Michigan Behavioral Risk Factor Surveillance System Mi BRFSS

Michigan Behavioral Risk Factor Surveillance System (Mi. BRFSS) 2021 MICHIGAN BRFSS DATA USERS MEETING JUNE 29 T H , 2021

Outline �Introduction Michigan Behavioral Risk Factor Surveillance System (Mi. BRFSS) Michigan Behavioral Risk Factor Survey (Mi. BRFS) � 2019 Mi. BRFS Annual Report Highlights � 2020 and 2021 Mi. BRFS Updates Current Progress � 2022 Mi. BRFS Plans CDC Core Questionnaire CDC Optional Module Michigan State‐added Topics

Michigan BRFSS (Mi. BRFSS) � The Mi. BRFSS comprises annual, statewide telephone surveys of Michigan adults aged 18 years and older and is part of the national BRFSS coordinated by the CDC. � Only source of state‐specific, population‐based health estimates among Michigan adults health behaviors, medical conditions, and preventive healthcare practices � Since 1989, Mi. BRFSS conducted on an annual basis Both landline and cell phone starting in 2011 Due to methodology changes that took place in 2011, BRFSS estimates from 2011 and moving forward cannot be compared to BRFSS estimates from 2010 and earlier. � Respondent source for the Michigan Asthma Call Back Survey (since 2005) Follow‐up survey for respondents that reported ever being diagnosed with asthma.

Mi. BRFS Questionnaire � CDC Core questions � CDC optional modules � State‐added questions � www. Michigan. gov/BRFS

Mi. BRFS Data Collection �Mi. BRFSS data collection conducted through a contract with Office for Survey Research at Michigan State University (1996‐ 2020) ICF Marco Inc. (2021‐) �Mi. BRFSS funding for data collection Cooperative agreement with the Centers for Disease Control and Prevention (CDC) � ~50% of data collection costs � To support CDC core questions Other state programs and health organizations � ~50% of data collection costs � To support state‐added questions and CDC optional modules

Mi. BRFS Annual Analysis � Data are weighted by CDC to adjust for the probabilities of selection and a raking weighting factor is used to adjust for the distribution of the Michigan adult population based on eight demographic variables. Telephone source (landline or cell phone), race/ethnicity, education level, marital status, age by gender, gender by race/ethnicity, age by race/ethnicity, and renter/owner status. � All analyses are performed using SAS‐callable SUDAAN® to account for the complex sampling design. If the 95% CIs for two estimates from different subpopulations or survey years did not overlap, they were considered to be statistically different. Unless otherwise specified, respondents who answered that they did not know or refused to answer were not included in the calculation of estimates. � Data suppression rules A denominator of less than 50 respondents Relative standard error (RSE) of greater than 30%: RSE=(Standard Error/Point Estimate)*100 � Results are available on Mi. BRFSS website (www. Michigan. gov/BRFS) and sent out via Gov. Delivery or email distribution list. � Data requests Estimates not included in the standard tables, please email coordinator with details of request Raw data requests: Mi. BRFSS data use agreement process

2019 Mi. BRFS Annual Tables �Annual tables are located on the Mi. BRFSS website www. michigan. gov/brfs 2019 Mi. BRFS Standard Tables 2019 Mi. BRFS Age and Gender Tables 2019 Mi. BRFS Race/Ethnicity Tables 2017‐ 2019 Expanded Race/Ethnicity Tables 2017‐ 2019 Regional and Local Health Department Tables 2017‐ 2019 Prosperity Region Tables 2017‐ 2019 Emergency Preparedness Region Tables � 2019 state‐added question results can be requested via email to the coordinator.

