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Table of Contents



Executive Summary 1

Chapter 1. Appointment of the President’s Council on 3

Physical Fitness and Sports

Chapter 2. Executive Order on Agency-wide Activities to Promote 4

Personal Fitness

Chapter 3. The President’s Recommendations for Improving Physical 5


Chapter 4. The President’s Recommendations for Improving Nutrition 8

Chapter 5. The President’s Recommendations for Prevention 10

Chapter 6. The President’s Recommendations for Avoiding Risky 14























President Bush’s HealthierUS Initiative is based on the premise that increasing personal fitness and becoming healthier is critical to achieving a better and longer life. Extensive research, much of it conducted or funded by the Federal Government, has shown that improving overall health, and thus preventing disease and premature death, is as easy as making small adjustments and improvements in the activities of daily life. The President’s HealthierUS Initiative uses the resources of the Federal Government to alert Americans to the vital health benefits of simple and modest improvements in physical activity, nutrition, and behavior.

Nearly half of American adults report that they do not exercise at all, and seven out of 10 do so infrequently. Too many of America’s youth do not exercise at all, are overweight, and have poor dietary habits. Five chronic diseases associated with obesity -- heart disease, cancer, stroke, chronic obstructive pulmonary disease (e.g., bronchitis, emphysema, asthma), and diabetes -- account for more than two-thirds of all deaths in the United States. In addition to claiming more than 1.7 million American lives each year, these diseases hinder daily living for more than one of every 10 Americans, or 25 million people. More than 100 million Americans live with chronic disease, and millions of new cases are diagnosed each year.

Although these chronic diseases are among the most prevalent and deadly health problems facing our nation, some of them are very preventable. Effective measures exist today to prevent or delay much of the chronic disease burden and curtail its devastating consequences. Families can take simple, affordable steps to work physical activity, good nutrition, and behavior changes into their daily routine. You don’t have to become a marathon runner or be able to afford a gym or health club membership to improve personal fitness. The health of Americans would improve with modest but regular physical activity and better eating habits.

People of all ages can benefit from these actions. For the nation’s seniors, poor health should not be a foregone consequence of aging. Improvements in diet and physical activity can greatly improve the quality of life at any age. Regular physical activity also helps older Americans maintain joint strength and mobility and substantially delays the onset of functional limitations and loss of independence.

The Administration is announcing two actions to promote fitness:

The President’s Council on Physical Fitness and Sports.

An important step in communicating the Administration’s message on fitness and health

is the revitalization of the President’s Council on Physical Fitness and Sports. Chaired by

Lynn Swann, and vice-chaired by Dot Richardson, the Council will coordinate its

activities with Federal, state, and private entities to serve communities across the country

more effectively.



Agency-Wide Activities to Promote Personal Fitness.

The President is signing an Executive Order that directs certain Federal agencies to review all policies, programs, and regulations related to physical activity, nutrition, screenings, and making healthy choices. The agencies will propose revisions, modifications, or new actions to further improve the promotion of personal fitness, and forward the recommendations to the President within 90 days.

The HealthierUS Initiative is based on a very simple formula: every little bit of effort counts. The Administration has identified four keys for a healthier America and is taking the following actions to promote them:

