CDE Detailed Report
Subdomain Name: General Health History
CRF: Behavioral History
Displaying 1 - 15 of 15
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Question Text | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C00710 | Tobacco current use indicator | TobcoUseCurntInd | Indicator for whether the participant/subject regularly uses tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) at the present time | Indicator for whether the participant/subject regularly uses tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) at the present tim | Current tobacco use? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose one. Response is obtained from participant/ subject, family member, friend, or chart/ medical record. Add date stamp for when assessed.Recommend collection at least on date of TBI. |
Corrigan JD, Bogner J, Holloman C. Lifetime history of traumatic brain injury among persons with substance use disorders. Brain Inj. 2012;26(2):139-50. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3170060 | |||||||
| C00733 | Alcohol use last month consumed more than four or five drinks days number | AlcohlLstMoConsmOvr5DrnkDayNum | Considering all types of alcoholic beverages, how many times during the past 30 days did you have X [X = 5 for men, X = 4 for women] or more drinks on an occasion? | Considering all types of alcoholic beverages, how many times during the past 30 days did you have X [X = 5 for men, X = 4 for women] or more drinks on an occasion? | Considering all types of alcoholic beverages, how many times during the past 30 days did you have X [X = 5 for men, X = 4 for women] or more drinks on an occasion? | Numeric Values |
The suggested range is 0 - 30. |
Please refer the Behavioral Risk Factor Surveillance System (BRFSS) instrument for capturing alcohol consumption http://www.cdc.gov/brfss/ | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 30 | ||||||||
| C00711 | Tobacco prior use indicator | TobcoPriorUseInd | Indicator of the participant's/subject's past regular tobacco (e.g., cigarettes, cigars, chewing tobacco or pipe) use prior to the past 12 months | Indicator of the participant's/subject's past regular tobacco (e.g., cigarettes, cigars, chewing tobacco or pipe) use prior to the past 12 months | Past tobacco use? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose one. Response is obtained by report of the participant/subject or proxy as soon as possible after visit/admission. Document when the behavioral history was collected so as to determine whether this information was obtained prior to study enrollment or later. Substance abuse directly before injury may have contributed to the incident causing injury. In general, substance abuse may indicate increased risk taking behavior. |
Corrigan JD, Bogner J, Holloman C. Lifetime history of traumatic brain injury among persons with substance use disorders. Brain Inj. 2012;26(2):139-50. | Adult;Pediatric | Supplemental | 3.00 | 7/20/2013 10:21:26 AM | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3170080 | |||||||
| C18670 | Subscribed drug or substance illicitly used category other text | SbscrbdDrgSubIllctUseCatOTH | The free-text field related to 'Subscribed drug or substance illicitly used category' specifying other text. Category of illegal drugs, prescription, or over-the-counter drugs the participant/subject used for purposes other than those for which they are meant to be used, or in large amounts | Subscribed drug substance illicitly used category specifying other text. Category of illegal drugs, prescription, or over-the-counter drugs the participant/subject used for purposes other than those for which they are meant to be used, or in large amounts | Other, specify | Alphanumeric |
Choose all that apply. Response is obtained from report by participant/subject or proxy. Document whether this information was obtained prior to study enrollment or later. Recommend collection as soon as possible after visit/admission. |
Corrigan JD, Bogner J, Holloman C. Lifetime history of traumatic brain injury among persons with substance use disorders. Brain Inj. 2012;26(2):139-50. | Adult;Pediatric | Supplemental | 1.10 | 2022-06-24 11:33:13.0 | Behavioral History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
3171797 | ||||||||
