CDE Detailed Report

Disease: Parkinson's Disease
Sub-Domain: Epidemiology/Environmental History
CRF: Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco

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 / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C09258 Risk Factor Questionnaire (RFQ) - age year start regularly smoking value RFQAgeYrStrtRegSmokingVal Age or year the participant/subject started regularly smoking cigarettes as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Age or year the participant/subject started regularly smoking cigarettes as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. If Yes, at what age (or in what year) did you start regularly smoking cigarettes? Numeric Values

Only answer for Age or Year; not both. Age should be answered in years Year should be answered in the 4-digit format

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C10474 Risk Factor Questionnaire (RFQ) - average cigarettes smoked per day number RFQAvgCigsSmokedPerDayNum Average number of cigarettes smoked per day by the participant/subject when regularly smoking as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Average number of cigarettes smoked per day by the participant/subject when regularly smoking as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. During the time that you regularly smoked, on average, how much did you smoke PER DAY? Numeric Values

No instructions available

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C09259 Risk Factor Questionnaire (RFQ) - age year stop regularly smoking value RFQAgeYrStopRegSmokingVal Age or year the participant/subject stopped regularly smoking cigarettes as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Age or year the participant/subject stopped regularly smoking cigarettes as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. If Yes, at what age (or in what year) did you stop regularly smoking cigarettes? Numeric Values

Only answer for Age or Year; not both. Age should be answered in years Year should be answered in the 4-digit format

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C10475 Risk Factor Questionnaire (RFQ) - currently use smokeless tobacco status RFQCurntlyUseSmklessTobcoStat Smokeless tobacco use status of the participant/subject to determine if they are currently using smokeless tobacco or snuff as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Smokeless tobacco use status of the participant/subject to determine if they are currently using smokeless tobacco or snuff as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Currently use Currently Use Currently Use Alphanumeric

No instructions available

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C09260 Risk Factor Questionnaire (RFQ) - period no regular smoking status RFQPrdNoRegSmokingStatus Smoking status of the participant/subject to determine if there were periods of a year or more where they did not regularly smoke as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Smoking status of the participant/subject to determine if there were periods of a year or more where they did not regularly smoke as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Were there periods of a year or more when you did NOT regularly smoke cigarettes? No;Yes No;Yes Alphanumeric

Skip to Question 4

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C09261 Risk Factor Questionnaire (RFQ) - start age no regular smoking value RFQStrtAgeNoRegSmokingVal Age where the participant/subject started to stop smoking as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Age where the participant/subject started to stop smoking as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Start age Numeric Values

Years

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C09262 Risk Factor Questionnaire (RFQ) - stop age no regular smoking value RFQStopAgeNoRegSmokingVal Age where the participant/subject started smoking again as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Age where the participant/subject started smoking again as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Stop age Numeric Values

Years

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C09263 Risk Factor Questionnaire (RFQ-U) - smoking no tobacco use age range RFQSmkngTobcoUsAgeRange Period 3: If Yes, what ages were you when you did NOT regularly smoke? Period 3: If Yes, what ages were you when you did NOT regularly smoke? Alphanumeric

Enter the 'Start Age' and 'Stop Age' for each period Age should be answered in years Year should be answered in the 4-digit format

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco Epidemiology/Environmental History Participant History and Family History 10

Free-Form Entry

C09264 Risk Factor Questionnaire (RFQ) - average packs smoked per day number RFQAvgPacksSmokedPerDayNum Average number of cigarette packs the participant/subject smoked per day when regularly smoking as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Average number of cigarette packs the participant/subject smoked per day when regularly smoking as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. During the time that you regularly smoked, on average, how much did you smoke PER DAY? Numeric Values

No instructions available

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C09265 Risk Factor Questionnaire (RFQ) - used smokeless snuff tobacco status RFQUsedSmklessSnuffTobcoStatus Determine if the subject/participant used smokeless tobacco or snuff regularly as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Determine if the subject/participant used smokeless tobacco or snuff regularly as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Have you ever used smokeless tobacco such as chewing tobacco or snuff regularly, that is, at least once per day for 6 months or longer? No;Yes No;Yes Alphanumeric

End of Questionnaire

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C09266 Risk Factor Questionnaire (RFQ) - age or year start regularly using smokeless tobacco value RFQAgeYrStrtRegSmklessTobcoVal Age or year when the subject/participant started using smokeless tobacco or snuff regularly as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Age or year when the subject/participant started using smokeless tobacco or snuff regularly as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. If Yes, at what age (or in what year) did you start regularly using smokeless tobacco? Numeric Values

Only answer for Age or Year; not both. Age should be answered in years Year should be answered in the 4-digit format.

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C09256 Risk Factor Questionnaire (RFQ) - lifetime smoked status RFQLifetimeSmokedStatus Lifetime smoking status of the participant/subject to determine if they have smoked 100 or more cigarettes as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Lifetime smoking status of the participant/subject to determine if they have smoked 100 or more cigarettes as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. In your lifetime, have you smoked 100 or more cigarettes (5 packs)? No;Yes No;Yes Alphanumeric

Skip to Question 5

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C09267 Risk Factor Questionnaire (RFQ) - age year stop regularly using smokeless tobacco value RFQAgeYrStpRgUsSmklessTobcoVal Age or year when the subject/participant stopped using smokeless tobacco or snuff regularly as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Age or year when the subject/participant stopped using smokeless tobacco or snuff regularly as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. If Yes, at what age (or in what year) did you stop regularly using smokeless tobacco? Numeric Values

Only answer for Age or Year; not both. Age should be answered in years Year should be answered in the 4-digit format.

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C09257 Risk Factor Questionnaire (RFQ) - lifetime regularly smoked status RFQLifetimeRegSmokedStatus Lifetime smoking status of the participant/subject to determine if they have smoked regularly as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Lifetime smoking status of the participant/subject to determine if they have smoked regularly as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. In your lifetime, have you ever regularly smoked cigarettes, that is, at least one cigarette per day for 6 months or longer? No;Yes No;Yes Alphanumeric

Skip to Question 5

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C10473 Risk Factor Questionnaire (RFQ) - currently smoking status RFQCurntlySmokingStatus Smoking status of the participant/subject to determine if they are currently smoking as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Smoking status of the participant/subject to determine if they are currently smoking as part of the Risk Assessment Questionnaire (RFQ) Smoking and Tobacco. Currently smoke Currently smoke Currently smoke Alphanumeric

No instructions available

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ-U) - Smoking and Tobacco Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

CSV