Behavioral Risk Factor
Surveillance System
The Behavioral Risk Factor Surveillance System
(BRFSS) is the world’s largest telephone survey.
The BRFSS tracks health risks throughout the
entire United States. Information from the survey
is used to improve the health of the American people.
Hawaii’s Behavioral Risk Factor Surveillance
System (BRFSS) is conducted and administrated
by the Hawaii Department of Health in collaboration
with the Centers for Disease Control and
Prevention (CDC). The results from the BRFSS are
used by the state to help formulate public health
policies, prevention and health promotion programs.
(http://www.hawaii.gov/health/statistics/
brfss/index.html)
Community
Communities (sub-county geographic regions) in
this report are defined by the aggregation of adjacent
zip codes with at least one school complex in
the area. A list of community zip codes can be
found at: http://www.state.hi.us/doh/stats/surveys/
2001/subarea.html
Diabetes
Adult respondents are asked, “Have you ever been
told by a doctor that you have diabetes?” If the
respondent is a female and her answer to that
question is “Yes”, then she is further asked, “Was
Diabetes Prevalence
• Prevalence rate
Diabetes prevalence rate is defined as the estimated
number of adults with diabetes divided
by the estimated total adult population. All
percentages or prevalence rates presented in all
the tables except the mortality tables are
weighted percentages.
• Age-adjusted prevalence rate
It is often necessary to compare diabetes rates
of different populations and/or years.
However, since diabetes rates increase with
age, a higher diabetes rate in one population
compared with another may simply reflect differing
age distributions within the populations.
Statistical techniques are used to “adjust” or
“standardize” the rates in the populations to
be compared, eliminating the effect of different
age distributions in the different populations.
Prevalence rates computed with these techniques
are called age-adjusted or age-standardized
prevalence rates. An age-adjusted prevalence
rate is not a real measure of condition
within a given population, but rather an artificial
measure that is used for comparison purposes.
In this report, prevalence rates with age
adjustment employed the age distribution #9
of the Year 2000 Projected U.S. Population
(DHHS/CDC/NCHS, 2001).
End-stage Renal Disease (ESRD)
• Incidence rate
The crude ESRD incidence rate is equal to the
number of newly diagnosed persons receiving
chronic ESRD therapy (dialysis) per million
population during 2002.
• Prevalence rate
The crude ESRD dialysis prevalence rate is
equal to the total number of persons presently
on dialysis per million population during 2002.
Ethnicity
Respondents are asked to choose one race from the
race list to answer the question: “What is your
race?” The race list includes Caucasian, Hawaiian,
Chinese, Filipino, Japanese, Korean, Samoan,
Black, American Indian/Alaska
native/Eskimo/Inuit, Vietnamese, Asian Indian,
Portuguese, Guamanian/Chamorro, Puerto Rican,
Mexican, Tongan, Laotian, Cambodian, Malaysian,
Fijian, Micronesian, and other Asian. In addition,
a respondent can specify their own ethnicity if it is
not listed, or they can say they don’t know, they
are not sure, or they refuse to answer. For simplicity,
this report re-categorizes ethnicity into White
(includes Portuguese), Hawaiian, Filipino,
Japanese, and “Others” (includes Chinese).
Mortality
• Diabetes mortality rate
The mortality rate is the frequency of occurrence
of death (diabetes-related) in a defined
population. Population denominators (916,580
adults) were estimated from the Hawaii
Behavioral Risk Factor Surveillance System,
2000~2002.
• Contributory cause of death (CCD)
Contributory cause of death is defined as conditions
that did not initiate the chain of events
leading to death, but resulted in death directly
or indirectly; or any other significant conditions
that unfavorably influenced the course of
the morbid process and thus contributed to the
fatal outcome.
• Underlying cause of death (UCD)
Underlying cause of death is defined as the
disease/condition that initiated the chain of
events leading to death.
Survey (BRFSS) Definitions
• Bodyweight status
The BRFSS uses Body Mass Index (BMI) as a
measure of bodyweight. Cutoffs for weight status
are defined as follows: normal weight (BMI
<> 25 and <> 30)
• Diabetes management education
The BRFSS uses the following question to
define diabetes management education: “Have
you ever taken a course or class in how to
manage your diabetes yourself?”
• Diabetes-related eye condition
The BRFSS uses the following question to define
diabetes-related eye complications: “Has a doctor
ever told you that diabetes has affected your
eyes or that you had retinopathy?”
• Diabetes-related foot complication
The BRFSS uses the following question to
define foot complications related to diabetes:
“Have you ever had any sores or irritations on
your feet that took more than four weeks to
heal?”
• General health status
The BRFSS uses the following question to
define and quantify general health status:
“Would you say that in general your health is:
1) Excellent, 2) Very Good, 3) Good, 4) Fair, or
5) Poor?”
• Physical activity (leisure time activity)
The BRFSS defines “no leisure time activity” as
those responding no to the question, “During
the past month, other than your regular job,
did you participate in any physical activities or
exercise such as running, calisthenics, golf, gardening,
or walking for exercise?”
• Smoking status
The BRFSS defines a “current smoker” as a
person who responds yes to the question
“Have you smoked at least 100 cigarettes in
your life time,” and still smokes everyday or
some days. A “former smoker” is a person
who smoked a least 100 cigarettes before, but
does not smoke anymore.
• Vegetable/fruit consumption
The BRFSS estimates the number of daily servings
of fruit/vegetable by asking the following
series of questions “Not counting juice, how
often do you eat fruit? How often do you eat
green? How often do you eat potatoes not
including French fries, fried potatoes, or potato
chips? How often do you eat carrots? Not
counting carrots, potatoes, or salad, how many
serving of vegetables do you usually eat?”
