COVID-19 OBSSR Research Tools

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COVID-19 OBSSR Research ToolsThe table below lists and links to data collection instruments, including surveys, for assessing COVID-19-relevant Behavioral and Social Science (BSSR) domainsfor clinical or population research. The NIH Office of Behavioral and Social Sciences Research (OBSSR) has compiled this list, with assistance from the NIHDisaster Research program (DR2). DR2 is a collaborative effort by the National Institute of Environmental Health Sciences and the National Library of Medicine(NLM) that aims to improve our nation’s capabilities for performing timely environmental health research in response to emerging threats and disasters. OBSSRhas selected these instruments using the expertise of its staff and based on the high credibility of tool sources. However, NIH does not endorse any specificinstrument as best practice for development, testing, or validation. Researchers are encouraged to test instruments (e.g., cognitive testing, pilot testing) beforefielding them in their studies, to the extent possible in this rapidly evolving COVID-19 research landscape. For questions related to specific instruments, sourcecontact information is provided (where available).Additional research tools can be found by searching for various keywords of interest in the results of this targeted search for COVID-19 research tools in NLM’sDisaster Lit database.The Database ID Number links to full descriptive information about each tool. Instrument Name links provide direct access to tools and surveys.Database IDNumber(full record)Instrument Name(access to tool)ID:22204Obsession with COVID-19-ScaleQuestion Areas Included in Instrument Obsession with Covid-19Source InformationChristopher Newport UniversityDr. Sherman Leesherman.lee@cnu.eduID:22203Coronavirus Anxiety Scale Anxiety due to Covid19Christopher Newport UniversityDr. Sherman Leesherman.lee@cnu.eduID:22198Psychological Stress Associated with the COVID-19 CrisisCOVID-19 OBSSR Research Tools COVID-19 related Lifestyle Change(work, sleep, school, testing positive,family, exercise)Stanford UniversityDr. Maheen Mausoof Adamsonmadamson@stanford.eduMay 14, 2020

Database IDNumber(full record)Instrument Name(access to tool)ID: 22126COVID-19 Impact on Health and Wellbeing Survey- English COVID-19 related DepressionCOVID-19 Impact on Health and Wellbeing Survey - Spanish COVID-19 related AnxietyDescription of Topics in Survey COVID-19 related StressStudy Sample InformationQuestion Areas Included in Instrument COVID-19 related Health literacySource InformationUniversity of Texas Rio GrandeValleyCandace Robledo, PhD, MPHcandace.robledo@utrgv.edu COVID-19 related Trusted sources ofinformationUniversity of Texas Rio GrandeValley COVID-19 related ComplianceJay Morrow, DVM, MPH COVID-19 related Financial stressjay.morrow@utrgv.edu COVID-19 related Physical activityCOVID-19 OBSSR Research ToolsMay 14, 2020

Database IDNumber(full record)Instrument Name(access to tool)ID: 22130COVID-19: Impact of the Pandemic and HRQoL in CancerPatients and Survivors (IPHCPS) questionnaireQuestion Areas Included in Instrument COVID-19 Specific Distress (Emotionaland Physical Reactions) —emotionaland physical impact of the COVID-19pandemic Health Care Disruptions and Concerns(Concerns About Medical Care) —howthe COVID-19 pandemic has impactedgeneral and cancer related care, as wellas health care concerns specific to thepandemicSource InformationDepartments of Psychology andMedicine, University of Miami /Sylvester Comprehensive CancerCenterFrank J. Penedo, PhDfrank.penedo@miami.edu Disruption to Daily Activities and SocialInteractions–how the pandemic hasimpacted routines, social activities andinteractions Financial Hardship—how the COVID-19pandemic has affected finances andcreated and/or exacerbated financialhardships Perceived Benefits—how experienceswith the pandemic has led to anyperceived benefit or positivecontribution Functional Social Support—availabilityand use of social resources during thepandemic Perceived Stress Management (Abilityto Manage Stress) —ability toimplement skills to manage pandemicrelated stressorsCOVID-19 OBSSR Research ToolsMay 14, 2020

