Priority Data Needs: Sources of National, State, and

Local-Level Data and Data Collection Systems

Insun Kim and Kenneth G. Keppel

Introduction

Healthy People 2000’s Priority Area 22 is focused on

the need for surveillance and data systems to measure the

health status of the population and to plan, implement,

describe, and evaluate public health policies and programs

(1). Objective 22.1 specifically addresses the need to develop

a set of health status indicators appropriate for all levels of

government and establish wide use of the indicators. In order

to support the implementation of Objective 22.1, the

National Center for Health Statistics (NCHS) of the Centers

for Disease Control and Prevention (CDC) established

Committee 22.1, composed of the members appointed from

the key public health associations and organizations. The

Committee was charged with developing a minimum set of

community health status measures to address Objective 22.1.

Its final report (2), released in 1991, contains the

Committee’s recommendations in the form of two summary

lists: Health Status Indicators (HSIs) (3,4,5) and Priority

Data Needs (PDNs). The purpose of this Statistical Note is

to provide definitions, State-level data sources, and

standardized core questions for PDNs. The details provided

in this Note should help State, Tribal, and local health

agencies collect and evaluate these data items and, thereby,

adopt the measures in the assessment of their community’s

health status and program planning, development, and

evaluation.

Priority Data Needs: Background

As part of their mandate to identify a set of indicators

of community health status which would be relevant to

public health practice, the Committee 22.1 identified PDNs

as indicators that would be important for evaluating the

health of a population; however, data for these indicators

were not necessarily available for all levels of government.

The Committee’s recommendation that existing data

collection systems be modified to accommodate the PDNs

served as an impetus for the development of alternative

collection mechanisms to measure the PDNs. One such

mechanism was developed by the Information Transfer

System, Inc., of Ann Arbor, MI (ITS), with a grant from the

Agency for Health Care Policy and Research. A survey

instrument was developed as a demonstration project having

the following features: i) a cost-effective telephone sampling

methodology for use at the local jurisdiction level, ii) a core

questionnaire covering as many PDNs as possible in a

manner that assured the highest level of comparability with

data from State (e.g., Behavioral Risk Factor Surveillance

Survey (BRFSS) (6)) and Federal surveys (e.g., National

Health Interview Survey (NHIS) (7)), and iii) an overall

research design that was as cost-effective as possible while

maintaining a high level of reliability and validity.

In 1992 NCHS funded ITS to pilot test the design and

instrumentation of the local survey. The pilot project covered

data collection (using list-assisted random digit dialing and a

Number 15

December 1997

From the CENTERS FOR DISEASE CONTROL AND PREVENTION/National Center for Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

CENTERS FOR DISEASE CONTROL

AND PREVENTION
computer-assisted telephone interview), analysis, reporting,

and consultation in a total of six pilot sites representing nine

local health jurisdictions across the nation.

The Committee reconvened on September 11, 1996.

Based on reviews of the pilot test (the design,

instrumentation, and data collection system of the pilot

survey) and the availability of published statistics from

national and State surveys, the Committee approved the

following changes and enhancements to the PDNs. The

changes also reflect the midcourse revisions of the Healthy

People 2000 objectives (8) and interpretations of the

previously published PDNs.

h The PDN for childhood immunization is defined to

follow the schedule used by the National Immunization

Survey (NIS) (9) and the NHIS.

h The PDN for adult immunization is subdivided into two

categories—pneumonia and influenza—to reflect data

availability.

h Water quality data are available separately for two

beneficial uses of three water body types (10). Therefore,

this PDN is subdivided into six subcategories. No survey

questions are recommended for use at the local level

because the PDN is not amenable to survey data collection.

h PDNs for Pap test and mammogram usage are defined

according to the corresponding year 2000 objectives.

h Health care coverage and regular source of care were

expressed in the original PDNs as negative indicators;

that is, the higher the statistic the worse the health status.

To be consistent with the other PDNs, the definitions of

these two items are restated as positive indicators.

Further, because data sources differ for children and

adults, the health care coverage PDNs are subdivided

into two age groups: i) under 18 years, and ii) 18–64

years. Regular source of dental services is defined as

having last visited a dentist within the past year.

h PDNs for cigarette smoking and alcohol misuse are

modified to be consistent with State-level surveys.

