BrfssEdit
The Behavioral Risk Factor Surveillance System (BRFSS) is the United States’ principal ongoing health survey program. Administered by the Centers for Disease Control and Prevention in partnership with state health departments and public health agencies, BRFSS collects data on health-related risk behaviors, chronic diseases, and the use of preventive health services from adults via telephone interviews. It is the largest and one of the longest-running health survey systems in the world, designed to provide a consistent, comparable picture of health trends across states and over time. The resulting data inform policy decisions, program design, and resource allocation at the state and federal levels, with the aim of improving population health outcomes. BRFSS data feed into national objectives such as those in Healthy People 2030 and support public health planning at multiple levels of government.
BRFSS is structured around a core set of questions that every state asks, supplemented by state-added modules that go into topics of local interest. Respondents are adults who answer questions about their health behaviors (such as tobacco use and physical activity), chronic conditions (like asthma or diabetes), and preventive practices (for example, vaccination status or cancer screening). The survey uses random-digit dialing to reach households via landlines and cell phones, a methodology that has evolved to keep pace with changing communication patterns. To ensure that information reflects the population, BRFSS applies statistical weighting and adjustments for nonresponse, producing estimates that are broadly representative of state populations. BRFSS data are frequently released as state-level dashboards and national summaries, and are used by researchers, policymakers, and local planners. See also survey methodology and data transparency for details on methods and disclosure.
History and scope
BRFSS began in the mid-1980s as a state-by-state effort to capture basic health indicators that could guide public health action. Over time, participation expanded to all 50 states, the District of Columbia, and several U.S. territories, creating a national tapestry of health data that can be disaggregated to the state and even county level in some cases. The system’s design centers on a core module that remains stable to allow trend analysis, while enabling states to add modules on topics of particular relevance to their populations. See 1980s in epidemiology and Healthy People for the broader policy context in which BRFSS operates. The shift from landline-only sampling to mixed-mode approaches, including cell phones, reflects ongoing efforts to improve coverage and accuracy. For more on how samples are drawn and adjusted, consult random-digit dialing and survey weighting.
Methods and data collection
BRFSS relies on telephone interviews conducted with adults who consent to participate. The core questionnaire covers established indicators such as tobacco use, physical activity, nutrition, alcohol consumption, and chronic disease status. State health departments can append modules on specialized topics—ranging from vaccination and preventive services to mental health and access to care—yielding a flexible data system that can address local priorities. Data collection and processing emphasize quality control, with standardized coding, validation procedures, and documentation that facilitate cross-state comparisons. Key methodological concepts include sampling (statistics), nonresponse bias assessment, and statistical weighting to produce representative estimates. See data quality and privacy for related considerations.
Content and data products
The BRFSS dataset is organized around two tiers: the universal core questions and the state-added modules. Core items enable longitudinal assessment of widely recognized risk factors such as smoking prevalence, obesity, physical activity, and vaccination coverage, while modules allow deeper dives into areas like respiratory illness, diabetes management, oral health, and health care access. The resulting estimates are used to track progress toward public health objectives, rank state performance, and guide targeted interventions. Public health researchers routinely link BRFSS data with other data sources such as Chronic disease registries, hospital admission data, and environmental indicators to build a more complete picture of health determinants. See also health disparities for discussions of how BRFSS data illuminate differences across groups.
Strengths, limitations, and debates
BRFSS’s strengths include its scale, regular cadence, and the ability to generate timely state- and nation-wide indicators that inform policy and program decisions. The self-reported nature of many items is a limitation, with potential biases in recall and social desirability influencing responses. Nevertheless, large sample sizes, robust weighting, and methodological transparency mitigate these concerns and enable credible trend analyses. Critics sometimes argue that survey content and interpretation reflect particular ideological priorities or that expanding data categories (for race, socioeconomic status, or sensitive topics) could politicize the data. From a practical standpoint, supporters contend that BRFSS remains a pragmatic instrument for measuring real-world behaviors and outcomes; the core objective is to inform actionable policy, not to pursue abstract debates over data granularity. Woke criticisms that BRFSS is inherently biased or weaponized tend to miss the system’s documented, peer-reviewed methodologies and the multiple checks that accompany each data release. In short, BRFSS is widely regarded as a high-value, policy-relevant instrument when used with proper context and methodological care.
Impact on policy and practice
BRFSS data underpin a wide range of policy and practice decisions. State health departments use estimates to identify communities at risk, allocate preventive services, and tailor health campaigns. At the federal level, BRFSS informs national health objectives, supports funding decisions, and provides benchmarks for evaluating the impact of public health programs. Researchers draw on BRFSS to examine trends in risk factors and disease prevalence, and to explore interactions among behavioral, environmental, and health system factors. The data also contribute to public accountability by enabling comparisons across states and over time. See public health policy and health statistics for related subjects.
Future directions
Efforts to modernize BRFSS continue to focus on expanding coverage (including better representation of hard-to-reach populations), refining weighting and imputation methods, and enhancing accessibility of results for policymakers and the public. Advances in technology and survey design aim to improve response rates, reduce measurement error, and speed data delivery. The ongoing collaboration between the CDC and state health departments ensures that BRFSS remains aligned with public health needs and national goals, while preserving the integrity of the long-running time series that health officials rely on. See also survey methodology and data sharing for related topics.
See also