2021 NSCH Questionnaire Content Revisions

Appendix A

2021 National Survey of Children’s Health
Questionnaire Content Revisions

2021 NSCH Questionnaire Content Revisions
Modifications or Additions to Existent Items
Updated 1/11/2021
Questionnaire

Section
N/A

Item
Number
(2020)
9

Item Number
(2021) & MT
number
9

Screener

Screener

N/A

11

11

2020 Content

2021 Revised Content
(Rationale)

Is this child limited or prevented in any way in his or her ability to do the
things most children of the same age can do?
Yes
No

Is this child limited or prevented in any way in their ability to do
the things most children of the same age can do?
Yes
No

Does this child have any kind of emotional, developmental, or behavioral
problem for which he or she needs treatment or counseling?
Yes
No

Does this child have any kind of emotional, developmental, or
behavioral problem for which they need treatment or
counseling?
Yes
No

If yes, has his or her emotional, developmental, or behavioral problem lasted
or is it expected to last 12 months or longer?
Yes
No
NSCH-T1,
NSCH-T2, &
NSCH-T3

Section C

C1

C1

DURING THE PAST 12 MONTHS, did this child see a doctor, nurse, or other
health care professional for sick-child care, well-child check-ups, physical
exams, hospitalizations or any other kind of medical care?

NSCH-T1

Section C

C7

C7

Answer the following question only if this child is at least 9 months old.
Otherwise skip to question C8.
DURING THE PAST 12 MONTHS, did a doctor or other health care provider
have you or another caregiver fill out a questionnaire about observations or
1

If yes, has their emotional, developmental, or behavioral problem
lasted or is it expected to last 12 months or longer?
Yes
No
DURING THE PAST 12 MONTHS, did this child see a doctor, nurse,
or other health care professional for sick-child care, well-child
check-ups, physical exams, hospitalizations or any other kind of
medical care? Include health care visits done by video or phone.
Answer the following question only if this child is at least 9
months old. Otherwise skip to question C8.
DURING THE PAST 12 MONTHS, did a doctor or other health care
provider have you or another caregiver fill out a questionnaire

Questionnaire

Section

Item
Number
(2020)

Item Number
(2021) & MT
number

2020 Content

2021 Revised Content
(Rationale)

concerns you may have about this child’s development, communication, or
social behaviors? Sometimes a child’s doctor or other health care provider
will ask a parent to do this at home or during a child’s visit.
If yes, and this child is 9-23 Months:
Did the questionnaire ask about your concerns or observations
about:
Mark (X) ALL that apply.
How this child talks or makes speech sounds?
How this child interacts with you and others?
If yes, and this child is 2-5 Years:
Did the questionnaire ask about your concerns or observations
about:
Mark (X) ALL that apply.
Words and phrases this child uses and understands?
How this child behaves and gets along with you and others?

NSCH-T1,
NSCH-T2, &
NSCH-T3

Section C

C9 (T1,
T2) C10
(T3)

C9 (T1, T2) C10
(T3)

If yes, where does this child USUALLY go first?
(X) ONE box.
Doctor’s Office
Hospital Emergency Room
Hospital Outpatient Department
Clinic or Health Center
Retail Store Clinic or “Minute Clinic”
School (Nurse’s Office, Athletic Trainer’s Office)
Some other place

2

Mark

about observations or concerns you may have about this child’s
development, communication, or social behaviors? Sometimes a
child’s doctor or other health care provider will ask a parent to do
this at home or during a child’s visit.
If yes, AND this child is 9-23 Months:
Did the questionnaire ask about your concerns or
observations about:
Mark (X) ALL that apply.
How this child talks or makes speech sounds?
How this child interacts with you and others?
If yes, AND this child is 2-5 Years:
Did the questionnaire ask about your concerns or
observations about:
Mark (X) ALL that apply.
Words and phrases this child uses and understands?
How this child behaves and gets along with you and

others?
[If yes,] Where does this child USUALLY go first?
Mark (X) ONE box.

Doctor’s Office
Hospital Emergency Room
Hospital Outpatient Department
Urgent Care Center
Clinic or Health Center
Retail Store Clinic or “Minute Clinic”
School (Nurse’s Office, Athletic Trainer’s Office)
Some other place

Questionnaire

Section

Item
Number
(2020)

Item Number
(2021) & MT
number

2020 Content

2021 Revised Content
(Rationale)

NSCH-T1,
NSCH-T2, &
NSCH-T3

Section C

C12 (T1)

C12 (T1)

DURING THE PAST 12 MONTHS, has this child had their vision tested, such as
with pictures, shapes, or letters?
Yes
No ➔ SKIP to question C14

Has this child EVER received a vision screening from a provider
other than an eye doctor? The screening could have occurred at a
pediatrician’s office, in a school, preschool/child care center, or
community setting, using pictures, shapes, letters, or a camera
like tool.
Yes
No

