Excessive alcohol use can result in harms such as motor vehicle injuries, violence, heart disease, cancer, alcohol poisoning, and poor birth outcomes. Excessive alcohol use includes binge drinking (five or more drinks per occasion for men or four or more drinks per occasion for women), heavy drinking (15 or more drinks a week for men or 8 or more drinks a week for women), and any alcohol use by pregnant women or underage youth (1).

Excessive drinking is responsible for about 88,000 deaths and 2.5 million years of potential life lost in the United States each year (2). Binge drinking is responsible for more than half of the deaths and two-thirds of the years of potential life lost resulting from excessive alcohol use (3). In , each year deaths and years of potential life are lost due to the harms resulting from excessive alcohol use (2).

The harms related to excessive alcohol use cost the United States $249.0 billion, or $2.05 per drink, in 2010. Most of these costs were due to reduced workplace productivity, law enforcement and other criminal justice expenses, the cost of treating people for health problems caused by excessive drinking, and costs attributable to motor vehicle crashes (6). In , excessive alcohol use cost , or per drink in 2010 (6).

This report focuses on the following evidence-based policies recommended by the Community Preventive Services Task Force for preventing alcohol-related harms (7,8):

• Increasing state excise taxes on beer
• Increasing state excise taxes on distilled spirits
• Increasing state excise taxes on wine
• Having commercial host (dram shop) liability laws

Other strategies recommended by the Community Preventive Services Task Force for reducing alcohol-related harms include regulating alcohol outlet density, avoiding further privatization of retail alcohol sales, and providing adults (including pregnant women) with screening and brief intervention for excessive alcohol use (9–11).

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 (2). It also provides critical information to food regulatory agencies and the food industry so that appropriate prevention and control measures can be implemented (3,4).

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 (5). Risk for infection and severity of illness vary at different ages and stages of health (6).

Foodborne illness is costly. According to a 2015 study, 15 pathogens alone are estimated to cost $15.5 billion in the United States per year. This includes medical costs (doctor visits and hospitalizations) and productivity loss due to premature death and time lost from work (7).

The three practices in this report are recommended by the Council to Improve Foodborne Outbreak Response and the US Food and Drug Administration (FDA) because scientific evidence supports their effectiveness in improving foodborne disease surveillance, detection, and prevention (2–4). These practices are

• 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
• Increasing the completeness of PFGE testing of Salmonella
• Adopting provisions recommended in the FDA Food Code into state food safety regulations

Other strategies supported by scientific evidence include using trained staff and standardized questionnaires to interview persons with suspected foodborne illness as soon as possible after illness is reported and conducting environmental assessments as a routine component of foodborne disease outbreak investigations (2).

Healthcare-associated infections (HAIs) are linked with increased illnesses, deaths, and healthcare costs (1, 2). Each year, about 1 in 25 US hospital patients is diagnosed with at least one infection related to hospital care. In 2011, there were approximately 722,000 HAIs in US acute care hospitals, and approximately 75,000 hospital patients with HAIs died during their hospitalizations (2).

Many HAIs are caused by antibiotic-resistant (AR) pathogens and Clostridium difficile (C. difficile), often as a consequence of inappropriate antibiotic use. Each year in the United States, at least 2 million people are infected by an AR pathogen and at least 23,000 will die as a direct result of these infections (3).

More than half of all hospital patients receive an antibiotic, and 30%–50% of all antibiotics are prescribed inappropriately or are unnecessary (4). Poor prescribing practices put patients at risk for adverse reactions and also contribute to antibiotic resistance, making these drugs less likely to work in the future.

Despite progress in reducing some HAIs—such as central line-associated bloodstream infections (CLABSIs)—more progress needs to be made in preventing other infections, including C. difficile  infection and catheter-associated urinary tract infections (CAUTIs). These infections can be prevented by using infection control and prevention procedures in healthcare settings and improving antibiotic prescribing.

This report highlights two practices to reduce HAIs and AR:

• Implementing state activities to build capacity for HAI prevention
• Implementing stewardship programs to improve antibiotic use in acute care hospitals

Improving health care through HAI and AR prevention, detection, and response are priorities for CDC, the US Department of Health and Human Services (HHS), and the White House. The White House’s National Strategy for Combating Antibiotic-Resistant Bacteria (CARB) and National Action Plan stress the judicious use of antibiotics to prevent transmission of AR infections (7,8). The HHS HAI action plan sets national goals for reducing HAIs and provides a framework for state HAI prevention plans (6). In CDC’s 2014 National Healthcare Safety Network (NHSN) Annual Hospital Survey, 39.2% of US hospitals reported having antibiotic stewardship programs (9) that included seven core elements CDC deems critical for such programs (4).

