Vital and Health Statistics

Series 2, Number 174 August 2017 

Data Quality Assessment of 

the 2014 Native Hawaiian 

and Pacific Islander National 

Health Interview Survey 
 

Copyright information 

All material appearing in this report is in the public domain and may be 

reproduced or copied without permission; citation as to source, however, is 

appreciated. 

Suggested citation 

Galinsky AM, Zelaya CE, Simile C, Barnes PM. Data quality assessment of the 

2014 Native Hawaiian and Pacific Islander National Health Interview Survey. 

National Center for Health Statistics. Vital Health Stat 2(174). 2017. 

Library of Congress Cataloging-in-Publication Data 

Names: National Center for Health Statistics (U.S.), issuing body. 

Title: Data quality assessment of the 2014 Native Hawaiian and Pacific Islander 

National Health Interview Survey. 

Other titles: Vital and health statistics. Series 2, Data evaluation and 

 methods research ; no. 174. | DHHS publication ; no. (PHS) 2017-1374. 0276­

4733. 

Description: Hyattsville, Maryland : U.S. Department of Health and Human 

Services, Centers for Disease Control and Prevention, National Center for 

Health Statistics, August 2017. | Series: Vital and health statistics, series 

2, data evaluation and methods research ; number 174 | Series: DHHS 

publication ; number (PHS) 2017-1374 | Includes bibliographical references. 

Identifiers: LCCN 2017027896 | ISBN 084060680X (pbk.) 

Subjects: | MESH: Native Hawaiian and Pacific Islander National Health 

 Interview Survey (U.S.) | Oceanic Ancestry Group | Health Surveys | Data 

Accuracy | Research Design | United States 

Classification: LCC LCC RA407.3 | NLM W2 A N148vb no. 174 2017 | 

DDC 614.4/273--dc23 

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Printed on acid-free paper. 
Vital and Health Statistics
 

Series 2, Number 174 

Data Quality Assessment of 

the 2014 Native Hawaiian 

and Pacific Islander National 

Health Interview Survey 

Data Evaluation and Methods Research 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 

Hyattsville, Maryland 

August 2017 

DHHS Publication No. 2017–1374 
National Center for Health Statistics 

Charles J. Rothwell, M.S., M.B.A., Director 

Jennifer H. Madans, Ph.D., Associate Director for Science 

Division of Health Interview Statistics 

Marcie L. Cynamon, Director 

Stephen J. Blumberg, Ph.D., Associate Director for Science 

Division of Research Methodology 

Charles J. Rothwell, M.S., M.B.A., Acting Director 

Donald Malec, Ph.D., Associate Director for Science 
 

 

 

 

 

 

iii

Contents

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Overview of NHPI NHIS Design and Operations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Sample Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Questionnaire and Interviewing Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Respondent Materials, Outreach, and Interviewer Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Frame Refinement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Analytical Data Sets and Sample Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Weighting and Variance Estimation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Analytical Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Comparison 1: Sociodemographic Characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Comparison 2: Health Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Comparison 3: Direction and Strength of Associations Between Health Outcomes and Age, Sex . . . . . . . . . . . . . . . . .8

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Appendix I. Definition of Selected Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Appendix II. Technical Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Detailed Tables

1. Percent distribution of American Community Survey addresses containing at least one Native Hawaiian

or Pacific Islander resident, by 2014 Native Hawaiian or Pacific Islander National Health Interview Survey

sample disposition and presence of Native Hawaiian and Pacific Islander residents according to

National Health Interview Survey criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

2. Weighted percentages of sociodemographic characteristics of Native Hawaiian and

Pacific Islander people, by survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

3. Weighted percentages of sociodemographic and health characteristics of Native Hawaiian

and Pacific Islander households, by survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

4. Weighted percentages of health characteristics of Native Hawaiian and Pacific Islander

people, by survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

5. Odds ratios from multiple logistic regression models of select health outcomes

on sex and age among Native Hawaiian and Pacific Islander people, by survey . . . . . . . . . . . . . . . . . . . . . . . 14
Acknowledgments 

The authors would like to thank 

Marcie Cynamon for her vision and 

leadership, Anne Furnia of the U.S. 

Census Bureau for her creative problem 

solving and tireless work on behalf 

of NHPI NHIS, Tina Norris for her 

expert preparation of the data files, and 

Christopher Moriarity, Jennifer Madans, 

and Stephen Blumberg for reviewing the 

report at various stages of development. 

iv 
 

Abstract 

Background 

The 2014 Native Hawaiian and 

Pacific Islander National Health 

Interview Survey (NHPI NHIS) is 

the first federal survey designed 

exclusively to measure the health of 

the noninstitutionalized civilian NHPI 

population of the United States. 

Purpose and Methods 

This report assesses the quality of 

the 2014 NHPI NHIS data, by 

examining if and how estimates of 

NHPI population characteristics 

calculated using the survey’s data 

differ from estimates of the same 

characteristics calculated using data 

from two other sources: the U.S. 

Census Bureau’s American 

Community Survey (the sampling 

frame for the 2014 NHPI NHIS) and 

the annual NHIS for combined years 

2010–2014. 

Results 

Estimates of 13 of the 18 

demographic characteristics were 

similar. The NHPI NHIS estimate 

of the percentage of the NHPI 

population with the marital status 

“separated” was higher, and the 

percentage that was Hispanic was 

lower, relative to corresponding 

estimates from the other two data 

sources. The percentages of NHPI 

households that were rented, had 

only one NHPI resident, and had at 

least one Hispanic resident, were 

lower. Three of the 24 NHPI NHIS 

population health estimates differed 

from the same estimates calculated 

using the 2010–2014 NHIS data, but 

they mirrored trends in the broader 

population between 2010 and 2014. 

Conclusions 

The results suggest that the 2014 

NHPI NHIS sample, with appropriate 

caveats, will be useful for estimating 

prevalence and predictors of health 

outcomes of NHPI persons in the 

United States. 

Keywords: survey error • bias • 

evaluation • National Health Interview 

Survey 

Data Quality Assessment of 

the 2014 Native Hawaiian and 

Pacific Islander National Health 

Interview Survey 

by Adena M. Galinsky, Ph.D.; Carla E. Zelaya, Ph.D.;Catherine Simile, 

Ph.D., and Patricia M. Barnes, M.A., Division of Health Interview 

Statistics 

Executive Summary 

The 2014 Native Hawaiian and 

Pacific Islander National Health 

Interview Survey (NHPI NHIS) is 

the first survey of its kind, namely a 

national survey of the health of the 

noninstitutionalized civilian NHPI 

population of the United States with a 

sample size larger than a few hundred 

NHPI households. The survey was 

conducted by the National Center 

for Health Statistics (NCHS), which 

also conducts the annual National 

Health Interview Survey (NHIS), the 

flagship federal health survey of the 

noninstitutionalized civilian population 

of the United States. NHPI NHIS 

was conducted by trained NHIS field 

interviewers, using the 2014 NHIS 

survey instrument. However, rather than 

using an area frame typical of NHIS, 

it used addresses from a single year of 

the U.S. Census Bureau's American 

Community Survey (ACS) as its frame. 

Specifically, the frame for the 2014 NHPI 

NHIS consisted of all addresses identified 

in a recent year of ACS with at least one 

resident of any age who was reported to 

have an NHPI racial identity, alone or 

in combination with one or more other 

racial identities. Because ACS had not 

previously been used as a frame for a 

follow-back survey of a rare (numerically 

small) population, and because both ACS 

frame data and annual NHIS data were 

available to assess the representativeness 

of the final NHPI NHIS sample, NCHS 

conducted a quality assessment of the 

2014 NHPI NHIS data. This assessment 

considers the ways and degree to 

which estimates of NHPI population 

characteristics calculated using data 

from the 2014 NHPI NHIS differ 

from estimates of the same population 

characteristics calculated using data 

from ACS and the annual NHIS (the two 

benchmarks). 

This report first presents an overview 

of the NHPI NHIS design and operations 

and explains how the frame was defined 

and constructed. It then presents the 

results of three types of comparisons 

designed to assess the representativeness 

of the sample. All analyses used weights 

to produce national population estimates. 

First, estimates of eight personlevel and 10 household-level NHPI 

demographic characteristics calculated 

using 2014 NHPI NHIS data were 

compared with the same estimates 

calculated using ACS frame data and 

5 years (2010–2014) of NHIS data. At 

both the person and household levels, 

some of these population estimates 

differed statistically across surveys. 

At the person level, the estimate of the 

percentage of the NHPI population that 

was Hispanic was lower when calculated 

using the 2014 NHPI NHIS data than 

when calculated using the other two data 

sources. The estimate of the percentage of 

the NHPI population (aged 15 and over) 

with the marital status “separated” was 

higher when calculated using 2014 NHPI 

NHIS data than when calculated using the 

other two data sources. At the household 

level, compared with the population 

estimates calculated using ACS frame 

data and the 2010–2014 combined NHIS 

data, the population estimates calculated 

Page 1 
Page 2  Series 2, No. 174 

using the 2014 NHPI NHIS data differed 

in the following ways: the population 

represented by the 2014 NHPI NHIS had 

a lower percentage of NHPI households 

with at least one Hispanic resident, a 

lower percentage of NHPI households 

with only one NHPI person, and a higher 

percentage of NHPI households that 

are resident owned, compared with the 

population represented by the other two 

data sets. 

