Attachment5_Summary of Questionnaire Changes_2025-2026_2025FEB14

Attachment 5

Summary of 2025-2026 Questionnaire Changes

Attachment 5: Summary of 2025-2026 Questionnaire Changes

Summary

The 2025–2026 NHANES interview consists of seven major components:

1. Household Screener Questionnaire (determines eligibility)

2. Survey Participant Questionnaire (CAPI and ACASI)

3. Household Questionnaire

4. MEC Interview Questionnaire (CAPI and ACASI) and Examination

5. Dietary Supplements Questionnaire (Telephone)

6. Post Dietary Recall Questionnaire (Telephone-Post Dietary)

7. Special Follow-up Questionnaire (Flexible Consumer Behavior Survey) (Telephone-Post Dietary)

The NHANES 2025–2026 interview content is similar to what was approved for the August 2021–August 2023 cycle. However, modifications were made throughout the major components to reduce question redundancy and improve questionnaire flow. Overall changes throughout all instruments include the following:

• Adding transition statements throughout to improve interview flow.

• Aligning wording for all questions with reference periods to begin with “last” instead of “past.” For example, “last 30 days.”

The modifications to existing questions for 2025–2026 are described below.

Description of Questionnaire Changes

Household Screener Questionnaire

Component Name

Descriptions

Screener Module

Questions Removed: Questions ascertaining mode removed because all screeners will be completed in person by an FI in 2025. Emancipated minor status. Household (HH) relationship module. Consent to text and alternative phone number. Questions Added: A question ascertaining whether someone who is 18 or older is available in the HH (YES/NO) and scripting to ask when a good time would be to return. Major Question Modifications: The HH health indicator questions (which are designed to support nonresponse bias analysis) were changed from 5 items only asking the health of the screener respondent to 3 items asking health status at the HH level. Added wording about information being voluntary and confidential at beginning of series of questions about household health. HH roster now begins with the person answering the screener. Age, race/ethnicity, and gender are collected for each rostered HH member prior to sample selection as age and race/ethnicity are used as part of the sampling process in 2025. Gender now includes “ANOTHER GENDER” as an option. Question asking for other members of the HH who may have been missed is now a consolidated YES/NO item, eliminating the need to ask about each type of missing persons separately. The rostering loop restarts if “YES” is selected to collect additional HH members. Roster verification now lists the name, age, race/ethnicity, and gender of each HH member. The only people who can be selected as the owner or renter of the HH are restricted to those who were rostered as being 18 or older, thus the items that ask whether the owner/renter is 18 or older or an emancipated minor are removed. Modified logic so that people’s whose age is “don’t know” or “refused” are accounted for as adults.

