LINA BALLUZ, SC.D. MPH
Acting Division Director
Division of Behavioral Surveillance,
Proposed Public Health Surveillance Program Office (PHSPO),
Office of Surveillance, Epidemiology and Laboratory Services (OSELS),
Centers for Disease Control and Prevention
BRFSS History
• State-based system in collaboration with CDC
• Established in 1984 with 15 states
• Began with six individual-level risk factors
associated with leading causes of premature
mortality among adults
• Cigarette smoking; Alcohol use; Physical inactivity; Diet;
Hypertension; Safety belt use
Current BRFSS
• Conducted by all 50 states, DC, Puerto Rico, U.S.
Virgin Islands, and Guam
• Largest continuously conducted telephone health
survey in the world
• More than 414,000 interviews in 2009
• More than 4 millions interviews overall
• Primary focus on adult behaviors linked with
leading causes of morbidity and mortality
Genesis of Project
• Demand for local data
• Increased sample size
• Analysis of smaller
areas possible
• Metropolitan/
Micropolitan
statistical areas
(MMSAs)
• Counties
MMSAs???
• Metropolitan Statistical Area
– Group of counties with 50,000 or more
• Metropolitan Division
– Group of counties within metropolitan statistical area of
2.5 million or more
• Micropolitan Statistical Area
– Group of counties between 10,000 and 50,000
SMART BRFSS was born!!!
• Selected
• Metropolitan/Micropolitan
• Area
• Risk
• Trends
Criteria needed to
included in SMART
• MMSA with at least 500 completed
interviews
• Counties with at least 250 completed
interviews
Data analysis
• MMSA and county specific estimates
• Statistical package that accounts for complex
design
• State weights are adjusted to produce MMSA and
county level weights
• Weighting classes are based on age, gender and
race.
Action
• Identify emerging health problems
• Program development
• Policy development
• Tracking health risk trends
• Program evaluation
MMSA Prevalence (%) of Selected
Health Indicators, 2008
Lowest
Highest
Obesity
14.8 (Boulder, CO)
38.7 (Orangeburg, SC)
Smoking
4.9 (Provo-Orem, UT)
30.9 (Wichita Fall, TX)
No Physical Activity
12.3 (Boulder, CO)
40.1 (Wichita Falls, TX)
Binge Drinking
2.9 (Provo-Orem, UT))
25.1 (Norfolk, NE)
Diabetes
2.8 (Bozeman, MT)
16.7 (Huntington-Ashland, WVKY-OH)
CHD or Angina
2.0 (Boulder, CO)
9.0 (Charleston, WV)
Hypertension
N/A
N/A
County Prevalence (%) of
Selected Health Indicators, 2008
Lowest
Highest
Obesity
11.7 (Summit Co , UT)
40.9 (Laurens Co, SC)
Smoking
4.7 (Utah Co, UT)
30.2 (St. Louis City, MO)
No Physical Activity
9.8 (Douglas Co, CO)
40.1 (Hinds Co, MS)
Binge Drinking
2.9 (Utah Co, UT)
25.4 (Pinal Co, AZ)
Diabetes
2.7 (Summit Co)
13.8 (Jefferson Co, AL)
CHD or Angina
0.8 (Franklin Co, MA)
9.8 (Kanawha Co, WV)
Hypertension
N/A
N/A
SMART BRFSS in Fargo
•
Fargo, ND – 22.3% binge
drinking vs. 15.5% nationwide
•
Formed community coalition:
AMP (Alcohol Misuse Prevention)
•
Mission: Reduce alcohol use among those under 21 in the
Fargo-Moorhead area.
– Anti-binge drinking campaign
– Policy change sanctioning facilities
Local BRFSS Data
Impact
• Williamson County, Texas — 56% no
physical activity, 34% overweight,
and 21% obese
• Local public health officials took
notice — and ACTION
• Created bicycle maps with routes,
roadway ratings, safety tips
• Developed Web-based application
for customized maps
Progression
•
SMART 2002 (BRFSS Sample size=250,121)
–
•
SMART 2003 (BRFSS Sample size= 264,684)
–
•
145 MMSAs, 234 counties for all years
SMART 2007 (BRFSS Sample size= 430,912)
–
•
153 MMSAs; 232 counties
SMART 2006 (BRFSS Sample size= 355,710)
•
•
134 MMSAs; 199 counties
SMART 2005 ((BRFSS Sample size= 356,112)
–
•
105 MMSAs; 153 counties
SMART 2004 (BRFSS Sample size= 303,822)
–
•
98 MMSAs ,146 counties
184 MMSA, 298 counties
SMART 2008 (BRFSS Sample size= 415,526)
–
177 MMSA, 266 counties
Issues
• Two situations in local areas:
• Previously had data
• Local data for first time
• Worked with BRFSS state coordinators
• Worked with National Association of County
and City Health Officials (NACCHO)
• Develop a plan of action
Plan of Action
• Data dissemination
• Contact local health officials
• Contact national partner organizations
• Develop a Web site
Working with NACCHO
• Database of local health officials
• Getting the word out to members
• Conducted regional conference calls
– BSB representatives and BRFSS state coordinators
– Invited all impacted local health officials;
representatives from national partner organizations
• Calls with partners (CSTE, CDD, APHA)
Communication
• Opportunity for feedback and
questions
• Briefed other CDC folks
• Mailed out over 1200 packets of
information
• Worked with APHA for public
announcement
Initial Release
• Started in 2002 but initial release
November 2003
• Progression
– SMART 2003 release (April 2004)
• SMART 2004 release (September 2005)
– SMART 2005 release (September 2006)
SMART Web Site
• Best way to reach our audience
• Set-up Web site in similar format to
existing BRFSS site
• Included new features and dimensions
• Quick-View Charts
• Displaying counties and MMSAs
• Selected variables
BRFSS Challenges
„
Telephone coverage
„
Increase in cell phone usage
„
Negative impact of telemarketers
„
Increasing number of questions
„
Rising demand for state and local level data
SAFER . HEALTHIER . PEOPLE
BRFSS Strengths
„
„
„
„
„
Standardized
− Allows state-to-state comparisons
Flexible
− Addition of questions to address relevant topics
Timely
− Address urgent and emerging health issues
Longevity
− Bank of archived questions
Essential and unique
SAFER . HEALTHIER . PEOPLE
2010 BRFSS
• Cell phone
• Mail survey
• Physical measure