities

11-1. Persons with Internet access at home 

(18+ years) (1998, 2009)







Bi 











ii B













B







B 

11-2a. Persons with proficient health literacy 

(16+ years) (2003) B B B B B

11-2b. Persons with below-basic health literacy 

(16+ years) (2003) B B B B B B

11-6a. Patients reporting that doctors or other 

health providers always listen carefully to 

them (18+ years) (2000, 2007)1,2

b  B B Bi  B B

11-6b. Patients reporting that doctors or other health 

providers always explain things so they can 

understand (18+ years) (2000, 2007)1,2

b   B B Bi Bi B Bi B B

11-6c. Patients reporting that doctors or other health 

providers always show respect for what they 

have to say (18+ years) (2000, 2007)1,2

b  B  B B Bi B B

11-6d. Patients reporting that doctors or other 

health providers always spend enough time 

with them (18+ years) (2000, 2007)1,2

b   B B Bi B B

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 11-3a 

through c, 11-4a through g, and 11-5.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

Measures of variability were available for all the objectives in this table. Thus, the variability of best group rates was assessed, and statistical significance was tested. 

Disparities of 10% or more are displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time 

are indicated by arrows when the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.
11-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 11-2. Health Disparities Table for Focus Area 11: Health Communication (continued)

LEGEND

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

1 Baseline data by race and ethnicity are for 2002.

2 Most recent data by disability status are for 2004. i

 The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix. ii Change in the summary index cannot be assessed. See Technical Appendix.

DATA SOURCES

11-1. Internet Use Supplement to the Current Population Survey (CPS): Department of Commerce, Census Bureau; Department of Labor (DOL), Bureau of Labor 

Statistics (BLS). 

11-2a–b. National Assessment of Health Literacy (NAAL), Department of Education, National Center for Education Statistics (NCES).

11-6a–d. Medical Expenditure Panel Survey (MEPS), AHRQ.
11 • HEALTH COMMUNICATION 11-13 Figure 11-3. Persons With Internet Access at Home (Age 18+), 2009 Healthy People 2010 objective 11-1 • Target = 80 percent NOTE: Rates are displayed by a Jenks classification for U.S. states. SOURCE: Internet Use Supplement to the Current Population Survey (CPS): Department of Commerce, Census Bureau; Department of Labor (DOL), Bureau of Labor Statis

Percent No stat

Heart Disease 

and Stroke

CHAPTER 12

Co-Lead Agencies

Centers for Disease Control and Prevention

National Institutes of Health

Contents

Goal ................................................................................................12-3

Highlights ......................................................................................12-3

Summary of Progress.....................................................................12-5

Transition to Healthy People 2020................................................12-5

Data Considerations.......................................................................12-7

References and Notes.....................................................................12-7

Comprehensive Summary of Objectives........................................12-9

Progress Chart..............................................................................12-10

Health Disparities Table...............................................................12-12

Coronary Heart Disease Deaths, 2005–07—Map.......................12-15

Stroke Deaths, 2005–07—Map...................................................12-16

12 • Heart Disease and Stroke 12-3

GOAL:

Improve cardiovascular health and quality of 

life through the prevention of risk factors; 

detection and treatment of risk factors; early 

identification and treatment of heart attacks 

and strokes; and prevention of recurrent 

cardiovascular events.

This chapter includes objectives for the Focus Area 

that monitors coronary heart disease (CHD) and stroke 

deaths, heart failure hospitalizations, risk factors for 

heart disease and stroke, knowledge of heart attack and 

stroke symptoms and response, and the availability of 

treatment options.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved for the majority of 

objectives in this Focus Area over the last decade [1]. 

Two-thirds of the Heart Disease and Stroke objectives 

with data to monitor progress moved toward or 

achieved their Healthy People 2010 targets. However, 

for three objectives, the change was opposite the 

direction of the target (Figure 12-1). Moreover, health 

disparities of 50% or more among racial and ethnic 

populations and education groups were observed 

(Figure 12-2), as highlighted below [2].

〉 The CHD death rate (objective 12-1) declined 35.4% 

between 1999 and 2007, from 195 to 126 deaths per 

100,000 population (age adjusted), exceeding the 

Healthy People 2010 target of 156 deaths per 100,000. 

Disparities were observed for a number of population 

groups, for example:

 Among racial and ethnic groups, the Asian 

or Pacific Islander population had the lowest 

(best) CHD mortality rate, 71 deaths per 100,000 

population (age adjusted) in 2007, whereas the 

non-Hispanic black population had a rate of 153 

deaths per 100,000 (age adjusted). The rate for the 

non-Hispanic black population was more than 

twice the best group rate [2].

 Among education groups, persons aged 25–64 

with at least some college education had the 

lowest (best) CHD mortality rate, 30 deaths 

per 100,000 population (age adjusted) in 2002. 

Persons aged 25–64 with less than a high school 

education had a rate of 83 deaths per 100,000 (age 

adjusted), and high school graduates in the same 

age group had a rate of 71 deaths per 100,000 (age 

adjusted). The rate for persons with less than a 

high school education was almost three times the 

best group rate, whereas the rate for high school 

graduates was almost two and a half times the 

best group rate [2].
12-4 HEALTHY PEOPLE 2010 FINAL REVIEW

〉 Although the Healthy People 2010 target for CHD 

deaths was largely met throughout the U.S., there 

remained geographic pockets with higher rates along 

the Ohio-Mississippi River Basin, a geographic region 

generally referred to as “Coronary Valley” (Figure 

12-3).

〉 The stroke death rate (objective 12-7) declined 32.3% 

between 1999 and 2007, from 62 to 42 deaths per 

100,000 (age adjusted), exceeding the 2010 target of 

50 deaths per 100,000. Disparities were observed for a 

number of population groups, for example:

 Among racial and ethnic groups, the American 

Indian or Alaska Native population had the lowest 

(best) rate, 30 deaths per 100,000 population 

(age adjusted) in 2007. The non-Hispanic black 

population had a rate of 62 deaths per 100,000 

(age adjusted), more than twice the best group 

rate [2].

 Among education groups, persons aged 25–64 

with at least some college education had the 

lowest (best) stroke death rate, 7 deaths per 

100,000 population (age adjusted) in 2002. 

Persons aged 25–64 with less than a high school 

education had a rate of 21 deaths per 100,000 (age 

adjusted), and high school graduates in the same 

age group had a rate of 16 deaths per 100,000 (age 

adjusted). The rate for persons with less than a 

high school education was three times the best 

group rate, whereas the rate for high school 

graduates was almost two and a half times the 

best group rate [2].

〉 Although the Healthy People 2010 target for stroke 

deaths was largely met throughout the U.S., there 

remained geographic pockets with higher rates in 

the Southeast, a geographic region generally referred 

to as the “Stroke Belt” (Figure 12-4).

〉 Hospitalization rates for congestive heart failure 

among persons aged 65–74 (objective 12-6a) declined 

35.6% between 1997 and 2007, from 13.2 to 8.5 

hospitalizations per 1,000, moving toward the 2010 

target of 6.5 hospitalizations per 1,000. Congestive 

heart failure hospitalizations among persons aged 

75–84 (objective 12-6b), declined 26.2% between 

1997 and 2007, from 26.7 to 19.7 hospitalizations 

per 1,000, moving toward the 2010 target of 13.5 

hospitalizations per 1,000; and among persons 

aged 85 and over (objective 12-6c), hospitalizations 

declined 37.6%, from 52.7 to 32.9 per 1,000, moving 

toward the 2010 target of 26.5 hospitalizations per 

1,000.

 In the 65–74 age group (objective 12-6a), the white 

population had the lowest (best) rate among 

racial and ethnic groups, 5.9 hospitalizations per 

1,000 population in 2007. The black population 

had a rate of 14.0 per 1,000, nearly two and a half 

times the best group rate [2].

 In the 75–84 age group (objective 12-6b), the white 

population also had the lowest (best) rate among 

racial and ethnic groups, 14.8 hospitlaizations per 

1,000 population in 2007. The black population 

had a rate of 25.9 per 1,000, almost twice the best 

group rate [2].

〉 The proportion of persons aged 18 and over who had 

their blood pressure measured in the past 2 years and 

who know their blood pressure level (objective 12-12) 

increased 1.1% between 1998 and 2008, from 90% 

to 91% (age adjusted), moving toward the Healthy 

People 2010 target of 95%. Disparities were observed 

for a number of population groups, for example:

 Among racial and ethnic groups, the nonHispanic white and non-Hispanic black 

populations had the highest (best) rate of blood 

pressure monitoring, 92% (age adjusted) in 2008, 

whereas the Hispanic or Latino population had 

a rate of 82% (age adjusted). When expressed as 

persons who do no monitoring, the rate for the 

Hispanic or Latino population was more than 

twice the rate for the non-Hispanic white and the 

non-Hispanic black populations [2].

 Among education groups, persons aged 25 and 

over with at least some college education had the 

highest (best) rate of blood pressure monitoring, 

94% in 2008, whereas persons aged 25 and over 

with less than a high school education had a rate 

of 83%. When expressed as persons who do no 

monitoring, the rate for persons with less than a 

high school education was almost three times 

the rate for persons with at least some college 

education [2].

 Persons with less than a high school education 

had blood pressure monitoring rates of 84% 

in 1998 and 83% in 2008, whereas persons 

with at least some college education had rates 

of 93% in 1998 and 94% in 2008. When rates 

are expressed in terms of persons who do no 

monitoring, the disparity between persons 

without a high school education and those 

with at least some college education decreased 

55 percentage points between 1998 and 2008 

[2,3].

〉 Mean total blood cholesterol levels among persons 

aged 20 and over (objective 12-13) declined 3.9% from 

1988–94 to 2005–08, from 206 to 198 mg/dL (age 

adjusted), exceeding the 2010 target of 199 mg/dL. 

During the same period, the proportion of persons 

aged 20 and over with high blood cholesterol levels 

(objective 12-14) fell 28.6%, from 21% to 15% (age 

adjusted), exceeding the 2010 target of 17%.

〉 The proportion of persons aged 18 and over who were 

aware of the symptoms of a heart attack and the 

importance of calling 911 (objective 12-2) declined 

11.9% between 2001 and 2008, from 42% to 37% (age 

adjusted), moving away from the 2010 target of 47%.
12 • Heart Disease and Stroke 12-5

〉 The proportion of persons aged 18 and over who were 

aware of the symptoms of a stroke (objective 12-8) 

declined by 10.0% between 2001 and 2009, from 60% 

to 54% (age adjusted), moving away from the 2010 

target of 65%.

〉 The prevalence of hypertension among persons aged 

18 and over (objective 12-9) increased 20.0% from 

1988–94 to 2005–08, from 25% to 30% (age adjusted), 

moving away from the 2010 target of 14%. Disparities 

were observed for a number of population groups, for 

example:

 Among racial and ethnic populations, the 

Mexican American population had the lowest 

(best) rate, 26% (age adjusted) in 2005–08. The 

rate for the non-Hispanic black population was 

42% (age adjusted), more than one and a half 

times the best group rate [2].

Summary of Progress

〉 Figure 12-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for Heart Disease and Stroke [1]. Data to 

measure progress toward target attainment were 

available for 15 objectives. Of these:

 Four objectives (12-1, 12-7, 12-13, and 12-14) 

exceeded their Healthy People 2010 targets.

 Eight objectives (12-4, 12-6a through c, 12-10 

through 12-12, and 12-15) moved toward their 

targets. A statistically significant difference 

between the baseline and the final data points 

was observed for each of these objectives.

 Three objectives (12-2, 12-8, and 12-9) moved 

away from their targets. A statistically significant 

difference between the baseline and the final data 

points was observed for each of these objectives.

〉 Two objectives (12-5 and 12-16) remained 

developmental, and two objectives (12-3a and b) had 

no follow-up data available to measure progress [4].

〉 Figure 12-2 displays health disparities in Heart 

Disease and Stroke from the best group rate for each 

characteristic at the most recent data point [2]. It 

also displays changes in disparities from baseline to 

the most recent data point [3].

 Of the 11 objectives with statistically significant 

racial and ethnic health disparities of 10% or 

more, the non-Hispanic white population had 

the unique best rate for three objectives (12-2, 12-

8, and 12-10), and the white population (including 

persons of Hispanic origin) had the best rate 

for two objectives (12-6a and b). The American 

Indian or Alaska Native (objective 12-7), Asian or 

Pacific Islander (objective 12-1), Asian (objective 

12-15), Mexican American (objective 12-9), and 

non-Hispanic black populations (objective 12-14) 

had the unique best rate for one objective each. 

The non-Hispanic black and non-Hispanic white 

populations were tied for the best group rate for 

one objective (12-12).

 Females had better rates than males for eight of 

the nine objectives with statistically significant 

health disparities of 10% or more by sex 

(objectives 12-1, 12-2, 12-6a and b, 12-8, 12-10, 

12-12, and 12-15). Males had a better rate for one 

objective (12-14).

 Persons with at least some college education had 

the best rates for all seven of the objectives with 

statistically significant health disparities of 10% 

or more by education level (objectives 12-1, 12-2, 

12-4, 12-7, 12-8, 12-12, and 12-15).

 Persons with middle/high incomes had the best 

rate for both of the objectives with statistically 

significant health disparities of 10% or more by 

income (objectives 12-9 and 12-10).

 Persons without disabilities had a better rate 

than persons with disabilities for two of the 

three objectives with statistically significant 

health disparities of 10% or more by disability 

status (objectives 12-8 and 12-9). Persons with 

disabilities had a better rate for the other 

objective (12-10).

 There were several objectives with health 

disparities of 100% or more. Most of these were 

discussed in the Highlights, above.

Transition to Healthy People 

2020

The goal of the Healthy People 2020 Heart Disease and 

Stroke Topic Area is consistent with the Healthy People 

2010 goal (stated on page 12-3, above). The Healthy 

People 2020 objectives expand on the prevalence, 

treatment, and control of individual heart disease and 

stroke risk factors and also include an overall measure of 

cardiovascular health that takes into account the status 

and interaction of all major cardiovascular disease 

(CVD) risk factors to generate a composite CVD risk 

score. The objectives also plan to monitor rehabilitation 

following heart attack and stroke. See HealthyPeople.

gov for a complete list of Healthy People 2020 topics and 

objectives.

The Healthy People 2020 Heart Disease and Stroke Topic 

Area objectives can be grouped into five sections:

〉 Prevention of risk factors
12-6 HEALTHY PEOPLE 2010 FINAL REVIEW

〉 Detection and treatment of risk factors

〉 Early identification and treatment of heart attack 

and stroke

〉 Prevention of recurrent cardiovascular events

〉 Cross-cutting.

The differences between the Healthy People 2010 

objectives and those included in Healthy People 2020 

objectives are summarized below:

〉 The Healthy People 2020 Heart Disease and Stroke 

Topic Area has a total of 49 objectives, 31 of which 

are developmental [4]. The Healthy People 2010 Heart 

Disease and Stroke Focus Area had 19 objectives, 2 of 

which were developmental.

〉 Ten Healthy People 2010 objectives were retained “as 

is” [5].

 Nine objectives were retained as measurable: 

coronary heart disease deaths (objective 12-1), 

stroke deaths (objective 12-7), knowledge of 

stroke symptoms (objective 12-8), hypertension 

prevalence (objective 12-9), blood pressure 

control (objective 12-10), blood pressure 

monitoring (objective 12-12), mean total 

cholesterol (objective 12-13), prevalence of high 

cholesterol (objective 12-14), and cholesterol 

screening (objective 12-15).

 One objective, adults with CHD who have their 

LDL cholesterol at or below the recommended 

level (objective 12-16), was retained as 

developmental.

〉 Eight Healthy People 2010 objectives were modified 

to create 12 Healthy People 2020 objectives [6].

 Three objectives for congestive heart failure 

hospitalizations among older adults aged 65–74, 

75–84, and 85 and over (objectives 12-6a through 

c) were expanded to heart failure hospitalizations.

 Fibrinolytic therapy within an hour of symptom 

onset and percutaneous intervention therapy 

within 90 minutes of symptom onset of heart 

attack (objectives 12-3a and b) were modified 

to within 30 and 90 minutes of hospital arrival, 

respectively.

 Training in cardiopulmonary resuscitation 

(CPR) in the past year (objective 12-4) and timely 

electrical shock therapy for out-of-hospital 

cardiac arrest (objective 12-5) were combined 

into one developmental objective. The resulting 

Healthy People 2020 objective addresses 

appropriate bystander response to, and 

emergency medical services for, out-of hospital 

cardiac arrest.

 Taking action to help control blood pressure 

(objective 12-11) was divided into six objectives. 

There are five developmental objectives for 

hypertension regarding meeting recommended 

guidelines for body mass index (BMI), saturated 

fat consumption, sodium intake, physical activity, 

and moderate alcohol consumption, as well as 

one objective for prescribed antihypertensive 

medication use among adults with hypertension.

〉 One Healthy People 2010 objective (objective 12-2) 

that tracks knowledge of heart attack symptoms and 

the importance of calling 911 was retained “as is” and 

was also modified to create three Healthy People 

2020 objectives. The other two objectives separately 

track the two knowledge components.

〉 Twenty-four new objectives, all of which are 

developmental, were added to the Healthy People 

2020 Heart Disease and Stroke Topic Area:

 A new objective tracking overall cardiovascular 

health.

 A new objective monitoring hypertension 

prevalence among children and adolescents.

 Five new objectives for prehypertension 

regarding meeting recommended guidelines 

for BMI, saturated fat consumption, sodium 

intake, physical activity, and moderate alcohol 

consumption.

 Eight new objectives on cholesterol-lowering 

management advice and adherence: diet, 

physical activity, weight control, and prescribed 

drug therapy.

 Three new objectives on aspirin use for CVD risk 

reduction.

 Two new rehabilitation objectives for heart 

attack and stroke survivors.

 Four new stroke objectives, including knowledge 

of stroke symptoms and the importance of calling 

911, knowledge of the importance of calling 911 

for stroke, acute reperfusion therapy within 3 

hours of symptom onset for stroke patients, and 

adults who have had a stroke who have their LDL 

cholesterol at or below recommended levels.

Six new objectives that address incidence, case fatality, 

and recurrence rates for both heart attacks and strokes 

were proposed but not included in the Healthy People 

2020 Heart Disease and Stroke Topic Area due to lack of 

national data sources.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.
12 • Heart Disease and Stroke 12-7

Data Considerations

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

Beginning in 2003, education data for CHD and stroke 

deaths (objectives 12-1 and 12-7) from the National Vital 

Statistics System were suppressed. The educational 

attainment item was changed in the new U.S. Standard 

Certificate of Death in 2003 to be consistent with the 

Census Bureau data and to improve the ability to 

identify specific types of educational degrees. Many 

states, however, are still using the 1989 version of the 

U.S. Standard Certificate of Death, which focuses on 

highest school grade completed. As a result, educational 

attainment data collected using the 2003 version are not 

comparable with data collected using the 1989 version 

[7].

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

References and Notes

1. Displayed in the Progress Chart (Figure 12-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 12-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 12-2). Disparity from the best group rate 

is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 
12-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 12-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 12-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

5. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy 

People 2010 and are developmental in Healthy People 

2020, and for which no numerator information is 

available.

6. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

7. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. 

Deaths: Final data for 2007. National vital statistics 

reports; vol 58 no 19. Hyattsville, MD: National Center 

for Health Statistics. 2010. Available from http://www.

cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf.
12 • Heart Disease and Stroke 12-9

Comprehensive Summary of Objectives: Heart Disease and Stroke

Objective Description Data Source or Objective Status

12-1 Coronary heart disease (CHD) deaths (age adjusted, per 

100,000 population)

National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

12-2 Knowledge of heart attack symptoms and importance of 

calling 911 (age adjusted, 20+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

12-3a Fibrinolytics within an hour of symptom onset National Registry of Myocardial Infarction (NRMI-4), National Acute 

Myocardial Infarction Project, CMS.

12-3b Percutaneous intervention (PCI) within 90 minutes of symptom 

onset

National Registry of Myocardial Infarction (NRMI-4), National Acute 

Myocardial Infarction Project, CMS.

12-4 Training in cardiopulmonary resuscitation (CPR) in past year 

(age adjusted, 20+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

12-5 Timely electrical shock therapy for out-of-hospital cardiac 

arrest

Developmental.

12-6a Congestive heart failure hospitalizations—65–74 years (per 

1,000 population)

National Hospital Discharge Survey (NHDS), CDC, NCHS.

12-6b Congestive heart failure hospitalizations—75–84 years (per 

1,000 population)

National Hospital Discharge Survey (NHDS), CDC, NCHS.

12-6c Congestive heart failure hospitalizations—85+ years (per 

1,000 population)

National Hospital Discharge Survey (NHDS), CDC, NCHS.

12-7 Stroke deaths (age adjusted, per 100,000 population) National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

12-8 Knowledge of stroke symptoms (age adjusted, 20+ years) National Health Interview Survey (NHIS), CDC, NCHS.

12-9 High blood pressure (age adjusted, 18+ years) National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

12-10 High blood pressure control (age adjusted, 18+ years) National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

12-11 Taking action to help control blood pressure (age adjusted, 

18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

12-12 Adults who had their blood pressure measured in past 2 years 

and know their blood pressure level (age adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

12-13 Mean total blood cholesterol levels (mg/dL, age adjusted, 20+ 

years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

12-14 High blood cholesterol levels (age adjusted, 20+ years) National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

12-15 Blood cholesterol screening in past 5 years (age adjusted, 

18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

12-16 Adults with CHD who have their LDL cholesterol at or below 

the recommended level

Developmental.
12-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 12-1. Progress toward target attainment for Focus area 12: Heart Disease and stroke

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

12-1. Coronary heart disease (CHD) deaths 

(age adjusted, per 100,000 population)

176.9% 156 195

(1999)

126

(2007)

-69 Yes -35.4%

12-2. Knowledge of heart attack symptoms 

and importance of calling 911 

(age adjusted, 20+ years)

47% 42%

(2001)

37%

(2008)

-5 Yes -11.9%

12-4. Training in cardiopulmonary resuscitation 

(CPR) in past year (age adjusted, 

20+ years)

 50.0% 12% 8%

(2001)

10%

(2008)

2 Yes 25.0%

12-6. Congestive heart failure hospitalizations 

(per 1,000 population)

a. 65–74 years 70.1% 6.5 13.2

(1997)

8.5

(2007)

-4.7 Yes -35.6%

b. 75–84 years 53.0% 13.5 26.7

(1997)

19.7

(2007)

-7.0 Yes -26.2%

c. 85+ years 75.6% 26.5 52.7

(1997)

32.9

(2007)

-19.8 Yes -37.6%

12-7. Stroke deaths (age adjusted, per 

100,000 population)

166.7% 50 62

(1999)

42

(2007)

-20 Yes -32.3%

12-8. Knowledge of stroke symptoms 

(age adjusted, 20+ years)

65% 60%

(2001)

54%

(2009)

-6 Yes -10.0%

12-9. High blood pressure 

(age adjusted, 18+ years)

14% 25%

(1988–94)

30%

(2005–08)

5 Yes 20.0%

12-10. High blood pressure control 

(age adjusted, 18+ years)

 44.2% 68% 25%

(1988–94)

44%

(2005–08)

19 Yes 76.0%

12-11. Taking action to help control blood 

pressure (age adjusted, 18+ years)

 50.0% 98% 84%

(1998)

91%

(2008)

7 Yes 8.3%

12-12. Adults who had their blood pressure measured in past 2 years and know their blood 

pressure level (age adjusted, 18+ years)

 20.0% 95% 90%

(1998)

91%

(2008)

1 Yes 1.1%

12-13. Mean total blood cholesterol levels 

(mg/dL, age adjusted, 20+ years)

114.3% 199 206

(1988–94)

198

(2005–08)

-8 Yes -3.9%

12-14. High blood cholesterol levels (age 

adjusted, 20+ years)

150.0% 17% 21%

(1988–94)

15%

(2005–08)

-6 Yes -28.6%

12-15. Blood cholesterol screening in past 5 

years (age adjusted, 18+ years)

61.5% 80% 67%

(1998)

75%

(2008)

8 Yes 11.9%

LeGenD Moved away from target1 Moved toward target Met or exceeded target
12 • Heart Disease and Stroke 12-11

Figure 12-1. Progress toward target attainment for Focus area 12: Heart Disease and stroke (continued)

NOTES

See the reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 12-3a, 12-3b, 12-5, and 12-16.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See technical appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See technical appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

DATA SOURCES

12-1. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

12-2. National Health Interview Survey (NHIS), CDC, NCHS.

12-4. National Health Interview Survey (NHIS), CDC, NCHS.

12-6a–c. National Hospital Discharge Survey (NHDS), CDC, NCHS.

12-7. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

12-8. National Health Interview Survey (NHIS), CDC, NCHS.

12-9–12-10. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

12-11–12-12. National Health Interview Survey (NHIS), CDC, NCHS.

12-13–12-14. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

12-15. National Health Interview Survey (NHIS), CDC, NCHS.
12-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 12-2. Health Disparities Table for Focus Area 12: Heart Disease and Stroke

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Income Location Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexUrban or metropolitanRural or nonmetropolitanPersons with disabilitiesPersons without disabilities

12-1. Coronary heart disease (CHD) deaths 

(age adjusted, per 100,000 population) 

(1999, 2007)1* 

Bi   B   B 

12-2. Knowledge of heart attack symptoms 

and importance of calling 911 (age 

adjusted, 20+ years) (2001, 2008)*

B B B Biii B

12-3a. Fibrinolytics within an hour of symptom 

onset (2000–04)† B i ii ii

12-3b. Percutaneous intervention (PCI) 

within 90 minutes of symptom onset 

(2000–04)†

i ii Bii

12-4. Training in cardiopulmonary resuscitation 

(CPR) in past year (age adjusted, 20+ 

years) (2001, 2008)*

B B B B

12-6a. Congestive heart failure hospitalizations—65–74 years (per 1,000 

population) (1997, 2007)*

ii Bii B

b. Congestive heart failure hospitalizations—75–84 years (per 1,000 

population) (1997, 2007)*

ii,iii Bii B

c. Congestive heart failure hospitalizations—85+ years (per 1,000 population) (1997, 2007)*

ii Bii Biv

12-7. Stroke deaths (age adjusted, per 

100,000 population) (1999, 2007)1* Biv i  B B

12-8. Knowledge of stroke symptoms (age 

adjusted, 20+ years) (2001, 2009)*  B v B  B  B

12-9. High blood pressure (BP) (age adjusted, 

18+ years) (1988–94, 2005–08)2* Biii,vi B  B B

12-10. High BP control (age adjusted, 18+ 

years) (1988–94, 2005–08)2* vi B B Biv B

12-11. Taking action to help control BP (age 

adjusted, 18+ years) (1998, 2008)3*

12-12. Adults who had their BP measured in 

past 2 years and know their BP level (age 

adjusted, 18+ years) (1998, 2008)3

*



 B B B   B 

12-13. Mean total blood cholesterol levels 

(mg/dL, age adjusted, 20+ years) 

(1988–94, 2005–08)2*

vi B B Biv Biv

12-14. High blood cholesterol levels (age 

adjusted, 20+ years) (1988–94, 

2005–08)2*

vi Biv B Biv B Biv B
12 • Heart Disease and Stroke 12-13

Figure 12-2. Health Disparities Table for Focus Area 12: Heart Disease and Stroke (continued)

Race and Ethnicity Sex Education Income Location Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexUrban or metropolitanRural or nonmetropolitanPersons with disabilitiesPersons without disabilities

12-15. Blood cholesterol screening in past 5 

years (age adjusted, 18+ years) (1998, 

2008)3*

B  v B  B  B  B

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 12-5 

and 12-16.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

L G De en

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See t a echnical ppendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. Nonetheless, 

disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix.

1 Most recent data by education level are for 2002.

2 Baseline data by disability status are for 1991–94. 

3 Baseline data by race and ethnicity are for 2003. 

i Data are for Asian or Pacific Islander.

ii Data include persons of Hispanic origin.

iiiReliability criterion for best group rate not met, or data available for only one group, at baseline. Change in disparity cannot be assessed. See Technical Appendix.
12-14 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 12-2. Health Disparities Table for Focus Area 12: Heart Disease and Stroke (continued)

iv The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

v Change in the summary index cannot be assessed. See Technical Appendix.

viData are for Mexican American.

DATA SOURCES

12-1. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

12-2. National Health Interview Survey (NHIS), CDC, NCHS.

12-3a–b. National Registry of Myocardial Infarction (NRMI-4), National Acute Myocardial Infarction Project, CMS.

12-4. National Health Interview Survey (NHIS), CDC, NCHS.

12-6a–c. National Hospital Discharge Survey (NHDS), CDC, NCHS.

12-7. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

12-8. National Health Interview Survey (NHIS), CDC, NCHS.

12-9–12-10. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

12-11–12-12. National Health Interview Survey (NHIS), CDC, NCHS.

12-13–12-14. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

12-15. National Health Interview Survey (NHIS), CDC, NCHS.
12 • Heart Disease an

dStroke 12-15

Figure 12-3. Coronary Heart Disease Deaths, 2005–07Healthy People 2010 objective 12-1 • Target = 156 per 100,000

NOTES: Data are for ICD-10 codes I20–I25 reported as underlying cause. Rates are age adjusted to the 2000 standard population and are displayed by a modified Jenks classifSOURCE: National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS. 

Rate pe

Lowest health s
HEALTHY PEOPLE 2010 FINAL REVIEW 12-16Figure 12-4. Stroke Deaths, 2005–07 Healthy People 2010 objective 12-7 • Target = 50 per 100,000 NOTES: Data are for ICD-10 codes I60–I69 reported as underlying cause. Rates are age adjusted to the 2000 standard population and are displayed by a modified Jenks classific

SOURCE: National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS. 

Rate 

Lowegreenthat m
HIV

CHAPTER 13

Co-Lead Agencies

Centers for Disease Control and Prevention

Health Resources and Services Administration

Contents

Goal ................................................................................................13-3

Highlights ......................................................................................13-3

Summary of Progress.....................................................................13-4

Transition to Healthy People 2020................................................13-5

Data Considerations.......................................................................13-6

References and Notes.....................................................................13-7

Comprehensive Summary of Objectives........................................13-8

Progress Chart................................................................................13-9

Health Disparities Table...............................................................13-11

New AIDS Cases, 2007—Map .....................................................13-13

HIV Infection Deaths, 2005–07—Map .......................................13-14

13 • HIV 13-3

GOAL:

Prevent human immunodeficiency virus (HIV) 

infection and its related illness and death.

The objectives in this chapter track cases of HIV infection 

and acquired immunodeficiency syndrome (AIDS), 

HIV/AIDS deaths, HIV/AIDS prevention, and HIV/AIDS 

testing.

All Healthy People 2010 tracking data quoted in 

this chapter, along with technical information and 

Operational Definitions for each objective, can be 

found in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in objectives for 

this Focus Area during the past decade [1]. Over 70% 

of the HIV objectives with data to measure progress 

moved toward or achieved their Healthy People 2010 

targets (Figure 13-1). However, health disparities 

were observed among racial and ethnic population 

groups, as well as by sex, education level, income, and 

disability status (Figure 13-2), as discussed below [2].

〉 A statistically significant downward trend was 

observed in the rate of new AIDS diagnoses among 

persons aged 13 and over (objective 13-1) [3]. The rate 

decreased 20.7% between 1998 and 2007, from 18.4 

to 14.6 new cases per 100,000 population, moving 

toward the Healthy People 2010 target of 0.9 per 

100,000 population.

 Among racial and ethnic groups, the combined 

Asian or Pacific Islander population had the 

lowest (best) rate of AIDS diagnoses, 4.7 new 

cases per 100,000 population in 2007. The rate 

for the Hispanic or Latino population, 20.9 new 

cases per 100,000, was almost four and a half 

times the best rate; the rate for the non-Hispanic 

black population, 58.6 per 100,000, was over 12 

times the best rate [2].

 Females had a lower (better) rate of annual AIDS 

diagnoses than males, 7.6 per 100,000 population 

in 2007. Males had a rate of 21.9 per 100,000, 

almost three times the rate for females [2].

〉 The rate of annual AIDS diagnoses varied by state. In 

2007, Alaska, the Central and Midwest states, Maine, 

New Hampshire, Vermont, and West Virginia, had 

the lowest rates. The District of Columbia, with 154.6 

new cases per 100,000 population, had the highest 

rate (Figure 13-3).

〉 The annual number of new AIDS diagnoses 

attributed to male-to-male sexual contact among 

adults and adolescents aged 13 and over (objective 

13-2) increased 0.7% between 1998 and 2007, from 

16,882 to 16,992, moving away from the 2010 target 

of 12,661.

〉 The number of new AIDS cases among persons 

aged 13 and over who injected drugs (objective 13-3) 

decreased 47.1% between 1998 and 2007, from 11,514 

to 6,093, exceeding the 2010 target of 8,636.

〉 The number of new AIDS cases among adult and 

adolescent males aged 13 and over who had sex with 

men and who injected drugs (objective 13-4) declined 

36.1% between 1998 and 2007, from 2,751 to 1,759, 

exceeding the 2010 target of 2,064.

〉 HIV-infection deaths (objective 13-14) declined 30.2% 

between 1999 and 2007, from 5.3 to 3.7 deaths per 

100,000 population (age adjusted), moving toward 

the 2010 target of 0.7 deaths per 100,000 population.
13-4 HEALTHY PEOPLE 2010 FINAL REVIEW

 Among racial and ethnic groups, the nonHispanic white population had the lowest (best) 

rates of HIV-infection deaths, 2.3 per 100,000 

population (age adjusted) in 1999 and 1.5 in 2007. 

The Hispanic or Latino population had rates 

of 6.9 in 1999 and 4.1 in 2007, whereas the nonHispanic black population had rates of 24.0 in 

1999 and 17.8 in 2007.

 In 2007, the HIV-infection death rate for the 

Hispanic or Latino population was more than 

two and a half times the best rate (that for the 

non-Hispanic white population), whereas the 

rate for the non-Hispanic black population was 

almost 12 times the best rate [2].

 Between 1999 and 2007, the disparity between 

the non-Hispanic black and non-Hispanic 

white populations increased 143 percentage 

points [4].

 Females had lower (better) HIV-infection 

death rates than males, 2.5 deaths per 100,000 

population (age adjusted) in 1999 and 2.1 in 2007. 

Males had rates of 8.2 in 1999 and 5.4 in 2007. In 

2007, the rate for males was more than two and 

a half times that for females. Between 1999 and 

2007, the disparity between males and females 

declined 71 percentage points [4].

〉 HIV-infection death rates varied by state. Among 

those states with reliable data for the period 2005–07, 

the HIV-infection death rates for Delaware, Florida, 

Georgia, Louisiana, Maryland, Mississippi, New York, 

and South Carolina ranged from 4.6 to 9.3 deaths 

per 100,000 population (age adjusted). The District 

of Columbia, with an HIV-infection death rate of 

34.9 per 100,000 (age adjusted), had the highest rate 

(Figure 13-4).

〉 A statistically significant upward trend was observed 

in the proportion of HIV-infected persons surviving 

3 or more years after an AIDS diagnosis (objective 

13-16) [3]. The proportion increased 12.8% between 

1998 and 2006, from 78% to 88%, exceeding the 2010 

target of 86%.

〉 A statistically significant downward trend was 

observed in the number of perinatally acquired AIDS 

diagnoses (objective 13-17b) [3]. The number declined 

88.5% between 1998 and 2007, from 243 to 28 new 

cases, exceeding the 2010 target of 75 new cases.

〉 HIV testing of tuberculosis patients aged 25–44 

years (objective 13-11) increased 19.7% between 1998 

and 2008, from 61% to 73%, moving toward the 2010 

target of 89%.

 Among racial and ethnic groups, the nonHispanic black population had the highest (best) 

rate of HIV testing among tuberculosis patients 

aged 25–44, 88% in 2008, whereas the Asian, the 

Native Hawaiian or Other Pacific Islander, and 

the Hispanic or Latino populations had rates of 

61%, 61%, and 69%, respectively. When expressed 

in terms of patients who were not tested for HIV, 

the rates for the Asian and the Native Hawaiian 

or Other Pacific Islander populations were 

almost three and a half times the rate for the 

non-Hispanic black population, whereas the rate 

for the Hispanic or Latino population was more 

than two and a half times the non-Hispanic black 

rate [2].

Summary of Progress

〉 Figure 13-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for HIV [1]. Data to measure progress 

toward target attainment were available for 15 

objectives. Of these:

 Four objectives exceeded their Healthy People 

2010 targets (objectives 13-3, 13-4, 13-16, and 

13-17b).

 Seven objectives moved toward their targets. 

A statistically significant difference between 

the baseline and the final data points was 

observed for one of these objectives (13-14). Data 

were unavailable to test the significance of the 

difference for the remaining six objectives (13-1, 

13-6a and b, 13-11, and 13-13d and f).

 Four objectives moved away from their targets 

(objectives 13-2, 13-8, and 13-13c and e). Data 

were unavailable to test the significance of the 

difference between the baseline and the final 

data points for all of these objectives.

〉 Six objectives (13-5, 13-13a and b, 13-15, 13-17a, and 

13-18) remained developmental, and four objectives 

(13-7, 13-9, 13-10, and 13-12) were deleted at the 

Midcourse Review [5].

〉 Figure 13-2 displays health disparities from the best 

group rate for each characteristic at the most recent 

data point [2]. It also displays changes in disparities 

from baseline to the most recent data point [4].

 Statistically significant health disparities of 10% 

or more by race and ethnicity were observed for 

three objectives. Health disparities of 10% or more 

by race and ethnicity were observed for seven 

additional objectives, although their significance 

could not be tested. Of these 10 objectives, the 

non-Hispanic black population had the best 

rate for four objectives (13-6a and b, 13-11, and 

13-13f). The Asian or Pacific Islander (objective 

13-1), the Hispanic or Latino (objective 13-13d), 

the American Indian or Alaska Native (objective 

13-13e), and the non-Hispanic white (objective 

13-14) populations had the unique best rate for 
13 • HIV 13-5

one objective each. The Asian or Pacific Islander 

and Hispanic or Latino populations were tied for 

the best rate for one objective (13-13c), whereas 

the Asian or Pacific Islander and non-Hispanic 

white populations were tied for the best rate for 

another (objective 13-16).

 One objective had statistically significant health 

disparities of 10% or more by sex, and three 

objectives had health disparities of 10% or more 

by sex but no data to assess significance. Of these 

four objectives, females had better rates than 

males for two (objectives 13-1 and 13-14), and 

males had better rates than females for the other 

two (objectives 13-11 and 13-13c).

 Persons with at least some college education had 

the best rates for all three of the objectives with 

statistically significant health disparities of 10% 

or more by education level (objectives 13-6a and 

b, and 13-14).

 Persons with middle/high incomes had the best 

rate for the one objective (13-6a) with statistically 

significant health disparities of 10% or more by 

income.

 Persons without disabilities had a better rate 

than persons with disabilities for the one 

objective (13-6a) with statistically significant 

health disparities of 10% or more by disability 

status.

 Several objectives exhibited health disparities 

of 100% or more, and some had changes in 

disparities of 50 percentage points or more 

over time. Many of these were discussed in the 

Highlights, above.

Transition to Healthy People 

2020

For Healthy People 2020, the focus of the HIV objectives 

has expanded to focus more on HIV testing among 

populations at increased risk of HIV infection. The 

general terminology has transitioned from the term 

HIV/AIDS to HIV. The term HIV focuses on persons 

diagnosed with HIV infection, regardless of their 

stage of disease. Nevertheless, AIDS diagnoses are still 

tracked for selected objectives. See HealthyPeople.gov

for a complete list of Healthy People 2020 topics and 

objectives.

The Healthy People 2020 HIV Topic Area objectives can 

be grouped into several sections:

〉 Diagnosis of HIV infection and AIDS

〉 Medical healthcare, survival, and death after 

diagnosis of HIV infection and AIDS

〉 HIV testing

〉 HIV prevention.

〉 The differences between the Healthy People 2010 

objectives and those included in Healthy People 2020 

are summarized below:

〉 The Healthy People 2020 HIV Topic Area has a 

total of 23 objectives, 7 of which are developmental, 

whereas the Healthy People 2010 HIV Focus Area had 

25 objectives of which 6 were developmental and 4 

were deleted at the Midcourse Review [5].

〉 Ten Healthy People 2010 objectives were retained “as 

is” [6]. These include:

 Eight measurable objectives: new AIDS cases 

(objective 13-1), AIDS among men who have 

sex with men (objective 13-2), AIDS among 

persons who inject drugs (objective 13-3), 

HIV counseling and education for persons in 

substance abuse treatment (objective 13-8), 

HIV testing in tuberculosis patients (objective 

13-11), HIV-infection deaths (objective 13-14), 

HIV infected persons surviving 3 or more years 

after a diagnosis of AIDS (objective 13-16), and 

perinatally acquired AIDS (objective 13-17b).

 Two developmental objectives: new HIV/AIDS cases 

(objective 13-5) and new HIV infections diagnosed 

before progression to AIDS (objective 13-15).

〉 Ten Healthy People 2010 objectives were modified to 

create five Healthy People 2020 objectives [7]:

 Two developmental and four measurable 

objectives addressing treatment according 

to guidelines among HIV-infected persons 

(objectives 13-13a through f) were combined to 

create one developmental objective in Healthy 

People 2020.

 Objective 13-7, measuring the number of HIVpositive persons who know their serostatus, was 

deleted at the Midcourse Review. It was reinstated 

in Healthy People 2020 as a measurable objective.

 Condom use among females and males (objectives 

13-6a and b, respectively) was modified to 

expand the age group of the target population 

from 18–44 to 15–44.

 Perinatally acquired HIV/AIDS diagnosed each 

year (objective 13-17a) was modified to monitor 

HIV only. This objective is still developmental.

〉 One Healthy People 2010 objective, AIDS among 

men who have sex with men and who inject drugs 

(objective 13-4), was archived [8].

〉 Three Healthy People 2010 objectives that were 

deleted at the Midcourse Review were not carried 

forward into Healthy People 2020. These include: 
13-6 HEALTHY PEOPLE 2010 FINAL REVIEW

HIV/AIDS, STD, and TB education in state prisons 

(objective 13-9), HIV counseling and testing in state 

prisons (objective 13-10), and screening for STDs and 

immunization for hepatitis B (objective 13-12). One 

developmental objective, HIV/AIDS diagnosed in 

adolescent and young females aged 13–24 (objective 

13-18), was removed during the Healthy People 2020 

planning process due to lack of a data source.

〉 Eight new objectives were added to the Healthy 

People 2020 HIV Topic Area:

 Five new objectives, including HIV transmission 

among adolescents and adults, new AIDS cases 

among adolescent and adult heterosexuals, 

HIV testing among adolescents and adults, HIV 

testing among pregnant women, and HIV testing 

among adolescents and young adults, were added 

as measurable objectives.

 Three new objectives, including new (incident) 

HIV infections among adolescents and adults, 

HIV testing among men who have sex with men, 

and the proportion of men who have sex with 

men who reported unprotected anal sex in the 

past 12 months, were added as developmental 

objectives.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

The HIV/AIDS Surveillance System—the data source for 

many Health People 2010 HIV objectives—was renamed 

the HIV Surveillance System in 2008, highlighting the 

focus on diagnosis of HIV infection regardless of the 

person’s stage of disease. Data in the HIV Surveillance 

System are continually updated, and new records are 

added as they are reported. For this reason, data for any 

given year may change over time. All data points for 

HIV objectives monitored through the HIV Surveillance 

System are updated annually, often resulting in revisions 

of baselines and targets.

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

〉 These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: 

General Data Issues, referenced below.

Beginning in 2003, education data for the mortality 

objective 13-14 (HIV-infection deaths) from the 

National Vital Statistics System have been suppressed. 

The educational attainment item was changed in the 

new U.S. Standard Certificate of Death in 2003 to be 

consistent with the Census Bureau data and to improve 

the ability to identify specific types of educational 

degrees. However, many states are still using the 1989 

version of the U.S. Standard Certificate of Death, which 

focuses on highest school grade completed. As a result, 

educational attainment data collected using the 2003 

version are not comparable with data collected using the 

1989 version [9].

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see 

http://www.cdc.gov/nchs/healthy_people/hp2010/

hp2010_data_issues.htm.
13 • HIV 13-7

References and Notes

1. Displayed in the Progress Chart (Figure 13-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 13-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 13-2). Disparity from the best group rate is 

defined as the percent difference between the best 

group rate and each of the other group rates for a 

characteristic. For example, racial and ethnic health 

disparities are measured as the percent difference 

between the best racial and ethnic group rate and 

each of the other racial and ethnic group rates. 

Similarly, disparities by sex are measured as the 

percent difference between the better group rate (e.g. 

female) and the rate for the other group (e.g. male). 

Some objectives are expressed in terms of favorable 

events or conditions that are to be increased, while 

others are expressed in terms of adverse events 

or conditions that are to be reduced. To facilitate 

comparison of health disparities across different 

objectives, disparity is measured only in terms of 

adverse events or conditions. For comparability 

across objectives, objectives that are expressed 

in terms of favorable events or conditions are reexpressed using the adverse event or condition for 

the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 13-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The presence of a monotonic increasing or decreasing 

trend in the underlying measure was tested with the 

nonparametric Mann-Kendall test; then the slope of 

a linear trend was estimated with the nonparametric 

Sen’s method. See Technical Appendix for more 

information.

4. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 13-2 footnotes, as well as 

the Technical Appendix, for more detail.

5. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

6. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

7. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

8. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.

9. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. 

Deaths: Final data for 2007. National vital statistics 

reports; vol 58 no 19. Hyattsville, MD: National Center 

for Health Statistics. 2010. Available from http://www.

cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf
13-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: HIV

Objective Description Data Source or Objective Status

13-1 New AIDS cases (per 100,000 population, 13+ years) HIV Surveillance System, CDC, NCHHSTP.

13-2 AIDS among men who have sex with men (no. new cases, 13+ 

years)

HIV Surveillance System, CDC, NCHHSTP.

13-3 AIDS among persons who inject drugs (no. new cases, 13+ years) HIV Surveillance System, CDC, NCHHSTP.

13-4 AIDS among men who have sex with men and who inject drugs 

(no. new cases, 13+ years)

HIV Surveillance System, CDC, NCHHSTP.

13-5 New HIV/AIDS cases diagnosed among adolescents and adults Developmental.

13-6a Condom use among sexually active unmarried persons 

(18–44 years)—Females

National Survey of Family Growth (NSFG), CDC, NCHS.

13-6b Condom use among sexually active unmarried persons 

(18–44 years)—Males

National Survey of Family Growth (NSFG), CDC, NCHS.

13-7 Knowledge of serostatus—Among HIV-positive persons Deleted at the Midcourse Review.

13-8 HIV counseling and education for persons in substance abuse 

treatment

Baseline data: Uniform Facility Data Set (UFDS), SAMHSA. 

Final data: National Survey of Substance Abuse Treatment 

Services (N-SSATS), SAMHSA.

13-9 HIV/AIDS, STD, and TB education in State prisons Deleted at the Midcourse Review.

13-10 HIV counseling and testing in State prisons Deleted at the Midcourse Review.

13-11 HIV testing in TB patients (25–44 years) National TB Surveillance System, CDC, NCHHSTP.

13-12 Screening for STDs and immunization for hepatitis B—

Among HIV counselees (18+ years)

Deleted at the Midcourse Review.

13-13a Treatment according to guidelines—Viral load testing among 

HIV-infected persons (13+ years)

Developmental.

13-13b Treatment according to guidelines—Tuberculin skin testing (TST) 

among HIV-infected persons (13+ years)

Developmental.

13-13c Any antiretroviral therapy among HIV-infected persons (13+ years) Adult and Adolescent Spectrum of HIV Disease (ASD) 

Surveillance Project, CDC, NCHHSTP.

13-13d Highly active antiretroviral therapy (HAART) among HIV-infected 

persons (13+ years)

Adult and Adolescent Spectrum of HIV Disease (ASD) 

Surveillance Project, CDC, NCHHSTP.

13-13e Pneumocystis carinii pneumonia (PCP) prophylaxis among 

HIV-infected persons (13+ years)

Adult and Adolescent Spectrum of HIV Disease (ASD) 

Surveillance Project, CDC, NCHHSTP.

13-13f Mycobacterium avium complex (MAC) prophylaxis among 

HIV-infected persons (13+ years)

Adult and Adolescent Spectrum of HIV Disease (ASD) 

Surveillance Project, CDC, NCHHSTP.

13-14 HIV-infection deaths (age adjusted, per 100,000 population) National Vital Statistics System—Mortality (NVSS-M), CDC, 

NCHS.

13-15 New HIV infection diagnosed before progression to AIDS Developmental.

13-16 HIV-infected persons surviving 3+ years after diagnosis of AIDS HIV Surveillance System, CDC, NCHHSTP.

13-17a Perinatally acquired HIV/AIDS diagnosed each year (no. new cases) Developmental.

13-17b Perinatally acquired AIDS (no. new cases) HIV Surveillance System, CDC, NCHHSTP.

13-18 HIV/AIDS diagnosed in adolescent and young females (13–24 years) Developmental.
13 • HIV 13-9

Figure 13-1. Progress Toward Target Attainment for Focus Area 13: HIV

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

13-1. New AIDS cases (per 100,000 population, 

13+ years)

21.7% 0.9 18.4

(1998)

14.6

(2007)

-3.8 Not tested -20.7%

13-2. AIDS among men who have sex with men 

(number of new cases, 13+ years)

12,661 16,882

(1998)

16,992

(2007)

110 Not tested 0.7%

13-3. AIDS among persons who inject drugs 

(number of new cases, 13+ years)

188.4% 8,636 11,514

(1998)

6,093

(2007)

-5,421 Not tested -47.1%

13-4. AIDS among men who have sex with men 

and who inject drugs (number of new 

cases, 13+ years)

144.4% 2,064 2,751

(1998)

1,759

(2007)

-992 Not tested -36.1%

13-6. Condom use among sexually active 

unmarried persons (18–44 years)

a. Females 37.0% 50% 23%

(1995)

33%

(2006–08)

10 Not tested 43.5%

b. Males 16.7% 54% 42%

(2002)

44%

(2006–08)

2 Not tested 4.8%

13-8. HIV counseling and education for persons 

in substance abuse treatment

70% 58%

(1997)

54%

(2008)

-4 Not tested -6.9%

13-11. HIV testing in TB patients (25–44 years) 42.9% 89% 61%

(1998)

73%

(2008)

12 Not tested 19.7%

13-13c. Any antiretroviral therapy among 

HIV-infected persons (13+ years)

95% 85%

(1997)

84%

(2003)

-1 Not tested -1.2%

13-13d. Highly active antiretroviral therapy (HAART) 

among HIV-infected persons (13+ years)

26.5% 95% 61%

(1997)

70%

(2003)

9 Not tested 14.8%

13-13e. Pneumocystis carinii pneumonia (PCP) 

prophylaxis among HIV-infected persons 

(13+ years)

95% 81%

(1997)

68%

(2003)

-13 Not tested -16.0%

13-13f. Mycobacterium avium complex (MAC) 

prophylaxis among HIV-infected persons 

(13+ years)

9.5% 95% 53%

(1997)

57%

(2003)

4 Not tested 7.5%

13-14. HIV-infection deaths (age adjusted, 

per 100,000 population)

34.8% 0.7 5.3

(1999)

3.7

(2007)

-1.6 Yes -30.2%

13-16. HIV-infected persons surviving 3+ years 

after a diagnosis of AIDS

125.0% 86% 78%

(1998)

88%

(2006)

10 Not tested 12.8%

13-17b. Perinatally acquired AIDS (number of 

new cases)

128.0% 75 243

(1998)

28

(2007)

-215 Not tested -88.5%

LEGEND Moved away from target1 Moved toward target Met or exceeded target
13-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 13-1. Progress Toward Target Attainment for Focus Area 13: HIV (continued)

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objective 13-5, 13-13a, 13-13b, 13-15, 13-17a, and 13-18. Objectives 13-7, 13-9, 13-10, and 13-12 were 

deleted at the Midcourse Review.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

DATA SOURCES

13-1–13-4. HIV Surveillance System, CDC, NCHHSTP.

13-6a–b. National Survey of Family Growth (NSFG), CDC, NCHS.

13-8. Baseline data: Uniform Facility Data Set (UFDS), SAMHSA. 

Final data: National Survey of Substance Abuse Treatment Services (N-SSATS), SAMHSA.

13-11. National TB Surveillance System, CDC, NCHHSTP.

13-13c–f. Adult and Adolescent Spectrum of HIV Disease (ASD) Surveillance Project, CDC, NCHHSTP.

13-14. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

13-16. HIV Surveillance System, CDC, NCHHSTP.

13-17b. HIV Surveillance System, CDC, NCHHSTP.

5 Final value – Baseline value Percent change = × 100.

Baseline value
13 • HIV 13-11

Figure 13-2. Health Disparities Table for Focus Area 13: HIV

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Income Location Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexUrban or metropolitanRural or nonmetropolitanPersons with disabilitiesPersons without disabilities

13-1. New AIDS cases (per 100,000 population, 13+ years) (1998, 2007)† 

 Bi 





















B 

13-6a. Condom use among sexually active 

unmarried persons—females (18–44 

years) (1995, 2006–08)1‡

 Bii   B B B Bii iii B

b. Condom use among sexually active 

unmarried persons—males (18–44 

years) (2002, 2006–08)1‡

 B    B   B Bii B

13-11. HIV testing in TB patients (25–44 years) 

(1998, 2008)† 

    B   B

13-13c. Any antiretroviral therapy among HIVinfected persons (13+ years) (1997, 

2003)†



 Bi Bii 











  B

13-13d. Highly active antiretroviral therapy 

(HAART) among HIV-infected persons 

(13+ years) (1997, 2003)†



 i Bii 





 

  B

13-13e. Pneumocystis carinii pneumonia (PCP) 

prophylaxis among HIV-infected persons 

(13+ years) (1997, 2003)†

Bii i 























Bii

13-13f. Mycobacterium avium complex (MAC) 

prophylaxis among HIV-infected persons 

(13+ years) (1997, 2003)†

 B   Bii

13-14. HIV-infection deaths (age adjusted, per 

100,000 population) (1999, 2007)2,3* 

 bi 







B B 





  B 

13-16. HIV-infected persons surviving 3+ 

years after a diagnosis of AIDS (1998, 

2006)†



 Bi   Bii  Bii B

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 13-2 

through 13-5, 13-8, 13-13a and b, 13-15, 13-17a and b, and 13-18. Objectives 13-7, 13-9, 13-10, and 13-12 were deleted at Midcourse Review.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.
13-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 13-2. Health Disparities Table for Focus Area 13: HIV (continued)

LEGEND

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. Nonetheless, 

disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix.

‡ Measures of variability were available only for the most recent data. Thus, the variability of best group rates was assessed only for the most recent data, and 

statistical significance was tested only for the most recent data. Disparities of 10% or more are displayed when the differences from the best group rate are 

statistically significant at the 0.05 level. Changes in disparities over time are displayed according to their magnitude, since measures of variability were not available 

at baseline and therefore statistical significance of changes in disparity could not be tested. See Technical Appendix.

1 Data by education level are for persons aged 25–44.

2 Data by education level are for persons aged 25–64. 

3 Most recent data by education level is for 2002. 

i

 Data are for Asian or Pacific Islander.

ii The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

iiiReliability criterion for best group rate not met, or data available for only one group, at baseline. Change in disparity cannot be assessed. See Technical Appendix.

DATA SOURCES

13-1. HIV Surveillance System, CDC, NCHHSTP.

13-6a–b. National Survey of Family Growth (NSFG), CDC, NCHS.

13-11. National TB Surveillance System, CDC, NCHHSTP.

13-13c–f. Adult and Adolescent Spectrum of HIV Disease (ASD) Surveillance Project, CDC, NCHHSTP.

13-14. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

13-16. HIV Surveillance System, CDC, NCHHSTP.
13 • HIV 13-13 Figure 13-3. New AIDS Cases (Age 13+), 2007 Healthy People 2010 objective 13-1 • Target = 0.9 per 100,000 NOTES: Rates are displayed by a Jenks classification for U.S. states. SOURCE: HIV Surveillance System, CDC, NCHHSTP. No state

Rate pe

District o= 154.6 
HEALTHY PEOPLE 2010 FINAL REVIEW 13-14Figure 13-4. HIV Infection Deaths, 2005–07 Healthy People 2010 objective 13-14 • Target = 0.7 per 100,000 NOTES: Data are for ICD-10 codes B20–B24 reported as underlying cause. Rates are age adjusted to the 2000 standard population and are displayed by a modified Jenks cla

SOURCE: National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS. Lowest 

states t

Rate p

District = 34.9 
Immunization 

and Infectious 

Diseases

CHAPTER 14

Lead Agency

Centers for Disease Control and Prevention

Contents

Goal ................................................................................................14-3

Highlights ......................................................................................14-3

Summary of Progress.....................................................................14-6

Transition to Healthy People 2020................................................14-7

Data Considerations.......................................................................14-9

Notes..............................................................................................14-9

Comprehensive Summary of Objectives......................................14-11

Progress Chart..............................................................................14-15

Health Disparities Table...............................................................14-21

Vaccination of Children 19–35 Months—3 Doses Hepatitis B 

(Hep B) Vaccine, 2008—Map...................................................14-25

Vaccination of Children 19–35 Months—1 Dose 

Measles-Mumps-Rubella (MMR) Vaccine, 2008—Map ..........14-26

Vaccination of Children 19–35 Months— 4 Doses 

Pneumococcal Conjugate Vaccine (PCV), 2008—Map ............14-27

14 • IMMUNIZATION AND INFECTIOUS DISEASES 14-3

GOAL:

Prevent disease, disability, and death from 

infectious diseases, including vaccinepreventable diseases.

The 87 objectives in this chapter cover five general areas 

in immunization and infectious diseases:

〉 Diseases preventable through universal vaccination. This area includes objectives monitoring 

progress in the reduction of vaccine-preventable 

diseases such as polio, pertussis, rubella, and 

hepatitis B.

〉 Diseases preventable through targeted vaccination. The objectives in this area address diseases 

affecting high-risk populations or certain endemic 

areas that can be prevented through targeted 

vaccination.

〉 Infectious diseases and emerging antimicrobial 

resistance. The objectives in this area focus on 

conditions such as tuberculosis and its treatment, 

hepatitis C, and hospital-acquired infections.

〉 Vaccine coverage and strategy. These objectives 

address immunization rates for children, adolescents, 

and adults.

〉 Vaccine safety. These objectives address the 

monitoring of adverse outcomes to vaccination.

All Healthy People 2010 tracking data quoted in 

this chapter, along with technical information and 

Operational Definitions for each objective, can be 

found in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in objectives for 

this Focus Area during the past decade [1]. Over 

80% of the Immunization and Infectious Diseases 

objectives with data to measure progress moved 

toward or achieved their Healthy People 2010 targets 

(Figure 14-1). However, health disparities of 10% or 

more were observed among select population groups 

(Figure 14-2), as highlighted below [2].

Diseases preventable through universal vaccination

Most of the objectives in this area moved toward or 

achieved the Healthy People 2010 targets.

〉 New cases of hepatitis B among children aged 2–18 

years (objective 14-1d) declined 92.9% between 1997 

and 2008, from 708 to 50 cases, moving toward the 

2010 target of 7 cases.

〉 Rubella cases (objective 14-1i) declined 97.3% between 

1998 and 2008, from 364 to 10 cases, moving toward 

the 2010 target of 0 cases. Similarly, cases of varicella 

(chicken pox) among persons under age 18 (objective 

14-1k) declined 73.7% between 1999 and 2008, from 

2,229,000 to 586,000 cases, moving toward the 2010 

target of 223,000 cases.

〉 The prevalence of hepatitis B in adults (objectives 

14-3a through g) declined for all age groups and highrisk groups. The number of hepatitis B cases among 

injection drug users (objective 14-3d) declined 80.3% 
14-4 HEALTHY PEOPLE 2010 FINAL REVIEW

between 1997 and 2008, from 7,135 to 1,408 cases, 

exceeding the 2010 target of 1,784 cases.

Hepatitis B—Persons aged 19–24 (objective 14-3a)

 Among racial and ethnic populations, the 

Hispanic or Latino population had the lowest 

(best) rate of hepatitis B for persons aged 19–24, 

1.4 cases per 100,000 population in 2008. The 

Asian or Pacific Islander, American Indian 

or Alaska Native, and non-Hispanic black 

populations had hepatitis B rates of 3.1, 5.1 and 

5.7 cases per 100,000, respectively. 

 The rate for the Asian or Pacific Islander 

population was more than twice the best 

group rate (that for the Hispanic or Latino 

population); the rate for the American Indian 

or Alaska Native population was more than 

three and a half times the best group rate; and 

the rate for the non-Hispanic black population 

was more than four times the best group rate 

[2].

 The non-Hispanic white population had the 

lowest (best) rate in 1997 (7.7 cases per 100,000 

population), whereas the Hispanic or Latino 

population had the lowest (best) rate in 2008 

(1.4 cases per 100,000). The rates for the Asian 

or Pacific Islander population were 33.7 cases 

per 100,000 in 1997 and 3.1 per 100,000 in 2008. 

Between 1997 and 2008, the disparity between 

the Asian or Pacific Islander population and the 

group with the best rate (non-Hispanic white 

in 1997; Hispanic or Latino in 2008) declined 

216 percentage points [3].

Hepatitis B—Persons aged 25–39 (objective 14-3b)

 The Asian or Pacific Islander population had the 

lowest (best) rate of hepatitis B for persons aged 

25–39, 2.7 cases per 100,000 population in 2008. 

The rate for the non-Hispanic white population, 

5.4 cases per 100,000, was twice the best group 

rate; the American Indian or Alaska Native 

population had a rate of 9.7 cases per 100,000, 

more than three and a half times the best group 

rate; and the rate for the non-Hispanic black 

population, 10.7 cases per 100,000, was about 

four times the best group rate [2].

Hepatitis B—Persons aged 40 and over (objective 

14-3c)

 The Asian or Pacific Islander population also had 

the lowest (best) rate of hepatitis B for persons 

aged 40 and over, 4.0 cases per 100,000 population 

in 2008. The American Indian or Alaska Native 

and non-Hispanic black populations had rates of 

10.3 and 13.2 cases per 100,000, respectively.

 The rate for the American Indian or Alaska 

Native population was more than two and 

a half times the best group rate (that for the 

Asian or Pacific Islander population), whereas 

the rate for the non-Hispanic black population 

was almost three and a half times the best 

group rate [2].

 Among persons aged 40 and over, the hepatitis 

B rate for males was twice the rate for females, 

9.5 and 4.6 cases per 100,000 population in 2008, 

respectively [2].

〉 The incidence of bacterial meningitis in young 

children aged 1–23 months (objective 14-4) declined 

34.6% between 1998 and 2008, from 13.0 to 8.5 cases 

per 100,000 population, exceeding the 2010 target of 

8.6 per 100,000.

〉 The incidence of invasive pneumococcal infections 

among young children and older adults (objective 

14-5a and b) declined between 1997 and 2008.

 Among children under age 5 years (objective 

14-5a), the incidence of invasive pneumococcal 

infections decreased 74.0% between 1997 and 

2008, from 77 to 20 new cases per 100,000 

population, exceeding the 2010 target of 46 per 

100,000.

 Among adults aged 65 and over (objective 14-

5b), the incidence of invasive pneumococcal 

infections decreased 33.9% between 1997 and 

2008, from 62 to 41 new cases per 100,000 

population, exceeding the 2010 target of 42 per 

100,000.

〉 The incidence of penicillin-resistant pneumococcal 

infections among young children under age 5 years 

(objective 14-5c) declined 56.3% between 1997 and 

2008, from 16 to 7 new cases per 100,000, moving 

toward the 2010 target of 6 per 100,000.

Diseases preventable through targeted vaccination

Two objectives in this area exceeded their Healthy 

People 2010 targets.

〉 The incidence of hepatitis A (objective 14-6) declined 

92.0% between 1997 and 2008, from 11.2 to 0.9 new 

cases per 100,000 population, exceeding the Healthy 

People 2010 target of 4.3 per 100,000.

 Among racial and ethnic groups, the nonHispanic black population had the lowest (best) 

rate of hepatitis A, 0.4 new cases per 100,000 

population in 2008. The rate for the Asian or 

Pacific Islander population was 1.3 new cases per 

100,000, almost three and a half times the best 

group rate [2]. The rate for Hispanic or Latino 

population was 1.0 new cases per 100,000, two 

and a half times the best group rate.

 The Asian or Pacific Islander population had the 

lowest (best) group rate in 1997 (4.4 new cases 
14 • IMMUNIZATION AND INFECTIOUS DISEASES 14-5

per 100,000), whereas the non-Hispanic black 

population had the lowest (best) group rate in 

2008 (0.4 per 100,000). The Hispanic or Latino 

population had rates of 23.4 per 100,000 in 1997 

and 1.0 per 100,000 in 2008. Between 1997 and 

2008, the disparity between the Hispanic or 

Latino population and the group with the best 

rate (Asian or Pacific Islander in 1997; nonHispanic black in 2008) declined 282 percentage 

points [3].

〉 The incidence of meningococcal disease (objective 

14-7) declined 69.2% between 1997 and 2008, from 1.3 

to 0.4 new cases per 100,000 population, exceeding 

the Healthy People 2010 target of 1.0 per 100,000.

Infectious diseases and emerging antimicrobial 

resistance

Many objectives in this area moved toward their 2010 

targets over the past decade.

〉 The following objectives exceeded the Healthy People 

2010 targets:

 The incidence of hepatitis C (objective 14-9) 

decreased 88.0% between 1997 and 2007, from 

2.5 to 0.3 new cases per 100,000 population, 

exceeding the target of 1.0.

 Treatment for high-risk persons with latent 

tuberculosis infection (objective 14-13) increased 

51.1% between 2000 and 2007, from 45% to 68%, 

exceeding the target of 57%.

 Invasive early onset group B streptococcal 

disease (objective 14-16) declined 70.0% between 

1996 and 2008, from 1.0 to 0.3 cases per 1,000 live 

births, exceeding the target of 0.5.

 Peptic ulcer hospitalizations (objective 14-17) 

decreased 39.4% between 1998 and 2007, from 

71 to 43 hospitalizations per 100,000 population 

(age adjusted), exceeding the target of 46.

 Antibiotics prescribed for ear infections in 

children under age 5 years (objective 14-18) 

declined 29.0% from 1996–97 to 2006–07, from 69 

to 49 courses per 100 population, exceeding the 

target of 56.

 Hospital-acquired infections among adult and 

infant intensive care patients (objectives 14-20a 

through e) declined for all categories, exceeding 

the 2010 targets.

〉 The incidence of tuberculosis (TB; objective 14-11) 

decreased 36.4% between 1998 and 2008, from 6.6 to 

4.2 new cases per 100,000 population, moving toward 

the 2010 target of 1.0 per 100,000.

 Among racial and ethnic groups, the nonHispanic white population had the lowest 

(best) rates of new TB cases, 1.5 per 100,000 

population in 1998 and 1.1 per 100,000 in 2008. 

All other racial and ethnic populations with 

data to measure disparity had rates that were at 

least 100% as high as the best rate [2]. The rates 

for the Hispanic or Latino population were 12.6 

new cases per 100,000 population in 1998 and 8.1 

per 100,000 in 2008. Between 1998 and 2008, the 

disparity between the Hispanic or Latino and the 

non-Hispanic white populations increased 189 

percentage points [3].

Vaccination coverage and strategy

Many of the vaccination coverage objectives either 

achieved or made substantial progress toward their 

Healthy People 2010 targets.

〉 Targets for the vaccination of children aged 

19–35 months were exceeded for the Haemophilus 

influenzae type b (Hib), hepatitis B (Hep B), 

measles-mumps-rubella (MMR), polio, and varicella 

vaccines (objectives 14-22b through f, respectively). 

Vaccination rates for pneumococcal conjugate 

vaccine (PCV) (objective 14-22g) increased 300.0% 

between 2002 and 2008, from 20% to 80%, moving 

toward the 2010 target of 90%.

〉 All but three states (Montana, Nevada, and 

Washington) had achieved the 90% target for Hep B 

vaccination (objective 14-22c) in 2008 (Figure 14-3). 

〉 Thirty-eight states had achieved the 90% target for 

MMR vaccination. MMR vaccination rates for the 

rest of the U.S. were above 85% (Figure 14-4).

〉 Vaccination rates for PCV, one of the newest vaccines, 

still varied among states. Only Connecticut achieved 

the 90% target for PCV (objective 14-22g) in 2008. 

The rates were lowest, at or below 70%, in Nevada, 

Oklahoma, and Wyoming (Figure 14-5).

〉 The vaccination targets for children in day care 

(objective 14-23) were met for diphtheria-tetanusacellular pertussis (DTap), MMR, polio, and Hib 

vaccines (objectives 14-23a, b, c, and l, respectively).

〉 The proportion of private providers who measured 

childhood vaccine coverage levels (objective 14-25b) 

tripled between 1999 and 2009, from 11% to 33%, 

moving toward the 2010 target of 55%.

〉 The percentage of children under age 6 years who 

participated in population-based immunization 

registries (objective 14-26) increased 257.1% between 

1999 and 2008, from 21% to 75%, exceeding the 2010 

target of 62%.

〉 Targets for the vaccination of adolescents aged 

13–15 were exceeded for Hep B and MMR vaccines 

(objective 14-27a and b, respectively). The proportion 
14-6 HEALTHY PEOPLE 2010 FINAL REVIEW

of adolescents in this age group who received a 

varicella vaccination (objective 14-27d) increased 

91.1% between 1997 and 2008, from 45% to 86%, 

moving toward the 2010 target of 90%. However, the 

receipt of a tetanus-diphtheria (Td) booster (objective 

14-27c) decreased 23.7% between 1997 and 2008, 

from 93% to 71%, moving away from the target. The 

combined tetanus, diptheria, and pertussis vaccine 

(Tdap) was introduced in 2006, leading to the decline 

in Td administration. However, overall tetanus 

booster vaccination (either through Td or Tdap) had 

been increasing over time.

Vaccine safety

〉 One objective in this area, the proportion of vaccine 

adverse event reports (VAERS) that were submitted 

electronically (objective 14-31b) increased 112.5% 

between 2003 and 2009, from 16% to 34%, exceeding 

the 2010 target of 30%.

Summary of Progress

〉 Figure 14-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for Immunization and Infectious 

Diseases [1]. Data to measure progress toward target 

attainment were available for 80 objectives. Of these:

 Thirty-three objectives met or exceeded the 

Healthy People 2010 targets (objectives 14-1a, b, 

and h; 14-3d; 14-4; 14-5a and b; 14-6; 14-7; 14-9; 14-

13; 14-16 through 14-18; 14-20a through e; 14-22b 

through f; 14-23a through c, and l; 14-26; 14-27a 

and b; 14-30a; and 14-31b).

 Thirty-two objectives moved toward their targets. 

A statistically significant difference between the 

baseline and the final data points was observed 

for eight of these objectives (14-1k, 14-19, 14-24a, 

14-27d, and 14-29a through d). No significant 

difference was observed for one objective (14-22a); 

and data to test the significance of the difference 

were unavailable for 23 objectives (14-1d, f, i, and 

j; 14-2; 14-3a, through c, and e through g; 14-5c; 

14-10 through 14-12; 14-22g; 14-25b; 14-28a and b; 

14-29f and g; 14-30b; and 14-31a).

 One objective (14-25a) showed no change.

 Fourteen objectives moved away from their 

targets. A statistically significant difference 

between the baseline and final data points was 

observed for one objective (14-27c). Data to test 

the significance of the difference were unavailable 

for 13 objectives (14-1c, e, and g; 14-5d; 14-8; 14-21; 

14-23f through j; 14-28c; and 14-29e).

〉 Two objectives (14-22h and 14-24b) remained developmental and four objectives (14-14; and 14-23d, 

e, and k) had no follow-up data available to measure 

progress [4]. One objective (14-15) was deleted at the 

Midcourse Review.

〉 Figure 14-2 displays health disparities in 

Immunization and Infectious Diseases from the best 

group rate for each characteristic at the most recent 

data point [2]. It also displays changes in disparities 

from baseline to the most recent data point [3].

 Ten objectives had statistically significant racial 

and ethnic health disparities of 10% or more. An 

additional 11 objectives had racial and ethnic 

health disparities of 10% or more but lacked data 

to test significance. Of these 21 objectives, the 

non-Hispanic white population had the unique 

best rate for eight objectives (14-11; 14-22g; 14-27d; 

and 14-29a, b, and e through g), while the white 

population (including persons of Hispanic origin) 

had the best rate for five objectives (14-5a through 

c, 14-7, and 14-16). The Asian or Pacific Islander 

(objectives 14-3b and c), Hispanic or Latino 

(objectives 14-3a and 14-22f), and non-Hispanic 

black (objectives 14-6 and 14-12) populations 

had the only unique rate for two objectives each. 

Persons of two or more races had the best group 

rate for one objective (14-24a). The Hispanic or 

Latino and non-Hispanic white populations both 

had the best rate for one objective (14-24a).

 Five objectives had statistically significant 

health disparities of 10% or more by sex. Eleven 

additional objectives had health disparities 

of 10% or more by sex, but lacked data to test 

significance. Females had the better rates for 15 

of these 16 objectives (14-3a through c; 14-4; 14-

5a, c, and d; 14-6; 14-8; 14-11; 14-12; 14-18; 14-22d; 

and 14-29b and c). Males had the better rate for 

the remaining objective (14-27a).

 Persons with at least some college education had 

the best rates for all four objectives (14-29a through 

c, and g) with statistically significant health 

disparities of 10% or more by education level.

 Persons living in an urban or metropolitan area 

had better rates than persons living in rural or 

nonmetropolitan areas for all three objectives 

(14-27a, c, and d) with statistically significant 

health disparities of 10% or more by geographic 

location.

 Persons with disabilities had better rates than 

persons without disabilities for four of the five 

objectives (14-29a through d) with statistically 

significant health disparities of 10% or more 

by disability status, whereas persons without 

disabilities had the better rate for the remaining 

objective (14-29e).
14 • IMMUNIZATION AND INFECTIOUS DISEASES 14-7

 Racial and ethnic health disparities of 100% 

or more, as well as changes in disparities of 

100 percentage points or more over time, were 

observed for several objectives. Most of these 

were discussed in the Highlights, above.

Transition to Healthy People 

2020

For Healthy People 2020, the focus of the Immunization 

and Infectious Diseases Topic Area was expanded to 

include vaccinations against seasonal influenza in more 

defined segments of the population. Also, the Healthy 

People 2010 objectives were modified to better address 

healthcare-associated infections. See HealthyPeople.

gov for a complete list of Healthy People 2020 topics and 

objectives.

The Healthy People 2020 Immunization and Infectious 

Diseases Topic Area objectives can be grouped into 

several sections:

〉 Diseases preventable through universal vaccination

〉 Diseases preventable through targeted vaccination

〉 Infectious diseases and emerging antimicrobial 

resistance

〉 Vaccination coverage and strategies

〉 Surveillance and monitoring.

The differences between the Healthy People 2010 and 

Healthy People 2020 objectives are summarized below:

〉 The Healthy People 2020 Immunization and 

Infectious Disease Topic Area has a total of 77 

objectives, five of which are developmental, whereas 

the Healthy People 2010 Immunization and Infectious 

Disease Focus Area had 87 objectives, of which two 

were developmental.

〉 Twenty-nine Healthy People 2010 objectives were 

retained “as is” [5].

 Diseases preventable through universal 

vaccination. Nine objectives were retained, 

including: congenital rubella syndrome (CRS) 

(objective 14-1a), measles (objective 14-1e), 

mumps (objective 14-1f), polio wild-type virus 

(objective 14-1h), rubella (objective 14-1i), 

varicella (objective 14-1k), chronic hepatitis B 

perinatal infections (objective 14-2), new invasive 

pneumococcal infections in children under 

age 5 years (objective 14-5a), and new invasive 

pneumococcal infections in persons aged 65 and 

over (objective 14-5b).

 Diseases preventable through targeted 

vaccination. The two retained objectives in this 

category are new hepatitis A cases (objective 

14-6) and new meningococcal disease cases 

(objective 14-7).

 Infectious diseases and emerging antimicrobial resistance. The following six 

objectives were retained: new tuberculosis 

(TB) cases (objective 14-11), curative therapy 

for TB (objective 14-12), treatment for latent TB 

(objective 14-13), group B streptococcal disease 

among newborns (objective 14-16), antibiotic 

misuse for ear infections (objective 14-18), and 

antibiotic misuse for common cold (objective 

14-19).

 Vaccination coverage and strategies. Twelve 

objectives were retained:

 Six childhood vaccination objectives: 4 doses 

diphteria tetanus-acellular pertussis (DTaP) 

(objective 14-22a), 3 doses hepatitis B (Hep B) 

(objective 14-22c), 1 dose measles-mumpsrubella (MMR) (objective 14-22d), 3 doses polio 

(objective 14-22e), 1 dose varicella (objective 

14-22f), and 4 doses pneumococcael conjugate 

vaccine (PCV) (objective 14-22g)

 Public health and private providers who 

measure childhood vaccination coverage levels 

(objectives 14-25a and b)

 Population-based immunization registries for 

children under age 6 years (objective 14-26)

 Hep B vaccination among occupationally 

exposed workers (objective 14-28c); pneumococcal vaccination among noninstitutionalized 

adults aged 65 and over (objective 14-29b); 

and pneumococcal vaccination among noninstitutionalized high-risk adults aged 18–64 

(objective 14-29d).

〉 Thirty Healthy People 2010 objectives were modified 

to created 28 Healthy People 2020 objectives [6].

 Diseases preventable through universal 

vaccination. Ten objectives were modified:

 Haemophilus influenzae type b (Hib) among 

children under age 5 years (objective 14-1c) 

and new hepatitis B cases among persons aged 

2–18 years (objective 14-1d) were modified due 

to new measurement units. 

 The target population for pertussis (objective 

14-1g) was changed from children under age 7 

years in Healthy People 2010 to children under 

age 1 year in Healthy People 2020. 

 Three hepatitis B infection objectives among 

high-risk adults aged 19–24, 25–39, and 40 

and over (objectives 14-3a through c) were 

consolidated into one objective for adults aged 

19 and over. 
14-8 HEALTHY PEOPLE 2010 FINAL REVIEW

 Hepatitis B infection among injection drug 

users and men who have sex with men 

(objectives 14-3d and f) were modified because 

of changes in the case definition.

 Invasive penicillin-resistant pneumococcal 

infections among children under age 5 years 

and adults aged 65 and over (objectives 14-5c 

and d) were modified because of changes in the 

case definition.

 Infectious diseases and emerging antimicrobial resistance. Two objectives were 

modified: the data source for hepatitis C 

(objective 14-9) was changed, and timely 

laboratory confirmation of tuberculosis cases 

(objective 14-14) was modified due to a change in 

the measurement unit and the data source.

 Vaccination coverage and strategies. Seventeen objectives were modified:

 Vaccination with 3 doses Hib (objective 14-

22b) was modified due to a change in the data 

collection method.

 The dosage for influenza vaccination among 

children aged 6–23 months (objective 14-22h) 

was modified from 1 dose for the developmental 

Healthy People 2010 objective to 1–2 doses, 

depending on age appropriateness, for the 

measurable Healthy People 2020 objective.

 All five vaccination objectives for kindergarten 

(DTaP, MMR, polio, Hep B, and varicella; 

objectives 14-23f through j, respectively) were 

modified to exclude children in licensed day 

care settings.

 Complete vaccination coverage among 

children (objective 14-24a) was updated to 

be consistent with the current guidelines 

established by the Advisory Committee for 

Immunization Practices. The revised series 

reflects a recommendation of: at least 4 doses 

DTaP, at least 3 doses polio, at least 1 dose 

MMR, at least 3 or 4 doses Hib (depending on 

vaccine brand), at least 3 doses Hep B, at least 1 

dose varicella, and at least 4 doses PCV.

 Among teens aged 13–15, the tetanus and 

diphtheria (Td) booster (objective 14-27c) was 

changed to the combined tetanus-diphtheriaacellular-pertussis (Tdap) booster, and the 

dosage was changed for the varicella vaccine 

from 1 or more (objective 14-27d) to 2 doses.

 Two Hep B vaccination objectives among highrisk adults including long-term hemodialysis 

patients and men who have sex with men 

(objectives 14-28a and b) were reverted to 

developmental status [4].

 The data source for influenza and pneumococcal vaccination among institutionalized 

adults (objective 14-29f) was changed in 

Healthy People 2020. All four influenza 

vaccination objectives (14-29a, c, e, and g) were 

modified to conform to a new definition of 

seasonal flu.

 Vaccine Safety. Active surveillance for vaccine 

safety via large linked databases (objective 

14-31a) was modified to address the scientific 

knowledge on vaccine safety and adverse events. 

This objective is developmental in Healthy People 

2020. 

〉 Twenty-five Healthy People 2010 objectives were 

archived [7].

 Diseases preventable through universal vaccination. Five objectives were archived: 

diphtheria (objective 14-1b) and tetanus (objective 

14-1j) among persons under age 35, hepatitis B 

among heterosexually active persons (objective 

14-3e), hepatitis B among occupationally 

exposed workers (objective 14-3g), and bacterial 

meningitis in young children (objective 14-4).

 Diseases preventable through targeted vaccination. One objective (14-8), Lyme disease, 

was archived because it was dependent on the 

availability of the vaccine for Lyme disease, which 

was pulled off the market by the manufacturer.

 Infectious diseases and emerging antimicrobial resistance. Seven objectives were 

archived due to changes in program priorities: 

identification of persons with chronic hepatitis C 

(objective 14-10); hospitalizations for peptic ulcer 

(objective 14-17); four hospital intensive care 

unit-acquired infections objectives (objectives 

14-20a, and c through e); and antimicrobial use 

in intensive care unit (objective 14-21).

 Vaccination coverage and strategies. Seven 

vaccination (DTaP, MMR, polio, Hep B, varicella, 

PCV, and Hib) objectives for day care (objectives 

14-23a through e, and 14-23k and l) were archived 

due to lack of a data source; and two vaccination 

objectives for teens (Hep B and MMR, objectives 

14-27a and b) were archived.

 Vaccine safety. Three objectives were archived: 

vaccine-associated paralytic polio (objective 

14-30a), febrile seizures following pertussis 

vaccines (objective 14-30b), and the number of 

vaccine adverse event reports (VAERS) that are 

submitted electronically (objective 14-31b).

〉 The Healthy People 2010 objective on prevention 

services for international travelers (objective 14-15) 

was deleted at the Midcourse Review due to lack 

of a data source. The objective intended to track 

adolescents aged 13–15 years who received the 

recommended vaccines (objective 14-24b), which 

remained developmental, was removed during the 

Healthy People 2020 planning process, also due to 

lack of a data source.
14 • IMMUNIZATION AND INFECTIOUS DISEASES 14-9

〉 Twenty new objectives were added to the Healthy 

People 2020 Immunization and Infectious Diseases 

Topic Area:

 Diseases preventable through universal 

vaccination. One objective, pertussis among 

adolescents, was added.

 Vaccination coverage and strategies. Fifteen 

new objectives were added to this section: 2 

doses hepatitis A vaccine, 1 birth dose Hep 

B vaccine, 2 or 3 doses rotavirus vaccine, 1 

dose meningococcal vaccine (MCV) among 

adolescents, 3 doses human papillomavirus 

vaccine (HPV) among female adolescents, 

five influenza (flu) vaccine objectives, zoster 

(shingles) vaccination, Hep B vaccination among 

injection drug users (developmental), the number 

of states collecting kindergarten vaccination 

records using minimum standards, and State 

participation in the Immunization Information 

System for adolescent vaccination. An objective 

that measures zero doses of vaccine among 

children aged 19–35 months was also added.

 Infectious diseases and emerging antimicrobial resistance. Four new objectives 

were added: electronic surveillance of rabies, 

influenza-virus resistance to antiviral agents, 

awareness of hepatitis C infection status and 

hepatitis B testing within minority communities 

experiencing health disparities (developmental).

〉 One objective, central line-associated bloodstream 

infection among intensive care unit patients 

(objective 14-20b), was moved to the HealthcareAssociated Infections Topic Area.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

The data source used to track the four vaccination 

coverage objectives among adolescents, (objectives 14-

27a through d) was the National Health Interview Survey 

for data years between 1997 and 2003. Starting in 2006, 

the data source was the newly implemented National 

Immunization Survey—Teen (NIS-Teen).

