Vital Signs: Mammography Use and Association with Social Determinants of Health and Health-Related Social Needs Among Women - United States, 2022.

Introduction: Approximately 40,000 U.S. women die from breast cancer each year. Mammography is recommended to screen for breast cancer and reduce breast cancer mortality. Adverse social determinants of heath (SDOH) and health-related social needs (HRSNs) (e.g., lack of transportation and social isolation) can be barriers to getting mammograms. Methods: Data from the 2022 Behavioral Risk Factor Surveillance System were analyzed to estimate the prevalence of mammography use within the previous 2 years among women aged 40-74 years by jurisdiction, age group, and sociodemographic factors. The association between mammography use and measures of SDOH and HRSNs was assessed for jurisdictions that administered the Social Determinants and Health Equity module. Results: Among women aged 50-74 years, state-level mammography use ranged from 64.0% to 85.5%. Having health insurance and a personal health care provider were associated with having had a mammogram within the previous 2 years. Among women aged 50-74 years, mammography prevalence was 83.2% for those with no adverse SDOH and HRSNs and 65.7% for those with three or more adverse SDOH and HRSNs. Life dissatisfaction, feeling socially isolated, experiencing lost or reduced hours of employment, receiving food stamps, lacking reliable transportation, and reporting cost as a barrier for access to care were all strongly associated with not having had a mammogram within the previous 2 years. Conclusions and Implications for Public Health Practice: Identifying specific adverse SDOH and HRSNs that women experience and coordinating activities among health care providers, social services, community organizations, and public health programs to provide services that help address these needs might increase mammography use and ultimately decrease breast cancer deaths.

Racial and Ethnic Differences in Social Determinants of Health and Health-Related Social Needs Among Adults - Behavioral Risk Factor Surveillance System, United States, 2022.

Social determinants of health (SDOH) are a broad array of social and contextual conditions where persons are born, live, learn, work, play, worship, and age that influence their physical and mental wellbeing and quality of life. Using 2022 Behavioral Risk Factor Surveillance System data, this study assessed measures of adverse SDOH and health-related social needs (HRSN) among U.S. adult populations. Measures included life satisfaction, social and emotional support, social isolation or loneliness, employment stability, food stability/security, housing stability/security, utility stability/security, transportation access, mental well-being, and health care access. Prevalence ratios were adjusted for age, sex, education, marital status, income, and self-rated health. Social isolation or loneliness (31.9%) and lack of social and emotional support (24.8%) were the most commonly reported measures, both of which were more prevalent among non-Hispanic (NH) American Indian or Alaska Native, NH Black or African American, NH Native Hawaiian or other Pacific Islander, NH multiracial, and Hispanic or Latino adults than among NH White adults. The majority of prevalence estimates for other adverse SDOH and HRSN were also higher across all other racial and ethnic groups (except for NH Asian) compared with NH White adults. SDOH and HRSN data can be used to monitor needed social and health resources in the U.S. population and help evaluate population-scale interventions.

National, State-Level, and County-Level Prevalence Estimates of Adults Aged ≥18 Years Self-Reporting a Lifetime Diagnosis of Depression - United States, 2020.

Depression is a major contributor to mortality, morbidity, disability, and economic costs in the United States (1). Examining the geographic distribution of depression at the state and county levels can help guide state- and local-level efforts to prevent, treat, and manage depression. CDC analyzed 2020 Behavioral Risk Factor Surveillance System (BRFSS) data to estimate the national, state-level, and county-level prevalence of U.S. adults aged ≥18 years self-reporting a lifetime diagnosis of depression (referred to as depression). During 2020, the age-standardized prevalence of depression among adults was 18.5%. Among states, the age-standardized prevalence of depression ranged from 12.7% to 27.5% (median = 19.9%); most of the states with the highest prevalence were in the Appalachian* and southern Mississippi Valley† regions. Among 3,143 counties, the model-based age-standardized prevalence of depression ranged from 10.7% to 31.9% (median = 21.8%); most of the counties with the highest prevalence were in the Appalachian region, the southern Mississippi Valley region, and Missouri, Oklahoma, and Washington. These data can help decision-makers prioritize health planning and interventions in areas with the largest gaps or inequities, which could include implementation of evidence-based interventions and practices such as those recommended by The Guide to Community Preventive Services Task Force (CPSTF) and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Health-related behaviors and health insurance status among US adults: Findings from the 2017 behavioral risk factor surveillance system.

Health insurance coverage has increased overtime in the US. This study examined the associations between health insurance status and adoption of health-related behaviors among US adults. Using data collected through the 2017 Behavioral Risk Factor Surveillance System on health insurance coverage and type of insurance, we examined four health-related behaviors (i.e., no tobacco use, nondrinking or moderate drinking, meeting aerobic physical activity recommendations, and having a healthy body weight) and their associations with health insurance status. We conducted log-linear regression analyses to assess the associations with adjustment for potential confounders. Results showed the percentages of adults who reported no tobacco use or meeting physical activity recommendations were significantly higher, and the percentages of adults with a healthy body weight were significantly lower among those who were insured versus uninsured, or among adults with private insurance versus uninsured. Adults with health insurance also had a higher prevalence of reporting all 4 health-related behaviors than those uninsured. These patterns persisted after multivariable adjustment for potential confounders including sociodemographics, routine checkup, and number of chronic diseases. Adults with public insurance were 7% more likely to report no tobacco use than adults who were uninsured. Additionally, adults with private insurance were 8% and 7% more likely to report no tobacco use and meeting physical activity recommendations, respectively, but 10% less likely to report nondrinking or moderate drinking than adults with public insurance. In conclusion, we found significant associations existed between having health insurance coverage and engaging in some health-related behaviors among US adults.

Prevalence of Disability and Disability Types by Urban-Rural County Classification-U.S., 2016.

INTRODUCTION: In the U.S., disability affects approximately 61.4 million (25.7%) adults, with mobility disability being the most prevalent type, affecting about 1 in 7 U.S. adults. However, little is known about the prevalence of disability and functional disability types by urbanization level. METHODS: Data from the 2016 Behavioral Risk Factor Surveillance System were analyzed. The prevalences of disability, overall and by functional disability type, were estimated among U.S. adults across 6 levels of urban-rural county categories based on the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties. Adjusted prevalence ratios with 95% CIs were estimated by conducting log-linear regression analyses with robust variance estimator while adjusting for study covariates. Data analyses were conducted in 2018. RESULTS: The prevalences of having any disability, functional disability type, or multiple disabilities were lowest in large metropolitan centers and fringe metropolitan counties and highest in noncore (rural) counties. After controlling for age, sex, race/ethnicity, education, and federal poverty level, adults living in noncore counties were 9% more likely to report having any disability, 24% more likely to report having 3 or more disabilities, and 7% (cognition) to 35% (hearing) more likely to report specific disability types than the adults living in large metropolitan centers. CONCLUSIONS: Results of this study suggest that significant disparities in the prevalence of disability exist by level of urbanization, with rural U.S. residents having the highest prevalence of disability. Public health interventions to reduce health disparities could include people with disabilities, particularly in rural counties.

Self-Perceived Poor/Fair Health, Frequent Mental Distress, and Health Insurance Status Among Working-Aged US Adults.

