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For more information, please visit www.cdc.gov/stltpublichealth/psr
Prevention Status Report | 2013
Georgia
Overview
1
Summary
2
Excessive Alcohol Use
4
Food Safety
8
HealthcareAssociated Infections
11
Heart Disease and Stroke
13
HIV
16
Motor Vehicle Injuries
19
Nutrition, Physical Activity, and Obesity
22
Prescription Drug Overdose
27
Teen Pregnancy
30
Tobacco Use
33
Suggested Citation:
Centers for Disease Control and Prevention.
Prevention Status Reports 2013—Georgia.
Atlanta, GA: US Department of Health and Human
Services; 2014.
Prevention Status Report | 2013
Georgia
The Prevention Status Reports (PSRs) highlight—for all 50 states and the District of Columbia—the status
of public health policies and practices designed to prevent or reduce 10 important health problems or
concerns:
Excessive alcohol use
Food safety
Healthcareassociated infections
Heart disease and stroke
HIV
Motor vehicle injuries
Nutrition, physical activity, and obesity
Prescription drug overdose
Teen pregnancy
Tobacco use
PSR Framework
The PSRs follow a simple framework:
•
Describe the public health problem using public health data
•
Identify potential solutions to the problem drawn from research and expert recommendations
•
Report the status of those solutions for each state and the District of Columbia
Criteria for Selection of Policies and Practices
The policies and practices included in the PSRs were selected because they
•
Can be monitored using statelevel data that are readily available for most states and the
District of Columbia
•
Meet one or more of the following criteria:
o Supported by systematic review(s) of scientific evidence of effectiveness (e.g., The Guide to
Community Preventive Services)
o Explicitly cited in a national strategy or national action plan (e.g., Healthy People 2020)
o Recommended by a recognized expert body, panel, organization, study, or report with an evidence
based focus (e.g., Institute of Medicine)
Ratings
The PSRs use a simple, threelevel rating scale to provide a practical assessment of the status of policies and
practices in each state and the District of Columbia:
•
A green rating indicates that the policy or practice is established in accordance with supporting evidence
and/or expert recommendations.
•
A yellow rating indicates that the policy or practice is established in partial accordance with supporting
evidence and/or expert recommendations.
•
A red rating indicates that the policy or practice is either absent or not established in accordance with
supporting evidence and/or expert recommendations.
It is important to note that the ratings reflect the status of policies and practices and do not reflect the status of
efforts by state health departments, other state agencies, or other organizations to establish or strengthen those
policies and practices. Strategies for improving public health vary by individual state needs, resources, and
public health priorities.
1
Prevention Status Reports—Summary for Georgia | 2013
The Prevention Status Reports (PSRs) highlight—for all 50 states and the District of Columbia—the status of
public health policies and practices designed to prevent or reduce 10 important health problems or concerns.
Below is a summary of Georgia’s PSR ratings for 2013.
PSR Policies and Practices by Topic
2013 PSR
Rating
Excessive Alcohol Use
State beer tax
Green
State distilled spirits tax
Red
State wine tax
Red
Commercial host (dram shop) liability law
Yellow
Local authority to regulate alcohol outlet density
Green
Food Safety
Speed of pulsedfield gel electrophoresis (PFGE) testing of reported E. coli O157 cases
Yellow
Completeness of PFGE testing of reported Salmonella cases
Green
HealthcareAssociated Infections (HAIs)
State health department participation in statewide HAI prevention efforts
Green
Heart Disease and Stroke
Implementation of electronic health records
Yellow
Pharmacist collaborative drug therapy management policy
Green
HIV
State Medicaid reimbursement for routine HIV screening
Data not
available
State HIV testing laws
Green
Reporting of CD4 and viral load data to state HIV surveillance program
Green
Motor Vehicle Injuries
Seat belt law
Yellow
Child passenger restraint law
Yellow
Graduated driver licensing system
Ignition interlock law
Red
Yellow
Nutrition, Physical Activity, and Obesity
Secondary schools not selling less nutritious foods and beverages
Red
State nutrition standards policy for foods and beverages sold or provided by state government agencies
Red
Inclusion of nutrition and physical activity standards in state regulations of licensed childcare facilities
Red
State physical education time requirement for high school students
Red
Average birth facility score for breastfeeding support
Red
Prescription Drug Overdose
State pain clinic law
Green
Prescription drug monitoring programs following selected best practices
Yellow
Teen Pregnancy
Expansion of state Medicaid family planning eligibility
Yellow
Tobacco Use
State cigarette excise tax
Red
Comprehensive state smokefree policy
Red
Funding for tobacco control
Red
2
Prevention Status Reports—Summary for Georgia | 2013
PSR Rating System *
Green
Yellow
Red
TThe policy or practice is established in accordance with supporting evidence and/or expert
recommendations.
TThe policy or practice is established in partial accordance with supporting evidence and/or
expert recommendations.
TThe policy or practice is either absent or not established in accordance with supporting
evidence and/or expert recommendations.
*The rating systems for the Excessive Alcohol Use (http://www.cdc.gov/stltpublichealth/psr/alcohol/) and Nutrition,
Physical Activity, and Obesity (http://www.cdc.gov/stltpublichealth/psr/npao/) reports varied slightly. For details,
please visit their respective pages on the PSR website. A more detailed explanation of the PSR rating system is
available at http://www.cdc.gov/stltpublichealth/psr/.
More Information
For more information about public health activities in Georgia, visit the Georgia Department of Public Health website
(http://www.health.state.ga.us/). For additional resources and to view reports for other states, visit the CDC website
(http://www.cdc.gov/stltpublichealth/psr/).
3
Prevention Status Report | 2013
Georgia
Excessive Alcohol Use
Public Health Problem
Excessive alcohol use is responsible for about 88,000 deaths and 2.5 million years of potential life lost in
the United States each year (1). Binge drinking (five or more drinks per occasion for men or four or more
drinks per occasion for women) is responsible for more than half the deaths and two-thirds of the years
of potential life lost resulting from excessive alcohol use (2).
Excessive drinking results in 2,555 deaths and 79,183 years of potential life lost each year in
Georgia (1).
In Georgia, 16.6% of adults and 17.5% of high school students reported binge drinking in 2011 (3,4).
Excessive alcohol use cost the United States $223.5 billion, or $1.90 per drink consumed, in 2006 as a
result of lost workplace productivity, healthcare expenses, and crime (5). In Georgia, excessive alcohol use
cost $6.3 billion, or $1.94 per drink (6).
Binge drinking among adults
30%
20%
40%
Binge drinking among high school
students
30%
18.3%
16.6%
US
GA
US
GA
20%
10%
10%
0%
0%
2011
Source: Behavioral Risk Factor Surveillance System (3)
Binge drinking intensity among adults
(in number of drinks per occasion)
2007
2009
2011
Source: Youth Risk Behavior Surveillance System (4)
5
8.0
7.7
6
4
US
GA
4
3
2.3
2.0
2
2
0
2005
Alcohol consumption per person aged ≥14
(in gallons)
10
8
2003
US
GA
1
2011
Source: Behavioral Risk Factor Surveillance System (3)
0
2010
Source: Alcohol Epidemiologic Data System (7)
4
Prevention Status Report | 2013
Georgia
Excessive Alcohol Use
Policy and Practice Solutions
This report focuses on policies and practices recommended by the Community Preventive Services Task Force on
the basis of scientific studies supporting their effectiveness in reducing excessive alcohol consumption and
related harms (8). These policies and practices include 1) increasing alcohol excise taxes (e.g., state taxes on
beer, distilled spirits, and wine); 2) having commercial host (dram shop) liability laws; and 3) regulating alcohol
outlet density (8–10). Other strategies supported by scientific evidence include avoiding further privatization of
retail alcohol sales and providing adults (including pregnant women) with screening and brief intervention for
excessive alcohol use (11,12). For information about why certain alcohol-related indicators were selected, and for
links to additional data and resources, visit the CDC website (http://www.cdc.gov/stltpublichealth/psr/alcohol/).
Status of Policy and Practice Solutions in Georgia
State beer tax
As of January 1, 2012, Georgia's excise tax per gallon of beer
was $1.01 (13).
Task Force on Community Preventive Services recommendation:
Increase alcohol excise taxes. Studies show that a 10% increase
in the price of beer would likely reduce beer consumption by
approximately 5% (8).
Rating State beer tax
Green
≥$1.00 per gallon
Yellow
$0.50–$0.99 per gallon
Red
$0.00–$0.49 per gallon
State distilled spirits tax
As of January 1, 2012, Georgia's excise tax per gallon of distilled
spirits was $1.89 (14).
Task Force on Community Preventive Services recommendation:
Increase alcohol excise taxes. Studies show that a 10% increase
in the price of distilled spirits would likely reduce distilled spirits
consumption by approximately 8% (8).
Rating State distilled spirits tax
Green
≥$8.00 per gallon
Yellow
$4.00–$7.99 per gallon
Red
$0.00–$3.99 per gallon
State wine tax
As of January 1, 2012, Georgia's excise tax per gallon of wine
was $0.42 (15).
Task Force on Community Preventive Services recommendation:
Rating State wine tax
Green
≥$2.00 per gallon
Increase alcohol excise taxes. Studies show that a 10% increase
in the price of wine would likely reduce wine consumption by
approximately 6% (8).
Yellow
$1.00–$1.99 per gallon
Red
$0.00–$0.99 per gallon
Commercial host (dram shop) liability laws
As of January 1, 2011, Georgia had commercial host liability
with major limitations (16,17).
Task Force on Community Preventive Services recommendation:
Presence of commercial host (dram shop) liability for sale or
service to either underage patrons or intoxicated adults.
Evidence shows these laws are associated with a reduction in
alcohol-related harms, including a median 6.4% reduction in
deaths from motor vehicle crashes (9).
Rating State had
Green
Commercial host liability with no
major limitations
Yellow Commercial host liability
with major limitations
Red
No commercial host liability
5
Prevention Status Report | 2013
Georgia
Excessive Alcohol Use
Local authority to regulate alcohol outlet density
As of January 1, 2012, Georgia had joint local and state alcohol
retail licensing (18).
Task Force on Community Preventive Services recommendation:
Use regulatory authority (e.g., through licensing and zoning) to
limit alcohol outlet density. Evidence shows greater alcohol outlet
density is associated with excessive drinking and related harms,
including injuries and violence (10). Local control allows
communities to better address density problems (18).
Rating State had
Green
Exclusive local or joint
state/local alcohol retail
licensing
Yellow
Exclusive state alcohol retail
licensing with local zoning
authority or other mixed policies
Red
Exclusive state alcohol retail
licensing
Simplified Rating System
A more detailed explanation of the rating system for excessive alcohol use is available at
http://www.cdc.gov/stltpublichealth/psr/alcohol/.
Green
The policy or practice is
established in accordance with
supporting evidence and/or
expert recommendations. Higher
tax levels are rated green.
Yellow
The policy or practice is established in
partial accordance with supporting
evidence and/or expert
recommendations. Intermediate tax
levels are rated yellow.
Red
The policy or practice is either absent
or not established in accordance with
supporting evidence and/or expert
recommendations. Lower tax levels
are rated red.