NSCH-T1

Section C

N/A

C12a (T1)

NSCH-T1

Section C

C13 (T1)

C13 (T1)

NSCH-T1

Section C

C13 (T1)

C13 (T1)

[If yes,] Was it recommended that this child see an eye doctor or
other eye care provider for an eye examination or additional
vision services as a result of the vision screening? An eye doctor
may be referred to as an optometrist or ophthalmologist.
Yes
No
If yes, where was this child’s vision tested?
ALL that apply.
or eye specialist (ophthalmologist, optometrist) office
Pediatrician or other general doctor’s office
Clinic or health center
School
Other, specify:

Mark (X)
Eye doctor

Has this child EVER seen an eye doctor? An eye doctor may be
referred to as an optometrist or ophthalmologist.
Yes
No

[If yes,] What care has this child received from the eye doctor?
Mark (X) ALL that apply.
Received eye examination
Prescribed eyeglasses or contact lenses

3

Questionnaire

Section

Item
Number
(2020)

Item Number
(2021) & MT
number

2020 Content

2021 Revised Content
(Rationale)
Diagnosis of a vision disorder other than nearsighted,
farsighted, or astigmatism

NSCH-T2, &
NSCH-T3

Section C

C12 (T2),
C13(T3)

C12 (T2),
C13(T3)

NSCH-T2, &
NSCH-T3

Section C

N/A

C12a (T2), C13a
(T3)

NSCH-T2, &
NSCH-T3

Section C

C13 (T2),
C14(T3)

C13 (T2),
C14(T3)

NSCH-T2, &
NSCH-T3

Section C

C13a
(T2),
C14a (T3)

C13a (T2), C14a
(T3)

DURING THE PAST 12 MONTHS, has this child had their vision tested, such as
with pictures, shapes, or letters?
Yes
No ➔ SKIP to question C14

If yes, where was this child’s vision tested?
ALL that apply.
or eye specialist (ophthalmologist, optometrist) office
Pediatrician or other general doctor’s office
Clinic or health center
School
Other, specify:

Mark (X)
Eye doctor

Some other care
DURING THE PAST 2 YEARS, has this child received a vision
screening from a care provider other than an eye doctor? The
screening could have occurred at a pediatrician’s office, in a
school, preschool/child care center, or a community setting using
pictures, shapes, letters, or a camera like tool.
[If yes,] Was it recommended that this child see an eye doctor or
other eye care provider for an eye examination or additional
vision services as a result of the vision screening? An eye doctor
may be referred to as an optometrist or ophthalmologist.
Yes
No
DURING THE PAST 2 YEARS, has this child seen an eye doctor? An
eye doctor may be referred to as an optometrist or
ophthalmologist.
Yes
No
[If yes,] What care has this child received from the eye doctor?
Mark (X) ALL that apply.
Received eye examination
Prescribed eyeglasses or contact lenses
Diagnosis of a vision disorder other than nearsighted,
farsighted, or astigmatism

4

Questionnaire

Section

Item
Number
(2020)

Item Number
(2021) & MT
number

2020 Content

2021 Revised Content
(Rationale)
Some other care

NSCH-T1,
NSCH-T2, &
NSCH-T3

Section C

C14 (T1,
T2),
C15(T3)

C14 (T1, T2),
C15(T3)

NSCH-T1

Section
H (ages
1-5)

N/A

H7

NSCH-T1

Section
H(ages
1-5)

N/A

H8

DURING THE PAST 12 MONTHS, did this child see a dentist or other oral
health care provider for any kind of dental or oral health care?
Yes, saw a dentist
Yes, saw other oral health care provider
No ➔ SKIP to question [insert question #]

DURING THE PAST 12 MONTHS, did this child see a dentist or
other oral health care provider for any kind of dental or oral
health care?
Mark (X) ALL that apply.
Yes, saw a dentist
Yes, saw other oral health care provider
No ➔ SKIP to question [insert question #]
DURING THE PAST WEEK, how many times did this child drink
sugary drinks such as soda, fruit drinks, sports drinks, or sweet
tea? Do not include 100% fruit juice.
This child did not drink sugary drinks
1-3 times during the past week
4-6 times during the past week
1 time per day
2 times per day
3 or more times per day
DURING THE PAST WEEK, how many times did this child eat
vegetables? Include any that were fresh, frozen, or canned. Do
not include French fries, fried potatoes, or potato chips.
This child did not eat vegetables
1-3 times during the past week
4-6 times during the past week
1 time per day
2 times per day

5

Questionnaire

Section

Item
Number
(2020)

Item Number
(2021) & MT
number

2020 Content

2021 Revised Content
(Rationale)
3 or more times per day

NSCH-T1

Section
H(ages
1-5)

