Behavioral Risk Factor Surveillance System (BRFSS)

Contributors: Wayne A. Honey, MPH

Jennifer E. Daniel, MPH

Annie Hickman, BS

Survey Unit, Injury & Behavioral Epidemiology Bureau

Epidemiology & Response Division, NM Department of Health

December 8, 2004

BRFSS - Objectives

Determine priority health issues & populations at highest risk for illness, disability, and death.

Support development of strategic plans

Target prevention programs

Educate the public, the health community, and policy makers about disease prevention.

BRFSS - Objectives

Support community policies that promote health and prevent disease.

Monitor the effectiveness of interventions and progress in meeting prevention goals (limited).

BRFSS – Applications (Examples on following slides)

Estimate: Prevalence & Distribution of Selected Diseases/Conditions

Estimate: Prevalence & Distribution of Risk Behaviors & Protective Factors

Comparison to HP2000 & HP2010

Monitor Trends

Binge Drinking 2003Lower UpperTOTAL 5,465 688 15.3 14.1 16.6GENDER

Male 2,211 476 23.7 21.5 25.9Female 3,254 212 7.4 6.3 8.6

AGE18-24 371 107 28.9 23.9 34.625-34 791 177 23.9 20.7 27.635-44 985 155 16.5 13.9 19.445-54 1,176 156 12.8 10.8 15.155-64 900 46 6.6 4.7 9.265-74 699 35 5.1 3.6 7.375+ 522 7 1.4 0.6 2.9

RACE/ETHNICITYWhite, non-Hispanic 3,090 332 12.6 11.2 14.2Hispanic 1,941 307 19.0 16.9 21.4Native American 186 23 15.7 9.9 23.9Other race or multi-racial 214 24 13.6 8.6 20.9

EDUCATIONLess than High School Graduate 734 91 16.9 13.4 21.1High School Graduate or G.E.D. 1,466 211 17.1 14.8 19.8Some College 1,484 211 17.3 14.9 20.0College Graduate 1,757 173 11.0 9.4 12.9

INCOMELess than $10,000 330 42 18.5 12.6 26.2$10-19,999 887 114 17.4 14.2 21.2$20-49,999 2,182 304 17.9 15.9 20.1$50,000 or more 1,509 188 12.3 10.5 14.4

EMPLOYMENTEmployed 3,175 508 18.4 16.7 20.1Unemployed 242 42 24.6 17.6 33.3Other** 2,024 134 8.2 6.7 9.9

REGIONR

NW (Health District 1) 1,194 152 16.1 13.5 19.0NE (Health District 2) 1,049 134 16.3 13.7 19.3SW (Health District 3) 1,072 146 16.8 14.2 19.7SE (Health District 4) 1,055 135 16.5 13.8 19.7Bernalillo County 1,095 121 12.9 10.5 15.6

Demographic Characteristics

Total Number Who Responded to the

Question*Total Number Who Responded "Yes"

Binge drinking: 5 or more drinks on one occasion in the past month

95% Confidence

Interval‡Weighted Percent

(%)§

2003 NM BRFSS & Healthy People 2010 Obj’s

Region‡ U.S.*General health status is fair or poor 16.9 (15.8, 18..1) NA Similar SimilarNo health care coverage 22.1 (20.7, 23.5) 0% Similar HigherNo leisure time physical activity or exercise during the past 30 days 22.9 (21.6, 24.3) < 20% Similar SimilarNo regular, moderate physical activity (30 or more minutes per day, 5 or more days per week) or no regular, vigorous physical activity (20 or more minutes per day, 3 or more days per week) 48.7 (47.0, 50.3) < 30% Similar LowerNo flu shot during the past year (Ages 65 years and older) 27.6 (24.9, 30.4) < 10% Similar SimilarNo pneumococcal vaccine ever (Ages 65 years and older) 36.1 (33.1, 39.2) < 10% Similar SimilarHigh blood pressure 21.1 (19.9, 22.4) < 16% Lower LowerNo blood cholesterol screening within past five years 32.0 (30.4, 33.6) < 20% Similar HigherHigh blood cholesterol 27.2 (25.7, 28.8) < 17% Lower LowerOverweight (BMI = 25.0-29.9) 36.4 (34.8, 38.0) NA Similar SimilarObese (BMI = 30.0+) 20.3 (19.0, 21.6) < 15% Lower LowerOverweight or obese (BMI = 25.0+) 56.6 (55.0, 58.3) NA Similar LowerDiagnosed arthritis 25.6 (24.3, 26.9) NA Similar Similar

