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Behavioral Risk Factor Surveillance System Survey
Dr. Cara Christ, M.D.Director, Arizona Department of Health Services
Robert BaileyBureau Chief, Division of Public Health Statistics
Judy Bass Arizona BRFSS Program Manager/Coordinator
Speakers
Robert Bailey, Bureau Chief, Public Health Statistics
Dr. Cara Christ, M.D., Director of AZDHS
Carol Pierannunzi, CDC’s BRFSS Senior Methodologist
Dr. Timothy Flood, M.D., Director, Bureau of Public Health
Piper Dubray, Senior Manager, ICF International
An Overview of BRFSS Methodological Approach
Public Health Surveillance Branch
Division of Population Health
Carol PierannunziSenior Survey Methodologist
BRFSS Partnership (since 1983)
CDC/PHSB
Technical assistance
& coordinatio
n
State/Territorial Health
DepartmentsImplementation
Sampling, Questionnaire, &
Data collectionPrograms
Offices (CDC, other federal
agencies)Proposals for
questions
BRFSS Partnership Provides a Unique Dataset
State/territorial-level estimates and confidence intervals
Selected Metropolitan/Micropolitan Area Risk Trends (SMART)
• Direct estimates and confidence intervals for cities and counties where sample size is sufficient
• Over 200 MMSAs in 2012
County-level indicators which are used by:
• Community Health Rankings; Community Health Status Indicators; Health Indicators Warehouse; MedMap
Public datasets which are subsets of data collected by states Rapid response for immunization data
Changes in Methodology
2011 Cell phone interviews included Weighting changes to accommodate cell phone
respondents Availability of new control totals from the ACS
All years since Improvements in sampling (cell geographies) Improvements in weighting controls
Increasing proportions of cell phone respondents Varies by cell phone users within each state Will continue to increase (35-65% in 2016)
• Currently landline-only households in US estimated at 8.5%
2016 Oversample of Alaska Native/ American Indians
Project of the HHS Office of Minority Health 200/300 completes over the 2014 American
Indian/ Alaskan Natives totals in each state PHSB be the liaison between the states and
the HHS PHSB will provide the sample, technical and
analytical support to grantees and data users
BRFSS SAE
Using 2013 data, 16 dichotomous indicators (risk behaviors, chronic disease, health care access)
County level estimates Using ACS PUMA as connection between
BRFSS county information and Census data Reliability and validity article to be released
in tandem with data Estimates, not data, will be released later in
the year Annual releases anticipated
Potential Future of BRFSS Samples Address-Based Sample
Universal coverage using USPS sample Begin by mailing web link
• Some federal surveys have moved to ABS; response rates are lower than current BRFSS
Web-based BRFSS using telephone sample Pilots in past of landline sample No way to connect cell phone to addresses
Internet panels Growing as potential source of information Respondents recruited by phone
Multi-mode samples Weighting and mode issues
Thank [email protected]
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: http://www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
National Center for Chronic Disease Prevention and Health Promotion
Division of Population Health
ARIZONA BRFSS GOALS ACHIEVED IN 2014
In 2014, the cost per interview for cell phones and landlines was
reduced, with cost savings over 3 years of nearly $900,000.
Arizona has rapidly expanded its sample size, reaching its goal of
14,640 completed and partial interviews in 2014.
Arizona collected data on respondents’ nearest cross-streets for
geocoding purposes in the 2014 and 2015 surveys, but this
information will not be released with the dataset.
Topics included in the 2014 survey for the first time were:
-Illegal substance abuse
-Abuse of Prescription Drugs
-Location of Nearest Cross-Streets (for Geocoding purposes)
Arizona’s BRFSS Goals Achieved in 2015
In 2015, Arizona is collecting an oversampling of the Hispanic population within Maricopa and Pima Counties, resulting in a truer representation of Arizona’s population.
Introduced American Sign Language video to capture those respondents with hearing impairment.
