 |
 
|
 |
 |
| |
 |
|
|
| ||||||||||
|
|
|
|
|
|
|
||||
| ||||||||||
 |
|
|
|
Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Behavioral Risk Factor Surveillance System: Summary of Data for 1991.SUGGESTED CITATION: General: Centers for Disease Control and Prevention. CDC Surveillance Summaries, August 27, 1993. MMWR 1993;42(No. SS-4). Specific: {Author(s).} {Title of particular article.} In: CDC Surveillance Summaries, August 27, 1993. MMWR 1993;42:(No. SS- 4):{inclusive page numbers}. CIO Responsible for this publication: Epidemiology Program Office Abstract Problem/Condition: High-risk behaviors, such as smoking cigarettes and driving under the influence of alcohol, contribute heavily to morbidity and mortality from noninfectious disease and injury. Substantial variation exists among states in the prevalences of these behaviors. Reporting Period: 1991. Description of System: The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based random-digit-dialing telephone survey of noninstitutionalized adults (greater than or equal to 18 years of age). In 1991, 47 states and the District of Columbia participated in BRFSS. The system focuses on behaviors that are related to one or more of the 10 leading causes of death. In 1991, BRFSS also began collecting data on self-reported lack of health insurance. Results: As in previous years, BRFSS data for 1991 indicate substantial state-to-state variation in the prevalence of risk factors such as chronic or binge alcohol consumption, sedentary lifestyle, and overweight. In addition to measures reported in previous years, the current report includes state prevalences of high blood cholesterol awareness (range = 13.5%-21.5%; median = 16.9%) and lack of health insurance (range = 7.2%-25.7%; median = 14.5%). Interpretation: Because prevalence estimates vary considerably from state to state, state estimates may be preferable to national ones for use in planning programs. Actions Taken: The BRFSS will continue to provide state-specific data about health behaviors to allow states to monitor trends that affect the burden of chronic diseases in the United States. INTRODUCTION From 1981 through 1983, 29 state health departments used random-digit dialing to conduct statewide point-in-time behavioral risk factor surveys. In 1984, the Behavioral Risk Factor Surveillance System (BRFSS) was established, and participating states (47 states and the District of Columbia) conducted monthly interviews with adults greater than or equal to 18 years of age. This report summarizes selected data for 1991. BRFSS items related to year 2000 health objectives for the nation are described in the companion report (1 ). METHODS Sampling Using random-digit-dialing telephone survey techniques, each state selects a probability sample of its noninstitutionalized adult population (greater than or equal to 18 years of age) with telephones. In 1991, 38 states used a multistage cluster-sampling design based on the Waksberg method (2). To meet individual needs, other states have chosen to use different sampling methods, such as simple random or stratified sample designs. Questionnaire The interviewing instrument consists of three parts: a) a series of core questions asked by all states, b) standardized modules of questions on selected topics that are developed by CDC and added at the discretion of each state, and c) questions developed and administered by a particular state to meet its own needs. Whenever feasible, questions used in national surveys such as the