BACKGROUND: Investigation into personal health has become focused on conditions at an increasingly local level, while response rates have declined and complicated the process of collecting data at an individual level. Simultaneously, social media data have exploded in availability and have been shown to correlate with the prevalence of certain health conditions. OBJECTIVE: Facebook likes may be a source of digital data that can complement traditional public health surveillance systems and provide data at a local level. We explored the use of Facebook likes as potential predictors of health outcomes and their behavioral determinants. METHODS: We performed principal components and regression analyses to examine the predictive qualities of Facebook likes with regard to mortality, diseases, and lifestyle behaviors in 214 counties across the United States and 61 of 67 counties in Florida. These results were compared with those obtainable from a demographic model. Health data were obtained from both the 2010 and 2011 Behavioral Risk Factor Surveillance System (BRFSS) and mortality data were obtained from the National Vital Statistics System. RESULTS: Facebook likes added significant value in predicting most examined health outcomes and behaviors even when controlling for age, race, and socioeconomic status, with model fit improvements (adjusted R(2)) of an average of 58% across models for 13 different health-related metrics over basic sociodemographic models. Small area data were not available in sufficient abundance to test the accuracy of the model in estimating health conditions in less populated markets, but initial analysis using data from Florida showed a strong model fit for obesity data (adjusted R(2)=.77). CONCLUSIONS: Facebook likes provide estimates for examined health outcomes and health behaviors that are comparable to those obtained from the BRFSS. Online sources may provide more reliable, timely, and cost-effective county-level data than that obtainable from traditional public health surveillance systems as well as serve as an adjunct to those systems.

BACKGROUND: Since Alan Pritchard defined bibliometrics as "the application of statistical methods to media of communication" in 1969, bibliometric analyses have become widespread. To date, however, bibliometrics has not been used to analyze publications related to the U.S. Behavioral Risk Factor Surveillance System (BRFSS). PURPOSE: To determine the most frequently cited BRFSS-related topical areas, institutions, and journals. METHODS: A search of the Web of Knowledge database in 2013 identified U.S.-published studies related to BRFSS, from its start in 1984 through 2012. Search terms were BRFSS, Behavioral Risk Factor Surveillance System, or Behavioral Risk Survey. The resulting 1,387 articles were analyzed descriptively and produced data for VOSviewer, a computer program that plotted a relevance distance-based map and clustered keywords from text in titles and abstracts. RESULTS: Topics, journals, and publishing institutions ranged widely. Most research was clustered by content area, such as cancer screening, access to care, heart health, and quality of life. The American Journal of Preventive Medicine and American Journal of Public Health published the most BRFSS-related papers (95 and 70, respectively). CONCLUSIONS: Bibliometrics can help identify the most frequently published BRFSS-related topics, publishing journals, and publishing institutions. BRFSS data are widely used, particularly by CDC and academic institutions such as the University of Washington and other universities hosting top-ranked schools of public health. Bibliometric analysis and mapping provides an innovative way of quantifying and visualizing the plethora of research conducted using BRFSS data and summarizing the contribution of this surveillance system to public health.