Database IDNumber(full record)Instrument Name(access to tool)ID: 22131COVID-19: Well-Being and HRQoL in Cancer Patients andSurvivors protocolQuestion Areas Included in Instrument N/A (not an instrument)Source InformationDepartments of Psychology andMedicine, University of Miami /Sylvester Comprehensive CancerCenterFrank J. Penedo, PhDfrank.penedo@miami.eduID: 22127Telling our stories in the age of COVID-19 COVID-19 Situational and ContextualfactorsCornell University COVID-19 Regional restriction statusJlw43@cornell.eduJanis Whitlock, MPH, PhD COVID-19 Concerns about health,finances, and overall impact COVID-19 health status COVID-19 impactID: 22100COPD Gene COVID-19 Survey COVID-19 Symptoms and RecoveryJames Crapo, MDjdc@crapodenver.comEdwin Silverman, MDreeks@channing.harvard.eduID: 22098Longitudinal Aging Study in India – Diagnostic Assessment ofDementia (LASI-DAD) Genomics Study: Monitoring the Health andSocioeconomic Impacts of COVID-19COVID-19 OBSSR Research Tools Coronavirus-related knowledge andbehaviors COVID-19 and Heath care and food security COVID-19 and Economic Effects COVID-19 and Discrimination and (mis)information COVID-19 and Mental Health, coping andwellbeingHelp@lasi-dad.orgMay 14, 2020

Database IDNumber(full record)Instrument Name(access to tool)ID: 22096JHU COVID-19 Community Response SurveyID: 22039Cyber-Abuse Research Initiative (CARI) COVID-19 Impact on DomesticAbuseQuestion Areas Included in InstrumentSource Information Knowledge and attitudes toward COVID19 COVID-19 symptoms and testing experience COVID-19 and Co-morbidities and careengagement COVID-19 and Mental health impacts COVID-19 impact and pandemic stress COVID-19 and Social distancing COVID-19 and Violence and trauma COVID-19 and Substance use COVID-19 and Sexual behaviorJohns Hopkins Bloomberg Schoolof Public Health Domestic Violence victimization andperpetration during COVID-19 Help-seeking and fear of violence duringCOVID-19Elizabeth MumfordShruti Mehta, PhD, MPHsmehta@jhu.eduMumford-Elizabeth@norc.orgEmily Rothmanerothman@bu.eduID: 22038Healthcare Worker Exposure Response & Outcomes (HERO)HERO: Daily Impact IndexHERO: Registry Protective Equipment SurveyHERO daily impact index (PI-designatedconcepts measured) Emily O’Brienemily.obrien@duke.eduSleep disturbancePainAnxietyDepressive symptomsStressAngerFatigueRegistry Protective Equipment Survey PPE surveyID: 22036All of Us COVID-19 Participant Experience Survey (COPE)COVID-19 OBSSR Research Tools COVID-19 Social Distancing ExperiencesCOVID-19 Related SymptomsCOVID-19 Related TestingCOVID-19 Related TreatmentCOVID-19 Related ImpactHolly Garriockholly.garriock@nih.govMay 14, 2020

Database IDNumber(full record)Instrument Name(access to tool)ID: 22037COVID-19 Adolescent Symptom & Psychological ExperienceQuestionnaire (CASPE)COVID-19 Adolescent Symptom & Psychological ExperienceQuestionnaire (CASPE) - PARENTID:22014ID: 21648Household Pulse QuestionnaireCOVID Symptom Tracker: COPE (COronavirus PandemicEpidemiology) Consortium IRB Tool KitCOVID-19 Symptom Tracker App QuestionsCOVID-19 Symptom Tracker Mobile App for AppleQuestion Areas Included in InstrumentSource Information General experience related to COVID andsocial distancing Emotional experience related to COVID andsocial distancing Cognitive experience related to COVID andsocial distancing Social experience related to COVID andsocial distancingCecile D. Ladouceur, PhD COVID-19 and employment COVID-19 and food security COVID-19 and health (mental health, healthinsurance coverage, and access to car) COVID-19 and housing security COVID-19 and education disruptionCassandra Logan, SurveyDirector, US Census COVID-19 Use of Personal ProtectiveEquipment (PPE) COVID-19 Symptoms COVID-19 Related exposure and use of PPEMassachusetts General Hospital COVID-19 diagnosis as it may relate tosense of smell COVID-19 diagnosis as it may relate to thesense of taste. COVID-19 recovery on the experience ofsmell and taste.Monell Chemical Senses Center COVID-19 Symptoms, testing, andpreventive behaviors COVID-19 Impact on daily life COVID-19 Psychosocial impactJohns Hopkins us.govAndrew T. Chanpredict@mgh.harvard.eduCOVID-19 Symptom Tracker Mobile App for Android/GoogleID: 22013ID: 22040Global Consortium for Chemosensory Research COVID-19 Survey(GCCR)Multicenter AID Cohort Study (MACS)/ Women’s Interagency HIVStudy (WIHS) Combined Cohort Study (MWCCS)Baseline COVID-19 Abbreviated Questionnaire (BLCOVID) – EnglishBaseline COVID-19 Abbreviated Questionnaire (BLCOVID) – SpanishDanielle Reedreed@monell.orgChristine Aldencalden@jhu.eduCOVID-19 Ascertainment Tracking Checklist (COVID ATC) – EnglishGuidance for Symptom Severity QB1 on BLCOVIDMACS/WIHS COVID-19 Survey ProtocolMACS/WIHS COVID-19 Abbreviated Questionnaire: ReferencesCOVID-19 OBSSR Research ToolsMay 14, 2020

