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![Page 1: National Health and Nutrition Examination Survey Monitoring the Nation’s Health Kathryn S. Porter, M.D., M.S. Director Division of Health and Nutrition.](https://reader035.fdocuments.in/reader035/viewer/2022070308/551c0a10550346b24f8b5089/html5/thumbnails/1.jpg)
National Health and Nutrition Examination Survey
Monitoring the Nation’s Health
Kathryn S. Porter, M.D., M.S.
Director
Division of Health and Nutrition Examination Surveys
National Center for Health StatisticsDivision of Health and Nutrition Examination Surveys
![Page 2: National Health and Nutrition Examination Survey Monitoring the Nation’s Health Kathryn S. Porter, M.D., M.S. Director Division of Health and Nutrition.](https://reader035.fdocuments.in/reader035/viewer/2022070308/551c0a10550346b24f8b5089/html5/thumbnails/2.jpg)
Objective
To assess the health and
nutritional status of adults and
children in the United States
![Page 3: National Health and Nutrition Examination Survey Monitoring the Nation’s Health Kathryn S. Porter, M.D., M.S. Director Division of Health and Nutrition.](https://reader035.fdocuments.in/reader035/viewer/2022070308/551c0a10550346b24f8b5089/html5/thumbnails/3.jpg)
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NHANES in the News
![Page 5: National Health and Nutrition Examination Survey Monitoring the Nation’s Health Kathryn S. Porter, M.D., M.S. Director Division of Health and Nutrition.](https://reader035.fdocuments.in/reader035/viewer/2022070308/551c0a10550346b24f8b5089/html5/thumbnails/5.jpg)
Goals
![Page 6: National Health and Nutrition Examination Survey Monitoring the Nation’s Health Kathryn S. Porter, M.D., M.S. Director Division of Health and Nutrition.](https://reader035.fdocuments.in/reader035/viewer/2022070308/551c0a10550346b24f8b5089/html5/thumbnails/6.jpg)
U.S. population-based estimates of:
•Health conditions
• Awareness, treatment and control of selected diseases
• Environmental exposures
•Nutrition status and diet behaviors
Goals of NHANES
![Page 7: National Health and Nutrition Examination Survey Monitoring the Nation’s Health Kathryn S. Porter, M.D., M.S. Director Division of Health and Nutrition.](https://reader035.fdocuments.in/reader035/viewer/2022070308/551c0a10550346b24f8b5089/html5/thumbnails/7.jpg)
History
![Page 8: National Health and Nutrition Examination Survey Monitoring the Nation’s Health Kathryn S. Porter, M.D., M.S. Director Division of Health and Nutrition.](https://reader035.fdocuments.in/reader035/viewer/2022070308/551c0a10550346b24f8b5089/html5/thumbnails/8.jpg)
National Health and Nutrition Examination Surveys
NHES I 1960-62 18-79 yearsNHES II 1963-65 6-11 yearsNHES III 1966-70 12-17 yearsNHANES I 1971-75 1-74 yearsNHANES II 1976-80 6 mo.-74 yearsHHANES 1982-84 6 mo.-74 yearsNHANES III 1988-94 2 mo. +
Survey Dates Ages
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National Health and Nutrition Examination Surveys
NHANES 1999-2000 All agesNHANES 2001-2002 All agesNHANES 2003-2004 All agesNHANES 2005-2006 All agesNHANES 2007-2008 All agesNHANES 2009-2010 All agesNHANES 2011-2012 All agesNHANES 2013-2014 All agesNHANES 2015-2016 All ages
Survey Dates Ages
![Page 10: National Health and Nutrition Examination Survey Monitoring the Nation’s Health Kathryn S. Porter, M.D., M.S. Director Division of Health and Nutrition.](https://reader035.fdocuments.in/reader035/viewer/2022070308/551c0a10550346b24f8b5089/html5/thumbnails/10.jpg)
Data Collection
![Page 11: National Health and Nutrition Examination Survey Monitoring the Nation’s Health Kathryn S. Porter, M.D., M.S. Director Division of Health and Nutrition.](https://reader035.fdocuments.in/reader035/viewer/2022070308/551c0a10550346b24f8b5089/html5/thumbnails/11.jpg)
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
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Stage 4Participants
Stage 1Counties
Stage 2Segments
Stage 3Households
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NHANES information flow
Advanceletter Screening
In-homeinterview
Exam
Biologic Specimens
Laboratories CDC/NCHS Participant
Informed consent
Banking facilities
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NHANES Home Interview
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NHANES Mobile exam center
![Page 16: National Health and Nutrition Examination Survey Monitoring the Nation’s Health Kathryn S. Porter, M.D., M.S. Director Division of Health and Nutrition.](https://reader035.fdocuments.in/reader035/viewer/2022070308/551c0a10550346b24f8b5089/html5/thumbnails/16.jpg)
NHANES Mobile exam center
