Consent Changes

Attachment 3a

National Health and Nutrition Examination Survey (NHANES)

Consent Form Changes

2016 Home Interview Consent

Original Language

You may take part in this survey or not. The choice is yours. You will not lose any benefits if you say no. If you choose to take part, you don’t have to answer every question.

We can do additional health research by linking the interview and exam data of everyone listed under “SP NAME” in the gray box below to vital statistics, health, nutrition, and other related records. May we try to link these survey records with other records?

 Yes  No  N/A

Do you have more questions about the survey? Do you have more questions about the survey? You can make a toll-free call to Dr. Joseph Woodring of the U.S. Public Health Service at 1-800-452-6115, Monday-Friday, 8:00 AM-5:30 PM ET.

Revised Language

You may take part in this survey or not. The choice is yours. You will not lose any benefits if you say no. If you choose to take part, you don’t have to answer every question and you can stop the interview at any time.

We can do additional health research by linking the interview and exam data of everyone listed under “SP NAME” in the gray box below to vital statistics, health, nutrition, and other related records. May we try to link these survey records with other records?

 Yes  No  N/A

Do you have more questions about the survey? You can make a toll-free call to the Senior Medical Officer at 1-800-452-6115, Monday-Friday, 8:30 AM-5:30 PM ET.

In addition, the date of this revised form was changed from 2014 to 2016.

2016 MEC Assent

Original Language

Your parents say that you can take part in this special survey. You have just read about the survey in this book. The survey tells us about the health of people. We will ask you to have an exam at our vans that are here in your town. This exam is a little like going to the doctor. Other kids and their families will be at the center. You do not have to do this if you do not want to. If you take part, you will learn some things about yourself. You will help us learn a lot about other kids in the United States.

Revised Language

Your parents say that you can take part in this special survey. You have just read about the survey in this book. The survey tells us about the health of people. We will ask you to have an exam at our vans that are here in your town. This exam is a little like going to the doctor. Other kids and their families will be at the center. You do not have to do this if you do not want to. You can also stop at any time and you do not have to do any tests that you do not want to. If you take part, you will learn some things about yourself. You will help us learn a lot about other kids in the United States.

In addition, the date of this revised form was changed from 2013 to 2016.

Consent/Assent and Parental Permission for Specimen Storage and Continuing Studies

Original Language

Q Why will a sample of blood and urine be kept for future health studies?

A We will store some of the blood and urine from persons who are examined in NHANES for future health studies. These samples will be frozen and kept in a specimen bank for as long as they last. Your participation is voluntary and no loss of benefits will result if you refuse.

Revised Language

Q Why will a sample of blood and urine be kept for future health studies?

A We will store some of the blood and urine from persons who are examined in NHANES for future health studies. These samples will be frozen and kept in a specimen bank for as long as they last. You can request that your samples be removed at any time. Your participation is voluntary and no loss of benefits will result if you refuse.

In addition, the date of this revised form was changed from 2013 to 2016.

The complete versions of these revised consents are provided in Attachment 3b.