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Selection of Nutrition Status Indicators for Field Surveys: The NHANES III Design^1,2,

Catherine E. Woteki^*, Ronette Briefel^*, Dale Hitchcock^*, Trena Ezzati and Kurt Maurer^*

^* Division of Health Examination Statistics Office of Research and Methodology, National Center for Health Statistics, Centers for Disease Control, Public Health Service, U. S. Department of Health and Human Services, Hyattsville, MD 20782

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.

KEY WORDS: • nutrition surveys • nutritional assessment • NHANES III

¹ Presented as part of a conference, "Nutrition Monitoring and Nutrition Status Assessment", at the first fall meeting of the American Institute of Nutrition, Charleston, South Carolina, December 8–10, 1989. The conference was supported in part by cooperative agreement HPU880004-02-1 with the DHHS Office of Disease Prevention and Health Promotion, the USDA Human Nutrition Information Service, the DHHS National Center for Health Statistics, and the International Life Sciences Institute-Nutrition Foundation.

² The Planning Committee for the meeting consisted of Drs. Helen A. Guthrie, Roy J. Martin, Linda D. Meyers, James A. Olson, Catherine E. Woteki, and Richard G. Allison (ex officio). The symposium papers were edited by a committee consisting of Dr. James Allen Olson (coordinator), Dept. of Biochemistry & Biophysics, Iowa State University, Ames, IA; Dr. Cathy C. Campbell, Division of Nutritional Sciences, Cornell University, Ithaca, NY; Dr. Roy J. Martin, Dept. of Foods & Nutrition, University of Georgia, Athens, GA; and Dr. Catherine E. Woteki, Food & Nutrition Board, National Academy of Sciences, Washington, DC.

Manuscript received 28 March 1990. Revision accepted 11 July 1990.