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, (DATA2010), 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see 

http://www.cdc.gov/nchs/healthy_people/hp2010/

hp2010_data_issues.htm.

Notes

1. Displayed in the Progress Chart (Figure 14-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 
14-10 HEALTHY PEOPLE 2010 FINAL REVIEW

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 14-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 14-2). Disparity from the best group rate 

is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 14-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 14-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

5. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy 

People 2010 and are developmental in Healthy People 

2020, and for which no numerator information is 

available.

6. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

7. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.
14 • IMMUNIZATION AND INFECTIOUS DISEASES 14-11

Comprehensive Summary of Objectives: Immunization and Infectious 

Diseases

Objective Description Data Source or Objective Status

14-1a Vaccine-preventable diseases—Congenital rubella syndrome (no. 

cases, <1 year)

National Congenital Rubella Syndrome Registry (NCRSR), CDC, NCIRD.

14-1b Vaccine-preventable diseases—Diphtheria (no. cases, <35 years) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-1c Vaccine-preventable diseases—Haemophilus influenzae type b 

(Hib)and unknown (no. cases, <5 years)

National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI; 

Active Bacterial Core Surveillance (ABCs), CDC, NCIRD.

14-1d Vaccine-preventable diseases—Hepatitis B (no. cases, 2–18 years) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-1e Vaccine-preventable diseases—Measles (no. cases) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-1f Vaccine-preventable diseases—Mumps (no. cases) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-1g Vaccine-preventable diseases—Pertussis (no. cases, <7 years) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-1h Vaccine-preventable diseases—Polio (wild-type virus) (no. cases) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-1i Vaccine-preventable diseases—Rubella (no. cases) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-1j Vaccine-preventable diseases—Tetanus (no. cases, <35 years) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-1k Vaccine-preventable diseases—Varicella (chicken pox) (no. cases 

in thousands, <18 years)

National Health Interview Survey (NHIS), CDC, NCHS.

14-2 Perinatal hepatitis B infections in infants and young children (no. 

cases, 1–24 months)

Perinatal Hepatitis B Prevention Program, CDC, NCHHSTP; National Vital 

Statistics System—Natality (NVSS-N), CDC, NCHS.

14-3a Hepatitis B in adults 19–24 years (cases per 100,000) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-3b Hepatitis B in adults 25–39 years (cases per 100,000) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-3c Hepatitis B in adults 40+ years (cases per 100,000) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-3d Hepatitis B in injection drug users (no. cases) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-3e Hepatitis B in heterosexually active persons (no. cases) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-3f Hepatitis B in men who have sex with men (no. cases) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-3g Hepatitis B in occupationally exposed workers (no. cases) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-4 Bacterial meningitis in young children (new cases per 100,000 

population, 1–23 months)

Active Bacterial Core Surveillance (ABCs), CDC, NCIRD.

14-5a Invasive pneumococcal infections—Children (new cases per 

100,000 population, <5 years)

Active Bacterial Core Surveillance (ABCs), CDC, NCIRD.

14-5b Invasive pneumococcal infections—Adults (new cases per 

100,000 population, 65+ years)

Active Bacterial Core Surveillance (ABCs), CDC, NCIRD.

14-5c Penicillin-resistant invasive pneumococcal infections—Children 

(new cases per 100,000 population, <5 years)

Active Bacterial Core Surveillance (ABCs), CDC, NCIRD.

14-5d Penicillin-resistant invasive pneumococcal infections—Adults (new 

cases per 100,000 population, 65+ years)

Active Bacterial Core Surveillance (ABCs), CDC, NCIRD.

14-6 Hepatitis A (new cases per 100,000 population) National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-7 Meningococcal disease (new cases per 100,000 population) Active Bacterial Core Surveillance (ABCs), CDC, NCIRD; National 

Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.
14-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Immunization and Infectious Diseases (continued)

Objective Description Data Source or Objective Status

14-8 Lyme disease in endemic States (new cases per 100,000 

population)

National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-9 Hepatitis C (new cases per 100,000 population) Sentinel Counties Study of Viral Hepatitis, CDC, NCHHSTP.

14-10 States reporting chronic hepatitis C infection (no. States) State health department databases of persons with HCV infection; 

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

14-11 Tuberculosis (new cases per 100,000 population) National TB Surveillance System, CDC, NCHHSTP.

14-12 Curative therapy for tuberculosis National TB Surveillance System, CDC, NCHHSTP.

14-13 Treatment for high-risk persons with latent tuberculosis infection Aggregate Reports for Tuberculosis Program Evaluation, CDC, NCHHSTP.

14-14 Timely laboratory confirmation of tuberculosis cases—Average 

number of days to report 75% of cases

Survey of State Public Health Laboratories, CDC, NCHSTP.

14-15 Prevention services for international travelers Deleted at the Midcourse Review.

14-16 Invasive early onset group B streptococcal disease (per 1,000 live 

births)

National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI; 

Active Bacterial Core Surveillance (ABCs), CDC, NCIRD.

14-17 Peptic ulcer hospitalizations (age adjusted, per 100,000 population) National Hospital Discharge Survey (NHDS), CDC, NCHS.

14-18 Antibiotics prescribed for ear infections in children (courses 

prescribed per 100 population, <5 years)

National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS; National 

Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

14-19 Antibiotics prescribed for common cold (courses prescribed per 

100,000 population)

National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS; National 

Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

14-20a Hospital-acquired infections among adult intensive care patients—

Catheter-associated urinary tract infection (per 1,000 days use)

Baseline data: National Noscomial Infections Surveillance System (NNIS), 

CDC, NCPDCID.

Final data: National Healthcare Safety Network (NHSN), CDC, NCPDCID.

14-20b Hospital-acquired infections among adult intensive care patients—

Central line-associated bloodstream infection (per 1,000 days use)

Baseline data: National Noscomial Infections Surveillance System (NNIS), 

CDC, NCPDCID.

Final data: National Healthcare Safety Network (NHSN), CDC, NCPDCID.

14-20c Hospital-acquired infections among adult intensive care patients—

Ventilator-associated pneumonia (per 1,000 days use)

Baseline data: National Noscomial Infections Surveillance System (NNIS), 

CDC, NCPDCID.

Final data: National Healthcare Safety Network (NHSN), CDC, NCPDCID.

14-20d Hospital-acquired infections among infants in intensive care 

weighing ≤1,000 grams at birth—Central line-associated 

bloodstream infection (per 1,000 days use)

Baseline data: National Noscomial Infections Surveillance System (NNIS), 

CDC, NCPDCID. 

Final data: National Healthcare Safety Network (NHSN), CDC, NCPDCID.

14-20e Hospital-acquired infections among infants in intensive care 

weighing ≤1,000 grams at birth—Ventilator-associated pneumonia 

(per 1,000 days use)

Baseline data: National Noscomial Infections Surveillance System (NNIS), 

CDC, NCPDCID.

Final data: National Healthcare Safety Network (NHSN), CDC, NCPDCID.

14-21 Antimicrobial use in intensive care units (daily doses per 1,000 

patient days)

National Noscomial Infections Surveillance System (NNIS), CDC, 

NCPDCID.

14-22a Vaccination of children 19–35 months—4 doses diphtheriatetanus-acellular pertussis (DTaP) vaccineNational Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

14-22b Vaccination of children 19–35 months—3 doses Haemophilus 

influenzae type b (Hib) vaccine

National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

14-22c Vaccination of children 19–35 months—3 doses hepatitis B (Hep 

B) vaccine

National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

14-22d Vaccination of children 19–35 months—1 dose measles-mumpsrubella (MMR) vaccineNational Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.
14 • IMMUNIZATION AND INFECTIOUS DISEASES 14-13

Comprehensive Summary of Objectives: Immunization and Infectious Diseases (continued)

Objective Description Data Source or Objective Status

14-22e Vaccination of children 19–35 months—3 doses polio vaccine National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

14-22f Vaccination of children 19–35 months—1 dose varicella vaccine National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

14-22g Vaccination of children 19–35 months—4 doses pneumococcal 

conjugate vaccine (PCV)

National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

14-22h Vaccination of children 6–23 months—1 dose influenza vaccine Developmental.

14-23a Vaccine coverage of children in day care—Diphtheria-tetanusacellular pertussis (DTaP) vaccineAnnual Immunization Assessment Reports, CDC, NCIRD.

14-23b Vaccine coverage of children in day care—Measles-mumps-rubella 

(MMR) vaccine

Annual Immunization Assessment Reports, CDC, NCIRD.

14-23c Vaccine coverage of children in day care—Polio vaccine Annual Immunization Assessment Reports, CDC, NCIRD.

14-23d Vaccine coverage of children in day care—Hepatitis B (Hep B) 

vaccine

Day Care and Head Start Assessment Reports, CDC, NCIRD.

14-23e Vaccine coverage of children in day care—Varicella vaccine Day Care and Head Start Assessment Reports, CDC, NCIRD.

14-23f Vaccine coverage of children in kindergarten—Diphtheria-tetanusacellular pertussis (DTaP) vaccineSchool Immunization Assessment Survey, CDC, NCIRD.

14-23g Vaccine coverage of children in kindergarten—Measles-mumpsrubella (MMR) vaccineSchool Immunization Assessment Survey, CDC, NCIRD.

14-23h Vaccine coverage of children in kindergarten—Polio vaccine School Immunization Assessment Survey, CDC, NCIRD.

14-23i Vaccine coverage of children in kindergarten—Hepatitis B (Hep B) 

vaccine

School Immunization Assessment Survey, CDC, NCIRD.

14-23j Vaccine coverage of children in kindergarten—Varicella vaccine School Immunization Assessment Survey, CDC, NCIRD.

14-23k Vaccine coverage of children in daycare—Pneumococcal conjugate 

vaccine (PCV)

Day Care and Head Start Assessment Reports, CDC, NCIRD.

14-23l Vaccine coverage of children in licensed daycare facilities—

Haemophilus influenzae type b (Hib) vaccine 

Day Care and Head Start Assessment Program, CDC, NCIRD.

14-24a Fully immunized young children 19–35 months National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

14-24b Fully immunized young children and adolescents 13–15 years Developmental.

14-25a Providers who measure childhood vaccination coverage levels—

Public health providers

Annual Immunization Assessment Reports, CDC, NCIRD.

14-25b Providers who measure childhood vaccination coverage levels—

Private providers

Annual Immunization Assessment Reports, CDC, NCIRD.

14-26 Children <6 years participating in population-based immunization 

registries

Annual Immunization Assessment Reports, CDC, NCIRD.

14-27a Vaccination coverage among adolescents 13–15 years—3+ doses 

hepatitis B (Hep B) vaccine

Baseline data: National Health Interview Survey (NHIS), CDC, NCHS. 

Final data: National Immunization Survey—Teen (NIS–Teen): CDC, 

NCIRD; CDC, NCHS.

14-27b Vaccination coverage among adolescents 13–15 years—2+ doses 

measles-mumps-rubella (MMR) vaccine

Baseline data: National Health Interview Survey (NHIS), CDC, NCHS. 

Final data: National Immunization Survey—Teen (NIS–Teen): CDC, 

NCIRD; CDC, NCHS.

14-27c Vaccination coverage among adolescents 13–15 years—1+ doses 

tetanus-diptheria (Td) booster

Baseline data: National Health Interview Survey (NHIS), CDC, NCHS. 

Final data: National Immunization Survey—Teen (NIS–Teen); CDC, 

NCIRD; CDC, NCHS.
14-14 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Immunization and Infectious Diseases (continued)

Objective Description Data Source or Objective Status

14-27d Vaccination coverage among adolescents 13–15 years—1+ doses 

varicella (excluding adolescents who have had varicella)

Baseline data: National Health Interview Survey (NHIS), CDC, NCHS. 

Final data: National Immunization Survey—Teen (NIS–Teen): CDC, 

NCIRD; CDC, NCHS.

14-28a Hepatitis B (Hep B) vaccination among high-risk groups—Longterm hemodialysis patientsAnnual Survey of Chronic Hemodialysis Centers: CDC, NCHHSTP; CMS.

14-28b Hepatitis B (Hep B) vaccination among high-risk groups—Men who 

have sex with men

Young Men's Survey, CDC, NCHHSTP.

14-28c Hepatitis B (Hep B) vaccination among high-risk groups—

Occupationally exposed workers

Periodic vaccine coverage surveys, CDC, NCPDCID.

14-29a Vaccination of noninstitutionalized high-risk older adults—Influenza 

vaccine in past 12 months (age adjusted, 65+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

14-29b Vaccination of noninstitutionalized high-risk older adults—

Pneumococcal vaccine ever received (age adjusted, 65+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

14-29c Vaccination of noninstitutionalized high-risk adults—Influenza 

vaccine in past 12 months (age adjusted, 18–64 years)

National Health Interview Survey (NHIS), CDC, NCHS.

14-29d Vaccination of noninstitutionalized high-risk adults—Pneumococcal 

vaccine ever received (age adjusted, 18–64 years)

National Health Interview Survey (NHIS), CDC, NCHS.

14-29e Vaccination of adults in long-term care or nursing homes—

Influenza vaccine in past 12 months (age adjusted, 18+ years)

National Nursing Home Survey (NNHS), CDC, NCHS.

14-29f Vaccination of adults in long-term care or nursing homes—

Pneumococcal vaccine ever received (age adjusted, 18+ years)

National Nursing Home Survey (NNHS), CDC, NCHS.

14-29g Vaccination of health care workers—Influenza vaccine in past 12 

months (age adjusted, 18–64 years)

National Health Interview Survey (NHIS), CDC, NCHS.

14-30a Adverse events from vaccinations—Associated paralytic polio 

(number of events)

National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-30b Adverse events from vaccinations—Febrile seizures caused by 

pertussis vaccines (number of events)

Vaccine Adverse Event Reporting System (VAERS): CDC, OD; FDA. 

Vaccine Safety Datalink (VSD), CDC, OD.

14-31a Active surveillance for vaccine safety via large linked databases 

(number in millions)

Vaccine Safety Datalink (VSD), CDC, OD.

14-31b Vaccine adverse event reports (VAERS) submitted electronically Vaccine Adverse Event Reporting System (VAERS): CDC, OD; FDA.
14 • IMMUNIZATION AND INFECTIOUS DISEASES 14-15

Figure 14-1. Progress Toward Target Attainment for Focus Area 14: Immunization and Infectious Diseases

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

14-1. Vaccine-preventable diseases (no. cases)

a. Congenital rubella syndrome (<1 year) 100.0% 0 7

(1998)

0

(2008)

-7 Not tested -100.0%

b. Diphtheria (<35 years) 100.0% 0 1

(1998)

0

(2008)

-1 Not tested -100.0%

c. Haemophilus infl uenzae type b and 

unknown (<5 years)

0 163

(1998)

193

(2008)

30 Not tested 18.4%

d. Hepatitis B (2–18 years) 93.9% 7 708

(1997)

50

(2008)

-658 Not tested -92.9%

e. Measles 0 74

(1998)

115

(2008)

41 Not tested 55.4%

f. Mumps 36.8% 0 666

(1998)

421

(2008)

-245 Not tested -36.8%

g. Pertussis (<7 years) 2,000 3,417

(1998)

4,166

(2008)

749 Not tested 21.9%

h. Polio (wild-type virus) Target met at 

baseline and fi nal 0 0

(1998)

0

(2008)

0 Not tested *

i. Rubella 97.3% 0 364

(1998)

10

(2008)

-354 Not tested -97.3%

j. Tetanus (<35 years) 57.1% 0 14

(1998)

6

(2008)

-8 Not tested -57.1%

k. Varicella (chicken pox) (no. cases in 

thousands, <18 years)

81.9% 223 2,229

(1999)

586

(2008)

-1,643 Yes -73.7%

14-2. Perinatal hepatitis B infections in 

infants and young children (no. cases, 

1–24 months) 

71.8% 400 1,682

(1995)

761

(2008)

-921 Not tested -54.8%

14-3. Hepatitis B

a. Adults 19–24 years (cases per 100,000) 87.4% 1.8 18.5

(1997)

3.9

(2008)

-14.6 Not tested -78.9%

b. Adults 25–39 years (cases per 100,000) 87.6% 5.2 20.5

(1997)

7.1

(2008)

-13.4 Not tested -65.4%

c. Adults 40+ years (cases per 100,000) 70.9% 3.7 14.7

(1997)

6.9

(2008)

-7.8 Not tested -53.1%

d. Injection drug users (no. cases) 107.0% 1,784 7,135

(1997)

1,408

(2008)

-5,727 Not tested -80.3%

e. Heterosexually active persons (no. cases) 54.1% 1,223 15,021

(1997)

7,563

(2008)

-7,458 Not tested -49.7%

f. Men who have sex with men (no. cases) 96.5% 1,302 5,209

(1997)

1,439

(2008)

-3,770 Not tested -72.4%

g. Occupationally exposed workers 

(no. cases)

90.5% 60 239

(1997)

77

(2008)

-162 Not tested -67.8%

14-4. Bacterial meningitis in young children 

(new cases per 100,000 population, 

1–23 months) 

102.3% 8.6 13.0

(1998)

8.5

(2008)

-4.5 Not tested -34.6%

LEGEND Moved away from target1 Moved toward target Met or exceeded target
14-16 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 14-1. Progress Toward Target Attainment for Focus Area 14: Immunization and Infectious Diseases (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

14-5. Invasive pneumococcal infections 

(new cases per 100,000 population)

a. Children (<5 years) 183.9% 46 77

(1997)

20

(2008)

-57 Not tested -74.0%

b. Adults (65+ years) 105.0% 42 62

(1997)

41

(2008)

-21 Not tested -33.9%

c. Penicillin-resistant—Children (<5 years) 90.0% 6 16

(1997)

7

(2008)

-9 Not tested -56.3%

d. Penicillin-resistant—Adults (65+ years) 7 8

(1997)

10

(2008)

2 Not tested 25.0%

14-6. Hepatitis A (new cases per 100,000 

population) 

149.3% 4.3 11.2

(1997)

0.9

(2008)

-10.3 Not tested -92.0%

14-7. Meningococcal disease (new cases per 

100,000 population)

300.0% 1.0 1.3

(1997)

0.4

(2008)

-0.9 Not tested -69.2%

14-8. Lyme disease in endemic States (new 

cases per 100,000 population) 

9.7 17.4

(1992–96)

50.1

(2008)

32.7 Not tested 187.9%

14-9. Hepatitis C (new cases per 100,000 

population)

146.7% 1.0 2.5

(1997)

0.3

(2007)

-2.2 Not tested -88.0%

14-10. States reporting chronic hepatitis C 

infection (no. States) 

61.9% 40 19

(2003)

32

(2008)

13 Not tested 68.4%

14-11. Tuberculosis (new cases per 100,000 

population) 

42.9% 1.0 6.6

(1998)

4.2

(2008)

-2.4 Not tested -36.4%

14-12. Curative therapy for tuberculosis 56.3% 90% 74%

(1996)

83%

(2007)

9 Not tested 12.2%

14-13. Treatment for high-risk persons with latent 

tuberculosis infection 

191.7% 57% 45%

(2000)

68%

(2007)

23 Not tested 51.1%

14-16. Invasive early onset group B streptococcal 

disease (per 1,000 live births) 

140.0% 0.5 1.0

(1996)

0.3

(2008)

-0.7 Not tested -70.0%

14-17. Peptic ulcer hospitalizations (age adjusted, 

per 100,000 population)

112.0% 46 71

(1998)

43

(2007)

-28 Yes -39.4%

14-18. Antibiotics prescribed for ear infections 

in children (courses prescribed per 100 

population, <5 years)

153.8% 56 69

(1996–97)

49

(2006–07)

-20 Yes -29.0%

14-19. Antibiotics prescribed for common 

cold (courses prescribed per 

100,000 population) 

85.0% 1,268 2,535

(1996–97)

1,458

(2006–07)

-1,077 Yes -42.5%

14-20. Hospital-acquired infections among adult 

intensive care patients (per 1,000 days use)

a. Catheter-associated urinary tract infection 740.0% 5.0 5.5

(1995–98)

1.8

(2009)

-3.7 Not tested -67.3%

b. Central line-associated bloodstream 

infection

780.0% 5.0 5.5

(1995–98)

1.6

(2009)

-3.9 Not tested -70.9%

c. Ventilator-associated pneumonia 700.0% 5.3 5.9

(2002–03)

1.7

(2009)

-4.2 Not tested -71.2%
14 • IMMUNIZATION AND INFECTIOUS DISEASES 14-17

Figure 14-1. Progress Toward Target Attainment for Focus Area 14: Immunization and Infectious Diseases (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

14-20. Hospital-acquired infections among infants 

in intensive care weighing ≤1,000 grams 

at birth

d. Central line-associated bloodstream 

infection (per 1,000 days use)

741.7% 11.0 12.2

(1995–98)

3.3

(2009)

-8.9 Not tested -73.0%

e. Ventilator-associated pneumonia 

(per 1,000 days use) 

466.7% 2.7 3.0

(2002–03)

1.6

(2009)

-1.4 Not tested -46.7%

14-21. Antimicrobial use in intensive care units 

(daily doses per 1,000 patient days)

85.1 106.4

(1996–2003)

108.3

(1996–2004)

1.9 Not tested 1.8%

14-22. Vaccination of children 19–35 months

a. 4 doses diphtheria-tetanus-acellular 

pertussis (DTaP) vaccine

16.7% 90% 84%

(1998)

85%

(2008)

1 No 1.2%

b. 3 doses Haemophilus infl uenzae type b 

(Hib) vaccine 

Target exceeded at 

baseline and fi nal 90% 93%

(1998)

91%

(2008)

-2 Yes -2.2%

c. 3 doses hepatitis B (Hep B) vaccine 233.3% 90% 87%

(1998)

94%

(2008)

7 Yes 8.0%

d. 1 dose measles-mumps-rubella (MMR) 

vaccine

Target exceeded at 

baseline and fi nal 90% 92%

(1998)

92%

(2008)

0 No 0.0%

e. 3 doses polio vaccine Target exceeded at 

baseline and fi nal 90% 91%

(1998)

94%

(2008)

3 Yes 3.3%

f. 1 dose varicella vaccine 102.1% 90% 43%

(1998)

91%

(2008)

48 Yes 111.6%

g. 4 doses pneumococcal conjugate vaccine 

(PCV)

85.7% 90% 20%

(2002)

80%

(2008)

60 Not tested 300.0%

14-23. Vaccine coverage of children in day care

a. Diphtheria-tetanus-acellular pertussis 

(DTaP) vaccine

Target exceeded at 

baseline and met at fi nal 95% 96%

(1997–98)

95%

(2000)

-1 Not tested -1.0%

b. Measles-mumps-rubella (MMR) vaccine 116.7% 95% 89%

(1997–98)

96%

(2000)

7 Not tested 7.9%

c. Polio vaccine Target exceeded at 

baseline and met at fi nal 95% 96%

(1997–98)

95%

(2000)

-1 Not tested -1.0%

Vaccine coverage of children in 

kindergarten 

f. Diphtheria-tetanus-acellular pertussis 

(DTaP) vaccine 

95% 95%

(2002–03)

93%

(2008)

-2 Not tested -2.1%

g. Measles-mumps-rubella (MMR) vaccine 95% 96%

(2002–03)

92%

(2008)

-4 Not tested -4.2%

h. Polio vaccine 95% 96%

(2002–03)

94%

(2008)

-2 Not tested -2.1%

i. Hepatitis B (Hep B) vaccine 95% 96%

(2002–03)

94%

(2008)

-2 Not tested -2.1%

j. Varicella vaccine 95% 93%

(2002–03)

91%

(2008)

-2 Not tested -2.2%

Vaccine coverage of children in licensed 

daycare facilities

l. Haemophilus infl uenzae type b (Hib) 

vaccine

Target exceeded 

at baseline 90% 94%

(2003–04)

N/A6 N/A6 N/A6 N/A6
14-18 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 14-1. Progress Toward Target Attainment for Focus Area 14: Immunization and Infectious Diseases (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

14-24a. Fully immunized young children 

19–35 months

71.4% 80% 73%

(1998)

78%

(2008)

5 Yes 6.8%

14-25. Providers who measure childhood 

vaccination coverage levels

a. Public health providers 0.0% 55% 40%

(1999)

40%

(2009)

0 Not tested 0.0%

b. Private providers 50.0% 55% 11%

(1999)

33%

(2009)

22 Not tested 200.0%

14-26. Children <6 years participating in 

population-based immunization registries 

131.7% 62% 21%

(1999)

75%

(2008)

54 Not tested 257.1%

14-27. Vaccination coverage among adolescents 

13–15 years

a. 3+ doses hepatitis B (Hep B) vaccine 104.8% 90% 48%

(1997)

92%

(2008)

44 Yes 91.7%

b. 2+ doses measles-mumps-rubella (MMR) 

vaccine

200.0% 90% 89%

(1997)

91%

(2008)

2 Yes 2.2%

c. 1+ doses tetanus-diptheria (Td) booster 90% 93%

(1997)

71%

(2008)

-22 Yes -23.7%

d. 1+ doses varicella (excluding adolescents 

who have had varicella)

91.1% 90% 45%

(1997)

86%

(2008)

41 Yes 91.1%

14-28. Hepatitis B (Hep B) vaccination among 

high-risk groups

a. Long-term hemodialysis patients 45.5% 90% 35%

(1995)

60%

(2001)

25 Not tested 71.4%

b. Men who have sex with men 7.8% 60% 9%

(1994–99)

13%

(1998–2000)

4 Not tested 44.4%

c. Occupationally exposed workers 93% 67%

(1995)

64%

(2008)

-3 Not tested -4.5%

14-29. Vaccination of noninstitutionalized highrisk older adults (age adjusted, 65+ years) 

a. Infl uenza vaccine in past 12 months 11.5% 90% 64%

(1998)

67%

(2008)

3 Yes 4.7%

b. Pneumococcal vaccine ever received 31.8% 90% 46%

(1998)

60%

(2008)

14 Yes 30.4%

Vaccination of noninstitutionalized high-risk 

adults (age adjusted, 18–64 years) 

c. Infl uenza vaccine in past 12 months 17.6% 60% 26%

(1998)

32%

(2008)

6 Yes 23.1%

d. Pneumococcal vaccine ever received 14.9% 60% 13%

(1998)

20%

(2008)

7 Yes 53.8%

Vaccination of adults in long-term care or 

nursing homes (age adjusted, 18+ years)

e. Infl uenza vaccine in past 12 months 90% 59%

(1997)

57%

(2004)

-2 Not tested -3.4%

f. Pneumococcal vaccine ever received 20.0% 90% 25%

(1997)

38%

(2004)

13 Not tested 52.0%

Vaccination of health care workers 

(age adjusted, 18–64 years)

g. Infl uenza vaccine in past 12 months 30.4% 60% 37%

(2000)

44%

(2008)

7 Not tested 18.9%
14 • IMMUNIZATION AND INFECTIOUS DISEASES 14-19

Figure 14-1. Progress Toward Target Attainment for Focus Area 14: Immunization and Infectious Diseases (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

14-30. Adverse events from vaccinations 

(number of events)

a. Associated paralytic polio 100.0% 0 5

(1997)

0

(2006)

-5 Not tested -100.0%

b. Febrile seizures caused by pertussis 

vaccines

72.4% 57 115

(1998)

73

(2006)

-42 Not tested -36.5%

14-31a. Active surveillance for vaccine safety via 

large linked databases (number in millions)

42.9% 13 6

(1999)

9

(2009)

3 Not tested 50.0%

14-31b. Vaccine adverse events reports (VAERS) 

submitted electronically

128.6% 30% 16%

(2003)

34%

(2009)

18 Not tested 112.5%

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 14-14, 14-22h, 14-23d, 14-23e, 14-23k, and 14-24b. Objective 14-15 was deleted at the 

Midcourse Review.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

6

 Data beyond the baseline are not available; diff erence, statistical signifi cance , and percent change cannot be calculated. See Technical Appendix for 

more information.

* Percent change cannot be calculated. See Technical Appendix for more information.

DATA SOURCES

14-1a. National Congenital Rubella Syndrome Registry (NCRSR), CDC, NCIRD.

14-1b. National Notifi able Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-1c. National Notifi able Diseases Surveillance System (NNDSS), CDC, NCPHI; Active Bacterial Core Surveillance (ABCs), CDC, NCIRD.

14-1d–j. National Notifi able Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-1k. National Health Interview Survey (NHIS), CDC, NCHS.

14-2. Perinatal Hepatitis B Prevention Program, CDC, NCHHSTP; National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

14-3a–g. National Notifi able Diseases Surveillance System (NNDSS), CDC, NCPHI. 

14-4. Active Bacterial Core Surveillance (ABCs), CDC, NCIRD.

14-5a–d. Active Bacterial Core Surveillance (ABCs), CDC, NCIRD.

14-6. National Notifi able Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-7. Active Bacterial Core Surveillance (ABCs), CDC, NCIRD; National Notifi able Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-8. National Notifi able Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-9. Sentinel Counties Study of Viral Hepatitis, CDC, NCHHSTP.

14-10. State health department databases of persons with HCV infection; National Health and Nutrition Examination Survey (NHANES), 

CDC, NCHS. 

14-11–12. National TB Surveillance System, CDC, NCHHSTP.

14-13. Aggregate Reports for Tuberculosis Program Evaluation, CDC, NCHHSTP.

14-16. National Notifi able Diseases Surveillance System (NNDSS), CDC, NCPHI; Active Bacterial Core Surveillance (ABCs), CDC, NCIRD.

14-17. National Hospital Discharge Survey (NHDS), CDC, NCHS.

14-18–19. National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS; National Hospital Ambulatory Medical Care Survey (NHAMCS), 

CDC, NCHS.
14-20 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 14-1. Progress Toward Target Attainment for Focus Area 14: Immunization and Infectious Diseases (continued)

14-20a–e. Baseline data: National Noscomial Infections Surveillance System (NNIS), CDC, NCPDCID. 

Final data: National Healthcare Safety Network (NHSN), CDC, NCPDCID.

14-21. National Noscomial Infections Surveillance System (NNIS), CDC, NCPDCID.

14-22a–g. National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

14-23a–c. Annual Immunization Assessment Reports, CDC, NCIRD.

14-23f–j. School Immunization Assessment Survey, CDC, NCIRD.

14-23l. Day Care and Head Start Assessment Program, CDC, NCIRD.

14-24a. National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

14-25a–b. Annual Immunization Assessment Reports, CDC, NCIRD.

14-26. Annual Immunization Assessment Reports, CDC, NCIRD.

14-27a–d. Baseline data: National Health Interview Survey (NHIS), CDC, NCHS. 

Final data: National Immunization Survey—Teen (NIS-Teen): CDC, NCIRD; CDC, NCHS.

14-28a. Annual Survey of Chronic Hemodialysis Centers: CDC, NCHHSTP; CMS.

14-28b. Young Men's Survey, CDC, NCHHSTP.

14-28c. Periodic vaccine coverage surveys, CDC, NCPDCID.

14-29a–d. National Health Interview Survey (NHIS), CDC, NCHS.

14-29e–g. National Nursing Home Survey (NNHS), CDC, NCHS.

14-30a. National Notifi able Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-30b. Vaccine Adverse Event Reporting System (VAERS): CDC, OD; FDA. Vaccine Safety Datalink (VSD), CDC, OD.

14-31a. Vaccine Safety Datalink (VSD), CDC, OD.

14-31b. Vaccine Adverse Event Reporting System (VAERS): CDC, OD; FDA.
14 • IMMUNIZATION AND INFECTIOUS DISEASES 14-21

Figure 14-2. Health Disparities Table for Focus Area 14: Immunization and Infectious Diseases

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Income Location Disability

Population-based objectiveAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexUrban or metropolitanRural ornonmetropolitanPersons with disabilitiesPersons without disabilities

14-3a. Hepatitis B in adults 19–24 years [cases 

per 100,000 population (pop.)] (1997, 

2008)†







 ii

  

Bi 

  Bi

b. Hepatitis B in adults 25–39 years (cases 

per 100,000 pop.) (1997, 2008)† 





Bi,ii 

  B

c. Hepatitis B in adults 40+ years (cases per 

100,000 pop.) (1997, 2008)† 





Bi,ii

















B 

14-4. Bacterial meningitis in young children (new 

cases per 100,000 pop., 1–23 months) 

(1998, 2008)†

iii





Biii B 

14-5a. Invasive pneumococcal infections in 

children (new cases per 100,000 pop., 

<5 years) (1997, 2008)†

ii iii

 Bi,iii B

b. Invasive pneumococcal infections in adults 

(new cases per 100,000 pop., 65+ 

years) (1997, 2008)†

iii Biii B

c. Penicillin-resistant invasive pneumococcal infections in children (new cases per 

100,000 pop., <5 years) (1997, 2008)1†

iii

 Biii B

d. Penicillin-resistant invasive pneumococcal 

infections in adults (new cases per 100,000 

pop., 65+ years) (1997, 2008)1†

Biii Biii Bi

14-6. Hepatitis A (new cases per 100,000 pop.) 

(1997, 2008)† 





ii 





Bi 







B 

14-7. Meningococcal disease (new cases per 

100,000 pop.) (1997, 2008)† iii Biii B B

14-8. Lyme disease in endemic States (5-year 

average, new cases per 100,000 pop.) 

(1992–96, 2008)†

B 

14-9. Hepatitis C (new cases per 100,000 

pop.) (1997, 2007)2† iii iii Bi

14-11. Tuberculosis (new cases per 100,000 

pop.) (1998, 2008)† 







 B iv B

14-12. Curative therapy for tuberculosis (1996, 

2007)†  Bi  iv B

14-16 Invasive early onset group B streptococcal 

disease (per 1,000 live births) (1996, 

2008)†

iii Biii

14-17. Peptic ulcer hospitalizations (age adjusted, 

per 100,000 pop.) (1998, 2007)* iii Biii B
14-22 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 14-2. Health Disparities Table for Focus Area 14: Immunization and Infectious Diseases (continued)

Race and Ethnicity Sex Education Income Location Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexUrban or metropolitanRural or nonmetropolitanPersons with disabilitiesPersons without disabilities

14-18. Antibiotics prescribed for ear infections 

in children (courses prescribed per 100 

pop., <5 years) (1996–97, 2006–07)*

iii iii B

14-19. Antibiotics prescribed for common cold 

(courses prescribed per 100,000 pop.) 

(1996–97, 2006–07)3‡

iii Biii

14-22a. Vaccination of children 19–35 months— 

4 doses diphtheria-tetanus-acellular pertussis (DTaP) vaccine (1998, 2008)4,5‡

b b b Bi  B B B

b. Vaccination of children 19–35 months—3 

doses Haemophilus influenzae type b (Hib) 

vaccine (1998, 2008)4,5‡

b b b  B B Bi B

c. Vaccination of children 19–35 

months—3 doses hepatitis B (Hep B) 

vaccine (1998, 2008)4,5‡

b b b b  Bi B B

d. Vaccination of children 19–35 

months—1 dose measles-mumps-rubella 

(MMR) vaccine (1998, 2008)4,5‡

B B

e. Vaccination of children 19–35 

months—3 doses polio vaccine (1998, 

2008)4,5‡

b b b  Bi B Bi

f. Vaccination of children 19–35 

months—1 dose varicella vaccine (1998, 

2008)4,5‡

b b Bi  B B B Bi

g. Vaccination of children 19–35 

months—4 doses pneumococcal conjugate vaccine (PCV) (2002, 2008)6*

b b  Bi v B B

14-24a. Fully immunized young children 19–35 

months (1998, 2008)4,5* b b Bi Bi B B

14-27a. Vaccination coverage among adolescents 

13–15 years—3+ doses of hepatitis B 

(Hep B) vaccine (1997, 2008)7,8*

Bi B B

b. Vaccination coverage among adolescents 

13–15 years—2+ doses of measles, mumps, 

rubella (MMR) vaccine (1997, 2008)7,8*

b v v B v B Bi b B

c. Vaccination coverage among adolescents 

13–15 years—1+ doses of tetanusdiptheria (Td) booster (1997, 2008)7,8*

b b b b v B B v v v B iv B v

d. Vaccination coverage among adolescents 

13–15 years—1+ doses of varicella vaccine 

(exclud. those with varicella) (1997, 2008)7,8*

b 

 B B Bi b B 

14-29a. Vaccination of noninstitutionalized high-risk older 

adults—Influenza vaccine in past 12 months 

(age adjusted, 65+ years) (1998, 2008)7

*

B iv Bi B B

b. Vaccination of noninstitutionalized high-risk older 

adults—Pneumococcal vaccine ever received 

(age adjusted, 65+ years) (1998, 2008)7

*

 B  Bi B B
14 • IMMUNIZATION AND INFECTIOUS DISEASES 14-23

Figure 14-2. Health Disparities Table for Focus Area 14: Immunization and Infectious Diseases (continued)

Race and Ethnicity Sex Education Income Location Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexUrban or metropolitanRural or nonmetropolitanPersons with disabilitiesPersons without disabilities

c. Vaccination of noninstitutionalized high-risk 

adults—Influenza vaccine in past 12 months 

(age adjusted, 18–64 years) (1998, 2008)7

*

b Bi B B B B

d. Vaccination of noninstitutionalized high-risk older 

adults—Pneumococcal vaccine ever re-ceived 

(age adjusted, 18–64 years) (1998, 2008)7

*

b Bi B B B B B

e. Vaccination of adults in long-term care or nursing 

homes—Influenza vaccine in past 12 months 

(age adjusted, 18+ years) (1997, 2004)9‡

b B vi Bvi

f. Vaccination of adults in long-term care or nursing 

homes—Pneumococcal vaccine ever received 

(age adjusted, 18+ years) (1997, 2004)9‡

b   B B v vi Bvi

g. Vaccination of health care workers— Influenza vaccine in past 12 months (age 

adjusted, 18–64 years) (2000, 2008)*

b B Bi   B  B v

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 14-1a 

through k, 14-2, 14-3d through g, 14-10, 14-13, 14-14, 14-20a through e, 14-21, 14-22h, 14-23a through l, 14-24b, 14-25a and b, 14-26, 14-28a through c, 14-30a and b, 

and 14-31a and b. Objective 14-15 was deleted at Midcourse Review.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

LEGEND

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.
14-24 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 14-2. Health Disparities Table for Focus Area 14: Immunization and Infectious Diseases (continued)

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. Nonetheless, 

disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix.

‡ Measures of variability were available only for the most recent data. Thus, the variability of best group rates was assessed only for the most recent data, and 

statistical significance was tested only for the most recent data. Disparities of 10% or more are displayed when the differences from the best group rate are 

statistically significant at the 0.05 level. Changes in disparities over time are displayed according to their magnitude, since measures of variability were not available 

at baseline and therefore statistical significance of changes in disparity could not be tested. See Technical Appendix.

1 Most recent data by race and ethnicity are for 2002.

2 Most recent data by sex and race and ethnicity are for 2003.

3 Baseline data by race and ethnicity are for 1998–99. Measures of variability by sex were available at both data points, see footnote * above.

4 Baseline data by race and ethnicity are for 2000. Measures of variability by sex and income were available at both data points, see footnote * above.

5 Baseline data by income exclude "middle/high income" for comparability with most recent data year.

6 Baseline data by income are for 2004.

7 Baseline data by race and ethnicity are for 1999.

8 Most recent data by disability status are for 2003.

9 Baseline data by disability status are for 2004.

i The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

ii Data are for Asian or Pacific Islander.

iiiData include persons of Hispanic origin.

ivChange in the summary index cannot be assessed. See Technical Appendix.

v Reliability criterion for best group rate not met, or data available for only one group, at baseline. Change in disparity cannot be assessed. See Technical Appendix.

vi For this objective, only severe disabilities are considered as disabilities.

DATA SOURCES

14-3a–c. National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-4. Active Bacterial Core Surveillance (ABCs), CDC, NCIRD.

14-5a–d. Active Bacterial Core Surveillance (ABCs), CDC, NCIRD.

14-6. National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-7. Active Bacterial Core Surveillance (ABCs), CDC, NCIRD; National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-8. National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

14-9. Sentinel Counties Study of Viral Hepatitis, CDC, NCHHSTP.

14-11–14-12. National TB Surveillance System, CDC, NCHHSTP.

14-16. National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI; Active Bacterial Core Surveillance (ABCs), CDC, NCIRD.

14-17. National Hospital Discharge Survey (NHDS), CDC, NCHS.

14-18–14-19. National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS; National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

14-22a–g. National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

14-24a. National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

14-27a–d. Baseline data: National Health Interview Survey (NHIS), CDC, NCHS. 

Final data: National Immunization Survey—Teen (NIS-Teen): CDC, NCIRD; CDC, NCHS.

14-29a–d. National Health Interview Survey (NHIS), CDC, NCHS.

14-29e–f. National Nursing Home Survey (NNHS), CDC, NCHS.

14-29g. National Health Interview Survey (NHIS), CDC, NCHS.
14 • IMMUNIZATION AND INFECTIOUS DISEASES 14-25 Figure 14-3. Vaccination of Children 19–35 Months—3 Doses Hepatitis B (HepB) Vaccine, 2008 Healthy People 2010 objective 14-22c • Target = 90 percent NOTE: Rates are displayed by a modified Jenks classification for U.S. states. SOURCE: National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS Percent Highest catego

show states tha

84.9–90.0–93.2–95.1–
HEALTHY PEOPLE 2010 FINAL REVIEW 14-26Figure 14-4. Vaccination of Children 19–35 Months—1 Dose Measles-Mumps-Rubella (MMR) Vaccine, 2008 Healthy People 2010 objective 14-22d • Target = 90 percent NOTE: Rates are displayed by a modified Jenks classification for U.S. states. SOURCE: National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS. Percent Highest categor

show states tha

85.9–90.0–91.3–993.2–
14 • IMMUNIZATION AND INFECTIOUS DISEASES 14-27 Figure 14-5. Vaccination of Children 19–35 Months—4 Doses Pneumococcal Conjugate Vaccine (PCV), 2008 Healthy People 2010 objective 14-22g • Target = 90 percent NOTE: Rates are displayed by a modified Jenks classification for U.S. states. SOURCE: National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS. Highes

shows 

Percen

Injury and

Violence Prevention

CHAPTER 15

Lead Agency

Centers for Disease Control and Prevention

Contents

Goal ................................................................................................15-3

Highlights ......................................................................................15-3

Summary of Progress.....................................................................15-6

Transition to Healthy People 2020................................................15-7

Data Considerations.......................................................................15-8

References and Notes.....................................................................15-9

Comprehensive Summary of Objectives......................................15-10

Progress Chart..............................................................................15-13

Health Disparities Table...............................................................15-17

Deaths From Unintentional Injuries, 2005–07—Map................15-21

Deaths From Motor Vehicle Crashes, 2005–07—Map ...............15-22

15 • INJURY AND VIOLENCE PREVENTION 15-3

GOAL:

Reduce injuries, disabilities, and deaths due to 

unintentional injuries and violence.

The objectives in this chapter monitor progress in three 

major areas:

〉 Injuries. This area includes objectives that track 

deaths and nonfatal injuries caused by both accidents 

(unintentional) and violence such as traumatic brain 

injuries, poisoning, and suffocation. The availability 

of surveillance systems to track injury-related 

incidents and deaths are also monitored.

〉 Unintentional injuries. This area includes 

objectives that track deaths and nonfatal injuries 

caused by accidents such as motor vehicle-related 

injuries, falls, drownings, and residential fire deaths. 

Individual behaviors and State laws for unintentional 

injury prevention are also monitored.

〉 Violence. The objectives in this area track deaths 

and injuries from violent acts such as homicide, child 

maltreatment, and sexual assault.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in objectives for 

this Focus Area during the past decade [1]. Seventyfour percent of the Injury and Violence Prevention 

objectives with data to monitor progress moved 

toward or exceeded their Healthy People 2010 

targets (Figure 15-1). Statistically significant health 

disparities were observed among racial and ethnic 

populations, as well as by sex, education level, and 

geographic location (Figure 15-2), as highlighted 

below [2].

Injuries

〉 The poisoning death rate (objective 15-8) increased 

84.5% between 1999 and 2007, from 7.1 to 13.1 per 

100,000 population (age adjusted), moving away 

from the Healthy People 2010 target of 1.5 per 100,000 

population.

 Among racial and ethnic groups, the Asian or 

Pacific Islander population had the lowest (best) 

rates of poisoning deaths: 1.6 deaths per 100,000 

population (age adjusted) in 1999 and 2.5 in 2007. 

The Hispanic or Latino population had rates of 

5.9 per 100,000 (age adjusted) in 1999 and 6.9 in 

2007; the non-Hispanic black population had 

rates of 8.2 in 1999 and 10.6 in 2007; and the nonHispanic white population had rates of 7.3 in 

1999 and 15.8 in 2007.

 In 2007, the rate for the Hispanic or Latino 

population was almost three times the best 

group rate (that for the Asian or Pacific Islander 

population); the rate for the non-Hispanic black 

population was more than four times the best 

group rate; and the rate for the non-Hispanic 

white population was almost six and a half 

times the best group rate [2].
15-4 HEALTHY PEOPLE 2010 FINAL REVIEW

 Between 1999 and 2007, the disparity in the 

poisoning death rate between the Hispanic 

or Latino population and the Asian or Pacific 

Islander population (group with the best rate) 

decreased 93 percentage points [3]; similarly, 

the disparity between the non-Hispanic black 

and the Asian or Pacific Islander population 

decreased 89 percentage points; and the 

disparity between the non-Hispanic white 

and the Asian or Pacific Islander population 

increased 176 percentage points.

 Among education groups, persons aged 25–64 

with at least some college education had the 

lowest (best) poisoning death rate, 7.9 deaths 

per 100,000 population (age adjusted) in 2002. 

Persons with less than a high school education 

had a rate of 25.8 deaths per 100,000 population 

(age adjusted), almost three and a half times 

the best group rate (that for persons with at 

least some college education) [2]. High school 

graduates had a rate of 22.4 per 100,000 (age 

adjusted), almost three times the best group rate.

Unintentional Injuries

〉 The unintentional injury death rate (objective 15-13) 

increased 13.3% between 1999 and 2007, from 35.3 to 

40.0 per 100,000 population (age adjusted), moving 

away from the Healthy People 2010 target of 17.1 per 

100,000 population.

 Among racial and ethnic groups, the Asian or 

Pacific Islander population had the lowest (best) 

rate of unintentional injury deaths, 17.0 per 

100,000 population (age adjusted) in 2007. The 

American Indian or Alaska Native, non-Hispanic 

black, and non-Hispanic white populations had 

rates of 55.7, 37.6, and 43.0 deaths per 100,000 

population (aged adjusted), respectively. The 

rate for the American Indian or Alaska Native 

population was almost three and a half times 

the best group rate (that for the Asian or Pacific 

Islander population); the rate for the nonHispanic black population was more than twice 

the best group rate; and the rate for the nonHispanic white population was about two and a 

half times the best rate [2].

 Females had a lower (better) unintentional injury 

death rate than males, 25.8 deaths per 100,000 

population (age adjusted) in 2007. The rate for 

males, 55.8 per 100,000 (age adjusted, was more 

than twice the rate for females [2].

 Among education groups, persons aged 25–64 

with at least some college education had the 

lowest (best) unintentional injury death rate, 

18.3 deaths per 100,000 population (age adjusted) 

in 2002. Persons with less than a high school 

education had a rate of 61.0 per 100,000 (age 

adjusted), almost three and a half times the best 

group rate; whereas high school graduates had a 

rate of 50.0 per 100,000 (age adjusted), more than 

two and a half times the best rate [2].

〉 Unintentional injury death rates varied by geographic 

area. In 2005–07, there were clusters of elevated 

rates in Appalachian West Virginia, Kentucky, and 

Tennessee, the Lower Mississippi Delta, and the 

Mountain West (Figure 15-3).

 Motor vehicle crash death rates decreased, 

moving toward the 2010 targets. Motor vehicle 

crash deaths per 100,000 population (objective 15-

15a) declined 6.1% between 1999 and 2007, from 

14.7 to 13.8 (age adjusted), moving toward the 

target of 8.0. Motor vehicle crash deaths per 100 

million vehicle miles travelled (objective 15-15b) 

declined 18.8% between 1998 and 2008, from 1.6 

to 1.3, moving toward the target of 0.8.

 The disparity patterns for motor vehicle crash 

death rates (objective 15-15a) were very similar 

to those for unintentional injury death rates, 

described above. Among racial and ethnic groups, 

the Asian or Pacific Islander population had the 

lowest (best) rate, 7.0 per 100,000 population (age 

adjusted). The American Indian or Alaska Native, 

non-Hispanic black, and non-Hispanic white 

populations had rates of 22.5, 14.1, and 14.2 per 

100,000 (age adjusted) in 2007, respectively. The 

rate for the American Indian or Alaska Native 

population was more than three times the best 

group rate; the rates for the non-Hispanic black 

and non-Hispanic white populations were about 

twice the best group rate [2]. 

 Females had a lower (better) motor vehicle crash 

death rate than males, 7.9 per 100,000 population 

(age adjusted) in 2007. The rate for males, 19.9 per 

100,000 (age adjusted), was approximately two 

and a half times that for females [2].

 Among education groups, persons aged 25–64 

with at least some college education had the 

lowest (best) rate of motor vehicle crash deaths, 

8.4 per 100,000 population (age adjusted) in 2002. 

High school graduates and persons with less 

than a high school education had rates of 22.3 

and 26.0 per 100,000 (age adjusted), respectively. 

The rate for high school graduates was more than 

two and a half times the best group rate, whereas 

the rate for persons with less than a high school 

education was more than three times the best 

group rate [2].

〉 Motor vehicle death rates varied by geographic area. 

In 2005–07, there were clusters of higher rates in 

Kentucky, South Florida, and the Mountain West. 

Several areas met the Healthy People 2010 target 

(Figure 15-4).
15 • INJURY AND VIOLENCE PREVENTION 15-5

〉 The nonfatal motor vehicle crash-related injury 

rate (objective 15-17) declined 34.7% between 1998 

and 2008, from 1,181 to 771 per 100,000 population, 

exceeding the 2010 target of 933 per 100,000.

〉 The use of safety belts (objective 15-19) increased 

25.4% between 1999 and 2009, from 67% to 84%, 

moving toward the 2010 target of 89%. However, there 

was no improvement in the use of child restraints 

(objective 15-20). As in 2002, the baseline year for this 

objective, in 2009, 88% of children aged 7 years and 

under were properly restrained in child safety seats. 

The number of states that adopted graduated driver 

licensing laws (objective 15-22) increased from 23 

states in 1999 to 50 states (including the District of 

Columbia) in 2009, moving toward the target of 51 (50 

states and the District of Columbia).

〉 The residential fire death rate (objective 15-25) 

declined 10.0% between 1999 and 2007, from 1.0 to 

0.9 per 100,000 population (age adjusted), moving 

toward the 2010 target of 0.2 per 100,000.

〉 The use of smoke alarms in residences also increased. 

The proportion of persons living in residences with 

functioning alarms on every floor (objective 15-26a) 

and the proportion of residences with functioning 

alarms on every floor (objective 15-26b) both 

increased 3.4% between 1998 and 2003, from 88% 

to 91% (age adjusted for objective 15-26a), moving 

toward the Healthy People 2010 targets of 100%.

〉 The death rate from unintentional falls (objective 

15-27) increased 45.8% between 1999 and 2007, from 

4.8 to 7.0 per 100,000 population (age adjusted), 

moving away from the 2010 target of 3.3 per 100,000.

 Among racial and ethnic groups, the nonHispanic black population had the lowest (best) 

rates of deaths from unintentional falls, 3.5 per 

100,000 population (age adjusted) in both 1999 

and 2007. The rates for the non-Hispanic white 

population were 5.0 per 100,000 (age adjusted) in 

1999 and 7.6 in 2007. In 2007, the rate for the nonHispanic white population was more than twice 

that of the non-Hispanic black population [2]. 

Between 1999 and 2007, the disparity between 

the non-Hispanic white and non-Hispanic black 

populations increased 74 percentage points [3].

 Among education groups, persons aged 25–64 

with at least some college education had the 

lowest (best) death rate from unintentional falls, 

1.3 per 100,000 population (age adjusted) in 2002. 

The rates for high school graduates and persons 

with less than a high school education were 2.6 

and 3.1 per 100,000 (age adjusted), respectively. 

The rate for high school graduates was twice the 

best group rate, whereas the rate for persons with 

less than a high school education was almost two 

and a half times the best group rate [2].

〉 Hospitalization rates for hip fractures among women 

and men aged 65 and over (objectives 15-28a and b) 

each decreased 22% between 1998 and 2007, from 

1,055.8 to 823.5 per 100,000 population (age adjusted) 

for women and from 592.7 to 464.9 per 100,000 

(age adjusted) for men. The hospitalization rate for 

women moved toward the 2010 target of 416.0 per 

100,000, whereas the rate for men exceeded the target 

474.0 per 100,000.

Violence

〉 The homicide rate did not change significantly over 

the decade. In 1999, the baseline year for this objective 

(15-32), the homicide rate was 6.0 per 100,000 

population (age adjusted), compared with a rate of 6.1 

in 2007 [1].

 Among racial and ethnic groups, the Asian or 

Pacific Islander population had the lowest (best) 

rate of deaths from homicide, 2.3 per 100,000 

population (age adjusted) in 2007. The rates for 

the American Indian or Alaska Native, Hispanic 

or Latino, and non-Hispanic black populations 

were 6.5, 6.9, and 21.8 per 100,000 (age adjusted), 

respectively. The rate for the American Indian or 

Alaska Native population was almost three times 

the best group rate; the rate for the Hispanic or 

Latino population was three times the best group 

rate; and the rate for the non-Hispanic black 

population was about nine and a half times the 

best group rate [2].

 The non-Hispanic white population had the 

lowest (best) rate of deaths from homicide at 

baseline, 2.9 deaths per 100,000 (age adjusted) 

in 1999, whereas the Asian or Pacific Islander 

population had the best rate at the most recent 

data point, 2.3 per 100,000 (age adjusted) in 2007. 

The non-Hispanic black population had rates of 

20.7 and 21.8 per 100,000 (age adjusted) in 1999 

and 2007, respectively. Between 1999 and 2007, 

the disparity between the non-Hispanic black 

population and the group with the best rate (nonHispanic white in 1999; Asian or Pacific Islander 

in 2007) increased 234 percentage points [3].

 Females had a lower (better) homicide rate than 

males, 2.5 per 100,000 population (age adjusted) in 

2007. The rate for males was 9.6 per 100,000 (age 

adjusted), nearly four times the rate for females [2].

 Among education groups, persons aged 25–64 

with at least some college education had the 

lowest (best) rate of deaths from homicide, 2.6 per 

100,000 population (age adjusted). The rates for 

high school graduates and persons with less than 

a high school education were 10.5 and 16.0 per 

100,000 (age adjusted), respectively. High school 

graduates had a rate that was approximately four 

times the best group rate; the rate for persons 
15-6 HEALTHY PEOPLE 2010 FINAL REVIEW

with less than a high school education was more 

than six times the best group rate [2].

〉 Physical assault by intimate partners (objective 

15-34) decreased 36.1% between 1998 and 2009, from 

3.6 to 2.3 per 1,000 population aged 12 years and over, 

exceeding the 2010 target of 2.7 per 1,000 population.

〉 Rape or attempted rape (objective 15-35) declined 

66.7% between 1998 and 2009, from 0.9 to 0.3 per 

1,000 population aged 12 years and over, exceeding 

the 2010 target of 0.8 per 1,000 population.

〉 Sexual assault other than rape (objective 15-36) 

declined 66.7% between 1998 and 2009, from 0.6 

to 0.2 per 1,000 population aged 12 years and over, 

exceeding the 2010 target of 0.4 per 1,000 population.

〉 Physical assaults (objective 15-37) declined 47.6% 

between 1998 and 2008, from 31.1 to 16.3 per 1,000 

population aged 12 years and over, moving toward 

the 2010 target of 13.6 per 1,000 population.

〉 Physical fighting among students in grades 9–12 

(objective 15-38) declined 13.9% between 1999 and 

2009, from 36% to 31%, exceeding the 2010 target of 

32%.

Summary of Progress

〉 Figure 15-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for Injury and Violence Prevention [1]. 

Data to measure progress toward target attainment 

were available for 43 objectives. Of these:

 Eight objectives (15-12, 15-17, 15-28b, 15-33a, 

15-34 through 15-36, and 15-38) met or exceeded 

their Healthy People 2010 targets.

 Twenty-four objectives moved toward their 

targets. A statistically significant difference 

between the baseline and the final data points 

was observed for eight of these objectives (15-15a, 

15-19, 15-25, 15-26a and b, 15-28a, 15-29, and 15-

37). No significant differences were observed for 

nine objectives (15-2, 15-3, 15-5, 15-7, 15-14, 15-18, 

15-21, 15-30, and 15-39); and data to test the 

significance of the difference were unavailable 

for seven objectives (15-6, 15-10, 15-11, 15-15b, 

15-16, 15-22, and 15-24).

 Two objectives (15-20 and 15-31a) showed no 

change.

 Nine objectives moved away from their targets. 

A statistically significant difference between the 

baseline and final data points was observed for 

six of these objectives (15-1, 15-8, 15-9, 15-13, 15-

27, and 15-31b). No significant differences were 

observed for two objectives (15-31c and 15-32); 

and data to test the significance of the difference 

were unavailable for one objective (15-33b).

〉 Three objectives (15-4 and 15-23a and b) had no 

follow-up data available to measure progress.

〉 Figure 15-2 displays health disparities in Injury and 

Violence Prevention from the best group rate for each 

characteristic at the most recent data point [2]. It 

also displays changes in disparities from baseline to 

the most recent data point [3].

 Of the 14 objectives with statistically significant 

racial and ethnic health disparities of 10% or 

more, the Asian or Pacific Islander population had 

the unique best rate for five objectives (15-3, 15-8, 

15-13, 15-15a, and 15-32). The non-Hispanic white 

population had the best rate for four objectives 

(15-4, 15-26a, 15-37, and 15-38) and the white 

population had the best rate for one objective 

(15-12). The Hispanic or Latino population had 

the unique best rate for two objectives (15-25 

and 15-29). The non-Hispanic black population 

had the best rate for one objective (15-27). The 

Asian or Pacific Islander and Hispanic or Latino 

populations both had the best rate for one objective 

(15-9). The Asian population had the best rate for 

one objective (15-16) with racial and ethnic health 

disparities of 10% or more, but without available 

data to assess statistical significance.

 Females had the better group rate for all 16 of the 

objectives with statistically significant health 

disparities of 10% or more by sex (objectives 15-1, 

15-3, 15-4, 15-8, 15-9, 15-12 through 15-14, 15-15a, 

15-25, 15-27, 15-29, 15-32, and 15-37 through 15-39) 

and one objective with health disparities of 10% or 

more by sex that lacked data to assess statistical 

significance (objective 15-16). Males had the better 

rate for one objective with health disparities of 

10% or more by sex that lacked data to assess 

statistical significance (objective 15-33a).

 Persons with at least some college education 

had the best rate for 10 of the 11 objectives with 

statistically significant health disparities of 10% 

or more by education level (objectives 15-3, 15-8, 

15-9, 15-13, 15-15a, 15-25, 15-26a, 15-27, 15-29, and 

15-32). High school graduates had the best rate 

for one objective (objective 15-4).

 Persons living in urban or metropolitan areas 

had the better rate for the one objective with 

statistically significant health disparities of 10% 

or more by geographic location (objective 15-29).

 Health disparities of 100% or more among racial 

and ethnic populations, by sex, and by education 

level were observed for a number of objectives in 

this Focus Area. Changes in disparities over time 

also were observed. Many of these disparities 

were discussed in the Highlights, above.
15 • INJURY AND VIOLENCE PREVENTION 15-7

Transition to Healthy People 2020

For Healthy People 2020, the focus of the Injury and 

Violence Prevention objectives has been expanded to 

include a broader range of types of injuries and violence 

and improved strategies for prevention, surveillance, 

and reducing the consequences of injuries. The Injury 

and Violence Prevention objectives primarily assess 

the rates of unintentional and violence-related injuries 

of varying severity, prevention including individual 

behaviors and State laws, and surveillance systems. See 

HealthyPeople.gov for a complete list of Healthy People 

2020 topics and objectives.

The Healthy People 2020 Injury and Violence Prevention 

Topic Area objectives can be grouped into three sections:

〉 Injury prevention

〉 Unintentional injury prevention

〉 Violence prevention.

The differences between the Healthy People 2010 

objectives and those included in Healthy People 2020 are 

summarized below:

〉 The Healthy People 2020 Injury and Violence 

Prevention Topic Area has a total of 65 objectives, 

nine of which are developmental, whereas the 

Healthy People 2010 Injury and Violence Prevention 

Focus Area had 46 objectives [4].

〉 Twenty-two Healthy People 2010 objectives 

were retained “as is” [5]. These include: nonfatal 

traumatic brain injury hospitalizations (objective 

15-1); nonfatal spinal cord injury hospitalizations 

(objective 15-2); firearm-related deaths (objective 

15-3); nonfatal firearm-related injuries (objective 

15-5); unintentional injury deaths (objective 15-13); 

nonfatal unintentional injuries (objective 15-14); 

motor vehicle crash-related deaths per population 

(objective 15-15a); motor vehicle crash-related 

deaths per vehicle miles traveled (objective 15-15b); 

pedestrian deaths (objective 15-16); nonfatal motor 

vehicle crash-related injuries (objective 15-17); 

nonfatal pedestrian injuries (objective 15-18); safety 

belt use (objective 15-19); motorcycle helmet use 

(objective 15-21); States with bicycle helmet laws 

(objective 15-24); residential fire deaths (objective 

15-25); unintentional drowning deaths (objective 

15-29); schools requiring students to wear appropriate 

protective gear in physical education (objective 

15-31a) and intramural activities or physical activity 

clubs (objective 15-31c); homicides (objective 15-32); 

physical assaults (objective 15-37); physical fighting 

among adolescents (objective 15-38); and weapon 

carrying by adolescents on school property (objective 

15-39).

〉 Thirteen Healthy People 2010 objectives were 

modified to create 19 Healthy People 2020 objectives, 

five of which are developmental [4,6].

 The threshold for the developmental objective on 

state-level child fatality review for deaths due to 

external causes (objective 15-6) was decreased 

from 100% to 90% of such deaths.

 A more reliable data source was selected for 

nonfatal poisonings (objective 15-7).

 Deaths from suffocation (objective 15-9) 

was modified to create three Healthy People 

2020 objectives to track only those that are 

unintentional among all persons, infants, and 

older adults (the age groups at highest risk).

 Emergency department and hospital discharge 

surveillance of ICD-9-CM external cause of injury 

codes (objectives 15-10 and 15-11) were modified 

to better assess how well states are performing.

 Emergency department visits for injuries 

(objective 15-12) was modified to eliminate the 

double counting of the more severe injuries that 

will be tracked by the new objectives for nonfatal 

injury hospitalizations and injury deaths.

 Child restraint use (objective 15-20) was modified 

to separately accommodate the four age-specific 

guidelines for types of child restraints.

 States with graduated driver licensing laws 

(objective 15-22) was modified to track those 

states with laws rated “good” based on the criteria 

set by the Insurance Institute for Highway Safety.

 Maltreatment of children (objective 15-33a) was 

modified to track only nonfatal maltreatment 

and avoid overlap with the child maltreatment 

fatalities objective (15-33b). The methodology 

for counting cases also was revised for both 

objectives.

 The data source for physical assault by intimate 

partners, rape or attempted rape, and sexual 

assault other than rape (objectives 15-34 through 

15-36), was changed to enable the prevalence of 

such violence to be monitored within a health 

context rather than a crime context, allowing for 

greater disclosure. Sexual assault other than rape 

(objective 15-36) was divided into two Healthy 

People 2020 objectives to separately track abusive 

sexual contact other than rape or attempted rape 

and noncontact sexual abuse. The Healthy People 

2020 data source is new and, therefore, these four 

objectives are developmental.

〉 Two Healthy People 2010 objectives were retained 

“as is” and also modified to create six Healthy People 

2020 objectives [5,6]:

 Poisoning deaths among all ages (objective 15-8) 

was retained. This objective also was modified to 

create three other Healthy People 2020 objectives: 
15-8 HEALTHY PEOPLE 2010 FINAL REVIEW

1) poisoning deaths among adults aged 35–54 

(the age group at highest risk); and unintentional 

or undetermined poisoning deaths among 2) all 

persons and 3) adults aged 35–54.

 Deaths from unintentional falls (objective 15-27) 

was retained. This objective also was modified 

to track unintentional fall-related deaths among 

older adults aged 65 and over, the age group at 

highest risk.

 Seven Healthy People 2010 objectives were 

archived [7]. Objectives tracking improper firearm 

storage in homes (objective 15-4), regular bicycle 

helmet use among children and adults (objectives 

15-23a and b), persons living in residences with 

functional smoke alarms on every floor (objective 

15-26a), and residences with functional smoke 

alarms on every floor (objective 15-26b) were 

archived due to the lack of an ongoing national 

data source. The objective regarding emergency 

department visits for dog bites (objective 15-30) 

was archived due to the low rate and lack of 

effective prevention programs. The objective on 

schools requiring students to wear appropriate 

protective gear in interscholastic sports (objective 

15-31b) was archived because it was near the 

maximum achievement level.

〉 Two objectives that track hospitalizations for hip 

fractures among older adults (separately for females 

and males, objectives 15-28a and b) were moved 

from the Healthy People 2010 Injury and Violence 

Prevention Focus Area to the Healthy People 2020 

Arthritis, Osteoporosis, and Chronic Back Topic 

Area.

〉 Eighteen new objectives, four of which are 

developmental, were added to the Healthy People 

2020 Injury and Violence Prevention Topic Area:

 Eight new injury objectives include fatal injuries, 

hospitalizations visits for nonfatal injuries, fatal 

traumatic brain injuries, emergency department 

visits for nonfatal traumatic brain injuries, fatal 

spinal cord injuries, a developmental objective 

on state-level child fatality review for sudden 

and unexpected infant deaths, population with 

trauma care access, and land mass with trauma 

care access.

 Two new unintentional injury objectives include 

pedalcyclist deaths and sports and recreation 

injuries.

 Eight new violence objectives include nonfatal 

physical assault injuries, bullying among 

adolescents, nonfatal intentional self harm 

injuries, children’s exposure to violence, three 

developmental objectives on types of intimate 

partner violence (sexual violence, psychological 

abuse, and stalking), and States with national 

violent death reporting systems.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Beginning in 2003, education data for mortality 

objectives 15-3, 15-8, 15-9, 15-13, 15-15a, 15-25, 15-27, 15-

29, and 15-32 from the National Vital Statistics System 

were suppressed. The educational attainment item was 

changed in the new U.S. Standard Certificate of Death 

in 2003 to be consistent with the Census Bureau data 

and to improve the ability to identify specific types of 

educational degrees. Many states, however, are still 

using the 1989 version of the U.S. Standard Certificate of 

Death, which focuses on highest school grade completed. 

As a result, educational attainment data collected using 

the 2003 version are not comparable with data collected 

using the 1989 version [8].

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

The age-adjusted rate of initial emergency department 

visits for injuries (objective 15-12) was significantly 

lower in 2007 (91 visits per 1,000 population) than in 

2006 (108 visits per 1,000 population); see DATA2010. 

In contrast, a flat trend in the rate of initial emergency 

department visits for injuries was observed between 

2001 and 2006 [9]. Some of the observed rate decrease 

from 2006 to 2007 may be related to a modification in 

the data collection instrument. In 2007, the checkbox 

for “initial visit for problem” under the “episode of care” 

item in the National Hospital Ambulatory Medical Care 

Survey patient record form was reinstated. This item was 

used in 1992 and 2001–04, but removed from the patient 

record in 2005. A proxy for initial visits was imputed in 

2005–06. The item was restored in 2007. The percentage 

of unknown or blank responses was higher in 2007 than 

in 2001–04.

The rate of child maltreatment (objective 15-33a) was 

significantly lower in 2007–09 than in 2000–06, even 

though the rates were relatively stable during these 
15 • INJURY AND VIOLENCE PREVENTION 15-9

separate time periods. Between 2006 and 2007, the rate 

of victimization dropped from 12.1 to 10.6 per 1,000 

children, a change of 12%. This decrease can be attributed 

to several factors including the increase in children 

who received an “other” disposition which is mostly 

used for low- or medium-risk cases, the decrease in the 

percentage of children who received a substantiated or 

indicated disposition, and the decrease in the number of 

children who received an investigation or assessment. It 

is not possible to tell whether this decrease indicates a 

trend until more data are collected [10].

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

References and Notes

1. Displayed in the Progress Chart (Figure 15-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 15-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 15-2). Disparity from the best group rate 

is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 15-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 15-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

5. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 
15-10 HEALTHY PEOPLE 2010 FINAL REVIEW

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

6. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

7. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.

8. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. 

Deaths: Final data for 2007. National vital statistics 

reports; vol 58 no 19. Hyattsville, MD: National Center 

for Health Statistics. 2010. Available from http://www.

cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf.

9. The presence of a monotonic increasing or decreasing 

trend in the underlying measure was tested with the 

nonparametric Mann-Kendall test; then the slope of 

a linear trend was estimated with the nonparametric 

Sen’s method. See Technical Appendix for more 

information.

10. Department of Health and Human Services 

(DHHS), Administration for Children and Families, 

Administration on Children, Youth and Families, 

Children’s Bureau. Child Maltreatment 2009. 

Washington, D.C.; 2010. Available from http://www.

acf.hhs.gov/programs/cb/stats_research/index.

htm#can.

Comprehensive Summary of Objectives: Injury and Violence Prevention

Objective Description Data Source

15-1 Nonfatal traumatic brain injury hospitalizations (age adjusted, 

per 100,000 population)

National Hospital Discharge Survey (NHDS), CDC, NCHS.

15-2 Nonfatal spinal cord injury hospitalizations (age adjusted, per 

100,000 population)

National Hospital Discharge Survey (NHDS), CDC, NCHS.

15-3 Firearm-related deaths (age adjusted, per 100,000 population) National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-4 Persons in homes with improperly stored firearms (loaded and 

unlocked) (age adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

15-5 Nonfatal firearm-related injuries (per 100,000 population) National Electronic Injury Surveillance System (NEISS), Consumer 

Product Safety Commission (CPSC).

15-6 State-level child fatality review for deaths due to external 

causes (≤17 years, no. states and D.C.)

Michigan Public Health Institute; National Vital Statistics System—

Mortality (NVSS-M), CDC, NCHS.

15-7 Emergency department visits for nonfatal poisonings (age 

adjusted, per 100,000 population)

National Hospital Ambulatory Medical Care Survey (NHAMCS), 

CDC, NCHS.

15-8 Deaths from poisoning (age adjusted, per 100,000 population) National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-9 Deaths from suffocation (age adjusted, per 100,000 

population)

National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-10 Emergency department routine collection of ICD-9-CM 

external causes of injury codes (no. states and D.C.)

External Cause of Injury Survey, American Public Health Association 

(APHA).

15-11 Hospital discharge mandated use of ICD-9-CM external 

causes of injury codes (no. states and D.C.)

External Cause of Injury Survey, American Public Health Association 

(APHA).

15-12 Initial emergency department visits for injuries (age adjusted, 

per 1,000 population)

National Hospital Ambulatory Medical Care Survey (NHAMCS), 

CDC, NCHS.

15-13 Deaths from unintentional injuries (age adjusted, per 100,000 

population)

National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-14 Nonfatal unintentional injuries (age adjusted, per 100,000 

population)

National Electronic Injury Surveillance System—All Injury Program 

(NEISS-AIP), CDC, NCIPC; Consumer Product Safety Commission 

(CPSC).
15 • INJURY AND VIOLENCE PREVENTION 15-11

Comprehensive Summary of Objectives: Injury and Violence Prevention (continued)

Objective Description Data Source

15-15a Deaths from motor vehicle crashes—Age adjusted, per 

100,000 population

National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-15b Deaths from motor vehicle crashes—Per 100 million vehicle 

miles traveled

Fatality Analysis Reporting System (FARS), Department of 

Transportation (DOT).

15-16 Pedestrian deaths on public roads (per 100,000 population) Fatality Analysis Reporting System (FARS), Department of 

Transportation (DOT).

15-17 Nonfatal motor vehicle crash-related injuries on public roads 

(per 100,000 population)

General Estimates System (GES), Department of Transportation 

(DOT).

15-18 Nonfatal pedestrian injuries on public roads (per 100,000 

population)

General Estimates System (GES), Department of Transportation 

(DOT).

15-19 Safety belt use National Occupant Protection Use Survey (NOPUS), Department of 

Transportation (DOT).

15-20 Child restraint use (≤7 years) National Occupant Protection Use Survey (NOPUS), Department of 

Transportation (DOT).

15-21 Motorcycle helmet use National Occupant Protection Use Survey (NOPUS), Department of 

Transportation (DOT).

15-22 Graduated driver licensing laws (no. states and D.C.) U.S. Licensing Systems for Young Drivers, Insurance Institute for 

Highway Safety.

15-23a Regular bicycle helmet use—Children (1–15 years) National Bike Helmet Use Survey, Consumer Product Safety 

Commission (CPSC).

15-23b Regular bicycle helmet use—Adults (16+ years) National Bike Helmet Use Survey, Consumer Product Safety 

Commission (CPSC).

15-24 Bicycle helmet laws for riders <15 years (no. states and D.C.) Bicycle Helmet Safety Institute.

15-25 Residential fire deaths (age adjusted, per 100,000 population) National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-26a Functional smoke alarms in residences—Persons living in 

residences with alarms on every floor (age adjusted)

National Health Interview Survey (NHIS), CDC, NCHS.

15-26b Functional smoke alarms in residences—Proportion of 

residences with alarms on every floor

National Health Interview Survey (NHIS), CDC, NCHS.

15-27 Deaths from unintentional falls (age adjusted, per 100,000 

population)

National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-28a Hospitalizations for hip fractures (age adjusted per 100,000 

standard population, 65+ years)—Females

National Hospital Discharge Survey (NHDS), CDC, NCHS.

15-28b Hospitalizations for hip fractures (age adjusted, per 100,000 

population, 65+ years)—Males

National Hospital Discharge Survey (NHDS), CDC, NCHS.

15-29 Unintentional drownings (age adjusted, per 100,000 

population)

National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-30 Emergency department visits for dog bite injuries (age 

adjusted, per 100,000 population)

National Hospital Ambulatory Medical Care Survey (NHAMCS), 

CDC, NCHS.

15-31a Schools requiring students to wear appropriate protective 

gear—Physical education

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

15-31b Schools requiring students to wear appropriate protective 

gear—Interscholastic sports

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

15-31c Schools requiring students to wear appropriate protective 

gear—Intramural activities or physical activity clubs

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.
15-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Injury and Violence Prevention (continued)

Objective Description Data Source

15-32 Homicides (age adjusted, per 100,000 population) National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-33a Maltreatment of children (per 1,000 population, <18 years) National Child Abuse and Neglect Data System (NCANDS), ACF.

15-33b Child maltreatment fatalities (per 100,000 population, <18 

years)

National Child Abuse and Neglect Data System (NCANDS), ACF.

15-34 Physical assault by intimate partners (per 1,000 population, 

12+ years)

National Crime Victimization Survey (NCVS), Department of Justice 

(DOJ), Bureau of Justice Statistics (BJS).

15-35 Rape or attempted rape (per 1,000 population, 12+ years) National Crime Victimization Survey (NCVS), Department of Justice 

(DOJ), Bureau of Justice Statistics (BJS).

15-36 Sexual assault other than rape (per 1,000 population, 12+ 

years)

National Crime Victimization Survey (NCVS), Department of Justice 

(DOJ), Bureau of Justice Statistics (BJS).

15-37 Physical assaults (per 1,000 population, 12+ years) National Crime Victimization Survey (NCVS), Department of Justice 

(DOJ), Bureau of Justice Statistics (BJS).

15-38 Physical fighting among students (grades 9–12) Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

15-38 Physical fighting among students (grades 9–12) Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

15-39 Weapon carrying by students on school property (grades 

9–12)

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.
15 • INJURY AND VIOLENCE PREVENTION 15-13

Figure 15-1. Progress Toward Target Attainment for Focus Area 15: Injury and Violence Prevention

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

15-1. Nonfatal traumatic brain injury 

hospitalizations (age adjusted, 

per 100,000 population)

53.6 71.7

(1998)

85.6

(2007)

13.9 Yes 19.4%

15-2. Nonfatal spinal cord injury hospitalizations 

(age adjusted, per 100,000 population) 

56.5% 2.6 4.9

(1998)

3.6

(2007)

-1.3 No -26.5%

15-3. Firearm-related deaths (age adjusted, 

per 100,000 population)

1.5% 3.6 10.3

(1999)

10.2

(2007)

-0.1 No -1.0%

15-5. Nonfatal fi rearm-related injuries 

(per 100,000 population)

20.0% 9.1 23.6

(1997)

20.7

(2007)

-2.9 No -12.3%

15-6. State-level child fatality review for deaths 

due to external causes (≤17 years, no. 

States and D.C.) 

9.8% 51 10

(2000)

14

(2007)

4 Not tested 40.0%

15-7. Emergency department visits for nonfatal 

poisonings (age adjusted, per 100,000 

population) 

38.5% 288.6 343.6

(1997)

322.4

(2007)

-21.2 No -6.2%

15-8. Deaths from poisoning (age adjusted, 

per 100,000 population)

1.5 7.1

(1999)

13.1

(2007)

6.0 Yes 84.5%

15-9. Deaths from suffocation (age adjusted, 

per 100,000 population)

3.3 4.2

(1999)

4.9

(2007)

0.7 Yes 16.7%

15-10. Emergency department routine collection 

of ICD-9-CM external causes of injury 

codes (no. States and D.C.) 

35.9% 51 12

(1998)

26

(2007)

14 Not tested 116.7%

15-11. Hospital discharge mandated use of 

ICD-9-CM external causes of injury codes 

(no. States and D.C.) 

11.1% 51 24

(1998)

27

(2007)

3 Not tested 12.5%

15-12. Initial emergency department visits for 

injuries (age adjusted, per 1,000 

population) 

Target met at baseline 

and exceeded at fi nal 107 107

(2001)

91

(2007)

-16 Yes -15.0%

15-13. Deaths from unintentional injuries 

(age adjusted, per 100,000 population) 

17.1 35.3

(1999)

40.0

(2007)

4.7 Yes 13.3%

15-14. Nonfatal unintentional injuries 

(age adjusted, per 100,000 population) 

71.4% 9,000.0 9,767.4

(2000)

9,219.3

(2008)

-548.1 No -5.6%

15-15. Deaths from motor vehicle crashes

a. Age adjusted, per 100,000 population 13.4% 8.0 14.7

(1999)

13.8

(2007)

-0.9 Yes -6.1%

b. Per 100 million vehicle miles traveled 37.5% 0.8 1.6

(1998)

1.3

(2008)

-0.3 Not tested -18.8%

15-16. Pedestrian deaths on public roads 

(per 100,000 population) 

80.0% 1.4 1.9

(1998)

1.5

(2008)

-0.4 Not tested -21.1%

LEGEND Moved away from target1 Moved toward target Met or exceeded target
15-14 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 15-1. Progress Toward Target Attainment for Focus Area 15: Injury and Violence Prevention (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

15-17. Nonfatal motor vehicle crash-related 

injuries on public roads 

(per 100,000 population) 

165.3% 933 1,181

(1998)

771

(2008)

-410 Yes -34.7%

15-18. Nonfatal pedestrian injuries on public 

roads (per 100,000 population) 

42.9% 19 26

(1998)

23

(2008)

-3 No -11.5%

15-19. Safety belt use 77.3% 89% 67%

(1999)

84%

(2009)

17 Yes 25.4%

15-20. Child restraint use (≤7 years) 0.0% 100% 88%

(2002)

88%

(2009)

0 No 0.0%

15-21. Motorcycle helmet use 90.0% 68% 58%

(2002)

67%

(2009)

9 No 15.5%

15-22. Graduated driver licensing laws 

(no. States and D.C.) 

96.4% 51 23

(1999)

50

(2009)

27 Not tested 117.4%

15-24. Bicycle helmet laws for riders <15 years 

(no. States and D.C.) 

20.0% 51 11

(1999)

19

(2009)

8 Not tested 72.7%

15-25. Residential fi re deaths (age adjusted, 

per 100,000 population)

12.5% 0.2 1.0

(1999)

0.9

(2007)

-0.1 Yes -10.0%

15-26. Functional smoke alarms in residences

a. Persons living in residences with alarms 

on every fl oor (age adjusted) 

25.0% 100% 88%

(1998)

91%

(2003)

3 Yes 3.4%

b. Proportion of residences with alarms on 

every fl oor 

25.0% 100% 88%

(1998)

91%

(2003)

3 Yes 3.4%

15-27. Deaths from unintentional falls 

(age adjusted, per 100,000 population)

3.3 4.8

(1999)

7.0

(2007)

2.2 Yes 45.8%

15-28. Hospitalizations for hip fractures 

(age adjusted, per 100,000 population, 

65+ years) 

a. Females 36.3% 416.0 1,055.8

(1998)

823.5

(2007)

-232.3 Yes -22.0%

b. Males 107.7% 474.0 592.7

(1998)

464.9

(2007)

-127.8 No -21.6%

15-29. Unintentional drownings (age adjusted, per 

100,000 population) 

37.5% 0.7 1.5

(1999)

1.2

(2007)

-0.3 Yes -20.0%

15-30. Emergency department visits for dog 

bite injuries (age adjusted, per 100,000 

population) 

76.6% 113.0 150.2

(1997)

121.7

(2007)

-28.5 No -19.0%
15 • INJURY AND VIOLENCE PREVENTION 15-15

Figure 15-1. Progress Toward Target Attainment for Focus Area 15: Injury and Violence Prevention (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

15-31. Schools requiring students to wear 

appropriate protective gear

a. Physical education 0.0% 85% 77%

(2000)

77%

(2006)

0 No 0.0%

b. Interscholastic sports 100% 98%

(2000)

94%

(2006)

-4 Yes -4.1%

c. Intramural activities or physical 

activity clubs

97% 88%

(2000)

86%

(2006)

-2 No -2.3%

15-32. Homicides (age adjusted, per 100,000 

population) 

2.8 6.0

(1999)

6.1

(2007)

0.1 No 1.7%

15-33a. Maltreatment of children (per 1,000 

population, <18 years) 

104.0% 10.2 12.7

(1998)

10.1

(2009)

-2.6 Not tested -20.5%

15-33b. Child maltreatment fatalities (per 100,000 

population, <18 years) 

1.5 1.7

(1998)

2.4

(2009)

0.7 Not tested 41.2%

15-34. Physical assault by intimate partners (per 

1,000 population, 12+ years) 

144.4% 2.7 3.6

(1998)

2.3

(2009)

-1.3 Yes -36.1%

15-35. Rape or attempted rape (per 1,000 population, 12+ years) 

600.0% 0.8 0.9

(1998)

0.3

(2009)

-0.6 Yes -66.7%

15-36. Sexual assault other than rape (per 1,000 

population, 12+ years) 

200.0% 0.4 0.6

(1998)

0.2

(2009)

-0.4 Yes -66.7%

15-37. Physical assaults (per 1,000 population, 

12+ years) 

84.6% 13.6 31.1

(1998)

16.3

(2008)

-14.8 Yes -47.6%

15-38. Physical fi ghting among students (grades 

9–12)

125.0% 32% 36%

(1999)

31%

(2009)

-5 Yes -13.9%

15-39. Weapon carrying by students on school 

property (grades 9–12)

65.0% 4.9% 6.9%

(1999)

5.6%

(2009)

-1.3 No -18.8%

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 15-4, 15-23a, and 15-23b.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value
15-16 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 15-1. Progress Toward Target Attainment for Focus Area 15: Injury and Violence Prevention (continued)

DATA SOURCES

15-1–15-2. National Hospital Discharge Survey (NHDS), CDC, NCHS.

15-3. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-5. National Electronic Injury Surveillance System (NEISS), Consumer Product Safety Commission (CPSC).

15-6. Michigan Public Health Institute; National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-7. National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

15-8–9. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-10–15-11. External Cause of Injury Survey, American Public Health Association (APHA).

15-12. National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

15-13. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-14. National Electronic Injury Surveillance System—All Injury Program (NEISS-AIP): CDC, NCIPC; Consumer 

Product Safety Commission (CPSC).

