Prevention Measure Definitions

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Lack of health insurance among adults aged 18–64 years
Population Adults aged 18 –64 years
Model-based measure A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults aged 18–64 who report having no current health insurance coverage. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.
Measure Type Prevalence (crude and age-adjusted)
Time Period of Case Definition Current
Summary In 2021, approximately 13.5% of U.S. adults aged 18–64 years did not have health insurance (1). People with low income and some racial and ethnic minorities are more likely not to have insurance (1). Without health insurance, people are less likely to receive preventive services which puts them at increased risk for developing diseases or disabilities and death (2,3). Federal social assistance programs that provide health coverage to families with lower incomes can help improve health insurance coverage (4).
Notes Since individual persons might move in and out of health insurance, this indicator might underestimate the prevalence of a lack of health insurance.
Related Objectives or Recommendations Healthy People 2030 objective: AHS‑01. Increase the proportion of people with health insurance.
  1. Cohen RA, Cha AE, Terlizzi EP, Martinez ME. Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2021. National Center for Health Statistics; 2022. https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202205.pdf.
  2. Fox JB, Shaw FE. Relationship of income and health care coverage to receipt of recommended clinical preventive services by adults – United States, 2011-2012. MMWR Morb Mortal Wkly Rep. 2014;63(31):666-70.
  3. Borksy A, Zhan C, Miller T, Ngo-Metzger Q, Bierman AS, Meyers D. Few americans receive all high-priority, appropriate clinical preventive services. Health Affairs. 2018; 37(6). doi: https://doi.org/10.1377/hlthaff.2017.1248.
  4. Healthy People 2030. Access to Health Services. U.S. Department of Health and Human Services. Accessed April 5, 2023. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-health-services.
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Routine checkup within the past year among adults
Population All Adults
Model-based measure A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults who report having been to a doctor for a routine checkup (e.g., a general physical exam, not an exam for a specific injury, illness, or condition) in the previous year. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.
Measure Type Prevalence (crude and age-adjusted)
Time Period of Case Definition Previous year
Summary In 2021, three-fourths of U.S. adults (73.6%) visited a doctor for a routine checkup in the past year (1). Uninsured adults, adults with lower incomes, and some racial and ethnic groups are less likely to get a routine checkup (1,2) Regular checkups includes receiving recommended vaccinations, screenings, and blood tests in addition to checking blood pressure, weight, and cholesterol with the purpose of maintaining wellness (3,4) Obtaining regular checkups can reduce morbidity and premature mortality from chronic conditions (e.g., cardiovascular disease, cancer, chronic lower respiratory diseases, and diabetes) (3,4) Federal and state programs that provide health coverage to adults with lower incomes can help improve routine checkups among adults (2).
Notes None
Related Objectives or Recommendations None
  1. BRFSS Web Enabled Tool. Centers for Disease Control and Prevention. Accessed April 5, 2023. https://nccd.cdc.gov/weat/#/analysis.
  2. Ayanian JZ, Weissman JS, Schneider EC, Ginsburg JA, Zaslavsky AM. Unmet health needs of uninsured adults in the United States. JAMA. 2000;284(16):2061–2069. doi: https://doi.org/10.1001/jama.284.16.2061.
  3. Gamble S, Mawokomatanda T, Xu F, Chowdhury PP, Pierannunzi C, Flegel D. Surveillance for certain health behaviors and conditions among states and selected local areas – Behavioral Risk Factor Surveillance System, United States, 2013 and 2014. MMWR Surveill Summ. 2017;66(16):1-144. Doi: https://doi.org/10.15585/mmwr.ss6616a1.
  4. Jin J. Routine checkups for adults. JAMA. 2022;327(14):1410. doi: https://doi.org/10.1001/jama.2022.1775.
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Visited dentist or dental clinic in the past year among adults
Population All Adults
Model-based measure A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults who report having been to the dentist or dental clinic in the past year. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.