Surveillance System
The Behavioral Risk Factor Surveillance System
(BRFSS) is the world’s largest telephone survey.
The BRFSS tracks health risks throughout the
entire United States. Information from the survey
is used to improve the health of the American people.
Hawaii’s Behavioral Risk Factor Surveillance
System (BRFSS) is conducted and administrated
by the Hawaii Department of Health in collaboration
with the Centers for Disease Control and
Prevention (CDC). The results from the BRFSS are
used by the state to help formulate public health
policies, prevention and health promotion programs.
(http://www.hawaii.gov/health/statistics/
brfss/index.html)
Community
Communities (sub-county geographic regions) in
this report are defined by the aggregation of adjacent
zip codes with at least one school complex in
the area. A list of community zip codes can be
found at: http://www.state.hi.us/doh/stats/surveys/
2001/subarea.html
Diabetes
Adult respondents are asked, “Have you ever been
told by a doctor that you have diabetes?” If the
respondent is a female and her answer to that
question is “Yes”, then she is further asked, “Was
this only when you were pregnant?” Gestational
diabetes is excluded from diabetes in this report.Diabetes Prevalence
• Prevalence rate
Diabetes prevalence rate is defined as the estimated
number of adults with diabetes divided
by the estimated total adult population. All
percentages or prevalence rates presented in all
the tables except the mortality tables are
weighted percentages.
• Age-adjusted prevalence rate
It is often necessary to compare diabetes rates
of different populations and/or years.
However, since diabetes rates increase with
age, a higher diabetes rate in one population
compared with another may simply reflect differing
age distributions within the populations.
Statistical techniques are used to “adjust” or
“standardize” the rates in the populations to
be compared, eliminating the effect of different
age distributions in the different populations.
Prevalence rates computed with these techniques
are called age-adjusted or age-standardized
prevalence rates. An age-adjusted prevalence
rate is not a real measure of condition
within a given population, but rather an artificial
measure that is used for comparison purposes.
In this report, prevalence rates with age
adjustment employed the age distribution #9
of the Year 2000 Projected U.S. Population
(DHHS/CDC/NCHS, 2001).
End-stage Renal Disease (ESRD)
• Incidence rate
The crude ESRD incidence rate is equal to the
number of newly diagnosed persons receiving
chronic ESRD therapy (dialysis) per million
population during 2002.
• Prevalence rate
The crude ESRD dialysis prevalence rate is
equal to the total number of persons presently
on dialysis per million population during 2002.
Ethnicity
Respondents are asked to choose one race from the
race list to answer the question: “What is your
race?” The race list includes Caucasian, Hawaiian,
Chinese, Filipino, Japanese, Korean, Samoan,
Black, American Indian/Alaska
native/Eskimo/Inuit, Vietnamese, Asian Indian,
Portuguese, Guamanian/Chamorro, Puerto Rican,
Mexican, Tongan, Laotian, Cambodian, Malaysian,
Fijian, Micronesian, and other Asian. In addition,
a respondent can specify their own ethnicity if it is
not listed, or they can say they don’t know, they
are not sure, or they refuse to answer. For simplicity,
this report re-categorizes ethnicity into White
(includes Portuguese), Hawaiian, Filipino,
Japanese, and “Others” (includes Chinese).
Mortality
• Diabetes mortality rate
The mortality rate is the frequency of occurrence
of death (diabetes-related) in a defined
population. Population denominators (916,580
adults) were estimated from the Hawaii
Behavioral Risk Factor Surveillance System,
2000~2002.
• Contributory cause of death (CCD)
Contributory cause of death is defined as conditions
that did not initiate the chain of events
leading to death, but resulted in death directly
or indirectly; or any other significant conditions
that unfavorably influenced the course of
the morbid process and thus contributed to the
fatal outcome.
• Underlying cause of death (UCD)
Underlying cause of death is defined as the
disease/condition that initiated the chain of
events leading to death.
Survey (BRFSS) Definitions
• Bodyweight status
The BRFSS uses Body Mass Index (BMI) as a
measure of bodyweight. Cutoffs for weight status
are defined as follows: normal weight (BMI
<> 25 and <> 30)
• Diabetes management education
The BRFSS uses the following question to
define diabetes management education: “Have
you ever taken a course or class in how to
manage your diabetes yourself?”
• Diabetes-related eye condition
The BRFSS uses the following question to define
diabetes-related eye complications: “Has a doctor
ever told you that diabetes has affected your
eyes or that you had retinopathy?”
• Diabetes-related foot complication
The BRFSS uses the following question to
define foot complications related to diabetes:
“Have you ever had any sores or irritations on
your feet that took more than four weeks to
heal?”
• General health status
The BRFSS uses the following question to
define and quantify general health status:
“Would you say that in general your health is:
1) Excellent, 2) Very Good, 3) Good, 4) Fair, or
5) Poor?”
• Physical activity (leisure time activity)
The BRFSS defines “no leisure time activity” as
those responding no to the question, “During
the past month, other than your regular job,
did you participate in any physical activities or
exercise such as running, calisthenics, golf, gardening,
or walking for exercise?”
• Smoking status
The BRFSS defines a “current smoker” as a
person who responds yes to the question
“Have you smoked at least 100 cigarettes in
your life time,” and still smokes everyday or
some days. A “former smoker” is a person
who smoked a least 100 cigarettes before, but
does not smoke anymore.
• Vegetable/fruit consumption
The BRFSS estimates the number of daily servings
of fruit/vegetable by asking the following
series of questions “Not counting juice, how
often do you eat fruit? How often do you eat
green? How often do you eat potatoes not
including French fries, fried potatoes, or potato
chips? How often do you eat carrots? Not
counting carrots, potatoes, or salad, how many
serving of vegetables do you usually eat?”
