MEN

TO

F H

E A

L T

H &

HU

National Health and Nutrition Examination Survey, 2005-2006 Examination Consent Brochure

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention

D EPART

MAN SER V IC ES • U SA

National Center for Health Statistics

cover2 10/19/04, 8:51 AM1

This booklet contains facts for you about theNational Health and Nutrition Examination Survey

If you agree to take part in NHANES, we ask you to sign the attached consent form toshow that you know the nature and purpose of the survey. Please be sure you understandthe facts we have given you and that all questions are answered.

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

NHANES is a survey conducted by the National Center for Health Statistics (NCHS). NCHS is a part of the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.

We select a sample of people in towns and cities across the country to be part of the survey. Each year of the survey, we will examine about 5,000 people in 15 different sites. NHANES programs began in the early 1960s. The current survey began in 1999 and will now be an ongoing pro­gram. More than 160,000 persons have been part of past NHANES programs.

We have designed the study to learn about the health and diet of people in the United States.

Our survey is unique. It combines a home interview with health tests, which we do in mobile units. These special exam centers travel the country with a highly trained medical team. Our team conducts an exam that looks at spe­cial health topics. They use the most up-to-date methods and equipment for medical and dental exams, and other lab tests.

We will use the data gathered in this survey to assess the number of people with certain health problems — for example, diabetes and high blood pressure. We will look at diet and other habits that affect health, such as smoking and exercise. NHANES data will describe the health and nutrition of people of all ages. It will also help design health programs and services, and expand our knowledge about the health of people in the United States.

72 Why were you selected?

We picked you and your household in a carefully designed sample of people living in the United States. We cannot choose someone in your place because no one has the same health profile as you. Having you as part of our survey will help make our information complete. We will add the data from your interview and exam to that from all others who join in this study. That data will give us a big picture of our nation’s health.

You may choose to take part in the survey and you may permit your child to join in. That is your choice. No penalties or loss of benefits will come from refus­ing to take part. You may refuse any part of the exam and are free to drop out anytime. Also, during the interviews you may choose not to answer any question.

What do you gain by taking part in the survey?

Free health test results, perhaps some of major value to you

The chance to help learn more about the health of the nation

A cash payment to thank you for your time and effort

Are the data we collect confidential?

We respect your privacy. Public laws keep all informa­tion you give confidential.

We will hold all data we collect in the strictest confi­dence. We gather and protect all data in keeping with the requirements of Federal laws: the Public Health Service Act (42 USC 242k) authorizes collection and Section 308(d) of that law (42 USC 242m) and the Privacy Act of 1974 (5 USC 552A) prohibit us from giving out information that identifies you or your family without your consent. This means that we cannot give out any fact about you, even if a court of law asks for it. However, if we find signs of child abuse during an exam, we will report it to the local department of social services or appropriate law enforcement agency.

We will keep all survey data safe and secure. Sometimes certain collaborators, such as the U.S. Department of Agriculture and the National Center for Environmental Health, assist us in data preparation, analysis, and re­search. When they do, the information is handled with strict requirements to protect your confidentiality as guaranteed by NCHS. When we allow other collabora­tors and researchers to use survey data, we protect your privacy. We assign code numbers in place of names and never reveal other facts that could directly identify you.

What about the exam?

Our interviewer will ask you to make an appointment for the exam at the mobile exam center. Our medical team will collect health data by examining you, doing testing, and asking questions about diet and health. No internal exam is included. No drug testing will be done. We will ask you to fast overnight for a morning exam. You will change into special exam clothes at the exam center. The exam may take from 21/2 to 4 hours for those 12 and older and 1-3 hours for younger children. The time depends on the age of the person examined, since some procedures are done only for certain ages. (For a full list of procedures, see page 5.)

Reports of Exam Findings

The survey exam does not replace regular health care. However, you will get some exam results at the exam site. If the exam reveals urgent health problems, we will notify you at once and refer you for treatment. If some urgent problem is found through your lab tests, right away we will send that information in a

6that can cause allergies. Results of the household dusttesting will be provided. A date and time to collect adust sample will be set up after your exam is finished.Persons who test positive for hepatitis C will becalled to request participation in a brief phoneinterview six months after the exam. Parents willrespond for children.

