Behavioral Risk Factor Surveillance System (BRFSS)

BRFSS collects state-specific data on preventive health practices and risk behaviors linked to chronic diseases, injuries, and preventable infectious diseases that affect adults. It is a collaborative program conducted by the Centers for Disease Control and Prevention (CDC) in which all 50 states, 3 U.S. territories and the District of Columbia participate.  BRFSS data are collected annually through a random-digit-dialed telephone (landline and cell) survey. Survey respondents are non-institutionalized adults (18 years or older) living in the U.S.

The BRFSS survey contains a standard set of core questions asked by every state; however, states can elect to include questions from optional modules on specific topics, as well as state-added questions. To collect important demographic information for employed adults, the CDC’s National Institute for Occupational Safety and Health (NIOSH) sponsored the BRFSS industry and occupation (I&O) optional module for years 2013–2017. Participants who were employed for wages, self-employed, or out of work for less than one year at the time of their interview were defined as “employed” and were asked these two I&O questions:

• Industry:
  • “What kind of business or industry do you work in, for example, hospital, elementary school, clothing manufacturing, restaurant?”
• Occupation:
  • “What kind of work do you do, for example, registered nurse, janitor, cashier, auto mechanic?”

The workers surveyed included those who worked for small businesses and contractors, or were self-employed.  Participants’ responses were coded to 2002 U.S. Census Bureau industry and occupation numeric codes using the NIOSH Industry and Occupation Computerized Coding System and human coders. For these analyses, the Census codes were grouped into the 21 North American Industrial Classification System (NAICS, 2002) sectors and 23 Standard Occupation Classification (SOC, 2000) major groups. Branches of the U.S. armed forces were excluded from analyses because the BRFSS data are not representative for active duty military.

Learn more about data collection and coding

BRFSS Interviewers: Tips for Obtaining Good Industry and Occupation Information, NIOSH BRFSS I&O Project. February 2015.

• Find other Industry and Occupation (I&O) coding resources

The following details the states participating in the I&O module in 2013 and 2014 and describes the study population used for the data tables.

2013 Data

The following is a description of the data sources for the I&O optional module collected during the 2013 BRFSS.

• In 2013, 19 states adopted the I&O optional module: California, Florida, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Oregon, Utah, and Wisconsin.
• Washington and Wyoming added I&O as state-added questions and gave CDC permission to include their data in the aggregate dataset.
  • Data Source: Washington State Department of Health, Center for Health Statistics, Behavioral Risk Factor Surveillance System, supported in part by Centers for Disease Control and Prevention, Cooperative Agreement, U58/SO000047-1 through 3 (2011-2013).
  • Data Source: Wyoming Department of Health, Public Health Division, Behavioral Risk Factor Surveillance System, supported in part by Centers for Disease Control and Prevention, Cooperative Agreement, U58/SO000016-1 through 3 (2011-2013).
• 102,258 BRFSS participants were currently employed and considered for analyses.
• Participants missing industry or occupation information were excluded from those analyses, respectively. Active duty military in non-military housing (not a representative sample of the military) or unpaid or retired workers who were inadvertently identified as employed were also excluded from analyses.
  Total excluded:
  • From industry analyses: 3,115 (3.0% of the sample)
  • From occupation analyses: 6,592 (6.4% of the sample)

2014 Data

• In 2014, 25 states adopted the I&O optional module: Colorado, Connecticut, Georgia, Idaho, Illinois, Iowa, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oregon, Tennessee, Utah, Vermont, Washington.
• 104,885 BRFSS participants were currently employed and considered for analyses.
• Participants missing industry or occupation information were excluded from those analyses, respectively. Active duty military in non-military housing (not a representative sample of the military) or unpaid or retired workers who were inadvertently identified as employed were also excluded from analyses.
  Total excluded:
  • From industry analyses: 2,969 (2.8% of the sample)
  • From occupation analyses: 6,634 (6.3% of the sample)

Learn more about the prevalence of health behaviors, health outcomes and access to care among various industries and occupations (unadjusted and weighted estimates) presented in these tables.