PROBLEM: Chronic diseases (e.g., heart disease, stroke, cancer, and diabetes) are the leading causes of morbidity and mortality in the United States. Engaging in healthy behaviors (e.g., quitting smoking and tobacco use, being more physically active, and eating a nutritious diet) and accessing preventive health-care services (e.g., routine physical checkups, screening for cancer, checking blood pressure, testing blood cholesterol, and receiving recommended vaccinations) can reduce morbidity and mortality from chronic and infectious disease and lower medical costs. Monitoring and evaluating health-risk behaviors and the use of health services is essential to developing intervention programs, promotion strategies, and health policies that address public health at multiple levels, including state, territory, metropolitan and micropolitan statistical area (MMSA), and county. REPORTING PERIOD: January-December 2010. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health-risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services and practices related to the leading causes of death and disabilities in the United States. This report presents results for 2010 for all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the U.S. Virgin Islands, 192 MMSAs, and 302 counties. RESULTS: In 2010, the estimated prevalence of high-risk health behaviors, chronic diseases and conditions, access to health care, and use of preventive health services varied substantially by state and territory, MMSA, and county. In the following summary of results, each set of proportions refers to the range of estimated prevalence for the disease, condition, or behaviors, as reported by survey respondents. Adults reporting good or better health: 67.9%-89.3% for states and territories, 72.2%-92.1% for MMSAs, and 72.8%-95.8% for counties. Adults with health-care coverage: 69.4%-95.7% for states and territories, 45.7%-97.0% for MMSAs, and 45.7%-97.2% for counties. Adults who had a dental visit in the past year: 57.2%-81.7% for states and territories, 47.1%-83.5% for MMSAs, and 47.1%-88.2% for counties. Adults aged ≥65 years having had all their natural teeth extracted (edentulism): 7.4%-36.0% for states and territories, 4.8%-34.8% for MMSAs, and 2.4%-39.3% for counties. A routine physical checkup during the preceding 12 months: 53.8%-80.0% for states and territories, 49.5%-82.6% for MMSAs, and 49.5%-85.3% for counties. Influenza vaccination received during the preceding 12 months among adults aged ≥65 years: 26.9%-73.4% for states and territories, 51.7%-77.1% for MMSAs, and 49.3%-87.8% for counties. Pneumococcal vaccination ever received among adults aged ≥65 years: 24.7%-74.0% for states and territories, 48.6%-79.9% for MMSAs, and 47.6%-83.1% for counties. Sigmoidoscopy or colonoscopy ever received among adults aged ≥50 years: 37.8%-75.7% for states and territories, 37.3%-79.9% for MMSAs, and 37.3%-82.5% for counties. Blood stool test received during the preceding 2 years among adults aged ≥50 years: 8.5%-27.0% for states and territories, 6.7%-51.3% for MMSAs, and 6.8%-57.2% for counties. Women who reported having had a Papanicolaou test during the preceding 3 years: 67.8%-88.9% for states and territories, 63.3%-91.2% for MMSAs, and 63.2%-95.7% for counties. Women aged ≥40 years who had a mammogram during the preceding 2 years: 63.8%-83.6% for states and territories, 60.3%-86.2% for MMSAs, and 59.3%-89.7% for counties. Current cigarette smokers: 5.8%-26.8% for states and territories, 5.8%-28.5% for MMSAs, and 5.9%-29.8% for counties. Binge drinking during the preceding month: 6.6%-21.6% for states and territories, 3.6%-23.0% for MMSAs, and 3.8%-24.0% for counties. Heavy drinking during the preceding month: 2.0%-7.2% for states and territories, 1.0%-10.0% for MMSAs, and 1.0%-14.2% for counties. Adults reporting no leisure-time physical activity: 17.5%-42.3% for states and territories, 13.1%-37.6% for MMSAs, and 8.5%-39.0% for counties. Adults who were overweight: 32.6%-40.7% for states and territories, 28.5%-42.5% for MMSAs, and 27.2%-46.4% for counties. Adults aged ≥20 years who were obese: 22.1%-35.0% for states and territories, 17.1%-42.1% for MMSAs, and 13.3%-42.1% for counties. Adults with current asthma: 5.2%-11.1% for states and territories, 3.4%-14.5% for MMSAs, and 3.3%-14.6% for counties. Adults with diagnosed diabetes: 5.3%-13.2% for states and territories, 4.6%-15.4% for MMSAs, and 2.6%-18.8% for counties. Adults with limited activities because of physical, mental or emotional problems: 10.8%-28.2% for states and territories, 13.5%-38.3% for MMSAs, and 11.7%-32.0% for counties. Adults using special equipment because of any health problem: 2.8%-10.6% for states and territories, 4.5%-15.5% for MMSAs, and 1.3%-15.5% for counties. Adults aged ≥45 years who have had coronary heart disease: 5.3%-16.7% for states and territories, 6.5%-19.6% for MMSAs, and 4.9%-19.6% for counties. Adults aged ≥45 years who have had a stroke: 2.4%-7.1% for states and territories, 2.3%-8.8% for MSMAs, and 1.7%-8.8% for counties. INTERPRETATION: The findings in this report indicate substantial variations in the health-risk behaviors, chronic diseases and conditions, access to health-care services, and the use of the preventive health services among U.S. adults at the state and territory, MMSA, and county levels. Healthy People 2010 (HP 2010) objectives were established to monitor health behaviors, conditions, and the use of preventive health services for the first decade of the 2000s. The findings in this report indicate that many of the HP 2010 objectives were not achieved by 2010. The findings underscore the continued need for surveillance of health-risk behaviors, chronic diseases, and conditions and of the use of preventive health-care services. PUBLIC HEALTH ACTION: Local and state health departments and federal agencies use BRFSS data to identify populations at high risk for certain health-risk behaviors, chronic diseases, and conditions and to evaluate the use of preventive health-care services. BRFSS data also are used to direct, implement, monitor, and evaluate public health programs and policies that can lead to a reduction in morbidity and mortality from chronic conditions and corresponding health-risk behaviors.