Michigan BRFSS website www. Michigan. gov/BRFS

2019 Mi. BRFS Results Number of Interviews by Survey Year Michigan BRFS 2000 -2019 14000 12759 12136 12024 Number 12000 9447 10000 7505 8000 9259 8863 10499 10518 10322 8466 8935 5934 6000 4000 10889 11049 4943 3830 2522 5684 3551 2000 0 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 '14 '15 '16 '17 '18 '19

2019 Mi. BRFS Results Selected Risk Factors - 2019 CDC BRFSS U. S. vs. Michigan 18, 2 Fair or Poor General Health Obese 18, 9 (BMI ≥ 32, 4 30) Overweight 25. 0 -29. 9) No Health Care Coverage 64 Years Old) (BMI 36, 0 34, 6 (18 - 34, 3 13, 6 11, 1 No Leisure Time Physical Activity 26, 4 16, 0 Current Smoking 16, 8 Binge Drinking 25, 4 18, 7 17, 9 64, 0 60, 7 Flu Shot in Past Year (65+) 9, 7 Current Asthma 4, 3 Ever Told Heart Attack 4, 5 10, 8 Ever Told Diabetes 0 11, 1 10 11, 1 20 U. S. median 30 % 40 Michigan 50 60 70

2019 Mi. BRFS Results General Health, Fair or Poor U. S. vs. Michigan, 2008 -2019 25 20 15 % 14, 5 14, 7 14, 2 15, 0 14, 5 14, 9 '08 '09 '10 17, 2 17, 1 17, 0 16, 9 16, 7 16, 8 16, 4 '11 '12 '13 '14 '15 '16 16, 8 17, 7 18, 0 17, 7 18, 5 19, 2 17, 6 17, 3 '17 '18 18, 9 18, 2 10 5 0 U. S. median Michigan Due to methodology changes that took place in 2011, BRFSS estimates from 2011 and moving forward cannot be compared to BRFSS estimates from 2010 and earlier. '19

2019 Mi. BRFS Results No Health Care Coverage Among Adults Aged 18 to 64 Years U. S. vs. Michigan, 2008 -2019 25 21, 3 20 17, 1 17, 0 20, 4 17, 9 18, 3 % 15 16, 1 20, 0 16, 6 17, 4 13, 7 15, 3 13, 0 12, 7 10 12, 3 12, 7 9, 9 9, 8 '16 '17 13, 2 12, 0 13, 6 11, 1 9, 0 5 0 '08 '09 '10 '11 '12 '13 U. S. median '14 '15 '18 Michigan Due to methodology changes that took place in 2011, BRFSS estimates from 2011 and moving forward cannot be compared to BRFSS estimates from 2010 and earlier. '19

2019 Mi. BRFS Results Obesity U. S. vs. Michigan, 2008 -2019 50 40 30, 1 30, 3 31, 7 31, 3 31, 1 31, 5 30, 7 31, 2 32, 5 29, 4 29, 6 29, 8 29, 9 '13 '14 '15 '16 30 % 20 26, 6 27, 1 27, 6 27, 8 27, 6 '08 '09 '10 '11 '12 32, 4 33, 0 31, 3 30, 9 '17 '18 36, 0 32, 4 10 0 U. S. median Michigan Due to methodology changes that took place in 2011, BRFSS estimates from 2011 and moving forward cannot be compared to BRFSS estimates from 2010 and earlier. '19

2019 Mi. BRFS Results Current Cigarette Smoking U. S. vs. Michigan, 2008 -2019 30 25 20 % 15 23, 3 20, 2 19, 6 18, 9 21, 2 18, 3 17, 9 17, 3 21, 4 21, 2 20, 7 20, 4 19, 4 18, 9 18, 7 19, 6 19, 0 18, 1 17, 5 17, 1 16, 0 10 Secondhand Smoke Exposure by Race and Gender Michigan, 2019 5 50 0 '08 '09 '10 '11 '12 '13 '14 '15 '16 '17 '18 '19 40 U. S. median 34, 1 Michigan 29, 1 30 % 20, 4 20 Due to methodology changes that took place in 2011, BRFSS estimates from 2011 and moving forward cannot be compared to BRFSS estimates from 2010 and earlier. 21, 8 24, 5 19, 1 10 0 White, non-Hispanic Total Male Black, non-Hispanic Female

