1. BRFSS Salt Intake Module Epidemiology and Surveillance Team Epidemiology and Surveillance Branch Division for Heart Disease and Stroke Prevention National Center For Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention DHDSP Grantee Meeting Sept, 2010

2. Sodium Recommendation (Sodium Chloride is the chemical name for salt and 90% of the sodium we consume is in the form of salt) NHANES 05-06 revealed average sodium intake was 3,466mg/day among US adults 2005 Dietary Guideline recommendation: <2,300 mg/day. “Specific Populations” recommended to consume ≤1,500 mg/day: –Hypertensive –Black –Middle or Older American

3. Sodium and Public Health Higher consumption of sodium means higher blood pressure. Therefore, it is also related to – Coronary heart disease – Stroke – Heart failure – Kidney disease

4. Burden of Heart Disease and Stroke In the US – >79 million CVD related doctors visit every year; – > 6 millions hospitalizations annually; – > 4 millions emergency visits annually and circulatory disorders were the most frequent reason for admission to the hospital through emergency department; – The cost for cardiovascular is $503.2 billion in 2010.

5. Reducing Salt, Reducing Mortality The lower the blood pressure, the lower the risk of heart disease (even for those without hypertension). Decreasing sodium intake from 3,500 mg/day to 1,500 mg/day could lead to a 30% decrease in hypertension prevalence.* *Source: Joffres MR, Campbell NR, Manns B, Tu K. Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada. Can J Cardiol 2007 May 1;23(6):437-43.

6. Relative Amounts of Dietary Sodium in the American Diet Source: Mattes RD, Donnelly, D. Relative contributions of dietary-sodium sources. J Am Coll Nutr. 1991 Aug;10(4):383-93.

7. Sample Food Label, U.S.

8. BRFSS and salt intake There is no state-level salt intake survey Adding salt intake module into BRFSS questions will enable CDC and states to assess salt intake behavior among US adults. In the long term, the module will provide the opportunity to evaluate the CDC funded heart disease and stroke prevention program of reduction salt intake.

9. Purpose To provide state level surveillance of salt intake behavior among American adults. The module will have the capability of measuring behavior, knowledge of salt intake among American adults, as well as if any action has been taking to reduce salt intake. Tracking these indicators allows CDC to monitor national and state-specific trends in these measurements over time and to compare these indicators across the states.

10. Funding If these questions are approved as a module for the 2012 BRFSS, ESB will provide support for the 4 questions contingent upon availability of resources. ESB will fund this module again later in rotation with other HDSP program modules during the odd years contingent upon resources available through the CDC budget process.

11. Criteria for the questions Relationship to personal behaviors Pertinence to Healthy People 2010 objectives or priority health issues Need to have state-specific data Alternate data sources Need to measure variable over time Relationship to other questionnaire topics Expected validity of questions

12. Analytic plan Descriptive in nature Frequency tables Combining questions from the core to estimate the sociodemographic characteristics

13. Sample table shells Question 1. Doctor or other health professional ever advised to reduce salt intake YesNo By age group 18-34 35-44 …… By sex Males Females By race/ethnicity ……

14. Sample table shells Question 2. Cutting down on salt intake now YesNo By age group 18-34 35-44 …… By sex Males Females By race/ethnicity ……

15. Sample table shells Question 3. Frequency of eating processed meats during past 30 days 0<55-910-1920-29>=30 By age group 18-34 35-44 …… By sex Males Females By race/ethnicity ……

16. Sample table shells Question 4. Frequency of eating salty snacks during past 30 days 0<55-910-1920-29>=30 By age group 18-34 35-44 …… By sex Males Females By race/ethnicity ……

17. Sample table shells Question 5. Frequency of eating frozen entrees during past 30 days 0<55-910-1920-29>=30 By age group 18-34 35-44 …… By sex Males Females By race/ethnicity ……

18. Sample table shells Question 6. Frequency of eating canned /package soup during past 30 days 0<55-910-1920-29>=30 By age group 18-34 35-44 …… By sex Males Females By race/ethnicity ……

19. Sample table shells Summary. Frequency of eating high salt foods during past 30 days during past 30 days <1010-1920-2930-5960-99>=100 By age group 18-34 35-44 …… By sex Males Females By race/ethnicity ……