Measure Type Prevalence (crude and age-adjusted)
Time Period of Case Definition In the past year
Summary Routine dental visits allow for oral health education, preventive care services, and early detection and treatment of oral diseases such as dental caries (cavities), periodontal (gum) disease, and oral cancer (1, 2). Estimates from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) indicated that 64.8% of adults aged ≥18 years reported having a past-year dental visit (3). In 2014, adults reported financial barriers to accessing dental care (12.8%) three times more frequently than children and adolescents (4.3%) (4). Studies found lower dental use among adults with lower income, less education, no health care coverage, and adults who were non-Hispanic Black, smoked, had dental or other chronic diseases, or lived in rural areas (1-2, 5-6). Increasing use of the oral health care system is a Healthy People 2030 Leading Health Indicator, representing a high-priority objective to reduce health disparities and improve the oral health of the nation (7).
Notes This indicator does not convey reasons for dental visits and is self-reported. Questions are part of the rotating core, currently collected in even years.
Related Objectives or Recommendations Healthy People 2030 objective: OH-08. Increase use of oral health care system.
  1. National Institutes of Health. Oral Health in America: Advances and Challenges. US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research; 2021. https://www.ncbi.nlm.nih.gov/pubmed/35020293.
  2. Institute of Medicine and National Research Council. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Institute of Medicine and National Research Council; 2011. https://nap.nationalacademies.org/catalog/13116/improving-access-to-oral-health-care-for-vulnerable-and-underserved-populations.
  3. Centers for Disease Control and Prevention, Division of Oral Health. Oral Health Data. Centers for Disease Control and Prevention; 2020. https://www.cdc.gov/oralhealthdata/.
  4. Vujicic M, Buchmueller T, Klein R. Dental care presents the highest level of financial barriers, compared to other types of health care services. Health Aff (Millwood). 2016;35(12):2176-82.
  5. Patel N, Fils-Aime R, Li CH, Lin M, Robison V. Prevalence of past-year dental visit among US adults aged 50 years or older, with selected chronic diseases, 2018. Prev Chronic Dis. 2021;18:E40.
  6. Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA, Genco RJ. Periodontitis in US adults: national health and nutrition examination survey 2009-2014. J Am Dent Assoc. 2018;149(7):576-88 e6.
  7. US Department of Health and Human Services. Healthy People 2030, Leading Health Indicators 2020. US Department of Health and Human Services; 2020. https://health.gov/healthypeople/objectives-and-data/leading-health-indicators.
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Taking medicine to control high blood pressure among adults with high blood pressure
Population All Adults
Model-based measure A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults with high blood pressure who reported currently taking medicine for high blood pressure. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.
Measure Type Prevalence (crude and age-adjusted)
Time Period of Case Definition Current
Summary According to the American College of Cardiology/American Heart Association (ACC/AHA) 2017 hypertension guideline, hypertension is defined as a blood pressure ≥130/≥80 mmHg (1). An estimated 116 million American adults (47.3%) have hypertension—nearly 1 in 2 adults 18 years of age and older (2). An estimated 1 in 5 adults with hypertension are recommended lifestyle modification only—approximately 24.3 million US adults (2). The rest, 4 out of 5 adults with hypertension, are recommended prescription medication with lifestyle modification—approximately 91.7 million US adults (2). However, only about half (49.6%) of all those with hypertension were on anti-hypertensive medication (based on 2015—2018 NHANES data) and only 20.6% had a controlled blood pressure (2). Many adults who are recommended to take medication may need it to be prescribed and/or start taking it—including 34.1 million US adults, of whom, two-thirds (23.2 million) have a blood pressure of 140/90 mm Hg or higher (2). Additionally, many adults already treated with medication may need the treatment modified to achieve control—33.6 million US adults using medication have a blood pressure of 130/80 mm Hg or higher, of whom, over half (3 in 5) (20.0 million) have a blood pressure of 140/90 mm Hg or higher. (2) On average, a 5 mm Hg reduction of systolic blood pressure reduced the risk of a major cardiovascular event by about 10%; the corresponding proportional risk reductions for stroke, heart failure, ischemic heart disease, and cardiovascular death were 13%, 13%, 8%, and 5%, respectively (3).