Further, both items are subdivided for two separate age

groups: i) adolescents in grades 9 through 12, and ii)

adults 18 years and older.

h The PDN for obesity is changed to overweight and

subdivided into adults and adolescents. The new

definition is consistent with the corresponding year 2000

objectives and available data.

h For hypertension and hypercholesterolemia, the

Committee decided to focus on the awareness of the

respective conditions.

h The PDN for confirmed abuse and neglect of children is

consistent with the definition used by the National Child

Abuse and Neglect Data System of the National Center

on Child Abuse and Neglect, Administration on Children,

Youth and Families (11). No survey questions were

recommended for use at the local level because the PDN

is not amenable to survey data collection.

h Childhood blood lead screening is assessed with two

PDN measures because screening is not conducted

universally. A measure of the proportion of children

screened in a community is considered a good indicator

of service delivery and awareness of the condition. The

second measure is the proportion of the screened

children who have elevated blood lead levels.

h The PDNs for incidence of hepatitis B and childhood

oral health are unchanged. These measures, however, are

not amenable to survey data collection.

Table 1 presents a summary of the revised PDNs, related

Healthy People 2000 objectives, applicable national data

sources, and recommended data sources for State-level

estimates. Data for recent data years are available for the

PDNs (and for the HSIs) through the Internet on the CDC

FTP-server (12).

Detailed definitions of PDNs

Each PDN is listed below in a short-text format. The

relevant year 2000 objectives are also given. Four sections

follow for each definition:

PDN definition— represents a supplementary, detailed

definition of the PDN, providing a more detailed

classification and specific target age group.

Data sources— describes data collection systems used to

produce national- and State-level estimates of the PDNs and

highlights similarities and differences between the nationaland State-level data sources. The most significant source of

State-level data is the BRFSS. BRFSS is a State-based

surveillance system in which all 50 States and the District of

Columbia participate. This data system has three

components: core, rotating core, and modules. The core

questionnaire is administered yearly by all participating

States, whereas items in the rotating core are collected in

alternating years. Optional modules are selected by states,

and the number of participating States may vary. The

BRFSS is a CDC and State collaborative data system with

funding from and the content determined by both CDC and

the States. While there are differences in the design and

operation of the survey among States (13), efforts are made

to maximize the similarities to facilitate data comparisons

among them.

Recommended data source for State-level estimates—

identifies data systems designed to provide State-level data.

A number of national data systems are based on reports

submitted by States and have available State-level data for

most States. Although included in the list, data from such

data systems should be used with caution when comparing

with other States because of wide variations in reporting

practices and different procedures and criteria used.

Recommended core questions— are a minimum set of survey

questions that could be used to measure PDNs at the local

level. These questions have been selected from the existing

surveys to promote the highest level of comparability with

national- and State-level sources. In cases where questions

were available from both national- and State-level data

sources but the questions were not identical, the latter was

selected. The national- or State-level survey from which the

recommended core questions are derived is provided in

brackets for ease of reference. Most questions were utilized

in their original form from these surveys. The BRFSS does

not obtain data on children under 18 years of age.

2
3
4
Therefore, the phrase ‘‘same as BRFSS adult question’’ is

indicated if BRFSS questions are utilized to address those

under 18 years of age. If the questions have been modified

from the source data system, this is also noted. All

additional questions required to capture relevant responses

are listed.

INDICATORS OF PROCESSES

1. Proportion of children 2 years of age who have

been immunized with the basic series [as defined by

the Immunization Practices Advisory Committee (14)]

Related Objective 20.11: Increase basic immunization

series among children through age 2 to at least

90 percent.

PDN definition: Proportion of children 19–35 months of age

who have been immunized with 4:3:1 series (four doses of

diphtheria, tetanus toxoids and pertussis vaccine; three doses

of poliovirus vaccine, and one dose of measles-mumpsrubella vaccine).

Data sources: The NIS is an ongoing telephone survey to

provide estimates of vaccination coverage levels among

children aged 19–35 months. Implemented in April 1994,

NIS collects quarterly data from all 50 States and the

District of Columbia. In addition, it currently provides

estimates of vaccination coverage levels in 27 urban areas

considered to be at high risk for undervaccination. The

NHIS Immunization Supplement, administered in-person,

also provides national-level estimates of immunization

coverage among children aged 19–35 months. Data from this

survey is used to adjust the NIS for non-phone bias. Both

NIS and NHIS have identical question wording and

sequence.

