National Health and Nutrition Examination Survey

NHANES 2009-2010 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 - 75 KB]
Screener Module 1 (Spanish)
This is the same module in Spanish.
[PDF - 121 KB]
Screener Module 2
This set of questions establishes the relationship of everyone in the household to each other.
[PDF - 78 KB]
Screener Module 2 (Spanish)
This is the same module in Spanish.
[PDF - 135 KB]

Family Questionnaire

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

Questionnaire Name Document
Consumer Behavior [PDF - 74 KB]
Demographic Background/Occupation [PDF - 40 KB]
Family Questionnaire Hand Cards [PDF - 48KB]
Food Security [PDF - 3 KB]
Housing Characteristics [PDF - 18 KB]
Income [PDF - 167 KB]
Smoking [PDF - 12 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 - 11 KB]
Arthritis [PDF - 95 KB]
Audiometry [PDF - 25 KB]
Blood Pressure [PDF - 25 KB]
Cardiovascular Disease [PDF - 17 KB]
Demographic [PDF - 54 KB]
Dermatology [PDF - 20 KB]
Diabetes [PDF - 32 KB]
Dietary Behavior [PDF - 58 KB]
Dietary Screener [PDF - 90 KB]
Dietary Supplements and Prescription Medication [PDF - 129 KB]
Early Childhood [PDF - 17 KB]
Health Insurance [PDF - 37 KB]
Hospital Utilization and Access to Care [PDF - 27 KB]
Immunization [PDF - 16 KB]
Kidney Conditions [PDF - 13 KB]
Medical Conditions [PDF - 89 KB]
Occupation [PDF - 68 KB]
Oral Health [PDF - 16 KB]
Osteoporosis [PDF - 43 KB]
Physical Activity and Physical Fitness [PDF - 37 KB]
Physical Functioning [PDF - 50 KB]
Respiratory Health and Disease [PDF - 25 KB]
Sample Person Questionnaire Hand Cards [PDF - 1 MB]
Sleep Disorders [PDF - 10 KB]
Smoking and Tobacco Use [PDF - 32 KB]
Weight History [PDF - 41 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 Use [PDF - 17 KB]
Drug Use [PDF - 57 KB]
Food Security [PDF - 22 KB]
Sexual Behavior [PDF - 116 KB]
Tobacco Use [PDF - 38 KB]

Computer-Assisted Personal Interview (CAPI) Questionnaire

Questionnaire Name Document
Alcohol Use [PDF - 17 KB]
Bowel Health [PDF - 30 KB]
Current Health Status [PDF - 18 KB]
Depression Screen [PDF - 25 KB]
Dietary Screener [PDF - 90 KB]
Kidney [PDF - 27 KB]
MEC CAPI Questionnaire Hand Cards [PDF - 455 KB]
Pesticide Use [PDF - 11 KB]
Physical Activity [PDF - 29 KB]
Reproductive Health [PDF - 78 KB]
Tobacco [PDF - 25 KB]
Volatile Toxicants Use [PDF - 22 KB]
Weight History [PDF - 31 KB]

Special Follow-up Questionnaires

Questionnaire Name Document
Flexible Consumer Behavior Survey (FCBS) Handcards [PDF - 374 KB]
Flexible Consumer Behavior Survey (FCBS) Module [PDF - 233 KB]
NHANES Hepatitis C Follow-up [PDF - 365 KB]


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
24-Hour Dietary Supplement and Antacids Use [PDF - 93 KB]
Dietary Recall [PDF - 76 KB]
Measuring Guides for the Dietary Recall Interview