Men with a high PSA test result will be called torequest participation in a brief phone interview sixmonths after the exam.

Taking part in these interviews and health examsafter your visit to the exam center is voluntary.

How are NHANES data used?

What you tell us, your exam findings, andsamples you give are a rich resource for healthscience. Many Federal agencies, universities, andother public and private groups use NHANESdata. They use it to help find new cures andtreatments for diseases and disabilities. The aimis to enhance the health of all people. Results ofthis survey may be reported in journals, at majormeetings, or through other news media. None ofthese reports will ever name or use data that canpoint to any person who took part in the survey.

Many of the National Institutes of Health help usin this survey. The U.S. Department of Agricul-ture is our partner in planning how to get data onthe foods you eat. We share with them the task oflooking at people's diets in the U.S. The U.S.Environmental Protection Agency is another ofour many partners. Your survey data helps studyharmful effects of being exposed to environmentalhazards.

Combining NHANES results with other factsabout you can be useful. An example of this isusing Social Security numbers to link survey datawith vital statistics and other health records. Also,we may need to contact you in the future. To dothis we would ask public or private agencies, suchas the Post Office, to provide changes in youraddress.

In the past, we have had the chance to call orrevisit people who took part in this survey. Wemay contact you in the future to ask you to be partof other research projects.

More questions?

Our survey representative can discuss otherquestions or concerns or give you other printedmatter that can help. She or he can give you aphone number in your area that you can callfor more facts about the survey. Also, you canmake a free call to Dr. Kathryn Porter of theU.S. Public Health Service to discuss anyaspect of the survey. She can be reached at 1-800-452-6115, Monday-Friday, 8 AM - 6 PMEST. You may also contact her regarding anysurvey-related injury. You can also get answersto your questions by mail (Room 4322, 3311Toledo Rd., Hyattsville, MD 20782). If youhave questions about your rights as a partici-pant, call the Research Ethics Review BoardChairperson at 1-800-223-8118.

3

letter to your home address. If you wish, we will mail the routine findings report to you about 12-16 weeks after the exam. In general, we give results only to the person examined or to the parents/ guardians of children. Some results, such as sexually transmitted disease (STD) tests, are given in special ways explained below. We will not give you results from some tests because they will be used only for research. Better ways to look at some of the tests may be developed in the future. Some of the tests such as the digital image of your eye, the bone density test, or the tests on dust in your home may be read again. We will not report the results of future tests to you. NHANES does not cover the cost of any health care you may decide to seek after the exam.

Safety of Tests

We chose the tests and measurements because they are safe. Some of the exams or procedures may cause you slight discomfort. Examples are collecting a blood sample or fasting for 9 hours. For the blood sample, a person will have a small amount of blood drawn from a vein in his/her arm with a needle. Participants 12 years and older with a morning appointment will be asked to drink a sugar solution and have blood taken a second time. Although rare, the sugar solution can cause nausea, vomiting, bloating, or head­ache. We will not ask you to have any test or procedure that is wrong for you because of a health problem or condition.

We will give bone density tests that involve low-dosage x-rays to persons 8 years old and older. Radiation exposure during this test is equal to a cross-country airline flight or a few days of natural background radiation. But because the bone density scan involves x-rays, no one who is pregnant should get this exam. We will obtain information about periods from girls and women, and those who have started their periods will have a urine pregnancy test. We report positive test results only to the person tested if she is 14 years or older. If a girl is under 14 and has a positive pregnancy test, we will inform both her and her parent/guardian. Those with a positive test will not have the bone density scan. Also, pregnant women and girls will not have fitness testing if they are in their second or third trimester.

