Self-reported oral health perceptions of Somali adults in Minnesota: a pilot study

Abstract: Objective: To assess self‐reported oral health perceptions and associated factors in an adult Somali population living in Minnesota, USA. Methods: We analysed data from a cross‐sectional study of Somali adults aged 18 to 65+ years attending a dental school clinic for care. A comprehensive oral examination was performed by the dental school outreach team on all patients who attended a 2‐week designated Somali dental clinic. Adults who consented were given an oral health questionnaire to collect information on sociodemographics, marital status, language preference and self‐rated oral and general health. We performed summary statistics and differences between proportions using Fisher’s exact test and a comparison of means using one‐way anova or a two‐sample t‐test. Results: The sample consisted of 53 adults, 75% of whom were females. About 49% of subjects reported poor/fair oral health and 38% reported poor/fair general health. Seventy‐four percent rated their access to dental care as poor/fair and 83% reported that they did not have a regular source of dental care. Self‐rated oral health was significantly associated with marital status (P < 0.05) and self‐rated general health (P < 0.01) using Fisher’s exact test. Conclusion: A substantial proportion of Somali adults rated their oral health and access to dental care as poor/fair. These findings suggest that this population would benefit from improved access to oral health care and culturally appropriate oral health education and promotion programs.     

Impact of oral disease on quality of life in the US and Australian populations

Abstract – The US National Health and Nutrition Examination Survey (NHANES 2003–2004) evaluated oral health quality of life for the first time using a previously untested subset of seven Oral Health Impact Profile (OHIP) questions, i.e. the NHANES‐OHIP. Objectives: (i) To describe the impact of dental conditions on quality of life in the US adult population; (ii) to evaluate construct validity and adequacy of the NHANES‐OHIP in NHANES 2003–2004 and a comparable Australian survey. Methods: In the cross‐sectional NHANES 2003–2004 survey of a nationally representative sample of US adults (n = 4907), prevalence was quantified as the proportion of adults who reported experiencing one or more impacts fairly often or very often within the past year. Construct validity was tested by comparing prevalence estimates across categories of sociodemographic, dental health and utilization characteristics known to vary in oral health. In 2002, Australian cross‐sectional survey of a nationally representative sample of adults (n = 2644), adequacy of the NHANES‐OHIP questions were tested with reference to a slightly modified version of the OHIP‐14 questions. Results: NHANES‐OHIP prevalence estimates were markedly similar in the United States (15.3%) and Australia (15.7%). In the US construct, validity was evidenced by higher NHANES‐OHIP scores among groups with greater levels of tooth loss, perceived treatment need and problem‐oriented visiting and with lack of private dental insurance and low income. In Australia, prevalence for the NHANES‐OHIP closely resembled prevalence estimates of the modified OHIP‐14. Both varied to a similar degree across levels of tooth loss, perceived treatment need, problem‐oriented visiting, and private dental insurance and income, demonstrating adequacy of the NHANES‐OHIP as a brief independent instrument. Conclusions: There was acceptable construct validity and adequacy of the NHANES‐OHIP questionnaire. In the United States, the impact of oral disease disproportionately affected disadvantaged groups, a finding that supports application of the US Healthy People 2010 major goals of improved quality of life and reduced health disparities.     

Geriatric oral health issues in Australia

Aim : To identify and discuss geriatric oral health issues in Australia. Methods : A discussion of the demographic trends, oral health trends, and barriers to dental care for older Australians is presented, together with a review of Australian public and private sector geriatric dental services, geriatric dental research, and geriatric dental education. Conclusions : Key geriatric oral health issues for Australia include: edentulism is decreasing and older Australians are retaining more natural teeth; coronal and root caries are significant problems, especially as older adults become more functionally dependent, cognitively impaired, and medically compromised; the oral health status of institutionalised older Australians is poor; the onset of severe oral diseases appears to occur in many older Australians prior to their institutionalisation, when they are homebound and dependent upon carers; carers of older adults do not have access to practical education about dental care; the majority of older Australians are eligible to use public‐funded dental services, but barriers limit their access to these services; few Australian public or private dental services are designed with a geriatric focus; geriatric dental education does not have a high profile in Australian dental schools; no specialty exists in Australia for geriatric dentistry, nor is there a national geriatric dentistry association.     

