Health Components of Public Health- 2 page not including front page and references
jontha4
turnock.pdf
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23.
Doll R, Hill AB. Smoking and carcinoma of the lung. Br Med J. 1950;2:740–748.
24.
Teutsch SM, Churchill RE, eds. Principles and Practice of Public Health Surveillance. New York: Oxford University Press; 1994.
25.
Remington PL, Smith MY, Williamson DF, et al. Design, characteristics and usefulness of statebased behavioral risk factor surveillance, 1981–87. Public Health Rep. 1988;103:366–375.
26.
Kann L, Kinchen SA, Williams BI, et al. Youth risk behavior surveillance: United States, 1997. In: CDC surveillance summaries (August 14). MMWR. 47(no. SS3).
27.
Mosher WD. Design and operation of the 1995 national survey of family growth. Fam Plann Perspect. 1998;30:43– 46.
28.
Centers for Disease Control and Prevention. Summary of notifiable diseases, United States, 1997. MMWR. 1997;46(no. SS54).
29.
Langmuir AD. The surveillance of communicable diseases of national importance. N Engl J Med. 1963;268:182–192.
30.
Centers for Disease Control and Prevention. History perspectives: history of CDC. MMWR. 1996;45:526–528.
31.
Roemer MI. Preparing public health leaders for the 1990s. Public Health Rep. 1988;103: 443–451.
32.
Winkelstein W, French FE. The training of epidemiologists in schools of public health in the United States: a historical note. Int J Epidemiol. 1973;2:415–416.
33.
Association of Schools of Public Health. Enrollment of U.S. schools of public health 1987–1997. http://www.asph.org/webstud1.gif. Accessed December 14, 1999.
34.
Crawford BL. Graduate students in U.S. schools of public health: comparison of 3 academic years. Public Health Rep. 1979;94:67–72.
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35.
Association of Schools of Public Health. Ten most frequently asked questions by perspective students. http://www.asph.org/10quest.htm. Accessed December 14, 1999.
36.
U.S. Treasury Department/Public Health Service. History of county health organizations in the United States 1908– 1933. In: Public Health Bulletin (No. 222). Washington, DC: Public Health Service, 1936.
37.
Altman D, Morgan DH. The role of state and local government in health. Health Aff. 1983;2;7–31.
38.
Mountin JW, Flook E. Guide to Health Organization in the United States, 1951. Washington, DC: Public Health Service, Federal Security Agency, Bureau of State Services, 1951; Public Health Service publication no. 196.
39.
Emerson H, Luginbuhl M. 1200 local public school departments for the United States. Am J Public Health. 1945;35:898–904.
40.
Dyal WW. Ten organizational practices of public health: a historical perspective. Am J Prev Med. 1995;11(suppl 2):6– 8.
41.
Institute of Medicine. The Future of Public Health. Washington, DC: National Academy Press, 1988.
42.
Public Health Service. Healthy People 2000: National Health Promotion and Disease Prevention Objectives: Full Report, With Commentary. Washington, DC: U.S. Department of Health and Human Services, Public Health Service, 1991; Department of Health and Human Services publication no. (Public Health Service) 9150212.
43.
Centers for Disease Control and Prevention. Selected characteristics of local health departments: United States, 1992– 1993. MMWR. 1994;43:839–843.
44.
Centers for Disease Control and Prevention. Estimated expenditures for core public health functions: selected states, October 1992–September 1993. MMWR. 1995;44: 421:427–429.
45.
Adapted from U.S. Department of Health and Human Services. Healthy People 2010 Midcourse Review: Chapter 23, Public Health Infrastructure. Washington, DC: Department of Health and Human Services–Public Health Service; 2006.
