Tobacco Implementation Guide-Demography
General Demography
What is the subject's date of birth?	01 Jan 2000
What is the sex of the subject?	Choose Female Male Unknown Undifferentiated
Do you consider yourself Hispanic/Latino or not Hispanic/Latino?	Choose Hispanic or Latino Not Hispanic or Latino Not Reported Unknown
Which of the following five racial designations best describes you? (More than one choice is acceptable.)	Choose American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Not Reported Unknown Other
If Race: Asian
Which of the following Asian racial designations best describes you? (More than 1 choice is acceptable.)	Choose Asian American Asian Indian Bangladesh Chinese Japanese Korean
If Race:Black or African American
Which of the following black or african american racial designations best describes you? (More than 1 choice is acceptable.)	Choose African African American African Caribbean Bahamian Barbadian Black Black Central American

* Mandatory field