N/A

H9

DURING THE PAST WEEK, how many times did this child eat fruit?
Include any that were fresh, frozen, canned, or dried. Do not
include juice.
This child did not eat fruit
1-3 times during the past week
4-6 times during the past week
1 time per day
2 times per day
3 or more times per day

NSCH-T1

Section
H (ages
3-5)

N/A

H10

ON MOST WEEKDAYS, how much time does this child spend
playing outdoors? Include time spent playing in your yard or
neighborhood, outside at school or child care, in a park,
playground or other outdoor recreation area. Your best estimate
is fine.
Less than 1 hour per day
1 hour per day
2 hours per day
3 hours per day
4 or more hours per day

NSCH-T1

Section
H
(ages 35)

N/A

H11

ON AN AVERAGE WEEKEND DAY, how much time does this child
spend playing outdoors? Include time spent playing in your yard
or neighborhood, in a park, playground or other outdoor
recreation area. Your best estimate is fine.
Less than 1 hour per day
1 hour per day
6

Questionnaire

Section

Item
Number
(2020)

Item Number
(2021) & MT
number

2020 Content

2021 Revised Content
(Rationale)
2 hours per day
3 hours per day
4 or more hours per day

NSCH-T1

Section I

I9

I9

To the best of your knowledge, has this child EVER experienced any of the
following?
A. Parent or guardian divorced or separated
B. Parent or guardian died
C. Parent or guardian served time in jail
D. Saw or heard parents or adults slap, hit, kick, punch one another in
the home
E. Was a victim of violence or witnessed violence in their
neighborhood
F. Lived with anyone who was mentally ill, suicidal, or severely
depressed
G. Lived with anyone who had a problem with alcohol or drugs
H. Treated or judged unfairly because of their race or ethnic group

NSCH-T2 &
NSCH-T3

Section I

I10

I10

To the best of your knowledge, has this child EVER experienced any of the
following?
A. Parent or guardian divorced or separated
B. Parent or guardian died
C. Parent or guardian served time in jail
D. Saw or heard parents or adults slap, hit, kick, punch one another in
the home
E. Was a victim of violence or witnessed violence in their
neighborhood
7

To the best of your knowledge, has this child EVER experienced
any of the following?
A. Parent or guardian divorced or separated
B. Parent or guardian died
C. Parent or guardian served time in jail or prison
D. Saw or heard parents or adults slap, hit, kick, punch one
another in the home
E. Was a victim of violence or witnessed violence in their
neighborhood
F. Lived with anyone who was mentally ill, suicidal, or
severely depressed
G. Lived with anyone who had a problem with alcohol or
drugs
H. Treated or judged unfairly because of their race or ethnic
group
I. Treated or judged unfairly because of a health condition
or disability
To the best of your knowledge, has this child EVER experienced
any of the following?
A. Parent or guardian divorced or separated
B. Parent or guardian died
C. Parent or guardian served time in jail or prison
D. Saw or heard parents or adults slap, hit, kick, punch one
another in the home
E. Was a victim of violence or witnessed violence in their
neighborhood

Questionnaire

Section

Item
Number
(2020)

Item Number
(2021) & MT
number

2020 Content

2021 Revised Content
(Rationale)

F. Lived with anyone who was mentally ill, suicidal, or severely
depressed
G. Lived with anyone who had a problem with alcohol or drugs
H. Treated or judged unfairly because of their race or ethnic group
I. Treated or judged unfairly because of their sexual orientation or
gender identity

F. Lived with anyone who was mentally ill, suicidal, or
severely depressed
G. Lived with anyone who had a problem with alcohol or
drugs
H. Treated or judged unfairly because of their race or ethnic
group
I. Treated or judged unfairly because of their sexual
orientation or gender identity
J. Treated or judged unfairly because of a health condition
or disability
DURING THE PAST 12 MONTHS, has this child had any health care
visits by video or phone?
Yes
No

NSCH-T1, T2
& NSCH-T3

Section I

?

NSCH-T1, T2
& NSCH-T3

Section I

?a

[If yes] Were any of this child’s health care visits by video or
phone because of the coronavirus pandemic?
Yes
No

NSCH-T1, T2
& NSCH-T3

Section I

?

DURING THE PAST 12 MONTHS, did this child miss, delay or skip
any PREVENTIVE check-ups because of the coronavirus
pandemic?
Yes
No

NSCH-T1

Section I

?

DURING THE PAST 12 MONTHS, has this child’s regular daycare or
other childcare arrangement been closed or unavailable at any
time because of the coronavirus pandemic?
Yes
No
8

Questionnaire

Section

NSCH-T2

Section I

Item
Number
(2020)

Item Number
(2021) & MT
number
?

2020 Content

2021 Revised Content
(Rationale)
DURING THE PAST 12 MONTHS, have any of this child’s regular
childcare arrangements been closed or unavailable at any time
because of the coronavirus pandemic? Please include before
school care, after school care, and all other forms of childcare
that were unavailable.
Yes
No

9