Instructions
Scenario:
A generation ago, people used to see their doctor only when they were sick or dying. Today, preventative health care is becoming commonplace as people become more educated and empowered about their own health. Regular, routine medical check-ups can help find potential health issues before they become a problem. Early detection of problems gives the best chance for getting the right treatment quickly, avoiding any complications.
You have been employed as part of an active public health campaign that is aiming to increase routine 12-monthly check-ups. Your job is to identify groups of people with lower rates of check-ups in the last 12 months where a targeted campaign would be of most benefit.
The Behavioral Risk Factor Surveillance System (BRFSS) is a collaborative project between all of the states in the United States (US) and participating US territories and the Centers for Disease Control and Prevention (CDC). The BRFSS is a system of ongoing health-related telephone surveys designed to collect data on health-related risk behaviours, chronic health conditions and use of preventive services from the non-institutionalised adult population (≥18 years) residing in the United States. Using the prepared BRFSS data, identify demographic, social and behavioural factors that are associated with routine check- up attendance.
Dataset:
BRFSS 2024 data
Format:
Your written briefing document must consist of a 250-word executive summary and a detailed structured results section. This template will assist you with the format and information required.
Executive Summary (Marks: 25)
The 250-word summary should identify demographic, social and behavioural factors that are associated with routine check-up attendance in a statistically valid, clear and concise manner that can be understood by someone with minimal knowledge of epidemiology and biostatistics. You must identify a group or groups of people where a targeted campaign would be of most benefit.
Results:
The BRFSS:
A short summary of the study design of the BRFSS and a brief discussion of its limitations (no more than 250 words (Marks: 6)
Find a peer-reviewed primary quantitative research study in the literature that investigates the determinants of routine check-up attendance. Compare the designs between the study described in that paper and BRFSS (not more than 150 words). (Marks: 4)
Description of the population and analysis:
1) By analysing the BRFSS dataset, answer the following questions:
In your dataset, what percentage of participants reported routine check-up attendance? (Marks: 5)
Create a table of routine check-up attendance and 3 demographic factors, one of which must be binary, one numerical and one multi-category categorical (either nominal or ordinal). (Marks: 15)
Each cell should contain the appropriate summary measure and 95% confidence interval
The final column in the table should contain the p-value for statistical tests of difference or independence (i.e., tests that we covered in week 6). Footnotes should be used to indicate which statistical tests were used.
2) Examine the association between 4 social and/or behavioural factors and routine check-up attendance:
In an appropriate manner, present the results of analysis into the effect of four social and/or behavioural factors on routine check-up attendance. You must analyse a binary, numeric, nominal and ordinal factor. (Marks: 20)
For each factor you should report:
Variable name and data type
Name of measure calculated
Results of statistical analysis performed
Statistical interpretation
The Stata output (including visible code) e.g.
For one of the identified factors, you should explore the possibility of confounding or effect modification by sex. (Marks: 10)
Perform appropriate analysis
Present STATA output (including visible code)
Report the results in a table
Interpret your result
Conduct a multivariable regression and present the results of the adjusted regression model by including the four factors you examined in your analysis of social and behavioural factors. (Marks: 10)
Present STATA output (including visible code)
Report the results in a table.
Interpret your result
PHE5EPBAssessment4Template2024T2.docx
overview-2019-508.pdf
2019-calculated-variables-Version4-508.pdf
NOTE: The following is a template for your response to Assessment 4. All sections are required; however, the number of paragraphs written is at your own discretion.
PHE5EPB – Assessment 4
Name and Student Number
Executive Summary:
(250-word summary) YOUR TEXT HERE…
Results:
The BRFSS
(A 250-word summary of the study design of the BRFSS and a brief discussion of its limitations) YOUR TEXT HERE…
Paragraph 2 YOUR TEXT HERE (150 words) : Comparison of the study design between the BRFSS and the paper you identified in the literature.
In my dataset, X.XX% of participants reported routine check-up attendance.
