CDASH Example.Tobacco Product Use History

Section 1

Order	Question Text	Prompt	CRF Completion Instructions	Type	Collection Variable	Tabulation Target	Mapping Instuctions	Controlled Terminology Code List Name	Permissible Values	Pre-Populated Value
1	What is the object?			Text	FAOBJ	FAOBJ				TOBACCO
2	What was the age of the subject when they started smoking?	Age Started Smoking	Record the Age Category when the subject started smoking	Text	AGESTSMK__FAORRES	FAORRES	FAORRES WHERE FATESTCD = "AGESTSMK" and FAOBJ = "TOBACCO"		16-24 years; 25-34 years; 45–64 years; 65 years and older
3	Did the subject have any tobacco cessation counseling?	Tobacco Cessation Counseling	Indicate whether the subject had previous tobacco cessation counseling	Text	TBCESSCO__FAORRES	FAORRES	FAORRES WHERE FATESTCD = "TBCESSCO" and FAOBJ = "TOBACCO"	(NY)	No;Yes
4	What is the longest duration of previous abstinence from tobacco use?	Longest Duration of Abstinence	Record the longest duration of tobacco abstinence	Text	LDURABS__FAORRES	FAORRES	FAORRES WHERE FATESTCD = "LDURABS" and FAOBJ = "TOBACCO"		≤7 days; 8–28 days;1–6 months; >6 months

Section 2

Order	Question Text	Prompt	CRF Completion Instructions	Type	Collection Variable	Tabulation Target	Mapping Instuctions	Controlled Terminology Code List Name	Permissible Values
5	What is the type of tobacco product used by the subject?	Substance Use Category	Record the type of tobacco product used.	Text	SUCAT	SUCAT			SMOKED TOBACCO PRODUCT; SMOKELESS TOBACCO PRODUCT (e.g., CHEWING TOBACCO, SNUFF, DIP, SNUS, or DISSOLVABLE TOBACCO PRODUCT)
6	What was the brand name of the tobacco product?	Product Name	Record the brand name of the tobacco product used.	Text	SUTRT	SUTRT
7	Is this the subject's usual brand of tobacco product?	Substance Use Subcategory	Indicate if this is the subject's usual brand of tobacco product used	Text	SUSCAT	SUSCAT			USUAL BRAND; NOT USUAL BRAND
9	What was the duration of use of the tobacco product ?	Duration	Provide the duration for the product used	Text	SUCDUR	SUDUR
9	What was the unit of duration of use of the tobacco product?	Unit	Select the appropriate duration unit for the product used	Text	SUCDURU	SUDUR			DAYS; MONTHS; YEARS;
10	Is the tobacco use ongoing?	Ongoing	Record the product used as ongoing if the subject has not stopped taking the product used at the time of data collection. The end date should be left blank.	Text	SUONGO	SUENRF; SUENRTPT	SUENRF or SUENRTPT	(NY)	No;Yes
11	What was the end date?	End Date	Record the date the product used was stopped using this format (DD-MON-YYYY). If the subject has not stopped taking the product used leave this field blank.	Date	SUENDAT	SUENDTC

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