2.2 - Sources of Public Health Surveillance Data

Integrated Surveillance Information Systems/National Electronic Disease Surveillance System
In the U.S., this has been developed to standardize health reporting and link laboratory, hospital, and managed care data.

Pennsylvania’s Department of Health Vital Records

Enterprise Data Dissemination Informatics Exchange (EDDIE)
This is an interactive health statistics dissemination web tool where you can create customized data tables, charts and maps for various health related data.
 
CDC WONDER
This organization furthers the CDC's mission of health promotion and disease prevention by speeding and simplifying access to public health information for state and local health departments, the Public Health Service, and the academic public health community.

SEER
Surveillance, Epidemiology, and End Results Program of the National Cancer Institute

The SRTR Database
The Scientific Registry of Transplant Recipients

U.S. Fire Administration (USFA)
The USFA collects data from a variety of sources to provide information and analyses on the status and scope of the fire problem in the United States.

The Behavioral Risk Factor Surveillance System (BRFSS) is the nation’s premier system of health-related telephone surveys that collect state data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services. Established in 1984 with 15 states, BRFSS now collects data in all 50 states as well as the District of Columbia and three U.S. territories. BRFSS completes more than 400,000 adult interviews each year, making it the largest continuously conducted health survey system in the world.

Health Survey	Target Population	Mode/ Sampling Strategy/Size	Health Issues; Example of a Disease/ Outcome and an Exposure
BRFSS	Non-institutionalized adult residents of the 50 states and the District of Columbia and selected territories	Mode: telephone (cell and landline) survey Sampling strategy: Random-digit dial with post-stratification weighting Size: 400,000+ each year	Health-related risk behaviors and events, chronic health conditions, use of preventive services, emerging health issues (e.g. vaccine shortage, influenza-like illnesses) Example: 2012, Number of adults age 50+ Who Had Blood Stool Test Screening within Last Two Years for Colorectal Cancer 38.8% Yes(CI 31.7-45.9, n=208) No 61.2% (CI 54.1-68.3, n=308) http://apps.nccd.cdc.gov/brfsssmart/MMSARiskChart.as p?yr=2012&MMSA=281&c at=CC&qkey=8521&grp=0

The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of health-related behaviors that contribute to the leading causes of death and disability among youth and adults, including—

• Behaviors that contribute to unintentional injuries and violence
• Sexual behaviors related to unintended pregnancy and sexually transmitted diseases, including HIV infection
• Alcohol and other drug use
• Tobacco use
• Unhealthy dietary behaviors
• Inadequate physical activity

YRBSS also measures the prevalence of obesity and asthma and other health-related behaviors plus sexual identity and sex of sexual contacts.

YRBSS is a system of surveys. It includes 1) a national school-based survey conducted by CDC and state, territorial, tribal, and 2) local surveys conducted by state, territorial, and local education and health agencies and tribal governments.

Health Survey	Target Population	Mode/ Sampling Strategy/Size	Health Issues; Example of a Disease/ Outcome and an Exposure
YRBSS	Students in public and private high school (9th-12th grade) at the national, state, and local levels in the U.S.	Mode: Anonymous, school-based questionnaire survey, administered in odd-numbered years. Sampling strategy: multi-stage cluster design. Size: In 2013, 13,000 youth in 42 states, 21 large urban schools, some tribal governments	Behaviors that contribute to unintentional injuries and violence, Sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection, Alcohol, and other drug use, Tobacco use, Unhealthy dietary behaviors, Inadequate physical activity, obesity, and asthma Example: among U.S. high school students surveyed in 2013146.8% had ever had sexual intercourse 34.0% had had sexual intercourse during the previous 3 months, and, of this 40.9% did not use a condom the last time they had sex 15.0% had had sex with four or more people during their life http://www.cdc.gov/healthyyouth/sexualbehaviors/index.htm

The National Health Interview Survey (NHIS) has monitored the health of the nation since 1957. NHIS data on a broad range of health topics are collected through personal household interviews. Survey results have been instrumental in providing data to track health status, health care access, and progress toward achieving national health objectives.