Notes This measure does not include people with hypertension who have their blood pressure successfully controlled through lifestyle changes and without medication. It only measures those who recall being told they have high blood pressure and not those who have not been told they have hypertension. Additionally, reports are not validated against actual blood pressure measurements or medical records. Survey questions are part of the BRFSS Rotating Core (odd years).
Related Objectives or Recommendations Healthy People 2030 objective: HDS-05. Increase control of high blood pressure in adults.
    1. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond. Circulation. 2010;121(4):586–613. doi: https://doi.org/10.1161/circulationaha.109.192703.
    2. Division for Heart Disease and Stroke Prevention. Estimated Hypertension Prevalence, Treatment, and Control Among U.S. Adults. Centers for Disease Control and Prevention; Accessed February 24, 2022. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html.
    3. The Blood Pressure Lowering Treatment Trialists’ Collaboration. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet. 2021;397(10285):1625–1636. doi: https://doi.org/10.1016/s0140-6736(21)00590-0.
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Cholesterol screening among adults
Population All Adults
Model-based measure A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among respondents aged ≥18 years who report having their cholesterol checked within the previous 5 years. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.
Measure Type Prevalence (crude and age-adjusted)
Time Period of Case Definition Previous 5 years
Summary In 2021 among U.S. states, District of Columbia, and Territorials, a median of 14. 1% of adults aged ≥18 years still have not had their cholesterol checked within the past 5 years or never had their cholesterol checked (1). In 2017–2020, about 10% of adults ages 20 and older had total cholesterol above 240 mg/dL, and about 17% had high-density lipoprotein (HDL, or “good”) cholesterol levels below 40 mg/dL (2). Slightly more than half of U.S. adults (54.5%, or 47 million people) who could benefit from cholesterol medicine are currently taking it (3). High cholesterol commonly has no symptoms, so many people don’t know that their cholesterol is too high. Having high blood cholesterol raises the risk for heart disease, the leading cause of death, and for stroke, the fifth leading cause of death in 2021. Lifestyle changes and medications can reduce cholesterol and prevent heart disease among people with elevated serum cholesterol (4).
Notes The validity and reliability of this measure can be low because patients might not be aware of the specific tests conducted on their blood samples collected in clinical settings.
Related Objectives or Recommendations Healthy People 2030 objective HDS-6: Reduce cholesterol in adults.
  1. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. Accessed Jun 05, 2024. URL: https://www.cdc.gov/brfss/brfssprevalence/.
  2. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics—2023 update: a report from the American Heart Association. Circulation. 2023;147(8):e93–e621. doi: https://doi.org/10.1161/CIR.0000000000001123.
  3. Wall HK, Ritchey MD, Gillespie C, Omura JD, Jamal A, George MG. Vital Signs: Prevalence of key cardiovascular disease risk factors for Million Hearts 2022—United States, 2011–2016. MMWR Morb Mortal Wkly Rep. 2018;67(35):983–991.
  4. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2019;139(25):e1082–e1143. doi: https://doi.org/10.1161/cir.0000000000000625.
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Mammography use among women aged 50-74 years
Population Females aged 50–74 years
Model-based measure A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among females aged 50–74 years who report having had a mammogram within the previous 2 years. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.
Measure Type Prevalence (crude and age-adjusted)
Time Period of Case Definition Previous 2 years
Summary Female breast cancer is a leading cause of cancer death and in 2021, nearly 43,000 females died from the disease (1). Screening can detect breast cancer early when treatment is more likely to be effective. The U.S. Preventive Services Task Force recommends that women who are 50 to 74 years old and are at average risk for breast cancer get a mammogram every two years. Women who are 40 to 49 years old should talk to their doctor or other health care provider about when to start and how often to get a mammogram (2).
Notes Recommendations for mammography screening are not always consistent among national groups. The questions are part of the BRFSS Rotating Core (even years).
Related Objectives or Recommendations Healthy People 2030 objective: C-05. Increase the proportion of females who get screened for breast cancer.
  1. Centers for Disease Control and Prevention. CDC WONDER. Underlying Cause of Death, 2018-2021, Single Race. https://wonder.cdc.gov/ucd-icd10-expanded.html.
