Survey Content Justification

Attachment 3a – NHIS Survey Content Justification
The content of the NHIS consists of four types: 1) annual core content that appears every year;
2) rotating core content that appears with fixed periodicity and supplements the content on the
annual core; 3) sponsored content of interest to funding partners and which needs more indepth treatment; and 4) emerging content that addresses issues of growing interest to the
Department of Health and Human Services.
Annual Core Content
Annual core content covers demographics and five major health domains: chronic conditions,
functioning and disability, health insurance, health care access and use and health-related
behaviors.
Chronic Conditions: Chronic diseases are a significant public health problem, which result in
morbidity, mortality, disability, and decreased quality of life. Chronic diseases represented
seven of the top 10 causes of death in the United States in 2014. These data can help to
describe the burden of chronic disease and risk factors, as well as identify research gaps,
monitor population trends, and guide program evaluation.
Functioning and Disability: Limitations in physical and cognitive functioning have long been
recognized as major health issues. With an aging and increasingly diverse population, the need
to better understand functioning and disability is imperative since it is higher among elderly,
minority, and economically disadvantaged persons. The 1990 passage of the Americans with
Disabilities Act (ADA) also underscored the need for clear and objective data on disabilities in
the population. The Washington Group questions on functioning and disability assess whether
the respondent has a disability based on their responses to questions that assess difficulties
with universal basic activities rather than by asking them to identify as having a disability. This
approach is consistent with that of the international Sustainable Development Goals, which
outline major goals for policy formulation and program planning.
Health Insurance: Since 1990, the NHIS has collected extensive health insurance information on
an annual basis. These data are particularly needed by policy analysts to evaluate the impact of
changes to health care delivery and financing. Health insurance is critical to maintaining health
and treating disease while protecting people from unexpected, high medical costs. Having upto-date information about who has health insurance and what kind is a mission critical
component of the NHIS.
Health Care Access and Use: Changes to the U.S. health care delivery system have focused
attention on the need for data to assess the types and sources of health care being utilized as
well as barriers to obtaining needed health care. The data collected can be used to monitor
progress towards goals in preventive care utilization, and to examine disparities in utilization by
socioeconomic characteristics. This information is important to those making decisions about

allocation of health care resources and for evaluating the impact of changes to health care
delivery and financing.
Health-Related Behaviors: Key concepts in health behavior are incorporated into the Sample
Adult and Sample Child annual and rotating core modules. Some behaviors are monitored
annual (e.g. cigarette smoking) to provide data to monitor DHHS Agency Priority Goals. Others
are monitored periodically (e.g. alcohol use, physical activity, sleep) to allow for the study of
relationships between these behaviors and chronic disease outcomes. These data may also be
used to evaluate the impact of programs impacting aimed at changing these behaviors.
Demographics: As in the past, the NHIS will collect information on socio-economic and
demographic characteristics of adult and child survey participants. One of the well-recognized
and longstanding strengths of the NHIS is its ability to allow examination of health measures by
a number of demographic and economic variables.
Rotating Core Content
Rotating content provides information on topics periodically over time. This includes content on
the utilization of mental, dental and other health services, mental health and psychological
distress assements, data about other health conditions, preventative services, recent injuries.
Information is collected about the Sample Adult’s employment, and pain. Rotating content also
includes information about stressful life events that occurred in the Sample Child’s lifetime.
Sponsored Content
Sponsored content and emerging content are evaluated on an annual basis according to criteria
described in the Supporting Statement A in the section entitled “Adding Questions to the
National Health Interview Survey (NHIS): Guidance for Sponsor.”
Emerging Content
Emerging content addresses issues of growing interest to the Department of Health and Human
Services. In the past, emerging content has included questions on prescription opioid use and
pain management.