Family Health History Survey

Participant Surveys: Family Health History

For this survey, the following applies to all questions:

Original source question text
Not applicable

From which existing source was this question derived?
This question was developed specifically for use within the All of Us Research Program

Year of Original Source
Not applicable

Brief Description
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URL
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How much do you know about illnesses or health problems for your parents, grandparents, brothers, sisters, and/or children?

Has anyone in your family ever been diagnosed with the following cancer conditions? Think only of the people you are related to by blood. Select all that apply.

options and variations noted below:

  • Who in your family has had bladder cancer? Select all that apply.
  • Who in your family has had bone cancer? Select all that apply.
  • Who in your family has had blood or soft tissue cancer? Select all that apply.
  • Who in your family has had brain cancer? Select all that apply.
  • Who in your family has had breast cancer? Select all that apply.
  • Who in your family has had cervical cancer? Select all that apply.
  • Who in your family has had colon cancer/rectal cancer? Select all that apply.
  • Who in your family has had endocrine cancer? Select all that apply.
  • Who in your family has had endometrial cancer? Select all that apply.
  • Who in your family has had esophageal cancer? Select all that apply.
  • Who in your family has had eye cancer? Select all that apply.
  • Who in your family has had head and neck cancer? Select all that apply.
  • Who in your family has had kidney cancer? Select all that apply.
  • Who in your family has had lung cancer? Select all that apply.
  • Who in your family has had ovarian cancer? Select all that apply.
  • Who in your family has had pancreatic cancer? Select all that apply.
  • Who in your family has had prostate cancer? Select all that apply.
  • Who in your family has had skin cancer? Select all that apply.
  • Who in your family has had stomach cancer? Select all that apply.
  • Who in your family has had thyroid cancer? Select all that apply.
  • Who in your family has had other cancer(s)? Select all that apply.
    • Please list other cancer(s) your mother has had.
    • Please list other cancer(s) your father has had.
    • Please list other cancer(s) your sibling(s) has had.
    • Please list other cancer(s) your daughter(s) has had.
    • Please list other cancer(s) your son(s) has had.
    • Please list other cancer(s) your grandparent(s) has had.

Has anyone in your family ever been diagnosed with the following heart and blood conditions? Think only of the people you are related to by blood. Select all that apply.

options and variations noted below:

  • Who in your family has had anemia? Select all that apply.
  • Who in your family has had aortic aneurysm? Select all that apply.
  • Who in your family has had atrial fibrillation (or a-fib) or atrial flutter (or a-flutter)? Select all that apply.
  • Who in your family has had congestive heart failure? Select all that apply.
  • Who in your family has had coronary artery/coronary heart disease (includes angina)? Select all that apply.
  • Who in your family has had a heart attack? Select all that apply.
  • Who in your family has had heart valve disease? Select all that apply.
  • Who in your family has had high blood pressure (hypertension)? Select all that apply.
  • Who in your family has had high cholesterol? Select all that apply.
  • Who in your family has had peripheral vascular disease? Select all that apply.
  • Who in your family has had pulmonary embolism or deep vein thrombosis (DVT)? Select all that apply.
  • Who in your family has had sickle cell disease? Select all that apply.
  • Who in your family has had a stroke? Select all that apply.
  • Who in your family had sudden death? Select all that apply.

Has anyone in your family ever been diagnosed with the following digestive conditions? Think only of the people you are related to by blood. Select all that apply.

options and variations noted below:

  • Who in your family has had acid reflux? Select all that apply.
  • Who in your family has had celiac disease? Select all that apply.
  • Who in your family has had colon polyps? Select all that apply.
  • Who in your family has had Crohn’s disease? Select all that apply.
  • Who in your family has had diverticulitis/diverticulosis? Select all that apply.
  • Who in your family has had gall stones? Select all that apply.
  • Who in your family has had irritable bowel syndrome (IBS)? Select all that apply.
  • Who in your family has had a liver condition (e.g., cirrhosis)? Select all that apply.
  • Who in your family has had peptic (stomach) ulcers? Select all that apply.
  • Who in your family has had ulcerative colitis? Select all that apply.

Has anyone in your family ever been diagnosed with the following hormone and endocrine conditions? Think only of the people you are related to by blood. Select all that apply.

options and variations noted below:

  • Who in your family has had hyperthyroidism? Select all that apply.
  • Who in your family has had hypothyroidism? Select all that apply.
  • Who in your family has had type 1 diabetes? Select all that apply.
  • Who in your family has had type 2 diabetes? Select all that apply.
  • Who in your family has had other/unknown diabetes? Select all that apply.