  2. Siu AL, US Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016. doi: https://doi.org/10.7326/M15-2886.
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Cervical cancer screening among women aged 21–65 years
Not available in the 2024 release.
Population Females aged 21–65 years
Model-based measure A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among female respondents aged 21–65 years who do not report having had a hysterectomy and who report having had a Papanicolaou (Pap) test within the previous 3 years AND, female respondents 30–65, who do not report having had a human papilloma virus (HPV) test alone or in combination with a HPV test (also known as a co-test) within the previous 5 years. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.
Measure Type Prevalence (crude and age-adjusted)
Time Period of Case Definition For age 21–65: Previous 3 years for Pap test alone
For age 30–65 only: Previous 5 years for HPV test alone or combination of Pap test (co-test).
Summary In 2021, more than 4,300 females died from cervical cancer (1). Screening can help prevent cervical cancer or find it early, when treatment is more likely to be effective. The U.S. Preventive Services Task Force recommends for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) (2).
Notes In August 2018, the U.S. Preventive Services Task Force changed its cervical cancer screening recommendation to include another type of screening (hrHPV testing alone every 5 years). Estimates of people getting cervical cancer screening are not comparable to previous years. Recommendations for cervical cancer screening are not always consistent among national groups. The questions are part of the BRFSS Rotating Core (even years).
Related Objectives or Recommendations Healthy People 2030 objective: C-09. Increase the proportion of females who get screened for cervical cancer.
  1. Centers for Disease Control and Prevention. CDC WONDER. Underlying Cause of Death, 2018-2021, Single Race. https://wonder.cdc.gov/ucd-icd10-expanded.html.
  2. US Preventive Services Task Force. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(7):674–686. doi: https://doi.org/10.1001/jama.2018.10897.
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Colorectal cancer screening among adults aged 45–75 years
Population: Adults aged 45–75 years
Model-based measure A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults aged 45–75 years who report having had a fecal occult blood test (FOBT) within the previous year; a FIT-DNA test within the previous 3 years; a sigmoidoscopy within the previous 5 years; a sigmoidoscopy within the previous 10 years with a FIT in the past year; a colonoscopy within the previous 10 years; or a CT colonography (virtual colonoscopy) within the previous 5 years. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.
Measure Type Prevalence (crude and age-adjusted)
Time Period of Case Definition Previous year for FOBT alone; previous 3 years for FIT-DNA test alone; previous 5 years for sigmoidoscopy alone; 10 years for a sigmoidoscopy combined with a FIT in the past year; 10 years for a colonoscopy alone; every 5 years for CT colonography (virtual colonoscopy) alone.
Summary Colorectal cancer is a leading cause of cancer incidence and death (1). In 2021, more than 142,000 people were diagnosed with and 52,000 people died from the disease (1). Screening can prevent colorectal cancer by detecting and removing precancerous polyps and can detect cancer early when treatment is more likely to be effective. The U.S. Preventive Services Task Force recommends that adults aged 45 to 75 be screened for colorectal cancer (2). There are different time intervals and several types of tests for colorectal cancer screening, including stool tests (including one that detects altered DNA in the stool), flexible sigmoidoscopy, colonoscopy, and computed tomography (CT) colonoscopy (or virtual colonoscopy) (2).
Notes In May 2021, the U.S. Preventive Services Task Force changed its colorectal cancer screening recommendation. The age at which adults at average risk of getting colorectal cancer were recommended to begin screening was lowered from 50 to 45. The BRFSS 2020 colorectal cancer screening questions changed to include five test types (FIT, sigmoidoscopy, colonoscopy, FIT-DNA, and CT colonography) compared to three types (FIT, sigmoidoscopy, and colonoscopy) included previously. Estimates of people getting colorectal cancer screening are not comparable to previous years. Recommendations for colorectal cancer screening are not always consistent among national groups. The questions are part of the BRFSS Rotating Core (even years).
Related Objectives or Recommendations Healthy People 2030 objective: C-07. Increase the proportion of adults who get screened for colorectal cancer.
