Eve Powell-Griner, PhD National Center for Health Statistics Centers for Disease Control and Prevention National Center for Health Statistics Overview of the National Health Interview Survey (NHIS)

NHIS purpose To collect data on the health status and health services utilization of the US population To address specific issues of current public health concern To provide national health data to the public

Uses of NHIS data “Snapshot” of health of the US population Track national health objectives Plan and evaluate health policies Public health research

NHIS sample design Household based Representative of U.S. and of four Census regions (non-institutionalized civilian population) Provides sampling frame for Medical Expenditures Panel Survey (MEPS)

NHIS sample design 2006 design  40,000 households 100,000 persons 37,000 Sample Adults 15,000 Sample Children  Over-samples blacks, Hispanics, Asians, elderly minorities

NHIS questionnaire modules Basic Module or Core  Fielded each year Supplemental Modules  New topics or more detail on Core topics  Different each year

Health conditions Chronic Disease Hearing and vision impairment Health status compared to year ago Injuries/poisonings Functional limitation and associated conditions Mental health questions (vary by age)

Utilization and access to care Hospitalizations Medical care contacts by provider Surgical procedures Dental Immunizations Usual place of care Delayed care and why Unmet need by type

Health behaviors and risk factors Smoking Physical activity Alcohol Height/Weight (BMI)

Socio-demographic variables Hispanic ethnicity, race, sex, age Family type/structure Generational relationships Birthplace and citizenship Country of birth (only on in-house file) US/not US (on public use file) Citizen or non-citizen of US

Economic variables Characteristics of family housing unit Number of working adults in family Education/family income Health Insurance  Type of coverage  Cost/policy holder/source  Reason for no coverage Work loss/sick days

NHIS Supplements :Cancer Control 2001:Healthy People 2010, Children’s mental health 2002:Healthy People 2010, Complementary and Alternative Med., Children’s mental health 2003:Healthy People 2010, Children’s mental health 2004:Healthy People 2010 Children’s mental health, adult immunization 2005: Healthy People 2010, Cancer control 2006:Adult chronic conditions (Stroke, diabetes, arthritis)

NHIS Products Microdata files Annual reports of estimates  Population; Children; Adults Reports on specific topics FastStats Early Release

Background As timeliness of annual MICRODATA release improved, a need for timely release of ESTIMATES Expert meeting: Identified key measures Determined how to expedite editing and weighting Chose to release on Internet only First release: April 2001 NHIS Early Release (ER) Program

2 reports: main and detailed health insurance Releases updated ESTIMATES every 3 months Releases occur 6 months after the end of each quarter of data collection (March, June, September, December) Internet only release NHIS ER Program

Objectives  Provide ready and timely access to the most recent NHIS key estimates  Monitor health and health care  Measure progress toward national public health objectives

ER Indicator Selection Public health objectives which benefit from timely data Healthy People 2010 Leading Health Indicators Key areas for the elimination of racial disparities in health Stable definitions over past several data years Sufficient sample sizes

Main report 1.Health insurance coverage 2.Usual place to go for medical care 3.Obtaining needed medical care 4.Influenza vaccination 5.Pneumococcal vaccination 6.Obesity 7.Leisure-time physical activity 8.Current smoking 9.Alcohol consumption 10.HIV testing 11.General health status 12.Personal care needs 13.Serious psychological distress 14.Diabetes 15.Asthma Indicators

Main ER report Format Graph of trend since 1997 Graph of current estimates by age group and gender Graph of current estimates by race/ethnicity Data tables for all graphs Extra graph and/or tables as needed Text highlights

Detailed health insurance ER report  Lack of health insurance coverage at time of interview for at least part of the past year for more than a year  Type of health insurance coverage public health plan coverage private health insurance coverage  Noncoverage for selected sociodemographic measures  Annual state-level estimates for large states

Uses of ER data Cited in other government publications and Web sites Data requests for universities and other government agencies Collection of indicators used in methodological research Other health measures can be added to ER production to do expedited research

Percentage of persons who had received an influenza vaccination during the past 12 months, by age group and sex: United States, 2005

Percentage of adults aged 65 years and over who had received an influenza vaccination during the past 12 months, by race/ethnicity: United States, 2005

Percentage of persons without health insurance, by three measurements and age group; and percentage of persons with health insurance, by coverage type and age group: United States, 2005

Percentage of persons under 65 years of age without health insurance coverage at the time of interview, by age group and sex: United States, 2005

Prevalence of current smoking among adults aged 18 years and over: United States, 1997– March 2005

Prevalence of obesity among adults aged 20 years and over: United States, 1997– 2005

Percent distribution of respondent-assessed health status, by sex for all ages: United States, 2005

Prevalence of current asthma among persons of all ages, by age group and sex: United States, 2005

Sex-adjusted prevalence of current asthma among persons of all ages, by age group and race/ethnicity: United States, 2005

Other examples of NHIS Estimates

Percentage of adults aged 18 years and over who engaged in any leisure-time strengthening activity, by sex and age group — United States, 2005 National Health Interview Survey

Percentage of adults aged 18 years and over who had received an influenza vaccination during the past 12 months, by age group and quarter — United States, 1997–2005 National Health Interview Survey

Annual rate of nonfatal, medically attended fall injury episodes among noninstitutionalized adults aged 65 years and over — United States, 2001–2003 National Health Interview Survey

Percentage of foreign-born Hispanic adults aged 18 years and over with selected health conditions, by length of time living in the United States, 1998–2003 National Health Interview Survey

Cigarette smoking prevalence among adults aged 18 years and over who have ever spent >24 hours on the streets, in a shelter, or in a jail or prison, by sex — United States, 2004 National Health Interview Survey

Percentage of children under 18 years of age with current asthma, by race/ethnicity and sex — United States, 2001–2004 National Health Interview Survey

Percentage of young adults aged 18–24 years who never smoked cigarettes — United States, 1998–2004 National Health Interview Survey

Percentage of teens aged 14–17 years who used indoor tanning devices during the preceding 12 months, by sex and age — United States, 2005 National Health Interview Survey

Distribution of type of health insurance for working age adults (18 – 64 years), United States 2005 Uninsured 19.1% Private HMO 29.9% Private non-HMO 40.7% Medicaid HMO 5.3% Medicaid non-HMO 1.6% Other 3.0% Source: estimates for health insurance type are calculated using the person file

NHIS Strengths Large, representative sample In-person survey Broad range of information Demographic detail Ongoing annual survey Topical supplementary information Relatively high response rates Links to NDI, MEPS

NCHS Web site: Information Showcase NHIS Web site: What’s New listserv Where to find NHIS Products