CDC’s decision to move to this new method for the BRFSS was based on their desire to provide more reliable and current county-level estimates (due to the inclusion of cell phone only users) for all counties. (Previously, even using seven years of data, there were many counties where there were not enough BRSS respondents to provide any estimates). We knew that this might lead to differences in estimates of varying size. Our best advice for counties with unexpectedly large changes is to look to other sources of estimates of people’s quality of life and health behaviors and examine all the results together. You may want to look at the Premature Death data included in your snapshot to understand how trends in mortality align with your new estimates of quality of life. Counties might also want to consider consulting any existing locally based data sources, e.g., hospitals or health care systems that conduct their own surveys or gather information in electronic health records. One area of last resort might be to conduct your own survey – although web-based or text-based surveys come with their own limitations, they can be a relatively inexpensive way to gather data from residents.