• This website provides an Interactive Data Query System for accessing data from the NHIS: https://www.cdc.gov/nchs/nhis/shs.htm

Health Survey	Target Population	Mode/ Sampling Strategy/Size	Health Issues; Example of a Disease/ Outcome and an Exposure
NHIS	Noninstitutionalized civilian adult population residing in the United States	Mode: Cross-sectional household interview survey Sampling Strategy: stratified multistage household sample, with oversampling of elderly and minorities. Size: 30,000-40,000 households per year (75,000-100,000 persons)	Monitor trends in illness and disability, track progress toward achieving national health objectives, epidemiologic and policy analysis of such timely issues as characterizing those with various health problems, determining barriers to accessing and using appropriate health care, and evaluating Federal health programs. Example: In 2012 the NHIS showed that 18% percent of U.S. adults were current smokers and 21% were former smokers http://www.cdc.gov/nchs/ data/series/sr_10/sr10_26 0.pdf

The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations. NHANES is a major program of the National Center for Health Statistics (NCHS). NCHS is part of the Centers for Disease Control and Prevention (CDC) and has the responsibility for producing vital and health statistics for the Nation.

The NHANES program began in the early 1960s and has been conducted as a series of surveys focusing on different population groups or health topics. In 1999, the survey became a continuous program that has a changing focus on a variety of health and nutrition measurements to meet emerging needs. The survey examines a nationally representative sample of about 5,000 persons each year. These persons are located in counties across the country, 15 of which are visited each year.

The NHANES interview includes demographic, socioeconomic, dietary, and health-related questions. The examination component consists of medical, dental, and physiological measurements, as well as laboratory tests administered by highly trained medical personnel.

Findings from this survey will be used to determine the prevalence of major diseases and risk factors for diseases. Information will be used to assess nutritional status and its association with health promotion and disease prevention. NHANES findings are also the basis for national standards for such measurements as height, weight, and blood pressure. Data from this survey will be used in epidemiological studies and health sciences research, which help develop sound public health policy, direct and design health programs and services, and expand the health knowledge for the Nation.

Health Survey	Target Population	Mode/ Sampling Strategy/Size	Health Issues; Example of a Disease/ Outcome and an Exposure
NHANES	Non-institutionalized adults and children in U.S.	Mode: Face-to-face interviews and clinical examinations. Sampling strategy: Multistage area probability sampling. Size: 5,000 persons each year.	Determine the prevalence of major diseases and risk factors for diseases assess nutritional status and its association with health promotion and disease prevention. Establishes the basis for national standards for such measurements as height, weight, and blood pressure. Example: During 2007– 2012, 46.2% of adults aged 40–79 with lung obstruction currently smoked cigarettes. About 41% with mild and 55% with moderate or worse obstruction were current smokers. http://www.cdc.gov/nchs/ data/databriefs/db181.html

The California Health Interview Survey (CHIS) is the largest state health survey in the nation. It is a web and telephone survey that asks questions on a wide range of health topics. CHIS is conducted on a continuous basis allowing the survey to generate timely one-year estimates. CHIS provides representative data on all 58 counties in California and provides a detailed picture of the health and healthcare needs of California’s large and diverse population.

Health Survey	Target Population	Mode/ Sampling Strategy/Size	Health Issues; Example of a Disease/ Outcome and an Exposure
CHIS	Non-institutionalized civilian population of California (adults, teenagers and children)	Mode: Telephone (cell phones and land-lines) survey Sampling strategy: random-digit-dial with a supplemental surname list frame for Korean and Vietnamese populations. Size: 42,000-50,000	From asthma, diabetes, and obesity to immigrant health and health insurance coverage, CHIS covers dozens of essential health topics. Example: Projections from the California Simulation of Insurance Markets (CalSIM) model indicate that up to half of Californians remaining uninsured will be undocumented immigrants who are not eligible under the Affordable Care Act (ACA). Most others lacking insurance will be eligible for Medi-Cal or subsidized insurance through Covered California but remain unenrolled due to difficulties with the enrollment process, inability to afford coverage, concerns about negative immigration-related consequences for themselves or their family members, or other barriers. Almost three/fourths of the remaining uninsured will be Latino, almost one-third will reside in Los Angeles County, and about 70 percent will CHIS is conducted by the UCLA Center for Health Policy Research in collaboration with the California Department of Public Health and the Department of Health Care Services be exempt from paying a tax penalty for lacking coverage. http://healthpolicy.ucla.edu /chis/research/Pages/default.aspx