We examined associations of health insurance status with self-perceived poor/fair health and frequent mental distress (FMD) among working-aged US adults from 42 states and the District of Columbia using data from the 2014 Behavioral Risk Factor Surveillance System. After multiple-variable adjustment, compared with adequately insured adults, underinsured and never insured adults were 39% and 59% more likely to report poor/fair health, respectively, and 38% more likely to report FMD. Compared with working-aged adults with employer-based insurance, adults with Medicaid/Medicare or other public insurance coverage were 28% and 13% more likely to report poor/fair health, respectively, and 15% more likely to report FMD. Increasing insurance coverage and reducing cost barriers to care may improve general and mental health.

Surveillance for Certain Health Behaviors and Conditions Among States and Selected Local Areas - Behavioral Risk Factor Surveillance System, United States, 2015.

PROBLEM: Chronic conditions and disorders (e.g., diabetes, cardiovascular diseases, arthritis, and depression) are leading causes of morbidity and mortality in the United States. Healthy behaviors (e.g., physical activity, avoiding cigarette use, and refraining from binge drinking) and preventive practices (e.g., visiting a doctor for a routine check-up, tracking blood pressure, and monitoring blood cholesterol) might help prevent or successfully manage these chronic conditions. Monitoring chronic diseases, health-risk behaviors, and access to and use of health care are fundamental to the development of effective public health programs and policies at the state and local levels. REPORTING PERIOD: January-December 2015. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health-risk behaviors, chronic diseases and conditions, access to and use of health care, and use of preventive health services related to the leading causes of death and disability. This report presents results for all 50 states, the District of Columbia, the Commonwealth of Puerto Rico (Puerto Rico), and Guam and for 130 metropolitan and micropolitan statistical areas (MMSAs) (N = 441,456 respondents) for 2015. RESULTS: The age-adjusted prevalence estimates of health-risk behaviors, self-reported chronic health conditions, access to and use of health care, and use of preventive health services varied substantially by state, territory, and MMSA in 2015. Results are summarized for selected BRFSS measures. Each set of proportions refers to the median (range) of age-adjusted prevalence estimates for health-risk behaviors, self-reported chronic diseases or conditions, or use of preventive health care services by geographic jurisdiction, as reported by survey respondents. Adults with good or better health: 84.6% (65.9%-88.8%) for states and territories and 85.2% (66.9%-91.3%) for MMSAs. Adults with ≥14 days of poor physical health in the past 30 days: 10.9% (8.2%-17.2%) for states and territories and 10.9% (6.6%-19.1%) for MMSAs. Adults with ≥14 days of poor mental health in the past 30 days: 11.3% (7.3%-15.8%) for states and territories and 11.4% (5.6%-20.5%) for MMSAs. Adults aged 18-64 years with health care coverage: 86.8% (72.0%-93.8%) for states and territories and 86.8% (63.2%-95.7%) for MMSAs. Adults who received a routine physical checkup during the preceding 12 months: 69.0% (58.1%-79.8%) for states and territories and 69.4% (57.1%-81.1%) for MMSAs. Adults who ever had their blood cholesterol checked: 79.1% (73.3%-86.7%) for states and territories and 79.5% (65.1%-87.3%) for MMSAs. Current cigarette smoking among adults: 17.7% (9.0%-27.2%) for states and territories and 17.3% (4.5%-29.5%) for MMSAs. Binge drinking among adults during the preceding 30 days: 17.2% (11.2%-26.0%) for states and territories and 17.4% (5.5%-24.5%) for MMSAs. Adults who reported no leisure-time physical activity during the preceding month: 25.5% (17.6%-47.1%) for states and territories and 24.5% (16.1%-47.3%) for MMSAs. Adults who reported consuming fruit less than once per day during the preceding month: 40.5% (33.3%-55.5%) for states and territories and 40.3% (30.1%-57.3%) for MMSAs. Adults who reported consuming vegetables less than once per day during the preceding month: 22.4% (16.6%-31.3%) for states and territories and 22.3% (13.6%-32.0%) for MMSAs. Adults who have obesity: 29.5% (19.9%-36.0%) for states and territories and 28.5% (17.8%-41.6%) for MMSAs. Adults aged ≥45 years with diagnosed diabetes: 15.9% (11.2%-26.8%) for states and territories and 15.7% (10.5%-27.6%) for MMSAs. Adults aged ≥18 years with a form of arthritis: 22.7% (17.2%-33.6%) for states and territories and 23.2% (12.3%-33.9%) for MMSAs. Adults having had a depressive disorder: 19.0% (9.6%-27.0%) for states and territories and 19.2% (9.9%-27.2%) for MMSAs. Adults with high blood pressure: 29.1% (24.2%-39.9%) for states and territories and 29.0% (19.7%-41.0%) for MMSAs. Adults with high blood cholesterol: 31.8% (27.1%-37.3%) for states and territories and 31.4% (23.2%-42.0%) for MMSAs. Adults aged ≥45 years who have had coronary heart disease: 10.3% (7.2%-16.8%) for states and territories and 10.1% (4.7%-17.8%) for MMSAs. Adults aged ≥45 years who have had a stroke: 4.9% (2.5%-7.5%) for states and territories and 4.7% (2.1%-8.4%) for MMSAs. INTERPRETATION: The prevalence of health care access and use, health-risk behaviors, and chronic health conditions varied by state, territory, and MMSA. The data in this report underline the importance of continuing to monitor chronic diseases, health-risk behaviors, and access to and use of health care in order to assist in the planning and evaluation of public health programs and policies at the state, territory, and MMSA level. PUBLIC HEALTH ACTION: State and local health departments and agencies and others interested in health and health care can continue to use BRFSS data to identify groups with or at high risk for chronic conditions, unhealthy behaviors, and limited health care access and use. BRFSS data also can be used to help design, implement, monitor, and evaluate health-related programs and policies.

Health Insurance Status and Clinical Cancer Screenings Among U.S. Adults.

INTRODUCTION: Health insurance coverage is linked to clinical preventive service use. This study examined cancer screenings among U.S. adults by health insurance status. METHODS: The Behavioral Risk Factor Surveillance System collected data on healthcare access and cancer screenings from 42 states and the District of Columbia in 2014. Data analyses were conducted in 2016. Participants' health insurance status during the preceding 12 months was categorized as adequately insured, underinsured, or never insured. Primary type of insurance coverage was categorized as employer-based or Medicare (aged ≥65 years), self-purchased plan, Medicaid/Medicare (aged <65 years), and other public insurance. Clinical cancer screenings were assessed following the U.S. Preventive Services Task Force recommendations. RESULTS: Compared with adequately insured adults, underinsured and never insured women were 6% (p<0.001) and 41% (p<0.001) less likely to receive breast cancer screening, respectively; 1% (p<0.05) and 19% (p<0.001) less likely to receive cervical cancer screening, respectively; and 3% (p<0.01) and 47% (p<0.001) less likely to receive colorectal cancer screening, respectively; underinsured and never insured men were 6% (p<0.001) and 52% (p<0.001) less likely to receive colorectal cancer screening, respectively. Compared with adults with employer-based insurance/Medicare (aged ≥65 years), women with all other types of insurance were less likely to receive breast and cervical cancer screenings; women and men with self-purchased plans were less likely to receive colorectal cancer screening; however, men with other public insurance were more likely to receive colorectal cancer screening. CONCLUSIONS: Disparities in cancer screenings by health insurance status and type of insurance exist among U.S. adults. Greater efforts to increase screening rates and to reduce disparities in cancer screenings are an important strategy to help improve overall population health.

Surveillance for Certain Health Behaviors and Conditions Among States and Selected Local Areas - Behavioral Risk Factor Surveillance System, United States, 2013 and 2014.

