., 

.	 Vital and 

,.HealthStatistics 

Inventory of


Pain Data From


the National Center


for Health Statistics


Series 1: 

Programs and Collection Procedures 

No, 26 

In this report, National Center for Health Statistics data sets that contain 

information on pain and pain-related condi~ons are identified and a detailed 

summary of these data elements is provided, 

,.. 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES


Public Health Service


Centers for Disease Control


National Center for Health Statistics


Hyattsville, Maryfand


June 1992


DHHS Publictilon No, [PHS) 92-1308


~”

Copyright Information 

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

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

appreciated. 

Suggested Citation 

Turczyn, Kathleen M, An inventory of pain data from the National Center for 

Heaith Statistics, Kathleen M. Turczyn and Thomas F, Drury. 

Library of Congress Cataloging-in-Publication Data 

The 1989 revision of the U.S. standard certificates and reports. 

p,cm. – (Vital and health statistics. Series 1, Programs and collection 

procedures ; no. 26) (DHHS publication ; no. (PHS) 92-1 308) 

Includes bibliographical references. 

Supt. of Dots. no.: HE 20.6209:1/26 

ISBN 0-8406-0439-4 

1. Pain – United States– Statistics. 2, Intractable pain – United 

States– Statistics, 3, National Center for Health Statistics (U.S.) 1.Drury, 

Thomas F, Il. National Center for Health Statistics (U.S.) Ill, Title, IV. Seties, V, 

Series: DHHS publication ; No. (PHS) 92-1308. 

[DNLM: 1. Pain – epidemiology–United States, W2 A N148.a no. 26] 

RA409.U44 no, 26 

[RB127] 

362.1 ‘0723 S –dc20 

[362.1 ‘960472’0973021 ] 

DNLM/DLC 

for Library of Congress 91-13401 

,CIP 
, 

National Center for Health Statistics 

Manning Feinleib, M. D., Dr.P.H., Director 

Jacob J. Feldman, Ph. D., Associare Director for Analysis 

and Epidemiology 

Gail F. Fisher, Ph.D., Associate Direc[orfor Planning and 

Extramural Programs 

Peter L. Hurley, Associate Director for VW and Health 

Statistics Systems 

Robert A. Israel, Associate Director for International 

Statistics 

Stephen E. Nieberding, Associate Director for 

Management 

Charles J. Rothwell, Associate Director for Data 

Processing and Services 

Monroe G. Sirken, Ph. D., Associate Director for Research 

and Methodology 

David L. Larson, Assistant Direcfor, Atlanta 

Division of Epidemiology and Health Promotion 

Ronald W. Wilson, Director 

Patricia M. Golden, Special Assistant 

Diane K. Wagener, Ph. D., Chief Environmental Studies 

Branch 

Ronald W. Wilson, Acting Chiej Health Status 

Measurement Branch 
Acknowledgments


. 

The initial impetus for this inventory came from Drs. 

Ng and Bonica, editors of Pain, f)i-sconz~ortand Hzmzmzitariarz Care (l), in which the need for a systematic examination of publicly available nationaI data resources for 

comprehensive, population-based studies of pain is highlighted. The consultation of Dr. Harold Merskey was also 

most helpful in the early “stages of the project with regard 

to definitional approaches to pain and the classification of 

pain syndromes. Further impetus for the project came 

from participation in a number of meetings of the U.S. 

Department of Health and Human Services Commission 

on the Evaluation of Pain; the Institute of Medicine’s 

Committee on Pain, Disability, and Chronic Illness 

Behavioq the National Institutes of Health Consensus 

Development Conference on The Integrated Approach to 

the Management of Pain; and the Social Science Research 

Council’s Workshop on Cognition and Measurement of 

Pain. The annual meetings of the American Pain Society 

have also provided an important context for formal and 

informal discussions of the need for and uses of general 

population data on a broad spectrum of pain problems. 

Within the National Center for Health Statistics (NCHS), 

special acknowledgment needs to be given to Dr. Charlotte Schoenbom, whose earlier Inventory of Alcohol, 

Drug Use, and Mental Health Data Available through 

NCHS Data Systems has provided a template for the 

present effort. Finally, to all the contact persons who are 

listed throughout this publication as resource persons for 

specific NCHS data systems, our lasting gratitude. 

,..

Ill 
Acknowledgments,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .’. . . . . . . . . . . . . . . 

Evaluating NCHS pain data.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

NCHS data systems with pain data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Substantive perspectives underlying the inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Sources of information on NCHS data systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 

Summary of the inventory’s content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Organization of the inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Using the inventory to identify multiple avenues ofanalysis: Thecase ofback pain andreIated back disorders.. 

Secondary analysis for population-based studies of pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 

Current and future efforts ..,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

General Population Surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Health Examination Survey, Cycle I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Health Examination Survey, Cycle II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Health Examination Survey, Cycle III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

First National Health and Nutrition Examination Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Second National Health and Nutrition Examination Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Hispanic Health and Nutrition Examination Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Third National Health and Nutrition Examination Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

NHANESI Epidemiologic FolIowup Study . . . . . . . . . . . . . . . . . . ...’... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

\	 National Health Interview Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Medical Care Utilization and Expenditure Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Sumeyof Personal Health Practices and Consequences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Surveyof Family Growth Cycles III and IVand Followup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Health care surveys.........,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Hospital Discharge Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

NationaI Nursing Home Sumey . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 

Next-of-Kin Component ofthe 1985 NNHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Master Facility Inventory and1986 Inventory ofLong-Term Care Places . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Vital statistics surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 

National Natality Survey and National Fetal Mortality Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

National Mortality Followback Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

1988 National Maternal and Infant Health Survey and 1990 Longitudinal Followup . . . . . . . . . . . . . . . . . . . . . . . . . 

Vital statistics registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Mortality Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Divorce Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Appendixes 

1. Projected pain-related items in future NCHS surveys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,. 

II. 1989 National Health Interview Suwey Current Health Topics section R: Orofacial pain . . . . . . . . . . . . . . . . . . . 

... 111 

1 

1“ 

2 

2 

4 

4 

5 

6 

9 

9 

10 

10 

10 

11 

12 

15 

18 

20 

22 

25 

35 

35 

36 

38 

38 

39 

40 

41 

42 

44 

44 

44 

45 

47 

47 

49 

51 

57 

58 

,$’ v J 
--

HI. 1989National Health Interview Survey Current Health Topics section S2: Abdominal pain. . . . . . . . . . . . . . . . . 60 

IV. Classification variables foranalysis of pain data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 

V. Summary ofselected pain measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 

VI. International Classification of Diseases description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 

Text figure 

1.	 Data systems with pain and pain-related data components within the organizational structure of the National 

Center for Health Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 

Symbols 

Data not available 

. . . Category not applicable 

— Quantity zero 

0,0	 Quantity more than zero but less 

than O.05 

* Figure does not meet standard of 

reliability or precision 

vi 
Inventory of Pain Data 

From National Center 

for Health Statistics 

by Kathleen M. Turczyn, M. P.H., and 

Thomas F. Drury, Ph.D. 

Introduction 

In the past 15 years, the Public Health Service and the 

Department of Health and Human Services have increasingly recognized chronic” pain as a major public health 

problem with enormous impact on the health care system 

(l-7). The pain literature has continuously cited the need 

for more complete and comprehensive epidemiologic data 

on pain (8–9), has explored the feasibility of pooling and 

sharing data from pain clinics and other treatment facilities for this purpose (10-11), and has called repeatedly for 

more adequate measurement attention to pain phenomena in general population surveys (1,2,4,6). Although 

many information gaps will be filled only by the collection 

.	 and analysis of new data, a number of questions are 

potentially, and at least partially, answerable through 

secondary analysis of available data. A major barrier, 

however, to such secondary analysis has been a basic lack 

of knowledge about the kinds of pain-related data that 

exist nationally. In response to this need, this inventory 

provides an exhaustive listing of information obtained 

through National Center for HeaIth Statistics (NCHS) 

data systems related to population-based studies of pain \ problems and identifies the sources for gaining access to 

this information. 

This introduction serves the following purposes: 

To position this inventory within the context of a com­


prehensive evaluation of NCHS pain data.


To acquaint the user of this inventory with the broad


spectrum of NCHS data systems that include pertinent


information about pain.


To outline the substantive perspectives used as sifting


criteria in the review of NCHS data systems.


To identify the major sources of information used in


identi&ing relevant content.


To describe key characteristics of the types of infor­


mation included in the inventory and provide a descrip­


tion of the analytical summary of its major content


areas.


To explain how the inventory is organized.


To exemplify how the invento~ might be used to iden­


tify multiple avenues of analysis in the comprehensive


study of selected pain problems.


.	 To clarify selected features of the problems and prospects of secondmy analysis for population-based 

studies of pain. 

.	 To sketch the relationship of this report to others that 

will appear in the near future either as NCHS reports 

or as contributions to the journal literature on pain. 

In accordance with these objectives, the remainder of 

this introduction is organized into nine main sections. 

Evaluating NCHS pain data 

In response to the need for more and better information on pain, several years ago the staff of the NCHS 

Health Status Measurement Branch of the Division of 

Epidemiology and Health Promotion, Office of Analysis 

and EpidemioIogy, began to evaluate the efforts that had 

been made in NCHS data systems to measure pain and 

pain-related phenomena. As initially conceived, the evaluation would deal with five basic aspects of the NCHS 

statistical programs (12): 

An evacuation of the efforts made to measure pain


phenomena in the form of an inventory of pain data


available from NCHS.


An evaluation of the effectiveness of these efforts in


terms of the reliabili~ and validity of the resulting


measures (13-16) and in terms of the epidemiologic


usefulness of the information obtained (17).


An evaluation of the efficiency of the pain measure­


ment process in terms of total survey design consider­


ations (18).


An evaluation of the adequaey of NCHS pain data in


terms of the information actually needed at the national


level for societal enlightenment, program intelligence, ‘


and operational feedback (19).


An evaluation of the process and procedural aspects of


the survey measurement process–from identification


and conceptualization of pain phenomena, through the


political-economic aspects of obtaining funding and


organizational support for pain components on


1

� 

� 

� 

� 

surveys, to the development and implementation of 

sampling, data collection, data analysis, and data 

dissemination procedures (20). 

The initial idea was to perform the entire evaluation 

plan under one or more contracts. Because of funding 

constraints, however, the overall plan had to be divided 

into priority projects that might be pursued by in-house 

staff and into projects that would be more appropriately 

performed by contractors with national and international 

expertise in pain. According to this revised plan, in-house 

staff would evaluate the effort. Priority would also be 

given to having outside experts evaluate the adequacy of 

existing information for meeting national data needs in 

the pain area. Funds permitting, evaluation of adequacy 

would be followed by a series of analytical projects carried 

out by outside experts, possibly in collaboration with 

in-house staff, under a series of professional services 

contracts. Major aspects of this more limited plan were 

actually implemented. 

This report is the first publication in the NCHS L’ltal 

and Health Statistics series from this evaluation project, 

and it represents the efforts by in-house staff to evaluate 

the efforts made so far in NCHS data systems to measure 

and assess pain phenomena. The relationships of this 

report to others that are in press or in preparation at the 

time of this writing are highlighted in the concluding 

remarks to this introductory overview. 

NCHS data systems with pain data 

Although the mission of NCHS includes collection, 

analysis, and dissemination of data on the Nation’s health, 

it does not currently have any explicit charge to collect 

data on any specific pain syndrome or even on pain 

problems more generally. The enabling legislation for 

NCHS activities specifically states that it shall collect data 

on the following: 

The extent and nature of illness and disability of the


population of the United States and its subgroups.


The impact of illness and disability of the population on


the economy and on the well-being of the population,


Environmental, social, and other health hazards.


Determinants of health.


Health resources, including health professionals by


specialty and types of practice, the supply of services by


hospitals, extended care facilities, home health agen­


cies, and other institutions.


Utilization of health care, including ambulatory health


services, hospitals, extended care facilities, home


health agencies, and other institutions.


Health care costs and financing.


Family formation, growth, and dissolution.


National vital statistics –births, deaths, marriages, and


divorces.


Nonetheless, the data collection mechanisms of 

NCHS that implement this broad mandate –general 

population surveys, health care surveys, special purpose 

surveys, and vital statistics – have obtained extensive, and 

in some instances intensive, information that may be used 

to clarify important aspects of the magnitude, scope, and 

impact of selected pain problems in the United States. 

The organizational chart shown in the figure identifies 

particular data systems relevant to pain and pain-related 

factors, and locates these data systems within NCHS 

programs primarily responsible for them. As is evident 

from the chart, primary data collection and analysis 

responsibilities for current NCHS data systems are located 

in the Office of Vital and Health Statistics Systems and 

the Office of Analysis and Epidemiology, Detailed . 

descriptions of these data systems have been published 

(21). 

Other NCHS programs, however, play major roles in 

the development, operation, and analysis of these data 

collection systems. The Office of Research and Methodology provides statistical consultation and technical assistance to all NCHS data systems, and formulates statistical 

standards regarding survey design, data collection, coding, 

data analysis, data presentation, and statistical computing. 

The Office of Planning and Extramural Programs 

serves as the focal point for coordination of health statistical activities within NCHS and for developing and coordinating the collaborative statistical activities of NCHS ‘“ 

with other organizations and agencies, both national and 

international. The Office of Planning and Extramural 

Programs also collects, assesses, maintains, and disseminates current information on State and national health 

statistics systems, both public and private. 

The Office of Data Processing and Services (ODPS) is , 

the statistical operations component of NCHS. ODPS is t 

responsible for the collection of data for the National 

Health and Nutrition Examination Survey and NCHS 

surveys conducted by mail; data preparation, data entry, 

and automated data processing for all NCHS surveys; the 

editing, composition, and printing of NCHS publications; 

and the marketing, dissemination, and information services for NCHS statistical products. ODPS also provides 

training and technical assistance to NCHS staff. 

Substantive perspectives 

underlying the inventory 

A major purpose of the inventory is to provide a 

comprehensive listing of available data that might be 

useful in comprehensive, population-based studies of a 

broad variety of pain problems. To achieve this overall 

objective, it was necessary to develop a set of criteria that 

could be utilized in sifting through the various information 

sources for each of the NCHS data systems. Given the 

range of phenomena dealt with, as well as the complexity 

of the data systems being reviewed, a precise set of sifting 

2 
------ .- -— 

I ~ce of Office of the 

Management Director 

I 

Cflice of Cffice of 

Data Processing Research 

and Services Methodology 

I

I I I

I I Zi!!!il

Division ‘bJA&c&l Survey ~eg~l 

of Data ch3s3s#l 

Processing services staff 

m I 

Division of Diiision of Division of DivviQfiof 

vi H~;eas;cre HeaJ~r@ckw 

statistics Exa%mJ:;isM 

NautiwiolNafality National National Healtfr Vational Health 

Ambulatory Interview Examination 

National Survey 

of Family Growth 

Medical Care 

Survey 

suNey 

National Medical 

survey 

Cycles 1, 11,and Ill 

Mortality 

statistics 

Divorce 

statistics 

National Hospital 

Discharge Survey 

National Nurskrg 

Home Survey 

Care Utilization 

and Expenditure 

suNey 

Vational Health 

and Nutriion 

Examination 

Survey 1, 11,and 111 

National Maternal National Master +Ispanic Health 

and Infant Health Facilii Inventory and NuWon 

Survey and 1990 and 1986 Examination 

Longitudinal Inventory of suNey 

Followup Long-Term Care 

Suwey Places ‘ 

National Mortality 

Followback 

Survey 

Statistical Division of 

Tec&hno$gy Analysis 

National Heatth and 

Nutrition Examination 

Epidemiologic FOIIOWUP 

suNey 

Next-of-kin Component 

of 1985 National 

Nursing Home Survey 

Cffice of Planning 

and Extramural 

Programs 

I 

I 

Divisionof 

Epidemiologyand 

Health Promotion 

National Survey of 

Personal Health 

Practices end 

Consequences 

I I I I 

) I I I I II 

WWHE 

Figure. Data systems with pain and pain-related data components within the organizational structure of the National Center for Health Statistics 

w 
criteria were never developed. However, two broad sets of 

criteria were developed and applied to each data system to 

determine, first, whether it should be included at all, and, 

second, the measurement content for inclusion. The first 

set of criteria took the form of a paradigm or a systematic 

set of questions for population-based studies of pain. The 

second set of criteria took the form of a set of guiding 

images about pain. 

Paradigm for population-based studies of 

pain 

Data systems were considered pertinent to populationbased studies of pain (as identified below) if they had a 

bearing on any of the following: 

�	 The identification and classification of various pain 

syndromes and pain states, including issues surrounding the development and validation of diagnostic 

criteria. 

�	 The magnitude of various pain problems in the United 

States, including estimates of the size of the population 

at risk for various pain problems, treated and untreated 

prevalence of the problem, magnitude among noninstitutionalized and institutionalized populations, incidence of the problem, and severity of the problem. 

�	 The scope of the problem – that is, its relative frequency across sociodemographic groups. 

�	 The structure of the problem in terms of types of pain 

patients and interrelationships with various conditions 

and other pain problems, including the identification of 

new pain syndromes. 

� The natural history and clinical course of the problem 

�	 The determinants of the problem, including the etioIogical processes and risk factors associated with various pain problems. 

�	 The consequences of various pain problems for individuals, families, employers, and society at large in 

tetms of morbidity, disability, use of health services, 

health care expenditures, psychological well-being, 

social and economic impact, and premature mortality. 

�	 Treatments, medical and medicolegal processes, and 

the operation of the health care system with respect to 

specific pain problems, provider-patient relationships, 

quality of care, effectiveness, and costs of health care 

services. 

� Availability of health care resources for dealing with 

various pain problems. 

� Historical trends and projections related to any of the 

above aspects of various pain problems. 

�	 Conceptual, research design, measurement, data analytic, statistical, computational, and interpretive issues 

related to any of the above types of substantive issues. 

The preceding topics focus on issues addressed by 

community-based epidemiology with respect to the frequency, distribution, and determinants of pain problems 

in well-defined populations (22), as well as on issues 

addressed within the field of clinical epidemiology with 

respect to diagnosis, treatment, and treatment outcomes 1,


(23). Some of the preceding topics go well beyond the


fields of community and clinical epidemiology and address


a range of issues considered central to the field of health


services research (24).


Guiding images of pain 

The second set of criteria used in sifting NCHS data 

systems for the measurement content of this inventory 

derive from recent efforts to define pain and classify pain 

syndromes, as well as from the lively discussions that have 

accompanied such efforts (9). The International Association for the Study of Pain (IASP) has defined pain as “an 

unpleasant sensory and emotional experience associated 

with actual or potential tissue damage, or described in terms 

of such damage” and has developed a taxonomy of pain 

syndromes (25). As has been discussed elsewhere (20), central to the IASP definition is an image of pain as a unitary 

subjective experience, which leads to an emphasis on selfreports as a source of information (26). Because much of the 

pain data avaiIable from NCHS come from surveys utilizing 

interviews with respondents or household informants, the 

IASP framework has been very useful in crafting this inventory. At the same time, however, pain experts with a behavioral focus prefer to image pain as a set of events, which 

leads to an emphasis upon pain behaviors as an information \ 

source (27-29). Within this behavioral framework, a self- r 

report about pain or talking about pain is one of a range of 

pain behaviors. Loeser’s distinctions among nociception, I 

pain, pain behavior, and suffering (30) have also been influ- 1 

ential in clari~ing and providing a conceptual foundation I 

for partial integration of current definitional controversies. 

These images of pain have very different implications 

for survey case definitions and provide different rationales 

for obtaining, summarizing, and interpreting self-report I and observational data (20). The question of what to 

include in this report was also influenced by general, even 

if somewhat more specific, discussions of acute pain, 

recurrent or episodic pain, chronic pain, and cancer pain. 

Acute pain has traditionally been defined as pain of 

relatively short duration that is usually evoked by a welldefined noxious stimulus. It often has a rapid onset and 

diminishes progressively as healing occurs. Acute pain I 

produced by tissue damage is the most common type of 

pain. It has an adaptive biological significance, as it often 

provides a warning signal to enable an organism to avoid 

harm and prolong survival. It is usually not associated with 

prolonged emotional distress, because the pain is explicable and may be controlled effectively (31). Recurrent 

pain can be thought of as a subset of chronic pain (see 

below) or as a pain state in its own right. Sternbach (32) 

has argued that pain can be thought of as a series of states 

that vary along a temporal dimension and represent a 

continuous interaction of biological, psychological, and h 

social components. He defines recurrent pain as a current 

pain problem in which the episode has persisted for less 

than a month but which has occurred in three episodes or 

more over the patient’s lifetime. 

4 
Chronic pain is defined by Bonica (9) as pain that 

“persists a month beyond the usual course of an acute 

disease or reasonable time for an injury to heal, or pain 

that recurs at intervals for months or years.” This definition is similar to that adopted by the IASP Subcommittee 

on Taxonomy, which has stated that chronic pain is “that 

pain which persists past the normal time of healing” (25). 

Although the length of time that elapses after which acute 

pain is regarded as chronic pain is variable, depending on 

the nature of the original injury, chronic pain is often 

defined as pain that persists for 3-6 months (31). The 

IASP Subcommittee (25) adopted “three months as the 

most convenient point of division between acute and 

chronic pain.” In this context it is interesting to note that, 

except for conditions that are always considered chronic 

regardless of the time of onset, a 3-month time period has 

also conventionally been used by NCHS (particularly in 

the National Health Interview Survey (NHIS)) for distinguishing chronic from acute conditions. 

Chronic pain may be distinguished from acute pain on 

the basis of several features in addition to temporal 

duration (31). In the case of chronic pain, the source of 

noxious stimulation is usually poorly defined. The pain 

generally has no biological significance as a warning 

signal. There is usually prolonged physical and psycholog­

/J ical distress, as evidenced by fatigue, sleeplessness, 10SSof 

motion, restricted physical abilities, additional somatic 

complaints, irritabilily, fear, anger, anxiety, depression, 

and a preoccupation with somatic concerns. Situational 

factors often include a lack of control over the pain, an 

increasing reliance on medication as the only possible 

source of relief, inaccurate expectations about the diagnosis and prognosis, and concerns about the lifethreatening potential of the source of the pain. The pain 

may also be refractory to treatment. 

A broad spectrum of pain problems –acute and 

{ chronic–come together in cancer pain. Some acute and 

chronic cancer pains are related to tumors and tumor 

progression; others, to cancer treatments; and still others 

(what some would prefer to label as “suffering”), to the 

psychological stress of living with a potentially fatal disease. Because of the unique constellation of emotional, 

physiological, and behavioral consequences of the diagnosis and treatment of cancer (31, 33, 34), cancer pain is 

generally regarded as a special category of pain. 

I Although it has recently been suggested that viewing 

cancer pain as a special case may have the unintended 

i consequence of narrowing the range of treatment options 

considered in the management of cancer pain (35), from 

the standpoint of population-based studies of cancer pain, 

it is perhaps crucial to recognize its special nature. Cancer 

is not one disease but many, and persons with specific 

types of cancer are not identified in most national surveys 

of the general population. (The sample sizes are too small 

to develop reliable estimates for specific cancer sites, and 

for years asking about cancer was considered too sensitive 

a ,topic to include in a survey.) Thus, it is important to 

think about cancer pain epidemiologically as a special case 

in need of special study. 

Despite the dearth of national information about 

cancer pain, Bonica (36) has shown how the limited 

information on mortality from cancers can be used to 

develop estimates of the magriitude of the problem of 

cancer pain by integrating estimates of severe pain in, 

different stages of cancer for various types of cancer 

obtained from clinical studies and clinical series with 

estimates of the size of the population at risk for such pain 

obtained from mortality data. Bonica’s pioneering work in 

this area needs to be continued, possibly by extending 

existing data collection systems based on cancer registries. 

Sources of information on NCHS 

data systems 

In constructing the inventory, four principal sources 

were used: Questionnaires, data tape formats, methodological reports, and consultations with NCHS staff 

responsible for the collection and analysis of data. First, 

questionnaires were systematically reviewed for pain data 

content. The data tape formats were then examined for 

specific coding and editing algorithms. Methodological 

reports were reviewed for background information about 

the surveys and vital statistics systems. Program staff were 

consulted to clarify questions related to content, methods, 

coverage, and data availability, 

Summary of the inventory’s 

content 

The invento~ covers the approximately 20-year 

period for which NCHS public use data tapes are generally available (37,38). Because a major purpose of the 

inventory is to stimulate the use of NCHS pain data for 

secondary analysis, it focuses on data available through 

the public use data tape distribution program. Pain data 

elements are identified only for data years in which public 

use tapes are or will be available. Surveys with pain or 

pain-related eIements that were in the planning or early 

design stages at the time this manuscript went to press are 

listed in a~pendix I. NCHS. data systems that do not 

address pain at some level have not been described here. 

Most data systems within NCHS, however, contain at least 

some pain components. In the case of the 1989 NHIS, all 

of the orofacial and abdominal pain components of the 

Current Health Topics Supplement are included in their 

original form in appendixes II and 111.In other cases, such 

as the arthritis components of the first and second 

National Health and Nutrition Examination Surveys 

(NHANES I and 11) and the NHANES I Epidemiologic 

Followup ‘Sttidy, extensive detailed questions are documented. In yet”other cases, only a few relevant items in the 

survey or da~a system can be documented. ‘ ; ‘‘ 

“$. ,.., 

,,.

., 

5. 

. 
Pain data elements have been broadly delimited for 

this inventory. However, whenever possible, attention is 

focused on specific pain syndromes. Specific acute pain 

problems covered in this inventory include (but are not 

restricted to) acute headache, toothache, pain of acute 

myocardial infarction, labor pain, postoperative pain, 

severe posttraumatic pain, and burn pain, Specific chronic 

pain problems covered include headache, orofacial pain, 

chest or heart pain, abdominal pain, back pain, and 

arthritic (joint) pain, Items related to conditions or circumstances that may have an impact upon, or be a 

consequence of, a person’s painful condition, such as drug 

use, life event stress, and sleep disturbance, have also 

been included. 

An effort was also made to identify sociodemographic 

and other classification variables available in each of the 

surveys (appendix IV). An attempt was made to place the 

pain data components in context by providing general 

descriptions of the types of nonpain data available in each 

of the surveys and vital statistics systems. The brief 

descriptions of data elements contained in this inventory 

are primarily designed, however, to sketch possibilities for 

data analysis. 

Appendix V provides an overall summary of available 

pain measures in NCHS data systems. The summary 

includes only major categories of variables and is neither 

definitive nor comprehensive. In some surveys, questions 

about a specific pain syndrome were asked differently in 

different years, covering a varying amount of epidemiologic information. A detailed cross-classification of individual questions is beyond the scope of this document 

because of the extent of variation in question wording and 

intent among the surveys. Such a classification is available, 

however, for NHANES and the National Health Examination Survey (NHES) (39). 

Organization of the inventory 

The inventory is arranged according to survey or vital 

statistics system. General population surveys are described 

first, followed by data systems dedicated to the production 

of health care statistics, Vital statistics surveys are inventoried next, with the description of pertinent vital statistics 

data systems rounding out the review. 

With the exception of the health examination surveys, 

each survey or system is described once, regardless of the 

number of years for which data are available. NHES 

Cycles I, II and 111; NHANES I, H and HI; NHANES I 

Epidemiologic Followup Study; and the Hispanic Health 

and Nutrition Examination Survey are described separately because of the extensive pain data contained in 

each. 

Descriptions of the surveys or data systems have six 

components, designed to provide a brief overview of the 

data system and detailed information concerning pain 

data. The format is as follows: 

�	 Name of program or data system –The name of the 

survey or vital statistics system is provided, along with 

its acronym. 

�	 Survey design –The target population and geographic ,. 

boundaries of the survey or vital statistics system are 

identified and the sampling procedures are briefly 

described. The data collection method and the time 

period during which the data were collected are 

specified. 

�	 Basic data elements – A brief overview is given of the 

types of nonpain data available from the data system. 

More complete summaries are available elsewhere. 

�	 Pain data elements –Pain and pain-related data elements are identified and listed in detail. For the most 

part, they are sequenced in the order in which they ‘, 

appear in the questionnaires. Although they are sum- , 

marized whenever possible, questionnaire items are 

documented in their entirety when summarization 

would make interpretation difficult. In two cases, the 

magnitude and complexity of the pain elements are 

such that appropriate sections of the questionnaires 

themselves are provided as appendixes. The data frequencies for pain variables have not been examined, 

and in some instances the number of cases maybe quite 

small. 

�	 Data tape availabdi~ –A listing of available public use .!! 

data tapes is provided. For persons with university affil- , 

iation, many NCHS tapes are available through the 

schools of public health of major universities. Schools 

of public health at the following universities participate 

in the NCHS data tape acquisition program at this time: 

Boston University; University of California, Berkeley; 

University of California, Los Angeles; Columbia University; Harvard University; University of Hawaii; University of Illinois; Johns Hopkins University; Loma 

Linda University; University of Massachusetts; University of Michigan; University of Minnesota; University of 

North Carolina, Chapel Hill; University of Pittsburgh; 

San Diego State University; University of South Carolina; University of South Florida; University of Texas; 

University of Washington, Seattle; and Yale University. 

Names of appropriate contact persons at these schools 

can be obtained by contacting the Scientific and Technical Information Branch, NCHS, 6525 Belcrest Road, 

Hyattsville, Maryland 20782. The telephone number is ~ 

(301) 436-8500. 

