Previous Use and Development 2028

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 Survey Questions for the Redesigned Multi-Mode National Health Interview Survey


Introduction

 Development of questions to be cognitively tested for use on the 2028 National Health Interview Survey.

Topics
    A. Asthma 
        a. Ever, how long since last episode
        b. Past 12 months emergency room/urgent care visit
        c. Past 12 months use of preventer inhaler, corticosteroids 
    B. Health insurance and health care costs
        a. Currently covered
        b. Have high deductible health plan (HDHP)
        c. HDHP plan covers someone else
        d. HDHP amount of deductible, includes health savings account
        e. How often insurance meets needs, allows to see providers you need, leaves you with out-of-pocket costs
        f. Any bills past due or unable to pay
    C. Primary care
        a. Usual place for care, type of place
        b. Usual doctor or nurse
        c. Sees usual doctor or nurse for routine care 
    D. Marijuana
        a. Past 30 days use
        b. Reasons for use
    E. Employment
        a. Employment status
        b. Type of work
        c. Type of business/industry
        d. Paid sick leave, health insurance available
    F. Short-term illness
        a. Past 30 days head or chest cold, number of days spent in bed
        b. Past 30 days stomach or intestinal illness, number of days spent in bed
    G. Program participation
        a. Number of family members in household
        b. Any family members received SNAP, WIC, free/reduced price school lunch

Process
    1. Identify existing NHIS questions to be retained or adapted through redesign, identify emerging or returning topic areas to develop new questions
    2. Submit to cognitive testing
    3. Select and revise questions as-needed. Results from evaluation, along with expert review and public comment, will inform final redesign content decisions.





Questions and sources

Topic
Proposed Question
Sources
 Notes
Asthma
    1. Ever had asthma
Have you EVER been told by a doctor or other health professional that you had asthma?  
    A. Yes   
    B. No

Current NHIS
This question has previously been evaluated and is not a primary focus of this testing. It is included for evaluation in context of new and revised questions on asthma.
    2. How long since last asthma episode
How long has it been since you last had an asthma attack, flare-up, or episode?  
    A. Less than 12 months ago  
    B. At least 1 year ago but less than 2 years ago  
    C. At least 2 years ago but less than 5 years ago  
    D. At least 5 years ago but less than 10 years ago  
    E. 10 years ago or more  
    F. Never 
Adapted from current NHIS
This question expands on a question currently in use on the NHIS which asks about episodes in the past year:

During the past 12 months, have you had an episode of asthma or an asthma attack? 
Yes
No

    3. Past 12 months emergency room/urgent care visit 
During the past 12 months, have you had to visit an emergency room or urgent care center because of asthma?  
    A. Yes  
    B. No 

Current NHIS
This question has previously been evaluated and is not a primary focus of this testing. It is included for evaluation in context of new and revised questions on asthma.
    4. Past 12 months use of preventer inhaler 
During the past 12 months, have you used a preventer inhaler or daily inhaler?   
    A. Yes   
    B. No 
New
This and the following item were newly written for the 2028 NHIS, based on research indicating that asthma remission is an increasing focus of treatment. Use of preventer/daily inhalers was identified as one component of proposed definitions of asthma remission.

    5. Past 12 months use of corticosteroids
During the past 12 months, have you taken oral corticosteroids to help with your asthma?  
    A. Yes  
    B. No 
New 
(See note above). Use of oral corticosteroids was identified as one component of proposed definitions of asthma remission.
Health insurance and health care costs
    1. Currently covered
Are you currently covered by any kind of health insurance or some other kind of health care plan?
    A. Yes
    B. No
Current NHIS
This question is not a primary focus of this testing. It is included to facilitate the evaluation of new and revised questions on asthma.
    2. Have high deductible health plan (HDHP) 
Do you have a high-deductible health plan or a HDHP? 
    1. Yes
    2. No

Adapted from current NHIS
This question and the next three questions were adapted from the NHIS because respondents were having some difficulty answer the questions as they stand. 
    3. HDHP plan covers someone else
Does this plan cover someone other than yourself? 
    A. Yes
    B. No

New
This question was included as a preface to the next question to help respondents’ recall. 
    4. HDHP amount of deductible
About how much is this plan’s annual deductible? A deductible is the amount you have to pay for health care before your health insurance or health coverage plan will start paying your medical bills.
    A. Less than $1,750 
    B. $1,750 to less than $3,500
    C. $3,500 or more
Adapted from current NHIS
Amounts in response options will be updated to reflect any changes in IRS definition for HDHPs.

Current NHIS question:
Is the annual deductible for medical care for this plan less than [dollar amount], or [dollar amount] or more? 