In the second comparison, estimates 

of 18 health characteristics of the 

NHPI population calculated using the 

2014 NHPI NHIS data were compared 

with estimates of the same health 

characteristics of the NHPI population 

calculated using the 

2010–2014 NHIS data. Three 

characteristics were examined in the total 

population, six were examined separately 

among the child and adult populations, 

five were examined only among the adult 

population, and four were examined 

only among the child population, for a 

total of 24 comparisons. Three of the 24 

population estimates calculated using 

the 2014 NHPI NHIS data differed from 

the same estimates calculated using 

the 2010–2014 NHIS data, but these 

differences mirrored trends in the broader 

population between 2010 and 2014. 

In the third comparison, logistic 

regression models (using sex and age 

to predict NHPI health outcomes) were 

constructed using both the 2014 NHPI 

NHIS data and, separately, the 

2010–2014 NHIS data. While 

not speaking directly to the 

representativeness of the final sample, 

finding that nearly all associations 

identified in each model were within 

the confidence intervals (CIs) of the 

corresponding associations identified in 

the other model would provide evidence 

of a lack of selection bias in the sample. 

In fact, this was the case. 

In conclusion, in some regards the 

NHPI population estimates calculated 

using the 2014 NHPI NHIS data differ 

significantly from the NHPI population 

estimates calculated using ACS frame 

data and 2010–2014 NHIS data. 

Data users should be aware of these 

differences and may want to include 

caveats regarding these differences 

when presenting results from the 2014 

NHPI NHIS, especially if the health 

characteristics examined are strongly 

related to Hispanic ethnicity, marital 

status, or homeownership. However, for 

most analytic purposes, these differences 

between the samples were not substantial 

enough to raise concerns about the 

underlying quality of the 2014 NHPI 

NHIS data. The results from these three 

sets of analyses suggest that the 2014 

NHPI NHIS sample, with appropriate 

caveats, will be useful for estimating 

prevalence and predictors of healthrelated characteristics of NHPI persons in 

the United States. 

Introduction 

In 1997, the Office of Management 

and Budget (OMB) mandated the 

federal use of a new racial category that 

disaggregated Native Hawaiian people 

and Pacific Islander people (NHPI) from 

Asian people (1). The new category was 

defined as “A person having origins in 

any of the original peoples of Hawaii, 

Guam, Samoa, or other Pacific Islands.” 

Approximately 0.4% of the total U.S. 

population identifies as NHPI alone or 

in combination with one or more other 

races, according to 2010 census data (2). 

It is a challenge to include NHPI 

people in sufficient numbers in most 

population-based surveys, because the 

small population size and geographic 

concentration (or “clustering”) of a 

substantial fraction of the population in 

certain states and areas make traditional 

oversampling strategies prohibitively 

expensive. Geographic concentration 

does not mean that NHPI people live 

only in certain areas, but rather that 

a substantial fraction are clustered in 

certain states and areas, while the rest 

are widely dispersed across the country. 

Because the population is numerically 

small, in any given area of the country 

in which the NHPI population is not 

concentrated, there are very few NHPI 

people. Therefore, using traditional 

oversampling strategies to obtain 

representative NHPI samples in areas of 

the country in which the NHPI population 

is not concentrated, hundreds or even 

thousands of households would likely 

need to be screened per NHPI household 

identified. As a result, NHPI people are 

not typically oversampled, and only small 

samples of NHPI people are available 

in even the largest health surveys. To 

respect respondent confidentiality and 

meet reliability standards, NHPI health 

statistics are usually suppressed. 

As one of the largest national 

health surveys, the NHIS is one of the 

few sources of national health data 

on the NHPI population. Beginning 

in 1997, complying with OMB 

Statistical Directive 15 (1), NHIS began 

disaggregating NHPI statistics from 

Asian statistics. However, because the 

sample sizes were so small (between 100 

and 250 households with NHPI persons 

per year), many NHPI statistics were 

unreliable and were not released for 

public use, and NHPI identity cannot be 

released in the public-use file to avoid 

inadvertent data disclosure. Analysts 

could apply to use the restricted NHIS 

data files, and combine multiple years 

of data, to obtain an identifiable and 

larger NHPI sample and calculate more 

reliable NHPI statistics. Yet, it can be 

difficult to interpret statistics calculated 

using multiple years of data, and such 

statistics conceal the variation that may 

have occurred between years. To address 

this problem, NCHS has been looking for 

a way to obtain an NHPI sample of a size 

sufficient to calculate reliable single-year 

statistics. 

In 2012, a new policy on the use of 

the ACS as a frame for federal followback surveys introduced a mechanism 

that made a solution possible. ACS is 

an ongoing U.S. household survey that 

collects information from about 3.5 

million sample households a year on a 

wide range of demographic, economic, 

social, and housing indicators. As the 

successor to the decennial census long 

form, response to ACS is required by law. 

NCHS decided that a frame drawn from 

ACS was the best available sampling 

frame for the NHPI population, given that 

ACS: 

● Has high response rates (96.7% 

among U.S. housing units in the 

United States in 2014, see https:// 

www.census.gov/acs/www/ 
Series 2, No. 174  Page 3 

methodology/sample-size-and-dataquality/response-rates/ for more 

details). 

●		 Implements a range of robust 

operations and procedures designed 

to assess and assure data quality (3). 

●		 Identifies thousands of households 

each year that contain at least one 

person who identifies as NHPI alone 

or in combination with one or more 

other races. 

Using ACS in this way was expected 

to be an efficient and cost-effective 

method of yielding a representative 

sample of the NHPI population that 

was sufficiently large to calculate 

reliable statistics. There was, however, 

a tempered a priori expectation for 

the sample yield, given that the NHPI 

population has a very high level of 

population mobility and of racial identity 

response variance (4–6). Nonetheless, 

because this frame was the best available, 

and the need for NHPI health data is so 

great, the decision was made to apply to 

use ACS as a frame for an NHPI health 

survey. 

In 2013, NCHS applied and was 

approved, to use a single recent year 

of ACS as a frame for this survey. 

Specifically, the frame for the 2014 NHPI 

NHIS consisted of all noninstitutional 

addresses identified in the most recent 

year of ACS available as of 2013 with 

at least one resident of any age who 

was reported to have an NHPI racial 

identity, alone or in combination with 

one or more other racial identities. 

Residents of noninstitutional group 

quarters, such as college dormitories, 

were not available for NHPI NHIS (such 

residents compose approximately 2% 

of the NHPI population). In this report, 

the term “NHPI people” refers to people 

with an NHPI racial identity, alone or 

in combination with one or more other 

racial identities. 

Because ACS had not previously 

been used as a frame for a follow-back 

survey of a rare population, and because 

both frame (ACS) and annual NHIS 

data were available, NCHS conducted 

a quality assessment of the 2014 NHPI 

NHIS data. The overall purpose of this 

report is to investigate the quality of the 

2014 NHPI NHIS data by investigating 

the representativeness of the final 2014 

NHPI NHIS sample. To achieve this 

end, this report presents estimates of the 

demographic and health characteristics 

of the NHPI population calculated using 

data from the 2014 NHPI NHIS, and 

examines how (and the degree to which) 

they differ from estimates of the same 

characteristics of the NHPI population 

calculated using data from ACS and the 

2010–2014 combined years of the annual 

NHIS
 

(the two benchmarks). 

Overview of NHPI 

NHIS Design and 

Operations 

Sample Selection 

NHPI NHIS data collection began 

in February 2014 and concluded in 

November 2014. Households were 

screened using the household roster of 

the NHIS instrument. Only households 

with one or more civilian NHPI residents 

(civilian residents identified as NHPI 

alone or in combination with one or more 

other racial identities) screened in and 

were eligible to participate. If there were 

multiple families within a household, 

only those families with a civilian NHPI 

member were selected to be interviewed. 

No attempt was made to verify that the 

residents at the address in 2014 were the 

same as the residents who had responded 

to ACS. No attempt was made to follow 

NHPI residents who had moved between 

the year of ACS frame and 2014 (when 

NHPI NHIS was fielded). 

Questionnaire and 

Interviewing Procedures 

To maintain comparability with 

the annual NHIS, the procedures for 

collecting information on the 2014 

NHPI NHIS paralleled those of the 

annual NHIS. The U.S. Census Bureau, 

under a contractual agreement, is 

the data collection agent for NHIS. 

Accordingly, the field staff coordinating 

and conducting the 2014 NHPI NHIS 

interviewers were trained NHIS 

interviewers from U.S. Census Bureau. 

Those NHIS interviewers used the 

standard 2014 NHIS survey instrument, 

modified for the 2014 NHPI NHIS in two 

ways: 

1.	 The sample control (screening 

rule) logic of the instrument 

was modified, to implement the 

screening process described in the 

"Sample Selection" section above. 

2.	 Medicare numbers and the last 

four digits of the Social Security 

number—data used to link to other 

Department of Health and Human 

Services data sets—were not 

collected, because such linking is 

not permitted under the legislative 

authority governing the 2014 NHPI 

NHIS. 

As in the annual NHIS, the 

interviews were conducted face-to-face in 

respondents’ homes, although telephone 

follow-ups were permitted when 

necessary to complete interviews. No 

compensation or other incentives were 

provided for participation in the 2014 

NHPI NHIS. 

Respondent Materials, 

Outreach, and Interviewer 

Training 

To achieve maximum cooperation, 

NCHS and the Census Bureau 

implemented extensive outreach efforts 

before and during the field period and 

tailored the respondent materials to 

ensure NHPI cultural appropriateness. 