OBJECTIVE: To examine the association between bodyweight status and provision of population-based prevention services. DATA SOURCES: The National Association of City and County Health Officials 2005 Profile survey data, linked with two cross-sections of the Behavioral Risk Factor Surveillance System (BRFSS) survey in 2004 and 2005. STUDY DESIGN: Multilevel logistic regressions were used to examine the association between provision of obesity-prevention services and the change in risk of being obese or morbidly obese among BRFSS respondents. The estimation sample was stratified by sex. Low-income samples were also examined. Falsification tests were used to determine whether there is counterevidence. PRINCIPAL FINDINGS: Provision of population-based obesity-prevention services within the jurisdiction of local health departments and specifically those provided by the local health departments are associated with reduced risks of obesity and morbid obesity from 2004 to 2005. The magnitude of the association appears to be stronger among low-income populations and among women. Results of the falsification tests provide additional support of the main findings. CONCLUSIONS: Population-based obesity-prevention services may be useful in containing the obesity epidemic.

This study re-examined the role of geographic scale in measuring income inequality and testing the income inequality hypothesis (IIH) as an explanation of health disparities. We merged Behavioral Risk Factor Surveillance System (BRFSS) 2000 data with income inequality indices constructed at different geographic scales to test the association between income inequality and four different health indicators, i.e., self-assessed health status as a morbidity measure, vaccination against influenza as a measure of use of preventive healthcare, having any kind of health insurance as a measure of access, and obesity as a modifiable health risk factor measure. Multilevel models are used in our regression of the health indicators on measures of income inequalities and control variables. Our analysis suggests that because income inequality is a contextual variable, income inequalities measured at different geographic scales have different interpretations and relate to societal characteristics at different levels. Therefore, a rejection of the IIH at one level does not necessarily negate the possibility that income inequality affects health at another level. Assessment across a variety of scales is needed to have a comprehensive picture of the IIH in any given study. Empirical results also show that whether the IIH holds could depend on the sex group examined and the health indicator used, which implies different mechanisms of IIH exist for different sex groups and health indicators, in addition to the geographic scale. The role of geographic scale should be more rigorously considered in social determinants of health research.

Although the concentration index (CI) and the health achievement index (HAI) have been extensively used, previous studies have relied on bootstrapping to compute the variance of the HAI, whereas competing variance estimators exist for the CI. This paper provides methods of statistical inference for the HAI and compares the available variance estimators for both the CI and the HAI using Monte Carlo simulation. Results for both the CI and the HAI suggest that analytical methods and bootstrapping are well behaved. The convenient regression method gives standard errors close to the other methods, provided the CI is not too large (< 0.2), but otherwise tends to understate the standard errors. In our simulation setting, the improvement from the Newey-West correction over the convenient regression method has mixed evidence when the CI ≤ 0.1 and is modest when the CI > 0.1. Published 2011. This article is a US Government work and is in the public domain in the USA.