2019 Mi. BRFS Results Binge Drinking U. S. vs. Michigan, 2008 -2019 25 20 19, 7 17, 6 % 18, 9 18, 5 19, 0 16, 3 16, 9 17, 4 '15 '16 '17 18, 9 17, 0 15 19, 2 15, 5 15, 1 '08 '09 '10 18, 3 16, 9 16, 8 '12 '13 18, 2 17, 9 16, 2 16, 8 '19 10 5 0 '11 U. S. median Michigan Due to methodology changes that took place in 2011, BRFSS estimates from 2011 and moving forward cannot be compared to BRFSS estimates from 2010 and earlier.

2019 Mi. BRFS Results Lifetime Adult Asthma U. S. vs. Michigan, 2008 -2019 20 15, 7 15, 8 13, 6 13, 4 13, 8 13, 6 13, 3 '08 '09 '10 '11 '12 15, 4 15 % 14, 8 15, 5 16, 6 16, 3 16, 0 15, 9 16, 4 14, 3 14, 0 14, 2 14, 7 14, 9 '15 '16 '17 '18 '19 15, 3 15, 7 14, 1 13, 8 '13 '14 10 5 0 U. S. median Michigan Due to methodology changes that took place in 2011, BRFSS estimates from 2011 and moving forward cannot be compared to BRFSS estimates from 2010 and earlier.

2019 Mi. BRFS Results Cardiovascular Disease by Gender Michigan, 2019 Male Ever Told Cancer by Gender Michigan, 2019 Total Female 12 10, 5 10 13, 5 15 8, 3 % 8 4 Female 20 14 6 Male % 10 5, 8 5, 2 3, 7 3, 3 8, 3 14, 6 12, 3 9, 6 6, 8 6, 7 6, 8 7, 0 Skin Cancer Any Other Type of Cancer 3, 8 5 2 0 0 Heart Angina or Attack Coronary Disease Stroke Any CVD Any Cancer

2020 Mi. BRFS Status Update � Survey Statistics Completed = 7, 270 interviews Landline = 2, 205 Cell Phone = 5, 065 � All data submitted to CDC on March 8, 2021 � Asthma Callback Survey Completed 482 interviews (415 adults and 67 children) Data submitted to CDC on March 29, 2021 � Public use data expected to be available August/September 2021. � MDHHS Standard Tables expected to be available November/December 2021 at www. michigan. gov/brfs.

2021 Mi. BRFS Status Update � Current Survey Progress (as of June 22 nd) Completed = 2, 722 interviews Landline = 1, 049 Cell Phone = 1, 673 � 2021 Survey Target Numbers Completed = 7, 500 interviews (30/70 split) Landline = 2, 256 Cell Phone = 5, 244 � Asthma Call‐Back Survey is also being conducted in 2021 Began February 1 Progress: 257 completed interviews (233 adults, 24 children)

CDC BRFS Core Topics Planning 2021‐ 2026 Health Status Healthy Days Health Care Access 2021 √ √ √ 2022 √ √ √ 2023 √ √ √ 2024 √ √ √ 2025 √ √ √ 2026 √ √ √ Exercise Hypertension Cholesterol Chronic Conditions Arthritis Demographics Disability Tobacco Use Alcohol Immunization √ √ √ √ √ √ √ √ √ √ √ √ √

CDC BRFS Core Topics Planning 2021‐ 2026 H. I. V. /AIDS Falls Physical Activity Breast and Cervical Cancer Prostate Cancer Colorectal Cancer Drinking Driving/ Seat Belt Use Inadequate Sleep Oral Health Fruits and Vegetables 2021 √ 2022 √ √ 2023 √ √ √ 2024 √ 2025 √ √ √ √ 2026 √ √ √