For example, NCHS tailored the standard 

advance and thank you letters to include 

greetings and expressions of thanks 

in more than 20 NHPI languages, and 

developed a culturally appropriate 

brochure about the survey (provided to 

respondents and distributed as part of 

the outreach efforts). Outreach packets 

and information about the survey were 

distributed widely via conventional mail, 

e-mail and listservs, traditional media, 

and social media. Recipients included 

key NHPI stakeholders in the community 

and government, NHPI-focused listservs, 

and NHPI community-serving faith-based 

organizations and community health 
Page 4  Series 2, No. 174 

centers around the country. For more 

information on the multifaceted outreach 

efforts, most of which have no parallel in 

the operations of the annual NHIS, see 

the 2014 NHPI NHIS Survey Description 

(7). In addition, NCHS and the Census 

Bureau provided special training to 

all interviewers working on the 2014 

NHPI NHIS, covering the special 

procedures for the survey and NHPI 

cultural sensitivity, and emphasizing 

standard NHIS procedures of particular 

importance in NHPI NHIS. For example, 

because many NHPI people identify as 

more than one race, interviewers were 

reminded that if a respondent mentioned 

only one race, the interviewer might 

need to gently probe (“anything else?”) 

to indicate to the respondent that the 

instrument could capture as many races 

as they felt were applicable. 

Frame Refinement

 In the early stages of this quality 

assessment research, after data collection 

was complete, it was discovered that the 

rules used by the Census Bureau and 

ACS for recoding and thereby defining 

racial identity differ from those used by 

NHIS. Specifically, the Census and ACS 

rules (henceforth referred to as ACS rules 

or criteria) are more inclusive than those 

of NHIS. ACS accepts all indications of 

all racial identities as valid, while NHIS 

accepts most but not all racial identity 

responses as valid. This has implications 

for the definition of the 2014 NHPI NHIS 

frame. 

By definition, all ACS households 

identified by ACS as containing one or 

more NHPI people (the initial frame) 

contained at least one resident who met 

ACS criteria for NHPI racial identity. 

However, not all such households 

contained at least one resident who met 

the NHIS criteria for an NHPI identity. 

Because the purpose of the 2014 NHPI 

NHIS was to collect NHPI health data 

in such a way that the results would 

be comparable with the health data 

collected for all races in the annual 

NHIS, in hindsight, it may have been 

better to apply NHIS racial identity 

classification and edit rules to ACS data 

from the beginning when identifying 

households in ACS “with one or more 

NHPI residents.” However, because the 

ACS rule was used initially, the 2014 

NHPI NHIS provided an unexpected 

opportunity to compare these two sets 

of criteria. Before presenting the results 

from this comparison, first the one way 

that ACS and NHIS racial identity coding 

differ is explained. In all but this one way, 

ACS and NHIS definitions of an NHPI 

identity are identical. In both surveys: 

●		 If one or more of the racial identity 

options Native Hawaiian, Samoan, or 

Guamanian or Chamorro are selected 

or given as a verbatim answer, that 

response is considered valid evidence 

of an NHPI racial identity. 

●		 If the “Other Pacific Islander” (OPI) 

option is selected and no further 

verbatim information is provided in 

the “Other Specify” line or followupquestion to the OPI checkbox or 

choice, that response is considered 

valid evidence of an NHPI racial 

identity. 

●		 If a verbatim answer of any other 

specific (e.g., “Tongan” or “Fijian”) 

or general (e.g. “Micronesian” or 

“Pacific Islander”) NHPI group is 

provided at any point in the racial 

identity section, that response is 

considered valid evidence of an 

NHPI racial identity. 

The one exception to the otherwise 

identical racial identity coding criteria is 

the following: when the OPI checkbox 

or choice is indicated, and a non-NHPI 

race is provided for the “Other Specify” 

line or follow-up question to the OPI 

checkbox or choice, and no other 

indication is given of any other general 

or specific NHPI identity. One example 

of this would be a person who indicates 

“Other Pacific Islander,” indicates 

Filipino (an Asian race) in the “Other 

Specify” verbatim follow-up to the OPI 

checkbox or choice, and does not provide 

any other indication of an NHPI racial 

identity. In such cases, ACS codes that 

person as both NHPI and the provided 

verbatim non-NHPI race. In the example 

just mentioned, that person would be 

coded both NHPI and Asian in ACS. In 

contrast, in NHIS, that person is coded 

as the provided verbatim non-NHPI race 

(in the example, that would be Asian) 

but is not coded as NHPI. For both the 

annual NHIS and the 2014 NHPI NHIS, 

during the interview, all races provided 

are treated as valid (ACS rule). The more 

restrictive NHIS race recoding rule is 

applied only during post-data-collection 

processing. As a result, a small number 

of households that screened in to the 

2014 NHPI NHIS initially (because 

according to ACS rule as applied at the 

time of NHPI NHIS, the household had 

a civilian NHPI resident) were recoded 

during data processing as screening out. 

This occurred when all of the NHPI 

racial identities reported by people at that 

address in the 2014 NHPI NHIS fell in 

the NHIS “exception” category. 

Table 1 separates ACS addresses 

originally identified by ACS as 

containing at least one NHPI resident 

into two groups, shown in the last two 

columns: those that met the NHIS criteria 

for having a resident with NHPI identity 

in ACS (n = 7,074), and those that did 

not (n = 1,153). It then shows, in the 

rows, the screen-in, screen-out, and no 

interview rates for those two groups 

in the 2014 NHPI NHIS, before and 

after NHPI NHIS race recoding. Screen 

in means that the 2014 NHPI NHIS 

determined that the household had at 

least one civilian NHPI resident at the 

time of, and was therefore eligible for, the 

2014 NHPI NHIS. Screen out means that 

the household was not eligible because 

the household had no such civilian NHPI 

resident. See Appendix II for more 

information on the meaning of these 

categories. 

Summary of results from 

Table 1 

●		 Of the 8,227 addresses originally 

identified by ACS as containing 

at least one NHPI resident, 13.8% 

(1,153 addresses) did not meet NHIS 

criteria for having a resident in ACS 

with an NHPI identity. 

●		 Of the 1,153 addresses that did 

not meet NHIS criteria for having 

a resident in ACS with an NHPI 

identity: 

○		 Very few (7.6%) screened in 

to the 2014 NHPI NHIS and 

most (76.2%) screened out as 
Series 2, No. 174  Page 5 

non-NHPI, using only the racial 

identity coding rules that both 

surveys agree on, before the 

more stringent NHIS racial 

identity rule was applied. 

○		 These percentages changed to 

3.8% and 80.0%, respectively, 

after NHIS race recoding (which 

applies the more restrictive NHIS 

racial identity coding rule to the 

NHIS racial identity variables). 

●		 In comparison, of the 7,074 addresses 

that did meet NHIS criteria for 

having an NHPI resident in ACS: 

○		 Nearly one-half (46.1%) screened 

in to the 2014 NHPI NHIS and 

only a one-third (33.5%) screened 

out as non-NHPI, using only the 

racial identity coding rules that 

both surveys agree on, before 

the more stringent NHIS racial 

identity rule was applied. 

○		 The percentages that screened 

in and out barely changed (to 

45.4% and 34.2% respectively, 

after NHIS race recoding (which 

applies the more restrictive NHIS 

racial identity coding rule to the 

NHIS racial identity variables). 

During postprocessing of the 2014 

NHPI NHIS data, the 2014 NHPI NHIS 

outcome code given to households at 

these 1,153 addresses, which did not meet 

NHIS criteria for having a resident in 

ACS with an NHPI identity, was changed 

to indicate that the households were “out 

of scope,” regardless of what outcome 

code was originally assigned. 

As a result of this analysis, the 7,074 

addresses from ACS that met NHIS 

criteria for containing at least one NHPI 

person were determined to constitute the 

final frame for the 2014 NHPI NHIS. In 

the remainder of this report, all analyses 

of ACS frame data are conducted 

using household data from these 7,074 

addresses. This is the main reason that 

estimates reported here will not match 

published ACS estimates for the NHPI 

population. 

Methods 

Analytical Data Sets and 

Sample Size 

In this report the NHPI people and 

households identified in the 2014 NHPI 

NHIS (referred to as the “2014 NHPI 

NHIS’) are compared to two benchmarks: 

the NHPI people and households 

identified in ACS (referred to as the 

‘ACS frame’), and the NHPI people and 

households identified in the 2010–2014 

NHIS (referred to as the ‘NHPI sample 

from the 2010–2014 NHIS’). Each 

analytical data set has the following 

sample size: 

1.	 The 2014 NHPI NHIS consists of 

3,195 NHPI addresses, 3,197 NHPI 

households, and 8,661 NHPI persons. 

2.	 ACS frame consists of 7,074 NHPI 

addresses/households (the ACS data 

set did not distinguish between the 

two) and 16,912 NHPI persons 

3.	 The NHPI sample from the 

2010–2014 NHIS consists of 919 

NHPI households and 2,217 NHPI 

persons. 

Combining multiple years of NHIS 

was necessary to obtain an adequate 

sample size for analysis. The sample 

sizes of NHPI persons and households in 

the annual NHIS are so small, however, 

that even when combining 5 years of 

data many estimates are still not reliable. 

The analyses described below focus on 

measures with reliable estimates. 

Weighting and Variance 

Estimation 

In all analyses, the weights and 

variance estimation variables and 

techniques appropriate for each data 

source (survey) were used to calculate 

national population estimates and 

standard errors. 

