Agencies That Collect Health Care Data (BRFSS, NVSS, NHIS, NHANES, U.S. Census Bureau): Case Study Answers

Case study assignment

We learn that health care services require such elements as a robust financing mechanism; a well-trained and adequately paid workforce; well-maintained facilities and logistics to deliver quality medicines and technologies, and one important element is “reliable information on which to base decisions and policies” according to the World Health Organization (WHO). Choose one (1) of the following agencies that collect health care data: Behavioral Risk Factor Surveillance System (BRFSS), National Vital Statistics System (NVSS), National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), or U.S. Census Bureau.

Once you have selected your agency, answer the following questions:

Summarize the type of data the agency collects and how they ensure the reliability of their surveys.
Provide three (3) facts you learned from the agency’s most recent publication, resources, fact sheet or data related to current challenges in the U.S. health care system.
How do basic demographic characteristics of the U.S. population affect mortality and morbidity, and why is this important?
What health care system challenges are unique to the state you reside in? How do they relate to primary, secondary, and tertiary prevention?
In the city where you reside, what community-based care, public health clinics, ambulatory care, outpatient, long-term, and emergency care are available to you?

Why health data matter

The World Health Organization lists reliable health information among the essential building blocks of a well-functioning health system, alongside financing, workforce, facilities, medicines and leadership (World Health Organization [WHO], 2010). In the United States, several federal data systems supply that information. They show who is sick, who is dying and why, who has insurance, and where gaps in care exist. Policymakers, public health departments, hospitals and nurses use these data to set priorities, allocate resources and evaluate programs.

The five data sources at a glance

Before choosing one agency, it helps to understand how the five sources differ.

Data source	Run by	How data are collected	Main types of data
BRFSS (Behavioral Risk Factor Surveillance System)	CDC, with state health departments	State-based telephone survey (landline and cell phone) of adults 18+; more than 400,000 interviews a year	Health risk behaviors (smoking, physical activity, alcohol), chronic conditions, health-care access, preventive services; state-level estimates
NVSS (National Vital Statistics System)	CDC National Center for Health Statistics (NCHS)	Compiles birth and death certificates from all states and territories	Births, deaths, causes of death, life expectancy, infant and maternal mortality, fetal deaths
NHIS (National Health Interview Survey)	NCHS (interviews conducted by Census Bureau field staff)	Continuous, in-person household interviews, with telephone follow-up, of a nationally representative sample	Health status, chronic conditions, disability, insurance coverage, access to and use of care
NHANES (National Health and Nutrition Examination Survey)	NCHS	Household interviews plus physical examinations and laboratory tests in mobile examination centers	Measured blood pressure, BMI, cholesterol, diabetes (including undiagnosed), nutrition, environmental exposures
U.S. Census Bureau	U.S. Department of Commerce	Decennial census; American Community Survey (ACS); Current Population Survey	Population size, age, sex, race and ethnicity, income, poverty, education, disability, health insurance coverage

The worked example below uses BRFSS as the selected agency, with Texas and Houston as the example state and city. Students should answer questions 4 and 5 for their own state and city. A quick guide to doing that appears at the end.

1. BRFSS: type of data collected and how reliability is ensured

Type of data

Established in 1984, the BRFSS is the nation’s premier system of health-related telephone surveys and the largest continuously conducted health survey in the world. It completes more than 400,000 adult interviews each year in all 50 states, the District of Columbia and participating U.S. territories (Centers for Disease Control and Prevention [CDC], n.d.). It collects data on:

Health risk behaviors: tobacco use, alcohol use, physical inactivity, diet, seat belt use.
Chronic health conditions: obesity, diabetes, heart disease, asthma, arthritis, depression, cancer.
Health-care access: insurance, having a personal doctor, cost as a barrier to care.
Use of preventive services: cancer screening, immunizations, HIV testing.
Optional state modules on topics such as caregiving, cognitive decline, social determinants of health and adverse childhood experiences.

Because BRFSS produces state-level (and some local) estimates, it is widely used by state health departments and feeds national tools such as CDC PLACES, the Chronic Disease Indicators and Healthy People 2030 objectives.

