2011-2012 National Health and Nutrition Examination Survey (NHANES)
The Questionnaires can be viewed using Adobe Acrobat reader.
Questionnaires are administered to NHANES participants both at home and in the MECs. The questionnaires and a brief description of each section follows.
- 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.
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]
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]
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.
- 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]
- 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]
- Dietary Recall [PDF - 112 KB]