  • Be Physically Active Every Day. Many chronic diseases can be prevented with modest exercise, in some cases as simple as walking for half an hour. There are countless opportunities for physical activity that do not need to be strenuous or very time-consuming to be beneficial. Enjoy the outdoors with your children and family and show them that exercise can be fun and achievable. Administration actions to promote physical activity include:
  • Declaring a Fee-Free Weekend in America’s National Parks and Federal Lands
  • Creating a Web Site
  • Promoting the Use of Public Lands and Water
  • Highlighting the Rivers, Trails, and Conservation Assistance Program
  • Eat a Nutritious Diet. Americans should make simple adjustments to their diet and avoid excessive portions. Increasing fruit and vegetable consumption is a central part of a healthier diet, and good overall nutrition lowers the risk of getting heart disease, stroke, cancer, and osteoporosis. Administration actions to promote better nutrition include:
  • Enhancing the National 5 A Day for Better Health Program
  • Promoting Nutrition Curriculum and Education in Our Schools
  • Supporting the Eat Smart-Play Hard Campaign
  • Get Preventive Screenings. Americans may be surprised to learn how a simple test like a cholesterol screen or a blood pressure check can reveal current health status and identify a need to adjust diet or behavior. Administration actions to promote preventive medicine include:
  • Creating the Healthy Communities Innovation Initiative
  • Raising Awareness of Diabetes Screening, Especially for Women
  • Strengthening and Improving Medicare
  • Make Healthy Choices. Avoid tobacco and drugs and the abuse of alcohol and make smart and safe choices in your everyday life. Administration actions to promote healthy choices include:
  • Creating a CDC Tobacco Control Toolkit
  • Highlighting the Drug Free Communities Support Program
  • Promoting Bicycle Safety Initiatives

HealthierUS: The President’s Health and Fitness Initiative

Chapter 1. Appointment of the President’s Council on Physical Fitness and Sports

A reinvigorated Council on Physical Fitness and Sports will raise Americans’ awareness of the importance of increasing personal fitness and becoming healthier. The President has appointed 20 outstanding volunteer citizens, including distinguished athletes and experts from the health care community, to serve on the Council.

The Council members will use their expertise to advise the Administration on the quality and content of Administration programs to promote physical fitness. Their diverse backgrounds will help the Administration reach more Americans, and individuals will serve as an inspiration for a more active lifestyle through personal and professional examples. Their experiences and background make them qualified to communicate important fitness messages to individuals of any age and ability.

The Council will focus on all populations, including young Americans among whom there is an

alarming trend in obesity and inactivity. Council members will help to educate community

leaders and all citizens on the HealthierUS Initiative. Specific activities include:

Refocusing the President’s Challenge Awards Program

    • Presidential Adult Active Lifestyle Award--A new award to recognize adults for committing to regular physical activity five days a week for six weeks in partnership with a child or adolescent.
    • President's Sports and Fitness Award--Like its predecessor, the Presidential Sports Award, this renewed program will allow individuals of all ages, not just children, to earn Presidential recognition for sustained commitment in over 60 categories of physical activity and sports.
    • Other Awards--The existing school-based awards for children who are tested for overall physical fitness will remain as important motivators of fitness.


    • This web site has been revised to include educational resources, a monthly letter from the executive director, "timely topics" related to physical activity and healthy living, and current physical activity news.



Chapter 2. Executive Order on Agency-wide Activities to Promote Personal Fitness

Existing information on the importance of appropriate physical activity, diet, preventive health screenings, and avoiding harmful substances is often not received by the public or cannot be sufficiently integrated by Americans into their daily lives. However, individuals of all ages, in all locations, and of all levels of personal fitness can benefit from some amount of appropriate physical activity, dietary guidance, preventive health screening, and making healthy choices.

While personal fitness is an individual responsibility, the Federal Government should expand opportunities for individuals to empower themselves to improve their general health. Such opportunities should include improving the flow of information about personal fitness, assisting in the utilization of that information, increasing the accessibility of resources for physical activity, and reducing barriers to achieving good personal fitness.

The Departments of Agriculture, Education, Health and Human Services, Housing and Urban Development, Interior, Labor, Transportation, and Veterans Affairs, and the Office of National Drug Policy together oversee programs and initiatives that promote or enhance personal fitness and health. Under the new Executive Order issued by President Bush, these agencies will review and evaluate the policies, programs, and regulations of their respective agencies relating to personal fitness and health of the general public. Based on that review, they will make recommendations to the President on whether existing policies, programs, and regulations of their respective agencies should be modified or whether new policies or programs should be implemented. These policies and programs shall improve the Federal Government's assistance of individuals, private organizations, and State and local governments in increasing physical activity; improving responsible dietary habits; increasing utilization of preventive health screenings; and discouraging the use of tobacco and drugs, and the abuse of alcohol.