Public Health Spotlight on Safer and Healthier Foods
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PUBLIC HEALTH ACHIEVEMENTS IN 20TH CENTURY AMERICA1
During the early 20th century, contaminated food, milk, and water caused many foodborne infections, including typhoid fever, TB, botulism, and scarlet fever. In 1906, Upton Sinclair described in his novel The Jungle the unwholesome working environment in the Chicago meatpacking industry and the unsanitary conditions under which food was produced. Public awareness dramatically increased and led to the passage of the Pure Food and Drug Act.2 After the sources and characteristics of foodborne diseases were identified—long before vaccines or antibiotics— they could be controlled by handwashing, sanitation, refrigeration, pasteurization, and pesticide application. Healthier animal care, feeding, and processing also improved food supply safety. In 1900, the incidence of typhoid fever was approximately 100 per 100,000 population; by 1920, it had decreased to 33.8 and by 1950 to 1.7 (Figure 69). During the 1940s, studies of autopsied muscle samples showed that 16% of persons in the United States had trichinellosis; 300 to 400 cases were diagnosed every year, and 10 to 20 deaths occurred.3 Since then, the rate of infection has declined markedly; from 1991 through 1996, three deaths and an average of 38 cases per year were reported.4
Figure 69 Incidence of typhoid fever, by year, United States, 1920–1960.
Source: From Centers for Disease Control and Prevention. Achievements in public health, United States, 1900–1999: safer and healthier foods. MMWR. 1999;48 (40):905–913.
Nutritional sciences also were in their infancy at the start of the century. Unknown was the concept that minerals and vitamins were necessary to prevent diseases caused by dietary deficiencies. Recurring nutritional deficiency diseases, including rickets, scurvy, beriberi, and pellagra, were thought to be infectious diseases. By 1900, biochemists and physiologists had identified protein, fat, and carbohydrates as the basic nutrients in food. By 1916, new data had led to the discovery that food contained vitamins, and the lack of “vital amines” could cause disease. These scientific discoveries and the resulting public health policies, such as food fortification programs, led to substantial reductions in nutritional deficiency diseases during the first half of the century. The focus of nutrition programs shifted in the second half of the century from disease prevention to control of chronic conditions, such as cardiovascular disease and obesity.
Food Safety
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Perishable foods contain nutrients that pathogenic microorganisms require to reproduce. Bacteria such as Salmonella sp., Clostridium sp., and Staphylococcus sp. can multiply quickly to sufficient numbers to cause illness. Prompt refrigeration slows bacterial growth and keeps food fresh and edible.
At the turn of the 20th century, consumers kept food fresh by placing it on a block of ice or, in cold weather, burying it in the yard or storing it on a window sill outside. During the 1920s, refrigerators with freezer compartments became available for household use. Another process that reduced the incidence of disease was invented by Louis Pasteur— pasteurization. Although the process was applied first in wine preservation, when milk producers adopted the process, pasteurization eliminated a substantial vector of foodborne disease. In 1924, the PHS created a document to assist Alabama in developing a statewide milk sanitation program. This document evolved into the Grade A Pasteurized Milk Ordinance, a voluntary agreement that established uniform sanitation standards for the interstate shipment of Grade A milk and now serves as the basis of milk safety laws in the 50 states and Puerto Rico.5
Along with improved crop varieties, insecticides and herbicides have increased crop yields, decreased food costs, and enhanced the appearance of food. Without proper controls, however, the residues of some pesticides that remain on foods can create potential health risks.6 Before 1910, no legislation existed to ensure the safety of food and feed crops that were sprayed and dusted with pesticides. In 1910, the first pesticide legislation was designed to protect consumers from impure or improperly labeled products. During the 1950s and 1960s, pesticide regulation evolved to require maximum allowable residue levels of pesticides on foods and to deny registrations for unsafe or ineffective products. During the 1970s, acting under these strengthened laws, the newly formed EPA removed DDT and several other highly persistent pesticides from the marketplace. In 1996, the Food Quality Protection Act set a stricter safety standard and required the review of older allowable residue levels to determine whether they were safe. In 1999, federal and state laws required that pesticides meet specific safety standards; the EPA reviews and registers each product before it can be used and sets levels and restrictions on each product intended for food or feed crops.