PROBLEM: Chronic diseases and conditions (e.g., heart diseases, stroke, arthritis, and diabetes) are the leading causes of morbidity and mortality in the United States. These conditions are costly to the U.S. economy, yet they are often preventable or controllable. Behavioral risk factors (e.g., excessive alcohol consumption, tobacco use, poor diet, frequent mental distress, and insufficient sleep) are linked to the leading causes of morbidity and mortality. Adopting positive health behaviors (e.g., staying physically active, quitting tobacco use, obtaining routine physical checkups, and checking blood pressure and cholesterol levels) can reduce morbidity and mortality from chronic diseases and conditions. Monitoring the health risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services at multilevel public health points (states, territories, and metropolitan and micropolitan statistical areas [MMSA]) can provide important information for development and evaluation of health intervention programs. REPORTING PERIOD: 2013 and 2014. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services and practices related to the leading causes of death and disability in the United States and participating territories. This is the first BRFSS report to include age-adjusted prevalence estimates. For 2013 and 2014, these age-adjusted prevalence estimates are presented for all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, Guam, and selected MMSA. RESULTS: Age-adjusted prevalence estimates of health status indicators, health care access and preventive practices, health risk behaviors, chronic diseases and conditions, and cardiovascular conditions vary by state, territory, and MMSA. Each set of proportions presented refers to the range of age-adjusted prevalence estimates of selected BRFSS measures as reported by survey respondents. The following are estimates for 2013. Adults reporting frequent mental distress: 7.7%-15.2% in states and territories and 6.3%-19.4% in MMSA. Adults with inadequate sleep: 27.6%-49.2% in states and territories and 26.5%-44.4% in MMSA. Adults aged 18-64 years having health care coverage: 66.9%-92.4% in states and territories and 60.5%-97.6% in MMSA. Adults identifying as current cigarette smokers: 10.1%-28.8% in states and territories and 6.1%-33.6% in MMSA. Adults reporting binge drinking during the past month: 10.5%-25.2% in states and territories and 7.2%-25.3% in MMSA. Adults with obesity: 21.0%-35.2% in states and territories and 12.1%-37.1% in MMSA. Adults aged ≥45 years with some form of arthritis: 30.6%-51.0% in states and territories and 27.6%-52.4% in MMSA. Adults aged ≥45 years who have had coronary heart disease: 7.4%-17.5% in states and territories and 6.2%-20.9% in MMSA. Adults aged ≥45 years who have had a stroke: 3.1%-7.5% in states and territories and 2.3%-9.4% in MMSA. Adults with high blood pressure: 25.2%-40.1% in states and territories and 22.2%-42.2% in MMSA. Adults with high blood cholesterol: 28.8%-38.4% in states and territories and 26.3%-39.6% in MMSA. The following are estimates for 2014. Adults reporting frequent physical distress: 7.8%-16.0% in states and territories and 6.2%-18.5% in MMSA. Women aged 21-65 years who had a Papanicolaou test during the past 3 years: 67.7%-87.8% in states and territories and 68.0%-94.3% in MMSA. Adults aged 50-75 years who received colorectal cancer screening on the basis of the 2008 U.S. Preventive Services Task Force recommendation: 42.8%-76.7% in states and territories and 49.1%-79.6% in MMSA. Adults with inadequate sleep: 28.4%-48.6% in states and territories and 25.4%-45.3% in MMSA. Adults reporting binge drinking during the past month: 10.7%-25.1% in states and territories and 6.7%-26.3% in MMSA. Adults aged ≥45 years who have had coronary heart disease: 8.0%-17.1% in states and territories and 7.6%-19.2% in MMSA. Adults aged ≥45 years with some form of arthritis: 31.2%-54.7% in states and territories and 28.4%-54.7% in MMSA. Adults with obesity: 21.0%-35.9% in states and territories and 19.7%-42.5% in MMSA. INTERPRETATION: Prevalence of certain chronic diseases and conditions, health risk behaviors, and use of preventive health services varies among states, territories, and MMSA. The findings of this report highlight the need for continued monitoring of health status, health care access, health behaviors, and chronic diseases and conditions at state and local levels. PUBLIC HEALTH ACTION: State and local health departments and agencies can continue to use BRFSS data to identify populations at risk for certain unhealthy behaviors and chronic diseases and conditions. Data also can be used to design, monitor, and evaluate public health programs at state and local levels.

Surveillance for Health Care Access and Health Services Use, Adults Aged 18-64 Years - Behavioral Risk Factor Surveillance System, United States, 2014.

PROBLEM/CONDITION: As a result of the 2010 Patient Protection and Affordable Care Act, millions of U.S. adults attained health insurance coverage. However, millions of adults remain uninsured or underinsured. Compared with adults without barriers to health care, adults who lack health insurance coverage, have coverage gaps, or skip or delay care because of limited personal finances might face increased risk for poor physical and mental health and premature mortality. PERIOD COVERED: 2014. DESCRIPTION OF SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Data are collected from states, the District of Columbia, and participating U.S. territories on health risk behaviors, chronic health conditions, health care access, and use of clinical preventive services (CPS). An optional Health Care Access module was included in the 2014 BRFSS. This report summarizes 2014 BRFSS data from all 50 states and the District of Columbia on health care access and use of selected CPS recommended by the U.S. Preventive Services Task Force or the Advisory Committee on Immunization Practices among working-aged adults (aged 18-64 years), by state, state Medicaid expansion status, expanded geographic region, and federal poverty level (FPL). This report also provides analysis of primary type of health insurance coverage at the time of interview, continuity of health insurance coverage during the preceding 12 months, and other health care access measures (i.e., unmet health care need because of cost, unmet prescription need because of cost, medical debt [medical bills being paid off over time], number of health care visits during the preceding year, and satisfaction with received health care) from 43 states that included questions from the optional BRFSS Health Care Access module. RESULTS: In 2014, health insurance coverage and other health care access measures varied substantially by state, state Medicaid expansion status, expanded geographic region (i.e., states categorized geographically into nine regions), and FPL category. The following proportions refer to the range of estimated prevalence for health insurance and other health care access measures by examined geographical unit (unless otherwise specified), as reported by respondents. Among adults with health insurance coverage, the range was 70.8%-94.5% for states, 78.8%-94.5% for Medicaid expansion states, 70.8%-89.1% for nonexpansion states, 73.3%-91.0% for expanded geographic regions, and 64.2%-95.8% for FPL categories. Among adults who had a usual source of health care, the range was 57.2%-86.6% for states, 57.2%-86.6% for Medicaid expansion states, 61.8%-83.9% for nonexpansion states, 64.4%-83.6% for expanded geographic regions, and 61.0%-81.6% for FPL categories. Among adults who received a routine checkup, the range was 52.1%-75.5% for states, 56.0%-75.5% for Medicaid expansion states, 52.1%-71.1% for nonexpansion states, 56.8%-70.2% for expanded geographic regions, and 59.9%-69.2% for FPL categories. Among adults who had unmet health care need because of cost, the range was 8.0%-23.1% for states, 8.0%-21.9% for Medicaid expansion states, 11.9%-23.1% for nonexpansion states, 11.6%-20.3% for expanded geographic regions, and 5.3%-32.9% for FPL categories. Estimated prevalence of cancer screenings, influenza vaccination, and having ever been tested for human immunodeficiency virus also varied by state, state Medicaid expansion status, expanded geographic region, and FPL category. The prevalence of insurance coverage varied by approximately 25 percentage points among racial/ethnic groups (range: 63.9% among Hispanics to 88.4% among non-Hispanic Asians) and by approximately 32 percentage points by FPL category (range: 64.2% among adults with household income <100% of FPL to 95.8% among adults with household income >400% of FPL). The prevalence of unmet health care need because of cost varied by nearly 14 percentage points among racial/ethnic groups (range: 11.3% among non-Hispanic Asians to 25.0% among Hispanics), by approximately 17 percentage points among adults with and without disabilities (30.8% versus 13.7%), and by approximately 28 percentage points by FPL category (range: 5.3% among adults with household income >400% of FPL to 32.9% among adults with household income <100% of FPL). Among the 43 states that included questions from the optional module, a majority of adults reported private health insurance coverage (63.4%), followed by public health plan coverage (19.4%) and no primary source of insurance (17.1%). Financial barriers to health care (unmet health care need because of cost, unmet prescribed medication need because of cost, and medical bills being paid off over time [medical debt]) were typically lower among adults in Medicaid expansion states than those in nonexpansion states regardless of source of insurance. Approximately 75.6% of adults reported being continuously insured during the preceding 12 months, 12.9% reported a gap in coverage, and 11.5% reported being uninsured during the preceding 12 months. The largest proportion of adults reported ≥3 visits to a health care professional during the preceding 12 months (47.3%), followed by 1-2 visits (37.1%), and no health care visits (15.6%). Adults in expansion and nonexpansion states reported similar levels of satisfaction with received health care by primary source of health insurance coverage and by continuity of health insurance coverage during the preceding 12 months. INTERPRETATION: This report presents for the first time estimates of population-based health care access and use of CPS among adults aged 18-64 years. The findings in this report indicate substantial variations in health insurance coverage; other health care access measures; and use of CPS by state, state Medicaid expansion status, expanded geographic region, and FPL category. In 2014, health insurance coverage, having a usual source of care, having a routine checkup, and not experiencing unmet health care need because of cost were higher among adults living below the poverty level (i.e., household income <100% of FPL) in states that expanded Medicaid than in states that did not. Similarly, estimates of breast and cervical cancer screening and influenza vaccination were higher among adults living below the poverty level in states that expanded Medicaid than in states that did not. These disparities might be due to larger differences to begin with, decreased disparities in Medicaid expansion states versus nonexpansion states, or increased disparities in nonexpansion states. PUBLIC HEALTH ACTION: BRFSS data from 2014 can be used as a baseline by which to assess and monitor changes that might occur after 2014 resulting from programs and policies designed to increase access to health care, reduce health disparities, and improve the health of the adult population. Post-2014 changes in health care access, such as source of health insurance coverage, attainment and continuity of coverage, financial barriers, preventive care services, and health outcomes, can be monitored using these baseline estimates.

