National Health and Nutrition Examination Survey

NHANES 2005-2006 Questionnaire Instruments

Questionnaires are administered to NHANES participants both at home and in the mobile examination centers (MECs). The questionnaires and a brief description of each section follows.

Screener Module: In-person/Telephone Instrument

The following questionnaires are used by field interviewers to collect screener information during the in-person interview on the doorstep or through a telephone interview with an adult household member.

Module Name Document
Screener Module 1
This set of questions determines if anyone in the household is eligible to be in the sample.
[PDF - 44 KB]
Screener Module 2
This set of questions establishes the relationship of everyone in the household to each other.
[PDF - 46 KB]

Family Questionnaire

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

Questionnaire Name Document
Demographic Background/Occupation [PDF - 43 KB]
Family Questionnaire Hand Cards [PDF - 45 KB]
Food Security [PDF - 43 KB]
Housing Characteristics [PDF - 28 KB]
Income [PDF - 67 KB]
Smoking [PDF - 19 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
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 - 60 KB]
Dermatology [PDF - 27 KB]
Diabetes [PDF - 54 KB]
Diet Behavior and Nutrition [PDF - 85 KB]
Dietary Supplements and Prescription Medication [PDF - 98 KB]
Early Childhood [PDF - 30 KB]
Health Insurance [PDF - 38 KB]
Hospital Utilization and Access to Care [PDF - 27 KB]
Immunization [PDF - 14 KB]
Introduction and Verification [PDF - 56 KB]
Kidney Conditions [PDF - 13 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]
Sample Person Questionnaire Hand Cards [PDF - 837 KB]
Sleep Disorders [PDF - 39 KB]
Smoking and Tobacco Use [PDF - 43 KB]
Social Support [PDF - 23 KB]
Vision [PDF - 34 KB]
Weight History [PDF - 58 KB]

Post-Examination Questionnaires

Questionnaire Name Document
Food Frequency (formerly called Food Propensity): Mailed to Respondent [PDF - 1.05 MB]
Hepatitis Follow-up: Telephone Interview [PDF - 365 KB]
Prostate Follow-up: Telephone Interview [PDF - 44 KB]

MEC ACASI and CAPI Questionnaires

Audio computer-assisted 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 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
Alcohol (ages 20+) [PDF - 13 KB]
Bowel Health (ages 20+) [PDF - 34 KB]
Current Health Status (ages 12+) [PDF - 13 KB]
Depression Screen (ages 12+) [PDF - 22 KB]
Kidney/Urological Health (ages 20+) [PDF - 26 KB]
MEC CAPI Questionnaire Hand Cards [PDF - 94 KB]
Pesticide Use (ages 8+) [PDF - 10 KB]
Physical Activity (ages 12-15) [PDF - 216 KB]
Reproductive Health (ages 12+) [PDF - 59 KB]
Tobacco (ages 20+) [PDF - 20 KB]
Volatile Toxicants (ages 12+) [PDF - 16 KB]
Weight History (ages 8-15) [PDF - 23 KB]

Dietary

These questions on dietary intakes and dietary supplement uses are asked to participants after their visits to the mobile examination center through telephone interviews.

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