Recommended data source for State-level estimates: NIS

Recommended immunization questions for children:

For children 19–35 months of age [From the NIS and an NHIS

Supplement]:

If shot record is available

h Looking at the shot record, please tell me how many times (child) has

received (vaccine list).

If no shot record is available

h Has (child) ever received an immunization, that is a shot or drops?

If yes:

h Has (child) ever received (vaccine list)?

If yes:

h How many (vaccine list) shots did (child) ever receive?

Vaccine List

+ a DPT/DT shot (sometimes called a DPT shot, diphtheria-tetanus-pertussis

shot, baby shot, or three-in-one shot)?

+ a polio vaccine by mouth (pink drops) or a polio shot?

+ measles or MMR (Measles-Mumps-Rubella) shot?

2. Proportion of adults aged ≥ 65 years who have

been immunized for pneumococcal pneumonia and

influenza

Related Objective 20.11: Increase pneumococcal

pneumonia and influenza immunization among

noninstitutionalized, high-risk populations, as defined by

the Immunization Practices Advisory Committee, to at

least 60 percent.

PDN definition: Proportion of adults aged 65 years and older

a) who have ever been immunized for pneumococcal

pneumonia, and b) who have been immunized for influenza

within the preceding 12 months.

Data sources: The 1995 NHIS Year 2000 Objectives

Supplement provides an estimate of adult vaccination

coverage level for the nation, and the BRFSS provides

estimates for all 50 States and the District of Columbia as

part of a rotating core that is administered in alternating

years. The NHIS and the BRFSS core use identical

questions. Questions on adult vaccination became part of the

NHIS core beginning in 1997.

Recommended data source for State-level estimates: BRFSS

Recommended immunization questions for adults 65 years of

age and over:

[From the BRFSS rotating core and an NHIS Supplement]:

h Have you ever had a pneumonia vaccination? This shot was first made

available in 1977 and is usually given once in a person’s lifetime.

h During the past 12 months, have you had a flu shot? This vaccination is

usually given in the Fall and protects against influenza for the flu season.

3. Proportion of assessed rivers, lakes, and

estuaries that support beneficial uses (fishing and

swimming approved)

Related Objective 11.10: Reduce potential risks to

human health from surface water, as measured by an

increase in the proportion of assessed rivers, lakes, and

estuaries that support beneficial uses, such as

consumable fish and recreational activities. (Targets set

separately for each subcategory)

PDN definition: Proportion of assessed rivers, lakes, and

estuaries that fully support a) consumable fish and b)

recreational activities. Note: Consumable fish is defined as

[water body supporting] fish free from contamination that

could pose a human health risk to consumers. Recreational

activity is defined as [water body supporting] primary

contact recreation, e.g., swimming, without risk of adverse

human health effects such as catching waterborne diseases.

Data sources: The National Water Quality Inventory (10),

coordinated by the Office of Water, U.S. Environmental

Protection Agency (EPA), is a report to the Congress

required by the EPA’s Clean Water Act. It provides nationaland State-level information on use-support status of rivers,

lakes, and estuaries based on water quality assessment

reports submitted by the States and other participating

jurisdictions every 2 years.

Recommended data source for State-level estimates: It is

important to note that States and other participating

jurisdictions do not use identical survey methods or criteria

to rate their water quality. Furthermore, most States do not

survey all of their waterbodies, and the percentage of total

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waters surveyed varies widely by State and by the type of

water body. Thus, caution should be used when comparing

data among States or comparing water quality information

submitted during different reporting periods because States

may modify their criteria or survey different waterbodies

every 2 years. This item is not amenable to survey data

collection.

4. Proportion of women receiving a Papanicolaou

test at an interval appropriate for their age

Related Objective 16.12: Increase to at least 95 percent

the proportion of women aged 18 and older who have

ever received a Pap test, and to at least 85 percent those

who received a Pap test within the preceding 1–3 years.

PDN definition: Proportion of women 18 years and older

who have received a Papanicolaou test within the preceding

3 years

Data sources: The 1994 NHIS Year 2000 Objectives

Supplement provides national data, and the BRFSS core

provides State-level information. The NHIS and the BRFSS

have different question wording and structure.

