Hawai‘i State Department of Health

* Duplicate objectives which appear in two or more priority areas are marked with an asterisk alongside the objective number.

1.A Increase to at least 40% the proportion of people aged 6 and older who engage regularly, preferably daily, in light to moderate physical activity for at least 30 minutes per day.* (Baselines(1992): Adults, overall: 44.5; males: 48.7; females: 40.3; Children, 9th-12th grades(1995): 41.0)
NOTE: *Light to moderate physical activity requires sustained, rhythmic muscular movements, is at least equivalent to sustained walking, and is performed at less than 60 percent of maximum heart rate for age, three or more days per week. Maximum heart rate equals roughly 220 beats per minute minus age. Examples may include walking, swimming, cycling, dancing, gardening and yard work, various domestic and occupational activities, and games and other childhood pursuits.

1.B * Reduce coronary heart disease deaths to no more than 70 per 100,000 people. (Baseline: 72.2 in 1993)

1.C * Reduce overweight to a prevalence of: i. no more than 20% among people aged 18 and older, and ii. no more than 15% among adolescents aged 12-17. (Baselines(1993): Adults(based on BMI), overall: 19.7; males: 22.5; females: 16.9; Children, 5th grade(1990), overall: 15; males: 14, females: 16)

1.D Increase to at least 20% the proportion of people aged 18 and older and to at least 75% the proportion of children and adolescents aged 6-17 who engage in vigorous physical activity that promotes the development and maintenance of cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion. (Baselines: Adults(1990): 18.3; Children, 9th-12th grades(1995): 61.2)

1.E Reduce to no more than 15% the proportion of people aged 6 and older who engage in no leisure-time physical activity. (Baseline: 20.7 in 1994)

1.F Increase to at least 40 percent the proportion of people aged 6 and older who regularly perform physical activities that enhance and maintain muscular strength, muscular endurance, and flexibility. (Baselines: Children, 9th-12th grades(1995): Strengthen/tone: 46.4; Flexibility: 49.8)

1.G * Increase to at least 50% the proportion of overweight people aged 12 and older who have adopted sound dietary practices combined with regular physical activity to attain an appropriate body weight. 12-17. (Baselines(1994): Adults(based on BMI): 5.2; Children reporting trying to lose weight (1990): 8th grade: males: 26, females: 44; 10th grade: males: 25, females: 53)

1.H Increase to at least 50 percent the proportion of school physical education class time that students spend being physically active, preferably engaged in lifetime physical activities. (Baselines: Children, 9th-12th grades: 35.8 in 1995)

1.I Increase availability and accessibility of physical activity and fitness facilities at the community level through coalition initiatives. (Baseline: 247, 394 acres devoted to National Parks, 605 county parks statewide, in 1993-94)

1.J Increase to at least 50% the proportion of primary care providers who routinely access and counsel their patients regarding the frequency, duration, type, and intensity of each patient’s physical activity practices. (Baseline data unavailable)

2.A * Reduce prevalence of overweight in adults 18 and older to no more than 20%. (Baseline (based on BMI) (1993): Overall: 19.7; males: 22.5; females: 16.9)

2.B * Reduce prevalence of overweight adolescents aged 12-17 to no more than 15%. (Baseline of children, 5th grade(1990): Overall: 15; males: 14, females: 16)

2.C Increase the percent of adults consuming fruits and vegetables at least five times each day. (Baseline (1994): Overall: 19.7; males: 16.0; females: 23.3)

2.D Increase percent of school age children consuming fruits and vegetables at least five times each day to 25%. (Baselines (1990): 5th graders: overall: 24; males: 20; females: 27; 8th graders: overall: 16; males: 14; females: 17; 10th graders: overall: 21; males: 19; females: 24)

2.E Reduce growth retardation among low income children aged 5 and younger to less than 10%. (Baseline: 8.8 percent below the 5th percentile for height/age in 1994)

