What is the BRFSS?
BRFSS website: http://www.cdc.gov/brfss/
The Behavioral Risk Factor Surveillance System (BRFSS) is the world’s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. Conducted by the 50 state health departments as well as those in the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands with support from the CDC, the BRFSS provides state-specific information about issues such as asthma, diabetes, health care access, alcohol use, hypertension, obesity, cancer screening, nutrition and physical activity, tobacco use, oral health and more.
Federal, state, and local health officials and researchers use this information to track health risks, identify emerging problems, prevent disease, and improve treatment.
Each year every state completes that year’s BRFSS core set of questions (and the core questions can differ from year to year), but states are also free to add additional modules of questions focusing on specific topics such as diabetes, childhood asthma, or access to eye care.
The BRFSS data includes information at the county level for all states. Some states have also included zip code information. These variables will allow SORHs to differentiate between urban and rural data in the databases and run descriptive and inferential statistics by location.
The complete BRFSS information and data are available from CDC at the above website. From this link you can download the questionnaires in English and Spanish; see what modules were used by your state in each year; create state-level tables and graphs from the interactive databases; and download the full data set for your own data analysis needs, using a statistical software program.
Interactive Guide to BRFSS
Walkthroughs of various portions of the BRFSS website have been created to help you navigate the BRFSS website. They are broken up into the short sections below so that you can walk through those that you feel will best fit your needs.
You will need Adobe's Flash Player to view the animations. You can download the latest version of Flash Player here: Adobe Flash Player
All of the questionnaires for the BRFSS are available on the website. The questionnaires change each year so the variables available are different every year. In addition each state has the option to add questions or include additional modules beyond the core set of questions. The walkthrough below will show you how to get to the questionnaires and determine what questions are available for your state.
|TAKE THE QUESTIONNAIRE WALKTHROUGH|
As stated above, in order to obtain rural data for your state from the BRFSS you will need to download the full data set for your state and analyze it using a statistical software package such as SPSS or SAS.
RECOMMENDATION: You need to determine if there is a department or person at the state level who already downloads the complete BRFSS data set for your state each year and ascertain what analyses they are performing with the data. If this is already happening, then you should get to know the statistician who is doing this and his/her supervisor. Hopefully you can work collaboratively with them to fulfill your rural data needs. If no one is doing this at the state level, you should talk with people in your state health department who could benefit from the BRFSS data and develop an arrangement to work on the data analysis together. USING THE BRFSS DATA SET FOR YOUR STATE REQUIRES THE WORK OF A STATISTICIAN. If you don’t have such a person on your SORH staff, then you need to locate someone who can work with you and negotiate an arrangement to compensate the person if necessary.
Downloading the Data
There are two different data file types available for download. It is important to distinguish between the full annual survey data and the Selected Metropolitan/Micropolitan Area Risk Trends (SMART) data. In order to find information for the entire state and to have geographic variables that allows for differentiation between urban and rural counties, it is important to download the full data set each year. The SMART data is a smaller data set that only includes data from selected metropolitan and micropolitan statistical areas (M/MSAs) and thus does not contain the data necessary to access rural information ( see more information about the SMART data below).
Codebooks and weighting formulas are also available for download, and for those using SAS the format library can be downloaded as well. The statistician you are working with will know what is needed depending on the kind of data analysis you want to perform. To give you an idea of the kind of rural data you can obtain and how you can present it, we have selected one question from the BRFSS core questions on Oral Health, done an example statistical analysis for Arizona, and created a couple of sample charts/graphs/tables that could be used to present the data.
The sample question and possible responses are:
6.1 How long has it been since you last visited a dentist or a dental clinic for any reason? Include visits to dental specialists, such as orthodontists.
- Within the past year (anytime less than 12 months ago)
- Within the past 2 years (1 year but less than 2 years ago)
- Within the past 5 years (2 years but less than 5 years ago)
- 5 or more years ago
- Don’t know / Not sure
Arizona responses, coded by MSA (Metropolitan Statistical Area)
Arizona responses, coded by county
Below is a walkthrough to help you navigate what it means to download a complete data set for your state. If you eventually decide to do this, you will most probably work with a statistician in order to be sure you obtain what is needed.
|TAKE THE DATA DOWNLOAD WALKTHROUGH|
There are several interactive databases available on the BRFSS website. These allow you to look at the data at state and national levels, but not at rural versus urban levels. You can look at prevalence data by year (not all data is available every year as the questionnaires change over time); trends in specific data over multiple years; and GIS maps to show comparisons at the national, state, and MSA level. Below are four walkthroughs to help you understand what kind of data you can get from these interactive data bases that may be of help to you and others in your state.
State Prevalence Data
The prevalence data allows you to choose specific topics by state and year.
|TAKE THE PREVALENCE WALKTHROUGH|
The trends data allows you to look at 16 negative behaviors or circumstances over time including: binge drinking, chronic drinking, current smokers, diabetes awareness, no blood pressure checks, no cholesterol checks, no flu shots, no health insurance, no leisure time physical activity, no mammogram and breast exam, no pap smear, no pneumonia shot, not enough fruits and vegetables, obesity, and overweight.
|TAKE THE TRENDS WALKTHROUGH|
Starting with the 2002 data, GIS maps are available for several different variables by year. The maps are shown of the entire nation for comparison between the states, but you can zoom in to get a closer look at your specific state. Any data for the selected M/MSAs in your state will also be shown for comparison.
|TAKE THE GIS MAPS WALKTHROUGH|
The BRFSS website calls SMART data “local area data” which could easily be interpreted as small local areas or rural areas. This is a good example of several national data bases that say they have local area data. When you look more closely however, you will find that the local areas they are talking about are large cities or M/MSAs. In additional only M/MSAs where at least 500 interviews were completed are selected for the SMART data set. For example, in Arizona the SMART data are available as follows:
Phoenix-Mesa-Scottsdale, AZ Metropolitan Statistical Area
Maricopa County, AZ
Pinal County, AZ
Tucson, AZ Metropolitan Statistical Area
Pima County, AZ
Yuma, AZ Metropolitan Statistical Area
Yuma County, AZ
None of these “local” areas are rural. So if you have a specific interest in looking at this type of data click on the walkthrough link below. However, if you are looking for information at the rural level, this data will not be useful to you.
|TAKE THE SMART DATA WALKTHROUGH|