Problem: Chronic diseases (e.g., diabetes, cancer, heart disease, and stroke) are the leading causes of morbidity and mortality in the United States. Data on health risk behaviors that increase the risk for chronic diseases and use of preventive practices are essential for the development, implementation, and evaluation of health promotion programs, policies, and intervention strategies to decrease or prevent the leading causes of morbidity and mortality. Surveillance data from states and territories, selected metropolitan and micropolitan areas, and counties are vital components of these various prevention and intervention strategies.

Reporting Period: January--December 2008

Description of the System: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit--dialed telephone survey of noninstitutionalized adults residing in the United States. BRFSS collects data on health risk behaviors, preventive health services and practices, and access to health care related to the leading causes of death and disability in the United States. This report presents results for 2008 for all 50 states, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, 177 metropolitan and micropolitan statistical areas (MMSAs), and 266 counties.

Results: In 2008, the estimated prevalence of high-risk behaviors, chronic diseases and conditions, screening practices, and use of preventive health-care services varied substantially by state and territory, MMSA, and county. The following is a summary of results listed by BRFSS question topic. Each set of proportions refers to the range of estimated prevalence for the disease, condition, or behavior as reported by the survey respondent. Adults reporting good or better health: 68% to 89% for states and territories and 69% to 93% for selected MMSAs and counties. Health care insurance coverage: 72% to 96% for states and territories, 61% to 97% for MMSAs, and 61% to 98% for counties. Teeth extractions among persons aged ≥65 years: 10% to 38% for states and territories, 5% to 36% for MMSAs, and 4% to 34% for counties. Adults who had a checkup during the preceding 12 months: 56% to 81% for states and territories, 51% to 85% for MMSAs, and 51% to 89% for counties. Influenza vaccination among persons aged ≥65 years: 31% to 78% for states and territories, 52% to 82% for MMSAs, and 51% to 86% for counties. Pneumococcal vaccination among persons aged ≥65 years: 28% to 73% for states and territories, 46% to 82% for MMSAs, and 41% to 83% for counties. Adults aged ≥50 years who had a sigmoidoscopy/colonoscopy: 38% to 74% for states and territories, 45% to 78% for selected MMSAs, and 45% to 80% for counties. Adults aged ≥50 years who had a blood stool test during the preceding 2 years: 8% to 29% for states and territories, 7% to 51% for MMSAs, and 7% to 40% for counties. Among women aged ≥18 years who had a Papanicolaou test during the preceding 3 years: 67% to 89% for states and territories, 66% to 93% for selected MMSAs, and 66% to 96% for counties. Women aged ≥40 years who had a mammogram during the preceding 2 years: 64% to 85% for states and territories, and 61% to 88% for MMSAs and counties. Men aged ≥40 years who had a Prostate-Specific Antigen (PSA) test during the preceding 2 years: 34% to 66% for states and territories, 39% to 70% for MMSAs, and 37% to 71% for counties. Current cigarette smoking among adults aged ≥18 years: 6% to 27% for states and territories, 5% to 31% for MMSAs, and 5% to 30% for counties. Adults who reported binge drinking during the preceding month: 8% to 23% for states and territories, 3% to 25% for selected MMSAs, and 3% to 26% for counties. Heavy drinking among adults during the preceding month: 3% to 8% for states and territories, <1% to 10% for MMSAs, and 1% to 11% for counties. Adults who reported no leisure-time physical activity: 18% to 47% for states and territories, 12% to 40% for MMSAs, and 10% to 40% for selected counties. Adults who were overweight (BMI ≥25.0 and <30.0): 33% to 40% for states and territories, 31% to 46% for selected MMSAs, and 28% to 50% for counties. Adults aged ≥20 years who were obese (BMI ≥30.0): 20% to 34% for states and territories, 15% to 40% for MMSAs, and 13% to 40% for counties. Asthma among adults: 5% to 11% for states and territories, 4% to 13% for MMSAs, and 4% to 15% for counties. Diabetes among adults: 6% to 12% for states and territories, 3% to 17% for selected MMSAs, and 3% to 14% for counties. Adults aged ≥18 years who had limited activity because of physical, mental, or emotional problems: 10% to 30% for states and territories, 13% to 33% for MMSAs, and 12% to 31% for counties. Adults who required use of special equipment: 4% to 11% for states and territories, 3% to 12% for MMSAs, and 2% to 13% for counties. Angina and coronary heart disease among adults aged ≥45 years: 5% to 19% for states and territories, 6% to 22% for MMSAs, and 4% to 22% for counties. Adults aged ≥45 years with a history of stroke: 3% to 7% for states and territories, 2% to 11% for selected MMSAs, and 1% to 12% for counties.

Interpretation: The findings in this report indicate substantial variation in health-risk behaviors, chronic diseases and conditions, and use of preventive health-care services among U.S. adults at the state and territory, MMSA, and county level. The findings underscore the continued need for surveillance of health-risk behaviors, chronic diseases and conditions, and the use of preventive health services.