Behavioral Risk Factor Survey

With the year 2000 approaching, health care this century has moved from treating symptoms in 1900 to curing disease in 1997. Some conditions that were not even curable in the year 1900 now are preventable through lifestyle and behavior changes or through the use of appropriate screening routines.

In fact, in the early 1900s the infectious diseases of pneumonia, influenza, tuberculosis, gastritis, enteritis and colitis accounted for nearly one-third of all deaths. Today, with increased environmental sanitation, the introduction of antibiotics and the use of immunizations, the chronic diseases of heart disease, cancer and cerebrovascular disease (stroke) account for nearly two-thirds of all deaths.1

This document summarizes the results of the 1996 Behavioral Risk Factor Survey (BRFS) conducted by the North Dakota Department of Health.

About BRFS...

• Since 1985, the BRFS has collected information about North Dakota residents and the behaviors that put them at risk for chronic diseases.

• In 1996, 1,811 telephone survey respon- dents provided information that will assist program planners, provide insight to health professionals and inform the public about the status of a variety of health issues.

• This summary shows the significance of these findings and compares North Dakota's results with the Healthy People 2000 objectives for the nation (herein referred to as Year 2000 objectives).2

• The BRFS is made possible by resident participation. The North Dakota Depart- ment of Health greatly appreciates the willingness of North Dakota residents to complete this survey.

Topics Included in the 1996 Survey


1Brownson, R.C., Remington, P.L., & Davis, J. R. (1993). Chronic Disease Epidemiology and Control. Washington, D.C.: American Public Health Association.

2U.S. Dept. of Health and Human Services Public Health Service. (1990). Healthy People 2000: National Health Promotion and Disease Prevention Objectives. DHHS Publication Number 91-50212.

Health Risks

Tobacco Use

Smoking, a major contributor to cardiovascular disease and cancer, is the most preventable cause of death. About 23 percent of the adults in North Dakota currently smoke. This percentage has increased from about 20 percent in 1993 and 1994.

At 29 percent, young women age 18-24 are at the highest risk for this behavior. The Year 2000 objective is to reduce current smokers to less than 15 percent.

Smokeless Tobacco Use

Using smokeless tobacco such as chewing tobacco or snuff is a significant health risk. It is not a safe substitute for cigarettes. The use of smokeless tobacco can result in a variety of health problems including cancer of the mouth, esophagus and/or stomach. Its use also leads to bad breath, stained teeth, tooth decay, tooth abrasion, gum recession, periodontal bone loss and nicotine dependency.

In North Dakota, 5 percent of adults use some form of smokeless tobacco product. The Year 2000 objective is to reduce smokeless tobacco use to no more than 4 percent.

Health Care Access

Access to health care is essential to obtaining recommended medical screening and exams. Recent social and political developments indicate that health care access issues are foremost on the minds of Americans.

In 1996, the North Dakota BRFS indicated 12 percent of residents over age 18 did not have health insurance coverage and 27 percent of those who were uninsured had been without coverage for five years or more.

Furthermore, the BRFS indicated 7 percent of residents were unable to see a physician because of the cost, while 35 percent had not had a routine checkup in the past year.

Body Weight

Being overweight continues to be a problem in North Dakota. According to the Body Mass Index (BMI), 32 percent of North Dakota residents were overweight in 1996. The prevalence of overweight has continued to increase from 23 percent in 1986. The Year 2000 objective aims to reduce the number of overweight residents to less than 20 percent.

Body Mass Index

BMI is determined by taking body weight in kilograms and dividing by height in meters squared.

Women are considered over- weight if their BMI > 27.3.
Men are considered over-weight if their BMI > 27.8.



Weight Control

Genetic and environmental factors interact to influence weight. Nationally, it is estimated that 300,000 premature deaths each year are due to obesity. However, no method of safe, effective treatment has been developed for losing and maintaining significant amounts of weight. As with weight gain, negative physical and psychological consequences have been associated with weight loss. Therefore, reduced fat and increased vegetable, fruit and grain consumption, along with moderate physical activity, should be the focus of good health.



Eating a high-fiber, low-fat diet is linked to decreased blood cholesterol levels, decreased obesity and decreased hypertension. It also may help reduce the risk of some cancers. The Year 2000 objective for a healthy diet is to increase complex carbohydrate and fiber-containing foods to five or more daily servings of vegetables (including
legumes) and fruits and to six or more daily servings of grain products. In North Dakota, 18 percent of adults consume five or more daily servings of fruits and vegetables. At 25 percent, women are more than twice as likely as men, 10 percent, to eat the recommended amounts.

Physical Activity

According to the first-ever Surgeon General's report on Physical Activity and Health, regular physical activity offers substantial benefits to health and well-being. It is recommended that adults accumulate 30 minutes or more of moderate physical activity on most, if not all, days of the week.

The Year 2000 objective is to reduce to no more than 15 percent the proportion of people who are physically inactive (engage in no leisure-time physical activity). In 1996, 34 percent of the adults in North Dakota were classified as physically inactive.


BRFS Definitions

Sedentary Lifestyle is defined as no physical activity OR a physical activity or pair of activities that are done for 20 minutes or less, fewer than three times per week.

Regular and Sustained Activity is defined as a physical activity or pair of activities that are done for 30 minutes or more per session, five or more times per week.


Disease Prevention

Cancer Screening

In 1996, North Dakota women were close to or had reached several of the Year 2000 objectives for mammography and Pap test screening. With these screenings, women greatly increase their chances for early detection and treatment of breast and cervical cancers.

Two Year 2000 objectives for breast and cervical cancer screening are:

  1. Increase to at least 80 percent the proportion of women age 40 and older who have had clinical breast examinations (CBE) and mammograms, and to at least 60 percent those age 50 and older who have had them within the preceding two years. In 1996, 79 percent of North Dakota women age 40 and older reported having had a mammogram and CBE at least once in their lifetime, and 65 percent of women age 50 and older reported having had them within the past two years.

  2. Increase to at least 95 percent the proportion of women age 18 and older with intact uterine cervixes who have had at least one Pap test and to at least 85 percent those who have received Pap tests within the preceding three years. In 1996, 95 percent of North Dakota women reported having at least one Pap test in their lifetime, and 82 percent reported having a Pap test within the past three years.

It should be noted, however, that the Year 2000 objectives for low-income* women to have had mammograms or Pap tests are not being met in the state.

* Low-income is defined as having an annual household income of ess than $10,000 per year.


Diabetes is a serious health problem affecting more than 16 million Americans. In 1996, 3 percent of North Dakota residents had been told by physicians that they had diabetes. This exceeds the Year 2000 objective which aims to reduce the number of people affected by the disease to 2.5 percent.


In 1996, North Dakotans held the following opinions about HIV infection and AIDS.


Last Updated: Sunday, January 25, 1998 1:27:14 PM
Allen Johnson - ND Health Dept. DP Coordinator -