� Questionnaire source items –This component identifies /’,, references that contain the questionnaire items listed in 

the inventory. Most of these references are available 

from the U.S. Government Printing Office, Washington, D.C. 20402. If the questionnaire has not been 

published, a copy can usually be obtained from the 

technical contact person. 

After each pertinent data system has been described 

according to the above outline, there are six appendixes. 

Appendix I lists future NCHS surveys in the planning and 

6 

v 
design stages that have projected the inclusion of pain and 

pain-related data. 

The orofacial pain and abdominal pain questions for 

the 1989 NHIS were particularly detailed and not easily 

summarized; thus, they are included in their entirety as 

appendixes II and III. 

I Appendix IV provides an overview of the classification 

variables available for each of the data systems that may 

! be appropriate to the study of acute, recurrent, chronic, 

and cancer pain. Appendix V is a summary of pain 

measures included in the various surveys. . Appendix VI discusses the use of the International 

Classification of Diseases (ICD) for coding of NCHS 

morbidity and mortality data. The discussion is limited to 

those data systems that are included in the inventory. In 

some instances the purpose of the question is not to elicit 

pain information specifically, but rather to gather general 

health information, such as days lost from work or days 

spent in bed because of ill health. In reporting such 

events, respondents provide information about conditions 

that caused them to restrict their activity. These conditions are then coded into ICD categories that include 

relevant painful condition codes. AIthough the IASP Classification of Chronic Pain, developed by the IASP Subcommittee on Taxonomy and published as a supplement ) to the journal Pain, has not been used in the coding of 

NCHS pain data, a crosswalk has been developed that 

allows translation of codes to the eighth and ninth revisions of the International Classification of Diseases (40). 

Using the inventory to identify 

multiple avenues of analysis: the 

case of back pain and related back 

disorders 

The usefulness of the inventory for identifying areas in 

which secondary analysis of existing data maybe a productive research strategy is perhaps best illustrated for the case 

of back pain and related back disorders, Although far from 

being exhaustive of the analytic possibilities, the following 

examples show the extent to which the data systems of 

NCHS provide a rich national resource and an important set 

of scientific opportunities for population-based studies of 

pain. To provide some structure to this case study of the 

usefulness of the inventory in identifying analytic possibilities, seven issue areas in the comprehensive study of back 

pain and related back disorders are identified and the relevance of existing NCHS data to these issue areas is discussed. 

Alternative definitions of the magnitude of 

i the problem 

Data are available from NHIS and the National Medical Care Utilization and Expenditure Survey (NMCUES) 

on the incidence of acute backaches and’ associated 

disability days, as well as back injuries and associated 

disability days. Information is available from NHIS on 

whether aback injury occurred at work. Information is also 

available from NHIS on chronic back pain, including the 

prevalence and characteristics of impairments of the back 

or spine. NIIIS is also a major source of information on 

various types of disability caused by back problems. 

NHANES 1 and II are a source of self-report data on 

back pain, physician examination findings of back problems, and medical history information on diagnosed back 

problems. NHANES II also has data on x-ray examination 

findings for the lower back, which cmdd be made available to 

the public on a case-by-case basis. The 1982-84 NHANES I 

Epidemiologic Followup Study (NHEFS) ako measures the 

magnitude of back pain. 

Data are available from NHIS and NMCUES on 

physician visits involving diagnosis or treatment for acute 

and chronic back problems, and extensive data are available from the National Ambulatory Medical Care Survey 

(NAMCS) for visits to office-based physicians in the 

United States for back pain symptoms and back problems: 

AIthough NAMCS and the National Hospital Discharge Survey (NHDS) are provider-based surveys, back 

pain data from these surveys measure the magnitude of 

the back pain problem among visits to office-based physicians or to short-stay hospitak for treatment. 

NHDS is a source of information on short-stay hospital discharges and hospital days for back problems, 

including important data on laminectomies and spinal 

fusions. NHIS also has selected information on short-stay 

hospitaI experiences for back problems. 

The National Nursing Home Survey (NNHS) is a 

source of information on the prevalence of back problems 

among nursing home residents. Mortality data are also 

important in certain limited cases. 

From these data, it should be possible to extract a 

comprehensive statement of alternative definitions of the 

magnitude of the problem of back pain in the United 

States. This comprehensive statement could be com~ared 

with and contrasted to other definitions and estimates in 

the literature (41-47). ,, 

Socioeconomic differentials 

A major task in the epidemiology of back pain is to 

clari~ the extent to which the problem of back pain varies 

among sociodemographic categories of the population. 

Many studies have found that back pain is proportionately 

more common among people in the lower socioeconomic 

strata. However, several aspects of this empirical generalization need to be clarified. Socioeconomic status can be 

indexed in a variety of ways (including education, family 

income, occupation, and household social standing). How 

consistent is the generalization of socioeconomic status and 

the relative frequency of back pain across these different 

indicators? To what extent is the association of socioeconomic status and back pain independent of the effects of 

other factors associated with bothsocioeconomic status and 

back pain? How does the independent effect of socioeconomic status on back pain vary among categories of the 

7 
population defined in terms of factors associated either with 

socioeconomic status or with back pain, but not with both? 

How important is socioeconomic status as a predictor of 

back pain, compared with other sociodemographic factors 

that are associated with back pain? Which components of 

socioeconomic status have the greatest effects on back 

pain? 

What are the major alternative interpretations that 

can be advanced to explain the patterns of association 

between socioeconomic status and back pain? To what 

extent can these alternative interpretations be evaluated 

directly or indirectly with available NCHS data? When the 

empirical implications of these alternative interpretations 

can be evaluated with the data at hand, what do the 

results show? 

Based on all these analyses, what can be concluded 

about the relationship between socioeconomic status and 

back pain? How do these generalizations based on an 

analysis of available NCHS data compare with existing 

generalizations in the literature? What are the major 

implications of the results of these analyses and comparisons with the literature? 

These questions and others related to socioeconomic 

differentials can be answered using NCHS data documented in the inventory. Data on the scope of the problem 

of back pain and related back disorders are available from 

the same data systems identified as dealing with the 

magnitude of the problem, for comprehensive data on the 

sociodemographic characteristics of respondents are routinely collected in NCHS surveys. In addition to these data 

systems, sociodemographic differentials can be studied 

using data from the 1988 National Maternal and Infant 

Health Survey and the 1990 Longitudinal Followup, 

Health characteristics 

In addressing the structure of the problem of back pain 

and related back disorders, a major strength of the 

population-based health surveys of NCHS is that persons 

with a certain health problem can be compared with persons 

without that particular problem in terms of a wide variety 

of other health characteristics. The analyst could capitalize 

on these national data resources to compare the health 

characteristics of persons with and without back pain and 

related back disorders. 

The inventory identifies NHIS, NHANES I and II, 

and NMCUES as data systems from which a comprehensive description of persons with back pain could be prepared in terms of acute illnesses and injuries, disability 

days, selected chronic conditions (including conditions in 

which pain predominates), limitation of activity from a 

chronic condition or impairment, limitation of mobility, 

need for long-term care, self-assessed health status, psychological well-being, depressive symptoms, use of physicians, use of dentists, use of short-stay hospitals, usual 

sources of medical care, health insurance, out-of-pocket 

health expenses, health practice;, and knowledge and 

attitudes related to various aspects of health promotion 

and disease prevention. 

To the extent feasible, the description of these health 

characteristics could take into account differences in the 

sociodemographic characteristics of persons with and 

without back pain that are also associated with the health 

characteristic being described. These analyses could serve 

to clarify important aspects of the structure of the 

problem of back pain and could have important implications for the development of topologies of persons with 

back pain. 

Risk factors for back pain and related 

back disorders 

A variety of workplace (48) and individual (49) characteristics have been identified in the literature as factors 

that increase the risk of having an episode of low back pain 

or that influence the seriousness or disabling consequences 

of such an episode. 

Workplace characteristics associated with the risk of 

an episode of low back pain include the following: 

.	 Physical work characteristics, such as the extent to 

which a job requires heavy lifting, pushing, pulling, 

cyclic loading, exposure to vibrations, prolonged sitting, 

and certain other postures a worker assumes in carrying out job duties. 

.	 Psychological characteristics, such as monotony, 

boredom, and job dissatisfaction. 

Individual characteristics associated with the occurrence, seriousness, and disabling consequences of an episode of low back pain include the following: 

�	 Constitutional factors, such as age, physical fitness, 

abdominal muscle strength, flexor or extensor balance, 

and muscular insufficiency. 

�	 Postural and structural factors, such as severe scoliosis, 

certain congenital abnormalities, and a narrowed spinal 

canal. 

�	 Radiographic findings of specific structural abnormalities, namely, spondylolysis, fractures, multilevel degenerative disc disease, and spondyloarthropathies. 

�	 Personal health care factors, such as smoking, alcohol 

use, and diet. 

�	 Participation in certain kinds of recreational activities, 

such as golfing, tennis, football, gymnastics, jogging, 

and cross-country skiing. 

� Psychosocial factors, such as anxiety, depression, hypochondriasis, and somatization. 

� Other factors, such as familial clustering of back prob­

!

lems and multiple births in females. I 

Several NCHS data sets, including NHIS, NHANES I 

1 and H, and the Hispanic Health and Nutrition Examination Survey, provide a basis for retrospective comparisons 

of individuals with and without back pain in terms of many 

of these known risk factors. Information from the 

8 
. 

NHEFS and NMCUES also provide a basis for several 

prospective analyses of the effects of some of these risk 

factors on back pain. Available NCHS data could be 

examined for their bearing upon the nature and relative 

importance of these known risk factors and could be 

explored for the relevarice of additional risk factors that 

have been suggested in the literature but never empirically 

tested. 

Economic impact 

One consequence of back pain problems is the economic costs for the individual, his or her family and 

employer, and society at large. Estimates of the economic 

impact of illnesses in the United States are most commordy 

developed using a “human capital” approach (50-53) that 

differentiates two broad categories of costs: Direct medical 

care costs and indirect costs resulting from disability and 

premature mortality. 

Direct medical care costs include public and private 

expenditures for prevention, detection, treatment, rehabilitation, research, training, and capital investments in medical facilities. Under direct medical care costs are the 

more familiar specific categories of personal services and 

supplies and nonpersonal services. The former of these 

specific categories, personal services and supplies, 

includes hospital care, nursing home care, physicians’ 

services, dentists’ services, other medical professional services, drugs and drug sundries, eyeglasses and appliances, 

school health services, industrial health services, and medical activities in Federal units other than hospitals. The 

latter specific category, nonpersonal services, includes 

medical agencies and health insurance costs. Because of 

the ambiguities that confound the allocation of these 

nonpersonal service costs to specific diseases, they are 

generally not estimated for specific diseases. 

Indirect costs – a measure of potential productivity 

lost to society– include loss of output to the economy (as a 

result of illness, disability, and premature death) in terms 

of wages lost because of days lost from work. One component of these indirect costs is morbidity 10SSbecause of 

decreased productivity on the job, absenteeism, and 

unemployment. A second component is the value of productivity not realized in a year due to disease-related 

deaths as well as the present value of future productivity 

lost as a result of deaths in that year. 

In early efforts to document the economic impact of 

back pain problems in the United States (54), an attempt 

was made to estimate selected components of these costs 

using published data. More recently, efforts have been 

made to develop a more comprehensive statement of the 

economic impact of back pain by estimating a broader 

range of cost components using public use data tapes (43). 

Specialized studies codifying what is currently known 

about compensation costs for back pain have also been 

published (55). 

A great majority of the data for these studies of 

economic impact are obtained from NCHS data systems 

that provide base estimates of the magnitude and scope of 

the problem. Data are available from NHIS, NHANES I 

and II, NAMCS, NHES, and NMCUES. 

A critical review of previous efforts to estimate the 

direct and indirect costs associated with back pain and 

related back disorders could be undertaken, and the 

development of more up-to-date estimates of the economic impact of back pain and related back disorders, 

going beyond the limitations of previous estimates to the 

extent feasible, could be attempted using available NCHS 

data. 

Back pain management 

The management of back pain and related back disorders includes a variety of options for doctors and individuals 

(56). Physicians can diagnose the back problem, which usually involves the use of clinical tests and laboratory measurements, and treat the problem, which may include 

prescribed bed rest; use of medications, braces, corsets, 

collars, traction, physical therapy, transcutaneous electrical 

nerve stimulation, injections, or surge~ or referral to a 

back school or pain clinic. The services of chiropractors and 

other health care professionals are also sometimes used. In 

addition to their compliance with medical interventions, 

individuals can do many things to manage their own back 

problems. 

Data bearing on the management of back pain and 

related back disorders are available from NHIS, 

NHANES I and II, NHEFS, NMCUES, NAMCS, NHDS, 

and NNHS. Most of these data are concentrated on the 

services of the medical care systerrq however, the information from these various data sets could be integrated to 

provide a fairly comprehensive description of the management of back pain and related back disorders in the 

United States. 

Temporal variations 

A major task of an epidemiology of back pain is to 

clari~the extent to which problems of back pain and related 

back disorders are changing over time with respect to magnitude, scope, structure, etiology, consequences, and treatments. Data systems of NCHS provide a basis for describing 

selected aspects of such changes in the United States. 

Trend data are available from the NHIS on incidence 

of acute backaches, disability days associated with acute 

backaches, the prevalence and impact of chronic back and. 

spine impairments, the prevalence and impact of slipped 

disc problems, physician visits involving diagnosis or treatment for acute and chronic back problems, and short-stay 

hospital discharges for back problems, including surgical 

treatment for back problems. NHANES I and II data 

provide replicate information on the prevalence and characteristics of adults with back pain. NAMCS provides 

trend information on the characteristics of visits to officebased physicians for back pain and related back disorders. 

NHDS provides trend information for short-stay hospital 

9 
discharges, hospital days, and surgery associated with back 

problems. NNHS has limited information on the prevalence of problems of the back or spine among nursing 

home residents. 

The analyst could use this information to describe 

selected trends in the problem of back pain in the United 

States. To the extent that the data permit, an effort could 

also be made to evaluate the observed trends (57) in 

relationship to changes in survey procedure, changes in 

the SOC1‘ composition of the population, changes in the 

organization and operation of the health care system, and 

changes in values related to the definition, diagnosis, and 

report of back pain. Moreover, because increasing attention is being given in public health discussions to the 

magnitude, scope, and impact of various health problems 

projected over the next several decades, an effort could 

also be made to develop preliminary projections (58) of 

the magnitude and severity of the problem of back pain in 

the United States in the future. 

Secondary analysis for 

population-based studies of pain 

As the preceding case study amp[y demonstrates, the 

NCHS has collected a variety of data appropriate to the 

study of pain and pain-related issues. A basic assumption 

of this inventory is that NCHS surveys are a good source 

of data for secondary (and in some cases for primary) 

analysis of pain issues. Some of the data presented in this 

inventory have already been analyzed by NCHS staff or 

others. NCHS statistical compendiums such as Health, 

United Sfatet (59) have included selected information on 

pain syndromes, most notably on back pain, as have 

selected reports in the Wal and Health Statistics series 

(such as (60-73)) and in Advance Data From P2tal and 

Health Statistics (such as (74-96)). However, much of the 

pain data collected by NCHS have not been analyzed, 

Even those data that have received attention offer potential for further analysis. This inventory is a first attempt to 

systematically identify these data and make their existence 

known to interested researchers and poIicy analysts. 

The benefits of secondary analysis are many (97). On 

the practical side, the approach requires fewer resources, 

in terms of both money and time, than a full-scale survey 

effort. Secondary analysis also has several substantive 

advantages, It provides historical perspective on important 

issues. It permits trend studies and comparative analyses 

that a single research endeavor cannot achieve. It also 

promotes the expansion of existing theory by forcing the 

researcher to think broadly and abstractly to find overarching concepts or categories within which available indicators can be contained. 

Secondary analysis, particularly analysis of large-scale, 

complex surveys, requires careful consideration of the 

intricacies and limitations of the data (18,98–101). 

Methods, target populations, units of analysis, and 

response rates vary among data systems. Although items 

may appear similar in a questionnaire, their possible uses 

can vary substantially. Trend studies in particular warrant 

critical examination of methodological and measurement 

variation (57,102,103). Detailed discussion of these issues 

is beyond the scope of this report. The user is urged to 

consult other publications for a more complete description 

of the data systems and for references to detailed methodological reports (21,37,104). Excellent overviews of the 

current state of the art of pain measurement are also 

available in the literature (14,16) and constitute fundamental resources for evaluating the sources and quality of 

pain data. 

Current and future efforts 

During the past 15 years, there have been numerous 

efforts to document the problem of pain in the United 

States. Each of these efforts has called attention to the 

need for more complete and comprehensive information 

on pain with respect to the magnitude of pain problems 

and their scope, structure, sources, impact, treatments, 

and trends. Because NCHS is the only Government 

agency mandated by law to collect general-purpose, 

descriptive statistics on the Nation’s health, NCHS staff 

began several years ago to evaluate existing NCHS data on 

pain. The first step in this evaluation was an examination 

of the efforts already made in NCHS data systems to 

measure pain and pain-related phenomena, The results of 

this initial evaluation of NCHS efforts in the study of pain 

are presented in the main body of this report, which 

follows this section. 

A second report, “Pain Data Available From the 

National Center for Health Statistics: An Evaluation of 

Adequacy, Epidemiologic Uses, and National Data 

Needs” (105), which focuses on the methodological 

quality, substantive adequacy, and epidemiologic uses of -

currently available NCHS pain data, is in the final stages 

of preparation at the time of this writing and will appear 

in the near future in Series 4 of Vitaland Health Statistics. 

Because of funding and staffing constraints, only a 

limited number of analytical projects were funded, 

including analyses of NHANES, NHDS, and NAMCS 

data on back pain. The results of these analyses are 

making their way into the pain literature through presentations and poster sessions at professional meetings, as / well as through publication in appropriate journals 

(106-111). 

10

.

General population 

surveys 

National Health Examination 

Survey (NHES), Cycle I 

!. Survey design \ 

. 

Survey of U.S. civilian noninstitutionalized adults ages 

18-79 years, using a multistage, clustered probability 

sample stratified by geographic region and population size. 

Interviews and examinations with about 6,700 persons conducted from October 1959 through December 1962. 

Basic data elements 

Data include a household interview, medical history, 

medical examination, dental examination, x ray, electrocardiogram readings, laboratory blood tests, vision and 

hearing tests, and anthropometric measurements. Also 

included are a personal medical history and results of a 

physician examination related to the cardiovascular system, 

arthritis, and diabetes. Data are located on multiple tapes. 

Pain data elements 

Cardiovascular data: 

Frequency of headaches in past few years 

Do they bother you? 

Chest pain in past few years? Heart pain in past few years? 

Location { 

Does it move around? 

Duration 

When does it usually come? When exercising, when 

quiet, makes no difference, other? When upset, makes 

no difference, other? 

Take medication for chest pain? Take medication for 

heart pain? 

Leg cramps?


Angina pectoris (examining physician’s impression)?


Osteoarthritis and rheumatoid arthritis:


Osteoarthritis x-ray readings on hands and feet: None,


doubtful, minimal, moderate, severe


Rheumatoid x-ray readings on hands and feet: None,


doubtful, minimal, moderate, severe


Osteoarthritis diagnosis


Limitation of activity


Presence of iritis in one or both eyes?


Tenderness?


Pain on motion except distal-interphalangeal and


spine?


Benonite flocculation (dilution range from negative to


more than 1:16)


Rheumatoid arthritis diagnosis: Classical, definite,


probable, possible


Frequency of joint pain


Think you have arthritis or rheumatism? Confirmed by


a doctor?


Duration


Had in the past year?


Take medicine for it?


Have gout?


Data tape availability 

NHES I Cardiovascular Data (tape no 1004), NTIS acces­


sion no PB 293138


NHES 10steoarthritis and Rheumatoid Arthritis (tape no


1005), NTIS accession no PB 293130


Technical contact: 

Patricia Vaive


Division of Health Examination Statistics


6525 Belcrest Road, Room 900


HyattsviIle, MD 20782


(301) 436-7081


Questionnaire source items 

National Center for Health Statistics. Plan and initial pro- ~ 

gram of the Health Examination Survey. National Center 

for HeaIth Statistics. Vital Health Stat 1(4). 1965. 

National Health Examination 

Survey (NHES), Cycle II 

Survey design 

Survey of U.S. civilian noninstitutionalized children 

ages 6 months–n years, using a multistage, clustered probability sample stratified by geographic region and population size. Interviews and examinations with approximately 

7,100 children conducted from 1963 through 1965. 

11

Basic data elements 

Data include detailed medical and developmental histories from a household adult, usually the mother; information from the school; medical, dental, and psychological 

examinations; vision and hearing tests; and anthropometric 

measurements. Major data elements are on one tape. 

Approximately one-third of the children examined in Cycle 

II were reexamined in Cycle HI. These children are identified on both the Cycle II and Cycle III tapes, making 

longitudinal analyses possible. 

Pain data elements 

Sore throats? 

Earaches? 

Injury to ears? 

Eardrums opened or lanced? 

Number of times 

Data tape availability 

NHES II Integrated Data Tape (tape no 21DT), NTIS 

accession no PB 293124 

Technical contact: 

Patricia Vaive


Division of Health Examination Statistics


6525 Belcrest Road, Room 900


Hyattsville, MD 20782


(301) 436-7081


Questionnaire source items 

National Center for Health Statistics: Plan, operation, and 

response results of a program of children’s examinations. 

National Center for Health Statistics. Vital Health Stat 

1(5). 1967, (Selected questionnaire items only,) 

Questionnaires available upon request from technical contact person. 

National Health Examination 

Survey (NHES), Cycle Ill 

Survey design 

Survey of the U.S. civilian noninstitutionalized population ages 12-17 years, using a multistage, clustered probability sample stratified by geographic region and 

population size, Interviews and examinations with approximately 6,800 youths conducted from 1966 through 1970. 

Basic data elements 

Data include a household interview; detailed medical 

and developmental histories; information from the school; 

medical, dental, and psychological examinations; vision and 

hearing tests; anthropometric measurements; x rays; and 

laboratory tests. Major data elements are on one tape. 

Approximately one-third of the youths examined in Cycle 

HI were examined earlier in Cycle II. These youths are 

identified on both the Cycle H and Cycle 111tapes, making 

longitudinal analyses possible. 

Pain data elements	 1, 

. 

Medical Histoy of Youth From Parent 

Questionnaire 

Any bones ever broken? 

Ever had any serious accidents or injuries? 

Number 

Hospitalized for accident or injury 

International Classification of Diseases (8th revision) .


code for most serious illness or disease (using Inter-


national Classification of Diseases, Adapted for Use in


the United States)


Age when illness started 

Seriousness of illness or disease 

Any injury to ears? 

Earache in past year? 

Inclination to consult physician if youth: Had a stomach { 

ache, sore throat, headache; hurt aIl over; had pain in 

chest 

Pain or discomfort from periods? 

How often painful: Very often, occasionally


Severity of pain or discomfort when present: Mild,


moderate, severe


Remedy used to ease pain: Takes medicine, goes to


sickroom or nurse, stays in bed, stays home from


school


Talked to a doctor about the pain?


Health Habits and Histoq – youth Questionnaire 

Ever broken any bones? 

Number of times 

Ever had any other injuries or accidents? 

Ears ever damaged or injured? 

Any earaches in past year? 

Anything that prevents complete use of legs or arms? 

Any backaches in past year or two? 

Inclination to consult physician if Had a stomach ache, 

sore throat; hurt all over; had a headache; had pain in 

chest, sore gums, a toothache, sores in mouth 

Nurse’s Questionnaire – Females 

Pain or discomfort from periods? 

Frequency: Most periods, occasionally 

Severity: Mild, moderate, severe 

Medicine for discomfort? 

Use sickroom or nurse? 

Miss school or work? 

Talked to doctor about pain or discomfort? 

Data tape availability 

NHES III Extended Data Tape (tape no 3EDT), NTIS 

accession no PB 296025 

12

. 

Technical contact: 

Patricia Vaive


Division of Health Examination Statistics


6525 Belcrest Road, Room 900


Hyattsville, MD 20782


(301) 436-7081


Questionnaire source items 

Questionnaires available upon request from technical contact person. 

First National Health and Nutrition 

Examination Survey (NHANES 1) 

Survey design 

Survey of the U.S. civilian noninstitutionalized population ages 1–74 years, using a multistage, clustered probability sample stratified by geographic region and 

population size. Interviews and examinations with about 

21,000 persons yere conducted from 1971 through 1974. 

This sample was augmented with approximately 3,000 per­

“sons ages 25–74 in 1974 and 1975, 

Basic data elements 

Data on all examined persons include household and 

demographic information; nutrition information; medical, 

dental, derrnatological, and ophthalmological examinations; anthropometric measurements; hand-wrist x rays 

(ages 1-17 only); and a variety of laboratory tests. Information on a subsample of adults includes a supplementary 

medical history tobacco and alcohol use; mental health and 

depression measures; supplementary inforriation concerning arthritis, respiratory, and cardiovascular conditions; health care needs; an extended medical examination; 

x rays of the chest and hip and knee joints; and a variety of 

additional clinical procedures and laboratory tests. Data are 

located on multiple tapes. 

Pain data elements 

MedicalHi.sto~ Questionnaire (ages1-11 years) 

Ever had a bad accident? 

Still have the effects of it? 

Ages 6–11 years: 

Ever been treated for a stomach or intestinal disorder? Kidney disease or infection? Cancer or 

tumors? 

Unable to do some things because of a condition 

that has bothered for a long time? 

MedicalHistory Questionnaire (ages 12–74years) 

Episodes of pain or discomfort in abdomen or stomach 

at least 3 days a month? 

Has a doctor ever told you that you have any of the 

following conditions, and if so, do you still have it? How 

many years ago did you first have it? 

Arthritis? Gout? Heart attack? Peptic, stomach, or 

duodenal ulcer? Recurrent or chronic enteritis? 

Colitis? Gallstones? Hiatus hernia of the diaphragm? Kidney disease or kidney stones? Malignant tumor or growth? Fracture of hip, wrist, spine, 

any other bone? 

During the past 6 months have you used any medicine, 

drugs, or pills for any of the following: Headache? 

Other pains? 

Detailed Medical History Supplement (ages25–74years) 

Health problems now that you would like to talk to a 

doctor about: 

Headaches? Trouble with joints, pain, aching, 

swelling, stiffness? Possible heart or circulatory 

trouble including trouble with veins, leg pains, and 

chest pains? Gastrointestinal troubles including 

heartburn, abdominal pain? Kidney or bladder 

trouble, pain when passing urine? 

In past 5 years, injury resulting in a broken hip, wrist,


spine, other bone?


In past 5 years, a back injury?


Ever had pain present for at least 1 month on most days:


In any of your joints either at rest or when moving


them?


In neck or back?


In or around either hip joint?


In or around the knee?


In a swollen joint?


Ever had: Trouble with any pain or discomfort in your 

chest? 

Severe pain across the front of your chest lasting for 

half an hour or more? 

Pains in either leg while waIking? 

Pain or burning sensation when passing urine? 

Health CareNeeds Questionnaire (ages25-74 years) 

Toothache was the main reason for last visit or talk with 

a dentist at either his office or clinic. 

General Well-BeingSchedule (ages25-74 years) 

‘In past month, bothered by any illness, bodily. disorder, 

pains, or fears about health? 

SupplementA –Arthritis (ages25-74 years) 

Pain in either the back or neck on most days for at least 

1 month? 

Has pain been present on any one occasion for at 

least 6 weeks? 

Is pain usually located in neck? Upper back? Midback? Lower back? 

Is pain most intense in neck? Upper back? Midback? Lower back? 

Is pain present when resting at night? 

Does pain awaken you from sleep at night? 

Does pain in back ever seem to spread? 

Does pain spread to the back of the right leg? 

Left leg? Both legs? Top of the head? The sides 

of the body? 

Has pain in neck ever seemed to spread? 

13


I 
If so, does pain spread to top and back of head? 

Either shoulder area? The arms or hands? 

Other locations? 

Is back or neck pain made worse: 

By coughing, sneezing, or deep breathing? 

With bending or twisting motion? 

After prolonged activity? 

After prolonged sitting? 

After prolonged standing? 

Age when first experienced recurring back or neck


pain


When last had this pain


The longest episode of back or neck pain ever had


Does back or neck pain occur more frequently now


than before?


Ever had a sprained back because of some type of


physical activity?


Ever had a “whiplash” injury of the neck?


Ever had a ruptured disc in either your back or


neck?


If so, at what age? 

Were you in traction? 

Was surgery necessary? 

Ever stayed overnight in a hospital for back or neck 

pain? 

Had pain in or around either hip joint on most days for 

at least 1 month? 

Has pain in the hip area been present on any one


occasion for at least 6 weeks?


Where did you first notice it? Left hip? Right hip?


Both hips?


In hip area, is the pain usually most intense in the


right buttock? Left buttock? Both buttocks? Right


groin? Left groin? Both groins? Side of right thigh?


Side of left thigh? Sides of both upper thighs?


Other areas?


From the hip, has the pain tended to spread to:


The ins{de of your-leg? 

The front of your leg? 

The outside of your leg? 

The back of your leg? 

Had pain in or around the hip when either


coughing or sneezing?


