Attachment 3_Strategic Directions

Strategic Directions and Examples of CDC-Recommended Evidence- and Practice-Based Strategies Table

Strategic Direction 1: Tobacco Free Living Goal: Prevent and Reduce Tobacco Use
CDC Recommended Evidence- and Practice-Based Strategies	Links to Guidance Documents	Healthy People 2020 Health Outcome Targets*
Implement evidence-based strategies to protect people from second-hand smoke.	CDC. Evaluation Toolkit for Smoke-Free Policies (2008). http://www.cdc.gov/tobacco/basic_information/secondhand_smoke/evaluation_toolkit/index.htm Tobacco The Business of Quitting: An Employer’s website for Tobacco Cessation http://www.businessgrouphealth.org/tobacco/ developed by the National Business Group on Health and supported by the CDC provides tools and resources for workplaces to establish a culture of health, select tobacco cessation benefits, establish workplace policies, communicate with employees and evaluate the effectiveness of the programs, policies, and practices. Tobacco-Free Workplace Campus Initiative This toolkit provides guidance for assessing, planning, promoting, implementing, and evaluating a tobacco-free campus (TFC) initiative that includes a policy and comprehensive cessation services for employees. http://www.cdc.gov/nccdphp/dnpao/hwi/toolkits/tobacco/index.htm http://www.cdc.gov/healthyhomes/Healthy_Homes_Manual_WEB.pdf US. Department of Housing and Urban Development (HUD): Optional Smoke-Free Housing Policy Implementation (Sept. 15, 2010) http://portal.hud.gov/portal/page/portal/HUD/program_offices/administration/hudclips/notices/hsg/files/10-21hsgn.pdf Housing Interventions and Health: A Review of the Evidence http://journals.lww.com/jphmp/toc/2010/09001#-1750774083	Tobacco Use 2: Increase the proportion of persons covered by indoor worksite policies that prohibit smoking. 20: Increase the proportion of smoke-free homes
Implement evidence-based strategies to prevent and reduce tobacco use among youth and adults.	http://www.thecommunityguide.org/tobacco/index.html http://www.cdc.gov/tobacco/
Increase types of outdoor venues where tobacco use is prohibited. Implement smoke-free parks. Implement smoke-free schools and campuses.	Tobacco-free sports http://www.cdc.gov/tobacco/youth/sports/index.htm CDC School Health Guidelines	Tobacco Use 12: Increase tobacco-free environments in schools.
Tobacco Free Living Innovative Proposals	Recipient will provide	Recipient will link to HP2020 objective
Strategic Direction 2: Active Living and Healthy Eating Goals: Prevent and Reduce Obesity, Increase Physical Activity; Improve Nutrition in Accordance with the Dietary Guidelines for Americans 2010
Improve jurisdiction-wide nutrition, physical activity, and screen time policies and practices in early child care settings.	Preventing Childhood Obesity in Early Care and Education Programs Selected Standards from Caring for our Children: National Health and Safety Performance Standards (Selected Standards Book, 2010). This book provides is the new set of national standards describing evidence-based best practices in nutrition, physical activity, and screen time for early care and education programs. The standards are for ALL types of early care and education settings centers and family child care homes. The Third Edition (CFOC, 3rd Ed.) is projected to be released in 2011. http://nrckids.org/CFOC3/PREVENTING_OBESITY/index.htm Farm to Preschool Farm to Preschool programs connect child care providers and local food producers and processors, with the goal of serving healthy meals to children, providing agriculture, health and nutrition education opportunities, and supporting local and regional farmers. Food and garden-based education in preschools increases access to fresh fruits and vegetables. Resources include: National Farm to School Network http://www.farmtoschool.org	Nutrition and Weight Status 19: Increase the number of States with nutrition standards for foods and beverages provided to pre-school aged children in childcare.
Increase the number of designated Baby-friendly hospitals.	The CDC Guide to Breastfeeding Interventions. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005. http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf	Maternal, Infant and Child Health 28: Increase the percentage of live births that occur in facilities that provide recommended care for lactating mothers and their babies.
