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Smoking status (self-reported and biochemically validated)
| Panel |
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| title | SMOKING CESSATION PRODUCT |
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| Xformpusher |
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| CDASH Variable | Order | Question Text | Prompt | CRF Completion Instructions | Type | SDTMIG Target Variable | SDTMIG Target Mapping | Controlled Terminology Code List Name | Permissible Values | Pre-Populated Value | Query Display | List Style | Hidden | | SUCAT | 1 | What is the category of the substance used? |
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| Substance Use Category | Record the Substance Used category, if not pre-printed on the CRF. | Text | SUCAT | Recreational Drugs | Indicate if
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| SMOKING CESSATION PRODUCT USAGE |
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| | SUYN | 2 |
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Age subject began smoking daily | Any Recreational Drugs Used | had used any recreational drugs.Text | N/A | (NY) | Yes; No | SUTRT | 3 | Average number of cigarettes
smoked per day over the past year | Type of Recreational Drug Used | Record the name of the recreational drug used. | Text | SUTRT | SUNCF | 4 | Has the subject attempted to quit
with the use of Nicotine Replacement
Therapy (NRT)? List details of NRT
products used in the section | Usage | Check the appropriate box to indicate if the subject currently or formerly used recreational drugs. | Text | SUOCCUR; SUSTRTPT; SUSTRF; SUENRTPT; SUENRF | SUOCCUR = "Y" WHEN SUNCF = "CURRENT". SUOCCUR = "Y" WHEN SUNCF = "FORMER". | (NCF) | Current; Former | Prompt | SUDSTXT | 5 | Has the subject attempted to quit
with the use of pharmaceuticals
other than NRTs? List details of
other pharmaceuticals used in the
section. | Amount | Indicate the amount of recreational drugs the subject consumes on a regular basis. | Text | SUDOSE; SUDOSTXT | SUDOSFRQ | 6 | Has the subject attempted to quit
with the use of other smoking
cessation aids? List details of other
smoking cessation aids used in the
ection. | Frequency | Record how often the subject regularly uses recreational drugs. | Text | SUDOSFRQ | (FREQ) | QD; EVERY WEEK; QM; PA | Prompt | SUCDUR | 7 | Has the subject made any other
attempts to quit smoking? List details
of other quit attempts in the
Comments section. | Duration | Provide the duration of the substance use (e.g., how long the subject has smoked). | Text | SUDUR | Prompt |
| Panel |
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| title | Type of Product Used to Quit Smoking |
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| previously use any products to attempted to quit smoking? |
| Indicate if the subject had used any products to attempted to quit smoking. |
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| | SUSCAT | 3 |
| | Xformpusher |
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| CDASH Variable | Order | Question Text | Prompt | CRF Completion Instructions | Type | SDTMIG Target Variable | SDTMIG Target Mapping | Controlled Terminology Code List Name | Permissible Values | Pre-Populated Value | Query Display | List Style | Hidden | | SUCAT | 1 | What is the type of product the subject subject used to attempted to quit smoking? | Substance Use Category | Record the type of tobacco product used | Text | SUCATSUSCAT |
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| Nicotine Replacement
Therapy (NRT Pharmaceuticals
other than NRTs Other
Smoking Cessation aids
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| | SUTRT | 4 | What was the name of the product the subject used to attempted to quit smoking?
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| Text | SUTRT |
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| | SUDSTXT | 5 | What was the amount of tobacco product used to quit smoking? | Amount | Indicate the amount of amount of tobacco product used to quit smoking? | Text | SUDOSE; SUDOSTXT |
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| | SUDUR | 6 | What was the duration of the tobacco product usage to quit smoking? | Duration | Provide the duration of the substance use | Text | SUDOSFRQ |
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| QD; EVERY WEEK; QM; PA |
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| | SUCDURU | 7 | What was the duration unit of the tobacco product used to quit smoking? | Unit | Select the appropriate duration unit of the tobacco product used | Text | SUDUR | DAYS; MONTHS; YEARS | Prompt | SUDOSFRQ | 8 | What was the frequency of of the tobacco product used to quit smoking | Frequency | (FREQ) | QD; EVERY WEEK; QM; PA | Prompt |
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| Panel |
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| title | Tobacco Product Usage |
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| Xformpusher |
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| CDASH Variable | Order | Question Text | Prompt | CRF Completion Instructions | Type | SDTMIG Target Variable | SDTMIG Target Mapping | Controlled Terminology Code List Name | Permissible Values | Pre-Populated Value | Query Display | List Style | Hidden | | SUCAT | 1 | What is the product the subject used to attempted to quit smoking? | Substance Use Category | Record the type of tobacco product used | Text | SUCAT | Smoked tobacco products; Chewed tobacco products; Smokeless tobacco (e.g., chewing tobacco, snuff, dip, snus, or dissolvable tobacco) SUTRT | 4 | What was the Nicotine Replacement
Therapy (NRT) used to quit smoking?
Text | SUTRT | SUDSTXT | 5 | SUCDURU | 7 | What was the amount of tobacco product used to quit smoking? | Amount | Indicate the amount of amount of tobacco product used to quit smoking? | Text | SUDOSE; SUDOSTXT | Prompt | SUDUR | 6 | What was the duration of the tobacco product usage to quit smoking? | Duration | Provide the duration of the substance use | Text | SUDOSFRQ | QD; EVERY WEEK; QM; PA | Prompt | What was the duration unit of the tobacco product used to quit smoking? | Unit | Select the appropriate duration unit of the tobacco product used | Text | SUDUR |
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| DAYS; MONTHS; YEARS |
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| | SUDOSFRQ | 8 | What was the frequency of of the tobacco product used to quit smoking | Frequency |
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| (FREQ) | QD; EVERY WEEK; QM; PA |
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