Justification for Change

Change Request

2016 Behavioral Risk Factor Surveillance System (BRFSS)

(OMB No. 0920-1061 Exp. Date 3/31/2018)

September 25, 2015

Summary

Information collection for the Behavioral Risk Factor Surveillance System (BRFSS) consists of landline and cell phone interviews in each of the 50 states, Washington DC and several US territories. Personal interviews are conducted in one territory where phone lines are unavailable. The survey consists of a standardized core questionnaire, optional modules with set questions and state added questions (which are not overseen by the CDC and are not included in this document). Each state designs its own sample with technical assistance from the CDC.

We request the following:

OMB approval of minor modifications of the core questionnaire including new questions on e-cigarette use in the emerging core section. Approval of a different set of previously reviewed modules for use in 2016 and inclusion of some new modules. Approval of updated calling protocol (see Attachment 10a-2016) for data collection to 1) take advantage of new sampling information available for cell phones and new screening information for landline samples; 2) modify procedures to ensure compliance with new FCC regulations; 3) clarify and standardize procedures related to telephone answering device changes.

Background and Justification

BRFSS is a unique collaboration between the federal government and states. It is highly responsive to diverse needs and priorities for states, the federal government, and non-governmental agencies. The core questionnaire has an even and odd numbered year version, so some of the changes in the 2016 are reflective of the move to the even numbered year questionnaire. These changes include sections on oral health, falls, breast and cervical cancer, prostate cancer, colorectal cancer and drinking and driving. Sections on fruit and vegetable consumption, physical activity, hypertension awareness, cholesterol awareness, arthritis burden, which appeared in the 2015 questionnaire have been deleted as they are part of the odd numbered year rotating core. (Note that these sections are available to states as optional modules in off-years). All of these sections were previously reviewed by OMB in the full review in 2015.

Other changes were also made in the 2016 BRFSS Questionnaire (See Attachment 5a-2016). These were in response to changing requirements or needs of programs within CDC, and were voted on by the states at the annual BRFSS meeting in June. These included:

1. The addition of questions on e-cigarette use in the core questionnaire;

2. The adoption of a new optional module on marijuana use;

3. The adoption of a new optional module on health literacy;

4. The adoption of a new optional module on sleep disorder, and;

5. The adoption of a new optional module on menu labeling.

The use of electronic cigarettes is an emerging health issue, not previously address by the BRFSS. A concern has been raised in all states about the use of electronic or e-cigarettes and other “vaping” products by the public. In accordance with other emerging health issues, two questions on e-cigarettes were considered at the BRFSS meeting and voted on for adoption. The questions have been previously used by a number of states as state added questions. These question are:

Read if necessary: Electronic cigarettes (e-cigarettes) and other electronic “vaping” products include electronic hookahs (e-hookahs), vape pens, e-cigars, and others. These products are battery-powered and usually contain nicotine and flavors such as fruit, mint, or candy.

Have you ever used an e-cigarette or other electronic “vaping” product, even just one time, in your entire life?

Yes

No

Don’t know / Not Sure

Refused

Do you now use e-cigarettes or other electronic “vaping” products every day, some days, or not at all?

Every day

Some days

Not at all

Don’t know / Not sure

Refused

In the past the BRFSS included disability questions in the demographics section of the questionnaire, but excluded the question on hearing impairment, due to the mode of the interview. In 2016, the hearing impairment question will be included in the interview.

Are you deaf or do you have serious difficulty hearing?

1 Yes

2 No

7 Don’t know / Not Sure

9 Refused

Two questions were removed from the core. These questions were both related to disability. Given the increase in the number of disability questions in the demographic section, these questions were redundant and created extra burden on respondents. The net effect was to maintain the length of the core questionnaire at the same number of questions (without noting changes in length due to rotating core). The two questions that were removed were:

Are you limited in any way in any activities because of physical, mental, or emotional problems?

1 Yes

2 No

7 Don’t know / Not Sure

9 Refused

Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?

1 Yes

2 No

7 Don’t know / Not Sure

9 Refused

Minor changes were made in the interviewer instructions and other skip patterns to improve the flow of the interview. These included:

1. After asking the number of adults in the household and the number of adult men, the interviewer verifies, rather than asks, the number of adult women.

2. The gender of the respondent is populated by the enumeration by the CATI system in the landline interview, rather than the interviewer coding it later.

3. In order to reduce confusion regarding location, the question on residence was changed from, “Do you reside in [STATE]?” to “In what state do you currently live?” This phase was also use for zip code (“What is the zip code where you currently live?”). These changes were made due to the fact that some respondents are interviewed from locations where they live during parts of the year.

All changes in the 2016 questionnaire are provided in red text in Attachment 5a-2016 BRFSS Questionnaire.

Effect of Proposed Changes on the Burden Estimate

None. The 2016 BRFSS core added two questions and removed two questions resulting in no change in the overall question count or the estimated burden per response (not including length changed due to the rotating core). The number of interviews declined in 2014 from previous years and was approximately 30,000 short of the anticipated annual total. States are also careful to ensure that total survey length does not exceed 27 minutes, inclusive of household enumeration on landline interviews and optional modules. In 2015 we are also below targeted number of completes. Therefore, there is no change in the estimated number of respondents or individual respondent burden for 2016.

Effect of Proposed Changes on Currently Approved Instruments and Attachments

The following table describes those attachments which have been updated as a result of changes in the questions or screener language of the BRFSS. All updates are provided in red text in each attachment.

Previous Attachment Title	Change Request Attachment Title
4a-2015 Summary of Approved Optional Modules	4a-2016 Summary of Approved Optional Modules
4b-2015 Reference Set of Approved Questions by Optional Module	4b-2016 Reference Set of Approved Questions by Optional Module
5a-2015 BRFSS Questionnaire	5a-2016 BRFSS Questionnaire
8a-2015 Landline interview screener	8a-2016 Landline interview screener
8b-2015 Cellphone interview screener	8b-2016 Cellphone interview screener
10a-2015 Disposition table with Callback Rules	10a-2016 Calling Protocol with Disposition Table with Callback Rules

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