Designees from each agency shall meet no less than twice a year as part of a Personal Fitness Interagency Working Group to ensure cooperation, coordination, and efficiency in Federal fitness activities.











Chapter 3. The President’s Recommendations for

Improving Physical Fitness

Be Physically Active Every Day



Fitness problems such as obesity and overweight have reached truly epidemic proportions in the United States. In the last 20 years, obesity rates have increased by more than 60 percent among adults. In 1999, 61 percent of the adult population was either overweight or obese. The obesity epidemic impacts other diseases as well. For example, the incidence of type 2 diabetes, a major consequence of obesity, is on the rise. Among U.S. adults, diagnosed diabetes increased 49 percent from 1990 to 2000.

The rate of increase in overweight among young people has been even steeper. This is particularly troubling since many of the behaviors that lead to adult obesity are established during childhood. Just 10 years ago, type 2 diabetes was virtually unknown in children and adolescents. Indeed, the medical community commonly referred to the condition as "adult onset diabetes." Today, it accounts for almost 50 percent of new cases of pediatric diabetes in some communities. Medical complications associated with obesity in children can lead to hospitalizations for type 2 diabetes, sleep apnea, and asthma. Since 1980, the percentage of children who are overweight has nearly doubled, and the percentage of adolescents who are overweight has nearly tripled. About 8 million young Americans, almost 15 percent of all children, are overweight.

Americans young and old should incorporate regular physical activity into their everyday lives. This does not necessarily mean joining an expensive gym or committing to a rigorous exercise or training routine. It is sufficient to choose activities that fit into your daily routine that speed your heart rate and breathing, or increase your strength and flexibility. Examples include walking to work, gardening, taking extra stairs, or mowing the lawn with a push mower. Besides building strength and aerobic fitness, regular exercise relieves stress, provides motivation, promotes relaxation, and facilitates sleep. Such activity reduces the risk of dying of coronary heart disease and decreases the risk for colon cancer, diabetes, and high blood pressure.

Regular physical activity is important throughout life. Healthy lifestyles are more influential than genetic factors in avoiding deterioration traditionally associated with aging. The growing number of older Americans places increasing demands on the public health system and on medical and social services. Currently, almost one-third of total U.S. health care expenditures are for older adults. These expenditures are largely due to treatment and care of chronic diseases, and the cost associated with many of these conditions could be reduced through regular physical activity.

For children, almost any physical activity is sufficient as long as they are moving. Playing actively or participating in athletic or physical fitness activities during school, running, biking, jumping rope, and dancing -- instead of watching television or playing video games -- all provide children with the kinds of activity they need.

The President’s Challenge:

Regular physical activity substantially reduces the risk of poor health. Physical activity need not be strenuous or very time-consuming to be beneficial, and all ages can benefit from modest physical activity. Every little bit of effort counts:

  • Adults, get at least 30 minutes of physical activity each day. If it is too hard to set aside 30 minutes at one time, break it up into 10 or 15 minute segments. Developed by a panel of scientists under the leadership of Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) as a part of the 2000 Dietary Guidelines for Americans, these recommendations for daily activity are based on the results of studies that examined the relationship between physical activity and health. If only 10 percent of American adults began regularly walking, $5.6 billion in health care costs associated with heart disease could be saved.
  • Children and teenagers, get at least 60 minutes of physical activity each day. For children, setting aside time for physical activity should be easy. Unfortunately, even children have busy schedules today. According the Dietary Guidelines for Americans, they can break activity up into segments. Regular activity for children is important. Normal childhood play or outdoor activity helps control blood pressure and manages weight while building and maintaining healthy bones, muscles, and joints.
  • Parents, commit to family activities that involve physical activity. It can be easier to work physical activity into your daily routine if you combine it with family time.

