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National Oral Health Surveillance System

Data Sources


Analytic considerations for the surveys
(BRFSS, NHANES, NHIS, YRBSS) Estimates for certain population subgroups may be based on small numbers and be subject to relatively large sampling error. When the number of events is small and the probability of such an event is small, considerable caution must be observed in interpreting the conditions (cell size < 50). Data from multiple years may be pooled to obtain adequate sample size.

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BRFSS
The Behavioral Risk Factor Surveillance System is a state-based, ongoing data collection program designed to measure behavioral risk factors in the adult, non-institutionalized population 18 years of age or older. Every month, states select a random sample of adults for a telephone interview. This selection process results in a representative sample for each state so that statistical inferences can be made from the information collected.

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BSS
The Basic Screening Survey (BSS) is a standardized set of surveys designed to collect information on the observed oral health of participants, self-report or observed information on age, gender, race and Hispanic ethnicity, and self-report information on access to care for preschool, school-age, and adult populations. The surveys are cross-sectional and descriptive. In the observed oral health survey, gross dental or oral lesions are recorded by dentists, dental hygienists, or other appropriate health care workers in accordance with state law. The examiner records presence of untreated cavities and urgency of need for treatment for all age groups. In addition, for preschool and school-age children, caries experience (treated and untreated decay) is also recorded. School-age children are also examined for presence of sealants on permanent molars. Edentulism (no natural teeth) is recorded for adults. States may use one or more of the surveys in the BSS to obtain oral health status and dental care access data for monitoring Healthy People 2010 objectives. Training materials are provided with the surveys and technical assistance from ASTDD on sampling and analysis is available to states undertaking these surveys using the standard protocol. BSS was developed by the Association of State and Territorial Dental Directors with technical assistance from CDC.

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CDC Fluoridation Census 1992
The 1992 Fluoridation Census provides information regarding the fluoridation status for each state. States reported each fluoridated public water system and the communities each system served; the type of fluoridation—adjusted or natural (including fluoridated water purchased by non-fluoridating systems); the number of people receiving fluoridated water; the date on which fluoridation started; and the chemical used for fluoridation, if adjusted. CDC. National Center for Prevention Services. Fluoridation Census 1992. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, CDC, 1993. See Fact Sheet on the Fluoridation Census 1992.

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CDC Water Fluoridation Reporting System (WFRS)
WFRS provides state oral health program staff a tool for monitoring the quality of the water fluoridation program in their state. Data provided by water systems is used by state oral health program staff to recognize excellent work in water fluoridation and identify opportunities for continuous improvement in the water fluoridation program. The data are also used to develop estimates of the percentage of the population that receives fluoridated water to track Healthy People 2010 Objective 21-9: "Increase the proportion of the U.S. population served by community water systems with optimally fluoridated water. Target: 75%." The publication Populations Receiving Optimally Fluoridated Public Drinking Water — United States, 2000 (MMWR Vol. 51, No. 7;144-147.) provides the status of water fluoridation by state for 2000. This Web site is the official source for the 2002 estimates.

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NHANES
Oral health data were collected in the National Health and Nutrition Examination Survey (NHANES I, NHANES III, and NHANES 1999-2004).

NHANES I was conducted between 1971 and 1975. This survey was based on a national sample of about 28,000 persons between the ages of 1 and 74. Extensive data on health and nutrition were collected by interview, physical examination, and laboratory analyses. The sampling design of NHANES I did not include persons of Hispanic/Latin origin.

NHANES III, conducted between 1988 and 1994, included about 40,000 people selected from households in 81 counties across the United States. To obtain reliable estimates, infants and young children (aged 1 to 5 years), older persons (aged 60 years and older), Black Americans and Mexican Americans were sampled at a higher rate. NHANES III also placed an additional emphasis on the effects of the environment upon health. Data were gathered to measure the levels of pesticide exposure, the presence of certain trace elements in the blood, and the amounts of carbon monoxide present in the blood.

NHANES 1999–2004 began in April 1999 and is a continuous survey visiting 15 U.S. locations per year. Approximately 5,000 people are surveyed annually. Oral health data from the current NHANES will be added to NOHSS when data from each phase of the survey become publicly available.

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NHIS
The National Health Interview Survey is a cross-sectional household interview survey on the health of the civilian noninstitutionalized population of the United States. The sampling plan follows a multistage area probability design that permits the representative sampling of households. NHIS data are collected annually from approximately 43,000 households including about 106,000 persons.

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PRAMS
The Pregnancy Risk Assessment Monitoring System collects state-specific, population-based data on maternal attitudes and experiences prior to, during, and immediately following pregnancy. The PRAMS sample of women who have had a recent live birth is drawn from the state's birth certificate records. Each participating state samples between 1,300 and 3,400 women per year. Women from some groups are sampled at a higher rate to ensure adequate data are available in smaller but higher risk populations. Information is gathered by mail and telephone. Data collection procedures and instruments are standardized to allow comparisons between states. PRAMS allows CDC and state health officials to monitor changes in maternal and child health indicators (e.g., unintended pregnancy, prenatal care, breastfeeding, smoking, alcohol use, infant health).

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State Oral Health Surveys
Many states conduct periodic oral health surveys. Some states now use the BSS (Basic Screening Survey) protocol or similar protocols for their surveys. States can submit results from these surveys for inclusion in NOHSS. State data that meet criteria for inclusion in NOHSS are published on the NOHSS Web site. More information on state oral health surveys is provided at State Oral Health Surveys.

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State Synopses
The Synopses of State and Territorial Dental Public Health Programs collects oral health program information provided to the Association of State and Territorial Dental Directors (ASTDD) annually by each state's dental director or oral health program manager. ASTDD, in conjunction with CDC's Division of Oral Health, presents that information with data from standard sources (U.S. Census, Department of Education, Bureau of Labor Statistics, etc.) on the State Synopses Web site. Each state has its own synopsis which contains state-specific information on demographics, oral health infrastructure, oral health program administration, and oral health program activities. An interactive national trend table aggregates that information to track changes over time. Maps display which states conduct each of 12 types of oral health activities and which states have full-time dental directors.

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YRBSS
The Youth Risk Behavior Surveillance System is a CDC school-based survey conducted biennially to assess the prevalence of health risk behaviors among high school students. YRBSS includes national, state, territorial, and local school-based surveys of high school students. The school-based surveys employ a cluster sample design to produce a representative sample of students in grades 9–12. Survey procedures are designed to protect the students’ privacy by allowing for anonymous and voluntary participation.

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Page last reviewed: January 23, 2008
Page last modified: December 12, 2006
Content Source: Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion

 

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