By the early 1980s, scientific research clearly showed that personal
health behaviors played a major role in premature morbidity and mortality.
Although national estimates of health risk behaviors among U.S. adult
populations had been periodically obtained through surveys conducted by the
National Center for Health Statistics (NCHS), these data were not available
on a state-specific basis. This deficiency was viewed as critical for state
health agencies that have the primary role of targeting resources to reduce
behavioral risks and their consequent illnesses. National data may not be
appropriate for any given state; however, state and local agency
participation was critical to achieve national health goals.
About the same time as personal health behaviors received wider
recognition in relation to chronic disease morbidity and mortality,
telephone surveys emerged as an acceptable method for determining the
prevalence of many health risk behaviors among populations. In addition to
their cost advantages, telephone surveys were especially desirable at the
state and local level, where the necessary expertise and resources for
conducting area probability sampling for in-person household interviews were
not likely to be available.
As a result, surveys were developed and conducted to monitor state-level
prevalence of the major behavioral risks among adults associated with
premature morbidity and mortality. The basic philosophy was to collect data
on actual behaviors, rather than on attitudes or knowledge, that would be
especially useful for planning, initiating, supporting, and evaluating
health promotion and disease prevention programs.
To determine feasibility of behavioral surveillance, initial
point-in-time state surveys were conducted in 29 states from 1981–1983. In
1984, The Centers for Disease Control and Prevention (CDC) established the
Behavioral Risk Factor Surveillance System (BRFSS), and 15 states
participated in monthly data collection. Although the BRFSS was designed to
collect state-level data, a number of states from the outset stratified
their samples to allow them to estimate prevalence for regions within their
CDC developed standard core questionnaire for states to use to provide
data that could be compared across states. The BRFSS, administered and
supported by the Division of Adult and Community Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, is an ongoing data
collection program. By 1994, all states, the District of Columbia, and three
territories were participating in the BRFSS.