Survey Text

2016
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2016
Survey form view entire document:  text  image
Question ID: BAL.060_01.000

Instrument Variable Name: BTYPE_1
Questionnaire File Name: Sample Adult
Question Text:
This next question is about symptoms of dizziness or balance problems. Please tell me if you have had any of these problems in the past 12 months. Please say yes or no to each.
A spinning or vertigo sensation or other illusion of motion such as tipping, tilting, or rocking
*Read if necessary: Vertigo is an illusion of rotation or other motion, as if riding a carousel.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ had a dizziness or balance problem in the last 12 months or at least one balance related problem in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BTYPE_2]

Survey form view entire document:  text  image
Question ID: CBL.020_00.000

Instrument Variable Name: CBALVRTG
Questionnaire File Name: Sample Child
Question Text:
These next questions are about balance problems or disorders that children may experience such as feeling unsteady, dizzy, light headed, or woozy or having body or motor coordination problems.
DURING THE PAST 12 MONTHS, has [fill1: S.C. name] been bothered by episodes of any of the following dizziness or balance problems...
a spinning or vertigo feeling with a sense of movement, such as rocking of oneself or as if riding a Merry-Go-Round?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample children 3+
Skip Instructions:
(1,2,R,D) [goto CBALSTED]

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2012
Survey form view entire document:  text  image
Question ID:: CBL.020_00.000

Instrument Variable Name:: CBALVRTG
QuestionText:
These next questions are about balance problems or disorders that children may experience such as feeling unsteady, dizzy, light headed, or woozy or having body or motor coordination problems. DURING THE PAST 12 MONTHS, has {fill1: S.C. name} been bothered by episodes of any of the following dizziness or balance problems? Vertigo, a spinning sensation like a Merry-Go-Round?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 3+
SkipInstructions:
(1,2,R,D) [goto CBALSTED]

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2008
Survey form view entire document:  text  image
Question ID:BAL.060_01.000

Instrument Variable Name:BTYPE_01
QuestionText:
This next question is about symptoms of dizziness or balance problems. Please tell me if you have had any of these problems in the past 12 months. Please say yes or no to each....A spinning or vertigo sensation, a rocking of yourself or your surroundings
*Read if necessary: Vertigo is an illusion of rotation or other motion, as if riding a carousel.
* Read if necessary: Do not include times when drinking alcohol.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText:Sample adults 18+ who have had a problem(s) with dizziness or balance
SkipInstructions:
(1,2,R,D) [goto BTYPE_02]