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Web Access to Rhode Island Public Health Data. Developed by: Annie Gjelsvik, PhD, Karine Tolentino, MPH, Halima Ahmadi, and Christin Giordano. In collaboration with the Rhode Island Department of Health Asthma Control Program

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developed by annie gjelsvik phd karine tolentino mph halima ahmadi and christin giordano

Web Access to Rhode Island Public Health Data

Developed by: Annie Gjelsvik, PhD,

Karine Tolentino, MPH, Halima Ahmadi, and Christin Giordano

In collaboration with the Rhode Island Department of Health Asthma Control Program

This program is a part of the Public Health Training Program (PHTP): A joint activity of the Brown University Program in Public Health, the RI Department of Health and funded by an education grant from Pfizer, Inc

Center for Health Data and Analysis, Rhode Island Department of Health

Funding source: Center for Disease Prevention and Control Cooperative Agreement U82/CCU122380-01

introduction to public health data
Introduction to Public Health Data

Valid, reliable data on the communities we serve

can help us to:

  • assess the health of a community or population
  • search for causes of disease, injury and disability
  • plan programs to meet community needs
  • measure progress in prevention and control efforts

Adapted from: Public Health Data: Our Silent Partner, http://www.cdc.gov/nchs/data/training/introduction.pdf

individual and population based data
Individual and Population-based Data
  • Quantitative health data can focus on individuals or entire populations.
  • Classic example of individualized data is a patient’s medical record. The data are used primarily to improve the health of that one individual.
  • In public health focus is primarily on populations (communities, cities, counties, states).
  • Population-based data tell us about the overall “health” of that population.

Adapted from: Public Health Data: Our Silent Partner, http://www.cdc.gov/nchs/data/training/introduction.pdf

quantitative data
Quantitative Data
  • Provide what, who, when, & where
  • Measurable
  • Involves the counting of people, behaviors, conditions, or other discrete events.

Adapted from: Public Health Data: Our Silent Partner, http://www.cdc.gov/nchs/data/training/introduction.pdf

quantitative data5
Quantitative Data

Examples:

  • Numbers of deaths can be used to identify leading causes of death (what).
  • Numbers of smokers and nonsmokers by gender can be used to determine whether men are more likely to smoke than women (who).
  • Keeping track of the number of people with flu can identify the beginning of the flu season (when).
  • Comparing the proportion of women who began prenatal care after the first trimester in various counties will provide an indication of where access to prenatal services may be a problem.

Adapted from: Public Health Data: Our Silent Partner, http://www.cdc.gov/nchs/data/training/introduction.pdf

behavioral risk factor surveillance system brfss
Behavioral Risk Factor Surveillance System (BRFSS)

It enables the Centers for Disease Control and Prevention (CDC), state health departments, and other health and education agencies to monitor risk behaviors related to chronic diseases, injuries and death.

The BRFSS is the largest continuously conducted telephone health survey in the world.

behavioral risk factor surveillance system
Behavioral Risk Factor Surveillance System

Rhode Island undertook the BRFSS for the first time in 1984.

For more information, please visit www.cdc.gov/brfss/

behavioral risk factor surveillance system8
Behavioral Risk Factor Surveillance System

The BRFSS includes data about health care access, nutritional facts, alcohol and tobacco use, exercise habits, injury prevention, vaccinations, women’s health issues and much more.

youth risk behavior survey yrbs
Youth Risk Behavior Survey(YRBS)

The YRBS was developed in 1990 and includes national and state school-based surveys of representative samples of 9th through 12th grade students, conducted every other year.

The schools and classrooms are randomly selected.

youth risk behavior survey
Youth Risk Behavior Survey

The YRBS surveys teens on weight and dietary practices, sexual practices, tobacco and alcohol use, exercise habits, violence, depression and much more.