Perceptions and use of dental quacks (unqualified dental practitioners) and self rated oral health in Trinidad

OBJECTIVE: To investigate reasons for use of dental quacks, treatment received, satisfaction with treatment, perceived differences to qualified dentists, and relationships to sociodemographic factors and self rated oral health. METHOD: A 14-item questionnaire including closed and open questions, was administered by interview to adult patients attending government health centres in Trinidad. RESULTS: Data were collected between November 2001 and March 2002. Two hundred and two people from 273 invited to participate, were interviewed (response rate 74%). Sixty seven per cent reported visiting a dental quack. People who had used a quack were older, from lower socioeconomic groups and more likely to be living in an area where there were fewer government dental clinics. The most common reason for visiting a quack was toothache (74%) and extraction was the most common treatment received (61%). Forty three per cent of respondents were dissatisfied with the treatment received from a quack and 83% felt that treatment provided by a qualified dentist was different. Main reasons for using a quack were cost (53%) and availability (20%). People who had used a quack were less likely to rate their oral health as 'Very good' or 'Excellent'. CONCLUSION: Those using the services of dental quacks in Trinidad were more likely to have lower, self rated oral health. Affordability and availability of dental treatment were identified as barriers to care from qualified dentists.     

Self-reported oral health of a metropolitan homeless population in Australia: comparisons with population-level data

Background: There is limited information on self‐perceived oral health of homeless populations. This study quantified self‐reported oral health among a metropolitan homeless adult population and compared against a representative sample of the metropolitan adult population obtained from the National Survey of Adult Oral Health. Methods: A total of 248 homeless participants (age range 17–78 years, 79% male) completed a self‐report questionnaire. Data for an age‐matched, representative sample of metropolitan‐dwelling adults were obtained from Australia’s second National Survey of Adult Oral Health. Percentage responses and 95% confidence intervals were calculated, with non‐overlapping 95% confidence intervals used to identify statistically significant differences between the two groups. Results: Homeless adults reported poorer oral health than their age‐matched general population counterparts. Twice as many homeless adults reported visiting a dentist more than a year ago and that their usual reason for dental attendance was for a dental problem. The proportion of homeless adults with a perceived need for fillings or extractions was also twice that of their age‐matched general population counterparts. Three times as many homeless adults rated their oral health as ‘fair’ or ‘poor’. Conclusions: A significantly greater proportion of homeless adults in an Australian metropolitan location reported poorer oral health compared with the general metropolitan adult population.     

Oral health status of rural adults in the United States

BACKGROUND: Many sociodemographic indicators of oral health disparity in the United States have been documented. Rural residence, however, has not been researched thoroughly, though it has been considered to be a potential indicator of disparity. The authors conducted this study to present information on the effects of rural residence on oral health in the United States. METHODS: The authors conducted their analyses using data from adults aged 18 to 64 years from the 1995, 1997 and 1998 National Health Interview Surveys and the Third National Health and Nutritional Examination Survey, 1988-94. The authors present national estimates for various oral health status indicators including dental insurance coverage, unmet care needs, frequency of dental visits, caries experience and prevalence of edentulism by rural/urban residence. RESULTS: The authors found that adults living in rural areas were more likely to report having unmet dental care needs and were less likely to have had a dental visit in the past year compared with adults living in urban areas. The prevalence of edentulism among rural adults was 16.3 percent-almost twice that of urban adults. Caries experience also was more likely to be greater among adults residing in rural areas. CONCLUSIONS: Oral health disparities exist among U.S. adults living in rural and urban areas. Compared with urban residents, rural residents were less likely to report a dental visit in the past year and were more likely to be edentulous. PRACTICE IMPLICATIONS: By understanding the rural/urban differences in adult oral health status, practitioners, policy-makers and rural health advocates will have better information to use to promote activities that better meet the needs of rural adults in the United States.     

