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Curated

National Health and Nutrition Examination Survey (NHANES), 1999-2000 (ICPSR 25501)

Released/updated on: 2012-02-22
Geographic coverage: United States
Time period: 1999-01-01--2000-01-01
The National Health and Nutrition Examination Surveys (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The NHANES combines personal interviews and physical examinations, which focus on different population groups or health topics. These surveys have been conducted by the National Center for Health Statistics (NCHS) on a periodic basis from 1971 to 1994. In 1999 the NHANES became a continuous program with a changing focus on a variety of health and nutrition measurements which were designed to meet current and emerging concerns. The surveys examine a nationally representative sample of approximately 5,000 persons each year. These persons are located in counties across the United States, 15 of which are visited each year. The 1999-2000 NHANES contains data for 9,965 individuals (and MEC examined sample size of 9,282) of all ages. Many questions that were asked in NHANES II, 1976-1980, Hispanic HANES 1982-1984, and NHANES III, 1988-1994, were combined with new questions in the NHANES 1999-2000. The 1999-2000 NHANES collected data on the prevalence of selected chronic conditions and diseases in the population and estimates for previously undiagnosed conditions, as well as those known to and reported by respondents. Risk factors, those aspects of a person's lifestyle, constitution, heredity, or environment that may increase the chances of developing a certain disease or condition, were examined. Data on smoking, alcohol consumption, sexual practices, drug use, physical fitness and activity, weight, and dietary intake were collected. Information on certain aspects of reproductive health, such as use of oral contraceptives and breastfeeding practices, were also collected. The interview includes demographic, socioeconomic, dietary, and health-related questions. The examination component consists of medical, dental, and physiological measurements, as well as laboratory tests. Demographic data file variables are grouped into three broad categories: (1) Status Variables: Provide core information on the survey participant. Examples of the core variables include interview status, examination status, and sequence number. (Sequence number is a unique ID assigned to each sample person and is required to match the information on this demographic file to the rest of the NHANES 1999-2000 data). (2) Recoded Demographic Variables: The variables include age (age in months for persons through age 19 years, 11 months; age in years for 1-84 year olds, and a top-coded age group of 85+ years), gender, a race/ethnicity variable, an education variable (high school, and more than high school education), country of birth (United States, Mexico, or other foreign born), and pregnancy status variable. Some of the groupings were made due to limited sample sizes for the two-year dataset. (3) Interview and Examination Sample Weight Variables: Sample weights are available for analyzing NHANES 1999-2000 data. For a complete listing of survey contents for all years of the NHANES see the document -- Survey Content -- NHANES 1999-2010.
Curated

National Health and Nutrition Examination Survey (NHANES), 2001-2002 (ICPSR 25502)

