Canadian Health Measures Survey – Information and Consent Booklet – Cycle 8

Table of contents

• At a glance
• Household interview
• Temporary examination centre
• Laboratory tests
• Results
• Biobank
• Canadian Health Measures Survey publications and data sharing
• Appendix A: Laboratory tests
• Appendix B: Pre-testing instructions: Fasting and Non-fasting

At a glance

One or two members of your household are invited to take part in a major health initiative led by Statistics Canada called the Canadian Health Measures Survey (CHMS).

By participating in this survey, you will receive valuable information about your health and help to improve the delivery of health services in Canada.

The CHMS is a voluntary survey. Before you decide to participate, it is important that you understand why we are conducting this survey and what your participation involves.

We invite you to read this booklet. Additional information, including videos, is available at www.statcan.gc.ca/chms.

What is the Canadian Health Measures Survey (CHMS)?

The CHMS is a collaborative project between Statistics Canada, Health Canada and the Public Health Agency of Canada. It is a national survey that collects health information from Canadians.

This survey is unique at Statistics Canada since it combines an interview with a physical examination.

What is the purpose of the Canadian Health Measures Survey (CHMS)?

The CHMS aims to help us better understand how the health of Canadians aged 1 to 79 is affected by their lifestyle and environment. Questionnaire answers, physical measurements and biological samples from participants provide data that support ongoing research and contribute to exploring emerging public health issues. The main purpose of this survey is to help improve the prevention, diagnosis and treatment of illnesses and to promote health and wellness across Canada.

Who uses the information collected?

Objective statistical information is vital to researchers, analysts and decision makers across Canada. CHMS results could be used by:

• Parliament and other policy makers to track major initiatives, set priorities for prevention and research programs, and evaluate policy and program outcomes
• epidemiologists and biomedical and health service researchers to understand trends in diseases and the relationship between observed risk factors to diseases
• individual physicians to evaluate the health and risk factors of their patients (for example, by using the reference standards for height, weight and blood pressure that will be developed)
• public health professionals to track preventable illnesses and evaluate the impact of prevention and intervention programs
• advocacy groups to raise awareness and help them monitor health problems such as heart disease, cancer, diabetes, child nutrition, obesity and health disparities.

How did I get selected to participate in this survey?

Your household was randomly selected. Participants are then chosen based on a selection formula that takes into account the number of people living in the household and the age of each person. The goal is to ensure that the sample represents the Canadian population. By participating, you will be representing up to 6,000 other Canadians.

Why should I participate in this survey?

By participating in this survey, you will give valuable information that will help us better understand the health factors affecting Canadians. Your information will improve health services in Canada, and this will benefit all Canadians.

You will also receive a free comprehensive health report. This report includes many physical and laboratory test results that you would not typically receive during a regular visit to a medical doctor or other health professional. You may learn something new about your physical health!

What does participating in the Canadian Health Measures Survey (CHMS) involve?

The CHMS is a two-step survey:

First step: An in-home interview

An in-home interview lasts one hour and questions cover topics that include:

• Nutrition
• Tobacco use
• Alcohol use
• Medical history
• Current health condition
• Lifestyle
• Physical activity
• Environment (including a tap water sample)
• Demographic, social and economic data.

Second step: A visit to the temporary examination centre (TEC)

The temporary examination centre (TEC), formally referred to as the mobile examination clinic (MEC), is made up of three semi-trailers temporarily set up in or near your community. The TEC was designed to ensure your comfort, safety and privacy.

A visit to the TEC lasts one hour and a half and trained and certified health specialists will.

• measure your height and weight
• measure your waist circumference
• measure your blood pressure and heart rate at rest
• collect blood* and urine samples.

*For more information on how much blood is collected, see the "Blood sample" section.

Do I have to participate in the Canadian Health Measures Survey (CHMS)?

Participation in this survey is voluntary. In other words, you decide whether or not you want to contribute to this health initiative. If you decide to participate, we will ask you to sign a consent form at the beginning of your visit at the TEC.

Do I need to agree to everything?

If you feel uncomfortable answering certain questions, you do not need to answer. Also, if you have concerns about certain measurements, the biological samples (such as blood, or urine) or the survey, please speak to a staff member.

Are there any risks in participating in the Canadian Health Measures Survey (CHMS)?

Participation in the CHMS should not cause you any harm. As with any health examination, some procedures may cause slight discomfort (for example, the sting of a needle during the blood sample). Rest assured that we have chosen these measures and tests because they are safe. We will not ask you to take part in a procedure or test that is not appropriate for your current health status.

Statistics Canada takes all necessary precautions to ensure that the health information and biological samples are collected in a way that is safe for participants. Qualified and accredited health specialists take all the measurements, and they follow strict standard clinical procedures when administering tests.

How will my information be kept private and confidential?

Statistics Canada goes to extraordinary lengths to protect you. Your information is collected under the authority of the Statistics Act, which ensures that it will be kept strictly confidential.