National weighting of data from the Behavioral Risk Factor Surveillance System (BRFSS).

BACKGROUND: The Behavioral Risk Factor Surveillance System (BRFSS) is a network of health-related telephone surveys--conducted by all 50 states, the District of Columbia, and participating US territories-that receive technical assistance from CDC. Data users often aggregate BRFSS state samples for national estimates without accounting for state-level sampling, a practice that could introduce bias because the weighted distributions of the state samples do not always adhere to national demographic distributions. METHODS: This article examines six methods of reweighting, which are then compared with key health indicator estimates from the National Health Interview Survey (NHIS) based on 2013 data. RESULTS: Compared to the usual stacking approach, all of the six new methods reduce the variance of weights and design effect at the national level, and some also reduce the estimated bias. This article also provides a comparison of the methods based on the variances induced by unequal weighting as well as the bias reduction induced by raking at the national level, and recommends a preferred method. CONCLUSIONS: The new method leads to weighted distributions that more accurately reproduce national demographic characteristics. While the empirical results for key estimates were limited to a few health indicators, they also suggest reduction in potential bias and mean squared error. To the extent that survey outcomes are associated with these demographic characteristics, matching the national distributions will reduce bias in estimates of these outcomes at the national level.

Surveillance for Certain Health Behaviors, Chronic Diseases, and Conditions, Access to Health Care, and Use of Preventive Health Services Among States and Selected Local Areas- Behavioral Risk Factor Surveillance System, United States, 2012.

PROBLEM: Chronic diseases (e.g., heart diseases, cancer, chronic lower respiratory disease, stroke, diabetes, and arthritis) and unintentional injuries are the leading causes of morbidity and mortality in the United States. Behavioral risk factors (e.g., tobacco use, poor diet, physical inactivity, excessive alcohol consumption, failure to use seat belts, and insufficient sleep) are linked to the leading causes of death. Modifying these behavioral risk factors and using preventive health services (e.g., cancer screenings and influenza and pneumococcal vaccination of adults aged ≥65 years) can substantially reduce morbidity and mortality in the U.S. POPULATION: Continuous monitoring of these health-risk behaviors, chronic conditions, and use of preventive services are essential to the development of health promotion strategies, intervention programs, and health policies at the state, city, and county level. REPORTING PERIOD: January-December 2012. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health-risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services related to the leading causes of death and disability. This report presents results for all 50 states, the District of Columbia, participating U.S. territories that include the Commonwealth of Puerto Rico (Puerto Rico) and Guam, 187 Metropolitan/Micropolitan Statistical Areas (MMSAs), and 210 counties (n = 475,687 survey respondents) for the year 2012. RESULTS: In 2012, the estimated prevalence of health-risk behaviors, chronic diseases or conditions, access to health care, and use of preventive health services substantially varied by state and territory, MMSA, and county. The following portion of the abstract lists a summary of results by selected BRFSS measures. Each set of proportions refers to the range of estimated prevalence for health-risk behaviors, chronic diseases or conditions, and use of preventive health care services among geographical units, as reported by survey respondents. Adults with good or better health: 64.0%-88.3% for states and territories, 62.7%-90.5% for MMSAs, and 68.1%-92.4% for counties. Adults aged 18-64 years with health care coverage: 64.2%-93.1% for states and territories, 35.4%- 93.7% for MMSAs, and 35.4%-96.7% for counties. Adults who received a routine physical checkup during the preceding 12 months: 55.7%-80.1% for states and territories, 50.6%-85.0% for MMSAs, and 52.4%-85.0% for counties. An influenza vaccination received during the preceding 12 months among adults aged ≥65 years: 26.3%-70.1% for states and territories, 20.8%-77.8% for MMSAs, and 24.1%-77.6% for counties. Ever received pneumococcal vaccination among adults aged ≥65 years: 22.2%-76.2% for states and territories, 15.3%-83.4% for MMSAs, and 25.8%-85.2% for counties. Adults who had a dental visit in the past year: 53.7%-76.2% for states and territories, and 44.8%-81.7% for MMSAs and counties. Adults aged ≥65 years who have lost all of their natural teeth from tooth decay or gum disease: 7.0%-33.7% for states and territories, 5.8%-39.6% for MMSAs, and 5.8%-37.1% for counties. Adults aged 50-75 years who received a colorectal cancer screening on the basis of the U.S. Preventive Services Task Force recommendation: 40.0%-76.4% for states and territories, 47.1%-80.7% for MMSAs, and 47.0%-81.0% for counties. Women aged 21-65 years who had a Papanicolaou test during the preceding 3 years: 68.5% to 89.6% for states and territories, 70.3% to 92.8% for MMSAs, and 65.7%-94.6% for counties. Women aged 50-74 years who had a mammogram during the preceding 2 years: 66.5%- 89.7% for states and territories, 61.1%-91.5% for MMSAs, and 61.8%-91.6% for counties. Current cigarette smoking among adults: 10.6%-28.3% for states and territories, 5.1%-30.1% for MMSAs, and 5.1%-28.3% for counties. Binge drinking among adults during the preceding month: 10.2%-25.2% for states and territories, 6.2%-28.1% for MMSAs, and 6.2%-29.5% for counties. Heavy drinking among adults during the preceding month: 3.5%-8.5% for states and territories, 2.0%-11.0% for MMSAs, and 1.9%-11.0% for counties. Adults who reported no leisure-time physical activity: 16.3%-42.4% for states and territories, 9.2%-47.3% for MMSAs, and 9.2%-39.0% for counties. Self- reported seat belt use: 62.0%-93.7% for states and territories, 54.1%-97.1% for MMSAs, and 50.1%-97.4% for counties. Adults who were obese: 20.5%-34.7% for states and territories, 14.8%-44.5% for MMSAs and counties. Adults with diagnosed diabetes: 7.0%-16.4% for states and territories, 3.4%-17.4% for MMSAs, and 3.1%-17.4% for counties. Adults who ever had any type of cancer: 3.0%-13.7% for states and territories, 3.8%-19.2% for MMSAs, and 4.5%-19.2% for counties. Adults with current asthma: 5.8%-11.1% for states and territories, 3.1%-15.0% for MMSAs, and 3.1%-15.7% for counties. Adults with some form of arthritis: 15.6%-36.4% for states and territories, 16.8%-45.8% for MMSAs, and 14.8%-35.9% for counties. Adults having had a depressive disorder: 9.0%-23.5% for states and territories, 9.2%-28.3% for MMSAs, and 8.5%-28.4% for counties. Adults aged ≥45 years who have had coronary heart disease: 7.4%-19.0% for states and territories, 6.1%-23.3% for MMSAs, and 6.1%-20.6% for counties. Adults aged ≥45 years who have had a stroke: 3.1%-7.3% for states and territories, 2.1%-9.3% for MMSAs, and 1.5%-9.3% for counties. Adults with limited activities because of physical, mental, or emotional problems: 15.0%-28.6% for states and territories, 12.0%-31.7% for MMSAs, and 11.3%-31.7% for counties. Adults using special equipment because of any health problem: 4.8%-11.6% for states and territories, 4.0%-14.7% for MMSAs, and 2.8%-13.6% for counties. INTERPRETATION: This report underscores the need for continuous surveillance of health-risk behaviors, chronic diseases or conditions, health care access, and use of preventive care services at state and local levels. It will help to identify high-risk populations and to evaluate public health intervention programs and policies designed to reduce morbidity and mortality from chronic disease and injury. PUBLIC HEALTH ACTION: State and local health departments and agencies can continue to use BRFSS data to identify populations at high risk for unhealthy behaviors and chronic diseases or conditions, lack of health care access, and inadequate use of preventive care services. Additionally, states can use the data to design, implement, monitor, and evaluate public health programs and policies at state and local levels.

