--

Library of Congress Cataloging in Publication Data

United States. National Center for Health Statistics.

Plan and operation of the second National Health and Nutrition

Examination Survey, 1976-4980.

(Vital and health statistics: Series 1, Programs and collection

procedures; no. 15) (DHHS publication; no. (PHS) 81-1317)

Prepared by A. McDowell and others.

Includes bibliographical references.

Supt. of Dots. no.: HE 20.6209:1/15

1. Health and Nutrition Examination Survey. I. McDowell, Arthur.

II. Title. I II. Series: United States. National Center for Health Statistics.

Vital and health statistics: Programs and collection procedures; no. 15.

IV. Series: United States. Dept. of Health and Human Services. DHHS

publication; no. (PHS) 81-1317. [DNLM: 1. Health Surveys-United

States. 2. Nutrition surveys-United States. W2AN148va no. 151

RA409.U44 no. 15 [ RA407.31 312 ‘ .0723s 80-607914

ISBN o-8406-01 93-X [312 ’ .0723]

For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402
Plan and Operation of

the Second National

Health and Nutrition

Examination Survey

1976-80

,Programs and Collection Procedure

Series 1, No. 15

A description of the National Health and

Nutrition Examination Survey of a

probability sample of the U.S. population

6 months through 74 years of age.

DHHS Publication No. (PHS) 81-I 317

U.S. Department of Health and Human Services

Pub1 ic Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statistics

Hyattsville, Md.

July 1981
National Center for Health Statistics

DOROTHY P. RICE, Director

ROBERT A. ISRAEL, Deputy Director

JACOB J. FELDMAN, Ph.D., Associate Director for

Analysis and Epidemiology

GAIL F. FISHER, Ph.D., Associate Director for the

Cooperative Health Statistics System

GARRIE J. LOSEE, Associate Director for Data

Processing and Services

ALVAN 0. ZARATE, Ph.D., Assistant Director for

International Statistics

E. EARL BRYANT, Associate Director for Interview

and Examination Statistics

ROBERT C. HUBER, Associate Director for

Management

MONROE G. SIRKEN, Ph.D., Associate Director for

Research and Methodology

PETER L. HURLEY, Associate Director for Vital and

Health Care Statistics

ALICE HAYWOOD, Information Officer

Library of Congress Catalog Card Number 80-6079 14

Division of Health Examination Statistics

ROBERT S. MURPHY, Director

JEAN ROBERTS, Chiex Medical Statistics Branch

SIDNEY ABRAHAM, Chiefl Nutritional Statistics Branch

KURT R. MAURER, chief, Survey Planning and

Development Branch

Division of Data Services

PHILLIP R. BEATTIE, Director

HENRY W. MILLER, Chiefl Health Examination Field

Operations Branch

Under the legislation establishing the National Health Survey, the

Public Health Service is authorized to use, insofar as possible, the

services or facilities of other Federal, State, or private agencies. In

accordance with specifications established by the National Center for

Health Statistics, the U.S. Bureau of the Census participated in the

design and selection of the sample and carried out the household

interview stage of the data collection and certain parts of the statistical

processing.

The Center for Disease Control acted as laboratory consultants

and performed a series of biochemical, hematological, and serological

assessments on blood specimens of persons participating in the survey.

Office of Research and Methodology

JAMES T. MASSEY, Ph.D., chiei Survey Design Staff
Contents

Introduction............................................................................ 1

Planningprocess........................................................................,

Summary statement of data collection techniques. ..................................................

Questionnaires.. ......................................................................

Examination by physician. ................................................................

Special clinical procedures and tests ..........................................................

X-rays ..............................................................................

Urinetests ...........................................................................

Tests on blood samples. ..................................................................

Nutritional status assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Detailed health examination ................................................................. 9

Major new target conditions ............................................................... 9

Other important target conditions ........................................................... 12

Sample design for NHANES II. ................................................................ 15

Design specifications .................................................................... 15

Definition and stratification of primary sampling units. ............................................. 16

Formation of superstrata in NHANES II ....................................................... 17

Selection of sample locations. ............................................................... 21

Selection of housing units within sample locations. ................................................ 23

Selection of sample persons. ............................................................... 25

Operational plan .........................................................................

Stand sequencing and scheduling ............................................................

Advance contacts and logistics. .............................................................

Household interviewing and appointment process .................................................

Examination center and staff. ............................................................

Examination process and medical reports.

., .

......................................................

Qualitycontrol................................................................ , . . . . . . . . . 31

Pilottesting............................................................................

Plans for analysis and publication of data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

References..............................................................,.............. 35

2

27

27

27

28

28

29

33

. . .

III
Appendixes

_. B

Contents.........~ .................................................................... 37 1) 1’1

I. Examination components by age groups 38 t

....................................................

II. Blood and urine assessments by specimen types and age groups ..................................... 39

II I. Pesticide residue and metabolite determinations ............................................... 40

IV. National Center for Health Statistics and Center for Disease Control staff involved in the planning, development, and

operation of NHANES II .............................................................. 41

V. Data collection forms for NHANES II. ..................................................... 43

List of Text Figures

1. Comparison of regional boundaries for the National Health and Nutrition Examination Survey, 197680, with those

defined by the U.S. Bureau of the Census. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

2. An example of a sample berson selection sheet nsed in the National Health and Nutrition Examination Survey, 1976-80 . . 26

3. Mobile examination center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

List of Text Tables

A. Number and population of National Health Interview Survey (NHIS) strata before and after subdivision of self-representing

primary sampling units, by type of stratum and National Health and Nutrition Examination Survey region . . . . . . . . . . . 17

B. Variables in final stepwise regression model, by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I. . . . . 20

C. Correlation matrix for health and sociodemographic variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

D. Variables used for stratification in the National Health and Nutrition Examination Survey, by region . . . . . . . . . . . . . . . 22

E. Definition of control classes used for the selection of primary sampling units, by region: National Health and Nutrition

Examination Survey, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . 23

F. Expected and actual number of sample primary sampling units (PSU’s) within control classes, by region and type of

stratum............................................................................. 24

G. Primary sampling units, stand sites, and percent of persons examined, by region: National Health and Nutrition Examination Survey, 1976-80.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Symbols

- - - Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

Z Quantity more than zero but less than

500

* Figure does not meet standards of

reliability or precision

# Figure suppressed to comply with

. confidentiality requirements
Plan and Operation of the

Second National Health and

Nutrition Examination Survey,

1976-80

by Arthur McDowell, formerly with Division of Health

Examination Statistics, Arnold Engel, M.D., Division of

Health Examination Statistics, James T. Massey, Ph.D.,

Office of Research and Methodology, and Kurt Maurer,

Division of Health Examination Statistics

Introduction

The second National Health and Nutrition Examination Survey is another in a series of related programs carried out over the past 20 years by the

National Center for Health Statistics. These programs,

authorized by Congress under the National Health

Survey Act of 1956, are characteristically national in

scope, based on probability sampling, and used to

collect a broad range of morbidity data and related

health information. The essential differentiating

characteristic of the health examination surveys is

their primary concern with those kinds of healthrelated data obtained only (or at least optimally)

from specially standardized direct medical examinations, including tests and other procedures used in

clinical practice. Such examinations given to persons

selected in the scientific sample permit estimates of

the prevalence of specifically defined diseases in the

U.S. population, including cases not previously

identified. They also permit estimation of the distribution within the population of a broad variety of

health-related measurements, including not only

physical measurements such as height, weight, and

various skinfolds, but also physiological measurements, such as diastolic blood pressure and serum

cholesterol level and psychological measurements.

During the years 1959-76, the National Center

for Health Statistics (NCHS) conducted four separate

examination surveys. The first of these, the National

Health Examination Survey, Cycle I, (NHES I)

focused on the prevalence of selected chronic disease

in civilian noninstitutionalized U.S. adults aged

18-79.1 The next two surveys, which were conducted

from July 1963 through March 1970, were largely

devoted to the growth and development of children

6-11 (the National Health Examination Survey, Cycle

II-NHES II)2 and 12-l 7 years of age (the National

Health Examination Survey, Cycle III-NHES III)?

The fourth survey a new emphasis. In

1969 the Department of ealth, Education, and

Welfare established within NCHS a continuing activity

to measure the nutritional status of the U.S. population and to monitor changes in status over time. After

careful study by an NCHS task force, it was decided

to combine the proposed national nutrition surveillance survey with the existing National Health Examination Survey in order to enhance the performance

of each component and to permit relating nutritional

variables to health measures. The resultant survey is

known as the National Health and Nutrition Examination Survey, or NHANES.

The first segment of NHANES (the National Health

and Nutrition Examination Survey-NHANES I) was

conducted from 197 1 through 1 974.4 An assessment

of nutritional status was made on a representative

sample of the U.S. population aged 1-74 years, and a

detailed examination was given to a subsample aged

25-74 years. This segment of the NHANES I program

was followed by a 14month period (197475) in

which an additional national sample of persons 2574

years of age was given the detailed examination, to

augment the size of the sample originally included in

NHANES I (referred to as the National Health and

Nutrition Examination Survey, Augmentation CycleNHANES IA)? Data collected in successive surveys

have been published in more than 100 separate

publications6 and have also been made available on

computer tapes for further study.7 The reports serve

a broad spectrum of uses:

They provide estimates of the prevalence of characteristics or conditions.

Normative or descriptive data permit the monitoring or measurement of changes in health and nutritional status over time through successive

assessment surveys.

Problems of possible public health importance

can be identified.

The interrelationship of health and nutritional

variables in the general’ population is made

possible.

1
Planning process

The continuing responsibility for measuring and

monitoring the nutritional health status of the U.S.

population meant that the first assessment survey,

NHANES I, would be followed by later assessment

surveys. These would permit comparisons with the

NHANES I baseline data and thereby allow measurements of changes over time. Thus, in a sense, the

planning of the nutritional aspects of the second

National Health and Nutrition Examination Survey,

1976-80, NHANES II, began with NHANES I.

Throughout the course of its operation there was

an awareness of this. Constant consideration was

given to procedures and content items in terms of

whether they should be repeated in the succeeding

survey. Then, too, the necessity for comparing

NHANES II data with those from NHANES I required that some of the same measurements be

made in the same way and on the same age segment

of the U.S. population in both surveys. The complex

process of planning the NHANES II program began in

a systematic way, however, only in mid-1974, about a

year and a half before the survey was to begin operation.

The planning phase of a national health examination survey is critically important. The planning

process used in the NHANES and predecessor surveys

has been described in more detail elsewhere, but part

of that statement deserves repeating here:

One aspect of planning is of prime importance, namely, specifying the survey’s specific

goals or substantive purposes. . . With respect

to each element to be considered for inclusion

in a health examination survey-for example,

information on diabetes- the following questions should be answered by the appropriate

personnel :

0i How and for what purposes will the information be used? (Outlines of proposed

analyses are desirable.)

(ii) What specific data are needed?

2

(iii)

(iv)

(V 1

(vi)

(vii)

(viii)

How can those data be obtained? (What

specific tests, measures, and questionnaire

items are needed, and what level of skill is

required of examining personnel?)

Is the health examination survey the appropriate mechanism to get these data?

Is the expected prevalence level consonant

with the ability of the planned survey to

determine it within reasonable confidence

limits?

Can the entire process of obtaining these

data be adequately standardized?

What cost factors are involved in equipment, laboratory work, skilled personnel,

and-. so on?

Finally, if questions (i)-(vii) all are answered

satisfactorily-what is the place of this particular data need in an ordered priority

listing with other potential needs?

The appropriate personnel vary with the

question asked. For example, for question (i), the

head of a health planning agency would qualify,

while for (iii) it might be an expert in the medical

specialty involved. In the USA the process of

determining the conditions to be included in each

health examination survey has been a multi-stage

effort involving hundreds of institutions, organizations, and individuals. At the beginning a wide

net is cast and opinions are sought from hundreds

of health planners, health researchers, medical

care providers, and health educators as to the

kinds of data, appropriate to this type of survey,

that are most needed. Important in this stage is

the input from Federal Government agencies,

particularly the various elements of the Qep,artment of Health, Education, and Welfare. Further

follow-up contacts are made with respect to some

of the suggested items which seem to be reasonable prospects for inclusion, and information is

obtained in greater detail so as to answer each of

the questions listed in the preceding paragraph.
This leads to further stages of consultation and

perhaps to convening ad hoc meetings of experts

in a particular field to assist in determining

feasibility and relative priorities. In the end,

decisions must be made at the level of the NCHS,

but these must be approved at successive Govemmental levels up to the Office of Statistical Policy

within the Office of Management and Budget in

the Executive Office of the President.8

The processes described in the foregoing paragraphs were the general pattern of the planning

process carried out in 1974 and 1975 to determine

the content and data goals of the NHANES II program. During this same time many related determinations had to be made concerning sample size and

design, method of operation in data collection,

quality control procedures, field staff retraining, pilot

testing and pretesting, and further resultant modifications.

. Although it has not been unusual for NCHS to

collaborate with other Federal agencies in the planning, data collection, and analysis of previous National Health Examination Surveys, the level of collaboration involved in NHANES II was unprecedented:

l The Bureau of Laboratories, Center for Disease

Control, served as a technical consultant for the

planning and quality control of NHANES laboratory efforts, in addition to performing most of

the health- and nutrition-related biochemistry

and providing some of the funding for this effort.

l _ The National Institute of Arthritis, Metabolism,

and Digestive Diseases, National Institutes of

Health, supported the serum creatinine testing,

the development of a glucose tolerance testing

protocol, plasma glucose determinations at the

Center for Disease Control, and processing of the

data to make it more quickly available for

analysis.

l The National Heart, Lung, and Blood Institute,

National Institutes of Health, developed plans for

assessing cholesterol, triglyceride, and high

density lipoprotein (HDL) levels through the

Lipid Research Clinic Laboratory at George

Washington University, the results processed at

the Coronary Patient Registry at the University of

North Carolina.

The Office of Pesticides and Toxic Substances,

Environmental Protection Agency, served as a

technical consultant in collecting blood and urine

specimens suitable for processing for residues and

metabolites of certain pesticides. It processed the

samples, monitored the quality of the processing,

and coded the data in machine-readable form.

The Bureau of Foods, Food and Drug Administration, supported the development of a serum ferritin

assessment as part of the characterization of

anemia. It also supported the measurement of

blood lead levels at the Center for Disease Control.

The Department of Energy supported Dr. Edward

Radford at the University of Pittsburgh in his

assessment of carboxyhemoglobin levels in blood.

Randomly selected blind samples both from Dr.

Radford’s laboratory and from NCHS mobile

examination centers were analyzed by accepted

gas chromatographic procedures at the Naval

Medical Research Institute, insuring quality control and providing a reference standard.

The Bureau of State Services, Center for Disease

Control, made arrangements in each sample area

for supplies and testing for gonorrhea.

The remaining sections of this report present the

outcome of the planning with respect to the objectives

of NHANES II. They describe in more detail some of

the reasons for the selections and go into details of

the sample design and operational plan.

The appendixes of this report contain listings of

the examination components; blood and urine assessments; pesticide residue and metabolite determinations; staff participation in the planning, development,

and operation of NHANES II; and data collection

forms.
Summary statement of data

collection techniques

The plan developed with respect to the content of

NHANES II called for the following items.

Questionnaires

Household questionnaire. -For each household

member, this questionnaire included the family

relationships; certain demographic items such as age,

sex, and race; selected housing information; items

such as occupation, income, veteran status; and an

indication of participation in food stamp programs.

Medical history questionnaires. -For each sample

person at ages 6 months to 11 years a questionnaire

included items on birth weight, prematurity, developmental congenital conditions, medication, neurological conditions, lead poisoning, accidents, hospital

care, disability, diarrhea, pica, vision, and a variety of

chronic conditions. In addition, there were major

sections on allergies, kidney and bladder disease,

anemia, speech and hearing, lung and chest conditions, and participation in food programs.

Two questionnaires for each sample person at

ages 12-74 years included items on medication; hospital care and tuberculosis; nutrition; a variety of

acute and chronic diseases; tobacco, tea, and coffee

usage; physical activity; weight;. height; vision disability; exposure to pesticides; gastrointestinal problems; and for females, a menstrual and pregnancy

history. In addition, there were major sections on

anemia, diabetes, respiratory condition, hearing and

speech, liver and gallbladder conditions, kidney and

bladder disease, allergies, hypertension, cardiovascular

conditions, stroke, arthritis (stressing middle and

upper back and neck problems), and participation in

food programs.

Two dietary questionnaires. -For each sample

person, a dietitian recorded the quantity of every

item of food or drink consumed during the previous

day, so that after computer calculation, the data

yielded measures of calories, cholesterol, fat,

unsaturated fats, protein, carbohydrates, and specific

vitamins and minerals consumed during the recall

period.

A food frequency interview ascertained the usual

pattern of food consumption, recording whether or

not it included any foods in various groupings, including milk, meat, fish, eggs, fats and oils, legumes

and nuts, cereals, fruits, vegetables, and alcoholic

beverages. It also showed reported daily and/or

weekly number of times each food was consumed and

noted the use of salt and vitamin and mineral supplements.

Medications and vitamin usage.-This elicited a

history of the preceding week’s usage of any

medicines, vitamins, or minerals, for all examined

persons.

Dietary supplement interview form. -This form

recorded the history of special diets, prior

medications, and barriers to purchasing groceries or

eating foods for examined persons aged 12-74 years.

Behavior questionnaire.-This questionnaire

elicited data on behavior possibly associated with

coronary heart disease for examined persons 2574

years of age.

Examination by physician

A physician performed and. recorded a medical

ex amination giving special at ten tion to specified

findings related to nutrition; hearing; the thyroid

gland; and the cardiovascular, respiratory, neurological, and musculoskeletal systems.

Special clinical procedures and tests

A specially trained health technician carried out

the following tests and procedures on examined

persons in the designated age ranges.

Spirometry trials.-These were digitized and

recorded on magnetic tape for examined persons 6-24

years of age for various pulmonary function ’

indicators such as forced vital capacity (FVC), forced

expiratory volume in 1 second (FEVl), and peak

flow rate.

4
Electrocardiograms.- Digitized and recorded on

magnetic tape for examined persons 25-74 years of

age, electrocardiograms provided normative data on

amplitudes and durations and permitted diagnostic

interpretations of heart disease according to the

Minnesota code.

Body measurements.- The measurements made

on examinees includead standing height, body weight,

triceps and subscapular skinfolds, and several others.

Puretone audiometry.- This test carried out on

examined persons between the ages of 4 and 19

permitted determination of threshold levels of

hearing for frequencies of 500, 1000, 2000, and 4000

Hertz for right and left ears.

Speech recording. -This involved the use of a tape

recording of the subject’s repetition of specially developed sentences. It was carried out on examined

persons between the ages of 4 and 6, permitting interpretations as an indication of problems with articulation and language development.

Allergy tests.-These involved skin tests (the prick

test) with eight common allergens (housedust, alternaria, cat fur, dog fur, ragweed, oak, rye grass, and

Bermuda grass). The tests were made on examined

persons between the ages of 6 and 74 to obtain degrees of skin reaction.

X-rays

For examined persons 25-74 years of age two

X-rays were made. No X-rays were done on pregnant

women, and no lumbar X-rays were done on women

under 50 years of age.

X-ray of cervical and lumbar spine.-This

provided evidence of osteoarthritis and degenerative

disc disease.

X-ray of chest.-The chest X-ray was used in the

diagnosis of respiratory diseases and served as a

measure of left ventricular enlargement.

Urine tests

Tests as follows were performed on casual samples of urine.

NMultistix tests.-These urinary dipstick tests for

qualitative protein, glucose, ketones, bilirubin, blood,

urobilinogen, pH, and bacteriuria (nitrite test) were

done for examined persons 6-74 years of age.

Urinary sediments. -Sediments including red cells,

white cells, and casts were measured for a subsample

of examined adults 20-74 years of age.

Gonorrhea cultures.-Cultures of urinary

sediments were performed for male and female

examined persons 12-40 years of age. However, of

those females who received the glucose tolerance test

(GTT), only those 20-24 years of age had the

gonorrhea test performed.

Analyses for pesticide levels.-Urine samples from

a subsample of examined persons 12-74 years of age

were tested for the presence of alkyl phosphate residues and metabolites, carbamate residues, phenolic

compound residues and malathion metabolites.

Appendix III has a complete listing of the pesticide

residues and metabolites tested for.

Tests on blood samples

Samples of blood provided a broad range of

information related to health and nutrition. The

particular tests performed varied with the specific

target condition and age group (appendix II). The

discussion of the development of the plan for

NHANES II later in this report specifies the age

groups and, in some instances, the subsampling

pattern followed for each of the following tests.

Glucose tolerance test.-This test involved the

collection of blood specimens from examined persons

while they were in a fasting state as well as at 1 and 2

hours after glucose challenge. The test was performed

on a specified subsample of examined adults to

provide estimates of the prevalence of diabetes.

Tests related to liver function.-The postprandial

liver bile acid test measured the ability of the liver to

remove bile acids from the blood following consumption of a food preparation that induced the eventual

addition of bile acids to the blood via contraction of

the gallbladder.

Biochemical liver tests performed included bilirubin, SGOT, and alkaline phosphatase.

Anemia-related laboratory tests.-The tests made

to diagnose anemia consisted of protoporphyrin, iron,

total iron binding capacity (TIBC), zinc, copper, red

cell folates, serum folates, serum ferritin, vitamin

B 12, and the determination of abnormal hemoglobin.

Other biochemical nutritional tests.-These tests

included albumin, vitamin A, and vitamin C.

Serum lipids.-Because of their important

relevance to cardiovascular disease, determinations

were made of cholesterol, triglycerides, and high

density lipoprotein (HDL).

Biochemical tests for body burden from environmental exposures.- Determinations were made of the

levels of lead and organochlorine pesticide residues

and metabolites. Tests were also performed for

carboxyhemoglobin, which reflects environmental

exposure to carbon monoxide and the individual’s

smoking habits.

Hematology.-The hematology included determinations of hemoglobin, hematocrit, red blood cell

count, white blood cell count and differential analysis,

and red blood cell morphology.

Kidney function.- The only test for kidney

function performed on blood samples was the serum

creatinine test.

Syphilis.-The serology determinations for

syphilis included qualitative and quantitative ART, an

FTA-ABS, and MHA-TP.

5
The foregoing list summarizes the content finally

decided upon for inclusion in NHANES II. However,

the planning process almost always involves a great

deal of effort in connection with proposals that, for

a variety of reasons, are not included in the final plan.

A few of the important components considered in the

process of planning but deleted from the final

NHANES II plan deserve to be noted. Two of the

proposals that were seriously considered had to be

deleted because of staff limitations or examination

time. One of these would have involved administering

a tuberculin skin test at the examination site with

subsequent reading at the household; the other would

have involved administration of a psychological

schedule used in NHANES I, the General Well-Being

Test. A third proposal involved completion of a

questionnaire at the school attended by children and

‘youth who were sample persons. In that case, considerations related to confidentiality and privacy, and

the related clearance process required more time than

was available for their resolution. Finally, in the early

stages of planning, consideration was given to including an extensive neurological component based on -

computer analysis of tape recorded electroencephalograms. The main purpose would have been the

provision of normative data on the, distributions of

the electroencephalogram variables in the general

population and of some data on the prevalence of

brain damage and related brain pathology. It was

finally decided to drop this from NHANES II, with the

possibility of considering it in a later program. A

major factor in this decision was the recommendation

by the National Institutes of Health advisory committee that reviewed the plan. While approving the

general concept of such data collection and analysis,

this group believed that the methodology available at

the time was not appropriate for use in NHANES II.

Certain other components considered in planning but

finally omitted from NHANES II are noted later in

the detailed description in this report.

6
Nutritional status

assessments

The basic purpose of the NHANES II program

with respect to nutritional status assessment required

that the program continue to use, with some modification, the same or essentially the same format of

NHANES I. In order to monitor the nutritional status

of the population, the data to be collected needed to

be not only comparable, at least in considerable part,

but also carried out as in NHANES I on a probability

sample of the civilian noninstitutionalized population

of the United States. Again as in NHANES I, emphasis

needed to be placed on the segments of the population classified as at or below the poverty level, the

young children and the aged, since these were assumed to be at special risk of having nutritional

problems. These groups then would again be sampled

at rates substantially higher than their proportions in

the general population.

It is necessary, in order to assess nutritional

status, to obtain data of four different types. The

fourfold approach used in NHANES I and NHANES

II involved the collection of information on dietary

intake patterns along with the results of various

hematological and biochemical tests, anthropometric

measurements, and clinical assessments.

The experience gained in the NHANES I program,

however, made possible certain modifications of

NHANES II in order to make the data obtained more

useful while continuing to provide a considerable

amount of comparable data for monitoring purposes.

The NHANES I information indicated that vitamin A

deficiencies were not a problem in the older age

groups in our U.S. population, and as a result, collection of information on the biochemical findings of

vitamin A was limited in NHANES II to the 3-11 years

age group. (It was not recognized at the time that

vitamin A levels in adults would be of considerable

interest in cancer research.) Technical problems in

the collection of blood samples and their analysis for

vitamin C during the NHANES I program had resulted in unsatisfactory data. These problems were

solved, and vitamin C determinations were again

made in NHANES II. The methods used in NHANES

I for determining the iodine, thiamine, and riboflavin

values in urine were found to be inadequate, however. Therefore, the decision was made to exclude

those determinations from NHANES II. Some consideration was given to using the more sensitive

enzyme analysis method to detect any riboflavin or

thiamine deficiencies. Some of the investigations at

the Center for Disease Control involved the spectrophotometric erythrocyte transketolase method- as

well as a spectrophotometric method for erythrocyte

gluthathione reductase. This work identified a number of compromises in basic enzyme assay principles and certain questions in the color development

procedure that would require a considerable amount

of additional time to evaluate fully. It was, therefore,

decided not to include these in the NHANES II

program. On the other hand, the serum albumin test

used in NHANES I was continued in NHANES II as a

monitor of protein deficiency in the U.S. population.

The relationship of the serum albumin test to clinical

health status was also an important factor in its

retention, since as a whole there is little evidence of a

gross pattern of protein deficiency in the U.S. population.

An important addition in NHANES II to the biochemical data obtained in NHANES I related to the

investigation of the trace elements zinc and copper in

blood. It was known in 1974 that there are more than

70 enzymes that need zinc for their proper function.

Important factors in decreasing the absorption of

dietary zinc are the fiber and phosphates in predominantly cereal-based diets. The consumption of

alcohol increases urinary excretion. A number of

diseases such as steatorrhea, regional enteritis, liver

cirrhosis, hemolytic anemia, psoriasis, thalassanemia,

and sickle cell disease may lead to zinc deficiency.

Pregnancy may also predispose to zinc deficiency.

Zinc is involved in the production of insulin, and zinc

deficiency may impair wound healing. Copper deficiency is important for a number of reasons. The first

7
sign of copper deficiency in humans is usually neutropenia. In advanced copper deficiency, iron is not

absorbed. A copper-containing enzyme (ceruloplasmin) is necessary for the human body to use iron.

Copper is essential in hematopoiesis and plays a key

role in connective tissue metabolism.

Since in trace element surveys many factors can

grossly interfere with the integrity of the specimens,

a number of precautions were taken. A thorough

investigation was made of various aspects of the

collection, storage, stability, and possibilities of

contamination of specimens. Special blood-drawing

equipment and specimen storage containers were

employed. A laminar flow table was used to prevent

air-born contamination during specimen processing at

the laboratory in the examination center.

As in the NHANES I program, the two principal

means of obtaining data on dietary intake were the

24hour recall and the food frequency questionnaire.

In order to facilitate comparison of the various types

of information, the schedules used were modified

somewhat in NHANES II so that both of them used

identical food groupings. This was done in a way that

still permits the comparison of NHANES II with

NHANES I data.

Considerably increased amounts of information

on vitamin and mineral supplements were obtained in

NHANES II as compared with NHANES I. In

NHANES II, information was obtained on participation in such food programs as food stamps, commodities, school lunches, home-delivery meals, and the like.

This information will permit comparisons between

the measures of nutritional status of individuals participating in these programs and individuals of similar

socioeconomic status who are not participating.

- _.- The body measurements obtained in NHANES II,

the third part of the fourfold approach to assessing

nutritional status, were the same as those used in

NHANES I. They were as follows: standing height,

sitting height, weight, bitrochanteric breadth, elbow

breadth, upper arm girth, head circumference, triceps

skinfold, and subscapular skinfold. The only change

made was to obtain measures in 3-year-olds of both

standing height and recumbent length, along with

sitting height and a crown-rump measurement.

The fourth approach to assessing nutritional

status, a physician’s examination, was also largely

unchanged from the examination given in NHANES I.

The examining physician’s clinical diagnostic impression was based on the physical examination and

medical history along with the examining physician’s

own reading of the electrocardiogram and X-ray and

the results of some laboratory determinations immediately available at examination time (hematocrit,

hemoglobin, white blood cell, red blood cell, redblood-cell-urinary test tape, and microscopic urinalysis). The examining physician’s reading of the

electrocardiogram and X-ray were not, of course,

equivaient to the readings that were obtained later

from medical specialists. The examining physician’s

clinical diagnostic impression of many conditions

was, in fact, based on much less than a complete

workup. For many other conditions, however, the

examining physician’s clinical diagnostic impression

may have had a reasonable degree of accuracy. For

their diagnostic impressions, the physicians entered

the four-digit coding of the Eighth Revision International Classification of Diseases, Adapted for Use in

the United States9 rather than the three-digit code

used in NHANES I.

The most important change in the approach to

nutritional assessment adopted for the NHANES II

program was in relation to anemia. Since this condition had been revealed by NHANES I to be a significant health problem in the U.S. population, anemia

was investigated in more detail in NHANES II. The

approach used to characterize anemia was one that

had been recommended by Dr. William Darby, President of the Nutritional Foundation, Inc., Center for

Disease Control personnel, and others. It involved

symptoms, signs, and causes of anemia gathered in

medical history questionnaires and physicians’ examinations; and it involved laboratory assessments in

blood as follows:

l A complete blood count: hematocrit, hemoglobin,

white blood cell, red blood cell, cell differential,

red cell morphology, and the determination of

hemoglobinopathies.

0 Iron, iron-binding capacity*, serum ferritin, and

red cell protoporphyrin to d.esignate iron status.

l Serum folates, red cell folates, vitamin B 12, zinc,

copper, lead, and other indicators of anemia.

The folate, ferritin, and vitamin B12 determinations were done on anemic individuals and on a subsample of the entire group. This approach used to

characterize anemia should make a better determination of the prevalence of anemia in the U.S. population possible than could be done from the NHANES I

data and will enable the relationships among the various iron-related measures to be characterized. Such

a determination is important for various public policy

actions such as recommendations for enrichment ofI

food products with iron.

8
Detailed health examination

Major new target conditions

The NHANES programs have been referred to as

dual-purpose surveys, the purposes involving the

assessment of both nutritional and health status. It

might be more precise to refer to them as surveys to

measure health status with special emphasis on one of

the major determinants of health-nutrition. Be that

as it may, information about a number of health

conditions regarded as target conditions was collected

in NHANES I, and many of these same target conditions were included in NHANES II. The new target conditions included in NHANES II were diabetes,

kidney pathology, liver function, and allergy.

Diabetes.-Diabetes has long been recognized as

an extremely serious disease affecting a significant

proportion of the U.S. population. Despite this

fact, there has been wide variation in the estimated

prevalence of diabetes in the population. A problem

arises as a result of the presence of unrecognized or

undiagnosed cases of diabetes that need to be added

to the recognized or diagnosed to obtain the total

prevalence. A health examination survey is an ideal

mechanism to obtain prevalence estimates that

include both diagnosed and undiagnosed cases. The

prevalence of known cases of diabetes has been monitored by another NCHS survey, the National Health

Interview Survey, and unpublished data from that

program appears to indicate an increase in the pre- . valence of diabetes. The apparent increase, however,

may be -due to the wider use of diabetes-detecting

clinical tests in the U.S. population and not to a true

increase in the prevalence of the disease. The first

National Health Examination Survey ( 1960.62)

provided some information on the prevalence of

diabetes, based on a l-hour glucose tolerance

test, lo-13 but a closer approximation to a standard

glucose tolerance test than was then used14 would

have been essential to provide an adequate estimate

of the total prevalence of diabetes mellitus. Increased

attention to diabetes was mandated by the National

Diabetes Mellitus Research and Education Act,

enacted by Congress on July 23, 1974 (Public Law

93-354). Its purpose was to

(1) expand the authority of the National

Institutes of Health to advance the national attack on diabetes mellitus; and

(2) as part of that attack, to establish a longrange plan to

(A) expand and coordinate the national

research effort against diabetes mellitus;

(B) advance activities of patient education, professional education, and

public education which will alert

the citizens of the United States to

the early indications of diabetes

mellitus ; and

(C) to emphasize the significance of

early detection, proper control and

complications which may evolve from

the disease.

In planning NHANES II, NCHS worked closely

with the National Commission on Diabetes (established under Public Law 93-354) and with the National Institute of Arthritis, Metabolism, and Digestive

Diseases of the National Institutes of Health. Dr. G.

Donald Whedon, Director of this Institute, specially

requested that a diabetes component be included in

NHANES II in order to determine both the prevalence of diabetes mellitus in the U.S. population and

the ratio of previously diagnosed to undiagnosed

cases. In addition, the distribution of diabetes within

the population according to various demographic

characteristics ‘was of interest. In addition to the

assistance obtained from the National Institutes of

Health directly, a number of consultants on the

diabetes component were used in planning the

NHANES II program. The principal ones were Drs.

Peter Bennett, John O’Sullivan, Kelly West, and

Harvey Knolls.

A number of questions arose during the detailed

9
planning of the diabetes component. One of these

was whether or not to require the consumption of a

specific number of grams of carbohydrates during the

3 days before the examination. The major drawback

of such a procedure for NHANES was the elimination

of the 24hour recall diet history from the nutritional

dietary survey for individuals undergoing the glucose

tolerance test, since the diet preparation would have

seriously altered the previous day’s food intake. Consideration was given to interviewing persons to receive

the glucose tolerance test at home at a time other

than the 3 days before the examination, but limitations of budget and personnel precluded this solution.

The question of diet preparation was brought up at a

session of the work group on epidemiology of the

Committee on Scope and Impact, a subcommittee of

the National Commission on Diabetes. The work

group did not reach general agreement.

The group’s final decision was that the consumption of a specific amount of carbohydrates prior to

the test would not be required. But data from the

240hour recall and the presence of ketones found in

the urine sample would serve as an indication of

whether or not there had been an inadequate consumption of carbohydrates prior to the test. Some

consideration was also given to the collection of data

reflecting levels of circulating insulin and glucagon.

After due consideration, it was decided to omit

determinations of insulin and glucagon, largely

because of the lack of adequate resources.

The test finally decided upon for the diabetes

component was as follows: a one-half sample of

persons 20-74 years of age was scheduled for examination in the mornings. (Analysis of Cycle I glucose

tolerance data indicated that sample variances for this

reduced sample would be low enough to permit data

analysis.) Three blood glucose specimens were collected, a fasting one and specimens collected at l- and

2-hour intervals after the glucose “challenge” had

been drunk. Data could then be tabulated for each

blood specimen, and some combination of the three

values could be used to decide whether or not sample

persons had diabetes. Previous studies had indicated

that a 3-hour value did not contribute significantly to

the diagnosis of diabetes and that attempting to

obtain it would only increase nonresponse and

unduly lengthen the examination time. A 75gram

glucose challenge was selected. Available information

suggested that data derived from larger loading doses

were generally interchangeable with the 75gram

dose. The tests were done only in the morning

because glucose tolerance decreases later in the day.

In general, health conditions, such as pregnancy, that

were known to alter carbohydrate metabolism were

not grounds for exclusion from testing. The test was

also given to those individuals who had been told by

their physicians that they were diabetic and whose

condition had been controlled by diet or by oral

hypoglycemic medication. The test was not given to

insulin-dependent diabetics.

The examinees were instructed not to eat anything after 1l:OO p.m. on the evening before the

test. On the morning of the examination, after a

fasting venal blood specimen had been drawn and a

urine specimen had been analyzed for glucose, the

examinee was given 7 ounces of caffeine-free cola

(Glucola) to drink, which contained an equivalent

of 75 grams of glucose. Two more specimens of

blood were drawn at l- and 2-hour intervals. The

blood was processed in the examination center

laboratory, and the frozen plasma was shipped to the

Center for Disease Control in Atlanta, Ga. There the

plasma was analyzed by the hexokinase Glucose

6-Phosphate Dehydrogenase Procedure, using an

automated modification of the National Glucose

Reference Method developed at the Center for

Disease Control.

i I’

1

I

‘I

Kidney pathology.-A second major new target

condition selected for inclusion in the NHANES II

program was kidney pathology. Very little data

directly bearing on this had been collected in previous

NHANES or NHES programs, and numerous requests

to have a kidney component in the examination

survey programs had been received ‘over the years

from the National Institutes of Health, the National

Kidney Foundation, and several nephrologists in the

NHANES professional inquiry groups.

Malfunction of the kidneys is an important health

condition, made more so by the very expensive and

complex nature of the therapy that is provided by

the artificial kidney. In planning this component,

numerous people, including Dr. George Schreiner,

Georgetown University Hospital, Dr. Nancy Cummings,

National Institutes of Health, and Dr. James C. Hunt,

Mayo Clinic, were consulted. A number of tests and

procedures were considered in addition to an expanded medical history questionnaire, including a

variety of questions related to urinary problems.

Various modalities were investigated, some of which

had to be rejected because of difficulties in the field

situation. For example, because it was desirable to

obtain a measure of bacteriuria, an indication of’

possible urinary infection, modifications of quantitative culture techniques and direct examination of

urine for bacteria by gram stain were considered.

However, to avoid the likelihood of false positive

results, it is desirable to obtain at least three separate specimens in any procedure involving a bacterial culture. Previous examination survey experience had made apparent the difficult logistical

problems encountered in requiring repeated visits.

Given the constraints, it was finally decided to rely

upon the simple nitrite test using a dipstick to test

for bacteriuria. The test is highly specific but not

highly sensitive.

The creatinine clearance test, a widely used test
of kidney function that involves the collection of

timed urine specimens and a blood specimen, was

also carefully considered. The original plans were

to include a 2-hour creatinine clearance test with a

water load of approximately 400 cubic centimeters

at the start of the test. However, one of the major

sources of error involved in 2-hour collection is inadequate emptying of the bladder. Since the amount

of urine collected in this instance would be relatively

-.small, any retained urine could cause considerable

error in test results. Methods for measuring retention

of urine, such as use of isotopes, were not regarded

as feasible in the field survey. Pilot testing of the

timed urine collection strongly suggested that a

significant number of individuals did not empty

their bladders adequately. As a result of all these

things, it was decided not to use the 2-hour creatinine clearance test but to rely only on a serum

creatinine test, a widely used but less sensitive indicator. Support for the laboratory work for this

biochemical determination was provided by the

National Iastitute of Arthritis, Metabolism, gnd

Digestive-Diseases.

blood glucose, and ketones were also included in the

NHANES II program. Optical density, .,as read on a

refractometer, was also determined to assist in interpreting the data, since it gives some indication of the

concentration of urine. In addition, an osmolarity

determination, another index of the concentration of

urine, was made at the central laboratory where pestitide determinations in urine were made.

Liver disease.-There is a lack of reliable epidemiological data on the prevalence of liver disease in the

general population. Some information on the prevalance of hepatitis comes as a result of serological

tests; and considerable evidence based on mortality

data, including autopsy records, indicates that liver

disease is fairly widespread. Experts, including Dr.

Paul Beck, of the National Institutes of Health, and

Dr. Norman Javitt, of Cornell Medical Center, were

consulted. The problem was to decide on appropriate

tests to use in a sample survey. Unfortunately, the

most commonly used test to detect liver disease (the

BSP test), one both sensitive and specific, involves the

intravenous injection of a material that may not be

entirely safe. For this reason it was out of the question that it be used in the NHANES II program.

Other tests that were considered, including various

enzyme tests such as the SGOT, SGPT, alkaline

phosphatase, and so on, are not as sensitive as the

BSP test; nor are they specific, since results can be

elevated when conditions other than liver disease are

present. In this situation, Dr. Javitt suggested that a

test for elevated serum postprandial bile acids be

used. Bile acids are removed by the liver from blood

returning to the heart via the portal vein. The liver

cells rapidly secrete the recirculated bile salts into

cuniculi where they pass down the ductal system to

enter the gallbladder. Under the influence of gastrointestinal hormones, the bile is discharged into the

intestine. The bile acids are then absorbed by the

intestine and later enter the portal vein to start the

cycle again. Because a diseased liver will not remove

bile acids as efficiently as a healthy liver, and bile

acids will accumulate in the blood stream, a measurement of bile acids in the serum is relevant. A meal

containing fat causes a contraction of the gallbladder

and in effect results in a greater elevation of bile acids

than that occurring under fasting conditions. For the

NHANES II survey it was decided that sufficient fat

to elevate bile acids could be obtained by the sample

person’s drinking an eggnog preparation. Peanut

butter cups were substituted for eggnog for the

occasional person who was allergic to eggs and egg

products. Blood was collected 2 hours after administering the eggnog preparation or the substitute, and

the test was given only to adults 35 years of age and

over, since the cost of laboratory work was relatively

high. The results of the test were to be combined

with information from special medical history questions related to liver disease. Since data on alcohol

Microscopic examination of urinary sediments

was another of the procedures considered for inclusion in the survey. While consideration was given to

an exact quantitative test of urinary sediments using

an aliquot of a timed urine specimen-a highly

accurate procedure according to some reports-it was

decided after the recommendation of consultants to

use a method more closely approximating that used

in clinical laboratories. The procedure finally adopted

was the one used for urinalysis in the Mayo Clinic. It

consisted of centrifuging the urine specimen, decanting the supernatent fluid, and examining the

sediment for the presence of red and white blood

cells and cell casts. Ten microscopic fields were

examined for each specimen, using lo-power and

400power magnification. However, if the voided urine

was dilute, the counts on urinary sediments would be

much lower than if the urine sample had been highly

concentrated. For this reason it was decided to do the

microscopic analysis only on the adult subsample of

persons 20-74 years of age who were also to receive

the diabetes test. This group would have had a

sufficient number of hours of fluid deprivation

immediately preceding the test, during the time spent

sleeping, , to produce sufficiently concentrated urine

(specific gravity of 1.015 or greater) for the test. This

particular procedure was also used in a study of

kidney disease in the Scandinavian population. 15 One

finding from that study was an average of almost 60-

percent lower frequency of pyuria in both men and

women when midstream specimens were used.

Therefore, a midstream collection procedure was used

.

1 for women and a 2-glass procedure for men, with the

F

ai I ’ sediment analysis carried out on the second specimen.

Dipstick tests for bilirubin, nitrite, urobilinogen,

11
consumption were also collected inNHANES II, there

is the possibility of relating such data to the findings

with respect to liver disease.

