Using the New BRFSS Modules

Fruit and Vegetable Module change in BRFSS 2017 Q&A

Why did the fruit and vegetable module change in BRFSS 2017?

The module was changed to make it easier and quicker for respondents to answer the questions on the phone. The new module is shorter and simpler and is based on an existing validated module used in the National Cancer Institute’s Dietary Screener Questionnaire.

What were the main changes to the module?

The new module is still 6 items like the prior versions but takes nearly half the time to answer and is also cognitively easier to answer. The module is based on a validated module used in the National Cancer Institute’s Dietary Screener Questionnaire. The National Cancer Institute’s Dietary Screener Questionnaire has been used in a variety of studies and in other national surveillance systems including the 2009-10 National Health and Nutrition Examination Survey and the National Health Interview Survey Cancer Control Module. A comparison of the module used in BRFSS from 2011-2015 and the new version is below.

Table: A comparison of the module used in BRFSS from 2011-2015 and the new version
BRFSS 2011-2015 BRFSS 2017
Introduction These next questions are about the fruits and vegetables you ate or drank during the past 30 days. Please think about all forms of fruits and vegetables including cooked or raw, fresh, frozen or canned. Please think about all meals, snacks, and food consumed at home and away from home. I will be asking how often you ate or drank each one: for example, once a day, twice a week, three times a month, and so forth. Now think about the foods you ate or drank during the past month, that is, the past 30 days, including meals and snacks.
Fruits
  • During the past month, how many times per day, week or month did you drink 100% PURE fruit juices? Do not include fruit-flavored drinks with added sugar or fruit juice you made at home and added sugar to. Only include 100% juice.
  • During the past month, not counting juice, how many times per day, week, or month did you eat fruit? Count fresh, frozen, or canned fruit.
  • How often did you drink 100% fruit juice such as apple or orange juices? Do not include fruit-flavored drinks or fruit juices you added sugar to.
  • During the past month, how often did you eat fruit? Do not include juices. You can tell me times per day, per week or per month.
Vegetable
  • During the past month, how many times per day, week, or month did you eat cooked or canned beans, such as refried, baked, black, garbanzo beans, beans in soup, soybeans, edamame, tofu or lentils. Do NOT include long green beans.
  • During the past month, how many times per day, week, or month did you eat dark green vegetables for example broccoli or dark leafy greens including romaine, chard, collard greens or spinach?
  • During the past month, how many times per day, week, or month did you eat orange- colored vegetables such as sweet potatoes, pumpkin, winter squash, or carrots?
  • Not counting what you just told me about, during the past month, about how many times per day, week, or month did you eat OTHER vegetables? Examples of other vegetables include tomatoes, tomato juice or V-8 juice, corn, eggplant, peas, lettuce, cabbage, and white potatoes that are not fried such as baked or mashed potatoes
  • How often did you eat a green leafy or lettuce salad, with or without other vegetables?
  • How often did you eat any kind of fried potatoes, including French fries, home fries, or hash browns?
  • How often did you eat any other kind of potatoes, such as baked, boiled, mashed potatoes, or potato salad?
  • Not including lettuce salads and potatoes, how often did you eat other vegetables?

What is the source of these questions?

The new fruit and vegetable module is adapted from a validated module from the National Cancer Institute’s 26 item Dietary Screener Questionnaire (DSQ).  The DSQ has been used in the 2009-10 National Health and Nutrition Examination Survey as well as other surveys and studies.

Ten fruit and vegetable groups are used in the DSQ to measure frequency of fruit and vegetable intake. These fruit and vegetable groups were selected either because they have been shown to be important predictors of fruit and vegetable intake in research and evaluation studies or to be consistent and comparable with other dietary surveys.