Recommended data source for State-level estimates: BRFSS

Recommended questions for Pap test:

For women 18 years and over [From the BRFSS core]:

h A Pap smear is a test for cancer of the cervix. Have you ever had a Pap

smear?

If yes:

h How long has it been since you had your last Pap smear?

5. Proportion of women receiving a mammogram at

an interval appropriate for their age

Related Objective 16.11: Increase to at least 60 percent

those women aged 50 and older who have received a

clinical breast examination and a mammogram within

the preceding 1–2 years.

PDN definition: Proportion of women 50 years and older who

have received a mammogram within the preceding 2 years

Data sources: The 1994 NHIS Year 2000 Objectives

Supplement provides data for national-level, and the BRFSS

core provides State-level estimates of mammogram usage.

Although similar, the NHIS and the BRFSS have different

question structure.

Recommended data source for State-level estimates: BRFSS

Recommended questions for mammogram usage:

For women 50 years and over [From the BRFSS core]:

h A mammogram is an X-ray of each breast to look for breast cancer. Have

you ever had a mammogram?

If yes:

h How long has it been since you had your last mammogram?

6. Proportion of the population insured for medical

care

Related Objective 21.4: Improve financing and delivery

of clinical preventive services so that virtually no

American has a financial barrier to receiving, at a

minimum, the screening, counseling, and immunization

services recommended by the U.S. Preventive Services

Task Force.

PDN definition: Proportion of the population i) under 18

years of age, and ii) between 18 and 64 years of age who

have any kind of health care coverage, including health

insurance, prepaid plans such as health maintenance

organizations (HMOs), or government plans such as

Medicaid.

Data sources: The Current Population Survey (CPS) (15), a

monthly nationwide survey of about 60,000 households

conducted by the Bureau of Census of the U.S. Department

of Commerce, collects information on health care coverage

of individuals of all ages in its March Supplement. CPS

releases State-level estimates of health care coverage for the

population of all ages combined. For children under 18 years

of age, only national estimates are available from CPS. For

the population 18 years and older, the 1995 NHIS Family

Resources Supplement and the BRFSS provide national- and

State-level estimates, respectively. The wording of the NHIS,

the CPS, and the BRFSS differ.

Recommended data source for State-level estimates: BRFSS

(Persons 18–64 years of age)

Recommended questions for health care coverage:

6a. For adults 18–64 years of age [From the BRFSS core]:

h Do you have any kind of health care coverage, including health insurance,

prepaid plans such as HMOs, or government plans such as Medicaid?

6b. For children under 18 years of age [Same as BRFSS adult

question]:

h Does (child) have any kind of health care coverage, including health

insurance, prepaid plans such as HMOs, or government plans such as

Medicaid?

7. Proportion of the population with a regular

source of primary care (including dental services)

Related Objectives:

13.14: Increase to at least 70 percent the proportion of

people aged 35 and older using the oral health care

system during each year.

21.3: Increase to at least 95 percent the proportion of

people who have a specific source of ongoing primary

care for coordination of their preventive and episodic

health care.

PDN definition:

a. Proportion of the population i) under 18 years of age, and

ii) 18 years and older with one particular clinic, health

center, doctor’s office, or other place that the individual

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usually goes to if sick or in need of advice about one’s

health.

b. Proportion of the population i) 5–17 years of age, and

ii) 18 years and older who have used the dental health

care system during the preceding year.

Data sources: National-level data for both children and

adults [7a.i and 7a.ii] are collected in the 1995 NHIS Family

Resources Supplement. These items are part of the NHIS

core beginning 1997. BRFSS provides State-level

information on the usual source of care for the population 18

years and older [7a.ii and 7b.ii] as part of an optional

module. For a regular source of primary care, NHIS and

BRFSS use similar questions. For a regular source of dental

services, the BRFSS question wording has been modified to

add a phrase for questions related to dental services [7b] ‘‘or

other dental health professional for any reason including a

check up or because of a problem with your mouth, teeth, or

gums.’’

Recommended data source for State-level estimates: No

nationwide data source for 7a.i or 7b.i; BRFSS for 7a.ii and

7b.ii

Recommended questions for source of primary care:

7a.i. For children under 18 years of age [Same as BRFSS adult

question; similar to NHIS]:

h Is there one particular clinic, health center, doctor’s office, or other place that

your child usually goes to if your child is sick or needs advice about his or

her health?