Allergy.-The need for better data on the epidemiology of allergic conditions in the U.S. population

has long been known and was specifically pointed out

to the National Center for Health Statistics by Dr.

Sheldon C. Siegal, who at the time was president of

the American Academy of Allergy. Dr. Siegal strongly

recommended that an allergy component be included

in the examination survey program. Data from other

NCHS surveys and from other sources showed that

the clinical manifestations of allergy were responsible

for a large number of ambulatory care visits and

widespread use of prescription and nonprescription

drugs. Seasonality would be a problem in measuring

the clinical manifestations of allergies in a survey with

the NHANES design because of the scheduling of the

examination sites. However, reactions to skin tests are

closely related to the presence of various respiratory

conditions, including asthma and allergic rhinitis. 16

Further consultation on the possibility of including

such a component was held with Dr. Phillip S.

Norman, who succeeded Dr. Siegal as president of the

Academy. It was recommended that data be collected, including an allergy history and the results of

a skin test. At Dr. Siegal’s request, Drs. John Farghan,

Charles Read, and Albert Schaeffer drew up a specific

format and content for the allergy examination.

The recommendation of the consultants was that

the prick test be used, which, along with the scratch

test, is considered to be among the safest procedures

used for skin testing. The test involves pricking the

skin through a drop of antigen placed on the skin.

Their recommendation was adopted, as was the

recommendation to use eight separate aeroallergen

extracts: housedust, alternaria, cat fur, dog fur,

mixed long and short ragweed, oak, perennial rye

grass, and Bermuda grass. In addition to the eight

allergens, two controls, one containing the diluent

used for the antigens and another consisting of a

histamine phosphate solution, were used.

The allergy skin test was administered to examinees 6-74 years of age. The back, frequently considered the most uniform site for skin tests, was

deemed impractical to use for testing because of

lack of facilities for keeping examinees in a prone

position for the required time. Therefore, the nonvascular area of the forearm was used. Special precautions were taken for individuals with a history

of allergy to ragweed and even more particularly to

cats or dogs, as revealed from the allergy history

questions. After the administration of the allergens,

readings were taken both at lo- and 20-minute (the

more commonly used standard measurement) periods. Both the length and width of the wheal and its

flare were measured, and standard clinical recordings

were made of the allergic reaction. The consultants

had originally recommended that lyophilized extracts

of the allergen be used, but they were not commercially available, and standard scratch test antigens

preserved in glycerin were used instead.

Other important target conditions

Osteoarthritis and disc degeneration.-Osteoarthritis is one of the most common diseases in

older Americans. The disease is an important cause of

disability, causing limitation of activity and mobility.

Osteoarthritis has two basic causes. A gene that is

very common in the population produces a syndrome

of hereditary osteoarthritis associated with Heberden’s

Nodes. In this condition, severe disc degeneration and

degeneration of the apophysial joint of the cervical

spine are commonly seen: The second type of osteoarthritis is due to mechanical wear and tear. There is

little doubt that individuals who are exposed to high

degrees of trauma develop severe disc degeneration of

the cervical and lumbar spines. In addition to chronic

pain, many syndromes may be noted. For example,

severe involvement of the cervical spine may produce

vertebral artery insufficiency and can cause severe

dysphagia. Although findings from physical examination often lead to an inaccurate assessment of osteoarthritis, radiological methods are available for accurately assessing the severity of lesions. These methods . were used in NHANES II. X-ray films taken in the

survey include lateral views of the lumbar and the

cervical spine. To avoid any possible X-ray damage

to a fetus, lumbar spine X-rays of females were

taken only at ages 50 and over. As in previous cycles

of the National Health Examination Surveys, certain

aspects of the physical examination and medical

history were included in the survey to give a picture

of the functioning of the joints and the disabilities

associated with joint pathology.

Consultation on this aspect of the surviy was

mostly with Dr. William O’Brien of the University of

Virginia and Dr. Peter Bennett, National Institute of

Arthritis, Metabolism, and Digestive Diseases. The

proposal was also reviewed by the Subcommittee of

Epidemiology of the National Arthritis Commission.

Cardiovascular conditions.-One part of the

planned NHANES II cardiovascular component was

an investigation of cardiac arrhythmia by means of

Holter electrocardiogram recordings. Because cardiac

arrhythmias are believed to be respon sible for most

sudden cardiac d eaths, this study appeared to provide

the opportunitY for uncovering epidemiological data

of major importance. In clinical practice, the Holter

electrocardiogram recorders are attached to the patient, and recordings are made during a lo- or 24.

hour period while the patient goes about usual daily

activities. To reduce the number of recorders and to

lessen the operational complexities in NHANES II,

the recordings were to be made over only a 2-hour

period, while the examinee was engaged in other

12
parts of the examination. A tryout of the procedure

during the pilot test demonstrated that recordings of

a good quality could be obtained. However, an expert

committee assembled by NCHS -and the National

Heart, Lung, and Blood Institute to give advice on

the proper processing of the tapes was of the opinion

that certain parts of the examination, such as the

glucose tolerance test, would affect the production

of arrhythmias. Unfortunately, the committee recommendations would have necessitated a redesign

of the examination that would have added more

time to the length of the examination than was

judged feasible. When this determination had been

reached, there was not enough time left in the planning process to explore alternative proposals, and SO

the Holter electrocardiogram recordings had to be

eliminated from the final NHANES II plan.

To record the electrocardiogram, equipment that

would record three channels of data simultaneously

(12.standard lead and 3-Frank lead), with immediate

conversion from analog to digital format, was used.

The electrocardiogram was taken with the examinee

resting in a -supine position. It should be noted that

the computer program available for three-channel

processing was much more accurate than those previously available for one-channel processing. TO

obtain continuing information on hypertension and

the status of related medical control efforts in the

United States, blood pressures were taken and appropriate medical history questions were included in

NHANES II, as they had been in the previous cycle

of examinations (NHANES I). As is mentioned above,

determinations were made of cholesterol, triglycerides, and high density lipoproteins (HDL).

Spirometry.-To provide normative data on

pulmonary function similar to that obtained in

NHANES I for persons 25-74 years of age, spirometry

was performed in NHANES II on individuals 6-24

years of age. As in NHANES I, the data were

recorded on tape, using the same equipment as that

used for the electrocardiogram recordings. A

computer program was used for processing the data

and converting it into the individual parameters that

describe pulmonary function. The data can be

analyzed in relation to the allergy component and the

respiratory data obtained from the medical history

and examination.

Speech pathology and hearing.-The originally

planned speech and hearing component of the survey

was markedly shortened as a result of consultation

and pilot testing. Impedance audiometry had been an

important component of the original plan. This

procedure was designed to give a measure of the

prevalence of middle ear pathology in the United

States. During the pilot test, however, difficulties

were encountered in getting an adequate airseal;

I

I 1i I Id several examinees experienced discomfort; and the

test took longer than expected. A decision to discontinue the procedure was made after the pilot test,

since although additional months of experience with

the procedure might have reduced the problems

encountered, the entire survey schedule would still

have been disrupted. Although impedance audiometry was dropped from the survey, puretone audiometry was included for all sample persons 4-19 years of

age. It had originally been planned to obtain a speech

sample from individuals 4-74 years of age for speech

pathology testing, but the instrument finally selected

for the speech test was the Stephens Oral Language

Test,17 a test using standardized stimulus sentences

that had been used to screen children of from 4

through 6 years of age for deficiencies in syntax and

articulation. Although the test had been used extensively in the 4-6 age group, there was only a very

limited experience of its use in older age groups. In

NHANES II only those 4-6 years of age were tested,

since the test had received adequate validation only in

that group. Because of substantial oversampling of

this age group for the nutrition survey, there were

enough children for the resulting data to be useful.

Since trained speech pathologists were not available for the survey team, speech recordings of the 15

sentences used in the test were made at the examination site. These recordings could be evaluated subsequently by a speech pathologist. Considerable effort

was expended in designing a recording setup that

would produce excellent high-fidelity recordings. In

order to provide a standard stimulus for eliciting the

speech sample, Dr. Irene Stephens, Associate Professor, Department of Communicative Disorders,

Northern Illinois University, recorded a reading of the

speech test on separate Language Master cards. Subsequent evaluation by Dr. Stephens of about 400 recordings taped by the survey demonstrated the feasibility of this approach.

Blood tests: carbon monoxide, lead and pesticide

levels, and venereal disease. -The increasing involvement of NHANES in studying environmental health

factors has reflected the increasing interest in the

effect of the environment on health. In NHANES I

the major project in the environmental field was the

collection and analysis of household water samples

for various bulk elements and trace metals. New

environmentally related tests were developed for

NHANES II.

Air pollution or, specifically, carbon monoxide

pollution is an often cited problem in many cities of

the United States. Carbon monoxide is a colorless,

odorless gas that is a product of incomplete combustion and is primarily produced from industrial plants,

electric power plants, and automobile exhaust. It has

been suggested that carbon monoxide may act to

precipitate cardiac symp tomatology or episodes by

reducing the supply of oxygen to a heart already

compromised by coronary disease. Because of the

lack of acceptable information on the body burden

13
of carbon monoxide and the potential deleterious

health effects due to carbon monoxide air pollution, it was thought to be an appropriate area of

study for NHANES II. ’ Since smoking also results in higher carbon

monoxide levels, questions on smoking were included

in the survey. Carboxyhemoglobin determinations

were done on a half-sample of examinees 3-74 years

of age. Special care was taken in quality control for

the laboratory determinations, including the use of a

reference laboratory. Analysis of data should indicate

whether and where carbon monoxide pollution is a

significant problem.

For many years lead poisoning has been considered an important public health problem, particularly

in children. Some important causes of high body

levels of lead are contaminated foods, automobile

exhaust, and, in children, lead paint. Lead poisoning

can produce many adverse effects, including anemia,

anorexia, colic, p arietitis, hypertension, arteriola

degeneration, permanent renal damage, encephalopathy, mental retardation, blindness, cerebral atrophy, glycosuria, visual disturbances, epilepsy, and

palsy.

In a meeting on trace elements, Dr. Katherine

Mahaffey of the Food and Drug Administration gave

the following rationale for a survey of lead levels in

blood :

l Available data come either from populations

where lead contamination is suspected to be high

or from specific control groups where lead contamination is expected to be very low. There is no

information about the distribution of lead levels

in blood for the general U.S. population.

0

The variability with age is not known.

With expected large-scale changes in exposure of

the population to lead, knowledge of present

serum lead levels is needed as a baseline for future

studies. Normative information is essential to substantiate regulatory decisions based upon knowledge of the biological meaning of high lead levels

coupled with available data on lead levels at minimal lead exposure.

Blood determinations were made on all children

through the age of 6 and on a half-sample of all examinees over that age. Because of the interest of the

Food and Drug Administration in the lead determinations, the laboratory cost of the test was underwritten by the Bureau of Foods, Food and Drug

Administration, and the determinations were made

by the Bureau of Laboratories of the Center for

Disease Control.

The Environmental Protection Agency is authorized under Public Law 92-5 16 to monitor not only

the environment but human beings as well for evidence of pesticide exposure or contamination. The

National Human Monitoring Program for Pesticides

is operated by the Environmental Protection Agency

in partial fulfillment of the legislative mandate. The

program’s goal is to determine on a national scale the

amount of exposure of the general population to

pesticides. It was considered by the Environmental

Protection Agency that NHANES II could establish

important baseline data on the body burdens of

several types of pesticides through blood and urine

analysis (appendix III). With the use of chlorinated

hydrocarbon pesticides declining and that of organophosphate carbamate and phenoxy-type compounds

increasing, the capacity to determine human exposure

to these new, widely used pesticides has become imperative. In order to obtain this information, the

Environmental Protection Agency offered to underwrite the laboratory cost of pesticide level determinations of a half-sample of NHANES II examinees

12-74 years of age. A few questions relating to exposure to pesticides were added to the questionnaires,

and blood and urine specimens were obtained on

the half-sample.

The Center for Disease Control asked NCHS to

include a survey component for venereal disease in

NHANES II. The two diseases to be studied were

gonorrhea and syphilis. Syphilis testing involved few

problems because it had already been included in

NHFS I (1960-62)1 and the 197475 NHANES I

Augmentation Survey. 5 Inclusion of the serological

tests for syphilis on the full sample of persons 12-74

years of age provided opportunity for analysis of the

data by population subgroups as well as a comparison

with the 1960-62 survey. The serology determinations for syphilis included qualitative and quantitative

ART, an FTA-ABS, and an MHA-TP. The tests are

classified respectively as flocculation, immunofluorescence, and hemeagglutination.

It is more difficult to test for the presence of

gonorrhea. At present there is no serological test

for gonorrhea specific enough to be suitable for

survey purposes. The standard clinical method for

women involves taking an endocervical culture at

the same time that a Pap specimen is taken. Experience at our initial pretesting operation indicated that

many women were unwilling to undergo this procedure in a survey setting, and it was therefore decided

to omit it from the examination. Instead, a somewhat

less sensitive method was used that involved culturing

urinary sediments obtained after centrifuging urine

specimens. The age range of individuals studied was

12-40 years for males and females, and of those ‘females who received the glucose tolerance test, only

those 20-24 years of age had the gonorrhea test done.
Sample design for

NHANES II

The general structure of the NHANES II sample

design is similar to the designs of NHANES 14 and the

first three health examination surveys conducted by

the National Center for Health Statistics.l-3, 18 The

design is a stratified, multistage, probability cluster

sample of households throughout the United States.

The process’ of selecting a sample of persons to be

examined is a cascading one that involves the selection of primary sampling units (PSU’s-a PSU is a

county or small group of contiguous counties), census

enumeration districts (ED’s), segments (a segment is a

cluster of households), households, eligible persons,

and finally sample persons. The major difference

between the NHANES I and NHANES II designs is

the use of a different set of definitions and stratification procedures for PSU’s. The details of the

NHANES II sampling plan, which resulted in a total

of 27,803 sample persons and 20,325 examined

persons in 64 PSU’s throughout the United States, are

described in the following sections.

Design specifications

The planning phase for NHANES II is described

in a previous section, along with many of the survey

objectives. The survey specifications that directly

affected the sample design were as follows:

l NHANES II should be a probability sample whose

target population is the civilian, noninstitutionalized population of the United States (including

for the first time Alaska and Hawaii) for persons

6 months through 74 years of age.

0 Subgroups of the population of special interest

for nutritional assessment should include preschool children (6 months - 5 years), the aged (60

- 74 years), and the poor (persons below the

poverty level as defined by the U.S. Bureau’of the

Census using 1970 census results). These groups

should be oversampled to improve the reliability

of the statistics for the subgroups.

l The total sample size selected for NHANES II

should result in approximately 2 1,000 examined

persons.

The number of sample persons selected in each

PSU should be between 300 and 600.

The data collection mechanism used in NHANES

I should be used in NHANES II with appropriate

modifications. Examinations should be conducted

in three mobile examination centers. At any time

during the survey period (except holidays) two of

the centers should be operating in different locations while the third is being serviced or relocated.

The total period of data collection should be 3 to

4 years.

The average length of an individual examination

should be between 2 and 3 hours, but it should

vary depending on the age of the examinee. The

time required to examine a preschooler should be

less than 1 hour, while the time for an adult

should not exceed 2% to 3 hours.

Approximately one person per sampie household

should be selected for an examination. The exact

number of persons selected for an examination in

each household should be determined by applying

the sampling rates designated for the different age*

groups.

The size of the PSU should be defined so that it

is optimal with respect to cost and response and

results in national statistics with an acceptable

level of precision.

The survey should be designed so that precise

statistics can be produced for the four broad

geographic regions of the United States and for

the total population by qq, lsi % ,

classifications.

These sample design specifications took a number

of factors into account, including budgetary resources,

logistical constraints, time limitations, equipment

mobility, and unit operating costs. The specifications

15
also reflected the experience gained from past examination surveys.

One of the major survey objectives of NHANES II

was the examination of a high percent of sample persons. The overall response rates in the examination

surveys conducted by NCHS had continually declined

since the 1960’s. The response rate for the two

surveys of the total U.S. population had declined

from 87 percent in the early 1960’s to 74 percent in

the early and mid-l 970’s. There were multiple

reasons for this decline in response-some controllable and some not. Whatever the reasons, the results

of the survey may have been biased because a large

proportion of sample persons had not been examined.

A design change that was investigated for improving

response was the use of smaller geographical areas as

PSU’s. The PSU’s used in previous examination

surveys had been defined either as a single county or

as a group of contiguous counties (except in certain

parts of New England). Many of the larger PSU’s were

defined as standard metropolitan statistical areas

(SMSA’s) and often contained several counties. The

PSU’s that contained several counties and covered a

large area were not ideally suited for an examination

survey. Attempting to survey large geographic areas

from a centrally located examination center created a

number of logistical problems. Some examinees had

been asked to travel more than 50 miles to be examined, while others had been asked to travel through

very congested areas. Many respondents were reluctant to travel under such conditions. The cost of

followup visits to the households was also a function

of the distance or time from the examination center.

An analysis of the response rates for several stands in

NHANES I lent further support to these assumptions.

The use of smaller areas as PSU’s would reduce both

the average distance traveled to the examination

center by examinees and the cost of the field work.

These considerations were the basis for redefining and

restratifying the PSU’s in NHANES II.

Definition and stratification of

primary sampling units

The first-stage sampling units selected in the

previous NHES and NHANES I surveys were subsets

of the sample PSU’s in the National-Health Interview

Survey (NHIS). NHIS is one of the NCHS major data

collection programs, the design of which is described

in an NCHS report19 and in a technical paper20 by

the U.S. Bureau of the Census. In NHIS the United

States is subdivided into 1,924 PSU’s, with 376 of the

PSU’s being selected for the sample. Sixty-five of

these 376 sample PSU’s were selected as the

NHANES I sample. In redefining PSU’s for NHANES

II, the formation of PSU’s for NHIS was reviewed.

The PSU’s for NHIS had been defined by the Bureau

of the Census and are the same as those used for the

Current Population Survey.2O With some slight overi6

simplifications the following criteria had been used to

define PSU’s for NHIS: 1, i”I

Each SMSA is a separate PSU.

Each PSU is composed of a single county or contiguous counties (in some New England States

minor civil divisions are used).

EachPSU is defined within the four census

regional boundaries.

The area of a PSU is less than 2,000 square miles

in the West and less than 1,500 square miles elsewhere.

The 1970 population of a PSU is at least 7,500 in

the West and at least 10,000 elsewhere.

The NHIS PSU’s that contained more than one

county were either SMSA’s or had been defined using

the last criterion above and represent rural areas.

Since rural areas have traditionally had high response

rates in the health examination surveys, the only

PSU’s considered for redefinition were the SMSA’s.

In the NHIS design, about 60 percent of the SMSA’s

contained a sufficiently large population to be

selected for the sample with certainty (with a probability of one) and are referred to as self-representing

PSU’s. In NHIS, 156 of the 376 PSU’s are self-representing SMSA’s. It was these 156 self-representing

SMSA’s in the NHIS design that were redefined and

restratified for the NHANES II design.

For NHANES II, the self-representing PSU’s in

NHIS were first split along county boundaries. Within

each region, each of the counties was classified as

being either a self-representing or a nonself-representing PSU. The PSU’s that were nonself-representing

were further combined into homogeneous classes or

strata equal in size to the NHIS strata -containing

nonself-representing PSU’s.

the

0

0

0

The formation of new strata were governed by *

following rules:

Each new PSU with a population of more than

250,000 in 1970 was classified as a self-representing PSU. In a few special cases, some PSU’s with

slightly smaller populations were classified as selfrepresenting.

The remaining newly defined PSU’s were combined with other PSU’s having similar sociodemographic characteristics to form a number of

nonself-representing strata. The PSU’s within a

stratum were all located in the same geographic

region. 1

Each of the nonself-representing strata was made

to have about the same population. The average

stratum contained about 350,000 persons in

1970.

This method of stratification and the stratification variables used to form NHIS nonself-representing
strata are the basis for the procedures used to form

the larger strata for NHANES II described in the next

section.

The regional boundaries used in stratifying PSU’s

differ from regional boundaries as defined by the

Bureau of the Census. Figure 1 shows the different

regional boundaries used in NHANES II and the

census. In order to produce regional estimates with

approximately equal precision, the NHANES II

regions were defined so that they would each contain

approximately the same number of sample PSU’s.

Because of the small sample size for NHANES II, a

regionally balanced design was needed for producing

regional statistics.

Table A shows the effect of subdividing the selfrepresenting PSU’s in NHIS and redefining the PSU’s

by using county boundaries. A total of 397 PSU’s

were formed from the 156 self-representing PSU’s:

198 were defined as self-representing, and 199 were

defined as nonself-representing and subsequently used

to form an additional 43 nonself-representing strata.

The average population of a self-representing PSU was

reduced -from 838,000 to 584,000. In area, the

average size of these PSU’s was reduced more than 60

percent, from 2,185 square miles to 855 square miles.

Formation of superstrata in NHANES II

- After the 46 1 first-stage units (NHIS strata) had

been defined, they were further stratified into a total

of 64 superstrata for the NHANES II design. One

PSU was selected from each of the superstrata, and

these PSU’s represented the 64 geographic locations

visited by the mobile examination centers during the

survey period. The stratification and selection of

first-stage units in NHANES II is as follows.

The number of primary sampling units had to be

determined before the number of superstrata could

be determined. Because of the design specifications,

the maximum number of locations that could be

visited during a 4-year period is approximately 80

stands.

In order to decide the number of first-stage units

to select, a series of design calculations were made. A

general description of the process is presented elsewhere 18 The design model used incorporated such

factors as total budget, unit costs, and precision of

estimates obtained in previous surveys for a variety

of health characteristics. These calculations showed

that the optimum number of locations to select was

130, examining 160 persons per stand. One important

variable not builtinto the design model, however, was

“down time. ” Moving from one location to another

requires 1 full week, even when a third examination

center can be relocated and hooked up in advance.

Time is required for closing the office, packing the

equipment, traveling to the new location, and setting

up and calibrating the equipment. Locating in 130

different areas over a 3- to 4-year period implies that

2 weeks or less would be spent at each location. This

length of time was felt to be too short to achieve

required response rates since, in many areas, repeated

callbacks are required to achieve a 75-percent examination rate. Previous field experience had indicated

that staying in an area for only 2 weeks could reduce

response rates by as much as 10 percent.

Taking all of the logistical problems into consideration led to the selection of a design of 64 primary

locations with an average expected number of about

440 sample persons per location. Thus, an examination center would be located in each area for a period

of 4 to 6 weeks. With two examination teams being

Table A. Number and population of National Health Interview Survey (NHIS) strata before and after subdivision of self-representing primary

sampling units, by type of stratum and National Health and Nutrition Examination Survey region

[Population estimates are based on 1970 Decennial Census]

Type of stratum

and region Number

of

strata

NH/S strata

Population

in

thousands

Average Number

population of

in thousands strata

Rede fined strata

Pop&ation

in

thousands

A verage

pop&a tion

in thousands

Self-representing

All strata. ........

Northeastern. ......

Midwestern ......

Southern .........

Western. .........

Nonself-representing

156 130,760 838 198 115,629 584

850 41,897 838 64 36,795 575

30 3 1,890 1,063 43 27,831 647

38 22,706 598 49 19,674 402

38 34,266 902 42 3 1,329 746

All strata. ........ 220 72,679 330 263 87,811 334

Northeastern. ...... 20 7,144 357 34 12,246 360

/

B

I

Midwestern ....... 61 20,279 332 73 24,339 333

b ’ . Southern. ........ 84 26,752 318 93 29;785 320

Western. ......... 55 18,504 336 63 21,441 - 340

Ii

17
Figure 1. Comparison of regional boundaries for the National Health and Nutrition Examination Survey, 1976-80, with those

defined by the U.S. Bureau of the Census

18
employed simultaneously, about 16 stands could be

completed per year. A final comparison was made

between the selected design and the design that was

optimum with respect to sampling error. It was concluded that the final selected design would decrease

the reliability of the survey estimates by about 10

percent from those of the optimum design but would

substantially reduce the nonsampling component of

error.

Because of the small number of primary sampling

units, it was decided that the maximum amount of

stratification should be used: that the NHIS strata

be stratified in 64 superstrata and one PSU be selected per superstratum. The object of stratification is to

group the strata with similar characteristics into

homogeneous superstrata. A stepwise regression

analysis was used to determine which variables would

be most effective for collapsing NHIS strata into

superstrata. Since NHANES II is a health survey, it

would be preferable to use health or health-related

variables for stratification. The variables used for

stratification must, however, be available at the

county level to combine counties or groups of counties into strata. Since health variables were not

available at the county level, the stepwise regression

analysis was used to study the relationship between

the sociodemographic variables that are available for

all counties and a set of selected health variables from

a previous health examination survey. For the analysis, measurements on all the variables listed below

were made for each of the sample PSU’s in the first

health examination survey. The dependent variables

used in the regression analysis were

l Infant mortality rate and number of infant

deaths.

l Percent and number of persons with kidney

trouble.

l Percent and number of persons with heart trouble.

l Percent and number of persons with hypertension.

@ Percent and number of persons with high levels of

serum cholesterol.

The independent variables used in the analysis were

l Population.

l Rate of growth.

l Density (population per square mile).

l Percent urban.

l Percent manufacturing.

l Median income.

l Percent races other than white.

l Percent below poverty level.

l Percent Hispanic origin.

l Total Hispanic population.

.

0 Population below poverty level.

These variables were defined by the U.S. Bureau

of the Census and included the variables that had

previously been used for stratification in NCHS

examination surveys.

A stepwise regression was performed for each of

the dependent variables. When the total number

(rather than percent) of persons with a health condition was used for a PSU as the dependent variable,

the only independent variable that entered the

regression model was population. This demonstrates

the importance of either stratifying the PSU’s accord- _-..

ing to their population size or selecting the sample

PSU’s from strata with a probability proportional to

their size. When the stepwise regressions were run for

the percent of persons with a given health condition,

a number of independent variables entered the

regression model. Table B presents the results of the

analysis by region. Table C shows the correlation

matrix for the health variables and for selected

sociodemographic variables. The independent variables

that entered the final regression model varied by

health condition and among regions. Summarizing the

results over all of the health conditions within each

region led to some general conclusions: median

income was the first or second most important

independent variable within each region; the percent

of the population below the poverty level was always

among the three most important variables in each

region; and either “percent races other than white” or

“percent Hispanic origin” was among the three most

important variables in all but one of the regions.

These results were further supported by the correlations shown in table C for the total U.S. population.

Although the overall correlation between percent

Hispanic and the health variables is low for the total

United States, percent Hispanic entered the regression

model for the Northeastern and Western Regions.

Because of these results, the following sample design

decisions were made and implemented:

The first and second most significant independent

variables in each region were used as stratification

variables.

The third most important independent variable in

the stepwise regression analysis in each region was

used as a control selection variable (described in

the next section).

The formation of superstrata was performed separately for self-representing and nonself-representing strata within each region.

Population size was used at the first level of

stratification within each region.

Sixteen superstrata were formed in each region.

The superstrata were each about the same size,

each containing approximately 3,200,OOO persons

according to the 1970 decennial census.

19
Table 6. Variables in final stepwise regression model, by region

Dependent variable

Northeastern Region

Independent variables in final regression model

Midwestern Region Southern Region Western Region

Infant mortality rate Percent below poverty

level

Percent races other than

white

Median income

Percent Hispanic origin

Percent manufacturing

Percent races other than

white

Percent Hispanic origin

Percent races other than

white

Percent urban

Percent below poverty

level

Median income

Percent below poverty level

Median income

Percent manufacturing

Rate of growth

Percent Hispanic origin

Percent with kidney

trouble

Percent Hispanic origin

Percent below poverty

level

Median income

Percent races other than

white

Median income

Rate of growth

Percent manufacturing

Percent below poverty

level

Median income

Percent Hispanic origin

Percent races other than white

Rate of growth

Percent manufacturing

Percent below poverty level

Median income

Percent with heart

trouble

Percent races other than

white

Percent manufacturing

Percent Hispanic origin

Median income

Median income

Rate of growth

Percent below poverty

level

Median income

Percent manufacturing

Percent urban

Percent Hispanic origin

Percent with

hypertension

Rate of growth

Percent below poverty

level

Rate of growth Percent below poverty

Percent races other than level

white Median income

Percent below poverty Rate of growth

level Percent urban

Percent Hispanic origin Percent races other than

Median income white

Percent Hispanic origin

Rate of growth

Percent manufacturing

Median income

Percent with high

serum cholesterol

Percent Hispanic origin

Median income

Percent manufacturing

Percent below poverty

level

Median income

Percent below poverty

level

Percent Hispanic origin

Percent races other than

white

Percent manufacturing

Percent below poverty

level

Median income

Infant mortality rate

Median income

Percent Hispanic origin

Rate of growth

In accordance with the decision to use the first

and second most significant independent variables in

addition to population size, the following variables

were used as stratification variables for NHANES II:

Northeastern Region:

Population in stratum

Median income

Percent below proverty level

Midwestern Region:

Population in stratum

Median income

Rate of growth

Southern Region:

Population in stratum

Median income

Races other than white plus Hispanics

Western Region:

Population in stratum

Median income

Races other than

The actual

NHANES II was

20

white plus Hispanics

formation of the superstrata in

performed in two stages. During the

first stage the NHIS strata were classified into 64

superstrata according to region, type of stratum (selfrepresenting or nonself-representing), size of stratum

(large or small), income (low, middle, or high),

percent races other than white plus Hispanics (low or

high), and percent below poverty level or rate of

growth (low or high). The classification procedure

used to form the preliminary superstrata is shown in

table D. An important effect of the stratification

process was the formation of superstrata containing

only central cities, suburban counties, or rural counties. Although some precision was lost by splitting the

larger SMSA’s, it was hoped that a gain in precision

would result from the division of central cities and

noncentral cities into separate strata.

The final stage in the formation of superstrata

was a cluster analysis of the superstrata formed in the

first stage. The cluster analysis was performed separately in each region for the self-representing and

nonself-representing strata. Within each of these

subdomains the strata were ranked from lowest to

highest by population size, area, percent manufacturing, rate of growth, percent urban, percent races

other than white plus Hispanics, median income, and

percent below poverty level. For each pairwise
combination of strata, the Euclidean distance between the ranks was computed. For stratum A and

stratum B, the Euclidean distance is defined as

d(A,B) = ~ (‘in-rie)*

i=l

where

p is the number of variables,

riA is the rank of the ith variable for NHIS stratum A, and

56 is the rank of the ith variable for NHIS stratum B.

The smaller the value of d(A,B) the more alike

the strata are. The &A,B) values were then evaluated

for each pairwise combination of strata in the

NHANES superstrata. Because of the overlap between

the variables used for stratification and the variables

used to compute the measure d(A,B), the d(A,B)

values within a superstratum should be relatively

small. This was generally true. A substantial number

of individual strata were identified, however, whose

sum of d(A,B) values with other members of the

superstratum was large. In these cases, an attempt was

made to realine the strata within the superstrata so

that the sum of the d(A,B) values over all of the

superstrata was minimized for each subdomain.

Because of the number of constraints imposed on the

stratification process, these adjustments were performed manually. This procedure substantially

reduced the sum of the d(A,B) values within the

superstrata and produced a more efficient stratification. Cluster analysis was also similarly used for the

formation of nonself-representing strata using the

newly defined nonself-representing PSU’s.

Selection of sample locations

The selection of one PSU per superstratum

utilized a modified Goodman-Kish2 l y2 2 control

selection technique. The control selection procedure

was used to insure that the selected first-stage sampling units represented a “balanced” sample with

respect to the control selection variables used. For

example, within a region one might want to insure

that the final sample PSU’s were distributed evenly

across States or across groups of States. This could be

achieved by using the “State groups” within a region

to control the number of PSU’s selected within

each State group. The first step in this selection

process involves defining a set of admissible patterns

(samples) so that each pattern has an acceptable

distribution of PSU’s across the control classes. A

pattern or potential sample is admissible if the

difference between the number of selected PSU’s is

within 1 of the number of PSU’s expected to be

21
Table D. Variables used for stratification in the National Health and Nutrition Examination Survey, by region

Stratification variables

Region and type Number of

of stratum superstrata Income Races other than Rate of growth or

white plus Hispanics percen t below poverty level

Northeastern. ....................

Self-representing strata. ..............

Highly urban-New England’ .........

Other urban-New England ..........

Large counties (by population) ........

Small counties (by population) ........

Nonself-representing strata. ............

New England places. ..............

Other. ......................

Midwestern .....................

Self-representing strata. ..............

Certainty*. ...................

Large counties (by population) ........

Small counties (by population) ........

Nonself-representing strata. ............

Large strata (by, population). .........

Small strata (by population). .........

Southern. ......................

Self-representing strata. ..............

Large counties (by population) ........

Small counties (by population) ........

Nonself-representing strata. ............

Large strata (by population). .........

Small strata (by population). .........

Western. .......................

Self-representing strata. ..............

Certainty*. ...................

Large counties (by population) ........

Small counties (by population) ........

Nonself-representing strata. ............

Large strata (by population). .........

Small strata (by population). .........

16

12

1

1

6

4

4

1

3

16

16

6

3

3

10

6

4

16

high, medium, low high, low

high, low, high, low

Percent below poverty level

high, medium, low

Rate of growth

high, low

high, medium, low

high, low

high, loti high, IOW

high, low high, low

high, medium, low

high, medium, low

high, medium, low high, low

‘high, low high, low

’ high, low

high, medium, low

high, low

high, medium, low

high, low

high, low

‘New England is subdivided into townships rather than counties.

*Cook County in the Midwestern Region and Los Angeles County (2 stands) in the Western Region were selected into the sample with-a probability

of 1.

drawn from each control class based on its population.

The total set of patterns is formed so that the probability of selecting any PSU within a superstratum is

proportional to its population. Each pattern within

the set is assigned a probability of seiection based onthe size of the sample PSU’s within the pattern. The

sum of the probabilities of selection over all patterns

is equal to 1. After the probabilities of selection for

the patterns were accumulated, a sample pattern was

randomly selected for NHANES II. A detailed description of this controlled selection process is given

in an NCHS report? 8

Two control selection variables were chosen

within each region for NHANES II. The variable

-5 iaec g~oq~“. ‘tii‘;js iis~<l jxt ,.;!I fi-yl~- rqjons. 2nd

“percent below poverty level” was used in every

region except the Northeastern, where “percent races

other than white plus Hispanics” was used. Thus, the

final sample of PSU’s was drawn so that the sample

did not appreciably overrepresent or under-represent

22

any State group or quartiles representing percent

below poverty level or percent races other than white

plus Hispanics. The control selection procedure was

applied separately within the self-representing and

nonself-representing superstrata in every region

except the Northeastern, where the control selection

was applied to the total region. The control variables

used within each region are defined in table E, and

the expected and actual number of PSU’s selected

from each control class are shown in table F. The

“percent below poverty level” or “percent of races

other than white plus Hispanics” classes were defined

within each region by classifying approximately equal

numbers of NHIS strata into quartiles.

Classifying the strata into control classes was

straigl~ tfcmvard for th.e self-representing strata (one

PSU per stratum). The classification of the nonselfrepresenting strata into control classes was more

complicated. The PSU’s within each of the NHIS

strata are often not all in the same State group,
“percent below poverty level,” or “percent races

other than white plus Hispanics.” This complication

was remedied by selecting a sample PSU within each

of the nonself-representing strata. Within each of the

original NHIS nonself-representing strata, the NHIS

sample PSU was designated as the NHANES II sample

PSU. In the newly defined nonself-representing strata

a sample PSU was selected with a probability proportional to its size. The sample PSU’s within the strata

were selected before the sample strata were selected

within the superstrata. The sample PSU’s within the

nonself-representing strata were then used to classify

the strata by State group, percent below poverty

level, or percent races other than white plus Hispanics.

The selected survey locations for NHANES II are

shown in table G.

Selection of housing units within sample locations

The Bureau of the Census had the responsibility

for selecting housing units and sample persons within

each of the 64 primary locations. The Bureau of the

Census was also responsible for specifying and implementing the sample design within PSU’s and for oversampling the subgroups of the population of special

interest.

Two sampling frames were used to select the

sample of housing units within each of the PSU’s.

The larger frame was based on the 1970 census of the

population. This frame was supplemented by a frame

that contained new housing units constructed since

the 1970 census.

The first stage of design within a PSU involved

the selection of clusters of housing units (segments)

within enumeration districts (ED’s). An ED is a geographical area containing approximately 3 00 housing

units. In order to oversample persons with low incomes, the ED’s were sorted into poverty or non-

--_ -_Ipoverty strata as follows: the poverty strata contained

ED’s with 13 percent or more of persons below the

poverty level, and the nonpoverty strata contained

ED’s with less than 13 percent of persons below the

poverty level as determined by the 1970 census. The

poverty index for households was based on 1969 -.-- _

income, size of family, sex of head of family, age ’

(under 65 years or 65 years and over) of head of

family, and farm or nonfarm status. A measure of size

was determined for each ED by dividing the number

of listed housing units in an ED by 4. Within each

stratum the ED’s were then selected with a probability proportional to their measure of size. The

number of ED’s selected in each stratum was based

on a number of factors that are described below.

According to previous experience, it was assumed

that a response rate of approximately 75 percent

would be obtainable in NHANES II. To examine

2 1,000 persons, approximately 28,000 persons

--needed -_.__

to_----be selected from the sample households. A

mathematical mod& 3

- .-_ _ _a . __ _ __ _ . _ -- --e-m

was used to determine the

sample size for each PSU and the optimum number to ’ select in the poverty and nonpoverty strata within

PSU’s. The sample was allocated in such a way as to

minimize the variance of the estimated proportion of

persons below the poverty level for a fixed total

Table E. Definition of control classes used for the selection of primary sampling units, by region: National Health and Nutrition Examination

Survey, 1976-60

Region State

group

code

1st variable

State group Quartile

2nd variable

Definition of quartile

Percent races other than white-plus Hispanics

Northeastern A Connecticut, Maine, Massachusetts, New 1 Lowest

Hampshire, Rhode Island, Vermont 2 Low-middle

B New York 3 Middle-high

C New Jersey, Pennsylvania 4 Highest

Rate of growth and percent below poverty level

Midwestern A Ohio 1 Lowest

B Indiana, Michigan, Wisconsin 2 Low-middle

C Illinois 3 Middle-high

D Minnesota 4 Highest

E Iowa, Missou ri

Percent below poverty level

Southern A Delaware, District of Columbia, Maryland, Virginia 1 Lowest

B Kentucky, Tennessee, West Virginia 2 Low-middle

C Alabama, Arkansas, Louisiana, Mississippi 3 Middle-high

D Georgia, North Carolina, South Carolina 4 Highest

E Florida

Western A California 1 Lowest

B Oregon, Washington 2 Low-middle

i

I

C Texas 3 Middle-high

11 D Arizona, Colorado, Idaho, Montana, Nevada, New 4 Highest

Mexico, Oklahoma, Utah, Wyoming, Alaska, ,Hawaii

1 E Kansas, Nebraska, North Dakota, South Dakota

23
Table F. Expected and actual number of sample primary sampling units (PSU’s) within control classes, by region and type of stratum

[lhe control classes are defined in table E. The expected number of PSU’s in a control class is based on its population]

Quartiles represen ting percent below

Region and type of stratum State group poverty level or percent races

other than white plus Hispanics

A 8 c D E I 2 3 4

Northeastern’

Expected number of PSU’s . . . . . . . . . . . . . . . 3.86

Actual number of PSU’s . . . . . . . . . . . . . . . . . 4

Midwestern

Self-representing strata2 :

Expected number of PSU’s . . . . . . . . . . . . . . . 1.93

Actual number of PSU’s . . . . . . . . . . . . . . . . . 2

Nonself-representing strata:

2.71 0.80 0.57 0.99 1.05 2.73 2.38 0.84

2 1 1 1 1 2 3 1

Expected number of PSU’s . . . . . . . . . . . . . . . 1.17

Actual number of PSU’s . . . . . . . . . . . . . . . . . 1

Southern

Self-representing strata:

3.57 0.65 0.84 1.76 2.05 1.86 2.02 2.07

4 1 1 1 2 2 2 2

Expected number of PSU’s . . . . . . . . . . . . . . . 1.94

Actual number of PSU’s . . . . . . . . . . . . . . . . . 2

Nonself-representing strata:

0.72

Expected number of PSU’s . . . . . . . . . . . . . . . 1.18

Actual number of PSU’s . . . . . . . . . . . . . . . . . 1

Western

Self-representing strata2:

2.45 2.83 2.82

3 3 3

Expected number of PSU’s . . . . . . . . . . . . : . . 3.16

Actual number of PSU’s . . . . . . . . . . . . . . . . . 3

Nonself-representing strata:

0.84 1.55 1.26

3 1 1

Expected number of PSU’s . . . . . . . . . . . . . . . 0.82 0.98

Actual number of PSU’s . . . . . . . . . . . . . . . . . 1 1

5.56 6.58 . . .

5 7 . . .

0.95 1.02 1.37 1.61 1.57 1.54 1.28

1 1 2 2 2 1 1

1.92 2.16

2 2

. . . 4.42 3.66 3.97 3.94

. . . 4 4 4 4

0.72 2.44 2.57 2.46 2.53

2 3 2 3

0.19

1

1.12

1

2.01 1.76

2 2

2.09

2

1.73

1

1.15

1

1.80 1.81

2 2

1.65

2

‘Self-representing and nonself-representing strata combined for control selection.

2Excludes self-representing superstrata from the National Health and Nutrition Examination Survey, 1976-80.

sample size. The allocation procedure employed

produced a sample that varied in expected sample size

from 28 1 to 78 1, with an average of 437 persons per

PSU. All but 11 of the sample sizes were within the

operationally acceptable range of 300 to 600 sample

persons. To conform to the design specifications, the

expected sample size for each of these PSU’s was

adjusted to fall between 3 15 and 585 persons. The

average ratio of the sampling rate within the poverty

stratum to the sampling rate within the nonpoverty

stratum was 2.3. This ratio ranged from 1.48 to 5.01

across the sample PSU’s, with 90 percent of the ratios

being between 1.5 and 3.0.

The households within each ED were clustered

into segments in order to reduce the expense of

interviewing within ED’s. Results from previous

surveys had indicated that a cluster of eight listed

addresses would T provide an adequate design. To

further insure the sampling reliability, clusters of 16

listed addresses were drawn from the sampling frames

and then systematically subsampled at a rate of 1 out

of 2 to produce a final segment of eight address

listings.

Using the survey specification that approximately

one person should be examined per household (see

24

the next section for the household sampling procedure), the expected number of segments needed

within each PSU was determined by dividing the PSU

sample size by 8. The segments were drawn separately

from within the poverty and nonpoverty strata. A

systematic sample of segments were then selected

across all ED’s, with no more than one segment being

selected per ED. The new construction frame was

sampled at the same rate as the nonpoverty stratum.

