Screening, HPV Vaccination, and Risk Factor Prevalence Estimates

Screening and Risk Factors

Healthy behaviors such as being physically active, avoiding tobacco, limiting the amount of alcohol you drink, and getting cancer screening tests when recommended may prevent or help successfully manage cancer.¹

Monitoring health risk behaviors and use of health care is fundamental to the development of effective public health programs and policies at the state and local levels.²

Because cancer registries do not routinely collect information on health risk behaviors, the data displayed in this section are obtained from the Behavioral Risk Factor Surveillance System (BRFSS). BRFSS is the nation’s premier system of state-based health-related telephone surveys that collect data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services. BRFSS collects data in all 50 states, the District of Columbia, and three U.S. territories. BRFSS completes more than 400,000 adult interviews each year.

Prevalence is the measured or estimated percentage of people with an attribute or disease during a specific time period. The prevalence estimates are from the BRFSS core survey at the state level as well as model-based prevalence estimates for all the counties in the United States.

Crude and age-adjusted prevalence (standardized by direct method to the year 2000 U.S. population, distribution 9 for county estimates)³ are displayed for breast (female), cervical, and colorectal cancer screening measures, and measures for unhealthy behaviors such as physical inactivity, poor nutrition, alcohol consumption, tobacco use, and obesity. Prevalence of lung cancer screening was not included because it is not yet available for all states.

Age-adjusted prevalence is the measured or estimated percentage of people with an attribute or disease during a specific time period, standardized by direct method to the age distribution of the U.S. 2000 standard million population (for state-level estimates). Estimates in the U.S. Cancer Statistics Data Visualizations tool may differ slightly from those published by the National Center for Health Statistics (NCHS) because NCHS uses age groups as recommended by the U.S. Department of Health and Human Services in its adjustment of death rates. In addition, the 2000 U.S. standard population weights are not race- or sex-specific, so they do not adjust for differences in race or sex distribution between geographic areas or populations being compared. They do, however, provide the basis for adjusting for differences in the age distributions across groups defined by sex, race and ethnicity, geography, or other categories.

Data are suppressed if there are fewer than 50 respondents in a specific category such as sex, race, or ethnicity.

Small Area Estimates (County Level)

Small area estimates at the county level using an innovative peer-reviewed multilevel regression and poststratification approach⁴ are calculated using data from CDC’s BRFSS. The primary data sources are BRFSS and the Census 2010 population. You can learn details about the methodology.

The following table shows the measures displayed in the U.S. Cancer Statistics Data Visualizations tool. For measures included in the PLACES website, links to their definitions are also provided.

The following measures, physical activity, fruit consumption, vegetable consumption, ever smoking, and never smoking, are not available in PLACES and are defined below.

150 Minutes or More of Aerobic Physical Activity per Week Among Adults Aged ≥18 Years

Consumed Fruits Less Than Once a Day Among Adults Aged ≥18 Years

Consumed Vegetables Less Than Once a Day Among Adults Aged ≥18 Years

Ever Smoking Among Adults Aged ≥18 Years

Never Smoking Among Adults Aged ≥18 Years

Human Papillomavirus (HPV) Vaccination Coverage

Vaccination against human papillomavirus (HPV) is recommended to prevent new HPV infections and HPV-associated diseases, including some cancers.⁵

Teen vaccination coverage data displayed in U.S. Cancer Statistics Data Visualizations tool are collected through the National Immunization Survey-Teen (NIS-Teen). The NIS-Teen is a random-digit-dialed survey of parents or guardians of teens who are 13 to 17 years old. It has a sample size of more than 20,000 teens. The telephone survey is followed by a questionnaire mailed to vaccination providers to obtain the teen’s vaccination history. Vaccination coverage estimates are based on provider-reported vaccination histories. Complex statistical methods are used to adjust for teens whose parents did not participate in the survey, who lived in households without telephones, or whose vaccination histories were not reported by their providers. You can learn more about how CDC estimates HPV vaccination coverage and the NIS-Teen survey in the NIS-Teen vaccination coverage technical notes.

The Data Visualizations Tool displays HPV vaccination coverage estimates (percentage) by sex for the entire United States, each state, and the District of Columbia, for teens aged 13 to 17 years who were reported being up-to-date on HPV vaccination as recommended by the Advisory Committee on Immunization Practices.

References

1. Pickens CM, Pierannunzi C, Garvin W, Town M. Surveillance for certain health behaviors and conditions among states and selected local areas—Behavioral Risk Factor Surveillance System, United States, 2015. MMWR Surveillance Summaries 2018;67(SS-9):1–90.
2. Holt JB, Huston SL, Heidari K, Schwartz R, Gollmar CW, Tran A, Bryan L, Liu Y, Croft JB. Indicators for chronic disease surveillance—United States, 2013. MMWR Recommendations and Reports 2015:64(RR01):1–15.
3. Klein RJ, Schoenborn CA. Age adjustment using 2000 projected U.S. population. Healthy People 2010 statistical notes, no. 20. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2001.
4. Zhang X, Holt JB, Yun S, Lu H, Greenlund KJ, Croft JB. Validation of multilevel regression and poststratification methodology for small area estimation of health indicators from the Behavioral Risk Factor Surveillance System. American Journal of Epidemiology 2015;182(2):127–137.
5. Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. MMWR 2019;68:698–702.