Surveillance for certain health behaviors among States and selected local areas - United States, 2010.

PROBLEM: Chronic diseases (e.g., heart disease, stroke, cancer, and diabetes) are the leading causes of morbidity and mortality in the United States. Engaging in healthy behaviors (e.g., quitting smoking and tobacco use, being more physically active, and eating a nutritious diet) and accessing preventive health-care services (e.g., routine physical checkups, screening for cancer, checking blood pressure, testing blood cholesterol, and receiving recommended vaccinations) can reduce morbidity and mortality from chronic and infectious disease and lower medical costs. Monitoring and evaluating health-risk behaviors and the use of health services is essential to developing intervention programs, promotion strategies, and health policies that address public health at multiple levels, including state, territory, metropolitan and micropolitan statistical area (MMSA), and county. REPORTING PERIOD: January-December 2010. 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. This report presents results for 2010 for all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the U.S. Virgin Islands, 192 MMSAs, and 302 counties. RESULTS: In 2010, the estimated prevalence of high-risk health behaviors, chronic diseases and conditions, access to health care, and use of preventive health services varied substantially by state and territory, MMSA, and county. In the following summary of results, each set of proportions refers to the range of estimated prevalence for the disease, condition, or behaviors, as reported by survey respondents. Adults reporting good or better health: 67.9%-89.3% for states and territories, 72.2%-92.1% for MMSAs, and 72.8%-95.8% for counties. Adults with health-care coverage: 69.4%-95.7% for states and territories, 45.7%-97.0% for MMSAs, and 45.7%-97.2% for counties. Adults who had a dental visit in the past year: 57.2%-81.7% for states and territories, 47.1%-83.5% for MMSAs, and 47.1%-88.2% for counties. Adults aged ≥65 years having had all their natural teeth extracted (edentulism): 7.4%-36.0% for states and territories, 4.8%-34.8% for MMSAs, and 2.4%-39.3% for counties. A routine physical checkup during the preceding 12 months: 53.8%-80.0% for states and territories, 49.5%-82.6% for MMSAs, and 49.5%-85.3% for counties. Influenza vaccination received during the preceding 12 months among adults aged ≥65 years: 26.9%-73.4% for states and territories, 51.7%-77.1% for MMSAs, and 49.3%-87.8% for counties. Pneumococcal vaccination ever received among adults aged ≥65 years: 24.7%-74.0% for states and territories, 48.6%-79.9% for MMSAs, and 47.6%-83.1% for counties. Sigmoidoscopy or colonoscopy ever received among adults aged ≥50 years: 37.8%-75.7% for states and territories, 37.3%-79.9% for MMSAs, and 37.3%-82.5% for counties. Blood stool test received during the preceding 2 years among adults aged ≥50 years: 8.5%-27.0% for states and territories, 6.7%-51.3% for MMSAs, and 6.8%-57.2% for counties. Women who reported having had a Papanicolaou test during the preceding 3 years: 67.8%-88.9% for states and territories, 63.3%-91.2% for MMSAs, and 63.2%-95.7% for counties. Women aged ≥40 years who had a mammogram during the preceding 2 years: 63.8%-83.6% for states and territories, 60.3%-86.2% for MMSAs, and 59.3%-89.7% for counties. Current cigarette smokers: 5.8%-26.8% for states and territories, 5.8%-28.5% for MMSAs, and 5.9%-29.8% for counties. Binge drinking during the preceding month: 6.6%-21.6% for states and territories, 3.6%-23.0% for MMSAs, and 3.8%-24.0% for counties. Heavy drinking during the preceding month: 2.0%-7.2% for states and territories, 1.0%-10.0% for MMSAs, and 1.0%-14.2% for counties. Adults reporting no leisure-time physical activity: 17.5%-42.3% for states and territories, 13.1%-37.6% for MMSAs, and 8.5%-39.0% for counties. Adults who were overweight: 32.6%-40.7% for states and territories, 28.5%-42.5% for MMSAs, and 27.2%-46.4% for counties. Adults aged ≥20 years who were obese: 22.1%-35.0% for states and territories, 17.1%-42.1% for MMSAs, and 13.3%-42.1% for counties. Adults with current asthma: 5.2%-11.1% for states and territories, 3.4%-14.5% for MMSAs, and 3.3%-14.6% for counties. Adults with diagnosed diabetes: 5.3%-13.2% for states and territories, 4.6%-15.4% for MMSAs, and 2.6%-18.8% for counties. Adults with limited activities because of physical, mental