Promoting Physical Fitness: Administration Actions

Fee-Free Weekend in America’s Federal Lands--Free admission has been granted to many of America’s Federally managed areas this weekend, June 22 and 23, 2002. In support of physical fitness, Americans are encouraged to visit one of the 385 National Parks or numerous other Federal recreation areas throughout the country. Public Service Announcements have been running nationwide to alert Americans of the effort. Eliminating entrance fees and increasing accessibility will allow more Americans to benefit from our public lands. Web Site--This interactive web site will be the central repository of information related to the President’s initiative and will serve as a portal to resources throughout the Federal government related to promoting fitness. This site will provide links to, the web site of the President’s Council on Physical Fitness and Sports;, an interactive site encouraging increased physical activities for adolescents;, an exhaustive source of information on health care topics prepared by the Centers for Disease Control and Prevention (CDC); and many other fitness, nutrition, prevention, and safety sites from across the Federal agencies.

Promoting Use of Public Lands and Waters--A Memorandum of Understanding (MOU) has been entered into by the Departments of Interior (DOI), USDA, HHS, and the Army Corps of Engineers to promote the use of public lands to enhance physical and physiological health. The cooperating agencies will collaborate to raise public awareness of the role and benefits of physical activity in maintaining good physical and mental health. They will raise public awareness of the many places in America’s public lands where recreation opportunities exist. Programs will be developed with a focus on preventing or reducing obesity, and encouraging a physically active lifestyle. Where appropriate these collaborative projects will focus on the needs of urban and underserved populations, especially those living near public lands and waters. Volunteer events such as National Public Lands Day, National Fishing and Boating Week, National Trails Day, and Great Outdoors Week shall be promoted as benefiting people through activity in natural and cultural landscapes.

Rivers, Trails, and Conservation Assistance--Also known as Rivers & Trails or RTCA, this program works with community groups and local and State governments to conserve rivers, preserve open space, and develop trails and greenways as "pathways to health." The National Park Service (NPS) administers the technical assistance with support from HHS and USDA and other federal and nonprofit partners. RTCA has worked with communities on urban promenades, trails along abandoned railroad rights-of-way, wildlife corridors, downtown riverfronts, and regional water trails.





















Chapter 4. The President’s Recommendations for Improving Nutrition

Eat a Nutritious Diet


Eating right is vital to promoting health and reducing the risk for death or disability due to chronic diseases such as heart disease, certain cancers, diabetes, stroke, and osteoporosis. In fact, it has been estimated that dietary changes could reduce cancer deaths in the United States by as much as 35 percent.

Nevertheless, a large gap remains between recommended dietary patterns and what Americans actually eat. Very few Americans meet the majority of recommendations of the Food Guide Pyramid or the Dietary Guidelines for Americans. Only 3 percent of all individuals meet four of the five recommendations for the intake of grains, fruits, vegetables, milk products, and meat and bean food groups. Only one-fourth of U.S. adults eat the recommended servings of fruits and vegetables each day. Unfortunately, poor eating habits are usually established during childhood. And more than 60 percent of young people eat too much fat, and less than 20 percent eat the recommended servings of fruits and vegetables.

The Food Guide Pyramid is an outline of what to eat each day, and it calls for a variety of food and nutrients. Fruits and vegetables provide essential vitamins and minerals, fiber, and other substances that are associated with good health. Low fat diets rich in fiber-containing grain products, fruits, and vegetables may reduce the risk of heart disease and some types of cancer. Milk products provide protein, vitamins and minerals and are the best source of calcium. However, fats, oils, and sweets provide calories and little else, and should be used sparingly. Drinking enough water is also essential to keeping hydrated, converting food into energy, carrying nutrients through the body, and removing waste.

