The indicators selected for the 2010 Colorado Health Report Card come from seven different data sources. The most frequently used source, the Behavioral Risk Factor Surveillance System (BRFSS), was used for 15 indicators. The BRFSS, Vital Statistics System and the Pregnancy Risk Assessment Monitoring System (PRAMS) are each maintained by state health departments in cooperation with the federal Centers for Disease Control and Prevention (CDC).1 CDC's administrative oversight and funding of these state data collection efforts ensure that indicators are comparable across states by using common data collection instruments. The Current Population Survey (CPS) is administered and maintained by the U.S. Census Bureau. The National Immunization Survey and the National Survey of Children's Health (NSCH) are administered through the CDC.
Behavioral Risk Factor Surveillance System Survey
The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based health survey that has been conducted since 1984. By 1994, all states, the District of Columbia and three territories were participating in the BRFSS. It is a cross-sectional, monthly telephone survey conducted by state health departments. Home telephone numbers are obtained through random-digit dialing and adults 18 years or older are asked to take part in the survey. BRFSS interviewers ask questions related to behaviors that are associated with preventable chronic diseases, injuries and infectious diseases. The content of the BRFSS questionnaire is determined by the state BRFSS coordinators and CDC. BRFSS data are weighted for the probability of selection of a telephone number, the number of adults in a household and the number of telephones in a household. A final poststratification adjustment is made for nonresponse and noncoverage of households without telephones. The weights for each relevant factor are multiplied together to get a final weight. Since 2002, in Colorado, more than 4,000 interviews have been conducted annually in English and Spanish.
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Current Population Survey
The Current Population Survey (CPS) is conducted by the U.S. Census Bureau annually. Respondents are drawn from the civilian noninstitutionalized population and from military personnel who live in households with at least one other civilian adult. In March of each year, CPS asks respondents about their insurance status and their income for the entire past calendar year. To obtain this information, the interviewer visits the sample address to determine if the sample unit exists, if it is occupied and if a responsible adult will provide the requested information. If someone at the sample unit agrees to the interview, a telephone survey is conducted at a scheduled time. Interviewers will complete an in-person interview with households that do not have a telephone or who have poor English language skills.
The specific questions to be asked appear on a computer screen, and the interviewer has been trained to ask each question exactly as it is worded. Based upon the response entered by the interviewer, the computerized questionnaire determines the next question to be asked. Completed interviews are electronically transmitted to a central processor where the responses are edited for consistency, imputations are made for missing data, and various codes are added. Based on the probability of selection, a weight is added to each responding household and person record so that estimates of the population match the population projections made by the Census Bureau. Statistical considerations require that averages be calculated from multiple years of data to produce stable estimates. In general, statewide data are reported as three-year averages.
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National Immunization Survey
The National Immunization Survey (NIS) is sponsored by CDC's National Immunization Program (NIP) and conducted jointly by NIP and CDC's National Center for Health Statistics (NCHS). The NIS is a list-assisted, random-digit-dialing telephone survey followed by a mailed survey to children's immunization providers that began data collection in April 1994 to monitor childhood immunization coverage.
The target population for the NIS is children between the ages of 19 and 35 months living in the United States at the time of the interview. Data from the NIS are used to produce timely estimates of vaccination coverage rates for all childhood vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP). Estimates are produced for the nation and for each of 78 Immunization Action Plan (IAP) areas, which consist of the 50 states, the District of Columbia and 27 large urban areas. The official estimates of vaccination coverage rates from the NIS are rates of being up-to-date with respect to the ACIP-recommended numbers of doses of vaccines. Vaccinations included in the survey are diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP), poliovirus vaccine (polio), measles-containing vaccine (MCV), Haemophilus influenzae type b vaccine (Hib), hepatitis B vaccine (Hep B), varicella zoster vaccine, pneumococcal conjugate vaccine (PCV), hepatitis A vaccine (Hep A) and influenza vaccine (FLU).
