Chronic Disease Teaching Tools - National Health Behavior Data

What national level data are available about health behaviors?

The National Center for Health Statistics collects data on health behaviors through a number of surveys. These include the National Health Interview Survey, the National Health and Nutrition Examination Survey, the Hispanic Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance Survey.

What is the National Health Interview Survey (NHIS)?

The National Health Interview Survey collects current statistical information on the effects of illness in the United States. This household interview survey provides national incidence data for acute illnesses and accidental injuries, plus prevalence data on chronic conditions and impairments, the extent of disability, and utilization of health care services.

The National Health Interview Survey (NHIS) is a continuing nationwide sample survey in which data are collected through personal household interviews. Information is obtained on personal and demographic characteristics including race and ethnicity. Information is also obtained on illnesses, injuries, impairments, chronic conditions, utilization of health resources, and other health topics. The household questionnaire is reviewed each year with special health topics being added or deleted. For most health topics, data are collected

The sample design plan of the NHIS follows a multistage probability design that permits a continuous sampling of United States residents. Those in institutions or the military are excluded. The survey is designed in such a way that the sample scheduled for each week is representative of the target population and the weekly samples are additive over time. The response rate for the ongoing portion of the survey (core) has been between 94 and 98 percent over the years. Response rates for special health topics (supplements) have generally been lower. For example, the response rate was 80 percent for the 1994 Year 2000 Supplement, which included questions about cigarette smoking and use of such preventive service as mammography.

The NHIS sample was redesigned in 1985 and 1995. Major design changes in 1995 included increasing the number of households from 198 to 358 and oversampling both the black and Hispanic populations to improve the precision of the statistics. The sample was designed so that a typical NHIS sample for the data collection years 1995 - 2004 will consist of approximately 7,000 households. The sample of 44,000 occupied respondent households is expected to reach about 106,000 people. In 1995 there was a sample of 102,467 people.

A description of the survey design, the methods used in estimation, and the general qualifications of the data obtained from the survey are presented in:

Massey JT, Moore TF, Parsons VL, Tadros W. Design and estimation for the National Health Survey, 1985-94. National Center for Health Statistics. Vital Health Stat 2(110). 1989.

Kovar MG, Poe GS. The National Health Interview Survey Design, 1973-84, and Procedures, 1975-83. National Center for Health Statistics. Vital Health Stat 1(18). 1985.

Adams PF, Marano M. Current Estimates from the National Health Interview Survey, 1994. National Center for Health Statistics. Vital Health Stat 10 193). 1995.

Source: National Center for Health Statistics, Health, United States, 1996-97 and Injury Chartbook. Hyattsville, MD: 1997.

What is the National Health and Nutrition Examination Survey (NHANES)?

The National Health and Nutrition Examination Survey has evolved over the years from the National Health Examination Survey (NHES I) in 1960-62, to the current NHANES III covering 1988-1994.

For the first program or cycle of the National Health Examinations Survey, 1960-62, data were collected on the total prevalence of certain chronic diseases as well as the distributions of various physical and physiological measures, including blood pressure and serum cholesterol levels. For that program, a highly stratified, multistage probability sample of 7,710 adults, of whom 86.5 percent were examined, was selected to represent the 111 million United States resident adults 18-79 years of age at that time. The sample areas consisted of 42 primary sampling units (PSU's) from the 1,900 geographic units.

The NHES II (1963-65) and NHES III (1966-70) examined probability samples of the nation's noninstitutionalized children between the ages of 6 and 11 years (NHES II) and 12 and 17 years (NHES III) focusing on factors related to growth and development.

For more information on NHES I, see:

Gordon T, Miller HW. Cycle I of the Health Examination Survey: Sample and response, United States, 1960-62. National Center for Health Statistics. Vital Health Stat 11(1). 1974.

For more information on NHES II, see:

Plan, Operation And Response Results of a Program of Children's Examinations. National Center for Health Statistics. Vital Health Stat 1(5). 1967.

For more information on NHES III, see:

Schaible, WL. Quality Control in a National Health Examination Survey. National Center for Health Statistics. Vital Health Stat 2(44). 1972.

In 1971 a nutrition surveillance component was added and the survey name was changed to the National Health and Nutrition Examination Survey (NHANES). In NHANES I, conducted from 1971 to 1974, a major purpose was to measure and monitor indicators of the nutrition and health status of the US population through dietary intake data, biochemical tests, physical measurements, and clinical assessments for evidence of nutritional deficiency. Detailed examinations were given by dentists, ophthalmologists, and dermatologists with an assessment of need for treatment. In addition, data were obtained for a subsample of adults on overall health care needs and behavior, and more detailed examination data were collected on cardiovascular, respiratory, arthritic, and hearing conditions.

