Other Area Level Estimates for Cancer Risk Factors & Screening Behaviors

The following are other resources for area level data, and their limitations.

Behavioral Risk Factor Surveillance System

The Behavioral Risk Factor Surveillance System (BRFSS) is the world's largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. Conducted by the 50 state health departments as well as those in the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands with support from the Centers for Disease Control and Prevention (CDC), BRFSS provides state-specific information about issues such as asthma, diabetes, health care access, alcohol use, hypertension, obesity, cancer screening, nutrition and physical activity, and tobacco use. The following BRFSS data are available:

• BRFSS Direct Estimates
  Yearly estimates for smoking and screening can be obtained by state and for the nation.
• Local Area Data – SMART BRFSS
  Although the BRFSS was designed to produce state level estimates, recent growth in the sample size has made it possible to produce prevalence estimates for smaller areas and led to SMART BRFSS (Selected Metropolitan/Micropolitan Area Risk Trends from the BRFSS). This project produces prevalence estimates from the state BRFSS data for metropolitan and micropolitan statistical areas (MMSAs) for which there are at least 500 completed interviews. Data are available from 2002 onward for over 140 MMSAs and many counties within those areas.
• BRFSS Maps
  BRFSS Maps is the product of an interactive mapping application that graphically displays the prevalence of behavioral risk factors by state and by MMSA. With the use of geographic information system mapping technology and BRFSS data, the Web site allows users to visually compare prevalence data for states, territories, and MMSAs. Beginning with the 2002 BRFSS data, visitors to the BRFSS Maps Web site can create, save, and print state and MMSA maps detailing a variety of health-related risk factors including smoking.

Limitations: For data up to 2010, households without landline telephone are not interviewed, possible nonresponse bias, and variability of estimates.

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National Health Interview Survey

Through the National Health Interview Survey (NHIS), the National Center for Health Statistics, with data collection by the Bureau of the Census, monitors the health of the noninstitutionalized civilian population of the United States by collecting and analyzing data on a broad range of health topics. A major strength of this survey is its ability to display these health characteristics by many demographic and socioeconomic characteristics. Behavioral data are available for alcohol use, cigarette use, leisure-time physical activity, body weight status, and sleep.

• NHIS Early Release Program (ER)
  ER is a Web-based data dissemination mechanism at the NCHS designed to release timely estimates from the NHIS. Through this mechanism, NCHS provides estimates for a selected group of key health measures based on the most recent data from the NHIS. Estimates derived from full- or partial-year data are released about six months after the end of data collection. Trend data starting in 1997, the year the NHIS questionnaire was redesigned, are also provided. Each Early Release includes numerous graphs and tables.

Limitations: Collects data for about 25% of the U.S. counties, and that some of the sample sizes for counties are very small.

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Model-Assisted Estimates

Model-assisted estimates could be computed to estimate county and state level estimates using data from both the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS). This method corrects for potential biases in the BRFSS estimates by manipulating the BRFSS statistical weights. Then, the estimates computed using the modified weights "look" more like the National Health Interview Survey (NHIS) estimates. For more information about this method see the reference below, where the method was applied using the NHIS public use files, with geographical identifiers available only at the regional level.

Limitations: While the model-assisted estimates correct for the non-coverage and nonresponse biases, they are still quite variable for many counties that have small sample sizes.

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Tobacco Use Supplement to the Current Population Survey

The Tobacco Use Supplement to the Current Population Survey (TUS-CPS) is an NCI-sponsored survey of tobacco use that has been administered as part of the U.S. Census Bureau's Current Population Survey in 1992-1993, 1995-1996, 1998-1999, 2000, 2001-2002, and 2003, 2006-2007, 2010-2011, and 2014-2015. The TUS-CPS is a key source of national and state level data on smoking and other tobacco use in U.S. households. While proxy responses are allowed for the smoking questions, a majority of the responses are self reports. The responses are obtained via both household and telephone interviews. Details and results from the TUS-CPS can be found at its website.

Limitations: tobacco only, direct estimates below the state level are not available because of confidentiality and reliability consideration.

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California Health Interview Study

The California Health Interview Study (CHIS) is the largest state health survey in the United States. It is a telephone survey that provides health-related data or adults and children within the state of California. CHIS is a biennial survey that was fielded for the first time in 2001 and includes an important focus on diverse population groups such as African-Americans, Latinos and Hispanics, Native Americans and Alaska Natives, and Asian-Americans and Pacific Islanders. CHIS Data and Findings can be found at its website.

Limitations: California only, households without telephone are not interviewed, possible nonresponse bias.

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