Survey Participant Questionnaire

Component Name	Descriptions
Respondent Selection	Removed questions about selecting interview mode and questions related to emancipated minors. Moved questions about interpreter use to earlier in section. Modified introduction and interview consent module and included a video to provide consent information to the respondent. Moved the consent to data linkage to the Demographic section to better connect it with the request of Social Security number. Added new derived age variables when impartial date of birth of SP is provided. Replaced the two-part gender question to a single question with an addition option for “Transgender, non-binary, or another gender,” and allowing selection of all categories that apply.
Early Childhood	Expanded target group to survey participants (SPs) from birth to 17 years (previously birth to 15 years). Added questions about biological mother’s weight and height. Added validation checks to prevent illogical and/or unlikely responses.
Healthcare Utilization	Added back the question about the length of time since last health care visit. Dropped the question on receiving health care via telemedicine in the last 12 months. Added validation checks to prevent illogical age responses.
Immunization	Two new questions have been added to ask about hepatitis B vaccine. Extended target age group from 9-49 to 9-64 years for HPV vaccination questions. In addition, the 2 gender-specific question on whether the SP has ever received HPV vaccine(s) have been combined into one gender-neutral question. Moved question on flu vaccinations from COVID-19 section (COQ) to this section. Added phonetic spelling of medical terms, where needed.
Medical Conditions	Added questions about age asthma first diagnosed, taking steroids for asthma, asthma caused or symptoms made worse by the job, subjective cognitive decline, and family history on asthma, diabetes, breast cancer, colon/rectal cancer, heart attack/angina before the age of 50, and stroke before the age of 65. Removed questions about emergency room visit due to asthma, hay fever, identifying specific type of liver condition, and gallbladder surgery. Added validation checks to prevent illogical age responses. Added phonetic spelling of medical terms, where needed.
Hepatitis	Expanded target group to SPs at least 5 years of age (previously at least 6 years of age). Added questions about history of Hepatitis C and prescribed medication for Hepatitis B and Hepatitis C. Added validation checks to prevent illogical age responses. Added phonetic spelling of medical terms, where needed.
Kidney Conditions	Expanded target group to SPs at least 18 years of age (previously at least 20 years of age). Added phonetic spelling of medical terms, where needed.
Diabetes	Added questions about specifying type of diabetes, checking A1C, and diabetes affecting SP’s eyesight. Adjusted language in the question about testing for high blood sugar or diabetes to specify the time since last tested by a doctor. Removed the question on the length of insulin use and added two questions on the time starting insulin usage since diabetes diagnosed and whether the usage has been stopped. Added validation checks to prevent illogical age responses. Added phonetic spelling of medical terms, where needed.
Blood Pressure	Restricted target group to SPs at least 18 years of age (previously at least 16 years of age). Added phonetic spelling of medical terms, where needed.
Osteoporosis	Added new section that asks about broken or fractured hips, wrists, or spine, osteoporosis, medication prescribed for osteoporosis, taking prednisone or cortisone pills daily, and whether the SP’s biological mother and father ever fractured their hips before or after the age of 50. Added phonetic spelling of medical terms, where needed.
Respiratory Health and Allergy	Added new section that asks about SP’s experience with wheezing, coughing, shortness of breath, seasonal or year-round allergy symptoms, eczema or atopic dermatitis, and food allergies. Added validation checks to prevent illogical age responses. Updated routing logic based on external feedback. Added phonetic spelling of medical terms, where needed.
Vision	Added new section that asks about SP’s ability to see light, blindness, difficulty doing certain activities that involve eyesight, last eye exam, glaucoma, age-related macular degeneration, cataract surgery, and diabetic retinopathy. Added phonetic spelling of medical terms, where needed.
Audiometry	Restricted target group to SPs ages 5 to 44 (previously at least 1 year of age). Added questions about usage of hearing aid, hearing without hearing aid, ear infections or temporary hearing loss, bothersome ringing or buzzing, dizziness and balance problems, migraines or severe headaches, significant head injury or concussions, bothered by everyday sounds or noises, use of earphones to listen to music, receiving Special Education or Early Intervention Services for developmental or disability problems, diagnosed child developmental disorders related to hearing issues, and exposure to loud and very loud noise, both during and outside of work. Added validation checks to prevent illogical age responses. Added phonetic spelling of medical terms, where needed.
Sun Protection Behavior	Renamed the section from “Dermatology” to “Sun Protection Behavior” to better reflect the question content on the use of protection when exposed to sun. Extended the target age from 20-59 to 18-64 years.
Oral Health	Added questions about SP’s last visit to the dentist, ability to access dental care, personal oral hygiene practice, use of toothpaste, receiving of dental sealants, preventive conversations with a dental hygienist, self-perceived periodontal disease, preventive examinations for oral cancer, and personal use of tap water at home. Condensed the dental health–related quality of life module by removing two questions. Added validation checks to prevent illogical age responses. Added validation checks to prevent illogical and/or unlikely responses, not related to age. Added phonetic spelling of medical terms, where needed.
Physical Activity and Physical Fitness	Restricted target group to SPs ages 2 to 11 (through a proxy interview) and at least 18 years of age (12-17 years will be asked the same questions as those for 2-11 years in the MEC). Replaced the screen time question for children with the question adapted from the National Survey of Children’s Health, which uses categorical responses to better capture information that can be used to evaluate evolving recommendations on screen time by age. Added validation checks to prevent illogical responses.
Functioning	Minor wording changes to the questions on walking and self-care. Added validation checks to prevent illogical and/or unlikely responses.
Sleep Disorders	Restricted target group to SPs at least 18 years of age (previously at least 16 years of age). Added questions about snoring while sleeping, snorting or gasping while sleeping, diagnosis of trouble sleeping by a doctor, and diagnosed sleep apnea. Added validation checks to prevent illogical responses. Added phonetic spelling of medical terms, where needed.