Self-rated general and oral health in New York City adults: assessing the effect of individual and neighborhood social factors

Borrell LN, Baquero MC. Self‐rated general and oral health in New York City adults: assessing the effect of individual and neighborhood social factors. Community Dent Oral Epidemiol 2011; 39: 361–371. © 2011 John Wiley & Sons A/S Abstract – Objective: This study investigates the independent and joint effects of individual and neighborhood socioeconomic characteristics on self‐rated general and oral health before and after controlling for selected characteristics in adults aged 18 years and older in New York City. Methods: Data for 1168 individuals who participated in the 2004 Social Indicators Survey were linked to neighborhood data from the 2000 US Census. Log‐binomial regression models fitted using generalized estimating equations were used to calculate prevalence ratios (PR) and 95% confidence intervals (CI). sudaan was used to accommodate the complex sampling design of the survey and the intra‐neighborhood correlation of outcomes of individuals residing within the same neighborhoods. Results: After adjusting for selected characteristics, survey participants with 12 years of education or less were almost twice more likely to rate their general health as fair/poor than counterparts with more than 12 years of education [PRs 1.86 (95%CI: 1.16, 3.00) and 1.82 (95%CI: 1.18, 2.82)]. Participants earning <$20 000 (PR: 2.29; 95%CI: 1.23, 4.29) or between $20 000 to $39 999 yearly (PR: 2.24; 95%CI: 1.11, 4.53) were more than twice as likely to rate their general health as fair/poor compared to their counterparts earning over $40 000 yearly. When compared to participants with more than 12 years of education and those reporting an annual income ≥$40 000, the probability of rating oral health as fair/poor was at least 50% greater in participants with <12 years of education (PR: 1.58; 95%CI: 1.11, 2.26) and in participants earning an annual income of <$20 000 (PR: 1.55; 95%CI: 1.10, 2.19). No association was found between neighborhood characteristics for either self‐rated general or oral health. Conclusions: Individual socioeconomic characteristics may be important for both self‐rated general and oral health by affecting individuals’ behaviors and access to resources.     

Evaluating the role of dental behaviour in oral health inequalities

OBJECTIVE: The aim of this study was to describe differences in dental attendance and dental self-care behaviour between socioeconomic groups and to investigate the extent to which the socioeconomic gradient in oral health was explained by these behaviours. METHODS: We used data from a representative sample of adults in Australia, surveyed by telephone interview and by self-complete questionnaire. The dependent variables were self-reported missing teeth and the social impact of oral conditions evaluated with the 14-item Oral Health Impact Profile (OHIP-14). Socioeconomic position was measured at the small-area level. We conducted bivariate analysis using one-way analysis of variance and 95% confidence intervals (95% CI) and adjusted for the effect of age. After adjusting for age, dental behavioural variables were entered individually into multivariate linear regression models. RESULTS: Data were obtained for 3678 dentate adults aged 18-91 years. Missing teeth and OHIP-14 scores followed a social gradient with poorer adults experiencing poorer outcomes. Routine dental attendance and diligent dental self-care were associated with inverse monotonic gradients in missing teeth (P < 0.05) and OHIP-14 scores (P < 0.05). Although adults living in areas with the least disadvantage had a preventive dental attendance orientation, no socioeconomic pattern was found for dental self-care. In multivariate analysis, the slope of the socioeconomic gradient [beta estimate for Index of Relative Socioeconomic Disadvantage (IRSD)] in missing teeth was not significantly attenuated by either dental attendance or dental self-care. For OHIP-14 scores, the slope of the socioeconomic gradient was significantly attenuated by dental visiting, but not by dental self-care and not by the combined effect of both behaviours. CONCLUSION: The commonly held view that the poor oral health of poor people is explained by personal neglect was not supported in this study.     

Association between routine visits for dental checkup and self-perceived oral health in an adult population in Rio de Janeiro: the Pró-Saúde Study

OBJECTIVE: To investigate the association between routine visits for dental checkup and self-perceived oral health. METHODS: Cross-sectional data from a study of university employees in Rio de Janeiro - The Pró-Saúde Study. Self-perceived oral health and the reported pattern and frequency of visits to the dentist were obtained through a multidimensional self-administered questionnaire. RESULTS: Data were obtained from 3252 participants. When compared with individuals who reported self-perceived oral health as good ('very good', 'good' or 'fair') individuals who reported self-perceived oral health as bad ('bad' or 'very bad') were significantly more likely to be older, male, less educated, poorer; they also reported more frequently to have lost more teeth and not visiting the dentist for routine dental 'checkup'. Among those who reported visiting for dental checks at least annually, 3% reported bad oral health, as opposed to 15% among those who reported visiting the dentist only when in trouble. Compared with those who reported visiting the dentist at least annually, odds ratio of bad oral health was 3.9 (95% CI, 2.68-5.67) for subjects who reported visiting only when in trouble, 2.6 (95% CI, 1.51-4.62) who reported visiting for dental checks less frequently than once every 2 years, and 1.4 (95% CI, 0.77-2.52) for subjects who reported visiting for dental checks once every 2 years, after controlling for sex, age, education, income and tooth loss. CONCLUSIONS: Not visiting the dentist for a routine dental check increased the chance of reporting one's own oral health as bad. In any case, the habit of visiting for dental 'checkup, once per year or once every 2 years was associated with nearly all the individuals perceiving his/her oral health positively. However, in order to gather more solid scientific data to guide public policies it is necessary to perform longitudinal studies, especially experiments in different populations focused mainly on the socioeconomic characteristics and dental clinical conditions.     

