Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group.

The purpose of evaluating public health surveillance systems is to ensure that problems of public health importance are being monitored efficiently and effectively. CDC's Guidelines for Evaluating Surveillance Systems are being updated to address the need for a) the integration of surveillance and health information systems, b) the establishment of data standards, c) the electronic exchange of health data, and d) changes in the objectives of public health surveillance to facilitate the response of public health to emerging health threats (e.g., new diseases). This report provides updated guidelines for evaluating surveillance systems based on CDC's Framework for Program Evaluation in Public Health, research and discussion of concerns related to public health surveillance systems, and comments received from the public health community. The guidelines in this report describe many tasks and related activities that can be applied to public health surveillance systems.

Evaluation of the 1990 Centers for Disease Control and Prevention smoke-free policy.

PURPOSE: To determine the prevalence of tobacco use among Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) employees and the effect of the smoke-free policy on smoking behavior and air quality at work. DESIGN: A stratified telephone survey of 1181 CDC/ATSDR employees randomly selected from employee rosters. SETTING: CDC/ATSDR work sites in Atlanta, Georgia, and other major CDC locations throughout the United States and Puerto Rico. SUBJECTS: Randomly selected employees of CDC/ATSDR1, or about 22% of the total CDC/ATSDR population; 98% of eligible persons selected agreed to participate. MEASURES: Demographic and smoking history variables, attitudes toward and impact of the smoke-free policy on smoking behavior, and self-report changes in air quality were the measures used. RESULTS: Overall cigarette smoking prevalence was only 11.1%. One percent reported using chewing tobacco, 1.1% reported smoking a pipe, and 1.4% reported smoking cigars. Average self-reported, daily cigarette consumption significantly decreased after the smoking ban took effect. Overall, 90% of the employees supported the smoke-free policy, and 80% of the employees believed that smokers were complying with the smoke-free policy. Most employees believed that the air quality of work areas and nonwork areas (65% and 69%, respectively) had improved since the smoke-free policy was implemented. CONCLUSIONS: These findings are consistent with previous evaluations of smoke-free policies and suggest that most employees are generally supportive of workplace smoking restrictions. Such policies can also have a positive impact on smoking behavior and perceived air quality.

Public attitudes about cigarette smoking: results from the 1990 Smoking Activity Volunteer Executed Survey.

The 1990 Smoking Activity Volunteer Executed Survey collected information on a wide range of policy-relevant issues concerning public attitudes about cigarette smoking. These issues include cigarette taxes, advertising restrictions, minors' access to tobacco products, school-based prevention, and exposure to environmental tobacco smoke in workplaces and public areas. Survey data were collected during the spring and summer months of 1990 from random samples of adults from Arizona, Michigan, Pennsylvania, and Texas. Telephone interviews were conducted by trained American Cancer Society volunteers using standardized questionnaires. Cluster sampling techniques, interviewer training and supervision, and data collection procedures were designed in conformity with the methodology of the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention. Smoking prevalence ranged from a low of approximately 20 percent in Texas to a high of 31 percent in Michigan. Between 60 and 69 percent of the respondents in the four States, including between 44 and 71 percent of current smokers, believe tobacco should be classified as a drug. Around 65 percent of the respondents would support an extra tax on tobacco to finance public campaigns against smoking, and between 61 percent and 69 percent favor banning cigarette advertising in the print media and on billboards. More than 82 percent of the respondents believe that stronger laws should be enacted to prevent the sale of tobacco products to minors, and more than 86 percent believe that existing laws should be better enforced. Current smokers were only slightly less likely than were former and never smokers to indicate support of policy changes to prevent minors'access to tobacco products; the two groups had somewhat more disagreement in the amount of support for the other smoking control policies.Finally, although between 62 and 88 percent of working respondents reported the presence of smoking restrictions at their workplace, between 26 and 48 percent still reported being bothered by smoking at work.These study findings suggest that existing smoking control policies are not restrictive enough or are inadequately enforced. The study documents strong public concern in the four States about the in adequacy of current policies and support for the enactment of stronger legislation to control smoking behavior.

Behavioral Risk Factor Surveillance System: summary of data for 1991.

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 (> or = 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.

Behavioral risk factor surveillance, 1986-1990.

Since 1984, an increasing number of states (including the District of Columbia) have participated in the Behavioral Risk Factor Surveillance System (BRFSS). This report provides state-specific estimates of the prevalence of selected health-risk behaviors for the years 1986 through 1990. Apparent trends and progress toward several of the year 2000 national health objectives are discussed, both for the entire adult population (persons ages greater than or equal to 18 years) and selected high-risk demographic subgroups. Now that BRFSS includes 45 states and covers over 90% of the nation's adult population, it can be used both as a measure of state-specific risk factor prevalence and an indicator of national trends.

Behavioral Risk Factor Surveillance, 1988.

In 1988, 36 states (including the District of Columbia) participated in the Behavioral Risk Factor Surveillance System (BRFSS). This report provides state-specific estimates of the prevalence of certain health-risk behaviors and of the delivery of clinical preventive services as measured by the BRFSS during 1988. Because estimates vary considerably from state to state, national estimates are not always suitable for states to use in planning local programs. Therefore, the BRFSS will continue to provide state-specific data about health behaviors and the use of preventive health services. These data can be used to monitor trends in health behaviors that affect the burden of chronic diseases in the United States and to assess progress toward the year 2000 objectives for the nation.