Description of the population
Table 1: Demographic differences by routine check-up attendance
Attended routine check-up
p-value
Yes
No
Binary variable %
Yes
% (95% CI)
% (95% CI)
No
% (95% CI)
% (95% CI)
Numerical variable
Measure (95% CI)
Measure (95% CI)
Categorical variable %
Category 1
% (95% CI)
% (95% CI)
Category 2
% (95% CI)
% (95% CI)
Category 3
% (95% CI)
% (95% CI)
Footnote:
Analysis of Social and Behavioural Factors
Factor #1 – Numerical
· Variable name: (Stata variable)
· Data type: (Continuous/Discrete)
· Measure: (Name of measure calculated)
· Results: (Number and 95%CI from statistical analysis performed)
· Statistical interpretation: YOUR TEXT HERE…
· [Output]
Factor #2 – Binary
· Variable name: (Stata variable)
· Data type: Binary
· Measure: (Name of measure calculated)
· Results:
· (Reference category)
· (Number and 95%CI from statistical analysis performed)
· Statistical interpretation: YOUR TEXT HERE…
· [Output]
Factor #3 – Categorical (Nominal)
· Variable name: (Stata variable)
· Data type: Nominal
· Measure: (Name of measure calculated)
· Results:
· (Reference Category)
· (Number and 95%CI from statistical analysis performed – Category 2)
· (Number and 95%CI from statistical analysis performed – Category 3)
· (etc)
· Statistical interpretation: YOUR TEXT HERE…
· [Output]
Factor #4 – Categorical (Ordinal)
· Variable name: (Stata variable)
· Data type: Ordinal
· Measure: (Name of measure calculated)
· Results:
· (Reference Category)
· (Number and 95%CI from statistical analysis performed – Category 2)
· (Number and 95%CI from statistical analysis performed – Category 3)
· (etc)
· Statistical interpretation: YOUR TEXT HERE…
· [Output]
Possible confounding
Paragraph YOUR TEXT HERE…
Table 2: Stratification by (Confounder Name)
Pooled
Strata 1
Strata 2
Odds Ratio
Interpretation: YOUR TEXT HERE…
Multivariable regression
Table 3: Multivariable regression examining the adjusted odds ratio of the social/behavioural factors on routine check-up attendance
Factors
Adjusted Odds Ratio (95% CI)
Factor 1 (i.e., Numerical factor)
X.XX (A.AA – B.BB)
Factor 2 (i.e., Binary factor)
Category 1 (reference)
1
Category 2
X.XX (A.AA – B.BB)
Factor 3 (i.e., Categorical nominal)
Category 1 (reference)
1
Category 2
X.XX (A.AA – B.BB)
Category 3
X.XX (A.AA – B.BB)
Etc.
X.XX (A.AA – B.BB)
Factor 4 (i.e., Categorical ordinal)
Category 1 (reference)
1
Category 2
X.XX (A.AA – B.BB)
Category 3
X.XX (A.AA – B.BB)
Etc.
X.XX (A.AA – B.BB)
Interpretation: YOUR TEXT HERE…
References
2
image1.png
,
Behavioral Risk Factor Surveillance System
OVERVIEW: BRFSS 2019
July 26, 2019
Background The Behavioral Risk Factor Surveillance System (BRFSS) is a collaborative project between all of the states in
the United States (US) and participating US territories and the Centers for Disease Control and Prevention (CDC).
The BRFSS is administered and supported by CDC’s Population Health Surveillance Branch, under the Division
of Population Health at the National Center for Chronic Disease Prevention and Health Promotion. The BRFSS
is a system of ongoing health-related telephone surveys designed to collect data on health-related risk behaviors,
chronic health conditions, and use of preventive services from the noninstitutionalized adult population (≥ 18
years) residing in the United States.
The BRFSS was initiated in 1984, with 15 states collecting surveillance data on risk behaviors through monthly
telephone interviews. Over time, the number of states participating in the survey increased; BRFSS now collects
data in all 50 states as well as the District of Columbia and participating US territories. During 2019, All 50
states, the District of Columbia, Guam, and Puerto Rico collected BRFSS data. In this document, the term
“state” is used to refer to all areas participating in the BRFSS, including the District of Columbia, Guam, and
the Commonwealth of Puerto Rico. New Jersey was unable to collect enough BRFSS data in 2019 to meet the
minimum requirements for inclusion in the 2019 annual aggregate data set.
BRFSS’s objective is to collect uniform state-specific data on health risk behaviors, chronic diseases and
conditions, access to health care, and use of preventive health services related to the leading causes of
death and disability in the United States. Factors assessed by the BRFSS in 2019 included health status,
healthy days/health-related quality of life, health care access, exercise, inadequate sleep, chronic health
conditions, oral health, tobacco use, e-cigarettes, alcohol consumption, immunization, falls, seat belt use,
drinking and driving, breast- and cervical cancer screening, prostate cancer screening, colorectal cancer
screening, and HIV/AIDS knowledge. Since 2011, the BRFSS has been conducting both landline telephone-
and cellular telephone-based surveys. All the responses were self-reported; proxy interviews are not conducted
by the BRFSS. In conducting the landline telephone survey, interviewers collect data from a randomly selected
adult in a household. In conducting the cellular telephone survey, interviewers collect data from adults
answering the cellular telephones residing in a private residence or college housing. Beginning in 2014, all
adults contacted through their cellular telephone were eligible, regardless of their landline phone use (i.e.,
complete overlap).