Increase policies and practices to support breastfeeding in health care, community, workplaces, and learning and childcare settings.	Ten Steps to Healthy Breastfeeding Friendly Child Care Centers Guide http://www.dhs.wisconsin.gov/health/physicalactivity/pdf_files/BreastfeedingFriendlyChildCareCenters.pdf This guide is designed to help child care centers improve existing breastfeeding policies and practices and their current compliance with the requirements for the Breastfeeding Friendly designation. Purchaser’s Guide to Clinical Preventive Services provide summary plan description language that benefits managers can use to purchase recommended breastfeeding counseling coverage (USPSTF B Recommendation) http://www.businessgrouphealth.org/preventive/topics/breastfeeding.cfm Investing in Workplace Breastfeeding Program and Policies: An Employer’s Toolkit This National Business Group on Health toolkit provides information for assessing, planning, promoting, implementing, and evaluating a worksite lactation support program. http://www.businessgrouphealth.org/benefitstopics/breastfeeding.cfm The CDC Guide to Breastfeeding Interventions. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005. Included in this guide are breastfeeding interventions that are practice and evidence based, with a focus on selecting community and other interventions that address disparities within specific population groups http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf	Maternal, Infant and Child Health 12: Increase the proportion of mothers who breastfeed their babies 26: Increase the percentage of employers who have worksite lactation programs.
Improve nutrition quality of foods and beverages served or available in schools consistent with the Institute of Medicine’s Nutrition Standards for Foods in Schools. Increase access to fruits and vegetables in schools. Decrease amount of sodium in foods in schools. Reduce access to competitive low nutrition foods and beverages. Ensure availability of plain, cold drinking water throughout the day at no cost to students.	Institute of Medicine Report: Nutrition Standards for Foods in Schools http://www.iom.edu/Reports/2007/Nutrition-Standards-for-Foods-in-Schools-Leading-the-Way-toward-Healthier-Youth.aspx Sodium Procurement Guide http://www.cdc.gov/salt/pdfs/DHDSP_Procurement_Guide.pdf NPLAN’s Developing Healthy Vending Beverage Agreements http://www.nplanonline.org/sites/phlpnet.org/files/nplan/HealthyVendngAgrmnt_FactSheet_FINAL_090311.pdf CSPI’s Sweet Deals—School Fundraising can be Healthy and Profitable http://cspinet.org/new/pdf/schoolfundraising.pdf NPLAN’s Model Wellness Policy Language for Water Access in Schools http://www.nplanonline.org/childhood-obesity/products/water-access CDC Guide to Fruit and Vegetables Strategies to Increase Access, Availability and Consumption http://www.cdph.ca.gov/SiteCollectionDocuments/StratstoIncreaseFruitVegConsumption.pdf USDA’s Be Salt Savvy—Cut Back on Sodium for Healthier School Meals Fact Sheet http://smartsavor.com/Images/USDA%20Sodium%20Fact%20Sheet.pdf	Nutrition and Weight Status 6: Increase the contribution of fruits to the diets of the population aged 2 years and older. 18: Increase the number of States that have State-level policies that incentivize food retail outlets to provide foods that are encouraged by the Dietary Guidelines. 20: Increase the percentage of schools that offer nutritious foods and beverages outside of school meals.
Improve the quality and amount of physical education and physical activity in schools. Increase the amount of time students spend in moderate or vigorous physical activity during physical education class. Increase the total number of physical activity opportunities implemented at school facilities, including daily recess, intramurals/physical activity clubs, and walk or bicycle to and from school. Increase number of public places (e.g. schools) accessible to the public for physical activity.	The Community Guide Physical Activity chapter www.thecommunityguide.org CDC’s Physical Education Curriculum Analysis Tool http://www.cdc.gov/healthyyouth/pecat CDC’s Strategies to Improve the Quality of Physical Education http://www.cdc.gov/healthyyouth/physicalactivity/pdf/quality_pe.pdf NASPE’s National Standards for PE http://www.aahperd.org/naspe/standards/nationalStandards/PEstandards.cfm CDC’s Youth Physical Activity Guidelines Toolkit http://www.cdc.gov/HealthyYouth/physicalactivity/guidelines.htm#1 NASPE’s Position Statement on Comprehensive School PA Programs http://www.aahperd.org/naspe/standards/upload/Comprehensive-School-Physical-Activity-Programs2-2008.pdf NPLAN’s Joint Use Agreement Resources http://www.nplanonline.org/childhood-obesity/products/nplan-joint-use-agreements KidsWalk-to-School: A Guide to Promote Walking to School http://www.cdc.gov/nccdphp/dnpa/kidswalk/resources.htm#guide National Center for Safe Routes to School Guide, Toolkit, and Other Resources http://www.saferoutesinfo.org/resources/ DHHS Physical Activity Guidelines http://www.health.gov/paguidelines/	Physical Activity and Fitness 2: Increase the proportion of schools that require daily physical activity for all students. 3: Increase daily school physical education. 4: Increase the proportion of adolescents who spend at least 50 percent of school physical education class time being physically active. 7: Increase the proportion of adolescents that meet current physical activity guidelines 10, 11: Increase the proportion of trips made by walking and bicycling. 12: Increase the proportion of States and school districts that require regularly scheduled elementary school recess. 13: Increase the proportion of school districts that require or recommend elementary school recess for an appropriate time period.