Diet Behavior and Nutrition	Restricted target group for questions on breastfeeding and other childhood feeding practices to SPs 4 years of age or younger (previously 6 years of age or younger). Added one question about source of water for preparing infant formula for SPs 23 months of age or younger. Added one question on the frequency of introducing new food to infant for SPs 11 months of age or younger. Added questions on the consumption frequency for specific foods in the last 7 days and questions on childcare for SPs 4 years of age or younger. Restricted target group for questions about Women, Infants, and Children program (WIC) to SPs 4 years of age or younger (previously 5 years of age or younger). Adjusted language of questions asking about SP’s age when receiving benefits from WIC program. Added questions about My Plate program. Added one question on current milk consumption pattern. Removed questions about meals provided by community or government programs for SPs at least 60 years of age. Added one question on the type of cereal SP < 2 years ate. Modified question to ask about apple and grape juice consumption, and not just apple juice. Added a question on whether the spinach was a commercially prepared baby food or made from ingredients at a home. Replaced question on hours of childcare received outside the home with whether or not SP received regular care during most weeks from someone other than their parent or guardian. Added a question on the number of hours SP received care from someone other than the parent or guardian. Updated variable names. Added validation checks to prevent illogical age responses. Updated routing logic based on external feedback.
Weight History	Restricted target group to SPs 18 years of age or older (previously 16 years of age or older). Added validation checks to prevent illogical and/or unlikely responses.
Smoking and Tobacco Use	Removed a question on whether the SP smokes menthol or non-menthol cigarettes. Added validation checks to prevent illogical and/or unlikely responses.
COVID-19	Added one question on time since last having/suspected of having COVID-19. Removed questions about testing for active COVID infections, antibody blood testing for past infection, household members’ positive tests for COVID-19, and weakened immune systems. Simplified questions on COVID vaccinations by replacing detailed questions on the number of doses, vaccine brand, and timing of vaccination received with one single question on whether a COVID-19 vaccine was received in the last 12 months. Moved the question about flu vaccination to the Immunization section. Added validation checks to prevent illogical age responses.
Occupation	Restricted target group to SPs ages 18 years and older (previously 16 years of age and older). Adapted the 6-item employment questions from NHIS. Added one question on work schedule. Added validation checks to prevent illogical and/or unlikely responses.
Demographics Information	Restricted target group for the education question to SPs 18 years of age or older (previously 6 years of age or older). Restricted target group for the question on ever served on active duty in the U.S. Armed Forces to SPs 18 years of age or older (previously 17 years of age or older). Restricted target group for the question on marital status to SPs 18 years of age or older (previously 14 years of age or older). Removed questions about SP’s current school enrollment, other first name, maiden name, and father’s last name. Replaced the race and Hispanic origin questions with the single race/ethnicity question per updated OMB recommendation. Simplified the question on the length of residency in the United States by providing categorical response options. Removed the question on the state/U.S. territory where the SP was born. Moved the consent to data linkage to this section to better connect it with the request of Social Security number. A video will be used to introduce the data linkage consent to the respondent. Updated wording for the question on Social Security number and restricted its target group to only those who provided data linkage consent (previously all SPs). Added validation checks to prevent illogical and/or unlikely responses.
Acculturation	Updated response category for language usually spoken at home question, so the same question can be used for all race/ethnicity groups (previously, separate ethnic-specific questions were used for Hispanic, Asian, and other groups). Added questions on the language the SP speaks more often at home, if multiple languages were reported.
Health Insurance	Restricted the target group for the question on Medicare Number to only those who provided data linkage consent (previously all SPs received Medicare). Removed the question about any time in the last year when the SP did not have any health insurance coverage.
Infant Formula	Added new section for SPs 1 year of age or younger about infant and toddler formulas used in the last 2 weeks. Includes questions about the number of formulas taken, formula’s name, and the length of time the SP has been fed with the formula. The interviewer will ask to see the container(s) of the formula and record brand name, base, form, added ingredients or descriptions, and manufacturer. Added validation checks to prevent illogical age responses.
Prescription Medication	Added questions about the use of prescription medication(s). Interviewer will ask to see the container(s) of the medication(s) that the SP takes. Interviewer records the medication name and asks about the duration of use and the reason for use. Added a question to the use of low-dose aspirin module on whether advised by a doctor to stop taking low-dose aspirins. In addition, the target group for the module is restricted to 45 years and older (previously 40 years and older). Removed questions about prescriptions to treat or prevent COVID-19. Added validation checks to prevent illogical age responses.
ACASI Tutorial	Implemented ACASI mode as part of the SP questionnaire to administer sections with sensitive questions at home. Added to introduce ACASI sections and navigating the laptop to the SP. Added a clear button, where applicable.
Reproductive Health	Moved from MEC interview to SP interview at home but retained the ACASI mode of administration. Restricted target group to SPs 18 years of age or older (the section will be administered to SPs 12-17 years of age in the MEC). Removed question about being treated for a pelvic infection. Added a clear button, where applicable.
Bladder Functioning	Moved from MEC interview to SP interview at home but retained the ACASI mode of administration. Renamed the section from “Kidney Conditions” to “Bladder Functioning” to better reflect the question content which is focusing on bladder function and urine leakage. Extended the target age from 20 to 18 years of age or older.
Depression Screen	Moved from MEC interview to SP interview at home but retained the ACASI mode of administration. Restricted target group to SPs 18 years of age or older (the section will be administered to SPs 12-17 years of age in the MEC). Removed question on suicidality.
Alcohol Use	Moved from MEC interview to SP interview at home but retained the ACASI mode of administration. Restricted target group to SPs 18 years of age or older (the section will be administered to SPs 12-17 years of age in the MEC). Reduced number of questions on binge drinking. Added a clear button, where applicable.
Balance	Removed section.
Mailing address	Formatting of mailing item has been updated for consistency.
Incentive Card	Removed item to load incentive on an existing card. Updated question stem to reflect incentive process.

