State Behavioral Risk Factor Surveillance Research Articles

The association between food insecurity and colorectal cancer screening: 2018-2021 New York State Behavioral Risk Factor Surveillance System (BRFSS).

To assess the association between food insecurity and colorectal cancer screening uptake in screening eligible participants in New York State. We analyzed 28,154 adults who participated in New York State Behavioral Risk Factor Surveillance System (BRFSS) from 2018 to 2021, were age-eligible for colorectal cancer screening based on the USPSTF guidelines at the time of survey administration and answered a version of the administered survey that included the module on food insecurity. Participants were defined as food insecure if they self-reported being always, usually, or sometimesstressed about having enough money to buy nutritious meals in the past 12months. We compared demographic, healthcare access, overall health status, food insecurity by colorectal cancer screening status. Multivariable analyses were performed to assess the association of food insecurity and colorectal cancer screening status after adjusting for relevant covariates. Weighted analyses were performed using survey procedures to obtain population estimates. Food insecurity was statistically significantly associated a decreased likelihood of being up to date on colorectal cancer screening (ORadj 0.83, 95% CI [0.72, 0.94]) and being ever screened for colorectalcancer (ORadj 0.74, 95% CI [0.64, 0.87]) after adjusting for overall health status, healthcare coverage, interview year, age, race/ethnicity, sex, educational attainment, and income. Health status, health coverage, age, and Non-Hispanic Black race/ethnicity showed positive, statistically significant association with ever being screened and with being up to date for colorectal cancer screening. Lower income, lower educational attainment, and non-Hispanic Asian race/ethnicitywere statistically significant inverse predictors of ever being screened and being up to date on screening. This project assessed the association between food insecurity and colorectal cancer screening uptake using the BRFSS survey. Food insecurity may be an important predictor for colorectal cancer screening uptake in eligible adults in the United States. The results from the study can inform future interventions and policies designedto improve participation inroutinecolorectal cancer screening.

Association between food insecurity and colorectal cancer screening using the New York State Behavioral Risk Factor Surveillance System (BRFSS)

Association between food insecurity and colorectal cancer screening using the New York State Behavioral Risk Factor Surveillance System (BRFSS)

Association Between Lifestyle Behaviors and Obesity Among Stroke Survivors.

The aim was to investigate factors influencing obesity among stroke survivors based on demographics and lifestyle behaviors. Stroke survivors are more likely to experience stroke recurrence within a few years. As obesity is a traditional risk factor for stroke, obesity should be managed in stroke survivors to prevent stroke recurrence. A cross-sectional secondary data analysis analyzed data from the 2017 United States Behavioral Risk Factor Surveillance System (BRFSS) survey. Demographics, frequency of vegetable and fruit intake, smoking, alcohol use, physical activity, and sleep were examined. Among 1032 stroke survivors, 57.8% were obese. Advanced age, female sex, veteran status, at least once-daily fruit intake, current smoking, and lack of physical activity were associated with obesity. Stroke survivors should be encouraged to pursue healthy behaviors to manage obesity. Appropriate transitional care, including diet education and tailored exercise, can be an effective strategy.

Relationships between sleep duration and health among U.S. adults with a history of household incarceration during childhood.

The rate of incarceration in the United States has increased at an alarming rate in the past 30 years and thus so has the number of children having a household member incarcerated (referred to as household incarceration). Associations between experiencing household incarceration in childhood and later negative health and developmental outcomes are well-documented; however, the underlying mechanisms linking this childhood stressor and adult outcomes have been less well studied. Using state Behavioral Risk Factor Surveillance System survey data (N = 145,102), this study examines how experiencing household incarceration during childhood is associated with mental and physical health in adulthood and mediational pathways through suboptimal sleep (short or long sleep). Results indicate there were significant indirect effects of household incarceration to physical and mental distress through short sleep (≤ 6 hr per 24 hr) and long sleep (≥ 10 hr per 24 hr), and a significant indirect effect of household incarceration to body mass index through short sleep. Findings from the present study highlight indirect pathways through which household incarceration in childhood is linked with sleep health in adulthood and, in turn, to negative mental and physical health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Association between Adverse Childhood Experiences and Mental Health Wellbeing during the Adulthood: The Cross-Sectional Study of the 2020 United States Behavioral Risk Factor Surveillance System (BRFSS)

To understand the frequency of retrospectively self-reported adverse childhood experiences (ACEs) and evaluate whether early ACEs are independently associated with mental health wellbeing during adulthood.