or emotional problems: 10.8%-28.2% for states and territories, 13.5%-38.3% for MMSAs, and 11.7%-32.0% for counties. Adults using special equipment because of any health problem: 2.8%-10.6% for states and territories, 4.5%-15.5% for MMSAs, and 1.3%-15.5% for counties. Adults aged ≥45 years who have had coronary heart disease: 5.3%-16.7% for states and territories, 6.5%-19.6% for MMSAs, and 4.9%-19.6% for counties. Adults aged ≥45 years who have had a stroke: 2.4%-7.1% for states and territories, 2.3%-8.8% for MSMAs, and 1.7%-8.8% for counties. INTERPRETATION: The findings in this report indicate substantial variations in the health-risk behaviors, chronic diseases and conditions, access to health-care services, and the use of the preventive health services among U.S. adults at the state and territory, MMSA, and county levels. Healthy People 2010 (HP 2010) objectives were established to monitor health behaviors, conditions, and the use of preventive health services for the first decade of the 2000s. The findings in this report indicate that many of the HP 2010 objectives were not achieved by 2010. The findings underscore the continued need for surveillance of health-risk behaviors, chronic diseases, and conditions and of the use of preventive health-care services. PUBLIC HEALTH ACTION: Local and state health departments and federal agencies use BRFSS data to identify populations at high risk for certain health-risk behaviors, chronic diseases, and conditions and to evaluate the use of preventive health-care services. BRFSS data also are used to direct, implement, monitor, and evaluate public health programs and policies that can lead to a reduction in morbidity and mortality from chronic conditions and corresponding health-risk behaviors.

Surveillance of certain health behaviors and conditions among states and selected local areas --- Behavioral Risk Factor Surveillance System, United States, 2009.

PROBLEM: Chronic diseases and conditions (e.g., heart disease, cancer, stroke, and diabetes) are the leading causes of death in the United States. Controlling health risk behaviors and conditions (e.g., smoking, physical inactivity, poor diet, excessive drinking, and obesity) and using preventive health-care services (e.g., physical examination, vaccination, screening for high blood pressure and high cholesterol, consumption of fruits and vegetables, and participation in regular leisure-time physical activity) can reduce morbidity and mortality from chronic diseases. REPORTING PERIOD: January 2009--December 2009. 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 and conditions, chronic diseases and conditions, access to health care, and use of preventative health services and practices related to the leading causes of death and disabilities in the United States. This report presents results for 2009 for all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the U.S. Virgin Islands, 180 metropolitan and micropolitan statistical areas (MMSAs), and 283 selected counties. RESULTS: In 2009, the estimated prevalence of general health status, use of preventive health-care services, health risk behaviors and conditions, chronic diseases, and health impairments and disabilities varied substantially by state and territory, MMSA, and county. The following is a summary of results listed by BRFSS question topics. Each set of proportions refers to the range of estimated prevalence for the disease, condition, or behavior, as reported by the survey respondent. Adults who reported having fair or poor health: 10.1%--30.9% for states and territories, 7.9%--25.8% for MMSAs, and 4.5%--26.1% for counties. Adults with health-care coverage: 71.4%--94.7% for states and territories, 52.7%--96.3% for MMSAs, and 52.7%--97.6% for counties. Annual routine physical checkup among adults aged ≥18 years: 55.8%--79.3% for states and territories, 51.8%--80.7% for MMSAs, and 49.2%--83.5% for counties. Annual influenza vaccination among adults aged ≥65 years: 26.8%--76.8% for states and territories, 55.4%--81.4% for MMSAs, and 50.5%--83.5% for counties. Pneumococcal vaccination among adults aged ≥65 years: 19.1%--73.9% for states and territories, 52.9%--81.3% for MMSAs, and 41.9%--82.0% for counties. Adults who had their cholesterol checked within the preceding 5 years: 67.5%--85.3% for states and territories, 58.2%--88.8% for MMSAs, and 58.2%--92.4% for counties. Adults who consumed at least five servings of fruits and vegetables