The Basics Survey

Participant Surveys: The Basics

In what country were you born?

Original source question text
In what country {were you/was NON-SP Head} born?

From which existing source was this question derived?
National Health and Nutrition Examination Survey (NHANES)

Year of Original Source
2017

Brief Description
The National Health and Nutrition Examination Survey (NHANES) is a program conducted by the National Center for Health Statistics that aims to assess the health and nutritional status of the United States population. Approximately 5,000 participants from different counties across the nation complete the NHANES interview each year. Specific survey components include demographic, socioeconomic, dietary, and health-related questions.

URL
https://www.cdc.gov/nchs/nhanes/

Which categories describe you? Select all that apply. Note, you may select more than one group.

Original source question text
Which categories describe Person 1? Mark all boxes that apply AND print details in the spaces below. Note, you may report more than one group.

From which existing source was this question derived?
U.S. 2020 Census (original draft version race and ethnicity question)

Year of Original Source
2017

Brief Description
In 2017, in preparation for the 2020 Census, the U.S. Census Bureau tested new methods for capturing more accurate data on race and ethnicity than had been captured in previous census years. In 2018, the Census Bureau decided not to use the detailed versions of these questions.

URL
https://www.census.gov/

options and variations noted below (all options derived from U.S. 2020 Census (original draft version race and ethnicity question):

  • American Indian or Alaska Native (For example: Aztec, Blackfeet Tribe, Mayan, Navajo Nation, Native Village of Barrow (Utqiagvik) Inupiat Traditional Government, Nome Eskimo Community, etc.)
    • Original source question text: American Indian or Alaska Native – Print name of enrolled or principal tribe(s), for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.
  • Asian (For example: Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, etc.)
    • Original source question text: Asian – Provide details below.
  • Black, African American, or African (For example: African American, Ethiopian, Haitian, Jamaican, Nigerian, Somali, etc.)
    • Original source question text: Black or African Am. – Provide details below.
  • Hispanic, Latino, or Spanish (For example: Colombian, Cuban, Dominican, Mexican or Mexican American, Puerto Rican, Salvadoran, etc.)
    • Original source question text: Hispanic, Latino, or Spanish – Provide details below.
  • Middle Eastern or North African (For example: Algerian, Egyptian, Iranian, Lebanese, Moroccan, Syrian, etc.)
    • Original source question text: Middle Eastern or North African – Provide details below.
  • Native Hawaiian or other Pacific Islander (For example: Chamorro, Fijian, Marshallese, Native Hawaiian, Tongan, etc.)
    • Original source question text: Native Hawaiian or other Pacific Islander – Provide details below.
  • White¬†(For example: English, European, French, German, Irish, Italian, Polish, etc.)
    • Original source question text: White – Provide details below.

What was your biological sex assigned at birth?

Original source question text
What sex were you assigned at birth, on your original birth certificate?

From which existing source was this question derived?
Gender Identity in U.S. Surveillance (GenIUSS)

Year of Original Source
2014

Brief Description
To address gaps in federally-supported population health surveys in the identification of gender minorities, the Gender Identity in the U.S. Surveillance (GenIUSS) Group, offered recommendations for collecting information about sex assigned at birth and current gender identity. The questions are published in their 2014 report, “Best Practices for Asking Questions to Identify Transgender and Other Gender Minority Respondents on Population-Based Surveys.”

URL
https://williamsinstitute.law.ucla.edu/research/census-lgbt-demographics-studies/geniuss-report-sept-2014/

What terms best express how you describe your gender identity? (Check all that apply)

Original source question text
What is your current gender identity? (Check all that apply)

From which existing source was this question derived?
Gender Identity in U.S. Surveillance (GenIUSS)

Year of Original Source
2014

Brief Description
To address gaps in federally-supported population health surveys in the identification of gender minorities, the Gender Identity in the U.S. Surveillance (GenIUSS) Group, offered recommendations for collecting information about sex assigned at birth and current gender identity. The questions are published in their 2014 report, “Best Practices for Asking Questions to Identify Transgender and Other Gender Minority Respondents on Population-Based Surveys.”

URL
https://williamsinstitute.law.ucla.edu/research/census-lgbt-demographics-studies/geniuss-report-sept-2014/

options and variations noted below:

  • Are any of these a closer description to your gender identity? (Check all that apply)
    • Original source question text: Not applicable

Which of the following best represents how you think of yourself?

Original source question text
Which of the following best represents how you think of yourself?