National Health and Nutrition Examination Surveys (NHANES) and the National Health Interview Survey (NHIS) have been adopted. Data Processing and Analysis When the interviewing cycle is completed each month, the data are sent to CDC for editing. In 1991, 36 states used a computer-assisted telephone interviewing (CATI) system, which permits direct entry of data into a computer file. CATI facilitates interviewer monitoring, data coding and entry, and quality-control procedures. For the current study, the edited data were weighted to the age-, race-, and sex- specific population counts from the 1990 census in each state, as well as for the respondent's probability of selection (3,4). These weights are used to estimate the prevalence of risk factors and the use of medical screening tests for each state. SESUDAAN, a procedure for analyzing complex sample-survey data, is used to calculate the standard errors for the prevalence estimates (5). State sample sizes ranged from 1,178 to 3,417. Definitions Risk factors included in BRFSS were defined as follows: Overweight -- 120% or more of ideal body weight, defined as the midvalue for a medium-frame person on the 1959 Metropolitan Life Insurance Company height/weight tables. Sedentary lifestyle -- fewer than three 20-minute sessions of leisure-time physical activity per week. Chronic drinking -- 60 or more drinks of alcohol during the past month. Binge drinking -- consumption of five or more alcoholic beverages on at least one occasion during the past month. Drinking and driving -- at least once in the past month, operation of a motor vehicle after drinking too much alcohol. High blood pressure awareness -- respondents ever told by a health professional that their blood pressure is elevated. High blood cholesterol awareness -- respondents ever told by a health professional that their blood cholesterol is elevated. Lack of health insurance -- respondents not presently covered under any health-care plan. The definitions for overweight and sedentary lifestyle behaviors differ somewhat from those presented in the companion article on objectives for the year 2000 (1). Although somewhat duplicative, these measures are included because they have been reported each year since the inception of BRFSS in 1984 and provide a means for states to monitor changes over time. RESULTS Overweight The reported percentage of overweight persons ranged from 21.3% in Colorado to 34.1% in Michigan (median = 27.8%) (Table_1). The lowest prevalences were noted mostly in western states: New Mexico, 22.3%; Hawaii, 23.5%; Washington, 24.1%; Montana, 24.3%; and Utah, 24.4%. Sedentary Lifestyle The prevalence of sedentary lifestyle ranged from 46.6% in Oregon to 73.4% in Virginia (median = 56.5%) (Table_1). Of the five states with prevalence less than 50% (Colorado, Montana, New Hampshire, Oregon, and Utah), four were western states. Ohio, South Carolina, and Virginia reported prevalences greater than 70.0%. Chronic Drinking The prevalence of chronic alcohol consumption varied more than fourfold, from 1.3% in South Carolina and Tennessee to 5.4% in New Hampshire (median = 3.4%) (Table_1). Five states reported a prevalence less than or equal to 2.0%: Georgia, Illinois, South Carolina, Tennessee, and West Virginia. Six states reported a prevalence greater than or equal to 5.0%: Hawaii, Massachusetts, New Hampshire, Pennsylvania, Texas, and Wisconsin. Binge Drinking The prevalence of binge drinking varied more than fivefold, from a high of 23.3% in Wisconsin to a low