Access to dental care among older adults in the United States

Oral health is essential to an older adult's general health and well-being. Yet, many older adults are not regular users of dental services and may experience significant barriers to receiving necessary dental care. This literature review summarizes national trends in access to dental care and dental service utilization by older adults in the United States. Issues related to geriatric dentistry and concerns about access to dental care include the increasing diversity of the older adult population, concerns about the degree to which the dental workforce is prepared to meet the oral health needs of older patients, and the adequacy of the future workforce, including concern about training opportunities in gerontology and geriatrics for dental and allied dental practitioners.     

Oral health-related quality of life in a birth cohort of 32-year olds

Abstract – Objectives: To describe oral health‐related quality of life (OHRQoL) among New Zealand adults and assess the relationship between clinical measures of oral health status and a well‐established OHRQoL measure, controlling for sex, socioeconomic status (SES) and use of dental services. Methods: A birth cohort of 924 dentate adults (participants in the Dunedin Multidisciplinary Health and Development Study) was systematically examined for dental caries, tooth loss, and periodontal attachment loss (CAL) at age 32 years. OHRQoL was measured using the 14‐item Oral Health Impact Profile questionnaire (OHIP‐14). The questionnaire also collected data on each study member’s occupation, self‐rated oral health and reasons for seeing a dental care provider. SES was determined from each individual’s occupation at age 32 years. Results: The mean total OHIP‐14 score was 8.0 (SD 8.1); 23.4% of the cohort reported one or more OHIP problems ‘fairly often’ or ‘very often’. When the prevalence of impacts ‘fairly/very often’ was modeled using logistic regression, having untreated caries, two or more sites with CAL of 4+ mm and 1 or more teeth missing by age 32 years remained significantly associated with OHRQoL, after adjusting for sex and ‘episodic’ dental care. Multivariate analysis using Poisson regression determined that being in the low SES group was also associated with the mean number of impacts (extent) and the rated severity of impacts. Conclusions: OHIP‐14 scores were significantly associated with clinical oral health status indicators, independently of sex and socioeconomic inequalities in oral health. The prevalence of impacts (23.4%) in the cohort was significantly greater than age‐ and sex‐standardized estimates from Australia (18.2%) and the UK (15.9%).     

The dental therapist movement in the United States: A critique of current trends

Dental therapists are members of the oral health workforce in over 50 countries in the world typically caring for children in publically funded school‐based programs. A movement has developed in the United States to introduce dental therapists to the oral health workforce in an attempt to improve access to care and to reduce disparities in oral health. This article critiques trends in the United States movement in the context of the history and success of dental therapists practicing internationally. While supporting the dental therapist movement, we challenge: a) the use of dental therapists treating adults, versus focusing on children; b) the use of dental therapists in the private versus the public/not‐for‐profit sector; and c) requirements that a dental therapist must also be credentialed as a dental hygienist.     

