Racial and Ethnic Differences in Social Determinants of Health and Health-Related Social Needs Among Adults - Behavioral Risk Factor Surveillance System, United States, 2022.

Social determinants of health (SDOH) are a broad array of social and contextual conditions where persons are born, live, learn, work, play, worship, and age that influence their physical and mental wellbeing and quality of life. Using 2022 Behavioral Risk Factor Surveillance System data, this study assessed measures of adverse SDOH and health-related social needs (HRSN) among U.S. adult populations. Measures included life satisfaction, social and emotional support, social isolation or loneliness, employment stability, food stability/security, housing stability/security, utility stability/security, transportation access, mental well-being, and health care access. Prevalence ratios were adjusted for age, sex, education, marital status, income, and self-rated health. Social isolation or loneliness (31.9%) and lack of social and emotional support (24.8%) were the most commonly reported measures, both of which were more prevalent among non-Hispanic (NH) American Indian or Alaska Native, NH Black or African American, NH Native Hawaiian or other Pacific Islander, NH multiracial, and Hispanic or Latino adults than among NH White adults. The majority of prevalence estimates for other adverse SDOH and HRSN were also higher across all other racial and ethnic groups (except for NH Asian) compared with NH White adults. SDOH and HRSN data can be used to monitor needed social and health resources in the U.S. population and help evaluate population-scale interventions.

Mortality and mortality disparities among people with epilepsy in the United States, 2011-2021.

Studies on epilepsy mortality in the United States are limited. We used the National Vital Statistics System Multiple Cause of Death data to investigate mortality rates and trends during 2011-2021 for epilepsy (defined by the International Classification of Diseases, 10th Revision, codes G40.0-G40.9) as an underlying, contributing, or any cause of death (i.e., either an underlying or contributing cause) for U.S. residents. We also examined epilepsy as an underlying or contributing cause of death by selected sociodemographic characteristics to assess mortality rate changes and disparities in subpopulations. During 2011-2021, the overall age-standardized mortality rates for epilepsy as an underlying (39 % of all deaths) or contributing (61 % of all deaths) cause of death increased 83.6 % (from 2.9 per million to 6.4 per million population) as underlying cause and 144.1 % (from 3.3 per million to 11.0 per million population) as contributing cause (P < 0.001 for both based on annual percent changes). Compared to 2011-2015, in 2016-2020 mortality rates with epilepsy as an underlying or contributing cause of death were higher overall and in nearly all subgroups. Overall, mortality rates with epilepsy as an underlying or contributing cause of death were higher in older age groups, among males than females, among non-Hispanic Black or non-Hispanic American Indian/Alaska Native persons than non-Hispanic White persons, among those living in the West and Midwest than those living in the Northeast, and in nonmetro counties compared to urban regions. Results identify priority subgroups for intervention to reduce mortality in people with epilepsy and eliminate mortality disparity.

National, State-Level, and County-Level Prevalence Estimates of Adults Aged ≥18 Years Self-Reporting a Lifetime Diagnosis of Depression - United States, 2020.

Depression is a major contributor to mortality, morbidity, disability, and economic costs in the United States (1). Examining the geographic distribution of depression at the state and county levels can help guide state- and local-level efforts to prevent, treat, and manage depression. CDC analyzed 2020 Behavioral Risk Factor Surveillance System (BRFSS) data to estimate the national, state-level, and county-level prevalence of U.S. adults aged ≥18 years self-reporting a lifetime diagnosis of depression (referred to as depression). During 2020, the age-standardized prevalence of depression among adults was 18.5%. Among states, the age-standardized prevalence of depression ranged from 12.7% to 27.5% (median = 19.9%); most of the states with the highest prevalence were in the Appalachian* and southern Mississippi Valley† regions. Among 3,143 counties, the model-based age-standardized prevalence of depression ranged from 10.7% to 31.9% (median = 21.8%); most of the counties with the highest prevalence were in the Appalachian region, the southern Mississippi Valley region, and Missouri, Oklahoma, and Washington. These data can help decision-makers prioritize health planning and interventions in areas with the largest gaps or inequities, which could include implementation of evidence-based interventions and practices such as those recommended by The Guide to Community Preventive Services Task Force (CPSTF) and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Excess Burden of Poverty and Hypertension, by Race and Ethnicity, on the Prevalence of Cardiovascular Disease.

