The Centers for Disease Control and Prevention (CDC), operating under the Department of Health and Human Services (HHS), has opened a public comment period regarding the National Health Interview Survey (NHIS), a cornerstone of federal health data collection. This notice outlines plans for both the immediate future of the survey in 2027 and a significant, systemic redesign slated for 2028. The NHIS, which has continuously tracked the health of the U.S. population since 1957, is undergoing these changes to enhance its utility, reduce respondent burden, and adapt to contemporary data collection methodologies.
The National Health Interview Survey: A Foundation of Public Health Data
Authorized by Section 306 of the Public Health Service Act, the NHIS is managed by the National Center for Health Statistics (NCHS) and is a vital source of general statistics on the health of the U.S. population. This voluntary and confidential household-based survey gathers demographic and health-related information from a nationally representative sample of noninstitutionalized, civilian individuals. Its data are widely used by government, academic, and private researchers to evaluate general health trends and specific issues, including chronic diseases, healthcare access, and health insurance coverage. The NHIS is also a primary data source for Congressionally-mandated reports like "Health, United States" and crucial for monitoring progress towards HHS health objectives.
Evolution in 2027: Content Rotation and Sponsored Inquiries
For 2027, the NHIS will continue its established practice of rotating content on its Sample Adult and Sample Child Questionnaires. Certain annual core content, such as service utilization, physical activity, and sleep, will rotate off, while new or returning topics will be introduced. For adults, 2027 will see the inclusion of questions on chronic conditions, allergies, hearing and communication, preventative screening, aspirin use, and chronic pain. The child questionnaire will feature questions on injuries, allergies, and stressful life events. Additionally, sponsored content on complementary and integrative health will be included for both adults and children, alongside ongoing sponsored modules covering areas like life satisfaction, diabetes, social support, loneliness, tobacco product use, immunizations, and whole person health. New sponsored content for 2027 includes cancer screening, caregiving, epilepsy, psoriasis, and occupational health.
This annual rotation ensures the survey remains responsive to emerging public health concerns while maintaining a consistent core of data. Respondents to the 2027 NHIS will also continue to serve as a sampling frame for the Medical Expenditure Panel Survey, integrating federal health data collection efforts.
The 2028 Redesign: Modernizing for the Next Decade
The most significant proposed changes involve a systemic redesign of the NHIS for implementation in 2028. This overhaul is driven by the need to maintain data quality, contain operational costs, and align with advancements in survey methodology. The redesign will introduce a sequential mixed-mode data collection approach. Sampled households will first be invited to respond using self-administered online and paper questionnaires. For households that do not self-respond, Census Bureau field representatives will conduct in-person follow-up, aiming to preserve the long-standing quality standards of the NHIS while making the process more efficient and responsive to respondent preferences.
This strategic timing also coordinates with the data cycle for monitoring Healthy People 2030 objectives and coincides with the Census Bureau's deployment of its new Data Ingest and Collection for the Enterprise (DICE) program, which will improve the NHIS's ability to collect data through various modes.
Questionnaire Changes and Focus Areas for 2028
The redesigned 2028 NHIS will continue to include an Adult Questionnaire for one randomly selected adult and a Child Questionnaire for one randomly selected child in households with children. Information for adults will typically be self-reported, with proxies allowed if necessary. Child information will be collected from a parent or guardian. Draft questionnaires for both are available for public review.
The 2028 questionnaires will be shorter and less complicated in structure due to the incorporation of self-administered online and mailed modes. This means that many detailed topics previously fielded annually will not be included. The redesign also moves away from a detailed schedule of rotating content, a necessary shift for a more streamlined survey. Key health measures will be retained, including chronic conditions, foundational measures of disability and functional status using the Washington Group Short Set, and measures of health insurance coverage, continuity, and adequacy. New content areas in the adult questionnaire reflect contemporary health information needs, such as the Whole Person Health Index, high-deductible health plans, insurance adequacy, primary care, asthma treatment, and marijuana use.
Call for Public Input and Implications
The NCHS is particularly interested in public comments that will support the planning of the 2028 redesign. Feedback is specifically welcomed regarding the structure, length, and clarity of the redesigned questionnaires, the implications of adopting a sequential mixed-mode design, the importance of specific content additions or removals, and the potential effect of these changes on data quality, usability, and trend measurement. Commenters suggesting new questions are encouraged to identify minimum question sets to meet data needs. The NCHS also seeks comments on the practical utility of child-level data collection for population estimates.
This robust public comment period underscores the federal government's commitment to ensuring that the NHIS remains a relevant, accurate, and efficient tool for monitoring the nation's health. The success of this redesign hinges on comprehensive input from stakeholders to balance modernization with the critical need for consistent, high-quality public health data.