From which existing source was this question derived?
National Health Interview Survey (NHIS)

Year of Original Source
2016

Brief Description
The National Health Interview Survey (NHIS) is a program of the CDC’s National Center for Health Statistics. Since 1957, the NHIS has collected data on a variety of socioeconomic characteristics and health topics (e.g., conditions, medications, access to medical care, etc.) every 10-15 years.

URL
https://www.cdc.gov/nchs/nhis/

options and variations noted below:

  • Are any of these a closer description of how you think of yourself?
    • Original source question text: What do you mean by something else?
    • From which existing source was this question derived? National Health Interview Survey (NHIS)
    • Year of Original Source: 2014
    • Brief Description: The National Health Interview Survey (NHIS) is a program of the CDC’s National Center for Health Statistics. Since 1957, the NHIS has collected data on a variety of socioeconomic characteristics and health topics (e.g., conditions, medications, access to medical care, etc.) every 10-15 years.
    • URL: https://www.cdc.gov/nchs/nhis/ h

What is the highest grade or year of school you completed?

Original source question text
What is the highest grade or year of school you completed?

From which existing source was this question derived?
Behavioral Risk Factor Surveillance System (BRFSS)

Year of Original Source
2016

Brief Description
The Behavioral Risk Factor Surveillance System (BRFSS), established in 1984, is an annual national health-related telephone survey. Each year, data is collected on approximately 400,000 adults across the United States. about health-related risk behaviors, chronic health conditions, and use of preventive services.

URL
https://www.cdc.gov/brfss/

Have you ever served on active duty in the United States Armed forces, either in the regular military or in a National Guard or military reserve unit?

Note: Active duty does not include training for the Reserves or National Guard, but DOES include activation, for example, for the Persian Gulf War

Original source question text
Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit?

From which existing source was this question derived?
Behavioral Risk Factor Surveillance System (BRFSS)

Year of Original Source
2016

Brief Description
The Behavioral Risk Factor Surveillance System (BRFSS), established in 1984, is an annual national health-related telephone survey. Each year, data is collected on approximately 400,000 adults across the United States. about health-related risk behaviors, chronic health conditions, and use of preventive services.

URL
https://www.cdc.gov/brfss/

What is your current marital status?

Original source question text
Are you?:

From which existing source was this question derived?
Behavioral Risk Factor Surveillance System (BRFSS)

Year of Original Source
2016

Brief Description
The Behavioral Risk Factor Surveillance System (BRFSS), established in 1984, is an annual national health-related telephone survey. Each year, data is collected on approximately 400,000 adults across the United States. about health-related risk behaviors, chronic health conditions, and use of preventive services.

URL
https://www.cdc.gov/brfss/

Not including yourself, how many other people live at home with you?

Original source question text
How many members of your household, including yourself, are 18 years of age or older?

From which existing source was this question derived?
Behavioral Risk Factor Surveillance System (BRFSS)

Year of Original Source
2016

Brief Description
The Behavioral Risk Factor Surveillance System (BRFSS), established in 1984, is an annual national health-related telephone survey. Each year, data is collected on approximately 400,000 adults across the United States. about health-related risk behaviors, chronic health conditions, and use of preventive services.

URL
https://www.cdc.gov/brfss/

Think of other people who live with you. How many are under the age of 18 years?

Original source question text
How many children less than 18 years of age live in your household?

From which existing source was this question derived?
Behavioral Risk Factor Surveillance System (BRFSS)

Year of Original Source
2016

Brief Description
The Behavioral Risk Factor Surveillance System (BRFSS), established in 1984, is an annual national health-related telephone survey. Each year, data is collected on approximately 400,000 adults across the United States. about health-related risk behaviors, chronic health conditions, and use of preventive services.

URL
https://www.cdc.gov/brfss/

Are you covered by health insurance or some other kind of health care plan?

Original source question text
Are you covered by health insurance or some other kind of health care plan?

From which existing source was this question derived?
National Health and Nutrition Examination Survey (NHANES)

Year of Original Source
2017

Brief Description
The National Health and Nutrition Examination Survey (NHANES) is a program conducted by the National Center for Health Statistics that aims to assess the health and nutritional status of the United States population. Approximately 5,000 participants from different counties across the nation complete the NHANES interview each year. Specific survey components include demographic, socioeconomic, dietary, and health-related questions.