Several factors were used to decide the sample

size within each PSU. The sample size needed in each

PSU was a function of the age distribution within the

PSU, the proportion of the population below the

poverty level, the expected number of vacant and

other types of ineligible units, the expected number

of refusals, and the expected number of persons in

group quarters. Since the census information did not

include the number of persons per segment and was

out of date, an additional 15 reserve segments were

drawn for each PSU as a precautionary measure.

These segments were drawn from both poverty and

nonpoverty strata.

Because of the complexity of the examination

survey and the logistical arrangements that had to be

planned in advance, the number of persons selected
Table G. Primary sampling units, stand sites, and percent of persons examined, by region: National Health and Nutrition Examination Survey, 1976-80

Primary sampling units

within regions Stand site

Petzen t

of persons

examined

Primary sampling units

within regions Stand site

Percent

of persons

examined

United States . . . . . . . . . . . 64 73.1

Northeastern. . . . . . . . . . . . 16 67.4

Bronx, NY. . . . . . . . . . . . .

Westchester, NY. .........

Manhattan, N.Y. .........

Bergen, N.J. ............

Allegheny, Pa ............

Mercer, N.J. ............

Montgomery, Pa. .........

Union, N.J. ............

Erie, Pa. ..............

Orange, NY.............

Norfolk (part), Mass. .......

Hartford (part), New Haven

(part), Conn............

Cumberland (part), Maine ....

Lycoming, Pa............

Delaware, N.Y. ..........

Bristol (part), Norfolk (part),

Mass .................

Midwestern _ . . . . . . . . . . . .

Cook, Ill ...............

Wayne, Mich. ...........

Hamilton, Ohio ..........

Marion, I nd. ............

Hennepin, Minn. .........

Montgomery, Ohio ........

Lake, Ill. ..............

Polk, Iowa. ............

Dakota, Minn............

Racine, Wis. ............

Greene, Monroe, Ind........

Coles, Cumberland, I II. ......

lonia, Montcalm, Mich.......

Richland, Ohio ..........

Cheboygan, Emmet, Mich .....

New Madrid, Stoddard, MO. ...

New York City’ 61.8

New York City’ 51.4

New York City’ 56.7

Patterson-Clifton-Passaic’ 63.6

Pittsburgh’ 60.4

Trenton’ 70.5

Philadelphia’ 57.8

Newark’ 61.9

Erie’ 77.4

Middletown’ 70.8

Boston’ 58.0

New Britain ,I Meriden ’ 69.2

Portland’ 70.8

Williamsport 79.0

Oneonta 79.5

Pawtucket 74.8

16

Chicago’

Detroit’

Cincinnati’

Indianapolis’

Minneapolis-St. Paul’

Dayton’

Chicago’

Des Moines’

Minnea olis-St. Paul’

Racine P

Bloomington

Mattoon

Greenville

Mansfield ‘l

Cheboygan

Baxter

-_ _ __._ -_ -. - .-----~-- -. - .- - .-- - ---~ .___ ---._ _-

73.7

54.8

71.4

73.2

70.7

79.3

74.2

65.8

73.0

83.7

78.1

78.5

74.3

80.6

74.8

78.5

73.6

Southern. ............. 16 73.8

De Kalb, Ga............. Atlanta’ 70.6

Newport News (city),

Hampton (city), Va........ Newport News-Hampton’ 79.3

Dade, Fla. .............

District of Columbia .......

Caddo, La..............

Brevard, Fla.............

Poinsett, Ark. ...........

Bledsoe, McMinn, Meigs,

Rhea, Tenn. ...........

Blount, St. Claire, Ala. ......

Hardin, Larue, Nelson, Ky. ...

Greene, Harrisonburg (city),

Rockingham, Va. . . . . . . . . Harrisonburg 70.4

Lafayette, La. . . . . . . . . . . . Lafayette’ 69.2

Floyd, Johnson, Magoffin, Ky. . Saylersville, Prestonburg 69.1

Craven, Pitt, N.C. . . . . . . . . . Greenville, New Bern 76.0

Banks, Hall, Towns, White, Ga. . Gainesville, Cleveland 74.5

Cherokee, York, S.C. . . . . . . . Rock Hill 78.6

Western. .............. 16

Harris, Tex. ............ Houston’

Santa Clara, Calif .......... San Jose’

Honolulu, Hawaii ......... Honolulu’

San Diego, Calif. ......... San Diego’

Pierce, Wash ............. Tacoma’

Sedgwick, Kans........... Wichita’

Fresno, Calif. ........... Fresnol

Linn, Oreg.............. Albany

Potter, Randall, Tex. ....... Amarillo’

Yolo, Calif. ............ Woodland

Laramie, Wyo............ Cheyenne

Bingham, Idaho. ......... Blackfoot

Hickory, St. Clair, MO. ...... Osceola

Parmer, Tex ............. Bovena

Los Angeles (part), Calif ...... Los Angeles’

Los Angeles (part), Calif ...... Los Angeles’

Miami’ 72.8

Washington, D.C.’ 68.7

Shreveport’ . 71.4

Cocoa 74.2

Marked Tree 84.7

Athens, Pi keville

Oneonta, Pell City

Elizabethtown,

Bordstown

71.4

73.3

76.0

77.4

65.2

74.2

71.8

73.4

80.4

76.7

82.8

84.1

79.7

82.6

83.4

88.4

75.8

85.4

62.4

69.5

‘1970 standard metropolitan statistical area containing the survey location. Some of the SMSA’s have been redefined since 1970.

for examination had to be carefully controlled. A

sequential sampling procedure known as “Perkins’

Stop Rule” was used to insure that the number of

persons selected in each PSU was within 15 of the

expected number of sample persons. Perkins’ Stop

Rule, as described in a Bureau of the Census publication,24 is an unbiased procedure for determining

both the number of reserve segments to use in each

PSU and when to stop interviewing sample persons

within selected households. Since the expected

number of persons in each PSU is between 3 15 and

585, the stop rule also insures that the actual number

of sample ‘persons in each PSU is between 300 and

600. For NHANES II, the number of sample persons

ranged from 306 to 598 with an average of 334 per

PSU.

Selection of sample persons

After the sample segments had been identified

and assigned to interviewers, a sample of persons to

be examined from individual households was selected. _ -. The sample was selected so that young and old age

groups were oversampled and so that approximately

one person was selected per household. The Bureau

of the Census evaluated a number of alternative subsampling schemes within the household with respect

to these objectives. The subsampling procedure that

best satisfied both of these survey objectives was one

that selected 3 out of every 4 persons who were 6

months through 5 years of age or 60 years through 74

years of age and 1 out of every 4 persons who were 6

through 59 years. The sample person selection sheet

is shown in figure 2.

Once in the household, the interviewer listed

everyone who lived in the household in a specified

order. The number of persons within each age group

was indicated, and letter codes were used to select

persons from each of the three age groups for the

sample. The letters used to sample persons from each

age group are shown in figure 2. After a random start,

64 three-letter combinations were systematically --

25
assigned to the household questionnaires for each

PSU in the Bureau of the Census regional office. _ ___- %%e lettek ere circled on each questionnaire

before it was assigned to an interviewer. For example,

suppose that the letters “A,” “K,” and “W” were

circled on the household questionnaire for a family of

four: one baby 9 months old, two adults of ages 30

and 3 1, and one adult aged 66. The number of

persons in each of the three age groups (see figure 2)

is 1, 2, and 1, respectively. The letters “A,” “K,” and

“W” indicate that the intewiewer should select the

first person in the age group 6 months to 5 years, the

second person listed in the 6-59 years age group, and

the second person in the 60-74 years age group, as

sample persons. In the example, since there was no

second person listed in the 60-74 years age group, the

9-month-old son tid the 310year-old wife were

selected as sample persons for the examination.

l . DO any of the pe

8, dotives, of roomers?

What is the-doto

of --‘I birth?

I I

Ale

Age group

Mark for coch

Use cord to check ELlGl8LE oerson

Mow is -- related to --

(hood of household)?

Name (First. middle initial. lost)

Circle fine number of

household respondent

birth dote ond age Circle Sb’s

for consistency

20.

2e. 2d. * Month Day Year Ale w,. 6- 59 Yr. 60- 74Yf.

lb 07 95 30 %

4’ w 4t 3 I

a // 7f +@ L&i

I

SAMPLE PERSON SELECTION

PERSONS

6 years - 59 years

PERSONS

60 years - 74 years

PERSONS

6 months - 5 years

1st. Znd, 3rd, Sth, 6th, 7th Ist, 5th. 9th 1st. Znd, 3rd. 5th. 6th, 7th

2nd. 3rd, 4th, 6th. 7th. 8th 2nd. 6th, 10th Znd, 3rd, 4th. bth, 7th, 8th

C 1 X

Ist, 3rd, 4th. Sth, 7th. 8th 3rd. 7th, 11 th 1st. 3rd, 4th, 5th. 7th, 8th

D M Z

Ist, Znd, 4th, Sth, 6th, 8th 4th, 8th, 12th Ist, 2nd. 4th, Sth, bth, 8th

0 No Sample Person(s) - Explain to respondent why no further

CHECK ITEM A Go to page I , item 13.

Sample Person(s) - Fill Medico1 History

lotcs

L

--- ---

Nutrition

--_.--

=igure 2. An example

-. _-

sar$le person-selection sheet used in

Examination Survey, 1976-80

the National Health

26
Operational plan.

Stand sequencing and scheduling

As in previous cycles of NHES and NHANES, the

scheduling of stands (examination locations) for

NHANES II was arranged so that the North was

avoided in winter. This was done because of operational problems that would otherwise have resulted.

To the extent that any of the items of data collected

by the survey were subject to seasonal variation, this

procedure -may have resulted in some bias, but since

the survey was designed more to measure the prevalence of chronic conditions rather than acute manifestations of conditions, seasonal variation was not

considered to be a major factor.

Another important consideration in the sequencing of stands was economy in operation. Efforts were

made to insure the minimum amount of travel. by

sequencing examination locations with regard to

geographic proximity. At each location, the regular

procedure involved the -following sequence of advance

arrangements: U.S. Bureau of the Census interviewing

in the household, mobile exam center setup, dry-run

examinations, and, finally, follow-back with sample

persons by Health Examination Representatives when

indicated, and regular examinations of the sample

persons. The number of weeks allotted for examinations was dependent upon the expected sample size

at a particular stand but varied between 4 and 6

weeks.

Advance contacts and logistics

Before household interviewing could begin in a

sample area, contacts with professionals and the

public and logistical arrangements were necessary. It

was the policy of the survey to contact the Public

Health Service representatives in the Department of

Health and Human Services (formerly the Department

of Health, Education, and Welfare) regional offices,

the State and local health authorities, and the medical,

dental, and osteopathic professional organizations in

the States and communities. This was done to acquaint them with the NHANES objectives and

methods of operation, including the local schedule of

operations. School officials were also notified because

of the necessity of requesting release from school for

the examination of school children. This notification

usually consisted of a letter announcing the survey,

the local areas to be sampled, and the dates of survey

operations, along with a brochure describing the

survey, mailed 2 months before examinations were

scheduled to begin. The letters to local health authorities included a request to provide NHANES with

a listing of local and State health agencies and clinics

to which NHANES examinees who did not have

current medical resources and who required medical

care could be referred, or to which a report of the

examination findings could be sent. Personal visits by

NHANES medical staff were made to any health

agencies or societies requesting them.

A general news release explaining the program

was prepared for each sample area and distributed to

local news media. The release was timed to coincide

with the start of the Bureau of the Census interviewing. As a result, local newspapers at most of the

locations published items concerning the program.

Special efforts were also made to obtain television

and radio publicity for the survey. Any pictures taken

for these efforts used NHANES staff as subjects,

because pictures of examinees would have involved a

loss of confidentiality. Sample households with

known addresses were sent an “advance” letter by the

Bureau of the Census several days before interviewing

began. This letter informed the household members

that a Bureau of the Census interviewer would call at

their home within the next few days in connection

with a survey being conducted in the area by the

Public Health Service.

Six to eight weeks before the start of examinations

at a particular location, a member of the NHANES

field staff, the Field Operations Manager, visited

the sample area to make physical arrangements for

the mobile examination center and the administrative

27
offices, to meet personally with local health and

school officials, and to initiate the many logistical

actions required for the survey. Selection of a site

for the mobile examination center and arrangements

for electricity, water, sewerage, telephone, and transportation services were also made on this initial visit

to the area.

Household interviewing and

appointment process

Trained Bureau of the Census personnel conducted. the household interviews to obtain household

composition, demographic, and other data. At this

initial visit the census interviewer determined which

members of the household were to be selected for

inclusion in the sample. The census interviewer

explained the survey, asked a series of medical history

questions of the prospective examinees, and made

appointments for the selected sample persons willing

to come in for the examination. As an incentive to

participate in the examination, the sample persons

were told that they would receive $20 for any inconvenience caused them because of their participation.

The census interviewer also obtained written consent

for the examination of minors and written authorization to obtain additional information from the

records of physicians, hospitals, schools, and State

registry offices. The census interviewer informed

sample persons that reports *of significant findings

would be sent to their physicians or clinics if they so

desired.

A! individual who did not make an appointment

at the time of the visit by the census interviewer was

subsequently visited by a Health Examination Representative, who explained the program more fully,

using photographs and a film strip. The Health Examination Representative answered any questions about

how the sample was selected or the examination

conducted and about what was included in the examination. Points that were stressed included personal

benefit to be derived from the examination, contributions to medical research, and civic pride. In addition, it was stressed to sample persons that they were

statistically chosen for the survey and no one else

could be substituted for them. By carefully explaining

details of the examination, the representative attempted to allay any fears or anxieties about it. This

additional effort resulted in scheduling for examination many of the persons from whom the census

interviewer had been unable to obtain appointments.

The typical weekly examination schedule called for

five morning sessions (including Saturday), three

afternoon sessions (including Saturday), and two

evening sessions. Individuals receiving the glucose

tolerance test were scheduled for the morning sessions

only. Sample persons could elect to drive themselves

to the examination center, but use of a taxi for which

arrangements had been made was encouraged. Trans28

portation costs were paid by NHANES under either

arrangement. Appointments for persons who for one

reason or another had canceled or broken their

appointments or who had not been available for taxi

pickup at the scheduled time were rescheduled if

possible. Any necessary rescheduling was accomplished

by the health representative as soon as possible,

preferably the same day, a policy that helped reinforce in the sample persons’ minds the importance

placed on their participation.

Examination center and staff

As in the previous examination programs, examinations were carried out in specially designed mobile

examination --- centers (figure 3), which were moved

from location to location in a predetermined fashion

so that a sample of the civilian noninstitutionalized

population was administered a standardized set of

questions, examinations, and laboratory tests in

comparable settings by a fully trained staff. Each

mobile examination center consisted of three trailers,

each 45 feet long and 8 feet wide. The sets of trailers

constructed for NHANES I had been refitted with

some interior modifications and used for NHANES II.

They were set up side- by side on a level hard surface

area and connected by enclosed passageways. The

trailers themselves were then further leveled to enable

connection of the plumbing and proper alinement of

the passageways. Heating and air-conditioning units

I FLOOR PLAN - MOBILE EXAMINATION CENTER

Staff room

measurements

Staff

en trance

I

~‘fljqT$J

Examinee entrance

Figure 3. Mobile examination center
helped provide a standardized environment in which

to conduct the examinations and perform laboratory

procedures.

For NHANES II the trailer setup was as follows:

The first trailer contained the waiting room where the 1

sample persons were checked in by a coordinator.

The coordinator’s main function was to assign the

examinees to the staff members conducting different

parts of the examination in such a way as to minimize

the examinees’ total waiting time. To the side of the

waiting room were two small rooms used for dietary

interviews. Another slightly larger room in this trailer

was used for administering the allergy test and

conducting health interviews. A laboratory was

equipped with a Coulter Counter, a hemoglobinometer, an incubator, a microhemato&it centrifuge and

reader, a centrifuge, a refrigerator and freezer, a

microscope, and a laminar flow table. The room

where respiratory testing was done was located next

to the laboratory and contained a spirometer, a

two-channel paper recorde r, and an oscilloscope. The

spirome ter was connected to a Marquette electrocardiogram recorder located in the third trailer.

The second trailer had an X-ray room containing

an X-ray machine, reciprocating buckey, and table.

This room was used for chest, back, and neck X-rays.

Adjoining the X-ray room was a dark room. An

X-omat for developing X-ray film automatically was

in an open space adjacent to the dark room. The walls

of the open space contained X-ray viewing boxes. The

second trail er also contained one of the two washrooms used for dressing and obtaining urine specimens. In the second trailer there were two other

rooms. One of these rooms contained an examining

table and a mercury sphygmomanometer, and the

other a table and equipment for drawing blood.

The third trailer -contained a soundproof room

used for hearing tests. At test frequencies, the background noise level was below 35 decibels relative

to American Standards Association audiometric zero

(National Bureau of Standards). This room contained

an audiometer with masking capability and earphones

for pure-tone audiometry. It also contained a Revox

tape deck, a condenser microphone, and a playback

machine for the Stephens Oral Language Screening

Test. Adjoining the audiometry room was a washroom. Another room contained the Marquette

electrocardiogram recorder and a table. Electrocardiograms as well as spirometries were recorded on

tape there. The final examination room was the

body-measurement room. It contained a large and

very accurate weight scale, a set of calibration weights,

a device for measuring heights, an examining table

for measuring sitting heights, and a variety of anthropometric instruments. The third trailer also included

a staff room. There was storage space both within and

under the trailers.

The field staff necessary to carry out the operation of the survey consisted of three groups. The first

one was the team of census interviewers and their

supervisor. The second group consisted of administrative staff and Health Examination Representatives.

The usual complement was a field operations manager,

field management assistant, one or two local parttime employees, and five Health Examination Representatives. The third group was the examining

staff, operating within the mobile examination

center, consisting of a physician, a nurse, two dietary

interviewers, three health technicians, two laboratory

technicians, and a coordinator. Everyone on the

examining staff had been thoroughly trained to

conduct the standardized procedures. All the field

staff except the physician were civil service employ--

-- --- --

ees; the physicians -were employed on long-term

personal services contracts. The administrative staff

was responsible for all procedures involved in processing examinees prior to their entry in the exam center.

The health technicians conducted most of the testing,

including taking X-rays, electrocardiograms, body

measurements, and spirometries; and audiometry,

the allergy exam, and the administration of questionnaires. The laboratory technicians performed all the

laboratory work that had to be done on site, including preparation of blood and urine specimens for

shipment. The nurse was mainly occupied with

drawing blood.

Examination process and medical reports

Each examinee was assigned to whatever examiner happened to be free at the time. However, certain

restrictions were built into the examination. For

example, since oral glucose intake induces changes in

electrocardiogram patterns, the electrocardiogram

had to be done before the glucose tolerance test.

Similarly, because of a possibility that an occasional

allergy test might affect pulmonary function, spirometry was done before the allergy test. The requirement of a concentrated urine for microscopic examination necessitated urine collection before the

glucose tolerance test. It was also desirable to expedite

blood samples in order not to stretch out the laboratory work day unduly.

A report of medical findings, including laboratory

results, was sent to the examinee’s personal physician

or other source of medical care designated by the

examinee. Any condition that in the opinion of the

examining physician required immediate medical

attention was immediately reported by phone to the

personal physician or medical care facility designated

by the examinee. A chest X-ray and a copy of the

electrocardiogram were sent with the report. Some

findings were not included on the regular report because they were not available at the time the report

was mailed. For example, the back and neck Xrays were read by -three rheumatologists at a later

29
time, so the results of their assessment were not aminee’s source of medical care when they became b . immediately available. If some degree of pathology available.

was found, these results were reported to the ex- I 1’

Ii I
Quality control

Measurement error, an important concern in any

survey, was even more so in one as complex as

NHANES. Minimizing measurement error required a

considerable amount of careful effort. Before the

collection of data, it was necessary to define precisely

what was to be measured and to describe clearly how

the measurements were to be taken. Before the

survey began, the NHANES staff, assisted by advisers, -- -.__ _ . delineated the necessary definitions and instructions,

which were incorporated into a staff instruction

manual covering all procedures. Intensive specialized

training was given to all staff members in the specific

procedures performed by them in the survey. Periodic

retraining was provided in order to achieve consistency over the entire survey period.

An important requirement for quality control is

the proper calibration of instruments. Among the

instruments calibrated were the spirometers, audiome ters, earphones, electrocardiogram recorders,

speech recording equipment, laboratory equipment,

scales, and body measurement equipment. The

instruments were calibrated at different intervals, that

is, with each examination, daily, weekly, or before

the beginning of each stand location. Calibration of a

particular instrument might be done in more than one

fashion: for example, the spirometer was calibrated

both electronically and pneumatically. Calibration of

- ---- __- -- -

the audiometers-was done both in the field and also

more thoroughly at a central laboratory to which

they were sent on a rotating basis.

Preventive maintenance was also quite important

in keeping the equipment running properly. Prompt

repair -of the instruments was essential in order to

avoid excessive loss of data. The staff biomedical

engineer was invaluable in providing for the proper

functioning of the equipment. The engineer also

played a major role in designing the equipment setup,

arranging for its installation, and working out any

difficulties that developed in the system.

Several methods were used to obtain adequate

quality control. For certain procedures such as those

involved with height, weight, X-rays, spirometry,

electrocardiographs, and speech, “hard documents”

were produced, the quality of which could be evaluated and the significance assessed at a central location.

For example, X-ray films were evaluated for readability, interpreted by expert readers, and subjected to

replicate readings. Replicates involved having the

same part of the examination, for example, body

measurements, performed independently at different

times by two observers. Another more experienced

observer, such as a supervisory technician, could be

used as the standard. Replicates were a powerful tool

in demonstrating interobserver differences. For

biochemistry tests, replicates took the form of a

duplicate pair of specimens being sent, one of them

under a ;‘dummy” number, to the same laboratory.

Another method of quality control in the evaluation of the different procedures was to compare mean

values and frequency distributions by stand location

and by individual observers. If there was an unusual

set of results in one location, this could be investigated. Similarly, if one of the technicians consistently

obtained higher or lower values than the others, this

could also be investigated.

All recording forms were reviewed by the examining staff before the examinees left in order to detect

errors such as omission of data. Samples of the forms

were checked again, more thoroughly, at headquarters.

If the staff was making a systematic error, it could be

detected, and proper remedial action taken.

The performance of some of the field staff could

also be checked by tape recordings. At every location,

each dietary interviewer recorded two complete

interviews on randomly selected subjects. The recorded interviews were evaluated later at headquarters for adherence to established procedures.

Retention of a reserve container of serum provided an opportunity for repeating and possibly correcting biochemical assessments. If an error was

detected in the processing of a batch of serum, or an

unusual value was observed, a reserve supply of serum

was available for many sample persons to provide

31
analytical results, either to replace the unsatisfactory

data or to verify the unusual value.

In all laboratories to which specimens had been

sent for analysis, standard quality control procedures

were used. These included blind quality control

specimens from known control pools. For quality

control samples, several statistics were produced,

including trend lines, plots, means, and standard

deviations. Known test materials were used; and all

reagents, calibrations, and the like were logged. Determinations were repeated for specimens showing

extreme values.

A useful procedure for quality control of laboratory data was implemented in 1978. This procedure

was as follows: from a frequency distribution of

values, the value closest to the 75th percentile was

selected. For example, suppose fasting blood glucose

data showed .246 of the population with values of

98 or over. In a run of 13 specimens, if one were to

find 9 specimens with values of 98 or over, the

chances of this happening according to the cumulative binomial distribution is .0009. This is quite

unlikely, and the matter would be carefully looked

into.

A similar procedure was followed with a low

cutoff value at or near the 25th percentile. In fact,

the glucose determinations showed only four runs

with a probability of less than .Ol out of a total of

240 (including both high and low cutoffs). Since on a

chance basis five runs might have been expected, this

suggested that the procedure’ was in control during

this period.

--____---- --- ---

A major effort was made in all NHES surveys to

control and reduce the magnitude of the nonresponse.

If the nonrespondents in a survey differ from respondents with respect to the measurements being

made, the survey results will be biased. The potential

for a nonresponse bias is much greater when response

rates are low. A number---__ of _ - - - steps .- taken to reduce

. -.-_ -__. -..- -_ _

nonresponse in NHANES II ha%-. already been discussed. The size of the primary sampling units was

reduced primarily to decrease the logistical problems

of sample persons coming to the mobile examination

centers. Much of the advance publicity was directed

to improving the overall response rate in *a community. The extra efforts of the Health Examination

Representatives to schedule appointments and to

arrange transportation to the Mobile Examination

Centers were very important in the achievement of

acceptable response rates. Several reports have been

written that discuss cooperation in National Health

Examination Surveys and the factors related to

response.2 5 -2 8

The response rates for both NHANES I and

NHANES II were between 70 and 75 percent-lower

than the response rates obtained in previous NCHS

examination surveys. Concern over the lower response

rate in the NHANES programs resulted in two studies,’

being conducted to determine the effect of paying

respondents to participate in NHANES. The first

study was conducted in San Antonio, Tex., in 1972.

The findings from that study showed that the offer of

a payment of $10 to sample persons to participate in

NHANES significantly improved the response rate.2 9

As a result of that study, a payment of $10 was routinely offered to all sample persons for participating

in the examination. A second study on the effects of

remuneration to sample persons was conducted in

two locations in 1978. A slightly more elaborate

design was used to study the relationship between the

amount of the payment offered sample persons to

participate in the examination and the number of

sample- persons in the household. The results showed

that the total amount of remuneration in a household

had a significant positive effect on response,3 0

32
Pilot testing

Pilot testing was much shorter in NHANES II

than in NHANES I. The first pilot test was in Atlanta,

Ga., from November 17 through December 19, 1975.

Center for Disease Control personnel and their families were the examinees. The location was next to the

Center for Disease Control in order to have ready

access to assistance in carrying out the complicated

laboratory procedures. The second pretest was held in _. _ _ -..- _

another part-of the Atlanta metropolitan area from

January 21 throu& February 12, 1976, using a population sample of the area selected by the U.S.

Bureau of the Census. The NHANES II survey began

examinations at its first regular location in Miami,

Fla., on February 19, 1976.

33
Plans for analysis and

publication of data

ing

0 L

Producing reports of findings involves the followsteps:

Sometimes, as with X-rays, there must be further

processing to produce the data unit that is to be

tabulated. This type of pr0cessin.g is done under

contract concurrently with data collection if

resources permit.

Data must be reduced to machine-readable form.

Data must be edited and validated.

Data must be analyzed.

Reports must be written, edited, and printed.

In addition, before any analysis can take place,

,

I 1

the sampling weights, that is, the designated number

of people a sample person represents in the population, must be determined. For selected measures,

imputation procedures for item nonresponse must be

developed and reviewed by consultants.

The procedure used before 1977 was to allot a

certain number of years after completion of a survey

in which NHANES amilytical staff could publish

series reports based on the survey. After that, a set of

computer tapes ‘containing the edited data was prepared for the use of outside investigators in universities, other government agencies, and so forth. The

procedure used since 1977 has been to release for

outside use all completely edited, validated, and

documented tapes, whether or not NCHS has published reports based on the data. It was planned to

have a series of edited tapes containing the NHANES

II data available for purchase from 1 to 2 years after

completion of the NHANES II survey.

In general, descriptive, analytical, and methodological reports are published by the National Center for

Health Statistics in Vital and Health Statistics, series

1, 2, and 11. To a lesser extent, information is made

available in journal articles and in papers presented

at professional meetings. The reports are written by

NCHS staff, staff of Federal agencies collaborating on

data collection, and experts who are not Federal

employees. In addition, to expedite publication of

more detailed analyses of selected topics covered in

the data collection, NCHS plans to support to a

limited extent competitively awarded contractual

analyses and report-writing efforts. A limited number

of special tabulations and analyses are furnished on

request to various individuals and groups both inside

and outside the Government.

Procedures and methods manuals are made available upon request about a year after the surveys are

completed or concurrently with the release of microdata tapes. In this way the data can be evaluated, and

the methodology employed by NCHS in NHANES

can be utilized by others.
References

I

!? I ‘1 , I

INational Center for Health Statistics: Plan and initial program of the Health Examination Survey. Vital and Health

Statistics. PHS Pub. No. 1000Series l-No. 4. Public Health

Service. Washington. U.S. Government Printing Office, July

1965.

2National Center for Health Statistics: Plan, operation, and

response results of a program of children’s examinations. VitaE

and Health Statistics. PHS Pub. No. 1000Series l-No. 5.

Public Health Service. Washington. U.S. Government Printing

Office, Oct. 1967.

3National Center for Health Statistics: Plan and operation of a

Health Examination Survey of U.S. youths 12-17 years of age.

Vital and Health Statistics. PHS Pub. No. 1000Series l-No. 8.

Public Health Service. Washington. U.S. Government Printing

Office, Sept. 1969.

4National Center for Health Statistics: Plan and operation of

the Health and Nutrition Examination Survey, United States,

1971-1973, by H. W. Miller. Vital and Health Statistics. Series

1-Nos. 1Oa and lob. DHEW Pub. No. (PHS) 79-1310. Public

Health Service. Washington. U.S. Government Printing Office,

Jan. 1977.

5National Center for Health Statistics: Plan and operation of

the HANES I Augmentation Survey of adults 25-74 years,

United States, 1974-1975, by A. Engel et al. Vitaland Health

Statistics. Series l-No. 14. DHEW Pub. No. (PHS) 78-1314.

Public Health Service. Washington. U.S. Government Printing

Office, June 1978.

6National Center for Health Statistics: Current listing and

topical index to the Vital and Health Statistics Series, 1962.

1978. DHEW Pub. No. (PHS) 79-1301. Public Health Service.

Washington. U.S. Government Printing Office, Apr. 1979.

‘National Technical Information Service, 5285 Port Royal

Road, Springfield, Va. 22151, telephone (703) X7-4650.

8McDowell, A. J.: Health examination surveys - in theory and

application, in P. Armitage, ed., National Health Survey

Systems in the European Economic Community. Proceedings

of a conference held in Brussels on Oct. 6-8, 1975. Commission of the European Communities, EUR 5747e, 1977.

9National Center for Health Statistics: Eighth Revision International Classi’cation of Diseases, Adapted for Use in the

United States. PHS Pub. No. 1693. Public Health Service.

Washington. U.S. Government Printing Office, 1967.

lONational Center for Health Statistics: Glucose tolerance of

adults, United States, 1960-1962, by T. Gordon. Vital and

Health Statistics. PHS Pub. No. 1000Series 1 l-No. 2. Public

Health Service. Washington. U.S. Government Printing Office,

May 1964.

1 lNational Center for Health Statistics: Blood glucose levels

in adults, United States, 1960-1962, by C. C. Garst. Vitaland

Health Statistics. PHS Pub. No. 1000Series 1 l-No. 18. Public

Health Service. Washington. U.S. Government Printing Office,

Sept. 1966.

12National Center for Health Statistics: Blood pressure as it

relates to physique, blood glucose, and serum cholesterol,

United States, 1960-1962, by C. duV. Florey and R. M.

Acheson. Vital and Health Statistics. PHS Pub. No.

1000Series 1 l-No. 34. Public Health Service. Washington.

U.S. Government Printing Office, Oct. 1969.

1 3National Center for Health Statistics: Selected examination

findings related to periodontal disease among adults, United

States, 1960-1962, by J. E. Kelly and A. Engel. Vital and

Health Statistics. PHS Pub. No. 1000Series 1 l-No. 33. Public

Health Service. Washington. U.S. Government Printing Office,

Sept. 1969.

14National Center for Health Statistics: The one-hour oral

glucose tolerance test. Vital and Heatth Statistics. Series ~-NO.

3. DHEW Pub. No. @IRA) 74-127 1. Health Resources Admini

istration. Washington. U.S. Government Printing Office, Aug.

1973. Reprinted.

1 5Nil, A. A. J.: A population study of urinary trace disease II.

Acta. Med. Stand. 194: 529-534, 1973.

16Burrows, B., Leborwitz, M., and Barbee, R. A.: Respiratory

Disorders and Allergy Skin Test Reactions. Ann. Intern. Med.

84(2): 134-139, Feb. 1976.

l’stephens, I.: Stephens Oral Language Screening Test. Interim Publishing Co., Dec. 1977.

1 *National Center for Health Statistics: Sample design and

estimation procedures for a National Health Examination

Survey of children, by E. E. Bryant, J. T. Baird, and H. W.

Miller. Vital and Health Statistics. Series ~-NO. 43. DHEW Pub. . No. (HSM) 72-1005. Health Services and Mental Health

Administration. Washington. U.S. Government Printing Office,

Aug. 1971.
1 9U S National Health Survey: The statistical design of the

Health Household-Interview Survey. Health Statistics. PHS

Pub. No. 584.A2. Public Health Service. Washington. U.S.

Government Printing Office, July 1958.

2eU.S. Bureau of the Census: The Current Population Survey:

Design and Methodology. Technical Paper 40. U.S. Department of Commerce. Washington. U.S. Government Printing

Office, Jan. 1978.

2 lGoodman, R., and Kish, L.: Controlled selection-a technique in probability sampling. J. Am. Statis. A.

45(251):350-373, Sept. 1950.

22Kish L.: Survey Sampling. New York. John Wiley and Sons,

Inc., 1965.

23U.S. Bureau of the Census: Determination of Poverty/Nonpoverty Strata and Optimal Sample Allocation, HES Cycle IV.

Memorandum from Paul Tomlin to Gary Shapiro, Oct. 26,

1972.

24U S Bureau of the Census: Technical Notes No. 3. Washington, D.C. 1970.

2 5U.S. National Health Survey: Attitudes toward co-operation

in a Health Examination Survey. Health Statistics. PHS Pub.

No. 584Series D-No. 6. Public Health Service. Washington.

U.S. Government Printing Office, July 196 1.

26National Center for Health Statistics: Cooperation in Health

Examination Surveys. Vital and Health Statistics. PHS Pub.

No. 1000Series ~-NO. 9. Public Health Service. Washington.

U.S. Government Printing Office, July 1965.

27National Center for Health Statistics: Factors related to

response in a Health Examination Survey, United States, 1960.

1962, by H. Miller and P. Williams. Vital and Health Statistics.

PHS Pub. No. 1000Series ~-NO. 36. Public Health Service.

Washington. U.S. Government Printing Office, Aug. 1969.

28National Center for Health Statistics: Quality control in a

National Health Examination Survey, by W. L. Schaible.

Vital and Health Statistics. Series ~-NO. 44. DHEW Pub. No.

(HSM) 72-1023. Health Services and Mental Health Administration. Washington. U.S. Government Printing Office,

Feb. 1972.

2gNational Center for Health Statistics: A study of the effect

of remuneration upon response in the Health and Nutrition

Examination Survey, United States, by E. E. Bryant, M. G.

Kovar, and H. Miller. Vital and Health Statistics. Series ~-NO.

67. DHEW Pub. No. (HRA) 76-1341. Health Resources

Administration. Washington. U.S. Government Printing Office,

Oct. 1975.

30Findley, J. S., National Center for Health Statistics, and

Schaible, W. L., U.S. Bureau of Labor Statistics: A study of

the effect of increased remuneration on response in a Health

and Nutrition Examination Survey. Paper presented at the

American Statistical Association Meeting, Survey Research

Methods Section. Houston, Aug. 1980.

36
Appendixes

Contents

1.

I I.

III.

IV.

v .

Examination components by age groups ..................................................... 38

Blood and urine assessments by specimen types and age groups ...................................... 39

Pesticide residue and metabolite determinations ................................................ 40

National Center for Health Statistics and Center for Disease Control staff involved in the planning, development, and

operation of NHANES II ............................................................... 41

National Center for Health Statistics. ..................................................... 41

Center for Disease Control ............................................................. 42

Data collection forms for NHANES II. ...................................................... 43

NHANES Household Questionnaire ...................................................... 43

Medical History Questionnaire, Ages 6 Months-l 1 Years. ........................................ 51

Medical History Questionnaire, Ages 12-74 Years ............................................. 68

Health History Supplement, Ages 12-74 Years ................................................ 95

Dietary-24 Hour Recall and Dietary Frequency. ............................................. 114

Dietary Supplement, Ages 12-74 Years .................................................... 116

Medications/Vitamin Usage. ........................................................... 118

Behavior Questionnaire, Ages 25-74 Years .................................................. 119

Control Record. ................................................................... 122

BodyMeasurements.............................................’.................... 123

Audiometry (Air), Ages 4-19 Years. ...................................................... 125

AllergyTesting .................................................................... 126

Spirometry, Ages 6-24 Years. .......................................................... 127

Liver Function Test, Ages 35-74 Years .................................................... 128

Glucose Challenge, Ages 20-74 Years. ..................................................... 129

Speech Pathology Test, Ages 4-6 Years .................................................... 130

Physician’sExamination,Ages6Months-74Years.. ............................................ 131

Interviewer Information Card Booklet. .................................................... 140

37
Appendix 1. Examination components

by age groups

6 months-2 years 3-11 years IZ- 19 years 2@74 years

(bile acids test group)

20-74 years

(glucose tolerance Zest group)

Body measurements

Physician exam

Ven ipunctu re

Dietary interview

Urine: 6-11 years only

Body measurements

Physician exam

Venipuncture

Dietary interview

Audiometry: 4-11 years only

Speech test: 4-6 years only

Allergy test: 6-11 years only

Spirometry: 6-11 years only

. . .

. . .

. . .

. . .

. . .

Urine

,Body measurements

Physician exam

Venipuncture

Dietary interview

Audiometry

. . .

,Al lergy test

Spirometry

I

. . .

.

Urine Urine

Body measurements Body measurements

Physician exam Physician exam

Venipuncture Venipuncture

Dietary interview Dietary interview

. . . . . .

. . .

Allergy test

. . .

Allergy test

Spirometry: 20-24 years only

Electrocardiogram: 25-74 years only

Chest and neck X-rays: 25-74 years

only

Spirometry : 20-24 years only

Electrocardiogram: 25-74 years only

Chest and neck X-rays: 25-74 years

only

Back X-ray: 25-74 years for men;

50-74 years for women

. . . .

Back X-ray: 25-74 years for men;

50-74 years for women

Glucose tolerance test

IBile acids test: 35-74 years only . . .

38
Appendix II. Blood and urine assessments

by specimen types and age groups

fz

2

0.-

. . G

. .

. . hî

z

2

0.a

. . 5

. .

. . t?

. . .

. . .

. . .

. . .

. . .

. . .

a
Appendix Ill. Pesticide residue

and metabolite determinations

Urine

.

Hexachlorobenzene

tram Nonachlor

DDT and Associated Analogs

alpha-BHC

gamma-BHC

be ta-BHC

delta-BHC

Aldrin

Dieldrin

Endrin

Hep tachlor

Heptachlor Epoxide

Oxychlordane

Mirex

alpha Monocarboxylic acid

Dicarboxylic acid

3,5,6-Trichloro-2-pyridinol

Isopropoxyphenol

Carbofuranphenol

3-Ketocarbofuran

Dicamba

2,4-D

Pen tachlorophenol

para-Nitrophenol

alpha-Naphthol

DMTP

DETP

DMDTP

DEDTP

DMP

DEP

2,4,5-T

Silvex

2,4,5=Trichlorophenol
Appendix IV. National Center for Health

Statistics and Center for Disease Control

staff involved in the planning, development,

and operation of NHANES II

National Center for Health Statistics

Division of Health Examination Statistics

Robert S. Murphy, Chief, Survey Planning and

Development Branch

James Scanlon

Everette M. Collins

Evelyn Stanton

Dorothy Blodgett

Dale Hitchcock

Mary Margret Wilson

Connie Dresser

Arnold Engel

Helen Barbano

Statistical Methods Staff

E. Earl Bryant, Chief

James T. Massey, Mathematical Statistician

Division of Operations

Headquarters Staff

Henry Miller, Branch Chief, Health Examination

Field Operations Branch

Philip Howley, Operations Manager

Thomas Makepeace, Assistant Operations Manager

David Larson, Biomedical Engineer

Jean Findlay, Survey Statistician

Paula Wallace, Statistical Clerk

Hilda Davis, Management Technician

Judy Gray, Management Assistant

Robert Benson, Clerical Assistant

Kenneth McDowell, Supervisory Health Technician

Brenda Lewis, Supervisory Medical Technologist

Penny Allen, Management Assistant

Charles Gallese, Operations Manager

Field Staff

Joseph Campagna, Field Operations Manager

Christine File, Field Operations Manager

John Aldrich, Field Operations Manager

Jay Anderson, Field Operations Manager

Jerry Coffman, Field Operations Manager

Althea Engle, Field Operations Manager

Eileen Kennedy, Field Operations Manager

Denis Hill, Field Operations Manager

Margaret Kelly, Field Management Assistant

Charlene Morton, Field Management Assistant

Anita Allen, Field Management Assistant

Holly Ferazzi, Field Management Assistant

Gary Warren, Field Management Assistant

Janet Warren, Field Management Assistant

Marie Abbott, Health Examination Representative

Dorothy Briggs, Health Examination Representative

Mary Colbert, Health Examination Representative

Laurel McDowell, Health Examination Representative

Martha Peters, Health Examination Representative

Linda Fant, Health Examination Representative

Barbara Greene, Health Examination Representative

Alfonso Small, Health Examination Representative

Paul Terr, Health Examination Representative

Doris Thompson, Health Examination Representative

Linda Day, Health Examination Representative

Alma Eubank, Health Examination Representative

Patricia Warchol, Health Examination Representative

Esther Allen, Field Operations Assistant

Carolyn Petty, Field Operations Assistant

Elizabeth Hill, Dietary Coordinator

Janet Williams, Dietary Coordinator

Ruth Griles, Dietary Coordinator

Lorraine McCullen, Dietary Coordinator

Lori Hornfeck, Dietary Interviewer

Marie Mitchell, Dietary Interviewer

Connie Foster, Dietary Interviewer

Rebecca Wilson, Dietary Interviewer

Dollie Kendrick, Laboratory Technician

James McGuffey, Laboratory Technician

Patricia Dowling, Laboratory Technician

Ronette Hunt, Laboratory Technician

William Johnston, Laboratory Technician

Wilda Andress, Nurse

Judy McKnight, Nurse ’ Kevin Aubin, Health Technician

Roberta Brady, Health Technician
Vondell Clark, Health Technician

Charles Johnston, Health Technician

Charlotte Leahy, Health Technician

David Edwards, Health Technician

Meris Emery, Health Technician

Jane Robinson, Health Technician

Jerome Waite, Health Technician

Richard Driessel, Physician

William Dodd, Physician

Harold Holleran, Physician

Lindsey Kirkham, Physician

Verla McAnelly , Physician

John Shirey , Physician

Robert Wildt, Physician

NOTE : This

of the suwey

appendix shows the organization and staff as of the time

Center for Disease Control

David Bayse, Director, Clinical Chemistry Division

Jane Neese, Chief, Nutritional Biochemistry Branch

Richard Carter, Chief, Nutritional Biochemistry Research and Reference Section

Wayman Turner, Chief, Nutritional Biochemistry

Technical Services Section

Elaine Gunter, Supervisory Medical Technologist

Onno van Assendelft, Chief, General Hematology

Branch

Comelia R. McGrath, NHANES Hematological

Coordinator

,

42
Appendix V. Data collection

fork&for NHANES Ii”

NHANES Household Questionnaire

. n. . . , “.W ..“.

