Professional Development Training:Utilization of the Behavioral Risk Factor

Surveillance System (BRFSS) Data

LaTonya BynumArkansas BRFSS Survey Coordinator

October 25, 2011

OutlineoOverview of BRFSS survey

oHistory and purpose of BRFSS

oSurvey Methods

oProcess for Adding Questions

oReview of BRFSS survey results

oDemonstration on how to access data

oExamples of BRFSS Data to Action

Behavioral Risk Factor Surveillance SystemBRFSS is a random digit dial telephone survey that collects health

information from adults on behaviors that put health at risk for premature death and disease.

Six benefits of the survey:

1) Covers most health topics2) Identifies health disparities3) Public data use file4) Results can be viewed online5) Data collected annually6) FREE Technical assistance

• In the 1980s research showed health behaviors play an important role in unnecessary deaths and diseases.

• In 1984 CDC started the state-based BRFSS to collect health information on risk behaviors and health practices that affect health status.

• By 1997 all states were participating.

BRFSS History

BRFSS Survey Design

Telephone SurveysHouseholds with a telephone are selected

People 18 and older are randomly selected

Random Sample

Interviewers are Trained

Computer Assisted Telephone Interview

• Telephone Interview

• Data Entry

Calls are made 7 days a week

• 2,300 – 2,500 calls per month

• More than 100,000 calls nationwide per year

Data Collection

• Arkansas BRFSS contracts with Clearwater Research

• Interviews are monitored to maintain and ensure data quality.

• Data are sent to state & CDC

• CDC aggregates monthly data for the entire year.

• Final data are available by March of the following survey year.

Data are weighted...· to compensate for unequal selection

probability

· to ensure that data can be used to represent the Arkansas adult population

Arkansas BRFSS Facts & Update

• Data collected continuously since 1993

• Sample sizes range: 1,764 – 5,732

• Sends out monthly advance letters

• Moving towards multimodal survey & new weighting procedure

• Cell phone data collection began in 2009

• Oversampling for Blacks and Hispanics

1991

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

0

50

100

150

200

250

300

350

400

450

500

550

600

650

700

750

Arkansas BRFSS Minority Sample Size: Survey Years 1991, 1993 - 2010

Black, NH Hispanic Other, NH

Survey Year

Sa

mp

le S

ize

s

1) Core Asked by all states

2) Optional Modules Specialized topic questions states can choose to

include

3) State-added questions State specific questions to address state and

local issues

Design of BRFSS Questionnaire

• ~ $1,200 - $1,300 per question•July 1 planning for next annual survey begins•New question proposals are due by September•Proposals are reviewed in October•Pre-testing of state added questions begins October•December questionnaire is finalized•New questions are included on survey from January 1 – December 31

How to add BRFSS Questions

CDC Required Response Rate: 40.0%

Arkansas BRFSS 2010 Response Rate: 53.0%

Response Rate for 2010

Who uses it?

· State and Local Health Departments

· Students and Researchers· Non-Profit Agencies· Federal Agencies· Research organizations· Insurance companies· Media

How it is used?· Plan and implement programs like the

UAMS Disability and Health Program· Develop plans to reduce the burden of

Diabetes, Obesity, Heart Disease, and Tobacco

· Identify health disparities across the state

· Prepare grant proposals for state and local level projects

· Conduct public health awareness campaigns for the Arkansas BreastCare program

· Publish scientific articles in professional journals

 

BRFSS

TOBACCO

CANCER CONTROL

ALCOHOL

DISABILITYDIABETES

OBESITY/ OVERWEIGHT

ORAL HEALTH

HEALTH CARE ACCESSWOMEN’S HEALTH

MENTAL HEALTH

+ 100 OTHER TOPICS3

IMMUNIZATIONINJURY

ELDER HEALTH

DEPRESSION

RACISM

BRFSS Topics of Interest...

