Surveillance for certain health behaviors among states and selected local areas--Behavioral Risk Factor Surveillance System, United States, 2011.

PROBLEM Chronic conditions (e.g., heart diseases, cerebrovascular diseases, malignant neoplasms, and diabetes), infectious diseases (e.g., influenza and pneumonia), and unintentional injuries are the leading causes of morbidity and mortality in the United States. Adopting positive health behaviors (e.g., staying physically active, quitting tobacco use, always wearing seatbelts in automobiles) and accessing preventive health-care services (e.g., getting routine physical checkups, receiving recommended vaccinations on appropriate schedules, checking blood pressure and cholesterol and maintaining them at healthy levels) can reduce morbidity and mortality from chronic and infectious diseases. Monitoring the health-risk behaviors of a community's residents as well as their participation in and access to health-care services provides information critical to the development and maintenance of intervention programs as well as the implementation of strategies and health policies that address public health problems at the levels of state and territory, metropolitan and micropolitan statistical area (MMSA), and county. REPORTING PERIOD January-December 2011. 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. In 2011, BRFSS adopted a new weighting methodology (iterative proportional fitting, or raking) and for the first time included data from respondents who solely use cellular telephones (i.e., do not use landlines). This report presents results for the year 2011 for all 50 states, the District of Columbia, and participating U.S. territories including the Commonwealth of Puerto Rico and Guam, 198 MMSAs, and 224 counties. RESULTS In 2011, the estimated prevalence of health-risk behaviors, chronic conditions, access to health care, and use of preventive health services substantially varied by state and territory, MMSA, and county. The following portion of this abstract summarizes selected results by some BRFSS measures. Each set of proportions refers to the range of estimated prevalence of the behaviors, diseases, or use of preventive health-care services as reported by survey respondents. Adults with good or better health: 65.5%-88.0% for states and territories, 72.0%-92.4% for MMSAs, and 74.3%-94.2% for counties. Adults aged <65 years with health-care coverage: 65.4%-92.3% for states and territories, 66.8%-94.7% for MMSAs, and 61.3%-95.6% for counties. Influenza vaccination received during the preceding 12 months among adults aged ≥65 years: 28.6%-70.2% for states and territories, 42.0% -80.0% for MMSAs, and 41.1%-78.2% for counties. Adults meeting the federal physical activity recommendations for both aerobic physical activity and muscle-strengthening activity: 8.5%-27.3% for states and territories, 7.3%-32.0% for MMSAs, and 11.0%-32.0% for counties. Current cigarette smokers: 11.8%-30.5% for states and territories, 8.4%-30.6% for MMSAs, and 8.1%-35.2% for counties. Binge drinking during the last month: 10.0%-25.0% for states and territories, 7.0%-32.5% for MMSAs, and 7.0%-32.5% for counties. Adults always wearing seatbelts while driving or riding in a car: 63.9%-94.1% for states and territories, 51.8%-96.9% for MMSAs, and 51.8%-97.0% for counties. Adults aged ≥18 who were obese: 20.7%-34.9% for states and territories, 15.1%-37.2% for MMSAs, and 15.1%-41.0% for counties. Adults with diagnosed diabetes: 6.7%-13.5% for states and territories, 3.9%-15.9% for MMSAs, and 3.5%-18.3% for counties. Adults with current asthma: 4.3%-12.1% for states and territories, 2.9%-14.1% for MMSAs, and 2.9%-15.6% for counties. Adults aged ≥45 years who have had coronary heart disease: 7.1%-16.2% for states and territories, 5.0%-19.4% for MMSAs, and 3.9%-18.5% for counties. Adults using special equipment because of any health problem: 5.1%-11.3% for states and territories, 3.9%-13.2% for MMSAs, and 2.4%-14.7% for counties. INTERPRETATION Because of the recent change in the BRFSS methodology, the results should not be compared with those from previous years. The findings in this report indicate that substantial variations exist in the reported health-risk behaviors, chronic diseases, disabilities, access to health-care services, and the use of preventive health services among U.S. adults at state and territory, MMSA, and county levels. The findings underscore the continued need for surveillance of health-risk behaviors, chronic conditions, and use of preventive health-care services as well as surveillance-informed programs designed to help improve health-related risk behaviors, levels of chronic disease and disability, and the access to and use of preventive services and health-care resources. PUBLIC HEALTH ACTION State and local health departments and agencies can continue to use BRFSS data to identify populations at high risk for certain unhealthy behaviors and chronic conditions. Additionally, they can use the data to inform the design, implementation, direction, monitoring, and evaluation of public health programs, policies, and use of preventive services that can lead to a reduction in morbidity and mortality among U.S. residents.