1. Biostatistics Assignment 1 Analysis of Metropolitan Statistical Area (MSA) data from the Behavioral Risk Factor Surveillance System (BRFSS), 2007

2. Presentation Overview • Health-Related Quality of Life (HRQOL): concepts and measurement • CDC HRQOL Surveillance Program’s Healthy Days Measures • Geographic trends in unhealthy days • Assignment overview: BRFSS MSA data analysis

3. Broad outcome measures designed to measure physical, emotional, and social dimensions of health(McDowell & Newell, 1996). • No one definition of HRQOL is agreed upon, but generally assessed with generic measures (e.g., Short-Form 36) or disease-specific measures (e.g., Quality of Life in Epilepsy Scale-10(Ware & Sherbourne, 1992; Cramer et al., 1996). • Quality of Life Instruments Database (QOLID): Online database of generic and disease-specific measures. http://www.proqolid.org Measuring Health-Related Quality of Life (HRQOL)

4. What is Health-RelatedQuality of Life (HRQOL)? • For public health surveillance purposes, HRQOL was defined as…“an individual’s or group’s perceived physical and mental health over time.”(Measuring Healthy Days, CDC 2000) • http://www.cdc.gov/hrqol • http://www.cdc.gov/brfss

6. Core Healthy Days Measures 1. Would you say that in general your health is excellent, very good, good, fair, or poor? 2. Now thinking about your physical health, which includes physical illness and injury, for how many days during thepast 30 days was your physical healthnot good? 3. Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how manydays during the past 30 days was your mental healthnot good? 4. During the past 30 days, for about how many days did poor physical or mental healthkeep you from doingyour usual activities, such as self-care, work, or recreation?

7. Unhealthy Days = days in the past 30 days when both physical and mental health were not good = Mentally unhealthy day = Physically unhealthy day = Healthy day

8. Trends in Unhealthy Days in the U.S., BRFSS 1996-2008 1996-1998 1999-2001 2002-2008 Mean number of unhealthy days 0 - 4.9 5.0 - 6.0 > 6.0 Source: CDC HRQOL Program, 2009

9. Assignment Instructions • Become familiar with the codebook and the variables included in the dataset. • Download and import the data file into the statistical software program to be used for the assignment. Use the program’s help file for instructions on importing the data if needed. Data should be cleaned prior to analysis. • Examine the distribution of a few of the key variables (i.e., PHYSHLTH, MENTHLTH, POORHLTH, and UNHEALTH) in the dataset. Consider these distributions and what impact they may have on the statistical tests you might use. • Create race/ethnicity groups from the RACE2 variable according to the following groupings: White, Black, Hispanic, and all other race/ethnicity groups. A response of “don’t know/not sure/refused” should be treated as missing.

10. Instructions continued: • Calculate mean, median, SD, and 95% CI for each of the following variables by sex and race/ethnicity: PHYSHLTH, MENTHLTH, POORHLTH, and UNHEALTH. • Perform simple t-tests on PHYSHLTH, MENTHLTH, POORHLTH, and UNHEALTH variables according to sex. • Conduct separate, simple ANOVAs with post-hoc comparisons treating PHYSHLTH, MENTHLTH, POORHLTH, and UNHEALTH as dependent variables and race/ethnicity as an independent variable. • Print out statistical program code and output results. • Answer the following questions.

11. Questions: • What are the mean, median, SD, and 95% CI for males and females on the following variables: PHYSHLTH, MENTHLTH, POORHLTH, and UNHEALTH? For Whites, Blacks, Hispanics and all other race/ethnicities? • Are there any statistically significant differences between males and females on the following variables: PHYSHLTH, MENTHLTH, POORHLTH, and UNHEALTH? Provide your determination and the relevant statistic(s) used to make the decision. • Are there any statistically significant differences on each of the following variables according to race/ethnicity: PHYSHLTH, MENTHLTH, POORHLTH, and UNHEALTH? Provide your determination and the relevant statistic(s) used to make the decision.