Survey Text

2012
2007
2002
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2012
Survey form view entire document:  text  image

QuestionID: ALT.531_00.000

Instrument Variable Name: TP1_COND Adult CAM
QuestionText:
For what health problems, symptoms, or conditions did you {fill1: see a practitioner for/use} {fill2: modality}?
*Enter all that apply, separate with commas.
01 Abdominal pain
02 Acid reflux or heartburn
03 Feeling anxious, nervous or worried
04 Asthma
05 Arthritis
06 Attention Deficit Disorder/Hyperactivity
07 Benign tumors, cysts
08 Bipolar Disorder
09 Birth defect
10 Cancer
11 High Cholesterol
12 Chronic Bronchitis
13 Circulation problems (other than in the legs)
14 Coronary heart disease
15 Dental pain
16 Depression
17 Diabetes
18 Digestive allergy
19 Excessive sleepiness during the day
20 Excessive use of alcohol or tobacco
21 Fatigue or lack of energy more than 3 days
22 Fever more than 1 day
23 Fibromyalgia
24 Fracture, bone/joint injury
25 Gout
26 Gynecologic problem
27 Hay fever
28 Head or chest cold
29 Hearing problem
30 Heart condition or disease, other than coronary heart disease
31 Hernia
32 Hypertension
33 Infectious diseases or problems of the immune system
34 Influenza or pneumonia
35 Insomnia or trouble sleeping
36 Jaw pain
37 Joint pain or stiffness/Other joint condition
38 Knee problems (not arthritis, not joint injury)
39 Liver problem
40 Lung/breathing problem
41 Lupus
42 Memory loss or loss of other cognitive function
43 Menopause
44 Menstrual problems
45 Intellectual disability, also known as mental retardation
46 Missing limbs (fingers, toes or digits), amputee
47 Nausea and/or vomiting
48 Neurological problems
49 Osteoporosis, tendinitis
50 Allergies other than hay fever, respiratory, food, digestive, or skin allergies
51 Chronic pain
52 Other developmental problem
53 Injury other than fracture, bone/joint injury
54 Mental health disorders
55 Muscle or bone pain
56 Nerve damage, including carpal tunnel syndrome
57 Problems with being overweight
58 Phobia or fears
59 Polio (myelitis), paralysis, para/quadriplegia
60 Poor circulation in your legs
61 Prostate trouble or impotence
62 Recurring headache, other than migraine
63 Respiratory allergy
64 Rheumatoid arthritis
65 Senility
66 Sinusitis
67 Eczema or any kind of skin allergy
68 Skin problems, other than eczema or skin allergies
69 Sore throat other than strep or tonsillitis
70 Sprain or strain
71 Frequent stress
72 Strep throat or tonsillitis
73 Substance abuse, other than alcohol or tobacco
74 Filled problem from AFLHCA_S1
75 Filled problem from AFLHCA_S2
76 Ulcer
77 Urinary problems
78 Varicose veins, hemorrhoids
79 Vision problem
80 Weak or failing kidneys
81 COPD
82 Back pain or problem
83 Neck pain or problem
84 Severe headache or migraine
85 Stomach or intestinal illness
86 Other specify
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who have used first of top three modalities and saw a practitioner or used modality for a specific health problem, symptom or condition
SkipInstructions:
(1-86) If TP1_CNT GT 1 [goto TP1_CMST],
else if TP1_CNT=1 [goto TP1_CHLP];
(86) [goto TP1_SPEC];
(R,D) if self-care modality (ALT_TP31 in (6,7,10-16)) [goto TP1_RS5];
else [goto TP1_RS6]
QuestionID: ALT.531_00.010

Instrument Variable Name: TP1_SPEC Adult CAM
QuestionText:
*Enter condition for which [fill1: modality] was used. If respondent gives more than one condition, probe for condition which is most important.
97 Refused
99 Don't Know
Verbatim Verbatim response
UniverseText: Sample adults 18+ who have used first of top three modalities and used modality to treat other health problem or condition
SkipInstructions:
(Allow 75, R,D) If TP1_CNT GT 1 [goto TP1_CMST], elseif TP1_CNT =1 [goto TP1_CHLP];
(R,D) If TP1_CNT=1 and if self-care modality (ALT_TP31 in (6,7,10-16)) [goto TP1_RS5];
else [goto TP1_RS6]

