Working with the Behavioral Risk Factor Surveillance System (BRFSS) Nagi Salem, Ph.D.

Senior Research Scientist Supervisor Minnesota Department of Health

Outline of Presentation • Minnesota BRFSS • 2005 BRFSS Long Term Plan • Follow-back Surveys • Current Quality Control Issues in BRFSS • Recent State Add-on Topics

BRFSS in Minnesota • Minnesota and it’s population • 87 Counties, Metropolitan Area - 7 counties • Hennepin is the largest county – 25% of the population • Participated in BRFSS since it’s inception in 1984 • Sample size about 4000, without stratification • Quality control measures • Use of synthetic estimates to provide local estimates

Long Term Plan for the BRFSS Questionnaire 2005-2010 • Goals • Building consensus among the States, Behavioral Surveillance Branch (BSB), and CDC Programs concerning length of questionnaire • Having a long term plan should provide assistance to the States in developing their own plan for the state added questions

Long Term Plan for the BRFSS Questionnaire 2005-2010 • Objectives • Monitor behavioral risk that has impact on morbidity and mortality related to chronic conditions • Monitor the health status of the population and the receipt of preventive health services • Assess the prevalence of selected chronic conditions • Facilitate the assessment of selected 2010 National Health Objectives

Fixed Core Questionnaire Topics • Demographics 19 Q’s • General Measures 11 Q’s • Risk Behaviors 16 Q’s • Chronic Conditions 6 Q’s • Emerging Core 4 Q’s

Rotating Core Questionnaire •

Odd Years

• Fruits & Veget. 6 Q’s • Phys. Activities 7 Q’s • Hypertension 2 Q’s • Cholesterol 3 Q’s • Arthritis 5 Q’s •

Even Years

• Women Health 7 Q’s • Prostate Screen 5 Q’s • Colorectal Scr. 4 Q’s • Oral Health 3 Q’s • Injury 4 Q’s

Fixed Core Questions Demographics

• Age • Gender • Racial Makeup • Race • Marital Status • Education Level • Employment Status • Income • Resident County Code • Zip Code 1 Q 1 Q 1 Q 2 Q 1 Q 1 Q 1 Q 1 Q 1 Q 1 Q

Fixed Core Questions Demographics (continued)

• Number of Children • Height/Weight • Number of telephone #’s • Phone interruption • Pregnancy • Veteran Status 1 Q 1 Q 2 Q 2 Q 1 Q 1 Q

Fixed Core Questions General Measures

• Health Status • Health Care Access • Healthy Days • Life Satisfaction • Emotional Support • Disability 1 Q 4 Q 3 Q 1 Q 1 Q 2 Q

Fixed Core Questions Risk Behaviors

• Tobacco Use • Alcohol Consumption • Exercise • Immunization • HIV/AIDS 3 Q 5 Q 1 Q 3 Q 4 Q

Fixed Core Questions Chronic Health Conditions

• Diabetes • Asthma • Cardiovascular Disease 1 Q 2 Q 3 Q

Optional Modules Available in 2007 • Random Child Selection • Childhood Asthma Prevalence • Diabetes • Visual Impairment and Access to Eye Care • Healthy Days (Symptoms) • Cardiovascular Health • Actions to Control High Blood Pressure • Heart Attack and Stroke • Women’s Health • Prostate Cancer Screening • Colorectal Cancer Screening

Optional Modules Available in 2007 (continued) • Adult Asthma History • Arthritis Management • Veteran’s Health Status • Reactions to Race • Mental Illness & Stigma • Sexual Violence • Intimate Partner Violence • General Preparedness

Follow Back Surveys • The response to the question

“may we contact you again to invite you to participate in other studies?”

may provide for an excellent sampling frame for follow back surveys.

• Approximately 90% of BRFSS participants agreed to be called back.

• Excellent response rate among those that could be reached again.

Follow Back Surveys • Follow back surveys could be utilized to assess reliability of data collected through the BRFSS system.

• Target selected populations, for example: Cancer Screening in rural communities Menopausal Study Asthma Callback Survey

Quality Control Issues • Decline in telephone survey response rate • Telecommunication technological changes • Bias and response rate • Other quality control measures, e.g., age group, gender, don’t know/refused, etc.

• Remedies to enhance response rate includes: *Advance letters to encourage participation *Dual mode surveys *Use of postal service household mailing lists

Selected State Added Topics Depression and Anxiety • It is vital for assessment of population health • Evaluating the relationship between depression and anxiety, chronic diseases, and health behaviors • Patient Health Questions 8 (PHQ-8) provides for the development of an index of depression severity • The 8 mode assessment questions include: little interest in doing things; feeling down; trouble falling asleep; feeling tired; poor appetite; feeling bad about self; trouble concentrating; moving slowly • Two questions to assess diagnosed anxiety & depression

Selected State Added Topics Dietary Habits • A short module of six questions to develop a baseline of dietary habit that may impact weight status *Breakfast intake *Frequency of snacking *Use of sugar sweetened beverages *Consumption of fast food meals and main item consumed at last visit *Attempt at reduction of calorie intake

Selected State Added Topics Diabetes Prevention Measures • Diabetes Prevention is a collaborative project between CDC and three States (CA, MA, MN) • Surveillance is a focus area of this project • Minnesota is taking the lead in development of a module to assess the prevalence of pre-diabetes, as well as, the risk for pre-diabetes *Self-reported pre-diabetes *Blood glucose testing *Family history of diabetes *Weight gain *Waist measurement

Contact Information [email protected]

651-201-5996