BRFSS Data Release Notes

General Release Notes

2022 BRFSS

Race/Ethnicity Data

HHDW has been working on standardizing the category descriptions across data sets. As part of this standardization the display order for DOH Race/Ethnicity has been changed to be the same across all data sets. The new display order is:

American Indian or Alaska Native
Black
Chinese
Filipino
Japanese
Other Asian
Native Hawaiian
Other Pacific Islander
White
Other*

*Note: In 2022, the "Other" category was not included in the response options for MRACE2. Accordingly, users will notice an unusually low response rate for this race/ethnicity category. The Hawaiʻi BRFSS program has worked with the CDC to ensure this response option will be included in the 2023, 2024 and future surveys.

The display order for Census Race has also been changed to be the same across all data sets. The new display order is:

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian and Other Pacific Islander
White
Other

New indicators added in 2022

Access to Health Care

Health Insurance - have coverage (2021+)
Health Insurance - have coverage (18-64, 2021+)
Health care access - have a personal HCP (2021+)
Health care access - have a personal HCP (2021+, cat)

Chronic Diseases and Conditions

CHD or heart attack prevalence
Cancer - age when diagnosed (cat)

Demographics

Household income expanded (2021+)

Health Behaviors

Spinal cord injury - ever had
Spinal cord injury - disability status (cat)
Traumatic brain injury - ever had
Traumatic brain injury - disability status (cat)
Physical activity - in neighborhood 1+ days, past 30 days
Physical activity - in neighborhood 15+ days, past 30 days

Screening and Preventive Services

Colorectal screening - meets new guidelines (45-75)
Colorectal screening - blood stool test in past year (45-75)
Sunburn - in past 12 months (cat)
Sunburn - painful, 1+ times, in past 12 months
Sunburn - painful, in past 12 months (cat)
HPV - number of shots received (18-49, cat)
Tetanus - shot in past 10 years

2021 BRFSS

Race/Ethnicity Title Changes

With the 2021 data load we made a couple of changes to the race/ethnicity titles, to be consistent across data sets and years. Now, we are using "White" and "American Indian or Alaska Native" as category titles.

Indicator Category Changes

With the 2021 data load we made several changes to the categories and sub-categories. We alphabetized the categories and created a new category for Substance Use and new subcategories in Demographics, Health Behavior and Mental Health Status. Here is a listing of all of the current categories and subcategories:

Access to Health Care

Caregiving
Insurance and Health Care Access

Chronic Diseases and Conditions

Arthritis
Asthma
Cancer
Diabetes
Heart Disease
High Blood Pressure and Cholesterol
Other Chronic Conditions

Demographics

Age, Sex and Race/ethnicity
Employment and Income
Geography
Sexual Identity and Orientation
Other

General Health Status and Disability

Body Mass Index (BMI)
Disability
Health Status

Health Behaviors

Family Planning
Injury
Intimate Partner and Sexual Violence
Nutrition
Nutrition - Food Insecurity
Physical Activity
Sleep

Mental Health Status

Adverse Childhood Experiences
Cognitive Decline
Mental Health

Screening and Preventive Services

Blood Cholesterol
Cancer Screening - General
Cancer Screening - Sex-Specific
HIV Screening
Immunization and Preventive Health
Oral Health

Substance Use

Alcohol Use
Marijuana
Prescription Medication
Tobacco Use - Cessation and Second Hand Smoke
Tobacco Use - Prevalence

New BRFSS indicators added in 2021

There are many new indicators available:

Access to Health Care

Caregiving - person receiving care has dementia
Caregiving - age of person receiving care (cat)

Chronic Diseases and Conditions

Arthritis - self-management class, ever
Arthritis - HCP suggested physical activity
Cancer - treatment status (cat)
Cancer - participated in a clinical trial
Cancer - ever denied insurance
Kidney disease - with high blood pressure