HIV or STD

SLEEP

Physical Activities or Exercise

1996 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 201045

55

65

75

85

Percentage of Persons 18 and Older Participating in Any Phys-ical Activities or Exercises In The Past Month By Year,

U.S. versus ArkansasU.S. Arkansas

Pe

rce

nta

ge

Source: http://apps.nccd.cdc.gov/brfss/index.asp

Percentage of Persons 18 and Older Participating in Any Physical Activities or Exercises In The Past Month By State, 2010 BRFSS

Source: http://apps.nccd.cdc.gov/gisbrfss/default.aspx

White Black Hispanic Other30

40

50

60

70

80

90

100

70.668.3

70.1 67.6

Percentage of Persons Age 18 and Older Participating in Any Physical Activities or Exercises In The Past Month by Race/

Ethnicity, Arkansas 2009 and 2010

Race/Ethnicity

Perc

ent

State %: 70.2

18-24 25-34 35-44 45-54 55-64 65+0

10

20

30

40

50

60

70

80

90

100

74.6 75.2 74.6 69.1 66.6

62.7

Percentage of Persons Age 18 and Older Participating in Any Physical Activities or Exercises In the Past Month by Age

Group,Arkansas 2009 and 2010

Age Group

Perc

ent

State %: 70.2

< HS Education HS Grad Some College College0

10

20

30

40

50

60

70

80

90

51.5

64.8

70.8

83.6

Percentage of Persons Age 18 and Older Participating in Any Physical Activities or Exercises In the Past Month by Educa-

tional Level, Arkansas 2009 and 2010

Educational Level

Perc

ent

State %: 70.2

0

10

20

30

40

50

60

70

80

90

54.1

63.1

67.4

82.6

Percentage of Persons Age 18 and Older Participating in Any Physical Activities or Exercises In the Past Month by Income

Level, Arkansas 2009 and 2010

Income Level

Perc

ent

State %: 70.2

Nutrition: Consumption of 5 Fruits and

Vegetables Per Day

1996 1998 2000 2002 2003 2005 2007 200910

15

20

25

30

35

40

Percentage of Adults Age 18 and Older Consuming 5 or More Fruits and Vegetables Per Day by Year, U.S. versus Arkansas

U.S. Arkansas

Pe

rce

nta

ge

Source: http://www.brfss.ar.gov

White Black Hispanic Other0

5

10

15

20

25

30

35

20.723.3

21.1

26.8

Percentage of Adults Age 18 and Older Consuming 5 or More Fruits and Vegetables Per Day by Race/Ethnicity,

Arkansas 2007 and 2009

Race/Ethnicity

Perc

ent

State %: 21.1

18-24 25-34 35-44 45-54 55-64 65+0

5

10

15

20

25

30

35

20.1 19.3 19.9 19.9 21.3

25.5

Percentage of Adults Age 18 and Older Consuming 5 or More Fruits and Vegetables Per Day by Age Group,

Arkansas 2007 and 2009

Age Group

Perc

ent

State %: 21.1

< HS Education HS Grad Some College College0

5

10

15

20

25

30

35

40

15.3

18.521.7

25.9

Percentage of Adults Age 18 and Older Consuming 5 or More Fruits and Vegetables Per Day by Educational Level,

Arkansas 2007 and 2009

Educational Level

Perc

ent

State %: 21.1

0

5

10

15

20

25

30

35

40

18.020.3

22.1 22.1

Percentage of Adults Age 18 and Older Consuming 5 or More Fruits and Vegetables Per Day by Income Level, Arkansas

2007 and 2009

Income Level

Perc

ent

State %: 21.1

HIV Testing Results

Arkansas Nationwide (2010 Data)0

10

20

30

40

50

60

35.0

37.2

Percentage of Persons Age 18 - 64 Ever Been Tested for HIV,Arkansas versus US 2009 - 2010P

erce

nt

Source: http://www.brfss.ar.gov

White Black Hispanic0

10

20

30

40

50

60

70

32.4

61.5

31.8

Percentage of Persons Age 18 - 64 Ever Been Tested for HIV by Race/Ethnicity, Arkansas 2009 and 2010

Race/Ethnicity

Perc

ent

State %: 35.0

18-24 25-34 35-44 45-54 55-640

10

20

30

40

50

60

24.5

52.9

42.4

29.5

18.8

Percentage of Persons Age 18 - 64 Ever Been Tested for HIV by Age Group: Arkansas, 2009 and 2010

Age Group

Perc

ent

State %: 35.0

< HS Education HS Grad Some College College0

10

20

30

40

50

60

28.9

33.1 36.8 37.3

Percentage of Persons Age 18 - 64 Ever Been Tested for HIV by Educational Level: Arkansas, 2009 and 2010

Educational Level

Perc

ent

State %: 35.0

0

5

10

15

20

25

30

35

40

45

5045.5

37.435.4 34.3

Percentage of Persons Age 18 - 64 Ever Been Tested for HIVby Income Level: Arkansas, 2009 and 2010

Income Level

Perc

ent

State %: 35.0

Drug treatment facility

Jail or Prison

Counseling and testing office

At home

Somewhere else

Hospital

Clinic

Private Doctor or HMO Office

0 10 20 30 40 50

0.5

1.7

2.9

3.1

12.4

14.6

26.1

38.7

Where did you have your last HIV test?