15-15a. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-15b. Fatality Analysis Reporting System (FARS), Department of Transportation (DOT).

15-16. Fatality Analysis Reporting System (FARS), Department of Transportation (DOT).

15-17–15-18. General Estimates System (GES), Department of Transportation (DOT).

15-19–15-21. National Occupant Protection Use Survey (NOPUS), Department of Transportation (DOT).

15-22. U.S. Licensing Systems for Young Drivers, Insurance Institute for Highway Safety.

15-24. Bicycle Helmet Safety Institute.

15-25. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-26a–b. National Health Interview Survey (NHIS), CDC, NCHS.

15-27. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-28a–b. National Hospital Discharge Survey (NHDS), CDC, NCHS.

15-29. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-30. National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

15-31a–c. School Health Policies and Programs Study (SHPPS), CDC, NCCDPHP.

15-32. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-33a–b. National Child Abuse and Neglect Data System (NCANDS), ACF.

15-34–15-37. National Crime Victimization Survey (NCVS), Department of Justice (DOJ), Bureau of Justice Statistics (BJS).

15-38–15-39. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.
15 • INJURY AND VIOLENCE PREVENTION 15-17

Figure 15-2. Health Disparities Table for Focus Area 15: Injury and Violence Prevention

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Location

Population-based objectiveAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexUrban or metropolitanRural ornonmetropolitan

15-1. Nonfatal traumatic brain injury hospitalizations (age adjusted, per 100,000 

population) (1998, 2007)*

i Bi B

15-2. Nonfatal spinal cord injury hospitalizations (age adjusted, per 100,000 

population) (1998, 2007)*

i i

15-3. Firearm-related deaths (age adjusted, 

per 100,000 population) (1999, 

2007)1* 

Bii 













 B   B

15-4. Persons in homes with improperly 

stored firearms (loaded and unlocked) 

(age adjusted, 18+ years) (1998)*

ii b B B B

15-5. Nonfatal firearm-related injuries (per 

100,000 population) (1997, 2007)*

15-7. Emergency department visits for 

nonfatal poisonings (age adjusted, per 

100,000 population) (1997, 2007)*

i i

15-8. Deaths from poisoning (age adjusted, 

per 100,000 population) (1999, 

2007)1*

Bii 













B   B

15-9. Deaths from suffocation (age adjusted, 

per 100,000 population) (1999, 

2007)1*



 Bii,iii B    B B

15-12. Initial emergency department visits 

for injuries (age adjusted, per 1,000 

population) (2001, 2007)*

i Bi B

15-13. Deaths from unintentional injuries (age 

adjusted, per 100,000 population) 

(1999, 2007)1*

Bii   B   B 

15-14. Nonfatal unintentional injuries (age 

adjusted, per 100,000 population) 

(2000, 2008)*

B

15-15a. Deaths from motor vehicle crashes (age 

adjusted, per 100,000 population) 

(1999, 2007)1*

Bii  B    B 

15-16. Pedestrian deaths on public roads (per 

100,000 population) (1998, 2008)2† 





B  





 B

15-17. Nonfatal motor vehicle crash-related 

injuries on public roads (per 100,000 

population) (1998, 2008)*

B

15-18. Nonfatal pedestrian injuries on public 

roads (per 100,000 population) (1998, 

2008)*

B iv

15-25. Residential fire deaths (age adjusted, 

per 100,000 population) (1999, 

2007)1*

bii B B  

 B
15-18 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 15-2. Health Disparities Table for Focus Area 15: Injury and Violence Prevention (continued)

Race and Ethnicity Sex Education Location

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexUrban or metropolitanRural or nonmetropolitan

15-26a. Persons living in residences with functional smoke alarms on every floor (age 

adjusted) (1998, 2003)3*

b B B Biii  B 

15-27. Deaths from unintentional falls (age 

adjusted, per 100,000 population) 

(1999, 2007)1*

ii  B 

  B  B

15-28a. Hospitalizations for hip fractures—Females (age adjusted, per 100,000 

population, 65+ years) (1998, 2007)*

i i

b. Hospitalizations for hip fractures—Males 

(age adjusted, per 100,000 population, 

65+ years) (1998, 2007)*

i i

15-29. Unintentional drownings (age adjusted, 

per 100,000 population) (1999, 

2007)1*

ii Biii  B 

 B B

15-30. Emergency department visits for dog 

bite injuries (age adjusted, per 100,000 

population) (1997, 2007)*

i i

15-32. Homicides (age adjusted, per 100,000 

population) (1999, 2007)1* Bii,iii 









 B  B

15-33a. Maltreatment of children (per 1,000 

population, <18 years) (1998, 2009)† B

15-33b. Child maltreatment fatalities (per 

100,000 population, <18 years) 

(1998, 2009)†

B

15-34. Physical assault by intimate partners 

(per 1,000 population, 12+ years) 

(1998, 2009)4*

15-35. Rape or attempted rape (per 1,000 

population, 12+ years) (1998, 2009)4* i i

15-36. Sexual assault other than rape (per 

1,000 population, 12+ years) (1998, 

2009)4,5*

i i

15-37. Physical assaults (per 1,000 population, 

12+ years) (1998, 2008)4* b B B 

15-38. Physical fighting among students 

(grades 9–12) (1999, 2009)* B B

15-39. Weapon carrying by students on school 

property (grades 9–12) (1999, 2009)* 

 b Biii Biii iv
15 • INJURY AND VIOLENCE PREVENTION 15-19

Figure 15-2. Health Disparities Table for Focus Area 15: Injury and Violence Prevention (continued)

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 15-6, 

15-10, 15-11, 15-15b, 15-19 through 15-22, 15-23a and b, 15-24, 15-26b, and 15-31a through c.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

LEGEND

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. Nonetheless, 

disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix.

1 Most recent data by education level are for 2002.

2 Baseline data by race and ethnicity are for 2000. 

3 Baseline data by race and ethnicity are for 2003. 

4 Baseline data by race and ethnicity are for 2003.

5 Most recent data by race and ethnicity are for 2008. 

i

 Data include persons of Hispanic origin.

ii Data are for Asian or Pacific Islander.

iiiThe group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

iv Reliability criterion for best group rate not met, or data available for only one group, at baseline. Change in disparity cannot be assessed. See Technical Appendix.
15-20 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 15-2. Health Disparities Table for Focus Area 15: Injury and Violence Prevention (continued)

DATA SOURCES

15-1–15-2. National Hospital Discharge Survey (NHDS), CDC, NCHS.

15-3. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-4. National Health Interview Survey (NHIS), CDC, NCHS.

15-5. National Electronic Injury Surveillance System (NEISS), Consumer Product Safety Commission (CPSC).

15-7. National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

15-8–15-9. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-12. National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

15-13. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-14. National Electronic Injury Surveillance System—All Injury Program (NEISS-AIP): CDC, NCIPC; Consumer Product Safety 

Commission (CPSC).

15-15a. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-16. Fatality Analysis Reporting System (FARS), Department of Transportation (DOT).

15-17–15-18. General Estimates System (GES), Department of Transportation (DOT).

15-25. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-26a. National Health Interview Survey (NHIS), CDC, NCHS.

15-27. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-28a–b. National Hospital Discharge Survey (NHDS), CDC, NCHS.

15-29. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-30. National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

15-32. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

15-33a–b. National Child Abuse and Neglect Data System (NCANDS), ACF.

15-34–15-37. National Crime Victimization Survey (NCVS), Department of Justice (DOJ), Bureau of Justice Statistics (BJS).

15-38–15-39. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.
15 • INJURY AND VIOLENCE PREVENTION 15-21 Figure 15-3. Deaths From Unintentional Injuries, 2005–07 Healthy People 2010 objective 15-13 • Target = 17.1 per 100,000 NOTES: Data are for ICD-10 codes V01–X59 and Y85–Y86 reported as underlying cause. Rates are age adjusted to the 2000 standard population and are displayed by a Jenk

areas. SOURCE: National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS. No hea

Rate pe
HEALTHY PEOPLE 2010 FINAL REVIEW 15-22Figure 15-4. Deaths From Motor Vehicle Crashes, 2005–07 Healthy People 2010 objective 15-15a • Target = 8.0 per 100,000 NOTES: Data are for ICD-10 codes V02–V04 (.1– .9), V09.2, V12–V14 (.3–.9), V19 (.4–.6), V20–V28 (.3–.9), V29 (.4–.9), V30–V39 (.4–.9), V40–V49 (.4–.9), V50–V59 (.4–.9), V60–

V81.1, V82.1, V83–V86 (.0–.3), V87 (.0–.8), and V89.2 reported as underlying cause. Rates are age adjusted to the 2000 standard population and are displayed by modified Jenks classification for U. S. health service areas. SOURCE: National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS. Lowes

health 

Rate p
Maternal, Infant, 

and Child Health

CHAPTER 16

Co-Lead Agencies

Centers for Disease Control and Prevention

Health Resources and Services Administration

Contents

Goal ................................................................................................16-3

Highlights ......................................................................................16-3

Summary of Progress.....................................................................16-5

Transition to Healthy People 2020................................................16-6

Data Considerations.......................................................................16-8

References and Notes.....................................................................16-9

Comprehensive Summary of Objectives......................................16-11

Progress Chart..............................................................................16-14

Health Disparities Table...............................................................16-17

Low Birth Weight (LBW) Births, 2006–08—Map.......................16-22

Preterm Live Births, 2006–08—Map..........................................16-23

16 • MATERNAL, INFANT, AND CHILD HEALTH 16-3

GOAL:

Improve the health and well-being of women, 

infants, children, and families.

The objectives in this chapter address a wide range of 

conditions related to the health and quality of life for 

mothers, infants, and children. These include infant 

and child deaths, congenital anomalies, pregnancyrelated illness, low birth weight and preterm deliveries, 

prenatal care, breastfeeding, newborn screenings, and 

availability of medical homes for children with special 

health care needs.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this focus area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in objectives for 

this Focus Area during the past decade [1]. Twothirds (66.7%) of the Maternal, Infant, and Child 

Health objectives with data to measure progress 

moved toward or achieved their Healthy People 2010 

targets (Figure 16-1). However, health disparities of 

100% or more among racial and ethnic population 

groups, as well as by sex and education level also 

were observed (Figure 16-2) [2].

〉 The fetal, perinatal, infant, neonatal, and postneonatal 

mortality rates (objectives 16-1a through e) declined 

over the decade, moving toward their 2010 targets. 

Between 1997 and 2005, the fetal mortality rate 

(deaths to fetuses of 20 weeks or more gestation per 

1,000 live births and fetal deaths, objective 16-1a) 

decreased 8.8%, from 6.8 to 6.2, moving toward the 

2010 target of 4.1. The infant mortality rate (deaths to 

infants under age 1 year per 1,000 live births, objective 

16-1c) declined 6.9% between 1998 and 2006, from 7.2 

to 6.7, moving toward the 2010 target of 4.5.

 Among racial and ethnic groups, the Asian or 

Pacific Islander population had the lowest (best) 

death rates for all of these objectives (16-1a 

through e). Disparities of 100% or more in all these 

objectives were observed for the non-Hispanic 

black population compared with the Asian or 

Pacific Islander population. For example:

 In 2005, the fetal mortality rate for the Asian 

or Pacific Islander population (objective 16-1a) 

was 4.8 fetal deaths per 1,000 live births plus 

fetal deaths, whereas the rate for the nonHispanic black population was 11.1, almost 

two and a half times that for the Asian or 

Pacific Islander population [2].

 Similarly, the infant mortality rate for the Asian 

or Pacific Islander population (objective 16-1c) 

was 4.5 per 1,000 live births in 2006, whereas 

the rate for the non-Hispanic black population 

was 13.4, about three times that for the Asian 

or Pacific Islander population [2].

 The American Indian or Alaska Native 

population also experienced large disparities 

in infant (objective 16-1c) and postneonatal 

mortality rates (objective 16-1e; deaths to 

infants aged 28 days to under age 1 year per 

1,000 live births). In 2006, the American Indian 

or Alaska Native population had an infant 

mortality rate of 8.3, almost twice the Asian 

or Pacific Islander population rate of 4.5. The 

American Indian or Alaska Native population 

also had a postneonatal mortality rate of 4.0 

per 1,000 live births, almost three times the 

Asian or Pacific Islander population rate of 

1.4. The postneonatal mortality rate for the 
16-4 HEALTHY PEOPLE 2010 FINAL REVIEW

non-Hispanic black population (4.4 per 1,000 

live births) was more than three times that for 

the Asian or Pacific Islander population [2].

 Among education groups, infants of mothers 

aged 20 and over with at least some college 

education had the lowest (best) postneonatal 

mortality rate (objective 16-1e), 1.4 postneonatal 

deaths per 1,000 live births in 2002. Infants 

whose mothers had less than a high school 

education had a rate of 3.3 postneonatal deaths 

per 1,000 live births, almost two and a half 

times the best group rate [2].

〉 Deaths from sudden infant death syndrome (SIDS; 

objective 16-1h) among infants under age 1 year 

declined 17.9% between 1999 and 2006, from 0.67 to 

0.55 deaths per 1,000 live births, moving toward the 

2010 target of 0.23. The proportion of infants under 

age 8 months who were placed to sleep on their backs 

(objective 16-13) increased 105.6% between 1996 and 

2009, from 36% to 74%, exceeding the target of 70%. 

Placing infants to sleep on their backs is considered 

one of the best ways to reduce risk of SIDS [3].

 Among racial and ethnic groups, the Hispanic 

or Latino population had the lowest (best) SIDS 

death rate, 0.27 deaths per 1,000 live births in 

2006. The non-Hispanic white population had 

a SIDS death rate of 0.56 per 1,000 live births, 

more than twice the best group rate (that for the 

Hispanic or Latino population); the non-Hispanic 

black population had a rate of 1.05 per 1,000 live 

births, almost four times the best rate; and the 

rate for the American Indian or Alaska Native 

population was 1.19 per 1,000 live births, almost 

four and a half times the best group rate [2].

 Among education groups, infants of mothers 

with at least some college education had the 

lowest (best) rate of SIDS death in 2002, 0.27 

per 1,000 live births. The rate for infants whose 

mothers were high school graduates was 0.69, 

about two and a half times the best group rate. 

The rate for infants whose mothers had less than 

a high school education was 0.86, more than 

three times the best rate [2].

〉 Death rates among children and adolescents 

(objectives 16-2a and b, and 16-3a and b) declined 

11% to 21% between 1998 and 2007, moving toward 

the 2010 targets. Yet the death rate for young adults 

aged 20–24 (objective 16-3c) increased 6.0%, from 

92.7 to 98.3 deaths per 100,000 population, moving 

away from the 2010 target of 41.5.

 In 2007, among racial and ethnic groups, the 

Asian or Pacific Islander population had the 

lowest (best) mortality rates for all age groups, 

although the rate for children aged 5–9 years 

(objective 16-2b) did not meet the reliability 

criterion for the best group rate. Therefore, the 

non-Hispanic white population was considered 

to have the best rate for the purpose of racial and 

ethnic disparity comparisons for this objective; 

see Figure 16-2 footnotes.

Mortality—Children aged 1–4 years (objective 

16-2a)

 The Asian or Pacific Islander population had 

the lowest (best) mortality rate among children 

aged 1–4 years, 21.7 deaths per 1,000 population 

in 2007, whereas the American Indian or Alaska 

Native and non-Hispanic black populations had 

rates of 54.9 and 43.7 per 1,000, respectively. The 

rate for the American Indian or Alaska Native 

population was about two and a half times the 

best rate, whereas that for the non-Hispanic 

black population was about twice the best rate 

[2].

Mortality—Adolescents aged 10–14 years (objective 

16-3a)

 The Asian or Pacific Islander population had the 

lowest (best) mortality rate among adolescents 

aged 10–14 years, 12.3 deaths per 100,000 

population in 2007. The non-Hispanic black 

population had a rate of 24.6 per 100,000, twice 

the best rate [2].

Mortality—Adolescents aged 15–19 years (objective 

16-3b)

 In 2007, the Asian or Pacific Islander population 

had the lowest (best) mortality rate among 

adolescents aged 15–19 years, 32.7 deaths per 

100,000 population, whereas the American 

Indian or Alaska Native and non-Hispanic black 

populations had rates of 86.5 and 85.7 deaths per 

100,000, respectively, more than two and a half 

times the best rate [2].

Mortality—Young adults aged 20–24 years 

(objective 16-3c)

 The Asian or Pacific Islander population had 

the lowest (best) mortality rates among young 

adults aged 20–24 years, 41.6 deaths per 100,00 

population in 1998 and 53.2 in 2007. The American 

Indian or Alaska Native population had rates of 

127.6 in 1998 and 120.7 in 2007, whereas the nonHispanic black population had rates of 163.4 in 

1998 and 142.2 in 2007. 

 In 2007, the rate for the American Indian or 

Alaska Native population was almost two and 

a half times the best rate (that for the Asian or 

Pacific Islander population); and the rate for 

the non-Hispanic black population was more 

than two and a half times the best rate [2].

 Between 1998 and 2007, the disparity between 
16 • MATERNAL, INFANT, AND CHILD HEALTH 16-5

the American Indian or Alaska Native 

population and the Asian or Pacific Islander 

population (group with the best rate) decreased 

80 percentage points, whereas the disparity 

between the non-Hispanic black population 

and the Asian or Pacific Islander population 

decreased 125 percentage points [4].

Mortality—Females aged 15–19 and 20–24 years 

(objectives 16-3b and c)

 Females aged 15–19 and 20–24 years had lower 

(better) death rates than males, 35.7 and 48.4 

deaths per 100,000 population, respectively in 

2007. The rate for males aged 15–19 years was 

86.8 per 100,000, almost two and a half times the 

rate for females. The rate for males aged 20–24 

years was 145.2 per 100,000, three times the rate 

for females [2].

〉 Cesarean births to low-risk women increased 

between 1998 and 2007. During this period the 

proportion of cesarean births to low-risk women who 

had not had a previous cesarean (objective 16-9a) 

rose 44.4%, from 18% to 26%, moving away from the 

2010 target of 15%. The proportion of repeat cesarean 

births (objective 16-9b) increased 26.4%, from 72% to 

91%, moving away from the 2010 target of 63%.

〉 Between 1998 and 2007, the proportion of live births 

that were low birth weight (under 2,500 grams, 

objective 16-10a) and very low birth weight (under 

1,500 grams, objective 16-10b) increased 7.9% 

(from 7.6% to 8.2%) and 7.1% (from 1.4% to 1.5%), 

respectively, moving away from the 2010 targets of 

5.0% and 0.9%.

 Among racial and ethnic groups, the Hispanic 

or Latino population had the lowest (best) rate 

of low birth weight births, 6.9% in 2007. The nonHispanic black population had a rate of 13.9%, 

about twice the best rate. The Asian or Pacific 

Islander population had the lowest (best) rate 

of very low birth weight births, 1.1%. The rate of 

very low birth weight births for the non-Hispanic 

black population was 3.2%, almost three times 

the best rate [2].

〉 Low birth weight birth rates varied by geographic 

region. In 2006–08, the proportions of low birth 

weight infants born in the Southeast and Mountain 

West were higher than the proportions of low birth 

weight infants born in the Northwest, Midwest, and 

Northeast regions of the U.S. A few geographic areas 

met the 2010 target of 5.0 low birth weight births per 

1,000 live births (Figure 16-3).

〉 Between 1998 and 2007, the proportion of preterm 

live births (less than 37 completed weeks of gestation, 

objective 16-11a) increased 9.5%, from 11.6% to 12.7%, 

moving away from the 2010 target of 7.6%.

〉 Preterm live births varied by geographic region. In 

2006–08, the proportion of preterm infants born 

in the Southeast was higher than the proportion of 

preterm infants born in the Northwest, Midwest, or 

Northeast regions of the U.S. (Figure 16-4).

〉 The proportion of nonpregnant women aged 15–44 

years who consumed at least 400 μg of folic acid 

(objective 16-16a) increased 14.3% between 1991–94 

and 2005–06, from 21% to 24%, moving toward the 

2010 target of 80%. The median red blood cell (RBC) 

folate level (objective 16-16b) among nonpregnant 

women aged 15–44 years increased 58.2% from 

1988–94 to 2005–06, from 158 to 250 ng/ml, 

exceeding the 2010 target of 220. Between 1996 and 

2007, the rate of spina bifida and other neural tube 

defects (objective 16-15) decreased 20.0%, from 60 to 

48 new cases per 100,000 live births, moving toward 

the 2010 target of 30 per 100,000.

〉 The proportion of mothers who breastfed their 

infants (objectives 16-19a through e) increased for 

every category, moving toward the 2010 targets. The 

largest increase was observed for the proportion of 

mothers who breastfed their infants at 1 year after 

birth (objective 16-19c). Between 2000 and 2006, 

the proportion increased 43.8%, from 16% to 23%, 

moving toward the 2010 target of 25%.

Summary of Progress

〉 Figure 16-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for Maternal, Infant, and Child Health [1]. 

Data to measure progress toward target attainment 

were available for 42 objectives. Of these:

 Three objectives (16-13, 16-14c, and 16-16b) 

exceeded their 2010 targets.

 Twenty-five objectives moved toward their 

targets. A statistically significant difference 

between the baseline and the final data points 

was observed for 19 of these objectives (16-1a 

through e; 16-1g and h; 16-2a and b; 16-3a and 

b; 16-6a and b; 16-17c; and 16-19a through e). 

No significant differences were observed for 

3 objectives (16-4, 16-5a, and 16-21); and data 

to test the significance of the difference were 

unavailable for 3 objectives (16-8, 16-15, and 

16-16a).

 Five objectives (16-1f; 16-11c; and 16-17a, b, and d) 

showed no change.

 Nine objectives moved away from their targets. 

A statistically significant difference between 

the baseline and final data points was observed 

for seven of these objectives (16-3c; 16-9a and b; 
16-6 HEALTHY PEOPLE 2010 FINAL REVIEW

16-10a and b; and 16-11a and b). No significant 

differences were observed for two objectives (16-

14a and b).

〉 Three objectives (16-12, and 16-20a and b) remained 

developmental [5]. Follow-up data were unavailable 

to measure progress for four objectives (16-7, 16-18, 

16-22, and 16-23). Four objectives (16-5b and c, 16-14d, 

and 16-20c) were deleted at the Midcourse Review.

〉 Figure 16-2 displays health disparities in Maternal, 

Infant, and Child Health from the best group rate for 

each characteristic at the most recent data point [2]. 

It also displays changes in disparities from baseline 

to the most recent data point [4].

 Thirty-three objectives had statistically significant racial and ethnic health disparities of 10% 

or more, and four additional objectives had racial 

and ethnic health disparities of 10% or more, but 

lacked data to assess statistical significance. Of 

these 37 objectives, the Asian or Pacific Islander 

population had the unique best rate for 13 

objectives (16-1b through f; 16-2a; 16-3a through c; 

16-10b; and 16-11a through c). The non-Hispanic 

white population had the unique best rate for 

11 objectives (16-2b, 16-4, 16-5a, 16-6a and b, 

16-7, 16-13, 16-14a, 16-14c, and 16-16a and b). The 

Asian population had the unique best rate for 

four objectives (16-19b through e). The Hispanic 

or Latino population had the unique best rate for 

three objectives (16-1h, 16-10a, and 16-19a). And 

the non-Hispanic black and American Indian 

or Alaska Native population had the unique 

best rate for one objective each (16-15 and 16-

9a, respectively). The non-Hispanic white and 

Hispanic or Latino populations both had the 

best rate for two objectives (16-1g and 16-18). 

The Asian or Pacific Islander and non-Hispanic 

white populations both had the best rate for one 

objective (16-1a). And the Asian or Pacific Islander 

and Hispanic or Latino populations both had the 

best rate for one objective (16-17c).

 Twelve objectives had statistically significant 

health disparities of 10% or more by sex. Females 

had better rates for 11 of these 12 objectives (16-

1b through 1e; 16-1h; 16-2a and b; 16-3a through 

c; and 16-14a). Males had the better rate for the 

remaining objective (16-10a).

 Twenty-three objectives had statistically 

significant health disparities of 10% or more by 

education level (16-1a through h; 16-4; 16-6a and 

b; 16-10a and b; 16-11a through c; 16-16a and b; 

16-17c; and 16-19a through d), and one additional 

objective (16-7) had a health disparity of 10% or 

more by education level but lacked data to assess 

statistical significance. Persons with at least 

some college education had the best rate for each 

of these 24 objectives.

 Persons without disabilities had a better rate 

for the one objective (16-16a) with statistically 

significant health disparities of 10% or more by 

disability status.

 Twenty objectives had racial and ethnic health 

disparities of 100% or more. Three objectives had 

health disparities of 100% or more by sex, and six 

objectives had health disparities of 100% or more 

by education level. Changes in disparity between 

the baseline and most recent points were 

observed for several objectives. Many of these 

disparities were discussed in the Highlights, 

above.

Transition to Healthy People 

2020

For Healthy People 2020, the Maternal, Infant, and Child 

Health Topic Area continues to address a wide range 

of conditions, health behaviors, and health systems 

indicators that affect the health, wellness, and quality 

of life of women, infants, children, and families. See 

HealthyPeople.gov for a complete list of Healthy People 

2020 topics and objectives.

The Healthy People 2020 Maternal, Infant, and Child 

Health objectives can be grouped into seven sections:

〉 Morbidity and mortality

〉 Pregnancy health and behaviors

〉 Preconception health behaviors

〉 Postpartum health and behaviors

〉 Infant care

〉 Disability and other impairments

〉 Health services.

The transition from Healthy People 2010 to Healthy 

People 2020 objectives is summarized below:

〉 The Healthy People 2020 Maternal, Infant, and Child 

Health Topic Area has 71 objectives, 10 of which 

are developmental, whereas the Healthy People 

2010 Focus Area had 53 objectives, 3 of which were 

developmental [5].

〉 Thirty Healthy People 2010 objectives, including 13 

mortality objectives (16-1a through h; 16-2a and b; 

and 16-3a through c), 5 morbidity objectives (16-5a, 

16-10a and b, and 16-11a and c), 5 breastfeeding 

objectives (16-19a through e), 3 obstetrical/infant 

care objectives (16-9a and b, and 16-22), 1 folic acid 
16 • MATERNAL, INFANT, AND CHILD HEALTH 16-7

intake objective (16-16a), 2 objectives on abstinence 

from illicit drugs and alcohol during pregnancy 

(objectives 16-17a and d), and 1 objective on very 

low birth weight infants born at level III facilities 

(objective 16-8) were retained “as is” [6].

〉 One Healthy People 2010 objective (16-14a), children 

diagnosed with mental retardation, was archived [7].

〉 Four Healthy People 2010 objectives were deleted at 

the Midcourse Review due to lack of a national data 

source. These objectives include: hospitalization for 

ectopic pregnancies (objective 16-5b), hospitalizations 

for postpartum complications including depression 

(objective 16-5c), children diagnosed with epilepsy 

(objective 16-14d), and enrollment of infants with 

disorders diagnosed through newborn bloodspot 

screening in appropriate service interventions 

(objective 16-20c).

〉 Eighteen Healthy People 2010 objectives were 

modified to create 24 Healthy People 2020 objectives 

[8]:

 Maternal mortality statistics are based upon 

the information recorded on death certificates 

and collected by State and local vital records 

offices. Due to concerns about data quality in 

the ascertainment of maternal mortality, the 

2003 revision of the standard death certificate 

introduced improved data quality but produced 

rates that are not comparable with rates produced 

using the 1989 version of the death certificate [9]. 

For Healthy People 2010, data obtained from the 

1989 version of the standard death certificate 

were used from the baseline through 2002 to 

track this objective (16-4). The Healthy People 

2020 objective will be tracked with data from the 

2003 standard death certificate.

 Objectives on prenatal care (objective 16-6a and 

b) and maternal smoking during pregnancy 

(objective 16-17c) were derived from information 

recorded on birth certificates and also collected 

by State and local vital records offices. Due to the 

desire to produce more robust information, the 

2003 revision of the standard birth certificate 

introduced improved data quality but produced 

rates that are not comparable with rates produced 

using the 1989 version of the birth certificate 

[10,11]. For Healthy People 2010, data obtained 

from the 1989 version of the standard birth 

certificate were used from the baseline through 

2002 to track these objectives. The Healthy 

People 2020 objectives will be tracked with data 

from the 2003 standard birth certificate.

 The objective on maternal weight gain 

during pregnancy (objective 16-12) remained 

developmental throughout the tracking period 

for Healthy People 2010. New data from the 2003 

revision of the standard birth certificate will be 

used to track this objective in Healthy People 

2020.

 In Healthy People 2010, only one national data 

point could be obtained to monitor the proportion 

of pregnant women who attended childbirth 

classes (objective 16-7). The data system used to 

track this objective is being changed for Healthy 

People 2020 in the effort to provide trend data.

 Preterm birth at 32–36 weeks gestation (objective 

16-11b) was revised to include an additional 

objective to monitor the rate of late preterm birth 

(live births at 34–36 weeks gestation) in addition 

to live births at 32–33 weeks gestation, live births 

at less than 32 weeks gestation, and total preterm 

births. This change was made in recognition of 

evidence showing that late preterm infants, 

those born between 34 and 36 completed weeks 

of gestation, comprise over 70% of all preterm 

births and account for almost all of the increase 

in the U.S. preterm birth rate over the past two 

decades [12]. These new reporting categories are 

consistent with reports on birth outcomes [13].

 Fetal alcohol syndrome (objective 16-18) is 

tracked with data from the Fetal Alcohol 

Syndrome Surveillance Network (FASSNet). 

For Healthy People 2010, the overall prevalence 

was determined using data from four of the five 

funded states for the birth years 1995 through 

1997 [14]. When the FASSNet cooperative 

agreement ended, seven programs from eight 

states were funded under a different agreement 

to conduct prevention and surveillance of fetal 

alcohol syndrome. Colorado was the only state 

to be funded under both FASSNet and the new 

agreement. Because the remaining funded states 

did not include the FASSNet states, the data used 

to monitor the Healthy People 2020 objective are 

not comparable with the Healthy People 2010 

data.

 In 2002, the National Institute on Alcohol Abuse 

and Alcoholism revised the definition of binge 

drinking for women from drinking five or more 

alcoholic beverages at the same time or within 

a couple of hours of each other to four or more 

alcoholic beverages [15]. For Healthy People 2010, 

binge drinking during pregnancy (objective 

16-17b) is tracked with the original definition. 

Healthy People 2020 will track binge drinking 

with the revised definition.

 Data for newborn bloodspot screening and followup was never obtained to track the two Healthy 

People 2010 objectives (16-20a and b). In Healthy 

People 2020, the data source was changed, and 

the objectives were modified so that they could 

be tracked. An additional objective that tracks 

annual assessments of services was also added.
16-8 HEALTHY PEOPLE 2010 FINAL REVIEW

 The Healthy People 2010 infant sleep position 

objective (16-13) was tracked using data from 

the National Infant Sleep Position Study. The 

Pregnancy Risk Assessment Monitoring System 

is used to measure infant sleep position for the 

Healthy People 2020 objective. The new data 

source will monitor the percentage of infants 

who are placed to sleep on their backs.

 The Healthy People 2010 objective monitoring 

the rate of cerebral palsy in children (objective 

16-14b) was revised to track the proportion of 

children with cerebral palsy born at low birth 

weight (less than 2,500 grams). The scope was 

shifted because cerebral palsy is the most 

common motor disability in childhood affecting 

approximately 1.5 to 3.3 per 1,000 live births [16]. 

The inverse relationship between increased risk 

of cerebral palsy and being born at lower birth 

weights has been consistently well supported 

over time [17].

 The Healthy People 2010 objective that tracked 

the average age at which autism spectrum 

disorders were identified in children (objective 

16-14c) was revised into three Healthy People 

2020 objectives: the proportion of young children 

screened for autism spectrum disorders (ASD) by 

age 24 months, the proportion of children with 

an ASD with a first evaluation by age 36 months, 

and the proportion of children with an ASD 

enrolled in special services by age 48 months.

 The Healthy People 2010 objective that tracked 

the occurrence of spina bifida and other neural 

tube defects (objective 16-15) was revised into 

two Healthy People 2020 objectives: the rate of 

anencephaly diagnosed in infants and the rate of 

spina bifida diagnosed in infants.

 The Healthy People 2010 objective that 

tracked the median red blood cell (RBC) folate 

concentration in nonpregnant women (objective 

16-16b) was revised for Healthy People 2020 to 

track the proportion of non-pregnant women 

with low RBC folate levels. The Healthy People 

2010 target for this objective was exceeded; 

the revision reflects a continued interest in 

monitoring women at greatest risk sub-optimal 

RBC folate concentrations.

 The Healthy People 2010 objective that tracked 

the rate of hospitalization for sickle cell disease 

in black or African-American children (objective 

16-21) was moved to the Blood Disorders and 

Blood Safety Topic Area for Healthy People 2020.

 The Healthy People 2010 objective addressing the 

proportion of children with special health care 

needs under age 18 years who receive their care 

in family-centered, comprehensive, coordinated 

systems (objective 16-23) was divided into two 

objectives: children under age 11 years and 

children aged 12–17 years.

〉 Seventeen new objectives, seven of which are 

developmental, were added to the Healthy People 

2020 Topic Area:

 Two new objectives that track infant deaths; one 

from sudden unexpected infant deaths (SUID) 

and the other is for infants diagnosed with Down 

syndrome.

 Six new objectives relate to preconception care 

services and health behaviors prior to pregnancy:

 Discussed preconception health with a health 

professional

 Took multivitamins/folic acid

 Did not smoke

 Did not drink

 Had a healthy weight

 Used contraception to plan pregnancy.

 Two new objectives (targeting men and women, 

individually) will track impaired fecundity.

 Two new objectives will track postpartum health 

and behaviors: the relapse of smoking among 

women who quit smoking during pregnancy 

and the proportion of women giving birth who 

attend a postpartum care visit with a health care 

professional.

 Three new objectives will target infant care:

 Employers that have worksite lactation support 

programs

 Breastfed newborns not given formula within 

the first 2 days of life

 Births in facilities that provide recommended 

care for lactating mothers and their babies.

 Two new objectives will track children with 

developmental delays. The first will track the 

child’s age at first evaluation and the second will 

track the child’s age when enrolled in special 

services.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 
16 • MATERNAL, INFANT, AND CHILD HEALTH 16-9

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Beginning in 2003, education data from the National 

Vital Statistics System have been suppressed. The 

educational attainment item was changed in the new 

U.S. Standard Certificates for Births, Deaths, and Fetal 

Death in 2003 to be consistent with the Census Bureau 

data and to improve the ability to identify specific types of 

educational degrees. Many states, however, are still using 

the 1989 version of the U.S. Standard Certificates, which 

focuses on highest school grade completed. As a result, 

educational attainment data collected using the 2003 

version are not comparable with data collected using the 

1989 version [18].

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

References and Notes

1. Displayed in the Progress Chart (Figure 16-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 16-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 16-2). Disparity from the best group rate 

is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 
16-10 HEALTHY PEOPLE 2010 FINAL REVIEW

See the Figure 16-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. More information about infant sleep positions and 

SIDS can be found from the Back to Sleep Campaign 

website: http://www.nichd.nih.gov/publications/pubs/

safe_sleep_gen.cfm.

4. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 16-2 footnotes, as well as 

the Technical Appendix, for more detail.

5. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

6. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

7. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020. 

8. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

9. Chang J, Elam-Evans LD, Berg CJ, Herndon J, 

Flowers L, Seed KA, Syverson CJ. Pregnancy-related 

mortality surveillance—United States, 1991–1999. In: 

CDC surveillance summaries (February 21). MMWR 

52(SS-2):1–8. 2003. Available from http://www.cdc.

gov/mmwr/pdf/ss/ss5202.pdf.

10. National Center for Health Statistics. 2003 revision 

of the U.S. Standard Certificate of Live Birth. 

Hyattsville, MD: National Center for Health Statistics. 

2003. Available from http://www.cdc.gov/nchs/nvss/

vital_certificate_revisions.htm.

11. National Center for Health Statistics. Report of the 

panel to evaluate the U.S. Standard Certificates and 

Reports. Hyattsville, MD: National Center for Health 

Statistics. 2000. Available from http://www.cdc.gov/

nchs/data/dvs/panelreport_acc.pdf.

12. More information can be found from the March of 

Dimes website: http://www.marchofdimes.com/.

13. Hamilton BE, Martin JA, Ventura SJ. Births: 

Preliminary data for 2007. National vital statistics 

reports; vol 57 no 12. Hyattsville, MD: National Center 

for Health Statistics. 2009. Available from http://

www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf. 

14. Meaney FJ, Miller LA. A comparison of fetal alcohol 

syndrome surveillance network and birth defects 

surveillance methodology in determining prevalence 

rates of fetal alcohol syndrome. Birth Defects Res 

A Clin Mol Teratol 67:819–21. 2003. DOI: 10.1002/

bdra.10122.

15. NIAAA Newsletter, NIH Publication No. 04–5346. 

Available from http://pubs.niaaa.nih.gov/publications/

Newsletter/winter2004/Newsletter_Number3.pdf.

16. Pakula A, Van Naarden-Braun K, Yeargin-Allsopp M. 

Epidemiology and Classification of Cerebral Palsy, 

Phys Med Rehab 20(3):425–52. 2009, Aug.

17. Wu YW, Xing G, Fuentes-Afflick GE, Danielson 

B, Smith LH, Gilbert WM. Racial, Ethnic, and 

Socioeconomic Disparities in the Prevalence of 

Cerebral Palsy. Pediatrics 127(3):e674-81. 2011. 

Published ahead of print February 21, 2011. 

DOI:10.1542/peds.2010-1656.

18. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. 

Deaths: Final data for 2007. National vital statistics 

reports; vol 58 no 19. Hyattsville, MD: National Center 

for Health Statistics. 2010. Available from http://www.

cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf.
16 • MATERNAL, INFANT, AND CHILD HEALTH 16-11

Comprehensive Summary of Objectives: Maternal, Infant, and 

Child Health

Objective Description Data Source or Objective Status

16-1a Fetal deaths (20+ weeks gestation, per 1,000 live births plus 

fetal deaths)

National Vital Statistics System—Fetal Death and Natality (NVSSFD, NVSS-N), CDC, NCHS.

16-1b Perinatal deaths (28 weeks gestation to <7 days after birth, 

per 1,000 live births plus fetal deaths)

National Vital Statistics System—Fetal Death, Mortality and 

Natality (NVSS-FD, NVSS-M, NVSS-N), CDC, NCHS.

16-1c All Infant deaths (<1 year, per 1,000 live births) National Vital Statistics System—Mortality and Natality (NVSS-M, 

NVSS-N), CDC, NCHS.

16-1d Neonatal deaths (<28 days, per 1,000 live births) National Vital Statistics System—Mortality and Natality (NVSS-M, 

NVSS-N), CDC, NCHS.

16-1e Postneonatal deaths (28 days to <1 year, per 1,000 live 

births)

National Vital Statistics System—Mortality and Natality (NVSS-M, 

NVSS-N), CDC, NCHS.

16-1f Infant deaths due to birth defects (<1 year, per 1,000 live 

births)

National Vital Statistics System—Mortality and Natality (NVSS-M, 

NVSS-N), CDC, NCHS.

16-1g Infant deaths due to congenital heart defects (<1 year, per 

1,000 live births)

National Vital Statistics System—Mortality and Natality (NVSS-M, 

NVSS-N), CDC, NCHS.

16-1h Infant deaths due to sudden infant death syndrome (SIDS) (<1 

year, per 1,000 live births)

National Vital Statistics System—Mortality and Natality (NVSS-M, 

NVSS-N), CDC, NCHS.

16-2a Child deaths—1–4 years (per 100,000 population) National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

16-2b Child deaths—5–9 years (per 100,000 population) National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

16-3a Adolescent and young adult deaths—10–14 years (per 

100,000 population)

National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

16-3b Adolescent and young adult deaths—15–19 years (per 

100,000 population)

National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

16-3c Adolescent and young adult deaths—20–24 years (per 

100,000 population)

National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

16-4 Maternal deaths (per 100,000 live births) National Vital Statistics System—Mortality and Natality (NVSS-M, 

NVSS-N), CDC, NCHS.

16-5a Maternal complications during hospitalized labor and delivery 

(per 100 deliveries)

National Hospital Discharge Survey (NHDS), CDC, NCHS.

16-5b Maternal illness and complications due to pregnancy—

Hospitalizations for ectopic pregnancies

Deleted at the Midcourse Review.

16-5c Maternal illness and complications due to pregnancy—

Hospitalizations for postpartum complications, including 

depression

Deleted at the Midcourse Review.

16-6a Prenatal care—Beginning in first trimester National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-6b Prenatal care—Early and adequate National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-7 Childbirth class attendance—Pregnant women who attend National Survey of Early Childhood Health (NSECH): HRSA, MCHB; 

CDC, NCHS.

16-8 Very low birth weight infants born at level III hospitals Title V Reporting System, HRSA.

16-9a Cesarean births—No prior cesarean birth National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-9b Cesarean births—Prior cesarean birth National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.
16-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Maternal, Infant, and Child Health (continued)

Objective Description Data Source or Objective Status

16-10a Low birth weight (LBW), infants (<2,500 grams) National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-10b Very low birth weight (VLBW), infants (<1,500 grams) National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-11a Preterm live births—Total (<37 weeks gestation) National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-11b Preterm live births—32–36 weeks gestation National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-11c Preterm live births—<32 weeks gestation National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-12 Recommended weight gain during pregnancy Developmental.

16-13 Infants put to sleep on their backs (<8 months) National Infant Sleep Position Study (NISP), NIH, NICHD.

16-14a Developmental disabilities—Mental retardation—IQ ≤70 (per 

10,000 population, Metropolitan Atlanta, 8 years)

Metropolitan Atlanta Development Disabilities Surveillance Program 

(MADDSP), CDC, NCBDDD.

16-14b Developmental disabilities—Cerebral palsy (per 10,000 

population, Metropolitan Atlanta, 8 years)

Metropolitan Atlanta Development Disabilities Surveillance Program 

(MADDSP), CDC, NCBDDD.

16-14c Developmental disabilities—Age at first identification of 

autism spectrum disorder (in months, Metropolitan Atlanta, 8 

years)

Metropolitan Atlanta Development Disabilities Surveillance Program 

(MADDSP), CDC, NCBDDD.

16-14d Epilepsy—Metropolitan Atlanta Deleted at the Midcourse Review.

16-15 Spina bifida and other neural tube defects (new cases per 

100,000 live births)

National Birth Defects Prevention Network (NBDPN), CDC, 

NCBDDD.

16-16a Folic acid consumption ≥400μg daily by nonpregnant women 

(15–44 years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

16-16b Median red blood cell (RBC) folate level among nonpregnant 

women (ng/ml, 15–44 years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

16-17a Pregnant women abstaining from alcohol in past month 

(15–44 years)

National Survey on Drug Use and Health (NSDUH), SAMHSA.

16-17b Pregnant women abstaining from binge drinking in past month 

(15–44 years)

National Survey on Drug Use and Health (NSDUH), SAMHSA.

16-17c Pregnant women abstaining from cigarette smoking during 

pregnancy

National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-17d Pregnant women abstaining from illicit drugs in past month 

(15–44 years)

National Survey on Drug Use and Health (NSDUH), SAMHSA.

16-18 Fetal alcohol syndrome (cases per 1,000 live births) Fetal Alcohol Syndrome Surveillance System (FASSNet), CDC, 

NCBDDD.

16-19a Breastfeeding—Ever National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

16-19b Breastfeeding—At 6 months National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

16-19c Breastfeeding—At 1 year National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

16-19d Exclusive breastfeeding—Through 3 months National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

16-19e Exclusive breastfeeding—Through 6 months National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

16-20a Newborn bloodspot screening—State-mandated conditions Developmental.

16-20b Newborn bloodspot screening—Timely follow-up diagnostic 

testing for screening positives

Developmental.
16 • MATERNAL, INFANT, AND CHILD HEALTH 16-13

Objective Description Data Source or Objective Status

16-20c Newborn bloodspot screening—Timely enrollment of infant 

with diagnosed disorders in appropriate service interventions

Deleted at the Midcourse Review.

16-21 Hospital discharges for sickle cell disease (per 100,000 black 

or African-American children, ≤9 years)

National Hospital Discharge Survey (NHDS), CDC, NCHS.

16-22 Medical homes for children with special health care needs National Survey of Children with Special Health Care Needs (NSCSHCN), CDC, NCHS.

16-23 Service systems for children with special health care needs National Survey of Children with Special Health Care Needs (NSCSHCN), CDC, NCHS.

Comprehensive Summary of Objectives: Maternal, Infant, and Child Health (continued)
16-14 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 16-1. Progress Toward Target Attainment for Focus Area 16: Maternal, Infant, and Child Health

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

16-1a. Fetal deaths (20+ weeks gestation, 

per 1,000 live births plus fetal deaths)

22.2% 4.1 6.8

(1997)

6.2

(2005)

-0.6 Yes -8.8%

16-1b. Perinatal deaths (28 weeks gestation to 

<7 days after birth, per 1,000 live births 

plus fetal deaths)

24.1% 4.4 7.3

(1997)

6.6

(2005)

-0.7 Yes -9.6%

16-1c. All Infant deaths (<1 year, per 1,000 

live births)

18.5% 4.5 7.2

(1998)

6.7

(2006)

-0.5 Yes -6.9%

16-1d. Neonatal deaths (<28 days, per 1,000 

live births)

15.8% 2.9 4.8

(1998)

4.5

(2006)

-0.3 Yes -6.2%

16-1e. Postneonatal deaths (28 days to <1 year, 

per 1,000 live births)

16.7% 1.2 2.4

(1998)

2.2

(2006)

-0.2 Yes -8.3%

16-1f. Infant deaths due to birth defects 

(<1 year, per 1,000 live births)

0.0% 0.7 1.4

(1999)

1.4

(2006)

0.0 No 0.0%

16-1g. Infant deaths due to congenital heart 

defects (<1 year, per 1,000 live births)

34.8% 0.23 0.46

(1999)

0.38

(2006)

-0.08 Yes -17.4%

16-1h. Infant deaths due to sudden infant death 

syndrome (SIDS) (<1 year, per 1,000 

live births)

27.3% 0.23 0.67

(1999)

0.55

(2006)

0.12 Yes -17.9%

16-2. Child deaths (per 100,000 population)

a. 1–4 years 39.0% 20.0 34.1

(1998)

28.6

(2007)

-5.5 Yes -16.1%

b. 5–9 years 83.3% 13.0 17.2

(1998)

13.7

(2007)

-3.5 Yes -20.3%

16-3. Adolescent and young adult deaths 

(per 100,000 population)

a. 10–14 years 92.0% 16.5 21.5

(1998)

16.9

(2007)

-4.6 Yes -21.4%

b. 15–19 years 24.1% 38.0 69.5

(1998)

61.9

(2007)

-7.6 Yes -10.9%

c. 20–24 years 41.5 92.7

(1998)

98.3

(2007)

5.6 Yes 6.0%

16-4. Maternal deaths (per 100,000 live births) 17.9% 4.3 9.9

(1999)

8.9

(2002)

-1.0 No -10.1%

16-5a. Maternal complications during hospitalized 

labor and delivery (per 100 deliveries)

1.4% 24.0 31.2

(1998)

31.1

(2007)

-0.1 No -0.3%

16-6. Prenatal care

a. Beginning in fi rst trimester 14.3% 90% 83%

(1998)

84%

(2002)

1 Yes 1.2%

b. Early and adequate 6.3% 90% 74%

(1998)

75%

(2002)

1 Yes 1.4%

16-8. Very low birth weight infants born at level 

III hospitals

17.6% 90% 73%

(1996–97)

76%

(2008)

3 Not tested 4.1%

LEGEND Moved away from target1 Moved toward target Met or exceeded target
16 • MATERNAL, INFANT, AND CHILD HEALTH 16-15

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

16-9. Cesarean births

a. No prior cesarean birth 15% 18%

(1998)

26%

(2007)

8 Yes 44.4%

b. Prior cesarean birth 63% 72%

(1998)

91%

(2007)

19 Yes 26.4%

16-10a. Low birth weight (LBW), infants 

(<2,500 grams)

5.0% 7.6%

(1998)

8.2%

(2007)

0.6 Yes 7.9%

16-10b. Very low birth weight (VLBW), infants 

(<1,500 grams)

0.9% 1.4%

(1998)

1.5%

(2007)

0.1 Yes 7.1%

16-11. Preterm live births

a. Total (<37 weeks gestation) 7.6% 11.6%

(1998)

12.7%

(2007)

1.1 Yes 9.5%

b. 32–36 weeks gestation 6.4% 9.6%

(1998)

10.6%

(2007)

1.0 Yes 10.4%

c. <32 weeks gestation 0.0% 1.1% 2.0%

(1998)

2.0%

(2007)

0.0 No 0.0%

16-13. Infants put to sleep on their backs 

(<8 months)

111.8% 70% 36%

(1996)

74%

(2009)

38 Not tested 105.6%

16-14. Developmental disabilities (Metropolitan 

Atlanta, 8 years)

a. Mental retardation—IQ ≤70 (per 10,000 

population)

118.7 124.9

(1991–94)

136.0

(2008)

11.1 No 8.9%

b. Cerebral palsy (per 10,000 population) 30.2 31.8

(1991–94)

36.4

(2008)

4.6 No 14.5%

c. Age at fi rst identifi cation of autism 

spectrum disorder (in months)

300.0% 66 69

(1996)

60

(2008)

-9 Not tested -13.0%

16-15. Spina bifi da and other neural tube defects 

(new cases per 100,000 live births)

40.0% 30 60

(1996)

48

(2007)

-12 Not tested -20.0%

16-16a. Folic acid consumption ≥400μg daily by 

nonpregnant women (15–44 years)

5.1% 80% 21%

(1991–94)

24%

(2005–06)

3 Not tested 14.3%

16-16b. Median red blood cell (RBC) folate 

level among nonpregnant women (ng/ml, 

15–44 years)

148.4% 220 158

(1988–94)

250

(2005–06)

92 Yes 58.2%

16-17. Pregnant women abstaining from

a. Alcohol in past month (15–44 years) 0.0% 95% 90%

(2002–03)

90%

(2008–09)

0 No 0.0%

b. Binge drinking in past month 

(15–44 years)

 0.0% 100% 96%

(2002–03)

96%

(2008–09)

0 No 0.0%

c. Cigarette smoking during pregnancy 16.7% 99% 87%

(1998)

89%

(2002)

2 Yes 2.3%

d. Illicit drugs in past month (15–44 years) 0.0% 100% 96%

(2002–03)

96%

(2008–09)

0 No 0.0%

Figure 16-1. Progress Toward Target Attainment for Focus Area 16: Maternal, Infant, and Child Health (continued)
16-16 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 16-1. Progress toward Target Attainment for Focus Area 16: Maternal, Infant, and Child Health (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

16-19. Breastfeeding

a. Ever 75.0% 75% 71%

(2000)

74%

(2006)

3 Yes 4.2%

b. At 6 months 56.3% 50% 34%

(2000)

43%

(2006)

9 Yes 26.5%

c. At 1 year 77.8% 25% 16%

(2000)

23%

(2006)

7 Yes 43.8%

16-19. Exclusive breastfeeding

d. Through 3 months 40.0% 40% 30%

(2003)

34%

(2006)

4 Yes 13.3%

e. Through 6 months 57.1% 17% 10%

(2003)

14%

(2006)

4 Yes 40.0%

16-21. Hospital discharges for sickle cell disease 

(per 100,000 black or African-American 

children, ≤9 years)

93.4% 182.2 227.8

(1995–99)

185.2

(2003–07)

-42.6 No -18.7%

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 16-7, 16-12, 16-18, 16-20a, 16-20b, 16-22, and 16-23. Objectives 16-5b, 16-5c, 16-14d, and 

16-20c were deleted at the Midcourse Review.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

DATA SOURCES

16-1a. National Vital Statistics System—Fetal Death and Natality (NVSS-FD, NVSS-N), CDC, NCHS. 

16-1b. National Vital Statistics System—Fetal Death, Mortality and Natality (NVSS-FD, NVSS-M, NVSS-N), CDC, NCHS. 

16-1c–h. National Vital Statistics System—Mortality and Natality (NVSS-M, NVSS-N), CDC, NCHS. 

16-2a–b. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

16-3a–c. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

16-4. National Vital Statistics System—Mortality and Natality (NVSS-M, NVSS-N), CDC, NCHS.

16-5a. National Hospital Discharge Survey (NHDS), CDC, NCHS.

16-6a–b. National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-8. Title V Reporting System, HRSA.

16-9a–b. National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-10a–b. National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-11a–c. National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-13. National Infant Sleep Position Study (NISP), NIH, NICHD.

16-14a–c. Metropolitan Atlanta Development Disabilities Surveillance Program (MADDSP), CDC, NCBDDD.

16-15. National Birth Defects Prevention Network (NBDPN), CDC, NCBDDD.

16-16a–b. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

16-17a–b. National Survey on Drug Use and Health (NSDUH), SAMHSA.

16-17c. National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-17d. National Survey on Drug Use and Health (NSDUH), SAMHSA.

16-19a–e. National Immunization Survey (NIS): CDC, NCIRD; CDC, NCHS.

16-21. National Hospital Discharge Survey (NHDS), CDC, NCHS
16 • MATERNAL, INFANT, AND CHILD HEALTH 16-17

Figure 16-2. Health Disparities Table for Focus Area 16: Maternal, Infant, and Child Health

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPersons with disabilitiesPersons without disabilities

16-1a. Fetal deaths (20+ weeks gestation, per 1,000 live 

births plus fetal deaths) (1997, 2005)1,2,3* Bi  Bii B B

16-1b. Perinatal deaths (28 weeks gestation to <7 days 

after birth, per 1,000 live births plus fetal deaths) 

(1997, 2005)1,2,3*

 Bi B B

16-1c. All Infant deaths (<1 year, per 1,000 live births) 

(1998, 2006)1,2,3* Bi     B B

16-1d. Neonatal deaths (<28 days, per 1,000 live births) 

(1998, 2006)1,2,3* Bi 







 B B

16-1e. Postneonatal deaths (28 days to <1 year, 

per 1,000 live births) (1998, 2006)1,2,3* Bi   B  B 

16-1f. Infant deaths due to birth defects (<1 year, 

per 1,000 live births) (1999, 2006)1,2,3* Bi B B

16-1g. Infant deaths due to congenital heart defects (<1 

year, per 1,000 live births) (1999, 2006)1,2,3* bi Bii  B B Bii  B

16-1h. Infant deaths due to sudden infant death 

syndrome (SIDS) (<1 year, per 1,000 live births) 

(1999, 2006)1,2,3*

bi B  B  B

16-2a. Child deaths—1–4 years (per 100,000 

population) (1998, 2007)* Bi 

  B

b. Child deaths—5–9 years (per 100,000 

population) (1998, 2007)* bi 

 Bii B

16-3a. Adolescent and young adults deaths—10–14 

years (per 100,000 population) (1998, 2007)* Bi,ii B 

b. Adolescent and young adult deaths—15–19 

years (per 100,000 population) (1998, 2007)* 

 Bi B

c. Adolescent and young adult deaths—20–24 

years (per 100,000 population) (1998, 2007)* 

 Bi 







 

 B

16-4. Maternal deaths (per 100,000 live births) 

(1999, 2002)* i B B

16-5a. Maternal complications during hospitalized labor 

and delivery (per 100 deliveries) (1998, 2007)* iii Biii

16-6a. Prenatal care—Beginning in first trimester 

(1998, 2002)*  i B   B 
16-18 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 16-2. Health Disparities Table for Focus Area 16: Maternal, Infant, and Child Health (continued)

Race and Ethnicity Sex Education Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPersons with disabilitiesPersons without disabilities

b. Prenatal care—Early and adequate 

(1998, 2002)* i B  B 

16-7. Childbirth class attendance among pregnant 

women (2000)† B B

16-9a. Cesarean births—No prior cesarean birth 

(1998, 2007)1,2,3* B i  B

b. Cesarean births—Prior cesarean birth 

(1998, 2007)1,2,3* B i Bii

16-10a. Low birth weight (LBW), infants (<2,500 grams) 

(1998, 2007)1,2,3* i B B  B

16-10b. Very low birth weight (VLBW), infants 

(<1,500 grams) (1998, 2007)1,2,3* Bi Bii B B

16-11a. Preterm live births—Total (<37 weeks gestation) 

(1998, 2007)1,2,3* Bi,ii B B

b. Preterm live births—32–36 weeks gestation 

(1998, 2007)1,2,3* Bi,ii B B

c. Preterm live births—<32 weeks gestation 

(1998, 2007)1,2,3* Bi  B B

16-13. Infants put to sleep on their backs (<8 months) 

(1996, 2009)† iii

 Biii

16-14a. Developmental disabilities—Mental retardation—

IQ ≤70 (per 10,000 population, Metropolitan 

Atlanta, 8 years) (1991–94, 2008)*

B iv B 



16-14b. Developmental disabilities—Cerebral palsy 

(per 10,000 population, Metropolitan Atlanta, 

8 years) (1991–94, 2008)*

16-14c. Developmental disabilities—Age at first identification of autism spectrum disorder (in months, 

Metropolitan Atlanta, 8 years) (1996, 2008)†

B Bii

16-15. Spina bifida and other neural tube defects (new 

cases per 100,000 live births) (1996, 2007)4* Bii iv

16-16a. Folic acid consumption ≥400μg daily by 

nonpregnant women (15–44 years) 

(1991–94, 2005–06)5‡

v B   B  B

16-16b. Median red blood cell (RBC) folate level among 

nonpregnant women (ng/ml, 15–44 years) 

(1988–94, 2005–06)6

*

v B B B
16 • MATERNAL, INFANT, AND CHILD HEALTH 16-19

Figure 16-2. Health Disparities Table for Focus Area 16: Maternal, Infant, and Child Health (continued)

Race and Ethnicity Sex Education Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPersons with disabilitiesPersons without disabilities

16-17a. Pregnant women abstaining from alcohol in past 

month (15–44 years) (2002–03, 2008–09)*

b. Pregnant women abstaining from binge 

drinking in past month (15–44 years) 

(2002–03, 2008–09)*

c. Pregnant women abstaining from cigarette 

smoking during pregnancy (1998, 2002)* Bi Bii   

  B 

d. Pregnant women abstaining from illicit drugs 

in past month (15–44 years) (2002–03, 

2008–09)*

16-18. Fetal alcohol syndrome (cases per 1,000 

live births) (1995–97)† Bvi iii B

16-19a. Breastfeeding—Ever (2000, 2006)2,3*

b  Bii 

 B

b. Breastfeeding—At 6 months (2000, 2006)2,3* 

 B    iv B

c. Breastfeeding—At 1 year (2000, 2006)2,3*  Bii   iv B

d. Exclusive breastfeeding—Through 3 months 

(2003, 2006)2,3* Bii  iv B

e. Exclusive breastfeeding—Through 6 months 

(2003, 2006)2,3*  Bii   iv B

16-21. Hospital discharges for sickle cell disease (per 

100,000 black or African-American children, ≤9 

years) (1995–99, 2003–07)*

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 16-8, 

16-12, 16-20a and b, 16-22, and 16-23. Objectives 16-5b and c, 16-14d, and 16-20c, were deleted at Midcourse Review.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.
16-20 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 16-2. Health Disparities Table for Focus Area 16: Maternal, Infant, and Child Health (continued)

LEGEND

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. Nonetheless, 

disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix.

‡ Measures of variability for data by education level and disability status were available only for the most recent data. Thus, the variability of best group rates was 

assessed only for the most recent data, and statistical significance was tested only for the most recent data. Disparities of 10% or more are displayed when the 

differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are displayed according to their magnitude, since 

measures of variability were not available at baseline and therefore statistical significance of changes in disparity could not be tested. See Technical Appendix.

1 Most recent data by education level are for 2002.

2 Data by education level are for the mother.

3 Data by race and ethnicity are for the mother.

4 Baseline data by race and ethnicity are for 1998.

5 Baseline data by race and ethnicity are for 2001–02. Measures of variability were available by race and ethnicity for 2001–02, see footnote * above.

6 Baseline data by disability status are for 1991–94.

i Data are for Asian or Pacific Islander.

ii The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. 

See Technical Appendix.

iiiData include persons of Hispanic origin.

ivChange in the summary index cannot be assessed. See Technical Appendix.

v Data are for Mexican American.

viData exclude black of Hispanic origin.

DATA SOURCES

16-1a. National Vital Statistics System—Fetal Death and Natality (NVSS-FD, NVSS-N), CDC, NCHS.

16-1b. National Vital Statistics System—Fetal Death, Mortality, and Natality (NVSS-FD, NVSS-M, NVSS-N), CDC, NCHS.

16-1c–h. National Vital Statistics System—Mortality and Natality (NVSS-M, NVSS-N), CDC, NCHS.

16-2a–b. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

16-3a–c. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

16-4. National Vital Statistics System—Mortality and Natality (NVSS-M, NVSS-N), CDC, NCHS.

16-5a. National Hospital Discharge Survey (NHDS), CDC, NCHS.
16 • MATERNAL, INFANT, AND CHILD HEALTH 16-21

Figure 16-2. Health Disparities Table for Focus Area 16: Maternal, Infant, and Child Health (continued)

16-6a–b. National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-7. National Survey of Early Childhood Health (NSECH): HRSA, MCHB; CDC, NCHS.

16-9a–b. National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-10a–b. National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-11a–c. National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-13. National Infant Sleep Position Study (NISP), NIH, NICHD.

16-14a–c. Metropolitan Atlanta Development Disabilities Surveillance Program (MADDSP), CDC, NCBDDD.

16-15. National Birth Defects Prevention Network (NBDPN), CDC, NCBDDD.

16-16a–b. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

16-17a–b. National Survey on Drug Use and Health (NSDUH), SAMHSA.

16-17c. National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

16-17d. National Survey on Drug Use and Health (NSDUH), SAMHSA.

16-18. Fetal Alcohol Syndrome Surveillance System (FASSNet), CDC, NCBDDD.

16-19a. National Immunization Survey (NIS), CDC, NCIRD and NCHS.

16-21. National Hospital Discharge Survey (NHDS), CDC, NCHS.
HEALTHY PEOPLE 2010 FINAL REVIEW 16-22Figure 16-3. Low Birth Weight (LBW) Births, 2006–08 Healthy People 2010 objective 16-10a • Target = 5.0 percent NOTES: Data are for low birth weight births (< 2,500 grams) as a percent of all live births. Rates are displayed by modified Jenks classification for U. S. health service areas. SOURCE: National Vital Statistics System—Natality (NVSS-N), CDC, NCHS. Lowest 

service 

Percen
16 • MATERNAL, INFANT, AND CHILD HEALTH 16-23 Figure 16-4. Preterm Live Births, 2006–08 Healthy People 2010 objective 16-11a • Target = 7.6 percent NOTES: Data are for preterm births (< 37 weeks gestations) as a percent of all live births. Rates are displayed by modified Jenks classification for U.S. health service areas. SOURCE: National Vital Statistics System—Natality (NVSS-N), CDC, NCHS. Lowes

service 

Percen

Medical Product 

Safety

CHAPTER 17

Lead Agency

Food and Drug Administration

Contents

Goal ................................................................................................17-3

Highlights ......................................................................................17-3

Summary of Progress.....................................................................17-3

Transition to Healthy People 2020................................................17-4

Data Considerations.......................................................................17-4

Notes..............................................................................................17-5

Comprehensive Summary of Objectives........................................17-6

Progress Chart................................................................................17-7

Health Disparities Table.................................................................17-8

17 • MEDICAL PRODUCT SAFETY 17-3

GOAL:

Ensure the safe and effective use of medical 

products.

The objectives in this chapter track the use of electronic 

medical records and prescription services, patient receipt 

of counseling about prescriptions, and availability of 

surveillance systems to monitor adverse drug reactions.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data1010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Some progress was achieved in objectives for this 

Focus Area during the past decade [1]. Five of the 

eight Medical Product Safety objectives with data 

to measure progress (objectives 17-2a through 17-2d, 

and 17-5a) moved toward or achieved their Healthy 

People 2010 targets (Figure 17-1).

〉 The use of electronic medical records by health care 

providers in health care organizations (objective 

17-2a) increased 166.7% between 2000 and 2007, from 

12% to 32%, exceeding the 2010 target of 18%.

〉 The use of computerized prescriber order entry in 

general and children’s hospitals (objective 17-2c) 

increased 533.3% between 2003 and 2010, from 3% to 

19%, exceeding the 2010 target of 4%. Similarly, the 

use of computerized prescriber order entry in urban 

acute care facilities (objective 17-2d) increased 76.9% 

between 2007 and 2009, from 13% to 23%, exceeding 

the 2010 target of 20%.

〉 The monitoring of adverse events associated with 

medical practice (objective 17-1a) declined 25.6% 

between 1999 and 2009, from 82% to 61%, moving 

away from the 2010 target of 90%.

〉 Blood donations among adults aged 18 and over 

(objective 17-6) remained stable. Six percent (age 

adjusted) of the U.S. population donated blood in 

2008, showing no change from 1998. This objective 

did not meet the 2010 target of 8%.

Summary of Progress

〉 Figure 17-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for Medical Product Safety [1]. Data to 

measure progress toward target attainment were 

available for eight objectives. Of these:

 Three objectives (17-2a, c, and d) met or exceeded 

their Healthy People 2010 targets.

 Two objectives (17-2b and 17-5a) moved toward 

their targets, but data to test the significance 

of the difference between the baseline and final 

data points were unavailable.

 One objective (17-6) showed no change.

 Two objectives (17-1a and 17-5b) moved away from 

their targets, but data to test the significance of 

the difference between the baseline and final 

data points were unavailable.

〉 One objective (17-4) had no follow-up data available 

to measure progress, and two objectives (17-1b and 

17-3) were deleted at the Midcourse Review.
17-4 HEALTHY PEOPLE 2010 FINAL REVIEW

〉 Figure 17-2 displays health disparities in Medical 

Product Safety from the best group rate for each 

characteristic at the most recent data point [2]. It 

also displays changes in disparities from baseline to 

the most recent data point [3].

 Disparity data were available for only one 

objective (17-6, blood donations). This objective 

showed no health disparities of 10% or more 

by race and ethnicity, sex, education level, or 

disability status.

Transition to Healthy People 

2020

The range of objectives covered in the Medical Product 

Safety chapter for Healthy People 2020 has been 

narrowed in comparison with the objectives presented 

in Healthy People 2010. The Healthy People 2010 Focus 

Area covered topics including electronic medical record 

use, blood donation, oral counseling on prescription 

medications and adverse medical events. In contrast, 

the Healthy People 2020 Topic Area focuses on overall 

improvement of patient treatment and appropriate 

use of medical products including drugs, biological 

products, and medical devices. The Healthy People 2020 

objectives reflect strong scientific support for safe use of 

medical products, which promotes better health among 

Americans. See HealthyPeople.gov for a complete list of 

Healthy People 2020 topics and objectives.

Objectives in the Healthy People 2020 Medical Product 

Safety Topic Area fall into two major categories:

〉 Monitoring of adverse medical events

〉 Safe and effective treatment of pain.

The differences between the Healthy People 2010 

objectives and those included in Healthy People 2020 

objectives are summarized below:

〉 The Healthy People 2020 Medical Product Safety 

Topic Area has a total of 11 objectives, 5 of which are 

developmental [4]. The Healthy People 2010 Medical 

Product Safety Focus Area also had 11 objectives.

〉 Two Healthy People 2010 objectives were retained 

“as is” [5]. Monitoring and analyzing adverse medical 

events within health care organizations and blood 

donations (objective 17-1a) was retained. The blood 

donation objective (objective 17-6) was also retained, 

but was moved to the Blood Safety Topic Area.

〉 Two Healthy People 2010 objectives were deleted at 

the Midcourse Review due to a lack of tracking data. 

These objectives include: adverse medical events 

associated with medical devices (objective 17-1b) and 

provider review of medications taken by patients and 

those with chronic conditions (objective 17-3).

〉 Seven Healthy People 2010 objectives were archived 

[6].

 Three objectives addressing the receipt of oral 

counseling and useful information regarding 

prescription medications were archived due to 

a lack of national data in the future (objectives 

17-4, 17-5a, and 17-5b).

 Four objectives that refer to electronic medical 

record use (objectives 17-2a through 17-2d) in 

Healthy People 2010 were also archived, as the 

Medical Product Safety Topic Area is no longer 

focusing on that issue.

〉 Although the Healthy People 2010 objectives on 

electronic medical record use have all been archived, 

there is a new objective on monitoring the proportion 

of medical practices that use electronic health records 

in the Healthy People 2020 Health Communication 

and Health Information Technology Topic Area.

〉 Nine new objectives were added to the Healthy 

People 2020 Medical Product Safety Topic Area:

 Four objectives that track the safe and effective 

treatment of pain have been added. These 

objectives track patients suffering from untreated 

pain due to a lack of access to pain treatment, the 

number of non-FDA approved pain medication 

on the market, and serious injuries and death 

from pain medications.

 Another new objective tracks the use of safe 

and effective medical products associated with 

predictive biomarkers.

 Four objectives were added to measure the 

number of emergency department visits for 

common, preventable adverse events from 

medication.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 
17 • MEDICAL PRODUCT SAFETY 17-5

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

Notes

1. Displayed in the Progress Chart (Figure 17-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 17-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 17-2). Disparity from the best group rate 

is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 17-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 17-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

5. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

6. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.
17-6 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Medical Product Safety

Objective Description Data Source or Objective Status

17-1a Monitoring and analyzing adverse events associated with 

medical therapies

National Survey of Pharmacy Practice in Acute Care Settings, 

American Society of Health Systems Pharmacists.

17-1b Monitoring of adverse medical events associated with medical 

devices 

Deleted at the Midcourse Review.

17-2a Electronic medical record use by health care providers in 

health care organizations

Annual Health Care Information and Management Systems Society 

Leadership Survey, Healthcare Information and Management 

Systems Society.

17-2b Electronic medical record use by pharmacists in managed 

care and integrated health systems

National Survey of Ambulatory Care Responsibilities of Pharmacists 

in Managed Care and Integrated Health Systems, American Society 

of Health Systems Pharmacists.

17-2c Computerized prescriber order entry use by general and 

children's hospitals

National Survey of Pharmacy Practice in Hospital Settings, 

American Society of Health Systems Pharmacists.

17-2d Computerized prescriber order entry use by urban acute care 

facilities

The Leapfrog Group Hospital Patient Safety Survey.

17-3 Provider review of medications taken by older patients and 

those with chronic conditions

Deleted at the Midcourse Review.

17-4 Receipt of useful information about prescriptions from 

pharmacies

Evaluation of Written Prescription Information Provided in 

Community Pharmacies, Food and Drug Administration.

17-5a Oral counseling about medications from prescribers National Survey of Prescription Medicine Information Received by 

Consumers, FDA.

17-5b Oral counseling about medications from pharmacists National Survey of Prescription Medicine Information Received by 

Consumers, FDA.

17-6 Blood donations (age adjusted, 18+ years) National Health Interview Survey (NHIS), CDC, NCHS.
17 • MEDICAL PRODUCT SAFETY 17-7

Figure 17-1. Progress Toward Target Attainment for Focus Area 17: Medical Product Safety

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

17-1a. Monitoring and analyzing adverse events 

associated with medical therapies

90% 82%

(1998)

61%

(2009)

-21 Not tested -25.6%

17-2. Electronic medical record use by

a. Health care providers in health care 

organizations

333.3% 18% 12%

(2000)

32%

(2007)

20 Not tested 166.7%

b. Pharmacists in managed care and 

integrated health systems

13.3% 46% 31%

(1999)

33%

(2001)

2 Not tested 6.5%

Computerized prescriber order entry 

use by

c. General and children’s hospitals 1,600.0% 4% 3%

(2003)

19%

(2010)

16 Not tested 533.3%

d. Urban acute care facilities 142.9% 20% 13%

(2007)

23%

(2009)

10 Not tested 76.9%

17-5. Oral counseling about medications from

a. Prescribers 2.8% 95% 24%

(1998)

26%

(2004)

2 Not tested 8.3%

b. Pharmacists 95% 14%

(1998)

6%

(2004)

-8 Not tested -57.1%

17-6. Blood donations (age adjusted, 18+ years) 0.0% 8% 6%

(1998)

6%

(2008)

0 No 0.0%

LEGEND Moved away from target1 Moved toward target Met or exceeded target

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objective 17-4. Objectives 17-1b and 17-3 were deleted at the Midcourse Review.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

DATA SOURCES

17-1a. National Survey of Pharmacy Practice in Acute Care Settings, American Society of Health Systems Pharmacists. 

17-2a. Annual Health Care Information and Management Systems Society Leadership Survey, Healthcare Information and Management 

Systems Society.

17-2b. National Survey of Ambulatory Care Responsibilities of Pharmacists in Managed Care and Integrated Health Systems, American Society 

of Health Systems Pharmacists.

17-2c. National Survey of Pharmacy Practice in Hospital Settings, American Society of Health Systems Pharmacists.

17-2d. Th e Leapfrog Group Hospital Patient Safety Survey.

17-5a–b. National Survey of Prescription Medicine Information Received by Consumers, FDA.

17-6. National Health Interview Survey (NHIS), CDC, NCHS.
17-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 17-2. Health Disparities Table for Focus Area 17: Medical Product Safety

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPersons with disabilitiesPersons without disabilities

17-6. Blood donations (age adjusted, 18+ years) 

(1998, 2008)1 Bi B B B Bi B

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 17-1a, 

17-2a through d, 17-4, and 17-5a and b. Objectives 17-1b and 17-3 were deleted at Midcourse Review.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

Measures of variability were available for the objective in this table. Thus, the variability of best group rates was assessed, and statistical significance was tested. 

Disparities of 10% or more are displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time 

are indicated by arrows when the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

LEGEND

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTE

1

 Baseline data by race and ethnicity are for 1999.

i

 The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. 

See Technical Appendix.

DATA SOURCE

17-6. National Health Interview Survey (NHIS), CDC, NCHS.
Mental Health and 

Mental Disorders

CHAPTER 18

Co-Lead Agencies

National Institutes of Health

Substance Abuse and Mental Health Services Administration

Contents

Goal ................................................................................................18-3

Highlights ......................................................................................18-3

Summary of Progress.....................................................................18-4

Transition to Healthy People 2020................................................18-5

Data Considerations.......................................................................18-5

References and Notes.....................................................................18-6

Comprehensive Summary of Objectives........................................18-8

Progress Chart................................................................................18-9

Health Disparities Table...............................................................18-10

Suicide, 2005–07—Map ..............................................................18-12

18 • MENTAL HEALTH AND MENTAL DISORDERS 18-3

GOAL:

Improve mental health and ensure access to 

appropriate, quality, mental health services.

The objectives in this chapter monitor a broad range of 

mental health disorders, behaviors, and problems, as 

well as the availability of a variety of community-based 

and other treatment programs for persons in need of 

mental health services.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in objectives for 

this Focus Area during the past decade [1]. All but 

one of the 11 Mental Health and Mental Disorders 

objectives with data to measure progress moved 

toward or achieved their Healthy People 2010 targets 

(Figure 18-1). However, health disparities persisted 

among racial and ethnic populations, as well as 

by sex and education level [2]. As discussed below, 

health disparities of 50% or more were observed for a 

number of objectives (Figure 18-2).

〉 The suicide rate (objective 18-1) increased 7.6% 

between 1999 and 2007, from 10.5 to 11.3 per 100,000 

population (age adjusted), moving away from the 2010 

target of 4.8 per 100,000. Disparities were observed 

for a number of population groups, for example:

 Among racial and ethnic groups, the nonHispanic black population had the lowest (best) 

suicide rate, 5.1 per 100,000 population (age 

adjusted) in 2007. The rates for the American 

Indian or Alaska Native and the non-Hispanic 

white populations were 11.5 and 13.5 per 100,000 

(age adjusted), respectively. The rate for the 

American Indian or Alaska Native population 

was almost two and a half times the best group 

rate (that for the non-Hispanic black population), 

whereas the non-Hispanic white rate was more 

than two and a half times the best group rate [2].

 The non-Hispanic white population had 

suicide rates of 12.0 per 100,000 population (age 

adjusted) in 1999 and 13.5 in 2007, whereas the 

non-Hispanic black population had rates of 5.7 

in 1999 and 5.1 in 2007. The disparity between 

the non-Hispanic white and non-Hispanic 

black populations increased 54 percentage 

points between 1999 and 2007 [3].

 Females had a lower (better) suicide rate than 

males, 4.7 per 100,000 population (age adjusted) 

in 2007. The rate for males was 18.4 per 100,000 

(age adjusted), almost four times the rate for 

females [2].

 Males had suicide rates of 17.8 per 100,000 

population (age adjusted) in 1999 and 18.4 in 

2007, whereas females had rates of 4.0 in 1999 

and 4.7 in 2007. The disparity between males 

and females declined 53 percentage points 

between 1999 and 2007 [3].

 Among education groups, persons with at least 

some college education had the lowest (best) 

suicide rate, 9.9 per 100,000 population (age 

adjusted) in 2002, whereas high school graduates 

had a rate of 18.4 per 100,000 (age adjusted), 

almost twice the best group rate [2].

〉 Suicide rates varied by geographic region. In 2005–07, 

the suicide rate was generally higher in the western 

U.S. than in the rest of the country (Figure 18-3).
18-4 HEALTHY PEOPLE 2010 FINAL REVIEW

 Suicide attempts by students in grades 9–12 

that required medical attention (objective 18-2) 

decreased 26.9% between 1999 and 2009, from 2.6% 

to 1.9%, moving toward the 2010 target of 1.0%.

〉 Six objectives exceeded their 2010 targets:

 The proportion of homeless adults aged 18 and 

over with mental health problems who received 

mental health services (objective 18-3) increased 

85.2% between 2000 and 2009, from 27% to 50%, 

exceeding the target of 30%.

 The proportion of adolescents (students in 

grades 9–12) who engaged in disordered eating 

to control their weight (objective 18-5) declined 

26.3% between 2001 and 2009, from 19% to 

14%, exceeding the target of 16%. Disparities 

were observed for some population groups, for 

example:

 Boys had a lower (better) rate of disordered 

eating than girls, 10% in 2009, whereas girls had 

a rate of 19%, almost twice the rate for boys.

 The proportion of primary care facilities that 

provided mental health treatment (objective 18-

6) increased 12.9% between 2000 and 2009, from 

62% to 70%, exceeding the target of 68%.

 The proportion of children aged 4–17 years with 

mental health problems who received treatment 

(objective 18-7) increased 15.0% between 2000 

and 2008, from 60% to 69%, exceeding the target 

of 67%.

 The proportion of juvenile residential facilities 

that screened new admissions for mental 

health problems (objective 18-8) increased 

16.0% between 2000 and 2006, from 50% to 58%, 

exceeding the target of 55%.

 The proportion of counties served by communitybased jail diversion programs for adults with 

serious mental illness (objective 18-11) more than 

doubled between 2004 and 2010, from 6.9% to 

14.1%, exceeding the target of 7.6%.

〉 Racial and ethnic health disparities were observed 

in the treatment of adults for serious mental illness, 

depression, and schizophrenia (objectives 18-9a 

through c).

 Non-Hispanic white adults aged 18 and over 

had the highest (best) rate of treatment for 

serious mental illness (objective 18-9a), 68% 

in 2002, whereas Hispanic or Latino and nonHispanic black adults had rates of 45% and 

51%, respectively. When expressed as persons 

not receiving treatment, the rate for Hispanic or 

Latino adults was more than one and a half times 

the rate that for non-Hispanic white adults [2]. 

The rate for non-Hispanic black adults was about 

one and a half times the non-Hispanic white rate.

 Non-Hispanic white adults also had the highest 

(best) rate of treatment for depression (objective 

18-9b), 63% in 2002, whereas Hispanic or Latino 

and non-Hispanic black adults had rates of 

42% and 43%, respectively. When expressed 

as persons not receiving treatment, the rate for 

Hispanic or Latino adults was more than one 

and a half times the rate that for non-Hispanic 

white adults, whereas the rate for non-Hispanic 

black adults was about one and a half times the 

non-Hispanic white rate [2].

 Similarly, non-Hispanic white adults had the 

highest (best) rate of treatment for schizophrenia 

(objective 18-9c), 63% in 2002, whereas Hispanic 

or Latino and non-Hispanic black adults had rates 

of 42% and 41%, respectively. When expressed as 

persons not receiving treatment, the rates for both 

groups (Hispanic or Latino and non-Hispanic 

black adults) were more than one and a half times 

the rate for non-Hispanic white adults [2].

〉 Males had a higher (better) employment rate than 

females for persons with serious mental illness 

(objective 18-4), 60% vs. 46% in 2002. When expressed 

as persons with serious mental illness who were 

unemployed, the rate for females was almost one and 

a half times that for males [2].

Summary of Progress

〉 Figure 18-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for Mental Health and Mental Disorders [1]. 

Data to measure progress toward target attainment 

were available for 11 objectives. Of these:

 Six objectives (18-3, 18-5 through 18-8, 18-11) 

exceeded their Healthy People 2010 targets.

 Four objectives moved toward their targets. A 

statistically significant difference between the 

baseline and the final data points was observed 

for one of these objectives (18-2). Data to test the 

significance of the difference were unavailable for 

the other three objectives (18-12 through 18-14).

 One objective moved away from the 2010 target. 

A statistically significant difference between the 

baseline and final data points was observed for 

this objective (18-1).

〉 Six objectives had no follow-up data available to 

measure progress (objectives 18-4, 18-9a through d, 

and 18-10).

〉 Figure 18-2 displays health disparities in Mental 

Health and Mental Disorders from the best group 

rate for each characteristic at the most recent data 
18 • MENTAL HEALTH AND MENTAL DISORDERS 18-5

point [2]. It also displays changes in disparities from 

baseline to the most recent data point [3].

 Five objectives had statistically significant 

racial and ethnic health disparities of 10% or 

more (objectives 18-1, 18-5, and 18-9a, b, and d), 

and one objective had racial and ethnic health 

disparities of 10% or more but lacked data to 

assess statistical significance (objective 18-9c). 

Of these six objectives, the non-Hispanic white 

population had the best rate for five objectives 

(18-5, and 18-9a through d), and the nonHispanic black population had the best rate for 

one objective (18-1).

 Health disparities of 50% to 99% between the 

non-Hispanic white (best rate) population 

and the other racial and ethnic populations 

with data (the Hispanic or Latino and the nonHispanic black populations) were observed 

for three treatment-related objectives: the 

proportion of adults with mental disorders 

who received treatment for serious mental 

illness (objective 18-9a), depression (objective 

18-9b), and schizophrenia (objective 18-9c); see 

Highlights, above.

 Females had better rates than males for three of 

the five objectives with statistically significant 

health disparities of 10% or more by sex (objectives 

18-1, and 18-9a and b). Males had better rates 

for the remaining two objectives (18-4, 18-5). 

Females also had a better rate of treatment for 

schizophrenia (objective 18-9c), the one objective 

with health disparities of 10% or more by sex that 

lacked data to assess statistical significance.

 Four objectives had statistically significant 

health disparities of 10% or more by education 

level (objectives 18-1, 18-4, and 18-9a and d), and 

one objective (18-9c) had health disparities of 

10% or more by education level but lacked data 

to assess statistical significance. Persons with at 

least some college education had the best rates 

for three of these five objectives (18-1, 18-4, and 

18-9d). High school graduates had the best rates 

for two objectives (18-9a and c).

 The disparities for objective 18-1, suicide, were 

discussed in the Highlights, above.

Transition to Healthy People 

2020

The focus of the Mental Health and Mental Disorders 

Healthy People 2020 Topic Area continues to include the 

broad range of objectives presented in Healthy People 

2010. Two objectives were added to the Topic Area, as 

noted below. See HealthyPeople.gov for a complete list of 

Healthy People 2020 topics and objectives.

The differences between the Healthy People 2010 

objectives and those included in Healthy People 2020 

objectives are summarized below:

〉 The Healthy People 2020 Mental Health and Mental 

Disorders Topic Area has a total of 15 objectives, 

whereas the Healthy People 2010 Mental Health and 

Mental Disorders Focus Area had 17 objectives.

〉 Seven Healthy People 2010 objectives (18-1 through 

18-3, 18-5 through 18-8) were retained “as is” [4].

