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**Health Measures in the New 1997 Redesigned National Health Interview Survey (NHIS)**

**Introduction**This document describes the general health    measures included in the Redesigned NHIS Basic Module starting in January 1997.    Information in the Family Core questionnaire is collected on all household members. A    household adult reports information for a randomly selected child less than 18 years of    age in the Child Core questionnaire, and a randomly selected adult reports for him/herself    in the Adult Core questionnaire.

**Limitation of Activity**    Questions in this****section are designed to retain comparability to previous NHIS    surveys for reporting of activity limitation due to physical, mental, or emotional    problems. Information on activity limitation is collected on each family member and can be    categorized to four major groups including: 1) unable to perform major activity, 2)    limited in major activity, 3) limited in other activity, and 4) not limited. Included in    this section are questions about the need for assistance with personal care needs such as    eating, bathing, dressing or getting around, or assistance handling routine needs such as    everyday household chores, doing necessary business, shopping or getting around for other    purposes. If any limitations are identified, the respondents are asked to specify the    health condition causing the limitation and indicate how long they have had the condition.    Since cognitive impairment is increasingly recognized as a source of activity limitation    among older adults, a new question has been added to determine if anyone in the family is    limited because of difficulty remembering or periods of confusion. Other new measures in    this section include determining if any family members have difficulty walking without any    special equipment and identifying children who receive Special Education or Early    Intervention Services. At the end of this section, the general health status of each    household member is reported as excellent, very good, good, fair, or poor.

Questions on limitation of activity in    the Adult Core are used to determine the number of work-loss days and bed days reported    during the 12 months prior to the interview. In addition, respondents are asked if their    health is better, worse, or the same compared with 12 months ago. There are also nine Nagi    items which attempt to measure physical functioning in a context that is not activity    specific. The questions allow persons to report the degree of difficulty they experience    doing activities such as walking 3 city blocks, standing for 2 hours, or lifting or    carrying something as heavy as 10 pounds such as a bag of groceries. Respondent are also    asked to rate the difficulty they experience in engaging in social activities and    recreation.

Questions on limitation of activity in    the Child Core are used to determine limitations in movement such as walking, running, or    playing and whether or not the causal impairment is expected to last a year or more.    Respondents are asked whether the child has a health problem that requires prescription    medicine for a duration of 3 months or longer. This question is designed to assess    chronicity of the health problem. Respondents are also asked if they had ever been told by    a school official or health care provider that the child has a learning disability.

**Injuries**    Questions in this section are designed to improve injury surveillance by asking about the    external causes and circumstances of injury. Two screening questions capture injury and    poisoning events that occurred in the 3 months prior to interview and required medical    attention. The recall period was lengthened from 2 weeks (old NHIS) to 3 months in order    to obtain larger numbers of events. Verbatim responses on how the injury happened, the    kind of injury, and the body part or parts affected are recorded by the interviewers and    are then coded to ICD 9-CM e-codes during data processing. Additional information related    to activity and place of occurrence of the injury is being collected to be used in new    external cause-of-injury groupings for reporting injury morbidity data.

**Health Insurance**    The purpose of this section is to classify all household members by type of health care    coverage. Information is provided by an adult knowledgeable about the family's health    insurance, when available; else, information is collected from the family respondent.    Questions are asked about who in the family is covered and the kind of coverage (private,    Medicare, Medicaid, Military/Champus/Tricare, Indian Health Service, State-sponsored or    government plan) he/she receives. When indicated, respondents are asked to provide the    full names of the plans which are recorded verbatim by the interviewers. Plan names are    coded into known types such as fee-for-service, HMO, PPO, POS, etc., during data    processing by means of an updated list of U.S. health plans maintained by NCHS. Other    information collected from respondents includes the source of coverage, i.e., the    workplace or direct purchase, and the annual amount spent for health insurance premiums    including payroll deductions. Information is also collected on noncovered household    members on the length of time without coverage as well as the reasons that coverage    stopped. The last question in the health insurance section asks respondents to estimate    the annual household expenditure for medical care, including dental care.