Database IDNumber(full record)Instrument Name(access to tool)ID: 22041COVID-19 Exposure and Family Impact Survey (CEFIS) – EnglishCOVID-19 Exposure and Family Impact Survey (CEFIS) – SpanishQuestion Areas Included in Instrument COVID-19 Family Exposure COVID-19 Family ImpactSource InformationNemours Children’s HealthCenterAnne KazakAnne.Kazak@nemours.orgID: 21923ID: 21877CAIR (Complementary and Integrative Research Lab) PandemicImpact Questionnaire (C-PIQ)COVID-19 Household Environment Scale (CHES) - EnglishCOVID-19 Household Environment Scale (CHES) - SpanishID: 21876COVID-19 Cannabis Health Questionnaire (CCHQ) - EnglishCOVID-19 Cannabis Health Questionnaire (CCHQ) - SpanishCOVID-19 OBSSR Research Tools COVID-19 Health Impacts COVID-19 Negative Social and BehavioralImpacts COVID-19 Mental health impact COVID-19 Impact on Sleep COVID-19 Positive ImpactsUniversity of California, SanDiego COVID-19 Social Distancing and Symptoms COVID-19 on Family Conflict COVID-19 on Family TogethernessUniversity of Miami University of MiamiCOVID-19 & ComorbiditiesCOVID-19 & Cannabis UseEconomic Impact of COVID-19COVID-19 Symptoms, Diagnoses & TestingWorry about COVID-19 Infection COVID-19& Mental Health Coping Strategies COVID-19Dr. Ariel J. Langajlang@health.ucsd.eduDr. Victoria Behar-ZusmanVbehar-zusman@miami.eduDr. Denise Vidotdvidot@med.miami.eduMay 14, 2020

Database IDNumber(full record)Instrument Name(access to tool)Question Areas Included in InstrumentSource InformationID: 21878COVID-19 and Perinatal Experiences (COPE) StudyCOPE-ISNYU Langone HealthCoronavirus Perinatal Experiences Impact Survey (COPE-IS)Coronavirus Perinatal Experiences Impact Update (COPE-IU) Prenatal experiences of COVID-19(pregnant women) Perinatal experiences of COVID-19(postpartum women) Exposures and symptoms Financial impacts Social support impacts Social distancing and restricted activities Coping and adjustment Emotional impact Health background, mental health, andsubstance use DemographicsDr. Moriah ThomasonMoriah.thomason@nyulangone.orgCOPE-IU Exposures and Symptoms Impact on daily life, experiences, andfeelingsID: 21875Pandemic Stress Index (PSI) - EnglishPandemic Stress Index (PSI) - SpanishID: 21767CoRonavIruS Health Impact Survey (CRISIS)Adult Self-Report Baseline FormAdult Self-Report Follow Up FormParent/Caregiver Baseline FormParent/Caregiver Follow Up FormYouth Self-Report Baseline FormYouth Self-Report Follow Up FormLink to all forms & background materialCOVID-19 OBSSR Research Tools Behavior Change Overall Impact on Participants’ lives StressorsUniversity of Miami Coronavirus/covid-19 health/exposurestatus Life changes due to coronavirus/covid-19crisis Daily behaviors during covid-19 Emotions/worries during covid-19 Media use (e.g., mobile devices, media,etc.) during covid-19 Substance use (e.g., tobacco, alcohol, otherdrugs) during covid-19National Institute of MentalHealth Intramural ResearchProgram Mood SpectrumCollaborationDr. Audrey Harnessaharkness@miami.eduDr. Kathleen Merikangasmerikank@mail.nih.govMay 14, 2020