Newly recognized foodborne pathogens have emerged in the United States since the late 1970s; contributing factors include changes in agricultural practices and food processing operations and the globalization of the food supply. Seemingly healthy food animals can be reservoirs of human pathogens. During the 1980s, for example, an epidemic of eggassociated Salmonella serotype Enteritidis infection spread to an estimated 45% of the nation’s egglaying flocks, which resulted in a large increase in eggassociated foodborne illness within the United States.7,8 Escherichia coli O157:H7, which can cause severe infections and death in humans, produces no signs of illness in its nonhuman hosts.9 In 1993, a severe outbreak of E. coli O157:H7 infections attributed to consumption of undercooked ground beef resulted in 501 cases of illness, 151 hospitalizations, and 3 deaths and led to a restructuring of the meat inspection process.10 The most common foodborne infectious agent may be the calicivirus (a Norwalklike virus), which can pass from the unwashed hands of an infected food handler to the meal of a consumer. Animal husbandry and meat production improvements that have contributed to reducing pathogens in the food supply include pathogen eradication campaigns, the Hazard Analysis and Critical Control Point,11 better animal feeding regulations,12 the use of uncontaminated water in food processing,13 more effective food preservatives,14 improved antimicrobial products for sanitizing food processing equipment and facilities, and adequate surveillance of foodhandling and preparation methods.15 Hazard Analysis and Critical Control Point programs also are mandatory for the seafood industry.16
Improved surveillance, applied research, and outbreak investigations have elucidated the mechanisms of contamination that are leading to new control measures for foodborne pathogens. In meatprocessing plants,17 the incidence of Salmonella and Campylobacter infections has decreased; however, in 1998, apparently unrelated cases of Listeria infections were linked when an epidemiologic investigation indicated that isolates from all cases shared the same genetic DNA fingerprint; approximately 100 cases and 22 deaths were traced to eating hot dogs and deli meats produced in a single manufacturing plant.18 In 1998, a multistate outbreak of shigellosis was traced to imported parsley.19 During 1997 to 1998 in the United States, outbreaks of cyclosporiasis were associated with mesclun mix lettuce, basil/basilcontaining products, and Guatemalan raspberries.20 These instances highlight the need for measures that prevent food contamination closer to its point of production, particularly if the food is eaten raw or is difficult to wash.21
Any 21st century improvement will be accelerated by new diagnostic techniques and the rapid exchange of information through use of electronic networks and the Internet. PulseNet, for example, is a network of laboratories in
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state health departments, the CDC, and foodregulatory agencies. In this network, the genetic DNA fingerprints of specific pathogens can be identified and shared electronically among laboratories, enhancing the ability to detect, investigate, and control geographically distant yet related outbreaks. Another example of technology is DPDx, a computer network that identifies parasitic pathogens. By combining PulseNet and DPDx with field epidemiologic investigations, the public health system can rapidly identify and control outbreaks. The CDC, the Food and Drug Administration, the U.S. Department of Agriculture (USDA), other federal agencies, and private organizations are enhancing food safety by collaborating in education, training, research, technology, and transfer of information and by considering food safety as a whole—from farm to table.
Nutrition
The discovery of essential nutrients and their roles in disease prevention has been instrumental in almost eliminating nutritional deficiency diseases such as goiter, rickets, and pellagra in the United States. During 1922 to 1927, with the implementation of a statewide prevention program, the goiter rate in Michigan fell from 38.6% to 9%.22 In 1921, rickets was considered the most common nutritional disease of children, affecting approximately 75% of infants in New York City.23 In the 1940s, the fortification of milk with vitamin D was a critical step in rickets control.
Because of food restrictions and shortages during World War I, scientific discoveries in nutrition were translated quickly into public health policy; in 1917, the USDA issued the first dietary recommendations based on five food groups; in 1924, iodine was added to salt to prevent goiter. The 1921 to 1929 Maternal and Infancy Act enabled state health departments to employ nutritionists, and during the 1930s, the federal government developed food relief and food commodity distribution programs, including school feeding and nutrition education programs, and national food consumption surveys.
Pellagra is a good example of the translation of scientific understanding to public health action to prevent nutritional deficiency. Pellagra, a classic dietary deficiency disease caused by insufficient niacin, was noted in the South after the Civil War. Then considered infectious, it was known as the disease of the four Ds: diarrhea, dermatitis, dementia, and death. The first outbreak was reported in 1907. In 1909, more than 1000 cases were estimated based on reports from 13 states. One year later, approximately 3000 cases were suspected nationwide based on estimates from 30 states and the District of Columbia. By the end of 1911, pellagra had been reported in all but nine states, and prevalence estimates had increased nearly ninefold.24 During 1906 to 1940, approximately 3 million cases and approximately 100,000 deaths were attributed to pellagra.25 From 1914 until his death in 1929, Joseph Goldberger, a PHS physician, conducted groundbreaking studies that demonstrated that pellagra was not infectious but was associated with poverty and poor diet. Despite compelling evidence, his hypothesis remained controversial and unconfirmed until 1937. The near elimination of pellagra by the end of the 1940s has been attributed to improved diet and health associated with economic recovery during the 1940s and to the enrichment of flour with niacin. Today, most physicians in the United States have never seen pellagra, although outbreaks continue to occur, particularly among refugees and during emergencies in developing countries.26
The growth of publicly funded nutrition programs was accelerated during the early 1940s because of reports that 25% of draftees showed evidence of past or present malnutrition; a frequent cause of rejection from military service was tooth decay or loss. In 1941, President Franklin D. Roosevelt convened the National Nutrition Conference for Defense, which led to the first recommended dietary allowances of nutrients and resulted in issuance of War Order Number One, a program to enrich wheat flour with vitamins and iron. In 1998, the most recent foodfortification program was initiated; folic acid, a watersoluble vitamin, was added to cereal and grain products to prevent neural tube defects.