When hip pain present, does it hurt at rest as well


as when moving?


Age when first experienced recurring pain in the


hip


Last time had pain


Longest episode of hip pain you have ever had


Ever had a fractured hip?


If yes, which hip was broken?


Age when it happened


Was hip in traction?


Was there surgery?


Ever had a dislocated hip? 

If yes, which hip was dislocated? 

Age when it happened 

Was hip in traction? 

Was there surgery? 

Had pain in or around knee on most days for at least 

1 month? 

Has pain in the knee area been present on any one 

occasion for at least 6 weeks? 

In which knee did you first have it? 

Age when first experienced recurring pain in 

the knee 

When knee pain present, is it most intense in right 

knee, left knee, both knees, behind the right knee, 

behind the Ieft knee or behind both knees? 

Does it hurt at rest as well as when moving?


Is there also swelling of the knee joint?


Ever had “locking” of the knee?


Has either knee ever “given way” under you? 

If yes, which knee gave way? 

Last time had this knee pain 

Longest episode of knee pain ever had 

Ever had a fractured knee? 

Which knee fractured? 

Ever had a severe twisting of either knee with 

resultant sprain or swelling lasting more than 

2 weeks? Which knee? 

Ever had any other knee injury? Which knee? 

Ever had hip, knee, or back disease treated by an operation? 

Which joint? 

If hip, which hip? 

If knee, which knee? 

Had pain or aching in any joint other than the hip, back, 

or knee on most days for at least 6 weeks? 

Were fingers painful? Which fingers? 

Was wrist painful? Which wrist? 

Was elbow painful? Which elbow? 

Was shoulder painful? Which shoulder? 

Was ankle painful? Which ankle? 

Was foot painful? Which foot? 

Any swelling of joints with pain present when the joint 

was	 touched on most days for at least 1 month? 

Has this swelling been present on any one occasion 

for at least 6 weeks? 

Is swelling and tenderness on touching: 

In fingers? Which fingers?


In wrists? Which wrist?


In elbows? Which elbow?


In shoulders? Which shoulder?


In hips? Which hip?


In knees? Which knee?


In ankles? Which ankle?


In feet? Which foot?


Age when first experienced this swelling of the 

joints 

Last time you had this swelling 

Ever had pain, swelling, or stiffness in a joint as result 

of an accident or injury? 

Was this the cause of the pain, swelling, or stiffness 

mentioned previously? 

Is this the cause of any pain, swelling, or stiffness 

14

which might still be present? 

Ever been treated by any-of the following for your joint 

troubles? 

General practitioner, internist, rheumatologist, 

orthopedist, chiropractor, osteopath, foot doctor, 

physical therapist, occupational therapist, other, 

never been treated 

Are you currently being treated by a doctor for the 

troubles you have just described? 

Type of doctor specified 

Doctor’s diagnosis: Acute arthritis; arthritis of 

spine, hip, upper and lower extremities; arthritis 

because of an infection; rheumatoid arthritis; 

osteoarthritis and allied conditions; other specified 

forms “of arthritis; arthritis, unspecified; rheumatism, polymyositis, and dermatomyositis; rheuma­

[ tism, specified; osteomyelitis and periostitis; other 

1 diseases of the musculoskeletal system; other , Last time saw doctor 

Who originally referred you to this doctor? 

Where usually see doctor? 

How long will it be until next visit to doctor? v Have you ever used any of the following kinds of treatment for your joint troubles? Do they do you any good? 

Do you use them regularly? 

Splints or casts? Braces? Diathermy or paraffin? 

Hot packs or heating pads? Cold packs or ice? 

Rest? Traction? Exercises or physical therapy? 

Aspirin? Cane? Crutch? Stiff mattress? Bed 

board? 

Ever had injections into joints? Did they do you any 

good? 

Ever taken any of the following medications for your 

joints? Did it do any good? 

Any cortisone-like medicine by mouth? ButazoIidin? Darvon or Tylenol? Indocin? 

Can you do the following things without the help of 

I someone else or the help of some special device: 

Go up or down stairs? Get into or out of a car? Use 

washing facilities? Dress yourself? Feed yourself? 

Get into or out of bed? 

At present time, does joint condition restrict your physical activi~ very little, quite a bit, or a whole lot? 

Ever had to stay in bed for long periods of time because 

of joints? 

Ever stayed overnight in a hospital because of joint 

problems? 

With respect to your joint trouble, would you say your 

condition is mild, moderate, or severe? .. Job status 1 month before first developing joint condition 

Change in job status as a result of joint condition? 

Current job status 

Number of workdays lost during past 12 months as 

result of joint condition 

X-ray readings 

Supplement B–Respirato~ (ages 25–74 years) 

Chest pains: With persistent coughing? With morning 

coughing spells? Along with shortness of breath? 

Where? Upper back, lower back, upper chest, 

along the rib edge, on the sides? 

Supplement C– Cardiovascular (ages 25–74 years) 

Have chest pains, chest discomfort, pressure, or heavi­


ness?


Description of pain: Heaviness? Burning sensation?


Tightness? Stabbing pain? Pressure? Sharp pain?


Shooting pains?


Had it more than three times?


Been bothered by this within the past 12 months?


Age when first had it


Get it if you walk at an ordinary pace on level


ground?


Get it if you walk uphill or hurry?


What do you do if you get it while walking: Stop,


S1OWdown, continue at same pace, take medicine?


If you do stop or slow down, is it relieved?


How soon? 

When you get pain or discomfort, where is it located: 

Upper middle chest? Lower middle chest? Left side of 

chest? Left arm? Right side of chest? Other? 

Do any of these things tend to bring it on? Excitement 

or emotion, stooping over, eating a heavy meal, , 

coughing spells, cold wind, exertion? 

Ever had severe pain across the front part of chest 

lasting half an hour or more? 

How many of these attacks have you had?


Date of last attack (month, year)


Duration of pain during last attack


See a doctor about last attack?


What did doctor say it was? Rheumatic fever,


chronic rheumatic heart disease, hypertension,


ischemic heart disease, other forms of heart dis­


ease, cerebrovascular disease, arteriosclerosis,


other diseases of the circulatory system


Get pain or disco~ort in either leg while walking? 

Also get this pain in your legs while standing still? 

Parts of leg in which pain is felt Lower (calf), upper 

(thigh); both 

Have the leg pain while quiet or while sitting? 

Get it when you walk up a hill in a hurry? 

Get it when you walk at an ordinary pace on level 

ground? 

Does the pain in your legs come on after you have 

taken a few steps? 

Does the pain disappear while you are still 

walking? 

What do you do when you get it while you are 

walking: Stop, slow down, continue at same pace, 

take medicine? 

If you stop, is it relieved? How soon after stopping? 

15 “
 ,,

Is the pain more likely to occur when you are 

hurrying than when you are walking at a slower, 

more even pace? 

Seen a doctor about chest pains, chest discomfort, pains 

in the legs while walking, or heart failure? 

Type of doctor: General practitioner, osteopath, 

heart specialist, other specialist, other 

Types of diagnostic procedures 

Types of treatments 

Ever been disabled because of chest pain, leg pain, or


heart failure?


Ever stayed overnight in a hospital because of chest


pain, leg pain, or heart failure?


Job status 1 month before developing chest pain, leg


pain, or heart failure


As a result of your condition, has there been a change


in your job status?


Current job status 

Medical Examination (ages 1-74 years) 

Pain on motion of knees: 

Active, passive, both; tenderness 

Right and/or left medial 

Right and/or left lateral 

Right and/or left diffuse 

Pain on motion of hips: 

Active, passive 

Extension 

Flexion 

Abduction 

Adduction 

External rotation 

Internal rotation 

Pain on motion of (right and/or left) shoulder, elbow, 

wrist, (number of) metacarpophalangeal, (number of) 

proximalinterphalangeal, (number of) distalinterphaIangeal, ankle, foot 

Pain on flexion, extension, right and/or left lateral 

bending, right and/or left rotation of back (location): 

Cervical 

Thoracic 

Low back 

Diffuse 

Uncertain 

Data tape availability 

NHANES I Medical History Questionnaire, Ages 1-11


(tape no 4067), NTIS accession no PB 296031


NHANES I Medical History Questionnaire, Ages 12-74


(tape no. 4081), NTIS accession no PB 296073


NHA.NES I Detailed Medical History, Health Care Needs,


Respiratory, and Cardiovascular Supplements, Ages 25-74


(tape no 4091), NTIS accession no PB 296029


NHANES I General Well-Being and the Center for Epi­


demiologic Studies Depression Scale Developed by the


National Institute of Mental Health, Ages 25-74 (tape no


4171), NTIS accession no PB 296020


NHANES I Medical Examination, Ages 1-74 (tape no


4233), NTIS accession no PB 296035


Technical contact: 

Patricia Vaive


Division of Health Examination Statistics


6525 Belcrest Road, Room 900


Hyattsville, MD 20782


(301) 436-7081


Questionnaire source items 

National Center for Health Statistics. Plan and operation of 

the Health and Nutrition Examination Survey: United 

States, 1971–1973, National Center for Health Statistics. 

Vital Health Stat l(lOb). 1977. 

Engel A, Murphy RS, Maurer K, Collins E. Plan and operation of the HANES I Augmentation Survey of Adults 

25–74 years: United States, 1974-1975. National Center for 

Health Statistics. Vital Health Stat 1(14). 1978. 

Second National Health and 

Nutrition Examination Survey 

(NHANES 11) 

Survey design 

Survey of the U.S. civilian noninstitutionalized population ages 6 months-74 years, using a multistage, clustered 

probability sample stratified by geographic region and population size. Interviews were conducted with approximately 

25,000 persons. Of these respondents, approximately 21,000 

persons were examined from 1976 through 1980. 

Basic data elements 

Data include household and demographic information, 

a medical history, nutrition information, medication and 

vitamin usage, tobacco use, behavioral characteristics, exercise frequency, a medical examination, anthropometric , measurements, and a variety of clinical procedures and k 

laboratory tests. Information for all interviewed persons 

(not just examined persons) is located on multiple tapes. 

Pain data elements 

Child’s Medical History Questionnaire (ages 6 months11 years) 

Ever had any bad accidents? 

Burned? 

Break a bone? 

Still have effects of accident? 

Unable to do some things because of a condition that 

has bothered for a long time? 

Ever been treated for cancer or tumors? 

Ever had any infections of the kidney, bladder, or urinary tract? 

Number of times 

Ever seen a doctor for any kidney, bladder, or other 

urinary problem? 

Type of doctor 

Ever been told by a doctor that you had the following? ~ 

16

Still have it? When first had it? 

Nephritis? 

Kidney stones or stones in the ureter? 

Nephrosis? 

Kidney infection? 

Kidney abscess? 

Bladder infection? 

Bladder stones? 

Urinary tract infection? 

Ear infection? 

Health HistcnySupplement (ages 12–74years) 

Ever had any trouble with pain, discomfort, or pressure


in your chest when you walk fast or uphill?


Description of pain: Heaviness? Burning sensation?


Tightness? Stabbing pain? Pressure? Sharp pain?


Shooting pains?


Had the pain or discomfort more than three times?


Been bothered by the pain or discomfort within the past


12 months?


Age when first had the pain or discomfort


Get the pain or discomfort if walk at an ordinary pace


on level ground?


If so, do you: Stop? S1OWdown? Continue at the 

same pace? Take medicine? 

If stop or slow down, is the pain or discomfort 

relieved? 

How soon is the pain relieved? 

Where is the pain or discomfort located: Upper middle 

chest? Lower middle chest? Left side of chest? Left 

arm? Right side of chest? Some other place? 

Do any of the following things tend to bring the pain or 

discomfort on? 

Excitement or emotion?


Stooping over?


Eating a heavy meal?


Coughing spells?


Cold wind?


Exertion?


Ever had severe pain across front of chest lasting onehalf hour or more? 

Number of these pain attacks 

Date of last attack 

~	 Duration of pain during last attack 

Doctor seen about last attack 

Doctor’s diagnosis: Rheumatic fever, chronic rheumatic heart disease, hypertension, ischemic heart 

disease, other forms of heart disease, cerebrovascular disease, arteriosclerosis, other diseases of the 

circulatory system, or other chest pain —not cardiovascular 

Ever seen a doctor about chest pains, chest discomfort, 

or heart failure? 

Type of doctor: General practitioner? Internist? 

Osteopath? Heart specialist? Some other medical 

person? 

Ever stayed in a hospital overnight or longer because of 

chest pains or a heart condition? 

Estimated workdays lost because of a heart condition 

Chest pains along with shortness of breath? 

Location of chest pains: Upper ches~? Upper back? 

Lower,back? Along the lower, ribs~ On the sides? 

Ever had p~n in your back qn mo,st days for at least 

2.weeks? . . 

Longest episode of back pain ever had 

Usual locatiori of back pain: Upper back? Midback? Lower back? ; 

Where is it most intense: Upper, back? Midback? Lower back? ,,, , ,, 

ISback pain usually present when resting at ti,ght? 

Does the back pain awaken you from sleeping at 

night? ,. 

Does the back pain ever seem to spread?. 

Does it spread to the: Back of the,right leg? 

Back of the left leg? Back of both legs? Top of 

the head? Sides of the body? 

Is your back pain made worse: By coughing, 

sneezing, or deep breathing? ,With bending or 

twisting motion? After prolonged sitting? After 

prolonged standing? After prolonged activity? 

Age when first experienced .recurring back pain 

Last time had this back pain ,. 

Does this back pain occur more frequently now 

than it used to occur? 

Has this back pain usually been mild, moderate, or 

severe? 

Ever had a sprained back because of some type of 

physical activity? 

Ever had a disc pro?Jem in either your back or 

neck? 

A ruptured disc? ‘ 

Was the disc problem in you; back or neck? 

Age when first had the disc problem 

Were you in traction? 

Was surgery necessa~? 

Ever stayed in a hospitaI overnight or longer 

for back pain? 

Ever had pain in-your neck on most days for at least 

2 weeks? 

Longest episode of neck pain ‘ 

Neck pain present when resting at nighl? 

Does the neck pain ever seem to spread? 

Does it spread to: The top and, back .pf She: 

head? Either shoulder area? The arms or 

hands? Other? . . i 

Is neck pain made worse: By coughing, sheering, or 

deep breathing? With bending or twisting motion? 

After prolonged activity? Afterprolonged sitting?. 

After prolonged standing? “ “ ‘‘ 

Age when first experienced this recurring ne’ck 

pain” 

Last time had this pain “ ; ““ “““ 

Does this neck pain occur more frequently “now 

than it used to occur? .,; ., - ., Neck pain usually mild, moderate, or severe? ‘ -

Ever had a “whiplash” ‘injury of the neck? ‘‘ ~‘’ ; ~”‘“ ,, .,. . ,.. 

17


,’

Ever used any of the following kinds of treatment for 

your back or neck troub[e? Did it do you any good? Are 

you using it regularly? 

Splints or casts? Braces? Diathermy or paraffin? 

Hot packs or heating pads? Cold packs or ice? 

Rest? Traction? Exercises or physical therapy? 

Aspirin? Cane? Crutch? Stiff mattress? Bed 

board? 

Back or neck condition restricts physical activity very 

little, quite a bit, a whole lot? 

Ever had to stay in bed at home for long periods of time 

because of back or neck trouble? 

Ever stayed overnight in a hospital because of back or 

neck problems? 

Would you say your back or neck condition is mild, 

moderate, or severe? 

At any time during the past year did your back or neck 

trouble cause you to cut down on the things you usually 

do? 

Number of activity cut-down days 

Number of days lost from work or school, not 

counting work around the house 

Number of days condition limited the kind or 

amount of work around the house 

Number of bed days 

Ever had pain, swelling, or stiffness in your back or 

neck as the result of an accident or injury? 

Think the accident or injury is the cause of any 

pain, swelling, or stiffness that might still be 

present? 

Ever been treated by a medical person for back or neck 

trouble? 

Type of medical person: General practitioner? 

Internist? Rheumatologist? Orthopedist? Chiropractor? Osteopath? Physical therapist? Occupational therapist? Other? 

Diagnosis: Arthritis; rheumatoid arthritis; osteoarthritis and allied conditions; rheumatism, polymy ­

ositis, dermatomyositis; osteomyelitis and 

periostitis; other diseases Of the musculoskeletal 

system 

Now being treated by a medical person for back or neck 

trouble? 

Type of medical person: General practitioner? 

Internist? Rheumatologist? Orthopedist? Chiropractor? Osteopath? Physical therapist? Occupational therapist? Other? 

Current diagnosis: Arthritis; rheumatoid arthritis; 

osteoarthritis and allied conditions; rheumatism, 

polymyositis, dermatomyositis; osteomyelitis and 

periostitis; other diseases of the musculoskeletal 

system 

Ever had an operation for a back or neck disease or 

injury? 

Was it your back or neck? 

Had pain or aching in any joint other than the back or 

neck on most days for at least 6 weeks? 

Which joints were painful? 

18


Fingers? Which fingers?


Wrist? Which wrist?


Elbow? Which elbow?


Shoulder? Which shoulder?


Hip? Which hip?


Knee? Which knee?


Ankle? Which ankle?


Foot? Which foot?


Had any swelling of joints with pain present when the 

joint was touched on most days for at least 1 month? 

Has this swelling been present on any 1 occasion for 

at least 6 weeks? 

Joints usually involved whenever you have this 

swelling and tenderness on touching: 

Fingers? Which fingers?


Wrist? Which wrist?


Elbow? Which elbow?


Shoulder? Which shoulder?


Hip? Which hip?


Knee? Which knee?


Ankle? Which ankle?


Foot? Which foot?


Age when first experienced this swelling of the 

joints 

Last time had this 

Ever had a job which placed frequent stress or strain on 

your back? 

Length of time worked at that kind of job 

Ever had pain or burning sensation on urination accompanied by more frequent urination than usual? 

Number of separate times this has happened 

Have a physical disability or handicap that prevents or 

limits normal daily activities, such as the kind or amount 

of work that you can do, housework, schoolwork, using 

public transportation, and so on? 

Adult Medical Hhtory Questionnaire (ages 12–74 years) 

During the past 12 months, stayed in hospital overnight


or longer for (painful) condition? Eighth Revision


International Classification of Diseases, Adapted for


Use in the United States (ICDA) code


(Painful) illness or condition that interferes with your


eating, digestion, or appetite? ICDA code


Has a doctor ever told you that you had any of the


following conditions, and if so, do you still have it? How


many years ago did you first have it?


Arthritis?


Back injury?


Bladder infection?


Bladder stones?


Cancer?


Gallstones?


Gout?


Heart attack?


Kidney infection?


Kidney stones or stones in the ureter?


Neck injury?


Nephritis?


A peptic, stomach, or duodenal ulcer?

Recurrent or chronic enteritis?


Spastic colon or mucose colitis?


Ulcerative colitis?


Urinary tract infection?


During the past 6 months, use of aspirin or aspirin-type 

pills 

On the average, use these pills one or more times 

per week? 

Ever had kidney stones? 

Ever passed a stone? 

Kind of treatment for stones: Medicines? Surgery? 

Special diet? Any other treatment? 

Have you ever,had any infections of the kidney, bladder, 

or urina~ tract? 

Number of times 

Number of times doctor seen 

Type of practitioner General practitioner? 

Internist? Urologist? Nephrologist? Other? 

Number of schooldays or workdays lost because of 

kidney, bladder, or urinary condition 

Special x rays? 

Hospitalizations? 

Last time saw doctor 

Specific treatments 

Had any trouble with pain from kidney, bladder, or 

urinary problems? 

Location of pain: Right, left, or both sides and 

back? Area over the bladder? Lower abdomen? 

Number of times had this pain 

Ever had any trouble with pain, discomfort, or pressure


in your chest when you walk fast or uphill?


Ever had severe pain across the front of chest lasting for


half an hour or more?


Number of these attacks 

Ever had pain in back on most days for at least 2 weeks? 

Ever had pain in neck on most days for at least 2 weeks? 

Ever had pain or aching in any joint, other than the back 

or neck, on most days for at least 6 weeks? 

Ever had any swelling of joints with pain present when 

the joint was touched on most days for at least 1 month? 

Ever changed job or stopped working because of a 

health problem? 

Physician>Examination (ages6 months–74 years) 

Costovertebral tenderness


Pain on motion of (right, left, both) shoulder, elbow,


wrist, (number of) metacarpophalangeal, (number of)


proximal interphalangeal, (number of) distal interpha­


langeal, ankle, foot, knee, hip


Pain on flexion, extension, right and/or left lateral


bending, right and/or left rotation of back (location):


Cervical: Severity of pain (none, doubtful, minimal,


moderate, maximal)


Thoracic


Low back


Diffuse


Uncertain


Data tape availability 

NHANES II Medical History Questionnaire, Ages


6 Months-n Years (tape no 5010),


NTIS accession no PB 83-215616


NHANES II Health History Supplement, Ages 12–74 Years


(tape no 5305),


NTIS accession no PB 83-256537


NHANES II Medical History Questionnaire, Ages 12–74


Years (tape no. 5020),


NTIS accession no PB 83-154815


NHANES II Physician’s Examination, Ages 6 Months-74


Years (tape no 5302), NTIS accession no PB-242930


Technical contact: 

Patricia Vaive


Division of Health Examination Statistics


6525 Belcrest Road, Room 900


Hyattsville, MD 20782


(301) 436-7081


Questionnaire source items 

McDowell A, Engel A, Massey JT, Maurer K. Plan and 

operation of the second National Health and Nutrition 

Examination Survey, 1976-80. National Center for Health 

Statistics. Vital Health Stat 1(15). 1981. 

Hispanic Health and Nutrition 

Examination Survey (HHANES) 

Survey design 

Survey of civilian noninstitutionalized persons of Hispanic origin ages 6 months-74 years, using a multistage, 

clustered probability sample drawn from a universe comprised of 229 counties in Texas, Arizona, CoIorado, New 

Mexico, and California (the Mexican-American sample); 

New York City (the Puerto Rican sample); and Miami (the 

Cuban-Anerican sample) areas. An estimated 76 percent 

of the Hispanic-origin population of the United States 

resides in these counties. Interviews and examinations with 

about 12,000 persons were conducted from 1982 through 

1984. 

Basic data elements 

Data include household and demographic information, 

a medical history, medication and vitamin use, tobacco and 

alcohol use, drug abuse, health care needs, utilization of 

health services, a medical examination, a dental examination, anthropometric measurements, nutrition, and a 

variety of clinical procedures and laborato~ tests. 

Pain data elements 

Child Histo~ Questionnaire (ages6 months–n years) . 

Ever had an ear infection or an earache? 

19


/. .€
Number of times€

Ever treated by a doctor for it?€

Ever had tubes placed in ear(s) by a doctor?€

Ever had a ruptured eardrum? 

Cause of functional limitation: 

Acute (onset within past 3 months) 

Chronic (onset more than 3 months ago) 

The following information is not yet available on the 

current Child Sample Person public use data tape: 

Use of nonprescription medicines in past 2 weeks: 

Pain relievers such as aspirin or Tylenol? 

Sleeping tablets, sedatives, or tranquilizers? 

Use of prescription medicines in past 2 weeks: 

Name 

Strength 

Prescribed dosage 

Prescribed frequency 

Problem for which prescribed 

Frequency taken 

Side effects – specified 

Adolescent and Adult Medical Histoiy Questionnaire 

(ages 12-74 years) 

Average number of hours of sleep each day€

Main reason for last visit for dental care was toothache€

Digestive disease (ages 20 years and over)€

Has a doctor ever told you that you had gallstones?€

Have you ever had surgery or an operation for gall-€

stones or gallbladder disease?€

During the past 5 years, have you had pain in your€

abdomen or lower chest which lasted a half hour or€

more?€

Location of pain€

Last time had pain€

Usual duration€

Pain steady or come in waves?€

When have the pain, do you move around or lie€

still?€

Time pain usually starts€

Ever been awakened from sleep by this pain?€

Get this pain while eating, after eating, or is it not€

related to eating?€

How long after eating do you get this pain?€

Usually feel sick to stomach either before or after€

get this pain?€

Within a day or two of having the pain, had any of€

the following:€

Fever or chills?€

Itching?€

Yellow jaundice?€

Unusually dark colored urine?€

Unusually light colored bowel movements?€

Number of days in past year had this pain in the€

abdomen or lower chest€

In the past year, what was the longest period of€

days, weeks, or months in which you did not have€

this pain?€

Age at first attack of this pain€

Ever seen a doctor about this pain?€

Doctor’s diagnosis€

Cause of this pain€

Ever received an injection of medication to relieve€

this pain?€

Ever hospitalized for this pain?€

During the past year, had heartburn or burning pain 

after eating? 

Frequency 

Distress caused by any of the following foods: 

Milk?€

Fatty foods?€

Green vegetables?€

Seafood?€

Any other food?€

Cardiovascular conditions (ages 20 years and over): 

Ever had any pain or discomfort in your chest? 

Do you get it when you walk uphill or hurry? 

Do you get it when you walk at an ordinary pace on 

the level? 

What do you do if you get the pain or discomfort 

while you are walking? 

Stop or slow down? 

Continue at the same pace? 

Take medicine? 

If you stand still, what happens to the pain or 

discomfort? Is it relieved? 

How soon is it relieved? 

Location of pain or discomfort 

Doctor seen? 

Doctor’s diagnosis: Coronary heart disease; 

other cardiovascular disease; respiratory conditions; chest pain, noncardiovascular; stress, 

tension, or nervous conditions 

Ever had severe pain across the front of your chest 

lasting for half an hour or more? 

Number of these attacks 

Date of first attack; duration of pain 

Date of last attack; duration of pain 

See a doctor because of this pain? 

Doctor’s diagnosis 

Functional impairment (ages 18-70 years): 

Cause of functional limitation is: 

Acute (onset within the past 3 months) 

Chronic (onset more than 3 months ago) 

Ever changed job, stopped working, or made any 

changes in housework because of a disability or 

health problem? (ages 18 years and over) 

Condition list: 

Doctor ever told you that you had a heart attack? 

Time since had first attack 

Doctor ever told you that you had kidney problems? 

Still have problems? 

Time since first had problems 

20 
The following information is not yet available on the ETHANES Gallbladder Ultrasound Data, Ages 2&74 Years, 

current Adolescent and Adult Medical History public Version 1 (tape no 6504), ITITS accession no PB 89-164511 

use data tape: H.HANES Measures of Depression, Ages 20-74 Years 

Use of nonprescription medicines in past 2 weeks: (tape no 6523), NTIS accession no PB 87-100391 

Pain relievers such as aspirin or TyIenol? Technical contact 

Sleeping tablets, sedatives, or tranquilizers? Patricia Vaive 

Use of prescription medicines in past 2 weeks: Division of Health Examination Statistics 

Name 6525 Belcrest Road, Room 900 Strength Hyattsville, MD 20782 

Prescribed dosage (301) 436-7081 

Prescribed frequency 

Problem for which prescribed Questionnaire source items 

Frequency taken


Side effects –speci@ Maurer KR. PIan and operation of the Hispanic Health and


Nutrition Examination Survey, 1982–84. National Center 

Physician’s Examination (ages 6 months–74 years) for Health Statistics. Vital Health Stat 1 (19). 1985.


Tender lymph nodes?


Thyroid tenderness? Third National Health and Nutrition
 Costovertebral angle tenderness?


Tenderness on palpation of the abdomen (nine spec- Examination Survey (NHANES Ill)


ified areas)?


During the past 5 years has examinee had pain in the Survey design


gallbladder area that lasted a half hour or more? Sutiey of the U.S. civilian noninstitutionalized popu-


Does examinee usually feel sick to his or her lation ages 2 months and over, using a multistage, clustered 

stomach either before or after getting this pain? probability samp~e stratified by geographic region and popLikelihood examinee has gallstones ulation size. Interviews and examinations will be conducted 

Leg ulceration: Which leg? from 1988 through 1994, with both the first and second 

Edema in legs: Which leg? Severi~? 3 years of data collection constituting national samples. The 

Pain with ankle dorsiflexion: Which leg? total sample size of 40,000 is expected to yield about 30,000 

Tenderness in the following joints (ages 10 and over): examined persons. 

Hips? Which hip?


Knees? Which knee? Basic data elements


Ankles? Which ankle?


Feet? Which foot? Data on all examined persons include household and


Shoulders? Which shoulder? demographic information, nutrition information, medical


Elbows? Which elbow? and dental examinations, anthropometric measurements,


Wrists? Which wrist? and a variety of laborato~ tests. Examination data on sub-


Hands? Which hand? samples, determined mainly by age of examinee, include


Tenderness in the back (ages 5 and over): electrocardiograms, eye fundus photographs, radiographs 

Sciatic notch? Which side? of hand-wrist and knee, ultrasound of the gallbladder, 

Sacroiliac? Which side? spiromet~, bone densitometry, and tests for hearing, allerVaricose veins: Which leg? Severe, moderate, or mild? gies, and physical and cognitive functions. Target diseases 

and conditions include cardiovascular disease, chronic 

Measures of Depression (ages 20-74 years) obstructive pulmonary disease, diabetes, kidney disease, 

National Institute of Mental HeaIth Diagnostic Inter- gallbladder disease, osteoporosis, arthritis, infectious disview Schedule Depression Section eases, dental health, allergy, cancer, mental health, and 

Center for Epidemiologic Studies Depression Scale hearing. Data will probably be located on multiple tapes. 

