Using the Behavioral Risk Factor Surveillance System (BRFSS) for Occupational Health

Safety & Health Assessment & Research for Prevention (SHARP) — Research for Safe Work

The BRFSS is a national telephone survey, collecting nationwide population-based state-level data on a multitude of health behaviors and conditions.

Work is an important factor in our lives. On average, we spend more than half of our waking hours at work.  Work is a social determinant of health, and workers face a wide variety of exposures and hazards in the workplace. Workplace injuries and illnesses are common and costly - an estimated 2-10% of workers suffer workplace injuries (nonfatal) or illnesses every year; the annual cost of these occupational injuries has been estimated at $250 billion nationally1.

Because work is central to the lives of most adults, the workplace presents a setting for health promotion and disease prevention, where effective workplace policies and programs could reduce health risks for American workers. The costs associated with occupational injuries and illnesses, as well as the impact of chronic diseases on insurance premiums, workers’ compensation claims, absenteeism and productivity could all be positively impacted in the workplace. A healthier workforce benefits not only the employee, but also employer, the health-care system, and society.  To effectively target prevention and workplace-based interventions, industry and occupation data are needed to identify the prevalence of chronic disease and injuries. Research using state- level industry or occupation specific estimates are lacking.

Since 2002, the Safety & Health Assessment & Research for Prevention (SHARP) program at the Washington State Department of Labor & Industries has been adding industry and occupation (I/O) questions to the Washington Behavioral Risk Factor Surveillance System (BRFSS), and using the resulting I/O data to examine the prevalence of several chronic diseases and the burden of work-related injury. The BRFSS is a national telephone survey, collecting nationwide population-based state-level data on a multitude of health behaviors and conditions.  Results of limited comparisons between groups demonstrate that there are statistically significant differences in health (e.g. behaviors, chronic diseases, health-care access) across industrial and occupational groups. The systematic collection of industry and occupation data can help identify worker populations with high burdens of disease and injury, and can be used to target disease prevention efforts.

In this issue of SHARP focus, we highlight some findings from our ongoing research using the Washington (WA) BRFSS.

SHARP has used BRFSS data to examine:

For more information on SHARP research using BRFSS data:

Links to the free full-text publications at:

1 Leigh, JP. Economic Burden of Occupational Injury and Illness in the United States. Milbank Quarterly, 2011; 89(4):728-772.
Bonauto, DK, Fan JZ, Largo TW, et al., Proportion of workers who were work-injured and payment by workers' compensation systems - 10 states, 2007.  MMWR Morb Mortal Wkly Rep, 2010; 59(29): 897-900.

What is the BRFSS?

    • The Behavioral Risk Factor Surveillance System (BRFSS) is the world’s largest ongoing telephone survey in the world, and has been in operation by the CDC since 1984, nationally since 1993. It is conducted on U.S. residents (18+) in all 50 U.S. states, DC, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and Palau.
    • The BRFSS collects nationwide population-based state-level data on health-related risk behaviors, chronic health conditions, and use of preventive services, and emerging health issues. Topics include: smoking, alcohol use, physical inactivity, diet, hypertension, and asthma. States may include optional modules and state-added questions.
    • These data are used by federal, state, and local agencies to help target resources for prevention & interventions.

How does SHARP get & use this data?

    • SHARP partners with the Washington Dept. of Health, which manages the WA BRFSS, to get the BRFSS data (and coding industry & occupation for Washington).
    • When used in conjunction with the industry and occupation questions that SHARP adds to the WA BRFSS each year, BRFSS data allows for:
      • Quantifying prevalence by industry & occupation on health factors/behaviors and chronic disease;
      • Identifying substantial health disparities and risks by occupation;
      • Improving understanding of work-relatedness;
      • Identifying high-risk occupations/industries in states;
      • Aiding in targeting prevention efforts to address health disparities.
  • Employers, policymakers, and health promotion practitioners can utilize the study findings through BRFSS research to target and prioritize workplace chronic disease prevention programs and health promotion.
  • Washington State has been collecting the industry & occupation of Washington workers (currently employed or self-employed) on the WA BRFSS since 2002 as a state-added question.
    • WA BRFSS collects the respondent’s occupation by including the following question:
      • “What is your job title?” If no job title is given, the respondent is then asked “What kind of work do you do?”
    • WA BRFSS also adds a question on worker injury/illness:
      • In the past 12 months, have you been injured while performing your job, OR has a doctor or other medical professional told you that you have a work-related illness?”
    • Industry & Occupation are collected as narrative text responses and recorded verbatim.
      • Historically, responses are autocoded using the Standardized Occupation and Industry Coding (SOIC) software developed by the National Institute for Occupational Safety and Health (NIOSH).  The SOIC program codes match a 1990 Census Bureau occupation code to the narrative text.  Where autocoding is not possible, the responses are manually coded by SHARP staff (NIOSH-trained coders). Recently, NIOSH has coded states’ data.

