CDE Detailed Report

Disease: Sport Related Concussion
Sub-Domain: General Health History
CRF: Substance Use

Displaying 1 - 11 of 11
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
C19502 Tobacco cigarettes smoke daily average value TobccoCigrtSmkeDailyAvgVal Tobacco cigarettes smoked daily average number If participant is a former or current smoker, documents the average number of cigarettes he/she smokes or did smoke on a daily basis If a current or former smoker, on average how many cigarettes do (did) you smoke on a daily basis: Numeric Values Adult Supplemental 3.00 2013-07-17 09:26:36.973 Substance Use General Health History Participant History and Family History

Free-Form Entry

C06103 Tobacco smoke quit date TobccoSmkeQuitDate Date (and time, if applicable and known) the participant/subject quit smoking Date (and time, if applicable and known) the participant/subject quit smoking If a former smoker, which year did you quit smoking? Date or Date & Time Adult Supplemental 3.00 2013-07-17 09:26:36.973 Substance Use General Health History Participant History and Family History

Free-Form Entry

C06106 Tobacco cigar smoke daily average value TobccoCigrSmkeDailyAvgVal If participant is a former or current smoker, documents the average number of cigars he/she smokes or did smoke on a daily basis If participant is a former or current smoker, documents the average number of cigars he/she smokes or did smoke on a daily basis If a former or current smoker, on average how many cigars do (did) you smoke on a daily basis Numeric Values Adult Supplemental 3.00 2013-07-17 09:26:36.973 Substance Use General Health History Participant History and Family History

Free-Form Entry

C06107 Tobacco pipe bowl smoke daily average value TobccoPipeBwlSmkeDailyAvgVal If participant is a former or current smoker, documents the average number of pipe bowls he/she smokes or did smoke on a daily basis If participant is a former or current smoker, documents the average number of pipe bowls he/she smokes or did smoke on a daily basis If a former or current smoker, on average how many pipe bowls do (did) you smoke on a daily basis Numeric Values Adult Supplemental 3.00 2013-07-17 09:26:36.973 Substance Use General Health History Participant History and Family History

Free-Form Entry

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: [ (average number of cigarettes smoked daily)/20] x (number of year smoked): Numeric Values Adult Supplemental 3.00 2013-07-17 09:26:36.973 Substance Use General Health History Participant History and Family History

Free-Form Entry

pack-years
C22777 Illicit drug indicator IllctDrgInd Indicator of subject's use of illicit or non-prescription drugs Indicator of subject's use of illicit or non-prescription drugs During the last 12 months (or during the time since your injury, if year 1 follow-up) did you use any illicit or non-prescription drugs? No;Refused;Unknown;Yes No;Refused;Unknown;Yes Numeric Values Adult Supplemental 3.00 2013-07-20 10:21:25.65 Substance Use General Health History Participant History and Family History

Single Pre-Defined Value Selected

C22778 Illicit drugs used type IllcitDrgUseTyp Illicit or non-prescription drugs used by the subject. Illicit or non-prescription drugs used by the subject. If yes for above, please indicate the drugs used: Crack/Cocaine;Pot/Marijuana;LSD/Hallucinogens;Heroin/Opiates;Speed/Stimulants;Unknown;List other drugs Crack/Cocaine;Pot/Marijuana;LSD/Hallucinogens;Heroin/Opiates;Speed/Stimulants;Unknown;List other drugs Alphanumeric Adult Supplemental 3.00 2013-07-20 10:21:25.65 Substance Use General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

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 Never;Less than monthly;Monthly;Weekly;Daily or almost daily Alphanumeric Adult Supplemental 3.00 2013-07-18 16:35:19.49 Substance Use General Health History Participant History and Family History

Single Pre-Defined Value Selected

3171659
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) If a former or current smoker, for how many years did (have) you smoked? Numeric Values Adult Supplemental 3.00 2013-07-20 10:21:25.65 Substance Use General Health History Participant History and Family History

Free-Form Entry

0 99 year
C00730 Alcohol use frequency AlcUseFreq The frequency of consumption of alcohol by the participant. The frequency of consumption of alcohol by the participant. 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;Never Monthly or less;2 to 4 times a month;2 to 3 times a week;4 or more times a week;Never Alphanumeric Adult Supplemental 3.00 2013-07-18 16:35:19.49 Substance Use General Health History Participant History and Family History

Single Pre-Defined Value Selected

3171627
C06102 Tobacco smoke history status TobccoSmkeHistStatus Qualitative categorization of the participant's/subject's smoking history Qualitative categorization of the participant's/subject's smoking history Tobacco history: Never smoked;Former smoker;Current smoker;Unknown Never smoked;Former smoker;Current smoker;Unknown Alphanumeric Adult Supplemental 3.00 2013-07-17 09:26:36.973 Substance Use General Health History Participant History and Family History

Single Pre-Defined Value Selected

CSV