Gallbladder Ultrasound Data (ages 20-74 years) Pain data elements 

Household Youth Questionnaire (ages 2 months–16years) Data tape availability Selected conditions: 

HHANES Child History Questionnaire, Ages 6 Months– Complaints of headaches during the past 12


11 Years, Version 2 (tape no 6522), NTIS accession no PB months


8’7-182424 Complaints of stomach aches


HHANES Adolescent and Adult History Questionnaire, Dental care and status (ages 2-16 years)


Ages 12-74 Years, Version 2 (tape no 6521), Type of dental care needed now ReIief of pain?


NTIS accession no PB 87-182440 Vision and hearing


HHANES Physician’s Examination, All Ages (tape no Ever have an ear infection or an earache?


6509), NTIS accession no PB 87-158416 Number of times


21


,.,
 - .
Age at first infection or earache 

Treated by a doctor? 

Tubes in ears? 

Household Adult Questionnaire (ages 17 years and over) 

Selected conditions: 

Has a doctor ever told you that you had: 

Arthritis? 

Type 

Lupus? 

Gout? 

Cardiovascular disease: 

Ever had any pain or discomfort in your chest? 

Get it when you walk uphill or hurry? 

Get it when you walk at an ordinary pace on level 

ground? 

What do you do when you get it while walking: 

Stop, slow down, continue at same pace? 

Pain or discomfort relieved if you stand still? 

How soon? 

Location of pain or discomfort 

Ever had a severe pain across the front of your chest 

lasting half an hour or more? 

Has a doctor ever told you that you had a heart attack? 

Number


Age at (first) attack


Age at last attack


Get	 pain in either leg while walking? 

Does pain ever begin while standing still or sitting? 

Pain in calves? 

Get it when you walk uphill or hurry? 

Get it when you walk at an ordinary pace on level 

ground? 

Pain ever disappear while walking? 

What do you do if you get it while walking: Stop, 

slow down, continue at same pace? 

Pain relieved if you stand still? 

How soon? 

Musculoskeletal conditions (ages 20 years and over): 

Ever had pain in back on most days for at least 1 month? 

Had this pain within the past 12 months? 

Location of back pain 

Ever had pain in hands on most days for at least 6 

weeks? 

Which joints? 

Ever had pain in knees on most days for at least 6 

weeks? 

Right, left, both? 

Hurt at rest as well as when moving? 

Ever had pain in hips on most days for at least 6 weeks? 

Right, left, both? 

Gallbladder disease:


During the past 12 months, have you had pain in (the


area shaded on a diagram shown the respondent)?


Location of most uncomfortable pain


Duration of longest episode of pain


Number of days in past 12 months with this pain


Was pain continuous, or did it tend to come and go?


Hurt more, less, or no difference if moved around? 

Ever seen a doctor about this pain? 

What doctor said caused the pain 

Has a doctor ever told you that you had gallstones? 

Was pain the reason for visiting doctor the time 

you were told that you had gallstones? 

Ever had gallbladder surgery? 

Age when surgery performed 

Did the pain that caused your doctor visit continue after gallbladder surgery? 

Dental care and status:


Type of dental care needed now: Relief of pain?


Vitamin, mineral, and medicine usage:


Use of prescription medicines in past month 

Name 

Problem for which prescribed 

Length of time taken 

Use of antacids in past month 

Name 

Frequency taken 

Magnitude of dosage 

Length of time taken 

Use of nonprescription pain relief medicines 

In the past month, taken any 

Aspirin, Anacin, Bufferin, Ecotrin, Ascriptin, or 

Midol? 

Tylenol, Anacin-3, or acetaminophen? 

Advil, Nuprin, Medipren, or ibuprofen? 

Other (specified)? 

Frequency taken 

Physician’s Examination 

Pain on passive motion of wrist, finger joints (specified), 

great toe, knee: right, left, or both (ages 60 years and 

over) 

Home Examination (ages 2–1 1 months and 20 years and 

over) 

Pain reported on walking? 

Family Questionnaire 

Health insurance coverage


Medicare coverage


Medicaid coverage during past 12 months


Was father or mother ever told by a doctor that he or


she had a heart attack or angina before the age of 50?


Data tape availability 

The survey reaches its midpoint in 1991 with a 3-year 

national probability sample. Public use data tapes from this 

sample are projected to be available in 1994. The public use 

data tapes from the full survey are expected to be available 

in 1997. 

Technical contact; 

Patricia Vaive


Division of Health Examination Statistics


6525 Belcrest Road, Room 900


Hyattsville, MD 20782


(301) 436-7081


22 
Questionnaire source, items 

Copies of the questionnaires can be obtained by writing to 

the following address: 

National Center for Health Statistics


Division of Health Examination Statistics


Survey Operations Branch


6525 Belcrest Road, Room 900


Hyattsville, MD 20782


NHANES 1 Epidemiologic Followup 

Study (NHEFS) 

Survey design 

Conducted in three waves with respondents or their 

proxies (for deceased or incapacitated respondents) initially interviewed and examined during 1971–75 in the first 

National Health and Nutrition Examination Survey 

(NHANES I). The 1982-84 first wave of NHEFS data collection included all persons who were 25–74 years of age at 

their NHANES I examination (n = 14,407). Personal interviews were conducted in respondents’ residences, including 

institutions. The second wave, the 1986 NHEFS, was conducted for members of the NHEFS cohort who were 55-74 

years of age at their baseline examination and not known to 

be deceased at the 1982X34 NHEFS (n = 3,980). 

Computer-assisted telephone interviews were conducted 

with survey subjects or their proxies. In the 1987 NHEFS, 

the third wave of the ~EFS, information was collected 

from 11,750 subjects who were 25–74 years of age at baseline 

and not known to be deceased in the previous NHEFS 

surveys. 

Basic data elements 

Data include demographic information; a family history a female medical history a health condition checklis~ 

sections on nutrition, arthritis, functional limitation (activities of daily living), tobacco and alcohol use, mental status 

measures, medication use, physical activity, sleep habits and 

problems, vision and hearing impairments, and dental probIems.Blood pressure, pulse rate, and weight were measured 

in the initial followup. Admission and discharge diagnoses 

coded according to the 9th Revision, International Classification of Diseases were obtained for each health care 

facility stay. Death certificates were obtained for 

NHANES I participants who had died, and proxies provided information on the decedents’ last days. 

Pain data elements 

Subject Questionnaire’ 

Ever had pain or discomfort in chest? (1982-84) 

d Pain data were collected in all years of survey unless indicated by dates 

in parentheses. 

When do you get it? 

When you walk uphill or hurry? 

When you walk at an ordina~ pace on level 

ground? 

What do you do if you get this pain or discomfort 

while you are walking? .. Stop or SIOWdown? 

Take nitroglycerin? 

Continue at ‘the same pace? 

If you do stop or slow down, is pain relieved? 

How soon? 

Ever had this pain or discomfort more than three 

times? 

Age when first had it 

Been bothered by this pain or discomfort in the 

past 12 months? 

Year when last experienced the pain oi discomfort 

Region of pain indicated on a diagram shown the 

respondent 

Ever had a severe pain across the front of your 

chest lasting half an hour or more? 

See a doctor because of this pain?


What did the doctor say it was? Angin~ coro­


nary; other heart disease; intestinal or intraab­


dominal problems; lungs, pleura, trachea;


chest waI1; other


Number of these attacks


Year of (first) attack


Length of episode of pain


Year of last attack


Length of episode of pain


Since 1970, been hospitalized overnight for


this/these attacks?


Get pain in either leg when walking? (1982-84) 

Pain ever begin when standing still or sitting? 

Part of leg affected 

Get this pain when walking uphill or hurrying? 

Get this pain when walking at an ordinary pace on 

level ground? 

Does this pain ever disappear while still walking? 

What do you do if get this pain while walking Stop 

or slacken your pace or continue at the same pace? 

If you do stop, is the pain relieved?


How soon after stopping is the pain relieved?


Age when first had it


Been bothered by this condition in the past 12


months?


In what year did you last experience this problem?


Did a doctor ever tell you that a cyst or lump in your


breast was cancerous or malignant? (1982-84)


Ever had one or both of your breasts removed?


(1982-84)


Year told had breast cancer (1987)


Ever had a skin tumor, growth on your skin, skin ulcer,


or other skirt lesions for which you received medical


treatment by a doctor? Which? (1982-84)


Listed skin conditions include shingIes and, lupus 

erythematosus 

23 
Number of times this condition recurred that


required treatment by a doctor, including surgical


removal


Parts of the body on which this condition located:


Head or face, arms, hands, legs, feet, other (spec­


ified)


Since 1970, ever stayed in a hospital overnight for


treatment of this condition?


Did a doctor ever tell you that you had any cancer?


(1982-84)


Since (month and year) had any type of cancer diag­


nosed? (1986, 1987)


Location


Type


When first told


Since 1970, been hospitalized overnight for this


condition?


When a child or teenager, were you ever sunburned so


badly that your skin blistered? (1982-84)


In the past 10 years, ever been confined to bed for most


of the day for at least a 2-week period? (1982-84)


Ever had a bedsore, an open sore caused by being


confined to bed for a long time or unable to move about


as usual? (1982-84)


Had pain on most days for at least 1 month: In neck; in


back; in or around either hip joint, including the but­


tock, groin, and side of upper thigh; in or around the


knee, including back of knee? Which knee?


Had pain or aching in any joint other than the hip, back,


or knee on most days for at least 6 weeks? (1982–84)


Had any swollen joints that were painful when touched


on most days for at least 1 month? (1982–84)


The longest episode of neck pain ever had: 1 month, 2-5


months, 6-12 months, more than 1 year (1982–84)


Age when first experienced this recurring neck


pain


Still having this neck pain?


When was the last time you had this pain?


Does this neck pain occur more frequently than it


used to?


Pain present when you areiwere resting at night?


Pain awaken(s) you from sleep at night?


Pain seem(s) to spread?


Pain spread(s) to:


The top and back of the head?


Either shoulder?


The arms or hands?


Is/was your neck pain made worse: 

By coughing, sneezing, or deep breathing? 

With bending or twisting motion? 

After prolonged sitting? 

After prolonged standing? 

With other motion? 

Ever had neck pain caused by an injury? (1982-84) 

Was the neck pain caused by playing a sport, doing 

your job at work, or some other activity? 

Ever been told by a doctor that you had a “whiplash” 

injury of the neck? (1982–84) 

Ever been told by a doctor that you had a slipped or 

ruptured disc in your neck? (1982–84) 

Were you in traction to treat this sIipped or ruptured disc? 

Ever stayed in a hospital overnight for neck pain? 

(1982-84) 

Have any surgery for neck pain? (1982-84) 

Number of times 

Had pain in back on most days for at least 1 month? 

(1982-84) 

The longest episode of back pain ever had 

Age when first experienced this recurring back pain 

Still having this pain? 

The last time you had this pain 

Does this pain occur more frequently than it used 

to? 

Where is/was the pain located: Upper back, midback, lower back? 

When have/had this pain, where is/was it most 

intense: Upper back, mid-back, lower back? 

Was/is the pain present when resting at night? 

Does/did it awaken you from sleep at night? 

Does/did the pain seem to spread? 

Does/did the pain spread to: Back of right leg? 

Back of left leg? Top of the head? Sides of body? 

Is/was your back pain made worse: 

By coughing, sneezing, or deep breathing? 

With bending or twisting motion? 

After prolonged sitting? 

After prolonged standing? 

With other motion? 

Ever had back pain caused by an injury? (1982-84) 

Was the back pain caused by playing a sport, doing 

your job at work, or some other activity? 

Ever been told by a doctor that you had a slipped or 

ruptured disc in your back? (1982–84) 

Were you in traction to treat this slipped or ruptured disc? 

Ever stayed in a hospital overnight for back pain? 

(1982-84) 

Was this hospitalization since 1970? 

Have any surgery? 

How many times? 

Had pain in or around either hip joint, including the 

buttock, groin, and side of the upper thigh, on most days 

for at least 1 month? 

Longest episode of hip pain ever had 

Age when first experienced this recurring pain in 

the hip 

Still having this hip pain? 

When was the last time had the hip pain? 

Areas of the body the hip pain is/was usually most 

intense: Right buttock, leftbuttock, right groin, left 

groin, side of right upper thigh, side of left upper 

thigh, somewhere else? 

From the hip does/did the pain tend to spread? 

24 
.

,.	 Does/did the pain .tend to spread to: Inside of 

leg, front of leg, outside. of leg, back of leg, 

sorne.where else?, 

Do/did you have pain in or around the hip when


either, coughing or sneezing?


l$%en this pain islwas present, doesldid it hurt


when resting as well as when moving?


Since 1970, stayed overnight in a hospital for prob­


lems related to,.your hip pain?


Had pain in or around the knee, including the back of 

the	 knee, on most days for at least 1 month? 

Which knee? 

Longest episode, of .kqee pain ever had 

Age when first experienced recurring pain in the 

knee 

Still having this knee pain? 

Last time had this knee pain 

When this pain is/was present, does/did it hurt 

when resting as well as when moving? 

When. this @ee pain islwas present, islwas there 

also swelling of the knee joint? 

Is/was the joint warm to the touch? 

Does/did’ the joint appear red? 

Ever had “locking” of the knee? (1982-84) 

Which knee? 

Has either knee ever “given way” under you? (1982-84) 

Which knee? ~ -

Ever had a severe twisting of either knee resulting in a 

sprain or swelling lasting more than 2 weeks? (1982-84) 

Which knee? 

Had pain or aching in any joint other than the hip, back, 

neck, or knee on most days for at least 6 weeks? 

(1982-84) 

Which joints were painful? ‘ 

.	 Finger(s)? Right or left hand? 

Wrists? Right or left? 

Elbows? RigM or left? 

Shoulders? Right or left? 

Ankles? Right or left? 

Toes? Right or left foot? 

Ever had any swollen joints that were painful when 

touched on most days for at Ieast 1 month? (1982-84) 

Age when first experienced swelling of your joints 

,	 Still having this swelling of your joints? 

ThS last time you had this swelling 

Which joints are/were usually involved whenever 

you have/had this swelling with tenderness on 

touching? 

Finger(s)? Right or left hand? 

Wrists? Right or left? 

Elbows? Right or left? 

Shoulders? ‘Right or left? 

Hips? Right or left? 

Knees? Right or left? 

Ankles? Right or left? 

Toes? ,Right: or left foot? 

Did you ever have a surgical procedure on any of your 

joints? (1982-84) 

Which joints were operated on? 

Finger(s)? Right or left hand? ,, ,.


Wrist? Right or left?


Elbow? Right or left?


Shoulder? Right.,or left?


Hip? Right or left? ,:. .


free? Right or left? .’. .,,


Ankle? Right or left? ,, .


Toes? Right or left foot? :


Did you have any joints replaced? Which jgints?


How many replacements?


If finger(s), on right or left hand?


If hip, on right or left side?


If knee, right or left?


Any other joints?


Ever stayed overnight in a hospital. because of joint


problems? (1982-84)


Arthritis ever diagnosed by a doctor?’ (1986, 1987)


Type 

Ever had an x~for guthritis? : 

Time since first x~{y ,, 

Time since last x ,“ 

P Gout ever diagnosed by a doctor?. (1986, 1987) 

Year first toId ,.. Year had last episode of gout 

Ever had an attack of arthritis that the doctor said was 

caused by gout? (1986, 1987) -

Since (1980 or 1970), hospitalized for arthritis/gout? 

(1986, 1987) 

Since 1970, stayed overnight in a hospital because of 

joint problems? (1982-84). 

Pain visual analog scale measure for joint condition 

pain in the past week (1982-84) 

Ever been told by a doctor you had a fractured hip? 

A dislocated hip? (1982-84) 

Which hip? 

Age when it happened 

What year? (1986, 1987) 

Another fractured hip since then? (1986, 1987) 

Have surgery? 

Since 1970, hospitalized for this problem? 

. Had any broken or fractured bones (other than hip) 

since 1970? (1986) 

Which bone? 

What year? ,. 

Hospitalized? 

Since (month and year) had a br~ken or fractured 

wrist? (1987) 

Wliat yea?? 

Use of antacid:, aspirin, tranquilizers, antidepressants, 

vitamins, nutritional supplements (1982v84) 

Have any problems that prevent the use of one or more 

arms or legs? (1986, 1987) 

Because of severe arthritis? . 

Which limbs are involved? 

~ Use of special equipment (1986, 1987), , ‘“ 

For the following conditions, 

Ever diagnosed by a physician? , ; ~ 

Year first diagnosed , .:. ,. 

Hospitalized since 1970 for this condition? 

25 

,, 
Migraines (1982-84)


Ulcers: Peptic, stomach, or duodenal


(1982-84)


Kidney disorder or kidney stones


Urinary tract or kidney infection more than


three times


Colitis, enteritis (1982-84)


Angina (1982-84):


Frequency of (1982-84): 

Trouble falling asleep 

Trouble with waking up during the night 

Trouble with waking up too early and not being 

able to fall asleep again 

Getting so sleepy during the day or evening that you 

have to take a nap 

Taking a sedative or sleeping pill prescribed by a 

doctor for sleep 

Compared with 1 year ago, have sleep problems much


more now, somewhat more now, somewhat less now,


much less now, or is sleeping pattern about the same?


(1982-84)


Usual number of hours of sleep (1982-84)


Medicare coverage (1987)


If subject dead (1982-84): 

Was pain medication received during the 24 hours preceding death? 

Whether medication was received or not, were there 

complaints of pain or evidence of pain during the 24 

hours preceding death? 

Was the pain mild, moderate, or severe? 

Any chest pain within 72 hours preceding death? 

Duration of pain 

Any medication to ease chest pain? 

Abbreviated General Well-Being Schedule (1982-84) 

During past month, bothered by any illness, bodily disorder, pains, or fears about your health? 

Center for Epidemiologic Studies Depression Scale 

(1982+?4) 

Feelings during the past week 

Data tape availability 

1982-84 NHEFS Mortality, NTIS accession no PB 88-


102306


1982–84 NHEFS Health Care Facilities, NTIS accession no


PB 88-102280


1982-84 NHEFS Interview, NTIS accession no PB 88-


121298


1982–84 NHEFS Vital and Tracing Status, NTIS accession


no PB 88-102264


Technical contact: 

Christine S. Cox


Division of Analysis


6525 Belcrest Road, Room 1080


Hyattsville, MD 20782


(301) 436-5978


1986 NHEFS Mortality, NTIS accession no PB 90-501651


1986 NHEFS Health Care Facilities, NTIS accession no


PB 90-501669


1986 NHEFS Interview, NTIS accession no PB 90-501667


1986 NHEFS Vital and Tracing S~atus, NTIS accession no


PB 90-501664


Technical contact: 

Fanchon F. Finucane


Division of Analysis


6525 Belcrest Road, Room 108(I


Hyattsville, MD 20782


(301) 436-5975


Questionnaire source items 

Cohen BB, Barbano HE, Cox CS, et al. Plan and operation


of the NHANES I Epidemiologic Followup Study, 1982–84.


National Center for Health Statistics. Vital Health Stat


1(22), 1987.


Fried VM, Finucane FF, Madans JH, et al. Plan and oper­


ation of the NHANES I Epidemiologic Followup Study,


1986. National Center for Health Statistics. Vital Health


Stat 1(25). 1990.


Continued followup questionnaires can be obtained by


writing to technical contact person,


National Health interview Survey 

(MIS) 

Survey design 

General household health survey of the U.S. civilian 

noninstitutionalized population using a multistage probability design that permits continuous sampling throughout 

the year. The sample is designed in such a way that the 

sample of households interviewed each week is representative of the target population and that weekly samples are 

additive over time. Independent samples are selected each 

year. Interviews have been conducted annually since 1957 

with approximately 111,000 persons living in about 42,000 

households. The sample has ranged in magnitude from a 

high of about 134,000 persons in some 44,000 households in 

1972 to a low of about 62,000 people in approximately 

35,000 households in 1986. The 1986 sample represented 

only one-half of the new sample, which was redesigned in 

1985. About 123,000 persons in 1987 and about 122,000 

persons in 1988 and 1989 were interviewed in approximately 

47,000 households each year. 

Basic data elements 

Data include information on household and sociodemographic characteristics; acute illnesses and injuries; disability days (for example, bed days, work-loss days, and 

school-loss days) associated with acute and chronic conditions; prevalence of selected chronic conditions and 

impairments; limitation of activity because of one or more 

26 
chronic conditions or impairments; and use of physicians, 

dentists, and short-stay hospitals. Supplements to the core 

questionnaire change from year to year in response to current interest in special health topics. Health insurance 

information is collected periodically. Data are located on 

multiple tapes. 

Pain data elements 

Core questionnaire items 

Restricted activity in past 2 weeks because of (painful) 

condition? Coded according to the International Classification of Diseases (ICD) 

Number of bed days


Number of work-loss days


Number of school-loss days


Number of reduced-activity days


Limitation of activity because of ICD-coded (painful) 

condition: 

Unable to perform usual activity for one’s age and 

sex group? 

Limited in kind or amount of usual activity? 

Limited, but not in usual activity? 

Physician visit(s) in past 2 weeks because of ICD-coded 

(painfuI) condition? 

Type of doctor seen (most years) 

Short-stay hospitalizations because of ICD-coded 

(painful) condition (condition data available for 

1969-81): 

Number of discharges or episodes


Number of days


Average length of stay


Operations performed


When and how bothered by condition (Most years 

1969-81) 

Surgery for condition? (Most years 1969-81) 

Hospitalization for condition? (Most years 1969-81) 

Injuries: Class of accident 

Pain-related items -

Various pain-related items have been placed among 

core questionnaire items in different years. Some are 

listed as follows: 

Limitation of mobility caused by (painful) chronic 

condition coded according to Eighth Revtiion Irzternational Classification of ,Dkeases, Adapted for Use 

in the United States (ICDA) (1969, 1971, 1972) 

Duration 

Cause of pain on movement or joint tenderness 

(1969): 

Any accident or injury


Exertion from sports and so forth


Bursitis and/or tendinitis


Heart condition, hypertension, and so forth


Back, neck, or spine trouble


Arthritis, rheumatism, and so forth


Old age


Received disability payments or benefits from 

(1977): 

Social Security Administration? 

Veterans Administration? 

Public assistance? 

Chronic condition checklists: 

Musculoskeletal system and skin condition list 

(1969, 1976, 1978-90), which includes: 

Arthritis or rheumatism


Gout


Lumbago


Sciatica (198+90)


Bone cyst or bone spur (1989-90)


Osteomyelitis (through 1988)


Slipped or ruptured disc


Repeated trouble with neck, back, or spine


Bursitis or synovitis


Trouble with fallen arches, flatfeet, or


clubfoot (through 1988)


Trouble with ingrown toenails or


fingernails


Trouble with bunions, corns, or calluses


Impairment condition list (1971, 1977-90), 

which includes: 

Repeated trouble with back or spine 

Any trouble with fallen arches or flatfeet 

Any condition caused.by an old accident or 

injury— specified 

Digestive condition list (1975, 1978-90), which 

includes: 

Gallstones 

Gallbladder trouble 

Ulcer 

Hernia or rupture 

Gastritis 

Enteritis 

Diverticulitis 

Colitis 

Cancer of the stomach, colon, or rectum 

Glandular, blood, nervous, and genitourinary 

condition list (1973, 1978–90), which includes: 

Migraine 

Neuralgia or neuritis 

Sciatica (1973, 1978-83) 

Nephritis 

Kidney stones 

Cardiovascular condition list (1972, 1978-90), 

which incIudes: 

Angina pectoris 

Myocardial infarction 

Hemorrhoids 

Phlebitis or thrombophlebitis 

Miscellaneous condition list (1973), which 

includes: 

Migraine 

Neuralgia or neuritis 

Sciatica 

Nephritis 

Kidney stones 

27 

,, 
All conditions and impairments are ICD-codeci and 

can be identified by individual code. Listings that group, 

or recode, common conditions and diseases have also been 

developed. Prior to 1982, there were five condition 

recodes. Recode 1 lists 278 categories of diseases, injuries, 

and impairments; recode 2 [ists 33 of the most common 

acute conditions from recode 1; recode 3 lists 53 chronic 

conditions and impairments from recode 1; recode 4 is a 

38-code condition list used in tabulating the diagnosis 

reported for each hospitalization; and recode 5 is a 

58-code listing of diseases, injuries, and impairments. 

Since 1982, conditions and impairments have been 

recoded into three diagnostic recodes, Recode A consists 

of 32 four-digit categories of frequently reported acute 

conditions, including fractures; sprains and strains; acute 

back, spine, and neck pain; and headache, excluding 

migraine. Recode B is a modified listing of diseases and 

injuries developed by the World Health Assembly and is 

primarily used in NHIS to classify conditions reported as 

causing activity limitation. Recode C consists of 134 threedigit categories of chronic conditions and impairments, 

The categories correspond to the conditions that appear 

on the checklists of selected chronic conditions. These 

categories are used in NHIS to produce prevalence estimates of selected chronic conditons. 

Supplements to the core questionnaire are presented 

here by type of data collected and are listed below according 

to the major epidemiologic uses, as outlined in appendix V. 

Type of data Major uses 

Morbidity– acute and Magnitude, scope, and 

chronic structure 

Disability	 Magnitude, scope, and 

structure 

General health status Magnitude, scope, 

and psychological structure, risk factors, 

well-being and impact 

Health practices Risk factors 

Use of health services Impact and 

and availability of management 

resources 

Social and economic	 Impact and 

management 

Morbidi& (acute and chronic) 

Accident Supplement (all ages) (1975) 

ICDA-coded condition resulting from an accident 

When accident happened: Past week, week before that, 

2weeks-1 month, 1–2 months, 2–3 months, 3–4 months, 

4-6 months, 6 or more months 

Number of times saw doctor 

Restricted-activity days 

Bed-disability days 

Work- or school-loss days 

Where accident happened 

How accident happened 

28 

Cancer Control Supplement (ages 18 years and over) (1987) 

Was last Pap smear, breast physical examination, mammogram, digital rectal examination, blood stool test, 

proctoscopic example because of a health problem? 

What was the problem? Pain? 

Supplement Booklet Section N2: Back Pain (ages 18 years 

and	 over) (1988) 

Back pain other than menstrual pain every day for a 

week during the past 12 months? 

Number of ciays of back pain 

Number of full days missed from work because of back 

pain 

Part of back bothered the most: Upper, middle, lower 

Back pain ever spread to: Buttocks? Thighs? Lower leg 

or foot? 

Is the back pain the result of: 

A single accident or injury, such as slipping, falling,


twisting, lifting something, or being in a car acci­


dent?


Repeated activities, such as lifting, pushing,


pulling, bending, twisting, or reaching?


Where back pain started: At work, at home, recre­


ational site, other


Occupation, industry, and type of work done


Cause of back pain


Has your back bothered you today?


When last had back pain


Number of consecutive days of back pain


Year first had an episode of back pain that lasted for


a week or more


Number of years have had episodes of back pain lasting


for a week or more


Longest period of time had back pain every day


Ever stopped working at a job or changed jobs because


of back pain?


Ever made a major change in work activities because of


back pain?


Supplement Booklet Section N3: Hand Discomfort (ages 18 

years and over) (1988) 

During the past 12 months, had discomfort in hands, 

wrists, or fingers? (Discomfort can mean pain, burning, 

stiffness, numbness, or tingling.) 

Number of days in past 12 months with discomfort


in hands, wrists, or fingers


Have discomfort every day for a week or more


during past 12 months?


Which hand had discomfort: Right, left, or both?


Discomfort worse when trying to sleep or did it awaken


you from sleep?


Hand(s) bothered you today’?


Time since last had discomfort


Number of consecutive days, weeks, or months of dis­


comfort


Year first noticed this hand discomfort


Total number of different years of hand discomfort 

During past 12 months, were you away from work for 

more than 1 week for any reason? 
When away from work for more than 1 week, did 

hand discomfort increase, decrease, or stay the 

same? 

During past 12 months, miss at least a full day from 

work because of hand discomfort? 

Ever stopped working at a job or changed jobs because 

of hand discomfort? 

Ever made a major change in your work activities 

because of hand discomfort? 

Time since last saw or talked to a medical doctor, chiropractor, physical therapist, or other medical person 

about your hand discomfort 

Diagnosis 

Ever had any of the following conditions? 

Arthritis of the hand, wrist, or fingers? 

A broken bone in your hand, wrist, or fingers? 

A condition affecting the ,wrist and hand called 

carpal tunnel syndrome? 

Supplement Booklet Section N7: Conditions (ages 18 years 

and over) (1988) 

During past 12 months, had: 

Repeated trouble with neck, back, or spine? 

A condition affecting the wrist and hand called 

carpal tunnel syndrome? 

A condition affecting the fingers and/or toes called 

Raynaud’s phenomenon? 

A condition affecting the tendons called tendinitis? 

Ever told by a doctor or other medical person that 

[above condition] was related to any job you ever 

had? 

A worker’s compensation claim ever filed for your 

[above condition]? 

During past 12 months, told by your doctor or 

employer to stay home from work temporarily 

because of your [condition]? 

During past 12 months, did your employer transfer 

you to another job, either temporarily or permanently, because of your [condition]? 

During past 12 months, did your employer give you 

lighter work or excuse you from certain duties at 

work because of your [condition]? 

