Van S. Hubbard, M.D., Ph.D.
National Institutes of Health
and
Clifford L. Johnson, M.S.P.H.
Centers for Disease Control and Prevention
Department of Health and Human Services
National Health and Nutrition
Examination Survey
Objective
To assess the health and nutritional
status of adults and children in the
United States
 Unique in combining a home
interview with health examinations
conducted in a mobile examination
center
 Almost 50 years experience
conducting survey using direct
physical measures
To produce U.S. population-based estimates
of:
Health conditions and environmental
exposures
Awareness, treatment and control of
selected diseases
Prescription drug and supplement use
Nutrition status and diet behaviors
35
30
Percent
25
30
27
21
20
15
10
5
0
Total
SOURCE: CDC/NCHS
20
Measured
NHANES 99-00
Self-reported
NHANES 99-00
NHIS 2000
(self-reported)
BRFSS 2000
(self-reported)
Direct Measure vs. Self-report
Physical Activity
35
% meeting guidelines
30
25
BRFSS
20
15
10
NHANES
5
0
Self-report
Direct Measure
 Civilian, non-institutionalized
household population in the US
 All ages
 5,000 individuals each year
Oversample:
African Americans
Hispanics
Older persons aged 60+
Low income whites
Asians – new for 2011-14
Stage 1
Counties
Stage 2
Segments
Stage 3
Households
Stage 4
Participants
 Screener interview
 Participant interview (in-
person)
 Participant examination
 Additional interview or exam
components
• Doorstep screening
• Traditional CAPI interviewing with portable
keyboard.
Broad range of health conditions
Health-related behaviors and
exposures
Health care utilization
Health insurance
Prescription medications
Dietary supplements
 Systematic operation with travelling staff and
standardized environment
 MEC design provides standardized specimen collection
and exam protocols with regularly calibrated equipment
 Facilitates automated data collection
 Minimizes site-specific error
 Adults and teens: 3.5 hours
 Children: 1-2 hours
Two sessions per day; up to 12
participants per session
Morning, afternoon
Afternoon, evening
Morning, evening
NHANES response rates
1999-2008
%
100
80
60
1999
2000
2001
2002
2003
Interviewed
2004
2005
2006
Examined
2007
2008
 Public health
significance
 Scientific merit
 Appropriateness
 Feasibility and
ethical issues
 Financial
considerations











Hearing, Taste and Smell
Blood pressure
Muscles strength/Physical activity
monitor
Dietary recall
Private and AudioCASI interview
Spirometry w/bronchodilator, ENO
Oral health
Anthropometry/Body Composition
Cognitive function
Blood, urine collection, PPD
Specimen bank
 Reference data
Growth Charts
 Nutrition monitoring
Obesity, Cholesterol
 Disease control
Diabetes
 Prevention initiatives
Infectious Diseases,
Folate
 Monitor chemical/
Lead
pollutant exposure
 Track health behaviors
Second-hand Smoke
Monitoring Increase in Diabetes, Measuring
Disease Management & Undiagnosed Disease
Monitor Diagnosed and
Undiagnosed Disease
Diagnosed diabetes doubled
from 3.4% to 7.7 % between
1976-80 and 2005-2006
12.9% of adults age > 20 years
have diagnosed or undiagnosed
diabetes; no gender-specific
differences (2005-2006)
42% of adults age > 20 years
have diabetes or pre-diabetes
(2005-2006)
Monitor Improvements in
Diabetes Management
Hemoglobin A1C declined from
7.8% to 7.2% between 19992004 (good control = 7.0%)
Diabetes and Pre-diabetes (%)
2005-2006
45
40
29.5%
Impaired
Fasting
Glucose
or
Impaired
Glucose
Tolerance
10
5.1%
Undiagnosed
5
7.7%
Diagnosed
35
30
25
20
15
0
 Monitoring environmental
exposures through direct
measures of over 200 chemicals in
blood, urine, or hair
 Passive exposure monitors for
volatile chemicals, household dust,
allergen and water samples
 Data reported in CDC’s National
Report on Human Exposure to
Environmental Chemicals
Blood lead levels (mg/dL)
16
Blood lead levels in the U.S. Children
Ages 1-5 yrs, 1976 - 2002
14
12
10
8
6
4
2
0
1976 1978 1980 1982 1984 1986 1988 1990 1992
Year
1994 1996 1998
2000 2002
NHANES Data
Directly download from
our website
http://www.cdc.gov/nchs/nhanes.htm
Join our LISTSERV
Each new generation of surveys • Added unique specimens, post-exam components, and
follow-back surveys
• Required innovative survey design, operations, and methods
• Provided ability to integrate a breadth of interdisciplinary
health data
• Enhanced utility of baseline survey data
Additional urine
sample collected at
Tap water sample
Physical activity
home
Hair sample for
monitor worn for 7 daysfrom home
mercury measurement
Food frequency
questionnaire by mail
Hepatitis C and PSA
follow-up interview by
phone 6 months later
Self-administered
vaginal swab
2nd Dietary recall and Dust sample
Oral HPV rinse
FCBS follow-up
collected by vacuum
interview by phone
 Sound science
 Produce high quality data
 Responsive to emerging public



health issues
Timely
Innovative
Proven model
A Pot of Gold
and
a Gold Standard