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National Health and Nutrition Examination Survey : physician examination procedures manual
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January 2003
[PDF-9.15 MB]
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Description:This NHANES is the eighth in a series of national examination studies conducted in the United States since 1960.
The National Health Survey Act, passed in 1956, gave the legislative authorization for a continuing survey to provide current statistical data on the amount, distribution, and effects of illness and disability in the United States. In order to fulfill the purposes of this act, it was recognized that data collection would involve at least three sources: (1) the people themselves by direct interview; (2) clinical tests, measurements, and physical examinations on sample persons; and (3) places where persons received medical care such as hospitals, clinics, and doctors’ offices.
To comply with the 1956 act, between 1960 and 1984, the National Center for Health Statistics (NCHS), a branch of the U.S. Public Health Service in the U.S. Department of Health and Human Services, has conducted seven separate examination surveys to collect interview and physical examination data.
The first three national health examination surveys were conducted in the 1960s:
1. 1960-62 – National Health Examination Survey I (NHES I)
2. 1963-65 – National Health Examination Survey II (NHES II)
3. 1966-70 – National Health Examination Survey III (NHES III)
NHES I focused on selected chronic disease of adults aged 18-79. NHES II and NHES III focused on the growth and development of children. The NHES II sample included children aged 6-11, while NHES III focused on youths aged 12-17. All three surveys had an approximate sample size of 7,500 individuals.
Beginning in 1970 a new emphasis was introduced. The study of nutrition and its relationship to health status had become increasingly important as researchers began to discover links between dietary habits and disease. In response to this concern, under a directive from the Secretary of the Department of Health, Education and Welfare, the National Nutrition Surveillance System was instituted by NCHS. The purpose of this system was to measure the nutritional status of the U.S. population and monitor nutritional changes over time. A special task force recommended that a continuing surveillance system include clinical observation and professional assessment as well as the recording of dietary intake patterns. Thus, the National Nutrition Surveillance System was combined with the National Health Examination Survey to form the National Health and Nutrition Examination Survey (NHANES). Four surveys of this type have been conducted since 1970:
1. 1971-75 – National Health and Nutrition Examination Survey I (NHANES I)
2. 1976-80 – National Health and Nutrition Examination Survey II (NHANES II)
3. 1982-84 – Hispanic Health and Nutrition Examination Survey (HHANES)
4. 1988-94 – National Health and Nutrition Examination Survey (NHANES III)
The major difference between the current NHANES and previous surveys is that the current NHANES is conducted as a continuous, annual survey. Each single year and any combination of consecutive years of data collection comprises a nationally representative sample of the U.S. population. This new design allows annual statistical estimates for broad groups and specific race-ethnicity groups as well as flexibility in the content of the questionnaires and exam components. New technologic innovations in computer-assisted interviewing and data processing result in rapid and accurate data collection, data processing, and publication of results.
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