Survey Questionnaires, Examination Components and
Laboratory Components
2003-2004

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. 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. 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
Food Security
Housing Characteristics
Income
Pesticide Use
Smoking
Tracking and Tracing

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

Audiometry

Balance

Blood Pressure

Cardiovascular Disease

Cardiovascular Fitness

Demographics Information

Dermatology

Diabetes

Dietary Supplements and Prescription Medication

Diet Behavior and Nutrition

Dust Collection

Early Childhood

Health Insurance

Hospital Utilization and Access to Care

Immunization

Introduction and Verification

Kidney Conditions

Medical Conditions

Miscellaneous Pain

Occupation

Oral Health

Osteoporosis

Physical Activity and Physical Fitness

Physical Functioning

Respiratory Health and Disease

Smoking and Tobacco Use

Social Support

Vision

Weight History

Post-Examination Questionnaires

Food Frequency (formerly called Food Propensity):  Mailed to Respondent

Hepatitis Follow-up: Telephone Interview

Prostate Follow-up:  Telephone Interview

Mental Health Questionnaires

This questionnaire was conducted in the Mobile Examination Center (MEC).

Composite International Diagnostic Interview (188kb) consist of the following:
Generalized Anxiety Disorder Module
Major Depression Module
Interview Panic Disorder Module

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 (ages 12-19)

DISC Predictive Scale - Youth Conduct Disorder (ages 12-19)

Drugs (ages 12-59)

Food Security (ages 12-15)

Kidney Conditions (Prostate)

Sexual Behavior (ages 14-59)

Tobacco

Computer Assisted Personal Interview (CAPI) Questionnaire
Alcohol (ages 20+)
Current Health Status
Kidney
Physical Activity
Reproductive Health
Respondent Information
Tobacco (ages 20+)

Examination and Laboratory

Dietary Recall 103KB

Measuring Guides for the Dietary Recall Interview

Examination Components PDF 911 KB consist of the following:
Audiometry
Balance and Vestibular Testing
Body Composition
Body Measurements
Cardiovascular Fitness
Dermatology
Lower Extremity Disease
   Oral Health
   Physical Activity Monitor
Physician's Exam
Vision

Laboratory Components PDF 255KB 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

Nutritional Biochemistries and Hematologies
Sexually Transmitted Disease Profile
Tobacco Use
Blood lipids
Environmental Health Profile

Special Studies PDF 27 KB
 

This page last reviewed October 15, 2008