For more information, please visit www.cdc.gov/yrbs

brfss and yrbs strengths
BRFSS and YRBS: Strengths
  • Representative

For example, the BRFSS samples approximately 4000 adults and these adults represent the entire RI adult population via weighting.

Female

Male

brfss and yrbs strengths12
BRFSS and YRBS: Strengths
  • Comparable

Vs.

Since the surveys are conducted using the same methodology nationally, we can compare RI estimates to national, regional, or other state estimates.

brfss and yrbs strengths13
BRFSS and YRBS: Strengths
  • Timely

The BRFSS is conducted all year, every year and the YRBS is conducted in the spring every other year.

brfss and yrbs strengths14
BRFSS and YRBS: Strengths
  • Standard surveys

The BRFSS is conducted by trained interviewers using computer assisted telephone interview software.

The YRBS is a self-administered paper-based survey.

brfss and yrbs limitations
BRFSS and YRBS: Limitations

The BRFSS and YRBS are limited in the populations they are able to survey. For the BRFSS, a small percentage of the population do not have any phones, young and poor citizens only use cell phones and there is a greater rate of refusals for phone interviews than for face-to-face interviews. For the YRBS, private school and special education classrooms are excluded. In addition, not every student in the selected classroom will be attending school on that particular day.

brfss and yrbs limitations16
BRFSS and YRBS: Limitations

150.0

Versus

Another limitation is the validity of answers because people are self-reporting. Memory and attempts to normalize can affect one’s answers. For example, someone might actually weigh 150 pounds but reports 128.3 pounds.

Finally, the surveys have restricted times. The BRFSS is limited to about 20 minutes and the YRBS is limited to one class period. Therefore, not all topics can be covered.

slide17

www.health.ri.gov/data/webquery.php

Bookmark it!

This is the main page: Click on the HEALTH Web Query System-BRFS link to get to the BRFSS Web Query System.

slide20

Step One: Select the year (s) that interest you.

You can click here for variables definition and to find out which year (s) questions are available.

slide21

Step 2: Here you select your row topic. Once you highlight a specific topic, the questions asked for that topic will appear in the blank space. You must select a topic AND variable within that topic.

Step 3: Here you select your column topic. Once you highlight a specific topic, the questions asked for that topic will appear in the blank space. You must select a topic AND variable within that topic.

slide22

Step Four allows you to filter your results by specific populations. If you place too many restrictions, it is possible that you may get “Statistically Unreliable” results because of small sample size.

Note that you can make multiple selections or deselect selections by holding down the control key.

Step Five allows you to limit your results to a certain county or region.

slide23

Step Six allows you to check a box requesting population estimates or an estimated number of RI adults in the group.

slide24

Click here to clear the form completely.

Click here to submit your query.

case study scenario

Public Health Questions-BRFSS

Case-Study Scenario
  • A public health educator is interested in developing a community based awareness program about asthma. She is particularly interested in differences of asthma prevalence among Rhode Island adults.
  • In 2004, what is the percent of Rhode Island adults with lifetime asthma?
slide26

We are interested in 2004 so we check off the box corresponding to 2004.

“Then we select the row topic, in this case, Year.”

link

slide27

Next we select “year of interview”. You must highlight the variable even though it is the only one in the box.

slide29

Finally, we select the column variable “Ever told have asthma by health care professional” which corresponds to the question we want to ask.

slide32

Note that you can choose to include a graph.

This is the summary page. Check to make sure that you have selected the desired year (s), row and column variables and press submit. If something is incorrect, you can press back to return to the query page.

slide33

This is where your row topic appears. In this case the year you selected.

These are your results. Your search criteria will always appear on top.

This is where your column topic appears. In this case, whether or not the respondent has ever been told they have asthma by a health care professional.

slide34

604 respondents said “Yes,” that they had been told that they have asthma by a health care professional.

n is the number of people who were interviewed.

slide35

In 2004, among Rhode Island adults ages 18 and older, an estimated 14.6% have been diagnosed with asthma.