Indicator Definitions
State beer tax: The excise tax rate, in dollars per gallon, imposed by the state on beer containing 5% alcohol by
volume. State beer excise tax does not include any additional taxes, such as those based on price rather than
volume (e.g., ad valorem or sales taxes) that states may have implemented at the wholesale or retail level. State
beer taxes ranged from $0.02 to $1.07 across states for which excise tax data were available.
State distilled spirits tax: The excise tax rate, in dollars per gallon, imposed by the state on distilled spirits
containing 40% alcohol by volume. State distilled spirits excise tax does not include any additional taxes, such as
those based on price rather than volume (e.g., ad valorem or sales taxes) that states may have implemented at
the wholesale or retail level. State distilled spirits taxes ranged from $1.50 to $14.25 across states for which
excise tax data were available. For states with different tax rates for distilled spirits sold off-sale (e.g., at liquor
stores) and on-sale (e.g., at restaurants), the off-sale tax rate has been reported.
State wine tax: The excise tax rate, in dollars per gallon, imposed by the state on wine containing 12% alcohol
by volume. State wine excise tax does not include any additional taxes, such as those based on price rather than
volume (e.g., ad valorem or sales taxes) that states may have implemented at the wholesale or retail level. State
wine taxes ranged from $0.11 to $2.50 across states for which excise tax data were available.
Commercial host (dram shop) liability laws: Laws that hold alcohol retailers liable for alcohol-attributable
harms (e.g., injuries or deaths resulting from alcohol-related motor vehicle crashes) caused by patrons who were
illegally sold or served alcohol because they were either intoxicated or under the minimum legal drinking age of
21 years at the time of sale or service. State commercial host liability laws are considered to have major
limitations if they 1) cover underage patrons or intoxicated adults but not both, 2) require increased evidence for
finding liability, 3) set limitations on damage awards, or 4) set restrictions on who may be sued.
Local authority to regulate alcohol outlet density: The extent to which a local government can implement
zoning (land use) or licensing controls over the number of alcohol retailers (e.g., bars, restaurants, liquor stores)
in its geographic area.
6
Prevention Status Report | 2013
Excessive Alcohol Use
Georgia
References
1.
2.
3.
4.
5.
CDC. Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI) [database]. Accessed Dec 13, 2013.
CDC. Alcohol-attributable deaths and years of potential life lost, United States, 2001. MMWR 2004;53:866–70.
CDC. Behavioral Risk Factor Surveillance System (BRFSS) [database]. Accessed Dec 6, 2012.
CDC. Youth Online: High School Youth Risk Behavior Surveillance (YRBS) [database]. Accessed Feb 27, 2013.
Bouchery EE, Harwood HJ, Sacks JJ, et al. Economic costs of excessive alcohol consumption in the United States,
2006. American Journal of Preventive Medicine 2011;41:516–24; and correction, American Journal of Preventive
Medicine 2013;44:198.
6. Sacks JJ, Roeber J, Bouchery EE, et al. State costs of excessive alcohol consumption, 2006. American Journal of
Preventive Medicine 2013;45:474–85.
7. National Institute on Alcohol Abuse and Alcoholism. Alcohol Epidemiologic Data System. Apparent Per Capita
Alcohol Consumption: National, State, and Regional Trends, 1977–2010. Bethesda, MD: National Institutes of
Health; 2010.
8. Community Preventive Services Task Force. Preventing excessive alcohol consumption: increasing alcohol taxes.
In: Guide to Community Preventive Services. Updated Jun 2007.
9. Community Preventive Services Task Force. Preventing excessive alcohol consumption: dram shop liability. In:
Guide to Community Preventive Services. Updated Mar 2010.
10. Community Preventive Services Task Force. Preventing excessive alcohol consumption: regulation of alcohol
outlet density. In: Guide to Community Preventive Services. Updated Feb 2007.
11. Community Preventive Services Task Force. Preventing excessive alcohol consumption: privatization of alcohol
retail sales. In: Guide to Community Preventive Services. Updated Apr 2011.
12. US Preventive Services Task Force. Screening and Behavioral Counseling Interventions in Primary Care to Reduce
Alcohol Misuse [website]. Updated Oct 2012.
13. National Institute on Alcohol Abuse and Alcoholism. Alcohol beverages taxes: beer. Alcohol Policy Information
System [database]. Accessed Dec 6, 2012.
14. National Institute on Alcohol Abuse and Alcoholism. Alcohol beverages taxes: distilled spirits. Alcohol Policy
Information System [database]. Accessed Dec 6, 2012.
15. National Institute on Alcohol Abuse and Alcoholism. Alcohol beverages taxes: wine. Alcohol Policy Information
System [database]. Accessed Dec 6, 2012.
16. Substance Abuse and Mental Health Services Administration. Report to Congress on the Prevention and Reduction
of Underage Drinking. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2011.
17. Mosher JF, Cohen EN, Jernigan DH. Commercial host (dram shop) liability: current status and trends. American
Journal of Preventive Medicine 2013;45:347–53.
18. Mosher JF, Treffers R. State pre-emption, local control, and alcohol retail outlet density regulation. American
Journal of Preventive Medicine 2013;44:399–405.
7
Prevention Status Report | 2013
Food Safety
Georgia
Public Health Problem
Diseases spread by a wide variety of contaminated foods continue to challenge the public health system.
Bacteria, viruses, parasites, and chemicals can cause foodborne diseases, which can vary from mild to
fatal (1). Robust surveillance for these diseases is essential for detecting outbreaks. It also provides critical
information to food regulatory agencies and the food industry so that appropriate control and preventive
measures can be implemented (2).
CDC estimates that each year, roughly 1 in 6 Americans (or 48 million people) gets sick, 128,000 are
hospitalized, and 3,000 die due to foodborne diseases (3). Risk for infection and severity varies at different
ages and stages of health (4).
Foodborne illness is costly. According to a 2012 study, 14 pathogens alone are estimated to cost $14.1
billion in the United States per year. This includes medical costs (doctor visits and hospitalizations), loss due
to premature death, and time lost from work (5).
Policy and Practice Solutions
This report focuses on select practices recommended by the Council to Improve Foodborne Outbreak Response
on the basis of scientific evidence supporting their effectiveness in improving foodborne disease surveillance and
detection activities (2). These practices include 1) increasing the speed of DNA fingerprinting using pulsed-field
gel electrophoresis (PFGE) testing for all reported cases of Shiga toxin-producing Escherichia coli (E. coli) O157
and 2) increasing the completeness of PFGE testing of Salmonella. PFGE is a technique used to distinguish
between strains of organisms at the DNA level. For information about why certain food safety-related indicators
were selected, and for links to additional data and resources, visit the CDC website
(http://www.cdc.gov/stltpublichealth/psr/foodsafety/).
8
Prevention Status Report | 2013
Food Safety
Georgia
Status of Policy and Practice Solutions in Georgia
Speed of pulsed-field gel electrophoresis (PFGE) testing of reported
E. coli O157 cases
In 2011, Georgia tested 82.4% of E. coli O157 cases within 4
days (6).
CDC target: Testing of 90% of annual reported E. coli O157
cases within four days. The CDC Public Health Emergency
Preparedness Cooperative Agreement established this and other
national performance targets for food safety and provides federal
funding to states and the District of Columbia. Performing DNA
fingerprinting as quickly as possible for all Shiga toxin-producing
E. coli improves detection of outbreaks. Rapid outbreak
detection can help prevent additional cases and identify control
and prevention measures for food regulatory agencies and the
food industry (2).
Rating
Percentage of annual
reported cases tested
within four days:
Green
≥90.0%
Yellow 60.0%–89.9%
Red
<60.0%
Completeness of PFGE testing of reported Salmonella cases
In 2011, Georgia tested 100% of reported Salmonella cases
(6,7).
Research and experts in the field agree that performing
DNA fingerprinting of all Salmonella cases would improve
detection of outbreaks (2).
Rating
Percentage of annual
reported cases tested
by PFGE:
Green
≥90.0%
Yellow
60.0%–89.9%
Red
<60.0%
Simplified Rating System
A more detailed explanation of the rating system for food safety is available at
http://www.cdc.gov/stltpublichealth/psr/foodsafety/.
Green
The policy or practice is
established in accordance with
supporting evidence and/or
expert recommendations.
Yellow
The policy or practice is established in
partial accordance with supporting
evidence and/or expert
recommendations.
Red
The policy or practice is either
absent or not established in
accordance with supporting evidence
and/or expert recommendations.
9
Prevention Status Report | 2013
Food Safety
Georgia
Indicator Definitions
Speed of PFGE testing of reported E. coli O157 cases: The annual proportion of E. coli O157 PFGE patterns
reported to CDC (i.e., uploaded into PulseNet, the CDC-coordinated national molecular subtyping network for
foodborne disease surveillance) within four working days of receiving the isolate in the state or District of
Columbia public health PFGE lab.
Completeness of PFGE testing of reported Salmonella cases: The annual proportion of Salmonella cases
reported to CDC’s National Notifiable Diseases Surveillance System with PFGE patterns uploaded into PulseNet.
References
1. Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States—major pathogens. Emerging
Infectious Diseases 2011;17:7–15.
2. Council to Improve Foodborne Outbreak Response. Guidelines for Foodborne Disease Outbreak Response. Atlanta, GA:
Council of State and Territorial Epidemiologists; 2009.
3. Scallan E, Griffin P, Angulo F, et al. Foodborne illness acquired in the United States—unspecified agents. Emerging
Infectious Diseases 2011;17:16‒22.
4. Lund BM, O'Brien SJ. The occurrence and prevention of foodborne disease in vulnerable people. Foodborne Pathogens and
Disease 2011;8:961–73.
5. Hoffmann S, Batz M, Morris JG. Annual cost of illness and quality-adjusted life year losses in the United States due to 14
foodborne pathogens. Journal of Food Protection 2012;75:1292–1302.
6. CDC. PulseNet [database]. Accessed Dec 19, 2012.
7. CDC. Final 2011 reports of nationally notifiable infectious diseases. MMWR 2012;60(32):624–37.
10
Prevention Status Report | 2013
Healthcare-Associated Infections
Georgia
Public Health Problem
HAIs occur in all settings where patients receive medical care, including hospital and nonhospital settings,
and are associated with increased illness and death. CDC estimates that each year in the United States,
1 in 20 hospital patients gets an HAI (1).
More than one million HAIs occur across all US healthcare settings combined. For example, Clostridium
difficile infections kill 14,000 people in the United States each year (2).
HAIs result in an estimated $30 billion in excess healthcare costs nationally each year (3).
What is a standardized infection ratio
(SIR)?
Central line-associated bloodstream
infection—standardized infection ratio
2.5
2.0
1.5
1.0
US
0.85
0.98
0.68
0.77
0.5
0.0
2009
2010
0.82
0.59
2011
Source: National and State Healthcare-Associated
Infections Standardized Infection Ratio Report (4)
GA
The SIR is a summary measure used to track
HAIs over time. It adjusts for the fact that
each healthcare facility treats different types of
patients. The SIR compares the number of
infections reported to the National Healthcare
Safety Network in 2011 to the number of
infections that would be predicted based on
national, historical baseline data:
SIR =
Observed # of HAIs
Predicted # of HAIs
Policy and Practice Solutions
CDC recommends strategies for surveillance, prevention, and control of HAIs and antimicrobial resistance
wherever health care is provided, including hospitals as well as ambulatory and long-term care facilities. CDC
works closely with states and the District of Columbia on strategies to implement these recommendations. This
collaborative effort among CDC, state and district health departments, and facilities will improve healthcare
quality across the nation, working toward meeting the standards and targets set forth in the Department of
Health and Human Service’s National Action Plan to Prevent Healthcare-Associated Infections (5).