![Page 17: National Health and Nutrition Examination Survey Monitoring the Nation’s Health Kathryn S. Porter, M.D., M.S. Director Division of Health and Nutrition.](https://reader035.fdocuments.in/reader035/viewer/2022070308/551c0a10550346b24f8b5089/html5/thumbnails/17.jpg)
Mobile exam center entrance
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Reception
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Cardiovascular health
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Hearing and vision
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Anthropometry and body composition
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Whole body scan – percentage body fat
![Page 23: National Health and Nutrition Examination Survey Monitoring the Nation’s Health Kathryn S. Porter, M.D., M.S. Director Division of Health and Nutrition.](https://reader035.fdocuments.in/reader035/viewer/2022070308/551c0a10550346b24f8b5089/html5/thumbnails/23.jpg)
Sagittal abdominal diameter
Participants 8 years and older
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Taste and smell
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Private interviews
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Oral health
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Laboratory
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Mobile exam center laboratory
• Complete blood count
• Pregnancy test
• Specimen processing
• Blood, urine, water, swabs
• 500 assays
• 24 laboratories
![Page 29: National Health and Nutrition Examination Survey Monitoring the Nation’s Health Kathryn S. Porter, M.D., M.S. Director Division of Health and Nutrition.](https://reader035.fdocuments.in/reader035/viewer/2022070308/551c0a10550346b24f8b5089/html5/thumbnails/29.jpg)
NHANES labs/graders
10
31
![Page 30: National Health and Nutrition Examination Survey Monitoring the Nation’s Health Kathryn S. Porter, M.D., M.S. Director Division of Health and Nutrition.](https://reader035.fdocuments.in/reader035/viewer/2022070308/551c0a10550346b24f8b5089/html5/thumbnails/30.jpg)
NCHS
10
31
NHANES labs/graders
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Laboratory tests
• Nutritional biomarkers
• Hormone tests
• Diabetes
• Lipid profile
• Biochemistry profile
• Celiac disease
• Infectious diseases• Hepatitis viruses• Sexually
transmitted infections
• Environmental Chemicals
• Water fluoride levels
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Participant remuneration
• Remuneration $125
• Transportation (bus, taxi, mileage) reimbursed
• Additional remuneration for other components
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Post exam assessments
Day 2 Dietary Recall
Home urine collection
Physical Activity Monitor
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24-hour Urine Collection
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NHANES Response Rates
2013
Interviewed 72%
Interviewed and examined 70%
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Information technology architecture
hi
Household interviewsWestathome office
T1T1
NCHS
Labs&graders
T1
MEC
64kb
Fieldoffice
NationalFrame Relay
Network
OP96S049
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Data release process
• QA/QC
• Editing/cleanup
• Weighting
• Data preparation
• Documentation
• Confidentiality review
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Do we give participants their results?
Initial findings Abnormal values Call for STD resultsw/ pre-set passwords
Final report
Kathryn S. Porter, MD
Yes
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Benefits to Participants
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Early notification of abnormal results
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Interesting story – high mercury
Spanish-speaking family examined. Mom and three kids, the youngest was 3 years old.
All had high levels of mercury
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Interesting story, cont.
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Monitoring the nation’s health
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NHANES data findings
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Environmental health
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1976 1978 1980 1982 1984 1986 1988 1990 1992
2
4
6
8
10
12
14
16
Blo
od
lead
lev
els
(mg
/dL
)
0
1994 1996 1998 2000
Blood lead levels in U.S. childrenAges 1-5 yrs, 1976 - 2002
Year2002
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Second hand smoke
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Percent of non-smoking U.S. population
exposed to second hand smoke
Source: Pirkle JL et al. Trends in Exposure of Nonsmokers in the U.S. Population to SHS: 1988–2002. Env Hlth Persp. 2006; 114(6): 853–8.
