Award Date


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Environmental and Occupational Health

First Committee Member

Shawn Gerstenberger

Second Committee Member

Mark Buttner

Third Committee Member

Sheniz Moonie

Fourth Committee Member

Fatma Nasoz

Number of Pages



The basis of public health surveillance is the reporting of diseases and conditions to the health department by clinicians and laboratories. In the United States, over eighty diseases and conditions of national importance (e.g., tuberculosis, syphilis, and cancer) are included on the list of Nationally Notifiable Conditions (NNC) for submission to the Centers for Disease Control and Prevention (CDC) by the states. The legal basis for disease reporting is found at the state level, where inconsistent laws may differ in terms of which conditions are reportable and their reporting process. The process by which states require the reporting of NNCs has not been thoroughly described, and the potential bias introduced by different reporting requirements has not been evaluated.

State reportable disease lists were collected from state health department websites, state laws, and published CDC annual summaries. A descriptive, cross-sectional analysis of the reporting requirements of all 50 states, Washington D.C. and New York City was conducted. Factors associated with the states (e.g., population, public health funding) were evaluated to determine if any were associated with having large number of NNCs on the state’s reportable lists. Factors associated with the conditions (e.g. being vaccine preventable or a bioterrorism agent) were evaluated to determine if any were associated with the inclusion on state reporting lists. Additionally, pediatric influenza mortality, lead poisoning, tuberculosis and Shiga toxin-producing Escherichia coli infections were selected for an in-depth analysis of state reporting requirements.

States required 76% to 100% (mean 90%) of NNCs to be reported; only Louisiana required the reporting of all NNCs. No factors associated with the conditions were identified as having a significant association with being included on state reportable lists; only 43% of NNCs were reportable in all states. States used 28 different reporting timeframes and required reporting by 72 different types of reporters. Having a larger state population was associated with requiring a greater number of NNCs to be reported, but no linear relationship was identified. Detailed analysis of the selected conditions found that states did not follow national recommendations when setting state reporting criteria; the inclusion of a new condition on the NNC list is a reflection of reporting practices already established in states, and as such, is not an effective tool to change state reporting practices.

NNC data is frequently used in policy making, funding, and program evaluation, and bias introduced by different state reporting practices may make data collected unreliable for these purposes. This study proposes a method for the standardization of reporting practices across states, allowing for the standardize collection and interpretation of NNC data.


Disease reporting; Nationally notifiable conditions


Public Health

File Format


Degree Grantor

University of Nevada, Las Vegas




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