Survey Questionnaires, Examination Components and Laboratory Components 2001-2002
On this Page
- Questionnaires
- Screener Modules
- Family Questionnaire
- Sample Person Questionnaire
- Post-Examination Questionnaires
- Mental Health Questionnaires
- MEC ACASI and CAPI Questionnaires
- Audio Computer Assisted Personal Self Interview (ACASI) Questionnaire
- Computer Assisted Personal Interview (CAPI) Questionnaire
- Home Examination Questionnaires
- Examination and Laboratory
The Questionnaires and Exam Components can be viewed using Adobe Acrobat reader.
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
- Screener Module 1 [PDF - 48 KB]. This is administered on the doorstep. This set of questions determines if anyone in the household is eligible to be in the sample.
- Screener Module 2 [PDF - 40 KB]. This establishes the relationship of everyone in the household to everyone else in the household.
Family Questionnaire
Household and family level information is collected here. The sections are labeled to reflect content.
- Demographic Background/Occupation [PDF - 21 KB]
- Food Security [PDF - 30 KB]
- Health Insurance [PDF - 32 KB]
- Housing Characteristics [PDF - 32 KB]
- Income [PDF - 38 KB]
- Pesticide Use [PDF - 7 KB]
- Smoking [PDF - 5 KB]
- Tracking and Tracing [PDF - 8 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.
- Acculturation [PDF - 7 KB]
- Audiometry [PDF - 8 KB]
- Balance [PDF - 8 KB]
- Blood Pressure [PDF - 14 KB]
- Cardiovascular Disease [PDF - 5 KB]
- Demographics Information [PDF - 21 KB]
- Dermatology [PDF - 9 KB]
- Diabetes [PDF - 9 KB]
- Dietary Supplements and Prescription Medication [PDF - 47 KB]
- Diet Behavior and Nutrition [PDF - 38 KB]
- Digital Symbol Substitution Exercise [PDF - 9 KB]
- Dust Collection [PDF - 117 KB]
- Early Childhood [PDF - 9 KB]
- Hospital Utilization and Access to Care [PDF - 9 KB]
- Immunization [PDF - 4 KB]
- Introduction and Verification [PDF - 7 KB]
- Kidney Conditions [PDF - 11 KB]
- Medical Conditions MCQ.010 - MCQ.150 [PDF - 8 KB]
- Medical Conditions MCQ.160 - MCQ.190 [PDF - 8 KB]
- Medical Conditions MCQ.200 - MCQ.290 [PDF - 14 KB]
- Miscellaneous Pain [PDF - 10 KB]
- Physical Activity and Physical Fitness [PDF - 28 KB]
- Physical Functioning [PDF - 17 KB]
- Occupation [PDF - 23 KB]
- Oral Health [PDF - 10 KB]
- Osteoporosis [PDF - 13 KB]
- Respiratory Health and Disease [PDF - 11 KB]
- Respondent Selection [PDF - 90 KB]
- Smoking and Tobacco Use [PDF - 19 KB]
- Social Support [PDF - 6 KB]
- Vision [PDF - 8 KB]
- Weight History [PDF - 15 KB]
Post-Examination Questionnaires
Mental Health Questionnaires
This questionnaire was conducted in the Mobile Examination Center (MEC).
- Composite International Diagnostic Interview [PDF - 188 KB] consist of the following:
Generalized Anxiety Disorder Module
Major Depression Module
Interview Panic Disorder Module - Columbia University Diagnostic Schedule for Children (CDISC)
- General Documentation [PDF - 148 KB]
- DISC Interviewer Manual [PDF - 470 KB]
- DISC Telephone Interviewer Manual [PDF - 128 KB]
- Variable List [PDF - 3.3 MB]
- Attention Deficit Hyperactivity Disorder (2000-2004) (Parent Questionnaire [PDF - 446 KB])
- Conduct Disorder (2000-2004) (Parent Questionnaire [PDF - 572 KB])
- Major Depression/Dysthymic Disorder (2000-2004) (Youth Questionnaire [PDF - 529 KB], Parent Questionnaire [PDF - 528 KB])
- Eating Disorders (2000-2004) (Youth Questionnaire [PDF - 309 KB], Youth Questionnaire with Height and Weight Chart [PDF - 35 KB], Parent Questionnaire [PDF - 300 KB])
- Elimination Disorders (2000-2004) (Parent Questionnaire [PDF - 309 KB])
- Generalized Anxiety Disorder (1999-2004) (Youth Questionnaire [PDF - 256 KB])
- Panic (1999-2004) (Youth Questionnaire [PDF - 250 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
- Alcohol (12-19) [PDF - 5 KB]
- DISC Predictive Scale - Youth Conduct Disorder (12-19) [PDF - 6 KB]
- Drugs (12-59) [PDF - 8 KB]
- Kidney Condition (Prostate) [PDF - 74 KB]
- Sexual Behavior (14-59) [PDF - 14 KB]
- Tobacco [PDF - 106 KB]
Computer Assisted Personal Interview (CAPI) Questionnaire
- Alcohol (20+) [PDF - 6 KB]
- Current Health Status [PDF - 5 KB]
- Kidney [PDF - 5 KB]
- Physical Activity [PDF - 21 KB]
- Reproductive Health [PDF - 69 KB]
- Respondent Information [PDF - 4 KB]
- Tobacco (20+) [PDF - 19 KB]
Home Examination Questionnaires
- Current Health Status (age 50 and older) [PDF - 65 KB]
- Reproductive Health (age 50 and older) [PDF - 105 KB]
Examination and Laboratory
- Dietary Recall [PDF - 18 KB]
- Examination Components [PDF - 107 KB] consist of the following:
- Audiometry
- Balance and Vistibular Testing
- Body Composition
- Body Measurements
- Cardiovascular Fitness
- Dermatology
- Lower Extremity Disease
- Muscular Strength
- Oral Health
- Physician's Exam
- Vision
- Laboratory Components [PDF - 94 KB] consist of the following:
- Blood & Urine
- Venipuncture
- Urine Collection
- Bone Markers
- Diabetes Profile
- Infectious Disease Profile
- Markers of Immunization Status
- Miscellaneous Laboratory Assays
- Kidney Disease Profile
- Hormone Profile
- Nutritional Biochemistries and Hematologies
- Sexually Transmitted Disease Profile
- Tobacco Use
- Blood lipids
- Environmental Health Profile
- Special Studies [PDF - 32 KB]
Contact Us:
- National Center for Health Statistics
3311 Toledo Rd
Room 5419
Hyattsville, MD 20782 - 1 (800) 232-4636
- Contact CDC–INFO