Ever stop working at a job or change jobs because 

of your [condition]? 

Occupation and industry related to your 

[condition]? 

Supplement Booklet Section P5: Childhood Conditions 

(ages 17 years and under) (1988) 

Ever have: 

Repeated tonsillitis or enlargement of the tonsils or 

adenoids? 

Frequent or repeated ear infections? 

Frequent or severe headaches, including migraines? 

Arthritis or any other joint disease or joint 

problem? 

Have [condition] in the past 12 months?


Have had [condition] for at least 3 months in Iifetime?


Current Health Topics Section Q2 Diabetes Followup 

Questions (ages 18 years and over) (1989) 

Has a doctor ever told you that you had angina? 

Ever had symptoms of a bladder infection that lasted 

more than 3 months, such as frequent urination and 

pain in your bladder? 

Were you told that you had painful bladder syndrome or interstitial cystitis? 

Age when told 

Current Health Topics Section R: Orofacial Pain (ages 18


years and over) (1989)


See appendix II for a facsimile of the questionnaire.


Current Health Topics Section S1: Specific Digestive


Conditions (ages 18 years and over) (1989)


During the past 12 months, have gallstones? Any other


gallbladder trouble?


Ever have gallstones? Any other gallbladder trouble?


When first diagnosed 

During the. past 12 months, have an ulcer? 

Ever had an ulcer? 

When first diagnosed 

Type: Gastric, duodenal, peptic, or other 

During the past 12 months, have spastic colon, functional bowel, irritable colon, or irritable bowel syndrome? 

Ever had spastic colon, functional bowel, irritable 

colon, or irritable bowel syndrome? 

Have hemorrhoids in the past 12 months? 

Ever diagnosed by a doctor?


When last talked to a doctor about hemorrhoids


Ever had surgery for hemorrhoids?


Current Health Topics Section S2 Abdominal Pain (ages 18 

years and over) (1989) 

See appendix 111for a facsimile of the questionnaire. 

Current Health Topics Section S3: Normative Bowel


Functions (ages 18 years and over) (1989)


Frequency during past 12 months of bowel movements


accompanied by pain:


Always; most of the time; some of the time; rarely; 

never 

Have had a lot of trouble in the past year with: 

Abdominal pain 

Chest or heart pain 

Pain in the joints 

Pain in arms and legs, other than in the joints 

Backaches 

Headaches 

Pain when urinating 

Current Health Topics Section T: Diabetes Risk Factors 

(ages 18 years and over) (1989) 

Number of times in past 12 months had a bladder or 

urinary tract infection 

Ever had symptoms of a bladder infection that lasted 

more than 3 months, such as frequent urination and 

pain in your bladder? 

29 
Told that you had painful bladder syndrome or 

interstitial cystitis? 

Age when told 

1990 Supplement Booklet Section O: Podiatry 

During the past 12 months, anyone in the family have 

trouble with: 

Deformities of the toe or joint, including hammer


toe, claw toe, and missing toes?


Bunions?


An injury, such as a sprain, strain, fracture, or


dislocation of the foot?


Arthritis of the toes?


Still have [problem] or has it gone away or been


cured?


Duration of [problem]


[Problem] serious enough to consider getting


professional care?


During the past 12 months, get medical care for


the foot problem(s)?


If not, why not? 

Covered by health insurance that would pay for 

treatment for the foot problem(s)? 

If not, if insurance paid for the medical 

care, think you would have gone for the 

foot problem(s)? 

Types of health professionals seen in the past 

12 months about the foot problem(s): Podiatrist, orthopedic specialist or surgeon, osteopath, physical therapist, any other medical 

doctor, any other health professional 

Number of times seen each type


Where seen


Has or will health insurance pay for any


part of the care for the foot problem(s)?


If not, would you still have gone for 

medical care for the foot problem(s)? 

Disability 

Disability Person Supplement (ages 3 years and over)


(1977)


ICDA-coded conditions


Chronic or acute


Onset of (painful) condition


Because of (painful) condition, needs help with: 

Getting around (or stays in bed) 

Bathing 

Dressing 

Eating 

Using toilet 

How long help needed


How often needs help


How often receives help


Person providing help: Relative, friend, nurse, other,


unknown


Number of bed days in past 12 months


Because of (painful) condition, needs help with using


public transportation


Does (painful) disability or heaIth problem prevent


driving a car?


Is car specially equipped for you?


Hospital insurance coverage


Use of physical therapy, psychological counseling, job


counseling or guidance, job or vocational training in


past 12 months:


Received service? 

Helped by service? 

Now needs service? 

Tried to get service? 

Received services during past 12 months; if government


agency involved, type


Tried to get information in past year about health


problem or disability?


Source of information 

Specific source other than doctor 

Changes made to place of residence 

Specific changes 

Special Aids (all ages) (1977) 

ICDA-coded condition(s) causing need 

Chronic or acute 

Onset of painful condition 

Type of aid: Artificial arm; artificial leg; brace, foot or


leg; brace, other part of body; brace, not otherwise


specified; crutches; cane or walking stick; special shoes;


wheelchair; walker; guide dog


Frequency of use


Length of time used


HI	 Supplement (ages 20 years and over) (1977) 

Disability or h~alth problem prevents driving car 

Service-connected disability? 

Work-loss days in past 12 months 

Home Care Supplement (all ages) (1979-80) 

Conditions are ICD-coded, as well as recoded to a 

two-digit code reflecting acute or chronic status. 

Because of (painful) condition, needs help with: 

Walking


Going outside


Using toilet


Bathing


Dressing


Eating


Getting in and out of bed


Supplement Booklet Section M: MedicaI Devices (all ages) 

(1988) 

Artificial joints: 

Have you had increased pain over time with the 

[type of artificial joint] you have now? 

Time had the [type of artificial joint] when the 

increased pain was first noticed: Less than 30 days, 

30-90 days, more than 90 days 

Why needed a [type of artificial joint]: Osteoarthritis; rheumatoid arthritis; arthritis, unspecified; 

injury; pain; some other reason 

30 
Fixation devices, intraocular lenses, pacemakers, other 

devices: 

Ever had surgery to replace or repair fihe device]? 

Reason for the surgery: Pain or irritation 

Time had device before reason for surgery was first 

noticed: 

Less than 30 days, 30-90 days, more than 90 

days 

Other than discomfort generally associated with 

surgery and healing, have you had any other pain 

with [the device] you have now? 

Time had [the device] when pain was first 

noticed: Less than 30 days, 30-90 days, more 

than 90 days 

Genercdhealth status and psychologicalwell-being 

Child Health Supplement (ages 17 years and under) (1981) 

Medications for mother during labor for sample child 

under 6 years 

Number of overnight hospitalizations for sample child 

Operation(s) as inpatient and/or outpatient 

Number


Type of operation


Child ever had chronic conditions: 

Onset of condition 

Age at onset 

Condition present during past 12 months 

Status of condition 

Length of time with condition 

Chronic or nonchronic? 

Repeated ear infections?


Nephritis?


Urinary tract infection?


Ulcer?


Migraines?


Frequent or severe headaches?


Colitis?


Hernia or rupture?


Arthritis?


Rheumatism?


Trouble with flatfeet?


Tendon, muscle, or cartilage disease?


Sickle cell anemia?


Cancer of any kind?


Use of medications during 2-week reference period: 

Pain relievers such as aspirin or Tylenol? 

Main health problem for which child took the 

medication 

Prescribed by physician? 

Recommended by physician? 

Frequency taken in past 3 months 

Tranquilizers or sedatives? 

Main health problem for which child took the 

medication 

Prescribed by physician? 

Recommended by physician? 

Frequency taken in past 3 months 

School limitation of activity for children ages 5-17 years 

because of chronic condition? 

Special classes or special help because of disability 

or health problem? 

Behavioral problems?


Impact of illness or”disability of child on family mem­


ber(s) \


Usual number of hours of sleep each night .


Usually takes naps?


Aging Supplement (ages 55 years and over) (1984) 

Chronic conditions coded according to 9th Revision of 

ICD 

Still have condition? Cured? Under control? 

Length of time had condition before cured 

Condition present in past 12 months? 

Condition cause activity limitation? 

Social support


Retired because of health?


Retired because work caused health problem?


Now receiving disability from any source?


Time received disability


Ever received disability payments from Social


Security?


By yourself and not using aids, have any difficulty with 

the following? Degree of difficulty: Some, a lot, or 

unable to do it? Number of years with specified diffiC1.dty 

Walking for a quarter of a miIe


Walking up 10 steps without resting


Standing or being on feet for about 2 hours


Sitting for about 2 hours


Stooping, crouching, or kneeling


Reaching up over head


Reaching out (as if to shake someone’s hand)


Using fingers to grasp or handle


Lifthg or carrying 25 pounds


Lifting or carrying 10 pounds


Think there are some kinds of work could do now if jobs 

were available? 

Want to work at a job or business? 

Ever had: 

Osteoporosis?


A broken hip?


Angina pectoris?


A myocardiaI infarction?


Any other heart attack?


Cancer of any kind?


During the past 12 months, arthritis of any kind or


rheumatism?


ICD-coded (painful) conditions causing difficulty


with activities of daily living


Onset of condition


Degree of difficulty (some, a lot, unable to do


it) in:


Bathing or showering? 

Use of special equipment: Shower or 

bathtub seats, handrails 

31

Dressing? 

Use of special equipment: Special 

clothes, fasteners, zipper pulls 

Eating? 

Use of special equipment: Special 

utensils, trays 

Getting in and out of bed or chairs? 

Use of special equipment: Cane, 

walker, special lifts 

Walking? 

Use of special equipment: Cane, 

walker, crutch, wheelchair, artificial leg, brace(s) 

Getting outside? 

Use of special equipment: Cane, 

walker, crutch, wheelchair, artificial leg, brace(s) 

Using the toilet, including getting to the 

toilet? 

Use of special equipment: Cane, 

walker, crutch, wheelchair, artificial leg, brace(s), bedpan, raised toilet 

seat, special toilet, handrails near 

toilet 

Receive help from another person? Who? Is 

this help paid for? 

ICD-coded (painful) conditions causing difficulty 

with activities of daily living 

Onset of condition


Degree of difficulty (some, a lot, unable to do


it) in:


Preparing your own meals


Shopping for personal items


Managing your money


Using the telephone


Doing heavy housework


Doing light housework


Receive help from another person? Who? Is 

this help paid for? 

Use of special equipment or aids in activities of 

daily living? 

What type? 

ICD-coded (painful) condition causing confinement to bed or chair all or most of the time 

Onset of condition 

Ever been a resident or patient in a nursing home? 

Number of times 

Date admitted the first time 

Date discharged the last time 

Number of months in nursing home the last 

time 

Number of weeks in past 12 months spent in 

nursing home 

Worry over health: A great deal, some, hardly any, none


Physical activity level


Amount of control think have over future health: A


great deal, some, very little, none at all


Health practices 

Physical Fitness (all ages) (1975) 

Types of regular exercise 

Sports participant, team member, or tournament player 

by type of sport in past 12 months 

Think you are more, less, or about as active as other 

persons same age? 

Health Habits Supplement (ages 20 years and over) (1976) 

Used medicin&, drugs, or-pills for insomnia during the 

past 6 months? 

Used one or more times per week? 

Advised by doctor to take this medication? 

Used aspirin or aspirin-type pills in past 6 months? 

Used one or more times per week? 

Use of coffee, tea, tobacco 

Health status 

HI	 Supplement (ages 20 years and over) (1977) 

Number of hours usually slept 

Alcohol and tobacco use 

Physical activity relative to others same age 

Problems getting medical care 

Height and weight (also body mass index) 

Alcohol and Health Practices Supplement (ages 18 years 

and over) (1983) 

Ever had any of the following conditions: 

Arthritis or rheumatism? I 

Insomnia or sleeplessness? 

An ulcer, other than a skin ulcer? I 

Heart attack or heart failure? 

Angina pectoris? 

Cancer? 

Health Promotion and Disease Prevention (all ages) (1985) 

General health habits 

Number of hours of sleep 

Have a usual place of care? 

Kind of place 

One particular doctor at usual place? 

Main reason no particular place 

Injury control awareness 

Stress in past 2 weeks 

Effect of stress on health in past year 

Any physical exercise in past 2 weeks? 

Type: Walking; jogging or running; hiking; gardening or yardwork; aerobics or aerobic dancing; , 

other dancing; calisthenics or general exercise; 

golfi tennis; bowling; biking; swimming or water ‘ 

exercises; yoga; weight lifting or training; basketball; baseball or softball; football; soccer; volleyball; handball, racquetball, or squash; skating; 

skiing; other 

Number of times in past 2 weeks


Minutes spent each time


Increase in heart rate or breathing


32 
Degree of physical activi~ 

A-nount of physical work required on job 

Hours per day physical work done on job 

Amount of physical work required in main daily activity 

Hours per day physical work on daily activity 

On present job exposed to: Dangerous substances? 

Dangerous work conditions? Risk of accident? 

Type


Health effect: Cancer, headache, frostbite, bums


Useof health servicesand availabilityof resources 

Prescribed Medicines Supplement (all ages) (1973) 

Use of prescription medication in 2-week reference period 

Name of medication 

Condition for which medication was taken (painful 

conditions or general pain symptom) 

How obtained: 

Written prescription


Refill


Call to pharmacist


Given by physician


Source of payment 

Total cost 

Medical Care (all ages) (1974) 

U’ually, go to one particular doctor 

Place of usual care: Private doctor’s office, home, doctors’ clinic, group practice, hospital outpatient clinic, 

hospital emergency room, company or industry clinic, 

other 

Number of visits in past 12 months 

Kind of doctor usually seen 

Places doctor seen in past 12 months 

Reason for no particular doctor 

Sources of payment of doctor’s bills: Self or family 

social security Medicare; health insurance; worker’s 

compensation, accident insurance; Civilian Health and 

Medical Program of the Uniformed Services (CHAMPUS); veterans benefits; Medicaid; welfare; professional courtesy; employer, company doctor, or union; 

other insurance; no charge; other 

Problems getting care in past 12 months? 

Received as much care as needed? If not, why? 

In past 12 months, received services from: 

Chiropractor 

Podiatrist or chiropodist 

Physical therapist 

Currently Employed Person (ages 17 and over) (1974) 

Number of days lost time from work during past 2 weeks 

because of own illness or injury, medical care visit, 

someone else’s health problem or medical care visit 

Number of hours lost from work paid for: 

By employer: FuII, part, none


By loss-of-pay insurance, worker’s compensation,


State disability insurance, other


Earnings per hour 

Income per hour lost 

Number of days of wage-loss coverage (sick leave) 

Health Maintenance Organization (HMO) (all ages) (1975) 

Belong to HMO, covered by Blue Cross or Blue Shield, 

prepaid group, other health insurance? 

See other doctors? 

Reason 

Have one doctor or place of medical care? 

Type of placti Private doctor’s office, home, doctors’ clinic, group practice, hospital outpatient 

clinic, hospital emergency room, company or 

industry clinic, other 

Health Insurance (all ages) (1976) 

Medicare coverage? 

Medicaid used in past 12 months? 

Private health insurance coverage? 

Hospital 

Surgical 

Type of private health insurance plan 

How obtained: Through employer or union, 

through other group 

Hospital coverage? 

Surgical coverage? 

Use in past 12 months 

Reason for no Medicare and/or private health insurante coverage 

H1 Supplement (ages 20 years and over) (1977) 

Problems getting medical care? 

Reasons: Not available when needed, cost of care, 

didn’t know where to go, no transportation, inconvenient hours 

In past 12 months, received 

Veterans Administration medical care 

Medicare 

Worker’s compensation 

Disability benefits or payments from: 

Social Security Administration 

Veterans Administration 

Public assistance 

Health Insurance (all ages) (1978) 

Medicare coverage? 

Hospital? 

Doctor? 

Private health insurance coverage? 

Hospital? 

Surgical? 

Reason for no Medicare and/or private health insur­


ance coverage


Type of private health insurance plan


How obtained: Through employer or union,


through other group?


Hospital coverage?


Surgical coverage? .


Use in past 12 months


Aid to Families with Dependent Children and/or Supplemental Securi~ Income coverage? 

33 
Military pensioner or dependent?


Coverage by Veterans Administration health benefits?


Coverage by military benefits?


Supplemental Person (all ages) (1978) 

One source of care? 

Type 

Location (State, county) 

Travel time 

One particular doctor?


Place doctor last seen


Reason for no one source of care


Health Insurance (all ages) (1980) 

Medicare coverage? 

Hospital? 

Doctor? 

Private health insurance coverage? 

Hospital? 

Surgical? 

Reason for no Medicare and/or private health insur­


ance coverage


Type of private health insurance plan


How obtained: Through employer or union,


through other group?


Hospital coverage?


Surgical coverage?


Use in past 12 months


Doctor Service Supplement (all ages) (1983) 

Doctor visit in past 2 weeks for ICD-coded (painful) 

condition? 

Place of visit


Medical doctor actually talked to?


Kind of medical doctor


Type of medical assistant seen or talked to


Condition acute or chronic?


Operations performed during this visit?


Type of operation 

Travel time 

Reason for visit to this specific place 

Health Insurance (all ages) (1982-84 and 1989) 

Medicare coverage? 

Hospital? 

Doctor or surgeon? 

Current coverage if under 65 years 

Type of health insurance plan(s) 

Is plan an HMO? (1989) 

Obtained through employer or union? 

Now carried through employer or union? 

Plan pays for some or all: Hospital bills; doctor or 

surgeon bills for operations? 

Plan pays for some or all: Dental services; prescription drugs; mental health, alcoholism, or drug 

abuse services? (1989) 

Covered under private health insurance? 

Type 

Hospital coverage? 

Doctor or surgeon coverage? 

Covered by a plan that pays for a specific type of 

service? 

Type 

Reason for no Medicare and/or private health insurance coverage 

Aid to Families With Dependent Children or Aid to 

Dependent Children? 

Supplemental Security Income? 

Received Medicaid in past 12 months? 

Other public assistance health insurance coverage? 

Military health insurance coverage? 

Type 

Have an Armed Forces service-related disability? 

Veterans Administration compensation? 

Job layoff or loss in past 12 months? (1983, 1984, and 

1989) 

Number of times


Month laid off


Lost health insurance coverage?


No health insurance because of job layoff or loss?


Length of time without health insurance


Covered by other health care program?


Length of time covered 

Months with no insurance and no health care program 

Receipt of unemployment insurance benefits? 

(1984, 1989) 

Social and economic impacl 

Family Medical Expenses (all ages) (1975-76) 

Family type (by size, composition, and age of head) 

Personal and family expenses for: Dental bills, doctor 

bills, hospital bills, prescription medicine, other bills, 

health insurance premium 

Other expenses: Chiropractor, podiatrist, hearing 

aid, special braces, physical or speech therapy, special nursing care, nursing home or convalescent 

home care, multiple, and other 

Data tape availability 

National Health Interview Survey, Core Data 

Data year NTIS accession no 

1969 PB 235543 

1970 PB 237322 

1971 PB 238524 

1972 PB 285460 

1973 PB 285511 

1974 PB 285517 

1975 PB 281126 

1976 PB 300423 

1977 PB 80-203953 

1978 PB 81-179285 

1979 PB 82-157173 

1980 PB 83-248922 

1981 PB 84-111657 

1982 PB 85-236172/HAl 

1983 PB 86-138856 

‘ 

34 
1984 PB 87-121547 

1985 PB 87-148144 

1986 PB 88-146139 

1987 PB 89-140651 

1988 PB 90-501180 

National Health Interview Survey Supplements 

Data year Supplement 

1973 Prescribed Medicines 

1974 Currently Employed 

Medical Care 

1975	 Accident Supplement 

HMO –All Persons 

Physical Fitness 

Family Medical Expenses 

1976	 Health Habits 

Health Insurance 

Family Medical Expenses 

1977	 Disabili~ 

Special Aids 

H1 Supplement 

1978 Insurance 

Supplemental Person 

1979 Home Care –Person 

Supplement 

1980 Home Care –Person 

Supplement 

1981 Child Health 

1982 Health Insurance 

1983 Doctor Service 

Alcohol and Health


Practices


Health Insurance


1984 Aging 

Health Insurance 

1985 Health Promotion and Disease Prevention 

1987 Cancer Control 

1988 Supplement Booldet 

1989 Current Health Topics 

1990 Supplement Booklet 

Supplement tapes are available from the Division of Health 

Interview Statistics. 

Technical contact: 

Nelma Keen


Division of Health Interview Statistics


6525 Belcrest Road, Room 850


Hyattsville, MD 20782


(301) 436-7087


Questionnaire source items 

Gleeson GA, Interviewing methods in the Health Interview 

Survey. National Center for Health Statistics. Vital Health 

Stat 2(48). 1972. 

National Center for Health Statistics, Health Interview 

Survey procedure, 1957–1974. National Center for Health 

Statistics. Vital Health Stat 1(11). 1975. 

NationaI Center for Health Statistics. The National Health 

Interview Survey design, 1973–1984, and procedures, 

1975–1983. National Center for Health Statistics. Vital 

Health Stat 1(18). 1985. 

Blanken GE. Current estimates from the Health Interview 

Survey, United States, 1969. National Center for Health 

Statistics. Vital Health Stat 10(63). 1973. 

Wilder MH. Current estimates from the Health Interview 

Survey, United States, 1970. National Center for Health 

Statistics. VitaI Health Stat 10(72). 1973. 

Wilson RW. Current estimates from the Health Interview 

Survey, United States, 1971. National Center for Health 

Statistics. Vital Health Stat 10(79). 1973. 

Wilson RW. Current estimates from the Health Interview 

Survey, United States, 1972. National Center for Health 

Statistics. Vital HeaIth Stat 10(85). 1973. 

Wilder MH. Current estimates from the Health Interview 

Survey, United States, 1973. National Center for Health 

Statistics. Vital Health Stat 10(95). 1974. 

Ries PW. Current estimates from the Health Interview 

Survey, United States, 1974. National Center for Health 

Statistics. Vital Health Stat 10(100). 1977. 

Drury TF. Current estimates from the Health Interview 

Survey, United States, 1975. National Center for Health 

Statistics. Vital Health Stat 10(115). 1977. 

Black ER. Current estimates from the Health Interview 

Survey, United States, 1976. National Center for Health 

Statistics. Vital Health Stat 10(119). 1977. 

Howie LJ, Drury TF. Current estimates from the Health 

Interview Survey, United States, 1977. National Center for 

Health Statistics. Vital Health Stat 10(126). 1978. 

Givens JD.: Current estimates from the Health Inteiview 

Survey, United States, 1978. National Center for Health 

Statistics. Vital Health Stat 10(130). 1979. 

Jack SS, Ries PW. Current estimates from the National 

Health Interview Survey, United States, 1979. National 

Center for Health Statistics. Vital Health Stat 10(136). 

1981. 

Jack SS. Current estimates from the National Health Interview Survey, United States, 1980. National Center for 

Health Statistics. Vital Health Stat 10(139). 1981. 

Bloom B. Current estimates from the Health Interview 

Survey, United States, 1981. National Center for Health 

Statistics. Vital Health Stat 10(141). 1982. 

National Center for Health Statistics. Current estimates 

from the National Health Interview Survey; United States, 

1982. National Center for Health Statistics. Vital Health 

Stat 10(150). 1985. 

35 
National Center for Health Statistics. Current estimates 

from the National Health Interview Survey, United States, 

1983. National Center for Health Statistics. Vital Health 

Stat 10(154). 1986. 

Ries PW. Current estimates from the National Health 

Interview Survey, United States, 1984. National Center for 

Health Statistics. Vital Health Stat 10(156). 1986. 

Moss AJ, Parsons VL. Current estimates from the National 

Health Interview Survey, United States, 1985. National 

Center for Health Statistics. Vital Health Stat 10(160). 

1986. 

Dawson DA, Adams PF. Current estimates from the 

National Health Interview Survey, United States, 1986. 

National Center for Health Statistics. Vital Health Stat 10 

(164), 1987. 

Schoenborn CA, Marano M. Current estimates from the 

National Health Interview Survey, United States, 1987. 

National Center for Health Statistics, Vital Health Stat 10 

(166). 1988. 

Adams PF, Hardy AM. Current estimates from the 

National Health Interview Survey, 1988. National Center 

for Health Statistics. Vital Health Stat 10(173). 1989. 

Adams PF, Benson V. Current estimates from the National 

Health Interview Survey, 1989. National Center for Health 

Statistics, Vital Hea[th Stat 10(176). 1990. 

National Medical Care Utilization 

and Expenditure Survey (NMCUES) 

Survey design 

Health care expenditures and utilization survey of a 

panel of 17,500 civilian noninstitutionalized individuals 

throughout the United States and 13,400 individuals from 

Medicaid enrollment lists in California, Michigan, New 

York, and Texas. A multistage area probability sampling 

procedure was used, and five mutually exclusive samples 

were obtained. Data were collected in five rounds of household interviews, conducted at 3-month intervals in 1980 and 

1981. 

Basic data elements 

Data include access to medical care; episodes of illness 

and injury; number of bed days, restricted-activity days, 

hospital admissions, physician and dental visits, other medical care encounters, and purchases of prescribed medicine. 

Detailed data, including cost data, were obtained for each 

contact with the medical care system. 

Pain data elements 

Conditions coded according to the 9th revision, International Classification of Diseases 

Restricted activity since (reference date)h because of 

(painful) condition: 

Number of bed days 

Number of work-loss days 

Number of days cut down on activities 

Limitation of activity because of (painful) condition: 

Unable to perform usual activity for one’s age and 

sex group? 

Limited in kind or amount of usual activity? 

Limited, but not in usual activity? 

Functional limitations? 

Visit to a medical person since (reference date)b? 

Type of provider seen 

Number of times seen (since reference date)b 

Visit to emergency room because of (painful) condi­


tion?


Visit to a hospital c[inic or outpatient department since


(reference date)?b


Type of provider seen 

Hospitalized because of (painful) condition? 

Number of nights 

Operations performed? 

Medicines prescribed for relief of pain? 

Date last obtained 

Number of times obtained since (reference date)’ 

Total cost 

Data tape availability 

National Medical Care Utilization and Expenditure 

Survey, 1980, NTIS accession no PB 83-229542 

Technical contact: 

Robert Wright


Division of Health Interview Statistics


6525 Belcrest Road, Room 850


Hyattsville, MD 20782


(301) 436-7100


Questionnaire source items 

Bonham GS. Procedures and questionnaires of the 

National Medical Care Utilization and Expenditure Survey. 

National MedicaI Care Utilization and Expenditure Survey 

A(l). National Center for Health Statistics, Washington: 

Public Health Service. 1983. 

National Survey of Personal Health 

Practices and Consequences 

(NSPHPC) 

Survey design 

Telephone-administered two-wave panel survey of 

3,025 adults ages 20-64 years living in households with 

‘The refcrcncc date for the first round of interviews was January 1, 1980. 

The rcfcrcnce date for rounds 2-4 was 3 months prior to the interview. 

The date for the last round was Dcccmbcr 31, 1980. 

36 
telephones in the 48 contiguous United States. The multistage probability sample was selected using a randomdigit-dialing technique. The first wave of the survey was 

conducted in 1979. In 1980, 2,436 of the Wave I respondents were successfully contacted and reintewiewed with 

virtually the same questionnaire. 

Basic data elements 

Data include information on personal health practices 

(such as smoking, drinking, sleeping, eating, physical 

activity, brushing, flossing teeth, and use of seatbelts), 

health status, functional limitations, use of health services, 

and history of family longevity. 

Pain data elements” 

Frequency of taking medicines in past month (1980): 

Aspirin 

Medicine for indigestion 

Sleeping pills 

Tranquilizers 

Taken Valium in past year? (1980) 

Last time taken Valium 

Worry over health in past year? 

Perceived control over health 

Frequency of headaches 

Social suppoti 

Social group participation – 

Labor or professional organizations 

Church 

Scouts and so forth 

Community service 

Frequency of visits with any close friends and


relatives


Number of friends and relatives seen at least


monthly


Enough close friends and relatives?


Marital happiness


Data tape availability 

National Survey of Personal Health Practices and Consequences, Waves I and II, NTIS accession no PB 83-104323 

TechnicaIcontact: . 

Patricia M. Golden


Division of Epidemiology and Health Promotion


6525 Belcrest Road, Room 1070


Hyattsville, MD 20782


(301) 436-7032


Questionnaire source items 

Danchik KM, Schoenborn CA, Elinson J. Highlights from 

Wave I of the National Survey of Personal Health Practices 

and Consequences, United States, 1979. National Center 

for Health Statistics. Vital Health Stat 15(1). 1981. 

cItems appear in both Waves I and H unless otherwise indicated. 

Eisenstadt R~ Schoenbom CA. Basic data from Wave 11 

of the National Survey of Personal Health Practices and 

Consequences: United States, 1980. Working Paper Serieq 

no 13. Hyattsville, MD: National Center for Health Statistics. 1982. 

National Survey of Family Growth 

(NSFG) Cycles Ill and IV and 

Followup 

Survey design 

Survey of U.S. women ages 1544 years, conducted on 

a cyclical basis using a multistage area probability sample. 

Cycle III inte~ews were conducted in 1982 with approximately 8,000 women. Cycle IV interviews were conducted 

during January-August 1988 with about 8,500 women. A 

computer-assisted telephone interview (CATI) followup 

was conducted during July–November 1990 and Cycle V is 

scheduled for 1992. 

