Nonsubstantive Change Request
NATIONAL HEALTH INTERVIEW SURVEY
OMB No. 0920-0214, Expiration Date 12/31/2026
Contact Information:
Stephen Blumberg, PhD
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)
November 6, 2024
Sections
INTRODUCTION
A. JUSTIFICATION
1. Circumstances Making the Collection of Information Necessary
2. Purpose and Use of Information Collection
12. Estimates of Annualized Burden Hours and Costs
15. Explanation for Program Changes or Adjustments.
List of Attachments
Att 3b |
NHIS Snapshot 3 Year-Cycle Questionnaire Content and Periodicity
|
Att 5b |
2025 NHIS Proposed New Content - Concepts Measured, Duplication, and Proposed Uses of Data |
Att 9a |
2025 NHIS Roster Questionnaire |
Att 9b |
2025 NHIS Sample Adult Questionnaire |
Att 9c |
2025 NHIS Sample Child Questionnaire |
Att 9d |
2025 Reinterview Questionnaire |
-
NCHS National Health Interview Survey
INTRODUCTION
This is a request for approval of a nonsubstantive change to the National Health Interview Survey (NHIS) (OMB No. 0920-0214, Exp. Date 12/31/2026), conducted by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC). This nonsubstantive change requests changes in content for the 2025 NHIS.
Summary of 2025 NHIS Content Changes
The NHIS has been conducted every year since 1957. The current design of the NHIS questionnaire, implemented in 2019, features a rotational schedule consisting of annual core, rotating core, emerging content, and sponsored content modules. Summarized here are the proposed nonsubstantive changes from the 2024 NHIS to the 2025 NHIS.
The NHIS rotates core content onto the survey on a periodic basis such that all content will appear at least once in a three-year cycle begun in 2019. As of the end of 2021, all NHIS rotating core content has been fielded at least once.
The 2025 NHIS
The 2025 NHIS will include annual core and the rotating core scheduled for 2025 along with new sponsored content (that will replace the 2024 sponsored modules). Annual core content remains the same. Rotating core content largely remains the same except content on aspirin and preventative screening. The aspirin section changed from four to two questions given updated guidance on aspirin use for the prevention or control of heart disease. In the preventative screening section colorectal cancer questions will be administered to respondents 35 years old or older given updated guidance that expands the recommended age for colorectal cancer screening.
Removed Content
Rotating sample adult core content that was on the NHIS in 2024 and will rotate off the 2025 NHIS includes allergies, psychological distress, industry and occupation, injuries, and health related behaviors (physical activity, walking, sleep, fatigue, smoking history, and alcohol use). Sponsored content that will be removed includes content on menthol cigarettes, lunger cancer screening, other chronic conditions (Psoriasis, Chron’s disease, and chronic fatigue syndrome), immunosuppression, vaccination details (flu vaccination during pregnancy, follow-up shingles vaccination questions, Hepatitis A vaccination), work or volunteer activities in a medical facility, travel outside the United States, taste and smell, food security, sun care and protection, and perceptions of walking environment. Emerging content on housing costs and transportation barriers to care has also been removed.
Items on allergies, injury, and health related behaviors (physical activity, height and weight, neighborhood characteristics, sleep, and screen time) will rotate off the sample child core. Sponsored content on food security and taste and smell will also be removed.
Added Content
The 2025 rotating sample adult core will include questions that were previously fielded in the NHIS including mental health assessment, service utilization (dental care, vision care, therapy, and home health care), chronic pain, aspirin use, and preventative screening. All this rotating content has been fielded on the NHIS since the 2019 NHIS redesign. Sample adult sponsored content for 2025 includes items on life satisfaction, diabetes medications (insulin and GLP-1 injectables), age of disability onset, long COVID, vaccination (shingles, tetanus, Tdap, RSV), other tobacco products, concussions, social support and loneliness, preventative screening (diabetes and cancer), pain management, social connectedness and isolation, epilepsy, caregiving, ADHD/ADD diagnoses and treatment, whole person health, menopause, and voice, swallowing, speech, and language difficulty. Much of this sponsored content has been included on the survey since the 2019 NHIS redesign; However, sponsored content on menopause, social support and loneliness, and whole person health will be fielded for the first time in 2025. Emerging content on internet access and health information technology, language spoken at home, volunteer activities, civic engagement, and gender identity will be retained from the 2024 questionnaire, and content on social supports for parents will be added.
