Surveys may have a bad rap as sneaky ways to sell consumers more stuff or find out more about them. But health surveys have a higher goal: They might ask whether you smoke, whether you have been tested for HIV and whether you got a flu shot this year because the answers are crucial for government agencies, research scientists and others who assess health issues and make policy decisions. The information is often used to determine funding and initiate programs that might improve lives and extend life spans.
For example, in New Mexico, health experts cited data from the Behavioral Risk Factor Surveillance Survey showing that colorectal-cancer screening rates were significantly better in states with mandatory insurance coverage for the testing. That prompted New Mexico’s legislature to pass a law requiring that insurers cover colorectal screening for residents 50 and older.
In the District, BRFSS data have been used to compile a comprehensive overview of how often people get themselves screened for breast cancer and cervical cancer, and to provide baseline data for the city’s diabetes program. (This information was used to create consumer fact sheets and to aid in applying for grants.)
BRFSS, a national survey coordinated annually by the Centers for Disease Control and Prevention, has long been the model to follow for health surveys. Traditionally done by random-digit dialing of land-line telephone numbers, it got responses from more than 350,000 adults in 2010. But growing privacy concerns and changes in communications technology have caused a drop in response rates for the BRFSS and other surveys. And health researchers are desperate to adapt to the new reality.
“Telecommunication is changing around us, and we have to adapt as fast as we can in order to stay in business,” says Ali Mokdad, a former director of the BRFSS who is now a professor of global health at the Institute of Health Metrics and Evaluation at the University of Washington.
Thirty percent of U.S. households now have no land line and rely on cellphones, according to the National Center for Health Statistics. That’s up 14 percentage points from three years earlier. So the BRFSS began calling cellphone numbers in 2009.
But calling cellphones, which would include cellphone-only users, raises the question of how representative the survey will be.
Research published in 2009 by Stephen Blumberg, a senior scientist at the NCHS, found that cellphone-only users were more likely than land-line-only and land-line-plus-cellphone users to be male, Hispanic and young, with incomes below the poverty level. In addition, they were more likely than others to binge-drink and smoke, to have been tested for HIV and to have no health insurance. As a result of these differences, simply adding cellphone users to the survey can skew results.