Household Questionnaire

Component Name	Descriptions
Respondent Selection	Removed questions about selecting interview mode. Moved questions about interpreter use to earlier in section. Modified introduction and consent module to accommodate the in-person verbal consent process. Modified so informed consent is administered to respondents who are SPs who completed informed consent in SP questionnaire on an earlier date, in addition to non-SPs. Modified informed consent wording and added Assurance of Confidentiality in help on this screen. Added reminder of informed consent on the introduction screen for respondents who are SPs who consented in the SP questionnaire on the same day. On recording consent screen added a reminder for respondents who are SPs who consented in the SP questionnaire on the same day.
Housing characteristics	Questions Added One question ascertaining how long the SP has lived at the address Main source of tap water Presence of mildew or musty smell in the last 12 months Presence of cockroaches in the last 12 months Presence of small furry animals in the last 12 months Household member avoided bringing new pets to or removed pets due to allergies or asthma concerns
Smoking	Questions Added Whether smoking inside the home is allowed Whether smoking inside household vehicles is allowed
Consumer Behavior	Major Question Modifications The 7-item food expenditure module was simplified to 2 items to ask money spent on ready-to-eat/prepared meals and foods bought to be prepared at home separately. The 6 items used to identify main meal planner(s) and main food shopper(s) in the household is streamlined into 2 items.
Food Security	No changes anticipated.
Income	Major Question Modifications Annual and monthly incomes are only asked at the household (dwelling unit) level, no longer at the family level.
Demographic Background	Questions Removed State or U.S. territory where the household reference person was born. Questions Added Marital status of the household reference person. The household reference person’s spouse’s/partner’s education level.
Tracking and Tracing	No changes anticipated.

