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2001-2002 Survey Questionnaires

Questionnaires are administered to NHANES participants both at home and in the trailers. The questionnaires and a brief description of each section follows.

Screener Modules

Module Name Document
Screener Module 1
This is administered on the doorstep. This set of questions determines if anyone in the household is eligible to be in the sample.
[PDF - 48 KB]
Screener Module 2
This establishes the relationship of everyone in the household to everyone else in the household.
[PDF - 40 KB]

Family Questionnaires

Household and family level information is collected here. The sections are labeled to reflect content.

Questionnaire Name Document
Demographic Background/Occupation [PDF - 21 KB]
Food Security [PDF - 30 KB]
Health Insurance [PDF - 32 KB]
Housing Characteristics [PDF - 32 KB]
Income [PDF - 38 KB]
Pesticide Use [PDF - 7 KB]
Smoking [PDF - 5 KB]
Tracking and Tracing [PDF - 8 KB]

Sample Person Questionnaires

Individual level information on participants is collected here. The sections are labeled to reflect content. Please note that the Medical Conditions section covers many subject areas.

Questionnaire Name Document
Acculturation [PDF - 7 KB]
Audiometry [PDF - 8 KB]
Balance [PDF - 8 KB]
Blood Pressure [PDF - 14 KB]
Cardiovascular Disease [PDF - 5 KB]
Demographics Information [PDF - 21 KB]
Dermatology [PDF - 9 KB]
Diabetes [PDF - 9 KB]
Dietary Supplements and Prescription Medication [PDF - 47 KB]
Diet Behavior and Nutrition [PDF - 38 KB]
Digital Symbol Substitution Exercise [PDF - 9 KB]
Dust Collection [PDF - 117 KB]
Early Childhood [PDF - 9 KB]
Hospital Utilization and Access to Care [PDF - 9 KB]
Immunization [PDF - 4 KB]
Introduction and Verification [PDF - 7 KB]
Kidney Conditions [PDF - 11 KB]
Medical Conditions MCQ.010 - MCQ.150 [PDF - 8 KB]
Medical Conditions MCQ.160 - MCQ.190 [PDF - 8 KB]
Medical Conditions MCQ.200 - MCQ.290 [PDF - 14 KB]
Miscellaneous Pain [PDF - 10 KB]
Physical Activity and Physical Fitness [PDF - 28 KB]
Physical Functioning [PDF - 17 KB]
Occupation [PDF - 23 KB]
Oral Health [PDF - 10 KB]
Osteoporosis [PDF - 13 KB]
Respiratory Health and Disease [PDF - 11 KB]
Respondent Selection [PDF - 90 KB]
Smoking and Tobacco Use [PDF - 19 KB]
Social Support [PDF - 6 KB]
Vision [PDF - 8 KB]
Weight History [PDF - 15 KB]

Post-Examination Questionnaire

Questionnaire Name Document
Hepatitis Follow-up: Telephone Interview [PDF - 45 KB]

Mental Health Questionnaires

This questionnaire was conducted in the Mobile Examination Center (MEC).

Questionnaire Name Document
Composite International Diagnostic Interview consist of the following:
  • Generalized Anxiety Disorder Module
  • Major Depression Module
  • Interview Panic Disorder Module
[PDF - 188 KB]

Columbia University Diagnostic Schedule for Children (CDISC)

Questionnaire Name Document
General Documentation [PDF - 148 KB]
DISC Interviewer Manual [PDF - 470 KB]
DISC Telephone Interviewer Manual [KB - 128 PDF]
Variable List [PDF - 3.3 MB]
Attention Deficit Hyperactivity Disorder (2000-2004) (Parent Questionnaire) [PDF - 446 KB]
Conduct Disorder (2000-2004) (Parent Questionnaire) [PDF - 572 KB]
Major Depression/Dysthymic Disorder (2000-2004) (Youth Questionnaire) [PDF - 529 KB]
Major Depression/Dysthymic Disorder (2000-2004) (Parent Questionnaire) [PDF - 528 KB]
Eating Disorders (2000-2004) (Youth Questionnaire) [PDF - 309 KB]
Eating Disorders (2000-2004) (Youth Questionnaire with Height and Weight Chart) [PDF - 35 KB]
Eating Disorders (2000-2004) (Parent Questionnaire) [PDF - 300 KB]
Elimination Disorders (2000-2004) (Parent Questionnaire) [PDF - 309 KB]
Generalized Anxiety Disorder (1999-2004) (Youth Questionnaire) [PDF - 256 KB]
Panic (1999-2004) (Youth Questionnaire) [PDF - 250 KB]

MEC ACASI and CAPI Questionnaires

Audio computer assisted personal self interview (ACASI) and computer assisted personal interview (CAPI) questionnaires are administered in the MEC. During the visit to the examination center additional questions are administered that cover more sensitive areas such as reproductive health and illegal drug use. The sections are labeled to reflect content.

Audio computer Assisted Personal Self Interview (ACASI) Questionnaire

Questionnaire Name Document
Alcohol (12-19) [PDF - 5 KB]
DISC Predictive Scale - Youth Conduct Disorder (12-19) [PDF - 6 KB]
Drugs (12-59) [PDF - 8 KB]
Kidney Condition (Prostate) [PDF - 74 KB]
Sexual Behavior (14-59) [PDF - 14 KB]
Tobacco [PDF - 106 KB]

Computer Assisted Personal Interview (CAPI) Questionnaire

Questionnaire Name Document
Alcohol (20+) [PDF - 6 KB]
Current Health Status [PDF - 5 KB]
Kidney [PDF - 5 KB]
Physical Activity [PDF - 21 KB]
Reproductive Health [PDF - 69 KB]
Respondent Information [PDF - 4 KB]
Tobacco (20+) [PDF - 19 KB]

Home Examination Questionnaires

Questionnaire Name Document
Current Health Status (age 50 and older) [PDF - 65 KB]
Reproductive Health (age 50 and older) [PDF - 105 KB]

Dietary

Questionnaire Name Document
Dietary Recall
[PDF - 18 KB]
Measuring Guides for the Dietary Recall Interview
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