Self‐rated oral health and associated factors in Brazilian elders

Pattussi MP, Peres KG, Boing AF, Peres MA, da Costa JSD. Self‐rated oral health and associated factors in Brazilian elders. Community Dent Oral Epidemiol 2010; 38: 348–359. © 2010 John Wiley & Sons A/S Abstract – Objective: Self‐rating provides a simple direct way of capturing perceptions of health. The objective of this study was to estimate the prevalence and associated factors of poor self‐rated oral health among elders. Methods: National data from a cross‐sectional population‐based study with a multistage random sample of 4786 Brazilian older adults (aged 65–74) in 250 towns were analysed. Data collection included oral examinations (WHO 1997) and struct‐ured interviews at elderly households. The outcome was measured by a single five‐point‐response‐scale question dichotomized into ‘poor’ (fair/poor/very poor) and ‘good’ (good/very good) self‐rated oral health. Data analyses used Poisson regression models stratified by sex. Results: The prevalence of poor self‐rated oral health was 46.6% (95% CI: 45.2–48%) in the whole sample, 50.3% (48–52.5) in men and 44.2% (42.4–46) in women. Higher prevalence ratios (PR) were found in elders reporting unfavourable dental appearance (PR = 2.31; 95% CI: 2.02–2.65), poor chewing ability (PR = 1.64; CI: 1.48–1.8) and dental pain (PR = 1.44; CI: 1.04–1.23) in adjusted analysis. Poor self‐perception was also associated with being men, black, unfavourable socioeconomic circumstances, unfavourable clinical oral health and with not using or needing a dental prosthesis. Conclusion: Assessment and understanding of self‐rated oral health should take into account social factors, subjective and clinical oral symptoms.     

Effects of the COVID-19 pandemic on children’s oral health and oral health care use

BackgroundThe COVID-19 pandemic led to early restrictions on access to oral health care and social distancing requirements. The authors examined the early effects of the COVID-19 pandemic on children’s oral health and access to oral health care in the United States.MethodsUsing nationally representative data from the National Survey of Children’s Health, the authors compared several measures of children’s oral health and oral health care use early during the pandemic in 2020 with 1 year earlier. Logistic (multinomial or binary) regression models were estimated, adjusting for several child and household covariates and state fixed effects. Similar comparisons were estimated for 2019 relative to 2018 to evaluate prepandemic trends.ResultsChildren in 2020 were 16% (relative risk ratio, 0.84; 95% CI, 0.75 to 0.93) less likely to have excellent dental health as perceived by parents and 75% (relative risk ratio, 1.75; 95% CI, 1.14 to 2.67) more likely to have poor dental health than in 2019. In addition, children in 2020 had higher risk of bleeding gingivae (odds ratio, 1.46; 95% CI, 1.16 to 1.85). The likelihood of having a dental visit in the past 12 months was 27% (odds ratio, 0.73; 95% CI, 0.65 to 0.82) lower in 2020, including lower likelihood for preventive visits. The differences between 2020 and 2019 were observed across demographic and socioeconomic subgroups. There were no such differences between 2019 and 2018.ConclusionsThere was a widespread decline in children’s oral health status and access to oral health care early during the COVID-19 pandemic.Practical ImplicationsPrompt policies and oral health campaigns are needed to counter the pandemic effects and increase timely access to dental services.     

Older Americans' access to oral health care

To determine whether older Americans have difficulty obtaining access to dental care, we studied 7,265 adults nationwide. The objectives of this analysis are to: (1) determine the proportion of older Americans receiving dental services, (2) identify the types of services received, and (3) examine barriers to access to dental care in this population. Almost half of the respondents over the age of 60 reported a dental visit in the past year. This is consistent with the national trend of increasing utilization of dental services by older adults in the United States. However, older respondents reported significantly fewer dental visits in the past year than respondents aged 25-59. The mean time since the respondent's last dental visit increased with increasing age. Minority elders and those older adults with lower incomes, lower educational achievement, poorer perceived health status, chronic diseases, transportation problems, and those living in rural areas had disproportionately fewer dental visits than more socially advantaged respondents. In multivariate analyses, less education, lower income, increasing age, and poorer self-perceived health status were identified as independent risk factors for not having a dental visit, suggesting that certain subpopulations of older Americans are at risk for not receiving necessary oral health services.     

Strategic partnerships between academic dental institutions and communities: addressing disparities in oral health care

BACKGROUND: A landmark report from the U.S. surgeon general identified disparities in oral health care as an urgent and high-priority problem. A parallel development in the dental education community is the growing consensus that significant curriculum reform is long overdue. METHODS: The authors performed a literature review and conducted a series of structured interviews with key institutional and community stakeholders from seven geographical regions of the United States. They investigated a wide range of partnerships between community-based dental clinics and academic dental institutions. RESULTS: On the basis of their interviews and literature review, the authors identified common themes and made recommendations to the dental community to improve access to care while enhancing the dental curriculum. CONCLUSIONS: Reducing disparities in access to oral health care and the need for reform of the dental curriculum may be addressed, in part, by a common solution: strategic partnerships between academic dental institutions and communities. Practice Implications. Organized dentistry and individual practitioners, along with other major stakeholders, can play a significant role in supporting reform of the dental curriculum and improving access to care.     