2.F Reduce iron deficiency to less than 10% among low income children aged 1-2, 5% among low income children aged 3-4, and 4% among low income women of childbearing age. (Baseline: 11.9 percent ages 1-4 below the 5th percentile for hemoglobin level in 1994; baseline for women unavailable)

2.G Maintain at or above 75% the proportion of mothers who breastfeed at hospital discharge and increase to 50% the proportion who continue to breastfeed until their babies are 5-6 months old. (Baseline (1990): Early postpartum: overall: 78; low income: 66; 6 months postpartum: overall: 29; low income: unavailable)

2.H Reduce dietary fat intake to an average of 30 percent of calories or less and average saturated fat intake to less than 10 percent of calories among people aged 2 and older. (Baselines: Adults consuming relatively high fat diets(1990-91): Males, ages 18-24: 51.5; females, ages 18-24: 33.2; males, ages 25-34: 35.7; females, ages 25-34: 28.0; Children (1990): 5th graders: males: 35; females: 35; 8th graders: males: 35; females: 34; 10th graders: males: 34; females: 37)

2.I * Increase to at least 50 percent the proportion of overweight people aged 12 and older who have adopted sound dietary practices combined with regular physical activity to attain an appropriate body weight. (Baselines(1994): Adults(based on BMI): 5.2; Children reporting trying to lose weight (1990): 8th grade: males: 26, females: 44; 10th grade: males: 25, females: 53)

2.J Increase to at least 75 percent the proportion of parents and caregivers who use feeding practices that prevent baby bottle tooth decay. (Baselines (1990): Percent introducing cup by age 6 months: 24; by 9 months: 48; by 12 months: 88; Percent introducing soda, syrup or punch by 6 months:10; by 12 months: 44; Percent introducing sweetened fruit drinks by 6 months:13; by 12 months: 56)

2.K Increase to at least 90 percent the proportion of school lunch and breakfast services and child care food services with menus that are consistent with the nutrition principles in theDietary Guidelines for Americans. (Baseline data unavailable)

2.L Increase to at least 75 percent the proportion of Hawai`i’s schools that provide nutrition education from preschool through 12th grade, preferably as part of comprehensive school health education. (Baseline(1990-91): Percent of teachers teaching food and nutrition concepts: Grades K-6: 98; Home Economics: 97; Health/PE: 69; Other: 79)

2.M Increase to at least 75 percent the proportion of primary care providers who provide nutrition assessment and counseling and/or referral to qualified nutritionists or dietitians. (Baseline data unavailable)

2.N Increase calcium intake so at least 50 percent of people aged 11-24 and 50 percent of pregnant and lactating women consume an average of three or more daily servings of foods rich in calcium and at least 75 percent of children aged 2-10 and 50 percent of people aged 25 and older consume an average of two or more servings daily. (Baselines(1990-91): Percent of children with 2/3 RDA calcium: 5th graders: males: 48; females: 49; 8th graders: males: 69; females: 84; 10th graders: males: 58; females: 72; Percent of children with 4+ foods/day: 5th graders: males: 68; females: 68; 8th graders: males: 70; females: 80; 10th graders: males: 71; females: 77)

2.O Decrease salt and sodium intake so at least 65 percent of home meal preparers prepare foods without adding salt, at least 80 percent of people avoid using salt at the table, and at least 40 percent of adults regularly purchase foods modified or lower in sodium. (Baseline (1990): 46% of home preparers rarely add salt when preparing foods; 63% rarely add salt at the table; 36% regularly buy low salt/sodium foods)

2.P Increase to at least 85 percent the proportion of people aged 18 and older who use food labels to make nutritious food selections. (Baseline (1990): 34% always read the food label when purchasing a food for the first time; 13% always read the food label at other times)

3.A Slow the rise in lung cancer deaths to achieve a rate of no more than 42 per 100,000 people. (Baseline: 24.7 percent deaths due to lung cancer in 1993)

3.B Reduce cigarette smoking to a prevalence of no more than 15% among people aged 18 and over. (Baseline: 17.8 in 1995)

