CDE Detailed Report
Disease: Stroke
Subdomain Name: General Health History
CRF: Behavioral History
Displaying 1 - 30 of 30
Subdomain Name: General Health History
CRF: Behavioral History
Displaying 1 - 30 of 30
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C55953 | Tobacco use stopped age not applicable status | TobcoUseStopAgeNoAplcblStat | Status indicating that age stopped tobacco use does not apply to the subject/participant as they are still using tobacco | Status indicating that age stopped tobacco use does not apply to the subject/participant as they are still using tobacc | Age stopped tobacco use | N/A – still using tobacco | N/A – still using tobacco | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Skip if current tobacco use and past tobacco use are both NO. N/A (not applicable) should be selected if participant/ subject is still using tobacco. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
2524471 | ||||||
| C58945 | Regular moderate intense aerobic exercise physical activity indicator | RglrMdIntArbcExrcPhysActInd | Indicator related to whether or not the participant/subject participates in regular aerobic exercise (moderate intensity physical activity). Moderate-intensity physical activities cause small increases in breathing or heart rate and are done for at least 10 minutes continuously | Indicator related to whether or not the participant/subject participates in regular aerobic exercise (moderate intensity physical activity). Moderate-intensity physical activities cause small increases in breathing or heart rate and are done for at least |
Regular aerobic exercise (moderate intensity physical activity, such as brisk walking, bicycling, swimming, or golf) Moderate-intensity physical activities cause small increases in breathing or heart rate and are done for at least 10 minutes continuously. |
No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
Adapted from: Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Questionnaire (or Examination Protocol, or Laboratory Protocol). Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2017 https://wwwn.cdc.gov/nchs/data/nhanes/2017-2018/questionnaires/PAQ_J.pdf. | Adult;Pediatric | Supplemental | 1.00 | 2020-07-15 10:08:19.0 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C55966 | Alcohol use stopped age not applicable status | AlcUseStopAgeNoAplcblStat | Status indicating that age quit drinking does not apply to the subject/participant, as they are still ingesting alcoholic beverages, including social drinking | Status indicating that age quit drinking does not apply to the subject/participant, as they are still ingesting alcoholic beverages, including social drinking | Age quit drinking | N/A – still drinking alcohol | N/A – still drinking alcohol | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Skip if current drinker and past drinker are both NO. N/A (not applicable) should be selected if participant/ subject is still drinking alcohol. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
2008448 | |||||||
| C58946 | Regular moderate intense aerobic exercise physical activity days week number | RglrMdIntArbcExrcPhysAcDyWkNum | Number of days per typical week that the participant/subject engages in at least moderate-intensity aerobic exercise physical activities. Moderate-intensity physical activities cause small increases in breathing or heart rate and are done for at least 10 minutes continuously | Number of days per typical week that the participant/subject engages in at least moderate-intensity aerobic exercise physical activities. Moderate-intensity physical activities cause small increases in breathing or heart rate and are done for at least 10 | On how many days in a typical week do you do at least moderate-intensity aerobic exercise, such as brisk walking, bicycling, swimming, or golf? | Numeric Values |
No instructions available |
Adapted from: Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Questionnaire (or Examination Protocol, or Laboratory Protocol). Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2017 https://wwwn.cdc.gov/nchs/data/nhanes/2017-2018/questionnaires/PAQ_J.pdf. | Adult;Pediatric | Supplemental | 1.00 | 2020-07-15 10:09:42.0 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 7 | day | |||||||
| C58936 | Drug or substance current illicit or recreational use indicator | DrgSubstCurrntIllicitRecUseInd | 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 | Current illicit or recreational drug or substance user? (Use of any illicit or recreational drug within the past year) | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
No references available | Adult;Pediatric | Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C58937 | Drug or substance illicit or recreational use category | DrgSubIllctRecUseCat | Category of illegal or recreational drugs or substances, 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, in large amounts, or for recreational purposes | Category of illegal or recreational drugs or substances, prescription, or OTC drugs subscribed by the participant/subject, and used for purposes other than those for which they are meant to be used, in large amounts, or for recreational purposes | IF YES, specify 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 |
Select all that apply. History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
No references available | Adult;Pediatric | Supplemental-Highly Recommended | 3.00 | 2013-07-22 09:34:41.527 | Behavioral History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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| C58938 | Drug or substance illicit or recreational use other text | DrgSubIllctRecUseOTH | The free-text field related to 'Drug or substance illicit or recreational use category', specifying other text | The free-text field related to 'Drug or substance illicit or recreational use category', specifying other tex | Other, specify | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
