Department of Health and Human Services
Centers for Disease Control and Prevention
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HEALTH RISKS IN THE UNITED STATES
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The BRFSS is a state-based system that is used to gather information through telephone surveys conducted by the health departments of all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam, with assistance from CDC. The BRFSS is the world’s largest continuously conducted telephone health surveillance system, which conducts more than 350,000 interviews per year.
States use BRFSS data to identify emerging health problems, establish health objectives and track their progress toward meeting them, and develop and evaluate public health polices and programs to address identified problems.
The BRFSS is the primary source of data for local entities, states, and the nation on the health-related behaviors of adults. States collect data through monthly telephone interviews with noninstitutionalized adults aged 18 years and older. BRFSS interviewers ask questions related to behaviors that are associated with preventable chronic diseases, injuries, and infectious diseases.
CDC works with states to ensure the success of the BRFSS. For example, CDC public health advisors provide technical assistance, and CDC epidemiologists help with survey methodology and data analysis. To ensure that the BRFSS data are of high quality, CDC generates a household calling list for each state, processes survey data, produces monthly and annual data quality reports, and provides online training for state-based BRFSS coordinators and interviewers. CDC also helps states develop resources to analyze, interpret, and use their survey data. State and local health departments rely on data from the BRFSS to
Researchers, professional groups, managed care organizations, and community-based groups use BRFSS data to develop targeted prevention activities and programs. Public health professionals use the data to monitor the progress of the nation, states, and local areas toward meeting the health objectives in Healthy People 2010. In addition, many countries, including China, Brazil, Mexico, Vietnam, Jordan, and Egypt recognize the value of the BRFSS and have asked CDC to help them establish and evaluate similar surveillance systems.
The BRFSS allows states the flexibility to add questions specific to their needs. At the same time, standard core questions on the survey enable health professionals to make comparisons among states and local areas and also to reach conclusions about the nation as a whole. BRFSS data also highlight state-to-state differences in key health issues. In 2007, for example, the percentage of adults who smoked ranged from 8.7% in the U.S. Virgin Islands to 26.9% in West Virginia.
BRFSS data also can be used to examine smaller geographic areas within states. For example, CDC has analyzed BRFSS data for more than 180 metropolitan and micropolitan statistical areas (MMSAs). The results of this analysis, which are available on a searchable Web site called Selected Metropolitan/Micropolitan Area Risk Trends (SMART) BRFSS, show that the prevalence of high-risk health behaviors varies substantially among MMSAs.
In areas analyzed for 2007,
[A text description of this map is also available.]
The BRFSS also can be used to address urgent and emerging health issues in a particular area. States can add questions on a wide range of important health issues, such as diabetes, indoor air quality, anxiety and depression, folic acid consumption, and natural disasters.
For example, following the devastating effects of Hurricanes Katrina and Rita in 2005, Alabama, Florida, Louisiana, Mississippi, and Texas added an emergency module to assess the impact of these events. In 2008, BRFSS added questions as modules about sleep, adverse childhood events, and social context.
The BRFSS is addressing the challenges presented by a growing demand for survey data. One such challenge is to keep phone interviews to a reasonable length while meeting the demand for data on additional topics. To meet the many challenges, the BRFSS has increased the number of adults interviewed in each state. In 2007, the average number of participants per state was 7,980, compared with 6,712 in 2006. This increase allows states to provide local data and to use split sampling, in which different portions of the sample population answer different sets of BRFSS questions. As a result, states can collect BRFSS data on a wider range of topics each year.
With the addition of the SMART BRFSS, CDC is able to provide data on specific risks for some communities. Another new resource is the BRFSS Maps interactive Web site, which graphically displays the prevalence of behavioral risk factors at state and MMSA levels. This tool is revolutionizing the way people at local, state, and federal levels use BRFSS data by providing easy access to specific examples important to local communities. It is available at http://www.cdc.gov/brfss.
BRFSS added a Web-Enabled Analysis Tool (WEAT) in 2007. WEAT is an online application that analyzes data using a variety of statistical methods. Users are able to run cross-tabulation and logistic regression. It is available at http://www.cdc.gov/brfss.
In 2008, BRFSS implemented the Cell Phone Pilot Survey in 21 states. By including cell phones in the survey, BRFSS is able to reach segments of the population that were previously inaccessible—those who had a cell phone but not a landline—and producing a more representative sample and higher quality data.