Basic data elements 

Data include marital history, a detailed pregnancy history, fecundity, expected or intended future births, pregnancy planning practices, utilization of specific 

contraceptive methods, source of financing of family planning services, information on sex education and the sexually 

active population, socioeconomic and demographic information including religion, and, in Cycle IV, child care 

arrangements. 

Pain data elements 

This survey provides denominators for women ages 

15-44 years at risk of menstrual, pregnancy, and childbirthrelated pain. 

Ear infections during first year of life of child (Cycle III) 

Ever been treated for pelvic inflammatory disease? 

(Cycles 111and IV, CATI followup) 

Number of times (Cycle IV, CATI followup) 

When first received treatment (Cycle IV) 

When last received treatment (Cycle IV) 

Number of times hospitalized for a pelvic infection 

(Cycles III and IV, CATI followup–half sample) 

During (last) pregnancy, ever take any of the following 

drugs or medications (Cycle IV): 

Tranquilizers such as Valium, Llbrium, Equanil, 

and so forth? 

Sedatives such as phenobarbital, Seconal, chloral 

hydrate, and so forth? 

Data tape availability 

National Survey of Family Growth, Cycle III,, 1982 

Combined Respondent-Interval File, NTIS accession no: 

PB 85-100022 

37 
Technical Contact: 

William Pratt


Division of Vital Statistics


6525 Belcrest Road, Room 840


Hyattsville, MD 20782


(301) 436-8731


Questionnaire source items 

Questionnaires availab[e upon request from technical contact person. 

38


I 
Health care surveys 

National Ambulatory Medical Care 

Survey (NAMCS) 

Survey design 

Survey of approximately 3,000 non-Federal physicians 

in office-based practices in the 48 contiguous United 

States who provide information, using medical record 

encounter forms, on a systematic sample of about 50,000 

patient visits annually. The survey is conducted weekly 

throughout the year using a multistage probability sample. 

NAMCS was conducted annually from 1973 through 1981, 

again in 1985, and annually again starting in 1989. 

Basic data elements ~ 

Reasons for visit and diagnoses coded according to the 

International Classification of Diseases (ICD), including 

injuries and poisonings, are listed up to a maximum of three 

each. Also included are data on whether a patient was ever 

seen for the particular problem before and on diagnostic 

and therapeutic services ordered or provided. Sociodemographic information on the patient includes date of birth, 

sex, race (all years), ethnicity ( 1979-81, 1985, 1989–90), 

geographic region, and whether located in standard metropolitan statistical area. 

Pain data elements 

Patient information


Patient’s problem, complaint, or symptom:


Principal 

Other 

Seriousness (1973-78) 

Acute or chronic (1973-76, 1979-81) 

Time since onset of symptoms (1977-78) 

Physician diagnosis (ICD coding): 

Principal 

Other 

Treatment or service ordered or provided: 

Prescription 

Physiotherapy 

Psychotherapy or therapeutic listening 

Disposition of visit 

Duration of visit 

Names of medications prescribed (1980-81, 1985, 

1989-90) 

PhysicianInformatwn 

Special~


Type of practice (for example, group or private)


Type of doctor (doctor of medicine, doctor of


osteopathy)


Data tape availability 

National Ambulatory Medical Care Survey 

Data year NTIS accessionno 

1973 PB 293900 

1975 PB 290478 

1976 PB 291152 

1977 PB 80-130230 

1978 PB 80-204092 

1979 PB 82-122029 

1980 PB 82-191941 

1981 PB 84-188960 

1985 PB 88-103676 

1989 PB 91-509745 

National Ambulatory Medical Care Survey-Drug 

Mentions 

Data year NTIS accessionno 

1980 PB 83–154799 

1981 PB 83-199570 

1985 PB 88-146113 

1989 To be assigned 

Technical contact: 

Ray Gagnon


Division of Health Care Statistics


6525 Belcrest Road, Room 952


Hyattsville, MD 20782


(301) 436-7132


Questionnaire source items 

NOTE Identical questionnaires were used for the years 

shown in parentheses after the citation. 

DeLozier JE, Gagnon RO. The National Ambulatory Medical Care Survey 1973 summary, United States, May 

1973–April 1974. National Center for Health Statistics. 

Vital Health Stat 13(21). 1975. (1973-74) 

Koch H, McLemore T. The National Ambulatory Medical 

Care Survey: 1975 summary, United States, 

39 
January-December 1975. National Center for Health Statistics. Vital Health Stat 13(33). 1978. (1975-76) 

Ezzati T, McLemore T. The National Ambulatory Medical 

Care Survey: 1977 summary, United States, January-December 1977. National Center for Health Statistics, Vital 

Health Stat 13(44). 1980. (1977-78) 

Gagnon RO, DeLozier JE, McLemore T. The National 

Ambulatory Medical Care Survey, United States: 1979 summary. National Center for Health Statistics. Vital Health 

Stat 13(66). 1982. (1979) 

Cypress BK, Patterns of ambulatory care in general and


family practice: The National Ambulatory Medical Care


Survey; United States, January 1980-December 1981.


National Center for Health Statistics, Vital Health Stat 13


(73). 1983. (1980-81)


Nelson C, McLemore T, The National ArnbulatoV Medical


Care Survey; United States, 1975-81 and 1985 trends.


National Center for Health Statistics. Vital Health Stat 13


(93). 1988. (1985)


National Hospital Discharge 

Survey (NHDS) 

Survey design 

Survey of patient discharges from about 450 nonFederal, short-stay hospitals throughout the United States 

using a two-stage probability sample. Hospital selection is 

stratified by bed size, geographic region, and ownership. 

Data are abstracted from the face sheets of a systematic 

sample of discharged patients. The survey has been conducted annually since 1965. 

Basic data elements 

From 1965, data elements include patient characteristics (age, race, and marital status); hospital characteristics 

(location, size, and ownership); all-listed diagnoses, 

including injuries and poisonings (coded according to the 

International Classification of Diseases (ICD) revision in 

use at the time of data collection); all-listed procedures; 

average length of stay; and discharge status. Since 1977, an 

item on expected source of payment has also been included. 

See appendix VI for discussion of ICD coding. 

Pain data elements 

Selected diagnoses involving pain. The following disorders are listed for illustrative purposes only. All disorders 

listed on the hospital record are available on the tape. 

Angina pectoris 

Ankylosing spondylitis 

Burns, site specified 

Degeneration of lumbar or lumbosacral intervertebral 

disc 

Disorders of synovium, tendon, and bursa 

Gout


Lumbago


Lumbar intervertebral disc without myelopathy


Migraine


Osteoarthritis


Rheumatoid arthritis


Sciatica


Sprains and strains, site specified


Traumatic amputation, site specified


Trigeminal nerve disorders


Ulcer, site specified


Data tape availability 

Data year NTIS accession no


1970 PB 270763


1971 PB 270765


1972 PB 270767


1973 PB 270769


1974 PB 270771


1975 PB 270773


1976 PB 82-179227


1977 PB 82-179326


1978 PB 82-179342


1979 PB 82-179334


1980 PB 83-126318


1981 PB 85-152338


1982 PB 85-153658


1983 PB 85-152304


1984 PB 86-107737


1985 PB 87-125613


1986 PB 88-129440


1987 PB 89-121537


Technical contact: 

Robert Pokras


Division of Health Care Statistics


6525 Belcrest Road, Room 952


Hyattsville, MD 20782


(301) 436-7125


Questionnaire source items 

NOTE: Identical questionnaires were used for the years 

shown in parentheses after the citation. 

Ranofsky AL, Utilization of short-stay hospitals: Annual 

summary for the United States, 1974. National Center for 

Health Statistics. Vital Health Stat 13(26). 1976. (1965-76) 

Haupt BJ, Utilization of short-stay hospitals: Annual summary for the United States, 1977. National Center for 

Health Statistics. Vital Health Stat 13(41). 1979. (1977-78) 

McCarthy E. Inpatient utilization of short-stay hospitals by 

diagnosis, United States, 1979. National Center for Health 

Statistics. Vital Health Stat 13(69). 1982. (1979-80) 

Graves EJ, Haupt BJ. Utilization of short-stay hospitals, 

United States: 1981 annual summary. National Center for 

Health Statistics. Vital Health Stat 13(72). 1983. (1981-82) 

40

Graves EJ. Utilization of short-stay hospitals, United 

States: 1983 annual summary. National Center for Health 

Statistics. Vital Health Stat 13(83). 1985. (1983-84) 

Graves EJ. Utilization of short-stay hospitals, United 

States, 1985 annual summary. National Center for Health 

Statistics. Vital Health Stat 13(91). 1987. (1985-86) 

Graves EJ. National Hospital Discharge Survey: Annual 

summary, 1987. National Center for Health Statistics. Vital 

Health Stat 13(99). 1989. (1987-89) 

The 1990 questionnaire can be obtained from the technical 

contact person. 

National Nursing Home Survey 

(NNHS) 

Survey design 

Survey of current residents, discharged residents, and 

employees of U.S. nursing homes, using a two-stage cluster 

probability sample. Nursing home selection was stratified 

by bed size and type of service. A systematic sample of 

current residents, discharged residents (1977 and 1985), 

and employees was then selected. (Only registered nurses 

were sampled in 1985.) Three cycles of NNHS have been 

conducted. The 1973–74 nationaI survey covered approximately 1,900 nursing homes, 19,000 current residents, and 

21,000 employees. The 1977 national survey covered 

approximately 1,500 nursing homes, 7,000 current residents, 5,100 discharged residents, and 13,600 employees. 

The national sample was augmented in 1977 in California, 

Illinois, Massachusetts, New York, and Texas to produce 

State-level estimates. The total sample for these five States 

included 650 nursing homes, 3,100 current residents, 2,500 

discharged residents, and 5,700 employees. The 1985 

national survey covered approximately 1,100 nursing 

homes, 5,200 current residents, 6,000 discharged residents, 

and 2,800 registered nurses. 

Basic data elements 

Administrative information for the facility and the staff. 

Data for current and discharged residents consist of information on diagnoses –limited to a list in 1973–74 and 1977 

and full International Classification of Diseases (ICD) 

coding in 1985 —functional status, physician and other services received, visitors, and overnight leave. In 1985, additional information was obtained on diagnosis-related group 

catego~ for any hospital visit and on sources of payment. 

Pain data elements 

FacilityQuestionnaire


Services routinely provided on premises:


Counseling or therapy by psychiatrist, psychologist, or 

mental health worker (1977) 

Supervision over medications that may be self-


administered (1973–74 1977)


Medications and treatments administered in accord­


ance with physician’s orders (1973–74, 1977)


Rub and massage (1973-74, 1977)


Physical therapy (1973-74, 1977)


Occupational therapy (1973-74, 1977)


Other rehabilitation therapies (1973-74, 1977)


Services provided to nonresidents: 

Physical therapy (1977, 1985) 

Services offered to residents (1985): 

Medical services 

Nursing services 

Mental health services 

Physical therapy 

Occupational therapy 

Vocational rehabilitation 

Prescribed medicines or nonprescribed medicines 

Resident Questionnaire 

Prima~ reason for admission 

Physical (illness or need for treatment) (1973-74, 1977) 

Primary diagnosis at time of admission 

Accidents, poisonings, and violence (for example, fracture of hip, other broken bones, burns, concussion) 

(1973-74) 

Diseases of the musculoskeletaI system and connective 

tissue (for example, arthritis, rheumatism, back pain) 

(1973-74) 

ICD code (1985) 

Primary diagnosis at time of last medical examination 

Accidents, poisonings, and violence (for example, fracture of hip, other broken bones, burns, concussion) 

(1973-74) 

Diseases of the musculoskeletaI system and connective 

tissue (for example, arthritis, rheumatism, back pain) 

(1973-74) 

Arthritis or rheumatism (1977) 

Gout (1977) 

Ulcers (1977) 

Current conditions or impairments 

Arthritis or rheumatism (1973-74, 1977) 

Any chronic trouble with back or spine (1973-74, 1977) 

ICD-coded (painful) condition (1985) 

Therapy services received in past month (1973–74, 1977, 

1985): 

Physical therapy 

Occupational therapy 

Medications received during past 7 days (1973-74): 

Tranquilizers 

Analgesics 

htianginal drugs 

Antidepressants 

Conditions for which resident received medication in past 

7 days (1977): 

Arthritis or rheumatism 

Chronic back or spine problems (excluding stiffness 

and deformity) 

41

A rub or massage received in the past 7 days? (1977) 

Is resident depressed or withdrawn? (1973-74, 1977) 

Does resident display depression which restricts functioning nearly every day? (1985) 

Discharged Resident Questionnaire (197Z 1985) 

Exhibition of any of the following conditions or impairments by former resident? (1977) 

Arthritis or rheumatism 

Chronic back or spine problems (excluding stiffness 

and deformity) 

Primary diagnosis at time of former resident’s admission: 

Arthritis or rheumatism (1977) 

Gout (1977) 

Ulcers (1977) 

ICD-coded (painful) condition (1985) 

Primary and other diagnoses (ICD-coded) at time of dis­


charge (1985)


A rub or massage received during last 7 days before dis­


charge? (1977)


During month prior to discharge did former resident


receive (1977):


Physical therapy? 

Occupational therapy? 

Staff Questionnaire (1973-74, 1977) 

Number of nondegree training courses taken in past year in: 

Physical therapy or rehabilitation 

Occupational therapy 

Pharmacology and care of drugs 

Enrollment in past 12 months in nondegree training in


mental or social problems of the aged or chronically ill?


(1977)


Performs work, counseling services? (1977)


Nursing Questionnaire (1985) 

Taken a continuing education workshop during the past 

year on: 

Occupational therapy? 

Pharmacolo~ and the aged or chronically ill? 

Physical therapy or rehabilitation? 

Data tape availability 

National Nursing Home Survey, 1973–74, NTIS accession 

no PB 89–159420 

National Nursing Home Survey, 1977, NTIS accession no 

PB 80-188030 

National Nursing Home Survey, 1977, five States (California, Illinois, Massachusetts, New York, Texas), NTIS 

accession no PB 80–188717 

National Nursing Home Survey, 1985, NTIS accession no 

PB 89-159503 

Technical contact: 

Esther Hing


Division of Health Care Statistics


6525 Belcrest Road, Room 952 

Hyattsville, MD 20782 

(301) 436-8830 

Questionnaire source items 

Sirrocco A, Koch H. Nursing homes in the United States 

1973–74, National Nursing Home Survey, National Center 

for Health Statistics. Vital Health Stat. 14(17). 1977. 

Van Nostrand JF, Zappolo A, Hing E, et al. The National 

Nursing Home Survey, 1977 summary for the United States. 

National Center for Health Statistics. Vital Health Stat 13 

(43). 1979. 

Hing E, Sekscenski E, Strahan G. The National Nursing 

Home Survey: 1985 summary for the United States. 

National Center for Health Statistics. Vital Health Stat 13 

(97). 1989. 

Next-of-Kin (NOK) Component of 

the 1985 National Nursing Home 

Survey (NNHS) 

Survey design 

Supplements the 1985 NNHS survey of current residents and discharged residents of U.S, nursing homes using 

a computer-assisted telephone interview system, Interviewing took place from October 1985 through March 1986, 

Of the 11,181 people eligible, NOK interviews were completed for 9,084 subjects, using proxy respondents (primarily next of kin) if the subject could not participate. 

Administrators or other facility personnel were contacted 

for a few subjects who were in facilities and for whom no 

next of kin could be located. The NOK component was 

conducted by NCHS in collaboration with the National 

Institute on Aging. 

Basic data elements 

The NOK was used to obtain information that was not 

readily available from patient records or other sources in 

the nursing home, Information was obtained on the resident’s status prior to the sample admission, past use of 

nursing homes, hospital admissions and discharges, activities of daily living at admission, reasons for entering the 

nursing home, method of payment, current vital status, and 

living arrangements, 

Pain data elements 

First five (pain-related) medical reasons for admission 

and main (pain-related) medical reason for admission: 

Hip fracture 

Other fracture 

Arthritis 

Central nervous system diseases, injuries 

Burns, skin diseases, infections 

42 
Data tape availability 

Next-of-Kin Component, 1985 National Nursing Home 

Survey, NTIS accession no: To be assigned 

Technical contact: 

Mary Ann Bush


Division of Analysis


6525 Belcrest Road, Room 1080


Hyattsville, MD 20782


(301) 436-7037


Questionnaire source items 

Questionnaire available upon request from technical contact person. 

National Master Facility Inventory 

(NMFI) and 1986 Inventory of 

Long-Term Care Places (ILTCP) 

Survey design 

Surveys of ailhospitals in the United States were made 

annually from 1963 through 1976. (Data for years subsequent to 1976 are available from the American Hospital 

Association, 840 Lake Shore Drive, Chicago, Illinois 

60611.) Surveys of all nursing and related-care homes in the 

United States were made in 1963, 1967, 1969, 1971, 1973, 

1976, 1978, 1980, and 1982. In 1986, the survey was called 

the Inventory of Long-Term Care Places, and, in addition 

to nursing and related-care homes, it included facilities for 

the mentally retarded. The data were gathered using a mail 

questionnaire. 

Basic data elements 

Comprehensive list of facilities in the United States that 

provide medical, nursing, personal, or custodial care to 

groupi of unrelated persons on an inpatient basis. Data for 

hospitals include name of facility, ownership, type of 

facility, number of beds, days of care, discharges, admissions, type of service, outpatient visits, employees, and facilities and services offered. Data for nursing homes and other 

health facilities include name of facility, address, number of 

beds, ownership, type of facility, ages and sexes served, and 

number of residents. 

Pain data elementsd 

Numing and related-care homes; 

Resident facility for: 

Extended care (1971-73) 

Skilled nursing home (1971-86) 

Skilled nursing facility of a hospital (1976, 1986) 

Nursing home (1971-86) 

dItems appear in all years of the survey unless otherwise noted. 

Convalescent home (1971-76)


Rest home (1971-73)


Home for the aged (1971-73)


Residential facilities (1986)


Nursing care unit of a retirement center (1971-76)


Average length of stay (1971) 

Information collected but not available on data tapes: 

Number of full- and part-time occupational therapists (1973–78) 

Number of full- and part-time occupational 

therapy assistants and aides (1973-78) 

Number of full- and part-time physical therapists 

(1973-78) 

Number of full- and part-time physical therapy 

assistants and aides (1973–78) 

RoutineIy provided services: 

Supervision over medications that may be self-


administered


Medications and treatments administered in


accordance with physician’s orders


Rub and massage


Hospitals: 

Type of service hospital provides to majority of patients: 

Rehabilitation 

Orthopedic 

Chronic disease . 

Facilities and services located within the hospital: 

Bum care unit 

PhysicaI therapy department 

Occupational therapy department 

Rehabilitation inpatient unit 

Number of beds 

Rehabilitation outpatient unit 

Home care department 

Annual number of visits 

Clinical psychology services (1973-76) 

Data tape availability 

National Master Faciliq Inventory, nursing homes and 

other health facilities 

Data year NTIS accession no 

1971 PB 287270 

1973 PB 287268 

1976 PB 287230 

1980 PB 83-178459 

1982 PB 86-237872 

Inventory of Long-Term Care Places 

Data year NTIS accession no 

1986 PB 88-110606 

National Master Facilip Inventory, hospitals 

Data year NTIS accession no 

1971 PB 284912 

1972 PB 284914 

1973 PB 284916 

1974 PB 284918 

43 
1975 PB 284920 

1976 PB 284922 

Technical contact:


Al Sirrocco€

Division of Health Care Statistics€

6525 Belcrest Road, Room 952€

HyattsvilIe, MD 20782€

(301) 436-8830€

Questionnaire source items 

Sirrocco A. Inpatient health facilities as reported from the 

1971 MFI Survey. National Center for Health Statistics. 

Vital Health Stat 14(12). 1974. 

Sirrocco A. Inpatient health facilities as reported from the 

1973 MFI Survey, National Center for Health Statistics. 

Vital Health Stat 14(16). 1976. 

44 

Sutton JF, Sirrocco A. Inpatient health facilities as reported 

from the 1976 MFI Survey. National Center for Health 

Statistics. Vital Health Stat 14(23). 1980. 

Strahan GW. Inpatient health facilities statistics, United 

States, 1978. National Center for Health Statistics. Vital 

Health Stat 14(24), 1981. 

Sirrocco A. Nursing and related care homes as reported 

from the 1980 NMFI Survey. NationaI Center for Health 

Statistics. Vital Health Stat 14(29). 1983. 

Sirrocco A. Nursing home characteristics: 1986 Inventory of 

Long-Term Care Places. National Center for Health Statistics. Vital Health Stat 14(33), 1989. 
.

Vital statistics surveys 

/


I National Natality Survey (NNS) and


National Fetal Mortality Survey 

. (NFMS) 

Survey design 

National Natality Surveys, conducted in 1963–69, 1972, 

and 1980, were based on pr-obability samples of registered 

births occurring in a calendar year in each registration area 

in the United States. Because all pain data elements were 

\. .)	 collected in the 1980 survey, only information from this 

survey is addressed here. For the first time in 1980, the 

natality survey was accompanied by the 1980 National Fetal 

Mortality Survey, based on a sample of registered late fetal 

\	 deaths. In NNS and NFMS, questionnaires were mailed to 

married mothers, hospitals where the deliveries occurred, 

attendants at delivery, and x-ray technicians and radiologists. The data set contains birth certificate information for 

all sample births and questionnaire information for survey 

respondents. The sample contained approximately 9,900 

live births and 6,400 late fetal deaths to married and unmarII	 ried women in the 1980 survey. Of the 7,825 married women 

with live births and 4,815 married women with fetal deaths 

who were sent questionnaires, response rates were 79.5 and 

74.5 percent, respectively. 

Basic data elements 

Survey data include about 300 items, including medical 

care of the mother, breastfeeding practices, information 

about previous pregnancies, childbearing expectations, 

sterilization, smoking and aIcohol use, heaIth status of 

mother and child, marital history, electronic fetal monitoring, and amniocentesis. The vital record contains basic 

sociodemographic data, State of birth, number of previous 

children born alive, number of fetal deaths, birth order, 

birth weight, and completed weeks of pregnancy. 

Pain data elements 

Total duration of labor (1980) 

Number of anesthetics used for delivery (1980) 

Type” of anesthetic used for delive~ (1980) 

Inhalation (general) 

Local (pudendal block) 

Spinal 

‘Epidural 

Other anesthetic used 

Type of delivery (1980)


Number of aspirin tablets taken per month during preg­


nancy (1980)


Data tape availability 

The National Natality Survey and the National Fetal 

Mortality Survey– 1980, NTIS accession no PB 

84-177310 

Technical contact: 

Paul Placek or Kenneth Keppel 

Followback Survey Branch 

Division of Vital Statistics 

6525 Belcrest Road, Room 840 

Hyattsville, MD 20782 

(301) 436-7464 

Questionnaire source items 

Keppel KG, Placek PJ, Heuser R, et al. Methods and 

response characteristics – 1980 National Natality and Fetal 

Mortali~ Surveys. National Center for Health Statistics. 

Vital Health Stat 2(100). 1986. 

National Mortality Followback 

Survey (NMFS) 

Survey design 

Survey based on a systematic random national sample 

of 1 percent of U.S. resident deaths occurring in 1986 to 

persons 25 years of age and over. The sample was stratified 

for race, age, cause of death, month of death, State, and sex. 

A total sample of about 18,500 decedents was drawn. Questionnaires were mailed to death certificate informants or 

other knowledgeable relatives and to all health care facilities that were used by decedents in the last year of life. Data 

collection was completed in 1988. 

Basic data elements 

Survey data from death certificate informants include 

hospital, nursing, and other facili& care in the last year of 

life; number of doctor visits in last year of life; Medicare 

coverage, sources of payment for health care in the last year 

of life; help for activities of daily living in the last year of life; 

problems getting care in the last year of life; lifestyle (for 

45 
example, tobacco and alcohol use, and diet); selected 

chronic conditions; occupation and income; family size; 

history of heart attack in family; and total value of things 

owned by decedent, Health care facility data for each discharge in the last year of life include length of stay, diagnoses, and medical procedures. Death certificate data 

include sociodemographic information, place of death, date 

of death, underlying cause, and relationship of informant to 

decedent. 

Pain data elements 

-. Cause(s) of death coded according to International 

Classification of Diseases 

Ever had a heart attack? 

How long before death was first heart attack? 

Ever had angina pectoris? 

How long before death when first noticed? 

Within the hour before death, did the person start 

having anew or sharply increased problem such as chest 

pain, difficulty breathing, or fainting? 

Data tape availability 

National Mortality Followback Survey, 1986 

NTIS accession no PB 90-501800 

Technical contact: 

Paul J. Placek 

Chief, Followback Survey Branch 

Division of Vital Statistics 

6525 Belcrest Road, Room 840 

Hyattsville, MD 20782 

(301) 436-7464 

Questionnaire source items 

Questionnaires available upon request from technical contact person. 

1988 National Maternal and Infant 

Health Survey (NMIHS) and 1990 

Longitudinal Followup (LF) 

Survey design 

In the 1988 NMIHS, conducted from December 1988 

through December 1990, 21,000 vital records of live births, 

infant deaths, and fetal deaths were sampled and a total of 

60,000 mothers, hospitals where the births and infant deaths 

occurred, and providers of prenatal care were surveyed. 

Questionnaires were linked with the vital records, which 

included 11,000 birth certificates, 6,000 death certificates 

for infants, and 4,000 reports of fetal death of 28 weeks 

gestation or more. In the 1990 LF, linked to NMIHS, 10,000 

respondents who had live births in 1988, their hospitals and 

pediatric providers, 1,000 women who had experienced 

infant deaths, and 1,000 women who had experienced stillbirths were reinterviewed. 

46 

Basic data elements 

For NMIHS, data from mothers include barriers to 

prenatal care; source of payment; use patterns of those in 

the Women, Infants, and Children (WIC) program; 

smoking; alcohol and marijuana use; work patterns before 

and after delive~; infant feeding practices; infant health 

and medical care up to 6 months; and sociodemographic 

characteristics, Data from hospitals include maternal hospitalizations; maternal and infant diagnoses and procedures 

coded according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM); 

charges for care and diagnosis-related groups; cesarean 

delivery and trial of labor; fetal monitoring; medicaI devices 

and monitors; neonatal intensive care; and infant hospitalizations up to 6 months. Data from prenatal care providers 

include prenatal visit measures, patient education, acquired 

immunodeficiency syndrome (AIDS) and sexually transmitted disease testing, sonograms and X rays, prescribed 

medications and vitamins, amniocentesis and chorionic 

villus sampling, and charges for care. 

For the 1990 LF, data from mothers include child 

development and behavior up to 3 years of age; child care; 

child nutrition and WIC food use; child immunizations; 

barriers and costs of primary pediatric care; parental 

smoking, drinking, and drug use; stress and social support; 

subsequent fertility; occupation; and environmental hazards. Data from pediatric care providers include child 

medical histories, AIDS testing, lead screening, medications, and charges for care. Data from hospitals incIude 

diagnoses and procedures (ICD-9-CM coding), child hospitalizations, and charges for care. 

Pain data elements 

1988 National Ma[emal and Infant Health Survey 

Mother’s Questionnaire 

Health problems or symptoms during this 

pregnancy: 

Abdominal cramps 

Severe headaches 

Hemorrhoids 

Illnesses or problems baby had during each of the 

first 6 months: 

Ear infection 

Eye infection 

Colic 

Injury from bad fall or accident 

Prenatal Care Provider Questionnaire 

ICD-9-CM code for any diagnoses and diagnostic 

or obstetric procedures performed during this 

pregnancy 

Names, dosage, and duration of therapy of medications or drugs recommended, prescribed, or 

administered 

Hospital Questionnaire 

ICD-9-CM code for any diagnoses and diagnostic 

or obstetric procedures for the mother: 

During the delivery 

I 
During her pregnancy


Up to 6 months after her delive~


Methods of anesthesia during delivery


Epidural


Spinal


Local or pudendal block


Inhalation


None


Names, dosage, and duration of therapy of medi­


cations or drugs recommended, prescribed, or


administered


ICD-9-CM code for any diagnoses and procedures


used on the infant after delivery and if


rehospitalized


1990 Longitudinal Followup 

Mother’s Questionnaire 

Number and circumstances of serious injuries of 

child that required a doctor’s or nurse’s care 

.- While riding in a car 

‘i Other than from a car accident 

Child ever suffered a burn that needed a doctor’s 

or nurse’s care? 

Number of times 

Circumstances 

Any injuries as a result of using an apnea monitor? 

Type of injury 

Conditions of the child in the past 30 days 

Stomach ache without vomiting 

Stomach “flu” with vomiting and diarrhea 

Ear infection or earache (otitis media) with 

fever 

Sore throat with high fever 

Urinary tract infection 

Tonsillitis 

Over-the-counter medicines given the child in the 

past 30 days 

Aspirin 

Tylenol 

Other pain relievers and fever reducers 

Number of medical visits for child for injuries 

Pediatric Care Provider Questionnaire 

Injuries requiring medical care? 

Description 

Date 

Circumstances 

Reported as child abuse? 

Poisoning requiring medical care? 

Type 

Date 

Circumstances 

Malignant or benign neoplasms? 

Type and site 

Date of diagnosis 

Ever concerned the child has experienced or reported 

the	 child for: 

Neglect? 