This report focuses on state health departments leading and participating in statewide HAI prevention efforts, a
practice that helps improve existing prevention strategies by investing in both new and ongoing HAI prevention
efforts and prioritizing HAIs as a serious public health concern. State health departments are encouraged to also
engage in other practices that will provide actionable HAI data and lead to expanded HAI prevention. These
include 1) state health departments validating data sent to CDC’s National Healthcare Safety Network (NHSN),
ideally including data on central line-associated bloodstream infections (CLABSIs); catheter-associated urinary
tract infections (CAUTIs); and surgical site infections; and 2) working with CDC and other partners using NHSN
data to target facilities and units most in need of consultation to prevent HAIs and antimicrobial resistance. For
information about why certain HAI-related indicators were selected, and for links to additional data and
resources, visit the CDC website (http://www.cdc.gov/stltpublichealth/psr/hai/).
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Prevention Status Report | 2013
Healthcare-Associated Infections
Georgia
Status of Policy and Practice Solutions in Georgia
State health department participation in statewide HAI prevention efforts
In 2013, Georgia led or participated in broad prevention
collaboratives to prevent multiple HAIs in acute care facilities,
including CLABSIs, CAUTIs, and C. difficile, as well as HAIs in
long-term care facilities (6).
Implementing HAI prevention strategies and tracking the
impact of those strategies have led to improvements in clinical
practice and medical procedures, development of
evidence-based infection control guidance, and prevention
successes (7).
Rating
State health department
Green
Led or participated in a broad
prevention collaborative
addressing at least one HAI
Yellow
N/A
Red
Did not participate in a broad
prevention collaborative
addressing HAIs
Simplified Rating System
A more detailed explanation of the rating system for HAIs is available at http://www.cdc.gov/stltpublichealth/psr/hai/.
Green
The policy or practice is
established in accordance with
supporting evidence and/or
expert recommendations.
Yellow
The policy or practice is established in
partial accordance with supporting
evidence and/or expert
recommendations.
Red
The policy or practice is either absent
or not established in accordance with
supporting evidence and/or expert
recommendations.
Indicator Definitions
Participation in statewide HAI prevention efforts: State health department participation in or leadership of
broad prevention collaboratives addressing one or more of the following types of HAIs: central line-associated
bloodstream infections, surgical site infections, catheter-associated urinary tract infections, ventilator-associated
pneumonia, methicillin-resistant Staphylococcus aureus, and C. difficile.
References
1. CDC. Healthcare-Associated Infections: The Burden [website]. Updated Dec 13, 2010.
2. CDC. Vital Signs—Making Health Care Safer: Stopping C. difficile Infections. Atlanta, GA: US Department of Health and
Human Services; 2012.
3. Scott RD 2nd. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of
Prevention. Atlanta, GA: US Department of Health and Human Services; 2009.
4. CDC. National and State Healthcare-Associated Infections Standardized Infection Ratio Report. January–December 2011.
Atlanta, GA: US Department of Health and Human Services; 2013.
5. US Department of Health and Human Services. National Action Plan to Prevent Healthcare-Associated Infections:
Roadmap to Elimination [website]. Updated Apr 2012.
6. CDC. State-Based HAI Prevention [website]. Updated May 10, 2013.
7. CDC. Preventing Healthcare-Associated Infections [website]. Updated Apr 17, 2012.
12
Prevention Status Report | 2013
Georgia
Heart Disease and Stroke
Public Health Problem
Cardiovascular disease—including heart disease, stroke, and other vascular diseases—is the leading cause
of death in the United States. Each year, nearly 800,000 people die from cardiovascular disease,
accounting for one in every three deaths (1).
An estimated 67 million American adults have high blood pressure and 71 million American adults have
high levels of low-density lipoprotein (LDL) cholesterol. These are two leading risk factors for heart disease
and stroke (2,3).
About one of every six healthcare dollars in the United States is spent on treating cardiovascular disease.
Annual US cardiovascular disease costs exceed $192.1 billion in direct medical expenses and $312.6 billion
when indirect expenses are included (4).
Coronary heart disease death rate
(age-adjusted rate per 100,000 population)
250
80
200
60
150
US
GA
100
2006
2007
2008
2009
0
2010
Source: National Vital Statistics System—Mortality (5)
Healthy People 2020 target: 100.8/100,000
(dotted blue line) (6)
2006
2007
2008
2009
2010
Prevalence of self-reported high
cholesterol (age-adjusted)
50%
50%
40%
40%
32.6%
29.6%
US
GA
20%
34.3%
33.4%
30%
US
GA
20%
10%
10%
0%
GA
Source: National Vital Statistics System—Mortality (5)
Healthy People 2020 target: 33.8/100,000
(dotted blue line) (6)
Prevalence of self-reported
hypertension (age-adjusted)
30%
US
40
20
50
0
Stroke death rate (age-adjusted rate per
100,000 population)
2011
Source: Behavioral Risk Factor Surveillance System
(BRFSS) (7)
Note: These rates were adjusted using the direct method
and the 2000 standard US population (8).
0%
2011
Source: Behavioral Risk Factor Surveillance System
(BRFSS) (7)
Note: These rates were adjusted using the direct method
and the 2000 standard US population (8).
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Prevention Status Report | 2013
Georgia
Heart Disease and Stroke
Policy and Practice Solutions
This report focuses on policies and practices recommended by the Community Preventive Services Task Force,
the US Surgeon General, and the Institute of Medicine on the basis of scientific studies supporting the policies'
effectiveness in the management of heart disease and stroke risks (9–12). These policies and practices include 1)
implementing electronic health records and 2) developing state policies that address collaborative drug therapy
management, such as the use of pharmacists to facilitate collaborative practice agreements (10). Other
strategies supported by scientific evidence and practice include promoting team-based care, establishing
state-level policies for patient-centered medical homes, establishing stroke systems of care, and reducing sodium
consumption at the community level. For information about why certain heart disease and stroke-related
indicators were selected, and for links to additional data and resources, visit the CDC website
(http://www.cdc.gov/stltpublichealth/psr/heartandstroke/).
Status of Policy and Practice Solutions in Georgia
Implementation of electronic health records
As of December 2012, 18.5% of office-based physicians in Georgia
met criteria for meaningful use of electronic health records (12).
Research shows that electronic health records, when used with
specific goals in mind (i.e., "meaningfully"), allow physicians, nurses,
pharmacists, and other healthcare providers to proactively monitor
and protect the health of their patients by tracking heart disease and
stroke risk factors (13–15).
Note: This indicator reflects the percentage of physicians using
electronic health records that can support 13 capabilities needed to
meet Stage 1 Core Set objectives to demonstrate meaningful use.
Other data from the federal Office of the National Coordinator for
Health Information Technology reflect the percentage of physicians
using a basic system, which has seven capabilities (16).
Rating Percentage of
office-based physicians
meeting meaningful use
criteria:
Green
31.0%–45.0%
Yellow 16.0%–30.9%
Red
0.0%–15.9%
Pharmacist collaborative drug therapy management (CDTM) policy
As of December 31, 2012, Georgia had a statewide pharmacist CDTM
policy for all health conditions (17).
State policies such as CDTM laws, which authorize pharmacists to
enter into collaborative practice agreements with prescribing
providers, can increase medication adherence rates and improve
health outcomes (e.g., lower blood pressure and LDL cholesterol,
reduced hemoglobin A1c, fewer adverse drug events) (10).
Rating CDTM policy
Green Authorized pharmacists to
collaborate for all health
conditions
Yellow
Authorized pharmacists to
collaborate but did not cover
chronic diseases, or
collaboration was limited to
specified hospital, medical, or
clinical practice settings
Red
Did not exist
Simplified Rating System
A more detailed explanation of the rating system for heart disease and stroke indicators is available at
http://www.cdc.gov/stltpublichealth/psr/heartandstroke/.
Green
Yellow
Red
The policy or practice is
established in accordance with
supporting evidence and/or
expert recommendations.
The policy or practice is established in
partial accordance with supporting
evidence and/or expert
recommendations.
The policy or practice is either
absent or not established in
accordance with supporting
evidence and/or expert
recommendations.
14
Prevention Status Report | 2013
Heart Disease and Stroke
Georgia
Indicator Definitions
Implementation of electronic health records: An electronic health record is a real-time, digital,
patient-centered record that replaces paper charts. "Meaningful use" of electronic health records means
meeting criteria that focus on such aspects as engaging patients in their own care, sharing information among
healthcare organizations, and providing support for decisions on national high-priority conditions. It is hoped
that if healthcare providers meet these criteria, "meaningful use" will lead to 1) creation of tools that measure
healthcare quality to improve clinical and population health, 2) increased transparency and efficiency, 3)
individuals empowered to access clinical information, and 4) more robust research data on health systems
(18). Electronic health records should include clinical decision supports, such as alerts for elevated blood
pressure and cholesterol levels based on laboratory results, to support guidelines-based clinical decision
making.
Pharmacist collaborative drug therapy management policy: A state legislative, regulatory, or other
written policy that authorizes qualified pharmacists working within the context of a defined protocol to perform
patient assessments; order drug therapy-related laboratory tests; administer drugs; and select, initiate,
monitor, continue, and adjust drug regimens (19).
References
1. Kochanek KD, Xu JQ, Murphy SL, et al. Deaths: final data for 2009. National Vital Statistics Report 2011;60(3).
2. CDC. Vital signs: awareness and treatment of uncontrolled hypertension among adults—United States, 2003–2010.
MMWR 2012;61(35):703–9
3. CDC. Vital signs: prevalence, treatment, and control of high levels of low-density lipoprotein cholesterol. United States,
1999–2002 and 2005–2008. MMWR 2011;60(4):109–14.
4. Fryar CD, Chen T, Li X. Prevalence of Uncontrolled Risk Factors for Cardiovascular Disease: United States, 1999–2010.
NCHS Data Brief, No. 103. Hyattsville, MD: US Department of Health and Human Services; 2012.
5. CDC. Compressed Mortality File 1999–2010. CDC WONDER [database]. Accessed Jan 2013.
6. US Department of Health and Human Services. Heart disease and stroke. In: Healthy People 2020. Rockville, MD: US
Department of Health and Human Services; Updated Sep 6, 2012.
7. CDC. Behavioral Risk Factor Surveillance System [database]. Accessed Jun 25, 2013.
8. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes,
No. 20. Hyattsville, MD: National Center for Health Statistics; 2001.
9. Community Preventive Services Task Force. Cardiovascular disease prevention and control: team-based care to improve
blood pressure control. In: Guide to Community Preventive Services. Updated Apr 2012.
10. Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. A
Report to the U.S. Surgeon General. Rockville, MD: US Public Health Service; 2011.
11. Institute of Medicine. Primary Care and Public Health: Exploring Integration to Improve Population Health. Washington,
DC: National Academies Press; 2012.
12. CDC. National Ambulatory Medical Care Survey. National Electronic Health Records Survey 2012. Unpublished data.
13. Kinn JW, Marek JC, O’Toole MF, et al. Effectiveness of the electronic medical record in improving the management of
hypertension. Journal of Clinical Hypertension 2002;4(6):415–9.
