[Federal Register Volume 88, Number 107 (Monday, June 5, 2023)]
[Notices]
[Pages 36581-36583]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-11859]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
[60Day-23-23FJ; Docket No. CDC-2023-0042]
Proposed Data Collection Submitted for Public Comment and
Recommendations
AGENCY: Centers for Disease Control and Prevention (CDC), Department of
Health and Human Services (HHS).
ACTION: Notice with comment period.
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SUMMARY: The Centers for Disease Control and Prevention (CDC), as part
of its continuing effort to reduce public burden and maximize the
utility of government information, invites the general public and other
federal agencies the opportunity to comment on a proposed information
collection, as required by the Paperwork Reduction Act of 1995. This
notice invites comment on a proposed information collection project
titled Evaluating Deep Learning Algorithm Assessment of Digital
Photographs for Dental Public Health Surveillance. This project entails
one-time data collection of oral health data from 1,000 school students
to examine the feasibility and validity of using digital photos taken
by non-dental professionals, which are analyzed by deep learning
algorithms to assess youth's oral health status.
DATES: CDC must receive written comments on or before August 4, 2023.
ADDRESSES: You may submit comments, identified by Docket No. CDC-2023-
0042 by any of the following methods:
Federal eRulemaking Portal: www.regulations.gov. Follow
the instructions for submitting comments.
Mail: Jeffrey M. Zirger, Information Collection Review
Office, Centers for Disease Control and Prevention, 1600 Clifton Road
NE, MS H21-8, Atlanta, Georgia 30329.
Instructions: All submissions received must include the agency name
and Docket Number. CDC will post, without change, all relevant comments
to www.regulations.gov.
Please note: Submit all comments through the Federal eRulemaking
portal (www.regulations.gov) or by U.S. mail to the address listed
above.
FOR FURTHER INFORMATION CONTACT: To request more information on the
proposed project or to obtain a copy of the information collection plan
and instruments, contact Jeffrey M. Zirger, Information Collection
Review Office, Centers for Disease Control and Prevention, 1600 Clifton
Road NE, MS H21-8, Atlanta, Georgia 30329; Telephone: 404-639-7118;
Email: [email protected].
SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995
(PRA) (44 U.S.C. 3501-3520), federal agencies must obtain approval from
the Office of Management and Budget (OMB) for each collection of
information they conduct or sponsor. In addition, the PRA also requires
federal agencies to provide a 60-day notice in the Federal Register
concerning each proposed collection of information, including each new
proposed collection, each proposed extension of existing collection of
information, and each reinstatement of previously approved information
collection before submitting the collection to the OMB for approval. To
comply with this requirement, we are publishing this notice of a
proposed data collection as described below.
The OMB is particularly interested in comments that will help:
1. Evaluate whether the proposed collection of information is
necessary
[[Page 36582]]
for the proper performance of the functions of the agency, including
whether the information will have practical utility;
2. Evaluate the accuracy of the agency's estimate of the burden of
the proposed collection of information, including the validity of the
methodology and assumptions used;
3. Enhance the quality, utility, and clarity of the information to
be collected;
4. Minimize the burden of the collection of information on those
who are to respond, including through the use of appropriate automated,
electronic, mechanical, or other technological collection techniques or
other forms of information technology, e.g., permitting electronic
submissions of responses; and
5. Assess information collection costs.
Proposed Project
Evaluating Deep Learning Algorithm Assessment of Digital
Photographs for Dental Public Health Surveillance--New--National Center
for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers
for Disease Control and Prevention (CDC).
Background and Brief Description
By age 19, 57% of U.S. adolescents have experienced tooth decay and
17% have at least one decayed tooth needing treatment. Prevalence of
untreated tooth decay among non-Hispanic Black and Mexican American
adolescents is about 30% higher than among non-Hispanic White
adolescents, and among low-income, almost twice the prevalence of
higher-income adolescents. Untreated tooth decay will not resolve and
can cause pain, infection, and difficulties in learning. Poor oral
health in youth is associated with both lower school attendance and
grades. More than 34 million school hours are lost annually due to
unplanned dental visits for acute care needs. Reducing the percentage
of youths who have experienced tooth decay and the percentage with
untreated tooth decay are national health goals (Healthy People 2030).
There are two highly effective interventions to prevent tooth
decay. Dental sealants prevent about 80% of cavities over two years in
the permanent molars where about 90% of tooth decay occurs. Fluoride
can prevent decay in permanent teeth by 15% to 43% per year depending
on mode of delivery. Although the American Dental Association
recommends dentists provide topical fluoride and dental sealants to
youth at risk for caries, uptake of these services is low with about
20% of low-income youth receiving them during an annual dental visit.