The CHMS also uses the following safeguards:

• No unauthorized people outside Statistics Canada will ever be allowed to see your individual responses.
• All Statistics Canada employees are under oath. This means they are subject to severe penalties, including prosecution, if they do not safeguard the confidentiality of your information.
• Statistics Canada never releases personal information collected in surveys, such as your name, address and phone number. All publications and other releases are carefully reviewed to ensure that no individual or identifiable data are ever published.
• For the CHMS, we consulted with Health Canada's Research Ethics Board and the Office of the Privacy Commissioner of Canada to ensure that we have every safeguard in place to store your samples securely and to protect your privacy and the confidentiality of your data.

How do I withdraw my consent after participating in the Canadian Health Measures Survey (CHMS)?

You can withdraw your consent at any time. You can request to have any part of the survey removed, including the stored blood or urine. We will contact participants who reach the age of 15 to reconfirm their consent to continue storing their biological sample. To withdraw your consent, visit our web page (www.statcan.gc.ca/chms) or see the last page of this booklet for contact information.

Will my travel expenses be reimbursed?

Yes. Every person who takes part in the testing at the temporary examination centre (TEC) and completes the survey will receive $150. This amount is to reimburse you for transportation, childcare services and parking expenses related to your appointment at the TEC. If two people are selected from the same household and they both complete the survey, each one will receive $150.

Can I receive a volunteering letter?

Yes. If you need one, we can provide you with an official volunteering letter, upon request, to recognize the time spent participating in the survey.

Household interview

What happens during the household interview?

A Statistics Canada interviewer will visit you at your home and give you information about the survey. With your consent, the interviewer will ask you a series of questions. Once the questionnaire has been completed, we will schedule an appointment for you to visit the Canadian Health Measures Survey temporary examination centre (TEC) at a time that suits you. 

With your consent, the interviewer will also collect a tap water sample during their visit at your home. Only participants who take part in the TEC part of the survey and are part of a smaller group of survey participants will have their tap water sample analysed and receive their tap water analysis results. It will be tested for perfluoroalkyl and polyfluoroalkyl substances (PFAS) to determine how common exposure to these substances is in Canada.

If children (aged 1 to 11) or youth (aged 12 to 17) are selected to participate, the interviewer will ask them questions similar to those asked of the adults. Parents or guardians of children will answer questions on their behalf. However, if the child is present, they may participate. Youth participants will be able to answer most questions themselves, but their parent or guardian can help if needed. 

Why do I need to provide my consent?

The interviewer will ask all participants for their verbal consent at the start of the household questionnaire (for the parent or guardian of participants aged 1 to 14 and for respondents aged 15 to 79).

The interviewer will also confirm verbal assent from 12- to 14-year-olds, since they will be asked to answer the household questions. The interviewer will not ask for assent from respondents younger than 12, since they do not have to be present for the household interview.

Temporary examination centre

How do I prepare for the temporary examination centre (TEC)?

At the end of your in-home interview, the interviewer will provide the pre-testing guidelines (e.g., clothing to wear, medications to bring, fasting requirements, etc.). For more information, please see Appendix B. The purpose of the pre-testing instructions is to make sure you are comfortable, safe and to control some factors that could affect certain test results.

Why do I need to provide my consent?

By signing the consent form, you are confirming your willingness to take part in the survey. In particular, you confirm that:

• you have been informed of the purpose of the survey, of how the information collected will be used and of who will use it
• you have had the opportunity to review the information about the survey and ask questions
• you understand what is involved in taking part in the survey
• you have been informed that you can withdraw from the survey at any time or can decline to participate in any test or measurement

What is the consent process at the temporary examination centre (TEC)?

If you are 15 years or older, we will ask you at the beginning of your appointment to provide your written consent to:

• participate in the physical measurement tests
• receive reports of your test results
• allow Statistics Canada to test your biological samples that may require mandatory reporting of results in the province of residence, and to contact you, as well as the appropriate provincial authorities, if the results are outside the established reference range and require a follow-up.
• allow for the storage and use of your biological samples for future health studies
• allow for the use of the participant's biological samples for future genetic studies to help understand the relationships between genes and medical conditions. More information will be provided at the TEC

If a child aged 1 to 14 is selected to participate in the survey, we will ask their parent or guardian to accompany them to the TEC and to sign the consent form. For children 1 to 2 years, an adult must accompany them at all times during the appointment. 

Children aged 6 to 14 will be asked to provide their assent to participate. The form describes a few examples of the tests we will administer and informs the child that

• we would like them to take part in some tests for the CHMS
• we will collect a small amount of their blood and urine
• they do not have to participate in any part of the survey they do not wish to.

Which physical measurements will be taken at the temporary examination centre (TEC)?

The measurements are based on age group. Most of the measurements are not taken during a regular visit to the doctor. Therefore, this is an opportunity for you to get extra information about your health. We will not do any tests or take any measurements without your consent, and the data we collect will remain confidential. One of our health specialists will monitor you throughout the process, and if for any reason, you cannot continue, we will stop the test. You will receive the results for many of these tests on the day of your appointment.