CDC. Vital Signs: Nonsmokers’ Exposure to Secondhand Smoke — United States, 1999-2008. MMWR. September 7, 2010. 59; 7-12
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Pediatric growth charts
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Obesity
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Americans heavier in 2007-2010 than
in the 1960s
Sources: CDC/NCHS: National Health and Nutrition Examination Survey; www.cdc.gov/nchs/data/ad/ad347.pdf; http://www.cdc.gov/nchs/data/databriefs/db82.htm http://www.cdc.gov/nchs/data/series/sr_11/sr11_252.pdf (NHESI, NHESII, 2007-2010)
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Prevalence of obesity in the US, 2011-2012
• 17% of children & teens 2-19 y
• 35% of adults ≥20 y
Source: CDC/NCHS, National Health and Nutrition Examination Survey, 2011-2012; Ogden et al. NCHS Data Brief 2013 and Ogden et al. JAMA 2014
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0
5
10
15
20
25
30
35
40
0
5
10
15
20
25
30
35
40
Percent
1960-2 1988-94
Percent
Trends in adult obesity, 20-74 years
Note: NHES and NHANES data; Age-adjusted by the direct method to the year 2000 US Bureau of the Census estimates using the age groups 20-39, 40-59 and 60-74 years. Obesity defined as BMI>=30.
99-0001-2
03-4
Male
Female
1971-4 1976-8005-6
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Federal Aviation Administration
TABLE 2-1. STANDARD AVERAGE PASSENGER WEIGHTS Standard Average Passenger
Weight Per Passenger
Summer Weights Average adult passenger weight 190 lb Average adult male passenger weight 200 lb Average adult female passenger weight 179 lb Child weight (2 years to less than 13 years of age) 82 lb
Winter Weights Average adult passenger weight 195 lb Average adult male passenger weight 205 lb Average adult female passenger weight 184 lb Child weight (2 years to less than 13 years of age) 87 lb
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Diet
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The 2010 Dietary Guidelines for Americansrecommend a sodium intake of less than 2300 mg per day
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Sugary drink consumption
70% of boys aged 2-19 years consume sugar drinks on any given day; 60% of girls
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Measuring Progress:trans-Fatty Acids Reduction Policies
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Birth Defect Prevention
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Birth Defect Prevention – Spina Bifida
• 20-50% of cases can be prevented
• Requires adequate intake of folic acid
(400 mcg daily)
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Median serum and red blood cell folate concentrations: US females
ages 15-45
SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys, 1988-94
1988-94
ng/mL ng/mLSerum folate Red blood cell folate
1988-94
5
10
15
20
4.8
0
50
100
150
200
250
300
160
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Median serum and red blood cell folate concentrations: US females
ages 15-45
SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys, 1988-94 and 2003-04
1988-94 1999-2000
ng/mL ng/mLSerum folate Red blood cell folate
1988-94 1999-2000
5
10
15
20
4.8
13.0
0
50
100
150
200
250
300
160
264
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15
20
25
30
1991 1993 1995 1997 1999 2001 2003 2005
Rate per 100,000
Spina bifida rates United States 1991-2005
NOTE: Excludes data for Maryland, New Mexico, and New York which did not require reporting for spina bifida
for some years. CI is 95% confidence interval.
SOURCE: National Vital Statistics System, NCHS, CDC
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Infectious disease
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Measuring Progress:HPV Vaccine Effectiveness
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Prescription medication use
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Prescription antidepressant use
NOTE: The 1988–1994 estimates for men are considered unreliable because the estimates have relative standard errors of 20%–30%.SOURCE: CDC/NCHS, Health, United States, 2013, Figure 25. Data from the National Health and Nutrition Examination Survey.
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Chronic disease
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Source: 2005–2008 National Health and Nutrition Examination Survey.
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Challenges
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Translated Materials
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Financial considerations
Internal funding Collaborators
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Who are our collaborators?
Around 25 partners with various degrees of collaboration
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Thank you