2014 NHPI NHIS 

To calculate the weighted 2014 

NHPI NHIS estimates the 2014 NHPI 

NHIS person, household, sample adult, 

and sample child weights as appropriate 

for the analysis were used (7). The 

standard errors of the 2014 NHPI 

NHIS estimates were calculated using 

the NHPI NHIS variance estimation 

variables and Taylor series linearization 

methods in SUDAAN software. The 

procedure for creating weights for the 

2014 NHPI NHIS was similar to the 

annual NHIS weight creation procedure, 

which is described elsewhere (8). For 

more information about the weights and 

variance estimation variables in the 2014 

NHPI NHIS, see the 2014 NHPI NHIS 

Survey Description document (7).

 ACS frame 

To calculate the weighted ACS 

frame estimates, ACS household- and 

person-level weights were used. The 

standard errors of ACS frame estimates 

were calculated using ACS replicate 

weights and SUDAAN software. 

2010–2014 NHIS 

To calculate the weighted 2010–2014 

NHIS estimates the 2010–2014 NHIS 

person, household, sample adult, and 

sample child weights as appropriate for 

the analysis were used. The standard 

errors of the 2010–2014 NHIS estimates 

were calculated using the variance 

estimation variables and SUDAAN 

software. For more information about the 

weights and variance estimation variables 

in NHIS, see the 2014 NHIS Survey 

Description document (9). 

Because the 2010–2014 NHIS has 

a different sample design than ACS, it is 

not appropriate to combine the NHIS data 

with the other two data sets. Attempts to 

link ACS and NHPI NHIS samples were 

only partially successful, yielding a data 

set that was not useful for analysis. As 

a result, all calculations of percentages 

and standard errors were done separately 

for each analytical data set. The t tests 

were then calculated using those results. 

Differences between percentages were 

evaluated by using two-sided significance 

tests at the 0.05 level. 

These analyses were conducted 

under the assumption of no overlap 

between the samples, although the 

linkage analysis showed that there is a 

non-zero level of correlation between 

ACS and NHPI NHIS data sets. By not 
Page 6  Series 2, No. 174 

taking this correlation into account, 

there is a possibility of increased Type II 

error (concluding there is no difference 

when one truly exists). To consider the 

differences with a lower likelihood of 

Type II error, the differences between 

ACS and NHPI NHIS percentages 

were also evaluated using a two-sided 

significance test at the 0.1 alpha level. 

The results did not change. 

Analytical Methods 

The following three comparisons 

were conducted to determine how 

representative the final 2014 NHPI 

NHIS sample is of the underlying NHPI 

population. 

Comparison 1—First, estimates of 

eight person-level and 10 household-level 

demographic characteristics of the NHPI 

population calculated using the 2014 

NHPI NHIS data were compared with 

the same estimates calculated using ACS 

frame and the NHPI sample from the 

2010–2014 NHIS. 

If the the population estimates 

calculated using the 2014 NHPI NHIS 

sample looked similar enough to 

estimates calculated using ACS frame and 

the NHPI sample from the 2010–2014 

NHIS, the sample could be considered 

representative. The interpretation of these 

results takes into account that: 

1.	 Both these benchmark surveys are 

also subject to various kinds of 

survey error. 

2.	 There are methodological 

differences between the 2014 NHPI 

NHIS and the ACS. 

3.	 There are period differences 

between the 2014 NHPI NHIS and 

both the ACS frame and the 2010– 

2014 NHIS. 

There are two particularly important 

methodological differences between 

the 2014 NHPI NHIS and ACS. First, 

NHPI NHIS was conducted in person, 

with telephone follow-ups only when 

necessary, while the ACS survey was 

mailed to households, with telephone 

follow-ups and in-person follow-ups only 

when necessary. Second, the NHPI NHIS 

questionnaire embeds sociodemographic 

questions in what is primarily a set 

of detailed health questions, while 

ACS questionnaire embeds health 

questions in what is primarily a set of 

sociodemographic questions. Differences 

would be expected in estimates 

between these two surveys as a result of 

differences in mode and question context. 

When examining the results, therefore, 

the focus was on consistent differences 

between the 2014 NHPI NHIS and both 

benchmarks (ACS frame and the 2010– 

2014 NHPI NHIS). 

Comparison 2—Second, estimates 

of 18 health characteristics of the 

NHPI population calculated using 

the 2014 NHPI NHIS were compared 

with estimates of the same health 

characteristics calculated using the 

NHPI sample from the 2010–2014 NHIS 

(Table 4) (No comparable health data are 

available in ACS). Three characteristics 

were examined in the total population, 

six were examined separately among 

the child and adult populations, five 

were examined only among the adult 

population, and four were examined only 

among the child population, for a total of 

24 comparisons. 

Because the 2014 NHPI NHIS used 

the same mode, instrument, measurement 

procedures, and survey staff as NHIS, 

it is reasonable to compare prevalences 

from the 2014 NHIS NHPI with 

prevalences calculated using 5 years of 

data from NHIS. There are, however, 

period differences between the 2014 

NHPI NHIS and the 2010–2014 NHIS. 

The characteristics examined here are 

those with adequate sample size in the 

NHPI sample from the 2010–2014 NHIS 

to obtain a reliable estimate and whose 

measurement in the annual NHIS has 

not changed over this period. Again, 

if the prevalences look similar to each 

other across the two surveys, or if the 

differences between them mirror trends 

in the larger population, this provides 

evidence that the 2014 NHPI NHIS 

sample is representative. 

Comparison 3—Third, the direction 

and strength of associations between 

health outcome variables and two 

key demographic variables—sex and 

age— were compared across models 

constructed using the two data sets. 

Specifically, this analysis compares the 

results of multiple logistic regression 

models constructed using the sample 

of NHPI persons from the 2014 NHPI 

NHIS with the results of models 

constructed using the NHPI sample from 

the 2010–2014 NHIS. The CI of each 

odds ratio was examined to determine if 

it encompassed the corresponding odds 

ratio from the other data set’s model. In 

particular, the focus was on consistent 

patterns: models where the point 

estimates for the odds ratio in both data 

sets’ models fell outside the CI of the 

corresponding odds ratio in the other data 

set’s model. While not speaking directly 

to the representativeness of the final 

sample, if odds ratios from one model 

estimated using one analytic data set are 

within the CIs for the corresponding odds 

ratios from the same model estimated 

using the other other analytic data set, 

evidence exists of a lack of selection bias 

in the sample. Had the 2014 NHPI NHIS 

systematically screened out unhealthy 

older people, for example, while 

retaining all young people and healthy 

older people, then the same associations 

between age and certain health outcomes 

common among older people but rarer in 

young people might not be seen between 

the 2014 NHPI NHIS and the benchmark. 

In all of these comparisons, not 

only statistical significance but also the 

magnitude and direction and, therefore, 

meaning of any statistically significant 

differences identified are considered.. 

Results 

Comparison 1: 

Sociodemographic 

Characteristics 

Summary of results from 

Table 2 – Person level 

Table 2 shows the comparison 

of the estimates of eight person-level 

sociodemographic characteristics of the 

NHPI population as calculated using the 

2014 NHPI NHIS sample with the same 

estimates calculated using ACS frame, 

and the NHPI sample from the 

2010–2014 NHIS. This analysis 
Series 2, No. 174  Page 7 

was restricted to variables for which 

comparable variables were available 

from both ACS and the 2014 NHPI 

NHIS. Only two measures had consistent 

differences between the 2014 NHPI 

NHIS and both benchmarks: 

●		 The 2014 NHPI NHIS estimates 

of the percentage of NHPI persons 

who are Hispanic is lower than the 

estimates calculated using ACS 

frame and the 2010–2014 NHIS (10% 

compared with 13.5% in the ACS 

frame and 17.1% in the 2010–2014 

NHIS). 

●		 The 2014 NHPI NHIS estimate of the 

percentage of NHPI persons aged 15 

and over whose marital status was 

“separated” is higher than the same 

estimates calculated using the two 

benchmarks (7.2% compared with 

2.4% in the ACS frame and 2.1% in 

the 2010–2014 NHIS). 

●		 For six characteristics (sex, age, 

NHPI alone compared to NHPI in 

combination with one or more other 

race, other race among NHPI in 

combination, educational attainment, 

and place of birth or citizenship 

status) the 2014 NHPI NHIS 

estimates did not differ significantly 

from at least one of the two 

corresponding estimates calculated 

using the benchmark survey data. 

Summary of results from 

Table 3 – Household level 

Table 3 shows the comparison of 

the estimates of 10 household-level 

sociodemographic characteristics of the 

NHPI population calculated using the 

2014 NHPI NHIS sample with the same 

estimates calculated using the NHPI 

households (households with at least one 

NHPI resident) identified in ACS frame 

and the NHPI households identified in 

the 2010–2014 NHIS. This analysis 

was restricted to variables for which 

comparable variables were available 

in both ACS frame and the 2010–2014 

NHIS. Here it is seen that: 

●		 The estimate of the percentage of 

NHPI households with only one 

NHPI resident calculated using 

the 2014 NHPI NHIS (36.9%) was 

lower than that same estimate when 

calculated using ACS frame (45.6%) 

and the 2010–2014 NHIS (46.2%). 

Also, the estimate of the percentage 

of NHPI households with seven or 

more NHPI residents calculated 

using the 2014 NHPI NHIS (5.2%) 

was higher than that same estimate 

when calculated using the ACS frame 

(3.6%) and the 2010–2014 NHIS 

(2.8%). 

●		 The estimate of the percentage 

of NHPI households with at least 

one Hispanic resident calculated 

using the 2014 NHPI NHIS (14.8%) 

was lower than that same estimate 

calculated using the two benchmarks 

(21.6% in ACS frame and 21.2% in 

the 2010–2014 NHIS). 

