2016 Summary of Modules by State

Attachment 5b-Summary of Optional Modules by State.docx

Behavioral Risk Factor Surveillance System (BRFSS)

2016 Summary of Modules by State

OMB: 0920-1061

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0920-1061 can be found here:

2023-12-11 - No material or nonsubstantive change to a currently approved collection
2022-12-16 - No material or nonsubstantive change to a currently approved collection

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Attachment 5b Summary of Modules by State and (Split) Samples

State	Mode Type	#Versions	#Modules	Module List
Alabama	Land Line	1	5	Adult Human Papilloma Virus (HPV) - Vaccination, Childhood Asthma Prevalence, Health Care Access, Pre-Diabetes, Random Child Selection
Alabama	Cell Phone	1	5	Adult Human Papilloma Virus (HPV) - Vaccination, Childhood Asthma Prevalence, Health Care Access, Pre-Diabetes, Random Child Selection
Alaska	Land Line	1	5	Cancer Survivorship, Diabetes, Health Care Access, Pre-Diabetes, Sodium or Salt-Related Behavior
Alaska	Cell Phone	1	5	Cancer Survivorship, Diabetes, Health Care Access, Pre-Diabetes, Sodium or Salt-Related Behavior
Arizona	Land Line	2	5	Common: Diabetes, Health Care Access, Pre-Diabetes Survey 2: Reactions to Race, Sodium or Salt-Related Behavior
Arizona	Cell Phone	2	5	Common: Diabetes, Health Care Access, Pre-Diabetes Survey 2: Reactions to Race, Sodium or Salt-Related Behavior
California	Land Line	3	4	Common: Childhood Asthma Prevalence, Random Child Selection Survey 1: Alcohol Screening & Brief Intervention (ASBI), Pre-Diabetes Survey 2: Alcohol Screening & Brief Intervention (ASBI), Pre-Diabetes
California	Cell Phone	3	4	Common: Childhood Asthma Prevalence, Random Child Selection Survey 1: Alcohol Screening & Brief Intervention (ASBI), Pre-Diabetes Survey 2: Alcohol Screening & Brief Intervention (ASBI), Pre-Diabetes
Colorado	Land Line	2	5	Survey 1: Health Care Access, Industry and Occupation Survey 2: Adult Human Papilloma Virus (HPV) - Vaccination, Industry and Occupation, Pre-Diabetes, Tetanus Diphtheria (TDAP) (Adults)
Colorado	Cell Phone	2	5	Survey 1: Health Care Access, Industry and Occupation Survey 2: Adult Human Papilloma Virus (HPV) - Vaccination, Industry and Occupation, Pre-Diabetes, Tetanus Diphtheria (TDAP) (Adults)
Connecticut	Land Line	1	8	Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Diabetes, Health Care Access, Industry and Occupation, Influenza, Pre-Diabetes, Random Child Selection
Connecticut	Cell Phone	1	8	Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Diabetes, Health Care Access, Industry and Occupation, Influenza, Pre-Diabetes, Random Child Selection
Delaware	Land Line	1	5	Adult Human Papilloma Virus (HPV) - Vaccination, Diabetes, Health Care Access, Pre-Diabetes, Sexual Orientation and Gender Identity
Delaware	Cell Phone	1	5	Adult Human Papilloma Virus (HPV) - Vaccination, Diabetes, Health Care Access, Pre-Diabetes, Sexual Orientation and Gender Identity
District of Columbia	Land Line	1	2	Alcohol Screening & Brief Intervention (ASBI), Health Care Access
District of Columbia	Cell Phone	1	2	Alcohol Screening & Brief Intervention (ASBI), Health Care Access
Florida	Land Line	2	4	Common: Diabetes, Industry and Occupation, Pre-Diabetes Survey 2: Alcohol Screening & Brief Intervention (ASBI)
Florida	Cell Phone	1	3	Survey 1: Diabetes, Industry and Occupation, Pre-Diabetes
Georgia	Land Line	1	14	Adult Asthma History, Adult Human Papilloma Virus (HPV) - Testing, Adult Human Papilloma Virus (HPV) - Vaccination, Childhood Asthma Prevalence, Diabetes, Health Care Access, Healthy Days (Symptoms), Industry and Occupation, Influenza, Pre-Diabetes, Random Child Selection, Social Context, Sodium or Salt-Related Behavior, Tetanus Diphtheria (TDAP) (Adults)
Georgia	Cell Phone	1	14	Adult Asthma History, Adult Human Papilloma Virus (HPV) - Testing, Adult Human Papilloma Virus (HPV) - Vaccination, Childhood Asthma Prevalence, Diabetes, Health Care Access, Healthy Days (Symptoms), Industry and Occupation, Influenza, Pre-Diabetes, Random Child Selection, Social Context, Sodium or Salt-Related Behavior, Tetanus Diphtheria (TDAP) (Adults)
Guam	Land Line	1	3	Diabetes, Pre-Diabetes, Sexual Orientation and Gender Identity
Guam	Cell Phone	1	3	Diabetes, Pre-Diabetes, Sexual Orientation and Gender Identity
Hawaii	Land Line	1	5	Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity
