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The National Health and Nutrition Examination Surveys (NHANES) are a series of cross-sectional surveys designed to provide national statistics on the health and nutritional status of the general household population through household interviews, standardized physical examinations, and the collection of biologic samples in special mobile examination centers. In NHANES III, race and/or ethnicity was categorized as non-Hispanic white, non-Hispanic African American and Mexican American.

Objectives. We examined racial/ethnic differences in the seroprevalence of selected infectious agents in analyses stratified according to risk categories to identify patterns and to determine whether demographic, socioeconomic, and behavioral characteristics explain these differences. Methods. We analyzed data from the third National Health and Nutrition Examination Survey, comparing differences among groups in regard to the prevalence of infection with hepatitis A, B, and C viruses, Toxoplasma gondii, Helicobacter pylori, and herpes simplex virus type 2. Results. Racial/ethnic differences were greater among those in the low-risk category. In the case of most infectious agents, odds associated with race/ethnicity were almost 2 times greater in that category than in the high-risk category. Conclusions. Stratification and adjustment for socioeconomic factors reduced or eliminated racial/ethnic differences in the prevalence of infection in the high-risk but not the low-risk group, wherein race/ethnicity remained significant and might have been a surrogate for unmeasured risk factors.

Objectives. The Dallas County study of a proposed national household seroprevalence survey was designed to assess the feasibility of conducting a national survey and to estimate the prevalence of human immunodeficiency virus (HIV) and hepatitis B virus infection for Dallas County. Risk behavior data were collected and correlated with HIV infection. Methods. Participants in this survey represented a probability sample of the county. A self-administered questionnaire on demographic characteristics and HIV risk behavior was completed and a blood sample was obtained. Results. Of the 1724 adults eligible for the survey, 1446 completed the questionnaire and 1374 provided a blood sample. The prevalence estimates were 0.4% for HIV and 7.3% for hepatitis B virus. A strong relationship was observed between HIV and hepatitis B status and risk behavior. Conclusions. In this study population, receptive anal intercourse and increasing numbers of male partners had the strongest correlation with the prevalence of HIV and hepatitis B virus infection in men. The high level of risk reporting for individuals positive for HIV or hepatitis B suggests that survey participants who engage in risk behaviors were willing to report those behaviors. (Am J Public Health. 1994;84:747-753), People who engage in behaviors that put them at risk for HIV infection appear willing to disclose this information during surveys. A total of 1,446 people between 18 and 54 years old completed a questionnaire about behaviors related to the risk of HIV infection for the Dallas County Household HIV Survey in 1989. Of these, 1,374 also provided a blood sample. Blood samples were analyzed for HIV and hepatitis B infections. Slightly more than 7% of those surveyed were infected with hepatitis B while 0.4% were HIV positive. Estimates of HIV and hepatitis B infection were significantly increased among those considered to be at high-risk for infection. Almost 5% of the men and 20% of the women reported participating in receptive anal intercourse. There was a strong association between HIV status and reports of high-risk behavior. Because these findings are consistent with known patterns of HIV transmission it appears that survey participants are willing to report high-risk behaviors. Responses obtained in this manner can be used to tailor HIV-prevention information to specific groups and areas.

A chart is presented that shows the percentage of adults aged 18 to 59 years who have been tested for HIV according to the number of lifetime sex partners and sex from 2007 to 2010 from the National Health and Nutrition Examination Survey in the U.S.

Background: HIV antibody testing has been included in the National Health and Nutrition Examination Survey, for ages 18-49 since 1999 and for ages 18-59 years since 2009 enabling estimation of trends in HIV prevalence as part of national surveillance in the U.S. household population. Self-reported HIV testing and antiretroviral use was also included in the survey since 1999., Setting: A continuous household-based probability sample of the U.S. population., Methods: From 1999 to 2018, 29,020 participants age 18-49 years were tested for HIV antibody and 34,092 participants age 18-59 years were asked about self-report of any previous HIV testing., Results: HIV prevalence was 0.41% among those aged 18-59 in 2009-2018 with a nonsignificant trend over time among those aged 18-49 years from 1999-2002 to 2015-2018. However, significant declines in prevalence were seen among those aged 18-39 years (0.37%-0.11%), women (0.22%-0.06%) and non-Hispanic black persons (2.14%-0.80%). Participants aged 18-39 years self-reported a decline in HIV testing, whereas those aged 40-49 and 50-59 years, non-Hispanic black persons and women reported an increase in getting a HIV test. Prevalence of infection and self-reported history of HIV testing varied by demographic and risk groups. HIV testing among HIV-positive persons was 83.9%. Antiretroviral therapy among those HIV-positive was under 50%., Conclusion: Although total HIV prevalence and previous self-reported HIV testing remained stable for the last 20 years, there were significant declines in age and demographic subgroups. Prevalence for both outcomes varied by demographic and risk variables., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