7a.ii. For adults 18 years and over [From a BRFSS module; similar

to NHIS]:

h Is there one particular clinic, health center, doctor’s office, or other place that

you usually go to if you are sick or need advice about your health?

7b.i. For children 5–17 years of age [Modified from BRFSS adult

question]:

h About how long has it been since (child) last visited a dentist or other dental

health professional for any reason including a check up or because of a

problem with (child’s) mouth, teeth, or gums?

7b.ii. For adults 18 years and over [Modified from BRFSS module]:

h About how long has it been since you last visited a dentist or other dental

health professional for any reason including a check up or because of a

problem with your mouth, teeth, or gums?

INDICATORS OF RISK FACTORS (age-specific

prevalence rates)

8. Cigarette smoking

Related Objectives:

3.4: Reduce cigarette smoking to a prevalence of no

more than 15 percent among people aged 18 and older.

Duplicate objectives: 15.12 and 16.6.

3.5: Reduce the initiation of cigarette smoking by

children and youth so that no more than 15 percent have

become regular cigarette smokers by age 20.

PDN definition:

a. Proportion of adolescents in grades 9 through 12 who

smoked at least one day during the past 30 days.

b. Proportion of the population 18 years and older who

have smoked at least 100 cigarettes in one’s entire life,

and who smoke currently.

Data sources: The Monitoring the Future Study (16), a

school-based survey conducted by the National Institute on

Drug Abuse of the National Institutes of Health (NIH),

provides national-level estimates of cigarette smoking among

high school seniors [8a]. State-level estimates of adolescent

smoking [8a] are available in the Youth Risk Behavior

Survey (YRBS), also a school-based survey, conducted by

the National Center for Chronic Disease Prevention and

Health Promotion of the CDC (17). Currently, estimates of

adolescent smoking [8a] are also available for 16 local

communities participating in YRBS. For the population 18

years and over [8b], the 1995 NHIS Year 2000 Objectives

Supplement and BRFSS, respectively, provide national- and

State-level information. Questions on adult smoking [8b] are

part of the NHIS Core beginning in 1997, when NHIS and

BRFSS use identical question wording.

Recommended data source for State-level estimates: YRBS

for 8a and BRFSS for 8b

Recommended questions for cigarette smoking:

8a. For adolescents in grades 9–12 [From the YRBS]:

h During the past 30 days, on how many days did you smoke cigarettes?

(Coded as current smoker if ‘‘1 day’’ or more)

8b. For adults 18 years and over [From the 1996 BRFSS core and

the NHIS]:

h Have you smoked at least 100 cigarettes in your entire life?

If yes:

h Do you now smoke cigarettes every day, some days, or not at all?

(Coded as current smoker if ‘‘every day’’ or ‘‘some days’’)

9. Alcohol misuse

Related Objective 4.7: Reduce the proportion of high

school seniors and college students engaging in recent

occasions of heavy drinking of alcoholic beverages to

no more than 28 percent of high school seniors and

32 percent of college students. Note: Recent heavy

drinking is defined as having five or more drinks on one

occasion in the previous 2-week period as monitored by

self-reports.

PDN definition: Proportion of a) adolescents in grades 9

through 12, and b) the population 18 years of age and older

who had five drinks or more on at least one occasion within

the preceding 30 days.

Data sources: National-level estimates of alcohol use among

high school seniors [9a] are available in the Monitoring the

Future Study (16). YRBS (17) collects state-level

information on 9a. Estimates of adolescent heavy drinking

are also available for 16 local communities participating in

YRBS. The 1997 NHIS Adult Core collects national-level

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information on alcohol use among population 18 years and

older. State-level information on alcohol misuse among

population 18 years and older is available in alternating

years as part of BRFSS rotating core. NHIS questions are

not comparable to those of BRFSS.

Recommended data source of State-level estimates: YRBS

for 9a and BRFSS for 9b

Recommended questions on use of alcohol:

9a. For adolescents in grades 9–12 [From the YRBS]:

h During the past 30 days, on how many days did you have 5 or more drinks

of alcohol in a row, that is, within a couple of hours?

9b. For adults 18 years and over [From the BRFSS rotating core]:

h Considering all types of alcoholic beverages, how many times during the

past month did you have 5 or more drinks on an occasion?

10. Overweight

The original reference to obesity has been changed to

overweight.