14. Ross SE, Moore LA, Earnest MA, et al. Providing a web-based online medical record with electronic communication
capabilities to patients with congestive heart failure: randomized trial. Journal of Medical Internet Research 2004;6:e12.
15. Rossi RA, Every NR. A computerized intervention to decrease the use of calcium channel blockers in hypertension.
Journal of General Internal Medicine 1997;12:672–8.
16. US Department of Health and Human Services. Office of the National Coordinator for Health IT, Health IT Dashboard.
Accessed Dec 2013.
17. CDC. Chronic Disease State Policy Tracking System [database]. Accessed Dec 7, 2012
18. US Department of Health and Human Services. EHR Incentives & Certification: How to Attain Meaningful Use [website].
Accessed Dec 7, 2012.
19. American College of Clinical Pharmacy. ACCP position statement: collaborative drug therapy management by
pharmacists—2003. Pharmacotherapy 2003;23(9)1210–25.
15
Prevention Status Report | 2013
HIV
Georgia
Public Health Problem
CDC estimates that more than 1.1 million people in the United States are living with HIV, and 15.8%
(about one in six) are not aware they are infected (1). In 2010, the White House released the first National
HIV/AIDS Strategy for the United States to increase the nation’s sense of urgency and to improve HIV
prevention and care (2).
In 2011, 1,834 people in Georgia were newly diagnosed with HIV infection (1). Twenty-seven percent of
these people were diagnosed late in the disease and therefore were at increased risk for disease progression,
death, and transmission of HIV to others. In 2010, more than 21,000 people with HIV were estimated to
have died in the United States. Of these, CDC estimates that 1,037 were from Georgia (1).
The lifetime cost of medical care for a person with an early HIV diagnosis is about $400,000 (3). This
means that lifetime medical costs for the 1,834 Georgia residents newly diagnosed with HIV in 2011 could
exceed $732 million.
Estimated annual prevalence rate of persons
living with diagnosed with HIV aged 13 years
and older (per 100,000 population)
900
50
800
40
700
US
GA
600
500
30
20
2008
2009
0
2010
Source: National HIV Surveillance System (4)
Note: The y-axis for this graph varies by state.
2008
2009
2010
2011
Source: National HIV Surveillance System (4)
Note: The y-axis for this graph varies by state.
Percentage of persons newly diagnosed with
HIV who have late stage HIV
100%
Estimated annual death rate among
persons diagnosed with HIV (per 1,000
people living with HIV)
50
40
80%
60%
US
GA
40%
30
US
GA
20
10
20%
0%
US
GA
10
400
300
Estimated annual rate of new HIV
diagnoses among persons aged 13 years
and older (per 100,000 population)
2008
2009
2010
2011
Source: National HIV Surveillance System (1)
Healthy People 2020 Target: 20.8% by 2015 (dotted
blue line) (5)
0
2008
2009
2010
Source: National HIV Surveillance System (1)
16
Prevention Status Report | 2013
HIV
Georgia
Policy and Practice Solutions
This report highlights policies that reflect recent scientific advances in HIV prevention and medical care. These
advances create new opportunities for reducing new HIV infections and HIV-related illness and death. These
policies are important state-level tools that further the goals of the 2010 National HIV/AIDS Strategy (2),
including 1) facilitating state Medicaid reimbursement for HIV screening (7), 2) making state HIV testing laws
compatible with the 2006 CDC HIV testing recommendations (6,10), and 3) reporting all CD4 lymphocyte and
HIV viral load data to the state HIV surveillance program (7). For information about how and why certain
HIV-related indicators were selected, and for links to additional data and resources, visit the CDC website
(http://www.cdc.gov/stltpublichealth/psr/hiv/).
Status of Policy and Practice Solutions in Georgia
State Medicaid reimbursement for routine HIV screening
2013 data were not available for Georgia for this measure (7).
CDC and the US Preventive Services Task Force recommend that
adolescents, adults, and pregnant women be screened for HIV,
regardless of risk (6,8). All state and District of Columbia Medicaid
programs cover medically necessary HIV testing (7).
Reimbursement for routine screening, meaning broad,
population-based HIV screening, in contrast with “medically
necessary” testing and screening targeted at those at higher risk,
increases the availability of this important preventive service for
low-income populations (6,9).
Rating State Medicaid plan
Green
Reimbursed for routine HIV
screening
Yellow
Red
N/A
Did not reimburse for routine
HIV screening
State HIV testing laws
As of July 2013, Georgia's HIV testing laws were consistent with
CDC’s 2006 HIV testing recommendations (10).
CDC recommends that all people aged 13–64 years be tested for
HIV (6). HIV testing enables individuals with HIV to become
aware of their health status and to access medical care and
treatment. Studies show that individuals diagnosed with HIV are
less likely to transmit HIV to others (2). State and District of
Columbia laws can facilitate access to HIV testing.
Rating State HIV testing laws
compared to CDC's
HIV testing
recommendations were
Green Consistent with consent
and counseling parameters
Yellow
Red
N/A
Inconsistent with consent or
counseling parameters
Reporting of CD4 and viral load data to state HIV surveillance program
As of July 2013, Georgia required reporting of all CD4 and viral
load results (including undetectable results) for surveillance
purposes (10).
CD4 and HIV viral load data are critical to the medical care and
health of people living with HIV. These data are also used to
monitor progress toward achieving the goals of the National
HIV/AIDS Strategy and to ensure that people living with HIV are
linked to HIV medical care and retained in care (2).
Rating State law, regulation, or
directive
Green Required reporting of all
CD4 and HIV viral load data
Yellow
Required reporting of some
but not all CD4 and HIV viral
load data
Red
Did not require reporting of
any CD4 and HIV viral load
data
17
Prevention Status Report | 2013
HIV
Georgia
Simplified Rating System
A more detailed explanation of the rating system for HIV is available at http://www.cdc.gov/stltpublichealth/psr/hiv/.
Green
The policy or practice is
established in accordance with
supporting evidence and/or
expert recommendations.
Yellow
The policy or practice is established in
partial accordance with supporting
evidence and/or expert
recommendations.
Red
The policy or practice is either
absent or not established in
accordance with supporting evidence
and/or expert recommendations.
Indicator Definitions
State Medicaid reimbursement for routine HIV screening: Medicaid reimbursement of healthcare providers
for costs associated with routine HIV screening regardless of risk. Data reflect the most recent survey examining
coverage as of January 2013.
State HIV testing laws: State laws governing HIV testing. Laws may or may not be consistent with key
parameters of consent and counseling outlined in CDC’s 2006 HIV testing recommendations (4). The consent
parameters include opt-out (rather than opt-in) testing, inclusion of HIV testing consent as part of general
medical consent forms (rather than HIV-specific consent forms), and permission to give consent orally. The
counseling parameter includes not requiring prevention counseling prior to testing.
Reporting of CD4 and viral load data to HIV surveillance program: Existence of state statutes, regulations
or directives that address the reporting of all CD4 values and all HIV viral load results (detectable and
undetectable) to the state HIV surveillance program. HIV viral load and CD4 data among people with HIV
infection are useful as indicators of program effectiveness. Viral load measures the amount of virus in a person’s
blood. CD4 results provide a measure of a person’s immune function and are used for determining the stage of
HIV infection. Among people with HIV, CD4 results are often used to monitor disease progression and to time
clinical care, and both HIV viral load and CD4 results are used to assess response to treatment.
References
1. CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States
and 6 U.S. dependent areas—2011. HIV Surveillance Supplemental Report 2013;18(No. 5).
2. White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States; 2010.
3. Farnham PG, Gopalappa C, Sansom SL, et al. Updates on lifetime costs of care and quality of life estimates for
HIV-infected persons in the United States: late versus early diagnosis and entry into care. Journal of Acquired Immune
Deficiency Syndrome. 2013; 64: 183–189.
4. CDC. NCHHSTP Atlas [website]. Updated Jul 2013.
5. Department of Health and Human Services. HIV. In: Healthy People 2020. Rockville, MD: US Department of Health and
Human Services. Updated Aug 28, 2013.
6. CDC. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings.
MMWR 2006;55(RR-14):1–17.
7. Kaiser Family Foundation. State Medicaid Coverage of Routine HIV Screening; 2013.
8. Moyer VA, on behalf of the US Preventive Services Task Force. Screening for HIV: US Preventive Services Task Force
recommendation statement. Annals of Internal Medicine 2013; Apr 30.
9. Kates J. Medicaid and HIV: A National Analysis. Menlo Park, CA: Kaiser Family Foundation; 2011.
10. CDC. HIV and the Law [website]. Updated Sep 2013.
18
Prevention Status Report | 2013
Motor Vehicle Injuries
Georgia
Public Health Problem
Motor vehicle crashes are a leading cause of death in the United States for people aged 30 years or
younger (1).
In 2011, motor vehicle crashes killed more than 32,000 people in the United States and injured more than
2.6 million (1,2).
In 2005 alone, motor vehicle crashes cost Americans $99 billion in medical care, rehabilitation, and lost
wages (3).
Motor vehicle-related death rate
among drivers aged 15–20 years (per
100,000 population)
Motor vehicle-related death rate
(per 100,000 population)
40
40
30
30
US
GA
20
10
10
0
0
2006
2007
2008
2009
2010
Source: National Highway Traffic Safety Administration (4)
Healthy People 2020 Target: 12.4/100,000 (dotted blue
line) (5)
2006
2007
2008
2009
2010
Source: National Highway Traffic Safety Administration (6)
Percentage of crash-related deaths that
involved alcohol-impaired drivers
Observed seat belt use
50%
100%
40%
90%
US
GA
80%
70%
60%
US
GA
20
30%
US
GA
20%
10%
0%
2007
2008
2009
2010
2011
Source: National Highway Traffic Safety Administration (7)
Healthy People 2020 Target: 92.4% (dotted blue line) (5)
2006
2007
2008
2009
2010
Source: National Highway Traffic Safety Administration (8)
Policy and Practice Solutions
This report focuses on policies recommended by the Community Preventive Services Task Force and the National
Highway Traffic Safety Administration on the basis of scientific studies supporting the policies’ effectiveness in
preventing or reducing crash-related injuries and deaths. These policies include 1) implementing primary seat
belt laws, 2) improving laws mandating the use of appropriate child passenger restraints (e.g., car seats and
booster seats) to cover children through at least age 8 years, 3) using comprehensive graduated driver licensing
systems, and 4) requiring the use of ignition interlock devices for all convicted driving-while-intoxicated (DWI)
offenders (9–16). For information about why certain motor vehicle injury-related indicators were selected, and
for links to additional data and resources, visit the CDC website
(http://www.cdc.gov/stltpublichealth/psr/motorvehicle/).
19
Prevention Status Report | 2013
Motor Vehicle Injuries
Georgia
Status of Policy and Practice Solutions in Georgia
Seat belt law
As of August 1, 2013, Georgia had a primary enforcement seat
belt law for only the front seating positions (17).
Task Force on Community Preventive Services recommendation:
Primary enforcement seat belt laws are recommended on the
basis of strong evidence that they are substantially more
effective than secondary enforcement laws at reducing motor
vehicle-related injuries and deaths (10,11). Rates of seat belt
use are an average of 9–14 percentage points higher in primary
enforcement states than in secondary states (10,11,18,19).
