Screening, HPV Vaccination, and Risk Factor Prevalence Estimates

Key points

  • Data on health risk behaviors are obtained from the Behavioral Risk Factor Surveillance System.
  • Teen vaccination coverage data are collected through the National Immunization Survey-Teen.

Screening and risk factors

Healthy behaviors such as being physically active, avoiding tobacco, limiting the amount of alcohol you drink, and getting cancer screening tests when recommended may prevent or help manage cancer.1

Monitoring health risk behaviors and the use of health care is fundamental to the development of effective public health programs and policies at the state and local levels.2

Cancer registries do not routinely collect information on health risk behaviors. So these data are obtained from the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is the nation's premier system of state-based health-related telephone surveys. The surveys collect data about adults' health-related risk behaviors, chronic health conditions, and use of preventive services. The BRFSS collects data in all 50 states, the District of Columbia, and three U.S. territories., and completes more than 400,000 interviews each year.

Prevalence is the measured or estimated percentage of people with an attribute or disease during a specific time period. The prevalence estimates are from the BRFSS core survey at the state level, as well as model-based prevalence estimates for all counties in the United States.

Age-adjusted prevalence is the measured or estimated percentage of people with an attribute or disease during a specific time period, standardized by direct method to the age distribution of the:

  • U.S. 2000 standard million population for state-level estimates.
  • Year 2000 U.S. population, distribution 9 for county estimates.3

Crude and age-adjusted prevalence are displayed for:

  • Female breast, cervical, and colorectal cancer screening.
  • Unhealthy behaviors including physical inactivity, poor nutrition, alcohol consumption, tobacco use, and obesity.

Estimates in the U.S. Cancer Statistics Data Visualizations tool may differ slightly from those published by the National Center for Health Statistics (NCHS) because NCHS uses the age groups recommended by the U.S. Department of Health and Human Services in its adjustment of death rates.

The 2000 U.S. standard population weights are not race- or sex-specific, so they do not adjust for differences in race or sex distribution between geographic areas or populations being compared. They do, however, provide the basis for adjusting for differences in the age distributions across groups defined by sex, race and ethnicity, geography, or other categories.

Data are suppressed if there are fewer than 50 respondents in a specific category such as sex, race, or ethnicity.

Small area estimates (county level)

County-level estimates are calculated using an innovative peer-reviewed multilevel regression and poststratification approach.4 The primary data sources are BRFSS and the Census 2010 population. You can learn details about the methodology.

The following list shows the measures displayed in the U.S. Cancer Statistics Data Visualizations tool. For measures included in the PLACES website, links to their definitions are also provided.

Cancer screening

Physical activity

Nutrition

  • Consumed fruits less than once a day among adults aged ≥18 years
  • Consumed vegetables less than once a day among adults aged ≥18 years

Alcohol use

Tobacco use

Obesity

Measures not available in PLACES

The following measures are not available in PLACES and are defined below. For more information, see the Calculated Variables in the 2021 Data File of the Behavioral Risk Factor Surveillance System.

150 minutes or more of aerobic physical activity per week

Demographic group: Adults aged 18 years or older.

Numerator: Adults aged 18 years or older who report 150 or more minutes of aerobic physical activity per week.

Denominator: Number of adults aged 18 years or older who reported information about any or no physical activity in the past month (excluding those who refused to answer, had a missing answer, or answered "don't know/not sure").

Measures of frequency: Annual prevalence: crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population, distribution 9)3 with 95% confidence intervals and by demographic characteristics when feasible.

Time period of case definition: Past month.

Consumed fruits less than once a day

Demographic group: Adults aged 18 years or older.

Numerator: Adults aged 18 years or older who report consuming fruits less than once per day.

Denominator: Number of adults aged 18 years or older who reported information about fruit consumption (excluding those who refused to answer, had a missing answer, or answered "don't know/not sure").

Measures of frequency: Annual prevalence: crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population, distribution 9)3 with 95% confidence intervals and by demographic characteristics when feasible.

Time period of case definition: Per day.

Consumed vegetables less than once a day

Demographic group: Adults aged 18 years or older.

Numerator: Adults aged 18 years or older who report consuming vegetables less than once per day.

Denominator: Number of adults aged 18 years or older who reported information about vegetable consumption (excluding those who refused to answer, had a missing answer, or answered "don't know/not sure").

Measures of frequency: Annual prevalence: crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population, distribution 9)3 with 95% confidence intervals and by demographic characteristics when feasible.

Time period of case definition: Per day.

Ever smoking

Demographic group: Adults aged 18 years or older.

Numerator: Adults aged 18 years or older who report they ever smoked 100 cigarettes.

Denominator: Number of adults aged 18 years or older who reported information about cigarette smoking (excluding those who refused to answer, had a missing answer, or answered "don't know/not sure").

Measures of frequency: Annual prevalence: crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population, distribution 9)3 with 95% confidence intervals and by demographic characteristics when feasible.

Time period of case definition: Lifetime.

Never smoking

Demographic group: Adults aged 18 years or older.

Numerator: Adults aged 18 years or older who report smoking fewer than 100 cigarettes.

Denominator: Number of adults aged 18 years or older who reported information about cigarette smoking (excluding those who refused to answer, had a missing answer, or answered "don't know/not sure").

Measures of frequency: Annual prevalence: crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population, distribution 9)3 with 95% confidence intervals and by demographic characteristics when feasible.

Time period of case definition: Lifetime.

Human papillomavirus (HPV) vaccination coverage

Vaccination against HPV is recommended to prevent new HPV infections and HPV-associated diseases, including some cancers.5

Teen vaccination coverage data displayed in U.S. Cancer Statistics Data Visualizations tool are collected through the National Immunization Survey-Teen (NIS-Teen). The NIS-Teen is a random-digit-dialed survey of parents or guardians of teens who are 13 to 17 years old. It has a sample size of more than 20,000 teens. The telephone survey is followed by a questionnaire mailed to vaccination providers to obtain the teen's vaccination history. Vaccination coverage estimates are based on provider-reported vaccination histories. Complex statistical methods are used to adjust for teens whose parents did not participate in the survey, who lived in households without telephones, or whose vaccination histories were not reported by their providers.

The Data Visualizations tool displays HPV vaccination coverage estimates (percentage) by sex for the entire United States, each state, and the District of Columbia. These estimates are for teens aged 13 to 17 years who were reported being up-to-date on HPV vaccination as recommended by the Advisory Committee on Immunization Practices.

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Content Source:
National Center for Chronic Disease Prevention and Health Promotion; Division of Cancer Prevention and Control
  1. Pickens CM, Pierannunzi C, Garvin W, Town M. Surveillance for certain health behaviors and conditions among states and selected local areas—Behavioral Risk Factor Surveillance System, United States, 2015. MMWR Surveill Summ. 2018;67(SS-9):1–90.
  2. Holt JB, Huston SL, Heidari K, et al. Indicators for chronic disease surveillance—United States, 2013. MMWR Recomm Rep. 2015:64(RR01):1–15.
  3. Klein RJ, Schoenborn CA. Age adjustment using 2000 projected U.S. population. Healthy People 2010 statistical notes, no. 20. Hyattsville, MD: U.S. Department of Health and Human Services, CDC, National Center for Health Statistics; 2001.
  4. Zhang X, Holt JB, Yun S, Lu H, Greenlund KJ, Croft JB. Validation of multilevel regression and poststratification methodology for small area estimation of health indicators from the Behavioral Risk Factor Surveillance System. Am J Epidemiol. 2015;182(2):127–137.
  5. Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019;68:698–702.