Oral health needs and access to dental care of homeless adults in the United States: a review

The homeless population in the United States is one of great diversity that continues to increase in number. Although data on the oral health status of individuals who are homeless is limited, studies consistently report both the perception and clinical evidence of dental needs among this population as well as a low utilization rate for dental services. This article reviews the oral health needs of people who are homeless as reported in literature, barriers to receiving dental care, and methods used to deliver dental care to this population. Many rehabilitation centers for adults who are homeless consider the establishment and maintenance of a state of good general and oral health as a priority and a key factor in helping homeless adults to return to the workforce and mainstream society.     

Parental perceptions of their preschool-aged children's oral health

BACKGROUND: Parents have an important role in making decisions about their children's oral health. The purpose of the authors' study was to determine parental perceptions of their children's oral health status and factors correlated with these perceptions of health. METHODS: The authors analyzed data for 3,424 children (2-5 years of age) from the Third National Health and Nutrition Examination Survey. They based the dependent variable on a question asked of primary caregivers: "How would you describe the condition of [child's name]'s natural teeth?" Explanatory variables included demographic variables, dental visits, perception of child's general health, need for dental care and presence of tooth caries. RESULTS: Eighty-nine percent of parents rated their child's oral health as excellent, very good or good, and 11 percent rated it as fair or poor (mean = 2.7 on a five-point scale, with 1 being excellent and 5 being poor). Tooth caries, perceived need for dental cleaning and treatment, lower income and poorer general health perceptions were associated with poorer parental ratings. CONCLUSIONS: Actual disease and perceived need are associated significantly with parents' perceptions of their children's oral health. PRACTICE IMPLICATIONS: Understanding parents' perceptions of their children's oral health and factors that motivate these perceptions can help dentistry overcome barriers that parents encounter in accessing dental care for their children.     

Expanding Oral Care Opportunities: Direct Access Care Provided by Dental Hygienists in the United States

Dental hygienists expand access to oral care in the United States.BackgroundMany Americans have access to oral health care in traditional dental offices however millions of Americans have unmet dental needs. For decades dental hygienists have provided opportunities for un-served and under-served Americans to receive preventive services in a variety of alternate delivery sites, and referral to licensed dentists for dental care needs.MethodsPublications, state practice acts, state public health departments, the American Dental Hygienists' Association, and personal interviews of dental hygiene practitioners were accessed for information and statistical data.ResultsDental hygienists in 36 states can legally provide direct access care. Dental hygienists are providing preventive services in a variety of settings to previously un-served and under-served Americans, with referral to dentists for dental needs.ConclusionDental hygienists have provided direct access to care in the United States for decades. The exact number of direct access providers in the United States is unknown. Limited research and anecdotal information demonstrate that direct access care has facilitated alternate entry points into the oral health systems for thousands of previously un-served and underserved Americans. Older adults, persons with special needs, children in schools, pregnant women, minority populations, rural populations, and others have benefited from the availability of many services provided by direct access dental hygienists. Legislatures and private groups are becoming increasingly aware of the impact that direct access has made on the delivery of oral health care. Many factors continue to drive the growth of direct access care. Additional research is needed to accumulate qualitative and quantitative outcome data related to direct access care provided by dental hygienists and other mid level providers of oral health services.     

Methodological aspects of a computer-assisted telephone interview survey of oral health

Despite the reported benefits of computer-assisted telephone interview (CATI) methods, experiences from their use in Australian oral health surveys have not been described. This report aimed to present methodological aspects of a CATI survey conducted in the five mainland states. A response rate of 66 per cent was obtained, yielding 4050 completed interviews. Analysis revealed generally small levels of non-response bias: persons who avoided or delayed dental treatment because of cost and non-health card holders were harder to contact, while non-English speakers and persons aged 20–29 years were less likely to participate. A total of 1770 person hours of interview time was spent on the survey: 64.5 per cent of that time was spent on the telephone with an average of 10 minutes 17 seconds per call (13 minutes 37 seconds per completed call). Only seven questions had missing data for more than 1 per cent of respondents. Comprehension of questions and cooperation with the interview was rated by interviewers as 'good' or 'very good' for more than 90 per cent of respondents. The CATI method was highly efficient and yielded good quality data for the survey.