national health and nutrition examination survey monitoring the nation’s health
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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
Objective
To assess the health and nutritional status of adults and children in the United States
NHANES in the News
Goals
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
History
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
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
Data Collection
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
Stage 4Participants
Stage 1Counties Stage 2
Segments
Stage 3Households
NHANES information flow
Advanceletter Screening In-home
interview Exam
Biologic Specimens
Laboratories CDC/NCHS Participant
Informed consent
Banking facilities
NHANES Home Interview
NHANES Mobile exam center
NHANES Mobile exam center
Mobile exam center entrance
Reception
Cardiovascular health
Hearing and vision
Anthropometry and body composition
Whole body scan – percentage body fat
Sagittal abdominal diameter
Participants 8 years and older
Taste and smell
Private interviews
Oral health
Laboratory
Mobile exam center laboratory
• Complete blood count• Pregnancy test• Specimen processing
• Blood, urine, water, swabs • 500 assays• 24 laboratories
NHANES labs/graders
10
31
NCHS
10
31
NHANES labs/graders
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
Participant remuneration
• Remuneration $125• Transportation (bus, taxi,
mileage) reimbursed• Additional remuneration for
other components
Post exam assessments
Day 2 Dietary RecallHome urine collection
Physical Activity Monitor
24-hour Urine Collection
NHANES Response Rates
2013
Interviewed 72%Interviewed and examined 70%
Information technology architecture
hi
Household interviews Westathome office
T1T1
NCHS
Labs&graders
T1
MEC
64kb
Fieldoffice
NationalFrame Relay
Network
OP96S049
Data release process
• QA/QC • Editing/cleanup• Weighting• Data preparation• Documentation• Confidentiality review
Do we give participants their results?
Initial findings Abnormal values Call for STD resultsw/ pre-set passwords
Final report
Kathryn S. Porter, MD
Yes
Benefits to Participants
Early notification of abnormal results
Interesting story – high mercury
Spanish-speaking family examined. Mom and three kids, the youngest was 3 years old.
All had high levels of mercury
Interesting story, cont.
Monitoring the nation’s health
NHANES data findings
Environmental health
1976 1978 1980 1982 1984 1986 1988 1990 1992
2
4
6
8
10
12
14
16
Blo
od le
ad le
vels
(mg/
dL)
0
1994 1996 1998 2000
Blood lead levels in U.S. childrenAges 1-5 yrs, 1976 - 2002
Year2002
Second hand smoke
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
Pediatric growth charts
Obesity
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)
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
0
5
10
15
20
25
30
35
40
0
5
10
15
20
25
30
35
40
Percent
1960-2 1988-94
PercentTrends 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
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
Diet
The 2010 Dietary Guidelines for Americansrecommend a sodium intake of less than 2300 mg per day
Sugary drink consumption70% of boys aged 2-19 years consume sugar drinks on any given day; 60% of girls
Measuring Progress:trans-Fatty Acids Reduction Policies
Birth Defect Prevention
Birth Defect Prevention – Spina Bifida
• 20-50% of cases can be prevented
• Requires adequate intake of folic acid
(400 mcg daily)
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
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
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
Infectious disease
Measuring Progress:HPV Vaccine Effectiveness
Prescription medication use
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.
Chronic disease
Source: 2005–2008 National Health and Nutrition Examination Survey.
Challenges
Translated Materials
Financial considerations
Internal funding Collaborators
Who are our collaborators?
Around 25 partners with various degrees of collaboration
Thank you
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