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Panel
titleTobacco Usage History
Xformpusher
CDASH VariableOrderQuestion TextPromptCRF Completion InstructionsTypeSDTMIG Target VariableSDTMIG Target MappingControlled Terminology Code List NamePermissible ValuesPre-Populated ValueQuery DisplayList StyleHidden
SUSCAT1What is the type of tobacco product used by the subject? Substance Use SubcategoryRecord the type of tobacco product usedTextSUSCAT

Smoked tobacco product;

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







SUTRT4What was the name of the tobacco product? 

Substance Treatment Record the brand name of the tobacco product used.  TextSUTRT

BRAND X;BRAND; BRAND Z;    



SUSCAT5Is this the subject usual brand of tobacco product? Substance Use Subcategory   Indicate if this is the subject usual brand of tobacco product usedTextSUSCAT


USUAL BRAND; 

NOT USUAL BRAND

Yes; No



FAORRES5What was the duration of use of the tobacco product ?  DurationProvide the duration of the tobacco product usedTextFAORRES



Prompt

SUCDURU6What was the unit of duration of use of the tobacco product?UnitSelect the appropriate duration unit of the  tobacco product usedTextFAORRESU

DAYS; MONTHS; YEARS;
Prompt

SUONGO9Is the tobacco use ongoing?OngoingRecord the tobacco product used as ongoing if the subject has not stopped taking the tobacco product used at the time of data collection and the end date should be left blank.TextSUENRF;  SUENRTPTSUENRF or SUENRTPT(NY)Yes

checkbox
SUENDAT10What was the end date?End DateRecord the date the tobacco product used was stopped using this format (DD-MON-YYYY). If the subject has not stopped taking the tobacco product used leave this field blank.DateSUENDTC



prompt

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