Prevalence of Sugar-Sweetened Beverage Intake Among Adults--23 States and the District of Columbia, 2013.

The 2015-2020 Dietary Guidelines for Americans recommend that the daily intake of calories from added sugars not exceed 10% of total calories. Sugar-sweetened beverages (SSBs) are significant sources of added sugars in the diet of U.S. adults and account for approximately one third of added sugar consumption. Among adults, frequent (i.e., at least once a day) SSB intake is associated with adverse health consequences, including obesity, type 2 diabetes, and cardiovascular disease. According to the 2009-2010 National Health and Nutrition Examination Survey (NHANES), an in-person and phone follow-up survey, 50.6% of U.S. adults consumed at least one SSB on a given day. In addition, SSB intake varies by geographical regions: the prevalence of daily SSB intake was higher among U.S. adults living in the Northeast (68.4%) and South (66.7%) than among persons living in the Midwest (58.8%). In 2013, the Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey, revised the SSB two-item optional module to retain the first question on regular soda and expand the second question to include more types of SSBs than just fruit drinks. Using 2013 BRFSS data, self-reported SSB (i.e., regular soda, fruit drinks, sweet tea, and sports or energy drinks) intake among adults (aged ≥18 years) was assessed in 23 states and the District of Columbia (DC). The overall age-adjusted prevalence of SSB intake ≥1 time per day was 30.1% and ranged from 18.0% in Vermont to 47.5% in Mississippi. Overall, at least once daily SSB intake was most prevalent among adults aged 18-24 years (43.3%), men (34.1%), non-Hispanic blacks (blacks) (39.9%), unemployed adults (34.4%), and persons with less than a high school education (42.4%). States can use the data for program evaluation and monitoring trends, and information on disparities in SSB consumption could be used to create targeted intervention efforts to reduce SSB consumption.

Health behaviors and obesity among Hispanics with depression, United States 2006.

OBJECTIVE: To examine the differences in health behaviors, and obesity between Hispanics and non-Hispanic Whites with depression. DESIGN: Depression data were gathered from 38 states, the District of Columbia, Puerto Rico, and the US Virgin Islands using the 2006 Behavioral Risk Factor Surveillance System, a state-based random-digit-dialed telephone survey of adults aged > or =18 years (n=156,991). The Patient Health Questionnaire 8 was used to determine current depression. Lifetime diagnosis of depression was assessed by self-report of physician diagnosis. Prevalence ratios were calculated to examine the racial/ethnic differences in leisure-time physical activity, cigarette smoking, binge drinking, heavy drinking and obesity among people with current depression and lifetime diagnosis of depression. RESULTS: There were significant differences in age, education, and health care coverage between Hispanics and non-Hispanic Whites with current depression and lifetime diagnosis of depression. Hispanics with current depression and with lifetime diagnosis of depression were more likely to be obese than non-Hispanic Whites. After adjusting for demographic factors, health care coverage, and self-rated health status, Hispanics with current depression were 17% more likely not to participate in leisure-time physical activity and 42% less likely to be a current cigarette smoker compared with non-Hispanic Whites. Hispanics with lifetime diagnosis of depression were 14% more likely not to participate in leisure-time physical activity and 44% less likely to be a current cigarette smoker than non-Hispanic Whites after adjusting for confounders. CONCLUSIONS: Public health intervention programs are needed to promote healthy behaviors especially physical activity participation with in the Hispanic community, and paying particular attention to people who already are depressed.

Surveillance for certain health behaviors among States and selected local areas - United States, 2010.

