CDE Detailed Report

Disease: Traumatic Brain Injury
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
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
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 2013-07-20 10:21:25.65 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
CSV