A process evaluation of the efforts in 28 of the CDC-funded states has been conducted. The evaluation focuses on policies, legislation, and environmental changes affecting nutrition and physical activity, implementation and coordination, and the inclusion of relevant partners. The evaluation found that the funded states had successfully involved partner organizations in planning and implementing interventions and cosponsored events aimed at improving body mass index (BMI) in children and adults; however, the evaluation also revealed potential service gaps, overlap with other programs aimed at preventing and controlling obesity, opportunities for additional services, and potential barriers to delivering services (CDC and RTI, 2006).

Steps to a HealthierUS Program

The Steps to a HealthierUS Program, initiated in 2003 by DHHS and administered by CDC, is another federal program intended to increase the capacity of local public health systems to address chronic health concerns. The Steps Program enables communities to develop an action plan, a community consortium, and an evaluation strategy that supports chronic disease prevention and health promotion to lower the prevalence of obesity, type 2 diabetes, and asthma through healthful eating, physical activity, and tobacco avoidance in disproportionately affected, at-risk and low-income populations including African Americans, Hispanics/Latinos, American Indians/Alaska Natives, Asian Americans, and Pacific Islanders (DHHS, 2005b,c). The Steps Program funds communities in three categories: large cities or urban areas, state-coordinated small cities or rural areas, and tribes or tribal entities. Initially funded at $13.6 million in FY 2003, during FY 2004 to FY 2006 the Steps Program received $35.8 million per year to support 40 communities nationwide. Aside from financial resources, CDC provides capacity through technical assistance to support evidence-based program planning and implementation, disease and risk factor surveillance, and program evaluation with the 40 funded communities participating in the annual BRFSS and biennial Youth Risk Behavior Surveillance System (YRBSS). The allocation of resources to support both surveillance and evaluation comprises 10 percent of the total program funding in the majority of the funded communities (MacDonald et al., 2006).

The Steps Program uses indicators developed by CDC that provide a comprehensive set of measures for assessing programs in chronic disease prevention and health promotion. The most relevant indicators related to nutrition and physical activity among youth include fruit and vegetable consumption, vigorous physical activity, television viewing, and monitor-



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