3.C Reduce the initiation of cigarette smoking by children and youth so that no more than 15% have become regular cigarette smokers by age 18. (Baseline: 17.8 percent of adults ages 18-24 in 1995)

4.A Reduce the proportion of high school seniors and young adults aged 18-24 engaging in recent occasions of heavy drinking of alcoholic beverages to no more than 28% of high school senior students and 32% of young adults aged 18-24. (Baselines (1995): Seniors: 25.2; Adults ages 18-24: 18.1)

4.B Increase by at least one year the average age of first use of cigarettes, alcohol and marijuana by adolescents aged 12 through 17. (Baselines for first use before age 13(1995): Cigarettes: 28.2; alcohol: 33.9; marijuana: 14.1)

4.C Reduce the proportion of young people who have used alcohol, marijuana, and cocaine in the past month. (Baselines (1995): Alcohol: 40.9; marijuana: 23.8; cocaine: 3.0)

4.D Increase the proportion of high school seniors who associate risk of physical or psychological harm with the heavy use of alcohol, occasional use of marijuana, and experimentation with cocaine, or regular use of cigarettes. (Baselines(1993): Alcohol: 84.4; marijuana: 83.9; cocaine: 84.6; cigarettes: 86.6)

4.E Reduce deaths caused by alcohol-related vehicle crashes to no more than 5.5 per 100,000 people. (Baseline: 5.39 in 1995)

4.F Reduce drug-related deaths to no more than 3 per 100,000 people. (Baseline data unavailable)

4.G Reduce drug abuse-related hospital emergency department visits by at least 20 percent. (Baseline data unavailable)

4.H Maintain the legal blood alcohol concentration tolerance levels of .08 percent for motor vehicle drivers aged 21 and older and zero tolerance (.02 percent and lower) for those younger than 21. (Baseline: The state law for adults was achieved in 1995. The law for younger people has not yet been achieved.)

5.A Reduce pregnancies among females aged 15-17 to no more than 39 per 1,000 adolescent females. (Baseline: 56.8 in 1995)

5.B Reduce to no more than 18% the proportion of most recent pregnancies that are unintended.(Baseline: 27.2 in 1992)
NOTES: Baseline: 27.2% of women married or living with a partner reported that their last pregnancy was unintended, unwanted or earlier than desired. Because Hawai`i data relates to whether only the last pregnancy was intended of women living with a partner and the national baseline relates to all pregnancies within the past five years, data may not be directly comparable.

5.C Increase to at least 95% the proportion of all females aged 15-44 at risk of unintended pregnancy who use contraception. (Baseline: 85.2 in 1992)

5.D Increase access to contraceptive services (including all FDA-approved methods and related medical services), in all health plans, for all subscribers and their dependents in need of contraception to be 95%. (Baseline: 66.6 percent of all health insurance plans in 1995)

6.A Reduce suicides to no more than 10.3 per 100,000 people. (Baseline: 10.3 in 1990-93)

6.B Reduce by 15% the incidence of injurious suicide attempts resulting in hospitalization to a rate of 59.5 per 100,000. (Baseline: 68.4 in 1990)

7.A Reduce homicides to no more than 3.3 per 100,000 people. (Baseline*: 4.8 in 1995)

7.B Reduce weapon-related violent death to no more than 6 per 100,000 people from major causes. (Baselines(1995)*: Overall rate=8.2; Firearms=5.8; Knives=1.3)
*Based on estimates of resident populations by the Federal-State Cooperative Program for Population Estimates.

7.C Reverse to less than 16 per 1,000 children the rising incidence of maltreatment of children younger than age 18. (Baseline: 15.1 in 1991)
NOTE: Since one of the strategies is to increase reporting, the Healthy Hawai i 2000 objective is higher than the 1991 baseline.