No references available | Adult;Pediatric | Supplemental-Highly Recommended | 1.00 | 2014-05-27 13:34:46.0 | Behavioral History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
3171797 | ||||||||
| C58939 | Tobacco cigarette use started age value | TobcoCigaretUseStrtAgeVal | Age in years when participant/subject started using cigarettes | Age in years when participant/subject started using cigarette | Age started cigarette use | Numeric Values |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Skip if cigarettes is NOT an answer in type(s) of tobacco used. The age in years should be collected. |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2020-07-15 09:46:07.0 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 120 | year | |||||||
| C58940 | Tobacco cigarette use stopped age value | TobcoCigaretUseStopAgeVal | Age in years when participant/subject stopped using cigarettes | Age in years when participant/subject stopped using cigarette | Age stopped cigarette use | Numeric Values |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Skip if cigarettes is NOT an answer in type(s) of tobacco used. The age in years should be collected or N/A (Not applicable if participant/ subject is still using cigarettes) should be selected. |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2020-07-15 09:47:51.0 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 120 | year | |||||||
| C58941 | Tobacco cigarette use stopped age not applicable status | TobcoCigaretUseStopAgeNoApStat | Status indicating that age stopped cigarette use does not apply to the subject/participant, as they are still using cigarettes | Status indicating that age stopped cigarette use does not apply to the subject/participant, as they are still using cigarette | Age stopped cigarette use | N/A – still using cigarettes | N/A – still using cigarettes | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Skip if cigarettes is NOT an answer in type(s) of tobacco used. N/A (not applicable) should be selected if participant/ subject is still using cigarettes. |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2020-07-15 09:54:41.0 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C58942 | E-cigarette electronic vapor product use ever indicator | EcigaretElecVapProdUseEverInd | The indicator related to whether the participant/subject has ever used an e-cigarette or other electronic vaping product, even just one time, in their entire life | The indicator related to whether the participant/subject has ever used an e-cigarette or other electronic vaping product, even just one time, in their entire lif | Have you ever used an e-cigarette or other electronic vaping product, even just one time, in your entire life? | Yes;No;Don't know/Not sure;Refused | Yes;No;Don't know/Not sure;Refused | Alphanumeric |
No instructions available |
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Questionnaire. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2018. | Adult;Pediatric | Supplemental | 1.00 | 2020-07-15 09:56:11.0 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C58943 | E-cigarette electronic vapor product use status | EcigaretElecVapProdUseStat | Status of participant/subject's use of e-cigarettes or other electronic vaping products | Status of participant/subject's use of e-cigarettes or other electronic vaping product | Do you now use e-cigarettes or other electronic vaping products every day, some days, or not at all? | Every day;Some days;Not at all;Don't know/Not sure;Refused | Every day;Some days;Not at all;Don't know/Not sure;Refused | Alphanumeric |
No instructions available |
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Questionnaire. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2018. | Adult;Pediatric | Supplemental | 1.00 | 2020-07-15 10:00:12.0 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C06108 | Tobacco smoke pack-year value | TobccoSmkePckYrVal | If participant is a former or current cigarette smoker, documents the number of pack-years of smoking [(average number smoked daily)/20] x (number of years smoked) = pack-years] | If participant is a former or current cigarette smoker, documents the number of pack-years of smoking [(average number smoked daily)/20] x (number of years smoked) = pack-years] | For former or current cigarette smokers only, the number of pack-years of smoking | Numeric Values |
[(average number of cigarettes smokes daily)/20] x (number of years smoked) |
No references available | Adult;Pediatric | Supplemental-Highly Recommended | 3.00 | 2013-07-17 09:26:36.973 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
pack-years | |||||||||
| C58944 | Alcohol 30 day use indicator | Alc30DayUseInd | Indicator of whether the participant/subject consumed at least one alcoholic drink within the past 30 days | Indicator of whether the participant/subject consumed at least one alcoholic drink within the past 30 days | Current drinker? Consumed at least one drink within past 30 days | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
No references available | Adult;Pediatric | Supplemental-Highly Recommended | 1.00 | 2020-07-15 10:07:22.0 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| 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 | Past drinker? (Consumed at least one drink per month prior to the past year) | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Past drinking is defined as consuming at least one drink per month prior to the past year. |