PROBLEM: Chronic diseases (e.g., heart disease, stroke, cancer, and diabetes) are the leading causes of morbidity and mortality in the United States. Engaging in healthy behaviors (e.g., quitting smoking and tobacco use, being more physically active, and eating a nutritious diet) and accessing preventive health-care services (e.g., routine physical checkups, screening for cancer, checking blood pressure, testing blood cholesterol, and receiving recommended vaccinations) can reduce morbidity and mortality from chronic and infectious disease and lower medical costs. Monitoring and evaluating health-risk behaviors and the use of health services is essential to developing intervention programs, promotion strategies, and health policies that address public health at multiple levels, including state, territory, metropolitan and micropolitan statistical area (MMSA), and county. REPORTING PERIOD: January-December 2010. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health-risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services and practices related to the leading causes of death and disabilities in the United States. This report presents results for 2010 for all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the U.S. Virgin Islands, 192 MMSAs, and 302 counties. RESULTS: In 2010, the estimated prevalence of high-risk health behaviors, chronic diseases and conditions, access to health care, and use of preventive health services varied substantially by state and territory, MMSA, and county. In the following summary of results, each set of proportions refers to the range of estimated prevalence for the disease, condition, or behaviors, as reported by survey respondents. Adults reporting good or better health: 67.9%-89.3% for states and territories, 72.2%-92.1% for MMSAs, and 72.8%-95.8% for counties. Adults with health-care coverage: 69.4%-95.7% for states and territories, 45.7%-97.0% for MMSAs, and 45.7%-97.2% for counties. Adults who had a dental visit in the past year: 57.2%-81.7% for states and territories, 47.1%-83.5% for MMSAs, and 47.1%-88.2% for counties. Adults aged ≥65 years having had all their natural teeth extracted (edentulism): 7.4%-36.0% for states and territories, 4.8%-34.8% for MMSAs, and 2.4%-39.3% for counties. A routine physical checkup during the preceding 12 months: 53.8%-80.0% for states and territories, 49.5%-82.6% for MMSAs, and 49.5%-85.3% for counties. Influenza vaccination received during the preceding 12 months among adults aged ≥65 years: 26.9%-73.4% for states and territories, 51.7%-77.1% for MMSAs, and 49.3%-87.8% for counties. Pneumococcal vaccination ever received among adults aged ≥65 years: 24.7%-74.0% for states and territories, 48.6%-79.9% for MMSAs, and 47.6%-83.1% for counties. Sigmoidoscopy or colonoscopy ever received among adults aged ≥50 years: 37.8%-75.7% for states and territories, 37.3%-79.9% for MMSAs, and 37.3%-82.5% for counties. Blood stool test received during the preceding 2 years among adults aged ≥50 years: 8.5%-27.0% for states and territories, 6.7%-51.3% for MMSAs, and 6.8%-57.2% for counties. Women who reported having had a Papanicolaou test during the preceding 3 years: 67.8%-88.9% for states and territories, 63.3%-91.2% for MMSAs, and 63.2%-95.7% for counties. Women aged ≥40 years who had a mammogram during the preceding 2 years: 63.8%-83.6% for states and territories, 60.3%-86.2% for MMSAs, and 59.3%-89.7% for counties. Current cigarette smokers: 5.8%-26.8% for states and territories, 5.8%-28.5% for MMSAs, and 5.9%-29.8% for counties. Binge drinking during the preceding month: 6.6%-21.6% for states and territories, 3.6%-23.0% for MMSAs, and 3.8%-24.0% for counties. Heavy drinking during the preceding month: 2.0%-7.2% for states and territories, 1.0%-10.0% for MMSAs, and 1.0%-14.2% for counties. Adults reporting no leisure-time physical activity: 17.5%-42.3% for states and territories, 13.1%-37.6% for MMSAs, and 8.5%-39.0% for counties. Adults who were overweight: 32.6%-40.7% for states and territories, 28.5%-42.5% for MMSAs, and 27.2%-46.4% for counties. Adults aged ≥20 years who were obese: 22.1%-35.0% for states and territories, 17.1%-42.1% for MMSAs, and 13.3%-42.1% for counties. Adults with current asthma: 5.2%-11.1% for states and territories, 3.4%-14.5% for MMSAs, and 3.3%-14.6% for counties. Adults with diagnosed diabetes: 5.3%-13.2% for states and territories, 4.6%-15.4% for MMSAs, and 2.6%-18.8% for counties. Adults with limited activities because of physical, mental or emotional problems: 10.8%-28.2% for states and territories, 13.5%-38.3% for MMSAs, and 11.7%-32.0% for counties. Adults using special equipment because of any health problem: 2.8%-10.6% for states and territories, 4.5%-15.5% for MMSAs, and 1.3%-15.5% for counties. Adults aged ≥45 years who have had coronary heart disease: 5.3%-16.7% for states and territories, 6.5%-19.6% for MMSAs, and 4.9%-19.6% for counties. Adults aged ≥45 years who have had a stroke: 2.4%-7.1% for states and territories, 2.3%-8.8% for MSMAs, and 1.7%-8.8% for counties. INTERPRETATION: The findings in this report indicate substantial variations in the health-risk behaviors, chronic diseases and conditions, access to health-care services, and the use of the preventive health services among U.S. adults at the state and territory, MMSA, and county levels. Healthy People 2010 (HP 2010) objectives were established to monitor health behaviors, conditions, and the use of preventive health services for the first decade of the 2000s. The findings in this report indicate that many of the HP 2010 objectives were not achieved by 2010. The findings underscore the continued need for surveillance of health-risk behaviors, chronic diseases, and conditions and of the use of preventive health-care services. PUBLIC HEALTH ACTION: Local and state health departments and federal agencies use BRFSS data to identify populations at high risk for certain health-risk behaviors, chronic diseases, and conditions and to evaluate the use of preventive health-care services. BRFSS data also are used to direct, implement, monitor, and evaluate public health programs and policies that can lead to a reduction in morbidity and mortality from chronic conditions and corresponding health-risk behaviors.

Surveillance of certain health behaviors and conditions among states and selected local areas --- Behavioral Risk Factor Surveillance System, United States, 2009.