The BRFSS field operations are managed by state health departments that follow protocols adopted by the
states, with technical assistance provided by CDC. State health departments collaborate during survey
development and conduct the interviews themselves or use contractors. The data are transmitted to CDC for
editing, processing, weighting, and analysis. An edited and weighted data file is provided to each participating
state health department for each year of data collection, and summary reports of state-specific data are prepared
by CDC. State health departments use the BRFSS data for a variety of purposes, including identifying
demographic variations in health-related behaviors; designing, implementing, and evaluating public health
programs; addressing emergent and critical health issues; proposing legislation for health initiatives; and
measuring progress toward state health objectives.1 For specific examples of how state officials use the finalized
BRFSS data sets, please refer to the appropriate state information on the BRFSS website.
Health characteristics estimated from the BRFSS pertain to the noninstitutionalized adult population—aged 18
years or older—who reside in the United States. In 2019, an optional module was included to provide a measure
for several childhood health and wellness indicators, including asthma prevalence for people aged 17 years or
younger. BRFSS respondents are identified through telephone-based methods. According to the 2018 American
Community Survey (ACS), 98.5% of all occupied housing units in the United States had telephone service
available and telephone non-coverage ranged from less than 1.0% in Delaware to 2.5% in Montana.2 It is
estimated that 4.0% of occupied households in Puerto Rico did not have telephone service.2 The increasing
percentage of households that are abandoning their landline telephones for cellular telephones has significantly
eroded the population coverage provided by landline telephone-based surveys to pre-1970s levels. The
preliminary results (January to June 2019) from the National Health Interview Survey (NHIS) indicate that
58.4% of adults were wireless-only.3 Using a dual-frame survey including landline and cellular telephones
improved the validity, data quality, and representativeness of BRFSS data.
In 2011, a new weighting methodology called iterative proportional fitting (or “raking”) 4 replaced the post-
stratification method to weight BRFSS data. Raking allows incorporation of cellular telephone survey data and
permits the introduction of additional demographic characteristics (e.g., education level, marital status, home
renter/owner) in addition to age-race/ethnicity-gender that improves the degree and extent to which the BRFSS
sample properly reflects the socio-demographic make-up of individual state. The 2019 BRFSS raking method
includes categories of age by gender, detailed race and ethnicity groups, education levels, marital status, regions
within states, gender by race and ethnicity, telephone source, renter or owner status, and age groups by race and
ethnicity. In 2019, 50 states, the District of Columbia, Guam, and Puerto Rico collected samples of interviews
conducted by landline and cellular telephone.
The BRFSS Design
The BRFSS Questionnaire
Each year, the states—represented by their BRFSS coordinators and CDC—agree on the content of the
questionnaire. The BRFSS questionnaire consists of a core component, optional modules, and state-added
http://www.cdc.gov/brfss/state_info/brfss_use_examples.htm
questions. Many questions are taken from established national surveys, such as the National Health Interview
Survey or the National Health and Nutrition Examination Survey. This practice allows the BRFSS to take
advantage of questions that have been tested and allows states to compare their data with those from other
surveys. Any new questions that states, federal agencies, or other entities propose as additions to the BRFSS
must go through cognitive testing and field testing before they can become part of the BRFSS questionnaire. In
addition, a majority vote of all state representatives is required before questions are adopted. The BRFSS
guidelines—agreed upon by the state representatives and CDC—specify that all states ask the core component
questions without modification. They may choose to add any, all, or none of the optional modules and may add
questions of their choosing as state-added questions.
The questionnaire has three parts:
1. Core component: A standard set of questions that all states use. Core content includes queries about current
health-related perceptions, conditions, and behaviors (e.g., health status, health care access, alcohol
consumption, tobacco use, fruits and vegetable consumptions, HIV/AIDS risks), as well as demographic
questions. The core component includes the annual core comprising questions asked each year and rotating core
questions that are included in even- and odd–numbered years.
