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Progress in Chronic Disease Prevention Survey of Chronic Disease Activities in State and Territorial Health Agencies

In February 1987, the Association of State and Territorial Health Officials (ASTHO) conducted a survey to gather information on current chronic disease activities in state and territorial health agencies. Ninety-five percent (52) of the 55 member agencies responded.

Forty-nine state and territorial agencies reported having a formal, written health plan. The chronic disease portion of 40 of these plans cite prevention and control activities specifically. The activities most frequently targeted hypertension, followed by heart disease and cancer (Table 1). Fourteen states reported having a cancer control plan separate from the state health plan.

Most states have a unit that administers chronic disease activities. Within such units, the disease most frequently addressed was cancer, with hypertension, diabetes, and heart disease following in close order (Table 2). The survey also investigated the degree of collaboration between state and territorial health agencies and voluntary associations. Forty-one health agencies communicate formally or informally with the American Cancer Society; 36, with the American Heart Association; 33, with the American Diabetes Association; and 25, with the Juvenile Diabetes Foundation. Three agencies have initiated joint projects with the American Cancer Society; eight, with the American Heart Association; ten, with the American Diabetes Association; and two, with the Juvenile Diabetes Foundation.

Risk-reduction activities occur in most states and territories. Forty-four respondents reported sponsoring diet-modification activities; 33 have smoking cessation programs; and 27 promote alcohol-abuse prevention programs. Twenty-eight respondents sponsor exercise programs, and 27 sponsor stress reduction activities. All 52 respondents indicated that cigarettes are taxed above the federal excise tax. Taxes range from 2 to 38 cents per pack, with the majority of states taxing within a range of 15 to 25 cents per pack (Figure 1).

In order to determine which data sources are most useful to state and territorial agencies, the survey included questions about their availability and frequency of use. Agencies indicated that hospital discharge data, mortality statistics, cancer registry data, and population-based survey data are frequently utilized (Table 3). Where private insurance or workmen's compensation data are available, fewer than half the states and territories use these sources.

Screening programs are available in over half the states and territories surveyed (Table 4). Hypertension screening is the program most frequently cited, followed by screening for cervical cancer and breast cancer. Twenty-four of the states with hypertension screening programs perform cholesterol screening as well. Nine of the states with cervical cancer screening programs have cytology laboratories that read Papanicolaou smears. Twenty-five states require licensing for cytology laboratories. Mammography is performed in nine of the states and territories with breast cancer screening programs, and breast palpation is performed in 28 of them. Thirty-seven health agencies provide education for breast self-examination. Many of these programs are conducted in conjunction with other agencies.

The needs most frequently mentioned in the comments section of the questionnaire were for a mechanism to exchange information among states; for additional funding for chronic disease control programs; for assistance in collecting and analyzing morbidity and mortality data; for national leadership in developing model programs and screening standards and in training staff; and for assistance in efforts to develop legislation related to chronic disease. Reported by the Association of State and Territorial Health Officials; Div of Chronic Disease Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: This survey represents an initial attempt to determine the extent of chronic disease activities in state and territorial public health agencies. The results suggest that the majority of states and territories have begun to establish a structure for the development and delivery of chronic disease programs. To better understand the level of effort and comparability of program activity, ASTHO will continue monitoring state and territorial activity.

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