The Behavioral Risk Factor Surveillance System
The majority of indicators (except where otherwise noted) use data from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based, random telephone survey of adults age 18 and older in the United States supported by the Centers for Disease Control and Prevention. Selected local level data are available through the BRFSS Selected Metropolitan/Micropolitan Area Risk Trends (SMART) project, which collects data from selected metropolitan and micropolitan statistical areas (MMSAs) with 500 or more respondents. BRFSS has been a major source of information on health behaviors, preventive health screenings, and immunizations related to the leading causes of death and disability since the mid 1980’s. In order to cover such a wide range of topics the questionnaires vary from year to year and allow states the flexibility to select optional topics. The BRFSS questionnaire consists of three parts: 1) core questions asked to all 50 states, the District of Columbia and selected territories, 2) supplemental modules which are a series of questions on specific topics (e.g. mental health, cognitive health, caregiving), and 3) state-added questions that are selected by individual states.
While the BRFSS has provided some very valuable data on health behaviors and conditions, it does have some limitations. Because it is a telephone survey, households without telephones or using only cell phones are excluded. Also excluded are adults in institutions such as nursing homes, and those that have physical or mental impairments that prevent them from participating in the survey. Results are based on self-reported information on receipt of screenings and vaccinations which has not been verified through chart or record reviews. Respondents also have a natural tendency to underreport undesirable behavior (e.g., smoking or drinking) or their weight and over-report their height. However, the BRFSS has been shown to be a reliable and valid source of health data.(1)
Additional Data Sources
Data for the “No Osteoporosis Screening” indicator come from the Medicare Current Beneficiary Survey (MCBS). MCBS is a continuous, multipurpose survey of a nationally representative sample of the Medicare population, conducted by the Office of Information Products and Data Analysis (OIPDA) of the Centers for Medicare & Medicaid Services (CMS) through a contract with Westat. The central goals of MCBS are to determine expenditures and sources of payment for all services used by Medicare beneficiaries, including co-payments, deductibles, and non-covered services; to ascertain all types of health insurance coverage and relate coverage to sources of payment; and to trace processes over time, such as changes in health status and spending down to Medicaid eligibility and the impacts of program changes, satisfaction with care, and usual source of care. Data are only available at the national level from this data source.
Data for the “No Smoking Cessation Counseling” indicator come from the Medical Expenditures Panel Survey (MEPS). MEPS) is a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States. MEPS is the most complete source of data on the cost and use of health care and health insurance coverage. Data are only available at the national level from this data source.
For data derived from the BRFSS, prevalence estimates and 95% confidence intervals were obtained using Stata Version 9.0 or 11.0 (depending on the year of analysis), which accounts for the complex sample design of the BRFSS. These analyses used sample weights that account for different probabilities of selection and are further adjusted so that results are representative of the adult population in each state by age and gender. Prevalence estimates were determined as mean values for variables coded as 1 for the measure of interest, or 0 for all others with non-missing responses. Stata, by default, computes standard errors and confidence intervals using first-order Taylor linearization; other software packages (e.g. SUDAAN) may use different methods and may produce slightly different confidence intervals, but the same point estimates. Results are presented for the total U.S. (50 states and the District of Columbia), for each state and for selected Metropolitan and Micropolitan Statistical Areas (MMSAs). When the sample size for any group was less than 50, results were not reported as they are thought to be unreliable.
The indicators contained in this Data Portfolio come from reports published by the Centers for Disease Control and Prevention’s Healthy Aging Program. Each report used its own methods and criteria for selecting indicators based on the unique focus area and features of that report.
This Data Portfolio provides user-friendly, easy access to the most currently available data for a selected group of indicators from each of these reports. In some instances, the data included here are more recent than the last hard copy report published. Historical data may be found in the hard copies or PDFs of the individual reports described below.
The State of Aging and Health in America indicators were selected based on their relative importance to the health of adults aged 65 years and older, the availability of data for at least 35 states, and the ability to take action on the particular indicator.
This report focuses on the uptake of selected preventive services in the 50 to 64 year old age group. Indicators were selected by meeting the following criteria:
- Grounded in science and recommended in The Guide to Clinical Preventive Services (A or B level), the Guide to Community Preventive Services, or the Advisory Committee on Immunization Practices
- Has measurable data from at least 35 states.
- High burden and public health significance
- Address one of three underlying risk factors – smoking, physical inactivity and unhealthy diet
- Have a major impact on the most vulnerable populations
- Hold the greatest promise for increasing the use of preventive services through community-based interventions.
This report focuses on gaps in clinical preventive services use among adults aged 65 years or older. The indicators were selected based on U.S. Preventive Services Task Force (i.e., received an A or B recommendation) and Advisory Committee on Immunization Practices recommendations for this age group, taking into consideration which had timely and sufficient data available at the state or national level.
BRFSS asks core questions related to mental health that collect information on the prevalence of social and emotional support, life satisfaction, and the number of mentally unhealthy days. An Anxiety and Depression module was developed for the BRFSS to collect additional information on mental health conditions. In 2006, 38 states and three territories used this module to determine the prevalence of current depression, lifetime diagnosis of depression, and lifetime diagnosis of anxiety. The State of Mental Health and Aging in America reports focus on six indicators related to mental health that were part of the 2006 BRFSS survey, both from core questions and the Anxiety and Depression module. Data are provided for the U.S. population age 50 years or older, with a focus on age, racial/ethnic differences, and sex.
- Nelson DE, Holtzman D, Bolen J, Stanwyck CA, Mack KA. Reliability and validity of measures from the Behavioral Risk Factor Surveillance System (BRFSS). Social and Preventive Medicine 2001;46(Suppl 1):S03-S42.
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