During the past decade, efforts to promote gender parity in the healing and public health professions have met with only partial success. We provide a critical update regarding the status of women in the public health profession by exploring gender-related differences in promotion rates at the nation's leading public health agency, the Centers for Disease Control and Prevention (CDC). Using personnel data drawn from CDC, we found that the gender gap in promotion has diminished across time and that this reduction can be attributed to changes in individual characteristics (e.g., higher educational levels and more federal work experience). However, a substantial gap in promotion that cannot be explained by such characteristics has persisted, indicating continuing barriers in women's career advancement.

We are proud to have had the opportunity to bring this supplemental issue to fruition. It represents directly the culmination of months of planning; an interactive and lively conference; and the hard work of many. The idea of bringing select social science perspectives and tools into the discussion of public health workforce (PHW) began with a conversation between David Meltzer of the University of Chicago (UC) and Carol Crawford of the Centers for Disease Control and Prevention (CDC). The conversation grew into a joint CDC/UC working group charged with identifying a small cadre of social scientists whose ideas or methodologies might hold promise for application to PHW issues with the intent of bringing these social scientists together with some PHW leaders in a conference format. | The significance of PHW research has increased as the role of public health in the United States has expanded in scope and sophistication.1,2 Emerging infectious diseases (eg, HIV/AIDS, SARS, swine flu); health epidemics (eg, obesity, diabetes); the persistence of racial and ethnic health disparities (eg, breast health, infant/fetal mortality, prostate cancer); terrorism and bioterrorism (eg, anthrax scare, events of September 11, 2001); and natural disasters (eg, 2004 tsunami, Hurricane Katrina in 2005, California forest fires) have redefined and heightened the importance of the role of public health in both citizen health and national security. As the role of public health has changed, the necessary call to understand and develop a workforce that is adequate in size and capable in skills has come and researchers have struggled to provide answers. Existing literature depicts a wide range of challenges to developing a research agenda in PHW such as understanding succession planning for an aging workforce, consensual definition of the PHW, enumerating the PHW, scope of duties of the PHW, public or private sponsorship, and implications of the responsive nature of the role of public health.3,4

The Centers for Disease Control and Prevention Office of Workforce and Career Development is committed to developing a competent, sustainable, and diverse public health workforce through evidence-based training, career and leadership development, and strategic workforce planning to improve population health outcomes. This article reviews the previous efforts in identifying priorities of public health workforce research, which are summarized as eight major research themes. We outline a strategic framework for public health workforce research that includes six functional areas (ie, definition and standards, data, methodology, evaluation, policy, and dissemination and translation). To conceptualize and prioritize development of an actionable public health research agenda, we constructed a matrix of key challenges in workforce analysis by public health workforce categories. Extensive reviews were conducted to identify valuable methods, models, and approaches to public health workforce research. We explore new tools and approaches for addressing priority areas for public health workforce and career development research and assess how tools from multiple disciplines of social sciences can guide the development of a research framework for advancing public health workforce research and policy.

An organization's workforce--or human capital--is its most valuable asset. The 2002 President's Management Agenda emphasizes the importance of strategic human capital management by requiring all federal agencies to improve performance by enhancing personnel and compensation systems. In response to these directives, the Centers for Disease Control and Prevention (CDC) drafted its strategic human capital management plan to ensure that it is aligned strategically to support the agency's mission and its health protection goals. In this article, we explore the personnel economics literature to draw lessons from research studies that can help CDC enhance its human capital management and planning. To do so, we focus on topics that are of practical importance and empirical relevance to CDC's internal workforce and personnel needs with an emphasis on identifying promising research issues or methodological approaches. The personnel economics literature is rich with theoretically sound and empirically rigorous approaches for shaping an evidence-based approach to human capital management that can enhance incentives to attract, retain, and motivate a talented federal public health workforce, thereby promoting the culture of high-performance government.