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 Statistics Division 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 years NHES II years NHES III years NHANES I years NHANES II mo.-74 years HHANES mo.-74 years NHANES III mo. + SurveyDatesAges

National Health and Nutrition Examination Surveys NHANES All ages NHANES All ages NHANES All ages NHANES All ages NHANES All ages NHANES All ages NHANES All ages NHANES All ages NHANES 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 4 Participants Stage 1 Counties Stage 2 Segments Stage 3 Households

NHANES information flow Advance letter Screening In-home interview Exam Biologic Specimens LaboratoriesCDC/NCHSParticipant Informed consent Banking facilities

NHANES Home Interview

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

NCHS 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 Recall Home urine collection Physical Activity Monitor

24-hour Urine Collection

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

Information technology architecture h i Household interviews Westat home office T1 NCHS Labs & graders T1 MEC 64kb Field office National Frame 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 results w/ 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

Blood lead levels (  g/dL) Blood lead levels in U.S. children Ages 1-5 yrs, Year 2002

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, MMWR. September 7, ; 7-12

Pediatric growth charts

Obesity

Americans heavier in than in the 1960s Sources: CDC/NCHS: National Health and Nutrition Examination Survey; CDC/NCHS: National Health and Nutrition Examination Survey; (NHESI, NHESII, )

Prevalence of obesity in the US, % of children & teens 2-19 y 35% of adults ≥20 y Source: CDC/NCHS, National Health and Nutrition Examination Survey, ; Ogden et al. NCHS Data Brief 2013 and Ogden et al. JAMA 2014

Percent Percent Trends in adult obesity, 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, and years. Obesity defined as BMI>= Male Female

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 Americans recommend a sodium intake of less than 2300 mg per day

Sugary drink consumption 70% 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 SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys, ng/mL Serum folateRed blood cell folate

Median serum and red blood cell folate concentrations: US females ages SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys, and ng/mL Serum folateRed blood cell folate

Spina bifida rates United States 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