Survey form view entire document:  text  image

Question ID: CAL.531_00.000

Instrument Variable Name: CTP1COND
QuestionText:
For what health problems, symptoms, or conditions did [fill: S.C. name] [fill1: see a practitioner for/use] [fill2: modality]?
*Enter all that apply, separate with commas.
01 Abdominal pain
02 Anemia
03 Feeling anxious, nervous or worried
04 Arthritis
05 Asthma
06 Attention Deficit Hyperactivity Disorder (ADHD)/Attention Deficit Disorder (ADD)
07 Autism/Autism Spectrum Disorder
08 Cerebral palsy
09 Chickenpox
10 High cholesterol
11 Congenital heart disease
12 Constipation
13 Cystic fibrosis
14 Depression
15 Dental pain
16 Diabetes
17 Down syndrome
18 Eczema or skin allergy
19 Excessive sleepiness during the day
20 Fatigue or lack of energy more than 3 days
21 Fever more than 1 day
22 Food or digestive allergy
23 Frequent or repeated diarrhea or colitis
24 Gynecologic problem
25 Hay fever
26 Head or chest cold
27 Hearing problem
28 Hypertension
29 Influenza or pneumonia
30 Insomnia or trouble sleeping
31 Joint pain or stiffness
32 Low back pain
33 Intellectual disability, also known as mental retardation
34 Menstrual problems
35 Migraine headaches
36 Muscular dystrophy
37 Nausea and/or vomiting
38 Neck pain
39 Chronic pain
40 Muscle or bone pain
41 Other developmental delay
42 Heart condition
43 Problems with being overweight
44 Non-migraine headaches
45 Respiratory allergy
46 Seizures
47 Sickle cell anemia
48 Sinusitis
49 Sore throat other than strep or tonsillitis
50 Sprain or strain
51 Strep throat or tonsillitis
52 Frequent stress
53 Stuttering or stammering
54 Three or more ear infections
55 Vision problems
56 Other specify
97 Refused
99 Don't Know
UniverseText: Sample children 4+ who have used first of top three modalities and saw a practitioner or used modality for a
SkipInstructions:
(1-56) If CTP1CNT GT 1 [goto CTP1CMST]
else if CTP1CNT=1 [goto CTP1CHLP];
(56) [goto CTP1SPEC];
(R,D) if self-care modality (CAL_TP31 in (6,7,10-16)) [goto CTP1RS5];
else [goto CTP1RS6]
Question ID: CAL.531_00.010

Instrument Variable Name: CTP1SPEC
QuestionText:
*Enter condition for which [fill1: modality] was used. If respondent gives more than one condition, probe for condition which is most important.
97 Refused
99 Don't Know
Verbatim Verbatim response
UniverseText: Sample children 4+ who have used first of top three modalities and used modality to treat other health problem or condition
SkipInstructions:
(Allow 75,R,D) If CTP1CNT GT 1 [goto CTP1CMST]
else if CTP1CNT=1 [goto CTP1CHLP];
(R,D) If CTP1CNT=1 and if self-care modality (CAL_TP31 in (6,7,10-16)) [goto CTP1RS5];
else [goto CTP1RS6]

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2007
Survey form view entire document:  text  image