〉 Three Healthy People 2010 objectives were modified 

[5]. Data sources had not been available for objectives 

addressing adults with mental health problems who 

received treatment (objectives 18-9a and b), adults 

with co-occurring substance abuse and mental 

health problems who received treatment (objective 

18-10), and adults with serious mental illness who 

were employed (objective 18-4). These objectives 

have been modified and will be tracked through the 

National Survey on Drug Use and Health.

〉 Two treatment objectives were archived due to lack 

of data: adults with generalized anxiety disorder who 

receive treatment (objective 18-9d), and adults with 

schizophrenia who received treatment (objective 

18-9c) [6]. Four additional objectives were archived 

due to policy considerations: community-based jail 

diversion programs for adults with serious mental 

illness (objective 18-11); state tracking of consumer 

satisfaction with mental health services (objective 

18-12); state mental health plans addressing cultural 

competence (objective 18-13); and state mental health 

plans addressing care of elderly persons (objective 

18-14).

〉 Two new objectives were added to the Healthy People 

2020 Topic Area. These objectives address:

 The proportion of persons who experience a 

major depressive episode

 Depression screening by primary care providers.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 
18-6 HEALTHY PEOPLE 2010 FINAL REVIEW

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

Beginning in 2003, education data for mortality objective 

18-1 (suicide) from the National Vital Statistics System 

have been suppressed. The educational attainment item 

was changed in the new U.S. Standard Certificate of 

Death in 2003 to be consistent with the Census Bureau 

data and to improve the ability to identify specific types 

of educational degrees. Many states, however, are still 

using the 1989 version of the U.S. Standard Certificate of 

Death, which focuses on highest school grade completed. 

As a result, educational attainment data collected using 

the 2003 version are not comparable with data collected 

using the 1989 version [7].

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

References and Notes

1. Displayed in the Progress Chart (Figure 18-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 18-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 18-2). Disparity from the best group rate is 

defined as the percent difference between the best 

group rate and each of the other group rates for a 

characteristic. For example, racial and ethnic health 

disparities are measured as the percent difference 

between the best racial and ethnic group rate and 

each of the other racial and ethnic group rates. 

Similarly, disparities by sex are measured as the 

percent difference between the better group rate (e.g., 

female) and the rate for the other group (e.g., male). 

Some objectives are expressed in terms of favorable 

events or conditions that are to be increased, while 

others are expressed in terms of adverse events 

or conditions that are to be reduced. To facilitate 

comparison of health disparities across different 

objectives, disparity is measured only in terms of 

adverse events or conditions. For comparability across 

objectives, objectives that are expressed in terms 

of favorable events or conditions are re-expressed 

using the adverse event or condition for the purpose 

of computing disparity, but they are not otherwise 

restated or changed. For example, objective 1-1, 

to increase the proportion of persons with health 

insurance (e.g., 72% of the American Indian or Alaska 

Native population under age 65 had some form of 

health insurance in 2008), is expressed in terms of the 

percentage of persons without health insurance (e.g., 

100% – 72% = 28% of the American Indian or Alaska 

Native population under age 65 did not have any form 

of health insurance in 2008) when the disparity from 

the best group rate is calculated. See the Reader’s 

Guide for more information. When standard errors 

were available, the difference between the best group 
18 • MENTAL HEALTH AND MENTAL DISORDERS 18-7

rate and each of the other group rates was tested at the 

0.05 level of significance. See the Figure 18-2 footnotes, 

as well as the Technical Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 18-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

5. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

6. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.

7. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. 

Deaths: Final data for 2007. National vital statistics 

reports; vol 58 no 19. Hyattsville, MD: National Center 

for Health Statistics. 2010. Available from http://www.

cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf.
18-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Mental Health and Mental 

Disorders

Objective Description Data Source

18-1 Suicide (age adjusted, per 100,000 population) National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

18-2 Suicide attempts by students that required medical attention 

(grades 9–12)

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

18-3 Homeless adults with mental health problems who receive 

mental health services (18+ years)

Projects for Assistance in Transition from Homelessness (PATH) 

Annual Application, SAMHSA.

18-4 Employment of persons with serious mental illness (SMI) (18+ 

years)

National Comorbidity Survey—Replication (NCS-R), NIH, NIMH.

18-5 Students engaging in disordered eating (grades 9–12) Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

18-6 Primary care facilities that provide mental health treatment Uniform Data System (UDS), HRSA.

18-7 Treatment for children with mental health problems (4–17 

years)

National Health Interview Survey (NHIS), CDC, NCHS.

18-8 Juvenile residential facilities that screen admissions for mental 

health problems

Juvenile Residential Facility Census (JRFC), National Center for 

Juvenile Justice.

18-9a Treatment for adults with serious mental illness (SMI) (18+ 

years)

National Comorbidity Survey—Replication (NCS-R), NIH, NIMH.

18-9b Treatment for adults with depression (18+ years) National Comorbidity Survey—Replication (NCS-R), NIH, NIMH.

18-9c Treatment for adults with schizophrenia (18+ years) Epidemiologic Catchment Area (ECA) Program, NIH, NIMH.

18-9d Treatment for adults with generalized anxiety disorder (18+ 

years)

National Comorbidity Survey—Replication (NCS-R), NIH, NIMH.

18-10 Treatment for co-occurring substance abuse and mental 

disorders (18+ years)

National Comorbidity Survey—Replication (NCS-R), NIH, NIMH.

18-11 Community-based jail diversion programs for adults with 

serious mental illness (SMI)

Mental Health Courts Survey (MHCS), SAMHSA.

18-12 State tracking of consumer satisfaction with mental health 

services (no. States and D.C.)

Uniform Reporting System (URS), SAMHSA.

18-13 State mental health plans addressing cultural competence (no. 

States and D.C.)

State Mental Health Agency Profiling System, National Association 

of State Mental Health Program Directors, National Research 

Institute; SAMHSA, CMHS.

18-14 State mental health plans addressing care of elderly persons 

(no. States and D.C.)

State Mental Health Agency Profiling System, National Association 

of State Mental Health Program Directors, National Research 

Institute; SAMHSA, CMHS.
18 • MENTAL HEALTH AND MENTAL DISORDERS 18-9

Figure 18-1. Progress Toward Target Attainment for Focus Area 18: Mental Health and Mental Disorders

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

18-1. Suicide (age adjusted, 

per 100,000 population)

4.8 10.5

(1999)

11.3

(2007)

0.8 Yes 7.6%

18-2. Suicide attempts by students that required 

medical attention (grades 9–12)

43.8% 1.0% 2.6%

(1999)

1.9%

(2009)

-0.7 Yes -26.9%

18-3. Homeless adults with mental health 

problems who receive mental health 

services (18+ years)

766.7% 30% 27%

(2000)

50%

(2009)

23 Not tested 85.2%

18-5. Students engaging in disordered eating 

(grades 9–12)

166.7% 16% 19%

(2001)

14%

(2009)

-5 Yes -26.3%

18-6. Primary care facilities that provide mental 

health treatment

133.3% 68% 62%

(2000)

70%

(2009)

8 Not tested 12.9%

18-7. Treatment for children with mental health 

problems (4–17 years)

128.6% 67% 60%

(2001)

69%

(2008)

9 Yes 15.0%

18-8. Juvenile residential facilities that screen 

admissions for mental health problems

160.0% 55% 50%

(2000)

58%

(2006)

8 Not tested 16.0%

18-11. Community-based jail diversion programs 

for adults with serious mental illness (SMI)

1,028.6% 7.6% 6.9%

(2004)

14.1%

(2010)

7.2 Not tested 104.3%

18-12. State tracking of consumer satisfaction 

with mental health services (no. States 

and D.C.)

94.1% 51 34

(2002)

50

(2009)

16 Not tested 47.1%

18-13. State mental health plans addressing 

cultural competence (no. States and D.C.)

33.3% 32 29

(2004)

30

(2009)

1 Not tested 3.4%

18-14. State mental health plans addressing care 

of elderly persons (no. States and D.C.)

12.1% 51 18

(2001)

22

(2009)

4 Not tested 22.2%

LEGEND Moved away from target1 Moved toward target Met or exceeded target

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 18-4, 18-9a through d, and 18-10.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

DATA SOURCES

18-1. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

18-2. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

18-3. Projects for Assistance in Transition from Homelessness (PATH) Annual Application, SAMHSA.

18-5. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

18-6. Uniform Data System (UDS), HRSA.

18-7. National Health Interview Survey (NHIS), CDC, NCHS.

18-8. Juvenile Residential Facility Census (JRFC), National Center for Juvenile Justice.

18-11. Mental Health Courts Survey (MHCS), SAMHSA.

18-12. Uniform Reporting System (URS), SAMHSA.

18-13–18-14. State Mental Health Agency Profi ling System, National Association of State Mental Health Program Directors, National Research 

Institute; SAMHSA, CMHS.
18-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 18-2. Health Disparities Table for Focus Area 18: Mental Health and Mental Disorders

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Income

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary index

18-1. Suicide (age adjusted, per 100,000 

population) (1999, 2007)1*  i  B 

  B   B

18-2. Suicide attempts by students that required medical attention (grades 9–12) 

(1999, 2009)*

18-4. Employment of adults with serious mental illness (SMI) (18+ years) (2002)* B B B

18-5. Students engaging in disordered eating 

(grades 9–12) (2001, 2009)* B ii B

18-7. Treatment for children with mental health 

problems (4–17 years) (2001, 2008)*

18-9a. Treatment for adults with serious mental 

illness (SMI) (18+ years) (2002)* B B B b

18-9b. Treatment for adults with depression 

(18+ years) (2002)* B B B

18-9c. Treatment for adults with schizophrenia 

(18+ years) (1984)† B B B

18-9d. Treatment for adults with generalized 

anxiety disorder (18+ years) (2002)* B B B

18-10. Treatment for co-occurring substance 

abuse and mental disorders 

(18+ years) (2002)*

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 18-3, 

18-6, 18-8, and 18-11 through 18-14.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.
18 • MENTAL HEALTH AND MENTAL DISORDERS 18-11

Figure 18-2. Health Disparities Table for Focus Area 18: Mental Health and Mental Disorders (continued)

LEGEND

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. Nonetheless, 

disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix.

1 Most recent data by education level are for 2002.

i Data are for Asian or Pacific Islander.

ii Change in the summary index cannot be assessed. See Technical Appendix.

DATA SOURCES

18-1. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

18-2. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

18-4. National Comorbidity Survey—Replication (NCS-R), NIH, NIMH.

18-5. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

18-7. National Health Interview Survey (NHIS), CDC, NCHS.

18-9a–b. National Comorbidity Survey—Replication (NCS-R), NIH, NIMH.

18-9c. Epidemiologic Catchment Area (ECA) Program, NIH, NIMH.

18-9d. National Comorbidity Survey—Replication (NCS-R), NIH, NIMH.

18-10. National Comorbidity Survey—Replication (NCS-R), NIH, NIMH.
HEALTHY PEOPLE 2010 FINAL REVIEW 18-12Figure 18-3. Suicide, 2005–07 Healthy People 2010 objective 18-1 • Target = 4.8 per 100,000 NOTES: Data are for ICD-10 codes *U03, X60–X84, and Y87.0 reported as underlying cause. Rates are age adjusted to the 2000 standard population and are displayed by a Je

areas. SOURCE: National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS. Rate pe

No heal

a reliabl
Nutrition and 

Overweight

CHAPTER 19

Co-Lead Agencies

Food and Drug Administration

National Institutes of Health

Contents

Goal ................................................................................................19-3

Highlights ......................................................................................19-3

Summary of Progress.....................................................................19-4

Transition to Healthy People 2020................................................19-4

Data Considerations.......................................................................19-5

References and Notes.....................................................................19-6

Comprehensive Summary of Objectives........................................19-8

Progress Chart..............................................................................19-10

Health Disparities Table...............................................................19-12

Obesity in Adults, 2008—Map....................................................19-15

19 • NUTRITION AND OVERWEIGHT 19-3

GOAL:

Promote health and reduce chronic disease 

associated with diet and weight.

The objectives in this chapter monitor trends in 

overweight and obesity, growth retardation, the 

consumption of various types of foods and nutrients, 

iron deficiency, diet and nutrition counseling, and food 

security (access to food).

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Almost no progress was made toward the Healthy 

People 2010 targets for objectives in this Focus Area 

[1]. Only one Nutrition and Overweight objective 

(19-11, calcium intake) showed significant positive 

movement (Figure 19-1). In addition, statistically 

significant health disparities were observed among 

racial and ethnic populations, as well as by sex, 

income, and disability status (Figure 19-2), some of 

which are discussed below [2].

〉 The proportion of adults aged 20 and over who were 

at a healthy weight based on directly measured 

height and weight (objective 19-1) decreased 26.2% 

from 1988–94 to 2005–08, from 42% to 31% (age 

adjusted), moving away from the Healthy People 2010 

target of 60%.

〉 Obesity in the U.S. population has increased, moving 

away from Healthy People 2010 targets. Based on 

directly measured height and weight, from 1988–94 

to 2005–08 the proportion of adults aged 20 and over 

who were obese (objective 19-2) rose 47.8%, from 

23% to 34% (age adjusted), moving away from the 

2010 target of 15%. During the same period, obesity 

increased 54.5% in children aged 6–11 years, from 

11% to 17% (objective 19-3a) and 63.6% in adolescents 

aged 12–19 years, from 11% to 18% (objective 19-3b), 

moving away from the 2010 targets of 5%.

〉 Obesity in adults varied by geographic area. Based on 

self-reported height and weight, in 2008, Colorado, 

Connecticut, the District of Columbia, Rhode Island, 

and Massachusetts had the lowest obesity rates, 

whereas Alabama, Mississippi, Oklahoma, South 

Carolina, and West Virginia had the highest rates 

(Figure 19-3).

〉 The proportion of persons with healthful eating 

patterns (objectives 19-5 through 19-11) showed little 

change. These objectives remained well below their 

2010 targets. One objective did show some positive 

progress: calcium intake among persons aged 2 

years and over (objective 19-11) increased 35.5% from 

1988–94 to 2003-04, from 31% to 42% (age adjusted), 

moving toward the Healthy People 2010 target of 74%.

〉 Food security among U.S. households (objective 

19-18) declined 3.4% between 1995 and 2008, from 

88% to 85%, moving away from the 2010 target of 94%. 

Disparities were observed for a number of population 

groups, for example:

 Among racial and ethnic groups, non-Hispanic 

white households had the highest (best) rate of 

food security, 89% in 2008, whereas non-Hispanic 

black, Hispanic or Latino, and American Indian 

or Alaska Native households had rates of 74%, 

73%, and 77%, respectively. When expressed 

as households with food insecurity, the rates 

for non-Hispanic black and Hispanic or Latino 
HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 19-2. Health Disparities Table for Focus Area 19: Nutrition and Overweight (continued)

19-4

households were almost two and a half times 

the rate that for non-Hispanic white households, 

whereas the rate for American Indian or Alaska 

Native households was more than twice the nonHispanic white rate (Figure 19-2) [2].

Summary of Progress

〉 Figure 19-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for Nutrition and Overweight. Data to 

measure progress toward target attainment were 

available for 20 objectives [1]. Of these:

 Two objectives moved toward their 2010 targets. 

A statistically significant difference between the 

baseline and the final data points was observed 

for one of these objectives (19-11). No significant 

difference was observed for the other objective 

(19-5).

 Three objectives (19-4, 19-6, and 19-12a) showed 

no change.

 Fifteen objectives moved away from their targets. 

A statistically significant difference between 

the baseline and final data points was observed 

for nine objectives (19-1, 19-2, 19-3a through 

c, 19-7, 19-12c, 19-17, and 19-18). No significant 

differences were observed for five objectives (19-8 

through 19-10, 19-12b, and 19-14); and data to test 

the significance of the difference were unavailable 

for one objective (19-13).

〉 One objective (19-16) had no follow-up data available 

to measure progress and one objective (19-15) was 

deleted at the Midcourse Review.

〉 Figure 19-2 displays health disparities in Nutrition 

and Overweight from the best group rate for each 

characteristic at the most recent data point [2]. It 

also displays changes in disparities from baseline to 

the most recent data point [3].

 Statistically significant health disparities of 10% 

or more by race and ethnicity were observed for 

10 objectives. Health disparities of 10% or more 

by race and ethnicity were observed for two 

additional objectives, although data to test their 

statistical significance were unavailable. Of these 

12 objectives, the non-Hispanic white population 

had the best rate for six objectives (19-1, 19-2, 

19-11, 19-12c, 19-13, and 19-18). The non-Hispanic 

black and American Indian or Alaska Native 

populations had the best rate for one objective 

each (objectives 19-3a and 19-4, respectively). The 

Mexican American population had the best rate 

for four objectives (19-5 and 19-8 through 19-10).

 Females had better rates than males for two of 

the three objectives with statistically significant 

health disparities of 10% or more by sex (objectives 

19-1 and 19-10). Males had a better rate for the 

third objective (19-11). Females also had a better 

rate for one objective with a disparity of 10% or 

more by sex for which statistical significance 

could not be assessed (objective 19-4).

 Persons whose income was above 130% of the 

poverty threshold (Federal poverty level; see 

Data Considerations section below) had better 

rates than persons whose income was below 

130% of the poverty threshold for six of the 

seven objectives with statistically significant 

health disparities of 10% or more by income 

(objectives 19-2, 19-3b and c, 19-11, 19-12c, and 

19-18). Persons whose income was below 130% 

of the poverty threshold had a better rate for the 

seventh objective (19-9).

 Persons without disabilities had a better rate than 

persons with disabilities for the one objective 

with statistically significant health disparities of 

10% or more by disability status (objective 19-2).

Transition to Healthy People 

2020

For Healthy People 2020, the focus of the Nutrition and 

Weight Status objectives was expanded to include a 

broader range of policies and environmental factors 

that support eating a healthful diet and maintaining 

a healthy body weight in settings such as schools, 

worksites, health care organizations, and communities. 

In addition, the wording and definitions of the food and 

nutrient consumption objectives have been revised to be 

applicable to the 2010 Dietary Guidelines for Americans 

(DGA) and minimize the need to revise the objectives 

with subsequent updates [4]. To better describe the 

range of weight-related objectives in Healthy People 

2020, the Topic Area name was changed to “Nutrition 

and Weight Status” from the Healthy People 2010 Focus 

Area name “Nutrition and Overweight.” The Nutrition 

and Weight Status objectives primarily assess individual 

behaviors regarding the consumption of healthful diets 

and achievement and maintenance of healthy body 

weights, and the policies and environments that support 

these behaviors. See HealthyPeople.gov for a complete 

list of Healthy People 2020 topics and objectives.

The Healthy People 2020 Nutrition and Weight Status 

Topic Area objectives can be grouped into six sections:

〉 Healthier food access

〉 Health care and worksite settings

〉 Weight status
19 • NUTRITION AND OVERWEIGHT 19-5

〉 Food insecurity

〉 Food and nutrient consumption

〉 Iron deficiency.

The differences between the Healthy People 2010 

objectives and those included in Healthy People 2020 are 

summarized below:

〉 The Healthy People 2020 Nutrition and Weight Status 

Topic Area has a total of 38 objectives, 7 of which are 

developmental [5]. The Healthy People 2010 Nutrition 

and Overweight Focus Area had 22 objectives, 1 of 

which was deleted at the Midcourse Review.

〉 Six Healthy People 2010 objectives were retained “as 

is” [6]. These objectives include: healthy weight in 

adults (objective 19-1), obesity in adults (objective 

19-2), obesity in children (separately assessed for 

those aged 6–11 years and 12–19 years; objectives 

19-3a and b, respectively), iron deficiency in pregnant 

females (objective 19-14), and the complement to food 

security (i.e., food insecurity) among U.S. households 

(objective 19-18).

〉 Three Healthy People 2010 objectives were archived 

[7]. These include: growth retardation in low-income 

children (objective 19-4), anemia in low-income 

pregnant females (objective 19-13), and total fat 

intake (objective 19-9). 

〉 One objective, meals and snacks at school (objective 

19-15), was deleted at the Midcourse Review due to 

lack of a national data source.

〉 Twelve Healthy People 2010 objectives were modified 

to create 13 Healthy People 2020 objectives [8].

 The age group tracked for obesity in children 

(objective 19-3c) was expanded from 6–19 years 

to 2–19 years.

 Three food consumption objectives for fruits 

(objective 19-5), vegetables (objective 19-6), and 

grains (objective 19-7) were changed to create 

four objectives that are applicable to the 2010 

DGA and assess mean intake. The objective for 

vegetables was divided into two objectives to 

separately monitor the quantity and variety of 

vegetables consumed.

 Three nutrient consumption objectives, including 

the percentage of calories from saturated fat 

(objective 19-8), total sodium (objective 19-10), 

and total calcium (objective 19-11), were also 

changed to assess mean intake rather than 

the percentage of the population meeting the 

DGA, to allow population groups’ progress to 

be assessed in meeting DGA recommendations 

over the decade without the need to modify the 

objectives with future releases of the DGA.

 The model used to determine iron deficiency 

was changed from the ferritin model to the 

body iron stores model for three iron deficiency 

objectives (19-12a through c) assessed among 

young children (aged 1–2 years and 3–4 years) 

and nonpregnant females.

 The objective (19-16) on worksite nutrition and 

weight management classes or counseling was 

moved back to developmental status until more 

current data become available.

 The objective (19-17) tracking physician office 

visits that include nutrition counseling or 

education for patients with cardiovascular 

disease, diabetes, or hyperlipidemia was modified 

to include additional diagnostic information 

from the patient record.

〉 Nineteen new objectives, six of which are 

developmental, were added to the Healthy People 

2020 Nutrition and Weight Status Topic Area [5]:

 Five new objectives tracking healthier food 

access include State nutrition standards for child 

care, schools not offering calorically sweetened 

beverages, school requirements for fruit and 

vegetable availability, State-level incentive 

policies for food retail, and a developmental 

objective on access to food retail outlets that 

sell a variety of foods that are encouraged by the 

DGA.

 Four new health care objectives include primary 

care physicians who assess child and adult 

patients’ body mass index (BMI), physician office 

visits with weight reduction, nutrition or physical 

activity counseling or education for obese patients, 

and nutrition counseling for all patients.

 Six new weight status objectives include 

obesity among children aged 2–5 years and 

five developmental objectives on inappropriate 

weight gain among youth and adults.

 A new food security objective tracks very low 

food security among children.

 Three new nutrient consumption objectives 

focus on the percentage of calories from solid 

fats, added sugars, and both.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

State-level rates for obesity among adults (objective 19-

2) in Figure 19-3 are based on self-reported height and 

weight data from Behavioral Risk Factory Surveillance 
HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 19-2. Health Disparities Table for Focus Area 19: Nutrition and Overweight (continued)

19-6

System (BRFSS) telephone interviews and may not be 

comparable with national rates in Figures 19-1 and 19-2, 

which are based on directly measured height and weight 

from the National Health and Nutrition Examination 

Survey (NHANES). BMI estimates derived from selfreported height and weight tend to be lower than 

those derived from measured height and weight due to 

underreporting of weight and overreporting of height 

[9]. However, BRFSS data is still useful in assessing 

geographic differences and changes over time.

The data label used for objectives 19-3a through c 

“overweight or obesity” in children and adolescents, was 

revised since the Healthy People 2010 midcourse and 

progress reviews to “obesity” even though the definition 

(BMI at or above the sex- and age-specific 95th percentile 

from the 2000 CDC Growth Charts) and interpretation 

are still the same. This terminology change in NCHS 

and other CDC publications is consistent with revisions 

made by the American Academy of Pediatrics, the 

Institute of Medicine, and other organizations. Because 

the indices used are based on body mass rather than 

fatness, the original terminology of “overweight” for 

children at or above the 95th percentile was intended 

to clarify that this cut-off point should not be used 

as diagnostic criteria. Rather, these children may or 

may not have excess body fat and should, therefore, 

be screened for obesity. However, because body fat is 

difficult to measure and the majority of children with 

BMI at or above the 95th percentile have high adiposity, 

on a population-wide basis, high weight-for-height can 

be considered as an indicator for obesity [10].

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

〉 These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: 

General Data Issues, referenced below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

References and Notes

1. Displayed in the Progress Chart (Figure 19-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 19-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 19-2). Disparity from the best group rate is 

defined as the percent difference between the best 

group rate and each of the other group rates for a 

characteristic. For example, racial and ethnic health 

disparities are measured as the percent difference 

between the best racial and ethnic group rate and 

each of the other racial and ethnic group rates. 

Similarly, disparities by sex are measured as the 

percent difference between the better group rate (e.g., 

female) and the rate for the other group (e.g., male). 

Some objectives are expressed in terms of favorable 

events or conditions that are to be increased, while 

others are expressed in terms of adverse events 

or conditions that are to be reduced. To facilitate 

comparison of health disparities across different 

objectives, disparity is measured only in terms of 

adverse events or conditions. For comparability 

across objectives, objectives that are expressed 

in terms of favorable events or conditions are reexpressed using the adverse event or condition for 

the purpose of computing disparity, but they are not 

otherwise restated or changed. For example, objective 

1-1, to increase the proportion of persons with health 

insurance (e.g., 72% of the American Indian or Alaska 

Native population under age 65 had some form of 
19 • NUTRITION AND OVERWEIGHT 19-7

health insurance in 2008), is expressed in terms of the 

percentage of persons without health insurance (e.g., 

100% – 72% = 28% of the American Indian or Alaska 

Native population under age 65 did not have any form 

of health insurance in 2008) when the disparity from 

the best group rate is calculated See the Reader’s 

Guide for more information. When standard errors 

were available, the difference between the best group 

rate and each of the other group rates was tested 

at the 0.05 level of significance. See the Figure 19-2 

footnotes, as well as the Technical Appendix, for more 

detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 19-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. Department of Health and Human Services (DHHS)

and Department of Agriculture (USDA). Dietary 

guidelines for Americans, 2010. 7th ed. Washington: 

Government Printing Office, 2011 Jan. Available from 

http://www.health.gov/dietaryguidelines/.

5. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

6. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

7. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.

8. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

9. Gorber SC, Tremblay M, Moher D, Gorber B. A 

comparison of direct vs. self-report measures for 

assessing height, weight and body mass index: a 

systematic review. Obes Rev 8(4):307–26. 2007 Jul.

10. Ogden CL, Flegal KM. Changes in terminology for 

childhood overweight and obesity. National health 

statistics reports; no 25. Hyattsville, MD: National 

Center for Health Statistics. 2010. Available from 

http://www.cdc.gov/nchs/data/nhsr/nhsr025.pdf.
HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 19-2. Health Disparities Table for Focus Area 19: Nutrition and Overweight (continued)

19-8

Comprehensive Summary of Objectives: Nutrition and Overweight

Objective Description Data Source or Objective Status

19-1 Healthy weight in adults (age adjusted, 20+ years) National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

19-2 Obesity in adults (age adjusted, 20+ years) National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

19-3a Obesity—Children 6–11 years National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

19-3b Obesity—Adolescents 12–19 years National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

19-3c Obesity—Children and adolescents 6–19 years National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

19-4 Growth retardation in low-income children (<5 years) Pediatric Nutrition Surveillance System (PedNSS), CDC, NCCDPHP.

19-5 Fruit intake—At least two daily servings (age adjusted, 2+ 

years)

Baseline data: Continuing Survey of Food Intakes by Individuals 

(CSFII), Department of Agriculture (USDA), Agricultural Research 

Service (ARS). Final data: National Health and Nutrition Examination 

Survey (NHANES), CDC, NCHS; Department of Agriculture (USDA), 

Agricultural Research Service (ARS).

19-6 Vegetable intake—At least three daily servings with at least 

1/3 dark green or orange (age adjusted, 2+ years)

Baseline data: Continuing Survey of Food Intakes by Individuals 

(CSFII), Department of Agriculture (USDA), Agricultural Research 

Service (ARS). Final data: National Health and Nutrition Examination 

Survey (NHANES), CDC, NCHS; Department of Agriculture (USDA), 

Agricultural Research Service (ARS).

19-7 Grain product intake—At least six daily servings with at least 

three being whole grains (age adjusted, 2+ years)

Baseline data: Continuing Survey of Food Intakes by Individuals 

(CSFII), Department of Agriculture (USDA), Agricultural Research 

Service (ARS). Final data: National Health and Nutrition Examination 

Survey (NHANES), CDC, NCHS; Department of Agriculture (USDA), 

Agricultural Research Service (ARS).

19-8 Saturated fat intake—Less than 10% of caloric intake (age 

adjusted, 2+ years)

Baseline data: Continuing Survey of Food Intakes by Individuals 

(CSFII), Department of Agriculture (USDA), Agricultural Research 

Service (ARS). Final data: National Health and Nutrition Examination 

Survey (NHANES), CDC, NCHS; Department of Agriculture (USDA), 

Agricultural Research Service (ARS).

19-9 Total fat intake—No more than 30% of caloric intake (age 

adjusted, 2+ years)

Baseline data: Continuing Survey of Food Intakes by Individuals 

(CSFII), Department of Agriculture (USDA), Agricultural Research 

Service (ARS). Final data: National Health and Nutrition Examination 

Survey (NHANES), CDC, NCHS; Department of Agriculture (USDA), 

Agricultural Research Service (ARS).

19-10 Total sodium intake—No more than 2,400 mg daily (age 

adjusted, 2+ years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS; Department of Agriculture (USDA), Agricultural Research 

Service (ARS).

19-11 Total calcium intake—At or above recommended level (age 

adjusted, 2+ years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS; Department of Agriculture (USDA), Agricultural Research 

Service (ARS).

19-12a Iron deficiency—Children 1–2 years National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

19-12b Iron deficiency—Children 3–4 years National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.
19 • NUTRITION AND OVERWEIGHT 19-9

Comprehensive Summary of Objectives: Nutrition and Overweight (continued)

Objective Description Data Source or Objective Status

19-12c Iron deficiency—Nonpregnant females 12–49 years National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

19-13 Anemia in low-income pregnant females in their third trimester Pregnancy Nutrition Surveillance System (PNSS), CDC, NCCDPHP.

19-14 Iron deficiency in pregnant females National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

19-15 Meals and snacks at school—Children and Adolescents 

(6–19 years) 

Deleted at the Midcourse Review.

19-16 Worksite nutrition and weight management classes or 

counseling

National Worksite Health Promotion Survey (NWHPS), Association 

for Worksite Health Promotion (AWHP) and OPHS, ODPHP.

19-17 Physician office visits with nutrition counseling for patients 

with cardiovascular disease, diabetes, or hyperlipidemia (age 

adjusted, 20+ years)

National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS.

19-18 Food security among U.S. households Food Security Supplement to the Current Population Survey (CPS): 

Department of Commerce, Census Bureau; Department of Labor 

(DOL), Bureau of Labor Statistics (BLS).
HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 19-2. Health Disparities Table for Focus Area 19: Nutrition and Overweight (continued)

19-10

Figure 19-1. Progress Toward Target Attainment for Focus Area 19: Nutrition and Overweight

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

19-1. Healthy weight in adults (age adjusted, 

20+ years)

60% 42%

(1988–94)

31%

(2005–08)

-11 Yes -26.2%

19-2. Obesity in adults (age adjusted, 

20+ years) 

15% 23%

(1988–94)

34%

(2005–08)

11 Yes 47.8%

19-3. Obesity

a. Children 6–11 years 5% 11%

(1988–94)

17%

(2005–08)

6 Yes 54.5%

b. Adolescents 12–19 years 5% 11%

(1988–94)

18%

(2005–08)

7 Yes 63.6%

c. Children and adolescents 6–19 years 5% 11%

(1988–94)

18%

(2005–08)

7 Yes 63.6%

19-4. Growth retardation in low-income children 

(<5 years)

 0.0% 4% 6%

(1997)

6%

(2009)

0 Not tested 0.0%

19-5. Fruit intake—At least two daily servings 

(age adjusted, 2+ years)

2.8% 75% 39%

(1994–96)

40%

(2003–04)

1 No 2.6%

19-6. Vegetable intake—At least three daily 

servings with at least 1/3 dark green or 

orange (age adjusted, 2+ years)

 0.0% 50% 4%

(1994–96)

4%

(2003–04)

0 No 0.0%

19-7. Grain product intake—At least six daily 

servings with at least three being whole 

grains (age adjusted, 2+ years) 

50% 4%

(1994–96)

3%

(2003–04)

-1 Yes -25.0%

19-8. Saturated fat intake—Less than 10% of 

caloric intake (age adjusted, 2+ years)

75% 36%

(1994–96)

34%

(2005–08)

-2 No -5.6%

19-9. Total fat intake—No more than 30% of 

caloric intake (age adjusted, 2+ years) 

75% 33%

(1994–96)

31%

(2005–08)

-2 No -6.1%

19-10. Total sodium intake—No more than 2,400 

mg daily (age adjusted, 2+ years) 

65% 15%

(1988–94)

13%

(2003–04)

-2 No -13.3%

19-11. Total calcium intake—At or above recommended level (age adjusted, 2+ years)

25.6% 74% 31%

(1988–94)

42%

(2003–04)

11 Yes 35.5%

19-12. Iron defi ciency

a. Children 1–2 years 0.0% 5% 9%

(1988–94)

9%

(1999–2002)

0 No 0.0%

b. Children 3–4 years 1% 4%

(1988–94)

6%

(2003–06)

2 No 50.0%

c. Nonpregnant females 12–49 years 7% 11%

(1988–94)

16%

(2003–06)

5 Yes 45.5%

LEGEND Moved away from target1 Moved toward target Met or exceeded target
19 • NUTRITION AND OVERWEIGHT 19-11

Figure 19-1. Progress Toward Target Attainment for Focus Area 19: Nutrition and Overweight (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

19-13. Anemia in low-income pregnant females 

in their third trimester 

20% 29%

(1996)

34%

(2009)

5 Not tested 17.2%

19-14. Iron defi ciency in pregnant females 9% 14%

(1999–2002)

16%

(2003–06)

2 No 14.3%

19-17. Physician offi ce visits with nutrition 

counseling for patients with cardiovascular 

disease, diabetes, or hyperlipidemia (age 

adjusted, 20+ years) 

75% 42%

(1997)

28%

(2007)

-14 Yes -33.3%

19-18. Food security among U.S. households 94% 88%

(1995)

85%

(2008)

-3 Yes -3.4%

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objective 19-16. Objective 19-15 was deleted at the Midcourse Review.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

DATA SOURCES

19-1–19-2. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

19-3a–c. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

19-4. Pediatric Nutrition Surveillance System (PedNSS), CDC, NCCDPHP.

19-5–19-9. Baseline data: Continuing Survey of Food Intakes by Individuals (CSFII), Department of Agriculture (USDA), Agricultural Research 

Service (ARS). 

Final data: National Health and Nutrition Examination Survey (NHANES): CDC, NCHS; Department of Agriculture (USDA), 

Agricultural Research Service (ARS).

19-10–19-11. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS; Department of Agriculture (USDA), Agricultural 

Research Service (ARS).

19-12a–c. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

19-13. Pregnancy Nutrition Surveillance System (PNSS), CDC, NCCDPHP.

19-14. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

19-17. National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS.

19-18. Food Security Supplement to the Current Population Survey (CPS): Department of Commerce, Census Bureau; Department of 

Labor (DOL), Bureau of Labor Statistics (BLS).
HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 19-2. Health Disparities Table for Focus Area 19: Nutrition and Overweight (continued)

19-12

Figure 19-2. Health Disparities Table for Focus Area 19: Nutrition and Overweight

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Income Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLower (≤130% of Federal poverty level)Higher (>130% of Federal poverty level)Persons with disabilitiesPersons without disabilities

19-1. Healthy weight in adults (age adjusted, 20+ years) 

(1988–94, 2005–08)1* i B B B B

19-2. Obesity in adults (age adjusted, 20+ years) (1988–94, 

2005–08)1* i B  B  B B

19-3a. Obesity—Children 6–11 years (1988–94, 2005–08)* i B b

b. Obesity—Adolescents 12–19 years (1988–94, 

2005–08)* i B ii ii B

c. Obesity—Children and adolescents 6–19 years 

(1988–94, 2005–08)* i Biii b B B

19-4. Growth retardation in low-income children (<5 years) 

(1997, 2009)† B iv B 

19-5. Fruit intake—At least two daily servings (age adjusted, 

2+ years) (1994–96, 2003–04)* Bi Biii B B

19-6. Vegetable intake—At least three daily servings with at 

least 1/3 dark green or orange (age adjusted, 2+ years) 

(1994–96, 2003–04)*

i Biii B Biii B

19-7. Grain product intake—At least six daily servings with at 

least three being whole grains (age adjusted, 2+ years) 

(1994–96, 2003–04)*

i B B

19-8. Saturated fat intake—Less than 10% of caloric intake 

(age adjusted, 2+ years) (1994–96, 2005–08)* Bi   B Biii

19-9. Total fat intake—No more than 30% of caloric intake 

(age adjusted, 2+ years) (1994–96, 2005–08)* Bi B Biii

19-10. Total sodium intake—No more than 2,400 mg daily 

(age adjusted, 2+ years) (1988–94, 2003–04)1* Bi B B B

19-11. Total calcium intake—At or above recommended level 

(age adjusted, 2+ years) (1988–94, 2003–04)1* i  B   B B Biii

19-12a. Iron deficiency—Children 1–2 years (1988–94, 

1999–02)* i

b. Iron deficiency—Children 3–4 years (1988–94, 

2003–06)2* i

c. Iron deficiency—Nonpregnant females 12–49 years 

(1988–94, 2003–06)1* i B B ii B
19 • NUTRITION AND OVERWEIGHT 19-13

Figure 19-2. Health Disparities Table for Focus Area 19: Nutrition and Overweight (continued)

Race and Ethnicity Sex Income Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLower (≤130% of Federal poverty level)Higher (>130% of Federal poverty level)Persons with disabilitiesPersons without disabilities

19-13. Anemia in low-income pregnant females in their third 

trimester (1996, 2009)†  iv B

19-14. Iron deficiency in pregnant females (1999–2002, 

2003–06)* i

19-17. Physician office visits with nutrition counseling for patients 

with cardiovascular disease, diabetes, or 

hyperlipidemia (age adjusted, 20+ years) (1997, 2007)*

Bv v B

19-18. Food security among U.S. households (1995, 2008)3,4*

biv   B 

 B

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objective 19-16. 

Objective 19-15 was deleted at Midcourse Review.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

LEGEND

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.
HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 19-2. Health Disparities Table for Focus Area 19: Nutrition and Overweight (continued)

19-14

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. Nonetheless, 

disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix.

1 Baseline data by disability status are for 1991–94.

2 Most recent data by race and ethnicity are for 1988–94.

3 Baseline data for American Indian or Alaska Native are based on years 1995–97.

4 Most recent data for American Indian or Alaska Native are based on years 2006–08.

i Data are for Mexican American.

ii Reliability criterion for best group rate not met, or data available for only one group, at baseline. Change in disparity cannot be assessed. See Technical Appendix.

iiiThe group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

ivData are for Asian or Pacific Islander.

v Data include persons of Hispanic origin.

DATA SOURCES

19-1–19-2. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

19-3a–c. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

19-4. Pediatric Nutrition Surveillance System (PedNSS), CDC, NCCDPHP.

19-5–19-9. Baseline data: Continuing Survey of Food Intakes by Individuals (CSFII), Department of Agriculture (USDA), Agricultural Research Service (ARS).

Final data: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS; Department of Agriculture (USDA), Agricultural Research 

Service (ARS).

19-10–19-11. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS; Department of Agriculture (USDA), Agricultural Research Service (ARS).

19-12a–c. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

19-13. Pregnancy Nutrition Surveillance System (PNSS), CDC, NCCDPHP.

19-14. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

19-17. National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS.

19-18. Food Security Supplement to the Current Population Survey (CPS): Department of Commerce, Census Bureau; Department of Labor (DOL), Bureau of Labor 

Statistics (BLS).
19 • NUTRITION AND OVERWEIGHT 19-15 Figure 19-3. Obesity in Adults (Aged 20+), 2008 Healthy People 2010 objective 19-2 • Target = 15 percent NOTES: Data are for adults aged 20 and over and are age-adjusted to the 2000 standard population. Rates are displayed by a Jenks classification for U.S. states. National data 

measured height and weight from the National Health and Nutrition Examination Survey (NHANES) and are the basis for setting the target. State data from the BRFSS are bweight and may not be comparable with national data from NHANES. The U.S. rate in 2008 from NHANES was 34%. The rate for all states combined from BRFSS in 2008 waSOURCE: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP. 

Perce

No sta

Occupational 

Safety and Health

CHAPTER 20

Lead Agency

Centers for Disease Control and Prevention

Contents

Goal ................................................................................................20-3

Highlights ......................................................................................20-3

Summary of Progress.....................................................................20-3

Transition to Healthy People 2020................................................20-4

Data Considerations.......................................................................20-5

Notes..............................................................................................20-5

Comprehensive Summary of Objectives........................................20-6

Progress Chart................................................................................20-8

Health Disparities Table...............................................................20-10

20 • OCCUPATIONAL SAFETY AND HEALTH 20-3

GOAL:

Promote the health and safety of people at work 

through prevention and early intervention.

The objectives in this chapter track work-related deaths, 

injuries, and selected health conditions, including 

hearing loss, elevated blood lead levels, and worksite 

stress reduction.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the Healthy 

People 2010 database, (DATA2010), available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved for objectives in 

this Focus Area during the past decade [1]. Almost 

two-thirds (64%) of the Occupational Safety and 

Health objectives achieved their Healthy People 

2010 targets. Only three objectives (20-1d through 

e, and 20-9) did not make progress toward the 2010 

targets (Figure 20-1). Health disparities among racial 

and ethnic groups and by sex were observed for one 

objective (Figure 20-2) [2].

〉 Work-related injury deaths among workers aged 

16 years and over in all industries (objective 20-1a) 

declined 26.7% between 1998 and 2009, from 4.5 to 

3.3 deaths per 100,000 workers, moving toward the 

2010 target of 3.2 deaths per 100,000 workers. Workrelated injury deaths among workers aged 16 years 

and over in mining (objective 20-1b) declined 46.2% 

between 1998 and 2009, from 23.6 to 12.7 per 100,000, 

exceeding the 2010 target of 16.5, Similarly, workrelated injury deaths among workers aged 16 years 

and over in construction (objective 20-1c) declined 

33.1%, from 14.5 to 9.7 per 100,000, exceeding the 

target of 10.1.

 Female workers had a lower (better) rate of workrelated injury deaths in all industries than male 

workers, 0.6 deaths per 100,000 in 2009. The rate 

for male workers, 5.5 deaths per 100,000, was more 

than nine times the rate for female workers [2].

〉 Work-related injuries per 100 full-time workers 

declined for all industry groups (objectives 20-2a 

through g), exceeding the 2010 targets. Work-related 

injuries in all industries (objective 20-2a) declined 

45.2% between 1998 and 2009, from 6.2 to 3.4 injuries 

per 100 full-time workers, exceeding the 2010 target 

of 4.3. Similar results were observed for individual 

industry sectors (e.g., construction, health services). 

Statistically significant downward trends in injuries 

were observed between the baseline (1997 or 1998) 

and 2009 for all industry sectors [3].

〉 Work-related homicides among workers aged 16 

years and over (objective 20-5) declined 20% between 

1998 and 2006, from 0.5 to 0.4 per 100,000 workers, 

meeting the 2010 target of 0.4. Work-related assaults 

among workers aged 16 years and over (objective 20-6) 

declined 66.4% between 1998 and 2009, from 1.10 to 

0.37 per 100 workers, exceeding the 2010 target of 0.78.

Summary of Progress

Figure 20-1 presents a quantitative assessment of 

progress in achieving the Healthy People 2010 objectives 

for Occupational Safety and Health [1]. Data to measure 

progress toward target attainment were available for 22 

objectives. Of these:
20-4 HEALTHY PEOPLE 2010 FINAL REVIEW

 Fourteen objectives (20-1b and c, 20-2a through g, 

20-3, 20-5, 20-6, 20-8, and 20-11) met or exceeded 

their Healthy People 2010 targets.

 Five objectives moved toward their targets. A 

statistically significant difference between the 

baseline and the final data points was observed 

for one of these objectives (20-7). Data to test the 

significance of the difference were unavailable 

for four objectives (20-1a, 20-2h, 20-4, and 20-10).

 Three objectives (20-1d, 20-1e, and 20-9) 

moved away from their targets, but data to 

test the significance of the difference between 

the baseline and the final data points were 

unavailable for these objectives.

〉 Figure 20-2 displays health disparities in 

Occupational Safety and Health from the best group 

rate for each characteristic at the most recent data 

point [2]. It also displays changes in disparities from 

baseline to the most recent data point [4]. Data on 

health disparities were only available for objective 

20-1a, work-related injury deaths for all industries:

 The non-Hispanic black population had a lower 

rate of work-related injury deaths than the 

Hispanic or Latino or the non-Hispanic white 

populations.

 Females had a lower rate of work-related injury 

deaths than males.

Transition to Healthy People 

2020

The Healthy People 2020 Occupational Safety and 

Health Topic Area consists of fewer objectives than those 

included in Healthy People 2010. See HealthyPeople.gov

for a complete list of Healthy People 2020 topics and 

objectives.

The Healthy People 2020 objectives can be grouped into 

several sections:

〉 Work-related fatalities

〉 Work-related injuries

〉 Objectives that target specific occupational hazards.

The differences between the Healthy People 2010 and 

Healthy People 2020 objectives are summarized below:

〉 The Healthy People 2020 Occupational Safety and 

Health Topic Area has 16 objectives, whereas the 

Healthy People 2010 Focus Area had 22 objectives.

〉 Eleven Healthy People 2010 objectives were retained 

“as is” [5].

 The titles of two of the five objectives addressing 

reduced deaths from work-related injuries were 

modified. 'Reduce deaths from work-related 

injury—Transportation' (objective 20-1d) was 

changed to '—Transportation and warehousing'; 

and 'Reduce deaths from work-related injury—

Agriculture, forestry, and fishing' (objective 

20-1e) was changed to '—Agriculture, forestry, 

fishing, and hunting'.

 Reduce the rate of injury and illness cases 

involving days away from work due to 

overexertion or repetitive motion (objective 20-3).

 Reduce pneumoconiosis deaths (objective 20-4).

 Reduce deaths from work-related homicides 

(objective 20-5).

 Reduce the proportion of persons who have 

elevated blood lead concentrations from work 

exposures (objective 20-7).

 Reduce occupational skin diseases or disorders 

among full-time workers (objective 20-8).

 Reduce new cases of work-related, noise-induced 

hearing loss (objective 20-11).

〉 Ten Healthy People 2010 objectives were modified [6].

 Objectives for nonfatal work-related injuries 

were reduced to a single objective tracking all 

industries (objectives 20-2a through 20-2g). 

 The targeted population for adolescent workers 

was expanded from age 15–17 years to age 15–19 

years (objective 20-2h).

 The objective to reduce work-related assaults 

will be tracked with a new data source (objective 

20-6).

 The objective to increase the proportion of 

employees who have access to workplace 

programs that prevent or reduce employee stress 

will be tracked with a new data source (objective 

20-9).

〉 Seven Healthy People 2010 objectives were archived 

[7]. Nonfatal work-related injury rates by specific 

industry sector were not substantially different than 

the overall rate. Existing data sources for needle stick 

injuries were not adequate to accurately track the 

objective because there is no single national sharps 

injury surveillance system. Another limitation 

is underreporting of injuries. It is estimated that 

approximately one half of exposures are reported, 

with reporting rates varying by occupational group.

〉 Reduce nonfatal work-related injuries:

 Construction (objective 20-2b)

 Health services (objective 20-2c)

 Agriculture, forestry, and fishing (objective 

20-2d)
20 • OCCUPATIONAL SAFETY AND HEALTH 20-5

 Transportation (objective 20-2e)

 Mining (objective 20-2f)

 Manufacturing (objective 20-2g).

 Reduce occupational needle stick injuries among 

hospital-based health care workers (objective 

20-10).

〉 One new objective was added to track work-related 

injuries treated in emergency departments.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

A number of objectives in this Focus Area are tracked 

through the data sources maintained by the Bureau of 

Labor Statistics. Work-related injury deaths (objective 

20-1) are monitored through the Census of Fatal 

Occupational Injuries and nonfatal injuries and illnesses 

are tracked through the Survey of Occupational Injuries 

and Illnesses. Over the past decade, industry data from 

these two sources were classified according to several 

different classification systems. From 1998 to 2002, 

data were classified using the 1987 Standard Industrial 

Classification (SIC) Manual. Data from 2003 to 2008 

were classified using the 2002 North American Industry 

Classification System (NAICS). Industry data after 2008 

are classified using the 2007 NAICS. The substantial 

differences between the SIC and NAICS result in breaks in 

series. From 1998 to 2005 rates were employment-based, 

whereas from 2006 to 2009 rates were hours-based. 

Effective January 1, 2002, the Occupational Safety and 

Health Administration (OSHA) revised its requirements 

for recording occupational injuries and illnesses. Due 

to the changes in classification systems and the revised 

OSHA reporting requirements, users are urged to use 

caution when examining trend data for the past decade.

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available 

in the General Data Issues section of the NCHS 

Healthy People website under Healthy People 2010; 

see http://www.cdc.gov/nchs/healthy_people/hp2010/

hp2010_data_issues.htm.

Notes

1. Displayed in the Progress Chart (Figure 20-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 20-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 20-2). Disparity from the best group rate 

is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 
20-6 HEALTHY PEOPLE 2010 FINAL REVIEW

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 20-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The presence of a monotonic increasing or decreasing 

trend in the underlying measure was tested with the 

nonparametric Mann-Kendall test; then the slope of 

a linear trend was estimated with the nonparametric 

Sen’s method. See Technical Appendix for more 

information.

4. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 20-2 footnotes, as well as 

the Technical Appendix, for more detail.

5. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy 

People 2010 and are developmental in Healthy People 

2020, and for which no numerator information is 

available.

6. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

7. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.

Comprehensive Summary of Objectives: Occupational Safety and 

Health

Objective Description Data Source

20-1a Work-related injury deaths—All industries (per 100,000 

workers, 16+ years)

Census of Fatal Occupational Injuries (CFOI), Department of Labor 

(DOL), Bureau of Labor Statistics (BLS).

20-1b Work-related injury deaths—Mining (per 100,000 workers, 

16+ years)

Census of Fatal Occupational Injuries (CFOI), Department of Labor 

(DOL), Bureau of Labor Statistics (BLS).

20-1c Work-related injury deaths—Construction (per 100,000 

workers, 16+ years)

Census of Fatal Occupational Injuries (CFOI), Department of Labor 

(DOL), Bureau of Labor Statistics (BLS).

20-1d Work-related injury deaths—Transportation (per 100,000 

workers, 16+ years)

Census of Fatal Occupational Injuries (CFOI), Department of Labor 

(DOL), Bureau of Labor Statistics (BLS).

20-1e Work-related injury deaths—Agriculture, forestry, and fishing 

(per 100,000 workers, 16+ years)

Census of Fatal Occupational Injuries (CFOI), Department of Labor 

(DOL), Bureau of Labor Statistics (BLS).

20-2a Work-related injuries—All industries (per 100 full-time 

workers)

Survey of Occupational Injuries and Illnesses (SOII), Department of 

Labor (DOL), Bureau of Labor Statistics (BLS).

20-2b Work-related injuries—Construction (per 100 full-time 

workers)

Survey of Occupational Injuries and Illnesses (SOII), Department of 

Labor (DOL), Bureau of Labor Statistics (BLS).
20 • OCCUPATIONAL SAFETY AND HEALTH 20-7

Comprehensive Summary of Objectives: Occupational Safety and Health (continued)

Objective Description Data Source

20-2c Work-related injuries—Health services (per 100 full-time 

workers)

Survey of Occupational Injuries and Illnesses (SOII), Department of 

Labor (DOL), Bureau of Labor Statistics (BLS).

20-2d Work-related injuries—Agricultural, forestry, and fishing (per 

100 full-time workers)

Survey of Occupational Injuries and Illnesses (SOII), Department of 

Labor (DOL), Bureau of Labor Statistics (BLS).

20-2e Work-related injuries—Transportation (per 100 full-time 

workers)

Survey of Occupational Injuries and Illnesses (SOII), Department of 

Labor (DOL), Bureau of Labor Statistics (BLS).

20-2f Work-related injuries—Mining (per 100 full-time workers) Survey of Occupational Injuries and Illnesses (SOII), Department of 

Labor (DOL), Bureau of Labor Statistics (BLS).

20-2g Work-related injuries—Manufacturing (per 100 full-time 

workers)

Survey of Occupational Injuries and Illnesses (SOII), Department of 

Labor (DOL), Bureau of Labor Statistics (BLS).

20-2h Work-related injuries among adolescent workers (per 100 

full-time workers, 15–17 years)

National Electronic Injury Surveillance System (NEISS): Consumer 

Product Safety Commission (CPSC); CDC, NIOSH.

20-3 Overexertion or repetitive motion injuries (per 100,000 fulltime workers)Survey of Occupational Injuries and Illnesses (SOII), Department of 

Labor (DOL), Bureau of Labor Statistics (BLS).

20-4 Pneumoconiosis deaths (number, 15+ years) National Occupational Respiratory Mortality System (NORMS), CDC, 

NIOSH.

20-5 Work-related homicides (per 100,000 workers, 16+ years) Census of Fatal Occupational Injuries (CFOI), Department of Labor 

(DOL), Bureau of Labor Statistics (BLS).

20-6 Work-related assaults (per 100 workers, 16+ years) National Crime Victimization Survey (NCVS), Department of Justice 

(DOJ), Bureau of Justice Statistics (BJS).

20-7 Elevated blood lead levels—≥25 μg/dL (per 100,000 

employed, 16+ years)

Adult Blood Lead Epidemiology and Surveillance Program (ABLES), 

CDC, NIOSH.

20-8 Occupational skin diseases or disorders (per 100,000 fulltime workers)Survey of Occupational Injuries and Illnesses (SOII), Department of 

Labor (DOL), Bureau of Labor Statistics (BLS).

20-9 Worksite stress reduction programs—Worksites with 50+ 

employees

National Survey of Worksite Health Promotion Activities (NSWHP), 

Association for Worksite Health Promotion (AWHP), and OPHS, 

ODPHP.

20-10 Needlestick injuries among hospital-based health care 

workers (thousands)

National Surveillance System for Hospital Health Care Workers 

(NaSH), CDC, NCPDCID; Exposure Prevention Information Network 

(EPINet), International Health Care Worker Safety Center, University 

of Virginia.

20-11 Noise-induced hearing loss, work-related (per 10,000 fulltime workers)Survey of Occupational Injuries and Illnesses (SOII), Department of 

Labor (DOL), Bureau of Labor Statistics (BLS).
20-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 20-1. Progress Toward Target Attainment for Focus Area 20: Occupational Safety and Health

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

20-1. Work-related injury deaths (per 100,000 

workers, 16+ years)

a. All industries 92.3% 3.2 4.5

(1998)

3.3

(2009)

-1.2 Not tested -26.7%

b. Mining 153.5% 16.5 23.6

(1998)

12.7

(2009)

-10.9 Not tested -46.2%

c. Construction 109.1% 10.1 14.5

(1998)

9.7

(2009)

-4.8 Not tested -33.1%

d. Transportation 8.3 11.8

(1998)

12.1

(2009)

0.3 Not tested 2.5%

e. Agriculture, forestry, and fi shing 16.3 23.3

(1998)

26.0

(2009)

2.7 Not tested 11.6%

20-2. Work-related injuries (per 100 full-time 

workers)

a. All industries 147.4% 4.3 6.2

(1998)

3.4

(2009)

-2.8 Yes -45.2%

b. Construction 173.1% 6.1 8.7

(1998)

4.2

(2009)

-4.5 Yes -51.7%

c. Health services 120.8% 5.5 7.9

(1997)

5.0

(2009)

-2.9 Not tested -36.7%

d. Agricultural, forestry, and fi shing 108.7% 5.3 7.6

(1998)

5.1

(2009)

-2.5 Yes -32.9%

e. Transportation 120.8% 5.5 7.9

(1997)

5.0

(2009)

-2.9 Not tested -36.7%

f. Mining 171.4% 3.3 4.7

(1998)

2.3

(2009)

-2.4 Yes -51.1%

g. Manufacturing 184.0% 6.0 8.5

(1998)

3.9

(2009)

-4.6 Yes -54.1%

20-2h. Work-related injuries among adolescent 

workers (per 100 full-time workers, 

15–17 years)

78.6% 3.5 4.9

(1998)

3.8

(2008)

-1.1 Not tested -22.4%

20-3. Overexertion or repetitive motion injuries 

(per 100,000 full-time workers)

116.0% 338 675

(1997)

284

(2009)

-391 Not tested -57.9%

20-4. Pneumoconiosis deaths (number, 

15+ years)

71.4% 1,900 2,928

(1997)

2,194

(2007)

-734 Not tested -25.1%

20-5. Work-related homicides (per 100,000 

workers, 16+ years)

100.0% 0.4 0.5

(1998)

0.4

(2006)

-0.1 Not tested -20.0%

20-6. Work-related assaults (per 100 workers, 

16+ years)

228.1% 0.78 1.10

(1998)

0.37

(2009)

-0.73 Not tested -66.4%

LEGEND Moved away from target1 Moved toward target Met or exceeded target
20 • OCCUPATIONAL SAFETY AND HEALTH 20-9

Figure 20-1. Progress Toward Target Attainment for Focus Area 20: Occupational Safety and Health (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

20-7. Elevated blood lead levels—≥25 μg/dL 

(per 100,000 employed, 16+ years)

47.9% 0.0 12.1

(1998)

6.3

(2009)

-5.8 Yes -47.9%

20-8. Occupational skin diseases or disorders 

(per 100,000 full-time workers)

145.0% 47 67

(1997)

38

(2009)

-29 Not tested -43.3%

20-9. Worksite stress reduction programs—

Worksites with 50+ employees

50% 37%

(1992)

25%

(2004)

-12 Not tested -32.4%

20-10. Needlestick injuries among hospital-based 

health care workers (thousands)

60.0% 269 384

(1998)

315

(2000)

-69 Not tested -18.0%

20-11. Noise-induced hearing loss, work-related 

(per 10,000 full-time workers)

100.0% 2.2 3.2

(2004)

2.2

(2009)

-1.0 Yes -31.3%

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

DATA SOURCES

20-1a–e. Census of Fatal Occupational Injuries (CFOI), Department of Labor (DOL), Bureau of Labor Statistics (BLS).

20-2a–g. Survey of Occupational Injuries and Illnesses (SOII), Department of Labor (DOL), Bureau of Labor Statistics (BLS).

20-2h. National Electronic Injury Surveillance System (NEISS): Consumer Product Safety Commission (CPSC); CDC, NIOSH.

20-3. Survey of Occupational Injuries and Illnesses (SOII), Department of Labor (DOL), Bureau of Labor Statistics (BLS).

20-4. National Occupational Respiratory Mortality System (NORMS), CDC, NIOSH.

20-5. Census of Fatal Occupational Injuries (CFOI), Department of Labor (DOL), Bureau of Labor Statistics (BLS).

20-6. National Crime Victimization Survey (NCVS), Department of Justice (DOJ), Bureau of Justice Statistics (BJS).

20-7. Adult Blood Lead Epidemiology and Surveillance Program (ABLES), CDC, NIOSH.

20-8. Survey of Occupational Injuries and Illnesses (SOII), Department of Labor (DOL), Bureau of Labor Statistics (BLS).

20-9. National Survey of Worksite Health Promotion Activities (NSWHP), Association for Worksite Health Promotion (AWHP), and OPHS, ODPHP.

20-10. National Surveillance System for Hospital Health Care Workers (NaSH), CDC, NCPDCID; Exposure Prevention Information Network 

(EPINet), International Health Care Worker Safety Center, University of Virginia.

20-11. Survey of Occupational Injuries and Illnesses (SOII), Department of Labor (DOL), Bureau of Labor Statistics (BLS).
20-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 20-2. Health Disparities Table for Focus Area 20: Occupational Safety and Health

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Income Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMalePoorNear poorMiddle/high incomeSummary indexPersons with disabilitiesPersons without disabilities

20-1a. Work-related injury deaths—All 

industries (per 100,000 workers, 

16+ years) (1998, 2009)1†

 B  B 

20-2h. Work-related injuries among adolescent 

workers (per 100 full-time workers, 

15–17 years) (1998, 2008)‡

20-6. Work-related assaults (per 100 workers, 

16+ years) (1998, 2009)1,2*

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 20-1b 

through e, 20-2a through g, 20-3 through 20-5, and 20-7 through 20-11.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

LEGEND

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.
20 • OCCUPATIONAL SAFETY AND HEALTH 20-11

Figure 20-2. Health Disparities Table for Focus Area 20: Occupational Safety and Health (continued)

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. Nonetheless, 

disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix.

‡ Measures of variability were available only for the most recent data. Thus, the variability of best group rates was assessed only for the most recent data, and 

statistical significance was tested only for the most recent data. Disparities of 10% or more are displayed when the differences from the best group rate are 

statistically significant at the 0.05 level. Changes in disparities over time are displayed according to their magnitude, since measures of variability were not available 

at baseline and therefore statistical significance of changes in disparity could not be tested. See Technical Appendix.

1 Baseline data by race and ethnicity are for 2000.

2 Baseline data by sex are for 2000. 

DATA SOURCES

20-1a. Census of Fatal Occupational Injuries (CFOI), Department of Labor (DOL), Bureau of Labor Statistics (BLS).

20-2h. National Electronic Injury Surveillance System (NEISS): Consumer Product Safety Commission (CPSC); CDC, NIOSH.

20-6. National Crime Victimization Survey (NCVS), Department of Justice (DOJ), Bureau of Justice Statistics (BJS).

Oral Health

CHAPTER 21

Co-Lead Agencies

Centers for Disease Control and Prevention

Health Resources and Services Administration

Indian Health Service

National Institutes of Health

Contents

Goal ................................................................................................21-3

Highlights ......................................................................................21-3

Summary of Progress.....................................................................21-4

Transition to Healthy People 2020................................................21-4

Data Considerations.......................................................................21-6

Notes..............................................................................................21-6

Comprehensive Summary of Objectives........................................21-7

Progress Chart................................................................................21-9

Health Disparities Table...............................................................21-11

21 • ORAL HEALTH 21-3

GOAL:

Prevent and control oral and craniofacial 

diseases, conditions, and injuries and improve 

access to related services.

The objectives in this chapter track dental caries, tooth 

loss, periodontal disease, and untreated dental decay. 

Preventive measures such as annual dental visits, the 

use of dental sealants, fluoridation programs, and the 

availability of school and community-based dental 

services are also monitored.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in objectives for 

this Focus Area during the past decade [1]. Seventyone percent of the Oral Health objectives with data 

to measure progress moved toward or achieved 

their Healthy People 2010 targets (Figure 21-1). 

However, health disparities among racial and ethnic 

population groups, as well as by sex and by education 

level, were observed (Figure 21-2), some of which are 

highlighted below [2].

〉 Dental caries experience in primary teeth for children 

aged 2–4 years (objective 21-1a) increased 33.3% from 

1988–94 to 1999–2004, from 18% to 24%, moving away 

from the Healthy People 2010 target of 11%.

〉 Dental caries experience in permanent teeth for 

adolescents aged 15 years (objective 21-1c) decreased 

8.2% from 1988–94 to 1999–2004, from 61% to 56%, 

moving toward the 2010 target of 51%.

〉 Untreated dental decay in permanent teeth for 

adolescents aged 15 years (objective 21-2c) decreased 

10.0% from 1988–94 to 1999–2004, from 20% to 18%, 

moving toward the 2010 target of 15%.

〉 The proportion of adults aged 35–44 with untreated 

dental decay (objective 21-2d) increased 3.7% from 

1988–94 to 1999–2004, from 27% to 28%, moving 

away from the 2010 target of 15%. However, the 

change was not statistically significant.

 Among education groups, persons with at least 

some college education had the lowest (best) rate 

of untreated dental decay, 18% in 1999–2004. 

Persons with less than a high school education 

had a rate of 50%, almost three times the best 

group rate [2].

〉 The proportion of adults aged 35–44 with no 

permanent tooth loss due to caries or periodontal 

disease (objective 21-3) increased 26.7% from 1988–94 

to 1999–2004, from 30% to 38%, moving toward 

the 2010 target of 40%. During the same period, the 

proportion of adults aged 65–74 who experienced 

complete tooth loss (objective 21-4) declined 17.2%, 

from 29% to 24%, moving toward the 2010 target of 

22%.

〉 The proportion of children aged 8 and of adolescents 

aged 14 years (objectives 21-8a and b, respectively) 

who had a dental sealant on at least one molar 

increased 39.1% and 40.0%, from 23% to 32% and 

15% to 21%, respectively, from 1988–94 to 1999–2004, 

moving toward their 2010 targets of 50%.
21-4 HEALTHY PEOPLE 2010 FINAL REVIEW

〉 Several objectives met or exceeded their 2010 targets:

 The proportion of school-based health centers 

providing dental sealants as part of an oral health 

program (objective 21-13a) doubled, increasing 

from 12% in 2001–02 to 24% in 2007–08, and 

exceeding the 2010 target of 15%.

 The proportion of community-based health 

centers with an oral health component (objective 

21-14) increased 44.2% between 1997 and 2007, 

from 52% to 75%, meeting the 2010 target of 75%.

 The number of State and local dental programs 

directed by public health professionals (objective 

21-17a) increased 38.5% between 2003 and 2009, 

from 39 to 54 programs, exceeding the 2010 

target of 41 programs.

 The number of Indian Health Service and Tribal 

dental programs directed by public health 

professionals (objective 21-17b) increased from 9 

programs in 2003 to 10 in 2006. The target for this 

objective (9 programs) was met at baseline and 

exceeded at the final data point.

Summary of Progress

〉 Figure 21-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for Oral Health [1]. Data to measure 

progress toward target attainment were available for 

24 objectives. Of these:

 Four objectives (21-13a, 21-14, and 21-17a and b) 

met or exceeded their 2010 targets.

 Thirteen objectives moved toward their targets. 

A statistically significant difference between the 

baseline and the final data points was observed 

for five of these objectives (21-3, 21-4, 21-5b, 

21-7, and 21-12). No significant differences were 

observed for four objectives (21-1c, 21-2c, and 21-

8a and b); and data to test the significance of the 

difference were unavailable for four objectives 

(21-9, 21-13b, 21-15, and 21-16).

 Seven objectives moved away from their targets. 

A statistically significant difference between the 

baseline and final data points was observed for 

one objective (21-1a). No significant differences 

were observed for five objectives (21-1b; 21-

2a, b, and d; and 21-10); and data to test the 

significance of the difference were unavailable 

for one objective (21-6).

〉 Follow-up data were unavailable to measure progress 

for two objectives (21-5a and 21-11).

〉 Figure 21-2 displays health disparities in Oral Health 

from the best group rate for each characteristic at the 

most recent data point [2]. It also displays changes 

in disparities from baseline to the most recent data 

point [3].

 Nine objectives had statistically significant racial 

and ethnic health disparities of 10% or more 

(objectives 21-1a and b, 21-2d, 21-3, 21-5b, 21-7, 

21-8a and b, and 21-10). Two additional objectives 

(21-5a and 21-6) had racial and ethnic health 

disparities of 10% or more, but lacked data to 

assess statistical significance. The non-Hispanic 

white population had the unique best group rate 

for 10 of these objectives; whereas the Hispanic or 

Latino and non-Hispanic white populations were 

tied for the best rate for objective 21-6.

 Four objectives had statistically significant 

health disparities of 10% or more by sex 

(objectives 21-1a, 21-2d, 21-3, and 21-10), and two 

objectives (21-5a and 21-6) had health disparities 

of 10% or more by sex but lacked data to assess 

statistical significance. Females had a better rate 

for five of these six objectives (21-1a, 21-2d, 21-5a, 

21-6, and 21-10). Males had a better rate for the 

sixth objective (21-3).

 Nine objectives had statistically significant 

health disparities of 10% or more by education 

level (objectives 21-1b and c, 21-2d, 21-3, 21-5b, 

21-7, 21-8a and b, and 21-10), and one objective 

(21-5a) had health disparities of 10% or more 

by education level but lacked data to assess 

statistical significance. Persons with at least 

some college education had the best group rate 

for all 10 of these objectives.

 Two objectives had health disparities of 100% 

or more by education level (objectives 21-2d and 

21-5b), and one objective (21-5b) had a change 

in disparity by education level over time of 100 

percentage points or more [3].

Transition to Healthy People 

2020

For Healthy People 2020, the focus of the Oral Health 

objectives has expanded to include a broader range of 

health behaviors, interventions to reduce tooth decay, 

improved methods of monitoring oral diseases and 

conditions, and programs that provide preventive oral 

health services at the community and national levels. 

See HealthyPeople.gov for a complete list of Healthy 

People 2020 topics and objectives.

The Healthy People 2020 objectives for Oral Health can 

be grouped into several sections:

〉 Oral health of children and adolescents
21 • ORAL HEALTH 21-5

〉 Oral health of adults

〉 Access to preventive services

〉 Oral health interventions

〉 Monitoring, surveillance systems

〉 Public health infrastructure.

The differences between the Healthy People 2010 and 

Healthy People 2020 objectives are summarized below:

〉 The Healthy People 2020 Oral Health Topic Area has 

33 objectives, 5 of which are developmental, whereas 

the Healthy People 2010 Oral Health Focus Area had 

26 objectives [4].

〉 Seven Healthy People 2010 objectives were retained 

“as is” [5]. These objectives include: untreated dental 

decay in adults (objective 21-2d), complete tooth loss 

in older adults (objective 21-4), community water 

fluoridation (objective 21-9), annual dental visits 

(objective 21-10), dental care and sealants provided 

in school-based health centers (objectives 21-13a and 

b), and community-based health centers with an oral 

health component (objective 21-14).

〉 Two Healthy People 2010 objectives were archived [6].

 The methodology for assessing gingival bleeding 

used at the baseline was modified over the course 

of the decade and a new definition has yet to be 

defined. Therefore, gingivitis in adults (objective 

21-5a) will not be tracked in Healthy People 2020.

 Use of the oral health care system by nursing 

home residents has not been collected in a 

national survey since the baseline. Therefore, 

the objective for residents in long-term facilities 

(objective 21-11) was archived due to lack of 

national data.

〉 Seventeen Healthy People 2010 objectives were 

modified to create 18 Healthy People 2020 objectives 

[7].

 The age groups tracked for the following 

objectives were modified and expanded: dental 

caries experience and untreated dental decay 

in children and adolescents (objectives 21-1a 

through c, and 21-2a through c), dental sealants 

in children and adolescents (objectives 21-8a and 

b), permanent tooth loss in adults (objective 21-

3), and destructive periodontal diseases in adults 

(objective 21-5b).

 The data sources for early detection of oral and 

pharyngeal cancers (objective 21-6) and oral 

and pharyngeal cancer screening by a dental 

professional (objective 21-7) were modified. In 

addition, the age group tracked for oral and 

pharyngeal cancer screening was expanded. This 

objective is developmental in Healthy People 

2020 [4].

 The definition of an annual preventive dental 

services visit for low-income youth (objective 

21-12) has been changed. The Healthy People 

2010 objective defines a preventive visit as one 

in which the patient received 1) an examination, 

2) a dental sealant, 3) a fluoride treatment, 4) a 

dental prophylaxis, or 5) an X-ray examination. 

The Healthy People 2020 objective defines a 

preventive visit as one in which the patient 

received 1) a dental sealant, 2) a fluoride 

treatment, or 3) a dental prophylaxis. In addition, 

the age group tracked was changed from 2–19 

years to 2–18 years.

 The objective tracking the number of States that 

record and refer children and youth diagnosed 

with a cleft lip or palate (objective 21-15) has 

been expanded to two developmental objectives, 

tracking the registry and referral of such children 

separately.

 The definitions of State oral and craniofacial 

surveillance systems (objective 21-16) and State 

and local dental health programs directed by 

public health professionals (objective 21-17a) 

were modified.

 The number of Indian Health Service and Tribal 

dental programs that serve jurisdictions of 

30,000 or more persons and are directed by a 

public health professional (objective 21-17b) has 

increased to 33: one headquarter or national 

program, 20 field programs, and 12 regional or 

area offices.

〉 Eight new objectives, two of which are developmental, 

were added to the Healthy People 2020 Topic Area [4]:

 One new objective tracks the proportion of 

patients who receive oral health at federally 

qualified health centers. Two objectives track 

untreated dental decay: adults aged 65–74 with 

coronal caries in at least one tooth, and adults 

aged 75 and over with root surface caries in at 

least one tooth.

 Two developmental prevention objectives focus

on counseling to reduce tobacco use and 

encourage smoking cessation and referral for 

glycemic control by dental professionals.

 One new objective tracks sealant placement on 

primary molars for children aged 3–5 years.

 One new objective expands the scope of services 

tracked in school-based health centers to include 

fluoride treatments.

 One new objective tracks the expansion of existing 

infrastructure by monitoring the increase of oral 

health prevention and care services provided by 

local health departments.
21-6 HEALTHY PEOPLE 2010 FINAL REVIEW

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can be 

found in the Technical Appendix and in Healthy People 

2010: General Data Issues, which is available in the 

General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

Notes

1. Displayed in the Progress Chart (Figure 21-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 21-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 21-2). Disparity from the best group rate is 

defined as the percent difference between the best 

group rate and each of the other group rates for a 

characteristic. For example, racial and ethnic health 

disparities are measured as the percent difference 

between the best racial and ethnic group rate and 

each of the other racial and ethnic group rates. 

Similarly, disparities by sex are measured as the 

percent difference between the better group rate (e.g., 

female) and the rate for the other group (e.g., male). 

Some objectives are expressed in terms of favorable 

events or conditions that are to be increased, while 

others are expressed in terms of adverse events 

or conditions that are to be reduced. To facilitate 

comparison of health disparities across different 

objectives, disparity is measured only in terms of 

adverse events or conditions. For comparability 

across objectives, objectives that are expressed 

in terms of favorable events or conditions are reexpressed using the adverse event or condition for 

the purpose of computing disparity, but they are not 

otherwise restated or changed. For example, objective 

1-1, to increase the proportion of persons with health 

insurance (e.g., 72% of the American Indian or Alaska 

Native population under age 65 had some form of 

health insurance in 2008), is expressed in terms of the 

percentage of persons without health insurance (e.g., 

100% – 72% = 28% of the American Indian or Alaska 

Native population under age 65 did not have any form 

of health insurance in 2008) when the disparity from 

the best group rate is calculated. See the Reader’s 

Guide for more information. When standard errors 
21 • ORAL HEALTH 21-7

were available, the difference between the best group 

rate and each of the other group rates was tested 

at the 0.05 level of significance. See the Figure 21-2 

footnotes, as well as the Technical Appendix, for more 

detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 21-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

5. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

6. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020. 

7. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

Comprehensive Summary of Objectives: Oral Health

Objective Description Data Source

21-1a Dental caries experience—Primary teeth—Young children 

(2–4 years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

21-1b Dental caries experience—Primary or permanent teeth—

Children (6–8 years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

21-1c Dental caries experience—Permanent teeth—Adolescents 

(15 years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

21-2a Untreated dental decay—Primary teeth—Young children 

(2–4 years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

21-2b Untreated dental decay—Primary or permanent teeth—

Children (6–8 years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

21-2c Untreated dental decay—Permanent teeth—Adolescents (15 

years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

21-2d Untreated dental decay—Adults (35–44 years) National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

21-3 No permanent tooth loss due to caries or periodontal disease 

in adults (35–44 years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

21-4 Complete tooth loss in older adults (65–74 years) National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

21-5a Gingivitis in adults (35–44 years) National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.
21-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Comprehensive Summary of Objectives: Oral Health (continued)

Objective Description Data Source

21-5b Destructive periodontal disease in adults (35–44 years) National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS; Oral Health Survey of Native Americans, 1999–2000, IHS.

21-6 Early detection of oral and pharyngeal cancers Surveillance, Epidemiology, and End Results (SEER) Program, NIH, 

NCI.

21-7 Annual examinations for oral and pharyngeal cancers in adults 

(age adjusted, 40+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

21-8a Dental sealants—Children (8 years) National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

21-8b Dental sealants—Adolescents (14 years) National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

21-9 Population served by optimally fluoridated community water CDC Fluoridation Census, CDC, NCCDPHP.

21-10 Annual dental visits (age adjusted, 2+ years) Medical Expenditure Panel Survey (MEPS), AHRQ.

21-11 Use of oral health care system by residents in long-term care 

facilities

National Nursing Home Survey (NNHS), CDC, NCHS.

21-12 Annual preventive dental services for low-income children and 

adolescents (<19 years)

Medical Expenditure Panel Survey (MEPS), AHRQ.

21-13a School-based health centers with oral health component—

Dental sealants

School-Based Health Care Census, National Assembly of School 

Based Health Care.

21-13b School-based health centers with oral health component—

Dental care

School-Based Health Care Census, National Assembly of School 

Based Health Care.

21-14 Community-based health centers with oral health components HRSA, Bureau of Primary Health Care.

21-15 Recording and referral of children and youth with cleft lip or 

palate (no. States and D.C.)

Annual Synopses of State and Territorial Dental Public Health 

Programs, Association of State and Territorial Dental Directors 

(ASTDD).

21-16 Oral and craniofacial State-based surveillance systems (no. 

States and D.C.)

Annual Synopses of State and Territorial Dental Public Health 

Programs, Association of State and Territorial Dental Directors 

(ASTDD).

21-17a State and local dental programs directed by public health 

professionals

Association of State and Territorial Dental Directors (ASTDD).

21-17b Indian Health Service and Tribal dental programs directed by 

public health professionals

IHS, Division of Oral Health.
21 • ORAL HEALTH 21-9

Figure 21-1. Progress Toward Target Attainment for Focus Area 21: Oral Health

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

21-1. Dental caries experience

a. Primary teeth—Young children 

(2–4 years)

11% 18%

(1988–94)

24%

(1999–2004)

6 Yes 33.3%

b. Primary or permanent teeth—Children 

(6–8 years)

42% 52%

(1988–94)

53%

(1999–2004)

1 No 1.9%

c. Permanent teeth—Adolescents (15 years) 50.0% 51% 61%

(1988–94)

56%

(1999–2004)

-5 No -8.2%

21-2. Untreated dental decay

a. Primary teeth—Young children 

(2–4 years)

9% 16%

(1988–94)

19%

(1999–2004)

3 No 18.8%

b. Primary or permanent teeth—Children 

(6–8 years)

21% 28%

(1988–94)

29%

(1999–2004)

1 No 3.6%

c. Permanent teeth—Adolescents (15 years) 40.0% 15% 20%

(1988–94)

18%

(1999–2004)

-2 No -10.0%

d. Adults (35–44 years) 15% 27%

(1988–94)

28%

(1999–2004)

1 No 3.7%

21-3. No permanent tooth loss due to caries 

or periodontal disease in adults 

(35–44 years)

80.0% 40% 30%

(1988–94)

38%

(1999–2004)

8 Yes 26.7%

21-4. Complete tooth loss in older adults 

(65–74 years)

71.4% 22% 29%

(1988–94)

24%

(1999–2004)

-5 Yes -17.2%

21-5b. Destructive periodontal disease in adults 

(35–44 years)

75.0% 14% 22%

(1988–94)

16%

(1999–2004)

-6 Yes -27.3%

21-6. Early detection of oral and pharyngeal 

cancers

51% 36%

(1992–95)

33%

(2006)

-3 Not tested -8.3%

21-7. Annual examinations for oral and pharyngeal cancers in adults (age adjusted, 

40+ years)

71.4% 20% 13%

(1998)

18%

(2008)

5 Yes 38.5%

21-8. Dental sealants

a. Children (8 years) 33.3% 50% 23%

(1988–94)

32%

(1999–2004)

9 No 39.1%

b. Adolescents (14 years) 17.1% 50% 15%

(1988–94)

21%

(1999–2004)

6 No 40.0%

21-9. Population served by optimally fl uoridated 

community water

76.9% 75% 62%

(1992)

72%

(2008)

10 Not tested 16.1%

21-10. Annual dental visits (age adjusted, 

2+ years)

56% 44%

(1996)

43%

(2008)

-1 No -2.3%

21-12. Annual preventive dental services for 

low-income children and adolescents 

(<19 years)

14.6% 66% 25%

(1996)

31%

(2008)

6 Yes 24.0%

LEGEND Moved away from target1 Moved toward target Met or exceeded target
21-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 21-1. Progress Toward Target Attainment for Focus Area 21: Oral Health (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

21-13. School-based health centers with 

oral health components

a. Dental sealants 400.0% 15% 12%

(2001–02)

24%

(2007–08)

12 Not tested 100.0%

b. Dental care 50.0% 11% 9%

(2001–02)

10%

(2007–08)

1 Not tested 11.1%

21-14. Community-based health centers with 

oral health components

100.0% 75% 52%

(1997)

75%

(2007)

23 Not tested 44.2%

21-15. Recording and referral of children and 

youth with cleft lip or palate (no. States 

and D.C.)

48.6% 51 16

(2003)

33

(2009)

17 Not tested 106.3%

21-16. Oral and craniofacial State-based 

surveillance systems (no. States and D.C.)

84.3% 51 0

(1999)

43

(2010)

43 Not tested *

21-17a. State and local dental programs directed 

by public health professionals

750.0% 41 39

(2003)

54

(2009)

15 Not tested 38.5%

21-17b. Indian Health Service and Tribal dental 

programs directed by public health 

professionals

Target met at baseline

and exceeded at fi nal 9 9

(2003)

10

(2006)

1 Not tested 11.1%

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 21-5a and 21-11.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

2

 Percent of targeted change achieved = Final value – Baseline value × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at the 

0.05 level. See Technical Appendix for more information.

5

 Percent change = Final value – Baseline value × 100.

Baseline value

* Percent change cannot be calculated. See Technical Appendix for more information.

DATA SOURCES

21-1a–c. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

21-2a–d. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS

21-3–21-4. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

21-5b. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

21-6. Surveillance, Epidemiology, and End Results (SEER) Program, NIH, NCI.

21-7. National Health Interview Survey (NHIS), CDC, NCHS.

21-8a–b. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

21-9. CDC Fluoridation Census, CDC, NCCDPHP.

21-10. Medical Expenditure Panel Survey (MEPS), AHRQ.

21-12. Medical Expenditure Panel Survey (MEPS), AHRQ.

21-13a–b. School-Based Health Care Census, National Assembly of School Based Health Care.

21-14. HRSA, Bureau of Primary Health Care.

21-15–21-16. Annual Synopses of State and Territorial Dental Public Health Programs, Association of State and Territorial Dental Directors (ASTDD).

21-17a. Association of State and Territorial Dental Directors (ASTDD).

21-17b. IHS, Division of Oral Health.
21 • ORAL HEALTH 21-11

Figure 21-2. Health Disparities Table for Focus Area 21: Oral Health

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPersons with disabilitiesPersons without disabilities

21-1a. Dental caries experience—Primary 

teeth—Young children (2–4 years) 

(1988–94, 1999–2004)1*

i Bii iii Bii

b. Dental caries experience—Primary or 

permanent teeth—Children (6–8 years) 

(1988–94, 1999–2004)1*

i B Bii B

c. Dental caries experience— 

Permanent teeth—Adolescents 

(15 years) (1988–94, 1999–2004)1*

i Bii iii iv B iv iv Bii iii

21-2a. Untreated dental decay—Primary 

teeth—Young children (2–4 years) 

(1988–94, 1999–2004)1*

i B

b. Untreated dental decay—Primary or 

permanent teeth—Children (6–8 years) 

(1988–94, 1999–2004)1*

i B b

c. Untreated dental decay— 

Permanent teeth—Adolescents 

(15 years) (1988–94, 1999–2004)1*

i

d. Untreated dental decay—Adults (35–

44 years) (1988–94, 1999–2004)* i B B B

21-3. No permanent tooth loss due to caries 

or periodontal disease in adults (35–44 

years) (1988–94, 1999–2004)*

i B Bii B

21-4. Complete tooth loss in older adults (65–

74 years) (1988–94, 1999–2004)* bi Bii B

21-5a. Gingivitis in adults (35–44 years) 

(1988–94)† i B B B

21-5b. Destructive periodontal disease in 

adults (35–44 years) (1988–94, 

1999–2004)*

i B







Bii iii

21-6. Early detection of oral and pharyngeal 

cancers (1992–95, 2006)† v Bii  B  B 

21-7. Annual examinations for oral and 

pharyngeal cancers in adults (age 

adjusted, 40+ years) (1998, 2008)2*

B B  B

21-8a. Dental sealants—Children (8 years) 

(1988–94, 1999–2004)1* i B B Bii iv iv B iii

b. Dental sealants—Adolescents 

(14 years) (1988–94, 1999–2004)1* i,iv iv B iii iv B iv iv B iii

21-10. Annual dental visits (age adjusted, 

2+ years) (1996, 2008)3* B B B B
21-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 21-2. Health Disparities Table for Focus Area 21: Oral Health (continued)

Race and Ethnicity Sex Education Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPersons with disabilitiesPersons without disabilities

21-11. Use of oral health care system by 

residents in long-term care facilities 

(1997)*

B B

21-12. Annual preventive dental services for 

low-income children and adolescents 

(<19 years) (1996, 2008)3*

b Bii B B

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 21-9, 

21-13a and b, 21-14 through 21-16, and 21-17a and b.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

LEGEND

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. Nonetheless, 

disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix.