Increase accessibility, availability, affordability and identification of healthy foods in communities, including provision of full service grocery stores, farmers markets, small store initiatives, mobile vending carts, and restaurant initiatives Carry more low-sodium and no-sodium options Promote healthy food and beverage availability and identification Placement and promotion strategies Incentivize new grocery store development Menu labeling support and promotion for restaurants not covered by federal law.	Equitable Development Toolkit: Healthy Food Retailing PolicyLink An online tool that focuses on increasing access to retail outlets that sell nutritious, affordable food in underserved communities. http://www.policylink.org/site/c.lkIXLbMNJrE/b.5137405/k.6042/Healthy_Food_Retailing.htm Strategic Alliance ENACT: Community Food Environment An online tool that focuses on attracting grocery stores to underserved areas through financial and regulatory incentives. http://www.preventioninstitute.org/sa/enact/neighborhood/supermarkets_underserved.php Healthy Corner Stores Describes successes and challenges of early corner store interventions and identifies steps for developing sustainable models: healthycornerstores.org Recommended Community Strategies and Measurements to Prevent Obesity in the United States http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5807a1.htm	Nutrition and Weight Status 10: Reduce consumption of sodium in the population aged 2 years and older. 18: Increase the number of policies that incentivize healthy food retail outlets. Heart Disease and Stroke 14: Increase the proportion of adults with prehypertension who meet the recommended guidelines (sodium intake). 15: Increase the proportion of adults with hypertension who meet the recommended guidelines (sodium intake).
Increase availability and affordability of healthful foods in institutional settings, workplaces, senior centers, and government facilities. Farm to Institution strategies Food procurement policies to increase access to low sodium options, decrease access to high sodium options. Increase availability of fruits and vegetables to employees in their work places	Vending Machine Food and Beverage Standards (California Department of Public Health Worksite Program California Fit Business Kit! http://www.cdph.ca.gov/programs/cpns/Documents/Network-FV-WP-VendingMachineStandards.pdf CDC’s Lean Works! offers interactive tools and evidence-based resources to design effective worksite obesity prevention and control programs. http://www.cdc.gov/leanworks/index.html Sodium Procurement Guide http://www.cdc.gov/salt/pdfs/DHDSP_Procurement_Guide.pdf Organizational Health Eating Policy Template (North Carolina Eat Smart Move More Worksite Initiative) http://www.eatsmartmovemorenc.com/PhysicalActivityAndHealthyEatingPolicy/PhysicalActivityAndHealthyEatingPolicy.html California Fit Business Kit helps employers develop and implement a culture and environment at their workplaces that support healthy eating and physical activity among workers. http://www.cdph.ca.gov/programs/cpns/Pages/WorksiteFitBusinessKit.aspx	Nutrition and Weight Status 6: Increase consumption of fruits. 7: Increase consumption of vegetables 9: Increase the proportion of persons who consume no more than 30 percent of calories from total fat. 15: Prevent inappropriate weight gain in youth and adults. 17: Reduce consumption of calories from solid fats and added sugars.
Promote purchase of fruits, vegetables, and other healthy foods through incentives associated with food assistance programs.	Supplemental Nutrition Assistance Program (SNAP) at Farmers Markets: A How-To Handbook. http://www.ams.usda.gov/AMSv1.0/getfile?dDocName=STELPRDC5085298&acct=wdmgeninfo Changes in the WIC Food Packages: A Toolkit for Partnering with Neighborhood Stores http://www.phlpnet.org/healthy-planning/products/changes-wic-food-packages-toolkit-partnering-neighborhood-stores Wholesome Wave Double Value Coupon Program http://wholesomewave.org/what-we-do/double-value-coupon-program/	Nutrition and Weight Status 6: Increase consumption of fruits. 7: Increase consumption of vegetables. 18: Increase the number of policies that incentivize healthy food retail outlets.