The BRFSS survey is cross-sectional, so it is not possible to make causal inferences. BRFSS responses are self-reported and, therefore, rely on the accuracy of a participant’s recall. The data used in this study were from an optional industry and occupation module not administered by every state so the results may not be nationally representative.

Websites

• CDC’s Behavioral Risk Factor Surveillance System (BRFSS) Main Website.
• NIOSH Industry and Occupation Coding Resources.
• NIOSH State-based Occupational Health Clearinghouse – search for state reports produced by states using the BRFSS data. The Clearinghouse also offers other state-produced publications that center on workplace safety and health surveillance.

Journal Articles

• Shockey TM, Zack M, Sussell A [2017]. Health-related quality of life among US workers: variability across occupation groups. Am J Public Health.
• O’Halloran AC, Lu PJ, Williams WW, Schumacher P, Sussell A, Birdsey J, Boal WL, Sweeney MH, Luckhaupt SE, Black CL, Santibanez TA [2017]. Influenza vaccination among workers—21 U.S. states, 2013.  Am J Infect Control 45:410-416.
• Marcum JL, Chin B, Anderson NJ, Bonauto DK [2017]. Self-reported work-related injury or illness — Washington, 2011‒2014.  MMWR 66:302‒306.
• CDC [2017]. Short sleep duration by occupation group — 29 states, 2013‒2014. MMWR 66:207‒213.
• CDC [2016]. Asthma among employed adults, by industry and occupation — 21 States, 2013. MMWR 65:1325‒1331.
• CDC [2016]. Cardiovascular health status by occupational group — 21 states, 2013. MMWR 65:794-798.
• CDC [2016]. Seat belt use among adult workers — 21 states, 2013. MMWR 65:593-597.
• Towle M, Tolliver R, Bui AG, Warner A, Van Dyke M [2015]. Adding industry and occupation questions to the Behavioral Risk Factor Surveillance System: new opportunities in public health surveillance. Public Health Rep. 130:153-60.
• Anderson NJ, Fan ZJ, Reeb-Whitaker C, Bonauto DK, Rauser E [2014].  Distribution of asthma by occupation:  Washington State Behavioral Risk Factor Surveillance System data, 2006‒2009. J Asthma 51:1035‒1042.
• Bonauto DK, Lu D, Fan ZJ [2014].  Obesity prevalence by occupation in Washington State, Behavioral Risk Factor Surveillance System.  Prev Chronic Dis 11:130219.
• Anderson NJ, Bonauto DK, Fan ZJ, Spector JT [2012].  Distribution of influenza-like illness (ILI) by occupation in Washington State, September 2009‒August 2010. PLoS One 7:e48806.
• Fan ZJ, Bonauto DK, Foley MP, Anderson NJ, Yragui NL, Silverstein BA [2012].  Occupation and the prevalence of current depression and frequent mental distress, WA BRFSS 2006 and 2008.  Am J Ind Med 55:893‒903.
• Fan ZJ, Anderson NJ, Foley M, Rauser E, Silverstein, BA [2011].  The persistent gap in health-care coverage between low- and high-income workers in Washington State:  BRFSS, 2003‒2007.  Public Health Rep 126:690‒699.
• Jarman DW, Naimi TS, Pickard SP, Daley WR, De AK [2007].  Binge drinking and occupation, North Dakota, 2004‒2005.  Prev Chronic Dis 4:A94.