The association between adverse childhood experiences and mental health wellbeing during the adulthood: the cross-sectional study of the 2020 United States Behavioral Risk Factor Surveillance System (BRFSS)

The association between adverse childhood experiences and mental health wellbeing during the adulthood: the cross-sectional study of the 2020 United States Behavioral Risk Factor Surveillance System (BRFSS)

Prevalence of Shared Decision-making in Prostate Cancer Screening in New York State.

Current guidelines recommend that physicians use a shared decision-making (SDM) approach to engage with patients on the potential benefits and harms of prostate cancer screening based on their individual risk. In a sample of 4,118 men aged 55-69 from the 2018 New York State Behavioral Risk Factor Surveillance Survey (BRFSS), we compared the frequency of screening recommendations and SDM conversations according to four race/ethnic groups. In logistic regression, we evaluated the likelihood of SDM conversations between race/ethnic groups. Our findings suggest that the odds of never having a SDM conversation with their healthcare provider were significantly higher among Hispanic men (OR 95% CI: 2.10, 1.11-3.99) and other/multiracial men (OR, 95% CI: 3.08, 1.46-6.52) compared to white men, while black men had comparable odds (1.52, 0.98-2.34). The lower frequency of SDM conversation among Hispanic and other/multiracial men suggest a missed opportunity for healthcare providers to guide informed screening decisions.

Model-based community health surveillance via multilevel small area estimation using state behavioral risk factor surveillance system (BRFSS): a case study in Connecticut

PurposeThe main objective of state behavioral risk factor surveillance system (BRFSS) is to produce reliable state-level estimates of various population health outcomes. A multilevel Regression and Post-stratification (MRP) methodology for small area estimation has been applied to the 500 Cities Project to provide population estimates at both city-level and census tract-level using national BRFSS data. To date, MRP has not been applied to any state BRFSS to produce health data at local geographic areas. In addition, the use of single year BRFSS might produce temporary inconsistency in small area estimates (SAEs). The predicted standard errors (SEs) and confidence intervals (CIs) of SAEs using Monte Carlo simulation could be substantially underestimated or overestimated. MethodsBy extending the current MRP approach and applying a parametric bootstrapping approach to Connecticut BRFSS (CT BRFSS), we were able to produce SAEs as well as SEs and CIs of SAEs for Connecticut counties and towns. We also applied this model to 5-year CT BRFSS (2011–2015) with an aim to improve the temporary consistency of SAEs. ResultsBoth single-year and 5-year estimates with SEs and CIs were generated for six selected population health indicators at town, county and state levels. Model-based SAEs were internally evaluated by comparing to single-year and 5-year direct BRFSS survey (2011–2015). SAEs were also externally validated when external data were available. ConclusionsModel-based SAEs are valid and could be used to characterize local geographic variations using single state BRFSS data.

Disparate Cardiovascular Hospitalization Trends Among Young and Middle-Aged Adults Within and Across Race and Ethnicity Groups in Four States in the United States.

Background Inpatient hospitalizations for cardiovascular disease (CVD) decreased nationally in the past decade. However, data are lacking on whether national declines represent trends within and across race and ethnicity populations from different US regions. Methods and Results Using State Inpatient Databases, Census Bureau and Behavioral Risk Factor Surveillance System data for Florida, Kentucky, New Jersey, and North Carolina, we identified all CVD hospitalizations and population characteristics for adults aged 18 to 64 years between January 1, 2009 and December 31, 2018. We calculated yearly CVD hospitalization rates for each state for the overall population, by sex, race, and ethnicity. We modeled yearly trends in age-adjusted CVD hospitalization rate in each state using negative binomial regression. State base populations were similar by age (mean age: 40-42 years) and sex (50%-51% female) throughout the study period. There were 314 973 and 288 843 total CVD hospitalizations among the 4 states in 2009 and 2018, respectively. Crude hospitalization rates declined in all states (age 18-44 years NJ: -33.4%; KY: -17.0%; FL: -11.9%; NC: -11.2%; age 45-64 years NJ: -29.8%; KY: -20.3%; FL: -12.2%; NC: -11.6%) over the study period. In age-adjusted models, overall hospitalization rates declined significantly in NJ -2.5%/y (95% CI, -2.9 to -2.1) and in KY -1.6%/y (-1.9 to -1.2) with no significant declining trend in FL and NC. Similar findings were present by sex. Among non-Hispanic White populations, mean yearly decline in hospitalization rate was significant in all states except FL, with the greatest declines in NJ (-3.8%/y [-4.4 to -3.2], P values for state-year interaction <0.0001). By contrast, a significant declining trend was present for non-Hispanic Black and Hispanic populations only in NJ (P values for state-year interaction <0.001). We found similar differences in trend between states in sensitivity analyses incorporating additional demographic and comorbid characteristics. Conclusions Decreases in CVD hospitalization rates in the past decade among nonelderly adults varied considerably by state and appeared largely driven by declines among non-Hispanic White populations. Overall declines did not represent divergent trends between states within non-Hispanic Black and Hispanic populations. Recognition of differences not just between but also within race and ethnicity populations should inform national and local policy initiatives aimed at reducing disparities in CVD outcomes.