Question ID: : ALT.036_00.000

Instrument Variable Name: ACU_COND
Question Text:
?[F1]
For what health problems or conditions did you use acupuncture?
*Enter all that apply, separate with commas.
01 Acid reflux or heartburn
02 Angina
03 Anxiety
04 Asthma
05 Arthritis
06 Attention Deficit Disorder/Hyperactivity
07 Autism
08 Benign tumors, cysts
09 Bipolar Disorder
10 Birth defect
11 Cancer
12 Cholesterol
13 Chronic Bronchitis
14 Circulation problems (other than in the legs)
15 Constipation severe enough to require medication
16 Coronary heart disease
17 Dementia, including Alzheimer's Disease
18 Dental pain
19 Depression
20 Diabetes
21 Emphysema
22 Excessive sleepiness during the day
23 Excessive use of alcohol or tobacco
24 Fibromyalgia
25 Fracture, bone/joint injury
26 Gout
27 Gum disease
28 Gynecologic problem
29 Hay fever
30 Hearing problem
31 Heart attack
32 Other heart condition or disease
33 Hernia
34 Hypertension
35 Inflammatory bowel disease
36 Influenza or pneumonia
37 Insomnia or trouble sleeping
38 Irritable bowel
39 Jaw pain
40 Joint pain or stiffness/other joint condition
41 Knee problems (not arthritis, not joint injury)
42 Liver problem
43 Lung/breathing problem (not already listed)
44 Lupus
45 Mania or psychosis
46 Memory loss or loss of other cognitive function
47 Menopause
48 Menstrual problems
49 Mental retardation
50 Missing limbs (fingers, toes or digits), amputee
51 Osteoporosis, tendinitis
52 Other developmental problem
53 Other injury
54 Other nerve damage, including carpal tunnel syndrome
55 Phobia or fears
56 Polio (myelitis), paralysis, para/quadriplegia
57 Poor circulation in legs
58 Prostate trouble or impotence
59 Regular headaches
60 Rheumatoid arthritis
61 Schizophrenia
62 Seizures
63 Senility
64 Sinusitis
65 Skin problems
66 Sprain or strain
67 Stroke
68 Substance abuse, other than alcohol or tobacco
69 Filled problem
70 Filled problem
71 Ulcer
72 Urinary problem
73 Varicose veins, hemorrhoids
74 Vision problem
75 Weak or failing kidneys
76 Weight problem
77 Back pain or problem
78 Head or chest cold
79 Neck pain or problem
80 Severe headache or migraine
81 Stomach or intestinal illness
82 Other - specify
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who use acupuncture for a specific condition
Skip Instructions:
(1-81) If more than one condition selected, [goto ACU_MOST], elseif only one condition selected, [goto
ACU_MED],
(82) [goto ACU_SPEC]
(Refused,Don't know) goto ACU_ENG
Question ID: : ALT.037_00.000

Instrument Variable Name: ACU_SPEC
Question Text:
*Enter condition for which acupuncture was used. If respondent gives more than one condition, probe for condition most
important for using acupuncture.
97 Refused
99 Don't know
Verbatim Verbatim response
Universe Text: Sample adults 18+ who used acupucture to treat other health problem or condition
Skip Instructions:
(Allow 75) if more than one condition selected [goto ACU_MOST]; else if only one condition selected [goto
ACU_MED]
(R,D) [if more than one condition (1-81) selected [goto ACU_MOST]; elseif only one condition (1-81) selected
[goto ACU_MED]; else [goto ACU_ENG]

Survey form view entire document:  text  image

Question ID: : CAL.105_00.000

Instrument Variable Name: CAC_COND
Question Text:
?[F1]
DURING THE PAST 12 MONTHS, for what health problems or conditions did [fill: S.C. name] use acupuncture?
*Enter all that apply, separate with commas.
01 Abdominal pain
02 Acid reflux or heartburn
03 Allergies other than hay fever, respiratory allergies, food or digestive allergies, or skin allergies
04 Anemia
05 Anxiety or stress
06 Arthritis
07 Asthma
08 Attention Deficit Hyperactivity Disorder (ADHD)/Attention Deficit Disorder (ADD)
09 Autism
10 Back or neck pain
11 Cancer
12 Cerebral palsy
13 Chickenpox
14 Congenital heart disease
15 Cystic fibrosis
16 Depression
17 Diabetes
18 Down syndrome
19 Eczema or skin allergy
20 Fatigue or lack of energy
21 Fever
22 Food or digestive allergy
23 Frequent or repeated diarrhea or colitis
24 Migraine headaches
25 Gum disease
26 Hay Fever
27 Head or chest cold
28 Hearing problem
29 Incontinence, including bed wetting
30 Influenza or pneumonia
31 Insomnia or trouble sleeping
32 Lung or breathing problem, other than Asthma
33 Mental Retardation
34 Menstrual problems
35 Muscular dystrophy
36 Nausea and/or vomiting
37 Neurological problems
38 Other chronic pain
39 Other developmental delay
40 Other heart condition
41 Phobia or fears
42 Problems with being overweight
43 Non-migraine headaches
44 Recurring constipation
45 Respiratory allergy
46 Seizures
47 Severe acne
48 Sickle cell anemia
49 Sinusitis
50 Skin problems other than eczema, acne, or warts
51 Sore throat other than strep or tonsillitis
52 Strep throat or tonsillitis
53 Stuttering or stammering
54 Three or more ear infections
55 Urinary problems, including urinary tract infection
56 Vision problem
57 Warts
58 Other specify
97 Refused
99 Don't know
Universe Text: Sample children LT 18 who used acupuncture for a problem or condition
Skip Instructions:
(1-57,R,D) Cycle through modalities, if CAY_USEM = 1 [goto CAY_TRET];
else [goto next selected modality.] If no more modalities selected [goto TRD]
(58) [goto CAC_SPEC]
Question ID: : CAL.106_00.000