To examine changes in seroprevalence of antibodies to hepatitis A virus (HAV) during a period in which universal vaccine recommendations for all U.S. children were implemented, results from serologic testing from the National Health and Nutrition Examination Survey (NHANES) from 2003-2010 were analyzed among 7,989 participants age 6-19 years, born in the U.S. in two birth cohorts (1986-1996 and 1997-2004). Overall prevalence increased over time from 24.4% in 2003-2006 to the highest ever reported (37.6%) in 2007-2010. Specifically, increases reached statistical significance in the birth cohort born in the years after implementation of vaccine recommendations (1997-2004), among those of race/ethnicity other than white, non-Hispanic, and among states where recommendations were implemented later. The greatest increase over time was among the subgroup of persons in states with early implementation who were of race/ethnicity other than white, non-Hispanic. Geographic region and birth cohort based on vaccine recommendations as well as race/ethnicity were the main predictors of seropositivity in 2007-2010. The increase in Hepatitis A seroprevalence occurred during a time of decreasing incidence and increasing vaccination, however race/ethnic disparities persist.

Objective: To monitor trends in HIV seroprevalence in the United States, HIV testing was included in the National Health and Nutrition Examination Survey (NHANES) conducted from 1999 to 2006., Methods: From 1999 to 2006, 11,928 participants aged 18–49 years were tested for HIV antibody. Prevalence estimates were weighted to account for over sampling and nonresponse., Results: There were 67 HIV antibody-reactive individuals for a seroprevalence of 0.5% [95% confidence interval (CI) 0.3–0.6]. In the only age subgroup directly comparable between surveys (18–39 years), HIV seroprevalence remained constant from NHANES III(1988–1994) to NHANES 1999–2002 and 2003–2006. In NHANES 1999–2006, non–Hispanic blacks had significantly higher HIV seroprevalence(2.0%, 95% CI 1.5–2.7) compared with individuals in all other race/ethnic groups combined. Seroprevalence was also higher in each race/ethnic group among men who have sex with men (9.4%95% CI 5.0–17.1), among persons who had detectable antibody to herpes simplex type-two (1.9% 95% CI 1.4–2.8), among those who had 50 or more lifetime sex partners (3.4%, 95% CI 1.7–6.7), and among those who never married (0.8%, 95% CI 0.5–1.3)., Conclusions: In this household-based population, seroprevalence did not significantly change from NHANES III to NHANES 1999–2006. Non–Hispanic blacks had significantly higher prevalence of infection compared with other race/ethnic groups. Male-to-male sex and the presence of HSV-2 antibody were the strongest predictors of HIV infection

Objective: To provide seroprevalence estimates for six selected infectious agents by various sociodemographic and risk behavior variables stratified by race/ethnicity for adults age 20 years or more., Methods: Seroprevalence estimates for hepatitis A, B, and C, Toxoplasma gondii, Helicobacter pylori, and Herpes simplex-2 were calculated from data in the third National Health and Nutrition Examination Survey, 1988-94 utilizing weights to account for differential oversampling by race/ethnicity and nonresponse to the interview and examination. Standard errors and 95% confidence intervals were calculated taking into account the complex sample design., Results: Age-adjusted prevalence estimates and 95% confidence intervals are presented for three enteric infectious diseases hepatitis A, Toxoplasma gondii, Helicobacter pylori, as well as three blood-borne/sexually transmitted diseases, hepatitis B, hepatitis C, and Herpes simplex-2 stratified by race/ethnicity and by various demographic factors including gender, poverty index, population size of area of residence, country of birth, household crowding, and years of education. In addition, estimates are presented for the three blood-borne/sexually transmitted diseases by various risk behaviors that include marital status, age at first sexual intercourse, number of lifetime sexual partners, cocaine use, and marijuana use.