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1995 Electrical Sensitivity Network Survey



Editor's Note: this survey is long over, but I am keeping it as general information

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.

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1995 Electrical Sensitivity Network Survey

The purpose of this survey is to learn more about how electromagnetic hypersensitivity (ES) occurs, how persons with ES are coping with their disability, and what their needs are. Electrical sensitivity means having an illness that reacts or intensifies near appliances, power lines, and/or other electromagnetic field sources. ES includes having recurring feelings of illness when near electric and/or magnetic fields. Symptoms of illness resulting from exposure to electrical stimulation that diminishes or disappears away from the EMF source constitutes a case of electrical sensitivity. Symptoms may include headache, dizziness, nausea, skin reactions, eye irritations, difficulty in concentrating, tingling or numbness in various parts of the body, joint pains, fatigue, dry cough, sleep disturbances and memory problems, as well as other problems.

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:

Electrical Sensitivity Network, Midwest
PO Box 645,
Elkhorn, Wisconsin, 53121

Please answer the following questions as completely as you can. If this form does not contain adequate space for your responses, please attach a separate sheet of paper.

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:

7) Ethnicity:

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:

11) What is your degree of electrical sensitivity? Check one 12) What are the symptoms which you feel from exposure to EMFs? Please check those which apply. 13) Are your symptoms made worse by exposure to any of the following? Check those which bother you. 14) What EMF sources trigger your symptoms? Check those which do. 15) Do you believe there was a link between the onset of your ES and exposure to:

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.

41) Does your home trigger your ES reaction? yes no

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.

47) Do you ever turn off the electricity in your house, partially or completely, so that you can rest there without ES reactions?

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.

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Electrical Sensitivity Network Support Group Questionnaire

Growing numbers of people who suffer with electromagnetic hypersensitivity (ES) have expressed interest in networking within a support group. If you are interested in the possible advantages which such organization could offer and wish to participate, please complete the following questionnaire.

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.

4) How could a support group for persons with ES be most helpful to you?

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:

7) How might you wish to participate?

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.)

Thank You!

Electrical Sensitivity Network, Midwest
P O Box 645
Elkhorn, Wisconsin 53121

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Cyndi Norwitz / webmaster@immuneweb.org / Last Modified: 1/19/98