Ziya Gizlice, Ph. D. BRFSS Project Director and Coordinator State Center for Health Statistics

1. Ziya Gizlice, Ph. D. BRFSS Project Director and Coordinator State Center for Health Statistics Division of Public Health North Carolina Department of Health and Human Services North Carolina Behavioral Risk Factor Surveillance System: Data Dissemination and Use in Planning and Evaluation

2. Today’s Presentation • North Carolina BRFSS • Establishing Partnerships (Funding) • Data Dissemination • Data Use • State Programs • Local Levels

3. North Carolina BRFSS • NC-BRFSS was funded by the Centers for Disease Control and Prevention (CDC) in 1984 • to monitor adult health-risk behaviors and health practices; • to collect state and regional estimates for targeting high-risk groups. • Collects 1,250 interviews/month • NC-BRFSS has its own survey laboratory with 20 work stations • 30 part time interviewers & 2 part-time supervisors.

7. 22 largest counties alone • 13 regions from remaining 78 counties • 2 Native American Census Tracks

8. NC BRFSS 2004 and Beyond • In 2004, the sample size was increased to 15,000 and 22 counties, 13 regions and census tracks with large American Indians have been over sampled. • 3,000 African Americans • 600 + Hispanics (300 Spanish Speaking) • 400 American Indians • 200 Asian Americans • Produce Race, Sex, and Race X Sex Specific Estimates for whites and African Americans

9. Funding the BRFSS

10. Funding the BRFSS • Federal BRFSS Grant • State Public Health Programs • County Health Departments • Special Surveys • CDC Programs • Health Associations (March of Dimes, ACS etc).

11. Funding the BRFSS • UNC School of Public Health • NC Blue Cross & Blue Shield • NC Medicaid • Glaxo Smith Kline? • State Appropriations- $23,000/year • Public Health Task Force 2004 Recommendation

12. Interim Report North Carolina Public Health Task Force 2004 • Essential Public Health Services:1) Monitor health status to identify and solve community health problems • Planning & Outcomes Committee: Improve the data and epidemiology for state and local decision-making and allocation of resources. • Establish a common set of core health indicators. • Build capacity to conduct the Behavioral Risk Factor Surveillance Survey (BRFSS) to provide county-specific or multi-county data ($300,000)

13. Data Dissemination

14. Data Dissemination • Internet • Data posting (close 10,000 data tables) • Annual Statewide and Local Summary PowerPoint Presentations (~5,000 slides) • Reports • Total Requests between July1, 2003-May31, 2004: 152,662 • 31.4 megabyte/day • Printed Reports • Electronic Distribution of Annual Survey Results • Data Requests (~300) • Community Level Summary Reports (besides BRFSS includes other mortality, hospitalization, cancer data, and other statistics).

15. Data Users’ SitesJuly 1, 2003-May 31, 2004 Number of Requests

16. Reports by the BRFSS

17. Data Use in Planning and Evaluation by State Programs • Tobacco Prevention and Control • Heart Disease and Stroke Prevention • Diabetes • Physical Activity and Nutrition • Cancer Control Program

18. Tobacco Prevention and ControlBRFSS Tracked Tobacco Measures • Current Smoking • Quit Smoking • Worksite and Home Smoking Policy • Visiting Doctor in the Past Year • Doctor Advice to Quit Smoking • Smokeless Tobacco Use • Other Tobacco Products • Tobacco Tax • Total Cigarette Consumption • Age at Smoking

19. Tobacco Prevention and ControlBRFSS Related Program Goals and Objectives Ultimate Outcome: Reducing morbidity and mortality related to tobacco use Goal: Prevent initiation of tobacco among young people • Maintain public support greater than 50% for increase of cigarette tax (2006) • Increase number of people who never smoked (2006) Goal: Eliminate exposure to secondhand smoke (SHS) • Increase % of workers covered by work-site smoke-free policies from 74.8% to 80% (2010) • Increase % of adults and youth who do not currently smoke from 74.3% to 77% of adults and from 73.2% to 80% of high school students (2010) Goal: Promote smoking cessation among adults and young people • Increase the % of adults who have stopped smoking for a day or longer during the last 12 months from 55.8% to 60% (2010) • Increase percent of adults “asked and advised” to quit by provider from 73.1 to 77% and “assessed, assisted and arranged follow-up” services from 0 to 25% (2006) Goal: Identify and eliminate tobacco-related disparities in specific population groups • Decrease tobacco use prevalence rates among priority populations (2010) • Increase cessation attempts among priority populations from 51% to 70% (2010)

20. % Current Smoking 1990-2003

21. Support for Tobacco Tax (any amount) by Sex, Race, Age, Education & Income (2003) % *Maintain public support greater than 50% for increase of cigarette tax

22. Support for Amount of Tax on Pack of Cigarettes by Smoking Status %

23. Worksites Prohibit Smoking in Both Public and Work Areas (2002) Percent * Target is 80%, baseline was 74.8%. In 2003 the rate is 77.8%

24. Current Smoker (2002) Percent *Increase % of adults who do not currently smoke from 74.3% to 77% of adults 2003 Rate: 75.2%