Has anyone in your family ever been diagnosed with the following kidney conditions? Think only of the people you are related to by blood. Select all that apply.

options and variations noted below:

  • Who in your family has had kidney disease? Select all that apply.
  • Who in your family has had kidney stones? Select all that apply.

Has anyone in your family ever been diagnosed with the following lung conditions? Think only of the people you are related to by blood. Select all that apply.

options and variations noted below:

  • Who in your family has had asthma? Select all that apply.
  • Who in your family has had chronic lung disease (COPD, emphysema, or bronchitis)? Select all that apply.
  • Who in your family has had sleep apnea? Select all that apply.

Has anyone in your family ever been diagnosed with the following brain and nervous system conditions? Think only of the people you are related to by blood. Select all that apply.

options and variations noted below:

  • Who in your family has had dementia (includes Alzheimer’s, vascular, etc.)? Select all that apply.
  • Who in your family has had epilepsy or seizure? Select all that apply.
  • Who in your family has had Lou Gehrig’s disease (amyotrophic lateral sclerosis)? Select all that apply.
  • Who in your family has had migraine headaches? Select all that apply.
  • Who in your family has had multiple sclerosis (MS)? Select all that apply.
  • Who in your family has had muscular dystrophy (MD)? Select all that apply.
  • Who in your family has had narcolepsy? Select all that apply.
  • Who in your family has had neuropathy? Select all that apply.
  • Who in your family has had Parkinson’s disease? Select all that apply.
  • Who in your family has had restless leg syndrome? Select all that apply.

Has anyone in your family ever been diagnosed with the following mental health or substance use conditions? Think only of the people you are related to by blood. Select all that apply.

options and variations noted below:

  • Who in your family has had an alcohol use disorder? Select all that apply.
  • Who in your family has had an anxiety reaction/panic disorder? Select all that apply.
  • Who in your family has had autism spectrum disorder? Select all that apply.
  • Who in your family has had bipolar disorder? Select all that apply.
  • Who in your family has had depression? Select all that apply.
  • Who in your family has had drug use disorder? Select all that apply.
  • Who in your family has had schizophrenia? Select all that apply.

Has anyone in your family ever been diagnosed with the following bone, joint, and muscle conditions? Think only of the people you are related to by blood. Select all that apply.

options and variations noted below:

  • Who in your family has had fibromyalgia? Select all that apply.
  • Who in your family has had gout? Select all that apply.
  • Who in your family has had osteoarthritis? Select all that apply.
  • Who in your family has had osteoporosis? Select all that apply.
  • Who in your family has had pseudogout (CPPD)? Select all that apply.
  • Who in your family has had rheumatoid arthritis (RA)? Select all that apply.
  • Who in your family has had systemic lupus? Select all that apply.
  • Who in your family has had spine, muscle, or bone disorders (non-cancer)? Select all that apply.

Has anyone in your family ever been diagnosed with the following hearing or eye conditions? Think only of the people you are related to by blood. Select all that apply.

options and variations noted below:

  • Who in your family has had cataracts? Select all that apply.
  • Who in your family has had glaucoma? Select all that apply.
  • Who in your family has had macular degeneration? Select all that apply.
  • Who in your family has had severe hearing loss or partial deafness in one or both ears? Select all that apply.

Has anyone in your family ever been diagnosed with the following other conditions? Think only of the people you are related to by blood. Select all that apply.

options and variations noted below:

  • Who in your family has had allergies or hay fever? Select all that apply.
  • Who in your family has had endometriosis? Select all that apply.
  • Who in your family has had fibroids? Select all that apply.
  • Who in your family has had obesity? Select all that apply.
  • Who in your family has had polycystic ovarian syndrome? Select all that apply.
  • Who in your family has had reactions to anesthesia (such as hyperthermia)? Select all that apply.
  • Who in your family has had skin condition(s) (e.g., eczema, psoriasis)? Select all that apply.
  • Who in your family has had other condition(s)? Select all that apply.
    • Please list other condition(s) your mother has had.
    • Please list other condition(s) your father has had.
    • Please list other condition(s) your sibling(s) has had.
    • Please list other condition(s) your daughter(s) has had.
    • Please list other condition(s) your son(s) has had.
    • Please list other condition(s) your grandparent(s) has had.