BRFSS data findings on a variety of topics that relate to occupational health:

  • Obesity:Our most recent publication is on the prevalence of obesity and other health behaviors, such as diet and physical activity, by occupation in Washington.
    • Obesity is a public health threat in the United States. Obesity contributes to costs associated with sick leave and absenteeism, and is associated with increased health risks. Obesity places a tremendous burden on employers as well as the health care system.
    • We found that, on average, about 25% of Washington State workers were obese (having a BMI of 30 or higher).
      • Truck drivers, transportation and material movers, protective services and cleaning and building services were among the most obese groups of workers.
      • Health diagnosing occupations were the least obese occupational group.
      • Healthy behaviors, such as consuming adequate fruits and vegetables and frequent exercising, were found to have a protective effect on obesity.
      • Employers should establish and promote workplace wellness programs, and encourage their workers to adopt healthy behaviors as a means to reduce obesity in the workplace and protect workers.
    • Occupational Group Prevalence of obesity Prevalence of adequate fruit and vegetable intake Prevalence of vigorous leisure time physical activity
      All occupations 25% 23% 34%
      Truck drivers 39% 16% 31%
      Transportation and material moving 38% 20% 31%
      Protective services 34% 20% 51%
      Cleaning and building services 30% 19% 28%
      Health diagnosing occupations 12% 38% 45%


    • Underreporting: BRFSS data can also be used to examine other topics such as the underreporting of work-related injuries or illness to workers’ compensation (WC).
      • Analysis of the 2002 BRFSS using the work-injury question found that self-reported work-related injuries or illnesses ranged from 4.3% to 24.7% across 9 industry groups.
      • The corresponding weighted proportions for WC claim filing among the injured or ill workers were 17.6% to 69.4%.
      Work Related Injury Graph

      • Asthma: Our most recent analysis (in press) is of asthma by occupation from the WA BRFSS Asthma Call-Back Survey (ACBS) 2006-2009, which found that more than half of Washington workers with current asthma report that their asthma symptoms are caused or worsened by current or previous work; but only~10% had spoken with a health care professional about their asthma being work-related.
      ACBS Question N
      (weighted frequency*)
       (95% CI)*
      Asthma symptoms caused or worsened by any current or past job (n=1,421) 930
      Ever discussed asthma being work-related with a health-care professional (n = 1,673) 271
      Ever changed or quit job because chemicals, smoke, fumes, or dust caused or worsened asthma (n = 444) 145
      Missed ≥1 day of work and/or couldn’t do usual activities due to asthma, in past 12 months (n = 1,285) 365

      *Data weighted to account for BRFSS survey sample; 95%CI =  95% Confidence Interval.

      • This research points to the burden of work-related asthma in Washington state.
        • Several occupations were identified as having higher prevalence of potential work–related asthma (asthma symptoms caused or worsened by any current or past job):  Agriculture, Forestry, and Fishing; Construction & Extraction; Mechanics, Repairers, Precision Production, and Plant & System Operators; and Other Health Services.
          • Many of these are occupations that may include more exposure to dust, fumes, and chemicals.
      • It also points to the importance of getting occupational histories from and considering occupational exposures in all patients presenting with asthma.

      SHARP analyses using BRFSS data have identified several occupations with occupational health needs:

      Occupational Health Issue Identified Industry/Occupation*
      Asthma & work-related asthma (WRA) Current Asthma: Teachers & Counselors; Administrative Support & Clerical; Other Health Services. 
      Potential WRA:  Agriculture, Forestry, & Fishing; Construction & Extraction; Mechanics, Repairers, Precision Production & Plant & System Operators; Other Health Services.
      Obesity Truck Drivers; Transportation and Material Movers; Protective Services; Cleaning & Building Services.
      Influenza-like Illness Janitors & Cleaners; Secretaries.
      Depression & Frequent Mental Distress Health Service Assistants; Truck Drivers; Machine Operators, Assemblers, and Inspectors.
      Health Care Coverage Discrepancy Low-income workers employed in Agriculture, Forestry & Fishing, Construction, and Retail.

      * Occupational groupings vary by study; to access the methods sections for a full description, please see links to the free full-text publications at


      This research was supported in part by Grant Number 5U60OH008487 from CDC – NIOSH. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH, the Centers for Disease Control and Prevention, or the Washington  State Department of Labor & Industries.

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