Access to these preventive services as measured by dental sealant
prevalence and receipt of preventive dental services among low-income
children are national health goals.
The Centers for Disease Control and Prevention (CDC) has collected
national data on caries, sealant, and fluorosis prevalence in the
National Health and Nutrition Examination Survey (NHANES) for over 30
years and has supported state oral health programs to collect data on
caries and sealant prevalence through cooperative agreements since
2001. Twenty states are currently funded from September 2018 to August
2023 by Actions to Improve Oral Health Outcomes, CDC-RFA-DP18-1810.
Collecting these data can be resource intensive as they are obtained
through visual/tactile examinations conducted by dental professionals.
These data, however, have enabled federal and state agencies to: (1)
prioritize groups at elevated risk for enhanced prevention efforts; (2)
monitor trends in children's oral health status and disparities; (3)
inform planning, implementation and evaluation of effective oral health
interventions, programs, and policies; (4) measure progress toward
Healthy People objectives; and (5) educate the public and policy makers
regarding cross-cutting public health programs. Having local estimates
of these measures would enable decision-makers to better prioritize
communities for programs that increase access to preventive dental
services.
CDC is examining the feasibility and validity of using digital
photos taken by non-dental professionals, which in turn would be
analyzed by deep learning algorithms to assess youth's oral health
status in lieu of human examination. This deep learning assessment tool
ultimately could be used by public health officials for dental public
health surveillance at the local, state, and national level. It is
anticipated that obtaining information on dental conditions via deep
learning assessment of digital images as opposed to human assessment
will: (1) be more cost-effective as it would not require dental
personnel; and (2) improve the accuracy of assessment due to minimal
bias and less confounding factors associated with the examiner (e.g.,
subjective index and thresholding). This tool also would offer
mobility, simplicity, and affordability for rapid and scalable
adaptation in community-based settings.
In order to train and test the deep learning algorithms to identify
caries, sealants, and fluorosis, data on these conditions as assessed
by standardized examiners and corresponding photos are required. The
CDC requests a one-year OMB approval for the one-time collection of
oral health data from 1,000 middle- and high-school students in
Colorado communities with naturally occurring fluoride in the tap water
at or exceeding one part per million. The Colorado State Health
Department will implement the collection by recruiting selected schools
and dental examiners, gaining consent, arranging logistics, and
collecting data from dental examination and photos taken by the dental
examiners. CDC will provide dental examination and photo taking
protocols and train the examiners. Data collected for each student will
include: (1) human assessment of fluorosis severity in the six upper
anterior teeth, and caries/sealant assessment of the occlusal surfaces
of the eight permanent molars; and (2) nine smartphone digital photos
of the upper anterior teeth and 24 intraoral camera digital photos of
the occlusal surfaces of the eight permanent molars. Only de-identified
data will be collected. All de-identified data--digital photos of the
teeth and the completed paper screening form--will be uploaded to a
HIPAA compliant cloud storage box that can only be accessed by
examiners and designated CDC researchers with administrative rights.
CDC is authorized to collect this information under the Public Health
Service Act, title 42, section 247b-14, Oral health promotion and
disease prevention; and the Public Health Service Act, title 42,
section 301.
CDC proposes using data collected from 750 students to train the
deep learning algorithms to assess caries, sealants, and fluorosis and
data from 250 students to evaluate the accuracy of the algorithms in
terms of agreement with standardized examiner assessment. Manuscripts
on: (1) the methodologies used to ensure sufficient photo quality when
taken under field conditions; and (2) the performance of the deep
learning algorithms will be submitted to peer-reviewed journals. The
deep learning tool if sufficiently accurate will be piloted in one data
collection cycle of NHANES that is administered by the National Centers
for Health Statistics (NCHS). Ultimately, the tool would be shared with
the state and local oral health programs, the Association of State and
Territorial Dental Directors, and other pertinent partners.
The CDC requests OMB clearance for data collection for one year.
The total estimated annualized burden hours are 827. There are no costs
to student respondents other than their time.
[[Page 36583]]
Estimated Annualized Burden Hours
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Number of Average burden
Type of respondent Form name Number of responses per per response Total burden
respondents respondent (in hr) (in hr)
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Child.......................................... Screening/photo/form................... 1,000 1 16/60 270
Parent or caretaker............................ Consent................................ 1,000 1 1/60 17
Screener....................................... Screening/photo form includes training, 6 1 90 540
travel, screening and photos, and
ongoing technical assistance.
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Total...................................... ....................................... .............. .............. .............. 827
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Jeffrey M. Zirger,
Lead, Information Collection Review Office, Office of Public Health
Ethics and Regulations, Office of Science, Centers for Disease Control
and Prevention.
[FR Doc. 2023-11859 Filed 6-2-23; 8:45 am]
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