Health Behaviors

IPV - unwanted sex, ever
IPV - physical abuse, ever
IPV - physical injuries, past 12 months
Food security - can't afford balanced meals
Food security - food didn't last

Screening and Preventive Services

PSA test - discussed with health care professional (40+)
HPV - at least one vaccine (18-49)

Substance Use

Marijuana - current use
Marijuana - frequent use
Marijuana - method of use (cat)
Marijuana - reason for use (cat)
Any tobacco - current use
Cigarettes - usually smoke menthol
Cigarettes/e-cigarettes - current use
Cigars - current use
Cigars - 3 level smoking status (cat)

2020 BRFSS

New BRFSS indicators added in 2020

There are many new indicators available:

Demographics

Housing - stand alone or multiunit

Health Behavior

Physical activity - swimming
Physical activity - snorkeling
Physical activity - surfing
Physical activity - boogie board or body surfing
Physical activity - paddle boarding
Physical activity - free diving
Prescription meds - time since last use
Prescription meds - pain meds left over, past year
Prescription meds - disposition of left over pain meds
Cessation - used a proven method, past 12 months

Screening and Preventive Services

PSA test - recommended by health care professional (40+)
PSA test - main reason for last test (40+, cat)
Oral health - all permanent teeth removed (45+)
Oral health - at least six teeth removed

Chronic Diseases and Conditions

Arthritis - moderate or severe pain, past 30 days
Cancer - current cancer or treatment pain
Cancer - pain status, amg those with pain (cat)
Cancer - pain under control, amg those with pain
Cancer - doctor who provides most health care (cat)
Cancer - insurance paid for treatment
Cancer - received written follow up care instructions
Cancer - 5 year survivor

Mental Health Status

HHDW has a new module for Adverse Childhood Experiences (ACE).

ACE - emotional abuse
ACE - physical abuse
ACE - sexual abuse
ACE - domestic violence in household
ACE - problem drinking or drug use in household
ACE - mental illness in household
ACE - parental separation or divorce
ACE - incarcerated household member
ACE - count (cat)
ACE - problem drinking in household
ACE - problem drug use in household
ACE - ever forced to have sex
ACE - ever touched sexually
ACE - ever forced to touch someone sexually
Increased confusion, memory loss - get help for daily activities (45+)

2019 BRFSS

The default report has been changed to the statewide estimate for the most recent three years of data. This change was implemented to better align with our other data sources. Users can still view all years of data and data by county by clicking on the Modify Query Definition, selecting all available years (Step 2: TIME PERIOD), setting the geography to county (Step 3: GEOGRAPHIC AREA), selecting geography as the display by (category) (Step 8), and clicking submit.

New BRFSS indicators added in 2019

There are many new indicators available:

Demographics

Census race
Primary care service area
Food security - food stamps or SNAP benefits
Food security - received free food

Health Behaviors

Alcohol - max number of drinks (cat)
Cessation - used a program or support group, past 12 months
Cessation - used a quitline, past 12 months
Cessation - used one-on-one counseling, past 12 months
Cessation - used patch, gum, or meds, past 12 months
Cessation - without help, past 12 months
Cigarettes - among adults with poor mental health
Cigarettes - among binge drinkers
Cigarettes - among heavy or binge drinkers
Daily frequency of total fruit and vegetable consumption (2017+, cat)
Daily frequency of total vegetable consumption (2017+, cat)
Family planning - any, last intercourse
Family planning - method used (cat)
Family planning - reason none used (cat)
Fell - treatment received, past 12 months (45+, cat)
Injury - can swim
Injury - ocean-based recreation
Physical activity - in neighborhood, past 30 days (cat)
Physical activity - neighborhood supports
Prescription meds - pain meds, past year
Read calories in restaurants (cat)
Read calories in restaurants, ever
Seat belt - seen or heard seat belt back seat msg
SSB - consumption per day (cat)
SSB - consumption per week (cat)
Sweetened drinks - consumption per day (cat)
Sweetened drinks - consumption per week (cat)