per day: 14.6%--31.5% for states and territories, 12.6%--33.0% for MMSAs, and 13.4%--34.9% for counties. Adults who engaged in moderate or vigorous physical activity: 28.0%--60.7% for states and territories, 34.6%--64.9% for MMSAs, and 33.6%--67.3% for counties. Adults who engaged in only vigorous physical activity: 13.7%--40.1% for states and territories, 13.8%--43.3% for MMSAs, and 14.2%--50.0% for counties. Current cigarette smoking among adults: 6.4%--25.6% for states and territories, 5.7%--29.0% for MMSAs, and 5.6%--29.8% for counties. Binge drinking among adults: 6.8%--23.9% for states and territories, 3.5%--23.2% for MMSAs, and 3.4%--26.3% for counties. Heavy drinking among adults: 1.9%--8.1% for states and territories, 1.0%--11.1% for MMSAs, and 0.9%--11.1% for counties. Adults who reported no leisure-time physical activity: 15.8%--45.6% for states and territories, 13.3%--40.2% for MMSAs, and 10.5%--40.2% for counties. Adults aged ≥18 years who were overweight: 31.6%--38.7% for states and territories, 28.7%--44.1% for MMSAs, and 25.6%--46.7% for counties. Adults aged ≥20 years who were obese: 19.7%--36.0% for states and territories, 15.4%--43.6% for MMSAs, and 13.8%--45.7% for counties. Adults aged ≥18 years who did not get enough rest or sleep: 34.3%--52.6% for states and territories, 28.2%--54.8% for MMSAs, and 24.5%--55.6% for counties. Adults who had received a high blood pressure diagnosis: 22.1%--38.5% for states and territories, 18.8%--43.9% for MMSAs, and 17.2%--43.6% for counties. Adults who had a high blood cholesterol diagnosis: 24.9%--42.2% for states and territories, 27.5%--47.8% for MMSAs, and 26.7%--51.4% for counties. Adults who had received a diagnosis of coronary heart disease: 2.5%--10.3% for states and territories, 2.6%--11.6% for MMSAs, and 1.6%--12.3% for counties. Adults who had received a stroke diagnosis: 1.4%--3.9% for states and territories, 0.8%--5.9% for MMSAs, and 0.8%--6.6% for counties. Adults who had received a diabetes diagnosis: 5.8%--12.9% for states and territories, 2.8%--15.4% for MMSAs, and 2.8%--14.7% for counties. Adults who had received a cancer diagnosis: 3.0%--12.6% for states and territories, 5.8%--15.1% for MMSAs, and 3.9%--16.2% for counties. Adults who had asthma: 4.4%--11.1% for states and territories, and 3.2%--15.3% for MMSAs, and 3.2%--15.7% for counties. Adults who had arthritis: 10.7%--35.6% for states and territories, 16.2%--36.0% for MMSAs, and 12.6%--39.4% for counties. Adults with activity limitation associated with physical, mental, or emotional problems: 10.2%--27.1% for states and territories, 13.1%--33.7% for MMSAs, and 10.4%--36.1% for counties. Adults who required special equipment because of health problems: 3.6%--10.2% for states and territories, 3.4%--11.5% for MMSAs, and 1.7%--13.0% for counties. INTERPRETATION: The findings in this report indicate substantial variations in self-rated general health status, health-care coverage, use of preventive health-care services, health risk behaviors and health conditions, cardiovascular conditions, other chronic diseases, and health impairments and disabilities among U.S. adults at the state and territory, MMSA, and county levels. The findings show that Healthy People 2010 objectives had not been met in many areas by 2009, which underscores the continued need for surveillance of general health status, use of preventive health-care services, health risk behaviors and conditions, chronic diseases, and health impairment and disability. PUBLIC HEALTH ACTION: Data on health risk behaviors, chronic health conditions, preventive care practices, and chronic diseases are used to develop health promotion activities, intervention programs, and health policies at the state, city, and county levels.. The overarching goals of Healthy People 2010 are to increase quality and years of healthy life and to eliminate health disparities. Local and state health departments and federal agencies should continue to use BRFSS data to identify populations at high risk for certain health risk behaviors and conditions, cardiovascular conditions, and other chronic diseases and to evaluate the use of preventive health-care services. In addition, BRFSS data can be used to direct, implement, monitor, and evaluate public health programs and policies that can lead to a reduction in morbidity and mortality.

Surveillance of certain health behaviors among states and selected local areas--United States, 2005.