This is the approximate actual percentage of the RI population that has this characteristic.

slide37

In 2004, an estimated 122,950 Rhode Island adults age 18 and older have been diagnosed with asthma.

N refers to the estimated number of RI adults in the group.

slide38

Notice the legend and suggested citation.

Your data can be downloaded to: Excel, PowerPoint and Microsoft Word.

public health question
Public Health Question
  • In 2004, were there differences based on race/ethnicity in percent of current asthma?
  • What happens when we combine years?
slide40

Step 2: The row topic is “Demographics.” From the list of available row variables, you select race/ethnicity.

We are interested in 2004 so we check off the box corresponding to 2004.

slide43

Note that data is not available for “Current Asthma” in 1998 and in 1999.

Now we can press “Submit Query” in order to submit our query.

slide45

In 2004, 346 White, Non-Hispanic respondents said that they currently have asthma.

Approximately 9.8%, or 69,185 RI White, Non-Hispanic adults currently have asthma.

slide46

In 2004, 21 Black, Non-Hispanic respondents said that they currently have asthma.

Approximately 10.7% or 2,854 RI White, Non-Hispanic adults currently have asthma.

slide47

In 2004, 26 Hispanic respondents said that they currently have asthma.

Approximately 5.8%, or 4,231 RI Hispanic adults currently have asthma.

slide48

For Asian/Pacific Islander, Non-Hispanic; Native American, Non-Hispanic and Other Non-Hispanic, the “Data is Statistically Unreliable.” Data Statistically Unreliable is displayed whenever the sample size for a row is <100.

How can we fix this?

slide49

To increase the sample size, we can add more years. This time we study years 2001 through 2004 while leaving everything else the same.

slide51

Note that, since we have added more years and thus have 187 responses, we now have data for the Asian/Pacific Islander, Non-Hispanic population.

confidence intervals
Confidence Intervals
  • An estimated range of values usually to 95% confidence; “We’re 95% confident that the confidence interval contains the true but unknown value.”
  • A very wide interval suggests that many possible values of the estimate are possible.
  • If the intervals overlap for two different populations, you cannot say that the populations are different.
slide53

Note that the 95%CI for White, non-Hispanic is very narrow, indicating a large sample size.

The 95% CI does not overlap for Whites and Hispanics.

slide55

Interpreting Results:

-

Combining 2001 to 2004, among Rhode Islanders age 18 and older the proportion of asthma among Black, Non-Hispanics and Whites, Non-Hispanics were higher than in Hispanics.

-The 95% CI do not overlap for Whites and Hispanics or for Blacks and Hispanics but they do overlap for Whites and Blacks.

case study scenario56
Case Study Scenario
  • A health clinic is applying for funds to increase the availability of routine check-ups for women.
  • They would like to demonstrate the connection between routine check-ups and mammograms.
  • What question should they ask to generate data that may be helpful in advocating for increased funds for routine check-ups?
mammograms
Mammograms
  • Do you want to know
    • what percent of women ages 40 and older who ever had a mammogram also had a routine check-up in the past 12 months

or

    • what percent of women ages 40 and older who have had a routine check-up in the past 12 months have ever had a mammogram?
mammograms58
Mammograms
  • Use “what percent of women who got a routine check-up in the past 12 months have ever had a mammogram?”
slide59

Next we select Health Care Access and then “Time since last routine check-up.”

Finally, you select Women’s Health and “Ever Mammogram-Age 40+.”

We are interested in 2004 so we check off the box corresponding to 2004.

slide63

This time we check off all years.

Next we select “Health Care Access” and then “Time since last routine check-up.”

Finally, you select “Women’s Health” and “Ever Mammogram-Age 40+.”

slide66

Interpreting Results:

- Combining 1998-2001 and 2004 an estimated 94.1% (95% CI 93.5% to 94.8%) of women age 40+ who had a checkup in the last year also had a mammogram in their lifetime

-If we look at the other intervals since last check-up, it is important to note that the percent of women who get a mammogram significantly decreases as the time since last check-up increases.