  1. Centers for Disease Control and Prevention. CDC WONDER. Underlying Cause of Death, 2018-2021, Single Race. https://wonder.cdc.gov/ucd-icd10-expanded.html.
  2. US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965–1977. doi: https://doi.org/10.1001/jama.2021.6238.
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Older adults aged ≥65 years who are up to date on a core set of clinical preventive services by sex
Discontinued in the 2024 release.
Population Adults aged 65 years and older
Model-based measure A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults aged 65 years and older by sex as follows:

Women: Number of women aged ≥65 years reporting having received all of the following: an influenza vaccination in the past year; a pneumococcal vaccination (PPV) ever; either a fecal occult blood test (FOBT/FIT) within the previous year, a FIT-DNA test within the previous 3 years, a sigmoidoscopy within the previous 5 years, a sigmoidoscopy within the previous 10 years with a FOBT in the previous year, a colonoscopy within the previous 10 years, or a CT colonography (virtual colonoscopy) within the previous 5 years; and a mammogram in the past 2 years.

Men: Number of men aged ≥65 years reporting having received all of the following: an influenza vaccination in the past year; a pneumococcal vaccination (PPV) ever; and either a fecal occult blood test (FOBT/FIT) within the previous year, a FIT-DNA test within the previous 3 years, a sigmoidoscopy within the previous 5 years, a sigmoidoscopy within the previous 10 years with a FOBT in the previous year, a colonoscopy within the previous 10 years, or a CT colonography (virtual colonoscopy) within the previous 5 years.

The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.
Measure Type Prevalence (crude and age-adjusted)
Time Period of Case Definition Calendar year
Summary By 2060, almost a quarter of the U.S. population will be age 65 or older (1). Older adults are at higher risk for chronic health problems like diabetes, osteoporosis, and Alzheimer’s disease (2). In 2018, 64% of adults aged ≥65 years had multiple chronic conditions (3) (i.e., two or more chronic conditions) (4). Older adults are at high risk for developing chronic illnesses and related disabilities. National experts agree on a set of recommended clinical preventive services for adults aged ≥65 years that can help detect many of these diseases and either delay their onset or identify them early in more treatable stages. These services include influenza vaccination, pneumococcal vaccination, colorectal cancer screening, and mammography screening for women (5). Colorectal cancer screening has been shown to significantly reduce mortality from the disease (6).
Notes The measure is limited to a select set of clinical preventive services by age and sex for which data are available in the Behavioral Risk Factor Surveillance System (BRFSS). Data on all services in the core set are not available every year given the rotating core questions on BRFSS. The indicator should not be assumed to cover all recommended clinical preventive services for this age group group and some services are recommended for adults at different age groups or with certain age limits. Thus, the measure may underestimate the prevalence for some preventive services such as colonoscopy and mammography use.
Related Objectives or Recommendations None
  1. Mather, M., Jacobsen, L.A., Pollard, K.M.  Aging in the United States. Population Bulletin 2015;70:2. [PDF file]. Retrieved from https://www.prb.org/wp-content/uploads/2016/01/aging-us-population-bulletin-1.pdf.
  2. US Department of Health and Human Services. Healthy People 2030. Atlanta, GA: US Department of Health and Human Services, CDC.
  3. Boersma P, Black LI, Ward BW. Prevalence of multiple chronic conditions among US adults, 2018. Prev Chronic Dis 2020;17:200130. http://dx.doi.org/10.5888/pcd17.200130
  4. US Department of Health and Human Services. Multiple chronic conditions—a strategic framework: optimum health and quality of life for individuals with multiple chronic conditions. Washington, DC: US Department of Health and Human Services; 2010. https://www.hhs.gov/sites/default/files/ash/initiatives/mcc/mcc_framework.pdf
  5. US Preventive Services Task Force. USPSTF A and B recommendations: 2011. Rockville, MD: US Preventive Services Task Force; 2014.
  6. Whitlock EP, Lin JS, Liles E, Bell TL, et al. Screening for colorectal cancer: a targeted systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2008;149:638–58.
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