Behavioral Data Essential
For Health Promotion
Over the last three decades, scientific evidence has clearly demonstrated how personal behaviors affect development of diseases. Smoking, physical inactivity, poor eating habits, or alcohol abuse can lead to a variety of chronic diseases like heart disease, cancer, diabetes, or lung diseases.
Behavioral risks also have an impact on communicable diseases—such as AIDS, sexually transmitted diseases, and vaccine-preventable diseases—and on injuries from violence and accidents.
As a result of this evidence, public health professionals are focusing on ways to help people change their behaviors to reduce risk of illness and premature death.
In order to accomplish this task, public
health professionals need to ask questions about risks. How many people are at risk? What populations
are most affected? With this kind of information, health agencies can develop health education programs
for the public, or targeted health promotion messages for people with greatest risk. This information
also can be used to determine the effectiveness of those programs, by looking for reductions in the number
of people who engage in risky behaviors. Policymakers use this information to make evidence-based decisions
that are beneficial to the public.
This kind of information is gathered through the Behavioral Risk Factor Surveillance System (BRFSS). In the early 1980s, the Centers for Disease Control and Prevention (CDC) worked with several states, including Delaware, to create the BRFSS and address these behavioral health risks. This unique, state-based surveillance system is the largest continuously conducted telephone health survey in the world. The BRFSS is now in all 50 states, the District of Columbia and three territories. The sample is randomized by state, producing more accurate data for state planning. The state-based system allows the flexibility to add questions of local interest.
Delaware has been collecting behavioral risk factor data continuously since 1990. The BRFSS is a random-sample
telephone interview survey. Interviewing is conducted during each month of every year, and data is analyzed
on a calendar-year basis. The annual sample in Delaware is about 4,000 adults age 18 and older. 
Three major partners are involved in this cooperative effort. CDC provides major funding for the Delaware BRFSS as well as basic analysis of the data. The Delaware Division of Public Health provides management of the program, analyses, interpretation, and dissemination of the data. The Center for Applied Demography and Survey Research of the University of Delaware does the telephone interviewing, data entry and additional analysis.
In April 2001, the Delaware Division of Public Health published a state health plan, called Healthy Delaware 2010. It includes analysis of Delaware's health problems, and objectives which the state's health care community are working to achieve by the year 2010. The BRFSS provides baseline data, and is used to track many of the objectives for Healthy Delaware 2010 and other state health plans for tobacco prevention, nutrition and physical activity, HIV/AIDS prevention, and diabetes prevention and control.
Future Challenges
Technological and cultural changes are posing challenges to survey research across the United States. One of the most significant challenges is the increase in households which do not have land-line phones and only use cell phones. The Behavioral Risk Factor Surveillance System is changing to address the increasing prevalence of cell phone-only households and other issues.
By 2010, the BRFSS will adopt a new method for weighting data that more accurately reflects the actual population of each state. In addition, the BRFSS is becoming a "multi-mode survey," using several modes of data collection—including land-line telephone interviews, cell phone interviews, and possibly options for mail and even Internet responses. Methods of sample selection may also change, as research demonstrates more effective methodologies.
These changes will improve the scientific validity of the BRFSS, and maintain the system as the leading source of essential behavioral data for public health planning, program development, education, and evaluation.
