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July 20 -- The Centers for Disease Control and Prevention (CDC) invites comment on the proposed design for the 2021-22 National Health and Nutrition Examination Survey (NHANES). Comments are due by September 18, 2020.
 
NHANES programs produce descriptive statistics, which measure the health and nutrition status of the general population. With physical examinations, laboratory tests, and interviews, NHANES studies the relationship between diet, nutrition and health in a representative sample of the United States.

NHANES monitors the prevalence of chronic conditions and risk factors and are used to produce national reference data on height, weight, and nutrient levels in the blood. Results from more recent NHANES can be compared to findings reported from previous surveys to monitor changes in the health of the U.S. population over time.
  
NHANES has been conducted periodically between 1970 and 1994 and continuously since 1999 by the National Center for Health Statistics (NCHS), CDC.
 
In 2021-22, the program is not considering any substantial changes to NHANES content or procedures. The proposed changes being requested are small additions and modifications to laboratory content, introductions to and wording of existing questions, and the addition of a conditional $40 incentive for the household interview. The base sample will remain at approximately 5,000 interviewed and examined individuals annually. It is possible that the survey may have to adapt its plans in response to Novel Coronavirus Disease (COVID-19) or related concerns.

NCHS collects personally identifiable information (PII). Participant level data items will include basic demographic information, name, address, social security number, Medicare number and participant health information to allow for linkages to other data sources such as the National Death Index and data from the Centers for Medicare and Medicaid Services (CMS).

A variety of agencies sponsors data collection components on NHANES. To keep burden down and respond to changing public health research needs, NCHS cycles in and out various components. The 2021-22 NHANES physical examination includes the following components: Anthropometry (all ages), 24-hour dietary recall (all ages), physician's examination (all ages, blood pressure is collected here), oral health examination (ages one and older), dual X-ray absorptiometry (DXA) (ages 50+ bone density; ages 8-69 total body scan) and audiometry (ages 6-19 and 70+). While at the examination center, additional interview questions are asked (six and older) and a second 24-hour dietary recall (all ages) is scheduled to be conducted by phone 3-10 days later.

The 2021-22 survey will be similar to what was fielded in 2019-20. It is possible that content will be deleted, if collaborator focus changes or resources are not available. NHANES plans to conduct developmental projects during NHANES 2021-22, with a focus on planning for NHANES 2023 and beyond. These may include activities such as tests of new equipment, crossover studies between current and proposed methods, tests of different study modes, settings or technology, outreach materials, incentive strategies, sample storage and processing or sample designs.
 
In 2021 we plan to add the following laboratory tests: Acetylcholinesterase Enzyme Activity in whole blood; an Environmental Toxicant in Washed Red Blood Cells (Hemoglobin Adducts); Environmental Toxicants in serum (seven terpenes); Environmental Toxicants in urine (seven volatile organic compound (VOC) metabolites); Infectious Disease Markers in serum (Enterovirus 68 (EV-D68) and Human Papilloma Virus (HPV) in serum); Nutritional Biomarkers in plasma (Four trans-fatty acids (TFA)); and two Nutritional Biomarkers in serum.

In 2021, the following Laboratory Tests will be modified: Steroid hormones in serum (11 steroid hormones). Cycling out of NHANES in 2021-22 is the Blood Pressure Methodology Study and laboratory tests of Adducts of Hemoglobin (Acrylamide, Glycidamide) and Urine flow rate.

Most sections of the NHANES interviews provide self-reported information to be used in combination with specific examination or laboratory content, as independent prevalence estimates, or as covariates in statistical analysis (e.g., socio-demographic characteristics). Some examples include alcohol, drug, and tobacco use, sexual behavior, prescription and aspirin use, and indicators of oral, bone, reproductive, and mental health. Several interview components support the nutrition-monitoring objective of NHANES, including questions about food security and nutrition program participation, dietary supplement use, and weight history/self-image/related behavior.

In 2021-2022, we plan to continue or expand upon existing multi-mode screening and electronic consent procedures in NHANES. Our yearly goal for interview, exam and post exam components is 5,000 participants. To achieve this goal, we may need to screen up to 15,000 individuals annually.
 
NHANES website:  https://www.cdc.gov/nchs/nhanes/index.htm
July 20 FRN summarizing 2021-22 NHANES and inviting public comment:  https://www.federalregister.gov/documents/2020/07/20/2020-15659/proposed-data-collection-submitted-for-public-comment-and-recommendations
2019-20 NHANES submittal to OMB: https://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=201809-0920-002
 
Point of contact:  Kathryn Porter, Director, Health and Nutrition Examination Surveys Division, NCHS, CDC  kzs4@cdc.gov   (301) 458-4441

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