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Xformpusher
CDASH VariableOrderQuestion TextPromptCRF Completion InstructionsTypeSDTMIG Target VariableSDTMIG Target MappingControlled Terminology Code List NamePermissible ValuesPre-Populated ValueQuery DisplayList StyleHidden
SUCAT1What is the category of the substance used?Substance Use CategoryRecord the Substance Used category, if not pre-printed on the CRF.TextSUCAT


Recreational Drugs


SUYN2Age subject began smoking daily Any Recreational Drugs UsedIndicate if the subject had used any recreational drugs.TextN/A
(NY)Yes; No



SUTRT3Average number of cigarettes
smoked per day over the past year		Type of Recreational Drug UsedRecord the name of the recreational drug used.TextSUTRT






SUNCF4Has the subject attempted to quit
with the use of Nicotine Replacement
Therapy (NRT)? List details of NRT
products used in Comments the section		UsageCheck the appropriate box to indicate if the subject currently or formerly used recreational drugs.TextSUOCCUR;  SUSTRTPT;  SUSTRF;  SUENRTPT;  SUENRFSUOCCUR = "Y" WHEN SUNCF = "CURRENT".  SUOCCUR = "Y" WHEN SUNCF = "FORMER".(NCF)Current; Former
Prompt

SUDSTXT5Has the subject attempted to quit
with the use of pharmaceuticals
other than NRTs? List details of
other pharmaceuticals used in the
Comments section section. 		AmountIndicate the amount of recreational drugs the subject consumes on a regular basis.TextSUDOSE; SUDOSTXT






SUDOSFRQ6Has the subject attempted to quit
with the use of other smoking
cessation aids? List details of other
smoking cessation aids used in the
Comments sectionection. 		FrequencyRecord how often the subject regularly uses recreational drugs.TextSUDOSFRQ
(FREQ)QD; EVERY WEEK; QM; PA
Prompt

SUCDUR7Has the subject made any other
attempts to quit smoking? List details
of other quit attempts in the
Comments section.		DurationProvide the duration of the substance use (e.g., how long the subject has smoked).TextSUDUR



Prompt

Panel
titleType of Product Used to Quit Smoking
Xformpusher
CDASH VariableOrderQuestion TextPromptCRF Completion InstructionsTypeSDTMIG Target VariableSDTMIG Target MappingControlled Terminology Code List NamePermissible ValuesPre-Populated ValueQuery DisplayList StyleHidden
SUCAT1What is the type of product the subject  used to attempted to quit smoking? Substance Use CategoryRecord the type of tobacco product usedTextSUCAT

Nicotine Replacement
Therapy (NRT

Pharmaceuticals
other than NRTs

Other
Smoking Cessation aids







SUTRT4What was the  name of the product the subject  used to attempted to quit smoking? 



TextSUTRT






SUDSTXT5What was the amount of tobacco product used to quit smoking? AmountIndicate the amount of amount of tobacco product used to quit smoking? TextSUDOSE; SUDOSTXT



Prompt

SUDUR6What was the duration of the tobacco product usage to quit smoking?  DurationProvide the duration of the substance use TextSUDOSFRQ

QD; EVERY WEEK; QM; PA
Prompt

SUCDURU7What was the duration unit of the  tobacco product used to quit smoking?  UnitSelect the appropriate duration unit of the  tobacco product usedTextSUDUR

DAYS; MONTHS; YEARS
Prompt

SUDOSFRQ8What was the frequency of  of the  tobacco product used to quit smokingFrequency



(FREQ)QD; EVERY WEEK; QM; PA
Prompt

Panel
titleTobacco Product Usage
Xformpusher
CDASH VariableOrderQuestion TextPromptCRF Completion InstructionsTypeSDTMIG Target VariableSDTMIG Target MappingControlled Terminology Code List NamePermissible ValuesPre-Populated ValueQuery DisplayList StyleHidden
SUCAT1What is the  product  the subject  used to attempted to quit smoking? Substance Use CategoryRecord the type of tobacco product usedTextSUCAT

Smoked tobacco products;

Chewed tobacco products;

Smokeless tobacco (e.g., chewing tobacco, snuff, dip, snus, or dissolvable tobacco)  







SUTRT4What was the  Nicotine Replacement
Therapy (NRT) used to quit smoking? 



TextSUTRT






SUDSTXT5What was the amount of tobacco product used to quit smoking? AmountIndicate the amount of amount of tobacco product used to quit smoking? TextSUDOSE; SUDOSTXT



Prompt

SUDUR6What was the duration of the tobacco product usage to quit smoking?  DurationProvide the duration of the substance use TextSUDOSFRQ

QD; EVERY WEEK; QM; PA
Prompt

SUCDURU7What was the duration unit of the  tobacco product used to quit smoking?  UnitSelect the appropriate duration unit of the  tobacco product usedTextSUDUR

DAYS; MONTHS; YEARS
Prompt

SUDOSFRQ8What was the frequency of  of the  tobacco product used to quit smokingFrequency



(FREQ)QD; EVERY WEEK; QM; PA
Prompt





Dataset wrap
Rowcaps
Row 1:Subject 1234005 is a 2-pack/day current smoker. “Current” implies that smoking started sometime before the time the question was asked (SUSTTPT = "2006-01-01", SUSTRTPT = "BEFORE") and had not ended as of that date (SUENTTP = "2006-01-01", SUENRTPT = "ONGOING"). See Section 4.4.7, Use of Relative Timing Variables for the use of these variables. Both the beginning and ending reference time points for this question are the date of the assessment.
Row 2:Subject 1234005 drank 3 cups of coffee on the day of the assessment.
Row 3:Subject 1234006 is a former smoker. The date this subject began smoking is unknown, but it was sometime before the assessment date; this is shown by the values of SUSTTPT and SUSTRTPT. The end date of smoking was collected, so SUENTPT and SUENRTPT are not populated. Instead, the end date is in SUENDTC.
Row 4:Subject 1234006 drank tea on the day of the assessment.
Row 5:Subject 1234006 drank coffee on the day of the assessment.
Row 6:Subject 1234007 had missing data for the smoking questions; this is indicated by SUOCCUR null and SUSTAT = "NOT DONE". The reason is in SUREASND.
Row 7:Subject 1234007 also had missing data for all of the caffeine questions.
Dataset2
RowSTUDYIDDOMAINUSUBJIDSUSEQSUTRTSUCATSUPRESPSUOCCURSUSTATSUREASNDSUDOSESUDOSUSUDOSFRQSUSTDTCSUENDTCSUSTTPTSUSTRTPTSUENTPTSUENRTPT
11234SU12340051CIGARETTESTOBACCOYY

2PACKQD

2006-01-01BEFORE2006-01-01ONGOING
21234SU12340052COFFEECAFFEINEYY

3CUPQD2006-01-012006-01-01



31234SU12340061CIGARETTESTOBACCOYY

1PACKQD
20032006-03-15BEFORE

41234SU12340062TEACAFFEINEYY

1CUPQD2006-03-152006-03-15



51234SU12340063COFFEECAFFEINEYY

2CUPQD2006-03-152006-03-15



61234SU12340071CIGARETTESTOBACCOY
NOT DONESubject left office before CRF was completed








71234SU12340072CAFFEINECAFFEINEY
NOT DONESubject left office before CRF was completed













NICOTINE REPLACEMENT  THERAPYNICOTINE
Y OR N 















SMOKELESS CIGARETTES 

Y or N 










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