The NHANES I target population was the civilian noninstitutionalized population ages one to 74 years of age residing in the continental United States, except for people residing on any of the reservation lands set aside for the use of American Indians.

For NHANES II, conducted from 1976 to 1980, the nutrition component was expanded from the one field tested for NHANES I. In the medical area primary emphasis was placed on diabetes, kidney and liver functions, allergy, and speech pathology. The NHANES II target population was the civilian noninstitutionalized population 6 months-74 years of age residing in the United States, including Alaska and Hawaii. Race information for NHANES I and NHANES II was determined primarily by interviewer observation.

For more information on NHANES I, see:

Miller HW. Plan and Operation of the Health and Nutrition Examination Survey, United States, 1971-73. National Center for Health Statistics. Vital Health Stat 1(10a) and 1(10b). 1977 and 1978.

Engel A, Murphy RS, Maurer K, Collins E. Plan and Operation of the NHANES I Augmentation Survey of Adults 25-74 years, United States 1974-75. National Center for Health Statistics. Vital Health Stat 1(14). 1978.

For more information on NHANES II, see:

McDowell A, Engel A, Massey JT, Maurer K. Plan and Operation of the Second National Health and Nutrition Examination Survey, 1976-80. National Center for Health Statistics. Vital Health Stat 1(15). 1981.

For information on nutritional applications of these surveys, see:

Yetley E, Johnson C. 1987. Nutritional Applications of the Health and Nutrition Examination Surveys (HANES). Ann Rev Nutr 7:441-63.

The third National Health and Nutrition Examination Survey (NHANES III) is a six year survey covering the years 1988-94. During this period, 39,695 people were selected for the survey, of which 30,818 (77.6 percent) were examined in the mobile examination center.

The NHANES III target population is the civilian noninstitutionalized population two months of age and over. The sample design provides for oversampling among children 24-35 months of age, people 70 years of age and over, black Americans, and Mexican Americans. Race is reported for the household by the respondent.

Although some of the specific health areas have changed from earlier NHANES surveys, the following goals of the NHANES III are similar to those of earlier NHANES surveys:

  • to estimate the national prevalence of selected diseases and risk factors;
  • to estimate national population distributions of selected health parameters; and
  • to document and investigate reasons for secular trends in selected diseases and risk factors.

Two new additional goals for the NHANES III survey are:

  • to contribute to an understanding of the causes of disease; and
  • to investigate the natural history of selected diseases.

For more information on NHANES III, see:

Ezzati TM, Massey JT, Waksberg J, et al. Sample Design: Third National Health and Nutrition Examination Survey. National Center for Health Statistics. Vital Health Stat 2(113). 1992.

Plan and Operation of the Third National Health and Nutrition Examination Survey, 1988-94. National Center for Health Statistics. Vital Health Stat 1(32). 1994.

Source: National Center for Health Statistics, Health, United States, 1996-97 and Injury Chartbook. Hyattsville, MD: 1997.

What is the Hispanic Health and Nutrition Examination Survey (HHANES)?

The Hispanic Health and Nutrition Examination Survey (HHANES), conducted during 1982-84, was similar in content and design to the previous National Health and Nutrition Examination Surveys. The major difference between HHANES and the previous national surveys is that HHANES employed a probability sample of three special subgroups of the population living in selected areas of the United States rather than a national probability sample.

In the HHANES three geographically and ethnically distinct populations were studied: Mexican American in Texas, New Mexico, Arizona, Colorado, and California; Cuban Americans living in Dade County, Florida; and Puerto Ricans living in parts of New York, New Jersey, and Connecticut. In the Southwest 9,894 people were selected (75 percent or 7,462 were examined), in Dade County 2,244 people were selected (60 percent or 1,357 were examined), and in the Northeast 3,786 people were selected (75 percent or 2,834 were examined).

The three HHANES surveys included approximately 84%, 57%, and 59% of the respective 1980 Mexican, Cuban, and Puerto Rican-origin populations in the continental United States. The Hispanic ethnicity of these populations was determined by self-report.

For more information on HHANES see:

Maurer KR. Plan and Operation of the Hispanic Health and Nutrition Examination Survey, 1982-84. National Center for Health Statistics. Vital Health Stat 1(19). 1985.

Source: National Center for Health Statistics, Health, United States, 1996-97 and Injury Chartbook. Hyattsville, MD: 1997.