CORM lltt30 OECK 371

110.I-WI

NOTICE - All informetion which would permit identifialial of the individuel will be held in strict

U.S. DeC*RtYcW7 oc CoMMRnCs confidrrce, will be used only by p8rson~ engeged in md for the purposes of the survey, md will not be

aullc*u oc rnc ccwsus

ACTIWO AS COLLICTIWO AeaWt roll tnc disclosed or relaased to otiers for my purpose.

U.S. l UILIC MLALTH smvlcc

HOUSEHOLD QUESTIONNAIRE 1. stand 2. identification 3. Control number

HRALTH AND WTRltlDN number code Fsu segmenr

m

krirl

RXAMIWATIDH SURVEY II m-o f

TYPR A

--------------------------------------------------------- i

r Sheet

0 Rafusal - DaaM8a f#l nowa

0 No one et hane - re$aamd calls

FIrI Irsm

dM7.118-c

----------------------------------- ----------

eiv I 5iue

;No. m

JXFiX-- I Line

0 femperuily ebsat - N0f.s

I t

;No. -

0 Other -’WW* 1

~9plJubb.

f*ls. uw 17)

t b. Is this your moili

x

eddross?

Muk box or speci if different. (Include ZIP code)

a Sane 8s 58 TYPE I)

------------------------------------------------------------------

0 Vocmt - nanuaronal

0 vacmt - Season81

0 Usuel residence elsewhere

y&sy4#

-------------------------------------- *k-o,

CiY

““““‘“““‘*“““““’

rState I ZIP code -0 Armed Forces

I

w n-16)

I f

I

0other -St-Q

c. Special pirce nme i Sanpie unit number 1 Type code

I

t TYPR C

6. YEAR BUILT 0 Unused line of listing sheet

0 Do NOT Ask (7) 0 Demolished

0 Ask - When wos this structwu origimlly hilt? 0 *u.d

i

(Flfl I-C

0 Oucsido swment

. Ilelukd,md

0 Before 4-I-70 (Continue interview) ?*lb)

0 After M-70 (Go to 8c, complete if required,

f-J su1lt after April I, IWO

ond end interview) q Odnr-WW+ ~

7. Type of living quarters . ..+ 1 0 Housing unit 2 0 OTHER unit

8. Area segments ONLY 15. Record of calls

0 0. Are hen eny occupied or veceot qwtors time

berider pur own in this buildiy? 0 Yes (fill Table X) 0 No Oete . CWllpleWd

Eesh~ins Endinr

0 b. Are thoro any occopiod or vocont liriy quortors

ksikr your own M this floor?

0 C. Is there oay other building on thir )ropotty for

people k livo in - either occepiod or vmcont?

0 d, None

0 Yes (F ill Table XI q No cm. a.m.

I p.m. p.m.

0 Yes (fill Table Xl 0 No 8.m. 8.m.

2 P.m. p.m.

) Go to page 2, quustien le. aem. 8.m.3 p.m. p.m.

9. Land use 8.m. 8&l.

1 q URBAN (12) 4

{

p.m. Pm*

Regular units coded 82 or 84 in item 2.

2 n RURAL (10) Special place units coded 82 or 84 in 8.m. 8Jn.

item 2 AND coded 85-88 in item SC.

5 p.m. p.m.

0. De you uwn er rent fhir piece? 00~ 0 Rent 0 Rent for free

8.m. 8.m.

6 p.m. p.m.

lo. Does this ploco you (own/rent/rent for froo) hove 10 acres 16. List line numbers of urnpie persons

or more? i pYes 2~NoWc) remaining to be interviewed,

b. During the post 12 months did selor of crops, livortock, oad i-J None

other form products from this ploco orount to $50 or man? . 1 0 Yes (12) 2 Q No (12) .

Line number

ca During 1110 pant 12 months did solos of crops, livestock, end

olhor form products from this pleco oaount to $250 or more? t 0 Yes 2ONo I I

2. What is fho telephone number hen?

I

0 None l7e. For “final” Type A noninterviews, enter names.

’ Telephone approximate ages, end sex of household members,

7 Area code I Numbor For refusal households, iircfe fine

i

number of person who nfvses.

NUW’ R8ce Age Sex

3. interviewer’s name i Code

i

I

I

I 2

lotus 3

4

6

b. Who ruppliod this information?

Name

Number and sweet, route, or box number

City

r 1

CEN6U~ Total number foral number of

of persons sample persons

USE

ONLY
1 la. tit is the nom of the head of this hourohold? Enter name on first line.

b. What am the IIO~OS of 011 other perso~r who live hero? List O/I persons who live here.

Be sure to list o/l persons in the correct order.

Yes *

;. I have lirtod (Read names). Is than anyone l lro staying hero now, such as friondr, relotivos, or roomers? a

d. flavo I missal oryolw who USUALLY lives hero but is now away from homo?. . . . . . . . . . . . . . . . , . . . 0

o.Ooonyofo1o~loirthirAoureholdhoveohomeanyrh~eoIso?.. . . . . . . . . . . . . . . . . . . . . . . . . a

*Apply household membership rules.

I

f. Alo any of the

tr

~sons in this hourohold now on fulbtime

oetivo duty wi tho Armed Forces of the United Stator? . . . . . Dyes----+ Line(s)- (Delete) ON0

Nmt (First, middle initial. lost)

Circle line number of

household respondent

now ir -- rolotod to --

(hood of household)?

whot i;p$o

of -0’

Use cord to check

birth dote ond age

for consistency

Ate

2

3

9

IO .L I

1

SAMPLE PERWH StLECtlON

PERSONS PERSONS PERSONS

6 months - 5 years 6 years - 59 years 60 years - 74 years

A

1st. 2nd, 3rd. 5th. 6th. 7th I

J

Ist, 5th. 9th

y

1st. 2nd. 3rd. Sth, 6th. 7th

B

2nd, 3rd. 4th, 6th. 7th. 8th

K

2nd. bth, 10th

W

2nd. 3rd. 4th, bth, 7th, 8th

r

C

1st. 3rd. 4th. 5th.

1

3rd. 7th, I I th

X

Ist, 3rd, 4th, 5th. 7th, 8th

D

1st. 2nd. 4th. Sib, 6th. 8th

M

4th. 8th. 12th

2

lit, Znd, 4th, 5th. 6th. 8th
I --
1 Item

@-

2 . Date of birth (Transcribe from page 2) 2. Month Day YINI

@ 63 @

3. Age (Transcribe from page 2) 3. Months Years

@ @

4. Sex 4. @ 1 OMale

z 0 Female

5. Race 5. @ 1 OWhite 2 0 Black

3 D Other

6. In what State was -- born? Enter the name of the State or foreign country. 6. State or foreign country

@

I

7. 18 -- now morriod, widowed, divorced, reporotod, or never morriod? Mark one box ‘* @ ‘0 Under 17 6 0 Divorced

2 0 Married s 0 Separated

3 [3 Wtdowed 6 0 Never married

PhOSe look at this cord. (Hand Card 0)

8. Which ono of tho8o group8 BEST describer --IS notional origin or oncertry?

@-

8. Enter precede

If under 6 years, mark “None.” Pa.

90. What i8 the highest grodo or yoor of rogulor school -- hos ever ottrnded?

@ 0 0 None /IO)

20Elem.. , . . 12345678

2OHigh.....l 2 3 4

4 OCollege . . . l 2 3 4 St

--------------------__________________^_------------------------------,--------------------------------

b. Did -- finish the -- grade (roar)? b. @ 1 q Yes 2 0 No

ASK IF /7t ; OTHERWISE GO TO NEXT SP OR QUEST/ON 14, PAGE 6.

100. What WOS -- doing MOST of the post 12 months ? (For males) Working or doing something *Iso? 100. @J 1 0 Working (f&f)

(For females) Keeping house, working, or doing 2 0 Keeping house (10~)

something else? 3 0 Something else

----------------------------------------------------------------------.--------------------------------

b. What WOS -- doing? b. @ I 0 Layoff 2 0 Retired

3 0 Student

40 III

6 0 Staying home

6 0 Looking for work

7 0 Unable to work

0 Q Other - specify ----------------^-----------------------------------------------------,--------------------------------

c. Did -- work at o iob or bu8ino88 AT ANY TIME during the pO8t THREE months? c. @ij 1 0 Yes 2 0 No (lib)

-------------------------------------------------------------------_--.--------------------------------

d. When -- was working, did ho USWily work full time or port time? d. @ 1 0 Full time 2 0 Part the

110. Did -- work at any time IOSt weok or tho weok boforo not counting work around tho hour.? 110. 020 c) i 0 Yes(12) 20No ------------^-------___^_____________^__--------------------------~,----- ------------------_---------

b. Even though -- did not work during thot time, does he hovo o iob or burinorr? b. @ 1 0Yes 20No ----~~---~~-~--~~^~~^__^________________~~~~~~~~~-~~~~-~~~~~~~~~~~~~~~~~~~~~~~~~~~~-~~~~~~~~~~~~~~~~~

C. War ho looking for work or on layoff from o iob? C. @g I Q Yes 2 c3 No (12) ----------~------~~~__^_________________~~~~~~~~~~~-~~-~~~~~~~~~~~~.~~~~~~~~-~~~~~~~~~~~~~~~~~~~~~~~~~,

d. Which - looking for work or on layoff from o iob? d. @ ; E ;.“;::I’

3 0 Both ’

Ask for all 120. For whom did -- work? Nome of compony. business, orgonizotion, or 120. Employer

persons with a other employer

“yes” in lla,b, -------^----------------------------------------------------- -----------------_-_-----------

Br c. If “Yes” b. What kind of bu8ino88 or industry is this? For example. TV ond radio

manufacturing, retoil shoe store, State Lobor Dept., form

in Ilc only, _

b.-‘@ rdr; ,

^__________------------------------------------------------- ----- - - - -------------------

questions I2a c. What kind of work WOS -- doing? For example. electrical engineer,

through I2e apply stock clerk, typist. former

c. -’ ~ [cyyioj

tothis PersOn,S __-----_------------------------------------------------------.----- - - - ___________________

d. What wore --’8 most impoftont OCtiViti88 or duties? for example, Duties

LAST full-!ime d .

types, keeps account books, files. sells cars, operates printing press,

civilian job. ____-______---------------------------------------------------.------------------------------- finishes concrete

Complete from entries in l2a-d; if not clear, ask: Class of worker

0. War -- on employee of o PRIVATE company, businerr, or individual e.

for wages, rolory, or commi88ion?. . . . . . . . . . . . . . . P @ ‘PP $01

0. o FEDERAL government employee? . . . . . . . . . . . . . . F

-0 o STATE government employee? . . , . . . . . . . . . . . . . S

2QF 6OSE

-0 o LOCAL government employee?. . . . . . . . . . . . . . . . L

-0 self-employed in OWN business, profesrionol proctico, or farm? 3lJs 7OWP

If not a farm, ask: Is the business incorporated?

Yes . . . . . . . . . . . . . . . . I ‘OL 6oNEV

No (or farm) . . . . . . . . . . . SE

-- working WITHOUT PAY in family business or form? . . . WP

--NEVER WORKED .,..,.,.,...,....a....,.. NEV

130. Did -- ever serve in the Armed Forcos of the United Stoter? 130. @ i 0 Yes 2 0 No (Next SP or 0. 14,

--_------_______------------------ ~----^--------------------------~-------~~~~~~~~~~~~~~~~~~~~~~~~~~~

b. When did he serve? Vietnam Era (Aug. ‘64-April ‘75). . . . VN

Korean War (June ‘S0-Jan.‘%). . . . . . KW ’ @ij lo”“’ 6OPVN

Mark br,/ in &sz?nq:rlg l ,r&r r,f prior1 ty. World War II (Sept. ‘O-July ‘47) . . . . WWI I 20 KW 60=

Thus rf tcr:‘,n :ere4 ‘I ‘/lt!nom and rn World War I (April ‘l7-Nov. ‘la). . . . . WWI

Korea, morC /II. Post Vietnam (May ‘75 to present) . . . PVN

3OWWII 8ODK

Other service (all other periods). . . . . OS 4~WWI

b GO TO NEXT SP OR QUESTION 14, PAGE 6.
6. State or foreign country

7. I r] Under 17 4 @ Dt vorced

z [I I Married 6 n Separated

3 [I] Wrdowed 6 0 Never married

a. @-

Enter Drecode

90. 0 c j None (IO)

2 [-I] Elem. . . . . 1234567E

3 [:I High.. . , , l 2 3 4

6L]College...l 2 3 4 St

----------------------------------

b. @ I 111 Yes * I:1 No

t LJ Working (f&Y)

2 Cj Keeping house /f&l

3 c? Somethrng else

-__--__________--_--------~----

t c! Layoff

2 c-1 Retired

3 n Student

4 L-1 Ill

s L] Staying home

6 L-1 Looking for work

7 L] Unable to work

0 0 Other - specify

___-----_----------------------~--

c. @ 1 UYes 2 CT] No fffb)

--_-__----~-----~----------~-~-~~-

d. @ I C] Full time 2 L] Part time

I lo. @j 1 @ Yes (12) 2 @ No

e--,...=----------------------------

.A

t

Q-!p_? ----_ 'P ___________

e. @j 10 Yes 2 @ No (721

d. 1 n Looking

2 @ Layoff

3 0 Both

120. Employer

__--------_---_---_

--_----------------

d. Duties

_____________--_---^I_____________

Class of worker

í [:I p SOI

2 0 F 6 @ SE

3 0 s 7ClWP

4 Cl L 6 [z] NEV

2 0 No (Next SP or 0. 74)

b GO TO NEXT SP OR QUEST/ON 14, PAGE 6.

7. 1 [I! Under 17 6 0 Divorced

2 (13 Married I 0 Separated

3 11-J Widowed 6 0 Never married

a. I @ Enter precede

Pa. 0 [z-j None fro)

2;1]Elem.. . . . 12345678

---

b.

3cJHigh.. . . . l 2 3 4

4 q College, . . I 2 3 4 St

----------------____-----------

(oi-3) lOYes 2 @ No

t 0 Working (f&Y)

2 i-J Keeping house (f&j

3 0 Something else

3 0 Student

4 @ III

5 0 Staying home

6 0 Looking for work

7 0 Unable to work

0 0 Other - Specify

--__----_----------------------

b. (011)

t

i q Yes 2q No --- -__---------------------------

c. (j$ 1 @Yes 2 @ No (12)

d. @ 1 n Looking

2 m Layoff

3 @ Both

120. Employer

------------_-----------

-;I--~;trj

I

,

--- ---- - - - -------------------

-::@--E-------------------

d. Duties

---

t

--_-----

Class

.------

of worker

e- @ ‘OP s Cl 1

2OF 6 @ SE

‘C S 7CJWP

4 El L s@NEV

130. 027

10

10 Yes z q No (Nexr SPof0. 14)

_-- -_____-_--_-----_-------------.

b . t q VN

2oKW

3OWWll

4OwwI

snPVN

6q 0s 9 q OK

6.

3 1 i Other

State or foreign country

3 E Widowed 6 m Never married

a. I @-Enfer mecode

90. @ 0 @ None f 10)

2mElem..... 12345678

3CjHigh.. . . . I 2 3 4

4 q College, . . I 2 3 4 St

----~---~-~-~------~~-~-~-~~~~~~~~

b. @ 1 c] Yes 2 q No

ë00. @ t 0 Working (1Od)

2 [I] Keeping house (f(k)

3 0 Something else

----~~~-~~~~~--_-~-~~--~~------~~~

b. @ 1 0 Layoff

2 0 Retired

3 0 Student

4q 111 S 0 Staying home

6 0 Looking for work

7 0 Unable to woh

0 0 Other - Specify

-------------------------------~--

d. Duties

---------------------------

Class of worker

*. @J ‘UP Scjl

2 Cl F 6 @ SE

3ClS 7CjWP

4BL Si~INEV

l@VN s r PVN

2!--JKW 6 ‘cci 0s

3 cj WWII 9 c! OK

rC,ww

47
de. Now many Nom8 ON irthir --? Cmt tho kit&a bat n9t ho be&roam. 1433 hems

------------------------------------------------------------------~,----------------------------------.

b. Now many bahoar l fo in this --? /f “None.” describe in noKe8. 43 eokomr

,,,,,---,,,---,,,,,,,-,,,----,,-----------------------------------------~.----~--------------------------.

ASK ONLY OF UNRELATED HOUSEHOLD MEMBERS; OTHERWfSE

CONTfNUE WITH QUEST/ON /So. c. @g) 1 CjYasW *

t* 09

kitec

Eli :f”lrc’~ ‘i~h~: ~~~~rns ‘:!~a01

Pw , w

2ONo

sm. Do yov (hareharo l CCo8s to) campleta kitchen f8cilitio, in this

hoar* (thoro living qawtetr); thet ir, a Litek rid with piped

watu, 0 rofrigorotof on4 0 femge ot cooltstoro?

‘k. @J 1C)Y08(fso~

2oe --------------------------------L---------------------------------‘~-------------------------------“--.

L. Do yea bdbevo wcoss to) -

A range u eHk8tove? . . . , . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h@ qgvos

2[3No

A rof~igaatu? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @j) tOYes

2(jNo

Arinltwithpapdwmtov? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @J t~YcsfiW

2aNo

----------------------------------------------C-------------------..----------------------------------.

c* Is than pid wrtov in t&s how80 (Ior0 living quorterr)? e. @ ‘aye=

20 No (16)

------------------------------------------------------------------ ----------------------------------.

6. I8 than bodb bet oad cold rotor? i*@ t 0 Yes (16)

20 No (16)

---------------------------------------------------------------.--,,----------------------------------.

0. Arm there kitchen feeilities use6 by l nyom NOT living in

lir hourahold?

4. @ re,Yes

2ONo

6. What ir tha MAIN type of bating ryrtn you hevo? Mark one. H* @j “0 Stern, 01 hat wrtef system

tz c) Central warm air furnace with ducts to

individual rooms, or central heat pump

(forced air)

t 2 Q Built-in electric units (permmently

instrlled in ~811, ceilin& or brseborrd)

trt) Floor, wrll, or pipelrss furnrce

ts0 Circul8ting. r8di8nt, or room heltefs,

WITH flue or vent, burning g88, oil,

ar kerosene

(6 0 Circuluing. r8dimt, or room herrerr

(not goruble), WITHOUT flue or vent,

burning ps, oil. or kerosene

17 c=] Fireplrces or stoves burning COII,

wood. or coke

18 [=1 Portable room herters of ny kind

19 t) Ssma 0th~ type - Describe

tl

2oQ None, unit is not hertad

17. @ 10 Yes - lndividurl room unit

2 0 Ye8 - Cenw8l 8ir-conditioning

rONo

8. It91 many motor vohicler me owned 09 regddy used 4or treargoetation by me&or8 of your family?

(Count company con left at home.)

k. Is any Iongwgo other lhea bglish fregumtly rpeker by

family members living here?

12.

@-Vehicles

“* @ 8 0 Yes

20 No(lO)

--------------------------------------------------------------.-,.--. --_-------------------------------

b. a8t h9@9.~9)? h Lwu4ds) rpokm

Notes

48
Pleoso look at thir cord: (Hand cord I) lncomc group

to. Which of tbeso income groups nprosonts yoor totol comhirod fomity income for 68

post 12 molbtbs, that is, years, our “‘8, ‘ok.? Ine,cludo income from oil sou1C.s

10. @ ‘q=lA rsOE ISa 1 I8)

such l s wqos, selarios, socio r

rod from proporty and so forth.

security or ntiromont knofits, hdp from rolotiros,

120 0 16 0 F 200 J (81

13oc 17c)G 2’ 0 K (8)

tad 0 1’3OH (8) 22 0 L (8)

Il. Outing the post 12 months, bow much money did yea and all momhors of your femily 21.

rocoivo in wages or salorios hefor. deductions? @s Amount ,

12. During tbo post 12 months, did you w ony mmbers 04 your family rocoivo oay money from - 220. @ii) ’ 0 Yes - How much l ltmgothor?

a. Social Security or Reilraod Rotiroment? 2C)No

@S,-, Amount

/

--------_-----------------------------------------------------. --..-~~----~-~___--~_______^___________

b. Wolfaro poymonts or other poblic assistorco (such as oid to families with dependent

children, old age assistoreo, or oid to the blind or totoIly disabled)?

b. @ I (-J Yes - How much l ltogothor?

2mNo

@I.-, Amount J

-_^---------------------------------------------------------- ,.-- _-_____--_______-___---------------

co Uwmploymont compensation or workman’s conpensotiw? c:‘@ : s i;S - Hew much *Itogether?

@S - Amount i

-------,---,,,-------,,-,------~----------------------------------,,--~-----------------------------------

d. Government employee pensions or private ponsions? de @ t 0 Yes - How much l ltogotbor?

20No

@JSJ

Amount _-------------------______I_____________----------------------..--~-----------------------------------

l . Dividends, interest, or rant? . .@J 10 Yes - Mow much l Ito@otfw?

2ONo

@S

J

Amount

--------------------------------------------------------------..---------------~----------------------

f. Net income from their own nonfarm husinoss, professional pnctico, or pmtnorsbip?

(If there wos a loss, mark “Loss” box and write in amount.)

‘0 @ tOYes-Hwnocholtoqethw?

z(-JNo

3 0Loss

@S -

i

Net income

--------------------------------------------------------------.,--------------------------------------

g. Not income from a form? (Net after opcrotrng expenses. Include comings OS Q tenant

farmer or sharecropper. If form lost money, mark “Loss” box and write in amount.)

9. @J 10 Yes - How match l ltogothor?

2DNo

3 (-J Loss

@S -

/

Net income

___________________--------------------------------------------.-- ------------------_----------------

b. Votwon’s poynmts? ,& ‘cl Yes- How web l ltogethor?

20No

/

@s .~,

A

Amount

___________________-____________________-------------------------------------------------------------

i. Alimony, child support, or contributions from ~WSOIIS not living in this bwsobold? @ '-@ I(3 Yes - How much oltogothor?

2ONo

@s ,-- Amount

J

_____________________________________^__-~-----------------------------------------------------------

j. Any other incomO? j-(&J 10 Yes - How much l Ito+hor?

20No

I@s ,- Amount

J

b

INTERVIEWER: Enter the sum of all money received from all sources in questions 21 and 22. @S -Total amount

CHECK ITEM B

@ 1 c) No program available (Q9. PI)

2 0 Food stamps available (23)

130. Are you certified to participate in tbo food stamp progmm? 230. @ t Q Yes

2ONo

-I o Q Don’t know CQQ. PIJ

_____________-___-_----------------------------------------------------------~-- -~--~---~__--_-_____

b. Are you buying food stomps now? b* @ I [3 Yes, regularly

2 0 Yes, occasionally )

OP. PI)

----------------

3ONo

-------------------------------------------------------------~----------------~------

C. Wbot is the MAIM rooson you aren’t porticipoting in ‘ibe program?

” @ : # %nE:ugh money at the time

3 0 No transportation

4 c) Pride

s 0 Other - Specify

Notes

4B
!

l r

I

L

60
Medical History Questionnaire, Ages 6 Months-1 1 Years

HEALTH AND NUTRITION

EXAMINATION SURVEY II

and will not isclosed or re

to others for any purpose.

-Pounds

2. Wos -- born prematurely, that is, early or

not carried the full nine months?

-Ounces

1

ss(DK

1

@J 1 q Yes

f

2 0 No

I s=DK

8

3. How old was -0’ s mother when he was born?

40. How many children has -0’s mother ever had?

b. How many were born before --?

5. .How many of --‘s brothers and sisters weighed

less thon five and one-holf pounds at birth?

I

I 0104 .-Years old

I 99 q DK

1

I1 10s -

I

0 Children . 1 q One(6)

I 99 11 DK (6)

I

I

I 106 0 -Children

I

I

o 0 None

99 q DK I

I1 107 , Brothers and sisters

1

0 o q None

t 99mDK

1

6. How old was -- when he first sot up by himself? I

I0108' Months .

f 77 0 Doesn’t sit up yet

I

I ssnDK

I

7. How old was -- when’he first walked by himself?

80. Was -- breast fed at any time on a regular basis?

I

f 0103 Months

I

!

77 n Doesn’t walk yet

I 99 q DK I

I 110

I

0

1 q Yes

2q No

b. How old was -- when he stopped breost feeding? I

$iiJ ~-Months

I

77 q Sti II breast fed

I o 0 Less than I month

I 99 q DK

I

61
90. As a baby, was -- at any time, regularly fed

commercial milk or formula from a bottle?

i@ * 1 cl yes

I

1

2 q No

I 9 q DK >

VW

b. Was the type’of milk or formula used -

I .

t Yes No DK

Whole cow’s milk? . . . . . . , . . . . . . . . . . . . . . . . . . j@ 11 20 sl-1

Commercially prepared nonfat mi Ik solids? . . . . . . . . . I@ I( 20 9c.l

A soy bore formula?. . . . . . . . . . . . . . . . . . . . . . . .

I

I0115 '0 21 9cl

Commercially prepared milk or milk based formula? i@ cl cl 91. i** 1

Sped fybfand 1

Any other type? - Specify 20 90

10. How old wos -- when he first started eating solid f

or mashed foods, such as cereal or fruit? 1118 0 - Months

I

INTERVIEWER - Round down to nearest whole I

I

number of months. I

o q Less than I month

. 99 0 DK I

I

110. Does or did -- have any conditions he wos born i Yes No DK

with that involved his -

I

I I

I

Heurt?........,....................... I

Eyes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @I a 20 cl

Ears?................................. 1

I0ii1 cl 20 cl

Mouth or throat? . . . . . . . . . . . . . . . . . . . . . . . . . . [@ cl cl cl

I

Stomach or intestines? . . . . . . . . . . . . . . . . . . . . . @ cl 21 cl

I

Kidneys or urinary system? . . . . . . . . . . . . . . . . . . @ 11 cl 90

Muscles, bones, or joints? . . . . . . . . . . . . . . . . . . . ‘0 cl

I

2El cl

Brain or nervous system? . . . . . . . . . . . . . . . . . . . ;@ cl cl cl

Any other condition that he was born with?d l . l l . l . /o cl 20 cl

I

Specify

b. Would you soy - -‘s health in general is excellent,

very good, good, fair or poor? ,

i

I

I I

I@ 1 0 Excellent

I 2 0 Very good

3 0 Good

4 u Fair

s q Poor

I

120. Has -- ever occidentally swallowed any medicine,

pills, or poison?

I@ I q ëYes

t 2 q No

I

WI

I

9 0 DK

b.

c. Did this result in any SERIOUS damage? I 130 0 i IYes

f 2 q No (13) I I
1%. Has -- over had any bad accidents? piJ loyes

I 2 0 No

I 9 0 OK > WI

b. In the accident(s) - Yes No I

Warheburned? . . . . . . . . . . . . . . . . . . . . . . . . . . 18 10 20

I

Didhebreakabone? . . . . . . . . . . . . . . . . . . . . . . ;(i$ cl 20

I

Was he knocked unconscious? . . . . . . . . . . . . . . . . .

Anything else? - Specify

cl

21

I

c. Dem -- still have any effects of the accident(s)? i(@ 1 clI

2 q No (14)

I

I

I&. Has -- ever stayed overnight or longer in a

horpital for an illness or condition?

I

c. Has -- ever had on oporotion? i

I 0138 I q Yes

I

I

2 q No (15)

I

Ma. I8 -- unable to do some things because of o

condition ht has bothorod him for o long time?

I

b. What is iho condition? - Spoci$

c. In whot woy is -- limited? - Specify

d

I

Mo. How many times has -- had pneumonia?

‘@

I

- Times

I o q None (17) I

I

b. Does bo bavo it now?

st siu months, how many colds

. 1

‘0 .-

f

Colds

I o 0 None (18)

I

b. Does bo hove on. now?
180. During the past six months, how many times t

has -- had diarrheo? 1 0144 Times

I

I o q None(19)

b. Does he hove it now?

I

I(;;;;, 1 q Yes

I 2010

I

190. Some children l ot unusual substances. Does -- eat

clay, starch, paint, plaster, dirt, or any moteriol I

I 0146 i 0 Yes

that might be considered unusual? I

1

2 q No (20)

b. Is it -

I

f Yes No

I

Clay? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I@ ‘I cl

I

Starch? . . . . . . . . .* . . . . . . . . . . . . . . . . . . . . . .

I@ ‘cl

I

cl

Paint or plaster? . . . . . . . . . . . . . . . . . . . . . . . . .

I(r;(;> ‘cl cl

I

Dirt? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1~

I 0 I 0 cl

Any other material? - Specify

200. Does -- hove unusual trouble seeing at night

or in the dark? -

I

2010

I

9aDK

I

b. Do you have any reason to think that -- is

color blind?

1 153 0 1 0 Yes

I 2110

I

I

I

9 0 DK

c. Has -- ever had a test to see whether he is

color blind?

/@ 10 Yes

I

2010

I

9 0 DK

I

21. Has -- ever been treated for -

I

I

’ I

Yes No DK

Abnormal bleeding? . . . . . . . . . . . . . . . . . . . . . . .

Tuberculosis? . . . . . . . . . . . . . . . . . . . . . . . . . . .

I@ ‘cl 21 cl

$iGJ ‘cl cl cl

Any other chest or lung conditions? . . . . . . . . . . . . .

/o cl 1 20 cl

Congenital heart disease? . . . . . . . . . . . . . . . . . . .

I@ ‘cl cl BEI

Rheumatic heart disease? . . . . . . . . . . . . . . . . . . .

j@ cl 1 21 cl

Any other heart condition? . . . . . . . . . . . . . . . . . . . 1160 10 2cl 91

Diabetes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I

0

$iJ 'El cl cl

Epilepsy or convulsions? . . . . . . . . . . . . . . . . . . . . @ ‘cl 21 cl

Stomach or intestinal disorder, excluding

diarrhea or flu? . . . . . . . . . . . . . . . . . . . . . . . . . .

f

I@ ‘cl 20 cl

Liver disorder? . . . . . ; . . . . . . . . . . . . . . . . . . . .

1

1 164 0 1 q 21 cl

I

Thyroid diseose or goiter? . . . . . . . . . . . . . . . . . . .

Cancer or tumors? . . . . . . . . . . . . . . . . . . . . . . . .

54
220. Has -- EVER hod ony skin tests I

for allergies? ;@ i q Yes

I 2 q No (23)

I

b. Did -- EVER hove a positive I Yes No

reaction to - t

Trees? . . . . . . . . . . . . . . . . . . . . .

I

I 0168 ' q 2 q I

Gross? . . . . . . . . . . . . . . . . . . . . .

I@ ‘cl cl

Weeds? . . . . . , . . . . . . . . . . . . . .

I

1170 ‘cl cl

I0

Housedust? . . . . . . . . . . . . . . . . . I@ 10 20

Molds?. . . . . . . . . . . . . . . . . . . . .

I

r

I 172 0 1 q 20

Bocterio? . . . . . . . . . . . . . . . . . . . @ ‘cl 21 .

Foods? . . . . . . . . . . . . . . . . . . . . I@ 10 20

L

.

c. Has -- EVER had allergy shots? ; 0175 i q Yes

I 2 q No 1

d. Has -- EVER hod any reaction to on

allergy (shot/test) which was more

than just o swelling around the sides

lo1176 cl 1 Yes

I

of the (shot/test)? I

I

2 0 No

hod -

If “Yes,” ask 23b and c.

Asthmo? , . . .’ . . . . . . . . . . . . . . . .

Hay fever? . . . . . . . . . . . . . . . . . .

If “Yes,‘* to my conditions in 23a ask

23d, otherwise go to question 24. f

d. Wos the doctor -

I

I

Yes No

A Cenerol Practitioner? . . . . . . . . . .

I

I 0 183 10 20

I

An Internist? . . . . . . . . . . . . . . . . . @ ‘cl cl

I

An Ear, Nose and Throat Specialist?. .

; 0185 1 q 20

An Allergist?. . . . . . . . . . . . . . . . . I@ cl 1 4zl

Some other type? - Specify . . . . . . .

J

I1 0187 1 0 2 q

t

II

Notes I

f 188 ,O .

55
240. During the post 12 months, not counting colds or

the flu, hos -- FREQUENTLY hod trouble with -

Yes No

Wheezing? .............................. I@ I q cl

I

Stuffy nose? ............................ I@ ‘El cl

Itchy nose? ............................. jo191 q1 cl

Watery discharge from the nose? ............... ‘@ ‘I

I

21

Post nasal drip? ......................... $g ‘cl 20

Watery, itchy eyes? . . . . . . . . . . . . . . . . . . . . . . . !@ I q cl I

Itchyears? . . . . . . . . . . . . . . . . . . . . . . . . . l . . . I@ 10 d.zl

I

Sinus infections? . . . . . . . . . . . . . . . . . . . . . . . . . pJ ‘I 20

CHECK ITEM A

2 q Al I other (25)

b. Because of --’

mentioned,hove you EVER -

I

Given him medication? . . . . . . . . . . . . . . . . . . . . .

i

l198C '0 cl

Moved to a different location? . . . . . . . . . . . . . . . .

I

I 199 0I 0 cl

I

Installed air-conditioning, o humidifier i . or on air cleaner? . . . . . . . . . . . . . . . . . . . . . . . . . $iiJ ‘I cl

I

Tried to keep him away from the things thot I

seem to bring on the condition or make

it worse?. . . . . . . . . . . . . . . . . . . . . . . . . , . . . . .

t

I201 0 cl cl I

c. Do the (allergies/symptoms) you mentioned

bother -- in the - Yes No

Spring? . . . . . . . . . . . . . . . . . *. . . . . . . . . . . . . @ ‘cl 20

I

Summer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ ‘cl cl

Fall until frost? . . . . . . . . . . . . . . . . . . . . . . . . . .

I

;@ ‘cl cl

I

Foil after frost? . . . . . . . . . . . . . . . . . . . . . . . . . . f 21 I

.

d. Do the (allergies/symptoms) you mentioned

bother him - Yes No

Outdoors?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I

I@ I ! cl I

e. Do the (allergies/symptoms) you mentioned seem

to get worse in - Yes No

Dry weather? . . . . . . . . . . . . . , . . . . . . . . . . . . . . ‘@ ‘I

t

21

Rainy or humid weother? . . . . . . . . . . . . . . . . . . . .

l

[@ ëcl 21

56
1 24. Continued i

I I

Do the (allergies/symptoms)

is around -

bother -- more when he

Yes No

Gross?. . . . . . . ; . . . . . . . . . . . . . . . . . . . . . . .

I@ 10 20

Trees? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I

1211 Kl ,O 20

g. How old was -- when he first began having trouble I 212 0

-

Years old

with the (allergies/symptoms) you mentioned? I

o q Less than one year

h. Are there any things or places which YOU, NOT YOUR

DOCTOR, associate with making --‘s symptoms or

al Iergy problem worse?

i. Has -- EVER had a -

If ‘@Yes,” ask 24j.

I

I

; @ I \ Yes - Specify

4

1

r

I

2 0 No

I

I

,-bj. Does’-- have one now? ’

I

Yes No Yes No

Do+-pet? . . . . . . . . . . . . . . . . . . . . . . . . . .

I@*10 al cl cl

Cat for 0 pet? . . . . . . . . . . . . . . . . . . . . . . . . . .

I

,@,a cl cl cl I

.

250. Does -- now have any health problems that you I

would like to talk to a doctor about? I 216 1 0 Yes

I

0

No (26)

260. Has -- ever been tested for lead poisoning? i 0 Yes

2 0 No

s 0 DK >

(27)

b. How long ago was -- tested? -.-I----- - ~

I

; 218

I

0

Years

I 219 0

Months

I o 0 Less than one month

c. Did the results indicate that he had lead poisoning

or high lead?

i

, 220 1 cl yes

*!

0

2 0 No (27)

d.. Has -- ever been treated for lead poisoning? i

I @iJ 1 cl Yes

I

I 20 No (27) -

l . How long ago was -- treated? I

,222 0 .l Years

I

, 223 0-Months

I

I o 0 Less than one month

I

270. Does -- take any medicine regularly, not

counting vitamins?

i

I 0 221 1 0 yes

I 2 0 No (28)

I

28. Does -- now take any vitamin or i

mineral supplements? $5J clyes

!

2 0N o

57
KIDNEY

29. Has -- EVER had any kidney, bladder, or

other urinary problems?

I

I

I

; @ 1 cl Yes

f

I 2 q No (32)

300. Has -- EVER had any INFECTIONS of the

kidney, bladder, or urinary tract?

I

I 227 1 q Yes I 0

I 2 f-J No (31)

I

b. About how many times hos he had on

infection of the kidney, bladder, or

f

I urinary tract? I

I $3 -Times

1

4

c. About how many times did tbe infection(s)

I

involve the -

I

I

Kidney? . . . . . . . . . . . . . . . . . . . . . . . . . . . . ‘@

.

t

,-Times

I

Bladder? . . . . . . . . . . . . . . . . . . . . . . . . . . .

t

I 230

I

0

PTimes

Urinary tract? . . . . . ; . . . . . . . . . . . . . . . . . .

I

;@---Times

I

d. Did -- have fever and chills with any of I

the infections? I@

I

1 IYes

I

2 q No I l . For how many of these infections did he

take antibiotics or sulfa drugs? I

I 233

1.

0

,-,lnfections

f. For how many of the infections did -- see

a doctor?

I o q None

I

I

I

I 234 0-Infections (3 I b)

I

1

I o q None

310. Hos -- EVER seen o doctor for any kidney,

bladder, or other urinary problemf

b. Was the doctor -

I

I@

I

1 IYes I

I

2 0 No (32)

I

I

Yes No

I I

A General Practitioner? . . . . . . . . . . . . . . . . . .

t

,(&II cl

I

An Internist? . . . . . . . . . . . . . . . . . . . . . . . . .

io(o cl

I

A Urologist? . . . . . . . . . . . . . . . . . . . . . . . . . @cl 2cl

1

A Nephrologist? . . . . . . . . . . . . . . . . . . . . . . . I@&0

1

cl

Someothertype?-Specify 1

d

. . . . . . . . . . . . . . .

I

@ 10 20

1

I

,’ I

I
31. Continued I

I

c. Did o doctor l vel tell you that -- hod - I

f

I

i

I1 d. Does -- stil! hove the condition?

1

f

If “Yes, ” ask 3/d and e.

Nephritis? . . . . . . . . . . . . . . . .

Kidq stones 01 stones in the ureter?

Nephrosis? . . . . . . . . . . . . . . . .

Kidney infection? . . . . . . . . . . . .

Kidney obcess? . . . . . . . . . . . . .

Hydronephrosis?. . . . . . . . . . . . .

Bladder infection? . . . . . . . . . . .

Blodder stones? . . . . . . . . . . . . .

Urinary tmct infection? . . . . . . . .

Any other condition of the kidney,

bladder or urinary tract? Specify . .

d

cl

Yes

3l.l

cl

30

cl

cl

30

cl

cl

31

scl

No DK

cl cl

cl scl

41 cl

cl cl

40 so

cl 90

cl cl

41 cl

cl 90

cl cl

-f. Has -- EVER had any specie1 X-rays ) 261

of the kidney, bladder, OR urinary tmct? 1 0 1 q Yes

I

2 q No

e. How old was

-0 when the

condition

first occurred?

Years

0 242

0 244

0 244 -

0 240

0 250 -

0 2s2

0 254

0 256

0 258-

0

260 -

g. Has -- EVER been hospitolired overnight or longer because of ony trouble in

@ clyes

I

I

2 0 No his kidney, bladder, or urinary tract? ,

h. When was the lost time -- saw a

doctor for o kidney, bladder, or

urinary tract condition?

I

I@ -Years ago

I o 0 Less than I year ago

i. Has -- EVER been treated for a kidney, )

bladder, or urinary tract problem by -

I

Yes NO

Diuretics or pills to lose woter? . . j@ cl cl

Steroids such as cortisone

and prednisone? . . . . . . . . . . . . .

1

1 265 1 cl 2 cl

I

0

Antibiotics? . . . . . . . . . . . . . . . @ cl 20

I

Sulfa drugs? . . . e . . . . . . . . . . . i@ cl cl

Surgery? t . . . . . . . . . . . . . . . . . I@ cl cl

Medicines to reduce blood pressure?

I

$j cl 20

A special diet? Specify

)!**-•* I@ a cl

I

I

Any other treatment? Specify . . . .

ti

59
*

32. Has --’s mother, father, sisters or I

I I I I 9

I

brothers EVER had -

I Mother I

, Father I

1

I Sister , Brother I

I No

(Anyone cl se% i I I I I

I I I I I

I I 1

I I

I I

I Polycystic disease of the kidney? . l . . I 272 * 1 !

0

I I

20 1 30

I I

1 4lIl ' cl I I I 1 I

BOTH chronic kidney disease AND

nerve deafness in childhood?. . . . . . . .

Kidney or blodder stones?. . . . . . . . . .

High blood pressure?. . . . . . . . . . . . .

330. Did o doctor ever tell you’thot -- hod ony

of the following in his urine -

/f “Yes,” ask 33b and c.

Protein or albumin? . . . . . . . . . . . . Times

Blood? . . . . . . . . . . . . . . . . . . . .

I -

I@ cl 20

lo

280 -Times

I

Sugar? . . . . . . . . . . e . . . . . . . . . . t(2’iii) cl 20 p+--- Times

I -

Anything else? - Specify xiii3 cl cl I@-Times

c. When did it LAST

happen?

0

270 -Years ago

0

281 -Years ago

0

204 -Years ago

0

207 -Years ago

34a. Has -- ever had onemia, sometimes called

“tired blood” or “low blood”?

[ 288

0

I IYes

I1

2 q No

>

(Check Item 6)

I

s 0 DK

\

b. How long ago? ‘@ Years

I

I

0 q Less than one year

99 0 Don’t remember

c. Did a doctor tell you that -- had anemia? 1 290 ‘0 I 0 Yes

I 2 q No (Check I tern 6)

d. Wos it coused by -

i Yes No DK

Poor diet? . . . . . . . . . . . . . . . . . .

I

@J cl 20 cl

Loss of blood due to accident or injury? @J cl 20 cl

llhss? . . . . . . . . . . . . . . . . . . . .

I

I@ cl cl cl

-

Surgery? . . . . . . . . . . . . . . . . . . . . I@ a 2cl cl

Something else? - Spec/fy isi3 cl 20 cl

l . Was -- treoted for this condition by a

doctor? ‘@

I

I q Yes

I

2 0No (Check /tern B)

f. Wos the treatment - f Yes

Better diet? . . . . . . . . . . . . . . . . .