How BRFSS ensures reliability

Standardized questionnaire: a core set of questions asked the same way in every state, which allows comparisons across states and over time. New questions undergo cognitive testing before use.
Probability sampling: random-digit-dialing samples of both landline and cell phone numbers. Cell phones were added in 2011 to reach the growing number of people without landlines.
Statistical weighting (raking): responses are weighted to match the population by age, sex, race and ethnicity, education, marital status, home ownership, region and phone ownership. This reduces bias from non-response and coverage gaps.
Trained interviewers and computer-assisted telephone interviewing (CATI): scripted, consistent administration with built-in skip patterns and range checks.
Data quality review: CDC cleans and checks data, publishes response rates and data quality reports, and suppresses estimates based on small samples.
Validation research: studies comparing BRFSS with other national surveys have found most measures to be reliable and valid (Pierannunzi et al., 2013).

Limitations: BRFSS data are self-reported. For example, people tend to under-report weight and over-report height, so self-reported obesity is usually lower than measured obesity in NHANES. Response rates have declined over time, and people without phones are excluded.

2. Three facts from BRFSS’s most recent data

The most recent BRFSS-based Adult Obesity Prevalence Maps, using 2025 data and updated in September 2026, highlight obesity as a major and unequal challenge for the U.S. health care system (CDC, 2026a):

Obesity remains very high nationwide. In 2025, 21 states, plus Guam and Puerto Rico, had an adult obesity prevalence of 35% or higher, and no state had a prevalence below 25%. Only the District of Columbia was under 25%. Obesity drives diabetes, heart disease, some cancers and health care costs.
Obesity is unequally distributed by race and ethnicity. Using combined 2023–2025 data, obesity prevalence was 35% or higher among American Indian or Alaska Native adults in 36 of 44 states with data, among Black adults in 35 states plus DC, and among Hispanic adults in 32 states, compared with only 13 states for White adults and none for Asian adults.
Middle-aged adults are most affected. Obesity was highest among adults aged 40–59: 40 states had a prevalence of 35% or higher in this age group, compared with 6 states for adults aged 18–39 and 11 states for adults 60 and older (CDC, 2026b). This is the age at which chronic diseases begin to accumulate and when prevention can have a large impact.

3. How demographic characteristics affect mortality and morbidity, and why this matters

Basic demographic characteristics, including age, sex, race and ethnicity, income, education and geography, strongly shape who becomes ill and who dies.

Characteristic	Effect on morbidity and mortality
Age	Chronic disease, disability and death rise sharply with age. The aging U.S. population increases demand for chronic, long-term and end-of-life care. Leading causes of death differ by age: unintentional injury (including overdose) and suicide dominate in younger adults, and heart disease and cancer in older adults.
Sex	Women live longer than men on average, but report more chronic conditions and disability. Men have higher death rates from heart disease, injuries, overdose and suicide.
Race and ethnicity	American Indian/Alaska Native and Black Americans experience shorter life expectancy and higher rates of diabetes, hypertension, obesity, and maternal and infant mortality, largely because of structural racism, socioeconomic disadvantage and unequal access to care.
Income and education	Lower income and education are linked with higher rates of smoking, obesity, chronic disease and premature death, and with less access to insurance and preventive care.
Geography	Rural residents face higher death rates from heart disease, injury and suicide, along with fewer hospitals and providers.

National mortality data show both progress and ongoing challenges. U.S. life expectancy rose to a record 79.0 years in 2024, the age-adjusted death rate fell almost 4%, and drug overdose deaths declined sharply, although about 79,000 people still died of overdoses. Heart disease, cancer and unintentional injuries remained the leading causes of death (National Center for Health Statistics [NCHS], 2026).

Why this is important: demographic patterns tell health systems and nurses where to focus. They help:

target prevention and screening to the groups at highest risk;
allocate resources (clinics, workforce, funding) to underserved areas;
plan for future needs, such as an aging population;
design culturally appropriate interventions; and
measure progress toward health equity goals such as those in Healthy People 2030.

4. Health care challenges unique to the state (example: Texas)

Example only. Students should describe their own state.

Uninsurance: Texas has had the highest uninsured rate in the nation for many years, according to U.S. Census Bureau data, and it has not expanded Medicaid. Uninsured residents often delay care until conditions become emergencies.
Rural access: Texas has many rural counties with few or no hospitals, primary care providers or obstetric services, and has lost rural hospitals in recent years.
Chronic disease burden: high rates of obesity and type 2 diabetes, especially in Hispanic communities and along the U.S.–Mexico border.
Border and immigrant health: language barriers, fear of using services, and infectious disease risks such as tuberculosis.
Climate and disasters: extreme heat, hurricanes and flooding disrupt care and worsen chronic illness.
Workforce shortages: shortages of nurses, primary care providers and mental health professionals in many counties.

