Approximately half of all deaths in the United States can be attributed to just nine factors: tobacco; diet/activity patterns; alcohol; microbial agents; toxic agents; firearms; sexual behavior; motor vehicles; and illicit use of drugs (McGinnis and Foege, 1993). Consequently, making substantial improvements in health outcomes (illness, death, injury, and disability) requires improving health behaviors. Community efforts to improve health depend on measurement of both health outcomes and health behaviors to design and measure the impact of local health intervention efforts.

Health outcomes can be measured in medical records and vital records, such as birth certificates and death certificates, but measuring the behaviors that have such a profound impact on health requires either observing what people do or asking them what they do. Structured interviewing (i.e., surveying) of large numbers of individuals randomly selected from the population (sampling) has been the most commonly employed and most economical method for measuring behavior.

While national prevalence estimates of health risk behaviors were available prior to the early 1980's through studies conducted by the National Center for Health Statistics (e.g., National Health and Nutrition Examination Surveys; National Health Interview Survey), these data were not available at the state level. It was recognized that national data may not be applicable to any given state, yet state health agencies have the primary role of targeting resources to reduce behavioral risks and their consequent health outcomes. As telephone survey methodology was gaining wide acceptance as a valid way of measuring health risk behaviors in populations, the Behavioral Risk Factor Surveillance System (BRFSS) was established in 1984 by the Centers for Disease Control and Prevention to provide such state-level data on behavioral health risks and preventive health practices.

The Behavioral Risk Factor Surveillance System, which is coordinated and partially funded by the Centers for Disease Control and Prevention, is the largest continuously conducted telephone survey in the world. It is conducted in every state, the District of Columbia, and several United States territories. The first BRFSS survey in Kansas was conducted as a point-in-time survey in 1990, and Kansas has conducted the BRFSS survey annually since 1992.