CGleason at hrsa.dhhs.gov
Thu Jun 18 10:18:14 PDT 1998
PLEASE PARDON THE CROSS POSTING. A long article but the subject impacts most of
us in our work.
Front Page Articles
A Comprehensive Check-Up on the Nation
Environmental Toxins, Osteoporosis Among Topics in Fourth Health and
By Sally Squires
Washington Post Staff Writer
Tuesday, June 16, 1998; Page Z07
Federal officials began gearing up last week to launch a health and
nutrition survey that will help shape health guidelines for the 21st
Known as the National Health and Nutrition Examination Survey
(NHANES), it is the fourth comprehensive study that tracks a wide
range of U.S. health trends such as the incidence of high blood
pressure, cholesterol levels, body weight, the debilitating bone
disease known as osteoporosis and environmental exposure to lead and
"NHANES is unique," said Michael Wolz, a statistician and project
officer for the National Heart, Lung and Blood Institute (NHLBI), part
of the National Institutes of Health (NIH). "It is one of the
cornerstones of our ability to estimate where the trends in disease
are going in the nation as a whole."
NHANES relies on a combination of interviews and physical exams to
sketch a detailed picture of the nation from a pool of Americans
carefully selected to reflect the whole country.
Few Americans have heard of the survey, but many rely on its
information regularly. NHANES data forms the basis for children's
height and growth charts used in pediatricians' offices. The surveys
have helped health leaders evaluate the value of prostate cancer
screening and identified the threat of antibiotic resistance.
NHANES findings also led to the elimination of lead from gasoline,
documented the rising number of diabetics in the United States and
enabled federal agencies to track what people eat. Most recently,
NHANES data prompted the NIH to reexamine the definition of overweight
in the United States.
"To say that it is helpful is putting it mildly," said Thomas Thom,
who helps collect morbidity and mortality statistics for the NHLBI.
"We rely on it strongly to get an idea of how many people are out
there with coronary artery disease, stroke and congestive heart
failure. It gives us details on blood pressure according to sex, age
and race. Without it we would not have a good handle on that at all."
The series of surveys began in the 1960s and is run by the National
Center for Health Statistics (NCHS) and funded by the Department of
Health and Human Services. The latest effort, NHANES IV, nearly fell
victim to budget cuts in 1996 and has been delayed by more than a year
and scaled back substantially because of financial constraints.
The last survey, NHANES III, was conducted from 1988 to 1994 and
included 40,000 randomly selected residents surveyed and examined at
88 locations. It cost $100 million, according to the NCHS.
NHANES IV, which began pilot testing last week, is expected to cost
$20 million and will survey 5,000 randomly selected Americans at 15
locations. Instead of periodic surveys, NHANES IV kicks off annual
testing of the population on a much smaller scale.
Even so, funding for the project is still $3.5 million short for
fiscal year 1999, according to Ed Hunter, chief of planning, budget
and legislation at the NCHS. "We are hopeful that we will find a way
to bridge that gap."
In the meantime, pilot testing began last week in Rockville and will
continue in the Washington area until Aug. 9. The testing is conducted
in four specially designed mobile trailers that use state-of-the-art
technology to gather and analyze information from test participants.
The four trailers form a mobile exam center -- one of three -- that
will go to various locations throughout the country. NHANES
participants are first interviewed at home by a team of health
professionals and then are referred to the mobile exam centers for
physicals, which are conducted on a separate day and take three to
four hours to complete. Participants receive some small compensation
to cover their time, transportation to the center and such incidental
expenses as babysitters.
The mobile centers are specially equipped to accommodate people in
Upon entering the mobile exam center, each participant is given a
gown, slippers and a computerized bracelet with a bar code that
dictates which tests are done and in what order. New technology allows
the researchers to do more tests and complete them faster than in past
surveys, according to Clifford L. Johnson, deputy director of the
NCHS' Division of Health Exam Statistics.
Aside from the standard height, weight, heart rate and blood pressure
measurements, the mobile exam centers are equipped to do exercise
testing, vision exams and bone scans.
Digitized photos will be used to examine skin and look for the
presence of psoriasis and irregularities in moles that could signal
malignant melanoma. There are hearing tests, blood and urine analysis
and simple exams to screen for signs of changes in peripheral nerves
that are linked with diabetes. A special room has been set up to test
lung function, given the rapid rise in asthma cases nationwide during
the past several years. NHANES IV will also test participants for
their contact with more than 1,000 volatile compounds to check for
exposure to environmental pollutants.
"A lot of these tests are done in the research setting," Johnson said.
"But NHANES takes it the next step."
Unlike past surveys, much of the data from NHANES IV is collected by
computer. Information is sent within 24 hours by satellite to NCHS
Advances in computer technology have also changed the way that
investigators collect information on sensitive topics. Small rooms
with computer touch screens are used to ask questions about drug and
alcohol use and sexual practices. In past surveys, this information
was collected in face-to-face interviews.
"Confidentiality is paramount," Johnson said. "Data that we collect is
not linked back to the respondent. And the information is encrypted to
c Copyright 1998 The Washington Post Company
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