25. Quit Smoking One Day or Longer in Past Year (2002) Percent *Increase the % of adults who have stopped smoking for a day or longer during the last 12 months from 55.8% to 60%. 2003 Rate is 52.6%

26. Advised by Health Professional to Quit Smoking in Past Year (2002) Percent *Increase percent of adults “asked and advised” to quit by provider from 73.1 to 77% 2003---76.1%

27. Tobacco Prevention and ControlPolicy Challenges • NC Preemption Law - NCGS 143-595-601 : Regulate smoking in public places and establishes standards for local governments electing to regulate smoking (1993). • Prohibits smoking in some public places such as school buses and health departments and facilities and requires designated smoking areas (20%) in state buildings • Prohibits local governments to regulate smoking more stringent than this law. • Possible BRFSS Questions to obtain public opinion data on this • Do you favor or oppose letting local NC communities have the option of passing their own laws to restrict smoking in public places, even if those laws may be stronger than the state law? • Do you feel that way strongly or not so strongly? • Tobacco Tax (5 Cents) –Increase to 75 Cents/pack • House Bill 1313 to allow local governments to levy taxes on tobacco- Not Passed • House Bill 254 to increase tax on tobacco at a rate of 30% of cost- Not Passed • Success with Tobacco Free School

28. Tobacco Prevention and ControlEducation and Other Efforts • A number of annually updated surveillance briefs featuring current smoking, worksite smoking policies, and quitting smoking. • Annual Report for Great American Smokeout day every November • One-pager fact sheets • Numerous presentations and other educational materials • Incorporate Adult Tobacco Survey into the BRFSS

29. Tobacco Prevention and ControlEducation and Other Efforts • 2004 BRFSS includes a question: • Are you aware of Quit Now NC smoking cessation phone lines or Quit Now websites?

30. Heart Disease & Stroke Prevention Program

31. Lead Health Depts. Priority Population Health Depts. HDSP Program Lead Counties Surry Nash Wake Pitt Henderson & Transylvania Cabarrus Craven Robeson

32. Heart Disease & Stroke Prevention ProgramBRFSS Tracked HDSP Measures • Physical activity • Fruit and vegetable consumption • Overweight and Obesity • Tobacco use • Diabetes • Hypertension • High cholesterol • Heart disease and stroke history • Knowledge of heart attack and stroke symptoms • Calling 911 for heart attack or stroke

33. Heart Disease & Stroke Prevention Program Original Focus - 1998-2003 • Improve Physical Activity & Healthy Eating • support Tobacco Prevention & Control Efforts • Through Policy & Environmental Change • In 4 Settings: • Community • Worksite • Schools • Healthcare

34. No Leisure Time Physical Activity Percent *Henderson/Transylvania, Pitt, Robeson, Wake

35. Fruits & Vegetables (5/Day-2002) Percent

36. Prevalence of Obesity (2002) Percent

37. Obesity Prevalence 1990-2003

38. Heart Disease & Stroke Prevention Program New Focus Beginning 2003 • Improve Hypertension and Dyslipidemia Prevention & Control, Emergency Response to Acute CVD Events, Secondary Prevention of CVD • support work of Phys. Act/Nutrition, Obesity, Tobacco, Diabetes Programs • Through Policy & Environmental Change • In the same 4 Settings • Program is in transition

39. Heart Disease & Stroke Prevention Program Program Goals

40. Heart Disease & Stroke Prevention Program BRFSS Related Program Objectives by 2010 • Increase to at least 90% the proportion of adults who have had their blood cholesterol checked within the preceding 5 years. • Maintain at 95% or more the proportion of adults who have had their blood pressure checked within the preceding 2 years. • Increase the proportion of adults who are aware of the early warning signs and symptoms of a stroke (developmental). • Increase the proportion of adults who are aware of the early warning signs and symptoms of a heart attack (developmental). • Increase the proportion of adults who are aware of the importance of accessing rapid emergency care for heart attack and stroke by calling 911 (developmental). • Increase to at least 75% the proportion of adults with coronary heart disease or stroke history who have been counseled about diet and exercise. • Increase to at least 95% the proportion of adults with a heart attack history (and with no contraindications to aspirin) who are taking aspirin daily or every other day.

41. Ever Told by Health Professional that You Have High Blood Pressure (2003)

42. Have Had Blood Cholesterol Checked within 5 Years

43. Told by a Doctor that Your Blood Cholesterol is High

44. Did Not Know All Heart Attack Symptoms -2003

45. Percent Who Recognized Signs & Symptoms of a Heart Attack-2003

46. Did Not Know All Stroke Symptoms -2003

47. Percent Who Recognized Signs & Symptoms of a Stroke -2003

48. Percent with History of CVD Counseled by Health Professional to:

49. Call 911 as First Response, if Someone Was Having a Heart Attack or Stroke:

50. Heart Disease & Stroke Prevention ProgramPolicy and Environmental Measures Obtained through BRFSS • Environmental tobacco smoke policies • worksite • home • Neighborhood environments relevant to physical activity (state-added) • perceived safety from crime • presence of sidewalks, trails, heavy traffic, unattended dogs • Social marketing efforts include • need to know stroke symptoms • take appropriate action (call 911)