Survey Text

2012
2007
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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]

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2007
Survey form view entire document:  text  image

Question ID: : CAL.260_00.000

Instrument Variable Name: CHB_CON1
Question Text:
?[F1]
For what specific health problems or conditions did [fill: S.C. name] take [fill2: herb]?
*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 have used at least one herb to treat a specific health problem or condition.
Skip Instructions:
(1-57, R, D) if CHRBTAKE = 1 herb [goto CHB_SPRT], else [goto CHB_TRT2]; (58) [goto CHB_SPC1].
Question ID: : CAL.261_00.000

Instrument Variable Name: CHB_SPC1
Question Text:
*Enter condition for which herb was used. If respondent gives more than one condition, probe for condition most important for using herb.
97 Refused
99 Don't know
Verbatim Verbatim response
Universe Text: Sample children LT 18 who have used herb(s) to treat other problem or condition
Skip Instructions:
(allow 75,R,D) if more than 1 herb [goto CHB_TRT2]; else [goto CHB_SPRT]