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The National Survey of Children's Health
The National Survey of Children's Health is a national survey conducted by NCHS. This telephone-based survey was first conducted in English and Spanish during 2003-2004 and for a second time in 2007-2008. The survey provides a broad range of information about children's health and well-being. Some of the topics covered in the survey are child and family demographics, children's physical and mental health status, health insurance status and type of coverage, access and use of health care services, and whether or not the child has a medical home.
Information from the survey is collected in a manner that allows for comparisons between states and at the national level. Telephone numbers are called at random to identify households with one or more children under 18 years old. In each household, one child was randomly selected to be the subject of the interview. The survey results are weighted to represent the population of noninstitutionalized children 0 to 17 years nationally and in each state.
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Pregnancy Risk Assessment Monitoring System
The Pregnancy Risk Assessment Monitoring System (PRAMS) is a state-specific, population-based telephone and mail survey that collects data on maternal attitudes and experiences before, during and immediately following pregnancy. Findings from the PRAMS survey are used to develop and assess perinatal health programs in public and private health care settings. In September of 1996, the Colorado Department of Public Health and Environment was awarded a grant from CDC to establish PRAMS in Colorado, and data collection began in the spring of 1997. Currently, there are 28 states participating in the PRAMS project. While each state's project is slightly different, data collection procedures and instruments are standardized to permit comparisons of data among the PRAMS states.
PRAMS uses a combination of two data collection approaches: statewide mailings of the surveys and telephone follow-up with women who do not return the survey by mail. Birth certificate data are also included for CDC reporting. The written questionnaires and telephone interviews can both be completed in Spanish when necessary. Approximately 240 women in Colorado will receive the survey each month, with an expected response rate of at least 70 percent. Data collected from women who gave birth in a given year are generally available for analysis and dissemination by late summer of the following year. The data are weighted annually for each state to adjust for nonresponse, noncoverage and sampling fractions. The annual weighted data sets contain data from all three sources.
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Vital Statistics System
The data included in the Vital Statistics System are provided through contracts between NCHS and vital registration systems operated in the various jurisdictions for events such as births, deaths, marriages, divorces and fetal deaths. In the United States, legal authority for the registration of these events resides individually with the 50 states, two cities (Washington, D.C., and New York City), and five territories (Puerto Rico, the Virgin Islands, Guam, American Samoa and the Commonwealth of the Northern Mariana Islands). These jurisdictions are responsible for maintaining registries of vital events and for issuing copies of birth, marriage, divorce and death certificates.
Standard forms for data collection and model procedures for the uniform registration of the events are developed and recommended for nationwide use through cooperative agreements between state jurisdictions and NCHS. Data related to births and causes of death for Colorado can be found at the Colorado Department of Public Health and Environment website.
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Youth Risk Behavior Survey
The Youth Risk Behavior Survey (YRBS) is one component of the Youth Risk Behavior Surveillance System developed by CDC in collaboration with representatives from multiple federal, state and local departments of education and health. The national sampling frame includes both public and private high schools, though only public high schools are surveyed in Colorado. High schools are randomly selected in proportion to enrollment size. To enable a separate analysis of data for black and Hispanic students, certain schools were oversampled. Individual classrooms are randomly selected within each sampled school, and all students in sampled classrooms are surveyed. Forty-seven states participated in the 2009 YRBS. In the 2009 national sample, 16,460 questionnaires were completed in 158 schools with an overall response rate of 67 percent.
The YRBS is a self-administered, anonymous questionnaire covering behaviors related to injuries and violence; tobacco, alcohol and drug use; sexual behaviors that result in HIV infection, other sexually transmitted diseases and unintended pregnancies; dietary behaviors; and physical activity. Local school parental permission procedures are followed before survey administration. View results from the Youth Risk Behavior Survey, 2009.
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- Not all states participate in the NCHS, YRBSS and PRAMS. The number of states providing indicator values derived from these surveys is illustrated on each indicator page and in the summary table.