Form Structure: National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire
Short Name:
NHANESCSQ
Description:
The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The NHANES is a major part of the National Center for Health Statistics (NCHS) which is part of the Center for Disease Control (CDC). The NHANES interview includes demographic, socioeconomic, dietary, and health-related questions. The examination component consists of medical, dental, and physiological measurements, as well as laboratory tests administered by highly trained medical personnel.References: Centers for Disease Control and Prevention (CDC) 2013-2014. https://www.cdc.gov/nchs/data/nhanes/nhanes_13_14/CSQ_H.pdf
Disease:
Traumatic Brain Injury
General (For all diseases)
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-10-24
Owner:
Number of Data Elements:
45
eForms:
N
Logically grouped data elements with defined frequency at which they repeat.
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | GUID | Global Unique ID which uniquely identifies a subject | GUID | Required | CDE |
| 2 | Subject identifier number | An identification number assigned to the participant/subject within a given protocol or a study. | SubjectIDNum | Optional | CDE |
| 3 | Age in years | Value for participant's subject age recorded in years. | AgeYrs | Recommended | CDE |
| 4 | Vital status | Status of participant/subject as alive or dead | VitStatus | Optional | CDE |
| 5 | Visit date | Actual interview or visit date | VisitDate | Recommended | CDE |
| 6 | Site name | The name of the site for the study | SiteName | Recommended | CDE |
| 7 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Optional | CDE |
| 8 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Optional | CDE |
| 9 | General notes text | General notes | GeneralNotesTxt | Optional | CDE |
Additional Element Groups
Listed below are your additional element groups.
Form Administration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Language form administration ISO code | Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration | LangCRFAdministratISOCode | Recommended | CDE |
| 2 | Language form administration ISO code other text | The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. | LangCRFAdministratISOCodeOTH | Recommended | CDE |
| 3 | Context type | The context to which the questions were answered | ContextType | Recommended | CDE |
| 4 | Context type other text | The free-text related to ContextType specifying other text | ContextTypeOTH | Recommended | CDE |
| 5 | Data source | Source of the data provided on the case report form | DataSource | Recommended | CDE |
| 6 | Data source other text | The free-text field related to Data source specifying other text. Source of the data provided on the case report form | DataSourceOTH | Recommended | CDE |
NHANES CSQ (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system smell difficulty indicator | Indicator that the participant has had a problem, including loss of smell and things not smelling the way they should, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQChemoSysSmeDiffInd | Recommended | CDE |
| 2 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system smell comparison difficulty condition type | Type of condition of the participant's smelling abilities compared to his or her smelling abilities when he or she was 25 years old, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSmeCompDiffCondTyp | Recommended | CDE |
| 3 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system non unpleasant smell bother indicator | Indicates that certain smells bother the participant even though these smells do not seem to bother other people, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysNUnpSmeBothInd | Recommended | CDE |
| 4 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system absent smell bother indicator | Indicates that the participant smells unpleasant, bad, or burning smells/odors when there are no such smells present, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysAbsSmeBothInd | Recommended | CDE |
| 5 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system smell first notice problem code | Code representing the time at which the participant first noticed a problem in his or her ability to smell, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysSme1stNoProCode | Recommended | CDE |
| 6 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system smell problem constant type | The type of problem the participant has with smell, whether it is constant or comes and goes, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysSmeProbConsTyp | Recommended | CDE |
| 7 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste difficulty indicator | Indicates whether or not the participant has had a problem with his or her ability to taste certain flavors or items within the last 12 months, as a part of the NHANES-CSQ | NHANESCSQCheSysTasteDiffInd | Recommended | CDE |
| 8 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste comparison difficulty type | Type of response for the participant's tasting abilities compared to his or her tasting abilities when he or she was 25 years old, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysTasCompDiffTyp | Recommended | CDE |
| 9 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste comparison salt difficulty status | Type of condition of the participant's tasting abilities compared to his or her tasting abilities when he or she was 25 years old in question a, as a part of the NHANES-CSQ | NHANESCSQCheTasCoSalDifCondTyp | Recommended | CDE |
| 10 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste comparison sour difficulty condition type | Type of condition of the participant's tasting abilities compared to when he or she was 25 years old in question b, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheTasCoSouDifCondTyp | Recommended | CDE |