In the new BRFSS FV module, we included 6 of these fruit and vegetable groups (fruit juice, fruit, fried potatoes, other potatoes, green leafy salads, and other vegetables).  Four of the vegetable groups were excluded from the BRFSS module because the contribution of these other sources were small based on analyses of how frequently different fruits and vegetables are consumed in various subpopulations. We also modified the fruit and vegetable DSQ module to shorten and adapt it for telephone use based on expert opinion. The new module was field tested for BRFSS in 2016. A comparison of the DSQ and BRFSS is below.

Table: A comparison of the DSQ and BRFSS
NHANES DSQ BRFSS 2017
Fruits
  • (During the past month), how often did {you/SP} drink 100% pure fruit juice such as orange, mango, apple, grape and pineapple juices? Do not include fruit-flavored drinks with added sugar or fruit juice you made at home and added sugar to. (You can tell me per day, per week or per month.)
  • (During the past month), how often did {you/SP} eat fruit? Include fresh, frozen or canned fruit. Do not include juices. (You can tell me per day, per week or per month.)
  • How often did you drink 100% fruit juice such as apple or orange juices? Do not include fruit-flavored drinks or fruit juices you added sugar to.
  • During the past month, how often did you eat fruit? Do not include juices. You can tell me times per day, per week or per month.
Vegetables
  • (During the past month), how often did {you/SP} eat a green leafy or lettuce salad, with or without other vegetables? (You can tell me per day, per week or per month.)
  • (During the past month), how often did {you/SP} eat any kind of fried potatoes, including French fries, home fries, or hash brown potatoes? (You can tell me per day, per week or per month.)
  • (During the past month), how often did {you/SP} eat any other kind of potatoes, such as baked, boiled, mashed potatoes, sweet potatoes, or potato salad? (You can tell me per day, per week or per month.)
  • (During the past month), how often did {you/SP} eat refried beans, baked beans, beans in soup, pork and beans or any other type of cooked dried beans? Do not include green beans. (You can tell me per day, per week or per month.)
  • (During the past month), not including what you just told me about (lettuce salads, potatoes, cooked dried beans), how often did {you/SP} eat other vegetables? (You can tell me per day, per week or per month.)
  • (During the past month), how often did {you/SP} have Mexican-type salsa made with tomato? (You can tell me per day, per week or per month.).
  • During the past month, how often did {you/SP} eat pizza? Include frozen pizza, fast food pizza, and homemade pizza. You can tell me per day, per week or per month.
  • (During the past month), how often did {you/SP} have tomato sauces such as with spaghetti or noodles or mixed into foods such as lasagna? {Please do not count tomato sauce on pizza.} (You can tell me per day, per week or per month.)
  • How often did you eat a green leafy or lettuce salad, with or without other vegetables?
  • How often did you eat any kind of fried potatoes, including French fries, home fries, or hash browns?
  • How often did you eat any other kind of potatoes, or sweet potatoes, such as baked, boiled, mashed potatoes, or potato salad?
  • Not including lettuce salads and potatoes, how often did you eat other vegetables?

I’d like to assess juice consumption by itself, is there a variable for that?

Yes, BRFSS uses the following question to assess 100% fruit juice: “How often did you drink 100% fruit juice such as apple or orange juices? Do not include fruit-flavored drinks or fruit juices you added sugar to.”

The two new fruit questions are very similar to the old module, can we still use these for trends analysis across time?

No, we do not recommend comparing the new fruit questions to the old module due to the changes in methodology including the change in the introduction and how questions are ordered. Data from the 2017 fruit and vegetable module provides a new baseline for assessing new fruit and vegetable trends.

Can we compare fruit and vegetable intake from 2017 to prior years?

No, due to the changes in methodology, we do not advise comparing 2017 findings to the previous modules. Data from the 2017 fruit and vegetable module provides a new baseline for assessing new fruit and vegetable trends.

Why was fried potatoes included in the new module?