Related Objective 1.2: Reduce overweight to a

prevalence of no more than 20 percent among people

aged 20 and older and no more than 15 percent among

adolescents aged 12–19. Duplicate Objectives: 2.3,

15.10, and 17.12.

PDN definition: Proportion of a) children 12–17 years of

age, and b) the population 18 years and older who are

overweight.

Data source: National Health and Nutrition Examination

Survey (NHANES) (18) collects national-level information

on overweight among adolescents [10a]. No data system

provides State-level information on 10a. NHIS and BRFSS,

respectively, provide national- and State-level information on

overweight among the population 18 years and older based

on self-reported information [10b]. Both NHIS and BRFSS

use identical questions to measure this item.

Recommended data source for State-level estimates: No

nationwide data source exists for 10a; BRFSS for 10b

Recommended questions for overweight:

10a. For adolescents 12–17 years of age [Same as BRFSS adult

question]:

h About how much does (child) weigh without shoes? (in pounds)

h About how tall is (child) without shoes? (in feet and inches)

10b. For adults 18 years and over [From the BRFSS core and

NHIS]:

h About how much do you weigh without shoes? (in pounds)

h About how tall are you without shoes? (in feet and inches)

NOTE: Body mass index, or BMI, is calculated as weight (kg)/height (m)2. For

people 20 years of age and over, overweight is defined as BMI equal to or

greater than 27.8 for men and 27.3 for women. For adolescents, overweight is

defined as BMI equal to or greater than 23.0 for males 12–14 years, 24.3 for

males 15–17 years, 25.8 for males 18–19 years, 23.4 for females 12–14 years,

24.8 for females 15–17 years, and 25.7 for females 18–19 years.

11. Hypertension

Related Objectives:

15.4: Increase to at least 50 percent the proportion of

people with high blood pressure whose blood pressure is

under control.

15.5: Increase to at least 90 percent the proportion of

people with high blood pressure who are taking action

to help control their blood pressure.

15.13: Increase to at least 90 percent the proportion of

adults who had their blood pressure measured within the

preceding 2 years and can state whether their blood

pressure was normal or high.

PDN definition: Proportion of the population 18 years and

older who have been told by a health care professional that

he/she has high blood pressure (awareness).

Data sources: The 1994 NHIS Year 2000 Objectives

Supplement provides national-level estimates. State-level

estimates are available in the BRFSS as part of the rotating

core administered in alternating years. BRFSS and NHIS

have similar wording but different question structure.

Recommended data source for State-level estimates: BRFSS

Recommended questions for hypertension:

For adults 18 years and over [From the BRFSS rotating core]:

h About how long has it been since you last had your blood pressure taken by

a doctor, nurse, or other health professional?

If other than ‘‘never’’:

h Have you ever been told by a doctor, a nurse or other health

professional that you have high blood pressure?

12. Hypercholesterolemia

Related Objectives:

15.8: Increase to at least 60 percent the proportion of

adults with high blood cholesterol who are aware of

their condition and are taking action to reduce their

blood cholesterol to recommended levels.

15.14: Increase to at least 75 percent the proportion of

adults who have had their blood cholesterol checked

within the preceding 5 years.

PDN definition: Proportion of the population 18 years or

older who have ever been told by health care professional

that he/she has high blood cholesterol (awareness).

Data sources: The 1993 NHIS Year 2000 Objectives

Supplement provides national-level estimates of this item.

State-level estimates are available in BRFSS in alternating

years as part of the rotating core. NHIS and BRFSS have

similar question wording.

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Recommended Data Source for State-Level Estimates:

BRFSS

Recommended questions for hypercholesterolemia:

For adults 18 years and over [From the BRFSS rotating core;

similar to a NHIS Supplement]:

h Blood cholesterol is a fatty substance found in the blood. Have you ever had

your blood cholesterol checked?

If yes:

h Have you ever been told by a doctor or other health professional that

your blood cholesterol is high?

13. Confirmed abuse and neglect of children

(per 1,000 children)

Related Objective 7.4: Reverse to less than 22.6 per

1,000 children the rising incidence of maltreatment of

children younger than age 18.

PDN definition: Substantiated or indicated abuse and neglect

of children (per 1,000 children) following investigation by

State child protective service agencies.