of 4.6% in Tennessee (median = 14.4%) (Table_1). Several southern states reported low prevalences: North Carolina, 7.6%; Mississippi, 8.1%; and Georgia, 8.0%. Alaska, Massachusetts, Minnesota, Pennsylvania, and Wisconsin reported prevalences greater than or equal to 20.0%. Drinking and Driving The prevalence of drinking and driving varied from 0.7% in West Virginia to 6.3% in Wisconsin (median = 2.5%) (Table_1). Five states reported values of less than or equal to 1.0%: Georgia, Maine, Maryland, South Carolina, and Tennessee. Wisconsin was the only state that reported a prevalence above 5.0%. High Blood Pressure Awareness The percentage of adults who were aware that they had high blood pressure varied twofold, from 14.8% in New Mexico to 29.8% in Mississippi (median = 21.0%) (Table_1). Alabama and Mississippi were the only states with prevalences above 25.0%. Only New Mexico and Virginia reported prevalences below 18.0%. High Blood Cholesterol Awareness The percentage of adults who were aware that they had elevated blood cholesterol ranged from 13.5% in New Mexico to 21.5% in Michigan (median = 16.9%) (Table_1). In four states, the prevalence was greater than or equal to 20.0%: Connecticut, Michigan, New Hampshire, and Rhode Island. Prevalences were less than 15.0% in the District of Columbia, Georgia, Louisiana, Mississippi, Nebraska, New Mexico, and Utah. Lack of Health Insurance Lack of health insurance varied more than threefold, from 25.7% in New Mexico to 7.2% in Hawaii (median = 14.5%) (Table_1). Four states reported prevalences above 20% -- Louisiana, Mississippi, New Mexico, and Texas. Five states reported prevalences below 9% -- Hawaii, Iowa, New Jersey, Rhode Island, and Wisconsin. DISCUSSION For several of the variables reported in this article, state-specific prevalence estimates for years before 1991 have been published previously. These variables include overweight, sedentary lifestyle, chronic drinking, binge drinking, and drinking and driving (6-9). State-specific BRFSS data on high blood pressure awareness, high blood cholesterol awareness, and lack of health insurance have not been previously published; 1991 was the first year in which BRFSS data on lack of health insurance were collected. The 1991 median prevalence of chronic alcohol consumption (3.4%) is similar to the 1989 (3.7%) and 1990 (3.2%) medians but substantially lower than the 1987 (5.6%) and 1988 (5.8%) medians. The abrupt change from 1988 to 1989 should be interpreted cautiously because of a change in questionnaire wording. Before 1989, respondents were asked separate questions about their consumption of three types of alcohol -- beer, wine, and liquor. Beginning in 1989, these questions were combined into a single question about consumption of alcoholic beverages. In an analogous case involving food consumption, a change from a long list of single-item questions to a shorter list of grouped-item questions decreased estimates of self-reported consumption (10). Thus, changes in the BRFSS questionnaire from single-item questions to a single grouped-item question may have contributed to observed decreases in self-reported alcohol consumption. The 1991 BRFSS median prevalence of high blood pressure awareness (21.0%) is similar to prevalence estimates obtained from men (18.3%) and women (20.3%) in a national household survey sponsored by the National Heart, Lung, and Blood Institute in September 1989 (11). These estimates, which are based on self-reported high blood pressure, are lower than