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Scientific Data Documentation
Behavioral Risk Factor Surveillance System (1989)
BRFS


ABSTRACT

 The Behavioral Risk Factor Surveillance System (BRFSS) is an on-going
 random-digit-dialed telephone survey used to determine the prevalence among
 adults 18 and older of behaviors and practices--such as cigarette smoking,
 seat belt use, blood cholesterol screening, high blood pressure control,
 physical activity, weight control, alcohol use, and drinking and driving--
 which are related to the leading causes of death in the US.  To maximize
 comparability, methods and questionnaires are standardized across partici-
 pating states and over time.  One-time surveys were conducted in 28 states
 (including DC) between 1981 and 1983.  On-going surveillance surveys were
 conducted in 15 states in 1984, 22 states in 1985, 26 states in 1986, 34
 states in 1987, 37 states in 1988, 40 states in 1989, and 45 states in 1990.
 WONDER contains data from the 1989 surveys.  In 1989 the median yearly sample
 size for states was almost 1700.  The results are weighted to take into
 account the effects of telephone non-coverage, non-response, refusals,
 sampling design, and to adjust the survey data to the age-, race-, or sex-
 specific population counts from the most recent census or intercensal
 estimate in each state.


BACKGROUND

 During the 1960s and 1970s, the role of personal behaviors--such as cigarette
 smoking, alcohol consumption, dietary habits, and physical inactivity--as
 risk factors for disease became recognized.  Accordingly, many state health
 departments launched health education and risk reduction programs to reduce
 the prevalence of behavioral risks in the population.  State specific data
 on which to plan or guide these efforts were, however, unavailable, unreli-
 able, or prohibitively expensive.  By 1980, telephone surveys had emerged as
 both a reliable and affordable alternative method for determining the preva-
 lence of behavioral risk factors in the population.  Accordingly, the CDC
 began working with state health departments to develop a system for the on-
 going surveillance of behavioral risk factors in the population using random-
 digit-dialed telephone techniques.  The goal of the system was to collect,
 analyze, and interpret state-specific behavioral risk factor data, in order
 to plan, implement, and monitor public health programs.

 From 1981 to 1983, random-digit-dialed one-time telephone surveys were
 conducted in 29 states (including the District of Columbia) by state health
 department personnel.  These surveys were supported, in part, through funds
 provided in the Health Education and Risk Reduction Grants, with the CDC
 providing training, coordination and standard methods.  Beginning in 1984,
 the surveys have been conducted in a seven-to-ten day period every month
 throughout the year, and have come to be known collectively as the Behavior-
 al Risk Factor Surveillance System (BRFSS).  The CDC continues to provide
 training, coordination, and standard methods and, in addition, provides funds
 directly to the participating state health departments through cooperative
 agreements.  The number of participating states has increased from 15 in
 1984 to 22 in 1985, 26 in 1986, 34 in 1987, 37 in 1988, 40 in 1989, and 45 in
 1990.  Several state health departments have also conducted surveys using
 the standard telephone survey methods and questionnaires without CDC funds.
 Since 1981, 53 different states and territories have participated with the
 CDC in the BRFSS.

 In the BRFSS, respondents are selected randomly from adult civilian residents
 with telephones.  In most states, the telephone number is selected using a
 multistage cluster design known as the Waksberg method.  After a household is
 contacted, an adult aged 18 years or older is randomly selected from among
 the adults residing in the household and interviewed.  If the adult selected
 is not available, the interview is done during a follow-up telephone call.
 To improve efficiency in contacting eligible respondents, the interviews are
 conducted primarily weekday evenings, but also during the day and on
 weekends.  Beginning in 1985, most states began using computer assisted
 telephone interviewing (CATI) to facilitate the interview, data coding and
 entry, and quality control procedures.

 The questionnaire used in Behavioral Risk Factor Surveillance has three
 components:  the core, standardized modules and state-added questions.  The
 core questions and the standardized modules are developed jointly by states
 and CDC.  For comparability, many of these questions have been selected from
 national surveys, such as the National Health Interview Surveys and the
 National Health and Nutrition Examination Surveys.  All states are expected
 to ask the core questions and may choose to add any or all of the standard-
 ized modules.  States with interests beyond the core and standardized mod-
 ules may develop their own state-added questions.  These questions are
 attached at the end of the questionnaire in order to maintain comparability
 between states and over time.

