By Megan Flaherty
Illustration by Malcolm Garris/PhotoDisc
March 29, 1999

The United States is getting a check-up. Next month, the National Center for Health Statistics (NCHS) will dispatch three mobile medical examination units to conduct a large-scale, ongoing survey to assess the nation’s health.

The state-of-the-art mobile units will soon be crisscrossing the country, hitting 15 counties and collecting data on about 5,000 people each year. Participants will receive medical and dental exams and physiological and laboratory tests, and answer detailed demographic, socioeconomic, dietary, and health-related questions on topics ranging from smoking and exercise habits to sexual practices.

Health of the nation

Information compiled through the updated National Health and Nutrition Examination Survey (NHANES) is the "gold standard" for assessing the nation’s health, said Yechiam Ostchega, PhD, RN, a consultant with the survey.

NHANES data—which has been periodically collected by the national Centers for Disease Control and Prevention’s NCHS since the 1960s—are used to determine the prevalence of diseases and the healthcare needs of the nation, and to identify national norms for blood pressure and children’s growth, Ostchega said. Emerging health problems are also identified through use of survey data. In the past it has helped spot trends in obesity, hypertension, and high cholesterol, Ostchega said. NHANES has a $25 million budget for 1999 and will be conducted throughout the year on an indefinite basis, NCHS officials said.

"It is a massive survey that gives you a good look at the health of the nation," said Mary C. White, PhD, MPH, RN, associate professor in community health systems at the UCSF School of Nursing. "It’s the baseline you use to measure your own patient population against, and it’s the basis for decisions about how healthcare resources are allocated."

Because NHANES is conducted using mobile units, the survey reaches a multicultural population that other studies may overlook, said Gloria McNeal, PhD, RN, assistant professor in the College of Nursing at Rutgers University in Newark, N.J. "It gets into indigent neighborhoods and includes medically underserved populations. This information is absolutely critical," McNeal said.

Door-to-door effort

NHANES randomly selects counties that will yield a representative sample of the U.S. population, Ostchega said. Advance teams then meet with local health officials and send letters to residents letting them know that the survey is coming to town and that they may be asked to participate. Then health interviewers—carrying portable computers—go door-to-door finding people who fit the desired demographic.

In California, the survey is tentatively scheduled to go to Los Angeles, Orange, San Diego, and Riverside counties.

Interviewers are armed with articles and fact sheets stressing the survey’s importance, said Linda Dapper, a field operations coordinator for the project who supervises the interviewing and office staff. "Most people are receptive to what we’re doing because health seems to be of major interest to everyone right now. Everyone is so conscious of their health and nutritional status," said Dapper, who visited New York, Pennsylvania, Louisiana, California, Missouri, and Ohio at the end of the last NHANES cycle, which lasted from 1988 to 1994.

"Interviewers are very well-informed about the survey and can answer a lot of questions about how it’s of benefit to the participant and the nation," said Catherine Novak, MS, RN, director of mobile exam center operations for the survey.

The health interviews take place in people’s homes. About 450 people from each county are interviewed in a nine-week period, and 85 to 90 percent of the interviewees come to the mobile units for the physical examination segment of NHANES, Dapper said.

A physician, a dentist, five X-ray technicians, three medical technicians, a phlebotomist, a manager, and a coordinator staff the units, Novak said. According to the NCHS, all participants have their pulse or blood pressure and body measurements taken. They also have a blood sample taken and get a dental exam. Other tests and procedures relate to anemia, cardiovascular disease, diabetes, hearing loss, infectious diseases, and other conditions.

Each survey participant receives a report of medical and dental findings. All information collected in the survey is kept highly confidential, with patient identifiers removed, Novak said. The data sets are released for use by researchers and the public.

Building a better survey

NHANES has changed in important ways since previous survey cycles, staff say. One of the biggest changes is the move to a continuous format, said NHANES director Raynard S. Kington, MD, PhD. Because NHANES will be in the field continuously rather than as a series of studies as in the past, it will be more flexible and responsive to shifting public health priorities and new scientific methodologies, he said. "We try to have a system that responds to important public health problems," Kington said.

Another major change is that advanced technology allows for more sophisticated and rapid data gathering and analysis, Kington said. Biomedical equipment is now integrated with computer systems, making documentation more efficient and accurate for the health professionals conducting the survey, Novak said. For example, the results of hearing tests are automatically registered into the computer system, eliminating the need for manual entry.

The survey will also track cardiovascular fitness by conducting treadmill tests for participants aged 12 to 49, Ostchega said, and new survey equipment will enable the measurement of bone density for the entire body. Chronic and infectious diseases will also will also get more attention from NHANES.

"Our agenda constantly changes as the nation gets older and different health issues emerge," Ostchega said.

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Related Sites
Centers for Disease Control and Prevention

National Health and Nutrition Examination Survey

National Center for Health Statistics