-What does this mean for the clinic?

slide67

Case Study Scenario

  • All women age 65+ have mammograms covered as a part of Medicare.
  • For 1998-2001 and 2004 combined, what percent of women age 40-64 who got a routine check-up in the past 12 months have ever had a mammogram?
slide68

We check off years 1998-2001 and 2004.

Next we select Health Care Access and then “Time since last routine check-up.”

We once again select Women’s Health and “Ever Mammogram-Age 40+.”

slide69

To get results for only women ages 40-64, we can select these age groups in Step 4. Hold down the control button to select multiple items or to deselect an item.

Press submit.

slide71

Interpreting Results:

  • Combining 1998-2001, and 2004, an estimated 94.0% (95% CI 93.2% to 94.9%) of women age 40-64 who had a checkup in the last year also had a mammogram in their lifetime.
  • -If we look at the other intervals since last check-up, it is important to note that the percent of women who get a mammogram significantly decreases as the time since last check-up increases.
public health questions yrbs
Public Health Questions- YRBS
  • In 2005, what percent of Rhode Islanders grades 9-12 were depressed (Past 12 months, ever felt so sad or hopeless almost every day for 2 wks in a row that stopped doing some usual activities?)?
  • In 2005, what percent of Rhode Islanders grades 9-12 were in a physical fight that caused injury (Past 12 months, times in physical fight in which injured and had to be treated by doctor or nurse?)?
  • In 2005, what percent of Rhode Island students grades 9-12 who were depressed had gotten in a physical fight that caused injury?
slide73

Here you check off “year of interview” and then “survey year”.

Lets start by answering the first question: In 2005, what percent of Rhode Islanders grades 9-12 were depressed (Past 12 months, ever felt so sad or hopeless almost every day for 2 wks in a row that stopped doing some usual activities?)?

We are interested in 2005 so we check off the box corresponding to 2005.

slide74

We select “Depression and Suicide” as the column topic and the specific question we are interested in as the column variable.

slide75

In 2005, an estimated 25.7% (95% CI 23.7 to 27.6) of Rhode Islander highschoolers were feeling so sad or hopeless almost everyday for two weeks or more in a row that they stopped doing their usual activities in the past year.

slide76

Next we select “year of interview” and “survey year”.

Now lets answer the second question: In 2005, what percent of Rhode Islanders grades 9-12 were in a physical fight that caused injury (Past 12 months, times in physical fight in which injured and had to be treated by doctor or nurse?)?

We are interested in 2005 so we check off the box corresponding to 2005.

slide77

We select “Violence” as the column topic and the specific question we are interested in as the column variable.

slide79

In 2005, an estimated 5.0% (95% CI 4.0 to 6.0) of Rhode Islander highschoolers were in a physical fight one or more times in which they were injured and had to be treated by a doctor or nurse in the past year.

depression and violence

We select the box corresponding to 2005.

We select “Depression and Suicide” as the row topic and the specific question we are interested in as the row variable.

Depression and Violence

Lastly, lets answer the third question: In 2005, what percent of Rhode Island students grades 9-12 who were depressed had gotten in a physical fight that caused injury?

slide81

We select “Violence” as the column topic and the specific question we are interested in as the column variable.

slide83

In 2005, an estimated 8.1% (95% CI 5.7% to 10.5%) of Rhode Islander high schoolers who were depressed were in a physical fight compared to 4.0% (95% CI 2.9% to 5.0%) of those who were not depressed.

appendix interpreting results
Appendix: Interpreting Results
  • Use the statement: “An estimated X% of [row variable] are [column variable].”
  • For example, if the row variable is those with asthma and the column variable is those who smoke, what would the statement be (if X were 40)?
    • An estimated 40% of those with asthma are smokers.