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Panel
title SMOKING CESSATION PRODUCT
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 Category
TextSUCAT


SMOKING CESSATION PRODUCT 


SUYN2Did  the subject previously use any products to  attempted to quit smoking?
Indicate if the subject had used any products to  attempted to quit smoking.TextSUOCCURSUOCCUR where SUTRT=Smoking  Cessation Product" (NY)Yes; No



FAORRES3How many times did the subject attempt to quit smoking  using a  smocking cessation product? times did the subject attempt to quit smoking 
TextFAORRESFAORRES where FAOBJ ="SMOKING CESSATION PRODUCT"  and FATEST= NUMBER OF ATTEMPTS"







Xformpusher

RECORD  THE INFORMATION FOR THE  LAST ATTEMPT  TO QUIT FOR EACH TYPE OF PRODUCT USED 

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?


SUCAT


SMOKING CESSATION PRODUCT 


SUSCAT3What is the type of product the subject used to attempted to quit smoking? Substance Use CategoryRecord the type of product the subject used to attempted to quit smoking. TextSUSCAT

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 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 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 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  product used to quit smokingFrequency
Text SUDOSFRQ
(FREQ)QD; EVERY WEEK; QM; PA
Prompt

Panel
title SMOKING CESSATION PRODUCT



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