●		 The estimate of the percentage of 

NHPI households with all residents 

under age 25 calculated using the 

2014 NHPI NHIS (1.5%) was lower 

than that same estimate calculated 

using the two benchmarks (5.0% 

in ACS frame and 7.5% in the 

2010–2014 NHIS). The estimate of 

the percentage of NHPI households 

that were resident-owned calculated 

using the 2014 NHPI NHIS (60.2%) 

was higher than that same estimate 

calculated using the ACS frame 

(48.3%) and the NHPI sample from 

the 2010–2014 NHIS (48.7%). 

●		 For seven characteristics (all 

residents were NHPI alone, number 

of people in the household, number 

of children in the household, 

maximum educational attainment 

of residents, immigrant status of 

residents, state, and region), the 

2014 NHPI NHIS estimates did not 

differ significantly from at least one 

of the two corresponding estimates 

calculated using data from the 

benchmark surveys. 

A disadvantage of conducting a 

follow-back survey is that some persons 

may have moved between surveys. 

Households that rent are more likely to 

be mobile and, therefore, missed in the 

follow-back survey. In addition, the fact 

that residents of noninstitutional group 

quarters (such as college dormitories) 

were not available for NHPI NHIS 

may explain part of the difference in 

the percentage of households with all 

residents under age 25. 

Comparison 2: Health 

Characteristics 

Summary of results from 

Table 4 

Table 4 shows the comparison of 

estimates of 18 person-level health 

characteristics of the NHPI population 

calculated using the 2014 NHPI NHIS 

with the same estimates calculated using 

the NHPI sample from the 2010–2014 

NHIS. Three characteristics were 

examined in the total population, six were 

examined separately among the child and 

adult populations, five were examined 

only among the adult population, and 

four were examined only among the child 

population, for a total of 24 comparisons. 

Here it is seen that: 

●		 For 21 of the 24 comparisons, there 

were no statistically significant 

differences across estimates from the 

two surveys. 

●		 Three differences were found 

between estimates calculated using 

the 2014 NHPI NHIS and those 

calculated using the NHPI sample 

from the 2010–2014 NHIS: two 

differences among adults and one 

among children. The estimate of the 

percentage of NHPI adults who are 

former smokers calculated using 

the 2014 NHPI NHIS is higher 

than the same estimate calculated 

using the 2010–2014 NHIS (19.5% 

compared with 13.1%). Also, the 

estimate of the percentage of NHPI 

adults who had the flu vaccine in 

the past 12 months calculated using 

the 2014 NHPI NHIS is higher 

than the same estimate calculated 

using 2010–2014 NHIS (42.5% 

compared with 34.8%). Finally, the 

estimate of the percentage of NHPI 

children who had a dental visit in 

the past year calculated using the 

2014 NHPI NHIS was higher than 

the same percentage calculated 

using the 2010–2014 NHIS (83.0% 

compared with 71.8%). All three of 

these differences mirror trends in 

the broader population of decreased 
Page 8  Series 2, No. 174 

smoking and increased access to 

and utilization of care over the years 

2010–2014 (10–12). In addition, 

seasonal administration of the flu 

vaccine in combination with the 

different calendar periods of data 

collection of the surveys (January 

through December for NHIS, and 

February through November for the 

2014 NHPI NHIS), could account 

for differences in the population 

estimates for the percentage of NHPI 

adults who had the flu vaccine in the 

past 12 months. Other differences 

between estimates calculated using 

the two analytical data sets, which 

did not rise to statistical significance, 

also trended in a direction consistent 

with these broader changes in health 

care utilization. 

Comparison 3: Direction 

and Strength of Associations 

Between Health Outcomes 

and Age, Sex 

Summary of results from 

Table 5 

Finally, in Table 5 associations are 

compared between health variables 

and two demographic predictors (sex 

and age) in the NHPI population as 

estimated using the 2014 NHPI NHIS 

with the same population associations 

estimated using the NHPI sample from 

the 2010–2014 NHIS. Multiple logistic 

regression models were used to estimate 

the associations. Health outcomes 

selected were those for which there were 

sufficient numbers of NHPI persons in 

the combined years of NHIS to calculate 

a reliable estimate (a total of 22 models). 

Overall: 

●		 For all health measures examined, no 

significant differences were found in 

the direction of the odds ratios across 

the models constructed using the two 

analytical data sets. 

●		 For all but one coefficient for one 

outcome (sex in the adult aerobic 

activity model), the CIs overlap 

across models. 

●		 In most cases when a coefficient 

from one model fell outside the 

CI of the other data set’s model’s 

corresponding coefficient, it was the 

NHIS coefficient that was outside 

the NHPI NHIS CI. The CIs for the 

NHPI NHIS models were mostly 

narrower, indicating more reliable 

estimates. 

●		 In none of the models did the point 

estimates for the age coefficients in 

both data sets’ models fall outside the 

CIs of the corresponding coefficients 

in the other data set’s model. 

●		 For only five of the 22 outcomes 

examined did the point estimate for 

the sex odds ratio in both data sets’ 

models fall outside the CI of the 

corresponding odds ratio in the other 

data set’s model. Specifically, this is 

the case for the adult hypertension, 

child skin allergy, adult aerobic 

activity, total population public 

or private comprehensive health 

coverage, and total population dental 

visit in the past year models. 

Discussion 

The 2014 NHPI NHIS is the first 

national NHPI health survey with a 

sample size larger than a few hundred 

NHPI households and is the first survey 

to use ACS as a frame for a follow-back 

survey of a numerically small population. 

Because ACS had not previously been 

used as a frame for a follow-back survey 

of a rare population, and because both the 

ACS frame and annual NHIS data were 

available to assess the representativeness 

of the final 2014 NHPI NHIS sample, 

NCHS conducted a quality assessment. 

The goal of this investigation was to 

describe patterns of differences between 

the sample obtained in NHPI NHIS 

and the sample obtained in the two 

benchmark surveys. For simplicity, and to 

keep the focus on the issue most relevant 

to data users, this report did not examine 

the reasons underlying these patterns of 

differences.

 In some regards, the 2014 NHPI 

NHIS sample differs significantly from 

the ACS frame and the NHPI sample 

identified in the 2010–2014 NHIS. The 

NHPI population as measured using 

the 2014 NHPI NHIS sample has a 

lower percentage of Hispanic NHPI 

persons, households with at least one 

Hispanic resident, households where 

all residents were under age 25, and 

households with a single NHPI person, 

and a higher percentage of persons 

(aged 15 and over) whose marital status 

was “separated” and households with 

seven or more NHPI person or that are 

resident-owned compared with the NHPI 

population measured using the other two 

benchmarks. 

The survey design and period 

differences may explain some of 

these differences, as discussed above. 

Data users should be aware of these 

differences and may wish to include 

caveats regarding these differences 

when presenting results from the 2014 

NHPI NHIS, especially if the health 

characteristics examined are strongly 

related to Hispanic ethnicity, marital 

status, homeownership, or household 

racial composition. However, for most 

analytic purposes, these differences 

are not likely to influence the results in 

a manner substantial enough to raise 

concerns about the underlying fitness of 

the data. 

The other two comparisons found a 

pattern of similarities and only isolated 

differences. Of the 24 comparisons of 18 

population health estimates calculated 

using the 2014 NHPI NHIS and the NHPI 

sample from the 2010–2014 NHIS, only 

three differed, and there are plausible 

period explanations for those differences. 

Finally, a range of associations found 

in the NHPI population using the 2014 

NHPI NHIS are consistent with those 

found using the NHPI sample from the 

2010–2014 NHIS. 

In conclusion, results from these 

three sets of analyses suggest that 

the 2014 NHPI NHIS sample, with 

appropriate caveats, will be useful for 

estimating prevalence and predictors of 

health-related characteristics of NHPI 

persons. 
Series 2, No. 174  Page 9 

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Page 10  Series 2, No. 174 

Table 1. Percent distribution of American Community Survey addresses containing at least one Native Hawaiian or Pacific Islander resident, 

by 2014 Native Hawaiian and Pacific Islander National Health Interview Survey sample disposition and presence of Native Hawaiian or 

Pacific Islander residents according to National Health Interview Survey criteria 

At least one resident NHPI by No resident NHPI by NHIS 

Total NHIS criteria, in ACS criteria, in ACS 

NHPI NHIS address disposition (n = 8,227) (n = 7,074) (n = 1,153) 

Percent 

Before NHIS race recoding: 

Screened in (at least one NHPI resident) . . . . . . . . . . . . . . . . . 40.7 46.1 7.6 

Screened out (no NHPI resident) . . . . . . . . . . . . . . . . . . . . . . . 39.5 33.5 76.2 

Not interviewed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.8 20.4 16.2 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 

After NHIS race recoding: 

Screened in (at least one NHPI resident) . . . . . . . . . . . . . . . . . 39.6 45.4 3.8 

Screened out (no NHPI resident) . . . . . . . . . . . . . . . . . . . . . . . 40.6 34.2 80.0 

Not interviewed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.8 20.4 16.2 

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 

NOTES: NHPI is Native Hawaiian and Pacific Islander. NHIS is National Health Interview Survey. ACS is American Community Survey. NHIS criteria for an NHPI identity are identical to ACS criteria for 

an NHPI identity during NHIS data collection. Only during race recoding, after data collection is completed, are the more stringent NHIS criteria were applied. The last two columns refer to the stringent 

NHIS definition applied to NHIS data collected in ACS. 
Series 2, No. 174  Page 11 

Table 2. Weighted percentages of sociodemographic characteristics of Native Hawaiian and Pacific Islander people, by survey 

