CDE Detailed Report
Disease: Sport-Related Concussion
Subdomain Name: General Health History
CRF: Substance Use
Displaying 1 - 11 of 11
Subdomain Name: 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 / 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
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| 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 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;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 |
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| 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 |
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| 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 |
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| 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 |
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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: [ (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 |
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| C22778 | Illicit drugs used type | IllcitDrgUseTyp | Illicit or non-prescription drugs used by the subject | Illicit or non-prescription drugs used by the subjec | 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 |