| 11 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste comparison sweet difficulty condition type | Type of condition of the participant's tasting abilities compared to when he or she was 25 years old in question c, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheTasCoSweDifConTyp | Recommended | CDE |
| 12 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste comparison bitter difficulty condition type | Type of condition of the participant's tasting abilities compared to when he or she was 25 years old in question d, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysTasCoBitCondTyp | Recommended | CDE |
| 13 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste flavor difficulty indicator | Indicates whether or not the participant can taste chocolate, vanilla, or strawberry is currently as good as it was 25 years ago, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysTasFlavDiffInd | Recommended | CDE |
| 14 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste persistence indicator | Indicates whether or not the participant has had a taste or other sensation in his or her mouth that would not go away, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysTastePersInd | Recommended | CDE |
| 15 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste persistence description code | Describes the taste or sensation that would not go away, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysTasPersDescCode | Recommended | CDE |
| 16 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste first notice problem type | Denotes how long ago the participant first noticed the problem with his or her taste, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysTas1stNotProTyp | Recommended | CDE |
| 17 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste smell discuss problem indicator | Indicates whether or not the participant has ever discussed the problem or change in his or her smell or taste with some sort of health care provider, as a part of the NHANES-CSQ | NHANESCSQCheSysTasSmeDisProInd | Recommended | CDE |
| 18 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste smell problem last discuss type | Denotes how long ago was the last time that the participant discussed the problem or change in his or her smell or taste with a health care provider, as a part of the NHANES-CSQ | NHANESCSQCheSysTasSmeProDisTyp | Recommended | CDE |
| 19 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste smell treatment indicator | Indicates whether or not the participant has tried to improve his or her ability to smell or taste within the last 12 months, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysTasSmeTreInd | Recommended | CDE |
| 20 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste smell affect life indicator | Indicates whether or not a problem with the participants smell or taste has affected his or her general life, work life, or enjoyment of life within the last 12 months, as a part of the NHANES-CSQ. | NHANESCSQCheSysTasSmeAffLifInd | Recommended | CDE |
| 21 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system head cold indicator | Denotes whether or not, in the past 12 months, the participant has experienced a head cold or flu for longer than a month, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysHeadColdInd | Recommended | CDE |
| 22 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system dry mouth indicator | Denotes whether or not, in the past 12 months, the participant has experienced persistent dry mouth, or lack or saliva, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysDryMouInd | Recommended | CDE |
| 23 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system nasal congestion indicator | Denotes whether or not, in the past 12 months, the participant has experienced frequent nasal congestion from allergies, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysNasConInd | Recommended | CDE |
| 24 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system ear infection indicator | Indicates whether or not the participant has experienced 3 or more ear infection in his or her entire life, including childhood, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysEarInfInd | Recommended | CDE |
| 25 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system drain ear fluid indicator | Indicates whether or not the participant has ever had a tube placed in his or her ear in order to drain fluid from it, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysDraEarFluInd | Recommended | CDE |
| 26 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system procedure injury wisdom teeth indicator | Indicates whether or not the participant has ever had his or her wisdom teeth removed, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysProInjWTeeInd | Recommended | CDE |
| 27 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system procedure injury tonsil indicator | Indicates whether or not the participant has ever had his or her tonsils removed, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysProcInjTonsInd | Recommended | CDE |
| 28 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system procedure injury head injury indicator | Indicates whether or not the participant has ever experienced a loss of consciousness because of a head injury, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysProInjHeaInjInd | Recommended | CDE |
| 29 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system procedure injury face skull injury indicator | Indicates whether or not the participant has ever experienced a broken nose or other serious injury to the face or skull, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysProInjFSInjInd | Recommended | CDE |
| 30 | National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system procedure injury sinus infection indicator | Indicates whether or not the participant has ever had two or more sinus infections, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). | NHANESCSQCheSysProInjSinInfInd | Recommended | CDE |
Keywords
