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2005-2006 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 - 44 KB]
Screener Module 2
This establishes the relationship of everyone in the household to everyone else in the household.
[PDF - 46 KB]

Family Questionnaire

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

Questionnaire Name Document
Family Questionnaire Hand Cards [PDF - 69 KB]
Demographic Background/Occupation [PDF - 43 KB]
Food Security [PDF - 43 KB]
Housing Characteristics [PDF - 27 KB]
Income [PDF - 66 KB]
Smoking [PDF - 19 KB]
Tracking and Tracing [PDF - 23 KB]

Sample Person Questionnaire

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
Sample Person Questionnaire Hand Cards [PDF - 916 KB]
Acculturation [PDF - 17 KB]
Allergy [PDF - 27 KB]
Audiometry [PDF - 29 KB]
Blood Pressure [PDF - 28 KB]
Cardiovascular Disease [PDF - 24 KB]
Demographics Information [PDF - 59 KB]
Dermatology [PDF - 26 KB]
Diabetes [PDF - 54 KB]
Dietary Supplements and Prescription Medication [PDF - 97 KB]
Diet Behavior and Nutrition [PDF - 85 KB]
Early Childhood [PDF - 30 KB]
Health Insurance [PDF - 38 KB]
Hospital Utilization and Access to Care [PDF - 27 KB]
Immunization [PDF - 17 KB]
Introduction and Verification [PDF - 56 KB]
Kidney Conditions [PDF - 15 KB]
Medical Conditions [PDF - 72 KB]
Occupation [PDF - 41 KB]
Oral Health [PDF - 22 KB]
Osteoporosis [PDF - 55 KB]
Physical Activity and Physical Fitness [PDF - 65 KB]
Physical Functioning [PDF - 48 KB]
Respiratory Health and Disease [PDF - 28 KB]
Sleep Disorders [PDF - 39 KB]
Smoking and Tobacco Use [PDF - 42 KB]
Social Support [PDF - 23 KB]
Vision [PDF - 34 KB]
Weight History [PDF - 58 KB]

Post-Examination Components

Questionnaire Name Document
Food Frequency (formerly called Food Propensity): Mailed to Respondent [PDF - 1 MB]
Hepatitis Follow-up: Telephone Interview [PDF - 365 KB]
Prostate Follow-up: Telephone Interview [PDF - 43 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 (ages 12-19) [PDF - 13 KB]
Drugs (ages 12-59) [PDF - 38 KB]
Food Security (ages 12-15) [PDF - 19 KB]
Sexual Behavior (ages 14-59) [PDF - 217 KB]
Tobacco (ages 12-19) [PDF - 28 KB]

Computer Assisted Personal Interview (CAPI) Questionnaire

Questionnaire Name Document
MEC CAPI Questionnaire Hand Cards [PDF - 125 KB]
Alcohol (ages 20+) [PDF - 13 KB]
Bowel Health (ages 20+) [PDF - 33 KB]
Current Health Status (ages 12+) [PDF - 13 KB]
Depression Screen (ages 12+) [PDF - 21 KB]
Kidney/Urological Health (ages 20+) [PDF - 25 KB]
Pesticide Use (ages 8+) [PDF - 10 KB]
Physical Activity (ages 12-15) [PDF - 216 KB]
Reproductive Health (ages 12+) [PDF - 58 KB]
Respondent Information [PDF - 20 KB]
Tobacco (ages 20+) [PDF - 20 KB]
Volatile Toxicants (ages 12+) [PDF - 15 KB]
Weight History (ages 8-15) [PDF - 22 KB]

Dietary

Questionnaire Name Document
Dietary Recall [PDF - 45 KB]
Measuring Guides for the Dietary Recall Interview
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