CDE Detailed Report

Disease: Stroke
Sub-Domain: General Health History
CRF: Behavioral History

Displaying 1 - 30 of 30
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (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
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.
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 1.00 2020-07-15 10:07:22.0 Behavioral History General Health History Participant History and Family History

Single Pre-Defined Value Selected

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 tobacco. 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

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

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

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 text. 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 cigarettes. 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 cigarettes. 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 cigarettes. 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

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 life. 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

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 products. 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

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 &#8211; 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.
History can be obtained from participant/ subject, family member, friend, or chart/ medical record.

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 time. 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.
The age in years should be collected or N/A (Not applicable if participant/ subject is still drinking alcohol) should be selected.

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 2013-07-20 10:21:25.65 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.
The age in years should be collected or N/A (Not applicable if participant/ subject is still using tobacco) should be selected.

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 taken. 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.
The age in years should be collected.

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.
The age in years should be collected.

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 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;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
CSV