Data sources: The NCANDS (11) provides national- and

State-level data on child abuse and neglect based on reports

submitted by State child protective services agencies. State

summaries include reports of alleged maltreatment,

disposition of investigation of alleged child abuse and

neglect, and data on the victims and perpetrators of

substantiated and indicated maltreatment. The data from

NCANDS represent the most complete and accurate

information available about child abuse and neglect known

to the State child protective services agencies.

Recommended data source for State-level estimates:

NCANDS was developed through a Federal-State

partnership. It is important to note, however, that there is a

wide variation in the sources of data, data collection

methods, and the level of evidence used to substantiate a

report that becomes part of NCANDS.

INDICATORS OF HEALTH STATUS OUTCOME

14. Percentage of children under 5 years of age

who are tested and have blood lead levels less than

15 μg/dL

Related Objective 11.4: Reduce the prevalence of

blood lead levels exceeding 15 μg/dL and 25 μg/dL

among children aged 6 months–5 years to no more than

300,000 and zero, respectively.

PDN definition: Percentage of children aged <5 years of age

who have been a) tested and b) tested and have blood lead

levels >15 μg/dL.

Data sources: NHANES provides national estimates of

elevated blood lead levels among children. No national data

system currently exists to monitor this indicator at the State

level. Lead screening programs at the State level range from

limited programs targeting certain high risk populations to

determine the extent of the problem in the State to programs

that require children to be screened in certain situations such

as before entering day care. Their screening standards and

classification criteria also vary widely. The National Center

for Environmental Health of CDC is presently working

toward a Federal-State partnership to establish a national

data collection and analysis program.

Recommended data source for State-level estimates: No

comparable State sources.

Recommended questions for blood lead levels:

14a. For children 5 years and under [From the NHANES]:

h Has (child) ever been tested for lead poisoning?

14b. For children 5 years and under [From the NHANES]:

h Has (child) ever been tested for lead poisoning?

If ‘‘yes’’:

h Did the result indicate that (child) has lead poisoning or high lead?

15. Incidence of hepatitis B, per 100,000 population

Related Objective 20.3: Reduce viral hepatitis B to 40

per 100,000 people.

PDN definition: Reported incidence of hepatitis B (per

100,000 population).

Data sources: National Notifiable Disease Surveillance

System (NNDSS) (19), coordinated by the Epidemiology

Program Office of the CDC, provides national- and

State-level incidence of hepatitis B. The number of cases

and incidence rate appear in the Morbidity and Mortality

Weekly Report (MMWR) and the MMWR Annual Summary

of Notifiable Diseases.

NOTE: For tracking of the Healthy People Year 2000

objective, the Viral Hepatitis Surveillance Program (20)

provides national estimates of hepatitis B incidence corrected

for underreporting in NNDSS using an algorithm that adjusts

the reported incidence upward by approximately 6-fold.

Recommended data source for State-level estimates: No

comparable data source at the State level. Because of wide

variations in reporting practices among States, an algorithm

for adjusting hepatitis B incidence rate within States has not

yet been developed. Accordingly, State-level incidence rates

of hepatitis B from the NNDSS are deemed unreliable. This

item is not amenable to survey data collection due to low

incidence.

16. Proportion of children aged 6–8 and 15 years

with one or more decayed primary or permanent

teeth

Related Objective 13.1: Reduce dental caries (cavities)

so that the proportion of children with one or more

caries (in permanent or primary teeth) is no more than

35 percent among children aged 6–8 and no more than

60 percent among adolescents aged 15.

PDN definition: Proportion of children a) aged 6–8, and b)

15 years with one or more decayed primary or permanent

teeth.

9
Data sources: National Survey of Dental Caries in U.S.

School Children (21), conducted during the 1986–87 school

year by the National Institute for Dental Research, NIH,

provides national- and regional-level estimates of dental

caries among children. All children in selected classes were

given a standardized examination by oral health

professionals for dental caries and for other oral health

concerns. No data system is currently in place to collect

comparable information at the State or local level.

References

1. U.S. Department of Health and Human Services. Healthy

People 2000: National health promotion and disease prevention

objectives. Washington: Public Health Service. 1991.

2. Centers for Disease Control and Prevention. Consensus set of

health status indicators for the general assessment of

community health status United States. MMWR 40(27):

449–51. 1991.

3. Freedman MA. Health status indicators for the year 2000.

Healthy people 2000 statistical notes, number 1. Hyattsville,

Maryland: National Center for Health Statistics. 1991.

