Behavioral Risk Factor Surveillance System

1. BRFSS 2001 Forsyth County BRFSS Survey Results Behavioral Risk Factor Surveillance System State Center for Health Statistics Division of Public Health North Carolina Department of Health and Human Services

2. Developed by the Centers for Disease Control and Prevention (CDC) and state health departments in the early 1980s in response to the need for: on-going assessment of adult health-risk behaviors and health practices; provision of state and regional (and now county) estimates for targeting high-risk groups. It is the largest and longest running telephone health survey in the world. History of the BRFSS Survey

3. BRFSS in the U.S., 1984

4. BRFSS in the U.S., 1990

5. BRFSS in the U.S., 1994 Guam Puerto Rico Virgin Islands

6. The annual sample size was increased from 2,000+ respondents to 6,000+ respondents. Ten of the largest counties in North Carolina were oversampled to produce county-specific estimates (Buncombe, Cumberland, Durham, Forsyth, Gaston, Guilford, Mecklenburg, New Hanover, Onslow, Wake) The remaining counties were stratified into three regions of the state: Western, Piedmont, and Eastern. (Regional estimates do not include the respective oversampled counties.) The NC 2001 BRFSS contained close to 250 survey questions, nearly twice the number of any previous survey. The Expansion of the North Carolina 2001 BRFSS

8. Standard BRFSSData Collection Methods • Ongoing monthly telephone interviews using random digit dialing • Computer-assisted telephone interviewing (CATI) • Probability sampling of noninstitutionalized adults (18+ years) in households with telephones

9. BRFSS data are directly weighted for the probability of selection of a telephone number, the number of adults (18+ yrs.) in a household, and the number of phones in a household. Additional weights are developed for non-coverage, i.e. households with no telephones, and for differences between the sample characteristics and the state population characteristics. A final weight is assigned to each respondent so that the weighted proportion and weighted number of respondents by sex, age, and race matches the state population. Weighting the BRFSS Data

10. The BRFSS Questionnaire • Standard Core Questions • Required by CDC and asked every year by all participants. • Rotating Core Questions • Required by CDC and asked every other year by all participants. • Emerging Core Questions • Required by CDC and asked every one time by all participants. • Optional Modules offered and supported by CDC • Included if sponsored by state programs/agencies. • State-Added Questions • Developed by state programs/agencies that also sponsor them.

11. Core Sections Health status High Blood Pressure Cholesterol Asthma/Diabetes Arthritis Immunization Tobacco/alcohol use Firearms Demographics Prostate/colorectal HIV/AIDs Optional Modules Oral health Tobacco indicators Heart attack/stroke Cardiovascular disease Diabetes care Fruits and vegetables Folic acid Survey Topics on the NC 2001 BRFSS • State-added • Substance abuse • Health care coverage • Cardiovascular prevention • Cancer • Osteoporosis • Physical activity • Disability • Family Planning • Sexual behavior • Sexual assault

12. Objectives:(1)promote BRFSS data use and dissemination by North Carolina public health professionals; and (2) by mixing or selecting specific slides, presentations may be tailored or modified to suit the needs of the county/presenter. Talking points: slides include talking points to help with interpretation of the results and offer further explanations. Survey questions: for reference purposes, the BRFSS survey question(s) is quoted verbatim in the talking points. Nationwide data: for core topics, nationwide estimates (means) are provided for comparison. Calculations: only weighted data are presented and all “unknowns/refusals” are excluded from calculations. About this 2001 BRFSS Slide Presentation

13. Cautionary Notes: These results need to be viewed as estimates and not the actual or true value of the outcome of interest. With any estimate based on a random sample, there is a margin of error. For the 10 oversampled counties the margin of error is about 5% if the question was asked of all respondents. This means that we can expect the true value to lie somewhere between the sample estimate plus or minus 5 percent. When county results are subset by age or race, for example, the margin of error increases as a function of the resulting smaller sample size. Use caution when comparing the results across counties, as the margin of error may not be the same for all counties. About this 2001 BRFSS Slide Presentation(continued)