PROBLEM: Behavioral risk factors such as smoking, poor diet, physical inactivity, and excessive drinking are linked to the leading causes of death in the United States. Controlling these behavioral risk factors and using preventive health services (e.g., influenza and pneumococcal vaccination of adults aged > or =65 years and hypertension and cholesterol screenings) can substantially reduce the morbidity and mortality in the U.S. population. Continuous monitoring of these behaviors and preventive services are essential for developing health promotion, intervention programs, and health policies at the state, city, and county level. REPORTING PERIOD COVERED: Data collected in 2005 are presented for states/territories, selected metropolitan and micropolitan statistical areas (MMSAs), metropolitan divisions, and selected counties. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit--dialed telephone survey of the noninstitutionalized U.S. population aged > or =18 years. BRFSS collects information on health risk behaviors and preventive health services related to leading causes of death. All 50 states, the District of Columbia (DC), the Commonwealth of Puerto Rico, and the U.S. Virgin Islands participated in BRFSS during 2005. Within these states and territories, 153 MMSAs and 232 counties that reported data for at least 500 respondents or a minimum sample size of 19 per weighting class were included in the analyses. RESULTS: Prevalence of health-risk behaviors, awareness of specific medical conditions, and use of preventive services varied substantially by state/territory, MMSA, and county. In 2005, prevalence of health insurance ranged from 60% to 95% for states/territories, MMSAs, and counties. Prevalence of leisure-time physical inactivity ranged from 16% to 49% for states/territories, 14% to 36% for MMSAs, and 12% to 41% for counties. Prevalence of adults who engaged in at least moderate physical activity ranged from 33% to 62%, and prevalence of vigorous physical activity ranged from 15% to 42% for states/territories, MMSAs, and counties. Prevalence of adults who currently smoke cigarettes ranged from 6% to 35% for states/territories, MMSAs, and counties. The prevalence of binge drinking was substantially higher than the prevalence of heavy drinking across all the states/territories, MMSAs, and counties. Prevalence of adults who were overweight ranged from 53% to 67 % for states/territories, 49% to 70% for MMSAs, and 44% to 71% for counties. Prevalence of current asthma ranged from 4% to 14% for states/territories, MMSAs, and counties. Prevalence of diabetes ranged from 4% to 14% for states/territories and MMSAs and from 3% to 14% for counties. Proportion of respondents with high blood pressure ranged from 13% to 39% for states/territories, MMSAs and counties. Prevalence of respondents with high cholesterol ranged from 31% to 41% for states/territories and 26% to 47% for MMSAs and counties. The prevalence estimates for respondents who reported being limited in any way in any activities because of physical, mental, or emotional problems ranged from 10% to 27% for states/territories, 12% to 31% for MMSAs, and 10% to 27% for counties. The percentage of respondents who required use of special equipment ranged from 4% to 10% for the states/territories, 3% to 15% for MMSAs, and 3% to 11% for counties. Prevalence of fair or poor health ranged from 11% to 34% for states/territories and 6% to 26% for MMSAs and counties. The prevalence of adults who checked their cholesterol during the preceding 5 years ranged from 55% to 86% for states/territories, MMSAs, and counties. Prevalence of annual influenza vaccination among adults aged > or =65 years ranged from 32% to 78% for states/territories, 48% to 83% for MMSAs, and 41% to 84% for counties. The estimated prevalence of pneumococcal vaccination among adults aged > or =65 years ranged from 28% to 72% for states/territories, 52% to 82% for MMSAs, and 35% to 83% for counties. INTERPRETATION: The findings in this report indicate a wide variation in health-risk behaviors, chronic conditions, and use of preventive services among U.S. adults at the state/territory, MMSA, and county level. The findings underscore a need for continuous efforts to evaluate public health intervention programs and policies designed to reduce morbidity and mortality caused by chronic disease and injury. PUBLIC HEALTH ACTION: The 2005 BRFSS data indicate a need for continued monitoring of health-risk behaviors, specific disease conditions, and use of preventive services to identify high-risk populations and to implement and monitor health-promotion programs and health policies at the state/territory, MMSA, and county level.

Surveillance for certain health behaviors among states and selected local areas--Behavioral Risk Factor Surveillance System, United States, 2003.

