A dual frame design for sampling elderly minorities and persons with disabilities.

Multiple data sources are sometimes available as potential sampling frames for population surveys, and in some situations the use of a multiple frame sample design is more advantageous than using a single sampling frame. The use of multiple sampling frames, however, has variance and bias implications, as well as sampling, data collection, and logistical considerations. These issues are addressed for a proposed dual frame sampling approach in the National Health Interview Survey (NHIS). The results of an investigation of the sampling efficiencies and operational issues in supplementing the NHIS area frame sample with a sample of elderly African and Hispanic Americans and persons with disabilities selected from Social Security Administration files are presented.

Sample design: Third National Health and Nutrition Examination Survey.

This report presents a detailed description of the sample design for the Third National Health and Nutrition Examination Survey, 1988-94, including a brief description of research that led to the choice of the final design. The National Health and Nutrition Examination Survey (NHANES) is one of the major surveys of the National Center for Health Statistics, Centers for Disease Control. Information on the health and nutritional status of the noninstitutionalized population of the United States is collected through the NHANES household interviews and standardized physical examinations.

Prevalence of diabetes in Mexican Americans, Cubans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey, 1982-1984.

The purpose of this study was to estimate the prevalence of diagnosed and undiagnosed diabetes among Mexican Americans, Cubans, and Puerto Ricans in the United States and compare these estimates to data from prior surveys for U.S. non-Hispanic whites and blacks. Data for this study are from the Hispanic Health and Nutrition Examination Survey, a multipurpose cross-sectional survey of three U.S. Hispanic populations conducted in 1982-1984. The interviewed sample of people aged 20-74 yr included 3935 Mexican Americans in the southwest, 1134 Cubans in Florida, and 1519 Puerto Ricans in the New York City area. The diabetes component consisted of interview questions on diabetes diagnosis and treatment and an oral glucose tolerance test administered to a subsample. The prevalence of diabetes was two to three times greater for Mexican Americans and Puerto Ricans than for non-Hispanic whites surveyed in 1976-1980. In Cubans, the prevalence was similar to that for non-Hispanic whites. In men and women 45-74 yr of age, the prevalence of diabetes was extremely high for both Mexican Americans (23.9%) and Puerto Ricans (26.1%) compared with Cubans (15.8%) or non-Hispanic whites (12%). The total prevalence of diabetes was not significantly different for Mexican Americans and Puerto Ricans but was significantly lower for Cubans. The relatively lower prevalence of diabetes among Cubans and the high prevalence in both Mexican Americans and Puerto Ricans may be related to socioeconomic, genetic, behavioral, or environmental factors.

Selection of nutrition status indicators for field surveys: the NHANES III design.

Planning a multipurpose survey in which nutritional status is assessed requires a series of scientific and practical decisions that are constrained by available resources of money and time and by the limits to what can be expected from the respondents. This paper describes the planning process for a multipurpose survey using our experience with the third National Health and Nutrition Examination Survey (NHANES III) as an example. Ideally, the goals and objectives are well defined at the outset, and these guide the development of the survey content and statistical design. Because the needs for information are so great, criteria need to be developed for evaluating which topics will be included in the survey and what tests will be used. In planning the NHANES III, the evaluation criteria used were the scientific merit of the topic, its public health importance, its practical utility to the government, and the feasibility of implementing it within the survey's mode of operation. After the topics to be covered in a survey have been selected, questionnaires and examination protocols are developed, pilot tested, and revised prior to implementing the survey. Procedures are established for providing for informed consent and assuring the confidentiality of findings.

Prevalence of gallstone disease in Hispanic populations in the United States.

The 1982-1984 Hispanic Health and Nutrition Examination Survey used ultrasonography to investigate the epidemiology of gallstone disease. Mexican American, Cuban American, and Puerto Rican men and women, aged 20-74 yr, were selected from household samples in Texas, New Mexico, Arizona, Colorado, California, Connecticut, New Jersey, New York, and Florida. Ultrasonography was performed on 2299 persons. The age-adjusted prevalence of gallstone disease (gallstones + cholecystectomy) among Mexican American men (7.2%) was 1.7 times that of Cuban American men and 1.8 times that of Puerto Rican men. The prevalence for Mexican American women (23.2%) was 1.5 times that of Cuban American women and 1.7 times that of Puerto Rican women. Rates were about three times higher among women than men and increased with age in both sexes and all ethnic groups except older Puerto Rican women. Among Mexican American women aged 60-74 yr, the prevalence of gallstone disease reached 44.1%. These results support the hypothesis that Mexican Americans are at increased risk of gallstone disease.