States and local areas will continue to rely on the BRFSS to gather the high-quality data they need to plan and evaluate public health programs and to allocate scarce resources. CDC will work closely with state and federal partners to ensure that the BRFSS continues to provide data that are useful for public health research and practice and for state and local health policy decisions.
In 2009, 45 states will begin using the pandemic influenza module. Monitoring the availability of influenza vaccination coverage is a critical element of CDC’s response to a pandemic influenza outbreak. In the event of a pandemic flu outbreak, BRFSS will be prepared to provide local, state, and federal public health officials with vital information to help guide decision making and planning.
As telecommunication technology evolves, CDC is implementing the use of multimode data collection for BRFSS. CDC is also working to make the BRFSS more representative by exploring new ways to reach hard-to-find populations. The challenge for BRFSS is to effectively manage an increasingly complex surveillance system, while adapting to changes in communications technology (increased use of cellular telephones and call-screening devices), societal behaviors (concerns about privacy and declining participation in surveys), and population diversity (increasing number of languages spoken in the United States and greater cultural and ethnic diversity). To address these challenges, BRFSS plans to
When CDC learned that flu vaccine would be in short supply in 2004, public health officials needed to rapidly assess current vaccination rates among groups at highest risk for the flu. Within 1 month, new questions were temporarily added to BRFSS surveys in all states to collect information on vaccine use by all residents aged 6 months or older. The resulting data helped to shape national and state public awareness messages about the vaccine shortage and to guide the distribution of the limited supply.
Data show that screening for colorectal cancer lags far behind screening for other cancers. In 2006, BRFSS data showed that New Mexico’s colorectal cancer screening rates were below the national median. Citing BRFSS data, which indicated better colorectal cancer screening rates in states with mandatory coverage, New Mexico’s legislature passed a law requiring health insurance providers to cover colorectal screening for New Mexico residents aged 50 years and older, joining 22 other states with mandatory coverage.
According to the U.S. Surgeon General, nonsmokers who are exposed to secondhand smoke at home or work have a 25%–30% higher risk for heart disease risk and a 20%–30% higher risk for lung cancer. No level of secondhand smoke exposure is safe. According to BRFSS, current smoking prevalence among Arkansas adults was 23.5% in 2005, compared with 20.5% nationwide. In April 2006, state lawmakers used BRFSS data to help inform their decision to pass the Arkansas Clean Indoor Act, which prohibits smoking in all work and public places including bars and restaurants.
Montana used the BRFSS survey to determine what types of outdoor recreational facilities its residents wanted and needed. The resulting data indicated a need for walking trails, fishing access sites, and boat ramps. State officials used this information to plan new programs, guide how money was spent, and promote physical activity throughout the state.
[A text description of this map is also available.]
Pollutants in the environment have been linked to chronic diseases, such as cancer, asthma, and cardiovascular health problems. Chronic Disease and the Environment is a project which links BRFSS data with EPA air quality data and documents the effects of environmental pollutants on adult health. Although the BRFSS does not directly measure environmental quality (e.g., air pollution, water pollution, community-wide pesticide spraying), environmental information available from other sources, such as the Environmental Protection Agency, was used in conjunction with BRFSS data to compare measures of environmental quality and chronic disease.
In the United States, obesity has risen at an epidemic rate during the past 20 years, and research indicates that the situation is worsening rather than improving. Data from the BRFSS detected a national, state-by-state obesity epidemic faster than any national data set by identifying the areas of the country facing a critical obesity problem. Maps based on BRFSS data were developed, which illustrated the dramatic change in the prevalence of obesity and focused national attention on the issue.
Trend data from BRFSS demonstrated the increasing prevalence of obesity in the United States, regardless of sex, age, race, or educational level. In 1991, four states reported obesity prevalence rates of 15%–19% and no state reported rates higher than 19%. In 2006, only four states had a prevalence of obesity less than 20%. Twenty-two states had obesity prevalence rates equal or greater than 25%, including two states with obesity rates higher than 30%.
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Page last reviewed:
March 31, 2009
Page last modified: March 31, 2009
Content source: National Center for
Chronic Disease Prevention and Health Promotion
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