State Reports

• Find State Reports in the State-based Occupational Health Clearinghouse.
• Michigan State University. [Spring 2017]. Prevalence in Michigan of cigarette smoking, COPD and asthma by occupation and industry. Project S.E.N.S.O.R News. 28(2).
• Massachusetts Department of Health [Fall 2016]. Asthma in Massachusetts Home Care Aides. Occupational Lung Disease Bulletin, Data Brief.
• New Hampshire Comprehensive Cancer Collaboration. [November 2016.] Examining Preventive Cancer Screening Rates among Vulnerable Adults in New Hampshire.
• Vermont Department of Health [November 2016]. General Worksite Wellness — Data Brief (4 of 4), 2014 Vermont Behavioral Risk Factor Surveillance System (BRFSS).
• Vermont Department of Health [October 2016]. Worksite Wellness & Risk Behaviors — Data Brief (3 of 4), 2014 Vermont Behavioral Risk Factor Surveillance System (BRFSS).
• Vermont Department of Health [September 2016]. Worksite Wellness: Chronic Disease — Data Brief, 2014 Vermont Behavioral Risk Factor Surveillance System (BRFSS).
• Vermont Department of Health [September 2016]. Worksite Wellness — Data Brief (1 of 4), 2014 Vermont Behavioral Risk Factor Surveillance System (BRFSS).
• Washington State Department of Labor and Industries [September 2016]. BRFSS 2012‒2014: Demographic and Employment Characteristics of Cell Phone Only Respondents.
• Louisiana Department of Health [May 2016]. Louisiana Service Worker Wellness Report, Results from the Behavioral Risk Factor Surveillance System 2013 and 2014.
• Massachusetts Department of Public Health [January 2016]. Putting Data to Work, 23 Health Indicators by Occupation and Industry: Findings from the Massachusetts Behavioral Risk Factor Surveillance System, 2012-2013.
• Utah Department of Health [September 2015]. Utah Health Status Update: Industry and Occupation Impact on Health.
• New Hampshire Division of Public Health Services [June 2015].Utilization of the NH Behavioral Risk Factor Surveillance System (BRFSS) to Better Understand Under-Reporting of Work-Related Injuries.
• New Hampshire Division of Public Health Services [November 2014]. Asthma Prevalence among New Hampshire Workers, Behavioral Risk Factor Surveillance System, 2011-2012.
• Montana Department of Labor and Industry [July 2014]. Industry and Occupation in the Behavioral Risk Factor Surveillance System (BRFSS): a Data Comparison.
• New Hampshire Division of Public Health Services [April 2014]. Health Behaviors of New Hampshire Healthcare Workers NH BRFSS.
• Massachusetts Department of Public Health [April 2014]. A Profile of Health among Massachusetts Adults, 2012: Results from the Behavioral Risk Factor Surveillance System.
• New Mexico Department of Health [March 2014]. Occupation and Health in New Mexico.
• Massachusetts Department of Health [Fall 2013]. On-the-job exposure to environmental tobacco smoke (ETS) in Massachusetts.
• Massachusetts Department of Public Health [October 2012]. Burden of Asthma among Massachusetts Service Workers, 2010.
• New Hampshire Division of Public Health Services [June 2011].  Using the 2008 NH Behavioral Risk Factor Surveillance System (BRFSS) to Estimate the Number of Work-related Injuries with Associated Payer.
• Massachusetts Department of Health [2010].Use of an Industry Sector Pick List to Collect Industry of Employment in the Massachusetts Behavioral Risk Factor Surveillance System (BRFSS).

BRFSS Newsletter Articles

• State Spotlight: Louisiana. Spring 2017
• State Spotlight: New Hampshire. Fall 2016.
• State Spotlight: New Hampshire. Fall 2014.
• State Spotlight: Washington. Summer 2014.
• State Spotlight: Massachusetts. Spring 2014.

Presentations

• Tippani SR, Zhang L, Vargas R. Mississippi State Department of Health. Prevalence of Cigarette Smoking by Industry and Occupation among Mississippi Adults. CSTE Annual Meeting, June 2016.
• Anderson NJ, Fan J, Bonauto DK, Lu W. Using the Behavioral Risk Factor Surveillance System (BRFSS) for Occupational Health. (Washington). BRFSS Data Users Webinar, August 2014.