PROBLEM: Chronic diseases and conditions (e.g., heart disease, cancer, stroke, and diabetes) are the leading causes of death in the United States. Controlling health risk behaviors and conditions (e.g., smoking, physical inactivity, poor diet, excessive drinking, and obesity) and using preventive health-care services (e.g., physical examination, vaccination, screening for high blood pressure and high cholesterol, consumption of fruits and vegetables, and participation in regular leisure-time physical activity) can reduce morbidity and mortality from chronic diseases. REPORTING PERIOD: January 2009--December 2009. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing state-based random-digit--dialed telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health risk behaviors and conditions, chronic diseases and conditions, access to health care, and use of preventative health services and practices related to the leading causes of death and disabilities in the United States. This report presents results for 2009 for all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the U.S. Virgin Islands, 180 metropolitan and micropolitan statistical areas (MMSAs), and 283 selected counties. RESULTS: In 2009, the estimated prevalence of general health status, use of preventive health-care services, health risk behaviors and conditions, chronic diseases, and health impairments and disabilities varied substantially by state and territory, MMSA, and county. The following is a summary of results listed by BRFSS question topics. Each set of proportions refers to the range of estimated prevalence for the disease, condition, or behavior, as reported by the survey respondent. Adults who reported having fair or poor health: 10.1%--30.9% for states and territories, 7.9%--25.8% for MMSAs, and 4.5%--26.1% for counties. Adults with health-care coverage: 71.4%--94.7% for states and territories, 52.7%--96.3% for MMSAs, and 52.7%--97.6% for counties. Annual routine physical checkup among adults aged ≥18 years: 55.8%--79.3% for states and territories, 51.8%--80.7% for MMSAs, and 49.2%--83.5% for counties. Annual influenza vaccination among adults aged ≥65 years: 26.8%--76.8% for states and territories, 55.4%--81.4% for MMSAs, and 50.5%--83.5% for counties. Pneumococcal vaccination among adults aged ≥65 years: 19.1%--73.9% for states and territories, 52.9%--81.3% for MMSAs, and 41.9%--82.0% for counties. Adults who had their cholesterol checked within the preceding 5 years: 67.5%--85.3% for states and territories, 58.2%--88.8% for MMSAs, and 58.2%--92.4% for counties. Adults who consumed at least five servings of fruits and vegetables per day: 14.6%--31.5% for states and territories, 12.6%--33.0% for MMSAs, and 13.4%--34.9% for counties. Adults who engaged in moderate or vigorous physical activity: 28.0%--60.7% for states and territories, 34.6%--64.9% for MMSAs, and 33.6%--67.3% for counties. Adults who engaged in only vigorous physical activity: 13.7%--40.1% for states and territories, 13.8%--43.3% for MMSAs, and 14.2%--50.0% for counties. Current cigarette smoking among adults: 6.4%--25.6% for states and territories, 5.7%--29.0% for MMSAs, and 5.6%--29.8% for counties. Binge drinking among adults: 6.8%--23.9% for states and territories, 3.5%--23.2% for MMSAs, and 3.4%--26.3% for counties. Heavy drinking among adults: 1.9%--8.1% for states and territories, 1.0%--11.1% for MMSAs, and 0.9%--11.1% for counties. Adults who reported no leisure-time physical activity: 15.8%--45.6% for states and territories, 13.3%--40.2% for MMSAs, and 10.5%--40.2% for counties. Adults aged ≥18 years who were overweight: 31.6%--38.7% for states and territories, 28.7%--44.1% for MMSAs, and 25.6%--46.7% for counties. Adults aged ≥20 years who were obese: 19.7%--36.0% for states and territories, 15.4%--43.6% for MMSAs, and 13.8%--45.7% for counties. Adults aged ≥18 years who did not get enough rest or sleep: 34.3%--52.6% for states and territories, 28.2%--54.8% for MMSAs, and 24.5%--55.6% for counties. Adults who had received a high blood pressure diagnosis: 22.1%--38.5% for states and territories, 18.8%--43.9% for MMSAs, and 17.2%--43.6% for counties. Adults who had a high blood cholesterol diagnosis: 24.9%--42.2% for states and territories, 27.5%--47.8% for MMSAs, and 26.7%--51.4% for counties. Adults who had received a diagnosis of coronary heart disease: 2.5%--10.3% for states and territories, 2.6%--11.6% for MMSAs, and 1.6%--12.3% for counties. Adults who had received a stroke diagnosis: 1.4%--3.9% for states and territories, 0.8%--5.9% for MMSAs, and 0.8%--6.6% for counties. Adults who had received a diabetes diagnosis: 5.8%--12.9% for states and territories, 2.8%--15.4% for MMSAs, and 2.8%--14.7% for counties. Adults who had received a cancer diagnosis: 3.0%--12.6% for states and territories, 5.8%--15.1% for MMSAs, and 3.9%--16.2% for counties. Adults who had asthma: 4.4%--11.1% for states and territories, and 3.2%--15.3% for MMSAs, and 3.2%--15.7% for counties. Adults who had arthritis: 10.7%--35.6% for states and territories, 16.2%--36.0% for MMSAs, and 12.6%--39.4% for counties. Adults with activity limitation associated with physical, mental, or emotional problems: 10.2%--27.1% for states and territories, 13.1%--33.7% for MMSAs, and 10.4%--36.1% for counties. Adults who required special equipment because of health problems: 3.6%--10.2% for states and territories, 3.4%--11.5% for MMSAs, and 1.7%--13.0% for counties. INTERPRETATION: The findings in this report indicate substantial variations in self-rated general health status, health-care coverage, use of preventive health-care services, health risk behaviors and health conditions, cardiovascular conditions, other chronic diseases, and health impairments and disabilities among U.S. adults at the state and territory, MMSA, and county levels. The findings show that Healthy People 2010 objectives had not been met in many areas by 2009, which underscores the continued need for surveillance of general health status, use of preventive health-care services, health risk behaviors and conditions, chronic diseases, and health impairment and disability. PUBLIC HEALTH ACTION: Data on health risk behaviors, chronic health conditions, preventive care practices, and chronic diseases are used to develop health promotion activities, intervention programs, and health policies at the state, city, and county levels.. The overarching goals of Healthy People 2010 are to increase quality and years of healthy life and to eliminate health disparities. Local and state health departments and federal agencies should continue to use BRFSS data to identify populations at high risk for certain health risk behaviors and conditions, cardiovascular conditions, and other chronic diseases and to evaluate the use of preventive health-care services. In addition, BRFSS data can be used to direct, implement, monitor, and evaluate public health programs and policies that can lead to a reduction in morbidity and mortality.

Surveillance of certain health behaviors and conditions among states and selected local areas - Behavioral Risk Factor Surveillance System, United States, 2007.

PROBLEM: Chronic diseases (e.g., heart disease, cancer, stroke, and diabetes) are the leading causes of death in the United States. Controlling health risk behaviors (e.g., smoking, physical inactivity, poor diet, and excessive drinking) and using preventive health-care services (e.g., cancer, hypertension, and cholesterol screenings) can reduce morbidity and mortality from chronic diseases. Monitoring health-risk behaviors, chronic health conditions, and preventive care practices is essential to develop health promotion activities, intervention programs, and health policies at the state, city, and county levels. REPORTING PERIOD COVERED: January 2007-December 2007. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based, on-going, random--digit-dialed household telephone survey of noninstitutionalized adults aged >or=18 years residing in the United States. BRFSS collects data on health-risk behaviors and use of preventative health services related to the leading causes of death and disability in the United States. This report presents results for 2007 for all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the Virgin Islands, 184 metropolitan and micropolitan statistical areas (MMSAs), and 298 counties. RESULTS: In 2007, prevalence estimates of risk behaviors, chronic conditions, and the use of preventive services varied substantially by state and territory, MMSA, and county. The following is a summary of results listed by BRFSS question topic. Each set of proportions refers to the range of estimated prevalence for the disease, condition, or behavior, as reported by the survey subject. Adults who reported fair or poor health: 11% to 32% for states and territories and 6% to 31% for MMSAs and counties. Adults with health-care coverage: 71% to 94% for states and territories and 51% to 97% for MMSAs and counties. Annual influenza vaccination among adults aged >or=65 years: 32% to 80% for states and territories, 48% to 83% for MMSAs, and 44% to 88% for counties. Pneumococcal vaccination among adults aged >/=65 years: 26% to 74% for states and territories, 44% to 83% for MMSAs, and 39% to 87% for counties. Adults who had their cholesterol checked within the preceding 5 years: 66% to 85% for states and territories and 58% to 90% for MMSAs and counties. Adults who consumed at least 5 servings of fruits and vegetables per day: 14% to 33% for states and territories, 16% to 34% for MMSAs and 14% to 37% for counties. Adults who reported no leisure-time physical activity: 17% to 44% for states and territories and 9% to 38% for MMSAs and counties. Adults who engaged in moderate or vigorous physical activity: 31% to 61% for states and territories and 36% to 67% for MMSAs and counties. Adults who engaged in only vigorous physical activity: 19% to 40% for states and territories and 15% to 45% for MMSAs and counties. Cigarette smoking among adults: 9% to 31% for states and territories, 7% to 34% for MMSAs, and 7% to 30% for counties. Binge drinking among adults: 3% to 8% for states and territories. Adults classified as overweight: 33% to 40% for states and territories and 26% to 47% for MMSAs and counties. Adults aged >or=20 years who were obese: 20% to 34% for states and territories and 14% to 38% for MMSAs and counties. Adults who were told of a diabetes diagnosis: 5% to 13% for states and territories and 2% to 17% for MMSAs and counties. Adults with high blood pressure diagnosis: 21% to 35% for states and territories and 16% to 38% for MMSAs and counties. Adults who had high blood cholesterol: 28% to 43% for states and territories, 29% to 49% for MMSAs, and 26% to 51% for counties. Adults with a history of coronary heart disease: 2% to 14% for states and territories, MMSAs, and counties. Adults who were told of a stroke diagnosis: 1% to 7% for states and territories, MMSAs, and counties. Adults who were diagnosed with arthritis: 14% to 36% for states and territories and 16% to 40% for MMSAs and counties. Adults who had asthma: 5% to 10% for states and territories and 3% to 13% for MMSAs and counties. Adults with activity limitation associated with physical, mental, or emotional problems: 10% to 26% for states and territories. Adults who required special equipment because of health problems: 3% to 10% for states and territories and 3% to 14% for MMSAs and counties. INTERPRETATION: The findings in this report indicate substantial variation in self-reported health status, health-care coverage, use of preventive health-care services, health behaviors leading to chronic health conditions, and disability among U.S. adults at the state and territory, MMSA, and county levels. The findings underscore the continued need for surveillance of health-risk behaviors, chronic diseases and conditions, and the use of preventive services. PUBLIC HEALTH ACTIONS: Healthy People 2010 (HP 2010) objectives have been established to monitor health behaviors and the use of preventive health services. Local and state health departments and federal agencies use BRFSS data to identify populations at high risk for certain health behaviors, chronic diseases and conditions and to evaluate the use of preventive services. In addition, BRFSS data are used to direct, implement, monitor, and evaluate public health programs and policies that can lead to a reduction in morbidity and mortality.