Relationship to the three levels of prevention

Level	Definition	Example in this state
Primary prevention	Prevents disease before it occurs	Community nutrition and physical activity programs to prevent obesity and diabetes; vaccinations; heat-safety education; tobacco prevention
Secondary prevention	Detects disease early to limit its impact	Diabetes, blood pressure and cancer screening at community health centers and mobile clinics for uninsured residents; TB screening
Tertiary prevention	Reduces complications and disability from established disease	Diabetes self-management education, foot and eye care to prevent amputation and blindness, cardiac and stroke rehabilitation, dialysis access

The high uninsured rate weakens primary and secondary prevention, because people miss screenings and early treatment. As a result, more care shifts to costly tertiary care and emergency departments.

5. Care available in the city (example: Houston, Texas)

Example only. Students should list services in their own city.

Type of care	Examples available in Houston
Community-based care	Federally qualified health centers (FQHCs) such as Legacy Community Health and community clinics; faith-based health ministries; home health and hospice agencies; community health worker programs
Public health clinics	Houston Health Department health centers (immunizations, STI testing, WIC, TB control); Harris County Public Health clinics
Ambulatory care	Harris Health System community health centers; primary care and specialty clinics; urgent care centers; retail clinics
Outpatient care	Outpatient centers of Texas Medical Center institutions (for example, Houston Methodist, Memorial Hermann, MD Anderson Cancer Center); ambulatory surgery centers; dialysis centers; outpatient rehabilitation
Long-term care	Skilled nursing facilities, assisted living communities, inpatient rehabilitation, long-term acute care hospitals, adult day programs, Veterans Affairs community living centers
Emergency care	Level I trauma centers (for example, Ben Taub Hospital and Memorial Hermann–Texas Medical Center); hospital emergency departments; Houston Fire Department EMS (911); the 988 Suicide & Crisis Lifeline

How to answer questions 4 and 5 for your own state and city

State health rankings: America’s Health Rankings and County Health Rankings & Roadmaps show your state’s and county’s key challenges.
State health department: its state health assessment or improvement plan lists priority problems.
Census Bureau data (data.census.gov): uninsured rate, poverty and demographics for your state and city.
Finding services: HRSA’s “Find a Health Center” tool for FQHCs; your city or county health department website for public clinics; Medicare Care Compare for nursing homes and home health; your state EMS and trauma system for emergency care.
Linking to prevention: for each challenge, give one primary, one secondary and one tertiary prevention example.

Conclusion

Reliable data are the foundation of good health policy and practice. The BRFSS, through standardized, weighted telephone surveys of more than 400,000 adults a year, provides state-level information on risk behaviors, chronic disease and access to care. Its latest data show that adult obesity remains very high and unequally distributed by race, ethnicity and age. Demographic characteristics strongly shape mortality and morbidity, which is why data must guide targeted prevention and equity efforts. Applying national data to state and local challenges, and knowing the range of community, public health, ambulatory, outpatient, long-term and emergency services available, prepares nurses to connect patients with the right care at the right level of prevention.

References

Centers for Disease Control and Prevention. (n.d.). About the Behavioral Risk Factor Surveillance System (BRFSS). https://www.cdc.gov/brfss/about/index.htm

Centers for Disease Control and Prevention. (2026a). Adult obesity prevalence maps. https://www.cdc.gov/obesity/data/prevalence-maps.html

Centers for Disease Control and Prevention. (2026b). Adult obesity prevalence by age group, BRFSS 2025 [Maps]. https://www.cdc.gov/obesity/media/pdfs/2026/09/2025_obesity-prevalence-age-maps-508.pdf

National Center for Health Statistics. (2026, January 29). U.S. life expectancy hits record high as drug overdose deaths decline in 2024 [Press release]. https://www.cdc.gov/nchs/pressroom/releases/20260129.html

Pierannunzi, C., Hu, S. S., & Balluz, L. (2013). A systematic review of publications assessing reliability and validity of the Behavioral Risk Factor Surveillance System (BRFSS), 2004–2011. BMC Medical Research Methodology, 13, 49. https://doi.org/10.1186/1471-2288-13-49

World Health Organization. (2010). Key components of a well functioning health system. WHO.

Academic Writer & Editor