ACS frame (SE) 2010–2014 NHIS (SE) 2014 NHPI NHIS (SE) 

Sociodemographic characteristics (n = 16,912) (n = 2,217) (n = 8,661) 

Male 49.3 (0.31) 52.1 (1.14) 50 (0.6) 

Age (years): 

Under 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.8 (0.28) 10.0 (0.82) 10.8 (0.55) 

5 – 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.3 (0.38) 26.0 (1.28) 24.7 (0.67) 

18 – 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.9 (0.33) 12.0 (1.25) 12.0 (0.56) 

25 – 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.7 (0.34) 16.2 (1.12) 15.6 (0.57) 

35 – 44 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.6 (0.33) 12.9 (0.86) 12.5 (0.46) 

45 – 54 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.0 (0.27) 11.7 (1.03) 11.2 (0.50) 

55 – 64 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3 (0.20) 6.7 (1.03) 7.6 (0.28) 

65 – 74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6 (0.13) 2.6 (0.46) 3.9 (0.26) 

75 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.8 (0.11) 1.8 (0.47) 1.9 (0.14) 

Hispanic ethnicity1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.5 (0.53) 17.1 (2.43) 10.0 (0.92) 

NHPI alone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51.7 (0.67) 60.7 (5.16) 51.2 (1.48) 

Among NHPI in combination, other race: 

White. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.8 (1.00) 34.0 (5.68) 32.7 (1.44) 

Asian. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.4 (0.97) 26.1 (3.89) 28.5 (1.20) 

White and Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28.6 (0.86) 21.0 (4.84) 28.3 (1.78) 

All other combinations1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.2 (0.81) 19.0 (3.55) 10.4 (0.81) 

Marital status (aged 15 and over): 

Now married, except separated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43.5 (0.47) 49.7 (1.87) 45.2 (1.02) 

Widowed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6 (0.15) 2.8 (0.72) 3.2 (0.25) 

Divorced . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.9 (0.38) 6.4 (0.80) 6.9 (0.48) 

Separated1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4 (0.22) 2.1 (0.50) 7.2 (0.59) 

Never married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.6 (0.49) 39.0 (1.55) 37.5 (0.89) 

Educational attainment (aged 25 and over): 

Less than high school diploma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.3 (0.53) 12.4 (1.47) 10.7 (0.58) 

High school graduate (includes equivalency) . . . . . . . . . . . . . . . . . . . . . 33.4 (0.82) 37.1 (3.67) 37.1 (1.31) 

Some college or associate’s degree . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35.9 (0.72) 30.2 (1.93) 34.1 (1.28) 

Bachelor’s degree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.9 (0.54) 12.9 (1.77) 12.1 (0.80) 

Graduate or professional degree. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.5 (0.27) 7.3 (1.29) 6.1 (0.52) 

Place of birth, citizenship staus: 

U.S. citizen (native born or born abroad 

to U.S. parents) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86.8 (0.39) 85.6 (2.28) 89.1 (0.89) 

Foreign born, naturalized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.4 (0.31) 6.2 (1.48) 5.1 (0.49) 

Foreign born, not a U.S. citizen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.8 (0.34) 8.2 (1.33) 5.8 (0.59) 

1

2014 NHPI NHIS estimate differs significantly from both 2010–2014 NHIS estimate and ACS estimate. 

NOTES: NHPI is Native Hawaiian and Pacific Islander. NHIS is National Health Interview Survey. ACS is American Community Survey. All other combinations includes “Some other race” in ACS. There 

is no value of “Some other race” in NHIS. SE is standard error. 
Page 12  Series 2, No. 174 

Table 3. Weighted percentages of sociodemographic and health characteristics of Native Hawaiian and Pacific Islander households, by 

survey 

ACS frame (SE) 2010–2014 NHIS (SE) 2014 NHPI NHIS (SE) 

Sociodemographic characteristics (n = 7,074) (n = 919) (n = 3,197) 

All NHPI residents were NHPI alone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44.9 (0.77) 55.3 (3.64) 43.0 (1.23) 

Number of NHPI people in household: 

11 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45.6 (0.75) 46.2 (2.86) 36.9 (1.28) 

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.1 (0.62) 19.6 (1.53) 20.1 (0.87) 

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.5 (0.47) 13.3 (1.68) 16.8 (0.90) 

4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.5 (0.39) 8.4 (1.08) 10.6 (0.85) 

5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.8 (0.36) 7.3 (1.19) 7.0 (0.82) 

6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.9 (0.27) 2.3 (0.60) 3.4 (0.43) 

7 or more1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6 (0.31) 2.8 (0.68) 5.2 (0.51) 

Number of people in household: 

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.7 (0.50) 14.6 (1.67) 13.5 (1.05) 

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.1 (0.68) 26.8 (1.85) 25.6 (0.79) 

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.9 (0.57) 20.1 (1.48) 19.3 (0.91) 

4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.1 (0.63) 15.0 (1.44) 17.4 (0.84) 

5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.7 (0.43) 12.6 (1.39) 11.4 (0.67) 

6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.0 (0.43) 5.4 (0.95) 5.7 (0.76) 

7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.0 (0.29) 3.0 (0.73) 3.5 (0.45) 

8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.6 (0.17) 1.8 (0.79) 1.7 (0.16) 

9 or more. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.9 (0.17) 0.7 (0.32) 2.0 (0.34) 

At least one resident was Hispanic1

 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.6 (0.63) 21.2 (2.24) 14.8 (0.85) 

Number of children (under age 18) in household: 

0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47.7 (0.63) 47.3 (1.95) 50.8 (1.20) 

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.8 (0.57) 20.6 (1.60) 18.7 (0.69) 

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.3 (0.54) 17.1 (1.63) 15.0 (0.63) 

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.7 (0.46) 9.2 (1.19) 9.2 (0.74) 

4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1 (0.38) 3.8 (0.63) 3.7 (0.51) 

5 or more. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *2.4 (0.27) 2.0 (0.72) 2.6 (0.41) 

Maximum educational attainment (among residents aged 25 or over: 

No one was aged 25 or over1

 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.0 (0.32) 7.5 (1.46) 1.5 (0.29) 

No resident aged 25 or over had a high school degree or higher . . . . . . . . . . . 3.9 (0.31) 5.3 (0.90) 4.4 (0.39) 

At least one resident aged 25 or over had a high school degree 

but no one had a bachelor's degree or higher . . . . . . . . . . . . . . . . . . . . . . . . 60.4 (0.73) 56.0 (3.48) 62.4 (1.05) 

At least one resident aged 25 or over had a bachelor's degree 

or higher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.8 (0.74) 31.2 (2.73) 31.7 (0.84) 

Immigrant status of residents: 

All residents were U.S. natives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62.8 (0.74) 73.7 (2.80) 76.9 (0.74) 

At least one resident but not all residents were immigrants . . . . . . . . . . . . . . . 28.8 (0.72) 19.8 (1.88) 19.2 (0.81) 

All residents were immigrants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.5 (0.40) 6.5 (1.58) 3.9 (0.29) 

Tenure: 

Owner1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48.3 (0.83) 48.7 (2.43) 60.2 (0.90) 

Renter1

 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49.5 (0.82) 48.2 (2.62) 37.1 (0.97) 

Occupied without payment of rent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 (0.23) 3.1 (0.83) 2.7 (0.38) 

State: 

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28.3 (0.57) 25.3 (13.37) 38.7 (0.81) 

California. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.5 (0.67) 21.8 (4.34) 22.0 (0.74) 

All other states . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48.3 (0.72) 52.9 (9.65) 39.3 (0.78) 

Region: 

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.6 (0.38) 5.2 (1.39) 2.8 (0.15) 

Midwest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 (0.33) 7.8 (1.93) 4.9 (0.31) 

South. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.9 (0.56) 16.2 (3.32) 11.6 (0.54) 

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.9 (0.66) 70.8 (5.60) 80.7 (0.62) 

* Estimates are considered unreliable. Data preceded by an asterisk have a relative standard error (RSE) greater than 30% and less than or equal to 50% and should be used with caution. 

1

The 2014 NHPI NHIS estimate differs significantly from both 2010–2014 NHIS estimate and ACS estimate. 