The 2025 rotating sample child core will include items on service utilization (dental care, mental health care, physical and other therapeutic care), mental health assessment, and stressful life events. All this rotating content has been fielded on the NHIS since the 2019 NHIS redesign. Sponsored content on COVID-19 vaccination, concussion, and voice, swallowing, speech, and language difficulty will be retained from the 2024 sample child questionnaire.
Reinterview Questionnaire Changes
Finally, some questions on the reinterview questionnaire will be replaced to reflect new content changes within the 2025 NHIS. Three questions asking whether the sampled adult respondent remembered being asked about difficulty smelling odors, experiencing a sunburn in the past 12 months, and experiencing an injury in the past 3 months will be replaced by three questions asking whether the sampled adult remembered being asked about voice difficulties or trouble speaking, ability to find meaning and purpose in daily life, and experiencing pain the past 3 months. One question asking whether the sample child respondent remembered being asked about their child’s allergies will be replaced with one question asking whether the sample child respondent remembered being asked about if their child had been separated from a parent or guardian because they went to jail.
Detailed List of 2025 NHIS Content Changes
Rotating Content
The NHIS annually rotates content in and out of the questionnaire on a fixed schedule (see Attachment 3b).
Below is a list of questions scheduled to be rotated in for the 2025 NHIS.
Adults
Rotate in 2 questions on aspirin use (Guidance on aspirin use was recently updated resulting in the removal of 2 additional questions that were in this section previously.)
Rotate in 3 questions on dental care
Rotate in 17 questions on preventative services and preventative screening
Rotate in 10 questions on chronic pain
Rotate in 3 questions on physical or other therapeutic care
Rotate in 8 questions on depression
Rotate in 7 questions on anxiety
Children
Rotate in 3 questions on physical or other therapeutic care
Rotate in 3 questions on dental care
Rotate in 7 questions on stressful life events
Rotate in 2 questions on mental health
Below is a list of questions scheduled to be rotated out for the 2025 NHIS. In accordance with the fixed schedule, these questions will return in future years.
Adults
Rotate out 3 questions on health conditions
Rotate out 6 questions on allergies
Rotate out 6 questions on serious psychological distress
Rotate out 8 questions on repetitive strain injury
Rotate out 21 questions on injury
Rotate out 3 questions on fatigue
Rotate out 8 questions on alcohol use
Rotate out 5 questions on physical activities
Rotate out 8 questions on walking
Rotate out 1 question on content of care about physical activity
Rotate out 7 questions on sleep
Rotate out 6 questions on detailed employment
Rotate out 4 questions on cigarettes and e-cigarettes
Children
Rotate out 6 questions on allergies
Rotate out 2 questions on height and weight
Rotate out 18 questions on injury
Rotate out 6 questions on physical activity
Rotate out 4 questions on neighborhood characteristics
Rotate out 6 questions on sleep
Rotate out 1 question on screen time
Sponsored Content
The NHIS also works with sponsors from other CDC centers, NIH, and other government agencies to field content relevant to their missions.
Below is a list of sponsored questions that will continue from 2024 to the 2025 NHIS.