If there is a separate deductible for prescription drugs, hospitalization, or out-of-network care, do not include those deductible amounts here.
Yes
No

    5. HDHP includes health savings account
There are special accounts or funds that can be used to pay for medical expenses, sometimes referred to as Health Savings Accounts or HSAs, Health Reimbursement Accounts or HRAs, Personal Care accounts, Personal Medical funds, or Choice funds. These are different from Flexible Spending Accounts or FSAs.

Does this plan include or allow you to contribute to a health savings account (HSA)?
    A. Yes
    B. No

Adapted from current NHIS
Current NHIS question:

There are special accounts or funds that can be used to pay for medical expenses, sometimes referred to as Health Savings Accounts or HSAs, Health Reimbursement Accounts or HRAs, Personal Care accounts, Personal Medical funds, or Choice funds. These are DIFFERENT from Flexible Spending Accounts or FSAs. 

Is there one of these accounts or funds with this plan?
Yes
No

    6. How often insurance meets needs
How often does your health insurance offer benefits or cover services that meet your needs?
    A. Always
    B. Usually
    C. Sometimes
    D. Never
NSCH
These questions have been extensively tested on parents of children, and the next step will be to test them on the general population. 
    7. How often insurance allows to see providers you need
How often does your health insurance allow you to see the health care providers you need?
    A. Always
    B. Usually
    C. Sometimes
    D. Never
NSCH
These questions have been extensively tested on parents of children, and the next step will be to test them on the general population.
    8. How often insurance leaves you with out-of-pocket costs
How often does your health insurance leave you with more out-of-pocket cost than you can comfortably pay without needing to cut back on other basic expenses?
    A. Always
    B. Usually
    C. Sometimes
    D. Never
New
This question was updated to be clearer regarding the intent of what was being collected. 
    9. Any bills past due or unable to pay
Do you currently have any medical or dental bills that are past due or that you are unable to pay?
    A. Yes
    B. No



KFF Health Tracking Poll
This question was included as it is a more direct question regarding the impact of medical or dental costs on the respondent. 
Primary care
    1. Usual place for care 
Is there a particular place that you usually go to if you are sick or need advice about your health?  
    A. Yes, there is one place  
    B. There is more than one place  
    C. No
Current NHIS
This question has previously been evaluated and is not a primary focus of this testing. It is included for evaluation in context of new and revised questions on sources of care and receipt of primary care.
    2. Type of place
What kind of place do you most often go to?  
    A. A doctor’s office or health center  
    B. An urgent care center or clinic in a drug store or grocery store  
    C. A hospital emergency room   
    D. A VA medical center or VA outpatient clinic  
    E. Some other place 
Adapted from current NHIS
This question closely mirrors existing NHIS content; the version here has been adapted for web and paper self-response. This adaptation includes eliminating the use of programmed fills based on respondent data, as these cannot be implemented in a paper self-response mode.

Current NHIS question:

What kind of place [is it/do you go to most often] - a doctor's office or health center; an urgent care center, a clinic in a drug store or grocery store; a hospital emergency room; a VA Medical Center or VA outpatient clinic; or some other place?
    3. Usual doctor or nurse
At this place, is there a particular doctor, nurse, or other health professional that you usually see when you get health care?  
    A. Yes  
    B. No
New
This series of questions were developed to identify whether a respondent had something akin to primary care—since that is an indicator of stable health care and better continuity of care. 
    4. Sees usual doctor or nurse for routine care  
Do you usually see this person when you need routine preventive care, such as a checkup or physical exam?  
    A. Yes  
    B. No






New
Please see above. 
Marijuana
    1. Past 30 days use
Do you currently use marijuana every day, most days, some days, or not at all?   

Do not include CBD-only products.   
    A. Every day  
    B. Most days
    C. Some days  
    D. Not at all
Adapted from NSDUH
These questions were included to provide parallel information on substance use along with cigarette, e-cigarette, and alcohol use. 
    2. 
For what reason or reasons do you use marijuana?
  
Mark (X) yes or no for each item.

For fun or to get high 
    A. Yes  
    B. No
Pain relief
    A. Yes  
    B. No
Nausea
    A. Yes  
    B. No
Anxiety, stress, or other mental health
    A. Yes  
    B. No
Help with sleep
    A. Yes  
    B. No
Other medical reasons 
    A. Yes  
    B. No




Adapted from NSDUH
Given the changing landscape in the use of medical marijuana this question is intended to provide more information on the reasons associated with the use of marijuana and associations with health outcomes. 
Employment
    1. Employment status
Which of the following best describes your current employment status? 
    A. Employed full-time 
    B. Employed part-time 
    C. Working without pay at a family-owned business 
    D. Retired
    E. Not employed but looking for work
    F. Not employed and not looking for work
Adapted from NHIS



With the move from in-person interviewing to web-first and then mail modes, the NHIS required a simplified approach to collecting these data. This combines several individual questions from the existing NHIS instrument into a single overall employment status question.
    2. Type of work
The next questions ask details about your employment. If you have more than one job, describe your main job where you work the most hours. Please be specific in your responses. 

