• Stella Cory, Ann Ussery-Hall, Shannon Griffin-Blake, Alyssa Easton, Justin Vigeant, Lina Balluz, William Garvin, Kurt Greenlund, and Centers for Disease Control and Prevention (CDC).
• Division of Adult and Community Health, National Center for Chronic Disease and Prevention, Atlanta, GA 30341, USA. spk9@cdc.gov
• MMWR Surveill Summ. 2010 Sep 24;59(8):1-37.

ProblemAt least one chronic disease or condition affects 45% of persons and account for seven of the 10 leading causes of death in the United States. Persons who suffer from chronic diseases and conditions, (e.g., obesity, diabetes, and asthma) experience limitations in function, health, activity, and work, affecting the quality of their lives as well as the lives of their family. Preventable health-risk factors (e.g., insufficient physical activity, poor nutrition, and tobacco use and exposure) contribute substantially to the development and severity of certain chronic diseases and conditions.Reporting Period Covered2006-2007Description Of The SystemCDC's Healthy Communities Program funds communities to address chronic diseases and related risk factors through policy, systems, and environmental change strategies. As part of the Healthy Communities Program, 40 Steps communities were funded nationwide to address six focus areas: obesity, diabetes, asthma, physical inactivity, poor nutrition, and tobacco use and exposure. During 2006-2007, 38 and 39 of the 40 communities conducted a survey to collect adult health outcome data. The survey instrument was a modified version of the Behavioral Risk Factor Surveillance System (BRFSS) survey, a state-based, random-digit-dialed telephone survey. The survey instrument collected information on chronic diseases and conditions, health risk behaviors, and preventive health practices related to Steps community outcomes from noninstitutionalized community members aged ≥18 years.ResultsPrevalence estimates of chronic diseases and conditions and risk behaviors varied among Steps communities that reported data for 2006 and 2007. The proportion of the population that achieved Healthy People 2010 (HP 2010) objectives also varied among the communities. In 2006, the estimated prevalence of respondents aged ≥18 years being overweight or obese as calculated from self-reported weight and height ranged from 51.8% to 73.7%. The nationwide 2006 BRFSS median was 62.3%; a total of 20 communities exceeded this median. In 2007, the estimated prevalence being overweight or obese ranged from 50.5% to 77.2%. The nationwide 2007 BRFSS median was 63.0%; a total of 18 communities exceeded this median. In 2006, the estimated prevalence of diagnosed diabetes (excluding gestational diabetes) ranged from 3.7% to 19.7%. None of the communities achieved the HP 2010 objective of increasing to 91% the proportion of adults with diabetes who have at least an annual clinical foot examination. Six communities reached the HP 2010 objective of increasing to 76% the proportion of adults with diabetes who have an annual dilated eye examination; 20 communities reached the HP 2010 objective of increasing to 65% the proportion of adults who have a glycosylated hemoglobin measurement (A1c) at least once a year. In 2007, the estimated prevalence of diagnosed diabetes (excluding gestational diabetes) ranged from 4.4% to 17.9%. None of the communities achieved the HP 2010 objective of increasing to 91% the proportion of adults with diabetes who have at least an annual clinical foot examination, eight communities achieved the HP 2010 objective of increasing to 76% the proportion of adults with diabetes who have an annual dilated eye examination, and 16 communities achieved the HP 2010 objective of increasing to 65% the proportion of adults who have an A1c at least once a year. In 2006, the prevalence of reported asthma ranged from 6.5% to 18.9%. Among those who reported having asthma, the prevalence of having no symptoms of asthma during the preceding 30 days ranged from 11.5% to 29.5% for five communities with sufficient data for estimates. In 2007, the estimated prevalence of reported asthma ranged from 7.5% to 18.9%. Among those who reported having asthma, the prevalence of having no symptoms of asthma during the preceding 30 days ranged from 10.3% to 36.1% for 12 communities with sufficient data for estimates. In 2006, the prevalence of respondents who engaged in moderate physical activity for ≥30 minutes at least five times a week or who reported vigorous physical activity for ≥20 minutes at least three times a week ranged from 42.3% to 59.9%. The prevalence of consumption of fruits and vegetables at least five times/day ranged from 11.1% to 30.2%. In 2007, the prevalence of moderate or vigorous physical activity ranged from 40.6% to 69.8%; 25 communities reached the HP 2010 objective to increase the proportion of adults who engage in physical activity to 50%. The prevalence of consumption of fruits and vegetables ≥5 times/day ranged from 14.6% to 37.6%. In 2006, the estimated prevalence among respondents aged >18 years who reported having smoked >100 cigarettes in their lifetime and who were current smokers on every day or some days at the time of the survey ranged from 12.5% to 48.0%. Among smokers, the prevalence of having stopped smoking for ≥1 day because of trying to quit smoking during the previous 12 months ranged from 48.4% to 67.9% for 31 communities. No communities reached the HP 2010 target of increasing to 75% smoking cessation attempts by adult smokers. In 2007, the estimated prevalence of current smokers ranged from 11.2% to 33.7%. Two communities reached the HP 2010 objective to reduce the proportion of adults who smoke. Among smokers, the prevalence of having stopped smoking for ≥1 day because of trying to quit smoking during the preceding 12 months ranged from 50.8% to 69.6% for 26 communities. No communities reached the HP 2010 objective of increasing to 75% smoking cessation attempts by adult smokers.InterpretationThe findings in this report indicate variations in health risk behaviors, chronic diseases and conditions, and use of preventive health screenings and health services among Steps communities. These findings underscore the continued need to evaluate prevention interventions at the community level and to design and implement policies to promote and encourage healthy behaviors.Public Health ActionSteps BRFSS data monitored the prevalence of health behaviors, conditions, and use of preventive health services. CDC (at the national level), and Steps staff at state, local, and tribal levels can use BRFSS data to demonstrate accountability to stakeholders; monitor progress in meeting objectives; focus activities on policy, systems and environmental change strategies with the greatest promise of results; identify collaboration opportunities; and identify and disseminate successes and lessons learned.

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