Behavioral Risk Factor Surveillance System

The Behavioral Risk Factor Surveillance System (BRFSS) is a survey conducted annually in the United States by the Centers for Disease Control and Prevention (CDC) in cooperation with state health departments. The BRFSS, whose primary focus is behavioral risks to health, began collecting data in 1984 with 15 states participating; since 1994, all 50 states, the District of Columbia, and the territories of Puerto Rico, Guam, and the U.S. Virgin Islands have been included in the BRFSS.

The BRFSS was the first ongoing national survey to collect data about health and health risk behaviors, and it was designed from the start to provide estimates of these behaviors at both the state and the national levels. Creation of the BRFSS was in large part due to the realization by epidemiologists and public health officials, in the early 1980s, of how much influence individual health and health risk behaviors such as smoking and exercise exerted on morbidity and mortality.

BRFSS data are collected through telephone surveys on a rolling basis throughout the year. The actual data collection is performed either by state health departments or by contractors, using a standardized questionnaire developed by the CDC in cooperation with the state health departments. [Page 76]Households surveyed are selected through randomdigit dialing, and one adult (defined as a person 18 years of age or older) in a selected household is surveyed. Information about health risk behavior of persons younger than 18 years is collected in a separate survey, the Youth Risk Behavior Surveillance System. Persons living in institutions or who do not have a home telephone are automatically excluded from the sample, as are people who are not willing and able to complete a telephone interview in English or Spanish. The states send the collected data to the CDC, who aggregates it, then returns it to the states, and publishes it on the BRFSS Web site.

The BRFSS questionnaire consists of three parts:

• 1.
  the core component, meaning those questions used by all states and territories; these questions are provided by the CDC and must be administered using exactly the wording and order in the questionnaire;
• 2.
  optional modules, meaning sets of questions on specific topics such as arthritis or exercise behaviors, which each state may choose to administer or not; these questions are provided by the CDC, and the states are required to use the module exactly as written and in its entirety (although once chosen, the module must be administered exactly as provided in the questionnaire); and
• 3.
  state-added questions, which are developed or otherwise acquired by an individual state in response to their specific concerns; these questions are not provided by the CDC, and their subject matter, wording, and order are determined entirely by the state using the questions.

The core component is further divided into fixed core component questions such as demographics and major risk behaviors such as smoking, which are asked every year; rotating core component questions that are included in the core every other year and as optional module questions in the alternate years; and emerging issues core questions that typically focus on ‘late-breaking’ health issues. Optional modules are self-contained units that consist of questions focused on a particular topic: For instance, in 2005 there were 26 optional modules whose focus included diabetes, prostate cancer screening, indoor air quality, and intimate partner violence. Up to 10 emerging issues questions may be included in a given year: After that year, they are either discontinued or incorporated into the core or optional modules.

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