Instrument Variable Name: CAC_SPEC
Question Text:
*Enter condition for which acupuncture was used. If respondent gives more than one condition, probe for condition most
important for using acupuncture.
97 Refused
99 Don't know
Verbatim Verbatim response
Universe Text: Sample children LT 18 who used acupuncture for other problem or condition
Skip Instructions:
(allow 75,R,D) Cycle through modalities, if CAY_USEM = 1 [goto CAY_TRET];
else [goto next selected modality.] If no more modalities selected [goto TRD]

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2002
Survey form view entire document:  text  image

ALT.005

For what health problems or conditions did you use acupuncture?

FR: MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.

(1) Yes
(2) No
(7) Refused
(9) Don't know
ACUCON01 (01) Allergic reaction to food
ACUCON02 (02) Allergic reaction to medication
ACUCON03 (03) Angina
ACUCON04 (04) Anxiety/depression
ACUCON05 (05) Arthritis, gout, lupus, or fibromyalgia
ACUCON06 (06) Asthma
ACUCON07 (07) Benign tumors, cysts
ACUCON08 (08) Birth defect
ACUCON09 (09) Bowel problems or constipation
ACUCON10 (10) Cancer
ACUCON11 (11) Cataracts
ACUCON12 (12) Cholesterol
ACUCON13 (13) Chronic bronchitis
ACUCON14 (14) Recurring pain
ACUCON15 (15) Circulation problems (other than in the legs)
ACUCON16 (16) Congestive heart failure
ACUCON17 (17) Coronary heart disease
ACUCON18 (18) Diabetes
ACUCON19 (19) Diabetic retinopathy
ACUCON20 (20) Emphysema
ACUCON21 (21) Excessive sleepiness during the day
ACUCON22 (22) Jaw pain
ACUCON23 (23) Fracture, bone/joint injury
ACUCON24 (24) Glaucoma
ACUCON25 (25) Gynecologic problems
ACUCON26 (26) Hay fever
ACUCON27 (27) Hearing problem
ACUCON28 (28) Heart attack
ACUCON29 (29) Heart condition or disease
ACUCON30 (30) Hernia
ACUCON31 (31) Hypertension
ACUCON32 (32) Irregular heartbeat
ACUCON33 (33) Knee problems (not arthritis, not joint injury)
ACUCON34 (34) Lung/breathing problem (not already listed)
ACUCON35 (35) Macular degeneration
ACUCON36 (36) Menopause
ACUCON37 (37) Menstrual problems
ACUCON38 (38) Mental retardation
ACUCON39 (39) Joint pain or stiffness
ACUCON40 (40) Missing limbs (fingers, toes, or digits), amputee
ACUCON41 (41) Multiple sclerosis
ACUCON42 (42) Neuropathy
ACUCON43 (43) Osteoporosis, tendinitis
ACUCON44 (44) Other developmental problem
ACUCON45 (45) Other injury
ACUCON46 (46) Other nerve damage, including carpal tunnel syndrome
ACUCON47 (47) Parkinson's
ACUCON48 (48) Polio (myelitis), paralysis, para/quadriplegia
ACUCON49 (49) Poor circulation in your legs
ACUCON50 (50) Insomnia or trouble sleeping
ACUCON51 (51) Liver problem
ACUCON52 (52) Dental pain
ACUCON53 (53) Prostate trouble or impotence
ACUCON54 (54) Seizures
ACUCON55 (55) Senility
ACUCON56 (56) Sinusitis
ACUCON57 (57) Skin problems
ACUCON58 (58) Sprain or strain
ACUCON59 (59) Stroke
ACUCON60 (60) Text of first other specify
ACUCON61 (61) Text of second other specify
ACUCON62 (62) Thyroid problem
ACUCON63 (63) Ulcer
ACUCON64 (64) Urinary problem
ACUCON65 (65) Varicose veins, hemorrhoids
ACUCON66 (66) Vision problems (not already listed)
ACUCON67 (67) Weak or failing kidneys
ACUCON68 (68) Weight problems
ACUCON69 (69) Back pain or problem
ACUCON70 (70) Head or chest cold
ACUCON71 (71) Neck pain or problem
ACUCON72 (72) Severe headache or migraine
ACUCON73 (73) Stomach or intestinal illness
ACUCON74 (74) Other, specify