Introduction: Cardiovascular disease (CVD) is the leading cause of death in the United States. Certain demographic characteristics are associated with disparities in CVD and its risk factors, which may interact with specific social determinants of health (SDOH). We examined the association of a single SDOH (ie, poverty level) with diagnosed CVD morbidity and the joint influence of poverty and hypertension on the prevalence of CVD morbidity among non-Hispanic Black, non-Hispanic White, and Hispanic people aged 30 years or older. Methods: We used data from the National Health and Nutrition Examination Survey collected during 1999 to 2018. We assessed the prevalence of diagnosed CVD morbidity (eg, self-reported coronary heart disease, angina, myocardial infarction, or stroke) by using a Poisson family with a log link regression model. We calculated the additive interaction of poverty level with hypertension on diagnosed CVD morbidity for each race and ethnicity. Results: We found excess CVD morbidity among non-Hispanic Black and Hispanic people experiencing poverty and diagnosed with hypertension compared with their non-Hispanic White counterparts. Multivariate analysis found a higher prevalence of CVD among participants of all races and ethnicities who were experiencing poverty and among non-Hispanic White people who had less than a college education. In addition, age, hypertension, poverty, smoking, and weight were significant predictors of the prevalence of CVD morbidity among all racial and ethnic groups. Conclusion: Changes to interventions, policies, and research may be needed to address the effect of key indicators of health disparities and specific SDOH, such as poverty level, that intersect with hypertension and contribute to excess CVD morbidity among people of some racial and ethnic groups, particularly non-Hispanic Black and Hispanic populations.

Chronic Conditions Among Adults Aged 18─34 Years - United States, 2019.

Chronic conditions are common, costly, and major causes of death and disability.* Addressing chronic conditions and their determinants in young adulthood can help slow disease progression and improve well-being across the life course (1); however, recent prevalence estimates examining chronic conditions in young adults overall and by subgroup have not been reported. CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) to measure prevalence of 11 chronic conditions among adults aged 18-34 years overall and by selected characteristics, and to measure prevalence of health-related risk behaviors by chronic condition status. In 2019, more than one half (53.8%) of adults aged 18-34 years reported having at least one chronic condition, and nearly one quarter (22.3%) reported having more than one chronic condition. The most prevalent conditions were obesity (25.5%), depression (21.3%), and high blood pressure (10.7%). Differences in the prevalence of having a chronic condition were most noticeable between young adults with a disability (75.8%) and without a disability (48.3%) and those who were unemployed (62.3%) and students (45.8%). Adults aged 18-34 years with a chronic condition were more likely than those without one to report binge drinking, smoking, or physical inactivity. Coordinated efforts by public and private sectors might help raise awareness of chronic conditions among young adults and help improve the availability of evidence-based interventions, policies, and programs that are effective in preventing, treating, and managing chronic conditions among young adults (1).

Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties - United States, December 14, 2020-April 10, 2021.

Approximately 60 million persons in the United States live in rural counties, representing almost one fifth (19.3%) of the population.* In September 2020, COVID-19 incidence (cases per 100,000 population) in rural counties surpassed that in urban counties (1). Rural communities often have a higher proportion of residents who lack health insurance, live with comorbidities or disabilities, are aged ≥65 years, and have limited access to health care facilities with intensive care capabilities, which places these residents at increased risk for COVID-19-associated morbidity and mortality (2,3). To better understand COVID-19 vaccination disparities across the urban-rural continuum, CDC analyzed county-level vaccine administration data among adults aged ≥18 years who received their first dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccine, or a single dose of the Janssen COVID-19 vaccine (Johnson & Johnson) during December 14, 2020-April 10, 2021 in 50 U.S. jurisdictions (49 states and the District of Columbia [DC]). Adult COVID-19 vaccination coverage was lower in rural counties (38.9%) than in urban counties (45.7%) overall and among adults aged 18-64 years (29.1% rural, 37.7% urban), those aged ≥65 years (67.6% rural, 76.1% urban), women (41.7% rural, 48.4% urban), and men (35.3% rural, 41.9% urban). Vaccination coverage varied among jurisdictions: 36 jurisdictions had higher coverage in urban counties, five had higher coverage in rural counties, and five had similar coverage (i.e., within 1%) in urban and rural counties; in four jurisdictions with no rural counties, the urban-rural comparison could not be assessed. A larger proportion of persons in the most rural counties (14.6%) traveled for vaccination to nonadjacent counties (i.e., farther from their county of residence) compared with persons in the most urban counties (10.3%). As availability of COVID-19 vaccines expands, public health practitioners should continue collaborating with health care providers, pharmacies, employers, faith leaders, and other community partners to identify and address barriers to COVID-19 vaccination in rural areas (2).