Other strategies supported by evidence include optimizing infection control practices within healthcare facilities, using a coordinated regional approach to preventing infections, and implementing CDC’s Targeted Assessment for Prevention (TAP) strategy (10,11).

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).

Twenty-nine percent of US adults—more than 70 million people—have high blood pressure and approximately 73.5 million have high levels of low-density lipoprotein (LDL) cholesterol. High blood pressure and high LDL 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 $195.6 billion in direct medical expenses and $320.1 billion when indirect expenses are included (3).

This report focuses on one policy and one practice recommended by the Community Preventive Services Task Force, the US Public Health Service, Institute of Medicine, and the American College of Clinical Pharmacy because scientific studies support their effectiveness in managing heart disease and stroke risks (8–11):

• Implementing meaningful use of certified electronic health records
• Establishing state collaborative drug therapy management (CDTM) policies that authorize pharmacists to provide certain patient services

Other strategies for reducing heart disease and stroke that are supported by scientific evidence and practice include promoting team-based care, implementing clinical decision-support systems, using interventions that engage community health workers, reducing out-of-pocket costs for cardiovascular disease preventive services, and reducing sodium consumption at the community level (12,13).

CDC estimates that more than 1.2 million people in the United States are living with HIV and that 12.8% (about one in eight) 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 2013, people (aged ≥13 years) in were diagnosed with HIV infection (1). percent of these people were diagnosed late in the disease (1) and therefore were at increased risk for disease progression, death, and transmission of HIV to others. In 2012, an estimated 17,858 people with HIV died in the United States. Of these, CDC estimates that were from (1).

The lifetime cost of medical care for a person with an early HIV diagnosis is about $402,000 (3). This means that lifetime medical costs for the residents diagnosed with HIV in 2013 could exceed .

This report highlights four policies that reflect recent scientific advances (6) in HIV prevention and medical care that can reduce new HIV infections and related illnesses and deaths:

• Facilitating state Medicaid reimbursement for HIV screening (7–9)
• Making state HIV testing laws compatible with the 2006 CDC and 2013 US Preventive Services Task Force HIV testing recommendations (8–10)
• Reporting all CD4 and all HIV viral load data to the state HIV surveillance program and complete lab reporting to CDC (11)
• Increasing the percentage of HIV-infected persons who have a suppressed viral load (2)

These policies are important state-level tools that further the goals of the 2010 National HIV/AIDS Strategy (2). Another strategy supported by scientific evidence is use of antiretroviral medications by persons with HIV to prevent transmission to uninfected partners (6).

Motor vehicle crashes are a leading cause of death in the United States for people aged 1–54 years (1).

In 2013, motor vehicle crashes killed more than 32,700 people in the United States and injured more than 2.3 million (1,2).

In 2013 alone, occupants in motor vehicle traffic crashes cost Americans nearly $56 billion in medical care and productivity losses (3).

The following policies are recommended by the Community Preventive Services Task Force and the National Highway Traffic Safety Administration because scientific studies support their effectiveness in preventing or reducing crash-related injuries and deaths (9–23):

• Implementing primary enforcement seat belt laws that cover occupants in all seating positions
• Mandating the use of car seats and booster seats for motor vehicle passengers through at least age 8 years
• Implementing comprehensive graduated driver licensing (GDL) systems, which help new drivers gain experience under low-risk conditions by granting driving privileges in stages. Research shows that more comprehensive GDL systems prevent more crashes and deaths than less comprehensive GDL systems (12–19). Components of comprehensive GDL systems include
• A minimum age of 16 years for learner’s permits
• A mandatory holding period of at least 12 months for learner’s permits
• Nighttime driving restrictions between 10:00 pm and 5:00 am (or longer) for intermediate or provisional license holders
• A limit of zero or one young passengers who can ride with intermediate or provisional license holders without adult supervision
• A minimum age of 18 years for unrestricted licensure
• Requiring the use of ignition interlock devices for everyone convicted of alcohol-impaired driving

Other strategies recommended by scientific evidence for preventing motor vehicle injuries include enhanced seat belt enforcement campaigns (9,12), 0.08% blood alcohol concentration laws (24), minimum legal drinking age laws (12,24), publicized sobriety checkpoint programs (12,24,25), alcohol-impaired driving mass media campaigns (12,26), increased alcohol taxes (27), car and booster seat distribution plus education campaigns (10), and community-wide car seat and booster seat information and enhanced enforcement campaigns (10).

Poor diet and physical inactivity contribute to many serious and costly health conditions, including obesity, heart disease, type II 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 2011–2014, approximately 17% of children and adolescents and 36% of adults were obese, according to data from the National Health and Nutrition Examination Survey (5).

US direct medical costs associated with adult obesity were estimated to be as high as $147 billion in 2008 (6).

