Change request for 2020 -Aug 2019

Change Request

Proposed Changes to the 2019 Behavioral Risk Factor Surveillance System (BRFSS)

(OMB No. 0920-1061 Exp. Date 3/31/2021)

August 1, 2019

Summary

We request the following: OMB approval of revisions to the 2020 BRFSS Questionnaire and Data Collectors’ Protocol for use in the 2020 BRFSS. Specifically, we request the following:

1. Approval of minor changes in the 2020 Core Questionnaire (notably changes in the introduction and changes to questions on colorectal cancer).

2. Approval to split an approved module on Cancer Survivorship into three shorter modules, to allow states to adopt subsets of questions which previously were mandated to be asked together.

3. Changes to the Data Collectors’ Protocol, to include information on partial completed interviews and changes in sampling.

Attachments

Attachment 5a-2020 BRFSS Questionnaire

Attachment 10a-2020 Calling Protocol and Dispositions

Background and Justification

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 (“states” or “BRFSS partners”). In addition, personal interviews are conducted in one territory where phone lines are unavailable. The currently approved survey instrument is based on modular design principles, consisting of a standardized core questionnaire administered by all states, and topic-specific optional modules that may be appended to the standardized core, at each state’s discretion. The modular design allows each state to customize the BRFSS questionnaire to address state-specific needs. To ensure that BRFSS content is relevant to the current needs of BRFSS partners, CDC updates selected items in the core questionnaire and/or the optional modules on an annual basis. Information collection needs and priorities for 2020 were discussed by CDC and the states at the annual BRFSS partners meeting held in April 2019. At that time states voted on the items to be modified in 2020. A field test of proposed changes was conducted under OMB review in June 2019, resulting in the finalization of minor changes to the core questionnaire for 2020, previously approved. The 2020 questionnaire includes 18 core sections and 23 modules. There are substantially fewer modules than in 2019 (when the questionnaire included 33 modules). There are only a few minor changes to the questionnaire to be approved in this change request. The table below lists all sections of the 2020 BRFSS core sections and optional modules to illustrate where in the questionnaire changes have been made.

Table 1 List of Changes to the BRFSS for 2020
Section	Previously Approved Text	New Text	Reason For Change
Introduction	HELLO, I am calling for the state of xxx Department of Health. My name is (name). We are gathering information about the health of US residents. This project is conducted by the health department with assistance from the Centers for Disease Control and Prevention. Your telephone number has been chosen randomly, and I would like to ask some questions about health and health practices.	HELLO, I am calling for the state of xxx Department of Health. My name is (name). We are gathering information about the health of US residents. This project is conducted by the health department with assistance from the Centers for Disease Control and Prevention. Your telephone number has been chosen randomly, and I would like to ask some questions about health and health practices.	By naming the state, respondents who had cell phones with local area codes assumed that they were not eligible. Since BRFSS interviews out-of-state residents and later transfers the data to the appropriate state, they are eligible. Removal of the state name eliminates some respondent confusion on eligibility for the survey.
Colorectal Cancer Screening	A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood. Have you ever had this test using a home kit? How long has it been since you had your last blood stool test using a home kit? Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the colon for signs of cancer or other health problems. Have you ever had either of these exams? For a sigmoidoscopy, a flexible tube is inserted into the rectum to look for problems. A colonoscopy is similar, but uses a longer tube, and you are usually given medication through a needle in your arm to make you sleepy and told to have someone else drive you home after the test. Was your most recent exam a sigmoidoscopy or a colonoscopy? How long has it been since you had your last sigmoidoscopy or colonoscopy?	The next questions are about the five different types of tests for colorectal cancer screening. A colonoscopy checks the entire colon. You are usually given medication through a needle in your arm to make you sleepy and told to have someone else drive you home after the test. Have you ever had a colonoscopy? How long has it been since you had this test? A sigmoidoscopy checks part of the colon and you are fully awake. Have you ever had a sigmoidoscopy? How long has it been since you had this test? Another test uses a special kit to obtain a small amount of stool at home to determine whether the stool contains blood and returns the kit to the doctor or the lab. Have you ever had this test using a home kit? How long has it been since you had this test? Another test uses a special kit to obtain an entire bowel movement at home and returns the kit to a lab. Have you ever had this test? How long has it been since you had this test? For a virtual colonoscopy, your colon is filled with air and you are moved through a donut shaped X-rays machine as you lie on your back and then on your stomach. Have you ever had a virtual colonoscopy? How long has it been since you had this test?	These questions have been previously reviewed by OMB as a module for odd year rotation and in a field test of BRFSS questions. Minor changes have been made to account for new home tests that are available. With the number of tests which are available it is important that the respondent can clearly differentiate among the types of test, so descriptions of the tests were added to the text. Changes in the virtual colonoscopy question were also made so that respondents did not respond that they had the test when in fact they had only seen video or photographs of the more common procedure for colonoscopy.
Cancer Survivorship Module	N/A	N/A	There are no changes in the questions to the cancer survivorship module. However the long old module which consisted of 13 questions has been divided into three modules: Type of Cancer (3 questions); Course of treatment (8 questions); Pain management (2 questions). This administrative change will allow states to adopt portions of the questions from the original module without committing to all of the questions. It will reduce burden for respondents.

There are not proposed changes to any modules offered in the administrations of the 2020 BRFSS.

Effect of Proposed Changes on the Burden Estimate

No increases are anticipated in burden estimate, as provided in the 2019 OMB review, and presented below in Table 2. Given the reduced number of optional modules provided for state use, it is likely that respondent burden will be lower than anticipated by preapproved estimates.

Table 2 Estimated Annual Burden to Respondents
Type of Respondents	Form Name	No. of Respondents	No. of Responses per Respondent	Avg. Burden per Response (in hr)	Total Burden (in hr)
U.S. General Population	Landline Screener	375,000	1	1/60	6,250
	Cell Phone Screener	292,682	1	1/60	4,879
	Field Test Screener	900	1	1/60	15
Annual Survey Respondents (Adults >18 Years)	BRFSS Core Survey	480,000	1	15/60	120,000
	BRFSS Optional Modules	440,000	1	15/60	110,000
Field Test Respondents (Adults >18 Years)	Field Test Survey	500	1	45/60	375
Total					241,519

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
5a- BRFSS Questionnaire	5a 2020 BRFSS Questionnaire
10a-2019 Calling Protocol and Dispositions	10a- 2020 Calling Protocol and Dispositions

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