Request for Change

Nonsubstantive Change Request

NATIONAL HEALTH INTERVIEW SURVEY

OMB No. 0920-0214, Expiration Date 12/29/2021

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)

swb5@cdc.gov

July 16, 2018

Table of Contents

1. Circumstance Making the Collection of Information Necessary 3

2. Purpose and Use of Information Collection 4

12. Estimates of Annualized Burden Hours and Costs 5

15. Explanation for Program Changes or Adjustments 7

List of Attachments

Attachment 1 – List of Proposed Changes

Attachment 2 – Proposed Main Adult Core (formerly attachment 4b)

Attachment 3 – Proposed Redesigned Adult Questionnaire (formerly attachment 5b)

Attachment 4 – Revised Advance Letter

NCHS National Health Interview Survey

This is a request for a nonsubstantive change to the National Health Interview Survey (NHIS) (OMB No. 0920-0214, Exp. Date 12/29/2020), conducted by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC).

The recently-approved revision request package includes a plan for two field tests of the redesigned NHIS questionnaire, which will be carried out in June and October-December of 2018, respectively. This submission seeks approval to make modifications (Attachment 1) to the October field test:

1. Add questions on prescription opioids and pain management to the redesigned instrument as part of the large-scale field test in the last quarter of 2018 and the 2019 NHIS.

2. Add six questions on arthritis to the redesigned adult questionnaire in the last quarter of 2018 and the 2019 NHIS

3. Add three questions to the redesigned adult questionnaire on continuous insulin use that will help determine respondent’s diabetes type in the last quarter of 2018 and the 2019 NHIS

4. Add six questions to determine respondents’ willingness to have biometrics taken after the NHIS interview to the redesigned adult questionnaire in the last quarter of 2018 and the 2019 NHIS

5. Add three questions about respondents subjective assessments of burden that will be included at the end of both the 2018 NHIS instrument and the redesigned NHIS instrument in the large-scale field test that starts during the last quarter of the year. These questions will not continue into 2019.

6. Revise the advance letter

The burden hours associated with the prescription opioid and pain management questions were previously accounted for as a part of the Redesigned Adult Questionnaire (Attachment 3) when a draft set of cognitively tested questions were available. Given the actual time to complete the final set of prescription opioid and pain management questions, combined with the new diabetes-related questions, arthritis questions, biometric questions, and respondent burden assessment questions, it is anticipated that the overall burden of the Redesigned Adult Questionnaire will increase from 39 to 42 minutes. The fractional time resulting from the inclusion of the three respondent burden assessment items to be administered to the last quarter of the 2018 Adult Core (Attachment 2) does not change the overall average burden from 15 minutes. Finally, the revisions to the advance letter are intended to streamline the letter that was approved in the initial revision package.

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.

The most recent redesign effort is in its final stages, with the new questionnaire slated for launch in January 2019.

Beginning in October and running through the fourth quarter of 2018, a split-sample field test or dress rehearsal will take place to give all Census interviewers an opportunity to gain experience with the instrument prior to full-scale implementation in 2019. This test will also allow for monitoring of process data to understand the impact of the redesign on survey methods indicators and health estimates.

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 2019 data collection year. They were included as Attachments 5b and 5c in the approved revision package, with a placeholder for questions on pain management noted in both the “Redesigned Questionnaire Modules and Periodicity” (Attachment 3a) and the “Methodological Projects” (Attachment 7) document.

2. Purpose and Use of Information Collection

The questions on prescription opioids and pain management, which underwent cognitive testing between the time of submission of the revision package and the current nonsubstantive change request, are critical for assessing the prevalence of and covariates associated with use of prescription medications for pain. These questions are especially timely and relevant in light of the current opioid epidemic, which represents an emerging public health crisis in the United States. The questions have undergone 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 07/31/2018).

The purpose of adding questions about subjective burden to the large-scale field test during the last quarter of the year is to better measure the impact of the NHIS redesign on survey burden. (The objective measure of burden such as interview length will also be used for this purpose.) The subjective measures provide respondent reports about the overall level of burden and more specific causes of burden such as question difficulty or sensitivity. These measures were provided by staff from the Bureau of Labor Statistics and the U.S. Census Bureau who have developed burden measures for other federal surveys (see Fricker, Yan, and Tsai, 2014 and Holzberg et al., 2018 for examples).