2022 CDC BRFS Core Topics �Health Status (1) �Demographics (19) �Healthy Days (3) �Disability (6) �Healthcare Access (4) �Colorectal Cancer �Breast and Cervical Cancer Screening (7) �Exercise (1) �Inadequate Sleep (1) �Oral Health (2) �Chronic Health Conditions (13) Screening (13) �Tobacco Use (4) �Lung Cancer Screening (6) �Alcohol Consumption (4) �Immunization (4) �HIV/AIDS (3) �Long‐term COVID Effects (3)

2022 CDC BRFS Optional Modules � Pre‐Diabetes (2) � Adverse Childhood Experiences (13) � Diabetes (7) � Social Determinants and Health � Place of Flu Vaccination (1) � HPV‐Vaccination (2) � � Shingles Vaccination (1) � � COVID Vaccination (6) � � Respiratory Health (5) � � Cancer Survivorship: Type of � � � Cancer (3) Cancer Survivorship: Course of Treatment (8) Cancer Survivorship: Pain Management (2) Prostate Cancer Screening (5) Cognitive Decline (6) Caregiver (9) � � � � Equity (11) Marijuana Use (7) Tobacco Cessation (2) Other Tobacco Use (4) Alcohol Screening & Brief Intervention (ASBI) (5) Firearm Safety (3) Industry and Occupation (2) Random Child Selection (6) Childhood Asthma Prevalence (2) Sex at Birth (1) Sexual Orientation and Gender Identity (SOGI) (2) Family Planning (7)

2022 CDC BRFS Optional Modules �Diabetes 7 questions for adults with diabetes 1. According to your doctor or other health professional, what type of diabetes do you have? 2. Insulin can be taken by shot or pump. Are you now taking insulin? 3. About how many times in the past 12 months has a doctor, nurse, or other health professional checked you for A‐one‐C? 4. When was the last time you had an eye exam in which the pupils were dilated, making you temporarily sensitive to bright light? 5. When was the last time a doctor, nurse or other health professional took a photo of the back of your eye with a specialized camera? 6. When was the last time you took a course or class in how to manage your diabetes yourself? 7. Have you ever had any sores or irritations on your feet that took more than four weeks to heal?

2022 CDC BRFS Optional Modules �Vaccination Place of Flu Vaccination (1) 1. HPV Vaccination for adults aged 18‐ 49 years (2) 1. Have you ever had an H. P. V. vaccination? 2. How many HPV shots did you receive? Shingle Vaccination for adults aged over 49 years (1) 1. At what kind of place did you get your last flu shot or vaccine? Have you ever had the shingles or zoster vaccine? COVID Vaccination (6) 1. 2. 3. 4. 5. 6. 7. Have you had a COVID‐ 19 vaccination? Would you say you will definitely get a vaccine, will probably not get a vaccine, will definitely not get a vaccine, or are you not sure? How many COVID‐ 19 vaccinations have you received? Which of the following best describes your intent to take the recommended COVID vaccinations… Would you say you have already received all recommended doses, plan to receive all recommended doses or do not plan to receive all recommended doses? During what month and year did you receive your (first) COVID‐ 19 vaccination? During what month and year did you receive your second COVID‐ 19 vaccination?

2022 CDC BRFS Optional Modules �Respiratory Health 5 questions 1. During the past 3 months, did you have a cough on most days? 2. During the past 3 months, did you cough up phlegm [FLEM] or mucus on most days? 3. Do you have shortness of breath either when hurrying on level ground or when walking up a slight hill or stairs? 4. Have you ever been given a breathing test to diagnose breathing problems? 5. Over your lifetime, how many years have you smoked tobacco products? �Firearm safety 3 questions 1. Are any firearms now kept in or around your home? 2. Are any of these firearms now loaded? 3. Are any of these loaded firearms also unlocked?

2022 CDC BRFS Optional Modules �Prostate Cancer Screening 5 questions for male adults over 39 years old 1. Have you ever had a P. S. A. test? 2. Who first suggested this PSA test: you, your doctor, or someone else? 3. About how long has it been since your most recent P. S. A. test? 4. What was the main reason you had this P. S. A. test – was it …? 5. When you met with a doctor, nurse, or other health professional, did they talk about the advantages, the disadvantages, or both advantages and disadvantages of the prostate‐specific antigen or PSA test?

