Survey Text

2016
2008
top
2016
Survey form view entire document:  text  image
Question ID: BAL.250_00.000

Instrument Variable Name: BCAUS1
Questionnaire File Name: Sample Adult
Question Text:
What did the doctor(s) or health care professional(s) tell you was the cause or causes of your dizziness or balance problem(s)?
* Enter all that apply, separate with commas.
*Read the list if necessary.
01 Allergies
02 Anxiety or depression
03 Benign positional vertigo (BPV or BPPV)
04 Crystals-loose or dislodged in ear
05 Diabetes
06 Headache or migraines
07 Head or neck trauma or concussion
08 Heart disease
09 Inner ear infection, viral labrynthitis
10 Méniêre’s (Men-e-AIRZ) disease
11 Neurological-multiple sclerosis (MS), seizures, etc.
12 Side effects from medications (antibiotics, cancer treatments, etc.)
13 Stroke
14 Other health problem(s)
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who were told cause of dizziness or balance problem
Skip Instructions:
(1-14,R,D) [goto BTRET1]

Survey form view entire document:  text  image
Question ID: CBL.050_00.000

Instrument Variable Name: CBALDGN2
Questionnaire File Name: Sample Child
Question Text:
What diagnoses or reasons were you told caused [fill1: S.C. name]'s balance or dizziness problems?
*Enter all that apply, separate with commas.
01 Developmental motor coordination disorder (“clumsy” child)
02 Diabetes (“juvenile diabetes”)
03 Ear infection(s) – otitis media, fluid, viral labrynthitis
04 Headache, including migraine
05 Crystals – loose or dislodged in the ear
06 Blurred vision with head motion, “bouncing” or rapid eye movements
07 Benign positional or paroxysmal vertigo (BPV)
08 Anxiety, including panic syndrome
09 Genetic syndrome, such as Usher’s or Waardenburg Syndrome
10 Depression or child psychiatric disorder
11 Head/neck injury or concussion
12 Low blood pressure (hypotension)
13 Malformation of the ear
14 Meniere’s disease
15 Neurological, such as cerebral palsy, seizure(s), etc.
16 Nutritional, such as low blood sugar (metabolic problem)
17 Side effects from medications (antibiotics, etc.)
18 Other health condition or cause
97 Refused
99 Don't know
Universe Text: Sample children 3+ who have ever been told a diagnosis for their balance or dizziness problems
Skip Instructions:
(1-18,R,D) [goto CBALPART]

top
2008
Survey form view entire document:  text  image
Question ID:BAL.250_00.000

Instrument Variable Name:BCAUS
QuestionText:
What did the doctor (s) or health care professional (s) tell you was the cause or causes of your (Fill: most bothersome or only feeling)?
* Enter all that apply, separate with commas.
* Read the list if necessary.
01 Antibiotics given through a needle or tube (I.V.)
02 Arthritis
03 Brain tumor
04 Cogan's syndrome or Sjogren's (SHO-grenz) syndrome
05 Loose or dislodged CRYSTALS in your ear or BPPV (benign positional vertigo)
06 Diabetes
07 Head or neck trauma or concussion
08 Heart disease
09 Inner ear infection
10 Meniere's (Men-e-AIRZ) disease
11 Migraine headaches
12 Neurological or muscular conditions (such as M.S., or M.D.)
13 Side effect or medicines or drugs
14 Stroke
15 TMJ or Temporal mandibular joint disorder
16 Other health problem(s)
97 Refused
99 Don't know
UniverseText:Sample adults 18+ who were told cause of symptoms of dizziness or balance problem
SkipInstructions:
(1-16, R, D) [goto BTRET]