Sexual abuse? 

Physical abuse? 

Hospital Questionnaire 

Hospitalization or emergency room episodes for child 

after the age of 6 months 

Admission and discharge dates 

ICD-9-CM coded diagnoses and procedures 

Data tape availability 

National Matemal and Infant Health Survey, 1988 

,NTIS accession no PB 92-500081 

Tapes are not yet available for the 1990 J_S 

Technical contact: 

Paul J, P1acek


Chief, Followback Survey Branch


Division of Vital Statistics


6525 Belcrest Road, Room 840


Hyattsville, M_D20782


(301) 436-7464


Questionnaire source items 

Questionnaires available upon request from technical contact person. 

47 
Vital statistics 

registration 

Mortality ,Statistics (MS) 

Survey design 

One-hundred percent registration of deaths in the 

United States since 1933. Deaths are registered by the 

States and reported to NCHS on an ongoing basis. 

Basic data elements 

Detailed data include characteristics of the location of 

residence of the deceased, age at death, day of death 

(1972-77), whether autopsy was performed (1972-77), 

whether findings were used (1972–77), multiple cause-ofdeath codes (1968-present), and underlying cause-of-death 

codes, which include codes for accidents and injuries. Mortality data are coded according to the International Classification of Diseases (ICD) revision in use at the time of 

data collection, (See appendix VI,) Local area summary and 

cause-of-death summary tapes contain selected data from 

the detailed tapes. 

Pain data elements 

All causes of death are ICD coded. To the extent that 

ICD rubrics can be used to identify painful conditions, 

magnitude and scope of mortality associated with pain can 

be ascertained. 

Data tape availability 

Vital statistics – mortali(y, detail 

Data year NTIS accession no


1968 PB 300800


1969 PB 299676


1970 PB 299679


1971 PB 300802


1972 PB 200885


1973 PB 300805


1974 PB 300807


1975 PB 300809


1976 PB 300811


1977 PB 300798


1978 PB 81-125106


1979 PB 83-132357


1980 PB 83-261552


1981 PB 84-213016


1982 PB 85-163897


1983 PB 86-120441


1984 PB 87-129706


48


1985 PB 88-101316


1986 PB 89-121180


1987 PB 90-500133


1988 PB 91-506626


Vital statistics –-mortali(y, local area summa~ 

Data year


1968


1969


1970


1971


1972


1973


1974


1975


1976


1977


1978


1979


1980


1981


1982


1983


1984


1985


1986


1987


1988


Vital statistics – 

Data year


1968


1969


1970


1971


1972


1973


1974


1975


1976


1977


1978


1979


1980


1981


1982


1983


NTIS accession no


PB 238827


PB 80-126618


PB 80-108749


PB 80-126642


PB 80-126667


PB 80-133374


PB 80-126683


PB 80-134158


PB 80-134117


PB 80-131675


PB 81-100232


PB 83-143230


PB 83-261636


PB 84-212992


PB 85-163913


PB 86-120482


PB 86-125639


PB 88-101357


PB 89-121586


PB 90-500158


PB 91-506642


mortali~, cause -of-dealh summaq 

NTIS accession no


PB 80-126550


PB 80-133358


PB 80-133333


PB 80-133317


PB 80-133275


PB 80-126576


PB 80-133291


PB 80-134133


PB 80-134091


PB 80-126592


PB 81-100257


PB 83-132373


PB 83-261578


PB 84-213032


PB 85-163764


PB 86-120466

1984 PB 87-129680 

1985 PB 88-101332 

1986 PB 89-121602 

1987 PB 90-500141 

Walstatisticsmortalip-multipleca useof death, detail 

Data year NTIS accession no 

I 1968 PB 82-191800 

1969 PB 82-155011 

1970 PB 82–121716 

1971 PB 82-142654 

1972 PB 82-191966 

1973 PB 82-191644 

1974 PB 82-186164 

1975 PB 82-157322 

1976 PB 81-186827 

1977 PB 81-217382 

1978 PB 82-105743 

1979 PB 83-153031 

1980 PB 84-112200 

1981 PB 85-153617 

1982 PB 85-224202 

1983 PB 86-138831 

1984 PB87-16103O 

1985 PB 87-235057 

1986 PB 89-121461 

1987 PB90-500448 

1988 PB 91-507343 

Technical contact: 

Mabel Smith 

Division of Vital Statistics 

6525 Belcrest Road, Room840 

Hyattsville, MD 20782 

(301) 436-8980 

The following vital statistics publications of the National 

Center for Health Statistics – all published in Washington 

by the Public Health Service-are now available. 

Questionnaire source items 

National Center for Health Statistics. Vital statistics of the 

United States, 1968, VO111, mortality, part A. Washington: 

Public Health Service. 1971. 

National Center for Health Statistics. Vital statistics of the 

United States, 1968, VO1II, mortality, part B. Washington: 

Public Health Service. 1971. 

t 

National Center for Health Statistics. Vital statistics of the 

United States, 1969, vol II, mortality, part A. Washington: 1’ Public Health Service. 1974.

1 National Center for Health Statistics. Vital statistics of the 

United States, 1969, vol II, mortality, part B, Washington: 

Public Health Service. 1973. r 

National Center for Health Statistics. Vital statistics of the 

) United States, 1970, vol II, mortality, part A. Washington: t Public Health Service. 1974. 

National Center for Health Statistics. Vital statistics of the 

United States, 1970, vol II, mortaIity, part B. Washington: 

Public Health Service. 1974. -

National Center for Health Statistics. Vital statistics of the 

United States, 1971, vol II, mortali~, part A. Washington: 

Public Health Service. 1975. 

National Center for Health Statistics. Vital statistics of the 

United States, 1971, VOIII, mortality, part B. Washington: 

Public HeaIth Service. 1974. 

National Center for Health Statistics. Vital statistics of the 

United States, 1972, vol II, mortality, part A. Washington: 

Public Health Service. 1975. 

National Center for Health Statistics. Vital statistics of the 

United States, 1972, vol II, mortality, part B. Washington. 

Public Health Service. 1975. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1973, vol II, mortality, part A. Washington. 

Public Health Service. 1977. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1973, vol II, mortality, part B. Washington. 

Public Health Service. 1975. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1974, vol 11, mortality, part A. Washington. 

Public Health Service. 1978. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1974, VOIH, mortality, part B. Washington. 

Public Health Service. 1976. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1975, vol H, mortality, part A. Washington. 

Public Health Service. 1979. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1975, vol II, mortaliiy, part B. Washington. 

Public Health Service. 1977. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1976, vol H, mortality, part A. Washington 

Public Health Service. 1980. 

National Center for Health Statistics. VitaI Statistics of the 

United States, 1976, VOI11, mortality, part B. Washington 

Public Health Service. 1980. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1977, VOIII, mortality, part A. Washington: 

Public Health Service. 1981. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1977, VO1II, mortality, part B. Washington: 

Public Health Service. 1980. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1978, VOIII, mortality, part A. Washington: 

Public Health Service. 1982. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1978, vol II, mortaliiy, part B. Washington: 

Public Health Service. 1982. 

49 
National Center for Health Statistics. Vital Statistics of the 

United States. 1979. vol II, mortality, part A. Washington: 

Public Health Service, 1984, 

National Center for Health Statistics. Vital Statistics of the 

United States. 1979. vol II, mortality, part B. Washington: 

Public Health Service. 1984. 

National Center for Health Statistics, Vital Statistics of the 

United States. 1980. vol II, mortality, part A, Washington: 

Public Health Service. 1985. 

National Center for Health Statistics. Vital Statistics of the 

United States. 1980. vol II, mortality, part B, Washington: 

Public Health Service. 1985. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1981. vol II, mortality, part A. Washington: 

Public Health Service. 1986. 

National Center for Health Statistics, Vital Statistics of the 

United States. 1981. vol II, mortality, part B. Washington: 

Public Health Service, 1986. 

National Center for Health Statistics. Vital Statistics of the 

United States. 1982. VOIII, mortality, part A. Washington: 

Public Health Service. 1986. 

National Center for Health Statistics, Vital Statistics of the 

United States. 1982. VOIII, mortality, part B, Washington: 

Public Health Service. 1986. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1983. VOIII, mortality, part A. Washington: 

Public Health Service. 1987. 

National Center for Health Statistics. Vital Statistics of the 

United States. 1983. vol II, mortality, part B. Washington: 

Public Health Service, 1987. 

National Center for Health Statistics. Vital Statistics of the 

United States. 1984. VOIII, mortality, part A. Washington: 

Public Health Service. 1987. 

National Center for Health Statistics, Vital Statistics of the 

United States. 1984. vol H, mortality, part B. Washington: 

Public Health Service. 1987. 

National Center for Health Statistics, Vital Statistics of the 

United States. 1985. vol H, mortality, part A. Washington: 

Public Health Service. 1988. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1985. vol II, mortality, part B. Washington: 

Public Health Service. 1988. 

National Center for Health Statistics. Vital Statistics of the 

United States. 1986. vol II, mortality, part A. Washington: 

Public Health Service. 1988. 

National Center for Health Statistics. Vital Statistics of the 

United States. 1986. VOIII, mortality, part B. Washington: 

Public Health Service. 1988. 

National Center for Health Statistics, Vital Statistics of the 

United States. 1987. VOIII, mortality, part A. Washington: 

Public Health Service, 1990. 

National Center for Health Statistics. Vital Statistics of the 

United States. 1987. vol H, mortality, part B. Washington: 

Public Health Service. 1989. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1988. VOIII, mortality, part A. Washington: 

Public Health Service, 1991, 

National Center for Health Statistics. Vital Statistics of the 

United States. 1988. vol II, mortality, part B. Washington: 

Public Health Service. 1990. 

Volumes for subsequent data years are not yet published, 

Divorce Statistics (DS) 

Survey design 

Divorce counts are obtained from all States and counties in the United States, In addition, States in the divorceregistration area (DRA) provide either microfilm copies of 

divorce certificates or machine-readable data tapes. The 

detailed divorce tapes contain a sample from the microfilm 

records and all the records from States that supply machinereadable tapes. Detailed data are available for all years 

since 1958 for States in the DRA. The following areas have 

participated in the DRA: Alabama, Alaska, California, 

Connecticut, Delaware, Georgia, Hawaii, Idaho, Illinois, 

Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Montana, Nebraska, New Hampshire, New 

York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode 

Island, South Carolina, South Dakota, Tennessee, Utah, 

Vermont, Virginia, Wisconsin, Wyoming, and the Virgin 

Islands. The number of participating States has expanded 

from 14 in 1958 to 31 in 1981. The District of Columbia 

joined in 1986; California dropped out in 1978, 

Basic data elements 

For 1958-67, data are published showing tabulations of 

counts of divorces by region, State, and county. For registration States there are also tabulations on plaintiff, duration of the marriage, and number of children. Shown 

separately for the husband and wife are race, ages at marriage and divorce, and marriage order. 

Beginning in 1968, computer tapes are available in 

addition to the published annual volumes. These tapes 

contain region, division, and State of divorce and marriage; month and year of marriage, separation, and divorce 

and durations between these events; plaintiff, and number 

of children under 18 years of age. They also contain, 

separately for the husband and wife, age; race; education; 

and number of times married, widowed, and divorced. Not 

all items are reported by every registration State in each 

year. 

Pain data elements 

Denominators are provided for people at risk of painful 

conditions that could be related to or exacerbated by I 

stresses that can be associated with divorce. 

50 
Total U.S. population 

?! Number of divorces by region, State, and county 

f Divorce-registration area States 

Number of this marriage 

Previous marital status 

Duration of marriage 

Number of children under 18 years of age 

Data tape availability 

PWalstatistics-divorce, detail 

Data year NTIS accessionno 

1968 PB 238824 

1969 PB 238825 

1970 PB 80-186745 

1971 PB 80-187164 

1972 PB 80-187180 

1973 PB 80-187149 

1974 PB 80-187123 

1975 PB 80-186786 

1976 PB 80-186760 

1977 PB 80-186729 

1978 PJ3 81-100216 

1979 PB 81-238800 

1980 . PB 83-242644 

1981 PB 84-164185 

1982 PB 85-179430 

1983 PB 86-165248 

1984 PB 87-125506 

1985 PB 88-127865 

1986 PB 89-209415 

1987 PB 90-501891 

1988 ~ PB 91-507731 

Technical contact: 

Barbara Wilson


Division of Vital Statistics


6525 Belcrest Road, Room 840


Hyattsville, MD 20782


(301) 436-8978,


I Questionnaire source items 

National Center for Health Statistics. Vital Statistics of the 

United States, 1968, vol III, marriage and divorce. Washington: Public Health Service. 1971. 

4	 National Center for Health Statistics. Vital Statistics of the 

United States, 1969, vol III, marriage and divorce. Washington: Public Health Service. 1972. ,$ 

National Center for Health Statistics. Vital Statistics of the 

United States, 1970, vol III, marriage and divorce. Washington: Public Health Service. 1974. 

National Center for Health Statistics, Vital Statistics of the 

United States, 1971,VOIIII, marriage and divorce. Washington: 

Public Health Service. 1975. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1972,VOIIII, marriage and divorce. Washin~om 

Public HeaIth Servic& 1976. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1973,VOIIII, marriage and divorce. Washington 

Public Health Service. 1977. 

National Center for ~ealth Statistics. Vit~ Statistics of the 

United States, 1974,VOIII, marriage and divorce. Washington 

Pubiic Health Service. 1977. 

National Center for Health Statistics. Vital Statistics of the 

United States, 1975,VOIIII, marriage and divorce. Washington: 

Public Health Service. 1979. 

National Center for Health Statistics. Vit~ Statistics of the 

United States, 1976,vol III, marriage and divorm. Washington: 

Public Health Service. 1980. 

National Center for Health Statistics. Vital Statistics of the 

United’StatR, 1977,vol III, marriage and divorce. Washington: 

Public HeaIth Service. 1981. 

NationaI Center for Health Statistics. Vital Statistics of the 

United States, 1978,vol III, marriage and divorce. Washington: 

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National Center for Health Statistics. Vital Statistics of the 

United States, 1979,vol III, marriage and divorce. Washington: 

Public Health Service. 1984. 

National Center for Health Statistics.. Vital Statistics of the 

United States, 1980;VOIIII, marriage and divorce. Washington 

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NationaI Center for Heakh Statistics. Vital Statistics of the 

United States, 1981,vol III, marriage and chorce. Washington 

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National Center for Health Statistics. Vital Statistics of the 

United States, 1983 vol III, marriage and divorce; Washington: 

Public Health Service. 1986. . . 

National Center for Health “Statistics. VitaI Statistics of the 

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National Center for Health Statistics. Vital Statistics of the 

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Volumes for subsequent data years are not yet published. 

..’ ,: 

‘51


i ,. 
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55 
Appendixes


Contents 

I, Projected pain-re!ated items in future NCHS surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57


II. 1989 National Health Intewiew Survey Current Health Topics section R: Orafacial pain. , . . . . . . . . . . . . . . . . . . . 58


HI. 1989 National Health Interview Survey Current Health Topics section S2: Abdominal pain. . . . . . . . . . . . . . . . . . 60


IV. Classification variables for analysis ofpain data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62


V, Summary ofselected pain measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63


VI. International Classification of Diseases description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66


List of appendix tables 

1. Classification variables available foranalysis ofpaindata, bysuwey or data system . . . . . . . . . . . . . . . . . . . . . . . 62


IL Pain measures, bysurvey or data system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63


56

Appendix I 

Projected pain-related 

: items in future NCHS 

‘!! surveys 

al


1991 National Health Interview Survey supplement Cause 

Treatment Inability to perform activities of daily living because of a Impact physical or mental condition


Need help from another person in performing activities of Incidence of falk in past 12 months


daily living because of a physical or mental condition Break hip as a result of a fail


Incidence of head injury where lost consciousness in past 12 1992 National Survey of Family Growth Cycle V 

months (18 years and over) Questions on pelvic inflammato~ disease Circumstances 

. 

. 

57 
-----

——— ——— ——----—

Appendix II 

1989 National Health 

Interview Survey 

Current Health Topics 

section R: Orofacial 

pain 

,.-—-. 

~ 00 NO~erson 18 + In familv ICoverwww of H@fAl

CHECK Sfar”. SLW7Pk Pec50n I O Avnitabl.a (Intro) Of 

ITEM 1 z O Callback rewired (Hhldptwy of HIS. 1) 

. m NonInterview (Section T) 

CHECK I I 6 

ITEM 2 Refer m 4b and 4f. ,, Oenral,. page 26. for sample person	 t O Sample person has no teeth (2J 

B= Other (1) 

1 a.	 During the pa.~ 6 m.wmh.. did you have. toothache mor. th WI tin.., I o Ye” I 7 

wh.m bltlql or .h.wdng? z � No /2/ 

.—. ——— ——— ——. ——— ——— ——— ——— ——— ——— —— 

b. Dld you fl..t hmve thl. p.in m.x. Xh.n 6 month. .w07 –,–~–y;; –––––––––– –––––––––– ––––”--u. 

20N0 

~ 2a. (Kku.lrw the p..t S month.) Dld vou have tmlnful sores or Ir.lt.tlons 1 0 Yes — .­

..mmd m. IIF8. o. erI the rm’wve, cheek.. or Qurn. rnc. m than on.. ? 

—————— —————————————————.————————— ——————————————— z D N. (3) ——-.———————— —-.—.— ~-i;,

b. Did VO” fk=a ho- the �-.9. or Irrlt-ri-n. m-r. *hen 6 month. �130? ! � Yes 20N0 --i 

3a.	 {DIWIIWI th= P-t 6 month.) Did you h... . prolonged, une.pl.in.d burning 1 � Yes I.-- ?3. . 

.=”..tlcm 1. your t.”wua or ..v other part of your mouth rnor. than 0.c,7 20No (4) 

————- ——..———————..—- 9DOK )

b. Whm you 

.—— h... tfd. ———..n..ttc.n, ———.——. 

doe. K ..nn. 

.—— ..d SF or 1. It I � Come 

. 

and go 

——.72 

CO”ttnuous mnd unlntunlpwd? 1 � Contlnuou%luninterrupted 

8 0 Other 

———————————————————————————————— uOOK ——— ——— ——— ——— ——— ——— ——— ——— ——— — —--- -—-— 

c.	 Durl”fI how rn..y DIFFERENT MONTHS i“ the P..t 6 month. dld 

“o” h.w. thl. .mt.ation? ——————.——————————————— D hfonrhs :—— —————— ————— ——— ———. ——— ——— ——— ——— ——— —— .—— —— — ; 

d. How snarIv ~otal d.v. 1“ th. P..* 6 month. did Y-U h.”. tht. sem..tlon? T � 1-3 days � � 16-30 days 7 D “Evmyday’” 

204-10dwa s � 31-45 days 9DOK 

3D 11-15 days .s � 46+ days 

—————— —————————————————————————— —————————————————————————— ————— ——— 

*6 e. Old YOU flu% hew- this s-”sJM- more *h-m 0 tn~rmh. qm? 

1 20N0 

1 � Yes EI 

4a.	 tOurlnw *h. P*.C 6 month.) Dld vou ham p.in in *h. I.v# jolm o. lrt 1 � Y,, L-E._ fret ef the . . . mo+m th.m on..? 

——-———.——————.——— -—————————————- —————————————————— 2 � No (5) —— ————————- — b. Wh.tt v-” h.w- this P.h’t, do.. it corn. � nd w- or 1. It comtlrmmu. �td t O Come and go I_-2.c I udmmruptad? z � Cont!nuou%lu”ln terrupted 

e O Other 

——————————————.——————————————— SUOK ——— .- . .----

c. DurlmI hew m.”v DIFFERENT MONTHS in th. p..t S month. did 1 1 L-.-l 18 

VOU ha”. *h!. Pal”? ~ Month, 

——— ——— ——— ——— ——— —__ ——— ——— ——— ——— —— _—— ——— ——— ——__— ——— ———_— ——— ——— ——— -. ,9—--

d. Mow mm”v ~ot-1 d-y, 1“ ti past S rn~”th, dld yc.u have this Pmlm7 1 0 1-3 days 4 � 16-30 days 7 � ,, Everyday,. 

204-10daw so 31-46 days aOOK


——— ——— —————————————————————————— ,0 11-15 dav. e O 46+ da.. ———.—— ---1——

a. D!d yaw flt.t h... this Pi. mom th.m S ,nc..tha �JW07 1 •1 Yes 20 

2UN0 

——_______________ ——— ——— ——— ——— ——— —————— ——-. 

r~zz f. On � 8=-1. of 1-10. -her- T 1s cnlld -“d 101. .-we,.. how would 

!ia.	

YOU 

IDWII’WI 

r.te 

*h. 

thl. 

p=.t 

palm 

S 

�

month.] 

i its wont? 

Dld you 

Circle 

h.... 

only one. 

dull, whlng P.in m.ro.. 1

12345678 

n Yes 

910 7

I 23 

your 

——— —————————————————————————— fmc. or ch.ek me.. th.m once? Do not count wlnu. pmtn. 2 � No (Check ttem 3) ——— ——_— — — ___________________ ———— ————— 2.I b. Whmn VOU h-v- lhl, p-in, doom h c-m .nd IJO -.1. It co”tlnuou8 and I � Come and go 

unl.turuptod? 2 � Contlnuousluninlerrupted 

e a Other 

LIUOK ———————————————————————————————- ————— —— ———

c. Durlnw how m-v DIFFERENT MONTHS In the P=.* 6 rnomth. dld 26 

you h... Ihl. p-h? = Months ——— ——— ——— ——— ——— ——— ——— ——— ——— ——— —— ————————————————————————— ——— —-. — —-— 

d. How mmv *0*.I d.vw lm tfm POW* O memth. dld VCUI h... thl. p9hT7 I � 1-3 days 40 16–30 days 7 n ‘, Everyday.’ 26 

2m4-10 days 6 � 31-45 d%’. SODK 

———————————————————————————————— ,0 11-15 davs e O 46+ davs 4 ——. — 27 e. Dld VDU flti h-w this p-k mom than S month. qfo? 1 0 Ye. 2nNo ‘--l ——— ——— ——— ——— ——— ——— —. ——— ——— ——— —— -

f.	 On � �C-IO CM 1-10. Wti 3 k ndld mnd ? 018 8-w-.*. hcsw would 12s —29 

vou rwea thlw P91n A tt* w-*7 Circle only one. 1234567 891O 

,O”M H!s. !A!, ,e, ) ,3 !...., 

58 
------ -------

--

,’., ----

-——..—––- .-–. . . aacuon n — unum GuAL VAa N — conmnuea 

1 ~ I CHECK I %D Two or more months in ..-/ one of 3c. 4c. or sc (6)

3 

Ref.,ZoSC,e, and5C. I

I 8 D Other (Saczlo” S] ITEM 

t Q 

6a.	 1“ th- w-t 6 month.. dJd vou .-or tmlk c- - DENTIST for 1 c1 Yes 

Sh- p-l” w- J-* dls=u..ocl? 1 2 n No (6C) 

——— ——— ——— ——— ——— ——— ——— ——— ——— ——— +——__— __________________________ 

= d“ri”a th- I..t 6 morsth. dld you ---or t-lk t- a , 

d.”tl.t bout C180p.1.? 1 — Tim.=. .. . 

1 999 D DK 

——— ——— ——— ——— ——— ——— ——— ——— ——— ——— —— ~——————— I ——— ——— ——— ——— ——— ——— ——— —.— 

m 

b. Hew cn-nvtlcn-.


C.	 II” Ch- P.*< 6 mwmih.} Did you s- or ti:k to - MEDICAL DOCTOR , * n Ye.. 

. bout *h. Ja.1-7 2 n No (Se) 

——————————————————————— .+-__ — ___________________________ -—————— 

d. H.ww cn.rwurn-.7 m 

: — Times ( 

1 sss O DK 

——— ——— ——— ——— ——— ——— ——— ——— ——— ——— —— I 

0.	 {In th. P=*C 6 months] DJd YOU *-- or talk to � nv othor r–~ii;:––––––––– –––-––––––––––––-m 

tYP= Of h-.lth Profo=.bn.l -bout th- P-1”? 1 2 n No f6hl 

——— ——— ——— ——— ——— ——— ——— ——— ——— ——— *_____________________ ——— ——— ——— —____ 

f. Wh-t kind of h--lth rmof-..l”.l?l? 1 Health professional e 

1 

t 

t ——— ——— ——— ——— ——— ——— ——— ——— ——— ——— ~——-— ———_________ —_____ ——— ——— ——— 

9.	 How rn-”y Utn-s during sh- P=st 6 rno”th. did you s.. o, 1 w 

t.lk to ~h- /parson i“ 6f)? — Times 1 

1 999 0 OK 

——— ——— ——— ——— ——— ——— ——— ——— ——— ——— —— l—— ——— ——— —__ ——— ——— ———-—————————, 

h. ([m th. P..* 6 rnca”th.) D;d you worry about tho h=alth Of I

t -CzCL 

YOUr SO-* -nd oums b-=-us- of tho P-1.? t o Yes 

: 2nNo 

-— —- ———-— ——— ——— ——— ——— ——— ——— ——— —— :—— — _______________________ _ 

i. (In th. P-t 6 sno”thml Old you w-q .botn th- h.atth of 8“ ~ D Yes m 

Y-.* bodv -=.”.. -r C18. p.l”? I 20N0 

t 

H.4ND CARD R 7 . R.L!d list if tatephrlne in r-rview.	 1 

8 

7.	 H-- Is - 11.t of Chi”g. P.OPI- do sh-n Ch.v h.”- t--th, mouth, o, I f-c- palm. PI---- c-11 m. M tilm~. you dld for the rmim d“rlmg tho 

p..= e m~.th.. I 

1 circle *II rh.m apply. 

: 

‘f — U.. - hot m. cold Gonwe.- 1 1 lE 

2 — T-k-. PNsri@on dN.Z :2 

! 2-

I 

3 — T-k= .“ owm-~ounsw drug IS ~= 

: 

4 - Drink -o- lZCWW or WIXI- &cmus- of UI. palm 14 

1 4E 

E — T-k- tins. off work : 6 em 

s- St.V h-- rno~ US-. USU4 16 6= 

7 — Avoid Tamlly mnd frb”dm :7 

8 7E 

1 

S — Am@iln~ -Is-? (Specify]” 8 8 (Specify] 8= 

0 - Non- of the above 10 

I OCIEC 

1 

S — Dc.rIh know 9 9DZC : 

Uocc.s 

.“ ,.,... . -..-.-.., P*O . .

59 
-- --

Appendix [11 

1989 National Health 

InterYiew Survey 

Current Health Topics 

section S2: Abdominal 

pain 

sectlcmT S2 — ABDOMINAL PAIN w 

I ~ Hmnd Card S 1. 

Th. .** ~e.tle.s � m .LMXN yin mu! dl..wntoe 1. the .bdome.. By 1 

.bd.mn.”. W. me-n [ths .hmdod � m. e“ thl, dleiw. rnlth. .,.* between the /


low.. rib. -A rlm hlp.1. Do not 1-14. p-in related to kldr.. y.. Mmddor, ix I , � ’YC!S
 .rlhrftl. [In.”.fi.tlo” m pmg”..cyl.


1. DURING THE PAST 12 MONTHS. h... you h-d .“Y fw.m of P-I” or 

; 213N0 C5ecflon S3/ 

.e”er,	 di%cmnfort in “our .bdom-r$ Ihr-e or m.,. tlme,7 1 90DK } ! 

~ 

2. H.”(I VO” .“-. m-d. m “l-it to - doctor for your =bdmnl”.1 Pal”? : t � Yes 

/f ssked, 0, tfm condltlo” thmt caused the Pal”. I 20N0 (4) 

1 90DK } 

313. Wh88t co”dltlon did .I’tm dc.cter ..Y wm. the cau,e of the P.lri? !

I ma Doctor dldn,l nay (4) 

Enfer first 5 code numbers end rhe Cc.ndlr)ons in rhe order rnenrkmwd. t 990 DK } 1 Do not probe. 1 Code Condition 

1 

I E 

1 

l— m 

1 — — E 

I 

m l— 

1 

m 

—- ——— ——— ——__—_ — _________ _____________ —__ ;---~ ————____—_————_——————————- ——— —.. —— .--— 

If only one response to 3JI. enter in 3b u+ fhc.uc asking. I 

b.	 Which of thea- ec.”dltlgns C-USA tfs- MOST PC)I,I durl”g the par ~ .— (Check irern 1) = 12 sne”th.? ! 