2022 CDC BRFS Optional Modules �Cognitive Decline 6 questions for adults aged 45 years and older 1. 2. 3. 4. 5. 6. During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse? During the past 12 months, as a result of confusion or memory loss, how often have you given up day‐to‐day household activities or chores you used to do, such as cooking, cleaning, taking medications, driving, or paying bills? As a result of confusion or memory loss, how often do you need assistance with these day‐to‐ day activities? When you need help with these day‐to‐day activities, how often are you able to get the help that you need? During the past 12 months, how often has confusion or memory loss interfered with your ability to work, volunteer, or engage in social activities outside the home? Have you or anyone else discussed your confusion or memory loss with a health care professional?

2022 CDC BRFS Optional Modules �Caregiver 9 questions 1. 2. 3. 4. 5. 6. 7. 8. 9. During the past 30 days, did you provide regular care or assistance to a friend or family member who has a health problem or disability? What is his or her relationship to you? For how long have you provided care for that person? In an average week, how many hours do you provide care or assistance? What is the main health problem, long‐term illness, or disability that the person you care for has? Does the person you care for also have Alzheimer’s disease, dementia or other cognitive impairment disorder? In the past 30 days, did you provide care for this person by managing personal care such as giving medications, feeding, dressing, or bathing? In the past 30 days, did you provide care for this person by managing household tasks such as cleaning, managing money, or preparing meals? In the next 2 years, do you expect to provide care or assistance to a friend or family member who has a health problem or disability?

2022 CDC BRFS Optional Modules �Adverse Childhood Experiences (ACE) 13 questions Now, looking back before you were 18 years of age: 1. Did you live with anyone who was depressed, mentally ill, or suicidal? 2. Did you live with anyone who was a problem drinker or alcoholic? 3. Did you live with anyone who used illegal street drugs or who abused prescription medications? 4. Did you live with anyone who served time or was sentenced to serve time in a prison, jail, or other correctional facility? 5. Were your parents separated or divorced? 6. How often did your parents or adults in your home ever slap, hit, kick, punch or beat each other up? 7. Not including spanking, (before age 18), how often did a parent or adult in your home ever hit, beat, kick, or physically hurt you in any way? 8. How often did a parent or adult in your home ever swear at you, insult you, or put you down? 9. How often did anyone at least 5 years older than you or an adult, ever touch you sexually? 10. How often did anyone at least 5 years older than you or an adult, try to make you touch them sexually? 11. How often did anyone at least 5 years older than you or an adult, force you to have sex? 12. For how much of your childhood was there an adult in your household who made you feel safe and protected? 13. For how much of your childhood was there an adult in your household who tried hard to make sure your basic needs were met?

2022 CDC BRFS Optional Modules �Social Determinants and Health Equity 11 questions 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. In the past 30 days have you lost employment or had hours reduced? During the past 12 months, have you received food stamps, also called SNAP, the Supplemental Nutrition Assistance Program on an EBT card? During the last 12 months, was there a time when you were not able to pay your mortgage, rent or utility bills? During the last 12 months was there a time when an electric, gas, oil, or water company threatened to shut off services? During the past 12 months has a lack of reliable transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living? How often do you get the social and emotional support that you need? How often do you feel you lack companionship? How often do you feel left out? Stress means a situation in which a person feels tense, restless, nervous or anxious or is unable to sleep at night because their mind is troubled all the time. Within the last 30 days, how often have you felt this king of stress? During the past 12 months how often did the food that you bought not last, and you didn’t have money to get more? During the past 12 months how often were you unable to afford to eat balanced meals?

