Progress Toward Healthy People 2010 Targets

The following discussion highlights objectives that met or exceeded their 2010 targets; moved toward the targets, demonstrated no change, or moved away from the targets; and those that lacked data to assess progress. Progress is illustrated in the Progress Quotient bar chart (see Figure 25-1), which displays the percent of targeted change achieved for objectives and subobjectives with sufficient data to assess progress.

Two objectives met or exceeded their targets, four full objectives and three subobjectives moved toward their targets, and four subobjectives moved away from their targets. Eleven objectives were not assessed, including seven that lacked data sources and one that moved to HIV (Focus Area 13).

Objectives that met or exceeded their targets. From the 1988–94 baseline of 17 percent, the proportion of adults aged 20 to 29 years with genital herpes infection (herpes simplex virus type 2 [HSV-2]) (25-4) decreased to 11 percent in the 1999–2002 period. This decline exceeded the target of 14 percent, reflecting achievement of 200 percent of the targeted change. No national program to prevent HSV-2 exists, and there is sparse evidence of specific strategies effective in reducing HSV-2.

Recent data from the Youth Risk Behavior Surveillance System suggest that increases in responsible sexual behavior among youth may be partially responsible for decreases in total HSV-2 cases.³ Decreases were measured in the percentage of students with multiple sex partners and in the percentage of students in grades 9 through 12 who engaged in sexual intercourse. An increase occurred in the use of condoms by students in grades 9 to 12.³

Recently published data more clearly demonstrate the benefit of condoms in reducing the risk of HSV-2 transmission.^{4, 5} Data are now collected and released for analysis on a regular 2-year cycle. More frequent data may help identify other factors contributing to the decrease in the overall portion of the population with herpes.

From 1995 to 2002, the proportion of females aged 15 to 44 years who have ever required treatment for PID (25-6) decreased from 8 percent to 5 percent, meeting the target. In addition, from 1995 to 2002, the proportion of childless females with fertility problems who had an STD or who required treatment for PID (25-7) decreased from 27 percent to 22 percent. Although objective 25-7 only met 42 percent of its targeted change, its progress is related directly to the forward movement demonstrated by objective 25-6. Reducing cases of PID is essential to reducing infertility among women.⁶ The combined success of these two objectives can be attributed, at least in part, to the National Infertility Prevention Program.⁷ This initiative, an HHS partnership with the Centers for Disease Control and Prevention (CDC) and the Office of Population Affairs, provides screenings and treatment of chlamydia and gonorrhea for low-income, sexually active women in family planning clinics, STD clinics, and other health care settings.

Objectives that moved toward their targets. From 1997 to 2003, the rate of new cases of gonorrhea (25-2a) decreased from 122 cases per 100,000 persons to 116 per 100,000 persons. The rate of new cases for females aged 15 to 44 years (25-2b) decreased from 279 cases per 100,000 females in 2002 to 270 per 100,000 females in 2003. These declines represented 6 percent and 4 percent achievement of the targeted change, respectively. The relatively small change in these rates may be linked to the fact that broad-based gonorrhea screening, the foundation of the national gonorrhea control program,⁸ has not sustained continued reductions of infection. Since gonorrhea disproportionately affects the black non-Hispanic population, focused prevention and control efforts are needed to enhance progress toward objective 25-2.^{9, 10}

From 1997 to 2003, the rate of new cases of primary and secondary syphilis (25-3) declined from 3.2 cases per 100,000 population to 2.5 cases, achieving 23 percent of the targeted change, but still well above the target of 0.2 cases per 100,000 population. From 1997 to 2003, the rate for congenital syphilis (25-9) achieved 63 percent of its targeted change. The overall rate declined from 28 cases per 100,000 live births to 11 cases per 100,000 live births. An initiative focused on syphilis prevention and treatment is the National Plan for the Elimination of Syphilis in the United States.¹¹Under the plan, affected communities are mobilized to develop and implement local syphilis elimination efforts. These efforts include enhancing surveillance, expanding access to high-quality clinical preventive services, improving knowledge about prevention of syphilis, strengthening outbreak-response preparedness, and increasing health promotion.

The proportion of childless females with fertility problems (25-7) moved toward its target and achieved 42 percent of its targeted change. The progress of objective 25-7 is intrinsically tied to PID treatment levels (25-6).

The proportion of females aged 24 years and under with chlamydial infections and enrolled in the National Job Training Program (25-1d) decreased from 10.1 percent to 9.9 percent between 2002 and 2003, achieving 6 percent of the targeted change.

Two of three subobjectives that examine responsible sexual behavior among adolescents (25-11a and c) demonstrated progress. From 1999 to 2003, the proportion of adolescents in grades 9 through 12 who have never had sexual intercourse (25-11a) increased from 50 percent to 53 percent, and the proportion of adolescents who used condoms at last intercourse (25-11c) increased from 58 percent to 63 percent, achieving 71 percent of the targeted change. Providing youth with effective education to protect themselves and others from HIV/STD infection over a lifetime and targeting youth at highest risk for HIV/STD infection with focused, intensive prevention activities is a component of national efforts. For example, some public schools use HIV/AIDS surveillance data by ZIP code to identify high schools serving areas with disproportionately high rates for HIV infection to offer intensive student-centered prevention workshops. ¹²

Objectives that demonstrated no change.No objective or subobjective for this focus area remained static since the launch of Healthy People 2010.

Objectives that moved away from their targets. Between 1997 and 2003, the proportion of females aged 15 to 24 years with chlamydial infections who attended family planning clinics increased from 5.0 percent to 6.4 percent (25-1a), and those who attended STD clinics increased from 12.2 percent to 14.1 percent (25-1b), moving away from the target of 3.0 percent. From 1997 to 2003, the proportion of males aged 15 to 24 years with chlamydial infections who attended STD clinics (25-1c) increased from 15.7 percent to 19.3 percent. The increase in the overall number of cases of chlamydial infections in family planning and STD clinics may be a reflection of increasingly sensitive diagnostic tests.¹⁰

Between 1999 and 2003, the proportion of adolescents who had sexual intercourse in their lifetime but not within the past 3 months (25-11b) decreased from 27 percent to 26 percent, moving away from the target of 30 percent. However, this change was not statistically significant.

Objectives that could not be assessed. Data to assess the proportion of Tribal, State, and local STD programs that routinely offer hepatitis B vaccines to all STD clients (25-13) were not available at the time of the midcourse review.

The objective for annual screening for genital chlamydia by MCOs (25-16) became measurable but lacked data to assess progress. Recognizing the increasingly important role of MCOs in STD prevention, the National Committee for Quality Assurance has developed a survey measure for the Health Employer Data and Information Set.¹³ This survey measure estimates the proportion of sexually active women aged 15 to 25 years who are screened in managed care settings (25-16a and b). In 2002, commercial MCOs reported 25 percent of sexually active women aged 25 years and under were screened (25-16a). Medicaid MCOs reported better performance (25-16b), with approximately 41 percent screened. The target for this objective is 62 percent.

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