This report focuses on four 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 and/or evidence from scientific studies that the policies and practices can improve diet, increase breastfeeding, increase physical activity, or reduce obesity (10–15). These policies and practices are

• Limiting the availability of less nutritious foods and beverages in schools
• Implementing nutrition standards for foods and beverages sold on government property
• Including obesity prevention standards in state regulations of licensed childcare facilities
• 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 are supported by scientific evidence or expert judgment (11–18). Examples include requiring daily physical education in schools (14), designing communities to support physical activity (16), and improving the availability and promotion of healthier foods in the retail environment (11).

Opioid pain relievers, such as oxycodone, hydrocodone, fentanyl, and hydromorphone, are responsible for three-fourths of all prescription drug overdose deaths and caused more than 16,200 deaths in the United States in 2013 (1). Nationally, deaths involving opioids have quadrupled since 1999 (1).

The sharp rise in prescription 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).

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 10 times that of the state with the lowest rate. ’s drug overdose death rate for 2013 (per 100,000 population) the national rate (13.8 per 100,000 population) (1).

The epidemic of prescription drug overdose imposes a major financial toll nationally and at the state level. The societal costs of prescription opioid abuse were estimated to exceed $55 billion in 2007, including workplace, healthcare, and criminal justice expenses (3). Prescription drug overdose also burdens state Medicaid programs, with prescription opioid abuse costing state Medicaid programs an estimated $8 billion (3).

CDC and other agencies continue to identify and evaluate interventions to reduce prescription opioid overdose deaths. This report focuses on two key policies concerning state prescription drug monitoring programs (PDMPs), electronic systems that track the dispensing of controlled substances to patients. The following policies are supported by emerging evidence, expert consensus, and extensive review of the primary drivers of the epidemic (5–7):

• Requiring timely data submission to the PDMP
• Requiring universal PDMP use by prescribers

These policies are especially promising but are not the only interventions needed to address this epidemic. Rather, they should be seen as key pieces in a much larger, multisector approach to preventing prescription drug abuse and overdose. Other important PDMP practices for states to consider include ensuring that their PDMP 1) is easy to use and access (e.g., by allowing delegates of the provider to access the system); 2) can be linked to electronic health records for point-of-care decision making by providers; 3) is accessible to public health agencies for tracking trends; and 4) has the capacity to proactively notify users of high-risk behaviors (5). Also, the Department of Health and Human Services outlines three priority areas to advance a comprehensive approach to reversing the epidemic: improving opioid prescribing practices, expanding use and distribution of naloxone, and expanding medication-assisted treatment to reduce opioid use disorders and overdose (6).

In 2014, about 252,000 women under age 20 gave birth; 99% (about 249,000) of these births were among girls aged 15–19 years of age (1). In 2014 in , teen girls aged 15–19 years gave birth (2).

Teen mothers are more likely to experience negative social outcomes, including lower school completion rates 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 during their teen years (3,4).

The annual costs of teen childbearing in 2010 were $9.4 billion in the United States (3,4) and in (5).

This report highlights the status of a key policy that states can use to reduce teen pregnancy: increasing access to contraceptive counseling and services by expanding the age and income eligibility levels for Medicaid coverage of family planning services to increase teens’ access to healthcare services, including contraception and other preventive services.

Prior to the Affordable Care Act (ACA), women qualified for full Medicaid coverage only if their incomes were very low and they belonged to one of Medicaid’s categories of eligibility—parent, senior, or disabled. Pregnant women were eligible for prenatal, delivery, and newborn care at a somewhat higher income level but generally lost coverage soon after delivery. Since the 1990s, many states have broadened Medicaid eligibility for family planning services and supplies for people who were not otherwise eligible for Medicaid (7). Many states offered family planning services to women at higher income levels through waivers applied for and granted by the Centers for Medicare and Medicaid Services (CMS). The ACA included an option for states to expand full Medicaid services to individuals based on income eligibility alone. Another ACA provision allowed states to make coverage for family planning services available at the same income level as for pregnancy care through a state plan amendment (8–13). Thus, states have three options to provide Medicaid coverage for family planning services to low-income individuals. Income-based Medicaid expansions have been shown to be effective in reducing births among teens aged 15–19 years (8–11).

States can expand access to their Medicaid family planning program and reduce teen births by 1) extending coverage to teens under age 18 years and 2) setting the income eligibility level for family planning coverage to at least the same income level required for pregnancy care coverage (this level varies by state). Expanding Medicaid coverage for family planning services is consistent with US Department of Health and Human Services recommendations to support reproductive and sexual health services (14) and with Healthy People 2020  family planning objectives (15). Other strategies for reducing teen pregnancy that are supported by scientific evidence include providing sexual health education for adolescents, using positive youth development approaches, and improving parent-child communication and parental monitoring of youth behavior (16–19).