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National Center for Chronic Disease Prevention and Health Promotion
Chronic Disease Prevention
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National Center for Chronic Disease Prevention and Health Promotion Chronic Disease Prevention Home | Contact Us |
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National Center for
Chronic Disease Prevention and Health Promotion Special Focus: Information Resources Internet Has Revolutionized How Chronic Disease Data Are Being Used Before the availability of the Internet, few people outside of public health were aware of CDC's wealth of surveillance data on chronic diseases. Now the data are available to anyone in the world with Internet access. As a result, CDC's chronic disease data are attracting a more diverse audience that includes not only state health departments and policymakers but also researchers, teachers, and the public. To meet the needs of this diverse group of people, CDC is strengthening its surveillance systems on the Web in several ways. "We are using more consistent standards and formats that will make it easier on users, we're putting more data on the Web, and we're making sure the data are more dynamic so that people can run their own analyses and stratify the data by whatever demographic variables they choose," said CDC epidemiologist Amy Zlot, MPH. "Having our Youth Risk Behavior Survey data on the Web means a lot more people have access to the data and use them. It's also a huge help to the media—another group of people who can get useful information from these surveys," noted Laura Kann, PhD, a CDC health survey research specialist who oversees the Youth Risk Behavior Surveillance System (YRBSS). In addition, fewer people are calling CDC to request paper copies of the surveillance reports, she said, because getting the information off the Web is so much faster and easier (see www.cdc.gov/yrbs). The Web has also streamlined and improved the efficiency of processing surveillance data, according to CDC health scientist Steven A. Kinchen, BSICS. "The YRBSS has 80 different surveys going on in the field at the same time. A password-protected, technical assistance Web site allows folks who participate in the YRBSS to see at any point the status of each of those 80 surveys. State and local health and education departments can check the status of their own surveys on-line and also request YRBSS handbooks, forms, and software." The latest development is a new YRBSS Web site that will allow on-the-fly statistical analysis of the raw survey data. "Someone will be able to come to our Web site and make selections about what they want their query to do. They're going to be able to access national, state, and local survey data," explained Mr. Kinchen. "They will be able to pick certain characteristics and do cross-tabulations of several variables. SAS and SUDAAN will be running in the background and cough up the results, but the person doesn't have to know a thing about SAS or SUDAAN to get answers to their queries." |
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"GIS is really expanding our audience because a lot of people—including the public and policymakers—respond to the visual aspects of maps," said Mr. Coss. "It's also a challenge for us. We're used to interacting with our traditional partners in public health, who are already familiar with the data, but newcomers often need more help understanding and interpreting the data," he explained. "This system has really brought that home to us." Reporting Data
On-line "Moving data transmission and reporting to the Web will actually simplify things for health departments and NCCDPHP," said Mr. Coss. Health departments will be able to access the data sooner, and they will not have to wait for CDC to send them CD-ROMs or hassle with loading special software. "More people will have access. All they will need is a computer, a browser, and an Internet connection." The Web is also being used to collect some nonsensitive data. When the data are submitted via the Web, "there will be fewer errors because we can put in range checks, and the data won't have to be re-entered, which means fewer opportunities for mistakes," noted Ms. Zlot. One of the first CDC surveillance systems to collect and edit data on-line is the Water Fluoridation Reporting System (WFRS), developed by CDC in collaboration with the Association of State and Territorial Dental Directors (ASTDD) to monitor fluoridation in the United States. "Since the Environmental Protection Agency does not regulate water fluoridation, most state drinking water programs do not monitor it either. As such, fluoridation monitoring is often left to the oral health programs," explained David M. Apanian, PE, CDC's national fluoridation engineer responsible for the development of WFRS. "Many of these programs do not have the resources or expertise to develop monitoring programs, so ASTDD asked CDC to do this." Since CDC launched WFRS on the Internet in January 2000, 31 states and two tribes have registered to use the system. "Currently, six states and two tribes are entering data each month, and we hope to double this number by the end of the year," Mr. Apanian said. WFRS allows state and tribal fluoridation managers to go on-line to update basic information—such as populations served, fluoridation status, and contact information— for more than 56,000 community water systems. WFRS also maintains data on the relationships between water systems that buy and sell water to each other. Thus, users can find the fluoride content of a water system and whether the system produces its own water or purchases water from another system. Users enter monthly data—such as high, low, and average fluoride concentrations— and indicate whether their water systems met the daily fluoride testing requirements. WFRS then automatically determines if the water system provided optimally fluoridated water for the month. Numerous reports, available with a click of the mouse, provide fluoridation managers with the tools they need to monitor the quality of fluoridation. "WFRS reports identify water systems not maintaining optimal levels of fluoride, making it easier for state and tribal fluoridation managers to provide assistance to these systems. Managers also can print reports listing systems that are optimally fluoridating so that awards can be given," noted Mr. Apanian. Currently, WFRS data can be accessed by registered users only, but plans are under way to provide the public with some information—for example, the fluoride content of any community water system. "Then, parents or pediatricians can check the water fluoride level before deciding whether fluoride supplements are appropriate for children," Mr. Apanian said. In addition, state fluoride managers will have the option of making monthly operational reports for each water system available on-line to the public. CDC also plans to use GIS to place state- and county-based fluoridation information on-line. Fluoridation maps will be overlaid with other oral health indicators, such as the prevalence of untreated decay and dental sealants. "This will allow public health officials to better target interventions to those areas most in need," explained Mr. Apanian. |
