2020

Behavioral Risk Factor Surveillance System Asthma Call-back Survey

Summary Data Quality Report

National Asthma Control Program

Version 1.0.0 09/01/2022

ACKNOWLEDGMENTS

The Asthma Call-back Survey (ACBS) is funded by the National Asthma Control Program (NACP) in the Asthma and Community Health Branch (ACHB) of the National Center for Environmental Health (NCEH). The state health departments jointly administer the ACBS with the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Population Health (DPH).

The NCEH and NCCDPHP greatly appreciate the efforts of the BRFSS staff in each ACBS- participating state.

Kanta Sircar, PhD, MPH, PMP Acting Branch Chief

Commander, US Public Health Service Asthma and Community Health Branch

Division of Environmental Health Science and Practice National Center for Environmental Health

Centers for Disease Control and Prevention 4770 Buford Hwy, NE

Mailstop S106-6 Atlanta, GA 30341 USA

Phone: (770) 488-3388

E-mail: ksircar@cdc.gov

Machell G. Town, PhD Branch Chief

Population Health Surveillance Branch Division of Population Health

National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention

4770 Buford Hwy, NE Mailstop S107-6 Atlanta, GA 30341 USA

Phone: (770) 488-4681

E-mail: mpt2@cdc.gov

2020 ACBS Summary Data Quality Report

2020 Asthma Call-back Survey (ACBS) Summary Data Quality Report

Introduction

Procedures for interview disposition and response rates for the Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS) follow the usual BRFSS procedures; however, some additions and adaptations are required for the call-back survey. Disposition codes, disposition code categories, and response rates are discussed in the sections below. Figure 1 is a flow chart that describes the eligibility paths BRFSS respondents with asthma follow through the ACBS process.

Because asthma characteristics vary by season, a seasonal analysis must consider any state for which interviewing was not conducted throughout the year. States may have interrupted interviewing due to contract interruptions with their data collection company. In addition, some ACBS interviews are finalized in the first few months of the next calendar year. If a state has less than 6 complete months of child or adult data, the data from that state are not considered sufficiently comparable with the data from other states and are excluded from the public release file and the response rate calculations. If a state has fewer than seventy-five (75) complete child interviews, reliable weights cannot be calculated and the child data from that state are excluded from the public release file. Also, if a state has fewer than two hundred (200) complete adult interviews, reliable weights cannot be calculated and the adult data for that state are excluded from the public release file.‌

Appendix A presents tables showing disposition code categories, response rates, and completed interviews by month for each state participating in the ACBS each year. Appendix B provides additional instructions on assigning the ACBS-specific disposition codes. Appendix C presents the ACBS nonresponse bias analysis plan and supporting tables showing demographic breakout and prevalence for each state. Details on BRFSS response rates and procedures can be found in the BRFSS Data Quality Report Handbook and the BRFSS Summary Data Quality Report for each survey year (http://www.cdc.gov/brfss/annual_data/annual_data.htm).

Disposition Codes

The BRFSS disposition codes are used for the ACBS; however, a few additional codes are needed to account for situations specific to a call-back survey. In the list below, disposition codes added to the ACBS are underlined and bolded. There are no equivalent BRFSS codes for ACBS-specific codes. Detailed descriptions of the ACBS codes can be found in Appendix B.

The ACBS 4-digit disposition codes for 2020 are:

1. Eligible, contacted: complete interview

   
   

   1100 Complete.

   1200 Partial complete (through the end of section 8).

   
   

2. Eligible, contacted: refusal or termination

   
   

   4413	Refused to participate in the call-back during the BRFSS interview.
   2112	Refused to begin the ACBS interview after contacted.
   2120	Terminated within the questionnaire during the ACBS interview before section 9.
   2211	Refused to allow combining ACBS responses with BRFSS responses.
   2212	Refused to answer the “ever had asthma” question during the ACBS interview.