Limit density of fast food outlets and other outlets featuring high calorie, high sodium, and low nutrition foods and encourage retail venues to provide access and availability to healthier foods. Zoning: regulate the number of fast food restaurants in a given area. Provide incentives to encourage existing stores or restaurants to provide healthier food options or to encourage the development of new retail venues that offer healthier foods.	The Center for Law and the Public's Health at Johns Hopkins and Georgetown Universities. The use of zoning to restrict fast food outlets: a potential strategy to combat obesity. http://www.publichealthlaw.net/Zoning%20Fast%20Food%20Outlets.pdf The City Planner’s Guide to the Obesity Epidemic: Zoning and Fast Food http://www.publichealthlaw.net/Zoning%20City%20Planners%20Guide.pdf The Food Trust: http://www.thefoodtrust.org/php/programs/corner.store.campaign.php	Nutrition and Weight Status 18: Increase policies that incentivize healthy food retail outlets. 22: Increase the proportion of Americans who have access to a food retail outlet that sells a variety of foods that are encouraged by the Dietary Guidelines for Americans
Increase opportunities for physical activity in communities and workplaces. Community-wide campaigns Access to facilities and places Joint use agreements Flextime Stairwell modification Incentives	Utah Department of Health Exercise and Health Activity Time Policy http://health.utah.gov/hearthighway/pdfs/Excercise_Release_Policy_worksites.pdf Workplace Stairwell Modification and Promotion to Increase Daily Physical Activity This toolkit provides information for implementing and promoting changes to workplace stairwells to encourage physical activity at work. http://www.cdc.gov/nccdphp/dnpao/hwi/toolkits/stairwell/index.htm NPLAN’s joint use agreement resources http://www.nplanonline.org/childhood-obesity/products/nplan-joint-use-agreements Discount Fitness Club Network This toolkit provides guidance on identifying and establishing a relationship with a nationwide discount fitness club network (DFCN) for employees of multi-site organizations http://www.cdc.gov/nccdphp/dnpao/hwi/toolkits/fitnessclub/ Strategic Alliance-ENACT, Community Activity Strategies http://www.eatbettermovemore.org/sa/enact/members/strategiesshow.php?e=4&se=1&aff69eff45a2561fef61a7d71cab272e Recommended Community Strategies and Measurements to Prevent Obesity in the United States http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5807a1.htm	Physical Activity and Fitness 5: Increase the schools that provide access to their physical activity spaces and facilities for all persons outside of normal school hours. 6: Increase physical activity in adults. 9: Increase access to and participation in employer-based exercise facilities and programs. 10: Increase walking. 11: Increase bicycling. Disability and Secondary Conditions 7: Reduce reported barriers
Active Living and Healthy Eating Innovative Strategies.	Recipient will provide	Recipient will link to HP2020 objective
Strategic Direction 3: Increased Use of High Impact Quality Clinical Preventive Services Goals: Increase control of high blood pressure and high cholesterol; increase access to and demand for high impact quality preventive services.
Provide training and technical assistance to health care institutions, providers and provider organizations to effectively implement systems to improve delivery of clinical preventive services, consistent with USPSTF recommendations. Implement strategies to translate known interventions into usual clinical care to increase control of high blood pressure and high cholesterol. Provide training and technical assistance to health care institutions, providers and provider organizations to effectively implement systems to increase delivery and use of treatment for tobacco use and dependence. Provide training and technical assistance to health care institutions, providers and provider organizations to effectively implement systems to increase delivery and use brief intervention to reduce excessive alcohol use. Provide training and technical assistance to health care institutions, providers and provider organizations to effectively implement systems to increase delivery and use of cancer screening services. Provide training and technical assistance to health care institutions, providers and provider organizations to effectively implement systems to increase appropriate testing of HIV and STDs and linkages to care and prevention with positives. Provide training and technical assistance to health care institutions, providers and provider organizations to effectively implement systems to increase recognition and enhance secondary prevention of chronic Hepatitis B and Hepatitis C infection.	Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.:  CD005182:: http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD005182/frame.html Purchaser’s Guide to increase use of clinical preventive services among employees http://www.cdc.gov/pcd/issues/2008/apr/07_0220.htm Guide to Clinical Preventive Services. The Community Guide: www.thecommunityguide.org Guide to Clinical Prevention Services (for screening); Health Affairs November 2010 issue: Designing Insurance To Improve Value In Health Care; Purchaser’s Guide to Clinical Preventive Services http://www.businessgrouphealth.org/preventive/background.cfm Get With the Guidelines: Outpatient http://outpatient.heart.org/GWTG/ WISEWOMAN http://www.cdc.gov/wisewoman/ Better Diabetes Care www.betterdiabetescare.nih.gov http://www.cdc.gov/ncbddd/fasd/research-preventing.html Project CHOICES is a brief motivational intervention for reducing alcohol-exposed pregnancies among women who are at high risk for such pregnancies. Drinking and Reproductive Health: A Fetal Alcohol Spectrum Disorders Prevention Tool Kit http://www.cdc.gov/ncbddd/fasd/acog_toolkit.html How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician’s* Evidence-Based Toolbox and Guide 2008: http://www5.cancer.org/aspx/pcmanual/default.aspx; http://www.cancer.org/acs/groups/content/documents/document/acspc-024588.pdf Electronic Health Records: Office of the National Coordinator for Health Information Technology http://healthit.hhs.gov/ Understanding Panel Management: A Comparative Study of an Emerging Approach to Population Care http://xnet.kp.org/permanentejournal/SUM07/panel-management.html NCI Patient Navigator Research Program http://crchd.cancer.gov/pnp/pnrp-index.html Patient Navigator Role of CHW can be found in Community Health Workers National Workforce Study. U. S. Department of Health and Human Services Resources and Services Administration Bureau of Health Professions. Community Health Worker National Workforce Study. 2007. http://bhpr.hrsa.gov/healthworkforce/chw/ Community Health Workers’ Sourcebook http://www.cdc.gov/dhdsp/library/chw_sourcebook/pdfs/sourcebook.pdf NCQA Patient-Centered Medical Home http://www.ncqa.org/tabid/631/default.aspx CDC Case Management Guidelines www.cdc.gov/nceh/lead/CaseManagement/caseManage_main.htm Medicare Accountable Care Organizations https://www.cms.gov/OfficeofLegislation/Downloads/AccountableCareOrganization.pdf RWJ Accountable Care Organization description http://www.rwjf.org/files/research/66449.pdf CDC Recommendation for Routine HIV Testing for Persons Age 13-64 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm National Chlamydia Coalition Testing Implementation Guidance. Why Screen for Chlamydia: An Implementation Guide for Healthcare Providers. Comprehensive guidance on Chlamydia testing and screening algorithms and assistance for clinical providers in dealing with test providers as well as discussing sexual health and testing with patients http://ncc.prevent.org/providers.html Centers for Disease Control and Prevention. Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection. MMWR 2008; 57(No. RR- 8): 1-20 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm American Association for the Study of Liver Diseases. Management, and Treatment of Hepatitis C: Practice Guidelines, 2009 Update (pp 1335-1339, sections on Testing, Counseling, and Test Interpretation) http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/Diagnosis_of_HEP_C_Update.Aug%20_09pdf.pdf	Access to Health Services 9: Increase the persons who receive appropriate clinical preventive services. Older Adults 2: Increase the older adults who are up to date on a core set of clinical preventive measures. Heart Disease and Stroke 4: Increase adults with hypertension whose blood pressure is under control 5: Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or highIncrease adults who can state whether their blood pressure was normal or high 6: Reduce the cholesterol levels among adults 7: Reduce high total blood cholesterol levels in adults. 8: Increase the proportion of adults who have had their blood cholesterol checked within the preceding 5 yearsIncrease blood cholesterol testing. 13: Reduce hypertension 18: Increase adherence to prescribed blood pressure medication. 19: Increase the proportion of adults with elevated LDL cholesterol who have been advised regarding cholesterol-lowering management Diabetes 14: Increase population with diagnosed diabetes whose blood pressure is under control. 15: Improve lipid control among the population with diagnosed diabetes. Cancer 9: Increase cancer screening counseling. 14: Increase number of women who receive a cervical cancer screening 15: Increase number of adults who receive a colorectal cancer screening 16: Increase number of women who receive breast cancer screening Substance Abuse 21: Decrease the number of alcohol related deaths. Maternal, Infant and Child Health 10: Increase abstinence from alcohol, cigarettes and illicit drugs among pregnant women. Adolescent Health 3: Increase the percentage of adolescents tested for HIV. HIV 6: Increase adults with TB who have been tested for HIV. 8: Increase the new HIV infections diagnosed before progression to AIDS. 10: Reduce the number of new cases of perinatally acquired HIV/AIDS and perinatally acquired AIDS. 12: Increase HIV-infected persons who know they are infected. 14: Increase HIV testing. Immunization and Infectious Diseases 1: Reduce chronic hepatitis B virus in infants and young children. 26: Increase persons aware they have a chronic hepatitis C infection. 27: Increase hepatitis B testing in communities experiencing health disparities. Sexually Transmitted Diseases 3: Reduce Chlamydia trachomatis infections. 4: Reduce gonorrhea rates. 5: Reduce transmission of syphilis. 6: Reduce genital herpes. 8, 9: Increase screening for genital Chlamydia infections. Disability and Secondary Conditions 14: Reduce reported delays in receiving primary care due to barriers. 15: Increase transition planning from pediatric to adult health care.