Body composition (1 to 79 years)

A health specialist will measure your height, weight and waist circumference. For participants 19 years and older, we will use your height and weight measurements to calculate your body mass index (BMI). The results will provide accurate data on how common obesity is in Canada.

Resting blood pressure and heart rate (6 to 79 years)

A health specialist will measure your resting blood pressure and heart rate using an automated device. The device measures the pressure that the blood exerts on the walls of your blood vessels. The results will provide information on the health of your heart and blood vessels. They will also provide a clear picture of how common hypertension, or high blood pressure, is in Canada. These results are key in diagnosing hypertension and other heart conditions.

Blood sample (1 to 79 years)

Certified medical laboratory professionals will collect blood samples from participants. These professionals have received extra training on blood collection techniques specifically for 1- to 2-year-old children. Numbing cream patches (EMLA) will be available to reduce the discomfort caused by the prick of the needle. Before taking the blood sample, we will ask you if your child is allergic to these patches.

As part of this survey, we will collect a small amount of blood from you or your child.

Restrictions on sampling for participants 1 to 19 years old

If you or your child is aged 1 to 19 and have had blood tests in the past 8 weeks or are scheduled to have a blood test within 8 weeks of your visit to the TEC, we will not collect any blood samples during your visit.

If, within 8 weeks of your visit to the TEC, you or your child require a blood test, we recommend that you inform your doctor or other health care professional of the blood sample taken at the TEC.

The blood tests results will give information about how common certain diseases are and the risk factors. They will also give baseline information on the health and nutritional status of the population and environmental contaminants.

Urine sample (3 to 79 years)

We will ask you to provide two urine samples. The first will be collected at the TEC. We will use the results of that sample to produce national information on the general health and lifestyle of Canadians for a variety of characteristics.

Activity monitor (3 to 79 years)

We will ask you to wear an activity monitor for seven days following your TEC visit. This small, portable monitor, called ActiGraph, tracks your physical activity and sleep. It is waterproof and must be worn on your right hip. The device will record data on your physical activity patterns and body movements. For more information on the device and how you should wear it, visit our website, (www.statcan.gc.ca/chms). We will provide prepaid packaging to return the device.

The results will allow us to learn more about the physical activity levels of Canadians and better understand the links between physical activity, sleep quality and overall health status.

Laboratory tests

Which blood and urine tests are conducted at the temporary examination centre (TEC)?

Appendix A lists all the blood and urine tests conducted for the CHMS. The results you will receive in your report will depend on your age, sex, fasting status, and whether the test is conducted on a smaller group of survey participants. Your participation in a smaller group is selected at random. The different types of blood and urine tests are described below.

Blood tests

Chemistry panel (3 to 79 years)

We will analyze a variety of elements in your blood to assess the functioning of different organs, such as the kidneys and liver. Examples of what we measure in the chemistry panel include calcium, potassium, creatinine and alanine aminotransferase (ALT)..

Cardiovascular health (various age groups)

We will test your blood for levels of high-density lipoprotein, known as "good cholesterol" ( helps remove cholesterol from the blood), and for levels of low-density lipoprotein, known as "bad cholesterol" (can cause cholesterol build-up in the blood vessels). We will also test for total cholesterol, triglycerides (a type of fat that the body uses to produce energy) and many fatty acids.

Complete blood count (1 to 79 years)

We will evaluate many components in your blood, including white blood cells counts, red blood cells counts, hemoglobin and platelets counts.

Diabetes (various age groups)

Diabetes is a chronic disease that stems from the body's inability to use and store glucose, a type of sugar that provides energy to cells. We will analyze your glucose levels and glycated hemoglobin (A1C). This gives an indication of your average blood sugar levels over the last two to three months.

Environmental exposure (various age groups)

We will analyze your blood samples to determine your exposure to substances found in the environment. These substances include cadmium, total arsenic, total mercury, nicotine, and flame retardants.

Nutritional status (various age groups)

We will analyze your blood sample to evaluate your nutritional status. For example, we will measure vitamin and mineral levels, including folate, vitamin B12, vitamin D and iron.

Urine tests

Environmental exposure (various age groups)

We will analyze your urine samples to determine your exposure to substances found in the environment. These substances include flame retardants, parabens, and herbicides (glyphosate).

Nutritional status (various age groups)

We will analyze your urine samples for indicators of your nutritional status, including iodine, which is essential for the thyroid gland to function properly.

Results

What happens once I complete the survey?

At the end of your TEC appointment, you will receive a report of the results of your physical measures that are available.

With your consent, after your appointment, we will send you a final report of your results for some of the tests that were administered. The final report will include:

• laboratory analysis results of your blood samples
• laboratory analysis results of your urine samples
• information on your level of physical activity and sleep time

Tests conducted as part of the CHMS do not replace regular health care and are not intended to be diagnoses. However, you will be notified if a test result is outside a normal range and you provided consent to receive test results. Our medical advisor will contact you if your test results require immediate attention. We will also provide a letter to give to your doctor or other health care professional in case you need a follow-up or if you want further explanation of the results.