Database IDNumber(full record)Instrument Name(access to tool)ID: 21768Fear of COVID-19 ScaleQuestion Areas Included in Instrument Fear of COVID-19Source InformationNottingham Trent UniversityDr. Mark GriffithsMark.Griffiths@ntu.ac.ukID: 21769Epidemic-Pandemic Impacts Inventory (EPII) - EnglishEpidemic-Pandemic Impacts Inventory (EPII) - SpanishID: 21805NIH Environmental Influences on Child Health Outcomes(ECHO)ECHO COVID-19 Questionnaire Adult Primary Version Form C19-aPVECHO COVID-19 Questionnaire Adult Alternate Version Form C19-aAVECHO COVID-19 Questionnaire Child-Parent Report Form C19-cPRECHO COVID-19 Questionnaire Child Self-Report Alternate VersionForm C19-cAVECHO COVID-19 Questionnaire Child Self-Report Primary VersionForm C19-cPV Impact of COVID-19 on Work andEmployment Impact of COVID-19 on Education andTraining Impact of COVID-19 on Home Life Impact of COVID-19 on Social Activities Impact of COVID-19 on Economic Activities Impact of COVID-19 on Emotional Healthand Well-Being Impact of COVID-19 on Physical HealthProblems Impact of COVID-19 on Physical Distancingand Quarantine COVID-19 Diagnosis/Symptoms Impact of COVID-19 on Positive ChangeAdult Versions (primary and alternative) COVID-19 Infection Impacts of the COVID-19 Outbreak on You Impacts of the COVID-19 Outbreak onPregnancy – Current Impacts of the COVID-19 Outbreak onPregnancy – RecallUniversity of Connecticut Schoolof MedicineDr. Damion Grassodgrasso@uchc.eduDuke UniversityDr. Brian SmithEchocc@duke.eduECHO COVID-19 QuestionnaireCover Page and ReferencesChild Self-Report Versions (primary andalternative) COVID-19 Infection Impacts of the COVID-19 Outbreak on YouChild Parent-Report Version COVID-19 Infection Impacts of the COVID-19 Outbreak on theChild Enrolled in ECHOCOVID-19 OBSSR Research ToolsMay 14, 2020

Database IDNumber(full record)Instrument Name(access to tool)ID: 21816Coronavirus Impact Scale – EnglishQuestion Areas Included in Instrument How Covid-19 has changed your lifeCoronavirus Impact Scale – SpanishSource InformationResearch Center for Child andFamily Traumatic Stress KennedyKrieger InstituteDr. Joan Kaufmanjoan.kaufman@kennedykrieger.orgUniversity of Colorado AnschutzMedical CampusDr. Joel Stoddardjoel.stoddard@cuanschutz.eduID: 21817KSADS-COPM with COVID-specific PTSD Trauma Screen Items Q02. A significant accident or medicalcondition, including coronavirus, for whichyou needed specialized, intensive, orpainful medical treatment. Q17. Learned about the life-threateningillness or sudden unexpected death of aloved one due to coronavirus, cancer,violence, or other causeResearch Center for Child andFamily Traumatic Stress KennedyKrieger InstituteDr. Joan Kaufmanjoan.kaufman@kennedykrieger.orgUniversity of Colorado AnschutzMedical CampusDr. Joel Stoddardjoel.stoddard@cuanschutz.eduID: 21818Pennington Biomedical COVID-19 SurveyCOVID-19 OBSSR Research Tools Regional Social Distancing COVID-19Mandates Impacts of COVID-19 on Food Security Worry about COVID-19 Infection Impacts of COVID-19 on Employment Impacts of COVID-19 on Changes toPhysical Activity and Sedentary Behaviors Impacts of COVID-19 on Dietary Changes Impacts of COVID-19 on Sleep Changes Impacts of COVID-19 on Well-BeingPennington Biomedical ResearchCenterDr. Leanne RedmanLeanne.redman@pbrc.eduMay 14, 2020