Although the first half of the century was devoted to preventing and controlling nutritional deficiency disease, the focus of the second half has been on preventing chronic disease with initiation of the Framingham Heart Study in 1949. This landmark study identified the contribution of diet and sedentary lifestyles to the development of cardiovascular disease and the effect of elevated serum cholesterol on the risk for coronary heart disease. With increased awareness, public health nutrition programs have sought strategies to improve diets. By the 1970s, food and nutrition labeling and other consumer information programs stimulated the development of products low in fat, saturated fat, and cholesterol. Since then, persons in the United States have significantly decreased their dietary intakes of total fat from approximately 40% of total calorie intake in 1977 to 1978 to 33% in 1994 to 1996,
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approaching the recommended 30%;27 saturated fat intake and serum cholesterol levels also have decreased.28 Prevention efforts, including changes in diet and lifestyle and early detection and improved treatment, have contributed to impressive declines in mortality from heart disease and stroke.29,30
Populations with diets rich in fruits and vegetables have a substantially lower risk for many types of cancer. In 1991, the National Cancer Institute and the Produce for Better Health Foundation launched a program to encourage eating at least five servings of fruits and vegetables daily. Although public awareness of the “5 A Day” message has increased, only approximately 36% of persons in the United States aged greater than or equal to 2 years achieved the daily goal of five or more servings of fruits and vegetables.29 A diet rich in fruits and vegetables that provide vitamins, antioxidants (including carotenoids), other phytochemicals, and fiber is associated with additional health benefits, including decreased risk for cardiovascular disease.
21ST CENTURY PUBLIC HEALTH CHALLENGES
The most urgent challenge to nutritional health during the 21st century will be obesity. In the United States, with an abundant, inexpensive food supply and a largely sedentary population, overnutrition has become an important contributor to morbidity and mortality in adults. As early as 1902, USDA’s W.O. Atwater linked dietary intake to health, noting that “the evils of overeating may not be felt at on ce, but sooner or later they are sure to appear— perhaps in an excessive amount of fatty tissue, perhaps in general debility, perhaps in actual disease.”31 In U.S. adults, overweight (body mass index [BMI] of greater than or equal to 25 kg/m2) and obesity (BMI greater than or equal to 30 kg/m2) have increased markedly, especially since the 1970s. Figure 610 tracks changes since 1960 using National Health and Nutrition Examination Survey data.32 Figure 611 demonstrates that this phenomenon is not limited to a few states or regions of the United States. Obesity rates doubled among American adults between 1980 and 2000, whereas the prevalence of overweight and obesity combined increased nearly 40%. More than two thirds of American adults are overweight and/or obese.
Figure 610 Overweight and obesity, selected age categories, United States, 1960–2006.
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Source: From Centers for Disease Control and Prevention, National Center for Health Statistics, Health, United States 2009, Figure 7. Hyattsville, MD: NCHS; 2009. Data from the National Health Examination Survey and the National Health and Nutrition Examination Survey.
Figure 611 Percentage of adults aged 18 years or over who were obese,* by state—Behavioral Risk Factor Surveillance System, United States, 1995, 2000, and 2005.
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Note: *Persons with a body mass index (BMI) greater than or equal to 30.0; selfreported weight and height were used to calculate BMI.
Source: From Centers for Disease Control and Prevention. Statespecific prevalence of obesity among adults, United States, 2005. MMWR. 2006;55(36): 985–988.
