Prevention and control of coronary heart disease and stroke--nomenclature for prevention approaches in public health: a statement for public health practice from the Centers for Disease Control and Prevention.

Successful prevention and control of coronary heart disease and stroke requires extensive collaboration and strategic partnerships with many health and non-health-related organizations and agencies in the voluntary, public, and private sectors. To assure a common language and purpose and to facilitate communication in these multiple settings, a simplified classification of prevention levels for public health practice is essential. This statement proposes three levels of prevention (health promotion, primary prevention, and secondary prevention) as a guide for public health practice. This statement is also intended to inform the design, implementation, and evaluation of programs and research initiatives that address the prevention and control of coronary heart disease and stroke, and to enhance communication and dialogue among health professionals, policymakers, and the public.

REACH 2010 Surveillance for Health Status in Minority Communities --- United States, 2001--2002.

PROBLEM/CONDITION: The U.S. population continues to diversify, and certain racial/ethnic minorities are growing at a substantially more rapid pace than the majority population. Limited large-scale population-based surveys and surveillance systems are designed to monitor the health status of minority populations. The Racial and Ethnic Approaches to Community Health (REACH) 2010 Risk Factor Survey is conducted annually in minority communities in the United States. The survey focuses on four minority populations (blacks, Hispanics, Asians/Pacific Islanders [A/PIs], and American Indians). REPORTING PERIOD COVERED: 2001-2002. DESCRIPTION OF SYSTEM: Telephone (n = 18 communities) and face-to-face (n = 3 communities) interviews were conducted in 21 communities located in 14 states (Alabama, California, Georgia, Illinois, Louisiana, Massachusetts, Michigan, New York, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, and Washington). An average of 1,000 minority residents aged >/=18 years in each community was sampled. Interviews were administered in English, Spanish, Vietnamese, Khmer, or Mandarin Chinese. The median response rate for household screenings was 74.0% for households that were reached and 72.0% for family members interviewed. The self-reported data from the community were compared with data derived from the Behavioral Risk Factor Surveillance System (BRFSS) for the metropolitan/micropolitan statistical area (MMSA) or the state where the community was located and compared with national estimates from BRFSS. RESULTS: Reported education level and household income were markedly lower in minority communities than the general population living in the comparison MMSA or state. More minorities reported being in fair or poor health, but they did not see a doctor because of the cost. Substantial variations were observed in the prevalence of health-risk factors and selected chronic conditions among minority populations and in communities within the same racial/ethnic minority. The median prevalence of obesity among A/PI men and women was 2.9% and 3.6%, respectively, whereas 39.2% and 37.5% of American Indian men and women were obese, respectively. Cigarette smoking was common in American Indian communities, with a median of 42.2% for men and 36.7% for women. Compared with the national level, fewer minority adults reported eating >/=5 fruits and vegetables daily and met recommendations for moderate or vigorous leisure-time physical activity. American Indian communities had a high prevalence of self-reported cardiovascular disease, hypertension, high blood cholesterol, and diabetes. A high prevalence of hypertension and diabetes was also observed in black communities (32.0% and 10.9%, respectively, for men and 40.4% and 14.3%, respectively, for women). Compared with the general U.S. population, a substantially lower percentage of Hispanics and A/PIs had reported receiving preventive services (e.g., cholesterol screenings; glycosylated hemoglobin tests and foot examinations for patients with diabetes; mammograms and Papanicolaou smear tests; and vaccination for influenza and pneumonia among adults aged >/=65 years). INTERPRETATION: Data from the REACH 2010 Risk Factor Survey demonstrate that residents in the minority communities bear greater risks for disease compared with the general population living in the same MMSA or state. Substantial variations in the prevalence of risk factors, chronic conditions, and use of preventive services among different minority populations and in communities within the same racial/ethnic population provide opportunities for public health interventions. These variations also indicate that different racial/ethnic populations and different communities should have different priorities in eliminating health disparities. PUBLIC HEALTH ACTIONS: The continuous surveillance of health status in minority communities is necessary so that culturally sensitive prevention strategies can be tailored to these communities and program interventions evaluated.