Enttw code number and condition. I 990 DK (Check hem 1) 

ea. Wh-t oo”dltlon do vou Chl”k wm. the C-USCJ of th- Pmln? 1 

Enter first 5 code numbers and the conditions in the order rnenrloned. I 990 DK (5) 

Do not probe. 1 Code Condition 

I m 1 

1 m 1 

1 

I_ EZ/IZ 

1 m 

I 

l— m 

——— ——— ——— ——— ——— ——— ——— —- ——— ——— ——— ———-— —-— l—— ——— ——— ——— ——— ——— ——— ——— ——— ——— ——--. ——— —- —— -—-- -

If onlv one response to 4.9, enrer in 4b w{rhcmt atsking. 1 

b.	 which of the.. corditiorm c-”smd the MOST p.!” d“rln~ the, pal ~ 

12 month.? (Check /zern 1) ~ ~ 

1 Enter code number and cc.ndirion. 99ii DK (Check Irern 11 

01 SPnstlc colon 22 G.llsvones 43 Tensloo 

02 F“”ctiO”E.1 bowel 23 Gestrltle 44 Trouble swallowing 

03 Irritable colon 24 Gastr.mnterltls 45 Tumor 

0.3 Irritable bowel syndrome 26 Growth 4e ulcer 

05 Allergies 26 Hewtb”rn 47 UIcmatlve colitis 

0S A“xlety 27 Hepatitis 4B Vlr”tl 

07 Arwe”diclti. 2S Hen+., other fhan hlatal 

08 Cancer 29 Hlatd hernia . 65 Arthritis 

09 Clrrhosl$ 30 Impaoted bowels . 66 Back problems 

70 Cc.litls 33 Ilxlia.st lo” - 67 81adder 

11 Conslipal!c.n 32 In fectIon - 6 B Kld”eya 

12 Croh”<s disease 33 Influenza - !59 Menstru al Ion 

13 Depmsslo” 34 Lectoe.e Intolerance . 60 Other female trouble 

14 Diarrhea 3 S Mad!cat{o” side effects . 61 Preunancy 

36 Dlvenlc”llt!m 3e Nerves _ 62 Prosrate 

16 Diverllculovls 37 Obc.twcted bowels 63 Othe, — Specify above 

1 7 E“t’ar!tl. 3 S Other bowel trouble S.4 OthcIr — SP.YCifV above 

1 S 

19 Esophr)git$s 

Flu 

3 S 

40 

Other Ilver Woubl. 

Other stomech troubla 

13S Other — Specify above 

20 Food PO!SO”t~~ 41 Padton$tls 6S Other — Specify obove 

21 Gallbladder problem 42 Stress S 7 Other - Specify above 

- DO not ask questions 6-27 -bout these conditions. 

la. 62 ,0.M .,.. ,. !,*.*, ,,..0.0. 

60 
--

section S2 - ABDOMINAL PAIN - C6”tl”tmd 

b	 Ask @estio”s S-27 about rhe first cond;rian coded 01 -04 i“ 3. o? 4.z. If “o”e, , k nbeut ccmdftion in 3fJ or 4b. If rhts Is an asrerlsked condition, ask about 

n-x? Cendltlon men tion.sd in 30 or da. tf rhls is . 7JK ‘e. begin wirh quest)on 6, bur d net read zfw Oar.mheticals . ,\f no erher Cond;tion, go to Section S3. 

, t 

— Code 

~ “-32 10. W-s tha pdh ort ih= right ,Id=. tha Iaft 1 1 � Right 6s 

CHECK condition. 

~ Mark all fh.st .Yp/J:”. I 

t a O Middle 67 

, Cc.ndltlon ~ Wh-n you got tftld palm. how 10”s , ss. ~ 

(Th--- m-xi qu.,tlomw �m � bouf PmlrI : I 3s do-, N USUALLY last? ( ,0 Minutes 

“S.*WJ *- *O”* ~enua.t 

Ask if .,Yes., in Z: .mherwi.e go 20 B. 

, o m None (8) 

Snow code and I ,Idm, or dew” the InlddlM? I 

1 20 Left 66 

ITEM 1 

: i o one ~7777 m Cen=trmt. all the time s. H-w mmmv DIFFERENT docton h9.m ~ 2 0 Two YOM	 W1.ltod *O, *I. p.l”? 1SBS8 o Varies too much fo, a 1 3 n Three o, more usual duration 1 

6. DURINQ TME PAST 32 MONTHS. ~ 00.0 None I 34-38 12. Durtmg how rnsmv d-y, lit th. Pmmt : Oo, none (75) 1 ez-e4 

hc.w m.”v cfocsor .M.. dld ycnJ h.- I 001 Oone v==* cfld TOM hmwothlw pmln? t
 beau,. of chls p-l”? _ Days
 1 

I_ Number ef visits ~ 3060 Every Vdav

1 If more Ihbn 7.$ days [h 72, QO to 74 I

13. old .11of thfs m.1” mee”r d“.l”m nm. I 7 0 v., (75) 1 es 

7. Wm.. .mv d ~ follcwni”g =..w de”. (s-: I 37 two vv..k p.rind? I ZONO 

dt.m”c!..	 ~au, (c c.”ditb” in check kern 7~? , 

1 14. D“r7”v h- t’!l.hv DIFFERENT ---*. . I... .- 1 I 66-67 . 

a. Upp.? kll ..,8”7 ,1” th- P.ht v-m, did vOU hh.”- this p.!”? : — Months 

Read if necessamc	 v-u drfnk. =h.lkv 1 i c1 Yes Whti ffquld emll.d I

I bmrlum 20No � “d th.” 

%-r-y. � ,- trek+. ! sDDK 

-— -- ________ ,__ &__ + __________ 

b. tf.rf.m .rmrn.? 1 m Read if “IK,7.,tJry: Vm” .“ @W.m .= 

� “.m. .txu.fn;”m : t a Yes b8rium .tsd X-r.p of i W&r9.bd 2UN0 ym-rt .- , 

I 90DIC 

20.	 Whett VO”U ha”. thl. P-!”. ... VOU, I 

bouwml ma..m.om. USUALLY Ioc...r j 1 n Yes 

———— *hm’1 n.a,m.t? ,nNe Y ___________ ___, d. LOW., ..dweepy e, .oi.rw.e.pv? :----’––---E R.-d {f necessaw: A 1!s.s n.xlbf. - , wffh . ll~ht em tk 

� nd 1. 1“.mrtti h th. 

“=*”wI .- them sh. 

j , 0 Yes 

limlrw of -1.-. : 2DN0 

Imr..tlw s.” b. 

. ..ml..d. 

, soDk 

—- —___________ .__-; -— —_4_________ 

0. Sow.pr.m er uffr..e..d? I L&_ 

Read If necessary: A s.1 IS rvbb.d cm ~ 

vow UPPU rl.ht .fd. I 

.nd .n In*cNrrl=nt 1- I 

rncw.d round th. I .,.. whll- 1 1 0 Yes 

.x.nsi”.r W.smh-. 2UN0 

-“ . twl.”i.len ; sDDK �C,*.”. 1 

Merk &. OF’mmk. I

I 0 ~T.lephc... I � 2 

l-fand Card S 7. intmvlew (9) 

8.	 Lmokl”m M thle e=rd. tdl mm thmn’nb8.. th.t .hcwy Wh.r. th. p.lm ; ?0 43 

[from tho lcondit;on in Check item 1n w.., ~ = 44 

Iec**-d? 1 30 � s t 

40 46 

h.%wk aff fhsr apply. 

; 50 (17) 47 

D.Y “or p,ebe. 1 so 4!! 

t 7n � 9 

80 so 

;}E en 61 

9.	 W.. th. flmhl .bOW. tfm w.1.tn-, i 1 � Above 62 b-10W ehm wml.t. or round th. 

W. I.W”*7 1 z n Below Sa 

Mark o)! that a~~fy. 1 3 � Around E 64 

,M HIS,. ,,,.s, ,,., C-.*, 

, ,. ,’ ,, 

. .. . . 

61

0) 

N Table 1. Classification variables available for analysis of pain data, by survey or data system

NHES NHANES 

NMF/ NNS NMIHS Q) 

Cycle Cycle Cyc/e NHANES and and and 

Classificatiorr variab/es / // /// / // HHANES /// NHEFS NHLS NMCLJES NSPHPC NSFG NAMCS NHDS NNHS NOK /LTCP NFMS NMFS LF MS DS 

Sex . . . . . . . . . . . . . . . X 

Age . . . . . . . . . . . . . . X 

Race . . . . . . . . . . . . . . X 

Hispanic origin . – 

Ethnicorigin, . . . . . . . . – 

Education of individual, X 

Education of head of 

household . . . . . . . . . X 

Personal income – 

Family income, . X 

Marital status. X 

Employment status. X 

Laborforcestatus. X 

Occupation. ... X 

Industry. . . . . . . . . . . . X 

Classofworker. X 

Region . . . . . . . . . . . . X 

Location of rasidence X 

Size of location of 

residence . . . . . . . . . . X 

Placeofbirth. . . . . . . . . – 

Veteran status, . . X 

Twin status . . . . . . . . . . – 

Numberofpersons in 

household . . . . . . . . . X 

Family relationship X 

Family structure. – 

Number of rooms. – 

Medical insurance – 

Disability status . – 

Height and weight . X 

Self-assessed heafth 

status . . . . . . . . . . ..X 

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x — x x x x x — x x x x x x x x x x x x x x i x x x x x x — — — x — 

x x x x x x x x x x x — — — x x x o x	 x x x x x x x x — — — x x — — 

x x x — x — — x x — — 

x x x x x x x x x x x — — x x x — x x x x x x x x x x x — — x x x x i — x x x x x x x x x x — — — x x x — x x x x x x x x x x — — — — x x — x x x x x x — x — — — — x x x — x x x x x x x- x — — — x x x — 

x x x x– x x– — — — x x x — 

x x x x x x x x x x x x x x — x — x x — 

x x x x x x– x x x x x — x — — x — x x — 

x x x x x x — x — — — — — — x x x x x x x x — — — — — — x x x — x x x — i i: — — — i x x — 

x x — — — — — — — x — — 

— — — 

x x x x x x x x x x x — — x x x — — x x x x x x x– x — — — — x x x x — — x x — x — — — — — — x — — — x x x x– x — — — — — — — — — — — x x- x i — x — x — — — x x — — — x x x x x x x — — x — — 

i x x x x x x x — x — — — — — x — — 

x x x x x x x x x x — — — — x — 

Note: X means relevant information available 

NHES


NHANES


HHANES


NHEFS


NHIS


NMCUES


NSPHPC


NSFG


NAMCS


NHDS


NNHS


NOK


NMFI


ILTCP


NNS


NFMS


NMFS


NMIHS


LF


MS


DS


National Health Examination Suwey.


National Health and Nutrhion Examination Survey,


Hispanic Health and Nutrition Examination Suwey.


NHANES I Epidemiologic Followup Study.


National Health interview Su~ey,


Nationai Medical Care Utilizatiorr and Expenditure Survev.


National Survey of Personal Heatth Practices and Consequences.


National Suwey of Family Gmwih.


National Ambulatory Medical Care Survey.


National Hospital Discharge Survey.


Nabonal Nursing Home Survey.


Nefl-of-tOn Component of the 19a5 NNHS.


Nationaf Master Facility Invenlory


Inventory of Long-Term Care Places.


National Natatii Survey.


Natiorraf Fetal Moriatify Survey.


National Mortaflty Fo[lowback Survey.


National Maternal and Infant Heafih Survey.


Longitudinal Foflow’up tothe NMIHS.


Mortalitv Statistics.


Divorce Sf2Jistics

,Table Il. Pain measures, by survey or data system 

,. NHES NHANES 

Cycle Cycle Cycle 

Classification variables 

Headache . . . . . . . . . .


Magnitude ., .,..,...


Scope . . . . . . . . . . . .


Structur e . . . . . . . . . .


Risk factors . . . . . . . . .


Impact . .. . . . . . . . . . .


Management . . . . . . . .


.Trende . .. . . . . . . . . . . 

Orofacial pain . . . . . . . . 

Magnitude . . . . . . . . . . 

Scope . . . . . . . . . . . .


Structure . . . . . . . . . . .


Risk factors, . . . . . . . .


Impact . . . . . . . . . . . .


Management . . . . . . . .


Trends . . . . . . . . . . . .


,. 

.Earache, . . . . . . . . . . . 

Magnitude .. . . . . . . . . .


Scope . . . . . . . . . . . .


Structure . . . . . . . . . . .


. Risk factors . .... . . . . .


Impact . . . . . . . . . . . . 

Management . . . . . . . . 

Trends . . . . . . . . . . . .


Toothache, . . . . . . . . . .


Magnitude . . . . . . . . . .


.Scope .. . . . . . . . . . . .


Structure, . . . . . . . . . .


Risk.factors , . . . . . . . .


‘ Impact, . . . . . . . . . . .


Management . . . . . . . .


,Trend$, . .,, .,.....


Ches~pain .’ . . . . . . . . . 

.Magpitude~ . . . . . . . . . .


Scope . . . . . . . . . . . .


S;ru@ure . . . . . . . . . . .


tjtskfactors . . . . . . . . .


Impact ...,.....+..


Management . , . . . . . .


Trends’. . .. . . . . . . . . . 

;,, 

‘.’!.’ 

/ Ii /// / Ii 

X — x
 —


x —
 x 

X 

X —

-

-

- i — -

— -

-

– 

-

– 

– 

-

-

— - x x x – x x — x – x - : i x –	 x x — -

- i — — 

– 

— - x — - — — — -

– — — 

– — 

-

- i 

— -

X x “x 

X x x 

.X x x 

X x x 

X — x x – — — x 

X	 — x ; -

NMFI NNS NMIHS 

NHANES and and and 

HHANES /// NHEFS NHIS NMCUES NSPHPC NSFG NAMCS NHDS NNHS NOK ILTCP NFMS NMFS LF MS 

x x(23) (9 x (5) (9 (s) (3,7) 

x x x x — — x 

x x x x x — x x x x i — x 

x x i i x — 

x [ x i x 

x : x x —

i x x x


X@) (’) (5, (% F) (3)

x — — x 1 i 

x x i x 

x x — — i i x 

x x — x i x 

x x : x x —

x x x 

x x(z,3) (] x (9 (3) (9 — X(3) : x x x — — x 

x x x x — x 

x 1! x x x i x — — x x x i i x 

x x — x x — — — —

i i x x x x 

i — — 

i x — — x x 

x x X(2,5) (4) (5) f’) (9 (9 — x x x —

x x x — — — i 

x x x i — 

x x — i i “; 

x x x x ii x 

i — x x x x x — — x x x x — — — —

x x x X(3) () (5) (3) (6) x (3) 

x x x x x 

x x x x x x i — :. x x x x x i x x . x x x x x i i x x 

x x x x x x x i — x x 

x x x x x x x x x 

x x x — x x


-. . . . 
03 Table Il. Pain measures, by survey or data system – Con. .& 

NHES NHANES 

Cycle Cyc/e Cyc/e NHANES 

C/assifi@tion variables / II Ill / II HHANES Ill 

Abdominal pain. . . — — X(8) x — x x 

Magnitude — . . . . . . . . . . x x x x 

Scope — . . . . . . . . . . . . x x x x — — — Structure . . . . . . . . . . . x x x x 

Risk — — — factors. . . x 

Impact . . . . . . . . . . . . . — — — — x i 

Management. — — — . x x x 

Trends . . . . . . . . . . . . — — — —

Backpain . . . . . . . . . . — x x x — x 

Magnitude . . . . . . . . . . x x x — x 

Scope . . — — x x x x 

Structure . . . . . . . . . . . — — x x x — x 

Riskfactors . .— — — x x — x 

Impact . . . . . . . . . . . . x x — — 

Management x x 

Trends . . . . . . . . . . . . 

Joint or arthritis pain x — — x x x x 

Magnitude . . . . . . . . . . x . x x x x 

Scope . . . . . . . . . . . . x — — x x x x 

Structure . . . . . . . . . . . x — x x x x 

Riskfactors — — — x x x x 

Impact . . . . . . . . . . . . — — x x — — 

Management . x x x — 

Trends . . . . . . . . . . . . 

Management 

Burns . . . . . . . . . . . . . — — — — x — — 

Magnitude . . . . . . . . . . — — — x — — 

Scope . . . . . . . . . . . . . — — — — x — — 

Structure . . . . . . . . . . . — — — x — — 

Riskfactors — — — — 

Impact . . . . . . . . . . . . — — — — — — — 

— — — — 

Trends . . . . . . . . . . . . 

Injuries . . . . . . . . . . . . — — x x x — — 

Magnitude . . . . . . . . . . — — x x x — — 

Scope . . . . . . . . . . . . — — x x x — 

Structure . . . . . . . . . . . — x x x — — 

Riskfactors — — — — — 

Impact . . . . . . . . . . . . — — — x x — — 

Management — — x x x — — 

Trends . . . . . . . . . . . . 

NMFI NNS NMIHS 

and and and 

NHEFS NHIS NMCUES NSPHPC NSFG NAMCS NHDS NNHS NOK ILTCP NFMS NMFS LF MS 

— x (3) (’) — — (9 (9 (’9 — — — [3.7) 

x x — — — — — x — x x x — x x — x — — — — x — — x x — — x i — — — — — x — — x x — — x x x — x x — — x x x — 

x x — — x x — — — — — — 

— — — — — — — — 

x X(3) (7	 — — t’) (3 X(6) f’) f)

x x x — —

x x x — x 

x x x — x — x 

x x x x x xx x x x x x — — — x — 

x x x x x x — x — — — — 

x x x — x x x — — 

— — 

x X(3) (’) — — (’) (3) X(6) x f’) — (9 — 

x x x — — — — — — — —

x x x x 

x x x — — — — x i — — x 

x x x — x x — x — x 

x x x — — x x x x xx x x x x x x x x x x x x x — — — — 

— — — — — — — 

— 

— x x — — — — — — x x — x x — — — — — — — — — x x — x x — — — x x — — x — — x x — x x — x — x — — x x — x x x x — x — x — x x x — x x x x x — x 

(2.3) (4) — (’) (’) (=) (10) x — X(3) (9 

x X(3) (’) — 

— t’)

— (’) X(6) X(I 1) F’)— — — — 

— X(3) (3) 

x x x x x 

x x x — — — — — x x x x x — — x x — — x — 

x x x — x i — x — — — x — 

x x x — — x x x x — — x — 

x x x — — x x x — i — — — — 

x x x x x — x — 
--

--

Table IL Pain measures, 

. 

Clas.sification variables 

Extremity pain . ...’... 

Magnitude . . . . . . . . . . 

Scope . . . . . . . . . . . . 

Structure . . . . . . . . . . . 

Risk.factors . . . . . . . . . 

Impact . . . . . . . .. e.. 

Management . . . . . . . . 

Trends . . . . . . . . . . . . 

Labor pain . . . . . . . . . . 

Magnitude . . . . . . . . . . 

Scope . . . . . . . . . . . . 

Structure . . . . . . . . . . . 

Flkkfactors . . . . . . . . . 

Impact . . . . . . . . . . . . 

Management . . . . . . . . 

Trends . . . . . . . . . . . . 

by survey or data system–Con. 

NHES NHANES NMF/ NNS NMIHS 

Cycle Cycle Cycle NHANES and and and 

I II Ill / II HHANES Ill NHEFS NHLS NMCUES NSPHPC NSFG NAMCS NHDS NNHS NOK ILTCP NFMS NMFS LF MS 

- – – x­ – – – X -

- - - x­ - - - X ­

- _ - x­

- - - X – 

- - - X – 

- – – – – 

– - - - -

- - - - -

- – – – -

– - - - -

– - – – – 

– – – – -

– - - - -

- - - - -

x x x X(3) (5) (9 (9 - (9 - - (3) ­ x x x x -. — .-

x x x x x xx x x x x — i:-:: xx x x .x x — — i i x­ — x x x x x x i- x­ — x x x x. x x x– i::––

- -— x x i x 

(4) (5) (3) - - - x - X(3) - -— - x — — -— x 

x — x 

1 

x 

,. ‘Variables are not identical across surveys. 

21f reporfed as owuming in past 2 weeks and meete the NHIS specifications. 

3[CD=oded ~ndi,lOns. 

4Questions about health or mectkal consequences lead to lCD-coded conditions that maybe identified as painful. 

:5P!atients’ symptoms and physicians’ diagnoses. 

‘lCD-coded condfions since 1985. 

7Durirrg specified pregnansy. 

‘Mensfrualpaln. 

‘Ortffopadic, physical therapy, and rehabifila.flcrn services. 

10BumS ara included in a category with skin diseasea and infeciiOn<­

. I lSelested injury data. 

‘NH& 

NHANES 

HHAJ4ES 

,,NHEFS 

NHIS 

NMCUES 

NSPHPC 

NSFG, 

NAMCS 

NHDS 

J4NHS 

NOK , : 

NMFI 

ILTCF! 

NNS ~ 

NFMS 

NMFS 

.NMIHS,’ 

‘LF _ 

MS. 

0s”’ 

National Health Examination Survey.


National Health and Nuhition Examination Survey.


Hispanic Health and Nutrition Examination Survey.


NHANES I Epidemiologic Followup Study.


National Healfh Interview Survey.


Nallonal Medical Care Utilization and Expenditure Survey.


National Survey of Personal Health Practicas and Consequences.


National Survey of Family Growlh.


National Ambulatory Medical Care Survey.


National Hospital Discharge Suwey.


National Nursing Home Suwey. .


Next-of.lQn Componant of Ihe 1985 NNHS,


National Master Facifity Invanlory.


Inventory of Lorrg-Term Care Places.


National Natafity Survey.


National Fetal Mortalibj Survey.


National Morrafity Followback Survey.


National Maternal and Infant Heaflh Survey.


Longitudinal Followup to the NMIHS.


Morlafity Statistics.


Divorce SL3fisfiss.


( 

. . 

m 

m 
Appendix VI 

h7ternationa/ 

Classification of 

Diseases description 

The International Classrjication of Diseases (ICD), 

used to classify cause of death, is pubIished by the World 

Health Organization and revised approximately every 10 

years. It has been used in most National Center for HeaIth 

Statistics (NCHS) surveys in which condition data are collected. Most NCHS data systems that employ the ICD 

coding system began using the ninth revision of the ICD 

(ICD-9) or the clinical modification of the ICD-9 (ICD9-CM) in 1979. (In the ICD-9-CM, developed jointly by 

NCHS, the Health Care Financing Administration, and 

other U.S. organizations in the health care field, an extra 

digit is added to many original codes and a number of the 

original ICD-9 codes are modified as well.) 

Prior to the ninth revision, NCHS data systems did 

not begin using the new revisions in the same data year. 

The eighth revision (including the ICD–Adapted) was 

used from approximately 1968 to 1978, and the seventh 

revision was used from approximately 1958 to 1967. Users 

who intend to use condition data from these earlier years 

should consult the data system’s technical contact 

regarding the ICD revision in use at the time and any 

modifications made to the official ICD codes, Comparability ratios between the eighth and ninth revisions, using 

data from two NCHS morbidity surveys – the National 

Ambulatory Medical Care Survey (NAMCS) and the 

National Hospital Discharge Survey (NHDS) – are available (112). Comparability ratios between the eighth and 

ninth revisions for selected causes of death, as well as 

comparability ratios for the seventh and eighth revisions, 

are also available (113). These ratios assist researchers in 

interpreting trends in ICD-coded conditions that may be 

attributable to changes in the classification system. 

The ICD is used for classifying cause of death for 

NCHS mortality statistics, as well as the coding of conditions reported in the Hispanic Health and Nutrition 

Examination Survey, the National Health Interview 

Survey, and the National Medical Care Utilization and 

Expenditure Survey. An extensive coding manual, developed by the Division of Health Interview Statistics, provides detailed guidelines for the coding of selected 

diagnoses and impairments. (Impairment codes are independent of the ICD.) 

The ICD-9-CM has been used in classifying physician 

diagnoses reported in NAMCS, NHDS, the examination 

components of the National Health and Nutrition Examination Surveys, and (in 1986) the National Mortality 

Survey. Before 1979, if a condition was listed with a 

symptom (such as “pain”), only the condition was coded 

in NHDS. 

Some NCHS data systems do not use the ICD coding 

system. The National Health Examination Surveys, Cycles 

I, II, and III, and the National Nursing Home Surveys 

(until 1985) contain data on clinical conditions, but these 

data are coded using non-ICD coding schemes. In the case 

of the National Nursing Home Survey, a preceded list of 

selected diagnoses, very much like but not identical to 

ICD-9 categories, was used until 1985; since 1985, conditions have been coded using the ICD. The National 

Survey of Personal Health Practices and Consequences, 

the National Master Facility Inventory, the National 

Survey of Family Growth, and the National Natality 

Survey contain no condition data that require medical 

coding. 

T!? U.S. GOVERNMENT PRINTING OFFICE 1992 –3 12 -0 82 I 6 00 06 

66 
Vital and Health Statistics 

series description 

SERIES 1.	 Programs and Collection Procedures–Reports 

describing the general programs of the National Center for 

Health Statistics and its offices and divisions and the data 

collection methods used. They also include definitions and 

other material necessary for understanding the data. 

SERIES 2.	 Data Evaluation and Methods Research –Studies of new 

statistical methodology including experimental tests of new 

survey methods, studies of vital statistics collection 

methods, new analytical techniques, objective evaluations 

of reliability of collected data, and contributions to statistical 

theoty. Studies also include comparison of u..% 

methodology with those of other countries. 

SERIES 3.	 Analytical and Epidemiological Studies–Reports 

presenting analytical or interpretive studies based on vital 

and health statistics, carrying the analysis further than the 

expository types of reports in the other series. 

SERIES 4.	 Documents and Committee Reports – Final reports of 

major committees concerned with vital and health statistics 

and documents such as recommended model vital 

registration laws and revised birth and death certificates. 

SERIES 5.	 Comparative International Vital and Health Statistics 

Reports-Analytical and descriptive reports comparing 

US. vital and health statistics with those of other countries. 

SERIES 6.	 Cognition and Survey Measurement – Repofls from the 

National Laboratory for Collaborative Research in Cognition 

and Survey Measurement using methods of cognitive 

science to design, evaluate, and test survey instruments. 

SERIES 10.	 Data From the National Health Interview Survey– 

Statistics on illness, accidental injuries, disability, use of 

hospital, medical, dental, and other services, and other 

health-related topics, all based on data collected in the 

continuing national household interview survey. 

SERIES 11.	 Data From the National Health Examination Survey and 

the National Health and Nutrition Examination Survey– 

Data from direct examination, testing, and measurement of 

national samples of the civilian noninstitutionalized 

population provide the basis for (1) estimates of the 

medically defined prevalence of specific diseases in the 

United States and the distributions of the population with 

respect to physical, physiological, and psychological 

characteristics and (2) analysis of relationships among the 

various measurements without reference to an explicit finite 

universe of persons. 

SERIES 12.	 Data From the Institutionalized Population Surveys – 

Discontinued in 1975. Reports from these surveys are 

included in Series 13, 

SERIES 13.	 Data on Health Resources Utilization – Statistics on the 

utilization of health manpower and facilities providing longterm care, ambulatory care, hospital care, and family 

planning services. 

SERIES 14.	 Data on Health Resources: Manpower and Facilities– 

Statistics on the numbers, geographic distribution, and 

characteristics of health resources including physicians, 

dentists, nurses, other health occupations, hospitals, 

nursing homes, and outpatient facilities. 

SERIES 15.	 Data From Special Su~eys–Statistics on health and 

health-related topics collected in special surveys that are 

not a part of the continuing data systems of the National 

Center for Health Statistics. 

SERIES 16.	 Compilations of Advance Data From Vital and Health 

Statistics –These reports provide early release of data 

from the National Center for Health Statistics’ health and 

demographic surveys. Many of these releases are followed 

by detailed reports in the Vital and Health Statistics Series. 

SERIES 20.	 Data on Mortality-Various statistics on mortali~ other 

than as included in regular annual or monthly reports. 

Special analyses by cause of death, age, and other 

demographic variables; geographic and time series 

analyses; and statistics on characteristics of deaths not 

available from the vital records based on sample surveys of 

those records. 

SERIES 21.	 Data on Natality, Marriage, and Divorce-Various 

statistics on natality, marriage, and divorce other than 

those included in regular annual or monthly reports. 

Special analyses by demographic variables; geographic 

and time series analyseq studies of fertili~ and stati~cs 

on characteristics of births not available from the vital 

records based on sample surveys of those records. 

SERIES 22.	 Data From the National Mortality and Natality Surveys– 

Discontinued in 1975. Reporta from these sample surveys 

based on vital records are included in Series 20 and 21, 

respectively. 

SERIES 23.	 Data From the National Survey of Family Growth– 

Statistics on fertility, family formation and dissolution, family 

planning, and related maternal and infant health topics 

derived from a periodic survey of a nationwide probability 

sample of women 1.5-44 years of age. 

SERIES 24.	 Compilations of Data on Natality, Mortali& Marriage, 

Divorce, and Induced Termination of Pregnancy– 

Advance reports of births, deaths, marriages, and divorces 

are based on final data from the National Vital Statistics 

System and are published annually as supplements to the 

Monthly Vital Statistics Report (MVSR). These reports are 

followed by the publication of detailed data in Vital 

Statistics of the United States annual volumes. Other 

reports including induced terminations of pregnancy issued 

periodically as supplements to the MVSR provide selected 

findings baaed on data from the National Vital Statistics 

System and may be followed by detailed reports in the Vital 

and Health Statistics Series. 

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

published in these series, contact 

Scientific and Technical Information Branch 

National Center for Health Statistics 

Centers for Disease Control 

Public Health Service 

6525 Belcrest Road, Room 1064 

Hyattsville, Md. 20782 

301-436-8500 
... 

DEPARTMENT OF 

BULK RATE HEALTH & HUMAN SERVICES POSTAGE & FEES PAID 

PHS/NCHS

Public Health Service PERMIT NO. G-281 

Centers for Disease Control 

National Center for Health Statistics 

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DHHS Publication No. (PHS) 92-1308, Series 1, No. 26