7.D Reduce partner abuse. (Insufficient data to establish specific objective.) (Baseline data unavailable)

7.E Reduce assault injuries to no more than 47.7 per 100,000 people. (Baseline: 51.5 in 1990)

7.F Control sexual assault to no more than 87.6 arrests per 100,000 residents (age-adjusted). (Baseline: 74.2 in 1992)

8.A Workplace (Objective not set.) (Baseline data unavailable)

8.B Family (Objective not set.) (Baseline data unavailable)

8.C Culturally-appropriate health education programs (Objective not set.) (Baseline data unavailable)

9.A Reduce deaths caused by unintentional injuries to no more than 24 per 100,000 people. (Baseline: 21.2 in 1994)

9.B Reduce non-fatal unintentional injury hospitalizations to no more than 380.1 per 100,000 people. (Baseline: 437.9 in 1990)

9.C Reduce deaths caused by motor vehicle crashes to: i. No more than 2.0 per 100 million vehicle miles traveled (VMT), and ii. No more than 14.4 per 100,000 people. iii. Reduce traffic-related injury hospitalizations to no more than 128.1 per 100,000 people. (Baselines (1995): Deaths per 100 million VMT=1.6; Deaths per 100,000 people=10.5; Hospitalizations per 100,000 people (1990)=140.9)

9.D Reduce residential injury deaths to no more than 2.4 per 100,000 people. (Baseline: 2.7 in 1990)

9.E Reduce hospitalizations for residential injuries to no more than 109.6 per 100,000 people. (Baseline: 123.8 in 1990)

9.F Reduce nonfatal head and spinal cord injuries so that hospitalizations for these conditions are no more than 75.3 per 100,000 people (age-adjusted). (Baseline: 77.6 in 1990)

9.G Reduce recreational deaths and injuries to: i. No more than 2.4 per 100,000 people, and ii. No more than 93.7 hospitalizations per 100,000 people, respectively. (Baselines: Deaths=2.8 in 1994; Hospitalizations=107.7 in 1990) 9.H Reduce drowning deaths to no more than 3.0 per 100,000 people. (Baselines(1994): Deaths, state residents=3.4; Deaths, de facto population=5.3)
NOTE: Hawai`i's baseline for this objective is not resident population-based, as it includes visitors. Therefore, it can not be compared to the national objective.

9.I Provide education and increase community awareness on injury prevention and control. (Baseline data unavailable)

10.A Reduce deaths from work-related injuries to no more than 4 per 100,000 full-time workers. (Baseline: 3.4 in 1994)

10.B Reduce work-related injuries resulting in medical treatment, lost time from work, or restricted work activity to no more than 8 cases per 100 full-time workers. (Baseline: 8.7 in 1994)

11.A Decrease annual beach closure days to 10. (Baseline: 4 days in 1995)

11.B 80% of the state's beaches will be in the "good" to "excellent" rating. (Baseline: 65% in 1990)

11.C 100% of Hawai`i's streams, ponds, wetlands, estuaries and other inland waters will be suitable for fish and wildlife and for human recreational and aesthetic enjoyment. (Baseline data unavailable)

11.D Put in place Well Head Protection (WHP) programs for each county. (Baseline: WHP programs have been developed and implemented on Moloka`i and Central O`ahu by 1995)
NOTE: Safe drinking water standards are measured using Maximum Contamination Level (MCL) standards set by the Environmental Protection Agency which define acceptable levels of contaminants.

11.E Reduce the amount of hazardous substances released in Hawaii. (Baseline: 2000 tons in 1993)

11.F Increase the amount of domestic sewage that is reclaimed or reused to 20 million gallons per day. (Baseline: 10 million gallons per day in 1994)

11.G Reduce to zero the emissions of air pollutants above permit levels by 2000. (Baseline data unavailable)

11.H Create a comprehensive indoor air quality program. (Baseline: Hawai`i currently has state laws and county ordinances prohibiting smoking in the workplace and enclosed public spaces.)

11.I Develop and establish a comprehensive statewide noise program which addresses regulations for all noise sources. (Baseline: Statewide administrative rules implemented in 1996.)

