1. Centers for Disease Control and Prevention Household Survey Comparison Melissa Heinen, M.P.H. Margaret Warner, Ph.D. Lois Fingerhut, M.A. Montreal 2002

2. Importance of Household Surveys Not limited to medical records Health professionals description More detail about the event Costs and resources

3. National Household Injury Surveys Surveys reviewed Canada – Canadian Community Health Survey (CCHS) and the National Population Health Survey (NPHS) New Zealand – National Health Survey Scotland – Scottish Health Survey South Africa – South African Demographic and Health Survey United States – National Health Interview Survey SOURCE: CDC/NCHS

4. National Household Injury Surveys Items compared Recall Period Severity Threshold Survey Methodology Unit of Analysis Injury Definitions Survey Frequency Probing / Screening Question SOURCE: CDC/NCHS

5. Recall Period Items to consider Memory decay Telescoping Heaping Sample size / relative standard error SOURCE: CDC/NCHS

6. Annual estimates of injury and poisoning conditions using different recall periods, NHIS 1997

7. Recall Period SOURCE: CDC/NCHS Canada12-months New Zealand12-months Scotland12-months South Africa1-month United States3-months

8. Severity Threshold Measurements Limitation in daily activities Medical advice or treatment Hospitalization status SOURCE: CDC/NCHS

9. Severity Threshold Items to consider Health insurance coverage Subjective - health seeking behaviors Accessibility of health professional (rural vs. urban) Emergency department visits SOURCE: CDC/NCHS

10. Severity Threshold SOURCE: CDC/NCHS CanadaLimitation of normal activities New ZealandReceived medical treatment ScotlandSaw a doctor, nurse, or other health professional South AfricaTreated by a doctor or a nurse United StatesGot medical advice or treatment

11. Survey Methodology Items to consider Non-response rates Representation Sensitive questions and non-reporting Cost and resources SOURCE: CDC/NCHS

12. Survey Methodology SOURCE: CDC/NCHS CanadaNPHS -Telephone CHHS – Telephone and face- to-face New ZealandFace-to-face ScotlandFace-to-face South AfricaFace-to-face United StatesFace-to-face

13. Unit of Analysis Items to consider Comparability of numbers Events (e.g., car crash) Persons Most severe Most recent Conditions (e.g., fractured leg) SOURCE: CDC/NCHS

14. Unit of Analysis SOURCE: CDC/NCHS CanadaInjury events New ZealandInjured persons ScotlandPerson based – most recent injury-related event South AfricaInjured persons United StatesInjury events

15. Injury Definitions Items to consider Self report vs. coding of self reports (ICD coding) Comparability SOURCE: CDC/NCHS

16. Injury Definitions SOURCE: CDC/NCHS CanadaICD coded injuries New ZealandICD coded injuries ScotlandSelf reported accidents South AfricaSelf reported injuries United StatesICD coded injuries

17. Survey Frequency Items to consider Trends over time Assess data Sample size SOURCE: CDC/NCHS

18. Survey Frequency SOURCE: CDC/NCHS CanadaConducts surveys annually and reports results every two years New ZealandConducts survey every three years ScotlandConducts survey every three years South AfricaConducts survey every five years United StatesConducts survey and reports results annually

19. Screener Question Items to consider Length Complexity Embedded examples SOURCE: CDC/NCHS

20. Screener Question SOURCE: CDC/NCHS Canada“(Not counting repetitive strain injuries), in the past 12 months, that is from ## to yesterday, were you injured?” New Zealand“In the last 12 months, have you had an injury which you received medical treatment?” Scotland“How many accidents – about which you saw a doctor, nurse, or other health professional – have you had in the last 12 months?”

21. Screener Question SOURCE: CDC/NCHS South Africa“Did you have any injury that was treated by a doctor or a nurse in the last 30 days?” United States“During the past 3 months, that is since ###, were you or anyone in the family injured or poisoned seriously enough that you got medical advice or treatment?”

22. US Survey Decrease injury rate Cognitive testing -screening question Length Definitions Severity

23. Screener Question Proposed changes for US During the past 3 months, that is since ##, did you have an injury where any part of your body was hurt, for example, with a broken bone, sprain, burn, wound, cut, bruise, or animal or insect bite? During the past 3 months, how many times were you injured? Did you talk to or see a medical professional about any of these injuries? Of the # times that you were injured, how many of those times was the injury serious enough that you consulted a medical professional? SOURCE: CDC/NCHS

24. Screener Question Proposed changes for US During the past 3 months, that is since ##, were you poisoned by swallowing or breathing in a harmful substance such as bleach, carbon monoxide, or too many pills or drugs? (Do not include food poisoning, sun poisoning, or poison ivy rashes) During the past 3 months, how many different times were poisoned? Did you talk to or see a medical professional about any of these poisonings? Of the # times that you were poisoned, how many of those times was the poisoning serious enough that you consulted a medical professional? SOURCE: CDC/NCHS

25. National Household Injury Surveys Additional items to consider Placement of injury section within a larger survey Length of survey Sample selection Definitions of injuries and poisonings Narrative introduction to the section Weighting of data Respondent vs. Proxy SOURCE: CDC/NCHS

26. National Household Injury Surveys Generic considerations Continuous funding Strong lobbying Demonstrating usefulness of data SOURCE: CDC/NCHS

27. Centers for Disease Control and Prevention Website: http://www.cdc.gov/nchs/about/oth eract/ice/housesur.htm

28. Considerations Should our goal be to compare our selves to each other to have better questions and survey methodology? Is it a worthwhile goal to standardize questions? Cause compatible with ICD? Should health behaviors be a priority? Is it even worth comparing numbers?