NHANES IV

[Carolyn Gleason]

PLEASE PARDON THE CROSS POSTING.  A long article but the subject impacts most of
us in our work.

     Health
     Front Page Articles
     
     Washington Post
     
     A Comprehensive Check-Up on the Nation
     Environmental Toxins, Osteoporosis Among Topics in Fourth Health and 
     Nutrition Survey
     
     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 
     century.
     
     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 
     mercury.
     
     "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 
     wheelchairs.
     
     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 
     headquarters.
     
     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 
     ensure privacy."
     
     c Copyright 1998 The Washington Post Company