Behavioral-Risk-Factor Surveillance--Selected States
Gary C. Hogelin Field Services Branch
Division of Nutrition Center for Health Promotion and Education
The 10 leading causes of premature death in the United States are related to known behavioral risk factors. Among these risk factors are cigarette smoking, excessive alcohol consumption, uncontrolled hypertension, sedentary lifestyle, obesity, and accidents (including automobile accidents related to heavy drinking, lack of seat-belt use, etc.). Although a few intermittent national surveys have been done, the prevalence of these risk factors within states has been largely unknown. Recently, six states performed surveys to determine the prevalence of these risk factors among their adult populations.
During 1981, five states (Colorado, Connecticut, Georgia, Minnesota, and Wisconsin) undertook random-digit-dialing telephone surveys (1,2t), and a sixth state, Maine, did a household survey to determine the prevalence of risk factors. The risk factors addressed in these surveys were the same (Table 1); however, data for each risk-factor category other than smoking reflect various definitions as footnoted in Table 1. Except for the hypertension question in the Maine study, in which blood pressure was measured at the time of interview, these self-reported survey responses were not validated. Three (Colorado, Minnesota, and Wisconsin) of the six surveys analyze unweighted data.
Smoking. Reported prevalence of cigarette smoking among male respondents was consistently higher than among female respondents and ranged in the six states surveyed from 23% for male respondents more than or equal to 55 years old in Wisconsin and Maine to 48% for young adult male respondents in Maine (Table 1, Figure 1). The prevalence of cigarette smoking reported among females in this study ranged from 16% for female respondents more than or equal to 55 years old in Wisconsin to 40% of the female respondents more than or equal to 55 years old in Colorado. Whereas rates of smoking for male respondents more than or equal to 55 years old were generally lower than those for the other age groups in the six states surveyed, the patterns of prevalence of cigarette smoking for both males and females varied to some degree.
Alcohol Use. Similarly, in this study, heavy drinking varied both by age and geographic location (Table 1). Chronic heavy drinking, like cigarette smoking, was more prevalent among males than females in all age groups and in all the states surveyed, but the variation among states was large. Similarly, young males were more likely than older male respondents to be both acute and chronic heavy drinkers, while the patterns were less consistent by age among female respondents.
Hypertension. On the other hand, there was not a consistent pattern of a relative increase in uncontrolled hypertension for male and female respondents in the six states surveyed. The reported prevalence in uncontrolled hypertension among male respondents ranged from a low of zero for male respondents 35-54 years old in Georgia to 26% among male respondents more than or equal to 55 years old in Minnesota.
Injury Control. Seat-belt use varied significantly among states, in part because of differences in case definition. In Colorado, 77% of female respondents in the age group 18-34 years reported not using seat belts at least 50% of the time, whereas, using the same criteria, 29% of female respondents of the same age in Connecticut reported using seat belts. However, when looking at those who reported using seat belts less than 50% of the time, there was little variation among age groups and between the sexes.
Obesity. Finally, there was a consistent increase in reported obesity by age in several states, although this pattern was not universal. For example, although only 8% of female respondents 18-34 years of age in Colorado reported being overweight, 42% of female respondents more than or equal to 55 years old in that state reported being overweight. On the other hand, 25% of the female respondents in Wisconsin in the age group 18-34 years reported obesity, whereas 24% of female respondents more than or equal to 55 years old reported being at least 20 pounds overweight.
These six 1981 state surveys together with similar surveys conducted earlier in California, Connecticut, Maryland, Massachusetts, New York, Rhode Island, South Carolina, and Utah represent important efforts by states to routinely collect behavioral risk-factor information in order to monitor the health status of their citizens. Some of the 1981 surveys mark the beginning of CDC's efforts to help conduct these telephone surveys of behavioral risk factors.
The data included in this report demonstrate the potential use for planning by state health programs based on risk-factor-prevalence data as well as the potential use for comparison, not only within age groups, but between states and regions and also with national prevalence. Finally, these surveys demonstrate state initiative and interest in health risk-factor appraisal.
Although the same risk factors were addressed in all these surveys, the resulting data are not directly comparable either within or between states because of the differences in the questionnaires themselves and in supporting definitions, methods, socioeconomic factors, and absence of common methods for estimating population (see Table 1, footnotes). Cigarette-smoking data in these surveys did not meet all the above standards required for comparability, although a consistent definition was used (Figure 1).
As the 1981 prevalence surveys pioneered by the six states are adapted and refined by other states, improvements in the survey methods and data uniformity are anticipated. Evaluating the validity of responses by using comparable criteria from state to state and conducting national validation studies, in addition to increasing study-group size for better estimates of subgroup prevalence are needed. To reach this goal, CDC and 29 states collaborated in 1982 on risk-factor-prevalence surveys using a standard core questionnaire, standardized methods, and uniform methods for estimating population.
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