Released/updated on: 2012-02-22
Geographic coverage: United States
Time period: 2001-01-01--2002-01-01
The National Health and Nutrition Examination Surveys (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The NHANES combines personal interviews and physical examinations, which focus on different population groups or health topics. These surveys have been conducted by the National Center for Health Statistics (NCHS) on a periodic basis from 1971 to 1994. In 1999 the NHANES became a continuous program with a changing focus on a variety of health and nutrition measurements which were designed to meet current and emerging concerns. The surveys examine a nationally representative sample of approximately 5,000 persons each year. These persons are located in counties across the United States, 15 of which are visited each year. The 2001-2002 NHANES contains data for 11,039 individuals (and MEC examined sample size of 10,477) of all ages. Many questions that were asked in NHANES II, 1976-1980, Hispanic HANES 1982-1984, and NHANES III, 1988-1994, were combined with new questions in the NHANES 2001-2002. As in past health examination surveys, data were collected on the prevalence of chronic conditions in the population. Estimates for previously undiagnosed conditions, as well as those known to and reported by survey respondents, are produced through the survey. Risk factors, those aspects of a person's lifestyle, constitution, heredity, or environment that may increase the chances of developing a certain disease or condition, were examined. Data on smoking, alcohol consumption, sexual practices, drug use, physical fitness and activity, weight, and dietary intake were collected. Information on certain aspects of reproductive health, such as use of oral contraceptives and breastfeeding practices, were also collected. The diseases, medical conditions, and health indicators that were studied include: anemia, cardiovascular disease, diabetes and lower extremity disease, environmental exposures, equilibrium, hearing loss, infectious diseases and immunization, kidney disease, mental health and cognitive functioning, nutrition, obesity, oral health, osteoporosis, physical fitness and physical functioning, reproductive history and sexual behavior, respiratory disease (asthma, chronic bronchitis, emphysema), sexually transmitted diseases, skin diseases, and vision. The sample for the survey was selected to represent the United States population of all ages. Special emphasis in the 2001-2002 NHANES was on adolescent health and the health of older Americans. To produce reliable statistics for these groups, adolescents aged 15-19 years and persons aged 60 years and older were over-sampled for the survey. African Americans and Mexican Americans were also over-sampled to enable accurate estimates for these groups. Several important areas in adolescent health, including nutrition and fitness and other aspects of growth and development, were addressed. Since the United States has experienced dramatic growth in the number of older people during the twentieth century, the aging population has major implications for health care needs, public policy, and research priorities. NCHS is working with public health agencies to increase the knowledge of the health status of older Americans. NHANES has a primary role in this endeavor. In the examination, all participants visit the physician who takes their pulse or blood pressure. Dietary interviews and body measurements are included for everyone. All but the very young have a blood sample taken and see the dentist. Depending upon the age of the participant, the rest of the examination includes tests and procedures to assess the various aspects of health listed above. Usually, the older the individual, the more extensive the examination. Some persons who are unable to come to the examination center may be given a less extensive examination in their homes. Demographic data file variables are grouped into three broad categories: (1) Status Variables: provide core information on the survey participant. Examples of the core variables include interview status, examination status, and sequence number. (Sequence number is a unique ID assigned to each sample person and is required to match the information on this demographic file to the rest of the NHANES 2001-2002 data). (2) Recoded Demographic Variables: these variables include age (age in months for persons through age 19 years, 11 months; age in years for 1-84 year olds, and a top-coded age group of 85 years of age and older), gender, a race/ethnicity variable, current or highest grade of education completed, (less than high school, high school, and more than high school education), country of birth (United States, Mexico, or other foreign born), Poverty Income Ratio (PIR), income, and a pregnancy status variable (adjudicated from various pregnancy related variables). Some of the groupings were made due to limited sample sizes for the two-year data set. (3) Interview and Examination Sample Weight Variables: sample weights are available for analyzing NHANES 2001-2002 data. For a complete listing of survey contents for all years of the NHANES see the document -- Survey Content -- NHANES 1999-2010.
Curated

National Health and Nutrition Examination Survey (NHANES), 2003-2004 (ICPSR 25503)

Released/updated on: 2016-07-11
Geographic coverage: United States
Time period: 2003-01-01--2004-01-01

The National Health and Nutrition Examination Surveys (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The NHANES combines personal interviews and physical examinations, which focus on different population groups or health topics. These surveys have been conducted by the National Center for Health Statistics (NCHS) on a periodic basis from 1971 to 1994. In 1999 the NHANES became a continuous program with a changing focus on a variety of health and nutrition measurements which were designed to meet current and emerging concerns. The surveys examine a nationally representative sample of approximately 5,000 persons each year. These persons are located in counties across the United States, 15 of which are visited each year.