Private Health Interview

At the exam center you will be asked some personal questions. A trained interviewer will ask some of these questions. Others, like those about sexual experience and drug use, will be

Health Measurements

* Doctor’s exam - all agesDoctor’s assessment of puberty - ages 8-19 years

* Blood pressure - ages 8 years and older* Body fat - ages 8-69 years* Bone density scans

Whole body, hip, and spine - ages 8-69 years Hip and spine - ages 70 years and older

* Oral health - ages 5 years and older* Vision test - ages 12 years and older* Hearing test - ages 12-19 and 70 years

and older* Fitness test - ages 12-49 years

(only afternoon/evening exams)* Height, weight, and other body measures

- all ages* Eye conditions - ages 40 years and older

Visual field test Retinal photographs

Lab Tests on Urine: (6 years and older)

Kidney function tests - ages 6 years and older*** Sexually transmitted disease (STD)

Chlamydia and gonorrhea - ages 14-39Human immunodeficiency virus (HIV)

- ages 18-49 (only if no blood is drawn)** Exposure to environmental chemicals

- selected persons ages 6 and older** Pregnancy test - females 12-59 and girls

8-11 who have periods* - ages 13 and under*** - ages 14 and over

Lab Tests on Blood: (1 year and older)

* Anemia - all ages* IgE Allergens - ages 1 and older* Lipids - ages 6 and older* Glucose measures - ages 12 and older** Infectious diseases - ages 2 and older* Kidney function tests - ages 6 and older* Lead - all ages** Cadmium - all ages** Mercury - all ages* Liver function tests - ages 12 and older

Nutrition status - all ages* Hormone tests - ages 6 and older

* Prostate Specific Antigen (PSA) - males ages 40 years and older

Lab Tests on Blood: (1 year and older) ... continued

Sexually transmitted diseases (STD)*** Herpes type 2 - ages 14-49 years*** Human immunodeficiency virus

(HIV) - ages 18-49 yearsHuman papillomavirus (HPV) antibody

ages 14-59 years** Exposure to environmental chemicals

- selected persons ages 6 years and older

Lab Tests on Water

** Environmental chemicals - selected persons ages 20-59 years

Other Lab Tests

*** Vaginal swab (self-administered) for Human papillomavirus (HPV)

- females ages 14-59 years

Private Health Interviews

Body image and eating behaviors - ages 8-15 yearsDepression Screening - ages 12 years and olderTobacco use - ages 12-59 yearsDrug and Alcohol use - ages 12-59 years (No drug testing will be done)Sexual experience - ages 14-59 yearsReproductive health - females ages 12 years and olderBladder and bowel health - ages 20 years and olderExposure to chemical products - ages 6 years and older

Dietary Interview

Questions on what you eat - all ages

5The NHANES Exam

* Results reported to you or to your child and you ** Results reported only if positive (or abnormal)*** Results reported only to person tested

4 asked in complete privacy. The interviewer will leave the room. The questions will be on a computer screen. You respond by touching an answer on the screen. Like all of the other information we collect, the responses you give us are kept strictly confidential. If you are under 18 years of age, we may notify your parents if we have reason to believe you are a danger to yourself.

Doctor’s Assessment of Puberty

Our doctor will determine the physical maturity of children 8-19 years. The doctor will quickly look at females' breasts and the genitals of males and fe­males. No touching is involved. Parents may ask to be present during the assessment if they choose. A chaperone will be present during the exam.

Tests for SexuallyTransmitted Disease (STD)

Females aged 14- 59 years will be asked to do a pri­vate, self-administered, vaginal swab for STD testing. In addition, all persons 14-49 years will have their blood and urine tested for STDs. We will not put these results in writing, but you can get STD test results a few weeks after the exam. Before leaving the exam center, you will receive a toll-free number, a password, and the dates to call for your results. Only you will get your test results by calling in and telling us your password. Parents will not be informed of their child's

STD test results. If your test results show that you have a current health problem, we will talk with you about the results and tell you how to seek treatment. We will keep all STD test results completely private, just like all other test results. If you do not want to be tested, you can tell a staff member.