Access to Health Care

Caregiving - main health problem (cat)
HCP arranged home health services
HCP referred to community based services
Health care access - have personal doctor
Health insurance - have Medicaid (2017+)

Screening and Preventive Services

Cholesterol - check in the last 5 yrs
HIV - high risk situations (18-64, 2017+)
Preventive services - checkup within the past year
Shingles - ever received vaccine (50+)

Chronic Diseases and Conditions

Asthma - current prevalence
Cancer - number of different types (cat)
Cholesterol - taking medicine for high blood cholesterol
Chronic conditions - 1 or more
Chronic conditions - count (cat)
Diabetes - prediabetes prevalence
Diabetes - self-management plan (cat)
Diabetes - self-management plan ever
HBP - self-management plan (cat)

New BRFSS dimensions added in 2019

A new geographic dimension was added in 2019 to allow users to view reports by Primary Care Service Area.

There are also several new dimensions available to allow users to view reports by other health behaviors or conditions:

Diabetes
Obese (BMI greater than or equal to 30)
Cancer (ever diagnosed with any kind of cancer)
Current Cigarette Smoker
Meets Physical Activity Recommendations (aerobic and strengthening)

Change in the raking methodology

The 2019 BRFSS raking method includes categories of age by gender, detailed race and ethnicity groups, education levels, marital status, regions within states, gender by race and ethnicity, telephone source, renter or owner status, and age groups by race and ethnicity.

2018 BRFSS

Changes in the race/ethnicity dimensions.

In 2018, the Hawaiʻi Department of Health (DOH) revised how it collects race/ethnicity information in the Behavioral Risk Factor Surveillance System (BRFSS). The new methodology better aligns with national data collection standards and complies with the race/ethnicity algorithm used by the Office of Health Status Monitoring in DOH.

There are now two versions of DOH race/ethnicity: (2011+, new) and (2011-2017).

DOH race/ethnicity (2011+, new) includes data from 2011-2017 which have been harmonized with 2018 data to be consistent across survey years and instruments. We will be supporting this dimension going forward.
DOH race/ethnicity (2011-2017) is the old version which you have seen in the past. Because of the changes, the 2018 BRFSS data is not available for the DOH race/ethnicity (2011-2017) dimension.

For a limited time, both versions of DOH race/ethnicity will be available, to give users an opportunity to compare and assess the impact of this change on indicators that are of interest to them. Please plan on transitioning to the new (2011+, new) race/ethnicity dimension going forward, as this is the new standard for DOH.

Program race/ethnicity (2011+, new) has also changed and includes data from 2011 forward. This dimension has been streamlined into 15 categories, down from 40 categories, based on changes in the data collection instrument.
In 2018, the Department of Health (DOH) revised how it collects race/ethnicity information in the Behavioral Risk Factor Surveillance System (BRFSS). The new methodology better aligns with national data collection standards and complies with the race/ethnicity algorithm used by the Office of Health Status Monitoring in DOH.

Poverty Level (2014+) dimension.

This new socioeconomic indicator dimension is based on multiple questions including the number of people living in the household and the annual household income from all sources. These numbers are compared to the annual US Department of Health and Human Services Poverty Guidelines to approximate the respondent's Federal Poverty Level percentage. This data is available from 2014 to the most recent year. Queries that request an indicator by this dimension will only include data from 2014 forward.

Sexual and Gender Minority (2014+) dimension.

This new demographic indicator dimension is based on sexual orientation and transgender identity. Adults who identify their sexual orientation as gay, lesbian, bisexual or something else, or who identify as transgender are coded as "yes" all others are coded as "no". This data is available from 2014 to the most recent year. Queries that request an indicator by this dimension will only include data from 2014 forward.

Transgender (2014+) dimension.