The President’s Challenge:

Americans can dramatically improve their overall health by making modest improvements to their diets. All Americans can benefit from reducing their fat intake and by working more fruits and vegetables into their daily meals. Every little bit of effort counts:

  • Eat at least five fruits and vegetables every day. A large number of research studies have shown that higher intakes of fruits and vegetables are related to decreased risk for cardiovascular disease as well as a lower incidence of certain cancers, including lung cancer, cancers of the mouth and pharynx, squamous esophageal cancer, laryngeal cancer, and some colon cancers.
  • Follow the Food Guide Pyramid and the Dietary Guidelines for Americans in your food choices. Use fruits, vegetables, and grains as the foundation of your meals, and limit your intake of fat and sugar. Foods in one group cannot replace another, nor is one group more important than another. Research studies examining American diets have documented that people who choose foods from all of the Food Guide Pyramid are not only improving their nutrition, but are better able to maintain a healthy weight.
  • If you are a parent, set good habits for your family by choosing and preparing food in a sensible way. When you shop for groceries, read labels and make wise choices for your family. Prepare foods using as little salt, oil, cholesterol, and fat as possible. Reducing blood cholesterol levels by dietary means has been shown to be effective in decreasing the risk for coronary heart disease. In addition, one study found that reducing saturated fat intake produced a trend towards a decrease in both coronary mortality (21 percent) and total mortality (6 percent).
  • Eat sensible and moderate portions. You can keep your weight in a healthy range by not overeating and balancing what you eat with the energy you expend. Compare the recommended serving size and portions of the food you prepare with what you actually eat. Be sure to eat appropriate servings to ensure proper vitamins, minerals, carbohydrates, and proteins are included in your diet.

Promoting Improved Nutrition: Administration Actions

Enhancing the National 5 A Day for Better Health Program--The Administration is strengthening this program by launching a more coordinated effort between the USDA, CDC, and the National Cancer Institute. The expertise of the science and medical communities will lend valuable support for improving overall nutrition and increasing the consumption of fruits and vegetables in the United States to five-to-nine servings every day. The program seeks to inform Americans that eating fruits and vegetables can improve their health and reduce the risk of heart disease and cancer, the two leading causes of death in the United States.

Promotion of Nutrition Curriculum and Education--The Department of Education (ED), USDA, and HHS are collaborating on a new MOU concerning the promotion of nutritional excellence in school. Just as USDA and HHS assist in the operation of the school lunch programs, these Departments will also provide guidance on good nutrition that can be incorporated into daily classes and lessons on health. Based on a successful program in elementary schools, this joint effort will be expanded to higher grades. The information will help students identify how a healthy meal is planned by using the school lunch as an example and will highlight examples of healthy lunches brought from home.

Eat Smart-Play Hard Campaign--This national nutrition education and promotion campaign is designed by the USDA to convey science-based, behavior-focused, and motivational messages about healthy eating and physical activity to pre-school and school-aged children. The campaign focuses on four basic themes: the importance of breakfast, healthy snacks, physical activity, and balancing what you eat with what you do. The campaign’s primary communication vehicle is Power Pantherä , a spokes-character who conveys nutrition and physical activity messages in a fun and non-threatening way as a peer. Future projects in this campaign include Spanish language materials, an interactive web site with an expanded children’s page, public service announcements, and a multi-year development and promotion plan.

Chapter 5. The President’s Recommendations for Prevention

Get Preventive Screenings



Preventive screenings and tests save lives. Unfortunately, many Americans do not routinely follow some basic health screening recommendations. Routine screenings can identify a previously undiagnosed condition or risk of condition. This allows physicians to intervene early with treatments and therapies to control the condition or inform the individual of lifestyle changes that can be taken to improve health outcomes and costs.

For example, screening for high blood pressure and high blood cholesterol is an important first step in identifying individuals who are at risk for chronic diseases but may be undiagnosed. Screening and appropriate follow-up for high blood pressure and elevated cholesterol can also save the lives of those at risk for heart disease. Early detection and treatment for diabetes can improve health, and the CDC recommends health professionals screen high-risk patients periodically, even when those individuals are visiting their doctor for another reason. Such opportunistic screenings can alert a health professional to troubling results requiring follow-up care.