NOTE: NHPI is Native Hawaiian and Pacific Islander. NHIS is National Health Interview Survey. ACS is American Community Survey SE is standard error.. 
Series 2, No. 174  Page 13 

Table 4. Weighted percentages of health characteristics of Native Hawaiian and Pacific Islander people, by survey 

Characteristic 2010–2014 NHIS 2014 NHPI NHIS 

Health status 

Total: 

Reported general health: 

Excellent, very good or good . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90.8 (1.07) 90.4 (0.52) 

Fair or poor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.2 (1.07) 9.6 (0.52) 

Adult: 

Currently obese . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42.9 (3.26) 42.6 (1.42) 

Ever had diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.1 (1.67) 12.1 (0.80) 

Ever had hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.2 (2.89) 22.5 (1.03) 

Ever had asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.9 (2.44) 20.0 (1.19) 

Current asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.5 (1.65) 9.6 (0.84) 

Child: 

Ever had chickenpox . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.2 (2.89) 9.6 (1.25) 

Respiratory allergy in past 12 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.2 (1.98) 8.7 (0.93) 

Skin allergy in past 12 months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.3 (3.06) 14.6 (1.39) 

Cold in past 2 weeks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.8 (3.24) 16.4 (1.60) 

Ever had asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.9 (3.77) 16.5 (1.13) 

Current asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.5 (3.39) 11.0 (1.03) 

Adult health behaviors 

Smoking: 

Current . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.0 (2.43) 17.0 (1.17) 

Former1

 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.1 (1.82) 19.5 (1.23) 

Never. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67.9 (2.78) 63.5 (1.54) 

Combined aerobic and strengthening guidelines: 

Met neither guideline. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38.6 (3.57) 38.0 (1.30) 

Met muscle-strengthening guideline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *5.2 (1.66) 3.0 (0.54) 

Met aerobic guideline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28.6 (2.77) 31.4 (1.48) 

Met both guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.6 (3.18) 27.6 (1.49) 

Health care utilization and access 

Total: 

Did not get needed medical care due to cost . . . . . . . . . . . . . . . . . . . . . . 6.4 (1.02) 4.3 (0.38) 

Delayed needed medical care due to cost. . . . . . . . . . . . . . . . . . . . . . . . . 8.0 (1.28) 6.2 (0.42) 

Adult: 

Flu vaccine in past 12 months1

 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34.8 (2.79) 42.5 (1.60) 

Interval since last dental visit: 

Past year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55.8 (3.16) 58.3 (1.70) 

Over 1 year, but under 5 years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.8 (2.76) 26.9 (1.40) 

Over 5 years, never . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.4 (1.98) 14.8 (1.23) 

Did not get dental care due to cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.7 (2.49) 12.6 (0.79) 

Have a usual source of care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.7 (3.71) 86.1 (1.01) 

Child: 

Flu vaccine in past 12 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56.2 (4.18) 57.0 (3.08) 

Interval since last dental visit: 

Past year1 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71.8 (4.08) 83.0 (1.59) 

Over 1 year, but under 5 years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.3 (3.06) 6.0 (0.88) 

Over 5 years, never . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.9 (3.04) 11.0 (1.55) 

Did not get dental care due to cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3 (1.77) 4.8 (0.69) 

Have a usual source of care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92.7 (2.03) 96.1 (0.74) 

* Estimates are considered unreliable. Data preceded by an asterisk have a relative standard error (RSE) greater than 30% and less than or equal to 50% and should be used with caution. 

1

The 2014 NHPI NHIS estimate differs significantly from 2010–2014 NHIS estimate. 

NOTE: NHPI is Native Hawaiian and Pacific Islander. NHIS is National Health Interview Survey. ACS is American Community Survey. 
Page 14  Series 2, No. 174 

Table 5. Odds ratios from multiple logistic regression models of select health outcomes on sex and age among Native Hawaiian and Pacific 

Islander people, by survey 

Characteristic NHIS 2010 (CI) NHPI NHIS (CI) 

Health status and conditions 

Sample adult ever had diabetes: 

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.52 (0.61–3.79) 1.36 (0.90–2.07) 

Age (years): 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.36 (3.32–16.32) 8.40 (5.41–13.04) 

Sample adult ever had hypertension: 

Men1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.50 (0.26–0.99) 1.18 (0.86–1.62) 

Age (years): 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.25 (2.84–9.71) 7.47 (5.36–10.41) 

Sample adult or sample child ever had asthma: 

Men and boys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 (0.65–1.56) 0.89 (0.67–1.20) 

Age (years): 

Under 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.64 (0.75–3.59) 0.87 (0.68–1.11) 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.59 (0.77–3.31) 1.14 (0.91–1.43) 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

Sample adult or sample child currently has asthma: 

Men and boys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.73 (0.43–1.24) 0.67 (0.46–0.97) 

Age (years): 

Under 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.60 (0.86–2.99) 1.26 (0.91–1.76) 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.30 (0.51–3.36) 1.25 (0.94–1.67) 

Sample adult or sample child had asthma episode 

(of those who ever had asthma), past year: 

Men and boys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.43 (0.19–0.98) 0.91 (0.60–1.40) 

Age (years): 

Under 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.41 (0.58–3.43) 2.23 (1.38–3.60) 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.77 (0.49–6.39) 1.91 (1.02–3.55) 

Sample child ever had chicken pox: 

Boys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.43 (0.58–3.51) 1 .00 (0.51–1.95) 

Sample child had respiratory allergy, past 12 months: 

Boys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.94 (0.42–2.10) 1.22 (0.61–2.44) 

Sample child had skin allergy, past 12 months: 

Boys1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.54 (0.23–1.30) 1.36 (0.58–3.20) 

Sample child had cold, past 2 weeks: 

Boys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.99 (0.30–3.26) 1.24 (0.81–1.89) 

Persons in fair or poor health: 

Men and boys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.85 (0.56–1.29) 0.92 (0.74–1.14) 

Age (years): 

Under 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.76 (1.69–8.36) 5.39 (3.36–8.62) 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.6 (6.34–29.17) 17.30 (11.78–25.39) 

Sample adult is obese: 

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.98 (0.61–1.56) 1.16 (0.87–1.54) 

Age (years): 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.03 (0.63–1.70) 0.83 (0.64–1.08) 

Health behaviors 

Sample adult meets guidelines for aerobic activity: 

Men1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.66 (1.66–4.26) 1.07 (0.86–1.33) 

Age (years): 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.38 (1.16–4.87) 1.75 (1.39–2.20) 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

Sample adult is current smoker: 

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.82 (0.93–3.55) 1.56 (1.09–2.23) 

Age (years): 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.28 (0.64–2.56) 1.34 (0.95–1.89) 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

See footnotes at end of table. 
Series 2, No. 174  Page 15 

Table 5. Odds ratios from multiple logistic regression models of select health outcomes on sex and age among Native Hawaiian and Pacific 

Islander people, by survey—Con. 

Characteristic NHIS 2010–2104 (CI) NHPI NHIS 2014 (CI) 

Health insurance 

Persons having any public or private comprehensive 

health insurance: 

Men and boys1 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.65 (0.48–0.88) 0.89 (0.70–1.13) 

Age (years): 

Under 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.87 (1.95–4.21) 3.53 (2.48–5.01) 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.67 (1.68–4.24) 2.49 (1.81–3.42) 

Persons having private comprehensive health insurance: 

Men and boys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.02 (0.83–1.27) 1.10 (1.00–1.21) 

Age (years): 

Under 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.69 (1.35–2.13) 1.64 (1.42–1.89) 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.72 (1.24–2.40) 1.65 (1.18–2.30) 

Persons having public comprehensive health insurance: 

Men and boys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.71 (0.58–0.87) 0.85 (0.76–0.94) 

Age (years): 

Under 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.19 (2.38–4.26) 2.63 (2.25–3.08) 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.38 (1.75–3.24) 2.53 (2.00–3.20) 

Health care access and utilization 

Sample adult or sample child has a usual source of care: 

Men and boys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.62 (0.34–1.13) 0.55 (0.36–0.84) 

Age (years): 

Under 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.20 (2.32–7.61) 5.12 (3.31–7.91) 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.71 (1.22–6.02) 2.86 (2.14–3.81) 

Persons did not get needed medical care because of cost: 

Men and boys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.75 (0.44–1.27) 0.99 (0.82–1.21) 

Age (years): 

Under 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.40 (2.60–11.21) 2.37 (1.62–3.47) 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.12 (1.37–7.09) 2.86 (1.64–4.97) 

Persons delayed needed medical care because of cost: 

Men and boys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.73 (0.49–1.09) 0.84 (0.70–1.01) 

Age (years): 

Under 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.75 (1.56–4.85) 2.62 (1.76–3.89) 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.59 (0.72–3.48) 3.07 (1.79–5.27) 

Sample adult or sample child had a dental visit in past year, 

aged 1 year and over: 

Men and boys1 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.29 (0.84–1.99) 0.78 (0.62–0.98) 

Age (years): 

Under 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.28 (1.51–3.46) 3.90 (2.79–5.47) 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.76 (1.07–2.90) 1.42 (1.05–1.92) 

Sample adult or sample child did not get dental care because of cost: 

Men and boys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.73 (0.42–1.26) 0.68 (0.54–0.86) 

Age (years): 

Under 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.95 (1.53–5.68) 2.87 (1.94–4.22) 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.44 (0.59–3.55) 2.67 (1.90–3.76) 

Sample adult or sample child had flu vaccination, past year: 

Men and boys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.65 (0.43–0.97) 0.84 (0.68–1.04) 

Age (years): 

Under 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.32 (2.21–4.99) 2.37 (1.82–3.08) 

18–49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 1.00 

50 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.32 (1.94–5.68) 2.53 (2.03–3.16) 

... Category not applicable.
 1

The point estimate for the odds ratio for this predictor in both data sets’ models falls outside the CI of the corresponding odds ratio in the other data set’s model.
 

NOTE: NHPI is Native Hawaiian and Pacific Islander. NHIS is National Health Interview Survey. ACS is American Community Survey. CI is confidence interval.
 
Page 16  Series 2, No. 174 

Appendix I. Definition of selected terms
	

Diabetes and hypertension —In separate 

questions, respondents were asked if 

they had ever been told by a doctor or 

other health professional that they had 

hypertension (or high blood pressure) 

or diabetes (or sugar diabetes; female 

respondents were instructed to exclude 

pregnancy-related diabetes). 

Responses from persons who said 

they had "borderline" diabetes were 

treated as unknown with respect to 

diabetes. 

Obese—Obesity is defined as Body 

Mass Index (BMI) greater than or 

equal to 30.0. BMI is calculated from 

the sample adult’s responses to survey 

questions regarding height and weight 

and is defined as BMI = Weight (in kg)/ 

[Height (in m)]2

. Note that self-reported 

height and weight may differ from actual 

measurements. 