Hawaii	Cell Phone	1	5	Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity
Idaho	Land Line	1	4	Health Care Access, Industry and Occupation, Pre-Diabetes, Sexual Orientation and Gender Identity
Idaho	Cell Phone	1	4	Health Care Access, Industry and Occupation, Pre-Diabetes, Sexual Orientation and Gender Identity
Illinois	Land Line	1	6	Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection, Sodium or Salt-Related Behavior
Illinois	Cell Phone	1	6	Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection, Sodium or Salt-Related Behavior
Indiana	Land Line	2	8	Common: Adult Human Papilloma Virus (HPV) - Vaccination, Childhood Asthma Prevalence, Diabetes, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity Survey 1: Health Care Access Survey 2: Alcohol Screening & Brief Intervention (ASBI)
Indiana	Cell Phone	2	8	Common: Adult Human Papilloma Virus (HPV) - Vaccination, Childhood Asthma Prevalence, Diabetes, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity Survey 1: Health Care Access Survey 2: Alcohol Screening & Brief Intervention (ASBI)
Iowa	Land Line	2	7	Common: Cancer Survivorship, Diabetes, Health Care Access, Industry and Occupation, Influenza, Sexual Orientation and Gender Identity Survey 1: Pre-Diabetes
Iowa	Cell Phone	2	7	Common: Cancer Survivorship, Diabetes, Health Care Access, Industry and Occupation, Influenza, Sexual Orientation and Gender Identity Survey 1: Pre-Diabetes
Kansas	Land Line	2	5	Common: Childhood Asthma Prevalence, Random Child Selection, Sexual Orientation and Gender Identity Survey 1: Alcohol Screening & Brief Intervention (ASBI), Pre-Diabetes
Kansas	Cell Phone	2	5	Common: Childhood Asthma Prevalence, Random Child Selection, Sexual Orientation and Gender Identity Survey 1: Alcohol Screening & Brief Intervention (ASBI), Pre-Diabetes
Kentucky	Land Line	1	6	Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Health Care Access, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity
Kentucky	Cell Phone	1	6	Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Health Care Access, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity
Louisiana	Land Line	1	8	Adult Asthma History, Childhood Asthma Prevalence, Diabetes, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity
Louisiana	Cell Phone	1	8	Adult Asthma History, Childhood Asthma Prevalence, Diabetes, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity
Maine	Land Line	2	7	Common: Diabetes, Pre-Diabetes Survey 1: Childhood Asthma Prevalence, Health Care Access, Influenza, Random Child Selection, Sodium or Salt-Related Behavior
Maine	Cell Phone	2	7	Common: Diabetes, Pre-Diabetes Survey 1: Childhood Asthma Prevalence, Health Care Access, Influenza, Random Child Selection, Sodium or Salt-Related Behavior
Maryland	Land Line	1	6	Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity
Maryland	Cell Phone	1	6	Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity
Massachusetts	Land Line	3	9	Common: Adult Human Papilloma Virus (HPV) - Vaccination, Health Care Access, Industry and Occupation, Influenza, Pre-Diabetes, Tetanus Diphtheria (TDAP) (Adults) Survey 1: Childhood Asthma Prevalence, Random Child Selection Survey 3: Alcohol Screening & Brief Intervention (ASBI)
Massachusetts	Cell Phone	1	5	Survey 1: Adult Human Papilloma Virus (HPV) - Vaccination, Health Care Access, Industry and Occupation, Influenza, Pre-Diabetes
Michigan	Land Line	3	6	Common: Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection Survey 3: Alcohol Screening & Brief Intervention (ASBI)
Michigan	Cell Phone	3	6	Common: Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection Survey 3: Alcohol Screening & Brief Intervention (ASBI)
Minnesota	Land Line	1	9	Adult Human Papilloma Virus (HPV) - Testing, Adult Human Papilloma Virus (HPV) - Vaccination, Alcohol Screening & Brief Intervention (ASBI), Emotional Support and Life Satisfaction, Health Care Access, Industry and Occupation, Pre-Diabetes, Reactions to Race, Sexual Orientation and Gender Identity
Minnesota	Cell Phone	1	9	Adult Human Papilloma Virus (HPV) - Testing, Adult Human Papilloma Virus (HPV) - Vaccination, Alcohol Screening & Brief Intervention (ASBI), Emotional Support and Life Satisfaction, Health Care Access, Industry and Occupation, Pre-Diabetes, Reactions to Race, Sexual Orientation and Gender Identity
Mississippi	Land Line	1	9	Cancer Survivorship, Childhood Asthma Prevalence, Diabetes, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection, Reactions to Race, Tetanus Diphtheria (TDAP) (Adults)
