Alcohol and Tobacco Use for Adults (BRFSS)

Abstract

The Alcohol and Tobacco for Adults (BRFSS) module represents a critical component of the Behavioral Risk Factor Surveillance System (BRFSS), a state-based system of health surveys conducted by the Centers for Disease Control and Prevention (CDC). This instrument is designed for the continuous, systematic collection of data on health-related risk behaviors, chronic health conditions, and the use of preventive services among non-institutionalized adults in the United States. Specifically, this module focuses on capturing detailed information regarding adult tobacco use (including smoking history, current frequency, cessation efforts, and smokeless tobacco use) and alcohol consumption patterns (frequency, average volume, and heavy episodic drinking).

The data derived from this module are essential for public health officials and policymakers to monitor trends, develop targeted interventions, and evaluate the effectiveness of programs aimed at reducing substance abuse and related chronic diseases across various states and demographic groups.

Keywords

Behavioral Risk Factor Surveillance System (BRFSS), Centers for Disease Control and Prevention (CDC), Alcohol Consumption, Tobacco Use, Smoking Status, Binge Drinking, Public Health Surveillance, Health Risk Behaviors, Cessation.

Authors

The module was developed and is maintained by the Centers for Disease Control and Prevention (CDC) as part of the broader Behavioral Risk Factor Surveillance System (BRFSS).

Purpose

The primary purpose of the Alcohol and Tobacco for Adults module is to provide standardized, state-specific data on the prevalence and trends of key behavioral risk factors associated with morbidity and mortality among the U.S. adult population. This specific set of questions allows health authorities to quantify the extent of regular and hazardous use of both combustible and smokeless tobacco products, as well as the frequency and intensity of alcohol consumption, including instances of binge drinking.

The data collected are used to inform public health initiatives, allocate resources effectively, and measure progress toward national health objectives, such as those defined by Healthy People initiatives. The consistency in methodology across states enables reliable comparisons of health behaviors nationwide.

Construct

The instrument measures two distinct but often co-occurring behavioral constructs: Tobacco Use Status and History and Alcohol Consumption Patterns. The tobacco construct assesses lifetime exposure, current dependency level (daily vs. intermittent smoking), and readiness or attempts to quit smoking. The alcohol construct focuses on the dimension of quantity and frequency, specifically targeting both regular moderate consumption and high-risk behaviors, such as consuming four or five or more drinks on a single occasion, which is a key indicator of hazardous alcohol use.

The design utilizes screening questions (e.g., T1: lifetime cigarette use) to branch participants efficiently through the questionnaire, ensuring that detailed follow-up questions are only posed to relevant subgroups (e.g., current smokers or recent quitters).

Validity

Measures derived from the BRFSS, including those related to alcohol and tobacco use, have been extensively studied for their psychometric properties to ensure their appropriateness for public health surveillance. Research, such as that conducted by Nelson et al. (2001), confirms the utility and accuracy of the BRFSS measures.

The questions related to alcohol and tobacco consumption are generally considered to possess strong face validity, as they directly address observable behaviors and adhere to standard epidemiological definitions of smoking status and drinking levels. The validity of self-reported data in large-scale telephone surveys is continually monitored through comparison with external data sources and biological markers, demonstrating acceptable levels of agreement for population-level estimates.

Reliability

The reliability of the BRFSS measures is critical for tracking trends over time. Studies evaluating the test-retest reliability of the BRFSS core modules, including the alcohol and tobacco sections, typically show moderate to high consistency, particularly for well-defined behaviors like lifetime smoking status or frequency of drinking.

The standardized protocol used across all states, including the consistent training of interviewers and the use of computer-assisted telephone interviewing (CATI), minimizes measurement error and enhances the internal consistency and reliability of the data collected regarding alcohol and tobacco behaviors.

Factor Analysis

Factor analysis is typically not applied to the Alcohol and Tobacco module in isolation, as it is a set of distinct, epidemiological surveillance questions rather than a psychometric scale designed to measure a latent trait. However, when these items are analyzed within the context of overall health risk behaviors measured by the BRFSS, they generally load onto separate factors corresponding to distinct substance use behaviors (e.g., smoking history vs. current binge drinking frequency).

Researchers often use the individual items to create composite variables (e.g., current smoker status, heavy drinker status) rather than relying on a continuous, unidimensional factor score for these measures.

Instrument

Test Type: Public Health Surveillance Module / Survey Questionnaire

Format: Structured, interviewer-administered telephone survey (CATI) or self-administered questionnaire (mail/web).

Language Available: Primarily English and Spanish for core BRFSS surveys, though availability may vary by state.

Population Group: Non-institutionalized adult residents.

Age Group: 18 years and older.