| C00712 | Subscribed drug or substance illicitly used category | SbscrbdDrgSubIllctUseCat | Category of illegal drugs, prescription, or over-the-counter drugs subscribed by the participant/subject, and used for purposes other than those for which they are meant to be used, or in large amounts | Category of illegal drugs, prescription, or over-the-counter drugs subscribed by the participant/subject, and used for purposes other than those for which they are meant to be used, or in large amounts | If YES, specify illicit drug type(s) used | Sedatives (e.g., sleeping pills, barbiturates, Seconal, Quaaludes, or Chloral Hydrate);Tranquilizers or anti-anxiety drugs (e.g., Valium, Librium, muscle relaxants, or Xanax);Painkillers (e.g., Codeine, Darvon, Percodan, Dilaudid, or Demerol);Stimulants (e.g., Preludin, Benzedrine, Methadrine, uppers, or speed);Marijuana, hash, THC, or grass;Cocaine or crack;Hallucinogens (e.g., Ecstasy, LSD, mescaline, psilocybin, PCP, angel dust, or peyote);Inhalants or Solvents (e.g., amyl nitrate, nitrous oxide, glue, toluene, or gasoline;Heroin;Other, specify (e.g., Methadone, Elavil, steroids, Thorazine, or Haldol) | Sedatives (e.g., sleeping pills, barbiturates, Seconal, Quaaludes, or Chloral Hydrate);Tranquilizers or anti-anxiety drugs (e.g., Valium, Librium, muscle relaxants, or Xanax);Painkillers (e.g., Codeine, Darvon, Percodan, Dilaudid, or Demerol);Stimulants (e.g., Preludin, Benzedrine, Methadrine, uppers, or speed);Marijuana, hash, THC, or grass;Cocaine or crack;Hallucinogens (e.g., Ecstasy, LSD, mescaline, psilocybin, PCP, angel dust, or peyote);Inhalants or Solvents (e.g., amyl nitrate, nitrous oxide, glue, toluene, or gasoline;Heroin;Other, specify (e.g., Methadone, Elavil, steroids, Thorazine, or Haldol) | Alphanumeric |
Choose all that apply. Response is obtained from report by participant/subject or proxy. Document whether this information was obtained prior to study enrollment or later. Recommend collection as soon as possible after visit/admission. |
Corrigan JD, Bogner J, Holloman C. Lifetime history of traumatic brain injury among persons with substance use disorders. Brain Inj. 2012;26(2):139-50. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | Behavioral History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
3171797 | |||||||
| C18770 | Tobacco product used other text | TobcoProdctUsedOTH | The free-text field related to 'Tobacco product used type' specifying other text. Type of tobacco product (e.g. cigarettes, cigars, chewing tobacco or pipe) used by the participant/subject | The free-text field related to 'Tobacco product used type' specifying other text. Type of tobacco product (e.g. cigarettes, cigars, chewing tobacco or pipe) used by the participant/subject | Other, specify | Alphanumeric |
Choose all that apply. Response is obtained from report by participant/subject or proxy. Document whether this information was obtained prior to study enrollment or later. Recommend collection as soon as possible after visit/admission. |
Corrigan JD, Bogner J, Holloman C. Lifetime history of traumatic brain injury among persons with substance use disorders. Brain Inj. 2012;26(2):139-50. | Adult;Pediatric | Supplemental | 1.00 | 2014-05-27 13:34:46.0 | Behavioral History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
3170860 | ||||||||
| C00713 | Drug or substance current illicit use indicator | DrgSubstCurrntIllicitUseInd | Indicator of participant's/subject's use of illegal drugs, prescription or over-the-counter drugs in the past year for purposes other than those for which they are meant to be used, or in large amounts | Indicator of participant's/subject's use of illegal drugs, prescription or over-the-counter drugs in the past year for purposes other than those for which they are meant to be used, or in large amounts | Indicates illicit drug use in the past year | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose one. Response is obtained by report of the participant/subject or proxy as soon as possible after visit/admission. Document when the behavioral history was collected so as to determine whether this information was obtained prior to study enrollment or later. Do not record medications that are prescribed for medical purposes (these should be entered in the element 'medical history'.) Collect information on substances and medications taken for reasons other than prescription, or taken more frequently or at higher doses than prescribed. Assure participant/subject that information on such use will be treated as strictly confidential. Recommend collection as soon as possible after visit/admission. Substance abuse directly before injury may have contributed to the incident causing injury. In general, substance abuse may indicate increased risk taking behavior. |
Corrigan JD, Bogner J, Holloman C. Lifetime history of traumatic brain injury among persons with substance use disorders. Brain Inj. 2012;26(2):139-50. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3171724 | |||||||