Health, Economic, and Social Disparities among Lesbian, Gay, Bisexual, and Sexually Diverse Adults: Results from a Population-Based Study

We investigated health, economic, and social disparities among lesbian, gay, bisexual, and sexually diverse adults, 18 years and older. Analyzing 2011–2019 Washington State Behavioral Risk Factor Surveillance System (N = 109,527), we estimated and compared the prevalence rates of background characteristics, economic and social indicators, health outcomes, chronic conditions, health care access, health behaviors, and preventive care by gender and sexual identity. Sexual minority adults reported heightened risks of poor general health, physical and mental health, disability, subjective cognitive decline, and financial barriers to health care, compared with their straight counterparts. Economic disparities and disability were evident for lesbians and both bisexual adult women and men. We found higher rates of smoking and excessive drinking among lesbians and bisexual women, and higher rates of smoking and living alone among gay men. Sexually diverse adults experience disparities in health care access. This study is one of the first to identify disparities among sexually diverse populations, in addition to lesbian, gay, and bisexual adults. More research is required to understand the mechanisms of disparities within these groups to address their distinct intervention needs.

Disparities in chronic physical health conditions in sexual and gender minority people using the United States Behavioral Risk Factor Surveillance System

This study analyzed the physical health status of adults who belong to a sexual or gender minority (SGM) population, and whether health inequities correlate with access to quality healthcare. The Centers for Disease Control and Prevention (CDC) 2014–2020 Behavioral Risk Factor Surveillance System (BRFSS) included data for 64,696 adults who identified as gay, lesbian, bisexual, other, and/or transgender and 1,369,681 adults who identified as cisgender and straight. Multivariable logistic regressions of the weighted sample were conducted to examine associations between demographics and health and access outcomes. After accounting for demographic variables, drinking, and smoking behavior, SGM respondents reported poorer physical and mental health, which worsened after the start of the COVID-19 pandemic. SGM respondents had higher odds than non-SGM of having asthma, arthritis, diabetes, kidney disease, hypertension, cardiovascular disease, heart attack, stroke, and chronic obstructive pulmonary disease (COPD), as well as difficulties “see[ing] the doctor because of cost,” particularly after the start of the COVID pandemic. SGM respondents had higher odds of lack of access to healthcare provider, delayed medical care, and issues taking medications due to cost and fewer routine checkups. Thus, the SGM group faced worse health and higher rates of some chronic conditions. This study found a significant relationship with cost barriers attributable to larger societal discrimination regarding SGM individuals, particularly in the workplace. Further research exploring these results is critical, but these findings have identified areas of healthcare inequity to be addressed via preventative health efforts in both public health and primary care settings.

Adverse childhood experiences and cognitive disability in the 2019 United States behavioral risk factor surveillance system

A growing number of studies have found associations between adverse childhood experiences (ACEs) and adult well-being, with disparities between subpopulations. Limited research exists about the association between ACEs and cognitive disability, and variations by race and ethnicity. This study reports a cross-sectional analysis of 2019 Behavioral Risk Factor Surveillance System (BRFSS) data (n = 93 692) conducted in 2021. Logistic regression models examined the association between ACEs and cognitive disability (as defined by serious difficulty concentrating, remembering or making decisions because of a physical, mental, or emotional condition) and whether the association varied by race and ethnicity, adjusting for demographics, (age, gender, marital status), socioeconomic factors (income and education), and perceived general health. Exposures to 1, 2, 3, and 4 or more ACEs were associated with elevated odds of cognitive disability; the association varied by race and ethnicity (p for interaction less than 0.05). In stratified analyses, ACEs were positively associated with cognitive disability among the American Indian/Alaskan Native group, though significant only among those reporting 4 ACEs or more (OR: 2.89; 95% CI 1.25, 6.66). A dose response was observed for Black, White and Hispanic groups though the association was larger among Hispanic respondents. The elevated odds of cognitive disability associated with ACEs warrant additional research to understand mechanisms underlying this relationship across racial and ethnic groups. Additionally, interventions to prevent cognitive disability may benefit from considering ACEs across all populations, particularly among those with highest prevalence.

