Program Implementation Measures (I)
I-1 Align budget with program goals and intended outcomes.	I-1.1 Fiscal resources allocated to address Steps focus areas and key health outcomes
I-2 Ensure community objectives and activities are supportive of state plans but do not duplicate interventions or activities.	I-2.1 Objectives and activities linked to the work of state programs to prevent and controlobesity, diabetes, asthma, or associated risk factors
I-3 Expand available resources by engaging in public-private ventures and securing foundation grants, other public funding, and in-kind contributions.	I-3.1 Resources secured to supplement funds received via the Steps Program (eg, nonfederal grants and in-kind support)
I-4 Participate in coordinated monitoring and evaluation activities, including data collection and reporting on common performance measures and planning and implementing national evaluation activities.	I-4.1 Submission of data on core performance measures according to established schedule I-4.2 Participation in national-level evaluation tasks (eg, sending feedback to Steps Program Office on draft documents, task-specific workgroups, conference calls)
I-5 Expand existing surveillance mechanisms to collect representative Behavioral Risk Factor Surveillance System (BRFSS) and Youth Risk Behavior Surveillance System (YRBSS) data.	I-5.1 Appropriate and representative data collected via BRFSS I-5.2 Appropriate and representative data collected via YRBSS
I-6 Use multiple, evidence-based public health strategies.	I-6.1 Documented evidence for activities related to all the diseases and risk factors of interest to the Steps Program
I-7 Improve integration of program components.	I-7.1 Implementation of 1) interventions that address at least 2 diseases or risk factors and 2) at least 1 intervention at each key sector I-7.2 Implementation of evidence-based interventions that address access to health care, quality of health care, and use of health care I-7.3 Implementation of evidence-based interventions across the socioecological model (ie, individual, interpersonal, organizational, community, and public policy) I-7.4 Partnership with the YMCA of the USA, or its local affiliate, to improve access to places for physical activity I-7.5 Composition and function of Steps Leadership Team (eg, inclusion of nontraditional agencies or partners, state or local categorical programs, key community-based organizations, or representatives of the health care sector) I-7.6 Composition and function of Steps State-Community Management Team (eg, inclusion of nontraditional agencies or partners, state or local categorical programs, key community-based organizations, or representatives of the health care sector) I-7.7 Provision of technical assistance to state-coordinated Steps communities (state only; eg, trainings and evaluation assistance)
I-8 Document that intended populations participate in Steps communities' activities and interventions.	I-8.1 Reach (eg, a tobacco intervention was implemented in an intervention area to serve specific populations identified in the community action plan)
Outcome Measures (O)
O-1 Increased knowledge and awareness about healthy behaviors such as healthful eating, physical activity, and avoiding tobacco use.	O-1.1 Community-specific indicators (eg, knowledge of recommended fruit and vegetable consumption among youth)
O-2 Increased knowledge about getting appropriate preventive screenings.	O-2.1 Community-specific indicators (eg, knowledge of recommended screenings for people with diabetes)
O-3 Increased physical activity and healthful eating for children and adults.	O-3.1 Fruit and vegetable consumption among adults aged 18 or older O-3.2 Fruit and vegetable consumption among youth O-3.3 Recommended physical activity among adults aged 18 or older O-3.4 Recommended physical activity among youth O-3.5 Television viewing among youth
O-4 Increased access to and quality of clinical services for diabetes, asthma, and tobacco use cessation.	O-4.1 Health care access O-4.2 Foot examination for adults aged 18 or older with diabetes O-4.3 Dilated eye examination for adults aged 18 or older with diabetes O-4.4 Glycosylated hemoglobin measurement at least twice a year for adults aged 18 or older with diabetes
O-5 Increased identification of people with prediabetes and diabetes.	O-5.1 Reduce the overall rate of diabetes that is clinically diagnosed among adults O-5.2 Reduce the overall rate of diabetes that is clinically diagnosed among youth
O-6 Improved self-management of diabetes and asthma.	O-6.1 Self blood-glucose monitoring among adults aged 18 or older with diabetes O-6.2 Self foot exam for adults aged 18 or older with diabetesO-6.3 Symptom-free days among adults aged 18 or older with asthma
O-7 Measurable improvements in healthful eating, physical activity, and tobacco use. Indicators include O-3.1–O-3.5, in addition to those at right.	O-7.1 Tobacco-use cessation attempts by adult smokers O-7.2 Tobacco-use cessation attempts by adolescent smokers O-7.3 Cigarette smoking among adults aged 18 or older O-7.4 Cigarette smoking among youth
O-8 Slowed upward trend of overweight and obesity in Steps communities.	O-8.1 Prevalence of overweight or obesity among adults aged 18 or older O-8.2 Obesity prevalence among adults aged 18 or older O-8.3 Overweight prevalence among youth
O-9 Reduced hospitalizations due to diabetes complications and asthma exacerbations.	O-9.1 Hospitalization with asthma among adults aged 18 or older O-9.2 Hospitalization with asthma among youth O-9.3 Hospitalization with diabetes among adults aged 18 or older
O-10 Improved health-related quality of life.	O-10.1 Mean number of healthy days among adults aged 18 or older