Overweight and obesity increase risk for and complications of hypertension, hyperlipidemia, diabetes, coronary heart disease, osteoarthritis, and other chronic disorders; total costs attributable to obesity are an estimated $100 billion annually.33 Obesity also is a growing problem in developing countries where it is associated with substantial morbidity and where malnutrition, particularly deficiencies of iron, iodine, and vitamin A, affects approximately 2
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billion people. Increasing physical activity in the U.S. population is an important step, but effective prevention and control of overweight and obesity will require concerted public health action.34
Factors contributing to overweight and obesity are many but in the end result from consuming more calories than are expended through physical activity. Genes, metabolism, behavior, environment, culture, and socioeconomic status can all play roles in determining energy imbalance and body weight. The rapid increase in the prevalence of overweight and obesity among all age groups over recent decades argues that genetic factors are not the primary factor involved.
Social, behavioral, cultural, and environmental factors are more likely contributors. American society has undergone major changes in food options and eating habits, including increased portion sizes, prepackaged foods, fast food restaurants, soft drinks, and more frequent snacking. Increased consumption of calories has not been accompanied by increased levels of physical activity. More than one fourth of American adults report no leisuretime physical activity. One positive trend, however, has been a steady decline in adult blood cholesterol levels, as demonstrated in Figure 6 12.
As the U.S. population ages, attention to both nutrition and food safety will become increasingly important. Challenges will include maintaining and improving nutritional status, because nutrient needs change with aging, and ensuring food quality and safety, which is important to an older, more vulnerable population. Continuing challenges for public health action include reducing iron deficiency, especially in infants, young children, and women of childbearing age; improving initiation and duration of breastfeeding; improving folate status for women of childbearing age; and applying emerging knowledge about nutrition on dietary patterns and behavior that promotes health and reduce risk for chronic disease. Behavioral research indicates that successful nutrition promotion activities focus on specific behaviors, have a strong consumer orientation, segment and target consumers, use multiple reinforcing channels, and continually refine the messages.35 These techniques form a paradigm to achieve public health goals and to communicate and motivate consumers to change their behavior.
Figure 612 Average total cholesterol level among men and women aged 20–74 years, National Health and Nutrition Examination Survey, United States, 1959–1962 to 2007–2008.
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Note: Graph points represent serum total cholesterol levels at the midpoint of the survey years for the National Health Examination Survey conducted during 1959–1962 and the National Health and Nutrition Examination Surveys conducted during 1971–1974, 1976–1980, 1988–1994, 1999–2000, 2001–2002, 2003–2004, 2005–2006, and 2007–2008. Data were age adjusted by the direct method to the 2000 Census population estimates using the age groups 20–39 years, 40–59 years, and 60–74 years.
Sources: From Centers for Disease Control and Prevention. Average total cholesterol level among men and women aged 20–74 years, National Health and Nutrition Examination Survey, United States, 1959–1962 to 2007–2008. MMWR. 2009;58(37):1045. Data from National Health Examination Survey, 1959–1962; National Health and Nutrition Examination Surveys, 1971–1974, 1976–1980, 1988– 1994, 1999–2000, 2001–2002, 2003–2004, 2005–2006, and 2007–2008.
In the Guide to Community Preventive Services (Community Guide), the Task Force on Community Preventive Services assessed the effectiveness of selected populationbased interventions aimed at promoting healthy growth and development in children and adolescents and supporting healthy weights among adults.36 Only a few interventions are recommended; others lacked sufficient evidence. In general, the task force found multicomponent counseling or coaching interventions to be effective in achieving or maintaining weight loss. Also effective were behavioral interventions to reduce screen time (time spent watching TV, videotapes, or DVDs; playing video or computer games; and surfing the Internet). These could be singlecomponent or multicomponent interventions that often focus on changing screen time through classes aimed at improving children’s or parents’ knowledge, attitudes, or skills. Components of these interventions may include:
• Skills building, tips, goal setting, and reinforcement techniques. • Parent or family support through provision of information on environmental strategies to reduce access to television, video games, and computers. • A TV turnoff challenge in which participants are encouraged not to watch TV for a specified number of days.