Health, economic and social disparities among transgender women, transgender men and transgender nonbinary adults: Results from a population-based study

We investigated health, economic, and social disparities among transgender adults (transgender women, men, and nonbinary) aged 18 years and older. Using population-based data from the Washington State Behavioral Risk Factor Surveillance System (WA-BRFSS), we pooled 2016 through 2019 data (n = 47,894). We estimated weighted distributions and prevalence by gender identity for background characteristics, economic, social and health indicators. We performed regressions of these indicators on gender identity, including transgender versus cisgender adults and transgender nonbinary adults compared to cisgender adults, followed by subgroup analyses: transgender women and men compared to each cisgender group and to one another, adjusting for covariates. Compared to cisgender adults, transgender adults overall were significantly younger and lower income with less education; more likely single with fewer children; and had several elevated health risks, including poor physical and mental health, and higher rates of chronic conditions and disability. Alternatively, transgender men and women had higher rates of flu vaccination than cisgender men. Between transgender subgroups, transgender men and transgender nonbinary adults were younger than transgender women; transgender men were significantly less likely married or partnered than transgender women; and, transgender women were more likely to live alone than nonbinary respondents. This is one of the first population-based studies to examine both between and within subgroup disparities among cisgender, transgender binary, and transgender nonbinary adults, revealing patterns of inequities across subgroups. More research understanding the mechanisms of these disparities and the development of targeted interventions is needed to address the unique needs of subgroups of transgender people.

Lung Cancer Screening Eligibility and Utilization Among Transgender Patients: An Analysis of the 2017-2018 United States Behavioral Risk Factor Surveillance System Survey.

Transgender and gender diverse (TGD) persons disproportionately face many health disparities including a higher risk of lung cancer. Lung cancer screening (LCS) using low-dose chest computed tomography has reduced lung cancer mortality in eligible high-risk smokers across several large trials, yet utilization of LCS remains low. TGD persons may be less likely to receive recommended cancer screening compared with cisgender populations. We sought to compare eligibility for and utilization of LCS between TGD and cisgender persons in the United States. We also examined if the utilization of LCS varied by smoking status within each gender identity group. We analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) cross-sectional survey to determine eligibility and utilization of LCS among TGD participants compared with cisgender persons. Logistical regression analysis of potentially confounding variables included age category, race/ethnicity, income, employment status, health insurance, and having a personal doctor. Of 37 023 weighted respondents, 0.5% were TGD. Although eligibility for LCS was statistically similar (8.8% TGD vs. 12.2% cisgender) (adjusted odds ratio = 0.81, 95% confidence interval = 0.27-2.39, p = .703), only 2.3% of TGD participants reported obtaining a LCS chest computed tomography versus 17.2% of cisgender participants (adjusted odds ratio = 0.04, 95% confidence interval = 0.01-0.59, p = .019). Smoking status showed no association with LCS utilization among gender identity groups. TGD persons may be less likely to receive LCS despite having similar smoking status and eligibility of cisgender persons, suggesting a disparity in utilization of this preventative health service. Targeted efforts to increase LCS utilization and promote smoking cessation for at-risk TGD patients may be warranted.

Assessing county-level determinants of diabetes in the United States (2003-2012).

Using data from the United States Behavioral Risk Factor Surveillance System (2003-2012; N=3,397,124 adults), we estimated associations between prevalent diabetes and four county-level exposures (fast food restaurant density, convenience store density, unemployment, active commuting). All associations confirmed our a priori hypotheses in conventional multilevel analyses that pooled across years. In contrast, using a random-effects within-between model, we found weak, ambiguous evidence that within-county changes in exposures were associated with within-county change in odds of diabetes. Decomposition revealed that the pooled associations were largely driven by time-invariant, between-county factors that may be more susceptible to confounding versus within-county associations.

Incarceration and adversity histories: Modeling life course pathways affecting behavioral health.

A consequence of a growing incarceration rate is that an increasing number of children face having an incarcerated household member, a known contributor to diverse lifelong behavioral health risks such as substance use and mental health impairment. Few studies have explored how household incarceration uniquely contributes to these subsequent behavioral health concerns, nor mediational contributors to these associations, within a theoretical framework. Using state Behavioral Risk Factor Surveillance System survey data (n = 14,001), this study tests pathways of household incarceration and Adverse Childhood Experiences (ACEs) to mental health impairment and substance use in adulthood. Within a life course stress process perspective, this study uses structural equation modeling to examine mediational pathways through adulthood incarceration and indicators of adulthood adversity, low income, and supportive resources. In line with stress process theorizing, results indicate significant direct and indirect paths of ACEs through nearly all theorized mediators, and indirect pathways of household incarceration, through incarceration and low income, to adulthood mental health impairment and substance use. Implications of these findings address preventive and interventive leverage points to mitigate long-term consequences of household incarceration and other childhood adversities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Using Behavioral Risk Factor Surveillance System Data as an Occupational Health Profile: Washington State Janitors, 2011 to 2017.

