Behavioral Risk Factor Surveillance System BRFSS INSTITUTE FOR
Behavioral Risk Factor Surveillance System (BRFSS) INSTITUTE FOR IMPLEMENTATION SCIENCE IN POPULATION HEALTH AT CUNY GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY JUNE 2016 Disclaimer: The information in this slide set was assembled by the The Institute for Implementation Science in Population Health at CUNY to inform the work of the NYC DSRIP HIV projects. The content of these slides is based on publicly available information as of June 2016. For detailed BRFSS inquiries, see the resources and contact information slides.
OUTLINE �Background �Content �How to use the data �Strengths and limitations �Resources
BACKGROUND �What is BRFSS? Annual statewide random-digit-dialed telephone surveillance system designed by the Centers for Disease Control and Prevention (CDC). Monitors modifiable risk behaviors and other factors contributing to the leading causes of morbidity and mortality in the population. Statewide representative samples are collected monthly and aggregated into yearly datasets; data are weighted. �Population and geography US-wide, including NYS Civilian, non-institutionalized adult household population, aged ≥ 18 years Not HIV specific; no data on HIV status (only asked in conjunction with other HIV risk factors and as part of an optional module)
BACKGROUND (2) �Timeframe of available data NYS: 1985 -2014 Since 2011, cellphones included � Move from post-stratification to raking as statistical weighting method; incorporates more variables, telephone type among them �Accessibility of data Public non-identifiable dataset is available from CDC and NYS DOH websites � SMART: BRFSS provides summary data on prevalence of conditions and risk factors on metropolitan and county levels GIS data for mapping and geospatial analysis also available from CDC website (2002 -2010) Interactive dashboards with summary data online Commercial analysis and visualization tools (paid)
CONTENT �What’s in the BRFSS data set Content varies somewhat from year to year � Standard core, rotating core, optional modules Main topic areas: � Demographics � Healthcare access � Behavioral risk factors, incl. sexual behavior, drug use, alcohol and tobacco use, diet, exercise � Chronic disease indicators � Health-related quality of life
CONTENT (2) �HIV-related indicators Ever tested for HIV Tested for HIV within the past 12 months Date of last HIV test (other than for blood donation) Location of last HIV test (e. g. private doctor, counseling and testing site, inpatient hospitalization, clinic, correctional facility, drug treatment facility, home, ER) Main reason for HIV testing Perceived HIV risk
How to use the BRFSS data
HOW TO USE THE DATA �Ever tested for HIV, by household income, NYS 2014 CDC, 2016
HOW TO USE THE DATA (2) �Trends in annual prevalence of past year HIV testing, overall and by age, among U. S. adults aged 50– 64 years, 2003– 2010 Ford et al. , 2015
HOW TO USE THE DATA (3) �Persons who had ever been tested for HIV and persons in cellphone-only households, 2003– 2013. [BRFSS combined with NHIS] Van Handel et al. , 2015
HOW TO USE THE DATA (4) �Recent HIV testing prevalence and setting by age among sexually active adults at any increased risk for HIV infection, 2 ooo* * Multiple sex partners, intravenous drug use, sexually transmitted infection, anal sex without a condom, or HIV-positive test (composite variable) Takahashi et al. , 2005
HOW TO USE THE DATA (5) �Setting of HIV test among young adults aged 18 -24, 2011 -2013 Van Handel et al. , 2016
HOW TO USE THE DATA (6) �Relationship between age and HIV testing, and time since diagnosis and HIV testing, among cancer survivors, 2009 Li et al. , 2014
HOW TO USE THE DATA (7) �Sexual behavior, HIV/STI testing, and healthcare access among MSM by migration status, San Francisco 2011 Lama et al. , 2015
HOW TO USE THE DATA (8) �Potential use of BRFFS to further DSRIP PPS work Identify subgroups in need of increased HIV testing or sexual health education Assess on the state level the setting (provider type) and recipients (demographics, insurance status) of HIV tests Examine the distribution of risk factors for chronic disease by HIV risk factor profile Support efforts of programs such as tobacco control to reduce the risk of chronic disease; monitor trends
STRENGTHS �Established survey with rigorous design, a lot of historical data, extensive documentation and support resources online �Publically accessible and free to use �Can combine multiple data years or assess temporal trends across them �SMART: BRFSS provides summary data on metropolitan and county levels
LIMITATIONS �What to keep in mind: Need to use analytic methods accounting for complex survey design (stratification, clustering, weighting) Estimates for small subgroups, especially within a single data year, may be unreliable Mostly state-level analyses: county and zip code not included in public-use datasets � SMART: BRFSS provides summary of selected data on metropolitan and county levels Relies on self-reported data, subject to recall and social desirability bias HIV-related variables sparse in most years Limited comparability of pre- and post-2011 data (added cell phone sample)
RESOURCES �Publications and reports MMWR summaries of BRFSS data NYS BRFSS reports �Guides/guidelines and general information NYS DOHMH BRFSS portal CDC BRFSS portal � CDC BRFSS national data � Interactive CDC BRFSS data visualizations � Interactive CDC BRFSS chronic disease datasets � Survey data and documentation � GIS data and documentation � BRFSS user guide � SMART: BRFSS City and County data
OTHER REFERENCES Ford, Chandra L. , et al. "Trends in HIV Testing Among US Older Adults Prior to and Since Release of CDC's Routine HIV Testing Recommendations: National Findings from the BRFSS. " Public Health Reports 130. 5 (2015). Lama, T. T. , et al. "Migration and HIV Risk Among Men Who Have Sex With Men, San Francisco, 2011. " AIDS Education and Prevention 27. 6 (2015): 538 -546. Li, Jun, et al. "Testing for human immunodeficiency virus among cancer survivors under age 65 in the United States. " Preventing chronic disease 11 (2013): E 200 -E 200. Takahashi, T. , et al. "A Population‐Based Study of HIV Testing Practices and Perceptions in 4 US States. " Journal of general internal medicine 20. 7 (2005): 618622. Van Handel, M. , et al. "HIV Testing Among US High School Students and Young Adults. " Pediatrics (2016): peds-2015. Van Handel, M. , et al. "Monitoring HIV testing in the United States: Consequences of methodology changes to national surveys. " Plo. S one 10. 4 (2015): e 0125637.
CONTACT INFORMATION �NYS DOH: brfss@health. ny. gov
Thank you! CUNY INSTITUTE FOR IMPLEMENTATION SCIENCE IN POPULATION HEALTH CUNYISPH. ORG
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