Methodological Issues Unique to Surveillance of Risk FactorsPresented by Keynote Speaker: Professor David McQueen, After the data collection year is complete, the Behavioural Surveillance Branch at CDC computes weighting factors for each response. The data are weighted because, even though the sample is random, individuals do not have an equal chance of being selected for an interview. Weighting is the process of adjusting the responses to compensate for unequal selection probability and to ensure that the data can be used to develop population estimates. Perhaps the most important part of the Behavioural Risk Factor Surveillance System is how it is used. These data are used by numerous groups in different ways. The states, of course, use the information extensively for tracking health risk trends as well as for program and policy development and evaluation. A good example that touches on each of these areas is how BRFSS mammogram data have been used. In the late 1980s, health officials believed that women were not getting the health screenings they needed. In fact, in 1987 only 44% of women over forty had a mammogram. As a result of having this information from the BRFSS, public health departments throughout the country developed educational programs to inform women of the need for mammograms. BRFSS charted the progress. By 1995, 82% of women were using this screening procedure - a striking increase from the 1987 figure. The programs worked. Meanwhile legislatures throughout the country were hearing the same message. They used the information to introduce legislation requiring that insurance plans cover mammogram screening. Mandatory reimbursement spread from 1 state in 1981 to 19 in 1989 to 43 in 1993. In this case, BRFSS data contributed to program development, policy development, and program evaluation, making BRFSS a powerful tool for health professionals. Public health departments use the BRFSS in similar ways to track many health objectives. This graph shows that progress toward public health objectives varies greatly. For example, do people use seatbelts? Overall 66% of them do, but compliance varies from a low of 44% in one state to a high of 87% in another. The public health goal is to reach an average of 85% compliance - far from the current median of 66%. Compliance with flu shot recommendations nearly meets the goal of 60% of people over 65, but again the range across states is wide with a low of 44% and a high of 70%. For cholesterol screening, the low is 55% and the high is 73%. The median is 65% - 10 points away from the public health goal. Tracking information like this gives health professionals the information they need to intervene in the health problems in their region. In addition to states, many other organizations and individuals use BRFSS data - academic researchers, health professionals in nonprofit organizations, insurance companies, and managed care organizations. Many BRFSS users break the data down to get information on different subgroups of the U.S. population. In the area of weight control, for example, BRFSS data tell us that men are more likely to be overweight than women and therefore are more at risk for some related-health problems. BRFSS can be analyzed by a variety of demographic variables, such as race, ethnicity, age, education, and income. This breakdown shows that Hispanics are about twice as likely as non-Hispanics to report having been unable to see a doctor when they needed to because they could not afford it. BRFSS data can also be used to identify geographical differences in risk behaviours. This may shows that the number of people who have no leisure time or physical activity is significantly higher in some states than in others. People in the media - radio, television and newspaper reporters and other health writers use BRFSS data extensively in their efforts to inform the public about health issues. Scientists and nonscientists alike are becoming increasingly aware of the importance of behavioural risk factors. Even the popular press, like Newsweek, often focuses on the relationship between behaviour and health. The press, of course, gets its information from publications produced using BRFSS data. Here are some publications by staff from the Behavioural Surveillance Branch at CDC. BRFSS data are frequently cited in other CDC publications like the MMWR. And, scientists at CDC and elsewhere who use BRFSS data publish their research findings in professional journals. Frequently, states produce their own BRFSS - related reports which become another source of health information for the media and the public. We have learned a lot about healthy lifestyles from information collected through the BRFSS. We know that regular physical activity can help keep you healthy. Physically active people live longer and maintain function longer than people who are not physically active. We have learned that eating fruits, vegetables, and grains instead of fatty foods reduces the incidence of diet-related disease. As a bonus, a healthier diet helps with weight control. Clean indoor air laws and laws restricting minors' access to cigarettes are effective strategies to reduce smoking. Overall, reduction in smoking has helped produce a healthier nation. We also know that taking care to prevent unintentional injuries saves lives, especially in minority communities where the injury rate is relatively high. Are we making progress toward improving health? Are certain kinds of people more at risk? We will know this only if we continue to monitor behaviours that determine health status. That is why we need a reliable accurate and timely diagnostic tool - the Behavioural Risk Factor Surveillance System. The BRFSS - it's a critical federal-state partnership for the health of our nation.
Authorised by: Executive Officer, NPHP Copyright | Disclaimer | Privacy statement
|