   
   

3. Eligible, lost to follow-up because unable to contact or communicate with the BRFSS respondent with asthma

   
   

   2111	Hang up or termination before respondent contacted. Household contacted but
   	ACBS respondent not contacted.
   2210	Selected respondent never reached or reached but did not begin interview during
   	interviewing period. Selected respondent away from residence during the entire
   	interviewing period.
   2220	Telephone answering device, message confirming private residential status.
   	Telecommunication technological barrier, message confirming private residential
   	status.
   2320	Selected respondent physically or mentally unable to complete an interview
   	during the entire interviewing period.
   2330	Language problem after respondent selection.
   3100	Contact, hang-up or termination, unknown if private residence.
   3130	No answer.
   3140	Telephone answering device, unknown if private residence.
   3200	Hang-up or termination, known household. Household contact, eligibility
   	undetermined.
   3322	Physical or mental impairment.
   3330	Language problem.
   4100	Household members away from residence during entire interviewing period.
   4900	Miscellaneous, non-eligible (for ACBS miscellaneous non-contact).
   4306	Selected ACBS respondent no longer living in the BRFSS household.
   Temporary codes: should be resolved prior to submission
   5050	Hang-up, unknown if housing unit.
   5100	Appointment.
   5111	Household-level refusal.
   5112	Refusal: hang-up or termination.
   5120	Break off/termination in questionnaire before Section 9.
   5130	No answer.
   5140	Answering machine, unknown if private residence.
   5220	Answering machine, message confirming residential status.
   5320	Physical or mental impairment.

   
   

   
   

   5330 Language problem.

   5550 Busy.

   5560 Unsafe location for interview.

   
   

4. Eligible, lost to follow-up for technical reasons

   
   

   3150	Telecommunication technological barrier, unknown if private residence.
   3700	On never-call list.
   4200	Dedicated fax/data/modem line with no human contact.
   4300	Telephone number no longer in service or changed. Non-working/disconnected
   4400	number. Busy/Fast busy/Circuit busy.
   4430	Call forwarding/Pager.
   4450	Landline sample number connects to cell phone.
   4460	Cell phone sample number connects to landline.
   4470	Cell phone respondent also has landline, less than 90% of all calls on cell phone.
   4500	Not a private residence – business.
   4510	Not a private residence – group home.
   5150	Technological barrier other than answering machine–unknown if private
   5200	residence. Fax/Data/Modem.
   5300	Phone number temporarily out of service. Possible non-working number.
   5400	Technological barrier other than answering machine with message confirming
   5599	residential status. Fast busy. Circuit busy. Mistaken Ctrl-End.
   5700	Supervisor attention needed.
   5900	Null attempt.
   9999	Missing disposition code.

   
   

5. Ineligible: all codes specific to ACBS (no BRFSS equivalent)

Definitions and Labels for Disposition Code Categories

Because the ACBS is a call-back interview, all those identified with asthma at the BRFSS interview are, with a few notable exceptions, eligible for the call-back survey. The ACBS eligibility flow chart (Figure 1) summarizes how BRFSS respondents are categorized for ACBS response rate calculation.

ACBS interviews are considered complete (COIN) if the respondents finish the entire interview or if they complete through section 8 of the ACBS interview. ACBS interviews are refusals if the respondent refuses participation at either the BRFSS interview or at the time of the ACBS interview. Terminations are ACBS interviews that start but are terminated during the interview before completing section 8 (Medication Section).

The disposition codes that relate to contact problems or technology issues are considered “eligible but lost to follow-up.” If they had been contacted, a small proportion of those eligible but lost to follow-up might have been ineligible.

BRFSS respondents with asthma who are considered ineligible for the ACBS include those who are not asked to participate at the time of the BRFSS interview. Each year, between 10% and 15% of those technically eligible are not asked to participate in the call-back survey.

Respondents might not be asked for several reasons:

• States with split samples may include respondents in the call-back only if they are in specified splits of the BRFSS sample. Counts for states that exclude split-sample respondents are excluded from the following tables and rate calculations.

• The BRFSS respondent may partially complete the BRFSS interview but terminate before the call-back request.

• Specific state BRFSS call-back contracts may limit the number of call-back interviews due to budgetary constraints.

• States may stop conducting call-back interviews during contract negotiations.

  
  

  BRFSS respondents with asthma who are asked to participate in the ACBS but are later classified as ineligible include:

• Respondents in households where both the selected adult and selected child in the household have asthma. When both have asthma, only one is eligible for the ACBS.

• Respondents who move out-of-state between the BRFSS interview and the ACBS interview in states that are not transferring ACBS interview data or to/from states not participating in the ACBS.

• Respondents who indicate, at the time of the ACBS interview, that the reported diagnosis of asthma was an error.