14. Sample size & demographics Health care access Chronic diseases Use of preventive health services Oral health Cardiovascular Health Tobacco Use and Prevention Health Risk Behaviors Physical activity Health status & quality of life Family Planning HIV/AIDS & sexual behavior BRFSS tracked HP2010 objectives Special topics Contents of Presentation Note: all results are based on weighted data

15. I. Sample Size & Demographics

16. 2001 BRFSS Sample Size

17. BRFSS 2001 Sample Demographic Characteristics *weighted percentages

18. BRFSS 2001 Sample Demographic Characteristics (Continued) *weighted percentages

19. Health insurance coverage Cost of seeing a doctor Usual source of care Personal provider Place of care II. Health Care Access

20. Health Insurance Coverage* HP 2010 Target: 100% *Adults < 65 yrs old XIII. HP 2010 Objectives

21. Health Insurance Coverage by Race & Sex North Carolina, 1991-2001 II Health Care Access

22. Health Insurance Coverage by Sex, Race, & Age: Forsyth & NC (adults <65 yrs. Old) II. Health Care Access

23. Could not See a Doctor Due to Cost in Past Year II. Health Care Access

24. Has a Usual Source of Medical care* HP 2010 Target: 96% *includes clinic, health center, doctor’s office II. Health Care Access

25. Has Personal Health Care Provider(s)* *one or more persons regarded as a personal doctor II. Health Care Access

26. Arthritis Asthma Cancer Diabetes Disability High cholesterol High Blood Pressure III. Chronic Diseases

27. Arthritis

28. Doctor-Diagnosed Arthritis III. Chronic Diseases: Arthritis

29. Arthritis* Prevalence by Sex, Race, & Age: Forsyth County & NC * doctor-diagnosed III. Chronic Diseases: Arthritis

30. Chronic Joint Symptoms (CJS) III. Chronic Diseases: Arthritis

31. Total Arthritis (CJS and/or Doctor Diagnosed) III. Chronic Diseases: Arthritis

32. Currently Treated by a Doctor for Arthritis III. Chronic Diseases: Arthritis

33. Arthritis and Quality of Life: North Carolina

34. Arthritis, Obesity and Physical Activity: North Carolina

35. Asthma

36. Ever Diagnosed with Asthma III. Chronic Diseases: Asthma

37. Asthma (ever had) Prevalence by Sex, Race, & Age: Forsyth County & NC III. Chronic Diseases: Asthma

38. Currently Has Asthma III. Chronic Diseases: Asthma

39. Cancer

40. Ever Diagnosed with Cancer (Age 40+) III. Chronic Diseases: Cancer

41. Cancer Prevalence (Age 40+) : North Carolina III. Chronic Diseases: Cancer

42. Cancer (Age 40+) Prevalence by Sex, Race, & Age: Guilford County & NC III. Chronic Diseases: Cancer

43. Family History of Prostate Cancer* * Asked of male respondents age 40+ III. Chronic Diseases: Cancer

44. Diabetes

45. Diabetes III. Chronic Diseases: Diabetes

46. Prevalence of Diabetes by Race & SexNorth Carolina, 1990-2001 III. Chronic Diseases: Diabetes

47. Diabetes Indicators: North Carolina & U.S.

48. Disability

49. North Carolina’s Definition of Disability A positive response to one or more of the following screener questions: • Are you limited in any activities because of physical, mental, or emotional problems? • Do you now have any health problem that requires you to use special equipment, such as a cane or wheelchair, a special bed, or a special telephone? • A disability can be physical, mental, emotional, or communication related. Do you consider yourself to have a disability? • Because of any impairment or health problem, do you have any trouble learning, remembering, or concentrating?

50. Activity Limitation b/c Physical or Emotional Problems III. Chronic Diseases: Disability