Form SU - Substance Use
Substance Use_Tobacco
What is/was the category of the substance (used)?
Has the subject ever used tobacco?
Current
Previous
Never
What [is/was] the [name/type] of (the) substance used?
Choose
Cigarettes
e-Cigarettes
Cigars
Pipe
Smokeless tobacco
What was the amount?
What was the unit?
Choose
Pack
Cigarette
Cigar
Milliliter
Pipe
Cartridge
Pouch
What [is/was] the frequency?
Choose
Daily
Once Weekly
Monthly
Per Year
What was the start date of use?
01 Jan 2000
What was the end date of use?
01 Jan 2000
*
Mandatory field