National Health and Nutrition Examination Survey Monitoring the Nation’s Health

1. National Health and Nutrition Examination SurveyMonitoring the Nation’s Health Kathryn S. Porter, M.D., M.S. Director Division of Health and Nutrition Examination Surveys National Center for Health Statistics Division of Health and Nutrition Examination Surveys

2. Objective To assess the health and nutritional status of adults and children in the United States

4. NHANES in the News

5. Goals

6. Goals of NHANES U.S. population-based estimates of: • Health conditions • Awareness, treatment and control of selected diseases • Environmental exposures • Nutrition status and diet behaviors

7. History

8. National Health and Nutrition Examination Surveys Survey Dates Ages NHES I 1960-62 18-79 years NHES II 1963-65 6-11 years NHES III 1966-70 12-17 years NHANES I 1971-75 1-74 years NHANES II 1976-80 6 mo.-74 years HHANES 1982-84 6 mo.-74 years NHANES III 1988-94 2 mo. +

9. National Health and Nutrition Examination Surveys Ages Dates Survey NHANES 1999-2000 All ages NHANES 2001-2002 All ages NHANES 2003-2004 All ages NHANES 2005-2006 All ages NHANES 2007-2008 All ages NHANES 2009-2010 All ages NHANES 2011-2012 All ages NHANES 2013-2014 All ages NHANES 2015-2016 All ages

10. Data Collection

11. NHANES Sample • Civilian, non-institutionalized household population in the United States • Target: 5,000 individuals examined annually Oversample: • African Americans • Asian Americans • Hispanics • Older persons aged 60+ • Low income whites

12. Stage 1 Counties Stage 2 Segments Stage 3 Households Stage 4 Participants

13. NHANES information flow Informed consent Advance letter In-home interview Screening Exam Banking facilities Biologic Specimens Laboratories CDC/NCHS Participant

14. NHANES Home Interview

15. NHANES Mobile exam center

16. NHANES Mobile exam center

17. Mobile exam center entrance

18. Reception

19. Cardiovascular health

20. Hearing and vision

21. Anthropometry and body composition

22. Whole body scan – percentage body fat

23. Sagittal abdominal diameter Participants 8 years and older

24. Taste and smell

25. Private interviews

26. Oral health

27. Laboratory

28. Mobile exam center laboratory • Complete blood count • Pregnancy test • Specimen processing • Blood, urine, water, swabs • 500 assays • 24 laboratories

29. NHANES labs/graders 10 3 1

30. NHANES labs/graders NCHS 10 3 1

31. Nutritional biomarkers Hormone tests Diabetes Lipid profile Biochemistry profile Celiac disease Infectious diseases Hepatitis viruses Sexually transmitted infections Environmental Chemicals Water fluoride levels Laboratory tests

32. Participant remuneration • Remuneration $125 • Transportation (bus, taxi, mileage) reimbursed • Additional remuneration for other components

33. Post exam assessments Day 2 Dietary Recall Home urine collection Physical Activity Monitor

34. 24-hour Urine Collection

35. NHANES Response Rates 2013 72% Interviewed 70% Interviewed and examined

36. i h Information technology architecture Household interviews Westat home office T1 T1 National Frame Relay Network Field office T1 64kb NCHS MEC Labs & graders OP96S049

37. Data release process • QA/QC • Editing/cleanup • Weighting • Data preparation • Documentation • Confidentiality review

39. Kathryn S. Porter, MD Final report Initial findings Abnormal values Call for STD results w/ pre-set passwords Do we give participants their results? Yes

40. Benefits to Participants

41. Early notification of abnormal results

42. Interesting story – high mercury Spanish-speaking family examined. Mom and three kids, the youngest was 3 years old. All had high levels of mercury

43. Interesting story, cont.

47. Monitoring the nation’s health

48. NHANES data findings

49. Environmental health

50. Blood lead levels in U.S. children Ages 1-5 yrs, 1976 - 2002 16 14 12 10 Blood lead levels (mg/dL) 8 6 4 2 0 2000 2002 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 Year