Youth aged 15 to 17 who consent to participate in the survey and receive their results will receive them directly.  The results for participants younger than 15 will be shared with their parent or guardian.

MyResults Portal

What is the MyResults Portal (MRP)?

The MyResults Portal is a web portal developed by Statistics Canada to provide a more efficient and eco-friendly method of sharing your results with you. The secure website can be accessed at www.statcan.gc.ca/my-results-portal.

Benefits of the MyResults Portal

Choosing to receive your survey results through the MyResults Portal offers several advantages:

• User-Friendly Interface:
  Enjoy a user-friendly interface that presents your results in both numerical and visual formats, making it easier to understand and interpret your health metrics. The portal can also accommodate extensions such as screen readers to aid in accessing results.
• Convenience and Accessibility:
  Results will be uploaded as they become available, therefore results will trickle in the weeks and months after your participation. The portal is designed to be accessible from various devices, including smartphones, tablets, and computers, allowing you to view your results anytime, anywhere. You will be notified by email every time a new results is uploaded. Results outside of the normal range will be flagged for your attention.
• Comprehensive Results:
  The portal provides detailed results that not only present your survey results but also offer insights and comparisons to threshold levels, helping you understand your health metrics in a broader context. Additionally, the printed version of your final results may not contain all the results for these substances, as the healthy ranges are still unknown. If you wish to receive results that are not in your final results, you would need to contact us. However, with the MyResults Portal, you would receive all of the results, regardless.
• Enhanced Security:
  Your data's privacy and security are paramount. The portal employs advanced security measures to protect your personal information. Prior to account creation, the website will walk you through the identity validation process. The meticulousness of identity validation is to ensure the respondent results are being accessed by the right person. Furthermore, MyResults Portal utilizes Multi-Factor Authentication for the added security and prevention of fraudulent sign-ins.
• Support and Resources:
  Access support resources directly through the portal, including FAQs and contact information.
• Eco-Friendly
  By moving to an online platform, Statistics Canada is reducing paper waste and the environmental footprint associated with printing and mailing physical copies. Support Statistics Canada's efforts to promote sustainability, reduce resource consumption, and allow Statistics Canada to allocate resources more efficiently.

By leveraging the MyResults Portal, Statistics Canada aims to enhance the overall experience for survey respondents, making it easier and more convenient to access and understand your health data.

How can I access the MyResults Portal?

You can access the portal by scanning the QR code with your cellphone camera or by accessing the following link: https://www.statcan.gc.ca/my-results-portal

Mailed Survey Results

At the beginning of the temporary examination center visit, we will ask for your consent to receiving your results through the MyResuts Portal. The alternative is to receive your results by mail. The mailed survey results will solely contain your individual results, without the additional comprehensive elements offered with the MyResults Portal. The mailed results can be received via regular mail or via courier mail. Mailout for physical results will be, at minimum, six to seven months after your visit. Results outside of the normal range will be mailed to you as soon as they are received.

Biobank

Why will my blood or urine samples be stored?

Biobanking helps advance the health of current and future generations through scientific discovery. Since 2007, Canadians have contributed biospecimens to the Statistics Canada biobank. The main purpose of the Statistics Canada biobank program is to support health research that will benefit all Canadians. In addition, storing your biological samples:

• reduces the need for researchers to collect new samples from participants for each research project
• gives researchers quicker and easier access to samples for their research needs
• helps Canadians benefit from advances in science and medicine

Summaries of approved projects are posted on the Statistics Canada webpage. This informs participants on how their samples are being used. For more information on the biobank, please visit the webpage at www.statcan.gc.ca/biobank.

With your consent, some of your blood and urine samples are and stored in freezers in a secure location for future health studies until they are no longer useful for research or as required by law.

How are my samples stored?

Each biological sample tube is labelled with a barcode. No other personal information is associated with your samples. 

Only authorized Statistics Canada employees can access this information on a need-to-know basis. A limited number of employees can associate the barcodes with other information you have provided. Your name and address are kept in a separate file at our head office. No one outside Statistics Canada will have access to your personal information.

Where will my samples be stored?

The blood and urine samples are frozen and stored at the Public Health Agency of Canada's National Microbiology Laboratory. This is a high-security facility that meets international security standards for laboratories. Samples are stored in accordance with Statistics Canada's strict confidentiality requirements.

How will researchers access my data and biological samples?

Before samples can be used, research projects undergo a thorough scientific, ethical and security review process. Only researchers from recognized institutions can submit research project proposals to access these biospecimens. Your samples will never be shipped and analyzed outside of Canada. Once a research project application is received at Statistics Canada:

An advisory committee including scientists, methodologists, and ethicists evaluates the scientific merit of the application and ensures that it abides to the biobank's guidelines for the use of biospecimens.

