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2009-2010 Survey Questionnaires

Questionnaires are administered to NHANES participants both at home and in the MECs. 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 - 189 KB]
Screener Module 1 (Spanish)
This is the same module in Spanish.
[PDF - 122 KB]
Screener Module 2
This establishes the relationship of everyone in the household to everyone else in the household.
[PDF - 204 KB]
Screener Module 2 (Spanish)
This is the same module in Spanish.
[PDF - 136 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 - 59 KB]
Demographic Background/Occupation [PDF - 156 KB]
Housing Characteristics [PDF - 43 KB]
Smoking [PDF - 29 KB]
Consumer Behavior [PDF - 85 KB]
Income [PDF - 273 KB]
Food Security [PDF - 92 KB]
Tracking and Tracing [PDF - 51 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 [1 MB]
Acculturation [PDF - 27 KB]
Arthritis [PDF - 168 KB]
Audiometry [PDF - 72 KB]
Blood Pressure [PDF - 62 KB]
Cardiovascular Disease [PDF - 31 KB]
Demographic [PDF - 156 KB]
Dermatology [PDF - 47 KB]
Diabetes [PDF - 88 KB]
Dietary Screener [PDF - 165 KB]
Dietary Supplements and Prescription Medication [PDF - 361 KB]
Dietary Behavior [PDF - 127 KB]
Early Childhood [PDF - 45 KB]
Health Insurance [PDF - 82 KB]
Hospital Utilization and Access to Care [PDF - 64 KB]
Immunization [PDF - 34 KB]
Kidney Conditions [PDF - 26 KB]
Medical Conditions [PDF - 210 KB]
Occupation [PDF - 174 KB]
Oral Health [PDF - 16 KB]
Osteoporosis [PDF - 100 KB]
Physical Activity and Physical Fitness [PDF - 98 KB]
Physical Functioning [PDF - 129 KB]
Respiratory Health and Disease [PDF - 70 KB]
Sleep Disorders [PDF - 25 KB]
Smoking and Tobacco Use [PDF - 92 KB]
Weight History [PDF - 135 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 Use [PDF - 44 KB]
Drugs Use [PDF - 149 KB]
Food Security [PDF - 45 KB]
Sexual Behavior [PDF - 216 KB]
Tobacco Use [PDF - 110 KB]

Computer Assisted Personal Interview (CAPI) Questionnaire

Questionnaire Name Document
MEC CAPI Questionnaire Hand Cards [PDF - 50 KB]
Alcohol Use [PDF - 30 KB]
Bowel Health [PDF - 57 KB]
Current Health Status [PDF - 39 KB]
Dietary Screener [PDF - 165 KB]
Depression Screen [PDF - 43 KB]
Kidney [PDF - 48 KB]
Pesticide Use [PDF - 17 KB]
Physical Activity [PDF - 54 KB]
Reproductive Health [PDF - 154 KB]
Respondent Information [PDF - 34 KB]
Tobacco [PDF - 45 KB]
Volatile Toxicants Use [PDF - 44 KB]
Weight History [PDF - 64 KB]

Special Follow-up Questionnaires

Questionnaire Name Document
Flexible Consumer Behavior Survey (FCBS) Module [234 KB]
Flexible Consumer Behavior Survey (FCBS) Handcards [313 KB]
NHANES Hepatitis C Follow-up [PDF - 366 KB]

Dietary

Questionnaire Name Document
Dietary Recall [PDF - 112 KB]
Measuring Guides for the Dietary Recall Interview
24-Hour Dietary Supplement and Antacids Use [PDF - 163 KB]
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