Rating State had
Green
A primary enforcement seat belt law
covering all seating positions
Yellow A primary enforcement seat belt
law covering only the front seats
Red
A secondary enforcement seat belt
law or no law
Child passenger restraint law
As of August 1, 2013, Georgia required that all motor vehicle
passengers aged 7 years or younger be in a car seat or booster
seat (17).
Evidence shows that laws mandating the use of car seats and
booster seats increase their use (12). Increasing the required
age for car seat or booster seat use is an effective way to keep
children protected. For example, among states that increased
the required age to 7 or 8 years, car seat and booster seat use
tripled (13).
Rating State law covered
Green
Children through age 8 years
Yellow Children through age 6 or 7 years
only
Red
Children aged 5 years or younger
only
Graduated driver licensing (GDL) system
As of August 1, 2013, Georgia fulfilled the recommended
passenger limit restriction but not the recommended nighttime
driving restriction (20).
Research indicates that more comprehensive GDL systems
prevent more crashes and save more lives compared with less
comprehensive GDL systems. Based on this evidence, the
following five components are recommended for more
comprehensive GDL systems: 1) minimum age of 16 years for
a learner’s permit, 2) mandatory holding period of at least six
months for a learner’s permit, 3) restrictions against nighttime
driving between 10:00 pm and 5:00 am (or longer), 4) limit of
zero or one for the number of young passengers without adult
supervision, and 5) minimum age of 18 years for full licensure
(9,14,15).
Rating State policy
Green
Required all five of the GDL
components
Yellow
Required both nighttime driving
and young passenger limits but not
all five components
Red
Lacked either the nighttime
driving or young passenger
limits, or both
Ignition interlock law
As of August 1, 2013, Georgia required ignition interlocks for
convicted repeat DWI offenders (21).
Task Force on Community Preventive Services
recommendation: Use of ignition interlocks is recommended
Rating State had
Green
for all people convicted of alcohol-impaired driving on the
basis of strong evidence of interlocks’ effectiveness in
reducing re-arrest rates while the interlocks are installed
(16).
A law requiring ignition interlocks for
all convicted DWI offenders (i.e.,
offenders with blood alcohol
concentrations [BAC] ≥0.08 g/dL,
which includes both first-time and
repeat offenders)
Yellow A law requiring ignition interlocks
for convicted repeat DWI
offenders or first-time offenders
with a particularly high BAC (e.g.,
BAC≥0.15 g/dL)
Red
No law requiring ignition interlocks for
any convicted DWI offenders
20
Prevention Status Report | 2013
Motor Vehicle Injuries
Georgia
Simplified Rating System
A more detailed explanation of the rating system for motor vehicle injuries is available at
http://www.cdc.gov/stltpublichealth/psr/motorvehicle/.
Green
The policy or practice is
established in accordance with
supporting evidence and/or
expert recommendations.
Yellow
The policy or practice is established in
partial accordance with supporting
evidence and/or expert
recommendations.
Red
The policy or practice is either absent
or not established in accordance with
supporting evidence and/or expert
recommendations.
Indicator Definitions
Seat belt law: A primary enforcement seat belt law allows police to stop a vehicle solely because a driver or passenger is not
wearing a seat belt. A secondary enforcement seat belt law requires police to have another reason for stopping a vehicle
before citing a driver or passenger for not buckling up. The most comprehensive policies are primary seat belt laws that cover
all occupants, regardless of where they are sitting. Some states have primary laws that cover only the front seat occupants.
Child passenger restraint law: A law that requires child passengers to travel in appropriate child passenger restraints, such
as car seats or booster seats, until adult seat belts fit them properly. All 50 states and the District of Columbia have some
form of child passenger restraint laws; however, the ages covered vary.
Graduated driver licensing (GDL) system: Policy that helps new drivers gain experience under low-risk conditions by
granting driving privileges in stages. As teens move through GDL stages, they are given additional privileges, such as driving
unsupervised or with a passenger.
Ignition interlock law: A law that mandates the use of ignition interlocks for drivers convicted of DWI. An ignition interlock
is a device that analyzes a driver’s breath and prevents the vehicle from starting if alcohol is detected.
References
1. CDC. WISQARS (Web-based Injury Statistics Query and Reporting System) [database]. Accessed Jun 5, 2013.
2. National Highway Traffic Safety Administration. Traffic Safety Facts, 2011 Data: Overview. Washington, DC: US
Department of Transportation; 2013.
3. Naumann RB, Dellinger AM, Zaloshnja E, et al. Incidence and total lifetime costs of motor vehicle-related fatal and
nonfatal injury by road user type, United States, 2005. Traffic Injury Prevention 2010;11:353–60.
4. National Highway Traffic Safety Administration, Fatality Analysis Reporting System [database]. US Department of
Transportation, Washington, DC. Accessed Dec 7, 2012.
5. US Department of Health and Human Services. Injury and violence prevention. In: Healthy People 2020. Rockville, MD:
US Department of Health and Human Services. Updated Oct 30, 2012.
6. National Highway Traffic Safety Administration. Traffic Safety Facts, 2010 Data: Young Drivers. Washington, DC: US
Department of Transportation; 2012.
7. National Highway Traffic Safety Administration. Traffic Safety Facts, Crash, Stats: Seat Belt Use in 2011—Use Rates in
the States and Territories. Washington, DC: US Department of Transportation; 2012.
8. National Highway Traffic Safety Administration. Traffic Safety Facts, 2010 Data: State Alcohol-Impaired Driving
Estimates. Washington, DC: US Department of Transportation; 2012.
9. Goodwin A, Kirley B, Sandt L, et al. Countermeasures That Work: A Highway Safety Countermeasures Guide for State
Highway Safety Offices. 7th edition. (Report No. DOT HS 811 727). Washington, DC: National Highway Traffic Safety
Administration; 2013.
10. Shults RA, Nichols JL, Dinh-Zarr TB, et al. Effectiveness of primary enforcement safety belt laws and enhanced
enforcement of safety belt laws: a summary of the Guide to Community Preventive Services systematic reviews. Journal
of Safety Research 2004;35(2):189–96.
11. Shults RA, Elder RW, Sleet DA, et al. Primary enforcement of seat belt laws are effective even in the face of rising belt
use rates. Accident Analysis and Prevention 2004;36(3):491–3.
12. Zaza S, Sleet DA, Thompson R, et al. Reviews of evidence regarding interventions to increase the use of child safety
seats. American Journal of Preventive Medicine 2001;21(4S):31–47.
13. Eichelberger AH, Chouinard AO, Jermakian JS. Effects of booster seat laws on injury risk among children in crashes.
Traffic Injury Prevention 2012;13:631–9.
14. Baker SP, Chen LH, Li G. National evaluation of graduated driver licensing programs. Washington, DC: US Department of
Transportation; 2006.
15. Williams AF, Tefft BC, Grabowski JG. Graduated driver licensing research, 2010–present. Journal of Safety Research
2012;43(3):195–203.
16. Elder RW, Voas R, Beirness D, et al. Effectiveness of ignition interlocks for preventing alcohol-impaired driving and
alcohol-related crashes. American Journal of Preventive Medicine 2011;40(3):362–76.
17. Insurance Institute for Highway Safety/Highway Loss Data Institute. Safety Belt and Child Restraint Laws. Arlington, VA:
Insurance Institute for Highway Safety/Highway Loss Data Institute; 2013.
18. Beck LF, West BA. Vital signs: nonfatal, motor vehicle-occupant injuries (2009) and seat belt use (2008) among
adults—United States. MMWR 2011;59:1681–6.
19. Shults RA, Beck LF. Self-reported seatbelt use, United States, 2002–2010: does prevalence vary by state and type of
seatbelt law? Journal of Safety Research 2012;43(5–6):417–20.
20. Insurance Institute for Highway Safety/Highway Loss Data Institute. Young Driver Licensing Systems in the U.S.
Arlington, VA: Insurance Institute for Highway Safety/Highway Loss Data Institute; 2013.
21. Insurance Institute for Highway Safety/Highway Loss Data Institute. DUI/DWI Laws. Arlington, VA: Insurance Institute
for Highway Safety/Highway Loss Data Institute; 2013.
21
Prevention Status Report | 2013
Nutrition, Physical Activity, and Obesity
Georgia
Public Health Problem
Poor diet and physical inactivity contribute to many serious and costly health conditions, including obesity,
heart disease, diabetes, some cancers, unhealthy cholesterol levels, and high blood pressure (1,2).
Obesity is associated with increased blood pressure; unhealthy cholesterol levels; chronic diseases such as
heart disease, diabetes, some cancers, and osteoarthritis; complications of pregnancy; and premature
death (3).
Children who are not breastfed are at greater risk for various health problems, including childhood
infections and obesity (4).
During 2009-2010, based on data from the National Health and Nutrition Examination Survey,
approximately 17% of children and adolescents and 36% of adults were obese (5).
US medical costs associated with adult obesity were approximately $147 billion in 2008 (6).
40%
30%
Percentage of high school students
who were obese
Percentage of adults who were
obese
27.8%
28.0%
27.6%
20%
29.1%
20%
15%
US
GA
10%
0%
GA
5%
2011
0%
2012
Source: Behavioral Risk Factor Surveillance System (7)
Percentage of high school students who drank
a can, bottle, or glass of soda or pop at least
one time per day (excludes diet soda or pop)
50%
40%
2003
2005
2007
2009
2011
Source: Youth Risk Behavior Surveillance System (8)
Percentage of high school students who
attended physical education classes on one or
more days in an average week when they were
in school
100%
80%
30%
US
GA
20%
60%
US
GA
40%
20%
10%
0%
US
10%
2007
2009
2011
Source: Youth Risk Behavior Surveillance System (8)
0%
2003
2005
2007
2009
2011
Source: Youth Risk Behavior Surveillance System (8)
22
Prevention Status Report | 2013
Nutrition, Physical Activity, and Obesity
Georgia
Percentage of low-income children aged
2 to <5 years who were obese
20%
15%
US
GA
10%
5%
0%
2007
2008
2009
2010
2011
Source: Pediatric Nutrition Surveillance System (9)
Policy and Practice Solutions
This report focuses on policies and practices recommended by the Institute of Medicine, Community Preventive
Services Task Force, US Surgeon General, CDC, and other expert bodies. The recommendations are based on
expert judgment or evidence from scientific studies that the policies and practices can improve diet, increase
breastfeeding, increase physical activity, or reduce obesity (10–17). These policies and practices include 1)
implementing nutrition standards to limit the availability of less nutritious foods and beverages in schools, 2)
implementing nutrition standards for foods and beverages in government facilities, 3) including nutrition and
physical activity standards in state regulations of licensed childcare facilities, 4) establishing physical education
time requirements in high schools, and 5) promoting evidence-based practices that support breastfeeding in
hospitals and birth centers.
Additional strategies to prevent obesity and promote healthy eating, physical activity, and breastfeeding have
been supported by scientific evidence or expert judgment (11–15,17). For information about why certain
indicators were selected, and for links to additional data and resources, visit the CDC website
(http://www.cdc.gov/stltpublichealth/psr/npao/).