a provisional estimate of 26% among persons 18-74 years of age that was obtained by direct blood pressure measurements in the 1988-1991 NHANES III (National Institutes of Health, unpublished data). Variation among states in the percentage of persons who reported they had high blood pressure may be attributable to true differences in population prevalence, differences in the percentage of true hypertensives who are aware of their condition, or a combination of the two. Because more than 90% of adults in all BRFSS states report that they had their blood pressure checked within the previous 2 years (data not shown), lack of awareness probably does not account for a large portion of the variation among states. Thus, state-to-state variation in awareness of high blood pressure can be expected to approximate true population prevalence differences. The BRFSS median percentage of persons who were aware that they had elevated blood cholesterol (16.9% in 1991) has increased steadily from 8.0% in 1987 (data not shown) but remains less than half the estimated percentage of adults who are candidates for medical advice to reduce their serum cholesterol (36%) (12). Possible reasons for this discrepancy include a) patients may not seek preventive care, b) physicians may not offer cholesterol screening to patients who do seek preventive care, and c) patients who undergo appropriate screening may not recall physician advice to take steps to reduce serum cholesterol. One recent study indicates that about 40% of adults who had seen a physician within the previous 2 years for preventive care reported never being screened for high blood cholesterol (13). Whereas state-to-state variation in the prevalence of high blood pressure awareness probably reflects variation in the true population prevalence of high blood pressure (see above), state-to-state variation in high blood cholesterol awareness is more likely a result of variation in screening rates. This is true for two reasons. First, since the prevalence of high blood cholesterol varies according to race much less than does the prevalence of high blood pressure, the demographic makeup of a state is unlikely to have a substantial effect on its true prevalence of hypercholesterolemia. Second, state-to-state variation in the percentage of persons who have undergone recent screening is much greater for blood cholesterol (1991 range = 56.2%-71.3%) (1) than for blood pressure. Screening rates should be taken into consideration when state variations in rates of cholesterol awareness are interpreted. BRFSS data indicate substantial state-to-state variation in the percentage of persons who lack health insurance. The median BRFSS prevalence for 1991 (14.5%) is similar to the 1989 estimate for lack of insurance among the noninstitutionalized adult population reported in NHIS (13.9%) (14). BRFSS data on state-specific percentages of adults without health insurance are similar to those reported by the U.S. Government Accounting Office (GAO) (15). In the GAO report, states with lower rates of employer-based private coverage tended to have a higher proportion of their populations not covered by health insurance. BRFSS data will be useful for monitoring trends in health insurance coverage and evaluating state and federal programs intended to reduce the number of persons who lack coverage. BRFSS will also be useful for determining how persons without health-care coverage differ from those who have coverage with respect to health- related behaviors and use of medical screening tests. References