Provide outreach, including paid and earned media, to increase use of clinical preventive services by the population or population subgroups.	GYT (Get Yourself Tested): http://www.itsyoursexlife.com/gyt/toolkit http://www.cahl.org/web/ , the National Chlamydia Coalition: http://ncc.prevent.org/ and Cicatelli Associates: http://www.cicatelli.org/AboutCAI/home.htm .	HIV 14: Increase HIV testing. Sexually Transmitted Diseases 8, 9: Increase screening for genital Chlamydia infections.
Increase coverage, availability and use of expedited partner therapy.	A description of EPT principles and CDC’s clinical guidance (p34) can be found at http://www.cdc.gov/std/treatment/EPTFinalReport2006.pdf. Program recommendations are contained in CDC’s MMWR recommendations at http://www.cdc.gov/nchhstp/partners/Partner-Services.html (See section on treatment for partners).	Sexually Transmitted Diseases 1: Reduce females who have ever required treatment for pelvic inflammatory disease. 3: Reduce Chlamydia trachomatis infections. 4: Reduce gonorrhea rates. 8, 9: Increase screening for genital Chlamydia infections. Access to Health Services 9: Increase the persons who receive appropriate clinical preventive services.
Prevent diabetes, especially in high risk populations. Increase coverage, availability and use of the National Diabetes Prevention Program Increase preventive services for pregnant women with gestational diabetes or a history of gestational diabetes.	Diabetes Training and Technical Assistance Center – **This site provides information on diabetes and in the future will house training, curriculum and recognition information on the National Diabetes Prevention Program. http://dttac.org/about/index.html Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403. National Diabetes Prevention Program http://www.cdc.gov/diabetes/projects/prevention_program.htm	Diabetes 16: Increase the people with pre-diabetes or multiple diabetes risk factors that engage in prevention behaviors. Access to Health Services 9: Increase the persons who receive appropriate clinical preventive services. HIV 14: Increase HIV testing.
Increase access to and use of school-based dental sealant programs.	Association of State and Territorial Dental Directors (ASTDD) Best Practice Approach Report: School-based Sealant Programs http://www.astdd.org/school-based-dental-sealant-programs/	Oral Health 10: Increase dental sealants on their molar teeth.
Improve arthritis, asthma, cardiovascular disease, and diabetes outcomes with chronic disease self management training programs.	Stanford Chronic Disease Self-Management Program http://patienteducation.stanford.edu/programs/cdsmp.html Arthritis evidence-based self-management programs http://www.cdc.gov/arthritis/interventions/self_manage.htm Guidelines for the Diagnosis and Management of Asthma www.nhlbi.nih.gov/guidelines/asthma/ Asthma: A Business Case for Employers and Health Care Purchasers http://asthmaregionalcouncil.org/uploads/Asthma%20Management/Asthma%20-%20%20A%20Business%20Case%20for%20Employers%20and%20Health%20Care%20Purchasers%20%202010.pdf The Asheville Project http://www.pharmacytimes.com/files/articlefiles/TheAshevilleProject.pdf Diabetes Self-Management Education Action Guide http://www.prevent.org/data/files/initiatives/diabetesprogram.pdf AADE Guidelines for the Practice of Diabetes Self-Management Education and Training http://www.diabeteseducator.org/DiabetesEducation/position/Practice_Guidelines.html	Arthritis, Osteoporosis, & Other Back Conditions 7: Increase provider counseling for arthritis. 8: Increase education for adults with arthritis. Respiratory Diseases 1, 2: Reduce hospitalizations and emergency visits for asthma 3: Reduce activity limitations among persons with asthma 4: Reduce activity limitation due to chronic lung/ breathing problems. Reduce asthma deaths 7: Reduce number of school or work days missed among persons with asthma 8: Increase the proportion of persons with asthma who receive formal patient education 9: Increase appropriate asthma care. Heart Disease and Stroke 4: Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or highIncrease adults who can state whether their blood pressure was normal or high. 6: Increase the proportion of adults who have had their blood cholesterol checked within the preceding 5 yearsIncrease adults who have had cholesterol checked. 7: Reduce high blood cholesterol levels 8: Reduce the mean total cholesterol among adults 11: Increase adherence to hypertensive prescriptions. 12: Increase controlled hypertension. 13: Increase cholesterol management. Diabetes 1: Increase diabetes education. 4: Reduce lower extremity amputations. 13: Improve glycemic control. 14, 15: Increase population with diagnosed diabetes whose blood pressure and lipids are under control.