Chronic joint symptoms§ 19.1 (17.8, 20.4) NA Similar HigherHistory of asthma 10.5 (9.5, 11.5) NA Similar LowerCurrent asthma 6.7 (6.0, 7.6) NA Similar SimilarDiabetes 5.7 (5.1, 6.4) < 2.5% Lower Lower

Current smokingz22.0 (20.7, 23.4) < 12% Similar Similar

Binge drinking¥ 15.3 (14.1, 16.6) < 6% Similar Similar

Heavy drinking¥ 5.6 (4.9, 6.5) NA Similar SimilarDid not eat 5 or more servings of fruits and vegetables per day 77.6 (76.3, 78.9) NA Similar SimilarHad a sunburn within the past 12 months 34.1 (32.5, 35.7) NA Similar SimilarUnaware that medical treatments can help a person with HIV to live longer 13.0 (11.8, 14.4) NA Similar HigherUnaware that treatment of pregnant mothers can reduce HIV transmission to child 50.5 (48.7, 52.4) NA Similar Higher

Risk Factor/ConditionWeighted Percent

(95% CI)**

New Mexico rates vs.Year 2010 Target̂

Monitor Trends

Breast Cancer ScreeningNo Significant Difference (Other than 1991 & 1997)All Female Respondents Age 40+, excluding DK/NS, Refused, or missing.

BRFSS – Applications (Examples on following slides)

Describe Associations Between Disease/Conditions & Risk Factors

Estimate: Prevalence of Health Care Coverage

Comparisons: State-to-State, State to Nation; sub-state areas

Estimate: Utilization of Preventive Screening

Associations

Prevalence of Chronic Health Conditions*, by disability status

0

20

40

60

80

100No disability

Disability not requiring assistance

Disability requiring assistance

Arthritis(2000)

Diabetes (1998-00)

Hypertension(1999)

Cardio-vasculardisease

(1998,99)

Pe

rce

nt

of

gro

up

wit

h c

on

dit

ion

Osteoporosis(1999)

* Rates are age-adjusted by the direct method to the weighted age distribution of the NM BRFSS survey for the designated year or years.

Comparisons: State-to-State; State-to-Region; State-to-Nation

Percentage of New Mexicans Without Health Care Coverage

Percentage of Adults without Health Care Coverage, by New Mexico, Region*, and U.S.**, 2003

22.1 22.515.4

0

20

40

60

New Mexico Region U.S.* Region includes Arizona, Colorado, Oklahoma, Texas, and Utah.

** U.S. includes the 50 states, plus the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands.

Source: U.S. BRFSS, 2003.

Percentage

Percentage of Women Age 40 and Older Who HaveNever Had a Mammogram, by Education. New Mexico, 2000.

11.07.1

13.9

20.6

0

10

20

30

40

50

< HighSchool

Graduate

HighSchool

Graduateor GED

Somecollege

CollegeGraduate

Percentage

BRFSS - Methodology

Telephone Survey Methods On going Survey of Adults Random Selection of Household Random Selection of One Adult (>= 18 Yrs.) Per

Household Computer-Aided Telephone Interviewing (CATI)

System

NM BRFSS Sample Geographic Stratification*

San Juan Rio Arriba

Los Alamos

TaosColfax Union

McKinley

MoraHarding

Quay

Sandoval

Cibola Bernalillo

Torrance GuadalupeValencia

CatronSocorro

Curry

Roosevelt

Chaves

Lincoln

Grant

HidalgoLuna

Dona Ana

Otero

Lea

Eddy

Sierra

San Miguel

De Baca

Santa Fe

STRATUM/DISTRICT 1 STRATUM/DISTRICT 4

STRATUM/DISTRICT 2 STRATUM 5

STRATUM/DISTRICT 3

21

5

43

Stratified since 2001

2004 Sample Size = 6,430

Sample Per Stratum = 1,286

DSS Design Replicated in each stratum.

2004: 6th Stratum over-sampling Native Americans

*County assignment to strata will change in 2006 to match new Public Health Districts.

BRFSS - Strengths

State & Sub-state Estimates State Control Timeliness Reasonable Reliability & Validity (with caveats) Efficiency (Cost) Effective Monitoring of Data Collection

BRFSS - Weaknesses

Validity (Self-report)

Reliability (Select Variables or small sample size)

Refusal Rates higher than Face-to-Face, and Increasing

Exclusion of non-telephone HH

Exclusion of Cell Phones

Accessing BRFSS Data

Submit requests to wayne.honey@doh.state.nm.usTables, charts, brief reports, or data files

On-Line NM BRFSS Reports: www.health.state.nm.us Click on Health Data tabClick on Health BehaviorsClick on AdultClick on report of choice

CDC BRFSS : www.cdc.gov\brfssClick on Prevalence Data or Trends Data hot keys