All human health research is overseen by the Health Canada/Public Health Agency of Canada Research Ethics Board, the Office of the Privacy Commissioner of Canada, and the researcher's institutional ethics committee. This ensures compliance with the Tri-Council Policy Statement on Ethical Conduct for Research Involving Humans.

Statistics Canada ensures that the respondents' privacy and confidentiality are upheld as required by the Statistics Act.

Published results are only be presented as aggregated data. Under no circumstances will personal or identifiable data be published.

What are the risks and benefits in agreeing to store my samples?

Due to the high security physical storage and barcoding of your biospecimens, there is a near-zero risk that you can be identified from your stored samples. Moreover, any researcher who wishes to use your samples for future research must adhere to the same strict confidentiality rules that govern Statistics Canada's employees, including the Statistics Act.

As a benefit to storing your samples, researchers in Canada may use your specimens to better understand health & disease, and new treatments may be developed as a direct result of this research. Further, your samples may serve as part of the historical record of health in Canada to better inform health researchers in the future.

How can I withdraw my samples?

If you wish to withdraw your biospecimens from a specific research project or from all future research, you can do so at any time by sending a written request by email to statcan.chms-biobank-ecms-biobanque.statcan@statcan.gc.ca. Please provide your full name, the approximate date and home address at the time of your clinic visit and the date of birth. This information will be solely used to ensure that the correct samples are removed and destroyed. Note that any data generated from your samples that were used for research and published prior to your withdrawal request cannot be removed.

Canadian Health Measures Survey publications and data sharing

How are the survey results made available?

To ensure anonymity, results are published at a high level. This means that any information you provide will be combined with the information of other participants and published as averages, totals or proportions. We do not release any information that could identify you or any member of your household.

Where can I find published survey results?

The results of previous cycles of the CHMS have been published in a variety of scientific and medical publications and on Statistics Canada's website. Links to Statistics Canada publications and external publications that have used CHMS data can be found on the CHMS web page.

What is data linkage and could my data be used?

During the survey, we will tell you about the possibility of linking the information you provide to the CHMS with information from other surveys or administrative data sources.

Data linkage combines information on survey participants from at least two different sources. This is done only for statistical and research purposes. Linking data helps governments monitor, evaluate and modify health policies. If you agree to data linkage, we will:

• ask you for your health card number to help with the linkage process
• combine the information we collect in this survey with some of your information that your provincial health ministry, health registries or other recognized health organizations already have on file
• remove personal identifiers such as your name, address and health card number from the linked file as soon as the linkage is complete
• destroy all linkage files at the end of the project

Only Statistics Canada employees will link data. All linked data will remain confidential in accordance with the Statistics Act. We will not provide any information about you to your provincial health ministry or any other organization.

For more information on data linkage, visit https://www.statcan.gc.ca/en/record/gen.

How could my data be shared?

We will ask you whether you consent to share the information you provide through the CHMS with Health Canada, and the Public Health Agency of Canada. Sharing data allows researchers to fully use the information we collect to improve health policies and, in turn, the health of Canadians. Data sharing also enables us to reduce the number of times we have to survey Canadians.

If you consent, we will share your data under the following conditions:

• We will remove your name, address (except postal code), date of birth and health card number from all files before we share them
• We will not share any information from the health ministry in your province or from your health records
• We will not share your information with any other party without your consent
• Health Canada and the Public Health Agency of Canada will use this information only for statistical and research purposes, and they must ensure its confidentiality

Support from health organizations and associations

The Canadian Health Measures Survey has received the support of many key Canadian health organizations, including the following:

• Canadian Public Health Association
• Heart and Stroke Foundation of Canada
• Canadian Association of Optometrists
• ParticipACTION
• Hypertension Canada
• Osteoporosis Canada
• College of Family Physicians of Canada
• Glaucoma Research Society of Canada
• Best Start Resource Centre
• World Health Organization
• Canadian Society for Exercise Physiology
• Obesity Canada
• Red Cross
• Canadian Medical Association
• Canadian Dental Hygienists Association
• Canadian Dental Association

For more information about the Canadian Health Measures Survey (CHMS)

Toll-free number: 1-888-253-1087

Email address: cdhm-cmds@statcan.gc.ca

Telecommunication device for people who are deaf: 1-866-753-7083

Web page: www.statcan.gc.ca/chms

Biobank web page: www.statcan.gc.ca/biobank

Appendix A: Laboratory tests

Whole blood, plasma, and serum measures

Diabetes biomarkers (Ages 6-79)

• Glycated hemoglobin A1c^{Footnote *}
• Insulin^{Footnote 1}

Cardiovascular health

• Apolipoproteins – Fasting (Ages 20-79)
  • Apolipoproteins A1
  • Apolipoproteins B
• Lipid profile & hsCRP – Fasting (Ages 6-79)
  • Total cholesterol^{Footnote *}
  • High sensitivity C-reactive protein
  • High density lipoprotein cholesterol
  • Triglycerides^{Footnote *}
  • Total cholesterol/High density lipoprotein-cholesterol ratio
  • Low density lipoprotein-cholesterol, calculated
• Lipid profile & hsCRP – NonFasting (Ages 3-79)
  • Total cholesterol^{Footnote *}
  • High sensitivity C-reactive protein
  • High density lipoprotein cholesterol
  • Triglycerides^{Footnote *}
  • Total cholesterol/High density lipoprotein-cholesterol ratio
  • Low density lipoprotein-cholesterol, calculated
• Homocysteine (Ages 3-79)