Implement Viral Hepatitis Action Plan	http://www.hhs.gov/ash/initiatives/hepatitis/
Clinical Preventive Services Innovative Interventions.	Recipient will provide	Recipient will link to HP2020 objective
Strategic Direction 4: Social and Emotional Wellness Goals: Increase child and adolescent health and wellness, including social and emotional wellness.
Promote effective parenting practices.	Bright Futures http://brightfutures.aap.org/3rd_Edition_Guidelines_and_Pocket_Guide.html http://www.cdc.gov/ace/index.htm School Connectedness: Strategies for Increasing Protective Factors among Youth http://www.cdc.gov/HealthyYouth/AdolescentHealth/pdf/connectedness.pdf http://www.cdc.gov/HealthyYouth/index.htm http://www.cdc.gov/ncbddd/disabilityandhealth/index.html	Maternal, Infant and Child Health 14: Increase the proportion of children with special health care needs who receive their care in family-centered, comprehensive, coordinated systems. 30: Increase screening, evaluation, and early intervention in young children with developmental delays. Mental Health and Mental Disorders 6: Increase treatment for children with mental health problems Early and Middle Childhood 5: Increase use of positive parenting. Disability and Secondary Conditions 20: Increase intervention services in home or community-based settings for children with disabilities. Adolescent Health 8: Increase the adolescents connected to a positive adult caregiver.
Implement effective positive youth development and risk reduction approaches to improve adolescent health.	Communities that Care http://www.sdrg.org/CTCInterventions.asp Raising Healthy Children http://www.sdrg.org/rhcsummary.asp Review of studies with impressive outcomes, Johns Hopkins School of Public Health http://www.jhsph.edu/bin/i/h/gbg.pdf
Social and Emotional Wellness Innovative Interventions.	Recipient will provide	Recipient will link to HP2020 objective
Strategic Direction 5: Healthy and Safe Physical Environment Goals: Increase bicycling and walking; improve the community environment to support health.
Increase adoption of comprehensive approaches to improve community design to enhance walking and bicycling and active transportation.	CDC Recommendations for Improving Health through Transportation Policy http://www.cdc.gov/transportation/recommendation.htm Active Design Guidelines: Promoting Physical Activity and Health in Design www.nyc.gov/html/ddc/html/design/active_design.shtml KidsWalk-to-School: A Guide to Promote Walking to School http://www.cdc.gov/nccdphp/dnpa/kidswalk/resources.htm#guide National Center for Safe Routes to School guide, toolkit, and other resources http://www.saferoutesinfo.org/resources/ http://www.cdc.gov/InjuryViolenceSafety/ http://www.cdc.gov/aging/	Environmental Health 9: Increase use of alternative modes of transportation. Disability and Secondary Conditions 7: Reduce reported barriers Physical Activity and Fitness 6, 7: Increase physical activity in adults and adolescents. 10: Increase walking. 11: Increase bicycling. Environmental Health 9: Increase use of alternative modes of transportation.
Establish community design standards to make streets safe for all users, including pedestrians, bicyclists and users of public transit.	Increasing Physical Activity Through Community Design: A Guide for Public Health Practitioners www.bikewalk.org/pdfs/IPA_full.pdf How to Develop a Pedestrian Safety Action Plan http://drusilla.hsrc.unc.edu/cms/downloads/howtoguide2006.pdf Complete Streets: Best Policy and Implementation Practices www.completestreets.org/webdocs/resources/cs-bestpractices-chapter5.pdf http://www.cdc.gov/InjuryViolenceSafety/	Environmental Health 9: Increase use of alternative modes of transportation. Physical Activity and Fitness 10: Increase walking. 11: Increase bicycling 16: Increase policies for the built environment that enhance access to and availability of physical activity opportunities.