1 Data by education level are for the head of household.

2 Baseline data by race and ethnicity are for 2008.

3 Baseline data by race and ethnicity are for 2002.

i

 Data are for Mexican American.
21 • ORAL HEALTH 21-13

Figure 21-2. Health Disparities Table for Focus Area 21: Oral Health (continued)

ii The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

iiiChange in the summary index cannot be assessed. See Technical Appendix.

iv Reliability criterion for best group rate not met, or data available for only one group, at baseline. Change in disparity cannot be assessed. See Technical Appendix.

v Data are for Asian or Pacific Islander.

DATA SOURCES

21-1a–c. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

21-2a–d. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

21-3–21-4. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

21-5a–b. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

21-6. Surveillance, Epidemiology, and End Results (SEER) Program, NIH, NCI.

21-7. National Health Interview Survey (NHIS), CDC, NCHS.

21-8a–b. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

21-10. Medical Expenditure Panel Survey (MEPS), AHRQ.

21-11. National Nursing Home Survey (NNHS), CDC, NCHS.

21-12. Medical Expenditure Panel Survey (MEPS), AHRQ.

Physical Activity 

and Fitness

CHAPTER 22

Co-Lead Agencies

Centers for Disease Control and Prevention

President’s Council on Physical Fitness and Sports

Contents

Goal ................................................................................................22-3

Highlights ......................................................................................22-3

Summary of Progress.....................................................................22-3

Transition to Healthy People 2020................................................22-4

Data Considerations.......................................................................22-5

References and Notes.....................................................................22-5

Comprehensive Summary of Objectives........................................22-7

Progress Chart................................................................................22-8

Health Disparities Table...............................................................22-10

No Leisure-Time Physical Activity Among Adults, 2008—Map....22-12

22 • PHYSICAL ACTIVITY AND FITNESS 22-3

GOAL:

Improve health, fitness, and quality of life 

through daily physical activity.

This chapter includes objectives that track participation 

in physical activities, access to physical activity and 

fitness programs, and the availability of physical activity 

facilities at schools and worksites.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions can be found in the Healthy People 2010 

database, DATA2010, available from http://wonder.cdc.

gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in objectives for 

this Focus Area during the past decade. About 70% of 

the Physical Activity and Fitness objectives with data 

to measure progress moved toward their Healthy 

People 2010 targets (Figure 22-1) [1]. However, 

almost all objectives in this Focus Area exhibited 

statistically significant health disparities among 

select populations [2]. These disparities ranged 

from 10% to 49% in magnitude, with the exception 

of two objectives (discussed below) which displayed 

statistically significant disparities of 50% or more 

(Figure 22-2).

〉 Television viewing by students in grades 9–12 

(objective 22-11) declined. The percentage of students 

who watched television for 2 or fewer hours a day 

increased 17.5% between 1999 and 2009, from 57% to 

67%, moving toward the Healthy People 2010 target 

of 75%. Disparities were observed for a number of 

population groups, for example:

 Among racial and ethnic groups, non-Hispanic 

white students had the highest (best) rate of 

television viewing for 2 or fewer hours a day, 75% 

in 2009, whereas Hispanic or Latino students and 

non-Hispanic black students had rates of 58% and 

44%, respectively. When expressed as viewing 

television for more than 2 hours a day, the rate for 

Hispanic or Latino students was more than one 

and a half times the rate for non-Hispanic white 

students. The rate for non-Hispanic black students 

was more than twice the non-Hispanic white rate.

〉 The proportion of adults who did not participate in 

any form of leisure-time physical activity (objective 

22-1) decreased 9% between 1997 and 2008, from 40% 

to 36%, moving toward the 2010 target of 20%.

 Among education groups, persons with at least 

some college education had the lowest (best) rate 

of no leisure-time physical activity, 27% in 2008. 

Persons with less than a high school education 

had a rate of 59%, more than twice the best group 

rate.

〉 Participation in leisure-time physical activity varied 

by geographic region. Colorado, Minnesota, Oregon, 

Vermont, and Washington had the lowest rates of 

non participation in 2008. These states achieved the 

Healthy People 2010 target. Kentucky, West Virginia, 

and a contiguous group of southern states (Alabama, 

Arkansas, Louisiana, Mississippi, Oklahoma, and 

Texas) had the highest rates (Figure 22-3).

Summary of Progress

〉 Figure 22-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for Physical Activity and Fitness [1]. Data 
22-4 HEALTHY PEOPLE 2010 FINAL REVIEW

to measure progress toward target attainment were 

available for 17 objectives.

 None of the objectives in this Focus Area achieved 

the Healthy People 2010 targets.

 Twelve objectives moved toward their targets. A 

statistically significant difference between the 

baseline and the final data points was observed 

for five of these objectives (22-1, 22-4, 22-11, and 

22-14a and b). No significant differences were 

observed for seven objectives (22-3, 22-5 through 

22-7, 22-8a, 22-9, and 22-10).

 One objective showed no change (objective 22-2).

 Four objectives moved away from their targets. 

A statistically significant difference between the 

baseline and final data point was observed for 

two objectives (22-8b and 22-15a). No significant 

differences were observed for the other two 

objectives (22-12 and 22-15b).

〉 Data were unavailable to measure progress for one 

objective (22-13); this objective had baseline data 

only.

〉 Figure 22-2 displays health disparities in Physical 

Activity and Fitness from the best group rate for each 

characteristic at the most recent data point [2]. It 

also displays changes in disparities from baseline to 

the most recent data point [3].

 Of the 10 objectives with statistically significant 

health disparities of 10% or more among racial 

and ethnic populations, the non-Hispanic white 

population had the best rate for 7 objectives (22-1 

through 22-4, 22-6, 22-7, and 22-11); the Hispanic 

or Latino population had the best rate for 2 

objectives (22-9 and 22-10); and persons of 2 or 

more races had the best rate for 1 objective (22-5).

 Health disparities of 100% or more were 

observed for one objective (22-11, student 

television viewing); see Highlights, above.

 Males had better rates than females for the four 

objectives with statistically significant health 

disparities of 10% or more by sex (objectives 22-1, 

22-4, 22-7, and 22-10).

 Persons with at least some college education had 

the best rates for five of the six objectives with 

statistically significant health disparities of 

10% or more by education level (objectives 22-1 

through 22-4, and 22-5). Persons with less than 

a high school education had the best rate for one 

objective (22-14a).

 Residents of urban or metropolitan areas had 

better rates than residents of rural areas for the 

three objectives with statistically significant 

health disparities of 10% or more by geographic 

location (objectives 22-1, and 22-14a and b).

 Persons without disabilities had better rates than 

persons with disabilities for the four objectives 

with statistically significant health disparities of 

10% or more by disability status (objectives 22-1 

through 22-4).

Transition to Healthy People 

2020

For Healthy People 2020, the focus of the Physical 

Activity objectives has been expanded to include a 

broader range of activities than those included in 

Healthy People 2010. The Healthy People 2010 Focus 

Area name was changed from “Physical Activity and 

Fitness” to “Physical Activity” to be consistent with 2008 

Physical Activity Guidelines for Americans [4]. With 

the exception of muscle strengthening, the objectives 

primarily assess aerobic physical activity behaviors 

and the environments and policies that support being 

physically active. See HealthyPeople.gov for a complete 

list of Healthy People 2020 topics and objectives.

The Healthy People 2020 Physical Activity Topic Area 

objectives can be grouped into several sections:

〉 Aerobic physical activity and muscular-strengthening 

activity in adults

〉 Aerobic physical activity and muscular-strengthening 

activity in children and adolescents

〉 Physical education and school recess

〉 Access to school physical activity facilities

〉 Environmental policies enhancing physical activity 

opportunities

〉 Physical activity policies in child care setting

〉 Physical counseling related to physical activity.

The differences between the Healthy People 2010 and 

Healthy People 2020 objectives are summarized below:

〉 The Healthy People 2020 Physical Activity Topic 

Area has a total of 36 objectives, 10 of which are 

developmental, whereas the Healthy People 2010 

Physical Activity and Fitness Focus Area had 18 

objectives [5].

〉 Five Healthy People 2010 objectives, including 

no leisure-time physical activity (objective 22-1), 

physical education requirement (objectives 22-8a 

and b), participation in daily physical education 

in schools (objective 22-9), and access to physical 

activities in school facilities (objective 22-12), were 

retained “as is” [6].
22 • PHYSICAL ACTIVITY AND FITNESS 22-5

〉 Six Healthy People 2010 objectives were modified 

(objectives 22-2 through 22-4, 22-6, 22-7, and 22-11) 

[7]. These physical activity and muscle strengthening 

activity in adults and adolescents objectives were 

changed to reflect 2008 Federal Physical Activity 

Guidelines recommendations.

〉 Five objectives addressing worksite physical activity 

programs (objective 22-13), and walking and 

bicycling for transportation (objectives 22-14a and b, 

and 22-15a and b), were returned to developmental 

status due to a lack of baseline data [5].

〉 Two objectives were archived [8]. The flexibility 

objective (22-5) was archived due to a change in the 

physical activity guideline recommendations. The 

physical activity in physical education class measure 

(objective 22-10) was archived because it lacked a 

national data source.

〉 The objective that tracks physician counseling about 

physical activity (objective 1-3a) was moved from 

Healthy People 2010 Focus Area “Access to Quality 

Health Services” into the Healthy People 2020 

Physical Activity Topic Area and modified to include 

two objectives on physician counseling or education 

related to exercise.

〉 Seventeen new objectives were added to the Healthy 

People 2020 Physical Activity Topic Area:

 Seven new objectives address physical activity 

programs for children and adolescents: time for 

recess, regularly scheduled school recess, daily 

physical education in elementary schools, and 

physical activity policies in child care settings.

 The television viewing objective (22-11) was 

expanded to include seven new objectives of 

other types of screen time such as computer use, 

video and computer games among children and 

adolescents aged under 17 years.

 Three new Healthy People 2020 environment 

objectives include measures to track legislative 

policies that enhance access and availability of 

physical activity opportunities.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Figure 22-3 (no leisure-time physical activity among 

adults) presents State-level data from the Behavioral 

Risk Factor Surveillance System (BRFSS). National 

data for this objective comes from the National Health 

Interview Survey (NHIS) and is the basis for setting the 

target. BRFSS data may not be comparable with the 

national data from NHIS.

In general, data on educational attainment are 

presented for persons 25 and over, consistent with 

guidance given by the Census Bureau. However, because 

of the requirements of the different data systems, the 

age groups used to calculate educational attainment 

for any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

References and Notes

1. Displayed in the Progress Chart (Figure 22-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 22-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 
22-6 HEALTHY PEOPLE 2010 FINAL REVIEW

(Figure 22-2). Disparity from the best group rate 

is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 22-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 22-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. 2008 Physical Activity Guidelines for Americans. 

Washington, D.C.: Department of Health and Human 

Services (DHHS); 2008. Available from http://www.

health.gov/PAGuidelines/.

5. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

6. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy 

People 2010 and are developmental in Healthy People 

2020, and for which no numerator information is 

available.

7. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

8. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.
22 • PHYSICAL ACTIVITY AND FITNESS 22-7

Comprehensive Summary of Objectives: Physical Activity and Fitness

Objective Description Data Source

22-1 No leisure-time physical activity (age adjusted, 18+ years) National Health Interview Survey (NHIS), CDC, NCHS.

22-2 Regular physical activity—Moderate or vigorous (age 

adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

22-3 Regular physical activity—Vigorous (age adjusted, 18+ years) National Health Interview Survey (NHIS), CDC, NCHS.

22-4 Regular muscle-strengthening activity (age adjusted, 18+ 

years)

National Health Interview Survey (NHIS), CDC, NCHS.

22-5 Flexibility training (age adjusted, 18+ years) National Health Interview Survey (NHIS), CDC, NCHS.

22-6 Moderate physical activity in students (grades 9–12) Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

22-7 Vigorous physical activity in students (grades 9–12) Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

22-8a Physical education requirement in middle and junior high 

schools

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

22-8b Physical education requirement in senior high schools School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

22-9 Student participation in daily physical education in schools 

(grades 9–12)

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

22-10 Student physical activity in physical education class (grades 

9–12)

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

22-11 Student television viewing—At most 2 hours per school day 

(grades 9–12)

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

22-12 Access to school physical activity facilities during non-school 

time

School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

22-13 Worksite physical activity and fitness programs National Worksite Health Promotion Survey (NWHPS), Association 

for Worksite Health Promotion (AWHP), and OPHS, ODPHP.

22-14a Walking for transportation—Adults—Trips ≤1 mile (age 

adjusted, 18+ years)

National Household Travel Survey (NHTS), formerly Nationwide 

Personal Transportation Survey (NPTS), Department of 

Transportation (DOT).

22-14b Walking for transportation—Children and adolescents—Trips 

to school ≤1 mile (5–15 years)

National Household Travel Survey (NHTS), formerly Nationwide 

Personal Transportation Survey (NPTS), Department of 

Transportation (DOT).

22-15a Bicycling for transportation—Adults—Trips ≤5 miles (age 

adjusted, 18+ years)

National Household Travel Survey (NHTS), formerly Nationwide 

Personal Transportation Survey (NPTS), Department of 

Transportation (DOT).

22-15b Walking for transportation—Children and adolescents—Trips 

to school ≤2 miles (5–15 years)

National Household Travel Survey (NHTS), formerly Nationwide 

Personal Transportation Survey (NPTS), Department of 

Transportation (DOT).
22-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 22-1. Progress Toward Target Attainment for Focus Area 22: Physical Activity and Fitness

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

22-1. No leisure-time physical activity 

(age adjusted, 18+ years)

20.0% 20% 40%

(1997)

36%

(2008)

-4 Yes -10.0%

22-2. Regular physical activity—Moderate or 

vigorous (age adjusted, 18+ years)

 0.0% 50% 32%

(1997)

32%

(2008)

0 No 0.0%

22-3. Regular physical activity—Vigorous 

(age adjusted, 18+ years)

14.3% 30% 23%

(1997)

24%

(2008)

1 No 4.3%

22-4. Regular muscle-strengthening activity 

(age adjusted, 18+ years)

33.3% 30% 18%

(1998)

22%

(2008)

4 Yes 22.2%

22-5. Flexibility training (age adjusted, 

18+ years)

7.7% 43% 30%

(1998)

31%

(2001)

1 No 3.3%

22-6. Moderate physical activity in students 

(grades 9–12)

25.0% 35% 27%

(1999)

29%

(2009)

2 No 7.4%

22-7. Vigorous physical activity in students 

(grades 9–12)

15.0% 85% 65%

(1999)

68%

(2009)

3 No 4.6%

22-8a. Physical education requirement in middle 

and junior high schools

50.0% 9.4% 6.4%

(2000)

7.9%

(2006)

1.5 No 23.4%

22-8b. Physical education requirement in senior 

high schools

14.5% 5.8%

(2000)

2.1%

(2006)

-3.7 Yes -63.8%

22-9. Student participation in daily physical 

education in schools (grades 9–12)

19.0% 50% 29%

(1999)

33%

(2009)

4 No 13.8%

22-10. Student physical activity in physical 

education class (grades 9–12)

25.0% 50% 38%

(1999)

41%

(2009)

3 No 7.9%

22-11. Student television viewing—At most 2 

hours per school day (grades 9–12)

55.6% 75% 57%

(1999)

67%

(2009)

10 Yes 17.5%

22-12. Access to school physical activity facilities 

during nonschool time

50% 35%

(2000)

29%

(2006)

-6 No -17.1%

22-14. Walking for transportation

a. Adults—Trips ≤1 mile (age adjusted, 

18+ years)

50.0% 25% 17%

(1995)

21%

(2001)

4 Yes 23.5%

b. Children and adolescents—Trips to 

school ≤1 mile (5–15 years)

26.3% 50% 31%

(1995)

36%

(2001)

5 Yes 16.1%

22-15. Bicycling for transportation

a. Adults—Trips ≤5 miles (age adjusted, 

18+ years)

2.0% 0.6%

(1995)

0.4%

(2001)

-0.2 Yes -33.3%

b. Children and adolescents—Trips to 

school ≤2 miles (5–15 years)

5.0% 2.4%

(1995)

1.5%

(2001)

-0.9 No -37.5%

LEGEND Moved away from target1 Moved toward target Met or exceeded target
22 • PHYSICAL ACTIVITY AND FITNESS 22-9

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

5 Final value – Baseline value Percent change = × 100.

Baseline value

Figure 22-1. Progress Toward Target Attainment for Focus Area 22: Physical Activity and Fitness (continued)

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objective 22-13.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

DATA SOURCES

22-1–22-5. National Health Interview Survey (NHIS), CDC, NCHS. 

22-6–22-7. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP. 

22-8a–b. School Health Policies and Programs Study (SHPPS), CDC, NCCDPHP. 

22-9–22-11. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP. 

22-12. School Health Policies and Programs Study (SHPPS), CDC, NCCDPHP. 

22-14a–b. National Household Travel Survey (NHTS), formerly Nationwide Personal Transportation Survey (NPTS), Department of 

Transportation (DOT). 

22-15a–b. National Household Travel Survey (NHTS), formerly Nationwide Personal Transportation Survey (NPTS), Department of 

Transportation (DOT). 
22-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 22-2. Health Disparities Table for Focus Area 22: Physical Activity and Fitness

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Location Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexUrban or metropolitanRural or nonmetropolitanPersons with disabilitiesPersons without disabilities

22-1. No leisure-time physical activity 

(age adjusted, 18+ years) (1997, 

2008)1

b  B B  B B   B

22-2. Regular physical activity—Moderate 

or vigorous (age adjusted, 18+ years) 

(1997, 2008)1

Bi B B B B

22-3. Regular physical activity—Vigorous (age 

adjusted, 18+ years) (1997, 2008)1 Bi B B B B

22-4. Regular muscle-strengthening activity 

(age adjusted, 18+ years) 

(1998, 2008)1

Bi B B B B

22-5. Flexibility training (age adjusted, 

18+ years) (1998, 2001)2 B B B B Bi

22-6. Moderate physical activity in students 

(grades 9–12) (1999, 2009) B B

22-7. Vigorous physical activity in students 

(grades 9–12) (1999, 2009) B B

22-9. Student participation in daily physical 

education in schools (grades 9–12) 

(1999, 2009)

B B

22-10. Student physical activity in physical 

education class (grades 9–12) 

(1999, 2009)

B B

22-11. Student television viewing—At most 2 

hours per school day (grades 9–12) 

(1999, 2009)

B B

22-14a. Walking for transportation—Adults—

Trips ≤1 mile (age adjusted, 18+ years) 

(1995, 2001)

B Bi B B

b. Walking for transportation—Children 

and adolescents—Trips to school ≤1 

mile (5–15 years) (1995, 2001)

Bi B

22-15a. Bicycling for transportation— 

Adults—Trips ≤5 miles (age adjusted, 

18+ years) (1995, 2001)

B B B

b. Bicycling for transportation—Children 

and adolescents—Trips to school ≤2 

miles (5–15 years) (1995, 2001)3
22 • PHYSICAL ACTIVITY AND FITNESS 22-11

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 22-8a 

and b, 22-12, and 22-13.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

Measures of variability were available for all objectives in this table. Thus, the variability of best group rates was assessed, and statistical significance was tested. 

Disparities of 10% or more are displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time 

are indicated by arrows when the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

LEGEND

The best group rate at the most recent 

data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by B or b at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

1 Baseline data by race and ethnicity are for 1999.

2 Baseline data by race and ethnicity are for 2001. 

3 Most current data by location are for 1995. 

i

 The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. 

See Technical Appendix.

DATA SOURCES

22-1–22-5. National Health Interview Survey (NHIS), CDC, NCHS.

22-6–22-7. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

22-9–22-11. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

22-14a–b. National Household Travel Survey (NHTS), formerly Nationwide Personal Transportation Survey (NPTS), Department of Transportation (DOT).

22-15a–b. National Household Travel Survey (NHTS), formerly Nationwide Personal Transportation Survey (NPTS), Department of Transportation (DOT).

Figure 22-2. Health Disparities Table for Focus Area 22: Physical Activity and Fitness (continued)
HEALTHY PEOPLE 2010 FINAL REVIEW 22-12Figure 22-3. No Leisure Time Physical Activity Among Adults (Aged 18+), 2008 Healthy People 2010 objective 22-1 • Target = 20 percent NOTES: Data are age adjusted to the 2000 standard population. Rates are displayed by a modified Jenks classification for U.S. states. National data for the objective come fro

Survey (NHIS) and are the basis for setting the target. State data from BRFSS may not be comparable with national data from NHIS. The U.S. rate in 2008 from NHIS was 36from BRFSS in 2008 was 24.4%. SOURCE: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP. 1

2222

Percent Lowest c

shows sta
Co-Lead Agencies

Centers for Disease Control and Prevention

Health Resources and Services Administration

Contents

Goal ................................................................................................23-3

Highlights ......................................................................................23-3

Summary of Progress.....................................................................23-4

Transition to Healthy People 2020................................................23-4

Data Considerations.......................................................................23-5

References and Notes.....................................................................23-6

Comprehensive Summary of Objectives........................................23-6

Progress Chart................................................................................23-9

Public Health 

Infrastructure

CHAPTER 23

23 • PUBLIC HEALTH INFRASTRUCTURE 23-3

The Public Health Infrastructure Focus Area supports 

the goals and objectives of all other Focus Areas, 

particularly those that address preparedness and 

prevention, the management of chronic disease, and 

those that emphasize healthy behavioral choices. The 

Public Health Infrastructure objectives encompass 

Tribal, rural, and urban populations. They focus on four 

components: data and information systems, workforce, 

public health organizations, and prevention research.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Over two-thirds of the Public Health Infrastructure 

objectives were developmental when Healthy People 

2010 was first published [1,2]. During the past 

decade, data sources were identified for many of 

these objectives, allowing them to be tracked and 

monitored. Because a number of objectives were 

revised and others added, the counts of objectives 

are not strictly comparable. As of this Final Review, 

6 of the 43 objectives in this Focus Area (14%) have 

remained developmental, and 3 (7%) were deleted at 

the Midcourse Review.

〉 Substantial progress was achieved in objectives for 

this Focus Area during the past decade, although 

the tracking period for a number of objectives was 5 

years or less [3]. Seventy percent of the Public Health 

Infrastructure objectives with data to measure 

progress moved toward or achieved their Healthy 

People 2010 targets (see Figure 23-1).

〉 The timely release of Healthy People 2010 data 

increased over the decade. The proportion of 

objectives measured by major data systems from 

which data were released within 1 year of the end 

of data collection (objective 23-7) increased 83.3% 

between 2000 and 2009, from 36% to 66%, moving 

toward the Healthy People 2010 target of 100%.

〉 The National Public Health Performance Standards 

Program assesses the public health system’s capacity 

to perform essential services (objectives 23-11a 

through d).

 The use of performance standards by State public 

health systems (objective 23-11a) increased 

177.8% between 2004 and 2009, from 9 to 25 states, 

moving toward the 2010 target of 35 states. The 

use of standards by local public health systems 

(objective 23-11b) more than doubled between 

2004 and 2009, from 12% to 28%, moving toward 

the target of 50%.

 During the same period, there was a small 

increase in the number of states meeting the 

optimal performance standards (objective 23-

11c), from 0% to 4%, moving toward the target 

of 50%. The proportion of local public health 

GOAL:

Ensure that Federal, Tribal, State, and local 

health agencies have the infrastructure to 

provide essential public health services 

effectively.
23-4 HEALTHY PEOPLE 2010 FINAL REVIEW

systems meeting the standards (objective 23-11d) 

increased 52.8% between 2004 and 2009, from 

36% to 55%, exceeding the 2010 target of 50%.

〉 The percent of State epidemiologists with formal 

training in epidemiology (objective 23-14a) increased 

50.0% between 2001 and 2008, from 58% to 87%, 

exceeding the target of 80%.

Summary of Progress

〉 Figure 23-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for Public Health Infrastructure [3]. Data 

to measure progress toward target attainment were 

available for 30 objectives. Of these:

 Five objectives (23-2a, c and d; 23-11d; and 23-

14a) met or exceeded their Healthy People 2010 

targets.

 Sixteen objectives (23-4; 23-6; 23-7; 23-11a 

through c; 23-13c, e, g, i, j, and k; 23-14c and d; 

and 23-15a and b) moved toward their targets. 

Data to test the significance of the difference 

between the baseline and final data points were 

unavailable for all of these objectives.

 One objective (23-3) showed no change.

 Eight objectives moved away from their targets. 

A statistically significant difference between the 

baseline and final data points was observed for 

one objective (23-8b). Data to test the significance 

of the difference were unavailable for the other 

seven objectives (23-12c and d, and 23-13a, b, d, 

f, and h).

〉 Six objectives (23-2b, 23-8a, 23-10a, 23-12a, 23-14b, 

and 23-17) remained developmental and four 

objectives (23-9, 23-10b and c, and 23-12b) had no 

follow-up data available to measure progress [1]. 

Three objectives (23-1, 23-5, and 23-16) were deleted 

at the Midcourse Review.

Transition to Healthy People 

2020

The objectives in the Healthy People 2020 Public Health 

Infrastructure Topic Area continue to be anchored in 

the provision of essential services. See HealthyPeople.

gov for a complete list of Healthy People 2020 topics 

and objectives. In addition, the Healthy People 2020 

objectives focus more on education of the workforce and 

improvement of health departments than in Healthy 

People 2010.

The Healthy People 2020 objectives can be grouped into 

three sections:

〉 Workforce

〉 Data and information systems

〉 Public health organizations.

The differences between the Healthy People 2010 

objectives and Healthy People 2020 are summarized 

below:

〉 The Healthy People 2020 Public Health Infrastructure 

Topic Area has 44 objectives, 19 of which are 

developmental, whereas the Healthy People 2010 

Focus Area had 43 objectives, including 6 that were 

still developmental at the end of the decade [1].

〉 Fifteen Healthy People 2010 objectives with data 

were retained “as is” [4]. These include: the use of 

core competencies in job descriptions at local health 

agencies and in public health curricula (objectives 

23-8b and 23-9), the use of performance standards 

in local public health systems (objective 23-11b), 

provision or assurance of comprehensive laboratory 

services to support essential public health services 

(objectives 23-13a through k), and the formal training 

of State epidemiologists (objective 23-14a). An 

additional four objectives that address Tribal health 

agency activities (objectives 23-8a, 23-10a, 23-12a, and 

23-14b) were also retained “as is” in developmental 

status [1].

〉 Ten Healthy People 2010 objectives were modified 

[5]. A new data source is being sought for monitoring 

the provision of continuing education to public 

health workers (objectives 23-10b and c); health 

improvement plans implemented at the State and 

local levels (objectives 23-12b through d) will be 

tracked and counted if conducted within the last 

5, rather than 3, years; and the mechanisms for 

measuring several other objectives (23-4, 23-6, 23-7, 

and 23-14c and d) will be changed.

〉 Three Healthy People 2010 objectives were deleted at 

the Midcourse Review. These include: public health 

employee access to the Internet (objective 23-1), data 

for Leading Health Indicators (objective 23-5), and 

data on public health expenditures (objective 23-16).

〉 Two Healthy People 2010 objectives that remained 

developmental were removed during the Healthy 

People 2020 planning process: availability of 

Tribal health indicators data (objective 23-2b) and 

population-based prevention research (objective 

23-17).

〉 Eight Healthy People 2010 objectives were archived 

[6]. Of these, the availability of health indicators 
23 • PUBLIC HEALTH INFRASTRUCTURE 23-5

data was considered complete (objectives 23-2a, c, 

and d); geocoding of major data systems (objective 

23-3) could not expand further than it had during the 

previous decade; the meeting of national performance 

standards (objective 23-11c and d) will be subsumed 

into the accreditation objective; and public health 

law and public health systems research (objectives 

23-15a and b) cannot be adequately measured at this 

time.

〉 Sixteen new objectives were added to the Healthy 

People 2020 Topic Area:

 Five new objectives measure availability of public 

health programs at the community college and 

undergraduate levels, as well as the uniformity 

of undergraduate programs in public health that 

incorporate core competencies in their curriculum.

 Objectives that track the levels of government 

expected to incorporate core competencies for 

public health professionals into job descriptions 

and performance evaluations have been 

expanded to include Federal and State public 

health agencies. Local boards of health were 

added to the objective targeting public health 

system assessment.

 Three objectives monitoring the number of 

states using the most recent edition of the U.S. 

Standard Certificates to collect vital statistics 

data were added.

 Objectives that track the quality and quantity of 

Healthy People 2020 data were expanded.

 A public health laboratory systems performance 

objective was added.

 Objectives addressing public health agency quality 

improvement and accreditation of State, Tribal, 

and local health departments also were added.

The Healthy People 2020 objectives reflect the everpresent importance of public health infrastructure to 

effectively provide essential public health services. For 

objectives that were deleted at the Midcourse Review 

or removed during the Healthy People 2020 planning 

process due to lack of data, the Department of Health 

and Human Services (DHHS) and the agencies that serve 

as the leads for the Healthy People 2020 initiative will 

consider ways to ensure that these public health issues 

retain prominence despite the lack of data to track them.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Data collection and data analysis have been a challenge 

for measuring the Tribal objectives in the Public Health 

Infrastructure Focus Area due to the diversity of 

services, methods of service delivery, and data collection 

and measurement.

The data source used to measure continuing education 

of public health workers (objectives 23-10b and c) was 

a national survey of registered nurses. These data were 

used to characterize all public health workers but only 

include one type of such employee. Furthermore, the 

survey was discontinued in 2000.

The Epidemiology Capacity Assessment, conducted by 

the Council of State and Territorial Epidemiologists, was 

the data source for tracking State epidemiology services 

(objectives 23-14a and c). States were asked if they had 

adequate epidemiologic capacity to provide the four 

essential public health services. The National Profile of 

Local Health Departments, conducted by the National 

Association of County and City Health Departments, 

was the data source for tracking epidemiology services 

provided through local public health agencies (objective 

23-14d). Respondents were asked to indicate which 

organization provided epidemiology and surveillance 

services in six categories. Agencies responding that 

services were provided by the local health department 

only, another local government agency only, a State 

agency only, or a nongovernment organization only, 

were categorized as providing adequate epidemiology 

services. Because of the different definitions of adequate 

services used, the data for State and local health 

departments should not be compared.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.
23-6 HEALTHY PEOPLE 2010 FINAL REVIEW

References and Notes

1. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

2. Department of Health and Human Services (DHHS). 

Healthy People 2010. 2nd ed. With Understanding 

and Improving Health and Objectives for Improving 

Health. 2 vols. Washington, D.C.: Government 

Printing Office, November 2000.

3. Displayed in the Progress Chart (Figure 23-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 23-1 footnotes, as well as the Technical 

Appendix, for more detail.

4. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy 

People 2010 and are developmental in Healthy People 

2020, and for which no numerator information is 

available.

5. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

6. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.

Comprehensive Summary of Objectives: Public Health Infrastructure

Objective Description Data Source or Objective Status

23-1 Public health employee access to the Internet Deleted at the Midcourse Review.

23-2a Health-related indicator data available—National Assessment of Objective Data Availability (AODA), CDC, NCHS.

23-2b Health-related indicator data available—Tribal Developmental.

23-2c Health-related indicator data available—State Assessment of Objective Data Availability (AODA), CDC, NCHS.

23-2d Health-related indicator data available—Local Assessment of Objective Data Availability (AODA), CDC, NCHS.

23-3 Use of geocoding in major health data systems Assessment of Objective Data Availability (AODA), CDC, NCHS.

23-4 Data for all population groups in Healthy People 2010 

objectives

Assessment of Objective Data Availability (AODA), CDC, NCHS.

23-5 Data for Leading Health Indicators Deleted at the Midcourse Review.

23-6 Healthy People 2010 objectives tracked at least every 3 years Assessment of Objective Data Availability (AODA), CDC, NCHS.

23-7 Release of data on Healthy People 2010 objectives within 1 

year of collection

Assessment of Objective Data Availability (AODA), CDC, NCHS.

23-8a Tribal agencies with core competencies in job descriptions and 

performance evaluations

Developmental.
23 • PUBLIC HEALTH INFRASTRUCTURE 23-7

Objective Description Data Source or Objective Status

23-8b Local agencies with core competencies in job descriptions and 

performance evaluations

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

23-9 Core competencies in public health curricula Public Health Competencies Survey, Council on Linkages, American 

Schools of Public Health, Association of Teachers of Preventive 

Medicine, and the Quad Council.

23-10a Continuing education—Tribal public health personnel Developmental.

23-10b Continuing education—State public health personnel National Sample Survey of Registered Nurses, HRSA, Bureau of 

Health Professionals.

23-10c Continuing education—Local public health personnel National Sample Survey of Registered Nurses, HRSA, Bureau of 

Health Professionals.

23-11a Use of performance standards—State public health systems 

(no. States)

National Public Health Performance Standards Program, CDC, 

OCPHP.

23-11b Use of performance standards—Local public health systems National Public Health Performance Standards Program, CDC, 

OCPHP.

23-11c Met performance standards—State public health systems National Public Health Performance Standards Program, CDC, 

OCPHP.

23-11d Met performance standards—Local public health systems National Public Health Performance Standards Program, CDC, 

OCPHP.

23-12a Health improvement plans—Tribal health agencies Developmental.

23-12b Health improvement plans—State health agencies Salary Survey of State and Territorial Health Officials, Association of 

State and Territorial Health Officials (ASTHO).

23-12c Health improvement plans—Local health agencies National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

23-12d Health improvement plans—Local plan linked to State plan National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

23-13a Public health laboratory services (States and D.C.)—Disease 

prevention control and surveillance

Comprehensive Laboratory Services Survey, Association of Public 

Health Laboratories (APHL).

23-13b Public health laboratory services (States and D.C.)—

Integrated data management

Comprehensive Laboratory Services Survey, Association of Public 

Health Laboratories (APHL).

23-13c Public health laboratory services (States and D.C.)—

Reference and specialized testing

Comprehensive Laboratory Services Survey, Association of Public 

Health Laboratories (APHL).

23-13d Public health laboratory services (States and D.C.)—

Environmental health and protection

Comprehensive Laboratory Services Survey, Association of Public 

Health Laboratories (APHL).

23-13e Public health laboratory services (States and D.C.)—Food 

safety

Comprehensive Laboratory Services Survey, Association of Public 

Health Laboratories (APHL).

23-13f Public health laboratory services (States and D.C.)—

Laboratory improvement and regulation

Comprehensive Laboratory Services Survey, Association of Public 

Health Laboratories (APHL).

23-13g Public health laboratory services (States and D.C.)—Policy 

development

Comprehensive Laboratory Services Survey, Association of Public 

Health Laboratories (APHL).

23-13h Public health laboratory services (States and D.C.)—

Emergency response

Comprehensive Laboratory Services Survey, Association of Public 

Health Laboratories (APHL).

23-13i Public health laboratory services (States and D.C.)—Public 

health related research

Comprehensive Laboratory Services Survey, Association of Public 

Health Laboratories (APHL).

Comprehensive Summary of Objectives: Public Health Infrastructure (continued)
23-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Objective Description Data Source or Objective Status

23-13j Public health laboratory services (States and D.C.)—Training 

and education

Comprehensive Laboratory Services Survey, Association of Public 

Health Laboratories (APHL).

23-13k Public health laboratory services (States and D.C.)—

Partnerships and communication

Comprehensive Laboratory Services Survey, Association of Public 

Health Laboratories (APHL).

23-14a Provide or assure comprehensive epidemiology services—

State epidemiologists with formal training

Epidemiology Capacity Assessment, Council of State and Territorial 

Epidemiologists (CSTE).

23-14b Provide or assure comprehensive epidemiology services—

Tribal agencies

Developmental.

23-14c Provide or assure comprehensive epidemiology services—

State agencies

Epidemiology Capacity Assessment, Council of State and Territorial 

Epidemiologists (CSTE).

23-14d Provide or assure comprehensive epidemiology services—

Local agencies

National Profile of Local Health Departments, National Association 

of County and City Health Officials (NACCHO).

23-15a Evaluation of public health laws—Turning Point Model State 

Public Health Act (no. States and D.C.)

Center for Public Health Law and the Public's Health, Georgetown 

University Law Center and Johns Hopkins Bloomberg School of 

Public Health.

23-15b Evaluation of public health laws—Model State Emergency 

Powers Act (no. States and D.C.)

Center for Public Health Law and the Public's Health, Georgetown 

University Law Center and Johns Hopkins Bloomberg School of 

Public Health.

23-16 Data on public health expenditures Deleted at the Midcourse Review.

23-17 Population-based prevention research Developmental.

Comprehensive Summary of Objectives: Public Health Infrastructure (continued)
23 • PUBLIC HEALTH INFRASTRUCTURE 23-9

Figure 23-1. Progress Toward Target Attainment for Focus Area 23: Public Health Infrastructure

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

23-2. Health-related indicator data available

a. National Target met 

at baseline 100% 100%

(2008)

N/A6 N/A6 N/A6 N/A6

c. State Target met 

at baseline 100% 100%

(2008)

N/A6 N/A6 N/A6 N/A6

d. Local Target met 

at baseline 100% 100%

(2008)

N/A6 N/A6 N/A6 N/A6

23-3. Use of geocoding in major health 

data systems

 0.0% 100% 50%

(2000)

50%

(2009)

0 Not tested 0.0%

23-4. Data for all population groups in Healthy 

People 2010 objectives

14.9% 100% 13%

(2004)

26%

(2008)

13 Not tested 100.0%

23-6. Healthy People 2010 objectives tracked at 

least every 3 years

3.6% 100% 44%

(2004)

46%

(2008)

2 Not tested 4.5%

23-7. Release of data on Healthy People 2010 

objectives within 1 year of collection

46.9% 100% 36%

(2000)

66%

(2009)

30 Not tested 83.3%

23-8b. Local agencies with core competencies 

in job descriptions and performance 

evaluations

31% 21%

(2005)

15%

(2008)

-6 Yes -28.6%

23-11. Use of performance standards

a. State public health systems (no. States) 61.5% 35 9

(2004)

25

(2009)

16 Not tested 177.8%

b. Local public health systems 42.1% 50% 12%

(2004)

28%

(2009)

16 Not tested 133.3%

Met performance standards

c. State public health systems 8.0% 50% 0%

(2004)

4%

(2009)

4 Not tested N/A7

d. Local public health systems 135.7% 50% 36%

(2004)

55%

(2009)

19 Not tested 52.8%

23-12. Health improvement plans

c. Local health agencies 80% 53%

(1999)

49%

(2008)

-4 Not tested -7.5%

d. Local plan linked to State plan 41% 37%

(2005)

33%

(2008)

-4 Not tested -10.8%

LEGEND Moved away from target1 Moved toward target Met or exceeded target
23-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 23-1. Progress Toward Target Attainment for Focus Area 23: Public Health Infrastructure (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

23-13. Public health laboratory services (States 

and D.C.)

a. Disease prevention control 

and surveillance

100% 98%

(2006)

88%

(2008)

-10 Not tested -10.2%

b. Integrated data management 73% 59%

(2006)

55%

(2008)

-4 Not tested -6.8%

c. Reference and specialized testing 73.3% 82% 67%

(2006)

78%

(2008)

11 Not tested 16.4%

d. Environmental health and protection 100% 57%

(2006)

55%

(2008)

-2 Not tested -3.5%

e. Food safety 16.9% 100% 17%

(2006)

31%

(2008)

14 Not tested 82.4%

f. Laboratory improvement and regulation 50% 46%

(2006)

41%

(2008)

-5 Not tested -10.9%

g. Policy development 10.8% 100% 63%

(2006)

67%

(2008)

4 Not tested 6.3%

h. Emergency response 100% 72%

(2006)

61%

(2008)

-11 Not tested -15.3%

i. Public health related research 12.5% 50% 26%

(2006)

29%

(2008)

3 Not tested 11.5%

j. Training and education 86.4% 50% 28%

(2006)

47%

(2008)

19 Not tested 65.9%

k. Partnerships and communication 31.0% 81% 52%

(2006)

61%

(2008)

9 Not tested 17.3%

23-14. Provide or assure comprehensive 

epidemiology services

a. State epidemiologists with formal training 131.8% 80% 58%

(2001)

87%

(2009)

29 Not tested 50.0%

c. State agencies 40.0% 15% 10%

(2004)

12%

(2009)

2 Not tested 20.0%

d. Local agencies 80.0% 57% 52%

(2005)

56%

(2008)

4 Not tested 7.7%

 23-15. Evaluation of public health laws

a. Turning Point Model State Public Health 

Act (no. States and D.C.)

14.3% 51 30

(2003)

33

(2007)

3 Not tested 10.0%

b. Model State Emergency Powers Act (no. 

States and D.C.)

56.3% 51 35

(2003)

44

(2006)

9 Not tested 25.7%
23 • PUBLIC HEALTH INFRASTRUCTURE 23-11

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

5 Final value – Baseline value Percent change = × 100.

Baseline value

Figure 23-1. Progress Toward Target Attainment for Focus Area 23: Public Health Infrastructure (continued)

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 23-2b, 23-8a, 23-9, 23-10a through c, 23-12a, 23-12b, 23-14b, and 23-17. Objectives 23-1, 

23-5, and 23-16 were deleted at the Midcourse Review.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

6

 Data beyond the baseline are not available; diff erence, statistical signifi cance, and percent change cannot be calculated. See Technical Appendix for 

more information.

7

 Percent change cannot be calculated. See Technical Appendix for more information.

DATA SOURCES

23-2a. Assessment of Objective Data Availability (AODA), CDC, NCHS. 

23-2c–d. Assessment of Objective Data Availability (AODA), CDC, NCHS. 

23-3–23-4. Assessment of Objective Data Availability (AODA), CDC, NCHS.

23-6–23-7. Assessment of Objective Data Availability (AODA), CDC, NCHS.

23-8b. National Profi le of Local Health Departments, National Association of County and City Health Offi cials (NACCHO). 

23-11a–d. National Public Health Performance Standards Program, CDC, OCPHP.

23-12c–d. National Profi le of Local Health Departments, National Association of County and City Health Offi cials (NACCHO).

23-13a–k. Comprehensive Laboratory Services Survey, Association of Public Health Laboratories (APHL).

23-14a. Epidemiology Capacity Assessment, Council of State and Territorial Epidemiologists (CSTE).

23-14c. Epidemiology Capacity Assessment, Council of State and Territorial Epidemiologists (CSTE).

23-14d. National Profi le of Local Health Departments, National Association of County and City Health Offi cials (NACCHO). 

23-15a–b. Center for Public Health Law and the Public's Health, Georgetown University Law Center and Johns Hopkins Bloomberg School 

of Public Health.

Respiratory

Diseases

CHAPTER 24

Co-Lead Agencies

Centers for Disease Control and Prevention

National Institutes of Health

Contents

Goal ................................................................................................24-3

Highlights ......................................................................................24-3

Summary of Progress.....................................................................24-4

Transition to Healthy People 2020................................................24-5

Data Considerations.......................................................................24-6

References and Notes.....................................................................24-7

Comprehensive Summary of Objectives........................................24-8

Progress Chart..............................................................................24-10

Health Disparities Table...............................................................24-12

Deaths From Chronic Obstructive Pulmonary Disease

(COPD, Excluding Asthma), 2005–07—Map...........................24-15

24 • RESPIRATORY DISEASES 24-3

GOAL:

Promote respiratory health through better 

prevention, detection, treatment, and 

education efforts.

The objectives in this chapter track deaths, 

hospitalizations, and lost school or work days due to 

asthma; appropriate asthma care; and State-based asthma 

surveillance systems. Chronic obstructive pulmonary 

disease (COPD) deaths and activity limitations due to 

chronic lung and breathing problems are also monitored, 

as are issues related to persons with sleep apnea.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in objectives for 

this Focus Area during the past decade [1]. Seventyone percent of the Respiratory Diseases objectives 

with data to monitor progress moved toward or 

achieved their Healthy People 2010 targets (Figure 

24-1). However, statistically significant health 

disparities were observed for some objectives by race 

and ethnicity, as well as by sex, education level, and 

income [2]. Disparities of 50% or more remained for 

severe outcomes such as asthma and COPD deaths 

(Figure 24-2), as discussed below.

〉 The asthma death rate declined among adolescents 

and adults, especially at older ages. Between 1999 

and 2007, asthma deaths among persons aged 15–34 

(objective 24-1c) declined 28.6%, from 5.6 to 4.0 

deaths per million population, moving toward the 

Healthy People 2010 target of 1.9 deaths per million; 

asthma deaths among persons aged 35–64 (objective 

24-1d) declined 29.0%, from 15.5 to 11.0 deaths per 

million population, moving toward the 2010 target 

of 8.0 deaths per million; and asthma deaths among 

persons aged 65 and over (objective 24-1e) declined 

37.7%, from 69.5 to 43.3 deaths per million population, 

exceeding the 2010 target of 47.0 deaths per million.

 Among adolescents and adults aged 15–34 

(objective 24-1c), the non-Hispanic black 

population had an asthma death rate of 11.5 

deaths per million in 2007, approximately 

four times the rate for the non-Hispanic white 

population (2.9 deaths per million) [2]. Among 

persons aged 35–64, the asthma death rate for 

the non-Hispanic black population (34.0 deaths 

per million) was more than four times that of the 

non-Hispanic white population (8.3 deaths per 

million). The asthma death rates among adults 

aged 65 and over (objective 24-1e) for the Asian 

or Pacific Islander and the non-Hispanic black 

populations were 63.9 and 63.8 deaths per million, 

respectively, more than one and a half times the 

rate for the non-Hispanic white population (40.9 

deaths per million).

 Females aged 65 and over (objective 24-1e) had 

asthma death rates of 84.2 deaths per million in 

1999 and 55.0 in 2007, whereas males had rates of 

48.4 in 1999 and 27.2 in 2007. In 2007, the asthma 

death rate for females was approximately twice 

the rate for males [2]. Between 1999 and 2007, the 

disparity between females and males increased 

28 percentage points [3].
24-4 HEALTHY PEOPLE 2010 FINAL REVIEW

 Adults aged 35–64 (objective 24-1d) with at least 

some college education had the lowest (best) 

asthma death rate among education groups, 

7.6 deaths per million in 2002, whereas high 

school graduates and persons with less than a 

high school education had rates of 20.5 and 25.7 

deaths per million, respectively. The rate for high 

school graduates was more than two and a half 

times the best group rate, whereas the rate for 

persons with less than a high school education 

was almost three and a half times the best group 

rate [2].

〉 The asthma hospitalization rates for persons aged 65 

and over (objective 24-2c) increased 42.9% between 

1998 and 2007, from 17.7 to 25.3 hospitalizations per 

10,000 population (age adjusted), moving away from 

the 2010 target of 11.0 hospitalizations per 10,000.

〉 The proportion of persons with asthma who received 

assistance in reducing exposure to environmental 

risk factors (objective 24-7f) increased 18.6% between 

2002 and 2008, from 43% to 51% (age adjusted), 

exceeding the 2010 target of 50%.

〉 The number of states (including D.C.) with statebased asthma surveillance systems (objective 24-8) 

increased from 19 states in 2003 to 36 states in 2009, 

exceeding the 2010 target of 25 states.

〉 The rates of activity limitations due to chronic 

lung and breathing problems (objective 24-9) for 

poor and near-poor persons aged 45 and over (5.1% 

in 2008, age adjusted) were more than three times 

the rate for middle/high-income persons (1.6% in 

2008, age adjusted) [2]. Between 1997 and 2008, the 

disparity between near-poor persons (3.8% in 1997, 

age adjusted; 5.1% in 2008) and persons with middle/

high incomes (1.8% in 1997, age adjusted; 1.6% in 

2008) increased 108 percentage points [3].

〉 Deaths from COPD among persons aged 45 and over 

(objective 24-10) declined 9.3% between 1999 and 2007, 

from 123.9 to 112.4 deaths per 100,000 population 

(age adjusted), moving toward the 2010 target of 62.3 

deaths per 100,000.

 Among racial and ethnic groups, the Asian or 

Pacific Islander population had the lowest (best) 

death rate for COPD: 47.6 deaths per 100,000 (age 

adjusted) in 1999 and 33.9 in 2007. The American 

Indian or Alaska Native population had COPD 

death rates of 91.8 per 100,000 (age adjusted) in 

1999 and 83.8 in 2007; the non-Hispanic black 

population had rates of 83.4 per 100,000 (age 

adjusted) in 1999 and 73.8 in 2007; and the nonHispanic white population had rates of 133.1 per 

100,000 (age adjusted) in 1999 and 124.8 in 2007.

 In 2007, the rate for the American Indian or 

Alaska Native population was about two and 

a half times the best group rate (that for the 

Asian or Pacific Islander population); the nonHispanic black population’s rate was more 

than twice the best group rate; and the rate for 

the non-Hispanic white population was more 

than three and a half times the best group rate 

[2].

 Between 1999 and 2007, the disparity in COPD 

death rates between the American Indian or 

Alaska Native population and the Asian or 

Pacific Islander population (group with the 

best rate) increased 54 percentage points [3]. 

During the same period, the disparity between 

the non-Hispanic white population and the 

Asian or Pacific Islander population increased 

89 percentage points.

 Persons aged 45–64 years with at least some 

college education had the lowest (best) COPD 

mortality rate (6.9 deaths per 100,000 in 2002, 

age adjusted) among education groups. The rate 

for high school graduates, 28.4 deaths per 100,000 

(age adjusted), was more than four times the best 

group rate; whereas the rate for persons with 

less than a high school education, 49.7 deaths 

per 100,000 (age adjusted), was more than seven 

times the best group rate [2].

〉 COPD death rates vary by geographic region. In 

2005–07, the highest rates were observed in the 

Ohio River Valley, the Great Plains, and Northern 

California (Figure 24-3). A few areas met the 2010 

target.

Summary of Progress

〉 Figure 24-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for Respiratory Diseases [1]. Data to 

measure progress toward target attainment were 

available for 24 objectives. Of these:

 Three objectives (24-1e, 24-7f, and 24-8) met or 

exceeded their Healthy People 2010 targets.

 Fourteen objectives moved toward their targets. 

A statistically significant difference between the 

baseline and the final data points was observed 

for four of these objectives (24-1c and d, 24-3b, 

and 24-10). No significant differences were 

observed for nine objectives (24-1b, 24-2a and b, 

24-3a and c, 24-4, 24-5, 24-7d, and 24-9); and data 

to test the significance of the difference were 

unavailable for one objective (24-12).

 Two objectives (24-7a and c) showed no change.

 Five objectives moved away from their targets. A 

statistically significant difference between the 

baseline and final data point was observed for 
24 • RESPIRATORY DISEASES 24-5

one objective (24-2c). No significant difference 

was observed for the remaining four objectives 

(24-1a, 24-6, 24-7b, and 24-7e).

 One objective (24-11b) remained developmental 

[4].

 Follow-up data were unavailable to measure 

progress for one objective (24-11a).

〉 Figure 24-2 displays health disparities in Respiratory 

Diseases from the best group rate for each 

characteristic at the most recent data point [2]. It 

also displays changes in disparities from baseline to 

the most recent data point [3].

 Of the 11 objectives with statistically significant 

health disparities of 10% or more by race and 

ethnicity, the non-Hispanic white population 

had the best rate for 6 objectives (24-1c through e, 

24-4, 24-7d, and 24-11a) and the white population 

(including persons of Hispanic origin) had 

the best rate for 1 objective (24-3b). The nonHispanic black population had the best rate for 3 

objectives (24-6, and 24-7a and c), and the Asian 

or Pacific Islander population had the best rate 

for 1 objective (24-10).

 Males had better rates than females for four of 

the eight objectives with statistically significant 

health disparities of 10% or more by sex 

(objectives 24-1d and e, 24-3b, and 24-9); females 

had better rates than males for the other four 

objectives (24-1c, 24-7f, 24-10, and 24-11a).

 Persons with at least some college education 

had the best rate for both of the objectives with 

statistically significant health disparities of 10% 

or more by education level (objectives 24-1d and 

24-10).

 Persons with middle/high incomes had the best 

rate for the three objectives with statistically 

significant health disparities of 10% or more by 

income (objectives 24-7c and d, and 24-9).

 Several objectives had health disparities of 100% 

or more. Many of these are discussed in the 

Highlights section, above.

Transition to Healthy People 

2020

The Healthy People 2010 Respiratory Diseases Focus 

Area was divided into two Healthy People 2020 Topic 

Areas: Respiratory Diseases and Sleep Health. Sleep’s 

contribution to public health is best communicated as 

a separate topic area because sleep is a fundamental 

biological requirement for health that crosscuts many 

topic areas and there are many nonrespiratory causes 

of disordered sleep. For Healthy People 2020, the 

Respiratory Diseases objectives have been expanded 

to include additional National Asthma Education and 

Prevention Program (NAEPP) guidelines for asthma care 

and indicators of the burden of COPD. The Respiratory 

Diseases objectives primarily assess the burden of 

asthma and COPD and related measures on prevention, 

detection, treatment, and education efforts. Sleep Health 

has added objectives tracking sufficient sleep. The 

Sleep Health objectives are focused on adequate sleep 

and treatment of sleep disorders as well as the impact 

of fatigue on motor vehicle crashes. See HealthyPeople.

gov for a complete list of Healthy People 2020 topics and 

objectives.

The Healthy People 2020 Respiratory Diseases Topic 

Area objectives can be grouped into two sections:

〉 Asthma

〉 Chronic Obstructive Pulmonary Disease.

The differences between the Healthy People 2010 

objectives and those included in Healthy People 2020 are 

summarized below:

〉 The Healthy People 2020 Respiratory Diseases Topic 

Area has a total of 27 objectives, 4 of which are 

developmental [4]. The Sleep Topic Area has a total 

of 4 objectives. The Healthy People 2010 Respiratory 

Diseases Focus Area had 26 objectives, 1 of which 

was developmental.

〉 Sixteen Healthy People 2010 objectives were retained 

“as is” [5]. These include: asthma deaths, separately 

assessed for persons aged 35–64 (objective 24-1d), 

and persons aged 65 and over (objective 24-1e); 

hospitalizations for asthma, separately assessed for 

persons under age 5 years (objective 24-2a), persons 

aged 5–64 years (objective 24-2b), and persons aged 

65 and over (objective 24-2c); emergency department 

visits for asthma, separately assessed for persons 

under age 5 years (objective 24-3a), persons aged 

5–64 years (objective 24-3b), and persons aged 

65 and over (objective 24-3c); activity limitations 

among persons with asthma (objective 24-4); patient 

education among persons with asthma (objective 

24-6); five objectives tracking NAEPP guidelines for 

asthma care, namely receipt of written asthma plans 

from health care provider (objective 24-7a), properuse instructions with inhalers (objective 24-7b), 

education on early signs, symptoms, and response 

to asthma episodes (objective 24-7c), appropriate 

medication regimens for asthma care (objective 

24-7d), and assistance in reducing exposure to 

environmental risks for asthma (objective 24-7f); and 

COPD deaths (objective 24-10).

〉 One Healthy People 2010 Respiratory Diseases 

objective, long-term management care after 
24-6 HEALTHY PEOPLE 2010 FINAL REVIEW

hospitalization for asthma (objective 24-7e), was 

archived due to a lack of reliable data [6].

〉 One developmental Healthy People 2010 Respiratory 

Diseases objective on long-term medical management 

for persons with symptoms of obstructive sleep 

apnea (objective 24-11b) was removed during the 

Healthy People 2020 planning process, due to the 

lack of a national data source.

〉 Six Healthy People 2010 Respiratory Diseases 

objectives were modified to create five Healthy 

People 2020 Respiratory Disease objectives [7]:

 Three asthma deaths objectives among persons 

under age 5 years (objective 24-1a), 5–14 years 

(objective 24-1b), and 15–34 (objective 24-1c) 

were combined into one objective for persons 

aged 35 and under.

 The objective tracking the average number of 

school or work days lost due to asthma (objective 

24-5) was divided into two separate objectives for 

children and adults and modified to assess the 

percentage of persons that miss school days or 

work days due to asthma, respectively.

 The objective tracking states with asthma 

surveillance systems (objective 24-8) was 

expanded to count territories, and the definition 

was modified to include recipients of either of two 

funding sources that require asthma surveillance 

in addition to states and territories participating 

in a detailed asthma survey.

 The objective tracking activity limitations due to 

chronic lung and breathing problems (objective 

24-9) was modified to target adults with COPD 

instead of adults with activity limitations.

〉 Six new objectives were added to the Healthy People 

2020 Respiratory Diseases Topic Area:

 Three new developmental NAEPP asthma care 

objectives: routine annual follow-up visits for 

asthma, annual medical assessment of asthma 

control, and consultation on any work-related 

causes of asthma.

 Two new health care utilization objectives 

for COPD: hospitalizations and emergency 

department visits.

 A new developmental objective tracking the 

diagnosis of underlying COPD.

〉 Two objectives were moved to the new Sleep Health 

Topic Area including persons with symptoms of 

obstructive sleep apnea who seek medical evaluation 

(objective 24-11a) and motor vehicle crashes due to 

drowsy driving (objective 24-12). The motor vehicle 

crash objective was modified to include all crashes, 

not just those involving driver fatalities.

〉 Two new objectives were added to the Healthy People 

2020 Sleep Health Topic Area:

 Sufficient sleep among students in grades 9–12

 Sufficient sleep among adults.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

Beginning in 2003, education data for asthma and 

COPD deaths (objectives 24-1c and d and 24-10) from the 

National Vital Statistics System have been suppressed. 

The educational attainment item was changed in the 

new U.S. Standard Certificate of Death in 2003 to be 

consistent with the Census Bureau data and to improve 

the ability to identify specific types of educational 

degrees. Many states, however, are still using the 1989 

version of the U.S. Standard Certificate of Death, which 

focuses on highest school grade completed. As a result, 

educational attainment data collected using the 2003 

version are not comparable with data collected using the 

1989 version [8].

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 
24 • RESPIRATORY DISEASES 24-7

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

References and Notes

1. Displayed in the Progress Chart (Figure 24-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 24-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 24-2). Disparity from the best group rate 

is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 24-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 24-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

5. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

6. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.
24-8 HEALTHY PEOPLE 2010 FINAL REVIEW

7. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

8. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. 

Deaths: Final data for 2007. National vital statistics 

reports; vol 58 no 19. Hyattsville, MD: National Center 

for Health Statistics. 2010. Available from http://www.

cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf.

Comprehensive Summary of Objectives: Respiratory Diseases

Objective Description Data Source or Objective Status

24-1a Deaths from asthma—Children <5 years (per million 

population)

National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

24-1b Deaths from asthma—Children and adolescents 5–14 years 

(per million population)

National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

24-1c Deaths from asthma—Adolescents and adults 15–34 years 

(per million population)

National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

24-1d Deaths from asthma—Adults 35–64 years (per million 

population)

National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

24-1e Deaths from asthma—Older adults 65+ years (per million 

population)

National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

24-2a Hospitalizations for asthma—Children <5 years (per 10,000 

population)

National Hospital Discharge Survey (NHDS), CDC, NCHS. 

24-2b Hospitalizations for asthma—Children and adults 5–64 years 

(age adjusted, per 10,000 population) 

National Hospital Discharge Survey (NHDS), CDC, NCHS.

24-2c Hospitalizations for asthma—Older adults 65+ years (age 

adjusted, per 10,000 population)

National Hospital Discharge Survey (NHDS), CDC, NCHS.

24-3a Emergency department visits for asthma—Children <5 years 

(per 10,000 population)

National Hospital Ambulatory Medical Care Survey (NHAMCS), 

CDC, NCHS.

24-3b Emergency department visits for asthma—Children and 

adults 5–64 years (per 10,000 population)

National Hospital Ambulatory Medical Care Survey (NHAMCS), 

CDC, NCHS.

24-3c Emergency department visits for asthma—Older adults 65+ 

years (per 10,000 population)

National Hospital Ambulatory Medical Care Survey (NHAMCS), 

CDC, NCHS.

24-4 Activity limitations among persons with asthma (age adjusted) National Health Interview Survey (NHIS), CDC, NCHS.

24-5 School or work days missed by persons with asthma, due to 

asthma (5–64 years)

National Health Interview Survey (NHIS), CDC, NCHS.

24-6 Patient education among persons with asthma (age adjusted) National Health Interview Survey (NHIS), CDC, NCHS.

24-7a Persons with asthma receiving written asthma plans from 

health care provider (age adjusted)

National Health Interview Survey (NHIS), CDC, NCHS.

24-7b Persons with asthma receiving proper-use instructions with 

prescribed inhalers (age adjusted)

National Health Interview Survey (NHIS), CDC, NCHS.

24-7c Persons with asthma receiving education on early signs, 

symptoms, and responses to asthma episodes (age adjusted)

National Health Interview Survey (NHIS), CDC, NCHS.

24-7d Persons with asthma receiving medication regimens that 

prevent need for >1 beta agonist inhalation canister per month 

(age adjusted)

National Health Interview Survey (NHIS), CDC, NCHS.
24 • RESPIRATORY DISEASES 24-9

Comprehensive Summary of Objectives: Respiratory Diseases (continued)

Objective Description Data Source or Objective Status

24-7e Persons with asthma receiving long-term management care 

after hospitalization due to asthma (age adjusted)

National Health Interview Survey (NHIS), CDC, NCHS.

24-7f Persons with asthma receiving assistance in reducing 

exposure to environmental risk factors (age adjusted)

National Health Interview Survey (NHIS), CDC, NCHS.

24-8 State-based asthma surveillance systems (no. States) Behavioral Risk Factor Surveillance System (BRFSS), CDC, 

NCCDPHP.

24-9 Activity limitations due to chronic lung and breathing problems 

(age adjusted, 45+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

24-10 Deaths from chronic obstructive pulmonary disease (COPD, 

excluding asthma) (age adjusted, per 100,000 population, 

45+ years)

National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

24-11a Medical evaluation for persons with symptoms of obstructive 

sleep apnea (age adjusted, 20+ years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

24-11b Long-term medical management among persons with 

symptoms of obstructive sleep apnea

Developmental.

24-12 Drivers involved in fatal motor vehicle crashes due to 

excessive sleepiness

Fatality Analysis Reporting System (FARS), Department of 

Transportation (DOT).
24-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 24-1. Progress Toward Target Attainment for Focus Area 24: Respiratory Diseases

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

24-1. Deaths from asthma (per million 

population)

a. Children <5 years 0.9 1.7

(1999)

2.2

(2007)

0.5 No 29.4%

b. Children and adolescents 5–14 years 18.2% 0.9 3.1

(1999)

2.7

(2007)

-0.4 No -12.9%

c. Adolescents and adults 15–34 years 43.2% 1.9 5.6

(1999)

4.0

(2007)

-1.6 Yes -28.6%

d. Adults 35–64 years 60.0% 8.0 15.5

(1999)

11.0

(2007)

-4.5 Yes -29.0%

e. Older adults 65+ years 116.4% 47.0 69.5

(1999)

43.3

(2007)

-26.2 Yes -37.7%

24-2. Hospitalizations for asthma

a. Children <5 years (per 10,000 population) 20.4% 25.0 45.6

(1998)

41.4

(2007)

-4.2 No -9 .2%

b. Children and adults 5–64 years 

(age adjusted, per 10,000 population)

29.2% 7.7 12.5

(1998)

11.1

(2007)

-1.4 No -11.2%

c. Older adults 65+ years (age adjusted, 

per 10,000 population)

11.0 17.7

(1998)

25.3

(2007)

7.6 Yes 42.9%

24-3. Emergency department visits for asthma

a. Children <5 years (per 10,000 population) 24.6% 80.0 150.0

(1995–97)

132.8

(2005–07)

-17.2 No -11.5%

b. Children and adults 5–64 years 

(per 10,000 population)

66.8% 50.0 71.1

(1995–97)

57.0

(2005–07)

-14.1 Yes -19.8%

c. Older adults 65+ years 

(per 10,000 population)

52.4% 15.0 29.5

(1995–97)

21.9

(2005–07)

-7.6 No -25.8%

24-4. Activity limitations among persons with 

asthma (age adjusted)

14.3% 7% 14%

(2001)

13%

(2008)

-1 No -7.1%

24-5. School or work days missed by persons 

with asthma, due to asthma (5–64 years)

38.5% 1.9 5.8

(2002)

4.3

(2008)

-1.5 No -25.9%

24-6. Patient education among persons with 

asthma (age adjusted)

38% 13%

(2003)

12%

(2008)

-1 No -7.7%

LEGEND Moved away from target1 Moved toward target Met or exceeded target
24 • RESPIRATORY DISEASES 24-11

Figure 24-1. Progress Toward Target Attainment for Focus Area 24: Respiratory Diseases (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

24-7. Persons with asthma receiving

a. Written asthma plans from health care 

provider (age adjusted)

 0.0% 40% 33%

(2002)

33%

(2008)

0 No 0.0%

b. Proper-use instructions with prescribed 

inhalers (age adjusted)

98.8% 96.0%

(2003)

95.9%

(2008)

-0.1 No -0.1%

c. Education on early signs, symptoms, 

and responses to asthma episodes 

(age adjusted)

 0.0% 68% 65%

(2003)

65%

(2008)

0 No 0.0%

d. Medication regimens that prevent need 

for >1 beta agonist inhalation canister 

per month (age adjusted)

25.0% 94% 86%

(2003)

88%

(2008)

2 No 2.3%

e. Long-term management care after 

hospitalization due to asthma 

(age adjusted)

87% 76%

(2003)

69%

(2008)

-7 No -9.2%

f. Assistance in reducing exposure to 

environmental risk factors (age adjusted)

114.3% 50% 43%

(2002)

51%

(2008)

8 Yes 18.6%

24-8. State-based asthma surveillance systems 

(no. States)

283.3% 25 19

(2003)

36

(2009)

17 Not tested 89.5%

24-9. Activity limitations due to chronic lung 

and breathing problems 

(age adjusted, 45+ years)

16.7% 1.9% 2.5%

(1997)

2.4%

(2008)

-0.1 No -4.0%

24-10. Deaths from chronic obstructive pulmonary disease (COPD, excluding asthma) 

(age adjusted, per 100,000 population, 

45+ years)

18.7% 62.3 123.9

(1999)

112.4

(2007)

-11.5 Yes -9.3%

24-12. Drivers involved in fatal motor vehicle 

crashes due to excessive sleepiness

80.0% 1.4% 2.4%

(2000)

1.6%

(2009)

-0.8 Not tested -33.3%

NOTES

See the Reader’s Guide for more information on how to read this figure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 24-11a and 24-11b .

FOOTNOTES

1

 Movement away from target is not quantified using the percent of targeted change achieved. See Technical Appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Difference = Final value – Baseline value. Differences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical significance of the difference between the final value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

DATA SOURCES

24-1a–e. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

24-2a–c. National Hospital Discharge Survey (NHDS), CDC, NCHS.

24-3a–c. National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

24-4–24-6. National Health Interview Survey (NHIS), CDC, NCHS.

24-7a–f. National Health Interview Survey (NHIS), CDC, NCHS.

24-8. Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.

24-9. National Health Interview Survey (NHIS), CDC, NCHS.

24-10. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

24-12. Fatality Analysis Reporting System (FARS), Department of Transportation (DOT).
24-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Race and Ethnicity Sex Education Income

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary index

24-1a. Deaths from asthma—Children <5 years 

[per million population (pop.)] (1999, 2007) i

b. Deaths from asthma—Children and adolescents 

5–14 years (per million pop.) (1999, 2007) i

c. Deaths from asthma—Adolescents and adults 

15–34 years (per million pop.) (1999, 2007)1 i b B B 

d. Deaths from asthma—Adults 35–64 years 

(per million pop.) (1999, 2007)1 bi b B  B B

e. Deaths from asthma—Older adults 65+ years 

(per million pop.) (1999, 2007) i b B  B

24-2a. Hospitalizations for asthma—Children <5 years 

(per 10,000 pop.) (1998, 2007) ii ii

b. Hospitalizations for asthma—Children and adults 

5–64 years (age adjusted, per 10,000 pop.) 

(1998, 2007)

ii ii

c. Hospitalizations for asthma—Older adults 

65+ years (age adjusted, per 10,000 pop.) 

(1998, 2007)

ii ii

24-3a. Emergency department visits for asthma— 

Children <5 years (per 10,000 pop.) 

(1995–97, 2005–07)

ii ii

b. Emergency department visits for asthma— 

Children and adults 5–64 years (per 10,000 pop.) 

(1995–97, 2005–07)

ii Bii B

c. Emergency department visits for asthma— 

Older adults 65+ years (per 10,000 pop.) 

(1995–97, 2005–07)

ii ii

24-4. Activity limitations among persons with asthma 

(age adjusted) (2001, 2008)







b B

24-5. School or work days missed by persons with 

asthma, due to asthma (5–64 years) 

(2002, 2008)2

24-6. Patient education among persons with asthma 

(age adjusted) (2003, 2008) Biii iv B Biii

24-7a. Persons with asthma receiving written asthma plans 

from health care provider (age adjusted) 

(2002, 2008)

 B iv B B

b. Persons with asthma receiving proper-use 

instructions with prescribed inhalers (age adjusted) 

(2003, 2008)

Figure 24-2. Health Disparities Table for Focus Area 24: Respiratory Diseases

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.
24 • RESPIRATORY DISEASES 24-13

Race and Ethnicity Sex Education Income

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary index

c. Persons with asthma receiving education on 

early signs, symptoms, and responses to asthma 

episodes (age adjusted) (2003, 2008)

b B B B

d. Persons with asthma receiving medication regimens 

that prevent need for >1 beta agonist inhalation 

canister per month (age adjusted) (2003, 2008)

B iv B

e. Persons with asthma receiving long-term 

management care after hospitalization due to 

asthma (age adjusted) (2003, 2008)2

f. Persons with asthma receiving assistance in 

reducing exposure to environmental risk factors 

(age adjusted) (2002, 2008)

b Biii B Biii

24-9. Activity limitations due to chronic lung and 

breathing problems (age adjusted, 45+ years) 

(1997, 2008)3

b B Biii 





B

24-10. Deaths from chronic obstructive pulmonary 

disease (COPD, excluding asthma) (age adjusted, 

per 100,000 pop., 45+ years) (1999, 2007)1



 Bi    B   B

24-11a. Medical evaluation for persons with symptoms of 

obstructive sleep apnea (age adjusted, 20+ years) 

(2005–08)

v B B B B B

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 24-8, 

24-11b, and 24-12.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

Measures of variability were available for all objectives in this table. Thus, the variability of best group rates was assessed, and statistical significance was tested. 

Disparities of 10% or more are displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time 

are indicated by arrows when the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

Figure 24-2. Health Disparities Table for Focus Area 24: Respiratory Diseases (continued)
24-14 HEALTHY PEOPLE 2010 FINAL REVIEW

LEGEND

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

1 Most recent data by education level is for 2002.

2 Most recent data by sex is for 2003.

3 Baseline data by race and ethnicity are for 1999.

i

 Data are for Asian or Pacific Islander.

ii Data include persons of Hispanic origin.

iiiThe group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. 

See Technical Appendix. ivChange in the summary index cannot be assessed. See Technical Appendix. v Data are for Mexican American.

DATA SOURCES

24-1a–e. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

24-2a–c. National Hospital Discharge Survey (NHDS), CDC, NCHS.

24-3a–c. National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

24-4–24-6. National Health Interview Survey (NHIS), CDC, NCHS.

24-7a–f. National Health Interview Survey (NHIS), CDC, NCHS.

24-9. National Health Interview Survey (NHIS), CDC, NCHS.

24-10. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

24-11a. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

Figure 24-2. Health Disparities Table for Focus Area 24: Respiratory Diseases (continued)
24 • RESPIRATORY DISEASES 24-15 Figure 24-3. Deaths From Chronic Obstructive Pulmonary Disease (COPD, Excluding Asthma, Age 45+), 2005–07 Healthy People 2010 objective 24-10 • Target = 62.3 per 100,000 NOTES: Data are for ICD-10 codes J40–J44 reported as underlying cause, for ages 45 and over. Rates are age adjusted to the 2000 standard population. Rates are displayed b

U.S. health service areas. SOURCE: National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS. Rate pe

Lowest shows hthat me

Sexually

Transmitted

Diseases

Lead Agency

Centers for Disease Control and Prevention

Contents

Goal ................................................................................................25-3

Highlights ......................................................................................25-3

Summary of Progress.....................................................................25-5

Transition to Healthy People 2020................................................25-6

Data Considerations.......................................................................25-7

Notes..............................................................................................25-8

Comprehensive Summary of Objectives........................................25-9

Progress Chart..............................................................................25-11

Health Disparities Table...............................................................25-13

Chlamydia Infections, 2009—Map .............................................25-15

Gonorrhea, 2009—Map ..............................................................25-16

Domestic Transmission of Primary and Secondary 

Syphilis, 2009—Map................................................................25-17

CHAPTER 25

25 • SEXUALLY TRANSMITTED DISEASES 25-3

Sexually transmitted diseases (STDs) refer to the more 

than 25 infectious organisms that are transmitted 

primarily through sexual activity. This chapter includes 

objectives that monitor cases of STD, responsible sexual 

behavior among adolescents, and the availability of 

screening programs for genital chlamydia.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in objectives for 

this Focus Area during the past decade [1]. Almost 

two thirds (63%) of the STD objectives with data to 

measure progress moved toward or achieved their 

Healthy People 2010 targets (Figure 25-1). However, 

health disparities of 50% or more among racial and 

ethnic populations, as well as by sex, were observed 

(Figure 25-2), as highlighted below [2].

〉 Chlamydia infections (objectives 25-1a through d) 

increased, moving away from the Healthy People 

2010 targets [3]. Infections among females aged 15–24 

attending family planning clinics (objective 25-1a) 

increased 62% between 1997 and 2009, from 5.0% 

to 8.1%. Similarly, for persons attending STD clinics, 

infections among females (objective 25-1b) increased 

34.4% between 1997 and 2009, from 12.2% to 16.4%, 

whereas infections among males (objective 25-1c) 

increased 52.9%, from 15.7% to 24.0%. Each of these 

three objectives had a 2010 target of 3.0%. Chlamydia 

infections among females aged 24 and under who 

were enrolled in National Job Training Programs 

(objective 25-1d) increased 15.8% between 2002 and 

2009, from 10.1% to 11.7%, moving away from the 

2010 target of 6.8%. Health disparities among racial 

and ethnic groups were observed for all four of these 

objectives. For example:

 In 2009, non-Hispanic white women attending 

family planning clinics, STD clinics, or enrolled 

in National Job Training Programs had the 

lowest (best) rates of chlamydia infection among 

racial and ethnic groups of women: 5.4%, 12.1%, 

and 5.9%, respectively. The rate for non-Hispanic 

black women attending family planning clinics, 

14.8%, was more than two and a half times the 

best rate (that for non-Hispanic white women), 

whereas the rate for non-Hispanic black women 

enrolled in National Job Training Programs, 

14.8%, was twice the best rate [2].

 Asian men attending STD clinics had the lowest 

(best) rate of chlamydia infection among racial 

and ethnic groups of men, 14.4% in 2009, whereas 

non-Hispanic black men had a rate of 29.4%, 

about twice the best rate [2].

GOAL:

Promote responsible sexual behaviors, 

strengthen community capacity, and increase 

accessibility to quality services to prevent 

sexually transmitted diseases (STDs) and their 

complications.
25-4 HEALTHY PEOPLE 2010 FINAL REVIEW

〉 Chlamydia infection varied by geographic area. In 

2009, the states of Idaho, Maine, New Hampshire, 

Utah, Vermont, and West Virginia had the lowest 

rates. Rates were highest in Alaska and Mississippi 

(Figure 25-3).

〉 The incidence of gonorrhea (objective 25-2a) declined 

18.9% between 1997 and 2009, from 122 to 99 new 

cases per 100,000 population, moving toward the 

2010 target of 19 new cases per 100,000 population. 

New cases of gonorrhea among females aged 15–44 

(objective 25-2b) declined 8.6% between 2002 and 

2009, from 279 to 255 per 100,000 population, 

moving toward the target of 42 new cases per 100,000 

population.

 Among racial and ethnic groups, the combined 

Asian or Pacific Islander population had the 

lowest (best) rates of new cases of gonorrhea 

(objective 25-2a), 19 new cases per 100,000 

population in 1997 and 18 new cases per 100,000 

in 2009. The Hispanic or Latino population had 

rates of 65 per 100,000 in 1997 and 59 in 2009; the 

American Indian or Alaska Native population 

had rates of 97 per 100,000 in 1997 and 113 in 

2009; and the non-Hispanic black population had 

rates of 809 per 100,000 in 1997 and 556 in 2009. 

 In 2009, the rate for the Hispanic or Latino 

population was almost three and a half times 

the best group rate (that for the Asian or Pacific 

Islander population); the rate for the American 

Indian or Alaska Native was almost six and a 

half times the best rate; and the rate for the 

non-Hispanic black population was almost 31 

times the best rate [2].

 Between 1997 and 2009, the disparity between 

the American Indian or Alaska Native 

population and the Asian or Pacific Islander 

population (group with the best rate) increased 

117 percentage points, whereas the disparity 

between the non-Hispanic black population 

and the Asian or Pacific Islander population 

decreased 1,169 percentage points [4].

 Racial and ethnic disparities in the incidence of 

gonorrhea among females aged 15–44 (objective 

25-2b) were similar to those observed in the total 

population. 

 The Asian or Pacific Islander population had 

the lowest (best) rate, 37 per 100,000 population 

in 2009. The rates for the non-Hispanic white, 

Hispanic or Latino, American Indian or Alaska 

Native, and non-Hispanic black populations 

were 83, 128, 311, and 1,198 per 100,000, 

respectively. 

 The rate for the non-Hispanic white population 

was more than twice the best group rate (that 

for the Asian or Pacific Islander population); 

the rate for the Hispanic or Latino population 

was about three and a half times the best rate; 

the rate for the American Indian or Alaska 

Native population was almost eight and a half 

times the best rate; and the rate for the nonHispanic black population was over 32 times 

the best rate [2].

 The incidence of gonorrhea among females aged 

15–44 (objective 25-2b) for the Asian or Pacific 

Islander population was 43 new cases per 100,000 

population in 1997 and 37 per 100,000 in 2009, 

whereas the rates for the American Indian or 

Alaska Native populations were 304 per 100,000 

in 1997 and 311 in 2009.

 Between 1997 and 2009, the disparity between 

the American Indian or Alaska Native 

population and the Asian or Pacific Islander 

population (group with the best rate) increased 

134 percentage points [4].

〉 Gonorrhea incidence varied by geographic region. In 

2009, incidence was lower in the West, Midwest, and 

Northeast. Seven states, including Idaho, Montana, 

Utah, and Wyoming in the West, and Maine, New 

Hampshire, and Vermont in New England, achieved 

the Healthy People 2010 target. The District of 

Columbia had the highest incidence of gonorrhea 

(Figure 25-4).

〉 Domestic transmission of primary and secondary 

syphilis (objective 25-3) increased 43.7% between 

1997 and 2009, from 3.2 new cases per 100,000 

population to 4.6 new cases per 100,000, moving 

away from the Healthy People 2010 target of 0.2 new 

cases per 100,000 population.

 Among racial and ethnic groups, the combined 

Asian or Pacific Islander population had the 

lowest (best) rates of new cases of syphilis: 0.3 

new cases per 100,000 population in 1997 and 1.6 

in 2009. Rates for the American Indian or Alaska 

Native population were 2.0 per 100,000 in 1997 

and 2.4 in 2009; rates for the Hispanic or Latino 

population were 1.6 per 100,000 in 1997 and 4.5 

in 2009; and rates for the non-Hispanic black 

population were 22.0 per 100,000 in 1997 and 19.2 

in 2009.

 In 2009, the rate for the Hispanic or Latino 

population was almost three times the best 

group rate (that for the Asian or Pacific 

Islander population), whereas the rate for the 

non-Hispanic black population was 12 times 

the best rate [2].

 Between 1997 and 2009, the disparity between 

the American Indian or Alaska Native 

population and the Asian or Pacific Islander 

population (group with the best rate) declined 

517 percentage points; whereas the disparity 

between the Hispanic or Latino population 

and the Asian or Pacific Islander population 
25 • SEXUALLY TRANSMITTED DISEASES 25-5

declined 252 percentage points; and the 

disparity between the non-Hispanic black 

population and the Asian or Pacific Islander 

population declined 6,133 percentage points 

[4].

 Females had lower (better) rates of new cases of 

syphilis than males: 2.9 new cases per 100,000 

population in 1997, and 1.4 in 2009. The rates for 

males were 3.6 new cases per 100,000 in 1997 and 

7.8 in 2009. The 2009 rate for males was more 

than five and a half times the rate for females [2]. 

Between 1997 and 2009, the disparity between 

males and females increased 433 percentage 

points [4].

〉 Domestic transmission of primary and secondary 

syphilis also varied by geographic area. Four states 

achieved the Healthy People 2010 target: Alaska, 

Idaho, South Dakota, and Vermont. In 2009, Louisiana 

had the highest incidence of domestic transmission 

of primary and secondary syphilis (Figure 25-5).

〉 The incidence of congenital syphilis (objective 25-9) 

declined 64.3% between 1997 and 2009, from 28 new 

cases per 100,000 live births to 10 new cases per 

100,000 live births, moving toward the 2010 target of 

1 new case per 100,000 population.

 Among racial and ethnic groups, the nonHispanic white population had the lowest (best) 

rates of new cases of congenital syphilis: 4 new 

cases per 100,000 live births in 1997 and 3 in 

2009. The American Indian or Alaska Native 

population had rates of 11 new cases per 100,000 

live births in 1997 and 12 in 2009; the Hispanic or 

Latino population had rates of 34 new cases per 

100,000 live births in 1997 and 12 in 2009; and the 

non-Hispanic black population had rates of 123 

new cases per 100,000 live births in 1997 and 35 

in 2009.

 In 2009, the rates for the American Indian 

or Alaska native and the Hispanic or Latino 

populations were four times the best rate 

(that for the non-Hispanic white population), 

whereas the rate for the non-Hispanic black 

population was almost 12 times the best rate 

[2].

 Between 1997 and 2009, the disparity between 

the American Indian or Alaska Native 

population and the non-Hispanic white 

population (group with the best rate) increased 

125 percentage points; whereas the disparity 

between the Hispanic or Latino and the 

non-Hispanic white population declined 450 

percentage points; and the disparity between 

the non-Hispanic black population and the 

non-Hispanic white population declined 1,908 

percentage points [4].

〉 The proportion of persons aged 20–29 with genital 

herpes infections (objective 25-4) declined 35.3% 

from 1988–94 to 2005–08, from 17% to 11%, exceeding 

the 2010 target of 14%.

〉 The proportion of women aged 15–44 who had ever 

required treatment for pelvic inflammatory disease 

(PID) (objective 25-6) declined 50% between 1995 and 

2006–08, from 8% to 4%, exceeding the 2010 target 

of 5%.

Summary of Progress

〉 Figure 25-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for STDs [1]. Data to measure progress 

toward target attainment were available for 16 

objectives. Of these:

 Two objectives exceeded their 2010 targets 

(objectives 25-4 and 25-6).

 Eight objectives moved toward their targets. No 

statistically significant difference between the 

baseline and final data points was observed for 

one of these objectives (25-7). Data to test the 

significance of the difference were unavailable 

for seven objectives (25-2a and b; 25-9; 25-11a and 

c; and 25-16-a and b).

 Six objectives moved away from their targets 

(objectives 25-1a through d; 25-3; and 25-11b). 

Data to test the significance of the difference 

between the baseline and final data points were 

unavailable for all of these objectives.