For NHANES 2003-2004, there were 12,761 persons selected for the sample, 10,122 of those were interviewed (79.3 percent) and 9,643 (75.6 percent) were examined in the mobile examination centers (MEC). Many of the NHANES 2003-2004 questions were also asked in NHANES II 1976-1980, Hispanic HANES 1982-1984, NHANES III 1988-1994, and NHANES 1999-2002. New questions were added to the survey based on recommendations from survey collaborators, NCHS staff, and other interagency work groups. As in past health examination surveys, data were collected on the prevalence of chronic conditions in the population. Estimates for previously undiagnosed conditions, as well as those known to and reported by survey respondents, are produced through the survey. Risk factors, those aspects of a person's lifestyle, constitution, heredity, or environment that may increase the chances of developing a certain disease or condition, were examined. Data on smoking, alcohol consumption, sexual practices, drug use, physical fitness and activity, weight, and dietary intake were collected. Information on certain aspects of reproductive health, such as use of oral contraceptives and breastfeeding practices, were also collected. The diseases, medical conditions, and health indicators that were studied include: anemia, cardiovascular disease, diabetes and lower extremity disease, environmental exposures, equilibrium, hearing loss, infectious diseases and immunization, kidney disease, mental health and cognitive functioning, nutrition, obesity, oral health, osteoporosis, physical fitness and physical functioning, reproductive history and sexual behavior, respiratory disease (asthma, chronic bronchitis, emphysema), sexually transmitted diseases, skin diseases, and vision. The sample for the survey was selected to represent the United States population of all ages. Special emphasis in the 2003-2004 NHANES was on adolescent health and the health of older Americans. To produce reliable statistics for these groups, adolescents aged 15-19 years and persons aged 60 years and older were over-sampled for the survey. African Americans and Mexican Americans were also over-sampled to enable accurate estimates for these groups. Several important areas in adolescent health, including nutrition and fitness and other aspects of growth and development, were addressed. Since the United States has experienced dramatic growth in the number of older people during the twentieth century, the aging population has major implications for health care needs, public policy, and research priorities. NCHS is working with public health agencies to increase the knowledge of the health status of older Americans. NHANES has a primary role in this endeavor. In the examination, all participants visit the physician who takes their pulse or blood pressure. Dietary interviews and body measurements are included for everyone. All but the very young have a blood sample taken and see the dentist. Depending upon the age of the participant, the rest of the examination includes tests and procedures to assess the various aspects of health listed above. Usually, the older the individual, the more extensive the examination. Some persons who are unable or unwilling to come to the examination center may be given a less extensive examination in their homes.

Demographic data file variables are grouped into three broad categories: (1) Status Variables: provide core information on the survey participant. Examples of the core variables include interview status, examination status, and sequence number. (Sequence number is a unique ID assigned to each sample person and is required to match the information on this demographic file to the rest of the NHANES 2003-2004 data). (2) Recoded Demographic Variables: these variables include age (age in months for persons through age 19 years, 11 months; age in years for 1- to 84-year-olds, and a top-coded age group of 85 years of age and older), gender, a race/ethnicity variable, current or highest grade of education completed, (less than high school, high school, and more than high school education), country of birth (United States, Mexico, or other foreign born), Poverty Income Ratio (PIR), income, and a pregnancy status variable (adjudicated from various pregnancy related variables). Some of the groupings were made due to limited sample sizes for the two-year data set. (3) Interview and Examination Sample Weight Variables: sample weights are available for analyzing NHANES 2003-2004 data. For a complete listing of survey contents for all years of the NHANES see the document -- Survey Content -- NHANES 1999-2010.

Curated

National Health and Nutrition Examination Survey (NHANES), 2005-2006 (ICPSR 25504)