After your visit to the NHANES exam center:

Persons asked about the foods they eat will receive a phone call 3-10 days after their exam for a similar interview. In addition, a food questionnaire will be mailed to your home. Persons two years old and older are asked to complete this questionnaire and return it to our office in a prepaid envelope provided. Parents or guardians will answer for children 2-5 years and assist children 6-11. The questions will take 20-30 minutes to answer.

Persons six years old and older will be asked to wear a physical activity monitor. Exam staff will give you the monitor at the exam. You will wear the monitor at home for seven days. Parents or guardians will assist children 6-11 years old. You will be asked to return the monitor to our office in a prepaid envelope provided.

A few weeks after your exam, a technician will visit your home to ask a short set of questions and collect a dust sample by vacuuming areas in the room where you sleep. The dust sample will be sent to a lab where it will be measured for allergens. Allergens are substances

(continued on page 6)

4asked in complete privacy. The interviewerwill leave the room. The questions will be on acomputer screen. You respond by touching ananswer on the screen. Like all of the otherinformation we collect, the responses you giveus are kept strictly confidential. If you areunder 18 years of age, we may notify yourparents if we have reason to believe you are adanger to yourself.

Doctor’s Assessment of Puberty

Our doctor will determine the physical maturity ofchildren 8-19 years. The doctor will quickly look atfemales' breasts and the genitals of males and fe-males. No touching is involved. Parents may ask tobe present during the assessment if they choose. Achaperone will be present during the exam.

Tests for SexuallyTransmitted Disease (STD)

Females aged 14- 59 years will be asked to do a pri-vate, self-administered, vaginal swab for STD testing.In addition, all persons 14-49 years will have theirblood and urine tested for STDs. We will not put theseresults in writing, but you can get STD test results afew weeks after the exam. Before leaving the examcenter, you will receive a toll-free number, a password,and the dates to call for your results. Only you will getyour test results by calling in and telling us yourpassword. Parents will not be informed of their child's

STD test results. If your test results show that you havea current health problem, we will talk with you aboutthe results and tell you how to seek treatment. We willkeep all STD test results completely private, just like allother test results. If you do not want to be tested, youcan tell a staff member.

After your visit to the NHANESexam center:

Persons asked about the foods they eat will receive aphone call 3-10 days after their exam for a similarinterview. In addition, a food questionnaire will be mailedto your home. Persons two years old and older are askedto complete this questionnaire and return it to our officein a prepaid envelope provided. Parents or guardians willanswer for children 2-5 years and assist children 6-11.The questions will take 20-30 minutes to answer.

Persons six years old and older will be asked to wear aphysical activity monitor. Exam staff will give you themonitor at the exam. You will wear the monitor at homefor seven days. Parents or guardians will assist children6-11 years old. You will be asked to return the monitorto our office in a prepaid envelope provided.

A few weeks after your exam, a technician will visityour home to ask a short set of questions and collect adust sample by vacuuming areas in the room where yousleep. The dust sample will be sent to a lab where itwill be measured for allergens. Allergens are substances

(continued on page 6)

5 The NHANES ExamHealth Measurements

* Doctor’s exam - all agesDoctor’s assessment of puberty

- ages 8-19 years * Blood pressure - ages 8 years and older * Body fat - ages 8-69 years * Bone density scans

Whole body, hip, and spine - ages 8-69 years Hip and spine - ages 70 years and older

* Oral health - ages 5 years and older * Vision test - ages 12 years and older * Hearing test - ages 12-19 and 70 years

and older * Fitness test - ages 12-49 years

(only afternoon/evening exams)* Height, weight, and other body measures

- all ages * Eye conditions - ages 40 years and older

Visual field test Retinal photographs

Lab Tests on Urine: (6 years and older)

Kidney function tests - ages 6 years and older *** Sexually transmitted disease (STD)

Chlamydia and gonorrhea - ages 14-39 Human immunodeficiency virus (HIV) - ages 18-49 (only if no blood is drawn)

** Exposure to environmental chemicals - selected persons ages 6 and older

** Pregnancy test - females 12-59 and girls 8-11 who have periods

* - ages 13 and under*** - ages 14 and over

Lab Tests on Blood: (1 year and older)

