1. National Center for Health Statistics U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics National Health Interview Survey (NHIS): Focus on Pain Margaret Lethbridge-Çejku, PhD Division of Health Interview Statistics

2. The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention

3. National Health Interview Survey Purpose  Collect data on the health status and health care utilization of the US population  Address specific issues of current public health concern  Provide a “snapshot” of US population’s health  Monitor trends  Track progress towards national health objectives  Public health research

4. NHIS Sample design  Nationally representative of the civilian, non- institutionalized population of the US  Oversampling of black, Hispanic, and Asian persons  Multistage probability sample with clustered design  Sample selected so each week is representative  Sample redesigned about every 10 years, following decennial census

5. The NHIS Questionnaire since the 1997 redesign  Basic module [ CORE ]  same every year  family, sample adult, and sample child questionnaires  includes injury episode file  Supplemental questions [imbedded in core files]  expand on topics already included in basic module  obtain detailed info for sample adult/child  typically one-time or periodic  Topical supplements  add-in segment - flexibility to address new topics

6. Linkage with NHIS data  Medical Expenditure Panel Survey (MEPS)  Mortality data in the National Death Index  Cycles 4 and 5 of the National Survey of Family Growth (NSFG) 1993, 1995  National Immunization Provider Record Check Study (NHIS/NIPRCS) 1997-1999

7. Pain questions in the NHIS Adults  Jaw pain (orofacial pain or TMD)  Neck pain  Low back pain  Joint pain  Chronic joint symptoms  Migraine

8. Other pain-related questions in the NHIS Adults  Chronic conditions  Cardiovascular disease  Diabetes  Respiratory conditions  Cancer  Arthritis  Functional limitations: social and physical  Activities of daily living (ADLs and IADLs)  Injury episodes

9. Pain and pain-related questions in the NHIS Children  Headaches/migraines  Chronic and non-chronic conditions  Ear infections  Cerebral palsy  Muscular dystrophy  Sickle cell anemia  Cystic fibrosis  Arthritis  Activity limitations: school and play  Activities of daily living (ADLs and IADLs)  Injury episodes

10. Supplements with pain-related data  1989 Orofacial pain supplement  1994-95 NHIS-D Disability survey and Supplement on Aging  2002 Complementary and alternative medicine (again in 2007)

11. Conceptual framework for analyzing NHIS pain data  Demographic characteristics - age, race/ethnicity, family structure, income, education  Mediating health factors - health behaviors (including alcohol, tobacco use), health insurance, access to care and health care utilization  Health outcomes - activity limitations, health status, mental health, co- morbidities: chronic conditions, injury

12. NHIS: Focus on Pain Examples

13. Prevalence of US adults with migraine or severe headache during preceding 3 months, by sex and age SOURCE: Unpublished. Data from the National Health Interview Survey 2005.

14. Prevalence of facial pain in non-Hispanic adult women by age and race: United States 2002 Adjusted for socio-economic differences. SOURCE: adapted from IADR 84rd General Session in Brisbane: Isong U, Fanshy SA, Plesh O, J Dent Res, 2006 (www.dentalresearch.org).

15. Prevalence of chronic joint symptoms in US adults, by sex and race/ethnicity: NHIS 2004 Adjusted for age SOURCE: Lethbridge-Cejku M, Rose D, Vickerie J. Summary health statistics for US Adults: National Health Interview Survey, 2004. National Center for Health Statistics.Vital Health Stat 10 (228). Hyattsville, MD 2006

16. Mean number of work days lost by employed adults with selected pain conditions Adjusted for age. SOURCE: Lethbridge-Cejku, M. Unpublished. Data from the National Health Interview Survey 2005.

17. Prevalence of selected pain conditions by level of education: US adults, 25 years and over Adjusted for age SOURCE: Lethbridge-Cejku M, Rose D, Vickerie J. Summary health statistics for US Adults: National Health Interview Survey, 2004. National Center for Health Statistics.Vital Health Stat 10 (228). Hyattsville, MD 2006

18. Prevalence of selected pain conditions by poverty status: US adults, 18 years and over Adjusted for age SOURCE: Lethbridge-Cejku M, Rose D, Vickerie J. Summary health statistics for US Adults: National Health Interview Survey, 2004. National Center for Health Statistics.Vital Health Stat 10 (228). Hyattsville, MD 2006

19. Prevalence of low back pain in men and women by body mass index (BMI) Adjusted for age Underweight is defined as a BMI = 30. SOURCE: Lethbridge-Cejku, M. Unpublished. Data from the National Health Interview Survey 2005.

20. Prevalence of complementary and alternative medicine (CAM) use during past 12 months for selected pain conditions Adjusted for age. CAM usage excludes megavitamin therapy and prayer. SOURCE: Adapted from Barnes P, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States 2002. Advance data from vital and health statistics (343). Hyattsville, MD: National Center for Health Statistics. 2004

21. Copyright ©2006 American Academy of Pediatrics Source: Strine TW, Okoro CA, McGuire LC, Balluz, LS. The Associations among childhood headaches, emotional and behavioral difficulties, and health care use. Pediatrics 2006;117:1728-1735. Data from NHIS 2003 Child Core and supplemental SDQ-EX data. Prevalence of high individual domain and total difficulties scores among children aged 4 to 17 years with and without frequent severe headaches

22. Copyright ©2006 American Academy of Pediatrics Source: Strine TW, Okoro CA, McGuire LC, Balluz, LS. The Associations among childhood headaches, emotional and behavioral difficulties, and health care use. Pediatrics 2006;117:1728- 1735. Data from NHIS 2003 Child Core and supplemental SDQ-EX data. Impact of difficulties with emotions, concentration, behavior, or getting along with other children on everyday functioning of children aged 4 to 17 years with and without frequent severe headaches

23. Increased likelihood of Any Herb Use with Co-occurrence of Depression/Anxiety and Pain : NHIS 2002 CAM Supplement Adjusted Odds Ratios WomenMen Depression/Anxiety & Pain1.251.37 Pain alone1.001.00 p=0.03p=0.01 Depression/Anxiety & Pain 1.271.43 Depression/Anxiety alone1.001.00 p=0.02p=0.01 Source: Adapted from Wallace et al. Project 4: Epidemiological Studies of Botanical Dietary Supplements. Iowa Botanical Supplements Research Center, 2005. Data source: NHIS 2002 Complimentary and Alternative Medicine Supplement

24. Serious difficulty in physical functioning by selected pain status Separate logistic regressions adjusted for age, sex, race/ethnicity, poverty, and education in all models. Referent groups are persons without the condition. Serious difficulty defined as “Can’t do this activity” or “Very difficult to do”. Activities: walking, standing, stooping, climbing stairs, sitting, reaching overhead, grasping, lifting 10 lbs., pushing object. Source: Lethbridge-Cejku, M. Unpublished. Data from the National Health Interview Survey 2000- 2002

25. Unable to work by selected pain status Separate logistic regressions adjusted for age, sex, BMI, race/ethnicity, poverty, and education in all models. Referent groups are persons without the condition. Source: Lethbridge-Cejku, M. Unpublished. Data from the National Health Interview Survey 2005.

26. Where to find out more about the NHIS:  http://www.cdc.gov/nchs/nhis.htm http://www.cdc.gov/nchs/nhis.htm  downloadable public use data files and documentation  SAS, Stata, and SPSS programs  publications in Adobe Acrobat format  http://www.cdc.gov/subscribe.html http://www.cdc.gov/subscribe.html  subscribe to the NHIS electronic mailing list  Special Request Files: in-house data (with suppressed information) through Research Data Center