• Child respondents for whom the adult BRFSS respondent is not the child’s parent or guardian.

• Some respondents in states that have reached a pre-specified quota for ACBS interviews.

The following table indicates how disposition codes are grouped into response rate categories shown in the eligibility flow chart (Figure 1):

Table 1: Disposition Code Categories

ACBS COIN

• Complete: code 1100

• Partial complete: code 1200

Lost to follow-up

• Contact/communication codes

• Technical problem codes

ACBS TERE

• Termination: code 2120

• Refusal: codes 2112, 2211, 2212

Lost to follow up for call-back

• Never called: code 4412

Permission granted

Ineligible for call-back:

• If adult, child selected for call- back: code 4490

• If child, adult selected for call- back: code 4491

• If child, no parent/guardian:

codes 2290, 2291

BRFSS TERE: refusal

• Permission denied: code 4413

Recruited for call-back Asked permission question

Figure 1: ACBS Eligibility Flow Chart:

BRFSS respondent with asthma ASTHMA3 = 1 (Yes)

Ineligible for call-back: code 4480

• Split sample

• Quota

• Skipped permission question

Respondent was called for ACBS interview

Ineligible for call-back

• Moved out of state: code 4405

• Does not have asthma: codes 4471, 4700

• Other: code 4411

ACBS Response Rates

The ACBS Interview Completion Rate is the proportion of completed interviews among eligible respondents who are contacted for and started the ACBS interview. Those who refuse at the initial BRFSS interview (4413), are ineligible, and those never contacted are excluded from the denominator. This rate is based on actual contacts with the eligible respondents at the time of the call-back interview. The numerator of the rate includes completed interviews (COIN). The denominator of the rate includes completed interviews (COIN), plus the number contacted later for the ACBS interview who refused or terminated the interview (disposition codes 2112, 2120, 2211, and 2212).

The ACBS Cooperation Rate is the proportion of completed interviews among all eligible respondents who are recruited and contacted for the ACBS interview. Eligible respondents who refuse the call-back at the time of the BRFSS interview are included. Non-contacts are excluded from the denominator, but contacts with communication problems specific to the respondent with asthma are included. The numerator of the rate consists of completed interviews (COIN). The denominator of the rate includes completed interviews (COIN), plus refusals and terminations (TERE), plus the number of non-interviews that involved language problems with the respondent with asthma (2330) or physical/mental impairment of the respondent with asthma (2320). A Cooperation Rate below sixty-five percent (65%) may indicate some problem with interviewing techniques.

The Refusal Rate is the percentage of all eligible respondents who refuse to be interviewed or terminate an interview early in the questionnaire. The numerator includes terminations and refusals (TERE). The denominator is the same as for the CASRO rate (below). The denominator includes completed interviews (COIN), terminations and refusals (TERE), and a proportion of those eligible, but lost to follow-up. The proportion represents an estimate of the number of those lost to follow-up who would be expected to remain eligible if they had been contacted. The proportion of cases lost to follow-up that are estimated to be eligible is the same as the proportion of cases not lost to follow-up that are eligible. A Refusal Rate above thirty-five percent (35%) indicates some problem with interviewing techniques.

The Council of American Survey Research Organizations (CASRO) rate is a measure of respondent cooperation and is generally defined as the proportion of all eligible respondents in the sample for whom an interview has been completed. The numerator of the CASRO rate includes completed interviews (COIN). The denominator includes completed interviews (COIN), terminations and refusals (TERE), and a proportion of those eligible, but lost to follow-up. The proportion represents an estimate of the number of those lost to follow-up who would be expected to remain eligible if they had been contacted. The proportion of cases lost to follow-up that are estimated to be eligible is the same as the proportion of cases not lost to follow-up that are eligible. A CASRO rate below forty percent (40%) should be cause for a review of data collection practices that could affect it, especially sample management and interviewer recruitment, retention, training, supervision, and monitoring.