Many studies have shown that dietary changes and therapies can dramatically reduce the risk of heart disease and stroke, especially when these modifications reduce high blood pressure and high blood cholesterol. When coupled with lifestyle changes, these therapies can be even more effective in lowering the risk of a heart attack or stroke. About 90 percent of all adults now have their blood pressure measured at least once every two years. In 1998, only 67 percent of adults had had their blood cholesterol checked within the preceding five years. Of the estimated 17 million people with diabetes in the country, about 5.9 million are undiagnosed. Without effective diagnosis and treatment, diabetes becomes a leading cause of blindness, kidney failure, heart disease, and stroke.

There are additional simple, preventive measures many Americans can take to reduce bad health outcomes. Pneumonia and influenza are responsible for more than 30,000 deaths among older adults each year. Immunization can substantially reduce the severity, risk of hospitalization, and risk of death from these diseases.

The President’s Challenge:

Basic preventive health services such as health screenings are the most important health information Americans can receive about their current health status. Regular screenings can motivate individuals to modify their current activities and behaviors to improve their overall health. And seeking follow-up care based on basic preventive screenings can save lives. Every little bit of effort counts:

  • Take advantage of basic health screening practices recommended by your treating physician or other health professionals. Screening and appropriate follow-up care for high blood pressure and elevated cholesterol can save the lives of those at risk for heart disease and stroke. Regular screening can detect many forms of cancer at early, less dangerous stages.
  • Get your blood pressure checked regularly, particularly if you are a high-risk individual. Effective blood pressure treatment is easy and reduces risk of stroke by 40 percent. Easy to use machines are conveniently located in public places.
  • Ask your doctor about a routine screening for diabetes. Lack of treatment for diabetes can lead to blindness, kidney failure, and amputations. Early detection with treatment can reduce diabetes-related blindness by up to 90 percent, kidney failure by up to 50 percent, and amputations by up to 50 percent.
  • Get the appropriate immunizations each year. In 1999, 33 percent of adults aged 65 or older reported they did not get a flu shot in the previous year, and 46 percent reported they had never been vaccinated against pneumococcal disease.

Promoting Preventive Health: Administration Actions

Healthy Communities Innovations Initiative--$25 million has been included in the Fiscal Year 2003 Budget for the development of best practices in communities to improve the health of their citizens and to prevent diabetes, asthma, and obesity. The Healthy Communities Innovation Initiative will fund demonstration projects in five communities to enhance access to services, encourage positive behavioral changes, and improve community health.

The Initiative will build partnerships at the local level and will match Federal with local resources to improve prevention and treatment activities. It will be administered by the HHS Health Resources and Services Administration in collaboration with the CDC and the Office of Disease Prevention and Health Promotion.

Diabetes Screening and Awareness--HHS is partnering with several medical and private organizations to increase the utilization of important diabetes screening tools. The Food and Drug Administration, the American Diabetic Association (ADA), and the National Association of Chain Drug Stores have partnered in a nationwide "Take Time to Care" campaign to raise the awareness of diabetes among women, who are at a greater risk for the disease. Distributing information at grocery stores, pharmacies, and other public places, the campaign highlights the warning signs that women need to recognize; the literature identifies all the screening services that are available. The program aims to arm women with key facts about preventing diabetes and guide them to appropriate, effective treatments once diagnosed.

HHS and ADA also have unveiled a new expert panel’s recommendations about pre-diabetes. Pre-diabetes is a condition affecting nearly 16 million Americans where blood glucose levels are higher than normal, sharply raising the risk for developing type 2 diabetes, but the individual does not yet have diabetes. The panel’s new recommendations call for physicians to begin screening overweight people age 45 and older for pre-diabetes and to counsel their patients about the high risk of getting diabetes.