Released/updated on: 2012-02-22
Geographic coverage: United States
Time period: 2005-01-01--2006-01-01
The National Health and Nutrition Examination Surveys (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The NHANES combines personal interviews and physical examinations, which focus on different population groups or health topics. These surveys have been conducted by the National Center for Health Statistics (NCHS) on a periodic basis from 1971 to 1994. In 1999 the NHANES became a continuous program with a changing focus on a variety of health and nutrition measurements which were designed to meet current and emerging concerns. The surveys examine a nationally representative sample of approximately 5,000 persons each year. These persons are located in counties across the United States, 15 of which are visited each year. For NHANES 2005-2006, there were 10,348 persons selected for the sample, 10,122 of those were interviewed (79.3 percent) and 9,643 (75.6 percent) were examined in the mobile examination centers (MEC). Many of the NHANES 2005-2006 questions were also asked in NHANES II 1976-1980, Hispanic HANES 1982-1984, NHANES III 1988-1994, and NHANES 1999-2004. New questions were added to the survey based on recommendations from survey collaborators, NCHS staff, and other interagency work groups. As in past health examination surveys, data were collected on the prevalence of chronic conditions in the population. Estimates for previously undiagnosed conditions, as well as those known to and reported by survey respondents, are produced through the survey. Risk factors, those aspects of a person's lifestyle, constitution, heredity, or environment that may increase the chances of developing a certain disease or condition, were examined. Data on smoking, alcohol consumption, sexual practices, drug use, physical fitness and activity, weight, and dietary intake were collected. Information on certain aspects of reproductive health, such as use of oral contraceptives and breastfeeding practices, were also collected. The diseases, medical conditions, and health indicators that were studied include: anemia, cardiovascular disease, diabetes and lower extremity disease, environmental exposures, equilibrium, hearing loss, infectious diseases and immunization, kidney disease, mental health and cognitive functioning, nutrition, obesity, oral health, osteoporosis, physical fitness and physical functioning, reproductive history and sexual behavior, respiratory disease (asthma, chronic bronchitis, emphysema), sexually transmitted diseases, skin diseases, and vision. The sample for the survey was selected to represent the United States population of all ages. Special emphasis in the 2005-2006 NHANES was on adolescent health and the health of older Americans. To produce reliable statistics for these groups, adolescents aged 15-19 years and persons aged 60 years and older were over-sampled for the survey. African Americans and Mexican Americans were also over-sampled to enable accurate estimates for these groups. Several important areas in adolescent health, including nutrition and fitness and other aspects of growth and development, were addressed. Since the United States has experienced dramatic growth in the number of older people during the twentieth century, the aging population has major implications for health care needs, public policy, and research priorities. NCHS is working with public health agencies to increase the knowledge of the health status of older Americans. NHANES has a primary role in this endeavor. In the examination, all participants visit the physician who takes their pulse or blood pressure. Dietary interviews and body measurements are included for everyone. All but the very young have a blood sample taken and see the dentist. Depending upon the age of the participant, the rest of the examination includes tests and procedures to assess the various aspects of health listed above. Usually, the older the individual, the more extensive the examination. Some persons who are unable or unwilling to come to the examination center may be given a less extensive examination in their homes. Demographic data file variables are grouped into three broad categories: (1) Status Variables: provide core information on the survey participant. Examples of the core variables include interview status, examination status, and sequence number. (Sequence number is a unique ID assigned to each sample person and is required to match the information on this demographic file to the rest of the NHANES 2005-2006 data). (2) Recoded Demographic Variables: these variables include age (age in months for persons through age 19 years, 11 months; age in years for 1- to 84-year-olds, and a top-coded age group of 85 years of age and older), gender, a race/ethnicity variable, current or highest grade of education completed, (less than high school, high school, and more than high school education), country of birth (United States, Mexico, or other foreign born), Poverty Income Ratio (PIR), income, and a pregnancy status variable (adjudicated from various pregnancy related variables). Some of the groupings were made due to limited sample sizes for the two-year dataset. (3) Interview and Examination Sample Weight Variables: sample weights are available for analyzing NHANES 2005-2006 data. For a complete listing of survey contents for all years of the NHANES see the document -- Survey Content -- NHANES 1999-2010.
Curated

National Health and Nutrition Examination Survey (NHANES), 2007-2008 (ICPSR 25505)