PROBLEM: Data on health risk behaviors (e.g., cigarette smoking, binge drinking, and physical inactivity) for chronic diseases and use of preventive practices (e.g., influenza and pneumococcal vaccination for adults aged > or =65 years and cholesterol screening) are essential for developing effective health education and intervention programs and policies to prevent morbidity and mortality from chronic diseases. Continuous monitoring of these behaviors and practices at the state, city, and county levels can help public health programs in evaluating progress toward improving their community's health. REPORTING PERIOD COVERED: Data collected in 2003 are presented for states, selected metropolitan and micropolitan statistical areas (MMSAs), and their counties. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed telephone survey of the civilian, noninstitutionalized U.S. population aged > or =18 years. All 50 states, the District of Columbia, Guam, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands participated in BRFSS during 2003. Within these states and territories, 105 MMSAs and 153 counties that reported data for at least 500 respondents or a minimum sample size of 19 per weighting class were included in the analyses. RESULTS: Prevalence of high-risk behaviors for chronic diseases, awareness of certain medical conditions, and use of preventive health-care services varied substantially by state/territory, MMSA, and county. The proportion of the population that achieved Healthy People 2010 (HP 2010) objectives also varied by state/territory, MMSA, and county. Twelve states, 39 MMSAs, and 65 counties achieved the HP 2010 objective to reduce the proportion of adults who engage in no leisure-time physical activity to 20%. Twenty states, 41 MMSAs, and 63 counties achieved the HP 2010 goal of 50% of adults engaging in moderate physical activity for at least 30 minutes per day. The HP 2010 goal of 30% of adults who engage in vigorous physical activity was achieved by 17 states, 33 MMSAs, and 57 counties. Two states, one MMSA, and one county achieved the HP 2010 current cigarette smoking goal of 12% prevalence. One county achieved the HP 2010 binge drinking goal of 6% prevalence among adults. One MMSA and eight counties achieved the HP 2010 goal of 15% for obesity prevalence. The HP 2010 goal for influenza and pneumococcal vaccination coverage of 90% was not achieved by any state, MMSA, or county. No state, MMSA, or county achieved the HP 2010 objective of 17% prevalence of high cholesterol among adults. INTERPRETATION: The findings in this report indicate substantial variation in health risk behaviors and use of preventative services among adults at state and local levels, indicating a need for appropriate public health interventions and continued efforts to evaluate public health programs and policies and health-care-related efforts designed to reduce morbidity and mortality. PUBLIC HEALTH ACTION: Data from BRFSS are useful for assessing national health objectives, for identifying and characterizing at risk populations, and for designing and evaluating health promotion and disease prevention programs and policies. The 2003 BRFSS data indicate a continued need to develop and implement health promotion programs for targeting specific behaviors and practices and provides information for measuring progress towards achieving disease prevention and health promotion goals at state and local levels.

Surveillance for certain health behaviors among selected local areas--United States, Behavioral Risk Factor Surveillance System, 2002.