CDC/National Center for Health Statistics. (2018). National Health Interview Survey Glossary - Alcohol. Accessed 01Apr2020 from: https://www.cdc.gov/nchs/nhis/alcohol/alcohol_glossary.htm.<br /><br />American Public Health Association and Education Development Center, Inc. (2008). Alcohol screening and brief intervention: A guide for public health practitioners. Washington DC: National Highway Traffic Safety Administration, U.S. Department of Transportation. Accessed 15Jul2020 from: https://www.lifespan.org/sites/default/files/lifespan-files/documents/centers/injury-prevention-center/alcohol-screeening-and-brief-intervention-web.pdf | Adult;Pediatric | Supplemental-Highly Recommended | 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 | |||||||
| C00707 | Alcohol consume six or more drinks frequency | AlcConsume6MoreDrinkFreq | The rate of occurrence for when the participant/subject consumes six or more drinks containing alcohol on one occasion. It is noted that the meaning of "drinks consumed" differs from one nation and culture to another, so the most common alcoholic beverages likely to be consumed will be defined as well as quantity of each that constitutes a drink (approximately 10 grams of pure ethanol). For example, one bottle of beer (330 ml at 5% ethanol), a glass of wine (140 ml at 12% ethanol), and a shot of spirits (40 ml at 40% ethanol) represent a standard drink of about 13 g of ethanol | The rate of occurrence for when the participant/subject consumes six or more drinks containing alcohol on one occasion. It is noted that the meaning of "drinks consumed" differs from one nation and culture to another | How often do you have six or more drinks on one occasion? | Never;Less than monthly;Monthly;Weekly;Daily or almost daily;Unknown | Never;Less than monthly;Monthly;Weekly;Daily or almost daily;Unknown | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
Question is from the Alcohol Use Disorders Identification Test (AUDIT) - http://www.who.int/substance_abuse/activities/sbi/en/ | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 16:35:19.49 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3171659 | |||||||
| C00708 | Alcohol use related to hospitalization indicator | AlcUseRelatedHospInd | Indicator of whether the participant/subject has been hospitalized for an alcohol-related problem (i.e., esophageal varices, delirium tremens (DTs), cirrhosis and others) | Indicator of whether the participant/subject has been hospitalized for an alcohol-related problem (i.e., esophageal varices, delirium tremens (DTs), cirrhosis and others) | Have you ever been hospitalized for an alcohol-related problem | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
e.g., esophageal varices, delirium tremens (DTs), cirrhosis, etc. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3171677 | |||||||
| C00709 | Tobacco cigarettes smoked daily average number | TobcoCigaretSmokedDlyAvgNum | Average number of cigarettes the participant/subject smokes daily (On the days you smoked cigarettes during the past 30 days, how many cigarettes did you smoke per day, on average?) | Average number of cigarettes the participant/subject smokes daily (On the days you smoked cigarettes during the past 30 days, how many cigarettes did you smoke per day, on average?) | Average number of cigarettes smoked per day | Less than one cigarette per day;1 cigarette per day;2 to 5 cigarettes per day;6 to 15 cigarettes per day (about 1/2 pack);16 to 25 cigarettes per day (about 1 pack);26 to 35 cigarettes per day (about 1 1/2 packs);More than 35 cigarettes per day (about 2 packs or more);Unknown | Less than one cigarette per day;1 cigarette per day;2 to 5 cigarettes per day;6 to 15 cigarettes per day (about ½ pack);16 to 25 cigarettes per day (about 1 pack);26 to 35 cigarettes per day (about 1 ½ packs);More than 35 cigarettes per day (about 2 packs or more);Unknown | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Skip if cigarettes is NOT an answer in type(s) of tobacco used. |
PhenX Toolkit: https://www.phenxtoolkit.org/index.php - Protocol 1: Tobacco - 30-Day Quantity and Frequency (Adolescent Protocol) #030801 | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3170853 | |||||||
| 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 |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
No references available | Adult;Pediatric | Supplemental-Highly Recommended | 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 | |||||||
| C00700 | Alcohol use stopped age value | AlcUseStopAgeVal | Age in years when participant/subject stopped ingesting alcoholic beverages, including social drinking | Age in years when participant/subject stopped ingesting alcoholic beverages, including social drinking | Age quit drinking | Numeric Values |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Skip if current drinker and past drinker are both NO. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 120 | year | 2008448 | ||||||
| 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 |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
No references available | Adult;Pediatric | Supplemental-Highly Recommended | 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 | |||||||
| C00701 | Tobacco use stopped age value | TobcoUseStopAgeVal | Age in years when participant/subject stopped using tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) | Age in years when participant/subject stopped using tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) | Age stopped tobacco use | Numeric Values |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Skip if current tobacco use and past tobacco use are both NO. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 120 | year | 2524471 | ||||||
