Adult-Parental-Consent-Assent-Brochure

Att_11e_Adult-Parental-Consent-Assent-Brochure_201124.pdf

National Health and Nutrition Examination Survey

Adult-Parental-Consent-Assent-Brochure

OMB: 0920-0950

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Attachment 11e

Centers for Disease
Control and Prevention
National Center for
Health Statistics

We will display a picture
of a MEC component,
social distancing, and masks.

National Health and
Nutrition Examination Study
What will I be asked to do at the
mobile center?

Overview
The National Health and Nutrition Examination
Survey (NHANES) is conducted by the National
Center for Health Statistics (NCHS), which is part of
the Centers for Disease Control and Prevention. We
designed the survey to learn about the health and
nutrition of people in the United States.
Our survey is unique. It combines an interview
with health measurements that are done in special
mobile exam centers. These centers travel across
the country, each with its own highly trained medical
team. The team looks at special health topics. We
use the most up-to-date methods and equipment for
medical exams and lab tests.

Why is this health survey important?
We use the data gathered in this survey to find
out the number of people with certain health
problems—for example, diabetes and high blood
pressure. We look at diet and other habits that
affect health, such as smoking and exercise.
NHANES provides health and nutrition information
on people of all ages. It is also used by those who
design health programs and services, and the
survey expands our knowledge about the health of
people in the United States.

What do I gain by taking part in
the exam?
• Free health test results.
• The chance to help learn more about the
health of the Nation.
• A token of thanks for your time and effort.
You may choose to be in the survey, and you may
allow your child to be in it, too. That is your choice.
There is no penalty if you refuse. You may refuse
any part of the exam and you are free to drop out
at any time. Also, during the interviews you may
choose not to answer every question.

Upon arriving at the mobile center, you will be
asked to change into a two-piece examination
outfit. Our medical team will then guide you to private rooms, where we will check your height and
weight, blood pressure, and body composition. We
will collect blood and urine samples.
If your appointment is scheduled in the morning,
we will ask you not to eat or drink anything except
water overnight. The health tests may take up to 2
½ hours. The time spent in the mobile center and
the tests you receive will be based on your age and
current medical condition. For a full list of exams
you may receive, see the Health Measurements List.

After your visit to the NHANES
mobile center
You will be asked to participate in two dietary
interviews by phone 3-7 days after your visit to the
mobile center. All survey participants will be asked
to take part in the interviews. An adult will answer
questions for children less than 5 years old and
will assist children 6-11 years old. Participants 12
years and older will respond for themselves.
You, or an adult in your family (if you are between
1-15 years old), will also be asked about food
shopping habits in a separate interview.
For each of these interviews you will receive a
token of thanks for your time and effort.

We will display a picture
of a MEC component,
social distancing, and masks.

2021 MEC Exam Consent/Assent Brochure

We will display a picture
of a MEC component,
social distancing, and masks.

Will I get my results?
You will get a report of your results. If the exam
shows urgent health problems, we will notify you
at once and refer you for treatment. If an urgent
problem is found through your lab tests, we will
immediately send that information in a letter to
your home address. If you wish, we will also mail
routine results to you approximately 3–4 months
after the exam. In general, we give results only to
persons examined or to the parents or guardians
of children. Some results, like those for sexually
transmitted diseases (STD) and pregnancy, are
not put in writing.

Are the tests safe?
The tests are safe. Some tests may cause you
slight discomfort. Examples are having a blood
sample taken or not eating for 8 hours. For the
blood sample, a person will have a small amount
of blood drawn from a vein in his or her arm
with a needle. We will not ask you to have any
test that is wrong for you because of a health
problem you have.

We report positive pregnancy results only to the
person tested if she is aged 14 years or over and
doesn’t already know that she is pregnant. If a girl
is younger than 14 and has a positive pregnancy
test, we will inform both her and her parent or
guardian.

We will perform a body composition scan that
involves low-dosage x-rays to persons aged 8
years and older. Radiation exposure during this
test is equal to a cross-country airline flight or a
few days of natural background radiation.
We will get information about periods from
girls and women, and those who have started
their periods will have a urine pregnancy test.
Those with a positive test will not have the body
composition scan.