PROBLEM: Monitoring risk behaviors for chronic diseases and participation in preventive practices are important for developing effective health education and intervention programs to prevent morbidity and mortality. Therefore, continual monitoring of these behaviors and practices at the state, city, and county levels can assist public health programs in evaluating and monitoring progress toward improving their community's health. REPORTING PERIOD COVERED: Data collected in 2002 are presented for states, selected metropolitan, and micropolitan statistical areas (MMSA), and their counties. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an on-going, state-based, telephone survey of the civilian, noninstitutionalized population aged >18 years. All 50 states, the District of Columbia (DC), Guam, the Virgin Islands, and the Commonwealth of Puerto Rico participated in BRFSS during 2002. Metropolitan and MMSA and their counties with >500 respondents or a minimum sample size of 19 per weighting class were included in the analyses for a total of 98 MMSA and 146 counties. RESULTS: Prevalence of high-risk behaviors for chronic diseases, awareness of certain medical conditions, and use of preventive health-care services varied substantially by state, county, and MMSA. Obesity ranged from 27.6% in West Virginia, 29.4% in Charleston, West Virginia, and 32.0% in Florence County, South Carolina, to 16.5% in Colorado, 12.8% in Bethesda-Frederick-Gaithersburg, Maryland, and 11.8% in Washington County, Rhode Island. No leisuretime physical activity ranged from 33.6% in Tennessee, 36.8% in Miami-Miami Beach-Kendall, Florida, and 36.8% in Miami-Dade County, Florida to 15.0% in Washington, 13.8% in Seattle-Bellevue-Everett Washington, and 11.4% in King County, Washington. Cigarette smoking ranged from 32.6% in Kentucky, 32.8% in Youngstown-Warren- Boardman, Ohio-Pennsylvania, and 31.1% in Jefferson County, Kentucky to 16.4% in California, 13.8% in Ogden- Clearfield, Utah, and 10.9% in Davis County, Utah. Binge drinking ranged from 24.9% in Wisconsin, 26.1% in Fargo, North Dakota-Minnesota, and 25.1% Cass County, North Dakota, to 7.9% in Kentucky, 8.2% in Greensboro- High Point, North Carolina, and 6.6% in Henderson County, North Carolina. At risk for heavy drinking ranged from 8.7% in Arizona, 9.5% in Lebanon, New Hampshire-Vermont, and 11.3% in Richland County, South Carolina, to 2.8% in Utah, 1.9% in Ogden-Clearfield, Utah, and 1.7% in King County, New York. Adults who were told they had diabetes ranged from 10.2% in West Virginia, 11.1% in Charleston, West Virginia, and 11.1% in Richland, South Carolina, to 3.5% in Alaska, 2.7% in Anchorage, Alaska, and 2.4% in Weber County, Utah. Percentage of adults aged>50 years who were ever screened for colorectal cancer ranged from 64.8% in Minnesota, 67.9% in Minneapolis-St. Paul-Bloomington Minnesota-Wisconsin, and 73.6% in Ramsey County, Minnesota, to 39.2% in Hawaii, 30.7% in Kahului-Wailuku, Hawaii, and 30.7% in Maui County, Hawaii. Persons aged >65 years who had received pneumococcal vaccine ranged from 72.5% in North Dakota, 74.8% in Minneapolis-St. Paul-Bloomington, Minnesota-Wisconsin, and 73.1% in Milwaukee County, Wisconsin, to 47.9% in DC, 47.5% in New York-Wayne-White Plains, New York, New Jersey, and 47.9% in DC County, DC. Older adults who had received influenza vaccine ranged from 76.6% in Minnesota, 80.0% in Minneapolis-St. Paul-Bloomington, Minnesota-Wisconsin, and 76.3% in Middlesex County, Massachusetts, to 57.0% in Florida, 55.8% in Houston-Baytown-Sugar Land, Texas, and 56.2% in Cook County, Illinois. INTERPRETATION: BRFSS data indicate substantial variation in high-risk behaviors, participation in preventive healthcare services, and screening among U.S. adults at states and selected local areas, indicating a need for continued efforts to evaluate public health programs or policies designed to reduce morbidity and mortality. PUBLIC HEALTH ACTIONS: Data from BRFSS are useful in developing and guiding public health programs and policies. Therefore, states, selected MMSA, and their counties can use BRFSS data as a tool to prevent premature morbidity and mortality among adult population and to assess progress toward national health objectives. The data indicate a continued need to develop and implement health promotion programs for targeting specific behaviors and practices and serve as a baseline for future surveillance at the local level in the United States.

State-specific prevalence of selected chronic disease-related characteristics--Behavioral Risk Factor Surveillance System, 2001.

