Editor's Note: this survey is long over, but I am keeping it as general
ELECTRICAL SENSITIVITY NETWORK
P.O. Box 4146
Prescott, AZ 86302
To: The Electrically Sensitive
From: Lucinda Grant
Hi! Good news! The long-awaited national survey of the electrically sensitive is underway. A copy of the survey form is enclosed. This survey will help us get on the map by finding out how people got sick, how they are coping, and what their needs are. This is your chance to get those thoughts on paper hat you've been wanting to say but didn't allow who to tell. Ruth Schultz, a nurse who is also ES, will be reviewing the forms to tally the data. Don't forget to make extra copies of the survey to give to ES friends and your local chemical sensitivity group. Ruth and I will be trying to get this survey published in full in as many newsletters, etc. as possible. Any ways you find to help get the word out would be greatly appreciated.
For your friends who are waiting for the American Medical Association to be worried about the health hazards of electromagnetic fields before they start to worry, I know just the report for them. Entitled "Effects of Electric and Magnetic Fields", this 24-page report lists many of the health effects reported under laboratory conditions. Nervous system changes under electric and magnetic fields are mentioned, as well as brain seizure induction under magnetic field conditions. The report was prepared by the AMA's Council on Scientific Affairs and recommends "that the AMA urge manufacturers, home-builders, and employers to begin planning to reduce the exposures of workers and the public to electromagnetic fields, including those from power lines, appliances, and equipment. A copy of this report is available from American Medical Association, 515 N. State St., Chicago IL 60610, Contact - Brenda Stuart, Council on Scientific Affairs, Phone: 1-312@64-5046. It's free!
Hope we can do a newsletter in the future, if enough people are interested. On the support group questionnaire enclosed, I thought to include a question about sub-group specialties, so ES people who are especially interested in a particular part of ES problems could network together. The technically oriented people who have contacted me regarding their efforts at reducing computer EMFs and other EMF reduction may particularly enjoy contacting each other to compare notes if they agree to be contacted by others.
All information in this survey is strictly confidential; individuals will not be identified. Survey participants may receive survey results by sending a self-addressed, stamped envelope to the address below. If you are ES, please complete this survey as soon as possible, but not later than December 31, 1995, and mail it to:
1995 Electrical Sensitivity Network Survey
1) Age at time of ES onset:
2) Current age:
3) Gender: Male Female
4) Country of current residence:
5) Father's occupation(s) prior to your birth:
6) Mother's occupation(s) prior to your birth:
White/Caucasian Black/African American Asian/Pacific Islander Native American Hispanic Other (explain)
8) Marital status: married divorced
separated widow/widower unmarried
9) Has your ES adversely affected your family status? no yes don't know comments:
10) Do you have family members who have:
16) Please explain any yes answers to question 15:
17) Are you also sensitive to chemicals? yes no not sure
18) If you are chemically sensitive, was pesticide exposure a likely factor
in your chemical sensitivity? yes no don't know.
Was exposure to building construction or remodeling materials a likely factor in your chemical sensitivity? yes no don't know
19) If chemically sensitive, what is the degree of sensitivity? mild moderate severe
20) If you are chemically sensitive, what chemicals bother you most and what are the symptoms?
21) Prior to the onset of your ES, was your health: excellent fair good poor
22) Please list health conditions/problems prior to ES onset:
23) Do you believe that your ES onset can be traced to a particular incident or situation? yes no
24) If yes, please explain
25) Have you ever had amalgam (silver/mercury) dental fillings? yes no don't know
26) If you have had such fillings, have you had them removed or replaced? yes no
27) Did replacing your amalgam fillings reduce your electrical sensitivity? yes no don't know
28) How many hours of television did you view weekly before the onset of ES?
29) Were you a computer user prior to the onset of your ES? yes no
30) If yes, for how many years had you been a computer user?
31) How many hours of computer work did you do weekly before the onset of ES?
32) Occupation at time of ES onset.
33) Length of time in that occupation prior to onset.
34) Has your ES ever prevented you from working?
35) Are you currently employed? yes no
36) If employed, do you work in your home in a location other than your home
37) What accommodations in your workplace have helped most to keep you on the job? _
38) What workplace accommodations would you need made in order for you to safely work at your job?
39) Did your ES make it necessary for you to find work that can be done at home? yes no
40) Have you applied for any of the following due to your ES condition? Please check those which apply.
42) Have you moved in order to obtain safer housing that reduces your ES reactions? yes no
43) Would you consider safe, low-income housing which was suitable for persons with ES? yes no
44) Have you found it necessary to camp out (with tent, travel trailer, etc. away from electricity in order to reduce your ES reactions? yes no
45) if yes, did camping out help you to feel better? yes no
46) What other changes. if any, have you made in your home to reduce your exposure to EMFs? Please check all that apply.
48) What products, supplements, or medical therapy have you used in an effort to reduce your ES reactions? immunotherapy vitamin supplements homeopathic treatment traditional medicine (please describe nature of treatment) other treatments (please describe)
49) What resources have most helped you to get information you needed to help yourself with ES?
50) Anything else you could share with us that may help others? (examples: housing, health care, legal or medical q resources, world issues, etc.) If so, please explain.
1) Are you willing to be contacted by others who are interested in electrical sensitivity? (if no, further information is optional.)
2) your name: (please print); address:
3) If you are Willing to be contacted, please date and sign your name in the space provided at the end of the following
statement I hereby authorize the ES Network to share my name, address, and phone number with other persons in efforts to provide increased understanding of electromagnetic hypersensitivity.
5) What questions do you have as part of this effort?
6) Would you be willing to collaborate with others from a position of expertise in a given area? Please check any areas of special interest or experience:
8) Are you aware of funding sources or other resources which could benefit the group? (examples might include 800 phone lines, access to office machines or research materials, printing or copying services, etc. Please describe.)
9) Are you aware of current support group efforts? If so, please describe, and list name, address, and telephone number of the contact person for this.
10) Please share any additional information which could be helpful or of interest to the group (such as legal or medical contacts, ongoing research, etc.)
Electrical Sensitivity Network, Midwest
P O Box 645
Elkhorn, Wisconsin 53121
is copyrighted. No reprints without permission