title: Utilization of the National Health and Nutrition Examination (NHANES) Survey for Symptoms, Tests, and Diagnosis of Chronic Respiratory Diseases and Assessment of Second hand Smoke Exposure.
abstract: BACKGROUND
  Respiratory diseases encompass a number of complex disorders that constitute a major cause of both morbidity and mortality worldwide with a major burden to the afflicted as well as the health care systems that care for them. Although the prevalence of chronic respiratory diseases (CRDs) has been decreasing in industrialized countries due to a decreasing number of smokers and stricter laws aimed at reducing exposure to secondhand smoke (SHS), the burden of CRDs in developing world populations is expected to worsen due to communicable disease prevention programs, aging populations, environmental air pollution, and continued tobacco smoke exposure. Although tobacco smoking has been shown to be significantly associated with many CRDs, evidence linking SHS exposure to different CRDs is mixed, especially with low levels of SHS exposure.
  
  
  METHODS
  The National Health and Nutrition Examination Survey (NHANES) is a series of studies designed to assess the health and nutritional status of non-institutionalized adults and children in the United States (U.S.). In addition to being used to monitor the health of the U.S. population, NHANES data allow for research into prevalent health problems and their risk factors in the population, such with CRDs and SHS exposure. NHANES data can be utilized to explore a variety of issues related to the assessment of SHS exposure and its association to respiratory symptoms and illnesses.
  
  
  RESULTS
  First, we provide a brief review of NHANES including its strengths and limitations. We then provide a summary of the variables and publically available population based data that can be used to study associations between SHS exposure and CRD symptoms, testing and diagnoses.
  
  
  CONCLUSIONS
  Rich and cost effective, NHANES data provide a unique opportunity for research into the risk factors for CRDs in the U.S. population, particularly into the possible health effects of low levels of SHS exposure.
authors.affiliation: Department of Epidemiology and Public Health, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.|Sylvester Comprehensive Cancer Center, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.
authors.forename: Tulay
authors.initials: T
authors.lastname: Koru-Sengul
authors.affiliation: Department of Epidemiology and Public Health, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.|Department of Internal Medicine, Kaiser Permanente, Los Angeles, California, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Clark
authors.affiliation: Department of Epidemiology and Public Health, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.|Sylvester Comprehensive Cancer Center, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.
authors.forename: Manuel A
authors.initials: MA
authors.lastname: Ocasio
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Wanner
authors.affiliation: Department of Epidemiology and Public Health, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.|European Centre for Environment and Human Health Peninsula, College of Medicine and Dentistry Knowledge Spa, Royal Cornwall Hospital Truro, Cornwall, UK.
authors.forename: Lora E
authors.initials: LE
authors.lastname: Fleming
authors.affiliation: Department of Epidemiology and Public Health, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.|Sylvester Comprehensive Cancer Center, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lee
keywords: Biomarker; Chronic respiratory disease; Cotinine; NHANES; NNAL; Second hand smoke exposure