* Anemia - all ages * IgE Allergens - ages 1 and older * Lipids - ages 6 and older * Glucose measures - ages 12 and older ** Infectious diseases - ages 2 and older * Kidney function tests - ages 6 and older * Lead - all ages** Cadmium - all ages** Mercury - all ages* Liver function tests - ages 12 and older

Nutrition status - all ages * Hormone tests - ages 6 and older

* Prostate Specific Antigen (PSA) - males ages 40 years and older

Lab Tests on Blood: (1 year and older) ... continued

Sexually transmitted diseases (STD) *** Herpes type 2 - ages 14-49 years *** Human immunodeficiency virus

(HIV) - ages 18-49 years Human papillomavirus (HPV) antibody

ages 14-59 years ** Exposure to environmental chemicals

- selected persons ages 6 years and older

Lab Tests on Water

** Environmental chemicals - selected persons ages 20-59 years

Other Lab Tests

*** Vaginal swab (self-administered) for Human papillomavirus (HPV)

- females ages 14-59 years

Private Health Interviews

Body image and eating behaviors - ages 8-15 years

Depression Screening - ages 12 years and older Tobacco use - ages 12-59 years Drug and Alcohol use - ages 12-59 years (No drug testing will be done) Sexual experience - ages 14-59 years Reproductive health - females ages 12 years and older Bladder and bowel health - ages 20 years and older Exposure to chemical products - ages 6 years and older

Dietary Interview

Questions on what you eat - all ages

* Results reported to you or to your child and you ** Results reported only if positive (or abnormal) *** Results reported only to person tested

letter to your home address. If you wish, we willmail the routine findings report to you about 12-16weeks after the exam. In general, we give resultsonly to the person examined or to the parents/guardians of children. Some results, such assexually transmitted disease (STD) tests, aregiven in special ways explained below. We willnot give you results from some tests because theywill be used only for research. Better ways tolook at some of the tests may be developed in thefuture. Some of the tests such as the digital imageof your eye, the bone density test, or the tests ondust in your home may be read again. We will notreport the results of future tests to you. NHANESdoes not cover the cost of any health care youmay decide to seek after the exam.

Safety of Tests

We chose the tests and measurements becausethey are safe. Some of the exams or proceduresmay cause you slight discomfort. Examples arecollecting a blood sample or fasting for 9 hours.For the blood sample, a person will have a smallamount of blood drawn from a vein in his/herarm with a needle. Participants 12 years andolder with a morning appointment will be askedto drink a sugar solution and have blood taken asecond time. Although rare, the sugar solutioncan cause nausea, vomiting, bloating, or head-ache. We will not ask you to have any test orprocedure that is wrong for you because of ahealth problem or condition.

We will give bone density tests that involvelow-dosage x-rays to persons 8 years old andolder. Radiation exposure during this test isequal to a cross-country airline flight or a fewdays of natural background radiation. Butbecause the bone density scan involves x-rays,no one who is pregnant should get this exam.We will obtain information about periods fromgirls and women, and those who have startedtheir periods will have a urine pregnancy test.We report positive test results only to the persontested if she is 14 years or older. If a girl isunder 14 and has a positive pregnancy test, wewill inform both her and her parent/guardian.Those with a positive test will not have the bonedensity scan. Also, pregnant women and girlswill not have fitness testing if they are in theirsecond or third trimester.

Private Health Interview

At the exam center you will be asked somepersonal questions. A trained interviewer willask some of these questions. Others, like thoseabout sexual experience and drug use, will be

36 that can cause allergies. Results of the household dust testing will be provided. A date and time to collect a dust sample will be set up after your exam is finished. Persons who test positive for hepatitis C will be called to request participation in a brief phone interview six months after the exam. Parents will respond for children.

Men with a high PSA test result will be called to request participation in a brief phone interview six months after the exam.

Taking part in these interviews and health exams after your visit to the exam center is voluntary.

How are NHANES data used?