 Upon completing the interviewing cycle each month, the data are keyed and
 sent to CDC for editing.  After editing, the data are weighted to provide
 representative population-based estimates of risk factor prevalence
 (accounting for telephone noncoverage, nonresponse, refusals, and the cluster
 survey design).  The weighted and unweighted tabulations are provided to the
 states within six months of completion of the last December interview.  In
 addition, the CDC publishes the annual summary and selected risk-factor
 specific reports throughout the year in the Morbidity and Mortality Weekly
 Report

 The information gathered under the BRFSS is expected to support risk reduc-
 tion and disease prevention activities by state health departments.
 Because comparable methods are used from state to state and from
 year to year, states can compare risk factor prevalence with other states and
 monitor the effects of interventions over time.  Also, the use of consistent
 methods in a large group of states permits the assessment of geographic
 patterns of risk factor prevalence.  These telephone survey techniques can
 also be applied at the community level to guide local efforts in reducing
 risk factor prevalence.  Taken together, the behavioral risk factor survey
 and surveillance data provide a new resource to guide state and local disease
 prevention efforts.

 The BRFSS is coordinated by the Behavioral Surveillance Branch (BSB), Office
 of Surveillance and Analysis, National Center for Chronic Disease Prevention
 and Health Promotion, CDC, Atlanta, Georgia.  Information about the BRFSS
 (including copies of BRFSS publications, presentations, or questionnaires)
 can be obtained from the participating state health departments or from the
 Behavioral Surveillance Branch.


RISK FACTOR DEFINITIONS

          SEATBELT(1)      RESPONDENTS REPORTING THEY "SELDOM" OR "NEVER"
                           USE SEATBELTS.
          SEATBELT(2)      RESPONDENTS REPORTING THEY "SOMETIMES", "SELDOM"
                           OR "NEVER" USE SEATBELTS.
                           THESE DATA ITEMS ARE CLOSER TO
                           VALIDATION STUDIES OF SEATBELT USAGE
                           THAN SEATBELT(1) I.E., _RFSEATB.
          HYPERTENSION(1)  RESPONDENTS WHO REPORT THEY HAVE NEVER BEEN
                           TOLD THEY ARE HYPERTENSIVE AND
                           THEIR BLOOD PRESSURE IS  "STILL HIGH".
          HYPERTENSION(2)  RESPONDENTS WHO REPORT THEY HAVE NEVER BEEN
                           TOLD THEY ARE HYPERTENSIVE.
          HYPERTENSION(3)  RESPONDENTS WHO REPORT THEY HAVE BEEN TOLD THEIR
                           BLOOD PRESSURE IS HIGH MORE THAN ONCE,
                           OR ARE ON MEDICATION,
                           OR REPORT THEIR BLOOD PRESSURE IS STILL HIGH.
                           THIS DATA ITEM HAS BEEN ADDED TO DEFINE
                           "CURRENT HYPERTENSIVES",
                           A REFLECTION OF THE KNOWN, DIAGNOSED
                           HYPERTENSIVES IN THE POPULATION.
                           THIS IS THE NATIONAL HEART, LUNG AND BLOOD
                           INSTITUTES DEFINITION.
          OVERWEIGHT (1)   RESPONDENT AT OR ABOVE 120% OF IDEAL WEIGHT.
                           IDEAL WEIGHT DEFINED AS THE
                           MID-VALUE OF A MEDIAN FRAME PERSON FROM THE
                           1959 METROPOLITAN HEIGHT-WEIGHT TABLES.
          OVERWEIGHT (2)   FEMALES WITH BODY MASS INDEX
                           (WEIGHT IN KILOGRAMS DIVIDED BY HEIGHT
                           IN METERS SQUARED (W/H**2)) >=27.3
                           AND MALES WITH BODY MASS INDEX >=27.8
          SMOKING          CURRENT REGULAR SMOKER (EVER SMOKED 100
                           CIGARETTES AND SMOKE NOW).
          ACUTE DRINKING   RESPONDENTS WHO REPORT HAVING FIVE OR MORE
                           DRINKS ON AN OCCASION, ONE OR MORE
                           TIMES IN THE PAST MONTH.
          DRINK/DRIVE      RESPONDENTS WHO REPORT HAVING DRIVEN AFTER
                           HAVING TOO MUCH TO DRINK, ONE OR
                           MORE TIMES IN THE PAST MONTH.
          CHRON. DRINKING  RESPONDENTS WHO REPORT AN AVERAGE OF 60 OR
                           MORE ALCOHOLIC DRINKS A MONTH.
          SEDENTARY LIFE   RESPONDENTS AT SEDENTARY OR IRREGULAR
                           ACTIVITY LEVEL.

SURVEY BY STATE



This page last reviewed: Thursday, January 28, 2016
This information is provided as technical reference material. Please contact us at cwus@cdc.gov to request a simple text version of this document.
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