Strengthening and Improving Medicare--Medicare+Choice plans are an increasingly reliable source for quality screening and prevention services. As a part of the President’s broader initiative to improve the Medicare program, Medicare+Choice plans would be strengthened and made available to more beneficiaries. In addition to being more affordable and providing prescription drug coverage, Medicare+Choice plans provide extra benefits to support seniors with serious and chronic health conditions, such as programs to help patients with diabetes and cancer avoid complications. Medicare+Choice plans also provide innovative health care services that are generally not available in the traditional Medicare plan, such as annual checkups to catch health problems early, exercise and wellness programs, and programs to improve patient safety. Making Medicare+Choice plans more available would give seniors access to modern, reliable coverage options, similar to those available to all Federal employees through the Federal Employee Health Benefits Program.































Recommended Preventative Health Screenings




Age: 19 to 39

Age: 40 to 64

Age 65 and older






Comprehensive screening exam

To promote wellness

Frequency should be tailored to age and health status. Consult your health professional.






Diagnostic Testing





Blood Pressure

To identify high blood pressure

Every 2 years for all ages



To reduce risk of heart disease

At least every 5 years



Diabetes screening

To test for diabetes

Depends on risk factors and age. Consult with your health professional.

Colon cancer screening: Options include: Stool blood (fecal test) Sigmoidoscopy, Colonoscopy, Barium enema

To detect colorectal cancer

After age 50: frequency depends on test: FOBT: every year Sigmoidoscopy: every 5 years Colonoscopy: every 10 years Barium enema: every 5 years

Sigmoidoscopy or colonoscopy

To detect colorectal cancer or large polyps

Every 5 years beginning at age 50

Vision exam

To test vision and screen for glaucoma

Discuss with your health professional.


Hearing test

To monitor hearing

Every 10 years

Hearing loss increases at age 50 so discuss frequency of tests with your health professional.






Men Only





Prostate-specific antigen (PSA)/DRE for prostate cancer

Blood test to detect prostate cancer

Guidelines vary. Discuss with your health professional.






Women only





Mammogram and clinical breast exam

Early detection of cancer

Every 1 to 2 years starting at age 40

Cervical cancer screening/pelvic exam

To detect cervical and ovarian cancer

Every 1-3 years depending on risk

Every 1-3 years depending on risk. Over age 65, if negative on previous screens, at your health professional’s discretion.

Rubella antibody

To determine rubella immunity

One time prior to first pregnancy



To identify those at risk

At least once after age 65; earlier for high risk women

Sources: U.S. Preventative Services Task Force


Chapter 6. The President’s Recommendations for

Avoiding Risky Behaviors

Make Healthy Choices


One of the most important things individuals and families can do to promote good health is to make smart choices. Avoiding risky behaviors such as using tobacco or drugs, or abusing alcohol - even driving without a safety belt - can save lives and improve health. Behavioral changes reduce the chance of illness or injury; even washing one’s hands regularly prevents the spread of many common illnesses and infections.

Misuse and abuse of alcohol continue to be a problem in this country. Alcoholic beverages supply calories but few nutrients and are harmful when consumed in excess. People who should not drink at all include children, adolescents, pregnant women, and individuals who cannot restrict their drinking to moderate levels. Having more than one drink per day for women or more than two drinks per day for men can raise the risk of high blood pressure, stroke, and some forms of cancer. American adults who drink should use alcohol responsibly in all social and recreational settings. The effects of alcohol abuse can be devastating, from adverse health consequences, to domestic abuse, to drinking and driving.

Tobacco use is the single most preventable cause of death and disease in the United States, causing more than 440,000 premature deaths annually during 1995-1999. Smoking can cause chronic lung disease, coronary heart disease, and stroke. Smoking has also been linked to cancer of the lungs, larynx, esophagus, mouth, and bladder. In addition, smoking contributes to cancer of the cervix, pancreas, and kidneys. Smokeless tobacco and cigars also have deadly consequences, including lung, larynx, esophageal, and mouth cancer. Aggressive and sustained anti-smoking programs prevent and reduce smoking and many states have successful efforts underway.