BRFSS survey included questions regarding– E Cigarettes– Substance Abuse– Use of any hearing aid devices– Hispanic Population Overlap– Nearest Cross-Streets for Geocoding
Arizona’s BRFSS 2016
As CDC stated Arizona will be participating in the oversampling of Americans Indians.
Arizona BRFSS will continue asking for oversample of Hispanics that are heavily populated in certain regions; and
Continue asking questions regarding:- Use of E-Cigarette- Nearest Cross Street to support GEOCODING- Use of Illegal Drugs
BRFSS Administrative Side
In 2014 a split survey was used to help minimize the length of the survey.
A Data Sharing Agreement will now be required in order to better track the use of the BRFSS data.
The BRFSS annual reports are now available by E-Book
ADHS BRFSS WEBSITE now includes links to CDC/BRFSS’ GIS interactive maps.
Caller ID is in place to help the respondent with questions or concerns they might have. This is another way the respondent can request their telephone number be removed, if they choose to opt out of participating in the survey.
BRFSS WEBSITE◦ http://azdhs.gov/phs/phstats/brfs
◦ What will you find: CDC BRFSS home page Prevalence and trend data “Healthy People” Web page
Arizona BRFSS data sets Data is available in both MS EXCEL
and SAS formats Code Books Questionnaires Trends in questions usage Additional resources
Gateway to Interactive Health data
Human Subject Review BoardDr. Timothy Flood
http://azdhs.gov/phs/phstats/brfs/documents/hsrb-guidelines.pdf
Useful Web links
• Community Profiles Dashboardhttp://azdhs.gov/phs/phstats/profiles/index.php
• Interactive Portalhttp://gis.cdc.gov/grasp/fluview/fluportaldashboard.html
• Chronic Disease GIS Exchange Map Gallery
http://www.cdc.gov/dhdsp/maps/gisx/mapgallery/index.html
Cross-street Questions will be included in AZ BRFSS State-Added questions section
(Timing .93)
The following question will remain on our survey in order to collect GEOCODING data at latitude / longitude coordinates
In order to help us learn more about environmental factors in your area, we would like to know what the nearest intersection to your home is. This information will only be used to group your responses with others from your neighborhood. Your identity and privacy are totally protected. Please name the two nearest major cross-streets (intersection).
This will assist with informed decision-making about financial obligations and to better assist with reporting purposes.
The geocoding and the nearest intersection responses will not be in the public data set.
Geocoding first to mark for 2014/2015
Arizona 2013 Highlights
The annual 2013 AZ BRFSS report will be available at:http://
azdhs.gov/phs/phstats/brfs/reports.htm
GIS interactive maps for Arizonans who reported having flu shots
Risk Factor & Healthcare Indicators re: Influenza flu National & Arizona
Arizonans reporting “Routine Medical Examination in the past 12
months”
Arizonans Could Not Afford Needed Health Care 2011, 2012 and 2013
Frequent Mental Distress by Household income for 2011, 2012 and 2013
Frequent Mental Distress by Smoking Status for 2011, 2012 and 2013
http://wwwn.cdc.gov/sortablestats/
http://wwwn.cdc.gov/sortablestats/
Routine Medial Examinations in the Past 12 Months
BRFSS 2013
2011 2012 2013
Arizona 60.5 62.7 62.6
National 66.1 67 67.9
5
15
25
35
45
55
65
Perc
ent
of
BR
FSS R
espondents
Report
ing h
avin
g a
R
outi
ne M
edic
al Exam
in t
he P
ast
12 M
onth
s
Arizonans Could Not Afford Needed Medical Care
2011 2012 2013
Arizona 18.9 20.9 17.1
National 17.1 16.8 15.3
2.5
7.5
12.5
17.5
22.5
Per
cen
t o
f B
RF
SS
Res
po
nd
ents
Wh
o
Co
uld
No
t A
ffo
rd N
eed
ed H
ealt
hca
re
Frequent Mental Distress (FMD) by Household Income
Below $25,000
$25,000 to 34,999
$35,000 to $49,999
$50,000 to $74,999
Above $75,000
0
5
10
15
20
252011 2012 2013
Income
Perc
en
t
Frequent Mental Distress (FMD) by Smoking Status
2011 2012 20130
5
10
15
20
25
30
35
Current Former Never Smoked
Year
Perc
en
t of
BR
FS
S R
e-sp
on
den
ts R
ep
ort
ing
Fre
-q
uen
t M
en
tal D
istr
ess
Maricopa30%
Yuma, La Paz, & Mohave
14%Apache, Coconino, Navajo, &
Yavapai14%
Pinal, & Gila14%
Cochise, Gra-ham, Greenlee
& Santa Cruz
9%
Pima20%
BRFSS 2014 Annual Target = 14,640
Completed Interviews
$643,020.00
2009 2010 2011 2012 2013 2014 2015$0.00
$100,000.00
$200,000.00
$300,000.00
$400,000.00
$500,000.00
$600,000.00
$700,000.00
$800,000.00
ARIZONA BRFSS FUNDING2009 - 2015
Behavioral Risk Factor Surveillance Survey BRFSS 2016
Core Questions
Optional Modules
State - Added Questions
JUSTIFICATIONS
Timing of the BRFSS 2016 Core questions 15.70 minutes with the introduction 18.59
minutesCore questions
# ?s Asked 2013
# ?s Asked 2014
# ?s Asked 2015
Core ?s 2016
Core ?s 2016 TimingBRFSS 2015
Alcohol Consumption 4 4 4 4 1.084Arthritis Burden 4 4Cancer, Breast/ Cervical 7 7 0.617Cancer, Colorectal 5 5 0.817Cancer, Prostate 6 6 0.246Cholesterol Awareness 3 3Chronic Health Conditions 12 13 13 13 1.455Demographics 29 28 28 28 4.777Diabetes 10 Diabetes-Pre 2 Drinking & Driving 1 1 0.100E-Cigarettes 2 0.4829Exercise (Physical Activity) 8 1 8 1 0.250Falls 3 2 0.677Fruits and Vegetables 6 6Health Care Coverage 8 8 4Health Care Access 1 1 4 0.900Health Days (Quality of Life) 3 3 3 3 0.765Health Literacy 2 0.610Health Status 1 1 1 1 0.210HIV/AIDS 3 3 3 3 1.010Hypertension Awareness 2 2Immunization 4 4 4 4 0.85Inadequate Sleep 1 1 1 0.25Oral Health 2 2 0.61Seatbelt Use 1 1 1 1 0.190Tobacco Use 5 5 5 5 0.402Total number of questions 107 97 89 93Total number of minutes 15.70
BRFSS 2016 Proposed Optional Module
Questions
# of Question
s Timing
Caregiver Module # 6 9 0.92Sugar Sweetened Beverages 2 0.71
Total time 11 1.63
How much time does it take to complete an interview?
Creating questions: Make sure they are short, concise and clear.
How much time are respondents willing to spend in completing the BRFSS survey?
How are we doing in comparison to the other states?
Arizo
na
Arkan
sas
Connec
ticu
t
District Of C
olu...
Mar
ylan
d
New
Ham
pshire
Rhode
Isal
and
Verm
ont
Was
hingto
n
Wyo
min
g0
5
10
15
20
25
30
35
23.5
25.9 25.2
30.3
22.4 22.6
25.6
22
29.2
20.5
BRFSS 2015 Interview Length of Time
Min
ute
s AVG 24.5 Minutes
Minutes
BRFSS 2014 – SPLIT SURVEY
– To keep all questions the Users Group voted on, while not exceeding the desired length of time of 25 minutes for questionnaire.
– BRFSS 2015 did not use a split survey because we were within the goal of 23 minutes to complete an interview.
BRFSS 2016 – core interview is currently timed at 15.82 minutes.
– If we try to stay within the 20-minute time frame, that would only allow
another approximately 1.41 minutes
– By using a split, we can double the number of additional questions, but only asking questions beyond the core and stay within an average length of less than 28 minutes. The effect that using a split survey has on data analysis really depends on the sample size.