See Appendix 2 of the preceding report. Table_1 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
TABLE 1. Selected prevalences among adults ages >=18 years, in participating states -- Behavioral Risk Factor Surveillance
System, 1991
===================================================================================================================================================================
Alcohol consumption
----------------------------------------------------- High blood High blood
Sedentary Drinking and pressure cholesterol Lack of health
Overweight * lifestyle + Chronic drinking & Binge drinking @ driving ** awareness ++ awareness && insurance @@
---------------- -------------- ------------------ ---------------- ------------- -------------- -------------- --------------
State % (95% CI ***) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI)
-----------------------------------------------------------------------------------------------------------------------------------------------------------------
Alabama 30.1 +/-(2.4) 56.6 +/-(2.5) 3.2 +/-(0.9) 11.9 +/-(1.7) 2.6 +/-(0.8) 26.7 +/-(2.3) 16.2 +/-(1.8) 16.1 +/-(1.9)
Alaska 30.1 (3.3) 50.6 (3.7) 4.0 (1.5) 22.1 (3.2) 2.3 (0.9) 19.2 (2.9) 17.9 (2.9) 14.7 (2.6)
Arizona 24.5 (2.4) 60.3 (2.8) 3.5 (1.2) 12.7 (2.1) 2.0 (0.8) 18.9 (2.2) 16.7 (2.2) 18.2 (2.3)
Arkansas 27.9 (2.6) 64.5 (2.9) 2.4 (0.9) 12.0 (1.9) 2.6 (0.9) 22.9 (2.4) 15.9 (2.0) 19.0 (2.4)
California 25.7 (1.8) 53.8 (2.0) 4.0 (0.8) 16.9 (1.5) 2.2 (0.6) 20.2 (1.6) 16.6 (1.5) 19.0 (1.8)
Colorado 21.3 (2.1) 46.8 (2.6) 4.2 (1.2) 14.9 (2.1) 2.5 (0.8) 18.5 (2.0) 15.4 (1.8) 14.7 (2.2)
Connecticut 24.5 (2.3) 53.6 (2.6) 3.9 (1.0) 14.8 (1.9) 2.8 (0.9) 22.0 (2.2) 20.0 (2.2) 9.8 (1.8)
Delaware 32.3 (2.7) 59.0 (2.9) 3.9 (1.2) 14.7 (2.2) 2.6 (1.0) 21.9 (2.4) 19.2 (2.2) 10.0 (1.8)
District of
Columbia 30.8 (2.8) 63.3 (3.0) 2.8 (1.2) 8.6 (1.8) 1.7 (0.9) 20.2 (2.5) 13.6 (2.1) 15.1 (2.2)
Florida 26.4 (2.2) 51.8 (2.3) 3.8 (1.0) 12.8 (1.7) 2.8 (0.9) 20.2 (2.0) 17.9 (1.8) 18.9 (2.1)
Georgia 25.8 (2.3) 67.3 (2.5) 1.9 (0.7) 8.0 (1.5) 0.9 (0.5) 20.8 (2.1) 14.0 (1.7) 14.8 (1.9)
Hawaii 23.5 (2.1) 53.4 (2.5) 5.1 (1.1) 16.0 (1.8) 3.6 (1.0) 21.2 (2.0) 19.4 (2.0) 7.2 (1.3)
Idaho 26.5 (2.2) 55.5 (2.7) 2.2 (0.7) 8.9 (1.6) 1.3 (0.6) 19.3 (2.0) 15.9 (1.8) 14.6 (1.9)
Illinois 27.7 (2.2) 65.0 (2.4) 2.0 (0.6) 11.7 (1.6) 1.5 (0.5) 22.2 (2.0) 16.9 (1.8) 12.0 (1.7)
Indiana 31.0 (2.2) 60.6 (2.4) 3.4 (0.9) 14.3 (1.8) 3.0 (0.9) 24.4 (1.9) 16.8 (1.7) 10.5 (1.6)
Iowa 29.6 (2.5) 60.9 (2.7) 3.5 (1.1) 13.3 (1.9) 2.7 (0.9) 20.5 (2.1) 15.4 (1.8) 8.3 (1.6)
Kentucky 30.6 (2.4) 67.6 (2.4) 3.3 (1.0) 12.0 (1.8) 1.9 (0.7) 22.4 (2.0) 17.7 (1.8) 18.5 (2.1)
Louisiana 31.7 (2.6) 60.6 (2.8) 4.5 (1.2) 17.7 (2.2) 3.5 (1.0) 20.9 (2.2) 15.0 (1.9) 21.7 (2.4)
Maine 27.7 (2.8) 59.9 (2.9) 3.4 (1.1) 10.3 (1.9) 0.8 (0.5) 21.6 (2.4) 17.3 (2.3) 13.5 (2.2)
Maryland 24.7 (2.4) 56.9 (2.7) 3.1 (1.1) 10.2 (1.9) 1.0 (0.6) 19.9 (2.1) 16.5 (2.0) 10.6 (1.7)
Massachusetts 25.2 (2.5) 52.6 (2.9) 5.1 (1.3) 20.0 (2.3) 2.5 (0.8) 21.6 (2.4) 18.2 (2.2) 9.3 (1.8)
Michigan 34.1 (2.1) 56.4 (2.3) 4.9 (1.1) 18.3 (1.9) 4.2 (0.9) 23.8 (1.9) 21.5 (1.8) 11.5 (1.6)
Minnesota 27.5 (1.6) 53.8 (1.9) 3.6 (0.7) 20.7 (1.6) 3.7 (0.8) 19.8 (1.4) 17.2 (1.4) 9.4 (1.1)
Mississippi 30.9 (2.6) 67.3 (2.7) 2.8 (1.0) 8.1 (1.6) 2.4 (1.0) 29.8 (2.6) 14.7 (1.9) 20.4 (2.5)
Missouri 28.0 (2.5) 58.3 (2.8) 4.4 (1.3) 14.6 (2.1) 2.4 (0.9) 23.8 (2.3) 16.5 (2.0) 15.7 (2.2)
Montana 24.3 (2.6) 49.5 (3.2) 3.8 (1.2) 19.9 (2.6) 4.1 (1.4) 18.5 (2.4) 17.1 (2.3) 16.8 (2.5)
