Survey Text

2012
2007
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2012
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: : CAL.155_00.000

Instrument Variable Name: CEH_COND
Question Text:
?[F1]
DURING THE PAST 12 MONTHS, for what health problems or conditions did [fill: S.C. name] use energy healing
therapy?
*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 energy healing therapy for a problem or condition
Skip Instructions:
(
1-57,R,D) Cycle through modalities, if CHY_USEM = 1 [goto CHY_TRET];
else [goto next selected modality.] If no more modalities selected [goto TRD]
(58) [goto CEH_SPEC]
Question ID: : CAL.156_00.000

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