2022 CDC BRFS Optional Modules �Tobacco Control Tobacco Cessation module among current smokers (2) 1. 2. How long has it been since you last smoked a cigarette, even one or two puffs? During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking? Other Tobacco Use module (4) 1. 2. 3. 4. Currently, when you smoke cigarettes, do you usually smoke menthol cigarettes? Currently, when you use e‐cigarettes, do you usually use menthol e‐cigarettes? Do you now use heated tobacco products every day, some days or not at all? Before today, have you heard of heated tobacco products? �Sexual Orientation and Gender Identity (SOGI) 2 questions 1. 2. Which of the following best represents how you think of yourself? Do you consider yourself to be transgender?

2022 CDC BRFS Optional Modules �Sex at Birth 1 question 1. What was your sex at birth? Was it male or female? �Oversamples If you are interested in conducting a regional oversample within the 2022 survey year, please complete the solicitation form and submit it to Tian. Y@michigan. gov by Friday, July 16 th, 2021. The costs associated with regional oversamples vary depending on the goals of each oversample and thus will need to be discussed further with Mi. BRFSS staff before exact costs can be determined.

2022 Mi. BRFS State‐Added Questions � In 2022, we will continue to ask programs that have state‐ added questions included within the Mi. BRFS to contribute financially towards the conduct and analysis of the survey. � For those interested in adding specific questions to the 2022 Mi. BRFS, please submit the State‐added Question Proposal form to Tian. Y@michigan. gov by July 16 th, 2021.

2022 Mi. BRFS State‐Added Questions Costs �Same as the 2021 Michigan BRFS �Question costs (per split of ~ 2, 500) < 20% of respondents = $2, 000 per question ≥ 20% of respondents = $2, 500 per question # of splits dependent on total sample size Inclusion of questions on multiple splits � Increase question sample size � Expanded analysis

2022 Mi. BRFS State‐Added Topics ‐‐‐Planned �Alcohol Screening & Intervention Brief 5 questions on all three splits 1. At your last routine checkup, were you asked in person or on a form if you drink alcohol? 2. Did the health care provider ask you in person or on a form how much you drink? 3. Did the healthcare provider specifically ask whether you drank [5 FOR MEN /4 FOR WOMEN] or more alcoholic drinks on an occasion? 4. Were you offered advice about what level of drinking is harmful or risky for your health? 5. Healthcare providers may also advise patients to drink less for various reasons. At your last routine checkup, were you advised to reduce or quit your drinking?

2022 Mi. BRFS State‐Added Topics ‐‐‐Planned �Family Planning 7 questions on all three splits Target population: women of reproductive age (18‐ 49 years). 1. In the past 12 months, did you have sexual intercourse? 2. The last time you had sexual intercourse, did you or your partner do anything to keep you from getting pregnant? 3. The last time you had sexual intercourse, what did you or your partner do to keep you from getting pregnant? 4. The last time you had sexual intercourse, what else, if anything, did you or your partner do to keep you from getting pregnant? 5. Where did you get the [response from Q 3] you used when you last had sexual intercourse? 6. What was your main reason for not doing anything to prevent pregnancy the last time you had sexual intercourse? 7. If you could use any birth control method you wanted, what method would you use?

2022 Mi. BRFS State‐Added Topics ‐‐‐Planned �Industry & Occupation 2 questions on all three splits 1. What kind of work do you do? For example, registered nurse, janitor, cashier, auto mechanic. 2. What kind of business or industry do you work in? For example, hospital, elementary school, clothing manufacturing, restaurant. �Marijuana Use 7 questions on one split 1. 2. 3. 4. 5. 6. 7. During the past 30 days, on how many days did you use marijuana or cannabis? During the past 30 days, did you smoke it (for example, in a joint, bong, pipe, or blunt)? During the past 30 days, did you eat it (for example, in brownies, cakes, cookies, or candy)? During the past 30 days, did you drink it (for example, in tea, cola, or alcohol)? During the past 30 days, did you vaporize it (for example, in an e‐cigarette‐like vaporizer or another vaporizing device)? During the past 30 days, did you dab it (for example, using a dabbing rig, knife, or dab pen)? During the past 30 days, did you use it in some other way?