Fried potatoes was included because the new BRFSS module is based on the National Cancer Institute’s 26 item Dietary Screener Questionnaire (DSQ). Fried potatoes, like the other fruit and vegetable groups included in the DSQ, have been shown to be important predictors of fruit and vegetable intake in research and evaluation studies. The Dietary Guidelines for Americans 2015-2020 also includes all fruits and vegetables when estimating intake, even fried potatoes.

Is there one variable in the dataset that allows us to say what percent of state residents are meeting fruit and vegetable recommendations?

No, we do not have one variable that estimates percent of state residents meeting fruit and vegetable recommendations. However, one can calculate percent of state residents meeting the fruit recommendation and the vegetable recommendation, separately. We are currently updating the conversion algorithm to match the revised questions.

Are these new questions the same as those in Youth Risk Behavior Surveillance System (YRBSS)?

No, they are not the same. YRBSS asks about consumption based on a 7-day recall period, while BRFSS asks a 30-day recall period. In YRBSS total vegetable intake is calculated using salad, potatoes, carrots, other vegetables, while BRFSS uses salad, fried potatoes, other potatoes, and other vegetables. YRBSS uses self-administered questionnaires in school classrooms versus being administered over the telephone like BRFSS. A comparison of the YRBSS and BRFSS is below.

Table: A comparison of the YRBSS and BRFSS
YRBSS 2017 BRFSS 2017
Introduction The next 9 questions ask about food you ate or drank during the past 7 days. Think about all the meals and snacks you had from the time you got up until you went to bed. Be sure to include food you ate at home, at school, at restaurants, or anywhere else. Now think about the foods you ate or drank during the past month, that is, the past 30 days, including meals and snacks.
Fruits
  • During the past 7 days, how many times did you drink 100% fruit juices such as orange juice, apple juice, or grape juice? (Do not count punch, Kool-Aid, sports drinks, or other fruit-flavored drinks.)
  • During the past 7 days, how many times did you eat fruit? (Do not count fruit juice.)
  • How often did you drink 100% fruit juice such as apple or orange juices? Do not include fruit-flavored drinks or fruit juices you added sugar to.
  • During the past month, how often did you eat fruit? Do not include juices. You can tell me times per day, per week or per month.
Vegetables
  • During the past 7 days, how many times did you eat green salad?
  • During the past 7 days, how many times did you eat potatoes? (Do not count French fries, fried potatoes, or potato chips.)
  • During the past 7 days, how many times did you eat carrots?
  • During the past 7 days, how many times did you eat other vegetables? (Do not count green salad, potatoes, or carrots.)
  • How often did you eat a green leafy or lettuce salad, with or without other vegetables?
  • How often did you eat any kind of fried potatoes, including French fries, home fries, or hash browns?
  • How often did you eat any other kind of potatoes, or sweet potatoes, such as baked, boiled, mashed potatoes, or potato salad?
  • Not including lettuce salads and potatoes, how often did you eat other vegetables?

Do the new questions measure portions or only frequency?

The 2017 BRFSS fruit and vegetable module, as in the past, still only measures frequency of intake (i.e. number of times fruits and vegetables are consumed).

Over time how have the FV questions changed?

The module has only had two revisions since 1989. The module administered from 1989–2009 asked respondents how often they drank or ate the following: 1) fruit juices such as orange, grapefruit, or tomato, 2) fruit, 3) green salad, 4) potatoes not including French fries, fried potatoes, or potato chips, 5) carrots, and 6) other vegetables.

In 2011, the module was revised to align more closely with the 2010 Dietary Guidelines for Americans. The revised questions asked respondents how often they drink or eat the following: 1) 100% pure fruit juices, 2) fruit, 3) cooked or canned beans, 4) dark green vegetables, 5) orange-colored vegetables, and 6) other vegetables.

The new 2017 module was developed by reviewing the federal nutrition guidance for fruit and vegetable intake, consulting with National Cancer Institute dietary assessment experts and BRFSS coordinators, and reviewing data on commonly consumed fruits and vegetables among adults from different demographic groups from the 2001–2010 National Health and Nutrition Examination Surveys.