Nutrition biomarkers (Ages 3-79)

• Ferritin^{Footnote *}
• Soluble Transferrin Receptor
• Red blood cell folate
• Vitamin B12^{Footnote *}
• Alpha(1)-acid glycoprotein
• Vitamin D
  • Total 25-OH Vitamin D^{Footnote *}
  • Vitamin D3 [25(OH)]
  • Vitamin D3 [3-epi-25(OH)]
  • Vitamin D2 [25(OH)]

EE – Nicotine and its metabolites (Ages 6-79)

• Free cotinine (non-smoking)
• Free cotinine (smoking)

Metals and Trace Elements (Ages 1-79)

• Cadmium (in blood)^{Footnote †}
• Lead^{Footnote *}
• Total mercury^{Footnote *}
• Methyl mercury^{Footnote *}
• Inorganic mercury
• Selenium
• Manganese
• Total arsenic^{Footnote *}

Complete blood count (CBC) (Ages 1-79)

• White blood cell count^{Footnote *}
• Red blood cell count
• Mean corpuscular volume
• Mean corpuscular hemoglobin
• Mean corpuscular hemoglobin concentration
• Red cell distribution width
• Hemoglobin^{Footnote *}
• Hematocrit
• Platelet count^{Footnote *}

Red blood cell fatty acids profile (Ages 20-79)

• Alpha-Linolenic acid
• Docosahexanoic acid
• Omega-3 docosapentanoic acid
• Eicosapentanoic acid
• Adrenic acid
• Arachidonic acid
• Dihomo-gamma-Linolenic acid
• Omega-6 docosapentanoic acid
• Gamma-Linolenic acid
• Linoleic acid
• Lauric acid
• Myristic acid
• Palmitic acid
• Stearic acid
• Palmitoleic acid
• Cis-Vaccenic acid
• Oleic acid
• Palmitelaidic acid
• Elaidic acid
• Trans-10-Octadecenoic acid
• Trans-Vaccenic acid
• Total saturated fatty acids
• Total trans-18:1 fatty acids
• Total trans-18:2 fatty acids
• Total trans fatty acids
• Total cis-18:1 fatty acids
• Total cis-monounsaturated fatty acids
• Total omega-6 polyunsaturated fatty acids
• Total omega-6 fatty acids (18:3; 20:3; 20:4; 22:4; 22:5)
• Total omega-3 polyunsaturated fatty acids
• Total omega-3 fatty acids (18:4; 20:4; 20:5; 22:5; 22:6)
• Total polyunsaturated fatty acids
• Omega-3 index
• Total omega-6 polyunsaturated fatty acids /Total omega-3 polyunsaturated fatty acids ratio
• Total long-chain omega-6 polyunsaturated fatty acids/Total long-chain omega-3 polyunsaturated fatty acids ratio
• Alpha-Linolenic acid/Eicosapentanoic acid ratio
• Arachidonic acid/Eicosapentanoic acid ratio
• Eicosapentanoic acid/Arachidonic acid ratio

Flame retardants: Polybrominated diphenyl ethers (PBDE)

• Metabolites^{Footnote 2} (Ages 3-79)
  • Pentabromoethylbenzene (PBEB)
  • 2-ethyl-1-hexyl 2,3,4,5-tetrabromobenzoate (EHTBB) or (TBB)
  • Bis (2-ethylhexyl) tetrabromophthalate (TBPH)
  • 5-hydroxy-2,2',4,4'-tetrabromodiphenyl ether (5-OH-BDE-47)
  • 6-hydroxy-2,2',4,4'-tetrabromodiphenyl ether (6-OH-BDE-47)
  • 6-methoxy-2,2',4,4'-tetrabromodiphenyl ether  (6-MeO-BDE-47)
  • 4'-hydroxy-2,2',4,5'- tetrabromodiphenyl ether (4'-OH-BDE-49)
• Parents^{Footnote 2} (Ages 3-79)
  • 2,2',4,4'-Tetrabromodiphenyl ether (PBDE 47)
  • 2,2',4,4',5-Pentabromodiphenyl ether (PBDE 99)
  • 2,2',4,4',6-Pentabromodiphenyl ether (PBDE 100)
  • 2,2',4,4',5,5'-Hexabromodiphenyl ether (PBDE 153)

Chemistry panel (Ages 3-79)

