The Behavioral Risk Factor Surveillance System: Past, Present, and Future

Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington 98121, USA.
Annual Review of Public Health (Impact Factor: 6.47). 05/2009; 30(1):43-54. DOI: 10.1146/annurev.publhealth.031308.100226
Source: PubMed


The Behavioral Risk Factor Surveillance System (BRFSS) is a large state-based telephone survey. BRFSS is designed to monitor the leading risk factors for morbidity and mortality in the United States at the local, state, and national levels. The BRFSS has proven to be a powerful tool for building heath-promotion activities. However, the use of telephone-based, random-digit-dial (RDD) methods in public health surveys and surveillance is at a crossroads. Rapid changes in telecommunication, declines in participation rates, increases in the required level of effort and associated costs are becoming key challenges for BRFSS. To maintain the highest data quality and service to the local and state health departments, BRFSS has adopted an ongoing effort to improve coverage and response to the survey. This article provides an overview of the issues faced by BRFSS and the strategies in place to address them.

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    ABSTRACT: Hypertension is an important and modifiable risk factor for cardiovascular disease and mortality. Over the last decade, national-levels of controlled hypertension have increased, but little information on hypertension prevalence and trends in hypertension treatment and control exists at the county-level. We estimate trends in prevalence, awareness, treatment, and control of hypertension in US counties using data from the National Health and Nutrition Examination Survey (NHANES) in five two-year waves from 1999-2008 including 26,349 adults aged 30 years and older and from the Behavioral Risk Factor Surveillance System (BRFSS) from 1997-2009 including 1,283,722 adults aged 30 years and older. Hypertension was defined as systolic blood pressure (BP) of at least 140 mm Hg, self-reported use of antihypertensive treatment, or both. Hypertension control was defined as systolic BP less than 140 mm Hg. The median prevalence of total hypertension in 2009 was estimated at 37.6% (range: 26.5 to 54.4%) in men and 40.1% (range: 28.5 to 57.9%) in women. Within-state differences in the county prevalence of uncontrolled hypertension were as high as 7.8 percentage points in 2009. Awareness, treatment, and control was highest in the southeastern US, and increased between 2001 and 2009 on average. The median county-level control in men was 57.7% (range: 43.4 to 65.9%) and in women was 57.1% (range: 43.0 to 65.46%) in 2009, with highest rates in white men and black women. While control of hypertension is on the rise, prevalence of total hypertension continues to increase in the US. Concurrent increases in treatment and control of hypertension are promising, but efforts to decrease the prevalence of hypertension are needed.
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    • "In its current form, the BRFSS not only produces a large data set covering a number of health risk behaviors, but also provides a number of services to states which are engaged in the process of data collection [5]. Generation of samples, weighting to account for demographic and geographic variables and programming to support report writing are provided to state coordinators and their staffs. "
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    ABSTRACT: Background In recent years response rates on telephone surveys have been declining. Rates for the behavioral risk factor surveillance system (BRFSS) have also declined, prompting the use of new methods of weighting and the inclusion of cell phone sampling frames. A number of scholars and researchers have conducted studies of the reliability and validity of the BRFSS estimates in the context of these changes. As the BRFSS makes changes in its methods of sampling and weighting, a review of reliability and validity studies of the BRFSS is needed. Methods In order to assess the reliability and validity of prevalence estimates taken from the BRFSS, scholarship published from 2004–2011 dealing with tests of reliability and validity of BRFSS measures was compiled and presented by topics of health risk behavior. Assessments of the quality of each publication were undertaken using a categorical rubric. Higher rankings were achieved by authors who conducted reliability tests using repeated test/retest measures, or who conducted tests using multiple samples. A similar rubric was used to rank validity assessments. Validity tests which compared the BRFSS to physical measures were ranked higher than those comparing the BRFSS to other self-reported data. Literature which undertook more sophisticated statistical comparisons was also ranked higher. Results Overall findings indicated that BRFSS prevalence rates were comparable to other national surveys which rely on self-reports, although specific differences are noted for some categories of response. BRFSS prevalence rates were less similar to surveys which utilize physical measures in addition to self-reported data. There is very little research on reliability and validity for some health topics, but a great deal of information supporting the validity of the BRFSS data for others. Conclusions Limitations of the examination of the BRFSS were due to question differences among surveys used as comparisons, as well as mode of data collection differences. As the BRFSS moves to incorporating cell phone data and changing weighting methods, a review of reliability and validity research indicated that past BRFSS landline only data were reliable and valid as measured against other surveys. New analyses and comparisons of BRFSS data which include the new methodologies and cell phone data will be needed to ascertain the impact of these changes on estimates in the future.
    BMC Medical Research Methodology 03/2013; 13(1):49. DOI:10.1186/1471-2288-13-49 · 2.27 Impact Factor
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