**Access to health care**    Many of the questions in this section are derived from the 1993-1995 NHIS Access to Care    supplements. Items in the family core assess the extent of access problems resulting from    cost considerations. Questions on access in the Adult and Child cores are designed to    identify persons who have a usual source of care and to determine the nature of that    source. Respondents are also asked if this usual source is also the place where preventive    care is received, or if it is received elsewhere. These questions are typical of usual    source questions used in many access surveys. Persons are asked if they have recently    changed their usual source(s) of care. In the past, respondents were asked to indicate a    variety of reasons for such changes. In this survey, respondents are asked directly about    reasons related to health insurance only. The last two questions identify persons who have    delayed care for reasons other than costs (couldn't get through on the phone, couldn't get    an appointment, etc.) and/or who have not gotten specific types of care that they needed    (prescription medicines, mental health, or dental care).

**Health Care Utilization**    The Family Core contains questions on hospitalizations that are used to monitor trends and    differentials in inpatient stays and length of stay by sociodemographic, health status,    and health insurance variables. Information on past 12 month hospitalizations including    the total number of days hospitalized is collected for all family members. A question    identifies hospitalization for childbirth that will allow analysts to exclude deliveries    from estimates of hospital stays. The Family Core also contains questions on health care    received in the 2 weeks prior to the interview. Respondents are asked whether they have    received care of any kind from medical doctors or any other health professionals such as    nurses, physical therapists, and chiropractors. Health care contacts are categorized by    home visits, phone contacts, and office/clinic or ER visits. 

Items in the Adult and Child core    include questions on the length of time since last contact with 1) a dentist or 2) a    doctor or other health care professional. Individuals report whether they have seen or    talked to specific types or categories of health care providers during the 12 months prior    to the interview. Categories of providers include mental health professionals, eye    doctors, foot doctors, chiropractors, allied health professional such as physical    therapist and speech therapists, and physician assistants or nurse practitioners.    Respondents are also asked about the type of medical doctor seen during encounters in the    12 months prior to the interview. The purpose of these questions is to track the    proportion of visits to generalists and to specialists. Additional information is    collected on the number of health care provider visits in each of the following places in    the 12 months prior to interview: hospital emergency room, home, and other places    including physician offices. Information on the number of inpatient or outpatient    surgeries during the 12 months prior to interview is also collected.

**Conditions**    The section on health conditions was designed with the goals of substantially reducing the    length of the NHIS survey and eliminating the analytic complexity of the data while    preserving the ability to produce national estimates of disease prevalence. Questions that    use to cover 133 conditions in six condition lists have been reduced to a single list    consisting of several domains which are in the Adult and Child cores. The domains for    adults are organized by organ system or health topic and include the following:    cardiovascular disease, respiratory conditions, cancer, diabetes, gastrointestinal    conditions, renal conditions, joint symptoms, oral health, sensory impairments, pain, and    mental health. The mental health section consists of a brief symptom screening battery    using a Likert scale with a 30 day reference period. General distress symptoms are known    predictors of service utilization. There is also one question on the impact of these    symptoms on a person’s activities to assess the severity of distress. Pain questions    in the NHIS are designed to assess pain a person experienced in the 3 months prior to the    interview. Respondents are asked about pain that lasted a whole day or more. Sample adults    are asked about neck pain, back pain, facial ache, or pain and headaches/migraines.

Information on conditions are    self-reported in the Adult Core and proxy reported in the Child Core. Questions on health    conditions for children include those that are associated with disabilities such as    cerebral palsy, mental retardation, Downs syndrome, among others; and those associated    with learning disabilities such as Attention Deficit Disorder. Information is also    collected on important childhood illnesses or impairments including, but not limited to,    asthma, allergic conditions, ear infections, headaches/migraines, seizure disorders,    hearing and visual impairments and stuttering. The redesigned NHIS also includes a brief    child behavior scale, or mental health indicator. These questions are derived from the    Child Behavior Check List. Items selected for inclusion were those that best discriminated    between children referred for mental health care and those who were not. Specific sets of    questions were developed for boys and girls by age groups.