〉 One objective remained developmental (objective 

25-5) and one objective had no follow-up data 

available to measure progress (objective 25-13) [5]. 

One objective (25-8) was moved to the HIV Focus 

Area and seven were deleted at the Midcourse Review 

(objectives 25-10, 25-12, 25-14, 25-15, 25-17, 25-18, and 

25-19).

〉 Figure 25-2 displays health disparities from the best 

group rate for each characteristic at the most recent 

data point [2]. It also displays changes in disparities 

from baseline to the most recent data point [4].

 Two objectives had statistically significant health 

disparities of 10% or more by race and ethnicity 

(objectives 25-4 and 25-7) and eight additional 

objectives with racial and ethnic disparities of 

10% or more lacked data to assess statistical 

significance (objectives 25-1a through d; 25-2a 

and b; 25-3; and 25-9).

 Of these 10 objectives, the non-Hispanic white 

population had the best rate for 6 objectives (25-

1a, b, and d; 25-2a; 25-9; 25-11a; and 25-11c). The 
25-6 HEALTHY PEOPLE 2010 FINAL REVIEW

combined Asian or Pacific Islander population 

had the best rate for 3 objectives (25-2a and b, 

and 25-3) and the Asian population had the best 

rate for 1 objective (25-1c).

 One objective had statistically significant 

disparities of 10% or more by sex (objective 

25-11c) and two additional objectives with 

disparities of 10% or more by sex lacked data to 

assess statistical significance (objectives 25-2a 

and 25-3). Of these three objectives, males had 

better rates for two objectives (25-2a and 25-11c) 

and females had a better rate for one objective 

(25-3).

 Health disparities of 100% or more were observed 

among racial and ethnic populations, as well as 

by sex. Changes in disparity of 100 percentage 

points or more also were observed. These findings 

are discussed in the Highlights section, above.

Transition to Healthy People 

2020

For Healthy People 2020, the Sexually Transmitted 

Diseases Topic Area has a smaller set of objectives than 

were included in Healthy People 2010. See HealthyPeople.

gov for a complete list of Healthy People 2020 topics and 

objectives.

The Healthy People 2020 objectives can be grouped into 

several sections:

〉 Bacterial STD illness and disability

〉 Viral STD illness and disability

〉 STD complications affecting females

〉 STD complications affecting fetuses and newborns

〉 Personal health services.

The differences between the Healthy People 2010 and 

Healthy People 2020 objectives are summarized below:

〉 The Healthy People 2020 Sexually Transmitted 

Diseases Topic Area has 18 objectives, whereas the 

Healthy People 2010 Focus Area had 26 objectives.

〉 Six Healthy People 2010 objectives were retained “as 

is” [6]. These objectives include:

 Chlamydia infections among females aged 15–24 

attending family planning clinics (objective 

25-1a)

 Chlamydia infections among females aged 24 

and under enrolled in a National Job Training 

Program (objective 25-1d)

 Gonorrhea infections among females aged 15–44 

(objective 25-2b)

 Young adults with genital herpes infection due to 

herpes simplex, type 2 (objective 25-4)

 Females aged 15–44 who have ever required 

treatment for PID (objective 25-6)

 Congenital syphilis (objective 25-9).

〉 Four Healthy People 2010 objectives (25-3, 25-5, and 

25-16a and b) were modified to create nine Healthy 

People 2020 objectives [7].

 The objective on sustained domestic transmission 

of primary and secondary syphilis (objective 

25-3) was divided into two objectives: domestic 

transmission of primary and secondary syphilis 

among males, and domestic transmission of 

primary and secondary syphilis among females.

 The objective on sexually active females aged 

24 and under enrolled in commercial health 

insurance plans who are screened for genital 

chlamydia infections during the measurement 

year (objective 25-16a) was split into two 

objectives: 1) sexually active females aged 

16–20 enrolled in commercial health insurance 

plans who are screened for genital chlamydia 

infections during the measurement year; and 

2) sexually active females aged 21–24 enrolled 

in commercial health insurance plans who are 

screened for genital chlamydia infections during 

the measurement year.

 The objective on sexually active females aged 24 

and under enrolled in Medicaid plans who are 

screened for genital chlamydia infections during 

the measurement year (objective 25-16b) was 

divided into two objectives: 1) sexually active 

females aged 16–20 enrolled in Medicaid plans 

who are screened for genital chlamydia infections 

during the measurement year; and 2) sexually 

active females aged 21–24 enrolled in Medicaid 

plans who are screened for genital chlamydia 

infections during the measurement year.

 The objective on human papillomavirus (HPV) 

infections among females aged 14–49 (objective 

25-5) was split into three objectives depicting the 

different HPV types: HPV types 6 and 11; HPV 

types 16 and 18; and all other HPV types.

〉 One developmental Healthy People 2010 objective 

was moved to the HIV Focus Area: heterosexually 

transmitted HIV infections in women aged 13–24 

(objective 25-8) [5].

〉 Seven Healthy People 2010 objectives were deleted 

at the Midcourse Review due to lack of nationally 

representative data sources: neonatal STDs (objective 

25-10); responsible sexual behavior messages on 

television (objective 25-12); screening for STDs 
25 • SEXUALLY TRANSMITTED DISEASES 25-7

in jails (objective 25-14); contracts with managed 

care providers to treat partners of STD patients 

(objective 25-15); STD screening of pregnant women 

during prenatal visits (objective 25-17); primary care 

provider compliance with STD treatment standards 

(objective 25-18); and provider referral services for 

partners of STD patients (objective 25-19).

〉 Eight objectives were archived [8]:

 Two objectives, chlamydia infections among 

females and males aged 15–24 attending STD 

clinics (objectives 25-1b and c), were archived 

because they were not deemed accurate 

measures of the community burden associated 

with chlamydia, since they focused on persons 

who had sought care for a suspected STD.

 One objective, new cases of gonorrhea (objective 

25-2a), was archived because it was redundant 

with the Healthy People 2020 gonorrhea 

objectives.

 One objective, fertility problems among childless 

females with an STD or PID (objective 25-7), was 

archived because it did not differentiate between 

STDs and PID and hence could not be used to 

assess STD-associated infertility.

 Three objectives, measuring responsible sexual 

behavior among students in grades 9–12 

(objectives 25-11a through c), were archived 

because they overlapped with the Family 

Planning objectives.

 One objective, Hepatitis B vaccines offered in 

tribal, state, and local STD clinics (objective 25-

13), was archived because it lacked a viable data 

source.

〉 Three new objectives were added to the Healthy 

People 2020 Sexually Transmitted Diseases Topic 

Area:

 Gonorrhea infections among males aged 15–44

 Chlamydia infections among females aged 15–44

 Chlamydia infections among males aged 24 and 

under who enrolled in a National Job Training 

Program.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.
25-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Notes

1. Displayed in the Progress Chart (Figure 25-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 25-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 25-2). Disparity from the best group rate 

is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 25-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. Most of the observed increases in chlamydia 

infections (objectives 25-1a through d) were due 

to increases in test sensitivity, which resulted in 

previously undiagnosed infections being detected. 

In addition, the chlamydia infection rates tracked in 

objectives 25-1a through d have not been adjusted 

for increases in screening rates and efforts to target 

screening to persons most at risk of infection. 

Therefore, the reader is urged to exercise caution in 

interpreting the observed increases in chlamydia 

infections.

4. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 25-2 footnotes, as well as 

the Technical Appendix, for more detail.

5. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

6. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy 

People 2010 and are developmental in Healthy People 

2020, and for which no numerator information is 

available.

7. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

8. Archived objectives had at least one data point in 

Healthy People 2010, but were not carried forward 

into Healthy People 2020.
25 • SEXUALLY TRANSMITTED DISEASES 25-9

Comprehensive Summary of Objectives: Sexually Transmitted Diseases

Objective Description Data Source or Objective Status

25-1a Chlamydia infections—Females 15–24 years attending family 

planning clinics 

STD Surveillance System (STDSS), CDC, NCHHSTP.

25-1b Chlamydia infections—Females 15–24 years attending STD 

clinics

STD Surveillance System (STDSS), CDC, NCHHSTP.

25-1c Chlamydia infections—Males 15–24 years attending STD 

clinics

STD Surveillance System (STDSS), CDC, NCHHSTP.

25-1d Chlamydia infections—Females ≤24 years enrolled in 

National Job Training Program

STD Surveillance System (STDSS), CDC, NCHHSTP; National Job 

Training Program.

25-2a Gonorrhea—New cases per 100,000 population STD Surveillance System (STDSS), CDC, NCHHSTP.

25-2b Gonorrhea—New cases per 100,000 population among 

females 15–44 years

STD Surveillance System (STDSS), CDC, NCHHSTP.

25-3 Domestic transmission of primary and secondary syphilis (new 

cases per 100,000 population)

STD Surveillance System (STDSS), CDC, NCHHSTP.

25-4 Genital herpes infection among adults 20–29 years National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

25-5 Human papillomavirus (HPV) infection—Females 14–49 

years

Developmental.

25-6 Treatment for pelvic inflammatory disease (PID) among 

females (15–44 years)

National Survey of Family Growth (NSFG), CDC, NCHS.

25-7 Fertility problems among childless females with an STD or PID 

(15–44 years)

National Survey of Family Growth (NSFG), CDC, NCHS.

25-9 Congenital syphilis (new cases per 100,000 live births) STD Surveillance System (STDSS), CDC, NCHHSTP; National Vital 

Statistics System—Natality (NVSS-N), CDC, NCHS.

25-10 Neonatal STDs Deleted at the Midcourse Review.

25-11a Students who never had sexual intercourse (grades 9–12) Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

25-11b Students who had sexual intercourse, but not in the past 3 

months (grades 9–12)

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

25-11c Students who used condoms at last intercourse (grades 9–12) Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

25-12 Responsible sexual behavior messages on television Deleted at the Midcourse Review.

25-13 Hepatitis B vaccines offered in STD clinics—Tribal, State and 

local

Survey of STD Programs, National Coalition of STD Directors 

(NCSD); HIS.

25-14 Screening for sexually transmitted diseases in detention 

facilities and jails

Deleted at the Midcourse Review.

25-15 Contracts with managed care providers to treat nonplan 

partners of STD patients

Deleted at the Midcourse Review.

25-16a Annual screening for genital chlamydia among females ≤25 

years—Enrolled in commercial managed care organizations 

(MCOs)

Healthcare Effectiveness Data and Information Set (HEDIS), National 

Committee for Quality Assurance (NCQA).
25-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Objective Description Data Source or Objective Status

25-16b Annual screening for genital chlamydia among females ≤25 

years—Enrolled in Medicaid managed care organizations 

(MCOs)

Healthcare Effectiveness Data and Information Set (HEDIS), National 

Committee for Quality Assurance (NCQA).

25-17 STD screening of pregnant women during prenatal health care 

visits

Deleted at the Midcourse Review.

25-18 Primary care provider compliance with recognized STD 

treatment standards

Deleted at the Midcourse Review.

25-19 Provider referral services for partners of STD patients Deleted at the Midcourse Review.

Comprehensive Summary of Objectives: Sexually Transmitted Diseases (continued)
25 • SEXUALLY TRANSMITTED DISEASES 25-11

Figure 25-1. Progress Toward Target Attainment for Focus Area 25: Sexually Transmitted Diseases

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

25-1. Chlamydia infections

a. Females 15–24 years attending family 

planning clinics

3.0% 5.0%

(1997)

8.1%

(2009)

3.1 Not tested 62.0%

b. Females 15–24 years attending STD 

clinics

3.0% 12.2%

(1997)

16.4%

(2009)

4.2 Not tested 34.4%

c. Males 15–24 years attending STD clinics 3.0% 15.7%

(1997)

24.0%

(2009)

8.3 Not tested 52.9%

d. Females ≤24 years enrolled in National 

Job Training Program

6.8% 10.1%

(2002)

11.7%

(2009)

1.6 Not tested 15.8%

25-2. Gonorrhea

a. New cases per 100,000 population 22.3% 19 122

(1997)

99

(2009)

-23 Not tested -18.9%

b. New cases per 100,000 population 

among females 15–44 years 

10.1% 42 279

(2002)

255

(2009)

-24 Not tested -8.6%

25-3. Domestic transmission of primary and 

secondary syphilis (new cases per 

100,000 population)

0.2 3.2

(1997)

4.6

(2009)

1.4 Not tested 43.7%

25-4. Genital herpes infection among adults 

20–29 years

200.0% 14% 17%

(1988–94)

11%

(2005–08)

-6 Yes -35.3%

25-6. Treatment for pelvic infl ammatory disease 

(PID) among females (15–44 years) 

133.3% 5% 8%

(1995)

4%

(2006–08)

-4 Not tested -50.0%

25-7. Fertility problems among childless females 

with an STD or PID (15–44 years) 

50.0% 15% 27%

(1995)

21%

(2006–08)

-6 No -22.2%

25-9. Congenital syphilis (new cases per 

100,000 live births) 

66.7% 1 28

(1997)

10

(2009)

-18 Not tested -64.3%

25-11a. Students who never had sexual intercourse (grades 9–12) 

66.7% 56% 50%

(1999)

54%

(2009)

4 Not tested 8.0%

25-11b. Students who had sexual intercourse, but 

not in the past 3 months (grades 9–12)

30% 27%

(1999)

26%

(2009)

-1 Not tested -3.7%

25-11c. Students who used condoms at last 

intercourse (grades 9–12) 

42.9% 65% 58%

(1999)

61%

(2009)

3 Not tested 5.2%

25-16. Annual screening for genital chlamydia 

among females ≤25 years

a. Enrolled in commercial managed care 

organizations (MCOs)

48.6% 62% 25%

(2002)

43%

(2009)

18 Not tested 72.0%

b. Enrolled in Medicaid managed care 

organizations (MCOs)

81.0% 62% 41%

(2002)

58%

(2009)

17 Not tested 41.5%

LEGEND Moved away from target1 Moved toward target Met or exceeded target
25-12 HEALTHY PEOPLE 2010 FINAL REVIEW

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 25-5 and 25-13. Objective 25-8 has been moved to Focus Area 13; see objective 13-18. 

Objectives 25-10, 25-12, 25-14, 25-15, and 25-17 through 25-19 were deleted at the Midcourse Review.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

DATA SOURCES

25-1a–c. STD Surveillance System (STDSS), CDC, NCHHSTP.

25-1d. STD Surveillance System (STDSS), CDC, NCHHSTP; National Job Training Program.

25-2a–b. STD Surveillance System (STDSS), CDC, NCHHSTP.

25-3. STD Surveillance System (STDSS), CDC, NCHHSTP.

25-4. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

25-6–25-7. National Survey of Family Growth (NSFG), CDC, NCHS.

25-9 STD Surveillance System (STDSS), CDC, NCHHSTP; National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

25-11a–c. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

25-16a–b. Healthcare Eff ectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA).

Figure 25-1. Progress Toward Target Attainment for Focus Area 25: Sexually Transmitted Diseases (continued)
25 • SEXUALLY TRANSMITTED DISEASES 25-13

Figure 25-2. Health Disparities Table for Focus Area 25: Sexually Transmitted Diseases

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Income

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary index

25-1a. Chlamydia infections—Females 15–24 

years attending family planning clinics 

(1997, 2009)†

  

 B i

b. Chlamydia infections—Females 15–24 

years attending STD clinics 

(1997, 2009)†

  B i

c. Chlamydia infections—Males 15–24 

years attending STD clinics 

(1997, 2009)†

B 

  i

d. Chlamydia infections—Females ≤24 

years enrolled in National Job Training 

Program (2002, 2009)†

 

 B 

25-2a. Gonorrhea—New cases per 100,000 

population (1997, 2009)† 





Bii 















Biii

25-2b. Gonorrhea—New cases per 100,000 

population among females 15–44 

years (2002, 2009)†







Bii   

25-3. Domestic transmission of primary and 

secondary syphilis (new cases per 

100,000 population) (1997, 2009)†







Bii 



















B







25-4. Genital herpes infection among adults 

20–29 years (1988–94, 2005–08)* iv

25-6. Treatment for pelvic inflammatory 

disease (PID) among females 

(15–44 years) (1995, 2006–08)‡

25-7. Fertility problems among childless 

females with an STD or PID 

(15–44 years) (1995, 2006–08)*

25-9. Congenital syphilis (new cases per 

100,000 live births) (1997, 2009)† 





ii 











B







25-11a. Students who never had sexual 

intercourse (grades 9–12) 

(1999, 2009)‡

B B Biii

25-11b. Students who had sexual intercourse, 

but not in the past 3 months (grades 

9–12) (1999, 2009)‡

B B

25-11c. Students who used condoms at last 

intercourse (grades 9–12) 

(1999, 2009)‡

 Biii  B
25-14 HEALTHY PEOPLE 2010 FINAL REVIEW

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 25-5, 

25-8, 25-13, and 25-16a and b. Objectives 25-10, 25-12, 25-14, 25-15, and 25-17 through 25-19, were deleted at Midcourse Review.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

LEGEND

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. Nonetheless, 

disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix.

‡ Measures of variability were available only for the most recent data. Thus, the variability of best group rates was assessed only for the most recent data, and 

statistical significance was tested only for the most recent data. Disparities of 10% or more are displayed when the differences from the best group rate are 

statistically significant at the 0.05 level. Changes in disparities over time are displayed according to their magnitude, since measures of variability were not available 

at baseline and therefore statistical significance of changes in disparity could not be tested. See Technical Appendix.

i Change in the summary index cannot be assessed. See Technical Appendix.

ii Data are for Asian or Pacific Islander.

iiiThe group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. See 

Technical Appendix.

ivData are for Mexican American.

DATA SOURCES

25-1a–c. STD Surveillance System (STDSS), CDC, NCHHSTP.

25-1d. STD Surveillance System (STDSS), CDC, NCHHSTP; National Job Training Program.

25-2a–b. STD Surveillance System (STDSS), CDC, NCHHSTP.

25-3. STD Surveillance System (STDSS), CDC, NCHHSTP.

25-4. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

25-6–25-7. National Survey of Family Growth (NSFG), CDC, NCHS.

25-9. STD Surveillance System (STDSS), CDC, NCHHSTP; National Vital Statistics System—Natality (NVSS-N), CDC, NCHS.

25-11a–c. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

Figure 25-2. Health Disparities Table for Focus Area 25: Sexually Transmitted Diseases (continued)
25 • SEXUALLY TRANSMITTED DISEASES 25-15 Figure 25-3. Chlamydia Infections (New Cases per 100,000 Population), 2009 NOTES: Data are crude rates, not age adjusted. Rates are displayed by a modified Jenks classification for U.S. states. Healthy People 2010 objectives for chlamydia (objective

specific groups separately. SOURCE: STD Surveillance System (STDSS), CDC, NCHHSTP. Rat
HEALTHY PEOPLE 2010 FINAL REVIEW 25-16Figure 25-4. Gonorrhea (New Cases per 100,000 Population), 2009 Healthy People 2010 objective 25-2a • Target = 19 per 100,000 NOTES: Data are crude rates, not age adjusted. Rates are displayed by a modified Jenks classification for U.S. states. SOURCE: STD Surveillance System (STDSS), CDC, NCHHSTP. 

DC
25 • SEXUALLY TRANSMITTED DISEASES 25-17 Figure 25-5. Domestic Transmission of Primary and Secondary Syphilis (New Cases per 100,000 Population), 2009 Healthy People 2010 objective 25-3 • Target = 0.2 per 100,000 NOTES: Data are crude rates, not age adjusted. Rates are displayed by a modified Jenks classification for U.S. states. SOURCE: STD Surveillance System (STDSS), CDC, NCHHSTP. 

Lead Agencies

National Institutes of Health

Substance Abuse and Mental Health Services Administration

Contents

Goal ................................................................................................26-3

Highlights ......................................................................................26-3

Summary of Progress.....................................................................26-5

Transition to Healthy People 2020................................................26-5

Data Considerations.......................................................................26-7

References and Notes.....................................................................26-7

Comprehensive Summary of Objectives........................................26-9

Progress Chart..............................................................................26-11

Health Disparities Table...............................................................26-14

Cirrhosis Deaths, 2005–07—Map...............................................26-18

Substance Abuse

CHAPTER 26

26 • SUBSTANCE ABUSE 26-3

This chapter includes objectives that track alcohol 

and drug-related deaths, the use of alcohol and illicit 

drugs by adolescents and young adults, adolescent 

attitudes toward alcohol and/or drug use, and state laws 

addressing driving under the influence of alcohol (DUI).

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this focus area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in objectives for 

this Focus Area during the past decade [1]. Almost 

two thirds (63%) of the Substance Abuse objectives 

with data to measure progress moved toward or 

achieved their Healthy People 2010 targets (Figure 

26-1). However, health disparities of 10% or more 

were observed among racial and ethnic populations, 

as well as by sex, education level, and income (Figure 

26-2), as highlighted below [2].

〉 The rate of alcohol-related motor vehicle crash deaths 

(objective 26-1a) declined 24.5% between 1998 and 

2009, from 5.3 to 4.0 deaths per 100,000 population, 

exceeding the Healthy People 2010 target of 4.8.

 Among racial and ethnic populations, the 

Asian population had the lowest (best) rate of 

alcohol-related motor vehicle crash deaths, 0.6 

per 100,000 population in 2008. The Hispanic or 

Latino, non-Hispanic white, non-Hispanic black, 

Native Hawaiian or Other Pacific Islander, and 

American Indian or Alaska Native populations 

had rates of 3.3, 3.6, 3.9, 3.9 and 10.9 per 100,000 

population, respectively. 

 The rates for the Hispanic or Latino, nonHispanic white, non-Hispanic black, and Native 

Hawaiian or Other Pacific Islander populations 

were five and a half to six and a half times the 

best rate (that for the Asian population). The 

rate for the American Indian or Alaska Native 

population was more than 18 times the best 

rate [2]. 

 Between 2000 and 2008, the disparities 

between these populations and the Asian 

population increased by at least 100 percentage 

points [3].

 Females had a lower (better) rate of motor 

vehicle crash deaths than males, 1.7 per 100,000 

population in 2009. The rate for males, 6.3, was 

more than three and a half times the rate for 

females [2].

〉 The cirrhosis death rate (objective 26-2) declined 

5.2% between 1999 and 2007, from 9.6 to 9.1 deaths 

per 100,000 population (age adjusted), moving 

toward the target of 3.2.

 Among racial and ethnic groups, the combined 

Asian or Pacific Islander population had the 

lowest (best) cirrhosis death rate, 3.3 deaths 

per 100,000 population (age adjusted) in 2007. 

The non-Hispanic white, non-Hispanic black, 

Hispanic or Latino, and American Indian or 

Alaska Native populations had rates of 7.5, 8.7, 

13.8, and 24.8 deaths per 100,000 (age adjusted), 

respectively. 

GOAL:

Reduce substance abuse to protect the health, 

safety, and quality of life for all, especially 

children.
26-4 HEALTHY PEOPLE 2010 FINAL REVIEW

 The rate for the non-Hispanic white population 

was almost two and a half times the best rate 

(that for the Asian or Pacific Islander population); 

the rate for the non-Hispanic black population 

was more than two and a half times the best rate; 

the rate for the Hispanic or Latino population 

was more than four times the best rate; and the 

rate for the American Indian or Alaska Native 

population was about seven and a half times the 

best rate [2].

 Females had a better cirrhosis death rate than 

males, 5.9 vs. 12.7 deaths per 100,000 population 

(age adjusted) in 2007. The rate for males was 

more than twice the rate for females.

 Among education groups, persons aged 25–64 

with at least some college education had the 

lowest (best) cirrhosis death rate, 5.6 deaths per 

100,000 population (age adjusted) in 2002. High 

school graduates had a rate of 15.2 and persons 

with less than a high school education had a rate 

of 20.9. The rate for high school graduates was 

more than two and a half times the best group 

rate, whereas the rate for persons with less than a 

high school education was more than three and a 

half times the best group rate [2].

〉 Cirrhosis death rates varied by geographical area. 

In 2005–07, the rates were highest in areas of the 

Southwest and West (Figure 26-3).

〉 The rate of drug-induced deaths (objective 26-3) 

increased 85.3% between 1999 and 2007, from 6.8 

deaths per 100,000 population (age adjusted) to 12.6, 

moving away from the 2010 target of 1.2.

 Among racial and ethnic groups, the combined 

Asian or Pacific Islander population had the 

lowest (best) rates of drug-induced deaths: 1.4 per 

100,000 population (age adjusted) in 1999 and 2.0 

in 2007. The Hispanic or Latino population had 

rates of 6.5 per 100,000 (age adjusted) in 1999 and 

6.5 in 2007; the non-Hispanic black population 

had rates of 9.4 per 100,000 (age adjusted) in 1999 

and 11.4 in 2007; the American Indian or Alaska 

Native population had rates of 6.1 per 100,000 

(age adjusted) in 1999 and 12.1 in 2007; and the 

non-Hispanic white population had rates of 6.8 

per 100,000 (age adjusted) in 1999 and 15.1 in 

2007.

 In 2007, the rate for the Hispanic or Latino 

population was almost three and a half times 

the best rate (that for the Asian or Pacific 

Islander population); the rates for the nonHispanic black and American Indian or Alaska 

Native population were about six times the 

best rate; the rate for the non-Hispanic white 

population was more than seven and a half 

times the best rate [2].

 Between 1999 and 2007, the disparity between 

the American Indian or Alaska Native 

population and the Asian or Pacific Islander 

population (the group with the best rate) 

increased 169.3 percentage points, whereas 

the disparity between the non-Hispanic white 

and the Asian or Pacific Islander populations 

increased 269.3 percentage points.

 During the same period, the disparity between 

the Hispanic or Latino population and the 

Asian or Pacific Islander population decreased 

132 percentage points [3].

 Among education groups, persons aged 25–64 

with at least some college education had the 

lowest (best) rate of drug induced deaths, 7.4 per 

100,000 population (age adjusted), in 2002. High 

school graduates had a rate of 22.4, about three 

times the best group rate. Persons with less than 

a high school education had a rate of 27.3, more 

than three and a half times the best group rate 

[2].

〉 Drug-related hospital emergency department visits 

(objective 26-4) increased 27.9% between 2004 and 

2009, from 1,619.05 (thousands) to 2,070.44, moving 

away from the 2010 target of 1,044.46 (thousands).

〉 The proportion of students in grades 9–12 who 

reported riding with a driver who had been drinking 

alcohol within the past 30 days (objective 26-6) 

decreased 15.2% between 1999 and 2009, from 33% to 

28%, exceeding the 2010 target of 30%.

〉 The proportion of high school seniors who never 

consumed alcohol (objective 26-9c) increased 47.4% 

between 1998 and 2009, from 19% to 28%, moving 

toward the 2010 target of 29%. During the same 

period, the proportion of high school seniors who 

never used illicit drugs (objective 26-9d) increased 

15.2%, from 46% to 53%, moving toward the 2010 

target of 56%.

〉 Between 1998 and 2009, steroid use among students 

in eighth, tenth, and twelfth grades (objectives 

26-14a through c) increased 8.3%, 8.3%, and 29.4% 

respectively, from 1.2% to 1.3%, from 1.2% to 1.3%, 

and from 1.7% to 2.2% respectively, moving away 

from the 2010 targets of 0.4% each.

〉 The number of states and the District of Columbia 

with laws restricting the legal operation of motor 

vehicles for drivers who had been drinking alcohol 

to a maximum blood alcohol concentration of 0.08 

(objective 26-25) increased from 15 in 1998 to 51 in 

2006, meeting the 2010 target of 51.
26 • SUBSTANCE ABUSE 26-5

Summary of Progress

〉 Figure 26-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for Substance Abuse [1]. Data to measure 

progress toward target attainment were available for 

38 objectives. Of these:

 Four objectives (26-1a, 26-6, 26-16d, and 26-25) 

met or exceeded their 2010 targets.

 Twenty objectives moved toward their targets. A 

statistically significant difference between the 

baseline and the final data points was observed 

for 14 of these objectives (26-2, 26-9a through d, 

26-10a and b, 26-11a and d, 26-15, 26-16b and e, 

and 26-17a and b). No significant differences were 

observed for three objectives (26-16a, c, and f); 

and data to test the significance of the difference 

were unavailable for three objectives (26-13a and 

b, and 26-20).

 Three objectives (26-10c, 26-18b, and 26-24) 

showed no change.

 Eleven objectives moved away from their targets. 

A statistically significant difference between 

the baseline and final data points was observed 

for two of these objectives (26-3 and 26-4). No 

significant differences were observed for seven 

objectives (26-11c, 26-14a through c, 26-17c, 26-

18a, and 26-21); and data to test the significance 

of the difference were unavailable for two 

objectives (26-11b and 26-12).

〉 Five objectives (26-5, 26-7, 26-19, 26-22, and 26-23) 

remained developmental and two objectives (26-8a 

and b) had no follow-up data available to measure 

progress [4]. Three objectives (26-1b through d) were 

deleted at the Midcourse Review.

〉 Figure 26-2 displays health disparities in Substance 

Abuse from the best group rate for each characteristic 

at the most recent data point [2]. It also displays 

changes in disparities from baseline to the most 

recent data point [3].

 Twenty-three objectives had statistically 

significant racial and ethnic health disparities of 

10% or more (objectives 26-2 through 26-4; 26-6; 

26-9a through d; 26-10a through c; 26-11a, c, and 

d; 26-14a; 26-16a c, d, and f; 26-17a through c; and 

26-21). Three additional objectives had racial 

and ethnic health disparities of 10% or more 

but lacked data to assess statistical significance 

(objectives 26-1a, and 26-13a and b). Of these 26 

objectives, the non-Hispanic black population 

had the best rate for 9 objectives (26-4, 26-9c and 

d, 26-10a and b, 26-11a and c, 26-17c, and 26-21). 

The Asian population had the best rate for 6 

objectives (26-1a, 26-9a, 26-13a and b, and 26-17a 

and b). The non-Hispanic white population had 

the best rate for 5 objectives (26-6, 26-9b, 26-

14a, and 26-16a and d); the Hispanic or Latino 

population had the best rate for 4 objectives (26-

10c, 26-11d, and 26-16c and f); and the Asian or 

Pacific Islander population had the best rate for 2 

objectives (26-2 and 26-3).

 Sixteen objectives had statistically significant 

health disparities of 10% or more by sex 

(objectives 26-2 through 26-4, 26-9d, 26-10b and 

c, 26-11a through c, 26-16a through f, and 26-17a). 

One additional objective had health disparities 

of 10% or more by sex but had no data to assess 

statistical significance (objective 26-1a). Females 

had the better group rate for all 17 of these 

objectives.

 Three objectives had statistically significant 

health disparities of 10% or more by education 

level (objectives 26-2, 26-3, and 26-10c) and one 

objective had health disparities of 10% or more 

by education level but had no data to assess 

statistical significance (objectives 26-13b). 

Persons with at least some college education had 

the best group rate for all four of these objectives.

 Persons in the poor population had the best 

group rate for four of the six objectives with 

statistically significant health disparities of 10% 

or more by income (objectives 26-10a, 26-11d, 

and 26-18a and b). Persons in the middle/highincome population had the best group rate for 

the remaining two objectives (26-9b and 26-15).

 Racial and ethnic health disparities of 100% 

or more were observed for several objectives, 

as were health disparities of 100% or more by 

sex and education level. Changes in disparity 

between the baseline and most recent data points 

also were observed. Many of these disparities are 

discussed in the Highlights section, above.

Transition to Healthy People 

2020

For Healthy People 2020, the focus of the Substance 

Abuse Topic Area continues to address a wide range of 

health behaviors and interventions. Specific objectives 

are targeted to protect the health, safety, and quality of 

life for all, especially children.

The Healthy People 2020 Substance Abuse Topic Area 

objectives can be grouped into three sections:

〉 Policy and prevention

〉 Screening and treatment

〉 Epidemiology and surveillance.
26-6 HEALTHY PEOPLE 2010 FINAL REVIEW

The differences between the Healthy People 2010 and 

Healthy People 2020 objectives are summarized below:

〉 The Healthy People 2020 Topic Area has 44 objectives 

whereas the Healthy People 2010 Substance Abuse 

Focus Area had 48 objectives.

〉 Twenty-seven Healthy People 2010 objectives were 

retained “as is” [5]. These include: nine objectives 

that target perceptions about and disapproval of 

substance use and abuse (objectives 26-16a through 

f and 26-17a through c), eight drug use/abstinence 

objectives (26-9d, 26-10b and c, 26-12, 26-14a through 

c, and 26-15), four treatment objectives (26-18a and 

b, 26-20 and 26-21), three alcohol use/abstinence 

objectives (26-9c, and 26-11a and b), two mortality 

objectives (26-2 and 26-3), and an objective that 

targets riding with a driver who has been drinking 

alcohol (objective 26-6).

〉 Five Healthy People 2010 objectives were archived [6]:

 Statistics to track lost productivity due to alcohol 

and drug abuse have not been calculated at the 

national level since baseline year data were 

obtained. As a result, these two objectives (26-8a 

and b) could not be retained in Healthy People 

2020.

 During the course of the tracking period for 

Healthy People 2010, all states and the District 

of Columbia had enacted laws restricting the 

legal operation of motor vehicles for drivers, 

aged 21 and over, who had been drinking alcohol 

to a maximum blood alcohol concentration of 

0.08. Due to the success experienced in the past 

decade, this objective (26-25) was archived in 

Healthy People 2020.

 Drug-related emergency department visits 

were tracked with data obtained from the Drug 

Abuse Warning Network (DAWN). Because all 

data collection activity will end once 2010 data 

have been collected, this objective (26-3) will be 

archived in Healthy People 2020.

 The Healthy People 2010 objective (26-24) that 

tracked administrative license revocation laws 

for persons under the influence of intoxicants 

also was archived in Healthy People 2020.

〉 Three objectives were deleted at the Midcourse 

Review:

 Drug-related motor vehicle crash deaths 

(objective 26-1c)

 Drug-related motor vehicle crash injuries 

(objective 26-1d)

 Alcohol-related motor vehicle crash injuries 

(objective 26-1b).

〉 Five Healthy People 2010 objectives that remained 

developmental were removed during the Healthy 

People 2020 planning process. The data systems 

proposed to measure these Substance Abuse 

objectives were unable to produce reliable estimates:

 Alcohol-related emergency department visits 

(objective 26-5)

 Intentional injuries from alcohol- and drugrelated violence (objective 26-7)

 Treatment in correctional institutions (objective 

26-19)

 Emergency department referrals for alcohol or 

drug problems and suicide attempts (objective 

26-22)

 Community partnerships and coalitions to 

prevent substance abuse (objective 26-23).

〉 Eight Healthy People 2010 objectives were modified 

to create seven Healthy People 2020 objectives [7].

 Alcohol-related motor vehicle crash deaths 

(objective 26-1a) were tracked in Healthy People 

2010 as a rate per 100,000 population. In Healthy 

People 2020, the rate of death will be tracked per 

vehicle miles traveled.

 The Healthy People 2010 objectives that tracked 

the average age at first use of adolescents who 

used alcohol (objective 26-9a) and marijuana 

(objective 26-9b) for the first time in the previous 

year were modified. The two revised objectives 

will track the proportion of at risk adolescents 

who used alcohol and marijuana for the first time 

in the previous year.

 The proportion of adolescents who did not 

use alcohol or illicit drugs in the past 30 days 

(objective 26-10a) was tracked in Healthy People 

2010. In Healthy People 2020, the complement 

of this objective will be monitored (i.e., the 

proportion of adolescents who did use alcohol or 

illicit drugs in the past 30 days).

 In 2002, the National Institute on Alcohol Abuse 

and Alcoholism revised the definition of binge 

drinking for women from drinking five or more 

alcoholic beverages at the same time or within 

a couple of hours of each other to four or more 

alcoholic beverages [8]. For Healthy People 

2010, binge drinking for adolescents and adults 

(objectives 26-11c and d) was tracked with the 

original definition. Healthy People 2020 will 

track binge drinking with the revised definition.

 Male and female adults who exceeded guidelines 

for low-risk drinking (objectives 26-13a and b) 

were tracked separately in Healthy People 2010. 

In Healthy People 2020, the focus was modified 

slightly to track excessive drinking and the two 

objectives were combined.
26 • SUBSTANCE ABUSE 26-7

〉 Ten new objectives, two of which are developmental, 

were added to the Healthy People 2020 Topic Area:

 Five objectives track past-year use of prescription 

drugs:

 Pain relievers

 Tranquilizers

 Stimulants

 Sedatives

 Any psychotherapeutic drug (including any 

noted above).

 Two new infrastructure-related objectives 

were added: one will track drug, driving while 

intoxicated (DWI), and other specialty courts, 

and the other will track states with mandatory 

ignition interlock laws for DWI offenders.

 Two new treatment-related objectives were 

added: one will track referrals and follow up 

of emergency department patients treated for 

alcohol and/or drug problems, and the other will 

track medical facilities that implement alcohol 

Screening and Brief Intervention.

 One new objective will track the number of 

deaths attributable to alcohol use.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

Beginning in 2003, education data for cirrhosis and 

drug-induced deaths (objectives 26-2 and 26-3) from 

the National Vital Statistics System were suppressed. 

The educational attainment item was changed in the 

new U.S. Standard Certificate of Death in 2003 to be 

consistent with the Census Bureau data and to improve 

the ability to identify specific types of educational 

degrees. Many states, however, are still using the 1989 

version of the U.S. Standard Certificate of Death, which 

focuses on highest school grade completed. As a result, 

educational attainment data collected using the 2003 

version are not comparable with data collected using the 

1989 version [9].

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

References and Notes

1. Displayed in the Progress Chart (Figure 26-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide
26-8 HEALTHY PEOPLE 2010 FINAL REVIEW

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 26-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 26-2). Disparity from the best group rate 

is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 26-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 26-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

5. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

6. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.

7. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa. 

8. NIAAA Newsletter, NIH Publication No. 04–5346. 

Available from http://pubs.niaaa.nih.gov/publications/

Newsletter/winter2004/Newsletter_Number3.pdf.

9. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. 

Deaths: Final data for 2007. National vital statistics 

reports; vol 58 no 19. Hyattsville, MD: National Center 

for Health Statistics. 2010. Available from http://www.

cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf.
26 • SUBSTANCE ABUSE 26-9

Comprehensive Summary of Objectives: Substance Abuse

Objective Description Data Sources or Objective Status

26-1a Alcohol-related motor vehicle crash deaths (per 100,000 

population)

Fatality Analysis Reporting System (FARS), Department of 

Transportation (DOT).

26-1b Alcohol-related motor vehicle crash injuries (per 100,000 

population)

Deleted at the Midcourse Review.

26-1c Drug-related motor vehicle crash deaths (per 100,000 

population)

Deleted at the Midcourse Review.

26-1d Drug-related motor vehicle crash injuries (per 100,000 

population)

Deleted at the Midcourse Review.

26-2 Cirrhosis deaths (age adjusted, per 100,000 population) National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

26-3 Drug-induced deaths (age adjusted, per 100,000 population) National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

26-4 Drug-related hospital emergency department visits 

(thousands)

Drug Abuse Warning Network (DAWN), SAMHSA.

26-5 Alcohol-related hospital emergency department visits Developmental.

26-6 Students who rode with a driver who had been drinking 

alcohol (grades 9–12)

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

26-7 Intentional injuries from alcohol and drug-related violence Developmental.

26-8a Lost productivity due to alcohol abuse (loss in dollars per 

capita)

NIH, NIAAA.

26-8b Lost productivity due to drug abuse (loss in dollars per capita) Office of National Drug Control Policy (ONPCP).

26-9a Average age at first use among adolescents who used alcohol 

for the first time in past year (12–17 years)

National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-9b Average age at first use among adolescents who used 

marijuana for the first time in past year (12–17 years)

National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-9c High school seniors never consuming alcoholic beverages Monitoring the Future Study (MTF), NIH, NIDA.

26-9d High school seniors never using illicit drugs Monitoring the Future Study (MTF), NIH, NIDA.

26-10a Adolescents not using alcohol or illicit drugs in past 30 days 

(12–17 years)

National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-10b Adolescents using marijuana in past 30 days (12–17 years) National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-10c Adults using illicit drugs in past 30 days (18+ years) National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-11a Binge drinking in the past 2 weeks—High school seniors Monitoring the Future Study (MTF), NIH, NIDA.

26-11b Binge drinking in the past 2 weeks—College students Monitoring the Future Study (MTF), NIH, NIDA.

26-11c Binge drinking in the past month—Adults (18+ years) National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-11d Binge drinking in the past month—Adolescents (12–17 years) National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-12 Average annual alcohol consumption (gallons per person, 14+ 

years)

Alcohol Epidemiologic Data System (AEDS), NIH, NIAAA.

26-13a Adults who exceed guidelines for low-risk drinking—Females 

(21+ years)

National Epidemiologic Survey on Alcohol and Related Conditions 

(NESARC), NIH, NIAAA.

26-13b Adults who exceed guidelines for low-risk drinking—Males 

(21+ years)

National Epidemiologic Survey on Alcohol and Related Conditions 

(NESARC), NIH, NIAAA.
26-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Objective Description Data Sources or Objective Status

26-14a Steroid use among students—8th graders Monitoring the Future Study (MTF), NIH, NIDA.

26-14b Steroid use among students—10th graders Monitoring the Future Study (MTF), NIH, NIDA.

26-14c Steroid use among students—12th graders Monitoring the Future Study (MTF), NIH, NIDA.

26-15 Inhalant use among adolescents (12–17 years) National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-16a Disapproval of people who take 1–2 drinks a day of 

alcohol—8th graders

Monitoring the Future Study (MTF), NIH, NIDA.

26-16b Disapproval of people who take 1–2 drinks a day of 

alcohol—10th graders

Monitoring the Future Study (MTF), NIH, NIDA.

26-16c Disapproval of people who take 1–2 drinks a day of 

alcohol—12th graders

Monitoring the Future Study (MTF), NIH, NIDA.

26-16d Disapproval of people who try marijuana or hashish once or 

twice—8th graders

Monitoring the Future Study (MTF), NIH, NIDA.

26-16e Disapproval of people who try marijuana or hashish once or 

twice—10th graders

Monitoring the Future Study (MTF), NIH, NIDA.

26-16f Disapproval of people who try marijuana or hashish once or 

twice—12th graders 

Monitoring the Future Study (MTF), NIH, NIDA.

26-17a Adolescents’ perception of risk (12–17 years)—5+ alcoholic 

drinks, once or twice per week

National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-17b Adolescents’ perception of risk (12–17 years)—Smoking 

marijuana once a month

National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-17c Adolescents’ perception of risk (12–17 years)—Cocaine use 

once a month

National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-18a Treatment for illicit drugs (12+ years) National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-18b Treatment for alcohol and/or drugs (12+ years) National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-19 Substance abuse treatment in correctional institutions Developmental.

26-20 Admissions for treatment for injection drug use (thousands) Treatment Episodes Data System (TEDS), SAMHSA.

26-21 Treatment for alcohol abuse or dependence (12+ years) National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-22 Hospital emergency department referrals for alcohol or drug 

problems and suicide attempts

Developmental.

26-23 Community partnerships and coalitions to prevent substance 

abuse

Developmental.

26-24 Administrative license revocation laws for DUI (no. states and 

D.C.)

Department of Transportation (DOT), National Highway Traffic 

Safety Administration (NHTSA).

26-25 Maximum blood alcohol concentration of 0.08 for motor 

vehicle drivers (21+ years, no. states and D.C.)

Department of Transportation (DOT), National Highway Traffic 

Safety Administration (NHTSA).

Comprehensive Summary of Objectives: Substance Abuse (continued)
26 • SUBSTANCE ABUSE 26-11

Figure 26-1. Progress Toward Target Attainment for Focus Area 26: Substance Abuse

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

26-1a. Alcohol-related motor vehicle crash deaths 

(per 100,000 population)

260.0% 4.8 5.3

(1998)

4.0

(2009)

-1.3 Not tested -24.5%

26-2. Cirrhosis deaths (age adjusted, 

per 100,000 population)

 7.8% 3.2 9.6

(1999)

9.1

(2007)

-0.5 Yes -5.2%

26-3. Drug-induced deaths (age adjusted, 

per 100,000 population)

1.2 6.8

(1999)

12.6

(2007)

5.8 Yes 85.3%

26-4. Drug-related hospital emergency 

department visits (thousands)

1,044.46 1,619.05

(2004)

2,070.44

(2009)

451.39 Yes 27.9%

26-6. Students who rode with a driver who had 

been drinking alcohol (grades 9–12)

166.7% 30% 33%

(1999)

28%

(2009)

-5 Yes -15.2%

26-9a. Average age at fi rst use among 

adolescents who used alcohol for the 

fi rst time in past year (12–17 years)

 8.7% 17.0 14.7

(2002)

14.9

(2008)

0.2 Yes 1.4%

26-9b. Average age at fi rst use among 

adolescents who used marijuana for 

the fi rst time in past year (12–17 years)

 10.0% 17.0 15.0

(2002)

15.2

(2008)

0.2 Yes 1.3%

26-9c. High school seniors never consuming 

alcoholic beverages

90.0% 29% 19%

(1998)

28%

(2009)

9 Yes 47.4%

26-9d. High school seniors never using 

illicit drugs

70.0% 56% 46%

(1998)

53%

(2009)

7 Yes 15.2%

26-10a. Adolescents not using alcohol or illicit 

drugs in past 30 days (12–17 years)

 30.8% 91% 78%

(2002)

82%

(2008)

4 Yes 5.1%

26-10b. Adolescents using marijuana in past 30 

days (12–17 years)

 20.0% 0.7% 8.2%

(2002)

6.7%

(2008)

-1.5 Yes -18.3%

26-10c. Adults using illicit drugs in past 30 days 

(18+ years)

 0.0% 3.2% 7.9%

(2002)

7.9%

(2008)

0 No 0.0%

26-11. Binge drinking in the past 2 weeks

a. High school seniors 33.3% 11% 32%

(1998)

25%

(2009)

-7 Yes -21.9%

b. College students 20% 39%

(1998)

40%

(2009)

1 Not tested 2.6%

Binge drinking in the past month

c. Adults (18+ years) 13.4% 24.3%

(2002)

24.9%

(2008)

0.6 No 2.5%

d. Adolescents (12–17 years) 25.0% 3.1% 10.7%

(2002)

8.8%

(2008)

-1.9 Yes -17.8%

26-12. Average annual alcohol consumption 

(gallons per person, 14+ years)

1.96 2.14

(1997)

2.31

(2007)

0.20 Not tested 7.9%

LEGEND Moved away from target1 Moved toward target Met or exceeded target
26-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 26-1. Progress Toward Target Attainment for Focus Area 26: Substance Abuse (continued)

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

26-13. Adults who exceed guidelines for low-risk 

drinking (21+ years)

a. Females 77.3% 50% 72%

(1992)

55%

(2001–02)

-17 Not tested -23.6%

b. Males 54.2% 50% 74%

(1992)

61%

(2001–02)

-13 Not tested -17.6%

26-14. Steroid use among students

a. 8th graders 0.4% 1.2%

(1998)

1.3%

(2009)

0.1 No 8.3%

b. 10th graders 0.4% 1.2%

(1998)

1.3%

(2009)

0.1 No 8.3%

c. 12th graders 0.4% 1.7%

(1998)

2.2%

(2009)

0.5 No 29.4%

26-15. Inhalant use among adolescents 

(12–17 years)

22.7% 2.2% 4.4%

(2002)

3.9%

(2008)

-0.5 Yes -11.4%

26-16. Disapproval of people who take 1–2 

drinks a day of alcohol

a. 8th graders 16.7% 83% 77%

(1998)

78%

(2009)

1 No 1.3%

b. 10th graders 37.5% 83% 75%

(1998)

78%

(2009)

3 Yes 4.0%

c. 12th graders 7.1% 83% 69%

(1998)

70%

(2009)

1 No 1.4%

Disapproval of people who try marijuana 

or hashish once or twice

d. 8th graders 200.0% 72% 69%

(1998)

75%

(2009)

6 Yes 8.7%

e. 10th graders 25.0% 72% 56%

(1998)

60%

(2009)

4 Yes 7.1%

f. 12th graders 15.0% 72% 52%

(1998)

55%

(2009)

3 No 5.8%

26-17 Adolescents’ perception of risk 

(12–17 years)

a. 5+ alcoholic drinks, once or twice 

per week

25.0% 50% 38%

(2002)

41%

(2008)

3 Yes 7.9%

b. Smoking marijuana once a month 50.0% 36% 32%

(2002)

34%

(2008)

2 Yes 6.3%

c. Cocaine use once a month 57% 51%

(2002)

50%

(2008)

-1 No -2.0%

26-18a. Treatment for illicit drugs (12+ years) 24% 18%

(2002)

16%

(2008)

-2 No -11.1%

26-18b. Treatment for alcohol and/or drugs 

(12+ years)

 0.0% 16% 10%

(2002)

10%

(2008)

0 No 0.0%
26 • SUBSTANCE ABUSE 26-13

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

26-20. Admissions for treatment for injection 

drug use (thousands)

94.2% 256.680 215.560

(1997)

254.278

(2008)

38.718 Not tested 18.0%

26-21. Treatment for alcohol abuse or 

dependence (12+ years)

11.9% 8.3%

(2002)

8.2%

(2008)

-0.1 No -1.2%

26-24. Administrative license revocation laws 

for DUI (no. States and D.C.)

 0.0% 51 42

(1998)

42

(2007)

0 Not tested 0.0%

26-25. Maximum blood alcohol concentration of 

0.08 for motor vehicle drivers (21+ years, 

no. States and D.C.)

100.0% 51 15

(1998)

51

(2006)

36 Not tested 240.0%

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 26-5, 26-7, 26-8a, 26-8b, 26-19, 26-22, and 26-23. Objectives 26-1b through d were deleted 

at the Midcourse Review.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value 

DATA SOURCES

26-1a. Fatality Analysis Reporting System (FARS), Department of Transportation (DOT).

26-2–26-3. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

26-4. Drug Abuse Warning Network (DAWN), SAMHSA.

26-6. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

26-9a–b. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-9c–d. Monitoring the Future Study (MTF), NIH, NIDA.

26-10a–c. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-11a–b. Monitoring the Future Study (MTF), NIH, NIDA.

26-11c–d. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-12. Alcohol Epidemiologic Data System (AEDS), NIH, NIAAA.

26-13a–b. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), NIH, NIAAA.

26-14a–c. Monitoring the Future Study (MTF), NIH, NIDA.

26-15. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-16a–f. Monitoring the Future Study (MTF), NIH, NIDA.

26-17a–c. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-18a–b. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-20. Treatment Episodes Data System (TEDS), SAMHSA.

26-21. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-24–26-25. Department of Transportation (DOT), National Highway Traffi c Safety Administration (NHTSA).

Figure 26-1. Progress Toward Target Attainment for Focus Area 26: Substance Abuse (continued)
26-14 HEALTHY PEOPLE 2010 FINAL REVIEW

Figure 26-2. Health Disparities Table for Focus Area 26: Substance Abuse

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.

Race and Ethnicity Sex Education Income

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary index

26-1a. Alcohol-related motor vehicle crash deaths 

(per 100,000 population) 

(1998, 2009)1,2†







B































B 

26-2. Cirrhosis deaths (age adjusted, 

per 100,000 population) (1999, 2007)3* Bii  B  B

26-3. Drug-induced deaths (age adjusted, 

per 100,000 population) (1999, 2007)3* 





Bii 











B   B

26-4. Drug-related hospital emergency 

department visits (thousands) 

(2004, 2009)*

Biii iii



B 

26-6. Students who rode with a driver who had 

been drinking alcohol (grades 9–12) 

(1999, 2009)*

B Biv

26-9a. Average age at first use among adolescents 

who used alcohol for the first time in past 

year (12–17 years) (2002, 2008)4*

B i Biv B

26-9b. Average age at first use among adolescents 

who used marijuana for the first time in past 

year (12–17 years) (2002, 2008)4*

b B B B 

26-9c. High school seniors never consuming 

alcoholic beverages (1998, 2009)5,6,7‡ B B Biv

26-9d. High school seniors never using illicit drugs 

(1998, 2009)5,6,7‡  B   B

26-10a. Adolescents not using alcohol or illicit drugs 

in past 30 days (12–17 years) 

(2002, 2008)4*

b B B Biv

26-10b. Adolescents using marijuana in past 30 

days (12–17 years) (2002, 2008)4* b Biv B B

26-10c. Adults using illicit drugs in past 30 days 

(18+ years) (2002, 2008)* b B B B

26-11a. Binge drinking in the past 2 weeks— 

High school seniors (1998, 2009)5,6,7‡  B 

  B

b. Binge drinking in the past 2 weeks— 

College students (1998, 2009)8* B 

26-11c. Binge drinking in the past month—Adults 

(18+ years) (2002, 2008)4* b B B B
26 • SUBSTANCE ABUSE 26-15

Race and Ethnicity Sex Education Income

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary index

d. Binge drinking in the past month— 

Adolescents (12–17 years) (2002, 2008)4* 





b b Biv b







B Biv

26-13a. Adults who exceed guidelines for low-risk 

drinking—Females (21+ years) 

(1992, 2001–02)†

 Biv   i Biv

b. Adults who exceed guidelines for low-risk 

drinking—Males (21+ years) 

(1992, 2001–02)†

 Biv 

 i B

26-14a. Steroid use among students—8th graders 

(1998, 2009)5,6,7‡ Biv

b. Steroid use among students—10th graders 

(1998, 2009)5,6,7‡  b Biv

c. Steroid use among students—12th graders 

(1998, 2009)5,6,7‡ b Biv

26-15. Inhalant use among adolescents 

(12–17 years) (2002, 2008)4* b b b B Biv B i

26-16a. Disapproval of people who take 1–2 drinks 

a day of alcohol—8th graders (1998, 

2009)5,6,7‡

 B B

b. Disapproval of people who take 1–2 drinks 

a day of alcohol—10th graders (1998, 

2009)5,6,7‡

B   B

c. Disapproval of people who take 1–2 drinks 

a day of alcohol—12th graders (1998, 

2009)5,6,7‡

Biv   B

d. Disapproval of people who try marijuana 

or hashish once or twice—8th graders 

(1998, 2009)5,6,7‡

 B  B

e. Disapproval of people who try marijuana 

or hashish once or twice—10th graders 

(1998, 2009)5,6,7‡

Biv B 

f. Disapproval of people who try marijuana 

or hashish once or twice—12th graders 

(1998, 2009)5,6,7‡

B B

26-17a. Adolescents' perception of risk 

(12–17 years)—5+ alcoholic drinks, 

once or twice per week (2002, 2008)4*

Biv b B B

b. Adolescents' perception of risk 

(12–17 years)—Smoking marijuana once 

a month (2002, 2008)4*

 Biv 

i

B Biv

c. Adolescents' perception of risk 

(12–17 years)—Cocaine use once a 

month (2002, 2008)4*

B Biv B

Figure 26-2. Health Disparities Table for Focus Area 26: Substance Abuse (continued)
26-16 HEALTHY PEOPLE 2010 FINAL REVIEW

Race and Ethnicity Sex Education Income

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary index

26-18a. Treatment for illicit drugs (12+ years) 

(2002, 2008)4* Biv B Biv B

b. Treatment for alcohol and/or drugs 

(12+ years) (2002, 2008)4* Biv B i Biv B

26-21. Treatment for alcohol abuse or 

dependence (12+ years) (2002, 2008)4* Biv B B

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 26-5, 

26-7, 26-8a and b, 26-12, 26-19, 26-20, and 26-22 through 26-25. Objectives 26-1b through d were deleted at Midcourse Review. 

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

LEGEND

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

Figure 26-2. Health Disparities Table for Focus Area 26: Substance Abuse (continued)
26 • SUBSTANCE ABUSE 26-17

Figure 26-2. Health Disparities Table for Focus Area 26: Substance Abuse (continued)

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% 

or more are displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are 

indicated by arrows when the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical 

Appendix.

† Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. 

Nonetheless, disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix.

‡ Measures of variability were available only for the most recent data. Thus, the variability of best group rates was assessed only for the most recent 

data, and statistical significance was tested only for the most recent data. Disparities of 10% or more are displayed when the differences from the best 

group rate are statistically significant at the 0.05 level. Changes in disparities over time are displayed according to their magnitude, since measures of 

variability were not available at baseline and therefore statistical significance of changes in disparity could not be tested. See Technical Appendix.

1 Baseline data by race and ethnicity are for 2000.

2 Most recent data by race and ethnicity are for 2008.

3 Data by education level are for persons aged 25–64 years. Most recent data by education level are for 2002.

4 Baseline data by income are for 2005.

5 Baseline data by race and ethnicity are for 2004–05.

6 Most recent data by race and ethnicity are for 2008–09.

7 Measures of variability were available for data by sex. See footnote * above.

8 Most recent data by sex are for 2007.

i Change in the summary index cannot be assessed. See Technical Appendix.

ii Data are for Asian or Pacific Islander.

iiiData include persons of Hispanic origin.

iv The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability 

criterion. See Technical Appendix.

DATA SOURCES

26-1a. Fatality Analysis Reporting System (FARS), Department of Transportation (DOT).

26-2–26-3. National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

26-4. Drug Abuse Warning Network (DAWN), SAMHSA.

26-6. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

26-9a–b. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-9c–d. Monitoring the Future Study (MTF), NIH, NIDA.

26-10a–c. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-11a–b. Monitoring the Future Study (MTF), NIH, NIDA.

26-11c–d. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-13a–b. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), NIH, NIAAA.

26-14a–c. Monitoring the Future Study (MTF), NIH, NIDA.

26-15. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-16a–f. Monitoring the Future Study (MTF), NIH, NIDA.

26-17a–c. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-18a–b. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-18b. National Survey on Drug Use and Health (NSDUH), SAMHSA.

26-21. National Survey on Drug Use and Health (NSDUH), SAMHSA.
HEALTHY PEOPLE 2010 FINAL REVIEW 26-18Figure 26-3. Cirrhosis Deaths, 2005–07 Healthy People 2010 objective 26-2 • Target = 3.2 per 100,000 NOTES: Data are for ICD-10 codes K70, K73, and K74 reported as underlying cause. Rates are age adjusted to the 2000 standard population. Rates are displayed by a manual c

areas. SOURCE: National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS. Rate pe

No healreliable 
Lead Agency

Centers for Disease Control and Prevention

Contents

Goal ................................................................................................27-3

Highlights ......................................................................................27-3

Summary of Progress.....................................................................27-4

Transition to Healthy People 2020................................................27-5

Data Considerations.......................................................................27-6

Notes..............................................................................................27-7

Comprehensive Summary of Objectives........................................27-8

Progress Chart..............................................................................27-11

Health Disparities Table...............................................................27-14

Tobacco Use by Adults—Cigarettes, 2008—Map .......................27-17

Tobacco Use

CHAPTER 27

27 • TOBACCO USE 27-3

The objectives in this chapter monitor tobacco use, 

smoking cessation and the availability of treatment 

programs, environmental exposure to tobacco smoke, 

adolescent attitudes toward smoking, and tobacco 

control laws.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was achieved in objectives for 

this Focus Area during the past decade [1]. Eightyfive percent of the Tobacco Use objectives with data 

to measure progress moved toward or achieved their 

Healthy People 2010 targets (Figure 27-1). However, 

statistically significant health disparities were 

observed among racial and ethnic populations, as 

well as by sex, education level, income, and disability 

status (Figure 27-2), as discussed below [2].

〉 The percentage of adults aged 18 and over who were 

current cigarette smokers (objective 27-1a) decreased 

12.5% between 1998 and 2008, from 24% to 21% 

(age adjusted), moving toward the Healthy People 

2010 target of 12%. However, from 2004 to 2008, the 

proportion of U.S. adults who were current cigarette 

smokers did not noticeably change. Disparities were 

observed for a number of populations, for example:

 Among educational groups, adults aged 25 and 

over with at least some college education had the 

lowest (best) current cigarette smoking rate, 15% 

(age adjusted) in 2008. Adults aged 25 and over 

with less than a high school education had a rate 

of 30% (age adjusted), twice the best group rate 

[2].

〉 Current cigarette smoking varied by geographic area. 

Utah was the only state to exceed the 2010 target, 

with an adult smoking rate of 9.2% in 2008. Indiana, 

Kentucky, Missouri, Oklahoma, and West Virginia 

had the highest smoking rates (Figure 27-3).

〉 The percentage of students in grades 9–12 who used 

tobacco products in the last month declined between 

1999 and 2009. Student use of all tobacco products 

(which includes use of cigarettes, chewing tobacco, 

snuff, or cigars) (objective 27-2a) decreased 35.0%, 

from 40% in 1999 to 26% in 2009, moving toward 

the 2010 target of 21%. Student cigarette smoking 

(objective 27-2b) decreased 45.7%, from 35% in 1999 

to 19% in 2009, moving toward the 2010 target of 16%; 

whereas cigar use (objective 27-2d) declined 22.2%, 

from 18% to 14%, moving toward the 2010 target of 

8%. Student bidi use (objective 27-2e) declined 41.5% 

between 2000 and 2009, from 4.1% to 2.4%, meeting 

the target of 2.4%.

 Female students had a lower (better) rate of cigar 

use in the past month than male students, 19% 

vs. 9% in 2009. The rate for male students was 

more than twice that of female students [2].

 The percentage of children aged 6 years and 

under exposed to tobacco smoke at home 

(objective 27-9) decreased 70.4% between 1994

GOAL:

Reduce illness, disability, and death related 

to tobacco use and exposure to secondhand 

smoke.
27-4 HEALTHY PEOPLE 2010 FINAL REVIEW

and 2005, from 27% to 8%, exceeding the 

Healthy People 2010 target of 10%. Disparities 

were observed among a number of population 

groups, for example: among income groups, 

children aged 6 years and under living in middle/

high-income households had the lowest (best) 

rates of exposure to tobacco smoke at home, 

5% in 2005, whereas children living in poor or 

near-poor households had rates of 15% and 12%, 

respectively. The rate for children living in poor 

households was three times the best group rate, 

whereas the rate for children living in near-poor 

households was almost two and a half times the 

best group rate [2].

 Children living in poor households had rates of 

exposure to tobacco smoke of 38% in 1994 and 

15% in 2005; those living in near-poor households 

had rates of 33% in 1994 and 12% in 2005; 

whereas those living in middle/high-income 

households had rates of 19% in 1994 and 5% in 

2005. The disparity between children living in 

poor households and those living in middle/

high-income households increased 100 percentage 

points between 1994 and 2005. During the same 

period, the disparity between children living in 

near-poor households and those living in middle/

high-income households increased 66 percentage 

points [3].

〉 The percentage of nonsmokers aged 4 years and over 

exposed to environmental tobacco smoke (objective 

27-10) declined 51.2% between 1988–94 and 2005–08, 

from 84% to 41% (age adjusted), exceeding the 2010 

target of 56%.

〉 The number of states with smoke-free indoor air laws 

(objectives 27-13a through f, and i) increased between 

1998 and 2009, moving toward the 2010 targets of 

51 (all 50 states plus the District of Columbia). The 

number of states that had laws prohibiting smoking 

in private workplaces increased from 0 states in 

1998 to 30 (29 states plus the District of Columbia) 

in 2009 (objective 27-13a). The number of states that 

prohibited smoking in restaurants increased from 1 

in 1998 to 28 (27 states plus the District of Columbia) 

in 2009 (objective 27-13c). And the number of states 

that prohibited smoking in bars increased from 

0 states in 1998 to 22 (21 states plus the District of 

Columbia) in 2009 (objective 27-13i).

 Twenty-one states had laws prohibiting smoking 

in private workplaces, restaurants, and bars in 

2009. Nineteen states, including large-population 

states like California and Texas, had no such laws 

(Figure 27-4).

〉 Exposure to tobacco advertising on the Internet 

among students in grades 6–12 (objective 27-16a) 

increased 32.1% between 2000 and 2009, from 28% to 

37%, moving away from the 2010 target of 25%.

〉 The average combined Federal and State excise taxes 

on a standard pack of cigarettes (objective 27-21a) 

increased nearly four-fold, from $0.63 in 1998 to $2.35 

in 2009, exceeding the 2010 target of $2.00. (The 2009 

figure includes an increase in the Federal cigarette 

tax to $1.01.)

 Twenty-nine states had cigarette taxes of at least 

$2.00 per pack in 2009, achieving the target. 

South Carolina had the lowest combined tax rate: 

$1.08 per pack (Figure 27-5).

Summary of Progress

〉 Figure 27-1 presents a quantitative assessment 

of progress in achieving the Healthy People 2010 

objectives for Tobacco Use [1]. Data to measure 

progress toward target attainment were available for 

40 objectives. Of these:

 Six objectives (27-2e, 27-9, 27-10, 27-16b, 27-20a, 

and 27-21a) met or exceeded their Healthy People 

2010 targets.

 Twenty-eight objectives moved toward their 

2010 targets. A statistically significant difference 

between the baseline and the final data points 

was observed for 11 of these objectives (27-1a, 

27-2a and b, 27-2d, 27-4a, 27-5, 27-11, 27-12, and 

27-17a through c). No significant differences were 

observed for 3 objectives (27-1b and c, and 27-3a); 

and data to test the significance of the difference 

were unavailable for 14 objectives (27-13a through 

f, 27-13i, 27-14a and b, 27-15, 27-19, 27-20b and c, 

and 27-21b).

 Six objectives moved away from their 2010 

targets. A statistically significant difference 

between the baseline and final data points was 

observed for two objectives (27-3b and 27-16a); 

no significant differences were observed for four 

objectives (27-2c, 27-4b, 27-6, and 27-7).

〉 Four objectives remained developmental (objectives 

27-13g and h, and 27-18b and d), and three had 

no follow-up data available to measure progress 

(objectives 27-8a and b, and 27-18a) [4]. Two objectives 

were deleted at the Midcourse Review (objectives 

27-1d and 27-8c).

〉 Figure 27-2 displays health disparities in Tobacco Use 

from the best group rate for each characteristic at the 

most recent data point [2]. It also displays changes 

in disparities from baseline to the most recent data 

point [3].

 Of the 10 objectives with statistically significant 

health disparities of 10% or more by race and 

ethnicity, the Asian population had the best 

rate for 3 objectives (27-12, and 27-16a and b); 
27 • TOBACCO USE 27-5

the non-Hispanic black population had the best 

rate for 2 objectives (27-2a and b); the Hispanic 

or Latino population had the best rate for 2 

objectives (27-1a and 27-10); the non-Hispanic 

white population had the best rate for 2 objectives 

(27-9 and 27-17a); and the non-Hispanic white 

and non-Hispanic black populations were tied 

for the best rate for 1 objective (27-4a).

 Females had better rates than males for 10 of the 

12 objectives with statistically significant health 

disparities of 10% or more by sex (objectives 

27-1a, 27-2a and d, 27-3b, 24-5, 27-7, 27-10, 27-12, 

and 27-17a and b). Males had better rates than 

females for 2 objectives (27-3a and 27-4a).

 Persons with at least some college education had 

the best rates for all five of the objectives with 

statistically significant health disparities of 10% 

or more by education level (27-1a and b, 27-5, 27-

10, and 27-12).

 Persons with middle/high incomes had the best 

rates for the four objectives with statistically 

significant health disparities of 10% or more by 

income (objectives 27-1, 27-4a, 27-9, and 27-12).

 Persons without disabilities had the better rates 

for both objectives with statistically significant 

health disparities of 10% or more by disability 

status (objectives 27-1a and c).

Transition to Healthy People 

2020

The focus of the Healthy People 2020 Tobacco Use 

objectives remains similar to that of Healthy People 

2010. There have been some changes in organization and 

some objectives have been expanded. See HealthyPeople.

gov for a complete list of Healthy People 2020 topics and 

objectives.

The Healthy People 2020 objectives can be grouped into 

several sections:

〉 The Tobacco Use Prevalence section focuses on 

reducing tobacco use and initiation among youth and 

adults.

〉 The Health System Changes section addresses policies 

and strategies to increase access, affordability, and 

use of smoking cessation services and treatments.

〉 The Social and Environmental Changes section 

monitors policies to reduce exposure to secondhand 

smoke, increase the cost of tobacco, restrict tobacco 

advertising, and reduce illegal sales to minors.

The differences between the Healthy People 2010 and 

Healthy People 2020 objectives are summarized below:

〉 The Healthy People 2020 Tobacco Use Topic Area has 

a total of 70 objectives, 19 of which are developmental, 

whereas the Healthy People 2010 Tobacco Use Focus 

Area had 49 objectives, 2 of which were deleted at the 

Midcourse Review [4].

〉 Twenty-two Healthy People 2010 objectives were 

retained “as is” [5]. These include: adult and adolescent 

tobacco use (objectives 27-1a through c, and 27-2a 

through d); initiation of cigarette use (objectives 

27-3a and b); smoking cessation attempts for adults 

(objective 27-5), adolescents (objective 27-7), and 

pregnant women (objective 27-6); indoor worksite 

policies (objective 27-12); smoke-free indoor air 

laws in private and public workplaces (objectives 

27-13a and b), restaurants (objective 27-13c), public 

transportation (objective 27-13d), and bars (objective 

27-13i); enforcement of illegal tobacco sales to minors 

(objectives 27-14a and b); and adolescent exposure to 

tobacco advertising and promotion on the Internet or 

in magazines and newspapers (objectives 27-16a and 

b).

〉 Seven Healthy People 2010 objectives were modified 

and expanded into 14 objectives [6]:

 Medicaid program coverage for treatment of 

nicotine dependency (objective 27-8b) will be 

measurable in Healthy People 2020 using a 

different data source.

 Exposure to environmental tobacco smoke 

(objective 27-10) was split into three age-group 

objectives including 3–11 years, 12–17 years, and 

18 and over.

 The smoke-free and tobacco-free schools 

objective (27-11) was modified to tobacco-free 

schools and has been split into three objectives 

including junior high, middle school, and high 

school.

 The objective on smoke-free indoor air laws in 

day care centers (objective 27-13e) was divided 

into two objectives for commercial and homebased centers.

 The preemptive tobacco control laws objective 

(27-19) was expanded to include objectives for 

preemption in smoke-free indoor air, advertising, 

and youth access.

 Two objectives that monitor increases in Federal 

and State tax on cigarettes (objective 27-21a) and 

smokeless tobacco products (objective 27-21b) 

will be measured differently in Healthy People 

2020.

〉 Three Healthy People 2010 objectives, evidence-based 

tobacco control programs for states, territories, and 

for tribes, were retained as developmental due to lack 

of baseline data (objectives 27-18a through c) [4].
27-6 HEALTHY PEOPLE 2010 FINAL REVIEW

〉 Thirteen Healthy People 2010 objectives were archived 

[7]. These include: adolescent use of bidis (objective 

27-2e); average age at first use of tobacco (objectives 

27-4a and b); managed care organization coverage for 

treatment of nicotine dependency (objective 27-8a); 

exposure to tobacco smoke at home (objective 27-9); 

smoke-free indoor air laws for retail stores (objective 

27-13f); retail license suspension for sales to minors 

(objective 27-15); adolescent disapproval of smoking 

for eighth (objective 27-17a), tenth (objective 27-17b) 

and twelfth (objective 27-17c) graders; sales-weighted 

average tobacco specific nitrosamines (objective 

27-20a); and polyaromatic hydrocarbon compounds 

(objective 27-20b) and volatile organic compounds 

(objective 27-20c) in cigarette smoke.

 While objective 27-9, to reduce the proportion of 

children who are regularly exposed to tobacco 

smoke at home, was archived, the modified 

Healthy People 2020 objective TU-11.1 measures 

the exposure to secondhand smoke among 

children aged 3–11 years using measured serum 

cotinine levels, and is thought to measure 

children’s exposure more accurately than selfreport data. 

〉 Two objectives were deleted at the Midcourse 

Review due to lack of data: adult use of other 

tobacco (objective 27-1d); and insurance coverage 

for treatment of nicotine dependency (objective 

27-8c). Two additional objectives that had remained 

developmental in Healthy People 2010 were removed 

during the Healthy People 2020 planning process, due 

to lack of data: smoke-free indoor air laws for tribes 

(objective 27-13g) and territories (objective 27-13h).

〉 Thirty one new objectives were added to the Healthy 

People 2020 Tobacco Use Topic Area:

 Six new objectives address age at first use for all 

tobacco products, smokeless tobacco, and cigars 

for both the 12–17 and the 18–25 age groups.

 Three new objectives monitor smoking cessation 

success and smoking cessation using evidencebased strategies.

 Eight objectives address screening and counseling 

in office-based ambulatory care settings, hospital 

ambulatory care settings, dental care settings, 

and substance abuse care settings.

 Ten new smoke-free indoor air objectives track 

indoor air in gaming halls, hotels and motels, 

multi-unit housing, vehicles with children, 

prisons and correctional facilities, substance 

abuse treatment facilities, mental health 

treatment facilities, entrances and exits of all 

public places, hospital campuses, and college and 

university campuses.

 An objective was added to include Head Start on 

the list of smoke-free and tobacco-free schools.

 One new objective will monitor increases in 

Federal and state tax on other smoked tobacco 

products.

 Two new objectives address adolescent exposure 

to tobacco advertising at the movies and at point 

of purchase.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.

Data Considerations

Figure 27-3 (Tobacco Use by Adults—Cigarettes) 

presents state-level data from the Behavioral Risk Factor 

Surveillance System (BRFSS). National data for these 

objectives come from the National Health Interview 

Survey (NHIS) and are the basis for setting the targets. 

BRFSS data may not be comparable with the national 

data from NHIS.

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.
27 • TOBACCO USE 27-7

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

Notes

1. Displayed in the Progress Chart (Figure 27-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 27-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 27-2). Disparity from the best group rate 

is defined as the percent difference between the 

best group rate and each of the other group rates 

for a characteristic. For example, racial and ethnic 

health disparities are measured as the percent 

difference between the best racial and ethnic group 

rate and each of the other racial and ethnic group 

rates. Similarly, disparities by sex are measured as 

the percent difference between the better group 

rate (e.g., female) and the rate for the other group 

(e.g., male). Some objectives are expressed in terms 

of favorable events or conditions that are to be 

increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of health disparities 

across different objectives, disparity is measured 

only in terms of adverse events or conditions. For 

comparability across objectives, objectives that are 

expressed in terms of favorable events or conditions 

are re-expressed using the adverse event or condition 

for the purpose of computing disparity, but they are 

not otherwise restated or changed. For example, 

objective 1-1, to increase the proportion of persons 

with health insurance (e.g., 72% of the American 

Indian or Alaska Native population under age 65 had 

some form of health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did 

not have any form of health insurance in 2008) when 

the disparity from the best group rate is calculated. 

See the Reader’s Guide for more information. When 

standard errors were available, the difference 

between the best group rate and each of the other 

group rates was tested at the 0.05 level of significance. 

See the Figure 27-2 footnotes, as well as the Technical 

Appendix, for more detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 27-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. To be included in Healthy People 2010, an objective 

must have a national data source that provides 

a baseline and at least one additional data point 

for tracking progress. Some objectives lacked 

baseline data at the time of their development but 

had a potential data source and were considered 

of sufficient national importance to be included in 

Healthy People. These are called “developmental” 

objectives. When data become available, a 

developmental objective is moved to measurable 

status and a Healthy People target can be set.

5. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

6. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.
27-8 HEALTHY PEOPLE 2010 FINAL REVIEW

7. Archived objectives had at least one data point in 

Healthy People 2010 but were not carried forward 

into Healthy People 2020.

Comprehensive Summary of Objectives: Tobacco Use

Objective Description Data Source or Objective Status

27-1a Tobacco use by adults—Cigarettes (age adjusted, 18+ years) National Health Interview Survey (NHIS), CDC, NCHS.

27-1b Tobacco use by adults—Spit tobacco (age adjusted, 18+ 

years)

National Health Interview Survey (NHIS), CDC, NCHS.

27-1c Tobacco use by adults—Cigars (age adjusted, 18+ years) National Health Interview Survey (NHIS), CDC, NCHS.

27-1d Tobacco use by adults—Other (age adjusted, 18+ years) Deleted at the Midcourse Review.

27-2a Tobacco use in past month by students—Tobacco products 

(grades 9–12)

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

27-2b Tobacco use in past month by students—Cigarettes (grades 

9–12)

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

27-2c Tobacco use in past month by students—Spit tobacco 

(grades 9–12)

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

27-2d Tobacco use in past month by students—Cigars (grades 

9–12)

Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

27-2e Tobacco use in past month by students—Bidis (grades 9–12) National Youth Tobacco Survey: American Legacy Foundation; CDC, 

NCCDPHP.

27-3a Initiation of cigarette use—Adolescents 12–17 years (percent 

at risk)

National Survey on Drug Use and Health (NSDUH), SAMHSA.

27-3b Initiation of cigarette use—Young adults 18–25 years 

(percent at risk)

National Survey on Drug Use and Health (NSDUH), SAMHSA.

27-4a Average age at first tobacco use—Adolescents 12–17 years National Survey on Drug Use and Health (NSDUH), SAMHSA.

27-4b Average age at first tobacco use—Young adults 18–25 years National Survey on Drug Use and Health (NSDUH), SAMHSA.

27-5 Smoking cessation attempts by adults (age adjusted, 18+ 

years)

National Health Interview Survey (NHIS), CDC, NCHS.

27-6 Smoking cessation in first trimester and for remainder of 

pregnancy (females, 18–49 years)

National Health Interview Survey (NHIS), CDC, NCHS.

27-7 Smoking cessation attempts by students (grades 9–12) Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

27-8a Managed care organization coverage for treatment of nicotine 

dependency

Addressing Tobacco in Managed Care Survey, Robert Wood 

Johnson Foundation.

27-8b Medicaid program coverage for treatment of nicotine 

dependency (no. States and D.C.)

Health Policy Tracking Service, National Conference of State 

Legislators.

27-8c Insurance coverage for treatment of nicotine dependency Deleted at the Midcourse Review.
27 • TOBACCO USE 27-9

Objective Description Data Source or Objective Status

27-9 Exposure to tobacco smoke at home among children (≤6 

years)

National Health Interview Survey (NHIS), CDC, NCHS.

27-10 Exposure to environmental tobacco smoke among 

nonsmokers (age adjusted, 4+ years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

27-11 Smoke-free and tobacco-free schools School Health Policies and Programs Study (SHPPS), CDC, 

NCCDPHP.

27-12 Indoor worksite policies that prohibit smoking Tobacco Use Supplement to the Current Population Survey (TUSCPS): Department of Commerce, Census Bureau; Department of 

Labor (DOL), Bureau of Labor Statistics (BLS).

27-13a Smoke-free indoor air laws—Private workplaces (no. States 

and D.C.)

State Tobacco Activities Tracking and Evaluation System (STATE), 

CDC, NCCDPHP.

27-13b Smoke-free indoor air laws—Public workplaces (no. States 

and D.C.)

State Tobacco Activities Tracking and Evaluation System (STATE), 

CDC, NCCDPHP.

27-13c Smoke-free indoor air laws—Restaurants (no. States and 

D.C.)

State Tobacco Activities Tracking and Evaluation System (STATE), 

CDC, NCCDPHP.

27-13d Smoke-free indoor air laws—Public transportation (no. States 

and D.C.)

State Tobacco Activities Tracking and Evaluation System (STATE), 

CDC, NCCDPHP.

27-13e Smoke-free indoor air laws—Day care centers (no. States 

and D.C.)

State Tobacco Activities Tracking and Evaluation System (STATE), 

CDC, NCCDPHP.

27-13f Smoke-free indoor air laws—Retail stores (no. States and 

D.C.)

State Tobacco Activities Tracking and Evaluation System (STATE), 

CDC, NCCDPHP.

27-13g Smoke-free indoor air laws—Tribes (number) Developmental.

27-13h Smoke-free indoor air laws—Territories (number) Developmental.

27-13i Smoke-free indoor air laws—Bars (no. States and D.C.) State Tobacco Activities Tracking and Evaluation System (STATE), 

CDC, NCCDPHP.

27-14a Jurisdictions with ≤5% illegal tobacco buy rate among 

minors—States and D.C.

State Synar Enforcement Reporting, SAMHSA.

27-14b Jurisdictions with ≤5% illegal tobacco buy rate among 

minors—Territories

State Synar Enforcement Reporting, SAMHSA.

27-15 Retail license suspension for sales to minors (no. States and 

D.C.)

State Tobacco Activities Tracking and Evaluation System (STATE), 

CDC, NCCDPHP.

27-16a Exposure to tobacco advertising and promotions among 

students—Internet (grades 6–12)

National Youth Tobacco Survey: American Legacy Foundation; CDC, 

NCCDPHP.

27-16b Exposure to tobacco advertising and promotions among 

students—Magazines and newspapers (grades 6–12)

National Youth Tobacco Survey: American Legacy Foundation; CDC, 

NCCDPHP.

27-17a Student disapproval of smoking 1+ pack of cigarettes per 

day—8th graders

Monitoring the Future Study (MTF), NIH, NIDA.

27-17b Student disapproval of smoking 1+ pack of cigarettes per 

day—10th graders

Monitoring the Future Study (MTF), NIH, NIDA.

27-17c Student disapproval of smoking 1+ pack of cigarettes per 

day—12th graders

Monitoring the Future Study (MTF), NIH, NIDA.

Comprehensive Summary of Objectives: Tobacco Use (continued)
27-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Objective Description Data Source or Objective Status

27-18a Evidence-based tobacco control programs (no. States and 

D.C.)

State Tobacco Activities Tracking and Evaluation System (STATE), 

CDC, NCCDPHP, OSH.

27-18b Evidence-based tobacco control programs (no. Territories) Developmental.

27-18c Evidence-based tobacco control programs (no. Tribes) Developmental.

27-19 Preemptive tobacco control laws (no. States and D.C.) State Tobacco Activities Tracking and Evaluation System (STATE), 

CDC, NCCDPHP.

27-20a Sales-weighted average tobacco-specific nitrosamines in 

cigarette smoke (ng per cigarette)

Office on Smoking and Health, CDC, NCCDPHP; Division of 

Laboratory Sciences, CDC, NCEH.

27-20b Sales-weighted average polyaromatic hydrocarbon 

compounds in cigarette smoke (ng per cigarette)

Office on Smoking and Health, CDC, NCCDPHP; Division of 

Laboratory Sciences, CDC, NCEH.

27-20c Sales-weighted average volatile organic compounds in 

cigarette smoke (μg per cigarette)

Office on Smoking and Health, CDC, NCCDPHP; Division of 

Laboratory Sciences, CDC, NCEH.

27-21a Average combined Federal and State excise taxes on retail 

price of a standard pack of cigarettes in all 50 States and D.C.

State Tobacco Activities Tracking and Evaluation System (STATE), 

CDC, NCCDPHP.

27-21b Increased taxes on smokeless tobacco (no. States and D.C.) State Tobacco Activities Tracking and Evaluation System (STATE), 

CDC, NCCDPHP.