Response rate formulae for the ACBS are specified below. Response rate tables for the ACBS, including response rates for each state/area participating in the ACBS, can be found in Appendix

A. Details on ACBS-specific disposition codes can be found in Appendix B.

Response Rate Formulae for the ACBS

ACBS Interview Completion Rate:

1100 + 1200

1100 + 1200 + 2112 + 2120 + 2211 + 2212

ACBS Cooperation Rate:

1100 + 1200

1100 + 1200 + 2112 + 2120 + 2211 + 2212 + 4413 + 2320 + 2330

ACBS CASRO Rate:

1100 + 1200

[ 1100 + 1200 + 2112 + 2120 + 2211 + 2212 + 4413] + P * [ Eligible lost]

ACBS Refusal Rate:

2112 + 2120 + 2211 + 2212 + 4413

[ 1100 + 1200 + 2120 + 2211 + 2212 + 2112 + 4413] + P * [ Eligible lost]

Where:

P (Proportion) = (COIN + ACBS TERE) / (COIN + ACBS TERE + Ineligible) [(1100+1200) + (2112 +2120 + 2211 + 2212)]

[(1100+1200)+(2112+2120+2211+2212)+4405+4700+4411+4471+2291+2290+4480+4490+

4491+4412)]

Eligible lost = 2111, 2210, 2220, 2320, 2330, 3100, 3130, 3140, 3200, 3322, 3330, 4100, 4900,

4306, 5050, 5100, 5111, 5112, 5120, 5130, 5140, 5220, 5320, 5330, 5550, 5560, 3150, 3700,

4200, 4300, 4400, 4430, 4450, 4460, 4470, 4500, 4510, 5400, 5150, 5200, 5300, 5599, 5700,

5900, 5999

ACBS Nonresponse Bias

The Asthma Call-back Survey (ACBS) uses post-stratification weighting to ensure the sample conforms to the state estimated asthma population with respect to geography, age, sex, race, ethnicity, and other characteristics. Nonresponse bias, however, cannot be completely removed. In order to communicate the potential impact of nonresponse bias on the ACBS analysis results, in Appendix C two groups of tables are being provided (see Appendix C). The first group of tables presents ACBS unweighted frequencies for respondents, non-respondents, and BRFSS- eligible asthma respondents by age, sex, and race/ethnicity demographic categories for each state. The second group of tables report current asthma prevalence (Appendix C). ACBS respondents are those respondents who completed or partially completed the interview.

Nonresponse for the ACBS is influenced by eligible BRFSS respondents for which no interview was conducted such as: (1) refusals, terminations, and non-consent; (2) lost to follow-up due to non-contact or communication; and (3) lost to follow-up due to technological circumstances.

BRFSS-eligible respondents are individuals on the BRFSS survey who answered, “Yes” to the question, “Has a doctor, nurse, or other health professional EVER told you that you had asthma?” A respondent is classified as current prevalence if he or she also responded “Yes” to the question: “Do you still have asthma?”

Appendix A:

List of Tables in the 2020 BRFSS ACBS Summary Data Quality Report Landline and Cell Phone Samples

Table 1.1 ACBS 2020 Disposition Categories by State/Territory: Adult Landline and Cell Phone Sample

Table 1.2 ACBS 2020 Disposition Categories by State/Territory: Child Landline and Cell Phone Sample

Table 2.1 ACBS 2020 Response Rates by State/Territory: Adult Landline and Cell Phone Sample Table 2.2 ACBS 2020 Response Rates by State/Territory: Child Landline and Cell Phone Sample

Table 3.1 ACBS 2020 Completed Interviews by State/Territory and Month: Adult Landline and Cell Phone Sample Table 3.2 ACBS 2020 Completed Interviews by State/Territory and Month: Child Landline and Cell Phone Sample

Note:

In this document, the term “state” is used to refer to all areas participating in the ACBS, including Puerto Rico

States included in public release file because of having more than 75 completes

States excluded from public releasing file because of less than 75 completes

Appendix B: Instructions for Assigning Additional ACBS Disposition Codes

Following are descriptions of the ACBS disposition codes adapted from standard BRFSS disposition codes and the ACBS disposition codes added to the standard set of BRFSS disposition codes. For detailed definitions for the standard BRFSS disposition codes, see the Data Quality Handbook for each survey year (http://www.cdc.gov/brfss/annual_data/annual_data.htm).

1. Eligible, contacted: complete interview

   
   

   1100 Complete

   Definition: Respondent completes the ACBS interview through the last question.

   
   

   1200 Partial complete

   Definition: Respondent completes the ACBS interview at least through the end of Section 8 (medications).

