This report describes the creation of the NHANES 2017–March 2020 prepandemic data files.
CDC COVID-19 surveillance systems monitor SARS-CoV-2 antibody prevalence to collect information about asymptomatic, undiagnosed, and unreported disease using national convenience samples of blood donor data from commercial laboratories (1,2). However, nonrandom sampling of data from these systems could affect prevalence estimates (1-3). The National Health and Nutrition Examination Survey (NHANES) collects SARS-CoV-2 serology data among a sample of the general U.S. civilian population (4). In addition, NHANES collects self-reported COVID-19 vaccination and disease history, and its statistical sampling design is not based on health care access or blood donation. Therefore, NHANES data can be used to better quantify asymptomatic SARS-CoV-2 infection prevalence and seropositivity attained through infection without vaccination. Preliminary NHANES 2021-2022 results indicated that 41.6% of adults aged ≥18 years had serology indicative of past infection and that 43.7% of these adults, including 57.1% of non-Hispanic Black or African American (Black) adults, reported never having had COVID-19, possibly representing asymptomatic infection. In addition, 25.5% of adults whose serology indicated past infection reported never having received COVID-19 vaccination. Prevalences of seropositivity in the absence of vaccination were higher among younger adults and Black adults, reflecting the lower observed vaccination rates among these groups (5). These findings raise health equity concerns given the disparities observed in SARS-CoV-2 infection and COVID-19 vaccination. Results from NHANES 2021-2022 can guide ongoing efforts to achieve vaccine equity in COVID-19 primary vaccination series and booster dose coverage.*The 2-year sample design of NHANES 2021-2022, includes 30 primary sampling units (usually a county) that are visited sequentially. In each 12-month data collection period, a nationally representative sample of 15 primary sampling units are visited. Preliminary data for adults aged ≥18 years from the first 10 primary sampling units (visited during periods of SARS-CoV-2 Delta [August-November 2021] and Omicron [December 2021-May 2022] variant predominance) (6) were analyzed as a convenience sample because data for all 15 primary * https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html (Accessed September 12, 2022).
OBJECTIVE: In 2009, the National Children's Study (NCS) Vanguard Study tested the feasibility of household-based recruitment and participant enrollment by using a birth rate probability sample. In 2010, the NCS Program Office launched 3 alternative recruitment methods. We tested whether direct outreach (DO) recruitment could be a more efficient strategy to recruit women of child-bearing age. METHODS:The NCS DO recruitment approach recruited women, 18 to 49 years, who were pregnant or trying to conceive using passive recruitment methods emphasizing broad community outreach and engagement to create study awareness. Study mailings to listed households included a pregnancy screening questionnaire to identify potentially eligible women from selected neighborhoods to contact the study center. Unique features of this recruitment approach included the following: (1) expansion of selected neighborhoods to maximize potential participant recruitment and enrollment while minimizing in-person participant contact and (2) offering 2 levels of study participation distinguished by data collection intensity. RESULTS:Ten study centers listed 255 475 geographically eligible households for contact representing, on average, 3.3% of households per Primary Sampling Unit. A total of 19 354 women were identified for screening, and 17 421 completed a pregnancy screener representing 6.8% of eligible households. Study-eligible pregnant women were older, more educated, and less likely to be Hispanic than the general population. Only 16% (2786) of 17 421 screened women were study-eligible, and 81.1% of these 2786 women consented to participate. CONCLUSIONS:Although feasible, the DO approach recruited a sample of study-eligible pregnant women significantly different from the population. This recruitment approach was labor intensive for the yield of enrolled women.
I dedicate this dissertation to God Almighty, who has kept me through the journey of completing this work. I also dedicate this work to my husband, John Riddles, my parents, Soonrim Sim and Namdoo Kim, my sister, Youngsun Kim, my parents-in-law, Deanna and Ron Riddles, and their family, Ronnie, Christine, and Angela Riddles, each of which have been very supportive of me throughout my dissertation. iii
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