Released/updated on: 2012-02-22
Geographic coverage: United States
Time period: 2007-01-01--2008-01-01
The National Health and Nutrition Examination Surveys (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The NHANES combines personal interviews and physical examinations, which focus on different population groups or health topics. These surveys have been conducted by the National Center for Health Statistics (NCHS) on a periodic basis from 1971 to 1994. In 1999 the NHANES became a continuous program with a changing focus on a variety of health and nutrition measurements which were designed to meet current and emerging concerns. The surveys examine a nationally representative sample of approximately 5,000 persons each year. These persons are located in counties across the United States, 15 of which are visited each year. For NHANES 2007-2008, there were 12,946 persons selected for the sample, 10,149 of those were interviewed (78.4 percent) and 9,762 (75.4 percent) were examined in the mobile examination centers (MEC). Many of the NHANES 2007-2008 questions were also asked in NHANES II 1976-1980, Hispanic HANES 1982-1984, NHANES III 1988-1994, and NHANES 1999-2006. New questions were added to the survey based on recommendations from survey collaborators, NCHS staff, and other interagency work groups. As in past health examination surveys, data were collected on the prevalence of chronic conditions in the population. Estimates for previously undiagnosed conditions, as well as those known to and reported by survey respondents, are produced through the survey. Risk factors, those aspects of a person's lifestyle, constitution, heredity, or environment that may increase the chances of developing a certain disease or condition, were examined. Data on smoking, alcohol consumption, sexual practices, drug use, physical fitness and activity, weight, and dietary intake were collected. Information on certain aspects of reproductive health, such as use of oral contraceptives and breastfeeding practices, were also collected. The diseases, medical conditions, and health indicators that were studied include: anemia, cardiovascular disease, diabetes and lower extremity disease, environmental exposures, equilibrium, hearing loss, infectious diseases and immunization, kidney disease, mental health and cognitive functioning, nutrition, obesity, oral health, osteoporosis, physical fitness and physical functioning, reproductive history and sexual behavior, respiratory disease (asthma, chronic bronchitis, emphysema), sexually transmitted diseases, skin diseases, and vision. The sample for the survey was selected to represent the United States population of all ages. The NHANES target population is the civilian, noninstitutionalized United States population. Beginning in 2007, some changes were made to the domains being oversampled. The primary change is the oversampling of the entire Hispanic population instead of just the Mexican American (MA) population, which has been oversampled since 1988. Sufficient numbers of MAs were retained in the sample design so that trends in the health of MAs can continue to be monitored. Persons 60 years of age and older, Blacks, and low income persons were also oversampled. In addition, for each of the race/ethnicity domains, the 12-15 and 16-19 year age domains were combined and the 40-59 year age minority domains were split into 10-year age domains of 40-49 and 50-59. This has led to an increase in the number of participants aged 40 and older and a decrease in 12- to 19-year-olds from previous cycles. The oversample of pregnant women and adolescents in the survey from 1999-2006 was discontinued to allow for the oversampling of the Hispanic population. NCHS is working with public health agencies to increase knowledge of the health status of older Americans. NHANES has a primary role in this endeavor. In the examination, all participants visit the physician who takes their pulse or blood pressure. Dietary interviews and body measurements are included for everyone. All but the very young have a blood sample taken and see the dentist. Depending upon the age of the participant, the rest of the examination includes tests and procedures to assess the various aspects of health listed above. Usually, the older the individual, the more extensive the examination. Demographic data file variables are grouped into three broad categories: (1) Status Variables: Provide core information on the survey participant. Examples of the core variables include interview status, examination status, and sequence number. (Sequence number [SEQN] is a unique ID number assigned to each sample person and is required to match the information on this demographic file to the rest of the NHANES 2007-2008 data.) (2) Recoded Demographic Variables: The variables include age (age in months for persons under age 80, age in years for 1 to 80-year-olds, and a top-coded age group of 80 years and older), gender, a race/ethnicity variable, an current or highest grade of education completed, (less than high school, high school, and more than high school education), country of birth (United States, Mexico, or other foreign born), ratio of family income to poverty threshold, income, and a pregnancy status variable (adjudicated from various pregnancy-related variables). Some of the groupings were made due to limited sample sizes for the two-year dataset. (3) Interview and Examination Sample Weight Variables: Sample weights are available for analyzing NHANES 2007-2008 data. Most data analyses require either the interviewed sample weight (variable name: WTINT2YR) or examined sample weight (variable name: WTMEC2YR). The two-year sample weights (WTINT2YR, WTMEC2YR) should be used for NHANES 2007-2008 analyses.
Curated

National Health Interview Survey, 1991: Child Health Supplement (ICPSR 6052)

Released/updated on: 1993-10-02
Geographic coverage: United States
The purpose of the National Health Interview Survey (NHIS) is to obtain information about the amount and distribution of illness, its effects in terms of disability and chronic impairments, and the kinds of health services people receive. The 1991 Child Health Supplement provides variables from the core Person File (see NATIONAL HEALTH INTERVIEW SURVEY, 1991 [ICPSR 6049]) including sex, age, race, marital status, veteran status, education, income, industry and occupation codes, and limits on activity. Variables unique to this supplement cover childhood immunizations and whether children were vaccinated for diphtheria, tetanus, pertussis, polio, measles, mumps, and rubella. Additionally, questions were asked about occurrences of diarrhea and ear infections, other possible physical and mental conditions, and whether the children were in day care with other children. Questions about seat belt usage and organized sports participation were asked as well.
Curated

New York City Health and Nutrition Examination Survey (NYC HANES), 2004 (ICPSR 31421)