Janitorial workers have a high burden of occupational injury and illness, but little information exists on their overall health. Data from the Washington State Behavioral Risk Factor Surveillance System (BRFSS) were analyzed to characterize the working population of Janitors in Washington State from 2011 to 2017 (n = 490) as compared with all other workers (n = 38,885). Compared with other workers, Janitors were significantly more diverse, had lower socioeconomic status, and reported poorer general health and higher rates of arthritis and depression. Janitors were less likely to have adequate sleep, health insurance, and access to technology. Janitors reported higher rates of smoking and marijuana use. Multiple risk factors compound the vulnerability of Janitors. BRFSS data can be used to characterize the health of occupational groups. Identifying overall health needs can better inform policy and help formulate strategies to improve workers' health.

Calculating State-Level Estimates of Upcoming Older Adult Health Needs.

Census demographers have provided projections of the increased numbers of older adults in upcoming decades, but it is less clear whether they will also be any more or less healthy than current seniors. This is critical information for state planners, as the majority of older adults will need assistance with activities of daily living to remain in their homes. Previous longitudinal and cohort studies have yielded national estimates, but those more costly sources are generally beyond the resources of state public health agencies. We provide a more practicable model for assessing state-level changes in health-related quality of life (HRQOL) among middle-aged versus older adults as a guide to probable upcoming home- and community-based service needs. We used 2 sets of state Behavioral Risk Factor Surveillance System data 15 years apart to calculate and compare adjusted odds ratios of 8 poor HRQOL measures for middle-aged and older adults. Compared with their peers only 15 years earlier, recent middle-aged adults had higher odds of poor outcomes across all HRQOL measures, whereas adults 65-74 years had higher odds of poor outcomes for far fewer of the measures. Among adults 75 years and older, odds were higher compared with 15 years ago for only 1 measure (multiple days of poor mental health). Compared with older adults, the health profile of middle-aged adults in this state appears to have worsened much more rapidly in the past 15 years, indicating that these adults will have many more health-related needs when they become seniors. While this model is less sophisticated than others using longitudinal data, it provides the state-level data that are often more compelling to state policy makers.

Firearm Ownership, Storage Practices, and Suicide Risk Factors in Washington State, 2013-2016.

To characterize firearm ownership and storage practices in Washington State and assess their relationship with suicide risk factors. Using Washington State Behavioral Risk Factor Surveillance System data for 2013 to 2016, we conducted survey-weighted multivariable Poisson regression models to obtain prevalence ratios (PRs) and confidence intervals (CIs). Of 34 884 adult respondents, 34.3% (95% CI = 33.7%, 35.0%) reported a firearm in their household, among whom 36.6% (95% CI = 35.4%, 37.7%) stored their firearm locked and unloaded. There were no differences in mental health indicators by firearm ownership or storage practice status. Binge and chronic alcohol use were somewhat more prevalent among adults from firearm-owning households (PR = 1.2; 95% CI = 1.1, 1.3; PR = 1.2; 95% CI = 1.1, 1.4, respectively) and among those living in households not practicing safe storage (PR = 1.4; 95% CI = 1.2, 1.7; PR = 1.9; 1.5, 2.3, respectively). Variability in mental health does not explain the substantial increased suicide risk among individuals in firearm-owning households. Greater prevalence of alcohol misuse among adults in firearm-owning households not practicing safe storage highlights the need for suicide prevention interventions.

Life Course Pathways From Adverse Childhood Experiences to Adult Physical Health: A Structural Equation Model.

This study examines pathways from adverse childhood experiences (ACEs) to physical health, directly and indirectly through lower income, health risk behaviors, social support, and adult adversity within a theoretical framework postulating stress proliferative and biological trajectories of cumulative adversity. Data were obtained from 12,549 adult respondents of a state Behavioral Risk Factor Surveillance System survey. Multigroup structural equation modeling elucidated pathways differentiated by sex and age (older/younger than 45). Good model fit was achieved in each test, indicating consistency with stress theorizing that ACEs significantly contribute to poorer physical health through direct and mediated paths. Younger adults evidenced direct ACE pathway to poor health suggesting early biological erosion, whereas paucity of social support among older adults was directly associated. Findings indicate that stress process roles in eroding physical health and experience of wellness. Addressing early adversity is an important strategy toward reducing preventable health problems.