Status of Policy and Practice Solutions in Georgia
Secondary schools not selling less nutritious foods and beverages
In 2012, 35.8% of secondary schools in Georgia did not sell the
following items in vending machines or at school stores,
canteens, or snack bars: candy, baked goods that are not low in
fat, salty snacks that are not low in fat, soda pop, or fruit drinks
that are not 100% juice (18).
In addition to providing school meals, many schools offer foods
and beverages in other venues, such as school stores, canteens,
snack bars, vending machines, and classrooms. The Institute of
Medicine recommends nutrition standards for such foods and
beverages (10), and CDC recommends that schools limit the
availability of less nutritious foods and beverages and ensure
that “only nutritious and appealing foods and beverages are
provided in all food venues in schools . . . .” (15).
Rating Percentage of secondary
schools that did not sell
less nutritious foods and
beverages in selected
venues:
Green
≥66.6%
Yellow
50.0%–66.5%
Red
<50.0%
23
Prevention Status Report | 2013
Nutrition, Physical Activity, and Obesity
Georgia
State nutrition standards policy for foods and beverages sold or provided by state
government agencies
In 2012, Georgia did not have a nutrition standards policy for
foods and beverages sold or provided by state government
agencies (19).
The Institute of Medicine recommends that government agencies
implement “strong nutrition standards for all foods and
beverages sold or provided through the government” and ensure
“that healthy options are available in all places frequented by the
public” to reduce the availability of less healthful foods and
beverages and increase the availability of more healthful options
(11). For purposes of this report, strong policies are those that
meet the following criteria: 1) apply to at least 90% of
government agencies in the state executive branch; 2) cover all
food purchased, contracted, distributed, or sold by government
agencies in the state executive branch; 3) provide quantifiable
standards for foods or nutrients (e.g., set a maximum for the
amount of sodium a food item can include); and 4) set minimal
standards that limit sodium content, fat content, and the
availability of high-calorie, low-nutrient foods and beverages.
Rating State nutrition standards
policy
Green
Met all criteria
Yellow
Met some but not all criteria
Red
Did not exist
Inclusion of nutrition and physical activity standards in state regulations of licensed
childcare facilities
In 2012, Georgia state regulations for licensed childcare facilities
included 4.3% of the 47 components of standards for infant
feeding, nutrition, physical activity, and screen time (20).
The Institute of Medicine has recommended including specific
requirements related to physical activity, sedentary activity, and
child feeding in childcare regulations (12). The American
Academy of Pediatrics, American Public Health Association, and
National Resource Center for Health and Safety in Child Care and
Early Education have identified 47 components that childcare
regulatory agencies and childcare providers should include in
standards for infant feeding, nutrition, physical activity, and
screen time in licensed childcare settings (16).
Rating Percentage of
components included in
state regulations:
Green
≥80.0%
Yellow
70.0%–79.9%
Red
<70.0%
State physical education time requirement for high school students
In 2012, Georgia did not have a physical education time
requirement for high school students (21).
The Community Preventive Services Task Force recommends the
implementation of quality physical education programs that
increase the length of, or activity levels in, school-based physical
education classes (13). This recommendation is based on strong
evidence of such programs’ effectiveness in improving physical
activity levels and physical fitness among school-aged children
and adolescents (13). CDC and the National Association for Sport
and Physical Education recommend that high school students
receive at least 225 minutes of physical education per week
(15,17). States and the District of Columbia can help increase
physical activity among high school students by setting minimum
requirements for time spent in physical education.
Rating State had
Green
A mandate for minutes per
week that high school students
must participate in physical
education
Yellow
N/A
Red
No mandate for minutes per
week that high school
students must participate in
physical education
24
Prevention Status Report | 2013
Nutrition, Physical Activity, and Obesity
Georgia
Average birth facility score for breastfeeding support
In 2011, Georgia had a birth facility score of 65 out of a possible
100 (22).
The US Surgeon General recommends that maternity care
practices throughout the United States fully support
breastfeeding (14). A review of evidence by the Cochrane
Collaboration found that institutional changes in maternity care
practices effectively increased breastfeeding initiation and
duration rates (23). CDC’s National Survey of Maternity Practices
in Infant Nutrition and Care assesses and scores the extent to
which hospitals and birth centers implement multiple
evidence-based strategies that support breastfeeding (22).
Rating State average birth
facility score for
breastfeeding support:
Green
≥80.0%
Yellow
70.0%–79.9%
Red
<70.0%
Simplified Rating System
A more detailed explanation of the rating system for nutrition, physical activity, and obesity is available at
http://www.cdc.gov/stltpublichealth/psr/npao/.
Green
The policy or practice is
established in accordance with
supporting evidence and/or
expert recommendations or is
widely implemented.
Yellow
Red
The policy or practice is established in
partial accordance with supporting
evidence and/or expert recommendations
or is not as widely implemented as at the
green rating level.
The policy or practice is either
absent or not established in
accordance with supporting evidence
and/or expert recommendations or is
not widely implemented.
Indicator Definitions
Secondary schools not selling less nutritious foods and beverages: Percentage of middle schools and high
schools that did not allow students to purchase less nutritious foods and beverages from vending machines,
school stores, canteens, and snack bars. For a school to be identified as not selling less nutritious foods and
beverages, the school principal had to respond “no” to each item when asked whether students could purchase
the following five items: 1) chocolate candy; 2) other kinds of candy; 3) salty snacks that are high in fat, such as
regular potato chips; 4) cookies, crackers, cakes, pastries, or other baked goods that are high in fat; and 5) soda
pop or fruit drinks that are not 100% juice. Data were provided for 45 states and the District of Columbia and
represented only those states that participated in the survey and had an overall school response rate of at least
70% (18).
State nutrition standards policy for foods and beverages sold or provided by state government
agencies: The presence of statewide nutrition standards for select foods or nutrients that cover foods and
beverages purchased, contracted, distributed, or sold by government agencies in the state executive branch.
Information was obtained using a search of the Westlaw database (19). State policies captured are statutes,
regulations, and administrative guidance. Data were updated November 2012. The search results did not indicate
whether a policy was implemented, only whether it existed.
Inclusion of nutrition and physical activity standards in state regulations of licensed childcare
facilities: Inclusion of 47 recommended components of standards in regulations for infant feeding, nutrition,
physical activity, and screen time in childcare settings (16). State regulations were considered to have included a
component if the regulation fully met the requirements of the component across all childcare entities licensed by
the state.
State physical education time requirement for high school students: A state mandate for minimum
number of minutes per week that high school students must participate in physical education (21).
Average birth facility score for breastfeeding support: The state birth facility score for breastfeeding
represents the average score across participating birth facilities in a state. Each participating birth facility, based
on its response to a self-administered survey, was scored on multiple evidence-based practices that support
breastfeeding across seven categories: 1) labor and delivery, 2) breastfeeding assistance, 3) mother-newborn
contact, 4) newborn feeding practices, 5) breastfeeding support after discharge, 6) nurse/birth attendant
breastfeeding training and education, and 7) structural and organizational factors related to breastfeeding (22).
The total score can range from 0 to 100, with a higher score representing more support. The national average
score across all states was 70.
25
Prevention Status Report | 2013
Nutrition, Physical Activity, and Obesity
Georgia
References
1. US Department of Agriculture and US Department of Health and Human Services. Dietary Guidelines for Americans,
2010. 7th edition. Washington, DC: US Government Printing Office; 2010.
2. US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington, DC: US
Department of Health and Human Services; 2008.
3. National Heart, Lung, and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of
Overweight and Obesity in Adults. Bethesda, MD: National Institutes of Health; 1998.
4. Ip S, Chung M, Raman G, et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries.
Evidence Report/Technology Assessment No. 153. AHRQ Publication No. 07–E007. Rockville, MD: Agency for Healthcare
Research and Quality; 2007.
5. Ogden CL, Carroll MD, Kit BC, et al. Prevalence of obesity in the United States, 2009–2010. NCHS Data Brief 2012;
82:1–8
6. Finkelstein EA, Trogdon JG, Cohen JW, et al. Annual medical spending attributable to obesity: payer-and service-specific
estimates. Health Affairs (Millwood) 2009;28(5):w822–31.
7. CDC. Behavioral Risk Factor Surveillance System [database]. Accessed Aug 9, 2013.
8. CDC. Youth Risk Behavior Surveillance System [database]. Accessed Jun 13, 2013.
9. CDC. Pediatric Nutrition Surveillance System. Accessed Aug 9, 2013.
10. Institute of Medicine. Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth. Washington,
DC: National Academies Press, 2007.
11. Institute of Medicine. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC:
National Academies Press; 2012.
12. Institute of Medicine. Early Childhood Obesity Prevention Policies. Washington, DC: National Academies Press; 2011.
13. Task Force on Community Preventive Services. Recommendations to increase physical activity in communities. American
Journal of Preventive Medicine 2002;22(4S):67–72.
14. Office of the Surgeon General. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: US
Department of Health and Human Services; 2011.
15. CDC. School health guidelines to promote healthy eating and physical activity. MMWR 2011;60(RR–5).
16. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in
Child Care and Early Education. Caring for Our Children: National Health and Safety Performance Standards; Guidelines
for Early Care and Education Programs. 3rd edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington,
DC: American Public Health Association; 2011.
17. National Association for Sport and Physical Education. Physical Education is Critical to Educating the Whole Child. Reston,
VA: National Association for Sport and Physical Education; 2011.
18. CDC. School Health Profiles 2012. Unpublished data.
19. CDC. Public Health Law Program. Unpublished analysis. November 2012.
20. National Resource Center for Health and Safety in Child Care and Early Education. Achieving a State of Healthy Weight:
2012. Aurora, CO: University of Colorado Denver; 2013.
21. National Association for Sport and Physical Education, American Heart Association. 2012 Shape of the Nation Report:
Status of Physical Education in the USA. Reston, VA: American Alliance for Health, Physical Education, Recreation, and
Dance; 2012.
22. CDC. National Survey of Maternity Practices in Infant Nutrition and Care (mPINC). Atlanta, GA: US Department of Health
and Human Services; 2011.
23. Fairbank L, O’Meara S, Renfrew MJ, et al. A systematic review to evaluate the effectiveness of interventions to promote
the initiation of breastfeeding. Health Technology Assessment 2000;4(25):1–171.
26
Prevention Status Report | 2013
Georgia
Prescription Drug Overdose
Public Health Problem
Opioid pain relievers—also called prescription painkillers—such as oxycodone, hydrocodone, fentanyl, and
hydromorphone are responsible for three-fourths of all prescription drug overdose deaths and caused
more than 16,600 deaths in the United States in 2010 (1). Nationally, deaths involving opioids have more
than quadrupled since 1999 (1). The drug overdose mortality rate is age adjusted and includes all drugs
and all intents.
The sharp rise in opioid overdose deaths closely parallels an equally sharp increase in the prescribing of
these drugs. Opioid pain reliever sales in the United States quadrupled from 1999 to 2010 (2). Similarly,
the substance abuse treatment admission rate for opioid abuse in 2010 was seven times higher than in
1999 (3).
The severity of the epidemic varies widely across US states and regions. For example, the state with the
highest drug overdose death rate has a rate more than eight times that of the state with the lowest rate.
Georgia’s overdose death rate for 2010 (10.7 per 100,000 population) is below the national rate (12.4 per
100,000 population) (1).
In addition to the human costs, the epidemic of prescription drug overdose imposes a major financial toll.
