Analysis of Interview Breakoff in the Behavioral Risk Factor Surveillance System, 2018 and 2019

• Published in: AJPM Focus 2023-06, Vol.2 (2), p.100076-100076, Article 100076
• Main Authors: Hsia, Jason, Gilbert, Madison, Zhao, Guixiang, Town, Machell, Inusah, Seidu, Garvin, William
• Format: Article
• Language: English
• Subjects: Behavioral Risk Factor Surveillance System; Interview breakoff; nonresponse; Program Evaluation; telephone survey; total survey error
• ISSN: 2773-0654; 2773-0654
• DOI: 10.1016/j.focus.2023.100076

•Breakoff, as a part of nonresponse, is a growing problem in behavioral risk factor surveys.•The reasons and risk factors for breakoff in telephone surveys are not well known.•We analyzed breakoff in the Behavioral Risk Factor Surveillance System (BRFSS) data.•Breakoff was associated with questionnaire length, extent of recollection, and location of questions, and varied among states.•The findings will aid in future BRFSS implementation and can be applied to other similar telephone surveys. Survey breakoff is an important source of total survey error. Most studies of breakoff have been of web surveys—less is known about telephone surveys. In the past decade, the breakoff rate has increased in the Behavioral Risk Factor Surveillance System, the world's largest annual telephone survey. Analysis of breakoff in Behavioral Risk Factor Surveillance System can improve the quality of Behavioral Risk Factor Surveillance System. It will also provide evidence in research of total survey error on telephone surveys. We used data recorded as breakoff in the 2018 and 2019 Behavioral Risk Factor Surveillance System. We converted questions and modules to a time variable and applied Kaplan–Meier method and a proportional hazard model to estimate the conditional and cumulative probabilities of breakoff and study the potential risk factors associated with breakoff. Cumulative probability of breakoffs up to the end of the core questionnaire was 7.03% in 2018 and 9.56% in 2019. The highest conditional probability of breakoffs in the core was 2.85% for the physical activity section. Cumulative probability of breakoffs up to the end of the core was higher among those states that inserted their own questions or optional modules than among those that did not in both years. The median risk ratio of breakoff among all states was 5.70 in 2018 and 3.01 in 2019. Survey breakoff was associated with the length of the questionnaire, the extent of expected recollection, and the location of questions. Breakoff is not an ignorable component of total survey error and should be considered in Behavioral Risk Factor Surveillance System data analyses when variables have higher breakoff rates.