Recent epidemiologic trends in periodontitis in the USA.

The most important development in the epidemiology of periodontitis in the USA during the last decade is the result of improvements in survey methodologies and statistical modeling of periodontitis in adults. Most of these advancements have occurred as the direct outcome of work by the joint initiative known as the Periodontal Disease Surveillance Project by the Centers for Disease Control and Prevention and the American Academy of Periodontology that was established in 2006. This report summarizes some of the key findings of this important initiative and its impact on our knowledge of the epidemiology of periodontitis in US adults. This initiative first suggested new periodontitis case definitions for surveillance in 2007 and revised them slightly in 2012. This classification is now regarded as the global standard for periodontitis surveillance and is used worldwide. First, application of such a standard in reporting finally enables results from different researchers in different countries to be meaningfully compared. Second, this initiative tackled the concern that prior national surveys, which used partial-mouth periodontal examination protocols, grossly underestimated the prevalence of periodontitis of potentially more than 50%. Consequently, because previous national surveys significantly underestimated the true prevalence of periodontitis, it is not possible to extrapolate any trend in periodontitis prevalence in the USA over time. Any difference calculated may not represent any actual change in periodontitis prevalence, but rather is a consequence of using different periodontal examination protocols. Finally, the initiative addressed the gap in the need for state and local data on periodontitis prevalence. Through the direct efforts of the Centers for Disease Control and Prevention and the American Academy of Periodontology initiative, full-mouth periodontal probing at six sites around all nonthird molar teeth was included in the 6 years of National Health and Nutrition Examination Surveys from 2009-2014, yielding complete data for 10 683 dentate community-dwelling US adults aged 30 to 79 years. Applying the 2012 periodontitis case definitions to the 2009-2014 National Health and Nutrition Examination Surveys data, the periodontitis prevalence turned out to be much greater than previously estimated, namely affecting 42.2% of the population with 7.8% of people experiencing severe periodontitis. It was also discovered that only the moderate type of periodontitis is driving the increase in periodontitis prevalence with age, not the mild or the severe types whose prevalence do not increase consistently with age, but remain ~ 10%-15% in all age groups of 40 years and older. The greatest risk for having periodontitis of any type was seen in older people, in males, in minority race/ethnic groups, in poorer and less educated groups, and especially in cigarette smokers. The Centers for Disease Control and Prevention and the American Academy of Periodontology initiative reported, for the first time, the periodontitis prevalence estimated at both local and state levels, in addition to the national level. Also, this initiative developed and validated in field studies a set of eight items for self-reported periodontitis for use in direct survey estimates of periodontitis prevalence in existing state-based surveys. These items were also included in the 2009-2014 National Health and Nutrition Examination Surveys for validation against clinically determined cases of periodontitis. Another novel result of this initiative is that, for the first time, the geographic distribution of practicing periodontists in relation to the geographic distribution of people with severe periodontitis is illustrated. In summary, the precise periodontitis prevalence and distribution among subgroups in the dentate US noninstitutionalized population aged 30-79 years is better understood because of application of valid periodontitis case definitions to full-mouth periodontal examination, in combination with reliable information on demographic and health-related measures. We now can monitor the trend of periodontitis prevalence over time as well as guide public health preventive and intervention initiatives for the betterment of the health of the adult US population.

Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans - United States, 1999-2015.

BACKGROUND: Although the overall life expectancy at birth has increased for both blacks and whites and the gap between these populations has narrowed, disparities in life expectancy and the leading causes of death for blacks compared with whites in the United States remain substantial. Understanding how factors that influence these disparities vary across the life span might enhance the targeting of appropriate interventions. METHODS: Trends during 1999-2015 in mortality rates for the leading causes of death were examined by black and white race and age group. Multiple 2014 and 2015 national data sources were analyzed to compare blacks with whites in selected age groups by sociodemographic characteristics, self-reported health behaviors, health-related quality of life indicators, use of health services, and chronic conditions. RESULTS: During 1999-2015, age-adjusted death rates decreased significantly in both populations, with rates declining more sharply among blacks for most leading causes of death. Thus, the disparity gap in all-cause mortality rates narrowed from 33% in 1999 to 16% in 2015. However, during 2015, blacks still had higher death rates than whites for all-cause mortality in all groups aged <65 years. Compared with whites, blacks in age groups <65 years had higher levels of some self-reported risk factors and chronic diseases and mortality from cardiovascular diseases and cancer, diseases that are most common among persons aged ≥65 years. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: To continue to reduce the gap in health disparities, these findings suggest an ongoing need for universal and targeted interventions that address the leading causes of deaths among blacks (especially cardiovascular disease and cancer and their risk factors) across the life span and create equal opportunities for health.

