Behavioral Risk Factor Surveillance System (BRFSS)

The Behavioral Risk Factor Surveillance System (BRFSS) was developed in 1984 as a state-based system designed to measure behavioral risk factors associated with chronic diseases and some infectious diseases. The BRFSS is the world's largest ongoing, random-digit dialing telephone survey on health of adults ages 18 years or older. The survey is administered by the health departments in the 50 U.S. states, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands. The target population is noninstitutiona-lized adults ages 18 years or older; however, BRFSS has also been used to collect information about children in the households. A large number of interviews (estimated at 350,000) are conducted annually, facilitating the development of local, state, and national estimates of health conditions and risk behaviors.

Participating areas use a standard core questionnaire of about 75 questions. In addition, states can elect to add their own questions or one or more optional standardized modules. In 2006, BRFSS offered 20 of these optional modules, which vary in number of questions and topic and averaged about six questions per module. The number of state-added questions also varies each year, with some states adding as many as 50. All information is self-reported. The core interview takes about 20 minutes to complete.

BRFSS data are collected by each state or territory with support from the Centers for Disease Control and Prevention (CDC). CDC helps to coordinate activities by the states and CDC-based programs, monitors and enforces standardized data collection protocols, ensures the validity and reliability of the data, assists the states in developing new methods and approaches to data collection, and provides BRFSS data files for public use. Because the states are responsible for conducting the survey, multiple contractors are involved. Standardization is achieved [Page 53]through the use of common training and interviewing protocols.

A stratified sample design is used, which facilitates production of estimates for 54 states and territories and for selected local areas. The Selected Metropolitan/Micropolitan Area Risk Trends (SMART-BRFSS) project uses BRFSS to develop estimates for selected metropolitan and micropolitan statistical areas (MMSAs) with 500 or more respondents. Data from the core survey in each state and territory are combined to produce national estimates.

BRFSS data are also used for rapid response surveillance during health emergencies. In the wake of the September 11, 2001, terrorist attacks in New York and Washington, D.C. BRFSS was used to monitor the mental health status of residents in the most affected areas. During the 2004–05 influenza season, when the supply of available influenza vaccine to the United States was cut nearly in half, the BRFSS was used to monitor influenza vaccination coverage during the season, providing national, state, and local health officials with critical information needed to make vaccine redistribution decisions and to inform public health messages encouraging vaccination among people in high-priority groups.

Procedures for maximizing response rates include online standardized interviewer training (required for all BRFSS interviewers), thorough pretesting of the survey questions, toll-free telephone numbers for participants, automated review of key quality indicators (e.g. response rates, refusal rates, percentage of key items with missing data, distribution of respondents by sex and age), and flexible calling schedules. BRFSS is conducted in English and Spanish.

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