Ten years ago, nearly one-quarter of Maine adults smoked.

The state wanted to get that rate down to 19 percent. From one in four people smoking to one in five — it seemed like a stretch.

But changes took place. The state’s cigarette tax more than doubled. A Maine Tobacco HelpLine began assisting would-be quitters so they didn’t have to go it alone. And state laws were passed that eventually prohibited smoking in almost every public space — and some private ones, too.

That goal of 19 percent? Surpassed. Only 17 percent of Maine adults now smoke, according to the latest available figures.

It is a health success story, one of about 18 goals that were met as part of the state’s decade-long Healthy Maine 2010 initiative, a Maine Center for Disease Control effort to get people healthier.

Over the past 10 years or so, Maine has seen an increase in the use of sealants on children’s teeth. More people are wearing seat belts, more women in their 40s are getting mammograms and clinical breast exams, and cases of coronary heart disease have dropped.

But for every health goal met, the state hasn’t met two others. The number of adults with health insurance has changed little in the past 10 years and isn’t close to the state’s goal of 100 percent. Fewer Mainers are protecting themselves against skin cancer. There are more substantiated child abuse and neglect cases. Homicides are up. Obesity is a major problem.

In 2000, Healthy Maine 2010 set out to measure and improve the health of Mainers in scores of areas. Ten years later, information on 72 of those areas has been updated. The result: 60 percent didn’t meet Healthy Maine 2010’s targets. About 23 percent did. The rest were mixed, with success among some populations but not others.

Public health officials recognize that Healthy Maine 2010’s results are both disappointing and a cause for celebration. But more than that, they see them as a guide for the future.

“I think of it as setting our direction,” said Stephen Sears, acting director of the Maine CDC. “We’re developing a road map.”

And they’re already looking to Healthy Maine 2020.

Goals met

The Maine CDC began Healthy Maine 2010 in part to comply with a federal requirement. With help from Maine medical professionals, public health experts and others, the CDC looked at 10 subject areas, including substance abuse, family planning, injury, mental health and chronic disease, and gathered dozens of baseline health statistics for each.

The idea was to gauge where Maine stood in key health areas, to set goals and to find ways to improve. The information would also be used in writing grants, particularly for federal funds. 

The goals were not meant to be easy.

“You try to put a stretch out there and go for it,” Sears said.

Similar projects had been done, but this one was more robust, with more measures to gauge progress. The Healthy Maine 2010 guide was published in 2002. A federal version — Healthy People 2010 — was published in the early 2000s.

Although state officials tried to find measures that would consistently offer updated information, through surveys, vital statistics, medical registries or other resources, some sources ran dry after a few years. For mental health measures, there’s no new information available.

Data was consistently updated for 72 measures. The most recent is from 2008 and 2009.

With that information, the CDC recently released an update of Healthy Maine 2010.

Among the goals met:

– More than 80 percent of adults have had their cholesterol checked in the past five years.

– More than 25,000 homes were tested for radon between 2001 and 2009, and more than 4,500 were mitigated.

– More than 92 percent of adults use seat belts.

– Less than 28 percent of teens got in fights in the past 12 months.

– More than 58 percent of sexually active teens use condoms.

– More than 75 percent of women in their 40s are getting mammograms or clinical breast exams.

Sears said he was particularly proud of the drop in smoking by adults. He called it “impressive,” and credited state efforts to curb smoking. He was also pleased by teen pregnancy rates, which dropped by 38 percent to surpass the goal.

Although he believes the goals are important, Sears said he also considers trends when looking at Healthy Maine 2010’s results. He pointed out that some measures improved, even though they didn’t meet targets.

The percentage of adults who ate five servings or more of fruits and vegetables a day rose from 24.5 percent in 2000 to 28 percent in 2009, just shy of the 30 percent goal, but an improvement. The percentage of children with health insurance rose from 89.6 percent in 2008 to 96 percent in 2009, short of the 100 percent target. The percentage of teens who smoked their first cigarette before age 13 dropped from 22.5 percent in 2001 to 12.1 percent in 2009, barely missing the 12 percent target.

“If it really looks like it’s trending upward, even though we may not have achieved the goal, we are clearly going in the right direction,” Sears said. “We may not stop looking at it, but we may not put as much effort into it because we’re moving in the right way.”

But not all are. 

Goals unmet

Among the goals not met:

– Only 62.5 percent of women in their 50s are getting mammograms or clinical breast exams, a 3 percent increase in 10 years and still short of the 70 percent goal.