URL
https://www.cdc.gov/nchs/nhanes/

options and variations noted below:

  • Are you currently covered by any of the following types of health insurance or health coverage plans? Select all that apply from one group.
    • Original source question text: Is this person CURRENTLY covered by any of the following types of health insurance or health coverage plans? Mark “Yes” or “No” for EACH type of coverage
    • From which existing source was this question derived? U.S. 2020 Census
    • Year of Original Source: 2020
    • Brief Description: The U.S. Census is used to collect information about every resident in the United States and takes place every 10 years. The 2020 U.S. Census is anticipated to count 330 million residents across 140 million households.
    • URL: https://www.census.gov/

What is your current employment status? Please select 1 or more of these categories.

Original source question text
Are you currently…?

From which existing source was this question derived?
Behavioral Risk Factor Surveillance System (BRFSS)

Year of Original Source
2016

Brief Description
The Behavioral Risk Factor Surveillance System (BRFSS), established in 1984, is an annual national health-related telephone survey. Each year, data is collected on approximately 400,000 adults across the United States. about health-related risk behaviors, chronic health conditions, and use of preventive services.

URL
https://www.cdc.gov/brfss/

What is your work street address?

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
Not applicable

URL
Not applicable

What is your annual household income from all sources?

Original source question text
Is your annual household income from all sources-

From which existing source was this question derived?
Behavioral Risk Factor Surveillance System (BRFSS)

Year of Original Source
2016

Brief Description
The Behavioral Risk Factor Surveillance System (BRFSS), established in 1984, is an annual national health-related telephone survey. Each year, data is collected on approximately 400,000 adults across the United States. about health-related risk behaviors, chronic health conditions, and use of preventive services.

URL
https://www.cdc.gov/brfss/

Do you own or rent the place where you live?

Original source question text
Do you own or rent your home? (Home is defined as the place where you live most of the time/the majority of the year.)

From which existing source was this question derived?
Behavioral Risk Factor Surveillance System (BRFSS)

Year of Original Source
2016

Brief Description
The Behavioral Risk Factor Surveillance System (BRFSS), established in 1984, is an annual national health-related telephone survey. Each year, data is collected on approximately 400,000 adults across the United States. about health-related risk behaviors, chronic health conditions, and use of preventive services.

URL
https://www.cdc.gov/brfss/

options and variations noted below:

How many years have you lived at your current address?

Original source question text
How many years have you lived at your current address?

From which existing source was this question derived?
UK Biobank

Year of Original Source
2011

Brief Description
The UK Biobank is a longitudinal, prospective cohort study in the United Kingdom of more than 500,000 individuals between the ages of 40-69 recruited between 2006-2010. Supported by the UK National Health Service, UK Biobank aims to prevent, diagnose, and treat multiple serious diseases.

URL
https://www.ukbiobank.ac.uk/

In the past 6 months, have you been worried or concerned about NOT having a place to live?

Original source question text
Are you worried or concerned that in the next 2 months you may NOT have stable housing that you own, rent, or stay in as part of a household?

From which existing source was this question derived?
VA Homelessness Screening Clinical Reminder

Year of Original Source
2012

Brief Description
The VA Homelessness Screening Clinical Reminder was developed in 2012 by the National Center on Homelessness among Veterans for use by the Veterans Health Administration to capture homelessness and risk of homelessness in the VA patient population.

URL
https://www.va.gov/homeless/nchav/research/assessment-tools/hscr.asp

What is your Social Security Number?

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
Not applicable

URL
Not applicable

The All of Us Research Program contact you periodically to gather additional health related information. In case we cannot contact you, please provide the names, addresses, and telephone numbers of 2 relatives or friends who would know where you could be reached in case we have trouble reaching you. (Please give us the names of persons not currently living in the household)

Original source question text
The Centers for Disease Control and Prevention may wish to contact you again to obtain additional health related information. Please give me the names, addresses, and telephone numbers of 2 relatives or friends who would know where you could be reached in case we have trouble reaching you. (Please give me the names of persons not currently living in the household.)

From which existing source was this question derived?
National Health and Nutrition Examination Survey (NHANES)

Year of Original Source
2009

Brief Description
The National Health and Nutrition Examination Survey (NHANES) is a program conducted by the National Center for Health Statistics that aims to assess the health and nutritional status of the United States population. Approximately 5,000 participants from different counties across the nation complete the NHANES interview each year. Specific survey components include demographic, socioeconomic, dietary, and health-related questions.

URL
https://www.cdc.gov/nchs/nhanes/