Collection of hierarchical information

in the family section

of the National Health Interview Survey

Jane F. Gentleman

National Center for Health Statistics

Presentation at National Academy of Sciences Household 

Survey Producers Workshop, Session on designs that 

effectively mix global and detail information to reduce burden 

and measurement error, June 2011

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About the National Health Interview Survey 

(NHIS)

Conducted by the National Center for Health 

Statistics

First time in the field: 1957

In-person household survey

Represents U.S. civilian noninstitutionalized

population
3 main sections of core, since 1997

Data for each family in a household:

Family Section: All family members

(Family Respondent answers)

Sample Child Section: One randomly-selected 

child (knowledgeable adult answers)

Sample Adult Section: One randomly-selected 

adult (answers for him/herself)
A dilemma: In what order to ask 

hierarchical questions about multiple 

family members

4
Assume, as an example:

Family has 3 members:

Dad, Mom, Kid

One adult serves as

the Family Respondent

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NHIS questions* about

injuries and poisonings

During the past 3 months,

did anyone in your family have an injury?

Who was this?

[Get a list of family members who had an 

injury]

[Assume all 3 were injured]

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How many times was Dad injured?

Did Dad talk to or see a medical professional about any 

of these injuries?

How many times was Mom injured?

Did Mom talk to or see a medical professional about 

any of these injuries?

How many times was Kid injured?

Did Kid talk to or see a medical professional about any 

of these injuries?

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[Now ask same types of questions for poisonings 

as for injuries]

During the past 3 months,

was anyone in your family poisoned?

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[Now ask for dates when the injuries/poisonings 

happened, one family member at a time]

When did Dad’s most recent injury/poisoning for which 

medical professional was consulted happen?

When did Dad’s second most recent 

injury/poisoning...happen?

When did Mom’s most recent injury/poisoning...happen?

When did Mom’s second most recent 

injury/poisoning...happen?

[Same for Kid]

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So NHIS asks about...

Medical consultations within number of injuries 

within family members, for injuries, then...

Medical consultations within number of 

poisonings within family members, for 

poisonings, then...

Dates of most recent injuries/poisonings within 

family members.

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Then NHIS goes on to ask, within family 

members...

How the injuries/poisonings happened 

(verbatim)

What the causes were (e.g., burned)

What body parts (≤4) were hurt

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Hard to figure out actual order of questions 

by reading the questionnaire!

Hard to program the survey instrument 

correctly!

12
INTERLEAFED versus GROUPED format

First: Ask ≥2 filter questions to determine respondent 

eligibility for subsequent items

Interleafed format: Subsequent items asked 

immediately after the relevant filter

Grouped format: Subsequent items asked after 

multiple filters 

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Format matters!

Study of mental health items found:

Respondents to interleafed format

less likely than

respondents to grouped format

to say “yes” to later filters

From Kreuter, McCulloch, Presser: AAPOR presentation, & forthcoming 

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Examples of surveys using interleafed format:

• Behavioral Risk Factor Surveillance Survey

• Consumer Expenditure Survey

Examples of surveys using grouped format:

• National Comorbidity Survey

• National Crime Victimization Survey

From Kreuter, McCulloch, Pr3sser

15
Experiments have shown:

Respondents gave fewer yes answers to filters 

as they learned that such answers led to 

additional questions.

From Kreuter, McCulloch, Presser

16
Another NHIS example:

Total family income questions

≤2005: Poor item response rates

2006: New questions were tested

≥2007: New improved questions used;

Item response rates up

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NHIS family income questions in 2005

Asked respondent to provide best estimate of total 

family income from all sources in last calendar year.

If not answered, asked if ≥$20,000 or <$20,000.

If <$20,000, list of 20 intervals shown (in $1,000 

increments).

If ≥$20,000, list of 24 intervals shown (in $1,000 

increments up to $35,000, & $5,000 increments up to 

$75,000+).

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NHIS family income questions in 2007

Asked respondent to provide best estimate of total 

family income from all sources in last calendar year.

If not answered, asked if <$50,000 or ≥$50,000.

If <$50,000, asked if <$35,000 or ≥$35,000

If <$35,000, asked if < appropriate poverty threshold*

If ≥$35,000, DONE 

If ≥$50,000, asked if <$100,000 or ≥$100,000

If <$100,000, asked if <$75,000 or ≥$75,000

If ≥$100,000, DONE** 

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Some recommendations from experts

• Distrust any general recipes.

•Do cognitive testing: 

Use focus groups.

Use “thinkaloud interviews.”

Have a cognitive expert examine the questionnaire.

• Do experiments.

• Do a pretest.

From Sudman, Brandburn, Schwarz: Thinking About Answers, 1996

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