I

,@ cl

Iron pills?. .................. [@ cl

Iron shots? .................. I@ cl

Vitamin pills? I................. I@ a

Vitamin shots? ................ I@

Blood transfusions? I

I 111

............ I202 ‘cl 0

Anything else? - Specify ka 11

No

cl

2cl

cl

20

21

cl .

21

g. Is -- rtill being treated for it? i

,304 0

I q Yes

I

I

I

2 q No I
CHECK ITEM‘ B

2 0 3 t years (35)

350. Has -- ever had a running ear or any discharge from

his ears, not counting wax in the ears?

b. How often has -- had this problem? I

I 307 0

1 0 Once only ’

I 2 q Twice

I

t

3 m 3 or more times

I

I

s~DK

c. Was this his left ear, right ear, or both ears? ’ 308

f

0

.

iq Left

1

2 q Right

1

3 0 Both

I ooDK

d. Did -- see a doctor because of the condition?

I

I@ I q Yes

I zrJ4lNo

I

3150. Did a doctor ever tell you that -- had on I@ i (1 Yes

ear infection? I

2 0 No (37)

1I 1

b. How many times has -- had on ear infection? I

;@iiJ Times

I /

c. For how many separate infections did a doctor

- prescribe any -

I

I

I

Oral medicine (PiI/s or Iiquid medicine)? . . . . . . . . I 312

I

0

-Jnfections

Shots or injections? . . . . . . . . . . . . . . . . . . . . .

I 313

I

0 -Infections

Ear drops or other external application? . . . . . . . .

I 0. 314 - Infections I

d. Did o doctor ever treat --‘s ear infection by

placing tubes in his ear?

t suDK I

37a. Has -- ever had deafness or trouble hearing with

one or both ears? Do not include any ptobloms

which losted just o short period of time such OS

during a cold.

b. Did -- ever see a doctor about it?

.

c. How old was -- when his hoaring trouble wos

first noticed? ;@g - Years old

d. Since this trouble began, has it gotten worse,

gotten better, or stayed about the same?

.

jo ‘cl Gotten worse

f

2 m Gotten better

I 3 q Stayed about the same

e. Wos --‘8 hearing trouble or deafness coosed by -

An ear infection? . . . . . . . . . . . . . . . . . . . . . . .

A loud noise, such OS that from mochinory,

gun fire, blosts. or explosions? . . . . . . . . . . . . . .

Ear surgery? . . . . . . . . . . . . . . . . . . . . . . . . . .

Anearinlury? •......~.~..~~....~..~..~.

Was he born with it? . . . . . . . . . . . . . . . . . . . . .

Some other touse? - Specify

61
380. How would you rate --‘s hearing in his RIGHT ear - I

good, fair, poor, or is he deaf? 1 326 í q Good

I 0

I

2 q Fair

.

3 0 Pow

4 m Deaf

b. How would you rote --‘s hearing in his LEFT ear -

good, fair, poor, or is he deaf?

1 u7 , q Good

I

0

t

2 q Fair

I

3 q Poor

I 4q Deaf

c. Has -- ever had an operation for an ear problem? i

I 328 0

i IYes

I

2 q No (38e)

d. Was it -

I Yes No OK

An incision of the ear drum? . . . . . . . . . . . . . . . .

I

I@ ‘cl cl gel

An operation on the stapes, one of the bones I

in the middle ear? . . . . . . . . . . . . . . . . . . . . . .

‘@ ‘El

A mastoidectomy? . . . . . . . . . . . . . . . . . . . . . . .

I

21 cl

$iJ ‘I 2El so

Some other operation? - Specify . . . . . . . . . . . . .

d

‘0 ‘I

I

21 gel

I

e. Has -- ever had his hearing tested? j (GJ ’ cl yes

t

2 0 No (38h)

f. How old was he when his hearing was LAST tested? i

/o Years old

g. Was his hearing normal? I

( @ ’ El Yes

I

1

2 (J No

h. Has -- ever used a hearing aid? i

I @ 1 cl Yes

I 2 q No (39)

i. Which ear? .

iI

I

0 337 1 0 Right

2 q Left

I

I 3 0 Both

j . Does - - now use a hearing aid? I

I 0 338 i 0 Yes

I 2 0 No

390. Has - - ever had any difficulties with his speech 1

which lasted for 6 months or longer? I@ i 0 Yes

f 2 0 No

b. Has a teacher or any other person mentioned to you

that -- might hove a speech problem?

i

I 340 1 0 Yes

f

0

I

2 0No

c. Does -- now have any spekch difficulties? i

) @ i 0 Yei

I

I 2 q No

CHECK ITEM C

No to 39 a, b and c (40)

2 0 All others (39d)

62
39. Continued ;

d. Was the speech problem -

I Yes No

Stuttering?. , . . . . . . . . . . . . . . . . . . . . . . . . . . . ; 343 1 cl 0

cl

Stammering?. . . . . . , . . . . . . . . . . . . . . . . . . . . .

I

I

0

344 1 I 21

Lisping?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ;@ ‘cl 20

Hoarseness? . . . . . . . . . . . . . . . . . . . . . . . . . . . ‘@ ‘0

I

cl

Difficulty saying certain sounds?. . , . . . . . . . . . . . ;@ ‘I cl

Some other problem? - Specify @ ‘cl

I

21

I 1

8.

f. Did -- see a doctor or speech specialist about it?

g. How old was -- when he first began having

speech problems?

I@I

I q Yes

I 20 No

/ 1

I

I 350 0

old Years I

h. Has -- ever had any training, therapy or other

treatment for his speech problem? ‘0

I

I 0 Yes

I

2 0 No (390)

i. Was the specialist who gave the speech therapy a - Yes No

I

Speech therapist? . , . . . . . . . . . . . . . . . . . . . . . . 18 ‘I 20

Neurologist? . . . . . . . . . . . . . . . . . . . . . . . . . . .

I

I 353 ’ cl 20

Psychologist? . . . . . . . . . . . . . . . . . . . . . . . . . .

I

0

I @J 1 II 20

I

I

Some other type? - Specify i

1 355 ’ cl 0

20

I

I

I

j. Altogether how long did this therapy last? I

I 356 0

‘\

1 Months

I

f 357 0

Years I

I

k. How old was -- when he began this therapy? I

$9 Years old I

I. Was the therapy provided by his school?

1

; 0 359 I q Yes

1 2 0 No

m. Is -- now receiving therapy for his speech problem? i

1 @J 1 0 Yes (390)

II 2 0 No

n. What was the MAIN reason for ending speech therapy? I

I@ I 0 Problem corrected

1

2 q Could not afford it

I 3 q No further improvement expected 1

4 0 Other - SpeciQ

0. Is -- now enrolled in any special education class

at school?

63
400. Has --’ s mother, father, sister(s) or.brother(s),

either living or deceased, ever had a speech

I 363 1 0 Yes

I 0

problem? * I 2 q No (40e) I

b. Was it his -

/f “Yes,” ask 40~.

Mother? . . . . . . . ‘. . . . . . . . . . . . . . . . .

Father? . . . . . . . . . . . . . . . . , . . . . : .

Sister? . . . . . . . . . . . . . . . . . . . . . . .

Brother? . . . . . . . . . . . . . . . . . . . . . .

I

I

1@

/@

1@f

I 347 I 0

Yes No

‘cl 20

‘cl 2El

‘El cl

cl 211

If “Yes, ” to brother or sister ask 40d.

d. How many of --’ s living brothers or sisters

have ever had a speech problem?

I

I@

I

-Brother(s)

I 369 0

Sister(s) I

c. Has --’ s mother, father, sister(s) or brother(s),

either living or deceased, ever had a hearing

I 370 , q yes

problem? f

0

I

2 q No (41)

I

f. Was it his - i Yes No

Mother? . . . . . . . . . . . . . . . . . . . . . . .

t

I371 ‘cl 020 I I

Father? . . . . . . . . . . . . . . . . . . . . . . . i@ 1 !-J 20

Sister?. . . . . . ; . . . . . . . . . . . . . . . . . @io cl

Brother? 1. . . . . . . . . . . . . . . . . . . . . .

I 374 ’ 0

,O cl

410. How old was -- when he spoke his first

rea I word?

f

1 375 1 0 Under I year 0

1 2 q I-M years

I

I

3 q I B-2 years

t

I

4 q Over 2 years

b. How old was -- when he started to use

sentences?

I@ I q Under I year

I

2 fl-2 years

I

3 q 2-3 years

I

4 0 3-4 years

I

I

5 q 4 years or older

-~

c. When -- talks, how well con you ond others 1

who know him well understand him? :

(Mark one box and stop) t

No problem understanding . . . . . . . . . . .

A little trouble understanding . . . . . . . . .

@‘O

I

Moderate amount of trouble understanding. . I

A lot of troublesunderstanding . . . . . . . . . i 4 q

Cannot understand him ot all . . . . . . . . . 1

v

so

d. When -- taIks,how well can strangers or i

people who do not know him well understand I

him?

(Mdc one box and stop)

I

No problem understanding . . . . . . . . . . .

f

A little trouble understanding . . . . . . . . .

@J’O

1 2 q

Moderate amount of trouble understanding. . 1 3 p

A lot of trouble understanding . . . . . . . . 1 4 q

Cannot understand himaat all . . . . . . . . . 1 cl

e. B&fore laarning English,did -- speak any

other language a good deal of the time?

@ ‘(Iyes

i

2 iNo

I

64
41. Cent inued

f. Does -- now speak any language other

than English?

I

I@J 1 0 Yes - Specify

I

2 q No (Check kern 0) I . I

g. Does -- now use (this/these) other language(s) -

f

(Mark one box and stop)

I

All of the time? . . . . . . . . . . . . . . . . . . . . . . . @j)(o

Most of the time? . . . . . . . . . . . . . . . . . . . . . . I 2 q

Some of the time? . . . . . . . . . . . . . . . . . . . . . .

I

, cl

Very little of the time? . . . . . . . . . . . . . . . . . .

CHECK ITEM D

2 q 6 t years (42)

420. Does -- have trouble with recurring or

persistent cough attacks?

i

I 383 1 q Yes I 0

I 2 q No (42~)

I

I

I 7

b. Has -- been bothered by such coughing attacks

during the post year? @ ayes

I

2 0 No

I

c. During the past 3 years, has -- had a period of i

increased cough and phlegm lasting for 3 I@ ’ cl yes

consecutive weeks or more? I

2 q No I

430. Has -- ever seen a doctor about a lung or

chest condition?

I@ ’ cl Yes

I

2 q No

f 91DK >

(46)

b. What did the doctor say the condition or conditions DATA PREPARATION USE ONLY

/ -

affecting his chest or lung were? - Specify

d ’

(ICDA Codes)

I

I

0 387 0 388

0 389 0 398

c. How old was -- when he first hod

the condition(s)?

44. About how many days of school has -- missed

during the past 12 months because of his . . . ,

(not counting colds or the “flu”)?

i

@ . -Years old

I

I

o q Less than I year old

1 392 I 0 None 0

I

20 I-4days

I

. 3 q 5-9 days

4 q 10-M days

s 0 IS-19 days

6 q 20-29 days

7 q 30 days or more

45. Has -- ever stayed in a hospital overnight or longer ;

because of a lung or chest condition? I

0

393 1 cl yes

I

2 f-J No

1 1 46. Did a doctor or other specialist ever tell you that -- hod - I Yes No

Polio or paralysis? . . . . . . . . . . . . . . . . . . . . .

i@ d 20

Cerebral palsy? . . . . . . . . . . . . . . . . . . . . . . .

I@ ‘cl 21

Any type of brain damage? . . . . . . . . . . . . . . . .

‘@ 11

I

20

Vision trouble? . . . . . . . . . . . . . . . . . . . . . . .

;@ cl 21

An emotional problem or disturbance? . . . . . . . . .

I@ cl cl

Hyperactivity? t

. . . . . . . . . . . . . . . . . . . . . . .

,@ ‘cl cl

. Mental retardation? . . . . . . . . . . . . . . . . . . . .

im cl cl
CHECK ITEM E

I q 6t years (47)

2 a Under 6 years (48)

470. Is -, now attending school? i

I 102 0

i 0 Yes

I

2 d No (48)

I .

b. What is the nome ond oddress of the school -- goes to? I NIllVW

I‘

I

M&es8 (@NR~W dmeet)

(19)

480. Is -- ottending o school or preschool program

of any kind?

i

I 403 0

I q Yes

1 2 0 No (SO)

b. Is it o -

I Yes No

Nursery? ............................ 25

Kindergarten? ......................... 25

Heodstort? ........................... 25

Doycore center? ........................ 20

Some other school or preschool progrom?d ....... 25

490. Is there o lunch program at the (school/. . .)

thot -- ottends? ‘@

I

i L-_J Yes

I

2 q No

> (494 I suDK

b. How mony times o weok does -- usually participate? ;

@-Times

1

0 0 None (49d)

c. How much does -- pay for his lunch per day? f1 0 411 Cents

I 0 0 Free

d. Is there o special milk program ot the (school/. . .)

thot -- attends? f 12

f 0

i 0 Yes

I

2 q No

I sf-JDK

VW

I

4

l . HOW many times o week does -- usuo!ly participate?

j@-Times

I . o 0 None (49g)

1

f. How much does --’ pay for his milk per day? I

I

0

414 Cents

I

I

o q Free

.

g. Is there o breakfast program ot the (school/. . .)

that -- ottends?

I

f 0

41s 4 IYes

I

2 0 No

(50)

I 9 q OK

h. How rnony times o wick does -- usually portiCipote? f

$$-- Times

f o q None(SO)

.

i. ‘How much does -- poy for his breakfast per day?

I

I

I

0

417 I Cents

I 0 q Free
b

500. How much dms --‘s mother weigh?

I

I

I@-Pounds

I 999 [ OK

I

b. How tall is she?

1

I

I 419 0

Feet

I

$ij

I

,-,lnches

I 999 q OK

. 1

510. How much does --‘s Whet weigh? I

18 Pounds

I 999 q OK

1

b. How tall is he? I

r@ Feet

I

$i&PInches

I

sss 0 OK

b. Respondent’s relationship to child covered by

this questionnaire. I 0 Mother

2 m Father

3 0 Sister or brother

4 0 Other - Specify

I 0 Another SP available for interview

CHECK ITEM F

(Next’Meciicol History Questionnoire)

2 0 No other SP available for interview

(Page 3 of the Household Questionmire)

I

Notes

CHECK ITEM F

I 0 Another SP available for interview

(Next’Meciicol History Questionnoire)

2 0 No other SP available for interview

(Page 3 of the Household Questionmire)

Notes
Medical History Questionnaire, Ages 12-74 Years

FORM HES-32

( l-23-76)

U.S. DEPARTMENT OF COMMERCE

BUREAU OF THE CENSUS

ACTING AS COLLECTING AGENT FOR THE

U.S. PUBLIC HEALTH SERVICE

MEDICAL HISTORY QUESTIONNAIRE

(Ages 12-74 Years)

HEALTH AND NUTRITION

EXAMINATION SURVEY 11

NOTICE - All information which would

permit identification of the individual

will be held in strict confidence, will

be used only by persons engaged in

and for the purposes of the survey, and

will not be disclosed or released to

others for any purpose.

o. Name (First, middle initial, last) b. Sex c. Deck No. d. NCHS Sample No.

I 0 Male

2 [1 Female ’ 020 0100

e. Segment No. f. Serial No. g. Line No. h. Age i. Date of birth _ Month !Dar ; YWir

. ! I

I I

1. Would you soy your health in general is excellent, ’

very good, good, fair, or poor? i@ i 0 Excellent

I

I

2 0 Very good

I 3 0 Good

I

I

4 0 Fair

I

I

5 0 Poor

2. Do you now have any health problems that you 1

would like to talk to a doctor about? 1 (ii?J 10 Yes

I

I 2 0No

I

30. Are you now taking.any medicine regularly, not

counting vitamins? I (+GJ i u Yes

i

I 2 u No (4)

b. What is the medicine for?

40. During the past 12 months how many different

times did you stay in a hospital overnight

or longer?

b. For whot condition(s) were you in the hospital -

the first time?

‘@

:

- Times

o 0 None (5)

DATA PREPARATION USE ONLY

010s -

the second time? 0106

A

the third time? ,O107

\ C. How long were you in the hospital -

I

the first time? . . . . . , . . . . . . . . . . . . . . . . @ -Days

1

the second time? . . . . . . . . . . . . . . . . . , . . @ -Days t .

I

the third time? . . . . . . . . . . . . . . . . . . . . _ .

~.. -Days

68
5. Have you ever lived in a household with a person

who had active tuberculosis?

I

I

2010

I 9 0 OK

NUTRITION

60. Do you have an illness or condition which interferes

with your eating, digestion, or appetite?

b. What is the illness or condition?

7. Do you have trouble biting or chewing food? 1

F O

Yes

I

2010

8. Do you avoid eating any of the following foods because

1

I

they disagree with you -

I

I

Yes No

Milk? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @I 10

i

20

Fats or fried foods? . . . . . . . . . . . . . . . . . . . . . . 1

Green vtgeta bles? . . . . . . . . . . . . . . . . . . . . . . . .

? n

cl

@ 10 20

Seafood? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Any other foods? . . . . . . . . . . . . . . . . . l . 20

69
~~~~_~~

PO. Hos a doctor EVER told you that you had -

‘,

I

If “Yes,” ask 9b and c.

I

I

I

I

I r

I Yes No

Arthritis? ...................... /o, ‘0 20

Gout?. ........................ /@ 10 2(

Chronic bronchitis?. ............... j8x ‘cl cl

Emphysema? .................... I@ 10 2(

Tuberculosis? ................ j@J* 10 20

_________________-----~-------- _I --------------.

Rheumatic fever ? ........... ..... i@* ‘0 20

Rheumatic heart disease? ........... /@* 10 20

Heart murmur? ................... i@* 10 20

Heort failure? ... ...............

Heart attack?

p* ‘cl 20

................... I 141 cl I 0 2 q I

_----s--v_ _ - - - - - _- -- - _____________ --._----------we.-

Any other heart trouble? ........... ,i@* ‘0 20

Hardening of the orteries? ........... j@ 10 20

A peptic, stomach, or duodenol ulcer? ... /@* ‘0 cl

Recurrent or chronic enteritis? . . . . . . . . i@+ ‘0 20

Ulcerative colitis? . . . . . . . . . . . . . /@* ‘0 20

___-------e--------v---------- ---- r

-----------

b. Do you still have . . .?

Yes No OK

Spastic colon or mucous colitis? ...... /o* ‘cl 20

I

Gallstones? .................. ;@* ‘cl cl

Hepatitis? ................... /@* ‘cl 20

Yellow jaundice? ................. ;@ * I q 2 0

Chronic cough? ................ $iiJ* lcl 21

----------------------- _____ -- -.----e--------J lPleurisy?

! e

...................... I@* ‘Cl 20

Low blood pressure? ............. i@, ‘cl 20

Cotorocts? .................. I@* ‘0 20

Gloucomo? ....... ............. @* 10 211

Thyroid disease? ................. '8 10 20

------ - ..- --.--------.- - - -.- - . -_ --- ; __ _ _ 2 _ __ _ -_ ._ _- - - - - -

Polio or paralysis? .............. /@* ‘0 cl

Hiotus hernio of the diaphragm?. ...... /8* ‘0 2)

Goiter? ..................... . /@* ‘0 20

Cancer? .......................

Benign tumor, growth, or cyst?

@* ‘0 20

. (Except fat or skin; not cancerous) ..... I@* 10 20

30 40 90

...........

.

............................................................................................................. ..~..~.:.:.:::::::::::::::::::::::::::::~::::.:.:.:.:.:.:.~ : .... :.:.:.>t+z.:.:.:.:.:. .............

..................... . . . ,.:.~:.:.:.:.:.:.:.:.~~:.:. . ‘.‘.‘.‘.‘.‘.‘.:.:.:.:.:.~:.:.:,::::::::::~::::

. . ...‘z.~~:.~:.:.:.:.:.: ......................... ...... ..~.~.~.......~...~.....‘.........’.~. .............. . ......... .

............................................... .................................................. ....................... . . ... . ... . . . . :.:.

......................................... :A’.’ . . . . . . . . . . . . .... ... ............... .............................. ..... .................. . . . . . . ........................................y ... ..................................................................... .5:.:.~:.~~:.~: ............... .

,‘r.-.-:.v.:.‘.: :.:.:.:.:...:.:.:.: .:................................................................. ............................................................ ................................................................ , . ... . . . .

.

30 a 90

.......... .......................................... ................ :.:.:.:.~:.:.~:.:.:.:.:.:.:.~:...:.:.:.:.~:.:.~~~~~:.:...:.:.:.:.:.:.:.:.: .~~:.~:.:.:.~:.~:.~.:.:.:.:.:.:.~:.:.:.:.~.:.~:.~:.: .................................... .. . .. . . . .. .:.~:.:.:.:...~:.:.:.~:.~:.:.:.:.:.:.:.:.:.~.:.:.~~.:.~:.:.:.:.:.:.:.~:.:.:.:.:.~~:.~:.:.:.:.:.:.:.:.:.:.: ~:.:.~:.~~~:.:.:.:.~.:.:.:.:.:.:.:.:.:.:.: ......................: : :: : : : : ; : : :.:. ..:‘:‘:‘:.:.:‘:.:.: .:.:.~:.:.::::::::::::::::.:.:.~~:.~:.~~:.~:.~~~:.:. .......................... .............

.... .................................. :.>:.: : ................... .:.:.~~:.:,~~:.:.~.:.:.:.:.:.:.:.~.:.~:.:.~~:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.~~.:,~:.:.:.~:.:.:.:.:.:.:.:.:.: .:.:.‘.‘.:.:.:.‘.:.:.:.~.:.:.:.:.:.:.:.:.:.:.:.:.:.: :.:.:.~:.:.:.:.:.:.:.:.:.:.:.:...:.:.:.:.:.:...~:.:.~:.:.~~~:.:.~~:.:.:.:.:.:.:.~.~.~.:.:.:

30 40 90

_____------ ---------

cl cl go

30 cl 90

30 40 90

30 40 go

......... . . . . * :.:.:.:+:. .......................... ............

.................................. ... . . . .:.>>>. .............................

..:.~:.:.:.~:.~:.:.:.:.:.:.:.:.:.~:.:.:.:.:.:.:.:.:.:.:.:.:.:.~:.:.~ ............................................................................. ............................................................................................................................ :::::::::::::::::::::::::::i::::::::::::~.:.:,:.:.:.::..:.:.~:.:.:,:.:.:.:.:.:.:.:.:.:.:.:

........................................ . . . . . . . . ................................................................. ............................................................................ ............ . . . . . . .. . . . . . . ........................................................................................................................................... ...... ............................................. i

.~.~.~‘.~.~........‘...‘...‘.....~.~~.~.~...~ ................................................................................ -__-------__ _____ - -

30 40 90

.. . . . . .. . . . .* ..... . . .. . . . .. . ... .... ... ... . . . ..... . ...... ....* ...* . . ... .. .. . . . .. . .. ... . .. . . . .......................... . . .......... * . .... . . . . . ... * ...... .. ..‘.......:.:.:.:.:.:.:.:.~.:.:.:.~~~~~..:.:.:.~.: . . .:.:.:.~.:.:.:.:f.:.~~..~~~.:.:.:.:.:.:.:.~~:.:......................... >>:.:.:. ............. ...... . . . . . ... . . . ........... . . . . . . . . . . . . . .

.. . ... .. . . . . .. . . .. . . .. . . . .. . . . .. . . .. . . . .. ‘.:.:.:.~f:,~.:.:.:.:.:.:.~ ........ . . ..... . .... * .... . .. . . ....................

. . ..... :f.:.:.:.:.:.:.:.:.:.:.~:.~~~~:.:

.......................

...........

................. ....... ..r,..........:.......: .................................... .........

............................... ..................... . :.:.f:.~.~:.:.:.:.:.‘.:.:.: ...................... >>>>:.z::::::::;.:.:.:::::: 2 :::: ::::. . . . . . .:::::::::::::::::R::::::::::~~:.:.:.:.:.:.:.~.:.:.:.:.~.:.:.: . . . . . . . . ..... . .:s.:15::.::.:.:.:.:.:.:.~~~:.: .:. ............... .................................................... ......................................... . ,

30 40 9 0

30 40 90

3 d 40 9.0

-_____---___-------- I

cl

cl

30

a

cl

----

30

31

30

30

30

--_

30

‘3 0

31

30

30

---

---

40

40

cl

40

cl

----.

cl

40

40

40

40

_-

40

40

40

40

40

---

90

go

90

c. How many

years ago

did you first

have it?

4

0124 -

0126 -

0128 -

0130 . 0132

0134 -

0136 ~-

0138

0140 -

0142 -

0144 -

0146 ,-

0148 -

0150 -

0152 -

r>L-154 -

0156 --

0158 -

90 ~

90

90

- - -- -

90

go

cl

go

90

3168 -

>J7J -

0

___-

172

--------

-

c7 174 -

0176 -

0178 ,-

0180 -

0182 -

70
9. Continued

a0 Has a doctor EVER told you that you had -

If “Yes,” ask 9b and c. r, b. DO you still have . . .? c. How many

years ago

did you first

have it?

\

Yes No Yes No OK

Trouble with blood not clotting properly? . . . .

I

f 183 0 ..+ ‘cl cl 311 4( 91 @-

Loss of blood from stomach or bowels? . . . . , . i@* ‘cl 2u 3c.l cl 91 @-,

Nervous breakdown? . . .

~~.~.~.~.‘.‘.‘.~.‘.-.~.~.~.~.~.~.~.~.~.~,~ . . . . . .:..: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~.~.~...~.~.~.......~.~.~.~.~,.,........... . . . . . . . . . . . . . .

. , . . . . . . . . . . .

[@ 1 n 21 ,iiiiiiiiiiiijiiiiiiiijiiiiijiiiiiiiiiji 188 ,......~.......5..................... .. . . . . . . . . .. . . . .. . . .. . . . .. . . .. . . . . . . . . .. . . . .. . . .. . . . .. . . . . . . . . ...~.~.~.........~...~...~.~.~.~...~.~.~. ,‘.i5................................... . . . . . . .._. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~.~.~.............~.~.~.~.~.~.~.~.~.~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~ 0

Neck injury? . . . . . . . . . . . . . . . . . . . . 1@* ‘I-J 2) 3l-J 4( 90 @,-~

Back injury? . . . . . . , . . . , . . . . . . . . I@* ‘cl 21 31 cl gel @-

lOa. Have you EVER had anemia, sometimes called I

“tired blood” or “low blood?” @J 1 IYes

I

2 0No

I

I

9 f-J OK >

(1,)

b. How many years ago did you first have it?

I

I

i@ Years

I o m Less than I ye&

I

I 99 0 Don’t remember

I

c. Did a doctor ever tell you that you had anemia? @ inyes

I

I

2 0 No (I I)

I

d. Was the anemia caused by -

I Yes No OK

I

‘P oor diet?. . . . . . . . . . . . _ . . . . . . . . . , , . ip& ‘D 20 go

(Ask only of females 18t)

Childbirth? . . . . . . . . . . . . . . . . . . . . . . . .

(Include sti/Ibirths, miscarriages and abortions)

1@ ‘cl 20 91

I

Loss of blood due to an accident or injury? . . . i@iiJ ‘cl -20 cl

Illness? . . . . . . . . . . . . . . . . . . . . . . . . . /@ ‘cl 21 91

Surgery? . . . . . . . . . . . . . . . . . . . . . . . . . . @i-J ‘I 21 91

Any other cause? - Specify $iGJ ‘0 20 cl

e. Were you treated for this condition by a doctor? /@ ayes

I

!

2 0No (I I)

f. Was the treatment you used -

I

I Yes No

I

Better diet?. . . . . . . . . . . . . . . . . . . . . . . . @J I 0 21

Iron pills? . . . . . . . . . . . . . . , . . . . . . . . . :@iJ ‘cl 20

Iron shots? . . . . . . . . . . . . . . . . ! . . . . . . . @ ‘0 20

Vitamin pills? . , . : . . . . . . . . . . . . . . . . . &i$ cl cl

Vitamin shots?. . . . . . . . . . . . . . . . . . . . . . I@ 1lJ 20

I

Blood transfusions? . . . . . . ,. . . . . . . . . . . . @ ‘Cl 20

Any other treatment? - Specify :@iJ ‘cl a

I

g. Are you still being treated for this condition?

71
1 lo. Do you cot clay, starch, or ony materials

which might be considered unusual?

@ij lOYes

I

2 0 No (12)

1 b. Which - No

Cloy?. . .I. . , . . . . . . . . . . . . . . . . . . . . . . . .

*cl

Starch?. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20

Some other material? -Specify

*cl

120. Are you on a special diet?

b. Wos this diet ordered by a doctor?

$j ‘ayes

I

I

2 0 No (Check I tern A)

$iiJ lOYes

I 2 0 No

CHECK ITEM A

130. Have you smoked ot IeaSt 100 cigarettes during

your entire life?

@ 10 18+ (13)

; 2 0 Under 18 (14)

$iiJ ‘CmS

I 20 No (l3h)

b. DO you smoke cigarettes now?

I

c. On the averoge, how many a day do you smoke?

I

;@ -Cigarettes per day (l3e) I

d. How long has it been since you smoked cigarettes

fairly regularly? /o .-Years (l3f)

I

I

77 I_I Under l ye&

I 98 0 Never smoked cigarettes regularly (131)

I

I 99~DK

e. On the average, how many cigarettes o day

I

~ were you smoking 12 months ago? @ --Cigarettes per day

I

98 0 Did not smoke

I 99 u DK

f. During the period when you were smoking the

most, about how mony cigarettes o doy did you

usually smoke?

jo Cigarettes per day ,

I 99ODK

9. About how old were you when you first started

smoking cigarettes fairly regularly?

!

; 224

I0

Years old

I

98 0 Never smoked regularly

I 99nDDK ,

I

h. Do you smoke cigars now?

i. About how mony cigars a day do you smoke? ;

;@ -Cigars per day

i

I

L

(IF LESS THAN 7 PER DAY)

I

I

I

98 03 to 6 per week

I

I 99 0 Less than 3 per week

j. Do you smoke o pipe now? 10 ayes .

I

I

2q No (14) I

k. About how many pipefuls of tobacco o day i

do you u~sually smoke? ’ @ ,-Pipefuls per day I

$-f/F LESS THAN 7 PER DAY)

7 7 03 to 6 per week

98 ll Less than 3 oer week

72
.

v

140. Do you drink coffee?

b. On the overage, how many cups or gl-asses a

doy do you drink?

c. Do you usually drink decaffeinated coffee or

regular coffee?

1

f

;@ -

Cups or glasses

t o 0 Less than one per day

ë0123’ q1 Decaffeinated

I

2 q Regular

I

, 3 0 Both

d. Were you EVER advised by a doctor to use

decoffeinoted coffee? (For example, Brim,

Deaf, or Sanka) I

I

I 2010

e. Hove you EVER been advised by a doctor to stop

drinking regular coffee?

I

j@ ’ cl yes

1

I

2010

150. Do you drink tea? ;

I 234 ’ 0 Yes

I0

t

2~No(lSc)

b. On the overage, how many cups or glosses

o day do you drink?

c. Have you EVER been advised by a doctor to stop

drinking tea?

i

I@I

,-Cups or glasses

f o q Less than one per day

j@ 1 q yes

I 2rJfIjo

160. During the past 6 months, did you use any aspirin

or aspirin-type pills? jo i OYes

I

I 2q No (I 7)

b. On the average, do you use these pi Ils one or more

times per week?

s ;

II2aNo

17. In things you do for RECREATION, for example,

sports, hiking, dancing, and so forth, do you get

much exercise, moderate exercise, or little or

no exercise?

I;@ ‘1 Much exercise

I

I

2 0 Moderate exercise

I

I

3 q Little or no exercise

18. In your usual day, ASIDE FROM RECREATION,

are you physically very active, moderately

active, or quite inactive?

[@ 10 Very active

; 2 0 Moderately active

I

I 3 q Quite inactive

. 190. What is the most that you have ever weighed? f

(Do not include the times you were pregnant.)

$jFPounds

I

b. How old were you then?

I I

I

I10242 ,-,Years old

Notes

73
CHECK ITEM B

>

@ 10 18-t (20)

I

I

2 0 Under 18 (Check Item D)

200. What is the least you have weighed since you were 18?

I 0244 Pounds I

b. How old were you then?

I@- Years old

I

CHECK ITEM C 2 0 Under 25 (Check Item D)

21. About how much did you weigh when you were 29

CHECK ITEM D

220. How many living children do you have?

CHECK ITEM E

I

I(7249 Children I

iI o 0 None

22b. How many children have you EVER had? t

(iii)- Children I

I -

I

I

o 0 None (23)

c. How many of these children weighed 9 or more

pounds at birth?

I

j@-Children

I

I

o 0 None

230. About how tall are you without shoes?

I@- Feet

I

.O1254 -Inches

I I

b. About how much do you weigh without clothes

or shoes? I

@-Pounds

240. During the past 6 months, have you lost any

weight without trying to?

@ ’ 0 yes

I

I 2 I3 No

I

9 0

>

DK (25)

1 b. About how much weight hove you lost? I

I

18 -Pounds

I 1 !

25a. Do you have any reason to think that you

are color blind?

@ ; E ;y

I

I

I

9 0 DK

b. Have you ever had a test to see whether

I

you ore color blind? &j : 5: ;;s

I

I

9 0 DK

- -

c. Do you have SERIOUS trouble seeing with one or

both eyes EVEN WHEN WEARING GLASSES?

Q

I

i 0 Yes

2 0 No (26)

I 1

d. Can you see well enough to read ordinary newspaper I

print WITH GLASSES with your - I Yes No

Left eye? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I@ ‘0 20

Right eye?. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I@10 20

e. Was your eye condition the result of an accident?

74
DIABETES

260. DO you have diabetes or sugar diabetes? @ ’ 0 Yes

2 0 No (27)

b. Did a doctor tell you that you hod it?.

1 - i@ q

Yes

I

20 No

270. How many living brothers and sisters do you have?

Do not count adopted, step or half brothers and sisters.

;

I@- Living

I

1

o 0 None (27~)

b. How many of these brothers and sisters have

diabetes or sugar diabetes?

i

j@ -

Di abeti cs

t

I o 0 None

- ~~~ -~~~

c. How many of your brothers and sisters are

not living?

d. How many of these-brothers and sisters had

diabetes or sugar diabetes?

i

I

I@ -

Not living

I

I

o 11 None (27e)

1

I

;@IDiabetics

I o q None

e. Including those living and deceased, how mony of

your brothers and sisters were born before you?

i

/@j Number

I o q None

f. Is your mother still living?

g. Does (did) she have diabetes or sugar diabetes?

I

I

20 No

Is your father still living?

i. Does (did) he have diabetes or sugar diabetes?

.

I 20 No I

28. Hove you EVER been told by a doctor that you have -

Yes No

Borderline diabetes? ......................... @ ‘cl 20

Prediabetes? .............................. @ ‘0 20

Potential diabetes?. ............ . . . . . . . . . . . . . $gj cl 20

otes

I

i

,OI 278

I

;@

7 5
CHECK ITEM F

About how old were you when the doctor first told you

that you had (diabetes/. . .I?

i

; 281 0 Years old 1

b. Were you Q patient in o hospital at the time a doctor

first told you that you had it?

I

;@ ’ cl Yes

I

2 q No (30)

- -

c. Were you in the hospital at that time because you had

symptoms of (diabetes/. . .I?

, 30. (Not counting that first time) Have you ever been

hospitqlired because of your (diabetes/. . .I?

I

1 283 0

i L_1 Yes

I

2( No

1

1 284 ’ 0 Yes

I

0 20 No

Have you EVER taken insulin injections? I

;@ í q ye*

I 2 f--J No (33)

Have you been taking insulin injections for most of

the past 12 months?

Are you NOW taking insulin injections?

How many

7 take) them.

ears (hove you been taking/did you I

I

1 288 0 -

Years

1

I

o 0 Less than 1 year

320. Do you know what an insulin reaction is? I@ 1 fl Yes

I

2 [ No (33)

b.

d. (Including these reactions) About how many have

you had during the past 12 months?

i

I

o i-J None

I

1

1292 0 -

Number

I

I

o q None

1330. Have you EVER taken diabetes pills?

b. Hove you taken them most of the past 12 months?

C. Are you NOW’taking diobetes pills?

d. What is the name of the medicine? - Specify

+

&j ’ El ye*

I

2 [ No (33e)

e. How many

take) them.I

ears (have you been taking/did you

I

o i Less than 1 year

76
Have you EVER been given a WRITTEN diet for

your (diabetes/ . . .)? $-j) ’ IYe*

I

I 2 f-J No (35)

Was this diet ordered by a doctor?

j@ ’ I yes

I

I 2010

I

Do you NOW follow this diet?

/@ ’ nye*

I

I 2 q No I

How many years (have you been/were you) on

a diet for your (diabetes/. . .)? rg$ Years

I

I

I 00 Less than 1 year

35. Do you carry or wear an

you as a (diabetic/. . .r

thing which identifies

?

i1 301 ,O 10 Yes

I

I

I 210 No

36. When did you last see or talk to a doctor

about your (diabetes/ . . .)?

I

‘@

I Days

I

I 303 ,O Weeks

I

@-Months

I

i@ Years I

370. During the past 12 months did your (diabetes/ . . .) )

cause you to cut down on the things you I@ í q ye*

usually do? I

I 2 0 No (Check Item G)

b. During the past 12 months, about how many days did ;

you cut down on your activity for all or most

of the day?

1 307 lO -Days

I

I o 0 None (Check Item G) I

c. During the past 12 months, about how many

days did this condition keep you from work or

school, not counting work around the house?

i

,O; 308 -- Days

II 0 0 None

, d. During the past 12 months, about how many I days did your condition limit the kind or amount

of work around the house you could do?

; 309 ‘0 Days

I

I o 0 None

7 7
RESPIRATORY CONDITIONS

38~1. Do you have trouble with recurring persistent

cough attacks?

b. Have you been bothered by such coughing attacks

during the past. 12 months?

I

I

i@ ’ 0 ye*

i

f

2 q No (39)

1

; 315 ,O i IYes

I

2 0No

39. During the past 3 years have you had a period of

increased cough and phlegm lasting for 3 weeks

or more?

I

400. Have you EVER seen a doctor about a lung or

chest condition? .

b. What did he say the condition or conditions

affecting your lung or chest were?

c. How old were you when you first had

the condition? I

io; 318 cl 1 Under IO - Specify

i

I

2 q IO-19 years old

I 3 q 20-24 years old

I

41. About h ow many work or school days have you I9st

during the past 12 months because of your lung

condition, not counting colds or the “flu?”

,@ 1 0 None

I

210 I-4days

I

I 3 q 5-9 days

I

I

4 j-‘J I O-l 4 days

I 5 0 IS-19 days

I

I

6 020-29 days

I

I 7 0 30 days or more

I

42. Have you EVER stayed in a hospital overnight

or longer because of a lung or chest condition? 101320 1 nye*

I

I

2 f-J N o

HEARING and SPEECH

430. During the past 12 months, have you EVER been

bothered by ringing or other funny noises in

your ears?

I

I

I

I@ 1 aYe*

r

I

I

2 0 No (44)

b. How often - every few days or less often? I (-J Every few days

I

2 0 Less often

c. When it does occur, does it bother you quite a

bit , just a little, or not at all?

@ ‘cl Quite a bit

,

I

2 m Just a little

I

I

3 0 Not at all

Have you EVER had a running ear or any discharge

from your ears not counting wax in the ears?

/ 324 0

i q Yes

1

2 f-J N o

I

I 9aDK >

(45)

How often have you had a running ear or any discharge

from your ear? ;@ cl 1 Once only

I 2 0 Twice

I

I

3 0 3-5 times

I

I

4 0 6 or more times

I 9nDK I

Did you see a doctor because of this condition? @ 1 cl-iI

2 f--J N o

I

I 9oDK

78
450. Did a doctor EVER tell you that you had an

ear infection?

b. How mony times have you had an ear infection?

c. For how many separate infections did a doctor

prescribe any -

;

,@ 1 cl ye*

I

2 fl No (46)

I

I

@g- Times

;

I

I

I

Oral medication (pills or liquid medicine)?. . . . . . . . . . I@ Infections

Shots or injections?. . . . . . . . . . . . . . . . . . . . . . . . .

i

@ Infections

I

Eardrops or other external applications? . . . . . . . . . . . @J Infections

I

d. Did a doctor EVER treat an ear infection you

hod by placing tubes in your ear?

I

; 332 0 1 n Ye*

I

I

20 No

I Ii 9 0 DK I

460. Have you EVER had deafness or trouble hearing with

one or both ears ? Do not include any problems which

lasted just o short period of time such as during a cold.

b. Did you EVER see a doctor about it?

c. How old were you when you first began having

trouble hearing?

I

@ 1 0 Yes

I

I 2 [ No (46j)

I

I1 334 ’ cl Yes

I0

I

2/--J No

I

I@ * FJ O-4 years old

I

I

2 LJ 5-9 years old

I

I

3 q lo-19 years old

I

I

4 q 20-29 years old

I

s [ 30-39 years old

f

I

6 q 40-49 years old

I

I

7 q 50 years old or older

d. Since this trouble began, has it gotton worse, gotten

better, or stayed about the same?

;

I

;@ 1 [ Gotten worse

I

I

2 m Gotten better

I I

I 3 0 Stayed about the same I

e. Was your hearing trouble or deofness caused by -

f Yes No DK

An ear infection? . . . . . . . . . . . . . . . . . . . . . . . . . .

I

1 337 1 0 21 91

A loud noise such as that from machinery, gunfire, I

0

blasts, or explosions? . . . . . . . . . . . . . . . . . . . . . . . @lo

t

2IIl 91

Ear surgery? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @q-J 21 91

An ear injury?. ............................. g)lO 20 91

Were you born with it? ....................... @IO 20 90

Some other cause? - Specify I@10

1

21 90

I
46. Continued

f. How would you rate your hearing in your RIGHT ear -

good, fair, poor or are you deaf?

j @ 1 LJ Good

I

I 2 @ Fair

I

I

I

3 r--J Poor

I 4 m Deaf

I

g. How would you rate your hearing in your LEFT ear -

good, fair, poor or are you deaf? i@ 1 LJ Good

I

I 2 0 Fair

I

I

I

3 1_1 Poor

I

I 4 i Deaf

h. Have you EVER had an operation on your ears? .