11.J Conduct inspections of all medical, industrial and veterinary facilities utilizing x-ray devices. (Baseline: There are 1,116 facilities statewide, all of which undergo periodic inspections in 1996.) 11.K Conduct statewide inspections of asbestos management plans of educational facilities K through 12; and compliance inspections of asbestos renovations and demolition. (Baseline: There are over 400 educational facilities K-12th grade statewide, all of which undergo periodic inspections in 1996.)

11.L Conduct polychlorinated biphenyl (PCB) compliance inspection to assure proper disposal. (Baseline data unavailable)

12.A Reduce infections caused by Salmonella species to incidence of no more than 40 per 100,000. (Baseline: 25.5 in 1995)

13.A Reduce dental caries (cavities) so that the proportion of children with one or more caries (in permanent or primary teeth) is no more than 50% among children ages six through eight. (Baseline: 72.7% in 1988-89)

13.B Reduce untreated dental caries (cavities) so that the proportion of children with untreated dental caries (in permanent or primary teeth) is no more than 30% among children ages six through eight. (Baseline: 36.2% in 1988-89)

13.C Increase to at least 50% the proportion of children who have received protective sealants on the occlusal (chewing) surfaces of permanent molar teeth. (Baseline: 15.2% in 1988-89)

13.D Reduce the prevalence of baby bottle tooth decay (BBTD) to no more than 10% among five-year-old children. (Baseline: 15.8% in 1988-89)

13.E Increase to at least 70% the proportion of children entering school programs for the first time who have received an oral health screening, referral, and follow-up for necessary diagnostic, preventive, and treatment services. (Baseline data unavailable) 13.F Reduce deaths due to cancer of the oral cavity and pharynx to no more than 13 per 100,000 men aged 45-74 and 5 per 100,000 women aged 45-74. (Baseline: Men=16.97, Women=7.52 in 1989-90)

14.A Reduce the infant mortality rate to no more than 5.8 per 1,000 live births. (Baseline: 5.7 in 1995)

14.B Reduce low birth weight to an incidence of no more than 5% of live births and very low birth weight to no more than 1% of live births. (Baseline: Low birth weight=6.5%, Very low birth weight=0.7% in 1994)

14.C Increase to at least 90% the proportion of all pregnant women who receive prenatal care in the first trimester of pregnancy. (Baseline: 81% in 1995)

14.E Reduce the rate of pregnancies resulting in neural tube defects to 2.5 per 10,000 live births. (Baseline: 5.1 in 1995)

15.A * Reduce coronary heart disease deaths to no more than 70 per 100,000 people. (Baseline: 72.2 in 1993)

15.B Reduce stroke deaths to no more than 20 per 100,000 people (age-adjusted). (Baseline: 24.7 in 1993)

15.C Increase to at least 50% the proportion of people with high blood pressure whose blood pressure is under control. (Baseline data unavailable)

15.D Increase to at least 90% the proportion of people with high blood pressure who are taking action to help control their blood pressure. (Baseline: 59.2 in 1990)

15.E Increase to at least 90% the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high. (Baseline data unavailable)

15.F Reduce the mean serum cholesterol levels to no more than 200 mg/dL among adults. (Baseline data unavailable)

15.G Reduce the prevalence of blood cholesterol levels of 240 mg/dL or greater to no more than 20% among adults. (Baseline: 33% of those screened were told their level was “high” in 1993)

15.H Increase to at least 40% the proportion of adults with high blood cholesterol who are aware of their condition and are taking action to reduce their blood cholesterol to recommended levels. (Baseline data unavailable)

16.A Reduce breast cancer deaths to no more than 20 per 100,000 women. (Baseline: 22.5 in 1986-90)

16.B Reduce deaths from cancer of the uterine cervix to no more than 1.3 per 100,000 women. (Baseline: 2.5 in 1986-90)

16.C Increase to at least 60% the proportion of people of all ages who limit sun exposure, use sunscreens and protective clothing when exposed to sunlight, and avoid artificial sources of ultraviolet light (e.g., sun lamps, tanning booths). (Baseline(1991): 24.3% of adults use sunscreen often before an outdoor activity, although 42.8% of adults never use sunscreen before outdoor activities.)