Percent

Loca

tion

Strengths

• State and County Estimates

• State based survey

• Timeliness

• Cost

• SMART-BRFSS (Statistical Metro-/Micropolitan Risk Trends) – Cities & counties with 500+ observations

• GIS and mapping capability – State and county-level

• Linking to other data sources – EPA & Census data

• Launching follow-up surveys of subpopulations identified in BRFSS – Asthma Follow-up

Weaknesses

• Self Reported

• Small cell sizes

• Telephone coverage

• Technology barriers

• Non-response

• Recall bias

• Language barriers

• Non-institutionalized population

How to Access BRFSS Data

Submit requests to latonya.bynum@arkansas.govTables, charts, fact sheets, GIS maps, or data files

AR BRFSS County Estimates: www.brfss.ar.govClick on BRFSS MapsClick on County DataClick on report of choice (2004 – 2010:xls)

CDC BRFSS: www.cdc.gov/brfssClick on BRFSS MapsClick on Prevalence Data and Trends DataClick on SMART: City and County Data

CDC Prevalence and Trends WebQuery is a web based tool provided by BRFSS

• Data can be exported to Excel

• List data for all states

• Compare state to state or state to nation

• Review or print graph of BRFSS data

• Copy graph and insert into presentation or report

• View trend data by year, state to state, and by respondent answer choice

http://apps.nccd.cdc.gov/brfss/index.asp

Bookmark it!

This is the main page: You can pull-down the

menus to search for

information by state, year and

category.

Select the state of interest, “Arkansas.”

Select the year, “2010.”

Select the category, “Overweight and Obesity

(BMI).” and Press the “Go” Option.

Select the option for “Weight classification by Body Mass Index

(BMI)” by clicking here.

Click the drop down menu and select the option for “Grouped

by Race” and click “Go” button.

This shows the percent of Black adults who reported

they are obese “44.5”.

This shows the Race Category is “Black”, % (Percent), CI

(Confidence Intervals), and n (number of people who were

interviewed).

Resources at www.brfss.ar.gov Arkansas BRFSS Presentations - Presentations that include Arkansas BRFSS data

Arkansas BRFSS Publications- Strategic plans, factsheets, and documents that include Arkansas BRFSS

data

Arkansas BRFSS Quick Links- National query systems that include Arkansas BRFSS data

Arkansas BRFSS Optional Module Data- CDC tabulated reports that include Arkansas BRFSS data on specific

health topics

Arkansas BRFSS GIS Maps- Geographic Information System (GIS) maps that visually display Arkansas

BRFSS county data estimates

Program Modification

The University of Arkansas Medical Sciences (UAMS) Partners for Inclusive (PIC) Communities

Office Modifies the Arkansas Disability and Health Program

The UAMS Partners for Inclusive Communities (PIC) used the BRFSS information to target their health

promotion efforts. After finding disparities in rates of obesity among persons who have a disability, the PIC implemented a new health intervention (Living Well

with a Disability) at local independent living centers in 2007.

Change In Policy

Clean Indoor Air Act Protects the Public from Secondhand Smoke: Act 8

According to the BRFSS, current smoking prevalence among Adults in Arkansas was 23.5% in 2005, compared with

20.5% nationwide. In April 2006, state lawmakers used the BRFSS data to support their decision to pass the

Arkansas Clean Indoor Act, which prohibits smoking in work and public places, including bars and restaurants.

Appropriation of Funds

State Legislator Appropriates $2 Million for Implementation of the Arkansas Cancer Plan

BRFSS data on breast and cervical cancer were included in the Arkansas Cancer Facts and Figures

publication which was used to educate the Arkansas Legislative Public Health Welfare and Labor Committee as well as foster support for

improving public health in Arkansas.

Through broad-based collaborative action, $2 million was successfully secured for

implementation of the Arkansas Cancer Plan.

A powerful tool for health

professionals.

BRFSS

LaTonya Bynum

Arkansas BRFSS Survey Coordinator

LaTonya.Bynum@arkansas.gov

www.brfss.ar.gov

Toll Free Phone: 1-800-462-0599 EXT. 2003

Questions…