I

I

;034s ’ 0 yes II 2q No (46j)

i. Was it -

i

I

Yes No OK

An incision of the eardrum? . . . . . . . . . . . . . . . . . . . @‘O 20 90

An operation on the stapes, one of the bones in

I

I

the middle ear? . . . . . . . . . . . . . . . . . . . . . . . . . . .

gi+n 21 91

A mastoidectomy? . . . . . . . . . . . . . . . . . . . . . . . . .

;‘0340 1 0 2cl gel

Some other operation ? - Specify @1n 21 91

, I

j. Have you EVER had your hearing tested?

- - -_-_

I

I 350 ,O 1 UYes

I

I 2 j--J No (46m)

k. How old were you when your hearing was

LAST tested?

I -

@ 1 n O-9 years old

z IJ I O-l 9 years old

3 1._1 20-29 years old

I. Was your hearing normal?

I

I 4 /-J 30 years old or older

1

; 352 ,O 1 (Yes

I

I 2 [ No

m. Have you EVER used a hearing aid?

n. Which ear?

I

I 9 0 OK

I

1 353 1 q Yes ;OI 2 •I No (Check Item l-l)

I

i@ 1 q Right

I

I 2 q Left

I

I

I 3 i Both I

c

47. Have you EVER worked at a job where the noise

level required that you speak much louder than

@ laYYes

you usually do? I 2 i---J No

80
LIVER AND GALLBLADDER CONDITIONS i

480. Has a doctor EVER told you that you

had a liver or gallbladder condition?

;@ 1uyes

I

2 r_l No (49)

b. Did the doctor say the condition

I

I

was any of the following -

I

I

I

I If “Yes,” ask 48c ond CL

I

I

I Yes No

r

Hepatitis? . . . . . . . . . . . . . . . . . . . . . . . . . @ ‘cl 20

I

*

Cirrhosis?. . . . . . . . . . . . . . . . . . . . . . . . . @i) ‘cl 21

I *

Inflammation of the gallbladder (Cholecystitis)? I@* 10 20

I

Gallstones? . . . . . . . . . . . . . . . . . . . . . . . .

I@, cl 20

I

Liver abcess? . . . . . . . . . . . . . . . . . . . . . .

I

Hemochromatosis (He-moe-crow-ma-toe-sis)? . . . @* cl 20

I

Some other liver or gallbladder condition?

Sped fy

c. DO you still have . . .? d. How many

years ago

,

did you first

have it?

Yes No OK

31-I 4cl 91 0360 -

31-1 41 90 @

31 40 91 0364

3u. ‘40 91 0366 -

3) 40 90 0368

3u 41 91 0370 p

30 40 90 0372 -

e. Has a doctor EVER treated the liver

or gallbladder condition with - Yes No

Removal of the gallbladder?. . . . . , . . . , . . . ,

,i@ ‘cl

Any other surgery?. . . . . . . . . . . . . . . . . . . .

Medication? ........................

Diet? ............................

20

2cl

Bedrest?. . . . . . . . . . . . . . . . . . . . . . . . . . 18 10 21

I

Some other way? - Specify @ 10 20

I

f. Have you EVER stayed in a hospital

overnight or longer for a liver or

gallbladder problem? I

I

2)N o

g. Are you NOW being treated by a doctor

for a liver or gallbladder condition?

h. About how many work or school days

have you lost during the past 12 months

OS a result of your liver or gallbladder

condition?

p

1

 cl None

I

20 I-4 days

I

I

3 m S-9 days

4)IO-14 days

sa IS-19 days

6 u20-29 days

7 q 30 days or more

81
490. Have you EVER had trouble with persistent itching oil

over your body? pj 1 cl Yes

2 u No (50)

I

I

b. Was there a rash along with the itching?

i

I

210 No

I

500. Have you EVER lost your appetite for a period lasting

one month or longer?

2 m No (51)

b. Do you have this problem now? i

@ 1 q Yes II 2(No

KIDNEY PROBLEMS

51. Hove you EVER had any kidney,.bladder, or other

urinary problems?

i

@J 10 Yes

I

I

2 0 No (56)

520. Have you EVER had kidney stones?

- -

b. Have you EVER passed a stone?

I

c. Have you EVER had any of the following kinds of I

treatment for stones -

I Yes No I

I

Medicines?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 389 10

Surgery? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ij cl 1

Special diet? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ 10

Any other treatment? - Specify

21

20

20

20

530. Have you EVER had any infections of the kidney,

bladder or urinary tract? @

I

i a Yes

I

2 0 No (54)

b. About how many times have you had an infection of

the kidney, bladder or urinary tract?

---

i

I

I@-Times

I

c. About how many times did the infection(s) involve the -

Kidney? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1039s _ Times

I

Bladder? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 396 0,- Times

Urinary tract?. . . . . . . . . . . . . . . . . . . . , . . . . . . . . . .

I@, -

Times

- 1-- ~~~ ~-~~~~~ ~ -~

d. Did .you have fever and chills with any of the infections?

i@ cl 1 Yes

I 2[No

I

e. For how many of these infections did you take antibiotics I

I

or sulfa drugs? I@ -Infections

I

I o q None I

f. For how many of the infections did you see a doctor? I

j@ Infections (54bJ

I

I o 0 None

82
54a. Have you EVER seen a doctor for any

kidney, bladder, or other urinary problem?

b. Was the doctor -

I

I 401

I 0 i q Yes

I 2 q No (55)

I

I Yes No

A General Practitioner? , . . . , . . , . . . . . I

,@ ‘cl 21

I

An Internist? . , . . . . . . . . . . . . . . . . . . 1403 0 1L-l 2cl I

A Urologist? . . . . . . . . . . . . . , . . . . . . 21

A Nephrologist? . . . . . . . . . . . . . . . . . . 1 4os I q 0I

21

Some other type? - Specify

c. Did a doctor EVER tell you that you had -

i

I I

I

I

I

If “Yes,” ask 54d and e. I Yes

Nephritis (Ne-fry-tis)? . . . . . . . , . , . . . .

I

I@* ‘ICI

I

Renal sclerosis?. .-. . . . . . . . . . . . . . . . ; 409 * ’ t

Kidney stones or stones in the ureter?, . . .

i

0

$i$ ‘1

1

*

Nephrosi s (Ne-fro-sis)? . . . . . . . . . . . . .

;@iJ ‘1

I *

Kidney abcess? . . . . . . . . . . . . . . . . . . j@ ‘El

I

*

Hydronephrosis? . . . . . . . . . . . . . . . . . . I@ I [

I *

I

(Males) Enlarged prostate? . . . . , . , . , . . ;@* I i

Bladder stones? . . . . . . . . . . . . . . . . . .

i

I 0421 1T-J I *

Kidney infection? . . . . . . . . . . . . . . . . . /@

*lo

Bladder infection?. . . . . . . . . . , . . . . . . ~o,io

I

Urinary tract infection?. . . . , . . . . . . . . . @ ‘i

1

*

Any other condition of the kidney,

bladder or urinary tract? Specify . . . . . , .

I

4

I 429, ’ L! t

0

I

1II

No

21

21

21

2iI.l

2EJ

23

20

2rl

21

2rl

21

27-7- J

f. About how many work or school days have you

I

1

lost during the past 12 months because of your i 431

kidney, bladder, or urinary condition?

0 ’ 0 None

I

21’ l-4 days

I

3 LJ 5-9 days

I

4 7J IO-14 days

t

5 q 15-b days

I

6 fl 20-29 days

I

7 iJ 30 days or more

d. Do you still have 3 . . . .

Yes No OK

sb 4cl 91

30 4; 9Lzl

31 4!Il 91

3El 41 91

30 4r-J 90

3LIl 41 91

3L-J 4j 9g

3LIl 41 91

3cl 41 91

3cl 4El scl

3r-J 40 91

sir--J 4/--J q----J

e. Mow marry

ywrs ago did

the condition

begin?

0 408 -

0 410

0 412 ,-

0 414 -

0 416

0 411

0 410

0 422

0 424

0 426 -

0 428 -

0 430 -

g. Have you EVER had any special X-rays

of your bladder, kidney, or urinary tract?

i

;@ i l--J Yes

t

2iN o

83
51. continued

I

i

b. Have yea EVER been hospimlized ovetni&t or m because of any ttouble in

‘0 cP*

your kidney, bbddet, 01 utinoty trot*?

;

I

2010

,

i. When was the bst *iw you sow a doetat i

for a kidmey, bbddet, 01 utinoty condition?

0

,u Years ago

j. Did the ttw~nt fot a kidney, bladder,

01 atirroty ttmti ptoblem include -

o 0 Less than I year ago

Yes No

Diutetics IDi-yr-ret-ic) or pills for

water loss?. . . . . . . . . . . . . . . . . . 20

I

Stetoids such as cortisone kor-ti-tone) I

and ptednisone (prtd-ni-zone)? . . . . . @ ‘0 20

Antibiotics? . . . . . . . . . . . . . . . ,@ ‘0 20

Sulfa dtugs? . . . . . . . . . . . . . . . . . @J ‘cl 20

Medicines to teduce blood pressure?. . @lD. 2(

surgery? . . . . . . . . . . . . . . . . . . . . .@ ‘cl 20

Special diet? - Specify

rl

. . . . . . . . . @ ‘0 20

Any olhet tteotment? - Specifyg. . . . . i @ 1 q 20

SSoc Nave you hod any ttouble with pain due to :

kidney, bloddet 01 utinoty ptoblems? :@ 1nye*

I

I

i

2 q No (56) I .

b. Was the poin located in -

! Yes No

YouttightsideANDbock? . . . . . . . . @ 10 a

YourIeftsideANDbock? . . . . . . . . . US 0

1 q 20

Both sides AND bock? . . . . . . . . . . @J ‘cl a

The mea over the bladder? . . . . . . . . @ ‘cl 20

Your lower abdomen? . . . . . . . . . . . @ ‘0 20

co About how many times have you hod a

this pain? Times

I

I I

56. Hos yout mo?het, [other, sisters, or

I I i

I

btotbets EVER had -

(Anyone else?)

? Mother 1 Father 1 Sister I

I

Brother 1 No

L I I I I

Polycystic disease of the kidney?. . . .

Both chtonic nephritis (Kidney disease)

and netve deafness in childhood?. . . .

Kidaeyotbloddetstmes?. . . . . . . . .

Highbloodptmssute? . . . . . . . . . . . . .Ii@ 10 I1 2( I

I

II 4CI sO
570. Did a doctor EVER tell you that you had

any of the following in your urine -

1i 1-b b. How many separate? C. rk!tipen?

times dtid It happen

If “Yes.” ask b ond c. I Yes No

I

Protein or albumin?. .‘. . . . . . . . . . . @ 10 20 0455 456 Times 0 Years ago

Blood? . . . . . . . . . . . . . . . . . . . . . @ 10 20 0458 -Times 0459 Years ago

I

Sugar? . . . . . . . . . . . . . . . . . . . . . @ q--J 20 0461 Times 0442 -Years ago

Anything else? Specify c**“‘*** I@ q-J 20 464 Times 465

1

0 0 Years ago

I

ALLERGIES I

580. Have you ever had skin tests

for allergies? p$ ‘(yes

I

2 0 No (59)

b. Did you ever have a positive skin I

reaction to -

I Yes No

Trees. . . . . . . . . . . . . . . . . . . . . .

?

Grass? . . . . . . . . . . . . . . . . . . . . .

@la 2) .-

1 468 0 1 II 2 I

Weeds?. . . . . . . . . . . . . . . . . . . . . @ 10 21

House dust?. . . . . . . . . . . . . . . . . .

Molds? . . . . . . : . . . . . . . . . . . . . .

p 10 2(

I 0471 1 q 20

Bacteria? . . . . . . . . . . . . . . . . . . . @ 10 2)

Foods?. . . . . . . . . . . . . . . . . . . . . 1 473 0 1 0 2 0

c. Have you ever had allergy shots? .j@ :;;;s

I

d. Have you ever had any reaction to an allergy

(shot/test) which was more than just a swelling

@ ‘(IYes

around the sides of the (shot/test)?

,I 2010 1

590. Did a doctor EVER tell you that

you had -

a

rl b. Do you sti II have . . .? c. How many

years ago

did you first

have it?

If “Yes,” osk 59b ond c. Yes No Yes N o OK

Asthma? . . . . . . . . . . . . . . . . . . . . @*lo 2( 30 40 90 @-

Hayfever? . . . . . . . . . . . . . . . . . . . @,a cl 30 cl cl @-

Any other allergies? Specify

4

. . . . l l @+I 21 cl cl cl @g-

?

b

If “Yes” to any condition in 590 ask

59d, otherwise, go to 60

1

I

d. Was the doctor - I Yes No

A General Practitioner? , . . . . . . . . . j@ 10 2izl

An Internist? , , . . . . . . . . . . . . . . . . @lo 20 .

An Ear, Nose and Throat Specialist?. . @ 10 20

An Allergist?. . , . . . ; . . . . . . . . . . j@ ‘0 21

Some other type? SpecifyC~““” I@ cl 2cl

I

i

85
600. During the past 12 months, not counting colds or the flu,

have you FREQUENTLY had trouble with -

I

I Yes No

Wheezing?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I

I 487 í q 21

Stuffy nose? . . . . , . . , . . , . . . . , , . . . . . . . . . . . ,

I 0

,@ 1 0 cl

I

Itchy nose? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @‘O 20

Watery discharge from the nose?. . . . . . . . . . . . . . . , j@‘O 20

Post nasal drip?. . . . . , , . . . . . . . . . . . . . . . . . . . I@l0 cl

Watery, itchy eyes? . . , . . . . . . . . . . . . . . . . . . . . . @‘O 2El

.

Itchy ears? . , . . . . . . . . . . . . . . . . . . . . . . . . . . . ~@a 2c-l

I

Sinus infections? . , . . . . . . . . . . . . . . . . . . , . . . . @l/-J 20

CHECK ITEM I

mentioned have you ever -

I

1

Taken medication? . . . . . . . . . , . . . . . . . . . . . . . . @‘O 21

I

Moved to a different location? . , . . . , . . , . . . . . . . . ) 0497 1 q 20 I

Installed air-conditioning, a

humidifier or an air-cleaner? . . . . . . . . . . . . . . . . . . @JO 20

Tried to keep away from the things that I

seem to bring on the condition or make

I

I

it worse?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @‘O 21

Asl< if 17+ I

Changed iobs? . . . . . . . . . . . . . . . . . . . . . . . . . . . @‘O 21 0 Under 17

c. Do these (allergies/symptoms) you mentioned

bother you in the - Yes . No I

I

Spring?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @po 20

Summer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @cl 20

I

I

Fall until frost? . . . . . . . . . . . . . . . . . . . . . . . . . . @‘O 21

I

Fall after frost? . . . . . . . . . . . . . . . . . . . . . . . . . . @‘O 20

d. Do the (allergies/symptoms) you mentioned I

bother you - I Yes No

Indoors? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Outdoors? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

e. Do the (allergies/symptoms) you mentioned seem

I

I

to get worse in -

I

I Yes No

Dry weather? . . . . . . . . . . . . . . . . . . . . . . *. . . . . . &i$n 20

Rainy or humid weather? . . . . . . . . . . . . . . . . . . . . 20

f. Do the (allergies/symptoms) hot), you more when i

you are around - I Yes No

I

I

Grass? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @cl cl

Trees? . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
. 60. Continued

g. How old were you when

I

ou first began

having trouble with the allergies/symptoms)

you mentioned?

h. Are there any things or places which YOU,

NOT YOUR DOCTOR, associate with making

your symptoms or allergy problem worse?

I

I

I

11,O511 -Years old

I

I

, @ 1 0 yes - SWCifV

I

2 0 No

I

I

I

I

I

i. Have you ever had a

I

- I + j. Do you have one now? ’

I

I

,

If “Yes,” ask 6Oj. 1 Yes No Yes No

Dog for a pet? 1. . . . . . . . . . . . . . . . . . . . . . . . I@ cl

*

21 31 40

I

Cat for a pet? . . . . . . . . . . . . . . . . . . . . . . . . $ipIl 30

, *

I Notes

I,O515

I

$i$

I

I‘0 517

87
HYPERTENSION ;

610. Have you EVER been told by o doctor that you had ’ @ 1 0 Yes (61~)

high blood pressure? I

I

I

t[No

b. Another nomt for high blood pressure is hypertension. ;

Hove you EVER been told by a doctor that you hod

hypertension?

;@ip cl Yes

i

.

2 [1 No (69

I

c. About how long ogo were you FIRST told by o doctor I

hot you hod (high blood pressure/hypertension)? I@-Months

I

jo Years

I

I 0 0 Less than 1 month

c I

620. During the past 12 months,obout how mony times have I

you seen or tollced to o doctor about your (high blood

pressure/byportension)?

1@

t

-Times

I o 0 None

.

b. Hos o doctor EVER advised you to lose wei ht

BECAUSE OF (HIGH BLOOD PRESSURE?

HYPERTENSION)?

r

I

1 523 ’ cl Yes

I0

I

2010

630. Hos o doctor EVER prescribed medicine for your

(high blood pressure/hypertension)?

b. Are you NOW taking any medicine prescribed by a

doctor for your (high blood pressurelhypertension)?

i

I

I 524 ’ cl Yes

I

0

I

2 0 No (64)

I I

i1

2 0 No (64)

c. How often ore you supposed to toke this medicine -

more than once o doy, once o day, or less thon once

a doy?

I@ I f More than once a day

I

t

2 0 Once a day

I

I

3 0 Less than once a day

.

d. How often do you take your medicine when you

are supposed to - all the time, often, once in

o while, or never?