Another effective community intervention strategy involves worksite nutrition and physical activity programs that include one or more approaches to support behavioral change including informational and educational, behavioral and social, and policy and environmental strategies. Such programs may include:
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• Informational and educational strategies designed to increase knowledge about a healthy diet and physical activity using lectures, written materials (provided in print or online), or educational software. • Behavioral and social strategies that target the thoughts (e.g., awareness, selfefficacy) and social factors that affect behavior changes through individual or group behavioral counseling, skillbuilding activities such as cue control, rewards or reinforcement, or inclusion of coworkers or family members to build support systems. • Policy and environmental approaches designed to make healthy choices easier and target the entire workforce by changing physical or organizational structures through improving access to healthy foods (e.g., changing cafeteria options and vending machine content) and/or providing more opportunities to be physically active (e.g., providing onsite facilities for exercise). • Modifying rules and procedures for employees such as health insurance benefits or costs or money for health club membership. • Worksite weight control strategies that may occur separately or as part of a comprehensive worksite wellness program that addresses several health issues (e.g., smoking cessation, stress management, cholesterol reduction).
The recognition of the obesity epidemic greatly influenced the Healthy People process. One of the 2010 national health objectives called for the prevalence of adult obesity to be reduced to less than 15% by 2010. Recent data, however, indicate the situation is getting worse rather than better, both for children (Figure 613) and older age groups (Figure 614). The prevalence of overweight among children has been climbing steadily since 2000, while rates among adults show no improvement since 2000, and have even been increasing for men.
Figure 613 Prevalence of overweight* among persons aged 2–19 years, by sex, National Health and Nutrition Examination Survey (NHANES), United States, 1999–2000 through 2003–2004.
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* Defined as having a body mass index (weight [kg]/height [m2]) at or above the 95th percentile for age and sex based on the reference population of the CDC 2000 growth charts.
Source: From Centers for Disease Control and Prevention. Prevalence of overweight among persons aged 2–19 years, by sex, National Health and Nutrition Examination Survey, United States, 1999–2000 through 2003–2004. MMWR. 2006;55(45):1229.
Figure 614 Prevalence of obesity* among adults aged more than 20 years by gender, National Health and Nutrition Examination Survey, United States, 1999–2000 through 2003–2004.
* Defined as having a body mass index (weight [kg]/height [m2]) >30.
Source: From Centers for Disease Control and Prevention. Prevalence of obesity among adults aged >20 years, by sex, National Health and Nutrition Examination Survey, 1999–2000 through 2003–2004. MMWR. 2006;55(44):1206.
The net result is that the lofty aspirations for obesity in the Healthy People process may not be realized and that the nation is losing, rather than gaining, ground in the battle being waged in the early decades of the 21st century. Figures 615 and 616 illustrate the challenges that lie ahead. The ageadjusted percentage of adults aged ≥20 years who were obese during 2003–2006 varied by race/ethnicity among women, ranging from 53.3% for nonHispanic black women to 41.8% for Mexican American women and 31.6% for nonHispanic white women. Obesity levels were more similar for Mexican American men (28.8%), nonHisp anic black men (35.0%), and nonHispanic white men (32.0%). None of the groups had met the Healthy People 2010 target of 15%. Figure 616 further documents the gap between achieved levels and year 2010 targets for adolescent and adult obesity.
Figure 615 Prevalence* of obesity† among adults aged ≥20 years, by race/ethnicity§ and sex, National Health and Nutrition Examination Survey, United States, 2003–2006.
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* Prevalence estimates are age adjusted to the 2000 U.S. standard population.
† Defined as having a body mass index (weight [kg]/height [m2]) ≥30.
§ The categories nonHispanic black and nonHispanic white include persons who reported only one race and exclude persons of Hispanic ethnicity. Persons of Mexican American ethnicity might be of any race.
¶ 95% confidence interval.
Sources: From Centers for Disease Control and Prevention. Prevalence of obesity among adults aged ≥20 Years, by race/ethnicity and sex, National Health and Nutrition Examination Survey, United States, 2003–2006. MMWR. 2009;58 (Data from National Health and Nutrition Examination Survey, 2003–2006. http://www.cdc.gov/nchs/nhanes.htm. Healthy People 2010 database. http://wonder.cdc.gov/data2010. US Department of Health and Human Services. Healthy People 2010. 2nd ed. With understanding and improving health and objectives for improving health. 2 vols. Washington, DC: U.S. Government Printing Office; 2000. http://www.health.gov/healthypeople. Accessed May 31, 2010.