| C00715 | Alcohol use duration | AlcoholUseDuratn | Duration in years participant/subject has used alcohol (ingesting of alcoholic beverages, including social drinking) | Duration in years participant/subject has used alcohol (ingesting of alcoholic beverages, including social drinking) | Alcohol use duration in years | Numeric Values |
Response is obtained by report of the participant/subject or proxy as soon as possible after visit/admission. Document when the behavioral history was collected so as to determine whether this information was obtained prior to study enrollment or later. Substance abuse directly before injury may have contributed to the incident causing injury. In general, substance abuse may indicate increased risk taking behavior. |
Corrigan JD, Bogner J, Holloman C. Lifetime history of traumatic brain injury among persons with substance use disorders. Brain Inj. 2012;26(2):139-50. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 99 | ||||||||
| C00716 | Drug or substance illicit use duration | DrgSubsIllctUseDur | Duration, in years, the participant/subject has used unprescribed, controlled psychoactive drugs or substances | Duration, in years, the participant/subject has used unprescribed, controlled psychoactive drugs or substance | Duration in years of illicit drug use | Numeric Values |
Response is obtained by report of the participant/subject or proxy as soon as possible after visit/admission. Document when the behavioral history was collected so as to determine whether this information was obtained prior to study enrollment or later. Do not record medications that are prescribed for medical purposes (these should be entered in the element 'medical history'.) Collect information on substances and medications taken for reasons other than prescription, or taken more frequently or at higher doses than prescribed. Assure participant/subject that information on such use will be treated as strictly confidential. Recommend collection as soon as possible after visit/admission. Substance abuse directly before injury may have contributed to the incident causing injury. In general, substance abuse may indicate increased risk taking behavior. |
Corrigan JD, Bogner J, Holloman C. Lifetime history of traumatic brain injury among persons with substance use disorders. Brain Inj. 2012;26(2):139-50. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 99 | Year | 2004152 | ||||||
| C00717 | Drug or substance prior illicit use indicator | DrugSubstncPriorIllictUseInd | Indicator of participant's/subjects use of illegal drugs, prescription or over-the-counter drugs prior to the past 12 months for purposes other than those for which they are meant to be used, or in large amounts | Indicator of participant's/subjects use of illegal drugs, prescription or over-the-counter drugs prior to the past 12 months for purposes other than those for which they are meant to be used, or in large amounts | Indicates illicit drug use prior to the past 12 months | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose one. Response is obtained by report of the participant/subject or proxy as soon as possible after visit/admission. Document when the behavioral history was collected so as to determine whether this information was obtained prior to study enrollment or later. Do not record medications that are prescribed for medical purposes (these should be entered in the element 'medical history'.) Collect information on substances and medications taken for reasons other than prescription, or taken more frequently or at higher doses than prescribed. Assure participant/subject that information on such use will be treated as strictly confidential. Recommend collection as soon as possible after visit/admission. Substance abuse directly before injury may have contributed to the incident causing injury. In general, substance abuse may indicate increased risk taking behavior. |
Corrigan JD, Bogner J, Holloman C. Lifetime history of traumatic brain injury among persons with substance use disorders. Brain Inj. 2012;26(2):139-50. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
||||||||
| C00718 | Tobacco use duration | TobcoUseDur | Duration in years participant/subject has used tobacco products (e.g. cigarettes, cigars, chewing tobacco or pipe) | Duration in years participant/subject has used tobacco products (e.g. cigarettes, cigars, chewing tobacco or pipe) | Tobacco use duration in years | Numeric Values |