DTP immunization status and tetanus antitoxin titers of Mexican American children ages six months through eleven years.

Data from the Mexican American portion of the Hispanic Health and Nutrition Examination Survey (HHANES), conducted in 1982-83, were analyzed for the number of diphtheria, tetanus, and pertussis (DTP) immunizations reported for Mexican American children 6 months-11 years of age and for levels of tetanus antitoxin titers in Mexican American children 4-11 years of age. In Mexican American children 6 months-11 years, 98.2 per cent had one or more DTP immunizations reported (95 per cent CI: 97.5, 98.9%); 85.1 per cent had three or more DTP immunizations reported (95 per cent CI: 83.2, 87.0%). The reported immunization coverage in Mexican American children was corroborated by the tetanus antitoxin titers which were above the minimum protective level (greater than or equal to 0.01 IU/ml) in 99.6 per cent of the 4-11 year olds. Using the American Academy of Pediatrics' (AAP) recommendations for the number of DTP immunizations, 61.1 per cent of the children 6 months-11 years of age had the age-appropriate number of immunizations (95 per cent CI: 58.5, 63.7%). AAP immunization completion rates were higher for children who: had a source of care reported (62.1 vs 44.3%; 95% CI of the difference: 7.1, 28.5); had insurance coverage (63.5 vs 56.1%; 95% CI of the difference: 2, 12.8); lived in a standard metropolitan statistical area (SMSA)-not central city as compared to SMSA-central city or not SMSA (66.6 vs 57.1%; 95% CI of the difference: 4.3, 14.7); and had 12 or more completed years of education for the head of the household (65.4 vs 58.3%; 95% CI of the difference: 1.8, 12.4).(ABSTRACT TRUNCATED AT 250 WORDS)

Enzymatic analysis of total- and HDL-cholesterol: comparison with the standardized Liebermann-Burchard method used by the Lipid Research Clinics program.

We compared two enzymatic cholesterol methods with the standardized chemical method used in the Lipid Research Clinic's (LRC) program. The methods were used to measure total cholesterol and high density lipoprotein (HDL) cholesterol in heparin-MnCl2 supernatants of 1,812 sera collected over a 16-mth period from subjects who were sampled as part of the Hispanic Health and Nutrition Examination Survey. Thirty percent of the subjects had fasted for 12 h or more before venepuncture. The enzymatic total cholesterol values were 1.4-1.8% lower than the LRC method and both enzymatic methods correlated highly with the LRC method (r greater than 0.97). The enzymatic HDL cholesterol values were 2.4 and 6.4% higher than the LRC method, and the correlation between the enzymatic and LRC methods was greater than 0.93. The differences between the enzymatic and LRC methods were the same in samples from fasting and non-fasting subjects.

Impaired glucose tolerance in women using oral contraceptives: United States, 1976-1980.

Based on 75-g oral glucose tolerance test results from the second National Health and Nutrition Examination Survey (1976-1980), women 20-44 years reporting the use of oral contraceptives (OCs) had decreased glucose tolerance compared with women not using OCs in this age group. Estimates of decreased glucose tolerance after adjustment for age and body mass index were 15.4% (95% CI, 7.6-23.2%) in OC users vs 6.3% (95% CI, 4.5-8.1%) in nonusers. Oral contraceptive use was associated with elevations in 1 and 2 hour plasma glucose concentrations. The mean adjusted difference between OC users and nonusers at 1 and at 2 hours postchallenge was 14 and 13 mg/100 ml, respectively. Characteristics of study nonrespondents vs respondents were analyzed to estimate potential bias due to nonresponse. No appreciable biases were found, but this does not rule out the possibility that some bias may exist.