Mississippi	Cell Phone	1	9	Cancer Survivorship, Childhood Asthma Prevalence, Diabetes, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection, Reactions to Race, Tetanus Diphtheria (TDAP) (Adults)
Missouri	Land Line	1	4	Cancer Survivorship, Childhood Asthma Prevalence, Pre-Diabetes, Random Child Selection
Missouri	Cell Phone	1	4	Cancer Survivorship, Childhood Asthma Prevalence, Pre-Diabetes, Random Child Selection
Montana	Land Line	1	6	Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Random Child Selection, Sexual Orientation and Gender Identity
Montana	Cell Phone	1	6	Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Random Child Selection, Sexual Orientation and Gender Identity
Nebraska	Land Line	2	8	Common: Cancer Survivorship, Childhood Asthma Prevalence, Health Care Access, Random Child Selection Survey 1: Diabetes, Pre-Diabetes Survey 2: Alcohol Screening & Brief Intervention (ASBI), Industry and Occupation
Nebraska	Cell Phone	2	8	Common: Cancer Survivorship, Childhood Asthma Prevalence, Health Care Access, Random Child Selection Survey 1: Diabetes, Pre-Diabetes Survey 2: Alcohol Screening & Brief Intervention (ASBI), Industry and Occupation
Nevada	Land Line	1	5	Childhood Asthma Prevalence, Health Care Access, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity
Nevada	Cell Phone	1	5	Childhood Asthma Prevalence, Health Care Access, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity
New Hampshire	Land Line	1	4	Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Random Child Selection
New Hampshire	Cell Phone	1	4	Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Random Child Selection
New Jersey	Land Line	3	6	Common: Childhood Asthma Prevalence, Diabetes, Health Care Access, Pre-Diabetes, Random Child Selection Survey 1: Industry and Occupation
New Jersey	Cell Phone	3	6	Common: Childhood Asthma Prevalence, Diabetes, Health Care Access, Pre-Diabetes, Random Child Selection Survey 1: Industry and Occupation
New Mexico	Land Line	1	8	Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Diabetes, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection, Reactions to Race
New Mexico	Cell Phone	1	8	Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Diabetes, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection, Reactions to Race
New York	Land Line	2	7	Common: Health Care Access, Sexual Orientation and Gender Identity Survey 1: Childhood Asthma Prevalence, Industry and Occupation, Pre-Diabetes, Random Child Selection Survey 2: Alcohol Screening & Brief Intervention (ASBI)
New York	Cell Phone	2	7	Common: Health Care Access, Sexual Orientation and Gender Identity Survey 1: Childhood Asthma Prevalence, Industry and Occupation, Pre-Diabetes, Random Child Selection Survey 2: Alcohol Screening & Brief Intervention (ASBI)
North Carolina	Land Line	2	4	Common: Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Random Child Selection
North Carolina	Cell Phone	2	4	Common: Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Random Child Selection
North Dakota	Land Line	1	5	Diabetes, Health Care Access, Industry and Occupation, Pre-Diabetes, Sodium or Salt-Related Behavior
North Dakota	Cell Phone	1	5	Diabetes, Health Care Access, Industry and Occupation, Pre-Diabetes, Sodium or Salt-Related Behavior
Ohio	Land Line	2	10	Common: Diabetes, Health Care Access, Pre-Diabetes, Sexual Orientation and Gender Identity Survey 1: Adult Human Papilloma Virus (HPV) - Testing, Cancer Survivorship, Childhood Asthma Prevalence, Healthy Days (Symptoms), Random Child Selection, Social Context
Ohio	Cell Phone	2	10	Common: Diabetes, Health Care Access, Pre-Diabetes, Sexual Orientation and Gender Identity Survey 1: Adult Human Papilloma Virus (HPV) - Testing, Cancer Survivorship, Childhood Asthma Prevalence, Healthy Days (Symptoms), Random Child Selection, Social Context
Oklahoma	Land Line	2	4	Common: Childhood Asthma Prevalence, Random Child Selection Survey 1: Health Care Access Survey 2: Pre-Diabetes
Oklahoma	Cell Phone	2	4	Common: Childhood Asthma Prevalence, Random Child Selection Survey 1: Health Care Access Survey 2: Pre-Diabetes
Oregon	Land Line	2	7	Common: Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection Survey 2: Sodium or Salt-Related Behavior
Oregon	Cell Phone	2	7	Common: Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection Survey 2: Sodium or Salt-Related Behavior
