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Perspectives in Disease Prevention and Health Promotion Behavioral Risk Factor Surveillance -- Selected States, 1987

Results from the 1987 Behavioral Risk Factor Surveillance System (BRFSS) indicated substantial variations in risk behaviors associated with cardiovascular disease, in drinking and driving behaviors, and in the use of recommended preventive health services among 32 states and the District of Columbia.

Health departments participating in the BRFSS use standard questionnaires and methods to conduct monthly random digit-dialed telephone interviews of adults greater than or equal to 18 years of age (1). The results are representative of the adult population of each participating state.

The prevalence of three risk factors related to cardiovascular disease--being overweight,* smoking, and having a sedentary lifestyle--varied widely by state. The prevalence of cigarette smoking ranged from 15.0% in Utah to 32.3% in Kentucky (median=25.2%), and that of sedentary lifestyle ranged from 47.2% in Montana to 73.5% in New York (median=59.0%) (Table 1).

Risk factors related to drinking and driving accounted for the greatest variation by state (Table 2). Binge drinking varied more than fourfold, from 6.6% in New Mexico to 29.4% in Wisconsin (median=15.3%); heavier drinking, from 3.7% in West Virginia to 10.3% in New Hampshire (median=5.6%); and drinking and driving, from 1.3% in Kentucky to 8.3% in Wisconsin (median=3.3%). The nonuse of seatbelts varied most (tenfold), from 7.0% in Hawaii to 72.2% in South Dakota (median=42.1%).

In 1987, data on the use of two preventive health services--cholesterol screening and mammography--were collected in the BRFSS for the first time. The proportion of respondents who had ever had their cholesterol level determined varied nearly twofold, from 29.3% in New Mexico to 56.8% in Maryland (median=46.6%) (Table 3). Among women greater than or equal to 40 years of age, the proportion who had ever had a mammogram also varied twofold, from 28.6% in New Mexico to 57.5% in New Hampshire (median=44.2%). Among all persons greater than or equal to 65 years of age, the proportion who had received an influenza vaccination within the preceding 12 months ranged from 24.0% in Rhode Island to 41.3% in Montana (median=34.3%). Reported by: The following BRFSS coordinators: R Strickland, Alabama; T Hughes, Arizona; L Parker, California; M Rivo, District of Columbia; S Hoecherl, Florida; JD Smith, Georgia;E Tash, Hawaii; J Mitten, Idaho; B Steiner, Illinois; S Joseph, Indiana; K Bramblett, Kentucky;R Schwartz, Maine; A Weinstein, Maryland; L Koumijian Yandel, Massachusetts; N Salem, Minnesota; N Hudson, Missouri; R Moon, Montana; R Thurber, Nebraska; K Zaso, New Hampshire; L Pendley, New Mexico; H Bzduch, New York; C Washington, North Carolina; B Lee, North Dakota; E Capwell, Ohio; J Cataldo, Rhode Island; D Lackland, South Carolina; L Post, South Dakota; D Riding, Tennessee; J Fellows, Texas; C Chakley, Utah; K Tollestrup, Washington; R Anderson, West Virginia; and R Miller, Wisconsin. Office of Surveillance and Analysis, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Data from the BRFSS have consistently shown that self-reported risk factors vary widely among respondents in reporting states (2-4). These variations emphasize the importance of state-specific data in measuring progress toward the 1990 (5) and year 2000 objectives for the nation and in setting appropriate health objectives at the state level. For example, in 1987 the prevalence of smoking in Utah was 15.0%, considerably less than the 1990 objective for the nation (25%). In contrast, it seems unlikely that states with high prevalences of smoking (e.g., Kentucky (1987 smoking prevalence=32.3%)) will achieve this objective by the year 1990.

Self-reported alcohol consumption is an important indicator of risk for injury (6), and BRFSS estimates of drinking and driving and of binge drinking have correlated highly with rates of alcohol-related motor vehicle crashes at the state level (7). BRFSS estimates of drinking and driving and of binge drinking declined in 10 states between 1982 and 1985, suggesting that some progress had been made in reducing these health risks (8). BRFSS estimates of self-reported seatbelt use also have correlated with observed use in 15 states (9). Thus, the trends in seatbelt use may be useful in assessing the effectiveness of mandatory seatbelt legislation.

Prevalence estimates for cholesterol screening and for the use of mammography are similar to those from other surveys. In 1986, the results of a cholesterol awareness survey coordinated by the National Heart, Lung, and Blood Institute and the Food and Drug Administration indicated that 46% of adults have had their cholesterol level determined (10), similar to the 1987 BRFSS median value (46.6%). In addition, a 1986 Gallup poll estimated that 43% of women greater than or equal to 40 years of age had ever had a mammogram (11), compared with the 1987 BRFSS median of 44.2%.

BRFSS data on cholesterol screening and mammography can be used to monitor changes in the delivery of these important preventive services in the states. For example, in 1987 the proportion of women greater than or equal to 50 years of age who reported having had a screening mammogram in the preceding 12 months increased substantially (12); however, this trend varied considerably among the states (13).

The BRFSS will continue to provide state-specific data about health behaviors and the utilization of preventive health services that can reduce the burden of chronic diseases in the United States. These data will be used in assessing state-specific progress toward the 1990 and year 2000 objectives for the nation. In the absence of national objectives for specific behaviors, state public health agencies may wish to use BRFSS methods to set appropriate objectives and to monitor trends in these behaviors.


  1. Remington PL, Smith MY, Williamson DF, Anda RF, Gentry EM, Hogelin GC. Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981-87. Public Health Rep 1988;103:366-75.

  2. CDC. Behavioral risk factor surveillance--selected states, 1984. MMWR 1986;35:253-4.

  3. CDC. Behavioral risk factor surveillance in selected states--1985. MMWR 1986;35:441-4. References 4-13 may be obtained from the Office of Surveillance and Analysis, CCDPHP, Mailstop F05, Centers for Disease Control, Atlanta, GA 30333. *The 1987 BRFSS findings concerning the prevalence of being overweight were recently reported in the MMWR (vol. 38, no. 24, dated June 23, 1989).

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