What you tell us, your exam findings, and samples you give are a rich resource for health science. Many Federal agencies, universities, and other public and private groups use NHANES data. They use it to help find new cures and treatments for diseases and disabilities. The aim is to enhance the health of all people. Results of this survey may be reported in journals, at major meetings, or through other news media. None of these reports will ever name or use data that can point to any person who took part in the survey.

Many of the National Institutes of Health help us in this survey. The U.S. Department of Agricul­ture is our partner in planning how to get data on the foods you eat. We share with them the task of looking at people's diets in the U.S. The U.S. Environmental Protection Agency is another of our many partners. Your survey data helps study harmful effects of being exposed to environmental hazards.

Combining NHANES results with other facts about you can be useful. An example of this is using Social Security numbers to link survey data with vital statistics and other health records. Also, we may need to contact you in the future. To do this we would ask public or private agencies, such as the Post Office, to provide changes in your address.

In the past, we have had the chance to call or revisit people who took part in this survey. We may contact you in the future to ask you to be part of other research projects.

More questions?

Our survey representative can discuss other questions or concerns or give you other printed matter that can help. She or he can give you a phone number in your area that you can call for more facts about the survey. Also, you can make a free call to Dr. Kathryn Porter of the U.S. Public Health Service to discuss any aspect of the survey. She can be reached at 1­800-452-6115, Monday-Friday, 8 AM - 6 PM EST. You may also contact her regarding any survey-related injury. You can also get answers to your questions by mail (Room 4322, 3311 Toledo Rd., Hyattsville, MD 20782). If you have questions about your rights as a partici­pant, call the Research Ethics Review Board Chairperson at 1-800-223-8118.

What is the National Health andNutrition Examination Survey(NHANES)?

NHANES is a survey conducted by theNational Center for Health Statistics (NCHS).NCHS is a part of the Centers for DiseaseControl and Prevention, U.S. Department ofHealth and Human Services.

We have designed the study to learn about thehealth and diet of people in the United States.

Our survey is unique. It combines a homeinterview with health tests, which we do inmobile units. These special exam centers travelthe country with a highly trained medical team.Our team conducts an exam that looks at spe-cial health topics. They use the most up-to-datemethods and equipment for medical and dentalexams, and other lab tests.

We select a sample of people in towns and citiesacross the country to be part of the survey. Eachyear of the survey, we will examine about 5,000people in 15 different sites. NHANES programsbegan in the early 1960s. The current surveybegan in 1999 and will now be an ongoing pro-gram. More than 160,000 persons have been partof past NHANES programs.

We will use the data gathered in this survey toassess the number of people with certain healthproblems — for example, diabetes and highblood pressure. We will look at diet and otherhabits that affect health, such as smoking andexercise. NHANES data will describe the healthand nutrition of people of all ages. It will alsohelp design health programs and services, andexpand our knowledge about the health of peoplein the United States.

1

If you agree to take part in NHANES, we ask you to sign the attached consent form to show that you know the nature and purpose of the survey. Please be sure you understand the facts we have given you and that all questions are answered.

final consent form 10/19/04, 8:52 AM1

____________________________ _________ _____________________________ _____________________

#3

NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY

CONSENT/ASSENT AND PARENTAL PERMISSION FOR EXAMINATION AT THE MOBILE EXAMINATION CENTER

Print name of participant _____________________ ____________________ ____________________________________ First Middle Last

The attached brochure gives the details about National Health and Nutrition Examination Survey (NHANES). After reading the information provided, please complete the form below.

For the Parent or Guardian of the Survey Participant who is Under 18 Years Old: (unless the participant is an emancipated minor ):

I have read the information in the attached NHANES brochure, which explains the nature and purpose of the survey. I freely choose to let my child take part in the survey.

_________________________________________________________Signature of parent/guardian of participant

If you do not want a written report of your child’s exam results, check here

___________

.

_____________________ Date

For the Survey Participant who is 12 Years Old or Older:

I have read the information in the attached NHANES brochure, which explains the nature and purpose of the survey. I freely choose to take part in the survey.