Comprehensive Summary of Objectives: Tobacco Use (continued)
27 • TOBACCO USE 27-11

Figure 27-1. Progress Toward Target Attainment for Focus Area 27: Tobacco Use

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

27-1. Tobacco use by adults (age adjusted, 

18+ years)

a. Cigarettes 25.0% 12% 24%

(1998)

21%

(2008)

-3 Yes -12.5%

b. Spit tobacco 9.5% 0.4% 2.5%

(1998)

2.3%

(2005)

-0.2 No -8.0%

c. Cigars 16.7% 1.2% 2.4%

(1998)

2.2%

(2005)

-0.2 No -8.3%

27-2. Tobacco use in past month by students 

(grades 9–12)

a. Tobacco products 73.7% 21% 40%

(1999)

26%

(2009)

-14 Yes -35.0%

b. Cigarettes 84.2% 16% 35%

(1999)

19%

(2009)

-16 Yes -45.7%

c. Spit tobacco 1% 8%

(1999)

9%

(2009)

1 No 12.5%

d. Cigars 40.0% 8% 18%

(1999)

14%

(2009)

-4 Yes -22.2%

e. Bidis 100.0% 2.4% 4.1%

(2000)

2.4%

(2009)

-1.7 Yes -41.5%

27-3. Initiation of cigarette use (percent at risk)

a. Adolescents 12–17 years 19.2% 4.1% 6.7%

(2002)

6.2%

(2008)

-0.5 No -7.5%

b. Young adults 18–25 years 4.4% 6.7%

(2002)

8.3%

(2008)

1.6 Yes 23.9%

27-4. Average age at fi rst tobacco use

a. Adolescents 12–17 years 13.8% 17.6 14.7

(2002)

15.1

(2008)

0.4 Yes 2.7%

b. Young adults 18–25 years 20.9 19.0

(2002)

18.9

(2008)

-0.1 No -0.5%

27-5. Smoking cessation attempts by adults 

(age adjusted, 18+ years)

 8.6% 80% 45%

(1998)

48%

(2008)

3 Yes 6.7%

27-6. Smoking cessation in fi rst trimester 

and for remainder of pregnancy 

(females, 18–49 years)

30% 14%

(1998)

11%

(2005)

-3 No -21.4%

27-7. Smoking cessation attempts by students 

(grades 9–12)

64% 61%

(2001)

59%

(2009)

-2 No -3.3%

27-9. Exposure to tobacco smoke at home 

among children (≤6 years)

111.8% 10% 27%

(1994)

8%

(2005)

-19 Yes -70.4%

27-10. Exposure to environmental tobacco 

smoke among nonsmokers (age adjusted, 

4+ years)

153.6% 56% 84%

(1988–94)

41%

(2005–08)

-43 Yes -51.2%

LEGEND Moved away from target1 Moved toward target Met or exceeded target
27-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

27-11. Smoke-free and tobacco-free schools 41.9% 100% 38%

(1994)

64%

(2006)

26 Yes 68.4%

27-12. Indoor worksite policies that 

prohibit smoking

19.4% 100% 69%

(1998–99)

75%

(2006–07)

6 Yes 8.7%

27-13. Smoke-free indoor air laws (no. States 

and D.C.)

a. Private workplaces 58.8% 51 0

(1998)

30

(2009)

30 Not tested *

b. Public workplaces 58.5% 51 10

(1998)

34

(2009)

24 Not tested 240.0%

c. Restaurants 54.0% 51 1

(1998)

28

(2009)

27 Not tested 2,700.0%

d. Public transportation 62.9% 51 16

(1998)

38

(2009)

22 Not tested 137.5%

e. Day care centers 63.3% 51 21

(1998)

40

(2009)

19 Not tested 90.5%

f. Retail stores 52.0% 51 1

(1998)

27

(2009)

26 Not tested 2,600.0%

i. Bars 43.1% 51 0

(1998)

22

(2009)

22 Not tested *

27-14. Jurisdictions with ≤5% illegal tobacco 

buy rate among minors

a. States and D.C. 9.8% 51 0

(1998)

5

(2009)

5 Not tested *

b. Territories 12.5% 8 0

(1998)

1

(2009)

1 Not tested *

27-15. Retail license suspension for sales to 

minors (no. States and D.C.)

7.1% 51 23

(1998)

25

(2009)

2 Not tested 8.7%

27-16. Exposure to tobacco advertising and promotions among students (grades 6–12)

a. Internet 25% 28%

(2000)

37%

(2009)

9 Yes 32.1%

b. Magazines and newspapers 357.1% 67% 74%

(2000)

49%

(2009)

-25 Yes -33.8%

27-17. Student disapproval of smoking 

1+ pack of cigarettes per day

a. 8th graders 46.7% 95% 80%

(1998)

87%

(2009)

7 Yes 8.8%

b. 10th graders 50.0% 95% 75%

(1998)

85%

(2009)

10 Yes 13.3%

c. 12th graders 50.0% 95% 69%

(1998)

82%

(2009)

13 Yes 18.8%

27-19. Preemptive tobacco control laws 

(no. States and D.C.)

3.6% 0 28

(1998)

27

(2009)

-1 Not tested -3.6%

Figure 27-1. Progress Toward Target Attainment for Focus Area 27: Tobacco Use (continued)
27 • TOBACCO USE 27-13

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

27-20a. Sales-weighted average tobacco-specifi c 

nitrosamines in cigarette smoke 

(ng per cigarette)

110.7% 109.4 121.5

(2003–04)

108.1

(2007)

-13.4 Not tested -11.0%

27-20b. Sales-weighted average polyaromatic 

hydrocarbon compounds in cigarette 

smoke (ng per cigarette)

64.6% 894.3 993.7

(2003–04)

929.5

(2007)

-64.2 Not tested -6.5%

27-20c. Sales-weighted average volatile organic 

compounds in cigarette smoke (μg per 

cigarette)

98.4% 636.3 707.0

(2002)

637.4

(2007)

-69.6 Not tested -9.8%

27-21a. Average combined Federal and state 

excise taxes on retail price of a standard 

pack of cigarettes in all 50 States and D.C.

125.5% $2.00 $0.63

(1998)

$2.35

(2009)

$1.72 Not tested 273.0%

27-21b. Increased taxes on smokeless tobacco 

(no. States and D.C.)

72.9% 51 3

(2000)

38

(2009)

35 Not tested 1,166.7%

NOTES

See the Reader’s Guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 27-8a, 27-8b, 27-13g, 27-13h, and 27-18a through c. Objectives 27-1d and 27-8c were 

deleted at the Midcourse Review.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical Appendix for more information.

2 Final value – Baseline value Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical Appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

* Percent change cannot be calculated. See Technical Appendix for more information.

DATA SOURCES

27-1a–c. National Health Interview Survey (NHIS), CDC, NCHS.

27-2a–d. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

27-2e. National Youth Tobacco Survey: American Legacy Foundation; CDC, NCCDPHP. 

27-3a–b. National Survey on Drug Use and Health (NSDUH), SAMHSA.

27-4a–b. National Survey on Drug Use and Health (NSDUH), SAMHSA.

27-5–27-6. National Health Interview Survey (NHIS), CDC, NCHS.

27-7. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

27-9. National Health Interview Survey (NHIS), CDC, NCHS.

27-10. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

27-11. School Health Policies and Programs Study (SHPPS), CDC, NCCDPHP.

27-12. Tobacco Use Supplement to the Current Population Survey (TUS-CPS): Department of Commerce, Census Bureau; Department of Labor 

(DOL), Bureau of Labor Statistics (BLS).

27-13a–f. State Tobacco Activities Tracking and Evaluation System (STATE), CDC, NCCDPHP.

27-13i. State Tobacco Activities Tracking and Evaluation System (STATE), CDC, NCCDPHP.

27-14a–b. State Synar Enforcement Reporting, SAMHSA.

27-15. State Tobacco Activities Tracking and Evaluation System (STATE), CDC, NCCDPHP.

27-16a–b. National Youth Tobacco Survey: American Legacy Foundation; CDC, NCCDPHP.

27-17a–c. Monitoring the Future Study (MTF), NIH, NIDA.

27-19. State Tobacco Activities Tracking and Evaluation System (STATE), CDC, NCCDPHP.

27-20a–c. Offi ce on Smoking and Health, CDC, NCCDPHP; Division of Laboratory Sciences, CDC, NCEH.

27-21a–b. State Tobacco Activities Tracking and Evaluation System (STATE), CDC, NCCDPHP.

Figure 27-1. Progress Toward Target Attainment for Focus Area 27: Tobacco Use (continued)
27-14 HEALTHY PEOPLE 2010 FINAL REVIEW

Race and Ethnicity Sex Education Income Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexPersons with disabilitiesPersons without disabilities

27-1a. Tobacco use by adults—Cigarettes 

(age adjusted, 18+ years) (1998, 2008)1* b B B  B  B   B

b. Tobacco use by adults—Spit tobacco 

(age adjusted, 18+ years) (1998, 2005)2* 

 B b B B

c. Tobacco use by adults—Cigars 

(age adjusted, 18+ years) (1998, 2005)2* b B B

27-2a. Tobacco use in past month by students—

Tobacco products (grades 9–12) 

(1999, 2009)*

B B

b. Tobacco use in past month by students—

Cigarettes (grades 9–12) (1999, 2009)* Bi 





ii B

c. Tobacco use in past month by students—

Spit tobacco (grades 9–12) 

(1999, 2009)*

d. Tobacco use in past month by students—

Cigars (grades 9–12) (1999, 2009)* Bi B B iii

e. Tobacco use in past month by students—

Bidis (grades 9–12) (2000, 2009)*

27-3a. Initiation of cigarette use—Adolescents 

12–17 years (percent at risk) 

(2002, 2008)3

*

b b b b B B b Bi

b. Initiation of cigarette use—Young adults 

18–25 years (percent at risk) 

(2002, 2008)3

*

B

27-4a. Average age at first tobacco use— 

Adolescents 12–17 years (2002, 2008)3* b Bi B B B

b. Average age at first tobacco use— 

Young adults 18–25 years (2002, 2008)3* b Bi B Bi

27-5. Smoking cessation attempts by adults 

(age adjusted, 18+ years) (1998, 2008)1* b b B B B Bi B

27-6. Smoking cessation in first trimester and for 

remainder of pregnancy (females, 

18–49 years) (1998, 2005)4*

27-7. Smoking cessation attempts by students 

(grades 9–12) (2001, 2009)* Bi B B

27-9. Exposure to tobacco smoke at home 

among children (≤6 years) 

(1994, 2005)4*

b B B









 B 

Figure 27-2. Health Disparities Table for Focus Area 27: Tobacco Use

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.
27 • TOBACCO USE 27-15

Race and Ethnicity Sex Education Income Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexPersons with disabilitiesPersons without disabilities

27-10. Exposure to environmental tobacco smoke 

among nonsmokers (age adjusted, 

4+ years) (1988–94, 2005–08)*

Biv 

  B   B 

27-12. Indoor worksite policies that prohibit 

smoking (1998–99, 2006–07)5* B  ii B    B  B

27-16a. Exposure to tobacco advertising and 

promotions among students—Internet 

(grades 6–12) (2000, 2009)*

Bi B

b. Exposure to tobacco advertising and promotions among students—Magazines and 

newspapers (grades 6–12) (2000, 2009)*

Bi  B

27-17a. Student disapproval of smoking 1+ pack 

of cigarettes per day—8th graders (1998, 

2009)6‡

B B

b. Student disapproval of smoking 1+ pack of 

cigarettes per day—10th graders (1998, 

2009)6‡

B Bi B

c. Student disapproval of smoking 1+ pack of 

cigarettes per day—12th graders (1998, 

2009)6‡

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 

27-8a and b, 27-11, 27-13a through i, 27-14a and b, 27-15, 27-18a through c, 27-19, 27-20a through c, and 27-21a and b. Objectives 27-1d and 27-8c were deleted at 

Midcourse Review.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

Figure 27-2. Health Disparities Table for Focus Area 27: Tobacco Use (continued)
27-16 HEALTHY PEOPLE 2010 FINAL REVIEW

LEGEND

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

‡ Measures of variability were available only for the most recent data. Thus, the variability of best group rates was assessed only for the most recent data, and 

statistical significance was tested only for the most recent data. Disparities of 10% or more are displayed when the differences from the best group rate are 

statistically significant at the 0.05 level. Changes in disparities over time are displayed according to their magnitude, since measures of variability were not available 

at baseline and therefore statistical significance of changes in disparity could not be tested. See Technical Appendix. 1 Baseline data by race and ethnicity are for 1999.

2 Baseline data by race and ethnicity are for 2000.

3 Baseline data by income group are for 2005.

4 Baseline data by race and ethnicity are for 2005.

5 Baseline data by race and ethnicity are for 2003.

6 Baseline data by race and ethnicity are for 2004–05, while most recent data by race and ethnicity are for 2008–09.

i

 The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. 

See Technical Appendix.

ii Change in the summary index cannot be assessed. See Technical Appendix. iiiReliability criterion for best group rate not met, or data available for only one group, at baseline. Change in disparity cannot be assessed. See Technical Appendix. ivData are for Mexican American.

DATA SOURCES

27-1a–c. National Health Interview Survey (NHIS), CDC, NCHS.

27-2a–d. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

27-2e. National Youth Tobacco Survey: American Legacy Foundation; CDC, NCCDPHP.

27-3a–b. National Survey on Drug Use and Health (NSDUH), SAMHSA.

27-4a–b. National Survey on Drug Use and Health (NSDUH), SAMHSA.

27-5–27-6. National Health Interview Survey (NHIS), CDC, NCHS.

27-7. Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

27-9. National Health Interview Survey (NHIS), CDC, NCHS.

27-10. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

27-12. Tobacco Use Supplement to the Current Population Survey (TUS-CPS): Department of Commerce, Census Bureau; Department of Labor 

(DOL), Bureau of Labor Statistics (BLS).

27-16a–b. National Youth Tobacco Survey: American Legacy Foundation; CDC, NCCDPHP.

27-17a–c. Monitoring the Future Study (MTF), NIH, NIDA.

Figure 27-2. Health Disparities Table for Focus Area 27: Tobacco Use (continued)
27 • TOBACCO USE 27-17 Figure 27-3. Tobacco Use by Adults—Cigarettes (Aged 18+), 2008 Healthy People 2010 objective 27-1a • Target = 12 percent NOTES: Data are age adjusted to the 2000 standard population. Data are for persons who have had at least 100 cigarettes in their lifetime and currently report smoking eve

by a modified Jenks classification for U.S. states. National data for the objective come from the National Health Interview Survey (NHIS) and are the basis for setting the targbe comparable with national data from NHIS. The U.S. rate in 2008 from NHIS was 20.6%. The rate for all states combined from BRFSS in 2008 was 18.5%. BRFSS data displaelsewhere that are not age adjusted.SOURCE: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP. 

Lowest cstate that 

Percent

Lead Agency

National Institutes of Health

Contents

Goal ................................................................................................28-3

Highlights ......................................................................................28-3

Summary of Progress.....................................................................28-4

Transition to Healthy People 2020................................................28-5

Data Considerations.......................................................................28-6

Notes..............................................................................................28-6

Comprehensive Summary of Objectives........................................28-7

Progress Chart................................................................................28-9

Health Disparities Table...............................................................28-11

Vision and

Hearing

CHAPTER 28

28 • Vision and Hearing 28-3

This chapter includes objectives that monitor progress 

in two major Healthy People areas:

〉 Vision. The objectives in this area track visual 

impairments, occupational eye injuries, eye 

examinations, visual rehabilitation services, and the 

use of protective equipment.

〉 Hearing. This area includes objectives that monitor 

hearing loss, newborn screening for hearing problems, 

the use of hearing aids, and hearing examinations.

All Healthy People tracking data quoted in this chapter, 

along with technical information and Operational 

Definitions for each objective, can be found in the 

Healthy People 2010 database, DATA2010, available from 

http://wonder.cdc.gov/data2010/.

More information about this Focus Area can be found in 

the following publications:

〉 Healthy People 2010: Understanding and Improving 

Health, available from http://www.healthypeople.

gov/2010/Document/tableofcontents.htm#under.

〉 Healthy People 2010 Midcourse Review, available from 

http://www.healthypeople.gov/2010/data/midcourse/

html/default.htm#FocusAreas.

Highlights

〉 Substantial progress was made in the Vision and 

Hearing Focus Area objectives during the past decade 

(Figure 28-1) [1]. Two thirds of the Vision objectives 

and over one half of the Hearing objectives with 

data available to measure progress moved toward or 

achieved their Healthy People 2010 targets. Health 

disparities were observed for some objectives among 

select population groups (Figure 28-2), as highlighted 

below [2].

〉 Several Vision objectives exceeded their Healthy 

People 2010 targets:

 Visual impairment due to diabetic retinopathy 

among adults aged 18 and over with diabetes 

(objective 28-5) declined, decreasing 40.0% 

between 2002 and 2008, from 45.8 to 27.5 per 

1,000 population (age adjusted), exceeding the 

2010 target of 40.9.

 Occupational eye injuries declined. A decrease of 

39.6% was observed for injuries resulting in lost 

work days (objective 28-8a) between 2002 and 

2008, from 4.8 to 2.9 per 10,000 full time workers 

in private industry, exceeding the 2010 target of 

3.4. The rate of eye injuries treated in emergency 

departments (objective 28-8b) also decreased 

38.6% between 1999 and 2008, from 21.0 to 12.9 

per 10,000 full-time workers, exceeding the 

target of 14.7.

 Females had a lower (better) rate of occupational eye injuries resulting in lost work days, 

1.3 per 10,000 full time workers in private 

industry in 2008. The rate for males, 4.0 per 

10,000 full-time workers in private industry, 

was more than three times the rate for 

females [2].

 Adult use of protective eyewear at home (objective 

28-9b) increased 21.2% between 2002 and 2008, 

from 33% to 40% (age adjusted), exceeding the 

Healthy People 2010 target of 37%.

 The use of vision rehabilitation services by 

visually impaired persons (objective 28-10a) more 

than doubled during the same period, increasing 

from 14.0 to 30.1 per 1,000 visually impaired 

adults aged 18 and over (age adjusted), exceeding 

the 2010 target of 15.5.

〉 A statistically significant disparity was observed in 

blindness and visual impairment among children 

and adolescents (objective 28-4). Persons without 

disabilities had lower (better) rates of blindness and 

visual impairment in both 1997 and 2008, 19 and 

GOAL:

Improve the visual and hearing health of the 

Nation through prevention, early detection, 

treatment, and rehabilitation.
28-4 HEALTHY PEOPLE 2010 FINAL REVIEW

24 per 1,000 population aged 17 years and under, 

respectively. The rates for persons with disabilities, 

were 92 per 1,000 population in 1997 and 68 in 2008. 

In 2008, the rate for children and adolescents with 

disabilities was almost three times the rate for those 

without disabilities. The disparity between children 

and adolescents without disabilities and those with 

disabilities declined by more than 100 percentage 

points between 1997 and 2008 [2,3].

〉 Several Hearing objectives, including the following, 

exceeded the 2010 targets:

 Otitis media in children and adolescents (objective 

28-12) declined by almost 30% between 1997 and 

2007, from 344.7 to 246.6 per 1,000 population 

aged under 18 years, exceeding the target of 294.

 The use of cochlear implants by deaf or very hard 

of hearing persons (objective 28-13b) increased 

between 2001 and 2006, from 57 to 92 per 10,000 

population, exceeding the target of 63.

 The use of hearing aids by adults with hearing 

loss (objectives 28-13c) also increased between 

2001 and 2007, from 255.2 to 289.1 per 1,000 

population aged 70 and over, exceeding the 

target of 280.7.

Summary of Progress

〉 Figure 28-1 presents a quantitative assessment of 

progress in achieving the Healthy People 2010 

objectives for Vision and Hearing. Data to measure 

progress toward target attainment were available for 

25 objectives [1]. Of these:

 Nine objectives (28-5, 28-8a and b, 28-9b, 28-10a, 

28-12, 28-13b and c, and 28-14b) met or exceeded 

their Healthy People 2010 targets.

 Six objectives moved toward their targets. A 

statistically significant difference between the 

baseline and the final data points was observed 

for one of these objectives (28-2). No significant 

differences were observed for three objectives 

(28-7, 28-9b, and 28-17); and data to test the 

significance of the difference were unavailable 

for two objectives (28-11a and b).

 One objective (28-1) showed no change.

 Nine objectives moved away from their targets. 

A statistically significant difference between the 

baseline and the final data points was observed 

for two of these objectives (28-3 and 28-10b). 

No significant differences were observed for six 

objectives (28-4, 28-6, 28-13a, 28-14a, 28-16a, 

and 28-18); and data to test the significance of 

the difference were unavailable for one objective 

(28-11c).

〉 Four objectives (28-13d, 28-14c, 28-15, and 28-16b) had 

no follow-up data available to measure progress.

〉 Figure 28-2 displays health disparities in Vision 

and Hearing from the best group rate for each 

characteristic at the most recent data point [2]. It 

also displays changes in disparities from baseline to 

the most recent data point [3].

 Of the 10 objectives with statistically significant 

racial and ethnic health disparities of 10% or 

more, the non-Hispanic white population had 

the best rate for 5 objectives (28-3, 28-9b, 28-

13c, 28-15, and 28-16b); the non-Hispanic black 

population had the best rate for 2 objectives 

(28-14a and b), as did the population of persons 

of two or more races (28-1 and 28-2); and the 

Hispanic or Latino population had the best rate 

for 1 objective (28-16a).

 For seven objectives, statistically significant 

health disparities of 10% or more were observed 

between females and males (objectives 28-1, 

28-7, 28-9b, 28-13c, 28-14a, and 28-16a and b). 

In addition, one objective exhibited a health 

disparity of 100% or more (see Highlights, above), 

but lacked data to assess statistical significance 

(objective 28-8a). Males had better rates than 

females for six of these eight objectives (28-7, 28-

9b, 28-13c, 28-14a, and 28-16a and b). Females had 

better rates for two objectives (28-1 and 28-8a).

 Persons with at least some college education had 

the best group rate for three of the four objectives 

with statistically significant health disparities of 

10% or more by education level (28-1, and 28-13a 

and c). High school graduates had the best group 

rate for one objective (28-7).

 Persons with middle/high incomes had the best 

group rate for three of the four objectives with 

statistically significant health disparities of 10% 

or more by income (objectives 28-3, 28-13-d, and 

28-16a). Near-poor persons had the best group 

rate for the fourth objective (28-9a).

 Persons with disabilities had better rates than 

persons without disabilities for two of the three 

objectives with statistically significant health 

disparities of 10% or more by disability status 

(objectives 28-14b and 28-15). Persons without 

disabilities had the better rate for one objective 

(28-4).

 Health disparities of 100% or more were 

observed for two objectives: blindness and 

visual impairment in children and adolescents 

(objective 28-4), and occupational eye injuries 

resulting in lost work days (objective 28-8a). 

A statistically significant decline in disparity 

also was observed for blindness and visual 

impairment in children and adolescents; see 

Highlights, above.
28 • Vision and Hearing 28-5

Transition to Healthy People 

2020

To emphasize the individual importance of Vision and 

Hearing, the Healthy People 2010 Vision and Hearing 

Focus Area was divided into two separate Topic Areas for 

Healthy People 2020: 1) Vision, and 2) Hearing and Other 

Sensory or Communication Disorders. Other sensory 

or communication disorders include disorders of the 

ear, nose, throat, and conditions associated with voice, 

speech, and language (ENT-VSL). See HealthyPeople.

gov for a complete list of Healthy People 2020 topics and 

objectives.

The Healthy People 2020 Vision Topic Area covers:

〉 Eye examinations among adults and vision screening 

among children

〉 Visual impairment due to selected eye diseases

〉 Occupational eye injuries

〉 Use of protective eyewear at home and during 

recreational activities

〉 Use of vision rehabilitation services and visual 

adaptive devices

〉 Comprehensive vision health service provided in 

Federally Qualified Health Centers (FQHCs).

The Healthy People 2020 Hearing and Other Sensory 

or Communication Disorders Topic Area includes new 

objectives in addition to the Healthy People 2010 hearing 

objectives. The Topic Area objectives can be grouped 

into several sections:

〉 Newborn hearing screening

〉 Ear infections (otitis media)

〉 Hearing

〉 Tinnitus

〉 Balance and dizziness

〉 Smell and taste (chemosenses)

〉 Voice, speech, and language

〉 Internet health care resources for ENT-VSL.

The differences between the objectives for Healthy 

People 2010 and Healthy People 2020 are summarized 

below:

〉 The Healthy People 2010 Vision and Hearing Focus 

Area had a total of 29 objectives, including 13 vision 

and 16 hearing objectives. For Healthy People 2020, 

the Vision Topic Area has 15 objectives and the 

Hearing and Other Sensory or Communication 

Disorders Topic Area has 36 objectives.

Vision

〉 Ten Healthy People 2010 Vision objectives (28-1 

through 28-4, 28-8a and b, 28-9a and b, and 28-10a 

and b) were retained “as is” [4].

〉 Three Vision objectives (28-5, 28-6, and 28-7) on 

reduction of visual impairment caused by age-related 

eye diseases were modified because of changes in 

survey methodology [5].

〉 Two new Vision objectives were added to the Healthy 

People 2020 Topic Area:

 The first addresses visual impairment due to 

age-related macular degeneration.

 The second measures the proportion of FQHCs 

that provide comprehensive vision health services.

Hearing and Other Sensory or 

Communication Disorders

〉 All sixteen Healthy People 2010 Hearing objectives 

(28-11a through 28-18) were retained “as is” [4].

〉 Twenty new objectives were added to this Healthy 

People 2020 Topic Area:

 Three tinnitus objectives focus on adults 

bothered by tinnitus who have seen a health 

provider, audiologist or otolaryngologist, and 

tried appropriate treatment.

 Twelve new objectives on balance, dizziness, and 

smell or taste disorders will track use of health 

care services, referrals to health care specialists, 

treatment, negative or adverse outcomes, falls 

and injuries caused by balance and dizziness 

conditions, and impact of these conditions on 

general health status and quality of life.

 Four voice, speech, and language objectives were 

introduced to Healthy People 2020 to highlight 

the importance of timely evaluation, treatment, 

and use of rehabilitation services in improving 

the quality of life of patients with VSL conditions.

 One new objective on the use of Internet health 

care resources for ENT-VSL disorders was added 

to measure the number of people who used the 

Internet for health care information, guidance, 

or advice.

Appendix D, “A Crosswalk Between Objectives From 

Healthy People 2010 to Healthy People 2020,” summarizes the changes between the two decades of objectives, 

reflecting new knowledge and direction for this area.
28-6 HEALTHY PEOPLE 2010 FINAL REVIEW

Data Considerations

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues, referenced below.

In general, data on educational attainment are presented 

for persons aged 25 and over, consistent with guidance 

given by the Census Bureau. However, because of the 

requirements of the different data systems, the age 

groups used to calculate educational attainment for 

any specific objective may differ from the age groups 

used to report the data for other Healthy People 2010 

objectives, as well as from select populations within 

the same objective. Therefore, the reader is urged to 

exercise caution in interpreting the data by educational 

attainment shown in the Health Disparities Table. See 

Healthy People 2010: General Data Issues, referenced 

below.

Additional information on data issues is available from 

the following sources:

〉 All Healthy People 2010 tracking data can be found 

in the Healthy People 2010 database, DATA2010, 

available from http://wonder.cdc.gov/data2010/.

〉 Detailed information about the data and data 

sources used to support these objectives can be 

found in the Operational Definitions on the DATA

2010 website, available from http://wonder.cdc.gov/

data2010/focusod.htm.

〉 More information on statistical issues related to 

Healthy People tracking and measurement can 

be found in the Technical Appendix and in Healthy 

People 2010: General Data Issues, which is available in 

the General Data Issues section of the NCHS Healthy 

People website under Healthy People 2010; see http://

www.cdc.gov/nchs/healthy_people/hp2010/hp2010_

data_issues.htm.

Notes

1. Displayed in the Progress Chart (Figure 28-1), the 

percent of targeted change achieved expresses the 

difference between the baseline and the final value 

relative to the initial difference between the baseline 

and the Healthy People 2010 target. As such, it is a 

relative measure of progress toward attaining the 

Healthy People 2010 target. See the Reader’s Guide

for more information. When standard errors were 

available, the difference between the baseline and the 

final value was tested at the 0.05 level of significance. 

See the Figure 28-1 footnotes, as well as the Technical 

Appendix, for more detail.

2. Information about disparities among select 

populations is shown in the Health Disparities Table 

(Figure 28-2). Disparity from the best group rate is 

defined as the percent difference between the best 

group rate and each of the other group rates for a 

characteristic. For example, racial and ethnic health 

disparities are measured as the percent difference 

between the best racial and ethnic group rate and 

each of the other racial and ethnic group rates. 

Similarly, disparities by sex are measured as the 

percent difference between the better group rate (e.g., 

female) and the rate for the other group (e.g., male). 

Some objectives are expressed in terms of favorable 

events or conditions that are to be increased, while 

others are expressed in terms of adverse events 

or conditions that are to be reduced. To facilitate 

comparison of health disparities across different 

objectives, disparity is measured only in terms of 

adverse events or conditions. For comparability 

across objectives, objectives that are expressed 

in terms of favorable events or conditions are reexpressed using the adverse event or condition for 

the purpose of computing disparity, but they are not 

otherwise restated or changed. For example, objective 

1-1, to increase the proportion of persons with health 

insurance (e.g., 72% of the American Indian or Alaska 

Native population under age 65 had some form of 

health insurance in 2008), is expressed in terms of the 

percentage of persons without health insurance (e.g., 

100% – 72% = 28% of the American Indian or Alaska 

Native population under age 65 did not have any form 

of health insurance in 2008) when the disparity from 

the best group rate is calculated. See the Reader’s 

Guide for more information. When standard errors 

were available, the difference between the best group 

rate and each of the other group rates was tested 

at the 0.05 level of significance. See the Figure 28-2 

footnotes, as well as the Technical Appendix, for more 

detail.

3. The change in disparity is estimated by subtracting 

the disparity at baseline from the disparity at the 
28 • Vision and Hearing 28-7

most recent data point and, therefore, is expressed 

in percentage points. See the Reader’s Guide for more 

information. When standard errors were available, 

the change in disparity was tested at the 0.05 level of 

significance. See the Figure 28-2 footnotes, as well as 

the Technical Appendix, for more detail.

4. As of the Healthy People 2020 launch, Healthy People 

2020 objectives that were retained “as is” from 

Healthy People 2010 had no change in the numerator 

or denominator definitions, the data source(s), or 

the data collection methodology. These include 

objectives that were developmental in Healthy People 

2010 and are developmental in Healthy People 2020, 

and for which no numerator information is available.

5. As of the Healthy People 2020 launch, objectives 

that were modified from Healthy People 2010 had 

some change in the numerator or denominator 

definitions, the data source(s), or the data collection 

methodology. These include objectives that went 

from developmental in Healthy People 2010 to 

measurable in Healthy People 2020, or vice versa.

Comprehensive Summary of Objectives: Vision and Hearing

Objective Description Data Source

28-1 Dilated eye examination within the past 2 years (age adjusted, 

18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

28-2 Vision screening for children (<6 years) National Health Interview Survey (NHIS), CDC, NCHS.

28-3 Uncorrected visual impairment due to refractive errors 

(age adjusted, per 1,000 population, 12+ years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

28-4 Blindness and visual impairment in children and adolescents 

(per 1,000 population, ≤17 years)

National Health Interview Survey (NHIS), CDC, NCHS. 

28-5 Visual impairment due to diabetic retinopathy (age adjusted, 

per 1,000 population, 18+ years with diabetes)

National Health Interview Survey (NHIS), CDC, NCHS.

28-6 Visual impairment due to glaucoma (age adjusted, per 1,000 

population, 45+ years) 

National Health Interview Survey (NHIS), CDC, NCHS.

28-7 Visual impairment due to cataract (age adjusted, per 1,000 

population, 65+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

28-8a Occupational eye injuries resulting in lost work days (per 

10,000 full-time workers in private industry)

Survey of Occupational Injuries and Illnesses (SOII), Department of 

Labor (DOL), Bureau of Labor Statistics (BLS).

28-8b Occupational eye injuries treated in emergency departments 

(per 10,000 full-time workers)

National Electronic Injury Surveillance System (NEISS), Consumer 

Product Safety Commission (CPSC) and CDC, NIOSH.

28-9a Use of protective eyewear at home—Children and 

adolescents 6–17 years

National Health Interview Survey (NHIS), CDC, NCHS.

28-9b Use of protective eyewear at home—Adults 18+ years (age 

adjusted)

National Health Interview Survey (NHIS), CDC, NCHS.

28-10a Use of vision rehabilitation services by visually impaired 

persons (age adjusted, per 1,000 population, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

28-10b Use of visual adaptive devices by visually impaired persons 

(age adjusted, 18+ years)

National Health Interview Survey (NHIS), CDC, NCHS.

28-11a Newborns receiving hearing screening before age 1 month Baseline data: Directors of Speech and Hearing Programs in State 

Health and Welfare Agencies. 

Final data: Early Hearing Detection and Intervention (EHDI) 

Program, CDC, NCBDD; and/or specific State data.
28-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Objective Description Data Source

28-11b Infants with possible hearing loss receiving hearing evaluation 

before age 3 months

Baseline data: Directors of Speech and Hearing Programs in State 

Health and Welfare Agencies.

Final data: Early Hearing Detection and Intervention (EHDI) 

Program, CDC, NCBDD; and/or specific State data.

28-11c Infants with hearing loss receiving intervention services before 

age 6 months

Baseline data: Directors of Speech and Hearing Programs in State 

Health and Welfare Agencies.

Final data: Early Hearing Detection and Intervention (EHDI) 

Program, CDC, NCBDD; and/or specific State data.

28-12 Otitis media in children and adolescents (per 1,000 

population, <18 years) 

National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS; 

National Hospital Ambulatory Medical Care Survey (NHAMCS), 

CDC, NCHS.

28-13a Use of hearing aids by adults with hearing loss (per 1,000 

population, 20–69 years)

National Health Interview Survey (NHIS), CDC, NCHS; National 

Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

28-13b New cochlear implants by deaf or very hard of hearing 

persons (per 10,000 population)

Healthcare Cost and Utilization Project (HCUP), AHRQ; National 

Health Interview Survey (NHIS), CDC, NCHS.

28-13c Use of hearing aids by older adults with hearing loss (per 

1,000 population, 70+ years)

National Health Interview Survey (NHIS), CDC, NCHS; National 

Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

28-13d Use of assistive listening devices by older adults with hearing 

loss (per 1,000 population, 70+ years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

28-14a Hearing examination in past 5 years—Adults 20–69 years 

(age adjusted)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

28-14b Hearing examination in past 5 years—Older adults 70+ years National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

28-14c Hearing examination in past 5 years—Adolescents 12–19 

years

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

28-15 Primary care provider referrals for hearing evaluation and 

treatment

National Health Interview Survey (NHIS), CDC, NCHS.

28-16a Use of ear protection devices when exposed to loud noises 

(age adjusted, per 1,000 population, 20–69 years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

28-16b Use of ear protection devices among adolescents when 

exposed 

to loud noises (per 1,000 population, 12–19 years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

28-17 Audiometric notches (both ears) signifying noise-induced 

hearing loss among adolescents (per 1,000 population, 12–19 

years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

28-18 Audiometric notches (both ears) signifying noise-induced 

hearing loss (age adjusted, per 1,000 population, 20–69 

years)

National Health and Nutrition Examination Survey (NHANES), CDC, 

NCHS.

Comprehensive Summary of Objectives: Vision and Hearing (continued)
28 • Vision and Hearing 28-9

Figure 28-1. Progress Toward Target attainment for Focus area 28: Vision and Hearing

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

28-1. Dilated eye examination within the past 

2 years (age adjusted, 18+ years)

 0.0% 58% 55%

(2002)

55%

(2008)

0 No 0.0%

28-2. Vision screening for children (<6 years) 25.0% 52% 36%

(2002)

40%

(2008)

4 Yes 11.1%

28-3. Uncorrected visual impairment due to 

refractive errors (age adjusted, per 1,000 

population, 12+ years)

101.1 118.0

(1999–2002)

136.1

(2005–08)

18.1 Yes 15.3%

28-4. Blindness and visual impairment in 

children and adolescents (per 1,000 

population, ≤17 years)

18 24

(1997)

28

(2008)

4 No 16.7%

28-5. Visual impairment due to diabetic 

retinopathy (age adjusted, per 1,000 

population, 18+ years with diabetes)

373.5% 40.9 45.8

(2002)

27.5

(2008)

-18.3 Yes -40.0%

28-6. Visual impairment due to glaucoma 

(age adjusted, per 1,000 population, 

45+ years)

10.7 13.5

(2002)

14.3

(2008)

0.8 No 5.9%

28-7. Visual impairment due to cataract (age 

adjusted, per 1,000 population, 65+ years)

1.8% 91.4 119.3

(2002)

118.8

(2008)

-0.5 No -0.4%

28-8a. Occupational eye injuries resulting in lost 

work days (per 10,000 full-time workers 

in private industry)

135.7% 3.4 4.8

(2002)

2.9

(2008)

-1.9 Not tested -39.6%

28-8b. Occupational eye injuries treated in 

emergency departments (per 10,000 

full-time workers)

128.6% 14.7 21.0

(1999)

12.9

(2008)

-8.1 Yes -38.6%

28-9. Use of protective eyewear at home

a. Children and adolescents 6–17 years 40.0% 20% 15%

(2002)

17%

(2008)

2 No 13.3%

b. Adults 18+ years (age adjusted) 175.0% 37% 33%

(2002)

40%

(2008)

7 Yes 21.2%

28-10a. Use of vision rehabilitation services by 

visually impaired persons (age adjusted, 

per 1,000 population, 18+ years)

1,073.3% 15.5 14.0

(2002)

30.1

(2008)

16.1 Yes 115.0%

28-10b. Use of visual adaptive devices by 

visually impaired persons (age adjusted, 

18+ years)

26% 22%

(2002)

11%

(2008)

-11 Yes -50.0%

28-11a. Newborns receiving hearing screening 

before age 1 month

66.7% 90% 66%

(2001)

82%

(2007)

16 Not tested 24.2%

28-11b. Infants with possible hearing loss receiving 

hearing evaluation before age 3 months

71.4% 70% 56%

(2001)

66%

(2007)

10 Not tested 17.9%

28-11c. Infants with hearing loss receiving 

intervention services before age 6 months

85% 57%

(2001)

50%

(2007)

-7 Not tested -12.3%

28-12. Otitis media in children and adolescents 

(per 1,000 population, <18 years)

193.5% 294.0 344.7

(1997)

246.6

(2007)

-98.1 Yes -28.5%

Legend Moved away from target1 Moved toward target Met or exceeded target
28-10 HEALTHY PEOPLE 2010 FINAL REVIEW

Percent of targeted 

change achieved2 Baseline vs. Final

Objective

2010 

Target

Baseline 

(Year)

Final

(Year)

Difference3Statistically 

Signifi cant4

Percent 

Change5 0 25 50 75 100

28-13a. Use of hearing aids by adults with hearing 

loss (per 1,000 population, 20–69 years)

182.5 165.9

(2001)

162.7

(2006)

-3.2 No -1.9%

28-13b. New cochlear implants by deaf or 

very hard of hearing persons 

(per 10,000 population)

583.3% 63 57

(2001)

92

(2006)

35 Yes 61.4%

28-13c. Use of hearing aids by older adults with 

hearing loss (per 1,000 population, 

70+ years)

132.9% 280.7 255.2

(2001)

289.1

(2007)

33.9 No 13.3%

28-14. Hearing examination in past 5 years

a. Adults 20–69 years (age adjusted) 35% 30%

(1999–2002)

29%

(2003–04)

-1 No -3.3%

b. Older adults 70+ years 100.0% 41% 38%

(1999–2002)

41%

(2003–06)

3 No 7.9%

28-16a. Use of ear protection devices when

exposed to loud noises (age adjusted,

per 1,000 population, 20–69 years)

514.5 489.8

(1999–2002)

483.0

(2003–04)

-6.8 No -1.4%

28-17. Audiometric notches (both ears) 

signifying noise-induced hearing loss 

among adolescents (per 1,000 

population, 12–19 years) 

4.3% 34.7 46.4

(1988–94)

45.9

(2005–06)

-0.5 No -1.1%

28-18. Audiometric notches (both ears) signifying 

noise-induced hearing loss (age adjusted, 

per 1,000 population, 20–69 years)

88.1 119.0

(1999–2002)

121.4

(2003–04)

2.4 No 2.0%

NOTES

See the reader’s guide for more information on how to read this fi gure. See DATA2010 at http://wonder.cdc.gov/data2010 for all HealthyPeople 2010 

tracking data. Tracking data are not available for objectives 28-13d, 28-14c, 28-15, and 28-16b.

FOOTNOTES

1

 Movement away from target is not quantifi ed using the percent of targeted change achieved. See Technical appendix for more information.

2

 Percent of targeted change achieved = × 100.

Healthy People 2010 target – Baseline value

Final value – Baseline value

3

 Diff erence = Final value – Baseline value. Diff erences between percents (%) are measured in percentage points.

4

 When estimates of variability are available, the statistical signifi cance of the diff erence between the fi nal value and the baseline value is assessed at 

the 0.05 level. See Technical appendix for more information.

5 Final value – Baseline value Percent change = × 100.

Baseline value

DATA SOURCES

28-1–28-2. National Health Interview Survey (NHIS), CDC, NCHS.

28-3. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

28-4–28-7. National Health Interview Survey, (NHIS), CDC, NCHS.

28-8a. Survey of Occupational Injuries and Illnesses (SOII), Department of Labor (DOL), Bureau of Labor Statistics (BLS).

28-8b. National Electronic Injury Surveillance System (NEISS), Consumer Product Safety Commission (CPSC) and CDC, NIOSH.

28-9a–b. National Health Interview Survey (NHIS), CDC, NCHS.

28-10a–b. National Health Interview Survey (NHIS), CDC, NCHS.

28-11a–c. Baseline data: Directors of Speech and Hearing Programs in State Health and Welfare Agencies. 

Final data: Early Hearing Detection and Intervention (EHDI) Program, CDC, NCBDD; and/or specifi c State data.

28-12. National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS; National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

28-13a. National Health Interview Survey (NHIS), CDC, NCHS; National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

28-13b. Healthcare Cost and Utilization Project (HCUP), AHRQ; National Health Interview Survey (NHIS), CDC, NCHS.

28-13c. National Health Interview Survey (NHIS), CDC, NCHS; National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

28-14a–b. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

28-16a. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

28-17–28-18. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

Figure 28-1. Progress Toward Target attainment for Focus area 28: Vision and Hearing (continued)
28 • Vision and Hearing 28-11

Race and Ethnicity Sex Education Income Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexPersons with disabilitiesPersons without disabilities

28-1. Dilated eye examination within the past 2 years 

(age adjusted, 18+ years) (2002, 2008)* Bi  B B

28-2. Vision screening for children (<6 years) 

(2002, 2008)* B Bi B Bi

28-3. Uncorrected visual impairment due to refractive 

errors (age adjusted, per 1,000 population, 

12+ years) (1999–2002, 2005–08)*

ii B B  B

28-4. Blindness and visual impairment in children and 

adolescents (per 1,000 population, ≤17 years) 

(1997, 2008)1*







B

28-5. Visual impairment due to diabetic retinopathy (age 

adjusted, per 1,000 population, 18+ years with 

diabetes) (2002, 2008)*

28-6. Visual impairment due to glaucoma 

(age adjusted, per 1,000 population, 45+ years) 

(2002, 2008)*

28-7. Visual impairment due to cataract (age adjusted, 

per 1,000 population, 65+ years) 

(2002, 2008)*

b b B B B

28-8a. Occupational eye injuries resulting in lost work days 

(per 10,000 full-time workers in private industry) 

(2002, 2008)2†

B 

28-8b. Occupational eye injuries treated in emergency 

departments (per 10,000 full-time workers) 

(1999, 2008)*

28-9a. Use of protective eyewear at home— 

Children and adolescents 6–17 years 

(2002, 2008)*

Bi iii B Bi

b. Use of protective eyewear at home— 

Adults 18+ years (age adjusted) (2002, 2008)* Bi B B

28-10a. Use of vision rehabilitation services by visually 

impaired persons (age adjusted, per 1,000 

population, 18+ years) (2002, 2008)*

B iv B Bi

28-10b. Use of visual adaptive devices by visually 

impaired persons (age adjusted, 18+ years) 

(2002, 2008)*

B Bi iii Bi B

28-12. Otitis media in children and adolescents (per 1,000 

population, <18 years) (1997, 2007)* i

28-13a. Use of hearing aids by adults with hearing loss 

(per 1,000 population, 20–69 years) 

(2001, 2006)*

i Bi v Bv

28-13b. New cochlear implants by deaf or very hard of 

hearing persons (per 10,000 population) 

(2001, 2006)*

B

Figure 28-2. Health Disparities Table for Focus Area 28: Vision and Hearing

Disparities from the best group rate for each characteristic at the most recent data point and changes in disparity from the baseline 

to the most recent data point.
28-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Race and Ethnicity Sex Education Income Disability

Population-based objective American Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderTwo or more racesHispanic or LatinoBlack, not HispanicWhite, not HispanicSummary indexFemaleMaleLess than high schoolHigh school graduateAt least some collegeSummary indexPoorNear poorMiddle/high incomeSummary indexPersons with disabilitiesPersons without disabilities

28-13c. Use of hearing aids by older adults with hearing 

loss (per 1,000 population, 70+ years) 

(2001, 2007)*

B B Bi Bv v

28-13d. Use of assistive listening devices by older adults 

with hearing loss (per 1,000 population, 

70+ years) (2005–06)*

ii B B B B

28-14a. Hearing examination in past 5 years— 

Adults 20–69 years (age adjusted) 

(1999–2002, 2003–04)*

ii B B B B

b. Hearing examination in past 5 years— 

Older adults 70+ years (1999–2002, 2003–06)* ii Bi  B   B  B

c. Hearing examination in past 5 years— 

Adolescents 12–19 years (2005–06)* ii

28-15. Primary care provider referrals for hearing 

evaluation and treatment (2007)* B B B B B

28-16a. Use of ear protection devices when exposed to 

loud noises [age adjusted, per 1,000 population 

(pop.), 20–69 years] (1999–2002, 2003–04)*

Bi,ii B  B

28-16b. Use of ear protection devices among adolescents 

when exposed to loud noises (per 1,000 pop., 

12–19 years) (2005–06)*

ii B B B

28-17. Audiometric notches (both ears) signifying noise-induced hearing loss among adolescents (per 1,000 

pop., 12–19 years) (1988–94, 2005–06)*

ii

28-18. Audiometric notches (both ears) signifying noiseinduced hearing loss (age adjusted, per 1,000 

pop., 20–69 years) (1999–2002, 2003–04)*

ii

NOTES

See DATA2010 at http://wonder.cdc.gov/data2010 for all Healthy People 2010 tracking data. Disparity data are either unavailable or not applicable for objectives 28-

11a through c.

Years in parentheses represent the baseline and most recent data years (if available).

Disparity from the best group rate is defined as the percent difference between the best group rate and each of the other group rates for a characteristic (e.g., race 

and ethnicity). The summary index is the average of these percent differences for a characteristic. Change in disparity is estimated by subtracting the disparity 

at baseline from the disparity at the most recent data point. Change in the summary index is estimated by subtracting the summary index at baseline from the 

summary index at the most recent data point. See Technical Appendix for more information.

Figure 28-2. Health Disparities Table for Focus Area 28: Vision and Hearing (continued)
28 • Vision and Hearing 28-13

Legend

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

FOOTNOTES

* Measures of variability were available. Thus, the variability of best group rates was assessed, and statistical significance was tested. Disparities of 10% or more are 

displayed when the differences from the best group rate are statistically significant at the 0.05 level. Changes in disparities over time are indicated by arrows when 

the changes are greater than or equal to 10 percentage points and are statistically significant at the 0.05 level. See Technical Appendix.

†Measures of variability were not available. Thus, the variability of best group rates was not assessed, and statistical significance could not be tested. Nonetheless, 

disparities and changes in disparities over time are displayed according to their magnitude. See Technical Appendix.

1 Baseline data by race and ethnicity are for 1999.

2 Baseline data by sex are for 2006.

i The group with the best rate at the most recent data point is different from the group with the best rate at baseline. Both rates met the reliability criterion. 

See Technical Appendix.

ii Data are for Mexican American.

iiiChange in the summary index cannot be assessed. See Technical Appendix.

iv Reliability criterion for best group rate not met, or data available for only one group, at baseline. Change in disparity cannot be assessed. See Technical Appendix.

v For this objective, only activity limitations are considered as disabilities.

DATA SOURCES

28-1–28-2. National Health Interview Survey (NHIS), CDC, NCHS.

28-3. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

28-4–28-7. National Health Interview Survey (NHIS), CDC, NCHS.

28-8a. Survey of Occupational Injuries and Illnesses (SOII), Department of Labor (DOL), Bureau of Labor Statistics (BLS).

28-8b. National Electronic Injury Surveillance System (NEISS), Consumer Product Safety Commission (CPSC) and CDC, NIOSH.

28-9a–b. National Health Interview Survey (NHIS), CDC, NCHS.

28-10a–b. National Health Interview Survey (NHIS), CDC, NCHS.

28-12. National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS; National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

28-13a. National Health Interview Survey (NHIS), CDC, NCHS; National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

28-13b. Healthcare Cost and Utilization Project (HCUP), AHRQ; National Health Interview Survey (NHIS), CDC, NCHS.

28-13c. National Health Interview Survey (NHIS), CDC, NCHS; National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

28-13d. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

28-14a–c. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

28-15. National Health Interview Survey (NHIS), CDC, NCHS.

28-16a–b. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

28-17–28-18. National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

Figure 28-2. Health Disparities Table for Focus Area 28: Vision and Hearing (continued)

Appendix A A-1

This appendix provides additional information on a 

number of issues related to monitoring progress in 

Healthy People 2010.

〉 Measuring progress toward target attainment—

Procedures used to measure progress toward the 

targets for Healthy People 2010 objectives.

〉 Measuring quality and years of healthy life—

Procedures used to measure quality and years 

of healthy life in connection with the first goal of 

Healthy People 2010.

〉 Measuring health disparities—Procedures used to 

measure and track health disparities among select 

population groups in connection with the second 

goal of Healthy People 2010.

〉 Mapping—Procedures used for mapping select 

Healthy People 2010 objectives.

〉 DATA2010—The online database for Healthy People 

2010 objectives.

〉 General data issues—The guide to measurement 

issues in Healthy People 2010.

〉 Tracking period—A note on how an objective’s 

tracking period is defined in the Healthy People 2010 

Final Review.

Measuring Progress Toward 

Target Attainment 

Progress toward the Healthy People 2010 targets at Final 

Review is shown in a Progress Chart (first figure in each 

Focus Area chapter). This chart displays the percent 

of targeted change that has been achieved for each 

objective.

Percent of Targeted Change Achieved

Targeted change is the difference between the baseline 

and the Healthy People 2010 (HP2010) target. The 

formula for the percent of targeted change achieved is 

as follows:

Percent of 

targeted 

change 

achieved 

= Final value − Baseline value× 100 .

HP2010 target − Baseline value 

The percent of targeted change achieved expresses the 

difference between the baseline and the final value as a 

percent of the initial difference between the baseline and 

the Healthy People 2010 target. As such, it is a relative 

measure of progress toward attaining the Healthy 

People 2010 target. In addition, the comparability of the 

percent of targeted change achieved does not depend 

on whether the underlying objective is expressed in 

terms of adverse or favorable events or conditions; see 

'Measuring Health Disparities', below. The percent of 

targeted change achieved was also used to monitor 

progress in Healthy People 2000 and was previously 

referred to as the 'progress quotient' [1,2].

Baseline data values were published at the beginning of 

the decade for Healthy People 2010 objectives for which 

data were available [3]. Baseline data for additional 

objectives have become available since the publication 

of Healthy People 2010 [4]. Data beyond the baseline 

are available for about 76% of the objectives in Healthy 

People 2010.

Example A-1

School-based objective 7-2c in Healthy People 2010 

called for an increase in the proportion of middle/

junior and senior high schools that provide education 

to prevent violence, from a baseline of 58% in 1994 to a 

target of 80%. In 2006, 77% of schools provided education 

to prevent violence, see Figure 7-1 in the Focus Area 7 

chapter. Using the formula above, 86.4% of the targeted 

change from the 1994 baseline to the Healthy People 

2010 target was achieved in 2006. Indeed,

APPENDIX A:

Technical Appendix
A-2 HEALTHY PEOPLE 2010 FINAL REVIEW

Percent of 

targeted

change

achieved 

= 77–58× 100 = 

19

× 100 = 86.4%.

80–58 22

For population-based objectives, the percent of 

targeted change achieved also can be used to measure 

progress toward the Healthy People 2010 target for each 

population group with data beyond the baseline.

Example A-2

The Healthy People 2010 target for objective 16-1c was 

to reduce the infant death rate to 4.5 deaths per 1,000 

live births. For the total population, the 1998 baseline 

rate was 7.2 infant deaths per 1,000 live births, whereas 

the 2006 rate was 6.7 infant deaths per 1,000 live births; 

see Figure 16-1 in the Focus Area 16 chapter. When the 

formula above is applied, 18.5% of the targeted change 

from the 1998 baseline to the Healthy People 2010 target 

was achieved in 2006:

Percent of 

targeted 

change 

achieved 

= 6.7–7.2 × 100 = -0.5 × 100 = 18.5%.

4.5–7.2 -2.7

In contrast, among infants of Asian or Pacific Islander 

mothers, the infant death rate declined from 5.5 deaths 

per 1,000 live births at baseline to 4.5 deaths per 1,000 

live births in 2006. Using the formula above, 100% of the 

targeted change from the 1998 baseline to the Healthy 

People 2010 target was achieved in 2006:

Percent of 

targeted 

change 

achieved 

= 4.5–5.5× 100= 

-1.0 × 100 = 100%.

4.5–5.5 -1.0

Thus, the Healthy People 2010 target was met for the 

Asian or Pacific Islander group in 2006, even though, 

overall, the population only achieved 18.5% of the 

targeted change.

Limitations

In addition to assessing differentials in progress toward 

target attainment within the population, the percent 

of targeted change achieved may be used to compare 

how much of the targeted change was achieved for an 

objective relative to other objectives, although care must 

be exercised in its interpretation. Generally speaking, 

the reader is advised to keep the following points in 

mind:

〉 The percent of targeted change achieved is calculated 

using only the Healthy People 2010 target, baseline, 

and final data points. Fluctuations that may occur 

during the intervening years are not considered, even 

though they may be substantial.

〉 The number of years between the baseline and final 

data points for Healthy People 2010 might vary both 

between objectives and within objectives.

 Between objectives, differences in the number of 

years available to meet targets are a function of 

the data sources and any choices that were made 

regarding the most appropriate baseline year for 

each objective.

 To assist the reader in the interpretation of 

these comparisons, the baseline and final data 

years used for each objective are shown in 

parentheses following the short descriptions 

in the left-most panel of the Progress Chart for 

each Focus Area.

 Within objectives, differences in the number 

of years available to meet Healthy People 2010 

targets for specific groups within the population 

can be affected by changes in the data templates 

used to classify the population (e.g., by race and 

ethnicity) during the tracking period.

 The period used to compute the percent of 

targeted change achieved will generally be 

consistent with the period used to estimate 

disparities, see the Measuring Health 

Disparities section below for more details.

〉 The (absolute) value of the Healthy People 2010 

targeted change from baseline might vary among 

select populations or across objectives with identical 

values for the percent of targeted change achieved. 

Therefore, two objectives may be identical in their 

percent of targeted change achieved, even though 

they differ in the magnitude of the change. See 

Example A-3 below.

Example A-3.

Objective 7-4b in Healthy People 2010 called for 50% of 

senior high schools with a nurse-to-student ratio of at 

least 1:750, whereas objective 7-4d called for a target of 

48% of elementary school to achieve that same nurseto-student ratio. The 1994 baseline data point for senior 

high schools was 26%, thus the absolute value of the 

targeted change for objective 7-4b was 24 percentage 

points. On the other hand, the 2000 baseline data point 

for elementary schools was 42%, resulting in a targeted 

change of only 6 percentage points. In 2006, 38% of senior 

high schools and 45% of elementary schools had attained 

the desired nurse-to-student ratio. As a result, both 

objectives achieved 50% of their targeted change—12 

of the targeted 24 percentage points for objective 7-4b, 

and 3 of the targeted 6 percentage points for objective 

7-4d—even though they differed in the magnitude of the 

change. See Figure 7-1 in the Focus Area 7 chapter.

In addition to the above limitations, there are a number 

of cases in which the percent of targeted change achieved 

cannot be calculated or does not adequately reflect 

change in an objective. Five hypothetical scenarios 
Appendix A A-3

are presented below for the reader’s consideration, 

further illustrating the care that must be exercised in 

the interpretation of the percent of targeted change 

achieved in Healthy People 2010.

Scenario 1: Target met at baseline and movement in 

desired direction

Target = 5; Baseline value = 5; Final value = 4; desired 

direction = decrease in value.

Percent of 

targeted 

change 

achieved 

= 4–5× 100 = 

-1 × 100 = undefined.

5–5 0

Cannot divide by 0.

Scenario 2: Target met at baseline and movement in 

undesired direction

Target = 0; Baseline value = 0; Final value = 2; desired 

direction = decrease in value.

Percent of 

targeted 

change 

achieved 

= 2–0× 100 = 

2 × 100 = undefined.

0–0 0

Cannot divide by 0.

Scenario 3: Target exceeded at baseline and 

movement in desired direction

Target = 30; Baseline value = 35; Final value = 40; desired 

direction = increase in value.

Percent of 

targeted 

change 

achieved 

= 40–35× 100 = 

5 × 100 = -100%.

30–35 -5

Here, progress has been made, but the percent of 

targeted change achieved appears to indicate movement 

away from the target.

Scenario 4: Target exceeded at baseline and 

movement in undesired direction

Target = 30; Baseline value = 35; Final value = 25; desired 

direction = increase in value.

Percent of 

targeted 

change 

achieved 

= 25–35× 100 = 

-10 × 100 = 200%.

30–35 -5

Here, progress has not been made, but the percent of 

targeted change achieved appears to indicate the target 

has been exceeded.

In the Progress Chart (first figure in each Focus Area 

chapter), objectives as in scenarios 1 and 3 above are 

shown with arrows in the positive direction. Those as in 

scenarios 2 and 4 are shown with arrows in the negative 

direction. In all cases, footnotes indicate the precise 

amount cannot be calculated.

Finally, when the targeted amount of change is small 

relative to the actual amount of observed change, 

the percent of targeted change achieved can have 

relatively large values that are difficult to interpret. 

Furthermore, the reader should be aware that target 

setting has a sizeable impact on the 'percent of targeted 

change achieved'. This phenomenon is illustrated in the 

following hypothetical scenario.

Scenario 5: Target set closer to baseline and 

movement in undesired direction

Baseline value = 50; Final value = 70; desired direction = 

decrease in value.

Case 1: Target = 30 

Percent of 

targeted 

change 

achieved 

= 70–50 × 100 = 

20 × 100 = -100%.

30–50 -20

Case 2: Target = 40

Percent of 

targeted 

change 

achieved 

= 70–50× 100 = 

20 × 100 = -200%.

40–50 -10

In both cases, progress has not been made, the final 

value having exceeded the baseline value by 20 points. 

Yet, a target of 40 having been set closer to the baseline 

value than a target of 30, the percent of targeted change 

achieved appears to indicate a worse scenario in the 

second case than in the first, even though the difference 

between the baseline and final values remains 

unchanged.

To circumvent the difficulty in interpretation that arises 

for objectives like in scenario 5 above, movement away

from the Healthy People 2010 target is not quantified 

using the percent of targeted change achieved in the 

Progress Chart (see footnote 1 for Figure 1 in each of 

the Focus Area chapters) for the Final Review. Instead, 

for such objectives, the reader is urged to examine the 

difference between the baseline and the final values to 

assess progress.

Testing for Trends

As stated in the Limitations section above, the percent 

of targeted change achieved is calculated using only 

the Healthy People 2010 target, baseline, and final 

data points. Fluctuations that may occur during the 

intervening years are not considered, even though they 

may be substantial. In addition, the number of years 
A-4 HEALTHY PEOPLE 2010 FINAL REVIEW

between the baseline and final data points for Healthy 

People 2010 might vary both between objectives and 

within objectives.

Nonetheless, the presence of a monotonic increasing 

or decreasing trend in the underlying measure can be 

tested with the nonparametric Mann-Kendall test, 

and the slope of a linear trend estimated with the 

nonparametric Sen’s method [5].

The Mann-Kendall test is suitable for cases where the 

trend may be assumed to be monotonic, and thus where 

no seasonal or other cycle is present in the data.

The Sen’s method uses a linear model to estimate the 

slope of the trend when the variance of the residuals 

may be assumed constant in time. Missing values are 

allowed and the data need not conform to any particular 

distribution. Also, the Sen’s method is not greatly 

affected by single data errors or outliers.

When the number of data points is less than 10, Sen’s S 

statistic can be used. When the number of data points 

is 10 or more, a normal approximation holds, and a Z 

statistic can be used instead.

Results of the trend tests described above are used in 

the Highlights section of selected Focus Area chapters—

namely, chapters 6, 10, 13, 15, and 20—to supplement 

findings on progress toward achieving Healthy People 

2010 targets during the decade.

Measuring Quality and Years of 

Healthy Life

Goal 1 of Healthy People 2010 is to increase the quality 

and length of healthy life-years. This goal is tracked with 

three summary measures of health that belong to the 

family of measures called “healthy life expectancy.” The 

three summary measures are:

1. Expected years of life in good or better health

2. Expected years of life free of activity limitation

3. Expected years of life free of selected chronic 

diseases.

These healthy life expectancy measures are given 

in life-years, which indicate the average number of 

healthy years a person can expect to live if age-specific 

death rates and age-specific illness rates remain the 

same throughout his or her lifetime. Thus, healthy life 

expectancy is a snapshot of current death and illness 

patterns and can illustrate the long-range implications 

of the prevailing age-specific death and illness rates. 

The methods used to create the healthy life expectancy 

measures are described next.

Methods

The measures of healthy life expectancy used in the 

Final Review are calculated using a double-decrement 

life table technique, based on the Sullivan method [6,7]. 

A traditional life table presents what would happen 

to a hypothetical cohort if it experienced exactly the 

same age-specific death rates during a given period of 

time [8]. A double-decrement life table analyzes what 

would happen to a hypothetical cohort if it experienced 

exactly the same age-specific death and age-specific 

illness rates during a given period of time. Although it 

is possible to create life tables based on single years of 

age, this analysis uses an abridged life table, with age 

intervals of 5 years.

To produce the measures of healthy life expectancy, 

age-specific death rates are combined with age-specific 

health prevalence rates to produce an estimate of overall 

healthy life expectancy [9].

The life table includes the following quantities:

〉 qx—Probability of dying—This column shows the 

probability of dying during the age interval. It is 

derived from death rates for a given year.

〉 lx—Number surviving—This column shows the 

number of persons from birth surviving to the 

beginning of the next age interval. The life table 

typically begins with a population at birth of 100,000, 

called the radix.

〉 dx—Number dying—This column shows the number 

of deaths in each age interval out of the original 

100,000 births. It is calculated by multiplying the qx

for the age interval by the lx for the same age interval.

〉 Lx—Person-years lived—This column shows the total 

time lived (in years) within the age interval by all of 

those who have survived to the beginning of the age 

interval.

〉 Tx—Total number of person-years lived—This column 

shows the total number of person-years lived that 

would be lived after the beginning of the age interval.

〉 Ex—Expectation of life—This column shows the 

average number of years remaining to be lived by 

those surviving to the age interval. It is derived by 

dividing the total number of person-years lived at the 

age interval and above by the number surviving to 

the beginning of the age interval (Tx/lx).

Life tables used to calculate healthy life expectancy 

include all of the quantities described above in addition 

to the following quantities regarding illness:

〉 Px—Age-specific illness rate—This column shows the 

percentage of persons in the age interval in a given 

poor health state.
Appendix A A-5

〉 Px × Lx—Healthy person-years lived—This column 

shows the number of healthy person-years lived 

during the age interval. This number is derived 

by multiplying the age-specific illness rate by the 

corresponding number of person-years lived during 

the age interval (Lx).

〉 THx—Total number of healthy person-years lived—This 

column shows the total number of healthy personyears that would be lived after the age interval.

〉 HLEx—Expectation of healthy life—The expectation 

of healthy life is the average number of years in good 

health remaining for those surviving to a given age 

with a given set of age-specific death rates and agespecific illness rates. It is derived by dividing the 

total healthy person-years that would be lived at age 

x by the total number of persons who survived to that 

age interval (THx/lx).

The use of measures of healthy life expectancy enables 

comparisons across populations, as well as over long 

periods of time. The use of the Sullivan method for 

estimating healthy life expectancy is most appropriate 

for the cross-sectional data used to track Healthy People 

2010 [10].

Data Systems

Analyses are based on 2000–01 (2002–03 for chronic 

conditions) and 2006–07 death data from the National 

Vital Statistics System (NVSS) and 2000–01 (2002–03 

for chronic conditions) and 2006–07 health data from 

the National Health Interview Survey (NHIS). NHIS is 

a nationally representative continuing cross-sectional 

survey, which provides a snapshot of the health of the 

U.S. population. Approximately 35,000 households are 

interviewed each year. NVSS is a complete registration 

of all vital events and includes detailed data on all of the 

deaths that occur within the U.S.

These data systems are used for the study of healthy life 

expectancy because they contain detailed information 

on health and death. However, the institutionalized 

population is excluded from the NHIS sample. Because 

the institutionalized population is more likely to 

report poor health, the Healthy People 2010 healthy life 

expectancy measures might underestimate the effect of 

poor health on measures of healthy life expectancy.

Survey Questions

Self-rated health status is measured by the single 

question from NHIS that asked respondents to rate their 

health as “excellent,” “very good,” “good,” “fair,” or “poor.” 

For the purpose of determining Healthy People 2010 

healthy life expectancy, a respondent was considered to 

be in poor health if he or she answered “fair” or “poor.” 

This self-assessed health rating was shown to be a useful 

indicator of one’s health for a variety of populations and 

allows for broad comparisons across different conditions 

and populations [11]. The measure also is included in 

the Behavioral Risk Factor Surveillance Survey (BRFSS), 

the National Health and Nutrition Examination Survey 

(NHANES), and other health surveys.

Activity limitation is measured using questions about 

personal care needs, limitations of activities, and use 

of special equipment. Adults were asked whether they 

needed assistance with personal care needs, such as 

eating, bathing, dressing, or getting around inside the 

home; whether they needed assistance with routine 

care needs, such as household chores; and whether they 

had a mental or physical problem that kept them from 

working at a job or that limits their activity in any way. 

They also were asked whether they had health problems 

that required the use of special equipment, such as a 

cane, wheelchair, or special telephone. If a respondent 

answered “yes” to any of these questions, he or she 

was classified as having activity limitations. Children 

were considered limited in activity if the proxy adult 

respondent responded “yes” to any of the limitation, 

special services, or special equipment questions that 

were specific to children.

Selected chronic disease prevalence is measured by 

several questions that asked respondents whether a 

doctor had ever diagnosed them with a given disease. 

The list of selected chronic diseases represented those 

chronic diseases that were included in Healthy People 

2010 and NHIS: heart disease, stroke, cancer, diabetes, 

hypertension, kidney disease, arthritis, and asthma. 

If a respondent answered “yes” to any of the selected 

diagnoses, he or she was classified as having a chronic 

disease. Ideally, such a healthy life expectancy would 

adjust for severity of disease. However, NHIS does not 

collect data on the severity of the disease. The primary 

limitation of this measure is that it is restricted to 

the diseases noted above, thus, it underestimates 

the contribution of chronic disease to healthy life 

expectancy because other chronic conditions, especially 

chronic mental health conditions, are not included.

Healthy People 2000

The 2010 healthy life expectancy measures differ from 

the measure used for Goal 1 of Healthy People 2000. The 

Healthy People 2000 measure combined information 

about death, self-rated health, and activity limitations 

into a single measure known as years of healthy life 

[12]. For Healthy People 2010, these illness components 

have been separated into distinct measures. This 

strategy allows for greater ease in interpreting change 

and determining the mechanisms of change. The same 

double-decrement life table technique used in Healthy 

People 2000 is used to create the healthy life expectancy 

measures for Healthy People 2010.
A-6 HEALTHY PEOPLE 2010 FINAL REVIEW

Limitations

Healthy life expectancy is computed using the Sullivan 

method, the standard method for computing healthy life 

expectancy on a routine basis. Although the Sullivan 

method accurately depicts the current status of the 

population’s health, it does not reflect the underlying 

transitions into and out of poor health states. In other 

words, the Sullivan method assumes that if a respondent 

reports an activity limitation at a given point in time, 

that respondent is limited in activities for the rest 

of his or her life. However, as the underlying disease 

processes have episodic fluctuations of deterioration 

and improvement over time, poor health states will 

also fluctuate. For example, a person diagnosed with 

functional limitations due to severe arthritis may take 

medication and experience better health states in the 

future, however, the Sullivan method does not account 

for future years of good health for such a person.

In addition, the Sullivan method can be biased when 

evaluating trends over a short period of time. Biases 

in trends of healthy life expectancy can occur if there 

are fluctuations in health over a short time period. 

The Sullivan method is less likely to give misleading 

estimates of trends in healthy life expectancy when 

changes in death rates and health status rates are 

smooth and relatively even.

Future Plans

Goal 1 of Healthy People 2010 challenged the Nation to 

increase quality and years of healthy life. Identifying 

the best approaches for measuring quality and years 

of healthy life is an evolving field, and future research 

will build upon these initial measures of healthy life 

expectancy. It would be desirable to include measures 

that account for the contribution of mental health status 

to quality of life and other health variables. In addition, 

the Healthy People 2010 healthy life expectancy measures 

are expected to be expanded to include expected years 

of life with good health behaviors in Healthy People 2020.

Measuring Health Disparities

The second overarching goal of Healthy People 2010 calls 

for eliminating health disparities among segments of the 

population, including differences that occur by race or 

ethnicity, sex, education or income, geographic location, 

disability, or sexual orientation [3]. These characteristics 

are applicable to objectives that measure aspects of the 

health of the population and do not apply to objectives 

that are based on schools, worksites, states, or other 

units of measures that are not population-based. 

The Health Disparities Table (second figure in each 

Focus Area chapter except Chapter 23) summarizes 

information about disparities from the best group rate 

for each of a selected set of population characteristics at 

the most recent data point, and changes in disparities 

from the baseline to the most recent data point.

The methods used to create the Health Disparities 

Table are described below. The rationale for methods 

employed in measuring disparity in Healthy People 

2010 was provided in a previous report [13]. The “Goal 

2: Eliminate Health Disparities” section in the Healthy 

People 2010 Final Review Overview presents additional 

key findings concerning disparities.

Measuring Objectives and Defining Groups

Technical information (i.e., Operational Definitions) 

concerning the measurement of each objective and the 

classification of the population characteristics employed 

in monitoring the objectives is provided in Tracking 

Healthy People 2010 [14]. The original classification of 

racial and ethnic groups shown in Healthy People 2010

was altered based on revisions to the standards for the 

classification of Federal data on race and ethnicity that 

were published by the Office of Management and Budget 

in 1997 [4,15]. These standards permit each person to 

identify either with only one race or with more than one 

race. The race and ethnicity categories used to monitor 

the Healthy People 2010 population-based objectives 

were modified accordingly, resulting in the following 

categories:

〉 American Indian or Alaska Native

〉 Asian

〉 Native Hawaiian or Other Pacific Islander

〉 Black or African American

〉 White

〉 Two or more races

 American Indian or Alaska Native; white

 Black or African American; white

〉 Hispanic or Latino

〉 Not Hispanic or Latino

 Black or African American

 White

Federal data systems have been revising their collection 

and tabulation procedures to comply with the new 

standards on racial and ethnic identification. Some data 

systems began reporting data for calendar year 1999 

using the new standards, and most of the remaining 

systems have adopted the new standards since then. 
Appendix A A-7

However, some data systems are still in the process of 

adopting the revised standards, so the availability of 

comparable data for racial and ethnic groups varies by 

data source and across objectives.

In the Healthy People 2010 Final Review, seven racial 

and ethnic groups are shown in the Health Disparities 

Table: American Indian or Alaska Native; Asian; Native 

Hawaiian or Other Pacific Islander; two or more races; 

Hispanic; white, not Hispanic; and black, not Hispanic. 

The first four groups might also include small numbers 

of persons of Hispanic origin. The data systems used to 

track the population-based objectives in Healthy People 

2010 might not provide data for all of these groups. 

Departures from the above categories are footnoted in 

the Health Disparities Table.

To maintain comparability of data by race and ethnicity 

over time for some objectives, a more recent data year 

might be used as the baseline because of the revised 

standards [15]. NHIS, for example, began reporting data 

according to the new racial and ethnic categories in 1999. 

Although the baseline year for objectives tracked with 

NHIS might be 1997 or 1998, data for 1999 are employed 

as the baseline for measuring disparities for race and 

ethnicity data only. These departures are indicated by 

footnotes in the Health Disparities Table.

Education and income are the primary measures of 

socioeconomic status in Healthy People 2010. Most data 

systems used in Healthy People 2010 define income as a 

family’s income before taxes. To facilitate comparisons 

among groups and over time, while adjusting for family 

size and for inflation, Healthy People 2010 categorizes 

income using the poverty thresholds developed by the 

Census Bureau. Thus, the three categories of family 

income that are primarily used are:

〉 Poor—below the Federal poverty level

〉 Near poor—100% to 199% of the Federal poverty level

〉 Middle/high income—200% or more of the Federal 

poverty level.

These categories may be overridden by considerations 

specific to the data system, in which case they are 

modified as appropriate. See Healthy People 2010: General 

Data Issues [16].

Availability of Data

The data used to monitor the Healthy People 2010 

objectives come from a wide variety of data systems. Data 

for a particular population group might not be available 

because they are not collected by the data system, 

because they have been collected but not analyzed, or 

because they have been suppressed. Data are suppressed 

when the number of events is too small to produce 

statistically reliable estimates, when disclosure might 

violate confidentiality requirements, when the sample 

design does not produce representative estimates for a 

particular group, or when there is high item nonresponse 

or a large number of unknown entries. Criteria for data 

suppression for the data systems included in Healthy 

People 2010 are published in a previous report [17].

Content of the Health Disparities Table

The Health Disparities Table provides information 

about disparities between groups for populationbased objectives. Short descriptions of the 

population-based objectives are listed along the leftmost column of the table. The baseline data year(s) is 

(are) shown in parentheses and, when more recent data 

are available, the most recent data year(s) is (are) also 

shown. The description of an objective generally also 

includes in parentheses any applicable information 

regarding the underlying measure (e.g., measurement 

unit) and the age of the targeted population.

Characteristics of the population (race and ethnicity, 

sex, education, income, geographic location, and 

disability status) are listed across the top of the Health 

Disparities Table. In general, characteristics applicable 

to each objective were designated in the original Healthy 

People 2010 document [4]. Race and ethnicity, sex, and 

education or income are available and included for most 

objectives; geographic location and disability status are 

included only if applicable and available.

Characteristics that were not designated for a particular 

objective are shaded in dark gray. When a characteristic 

is not applicable for any of the objectives in a Focus 

Area, it is omitted from the Health Disparities Table 

for that Focus Area. When data are not available for a 

particular population or for a particular characteristic, 

the corresponding boxes are shaded in light gray (see 

the fourth section of the legend reproduced in Figure 

A-1, below). If there are no characteristic-specific data 

available for an objective, or if it is not population-based, 

the objective is excluded from the table and annotated in 

the notes. In some cases, the data source for an objective 

provides data for groups that are defined in nonstandard 

ways. For example, some data sources provide data for 

the black and white populations that include persons of 

Hispanic origin. These departures from the standardized 

template used to monitor the Healthy People 2010 

population-based objectives are indicated by footnotes 

in the Health Disparities Table.

Measuring Disparity From the Best Group Rate

Definition. Disparity from the best group rate is defined 

as the percent difference between the best group rate 

and each of the other group rates for a characteristic.
A-8 HEALTHY PEOPLE 2010 FINAL REVIEW

For example, health disparities by race and ethnicity are 

measured as the percent difference between the best 

racial and ethnic group rate and each of the other racial 

and ethnic group rates. Similarly, disparities by sex are 

measured as the percent difference between the better 

group rate (e.g., female) and the rate for the other group 

(e.g., male).

Formula. The formula for disparity from the best group 

rate for a group G is as follows:

Disparity for group G = RG – RB × 100, 

RB

where RB is the best group rate and RG is the rate for 

group G for a particular characteristic.

Note. In computing disparities, the Final Review uses the 

display values for rates, proportions, and other estimates 

in DATA2010. Those are typically rounded to the nearest 

whole number or to at most one decimal place, see 

section on DATA2010 below. As a result, the best group 

rate RB may in some rare instances be displayed as zero 

and subsequently treated as a zero in the above formula, 

resulting in an undefined division by zero. To avoid such 

an artificial situation, a small continuity correction is 

applied to enable a meaningful calculation of disparities 

relative to the best group rate.

Some Healthy People 2010 objectives are expressed 

in terms of favorable events or conditions that are to 

be increased, while others are expressed in terms of 

adverse events or conditions that are to be reduced. 

To facilitate comparison of disparities across different 

objectives, disparity is measured only in terms of adverse 

events or conditions in Healthy People 2010 [1]. Those 

dichotomous objectives that are expressed in terms of 

favorable events or conditions are re-expressed using the 

adverse event or condition for the purpose of computing 

disparity [12,18,19], but they are not otherwise restated 

or changed.

Example. Healthy People 2010 objective 1-1, to increase 

the proportion of persons with health insurance (e.g., 

72% of the American Indian or Alaska Native population 

under age 65 had health insurance in 2008), is expressed 

in terms of the percentage of persons without health 

insurance (e.g., 100% – 72% = 28% of the American 

Indian or Alaska Native population under age 65 did not 

have health insurance in 2008) when the disparity from 

the best group rate is calculated.

Special cases. Healthy People 2010 objectives 26-9a, 

26-9b, and 27-4a, aim to increase the (average) age at 

first use of alcohol, marijuana, and tobacco, respectively, 

among adolescents aged 12–17 years. To facilitate 

comparison of disparities across different objectives, 

those three objectives are re-expressed using an adverse 

condition, as follows: decrease the (average) number of 

years between the (average) age at first use and age 18. 

Similarly, objective 27-4b aims to increase the (average) 

age at first use of tobacco among young adults aged 

18–25. This objective is re-expressed as follows: decrease 

the (average) number of years between the (average) 

age at first use and age 26. Finally, objective 16-16b 

aims to increase the median red blood cell (RBC) folate 

level among nonpregnant women aged 15–44. The 

underlying measure for this objective is a continuous 

measure which does not have a known upper limit. 

Nonetheless, an approximate upper limit is given by 

the 97.5th percentile of RBC folate concentration among 

women aged 20–59, estimated at 596 ng/mL [20]. Thus, 

objective 16-16b can be re-expressed using an adverse 

measure by subtracting the aggregate median RBC 

folate level for each population group from the value 596 

ng/mL. For the reader’s reference, among the population 

groups considered in the Health Disparities Table, the 

population group with the highest median RBC folate 

level was the group with at least some college education, 

with an aggregate median RBC folate level of 267 ng/mL 

in 2005–06.

As a result of measuring disparity only in terms of adverse 

events or conditions, the group identified as having 

the best rate for a given characteristic in the Health 

Disparities Table is always the group with the least 

adverse event or condition. Thus, disparities defined by 

the above formula remain nonnegative quantities, and 

equal zero only when the group G for which disparity is 

being assessed has a rate equal to the best group rate.

In the few instances when two groups for a characteristic 

have identical best rates, both groups are identified 

by a “B”. To ensure that disparity is measured from a 

reasonably stable data point, the most favorable group 

rate must have a relative standard error of less than 10%. 

When the relative standard error for the most favorable 

group rate is greater than or equal to 10%, a small letter 

“b” is included in the cell and the next most favorable 

group rate with a relative standard error of less than 10% 

is identified as the reference group for that characteristic. 

Disparities are not calculated for cells identified by a 

small letter “b”. When there is only one group with a 

relative standard error of less than 10%, a best group is 

not identified for purposes of measuring disparity, and 

the cells for all groups with data are blank, indicating 

that disparities could not be assessed. The first section of 

the legend for the Health Disparities Table (reproduced, 

here, in Figure A-1) addresses the identification of the 

best group rate for each characteristic.

When standard errors are not available, the best group is 

determined by the most favorable rate, see 'Estimates of 

Variability' below.
Appendix A A-9

Representing the Size of Health Disparities by a 

Color Gradient

In the Health Disparities Table, a color gradient is used 

to represent the size of the disparities (i.e., the percent 

differences between each group rate and the best group 

rate) at the most recent data point. In some cases, 

baseline data might be the only data available. The color 

gradient is shown in the second section of the legend, see 

Figure A-1.

When measures of variability (i.e., standard errors) are 

available, the variability of best group rates is assessed, 

and statistical significance is tested. For a group G 

within a given characteristic, a disparity of 10% or more 

is displayed when the (simple) difference from the best 

group rate (i.e., RG – RB) is statistically significant at the 

0.05 level (see Figure A-1):

〉 The lightest color in the color gradient indicates a 

group with a disparity < 10%. When measures of 

variability are available, the lightest color in the 

color gradient also indicates disparities for which the 

difference RG – RB is not statistically significant at the 

0.05 level.

〉 The darkest color in the color gradient indicates a 

group with a disparity ≥ 100% and, when measures 

of variability are available, a difference RG – RB that is 

statistically significant at the 0.05 level.

〉 The two intermediate colors in the color gradient 

indicate groups with a disparity of 10%−49% and 

groups with a disparity of 50%−99%.

The statistical significance of the (simple) difference 

RG – RB between groups can be assessed using the 

following Z-statistic:

Z = RG – RB

SEG

2 SEB2 +

,

where RG is the rate for a group G of interest, RB is the 

rate for the best group, SEG is the standard error of the 

rate for group G, and SEB is the standard error of the best 

group rate.

This formula assumes that the two groups are 

independent. Because, as mentioned earlier, the 

difference RG – RB remains nonnegative, a one-tailed 

test is employed to assess statistical significance. When 

Z ≥ 1.645, the difference RG – RB between the two group 

rates is statistically significant at the 0.05 level. When 

the (simple) difference RG – RB between the two group 

rates is significant, the disparity for group G relative to 

the best group rate is considered significant.

Changes in Health Disparities Over Time

When data beyond the baseline are available, change 

in disparity over time is estimated by subtracting the 

disparity at the baseline from the disparity at the most 

recent data point. The change is expressed in percentage 

points: positive differences represent an increase 

in disparity, and negative differences represent a 

decrease in disparity. See the third section of the legend 

reproduced in Figure A-1.

Changes in disparity over time are shown when:

LeGend

The “best” group rate at the most 

recent data point. B

The group with the best rate for 

specified characteristic. b

Most favorable group 

rate for specified characteristic, but reliability 

criterion not met.

Reliability criterion for 

best group rate not 

met, or data available 

for only one group.

Percent difference from the best group rate

Disparity from the best group rate at 

the most recent data point.

Less than 10%, or difference not 

statistically significant (when estimates 

of variability are available).

10%–49% 50%–99%

100% or 

more

Changes in disparity over time are shown when: 

(a) disparities data are available at both baseline and most recent time points; (b) data are 

not for the group(s) indicated by “B” or “b” at either time point; and (c) the change is greater 

than or equal to 10 percentage points and statistically significant, or when the change is 

greater than or equal to 10 percentage points and estimates of variability were not available. 

See Technical Appendix.

Increase in disparity (percentage points)

 10–49 points 

 50–99 points 





100 

points or 

more

Decrease in disparity (percentage points)

 10–49 points 

 50–99 points







100 

points or 

more

Availability of Data

Data not available.

Characteristic not 

selected for this 

objective.

Figure A-1. Legend for the Health Disparities Table
A-10 HEALTHY PEOPLE 2010 FINAL REVIEW

a) Disparities data are available at both baseline and 

most recent time points;

b) Data are neither for the group(s) with the best rate for 

the specified characteristic, nor for the group(s) with 

the most favorable rate but for which the reliability 

criterion was not met, at either time point; and 

c) The change is greater than or equal to 10 percentage 

points and statistically significant, or when the 

change is greater than or equal to 10 percentage 

points and estimates of variability are not available.

When standard errors are available for a data system, 

only statistically significant changes in disparities of 

10 percentage points or more between the baseline and 

the most recent data points are indicated with arrows, 

see Figure A-1. Several steps are required to evaluate the 

statistical significance of a change in disparities over 

time.

Step 1. The disparity or percent difference (PD) from the 

best group rate at each time point is based on the ratio 

of the simple difference SD = RG – RB between the rate for 

the group of interest and the best group rate to the best 

group rate RB:

Disparity for group G = SD × 100 .

RB

Step 2. The relative standard error (RSE) of the above 

ratio is computed based on the RSE of the numerator 

and the denominator. The RSE for the numerator SD is 

calculated as:

RSESD = RG – RB

SEG

2 SEB2 + ,

where SEG is the standard error of the rate for a group G 

of interest, SEB is the standard error for the best rate, RG

is the rate for group G, and RB is the best group rate.

Step 3. The RSE of the best group rate in the denominator 

of the ratio in step 1 is given by:

RSEB = SEB . RB

Step 4. An approximate relative standard error RSEPD

for the disparity or percent difference (PD) is computed 

via the so-called “Delta Method”—a first-order Taylor 

series linearization of the variance of the ratio of two 

random variables [21]—using the numerator RSE (from 

step 2) and the denominator RSE (from step 3):

RSEPD = RSESD

2 RSEB

2 + .