– Just over 86 percent of women got pap smears in the past three years, only a slight uptick in the past decade and still short of the 92 percent goal.

– Fewer Mainers overall — and fewer women, specifically — are protecting themselves from skin cancer. Only 1.3 percent more men are protecting themselves. 

– Nearly half of Mainers live in counties that exceed state recommended ozone levels, a rate that’s gone up and down since 1998 but hasn’t come close to the target of zero. 

– Fewer pregnancies are planned.

– More teens are sexually active.

– Fewer adults are getting flu shots.

–  Except for the chicken pox shot, which doubled in use, individual vaccination rates for very young children have remained the same or gotten worse.

Although Sears said he prefers to think of Healthy Maine 2010’s targets as something to continuously strive for, he was disappointed that the state hadn’t made better progress in certain areas.

Obesity is one.

In 2009, 12.5 percent of teenagers were obese, up from 10.4 percent in 2001 — moving Maine further from its goal of 5 percent. Just over 26 percent of adults are obese, a nearly 10 percent increase in a decade and far from the 15 percent target. Nearly 38 percent of Maine adults are overweight, a percentage virtually unchanged in a decade and one that did not meet the state’s goal of 30 percent.

“I think we’ve done a lot of good things (to fight obesity), but we’re not seeing change. And that has such profound long-term implications for the long-term public health, everything from increased diabetes rates to increased mortality rates. I think in the next decade, we’re going to have to be looking at those pretty significantly,” he said.  

And while adult smoking rates have steadily declined, teen smoking is a sudden concern. After years of plummeting rates — from over 28 percent in 1999 to 14 percent in 2007 — numbers suddenly jumped to 18 percent in 2009. 

“We’ve been doing so well for so long; that’s of great concern,” Sears said.

It also bothers the Maine Public Health Association.

“We’re starting to say to ourselves, ‘What are we missing?'” said Amy Olfene, senior policy analyst for the nonprofit group composed of hospitals, public health leaders and others.

The association believes it knows what the state must do to reduce teen smoking once more: Raise the cigarette tax by $1.50 a pack.

“Kids are the most sensitive to price,” Olfene said. “Here in Maine, while all the other states around us have increased their price on cigarettes and tobacco products, we’ve stayed the same since 2005.”  

The group is working with a Bar Harbor legislator to introduce a bill that would do that. If successful, Maine’s cigarette tax would stand at $3.50 a pack.

Obesity, teen smoking and other unmet goals weren’t the only causes of concern among health officials. Even some measures that met Healthy Maine 2010’s targets still nagged at them.

For example, coronary heart disease deaths have plunged in recent years, dropping nearly in half between the late 1990s and 2008. But Mark Lanzieri, a cardiologist with Central Maine Heart Associates, believes the statistic simply masks a continuing problem.

“I think we still see as much coronary disease as we ever did,” he said.

The difference is — with the advent of stents, drugs and implanted defibrillators — people are living longer with it.

“I would encourage people to interpret this as progress, in spite of people not taking care of themselves,” Lanzieri said.

The future

The Maine CDC will use Healthy Maine 2010 as a guide as it makes health policy and funding decisions. Some initiatives will continue. Others may not.

“If there are things we’ve been working on for the last four or five years and we’re not moving the numbers or improving the rates, we have to sort of say, ‘Maybe the strategies we’re using aren’t useful or maybe there’s something else going on that we need to better understand,'” Sears said. “And that’s often the case. There are so many factors that go into some of these indicators, but there are things that can be done to try and improve them.”

It will be up to the new governor’s administration to decide where public health funds go, which initiatives take priority and where public health officials will focus their energy.

Mary Mayhew, former vice president of the Maine Hospital Association and senior policy adviser to Gov. Paul LePage, said Thursday the new administration will use Healthy Maine 2010 as it seeks ways to reduce chronic disease and generally improve the health of Mainers — and with that healthier population, reduce health care spending in Maine. 

“It will be extremely instrumental in understanding the challenges we face in Maine,” she said.

The Maine CDC is beginning work on Healthy Maine 2020. Although it’s still in the planning stage, Sears said the CDC hopes to look more at emergency preparedness — an unusual topic pre-Sept. 11, 2001, when Healthy Maine 2010 was planned — and hopes to gather more information about smaller groups of people within the larger population.

It also plans to keep tabs on the measures that did well in 2010, even though it might seem like a problem has been solved.

“There’s always a tendency to sort of say, ‘Oh, we’ve done really well here,’ and not look at it again,” Sears said. “But you always have to do spot checks to make sure they’re not starting to go up.”

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