Some test results are not reported because
not enough information is currently known
to understand their meaning for your health.
Better ways to look at some of the tests may be
developed in the future. Some of the tests may be
read again. We will not report the results
of future tests to you.

Medical errors and injuries are rare. The NHANES
program cannot provide money or other
compensation if they occur. However, if you
believe you have been harmed as a result of
your participation in NHANES, we want to know
about it. Please call us at 1–800–452–6115. You
also have a right to file a claim under the Federal
Tort Claims Act (28 U.S. Code § 2674) with the
Centers for Disease Control and Prevention.
We can provide you with information about this
process. You must file the claim within 2 years
after the date you became aware of the personal
injury, loss of property, or other damage.

NHANES does not cover the cost of any health
care you may decide to get after the exam. If you
have questions about getting your results, please
call 1–800–452–6115.

Will you be asked personal questions?
At the mobile center, you will be asked some
personal questions in complete privacy. You
will answer the questions in a private room on a
computer screen. You answer by touching an answer
choice on the screen. Like all of the other data we
collect, your answers are kept strictly private.

We will display a picture
of a MEC component,
social distancing, and masks.

If you are under 18 years of age, we may notify your
parents if we have reason to believe you may harm
yourself because of sad feelings.
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How are NHANES data used?
What you tell us, your exam results, and the
samples you give are a good resource for health
science. Many federal agencies, universities, and
other public and private groups use NHANES data
and these data may be reported in journals, at
major scientific meetings, or through other news
media. They use it to help find new cures and
treatments for diseases and disabilities. The
aim is to make the health of all people better.
None of these reports will ever use data that can
identify any person who took part in the survey.

Will my information be kept private?
We respect your privacy. Public laws keep all
information you give private.
Assurance of Confidentiality: We take your
privacy very seriously. All information that relates
to or describes identifiable characteristics of
individuals, a practice, or an establishment will
be used only for statistical purposes. NCHS
staff, contractors, and agents will not disclose
or release responses in identifiable form without
the consent of the individual or establishment
in accordance with section 308(d) of the
Public Health Service Act (42 U.S.C. 242m) and
the Confidential Information Protection and
Statistical Efficiency Act of 2018 (Title III of the
Foundations for Evidence-Based Policymaking
Act of 2018 (Pub. L. No. 115-435, 132 Stat.
5529 § 302)). In accordance with CIPSEA, every
NCHS employee, contractor, and agent has
taken an oath and is subject to a jail term of up
to five years, a fine of up to $250,000, or both
if he or she willfully discloses ANY identifiable
information about you.

NHANES has been used in important national
reports. One of these highlights the food we eat.
Another tells us about the exposures we have to
chemicals in the environment. The survey has
also been used to track the number of people who
have health conditions like high blood pressure
or diabetes. Studies using NHANES data can be
found on our website,
https://www.cdc.gov/nchs/nhanes/participant.htm.
Health studies using NHANES can be enhanced
by combining your survey records with other data
sources. An example is linking your survey results
with vital statistics and Medicare claims. To do
this, we will ask your permission to collect your
Social Security and Medicare numbers. As we
stated earlier, we keep this information safe
and secure.

These laws do not allow us to give out data
that identifies you or your family without your
permission. However, if we find signs of child
abuse during an exam, we will report it to the
local department of social services or the police.

Also, we may need to contact you in the future. To
do this, we will ask public or private agencies, such
as the Post Office, to update us with changes to
your home address. In the past, we have called or
revisited people who took part in this survey. We
may contact you in the future to ask you to be part
of other public health studies. Your participation in
future studies is voluntary.

We will keep all survey data safe and secure.
When we share data with our partners, to help
prepare and process the data, we do so in a way
that protects your privacy as required by law.

Will you test for sexually transmitted diseases (STDs)?
Teenagers (14 years and older) and adults under age 60 will be 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 you leave the mobile center, you will be given 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 told 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 get 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. For details on the tests, please see the Health Measurements List.
3

Safety precautions

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File Modified	2020-11-24
File Created	2020-11-24