Pennsylvania	Land Line	1	6	Adult Human Papilloma Virus (HPV) - Testing, Childhood Asthma Prevalence, Health Care Access, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity
Pennsylvania	Cell Phone	1	6	Adult Human Papilloma Virus (HPV) - Testing, Childhood Asthma Prevalence, Health Care Access, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity
Puerto Rico	Land Line	1	6	Childhood Asthma Prevalence, Diabetes, Health Care Access, Influenza, Pre-Diabetes, Random Child Selection
Puerto Rico	Cell Phone	1	6	Childhood Asthma Prevalence, Diabetes, Health Care Access, Influenza, Pre-Diabetes, Random Child Selection
Rhode Island	Land Line	1	6	Adult Human Papilloma Virus (HPV) - Vaccination, Childhood Asthma Prevalence, Health Care Access, Pre-Diabetes, Random Child Selection, Tetanus Diphtheria (TDAP) (Adults)
Rhode Island	Cell Phone	1	6	Adult Human Papilloma Virus (HPV) - Vaccination, Childhood Asthma Prevalence, Health Care Access, Pre-Diabetes, Random Child Selection, Tetanus Diphtheria (TDAP) (Adults)
South Carolina	Land Line	1	4	Diabetes, Health Care Access, Pre-Diabetes, Random Child Selection
South Carolina	Cell Phone	1	4	Diabetes, Health Care Access, Pre-Diabetes, Random Child Selection
South Dakota	Land Line	1	4	Diabetes, Pre-Diabetes, Random Child Selection, Sodium or Salt-Related Behavior
South Dakota	Cell Phone	1	4	Diabetes, Pre-Diabetes, Random Child Selection, Sodium or Salt-Related Behavior
Tennessee	Land Line	1	11	Adult Asthma History, Childhood Asthma Prevalence, Diabetes, Health Care Access, Healthy Days (Symptoms), Industry and Occupation, Influenza, Pre-Diabetes, Random Child Selection, Social Context, Tetanus Diphtheria (TDAP) (Adults)
Tennessee	Cell Phone	1	11	Adult Asthma History, Childhood Asthma Prevalence, Diabetes, Health Care Access, Healthy Days (Symptoms), Industry and Occupation, Influenza, Pre-Diabetes, Random Child Selection, Social Context, Tetanus Diphtheria (TDAP) (Adults)
Texas	Land Line	2	8	Common: Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Random Child Selection Survey 1: Diabetes, Pre-Diabetes Survey 2: Adult Human Papilloma Virus (HPV) - Vaccination, Influenza, Tetanus Diphtheria (TDAP) (Adults)
Texas	Cell Phone	2	8	Common: Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Random Child Selection Survey 1: Diabetes, Pre-Diabetes Survey 2: Adult Human Papilloma Virus (HPV) - Vaccination, Influenza, Tetanus Diphtheria (TDAP) (Adults)
Utah	Land Line	2	4	Common: Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Random Child Selection
Utah	Cell Phone	2	4	Common: Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Random Child Selection
Vermont	Land Line	1	7	Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity, Tetanus Diphtheria (TDAP) (Adults)
Vermont	Cell Phone	1	7	Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity, Tetanus Diphtheria (TDAP) (Adults)
Virginia	Land Line	1	6	Diabetes, Health Care Access, Pre-Diabetes, Sexual Orientation and Gender Identity, Social Context, Tetanus Diphtheria (TDAP) (Adults)
Virginia	Cell Phone	1	6	Diabetes, Health Care Access, Pre-Diabetes, Sexual Orientation and Gender Identity, Social Context, Tetanus Diphtheria (TDAP) (Adults)
Washington	Land Line	1	6	Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection
Washington	Cell Phone	1	6	Alcohol Screening & Brief Intervention (ASBI), Childhood Asthma Prevalence, Health Care Access, Industry and Occupation, Pre-Diabetes, Random Child Selection
West Virginia	Land Line	1	5	Childhood Asthma Prevalence, Diabetes, Health Care Access, Pre-Diabetes, Random Child Selection
West Virginia	Cell Phone	1	5	Childhood Asthma Prevalence, Diabetes, Health Care Access, Pre-Diabetes, Random Child Selection
Wisconsin	Land Line	1	8	Alcohol Screening & Brief Intervention (ASBI), Cancer Survivorship, Childhood Asthma Prevalence, Health Care Access, Influenza, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity
Wisconsin	Cell Phone	1	8	Alcohol Screening & Brief Intervention (ASBI), Cancer Survivorship, Childhood Asthma Prevalence, Health Care Access, Influenza, Pre-Diabetes, Random Child Selection, Sexual Orientation and Gender Identity
Wyoming	Land Line	1	4	Adult Human Papilloma Virus (HPV) - Vaccination, Diabetes, Pre-Diabetes, Sexual Orientation and Gender Identity
Wyoming	Cell Phone	1	1	Adult Human Papilloma Virus (HPV) - Vaccination, Diabetes, Pre-Diabetes, Sexual Orientation and Gender Identity

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