**Behaviors**    Questions on health behaviors include tobacco use, physical activity, and alcohol use.    They are in the Adult Core questionnaire.

**Tobacco**:    The NHIS has long been an important part of national tobacco use surveillance. Questions    have been designed to monitor self-reported cigarette smoking behavior. Respondents are    asked if they ever smoked 100 cigarettes, and if so, the age at which they started    smoking. Information on smoking behavior is collected to categorize respondents as former,    current, or never smokers**.**Former smokers are asked to provide the length of time    since quitting. Current smokers are asked about the average number of cigarettes smoked    per day, and the number of days they smoked in the past month, and quit attempts.

**Physical activity**:    A program of regular physical activity is known to prevent a number of chronic health    conditions and enhance good health. Persons are asked about physical activities (exercise,    sports, or physically active hobbies) that are done during leisure time. Respondents are    asked about 2 levels of activity: 1) how often they do VIGOROUS activities lasting at    least 10 minutes that cause heavy sweating or large increases in breathing or heart rate,    2) how often they do LIGHT or MODERATE activities that cause light sweating or slight to    moderate increase in breathing or heart rate. Information on the duration of the activity    is ascertained for each of these levels. In addition, respondents are asked how often they    do physical activities designed to STRENGTHEN muscles such as lifting weights or doing    calisthenics. 

**Alcohol:**    Questions are similar to previous NHIS items on self-reported alcohol use. Respondents are    asked whether they have had at least 12 drinks in ANY ONE YEAR or in their ENTIRE LIFE.    Persons reporting alcohol use are asked about consumption in the past year. Respondents    are asked how often they drink, how much they drank on the days that they drank, and how    many days in the past year they had 5 or more drinks.

**Immunizations**    Both the Adult and Child Core questionnaires contain questions on immunizations. The Adult    questionnaire includes questions on receipt of a flu shot during the past 12 months and    ever having a pneumonia vaccine. These items are used to track progress toward a national    health objective for the year 2000, which is to increase pneumococcal and influenza    vaccination levels to greater than or equal to 60 percent for persons at high risk for    complications from these diseases, including older persons. 

Questions in the Child Core are    identical to those in previous NHIS Immunization Surveys, with the addition of new    questions on chicken pox vaccination and adolescent immunizations. The NHIS has been an    important part of the Childhood Immunization Initiative and is critical for monitoring    vaccination coverage of 2 year old children. Information is collected from a knowledgeable    adult about doses of DTP, Polio, MCV, Hib, Hep B, and Varicella given to sample children    under 7 years of age as well as all 12-35 month old children in the household. This    information is collected from a shot record, if available, or by history. Information on    children 7-17 years old is obtained for the following antigens: MCV, Hep B, Varicella and    Td (tetanus diphtheria booster). An ongoing National Immunization Provider Record Check    Study is done in conjunction with the NHIS to adjust the estimates of vaccination coverage    for children 12-35 months of age.

**AIDS**    The NHIS has included questions on AIDS since 1987, with a primary focus on AIDS knowledge    and attitudes from 1988 through 1995. As AIDS prevention programs have emphasized early    detection and treatment of HIV infection, the 1997 NHIS questions are designed to monitor    voluntary HIV counseling and testing. Respondents are asked about their blood donation    history and about any tests they may have had for HIV infection exclusive of blood    donation. Persons who have been tested for HIV are asked about the location of the test,    the reason they were tested, whether or not they received the results of their tests, how    the test results were received (by mail, telephone, or in person), and if they received    counseling at the time they received their results. Respondents who indicate that they    have not been tested are asked about any intentions to get tested in the next year, where    they are likely to be tested, and the likely reason they would have the test. Two    questions ask about self-perceived risk of infection, and whether or not any of a list of    risk items applies to the respondent (including being a hemophiliac, having used IV drugs,    and being a homosexual male).

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This page last reviewed July 25, 2000

**U.S.    DEPARTMENT OF HEALTH AND HUMAN SERVICES****Centers    for Disease Control and Prevention**    National Center for Health Statistics    Division of Data Services     Hyattsville, MD    20782-2003    (301) 458-4636 |
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