Adults
Continue 1 question on life satisfaction
Continue 3 questions on insulin use
Continue 1 question on injectable medications (GLP-1)
Continue 1 question on age of disability onset
Continue 4 questions on Long COVID
Continue 1 question on pregnancy resulting in live birth
Continue 1 question on Tdap vaccination
Continue 2 questions on COVID-19 vaccination
Continue 1 question on shingles vaccination
Continue 1 question on tetanus vaccination
Continue 5 questions on other tobacco products
Continue 5 questions on concussions
Continue 2 questions on social support and loneliness
Children
Continue 4 questions on Long COVID
Continue 2 questions on COVID-19 vaccination
Continue 5 questions on concussions
Below is a list of sponsored questions to be added in the 2025 NHIS
Adults
Add 2 questions on A1C testing
Add 1 question on stress from living with diabetes
Add 21 questions on preventative cancer screening (colorectal, prostate, cervical, and breast cancer)
Add 1 question on RSV vaccination
Add 11 questions on pain management
Add 4 questions on social connectedness and isolation
Add 4 questions on epilepsy
Add 1 question on caregiving
Add 17 questions on voice, swallowing, speech, and language difficulty
Add 5 questions on ADD and ADHD
Add 8 questions on whole person health
Add 5 questions on menopause
Children
Add 17 questions on voice, swallowing, speech, and language difficulty
Below is a list of sponsored questions to be removed from the 2025 NHIS
Adults
Remove 1 question on cigarette use
Remove 2 questions on menthol cigarettes
Remove 3 questions on Psoriasis, Ulcerative Colitis, and Chron’s disease
Remove 2 questions on chronic fatigue syndrome
Remove 2 question on immunosuppression
Remove 1 question on period of pregnancy
Remove 2 questions on flu vaccination during pregnancy
Remove 1 question on number of COVID-19 vaccinations
Remove 1 question on Hepatitis A vaccination
Remove 2 questions on work or volunteer activities in a medical facility
Remove 1 question on travel outside the United States
Remove 5 follow-up questions on shingles vaccination
Remove 1 question on receiving SNAP benefits in the past 30 days
Remove 10 questions on food security
Remove 17 questions on taste and smell, 5 of which are COVID-19 related
Remove 3 questions on lung cancer screening
Remove 12 questions on perceptions of walking environment
Remove 10 questions on sun care and protection
Children
Remove 1 question on receiving SNAP benefits in the past 30 days
Remove 10 questions on food security
Remove 8 questions on taste and smell
Emerging Content
Finally, as part of the redesigned NHIS some survey time is allotted to capture emerging issues relevant to NCHS mission.
Below is a list of emerging content questions that will continue from 2024 to the 2025 NHIS.
Adults
Continue 5 questions on Internet access and health information technology
Continue 6 questions on language spoken at home
Continue 2 questions on volunteer activities
Continue 2 questions on civic engagement
Continue 2 questions on gender identity
Below is a list of emerging content questions to be added for the 2025 NHIS.
Adults
Add 3 questions on social supports for parents
Below is a list of emerging content questions to be removed for the 2025 NHIS.
Adults
Remove 1 question on GLP-1 injectable diabetes medications
(This item is now included under sponsored content)
Remove 1 question on housing costs
Remove 1 question on transportation barriers to care
A. JUSTIFICATION
Background
The NHIS is conducted by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), to comply with the NCHS mandate under 42 USC 242k 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. NHIS data are used widely throughout the Department of Health and Human Services (DHHS) to monitor trends in illness and disability and to track progress toward achieving many of the health objectives for the nation. The data are also used by the public health research community for epidemiologic and policy analysis of such issues as characterizing those with various health problems, measuring levels of health insurance coverage, determining barriers to accessing and using health care, and evaluating the impact of changes in federal health programs.
In accordance with the 1995 initiative to increase the integration of surveys within DHHS, respondents to the NHIS serve as the sampling frame for the Medical Expenditure Panel Survey (MEPS; OMB# 0935-0118, expires 11/30/2025). MEPS uses completed interviews from the NHIS to identify and select the desired sample, contact that sample to collect additional data, and combine their survey data with the original NHIS data. These procedures reduce survey costs, reduce overall burden on the public, and increase the amount of data available for critical health-related analysis.
The NHIS has been conducted every year since 1957. The current design of the NHIS questionnaire implemented in 2019, features a rotational schedule consisting of annual core, rotating core and sponsored content modules. Attachment 3b provides a visual depiction of the content and module structure. The NHIS sample adult and sample child questionnaires include annual core content that is scheduled to be fielded every year, rotating content that is fielded periodically, emerging content to address new topics of growing interest to NCHS, CDC, and DHHS, and sponsored content that is fielded when external funding is available.
The purposes of the NHIS are (1) to provide national data on an annual basis on the prevalence of chronic conditions and impairments, the extent of disability, the utilization of health care services, and other health-related topics; (2) to provide more detailed information on selected topics periodically and on a one time basis (3) to provide a sampling frame for the Medical Expenditure Panel Survey and other follow-back surveys. It is also a main provider of data for the Congressionally mandated Health, United States report and provides data for many indicators used in monitoring progress toward current Healthy People goals and for detailing health disparities; and (4) provide a gold standard to benchmark and calibrate estimates from the NCHS Rapid Surveys System (OMB# 0920-1408, expires 6/30/2026).