MEC Interview Questionnaire

Component Name	Descriptions
Physical Activity and Physical Fitness	Modified target group to be SPs ages 12-17 (same questions were asked to proxy for SPs 2-11 years as part of the SP questionnaire). Replaced the screen time question with the one adapted from the National Survey of Children’s Health, which uses categorical responses to better capture information that can be used to evaluate evolving recommendations on screen time by age.
Sexual Orientation	Extended target group to be SPs ages 12–64 (previously 18-59 years). Consolidated the wording to have the same sexual orientation question for SPs of all genders.
Reproductive Health	Modified target group to be SPs ages 12–17 (same questions were asked to SPs 18+ years as part of the SP questionnaire).
Medical Condition	Added question on HIV status for SPs ages 12-64.
Depression Screen	Modified target group to be SPs ages 12–17 (same questions were asked to SPs 18+ years as part of the SP questionnaire). Removed question on suicidality.
Tobacco	Modified target group to be SPs ages 12–17. Removed question asking, “How long has it been since you quit smoking cigarettes?” Removed individual questions asking for total number of days respondent smoked various tobacco product(s) or e-cigarettes in the past 5 days, and the last time the SP smoked cigarette. Revised wording of the questions on the use of e-cigarettes and electronic vaping products and the use of smokeless tobacco products in the past 5 days. Added a new question about use of heated tobacco products in the past 5 days. Added a new question about total number of days respondent used any of the tobacco products they endorsed within the past 5 days. Added a new question about the last time the respondent used any of the tobacco products they endorsed.
Alcohol Use	Modified target group to be SPs ages 12–17 (the Alcohol Use section was administered to SPs 18+ years as part of the SP questionnaire).
Drug Use	Extended target group to be SPs ages 12–64 (previously 12-59 years). Removed questions asking about cocaine use, heroin use, and methamphetamine use. Added question asking about ways in which marijuana was used in the past 30 days. Added question about time since respondent last used a needle to inject a non-prescribed drug.
Sexual Behavior – Female	Modified target group to be female SPs ages 14-64 (previously 14-69 years). Added a question on ages first had any kind of sex. Added a question asking for total number of lifetime male oral sex partners. Added 2 questions on ever performed oral sex on a female partner, and (if yes), total number of lifetime female oral sex partners. Removed 2 questions on total numbers of male and female sex partners in past 12 months. Replaced 2 questions on diagnosed genital herpes and genital warts with a question allowing selection of all categories that apply on ever had diagnosed genital herpes, genital warts, HPV, gonorrhea, or chlamydia.
Sexual Behavior – Male	Modified target group to be male SPs ages 14-64 (previously 14-69 years). Added a question on ages first had any kind of sex. Added a question asking for total number of lifetime female oral sex partners. Added 2 questions on ever performed oral sex on a male partner, and (if yes), total number of lifetime male oral sex partners. Removed 2 questions on total numbers of male and female sex partners in past 12 months. Replaced 2 questions on diagnosed genital herpes and genital warts with a question allowing selection of all categories that apply on ever had diagnosed genital herpes, genital warts, HPV, gonorrhea, or chlamydia. Added a question on circumcision.
Current Health Status	Removed this section.
Kidney Conditions	Renamed to “Bladder Functioning” and moved to SP questionnaire.

Dietary Supplements Questionnaire

Component Name

Descriptions

Dietary Supplements

Added two new questions to supplements series: one asking whether the supplement was taken in the previous day and (if yes) one asking how much of the supplement had been taken in the previous day. Added two new questions to antacids series: one asking whether the antacid was taken in the previous day and (if yes) one asking how much of the antacid had been taken in the previous day. Added Day 2 interview, which gathers information about respondents’ use of supplements/antacids they reported using in the past 30 days during the previous day.

Post Dietary Recall Questionnaire (Phone-Post Dietary Recall)

Component Name	Descriptions
Post-Recall Questionnaire	Updated the examples on the question wording and the lists of fish and shellfish on the hand cards for the 30-day fish and shellfish consumption frequency questions. Removed questions asking about source of tap water, type of salt usually used at the table, use of salt at the table yesterday, and type of salt used at the table yesterday.

Special Follow-up Questionnaires (Flexible Consumer Behavior Survey) (Telephone)

Component Name	Descriptions
Calorie Labeling on Menus	Section removed with exception of first question, which has been edited to ask about general use of calorie or other nutrition information when deciding what to buy at all restaurant types listed on hand card 1. Thus, rather than reporting use of calorie or other nutrition information, respondents report general use of this information for all places listed on hand card 1.
Food Label	Removed questions asking about use of the following information on nutrition labels: expiration dates, health claims, serving sizes, number of servings in the package, footnotes, percent daily value, sugars, and nutrition labels with two columns. Removed questions asking about reasons for using (or not using) food labels when deciding to buy a product. Removed question asking about understanding of “serving size.” Removed question asking for recognition of older and new Nutrition Facts labels.
Respondent Information	Moved the question about gender of the respondent back into demographics at the end of instrument because now we only ask SPs the question that gender was needed for. FCBS is now administered before incentives/scheduling for all SPs, except 12-17 year olds, who get incentives/scheduling before FCBS.

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