2011-2012 National Health and Nutrition Examination Survey (NHANES)

Survey Questionnaires, Examination Components and Laboratory Components 2011-2012

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 - 189 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 1 (Spanish)  [PDF - 122 KB] This is the same module in Spanish.
• Screener Module 2  [PDF - 204 KB]. This establishes the relationship of everyone in the household to everyone else in the household.
  Screener Module 2 (Spanish)  [PDF - 136 KB] This is the same module in Spanish.

Family Questionnaire

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

• Demographic Background [PDF - 41 KB]
• Occupation  [PDF - 14 KB]
• Housing Characteristics  [PDF - 11 KB]
• Smoking  [PDF - 15 KB]
• Consumer Behavior  [PDF - 20 KB]
• Income  [PDF - 104 KB]
• Food Security  [PDF - 45 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 - 26 KB]
• Audiometry  [PDF - 45 KB]
• Blood Pressure  [PDF - 32 KB]
• Cardiovascular Disease  [PDF - 23 KB]
• Chemical Senses - Taste and Smell  [PDF - 39 KB]
• Demographic  [PDF - 86 KB]
• Dermatology  [PDF - 27 KB]
• Diabetes  [PDF - 56 KB]
• Dietary Supplements and Prescription Medication  [PDF - 130 KB]
• Dietary Behavior  [PDF - 71 KB]
• Early Childhood  [PDF - 24 KB]
• Health Insurance  [PDF - 45 KB]
• Hospital Utilization and Access to Care  [PDF - 35 KB]
• Immunization  [PDF - 25 KB]
• Kidney Conditions  [PDF - 21 KB]
• Medical Conditions  [PDF - 87 KB]
• Occupation  [PDF - 81 KB]
• Oral Health  [PDF - 36 KB]
• Physical Activity and Physical Fitness  [PDF - 62 KB]
• Physical Functioning  [PDF - 63 KB]
• Respiratory Health and Disease  [PDF - 36 KB]
• Sleep Disorders  [PDF - 18 KB]
• Smoking and Tobacco Use  [PDF - 41 KB]
• Tuberculosis  [PDF - 24 KB]
• Weight History  [PDF - 55 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 Use  [PDF - 22 KB]
• Drugs Use  [PDF -69 KB]
• Pubertal Maturation [PDF – 35 KB]
• Sexual Behavior  [PDF - 133 KB]
• Tobacco Use  [PDF - 59 KB]

 

Computer Assisted Personal Interview (CAPI) Questionnaire

• Alcohol Use  [PDF - 26 KB]
• Creatine Kinase  [PDF - 26 KB]
• Current Health Status  [PDF - 25 KB]
• Depression Screen  [PDF - 29 KB]
• Kidney  [PDF - 30 KB]
• Pesticide Use  [PDF - 16 KB]
• Physical Activity  [PDF - 64 KB]
• Reproductive Health  [PDF - 89 KB]
• Tobacco  [PDF - 34 KB]
• Volatile Toxicants Use  [PDF - 28 KB]
• Weight History  [PDF - 36 KB]

 

Special Questionnaire

•  Flexible Consumer Behavior Survey [PDF – 133 KB]

 

Examination and Laboratory

• Dietary Recall  [PDF - 112 KB]
  • Measuring Guides for the Dietary Recall Interview
  • 24-Hour Dietary Supplement and Antacids Use  [PDF - 163 KB]
• Examination Components  [PDF - 180 KB] consist of the following:
  • Audiometry
  • Body Composition—Dual-Energy X-Ray Absorptiometry (DXA)
  • Body Measurements - Anthropometry
  • Dietary Interview Component
  • MEC Interview
  • Muscle Strength
  • Oral Health
  • Physician’s Exam
  • Respiratory Health
  • Tuberculin Skin Test
  • Vaginal Swab Collection
• Laboratory Components  [PDF - 440 KB] consist of the following:
  • Venipuncture
  • Urine Collection
  • Bone Mineral Status Markers
  • Diabetes Profile
  • Thyroid Profile
  • Infectious Disease Profile
  • Miscellaneous Laboratory Assays
  • Kidney Disease Profile
  • Pregnancy Test
  • Testosterone Test
  • Nutritional Biochemistries and Hematologies
  • Sexually Transmitted Disease Profile
  • Inflammatory Disease Tests
  • Blood Lipids
  • Environmental Health Profile
  • Stored Specimens for Future Research
• Post-Examination Components  [PDF - 40 KB] consist of the following:
  • Home Urine Collection
  • Physical Activity Monitor Component
  • Hepatitis C Phone Follow-up Questionnaire