The Burden of Oral Disease:
How To Use This Reference Tool

A comprehensive state burden document will provide in-state users, the Centers for Disease Control and Prevention (CDC) and other states and organizations with data regarding a broad range of indicators relating to national and state health objectives.

This reference tool provides background information and graphic templates for building a comprehensive state burden of oral disease document. This tool provides an outline, example text, references, and national data for developing a document unique to your state. It is not prescriptive; the text can be freely edited or supplemented and the methods of data presentation altered. Where possible, links to online data sources have been provided in the references.

Recommended elements include oral health status indicators consistent with the National Oral Health Surveillance System (NOHSS), the Water Fluoridation Reporting System (WFRS), and the Association of State and Territorial Dental Directors (ASTDD) State Synopsis. This document and tables were prepared using Microsoft Word 2000™. Graphs were prepared using Excel 2000™. Graphs and tables are configured to allow easy editing of state values.

Legend:
Sections recommended for state-specific discussion are indicated with the star symbol.

Because this tool is intended to help state programs, we value your input and suggestions as you use it.

Guidelines for Using and Interpreting National Data

The estimates provided in this tool came from several data sources and national data reports; each has its own release schedule and standards for collecting or reporting race and ethnicity data.

These notes will help you in

• Planning for future updates to your burden document and related informational pieces
• Selecting categories of race and ethnicity that are
  • Available from national data
  • Comparable with your state’s data collection and reporting policies

Updating data

This tool compiles data from several national and centrally coordinated state-based surveys and key indicator publications.

Data and summary reports from national surveys such as the National Health and Nutrition Examination Survey (NHANES) and the National Health Interview Survey (NHIS) are released about every two years. The Behavioral Risk Factor Surveillance System (BRFSS) releases data every year but includes oral health on the core survey only in some years.

The release schedules for these surveys

• Do not usually coincide
• May not coincide with your state’s oral health surveillance schedule
• May vary from published schedules due to publishing issues

Estimates produced from these large surveys are often presented in key reports, such as Healthy People 2010, the Morbidity and Mortality Weekly Report (MMWR), and in peer-reviewed journal articles. These reports serve as credible, easily retrieved and verified sources for the data included in your burden document.

As new data and reports become available, updates will be made to this tool incorporating the new estimates and references from which the estimates are drawn.

• See Appendix b for a calendar of expected release dates for key data sources and reports. These dates may aid in planning for updates to informational pieces that use these data.
• You may wish to time updates to your core burden document and other informational pieces with these releases or with releases of key surveillance data from your state surveillance system.

Presenting Race/Ethnicity Data

Collecting and reporting of race and ethnicity data

• Is not entirely consistent across data sources or time
• Changed in the late 1990s at the federal level
• Changed in some states in the late 1990s and may change in others
• Has implications for privacy and risk of disclosure of participants’ information
• Requires some thought in putting together the burden document and other informational pieces

The federal Office of Management and Budget (OMB) issued a directive in 1997 that required federal data systems to allow participants to report multiple races. Concurrently, increased attention to preventing disclosure of survey or registry participants' identities or information has led to restrictions on releasing certain data elements that pose higher risks of disclosure. Additionally, most surveys have standards limiting presentation of estimates for groups with few survey participants or with large variance. The combination of these factors affects the availability of some categories of race/ethnicity data as well as other commonly used data elements, such as grade in school or parent's education level. Consequently, certain categories of race and ethnicity presented in Healthy People 2010 may not be available from some surveys collected since 1997 or in certain years or data sets that do not include a sample of adequate size to produce reliable estimates for those categories.

Some state governments have enacted laws or policies governing the collection and reporting of race and ethnicity data by state entities and these policies may differ from the new federal standards. Your state

• May collect more detailed race or ethnicity data for certain groups that are not reported separately in national data
• May restrict collection of some of the categories reported in national data

In preparing your comprehensive burden document for reference, it is important to

• Understand your state’s regulations for race/ethnicity data
• Include the range of ethnicity categories reported by national surveys
• Add race/ethnicity categories for which your state has (or needs) data
• Clearly mark categories for which your state does not have data by using the following annotations for national data or footnotes where other explanations are needed:
  • DNA for data not analyzed
  • DNC for data not collected
  • DSU for data that are statistically unreliable or do not meet the criteria for confidentiality or data quality
  • NA for not applicable

For short informational pieces, presenting multiple versions of race/ethnicity data can be overwhelming and confusing. For these informational pieces, focus on the following race/ethnicity categories:

• Those with the most recent data
• Those most relevant to your state population.

References and resources for race/ethnicity classification collection and reporting are provided below.

Office of Management and Budget (OMB). Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. Washington, DC; OMB, 1997. Available at http://www.whitehouse.gov/OMB/fedreg/ombdir15.html.
Also available at http://www.whitehouse.gov/OMB/fedreg/1997standards.html.

Office of Management and Budget (OMB). Provisional Guidance on the Implementation of the 1997 Standards for Federal Data on Race and Ethnicity. Washington, DC; OMB, 1997. Available at http://www.whitehouse.gov/OMB/inforeg/statpolicy.html.
Also available at http://www.whitehouse.gov/OMB/inforeg/re_guidance2000update.pdf (PDF–200K)

Parker JD, Schenker N, Ingram RD, Week JA, Heck KE, Madans JG. Bridging between two standards for collecting information on race and ethnicity: An application to Census 2000 and vital rates. Public Health Reports 2004;119:192–205. Available at http://www.publichealthreports.org/userfiles/119_2/119192.pdf*(PDF–160K)

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One or more documents on this Web page is available in Portable Document Format (PDF). You will need Acrobat Reader to view and print these documents.

* Links to non-Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organization Web pages found at this link.

Date last reviewed: September 21, 2007
Date last modified: June 4, 2007
Content source: Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion