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Using Kansas Local Behavioral Risk
Factor Surveillance System (BRFSS)
Data for Public Health Practice
Pratik Pandya, MPH
Ghazala Perveen, MBBS, PhD, MPH
Ericka Welsh, PhD
General Health Status
Health-Related Quality of
Life and Well-Being
Determinants of Health
Health Disparities
Healthy People 2020:
Foundational Health Measures
Healthy Kansans 2020:
Evaluation Focus Areas
Social determinants
of health in Kansas
Expand reach and
communication via new
technologies
Survey to assess
leading health
challenges
BRFSS Overview
World’s largest annual population-
based survey system, tracking
health conditions and risk behaviors
in the U.S. since 1984
Random digit dial telephone survey
Coordinated by the Centers for
Disease Control and Prevention
Conducted in every state and
several territories in the U.S.
BRFSS Overview
Survey participants
Non-institutionalized adults
18 years and older
Living in private residences
Landline and/or cell phone
services
Our Mission: To protect and improve the health and environment of all Kansans.
BRFSS Overview
Surveillance system to examine
& monitor
Disease status & trends
Risk factors & behaviors
Other issues of public health
importance to Kansans
Kansas BRFSS Overview
Conducted annually
since 1992
Done in-house by
Bureau of Health
Promotion, KDHE
Kansas Survey first
conducted in 1990
Cheyenne
Sherman
Rawlins
Thomas
Decatur Norton Phil lips Smith Jewell
Sheridan Graham Rooks
Wallace
Gree ley Wichita
Logan Gove Trego Ellis
Scott Lane Ness
HodgemanFinneyKearneyHamilton
FordGray
Haske llGrantStanton
Morton Stevens SewardMeade Clark
Russell
Ellsworth
Sa lineDickinson
Marion
Morris
Chase
Greenwood
Elk
Chautauqua
Lyon
M on tgom er yLabette Cherokee
Wilson Crawford
WoodsonAllen Bourbon
CoffeyAnderson
Linn
MiamiFranklin
Osage
WabunseeGeary
Shawnee
Osborne
Republic
CloudMitchell
LincolnOttawa
Washington
Clay
Marsha ll
Riley
Nemaha Brown
Doniphan
Pottawatomie
JacksonAtchison
Jefferson Leavenworth
Wyandotte
DouglasJohnson
Rush Barton
Pawnee
Edwards
Kiowa
Comanche
Stafford
Pra tt
Barber
Rice
Reno
Kingman
Harper
McPherson
Harvey
Sedgwick
Sumner Cowley
Butle r
Neosho
Counties Projected to Receive County Level Data Beginning 2009Counties Receiving County Level Data in Past
Kansas BRFSS Expansion Project:
Addressing Health Disparities
Nutrition, physical
activity, and obesity
Oral health
Reproductive and
sexual health
Social determinants
Maternal, infant,
and child health
Tobacco
Using 12 Leading Health Indicators
to Assess Population Health Status
Access to health
services
Clinical preventive
services
Environmental
quality
Injury and violence
Substance abuse
Mental Health
kansashealthmatters.org
www.kdheks.gov/brfss
www.kdheks.gov/brfss
Kansas Behavioral Risk Factor Surveillance
System (BRFSS) Local Data
Kansas BRFSS Homepage
www.kdheks.gov/brfss
KS BRFSS - Local Data, 2009 NEW
www.kdheks.gov/brfss/Expansion
31
Our Mission: To protect and improve the health and environment of all Kansans.
32
Use of Local BRFSS Data in
Public Health Practice
Community health profile
assessment
Public health policy/decision making
Design public health programs
Garner program funding
Evaluate public health programs
33
Our Mission: To protect and improve the health and environment of all Kansans.
Changes in BRFSS Methodology - Sampling Frame and Weighting Method
In 2011, changes in BRFSS methodology were
made:
o to take into account increasing number of
households with cell phone service use in the
population; and
o to take advantage of advanced statistical
weighting procedures to adjust survey data for
phone use and additional demographic
characteristics of the population.
Source: Blumberg SJ, Luke JV. ireless Substitution: Early Release of Estimates from the National Health Interview Survey,
January-June 2011. Division of Health Interview Statistics, National Center of Health Statistics. Centers of Disease Control
and Prevention. Released 12/21/2011.
9.
6
11.
8
12.6 14.
5
16.1 18.4
21.1 24.9
Cellular (Wireless) Telephone Use
Increased among younger adults
o49-60% ages 18-34; <9% aged 65+
Increased among adults in poverty
o40-51% at or near poverty; 29% higher incomes
Differences by race
o37-43% Hispanics & African Americans; 29% whites
Differences by region
o30-34% Midwest, South & West; 19% Northeast
Cellular (Wireless) Telephone Use
Other demographic variables
oGender
oMarital status
oHome ownership
oEmployment status
oHealth measures
Source: Blumberg SJ, Luke JV. Wireless substitution: Early release of estimates from the National Health Interview Survey,
July–December 2011. National Center for Health Statistics. June 2012. Available from: http://www.cdc.gov/nchs/nhis.htm.
Data Weighting
Increases data representativeness
Used when distributions of
demographic characteristics in
sample and target populations differ
Our Mission: To protect and improve the health and environment of all Kansans.
Changes in BRFSS Methodology
Before 2011 2011 and later
Landline Sample Only Landline and Cell Phone
Sample
Post-stratification weighting Raking
Weighted on less variables Weighted on additional
variables
Our Mission: To protect and improve the health and environment of all Kansans.
Raking reduces bias and allows us to weight for more
variables.
Variables in New Weighting Methodology
Source: “The Effects of Raking and Cell Phone Integration on BRFSS Outcomes” by Machell
Town, M.S. & Carol Pierannunzi, Ph.D. Division of Behavioral Surveillance. Office of
Surveillance, Epidemiology & Laboratory Services. Centers of Disease Control & Prevention.
Impact of New BRFSS Methodology on Estimates of Health Indicators
Must evaluate real changes vs. statistical
artifact in observed prevalence estimates
Cannot compare with prior year data weighted using post-stratification
Break in prevalence trend lines between data weighted by raking vs. post-stratification
Possible shift in absolute prevalence estimates of certain health indicators
oShape and slope of trend lines over time will not be affected by the change in methodology
Prevalence Estimates of Behaviors and Conditions, by Weighting
Method and Telephone Sample — Behavioral Risk Factor
Surveillance System (BRFSS), United States,* 2010
Current Smoking Prevalence Source: MMWR – June 8,2012. 61(22);410-413.
* Data are inclusive of all states and territories in BRFSS, except Tennessee and South Dakota,
which lacked sufficient numbers of cellular telephone interviews in 2010.
Weighted Prevalence Estimates for Current Smokers, by Year,
Weighting Method, and Telephone Source — Behavioral Risk Factor
Surveillance System (BRFSS), United States,* 2000–2010
Source: MMWR – June 8,2012. 61(22);410-413.
* Data are inclusive of all states and territories in BRFSS, except Tennessee and South Dakota,
which lacked sufficient numbers of cellular telephone interviews in 2010.
Prevalence Estimates of Current Smoking by Weighting method and telephone sample - Behavior Risk Factor Surveillance System
(BRFSS), Kansas
Current Smoking in KS - 2010 Data Comparison Using Single & Dual Sampling Frames & Different Weighting Methods
Current Smoking in KS - 2010 and 2011 Data Comparison Using Single & Dual Sampling Frames & Different Weighting Methods
Source: Kansas Behavioral Risk Factor Surveillance System, Bureau of Health Promotion, KDHE
17.0
22.2 24.1
0
5
10
15
20
25
30
Current Smoking
Pe
rce
nta
ge
Landlinetelephoneonly(poststratified)
Landlinetelephoneonly (raking)
Landline andcellulartelephone(raking)
17.0
22.0
0
5
10
15
20
25
30
Current Smoking
Pe
rce
nta
ge
Landlinetelephoneonly(poststratified) 2010estimateLandline andcellulartelephone(raking) 2011estimate
Weighted Prevalence Estimates for Current Smokers by Year,
Weighting Method, and Telephone Source – Behavioral Risk Factor
Surveillance System (BRFSS), KS 2000-2011
Landline telephone only (post stratification) Landline and cellular telephone (raking) Landline telephone only (raking)
Source: Kansas Behavioral Risk Factor Surveillance System, Bureau of Health Promotion, KDHE
21% 22% 22% 20% 20%
18% 20%
18% 18% 18% 17%
0%
5%
10%
15%
20%
25%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Pe
rce
nta
ge
Year
13.4
30.1
17.0 15.1
8.4 8.6 12.5
15.0
29.6
22.0
17.0
9.5 8.8
16.7
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Fair/PoorHealth
Obesity CurrentSmoking
BingeDrinking
Diabetes CurrentAsthma
Lack HealthCare
Coverage
Pe
rce
nta
ge
Health Indicators
2010 landline telephone only samplewith poststratification method
2011 combined landline and cellulartelephone sample with raking method
Source: Kansas Behavioral Risk Factor Surveillance System, Bureau of Health Promotion, KDHE
2010 and 2011 Prevalence Estimates of Health Indicators by
Weighting Method and Telephone Sample - BRFSS, Kansas
Summary
Healthy People 2020 and Healthy Kansans 2020 o Review HP2020 foundational health measures
o Review HP2020 leading health indicators
Accessing BRFSS and Expansion Project data o Kansas Health Matters website
o Access local data from KDHE BRFSS website
Utilization of local and regional BRFSS data o Interpretation of local BRFSS data
o Methodological changes in BRFSS in 2011
o Use of local BRFSS data for community health assessment
Contact Information
Pratik Pandya, MPH
Advanced Epidemiologist
Bureau of Health Promotion
Ericka Welsh, PhD
Senior Chronic Disease Epidemiologist
Bureau of Health Promotion
Ghazala Perveen, MBBS, PhD, MPH
Director of Science and Surveillance/Health Officer II
Bureau of Health Promotion
Our Mission: To protect and improve the health and environment of all Kansans.