What kind of work do you do? That is, what is your job title or occupation? For example, registered nurse, 4th-grade teacher, mechanical engineer, cable technician

____________________ (Open-ended write-in)
Modified from BRFSS
With the move from in-person interviewing to web-first and then mail modes, the NHIS required a simplified approach to collecting these data. 
    3. Type of business/industry
What kind of business or industry is this? That is, what does your company make or do? For example, hospital, elementary school, clothing manufacturing, auto repair 

____________________ (Open-ended write-in)

Modified from BRFSS
Please see above. 
    4. Paid sick leave available
At your workplace, is paid sick leave available to you if you need it?
    A. Yes
    B. No

NHIS
The impact of a change in mode from in-person to self-response first will be evaluated via the cognitive interviewing process. 
    5. Health insurance available
Is health insurance offered to you through your workplace?
    A. Yes
    B. No

NHIS
The impact of a change in mode from in-person to self-response first will be evaluated via the cognitive interviewing process.
Short-term illness
    1. Past 30 days head or chest cold
Did you have a head cold or chest cold that started during the past 30 days?  
    A. Yes
    B. No
Adapted from NHANES
Based on question on colds included on NHANES between 1999 and 2018. This item was selected for its use of plain language and focus on short-term illness that may not be captured by other data systems. Additionally, 30 days was considered to be an appropriate recall period for this topic.

NHANES question:
Did you have a head cold or chest cold that started during those 30 days?

    2. Number of days spent in bed during cold
Thinking of your most recent head or chest cold, how many days did you spend more than half the day resting in bed or on the couch?

_ _ days

Adapted from previous NHIS
From 1963-1996, NHIS interviews included a question on “bed days”; this question was adapted to facilitate self-response and so that the reported bed days could be linked to a specific illness.

Previous NHIS question:
During that 2-week period, how many days did you stay in bed all or most of the day?

    3. Past 30 days stomach or intestinal illness
Did you have a stomach or intestinal illness that started during the past 30 days?  
    A. Yes
    B. No
Adapted from NHANES
Based on question on stomach/intestinal illness included on NHANES between 1999 and 2018. This item was selected for its use of plain language and focus on short-term illness that may not be captured by other data systems. Additionally, 30 days was considered to be an appropriate recall period for this topic.

NHANES question:
Did you have a stomach or intestinal illness with vomiting or diarrhea that started during those 30 days?

    4. Number of days spent in bed during stomach illness
Thinking of your most recent stomach or intestinal illness, how many days did you spend more than half the day resting in bed or on the couch?

_ _ days

Adapted from previous NHIS
From 1963-1996, NHIS interviews included a question on “bed days”; this question was adapted to facilitate self-response and so that the reported bed days could be linked to a specific illness.

Previous NHIS question:
During that 2-week period, how many days did you stay in bed all or most of the day?

Program participation
    1. Number of family members in household
Not including yourself, how many of the people in your household are members of your family? 

For this survey, family refers to everybody living together who are related by birth, marriage, or adoption, as well as any unrelated children who are cared for by the family, such as foster children. Family also includes any people living together as a couple and their children. If you live alone or live only with unrelated roommates, please answer zero (00). 

____ Number of family members in household
New
The redesigned NHIS will simplify household rostering and collect less detail on individual household members and relationships, necessitating a simplified measure of number of family members, an important measure for interpreting data on income and program participation.
    2. Any family members received SNAP, WIC, free/reduced price school lunch
In 2027, for even one month, did you or any family members receive…

Mark (X) yes or no for each item.

Food stamps or SNAP benefits?
    A. Yes
    B. No
Benefits from the WIC program, that is, the Women, Infants, and Children program?
    A. Yes
    B. No
Free or reduced-price breakfasts or lunches at school?
    A. Yes
    B. No
Adapted from current NHIS
These questions closely mirror existing NHIS content; the version here has been adapted for web and paper self-response. This adaptation includes eliminating the use of programmed fills based on respondent or location data, as these cannot be implemented in a paper self-response mode.

Current NHIS questions:

At any time in the last 12 months did [you/you or anyone in your family] receive [fill with state-specific SNAP terminology]?

At any time in the last 12 months did [you/you or anyone in your family] receive benefits from the WIC program, that is, the Women, Infants, and Children program?

At any time in the last 12 months, did [child’s name/any child in your family] receive free or reduced-price breakfasts or lunches at school?