2. Optional BRFSS modules: These are sets of questions on specific topics (e.g., pre-diabetes, diabetes, sugar-
sweetened beverages, excess sun exposure, caregiving, shingles, cancer survivorship) that states elect to use on
their questionnaires. Generally, CDC programs submit module questions and the states vote to adopt final
questions that can be included as optional modules. For more information, please see the questionnaire section
of the BRFSS website.
3. State-added questions: Individual states develop or acquire these questions and add them to their BRFSS
questionnaires. CDC does not edit, evaluate, or track or report responses from these questions.
The BRFSS supported 23 modules in 2019, but states limited modules and state-added questions to only the
most useful for their state program purposes, in order to keep surveys at a reasonable length. Because different
states have different needs, there is wide variation between states in terms of question totals each year. The
BRFSS implements a new questionnaire in January and usually does not change it significantly for the rest of
the year. The flexibility of state-added questions, however, does permit additions, changes, and deletions at any
time during the year.
The 2019 list of optional modules used on both the landline telephone and cellular telephone surveys is
available on the BRFSS website. In order to allow for a wider range of questions in optional modules, combined
landline telephone and cellular telephone data for 2019 include up to three split versions of the questionnaire. A
split version is used when a subset of telephone numbers for data collection still followed the state sample
http://www.cdc.gov/brfss/questionnaires/index.htm
https://www.cdc.gov/brfss/questionnaires/modules/state2019.htm
design, and administrators used it as the state’s BRFSS sample, but the optional modules and state-added
questions may have been different from other split-version questionnaires. For additional information on split
version questionnaires, see the 2019 module data appendix table, published with this yearly release.
Annual Questionnaire Development
The governance of the BRFSS includes a representative body of state health officials, elected by region. During
the year, the State BRFSS Coordinators Working Group meets with CDC’s BRFSS program management.
Before the beginning of the calendar year, CDC provides states with the text of the core component and the
optional modules that the BRFSS will support in the coming year. States select their optional modules and ready
any state-added questions they plan to use. Each state then constructs its own questionnaire. The order of the
questioning is always the same—interviewers ask questions from the core component first, then they ask any
questions from the optional modules, and the state-added questions. This content order ensures comparability
across states and follows the BRFSS guidelines. Generally, the only changes that the standard protocol allows
are limited insertions of state-added questions on topics related to core questions. CDC and state partners must
agree to these exceptions. In some cases, however, states have not been able to follow all set guidelines. Users
should refer to the yearly Comparability of Data document, which lists the known deviations.
Once each state finalizes its questionnaire content—consisting of the core questionnaire, optional modules, and
state-added questions—the state prepares a hard copy or electronic version of the instrument and sends it to
CDC. States use the questionnaire without changes for one calendar year, and CDC archives a copy on the
BRFSS website. If a significant portion of any state’s population does not speak English, states have the option
of translating the questionnaire into other languages. Currently, CDC provides a Spanish version of the core
questionnaire and optional modules. Specific wording of the Spanish version of the questionnaire may be
adapted by the states to fit the needs of their Hispanic populations.
Sample Description
In a telephone survey such as the BRFSS, a sample record is one telephone number in the list of all telephone
numbers the system randomly selects for dialing. To meet the BRFSS standard for the participating states’
sample designs, one must be able to justify sample records as a probability sample of all households with
telephones in the state. All participating areas met this criterion in 2018. Fifty-one projects used a
disproportionate stratified sample (DSS) design for their landline samples. Guam and Puerto Rico used a simple
random-sample design.
In the type of DSS design that states most commonly used in the BRFSS landline telephone sampling, the
BRFSS divides telephone numbers into two groups, or strata, which are sampled separately. The high-density
http://www.cdc.gov/brfss/questionnaires.htm
and medium-density strata contain telephone numbers that are expected to belong mostly to households.
Whether a telephone number goes into the high-density or medium-density stratum is determined by the number
of listed household numbers in its hundred block, or set of 100 telephone num
Interested in getting help with this assignment?
Get a professional writing team to work on your assignment!
Order Now
Recent postsFor this final assignment, you will prepare a brief paper detailing the steps undertaken to complete a presentation that disseminates information you assemble
Please choose to answer only one of the 2 following questions. Option 1: In your opinion and based on scientific, peer-reviewed published evidence, does child
At the beginning of the previous academic year, the institution announced it would drop football at the conclusion of the season. The announcement created pub
you will review current research in Personality and provide a critical evaluation of that personality research through an annotated bibliography. An annotated
In Module 5, we considered the third in our three-part series on research design. Specifically, the focus was on the longitudinal studies, in which the resear
Need help with a similar or different Task?
We have the best writers to help you. Hire Writer Now