This first-order linearization assumes the simple 

difference SD = RG – RB between the rate RG for the group 

G of interest and the best group rate RB is independent of 

the best group rate.

Step 5. An approximate standard error SEPD for the 

percent difference (PD) is given by:

SEPD = RSEPD × PD .

Step 6. The statistical significance of a change in 

disparity or percent difference from the best group rate 

over time at the 0.05 level is assessed using the following 

Z-statistic:

Z = PD1 – PD0

SEPD,1

2 SEPD,0 2 +

,

where PD1 is the percent difference at the most recent 

time point, PD0 is the percent difference at baseline, 

SEPD,1 is the standard error of the percent difference at 

the most recent time, and SEPD,0 is the standard error of 

the percent difference at baseline.

Note. Because of the various assumptions involved 

in deriving an approximate standard error SEPD for 

the percent difference in step 5 above, and because an 

alternative, more direct method for testing statistical 

significance is available for the simple difference RG – RB

between the two group rates, the standard error SEPD is 

not used for assessing the significance of disparities at 

each data point. As explained earlier, when the simple 

difference RG – RB between the two group rates is 

statistically significant, the disparity for group G relative 

to the best group rate (i.e., the percent difference) is 

considered significant.

When measures of variability are not available, the 

variability of best group rates is not assessed, and 

statistical significance cannot be tested. Nonetheless, 

disparities and changes in disparities over time are 

displayed according to their magnitude. This is usually 

indicated in the footnotes of the Health Disparities Table 

by a † footnote. See also the Estimates of Variability 

section below for more information.

When measures of variability are available only for the 

most recent data, the variability of best group rates is 

assessed only for the most recent data, and statistical 

significance is tested only for the most recent data. 

Changes in disparities of 10 percentage points or more 

over time are displayed according to their magnitude, 

because measures of variability are not available at the 

baseline and therefore statistical significance of changes 

in disparity could not be tested. This is usually indicated 

in the footnotes of the Health Disparities Table by a ‡ 

footnote. See also the Estimates of Variability section 

below for more information.
Appendix A A-11

Summary Measures

Disparities are measured as percent differences 

between the best group rate and other group rates for 

a given population characteristic. When more than two 

groups are associated with that characteristic, such as 

race and ethnicity, income, and education, a summary 

index provides a way to determine whether, on average, 

disparities from the best group rate are increasing or 

decreasing. The formula for the summary index, also 

known as the index of disparity [22], is:

n-1

G=1 Summary index = n 1 –

PDG ,

where PDG is the nonnegative—possibly zero—disparity 

(i.e., percent difference) from the best group rate for each 

of the groups of interest (G = 1,2,... n), and n is the number 

of groups. Because the disparities are calculated with 

the best group rate as the reference point, the number 

of comparisons is equal to the number of groups minus 

1. These comparisons are made only when data are 

available for the same groups defined in the same way at 

the baseline and most recent data points.

Note. As explained previously, when the relative 

standard error for the most favorable group rate is greater 

than or equal to 10%, that group is flagged using a small 

letter “b” in the Health Disparities Table, and the next 

most favorable group rate with a relative standard error 

of less than 10% is identified as the reference group for 

that characteristic and flagged using a capital letter “B”. 

As a result, the observed disparity or percent difference 

from the best group rate for a group that is flagged with 

a small letter “b” becomes negative, because its observed 

rate is better than the best rate identified. Thus, all such 

groups with a “b” must be excluded from the calculation 

of the summary index, since the latter must remain 

nonnegative. However, in doing so, the summary index 

no longer accurately reflects the observed disparities 

in the population, since, by excluding the better rates, 

it necessarily underestimates the average disparity. 

For this reason, summary indices are not calculated 

for objectives where at least one group is identified 

with a small letter “b” for a given characteristic. The 

corresponding cell in the Health Disparities Table 

is shaded in light gray to indicate that data are not 

available to accurately compute the summary index.

The statistical significance of a change in the summary 

index over time is assessed when standard errors for the 

rates on which the summary index is based are available. 

The magnitude and direction of changes are indicated 

by arrow symbols as described above. When standard 

errors are not available for the rates on which the 

summary index is based, changes are classified by size 

and direction without regard to statistical significance.

To obtain a standard error for the summary index, a 

type of resampling or “bootstrap” procedure is employed 

[23]. This procedure uses the rate and standard error for 

each group to reestimate each group rate 25,000 times 

assuming a random normal distribution. Based on these 

group rates, 25,000 estimates of the summary index of 

disparity are generated, and the distribution of these 

estimates is used to estimate the standard error of the 

summary index.

The bootstrap procedure is used to estimate standard 

errors for the summary index at the most recent time 

and at the baseline, to determine whether a change in 

the summary index over time is statistically significant. 

A Z-statistic for the change in the summary index can be 

computed as follows:

Z = ID1 – ID0

SEID,1 2 SEID,0 2 +

,

where ID1 is the summary index at the most recent time 

point, ID0 is the summary index at the baseline, SEID,1 is 

the standard error of the summary index at the most 

recent time point, and SEID,0 is the standard error of the 

summary index at the baseline.

Because the value of the index could either increase 

or decrease, a two-tailed test is employed to assess 

statistical significance: a value of |Z| ≥ 1.96 indicates 

that the change in the summary index is statistically 

significant at the 0.05 level.

Estimates of Variability

Estimates of variability (standard errors) are available 

for most of the population-based objectives in Healthy 

People 2010. When standard errors are available, they 

can be employed to assess the reliability of the best group 

rate as described above. This assessment is performed 

to ensure that the group chosen as the reference point 

is reasonably stable. Standard errors also are used to 

perform the tests of statistical significance described 

above. Generally speaking, these tests guard against 

the possibility that observed disparities or changes in 

disparities occur because of sampling error or other 

random sources of error.

When measures of variability are not available, the 

stability of best group rates is not assessed, and 

statistical significance of disparities and changes in 

disparities could not be tested. For such objectives, there 

is no quantifiable assurance that observed disparities 

and changes in disparities are not due to sampling error 

or other random sources of error. For such objectives, 

the reader is urged to exercise caution in interpreting 

disparities findings.
A-12 HEALTHY PEOPLE 2010 FINAL REVIEW

In the Health Disparities Table, objectives based on data 

for which estimates of variability are available and those 

for which estimates of variability are not available are 

designated by footnotes following the short description 

of each objective. These footnotes are as follows:

* Measures of variability were available. Thus, the 

variability of best group rates was assessed, and 

statistical significance was tested. Disparities of 10% 

or more are displayed when the differences from the 

best group rate are statistically significant at the 0.05 

level. Changes in disparities over time are indicated 

by arrows when the changes are greater than or 

equal to 10 percentage points and are statistically 

significant at the 0.05 level. See Technical Appendix.

† Measures of variability were not available. Thus, 

the variability of best group rates was not assessed, 

and statistical significance could not be tested. 

Nonetheless, disparities and changes in disparities 

over time are displayed according to their magnitude. 

See Technical Appendix.

‡ Measures of variability were available only for the 

most recent data. Thus, the variability of best group 

rates was assessed only for the most recent data, and 

statistical significance was tested only for the most 

recent data. Disparities of 10% or more are displayed 

when the differences from the best group rate are 

statistically significant at the 0.05 level. Changes 

in disparities over time are displayed according to 

their magnitude, since measures of variability were 

not available at baseline and therefore statistical 

significance of changes in disparity could not be 

tested. See Technical Appendix.

If a footnote applies to all objectives in a particular 

Health Disparities Table, then it is added to the notes 

and no footnote is inserted.

Mapping

When data are available at the subnational level, selected 

objectives are mapped to display spatial variation in 

percents, rates, or counts. Subnational data are presented 

either at the state or Health Service Area (HSA) level. 

HSAs are defined as “...one or more counties that are 

relatively self-contained with respect to the provision of 

routine hospital care” [24]. HSAs are contiguous but may 

span state boundaries. They frequently contain more 

than 1 county with an average of 4 and maximum of 20 

counties. The current HSA classification system is based 

on the presence of at least one hospital in the HSA and 

patterns of travel between counties.

Maps are presented as simple chloropleths and use either 

a Jenks or modified Jenks classification [25]. A Jenks 

classification is a way to group ordered data in such a way 

that within-group variance is minimized and betweengroup variance is maximized. When geographic units 

(states or HSAs) have values that met the Healthy People 

2010 target, the classification is modified by manually 

setting the best (lowest for objectives that seek to reduce 

events and highest for objectives that seek to increase 

events) cut-point to the Healthy People 2010 target. In 

some instances where the number of geographic units 

meeting the target is large, a cut-point in the middle of 

the distribution is set to the target.

The Jenks classification is an iterative process whereby 

an arbitrary number of classes are created from an 

ordered set of data. For most maps presented here, the 

default number of classes is five. The process proceeds 

by calculating the sum of the squared deviations 

between classes (SDBC), calculating the sum of squared 

deviations from the array mean (SDAM), and subtracting 

the SDBC from SDAM giving the squared deviation from 

class means (SDCM). Observations are iteratively moved 

from classes with larger SDBCs to those with smaller 

SBDCs until all SBDCs are minimized.

Mapping was done using ArcGIS ArcMap [26]. Maps are 

presented using a North American conic equidistant 

projection based on the 1983 North America geographic 

coordinate system. The states of Alaska and Hawaii 

retain these attributes but are not shown to scale or 

correct location, and were placed independently for 

greater ease of interpretation.

DATA2010

DATA2010 is an online, searchable database that 

contains baseline data, tracking data, and targets for 

all measurable objectives in Healthy People 2010 [3]. 

The database has been updated throughout the decade, 

generally quarterly, to provide the most accurate and upto-date data for tracking Healthy People 2010 objectives.

DATA2010 allows users to search the database for 

estimates by Focus Area, objective, data source, and 

keyword. In addition, users can access Healthy People 

2010 Final Review data by downloading designated 

standard or statistical data spreadsheets in Excel format 

by Focus Area, accessible from http://wonder.cdc.gov/

data2010/ftpselec.htm. Standard spreadsheets contain 

rounded estimates, whereas statistical spreadsheets 

contain rounded data as well as unrounded data and 

standard errors (both rounded to one decimal place), 

when available.

All of the data used to produce the Final Review Progress 

Charts and Disparity Tables are reflected in these static 

Final Review tables. Calculations on the Progress Charts 

and Disparities Tables are based on standard estimates 
Appendix A A-13

and their associated unrounded standard errors, when 

available.

In addition, DATA2010 contains other technical 

information related to the Healthy People 2010 objectives, 

including Operational Definitions for each objective.

General Data Issues

Tracking Healthy People 2010 is a comprehensive 

guidebook on the statistics used for Healthy People 2010 

[14]. It provides detailed information on how the data are 

derived and the major issues affecting the interpretation 

of the statistics. During the Healthy People 2010 

Final Review, the General Data Issues section, Part 

A of Tracking Healthy People 2010, was updated as a 

standalone document titled Healthy People 2010: General 

Data Issues [16].

Healthy People 2010: General Data Issues discusses 

data-related topics that affect multiple objectives. 

Subjects covered include measuring years of healthy life; 

measuring health disparities; population estimates; the 

Healthy People 2010 population templates, including 

issues related to the revised Federal standards for 

classifying race and Hispanic origin; issues related to 

target setting and target adjustment; age adjustment, 

including implications of changes in the standard 

population for age adjustment; the ICD used for illness 

and death classification; state, local, and national data 

issues; and DATA2010.

Tracking Period

In general, the tracking period for Healthy People 2010 

was designed to cover a 10-year period. For most data 

systems, the final data year for Healthy People 2010 

was selected to coincide with the baseline year used 

in Healthy People 2020 for those systems, even if more 

recent data were available when the Healthy People 

2010 Final Review was being prepared. For example, the 

Healthy People 2010 final data point for most objectives 

based on data from the National Health Interview 

Survey (NHIS) was 2008, matching the baseline year for 

Healthy People 2020, although 2009 data were available. 

For objectives that were tracked from data sources that 

are not used in Healthy People 2020, the most recent 

data available were used as the baseline.

References

1. Department of Health and Human Services, Public 

Health 236009-A Service. Healthy People 2000 

Midcourse Review and 1995 Revisions. Washington, 

D.C.: Government Printing Office. 1995.

2. National Center for Health Statistics. Healthy People 

2000 Final Review. Hyattsville, MD. 2001.

3. DATA2010. Available from http://wonder.cdc.gov/

data2010.

4. Department of Health and Human Services. Healthy 

People 2010. 2nd ed. With Understanding and 

Improving Health and Objectives for Improving 

Health. 2 vols. Washington, D.C.: Government 

Printing Office. November 2000.

5. Gilbert RO. Statistical Methods for Environmental 

Pollution Monitoring. New York, NY: Van Nostrand 

Reinhold. 1987.

6. Sullivan DF. A single index of mortality and morbidity. 

HSMHS Health Reports 86, 347–54. 1971.

7. Sullivan DF. Disability components for an index of 

health. National Center for Health Statistics. Vital 

Health Stat 2(42). 1971.

8. Anderson RN. Method for constructing complete 

annual U.S. life tables. National Center for Health 

Statistics. Vital Health Stat 2(129). 1999.

9. Molla MT, Madans JH, Wagener DK, Crimmins EM. 

Summary measures of population health: Report of 

findings on methodologic and data issues. National 

Center for Health Statistics. Hyattsville, MD. 2003.

10. Crimmins EM. What can we expect from summary 

indicators of population health? In Murray CJL, et 

al., eds. Summary Measures of Population Health. 

Geneva, Switzerland: World Health Organization. 

2002.

11. Idler E, Benyamini Y. Self-rated health and mortality: 

A review of 28 studies. J Health Soc Behav 38(1), 

21–37. 1997.

12. Erickson P, Wilson R, Shannon, I. Years of healthy life. 

Healthy People Statistical Notes, no. 7. Hyattsville, 

MD: National Center for Health Statistics. 1995.

13. Keppel KG, Pearcy JN, Klein RJ. Measuring progress 

in Healthy People 2010. Statistical Notes, no. 25. 

Hyattsville, MD: National Center for Health Statistics. 

September 2004.
A-14 HEALTHY PEOPLE 2010 FINAL REVIEW

14. Department of Health and Human Services, Public 

Health Service. Tracking Healthy People 2010. 

Washington, D.C.: Government Printing Office. 

November 2000.

15. Office of Management and Budget. Revisions to the 

standards for the classification of Federal data on 

race and ethnicity. Federal Register 62/FR, 58781–90. 

1997.

16. Healthy People 2010: General Data Issues. Available 

from http://www.cdc.gov/nchs/healthy_people.htm.

17. Klein RJ, Proctor SE, Boudreault MA, Turczyn KM. 

Healthy People 2010 criteria for data suppression. 

Statistical Notes, no. 24. Hyattsville, MD: National 

Center for Health Statistics. June 2002.

18. Keppel KG, Pamuk E, Lynch J, et al.Methodological 

issues in measuring health disparities. National 

Center for Health Statistics. Vital Health Stat 2(141). 

2005.

19. Keppel KG, Pearcy JN. Measuring relative disparities 

in terms of adverse outcomes. J Public Health Manag 

Pract 11(6). 2005.

20. Pfeiffer CM, Johnson CL, Jain RB, Yetley EA, Picciano 

MF, Rader JI, et al. Trends in blood folate and vitamin 

B12 concentrations in the United Sates, 1988–2004. 

Am J Clin Nutr 86, 718–27. 2007.

21. Korn EL, Graubard BI. Analysis of Health Surveys. 

New York, NY: John Wiley & Sons. 1999.

22. Pearcy JN, Keppel KG. A summary measure of health 

disparity. Public Health Rep 117, 273–80. May–June 

2002.

23. Efron B. The Jackknife, the Bootstrap, and Other 

Resampling Plans. Philadelphia, PA: SIAM Publishing 

Company. 1982.

24. Makuc DM, Haglund B, Ingram DD, et.al. Health 

Service Areas for the United States. National Center 

for Health Statistics. Vital Health Stat (2)112. 1991.

25. Coulson MR. In the matter of class intervals for 

chloropleth maps: with particular reference to 

the work of George F Jenks. Cartographica: The 

International Journal for Geographic Information 

and Geovisualization. 24(2), 16-39. 2006.

26. ArcGIS Desktop: ArcMap 9.3 (build 1770). Redlands, 

CA: Environmental Systems Research Institute.
Appendix B B-1

APPENDIX B:

Published Issues of Healthy People Statistical 

Notes

This appendix provides a listing of published Healthy People statistical notes, which can be accessed from http://www.

cdc.gov/nchs/products/hp_pubs.htm.

Number Title Date

1 Health Status Indicators for the Year 2000 Fall 1991

2 Infant Mortality Winter 1991

3 Health Status Indicators: Definitions and National Data Spring 1992

4 Issues Related to Monitoring the Year 2000 Objectives Summer 1993

5 Revisions to Healthy People 2000 Baselines July 1993

6 Direct Standardization (Age-Adjusted Death Rates) March 1995

7 Years of Healthy Life April 1995

8 Evaluating Public Health Data Systems: A Practical Approach June 1995

9 Monitoring Air Quality in Healthy People 2000 September 1995

10 Health Status Indicators: Differentials by Race and Hispanic Origin September 1995

11 Operational Definitions for Year 2000 Objectives: Priority Area 20, Immunization and Infectious Diseases February 1997

12 Operational Definitions for Year 2000 Objectives: Priority Area 13, Oral Health May 1997

13 Healthy People 2000 Midcourse Revisions: A Compendium August 1997

14 Operational Definitions for Year 2000 Objectives: Priority Area 14, Maternal and Infant Health December 1997

15 Priority Data Needs: Sources of National, State, and Local-level Data and Data Collection Systems December 1997

16 Operational Definitions for Year 2000 Objectives: Priority Area 6, Mental Health and Mental Disorders February 1998

17 Operational Definitions for Year 2000 Objectives: Priority Area 21, Clinical Preventive Services December 1998

18 Operational Definitions for Year 2000 Objectives: Priority Area 1, Physical Activity and Fitness December 1998

19 Healthy People 2000: An Assessment Based on the Health Status Indicators for the United States and Each State November 2000

20 Age Adjustment Using the 2000 Projected U.S. Population January 2001

21 Summary Measures of Population Health: Methods for Calculating Healthy Life Expectancy August 2001

22 Summary Measures of Population Health: Addressing the First Goal of Healthy People 2010, Improving Health 

Expectancy

September 2001

23 Trends in Racial and Ethnic-Specific Rates for the Health Status Indicators: United States, 1990–98 January 2002

24 Healthy People 2010 Criteria for Data Suppression July 2002

25 Measuring Progress in Healthy People 2010 September 2004

26 Comparing Racial and Ethnic Populations Based on Healthy People 2010 Objectives August 2008

Appendix C C-1

APPENDIX C:

Healthy People 2010 Workgroup Coordinators 

and Contributing Members

1. Access to Quality Health Services

Workgroup Coordinators

Anne Dievler, PhD

Senior Public Health Analyst

Office of Research and Evaluation

Health Resources and Services Administration

Email: adievler@hrsa.gov

Claire A. Weschler, MSEd, CHES

Center for Primary Care, Prevention, and Clinical 

Partnerships

Agency for Healthcare Research and Quality

Email: claire.kendrick@ahrq.hhs.gov

Contributing Members

Samara Lorenz, MPA

Formerly: 

Special Assistant

Office of Planning, Analysis and Evaluation

Health Resources and Services Administration

Lenee Simon, MPH

Formerly: 

Public Health Advisor

Office of Disease Prevention and Health Promotion 

Office of the Assistant Secretary for Health 

U.S. Department of Health and Human Services

2. Arthritis, Osteoporosis, and Chronic Back 

Conditions

Workgroup Coordinators

Charles G. Helmick, MD

Medical Epidemiologist

Division of Adult and Community Health

National Center for Chronic Disease Prevention and 

Health Promotion 

Centers for Disease Control and Prevention

Email: cgh1@cdc.gov

Joan A. McGowan, PhD

Director 

Division of Musculoskeletal Diseases

National Institute of Arthritis and Musculoskeletal and 

Skin Diseases

National Institutes of Health

Email: joan_mcgowan@nih.gov

James S. Panagis, MD, MPH

CAPT, U.S. Public Health Service

Director, Orthopaedics Program

Division of Musculoskeletal Diseases

National Institute of Arthritis and Musculoskeletal and 

Skin Diseases

National Institutes of Health

Email: panagisj@mail.nih.gov

Phil Tonkins, DrPH

LCDR, U.S. Public Health Service

Health Scientist Administrator

Division of Skin and Rheumatic Diseases

National Institute of Arthritis and Musculoskeletal and 

Skin Diseases

National Institutes of Health

Email: tonkinsw2@mail.nih.gov
C-2 HEALTHY PEOPLE 2010 FINAL REVIEW

Contributing Members

Paul A. Scherr, PhD, DSc

Former workgroup coordinator

Supervisory Epidemiologist, retired

Division of Adult and Community Health

National Center for Chronic Disease Prevention and 

Health Promotion 

Centers for Disease Control and Prevention

Susana A. Serrate-Sztein, MD

Former workgroup coordinator

Director

Division of Skin and Rheumatic Diseases

National Institute of Arthritis and Musculoskeletal and 

Skin Diseases

National Institutes of Health

Email: szteins@mail.nih.gov

3. Cancer

Workgroup Coordinators

Kathy Cronin, PhD

Branch Chief

Data Analysis and Interpretation Branch

Division of Cancer Control and Population Sciences

National Cancer Institute

National Institutes of Health

Email: cronink@mail.nih.gov

Lisa C. Richardson, MD, MPH

Associate Director for Science

Division of Cancer Prevention and Control

National Center for Chronic Disease Prevention and 

Health Promotion 

Centers for Disease Control and Prevention

Email: LRichardson@cdc.gov

Martina V. Taylor, MT (ASCP)

Senior Advisor for Implementation Science

Office of the Director

Division of Cancer Control and Population Sciences

National Cancer Institute

National Institutes of Health

Email: martina.taylor@nih.gov

Contributing Members

Ralph J. Coates, PhD 

Acting Associate Director for Science

Public Health Surveillance Program Office

Office of Surveillance, Epidemiology, and Laboratory 

Services

Centers for Disease Control and Prevention

Email: rcoates@cdc.gov

Laurie Cynkin, MHS

Program Analyst

Office of the Director

Division of Cancer Control and Population Sciences

National Cancer Institute

National Institutes of Health

Email: cynkinl@mail.nih.gov

Jon Kerner, PhD

Formerly: 

Deputy Director for Research Dissemination and 

Diffusion

Division of Cancer Control and Population Sciences

National Cancer Institute

National Institutes of Health

Cheryl C. Thomas, MPH

Deputy Associate Director for Science

Division of Cancer Prevention and Control

National Center for Chronic Disease Prevention and 

Health Promotion 

Centers for Disease Control and Prevention

Email: ccthomas@cdc.gov

4. Chronic Kidney Disease

Workgroup Coordinators

Lawrence Agodoa, MD, FACP

Director

Chronic Kidney Disease and End Stage Renal Disease 

Programs

Office of Minority Health Research Coordination

National Institute of Diabetes, Digestive and Kidney 

Diseases

National Institutes of Health

Email: agodaoL@mail.nih.gov
Appendix C C-3

Paul W. Eggers, PhD

Program Director for

Kidney and Urology Epidemiology

National Institute of Diabetes, Digestive and Kidney 

Diseases 

National Institutes of Health

Email: eggersp@extra.niddk.nih.gov

Contributing Member

Beth Forrest

U.S. Renal Data System Coordinating Center

Email: bforrest@usrds.org

5. Diabetes

Workgroup Coordinators

Lawrence Barker, PhD

Associate Director of Science 

Division of Diabetes Translation

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: LBarker1@cdc.gov

Sanford Garfield, PhD

Senior Advisor

Biometry and Behavioral Research Program

Division of Diabetes, Endocrinology, and Metabolic 

Diseases

National Institute of Diabetes, Digestive and Kidney 

Diseases 

National Institutes of Health

Email: garfields@ep.niddk.nih.gov

Edward Gregg, PhD

Branch Chief

Epidemiology and Statistics Branch 

Division of Diabetes Translation

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: EGregg@cdc.gov

6. Disability and Secondary Conditions

Workgroup Coordinators

Donald Betts, MPA

Deputy Director

Division of Human Development and Disability

National Center on Birth Defects and Developmental 

Disabilities

Centers for Disease Control and Prevention

Email: dbetts@cdc.gov

David Keer, MA

Program Manager

National Institute on Disability and Rehabilitation 

Research

U.S. Department of Education

Email: david.keer@ed.gov

Monica M. Manns 

Public Health Analyst 

Office of Policy, Planning and Evaluation 

National Center on Birth Defects and 

Developmental Disabilities 

Centers for Disease Control and Prevention 

Email: mmanns@cdc.gov

Louis Quatrano, PhD

Program Director, BSRE, NCMRR

Eunice Kennedy Shriver National Institute of Child 

Health and Human Development

National Institutes of Health

Email: quatranol@mail.nih.gov

7. Educational and Community-Based Programs

Workgroup Coordinators

Chandak Ghosh, MD, MPH

Medical Consultant for Federal Policy

Office of Regional Operations

Health Resources and Services Administration

Email: cghosh@hrsa.gov

Audrey Williams

Public Health Advisor

Division of Adult and Community Health

Centers for Disease Control and Prevention

Email: akwilliams@cdc.gov
C-4 HEALTHY PEOPLE 2010 FINAL REVIEW

8. Environmental Health

Workgroup Coordinators

Whitney Neal, MSPH

Health Scientist

Office of Science

National Center for Environmental Health/Agency 

for Toxic Substances and Disease Registry Centers for 

Disease Control and Prevention

Email: WNeal@cdc.gov

Radha Pennotti, MPH 

Public Health Analyst

Office of Policy, Planning, and Evaluation

National Center for Environmental Health/

Agency for Toxic Substances and Disease Registry 

Centers for Disease Control and Prevention 

Email: RPennotti@cdc.gov

9. Family Planning

Workgroup Coordinators

Vanessa A. White, MPH

Public Health Advisor

Office of Family Planning

Office of Population Affairs

U.S. Department of Health and Human Services

Email: vanessa.white@hhs.gov

Contributing Members

Evelyn Kappeler

Former workgroup coordinator

Acting Director

Office of Adolescent Health

Office of the Assistant Secretary for Health

U.S. Department of Health and Human Services

Email: evelyn.kappeler@hhs.gov

Amy Margolis, MPH, CHES 

Former workgroup coordinator

Public Health Analyst

Office of Adolescent Health

Office of the Assistant Secretary for Health

U.S. Department of Health and Human Services

Email: amy.margolis@hhs.gov

Gladys Martinez

Statistician

National Center for Health Statistics

Centers for Disease Control and Prevention

Email: gmm7@cdc.gov

William Mosher

Statistician

National Center for Health Statistics

Centers for Disease Control and Prevention

Email: wdm1@cdc.gov

Susan Moskosky, MS, RNC

Director

Office of Family Planning

Office of Population Affairs

Office of the Assistant Secretary for Health

U.S. Department of Health and Human Services

Email: susan.moskosky@hhs.gov

Stephanie Ventura

Branch Chief

Reproductive Statistics Branch

National Center for Health Statistics

Centers for Disease Control and Prevention 

Email: sjv1@cdc.gov

10. Food Safety

Workgroup Coordinators

Elisa L. Elliot, PhD

Microbiologist

Center for Food Safety and Applied Nutrition

Office of Food Defense, Communication, and Emergency 

Response

Food and Drug Administration

Email: elisa.elliot@fda.hhs.gov

Delila Parham, DVM

Branch Chief

Zoonoses and Food Hazards Surveillance Branch

Applied Epidemiology Division

Office of Public Health Science

Food Safety and Inspection Service

U.S. Department of Agriculture

Email: delila.parham@fsis.usda.gov

11. Health Communication

Workgroup Coordinators

Cynthia Baur, PhD

Senior Advisor, Health Literacy

Office of the Associate Director for Communication

Centers for Disease Control and Prevention

Email: cbaur@cdc.gov
Appendix C C-5

Linda Harris, PhD

Public Health Advisor

Team Lead Health Communication and eHealth

Office of Disease Prevention and Health Promotion

Email: Linda.Harris@hhs.gov

12. Heart Disease and Stroke

Workgroup Coordinators

Yuling Hong, MD, PhD

Associate Director for Science

Division for Heart Disease and Stroke Prevention

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: yhong@cdc.gov

Joylene John-Sowah, MD, MPH

Medical Officer

Division for the Application of Research Discoveries

National Heart, Lung, and Blood Institute

National Institutes of Health

Email: johnsowahj@mail.nih.gov

Fleetwood Loustalot, PhD

Commission Corps Officer

Division for Heart Disease and Stroke Prevention

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: hgn1@cdc.gov

Contributing Members

James I. Cleeman, MD

Senior Medical Officer

Center for Quality Improvement and Patient Safety

Agency for Healthcare Research and Quality

Email: james.cleeman@ahrq.gov

Kurt Greenlund, PhD 

Senior Epidemiologist 

Division for Heart Disease and 

Stroke Prevention 

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: keg9@cdc.gov

Robinson Fulwood, PhD, MSPH

Former workgroup coordinator,

Acting Deputy Director, retired 

Division for the Application of Research Discoveries

National Heart, Lung, and Blood Institute

National Institutes of Health

Nora Keenan, PhD

Former workgroup coordinator 

Epidemiologist, retired

Division for Heart Disease and Stroke Prevention

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Darwin Labarthe, MD, MPH, PhD

Former workgroup coordinator

Director, retired

Division for Heart Disease and Stroke Prevention

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Paul A. Scott, PhD

Director

Office of Science Policy and Planning

National Institute of Neurological Disorders and Stroke

National Institutes of Health

Email: scottp@ninds.nih.gov

13. HIV

Workgroup Coordinators

J. Stan Lehman, MPH

Epidemiologist

Office of Policy and Planning

Division of HIV/AIDS Prevention

Centers for Disease Control and Prevention

Email: slehman@cdc.gov

Pamela Wilson, MSW, LCSW-C

Division of Science and Policy

HIV/AIDS Bureau

Health Resources and Services Administration

Email: pwilson@hrsa.gov
C-6 HEALTHY PEOPLE 2010 FINAL REVIEW

14. Immunization and Infectious Diseases

Workgroup Coordinators

Rebecca Gold, JD

Policy Analyst

National Center for Immunization and Respiratory 

Diseases

Centers for Disease Control and Prevention

Email: rgold@cdc.gov

C. Erik Williams

Office of Program Planning and Policy Coordination

National Center for HIV/AIDS, Viral Hepatitis, STD, and 

TB Prevention

Coordinating Center for Infectious Diseases

Centers for Disease Control and Prevention

Email: gqu2@cdc.gov

Contributing Members

Bethany Anderson, MPH

Health Policy Analyst

Financial Management Office

Centers for Disease Control and Prevention

Email: bja3@cdc.gov

Lawrence Barker

Science Officer

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: lsb8@cdc.gov

Achal Bhatt, PhD

Health Communications Specialist

National Center for Immunization and Respiratory 

Diseases

Centers for Disease Control and Prevention

Email: zvg8@cdc.gov

Shelly Bratton

Public Health Analyst

Center for Global Health

Centers for Disease Control and Prevention

Email: bwp8@cdc.gov

Jennifer Brooks

Public Health Analyst

Office of Public Health Preparedness and Response

Centers for Disease Control and Prevention

Email: jlc9@cdc.gov

Sandra Cook

Management and Program Analyst

Office of Public Health Preparedness and Response

Centers for Disease Control and Prevention

Email: sbc7@cdc.gov

Jonathan Edwards

Mathematician Statistician

National Center for Emerging Zoonotic and Infectious 

Diseases

Centers for Disease Control and Prevention

Email: jde3@cdc.gov

Paulette Ford-Knights

Public Health Analyst

National Center for Emerging Zoonotic and Infectious 

Diseases

Centers for Disease Control and Prevention

Email: pbf7@cdc.gov

Teresa Horan

Epidemiologist

National Center for Emerging Zoonotic and Infectious 

Diseases

Centers for Disease Control and Prevention

Email: tch1@cdc.gov

Laurie Johnson

Deputy Director

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: laj1@cdc.gov

Peng-Jun Lu

Senior Service Fellow

National Center for Immunization and Respiratory 

Diseases

Centers for Disease Control and Prevention

Email: lhp8@cdc.gov

Karen Mason, MPA

Public Health Analyst

National Center for Immunization and Respiratory 

Diseases

Centers for Disease Control and Prevention

Email: bbx3@cdc.gov

Nancy Meissonier

Medical Officer

National Center for Immunization and Respiratory 

Diseases

Centers for Disease Control and Prevention

Email: nar5@cdc.gov
Appendix C C-7

Thomas Navin

Branch Chief

Surveillance and Epidemiology Branch

National Center for Emerging Zoonotic and Infectious 

Diseases

Centers for Disease Control and Prevention

Email: trn1@cdc.gov

Amy Pulver

Public Health Analyst

Office of the Director

Centers for Disease Control and Prevention

Email: cex3@cdc.gov

Daniel Riedford

Associate Director for Policy Planning and Exter

National Center for HIV/AIDS, Viral Hepatitis, STD, and 

TB Prevention

Centers for Disease Control and Prevention

Email: dgr0@cdc.gov

Valerie Robison

Dental Officer

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: vcr6@cdc.gov

Sandra Roush, MT, MPH

Epidemiologist

National Center for Immunization and Respiratory 

Diseases

Centers for Disease Control and Prevention

Email: swr1@cdc.gov

James Singleton

Epidemiologist and Branch Chief

Assessment Branch

Immunization Services Division

National Center for Immunization and Respiratory 

Diseases

Centers for Disease Control and Prevention

Email: xzs8@cdc.gov

Nicole Smith

Associate Director for Policy

Center for Global Health

Centers for Disease Control and Prevention

Email: nba8@cdc.gov

Jeremy Sobel

Medical Officer

Center for Global Health

Centers for Disease Control and Prevention

Email: qzs3@cdc.gov

Carole Stanwyck

Epidemiologist

National Center for Immunization and Respiratory 

Diseases

Centers for Disease Control and Prevention

Email: cea9@cdc.gov

Shannon Stokley

Lead Epidemiologist

National Center for Immunization and Respiratory 

Diseases

Centers for Disease Control and Prevention

Email: zma2@cdc.gov

Susan Van Aacken, MSPP

Public Health Analyst

National Center for Chronic Disease and Public Health 

Promotion

Centers for Disease Control and Prevention

Email: zqi7@cdc.gov

Annemarie Wasley

Epidemiology

Center for Global Health

Centers for Disease Control and Prevention

Email: acw5@cdc.gov

Cindy Weinbaum

Medical Officer

National Center for Emerging Zoonotic and Infectious 

Diseases

Centers for Disease Control and Prevention

Email: chw4@cdc.gov

Elizabeth Zell

Mathematical Statistician

National Center for Immunization and Respiratory 

Diseases

Centers for Disease Control and Prevention

Email: ezr1@cdc.gov

15. Injury and Violence Prevention

Workgroup Coordinator

Arlene Greenspan, DrPH, MPH

Associate Director for Science

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Email: aig0@cdc.gov
C-8 HEALTHY PEOPLE 2010 FINAL REVIEW

Contributing Members

J. Lee Annest, PhD

Director

Office of Statistics and Programming 

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention 

Email: lannest@cdc.gov

Mick Ballesteros, PhD

Deputy Associate Director for Science

Division of Unintentional Injury Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Email: mballesteros@cdc.gov

Li-Hiu Chen, MS, PhD

Senior Service Fellow

Office of Analysis and Epidemiology

National Center for Health Statistics

Centers for Disease Control and Prevention

Email: lchen3@cdc.gov

Tad Haileyesus, MS

Mathematical Statistician

Office of Statistics and Programming

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Email: boq2@cdc.gov

Robin M. Ikeda, MD, MPH 

Former workgroup coordinator

Director 

Office of Noncommunicable Diseases, Injury and 

Environmental Health

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Email: rmi0@cdc.gov

Renee L. Johnson, RPT, MSPH

Epidemiologist

Division of Injury Response

National Center for Injury Prevention and Control 

Centers for Disease Control and Prevention 

Email: rjohnson1@cdc.gov

Caryll Rinehart 

Program Analyst

Office of Policy, Planning, and Evaluation

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Email: cdr6@cdc.gov

George W. Ryan, PhD

Mathematical Statistician

Office of Statistics and Programming

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Email: gyr0@cdc.gov

Thomas R. Simon, PhD 

Deputy Associate Director for Science 

Division of Violence Prevention 

National Center for Injury Prevention and Control 

Centers for Disease Control and Prevention 

Email: tsimon@cdc.gov

David A. Sleet, PhD

Associate Director for Science

Division of Unintentional Injury Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Email: dds6@cdc.gov

Margarette Warner, PhD

Health Statistician

Office of Analysis and Epidemiology

National Center for Health Statistics

Centers for Disease Control and Prevention

Email: mwarner@cdc.gov

16. Maternal, Infant, and Child Health

Workgroup Coordinators

Reem M. Ghandour, DrPH, MPA

Public Health Analyst

Office of Epidemiology

Policy and Evaluation Maternal and Child Health Bureau 

Health Resources and Services Administration 

Email rghandour@hrsa.gov

Monica M. Manns 

Public Health Analyst

Office of Policy, Planning and Evaluation 

National Center on Birth Defects and 

Developmental Disabilities 

Centers for Disease Control and Prevention 

Email: mmanns@cdc.gov

Mirna Perez, MA

Office of the Director, Division of Reproductive Health

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: mperezrodriquez@cdc.gov
Appendix C C-9

Contributing Members

William Byram Clayton

Public Health Analyst

Office of the Director

Division of Reproductive Health

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: Bjc5@cdc.gov

Heather C. Hamner, PhD, MS, MPH

Health Scientist

Division of Birth Defects and Developmental Disabilities 

National Center on Birth Defects and Developmental 

Disabilities

Centers for Disease Control and Prevention

Email: hfc2@cdc.gov

Harriet Jett, JD, MPA 

Associate Director for Partnership, Program 

Development, Policy, and Evaluation 

Division of Reproductive Health

National Center for Chronic Disease Prevention and 

Health Promotion 

Centers for Disease Control and Prevention 

Email: hjett@cdc.gov

James Kucik, MPH 

Health Scientist

Division of Birth Defects and Developmental Disabilities 

National Center on Birth Defects and Developmental 

Disabilities 

Centers for Disease Control and Prevention 

Email: jkucik@cdc.gov

Cara Mai, MPH 

Public Health Analyst

Division of Birth Defects and Developmental Disabilities 

National Center on Birth Defects and Developmental 

Disabilities 

Centers for Disease Control and Prevention 

Email: cmai@cdc.gov

Joe Mulinare, MD, MSPH

Medical Epidemiologist

Division of Birth Defects and Developmental Disabilities 

National Center on Birth Defects and Developmental 

Disabilities

Centers for Disease Control and Prevention

Email: jmulinare@cdc.gov

Sarah Tinker, PhD, MPH 

Epidemiologist

Division of Birth Defects and Developmental Disabilities

National Center on Birth Defects and Developmental 

Disabilities 

Centers for Disease Control and Prevention

Email: stinker1@cdc.gov

Kim Van Naarden Braun, PhD

Epidemiologist

Division of Birth Defects and Developmental Disabilities 

National Center on Birth Defects and Developmental 

Disabilities 

Centers for Disease Control and Prevention 

Email: Kvannaardenbraun@cdc.gov

17. Medical Product Safety

Workgroup Coordinators

Mary Ghods, RPh

Pharmacist

Office of the Center Director—Safe Use Initiative

Center for Drug Evaluation and Research

Food and Drug Administration

Email: Mary.ghods@fda.hhs.gov

Dale Slavin, PhD

Associate Director of Programs/Program/Policy Analyst

Office of the Center Director—Safe Use Initiative

Center for Drug Evaluation and Research

Food and Drug Administration

Email: dale.slavin@fda.hhs.gov

18. Mental Health and Mental Disorders

Workgroup Coordinator

Kevin J. Malone

Public Health Analyst

Office of Policy Planning and Innovation

Substance Abuse and Mental Health Services 

Administration

Email: kevin.malone@samhsa.hhs.gov
C-10 HEALTHY PEOPLE 2010 FINAL REVIEW

19. Nutrition and Overweight

Workgroup Coordinators

Nancy T. Crane, MS, MPH, RD

Expert Regulatory Review Scientist

Nutrition Programs Staff

Office of Nutrition, Labeling and Dietary Supplements

Food and Drug Administration

Email: nancy.crane@fda.hhs.gov

Deborah A. Galuska, MPH, PhD

Associate Director for Science

Division of Nutrition, Physical Activity, and Obesity

Centers for Disease Control and Prevention

Email: dgaluska@cdc.gov

Van S. Hubbard, MD, PhD

Rear Admiral, U.S. Public Health Service

Director 

Division of Nutrition Research Coordination

National Institutes of Health

Email: hubbardv@mail.nih.gov

Pamela E. Starke-Reed, PhD

Deputy Director

Division of Nutrition Research Coordination

National Institutes of Health

Email: starkep@mail.nih.gov

Contributing Members

Mary E. Cogswell, RN, DrPH

Epidemiologist

Division of Heart Disease and Stroke Prevention

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: MCogswell@cdc.gov

Karen Dalenius, RD, MPH

Team Lead

Division of Nutrition, Physical Activity, and Obesity

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: KDalenius@cdc.gov

Vincent DeJesus, MS

Nutritionist

Nutrition Programs Staff 

Office of Nutrition, Labeling and Dietary Supplements

Food and Drug Administration

Email: vincent.dejesus@fda.hhs.gov

Kevin W. Dodd, PhD

Mathematical Statistician

Division of Cancer Prevention

National Cancer Institute

National Institutes of Health

Email: doddk@mail.nih.gov

Joseph D. Goldman, MA

Mathematical Statistician

Food Surveys Research Group

Agricultural Research Service

U.S. Department of Agriculture

Email: joe.goldman@ars.usda.gov

Laurence Grummer-Strawn, PhD

Branch Chief

Nutrition Branch

Division of Nutrition, Physical Activity, and Obesity

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: LGrummer-Strawn@cdc.gov

Anne C. Looker, PhD

Distinguished Consultant

Office of Surveillance, Epidemiology and Laboratory 

Services

National Center for Health Statistics

Centers for Disease Control and Prevention

Email: ALooker@cdc.gov

Crystal McDade-Ngutter, PhD

Health Program Specialist

Division of Nutrition Research Coordination

National Institutes of Health

Email: mcdadengutterc@mail.nih.gov

Zuguo Mei, MD, MPH

Epidemiologist

Division of Nutrition, Physical Activity, and Obesity

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: ZMei@cdc.gov

Mark Nord, PhD

Sociologist

Food Economics Division

Economic Research Service

U.S. Department of Agriculture

Email: marknord@ers.usda.gov
Appendix C C-11

Christine Pfeiffer, PhD

Supervisory Research Chemist

Division of Laboratory Sciences

National Center for Environmental Health

Centers for Disease Control and Prevention

Email: CPfeiffer@cdc.gov

Barbara O. Schneeman, PhD

Director

Office of Nutrition, Labeling and Dietary Supplements

Food and Drug Administration

Email: barbara.schneeman@fda.hhs.gov

Bettylou Sherry, PhD

Team Lead

Division of Nutrition, Physical Activity, and Obesity

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: BSherry@cdc.gov

20. Occupational Safety and Health

Workgroup Coordinators

Jessica Bilics, MPH

Public Health Analyst

Office of the Director

National Institute for Occupational Safety and Health

Centers for Disease Control and Prevention

Email: JBilics@cdc.gov

Lore Jackson Lee, MPH

Public Health Analyst

Office of the Director

National Institute for Occupational Safety and Health

Centers for Disease Control and Prevention

Email: LJAcksonLee@cdc.gov

21. Oral Health

Workgroup Coordinators

Patrick Blahut, DDS, MPH, Diplomate ABDPH

Deputy Director

Division of Oral Health

Indian Health Service

Email: patrick.blahut@ihs.gov

Amit Chattopadhyay

Office of Science Policy Analysis

National Institute of Dental and Craniofacial Research

National Institutes of Health

Email: chattopadhyaya@nidcr.nih.gov

Hyewon Lee, DMD 

Dental Consultant

Office of Strategic Priorities

Office of Special Health Affairs

Health Resources and Services Administration

Email: hlee@hrsa.gov

Janet E. Leigh BDS, DMD

Senior Dental Advisor

Office of Strategic Priorities

Office of Special Health Affairs

Health Resources and Services Administration

Email: jleigh@hrsa.gov

Gina Thornton-Evans, DDS, MPH

Dental Officer

Surveillance, Investigations and Research Team

Division of Oral Health

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: gdt4@cdc.gov

Contributing Member

Bruce A. Dye, DDS, MPH

Dental Epidemiology Officer, U.S. Public Health Service

Division of Health and Nutrition Examination Statistics

National Center for Health Statistics

Centers for Disease Control and Prevention

Email: bfd1@cdc.gov

22. Physical Activity and Fitness

Workgroup Coordinators

Janet Fulton, PhD

Epidemiologist

Division of Nutrition, Physical Activity, and Obesity 

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: janet.fulton@cdc.hhs.gov
C-12 HEALTHY PEOPLE 2010 FINAL REVIEW

Jane Wargo

Program Analyst

President’s Council on Fitness, Sports & Nutrition

Email: jane.wargo@hhs.gov

Contributing Members

Sandra Ham

Former workgroup coordinator

Health Statistician

Division of Nutrition, Physical Activity, and Obesity

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Christine G. Spain

Former workgroup coordinator

Director, retired

Research, Planning, and Special Projects

President’s Council on Fitness, Sports & Nutrition

23. Public Health Infrastructure

Workgroup Coordinators

Liza Corso

Acting Branch Chief

Agency and Systems Improvement Branch

Division of Public Health Performance Improvement

Office of State, Tribal, Local, and Territorial Support

Centers for Disease Control and Prevention

Email: Lcorso@cdc.gov

Emily DeCoster, MPH

Healthy People Workgroup Coordinator 

Office of Planning, Analysis and Evaluation

Office of Research and Evaluation

Health Resources and Services Administration

Email: edecoster@hrsa.gov

Contributing Members

Stephanie Bailey, MD (retired)

Centers for Disease Control and Prevention

Beverly Helene Smith, MHS, RRT

Grants Management Specialist/ Public Health Analyst

Division of Grants Management Operations

Office of Federal Assistance Management 

Health Resources and Services Administration

Email: bsmith@hrsa.gov

24. Respiratory Diseases

Workgroup Coordinators

Joylene John-Sowah, MD, MPH

Medical Officer

Division for the Application of Research Discoveries 

National Heart Lung and Blood Institute 

National Institutes of Health 

Email: johnsowahj@mail.nih.gov

Jeanne Moorman, MS

Survey Statistician

Division of Environmental Hazards and Health Effects

National Center for Environmental Health

Centers for Disease Control and Prevention

Email: zva9@cdc.gov

Contributing Members

Lara Akinbami, MD

CDR, U.S. Public Health Service

Medical Officer III 

Office of Analysis and Epidemiology

National Center for Health Statistics

Centers for Disease Control and Prevention

Email: LAkinbami@cdc.gov

M. Beth Benedict, DrPH, JD

Social Science Research Analyst, retired 

Division of State Program Research 

Research and Evaluation Group 

Office of Research, Development and Information 

Centers for Medicare & Medicaid Services 

Charles F. Dillon, MD, PhD, MPH

Medical Research Officer

Division of Health and Nutrition Examination Statistics 

National Center for Health Statistics

Centers for Disease Control and Prevention

Email: cid2@cdc.gov

Robinson Fulwood, PhD, MSPH. 

Former workgroup coordinator

Acting Deputy Director, retired 

Division for the Application of Research Discoveries

National Heart, Lung, and Blood Institute

National Institutes of Health

Peter J. Gergen, MD, MPH

Medical Officer

Division of Allergy, Immunology and Transplantation

National Institute of Allergy and Infectious Diseases

National Institutes of Health

Email: pgergen@niaid.nih.gov
Appendix C C-13

William Jirles, MPH

Program Analyst

Office of Policy, Planning, and Evaluation

National Institute of Environmental Health Sciences

National Institutes of Health

Email: jirles@niehs.nih.gov

Elizabeth Lancet

Assistant Vice President, Research

American Lung Association

Email: elancet@lungusa.org

Daniel S. Lewin, PhD, D, ABSM

Program Director

Sleep Disorders Medicine Program

National Center on Sleep Disorders Research 

Division of Lung Diseases 

National Heart Lung and Blood Institute 

National Institutes of Health 

Email: LewinDS@nhlbi.nih.gov

Antonello Punturieri, MD, PhD 

Program Director 

Division of Lung Diseases 

National Heart, Lung, and Blood Institute

National Institutes of Health 

Email: punturieria@nhlbi.nih.gov

Stephen Reed, MD

Former workgroup coordinator

RADM, U.S. Public Health Service 

Director

Influenza Coordination Unit

Office of Infectious Diseases

Centers for Disease Control and Prevention

Email: SRedd@cdc.gov

Diana Schmidt, MPH

Coordinator, retired

National Asthma Education and Prevention Program

Division for the Application of Research Discoveries

National Heart, Lung, and Blood Institute

National Institutes of Health

Michael Twery, PhD

Director

National Center on Sleep Disorders Research 

Division of Lung Diseases

National Heart, Lung, and Blood Institute 

National Institutes of Health 

Email: Twery@nih.gov

25. Sexually Transmitted Diseases

Workgroup Coordinator

Rachel S. Wynn, MPH

Office of Policy, Planning, and External Relations 

Division of STD Prevention 

National Center for HIV/AIDS, Viral Hepatitis, STD and 

TB Prevention 

Centers for Disease Control and Prevention

Email: rwynn@cdc.gov

Contributing Members

Stuart Berman, MD, ScM

Senior Advisor to the Director 

Division of STD Prevention

National Center for HIV/AIDS, Viral Hepatitis, STD, and 

TB Prevention

Centers for Disease Control and Prevention

Email: SBerman@cdc.gov

John Douglas, MD

Chief Medical Officer

National Center for HIV/AIDS, Viral Hepatitis, STD, and 

TB Prevention

Centers for Disease Control and Prevention

Email: JDouglas@cdc.gov

Amy Pulver, MA, MBA, MA

Policy Analyst

Office of the Associate Director For Policy

Centers for Disease Contol and Prevention

Email: Amy.Pulver@cdc.hhs.gov

Jill Wasserman, MPH

Health Education Specialist

Office on Women's Health 

Office of the Assistant Secretary for Health

U.S. Department of Health and Human Services

Email: Jill.Wasserman1@hhs.gov

Hillard Weinstock, MD, MPH

Medical Epidemiologist 

Division of STD Prevention

National Center for HIV/AIDS, Viral Hepatitis, STD, and 

TB Prevention

Centers for Disease Control and Prevention

Email: HWeinstock@cdc.gov
C-14 HEALTHY PEOPLE 2010 FINAL REVIEW

26. Substance Abuse

Workgroup Coordinators

Ralph W. Hingson, ScD, MPH 

Director 

Division of Epidemiology and Prevention Research 

National Institute on Alcohol Abuse and Alcoholism 

National Institutes of Health 

Email: rhingson@mail.nih.gov

Geoffrey Laredo 

Senior Advisor to the Director 

Office of Science Policy and Communications 

National Institute on Drug Abuse 

National Institutes of Health 

Email: glaredo@nida.nih.gov

Kevin J. Malone

Public Health Analyst

Office of Policy, Planning, and Innovation

Substance Abuse and Mental Health Services 

Administration

Email: kevin.malone@samhsa.hhs.gov

Contributing Members 

Nancy P. Brady

Special Assistant and Public Health Analyst

Center for Behavioral Health Statistics and Quality

Substance Abuse and Mental Health Services 

Administration

Email: Nancy.brady@samhsa.hhs.gov

Bennett W. Fletcher, PhD

CAPT, U.S. Public Health Service

Senior Research Psychologist

Division of Epidemiology, Services and Prevention 

Research

National Institute on Drug Abuse

National Institutes of Health

Andrea K. Kamargo, MSW 

Senior Public Health Analyst 

Office of Program Analysis and Coordination 

Substance Abuse and Mental Health Services 

Administration 

E-mail: andrea.kamargo@samhsa.hhs.gov

Nancy J. Kennedy, DrPH

Senior Public Health Advisor

Division of Systems Development

Substance Abuse and Mental Health Services 

Administration

Email: nancy.kennedy@samhsa.hhs.gov

Kari Kinnard

Highway Safety Specialist

Impaired Driving Division

National Highway Traffic Safety Administration

Dorothy B. Lewis

Project Officer HIV/AIDS Team

Division of Services Improvement

Center for Substance Abuse Treatment 

Substance Abuse Mental Health Services Administration 

Email: Dorothy.Lewis@samhsa.hhs.gov

Carter A. Roeber, PhD

Senior Research Associate

LTG Associates, Inc.

27. Tobacco Use

Workgroup Coordinators

Allison MacNeil, MPH

Health Scientist

Office on Smoking and Health

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: amacneil@cdc.gov

Gabbi Promoff, MA

Issues Management Team Lead

Office on Smoking and Health

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: GPromoff@cdc.gov

Contributing Members

Ralph Caraballo, PhD

Branch Chief

Epidemiology Branch

Office on Smoking and Health

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: RCaraballo@cdc.gov

Timothy McAfee

Director, Office on Smoking and Health

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: TMcAfee@cdc.gov
Appendix C C-15

Terry Pechacek, PhD

Associate Director for Science 

Office on Smoking and Health

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: TPechacek@cdc.gov

Dana Shelton, MPH

Associate Director for Policy

Office on Smoking and Health

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: DShelton@cdc.gov

28. Vision and Hearing

Workgroup Coordinators

Howard J. Hoffman

Program Director for Epidemiology and Statistics

Division of Scientific Programs

National Institute on Deafness and Other 

Communication Disorders

National Institutes of Health

Email: hoffmanh@nidcd.nih.gov

Rosemary Janiszewski, MS, CHES

Associate Director for Communication, Health 

Education, and Public Liaison

National Eye Institute

National Institutes of Health

Email: rjaniszewski@nei.nih.gov

Lonnie L. Lisle

Office of Health Communication and Public Liaison

National Institute on Deafness and Other 

Communication Disorders 

National Institutes of Health

Email: lislel@nidcd.nih.gov

Adolescent Health

Trina Anglin, MD, PhD

Chief

Office of Adolescent Health

Maternal and Child Health Bureau

Health Resources and Services Administration

Email: tanglin@hrsa.gov

Cherie Gray, MA

Public Health Analyst

Office of the Director

Division of Adolescent and School Health

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention

Email: cng2@cdc.gov

Health of Racial/Ethnic Minority Populations 

Myrtha Beadle

Acting Deputy Director

Office of Public Health Science

Office of Minority Health

U.S. Department of Health and Human Services

Email: mbeadle@osophs.dhhs.gov

Women’s Health

Suzanne Haynes, PhD

Senior Science Advisor

Office on Women's Health

U.S. Department of Health and Human Services

Email: shaynes@osophs.dhhs.gov

Health of People with Disabilities

Eileen Elias 

Deputy Director

Office on Disability and Health 

U.S. Department of Health and Human Services

Email: eileen.elias@hhs.gov

APPENDIX D D-1

APPENDIX D:

A Crosswalk Between Objectives From Healthy 

People 2010 to Healthy People 2020

Definition of terms:

〉 As of the Healthy People 2020 (HP2020) launch, 

HP2020 objectives that were retained “as is” from 

Healthy People 2010 (HP2010) had no change in the 

numerator or denominator definitions, the data 

source(s), or data collection methodology. These 

include objectives that were developmental in 

HP2010 and are developmental in HP2020, and for 

which no numerator information is available.

〉 As of the HP2020 launch, objectives that were 

modified from HP2010 had some change in the 

numerator or denominator definitions, the data 

source(s), or data collection methodology. These 

include objectives that went from developmental in 

HP2010 to measurable in HP2020, or vice versa.

〉 Archived objectives had at least one data point in 

HP2010 but were not carried forward into HP2020.

〉 Dropped objectives were not carried forward into 

HP2020. These objectives were either developmental 

or deleted at the HP2010 Midcourse Review or at 

another time in HP2010.

Legend 

One objective in HP2010 was divided into two or 

more objectives in HP2020.

Two or more objectives in HP2010 were combined 

into one objective in HP2020.

Crosswalk

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

Focus Area 1: Access to Quality Health Services

1–1 AHS-1.1

1–2 Dropped

1–3a Archived

1–3b Archived

1–3c Archived

1–3d Archived

1–3e Dropped

1–3f Archived

1–3g Dropped

1–3h Archived

1–4a AHS-5.1

1–4b AHS-5.2

1–4c 

AHS-5.3

AHS-5.4

1–5 AHS-3

1–6 

AHS-6.1

AHS-6.2

AHS-6.3

AHS-6.4

1–7a Archived

1–7b Archived

1–7c Archived
D-2 HEALTHY PEOPLE 2010 FINAL REVIEW

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

1–7d Archived

1–7e Archived

1–7f Archived

1–7g Archived

1–7h Archived

1–8a Archived

1–8b Archived

1–8c Archived

1–8d Archived

1–8e Archived

1–8f Archived

1–8g Archived

1–8h Archived

1–8i Archived

1–8j Archived

1–8k Archived

1–8l Archived

1–8m Archived

1–8n Archived

1–8o Archived

1–8p Archived

1–8q Archived

1–8r Archived

1–8s Archived

1–8t Archived

1–9a Archived

1–9b Archived

1–9c Archived

1–10 Archived

1–11a AHS-8.1

1–11b AHS-8.2

1–11c Archived

1–11d Archived

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

1–11e Archived

1–11f Archived

1–11g Archived

1–12 Archived

1–13a Archived

1–13b Archived

1–13c Archived

1–13d Archived

1–13e Archived

1–13f Archived

1–13g Archived

1–13h Archived

1–13i Archived

1–14a Archived

1–14b Archived

1–15a Archived

1–15b Archived

1–15c Archived

1–15d Archived

1–16 Archived

Focus Area 2: Arthritis, Osteoporosis and Chronic Back Conditions 

2–1 AOCBC-1

2–2 AOCBC-2

2–3 AOCBC-4

2–4a AOCBC-7.1

2–4b AOCBC-7.2

2–5a AOCBC-6.1

2–5b AOCBC-6.2

2–6 Archived

2–7 AOCBC-9

2–8 AOCBC-8

2–9 AOCBC-10

2–10 Archived
APPENDIX D D-3

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

2–11 AOCBC-12

Focus Area 3: Cancer

3–1 C-1

3–2 C-2

3–3 C-3

3–4 C-4

3–5 C-5

3–6 C-6

3–7 C-7

3–8 C-8

3–9a C-20.5

3–9b C-20.6

3–10a Archived

3–10b Archived

3–10c Archived

3–10d 

C-18.3

3–10e 

3–10f C-18.1

3–10g C-18.2

3–10h Archived

3–11a Archived

3–11b C-15

3–12a 

C-16

3–12b 

3–13 C-17

3–14 C-12

3–15 C-13

Focus Area 4: Chronic Kidney Disease 

4–1 CKD-8

4–2

CKD-14.3

CKD-14.5

4–3 CKD-10

4–4 

CKD-11.1

CKD-11.2

CKD-11.3

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

4–5 CKD-12

4–6 

CKD-13.1

CKD-13.2

4–7 

CKD-9.1

CKD-9.2

4–8a 

CKD-4.1

CKD-4.2

4–8b CKD-5

Focus Area 5: Diabetes

5–1 D-14

5–2 D-1

5–3 Archived

5–4 D-15

5–5 D-3

5–6 Archived

5–7 Archived

5–8 Dropped

5–9 Dropped

5–10 D-4

5–11 D-12

5–12 D-11 *

5–13 D-10

5–14 D-9 *

5–15 D-8

5–16 Archived

5–17 D-13 *

Focus Area 6: Disability and Secondary Conditions 

6–1 DH-1

6–2 Archived

6–3 DH-18

6–4 DH-13

6–5 DH-17 *

6–6 Archived
D-4 HEALTHY PEOPLE 2010 FINAL REVIEW

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

6–7a DH-12.1

6–7b DH-12.2

6–8 DH-16

6–9 DH-14

6–10 DH-8

6–11 DH-10

6–12a 

DH-9

6–12b 

6–12c 

6–12d 

6–13a Archived

6–13b DH-2.4

6–13c DH-2.1

6–13d DH-2.5

6–13e DH-2.2 *

6–13f DH-2.6

6–13g DH-2.3

6–13h DH-2.7

Focus Area 7: Educational and Community-Based Programs

7–1 ECBP-6

7–2a ECBP-2.1

7–2b ECBP-2.2

7–2c ECBP-2.3

7–2d ECBP-2.4

7–2e ECBP-2.5

7–2f ECBP-2.6

7–2g ECBP-2.7

7–2h ECBP-2.8

7–2i ECBP-2.9

7–2j Archived

7–3 ECBP-7.1

7–4a ECBP-5.1

7–4b ECBP-5.2

7–4c ECBP-5.3

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

7–4d ECBP-5.4

7–5a ECBP-8.1

7–5b ECBP-8.2

7–5c ECBP-8.3

7–5d ECBP-5.4

7–5e ECBP-8.5

7–5f ECBP-8.6

7–6 ECBP-9

7–7 Dropped

7–8 Dropped

7–9 Dropped

7–10 

ECBP-10.1

ECBP-10.2

ECBP-10.3

ECBP-10.4

ECBP-10.5

ECBP-10.6

ECBP-10.7

ECBP-10.8

ECBP-10.9

7–11a Dropped

7–11b Dropped

7–11c Archived

7–11d Dropped

7–11e Dropped

7–11f Dropped

7–11g ECBP-11

7–11h Archived

7–11i Archived

7–11j Dropped

7–11k Dropped

7–11l Dropped

7–11m Archived

7–11n Archived
APPENDIX D D-5

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

7–11o Archived

7–11p Dropped

7–11q Archived

7–11r Archived

7–11s Archived

7–11t Archived

7–11u Archived

7–11v Archived

7–11w Dropped

7–11x Dropped

7–11y Archived

7–11z Archived

7–11A Archived

7–11B Dropped

7–12 Archived

Focus Area 8: Environmental Health

8–1a 

EH-1

8–1b 

8–1c 

8–1d 

8–1e 

8–1f 

8–1g 

8–2a EH-2.1

8–2b EH-2.2

8–2c EH-2.3

8–2d EH-2.4

8–3 Archived

8–4 

EH-3.1

EH-3.2

EH-3.3

8–5 EH-4

8–6 EH-5

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

8–7 EH-6

8–8a Archived

8–8b Archived

8–9 EH-7

8–10a Archived

8–10b Archived

8–11 EH-8.1

8–12a EH-9

8–12b Archived

8–12c Archived

8–12d Archived

8–13 EH-10

8–14a Dropped

8–14b EH-11

8–15 EH-12

8–16a Archived

8–16b Archived

8–16c EH-13.1

8–17 Dropped

8–18 Archived

8–19 

EH-14

EH-15

8–20 

EH-16.1

EH-16.2

EH-16.3

EH-16.4

EH-16.5

EH-16.6

EH-16.7

EH-16.8

EH-16.9

8–21 Archived
D-6 HEALTHY PEOPLE 2010 FINAL REVIEW

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

8–22 

EH-17.1

EH-17.2

EH-17.3

8–23 EH-19

8–24a Dropped

8–24b EH-20.9

8–24c EH-20.10

8–24d Archived

8–25a EH-20.1

8–25b EH-20.2

8–25c EH-20.3

8–25d Dropped

8–25e EH-20.4

8–25f Archived

8–25g Archived

8–25h EH-20.11

8–25i Archived

8–25j 

EH-20.12

EH-20.13

8–25k EH-20.14

8–25l Dropped

8–25m EH-20.6

8–25n Archived

8–25o EH-20.7

8–25p EH-20.8

8–25q EH-20.5

8–25r Archived

8–25s Archived

8–26 EH-21

8–27a EH-22.1

8–27b EH-22.2

8–27c EH-22.3

8–27d EH-22.4

8–27e EH-22.5

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

8–27f Archived

8–27g EH-22.6

8–27h EH-22.7

8–27i Archived

8–27j Archived

8–27k Archived

8–27l Dropped

8–27m Dropped

8–27n Dropped

8–27o Archived

8–28 Dropped

8–29 EH-24

8–30a Archived

8–30b Archived

8–30c Archived

8–30d Archived

8–30e Archived

8–30f Archived

8–30g Archived

8–30h Archived

8–30i Archived

8–30j Archived

8–30k Archived

8–30l Archived

Focus Area 9: Family Planning 

9–1 FP-1

9–2 FP-5

9–3 FP-6

9–4 FP-2

9–5 FP-3.2

9–6a Archived

9–6b Archived

9–6c Archived
APPENDIX D D-7

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

9–7 

FP-8.1

FP-8.2

9–8a FP-9.3

9–8b FP-9.4

9–9a FP-9.1

9–9b FP-9.2

9–10a FP-10.1

9–10b FP-10.2

9–10c FP-11.1

9–10d FP-11.2

9–10e FP-10.3

9–10f FP-10.4

9–10g FP-11.3

9–10h FP-11.4

9–11a FP-12.1

9–11b FP-12.2

9–11c FP-12.3

9–11d FP-12.4

9–11e FP-12.5

9–11f FP-12.6

9–11g FP-12.7

9–11h FP-12.8

9–11i FP-13.1

9–11j FP-13.2

9–11k FP-13.3

9–11l FP-13.4

9–11m FP-13.5

9–11n FP-13.6

9–11o FP-13.7

9–11p FP-13.8

9–12 

MICH-17.1

MICH-17.2

9–13 FP-4

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

Focus Area 10: Food Safety 

10–1a FS-1.1

10–1b FS-1.2

10–1c FS-1.3

10–1d FS-1.4

10–1e Dropped

10–1f FS-1.5

10–1g Dropped

10–2a Archived

10–2b Archived

10–3a FS-3.1

10–3b FS-3.2

10–3c FS-3.3

10–3d FS-3.4

10–3e Dropped

10–3f Dropped

10–3g Dropped

10–3h Dropped

10–3i Dropped

10–3j Dropped

10–3k Dropped

10–3l Dropped

10–3m Dropped

10–3n Dropped

10–3o Dropped

10–3p Dropped

10–4a Dropped

10–4b FS-4

10–5 

FS-5.1

FS-5.2

FS-5.3

FS-5.4
D-8 HEALTHY PEOPLE 2010 FINAL REVIEW

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

10–6a 

FS-6

10–6b 

10–6c 

10–6d 

10–6e 

10–6f 

10–6g 

10–6h 

10–6i 

10–7 Dropped

Focus Area 11: Health Communication 

11–1 HC/HIT-6.1

11–2a Archived

11–2b Archived

11–3a Archived

11–3b Archived

11–3c Archived

11–4a Archived

11–4b Archived

11–4c Archived

11–4d Archived

11–4e Archived

11–4f Archived

11–4g HC/HIT-8.1

11–5 Archived

11–6a HC/HIT-2.1

11–6b HC/HIT-2.2

11–6c HC/HIT-2.3

11–6d HC/HIT-2.4

Focus Area 12: Heart Disease and Stroke 

12–1 HDS-2

12–2 

HDS-16.1

HDS-16.2

HDS-16.3

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

12–3a HDS-19.1

12–3b HDS-19.2

12–4 

HDS-18

12–5 

12–6a HDS-24.1

12–6b HDS-24.2

12–6c HDS-24.3

12–7 HDS-3

12–8 HDS-17.2

12–9 HDS-5.1

12–10 HDS-12

12–11

HDS-10.1

HDS-10.2

HDS-10.3

HDS-10.4

HDS-10.5

HDS-11

12–12 HDS-4

12–13 HDS-8

12–14 HDS-7

12–15 HDS-6

12–16 HDS-20.1

Focus Area 13: HIV

13–1 HIV-4

13–2 HIV-6

13–3 HIV-7

13–4 Archived

13–5 HIV-1

13–6a HIV-17.1

13–6b HIV-17.2

13–7 HIV-13

13–8 HIV-16

13–9 Dropped

13–10 Dropped
APPENDIX D D-9

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

13–11 HIV-15

13–12 Dropped

13–13a 

HIV-10

13–13b 

13–13c 

13–13d 

13–13e 

13–13f 

13–14 HIV-12

13–15 HIV-9

13–16 HIV-11

13–17a HIV-8.1

13–17b HIV-8.2

13–18 Dropped

Focus Area 14: Immunizations and Infectious Diseases 

14–1a IID-1.1

14–1b Archived

14–1c IID-1.2

14–1d IID-1.3

14–1e IID-1.4

14–1f IID-1.5

14–1g IID-1.6

14–1h IID-1.8

14–1i IID-1.9

14–1j Archived

14–1k IID-1.10

14–2 IID-24

14–3a 

14–3b IID-25.1

14–3c 

14–3d IID-25.2

14–3e Archived

14–3f IID-25.3

14–3g Archived

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

14–4 Archived

14–5a IID-4.1

14–5b IID-4.2

14–5c IID-4.3

14–5d IID-4.4

14–6 IID-23

14–7 IID-3

14–8 Archived

14–9 IID-26

14–10 Archived

14–11 IID-29

14–12 IID-30

14–13 IID-31

14–14 IID-32

14–15 Dropped

14–16 IID-2

14–17 Archived

14–18 IID-5

14–19 IID-6

14–20a Archived

14–20b HAI-1

14–20c Archived

14–20d Archived

14–20e Archived

14–21 Archived

14–22a IID-7.1

14–22b IID-7.2

14–22c IID-7.3

14–22d IID-7.4

14–22e IID-7.5

14–22f IID-7.6

14–22g IID-7.7

14–22h IID-12.1

14–23a Archived
D-10 HEALTHY PEOPLE 2010 FINAL REVIEW

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

Focus Area 15: Injury and Violence Prevention

15–1 IVP-2.2

15–2 IVP-3.2

15–3 IVP-30

15–4 Archived

15–5 IVP-31

15–6 IVP-4

15–7 IVP-10

15–8 

IVP-9.1

IVP-9.2

IVP-9.3

IVP-9.4

15–9 

IVP-24.1

IVP-24.2

IVP-24.3

15–10 IVP-6

15–11 IVP-7

15–12 IVP-1.3

15–13 IVP-11

15–14 IVP-12

15–15a IVP-13.1

15–15b IVP-13.2

15–16 IVP-18

15–17 IVP-14

15–18 IVP-19

15–19 IVP-15

15–20 

IVP-16.1

IVP-16.2

IVP-16.3

IVP-16.4

15–21 IVP-22

15–22 IVP-17

15–23a Archived

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

14–23b Archived

14–23c Archived

14–23d Archived

14–23e Archived

14–23f IID-10.1

14–23g IID-10.2

14–23h IID-10.3

14–23i IID-10.4

14–23j IID-10.5

14–23k Archived

14–23l Archived

14–24a IID-8

14–24b Dropped

14–25a IID-17.1

14–25b IID-17.2

14–26 IID-18

14–27a Archived

14–27b Archived

14–27c IID-11.1

14–27d IID-11.2

14–28a IID-15.1

14–28b IID-15.2

14–28c IID-15.3

14–29a IID-12.7

14–29b IID-13.1

14–29c IID-12.6

14–29d IID-13.2

14–29e IID-12.8

14–29f IID-13.3

14–29g IID-12.9

14–30a Archived

14–30b Archived

14–31a IID-16

14–31b Archived
APPENDIX D D-11

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

15–23b Archived

15–24 IVP-21

15–25 IVP-28

15–26a Archived

15–26b Archived

15–27 

IVP-23.1

IVP-23.2

15–28a AOCBC-11.1

15–28b AOCBC-11.2

15–29 IVP-25

15–30 Archived

15–31a IVP-27.1

15–31b Archived

15–31c IVP-27.2

15–32 IVP-29

15–33a IVP-38

15–33b IVP-37

15–34 IVP-39.1

15–35 IVP-40.1

15–36 

IVP-40.2

IVP-40.3

15–37 IVP-33

15–38 IVP-34

15–39 IVP-36

Focus Area 16: Maternal, Infant, and Child Health

16–1a MICH-1.1

16–1b MICH-1.2

16–1c MICH-1.3

16–1d MICH-1.4

16–1e MICH-1.5

16–1f MICH-1.6

16–1g MICH-1.7

16–1h MICH-1.8

16–2a MICH-3.1

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

16–2b MICH-3.2

16–3a MICH-4.1

16–3b MICH-4.2

16–3c MICH-4.3

16–4 MICH-5

16–5a MICH-6

16–5b Dropped

16–5c Dropped

16–6a MICH-10.1

16–6b MICH-10.2

16–7 MICH-12

16–8 MICH-33

16–9a MICH-7.1

16–9b MICH-7.2

16–10a MICH-8.1

16–10b MICH-8.2

16–11a MICH-9.1

16–11b 

MICH-9.2

MICH-9.3

16–11c MICH-9.4

16–12 MICH-13

16–13 MICH-20

16–14a Archived

16–14b MICH-27

16–14c 

MICH-29.1

MICH-29.2

MICH-29.3

16–14d Dropped

16–15 

MICH-28.1

MICH-28.2

16–16a MICH-14†

16–16b MICH-15†

16–17a MICH-11.1

16–17b MICH-11.2
D-12 HEALTHY PEOPLE 2010 FINAL REVIEW

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

16–17c MICH-11.3

16–17d MICH-11.4

16–18 MICH-25

16–19a MICH-21.1

16–19b MICH-21.2

16–19c MICH-21.3

16–19d MICH-21.4

16–19e MICH-21.5

16–20a MICH-32.1

16–20b 

MICH-32.2

MICH-32.3

16–20c Dropped

16–21 BDBS-7

16–22 MICH-30.2

16–23 

MICH-31.1

MICH-31.2

Focus Area 17: Medical Product Safety 

17–1a MPS-1

17–1b Dropped

17–2a Archived

17–2b Archived

17–2c Archived

17–2d Archived

17–3 Dropped

17–4 Archived

17–5a Archived

17–5b Archived

17–6 BDBS-17

Focus Area 18: Mental Health and Mental Disorders

18–1 MHMD-1

18–2 MHMD-2

18–3 MHMD-12

18–4 MHMD-8

18–5 MHMD-3

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

18–6 MHMD-5

18–7 MHMD-6

18–8 MHMD-7

18–9a MHMD-9.1

18–9b MHMD-9.2

18–9c Archived

18–9d Archived

18–10 MHMD-10

18–11 Archived

18–12 Archived

18–13 Archived

18–14 Archived

Focus Area 19: Nutrition and Weight Status

19–1 NWS-8

19–2 NWS-9

19–3a NWS-10.2

19–3b NWS-10.3

19–3c NWS-10.4

19–4 Archived

19–5 NWS-14

19–6 

NWS-15.1

NWS-15.2

19–7 NWS-16

19–8 NWS-18

19–9 Archived

19–10 NWS-19

19–11 NWS-20

19–12a NWS-21.1

19–12b NWS-21.2

19–12c NWS-21.3

19–13 Archived

19–14 NWS-22

19–15 Dropped

19–16 NWS-7
APPENDIX D D-13

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

19–17 NWS-6.1

19–18 NWS-13‡

Focus Area 20: Occupational Safety and Health

20–1a OSH-1.1

20–1b OSH-1.2

20–1c OSH-1.3

20–1d OSH-1.4

20–1e OSH-1.5

20–2a OSH-2.1

20–2b Archived

20–2c Archived

20–2d Archived

20–2e Archived

20–2f Archived

20–2g Archived

20–2h OSH-2.3

20–3 OSH-3

20–4 OSH-4

20–5 OSH-5

20–6 OSH-6

20–7 OSH-7

20–8 OSH-8

20–9 OSH-9

20–10 Archived

20–11 OSH-10

Focus Area 21: Oral Health

21–1a OH-1.1

21–1b OH-1.2

21–1c OH-1.3

21–2a OH-2.1

21–2b OH-2.2

21–2c OH-2.3

21–2d OH-3.1

21–3 OH-4.1

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

21–4 OH-4.2

21–5a Archived

21–5b OH-5

21–6 OH-6

21–7 OH-14.2

21–8a OH-12.2

21–8b OH-12.3

21–9 OH-13

21–10 OH-7

21–11 Archived

21–12 OH-8

21–13a OH-9.1

21–13b OH-9.2

21–14 OH-10.1

21–15 

OH-15.1

OH-15.2

21–16 OH-16

21–17a OH-17.1

21–17b OH-17.2

Focus Area 22: Physical Activity and Fitness

22–1 PA-1

22–2 PA-2.1

22–3 PA-2.2

22–4 PA-2.3

22–5 Archived

22–6 PA-3.1

22–7 PA-3.2

22–8a PA-4.2

22–8b PA-4.3

22–9 PA-5

22–10 Archived

22–11 

PA-8.1

PA-8.2

PA-8.3
D-14 HEALTHY PEOPLE 2010 FINAL REVIEW

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

22–12 PA-10

22–13 PA-12

22–14a 

PA-13

22–14b 

22–15a 

PA-14

22–15b 

Focus Area 23: Public Health Infrastructure

23–1 Dropped

23–2a Archived

23–2b Dropped

23–2c Archived

23–2d Archived

23–3 Archived

23–4 PHI-7

23–5 Dropped

23–6 PHI-8.3

23–7 PHI-9

23–8a PHI-1.1

23–8b PHI-1.2

23–9 PHI-3

23–10a PHI-2

23–10b 

PHI-2

23–10c 

23–11a PHI-14.1

23–11b PHI-14.2

23–11c Archived

23–11d Archived

23–12a PHI-15.1

23–12b PHI-15.2

23–12c PHI-15.3

23–12d PHI-15.4

23–13a PHI-11.1

23–13b PHI-11.2

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

23–13c PHI-11.3

23–13d PHI-11.4

23–13e PHI-11.5

23–13f PHI-11.6

23–13g PHI-11.7

23–13h PHI-11.8

23–13i PHI-11.9

23–13j PHI-11.10

23–13k PHI-11.11

23–14a PHI-13.1

23–14b PHI-13.2

23–14c PHI-13.3

23–14d PHI-13.4

23–15a Archived

23–15b Archived

23–16 Dropped

23–17 Dropped

Focus Area 24: Respiratory Diseases

24–1a

24–1b RD-1.1

24–1c 

24–1d RD-1.2

24–1e RD-1.3

24–2a RD-2.1

24–2b RD-2.2

24–2c RD-2.3

24–3a RD-3.1

24–3b RD-3.2

24–3c RD-3.3

24–4 RD-4

24–5 

RD-5.1

RD-5.2

24–6 RD-6

24–7a RD-7.1
APPENDIX D D-15

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

24–7b RD-7.2

24–7c RD-7.3

24–7d RD-7.4

24–7e Archived

24–7f RD-7.5

24–8 RD-8

24–9 RD-9

24–10 RD-10

24–11a SH-1

24–11b Dropped

24–12 SH-2

Focus Area 25: Sexually Transmitted Diseases

25–1a STD-1.1

25–1b Archived

25–1c Archived

25–1d STD-1.2

25–2a Archived

25–2b STD-6.1

25–3 STD-7

25–4 STD-10

25–5 STD-9

25–6 STD-5

25–7 Archived

25–8 Dropped

25–9 STD-8

25–10 Dropped

25–11a Archived

25–11b Archived

25–11c Archived

25–12 Dropped

25–13 Archived

25–14 Dropped

25–15 Dropped

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

25–16a 

STD-4.1

STD-4.2

25–16b 

STD-3.1

STD-3.2

25–17 Dropped

25–18 Dropped

25–19 Dropped

Focus Area 26: Substance Abuse

26–1a SA-17

26–1b Dropped

26–1c Dropped

26–1d Dropped

26–2 SA-11

26–3 SA-12

26–4 Archived

26–5 Dropped

26–6 SA-1

26–7 Dropped

26–8a Archived

26–8b Archived

26–9a SA-2.1

26–9b SA-2.2

26–9c SA-2.3

26–9d SA-2.4

26–10a SA-13.1

26–10b SA-13.2

26–10c SA-13.3

26–11a SA-14.1

26–11b SA-14.2

26–11c SA-14.3

26–11d SA-14.4

26–12 SA-16
D-16 HEALTHY PEOPLE 2010 FINAL REVIEW

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

26–13a 

SA-15

26–13b 

26–14a SA-18.1

26–14b SA-18.2

26–14c SA-18.3

26–15 SA-21

26–16a SA-3.1

26–16b SA-3.2

26–16c SA-3.3

26–16d SA-3.4

26–16e SA-3.5

26–16f SA-3.6

26–17a SA-4.1

26–17b SA-4.2

26–17c SA-4.3

26–18a SA-8.1

26–18b SA-18.2

26–19 Dropped

26–20 SA-7

26–21 SA-8.3

26–22 Dropped

26–23 Dropped

26–24 Archived

26–25 Archived

Focus Area 27: Tobacco Use

27–1a TU-1.1

27–1b TU-1.2

27–1c TU-1.3

27–1d Dropped

27–2a TU-2.1

27–2b TU-2.2

27–2c TU-2.3

27–2d TU-2.4

27–2e Archived

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

27–3a TU-3.2

27–3b TU-3.6

27–4a Archived

27–4b Archived

27–5 TU-4.1

27–6 TU-6

27–7 TU-7

27–8a Archived

27–8b TU-8

27–8c Dropped

27–9 Archived

27–10 

TU-11.1

TU-11.2

TU-11.3

27–11 

TU-15.1

TU-15.2

TU-15.3

TU-15.4

27–12 TU-12

27–13a TU-13.1

27–13b TU-13.2

27–13c TU-13.3

27–13d TU-13.8

27–13e 

TU-13.6

TU-13.7

27–13f Archived

27–13g Dropped

27–13h Dropped

27–13i TU-13.4

27–14a TU-19.1

27–14b TU-19.2

27–15 Archived

27–16a TU-18.1
APPENDIX D D-17

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

27–16b TU-18.2

27–17a Archived

27–17b Archived

27–17c Archived

27–18a TU-20.1

27–18b TU-20.2

27–18c TU-20.3

27–19 

TU-16.1

TU-16.2

TU-16.3

27–20a Archived

27–20b Archived

27–20c Archived

27–21a TU-17.1

27–21b TU-17.2

Focus Area 28: Vision and Hearing

28–1 V-4

28–2 V-1

28–3 V-5.1

28–4 V-2

28–5 V-5.2

28–6 V-5.3

28–7 V-5.4

28–8a V-3.1

28–8b V-3.2

HP2010

Objectives

HP2020 Objectives

Retained Modified Archived Dropped

28–9a V-6.1

28–9b V-6.2

28–10a V-7.1

28–10b V-7.2

28–11a ENT-VSL-1.1

28–11b ENT-VSL-1.2

28–11c ENT-VSL-1.3

28–12 ENT-VSL-2

28–13a ENT-VSL-3.1

28–13b ENT-VSL-3.2

28–13c ENT-VSL-3.3

28–13d ENT-VSL-3.4

28–14a ENT-VSL-4.1

28–14b ENT-VSL-4.2

28–14c ENT-VSL-4.3

28–15 ENT-VSL-5

28–16a ENT-VSL-6.1

28–16b ENT-VSL-6.2

28–17 ENT-VSL-7

28–18 ENT-VSL-8

* Because of new data collection methodology adopted by BRFSS 

in 2011, this HP2020 objective may not be comparable with its 

corresponding HP2010 objective.

†

 Data for HP2010 are 2-year averages, whereas HP2020 data are 

4-year averages.

‡

 HP2020 objective NWS-13 equals 100% minus HP2010 objective 

19-18.

Appendix e e-1

Target Year 1990 2000 2010 2020

www.healthypeople.gov National Health Promotion and

Disease Prevention Objectives

Overarching Goals 〉 Decrease mortality: 〉 Increase span of healthy 〉 Increase quality and 〉 Attain high-quality, 

infants–adults life years of healthy life longer lives free of 

preventable disease, 

〉 Increase independence 〉 Reduce health disparities 〉 Eliminate health disability, injury, and 

among older adults disparities premature death 〉 Achieve access to 

preventive services 〉 Achieve health equity; 

for all eliminate disparities

〉 Create social and 

physical environments 

that promote good health

〉 Promote quality of life, 

healthy development, 

healthy behaviors across 

life stages

Number of 15 22 28 42

Topic Areas

Number of 226 319 969 1,200 (approximately)

Objectives

Appendix e:

Evolution of Healthy People


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