Periodontitis prevalence in adults ≥ 65 years of age, in the USA.

The older adult population is growing rapidly in the USA and it is expected that by 2040 the number of adults ≥ 65 years of age will have increased by about 50%. With the growth of this subpopulation, oral health status, and periodontal status in particular, becomes important in the quest to maintain an adequate quality of life. Poor oral health can have a major impact, leading to tooth loss, pain and discomfort, and may prevent older adults from chewing food properly, often leading to poor nutrition. Periodontitis is monitored in the USA at the national level as part of the Healthy People 2020 initiative. In this report, we provide estimates of the overall burden of periodontitis among adults ≥ 65 years of age and after stratification according to sociodemographic factors, modifiable risk factors (such as smoking status), the presence of other systemic conditions (such as diabetes) and access to dental care. We also estimated the burden of periodontitis within this age group at the state and local levels. Data from the National Health and Nutrition Examination Survey 2009/2010 and 2011/2012 cycles were analyzed. Periodontal measures from both survey cycles were based on a full-mouth periodontal examination. Nineteen per cent of adults in this subpopulation were edentulous. The mean age was 73 years, 7% were current smokers, 8% lived below the 100% Federal Poverty Level and < 40% had seen a dentist in the past year. Almost two-thirds (62.3%) had one or more sites with ≥ 5 mm of clinical attachment loss and almost half had at least one site with probing pocket depth of ≥ 4 mm. We estimated the lowest prevalence of periodontitis in Utah (62.3%) and New Hampshire (62.6%) and the highest in New Mexico, Hawaii, and the District of Columbia each with a prevalence of higher than 70%. Overall, periodontitis is highly prevalent in this subpopulation, with two-thirds of dentate older adults affected at any geographic level. These findings provide an opportunity to determine how the overall health-care management of older adults should consider the improvement of their oral health conditions. Many older adults do not have dental insurance and are also likely to have some chronic conditions, which can adversely affect their oral health.

A Methodological Approach to Small Area Estimation for the Behavioral Risk Factor Surveillance System.

Public health researchers have used a class of statistical methods to calculate prevalence estimates for small geographic areas with few direct observations. Many researchers have used Behavioral Risk Factor Surveillance System (BRFSS) data as a basis for their models. The aims of this study were to 1) describe a new BRFSS small area estimation (SAE) method and 2) investigate the internal and external validity of the BRFSS SAEs it produced. The BRFSS SAE method uses 4 data sets (the BRFSS, the American Community Survey Public Use Microdata Sample, Nielsen Claritas population totals, and the Missouri Census Geographic Equivalency File) to build a single weighted data set. Our findings indicate that internal and external validity tests were successful across many estimates. The BRFSS SAE method is one of several methods that can be used to produce reliable prevalence estimates in small geographic areas.

Standards for reporting chronic periodontitis prevalence and severity in epidemiologic studies: Proposed standards from the Joint EU/USA Periodontal Epidemiology Working Group.

Periodontal diseases are common and their prevalence varies in different populations. However, prevalence estimates are influenced by the methodology used, including measurement techniques, case definitions, and periodontal examination protocols, as well as differences in oral health status. As a consequence, comparisons between populations are severely hampered and inferences regarding the global variation in prevalence can hardly be drawn. To overcome these limitations, the authors suggest standardized principles for the reporting of the prevalence and severity of periodontal diseases in future epidemiological studies. These principles include the comprehensive reporting of the study design, the recording protocol, and specific subject-related and oral data. Further, a range of periodontal data should be reported in the total population and within specific age groups. Periodontal data include the prevalence and extent of clinical attachment loss (CAL) and probing depth (PD) on site and tooth level according to specific thresholds, mean CAL/PD, the CDC/AAP case definition, and bleeding on probing. Consistent implementation of these standards in future studies will ensure improved reporting quality, permit meaningful comparisons of the prevalence of periodontal diseases across populations, and provide better insights into the determinants of such variation.

