National Health and Nutrition Examination Survey

NHANES 2021-2022 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.

Interviewer Manuals

Manual Name Document
Interviewer Procedure Manual [PDF - 21.0 MB]
MEC ACASI Procedures Manual [PDF - 6.22 MB]

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 - 171 KB]
Screener Module 2
This set of questions establishes the relationship of everyone in the household to each other.
[PDF - 194 KB]

Screener Module: Web Instrument

The following is a web-based and self-administered questionnaire to collect screener information from an adult household member.

Module Name Document
Web Screener Module
This set of questions determines if anyone in the household is eligible to be in the sample, and to establish the basic relationship among household members.
[PDF - 308 KB]

Screener Module: Paper Instrument

The following is a paper questionnaire that is self-administered by an adult household member to collect screener information and mailed back to NHANES.

Module Name Document
Paper Screener Module
This set of questions determines if anyone in the household is eligible to be in the sample, and to collect limited information on the relationship between the household reference person and each of the household members.
[PDF - 758 KB]

Family Questionnaire

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

Questionnaire Name Document
Consumer Behavior [PDF - 118 KB]
Demographic Background [PDF - 109 KB]
Food Security [PDF - 179 KB]
Housing Characteristics [PDF - 98.3 KB]
Income [PDF - 175 KB]
Smoking [PDF - 104 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 - 85.3 KB]
Audiometry [PDF - 132 KB]
Balance [PDF - 100 KB]
Blood Pressure [PDF - 108 KB]
COVID-19 [PDF - 185 KB]
Demographic [PDF - 147 KB]
Dermatology [PDF - 77.2 KB]
Diabetes [PDF - 95.7 KB]
Diet Behavior and Nutrition [PDF - 124 KB]
Early Childhood [PDF - 90.3 KB]
Functioning [PDF - 142 KB]
Health Insurance [PDF - 114 KB]
Hepatitis [PDF - 97.0 KB]
Hospital Utilization and Access to Care [PDF - 89.9 KB]
Immunization [PDF - 111 KB]
Kidney Conditions [PDF - 105 KB]
Medical Conditions [PDF - 130 KB]
Occupation [PDF - 127 KB]
Oral Health [PDF - 82.5 KB]
Physical Activity and Physical Fitness [PDF - 124 KB]
Prescription Medication [PDF - 98.3 KB]
Respondent Selection [PDF - 192 KB]
Sleep Disorders [PDF - 79.5 KB]
Smoking and Tobacco Use [PDF - 110 KB]
Weight History [PDF - 85.9 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 - 113 KB]
Current Health Status [PDF - 70.6 KB]
Depression Screen [PDF - 95.6 KB]
Drug Use [PDF - 83.2 KB]
Kidney [PDF - 90.8 KB]
Physical Activity and Physical Fitness [PDF - 82.1 KB]
Reproductive Health [PDF - 147 KB]
Sexual Behavior - Female [PDF - 103 KB]
Sexual Behavior - Male [PDF - 144 KB]
Sexual Orientation [PDF - 86.5 KB]
Tobacco [PDF - 118 KB]

Computer-Assisted Personal Interview (CAPI) Questionnaire

Questionnaire Name Document
COVID-19 [PDF - 253 KB]

Special Follow-up Questionnaires

Questionnaire Name Document
Flexible Consumer Behavior Survey (FCBS) Module [PDF - 292 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
30-Day Dietary Supplement and Antacids Use [PDF - 179 KB]
Dietary Recall [PDF - 228 KB]
Measuring Guides for the Dietary Recall Interview