VII. Chronic Disease Prevention

FY 2000 Performance Plan - Revised Final FY 1999 Performance Plan

Heart Disease and Health Promotion

Heart disease is the Nation's number one killer among men and women of all racial and ethnic groups. More than 40% of all deaths in the United States, 900,000 each year, are directly attributable to heart disease and stroke. Associated annual costs exceed $286 billion. CDC is taking a crosscutting approach to address the burden of heart disease and other health risks in the U. S. through the prevention of risk factors (e.g. tobacco use, physical inactivity, and poor nutrition), surveillance, epidemiologic research, and health promotion activities. Cardiovascular disease is the leading cause of death in all states; CDC is implementing this approach to heart disease and stroke prevention by building state-specific capacity for cardiovascular health promotion, first in those states with the greatest heart disease and stroke burden. In subsequent years, efforts will expand to create capacity in all states and territories in order to build a nationwide cardiovascular health program.

Tobacco use is the leading preventable cause of disability and death, killing more than 400,000 Americans each year at an annual cost of $50 billion in direct medical costs. CDC serves as the focal point for DHHS' smoking and health prevention activities. Comprehensive state programs, including school based programs and local outreach efforts, have been shown to be effective in reducing the prevalence of tobacco use. CDC first funded tobacco prevention programs in 32 states and the District of Columbia in 1994. With funding requested in the President's FY 1999 budget, CDC will provide financial assistance to 50 state health departments, the District of Columbia, and 12 national organizations. The FY 2000 request would allow CDC to expand funding through states to more extensively reach local communities and schools. It also would allow for implementation of national media/educational campaigns. CDC currently conducts surveillance and analysis of tobacco use and its impact; implements national health communication and education campaigns; and distributes technical, health communication, and advertising materials to states and other constituents.

CDC is committed to reducing tobacco use in the population with an ultimate goal of reducing the burden of tobacco-attributable disease. Although CDC's FY 1999 GPRA measures represented processes necessary for states to establish tobacco control programs, CDC's FY 2000 measures will include an outcome indicator related to use of tobacco products. Specifically, CDC's FY 2000 measure for tobacco seeks to reduce smoking among teenagers.

It is important to note that reduction of tobacco use is a shared effort. Multiple agencies in DHHS address tobacco use, including CDC, the Food and Drug Administration (FDA), the National Institutes of Health (NIH), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition, state and local governments (e.g., health departments, Attorneys General), private organizations (e.g., American Cancer Society, the Robert Wood Johnson Foundation), and health care providers all play an important role in efforts to reduce tobacco use. Therefore, our accomplishments in the area of tobacco control will be collective, resulting from partnerships between government and non-government entities. In addition, it is important to note that environmental factors can counteract efforts to reduce tobacco use. Such factors includes tobacco advertising, industry pricing patterns, and glamorization of tobacco use in the popular media.

Performance Goals and Measures

Performance Goal: Reduce morbidity and mortality attributable to behavioral risk factors by building nationwide programs in chronic disease prevention and health promotion and intervening in selected diseases and risk factors.

Performance Measures:

¹ FY 1999 performance measure was changed (from " The number of states with 5 of the 7 core tobacco prevention capacities will be increased from 17 in 1996 to 30 in 1999" to " Reduce the percentage of teenagers (in grades 9-12) who smoke from 36.4% to 21% by 2010 by conducting education campaigns, providing funding, and technical assistance to state programs, and working with non-governmental entities." This would require an annual reduction of 1.2 percentage points (starting in 1997 and ending in FY 2010). As a result, FY 1999 and FY 2000 goals are the same. Please note that the original measure for FY 1999 was based on an old program model which included 7 core tobacco program components (that have been significantly modified under CDC's new 50 State program) The new measure is based on the new program model which is more outcome oriented, and the data that is currently being collected from the states will allow CDC to track performance for the FY 2000 goal and produce the upcoming annual performance plan.

² State Core Cardiovascular Capacities: (1) Develop and coordinate partnerships; (2) Develop scientific capacity to define the Cardiovascular Disease problem; (3) Develop an inventory of policy and environmental strategies; (4) Develop or update state plan; ( 5) Provide training and technical assistance; (6) Develop population-based strategies; (7) Develop culturally-competent strategies for priority populations, and (optional) (8) Enhanced school health programs.

³ This objective was deleted for FY 2000 and replaced by the core cardiovascular disease prevention program, which received new funding for FY 2000.

Verification/Validation of Performance Measures: The data source for the tobacco-related measures include the Youth Risk Behavior Survey (YRBS), National Household Survey on Drug Abuse (NHSDA), and the Monitoring the Future Survey (MTF). The YRBS is conducted biennially by the CDC. The NHSDA is conducted annually by the Substance Abuse and Mental Health Services Administration. The Monitoring the Future Survey is conducted annually by the University of Michigan's Institute for Social Research. All three surveys were created for purposes other than GPRA and have been conducted for many years. The 1997 YRBS found that 36.4% of high school student were current smokers (smoked during the previous month). Due to upcoming changes in the ways that tobacco data will be collected in the NHSDA, there are no baseline data available. Baseline data covering 1999 will be available during the Spring of 2000. According to the 1998 MTF study, 35.1% of 12th graders smoked during the past 30 days.

The Behavioral Risk Factor Surveillance System (BRFSS) is an annual state-based telephone survey (active in 50 states, District of Columbia and three territories) that routinely collects behavioral risk factor information and demographic information (age, race, sex, etc). States design the instrument that is used to collect data. CDC, besides providing funding, technical support, and consultation, edits and processes the data from each state's monthly interviews and then returns prevalence information and selected reports to states for their use. Behavioral risk factors are chosen based on their STRONGrelationship with many of the leading causes of premature death and disability. The information obtained is used to track progress in reducing behavioral risk factors over time. The data is collected on an ongoing basis and there are no foreseen data lags. A 1996 baseline is used because it is based on data available at the time of the creation of the measure.

State information on core cardiovascular disease prevention capacities will be collected annually and evaluated by CDC through grantee applications.

Links to DHHS Strategic Plan

These performance objectives are related to DHHS goal 1, particularly 1.1: Reduce major threats to health and productivity of all Americans by reducing tobacco use, especially among youth. CDC plans to reduce teen smoking among youth through intervention programs, community-based programs, health communication campaigns, and collaborative partnerships with schools and state programs. State capacities will be developed to reduce the burden of Cardiovascular Disease, a major threat to the health and productivity of Americans, through core capacities as well as the further development of data systems.

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