Smoking status—Current smokers have 

smoked at least 100 cigarettes in their 

lifetime and still currently smoke. Former 

smokers have smoked at least 100 

cigarettes in their lifetime but currently 

do not smoke at all. Nonsmokers have 

never smoked or smoked fewer than 100 

cigarettes in their lifetime. 

Leisure-time physical activity and 

muscle-strengthening activities—All 

survey questions related to leisure-time 

physical activity were phrased in terms of 

current behavior and lack a specific prior 

reference period, and reflect the federal 

“2008 Physical Activity Guidelines for 

Americans” (available from: http://www. 

health.gov/PAGuidelines/). The 2008 

federal guidelines recommend that for 

substantial health benefits, adults should 

perform at least 150 minutes (2 hours 

and 30 minutes) a week of moderateintensity or 75 minutes (1 hour and 15 

minutes) a week of vigorous-intensity 

aerobic physical activity, or an equivalent 

combination. Aerobic activity should 

be performed in episodes of at least 10 

minutes and preferably should be spread 

throughout the week. The 2008 federal 

guidelines also recommend that adults 

perform muscle-strengthening activities 

of moderate or high intensity that 

involve all major muscle groups on 2 or 

more days a week for additional health 

benefits. 

Categories with respect to the full 

guidelines are mutually exclusive. Adults 

who met neither the aerobic nor musclestrengthening 2008 federal guidelines 

may have engaged in lesser amounts 

of activity. Meeting the full musclestrengthening guidelines only means 

participating in leisure-time musclestrengthening activities 2 or more days 

per week with either no leisure-time 

aerobic activity or aerobic activity that 

did not meet the guidelines. Meeting 

the full aerobic activity guidelines only 

means participating in moderate-intensity 

leisure-time physical activities 150 

minutes or more per week or vigorousintensity activities 75 minutes or more 

per week, or an equivalent combination, 

and not meeting the muscle-strengthening 

guidelines. 

In addition, estimates presented in 

these tables are limited to leisure-time 

physical activity only. The 2008 federal 

physical activity guidelines refer to any 

kind of aerobic and muscle-strengthening 

activities, not just to leisure-time aerobic 

and muscle-strengthening activities. 

Therefore, the leisure-time aerobic and 

muscle-strengthening activity estimates 

in these tables may underestimate the 

frequencies and percentages of adults 

who met the guidelines for aerobic and 

muscle-strengthening activities. 

Influenza vaccination—Influenza 

vaccination estimates include both the 

seasonal influenza shot and seasonal 

intranasal influenza vaccination. 

Estimates are subject to recall error, 

which will vary depending on when the 

question is asked because the receipt 

of an influenza vaccination is seasonal. 

The prevalence of influenza vaccination 

during the past 12 months may differ 

from season-specific coverage (13) 

(estimates available from: http://www. 

cdc.gov/flu/fluvaxview). 

Usual place of health care—Based on 

a survey question that asked whether 

respondents had a place they usually went 

to when they were sick or needed advice 

about their health. If the response was 

“yes” or “there is more than one place,” 

they were asked, “What kind of place [is 

it/do you go to most often]—a clinic, a 

doctor’s office, an emergency room, or 

some other place?” Response choices 

for this second question are: “clinic or 

health center,” “doctor’s office or HMO,” 

“hospital emergency room,” “hospital 

outpatient department,” “some other 

place,” or “doesn’t go to one place most 

often.” Although “hospital emergency 

room” is not considered a “usual place 

of health care” in other publications 

(e.g., NCHS' Health, United States and 

the National Health Interview Survey 

Early Release reports), in these tables 

it is combined with “hospital outpatient 

clinic” and considered “a usual place of 

health care.” 
Series 2, No. 174  Page 17 

Appendix II. Technical Notes 

In NHPI NHIS, each family 

within a household at an address was 

assigned a survey outcome disposition. 

Most addresses had only one outcome 

disposition, but a small fraction of 

addresses had more than one, either 

because extra units (households) were 

identified at the address or because 

multiple families lived at the address. 

For the Frame Refinement analysis 

whose results are shown in Table 1, such 

addresses were assigned a 2014 NHPI 

NHIS disposition using the following 

rules: If any families screened in at the 

address, the household was considered 

a screen in. If no families screened in 

but at least one family screened out, the 

household was considered a screen out. 

If no families screened in and no families 

screened out, it was a non-interview. 

Screen in means that the 2014 NHPI 

NHIS determined that the household 

had at least one civilian NHPI resident 

at the time of, and was therefore eligible 

for, the 2014 NHPI NHIS. Screen out 

means that the household was not eligible 

because the household had no such 

civilian NHPI resident. No interview 

means that either the household was not 

eligible for a reason other than screen out 

(e.g., vacant or demolished), or is treated 

as if it were eligible despite the fact that 

it did not respond (e.g., refusal), or in a 

few cases was known to be eligible but 

nonresponding (e.g., some insufficient 

partial interviews). 
Vital and Health Statistics 

Series Descriptions 

Active Series 

Series 1. Programs and Collection Procedures 

Reports describe the programs and data systems of the 

National Center for Health Statistics, and the data collection 

and survey methods used. Series 1 reports also include 

definitions, survey design, estimation, and other material 

necessary for understanding and analyzing the data. 

Series 2. Data Evaluation and Methods Research 

Reports present new statistical methodology including 

experimental tests of new survey methods, studies of vital and 

health statistics collection methods, new analytical techniques, 

objective evaluations of reliability of collected data, and 

contributions to statistical theory. Reports also include 

comparison of U.S. methodology with those of other countries. 

Series 3. Analytical and Epidemiological Studies 

Reports present data analyses, epidemiological studies, and 

descriptive statistics based on national surveys and data 

systems. As of 2015, Series 3 includes reports that would 

have previously been published in Series 5, 10–15, and 20–23. 

Discontinued Series 

Series 4. 	 Documents and Committee Reports 

Reports contain findings of major committees concerned with 

vital and health statistics and documents. The last Series 4 

report was published in 2002; these are now included in 

Series 2 or another appropriate series. 

Series 5. 	 International Vital and Health Statistics Reports 

Reports present analytical and descriptive comparisons of 

U.S. vital and health statistics with those of other countries. 

The last Series 5 report was published in 2003; these are now 

included in Series 3 or another appropriate series. 

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Reports use methods of cognitive science to design, evaluate, 

and test survey instruments. The last Series 6 report was 

published in 1999; these are now included in Series 2. 

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Reports present statistics on illness; accidental injuries; 

disability; use of hospital, medical, dental, and other services; 

and other health-related topics. As of 2015, these are included 

in Series 3. 

Series 11.	 Data From the National Health Examination Survey, the 

National Health and Nutrition Examination Surveys, and 

the Hispanic Health and Nutrition Examination Survey 

Reports present 1) estimates of the medically defined 

prevalence of specific diseases in the United States and the 

distribution of the population with respect to physical, 

physiological, and psychological characteristics and 2) 

analysis of relationships among the various measurements. 

As of 2015, these are included in Series 3. 

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The last Series 12 report was published in 1974; these reports 

were included in Series 13, and as of 2015 are in Series 3. 

Series 13. 	 Data From the National Health Care Survey 

Reports present statistics on health resources and use of 

health care resources based on data collected from health 

care providers and provider records. As of 2015, these reports 

are included in Series 3. 

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The last Series 14 report was published in 1989; these reports 

were included in Series 13, and are now included in Series 3. 

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Reports contain statistics on health and health-related topics 

from surveys that are not a part of the continuing data systems 

of the National Center for Health Statistics. The last Series 15 

report was published in 2002; these reports are now included 

in Series 3. 

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Statistics 

The last Series 16 report was published in 1996. All reports 

are available online; compilations are no longer needed. 

Series 20.	 Data on Mortality 

Reports include analyses by cause of death and demographic 

variables, and geographic and trend analyses. The last Series 

20 report was published in 2007; these reports are now 

included in Series 3. 

Series 21.	 Data on Natality, Marriage, and Divorce 

Reports include analyses by health and demographic 

variables, and geographic and trend analyses. The last Series 

21 report was published in 2006; these reports are now 

included in Series 3. 

Series 22. 	 Data From the National Mortality and Natality Surveys 

The last Series 22 report was published in 1973. Reports from 

sample surveys of vital records were included in Series 20 or 

21, and are now included in Series 3. 

Series 23.	 Data From the National Survey of Family Growth 

Reports contain statistics on factors that affect birth rates, 

factors affecting the formation and dissolution of families, and 

behavior related to the risk of HIV and other sexually 

transmitted diseases. The last Series 23 report was published 

in 2011; these reports are now included in Series 3. 

Series 24. 	 Compilations of Data on Natality, Mortality, Marriage, and 

Divorce 

The last Series 24 report was published in 1996. All reports 

are available online; compilations are no longer needed. 

For answers to questions about this report or for a list of reports published 

in these series, contact: 

Information Dissemination Staff 

National Center for Health Statistics 

Centers for Disease Control and Prevention 

3311 Toledo Road, Room 4551, MS P08 

Hyattsville, MD 20782 

Tel: 1–800–CDC–INFO (1–800–232–4636) 

TTY: 1–888–232–6348 

Internet: https://www.cdc.gov/nchs 

Online request form: https://www.cdc.gov/info 

For e-mail updates on NCHS publication releases, subscribe 

online at: https://www.cdc.gov/nchs/govdelivery.htm. 

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road, Room 4551, MS P08

Hyattsville, MD 20782–2064

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DHHS Publication No. 2017–1374, Series 2, No. 174

CS278306