A major strength of the NHIS is its ability to display health characteristics by selected demographic and socio-economic characteristics of the U.S. civilian, noninstitutionalized population. NHIS data are typically used for program planning and evaluation, public health education and health promotion and epidemiological research. Input to the design of questions is solicited from experts in a variety of organizations within the federal government, and from outside researchers and public health professionals.
In addition to the principal questionnaires, like in past years, a small subsample (<5%) of respondents will be reinterviewed as a quality control measure; the reinterview questionnaire is provided in Attachment 9d.
Time Estimates
The average burden for each survey component for one complete one-year survey cycle is shown in the table below.
The estimated overall average annual burden for 2025, including the roster, adult questionnaire, child questionnaire, methodological projects, NHIS Teen and the reinterview component is 37,891 hours.
Lines 1-3 of the burden table represent the different sections of the NHIS questionnaire. Line 4 covers any methodological projects such as web and/or mail-based methodological projects, cognitive testing, and mixed-mode NHIS activities. Line 5 covers the NHIS-Teen survey. Small quality control reinterview surveys of participating households are represented on line 6.
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 |
Household Roster |
36,000 |
1 |
4/60 |
2,400 |
Sample Adult |
Adult Questionnaire |
33,000 |
1 |
49/60 |
26,950 |
Adult Family Member |
Child Questionnaire |
10,000 |
1 |
18/60 |
3,000 |
Adult Family Member |
Methodological Projects |
15,000 |
1 |
20/60 |
5,000 |
Sample Child |
NHIS-Teen survey |
333 |
1 |
15/60 |
83 |
Adult Family Member |
Reinterview Survey |
5,500 |
1 |
5/60 |
458 |
Total |
|
|
|
|
37,891 |
Not all questions apply to each person, and the questionnaire instrument automatically skips over questions that do not apply, based on earlier information given by the respondent. Thus, no respondent is ever asked all of the questions in the questionnaire.
The estimate of response burden above is based on an average length of interview per household. Variations occur in individual household interview times primarily because of differing numbers of persons in the household and variations in the number of health conditions reported in the household.
The burden on any single member of a sample family also varies according to who is designated respondent for each component. In some sample families the same adult could be the respondent for all of the major components: roster, adult, and child. In other families there could be a different respondent for each component. In the first case, the total average burden on the single respondent would be about one hour; in all other cases the burden on a single respondent would be less.
The amount of time needed to complete the 2025 sample adult (reduction of 550 hours ) and sample child questionnaires (reduction of 1,000 hours) is expected to be slightly reduced as compared to 2024 due to a cyclical, net reduction in survey content.
The amount of burden hours estimated for methodological projects and the reinterview survey is the same. The NHIS-Teen will not be conducted in 2025, but may be conducted in 2026, thus a reduced annualized burden (reduction of of 84 hours) is reflected in the table above.
B. Cost to Respondents
At an average wage rate of $35.21 per hour, the estimated annualized cost for the 37,892 burden hours is $1,334,165. (Wage information is from the Bureau of Labor Statistics: http://www.bls.gov/news.release/empsit.t19.htm.) 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 |
Household Roster |
2,400 |
$35.21 |
$84,504 |
Sample Adult |
Adult Questionnaire |
26,950 |
$35.21 |
$948,910 |
Adult Family Member |
Child Questionnaire |
3,000 |
$35.21 |
$105,630 |
Adult Family Member |
Methodological Projects |
5,000 |
$35.21 |
$176,050 |
Sample Child |
NHIS-Teen Survey |
83 |
$35.21 |
$2,934 |
Adult Family Member |
Reinterview Survey |
458 |
$35.21 |
16,138 |
Total |
$1,334,165 |
|||
There is a slight decrease in average annualized burden for the 2025 NHIS compared to the 2024 NHIS. This decrease in burden is due to net decreases in the number of survey items included in both the adult and child questionnaires, revised estimates to the burden of the child questionnaire based on monitoring of the 2024 NHIS, and a decision to not field the NHIS-Teen in 2025.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | gnx5 |
| File Modified | 0000-00-00 |
| File Created | 2024-11-14 |