   
   

2. Eligible, contacted: refusal or termination

   
   

   4413 Refused to participate in the call-back during the BRFSS interview

   Definition: During the BRFSS interview, respondents who indicate they have ever been told by a doctor that they have asthma are asked if they will participate in an additional survey at a later date. Some state Institutional Review Boards (IRBs) require that the content of the additional survey (asthma) be disclosed; other state IRBs require that the specific content not be disclosed. Some states have multiple call-back surveys in the field and do not specify the content of any of the call- back interviews. If a respondent refuses to participate in the call-back survey, that record is assigned disposition code 4413.

   2112 Refused to begin the ACBS interview after contacted

   Definition: If the selected respondent is contacted for the ACBS interview but refuses to begin the interview, then the record is assigned code 2112.

   2120 Terminated within the questionnaire during the ACBS interview

   Definition: If the respondent is contacted for the ACBS and terminates after the interview begins (section 3) but before completing section 8, then record is considered incomplete and is assigned disposition code 2120.

   
   

   2211 Refused to allow combining ACBS responses with BRFSS responses

   Definition: Some states require that the respondent provide active approval to combine their responses from the initial BRFSS interview with their responses from the ACBS interview. This approval may be requested at either the initial BRFSS interview or at the beginning of the ACBS interview. If the respondent does not approve combining data from the two interviews, the record is assigned disposition code 2211.

   2212 Refused to answer the “ever had asthma” question during the ACBS interview

   Definition: The selected respondent is contacted for the ACBS interview but refuses to answer the initial asthma question. If the respondent answers "don't know" or "refused" to the ACBS question EVER-ASTH (2.1) “Have you ever been told by a doctor or other health professional that (you have/sample child has) asthma?”, then the record is assigned code 2212.

   
   

3. Eligible, lost to follow-up because unable to contact or communicate with the BRFSS respondent

   
   

   4306 Selected ACBS respondent no longer living in the BRFSS household

   Definition: The BRFSS respondent with asthma left the BRFSS household between the BRFSS interview and the ACBS interview. If the selected respondent (from the BRFSS) no longer lives in the BRFSS household but did live in the household during the BRFSS interview, then attempts should be made to obtain new contact information for the selected respondent, and the follow-up should be conducted using the new telephone number. If this is not possible or the household refuses to provide new contact information, then the record is assigned disposition code 4306.

   
   

   Refer to the Data Quality Handbook for each survey year for the definitions of all other codes in this category (http://www.cdc.gov/brfss/annual_data/annual_data.htm).

   
   

4. Eligible, lost to follow-up for technical reasons

   
   

   Refer to the Data Quality Handbook for each survey year for the definitions of all codes in this category (http://www.cdc.gov/brfss/annual_data/annual_data.htm).

   
   

5. Ineligible

2290 The person the most knowledgeable about the selected child with asthma is not the parent or legal guardian (child ineligible)

Definition: This code applies only to the child ACBS interview. The child selected during the BRFSS interview is eligible for the ACBS (the BRFSS respondent indicated that the selected child has an asthma diagnosis). The ACBS child protocol allows a parent or guardian to transfer the interview to a more knowledgeable proxy respondent. If the BRFSS respondent is not the parent or guardian of the selected child with asthma, but the parent or guardian is present to transfer to the person most knowledgeable about the child’s heath, but the most knowledgeable person is not available, then the child is ineligible for the ACBS. The child record is assigned disposition code 2290

2291 No parent or legal guardian in the household (child ineligible)

Definition: This code applies only to the child ACBS interview. The child selected during the BRFSS interview is eligible for the ACBS (the BRFSS respondent indicated that the selected child has an asthma diagnosis); however, ACBS child

protocol requires that the BRFSS respondent must be the parent or guardian of the child to provide proxy responses for the child or to approve transfer to a more- knowledgeable proxy respondent. If there is no parent or guardian of the selected child with asthma in the household, the child is ineligible for the ACBS. The child record is assigned disposition code 2291.

4405 Out-of-state

Definition: The BRFSS question that determines eligibility for the ACBS is “Have you ever been told by a doctor, nurse, or other health professional that (you have/the sample child has) asthma?” Respondents who answer “yes” are eligible for the ACBS. If the respondent is a state resident at the time of the BRFSS interview, but moves to an out-of-state residence between the BRFSS interview and the ACBS interview, the respondent is not eligible for the ACBS if either the new state or the old state is not participating in record transfers, and the record is assigned disposition code 4405.

