Surveillance Surveys: Adolescent and Adult Health Surveys in Nebraska

1. Surveillance Surveys:Adolescent and Adult Health Surveys in Nebraska October 12, 2011 Jeff Armitage Epidemiology Surveillance Coordinator

2. Today’s Presentation • Overview of public health surveillance • SHARP Surveillance System • Behavioral Risk Factor Surveillance System (BRFSS)

3. What is Public Health Surveillance? • Ongoing, systematic collection, analysis, and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those responsible for prevention and control. (source: CDC)

4. The Nebraska Student Health and Risk Prevention (SHARP) Surveillance System

5. The SHARP Model • To lessen the burden on schools and communities, coordinate the administration of the three school-based student health surveys in Nebraska endorsed by both the Nebraska Department of Education and the Nebraska Department of Health and Human Services. YRBS Nebraska SHARP Surveillance System YTS NRPFSS

6. Youth Risk Behavior Survey (YRBS) Developed and coordinated by the CDC First conducted in Nebraska and U.S. in 1991 Administered every two years since 1991 Questions focus on a wide variety of health risk behaviors that contribute to the leading causes of death, disability, and social problems among youth and adults in the U.S. Targeted at public high school students in grades 9-12 State sample of 80 schools is drawn (classrooms then selected) School participation up in 2010 Why important… Only representative statewide survey of youth covering a variety of important public health topics Results by race/ethnicity limited

7. Youth Tobacco Survey (YTS) Developed and coordinated by the CDC First conducted in Nebraska in 1999/2000 Administered every two years since 2000 Questions focus on specific aspects to tobacco use and prevention, including attitudes, perceptions, media exposure, access, cessation, etc. Targeted at public middle and high school students State sample of 60 middle and 60 high schools is drawn (classrooms then selected) School participation up in 2010 but remains unweighted Why important… Captures detail necessary to effective prevention and tobacco use among youth Results by race/ethnicity limited

8. Nebraska Risk and Protective Factor Student Survey (NRPFSS) • Sponsored by the Nebraska Partners in Prevention (NePiP); administered by the NDHHS, in partnership with the NE Dept. of Education • Survey is specific to Nebraska, but adapted from nationally validated surveys • Conducted during the fall of 2003, 2005, 2007, and 2010 • Questions focus on substance abuse, delinquent behavior, bullying, gambling, and risk and protective factors • Targeted at all public and non-public students in grades 6, 8, 10, and 12 • Census survey, where participating schools get a school specific report of their results • Participation has increased each year, from ~25,000 in 2003 to ~33,000 in 2010 (474 schools)

9. NRPFSS, cont... • The Risk and Protective Factor Prevention Model • Developed by researchers at the University of Washington • Basic idea… to prevent problems from occurring we must identify the factors that contribute to or protect against these problems and target them • Risk factors increase the likelihood of problem behavior while protective factors buffer against the negative influence of risk • Grouped into four domains • Community • School • Family • Individual • This information helps communities identify broader risk and protective factors that need to be addressed and target them to reduce multiple problem behaviors

10. NRPFSS, Cont… • The Risk and Protective Factor Prevention Model • Because risk and protective factors have multiple dimensions, a single factor’s score is composed of the responses to several survey questions, then referenced against a cut-point.

11. NRPFSS, Cont… • Why are the data important • Only school-based public health survey that generates local and regional estimates for health planning and evaluation • What is available by race/ethnicity • 1,515 American Indian responses • 84 Alaska Native responses • Spread across Nebraska counties • Thurston (142) • Lancaster (111) • Lincoln (90) • Hall (77) • Scotts Bluff (71) • Madison (68)

12. Factor based on a combination of four survey questions

13. Factor based on a combination of four survey questions

15. Next Steps for SHARP & Conclusions • NRPFSS school district reports released in early September • NRPFSS community reports will be released in late October • Prepare for fall 2012 administration • Modify questionnaires as needed • Educate and inform community stakeholders and schools about SHARP • Encourage the schools in your area to participate • Conclusions • SHARP contains many important health measures for youth • YRBS and YTS have limited data available by race/ethnicity • Local and race-specific results available for the NRPFSS • *Opportunity to modify the collection of racial/ethnic data • SHARP Website: http://bosr.unl.edu/sharp

16. Questions?

17. The Behavioral Risk Factor Surveillance System (BRFSS)

18. What is the BRFSS? Behavioral Risk Factor Surveillance System Annual random-digit dial telephone survey Targeted at adults 18 and older Conducted in all 50 states, DC, and three territories Developed and coordinated by the CDC Collaboration between the CDC and states/territories Survey covers a wide variety of health behaviors, conditions, and attitudes

