2021-22 AFS - Content Summary and Field Dates

Att 7a - 2021-2022 Adolescent Follow-back Survey (AFS) - Content Summary and Field Dates.docx

National Health Interview Survey

2021-22 AFS - Content Summary and Field Dates

OMB: 0920-0214

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Attachment 7a - 2021-2022 Adolescent Follow-back Survey (AFS)

Content Summary and Field Dates

(DRAFT – September 14, 2020 – 94 questions)

General health and well-being

  • Self-assessed health status

  • Satisfaction with life §§


Height and weight

  • Self-reported height

  • Self-reported weight

  • Perception of weight status

  • Concern about weight


Physical activity

  • (Past 12 months) Played on sports teams, took sports lesson in school/community

  • (Past 12 months) Took PE or gym class

  • (Typical school week) How often physically active for a total of at least 60 minutes per day

  • (Typical school week) How often muscle strengthening activities

  • (Typical school week) How often walks for at least 10 minutes

  • (Typical school week) How often rides a bike for at least 10 minutes


Sleep

  • (Typical school week) How often do you wake up well-rested

  • (Typical school week) How often do you have difficulty getting out of bed in morning

  • (Typical school week) How often do you complain about being tired

  • (Typical school week) How often do you fall asleep during day

  • (Typical school week) How often do you go to bed at same time

  • (Typical school week) How often do you wake up at the same time


Screen time

  • (Typical weekday) Number of hours in front of TV, computer, cellphone, or other electronic device


Concussions

  • As a result of a blow or jolt to the head, ever knocked out or lost consciousness §

If no:

    • As a result of a blow or jolt to the head, ever been dazed or had a gap in your memory §

    • As a result of a blow or jolt to the head, ever had headaches, vomiting, blurred vision, changes in mood or behavior §

  • Ever been checked for a concussion or brain injury §

If yes:

    • Ever been diagnosed with a concussion or brain injury §


Health care utilization

  • Time since last seen doctor or health professional

If not never:

    • Time alone with doctor or health professional at last visit §§

  • Was most recent visit a wellness visit, physical, or general-purpose check-up

If no:

  • Time since last wellness visit, physical, or general-purpose check-up

If not never:

      • Time alone with doctor or health professional at last wellness visit §§

  • (Ever) Had visit with doctor or health professional that parents did not know about

If yes:

  • Type of visit (mental health, women’s health, other - specify)


Content of care in past year (or at last wellness visit)

  • Talked about understanding the changes in health care that happen at age 18

  • Talked about gaining skills to manage your health and health care

  • Talked about tobacco products or smoking

  • Talked about your mental or emotional health

  • Talked about puberty (e.g., changes to your body) or sexual health (e.g., safe sex practices)


Health care access

  • Has a usual place for care when sick

If yes or more than one place:

  • Type of place (or type of place visited most often)

  • Has a personal doctor or nurse §§


Complementary and alternative health

  • (Past 12 months) Use of meditation

  • (Past 12 months) Practice yoga

  • (Past 12 months) Visit a chiropractor


Mental health care use and unmet need

  • (Past 12 months) Any prescription medication taken to help with emotions, concentration, behavior, or mental health §

  • (Past 12 months) Received counseling or therapy from a mental health professional §

  • (Past 12 months) Any counseling or therapy needed but didn’t get due to cost

  • (Past 12 months) Any counseling or therapy needed but didn’t get due to fear of what others would think of you

  • (Past 12 months) Any counseling or therapy needed but didn’t get due to not knowing where to go or how to get help


Social support

  • How often do you receive the social and emotional support you need §§

  • How much can you rely on friends if you have a serious problem

  • How much can you open up to friends if you need to talk about your worries

  • How much can you rely on your parents/guardians if you have a serious problem

  • How much can you open up to your parents/guardians if you need to talk about your worries

  • Is there an adult in school, neighborhood, or community who makes a positive and meaningful difference in your life §§


Cognition

  • Compared with people of same age, level of difficulty learning things

  • Compared with people of same age, level of difficulty remembering things


Behavior

  • Compared with people of same age, level of difficulty controlling behavior

  • Level of difficulty focusing on activity you enjoy

  • Level of difficulty accepting changes in routine

  • Level of difficulty making friends




Depression and anxiety (PHQ-2 and GAD-2)

  • (Past 2 weeks) Frequency of…little interest or pleasure in doing things

  • (Past 2 weeks) Frequency of…feeling down, depressed, hopeless

  • (Past 2 weeks) Frequency of…feeling nervous, anxious, or on edge

  • (Past 2 weeks) Frequency of…not being able to stop or control worrying


Stressful life events / adverse childhood experiences

  • Ever victim of violence or witness any violence in neighborhood §

  • Ever been separated from a parent or guardian because they went to jail, prison, or detention center §

  • Ever live with anyone who was mentally ill or severely depressed §

  • Ever live with anyone who had a problem with alcohol or drugs §

  • Ever had a parent or guardian die

  • Ever had a parent or guardian divorce or separate

  • Ever lived with parent or guardian who frequently swore at you, insulted you, or put you down §

  • Ever been a time when your basic needs were not met §

  • Ever been treated or judged unfairly because of your race or ethnic group §§

  • Ever been treated or judged unfairly because of your sexual orientation or gender identity §§


Bullying

  • (Past 12 months) How often were you bullied, picked on, or excluded by others §§

  • (Past 12 months) Been electronically bullied §§

  • (Past 12 months) How often did you bully others, pick on them, or exclude them §§

  • (Past 12 months) Electronically bulled others


Everyday discrimination

  • How often are you treated with less courtesy or respect than other people your age

  • At restaurants or stores, how often do you receive poorer service than other people your age

  • How often do people act as if they think you are not smart


Demographics

  • Hispanic origin

  • Race

  • Sexual orientation

  • Sex at birth

  • Gender identity

  • School enrollment


Survey environment

  • Type of device used to complete the survey

  • Was survey completed at home

  • Did anyone help you answer questions in the survey

  • Was anyone else in the room when you completed the survey


Experience with survey

  • How burdensome was this survey

  • How easy or difficult was the survey

  • How sensitive were the questions

  • How would you describe the length of the survey





= Question already included in NHIS annual core or rotating core, sponsored, or emerging core in 2021

= Question already included in NHIS annual core or rotating core, sponsored, or emerging core in 2022

§ = New question to be added to the NHIS sample child interview in 2021 and/or 2022

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorBlumberg, Stephen J. (CDC/DDPHSS/NCHS/DHIS)
File Modified0000-00-00
File Created2021-01-13

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