16.D Increase the proportion of adults who believe exposure to sun increases the chances of getting skin cancer. (Baseline data unavailable)

17.A Reduce diabetes-related deaths to no more than 10 per 100,000 people. (Baseline: 9.3 in 1993)

17.B Reduce diabetes to a prevalence of no more than 20 per 1,000 people. (Baseline: 22.3 in 1992)
NOTE: It is believed that the prevalance data used above my seriously underestimate the prevalence rates in Hawai i, as compared with the analysis by Maskarinec using insurance claims data (1996).

17.C Reduce to no more than 10% the proportion of people with asthma who experience activity limitation. (Baseline data unavailable)

17.D Reduce asthma morbidity, as measured by a reduction in asthma hospitalizations to no more than 160 per 100,000 people. (Baseline data unavailable)

18.A Confine annual incidence of diagnosed AIDS cases to no more than 20 cases per 100,000. (Baseline: 17.8 (198 males and 12 females) in 1994 *)
*by year of diagnosis
Note: The AIDS case definition was expanded in 1993, which may be responsible in part for the increase in cases that year.

19.A By the year 2000, reported gonorrhea incidence will be maintained at less than 100 cases per 100,000 population. (Baseline: 47.6 in 1995)

19.B Reduce chlamydia incidence to less than 200 cases per 100,000 women. (Baseline: 326.3 in 1995)

19.C By the year 2000, reported incidence of primary and secondary syphilis will be maintained at a rate below 3 cases per 100,000 population. (Baseline: 0 in 1995)

20.A At least 95% of children under age two will have the basic immunization series. (Baseline: 58.9% completed the series in 1992*)
* Year in which child reached age two.

20.B Reduce indigenous cases of rubella and Congenital Rubella Syndrome (CRS) to zero. (Baseline for both: 0 in 1995)

20.C Reduce indigenous cases of pertussis to 3.9 cases per 100,000 population. (Baseline: 5.1 in 1995)

20.D Reduce indigenous cases of measles to zero. (Baseline: 0.08 in 1995)

20.E Increase hepatitis B immunization among infants of surface antigen-positive mothers to at least 96%. (Baseline: 89% in 1995)

20.F Increase immunization levels as follows: i. Pneumococcal pneumonia and influenza immunization among non-institutionalized, Medicare eligible people, 65 or older will be at least 60%, and ii. Pneumococcal pneumonia and influenza immunization among institutionalized chronically ill or older people will be at least 85%. (Baselines: Medicare eligible: pneumonia= 38% in 1993, influenza=36% in 1993-94; Institutionalized, chronically ill: pneumonia=37% in 1995, influenza=89% in 1995)

20.G Reduce tuberculosis (TB) to an incidence of no more than 15 cases per 100,000 population. (Baseline: 16.3% in 1995)

21.A Increase to 50% the proportion of people who have received selected clinical preventive screening and immunization services and at least one of the counseling services appropriate for their age and gender as recommended by the U.S. Preventive Services Task Force. (Baseline data unavailable)

21.B Improve financing and delivery of clinical preventive services so that virtually no resident has a financial barrier to receiving, at a minimum, the screening, counseling, and immunization services recommended by the U.S. Preventive Services Task Force. (Baseline data unavailable)

22.A Identify, improve access to, and/or create, where necessary, data sources to measure progress toward each of the Healthy Hawaii 2000 objectives. (Baseline: 83% (97 of 117 objectives)* in 1996)
* excludes objectives 22A and 22B as well as those not set

22.B Select five appropriate, available data sources and put them on the Department of Health (DOH) computer network. (Baseline: 3 in 1996)