This new demographic indicator dimension is based on transgender identity. Adults who identify as transgender (male-to-female, female-to-male or gender non-conforming) are coded as "yes" all others are coded as "no". This data is available from 2014 to the most recent year. Queries that request an indicator by this dimension will only include data from 2014 forward.

2017 BRFSS

The underlying SAS code was modified to more accurately generate the asymmetric confidence intervals that occur when point prevalences approach 0 and 1. This code change will impact all BRFSS reports. As a result, there may be slight differences in confidence intervals and relative standard errors, and hence, reportability, from previous years. Please check your query results carefully and re-run reports as necessary. HI-IBIS runs on SAS version 9.4 (SAS Institute Inc: Cary, NC).

2014 BRFSS

Beginning in 2014, all adults contacted through their cellular telephones are eligible to participate in the survey, regardless of their landline phone use (complete overlap).

2011 BRFSS

The BRFSS raking method includes categories of age by gender, detailed race and ethnicity groups, education levels, marital status, regions within states, gender by race and ethnicity, telephone source, renter or owner status, and age groups by race and ethnicity.

All Years

Race/Ethnicity Data

Respondents are asked the following question to ascertain their race/ethnicity:

Which one or more of the following would you say is your race?

This question is used to create the Race/ Ethnicity classifications. In HHDW, the most granular level is the program race/ethnicity (PRG) which rolls up into the DOH standard race/ethnicity (DOH), which rolls up into Census race reporting categories (Census). The table below illustrates how the data is aggregated.

Race/Ethnicity Classifications
Source Race/Ethnicity	Program Race/Ethnicity (PRG)	DOH Race/Ethnicity (DOH)	Census Race (Census)
American Indian or Alaska Native	American Indian or Alaska Native	American Indian or Alaska Native	American Indian or Alaska Native
Asian Indian	Asian Indian	Other Asian	Asian
Black	Black	Black	Black or African American
Chinese	Chinese	Chinese	Asian
Filipino	Filipino	Filipino	Asian
Guamanian or Chamorro	Guamanian or Chamorro	Other Pacific Islander	Native Hawaiian and Other Pacific Islander
Hawaiian	Hawaiian	Native Hawaiian	Native Hawaiian and Other Pacific Islander
Japanese	Japanese	Japanese	Asian
Korean	Korean	Other Asian	Asian
Samoan	Samoan	Other Pacific Islander	Native Hawaiian and Other Pacific Islander
Vietnamese	Vietnamese	Other Asian	Asian
Other Asian	Other Asian	Other Asian	Asian
Other Pacific Islander	Other Pacific Islander	Other Pacific Islander	Native Hawaiian and Other Pacific Islander
White	White	White	White
Other	Other	Other	Other

Documentation

Documentation is available here to describe how we collect and map race/ethnicity, geography, and poverty level.

HHDW Race/Ethnicity Documentation

HHDW Geography Documentation

HHDW Poverty Level Documentation

HHDW Sexual and Gender Minority Documentation

Other Information

Note about indicator/dimension titles:

The BRFSS is constantly changing. HHDW staff carefully review the BRFSS survey instrument each year to assess how changes in the survey instrument impact indicators and dimensions within the HHDW system. When an indicator has multiple categorical responses (other than Yes/No) the indicator title will have "(cat)" at the end. For example, Alcohol - max number of drinks (cat) or Daily frequency of total fruit consumption (cat). When an indicator or dimension is not available across all years, this information will be added to the name. For example, there are two versions of Adults with at least one disability: (2016+) and (2013-2016). In 2016, a question about auditory disability was added to the BRFSS so a new indicator was created to capture any disability including hearing issues--Adults with at least one disability (2016+). Poverty level (2014+) is available from 2014 forward only based on when questions about household members for cell phone respondents were added to the survey. A query with data by Poverty level (2014+) dimension will only contain data from 2014+ regardless of the years of data for the base indicator. If you have questions, check the Question Wording in the Data Notes section of the report.