Judith Graber M'S'1, Michele Polacsek Ph'D', M'H'S'2'

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BRFSS
State-Added Questions Missing the Big Picture

• Judith Graber M.S.1, Michele Polacsek Ph.D.,
  M.H.S.2.
• PRESENTED BY
• Katie Meyer ScD 1,3
• Chronic Disease Epidemiologist
• 1Maine Bureau of Health 2 Maine Center for Public
  Health
• 3 University of Southern Maine

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ME BRFSS State-Added Question Protocol

• Criteria and Procedures For Adding Questions to
  The Maine Behavioral Risk Factor Surveillance
  System
• Developed after reviewing other states procedure
• Largely based on Delaware's protocol
• Effective January 1, 2003

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State-Added Question Protocol

• Defines core, module and state-added questions
• Establishes a Questionnaire Advisory Committee
• Comprised of both program and technical staff
• Delineates cost, timeline and question placement
• Describes the application process

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Application process Modules

• Relevance to public health in Maine
• How the data will be used
• Who else will use the data
• Other sources of data
• Justification based on sample size
• How often repeat questions

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Application State-added questions

• Coordinator works closely with program to
  identify/develop questions
• Everything asked of the modules plus
• Source of the questions
• Extent of cognitive/validity testing
• Extent of field testing

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Application process Modules

• Applications must be made by a Maine Bureau of
  Health Program
• Outside agencies are encouraged to partner with
  BOH programs
• e.g. Maine Housing Authority partnered with the
  Maine Lead Prevention Program to develop KAB
  questions about lead poisoning in children

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Application process Something Missing

• Process was driven by categorically funded public
  health programs
• Potential exclusion of questions that cut across
  program areas
• Address SES or other social issues
• e.g. Sexual orientation social capital
  state-specific ethnicity/race questions

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Something Missing

• Cross-cutting questions can
• Be useful to multiple programs and statewide
  public health objectives.
• Be critical in better understanding the patterns
  and determinants of chronic disease.
• Enhance the use of BRFSS data for program
  planning, implementation and evaluation.

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Cross-cutting Questions Process

• Partnered with the Maine Center for Public Health
  to develop and implement 5-step process
• Engage key stakeholders to identify topics
• Prioritize the topics
• Identify questions to be used
• Distribute the results to stakeholders and,
• Complete questionnaire application process.
• .

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1. Engage key stakeholders

• Upper-level political buy-in
• Discuss idea with key Division Directors and
  State Health Officer
• Requires access and/or persistence
• Frontline Participation
• Program managers and epidemiologists
• Held discussion group to identify topics of
  interest

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1. Engage key stakeholders

• Demographics
• Born in Maine Occupation
• Sexual orientation
• Programmatic
• Media use/ information sources

• Risk Factors
• Depression (untreated)
• Food insecurity
• Social capital civic engagement
• Social capital social isolation
• Television watching/screen time
• Time driving/walking

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1. Engage key stakeholders

• Demographics
• Born in Maine Occupation
• Sexual orientation
• Programmatic
• Media use/ information sources

• Risk Factors
• Depression (untreated)
• Food insecurity
• Social capital civic engagement
• Social capital social isolation
• Television watching/screen time
• Time driving/walking

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2. Prioritize the topics

• Two steps
• Survey
• BOH leadership input

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2. Prioritize the topics

• Survey
• Developed a survey sent by e-mail to
• 22 BOH programs
• 4 epidemiologists
• Sent follow-up e-mail as reminder 1 week later
• Targeted follow-up with heavy BRFSS data users

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(No Transcript)
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2. Prioritize the topics

• Response rate about 59 (13 Reponses)
•  

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2. Prioritize the topics

• 2. Meet with BOH Leadership
• Division directors
• Very keen on depression/less on social capital
• State Health Officer to make final decision
• Very keen on social capital and sexual orientation

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2. Prioritize the topics

• Decision
• Sexual orientation Run every year
• Social capitol social isolation
• Depression
• Would like to run together but dont have room

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Identify questions to be used

• Social isolation
• Conducted literature review (MCPH)
• Reviewed BRFSS state-added data base
• Identified three areas
• Attendance at community meetings
• Membership in clubs
• Social connectivity
• .

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Social Isolation

• Attendance at community meetings
• In the past year, have you attended a local
  community event, such as a church supper, school
  concert or fair?
• In the past year, did you attend a public meeting
  on a town or school issue?

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Social Isolation

• Membership in clubs
• Are you an active member of a local organization
  or club?
• INTERVIEWER INSTRUCTIONS Examples can be given
  are such as social clubs, sports or craft clubs
  

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Social Isolation

• Social connectivity
• Thinking about the past month, how often have you
  had phone conversations with friends or family,
  would you say
• Thinking about the past month,, how often have
  you visited with friends or family or had friends
  and family visit with you
• Scale responses (very often, often..)

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Sexual Orientation

• Now I'll read a list of terms people sometimes
  use to describe themselves -- heterosexual or
  straight homosexual, gay or lesbian and
  bisexual.  As I read the list again, please stop
  me when I get to the term that best describes how
  you think of yourself
•  READ LIST
• FROM Greg Herek, UC Davis
• Found looking on Medline for related articles and
  contacting authors.
• Used in RDD survey on sexuality

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Depression

• Will use BRFSS Healthy Days Module

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Distribute the results to stakeholders

• Didnt do as good a job as wanted
• Most stakeholders informed at annual BRFS
  questionnaire meeting
• .

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Complete questionnaire application process.

• Questions for 2004 submitted to BRFSS
  Questionnaire Committee
• Sexual Orientation
• Social Capital
• Good feed-back/refinements
• Will run 2004
• .

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What next?

• Conduct analysis using 2004 BRFSS data to see if
  new questions useful to BOH programs
• Evaluate with programs
• .

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Lessons

• Traditional question selection processes may miss
  cross cutting questions
• Needed early buy-in from BOH leadership
• Partnering with outside agency can provide
  expertise and objectivity
• .