2022 Mi. BRFS State‐Added Topics ‐‐‐Planned �Childhood Asthma 8 questions on all three splits (included since 2005) Random child selection module (6) 1. 2. 3. 4. 5. 6. During the past 30 days, did you use it in some other way? Is the child a boy or a girl? Is the child Hispanic, Latino/a, or Spanish origin? Which one or more of the following would you say is the race of the child? Which one of these groups would you say best represents the child’s race? How are you related to the child? Childhood asthma prevalence module (2) 1. 2. Has a doctor, nurse or other health professional EVER said that the child has asthma? Does the child still have asthma? �Additional Demographics 2 questions on all three splits 1. 2. City of Detroit (included since 1994) Arab/Chaldean origin (included since 2007)

2022 Mi. BRFS State‐Added Topics ‐‐‐Planned �Cancer Survivorship 13 questions on all three splits Target population: MI residents who have had a diagnosis of cancer Type of cancer (3) 1. 2. 3. Course of treatment (8) 1. 2. 3. 4. 5. 6. 7. 8. How many different types of cancer have you had? At what age were you told that you had cancer? What kind of cancer is it? Are you currently receiving treatment for cancer? What type of doctor provides the majority of your health care? Is it a…. Did any doctor, nurse, or other health professional ever give you a written summary of all the cancer treatments that you received? Have you ever received instructions from a doctor, nurse, or other health professional about where you should return or who you should see for routine cancer check‐ups after completing your treatment for cancer? Were these instructions written down or printed on paper for you? With your most recent diagnosis of cancer, did you have health insurance that paid for all or part of your cancer treatment? Were you ever denied health insurance or life insurance coverage because of your cancer? Did you participate in a clinical trial as part of your cancer treatment? Pain management (2) 1. 2. Do you currently have physical pain caused by your cancer or cancer treatment? Would you say your pain is currently under control…?

2022 Mi. BRFS State‐Added Topics ‐‐‐Planned �Food Insecurity 6 questions on all three splits 1. “The food that I/we bought just didn’t last, and I/we didn’t have money to get more. ” Was that often, sometimes, or never true for you/your household in the last 12 months? 2. “I/we couldn’t afford to eat balanced meals. ” Was that often, sometimes, or never true for you/your household in the last 12 months? 3. In the last 12 months, since last [INSERT MONTH], did you/you or other adults in your household ever cut the size of your meals or skip meals because there wasn't enough money for food? 4. How often did this happen—almost every month, some months but not every month, or in only 1 or 2 months? 5. In the last 12 months, did you ever eat less than you felt you should because there wasn't enough money for food? 6. In the last 12 months, were you every hungry but didn't eat because there wasn't enough money for food?

2022 Mi. BRFS State‐Added Topics ‐‐‐Planned �Hepatitis C Virus Test 1 questions on 2 splits 1. Have you ever been tested for Hepatitis C Virus? �Pre‐Diabetes 2 questions on 3 splits 1. When was the last time you had a blood test for high blood sugar or diabetes by a doctor, nurse, or other health professional? 2. Has a doctor or other health professional ever told you that you had prediabetes or borderline diabetes?

Mi. BRFSS Questions �Questions related to the Mi. BRFSS Data Users Presentation �Have interest in state‐added question proposals for the 2022 or future survey �Need further information on other Mi. BRFSS‐ related topics �Contact Yan Tian Michigan BRFSS Coordinator/Epidemiologist Tian. Y@michigan. gov 517‐ 335‐ 8144

Mi. BRFSS Staff Information Michigan BRFSS Director: Patricia Mc. Kane, Mc. Kane. P@michigan. gov Michigan BRFSS Financial Specialist: Barbara Bidigare, Bidigare. B@michigan. gov Sarah Razak, Razak. S@michigan. gov Michigan BRFSS Coordinator/Epidemiologist: Yan Tian, Tian. Y@Michigan. gov Michigan BRFSS website: www. Michigan. gov/BRFS