I

; 527 I 0 All the time 0

I

2 0 Often

I

I

3 0 Once in a while

I

I

I

4 0Never

I s 0 Other - Specify

I

I

I

64. ABOUT how mony days during the post 12 months r

~~~~ -~

has (high blood pressure/hypertension) kept you

in bed oil or most of the doy?

@J -Oays

I

I

o 0 None

65. During the post 12 months, how many times was

1

your blood pressure token? Do not count times r

while a patient in o hospital. 1 529 0

.- Times

I

I

I o L-J None

CHECK ITEM J .

2 fl (8-24 (75)
-

CARDIOVASCULAR CONOITIONS I

I

66. Have you EVER had any trouble with pain, discomfoti,

or pressure in your chest when you walk fast or uphill?

: 531

1

c) t 0 Yes

I

I

2 0N o

670. Have you EVER had severe pain across the front of

your chest lasting for half an hour or more?

b. How many of these attacks hove you hod?

1

@ 10 Yes

I

I 2 0 No (68)

t 4 I

/o ’ cP=

I

I

I

. 3 0 4 or more

c. Are you taking any medication to strengthen your heart I

beat or to regulate it? jo 1OYts -

I

I

”

I

2DNo

1

680. Have you EVER had shortness of breath either

when hurrying on the level or walking up o f

slight hi II? ‘0 0

i

535 ’ Yes

b. Have you had this problem for ot least 90 days

of the year?

I

I 2 0 No (69) I 1

;@ ‘ayes

I

I

2 0N o

69. Have you EVER hod -

Loss of vision or blindness losting from

Yes No

several minutes to several days? . . . . . . . , . . . jo ‘cl 20

Difficulty in speaking or slurred speech I

I

lasting from several minutes to several

days? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +ij 1 0 2n

Loss of sensation, numbness or tingling

sensations losting from sever01 minutes t

to several days? . . . . . . . ; . . . . . . . . . . . . . .

20

A severe head injury leading to unconsciousness

losting for more than S minutes? , . . . . , , . , . , . 21

1 I

I Prolonged weakness or paralysis of one

or both-sides of the body lasting up to

sever0 I months? . . , . . . , . . . . . . . . . . . . . . . 20

, I 1

Notes 1

;(i;i)

I

SB
700. Have you EVER had a stroke?

b. Did a doctor tel I you this?

c. How many strokes have you had?

i

I@ i 0 Yes

I

I

I

2 0 No (71)

I

I

I

1 545 1 cl Yes I

0

i 2 0 No

I

I

I

I

;@ Strokes

I

1 10 One

I

I

I

;

@ Years

I

I

I

o 0 Less than I year

I

I

I

I@ Years

I

.

d. How long ago did you have the

(first) stroke?

If one stroke only, go to 70f

e. How long ago did you hove your

LAST stroke?

.

o q Less than I year

f. When you had your stroke(s), did

you have -

If ìYes,î ask 7Og

I

Yes

l

No

Paralysis of the face? . . . . . . . . . . . . . . . . , . .

j@lO cl

J

*

Paralysis of the arm or leg? . . . . . . . , . . . . . . ,

I *

Numbness of the arm or leg? . . . . . . . . . . . . . .

20 .

Change in vision? . . . . . . . . . . . . . . . . . . . . .

I

I 0ss2 1 Cl 20 I *

Change in speech? . . . . . . . . . . . . . . . . . . . . ,

~@a

; *

cl 30 40

Any other symptoms? - Specify 30 40

Notes

g. Do you still have . . .?

Yes No

cl cl

30 41

30 40

30 40

90

,

: b ,

‘I’
BACK AND NECK PROBLEMS

71. Hove you EVER had pain in your back on

m,ost days for at least 2 weeks?

I

I

10’ 556 1 Cl yes

i

I 2 /--J No

72. Hove you EVER had pain in your netk

on most days for at least 2 weeks? ; @ 1 t-3 yes

i

I

2 11 No

73. Have you EVER had pain or aching in any

joint, other than the bock or neck, on most

days for at least 6 weeks?

740. Have you EVER had any swelling of joints, with

pain present when the joint was touched, on most

days for at least 1 month?

I

!

. @ 1 m Yes

I

I

2 aNo

b. Have you had stiffness in your joints and muscles, ;

when first getting out of bed in the morning, on most ; 560 0 i q Yes

mornings for at least 1 month?

I

I

2 C:] No

75a. Have you ever changed your job or stopped

working because of a health problem?

I

b.

---I---_.--________

What was the health problem?

2 [-J No (Check Item K)

I

c. Did you -

I -

I Yes No

I

I I

Retire because of disability-? . . . . . . . . . . . . . . ,

Change permanently to an easier job? . . . . . . . . . . i,O563 I E 21

I Change temporarily to an easier iob? . . . . . . . . . . ] 0564 li 2 rIl

I

Cut down to part-time work only? . . . , . . . . . . . . @J I F 2cl I

Have to stop working for a few months? ........ i,O566 I c 21

Have to cut down on housework? ............. @ ‘cl 21

Stop doing any housework? . . . . . . . . . . . . . . . . . @J I Lj cl

Moke some other change? - Specify

CHECK ITEM K

I q Under 19 (76)

2 q 19-59 (80)

91
760. Is -- attending school now? I

I

@ i 0 Yes

b. What is the nome and address of the school he

goes to?

i

2 0 No (80)

I

I

Name

i

I

Address (Number ond street)

I

I

City

I

770. is there Q school lunch progrom ot the school

he attends?

(774

b. HOW many times a week does he usually

participate?

c. How much does he pay for his lunch per day?

I

I

I

@ Times

I

I

o 0 None (77d)

I

I

Cents

I

I

o 0 Free *

d. Is there a special milk program at the school

he attends?

e. How much does he pay for his milk per day?

i

I

I 57s 1 0 yes

I0

i

I

2 0 No

I

(77g)

I 9nDK >

I

i

I

!

0576 - Cents

I

o 0 Free

f. How many times a week does he usually

participate?

I 577 Times

I0I

I

I

o 0 None

g. Is there a school breakfast program at the

school he attends? Yes

i

i

2 ONo

>

WB

I

9 0 OK

h. How many times a week does he usually

participate?

i

I

I 579 Times

I

0

I

I

o 0 None (60)

i. How much does he pay for his breakfast

per day?

Cents

I

!80)

o 0 Free
78a. Do you porticpote in ony program in which

prepared meals OR groceries ore delivered

to your home on a regulor.basis?

I

1 581 01 cl Yes

I

I

2 0 No (79)

b. Are prepared meals or groceries delivered

to your home?

,

1

I@ I q Prepared meals only

I

I

2 0 Groceries only

I

I

I

3 f-J Both

I

I

4 0 Other - Specify -

1

i

I

c. Is the sponsor of the program - Yes No

A local health department?

I

. . . . . . . . . . . . .

I@ cl 20

I

Another department of local government? . . . . @ ‘cl cl

A State government? . . . . . . . . . . . . . . . . . .

i

@ ‘cl 20

A church group? I

. . . . . . . . . . . . . . . . . . . .

I@ cl 20

I

Some other voluntary orgoniration? Specify I

I 587 1 cl

co I0 cl

8

d. About how often is the food brought to

your home? 1

I 588 i 0 I q Two or three times a day

I

I

2 0 Once a day

I 3 0 Four to six times a week

4 0 Two or three times a week

s 0 Once a week

6 q Two or three times a month

7 a Once a month

8 0 Less than once a month

9 q Other - Specify

I

Notes

93
790. Do you participate on o regular basis in any

programs in which you go out to a place where

meals are served to groups of people?

I

’ 591

IO

i IYes

I

I

2 0 No (80)

b. Is the sponsor of the program- No

A local health deportment? . . . . . . , . . . . . . . . . .

21

Another department of local government? I . . , . . . . @Cl 21

A State government? . . . . . . . . . . . . . . . . . . . . .

j@a 21

I

A church group? . . . . . . . . . . . . . . . . . . . . . . . . @a a

I

Some other voluntary organization? Sped fy

b - * l l * @a

I

20

I

c. About how often do you 90 out for these meals?

;0597 I q Two or three times a day

1

I

2 0 Once a day

f

I

3 0 Four to six times a week

4 n Two or three times a week

I

I

s q Once a week

I

I 6 0 Two or th ree times a month

I

I

I

7 q Once a month

I

1

8 n Less than once a month

I 9 0 Other - Specify

80. RESPONDENT

Mark main respondent

I

;0598 i q Sample person

I

I 2 q Mother

I

I

I 3 a .Father

I

I

4 q Sister or brother

5 11 Other - Specify

CHECK ITEM L

Another SP available for interview

(Next Medico/ History Questionnaire)

2 m No other SP available for interview

(Page 3 of the Household Questionnaire)

94
Heath History Supplement, Ages 12-74 Years

FORM HRA-1 l-2

(3-17-76)

Form Approved

0,M.B. No. 68-R I502

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE NOTICE - All information which would

HEALTH RESOURCES ADMINISTRATION

NATIONAL CENTER FOR HEALTH STATISTICS permit identification of the individual

HEALTH HISTORY SUPPLEMENT

will be held in strict confidence, will

be used only by persons engaged in

(Ages 12-74 Years) and for the purposes of the survey, and

wil I not be disclosed or released to

HEALTH AND NUTRITION EXAMINATION SURVEY TI: others for any purpose.

a. Examinee name (First, middle initiol, last) b. Deck No. c. Sample No.

305 0100 -L-------

d. Sex e, Age f. Interviewer name , g. Interviewer No.

0 Male 0 Female

- - 0101 --

READ - I’d like to ask you some questions about health probJems or conditions you might have had in the past

or might have at the present time.

.

1

INTERVIEWER CHECK ITEM 1

@ I a 25 or over ask Question I

z c] Under 25 SKIP TO Question I7

la. Have you ever hod any trouble with pain, 1

discomfort or pressure in your chest l(iiiiJ i 0 Yes

when you walk fast or uphill? I

I zmNo- SUP to 2a

b. Would you describe this pain as any of the following?

I

I Yes N o

I

Heaviness,. . . . . . . . . . . . . . . . . II.. . . . . . . .,;a q---J 2u

.

Burning sensation. . . . . . . . . . . . . . . . . . . . . . . .,@ ’ L--J

Tightness.. . . . . . . . . . . . . . . . . . . . . . . . . . , ,I 106 0 'U

Stabbing pain. . . . . . . . . . . . . . . . . . . . . . . . . . l i

‘@ ‘U

Pressure. , . . . . . . . . . . . . . . . . . . . . . . . . . . .

I@ 10

‘ I

Sharp pain.. . . . . . . . . . . . . . . . . . . . . . . . . . . .I@ ‘17

@ q--J Shooting pains . . . . . . . . . . . . . . . . . . . . . . , . . .III

G Have you had the pain cr discomfort more I

than THREE times? @J 1 C_! Yes

I1

2 c-l No

d. Have you been bothered by the pain or discomfort within

the past 12 months?

I1 112 1 [-_I3 Yes

I 0

I

I

2 n No

e. How old were you when you first had the pain

I

or discomfort? /@ I L_J Under IO years old

I

I 2 n IO-19 years old

I

I

I 3 Cl 20-29 years old

1

I

4 0 30-39 years old

I

I

I

5 @ 40-49 years old

I 6 n 50-59 years old

1

I

7 E 60 years or older

L

f. DO you get the pain or discomfort if you walk at an

ordinary pace on level ground?

I

I

I 114 I 0

10 Yes

I 2 q No I

95
1. Continued

g. If you get the pain or discomfort while I

I

walking do you -

I Yes No

I

I

Stop?. . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . 18 l( 20

I

Slow down?. . . . . . . . . . . . . . . . . . . . . . . . . . . j@ 10 21

I

Continue at the some pace? . . . . . . . . . . . . . . . . 1 0117 1 0 2cl

I

Take medicine? . . . . . . . . . . . . . . . . . . . . . . . , 2cl

I

h. If you do stop or slow down, is the

pain or discomfort relieved or not?

I

I

i

i 119 0 I q Relieved - Ask i .

2 m Not relieved - SKIP to j

i. How soon is the pain relieved? i

i

1 120

I 0 I q Less than IO minutes

2 0 IO minutes or more

j. When you get pain or discomfort where

is it located? Is it in the - Yes . No

Upper middle chest? . . . . . . . . . . . . . . . . . . . . . 20

Lower middle chest? . . . . . . . . . . . . . . . . . . . . .

I

1@1~

I 21

Left side of chest? . . . . . . . . . . . . . . . . . . . . . . /@q-J 20

Left arm? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i

l&L-j

I

20

Right side of chest? . . . . . . . . . : . . . . . . . . . . . 21

Some other place? Specify

s

. . . . . . . . . . . . . .

i(g q---J

I

21

I

I

1

1 k. Do any of the following things tend to I

’ bring the pain or discomfort on? I

I

I

I

I

Yes No

I

I

I Excitement or emotion . . . . . . . . . . . . . . . . . . . 1137 0 ‘0 21

Stooping over . . . . . . . . . . . . . . . . . . . . . . . . .

I

Eating a heovy meal . . . . . . . . . . . . . . . . . . . . #&r--J

I Coughing spells . . . . . . . . . . . . . . . . . . . . . . . 1 0130 I q

21

2cl

21 I

Cold wind . . . . . . . . . . . . . . . . . . . . . . . . . . . I@ ;o

I

21

Exertion . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2a. Have you ever had severe pain across the front

of your chest lasting for half an hour or more? @ q1 Yes

I

I

2 0 No - SKIP to 3

b. How many of these attacks of poin have you hod? I

I 134 1 0 One

I

0

i

2 q Two

I

3 0 Three

I

I 4 q Four or more

cI What was the date of your last attack?

-Month 0136 - -Year

d. What was the duration of the pain during your

last attack?

;

I 0137 1 0 30-59 minutes

I

I

I 2 q l-2 hours

I 3 0 3-5 hours

4f-J66-ll hours

s 0 12-23 hours .

6 0 24-47 hours

7 0 2 days or more

e. Did you see a doctor about this last attack?

f. What did he say it was?

IF ENTRY IN 2f SK/P 7-O h; OTHERWISE ASK g

g. Have you ever seen a doctor about chest pains,

chest discomfort or heart failure?

I1 138 1 IYes

I 0

I

2 0 No - SKIP to g

DATA PREPARATION USE ONLY

@lo @ q-J

0141 1 f-J 0142 10

(&r-J (iii&o

(i&o

p cl 147 1 Yes

I

I

2 0 No - SKIP to i

h. What type of doctor was it? Was it a -

I

1

Yes No Don’t know

General Practitioner? . . . . . . . . . . . . . . . . . . . . @lo 20 90

Internist?. . . . . . . . . , . , . . . . . , . . . . . . . . . , po 20 90

Osteopath?.... . . . . . . . . . . . . . . . . . . . . . . .

I@ 10 20 90

Heart specialist? . . . . . . . . . . . . . . . . . . . . . . . p1rJ 20 90

Some other medical

person? - Specify ;@?a 20 90 I

i. Have you ever stayed in a hospital overnight or longer I

because of your chest pains or a heart condition? I 153 10 Yes

I 0

1 2010

j. During the past 12 months, obout how many work days

would you estimate you have lost because of a

heart condition?

i

4 0 lo-14 days

I

50 IS-19 days

I

I

6 0 20-29 days

I

I

7 0 30 days or more

97
SHORTNESS OF BREATH

3a. Have you ever had shortness of breath either when

hurrying on the level or walking up a slight hill?

f

i @ I LIJ Yes - Ask b

I

I

2 0 No - SKIP to 4

I

b. Have you had this problem on most days for

at least 90 days in the past year?

I

c. Do you get short of breath when walking with other

people at an ordinary pace on level ground?

d. Do you have to stop for breath when walking at

your own pace on level ground?

e, Do you have to stop for breath after walking about

100 yards or after a few minutes on level ground?

f. How long ago did you first have this trouble with

shortness of breath?

1 @ inYes

I

I

2110

I

I 158 iaYes

I 0

I

I

2110

1

I1 @ 1 q Yes

II

2110

1

I

I 160 I q Less than I year ago I 0

2 q l-3 years qgo

3 q 4-9 years ago

4 q IO years ago or more

9 q Don’t know

g. Have you gotten chest pains along with the shortness I

of breath? 1 161 I q Yes - Ask h

I

0

I 2 q No - SKIP to i

h. Were these pains located in the - 1 Yes No

Upper chest? . . , . . , . , , . . . . . . . . . . . . , . . . . i 162 0 1 q cl

i

Upper back?. . . . . . . . . . . . . . . . . . . . . . . . . . . ; @ 1 rj cl

Lower back? . . . . . . . . . . . . . . . . . . . . . . . . . .

]@lO 21

I

Along the lower ribs?. . . . . . 1 . . . . . . . . . . . . . , i@ 10 21 I

9 8
40. Have you ever had pain in your back on most days for

at least two weeks?

b. What is the longest episode of back pain you

have ever had?

I

i(iiiiJ inYes

I

I

I

2 q No - SKIP to 5

I

1

I@ I 0 Less than one month

I

I

2 -_- Fj One but less than 2 months

1 3 --I I -1 2-3 months

4 r_3 4-5 months

5 n 6 months or more

I

9 m Don’t remember

C* Where is the pain usually located? I

In the -

Yes No

Upper back?. . . . . . . . . . . . . . . . . . . . . . . . . . .

I

I@ 1 c] cl

Mid-back?. . . . . . . . . . . . . . . . . . . . . . . . . . . . I@ 1 u

I

2cl

Lower back? . . . . . . . . . . . . . . . . . . . . . . . . . . ;@lL-J 2u .

If only one marked in c, mark d without asking. I

d. When you have this back pain, where is it

most intense?

I

I Yes N o

Upper back? . . . . . . . . . . . . . . . . . . . . . . . . . . Qq-J

I

cl

Mid-back?. . . . . . . . . . . . . . . . . . . . . . . . . . . . cl

Lower back? . . . . . . . . . . . . . . . . . . . . . . . . . .

I

l@to cl I

e. Is the back pain usually present when you ore

resting at night?

f. When you have the back pain does it awaken you

from sleeping at night?

I1 0176 I 0 Yes I

I

2 0 No

I

I

I 177 1 q Yes I 0

I

I

2 j--J No

g. Does the back pain ever seem to spread? i

1 178 I q Yes

I

0

I

2q No - SKIP to i

h. Does it spread to the -

I Yes No

I

Back of the right leg? . . . . . . . . . . . . . . . . . . . . @lo 21

Back of the left leg? . . . . . . . . . . . . . . . . . . . . . i@lU 21

Back of both legs? . . . . . . . . . . . . . . . . . . ...* [@lo cl

Tap of the head?. ....................... ;@lo cl

Sides of the body? ...................... @lo cl

i. Is your back pain made worse -

ii Yes N o

By coughing, sneezing, or deep breathing?. . . . .‘. .

i 0184 1 q 21

With bending or twisting motion? . . . . . . . . . . . . .

I 18s 01 0 21

After prolonged sitting?. . . . . . . . . . . . . , . . . . .

il@!

1 q 21

After prolonged standing?. . . . . . . . . . . . . . . . . .

I@

I

1 m 20

After prolonged activity? . . . . . . . . . . . . , . . . . .

i

l@ 1 0 cl I

99
4. Continued

j. How. old were ou

this recurt’ing 1;

when rou first experienced

ock pain.

i

1 @ 1 0 Less-than 20 years old

I

1 2 q 20-29 years old

I

I 3 0 30-39 years old

I

I 4 0 40-49 years old

s 0 SO-59 years old

6 0 60 years old or older

k. When was the last time you had this pain? i

f 0190 1 q Have it now

1

1

2 0 Less than I year ago, but not now

I 3 C l-2 years ago

I

t

4 0 3-S years ago

I

I

5 q 6 years ago or more

I

I. Does this back pain occur mow froqumtly now

than it used to occur? 1 0191 10 Yes

I

I 2CNo

m. Has this back pain usually been mild,

moderate or severe?

i

I@ InMild

I

1

2 m Moderate

I

I 3 0 Severe .

n. Have you ever had a sprained back due to

some type of physical activity?

1

1 193 1 q Yes

I 0

I

I n[No

o. Have you ever had a disc problem in either

your bock or neck?

i

1@ 1 C Yes

I

I 2 0 No - SKIP to u

p. Was the problem a ruptured disc?

q. Was the disc problem in your back or neck?

r. How old were you when you first had the

di SC problem?

s. W8re you in traction?

t. Was surgery necessary?

i

I@ 1 CYes

1

I

20 No

I

I@

I

1 0 Back

t

2q Neck

I

I

3 0 Both

1

I

I

I

; 197 0 -- Years old

I

;(sJ 10 Yes

I 2aNo

I

1

I @ 1 (Yes

t

I 20 No

u. Have you ever stayed in a horpitol

overnight or longer for back pain? /@ 1 c

Yes

I

4-J No

mo
So. Hove you ever hod poin in your neck on

most doys for at least two weeks?

i

,@J InYes

I

I 2aNo- SKIP TO INTERVIEWER CiiEC/ 1 TE!‘, 1

I

b. Whot is the longest episode of neck pain

you hove ever hod?

,

. @q--J Less than one month

I

2 0 One but less than two months

! 3 0 2-3 months

I

I 4 0 4-5 months

1 s 0 6 months or more

I

1 s 1_1 Don’t remember

I

co Is the neck pain present when you are I

resting at night?

@J inYes

I

I

2 0 No

d. Does the neck poin ever seem to spreod? ‘0) 204 i q Yes

II 2 q No - SKIPto f

em Does it spread to -

I

I Yes No

The top ond back of the head?. . . . . . . . . . . . . . . @ 1 0 20

Either shoulder area? . . . . . . . . . . . . . . . . . . . . I@ 10

The arms or hands?. . . . . . . . . . . . . . . . . . . . . .

I

2cl

I@ ‘cl 21

Other? - Specify @l@ 20

1

f. Is your neck poin made worse -

f Yes No

By coughing, sneezing, or deep breathing? . . . . . . I@ 1 0 20

With bending or twisting motion? . , . . . . . , . . . . . /@ q-J 20

After prolonged activity? , , . , . . , . . . . . . . . , . . @ 1 0 20

After prolonged sitting?, , . , , , , , , . , . . , , , , . , &q--J

After prolonged stonding?. .‘. l . g l . l l l m l . e g . . ,

f

21

@J 1 0

20

g@ How old were you when you first experienced this

I

recurring neck poin? I@ I 0 Less than 20 years old

I

I

2 0 20-29 years old

I

i

h. When. was the last time you hod this pain?

i. Does this neck poin occur more frequently now thon

it used to occur?

j. Has this neck pain usually been mildi moderate,

of severe?

t

3 0 30-39 years old

I

4 0 40-49 years old

f

s 0 50-59 years old

6 0 60 years old or older

I

lof 21s 1 0

Have it now

f 2 0 Less than I year ago but not now

I 3 0 l-2 years ago

I

f

4 0 3-5 years ago

I

s 0 6 years ago or more

I

I@ i(IYes

I

I

2(-l No

@ I 0 Mild

I 2 q Moderate

I

I 3 q Severe

1

k. Hove’you ever hod a “whiplash” injury I

of the neck?

I 218 I q Yes

t

0

I

2( No

I

INTERVIEWER CHECK ITEM JI- If “Yes” in Questions 4a or Sa, (i.e., back pain or neck pain), ask questions 6-10;

otherwi se SKIP to Question I I

101
6a. Have you ever used any of the following

kinds of treatment for your back or neck trouble? I

b

C

Yes

Splints or casts . . . . . . . . . . . . . . . . . . . .

I

Braces . . . . . . . . . . . . . . , . . . . . . . . . . . @iJ 10

Diathermy or paraffin. . . . . . . . . . . . . . . . . @q-J

I

*cl

Hot packs or heating pads . , . . . . . . . , . , . I@ l@

I

*cl

Cold packs or ice. . . . . . . . . . . . . . . . . . . @lo *cl

I

Rest . . . . . ..-.................. @q-J

Traction . . . . . . . . . . . . . . . . . . . . . . . . . @lo

I

Exercises or physical therapy . . . . . . . . . . . @g l/--J

I

I

Aspirin. . . . . . . . . . . . . . . . . . . . . . . . . . @q--J

I

Cane........................... ’ 237 1 LJ

I0

Crutch . . . . . . . . . . . . . . . . . . . . , . . . . . @lo

I

Stiff mattress. . . . . . . . . . . . . . . . . . . . . . ,Ot 241 1 n

Bed board. . . . . . . . . . . . . . . . . . . . . . . . @lr;

No

*cl

*El

*cl

*cl

If “Yes” to 6a and b, ask:

Are you now using it regularly for your

back or neck trouble? Yes No

Splints or casts . . . . . . . . . . . . . . . . . . . . @lO *u

I

Braces . . . . . . . , . . . . . .- . . . . . . . . . . . . ë0; 246 1 q * cl

Diathermy or paraffin, . . . . . . . , . . . . . . . . im1j-J *El

I

Hot packs or heating pads . . . . . . . . , . . . . @lo * El

I

Cold packs or ice. . , . . . . . . . . . . . . . . . . ,O; 249 I 0 *cl

Rest . . . . . . . . . . . . . . . . . . . . . . . . . . . @ m *El

I

Traction . . . . . . . . . . . . . . . . . . . . . . . . . ,CI251 10 *cl

Exercises or physical therapy . . . . . . . . . . @,O *cl 7

I i

/

Aspirin . . . . . . . . . . . . 1. . . . , . . . . . . .

i 253 I 0

I

0 *cl

Cane . . . . . . . . . . . . . . . . . . . . . . . . . . . ; 2540I 0 *cl 1

Crutch . . . . . : . . . . . . . . . . . . . . . . . . . .

I@ q--J

I

*cl

Stiff mattress . . . . . . . . . . . . . . . . . . . . . @1n *cl

I

Bed board.. . . . . . . . . . . . . . . . . . . . . . .

i@lO I *cl

*cl

*cl

2;

*cl

*El

*cl

6b. Did it do you any good?

Yes

0220 1 c

No

*cl

0230 10 * r3

0232 I q * I--í3

0234 I n * LT1.l

@q-J * 1:27

0238 IL_I * cl

0 240E] 1 * L-111

0 2421_1 1 * r-1

0 244u 1 *Ill

102

. , , I I-.
7a. At the present time, does your back or neck condition I

restrict your physical activity very little, quite a bit,

or a whole lot?

I 258

I 0 i 0 Very little

i

I

2 L_! Quite a bit

/

3 q A whole lot

I

b. Have you ever had to stay in bed at home for long

periods of time because of your back or neck trouble? I@ 1 IYes

I

I

2 0 N o

I

C. Have you ever stayed overnight in a hospital because

of back or neck problems?

I@ i g Yes

I

1

2 0 N o

8. With respect to your back or neck trouble, would

you say your condition is mild, moderate, or severe? I 0 Mild

2 0 Moderate

3 0 Severe

-

t 9a. At any time during the past year did your back or

neck trouble cause you to cut down on the things you

;

usually do?

I 262

I 0 i IYes

I

I

2 n No - SKIP to IO

b. During the past year, about how many days did you

cut down on your activity?

i

i@--- Days

I

I

I

ooo FJ None - SK/P to IO -

c. During the past year, about how many days did i

your condition keep you from work or school, not

counting work around the house?

1 264 ---

I

0 & Days

I

I

ooo i

-.2 None

d. During the past year about how many days did your

condition limit the kind or amount of work around

the house you could do?

i

I@---

I

Days

I

I

I ooo q None -SKIP to 10

e, During the past year, about how many days has this i

condition kept you in bed all or most of the day? ia---Days

I

I

ooo [ None

‘Oa. Have you ever had pain, swelling, or stiffness in your I

back or neck as the result of an accident or injury? @

I

I 0 Yes - back

2 0 Yes - neck

3 q Yes - both

I 4nNo- SKIP to II

I

b. Do you think the accident or injury is the cause of any i

pain, swelling, or stiffness which might still be present? 1 268

I 0 1 L_I Yes

1

2 0 N o

I

I

9 c Don’t know

. 103
--

1 la. Hove you ever been treOted by a medico1 person

for bock or neck trouble? 0269 1 0 Ye*

2 f--J No - SK/P to 13

1

b. Was the medico1 person.0 -

I

I Yes No

I

General practitioner?. . . . . . . . . . . . . . . . . . . . $&r---J cl

Internist? . . . . . . . . . . . . . . . . . . . . . . . . . . . @Ia

I

cl

Rheumotologi St?. . . . . . . . . . . . . . . . . . . . . . . ;@1n cl

I

I Orthopedist?‘.... i.... . . . . . . . . . . . . . . . . @(o *cl

Chiropractor? . . . . . . . . l .,..,........... @lr-J cl

, Osteopath? . . . . . . . . . . . . . . . . . . . . . . . . . . . __ ,@q---J *cl

. ’

Physical therapist?. . . . . . . .,....I....... $&r-J

1

*cl

Occupotionol therapist? . . . . . . . . . . . . . . . . . . t 0277 I [1 21

I

i

Other? - Specify @I~ *cl

C. Whot did he soy the problem was? DATA PREPARATION USE ONLY

0 279 10 0 280 I i--J

@IO @iJn

0 283 I q 0 284 I q

d. Are you now being treated by o medico1 person for

bock or neck trouble? I 285 I !-J Yes

I 0

I

I 2 [ No - SK/P to I2

I

e. Is this o -

f Yes No

General practitioner?. . . . . . . . ,.......,... @lL? *cl

t

Internist? . . . . . . . . . . . . . . . . . . . . . . . . . . . I 287 0I q *cl

Rheumotologi st? . -

1

.,,...,,.............* @lo cl

Orthopedist? . . . . . . . . . , . . ,,,...a, a... ;@I0 cl

Chiropractor?. . . . . . . . . . . . . . . . . . , . . , . . . I@10 cl

Osteopath? ...i.; . . . . . . . . . . . . . . . . . . . . .

1

I 291 11-1

I 0 20

Physical therapist?. ,.*.*.. l ,,..,,..* . . . @Q--J cl

Occupotionol therapist? . . . . . . . . . . . . . . . . . . .

t

I293 0 10 21-I

I

I

I

Other? - Specify &+Cl *cl

f. Wkot did he soy the problem wos?

I

0297 q---J

0299 I (
120. Hove you ever hod on operation for o bock I

or neck diseose or injury? I

1 301 1 r]Yes 0

f

1

2aNNo-SKIP to 13

-u 1

b. Was it your bock or neck? I

i 302 10 Back

I

0

I

I 2q Neck

I

I

I

3 CJ Both

I

1

130. Hove you hod poin or aching in ony jo;C;t

other thon the bock or neck on most days

for ot least six weeks?

I

f

I @ 1 L_i Yes -Ask bond c ’ ~

I

I

I 20 No - SKIP to 14

I

b. Which joints were poinful? 1 7’ c. If “Yes,” - Which?

Yes No Left Both

I

Right

Fingers . . . . . . . . . . . . . . . . . . . . . . . .

)304 q-J 0 21 @ii3 ‘cl 20 31

I

I

\ Wrist . . . . . . . . . . . . . . . . . . . . . . . :. 1 0 306 ‘cl 20 @lo 2rr) SEl

I

I

Elbow . . . . . . . . . . . . . . . . . . . . . . . . . 1308 q--J 0 21 0309 ‘cl 2cl sl-1

I

Shoulder . . . . . . . . . . . . . . . . . . . . . . . . $ijq-J 20 0

311 10 21 scl

.I

Hip. . . . . . . . . . . . . . . . . . . . . . . . . . . @q---J 21 0

313 10 2cl sl-1

I

I

Knee . . . . . . . . . . . . . . . . . . . . . . . . . . i@q--J 2cl 0

315 q-J 2cl cl

I

Ankle. . . . . . . . . . . . . . . . . . . . . . . . . .

I

f

@IO 21-1 (g 10 21 31

I

Foot . . . . . . . . . . . . . :. . . . . . . . . . . . $&-J 21 (@y-J 20 SKI i

I

I

I

I

d. When wos the lost time you hod this poin? I

f So 1 n Have it now 1

0

I

I

I 2 q Less than I year ago, 

. . but not now

I

I

I

3 n I -2 years ago

I

I 4 m 3-5 years ago

I

I

I

s q 6 years ago or more

I

10s
L

140. Have you ever had any swelling of joints i

with pain present when the joint was

touched on most days for at least one month?

I 321 I q Yes

I

0 - Ask b

I 2 q No - SKIP to IS

b. Has this swelling been present on any

one occasion for at least six weeks?

I

I

I 322 1 q Yes

I 0I

I 2 @ No

I

G Which joints are usually involved whenever ,-b d. If “Yes,” - Which?

you have this swelling and tenderness

on touching?

I

I

1 Yes

Fingers . . . . . . . . . . . . . . . . . . . . . . . j@lO

I

Wrists . . . . . . . . . . . , . . . . . . . . . . . . ;&r-J

I

Elbows. . . . . . . . . . . . . . . . . . . . . . . . /OIL-J

Shoulders . . . . . . . . . . . . . . . . . . . . . . I 0329 I ;

I

Hips . . . . . . . . . . . . . . . . . . . . . . . . . i @ I 0

Knees . . . . . . . . . . . . . . . . . . . . . . . .

N o

21

cl

2n

cl

cl

Ankles . . . . . . . . . . . . . . . . . .

Feet . . . . . . . . . . . . . . . . . . . . . . . . . i@lO

2n

cl

Right Left

0 324 I LJ

0 326 1 0

0 328 I j---J

0 330 1 0

0 332 I 0

0 334 1 r-J

0 336 l[

0 338 cl

cl

cl

cl

cl

cl

cl

cl

cl

Both

31

this swelling of the joints?

0

339 I ( Less than 20 years old

I

1 2 q 20-29 years old

3 0 30-39 years old

4 q 40-49 years old

s 0 50-59 years old

6 q 60 years old or older

f. When was the last time you had this?

1 340 0 I INow

I

1

2 q Less than I year ago, but not now

3 a l-2 years ago

4 0 3-5 years ago

106
150. Have you had stiffness in your joints and

muscles when first getting out of bed in

the morning on most mornings for at least

one month?

i

I @ 1 0 Yes - Ask b

I

i

2 0 No - SKIP to 16

,

b. Has this morning stiffness been present i

on any one occasion for at least six weeks? I @J iiYes

I

I

2 q No

C. Which joints are usually involved

you have this morning stiffness?

whenever

Yes N o

Fingers ...................... @lo

I

cl

Wrists ....................... cl

Elbows. ...................... ‘@q--J

I

cl

Shoulders ..................... /@lo a-II

I

Hips . . . . . , . . . . . . . . . . . . . . . . .‘. 1 @ I TJ 2cIl

I

Knees . . . . . . . . . . . . . . . . . . . . . . . jolu 2cl 0354 1 r-J c!l 30

I

Ankles.. . . . . . . . . . . . . . . . . . . . . .@Jl@ 20

I

Feet..,..........,,...,..... I@,0

I Kl 0358 10 ~1 cl *

Back . . . . . . . . . . . . . . . . . . . . . . . .

I

!@1n

I

d. If “yes,” - Which?

Right Left Both

0344 1 @ 21 cl

0346 I 0 cl cl

0348 1 r-J cl 31

0350 1r-J cl ezl

0352 1 L--J 2L_I cl

0356 q---J cl 31

e* How long after getting up and moving around

does the morning stiffness last?

1

1 3600I q Less than I5 minutes

2 n I5 minutes to one half hour

f

3 m More than one half hour, but less than all day

I

I

4mAll day

f. How old were you when you first experienced 1

this morning stiffness of joints? 1’ 361 0I @ Less than 20 years old

t

I

2 [ 20-29 years old

3 q 30-39 years old

4 q 40-49 years old

s q 50-59 years old

6 @ 60 years old or older

go When was the last time you had this? I

;@ I 0 Now

f

1

2 0 Less than I year ago, but not now

I 3 0 I-3 years ago

4 0 4-9 years ago

5 q IO years ago or more

107
Ma. Have you ever had a iob which placed frequent

stress or strain on your back?

!

1 363 10 Yes

1

0

I

20No -SK/P to 17

b. Ho, long did you work at that kind of iob?

i@-- Months

I OR I

I 365 -- Years

I 0

17. Has a doctor ever told you that you had

mononucleosis?

180. Have you ever had yellow jaundice which

caused your skin or eyes to turn yellow?

I

@J 10 Yes

I

I

I

20 No

I

I@ 1 q Yes

I

I

I 2 a No - SKIP to g

b. When th i s happened,

become darker?

did your wine I

I @ 1 r]Yes

I

I

I 20 No I

c. Did your stools become lighter in color? I

I@

I

10Yes

I

I 20 No

d. Did your skin remain yellow for a month or longer?

e. Have you had yellow jaundice more than once?

f. How many times did you have it?

I

f @j 1 aYes

i

I 20 No

I

I

I

I @ 10 Yes

I

I

2 i---J No - SKIP to g

I

I

I

I

I

f @ _ .-, Times

I

As far as you know, hove you ever been ’

in contact with a person who may have

had yellow jaundice?

1 @ 1 q Yes

Ii

I 2(1 No

9 q Don’t know

19. Have you ever had an operation for

a hernia not including hiatus hernia

of the diaphragm?

I

I@ 1 m Yes

I

I

I 2m No

I

20. How many times have you used or had any

contact with carbon tetrochloride? @ o ] None

(Used, for example, in dry cleaning) 1 0 Once

2 0 2-4 times

3 0 5-9 times

4 q IO or more times

9 17 Don’t know

108
210. Are pesticides, such O S weed killers, insecticides, I

fungicides and other chemicals used for pest control, I

I Y i!S No Don’t know

used in your -

Home? . . , .

Garden? . . .

Yard?. . . . .

Place of emp I

Anywhere el!

I

. . ..a * . . . . . . . . . . * . . . . . . . . [,O 376 ’ III q-J 9 11:

. . . . . * . . * ..* . . . . . . . .,. . . . i@ ' c1 21 91 I

. . . . . . . . . . . . . . . . . . . . . . . . . I@ III' 21 90

oyment? . . . . . . . . . . . . . . . . . . .

I

, 0379 q---J *El 91

I

e around you? - Specify2 . . . . . . . . I@ 10 21 91

I

I

If ALL “NO’s” in Z/a, ask b; otherwise ask c

b. To your knowledge are any pesticides

used around you?

2L_I No

c. During the past 12 months, has anyone in

your family had pesticide poisoning

diagnosed by a doctor?

d. During the past 12 months, has your home or

place of employment been treated for pest

control by a commercial company?

I

I@ 1 q Yes

I

I

I

2LJNO .

.

I

;@ 1 L._I Yes

I

I

I 2( No

e. Are any disinfectants, such as Lysol or

Pine Oil, used in your home?

I

i@ 1 L-3 Yes

I

I

I

2[-JNo +

I

- /f Age 12-17, ask 22; otherwise SKIP to Question 23 1

22a. Have you smoked at least 100 cigarettes

during your entire life?

I@

I

I m Yes - As k b

I 21 ~~ - sw t0 23

I

b. Do you smoke cigarettes now?

r

I

I@ I r-1 Yes - Ask c

I

I 2 @ No - SKIP to d

I

c. On the average, about how many a day

do you smoke?

I

I

i@-- Cigarettes. per day

I Enter answer and SKIP to e

I

d. How long has it been since you smoked

cigarettes fairly regularly?

I

I

;O388 77 [ Under ot?e yea,r - Ask e

I

I

I

I

m-Years - Ent,er number of years aAd SKIP to f

1

’ .

I aa q Never smoked c+garettes regularly f SKIP to 23

I

I 99 a Don’t know - Ask e

I

e. On the average, about how many cigarettes

a day were you smoking 12 months ago?

L During the period when you were smoking

the most, about how many cigarettes a

day did you usually smoke?

go About how old were you when you first

I

I

;@--Cigarettes per day

I

I 88 [ Did not smoke

I

I

I

99 q Don’t know

I

I

started smoking cigarettes fairly regularly?

I@-- Cigarettes per day

I

I 99 0 Don’t know

I

I

i

i

I

I@--Years old

I

I aa 0 Never smoked regularly

I

I

99 0 Don’t know

109
’ 23a. Did a doctor ever tell you that you had ’

chronic kidney disease?

I

!loI 392 I q Yes

2( N o

I

I

b. Have you ever had pain or burning sensatiorl on urination

I

I

accompanied by more frequent urination thaln usual? 1 @j 10 Yes

2aNo- SK/P to 24

c. How many separate times has this happenled?

@Jr-- Times

I

24. Do you NOW have difficulty starting to u rinate? I

I

I*O395 1 pI Yes

i

I

20 N o

25. Do you NOW have periods of waking fr om sleep

I

I

two or three times a night to urinate?

I

‘I 2( No

%a. Have you ever noticed blood in your urine?

1

(FOR WOMEN - other than at the ti me of your period) i

I @ 1 aYes

i

I

2 i No - SKIP to 270

b. HOW many separate times has thi!; happened?

I

I@-- Times

I

C. When was the last time it happe ned?

I

1‘0399 I q Less than I year ago, but not now

2 q I-2 years ago

3 0 3-5 years ago

4 0 6 years ago or more

Notes

110
na. Have you ever noticed that your urine was I

a different color than the usual yellow?

(FOR WOMEN - other than at the time of your period)

$ij

I

i q Yes

I

20 No-SK/P to 28

b. how many different times has this happened? I

/ @j) 1 0 Once

I

I

2 q Twice

1 >

SKIP to e

3 0 3 or more

I

c. HOW old were you when it happened?

I

I

I

i (@ Years old

I

d. How long did the change in color last?

i 403 1 0 One time 0

1

I

2 [ One day

I SUP to h

I 3 q 2-6 days

I,

I

I 4 q I week or

I

longer

I

e. HOW old were you when it FIRST happened?

/ @ -- Years old

I

f. HOW long ago did it last happen?

i @ --Years ago

I

I

gc How long did the change in color last that time? I

’ 406 0

o 0 Less than one day

I

I

I

I - - Days

I

h, Did you see a doctor about it?

i. What did the doctor.say the problem was?

I

i 407 1 q Yes 0

I

I

I

2 r~ No - SK/P to 28

Do you have trouble with ydur bowels which makes

you constipated or gives you diarrhea? 1 408 I q Yes

1

0

- Constipation

i

z q Yes - Diarrhea

I

f

3010

aa. Have your bowel movements ever been white, gray, I

dark black, or streaked with blood? I@

1

1 q Yes

I 2 0 NO - SKIP to Question 300

I

b, Which was it? I

I Yes No

White. . , . , . . . . , . . . . . . , . . l l . l . l l - . . l l ë@ 10

I *

21

Gray .,....,.............. ....~ë.... I411 ë0

0 21

Dark black , . . , . , . . . . . . . . . . . l . . l . l l l l . ;@ln *cl

Streaked with blood . . . . . . . . . . l . l . . l - . - - l

21

111
30a. Do you hove a physical disability or handicap

which prevents or limits normal daily activitie’s,

such as the kind or amount of work that you

,’ Q-g ’ El yes

can do, housework, schoolwork, using public

I

I

transportation and so on? ;.

2 L-7 No - SKlj> TO INTERVIEWER CHECK ITEMIQ

I

b. What is the physical disability or handicap?

c. How long have you had this disability

or handicap?

I

I

I

/ 6,- Months

d. Does this disability or handicap I

PREVENT you from. . . . I

j e. Does it LIMIT you in

this activity?

(Age 18 and over) working at

a iob or business? . . . . . . . . . . . . . . . . . .

I Yes

I

I 417 q-----J

I 0

No

20

Yes

@q-J

No

20

I

I (Age 18 and over) driving a car? . . . . . . . . .

$ij 1 10 20 21

I I

\ I

(Under age 18) doing any I

regular school work? . . . . . . . . . . . . . . . . . @J 10 21 @ q-J 21

I

I

Using any public transportation I

such as buses, trains, and so on? . . . . . . . .@I ‘C 20 0424 I 0 2c.l

I I

I

Taking care of any of your personal f needs such as dressing or eating? . . , . . . . . 1 425

I 0 I p1 *cl 0426 ’ a 20

Doing work around the house? . . . . . . . . . . . i@ ’ III 21 IO428 1 0 2cl

r

INTERVIEWER CHECK ITEMti

i

I@ 1 [I Female - Ask Question 31

I

I 2 [I Male - END OF QUESTIONNAIRE

31a. How old were you when your periods I

or menstrual cycles started?

I

’

I a-,- Years - Ask b

a

I

I

I

02 [53 Haven’t started yet - END OF QUESTIONNAIRE

I J

b. Have your periods stopped entirely --

I

not counting pregnancy?

I

I 2 0 No - SKIP to d

c. At what age? i

I

ia-- Years - SKIP to 320

d. When did your last period or

menstrual cycle end?

I

1‘0433 00’0 Having it now

I

I

I

I

-m Days ago

112
I 320. Hove you token birth control pills

during the past six months?

;

1 @ I 0 Yes - Ask b

I

I

2 0 No - SKIP co 330

b. Are you taking them now? i

1 0435 1 0 Yes

1

I

2uNo

-330. Ii ave you EVER been pregnant?

b. What is the totol number of pregnancies

you hove had?

jo436 1I

Yes - Ask b

I

I

2 q No - END OF QUESTlONNAlRE

L

t

I

1 437 -

I 0 - Number

c. What is the totol number of

miscarriages you hove had?

d. What is the total number of live

births you have hod?

1 @ _ - Number

I

0440 1 cl Yes - Ask f

2uNo

>

SKIP co g

9 0 Don’t know

I

f. Which month of pregnancy are you in? I

I I

I

j@- - Month I

g. Have you had a pregnancy which

ended within the last twelve months?

h. How many months ago did that

pregnancy end?

I

I 442

f

0 I q Yes-Askh

I 2oNo-ENDOFQUESTlONNAlRE

I

I

I@ t 0 I O-12 months ago

I

2 0 7-9 months ago

3 0 4-6 months ago

4 q 0-3 months ago

i. Are you breast feeding?

END OF QUESTIONNAIRE I

113
Dietary-24 Hour Recall and Dietary Frequency

,! ,4 e

-L

t

I

--iI I

I

t

C

I

-i- -

PO!Jod UO!)Sakl I#?

. , - : ,
115
Dietary Supplement, Ages 12-74 Years ,

;So~,~,tl,RA4 13.

. . OEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Form Approved; O.M.B. No. 68-RI 502

/

PUBLIC HEALTH SERVICE

HEALTJI RESOaJRCES ADMINISTRATION

NATIONAL CENTER FOR HEALTH STATlSTlCS

HEALTH AND NUTRITION EXAMINATION SURVEY II:

DIETARY SUPPLEMENT AGES 12-74

o. Deck number 1 b. Age

(l-3) 313 I (4-W --

NOTICE - All information which w6uId wrmit identification of the individual will be held in strict confidence,

will be used only by persons engaged in and for the

purposes of the survey and will not be disclosed or

released to others for any purpose.

1 c. Sample number

I (a-10) m--mINSTRUCTIONS

This section of the examination contains questions about diets, medicines and problems you 1

might have that can affect your nutrition: For each question check the answer box which best

aoolies to YOU .

i

lo. Are you on a special diet? 1

1 (11) 1 DYES 2 0 NO - SKIP to guest/on 2a

b. If “YES,” is this diet -’

To lose weight? .................................

To gain weight? .................................

For diabetes? ......................... ..i*..e . .

*For kidney failure? ...............................

For ulcers? ....................................

For diverticulitis? l . ...*....**.**...*.*...**..*.. i (17) 10 cl

For allergies? . . . . . . . . . . . . . . . . . . . . . . . . . ..******e I 08) 1 0 2-1

For heart trouble?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I (19) 10 cl

For high blood pressure? .

. . . . . . . . . . . . . . . . . . . . . . . . . . .

I (20) 10 2tl

FEMALES ONLY - For pregancy? . . . . . . . ..*******e*.. I (21) 10 cl

For ony other reason? . . . . . . . . . . . . . . . . ..e.9*~~***.. 1 (22) 1 0 cl

If “YES,” give the reason I

I

I

I

c. What kind of diet is it - I

Is it -

f YES ’ NO

Low fat? . . . . ..*.......................**o**** ! (23) 1 0 cl

Low protein? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. 1 (24 I 0

1

21-1

High protein? . ..*.............................. (23) 1 q

Low salt? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 (26) 1 0

20

cl

Low carbohydrate? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i (27) 1 0 211

Low sugar? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i WI 1 0

Low co loriei . . . . . . . . . . . . . . . . .

Low cholesterol? . . .

. . . . . . . . . . . l . . . e . j (29) 1 f-J

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

High calorie?

) (30) 1 [3

l *.*..e**a........................ ; (31) 10

Vegetarian with animal by-products (eggs, dairy, etc.)? l .*e*** 1 (32) 1 0

Vegetarian without onimol by-products? . . . . . . . . . . . . . . . . .

’

; (33) 1 0

A blond diet? . . . . . . . . . . . . . . . . . . . . ..*........... ; (34) 10

Some other type? l ~~~~~.~~...~.....~.......~~....

If “YES,“describe the type of diet

I (3s) 1 0

I

!

cl

20

20

cl

20

a

cl

tll

d. About how long have you been on this diet?

Specify how many wee&s, months, OR yeofs

I

; (36-37) weeks

f (38.39)

I

1 (40.41)

months

years

l . Was this diet prescribed by o doctor, o dietition, or o nurse? i

1 (42) I OYES

1

20NO

116
&I. Have you token any of the following medicines or drugs I b. If “YES,” did you

within the PAST WEEK - I

!

toke it during the s

last 24 hours?

I YESJ-N O YES N O

Diuretics or pills for woter loss? . . . . . . . :;. . . . . . . . . . . . . I(49 ’ f--J 20 (44) ’ El CJ

Other medicines to lose weight except fluid pills?. ,......... i(45) 1 0 20 (46) ’ 0 20

Hormones? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; (47) 1 0 ill (48) ’ r] cl

Steroids? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i(49) 1 r--J 20 (SO) ’ 0 21-l

FEMALES - Birth control pills? . . . . . . . . . . . . . . . . . . . . . . p ’ 0 20 (52) ’ 0 20

Oilan+, used PO treat epilepsy 9r reitqres? . . . . * ., . . . . . . 9 F I(531 1 q 20 (54) 1 0 217

Medicine for lowering cholesterol? . . . . . . . . . . . . . . . . . . . . . I(55) 1 f--J 20 (56)- 1 0 20

Antihistamines (cold or hayfever pills)? . . . . . . . . . . . . . . . . . ; (57) 1 0 cl (58) ‘1 0 20

INH (Ironiaridi, a drug used foi TB: treatment _ I

and prophylaxis)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . l(59) 1 0

I

20 (601 1 0 2 0

I n

l IF YOU ARE 79 YEARS OLD OR YOUUCER YOU HAVE F/N/SHED THE FORM. THANK YOU FOR YOUR

YOUR COOPERATION.

l IF YOU ARE 20 YEARS OLD OR OLDER, PLEASE ANSWER QUESTIONS 3 AND 4. ’

3. 00 a y of the following problems FREQUENTLY prevent

you rom obtaining the groceries you need? r

I

t YES

Lack of transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . I(611 1 0

Lack of enough money . . . . . . . . . . . . . . . . . . . . . . . . . . . . ;(62) 10

A health problem - Specify j (63) 1 0

_ Any other problem - Specify !(64) 1 0

L

N O

20

20

Kl

cl

4. DO YOU FREQUENTLY have -

I YES

Trouble swallowing your food? . . . . . . . f

. . . .,. . . . . . . . . . . l/--J

Pain or discomfort.in your rtomoch ofter l oting?

p5)

. . . . . . . . . . . ;w 1 (--J

Spells of vomiting? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ;(67) 10

Spells of nausea? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ;wa 1 q

Loss of appetite? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; (69) 1 0

I

,

N O

cl

20

cl

20

20 ._.

Form completed by -

Comments

1 (70) 1 0 Examines

I

2 0 Interviewer - Specify beme _

I

r( ^

I

117
Medications/Vitamin Usage

FORM HRA-12-18

(5- 19.76) DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBL I C HEALTH SERVICE

HEALTH RESOURCES ADMINISTRATION

NATIONAL CENTER FOR HEALTH STATISTICS

HEALTH AbiD NUTRITION EXAMINATION SURVEY II

MEDICATIONS/VITAMIN USAGE

a. Name of examinee

Form Approved; O.M.B. No. 680R1502

NOTICE - All information which would permit identification

of the individual will be held in strictconfidence,wiII be used

only by persons engaged in and for the purposes of the survey,

and wil I not be disclosed or released to others for any purpose.

b. Deck number c. Sample number

304

INSTRUCTIONS

e

Please answer the following questions about the person whose name appears above. The questions refer only to the

person named above. For persons scheduled for an examination who are under 18 years of age, a parent, guardian; or

someone else who can provide the information about the child or youth should complete the form. Answer the questions

cs well as you can. In many instances, the name of a medicine or vitamin will be shown on the bottle label. Thank

you for your COOperatiOn. PLEASE REMEMBER TO BRlNG TN/S FORM WITH YOU TO THE EXAM/NAT/ON.

1. During the PAST WEEK has the person named above taken any vitamins

or minerals?

If “YES,” specify the brand name, manufacturer’s name, if known, and

the type of each vitamin or mineral.

Example

1:

I

I

; tOYES 2010 - Go to question 2

I

I

I

i Brand name/Manufacturer’s name Type of vitamin or mineral

I

k

I

I

Brand name/Manufacturer’s name Type of vi tamin or mineral I 1

’ i

+fl/* L& -A- j 2

~/~/GiAcJe-I3

t

I

I

14

2. During the PAST WEEK has the. person named above taken medicines,

drugs, or other pills?

If “YES,” specify the name of the medicine or drug and the reason

you are taking it.

Example

1

Name Reason

I

/5

.

I

I

; loYES 2 q NO - Go to question3

I1

I

I Name Reason

I

I

I

1

I 1

t

3. Relationship of person completing form to the person named above.

I 4

t

I

I

I 5

I

1 1 c] Self

i 2(1 Mother

I

, 3 0 Father

1

I 4 0 Sister

I

I

5 q Brother

6 c] Other - Specify

J

118
Behavior Questionnaire, Ages 2574 Years

ORM HRA-1 l-4

!-12-76) NOTICE - Al I information which

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE would permit identification of

PUBLIC HEALTH SERVICE

HEALTH RESOURCES ADMINISTRAT;ON

NATIONAL CENTER FOR HEALTH STATISTICS

BEHAVIOR QUESTIONNAIRE (AGES 25-74)

HEALTH AND NUTRITION

EXAMINATION SURVEY H

the individual will be held in

strict confidence, will be used

only by persons engaged in and

for the purposes of the survey,

and will not be disclosed or

released to others for any

purpose.

. Deck No.

317

b. Age c1 Sex d. Sample Number

0 Male 0 Female .O100

- - v----

I

INSTRUCTiONS - FOR EACH OF THE FOLLOWING QUESTIONS, MARK AU (X) IN THE BLOCK

FOR THE ONE BEST ANSWER FOR EACH QUESTION.

1. Do you ever have trouble finding time to get your ’

hair cut or styled? I 101

I 0 I c] Never

I 2 0 Occasionally

I 3 0 Almost always

I

2. When you are under stress or in a tense situation, 1

does your heart beat -

1 102 0

1 0 Go faster, harder or both?

I 2 0 Go slower or with an irregular “jumping” rhythm?

I 3 (-1 Remain the same?

I 4 0 Don’t know. I have never noticed.

I

3. Ordinarily, how rapidly do you eat? L

i@ 1 C l’m usually the first one finished.

I 2 0 I eat a I i ttle faster than average.

I 3 c] I eat at ab out the same speed as most people.

I

I 4 0 I eat more slowly than most people.

I

4. When you listen to someone talking, and this person @J

takes too long to come to the point, do you feel

I q Frequently

like hurrying him along? I

2 0 Occasionally

I

I

3 C .4Imost never

1

5. How often do you actually “put words in his mouth” 1 ,05

in order to speed things up?

f

0 I q Frequently

I

2 0 Occasionally

I

3 0 Almost never

- - I

6. If you tell your spouse or a friend that you will I

meet them somewhere at a definite time, how ;@ I 3 FrequentI?

often do you arrive late? I

I

2 0 Once in a while

I

3 0 Never late

1

7. Suppose you are to meet someone at 0 public place

(street corner, building lobby, restaurant) and the

1 0,07 , 0 Sit ond wait3

. 1

other person is already 10 minutes late. Wi II you - ) 2 0 Walk about while waiting?

II I

I

3 C] Usuolly carry some reading matter or writing paper

so you can get something done while waiting?

I

8. When you were younger, did most people consider I

you to be -

I 108

I

0 1 0 Definitely hard-d riving and competitive?

I

2 0 Probably hard-d riving and competitive?

I

3 0 Probabl y more relaxed and easy going?

. .

I

4 0 Definitely more relaxed and easy going?

9. Nowadays how would your spouse (or closest friend)

I

I

rate you? 1 109 0 I 0 Definitely hard-driving and competitive

I 2 0 Probably hard-d riving and competitive

I

I’

3 0 Probabl y relaxed and easy going

I

4 0 Definite1 y relaxed and easy going
10. When you’ore in the midst of doing o job and , ;

someone (not your boss) interrupts you, how do , 0110 I n I feel O.K. because I work better after

you usually feel inside? I an occasional break.

I 2 m I feel onl I

y mildly annoyed.

I

I

3 q I really feel irritated because most such

i

interruptions are unnecessary.

11. If rrpeoted interrupti

r8olly ongfy, do you

ons hove mode you

-

I

f0111 I CT] Tell the next interrupter in o firm way?

I

I

2 m Tell the n8xt interrupter in 0 quiet woy?

I

3 u Lock your door?

1

4 c Move to 0 quiet place?

12. When you ploy games with young children i

obout 10 yeors old (or when you used to do ’

; 112 0 I 0 Always

. so when your children were younger), how

often did you purposely let them win? i

2 0 Most of the time

!

3 q Half of the time

I

4 q Only occasionally

I

s 0 Never

13. When ploying on o teom or taking port in 1

some group activity -

I@ I 0 I am satisfied with myself only if my skill at

I that activity is better than most of the others

t

in the group.

I

1

2 0I am satisfied with myself if my skill is above

average for the group.

I

I

3 0 My satisfaction does not depend on how well I do,

I

since I take part only for enjoyment.

14. How do you feel about competition on

the job or in outside octivitias?

,. .

i1 114 0 1 c) Prefer to avoid it

I 2 q Accept it because it’s a necessary evi I

I 3 ( Enjoy it because it’s stimulating

I

15. Does your iob “stir you into action?”

.

i

I 11s

I

0

I q Less often than most people’s jobs

2 c] About average

i

3 0 More often than most people’s jobs

16. When you hove to work against o deodliue, is the quality of

your

work -

i

1 1 Better?

I

0 116 0

2 Worse?

.

0

1

17. Are you content to remoin at your present

iob level for the next five yeors?

_ .

3 0 The soml ( pressure makes no difference)?

I@ 1 IYes

i

2 0 No, I want to advance.

I

3 0 Definitely no. I strive to advance and would be

I

dissatisfied if not promoted in that length

I of time.

18. In the post three yeors hove you ever token

less thon your allotted number of vocation days? @

I

1 0 Yes

I

2 0 No

I 3 q My type of job does not provide regular vacations_

19. How mony different iob titles have you held in

the lost 10 yeors? (Be sure to count all shifts

in kind of work and to new employers, as well

as all shifts up and down in the firm(s) for

which you have worked.)

I

II19 0 i ~ZeroorOne

I

2 0 Two

t

3 r) Three

t

4 0 Four

I s 0 Five or more

r

I

.

20. Do you presently work ot o iob or business I

outside your home? I 120

I

0

I 0 Yes - Skip to Question 22

2 0 No

I

I

I b

120 .
I

21. Do you k88p hous or work around th8 hour8

a good d8al of th8 tim8?

i

0

121 1 q Yes

2 n No - Skip to Qhstion 23 I

I

22. In your iob (or hous8work) -

i

I Most Some

I

Hardly

I of the of the ever or

I

a. How much of the tim8 do you sp8nd i time time never

sitting doWn3•.~*~~~~~~..*~.,*.~.*,*,~. ‘0 cl

I

‘cl Oczl

4. HOW much of th8 tim8 do you sp8nd ’ I

walking or moving about? . . . . . . . . . . . . . . . . . ;(iisJ 20 ‘cl O!zl

I c. How much of th8 tim8 do YOU have to us8 lots

I

of arm, 189, or back musc!8s as in lifting, i

pulling, carrying, digging, and so on? . . . . . . . . . #iiJ 211 ‘cl OU I

I

23. Outsid of your iob or work around the house, i

how oft8n do you - i

I Hardly

a. Walk as much as a mil8 (S-9 blocks) a day

in getting to and from work, stor8s, ond

i Sometimes ever cir

:

. Frequent Iy

never

so on? f

. . . . . . . . . . . . . . . . . . . . . . . . ...*. @ 20 ‘cl Ocl

I

b, Tak8 hik8s or walks in good w8ath8r?. . . . . . . . . i @ 2 q

I ëcl On

C. Tok8 part in activiti8s which r8quiro i

a lot of body mov8m8nt or 8n8rgy, l ik8 I

ball gom8s, cycling, dancing, and so on?. . . . . . . f @ 2 0

I

‘i cl

24. Do you follow a REGULAR program of

physical 8%8rcis8?

@ 1nYes

I

I

2 0 No

25. On th8 av8rag8, ‘about how many hours p8? w88k do 1 1M

you sp8nd in mod8rot8ly strenuous or strenuous ; 0

o q LcSS than an hour

activiii88 quiring at I8ast OS much 8ffort as th8

fOllOWing 8%Ompl88: f -

,-,hours per week

Climbing up or down stairs, walking fast, using I

Q lawnmow8r, sawing wood, bicycling, dancing,

,

or playing t8nnis? I’

.

26. Filled oui by - 1 0 Examinte

i 2 (-J Interviewer

f 3 0 Both

1

121
Control Record

.

FORM HRA-12.1

T

FORMERLY HRA-12-l A Form Approved: 0,M.B. No, 68-R I502

(2-l 9-76) 1 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE NOTICE - All information which would permit

PUBLIC HEALT‘H SERVICE identification of the individual will be held in

HEALTH RESOURCES ADMINISTRATION

NATIONAL CENTER FOR HEALTH STATISTICS strict confidence, will be used only by persons

CONTROL RECORD

engaged in and for the purposes of the survey,

and wil I not be disclosed or released to others

HEALTH AND NUTRITION EXAMINATION SURVEY II for any purpose.

4

a* Name (First, middle initial, last) b. Deck No. C, Sex

300 q Male 0 Female

. 1

d. Date of birth t. Age f. Examination date g* Temperature

Month lDaY IYear Months I Years Month by 1 Year

I

I I

- - -- m- -

0)

- - 0

I

I 101 --;-A,-- 0102 ---.-

!

AGE TIME Procedure or part of overal I

PROCEDURE GROUP STAFF procedure not done

IN OUT (Enter reason for noncompletion)

(2) (3) (4) (5) (6)

1. Casual specimen

2, Body measurements AlI O104 m-k- 1050 s-L3, Physician’s examination All 0106 --I- w 107 0 -2-m

4. Veni puncture I All 0108 e-:-m 109 0 --:a--

‘5. Nutrition questionnaires All 0110 -&iv- 0111 --L -

6. Audiometry (air) 4-19 @--:--Q--:--

7. Speech test 4-6 0115 e-1116 0 w-:-m

8. Allergy test 6-n @ :-mm- :

9. Spi rometry 6-24 @ ,-__ :- - @ __ -:- -

10. Health History Supplement 12-74 @ --:--@ __ -:--

4

11. Glucose Challenge -7-s

12. Venipuncture II 20-74 @--LB @ e-:-w

13. Venipuncture Ill 20-74 @-w-- : 0128 - -:- -

14. ECG 25-74 @B-L- @m-L- . /

15. Chest X-rays 25-74 @F-*-m * 0134 - L- -

@ PREGNANT I /---J Yes 2CZ)No

I

16. Back and Neck X-rays 25-74 @ - -L - @ s -L -

17. Behavior questionnaire 25-774@-: -@ :--

TIME IN TIME OUT Sample number

N? 10164

0100

4

122
Body Measurements

FORM HRA-12-7

(FORMERLY HRA-12-7A)

(2-l 9-76)

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

HEALTH RESOURCES ADMINISTRATION

NATIONAL CENTER FOR HEALTH STATISTICS

BODY MEASUREMENTS

HEALTH AND NUTRITION EXAMINATION SURVEY IX

D. Deck No. b. Examiner No. c. Recorder No.

Form Approved: O.M. B. No. 68-R I502

NOTICE - All information which would

permit identification of the individual will

be held in strict confidence, wi II be used

only by persons engaged in and for the

purposes of the survey, and will not

be disclosed or released to others for

any purpose.

d. Age

Months Years

301 0101 - - --

OR --

I

NOTE - Measurement in cm. unless otherwise specified.

Measure left side also if the last digit of examinee’s sample number is 3 or 6.

1. Bitrochanteric breadth

I

I

I

i@--.-

I

I

I Right side

I

Left side

2. El bow breadth @ m-.- 0104 - -.-

I

I Right side Left side

I

3. Upper arm girth

4. Chest circumference - Midpoint

/@--*- 0106 --.- II

I

t

a. Erect (Ages 2 through 7) @ - -.-

____L_________---------------------- ----------------- t- ---------------------

I

I

I

I

b. Supine (Ages 3 and under)

5. Head circumference (Ages 7 and under)

/a--.- I)

8

I

I,Oho --•-

I

Right side Left side

6. Triceps skinfold (mm.)

7. Subscapular skinfold (mm.)

;

,o

111 --.-

I

I Right side

f

I@ --.-

I

I

0112 - -.-

Left side

0114 - -.-

80. Sitting height (Ages 2 and dver) I1115 0 --•-

--w-w------------ --__--------------- L______-----------_------_-____-___-------------

I

I

b. Crown rump (Ages 3 ond under) ,oI 116 p-.7

I

9. Is examine@ right or left handed? 18 I m Right handed

I

. ,

I

t

2 0 Left handed

10. Weight (Ibs.)

I

3 0 Uses both hands about the same

I

4 q Not sure

I

I Sample number

f

,Oi 118 -w-.-v 0100

123
I

I

Ilo. Standing height (cm.) (Ages 2 and over)

I

1119 0-- -.-

_________--------------------------- I------------------------------------ --- I

b. Standing height (inches) (Ages 2 and over)

1

1 -- /

--------------------___I________________----------------------------------- I

I

C. Recumbent length (cm.) (Ages 3 and under) I

IQ---•-

~-~~~~-~~----~~---~~~~---~------~~~~~~~~~~~~-~~~~ ---------------------------,

I

I

d. Recumbent length (inches) (Ages 3 and under) I

I --- I

12. Cervical Spine (Ages 18 ond over) I

I Right Left

I

a. Rotation (degrees) I 121 --- 122 -mv

----- I

--.-----.-------a.. --e--w------- .----m---e- 0 _--___-_____,___________________ 0

Severity of pain

(Mark one box in each column)

f 123 0 0 q None @ o 0 None

f 1 q Doubtful I q Doubtful

I 2 q Minimal 2 q Minimal

I

t

3 q Moderate 3 0 Moderate

I

4 q Maximal 4 q Maximal

i Right Left

b. Lateral bending (degrees) I1 012s - - - 0126 -mm

-------------------------------------------------------------- I ---e----m----

Severity of paln jo o fl None 0128 o q None

(Mark one box in each column) I

I 0 Doubtful I q Doubtful

I

I

2 q Minimal 2 0 Minimal

I 3 q Moderate 3 0 Moderate

I

t

4 q Maximal 4 q Maximal

13. Lumbar Spine (Ages 18 and over) i

Flexion Cl to SI f

a. Erect (cm.) 1129 0 ---

-.----------------------------------- -I --------- ----------------------s---w---.

I

124
Audiometry (Air), Ages 4-19 Years

~o~dii?A-12-10

(2-17-76)

Form Approved

O.M. 8. No. 68-RI 502

DEPARTMENTOFHEALTH,EbUCATION,ANDWELFARE NOTICE - All information which would

PUBLIC HEALTH SERVICE

HEALTH RESOURCES ADMINISTRATION permit. identification of the individual

NATIONAL CENTER FOR HEALTH STATlSTiCS will be held in strict confidence, will

AUDIOMETRY (AIR) be used only by persons engaged in

(AGES 4-l 9)

and for the purposes of the survey, and

will not be disclosed or released to

HEALTH AND NUTRITION EXAMINATION SURVEY II others for any purpose.

a. Deck No. b. Audio No. c. Examiner No. d. Age

306 0101 -mm--. 0102 -m -m -

b

START HERE IF SAMPLE NUMBER EVEN START HERE IF SAMPLE NUMBER ODD

1. AIR CONDUCTION - RIGHT EAR 2. AIR CONDUCTION - LEFT EAR

Retest R with Frequency Retest L with Frequency

masking on L* 0-W Hearing level masking on R* 0-M Hearing level

(a) W (4 (4 ib) (4

3

103 IO00 0104 Cl1cs IO00 0106

-

3

107 2000 0108 0109 2000 0110

3

111 4000 0112 0113 4000 0114

3

115 500 0116 0117 500 0118

@ 1000 0120 0121 1000 0122

3. CONDITION AFFECTING TEST RESULTS *Retest poorer ear with A/C masking on better ear only if

differences in A/C-l% between the two ears is 40 dF3 or more

Mark all that apply

3

**Specify frequencies affected and describe

123 I j--J None -7

*

2 q Cold or sinusitis now

3 fl Ear discharge

4 q Ringing or other noises in ears

3

124 5 0 Equipment defect**

*

6 q Cold or sinusitis within one week

7 q Earache within week

a q Other - Describe**

-7

Notes

Sample number

0100

I

Q

I ’

/ I

125
Allergy Testing

;o;~M,IJRA.~ 2-29 Form Approved: O.M.B. No. 680RI502

w -

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE NOTICE - All information which would permit

PUBLIC HEALTH SERVICE identification of the individual will be held in

HE.:i-TH RESOURCES ACMINISTRATION

NATIONAL CENTER FOR HEALTH STATISTICi: strict confidence, will be used only by

ALLERGY TESTING

persons engaged in and for the purposes of

the survey, and wil I not be disclosed or

HEALTH AND NUTRITION EXAMINATION SURVEY II released to others for any purpose.

I. Deck No. b. Examiner No. c. Sex

309 @ -- - aMale 0 Female

NOTE - If examinee has a history of strong positive reactions to allergy tests,

aspirin, or other drugs, consult doctor before giving allergy tests.

.

E Allergen

Wheal Confluent Flare

Reading * Minutes ** Test

= Length (mm) Width (mm) Yes Length (mm) Width (mm) results

i

(1) (2) (3) (4) (5) (7) (8) (9) (10)

1 House dust First @ m-103 104 0 - - 0q--J 20 0105 - - 0106 - - 0107 - - 0108 - -

Second @ 0 110 0 111 10 2r-J - - m - @ - - 0113 - - 0114 - - 0115 - -

2 Altemaria First @ v- 0117 - - 118 010 20 0119 - - 0120 - - 0121 - - 0122 - -

Second @ - - 0 124 @ ‘cl q-J @ w- 0127 e- 0128 - - 0129 m -

3 Cat First 0 m-130 0- -132 '0 20 0133 - - 0134 - - 0135 - - 0136 - -

Second @ @ @ 10 2( @ - - 0141 - - 0142 - s 0143 - -

4 Dog First @ @ @ 1 0 2 0 @ @ @ @

-- 0152 153 0 q--J 20 0154 m - - - 0155 - - 0156 - - 0157 - -

5! Ragweed First @ 0159 160 0I[ 20 162 -- -- @ 163 . - - 0 - - 0 w- @ - -

Second @ -- -- 0 166 @ q-1 20 @ - - 0169 e - 0170 - - 0171 - -

6 Oak First @

-m -- 0173 174 0q---J 20 0175 0176 0177 - - 0178

Second @ - - 0 180 0 181 1 u 2[ 0182 - - 0183 - - 0184 - - 0185 - -

7 Rye grass First @ - - 0187 188 01 [Is] 20 0189 0190 0191 - - 0192 - -

Second @ -- -- 0 194 0 195 1 r-J 20 @ - - 0197 - - 0198 - - 0199 - -

8 Bermuda First grass 0200 201 -- 0 0204 0205 0206 - - m - - - - -

Second @ - - 0 208 0 . 209 'u 20 @ w- 0211 m- 0212 - - 0213 m -

9 Control (di luent) First @ - -0215 B L0216 '0 20 0217 -- 0218 - - 0219 - - 0220--

Second @ -m0 222 - - @lo 20 @ - - 0 225 -- 0226 - - 0227---

0 Histamine First @ -- -- 20 @i) - - 0232 -w 0233 -m 0234 -e

Second @ s-0 236 e-0 237 I j--~ 21 0238 -v 0239 - - .O240 v - 0241 - -

d. Was test

satisfactory? 0242 1 [.J Yes 2 [-I] No (Give reason)

-

*Minutes from administration to reading record only if time differs from 10 minutes

for first reading and 20 minutes for second reading.

**Test result Codes and Definitions

10 No reaction 17 Both 15 and 16

11 Erythema between 5 and 21 mm in diameter 18 Test not given

12 Erythema larger than 21 mm in diameter-no wheal

- Doctor's orders (Sp~ifyl

13 Wheal with or without surrounding erythema

14 Whesl with pseudopods and surrounding erythema 19 Test not given - other reason (Spcpyj n

15 Test not given. Doctor’s orders - cat, dog, or Sample number

ragweed positive history of skin test

16 Test not given. Doctor’s orders - cat, dog, or

ragweed hi story of allergy

20 Erythema between 1 and

4 mm in dianetw 0100

. . ..___Lmnx7. -.‘.* _.%>. a- "v- . . m..- - _ --w."- ..,*U.."Fs,n- - - ,-.,, w... - .,e- .-.--.,.e . . ...-m-.-^_N_

126
Spirometry, Ages 6-24 Years

:,“p76,HRA- 12-9

I

Form Approved : O.M.B. No. 68-R I502 m s

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

HEALTH RESOURCES ADMINISTRATION

NATIONA L CENTER FOR HEALTH STATISTICS

SPIROMETRY (AGES 6-24)

HEALTH AND NUTRITION EXAMINATION SURVEY II

a. Deck NC. b. Age c. Examiner name

311 --

NOTICE - All information which would permit

identification of the individual will be held in

strict confidence, will be used only by persons

engaged in and for the purposes of the survey,

and will not be disclosed or released to others

for any purpose.

I Examiner No.

I

l

I 101 I 0

d. Room temperature

I

e. Uncorrected barometric pressure

0102 - - Oc 1 @ - - -.-mm.Hg.

f. SPIROMETER ~ r

I

I

Was test satisfactory?. . . . . . . . . . . . . . . . . . . . . . .I 104 01 q Yes

I

z q No (Give reason) 3

Notes

I

Sample number

0100

127
Liver Function Test, Ages 35-74 Years

FORM HRA-12-31 Form Approved

:3-Q-76) O.M.B. No. 680RI 502

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

NOTICE - All information which would

HEALTH RESOURCES ADMINISTRATION permit identification of the individual

NATIONAL CENTER FOR HEALTH STATISTICS will be held in strict confidence, will

LIVER FUNCTION TEST be used only by persons engaged in and

(AGES 35-74)

$or the purposes of the survey, and wi I I

not be disclosed or released to others

HEALTH AND NUTRITION EXAMINATION SURVEY IL for any purpose.

.

u. Deck No. b. Examiner No. c. Age

314 0101 -- -m

1. How many hours ago did you have your last meol? I

I

I@ -- Hours ago

2. Do you have an allergy to eggs or I

egg products? /@ I q Yes - Give substitute challenge (e.g. candy bar,cream cheese)

3. Challenge given

4. Time X-NOG or substitute ingested

5. Proportion of X-NOG drunk

- -

6. Time blood drawn

7. Was test satisfactory?

Notes

I z=No- Give X-NOG I

I

I@

1

I q X-NOG

I 2 0 Substitute

I

I

I

I

1105 --I---

l0 @ 1 0 A.M.

I

I

2 0 P.M.

I

I

p 1 cl All

I

2 r-J 314

I

I

3 0 i/2

I

I

4 0 I /4 or less

l

I

/@em:-- @ 1nA.M.

I

I

2 q P.M.

I

i(iiiiJ i q Yes

I

I

f

2 0 No - Give reason

I

t

I

I

Sample number

0100

128
Glucose Challenge, Ages 20-74 Years

FORM HRA-12-32 Form Approved

(3-2-76) O.M. 6. No. 68-R I 502

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE .

PUBLIC HEALTH SERVICE NOTICE - All information which would

HEALTH RESOURCES ADMINISTRATION

NATIONAL CENTER FOR HEALTH STATISTICS permit identification of the individual

GLUCOSE CHALLENGE

will be held in strict confidence, will

be used only by persons engaged in

(AGES 20-74) and for the purposes of the survey, and

will not be disclosed or ieleased to

HEALTH AND NUTRITION EXAMlNATtON SURVEY II others for any prupose.

a. Deck No. b. Examiner No. ce Age

315 0101 _ -

- -

1. Are you currently’taking insulin? I

1 0102 I q Yes (DO NOT GIVE GTT)

f

I

2 0 No (Ask Question 2)

2. Are you currently taking diabetes pills?

i

I 103 I 0 I q Yes

I 2 0 No (Ask Question 3)

3a. How many hours ago did you have

I

your last meal?

---_------- --------------I----------

b. Have you had anything to eat or drink,

except water, since that meal?

-----e-4 _____-___-------------------

c. If “Yes,” wl;gt was it?

------- _-_--------------------------

d. How many hours ago did you have it?

4a. About how many glasses or bottles of beer

have you had in the last 24 hours?

I - - Glasses or bottles

------- ---------s--m----- ----------- ----------------------e------------a--. t

b. About how many glasses of wine have you I

had in the last 24 hours? 1 108 o 0 None

i

0

-Glasses

-__-_-_---------------- ------------- --------- c - ---------------------- ---- ---.

c. About how many drinks of liquor have you

had in the last 24 hours? o 0 None

I

I

I -

-Drinks

50. Time glucose given I

I 110

I

0 . 0111 I q AA.M.

. --m-w

2 /---I P.M.

_____________--------------- --_-----

b. One hour specimen drawn

f----- ---_-__----__ -----------------.----

. 0113 I q A.M.

mm-m.

I

2 q P.M.

-__--------B-m _-__----_--_---------- t ----,,,-,,,~----d----L---~---------~~~

c. Two hour specimen drawn I

1 114 I 0 . 0115 I p1 A.M.

I ---m.

I 2 n P.M.

I

6. Was test satisfactory? I

I@ i OYes

I 2 r-J NO (Give reason)

. I

I

I

Notes Sample number

0100

129
Speech Pathology Test, Ages 4-6 Years

Form Approved

O.M. 6. No. 68-R I502

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

HEALTH RESOURCES ADMINISTRAT i>N

NATIONAL CENTER FOR HEALTH STATISTICS

SPEECH PATHOLOGY TEST

(AGES 4-6)

NOTICE - All information which would

permit identification of the individual

will be held in strict confidence, will

be used only by persons engaged in

and for the purposes of the survey, and

will not be disclosed or released to

HEALTH AND NUTRITION EXAMINATION SURVEY <II others for any purpose.

I. Deck No. b. Examiner No. C. Examiner name d. Age e. Sex

308 @

0 Male

- - /-‘J F&ale

) f. NOTE - Hearing aid should be worn during test if examinee normally wears one.

0102 I C] Hearing aid worn

2 CJ Does not wear hearing aid

I. SPEECH PATHOLOGY TEST

READ - “(Now we’re going to play a game.) I’m going to play some words and sentences on this

machine. You say just what the machine says. Let’s practice. ‘Hello’ (Hello.) ‘I’m fine,

thank you.’ (I’m fine, thank you.) ‘Is it raining?’ (Is it raining?) Good. Let’s go on.”

Note - Sentences may be repeated once.

1. Let’s talk together. 10. Aft= Dad fixed my bike I Iode around a lot.~

2. I like you. 11. My aunt who fell souldn’t walk.

3. Robert found a shiny penny. 12. Let him go to the ztore because we need some milk.

4. He wants to wa& himself. 13. Where wi II they sing for the &i Idren?

5. Someone burned a hole in the lug. -14, If you eat too much candy, you’ll be sick.

6. Why didn’t @ey tell anoaer story? 15. We &ought the baby knew how to say thank you.

7. She put the coyer on the jar _very tightly. 16. Joe must have bought three oranges.

8. There’s no reason for fighting with him. 17. It’s not for me but I would like to look at it.

9. Is Ralph playing a different game?

t. Conditions affecting the test

0103 I n None - Test was satisfactory 5 C] Unable to o ow directions due to lack of concentration f II

2 q Does not speak English 6 C] Equipment failure

3 0 Hoarseness or laryngitis due to cold 7 0 Some other problem - Explain

4 0 Strained voice in past few days

Notes

Sample number

0100

130
Physician’s Examination, Ages 6 Months-74 Years

DRtvl HRA-12-3

-27-76)

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUB! IC HEALTH SERVICE

HEALTH RESOURCES ADMINISTRATION

NATIONAL CENTER FOR HEALTH STATISTICS

PHYSICIAN’S EXAMINATION

Form Approved: O.M.8. No. 68-R 1502

NOTICE - All information which would permi

identification of the individual will be held ir

strict confidence, will be used only by person:

(AGES 6 MONTHS - 74 YEARS)

engaged in and for the purposes of the survey,

and will not be disclosed or released to other3

HEALTH AND NUTRITION EXAMINATION SURVEY II for any purpose.

I Name (First, middle initial, lost) b. Deck No. ’ c. Age: I d. Pulse

302 Months

4R

Years 0101

-m

g. Examiner No.

-mw

Blood pressure (age 6 years and over) f. Cuff Width

Systolic Diastolic 0104 I 0 Adult

1‘2 --- 0103 2 I-J Child 0

10s ---

0 HEAD, EYES, EARS, NOSE, ; @

l

AND THROAT:

I 0 Findings Aa HEAD, EYES, EARS, ;

I

If findings, mark applicable I 2 0 No NOSE, AND THROAT: 1~

Continued I - findings I Yes

box and continue with I. I 25. Serrations or swelling

If no findings, SKIP to 0 ; Yes

;

of tongue . . . . . . . . . . I 1310 i 0

1. Dry, staring hair . . . . . . . i@lO 26. Scarlet beefy tongue . . . I@I 10

2. Oyspigmented hair . , . . . . '0I 108 I 0

I@ 10

27. Magenta tongue . . . . . . / 133 0 I 0

3. Easily pluckable hair . . . .

i

28. Bleeding gums . e . . . . .@J l]

‘4. Abnormal texture or loss i 029. Diffuse marginal I .

of curl . . . . . . . . . . . . . . 1110 10 inflammation . . . . . . . . 1135 0 10

5. Circumcorneal injection . . . 18 10 30. Swollen red papillae . . . @, 10

6. Conjunctival injection . . . . i@ I 0 31. Recession . . . . . . . . . /8 l/-J

7. Angular blepharitis . . . . . . @ 10 32. Naso-labial seborrhea . . I @ I 0

8. Pupils and Iris . . . . . . . . i@ l( 33. Visible enlarged parotids ;cr;;;, , 10

9. Xerosis . . . . . . . . . . . . . i@ 1 0

I

34. Bossing of skull . . . . . i @ I 0

10. Lesions of Cornea (other). . /@ I 0 I 0

.

i@ l@

35. Other - Devribe . . . . . i @

I

11. Bitot’b spots . . . . . . . . . .

I

I

I

12. Conjugate Gaze . . . . . . . . I@ 10

I B. EXTERNAL EAR I ,

i@ 10

I

13. Keratomalacia . . . , . . . . .

(Except canal) I Right Lefl

I

i@ 1. No findings -

I

14. Strabismus.. . . . . , . . . . . I 0

15. Xerophthalmia , . . . . . . . . /@ I 0

SKIP to c . . . . . . . . . . @ 1 q @ 1 0

2. Findings -

I

I

I$. Conjunctiva (other) . . . . . . I@ I q

I

17. Lids and Sclera (other) . . . @ I 0

18. Angular lesions of lips . . . @ I 0

Continue with 3 . . . . . . 1 21 21

I----____--_------

3. Operative scar . . . . . . I@ 10 0145 1 0

1

-----------------

19. Angular scars of lips . . . . I@ 10

4. Other - Desycribe . . . . . I@

I

I 0 @ I j-J

I

20. Cheilosis . . . . . . . . . . . . @ I q II

21. Filiform papillary atrophy 1

of tongue . . . . . . . . . . . . 18 10

22. Fungi form papi I lary hyper- I

trophy of tongue . . . . . . . . i@ 10

23. Geographic tongue . . . . . . @ 10

24. Fissures of tongue . . . . . . I 130 0 I 0

I

I

+--qe;- _-------

I Yes

5. Pierced ears . . . . . . . . /@ 10 @ 10

* Sample number

,Oloo

131
AUDITOUY CNUL I . t Riglit Left

1. No findings - 1

SK/P ,to 0 .oo..bbb.* @lo (G&o

2. Findings - I1

Continue with 3 . . . . . l I 2 0 20 ;----L7-,---------

3. Occluded - 1

I

b. Completely. . . . . . . . ; 2 0 20 pLIIIIIILII------

4. Occluded by0. Cetumen . . . . . . . . . 1@lO 0 155 1f-J

1

b. Other - Dcpik. . . . I

1

2 0 a 2 0

1. DRUM i

I Right Left

2. Findings - i

CoMinuc with 4 . . l . . . 1 2 0 20

1

3. Not visible . . . . . . . . . t cl 30

~----...- ---a----me

4. Dull (Opaque). . . . . . . . #&f-J 0159 10

5. Transparent . . . . . . . . . : 2 n 20 L L-I-------------

1

6. Bulging . . . . l . . . . . . . . #i&o ($0

I

7. Reuacted i

. . . . . . . . . . 1 p(1 21

8. Cakium plaques. . . . . . i@q-J 0163 I 0

r

c-II------------

9. Red . . . . . . . ..b.bbb 0165 t 0

10. Othet discolorations . . . i 2 0 20

c -----II-----L---

11. Fluid . . . . . . . ..bbb. (i&o