Population Details: Data collection occurs across all 50 U.S. states, the District of Columbia, and three U.S. territories.

Test Methodology: Cross-sectional survey methodology using random digit dialing (RDD) or address-based sampling (ABS) to collect data on health behaviors over specific recall periods (e.g., lifetime, past 30 days, past 12 months).

Keywords

Public Health, Epidemiology, Addiction, Smoking Cessation, Hazardous Drinking, BRFSS, CDC, Survey Instrument, Risk Behavior.

Authors

Author ORCID Identifier: Not applicable (Organizational instrument)

Affiliation Email addresses: Contact information available via the CDC BRFSS website.

Correspondence Address: Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, U.S. Department of Health and Human Services.

Permissions & Fee and Test Year

Permissions & Fee: The BRFSS survey modules are public domain instruments developed by the U.S. government and are generally available for public use without specific licensing fees for research purposes.

Test Year: The BRFSS questionnaire is updated annually. The specific structure detailed in the source content reflects versions used around 2011, though similar questions remain standard in subsequent years.

Reference’s

• Nelson DE, Holtzman D, Bolen J, Stanwyck CA, Mack KA. Reliability and validity of measures from the Behavioral Risk Factor Surveillance System (BRFSS). Social and Preventive Medicine, 2001; 46, Suppl 1:S03-S42.
• Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Questionnaire. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011. The BRFSS official website is available here: http://www.cdc.gov/brfss/index.htm.
• This instrument can be found on pages 130-132 of Latino Families and Youth: A Compendium of Assessment Tools. The original document can be accessed here: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=23171&Itemid=

Items of the Alcohol and Tobacco for Adults (BRFSS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

T1. Have you smoked at least 100 cigarettes in your life? [NOTE: 5 packs = 100 cigarettes]

• 1. Yes
• 2. No [Skip to T5]
• 7. Don’t know/not sure [Skip to T5]
• 9. Refused [Skip to T5]

T2. At present‚ do you smoke cigarettes every day‚ some days‚ or never?

• 1. Every day
• 2. Some days
• 3. Never [Skip to T4]
• 7. Don’t know/not sure [Skip to T5]
• 9. Refused [Skip to T5]

T3. During the past 12 months‚ have you stopped smoking for a day or more because you were tryingto quit smoking?

• 1. Yes [Skip to T5]
• 2. No [Skip to T5]
• 7. Don’t know/not sure [Skip to T5]
• 9. Refused [Skip to T5]

T4. When did you stop smoking cigarettes regularly?

• 1. Within the past month (less than 1 month ago)
• 2. Within the past 3 months (at least 1 month but less than 3 months ago)
• 3. Within the past 6 months (at least 3 months but less than 6 months ago)
• 4. Within the past year (at least 6 months but less than 1 year ago)
• 5. Within the past 5 years (at least 1 year but less than 5 years ago)
• 6. Within the past 10 years (at least 5 years but less than 10 years ago)
• 7. 10 years ago or more
• 77. Don’t know/not sure
• 99. Refused

T5. A t present‚ do you use chewing tobacco‚ snuff‚ or “snus” every day‚ some days‚ or never? [NOTE:“Snus” (or Swedish snuff) is moist tobacco that is not smoked. It is usually sold in small bags thatare placed under the lip‚ pressing against the gum.]

• 1. Every day
• 2. Some days
• 3. Never
• 7. Don’t know/not sure
• 9. Refused

Alcohol consumption (A)

A1. During the past 30 days‚ how many days per week or per month did you consume at least onedrink of any alcoholic beverage such as beer‚ malt beverage‚ or liquor?

__ Days per week __ Days in the past 30 days

• 88 No drinks at all in the past 30 days [Finish the questions on alcohol]
• 77 Don’t know/not sure [Finish the questions on alcohol]
• 99 Refused [Finish the questions on alcohol]

A2. A “drink” is defined as a beer of 12 ounces (350 cl)‚ a glass of wine of 5 ounces (150 cl)‚ or a shot ofliquor. During the past 30 days‚ on the days when you drank‚ approximately how many drinks didyou consume on average? [NOTE: A beer of 40 ounces would be equivalent to three drinks; a cocktailwith two shots of alcohol would be equivalent to two drinks.]

__ Number of drinks

• 77 Don’t know/not sure
• 99 Refused

A3. Taking into account all types of alcoholic beverages‚ how many times during the past 30 days didyou consume X drinks or more [X = 5 for men‚ X = 4 for women] on one occasion?

__ Time(s)

• 88 Never
• 77 Don’t know/not sure
• 99 Refused

A4. During the past 30 days‚ what was the maximum number of drinks that you consumed on oneoccasion?

__ Number of drinks

• 77 Don’t know/not sure
• 99 Refused