4700 Household, no eligible respondent (respondent does not have asthma)

Definition: The BRFSS question that determines eligibility for the ACBS is “Have you ever been told by a doctor, nurse, or other health professional that (you have/the sample child has) asthma?” Respondents who answer “yes” are eligible for the ACBS. If the respondent informs the ACBS interviewer that the recorded response from the BRFSS interview was in error and terminates the call, then the respondent is not eligible for the ACBS, and the record is assigned disposition code 4700.

4411 Selected respondent not eligible for follow-up

Definition: If the respondent disagrees with the recorded response to the asthma question from the BRFSS interview and answers “no” to the ACBS question EVER-ASTH (2.1) “Have you ever been told by a doctor or other health professional that (you have/the sample child has) asthma?”, then the respondent is not eligible for the ACBS, and the record is assigned disposition code 4411.

4412 Transferred from BRFSS but not attempted (excluded by state)

Definition: The BRFSS question that determines eligibility for the ACBS is “Have you ever been told by a doctor, nurse, or other health professional that (you have/the sample child has) asthma?” Respondents who answer “yes” are eligible for the ACBS. Eligible respondents are then asked for permission to call back. Those that agree should be called for the ACBS interview, but if a respondent eligible to be called is transferred from BRFSS to the ACBS but never called, then the record is assigned disposition code 4412.

4471 Misdiagnosed asthma in respondent (2008 and later)

Definition: The BRFSS question that determines eligibility for the ACBS is “Have you ever been told by a doctor, nurse, or other health professional that (you have/the sample child has) asthma?” Respondents who answer “yes” are eligible for the ACBS. The initial diagnosis, however, could have been in error and changed.

This misdiagnosis is not captured by the BRFSS or ACBS. If the respondent informs the interviewer of the misdiagnosis, the respondent is not eligible for the ACBS, and the record is assigned disposition code 4470.

4480 Not recruited for call-back at BRFSS interview (excluded by state)

Definition: The BRFSS question that determines eligibility for the ACBS is “Have you ever been told by a doctor, nurse, or other health professional that (you have/the sample child has) asthma?” Respondents who answer “yes” are eligible for the ACBS. Eligible respondents are then asked for permission to call back. Those who agree should be called for the ACBS interview. However, if a respondent eligible to be called is not transferred from BRFSS to the ACBS and is never called, then the record is assigned disposition code 4480.

4490 Random child/adult selection: adult ineligible, child selected

Definition: If both the BRFSS respondent and the randomly selected child in the household have asthma and the BRFSS respondent agrees to the call-back interview, one or the other is randomly selected to be eligible for the call-back. If the child is selected, the adult is ineligible, and the adult record is assigned disposition code 4490.

4491 Random child/adult selection: child ineligible, adult selected

Definition: If both the BRFSS respondent and the randomly selected child in the household have asthma and the BRFSS respondent agrees to the call-back interview, one or the other is randomly selected to be eligible for the call-back. If the adult is selected, the child is ineligible, and the child record is assigned disposition code 4491.

Appendix C:

Asthma Call-back Survey (ACBS) Non-response Bias Analysis

Two data tables follow adult and child participants. The first table reports ACBS unweighted frequencies for respondents, non-respondents, and BRFSS-eligible asthma respondents by age, sex, and race/ethnicity demographic categories for each state. The second table reports estimated current asthma percentage among individuals who have ever been diagnosed with asthma.

Table 1A. Percentage of ACBS adult respondent, non-respondents, and BRFSS-eligible asthma respondents by demographic groups and state/territory

Table 1B. Percentage of ACBS child respondents (aged 0 -17), non-respondents, and BRFSS-eligible asthma respondents by demographic groups and state/territory

Table 2A. Estimated percentage of current asthma status among adults ever-diagnosed with asthma by state/territory

Table 2B. Estimated percentage of current asthma status among children (0-17 years) ever-diagnosed with asthma by state/territory

Notes:

In this document, the term “state” is used to refer to all areas participating in the ACBS, including Puerto Rico

For tables in Appendix C denominator excludes: Respondents with do not know/refused/missing responses