Nebraska 28.7 (2.7) 54.0 (3.0) 2.9 (1.1) 17.1 (2.4) 4.8 (1.5) 23.3 (2.4) 14.8 (2.0) 10.9 (2.1)
New
Hampshire 25.0 (2.4) 48.0 (2.8) 5.4 (1.4) 19.6 (2.4) 3.2 (1.1) 19.6 (2.3) 20.9 (2.3) 10.7 (1.8)
New Jersey 25.3 (2.5) 56.0 (2.9) 3.9 (1.2) 9.7 (1.8) 1.1 (0.6) 21.1 (2.4) 17.9 (2.2) 8.1 (1.7)
New Mexico 22.3 (2.8) 53.8 (3.0) 2.6 (1.0) 10.8 (2.0) 2.1 (1.1) 14.8 (2.4) 13.5 (2.1) 25.7 (2.8)
New York 28.0 (2.3) 58.4 (2.5) 2.5 (0.8) 11.6 (1.7) 1.9 (0.7) 21.5 (2.1) 16.8 (1.9) 15.3 (2.0)
North Carolina 27.5 (2.2) 61.0 (2.6) 2.9 (0.8) 7.6 (1.4) 1.2 (0.5) 18.1 (1.9) 16.5 (1.8) 16.0 (2.0)
North Dakota 28.6 (2.2) 55.0 (2.7) 2.5 (0.8) 16.5 (2.0) 3.5 (1.1) 18.6 (1.9) 16.7 (1.9) 13.2 (2.0)
Ohio 28.1 (2.8) 70.3 (2.9) 3.4 (1.4) 9.3 (1.9) 1.8 (1.2) 18.9 (2.4) 15.1 (2.2) 10.6 (1.9)
Oklahoma 28.5 (2.5) 61.0 (2.8) 2.3 (0.8) 9.6 (1.8) 1.3 (0.6) 24.3 (2.3) 17.2 (2.0) 19.7 (2.3)
Oregon 27.1 (1.6) 46.6 (1.9) 3.6 (0.7) 16.4 (1.5) 2.3 (0.6) 19.5 (1.4) 17.6 (1.4) 15.6 (1.5)
Pennsylvania 32.5 (2.1) 55.0 (2.2) 5.1 (1.0) 20.0 (1.8) 3.4 (0.8) 23.6 (1.9) 17.5 (1.6) 10.6 (1.4)
Rhode Island 25.0 (2.3) 54.8 (2.6) 4.8 (1.2) 16.9 (2.0) 3.2 (1.0) 21.9 (2.1) 20.0 (2.1) 8.5 (1.5)
South Carolina 29.1 (2.3) 70.6 (2.5) 1.3 (0.6) 9.5 (1.7) 2.0 (0.8) 23.8 (2.1) 17.2 (2.0) 18.3 (2.1)
South Dakota 28.8 (2.3) 57.3 (2.6) 2.7 (0.9) 17.8 (2.1) 3.7 (1.0) 18.7 (2.0) 15.7 (1.9) 9.7 (1.5)
Tennessee 28.8 (1.9) 64.4 (2.1) 1.3 (0.5) 4.6 (0.9) 1.0 (0.5) 23.0 (1.7) 15.5 (1.4) 15.8 (1.6)
Texas 29.5 (2.6) 54.1 (3.0) 5.0 (1.3) 19.0 (2.5) 4.6 (1.3) 20.6 (2.4) 15.8 (2.0) 21.5 (2.7)
Utah 24.4 (2.2) 47.5 (2.6) 3.3 (1.0) 9.0 (1.5) 1.4 (0.6) 19.6 (1.9) 14.4 (1.8) 11.5 (1.7)
Vermont 26.7 (2.5) 52.6 (3.0) 3.5 (1.3) 16.1 (2.1) 2.8 (1.1) 22.1 (2.1) 18.8 (2.1) 14.3 (2.1)
Virginia 22.3 (2.3) 73.4 (2.6) 2.8 (0.9) 14.8 (2.1) 3.5 (1.2) 15.5 (2.0) 17.1 (2.1) 12.1 (1.8)
Washington 24.1 (2.0) 51.9 (2.3) 3.3 (0.9) 15.2 (1.7) 2.7 (0.7) 19.0 (1.8) 18.1 (1.8) 13.0 (1.6)
West Virginia 32.1 (2.1) 66.7 (2.1) 1.8 (0.6) 7.2 (1.2) 0.7 (0.3) 24.4 (1.8) 19.5 (1.7) 17.4 (1.8)
Wisconsin 29.2 (2.7) 53.8 (3.0) 5.0 (1.5) 23.3 (2.6) 6.3 (1.5) 21.9 (2.4) 17.7 (2.3) 8.9 (1.8)
Median 27.8 56.5 3.4 14.4 2.5 21.0 16.9 14.5
Low 21.3 46.6 1.3 4.6 0.7 14.8 13.5 7.2
High 34.1 73.4 5.4 23.3 6.3 29.8 21.5 25.7
-----------------------------------------------------------------------------------------------------------------------------------------------------------------
* 120% or more of ideal body weight, defined as the midvalue of the medium-frame person on the 1959 Metropolitan Life Insurance Company height/weight
table.
+ Fewer than three 20-minute sessions of leisure-time physical activity per week.
& 60 or more drinks during the past month.
@ Consumption of five or more alcoholic beverages on at least one occasion during the previous month.
** Operation of a motor vehicle after drinking too much alcohol at least once in the previous month.
++ Respondents ever told by a health professional that their blood pressure is elevated.
&& Respondents ever told by a health professional that their blood cholesterol is elevated.
@@ Not presently covered under any health-care plan.
*** Confidence interval.
===================================================================================================================================================================
Return to top. Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. **Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.Page converted: 09/19/98 |
| |||||||
This page last reviewed 5/2/01
|