Probing depth is not a reliable predictor for changes in periodontitis.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Are changes in probing depth a reliable predictor of change in clinical attachment loss? Michalowicz BS, Hodges JS, Pihlstrom BE. J Am Dent Assoc 2013;144 (2):171-8. REVIEWER: Paul I. Eke, PhD, MPH, PhD PURPOSE/QUESTION: The authors sought to examine the utility of using changes in probing depth (PD) for predicting changes in clinical attachment loss (CAL) in clinical trials SOURCE OF FUNDING: Not provided TYPE OF STUDY/DESIGN: Secondary analysis of data from clinical trials LEVEL OF EVIDENCE: Level 2: limited-quality patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Not applicable.

Associations of self-reported chronic obstructive pulmonary disease with indicators of economic instability and stress - 16 states, 2017.

OBJECTIVES: To examine the association between chronic obstructive pulmonary disease status and indicators of economic instability and stress to better understand the magnitude of these issues in persons with chronic obstructive pulmonary disease. METHODS: Analyzed 2017 Behavioral Risk Factor Surveillance System data from 16 states that administered the 'Social Determinants of Health' module, which included economic instability and stress measures (N = 101,461). Associations between self-reported doctor-diagnosed chronic obstructive pulmonary disease status and each measure were examined using multinomial logistic models. RESULTS: Adults with chronic obstructive pulmonary disease were more likely (p < 0.001) than adults without to report not having enough money at month end (21.0% vs. 7.9%) or just enough money (44.9% vs. 37.2%); being unable to pay mortgage, rent, or utility bills (19.2% vs. 8.8%); and that often or sometimes food did not last or could not afford to eat balanced meals (37.9% vs. 20.6%), as well as stress all or most of the time (27.3% vs. 11.6%). Associations were attenuated although remained significant after adjustments for sociodemographic and health characteristics. DISCUSSION: Financial, housing, and food insecurity and frequent stress were more prevalent in adults with chronic obstructive pulmonary disease than without. Findings highlight the importance of including strategies to address challenges related to economic instability and stress in chronic obstructive pulmonary disease management programs.

Recording and surveillance systems for periodontal diseases.

This paper describes tools used to measure periodontal diseases and the integration of these tools into surveillance systems. Tools to measure periodontal diseases at the surveillance level have focussed on current manifestations of disease (e.g. gingival inflammation) or disease sequelae (e.g. periodontal pocket depth or loss of attachment). All tools reviewed in this paper were developed based on the state of the science of the pathophysiology of periodontal disease at the time of their design and the need to provide valid and reliable measurements of the presence and severity of periodontal diseases. Therefore, some of these tools are no longer valid. Others, such as loss of periodontal attachment, are the current de-facto tools but demand many resources to undertake periodical assessment of the periodontal health of populations. Less complex tools such as the Community Periodontal Index, have been used extensively to report periodontal status. Laboratory tests for detecting putative microorganisms or inflammatory agents present in periodontal diseases have been used at the clinical level, and at least one has been tested at the population level. Other approaches, such as self-report measures, are currently under validation. In this paper, we do not review indices designed to measure plaque or residual accumulation around the tooth, indices focussed only on gingival inflammation or radiographic approaches with limited applicability in surveillance systems. Finally, we review current case-definitions proposed for surveillance of periodontal disease severity.

Serologically determined in utero exposure to oral pathogens may be associated with increased risk for neonatal intensive care unit (NICU) admissions and length of stay.

SUBJECTS: The study sample was a subset of 1115 women enrolledinthe Oral Conditions and Pregnancy (OCAP) study, between 1997 and 2002, at Duke University Medical Center. Data from 650 women with umbilical cord blood samples and complete demographic information were analyzed for this study. KEY EXPOSURE/STUDY FACTOR: Fetal immunoglobulin M (IgM) antibody to periodontal organisms. MAIN OUTCOME MEASURE: Infant admission to the neonatal intensive care unit (NICU) and total length of NICU hospitalization. MAIN RESULTS: The primary results were that infants with serological evidence of exposure (as measured by IgM antibody) to periodontal organisms had a higher rate of NICU admission when compared with seronegative infants (11% versus 5% respectively), adjusting for gestational age, and seropositive infants were more likely than seronegative infants to stay more than 3 or more than 7 days at the NICU. Similarly, NICU patterns were not detected for infant umbilical cord serum C-reactive protein (CRP) levels. CONCLUSIONS: The authors concluded that in utero fetal exposure to oral pathogens increases the risk for NICU admissions and length of stay.

Dental visits among adult Hispanics--BRFSS 1999 and 2006.

