Survey Text

2012
2007
top
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]

top
2007
Survey form view entire document:  text  image

Question ID: : ALT.256_00.000

Instrument Variable Name: HYP_COND
Question Text:
?[F1]
For what health problems or conditions did you use hypnosis?
*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 hypnosis for a specific condition
Skip Instructions:
(1-81) If more than one condition selected, [goto HYP_MOST], elseif only one condition selected, [goto
HYP_MED]
(82) [goto HYP_SPEC]
(Refused,Don't know) goto HYP_ENG
Question ID: : ALT.257_00.000

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

Survey form view entire document:  text  image

Question ID: : CAL.165_00.000

Instrument Variable Name: CHY_COND
Question Text:
?[F1]
DURING THE PAST 12 MONTHS, for what health problems or conditions did [fill: S.C. name] use hypnosis?
*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 hypnosis for a problem or condition
Skip Instructions:
(1-57,R,D) Cycle through modalities, if CMS_USEM = 1 [goto CMS_TRET];
else [goto next selected modality.] If no more modalities selected [goto TRD]
(58) [goto CHY_SPEC]
Question ID: : CAL.166_00.000

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