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The Internet also is spurring efforts to make data sharing easier between surveillance systems. CDC's National Electronic Disease Surveillance System (NEDSS) is helping several states to develop surveillance systems that can communicate with CDC surveillance systems. NEDSS and these states are selecting standard protocols, languages, and tools they will use to ease such communications. Data sharing among Web sites will allow more one-stop shopping for people seeking health information on the Internet. People will eventually be able to go to an NCCDPHP Web site and get information on a particular topic from many different databases, not just CDC's data sources, predicted Ms. Zlot. "Our goal is to not recreate data sets that already exist. We want our Web sites to be able to draw information from other domains," she said. Why Reinvent the
Wheel? The surveillance system is helping public health programs track oral health at the state level so that they can plan and evaluate their activities. "We've heard from some state dental directors that they are using the system to help them document oral health issues in their states and to track Healthy People 2010 objectives," said Ms. Barker. "States also are identifying oral health data from other Web sites to use interactively with the NOHSS," added CDC dental officer Stuart Lockwood, DMD, MPH. Although the Web site's main target audience includes dental directors, "our Web site statistics show that the bulk of visitors are members of the public. They are accessing our site through the major Internet providers rather than from federal and state government domains," Ms. Barker noted. To help new visitors, the Web site has a glossary that defines oral health terms. "Visitors to the site can choose to view all of the oral health indicators for an individual state or to view one indicator across all states. And for some indicators there are national estimates at different time points," said Ms. Barker. These estimates can be grouped by sociodemographic factors and can be viewed as tables, graphs, or maps. Visitors can choose to compare one state to another or to the nation, overall or by sociodemographic factors." State profiles are another attractive feature of the NOHSS Web site, noted Dr. Lockwood. "They allow a user to select any state and obtain information on demographics, programmatic activities, and administrative characteristics such as the state oral health program's staffing, budget, and funding sources," he explained. Delivering Data to
Communities The Web site describes CDC's Healthy Days survey questions and index, which are used to track the number of days when a person's physical or mental health were not good or when usual activities were limited during the preceding month. Healthy Days questions are part of the BRFSS survey, and they have been adapted for use in other national and local surveys. Here are some examples of how the data are being used:
"Our future plans are to make the HRQOL Web site more comprehensive," said Mr. Moriarty. "We want to put together separate state- and county-level data sets that include BRFSS HRQOL data, key demographic data, and key risk factor data. We want it to be accessible to researchers, communities, and organizations that are putting together report cards for states and counties. And we want the Web site to be searchable and have more links to other, related Web sites and technical reports, such as CDC's new report, Measuring Healthy Days: Population Assessment of Health-Related Quality of Life, which has been successfully disseminated on the Web." "The long-term plan is to provide HRQOL data on the Web and to pro-vide a template for states to use to determine the HRQOL of a particular community," added CDC behavioral scientist Rosemarie Kobau, MPH. For example, a state could use the template to ask: What was the average number of unhealthy days for residents in DeKalb County compared with residents in Clayton County in 1999, and what is it now? Is it getting better or worse over time? "I think it would be helpful for local communities to have a summary measure of community health status that they can track over time. Communities will be able to use the findings to identify areas of need, develop interventions and policies to eliminate any health disparities that are uncovered, and ultimately track improvements in HRQOL," she explained. "It's helpful from a policy standpoint, too—legislators could link improvements in HRQOL to specific social policies." Norma Kanarek, PhD, associate scientist at The Johns Hopkins School of Hygiene and Public Health, agrees that communities will be hungry for this information. She has worked with the Public Health Foundation and CDC to identify community HRQOL indicators and has used HRQOL data to prepare the annual Community Health Status Indicators Reports, which describe the health status of each U.S. county. "We plan to have data queries on the Web so that counties will be able to run the analyses themselves instantly," she said. "This will allow counties to interactively poke around and explore their HRQOL data with some pretty sophisticated capabilities." Soon, such sophisticated uses of Internet data will become commonplace, and nearly everyone in the United States will be connected to the Web. "Today, 70% of all people in California have access to the Internet, and where California goes, everyone else follows," noted Nancy L. Atkinson, PhD, co-director of the Public Health Informatics Research Lab at the University of Maryland, College Park. She said the three fastest growing segments of Internet users in this country are older people, African Americans and Hispanics, and people with household incomes of less than $30,000. With such a diverse and expanding audience on the horizon, NCCDPHP will continue to strengthen its Internet sites by making them more interactive, adding tools such as GIS, and encouraging data sharing between systems. But most importantly, the center will strive to help people, especially newcomers, understand the chronic disease data they are viewing on the Internet, said Mr. Coss. "We have to be very responsible for what information we're putting out there and how it's interpreted."
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Privacy
Policy | Accessibility This page last reviewed August 10, 2004 United
States Department of Health and Human Services |
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