• Albumin^{Footnote *}
• Alanine aminotransferase^{Footnote *}
• Alkaline phosphatase
• Aspartate aminotransferase^{Footnote *}
• Calcium^{Footnote *}
• Chloride^{Footnote *}
• Creatinine^{Footnote *}
• Gamma-glutamyl transferase
• Glucose^{Footnote *}
• Magnesium^{Footnote *}
• Phosphorus^{Footnote *}
• Potassium^{Footnote *}
• Total protein
• Sodium^{Footnote *}
• Urea^{Footnote *}
• Uric acid^{Footnote *}

Per- and polyfluroalkyl substance (PFAS)^{Footnote 2}

• Perfluorobutanoic acid (PFBA)
• Perfluoropentanoic acid (PFPeA)
• Perfluorohexanoic acid (PFHxA)
• Perfluoroheptanoic acid (PFHpA)
• Perfluorooctanoic acid (PFOA)
• Perfluorononanoic acid (PFNA)
• Perfluorodecanoic acid (PFDA)
• Perfluoroundecanoic acid (PFUnA [PFUnDA])
• Perfluorododecanoic acid (PFDoA [PFDoDA])
• Perfluorotridecanoic acid (PFTrDA)
• Perfluorobutanesulfonic acid (PFBS)
• Perfluoropentanesulfonic acid (PFPeS)
• Perfluorohexanesulfonic acid (PFHxS)
• Perfluoroheptanesulfonic acid (PFHpS)
• Perfluorooctanesulfonic acid (PFOS)
• Perfluorononanesulfonic acid (PFNS)
• Perfluorodecane sulfonate (PFDS)
• Perfluorododecane sulfonate (PFDoS)
• Perfluorooctane sulfonamide (FOSA [PFOSA])
• N-methyl-perfluorooctane sulfonamide (MeFOSA)
• N-ethyl-perfluorooctane sulfonamide (EtFOSA)
• N-methyl-perfluorooctane sulfonamido acetic acid (MeFOSAA)
• N-ethyl-perfluorooctane sulfonamido acetic acid (EtFOSAA)
• 3:3 fluorotelomer carboxylate (3:3 acid [3:3 FTCA])
• 5:3 fluorotelomer carboxylate (5:3 acid [5:3 FTCA])
• 7:3 fluorotelomer carboxylate (7:3 acid [7:3 FTCA])
• 1H,1H, 2H, 2H-Perfluorohexane sulfonic acid (4:2 fluorotelomer sulfonate) (4:2 FtS [6:2 FTSA])
• 1H,1H, 2H, 2H-Perfluorooctane sulfonic acid (6:2 fluorotelomer sulfonate) (6:2 FtS [6:2 FTSA])
• 1H,1H, 2H, 2H-Perfluorodecane sulfonic acid (8:2 fluorotelomer sulfonate) (8:2 FtS [8:2 FTSA])
• Hexafluoropropylene oxide dimer acid (Perfluoro-2-propoxypropanoic acid) (HFPO-DA [GenX])
• 4,8-Dioxa-3H-perfluorononanoic acid (ADONA)
• 9-Chlorohexadecafluoro-3-oxanonane-1-sulfonic acid (9Cl-PF3ONS [6:2 Cl-PFESA])
• 11-Chloroeicosafluoro-3-oxaundecane-1-sulfonic acid (11Cl-PF3UdS)
• Perfluoro(2-ethoxyethane)sulfonic acid (PFEESA)
• Perfluoro-3-methoxypropanoic acid (PFMPA)
• Perfluoro-4-methoxybutanoic acid (PFMBA)
• Nonafluoro-3,6-dioxaheptanoic acid (3,6-OPFHpA) (NFDHA)
• N-Methylperfluorooctanesulfonamidoethanol (MeFOSE)
• N-Ethylperfluorooctanesulfonamidoethanol (EtFOSE)
• Perfluorotetradecanoic acid (PFTeDA [PFTA])

Urine measures

General characterization (Ages 3-79)

• Creatinine
• Specific Gravity

Environmental phenols^{Footnote 2} (Ages 3-79)

• Bisphenol 4-4' (BP44)
• Bisphenol A (BPA)
• Bisphenol B (BPB)
• Bisphenol E (BPE)
• Bisphenol F (BPF)
• Bisphenol S (BPS)
• Bisphenol Z (BPZ)
• Bisphenol AF (BPAF)
• Triclosan

Flame retardants: OP^{Footnote 2} (Ages 3-79)

• Bis(2-chloropropyl) phosphate (BCIPP)
• Bis(1,3-dichloro-2-propyl) phosphate (BDCIPP)
• Diphenyl phosphate (DPHP)
• Bis-2-(chloroethyl) phosphate (BCEP)
• Para-isopropylphenyl phenyl phosphate (ip-PPP)
• Dibutylphosphate (DBP)

Electrolytes (Ages 3-79)

• Sodium
• Potassium

Pesticides^{Footnote 2} (Ages 3-79)

• Glyphosate (GLYPH)
• Aminomethylphosphonic acid (AMPA)
• Glufosinate (GLUF) (or glufosinate ammonium)
• 3-Methylphosphinicopropionicacid(3-MPPA)

