Marshall Kreuter, Director of the Division of Chronic Disease Control and Community Intervention and his staff adapted and incorporated PRECEDE within a model planning process offered, with federal technical assistance, to state and local health departments to plan and evaluate health promotion programs (with their coalitions). The CDC model was called "PATCH", for Planned Approach to Community Health. The relevance of this initiative to the application of PRECEDE, and the inspiration for some of the extensions of the (PATCH) model to incorporate PROCEED dimensions was detailed in a special issue of the Journal of Health Education in 1992. In 1991, "PROCEED" was added to the framework in consideration of the growing recognition of the expansion of health education to encompass policy, regulatory and related ecological/environmental factors, in determining health and health behaviors. As health-related behaviors, such as smoking and alcohol abuse, increased or became more resistant to change, so did the recognition that these behaviors are influenced by factors such as the media, politics, and businesses, which are outside the direct control of the individuals. Hence more "ecological" methods were needed to identify and influence these environmental and social determinants of health behaviors. With the emergence of and rapid growth in the field of genetics, the PRECEDE–PROCEED model was revised, in 2005, to include and address the growing knowledge in this field. The PRECEDE–PROCEED planning model consists of four planning phases, one implementation phase, and 3 evaluation phases. The first stage in the program planning phase deals with identifying and evaluating the social problems that affect the quality of life of a population of interest. Social assessment is the "application, through broad participation, of multiple sources of information, both objective and subjective, designed to expand the mutual understanding of people regarding their aspirations for the common good". During this stage, the program planners try to gain an understanding of the social problems that affect the quality of life of the community and its members, their strengths, weaknesses, and resources; and their readiness to change. This is done through various activities such as developing a planning committee, holding community forums, and conducting focus groups, surveys, and/or interviews. These activities will engage the beneficiaries in the planning process and planners will be able to see the issues just as the community sees them. "Epidemiological diagnosis" deals with determining and focusing on specific health issue(s) of the community, and the behavioral and environmental factors related to prioritized health needs of the community. Based on these priorities, achievable program goals and objectives for the program being developed are established.