19. Statewide BRFSS in Nebraska First conducted in Nebraska in 1982 as a pilot, and has been done annually since 1986 Until 2004 the survey was a state random sample From 2004-2006 the survey was stratified by six health planning regions Starting in 2007 the survey was stratified by 20 local health department districts Cell phone data collection began in 2009, and will be incorporated into state estimates starting in 2011. The 2011 survey will collect roughly 18,000 completed surveys (15,000 landline and 3,000 cell phone)

20. Minority Oversample BRFSS in Nebraska Starting in 2001 there was an independent minority oversample BRFSS survey conducted Why conduct a minority oversample? How was it done? From 2001-2005 the minority oversample mirrored the state survey 2006 introduced the Native American oversample 2007 introduced the Asian oversample 2011 minority oversample was built into the state sample Data have been merged with state BRFSS to increase the number of respondents. DHHS BRFSS Data Users Group continues to discuss best approach to reporting results.

21. How is race/ethnicity collected in BRFSS? Three Questions (from 2011 survey)

22. How is race/ethnicity collected in BRFSS? Second Question

23. How is race/ethnicity collected in BRFSS? Third Question

24. Number of completed AI/AN surveys 1,640 surveys were completed by AI/AN respondents from 2006-2009 when combining the state BRFSS with the minority oversample. 78% were completed as part of the minority oversample 22% were completed as part of the state BRFSS (355) County breakdown of the 1,232 surveys completed during 2007-2009: Thurston (669 completes, 54%) Knox (142 completes, 12%) Sheridan (84 completes, 7%) Douglas (83 completes, 7%)

25. Obtained from: Health Status of American Indians and Alaska Natives in Nebraska ( 1st DRAFT ); NDHHS; October 2011

26. Obtained from: Health Status of American Indians and Alaska Natives in Nebraska ( 1st DRAFT ); NDHHS; October 2011

27. Conclusion • BRFSS provide a wealth of data on important health behaviors and health conditions among adults in Nebraska • Race/ethnicity information is collected, including an oversample of American Indians and Alaska Natives • CDC BRFSS Website: http://www.cdc.gov/brfss/ • DHHS BRFSS Website: http://www.dhhs.ne.gov/brfss/ • BRFSS query system coming soon

28. Questions?

29. Nebraska Vital Records October 12, 2011 Jeff Armitage Epidemiology Surveillance Coordinator

30. Today’s Presentation • What are Vital Records • How is Race/ Ethnicity Captured in Vital Records • Vital Records Data

31. What are Vital Records • Vital records include a formal record of each birth, death, fetal death (stillbirth), marriage, and divorce. • In Nebraska, the Division of Public Health, within the Nebraska Department of Health and Human Services has the authority to collect and report vital records information

32. Birth & Death Certificate Data • All statistical information for births and deaths in Nebraska are provided to the National Center for Health Statistics (NCHS) which is part of the CDC. • The NCHS uses the data from all jurisdictions to create a national data set.

33. Birth Certificate Data • A certificate of live birth is completed for all live births. • The birth certificate is populated using two forms: • Mother’s Worksheet for Child’s Birth, and • Facility Worksheet for the Live Birth Certificate • Information from the worksheets are entered into the Nebraska Electronic Registration system by employees of the birthing facilities

34. Race/Ethnicity on Birth Certificate • Race/ethnicity of mother and father is self-reported on the Mother’s Worksheet • Race of child is based on mother’s race • Race options consist of • American Indian or Alaska Native (name of enrolled or principal tribe) ___________________ • The majority of American Indian births include the name of the enrolled or principal tribe of the mother

35. Death Certificate Data • The certificate of death declares the date, location, and cause of the person’s death. • The legal and statistical information on the death certificate are collected by the funeral director while the medical information is collected by the medical certifier. • Information is submitted to NDHHS using the Nebraska Electronic Registration system or using funeral director software or typed or written on the certificate

36. Race/Ethnicity on Death Certificate • Race/ethnicity of the deceased is typically provided by the family during the interview with the funeral director • Race options consist of • American Indian or Alaska Native (name of enrolled or principal tribe) ___________________ • The majority of American Indian deaths include the name of the enrolled or principal tribe of the deceased

37. Examples of Birth Data • Between 2008-2010 there were 1,349 Native American births • Birth stats for Nebraska, 2008-2010 combined: (source: Nebraska Vital Records)

38. Examples of Death Data • Between 2008-2010 there were 265 Native American deaths • Death stats for Nebraska, 2008-2010 combined: (source: Nebraska Vital Records)

39. Conclusion • Vital Records provide a wealth of data important to understanding population health • Race/ethnicity information is collected, including tribal specific information for American Indians and Alaska Natives • Sub-state results are available

40. Questions / Contact Information Jeff Armitage Epidemiology Surveillance Coordinator Office of Community Health and Performance Management Division of Public Health Nebraska Department of Health and Human Services Email: jeff.armitage@nebraska.gov Phone: (402) 471-7733