_________________________________________________________Signature of participant

If you do not want a written report of your exam results, check here

_________

.

_____________________ Date

Signature of staff member Date Witness (if required) Date

___ ___ ___ ___ ___ ___ SP ID

04-0561 (10/04)

2Why were you selected?

We picked you and your household in a carefullydesigned sample of people living in the United States.We cannot choose someone in your place because noone has the same health profile as you. Having you aspart of our survey will help make our informationcomplete. We will add the data from your interviewand exam to that from all others who join in this study.That data will give us a big picture of our nation’shealth.

You may choose to take part in the survey and youmay permit your child to join in. That is your choice.No penalties or loss of benefits will come from refus-ing to take part. You may refuse any part of the examand are free to drop out anytime. Also, during theinterviews you may choose not to answer any question.

What do you gain by taking part inthe survey?

Free health test results, perhaps some ofmajor value to you

The chance to help learn more about thehealth of the nation

A cash payment to thank you for your timeand effort

Are the data we collect confidential?

We respect your privacy. Public laws keep all informa-tion you give confidential.

We will hold all data we collect in the strictest confi-dence. We gather and protect all data in keeping withthe requirements of Federal laws: the Public HealthService Act (42 USC 242k) authorizes collection andSection 308(d) of that law (42 USC 242m) and thePrivacy Act of 1974 (5 USC 552A) prohibit us fromgiving out information that identifies you or yourfamily without your consent. This means that wecannot give out any fact about you, even if a court oflaw asks for it. However, if we find signs of childabuse during an exam, we will report it to the localdepartment of social services or appropriate lawenforcement agency.

We will keep all survey data safe and secure. Sometimescertain collaborators, such as the U.S. Department ofAgriculture and the National Center for EnvironmentalHealth, assist us in data preparation, analysis, and re-search. When they do, the information is handled withstrict requirements to protect your confidentiality asguaranteed by NCHS. When we allow other collabora-tors and researchers to use survey data, we protect yourprivacy. We assign code numbers in place of names andnever reveal other facts that could directly identify you.

What about the exam?

Our interviewer will ask you to make an appointmentfor the exam at the mobile exam center. Our medicalteam will collect health data by examining you, doingtesting, and asking questions about diet and health. Nointernal exam is included. No drug testing will bedone. We will ask you to fast overnight for a morningexam. You will change into special exam clothes atthe exam center. The exam may take from 21/2 to 4hours for those 12 and older and 1-3 hours for youngerchildren. The time depends on the age of the personexamined, since some procedures are done only forcertain ages. (For a full list of procedures, see page 5.)

Reports of Exam Findings

The survey exam does not replace regularhealth care. However, you will get some examresults at the exam site. If the exam revealsurgent health problems, we will notify you atonce and refer you for treatment. If someurgent problem is found through your lab tests,right away we will send that information in a

nhanes.consent.signatures 10/19/04, 8:17 AM2

Black

7

Mobile Examination Center (MEC) Diagram

HearingTest

BodyMeasurement

BodyComposition

Dental Screening

Laboratory Staff Area

Pas

sage

way

Blood Draw

Fitness Testing

Vision Test ReceptionP

assa

gew

ay

DoctorDietary Interviews Interview Rooms

Eye Photos

National Health and NutritionExamination Survey, 2005-2006Examination Assent Brochure, 7-11 years of age

DEPARTMENT

OF

HEA

LTH

&H

UMAN SERVICES • USA

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics

7-11, 1/4 spread 10/13/04, 11:48 AM2-3

For more information about the National Center for Health Statistics, contact:

Information Dissemination StaffNational Center for Health Statistics3311 Toledo Road, Room 5412Hyattsville, Maryland 20782

Telephone: (301) 458-INFO (4636) E-mail: nchsquery@cdc.gov Internet: www.cdc.gov/nchs

For more information about the National Health and Nutrition Examination Survey you may visit the NHANES web site at: www.cdc.gov/nhanes.

04-0561 (10/04)