Released/updated on: 2011-11-03
Geographic coverage: New York City, United States, New York (state)
Time period: 2004-06-02--2004-12-19
The New York City Department of Health and Mental Hygiene, with support from the National Center for Health Statistics, conducted the New York City Health and Nutrition Examination Survey (NYC HANES) to improve disease surveillance and establish citywide estimates for several previously unmeasured health conditions from which reduction targets could be set and incorporated into health policy planning initiatives. NYC HANES also provides important new information about the prevalence and control of chronic disease precursors, such as undiagnosed hypertension, hypercholesterolemia, and impaired fasting glucose, which allow chronic disease programs to monitor more proximate health events and rapidly evaluate primary intervention efforts. Study findings are used by the public health community in New York City, as well as by researchers and clinicians, to better target resources to the health needs of the population. The NYC HANES data consist of the following six datasets: (1) Study Participant File (SPfile), (2) Computer-Assisted Personal Interview (CAPI), (3) Audio Computer-Assisted Self-Interview (ACASI), (4) Composite International Diagnostic Interview(CIDI), (5) Examination Component, and (6) Laboratory Component. The Study Participant File contains variables necessary for all analyses, therefore, when using the other datasets, they should be merged to this file. Variable P_ID is the unique identifier used to merge all datasets. Merging information from multiple NYC HANES datasets using SP_ID ensures that the appropriate information for each SP is linked correctly. (SAS datasets must be sorted by SP_ID prior to merging.) Please note that NYC HANES datasets may not have the same number of records for each component because some participants did not complete each component. Demographic variables include race/ethnicity, Hispanic origin, age, body weight, gender, education level, marital status, and country of birth.
Curated
Partially restricted
Simple Crosstabs

Project Migrante: Health Status and Access to Health Care Among Migrants on Mexico's Northern Border, 2020-2021 (ICPSR 38601)

Released/updated on: 2023-06-07
Geographic coverage: Tijuana, Matamoros, Mexico, Ciudad Juárez
Time period: 2020-01-01--2021-01-01

The Migrante Project is a binational study that examines health status and access to health care among Mexican migrants. Since 2007, Migrante investigators have implemented a series of cross-sectional probability-based surveys on Mexico's northern border. The current phase of Migrante includes three survey waves (N=1,200 each), each focused on a specific topic area. Data for the Wave I survey focused on HIV and sexual/reproductive health. Wave II is focused on non-communicable disease. Data collection for this wave is ongoing. Wave III (data to be collected in 2023) will focus on mental health and substance use. All surveys contain additional questions on socio-demographics, health status, health care access, migration history, and contextual factors related to migration stage. All waves also include biometric testing (for example, rapid HIV testing). Participants are sampled from four different migrant flows:

  • Northbound flow: Migrants traveling north and arriving at the border from other regions in Mexico
  • Southbound flow - Border: Migrants traveling from the Mexico side of the Mexico-US border to points farther south
  • Southbound flow - U.S.: Migrants returning to Mexico from the U.S. voluntarily
  • Deported flow: Migrants returning to Mexico from the U.S via deportation

The data herein come from the Wave I survey and were collected in Tijuana, Matamoros, and Ciudad Juárez, Mexico between August 2020 and September 2021. The study employed a multistage sampling design, with a combination of geographic and temporal sampling units, modeled after the Encuesta sobre Migración en la Frontera Norte de México (EMIF Norte). Migrante sampling sites for Wave I included bus stations, airports, and deportation stations in each of the three cities.

Eligible individuals were at least 18 years old, born in Mexico or other Latin American countries, fluent in Spanish, not residents of the city where the survey is being conducted (except for deported migrants), and traveling for labor reasons or change of residence. In total, there were 1,398 observations (northbound flow N=347, southbound flow N=703, and deported flow N=348) in Wave I, with 1,257 individuals completing the Wave I survey. Three hundred and six of these individuals belonged to the deported flow, 306 to the northbound flow, 336 to the southbound border flow, and 309 to the southbound U.S. flow. Consent rates ranged from 13% to 98% depending on the flow and survey city. Migrante surveys can be used to produce population-level estimates of health outcomes and health care access, investigate variations across migration phases, and explore the impact of health care and immigration policies on migrants' health outcomes, healthcare access, and individual and environmental health determinants.