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Primers on Key Selected Topics      |     July/August 2009     |   Volume Twelve Issue Four
 
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A primer on The Behavioral Risk Factor Surveillance System (BRFSS): we discuss the program established by the Centers for Disease Control and Prevention (CDC) that serves as a state-based system of health surveys that collects information on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury. Significant portions of this primer are excerpted from the CDC web site.
     
Primer
 
 Background
 

Established in 1984, CDC’s Behavioral Risk Factor Surveillance System (BRFSS) has helped states survey U.S. adults to gather information about a wide range of behaviors that affect their health. The primary focus of these surveys has been on behaviors and conditions that are linked with the leading causes of death—heart disease, cancer, stroke, diabetes, and injury—and other important health issues.

 

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. Many states also use BRFSS data to support health-related legislative efforts.

 

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.

 

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.

   

 
 Content
 

BRFSS includes a variety of content applications:

The Chronic Disease Indicators (CDI) is a cross-cutting set of 90 indicators that were developed by consensus and that allows states and territories to uniformly define, collect, and report chronic disease data that are important to public health practice and available at the state level. In addition to providing access to state-specific indicator data, the CDI web site serves as a gateway to additional information and data resources. Categories of Indicators include: Physical Activity and Nutrition, Tobacco and Alcohol; Cancer; Cardiovascular Disease; Diabetes; Arthritis; Overarching Conditions; and Other Diseases and Risk Factors. The Cronic Disease Indicators can be accessed at: http://apps.nccd.cdc.gov/cdi/

Prevalence and Trends Data: BRFSS data can be searched by State, Year and the following prevalence and trends categories: Alcohol Consumption, Arthritis, Asthma, Cardiovascular Disease, Cholesterol Awareness, Colrectal Screening, Demographics, Diabetes, Disability, Exercise, Fruits & Vegetables, Healthcare Access/Coverage, Health Status, Hypertension Awareness, Immunization, Oral Health, Overweight and Obesity, Physical Activity, Prostate Cancer, Tobacco Use, and Women's Health.

The Selected Metropolitan/Micropolitan Area Risk Trends (SMART) project has been introduced to use BRFSS to analyze the data of selected metropolitan and micropolitan statistical areas (MMSAs) with 500 or more respondents. BRFSS data can be used to identify emerging health problems, establish and track health objectives, and develop and evaluate public health policies and programs. BRFSS, CDC is able to provide data on specific risks for some communities.

BRFSS Maps interactive Web site, is a new resource 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.

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.

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.

In 2009, 45 states will be using the pandemic influenza module. BRFSS will be prepared to provide local, state, and federal public health officials with vital information to help guide pandemic decision making and planning.

  

 
 Methodologies
 
Detailed information on overall survey methodology is available in the BRFSS The User's Guide, which addresses:  Processes of the BRFSS; Data collection and management; Survey protocol; Quality assurance, funding; Staffing; Data use and promotion; Questionnaire development; Reference material; Survey methodology; and Tips and pointers from the states. The User's Guide is available at: ftp://ftp.cdc.gov/pub/Data/Brfss/userguide.pdf

In 2007, the BRFSS has increased the number of adults interviewed in each state, with the average number of participants per state increasing to 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.

The following is the computational formula and description of factors that can be taken into account when weighting a state's data for the BRFSS Annual Survey:

BRFSS Weighting Formula:
FINALWT = STRWT * 1 OVER NPH * NAD * POSTSTRAT

The computational formula above is intended to reflect all the possible factors that could be taken into account in weighting a state’s data. Where a factor does not apply its value is set to one.

  • FINALWT is the final weight assigned to each respondent.
  • STRWT accounts for differences in the basic probability of selection among strata (subsets of area code/prefix combinations). It is the inverse of the sampling fraction of each stratum. There is almost never a complete correspondence between strata, which are defined by subsets of area code/prefix combinations, and regions, which are defined by the boundaries of government entities.
  • 1/NPH is the inverse of the number of residential telephone numbers in the respondent's household.
  • NAD is the number of adults in the respondent's household.
  • POSTSTRAT is the number of people in an age-by-gender or age-by-race-by-gender category in the population of a region or a state divided by the sum of the products of the preceding weights for the respondents in that same age-by-gender or age-by-race-by-gender category. It adjusts for non-coverage and non-response and, before 1995, also adjusts for different probabilities of selection by region, where applicable.

Calculation of CHILDWT (the final weight assigned to each child):
CHILDWT = STRWT * 1 OVER NPH * CHILDREN * POSTCH

  • STRWT accounts for differences in the basic probability of selection among strata (subsets of area code/prefix combinations). It is the inverse of the sampling fraction of each stratum. There is almost never a complete correspondence between strata, which are defined by subsets of area code/prefix combinations, and regions, which are defined by the boundaries of government entities.
  • 1/NPH is the inverse of the number of residential telephone numbers in the respondent's household.
  • CHILDREN is the number of children (less than 18 years of age) in the respondent's household.
  • POSTCH is the number of children in an age-by-gender or age-by-race-by-gender category in the population of a region or a state divided by the sum of the products of the preceding weights for the children in that same age-by-gender or age-by-race-by-gender category. It adjusts for non-coverage and non-response.

Calculation of HOUSEWT (the weight assigned to each household)
HOUSEWT = STRWT * 1 OVER NPH * POSTHH

  • STRWT accounts for differences in the basic probability of selection among strata (subsets of area code/prefix combinations). It is the inverse of the sampling fraction of each stratum. There is almost never a complete correspondence between strata, which are defined by subsets of area code/prefix combinations, and regions, which are defined by the boundaries of government entities.
  • 1/NPH is the inverse of the number of residential telephone numbers in the household.
  • POSTHH is the number of households in the population of a region or a state divided by the sum of the products of the preceding weights for the households in that same category. It adjusts for non-coverage and non-response.


     

For More Information
 
CDC Behavioral Risk Factor Surveillance System Web Site:
http://www.cdc.gov/brfss/
  

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