PROBLEM: High-risk behaviors and lack of preventive care are associated with higher rates of morbidity and mortality in the United States. Without continued monitoring of these factors, state health departments would have difficulty tracking and evaluating progress toward Healthy People 2010 and their own state objectives. Monitoring chronic disease-related behaviors is also key to developing targeted education and intervention programs at the national, state, and local levels to improve the health of the public. REPORTING PERIOD COVERED: Data collected in 2001 are compared with data from 1991 and 2000, and progress toward Healthy People 2010 targets is assessed. DESCRIPTION OF SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, telephone survey of persons aged > or =18 years. State health departments collect the data in collaboration with CDC. In 2001, participants in data collection included all 50 states, the District of Columbia, Guam, the U.S. Virgin Islands, and the Commonwealth of Puerto Rico. BRFSS data are used to track the prevalence of chronic disease-related characteristics and monitor progress toward national health objectives related to 1) decreasing high-risk behaviors, 2) increasing awareness of medical conditions, and 3) increasing use of preventive health services. For certain national objectives, BRFSS is the only source of data. RESULTS: BRFSS data indicate changes in certain high-risk behaviors from 1991 to 2001. Among the findings are substantial increases in the prevalence of obesity among adults aged > or =20 years. Among states, prevalence of persons classified as obese in 2001 ranged from 15.5% in Colorado to 27.1% in Mississippi. From 1991 to 2001, the median prevalence for all participating states and territories increased from 12.9% to 21.6%. In 1991, no state had an obesity prevalence of > or =20%; in 2001, 37 states had a prevalence of > or =20%. Percentage increases in prevalence of obesity, from 1991 to 2001, ranged from 24.9% in the District of Columbia to 140.2% in New Mexico. In 2001, substantial variations also existed among states and territories regarding prevalence of other high-risk behaviors and awareness of medical conditions. Ranges included, for no leisure-time physical activity, 16.5% (Utah) to 49.2% (Puerto Rico); cigarette smoking, 9.6% (Virgin Islands) to 31.2% (Guam); binge drinking, 6.8% (Tennessee) to 25.7% (Wisconsin); heavy drinking, 2.5% (Tennessee) to 8.7% (Wisconsin); persons ever told they had diabetes, 4% (Alaska) to 9.8% (Puerto Rico); persons ever told they had high blood pressure, 20% (New Mexico) to 32.5% (West Virginia); and persons ever told they had high blood cholesterol, 24.8% (New Mexico) to 37.7% (West Virginia). Substantial variations also existed among states regarding prevalence of using preventive health services. Ranges included, for persons aged > or =50 years ever screened for colorectal cancer by use of sigmoidoscopy or colonoscopy, 30.5% (Virgin Islands) to 62% (Minnesota); persons aged > or =65 years who received an influenza vaccination in the past year, 36.8% (Puerto Rico) to 79% (Hawaii); persons aged > or =65 years who ever received a pneumococcal vaccination, 24.1% (Puerto Rico) to 70.9% (Oregon). In 2001, 13 states, Guam, and the U.S. Virgin Islands used the women's health module. Ranges included, for women aged > or =18 years who had a Papanicolaou (Pap) smear test in the past 3 years, 79.8% (Virgin Islands) to 89.6% (Wisconsin); women aged > or =40 years who ever had a mammogram, 71.9% (Virgin Islands) to 93% (Rhode Island); and women aged > or =40 years who had a mammogram in the past 2 years, 57.2% (Virgin Islands) to 85.1% (Rhode Island). BRFSS data in 2001 also indicated variations by sex, race or ethnicity, and age group. Greater percentages of men than women reported cigarette smoking, binge drinking, heavy drinking, and were classified as overweight; greater percentages of women reported no leisure-time physical activity. Among racial or ethnic groups, greater percentages of black non-Hispanics than other groups reported being told by a health professional they had high blood pressure and diabetes, and were classified as obese; greater percentages of white non-Hispanics than other groups reported being told they had high cholesterol. Among age groups, greater percentages of persons aged 18-24 years than those in older groups reported smoking cigarettes, binge drinking and heavy drinking; greater percentages of persons in older age groups than younger age groups reported being told they had diabetes, high blood pressure, and high blood cholesterol. Also, comparison of 2001 BRFSS data with 12 targets from Healthy People 2010 indicates that, in 2001, no state had met the targets for obesity, cigarette smoking, binge drinking, receiving a fecal occult blood test within the past 2 years, receiving annual influenza vaccinations, receiving pneumococcal vaccinations, and receiving Pap tests. Certain states had already met targets for no leisure-time activity, receiving a sigmoidoscopy or colonoscopy, having blood cholesterol checked within the past 5 years, and receiving a mammogram within the past 2 years. INTERPRETATION: BRFSS data in this report indicate that despite certain improvements, persons in a high proportion of U.S. states and territories continue to engage in high-risk behaviors and do not report making sufficient use of preventive health practices. Substantial variations (i.e., by state, sex, age group, and race/ethnicity) in prevalence of behaviors, awareness of medical conditions, and use of preventive services indicate a continued need to monitor these factors at state and local levels and assess progress toward reducing morbidity and mortality. PUBLIC HEALTH ACTIONS: BRFSS data can be used to guide public health actions at local, state, and national levels. For certain states, BRFSS is the only reliable source of chronic-disease-related, risk-behavioral data. BRFSS data enable states to design, implement, evaluate, and monitor health-promotion strategies, targeting specific high-risk behaviors among populations experiencing high burdens of disease. BRFSS data continue to be key sources for assessing progress toward both national Healthy People 2010 objectives and state health objectives.