Nonmedical use of opioid pain relievers—use without a prescription or simply for the feeling or experience
the drug causes—costs US insurance companies up to $72.5 billion annually in healthcare expenditures
(4). The epidemic also imposes substantial costs on state Medicaid programs. A 2009 Government
Accountability Office report found that in 2006–2007, roughly 65,000 Medicaid beneficiaries in five states
incurred over $60 million in drug costs related to "doctor shopping" for controlled substance prescriptions
(i.e., patients obtaining controlled substances from multiple healthcare practitioners without prescribers’
knowledge of other prescriptions) (5).
Prevalence of nonmedical use of
prescription pain relievers in the past year
among persons aged ≥12 years
Drug overdose death rate (age-adjusted
per 100,000 population)
30
10%
20
US
GA
10
0
2006
2007
2008
2009
2010
Source: National Vital Statistics System (1)
Note: These rates were adjusted using the direct method
and the 2000 standard US population (6).
US
GA
5%
0%
2007
2008
2009
2010
2011
Source: National Survey on Drug Use and Health (7)
15
Kilograms of morphine equivalents
of opioid pain relievers sold (per
10,000 population)
10
US
GA
5
0
2006
2007
2008
2009
2010
Source: Automation of Reports and Consolidated
Orders System (8)
27
Prevention Status Report | 2013
Georgia
Prescription Drug Overdose
Policy and Practice Solutions
The United States is in the early stages of addressing the prescription drug overdose epidemic. CDC and other
agencies are working to identify and evaluate interventions to reduce overdose deaths. This report focuses on
policies and practices supported by emerging evidence, expert consensus, and/or extensive review of the
primary drivers of the epidemic, including 1) implementing state pain clinic laws and 2) implementing
prescription drug monitoring programs that follow best practices. For information about why certain prescription
drug overdose-related indicators were selected, and for links to additional data and resources, visit the CDC
website (http://www.cdc.gov/stltpublichealth/psr/prescriptiondrug/).
Status of Policy and Practice Solutions in Georgia
State pain clinic law
As of July 2013, Georgia had a pain clinic law meeting selected
criteria (9).
Pain clinic laws hold promise for stopping the most egregious
overprescribing practices (10). A pain clinic law is rated green in
the PSR if the law requires state oversight and contains other
requirements concerning ownership and operation of pain
management clinics, facilities, or practice locations.
Rating State had
Green
A pain clinic law meeting
selected criteria
Yellow
N/A
Red
No pain clinic law
Prescription drug monitoring programs (PDMPs) following selected best practices
As of July 2013, Georgia had an active PDMP that followed one or
two selected best practices (11).
Prescription drug monitoring programs show early signs of
changing providers’ prescribing practices and can yield valuable
information for healthcare providers and regulatory agencies. The
selected best practices for PDMPs are 1) providing prescribers and
dispensers access to PDMPs, 2) interoperability with the PDMP of at
least one other state or the District of Columbia, and 3) proactively
reporting findings to law enforcement and regulatory agencies (12).
Rating State PDMP
Green
Followed all three selected
best practices
Yellow Followed one or two of the
selected best practices
Red
Did not follow any of the
selected best practices, was
authorized but was not yet
operating, or did not exist
Simplified Rating System
A more detailed explanation of the rating system for prescription drug overdose is available at
http://www.cdc.gov/stltpublichealth/psr/prescriptiondrug/.
Green
The policy or practice is
established in accordance with
supporting evidence and/or
expert recommendations.
Yellow
The policy or practice is established in
partial accordance with supporting
evidence and/or expert
recommendations.
Red
The policy or practice is either
absent or not established in
accordance with supporting evidence
and/or expert recommendations.
28
Prevention Status Report | 2013
Prescription Drug Overdose
Georgia
Indicator Definitions
State pain clinic law: A law that requires state oversight of pain management clinics or describes specific
registration, licensure, or ownership requirements for pain management clinics.
PDMP following selected best practices: A state prescription drug monitoring program that tracks the
prescribing and dispensing of controlled substances and that follows selected best practices articulated by the
Brandeis University PDMP Center of Excellence. These best practices include 1) providing prescribers and
dispensers access to PDMPs, 2) interoperability with a PDMP of at least one other state or the District of
Columbia, and 3) proactively reporting findings to law enforcement and regulatory agencies (12).
References
1. CDC. National Vital Statistics System [database]. Accessed Dec 10, 2012.
2. CDC. Vital Signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR
2011;60:1487–92.
3. Substance Abuse and Mental Health Services Administration. Treatment Episode Data Set (TEDS): 2000–2010.
National Admissions to Substance Abuse Treatment Services. DASIS Series S-61, HHS Publication No. (SMA)
12-4701. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2012.
4. Coalition Against Insurance Fraud. Prescription for Peril: How Insurance Fraud Finances Theft and Abuse of Addictive
Prescription Drugs. Washington, DC: Coalition Against Insurance Fraud; 2007.
5. General Accounting Office. Medicaid: Fraud and Abuse Related to Controlled Substances Identified in Selected States.
Washington, DC: General Accounting Office; 2009.
6. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes,
No. 20. Hyattsville, MD: National Center for Health Statistics; 2001.
7. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health [database],
2009–2010, 2007–2008, and 2005–2007. Accessed Dec 10, 2012.
8. Drug Enforcement Administration. Automation of Reports and Consolidated Orders System (ARCOS) [database].
Accessed Dec 10, 2012.
9. CDC. Public Health Law Program. Unpublished data; July 2013.
10. Office of National Drug Control Policy. Epidemic: Responding to America’s Prescription Drug Crisis. Washington, DC:
Executive Office of the President of the United States; 2011.
11. PDMP Center of Excellence, Brandeis University. Unpublished data; July 2013.
12. PDMP Center of Excellence. Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices.
Waltham, MA: Brandeis University; 2012.
29
Prevention Status Report | 2013
Georgia
Teen Pregnancy
Public Health Problem
Each year in the United States, about 750,000 women under age 20 become pregnant (1). In 2011 in
Georgia, 12,991 teens aged 15–19 years gave birth (2).
In 2011, young women of color—particularly Hispanic and African-American females aged 15–19
years—were disproportionately likely to give birth, with national birth rates of 49.6 and 47.3 per 1,000
population, respectively (3).
Teen mothers are more likely to experience negative social outcomes, including lower rates of school
completion and reduced earnings, than teens who do not have children. The children of teenaged mothers
are more likely to achieve less in school, experience abuse or neglect, have more health problems, be
incarcerated at some time during adolescence, and give birth as a teenager (4).
The annual costs of teen childbearing in 2008 were $10.9 billion in the United States and $465 million in
Georgia (5).
Birth rate among females aged 15–19 years
(per 1,000 population)
75
Proportion of high school students
who ever had sexual intercourse
75%
50
50%
US
GA
25
0
25%
2007
2008
2009
2010
0%
2011
Source: National Vital Statistics System—Births (6)
Proportion of currently sexually active
female high school students who used birth
control pills, any injectable birth control, any
birth control ring or implant, or intrauterine
device before last sexual intercourse
100%
2003
2005
2007
2009
2011
Source: Youth Risk Behavior Surveillance System (7)
Note: Georgia data were not available for one or
more years from the source used for this graph.
Similar data may be available from another national
or state source.
Proportion of currently sexually active high
school students who used a condom during
last sexual intercourse
100%
75%
75%
US
GA
50%
30.0%
US
GA
50%
25%
25%
0%
US
GA
N/A
2011
Source: Youth Risk Behavior Surveillance System (7)
Note: Georgia data were not available for one or more
years from the source used for this chart. Similar data
may be available from another national or state
source.
0%
2003
2005
2007
2009
2011
Source: Youth Risk Behavior Surveillance System (7)
Note: Georgia data were not available for one or more
years from the source used for this graph. Similar data
may be available from another national or state
source.
30
Prevention Status Report | 2013
Georgia
Teen Pregnancy
Policy and Practice Solutions
This report focuses on expanding eligibility for Medicaid family planning services to the income eligibility level for
pregnancy-related services and to include women younger than age 18 years, either by amending the Medicaid
waiver or by converting to the State Plan Amendment available through the Centers for Medicare and Medicaid
Services, or by expanding the full Medicaid program (8–12). This policy is consistent with the US Department of
Health and Human Services’ National Prevention Strategy recommendations to expand access to contraceptive
services and with a Healthy People 2020 objective to “increase the number of states that set the income
eligibility level for Medicaid-covered family planning services to at least the same level used to determine
eligibility for Medicaid-covered, pregnancy-related care” (13,14).
Other strategies supported by scientific evidence include providing comprehensive sexual health education for
adolescents, using positive youth development approaches, and improving parent-child communication and
parental monitoring of youth behavior (15–17). For information about why Medicaid family planning expansion
was selected as an indicator, and for links to additional data and resources, visit the CDC website
(http://www.cdc.gov/stltpublichealth/psr/teenpregnancy/).
Status of Policy and Practice Solutions in Georgia
Expansion of state Medicaid family planning eligibility
As of August 2013, Georgia had expanded Medicaid coverage of
family planning services to include adults with incomes up to
200% of the federal poverty level, the state’s income level for
pregnancy-related Medicaid coverage, but coverage did not
extend to teens under age 18 years (18,19).
Healthy People 2020 target: Increase the number of states that
set the income eligibility level for Medicaid coverage of family
planning services to at least the same level used to determine
eligibility for Medicaid coverage of pregnancy-related care
(14,18,19).
Rating
State Medicaid family
planning eligibility
Green
Was income-based, met the
income eligibility level for
pregnancy-related care, and
covered all women, including
teens
Yellow Was limited, was not
income-based, did not
meet the eligibility level
for pregnancy-related
services, and/or excluded
some teens
Red
Had not been expanded
Simplified Rating System
A more detailed explanation of the rating system for teen pregnancy is available at
http://www.cdc.gov/stltpublichealth/psr/teenpregnancy/.
Green
The policy or practice is
established in accordance with
supporting evidence and/or
expert recommendations.
Yellow
The policy or practice is established in
partial accordance with supporting
evidence and/or expert
recommendations.
Red
The policy or practice is either
absent or not established in
accordance with supporting evidence
and/or expert recommendations.
31
Prevention Status Report | 2013
Teen Pregnancy
Georgia
Indicator Definitions
Expansion of state Medicaid family planning eligibility (waiver or state plan amendment): State
expansion of eligibility for Medicaid coverage of family planning services to include teens under age 18 and to be
set at the eligibility level for pregnancy care (this level varies by state and the District of Columbia). This
expansion is achieved by 1) securing approval (officially known as a “waiver” of federal policy) from the Centers
for Medicare and Medicaid Services, 2) amending the state Medicaid plan with a State Plan Amendment (i.e., a
permanent change to the state’s Medicaid program), or 3) expanding the full state Medicaid program.
References
1. Ventura SJ, Curtin SC, Abma JC, et al. Estimated pregnancy rates and rates of pregnancy outcomes for the United
States, 1990–2008. National Vital Statistics Reports: 2012;60(7).
2. CDC. National Vital Statistics System [database]. Accessed Aug 5, 2013.
3. Martin JA, Hamilton BE, Ventura SJ, et al. Births: final data for 2011. National Vital Statistics Report 2013;62(1).
4. Hoffman S, Maynard R, eds. Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy.
Washington, DC: The Urban Institute Press; 2008.
