NHIS Non Sub Change Request

Nonsubstantive Change Request

NATIONAL HEALTH INTERVIEW SURVEY

OMB No. 0920-0214, Expiration Date 12/31/2020

Contact Information:

Stephen Blumberg

Division of Health Interview Statistics

National Center for Health Statistics/CDC

3311 Toledo Road

Hyattsville, MD 20782

301.458.4107 (voice)

301.458.4035 (fax)

[email protected]

October 22, 2019

Table of Contents

1. Circumstance Making the Collection of Information Necessary 4

2. Purpose and Use of Information Collection 4

12. Estimates of Annualized Burden Hours and Costs 5

15. Explanation for Program Changes or Adjustments 6

List of Attachments

Attachment 1 – Summary of changes to the 2020 NHIS

Attachment 2 – New 2020 NHIS Sample Adult Questions

Attachment 3 – New 2020 NHIS Sample Child Questions

Attachment 4 – Revised Advance Letter

Attachment 5 – Updated 2020 NHIS Reinterview Questionnaire

NCHS National Health Interview Survey

This is a request for approval of a nonsubstantive change to the National Health Interview Survey (NHIS) (OMB No. 0920-0214, Exp. Date 12/31/2020), conducted by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC).

As described in attachment 3a of the currently approved NHIS OMB revision package, the NHIS rotates content onto the survey on a periodic basis. This content is incorporated in the burden estimates in the initial submission and is presented here to show slight modifications to some of the questions. The topical areas of rotating content were described in attachment 12 of the revision package. This nonsubstantive change includes the following modifications:

Additions

1. Add 6 questions on detailed adult employment including name of employer, industry, occupation, most important activities on the job, supervisory status, and work category of main job.

2. Add 29 questions on adult injuries including questions about repetitive strain injuries, and accidental injuries.

3. Add 31 questions on adult health behaviors including questions about physical activity, walking, fatigue, sleep, alcohol use, smoking history and cessation.

4. Add 19 questions on child health behaviors including body mass index measurement, physical activity, neighborhood characteristics, sleep, and screen time.

5. Add 23 questions on child accidental injuries and child concussions.

Deletions

1. Remove 15 questions on mental health assessments for adults

2. Remove 8 questions on impact and location of pain for adults

3. Remove 22 questions on preventive services for adults

4. Remove 33 questions on mental health assessment for children

5. Remove 4 questions on stressful life events for children

In addition to content that was previously approved, this submission also seeks approval to add/delete sponsored content to the 2020 NIHS:

Additions

1. Add 11 questions on diabetes sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK, NIH) to assess diabetes risk and assist in diabetes related monitoring and prevention efforts. This includes questions about family history of diabetes, diabetes screening, and questions about weight loss, fitness, and diabetes prevention.

2. Add 30 questions as part of annual cancer control content sponsored by the National Cancer Institute (NCI, NIH) and the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP, CDC). This includes 6 questions about lung cancer screening including questions to assess eligibility for lung cancer screening and history of chest x-rays and CT scans to screen for lung cancer among current and former smokers; 12 questions about perceptions of the walking environment that ask about the walking environment of the respondents’ neighborhoods, if there are places respondents can walk to for different purposes, and barriers to walking; and 12 questions about sun care and safety including questions on protecting the skin from sun damage, sunburns, and tanning.

3. Add 5 questions to sample adult interview and 4 questions to the sample child interview about asthma sponsored by the National Heart, Lung, and Blood Institute (NHLBI, NIH), National Institute of Occupational Safety and Health (NIOSH, CDC), and the National Center for Environmental Health (NCEH, CDC). The questions are very similar to questions included on past years of the NHIS, most recently in 2018.

4. Add 1 question on the age of onset limitation sponsored by the Administration for Community Living (ACL, HHS).

Deletions

1. Remove 26 questions about cancer screenings

2. Remove 6 questions about arthritis

3. Remove 6 questions about willingness to participate in biometric measurements

4. Remove 4 questions related to immunizations

Replacements

1. Replace 3 questions in the pain management module sponsored by the National Center for Injury Prevention and Control (NCIPC, CDC) about strategies for treating pain.

The burden hours associated with these questions are a part of the sample adult questionnaire in the Redesigned Adult. The new sample adult questions for the 2020 NHIS are shown in Attachment 2 and the new sample child questions for the 2020 NHIS are shown in Attachment 3.

Meanwhile, the previous nonsubstantive change allowed for both the ongoing main survey and a bridge sample that was introduced to test the redesigned questions.  Now that the redesigned questions have been tested, there is no need to maintain both sets of questionnaires. Consequently, the previous four main core instruments and the related reinterview survey will be discontinued for 2020 and the previously split sample will be consolidated into the redesigned instruments.

Also included in this package are updates to the advance letter (Attachment 4) and reinterview questionnaire (Attachment 5) for the 2020 NHIS. Neither of these updates affect the burden of the NHIS.

1. Justification

1. Circumstance Making the Collection of Information Necessary

The NHIS is conducted by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC) to collect, on an annual basis, statistically valid data on the amount, distribution, and effects of illness and disability in the population and on the utilization of health care services for such conditions. The NHIS has been conducted every year since 1957, and the questionnaire has been periodically redesigned to reflect the latest state of the science and maintain the survey’s topical relevance toward its critical public health mission.

A redesigned questionnaire launched in January 2019. The redesigned instrument consists of annual and rotating core questions that are permanent fixtures on the redesigned NHIS questionnaire, as well as sponsored questions that comprise the scheduled sponsored content for the 2020 data collection year. This structure is described in attachment 3a of the revision package.