4. Klein RJ and Hawk SA. Health status indicators: Definitions

and national data. Healthy people 2000 statistical notes,

number 3. Hyattsville, Maryland: National Center for Health

Statistics. 1992.

5. Plepys C and Klein R. Health status indicators: Differentials

by race and Hispanic origin. Healthy people 2000 statistical

notes, number 10. Hyattsville, Maryland: National Center for

Health Statistics. 1995.

6. Centers for Disease Control and Prevention. State- and

sex-specific prevalence of selected characteristics Behavioral

Risk Factor Surveillance System, 1992 and 1993. MMWR 45

(SS-6). 1996.

7. National Center for Health Statistics. Current Estimates from

the National Health Interview Survey. Vital Health Stat 10.

Hyattsville, Maryland: Public Health Service. Published

annually.

8. U.S. Department of Health and Human Services. Healthy

people 2000: Midcourse review and 1995 revisions.

Washington: Public Health Service. 1995.

9. National, state, and urban area vaccination coverage levels

among children aged 19–35 months United States, April 1994

March 1995. MMWR 45(7): 145–150. 1996.

10. U.S. Environmental Protection Agency. National water quality

inventory: 1994 report to Congress. EPA841–R–95–005.

Washington, DC. 1995.

11. U.S. Department of Health and Human Services, National

Center on Child Abuse and Neglect. Child maltreatment 1994:

Reports from the states to the National Center on Child Abuse

and Neglect. Washington, DC. 1996.

12. Latest data for the nation and for each State are available for

Health Status Indicators and Priority Data Needs through

http://www.cdc.gov/nchswww/datawh/ftpserv/ftpserv.htm

13. Gentry EM, Kalsbeek WD, Hogelin GC, et al. The behavioral

risk factor surveys. Part II. Design, methods, and estimates

from combined state data. American J of Preventive Medicine

1:9–14. 1985.

14. Centers for Disease Control and Prevention. Recommended

childhood immunization schedule United States, 1995.

MMWR 44 (RR-5). 1995.

15. Current Population Reports. Health insurance coverage: 1994.

Census Bureau P60 190. Bureau of the Census, Economic and

Statistics Administration. Washington: U.S. Department of

Commerce. 1995.

16. National Institute on Drug Abuse. National survey results on

drug use from the Monitoring the Future Study, 1975–1994.

NIH 95 4026. 1995.

17. Centers for Disease Control and Prevention. Youth risk

behavior surveillance United States, 1995. MMWR 45(SS-4).

1996.

18. McDowell A, et al. Plan and operation of the second National

Health and Nutrition Examination Survey, 1976–1980.

National Center for Health Statistics. Vital Health Stat 1(15).

1981.

19. Centers for Disease Control and Prevention. Summary of

notifiable diseases, United States, 1994. MMWR 43(53). 1994.

20. Centers for Disease Control and Prevention. Hepatitis

surveillance report. No 56. Atlanta, Georgia. 1995.

21. Brunelle JA. Oral health of United States children: The

national survey of dental caries in U.S. school children,

1986–87. Bethesda, Maryland: NIDR. NIH 89 2247. 1989.

10
Published issues of Healthy People 2000 Statistical Notes

Number Title Date of Issue

1 Health Status Indicators for the Year 2000 Fall 1991

2 Infant Mortality Winter 1991

3 Health Status Indicators: Definitions and National Data Spring 1992

4 Issues Related to Monitoring the Year 2000 Objectives Summer 1993

5 Revisions to Healthy People 2000 Baselines July 1993

6 Direct Standardization (Age-Adjusted Death Rates) March 1995

7 Years of Healthy Life April 1995

8 Evaluating Public Health Data Systems: A Practical Approach June 1995

9 Monitoring Air Quality in Healthy People 2000 September 1995

10 Health Status Indicators: Differentials by Race and Hispanic Origin September 1995

11 Operational Definitions for Year 2000 Objectives: Priority Area 20, Immunization and

Infectious Diseases

February 1997

12 Operational Definitions for Year 2000 Objectives: Priority Area 13, Oral Health May 1997

13 Healthy People 2000 Midcourse Revisions: A Compendium August 1997

14 Operational Definitions for Year 2000 Objectives: Priority Area 14, Maternal and Child Health December 1997

11
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