Regular marijuana use may also cause many of the same respiratory problems as regular tobacco use. Some of the respiratory problems associated with marijuana use include daily cough and phlegm, symptoms of chronic bronchitis, and more frequent chest colds. Continuing to smoke marijuana can lead to abnormal functioning of lung tissue. Research shows that marijuana harms the brain, heart, lungs, and immune system and limits learning, memory perception, judgement, and the ability to drive an automobile. Any illegal drug possession or use should not be tolerated. More parents need to learn about the power of preventing youth drug abuse.

Other simple behavioral changes save lives as well. For example, handwashing has been show to be a fundamental factor in preventing the spread of infections. One study of school children found that those who washed their hands four times a day had fewer sick days due to respiratory illness and fewer days lost because of stomach upset.

Thousands of people needlessly die in traffic accidents yearly because they do not use safety belts. Seat belts are the most effective means of reducing fatalities and serious injuries in a traffic accident. In fact, seat belts save over 10,000 lives in America every year. Appropriate bicycle safety measures could also reduce the 690 fatalities and 51,000 traffic-related injuries that occur every year. Bike helmets reduce head injury risk by 85 percent. These are smart choices Americans can make that prevent injuries and death.

The President’s Challenge:

Healthy choices are about making smart decisions in your everyday life—from avoiding tobacco and illegal drugs, to moderate consumption of alcoholic beverages if you drink, to using safety belts and bike helmets. Every little bit of effort counts:

  • If you smoke, quit. If you don’t smoke, don’t start. After just one day without cigarettes, the risk for heart attack decreases. Over the next several months, coughing, sinus congestion, and fatigue decrease. One year after quitting, excess risk for heart disease is reduced by half; risk for stroke is reduced after five years of not smoking. Ten years after quitting, the lung cancer death rate is about half that of a smoker; 15 years after quitting, an ex-smoker’s risk for heart disease is about the same as that of a nonsmoker.
  • If you are a parent, set a good example and quit smoking before your children start. If you continue to smoke, avoid smoking inside or around your children. Each year an estimated 3,000 nonsmoking Americans die of lung cancer and up to 300,000 children suffer from respiratory tract infections because of exposure to secondhand smoke. Evidence also indicates that exposure to secondhand smoke causes heart disease.
  • Avoid illegal drugs. One of the largest factors contributing to emergency room episodes is the use of illegal drugs. In the first six months of 2001, more than 308,000 emergency room episodes were attributable to illegal drug use
  • Buckle up. About 41,730 people were killed in highway crashes in 2001, down from 41,821 in 2000, but 60 percent of the people killed were not wearing safety belts.

Promoting Healthy Choices: Administration Actions

CDC Tobacco Control Toolkit--CDC is starting to develop a toolkit to accompany the 2003 annual Tobacco Control State Highlights report. This toolkit will include information and resources to assist states in developing, implementing, and evaluating programs to limit tobacco use. The toolkit will enable CDC to guide states in investing in proven programs and strategies to reduce tobacco use that have been successful in the states.

Drug-Free Communities Support Program--This program supports community anti-drug coalitions that harness local energy and resources to reduce substance abuse. Coalitions include local partnerships among youth; parents; businesses; the media; schools; youth organizations; law enforcement; civic groups; religious or fraternal organizations; health care professionals; state, local, or tribal governmental agencies; and other organizations. Activities include parent drug education programs, youth summits, drug intervention counseling services, and tutoring and financial incentives for businesses that adopt drug-free workplace programs. The President's Budget for Fiscal Year 2003 provides $60 million for the Drug-Free Communities Support Program — an increase of $10 million over 2002.

Bicycle Safety Initiatives--The National Highway Traffic Safety Administration (NHTSA) is undertaking a series of initiatives to improve public information, education, enforcement, and outreach on bicycle safety. NHTSA sponsors the National Strategies for Advancing Bicycle Safety Conference, which is a key forum bringing together policy makers, educators, advocates, transportation experts, health and injury professional and others. The Conference ensures that all interested parties agree to, and cooperate in acting upon, established goals to improve national bike safety. NHTSA also actively promotes and distributes the most recent information on helmet safety standards from the Consumer Product Safety Commission.