– The split is highly recommended to obtain a better representation of the data collected. CDC does require a minimum of 2500 per split, but keeping in mind 500 per Stratum. At present Arizona has 6 stratums/or A.K.A Regions.
COSTS FOR STATE ADDED &OPTIONAL MODULE
State-added and Optional Module costs will be $6,100 per question for 2016
CDC is planning to increase the ratio of cell phone interviews from 30% to nearly 50% over the next 5 years
Therefore, the cost per question will likely increase to $7,100+ in 2017
Voting Process
Applicants have received the proposed questions
Only applicants who are present are allowed to vote
Those who are not qualified applicants will be asked to leave at
the end of the meeting
Q/A session – Discuss whether Arizona should use a Split Survey,
or
Decide which State-Added Questions should be eliminated.
Voting procedures
Final votes are “advisory” to the BRFSS program
Those who attend the meeting will be allowed to vote; each of you will have an electronic clicker which will allow you to vote on which questions you agree to include in the BRFSS 2016 Survey.
The cost for each question will be $6,100. Example: the Healthy Days (Symptoms) module contains 4 questions; therefore, the total cost would be $24,400.
Voting BallotRequest for Split Survey
Type of question
Total Number of questions
Total number of minutes
CORE QUESTIONS W/O Introduction 93 15.70
Caregiver Optional Module 9 0.91
Sugar Sweetened Beverages Module 2 .71
State-Added questions 50 7.31
Director’s request for E-Cig, Use of Illegal Drugs & Nearest Cross Streets
232
0.480.250.93
Grand Total 25.6515
Arizona 2015 vs. 2016 Sample Design
Split Survey?
1. Yes = True2. No = False
True
False
0%
100%
CDC’s Division of Global Migration and Quarantine/Division of Healthcare
Quality Promotion 6 questions1. Yes = True2. No = False
True
False
0%
100%
Preconception Health/Family Planning 7 questions
1. Yes = True2. No = False
True
False
0%
100%
Adverse Childhood Experience? 11 questions
1. Yes = True2. No = False
True
False
0%
100%
Cost of Care-giving for those with chronic disease and disability? 9
questions1. Yes = True2. No = False
True
False
0%
100%
Folic Acid Awareness and Consumption 3 Questions
1. Yes = True2. No = False
True
False
0%
100%
Food Assistance 3 questions
1. Yes = True2. No = False
True
False
0%
100%
Physical Activity Module?
1. Yes =True2. No = False
True
False
0%
100%
Fruits and Vegetables?
1. Yes = True2. No = False
True
False
14%
86%
Sugar Drinks
1. Yes = True2. No = False
True
False
29%
71%
Valley Fever? Two questions
1. Yes =True2. No = False
True
False
20%
80%
2008 2009 2010 2011 2012 2013 2014 2015 20160
10
20
30
40
50
60
46
59
27
48
33
28 29
19
11
Optional Module Question
Nu
mb
er
of
Qu
est
ion
s A
sked
2008 2009 2010 2011 2012 2013 2014 2015 20160
10
20
30
40
50
60
23 23
45
40
45 42
58
29
50
State-Added Questions
Nu
mb
er
of
Qu
esti
on
s A
sked
Arizona BRFSS Annual MeetingTuesday, August 18, 2015
150 N. 18th AvenueALS Training Room
10:00 a.m. -11:30 a.m.
Those who submitted an application were asked to be present or have a representative be physically at the meeting. The reason for this is that there must be someone who has authorization to make decisions that could affect their questions. For example, the eligible voters may ask if the program or stakeholder would be willing to eliminate or modify some of their questions. We have found that once this process begins, it is in the best interest of the program or stakeholder or representative with authorization to be present to make decisions at the meeting. This process can be difficult to decipher over the phone.
Voting Ballot Results
All the applicants voted in favor of a split survey and to include all 60 questions BRFSS Program received for the 2016 survey.
Contact Information
• Judy Bass• Phone # 602 542-1125• E-mail - [email protected]• Website: http://azdhs.gov/phs/phstats/brfs/index.htm