Increase mixed use zoning and transit-oriented development.	Creating Safe, Healthy and Active Living Communities: A Public Health Professional's Guide to Key Land Use and Transportation Planning Policies and Processes www.safehealthycommunities.com/pdfs/tools_guides_factsheets/CreatingSafeHealthyCommunities.pdf Creating Regulatory Blueprint for Healthy Community Design: A Local Government Guide to Reforming Zoning and Land Development Codes www.healthytransportation.net/Creating%20a%20Regulatory%20Blueprint%20for%20Healthy%20Community%20Design.pdf	Environmental Health 9: Increase use of alternative modes of transportation. Physical Activity and Fitness 10: Increase walking. 11: Increase bicycling
Establish community protocols to assess the impact of community changes on community health and wellbeing.	A Health Impact Assessment Toolkit: A Handbook to Conducting HIA www.humanimpact.org/component/jdownloads/finish/11/8 Practice Standards for Health Impact Assessment (HIA) http://www.humanimpact.org/doc-lib/finish/11/9 Planning for Healthy Places with Health Impact Assessments http://professional.captus.com/Planning/hia/default.aspx	Physical Activity and Fitness 6, 7: Increase physical activity in adults and adolescents. Disability and Secondary Conditions 7: Reduce reported barriers
Change building codes and other important policies to increase safe and healthy homes. Promote community-level building codes to require all new construction to be radon-resistant Promote community-level property maintenance and other codes to improve indoor home environments by improving requirements for smoke-, CO, and radon-detectors in homes. Promote community-level property maintenance and other codes in home environments such as bathrooms and stairs to reduce injury risks. Promote private and public health care policies to provide reimbursement for asthma education and environmental trigger reduction through home visits. Integrate healthy homes principles into home visiting program protocols. Implement community wide campaigns that promote safe and healthy homes.	Healthy Homes Guidance Document (CDC document cleared; link to be posted soon) Housing Interventions and Health: A Review of the Evidence (http://journals.lww.com/jphmp/toc/2010/09001#-1750774083) Healthy Housing Reference Manual (www.cdc.gov/nceh/publications/books/housing/housing.htm) Surgeon General’s Call to Action to Promote Healthy Homes (www.surgeongeneral.gov/topics/healthyhomes/calltoactiontopromotehealthyhomes.pdf) Trailer Document (CDC document not yet publicly available) Asthma Community Guide (www.thecommunityguide.org/asthma/index.html) HUD’s Strategic Plan (www.hud.gov/offices/lead/library/hhi/hh_strategic_plan.pdf) and Notice of Funding Availability (www.hud.gov/library/bookshelf12/supernofa/) www.cdc.gov/lead http://www.cdc.gov/Environmental/	Environmental Health 3: Reduce pesticide exposures. 5: Reduce physical problems in housing units. 13: Reduce blood lead levels in children. 16: Reduce indoor allergen levels. 17: Increase the number of homes with an operating radon mitigation system. 18: Increase number of homes constructed with radon-reducing features 24: Reduce the number of U.S. homes with lead-based paint hazards. Tobacco Use 20: Increase the proportion of smoke-free homes Disability and Health 21: Increase homes and residential buildings with visitable features.
	Association of State and Territorial Dental Directors (ASTDD) Best Practice Approach Report: Use of Fluoride – Community Water Fluoridation http://www.astdd.org/use-of-fluoride-community-water-fluoridation/	Oral Health 2: Increase the proportion of the U.S. population served by community water systems with optimally fluoridated water.
Reduce alcohol retail outlet density and reduce illegal beverage service.	Community Guide http://www.thecommunityguide.org/alcohol/outletdensity.html Community Guide http://www.thecommunityguide.org/alcohol/dramshop.html	Substance Abuse 8: Reduce average annual alcohol consumption 16: Reduce the proportion of adults who drank excessively 7:  Reduce the proportion of persons engaging in binge drinking of alcoholic beverages 20: Decrease the number of deaths attributable to alcohol.
Healthy and Safe Physical Environment Innovative Interventions.	Recipient will provide	Recipient will link to HP2020 objective

*Complete Healthy People 2020 Objectives can be found at: http://www.healthypeople.gov/hp2020/Objectives/TopicAreas.aspx

Additional guidance is available at www.cdc.gov and at specific programmatic links at the CDC website.

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