Behavioral Risk Factor Surveillance System

Behavioral Risk Factor Surveillance System
Name	Behavioral Risk Factor Surveillance System
Abbreviation	BRFSS
Formed	1984
Jurisdiction	United States
Parent agency	Centers for Disease Control and Prevention
Website	BRFSS

Behavioral Risk Factor Surveillance System.

The Behavioral Risk Factor Surveillance System is a state-based telephone survey system coordinated by the Centers for Disease Control and Prevention that collects self-reported data on health-related risk behaviors, chronic health conditions, and use of preventive services across the United States, its territories, and participating local jurisdictions. Initiated in the 1980s, the system supports state public health agencies, federal programs, and academic researchers by providing annual estimates used alongside administrative data from sources such as the National Health Interview Survey, the Medicare program, and the National Vital Statistics System. The program intersects with public health initiatives from agencies like the Department of Health and Human Services, collaborations with universities such as Johns Hopkins University and Harvard University, and informs policy debates in legislatures including the United States Congress and state capitols.

Overview

The system operates as a collaborative network linking the Centers for Disease Control and Prevention with state and territorial health departments including the California Department of Public Health, the New York State Department of Health, and the Florida Department of Health, producing annual datasets used by scholars at institutions like University of Michigan, University of Washington, and Yale University. BRFSS data are used in conjunction with surveillance systems such as the Youth Risk Behavior Surveillance System, population estimates from the United States Census Bureau, and disease registries like the National Cancer Institute’s databases. The program influences public health guidance from bodies including the World Health Organization and advisory committees such as the Community Preventive Services Task Force.

History and Development

Established in 1984 under the leadership of officials at the Centers for Disease Control and Prevention and advocates from state health agencies, the system expanded from a few states to a nationwide network by the 1990s, paralleling developments at the National Institutes of Health and policy shifts under administrations including those of Ronald Reagan and Bill Clinton. Key methodological updates occurred during collaborations with academic groups at George Washington University and University of California, Los Angeles, and were influenced by technological changes in telecommunications from companies such as AT&T and regulatory frameworks from the Federal Communications Commission. Major milestones include the adoption of cell-phone sampling in the 2000s and the integration of optional modules developed with partners like Kaiser Family Foundation and research centers at Columbia University.

Methodology and Data Collection

BRFSS employs complex survey design techniques, including stratified random sampling, weighting procedures informed by United States Census Bureau population estimates, and dual-frame telephone sampling that incorporates landline and cell phone frames following guidance from the American Association for Public Opinion Research and statisticians at National Center for Health Statistics. Interviews are conducted by state health department interviewers and contracted vendors using standardized questionnaires and computer-assisted telephone interviewing systems developed in consultation with teams from Rutgers University and Carnegie Mellon University. Data processing and quality control follow protocols from the Centers for Disease Control and Prevention and best practices recommended by methodologists at University of North Carolina at Chapel Hill and Pennsylvania State University.

Survey Content and Measures

Question modules address topics including smoking and tobacco use, alcohol consumption, physical activity, nutrition, chronic conditions such as diabetes and hypertension, preventive services like immunizations and cancer screenings, and social determinants of health; these modules were informed by literature from the National Academy of Medicine, guidelines from the Advisory Committee on Immunization Practices, and clinical definitions used by the American Diabetes Association and the American Heart Association. Optional state modules allow comparisons with federal surveillance like the National Health and Nutrition Examination Survey and collaboration with disease-specific programs at the National Institutes of Health and advocacy groups such as the American Cancer Society.

Data Use and Applications

Researchers at universities including Stanford University, Massachusetts Institute of Technology, and Duke University use BRFSS for epidemiologic studies, trend analyses, and model inputs for health economic research that inform policy decisions by the United States Congress, state legislatures, and agencies such as the Centers for Medicare & Medicaid Services. Public health programs at the Health Resources and Services Administration, state immunization programs, and nonprofit organizations like Robert Wood Johnson Foundation use BRFSS estimates for program planning, resource allocation, and evaluation of interventions tied to initiatives like the Healthy People objectives. BRFSS data contribute to peer-reviewed publications in journals such as The Lancet, Journal of the American Medical Association, and American Journal of Public Health.

Limitations and Criticisms

Critiques of the system cite reliance on self-reported data subject to recall bias and social desirability bias documented in comparative studies with the National Health and Nutrition Examination Survey and electronic health records from systems like Epic Systems Corporation. Methodological concerns include declining response rates paralleling trends reported by the Pew Research Center and challenges in reaching transient populations documented in research from Migration Policy Institute and the Kaiser Family Foundation. Coverage issues arise for populations in territories like Puerto Rico and for institutionalized groups covered in administrative datasets such as the Veterans Health Administration records. Epidemiologists at institutions like Johns Hopkins University and University of California, San Francisco have proposed triangulation with claims data from Centers for Medicare & Medicaid Services and surveillance from the National Notifiable Diseases Surveillance System.

Governance and Funding

BRFSS is administered by the Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion, funded through federal appropriations from annual budgets authorized by the United States Congress and supplemented by state health department contributions and grants from foundations such as the Robert Wood Johnson Foundation and partnerships with universities including University of Pittsburgh and Emory University. Oversight involves interagency coordination with the Department of Health and Human Services, compliance with Office of Management and Budget guidelines, and engagement with advisory groups including academic partners from Columbia University and Harvard University.

Category:Public health surveillance systems