5. National Campaign to Prevent Teen and Unplanned Pregnancy. Counting It Up: The Public Costs of Teen Childbearing.
Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy; Jun 2011.
6. CDC. VitalStats [database]. Accessed Aug 5, 2013.
7. CDC. Youth Risk Behavior Surveillance System [database]. Accessed Aug 5, 2013.
8. Foster DG, Biggs MA, Rostovtseva D, et al. Estimating the fertility effect of expansions of publicly funded family planning
services in California. Women’s Health Issues 2011;21:418–24.
9. Yang Z, Gaydos LM. Reasons for and challenges of recent increases in teen birth rates: a study of family planning service
policies and demographic changes at the state level. Journal of Adolescent Health 2010;46:517–24.
10. Kearney MS, Levine PB. Subsidized contraception, fertility, and sexual behavior. The Review of Economics and Statistics
2009;91(1):137–51.
11. Lindrooth RC, McCullough JS. The effect of Medicaid family planning expansions on unplanned births. Women’s Health
Issues 2007;17:66–74.
12. Edwards J, Bronstein J, Adams K. Evaluation of Medicaid Family Planning Demonstrations. The CNA Corporation, CMS
Contract No 752-2-415921:22; Nov 2003.
13. US Department of Health and Human Services. National Prevention Strategy: America’s Plan for Better Health and
Wellness. Rockville, MD: US Department of Health and Human Services; 2011.
14. US Department of Health and Human Services. Family Planning. In: Healthy People 2020. Updated Sep 6, 2012.
15. US Department of Health and Human Services. Teen Pregnancy Prevention: Evidence-Based Programs [database].
Accessed Dec 10, 2012.
16. Community Preventive Services Task Force. Prevention of HIV/AIDS, other STIs and pregnancy: interventions for
adolescents. In: Guide to Community Preventive Services. Updated Nov 30, 2010.
17. Oringanje C, Meremikwu MM, Eko H, et al. Interventions for preventing unintended pregnancies among adolescents.
Cochrane Database of Systematic Reviews 2009;4:CD005215.
18. Guttmacher Institute. State Policies in Brief (as of August 2013): Medicaid Family Planning Eligibility Expansions. New
York, NY: Guttmacher Institute; 2013.
19. Kaiser Family Foundation. Adult Income Eligibility Limits at Application as a Percent of the FPL by Coverage Authority
Parents (Table 4). In: Performing Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment,
Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011–2012. Washington, DC: Kaiser Family Foundation; 2012.
32
Prevention Status Report | 2013
Tobacco Use
Georgia
Public Health Problem
Tobacco use is the leading cause of preventable death in Georgia and the United States overall. Smoking
harms nearly every organ in the body and causes cancer, heart disease, stroke, respiratory illness, and
many other health problems (1).
During 2007–08, in the United States, 37% of adult nonsmokers and 54% of children aged 3–11 years
were exposed to secondhand smoke (2).
Smoking and exposure to secondhand smoke result in $96 billion in medical expenditures and $97 billion in
lost productivity annually in the United States. In Georgia, smoking causes $2.39 billion in personal
healthcare expenditures and $3.3 billion in lost productivity annually (3).
Proportion of high school students
who smoke cigarettes
Proportion of adults who smoke
cigarettes
40%
40%
30%
30%
20%
21.2%
21.2%
US
GA
10%
10%
0%
US
GA
20%
2011
Sources: Behavioral Risk Factor Surveillance System (4),
National Health Interview Survey (5)
Healthy People 2020 target: 12.0% (dotted blue line) (6)
0%
2003
2005
2007
2009
2011
Source: Youth Risk Behavior Surveillance System (7)
Healthy People 2020 target: 16.0% (dotted blue line) (6)
Policy and Practice Solutions
This report focuses on policies and practices recommended by the Institute of Medicine, World Health
Organization, Community Preventive Services Task Force, US Surgeon General, and Centers for Disease Control
and Prevention on the basis of scientific studies supporting the policies’ effectiveness in preventing or reducing
tobacco use (8–11,13,14). These policies and practices include 1) increasing state cigarette excise taxes, 2)
establishing statewide smoke-free policies, and 3) sustaining tobacco control program funding. Other strategies
also supported by scientific evidence include hard-hitting media campaigns and systemic changes to increase
access to and use of cessation services. For information about why certain tobacco-related indicators were
selected, and for links to additional data and resources, visit the CDC website
(http://www.cdc.gov/stltpublichealth/psr/tobacco/).
33
Prevention Status Report | 2013
Tobacco Use
Georgia
Status of Policy and Practice Solutions in Georgia
State cigarette excise tax
As of June 30, 2013, Georgia’s cigarette excise tax was $0.37 per
pack, compared with the highest state tax of $4.35 (range =
$0.17–$4.35) (15).
Healthy People 2020 target: An increased excise tax in all states
and the District of Columbia by $1.50 per pack by the year 2020
(6). This increase would generate millions of dollars in revenue
annually, prevent more children from starting to smoke, help
smokers quit, save lives, and save millions in long-term healthcare
costs (16,17).
Rating
State excise tax was
Green
$2.00 per pack or above
Yellow
$1.00–$1.99 per pack
Red
Less than $1.00 per pack
Rating
State smoke-free policy
covered
Green
Workplaces, restaurants, and
bars
Yellow
Two of the three locations
Red
One or none of the
locations
Rating
Funding level was at
Green
100% or more of CDC
recommendation
Yellow
50.0%–99.9% of CDC
recommendation
Red
Less than 50% of CDC
recommendation
Comprehensive state smoke-free policy
As of June 30, 2013, Georgia had no statewide smoke-free policy
covering workplaces, restaurants, or bars (15).
Healthy People 2020 target: A statewide ban on smoking in public
places and worksites in all states and the District of Columbia (6).
Studies have shown that smoke-free policies reduce secondhand
smoke exposure, help smokers quit, and reduce heart attack and
asthma hospitalizations (10,11,17–21).
Funding for tobacco control
As of fiscal year 2010, Georgia allocated 2.7% of the
CDC-recommended funding for tobacco control ($3.2 million of
$116.5 million) (22).
CDC recommendation: Tobacco control funding at 100% of CDC’s
recommended annual investment in all states and the District of
Columbia (14). States that have made larger investments in
comprehensive tobacco control programs have seen cigarette
sales drop more than twice as much as sales in the United States
as a whole, and smoking prevalence among adults and youth has
declined faster as spending for tobacco control programs has
increased (14,23,24).
Simplified Rating System
A more detailed explanation of the rating system for tobacco use is available at
http://www.cdc.gov/stltpublichealth/psr/tobacco/.
Green
The policy or practice is
established in accordance with
supporting evidence and/or
expert recommendations.
Yellow
The policy or practice is established in
partial accordance with supporting
evidence and/or expert
recommendations.
Red
The policy or practice is either
absent or not established in
accordance with supporting evidence
and/or expert recommendations.
34
Prevention Status Report | 2013
Tobacco Use
Georgia
Indicator Definitions
State cigarette excise tax: The amount of state excise tax, in dollars, on a pack of 20 cigarettes.
Comprehensive state smoke-free policy: A state law that prohibits smoking in all indoor areas of private
workplaces, restaurants, and bars, with no exceptions (25).
Funding for tobacco control: The amount of funding allocated for state tobacco control activities, including
state and federal dollars. Note: Data provided for fiscal year 2010 funding do not include nongovernmental
funding sources or federal funds from the American Recovery and Reinvestment Act Prevention Wellness
Initiative announced in March 2010. Additionally, the amount allocated per fiscal year does not always match the
amount spent during the year.
References
1. US Surgeon General. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable
Disease: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services; 2010.
2. CDC. Vital signs: nonsmokers’ exposure to secondhand smoke—United States, 1999–2008. MMWR 2010;59(35).
3. Smoking—Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) [database]. Accessed Dec 10, 2012.
4. CDC. Behavioral Risk Factor Surveillance System [database]. Accessed Jun 13, 2013.
5. Schiller JS, Lucas JW, Peregoy JA. Summary health statistics for U.S. adults: National Health Interview Survey, 2011.
Vital Health Statistics 2012;10(256).
6. US Department of Health and Human Services. Tobacco use across the life stages. In: Healthy People 2020. Rockville,
MD: US Department of Health and Human Services; Updated Nov 20, 2012.
7. CDC. Youth Risk Behavior Surveillance System [database]. Accessed Jun 13, 2013.
8. Institute of Medicine. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: National Academies
Press; 2007.
9. World Health Organization. WHO Report on the Global Tobacco Epidemic, 2008—The MPOWER Package. Geneva,
Switzerland: World Health Organization; 2008.
10. The Task Force on Community Preventive Services. The Guide to Community Preventive Services: What Works to
Promote Health? New York, NY: Oxford University Press; 2005.
11. CDC. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta,
GA: US Department of Health and Human Services; 2006.
12. CDC. Preventing Tobacco Use among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: US
Department of Health and Human Services; 2012.
13. CDC. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human
Services; 2000.
14. CDC. Best Practices for Comprehensive Tobacco Control Programs—2007. Atlanta, GA: US Department of Health and
Human Services; 2007.
15. CDC. State Tobacco Activities Tracking & Evaluation (STATE) System [database]. Accessed Dec 10, 2012.
16. Congressional Budget Office. Raising the Excise Tax on Cigarettes: Effects on Health and the Federal Budget.
Washington, DC: Congressional Budget Office; 2012.
17. Hopkins DP, Razi S, Leeks KD, et al. Smoke-free policies to reduce tobacco use: a systematic review. American Journal
of Preventive Medicine 2010;38(2S):275–89.
18. Hahn EJ. Smokefree legislation: a review of health and economic outcomes research. American Journal of Preventive
Medicine 2010;39(6 Suppl 1):S66–S76.
19. Institute of Medicine. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence.
Washington, DC: National Academies Press; 2010.
20. Millett C, Lee JT, Laverty AA, et al. Hospital admissions for childhood asthma after smoke-free legislation in England.
Pediatrics 2013;131(2):e495–e501.
21. Herman PM, Walsh ME. Hospital admissions for acute myocardial infarction, angina, stroke, and asthma after
implementation of Arizona's comprehensive statewide smoking ban. American Journal of Public Health 2011;101:491–6.
22. CDC. State tobacco revenues compared with tobacco control appropriations—United States, 1998–2010. MMWR
2012;61:370–4.
23. Farrelly MC, Pechacek TP, Chaloupka FJ. The impact of tobacco control program expenditures on aggregate cigarette
sales: 1981–2000. Journal of Health Economics 2003;22(5):843–59.
24. Tauras JA, Chaloupka FJ, Farrelly MC, et al. State tobacco control spending and youth smoking. American Journal of
Public Health 2005;954:338–44.
25. CDC. State smoke-free laws for worksites, restaurants, and bars—United States, 2000–2010. MMWR 2011;60:472–5.
35
| File Type | application/pdf |
| File Title | Prevention Status Reports 2013 - Georgia |
| Subject | Excessive Alcohol Use, Food Safety, Healthcare – Associated Infections, Heart Disease and Stroke, HIV, Motor Vehicle Injuries, N |
| Author | CDC |
| File Modified | 2014-10-08 |
| File Created | 2014-04-28 |