| C00714 | Behavioral history assessment date and time | BehavrlHistAssmtDateTime | Date (and time, if applicable and known) the participant/subject behavioral history was taken | Date (and time, if applicable and known) the participant/subject behavioral history was take | Date behavioral history taken | Date or Date & Time |
Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.). |
No references available | Adult;Pediatric | Supplemental-Highly Recommended | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
3170040 | |||||||||
| C00702 | Alcohol use started age value | AlcUseStrtAgeVal | Age in years when participant/subject started ingesting alcoholic beverages, including social drinking | Age in years when participant/subject started ingesting alcoholic beverages, including social drinking | Age started drinking | Numeric Values |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Skip if current drinker and past drinker are both NO. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 120 | year | 2008447 | ||||||
| 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;e-cigarette or vaping products | Filtered cigarettes;Non-filtered cigarettes;Low tar cigarettes;Cigars;Pipes;Chewing tobacco;Other, specify;e-cigarette or vaping products | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. If answer is filtered cigarettes, non-filtered cigarettes, or low tar cigarettes, then answer questions: age started cigarette use, age stopped cigarette use, average number of ciagrettes smoked per day, and number of pack-years of smoking. |
No references available | 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 | |||||||
| C00703 | Tobacco use started age value | TobcoUseStrtAgeVal | Age in years when participant/subject started using tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) | Age in years when participant/subject started using tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) | Age started tobacco use | Numeric Values |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. Skip if current tobacco use and past tobacco use are both NO. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 120 | year | 2178045 | ||||||
| C00730 | Alcohol use frequency | AlcUseFreq | The frequency of consumption of alcohol by the participant | The frequency of consumption of alcohol by the participan | How often do you have a drink containing alcohol? | Monthly or less;2 to 4 times a month;2 to 3 times a week;4 or more times a week;Unknown;Never | Monthly or less;2 to 4 times a month;2 to 3 times a week;4 or more times a week;Unknown;Never | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
Question is from the Alcohol Use Disorders Identification Test (AUDIT) - http://www.who.int/substance_abuse/activities/sbi/en/ | Adult;Pediatric | Supplemental-Highly Recommended | 3.00 | 2013-07-18 16:35:19.49 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3171627 | |||||||
| C00704 | Alcohol drinking day average drinks consumed range | AlcDrinkingDayAvgDrinksCnsmRng | The counted number of drinks containing alcohol consumed by the participant/subject on a typical day when he/she is drinking. It is noted that the meaning of "drinks consumed" differs from one nation and culture to another, so the most common alcoholic beverages likely to be consumed will be defined as well as quantity of each that constitutes a drink (approximately 10 grams of pure ethanol). For example, one bottle of beer (330 ml at 5% ethanol), a glass of wine (140 ml at 12% ethanol), and a shot of spirits (40 ml at 40% ethanol) represent a standard drink of about 13 g of ethanol | The counted number of drinks containing alcohol consumed by the participant/subject on a typical day when he/she is drinking. It is noted that the meaning of "drinks consumed" differs from one nation and culture to another | How many alcoholic drinks do you have on a typical day when you are drinking | 1 or 2;3 or 4;5 or 6;7, 8, or 9;10 or more;Unknown | 1 or 2;3 or 4;5 or 6;7, 8, or 9;10 or more;Unknown | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
Question is from the Alcohol Use Disorders Identification Test (AUDIT) - http://www.who.int/substance_abuse/activities/sbi/en/ | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 16:35:19.49 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3171647 | |||||||
| 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 |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. |
No references available | 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 | ||||||||
| C00705 | Alcohol current use indicator | AlcCurntUseInd | Indicator of whether the participant/subject consumed at least one alcoholic drink within the past 12 months | Indicator of whether the participant/subject consumed at least one alcoholic drink within the past 12 months | Current drinker? Consumed at least one drink within past year | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
History can be obtained from participant/ subject, family member, friend, or chart/ medical record. In the U.S., a single drink serving contains about 14 grams of ethanol or "pure" alcohol. Although the drinks below are different sizes, each one contains the same amount of pure alcohol and counts as a single drink: 12 oz. of beer (about %% alcohol) = 8-9 oz. of malt liquor (about 7% alcohol) = 5 oz. of wine (about 12% alcohol) = 1.5 oz. of hard liquor (about 40% alcohol) |
No references available | Adult;Pediatric | Supplemental-Highly Recommended | 3.00 | 2013-07-18 14:26:06.9 | Behavioral History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3171540 |
