Survey Text

2012
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2012
Survey form view entire document:  text  image

QuestionID: ALT.711_00.000

Instrument Variable Name: TP3_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 third of top three modalities and saw a practitioner or used modality for a specific health problem, symptom or condition
SkipInstructions:
(1-86) If TP3_CNT GT 1 [goto TP3_CMST], else if TP3_CNT=1 [goto TP3_CHLP];
(86) [goto TP3_SPEC];
(R,D) if self-care modality (ALT_TP33 in (6,7,10-16)) [goto TP3_RS5]; else (ALT_TP33 ne (6,7,10-16)) [goto TP3_RS6]
QuestionID: ALT.711_00.010

Instrument Variable Name: TP3_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 third of top three modalities and used modality to treat other health problem or condition
SkipInstructions:
(Allow 75, R,D) If TP3_CNT GT 1 [goto TP3_CMST], elseif TP3_CNT =1 [goto TP3_CHLP];
(R,D) If TP3_CNT=1 and if self-care modality (ALT_TP33 in (6,7,10-16)) [goto TP3_RS5];
else [goto TP3_RS6]

Survey form view entire document:  text  image

Question ID: CAL.711_00.000

Instrument Variable Name: CTP3COND
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
49Sore 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 third of top three modalities and saw a practitioner or used modality for a specific health problem, symptom or condition
SkipInstructions:
(1-56) If CTP3CNT GT 1 [goto CTP3CMST],
else if CTP3CNT=1 [goto CTP3CHLP];
(56) [goto CTP3SPEC]
(R,D) if self-care modality (CAL_TP33 IN (6,7,10-16)) [goto CTP3RS5];
else (CAL_TP33 ne (6,7,10-16)) [goto CTP3RS6]
Question ID: CAL.711_00.010

Instrument Variable Name: CTP3SPEC
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 third of top three modalities and used modality to treat other health problem or condition
SkipInstructions:
(Allow 75) If CTP3CNT GT 1 [goto CTP3CMST],
elseif CTP3CNT=1 [goto CTP3CHLP];
(R,D) If CTP3CNT=1 and if self-care modality (CAL_TP33 IN (6,7,10-16)) [goto CTP3RS5];
else [goto CTP3RS6]