~~~~~---~~--.

12. Scars . . . . . . . . . . . . . @Jo (ii&f-J

+----------~

13. Perforated

1

I

I

l . With discharge . . . . . :@cl 0171 1 0

b. Without dischrge . . . I

1

20 20

. MARES . I

I Right Left

1. No findings -

I

SKIPtoF . . . . . . . . . . 0175 1 r-J

2. Findings -

1

I

Continue with 3 . . . . . . t 2 CJ 20

I- ----------------

3. Obstruction t

o. Acute . . . . . . . . . . .

t@q ($0

b. Chronic. . . . . . . . . . i 2 (-J 20

‘B”-‘-----..s---w..--’

I

4. Other significant I

findings - 1

4

a. Deviated septum . . . . 0t 178 1 0 0179 10 t --a---------w---

I

b. Swollen turbinates . . . i 180 I 0

i0 0181 1 0

-------------L-ec. Chronic inflammation @lo (ii&a

f------------L---

d.Polyps . . . . . . . . . . :@q-J @q-J

l . Other - Degcribe. . . .

~G~~;-~G~~;

I

I

~~- I

:

.

NECK I

1. No findings - ’ i

SKIPtoG . . . . . . . . . . @ 10

2. Findings - I

Continue with 3 . . . . . . 1 2 0

3. Adenopathy . . . . . . . . . I @ 1 0

I

4. Tracheal deviation . . . . 1 0 190 1 0

1

5. Other - Devribe . . . . . 1 0 191 1 0

i

C. TWROID EVALUATION-~ @ 1 0 Group 0

1. (WHO Classificatiorr) 2 c] Group I

3 r--J Group 2

1

*I

4 0 Group 3

2. OTHER THYROID

f lNDlNCS -

‘0; 193 I 0 FindingsI

I

2 0 No findings -

1

GO to l-l

R L Both

I*

0. Tenderness . . . . . . . @J1n 2130

b. Nodule . . . . . . . . b. I@10 2)13n

C. Isthmus 1 . . . . . . . . . .

,@pcl

d. Other - Dqpe .

I

‘I /
H. CHEST EVALUATtON - b . i@ 1nFwJings ” *‘ ~ .

If findings, mdrk applicable box ond continue with 1. . I ‘

If no findings, SK/P to H6.

I

I

2 0 No frndings

I

Yes

1. Beading of ribs . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . , 1(199) 10 L

2. Follicular hyperkeratosis of upper back. ................. I@

I

1 0

?1. Wheezing on auscultation

I

. o. Diffuse. .................................... @i) 10

b.Focal.............. ........................ @la

4. Decreased breath sounds (diffuse) ..................... @

f

1 (-J

5. Masses (Breast) .................................

I0*O’ l o Right

20L :ft

3clB >th

-

wheetc 6. Auscultation

1 Dimin.

brth. ” bs

Absent

sounds f

. .

Rales ’

I

Rhonchi Bronchial

bcs.

Right chest

020s 1 0 No findings -

Upper lobe 0207 1 0

2 0 Findings

Middle lobe 0212 1 0

Lower lobe 0217 I 0

Left chest

Upper lobe

Lower lobe 0227 I 0

7. Other chest findings

0231 1 0 None 2 0 Findings

Notes

Sample number

133
I. HEART i

1. .P.M.l. (Age I8 and over) . . . . . . . . . . i 2320 1 0 Felt 2 ( Not felt

2. Interspace. . . . . . . . . . . . . . . . . . . . i 233 0 4 q s q 6 q 7 0

3. Midclavicular line. . . . . . . . . . . . . . l

;@ 1 /--J At 2 [7 Inside 3 0 Outside

4. Thrills . . . . . . . . . . . . . . . . . . . . . . ’ 233

I 0 10 Absent 2 0 Present

o. Systolic. . . . . . . . . . . . . . . . . . . . i 2360 1 0 Base 2 0 Apex

b. Diastolic. . . . . . . . . . . . . . . . . . . j 237 0 1 0 Base 2 n Apex

5. Heart sounds I

I

a. I st heart sound. . . . . . . . . . . . . . . 1 238 0 1 0 Normal 2 13 Accentuated 3 0 Diminished

b. 2nd heart sound. . . . . . . . . . . . . . . 1 239 0 I [zl Normal 2 ,a Accentuated 3 0 Diminished

6. Murmurs . . . . ‘. . . . . . . . . . . . . . . . . 1 0240 1 0 None - SKIP to 7

I------------------------------------------------

i

Systolic murmur(s) Diastolic murmur(s)

a. Type . . . . . . . . . . . . . . . . . . . . . 1 241 1 0 Functional 242 1 0 Functional

I

0 0 2 0 Organic 2 0 Organic

I

;--

9 0 Don’t know 9 0 Don’t know

---------------------c----------~-~-~----~-~~-~~~

b. Location I Grade Grade

(1) Apex.. . . . . . . . . . . . . . . . . . I@ cl22(33(440~cl60 @‘~po30405060

(2) Midprecordium . . . . . . . . . . . . . ’,@ ln2~3n4n5[76~ @ ~~2~3~4~~(6(

L -----------------------------------------------

(3) Left base . . . . . . . . . . . . . . . . /@ 1(2(3~4n5060 ‘@&~203040~~60

L -----------------------------------------------

(4) Right base . . . . . . . . . . . . . . . j@ 1~2n3~4~5~6n @ ln2n3y)405~6~

c. Origin ;

1

Systolic Diastolic

(1) Mitral. . . . . . . . . . . . . . . . . . . 1 251

I

0 10 4x.l

(2) A’ortic . . . . . . . . . . . . . . . . . . 1 252 0 1 0 2cl

(3) Tricuspid . . . . . . . . . . . . . . . . /@ q-J 2cl

I

(4) Pulmonic . . . . . . . . . . . . . . . . . I 254

I 0 I I=] 20

(5) ASD . . . . . . . . . . . . . . . . . . . . /@q-J 2cl

(6) VSD . . . . . . . . . . . . . . . . . . . . @q-J 20

(7) Other. . . . . . . . . . . . . . . . . . .

I

I@I1 0 20

(8) Don’t know . . . . . . . . . . . . . . . 1258 90 ci 0

Both

31

3cl

30

30

31

3cl

30

7. Other cardiac or 1

cardiovascular findings . . , . . . . . . , . ‘I 259

I

0 1 ~1 No - SKIP to J 2 0 Yes - Cbntinue

a. Edema.. . . . . . . . . . . . . . . . . . . . , 0260 1 0

with 7a

b. Cyanosis. . . . . . . . . . . . . . . . . . . ‘@ CJ

I

c. Irregular pulse . . . . . . . . . . . . . . . I 262 1 0

I 0

d. Other - Devribe . . . . . . . . . . . . . I@ I a

I

1

e. Neck vein distension . . . . . . . . . . . I0264 1 0

I

FORM HRA.12-3 (2.27-76) Page 4

134
J. PULSE - ARTERIAL EVALUATION I

(Age 18 and over) I

I. Palpation

I Sclerotic and

I Normal Sclerotic Tortuous Tortuous

\

a. Right radial . . . . . . . . . . . . . . . . . . . . ; 265 0 I 0 cl 31 41

b. Right femoral . . . . . . . . . . . . . . . . . . . @lo , 21 3c.J 411

c. Right dorsalis pedis. . . . . . . . . . . . . . . @lo 21 scl 4m

d. Left radial. . . . . . . . . . . . . . . . . . . . . i @ 1 0 21 Jrl 41

e. ‘Left femoral. . . . . . . . . . . . . . . . . . . . '@1= , 2c.l Jcl 4cl

f. Left dorsalis pedis. . . . . . . . . . . . . . . . /@lo 21 31 4cl

I

2. Pulsations I Normal Diminished Bounding Absent

o. Right radial . . . . . . . . . . . . . . . . . . . . @lU 21 31 4cl

b. Right femoral . . . . . . . . . . . . . . . . . . . iI@ 1 q 21 scl 41

c. Right dorsalis pedis . . . . . . . . . . . . . . 1 273 0 1 0 21 31 41

I

d.Other-Devribe . . . . . . . . . . . . . . . . @ 1 n 21 . 3 cl’ cl

i

I

e. Left radial. . . . . . . . . . . . . . . . . . . . [@lo 20 31 41

i

f. Left femoral. . . . . . . . . . . . . . . . . . . . ; @ 1 0

g. Left dorsalis pedis . . . . . . . . . . . . . . . 1 277 0 1 c)

h- Other - Deqyibe . . . . . . . . . . . . . . . . @lo

I

I

I

c. ABDOMINAL EVALUATION

AND KIDNEY

1 279 1 0 Findings

I0

If findings, mark applicable

I 20 No

box and continue with I. I findings

If no findings, SKIP to L.

I

I Yes

I

1. Hepatomegaly. . , . . . . . . . . @lo

2, Splenomegaly . . . . . . . . . . . . . @lo

3. Uterine enlargement . . .-. . . . . I282 0 1 c]

4. lnguinal hernia. . . . . . .‘. . . . . '@q-J ,

5. Femoral hernia. . . . . . . . . . . . I@ ii I

6. Umbilical hernia. . . . . . . . . . . I@ 1 0

I

7. Pot belly . . . . . ; . . . . . . . . . @ q--J

8. Mass(es). . . . . . . . . . . . . . . . /@q--J

(11 Area(s) - Enter number(s) l . ; 288

I0 -s- - -

(2) Other findings - Devribe . . @ 1 0

I

I n 1

I

3. Surgical scars . . . . . . . . . . . . @ q-J

(1) Area(s) - Enter number(s) . . I@----- ,

(2) Other findings - Devribe . l @ 1 0

I

I

I

l

Sample number

10. CVA Tenderness. . . . . . . . . . . I@ 1 q .

II

135
In

cl m

dJ

ml - N 3z

(Y

--

?i m

ItlIt - N z3N

:::::::::::::j::::::::::::j:, .‘.....‘.‘.............. ..I. :::::::::::::::::::::::::::::, .:.: :.:.:.:.:.:.:.:.:.:.~i :.:.:.:.:.:.:.:.:.:.:.:.:.:.: . . . . ...‘.........‘.5........ :::::::::::::::::::::::::::::: . ..-.... .::...... . . . . . . .

:::~:::::~:~::~.:::::::~ :::::::::::::::::::::::::::::: ::::::::::::j:::::::::::::::, :::::y$::::::::::y$:yf R::~::::::::::~:::::~::’ . . . ..‘............Z a....... :::::::~::::w::::::::::: :~:.:::::~.~.::::::::::::::: :::::::~:::::::::::::::::::: . . . . . . . . . . . . . . . ~.:.:.:.:‘:.:.:.:.:.:.:.:.:, ::::::::::::.:%~.::::~~:::::: ;:::::::::::::::;:::::;::::::, . . . . . . . . . . . . . . . ~~:.‘.:.:.:.:o:.:.:‘.:.:, :::::v::::::::::::::::::::::: m

cl Lm

dJ

Llc - N b

0

e

(v i um

d-l

no- N

e-l

17l-l.i - cu

33

-.m

c lm

d-l

cl@- 04

m

clm

v)3s

:.:.:.:.:.:.‘:.:.:.:.~.:

.:.:.:.:.:.:.:.:.:.:.:.:.:.

:.:.:.:.:.:.:.:.:.:.:.:.:.:

:::::::~.:::::::::s.:~:: ::::::::~:::::::A::::::

:~::~>;~:~~~~:<;

::::::::::::::::::::::::::: :::::::::::::::::::::::f:i:

s::::::::::::::~.:::::::: ... . ...‘......A.... ... . ..

:::::::::::::::::::::::::::

.:.:.:.:.:o:.:.:.:.:.~~

:.:.:.:.:.:.:.:.:.:.:.:.:.;

::::::::::::::~:::::::::::: :~::::::::::.i::::::::

:::::::::::::::~::::: :::::p.::*$$:::::::

:::::::::::v:::::::::::::::::

.:.:.:.:.:.:.;.:.:.:.:.:.:. a........ ,..............-.. :.:.:.:.:.:.~.:.:.:.:.:.:.:

:::::::::::::::::::::::::::

:::::::::::::::~.::::::~

:::::::::::::::::::::::::::

:::‘s::::::::::::::::::::::

:::::::::::::::::::~:::::: :5::::::::::::::::::::::::

:::::::::::::::::~::::::::

. . . . . . . . . . . . . :.:.:.:.:.:.t:.:.:.:.:.:.: ::::::::::::::::~:i:::::

.~~..:.:.:.:o:.:.:.:.:. __^m

c lm

mm

0 (0

d-l

ilo- N

3

s

c3

m I m

m0m

mr

L-l m

mm

0 lo m I m m m

q m /oI m
M. BACK ‘@

1

I c) No findings - SKIP to N

I

2 q Findings - Continue with I

1. Scoliosis . . . . . . . . . . . . . . . . , 363 0 1 q

2. Kyphosis . . . . . . . . . . . . . . . . I@ 1 c]

3. Lordosis. . . . . . . . . . . . . . . . . ‘@ 1-1

4. Tenderness I

a. Sciatic notch . . . . . . . . . . . . I@, raR 2clL 3 0 Both

b. Sacroiliac . . . . . . . . . . . . . . I@ 1 [3 R 2clL 3 q Both

c. Other - Devribe . . . . . . . . . I@10

I -

I

5. ‘Limitation of motion t

a. Thoracic spine . . . . . . . . . . . @q-J

b. Lumbar spine, right t

lateral flexion . . . . . . . . . . .0I 370 1 0

c. Lumbar spine, left I

lateral flexion . . . . . . . . . . . @J 1 0

d. Full extension . . . . . . . . . . . @ 1 0

I

6. Pain on motion. . . . . . . . . . . . . @ 1 0 Negative 2 0 Positive

,---------‘-,---‘-” -----m-v-------- --m-----w------

I

Cervical

I

Severity of pain Thoracic Low back Diffuse Uncertain

(Markone box)

7. Flexion. . . . . . . . . . . . . . . . . . @‘o 0 None (i&o @lo @(o (i&o

I

I

1 c] Doubtful

I

2 0 Minimal

3 0 Moderate

I 4 0 Maximal

-------------------

8. Extension . . : . . . . . . . . . . . . . I@

----m-m..---------- ------- c----

I

o 0 None

1 0 Doubtful

(@q-J @ij 10 @(o @(o

I

I

2 c] Minimal

I

3 q Moderate

I

4 0 Maximal

9. Right lateral bending. . . . . . . . . . 1. . . . . . , . . . . . . . . . . . @ I 0 @ 1 c] 387 10

10. Left lateral bending . . . . . . . . . 1. . . . . . . . . . . . . . . . . . @ I q @ 1 0

@ I 0

@ I q 8391 q-J

11. Right rotation . . . . . . . . . . . . . 1. . . . . . . . . . . . . . . . . . 392 1 q

12. Left rotation . . . . . . . . . . . . . .

I(....,............. &ii& 8:: gig::

N. STRAIGHT-LEG-RAISING ;

TEST I

\

1. Right leg . . . . . . . . . . . . . . . . /@ 1 0 Negative 2 0 Positive

2. Left leg . . . . . . . . . . . . . . . . . I@ I 0 Negative 2 c] Positive

3. Increase - f

a. On ankle (right leg) . . . , . . . . @ I 0 Yes 210 No

b. Dorsiflexion (left leg) . . . . . . I@I

I c] Yes 2 0 No

0. OTHER SYSTEMS

(Reticula endothelial, GA., etc.) 0404 ’ r 0 No findings - SK/P to P

2 0 Findings - Describe

-7

*

Sample number

FORM I-IRA. 12.3 (2-27-76) Page 7

137
P. MUSCULOSKELETAL i

EVALUATION - i 0405 I c] Findings

If findings, mark applicable i 2 0 No

box and continue with I. findings

If no findings, SKIP to Q. i

I Yes I

1. Bo-tied legs . . . . . . . . . . . . .@lO

2. Knock knees . . . . . . . . . . . . i‘0407 I 0

3. Epiphysial enlargement,

I

I wrists . . . . . , . . . . . . . . . . ,,O408 1 q

4. Under age 3 -

Abduction of hips . . . . . . . . . i 409 1 q

(Ortolani’s Maneuver) I 0

I

5. Other findings - Devri be. . . . @lo

I

I

I

Q. NEUROLOGICAL

EVALUATION

I

I0411 I 0 Findings

if findings, murk appli cob/e 1I2 0 No

box und continue with 1. I

findings

If no findings, SKIP to R. I Yes I

1. Absent knee jerks. . . . . . . . . 1 ,O412 I 0

I

2. Absent ankle jerks . . . . . . . . i @ 1 0

3. Positive Chvostek sign . . . . . I@,0 I

4. Apathy.. . . . . . . . . . . . . . . 1 415 1 [3 I 0

5. Marked hyperirritability . . . . . i, 0 416 1 0

6. Other findings - Devribe, . . . i 0 417 1 , 0

I

R. SKIN EVALUATION i

@J 1 [3 Findings

/f findings, murk upplicuble 2 0 No

box und continue with I.

1

I findings

If no findings, SKIP to S. 1 Yes

1. Follicular hyperkeratosis,

I

1

arms . . . . . . . . . . . . . . . . ; 419 ’ 0

I 0

2. Hyperpigmentation, hands 1

and face . . . . . . . . . . . . . . I420 10 I 0

i 3. Dry or scaling skin . . . . . . . , 421 0 1 [7

4. Perifolliculosis . . . . . . . . . 1 0422 1 13

5. Petechiae - Devribe . . . . . i @ 1 13

I

6. Mosaic skin. . . . . . . . . . . . I@ 1 0

7. Pellagrous dermatitis . . . . .

8. Ecchymoses - Desycribe. . . . @lo

9. Edema . . . . . . . , . . . . . . . I@ q--J

10. Other findings - Des,cribe . .

I

s. EXAMINER’S SUBJECTIVE 1

IMPRESSION OF NUTRITIONAL STATUS -

I

1.

I

Normal nutrition . . . . . . . . . 1 0 429 1 0

2. Abnormal nutrition . . . . . . . 1 2 0

T. 1. Obesity . . . . . . . . . . . . . .

I

2. No obesity . . . . . . . . . . . . ! 2 c]

Notes

I

Sample number

138
U. BLOOD PRESSURE 1 Cuff width Time Systolic Diastolic Examiner No3

1

1. Recumbent. . . . . . ;@ 1 [3 Adult @ @ 1 0A.M.@---0 435 ---0 438

2. Sitting . . .. . . . . I 2 0 Child --:-D 2

I

0IP.M. @ij --- 0 437--- --

V. SUMMARY OF DIAGNOSTIC I

IMPRESSIONS 10 439 1 c] Normal; no abnormal findings

I

I 2 c] Akcrmal; significant findings noted below

I

f Severity Certainty ICDA code

I

I Min. Mod. Sev. (O-9)

0 . j 0 440 1 r-J 21 31 0 441 -0 442 -s-.-

I

I

b. 21 31 O- 444 0 445 ---.-

I

c. c @JlO 20

I

31-1 O- 447 0 448 ---*-

I

d. ; 0 449 ' r--J 2El -

1

3c.J 0 450 0 451 ---.-

I

e. I@10 21

t

SrJ O- 453 0 454 ---*-

I

f. @lo 20 31-IO- 456 0 457 ---.-

I

I

90 - r@bo 20 scl 0 459 - 0 460 --s.-

I

i?. I

p'n0 21 31 0 462 - 0 463 -- -*-

I

I

i. l f464 0 10 *cl

f

sl-1 O- 465 0 466 ---.-

I

i* @q-J 20

I

3cl O- 468 0 469 s-s*-

I

k. 1, 0 470 1 r--J 21 30 0 471 -0 472 B-B.-

I

I

I. I1 0 473 1 0 20

I

31 0 474 - 0 475 ---.-

I

I m. 21 31O- 477 0 478 -s-.m

I

n.

0.

Name

21 JEI 0 480 m 0 481 ---.-

i

I14820 'I-1 21

I

3cl 0 483--0 484 -w-eI

1

Physician Sample Number 1

Number

--

1

139
PCwW>

PC

I-2 ,20

I-a>

PC0L2

0

0. nua0

I-Iaw

20

I-a2zaxW

140
(SW!/ UayOJC’j 6uop rn~)
I a

a

n

2

c

C

h

WP-032

cc

P

cr)

N

C

C

c

0

P

0

rnOhWs-v-mm

hcol

c

SZO

rr)

-4019

-- c N

il.

I I I

1 I I

I I I I
CARD 0

National Origin or Ancestry

01 Countries of Central or

South America

1 02 Chicano

03 Cuban

09 Other European, such as German,

Irish, English, French

IO Black, Negro, or Afro-American

I I American Indian or Alaskan Native

I2 Asian or Pacific Islander,

such as Chinese, Japanese,

Korean, Philippino, Samoan

04 Mexican

OS Mexican0

06 Mexi can -American

07 Puerto Rican

08 Other Spanish

OR

Another group not I isted - Specify

\

ml-+COO--N e -. -

. .

-4-

.

.

.

.

.

.

.

.

.

.

.

.

2

0

2

ln

3

.

.

.

l

.

.

.

.

.

.

.

.

5

5

-

. .

. .

. .

. .

. .

. . l . .

. . . . . . .

. . . . . .

. . . . . . . .

. . .

. .

. .

. . . . .

.

. . .
a

w

00 CL 2 5 u G . . . . . . . . . . . . . . . . . . . . . . . . . . l . . . * ic

8:

m

mîd

w 4h

I I

8

0

0

8

mîd

tc)*

cnw

8B

$5 . . . . . ’ . . . . . . . . . . . . . . . . . . . 0 . l l . . % 8

6:?

- cl w #

I I

8

0

9

8

- Pi

WIw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a

I-w . 0 . .. a 0 0 . l . . ..

144
Vital and Health Statistics series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 10.

SERIES 11,

SERIES 12.

SERIES 13.

Programs and Collection Procedures.-Reports describing

the general programs of the National Center for Health

Statistics and its offices and divisions and the data collection methods used. They also include definitions and

other material necessary for understanding the data.

Data Evaluation and Methods Research.-Studies of new

statistical methodology including experimental tests of

new survey methods, studies of vital statistics collection

methods, new analytical techniques, objective evaluations

of reliability of collected data, and contributions to statistical theory.

Analytical and Epidemiological Studies.-Reports presenting analytical or interpretive studies based on vital

and health statistics, carrying the analysis further than

the expository types of reports in the other series.

Documents and Committee Reports.-Final reports of

major committees concerned with vital and health statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

Data From the National Health Interview Survey.-Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other

health-related topics, all based on data collected in the

continuing national household interview survey.

Data From the National Health Examination Survey and

the National Health and Nutrition Examination SurveyData from direct examination, testing, and measurement

of national samples of the civilian noninstitutionalized

population provide the basis for (I) estimates of the

medically defined prevalence of specific diseases in the

United States and the distributions of the population

with respect to physical, physiological, and psychological characteristics and (2) analysis of relationships

among the various measurements without reference to

an explicit finite universe of persons.

Data From the Institutionalized Population Surveys.---Discontinued in 1975. Reports from these surveys are included in Series 13.

Data on Health Resources Utilization.-Statistics on the

utilization of health manpower and facilities providing

SERIES 14.

SERIES 15.

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

long-term care, ambulatory care, hospital care, and family

planning services.

Data on Health Resources: Manpower and Facilities.-

Statistics on the numbers, geographic distribution, and

characteristics of health resources including physicians,

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

Data From Special Surveys.-Statistics on health and

health-related topics collected in special surveys that

are not a part of the continuing data systems of the

National Center for Health Statistics.

Data on Mortality.- Various statistics on mortality other

than as included in regular annual or monthly reports.

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses;

and statistics on characteristics of deaths not available

from the vital records based on sample surveys of those

records.

Data on Natal@, Marriage, and Divorce.-Various statistics on natality, marriage, and divorce other than as

included in regular annual or monthly reports. Special

analyses by demographic variables; geographic and time

series analyses; studies of fertility; and statistics on

characteristics of births not available from the vital

records based on sample surveys of those records.

Data From the National Mortality and Natality Surveys.-

Discontinued in 1975. Reports from these sample surveys

based on vital records are included in Series 20 and 21,

respectively .

Data From the National Survey of Family Growth.-

Statistics on fertility, family formation and dissolution,

family planning, and related maternal and infant health

topics derived from a periodic survey of a nationwide

probability sample of ever-married women 15-44 years

of age.

For a list of titles of reports published in these series, write to:

Scientific and Technical Information Branch

National Center for Health Statistics

Public Health Service

Hyattsville, Md. 20782
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statistics , 3700 East-West Highway

Hyattsville, Maryland 20782

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PENALTY FOR PRIVATE USE, $300

from the Office of Health Research, Statistics, and Technology

DHHS Publication No. (PHS) 81-1317, Series 1, No. 15

for a listing of publications in the VITAL AND HEALTH STATISTICS series call 301-436-NCHS