Cardiovascular risk status and oral contraceptive use: United States, 1976-1980.

Data from the second National Health and Nutrition Examination Survey, conducted in 1976-1980, were analyzed for the prevalence of cardiovascular risk factors (cigarette smoking, serum cholesterol, and blood pressure) among 2,342 premenopausal women ages 20-44 years, stratified by oral contraceptive use. For oral contraceptive users and non-users, adjusted means were serum cholesterol, 205 vs 188 mg/dl (P less than 0.05); systolic blood pressure, 116 vs 113 mm Hg (P less than 0.01); and diastolic blood pressure, 74 vs 73 mm Hg (NS). The prevalence of cigarette smoking was significantly higher among oral contraceptive users (44% compared with 36% among nonusers; P less than 0.05). Using the 1984 NIH Consensus Development Conference Statement on Lowering Blood Cholesterol to define risk levels for serum cholesterol, 23% of the oral contraceptive users were at high risk compared with 12% of the nonusers, and 16% of the oral contraceptive users vs 11% of the nonusers were at moderate risk. For users and nonusers, the respective prevalence of a blood pressure at or above 140/90 mm Hg was 5.3% vs 8.8% (unadjusted) and 8.6% vs 8.0% (age adjusted). The percentage of women with multiple risk factors was also higher among oral contraceptive user; 14% of the users had two or more risk factors vs 7% of the nonusers (P less than 0.05). These cross-sectional national data support data from clinical studies regarding the effect of oral contraceptives on cholesterol and blood pressure levels. In addition, since the use of oral contraceptives is widespread in the population and users tend to see physicians more regularly than other women, the data suggest that users of the pill are a good target group among which to screen and monitor cardiovascular risk factors.

Prevalence and trends in oral contraceptive use in premenopausal females ages 12-54 years, United States, 1971-80.

Data from the second National Health and Nutrition Examination Survey (NHANES II) were analyzed to estimate the prevalence of oral contraceptive use in the United States, 1976-80. The overall unadjusted prevalence of oral contraceptive use was 16.7 per cent for premenopausal females ages 12-54 years (19.2 per cent for ages 15-44 years). Approximately 8.7 million females (95 per cent confidence interval, 6.9-10.5 million) were oral contraceptive users at the midpoint of NHANES II (March 1978). Comparison to the NHANES I, conducted in 1971-74, indicated a stable number of overall oral contraceptive users in the US population during the 1970s, with shifts in certain age groups: oral contraceptive use increased for females ages 12-19 years and decreased for females ages 20-49 years. The overall age-adjusted prevalences indicated a 2 per cent (95 per cent CI, 0.2-3.8 per cent) decline in oral contraceptive use from the early to the late 1970s. The NHANES provides comparative data and supports findings from another national survey showing a decrease in the per cent of females using oral contraceptives during 1973-82. Trends in oral contraceptive use are also presented by race, poverty level, rural-urban residence, marital status, and education level.

Oral glucose tolerance and the potency of contraceptive progestins.

Two-hour oral glucose tolerance test results from the Walnut Creek Contraceptive Drug Study, a 10-year prospective follow-up study on the metabolic and medical effects of the "pill," were analyzed to determine the contribution of six progestins and synthetic estrogen to an observed decrease in glucose tolerance. Glucose tolerance data and specific oral contraceptive formulation data were obtained for 354 oral contraceptive users and 1732 nonusers. Multiple linear regression analyses, using age, body mass index, and specific progestin and estrogen dosages as independent variables, were undertaken to define dose-response relationships between the contraceptive steroids and fasting, 1-hr and 2-hr glucose values. The results of these analyses were consistent with the observation that the mean 1- and 2-hr values were higher in users of the "pill." The 16% prevalence of impaired glucose tolerance in pill users was substantially higher than that of 8% in the nonusers. Examination of the regression coefficients suggested that one progestin (norgestrel) was more metabolically "potent" than the others. The remaining progestins appeared to have either a modest or no metabolic effect, in terms of 1- and 2-hr glucose values. Synthetic estrogens were shown not to be related to measures of glucose tolerance.