The purpose of adding the three diabetes questions on continuous insulin use is to improve measurement of the respondent’s type of diabetes. These questions previously appeared on the NHIS in 2016 and 2017. These three questions will be placed with existing questions on diabetes within the redesigned adult questionnaire. The six arthritis questions last appeared in the 2014 NHIS and will be used for monitoring Healthy People 2020/2030 objectives. The arthritis questions will be included in the rotating pain module in the redesigned adult questionnaire. The six biometric questions will be used to gauge respondents’ willingness to participate in the collection of physical and biological measurements that could be used to enhance or replace health questions in the future. This topic area is similar to the GenIC “Health Measures at Home Study” (OMB No. 0920-0237, Discontinued 10/31/2013) that investigated adding biological measures to a large household survey, such as the NHIS. The addition of these six biometric questions is to continue to investigate the feasibility of incorporating physical measures and biologic specimen collection into the NHIS. The biometric questions will be included at the end of the redesigned adult questionnaire.

The changes to the advance letter are intended to make the letter easier for respondents to read and understand (Attachment 4).

12. Estimates of Annualized Burden Hours and Costs

1. Time Estimates

The questions on prescription opioids and pain management were already accounted for in the burden estimate for the redesigned Adult questionnaire. In fact, it has been determined that these questions will not take as long as previously anticipated. However, the proposed inclusion of three additional diabetes-related questions, six arthritis questions, six biometric questions, and three respondent burden assessment questions to the redesigned Adult questionnaire will increase the overall average burden per response from 39 to 42 minutes.

Similarly, the three respondent burden assessment questions will be added to the last three months of data collection for the 2018 NHIS Adult Core. However, the minimal time added to the overall interview does not increase the overall average from 15 minutes.

Consequently, the annualized burden estimate slightly increases by 75 hours from 47,735 to 47,960 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	Main Household Composition and Family Core	39,375	1	23/60	15,094
Sample Adult	Main Adult Core	31,500	1	15/60	7,875
Adult Family Member	Main Child Core	12,250	1	10/60	2,042
Adult Family Member	Main Supplements	39,375	1	20/60	13,125
Adult Household Member	Redesigned Household Roster	5,625	1	5/60	469
Sample Adult	Redesigned Adult Questionnaire	4,500	1	42/60	3,150
Adult Family Member	Redesigned Child Questionnaire	1,750	1	27/60	788
Adult Family Member	Methodological Projects	15,000	1	20/60	5,000
Adult Family Member	Main Reinterview Survey	4,375	1	5/60	365
Adult Family Member	Redesigned Reinterview Survey	625	1	5/60	52
Total					47,960

B. Cost to Respondents

Given the unchanged burden hours, the cost to respondents remains unchanged as well. At an average wage rate of $21.00 per hour the estimated annualized cost for the 47,960 burden hours is $1,007,160. 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	Main Family Core	15,094	$21.00	$316,974
Sample Adult	Main Adult Core	7,875	$21.00	$165,375
Adult Family Member	Main Child Core	2,042	$21.00	$42,882
Adult Family Member	Main Supplements	13,125	$21.00	$275,625
Adult Household Member	Redesigned Household Roster	469	$21.00	$9,849
Sample Adult	Redesigned Adult Questionnaire	3,150	$21.00	$66,150
Adult Family Member	Redesigned Child Questionnaire	788	$21.00	$16,548
Adult Family Member	Methodological Projects	5,000	$21.00	$105,000
Adult Family Member	Main Reinterview Survey	365	$21.00	$7,665
Adult Family Member	Redesigned Reinterview Survey	52	$21.00	$1,092
Total	$1,007,160

15. Explanation for Program Changes or Adjustments

The changes proposed herein increase the overall previously approved burden hours from 47,735 to 47,960. The burden hours associated with the prescription opioid and pain management questions were previously accounted for as a part of the Redesigned Adult Questionnaire when a draft set of cognitively tested questions were available. Given the actual time to complete the final set of prescription opioid and pain management questions, combined with the new diabetes-related and respondent burden assessment items, it is anticipated that the overall burden of the Redesigned Adult Questionnaire will increase from 39 to 40 minutes. The fractional time resulting from the inclusion of the three respondent burden assessment items to be administered to the last quarter of the 2018 Adult Core does not change the overall average burden time for that instrument from 15 minutes.

References

Fricker S, Yan T, Tsai S. 2014. “Response Burden: What Predicts It and Who is Burdened Out?” Paper presented at the 69th Annual Conference of the American Association for Public Opinion Research. Anaheim, CA. May 16, 2014. Available online: https://www.bls.gov/osmr/pdf/st140170.pdf.

Holzberg J, Katz J, Morales G, Davis M. 2018. “Assessing Respondents’ Perceptions of Burden in the American Community Survey.” Paper presented at the Federal Committee on Statistical Methodology Research Conference. Washington, DC. March 9, 2018.

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