Surveillance of certain health behaviors among states and selected local areas--United States, 2005.

PROBLEM: Behavioral risk factors such as smoking, poor diet, physical inactivity, and excessive drinking are linked to the leading causes of death in the United States. Controlling these behavioral risk factors and using preventive health services (e.g., influenza and pneumococcal vaccination of adults aged > or =65 years and hypertension and cholesterol screenings) can substantially reduce the morbidity and mortality in the U.S. population. Continuous monitoring of these behaviors and preventive services are essential for developing health promotion, intervention programs, and health policies at the state, city, and county level. REPORTING PERIOD COVERED: Data collected in 2005 are presented for states/territories, selected metropolitan and micropolitan statistical areas (MMSAs), metropolitan divisions, and selected counties. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit--dialed telephone survey of the noninstitutionalized U.S. population aged > or =18 years. BRFSS collects information on health risk behaviors and preventive health services related to leading causes of death. All 50 states, the District of Columbia (DC), the Commonwealth of Puerto Rico, and the U.S. Virgin Islands participated in BRFSS during 2005. Within these states and territories, 153 MMSAs and 232 counties that reported data for at least 500 respondents or a minimum sample size of 19 per weighting class were included in the analyses. RESULTS: Prevalence of health-risk behaviors, awareness of specific medical conditions, and use of preventive services varied substantially by state/territory, MMSA, and county. In 2005, prevalence of health insurance ranged from 60% to 95% for states/territories, MMSAs, and counties. Prevalence of leisure-time physical inactivity ranged from 16% to 49% for states/territories, 14% to 36% for MMSAs, and 12% to 41% for counties. Prevalence of adults who engaged in at least moderate physical activity ranged from 33% to 62%, and prevalence of vigorous physical activity ranged from 15% to 42% for states/territories, MMSAs, and counties. Prevalence of adults who currently smoke cigarettes ranged from 6% to 35% for states/territories, MMSAs, and counties. The prevalence of binge drinking was substantially higher than the prevalence of heavy drinking across all the states/territories, MMSAs, and counties. Prevalence of adults who were overweight ranged from 53% to 67 % for states/territories, 49% to 70% for MMSAs, and 44% to 71% for counties. Prevalence of current asthma ranged from 4% to 14% for states/territories, MMSAs, and counties. Prevalence of diabetes ranged from 4% to 14% for states/territories and MMSAs and from 3% to 14% for counties. Proportion of respondents with high blood pressure ranged from 13% to 39% for states/territories, MMSAs and counties. Prevalence of respondents with high cholesterol ranged from 31% to 41% for states/territories and 26% to 47% for MMSAs and counties. The prevalence estimates for respondents who reported being limited in any way in any activities because of physical, mental, or emotional problems ranged from 10% to 27% for states/territories, 12% to 31% for MMSAs, and 10% to 27% for counties. The percentage of respondents who required use of special equipment ranged from 4% to 10% for the states/territories, 3% to 15% for MMSAs, and 3% to 11% for counties. Prevalence of fair or poor health ranged from 11% to 34% for states/territories and 6% to 26% for MMSAs and counties. The prevalence of adults who checked their cholesterol during the preceding 5 years ranged from 55% to 86% for states/territories, MMSAs, and counties. Prevalence of annual influenza vaccination among adults aged > or =65 years ranged from 32% to 78% for states/territories, 48% to 83% for MMSAs, and 41% to 84% for counties. The estimated prevalence of pneumococcal vaccination among adults aged > or =65 years ranged from 28% to 72% for states/territories, 52% to 82% for MMSAs, and 35% to 83% for counties. INTERPRETATION: The findings in this report indicate a wide variation in health-risk behaviors, chronic conditions, and use of preventive services among U.S. adults at the state/territory, MMSA, and county level. The findings underscore a need for continuous efforts to evaluate public health intervention programs and policies designed to reduce morbidity and mortality caused by chronic disease and injury. PUBLIC HEALTH ACTION: The 2005 BRFSS data indicate a need for continued monitoring of health-risk behaviors, specific disease conditions, and use of preventive services to identify high-risk populations and to implement and monitor health-promotion programs and health policies at the state/territory, MMSA, and county level.

Health care access among U.S. adults who drink alcohol excessively: missed opportunities for prevention.

INTRODUCTION: Excessive alcohol consumption kills approximately 75,000 people annually in the United States. Although alcohol screening among primary care patients is recommended by the U.S. Preventive Services Task Force, it is rarely performed. It is unclear whether low screening rates are due to limited access to health care, missed screening opportunities during patient visits, or both. METHODS: Data came from the 2002 Behavioral Risk Factor Surveillance System, a population-based telephone survey of noninstitutionalized U.S. adults. Current health insurance status and a history of a recent medical checkup (within 2 years) were assessed in relation to alcohol consumption status. Excessive drinkers included those who reported binge drinking (consuming five or more drinks on one or more occasions in the past month), heavy drinking (consuming more than 60 drinks in the past month for men or more than 30 for women), or both. RESULTS: The prevalence of excessive drinking among the general population (17%) was only slightly higher than the prevalence among those with current health insurance (15%) or a recent checkup (14%). Among excessive drinkers, 79% had current health insurance and 78% had a recent checkup. Although excessive drinkers were somewhat less likely to have health insurance or a recent checkup compared with nonexcessive drinkers and nondrinkers, these differences were less pronounced after stratifying by age. Excessive drinkers with the lowest rates of health insurance were young, Hispanic, less educated, and unemployed. However, most excessive drinkers who lacked insurance or a checkup were employed. CONCLUSION: Most excessive drinkers were insured and had a recent medical checkup, suggesting that low screening rates among excessive drinkers are mostly due to missed screening opportunities rather than a lack of screening opportunities. Systems approaches to address these missed opportunities should be aggressively implemented.

A comparison of national estimates from the National Health Interview Survey and the Behavioral Risk Factor Surveillance System.

OBJECTIVES: The purpose of this study was to compare national estimates from the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS). METHODS: The authors compared data from the 2 surveys on smoking, height, weight, body mass index, diabetes, hypertension, immunization, lack of insurance coverage, cost as a barrier to medical care, and health status. RESULTS: Overall national estimates were similar for 13 of the 14 measures examined. Small differences according to demographic characteristics were found for height and body mass index, with larger differences for health status. CONCLUSIONS: Although estimates differed within subgroups, the BRFSS provided national estimates comparable to those of the NHIS. BRFSS national data could provide rapidly available information to guide national policy and program decisions.