Database IDNumber(full record)Instrument Name(access to tool)ID: 21725The Multi-Ethnic Study of Atherosclerosis (MESA)’s Covid-19QuestionnaireID: 21726ID: 21681Question Areas Included in InstrumentSource Information Covid-19 Diagnosis and Testing Covid-18 Symptoms and Medicine Covid-19 Social DistancingMesa Coordinating CenterSocial Psychological Measurements of COVID-19: CoronavirusPerceived Threat, Government response, Impacts, and ExperiencesQuestionnaires Perceived Coronavirus Threat Qx Federal Governmental Response toCoronavirus Qx State Governmental Response toCoronavirus Qx City Governmental Response toCoronavirus Qx Coronavirus Impacts Qx Coronavirus Experiences Qx Perceived Coronavirus Threat Qx (Short) Governmental Response to Coronavirus Qx(Short) Coronavirus Impacts Qx (Short) Coronavirus Experiences Qx (Short)Dr. Lucian Gideon Conway, IIIQuestionnaire for Assessing the Impact of the COVID-19 Pandemicand Accompanying Mitigation Efforts on Older Adults (QAICPOA) COVID Diagnosis COVID Social Distancing and its ImpactDr. Peggy Cawthon,Mr. Craig Johnsonwcraigj@uw.eduUniversity of Montanaluke.conway@umontana.eduUniversity of California SanFranciscopcawthon@sfcc-cpmc.netID: 21680International COVID-19 Awareness and Responses Evaluation StudyCOVID-19 OBSSR Research Tools SociodemographicsHygiene and Social DistancingConcerns of InfectionWhere do you get COVID-19 InformationCurrent Health ConditionsCurrent Health BehaviorsMontreal Behavioural MedicineCentreDr. Kim Lavoiekim.lavoie@mbmc-cmcm.caDr. Simon Bacon simon.bacon@mbmc-cmcm.caMay 14, 2020

Database IDNumber(full record)Instrument Name(access to tool)ID: 21678Human Infection with 2019 Novel Coronavirus Person UnderInvestigation (PUI) and Case Report FormID: 21527CDC COVID-19 Community Survey Question Bank (DRAFT)(Note: This draft question bank contains potential questions forcommunity surveys and is offered by the CDC to interestedresearchers. It is not an official CDC form or data collectioninstrument)Question Areas Included in Instrument Interviewer Information Basic Information Symptoms, Clinical Course, Past Medicaland Social History Respiratory Diagnostic Testing Specimens for COVID-19 TestingCenters for Disease Control andPrevention (CDC) Useful Demographic CovariatesEpidemiologyCommunity InterventionsSocial Distancing BehaviorsAt-Risk PopulationsLower Priority QuestionsCenters for Disease Control andPrevention (CDC)Data Collector InformationIdentifier InformationSymptom HistoryLaboratory ResultsWorld Health Organization(WHO)ID: 21220Population-Based Age-Stratified Seroepidemiological InvestigationProtocol for COVID-19 Virus Infection ID: 21649Understanding America Study UAS 235: Health Tracking Long SurveyWave 1 COVID-19 Symptoms, Status, andHealthcare COVID-19 Knowledge, Attitudes, andAvoidant Behaviors Mental Health and Substance Use Labor Market Outcomes Economic Insecurity K-12 Education ImpactsUnderstanding America Study UAS 235: Health Tracking Long SurveyWave 2COVID-19 OBSSR Research ToolsSource Informationdsrstat@cdc.govUniversity of Southern CaliforniaMs. Jill Darlingjilldarl@usc.eduMay 14, 2020

Database IDNumber(full record)Instrument Name(access to tool)ID: 20720WHO Novel Coronavirus (nCoV) – Acute Respiratory Infection ClinicalCharacterization Data ToolCOVID-19 OBSSR Research ToolsQuestion Areas Included in Instrument Clinical Inclusion CriteriaEpidemiological FactorsDemographicsCo-morbiditiesOnset & AdmissionSigns and SymptomsPathogen TestingDaily Clinical AssessmentDaily Laboratory velAnimal ExposuresSource InformationInternational Severe AcuteRespiratory and EmergingInfection Consortium (ISARIC)ncov@isaric.orgMay 14, 2020

COVID-19 Mental health impact COVID-19 Impact on Sleep COVID-19 Positive Impacts University of California, San Dr. Ariel J. Lang ajlang@health.ucsd.edu ID: 21877 COVID-19 Household Environment Scale (CHES) - English COVID-19 Household Environment Scale (CHES) - Spanish COVID-19 Social Distancing and Symptoms COVID-19 on Family .

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