Response is obtained by report of the participant/subject or proxy as soon as possible after visit/admission. Document when the behavioral history was collected so as to determine whether this information was obtained prior to study enrollment or later. Substance abuse directly before injury may have contributed to the incident causing injury. In general, substance abuse may indicate increased risk taking behavior. |
Corrigan JD, Bogner J, Holloman C. Lifetime history of traumatic brain injury among persons with substance use disorders. Brain Inj. 2012;26(2):139-50. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 99 | year | |||||||
| C00719 | Tobacco product used type | TobcoProdctUsedTyp | Type of tobacco product (e.g., cigarettes, cigars, chewing tobacco or pipe) used by the participant/subject | Type of tobacco product (e.g., cigarettes, cigars, chewing tobacco or pipe) used by the participant/subject | Type(s) of tobacco used | Filtered cigarettes;Non-filtered cigarettes;Low tar cigarettes;Cigars;Pipes;Chewing tobacco;Other, specify | Filtered cigarettes;Non-filtered cigarettes;Low tar cigarettes;Cigars;Pipes;Chewing tobacco;Other, specify | Alphanumeric |
Choose all that apply. Response is obtained from report by participant/subject or proxy. Document whether this information was obtained prior to study enrollment or later. Recommend collection as soon as possible after visit/admission. |
Corrigan JD, Bogner J, Holloman C. Lifetime history of traumatic brain injury among persons with substance use disorders. Brain Inj. 2012;26(2):139-50. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Behavioral History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
3179449v1 | |||||||
| C00731 | Alcohol use last month days drank number | AlcoholUseLastMoDayDrnkNum | During the past 30 days, how many days per month did you have at least one drink of any alcoholic beverage such as beer, wine, a malt beverage or liquor? | During the past 30 days, how many days per month did you have at least one drink of any alcoholic beverage such as beer, wine, a malt beverage or liquor? | During the past 30 days, how many days per month did you have at least one drink of any alcoholic beverage such as beer, wine, a malt beverage or liquor? | Numeric Values |
The suggested range is 0 - 30. |
Please refer the Behavioral Risk Factor Surveillance System (BRFSS) instrument for capturing alcohol consumption http://www.cdc.gov/brfss/ | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 30 | ||||||||
| C00706 | Alcohol prior use indicator | AlcPriorUseInd | Indicator of the participant's/subject's alcohol consumption prior to the past 12 months | Indicator of the participant's/subject's alcohol consumption prior to the past 12 months | Indicates alcohol use prior to the last 12 months | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose one. Document when the behavioral history was collected so as to determine whether this information was obtained prior to study enrollment or later. Response is obtained by report of the participant/subject or proxy as soon as possible after visit/admission. Substance abuse directly before injury may have contributed to the incident causing injury. In general, substance abuse may indicate increased risk taking behavior. |
Corrigan JD, Bogner J, Holloman C. Lifetime history of traumatic brain injury among persons with substance use disorders. Brain Inj. 2012;26(2):139-50. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3171578 | |||||||
| C00732 | Alcohol use last month drinking day average drinks number | AlchlUseLstMoDrnkDyAvgDrnksNum | During the past 30 days, on the days when you drank, about how many drinks did you drink on the average? NOTE: One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or a drink with one shot of liquor. A 40 ounce beer would count as 3 drinks, or a cocktail drink with 2 shots would count as 2 drinks | During the past 30 days, on the days when you drank, about how many drinks did you drink on the average? NOTE: One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or a drink with one shot of liquor. A 40 ounce beer would count as 3 drinks, or a cocktail drink with 2 shots would count as 2 drink | During the past 30 days, on the days when you drank, about how many drinks did you drink on the average? | Numeric Values |
Response is obtained from report by participant/subject or proxy. Recommend collection as soon as possible after visit/admission. |
Please refer the Behavioral Risk Factor Surveillance System (BRFSS) instrument for capturing alcohol consumption http://www.cdc.gov/brfss/ | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 30 |