2. Purpose and Use of Information Collection

The purpose of including diabetes sponsored questions is to better monitor diabetes screening, risk factors, and preventions. These questions previously appeared on the NHIS in 2016 and 2017.

The questions included in the cancer control sponsored content will provide data on different aspects of cancer-related risk factors and preventive efforts. Similar content has appeared previously in the NHIS with the last time being 2015.

• The questions on lung cancer screening are required to assess the use of CT scans to conduct lung cancer screening and to determine if lung cancer screening is being conducted as recommended on the target audience. The questions underwent cognitive testing using burden hours from the generic OMB clearance of the Collaborating Center for Questionnaire Design and Evaluation Research (OMB No. 0920-0222, Expiration 08/31/2021).

• The purpose of adding questions about the perceptions of the walking environment is to better understand the ways respondents view their physical environment. These questions are planned to be included in the same years as NHIS rotating core on physical activity and walking. Together, these questions will help researchers understand the relationship the ways perceptions of the physical walking environment impact walking behavior.

• The questions about sun safety, sun burns, and tanning will help monitor skin cancer risk in the population. This set of questions will allow researchers to look at how different groups in the general public protect their skin from the sun and the frequency of sunburns and tanning.

The asthma questions are included to track progress towards meeting goals for reducing asthma attacks and asthma-related healthcare utilization. In addition, public health workers will be able to use this data to create education campaigns to help doctors provide higher quality and more consistent and timely work-related asthma medical care.

The question identifying the age of onset limitation will be used to identify adults who experienced disability before the age of 22.

Pain management questions will be used to understand the different ways that adults manage pain. The questions can be used in combination with the chronic pain and opioid questions that have been on the NHIS since 2019 to better understand non-opioid methods for managing pain.

12. Estimates of Annualized Burden Hours and Costs

1. Time Estimates

The questions included as scheduled rotating content in attachments 3a and attachment 12 of the revision package and were already accounted for in the burden estimate for the Redesigned Adult Questionnaire. The topical areas for the 2020 cancer control sponsored content were also previously described in attachment 12. In addition, these questions replace the questions on preventive cancer screening that were in the 2019 NHIS so there is no impact on the burden. Likewise, the 3 new pain management questions are replacing questions in the pain management section that has been on the NHIS 2019, so this change does not impact burden. However, the proposed inclusion of the 11 additional diabetes-related questions, 9 asthma related questions, and one question on the age of onset limitation increase the overall average burden per response to the Redesigned Adult Questionnaire from 42 to 49 minutes. The Redesigned Child Questionnaire has increased from 27 to 28 minutes. The burden times for no other data collection instrument will be impacted by the proposed modifications.

Consequently, the annualized burden estimate decreased by 13,589 hours from 47,960 to 34,371 hours. Any future modification that might impact the instruments and/or burden estimates will be submitted as a nonsubstantive change request for OMB review, as applicable.

Estimated Annualized Burden Hours

Type of Respondent	Form Name	Number of Respondents	Number of Responses per respondent	Average Burden per Response (in hours)	Total Burden Hours
Adult Household Member	Redesigned Household Roster	32,500	1	5/60	2,708
Sample Adult	Redesigned Adult Questionnaire	27,000	1	49/60	22,050
Adult Family Member	Redesigned Child Questionnaire	9,000	1	28/60	4200
Adult Family Member	Methodological Projects	15,000	1	20/60	5,000
Adult Family Member	Redesigned Reinterview Survey	4,950	1	5/60	413
Total					34,371

B. Cost to Respondents

At an average wage rate of $21.00 per hour, the estimated annualized cost for the 34,371 burden hours is

$817,068. This estimated cost does not represent an out of pocket expense but represents a monetary value attributed to the time spent doing the interview.

Estimated Annualized Burden Costs

Type of Respondent	Form Name	Total Burden Hours	Hourly Wage Rate	Total Respondent Costs
Adult Household Member	Redesigned Household Roster	2,708	$21.00	56,868
Sample Adult	Redesigned Adult Questionnaire	22,050	$21.00	463,050
Adult Family Member	Redesigned Child Questionnaire	4,200	$21.00	88,200
Adult Family Member	Methodological Projects	5,000	$21.00	105,000
Adult Family Member	Redesigned Reinterview Survey	4,950	$21.00	103,950
Total	817,068

15. Explanation for Program Changes or Adjustments

The burden hours associated with the rotating content and cancer control sponsored content were previously accounted for as a part of the Redesigned Adult Questionnaire when a draft set of cognitively tested questions were available. Given the additional time to complete the 11 diabetes items, 9 asthma questions, and 1 onset limitation question it is anticipated that the overall burden of the Redesigned Adult Questionnaire will increase from 42 to 49 minutes. The Redesigned Child Questionnaire has increased from 27 to 28 minutes. The overall burden times for no other data collection instrument will be impacted by the proposed modifications.

Meanwhile, the previous nonsubstantive change allowed for both the ongoing main survey and a bridge sample that was introduced to test the redesigned questions.  Now that the redesigned questions have been tested, there is no need to maintain both sets of questionnaires. Consequently, the previous four main core instruments and the related reinterview survey will be discontinued for 2020 and the previously split sample will be consolidated into the redesigned instruments. Overall, the changes proposed herein decrease the overall previously approved burden hours from 47,960 to 34,371.

9