Response to Public Comments

Attachment 2c - Program Response to the Public Comments to the 60-Day Federal Register Notice
The National Center for Health Statistics published a 60-day Federal Register Notice informing the
public of the National Health Interview Survey on April 16, 2020 (see Attachment 2a).
Five comments were received in response to this notice:
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A comment was received on April 17, 2020 from a private citizen expressing support for the
National Health Interview Survey, stating it would be something she would love to participate in.
Response: A standard CDC response was sent.

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A comment was received on April 23, 2020 from Pinney Associates recommending that items
related to smoking cessation be included in the NHIS annual core rather than rotating core.
Pinney Associates also noted the value of retaining consistent survey items from year to year, so
that patterns can be examined over time. A similar comment was received on June 15, 2020 from
Altria Client Services which also recommended the annual collection of cessation items and the
inclusion of additional tobacco items related to more novel tobacco products (e.g. smokeless
tobacco, cigars, pipes, heated tobacco products).
Response: The NHIS was redesigned in 2019 to reduce the burden on sample households. In
order to achieve the goal of reducing burden, NCHS prioritized content into annual core content
and rotating core content. Annual core content includes questions on the prevalence of chronic
conditions and impairments, the extent of disability, the utilization of health care services, and
health related behaviors that are most critical to achieve the goals of the survey. Annual core also
includes key sociodemographics. Rotating core content is asked less frequently and either
addresses new topic areas or provides expanded detail for the annual core. Questions on smoking
cessation and history provide additional detail on smoking related behaviors in the annual core.
Similar questions are asked on other major federal surveys such as the National Health and
Nutrition Examination Survey (NHANES), the Population Assessment of Tobacco and Health
(PATH), and the Behavioral Risk Factor Surveillance System (BRFSS). Some of these surveys
are able to devote more time to these topics and may also be good sources for estimates on
smoking cessation.
The Food and Drug Administration (FDA) sponsors NHIS questions on non-cigarette tobacco
use. As the commenter notes, questions on novel and innovative tobacco products could be
included by the FDA as part of their sponsored content to the NHIS depending on the funding
priorities of the FDA. Some of this content may already be covered on the Population
Assessment of Tobacco and Health (PATH).

•

A comment was received on June 15, 2020 from the Truth Initiative recommending additional
items related to menthol cigarettes, flavored tobacco products, e-cigarettes, heated tobacco
products, and nicotine pouches. The Truth Initiative cites that the addition of these questions will
allow for documentation of prevalent tobacco behaviors and provide specificity for e-cigarette
use by month and session.
Response: The NHIS was redesigned in 2019 to reduce the burden on sample households.
Content on menthol cigarettes, flavored tobacco products, detailed questions about e-cigarettes,
heated tobacco products, and nicotine pouches would require a substantial amount of space on

the survey and would likely need to be part of sponsored content on the NHIS. Some of this
content may already be covered on the Population Assessment of Tobacco and Health (PATH)
that covers detailed aspects of tobacco and e-cigarette product use.
•

A comment was received on June 15, 2020 from the UCLA School of Law, Williams Institute
recommending the inclusion of additional items asking about sexual orientation and gender
identity. The Williams Institute notes that NHIS is one of only eight data sources that include
sexual orientation items.
Response: The NHIS has provided data and health estimates by sexual orientation for several
years. The commenter stated that there are an estimated 1.4 million gender minority adults in the
U.S. This represents about .5% of U.S. adults. Estimates of interest from NHIS should have
expected prevalence greater than two percent and be fielded with a universe of sufficient size to
permit reliable estimates with a single year of data. Estimates of gender identity would not meet
this standard for reliability.