OBJECTIVES: This study examined and compared utilization of dental services by adult U.S. Hispanics 18 years and older in the years 1999 and 2006. METHODS: Dental utilization data collected by telephone interviews by the state-based Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. RESULTS: In 2006, the state mean and median prevalence of adult Hispanics with dental visits during the past year were 56.2 percent and 62.1 percent, respectively, and had not changed significantly since 1999. In 40 states, utilization was well below the national prevalence of 70.3 percent. Frequency of dental visits was significantly higher among females and those with higher income (> $50,000), higher education, nonsmokers, and persons having medical health insurance. CONCLUSIONS: Findings from this study suggest that barriers to utilization of dental services among Hispanic adults exist in most states and may contribute to existing oral health disparities. The magnitude of this problem may increase in the future with the expansion of the U.S. Hispanic population.

High PCR copy-counts of periodontal pathogens in saliva are associated with periodontal disease status.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Salivary infectious agents and periodontal disease status. Saygun I, Nizam SI, Keskiner N, Bal V, Kubar A, Acikel C, et al. J Periodont Res 2011:46:235-9. REVIEWER: Paul I. Eke, PhD, MPH, PhD. PURPOSE/QUESTION: To determine if salivary counts of 6 periodontal pathogens and Epstein-Barr virus could distinguish between persons with periodontal health, gingivitis, chronic periodontitis, and aggressive periodontitis. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Cross-sectional study LEVEL OF EVIDENCE: Level 3: Other evidence. STRENGTH OF RECOMMENDATION GRADE: Not applicable.

Nutrient removal as a function of benzene supply within vertical-flow constructed wetlands.

The role of benzene, macrophytes and temperature in terms of nutrient removal within constructed wetlands is unknown. Therefore, a research study over approximately 30 months was conducted to assess the potential of vertical-flow constructed wetlands to treat nutrients and to examine the effect of benzene concentration, presence of Phragmites australis (Cav.) Trin. ex Steud (common reed), and temperature control on nutrient removal. Experimental wetlands removed between 72% and 90% of benzene at an influent concentration of 1000 mg L(-1). A statistical analysis indicated that benzene is linked to increased effluent chemical oxygen demand and biochemical oxygen demand concentrations. However, there was no significant relationship between benzene treatment and both nitrogen and phosphorus removal. Phragmites australis played a negligible role in organic matter (chemical oxygen demand, biochemical oxygen demand, nitrogen and phosphorus) removal. Control of temperature favoured biochemical oxygen demand removal. However, no significant difference in chemical oxygen demand, and nitrogen and phosphorus removal was detected. Only the combination of the benzene and temperature variables had a significant impact on biochemical oxygen demand removal. The effluent biochemical oxygen demand concentrations in temperature-controlled benzene treatment wetlands were much lower than those located in the natural environment. However, any other combination between benzene, P. australis and the environmental control variables had no significant effect on biochemical oxygen demand, chemical oxygen demand, or nitrogen and phosphorus removal.

Assessment of self-report measures for predicting population prevalence of periodontitis.

BACKGROUND: Self-report measures have been used successfully for the surveillance of chronic diseases in adult populations. This pilot study assessed the use of self-report oral health measures for predicting the population prevalence of periodontitis in United States adults. METHODS: Data were collected from 456 subjects participating in a 2007 study conducted by the Centers for Disease Control and Prevention. Each subject answered eight predetermined oral health self-report questions obtained from in-person interviews and were given a full-mouth periodontal examination using the National Health and Nutrition Examination Survey protocol. The predictiveness of measures from these self-report questions was assessed by multivariable logistic regression modeling measuring receiver operating characteristic (ROC) statistics, sensitivity, and specificity. RESULTS: Multivariable modeling incorporating self-report measures on gum disease, loose teeth, and tooth appearance alone were most useful in predicting the prevalence of severe periodontitis and improved with the addition of demographic and risk factor variables, yielding an ROC value of 0.93, sensitivity of 54.6%, and specificity of 98% at the observed 4.8% prevalence of disease. Scaling and root planing treatments, loose teeth, and the use of mouthwash, combined with demographic and risk factor covariates, were moderately useful in predicting total periodontitis. CONCLUSIONS: Multivariable modeling of specific self-report oral health measures is promising for predicting the population prevalence of severe periodontitis, confirming earlier assessments from a national survey. These results justify further assessments of self-report oral health measures for use in the surveillance of periodontitis in the adult United States population.