Parabens^{Footnote 2} (Ages 3-79)

• Ethylparaben
• Methylparaben
• Propylparaben
• Butylparaben
• Benzyl-paraben
• Iso-butylparaben

Metals and trace elements (Ages 3-79)

• Speciated arsenic^{Footnote 2}
  • Arsenobetaine and arsenocholine
  • Arsenous acid (Arsenite)
  • Dimethylarsinic acid
  • Monomethylarsenic acid
  • Arsenic acid (Arsenate)
  • Total inorganic arsenic^{Footnote *Footnote †}
• Cadmium (in urine)^{Footnote 2Footnote †}
• Fluoride^{Footnote 2Footnote *Footnote †}
• Boron^{Footnote 2}
• Total arsenic^{Footnote 2Footnote *}

Neonicotinoids^{Footnote 2} (Ages 3-79)

• Acetamiprid (NXL)
• Clothianidin
• Dinotefuran (DTQ)
• Imidacloprid (ICP)
• Nitenpyram (NTM)
• Thiacloprid (TAP)
• Thiamethoxam (THM)
• Sulfoxaflor
• 4-Hydroxyimidacloprid
• 5-Hydroxyimidacloprid
• N-Desmethylacetamiprid
• N-Desmethylclothianidin
• N-Desmethylthiamethoxam

Tap water measures

Perfluoroalkyl and polyfluoroalkyl substances in tap water (Ages 1-79)

• 11-chloroeicosafluoro-3-oxaundecane-1-sulfonate (11Cl-PF3OUdS) (F53-B minor component)
• 3:3 perfluorohexanoic acid (3:3 FTCA)
• 3-Perfluoroheptyl propanoic acid (7:3 FTCA, 7:3 Fluorotelomer carboxylic acid)
• 4,8-Dioxa-3H-perfluorononanoic acid [ADONA, Dodecafluoro-3H-4,8-dioxananonoic acid]
• 4:2 fluorotelomersulfonate (4:2 FTS)
• 5:3 perfluorooctanoic acid (5:3 FTCA)
• 6:2 fluorotelomersulfonate (6:2 FTS)
• 8:2 fluorotelomersulfonate (8:2 FTS)
• 9-Chlorohexadecafluoro-3-oxanone-1-sulfonate (9Cl-PF3ONS, 9-Chlorohexadecafluoro-3-oxanone-1-sulfonic acid)
• Hexafluoropropylene oxide dimer acid (HFPO-DA)
• N-Ethylperfluorooctanesulfonamide (N-EtFOSA)
• N-Ethylperfluorooctanesulfonamidoacetic acid (N-EtFOSAA)
• N-Ethylperfluorooctanesulfonamidoethanol (N-EtFOSE)
• N-Methylperfluorooctanesulfonamide (N-MeFOSA)
• N-Methylperfluorooctanesulfonamidoacetic acid (N-MeFOSAA)
• N-Methylperfluorooctanesulfonamidoethanol (N-MeFOSE)
• Perfluoro(2-ethoxyethane)sulfonic acid (PFEESA)
• Perfluoro-3,6-dioxaheptanoic acid (NFDHA)
• Perfluoro-3-methoxypropanoic acid (PFMPA)
• Perfluoro-4-methoxybutanoic acid (PFMBA)
• Perfluorobutanesulfonic acid (PFBS, Perfluorobutanesulfonate)
• Perfluorobutanoic acid (PFBA, Perfluorobutanoate)
• Perfluorodecanesulfonic acid (PFDS, Perfluorodecanesulfonate)
• Perfluorodecanoic acid (PFDA, Perfluorodecanoate)
• Perfluorododecanesulfonic acid (PFDoS, Perfluorododecanesulfonate)
• Perfluorododecanoic acid (PFDoA, Perfluorododecanoate)
• Perfluoroheptanesulfonic acid (PFHpS, Perfluoroheptanesulfonate)
• Perfluoroheptanoic acid (PFHpA, Perfluorohepanoate)
• Perfluorohexanesulfonic acid (PFHxS, Perfluorohexanesulfonate)
• Perfluorohexanoic acid (PFHxA, Perfluorohexanoate)
• Perfluorononanesulfonic acid (PFNS, Perfluorononanesulfonate)
• Perfluorononanoic acid (PFNA, Perfluorononanoate)
• Perfluorooctanesulfonamide (PFOSA)
• Perfluorooctanesulfonic acid (PFOS, Perfluorooctanesulfonate)
• Perfluorooctanoic acid (PFOA, Perfluorooctanoate)
• Perfluoropentanesulfonic acid (PFPeS, Perfluoropentanesulfonate)
• Perfluoropentanoic acid (PFPeA, Perfluoropentanoate)
• Perfluorotetradecanoic acid (PFTeDA, Perfluorotetradecanoate)
• Perfluorotridecanoic acid (PFTrDA, Perfluorotridecanoate)
• Perfluoroundecanoic acid (PFUnA, Perfluoroundecanoate)

Appendix B: Pre-testing instructions